Late cardiac tamponade: a potentially lethal complication of open-heart surgery. Cardiac tamponade occurring late after open-heart surgery is a frequently fatal complication. Of the 13 cases previously reported in the literature, there were seven deaths. In this report, three additional patients with late cardiac tamponade successfully treated are presented. Postoperative anticoagulation with Coumadin appeared to contribute to this complication. Increased awareness of late cardiac tamponade allowing prompt recognition and immediate decompression of the pericardial sac should lower the high mortality rate previously associated with the condition.


Host factors in chronic obstructive pulmonary disease in an upper Midwest rural community. Design, case selection, and clinical characteristics in a matched-pair study. A series of 111 index subjects with chronic obstructive pulmonary disease (COPD) who had forced expiratory volume in 1 second (FEV1) of 70% or less of that predicted were matched on the basis of age, sex, occupation, and smoking history with control subjects who had an FEV1 of 85% or more of that predicted. Index and control subjects with seasonal or reversible airway disease were excluded. Men outnumbered women by a ratio of 4.5 to 1. Thirty-five percent of the women and 2% of the men were nonsmokers (0 pack-years). There were three PiZ phenotypes in the index group (two nonsmokers) and none in the controls. PiMZ phenotypes in the index group outnumbered those in the controls by 8 to 5. Host factors that might be important in these closely matched pairs were sought by history, physical examination, and a large battery of laboratory tests. A standard respiratory questionnaire revealed the anticipated significantly higher frequency of cough, phlegm, noisy respiration, and all grades of dyspnea in index subjects. Previous lower respiratory tract infections also were more frequent in index subjects than in controls. There were no detectable differences between groups in the frequency of upper airway infections, nasal polyps, sinus surgery, or reported allergy to any substance. If the British Medical Research Council's definition of chronic bronchitis were applied to our study, about two-thirds of our index subjects and almost one-third of our controls would be considered to have chronic bronchitis. Pack-years of smoking were not significantly associated with the amount and duration of cough and expectoration in male or female index subjects or controls. Significant differences between index and control groups on physical examination included the audible forced expiratory flow time over the trachea, the estimated maximal midexpiratory flow, breath sounds, rales, and total excursion of the hemidiaphragms. An endocrine questionnaire and measurement of blood sex hormones did not give any clues as to the propensity of males to develop COPD. Women with airway obstruction similar to that of men had histories of significantly fewer pack-years than did the men, and there was a much larger proportion of women who never smoked. Further studies, specifically on genetic and immunologic characteristics, are under way to identify potential host factors.


Incidence of iron deficiency anemia in patients with large diaphragmatic hernia. A controlled study. The incidence of anemia in 259 patients with a diaphragmatic hernia large enough to be seen on a routine chest roentgenogram was compared with that in 259 age- and sex-matched controls. Eighteen patients with diaphragmatic hernia were anemic, compared to one control subject (P less than 0.001). In thirteen patients with diaphragmatic hernia and in one control the anemia was proven to be caused by iron deficiency. The findings provide additional evidence that a large diaphragmatic hernia can cause anemia secondary to chronic gastrointestinal blood loss, which is usually not the result of reflux esophagitis.


[The portacaval anastomosis (author's transl)]. All patients treated in the authors' clinic for portal hypertension from 1958 to 1975 are reviewed and the problems encountered with portacaval anastomoses are explained with special reference to encephalopathy and hepatic failure. Intrahepatic block was recorded in 88% of 722 patients. Portacaval anastomoses were constructed in 292 cases, splenorenal anastomoses in 175, and mesenterico-caval anastomoses in 12. Among the patients with stationary  cirrhosis, the 6-year survival was unrelated to the type of operation performed and amounted to approximately 70%, while 6-year survival was only 40% in patients with progressive cirrhosis of the liver, whether they received surgical or conservative treatment.


[Subcutaneous transposition of the spleen: an experimental and clinical study (author's transl)]. The growing scepticism about the use of portocaval anastomosis operations to prevent renewed bleeding of esophageal varices has led to the testing of new methods. This report describes subcutaneous transposition of the resected spleen in normal experimental animals with the Vena porta constricted with Ameroid rings and liver cirrhosis induced by DMNA. The report also covers 9 patients operated on from 1972 to 1973 with subcutaneous transposition of the spleen. A 77-year-old woman died postoperatively, one patient died after 2 years 4 months, and one had slight bleeding. All the other patients are alive 2-4 years after the operation, with no signs of renewed bleeding. The advantage of subcutaneous transposition of the spleen is that it eliminates hypersplenism.


[New aspects in the treatment of pneumonitis (author's transl)]. Two groups of patients suffering from pneumonitis received different treatments and were compared retrospectively. The first group (38 patients) was treated with heparin and aprotinin. The overall mortality was 50 percent; of the patients who were artifically ventilated 64 percent died. The second group (60 patients) was treated with heparin, fresh-frozen plasma, nicotinic acid, methylprednisolone, and alpha-receptor blocking agents. In this group the overall mortality was 26.5 percent and the mortality among the patients who were artificially ventilated was 33 percent. These results lead the authors to feel that the treatment of pneumonitis with aprotinin is no longer indicated.


[Postoperative analgesia with continous epidural analgesia and with dolantin (author's transl)]. Hemodynamic reactions to the discontinuation of epidural analgesia and to the injection of Dolantin were studied in 16 patients. One of every three patients reacted to the postoperative pain with an increase in mean arterial pressure(+30%) and in the mean pressure in the arteria pulmonalis (+40%) associated with an increase in stroke volume (+41%) and cardiac output (+49%). The administration of Dolantin did not influence either pressure measurement. In such cases the administration of antihypertensive drugs (alpha-blocking agents) or the reinstitution of epidural analgesia is neccessary.


[X-ray findings in diverticulitis (author's transl)]. The frequency of congenital and acquired diverticula is discussed with reference to geographical aspects, their location and the function of the colon in diverticular disease. The X-ray findings in the presence of complications are demonstrated. Radiological differential diagnosis is discussed with special reference to cinematographic analysis of function. The possiblity of the simultaneous appearance of polyposis and carcinoma in diverticular diseases is indicated. A sensitive radiologic diagnostic procedure is important for planning of the optimal treatment.


[Neurophysiological basis of pain and pain therapy (author's transl)]. Painful stimuli are encoded by specialized nociceptors. In the spinal cord the afferent nerves transmit them at the synapse to dorsal horn neurons, which are considered here as models for neuronal mechanisms in nociception. In particular, inhibitory effects of spinal and of supraspinal origin are shown to modulate the nociceptive messages ascending to the brain. These inhibitions are activated by various methods of electrostimulation (of the peripheral nerves, dorsal columns, electroacupuncture) that are used clinically for the management of pain.


[Methods of pain modulation by electrical stimulation (author's transl)]. Different methods of modulating pain by electrical stimulation are described: (1) Nondestructive transcutaneous nerve stimulation is recommended for neurogenic pain syndromes prior to other procedures (success rate about 30%); (2) The implantation of electrodes on the dorsal columns yields good effects in 65% after careful selection; (3) First results with implantations in deep brain structures are discussed.


Neuro-otologic manifestations of sarcoidosis. Sarcoidosis is an idiopathic disease which presents in anatomic areas of concern to otorhinolaryngologists. It can cause dysfunction of both auditory and vestibular systems. In patients known previously to have sarcoidosis, this disease should be seriously considered. In patients presenting with otologic disorders and associated facial nerve paralysis or other neuropathies, uveitis, granulomatous meningitis or diabetes insipidus, sarcoidosis should be suspected. An examination of the eyes as well as a chest X-ray is imperative. Sudden and fluctuating neurosensory hearing loss has been reported. There is a great need for the study of temporal bones from sarcoidosis patients.


A problem-orientated outpatient record.

A problem-orientated outpatient record. A problem-orientated record for use in outpatient clinics has been in operation over a period of 2 1/2 years. Its special features include: (i) preprinted stationery bound in appropriate sequence in the conventional hospital record; (ii) clear presentation of an up-to-date list of each patient's past and present diagnoses; (iii) problem-orientated progress notes. This study considers the definition of an illness problem, recording of progress information, adjustments to a problem list in the outpatient setting and recording of minor "noise" problems. Experience with the system consisted of 5,000 patient attendances. A sampling of these indicated that there were 3-1 +/- SD 1-5 concurrently treated problems per patient, and there were 9-3 +/- SD 6-6 clinic visits per patient. The system was subjectively assessed by 18 doctors, using a semantic differential technique, with a high frequency of "yes" responses to "saves time", "benefits the patient" and "benefits the doctor". This and similar systems may help to resolve the present paradox of the clinical chart becoming decreasingly useful with increasing complexity of illness.


The influence of surgery on survival of patients with angina. Myocardial revascularization surgery has proved most effective in relieving angina pectoris. Its influence on the survival of patients with coronary atherosclerosis, however, remains a contentious subject and one which may not be finally settled for years. The follow-up results of the first 196 patients to undergo direct coronary artery surgery at the Prince Henry Hospital support those who claim increased longevity as one of its benefits.


Acute upper gastrointestinal haemorrhage with negative barium-meal x-ray findings: follow-up investigation. One-hundred and one patients admitted to hospital with acute upper gastrointestinal haemorrhage whose initial barium-meal X-ray examination revealed no abnormality have been followed up 5 to 14 years later. Forty-five were symptom-free, and 8 had dyspepsia, but the barium-meal X-ray findings were still normal. Disease of the lower oesophagus, the stomach or the duodenum was found in 20, 16 of whom had a chronic peptic ulcer and two had gastric carcinoma. There was a poor prognosis for those gastric-ulcer patients whose diagnosis had been missed initially.


Contribution of vasopressor and plasma kininogen changes towards acute adrenaline pulmonary edema in the rat. Acute pulmonary edema, evidenced by increased lung/body weight ratios, was evoked in rats within 5 min following the intravenous injection of 16-40 mug/kg of adrenaline. This change was accompanied by a decrease of 40% of circulatory kininogen not due to generalized plasma protein loss. Rats treated 10-20 min prior to adrenaline with 10 mg/kg of acetylsalicylate (Aspirin), 1000 KIU/kg of Kunitz anti-protease (Trasylol), or 10 mg/kg of soybean trysin inhibitor (SBTI), failed to exhibit pulmonary edema or decreased plasma kininogen levels, but were as sensitive as untreated animals to the arterial hypertensive effect of adrenaline. 4.8 mug/kg of carbamylcholine administered together with 40 mug/kg of adrenaline, prevented pulmonary edema. Carbamylcholine did not reduce plasma kininogen consumption by adrenaline, but effectively decreased the raised systolic arterial blood pressure, the increased systolic-diastolic pressure interval as well as the reflex slowing of the heart presented by adrenaline-treated rats. It seems that in the adrenaline-treated rat, pulmonary edema results from the joined action of vasopressor effects leading to hydrostatically forced outflow of vascular fluid, and of kinin release leading to increased peripheral vascular permeability.


L-5-hydroxytryptophan in treatment of several different syndromes in which myoclonus is prominent. The serotonin precursor L-5-hydroxytryptophan is useful therapy for patients with posthypoxic intention myoclonus. L-5-hydroxytryptophan plus carbidopa was administered to eight patients with this disorder or other syndromes in which myoclonus is prominent. This treatment (1) decreased the frequency of occurrence and amplitude of intention myoclonus in two patients with posthypoxic intention myoclonus and in one with idiopathic myoclonus, (2) had no effect in one patient with congenital encephalopathy and myoclonus, and (3) increased the frequency of occurrence and amplitude of myoclonus in two patients with lipid storage disease, one with myoclonic epilepsy, and in an additional patient with idiopathic myoclonus. Therefore, L-5-hydroxytryptophan does not effect improvement in all forms of myoclonus; it should be given with caution because it produces a high incidence of side effects. A patient's response to L-5-hydroxytryptophan therapy may be important in a diagnostic classification of myoclonic syndromes based on differences in indoleamine neurotransmitter function.


[Alpha 1-antitrypsin in the blood and pleural effusion fluid]. Alpha-1 antitrypsin levels were determined in 27 pleural effusion liquids classified as transudates and exudates in accordance with the clinical and laboratory data, and in their respective blood samples. Absolute values proved insufficient to distinguish transudates from exudates, though they were capable of signifying and replacing the relative protein value. The relation between liquid: serum alpha-1 AT ratio and the liquid: serum proteins ratio was direct and highly significant. Along with the liquid: serum LAD and liquid: serum proteins ratios, the liquid: serum alpha-1 AT ratio enables transudates and exudates to be differentiated with certainty.


[Endoscopic study on the gastric tolerance of antalgic-antirheumatic substances:parsalmide]. The gastric tolerance of parsalmide, a new analgesic, antirheumatic and sedative substance was tested on a group of 50 arthrorheumatic patients with the purpose of assessing gastric damage if any. It was also compared with the tolerance of the better known antitrheumatic drugs in current use. The study was conducted with the endoscopic method, parsalmide being administered in quantities of 600 mg/die per os, broken up into 3 doses, for a period of 20 days. Unlike phenylbutazone, indomethacin and cortisone, parsalmide showed no ulcerogenous effect nor haemorrhage type alterations at gastroduodenal level, at least in the cases treated. Furthermore, the slight surface oedematous gastropathies that appeared during the research were not important enough to demand suspension of the treatment. Endoscopically this picture can be judged of little clinical importance (as with the majority of well known analgesic-antirheumatic drugs) and its incidence came within the mean. A fair tranquillizing action, detectable in the particularly amenable behaviour of the subjects undergoing endoscopy, is also worth reporting.


Acute renal failure of obstetric origin. Acute renal failure of obstetric origin is common among North Indian patients and comprised 72 (22.1%) of 325 patients undergoing dialysis over an 11-year period. Of these, 46 gravidas had developed renal failure following abortion, and 29 cases were due to complications of late pregnancy. The most striking feature of this study was a high incidence of irreversible renal lesions of bilateral diffuse cortical necrosis in early (18.6%) as well as late pregnancy (37.8%). Overall incidence of diffuse cortical necrosis was 25%. In the remainder, acute tubular necrosis was seen in 52 (72.2%), patchy cortical necrosis in 1 (1.4%), and tubular necrosis along with glomerular involvement in 1 patient (1.4%). Pathogenetic factors which contributed to the development of renal failure, either singly or in combination, were loss of blood failure, either singly or in combination, were loss of blood (79.1%), septicemia (31.9%), hypotension due th hemorrhagic and septicemic shock (51.4%), eclamptic toxemia (11.1%), and disseminated intravascular coagulation in 12.5% patients. Infrequent occurrence of disseminated intravascular coagulation in the septic anc eclamptic patients who developed diffuse cortical necrosis was an interesting finding, as was the fact that coagulopathy was more frequently observed in acute tubular necrosis. Late referral, frequent sepsis, and high incidence of bilateral diffuse cortical necrosis contributed significantly to a high mortality (55.3%).


Quantitation of circulating T and B lymphocytes in children with whooping cough. The numbers of circulating T and B lymphocytes in seven children with whooping cough due to Bordetella pertussis and eight control subjects were determined. All the children with whooping cough had an absolute lymphocytosis (mean 29,142/mm3vs. 5,225/mm3) and by surface marker criteria both T cells and B cells were increased (mean T cells, whooping cough 15,794/mm3 vs. 3,516/mm3 controls; mean B cells, 13,393/mm3 whooping cough vs. 1,706/mm3 controls). However, the ratios of T cells to B cells in the whooping cough (1.4) and control group (1.9) did not differ significantly. This proportional increase in both T and B lymphocytes indicates that whatever mechanism are responsible for lymphocytosis in B. pertussis infection affect both populations in a similar manner.


Responses to tilting of fibers of the frog's saccular nerve. The activity of single fibers from the saccular nerve has been recorded in isolated head preparations in the frog (Rana esculenta). Nearly all the fibers present an activation or a depression of their activity during the tilting movement in a given direction. This is considered to correspond to the existence of two anatomical populations of haircells in the saccular macula which differ in their functional polarization. The activity of only some units (about 40%) remained increased or decreased when the head was in a tilted position for 4-5 min. This shows that the sacculus is sensitive to the direction of gravity.


The theoretical small signal impedance of the frog node, Rana pipiens. The small signal impedance of the frog node is calculated for frequencies from 1 Hz to 10,000 Hz and transmembrane potentials from -80 mV to -30 mV, by linearizing the voltage clamp equations of Dodge [7] and Hille [8]. The modulus of the impedance is presented for the total system, and separately for the potassium and sodium systems as a function of frequency and voltage. There is a broad resonance in the total impedance with a voltage-dependent peak frequency. At 22 degrees C, in the range -75 mV to -45 mV, the peak frequencies occur between 50 and 500 Hz. Removing the potassium system leaves a relatively sharp resonance centered around 200 Hz at -45 mV.


[Radioimmunoassay of antihemophilic factor A]. A radioimmunological method for the estimation of anti-haemophilic factor A was perfected and studied, making it possible to measure factor VII antigen as distinct from procoagulant factor VIII activity. The method uses a rabbit anti-factor VIII antibody, purified and labelled with I125. The technique of estimation is based upon the differential precipitability of specific factor VIII antigen-antibody complexes, which precipitate with 25 per cent saturated ammonium sulphate and of free antibody which does not precipitate under these conditions. The method is reproducible and sensitive, with the possibility of measuring 0.3 per cent of factor VIII antigen, i.e. 0.003 units/ml. Its specificity is confirmed by the absence of factor VIII antigen in a patient suffering from a severe form of von Willebrand's disease. Using this technique, normal subjects were found to have 96 +/- 31 per cent of factor VIII antigen in comparison with a pool of 25 normal plasmas. Haemophiliacs tested had, as would have been expected, antigen levels close to normal.


Complications of colonic diverticulitis. About half of the patients in whom diverticulitis develops have subsequent attacks. Recurrence increases the likelihood both of complications, such as perforation, abscess, fistula, obstruction, and hemorrhage, and of the necessity for surgical intervention. For these reasons, patients who have had two or more attacks of acute diverticulitis should be considered candidates for prophylactic resection.


Surgical management of colonic diverticulitis and complicated diverticulosis. The aim of surgery in the management of diverticulitis and complicated diverticulosis is to remove the disease process as quickly as possible. This approach reduces the likelihood of complications and often avoids the necessity of multistage procedures. Indications for resection include failure of a first attack to subside, recurrent attacks, and free perforation with spreading peritonitis. Three-stage procedures should be reserved for extremely serious disease. Other complications requiring surgery are fistula, obstruction, and massive and uncontrolled bleeding. Massive bleeding is caused by diffuse colonic diverticulosis and is rarely associated with diverticulitis. Abdominal mass, obstruction, or recurrent episodes of slight bleeding should suggest the possibility of underlying tumor and are compelling indications for early resection.


Rheumatic diseases. 2. Therapeutic considerations. In the management of rheumatic diseases, the use of corticosteroids should be reserved for active arthritis. Phenylbutazone (Butazolidin) is probably the drug of choice for acute gout and is also effective in ankylosing spondylitis, Reiter's syndrome, and psoriatic arthritis. Indomethacin (Indocin) also is useful in these conditions. Ibuprofen (Motrin) is only slightly more efficacious than aspirin. Aspirin is still the preferred treatment for rheumatoid arthritis and should be tried before ibuprofen. Osteoarthritis of the cervical or lumbar spine calls for a full program of physical therapy. Experimental procedures for total replacement of joints other than hip and knee show promise.


Radiology of colonic diverticular disease. Nonsurgical diagnosis of colonic diverticulosis and most complications of diverticular disease is best established by barium enema study. Multiple diverticula can produce narrowing and shortening of the colon that is unrelated to any complication occurring in the diverticula. The diagnosis of diverticulitis is made radiologically be demonstrating the effects on the lumen of the bowel of the pathologic changes visible on gross inspection, eg, local abscess, intramural dissection, fistula, obstruction. Frequently the radiologic findings are subtle.


The use of antithymocyte globulin in myasthenia gravis. Antithymocyte globulin (ATG) has been used to treat three female patients with myastenia gravis. No other immunosuppressive agent was used. All three cases responded favourably to ATG therapy. This suggest that further work should be undertaken in this field though the condition itself is extremely variable and this study was not controlled.


Antithymocyte antiserum therapy in myasthenia gravis. The therapeutic effect of goat anti-human thymocyte antiserum globulin (ATG) was assessed in 10 patients with myasthenia gravis. Prolonged, low dose therapy was used with 1-0--1-6 grams protein administered intramuscularly over a 28-73 day period. Varying degrees of therapeutic response were noted in 8 patients. Fllow-up examinations for over 5 years have been maintained and relapse rates determined. The clinical criteria for aptients selection and characteristics of therapeutic response are presented.


Human anti-T-cell cytotoxic sera as an approach to dissection of immunological systems. The initial work on the analysis and differentiation of human lymphoid cells is described. Cells from various lymphoid organs and blood were used as the antigen to prepare various antisera. These antisera were then used to define the lymphocyte populations of patients with primary and secondary immunodefiency. They are also being used to begin the analysis of the differentiation of the T-lymphocyte.


Antilymphocyte antibodies:an approach to dissecting the heterogeneity of the immune system. Antilymphocyte antibodies can be used to dissect the lymphocyte populations and subpopulations. In the mouse, at least seven gene loci govern the expression of allo-, hetero-and autoantigens at the surface of T-lymphocytes. The antisera, especially the alloantisera, permit definition of the differentiative state of cells and discriminate between subsets of T-cells with different functions. Less is known about human T-lymphocyte differentiation antigens and their genetic determinism. However, heterologous antisera specific for human T-cells have been prepared and their use has been of help in studying this cell population. The antigens recognized by such antisera are present at a higher concentration on thymocytes than on peripheral blood T-lymphocytes. They appear at the surface of bone marrow T-cell precursors after a short incubation with thymic factors. Such markers of T-lymphocytes in various stages of differentiation and the study of in vitro differentiation from precursor cells have already proven to be valuable tools for clinical investigation, especially in the realm of immunodeficiency diseases.


Sea anemone toxin:a tool to study molecular mechanisms of nerve conduction and excitation-secretion coupling. The effects of polypeptide neurotoxin from Anemonia sulcata on nerve conduction in crayfish giant axons and on frog myelinated fibers have been analyzed. The main features of toxin action are the following: (i) the toxin acts at very low doses and its action is apparently irreversible. (ii) The toxin selectively affects the closing (inactivation) of the Na+ channel by slowing it down considerably; it does not alter the opening mechanism of the Na+ channel or the steady-state potassium conductance. (iii) The tetrodotoxin-receptor association is unaffected by previous treatment of the axonal membrane with the sea anemone toxin. (iv) Conversely, the sea anemone toxin can only associate with the membrane when the Na+ channel is open for Na+; it does not bind when the channel is previously blocked by tetrodotoxin. (v) Besides its effect on the action potential, the sea anemone toxin displays a veratridine-type depolarizing action at low Ca2+ concentration which can be suppressed by tetrodotoxin. The sea anemone toxin greatly stimulates the release of gamma-[3H]aminobutyric acid from neurotransmitter-loaded rat brain synaptosomes. The apparent dissociation constant of the neurotoxin-receptor complex in this system is 20 nM. The sea anemone toxin effect is antagonized by tetrodotoxin.


Role of antigenic structure in cell to cell cooperation. Two synthetic polypeptides which differ only in the order of amino acids in their NH2-terminal side chains, namely, (Tyr-Tyr-Glu-Glu)-poly(DLAla)- -poly(LLys) and (Tyr-Glu-Try-Glu)-poly(DLAla)- -poly(LLys), were found to be under different genetic control. By three different in vivo systems for thymus-derived cell depletion, it was demonstrated that (Tyr-Tyr-Glu-Glu)-poly(DLAla)- -poly(LLys), which represents the random poly(Tyr,Glu)-poly(DLAla)- -poly(Lys) in the pattern of immune responses and in the quality of antibodies they elicit, is thymus-dependent whereas (Tyr-Glu-Tyr-Glu)-poly(DLAla)-poly(LLys) does not require thymus-derived cell help for efficient antibody production. Therefore, the two ordered polypeptides which are similar chemically differ in parameters, not yet determined, which affect their capability to trigger bone marrow-derived cells.


Effect of serotoninergic drugs on positive and negative reinforcing systems in cats. Administration of tryptophan and 5-hydroxytryptophan produced inhibition of self-stimulation through hypothalamic electrodes which was accompanied by drowsiness and decrease of motor activity. In cats pretreated with Ro 4-4602, an inhibitor of peripheral decarboxylase, both drugs did not produce drowsiness and markedly activated self-stimulation. Both drugs prolonged the latency of the escape reaction and inhibited the punishment reaction. The data suggest an activating effect of serotonin on the system of reward and an inhibitory effect on the system of punishment.


Kasabach-kasabach-.

Kasabach-kasabach-. Giant haemangiomas combined with a haemostasis disorder of the Kasabach-Meritt type are rare and even more rare are the problems posed during labour when vulvo-vagino-uterine sites are involved. Two cases are reported. After summary of the clinical and biochemical studies, the authors report attempts to improve the haemostasis disorder, first with heparin and then with antifibrinolytic preparations, and to improve the angiomas with antifibrinolytic preparations in the hope of stimulating intrasacular thrombosis. In particular, the obstetric and surgical problems are discussed in the context of labour. In one case the outcome of labour was successful only moderate transfusion being required, and in the other the outcome was fatal despite the use of about 100 bottles of blood in the first 24 hours. In both cases the infants were normal.


Selective arterial embolization in duodenal bleeding. Severe, unremitting bleeding of the upper gastrointestinal tract could be controlled by Gelfoam embolization of the posterior pancreaticoduodenal artery. The technique and indications of the method are presented.


Effect of apomorphine plus 5-hydroxytryptophan on plasma prolactin levels in male rats. The relative potency of dopaminergic inhibition and serotonergic stimulation of prolactin secretion in male rats was compared. 5-Hydroxytryptophan (5-HTP), 100 mg/kg, i.p., the precursor of serotonin, produced a 6-11 fold increase in plasma prolactin. Apomorphine, a dopamine agonist, at doses of 1-10 mg/kg, i.p., had no significant effect on plasma prolactin. However, when apomorphine was given with or before 5-HTP, it nearly completely blocked the increase in prolactin produced by 5-htp. these results indicate that inhibition of prolactin secretion by dopaminergic stimulation can overcome the prolactin releasing effect of serotonin. The results are consistent with the hypothesis that prolactin secretion is ordinarily under a weak serotonergic stimulation and a profound dopaminergic inhibition. It is also possible that apomorphine affects plasma prolactin levels by increasing prolactin clearance.


Positive inotropic action of Solanaceae glycoalkaloids. Six glycoalkaloids and one aglycone were tested for cardiotonic activities and compared with K-strophanthoside by use of the isolated frog heart. The decreasing order of potency was as follows: K-strophanthoside greater than tomatine greater than alpha-chaconine=alpha-solanine greater than demissine=commersonine greater than beta-chaconine greater than solanidine. Cardiotonic activity was directly related to the number of sugars in the molecule in which the glycoalkaloids had a common aglycone. On the other hand, glycoalkaloids with dissimilar aglycones, but with identical sugars, such as tomatine and demissine, differed significantly with respect to cardiotonic potency. Apparently, therefore, the cardiotonic activity of glycoalkaloids on the frog heart is determined by the nature of the aglycone and the number of sugars and not by the kinds of sugars or their stereochemical configuration.


On the mechanism of activation of the hypothalamo--pituitary--adrenal reaction to changes in the environment (the 'alarm reaction'). The amount of circulating noradrenaline increases considerably in parallel with an improvement in cardiovascular haemodynamics in adrenalectomized rabbits after intravenously injected hydrocortisone. In view of this finding, that as well as a constant regulation with negative retroaction of the corticotrophic-releasing factor--adrenocorticotrophic hormone (ACTH)--cortisol system, there exists an externally controlled servomechanism from nervous system activity related to the environment. Hydrocortisone favours passive avoidance, extinction and facilitates the activity of the cholinergic inhibiting system; ACTH facilitates active avoidance and catecholaminergic activation. It has already been demonstrated that stimulation of the inhibiting system or inhibition of the activating system released noradrenaline from the peripheral nerves of an adrenalectomized animal. It therefore seems that the early release of ACTH after aggression is capable of favouring locomotor activity in 'flight or fight'. If the latter is effective, there is a return to the previous behavioural and endocrine balance. On the other hand, if 'flight or fight' should be ineffective, there arises a vicious circle with positive retroaction, because secondary secretion of glucocorticoids will maintain inhibition and considerable activity in the noradrenergic system. The significance of the alarm reaction and the secondary release of the mineralocorticoids are discussed as well as the central mechanism of allegedly psychosomatic, illness. Aggression, as well as the lesion it induces, causes a reaction from the organism subjected to aggression. This is a non-specific reaction to which Selye (1936) has drawn attention. This reaction sets the central nervous system in action, which activates the vegetative nervous system and the endocrine system through the hypothalamus and the pituitary gland. In the vegetative system and the vasomotor changes related to it, the alarm syndrome has to be understood as a way to induce flight or fight, which allows the organism to move away from the aggressor. When this behaviour is impossible or ineffective the vasomotor reaction is threatened and it is depressed or inhibited (Laborit, 1952). Resuscitation techniques involving central or peripheral inhibitors, such as lytic cocktails, neuroplegy or neuroleptanalgesia, derive from this concept. The neuro--endocrine significance of the alarm reaction is still not understood and resuscitation techniques are quite empirical in relation to it.


Abnormal lymphocyte populations in pure red cell aplasia. Studies of blood lymphocytes from 4 patients with pure red cell aplasia were performed with lymphocyte surface markers, and with various in vitro tests for lymphocyte functions. Pathologically low B-lymphocyte values were found. In contrast, no marked deviation from normals were seen for T-lymphocytes and Fc-receptor-bearing lymphocytes thought largely to represent non-B, non-T-lymphocytes. In 3 patients normal lymphocyte transformation was found with unspecific and specific mitogens, while the DNA-synthesis induced by unspecific mitogens was subnormal in the fourth patients. The lymphocyte-mediated PHA-induced cytotoxicity against target cells in vitro was subnormal in 2 patients, while no depression was seen in antibody-dependent cytotoxicity mediated in vitro by lymphocytes (K-cells). It is concluded that considerable immunological abnormalities are associated with pure red cell aplasia, and the possible significance of this is discussed.


Effects of anticonvulsant drugs on the synthesis of DNA and protein by human bone marrow cells in vitro. Suspensions of human bone marrow cells were incubated with various concentrations of phenobarbitone or phenytoin sodium for 2 h, and the effects of this incubation on the subsequent incorporation of 3H-thymidine and3H-leucine into DNA and protein, respectively, were studied. Both drugs caused a depression of 3H-thymidine incorporation and this phenomenon was not prevented by the addition of 100 mug of pteroyl-glutamic acid, folinic acid or 5-methyltetrahydrofolate per ml of marrow culture. The lowest concentration of drug which caused a statistically significant depression of 3H-thymidine incorporation was 200 mug per ml for phenobarbitone and 50 mug per ml for phenytoin sodium. Both phenobarbitone and phenytoin sodium also caused an increase in the incorporation of 3H-leucine at concentrations of 50 and 20 mug per ml, respectively, suggesting the possibility that a stimulation of protein synthesis within erythropoietic cells may play an important role in the development of anticonvulsant-induced macrocytosis.


[The morphological and functional integrity of cryo-preserved leukocytes]. Human peripheral blood lymphocytes were frozen by a simplified method which is described. Light and electron microscopic investigations of the frozen-thawed cells showed no significant morphological changes compared to the fresh cells; comparison of E-rosette formation and nonspecific acid esterase activity before and after cryoconservation afford evidence of a possible slight change in the percent relationship of T- and B-cells, whereas thymidine uptake values within normal range after stimulation with PHA and homologous cells demonstrate the functional integrity of the lymphocytes.


Combined aortoiliac and femoropopliteal occlusive disease. In a series of 140 patients operated upon for aortoiliac occlusive disease over 11 1/2 years, 81 had concomitant occlusion of the superficial femoral artery. These 81 patients with combined segment disease were studied with particular emphasis on the relief of presenting symptoms by an aortic bypass procedure alone. Fifty-three patients underwent only aortic bypass and could be fully evaluated postoperatively. Ninety-six per cent presenting with rest pain or ischemic changes obtained complete relief of these sympotms. All 53 patients presented with claudication, and 88.7 per cent either had complete relief or improved to the point that no further theapy was needed. The results of this study confirm the efficacy of restoration of proximal flow to the profunda femoris arteries as the primary therapeutic goal in patients with combined segment disease.


Left main stem coronary artery disease. Retrospective review of 26 patients treated surgically or medically. The clinical, angiographic, exercise testing, operative, and follow-up data of 26 patients found at angiography to have left main stem coronary artery stenosis, defined as a reduction in the lumen diameter of 50% or more, are reviewed. There was a high incidence of significant proximal stenosis in the branches of the left main stem. No clinical features were found to distinguish patients with left main stem stenosis. All patients were considered for saphenous vein bypass grafting, selection being based upon the severity of symptoms, left ventricular function, and suitability of the coronary vessels for grafting. Two patients died within 24 hours of coronary angiography. Nine patients were operated on with no mortality. There has been one late cardiac death during a mean follow-up time of 13 months. All patients were symptomatically improved with a significant (P less than 0-01) increase in exercise ability postoperatively. Fifteen patients were not operated on. Six of these patients were regarded as operable but surgery was deferred; five have died at a mean time of 7-2 months. Five of the nine patients regarded as inoperable have died at a mean follow-up time of 14-8 months. The five non-surgical survivors remain symptomatic with no significant change in exercise ability. Recently reported surgical and medical series of patients with left main stem stenosis are reviewed.


[Hemorrhage in erosive gastritis].

[Hemorrhage in erosive gastritis]. The authors have examined 381 patients admitted with acute hemorrhage from the upper portion of the gastrointestinal tract. In 58 patients erosive gastritis was found by means of urgent gastroduodenoscopy. The clinical picture of this severe affection, the possibilities of diagnosis and the policy of treatment are described. Electron-microscopic studies of the gastric mucosa in erosive gastritis have evidenced different genesis of the erosions.


[Diverticulosis of the large intestine]. Under observation were 47 patients with colonic diverticula. The clinical classification of diverticulosis of the colon is suggested. The principal method of treatment in patients with uncomplicated forms of the diverticulosis should be conservative. In profuse hemorrhage and intestinal obstruction as well as in perforation of the diverticulum, that would not respond to conservative therapy, surgery is indicated.


[Maternal mortality in Austria from a clinical point of view]. The maternal mortality rate of 22.4 per 100,000 live births in 1973 is the lowest recorded in Austria. The figures for Austria are compared with the data from other European countries with similar health systems. Austria reflects the overall trend of a decreasing maternal mortality rate. 10 cases of maternal death recorded per 16,447 live births in the 2nd Department of Obstetrics, University of Vienna are presented and discussed with respect to the clinical diagnosis and compared with the main causes of maternal death in the national and international literature. As in other countries, haemorrhage in 3 out of the 10 cases ranks first, whilst in Austria generally, toxaemia has been the most common cause of death in recent years. The main cause of the bleeding is undetected rupture of the uterus, which is frequently concealed behind the clinical diagnosis of circulatory failure with cardiac arrest. 2/3 of the observed cases in the present series are considered to have been avoidable. It is recommended that in future every single reported case of maternal death in Austria is analyzed and the cause of death and the degree of avoidability discussed as is done in England.


[Fetal haemoglobin levels in acquired and congenital haematological diseases and malignant tumours in adults (author's transl)]. Hb F values were estimated in 336 adults on 525 occasions. A variable elevation appeared not only in patients with a variety of haematological diseases, but also in conjunction with malignant neoplasms, liver disease etc. The highest values were encountered in cases of pernicious anaemia, haemolytic anaemia, panmyelopathy and plasmocytoma. The determination of Hb F in peripheral blood smears by means of this extremely simple elution method (Betke and Kleihauer) represents a useful tool in the diagnosis of haematological disorders in adults, especially the haemoglobinopathies. The possible causes of this biochemical redifferentiation of erythropoiesis are discussed.


[Gastrointestinal hemorrhage in the internal medicine cases of a district hospital. Retrospective study from the years 1965-1974]. In the period between 1965-1974 564 patients with gastrointestinal hemorrhages were admitted in the medical clinic of the District Hospital St. Georg Leipzig. Of them 112 patients (20%) were at once or after failure of a conservative therapy admitted in the surgical clinic for operation. 82 patients died (18%) of the conservatively treated patients). The most frequent sources of haemorrhage duodenal ulcers with 32%, ventricular ulcers with 25% and carcinomas of the stomach with 19%. In 13% of the patients haemorrhages induced by drugs could be assumed. In 13% the case were recidivation haemorrhages. Severe gastrointestinal haemorrhages were observed only in 4% of the patients and consequently were less important in our patients. A further improvement of the diagnostic exactness is possible by perfection of the early diagnosis (emergency gastroscopy and angiography), which may be important with regard to a surgical intervention.


[Retrograde perfusion of the coronary sinus]. The investigations by Ratajczak-Pakalska showed peculiarities of cardiac venous circulation which make retrograde perfusion possible. Microcirculation is flowing in two directions, especially in diffuse cardiosclerosis. The results of the authors' animal experiments prove that the method of retrograde perfusion of coronary veins might be used ultimately in these cases.


[Cerebrospinal fluid T- and B-lymphocytes in serous meningitis]. By means of PHA-tests and rosette-formation the authors detected in the CSF of patients with serous meningitis T- and B-lymphocytes. They assume that in serous meningitis the penetration of alien antigens into the subarachnoidal space facilitates the migration of T- and B-lymphocytes into the CSF from the lymphoid organs and peripheral blood. On the grounds of these data the authors propose a new concept which assumes that besides the hematoenecephalic barrier, there is also an immunological brain barrier, the morphofunctional basis of which is the CSF with circulating T- and B-lymphocytes and immunoglobulins of different classes.


Epidemiological background to diabetes.

Epidemiological background to diabetes. Earlier seasonal inoidence studies indicated that juvenile diabetes is acquired mainly in the autumn and winter months, and more recent and extensive further studies conducted throughout Great Britain have confirmed these earlier findings. Studies relating the incidence of the disease to age among juveniles suggest that an initiating factor, probably viral in origin, is operative in early childhood and that after a latent period, a precipitating factor may then uncover the disease. This might explain the peak of juvenile diabetes which appears at age 11, in Britain. Studies on families in which diabetes has appeared almost simultaneously in two or more members, lends some support to the view that the disease may be precipitated by some infective process.


Clinical significance of anti-insulin-antibodies. Treatment of diabetic patients with common available insulin preparations in most cases results in formation of immuno-globulins called anti-insulin-antibodies. During the last 10-15 years it has been established, that these immuno-globulins, especially IgE, may be responsible for allergical manifestations. Moreover it has been established, that immuno-globulins, especially IgM, may be responsible for insulin resistance in many cases. It is concluded, that anti-insulin-antibodies also are important for the insulin requirement in non-resistant diabetics. The investigations could not reveal any significance of anti-insulin-antibodies for the degree of regulation. The remission period has been defined, 45 per cent of patients examined fulfilled the criteria for remission. The investigations support the assumption, that anti-insulin-antibodies may shorten the remission period, probably due to neutralizing effect upon the endogenous insulin supply. Finally our findings are in accordance with the view, that insulin-anti-insulin-antibody complexes might deteriorate late diabetic vascular complications.


The influence of insulin and insulin antibodies on the glomerular structure. Guinea pigs and rabbits were treated with heterologous insulin preparations of different purity for 3 months without Freund's adjuvant. The insulin binding capacity of the serum, as well as the light and electron microscopic structure of the glomeruli were studied and the glomerular structure was analyzed with quantitative methods. By a longer treatment with heterologous commercial insulin preparations a proliferation of mesangial cells and a thickening of the mesangium matrix were showed. Furthermore, hump-like basement membrane protuberances were found in the glomerular capillary wall. Their frequency increased when more insulin antibodies were formed. Rabbits treated with MC insulin showed no significant antibody formation and no significant changes in the glomerular structure. Otherwise, in animals treated with the impurities of the insulin preparations (a+b component) a marked increase in the basement membrane protuberances was demonstrable accompanied by a higher antibody titer. An increase in the mesangial cell density as well as an increase in the mesangial volume were also present. The results confirm the findings that a contaminating protein in crystalline insulin to be responsible for the antigenic properties.


[Assessment of the reinforcing properties of self stimulation in rats using the "discordance" index]. Histogramms of the duration of pedal pressing (PDH) as a function of stimulation parameters, were studied in fifteen rats with electrodes inserted in the lateral hypothalamus and with fixed series of brain stimulation. The "discordance" parameter was used to estimate the changes in PDH modes relative to the moment of the end of brain stimulation. It was found that an increase in the stimulation charge brought about a gradual replacement of positive discordance (the duration of pressing exceeds that of stimulation) by a negative one (duration of pressing is shorter than that of stimulation) and a rise of negative discordance. It is assumed that in the case of positive discordance the duration of the total brain stimulation possesses reinforcing properties, while in the case of negative discordance the beginning of the stimulation possesses reinforcing properties, and its continuation becomes negative.


Cellular interactions in the proliferative response of human circulating lymphocytes to PHA-analysis of the impaired response in old age. Peripheral blood lymphocytes (PBL) from old subjects were less responsive to PHA than those from young controls, in both groups the PBL content of macrophages, T and B cells were comparable. Macrophages were identified as peroxydase containing cells, rosette formation with sheep red blood cell was used as a T cell marker and immunoglobulin bearing lymphocytes were considered to be B cells. PBL were separated in two subpopulations of purified T cells (F1 and F2) differing in their responsiveness to PHA and in their ability to cooperate with B cells. Purified B cells had a synergistic effect on the F1 response to PHA whereas they were often suppressive for the corresponding F2 response. Peroxydase containing cells enhanced the response of unfractionated total PBL and of purified T cells in the young subjects. The depressed response of the old age group could be related mainly to a suppressive effect of monocytes and a decreased circulating pool of F1 T cells.


[The natural course of coronary heart disease]. For a critical evaluation regarding surgical therapy of coronary heart disease, we quote from important publications to the following points: Early mortality due to surgical treatment, by estimating the severity of the disease as determinated by the criterions of the New York Heart Association, or by the number of the diseased coronary vessels, or by important parameters of the function of the left ventricle (0% to 12%). Frequency of acute myocardial infarction, intra-or postoperatively (10% to 15% of the survivers, 50% of the lethal cases). Frequency of occlusion, of an aorto-coronary saphenous vein bypass (up to 30%). Amelioration of ischemic heart pain by surgical treatment (up to 90%). Prevention of the progression of coronary heart disease (not proved). Natural history of patients with coronary heart disease without surgical treatment, by estimating the number of the diseased vessels (2% for one-, 6% for two-, and 10% for three vessel diseases; 30% mortality rate due to stenosis of the left main coronary artery). Comparison of the mortality rates of surgically treated patients against those without surgery for coronary heart disease with equal severity (no difference). We investigated the connection between the severity of coronary heart disease (determinated by coronary angiography), and the mortality rate in our own patient material. A fundamental conformity appeared, with the results as quoted in the literature. Finally we difined the indications for surgical treatment of coronary heart disease due to angina pectoris, which cannot be managed conservatively and which makes a normal live difficult or impossible. Moreover, the function of the left ventricle should be fairly good. An absolute indication is a stenosis of the left main coronary artery.


Tone audiometry control of children treated for meningitis with large intravenous doses of ampicillin. Thirty-seven children treated for bacterial meningitis with ampicillin in high doses were followed up with audiometric control. Defects were recorded in 6 cases. Two of these were ascribed to chronic otosalpingitis. In 4 patients with sensorineural hearing loss, 3 were unilateral, and in only one case was the damage bilateral. Even here there was a previous history of hearing loss. A suggested ototoxicity of ampicillin could not be confirmed.


The taxonomy of haemophili isolated from conjunctivae. The paper provides a description of 112 Haemophilus strains isolated from cases of conjunctivitis in Egypt, Tunisia, Denmark, and the U.S.A., and aims at a clarification of the taxonomy of haemophili implicated in conjunctivitis. Although the study confirms the diversity of haemophili which can be isolated from inflamed conjunctivae, the vast majority of strains could be assigned to either biotype II or III of H. influenzae. Thirteen strains possessed all the characteristics of the Koch-Weeks bacillus. However, judged by the findings the recognition of the Koch-Weeks bacillus as a separate species does not seem tenable. It is suggested that this organism is considered a haemagglutinating variety of H. influenzae biotype III. The study indicates that the haemagglutinating ability per se, which can be found in strains of several taxa of Haemophilus, is associated with a special pathogenic potential.


Differential effect of cortisol on thymocytes from mice of different ages. The influence of cortisol in vivo and in vitro was studied in thymus sections, suspensions, and smears obtained from new-born, 6 days old, and 30 days old mice. Histology as well as differential counts revealed that new-born thymocytes are far more sensitive to the cytotoxic effect of cortisol than thymocytes from older animals, and thymocytes from 30 days old mice are more sensitive than cells from 6 days old animals. Thus, the number of pyknotic cells in the thymus of new-born and 30 days old mice increased up to 20 per cent 6 h after injection of cortisol compared to 10 per cent in 6 days old animals. At 24 h after injection, the per cent of pyknotic cells in the thymus of new-born mice was 50 compared with about 1 in the two older age-groups. Supravital dye exclusion showed that thymocytes in 6 days old mice are less sensitive to the cytolytic action of cortisol in vivo than thymocytes from new-born and 30 days old mice. Incorporation of 3H-TdR and 3H-UdR into thymocyte DNA and RNA, respectively, was inhibited in all groups after treatment in vivo. DNA-synthesis of thymocytes in new-born animals was inhibited in all groups after treatment in vivo. DNA-synthesis of thymocytes in new born animals was inhibited more than DNA-synthesis in thymocytes of older animals, whereas RNA-synthesis was inhibited to nearly the same extend in the three groups studied. Incubation in vitro with 10(-6)M cortisol inhibited the DNA-synthesis to the same extent in thymocytes from the three age groups studied whereas the inhibiting effect of 10(-5)M cortisol on thymocytes from 6 and 30 days old animals was more intense than that on cells in new-born mice. The RNA-synthesis of thymocytes from 6 days old mice incubated in 10(-5)M cortisol was inhibited far less than RNA-synthesis in cells from new-born and 30 days old mice. The experiments reported, showing differential effects of cortisol on thymocytes obtained from mice of different ages, may reflect different stages of thymocytes maturation during the process of ontogenesis.


Antinuclear factors in sera from healthy blood donors. Sera obtained from 466 healthy blood donors were investigated for presence of granulocyte-specific and organ-nonspecific antinuclear factors of the IgM, IgA and IgG classes, 110 sera also for complement-fixing and IgD class antinuclear factors. When undiluted sera were studied, most sera were found to contain antinuclear factors of one or more immunoglobulin classes (77 per cent). IgM, IgA and IgG antinuclear factors were found in 53, 44 and 14 per cent, respectively. At dilution 1:16, antinuclear factors of the IgM class were still detected in 16 per cent of the sera, while IgA and IgC antinuclear factors wre demonstrated in 6 and 2 per cent, respectively. Organ-nonspecific antinuclear factors were clearly more common than granulocyte-specific antinuclear factors. No serum contained complement-fixing or IgD class antinuclear factors. This study indicates the importance of using qualitative as well as quantitative techniques to distinguish between antinuclear factors in health and disease.


The cytotoxicity of specifically sensitized lymphocytes from mouse strains of varying H-2 specificities on LCM virus-infected L cells. During an LCM virus infection in mice, cytotoxic T lymphocytes appear to be directed against target cells infected with the virus. This cytotoxic reaction is restricted by the H-2 histo-compatibility between effector and target cells. To analyse this restriction, the cytotoxic effect of in vivo sensitized spleen cells from mice of various H-2 specificities on LCM virus-infecte of in vivo sensitized spleen cells from mice of various H-2 specificities on LCM virus-infected L cells (H-2k) was studied in vitro. When spleen cells from strains identical with C3H (H-2k) and L cells at the K as well as at the D locus were used as effector cells, the degree of lysis was of the same order as that obtained by C3H effector cells, whereas strains different at both loci did not respond significantly. The A/J and B10A strains, both identical with the L cells at the K locus but different at the D locus, gave low or moderate responses. C3H-H-20 lymphocytes, identical with the targets at the D but not at the K locus, showed high degrees of cytotoxicity although the level obtained by strains histocompatible with L cells at both loci was never reached. Effector cells from the F1 hybrids C3H/HeJ X BALB/c and C3H/HeJ X DBA both responded poorly in spite of the fact that one of their haplotypes carries the same marker loci as the L cells. This finding is in contrast with that obtained in other laboratories where the LCM virus system and other systems were studied. A point is made of the design and the evaluation of the experiments.


Serological studies in acute maxillary sinusitis. A comparison was performed between bacteriological and serological findings in 97 patients suffering from acute maxillary sinusitis. A significant titre change (larger than or equal to 2 titre steps) of complement-fixing antibodies to H. influenzae was demonstrated in 15 patients. H. influenzae was demonstrated in aspirated sinus secretions from 7 of these 15 patients. Further, titre changes to Neisseria catarrhalis were demonstrated in 25 patients. No significant titre changes in anti-streptolysin and anti-staphylolysin titres were demonstrated. The results are discussed briefly.


Some observations in treatment stimulation of epilepsy. In a group of 10 patients suffering from epilepsy therapeutic stimulation was applied by means of chronic electrodes and a technical stimulator three times in nucleus dentatus, five times in nucleus caudatus, once in both structures simultaneously. Once chronic electrodes were introduced into the amygdalo-hippocampal complex and non-specific thalanic system bilaterally. One patient was stimulated by means of a pacemaker and once by normal rhythm from the hypothalamus of the same patient using magnetic tape. The patients were subjected to stimulations once a day for a period of 1-8 days. The results obtained are being discussed with respect to Goddard's kindling phenomenon.


The effect of coronary bypass surgery on exercise-induced ventricular arrhythmias. Ninety-one patients with angiographically proved coronary artery disease and stable angina were randomly assigned into surgical and medical therapy. Graded exercise tests were performed on entry into the study and repeated in 1 year. Ventricular arrhythmias during exercise and 8 minutes of recovery were studied. Arrhythmias were graded on a scale of 0 to 7 by their presumed severity. On entry, both groups were similar in the severity of coronary disease, exercise capacity, and frequency and severity of exercise-induced ventricular arrhythmias. At 1 year, the frequency and severity of arrhythmias remained unchanged in both groups, whereas the surgically treated patients showed a marked improvement in their exercise capacity (p less than 0.005). The medically treated patients had a slight deterioration in their work capacity which, however, did not achieve statistical significance (p = 0.08). Twelve patients died suddenly. In seven medically treated patients who died suddenly, the frequency and severity of ventricular arrythmias on exercise were not different from those of the rest of the medical patients. In the five surgically treated patients who died suddenly, one had multiform premature ventricular beats, a second developed ventricular fibrillation (2 years before dying suddenly), and a third had no arrhythmias during exercise. Two died before the 1 year evaluation. Successful coronary surgery improves exercise capacity without decreasing associated ventricular arrhythmias. Exercise-induced ventricular arrhythmias, with the exception of ventricular fibrillation, may not be closely associated with the risk of sudden death.


Vein graft patency and intimal proliferation after aortocoronary bypass: early and long-term angiopathologic correlations. To determine the clinical significance of intimal proliferation as a cause of aortocoronary bypass vein graft obstruction, 492 vein grafts from 281 patients were studied 0 to 75 months postoperatively. All grafts had been inserted between 1968 and 1975 by one surgeon using one technique. The graft patency rate was 92 percent (55 to 60) in the first month; 91 percent (49 of 54) at 1 to 3 months; 84 percent (37 to 44) at 4 to 6 months; 77 percent (33 of 43) at 7 to 12 months; 81 percent (113 of 140) at 13 to 24 months; 82 percent (59 of 72) at 25 to 36 months; and 84 percent (66 of 79) at 37 to 75 months. Vein graft samples were obtained from 41 patients: In 27 patients with 51 grafts (early group), they were obtained 0 to 30 days (mean 14 days) postoperatively; in 14 patients with 27 grafts (late group) they were obtained 7 to 75 months (mean 34 months) postoperatively. Intimal proliferation was graded 1 to 4 corresponding to an intima/media thickness ratio of 1,2,3 or 4, respectively. In the early group, all 51 vein grafts howed grade 1 to 2 intimal proliferation; 5 of these grafts were occluded, all as a result of recent thrombosis. In the late group, 17 of the 27 grafts were studied histologically. All patent vein grafts showed grade 2 to 3 intimal prolferation. Four vein grafts were occluded but only one as a result of grade 4 intimal proliferation. In 14 patients in the late group, angiograms performed shortly before vein graft samples were obtained revealed 14 patent and 4 occluded vein grafts. Ten of the 14 patent vein grafts showed grade 2 to 3 intimal proliferation but were of uniformly good caliber angiographically (graft/artery ratio more than 1.5).


Haemophilus influenzae meningitis: an evolving therapeutic regimen. Ampicillin sodium has been the drug of choice in the treatment of Haemophilus influenzae meningitis. The development of ampicillin-resistant strains forces the clinician to focus on alternative therapies. We describe two patients in whom neutropenia was noted secondary to chloramphenicol administration, and streptomycin sulfate and sulfonamides were employed. An historical perspective summarizing the evolution of available therapeutic regimens is presented.


Familial congenital monochromatism, cataracts, and sensorineural deafness. Two sisters had diagnoses of congenital monochromatism, cataracts, bilateral nonprogressive sensorineural deafness, and hyperinsulinism in both, and labyrinthine dysfunction in one. This recessively inherited condition is added to the growing number of syndromes in which one of the features may be a disturbance of hypothalamic function.


Pancreatic pseudocyst as a cause of gastrointestinal bleeding and hemobilia. A case report. A case of hemobilia from a pancreatic pseudocyst which developed after cholecystostomy and aspiration of the pseudocyst, intended to relieve biliary obstruction, is discussed. These previously reported cases are briefly reviewed.


Autoantibodies in chronic gastritis.

Autoantibodies in chronic gastritis. Gastric parietal cell, antinuclear, smooth-muscle, mitochondrial and microsomal antibodies were determined in 12 Chinese patients with chronic atropic gastritis, 15 Chinese patients with chronic (superficial) gastritis, four Chinese patients with acute-on-chronic gastritis and 16 Chinese control subjects. With the exception of a weakly positive gastric parietal cell antibody test in one of the 12 patients with chronic atrophic gastritis, autoantibodies were not found in all the gastritis and contol groups. It is concluded that autoantibodies are rarely present in Chinese patients with chronic gastritis.


T and B lymphocytes in leukemia therapy. In order to evaluate the effect of radio- and chemotherapy on immunity, T and B lymphocyte surface receptors were studies sequentially in the blood from 28 previously untreated leukemic children. Following the initiation of chemotherapy an increase in the percent T and B cells was noted in the peripheral blood. In association with sanctuary therapy and chemotherapy there was a decrease in the total number of circulating T and B cells and a relative increase in lymphocytes lacking markers. Based on total numbers at remission the reduction in B cells was greater than in T cells, and the most marked changes occurred during sanctuary therapy. A reduction in the mean serum immunoglobulin was associated with decreasing B cell numbers.


Identification of T cell lymphoma tumor antigens on human T cell lines. All human T lymphoblast cell lines have been derived from subjects with leukemia secondary to thymic lymphoblastic lymphoma, a T cell malignancy, suggesting that such lines represent established cultures of neoplastic T cells. Based on this observation, we prepared rabbit antisera to T cell line HSB-2, removed reactivity for histocompatibility antigens and normal T cells by absorption with autocthonous B cell line CCRF-SB and normal thymocytes, and tested the absorbed antisera by complement-dependent cytotoxicity against a panel of normal and malignant cells. A representative antiserum reacted with all 4 T cell lines (mean cytotoxic index =56) and with tumor cells from 4 patients with T cell lymphoma (mean cytotoxic index = 50) but did not react with tumor cells from 6 patients with other types of leukemias (mean cytotoxic index = 2), with 3 B cell lines (mean cytotoxic index = 1), normal peripheral blood lymphocytes (mean cytotoxic index = 5), or normal thymocytes (mean cytotoxic index = 6). We conclude that appropriately absorbed antisera to human T cell lines detect T cell lymphoma tumor antigens.


Actions of ristocetin on platelets.

Actions of ristocetin on platelets. The absence of ristocetin-induced platelet aggregation appears to correlate with the platelet defect in von Willebrand's disease, suggesting that this reaction mimics a physiological process. The effect of ristocetin on plasma and on the residual levels of the von Willebrand factor (vWF), Factor VIII procoagulant activity, and Factor VIII-related protein in plasma after aggregation of platelet rich plasma by this agent has been studied in order to further elucidate the mechanism and requirements of this reaction. Ristocetin-induced platelet aggregation causes a consumption of vWF, Factor VIII procoagulant activity, and Factor VIII antigen from the supernatant plasma which is proportional to the number of platelets aggregated. Such a consumption of these factors does not appear to occur after aggregation by other agents. Factor VIII procoagulant activity does not appear necessary for ristocetin-induced platelet aggregation, yet is utilized in this process. These findings support the hypothesis that the molecule associated with Factor VIII procoagulant activity is carried by the molecule necessary for ristocetin-induced platelet aggregation.


Post-transfusion thrombocytopenic purpura: a case report. Post-transfusion thrombocytopenic purpura (PTTP) is a rare syndrome which was first brought to widespread attention by Shulman et al. Eighteen cases have been reported. The present report describes an additional patient, a multiparous female who developed petechia 7 days after blood transfusion. The patient's serum contained anti-P1A1 antibodies and her own platelets were P1A1-negative. She was treated with prednisone and recovered spontaneously without exchange transfusion of whole blood or plasma.


Traumatic endophthalmitis caused by an Erwinia species. A previously healthy 70-year-old white man sustained a plant injury to his left eye while gardening and was admitted here because of an ensuing perforated cornea and endophthalmitis. The lens was opaque and its anterior capsule was ruptured. Culture of fluid obtained by anterior chamber paracentesis yielded a species of the Erwinia herbicolalathyri group (Enterobacter agglomerans). Thirty-seven days after a course of cefazolin and gentamicin therapy, corneal edema necessitated a planned extracapsular cataract extraction. The aqueous humor and lens again revealed the identical Erwinia species in pure culture. The patient received another course of cefazolin and showed improvement after the lens aspiration.


Ocular and cerebral involvement in familial lymphohistiocytosis. A 5-month-old infant girl died of familial lymphohistiocytosis. The central nervous system showed widespread perivascular infiltration of the cerebral pia and arachnoid, the cerebral white matter and deep gray matter, the cerebellum, and brain stem by lymphocytes, benign appearing histiocytes, and macrophages with erythro-and lymphophagocytosis. The eyes had mild infiltration of the anterior uveal tract, moderate involvement of the inner retina, and marked infiltration of the optic nerves by identical cells.


Orbital rim fat atrophy after repository periocular corticosteroid injection. A 29-year-old white woman with acute recurrent nongranulomatous iridocyclitis of undetermined cause was treated with a retrobulbar injection of depocorticosteroid (Kenalog) through the inferior eyelid. This resulted in rapid clearing of the uveitis, but she developed subcutaneous and inferior orbital fat atrophy. This atrophy persisted during the 1 1/2 years of observation.


The acquisition of b-cell competence and diversity. The in vitro splenic focus technique has been used to establish the characteristics of the repertoire of B cells in adult BALB/c mice, its stimulation and development. Evidence is presented that the technique yields an accurate estimate of the precursor cell frequency by providing monoclonal responses of a constant portion (4%) of transferred B cells. Since the monoclonally derived antibodies can be analyzed, it has also been possible to determine the isotype and clonotype of many of the resultant antibodies. The adult spleen can be shown to contain a vast repertoire (over 10(7) clonotypes) of primary B cells, each clonotype represented by from less than ten to as many as 10(4) responsive cells. Antigenic stimulation of these primary B cells is highly specific and apparently affinity dependent and leads to both antibody-forming cell clone formation and a population of secondary B cells. Secondary B cells, though derived from the same clonotypes, differ from primary B cell in several characteristics, including a lower degree of secificity of antigenic stimulation. In addition, secondary B cells can be stimulated in collaboration with allogeneic antigen-specific T cells to yield clones producing antibody of the IgG1 isotope, whereas primary B cells similarly stimulated produce only IgM antibodies. Analyses of neonatal B cells indicate that the acquisition of the adult repertoire is a highly patterned process. Thus, whereas 10(4) clonotypes are present at birth, more and more clonotypes are acquired in a highly ordered pattern during the first few weeks of life. It is concluded that this process is probably evolutionarily determined, since antigen-driven events appear to play no role. However, since developing B cells can be shown to be exquisitely sensitive to tolerance induction, negative antigenic selection may play an important role, particularly in eliminating clonotypes recognizing self-determinants for which the species is polymorphic.


Pathogenesis of massively bleeding colonic diverticulosis: new observations. Colonic diverticulosis is a common cause of acute severe rectal hemorrhage. The precise site of bleeding, etiology, and pathogenesis have not been previously identified. Arteriographic, microangiographic, and detailed histologic observations in 10 cases of massively bleeding colonic diverticulosis demonstrated strikingly consistent changes related to the characteristic angioarchitecture of colonic diverticula. These changes included: (1) asymmetric rupture of the vas rectum toward the lumen of the diverticulum precisely at its dome or its antimesenteric margin; (2) conspicuous eccentric intimal thickening of the vas rectum, often with thinning of the media and duplication of the internal elastic lamina at and near the bleeding point; and (3) general absence of diverticulitis. Comparison with control colonic diverticula suggests that traumatic factors arising within the diverticular or colonic lumen induce asymmetric intimal proliferation and segmental weakening of the associated vas rectum, predisposing to rupture and massive bleeding.


Prevention of upper gastrointestinal hemorrhage in 582 burned children. In 582 burned children, neutralization of gastric acid and reduction of psychic stress were utilized to reduce upper gastrointestinal ulceration and hemorrhage. While receiving milk, diazepam, and psychologic support, two children required operation. Two of the children who died without clinically apparent gastrointestinal disease had ulcers discovered at autopsy. We conclude that a prophylactic regimen that reduced the amount of acid bathing the gastroduodenal mucosa, provides adequate calories, and minimizes psychic stress is useful in preventing gastrointestinal hemorrhage after burns.


Immunologic status and lymphedema of the arm in postoperative patients with cancer of the breast. Sixty women were evaluated regarding their immunologic status and for presence of lymphedema after surgery for breast carcinoma. Patients who had undergone radiotherapy were noted to have decreases in TLC, and increases in LIF. In addition, the patients also had an increased incidence of lymphedema after radical mastectomy.


[Model and the experimental therapy of acute increase of intraocular pressure (author's transl)]. Comparative experiments were carried out on 63 rabbits to study the acute increase in intraocular pressure which develops in the eye after introduction of prostaglandin F2 (instillations, subconjunctival injections) and other substances (hypertonic solution of sodium chloride, and reopirin). Tonometry, tonography, and radioisotope studies of aqueous humor (24Na, albumin-labeled 131I) were done. Differences in the display and mechanisms of acute increase of intraocular pressure were marked following administration of prostaglandin and a hypertonic solution of sodium chloride. It is stated that prostaglandin increases the permeability of the blood-aqueous humor barrier for the 24Na ions in comparison with hypertonic solution of sodium chloride, and that the eye, under the influence of prostaglandin, heightens intraocular pressure. Pretreatment with dizinon (etamsilat) reduces the increase in intraocular pressure caused by prostaglandin.


Experimental suture studies in strabismus surgery. I. Reattachment rate of extraocular muscles after recession and resection operations. We described a method for measuring the in vivo tensile strength of the muscle-scleral junction in rabbits. Data obtained on the reattachment time of extraocular muscles after recession and resection operations indicate the rate of healing is similar for both operations. Adequate wound healing is present by the 5th day after surgery, and sutures are probably unnecessary after 8 to 9 days. An ideal suture for strabismus surgery would be one that retains its strength during the first 8 to 9 days following surgery, then undergoes rapid absorption.


Experimental suture studies in strabismus surgery. II. Comparison of tensile strength of plain catgut with polyglycolic acid (Dexon) sutures after extraocular muscle surgery. From our experimental studies it appears Dexon satisfies more of the criteria for an ideal suture for strabismus surgery than plain catgut for the following reasons. Its handling, tying, and knot-holding (if tighthened firmly) qualities are excellent. Tissue reaction is minimal. It seems to be non-antigenic. Of paramount importance. Dexon's tensile strength is high initially and it retains its strength through the critical period of muscle-scleral wound healing, then dissolves in a rapid uniform manner.


[Findings on retinal surface by scanning electron microscopy. I. Retinal holes (author's transl)]. The findings by scanning electron microscopy on three retinal holes are described. An outgrow of a glial membrane with microvilli from the holes to the retinal surface can be seen. This epiretinal cell membrane grows on a felt of collagen fibres of the vitreoretinal borderlayer. Rudiments of visual receptors project from the deep walls into the holes. The layer of the pigment epithelial cells beneath the holes is remarkable by the abundance of microvilli.


Kuhnt intermediary tissue as a barrier between the optic nerve and retina. Utilizing adult albino rats and lanthanum nitrate as a tracer, electron microscopic studies were done to provide additional information on the blood-optic nerve barrier. Following injection into the cervical artery, lanthanum was observed to fill the intercellular space of the optic nerve parenchyma. Diffusion from the prelaminar optic nerve into the juxta-optic nerve retina was, however, prevented by the Kuhnt tissue at the level of the rod and cone layer. In this region, tight junctions were found between the glial cells of the Kuhnt intermediary tissue and were continuous from the tight junctions of the retinal pigment epithelial cells to the junctions (zonulae adhaerentes) of the outer limiting membrane. From the level of the outer limiting membrane to the inner limiting membrane there was no diffusion of lanthanum into the adjacent retina despite the absence of tight junctions, and the lanthanum which had diffused from the choroid was never observed in the area of the inner limiting membrane of the optic nerve head. It is in this region that the functional barrier may exist.


Ring-shaped acid burns of the rabbit cornea. In the extension of our previous work on alkali burns of the rabbit cornea we have studied acid burns of the rabbit cornea using a ring-shaped chromoatographic paper soaked with solutions of different kinds of acids. The ensuing changes were studied with the silver methods of McGovern and Jabonero.


Insulin resistance and acanthosis nigricans. Report of a case with antibodies to insulin receptors. A 64-year-old black man presented with the syndrome of acanthosis nigricans and insulin-resistant diabetes mellitus requiring up to 3000 units of insulin per day. The patient's plasma contained circulating antibodies to insulin receptors thought to be responsible for the insulin resistance. The marked insulin resistance, the manifestations of acanthosis nigricans, the evidence of immunologic dysfunction by the absence of expected circulating antibodies to insulin, and the demonstration of circulating  antibodies to insulin receptors put this patient in Kahn's category B of insulin resistance and acanthosis nigricans. There was no evidence of malignancy, lipodystrophy, or endocrine abnormality. The occurrence of acanthosis nigricans with insulin resistance due to binding of cell membrane insulin receptors by antibodies has been reported exclusively in women. This case report is the first description of a male patient with the syndrome of insulin resistance and acanthosis nigricans and focuses attention on features that might mislead one to suspect other causes of insulin resistance.


Involutional osteopenia: current concepts. Involutional osteopenia is the most common metabolic bone disorder affecting the elderly population. Improved diagnostic techniques now allow for earlier detection of a decrease in bone mass than is possible with routine skeletal roentgenograms. Methods developed for quantitating bone remodeling have given new insight to the mechanisms involved in age-related skeletal loss. Theories of pathogenesis include [1] inadequate skeletal acquisition during youth, [2] dietary deficiencies of calcium and vitamin D, [3] hormonal imbalance, and [4] local factors influencing skeletal remodeling, particularly at the endosteal envelope. Numerous agents affecting bone remodeling have been used to treat involutional osteopenia, but none has been proved to restore bone mass. New programs involving combinations of agents give promise for increasing bone mineral content and, it is hoped, reducing fracture rate.


Immunochemotherapy of lung cancer.

Immunochemotherapy of lung cancer. After surgical resection of their primary lung cancer, 33 patients were randomized into one of three groups. The first received high-dose methotrexate once per month with citrovorum rescue, for 3 months. The second group were immunized monthly with a homogenate of Freund's complete adjuvant and carefully characterized soluble antigen derived from allogeneic lung cancer cells of appropriate histology, for 3 months. The third group received a combination of methotrexate and immunization monthly, for 3 months. Each patient was monitored immunologically before, during, and after the treatment period, by use of delayed hypersensitivity reactions to recall and cancer antigens, in vitro lymphocyte response to mitogens, and mixed lymphocyte blocking factor activity. The group that received methotrexate showed little change in skin reactivity, a reduction of blocking factor activity, and significant rebound overshoot in in vitro lymphocyte performance. The immunized group showed a tendency to production of blocking factor activity, striking conversion and enhancement of skin reactivity, and little change in in vitro lymphocyte performance. The immunochemotherapy group showed dramatic increases in specific skin reactivity to cancer antigens, up to 2 years after treatment, in vitro lymphocyte rebound overshoot, and reduction of blocking factor activity production. Classic life table analysis of the probability of freedom from metastases in patients with stage-I cancer indicate that the disease-free interval in patients who received methotrexate is longer than in historic and concomitant controls but not as long as in those who received immunization. The best group appear to be those who received combination immunochemotherapy. We emphasize that the small numbers in this pilot study do not yet allow firm conclusions to be made.


Transfer factor versus combination chemotherapy: a preliminary report of a randomized postsurgical adjuvant treatment study in osteogenic sarcoma. Twenty-six patients with classic osteosarcoma were randomized to receive either transfer factor or combination chemotherapy. Eight of 14 patients who received transfer factor converted their skin test markers, evidence of activity of the transfer factor. Of these eight patients, all are alive; four are free of disease. Of the 18 patients who received combination chemotherapy, 14 are alive, 12 of whom are free of disease. The immunologic test procedures performed sequentially reveal that transfer factor appears to enhance cell-mediated immunity, but it is evident that in this study, a control (saline) arm in the protocol could not be included. It is of interest that the chemotherapy regimen used does not appear to suppress such activity permanently. The individual test results, however, are not very helpful for predicting response to treatment. The small numbers of patients and the short duration of this study, combined with the exclusion of parosteal osteogenic sarcomas and jaw tumors, do not permit a meaningful comparison with other published studies.


Cerebrospinal fluid pressure during O2 encephalography and N2O inhalation. Cerebrospinal fluid (CSF) pressure was studied in 8 patients and 5 dogs during pneumoencephalography (PEG) or ventriculography in which either O2 or N2O was used as the contrast gas prior to and during N2O inhalation. In 7 patients, the use of O2 as the contrast gas increased CSF pressure 8.7 torr (range 4 to 12 torr) following N2O inhalation. In 1 patient, when N2O was used as the contrast gas, CSF pressure did not change after N2O inhalation. These findings were confirmed in anesthetized animals ventilated at a constant PaCO2. The authors conclude that if N2O inhalation is required during PEG, maximum patient safety can be achieved if the contrast gas is also N2O.


Long-term follow-up of sequential aortocoronary venous grafts. In 1972 we reported myocardial revascularization of 130 patients using multiple sequential aortocoronary anastomoses to a single saphenous vein ]1]. Of the 122 survivors described in that report, 121 (99%) have been followed an additional 3 years. Twelve deaths occurred during the interval. The 110 currently followed patients represent 290 anastomoses; 54 have been studied angiographically since operation. Angiographic patency at 3 years in the studied group (18) was 70%. These figures exceed our follow-up data for 135 patients revascularized during the same period using individual vein grafts. Comparison of life table survival curves demonstrates this result. We believe the improved patency and decreased operating time that have resulted from employing this technique have outweighed the likelihood of a proximal stenosis causing closure of the whole graft system. We continue to use this technique in combination with internal mammary artery grafts in the management of multiple-vessel coronary disease. Good early results using this technique have been reported by other authors [2, 3, 5].


Why do radial artery grafts for aortocoronary bypass fail? A reappraisal. The reasons for the high failure rate of radial artery grafts for aortocoronary bypass (ACB) are appraised. Each of 11 dogs received four types of grafts: femoral arteries were grafted to carotid arteries, and jugular veins were grafted to femoral arteries bilaterally. One of each pair of grafts was wrapped in a plastic sheet in order to interfere with the regeneration of vasa vasorum. The grafts were examined 2 months later. The results suggest that although operative trauma and intraluminal pressure change play important roles, the thick-walled artery appears to depend more on vasa vasorum for its integrity than does the thin-walled vein. A free radical artery graft, with vasa vasorum disrupted at both ends, cannot regenerate readily from the adjacent tissue, as is the case at the ACB position, and is therefore more vulnerable to subintimal hyperplasia and occlusion than either the vein graft or the internal mammary artery graft; both of these grafts are thinner, and the internal mammary artery graft remains undisrupted at one end.


Coronary artery bypass occlusion second to postcardiotomy syndrome. Postcardiotomy syndrome following coronary vein bypass procedures may cause graft occlusion as a result of the associated myxedematous hyperemic inflammation that later forms dense obliterative fibrosis. Variability of symptoms and onset make early recognition of postcardiotomy syndrome difficult. However, the presence of the classic triad of fever, chest pain, and pleuroericardial reactions along with leukocytosis and elevated sedimentation rate should suggest the diagnosis. Early recognition and prompt institution of steroid therapy offer relief of symptoms and regression of inflammation and probably reduce the incidence of graft occlusion. From early experience with 14 patients who developed postcardiotomy syndrome and received only symptomatic treatment, 12 developed graft occlusion, whereas in 31 subsequent patients with this syndrome who were treated with steroids, only 5 demonstrated graft occlusion.


T and B lymphocytes in patients with pulmonary tuberculosis. Counts of T and B lymphocytes were made in the peripheral blood from patients with active and inactive pulmonary tuberculosis and in healthy subjects. In patients with active pulmonary tuberculosis the numbers of T cells were significantly lower than in the controls. After treatment for two months, if the patient's condition improved the percentage of T cells returned to nearly normal levels. If the patient failed to improve, the numbers of T cells remained low. The mechanism of these phenomena is discussed.


[Role of duration and intensity of activation of afferent fibers in regulating morphologic shifts in a neuron]. The afferent impulsation has a regulating influence on morphological and histochemical shifts in the neuron. The size and staining of spinal motoneurons of the frog are changed depending on the force and duration of the applied high frequency stimulation of afferent fibres. The threshold 10-minute-long activation results in the increased size and lighter staining of nerve cells. An increased force of high frequency stimuli causes darker staining and a decreased size of the motoneurons under study. One-minute-long activation of the afferent fibres by electric stimuli of 50 imp/sec failed to cause changes in the size and staining of nerve cells. Prolongation of the activation till 10 minutes results in a sharp decrease of the neuron size. Further activation of the afferent fibres for 2 hours causes pathological shifts in the structure of motoneurons: their vacuolization and melting. Besides, there appears a great number of dark stretched intensively stained nerve cells.


Vitrectomy in endophthalmitis. Results of study using vitrectomy, intraocular antibiotics, or a combination of both. A rabbit model of endophthalmitis was produced by inoculating Staphylococcus epidermidis and S aureus into the vitreous cavity. Elimination of microorganisms was compared using intravitreal administration of 0.1 mg of gentamicin alone, vitrectomy alone, and a combination of gentamicin and vitrectomy. In the case of S. epidermidis treated 24 hours after inoculation, all untreated eyes were culture-positive at one week, eyes treated with gentamicin alone or intravitreal gentamicin in combination with vitrectomy were all culture-negative, and vitrectomy alone rendered half of the eyes culture-negative. In the case of S aureus, eyes not treated by vitrectomy alone were all culture-positive at one week. Eyes treated with intravitreal gentamicin 25 to 31 hours after infection were culture-negative for S aireus in 33% at one week, while eyes treated with combined vitrectomy plus intraocular gentamicin were culture-negative in 83% of cases. When treatment was delayed 40 to 49 hours after inoculation of S aureus, intravitreal rendered 50% culture-negative at one week, while vitrectomy combined with intravitreal gentamicin eliminated the infection in 100% of eyes.


Cerebellopontine pantopaque cisternography and tomography of the internal acoustic meatus in the diagnosis of angle tumors. The results of 106 consecutive Pantopaque cisternographies performed at the neuro-radiological department, Rigshospitalet, are presented. 41 positive and 65 negative examinations were found. Good accordance between radiological tumor size estimation and size of actual, surgically verified tumor was noted. A comparison between tomography of the internal auditory canal and pantopaque cisternography of the posterior fossa has been made, and we found 6 cases with normal tomography and positive cisternography. Furthermore 17 cases (26%) with pathological tomographic examination of internal auditory canal as well as a negative finding at Pantopaque cisternography, were encountered. Therefore we conclude that asymmetry of the radiological appearance of the internal auditory canal at tomography is not of decisive importance in the indication for cisternography, but the examination should be included in the test battery in search for cerebellopontine angle pathology. We agree with other authors that Pantopaque cisternography is without any doubt the final and most conclusive examination available for the diagnosis of cerebellopontine angle tumors. A system of grading the different objective findings giving indication for Pantopaque cisternography has been made.


[The activity of motor units of the musculus splenius capitis in pheripheral vestibular lesions (author's transl)]. The activity of single motor units of the splenius-capitis muscle of healthy human subjects and patients with unilateral vestibular lesions was recorded by means of microelectrodes. The major part of these units reacted to vestibular stimulation in the same way as primary and secondary vestibular neurones of other vertebrates. The reactions of these units to trapezoidale stimuli is identical to that of vestibular neurones. An angular acceleration of more than 0.6 degrees/s2 is for these units a stimulus which is above threshold, this too corresponds to findings in the vestibular nerve. In patients with unilateral vestibular lesions the threshold for rotatory stimuli is markedly increased on the side of the lesion, whereas the threshold on the other side remains constant. This method is very sensitive and vestibular lesions can be detected which cannot be seen using the common technics for vestibular examination.


Factors affecting responses to immunization. Geoffrey Edsall once stated "...at its best, immunization is the cheapest and most practical means of controlling infectious disease...". While immunization against some diseases has been highly successful, the efficacy of some vaccines is far from adequate. Basic immunological research has identified many factors which control the development and operation of the immune system of vertebrate animals; application of this information to the development and practical use of vaccines for humans may eventually benefit this general approach to the control of infectious disease.


Immunological aspects of cancer.

Immunological aspects of cancer. Immunology occupies a central role in the area of cancer, both in research and clinical practice. This article first reviews normal immunity and describes the interaction of the cancer cell with cellular and humoral immune mechanisms. Such mechanisms play a considerable role in the emergence, proliferation, metastases, regression and recurrence of tumours. Immunological investigations are applicable to the diagnosis of some forms of cancer, especially leukaemias, lymphomas and myelomas as well as analysing the immune status of patients suffering from cancer, which give significant guidelines with respect to prognosis. Manipulation of immune response in the form of immunotherapy is emerging as an important area in cancer therapy.


Stimulation of B-lymphocyte colony formation in vitro by sera from patients with leukaemia or lymphoma. Studies were made on the effects of 665 sera, from normal donors or patients with various diseases, on B-lymphocyte colony formation in agar by mouse spleen cells. Undiluted serum from most normal donors inhibited colony formation, but 43-53% of sera from patients with histiocytic lymphoma, lymphocytic lymphoma or Hodgkin's disease stimulated colony formation, serum activity correlating with the stage of the disease. Moderate colony-stimulating activity was observed with serum taken from patients with acute lymphoid or myeloid leukaemia following, but not prior to, chemotherapy. Colony stimulating activity was not correlated with the blood group of serum donors and could not be ascribed to the presence of endotoxin, red cells or mouse red cell haemagglutinins in the active sera. Elevated colony stimulating activity was not observed in sera from patients with non-neoplastic disorders ot haemopoiesis or with diseases of other organ systems.


The fine structure of pulmonary contusion and the effect of various drugs. The results of contusion were examined by electron and light microscopy in the lungs of rats. It was found that the results here were very similar to those elsewhere in the body, with a few minor modifications due to the unique structure of the lung. Densitometry of protein concentration and visual estimation of oedema were used to quantitate the effects on the injury. The benzo-pyrone drug Venalot had a considerable effect in reducing the protein concentration in the air spaces and the interstitial tissue, and of the oedema in the latter. Neither the proteinase inhibitor Trasylol nor the pectin-based plasma expander HAS had any significant effect on the fine structural alterations of pulmonary contusion.


IgG antilymphocyte antibodies in SLE detected by 125I protein A. 125I-labeled protein A was utilized to detect lymphocyte binding of IgG at 37 degrees C in 50 sera from patients with SLE. IgG binding was partially inhibited by preincubation of test cells with immune complexes in 50% of sera. In 10%, cytophilic Ig was increased by immune complex preincubation, and in 40% no appreciable change was recorded. With purified preparations of T and B cells, binding of SLE IgG at 37 degrees C was equal for both cell populations.


Suppression of autoimmunity in NZB mice with steroid-sensitive X-radiation-sensitive syngeneic young thymocytes. NZB mice spontaneously lose thymic regulatory or suppressor cells and subsequently develop autoimmunity and lymphoreticular hyperplasia. Treatment with 2-week-old syngeneic thymocytes every 2 weeks starting at 4 weeks of age suppressed these disease manifestations. The active thymocyte subpopulation was found to be sensitive to corticosteroids and X-irradiation.