[The characteristics of the antibacterial activity of garlic (author's transl)]. It has been found by Cavallito (1944) that garlic (Allium sativum L.) has a strong antibacterial activity and the active principle of garlic is named "Allicin" and it has been confirmed by Stoll et al. (1948) that the allicin is derived from the alliin-alliinase system. Nevertheless, one worker in Japan (1951) stands on another view point which the effective component of garlic is some sugar-proteim because he could not find alliin in the native garlic. We intend to make sure that the alliin is contained in the native garlic, by using Hitachi Amino acid Analyser with Fraction Collecter and compared with garlic of other countrys' production. As the result of examinations, we found that the good amounts of alliin is contained in the native garlic also. The contents of alliin in garlic is varied by the species, the cultivation mode, and the district of production. The form of alliin in the tissue is a free style, and thereupon it is easy to change its chemical conformation by the method of extraction. We compared the relative capacity between 1 allicin unit by Klein (1954) and 1 cup unit by Schmidt et al. (1947). Furthermore we tested the antibiotic spectrum, using the pure crystallized alliin with the sufficient amount of raw alliinase gained by the isoelectric point precipitation and checked upon wide spectrum for Mycobacterium tuberculosis, Gram-positive and negative bacteria, and some fungi.


Multiclinical open studies on the effect of beta-methyldigoxin on congestive heart failure with atrial fibrillation. Clinical open trials of beta-methyldigoxin were carried out in 15 institutions in order to examine the effect, usefulness and ease of its oral administration. In the case of oral digitalization with 0.2 mg, 3 times daily, an effect was obtained in all of 13 cases of congestive heart failure accompanied by atrial fibrillation or flutter. The average time and dose required for digitalization were about 50 hours and 1.27 mg respectively. In 9 of the 13 cases, the effect was achieved within 48 hours. The average maintenance does of beta-methyldigoxin in 102 cases of congestive heart failure with atrial fibrillation was 0.177 mg per day. About 75% of the cases were maintained with 0.15 to 0.2 mg. This range of dose of beta-methyldigoxin was much smaller than that of digoxin in our series. This can be ascribed to a higher absorption rate of beta-methyldigoxin from the digestive tract. Studies on the cases in which patients previously treated with other glycosides were switched over to beta-methyldigoxin revealed that 1 mg of beta-methyldigoxin is equivalent to 1.8 mg of digoxin or to 0.59 mg of digitoxin. The usefulness and ease of beta-methyldigoxin in maintenance was evaluated as being somewhat superior to other cardiac glycosides, according to the global judgement of the physicians. The observed side effects were similar to those of other glycosides in frequency and character.


Microbial adjuvant and autoimmunity. I. Induction of antibody responses to syngeneic tissue extracts in mice treated with capsular polysaccharide of Klebsiella pneumoniae. With the use of the capsular polysaccharide of Klebsiella pneumoniae (CPS-K) as a powerful adjuvant, high precipitin responses could be induced in mice to syngeneic eyeball extracts and thyroid gland extracts which were normally nonimmunogenic. Only very weak responses were induced to eyeball extracts by Freund's complete adjuvant. Repeated administrations of the antigens mixed with CPS-K at time intervals of 30 days (more than twice for the eyeballs or more than three times for the thyroid glands) were required for induction of high precipitin responses. Antibody responses detectable by the immunofluorescent technique could be induced to syngeneic lymphoid tissue extracts by injecting the mixture of antigen and CPS-K more than five times at time intervals of 30 days. These findings suggest that repeated stimulation by autoantigens together with such a strong adjuvant as CPS-K can terminate natural tolerance against autoantigens.


Arginine gene cluster of Serratia marcescens. Biochemical and genetic studies on the arginine-requiring auxotrophs derived from a Serratia marcescens strain were carried out. The arg mutants were classified into seven biochemical groups based on their growth response to five precursors of arginine biosynthesis and enzyme deficiency. Reciprocal transduction tests among these arg mutants divided them into three linkage groups, and the fine mapping in each of the groups by two- or three-point crosses revealed the following arrangement of loci. (1) arg44-thy11-lys1; (2) met1-glt2-argE-(arg19-arg51)-arg120-argG-argH; (3) arg33-pyr4. Five of the seven biochemically distinct arg mutants belonged to the second linkage group, and they constituted an agr-gene cluster. A characteristic feature of the arg-gene cluster of S. marcescens is that it involves argG, which was previously reported only in the Proteus group of Enterobacteriaceae.


Chemical studies on the cell walls of Leptorspira biflexa strain Urawa and Treponema pallidum strain Reiter. The preparation and chemical properties of the cell walls of Leptospira biflexa Urawa and Treponema pallidum Reiter are described. Both cell walls are composed mainly of polysaccharides and peptidoglycans. The data of chemical analysis indicate that the cell wall of L. biflexa Urawa contains rhamnose, arabinose, xylose, mannose, galactose, glucose and unidentified sugars as neutral sugars, and alanine, glutamic acid, alpha, epsilon-diaminopimelic acid, glucosamine and muramic acid as major amino acids and amino sugars. As major chemical constituents of the cell wall of T. pallidum Reiter, rhamnose, arabinose, xylose, mannose, galactose, glucose, alanine, glutamic acid, ornithine, glycine, glucosamine and muramic acid have been detected. The chemical properties of protein and polysaccharide fractions prepared from the cells of T. pallidum Reiter were also partially examined.


Acquiescent renal infection.

Acquiescent renal infection. The relationship between bacterial infection of the renal parenchyma with Escherichia coli and the establishment of pathologic lesions has been investigate experimentally.  Infection was established in one kidney and the bacteriologic, pathologic and immunologic features of infection were compared in the pyelonephritic and contralateral unmanipulated kidney.  Whereas active bacterial infection was associated with pathologic changes in the pyelonephritic kidney, a poor correlation was found between bacterial growth and the gross pathology and histopathologic changes in the contralateral kidney.  The conclusion from these studies is that infection of the kidney is not always associated with pathologic changes.  The term "acquiescent infection" has been used to describe this host-parasite relationship in which active, persistent, bacterial infection is not associated with pathologic lesions.  Evidence is presented that bacteria in the contralateral unmanipulated kidney are present in the renal parenchyma and that bacterial proliferation can be induced following renal trauma.  Activation of infection and bacterial proliferation did not always result in histopathologic damage to the kidney and was not associated with an increase in serum antibody.


Cardiovascular disease in uremic patients on hemodialysis. In conclusion, patients on chronic maintenance dialysis have an increased incidence of death from cardiovascular disease. Hypertension plays a major role, and these patients must be carefully monitored for complete control of blood pressure. Adequacy of ultrafiltration to maintain normal extracellular volume is an essential part of the dialytic treatment. Hypertensive patients should be screened for excessive renin secretion because of its possible role in unresponsive hypertension in patients on dialysis. Nephrectomy should be used when necessary, where dialysis and antihypertensive medication have not adequately controlled blood pressure. Patients must be monitored for the presence of pericardial disease to avoid subsequent pericardial effusion and the development of constrictive pericarditis with its adverse effect on myocardial function. When constrictive pericarditis is present, it obviously should be relieved by appropriate surgery. Efforts should be made to minimize cardiac output in hemodialysis patients. Whether or not routine transfusions to maintain a higher hematocrit are indicated is a question that cannot yet be answered. However, patients with marginal cardiovascular function who are accepted on hemodialysis and must have an arteriovenous shunt should be supported in any manner to minimize an increase in cardiac output. Early and aggressive treatment of known episodes of sepsis is important in the elimination of valvular endocarditis in this patient population. Perhaps one of the finer indicators of adequacy of hemodialysis will be K rate and peak immunoreactive insulin levels. Continued abnormality of these parameters may contribute to cardiovascular disease. Clearly, further study of the effect of abnormal carbohydrate metabolism on lipid metabolism is in order. Serum triglyceride, serum cholesterol and lipid electrophoretic pattern should be followed to evaluate the beneficial effects of drug therapy and changes in dialytic technique on the development of cardiovascular disease. Careful monitoring of calcium, phosphorus, bone films and parathyroid hormone levels is indicated to assess parathyroid status. The use of aluminum binders and parathyroidectomy to prevent vascular and myocardial calcification is important in the therapy of these patients. The use of cardiac catheterization, coronary artery arteriography, and possibly cardiac vascular repair, should be considered in the chronic hemodialysis patient with coronary artery disease if he is otherwise well. Adequacy of hemodialysis perhaps can be evaluated through its effect on all of the above parameters. Whether or not changes in artificial kidney treatments can correct the final vascular disease remains to be seen.


Immunosuppression in rabbits: skin and kidney allografts. Both skin and kidney allografts were at least partially protected from rejection by daily treatment with 1-0 mg/kg of prednisolone acetate. Azathioprine, cyclophosphamide, antilymphocytic serum, and attempts to produce a tolerant state with prior grafting of specific donor antigen, all failed to alter the course of rejection.


Endothelial injury induced by thrombin or thrombi. A variety of blood constituents was injected into an isolated segment of rabbit aorta to determine which elements might be involved in early endothelial injury. Test materials consisted of platelet-rich plasma (PRP) alone; PRP plus adenosine diphosphate (ADP); PRP plus tendon extract; PRP plus thrombin; ultrasonicated PRP alone; platelet-poor plasma alone; and thrombin in saline. Each experimental mixture was left in the aorta for 15 minutes, followed by reflow for 20 minutes. The vessel was then fixed by glutaraldehyde perfusion. Thick sections of the entire circumference of the aorta were taken for phase contrast microscopy and representative arease were selected for electron microscopy. In control PRP alone, platelet-poor plasma alone and with PRP plus ADP there were occasional subendothelial vesicles. When PRP plus thrombin and platelet-poor plasma plus thrombin were injected separately to form a thrombus or when thrombin in saline was used, there was extensive subendothelial vesiculation with focal ulceration and adherence of thrombus to endothelium. Severe injury was associated with the presence of thrombin initiating the polymerization of fibrinogen to fibrin. Electron micrographs demonstrate the earliest lesion as a disruption of the superficial fibrilliary elastica with separation of overlying endothelium.


A controlled sequential morphologic study of hyperacute cardiac allograft rejection in the rat. A series of heterotopic cardiac allografts from ACI strain rat donors to ACI skin-presensitized Lewis strain recipients was examined by light and electron microscopy at intervals from 1 minute to 24 hours for a sequential morphologic study of hyperacute rejection. Syngeneic Lewis hearts grafts in ACI skin-presensitized Lewis recipients provided controls. Extensive platelet aggregation throughout the vasculature of the allografts in the presence of a largely intact endothelium was the initial morphologic event, which was present by 1 minute posttransplant and absent in all syngeneic controls. This was followed by widespread endothelial damage. Endothelial damage preceded neutrophil margination and emigration in the graft. Neutrophil degranulation or evidence of phagocytosis was not observed within the 1st hour. At 6 and 24 hours, degranulated forms were common and apparent extrusion of granule contents with progressive ischemic injury. Segmental occlusion of the vasculature by platelet plugs and progressive disruption and loss of capillaries combined with an increase in permeability may result in myocardial ischemia. Neutrophil-derived agents do not appear to be of major significance in hyperacute rejection during the early posttransplant phase, but may play a role in mediating myocardial injury if the allograft survives for alonger period. However, on morphologic grounds, it is suggested that microcirculatory hypoperfusion with resultant ischemia is a major determinant of myocardial damage and graft function. No significant change was noted over the observation period in peripheral neutrophil or platelet counts when compared to syngeneic controls, and a slight reudction in specific cytotoxic antibody titer in the allografts was immediate but very transient.


Perinatal reactions of the rabbit lung to maternal endotoxemia. The reactions of the fetal and newborn lung to in utero injury were investigated in rabbits using as a model maternal administration of Escherichia coli endotoxin, 2 to 4 mug per kg. of body weight, injected intravenously at the 29th gestational day. At 6 hours after endotoxin injection, the lung revealed diffuse alveolar damage-sparing type II cells which appeared resistant to injury but more mature than type II cells from control lungs. These changes were followed by a reparative phase which over a 2-day period resulted in increased interstitial cellularity, replacement of the damaged type I cells by proliferated type II cells, and marked intraalveolar accumulation of myelin figures. The above reactions were associated with an average increase of 100 per cent in the phospholipid content of the surfactant fraction isolated from lung washing. Postnatally, the lungs showed structural changes resembling those seen in hyaline membrane disease of the newborn. The findings suggest that the response of the alveolar epithelim to injury inudced late in gestation follows a pattern similar to that described previously in adult lung, and is assoicated with in utero increased release of surfactant. It is proposed that alveolar injury and repair, including reduction of the intracellular surfactant reservoir occurring prior to breathing, may interfere postnatally with formation and maintenance of a normal surfactant layer, thereby predisposing to respiratory distress.


Comments on operations for lower limb lymphoedema. Good results have been obtained from surgical operations for lymphoedema of the lower limbs using skin flaps with a blood supply to cover the muscles following reduction of swollen subcutaneous tissue. The Charles operation using free skin grafts for cover is reserved for tropical elephantiasis or patients with local skin in bad condition. A variety of other procedures of physiologic intent have given disappointing results and been abandoned. The results of 74 operations are reviewed with a view to improving still further the results. The mortality rate was nil and there were only minor complications.


Sliding esophageal hiatal hernia and reflux peptic esophagitis. The past two decades have seen outstanding contributions to our knowledge of the physiology of the esophagus, particularly of the lower esophageal sphincter. The clinical syndrome of reflux peptic esophagitis has been clearly delineated and is now well recognized. Although the relationship of the lower esophageal sphincter failure, which causes sliding esophageal hiatal hernia, remains obscure, successful hiatal herniorrhaphy by a variety of methods produces satisfactory clinical results in a majority of patients. There is a significant failure rate in all methods and a morbidity clearly related to operative intervention. Additive surgery such as vagotomy and pyloroplasty is not useful in preventing recurrence and is associated with increased morbidity. Peptic strictures with firm, fibrous stenosis can be satisfactorily treated in most cases with the Thal fundic patch to widen the lumen and Nissen fundoplication to prevent further gastroesophageal reflux.


Effects of parathyroid hormone on renal function. Parathyroid hormone has been recognized as an important factor in the regulation of renal function since the 1920s. Early investigations mainly characterized the role of the hormone in calcium and phosphorus metabolism. Subsequently, significant contributions have been made to the understanding of the influence of parathyroid hormone on acid-base balance and amino acid excretion. The following is a review of the effects of parathyroid hormone in the regulation of renal function with special emphasis on new developments.


The use of computerized transaxial tomography in the diagnosis of tuberous sclerosis. Computerized transaxial tomography is a useful test for the recognition of tuberous sclerosis when this diagnosis has not been firmly established by clinical methods. In addition, computerized transaxial tomography may demonstrate the location of obstruction in patients with tuberous sclerosis who have developed signs of increased intracranial presure. These generalizations are supported by evidence from four patients investigated by this test.


Adverse effects of iodides on thyroid function. The administration of pharmacologic quantities of iodine such as iodides for the treatment of pulmonary disease, organic iodine present in medications and x-ray contrast dyes, and the ingestion of iodine-rich natural foods, may result in goiter, hypothyroidism, or hyperthyroidism, especially in patients with underlying thyroid disease. Medications containing iodide may induce hypothroidism in euthyroid patients with Hashimoto's thyroiditis, 131I or surgically treated Graves' disease, or following hemithyroidectomy for nodules; and they may induce hyperthyroidism in patients with endemic iodine-deficient goiter, autonomous nodules or nontoxic nodular goiter, or in patients recently treated with antithyroid drugs for Graves' disease. Rarely, hypothyroidism or hyperthyroidism may develop in patients with completely normal thyroid function during administration of iodide. The etiology of iodide-induced goiter and hypothyroidism in patients with cystic fibrosis remains obscure. Iodide-induced myxedema may also occur in patients receiving drugs which alter thyroid function, such as lithium, phenazone, and sulfisoxazole. Finally, iodides do have a role in the treatment of hyperthyroidism but their use should probably be restricted to thyroid storm, preoperative preparation of the hyperthyroid patient, and following 131I treatment.


Gonadal steroids and gonadotropins in hyperthyroidism. Gynecomastia occurs in about 20 to 40 per cent of men with hyperthyroidism. Serum concentrations of total estradiol-17beta, total testosterone, and luteinizing hormone are supranormal in these patients. Serum concentration of SHBG is also high in hyperthyroidism. This can explain the high serum testosterone, essentially completely but not the high serum estradiol-17beta; thus, whereas serum unbound testosterone is normal, serum unbound estradiol-17beta is above normal in hyperthyroid men. This balance in relative concentrations of unbound gonadal steroids is apparently quite favorable to the development of gynecomastia in hyperthyroidism. Increased peripheral tissue metabolism of androgens to estrogens seems to be the major factor responsible for high estradiol-17beta in hyperthyroidism; increased glandular secretion of estradiol-17beta may also be important. The mechanism of hypomenorrhea or amenorrhea in hyperthyroidism remains unclear. Changes in circulating estrogens, androgens, and  luteinizing hormone in hyperthyroid women are similar to those in hyperthyroid men. The mid-cycle ovulatory peak of luteinizing hormone may be blunted in patients with scanty periods whereas it may be altogether absent in those with amenorrhea.


Anemia in thyroid diseases.

Anemia in thyroid diseases. Thyroid hormones generally stimulate erythropoiesis. These agents also increase erythrocyte 2,3-DPG concentrations, which serve to enhance the delivery of oxygen to tissues. In the absence of thyroid hormones, anemia frequently develops and may be normocytic, hypochromic-microcytic, or macrocytic. Anemia is an uncommon finding in hyperthyroidism but when present may be morphologically similar to that observed in hypothyroidism. Pernicious anemia has been strongly associated with hypothyroidism, hyperthyroidism, and thyroiditis. Complete correction of anemia often requires restoration of thyroid function as well as specific hematinic therapy. Continued attention to hematologic status is essential in the management of patients with thyroid diseases.


Thyroiditis: current views of pathogenesis. From indirect and circumstantial evidence it would appear that subacute thyroiditis is probably a viral infection of the thyroid gland. The thyroid may respond in the stereotyped manner to any one of a number of viruses. Despite the available evidence, however, the viral theory has yet to be finally proven. Autoimmunity does not appear to be a primary factor in the initiation of subacute thyroiditis, although transient immunologic responses occur as a secondary phenomenon. Autoimmune thyroiditis, on the other hand, is almost certainly a primary immunologic disease, and likely is due to a specific inherited defect in immunologic control. It would appear that both cell-mediated immunity and humoral immunity (i.e., T and B lymphocytes) are necessary for the full expression of this disorder.


Treatment of carcinoma of the base of the tongue and the larynx. Cancer of the base of the tongue and the larynx is usually treated primarily with irradiation to 6,000 rads. Persistence of tumor after irradiation is common and requires a logical, thoughtful approach designed to augment all tissues removed. Careful preoperative planning and the use of the lateral approach to the base of the tongue, in conjunction with pharyngostome and laryngostome formation allows wide resection of the cancer. Preservation of the function of speech and swallowing, and preservation of the mandibular contour are important, and correlate closely with carotid artery protection. Five different methods of approach to the problem are analyzed and presented.


Effects of bacteriophage M13 infection upon phospholipid and fatty acid compositions of Escherichia coli. Escherichia coli K38 were grown and infected with wild type and amber mutants of bacteriophage M13 in the early log phase. Lipid compositions of the infected and healthy cultures, grown under identical conditions, were determined 2 hr after infection. From the results, it was observed that total lipid and total phospholipid content remained nearly constant, suggesting that the cell membrane which contained the maximum phospholipids was not damaged by the infection. Moreover, the percentage of diphosphatidylglycerol and lyso- compounds corresponding to phosphatidylethanolamine and phosphatidylglycerol increased, while phosphatidylethanolamine and phosphatidylglycerol decreased. The increase in lyso- compounds may be due to the relase of phospholipase A2 (a periplasmic enzyme) from the cell wall after damage by the infection. Bacteriophage M13 infection had no effect on the fatty acid compostion of the phospholipids.


Coccidioidomycosis in compromised hosts. Experience at Stanford University Hospital. To determine the frequency and clinical characteristics of infection with Coccidioides immitis in immunosuppressed patients at Stanford University Hospital, clinical records of 14 years were examined. Thirteen cases met the diagnostic criteria. Half had Hodgkin's disease. In six the infection was disseminated; five of the six died early in the course of their infectious illness, frequently without diagnosis. Conclusions include: 1. The occurrence of coccidioidomycosis in immunosuppressed patients seen at institutions in or adjacent to the endemic area is not as rare as the literature suggests. 2. Dissemination is frequently explosive and the radiographic appearance of pulmonary involvement may appear late. Widespread pulmonary dissemination may occur within 24 hours after a negative x-ray. 3. Although the skin test loses its diagnostic value, the serology remains valid. Thus immunosuppressed patients with febrile illnesses (with or without radiographically evident pulmonary involvement) who have a history of travel to an endemic area should have serological examinations. 4. Lymphocytopenia correlates with risk of dissemination of coccidioidomycosis. 5. The administration of immunsuppressive chemotherapy correlates with such risk while radiotherapy and the malignant or non-malignant nature of the disease do not.


Cytochrome pigments in Mycobacterium leprae isolated from armadillos (Dasypus novemcinctus L.). The bacilli were isolated from granulomata harvested from armadillos. Cytochrome systems in whole cell suspensions as well as in cell-free extracts were examined spectrophotometrically. The intact cells contained cytochromes of the a+b3, b and c type which were found to be present mainly in the reduced form. The cytochrome systems in cell-free extracts of M. leprae were in the oxidized form but contained the same type of cytochromes as the intact bacteria. The presence of cytochromes was easily detectable in the anaerobically-reduced (no substrate added) as well as in the dithionite- or succinate-reduced minus O2-oxidized difference spectra. The dithionite-reduced plus CO minus reduced difference spectra exhibited cytochromes a3 and o monoxide binding pigments.


Specific antibodies and heterologous antigensin monofactor sera. A concentrated monofactor serum 9 (Wellcome lot K 8028) precipitated against proteins from 2 different strains of Salmonella enteritidis and from a strain of S. dublin, as well as against the proteinic moiety of the somatic antigen from S. typhi 0 901; no polysaccharide from the strains, sharing factor 9, precipitated against this serum. A concentrated monofactor serum 20 (Wellcome lot K 6733) precipitated against the proteins from S. emek (8, 20), but not against its polysaccharide. A monofactor serum 8 (Wellcome lot K 7801), different from a lot previously analysed (Wellcome lot K 6860), precipitated against the same proteins as the previous lot, but, in addition, precipitated strongly against the polysaccharide of S, newport (6.8) and weakly with the polysaccharide of S. emek too. According to these and previous results, it is not clear what sort of antibodies responsible for cross-agglutination are absorbed by the heterologous strains used in the operations. Since more often than not antipolysaccharide antibodies were not found in concentrated monofactor sera, it may be that just the antipolysaccharides. All the monofactor sera so far analysed (Wellcome) 1,2,4,5,8,9,20 are full of proteins left by the bacteria used for absorptions; due to these proteins, the presence of which may be meaningless for the agglutinations, strong precipitations in agar-gel were obtained between monofactor sera and different antibacterial and anti-protein sera containing antibodies induced against the corresponding free proteins.


Investigation into pyruvate kinases from Escherichia coli K-12 grown under aerobic and anaerobic conditions. Two forms of anaerobic Escherichia coli K-12 pyruvate kinase (EC 2.7.1.40) were separated by ammonium sulphate fractionations. Pyruvate kinases I is allosteric and pyruvate kinase II is non-allosteric to phosphoenolpyruvate. The addition of 1 mM FDP reversed the allostery to normal Michaelis-Menten kinetics. AMP had no effect, whereas 8 mM ATP completely inhibited the enzyme. The enzyme showed normal kinetics with ADP as substrate. Mg2+ and Mn2+ stimulated whereas Cu2+ severely inhibited the enzyme, which could be reversed by the addition of 1 mM FDP. Citrate, alpha-ketoglutarate, succinate, fumarate and alanine inhibited the enzyme, whereas phenylalanine had no effect. The allosteric pyruvate kinase from aerobic cultures was not only activated by FDP, but also by AMP. FDP changed Km and Vmax, whereas AMP influenced only the Km. During aerobic-anaerobic transition, pyruvate kinase synthesis increases and reaches a maximum under anaerobic conditions. The degree of FDP activation remains constant, but AMP activation is lost during transition. Aerobic cultures of E. coli K-12 grown on gluconeogenic substrates exhibited pyruvate kinase II activity (non-allosteric), which was stimulated by FDP and by AMP. It has been suggested that E. coli may have two types of pyruvate kinase II depending on the substrate and two types of pyruvate kinase I depending on oxygen tension in the medium.


Dilute performic acid--a versatile and easily to handle oxidant in general histology and histochemistry of structure bound sulphur compounds. Performic acid normally leads to frequent and nearly inevitable detaching of commonly attached tissue sections, thus rendering such methods unrecommendable for histological and histochemical routine work. By the use of alcohol dilute solutions instead of the crude reagent, this problem can be managed easily. Special attention is drawn to the ambiguity of methods for tissue sulphur, based on the demonstration of oxidation induced strong basophilia.


[Intravital accumulation of acriflavine in mitochondria of yeast organisms]. Acriflavine, a fluorochrome of the acridine series, inducing cytoplasmic mutations in yeast organisms, at low concentrations (0.25 to 2.50 mcg/ml) in the growth medium, is selectively accumulated in the mitochondria in which it forms complexes with nucleic acids. This binding of acriflavine to nucleic acids in the mitochondria has almost no effect on the cell viability though their respiratory activity decreases at these concentrations by 70 percent, and the activity of fermentation increases by 15 to 20 percent.


[New variant of the method for direct count of bacteria in water]. Direct counting of the bacteria in water is suggested to be done by means of the pitch limit stop of the microscope tube made as a washer with stop pins.


[Production and biological properties of L-like mutants (11r) of Escherichia coli]. Treatment of the strains of E. coli K12 with the mutagen N-nitroso-N-methylurea yielded mutants with the morphology similar to that of stable penicillin L-forms. Studies of the biological properties of the cultures have shown that the mutation of the gen 11r increases the susceptibility to antibiotics of various action spectra, ionic and non-ionic detergents and the resistance to UV and gamma radiation. Biochemical analysis of peptidoglycan from the cell walls of the parent bacterial cultures and L-mutants revealed no differences in its chemical composition.


[Ecology of the obligate thermophilic bacteria]. The obligate thermophilic non-sporeforming bacterium Thermus ruber, isolated from the thermal springs of Kamchatka at temperatures of 60 to 90 degrees C (Loginova et al.,1974), has a high lytic activity towards the living and dead cells of Escherichia coli and Micrococcus lysodeikticus.


[Effect of heliomycin on protein and nucleic acid synthesis in Escherichia coli]. Heliomycin at a concentration of 100 mcg/ml had almost no effect on the growth of Escherichia coli, which was inhibited only upon the combined action of heliomycin and ethanol that facilitated the penetration of the antibiotic into the cell. Heliomycin inhibited in these conditions the synthesis of RNA and had no effect on the synthesis of DNA in the three studied strains of E. coli. The synthesis of protein either was not inhibited by heliomycin at all or was inhibited only to a small extent.


Evidence for a functional association of DNA synthesis with the membrane in mitochondria of Saccharomyces cerevisiae. We have studied the effect of membrane fatty acid composition on replicative DNA synthetic activity in mitochondria isolated from Saccharomyces cerevisiae. Cells containing different levels of membrane unsaturated fatty acids were obtained by growth of a fatty acid desaturase mutant of Saccharomyces cerevisiae in glucose-limited chemostat cultures supplemented with various concentrations of Tween 80. Arrhenius plots of DNA synthetic activity in isolated mitochondria show a discrete discontinuity at specific temperature which are dependent on the membrane unsaturated fatty acid content of the mitochondria. This indicates a functional association of DNA replication with the mitochondrial membrane in Saccharomyces cerevisiae.


Complementary binding of oligonucleotides with 16S RNA and ribosomal ribonucleoproteins. The accessibility of single-stranded sequences in 16S RNA in free state and in ribonucleoprotein particles (RNP) to complementary binding with isoplith fractions of oligonucleotides was studied. RNP had different protein composition and corresponded to intermediate stages of E. coli 30S subunit assembly in vitro. Gel-filtration was used to detect the most strong binding. It was found that S4 essentially inhibited the hexamer binding to RNA. 'Core' proteins bound to 16S RNA strongly increased the shielding of single-stranded regions while 'split' proteins insignificantly changed the hexamer binding. Nevertheless evidence is presented that 'split' proteins might also interact directly with 16S RNA in the 30S subunit.


Efficacy of 17alpha-hydroxyprogesterone caproate in the prevention of premature labor. We conducted a double-blind study to determine the efficacy of 17alpha-hydroxyprogesterone caproate in preventing premature delivery in 43 high-risk patients. Premature delivery did not occur in 18 patients receiving the progestational agent, whereas 41 per cent of the 22 receiving the palcebo had premature delivery (P less than 0.01). The mean duration of pregnancy and the mean birth weight in the former group (38.6 weeks +/- 1.6 S.D., and 2836 g +/- 412 S.D.) were both significantly greater (P less than 0.025) than that in the latter (35.2 weeks +/- 6.7 S.D.; 2361 g +/- 1085 S.D.). The perinatal mortality rate in the group given the progestational agent (O per cent) was significantly less than that observed in the placebo group (27 per cent) (P less than 0.05). Although there were no complications attributable to the progestational drug, the study population was too small for assessment of immediate or long term safety. However, the results indicate a possible obstetric use for this drug.


Antiemetic effect of delta-9-tetrahydrocannabinol in patients receiving cancer chemotherapy. Anecdotal accounts suggested that smoking marihuana decreases the nausea and vomiting associated with cancer chemotherapeutic agents. Oral delta-9-tetrahydrocannabinol was compared with placebo in a controlled, randomized, "double-blind" experiment. All patients were receiving chemotherapeutic drugs known to cause nausea and vomiting of central origin. Each patient was to serve as his own control to determine whether tetrahydrocannabinol had an antiemetic effect. Twenty-two patients entered the study, 20 of whom were evaluable. For all patients an antiemetic effect was observed in 14 of 20 tetrahydrocannabinol courses and in none of 22 placebo courses. For patients completing the study, response occurred in 12 of 15 courses of tetrahydrocannabinol and in none of 14 courses of placebo (P less than 0.001). No patient vomited while experiencing a subjective "high". Oral tetrahydrocannabinol has antiemetic properties and is significantly better than a placebo in reducting vomiting caused by chemotherapeutic agents.


Genetic perturbations that reveal tertiary conformation of tRNA precursor molecules. The ubiquity of tRNA-like conformations in tRNA precursors of prokaryotes provides a common structural basis for precursor recognition by the maturation enzymes. This design eliminates need for multiple enzymes to achieve the maturation of different precursors. Moreover, the requirement of this specific conformation for maturation guards against the production of potentially deleterious mutant tRNAs.


In vitro synthesis of tRNA precursors and their conversion to mature size tRNA. Two Escherichia coli tRNA gene clusters, tRNA1Tyr (su3+ and su3-) and tRNA2Tyr, tRNA2Gly (su+36), tRNA3Thr, were transcribed in a purified in vitro system. Evidence indicates that the adjacent tRNA genes are transcribed together as a common precursor of large size, which, on incubation with crude cell extracts, yields mature tRNA molecules.


The importance of sensory nerve endings as sites of drug action. The role that sensory nerve endings can play in drug action and the strategy used for its experimental analysis and proof is first exemplified by three effects of nicotine which are seen when the lowest effective doses of the drug are given intravenously in the cat: (1) a vasopressor effect due to arterial chemoreceptor stimulation; (2) a triad of bradycardia, hypotension and apnea, and (3) a depressant effect upon somatic motor activity, both of which are traced to vagal afferent endings in the pulmonary circulation. While receptors in the lung are responsible at least for the initial phase of the reflex responses listed in (2) and (3), sensory endings in heart, aorta, and carotid sinus region may be recruited into action as the drug reaches them. Several of these reflex effects can also be elicited by other sensory stimulant agents such as phenyldiguanide, 5-hydroxytryptamine, and veratrum alkaloids. In the second part, a general outline is given of what may be classified as 'Afferent Pharmacology', dealing with drug action upon sensory receptors and with the resulting remote drug effects. The action upon sensory receptors can either be a direct one ('primary' drug effect) consisting of stimulation, sensitization, desensitization, depression or combinations thereof, or an indirect ('secondary') effect brought about by a variety of drug-induced changes in the tissues surrounding the receptors. Depending on the nature of the primary or secondary action, the remote drug effect can be either an initiation, modification or impairment of those reflexes which have their origin in the sensory endings acted upon. Indeed, the grossly observable pharmacological actions of 'afferent drugs' are generally those relating to the reflex response. To avoid blurring of the boundaries of afferent pharmacology, drugs acting on central synapses of reflex pathways, or on the elaborate efferent control system of afferent input, are not included. A discussion follows of the topics of investigation, the influence of experimental conditions and anesthesia, various approaches and methods, the physiological and pharmacological importance of inquiry in this area, and some of the therapeutic aspects. Finally, brief mention is made of certain features and problems which appear to be characteristic of afferent pharmacology.


Comparison of the effect of nalidixic acid and thymine deprivation on excision repair in Escherichia coli. There is a difference in the extent of inhibition of thymine dimers (TT) excision in ultravioley (UV) irradiated cells of E. coli after preirradiation depression of protein and DNA syntheses induced by a simultaneous deprivation of essential amino acids (AA-) and thymine(T-) or by deprivation of essential amino acids and addition of nalidixie acid (NAL+). This difference has been noted in both E. coli B/r Her+ and E. coli K12 SR20 uvr+ cells. Depression of DNA synthesis with the aid of malidixic acid as exogenous agent will inhibit TT excision to a lesser degree than depression of DNA synthesis by thymine starvation. The extent of TT excision has no appreciable influence on restoration of the sedimentation profile of newly synthesized DNA nor again on UV resistance of cells in conditions of dark repair. At the time when there are TT still present in DNA, the DNA molecule, having the size of the molecule of unirradiated cells, will become synthesized.


Changes in stored and short-term cultures of mouse bone marrow cells. Changes in cells of mouse bone marrow cultured for 6--24 hr were followed both when fresh, and after storage for 3 to 5 days at a temperature of +2 to +4 degrees C. Considerable alterations were observed in the morphology, activity and transformation of these cells both during the storage period and the subsequent culture. Phagocyte ability was also detected in these cultures.


Therapeutic effect of a water-salt extract from BCG in two patients with advanced breast cancer. Two cases of advanced breast cancer treated with a water-salt extract from BCG are presented, showing a positive response -- marked and durable regression of the breast tumor and of the axillar metastases, parallel in the second case with a disappearance of lung metastases.


Nonspecific resistance to tumor allograft. The effects of an increased volume of reticulohistiocyte system and macrophage activation in the recipient after treatment with BCG and Zymosan on the course of antitumor concomitant allograft-immunity reaction were studied. The results were verified on animals affected with immunosuppression due to whole body irradiation. A factor of essential significance for resistance to tumor allograft is an increase of the total number of small lymphocytes supplied by the transplantation of syngeneic spleen cells. A substantially lower efficiency was shown by prophylactic administration of BCG and Zymosan. Transplantation of macrophages syngeneic to the host failed to affect the latter's resistance to subsequent tumor allograft. The irradiated host's reactivity was regenerated with a suspesion of spleen cells of purified small lymphocytes, but transplantation of syngeneic macrophages remained without effect.


Lowering of the tumoricide activity of human serum with Varidase. II. Antibodies against Varidase in human serum measured by complement binding. Active human serum manifests a tumoricide effect against cells of the Ehrlich ascites tumor. Sera of patients with Ca ventriculi show a higher effect than those of patients with a chronic streptococcal disorder, in comparison with intact subjects. This tumorcide effect is depressed by Varidase, the degree of depression being greatest in the group of patients with streptococcal infection, smaller in healthy subjects and least in carcinoma patients. The investigated sera contained antibodies against Varidase, but not against streptokinase. The anti-Varidase antibodies are found also in sera of the new-born children. The decline of the tumoricide activity of Varidase-treated sera is related to the quantity of anti-Varidase antibodies determined by complement fixing reaction in non-treated sera.


Evaluation of the usefulness of nitroblue tetrazolium reduction test (NBT test) for detection of bacterial infection in cancer patients. False positivity of the NBT test in neoplastic diseases described by some authose may be a limitation in the use of the test for infection screening in cancer patients. For explaining this problem studies were performed in a group of 30 patients with various untreated malignancies without infection and in 20 of these with bacteriologically confirmed infections. The obtained results were compared with those in groups of normal persons without and with infection. Slightly modified Park method for spontaneous and stimulated NBT test was used. No significant differences between patients of both groups without infection were found. The increase in positivity of the test in presence of infection was lower in cancer patients than in normal subjects, however, it was non-significant. We did not observe any false-positive results in our patients, though one case of false negativity in myeloma is described separately. It is concluded that neoplastic disease does not cause, as such positivity of the NBT test. Because of similar response of NBT test to presence of infection, the NBT test is recognized as very useful for infection screening in cancer patients similarly as in normal persons.


Cellular hypersensitization to peripheral nervous antigens in the Guillain-Barré syndrome. The macrophage migration inhibition factor assay was used as a specific measure of cellular hypersensitivity to peripheral nervous system antigen in a large group of Guillain-Barre patients and control subjects. Lymphocytes from 34 patients with Guillain-Barre syndrome, 33 with other peripheral nervous system disease, and 33 normal controls were assayed for production of macrophage migration inhibition factor. A mean of 101 +/- 7.2 was obtained in the control group, 70 +/- 16.3 in the Guillain-Barre syndrome group, and 96 +/- 11.3 in those with other peripheral nervous system disease. Twenty-six of the 34 patients with Guillain-Barre syndrome, two patients with myeloradiculitis, and two with Bell's palsy gave significant values. These results support the hypothesis that cellular hypersensitization to peripheral nervous system antigens is a pathogenetic factor in Guillain-Barre syndrome.


Emergency medical services in crisis: an Italian case study. This paper deals with the system of emergency medical services in Italy. More specifically, it is a case study of the organization and operation of this system in the region of Tuscany. Recent decentralization decrees have established regional governments with major responsibilities for health care, including emergency medical services. The effects of a long history of social and political cleavages on provision of these services at the regional level are presented and discussed. The paper concludes that prospects for rational reform of emergency care service are dim.


[R. D. Laing's evaluation and critical methodology in the problems of psychological sciences]. The theory and methodology of psychotherapy and contemporary psychiatrics according to R. D. Laing are presented and examined from a critical point of view.


Ketoprofen (Orudis) in ankylosing spondylitis. A double-blind cross-over study is described in which ketoprofen (Orudis) is compared with phenylbutazone in 14 patients with ankylosing spondylitis. Results indicated a significant patient preference for phenylbutazone with greater improvement in the ESR. However, the absence of objective and laboratory deterioration with ketoprofen, when compared with the initial, or control, assessments, suggests that it may prove a useful alternative to phenylbutazone in spondylitic disease.


Urinary antiseptics in asymptomatic bacteriuria of pregnancy. A screening programme for the detection of asymptomatic bacteriuria in patients attending an antenatal clinic is described. The results obtained from the use of urinary antiseptics in a controlled trial over a period of two years are presented. The number of patients developing clinical pyelonephritis, fetal maturity at delivery and birth weight were recorded for treatment and control groups and compared with the equivalent results obtained from the total population of patients seen at the clinic.


A double blind controlled trial of a new anorectic agent AN448. AN448 is a new anorectic agent, which in the dose used, is without the CNS stimulant properties of the amphetamines. Patients entering the trial were a highly resistant group at least 20 percent above ideal weight chosen from an ischaemic-hyperlipidaemic clinic population. In a double blind trial of 12 patients on the active drug and nine patients on placebo, a highly significant weight loss occurred over 12 weeks in the active group only. A significant reduction in serum cholesterol occurred independently of weight loss but there was no reduction in the serum triglycerides and no change in the lipoprotein electrophoretic pattern. The drug is shown to be effective for this group of patients and may also be useful as a cholesterol lowering agent.


The father of radiology in New Zealand.

The father of radiology in New Zealand. Attention is drawn to the pioneering contribution of Dr Henry A. de Lautour to the practice of radiology in New Zealand and a brief sketch of his life and work is recorded. Information has been gathered from one of his patients who still possesses a copy of a radiograpy taken by Dr de Lautour in 1889, just four years after the discovery of x-rays. A 75-year follow-up radiograph shows that all but one of the lead pellets still remain in his hand.


Clinical experience with the oxytocin challenge test. II. An ominous atypical pattern. Three cases have been observed over the past 3 years at Los Angeles County-USC Medical Center, Women's Hospital, which have shown an unusual fetal heart rate response to induced uterine contractions during the antepartum period. All 3 cases resulted in perinatal death apparently due to asphyxia. This report describes this unusual pattern and presents a discussion of its possible significance.


Intraepithelial vaginal neoplasia following immunosuppressive therapy treated with topical 5-Fu. A case is reported of the successful treatment of multifocal intraepithelial neoplasia of the vagina by topical application of a cytotoxic agent, 5-fluorouracil. These lesions followed prolonged immunosuppressive therapy after renal transplantation. Intraepithelial neoplasia was present also in the cervix and was treated by conization.


Combination chemotherapy in disseminated melanoma and other solid tumors in adults. Eighty-eight patients with disseminated melanoma and 22 patients with various other solid tumors were treated with combination chemotherapy consisting of DTIC, at a fixed dose, with either adriamycin, CCNU, or hydroxyurea, at several dosages.  An objective response rate of 20% was observed in 84 evaluable melanoma patients.  The addition of the other agents to DTIC did not provide enhanced antitumor activity.  Combination chemotherapy increased toxicity.  Encouraging objective responses were observed in patients with synovial sarcoma (4/7) and teratocarcinoma of the testis (1/1) treated with the combination of adriamycin and DTIC.


Surgical treatment of the swan-neck deformity in rheumatoid arthritis. Swan-neck deformities vary not only in origin but also in the extent of functional loss. Careful examination used to determine the degree of flexion in all positions as well as x-ray examination of the joint has allowed us to group these patients into four types. Various surgical procedures are recommended according to this classification, which has made the treatment of these patients more orderly and rewarding.


Surgical treatment of the boutonniere deformity in rheumatoid arthritis. The rheumatoid boutonniere deformity does not limit hand function significantly until it becomes severe. For this reason the surgical procedures used should not risk or sacrifice existing function. For the mild cases one can improve the digital balance by a simple extensor tenotomy combined with dynamic splinting. In more advanced stages with passive correction possible, the deformity can be improved by reconstruction of the extensor mechanism. With fixed deformities one can choose between proximal interphalangeal joint fusion and arthroplasty. The decision is influenced by several factors, including the digit involved and the status of adjacent joints. After a careful evaluation of the patient's capabilities and needs, it is possible to improve these deformities by the methods discussed.


Preventive surgery - tenosynovectomy and synovectomy. The goal of preventative rheumatoid hand surgery is the eradication of the diseased synovium or tenosynovium before irreparable joint or tendon destruction occurs. Although there is general agreement that both dorsal and flexor tenosynovectomy are reliable and effective procedures to prevent the complications of tenosynovitis, the case for synovectomy is less well established. We have discussed the indications for both tenosynovectomy and synovectomy and described the surgical techniques used for dorsal tenosynovectomy and flexor tenosynovectomy in the wrist, palm, and digits. In addition, the treatment of both extensor and flexor tendon ruptures has been presented.


Preoperative and postoperative management: the role of allied health professionals. The success of a coordinated team approach is dependent upon respect and communication among all members, all directed toward the individual patient's goal. Standardized forms can be developed by each discipline and used as a formal mode of communication. These can be available in each patient's record for all the professional staff to read. Unitization has established an atomosphere for informal ongoing communication: i.e. allied health team members have been assigned to the same patient care unit. The same allied health members are therefore working together with the same patient on a day by day basis. Greater efficiency and communication tend to develop spontaneously within such a system. Full inpatient coverage seven days a week by the therapist as well as the nurses has improved continuity of care. Since these changes in staff distribution have taken place, a study of a significant number of patients undergoin total knee or toal hip procedures has shown that there has been a reduction in the average length of stay for the hospitalization, from two days for a total knee replacement to five days for a patient undergoing total hip replacement. Weekly or twice weekly meetings of allied health members, surgeons, and rheumatologists greatly facilitate the progression and coorination of the treatment program. Medical and nursing audits on patients with total hip procedures document a remarkably low rate of surgical complications. Early discharge planning has fostered a smooth transition of the patient to his home and ultimately to work.


Basic and clinical aspects of the alpha1-antitrypsin. A deficiency of the major serum alpha1-globulin, the alpha1-antitrypsin, was first described in five patients by Laurell and Eriksson in Sweden in 1963. It soon became obvious that severe alpha1-antitrypsin deficiency was familial, and highly associated with chronic lung disease, having its onset in the third or fourth decade of life. Since the early descriptions of this common deficiency state, it has become clearly associated with familial emphysema in some families, familial infantile cirrhosis in others, and occasionally with a combination of childhood lung and liver disease in siblings. For the pediatrician, severe alpha1-antitrypsin deficiency now enters into the differential diagnosis of both chronic pulmonary disease in childhood and obstructive jaundice in the newborn period; In addition, low levels of alpha1-antitrypsin in serum are characteristic of respiratory distress syndrome, and elevations of this protein may be found in a variety of clinical situations. The, alpha1-antitrypsin probably functions as a major control protein against the tissue-damaging effects of both endogenous and exogenous enzymes. This review will cover several basic and clinical features of this protein with respect to its importance in pediatrics.


The peripheral hemodynamic effects of continuous positive transpulmonary pressure breathing in neonates free from cardiorespiratory disease. We applied continuous positive transpulmonary pressure (CPTP) by face mask to 22 spontaneously breathing infants who were free from cardiorespiratory disease, and measured resultant changes in peak esophageal pressure (Pes) and peripheral perfusion (Q1). We measured Pes by balloon and transducer, and Q1 by venous occlusion plethysmography with a mercury-in-rubber strain gauge. Application of 7.6 cm H2O CPTP led to a 13% decrease in Q1 (paired t-test=2.39; P less than .02). Thirty-two percent of the applied CPTP was detected as a change in Pes. The biological significance of a 13% decrease in peripheral perfusion is probably minimal.


The therapeutic application of end-expiratory pressure in the meconium aspiration syndrome. The effectiveness of end-expiratory pressure (EEP) in relieving hypoxemia in the meconium aspiration syndrome (MAS) was studied in 14 patients with the disorder. These infants demonstrated a direct, mean PO2 response of 12 torr/cm H2O EEP. A maximum PO2 response was observed in an EEP range of 4 to 7 cm H2O. EEP was equally effective whether patients were breathing spontaneously or were being mechanically ventilated. EEP is useful in the treatment of hypoxemia in the infants with meconium aspiration syndrome.


Hyaline membrane disease treated with early nasal end-expiratory pressure: one year's experience. This report describes one year's experience treating hyaline membrane disease (HMD) with nasal end-expiratory pressure (NEEP). During the 12 months from July 1, 1973 through June 30, 1974, 119 children with HMD were admitted to the Intensive Care Unit of St. Paul Children's Hospital. Sixty-nine infants were treated early in the course of their disease with NEEP. The survival, incidence of complications, and the number of endotracheal intubations are reported and compared to our experience during a similar time period prior to the use of NEEP (1971-1972). Since the advent of the early application of modest amounts of end-expiratory pressure by nasopharyngeal tube, there has been an increase in the survival of all admissions with HMD, but the increase was statistically significant (P less than .01) only in those weighing 1,501 to 2,000 gm. There was a significant decrease (P less than .025) in the total number of children with HMD requiring endotracheal intubation. There was no change in the incidence of pneumothoraces or bronchopulmonary dysplasia. NEEP is a simple and effective technique for creating continuous airway distending pressure. Its effectiveness and ready availability make the routine endotracheal intubation of infants requiring only continuous airway distending pressure no longer justifiable.


Aspirin intolerance in chronic childhood asthma: Detected by oral challenge. Most previously reported individuals with acetylsalicylic acid (aspirin, ASA)-induced asthma have been adults. This study was undertaken to define the prevalence of ASA intolerance among children with intractable asthma. Fifty children (34 boys and 16 girls) ranging in age from 6 to 18 years with extrinsic (atopic) asthma were studied. None had a history of ASA sensitivity or nasal polyps; all required continuous medication including cromolyn sodium and daily or intermittent steroids. Anti-asthmatic medications were stopped 12 hours prior to testing. At the same time of day, each subject, in a doubleblind manner, on two separate days, ingested either 300 mg of ASA or 100 mg of lactose (placebo). Measurements of FVC, FEV1, and FEF25-75 were obtained prior to challenge and one half, one, two, three, and four hours after. ASA intolerance required a decrease of 30% in lung function with ASA as compared to placebo. Fourteen of 50 (28%) were ASA-intolerant; a greater number were girls, and they had more sinusitis and an onset of disease prior to 2 years of age. Steroid dependency, frequency of eczema, nasal eosinophilia, serum IgE levels, and peripheral eosinophil counts did not differ between the two groups. The use of aspirin in childhood asthma should be limited.


Apparent motion and the Pulfrich effect. The Pulfrich pendulum effect, obtained by viewing a moving object with a filter over one eye, was examined with target stimuli in apparent, rather than continuous, motion. The filter-induced depth effect persisted until a certain degree of intermittency in the presentations of the target was reached, and then it broke down. The degree of intermittency that could be tolerated before the depth effect broke down increased with the density of the filter. It could be argued that the filter determined a shift in the pairing of successive inputs to the eyes, such that the target position in the unfiltered eye was fused with the preceding target position in the filtered eye. However, it appears that the shifted-pairing effect cannot account for the depth impression seen when the target intermittency is less than about 30 ms. Below this value of intermittency a filter can produce a depth effect even when the delay it introduces is small in comparison to the intermittency of the input. The depth effect seen with intermittencies less than 30 ms appears to be of the same magnitude as that obtained with stimuli in continuous motion. It is concluded that a filter can cause two different kinds of depth shift with apparently moving stimuli.


[Transuterine migration of intrauterine contraceptive devices. 12 cases]. Transuterine migration of an IUCD is a rare complication, more spectacular than serious. In general asymptomatic or associated with only minor symptoms, such a perforation usually passes unnoticed. The diagnosis is made when the absence of the string at the cervix is noted at routine examination, and may be proved by radiological examination of the uterine cavity. Treatment consists of removal of the migratory foreign body either by coelioscopy or by laparotomy. Although the no single mechanism for the occurrence of such perforations exists, this study confirmed the high incidence of this complication when the device is inserted in the immediate post-partum period.


[Detection of hepatic lesions in patients with multiple injuries. Value of the determination of blood glutamo-pyruvic transaminase]. Serum glutamic pyruvic transaminase (S.G.P.T.) was measured in a series of 39 patients with multiple injuries in order to test its value in detecting liver lesion. An increase above five times the upper limit of the normal value was found in 15 out of the 20 patients having a liver injury and in all of those in whom S.G.P.T. was measured within the first 24 hours following the trauma. In contrast, a similar elevation was observed only in two out of the 19 patients without liver injury. It is suggested that S.G.P.T. determination should be routinely performed in patients with multiple injuries when abdominal signs are poor or concealed by associated lesions. A marked elevation of S.G.P.T. seems in any case suggestive enough to advise a liver arteriogram if hemodynamic conditions allow to perform it.


[Influence of restrictive use of antibiotics on the development of drug resistance in intestinal Escherichia coli from pigs (author's transl)]. A retrospective investigation into the drug resistance pattern of intestinal E. coli was carried out in 17 closely monitored herds in order to evaluate a possible influence of an improved diagnostic and a restrictive use of antibiotics in swine herds. The herds participated from October, 1970, in an investigation of preweaning mortality and morbidity, and during a two-year investigation period antibiotics were only used when therapeutically indicated. Sensitivity tests were regularly performed on the intestinal flora from post mortem examined pigs from the herds and the results forwarded to the local veterinarians. A total of 443 E. Coli strains were isolated in pure or almost pure culture from the  jejunum of post mortem examined pigs and tested for sensitivity, using the following antibiotics: streptomycin, compound sulphonamide, neomycin, oxytetracycline, chloramphenicol, nalidixic acid, furazolidone, and ampicillin. During the investigation period, the frequency of isolated multiresistant E. coli strains decreazed from 67.7 per cent to 9.5 per cent and the number of strains without antibiotic resistance increased from 3.0 per cent to 36.2 per cent (Table I; Fig. 1). Herds were divided into 3 groups according to different intensity of antibiotic administration and to closed or open management system (Table II). The most pronounced decrease in the number of multiresistant E. coli strains (from 64.9 to 2.0 per cent) was observed in Group I, which comprises closed herds with a rapid decrease in the use of antibiotics. In Group II, which comprises semi-closed herds with a decreasing, but in the last year of the investigation still frequent use of antibiotics, a somewhat slower decrease of the number of multiresistant strains to a level of 12.1 per cent was observed. The number of strains without resistance increased to approximately the same level as in Group I. In Group III, which comprises open herds with infrequent use of antibiotics, the incidence of resistant E. coli strains fluctuated (Table III; Fig. 2). The resistance was proved transferable in 60.5 per cent of the examined resistant strains. The frequency of transferability did not show any significant change during the investigation period (Table IV). The most frequently encountered resistance determinants were: sulphonamide (97 per cent), streptomycin (40 per cent), and oxytetracycline (34 per cent). Only resistance against sulphonamide, streptomycin, tetracycline, and chloramphenicol was proved transferable (Table V). It is concluded that it is possible to obtain a simultaneous reduction of induced antibiotic resistance of intestinal E. coli and of enteric diseases in sucking pigs in commercial herds, by adjustment of management and rational use of antibiotics based on improved diagnostic including in vitro sensitivity tests.


[Tests of stimulation of calcitonin secretion. Value in medullary cancer of the thyroid]. The detection of high circulating levels of calcitonin is a most valuable procedure to diagnose advanced cases of medullary carcinoma of the thyroid. However, the diagnosis of a primitive tumor in the early stages of development (as in cases of the familial form of the disease) or of a metastasis following ablation of the tumor is more difficult. In the latter cases, the levels of circulating calcitonin may be within normal limits, and for diagnosis one must then resort to tests to stimulate the secretion of calcitonin. We are reporting from our personal experiences the advantages, disadvantages and inconveniences of the three most well-known tests. All patients responded positively to administration of calcium or pentagastrin. The alcohol test, however, produced inconsistent results.


Problems of aging: diagnosing and treating leg pain due to arteriosclerosis obliterans. Management of patients with arteriosclerosis obliterans begins with organization of the history, results of physical examination, and blood flow measurements into a patient profile. This approach permits the practicing physician to monitor the progression of the obstructive process over time. With close observation, a controlled exercise program, and properly timed surgical intervention, if necessary, patients with arterioslcerosis obliterans can enjoy a full and productive life.


Pediatric ophthalmic mythology.

Pediatric ophthalmic mythology. Headaches in children are virtually never the result of eye problems. If a child needs glasses, young age is almost never a contraindication to their use. Any child in whom strabismus is recognized or suspected should be referred to an ophthalmologist. The strabismus may be a presenting sign of a serious disease. Even if it is not, spontaneous cure almost never occurs. Furthermore, the younger the child, the easier and more successful will be the treatment of both the strabismus and the amblyopia that often accompanies it. Dyslexia is not the result of abnormalities of the eyes and is unaffected by eye exercises. There are no significant ocular hazards in the use of standard mydriatic (dilating) eye drops in children.


Recognizing the allergic individual.

Recognizing the allergic individual. Patients with respiratory tract allergy present certain auditory and visual signs which, when correlated with the history, aid substantially in arriving at a conclusive diagnosis. The physician should be alert to the signs that indicate allergic disease. Early recognition followed by modern allergy management will help to prevent progression of the allergic process.


Vitamin E or vitamin A protects chickens against E. coli infection. The supplementation of either vitamin E (300 mg./kg. diet) or vitamin A (60,000 I.U./kg. diet) to a standard chick ration increased the protection of six week old immunized chickens against E coli infection, decreasing mortality from about 40% to 5%. The combination of the two vitamins, however, did not give as much protection as either vitamin alone. Vitamin E or A did not protect chicks from weight loss and severe morbidity due to infection, but slightly increased the rate of recovery.


Repetitive DNA replication of the incomplete genomes of phage T4 petite particles. The genomes of petite T4 phage particles presumably cannot circularize because they are deficient for a significant terminal segment and hence not terminally redundant like normal T4 genomes. Combined density- and 32P-labeling shows that the majority of such deficient DNA molecules can nevertheless replicate their entire length. Furthermore, the density-shift technique shows that replicated parental strands can exchange their partners for new light strands, indicating that noncircularized T4 DNA molecules replicate repeatedly. When taken together with previously published data, these results indicate that T4 replication is bidirectional from multiple, genetically fixed points of origin. Rolling circle models can, therefore, not be considered as an essential mechanism for the early rounds of T4 replication.


Reversible, coenzyme-A-mediated inactivation of biosynthetic condensing enzymes in yeast: a possible regulatory mechanism. alpha-Isopropylmalate synthase [3-hydroxy-4-methyl-3-carboxyvalerate 2-oxo-3-methylbutyrate-lyase (CoA-acetylating); EC 4.1.3.12], the enzyme catalyzing the first committed step in leucine biosynthesis, and homocitrate synthase [3-hydroxy-3-carboxyadipate 2-oxoglutarate-lyase (CoA-acetylating); EC 4.1.3.21], the first enzyme in lysine biosynthesis in yeast, are rapidly inactivated in the presence of low concentrations of coenzyme A, a product of both reactions. Closely related compounds like 3-dephospho-coenzyme A or oxidized coenzyme A are almost without effect, as are other sulfhydryl compounds. Citrate (si)-synthase [citrate oxaloacetate-lyase (pro-3S-CH2-COO-minus leads to acetyl-CoA); EC 4.1.3.7] appears to be completely resistant against inactivation by coenzyme A. Inactivated alpha-isopropylmalate and homocitrate synthases can be reactivated by dialysis, but not by adding excess substrate. Protection against coenzyme-A-mediated inactivation is provided by relatively high concentrations of the alpha-ketoacid substrate or the specific end product inhibitor of each of the two enzymes. The coenzyme-A-mediated inactivation of alpha-isopropylmalate synthase has been more closely investigated. It requires the presence of divalent metal ions, with Zn++being most effective. The inactivation does not require molecular oxygen. It occurs in the presence of low concentrations of substrates and is observed in toluene-treated cells. These results, together with evidence that alpha-isopropylmalate synthase and homocitrate synthase are located in the mitochondria, suggest a mechanism by which increasing intra-mitochondrial coenzyme A concentrations might serve as a signal of decreasing acetyl-coenzyme A levels, triggering a temporary inactivation of biosynthetic acetyl-coenzyme A-consuming reactions in order to channel the available acetyl-coenzyme A into the citrate cycle.


On becoming a confederation.

On becoming a confederation. This paper was presented as the keynote speech at the Seventh International Congress of the World Confederation for Physical Therapy. The question of what it will take to strengthen physical therapy as a world force for the health of mankind is examined. The past and present status of physical therapy and the Confederation are assessed as background for looking at ways to help the Confederation become truly a World Confederation for Physical Therapy.


Technique for vestibular neurotomy in the rat. A technique for vestibular neurotomy in the rat has been developed. Removal of the tympanic membrane and ossicles through the external auditory meatus permits access to the auditory bulla. After the pterygopalatine artery has been cauterized, and the electrode may be introduced through the oval widow. The vestibular branch of the VIII nerve can then be cauterized with the electrode without direct visualization.


Chemistor: a reusable telestimulation device for direct chemical stimulation of the nonhuman primate brain in freely moving animals. A reusable telemetric multi-injector unit (chemistor) suitable for injections into the brain of primates has been developed and tested in chronic experiments with rhesus monkeys freely moving and interacting with other monkeys. The chemistor unit, which measures 15.0 by 15.0 by 7.5 mm and weight 5.8 g, consists of a microinjector, equipped with an internal mechanical power source, and an electronic circuit connected with a receiving coil; a total volume of 27.0 mul to be injected in quanta of 0.9 mul at freely chosen time intervals makes this unit suitable for 30 injections. The desirable protection against possible damage is provided by a circular, head-mounted container (dia. 43.0 mm and 10.3 mm high) which leaves place for two complete chemistors. The device is small, light in weight, reliable and resistant to physical damage.


Inexpensive stereotaxic sighting microscope. An inexpensive low-power microscope is described for use in stereotaxic surgery. The microscope aids in the measurement of skull landmarks and improves the accuracy of stereotaxic surgery.


Some problems and potentialities of present-day psychoanalysis. In a critical review of the current historical situation of psychoanalysis and its unique problems, the author considers a variety of specific but interacting factors. The potentialities for advance as therapy and science, their interrelationship, and the possible channels for such advance are examined. The social, clinical, and scientific importance of derivative 'psychotherapies' and of rationally flexible boundaries of 'indication' are discussed. As differentiated from rational conservatism, the phenomenon of analysts' irrational resistance to potential change in basic tenets of technique or theory is held to be a critically formidable impediment to the further development of psychoanalysis.


Activity in chronic schizophrenic patients: comparison of pimozide with fluphenazine in a double blind trial. A double-blind crossover trial was carried out comparing pimozide with fluphenazine.  The effects of the drugs on the activity of 20 chronic inert male schizophrenic patients were measured using nursing observations, psychiatric rating, and an operant conditioning method.  When activity was assessed in these different ways, no significant difference was found between the two drugs on any of the measures.  It is concluded that pimozide does not effectively increase the activity in such patients.  It is considered that the free operant conditioning method used was shown to be a useful measure for comparing therapy in chronic schizophrenic patients.


Neuropharmacological studies on D145 (1,3-dimethyl-5-aminoadamantan). The effects of D145 (1,3-dimethyl-5-aminoadamantan) and amantadine on dopaminergic mechanisms in the rat were investigated by use of pharmacological agents known to disrupt dopamine function, by placing electrolytic lesions in the dopamine-containing areas of the extrapyrimidal and mesolimbic systems and by the direct application to dopamine sensitive areas. Stereotypy and circling behaviour were used as behavioural indices of dopaminergic stimulation and apomorphine and d-amphetamine were used as standard dopaminergic agonists. In addition, the possible importance of 5-hydroxytryptamine to the dopamine effects was investigated using electrolytic lesions of the midbrain raphé nuclei. Both D145 and amantadine caused a stereotyped behaviour characterized by periodic sniffing, repetitive limb movements and biting, but the effect of amantadine was far more periodic. In addition D145, but not amantadine, caused marked hyperactivity. These behavioural effects were resistant to pretreatment with alpha-methylparatyrosine but not to combined alpha-methylparatyrosine/reserpine or low doses of haloperidol. Also, the prior administration of D145 or amantadine inhibited the development of the biting components of apomorphine and d-amphetamine stereotypy. Both D145 and amantadine caused circling behaviour in animals with asymmetric lesions of the medial raphé nucleus or unilateral lesions of the substantia nigra but the action of D145 was more intense. Bilateral electrolytic lesions placed in the extrapyrimidal (caudate-putamen, globus pallidus, substantia nigra), mesolimbic (nucleus accumbens septi, tuberculum olfactorium, nucleus interstitialis stria terminalis, nucleus amygdaloideus centralis) nuclei or the neuronal pathways supplying them showed D145 and amantadine to act in both areas although their action on the extrapyrimidal system was most marked. However, of particular note was the significantly greater involvement of the substantia nigra with the D145 effect, and the greater involvement of the D145 effect with mesolimbic function. Lesions placed in the medial and/or dorsal raphé nucleus indicated some involvement of 5-hydroxytryptamine with the actions of both D145 and amantadine. The bilateral intrastriatal application of D145 or amantadine in nialamide pretreated animals failed to induce stereotyped or hyperactive behaviour although contralateral asymmetries, which were abolished by lesions of the substantia nigra, were recorded following the unilateral intrastriatal application of D145 or amantadine in haloperidol pretreated animals.


Psychotropic drugs and impairment of psychomotor functions. The present work deals with the effects of psychotropic drug therapy on the operation of psychomotor functions used in a clinical examination of suspected drunken drivers. 100 psychiatric mental, but otherwise health, patients were examined; the type of medication and the number of drugs used varied greatly. In 71 cases the mean degree of error in the clinical examination was higher, and, in several of these, markedly higher than the reference values obtained earlier on suspected drunken drivers when the blood contained very small amounts of alcohol or none at all. In 18 cases coarsely-divided nystagmus was registered in patients on psychotropes. This is an obvious sign of a marked side-effect of medication but was present more infrequently than in subjects with after ingestion of alcohol. The present results indicate that application of the clinical examination method, which was originally developed for and related to the examination of alcohol cases, to subjects on psychotropes is adequate, and it is possible with clinical examination to obtain valuable medicolegal information on the impairment of physiological functions. The present review of suspected drugged drivers examined in Helsinki in 1969--1972 also supports this view.


Changes in human tissue donor attitudes: 1969-1974. Surveys of various community groups reveals changes in attitudes regarding human tissue donation from 1969 to the present.  An overall donor ratio of 67% in 1969 is compared to a donor volunteer ratio of 78% in 1974.  Both prospective donors and nondonors rate various organ transplantation procedures more favorably now than in 1969, with nondonors showing a particularly striking rise in evaluation of such procedures.  Even transplant operations such as liver or heart, now largely abandoned, are viewed more favorably today.  Attitudes concerning giving or receiving of blood occupy a special place in donor regard since both donors and nondonors overwhelmingly favor blood transfusion and do not differ significantly in this respect.


Gastrointestinal complications following renal transplantation. Gastrointestinal complications developed in 29 (6%) of 510 patients following renal transplantation. Thirteen patients (45%) died as a result. Gastrointestinal bleeding, usually considered the commonest complication, was seen in only 7 cases. Other complications included pancreatitis and hyperamylasemia, massive ileus, fistulas with abscesses, bowel infarction, peptic ulcers without bleeding, obstruction, gangrenous cholecystitis, esophagitis, spontaneous perforation of the sigmoid colon, and pneumatosis cystoides intestinalis. Six patients had no clinical or laboratory findings suggesting the underlying gastrointestinal complication; it was the radiographic findings that called attention to the acute problem.


Regulation of coronary blood flow.

Regulation of coronary blood flow. A very schematic summary of possible factors that affect coronary vascular resistance is illustrated in Fig. 11. These factors are mechanical, myogenic, metabolic, and neural. Mechanical influence is passive and is essentially determined by the extravascular compression which is important only during systole and particularly in the subendocardial layers of the left ventricular myocardium. With respect to the myogenic factor it is controversial whether it plays a role in adjustments of coronary vascular tone. Metabolic processes are possibly integrated at the level of the myocardial cell PO2 which is the resultant of oxygen supply and need, which in turn depend on the myocardial contractile activity as well as other biochemical processes. A decrease in myocardial PO2 gives rise to the release of the vasodilator metabolite adenosine. Nevertheless, other chemical factors (H+, K+, osmolarity) known to be released by the heart (which by themselves are poor and transient coronary vasodilators and whose release does not correspond with changes in coronary resistance) may play a role by modulating the coronary sensitivity to adenosine and other factors.


Chymoral in the treatment of lumbar disc prolapse. Ninety-three patients with lumbar disc prolapse of less than six months duration were treated with Chymoral or an identical placebo in a double-blind study. Those patients given Chymoral exhibited significantly greater improvement of straight-leg raising and received significantly fewer analgesics. However, no difference was apparent with regard to other parameters, and similar numbers from both groups required further therapy. Over-all, the value of Chymoral in the treatment of lumbar disc prolapse seemed little better than a placebo.


[Surgical and prosthetic approach to the difficulties of fitting in the completely edentulous]. Prosthetic Surgery must not be considered as an exceptional process. It is likely to transform the comfort and stability of a complete prosthesis if the indications are well laid down. Two elements combine towards its success. 1. The surgical action, which may be -- a limited vestibuloplasty, destined to abolish the small ligaments, the hyperplasias or the polypoid formations; --an extensive vestibuloplasty, intended to deepen the non-retentive vestibules. The process of choice is a super-periosteal plasty of the CLARKE or VRASSE and BATAILLE type. It may be used above all on the mandible. For the maxilla, CELESNIK's intervention may be associated with it; --free skin grafts. They do not always give the results anticipated because of the cicatrical retraction which is almost constantly observed. 2. The retention is as important as the surgery. It is carried out by an anchorage with wires, in a hammock or transcutaneous, and by a plate of resin lined with a layer of elastomeres of silicon. The material appears very much superior to the sponges of polyvinylic alcohol advocated by VRASSE and NETTER.


Laminate-plasty reconstruction of partial auricular defects A new method. The problems surrounding the reconstruction of partial defects of the external ear are examined, and a new method is presented for the reconstruction of defects of the helix where up to one-half is missing. The operative procedure has the following underlying principles: that for ear to sit naturally there must be an 8-10 mm wide rim of cartilage along the whole periphery; and the three layers of the ear, like layers of veneer, can be seaprated from each other and, as flaps, reconstruct a defect where the donor area of the ear only needs to have two layers. This reconstruction can be carried out ambulatorily, and gives satisfactory cosmetic and functional results.


Transfixation in cross-leg procedures using Hoffman's instruments. Report of forty-two cases. The Hoffman transfixation equipment for fracture fixation gives simultaneously an excellent fixation of a flap in cross-leg procedures. Because of these favourable results in 42 cases this method for the fixation of the extremities in predicle flap procedures is recommended. It is possible to divide the flaps much earlier than is customary. In this material half of the flaps were divided on the 14th day or earlier. One or two preoperative flap delays are recommended. The method produces safer and faster healing of the flap.


[Diagnostic significance of the demonstration of fibrin and fibrinogen degradation products in the urine]. The concentration of fibrin/fibrinogen degradation products in urine (FDPu) was measured in samples obtained from 114 patients and 63 clinically healthy volunteers, once or repeatedly. The FDP titers measured by the hemagglutination inhibition (HI) method corresponded to less than 2.6 mug/ml FDP in all samples from healthy controls. Slightly elevated FDP concentrations were found in urine obtained from a few patients with disorders not primarily involving the urinary tract. The clinical importance of these isolated findings remains unclear. Urinary tract infections were not frequently accompanied by elevated FDPu concentrations. In patients with glomerulonephritis FDP excretion correlated somewhat better with severity of the renal affection. A further group of patients showed an unequivocal correlation between FDP excretion in the urine and postoperative complications following renal transplantation. However, the clinical diagnosis of acute rejection crisis was usually established at the same time or even before an increase in FDPu was found. Our results suggest that among diagnostic procedures the measurement of FDPu contributes little specific information for the evaluation of urinary tract disease. FDPu measurements in the immediate postoperative phase following renal transplantation may however be important for prognostic evaluation and, in individual cases, predict transplant rejection. We also attempted to define the FDPu qualitatively by simultaneous measurements using HI and the staphylococcal clumping test (SCT). Immunoelectrophoresis confirmed the well-known fact that the SCT detects only high-molecular FDP; this limits its clinical usefulness, despite its high sensitivity.


[Endocrine ophthalmology.  An overview of pathology, classification, and therapy]. A new uniform nomenclature will allow more accurate clinical study of endocrine ophthalmopathy, a disease that remains an enigma.  Clinical eye disease develops in 30-60% of patients with Graves' disease, but the severe malignant form occurs in a maximum of 5%, and most of these latter patients have been rendered euthyroid or hypothyroid by treatment of the hyperthyroidism.  Despite claims to the contrary, there is no convincing evidence that the mode of treatment (antithyroid drugs, surgery or radioiodine) has a bearing on the development of ophthalmopathy.  Circulating fragments of the TSH-molecule, which produce swelling of retroorbital tissue, and as autoimmune processes of the delayed type are currently under consideration as causative factors.  Medical treatment of endocrine ophthalmopathy has only a limited effect.  In cases of rapid progression with deterioration of vision it is recommended that operative decompression, preferably into the maxillary and ethmoidal sinus, be performed without delay.  Retroorbital administration of 2000 rad by a highly collimated megavoltage beam appears to be a valuable alternative to surgery.


Lymphoid response of the burn patient.

Lymphoid response of the burn patient. Clinical observations have long suggested immunologic compromise in burned patients. Resolution of the immune system into cooperative dual components of T-cells mediating delayed hypersensitivity and B-cells  mediating antibody responses prompted the present survey of T-cell and B-cell changes after acute thermal burn injury. Adults and children sustaining extensive burn injuries were studied for up to 60 days after injury. T-cell function was assessed by lymphocyte counts, in vitro lymphocyte synthesis of RNA and DNA with and without mitogenic stimulation, and lymphocyte response and stimulatory capacities in the mixed lymphocyte culture (MLC) reaction. B-cell function was studied by quantitation of the major classes of circulating immunoglobulins. Transient lymphocytopenia, increased RNA and DNA synthesis rates by both mitogenstimulated and unstimulated lymphocytes, and impairment of lymphocyte response and stimulation in the MLC were observed early in the postburn period. These parameters tended to normalize by the third week after injury. Immunoglobulin levels, particularly IgG, were depressed significantly the first week postburn, but were normal or elevated by 60 days. These studies document both T-cell and B-cell changes postburn,which appear to be reversible with the recovery phase. A transient shift of circulating lymphocytes toward the B-cell type is suggested and early depression of immunoglobulin levels is notable. Both types of changes likely contribute to the immunologic compromise of the acutely burned patient.


Carcinoma of the renal pelvis: a ten-year review. Twenty-two cases of renal pelvic carcinoma are reviewed, of which nine were squamous cell and 13 were transitional cell carcinomas. No difference in symptoms between the two types was seen except for an increased incidence of a palpable mass and weight loss among patients having the squamous cell variety. Thirteen of the 22 patients have died of renal pelvic carcinoma. Reasons for the low survival rate are discussed. Treatment of transitional cell carcinoma with nephroureterectomy and local lymph node dissection is recommended.


Autologous bone marrow transplantation.

Autologous bone marrow transplantation. Bone marrow cells can be aspirated from patients with malignant disorders, stored at low temperatures, and reinfused into the same patient at a later date. In the past, the results of this autologous bone marrow transplantation were equivocal. With the availability of better methods for cryopreservation and more accurate assays for the survival of hemopoietic progenitor cells, there has been a resurgence of interest in this procedure.


Southern thoracic surgery.

Southern thoracic surgery. The different cultures of North and South produced surgeons with subtle but identifiable differences in approaches to thoracic surgery. Some of these factors still represent a strength of the Southern thoracic surgeon, who is, at least spiritually, a descendant of early Southern surgical leaders. Background, contributions, observations, and attitudes of surgeons of the Confederate States of America are examined. Southern thoracic surgeons are urged to demand intellectual accomplishment and scientific achievement, even in the face of a changing, unstable, unpredictable sociopolitical environment of which we have little understanding and even less control.


The treatment of burns by early tangential excision and skin grafting. The principles, aims and detailed techniques of tangential excision and skin grafting of burns are described. The results and advantages of the method in 28 burned patients are discussed.


Malaria prophylaxis.

Malaria prophylaxis. A trial of malaria prophylaxis was carried out on 744 army personnel who were camping in an endemic area over a 3-month period. Three antimalarial drugs were used under strict control and the local population was used as a control, to prove that malaria was present during this time. No cases of malaria occurred in the trial group during this period.


Edendale Hospital, Pietermaritzburg. The first twenty-one years. Edendale Hospital celebrates its twenty-first anniversary in 1975. Among non-teaching hospitals it has led the field in training and advancement of Black nurses and it has pioneered the employment of full-time specialists. It claims to have the first intensive care unit, the first central sterilising department, and the first postoperative recovery room in Southern Africa. Aspects of Edendale's early history are recorded.


Cell electrophoretic studies on the cellular immune response to Candida albicans in rabbits. Rabbits were sensitized intracutaneously with Candida albicans total antigen by a series of booster injections. The electrophoretic migration time of lymph node lymphocytes was related to the time after injection. Two lymphocyte sub-populations could be distinguished. The proportion of each, changed during the course of the immune response. Characteristic changes also took place after in vitro incubation with Candidin. The results have been compared with agglutination titers and are discussed in relation to bursa and thymus-derived cells. The electrophoretic method may be valuable for the diagnosis of candidiasis.


Amino acid synthetic media for fungal pathogens based on aminopeptidase specificities: Histoplasma capsulatum, Blastomyces dermititidis, Paracoccidioides brasiliensis and Cryptococcus neoformans. The development of simple and chemically defined liquid media for Histoplasma capsulatum, Blastomyces dermatitidis, Paracoccidioides brasiliensis and Crypto-occus neoformans according to their aminopeptidases profiles as amino acid requirement was described. When 1.5% purified agar was added, these media also supported excellent mycelial growth and sporulation of the deep mycoses. H. capsulatum was converted to and maintained in yeast phase when 0.1% L-cystine was added to the solid medium incubated at 37 degrees C.


Immunoglobulin classes of antibodies to Aspergillus fumigatus in patients with pulmonary aspergillosis. An indirect immunofluorescence test was used to determine the titre and immunoglobulin classes of antibodies to Aspergillus fumigatus in human serum. In 15 patients with aspergillosis, significant titres of IgG but not IgA or IgM antibodies were found. The IgG, IgA and IgM fractions of serum from 2 patients with aspergillosis were separated. This confirmed that antibodies to A. fumigatus reside in highest titre in the IgG fraction. Precipitating antibodies to A. fumigatus in these patients also belonged to the IgG class of immunoglobulin.


Quantitative tissue invasion of the murine brain as a phenotypic marker of strain virulence in Aspergillus nidulans. In this study the extent of fungal invasion in tissues of the target organs (brain, heart and kidney) has been quantitated histologically in DBA/2J mice inoculated intravenously with 3 strains of Aspergillus nidulans of different virulence. This was done to determine the relation between tissue invasion and strain virulence as determined by time-mortality bioassay. It was found that quantitatively tissue invasion by A. nidulans was target organ specific. Relative tissue invasion within each of the tissues examined was dependent on the strain of A. nidulans injected. In the brain a direct relationship between strain virulence and the extent of tissue invasion was found. This relationship was not observed in the other 2 target organs. The observations suggest that an important phenotypic marker of murine virulence in A. nidulans is the relative ability to invade the tissues of the murine brain.


Respiratory care following open heart surgery. Respiratory care of patients undergoing open heart surgery should begin in the preoperative period. Patients must stop smoking, and if obese they are encouraged to lose weight. Pulmonary infection is treated and secretions must be eliminated. Postoperative hypoxemia, which is an expected event following anesthesia and surgery, is aggravated by circulatory instability and pulmonary complications. Following open heart surgery pulmonary complications such as atelectasis, congestion, edema, postperfusion lung, pneumothorax, pleural effusion, and hemothorax are common. Respiratory care should be planned to avoid these complications and to treat them promptly should they occur. Routinely every patient is mechanically ventilated for at least 12 to 18 hours following surgery. The type of ventilator used and its parameters are adjusted according to the clinical condition of the patient to maintain adequate oxygenation and to prevent any respiratory acidosis. When indicated, PEEP is applied to improve arterial oxygenation. Respiratory care is extended for at least 5 days after termination of artificial ventilation. Oxygen therapy is given with either a nasal catheter or a mask, according to the patient's need. IPPB and physiotherapy are continued until the patient shows no signs of pulmonary infection and is capable of effectively eliminating secretions. This routine management and extended postoperative respiratory care definitely contribute to the successful outcome of open heart surgery.


Use of ileal reservoir following proctocolectomy. A study of 37 patients who underwent ileostomy and creation of an ileal reservoir revealed that all had satisfactory pouches. In the 24 patients in whom a nipple valve was created, the stoma was continent in 21. In the patients without a nipple valve, about one-half are continent. There have been no skin problems in any of the 37 patients. In two patients, the reservoir has been removed, one because of obstruction and the other at the election of the patinet. Although ileostomy with an ileal reservoir does not solve all of the problems, it offers patients who have undergone proctocolectomy for chonic ulcerative colitis or multiple neoplastic disease a better quality of life than does ileostomy alone. An appliance need not be worn constantly, and the stoma can be flush with the skin edge and placed low in the abdominal wall. Nevertheless, management problems do exist in some patients, and the patients are exposed to complications similar to those in any patient who has undergone a major abdominal surgical procedure that involves resection of intestine and creation of an intestinal stoma. Our group is optimistic regarding the use of this procedure in selected patients.