Uptake of 67Ga in malignant lesions of the lung and lymphatic tissue. Thirty-nine patients were given 67Ga intravenously before thoracotomy because of suspected lung cancer. Specimens of relevant tissue were removed and counted in a well-counter. The uptake of 67Ga in bronchogenic epidermoid and anaplastic tumours was greater than the uptake in normal lung tissue, while the uptake in adenocarcinomas seemed to be equal to that in normal tissue. Two out of seven benign lesions showed greater uptake than normal tissue. Thus 67Ga seems to be of limited value in the differentiation of malignant from benign lesions of the lung. The uptake in lymphatic tissue showed a great variation which did not indicate whether metastases were present or not. For this reason 67Ga seems to be of no use for demonstration of metastases in regional lymph nodes from cancer of the lung.


Arterial to end-tidal CO2 difference in respiratory disease. The difference in CO2 tension between arterial blood and end-tidal alveolar gas (a-end-tidal)DCO2 was found to correlate fairly well with the VD/VT ratio in 13 healthy subjects and 50 patients with pulmonary diseases (r = 0.74), and to discriminate between healthy subjects and patient groups at least as effectively as did the VD/VT ratio. An increase in breathing frequency from 8 to 32/min, without simultaneous change in alveolar ventilation, was associated with a mean increase in (a-end-tidal) DCO2 of several mmHg in both the healthy subjects and the patient groups. It is concluded that measurement of (a-end-tidal)DCO2 seems to be a clinically useful alternative to measurement of VD/VT ratio for evaluation of the wasted ventilation component, provided that the effect of the breathing frequency on (a-end-tidal) DCO2 is taken into account.


Monosymptomatic exudative pleurisy in persons exposed to asbestos dust. Among 25 persons with monosymptomatic exudative pleurisy of unknown etiology there were 11 men who had been exposed to asbestos. Ten of them were investigated during an observation period of 4 to 8 years. The exudate was more or less sanguinolent, had a prolonged course and recurred on the same or opposite side in the majority of cases. Large numbers of eosinophilic cells were present in seven exudates. Clinical symptoms were very discrete. After the disappearance of the exudate, persisting pleural thickening was present in nine patients. Decortication was performed in four of these patients and signs of non-specific chronic pleurisy was found. Asbestos bodies were found in one case and suspected in another. No other etiological signs were observed in any of the 11 men during the period of observation. At the end of the period of observation, radiological signs of mild basal pulmonary fibrosis were found in one patient and signs suggestive of this were present in a further three patients. Six of the men were troubled by dyspnoea. Three of these had reduced physical working capacity owing to respiratory factors. It is concluded that asbestos should be suspected as the causative factor in monosymptomatic exudative pleurisy if other etiological factors can be excluded.


Simple electrocardiographic features of importance for prognosis in severe chronic bronchial obstruction. 228 patients between 40-69 years old, with chronic bronchila obstruction (FEV1 1.51/s or less) mainly due to chronic bronchitis were investigated by means of E.C.G. examinations. All patients had been referred to hospital for treatment or examination. Prognosis regarding survival after 4 years was calculated for various values of QRS axis, PII amplitude, and ischaemic changes in E.C.G. Survival was very poor in the groups of patients with an E.C.G. showing a QRS axis +90 degrees to +180 degrees and a PII amplitude of 0.20 mV or more. Only 37% and 42% of the patients with these respective changes were alive after 4 years. There was a 65% survival among patients with only ischaemic changes in E.C.G. This last result was based on few patients and probably influenced by selection. It was not significantly different from the 75% survival after 4 years among patients with normal E.C.G. Age and severity of bronchial obstruction had a small additional influence on survival in patients with abnormal E.C.G. Survival was nearly the same for all age groups and for all degrees of obstruction in patients with normal E.C.G. Patients with abnormalities in R/S in precordial leads V1 or V6 usually had abnormal extremity leads also. The patients who had changes in precordial leads as well as standard leads had a very low survival after 4 years. Patients with changes only in standard leads had a significantly better survival than patients with changes in precordial leads as well, but a significantly lower survival after 4 years than patients with normal E.C.G. It is suggested that an E.C.G. with a QRS axis +90 degrees to +180 degrees and/or a PII amplitude 0.20 mV or more in patients with bronchial obstruction indicates the presence of cor pulmonale even when precordial leads are normal. Survival in the first 4 to 6 years in patients with severe chronic bronchial obstruction is mainly related to the presence or absence of electrocardiographic signs of cor pulmonale rather than to the degree of obstruction.


Ruptured aneurysm of the superficial femoral artery. Femoral arterial aneurysms are rare, but their existence must be considered in cases of acute ischaemia of the leg or the occurrence of a pulsating swelling in the groin. Surgical intervention is mandatory, and venous autografts should be preferred to synthetic grafts. With adequate therapy, the prognosis is favourable, but the coexistence of multiple aneurysms should always be borne in mind. A successfully treated case of ruptured femoral aneurysm, combined with abdominal aortic aneurysm, is reported.


The Björk-Shiley tilting disc valve prosthesis. Echocardiographic findings. The echograms obtained following Björk-Shiley valve replacement are described-first, on an experimental model and later, in vivo. The echogram obtained consisted essentially of four main horizontal waves. Their origin is clarified. In artificially created peri-prosthesis leaks, a normal trace was obtained, while in trans-prosthesis leaks, a reduction in amplitude of motion occurred and the valve remained open in diastole (aortic valve). In vivo, a normal trace was obtained in peri-prosthesis leaks. Trans-prosthesis leaks with the Björk-Shiley valve have not hitherto been described, but the potential of echoscanning in detecting disc dysfunction is put forward.


Surgical correction of aortic valve stenosis with persistent ductus arterious and servere pulmonary hypertension. This is a report of a case in which the unusual association of severe aortic valve stenosis with persistent ductus arteriosus complicated by severe pulmonary hypertension, was diagnosed and correction of the anatomical lesions carried out in one stage. Re-investigation after one year showed that the duct was closed, the pulmonary artery pressure was lower than before the operation and the gradient across the aortic valve reduced. A modern approach to treatment based on full cardiac assessment is stressed. Problems arising during the operation are discussed.


In vitro test of heart muscle viability. The purpose of the present study was to establish viability criteria for hearts perfused with a non-biological synthetic perfusate in a Langendorff type preparation. During hypothermic perfusion, the only discriminant between eight undamaged and four hypoxically damaged hearts was resistance to perfusion flow. At near normothermic conditions, the damaged hearts exhibited a decreased respiratory rate. It was also suggested that adrenalin stress of the isolated heart might be useful instead of orthotopic transplantation, as a final test of viability.


Comparative haemodynamic effects of glucagon and isoprenaline in the early postoperative period in cardiac surgery. In order to study the haemodynamic effects of isoprenaline and glucagon in the immediate postoperative period, 16 patients who had single or multiple valve replacement or coronary artery bypass grafts were investigated. Measurements of cardiac index, stroke index, heart rate, arterial and right atrial mean pressures were made either before, during, or after the administration of both drugs. With the doses used, the inotropic effects of both drugs are similar, while the chronotropic action is statistically higher during isoprenaline infusion than after glucagon administration. This fact explains the greater increase in cardiac index after isoprenaline administration. Mean arterial pressure shows no significant changes after either drug, while right atrial mean pressure decreases significantly. Peripheral vascular resistance remained mostly constant. The activity of glucagon injected as a single bolus seems to be maximal 10 to 15 minutes after the injection and dissipates about 30 minutes later. The ideal dose of isoprenaline is between 0.8 and 2 mug/min. Within this range, the inotropic effect is maximal and the chronotropic and bathmotropic effects are limited. Above 2 mug/min, cardiac index and stroke index decrease, and arrhythmias become more frequent.


Effect of physical exercise on internal carotid artery blood flow after arterial reconstruction. The effect of physical exercise on internal carotid artery (ICA) blood flow in conscious man was studied with the aid of electromagnetic flowmetry. A flow probe was implanted on the ICA in 25 patients after reconstruction of the artery. ICA mean blood flow and brachial artery mean blood pressure were continuously monitored in supine (25 patients) and sitting (24 patients) position at rest, during 5-6 minutes exercise on a bicycle ergometer and at rest after exercise. Arterial carbon dioxide tension (PaCO2) was studied in 6/25 work tests in supine and 7/24 in sitting position. Cardiac output was measured at rest and during exercise in 10/25 patients in supine and 8/24 patients in sitting position. In the supine group, ICA flow increased significantly within 1 minute and reached a maximal flow 15% above control flow within 2 minutes after the onset of exercise. The ICA flow then gradually declined, but remained almost significantly elevated, 7.5% above control, on termination of exercise. At rest, after exercise, the ICA flow decreased almost significantly to a level of 5% below the control flow within 5 minutes. There was a significant PaCO2 increase of 2.6 mmHg during exercise and a highly significant increase (72%) in cardiac output during exercise. The ICA flow at rest, before exercise, was about 15% lower in the sitting group than in the supine group. It increased in average 11.5% with 2 minutes of exercise and then gradually diminished. At rest, after exercise, ICA flow decreased further to a level of 8% below control flow within 5 minutes. PaCO2 increased significantly in average 1.6 mmHg during exercise. Cardiac output increased highly significantly (85%) during exercise. The ICA flow changes obtained during exercise in the present study indicate the presence of a regulatory mechanism counteracting the increasing perfusion pressure, but it is unable to compensate the decreased perfusion pressure when the body position was altered from supine to sitting. The cerebral vascular bed in the present patient material seems to operate above and below the lower limit of its pressure range for an adequate autoregulation.


Right duct lymph during and after open-heart surgery. The right lymphatic duct (RLD) was cannulated in 26 patients operated upon with open-heart surgery. The thoracic duct was cannulated in 4 additional patients and both the thoracic and the right lymphatic ducts were cannulated in 2 further patients. The RLD was also cannulated in a control group consisting of 5 thoractomy-operated patients. Lymph was collected continuously and its flow and content of albumin, electrolytes and the enzymes, GOT, GPT, CPK and LDH were analysed. A significant amount of cardiac lymph was present in about 60% of the cannulations. After cardiopulmonary bypass, lymph enzyme concentrations often rose rapidly to very high levels. The significance of the enzyme concentration-patterns and some characteristics of the flow pattern are discussed.


Ergot-induced vasospasm of the lower extremities treated with epidural anaesthesia. No reliable treatment to reverse severe ergot-induced vasopasm is available. A case of ergotamine-induced vasospasm of the lower extremities is presented. A combined treatment of vasodilators, infusion of low molecular dextran and high epidural anaesthesia apparently prevented extremity gangrene from occurring.


Pulmonary diffusion-circulation interrelationships two to seven years after pneumonectomy. Ventilatory function, pulmonary diffusion capacity and right heart catheterization were studied in eight patients 2-7 years after pneumonectomy. The operation had been carried out for bronchial carcinoma. Dependence of pulmonary diffusion capacity on pulmonary perfusion rather than on ventilatory changes was characteristic of the elderly patients in the late post-pneumonectomy state. When decreased pulmonary perfusion, produced by cardiac disease or increased pulmonary vascular resistance, severely affects the pulmonary diffusion capacity, a careful assessment of the cardiac state is very important in the pre-operative evaluation of operability. In the absence of coexisting diseases, the cardiopulmonary state of long-term survivors usually remains good.


Pulmonary artery pressure measurements in surgical patients. In 23 patients, Swan-Ganz catheters for the measurement of the pulmonary artery pressure (PAP) were introduced on the day before elective vascular surgery. The following parameters were measured: pulmonary artery mean pressure (PAMP), pulmonary capillary wedge pressure (PCWP), pulmonary artery end-diastolic pressure (PAED), central venous pressure (CVP), arterial blood pressure (BP), pulse, plasma colloid osmotic pressure (COP) and blood volume. Pre-operatively, resting pressures and pressures during exercise and fluid infusion were measured. Continuous pressure measurements were made during induction of anaesthesia and operation and during the first 24 postoperative hours. The pre-operative PAP was an important parameter among those contra-indicating operation, particularly so in 5 patients, in 3 of whom the ultimate decision was made as a direct consequence of PAP. In one case, a sudden marked increase in PAP preceded all other signs of severe deterioration in the patient's condition by some 7 hours. In the period of apnoea immediately prior to and during endotracheal intubation, PAP and CVP rises were as marked as during the pre-operative exercise test. This exercise was strenuous, and the exercise PAP is thought to give perhaps the most reliable expression of the cardiac reserve. Finally, PAP was found to be a substantially more sensitive parameter of blood loss and adequacy of replacement than CVP.


Abdominal aortic aneurysm. An interhospital study of 171 surgically treated patients. A retrospective interhospital study of 171 surgically treated patients with atherosclerotic abdominal aortic aneurysm is presented (Orebro and Göteborg). Elective resection of the aneurysm was performed in 94 of the patients and emergency resection because of rupture or suspected rupture of the aneurysm in 77 cases. The mortality within the first postoperative month was 16% in the electively operated patients and 49% in the emergency operated patients. During the last 3 years, the mortality rate among electively operated patients was considerably lower (10%). The five-year survival rate was more than 50% in the electively operated patients. The main difference in long-term survival rate between emergency and electively operated patients was dependent on the primary mortality. The cause of late death was usually not related to the operation of the aneurysm, but to other manifestations of generalized atherosclerotic disease. The results seem to justify the conclusion that atherosclerotic abdominal aortic aneurysm should be resected irrespective of size and symptoms, unless the patient has symptoms of severe arterial hypertension and/or generalized atherosclerosis.


Scintigraphic examination of aneurysms of abdominal aorta and iliac arteries. The use of a radionuclide (99Tcm-pertechnetate) for the diagnosis of aortic and iliac aneurysms is described. The method is rapid, harmless for the patient and is performed without puncture of arteries. The extent of the aneurysm and the perfusion of the kidneys can be visualized. The method is well suited for differential diagnosis and for postoperative control. Some illustrative cases are described.


Spontaneous pneumothorax.

Spontaneous pneumothorax. Patients with spontaneous pneumothorax, who were treated in this department during the period 1950-59, were reviewed in 1963. Since the treatment of this group of patients has changed radically towards a greater surgical activity in the form of suction drainage and thoracotomy, the patients from the next decade, comprising 229 episodes in 202 patients, have now been reviewed to evaluate the results of this attitude. The conclusion from the earlier review, that recidivating pneumothorax should be operated upon, is further supported, and in quite a few patients (9%) thoracotomy had to be performed to control the first attack. Pleural rubbing, as an additional procedure to resection of bullae, seems as safe as partial pleurectomy in prevention of relapse. There were few serious operative complications. A rather protracted suction drainage has been practised in this series. One consequence of the experiences from the present review is that this time has been shortened.


Use of omental pedicle for treatment of bronchial fistula after lower lobectomy. Report of two cases. Postoperative bronchopleural fistula in two patients was successfully closed by omental pedicle flap. The primary operation in both cases was left lower lobectomy for bronchiectasis. The technique of the operation is described and the cases are reported.


A case of congenital bifid sternum.

A case of congenital bifid sternum. A case of bifid sternum is reported, which illustrates that it is sometimes not possible to repair the sternal defect either by approximation of the sternal bars or by a large autogenous cartilage graft from the ninth, tenth and eleventh ribs. In such cases, the only alternative is to take a graft from the mother.


[Normal erythropoiesis].

[Normal erythropoiesis]. The organism has at least three different mechanisms for the modulation of oxygen supply to tissues: 1) respiratory-circulatory, 2) modification of oxygen dissociation of hemoglobin, 3) modification of oxygen transport capacity by increasing the volume of circulating red cells. The erythroid, granulocytic and thrombocytic cell lines originate from a common pluripotent stem cell. In the course of differentiation the erythroid precursor cell acquires the capability of responding to the humoral regulator of total red blood cell volume, erythropoietin. Furthermore, the ability develops to take up tightly bound iron from transferrin, to synthesize large amounts of hemin and to express the few structural genes for hemoglobin polypeptides preferentially. The effects of these phenomena are discussed in the framework of the erythron.


[Dyserythropoiesis and dyserythropoietic anemias]. The expression "congenital dyserythropoietic anemia" (CDA) has been used to characterize the kinetic and morphological aberrations in the proliferation and maturation compartment of erythropoiesis, occurring in a group of hereditary anemias of unknown pathogenesis. The main symptoms of these disorders are moderate or mild anemia, increased hemoglobin turnover, ineffectiveness of erythropoiesis, striking morphological aberrations of the erythroblasts and tendency to secondary hemochromatosis. To date, three types have emerged from this group that may be hereditary nosological entities. They are distinguished not only on a morphological basis, but also by different modes of inheritance and immunological properties of the red cell membrane. A number of additional cases or families have been described which could not be attributed to one of these three types. Comparative investigations of morphological, biochemical and immunological details in CDA on the one hand, and other forms of ineffective erythropoiesis (e.g. thalassemia, refractory anemia) on the other demonstrate the lack of specificity of many of the single changes observed in CDA. These changes may well be secondary phenomenon of intramedullary cell destruction brought about by different underlying pathogenetic mechanisms.


[Red cell deformability, importance of its measurement in clinical medicine]. A new device for evaluation of red cell deformability is described. A population of red cells dispersed as a monolayer are subjected to a well defined fluid shear stress in a concentric cylinder viscometer. Red cell deformation is a function of rotational speed and red cell elongation is measured in a continuous manner using a diffraction method. Preliminary results in clinical medicine are presented.


[The fate of hemoglobin in the plasma].

[The fate of hemoglobin in the plasma]. The following aspects of intravascular hemolysis are briefly reviewed: pathogenesis; binding of hemoglobin to haptoglobin, hemopexin or serum albumin; hemoglobin oxidation, dissociation and renal excretion. The dissociation constant of hemoglobin tetramer into dimers was determined by gel filtration at 37 degrees C, using normal plasma for elution. This constant (5.1 x 10(-6) mol/l was used for calculation of renal clearance of hemoglobin. The rate of hemoglobin autooxidation was measured in normal plasma applying varying partial oxygen pressures. The results confirm that the formation of methemoglobin is enhanced under hypoxic conditions.


[Adaptive metabolic disorders in erythrocytes during shock]. In patients with shock the metabolic activity of the red blood cells was studied following separation according to cell-age by density layer centrifugation using Stractan II-Urografin solutions. Metabolic acidosis in patients with cardiogenic shock (n = 8) and with postoperative shock (n = 7) induced a pronounced fall in 2,3-diphosphoglycerate (2,3-DPG) levels and in adenosine triphosphate (ATP), in contrast to a raised lactate-pyruvate ratio. 2,3-DPG values were higher than normal in patients with hypoglycemic shock (n = 12), whereas further measured substrate levels were markedly decreased. The levels of these compounds of the red blood cells revealed a significant difference in the hemolysates derived from cells separated according to cell-age. The shock syndrome was also observed in patients suffering from severe congestive heart failure (n = 10) who received dopamine (300 mug/min) for its known action in improving hemodynamics and renal function. Following drug administration for 150 min a clinical improvement was associated with a change of extent and pattern of the red blood cell metabolic disorder.


[Dyserythropoietic anemia, type I: ineffective erythropoiesis due to disorders in the DNA-nucleoprotein complex]. The relative DNA, RNA histone and hemoglobin contents and 3H-thymidine incorporation in vitro were determined sequentially in individual erythroblasts of type I dyserythropoietic anemia. The histone/DNA ratio was increased due to a rise in histone extinction, indicating a pathological DNA-nucleoprotein complex. In addition, the erythroblasts displayed an increase in DNA content exceeding tetraploid values, a loss of DNA-synthesis activity at immature stages with low hemoglobin content, and a reduction of RNA. These variations were assumed to be caused by the preceding and primary impairment of the DNA-nucleoprotein complex.


Pathogenesis of the anemia in african trypanosomiasis: characterization and purification of a hemolytic factor. Acute anemia is a major feature of african trypanosomiasis. It has been shown to be of hemolytic nature. Hemolytic substances were found in serum from infected animals as well as in supernatant of trypanosome suspensions. A hemolytic pronase-sensitive factor of about 10000 M.W. has been purified from such supernatants.


[Familial autoimmune hemolytic animia (AIHA) with negative Coombs test, lymphocytopenia and hypogammaglobulinemia]. A family with several cases of autoimmune hemolytic anemia and dysgammaglobulinemia is described. Two sibling had documented antierythrocyte antibodies, but a third had repeatedly negative Coombs tests. Diminished immunoglobulin-producing cells and a hypogammaglobulinemia were found, but no functional defect of humoral or cell-mediated immunity could be detected.


[Improvement in the granulocyte harvest from normal donors by means of a combination of "continuous flow" centrifugation and filter leukapheresis]. In 27 healthy donors a total of 30 leukaphreses were performed with the Aminco cellseparator. Pretreatment by steroids, anticoagulation by heparin and addition of fluid gelatin to the input line was performed in all runs. The combination of continuous flow centrifugation and filtration leukapheresis in 9 of the 30 runs resulted in highly significant increase in the yield of neutrophil granulocytes to a mean of 59.6x10(9) as compared with a mean of 30.8x10(9) obtained the conventional continuous-flow centrifugation alone. This significance is valid for the total yield of granulocytes as well as for the yield per hour of run or per liter of blood processed. No adverse reaction occurred.


[Changes in the blood picture in liver diseases]. The occurrence of hematologic changes has been studied in 256 patients with various liver diseases. Macrocytosis on smears and by MCV was found in 50% of acute and in over 70% of chronic liver diseases. MCV increased from 98 +/- 8 mu3 (acute hepatitis) up to 108 +/- 12 mu3 in alcoholic cirrhosis. Anemia, which occurred rarely in hepatitis but in 67% of cirrhosis, was always macrocytic, not correlating with reticulocyte counts. Target cells were found in 20% of acute hepatitis and 41% of cirrhosis. In patients with chronic liver disease target cells were associated with macrocytosis and increased bilirubin. Thrombocytopenia was found in 11% of acute, in 53% of chronic inflammatory and in over 60% of cirrhotic liver disease.


[Relationship between the O2-affinity of the blood and erythropoiesis during the early months of life]. In 107 infants aged 3 hours to 9 months, hemoglobin concentration, 2,3-DPG concentration and GOT activity in red cells, and reticulocyte count were determined in order to evaluate whether the previously observed decrease in red cell 2,3-DPG [1] during the first 30-40 days of life related to red cell ageing. A significant positive correlation of 2,3-DPG vs. GOT, an indicator of red cell age, is found. The decrease in 2,3-DPG over a period of 25-30 days is finally followed by a sharp rise in reticulocyte count, suggesting that an alteration in blood oxygen affinity might trigger the onset of erythropoiesis in normal infants in this age group.


[Hemolysis and hemolysis mechanisms in congenital dyserythropoietic anemia (CDA) of type I. II., III]. On the basis of clinical symptoms, bone marrow morphology, electronmicroscopy and serological tests congenital dyserythropoietic anemia (CDA) was diagnosed in 3 families and identified as CDA type I, II, III respectively. Aside from intramedullary hemolysis, members of all three families showed peripheral hemolysis, in some cases severe, which was mediated through splenic (in all types) and additional intravascular destruction in types I and II. The underlying cause of the peripheral hemolysis appears to be reduced deformability of erythrocytes, as documented by reduced filterability. The latter appears to be caused, at least in type II, by an increase in viscosity of the cytoplasm which in turn is probably related to increased susceptibility to oxidative injury leading to inclusion body formation. Splenectomy in one patient with CDA II led to a definite reduction of hemolysis and cessation of hemolytic crises.


[Erythrocyte concentrate instead of whole blood: perspectives for blood banks and clinical therapy]. In 1974 some 117 000 units of blood were collected by the German Red Cross Blood Center in Ulm. Some 65 000 units were distributed to hospitals, mainly as whole blood. The surplus blood units (44%) were used for the preparation of plasma products. On 1 October 1974 glass bottles were replaced by plastic blood bags. The same date was chosen for the introduction of buffycoatfree red cell concentrates. It proved possible to replace whole blood almost entirely (92% of all blood units) by red cell concentrates within a few days after the deadline. The factors which prompted the clinicians to follow this new policy are described, and the clinical and economic implications are discussed.


[Lienal and intravascular corpuscular hemolysis in erythropoietic protoporphyria]. A report is presented on two brothers with erythropoietic protoporphyria (EPP) with massively and moderately elevated RBC-protoporphyrin content respectively. Both exhibited splenic and one also intravascular hemolysis. The mechanism of hemolysis was investigated on the basis of filterability, plasma trapping and osmotic resistance of in vivo RBCs and of incubated, UV-light exposed RBCs. Photodynamic damage to EPP-RBC, leading to increased RBC rigidity, increased splenic trapping and intravascular hemolysis, appears to play a crucial role in the causation of hemolysis in vivo as well as in vitro.


[Biochemical modifications of the erythrocyte membrane in various red cell disorders]. Glycopeptides were extracted by papain digestion from erythrocyte "ghosts" of subjects suffering from hematological disorders involving shortened red cell survival time. Chemical characterization demonstrated significant alterations.


[Non-HL-A specific autoantibody against granulocytes, lymphocytes and thrombocytes in a patient with agranulocytosis due to pyrazolone]. An antibody of hitherto unknown specificity has been found in the serum of a patient who suffered three episodes of agranulocytosis after ingestion of aminopyrine derivatives. In vitro, the antibody reacts not only with homologous and autologous granulocytes and thrombocytes. It belongs to the IgM class and absorption of the serum with earlier leukocytes or platelets eliminates the activity against all three cell types. An HL-A specificity (LA or Four locus) can be ruled out, since all tests are positive with cells of individuals differing from the patient in all four HL-A specificities. Addition of the patient's serum results in marked reduction of thymidine uptake in the mixed leukocyte culture as well as during stimulation of lymphocytes with phytohemagglutinin or PPD; however, almost no effect is observed on stimulation with small amounts of Pokeweed mitogen. The rosette formation of lymphocytes with sheep erythrocytes or sensitized human erythrocytes is not influenced by this serum. This pattern is comparable to what is known for alpha-methyl-dopa-induced autoimmune hemolytic anemia insofar as the antibody does not require the presence of the offending drug for its action.


[Characterization of megakaryocyte colonies in vitro]. Agar cultures of mouse bone marrow cells can be stimulated by medium conditioned by activated mouse lymphoid cells to produce pure or mixed colonies containing up to 80 megakaryocytes. These have been characterized on the basis of their morphology, polyploid mitoses and DNA content and high cytoplasmic content of acetylcholinesterase.


An introduction to the use of diagnostic ultrasound. This article is meant to serve as a simple introduction to diagnostic ultrasound, explaining the nature of sonar and the basic equipment for its production and use. A scans, B scans, time-position scans, and Doppler-shift techniques are described, with some examples of the clinical applications of each. Some recent innovations such as scan conversion to improve gray scaling and electrocardiographically triggered cardiac sector scans are mentioned. The limitations of the technique are indicated, with measures that can be adopted to reduce them. The safety of the procedure is emphasized, with its freedom from the known biological effects of ionizing radiation.


Ultrasound evaluation of the thyroid.

Ultrasound evaluation of the thyroid. Ultrasound provides a safe noninvasive means of imaging the thyroid gland. It affords a reliable method of distinguishing cystic masses from other types of hypofunctioning thyroid nodules that might require surgical exploration. Due to the reported small frequency of false positive ultrasonic diagnoses (i.e., solid or complex masses being misdiagnosed as cysts), all cystic masses should be confirmed by aspiration. With gray-scale two-dimensional imaging, high-frequency transducers, and careful attention to technique, a reduction in the number of incorrect diagnoses can be expected.


Nuclear medicine and ultrasound; correlation in diagnosis of disease of liver and biliary tract. Even though the radiocolloid scan is nonspecific it will be approximately 70%-80% accurate in predicting the presence or absence of liver disease and somewhat less accurate than that in making statements as to the specific type of disease. This compares well with other modalities. The ability of nuclear medicine techniques to provide a correct diagnosis is improved when additional isotopic techniques such as hepatic blood flow studies and 131I-rose bengal and 67Ga scanning are performed. Ultrasound scanning is also non specific. To date, the major application of ultrasound in the study of the liver has been in deciphering puzzling contour abnormalities seen on nuclear medicine scans and in demonstrating fluid-filled abnormalities. Its usefulness in diffuse and solid focal lesions has been less dramatic. More recently, however, the development of gray scale has necessitated a reevaluation of the technique. Gray scale demonstrates a large number of intrahepatic interfaces that were previously invisible, and it has already been shown to demonstrate focal disorders such as metastasis more easily than the nongray-scale method. It can also demonstrate dilated biliary radicals, the gallbladder, and gallstones. In addition, while routinely studying the liver one can evaluate diaphragmatic motion and various retroperitoneal structures such as the pancreas, lymph nodes, and abdominal vascular structures.


[Diagnosis of drowing as based on chloride, urea and creatinine values]. Chlorides, urea and creatinine values in the blood of the right and left heart were studied in 38 drowned bodies and 32 subjects with another cause of death. Pronounced differences between the right and left heart of the drowned bodies were found in chlorides and urea, less in creatinine. The probability of the diagnosis of drowning rises with the increasing difference between the right and left heart; in chlorides from the difference of 13 mg%, in urea 6 mg% and in creatinine 0,45 mg%. Contradictory results may, however, be obtained. Therefore the above mentioned laboratory test should be considered auxiliary only.


[Responsibility of technicians in departments of pathology and forensic medicine]. Several cases have been presented to demonstrate that the technicians' work in Departments of Pathology and Forensic Medicine is rather pretentious and responsible. Technicians must always bear in mind that any neglection may have severe consequences, social as well as medical and legal. Therefore technicians are expected to do their work meticulously, being aware of their responsibility. They should not obscure their errors. In only such cases the technician will adequately meet the requirements of our health care.


[Examination of vomits].

[Examination of vomits]. On the basis of examination of 10-day-old vomit, the author determined blood group, kind of food, probable time of meal and showed the presence of the drug bromisoval. The blood group of the offender found later on was identical with the blood group detected in the vomit.


Effect on coronary flow of atrial contraction. The transient decrease in coronary conductance and flow that is seen when the atria contract has been studied in 6 anaesthetized, open-chest dogs in heart block, paced via epicardial pacemaker leads. Left circumflex and anterior descending coronary flows were recorded via Doppler ultrasonic flow probes; aortic and left ventricular pressures and electrocardiogram were recorded simultaneously. The transient conductance and flow decrease in diastole were found from linear regression to be consistent with the left ventricular pressure rise caused by atrial contraction, in the case of the anterior descending coronary artery, which also showed no decrease in peak systolic conductance or flow when atria and ventricles contracted simultaneously. Circumflex conductance and flow were decreased by an atrial contraction to an extent greater than could be accounted for by the rise in left ventricular diastolic pressure. Peak circumflex flow and conductance were also decreased in systole, by 12 per cent, when atrial and ventricular contractions were exactly synchronous so that the atria could not discharge into the ventricles. The systolic effect and the excessive diastolic effect are ascribed to compression of atrial branches of the circumflex artery. This artrial compression mechanism accounted for 37-75 per cent of the effect of an atrial contraction on conductance in diastole. Values from 5 dogs of systolic and diastolic conductance changes due to atrial compression were linearly related. Calculation of atrial flow by applying this percentage to the transient flow decrease indicated that 17 per cent of circumflex diastolic flow was atrial, and that this percentage stayed constant throughout diastole.


Histochemically demonstrable changes in amylase activity in submaxillary salivary glands of puberal male mice following castration. The sexual dimorphism in mouse submaxillary glands is well documented. The main difference is seen in the granular convoluted tubules (G.C.T.) which in the adult male are large and in the adult female are small and fewer. Previous studies have shown that amylase is localized histochemically to these G.C.T.'s; that following castration there is a histological reduction in size and number of the G.C.T.'s and a roughly 50 per cent decrease in amylase activity demonstrable biochemically. In the present study 74 male mice aged 60 days were divided in six groups. The animals were fasted overnight. Under general anaesthesia, the submaxillary glands on the left side were removed and frozen in liquid nitrogen for subsequent histochemistry. The animals were then castrated and returned to their cages. At periods of 2, 4, 6, 8, 10 and 12 weeks later, the other submaxillary gland was removed under the same conditions, and the animals were then killed. Fresh frozen cryostat sections of both glands were subjected to the starch substrate film technique for the histochemical demonstration of amylase. Adjacent sections were stained with HE. The 2-week animals showed a slight but define reduction in size and number of G.C.T.'s and a parallel reduction in amylase activity. This was more pronounced by 4 and 6 weeks. In the 4-week animals, however, the changes were not consistent, being more pronounced in some animals than in others. This same phenomenon was observed in the 6-, 8- and 10-week animals, in some of whom there was considerable G.C.T. atrophy in the submaxillaries and in others very much less. In many of the 12-week animals there was very little evidence of G.C.T. atrophy. These findings confirmed other studies which suggested that there may be some regeneration of G.C.T's, possibly as a result of influence of other endocrine glands such as thyroid, adrenal and pituitary.


Stature and secular trend among Southern African Negroes and San (Bushmen). Despite a wide belief that little information is available on the dimensions of Southern African peoples, data for adult mean stature are presented for no fewer than 123 samples of S.A. Negro (93) and Khoisanoid (30) peoples. Many are published here for the first time. These have made possible a search for signs of the secular trend towards increased adult stature. Two main techniques are the study of longitudinal data (where time-spaced studies on the same population are available) and of age-ranked, cross-sectional data (where the lack of declining stature with age connotes the absence of a secular trens). Most Southern African populations for which data are available show either the absence of the secular trend (previously recognized) or a frankly reversed secular trend (a new concept), in which adults show a decline in mean stature compared with earlier generations. Similar absence or reversal of the secular trend characterizes peoples in Malawi, Kenya, Uganda, Sudan, Senegal, Upper Volta and Ivory Coast, as well as some Asian and South American samples. In the main, developed areas show the secular trend, while less developed areas show an absence or reversal of the trend. To this generalization, the San are a striking exception. All the evidence, first adduced in 1962, points to the usual secular trend as occurring in the San, despite their lowly, undeveloped economic status. Although the data are imperfect, it is possible too, that Xhosa and Moçambique Maravi show evidence of a positive secular trend. "The adult form of mankind is the outcome of growth enhanced, dwarfed, warped, or mutilated by the adventures of life. I am not decrying heredity. But I do insist that new knowledge gained for anthropology through the study of growth brings hope and confidence where formerly was only the grim figure of destiny." (T. Wingate Todd, 1935).


Characteristics of an ovine herpesvirus associated with pulmonary adenomatosis (jaagsiekte) in sheep. The isolation of an ovine herpesvirus from a cell culture of an adenomatous sheep lung is reported, confirming previous observations of a possible association of a herpesvirus with this tumour. Some growth properties and morphological characteristics of the virus are described, as well as serological data supporting a possible relationship between tumour and virus. Attempts to produce jaagsiekte by intratracheal injection of virus into lambs were unsuccessful, suggesting that a second factor may be involved inthe oncogenic process possibly similar to that proposed for the well-known EBV-Burkitt's lymphoma system.


Cranial neural crest extirpation and cyclopian development. Extirpation of cranial neural crest cells in presomite to 5 somite chick embryos produces monsters which in all essential respects are identical to human cyclopias. The primary lesion involves damage to the forebrain and consequently the inhibition of the nasal placode and nasal organ development as well as the destruction of the anterior neural crest cells, with the resultant absence of the nasal and interobital septa and of the facial dermal skeleton.


Ascorbate status of patients with porphyria cutanea tarda symptomatica and its effect on porphyrin metabolism. The ascorbate status and the effect of loading doses of ascorbic acid (1,5 g per day by mouth for 7 days) on the porphyric process were studied in 7 black men with porphyria cutanea tarda symptomatica. It was found that the ascorbate stores were depleted in these patients as judged by serum and leucocyte ascorbate levels. Temporary repletion of the ascorbate stores was effected by the loading doses of ascorbic acid: Serum iron concentrations increased in 6 patients; urinary iron excretion showed small peaks a few days after ascorbic acid therapy commenced; haemoglobin concentration was not affected; excessive amounts of oxalate were excreted in the urine; neither total urinary porphyrin excretion nor the composition of the urinary porphyrins was affected in a way which could be related to ascorbate therapy. Further evidence that ascorbate depletion is not important in the induction of porphyria was found when the ascorbate status of siderotic rats, rendered porphyric by hexachlorobenzene-feeding, was examined. Stores of ascorbate and the oxidative catabolism of ascorbate were not different in the prophyric rats as compared with normal litter mates.


Gastro-intestinal fibre-endoscopic polypectomy. Gastroscopic and colonoscopic polypectomy by means of a diathermy snare has been carried out on 23 patients, without any significant morbidity. The techniques and potential complications are discussed, and it is concluded that endoscopic polypectomy is a safe and rapid procedure in experienced hands, if close attention is given to detail and if the necessary precautions are taken.


An investigation of clozapine in the treatment of acute and chronic schizophrenia and gross behaviour disorders. Fifty-two mental hospital cases of acute and chronic schizophrenia and gross behaviour disorders were investigated and observed for 6-12 months during treatment with clozapine. Three-quarters of the acute cases recovered with full occupation capacity. Two-thirds of the chronic cases improved markedly. Antisocial behaviour was controlled in 12 out of the 13 behaviour-disordered group. The improvement in initiative and social capacity was striking and appeared to be due to improved awareness of the environment and the acquisition and handling of useful knowledge. The response to clozapine appears to be specific and relapses occurred when maintenance medication was stopped. It is of value in treating temper states in epilepsy and has the advantage of not causing extrapyramidal symptoms and side-effects are slight after the first week. Maximum improvement may not be reached before 8 weeks. Thereafter the maintenance dose can be small and fluctuations in the illness do not seem to occur. The dosage, side-effects and precautions are discussed. A rating system to display the effect of clozapine on individual parameters as well as on the over-all state was devised for this study.


The geriatric scene in Pietermaritzburg. Pietermaritzburg has 14 old-age homes which accommodate 656 residents, a general provincial hospital which caters largely for elderly patients, and various charitable organisations which are concerned with the needs of elderly people. However, the staff of the general hospital is constantly faced with the problem of patients who cannot be discharged from hospital because of the unsuitability of the conditions in their homes. This problem has prompted a study of existing facilities for the aged in Pietermaritzburg. It is concluded that more facilities are needed for the care of frail elderly people.


A career study of medical graduates of the University of the Witwatersrand, 1925--1972. A career study of the medical graduates of the University of the Witwatersrand, Johannesburg, between 1925 and 1969 has been conducted by postal survey. A return of 44,8% of the questionnaires and a lack of bias judged by criteria of geographic region, year of graduation and sex ratios, suggest that the sample is representative of the graduate population. Detailed analyses of active engagement in practice, geographic localities, fields of practice, specialist: general practitioner ratios, specialist rankings and academic appointments are presented and discussed. Career studies may be a valuable method of evaluating medical education.


The copper T intra-uterine device.

The copper T intra-uterine device. The Copper T intra-uterine device was evaluated in 500 Black women in Soweto township, Johannesburg. There were undesirable events in 263 of these subjects, 151 of whom were lost to follow-up.


Suppression of lactation with high doses of pyridoxine. Administration of high doses of vitamins B6, B1 and B12 successfully inhibited lactation without any untoward side-effects or discomfort in 96% of patients who had not yet established lactation, compared with 76,5% of control patients who received placebo.


Massive deposition of mineral oil after prolonged ingestion. A patient in whom prolonged mineral oil (liquid paraffin) ingestion caused the deposition of this material in the small intestine, abdominal lymph nodes, the liver, spleen and lungs, is described. The results of chemical and histochemical identification of the isolated material are presented. A description of the gross and microscopic pathology is followed by a brief consideration of some aspects of the subject of mineral oil ingestion. Prolonged unrestricted ingestion of mineral oil is dangerous and may cause structural and functional abnormalities which lead to severe malnutrition and death.


Multicentric reticulohistiocytosis. A case report. A patient with multicentric reticulohistiocytosis is reported, and the clinical and pathological features of the condition are discussed.


The prevalence of long-term illness among the elderly in a general practice. A retrospective study was performed to assess the prevalence of long-term illness in all patients aged 65 years and over in the practice of one family physician. Of 191 patients (10,6% of the practice population), 87% suffered from at least one illness and the mean prevalence rates were 2 129 diagnoses per 1 000 males and 1 955 for females. Fifty-eight per cent of the women and 14% of the men were widowed. The prevalence rates of 16 diagnostic categories are presented and compared with their prevalence among the general population. The findings are discussed with reference to the need for functional assessment and for prevention or relief of disability, so as to enable the individual to remain reasonably independent. The implications are discussed in relation to the need for the family physician to undertake increased responsibility for the comprehensive medical care of the elderly.


Malnutrition in South Africa: some thoughts on the problem. With special reference to pellagra and kwahiorkor, malnutirtion in South Africa is discussed in relation to the depth in which it is necessary to study malnutrition before action programmes are instituted; the time lag between research and adequate programmes for action; the importance of taking cultural factors into account in health education and in other applications of research; the importance of dealing with nutritional problems holistically and the limits of the researcher's responsibility. Suggestions regarding the responsibilities of various groups that should be involved in eradicating malnutrition are made.


"There is many a slip twixt the lip and the cell". My title is, of course, a parody of a well-known aphorism "There is many a slip twixt the cup and the lip". It opens up consideration of the many processes through which food has to pass after entering the mouth and before the contained nutrients satisfactorily nourish the individual cells of which the body is composed. It implies that the consumption of an adequate and nutritious diet does not necessarily ensure good health. The aim of this paper is to show that whereas we know very well what quantity of nutrients need to be consumed for health, we still know comparatively little about what happens to the foods after they have been consumed and started on the way to their metabolism by the cells of the body. Some conditioning factors are well-known temproary or permanent disturbances of normal metabolism and excretion. Less is known about the role of psychological and allergic factors.


Ascorbic acid and blood lipid and uric acid levels of students. Serum lipid and uric acid levels were investigated in two groups of healthy young students. Each member of the control group was given 1 g of citric acid, and each member of the experimental group 4 g of L-ascorbic aicd daily for 4 months. Blood samples were drawn every month and leucocyte ascorbic acid, serum ascorbic acid, cholesterol, free fatty acids, triglycerides and uric acid were determined. The ascorbic acid did not cause dramatic changes in lipid parameters, and no evidence could be found that ascorbic acid raises serum uric acid levels.


Vitamin metabolism and requirements: some aspects reviewed. Current knowledge concerning the metabolism and requirements of thiamine, riboflavine, vitamin B6, vitamin A, and vitamin C in the human is reviewed. The requirements of these nutrients appear to be the results of their excretory losses in the urine and faeces and through metabolic degradations. Although influenced by numerous factors, the catabolism appears in general to be the result of actions by degradative pathways unrelated to the biochemical or physiological functions of the vitamins. As a consequence, these excretory and catabolic losses cause continuous obligatory requirements for the vitamins that must be provided by dietary means.


Prevention of hazardous pollution in hospital operating theatres with the use of mechanical systems. This article describes, with the aid of sketches, the mechanical systems which could economically be designed for hospital operating theatres in an endeavour to eliminate the effects of hazardous pollution which exists in the majority of operating theatres. This article describes two seperate systems to combat the two major sources of pollution in operating theatres - contaminated air which reaches the operative wound of the patient, and the hazardous anaesthetic gases which are released into the atmosphere of operating theatres and associated areas such as recovery rooms.


Acute cholecystitis in children.

Acute cholecystitis in children. Data from retrospective review of 16 patients treated for acute cholecystitis indicate that the cause of this disease is different in children than in adults. The incidence of acute acalculous cholecystitis is higher in children. Congenital abnormalities of the gallbladder or bile ducts were not found in our patients. Cultures of the bile failed to establish a relationship with preceding infection, although infection seems to be an important etiologic factor. Diagnosis should be based on clinical signs and cholecystography. Early cholecystectomy is the treatment of choice. In patients with jaundice, operative choledochography is recommended.


Changes in serum phosphate levels associated with intestinal infarction and necrosis. Masive intestinal necrosis due to any cause is associated with a chemical complex that may be helpful in the early diagnosis of these conditions. This consists of elevated serum phosphate level, metabolic acidosis with significant  base deficit, elevated white blood count, and elevated hemoglobin and hematocrit values. This chemical complex associated with clinical signs and symptoms, may indicate the need for laparotomy. In this way, the time period between vascular occlusion and operation could be shortened and possible lead to more gratifying results than the present day extremely high morbidity and mortality rates which are associated with massive intestinal necrosis.


Treatment of carcinoma of the breast by modified radical mastectomy. To evaluate the results of treatment of Stage I and Stage II-T1 and T2, NO and N1-carcinoma of the breast by modified radical mastectomy with preservation of the pectoralis major muscle, the survival rates of all such patients treated by the senior author from 1965 through 1968 were compared with the survival rates of a simultaneous group of patients with similar stage disease treated by conventional radical mastectomy by the same surgeon. There were a total of 134 patients, of whom 51 had modified radical mastectomy and 83 conventional radical mastectomy. The five year survival rate for those treated by standard radical mastectomy was 81 per cent, and for those treated by modified radical mastectomy, it was 84 per cent. In patients with histologically negative axillary lymph nodes, the rates were 86 per cent following both radical mastectomy and modified radical mastectomy. Four per cent of the surviving patients after modified radical mastectomy and 7 per cent of the five year survivors after radical mastectomy had evidence of metastases at five years. Locally recurrent disease was noted in 5 per cent of those who had modified radical mastectomy and 7 per cent of those who underwent standard radical mastectomy. This analysis demonstrates that there is no significant difference in the survival and recurrence rates after conventional radical mastectomy and ,odified radical mastectomy of the Patey type. There is a high incidence of recurrence-free survival after both of these operations. Since modified radical mastectomy is less traumatic, involving less damage to muscular tissues, and is followed by significantly decreased deformity, it is advised as the treatment of choice for patients with carcinoma of the breast having no or minimal evidence of axillary node involvement. More extensive tumors adherent to the pectoral fascia or associated with multiple or large palpable axillary nodes should still be treated by conventional radical mastectomy.


The influence of resection of the small intestine on gastrin levels. In 16 dogs, serum gastrin levels were determined after resection of the distal and proximal half of the small intestine. The response to feeding was significantly increased after intestinal resection. Higher postresectional levels were reached after resection of the proximal half of the intestine. This may be evidence that the proximal half of the small intestine, in addition to the liver and kidney, plays an important role in the inactivation of endogenous gastrin.


Diverticular disease of the right colon. Diverticular disease of the right colon is uncommon. Most frequently, rightsided diverticula occur in the cecum, and usually, they are solitary. Generally, the diverticular are true diverticular containing all coats of the intestine, and usually the younger age group is affected. Right-sided diverticulitis mimics appendicitis. The diverticulum and adjacent reaction may be mistaken for carcinoma. Surgical excision is indicated to prevent recurrent symptoms as well as confusion at later barium studies.


Use of the colon as a conduit for urinary diversion. The use of a colonic conduit for  urinary diversion has a definite place as a salvage procedure after an unsuccessful ileal conduit, ureterosigmoidostomy, rectal bladder substitutes, or vesicobaginorectal fistulas. Under these conditions, correction by means of a colonic conduit has been accomplished in eight patients. A colonic conduit is a safe surgical procedure due to its low mortality and complication rates. It also alleviates some of the pitfalls of the ileal conduit, such as free reflux of urine and stomal stenoses.


Translumbar aortography updated.

Translumbar aortography updated. Although translumbar aortography is the oldest form of aortography, we belive it to be the procedure of choice in studying patients with aortoiliac and more distal peripheral vascular occlusive disease. It may be performed rapidly and easily and carried a low serious complication rate. The aorta should be punctured below the renal detail even in the feet, and some life threatening complications that have been reported when the aorta was punctured above the renal arteries may be avoided.


The importance of candida as an infectious agent. During the two and a half year period from January 1971 through Jyly 1973, 23 patients had cultures positive for candida from intra-abdominal isolates. Most of these patients had intestinal or biliary fistulas or abscesses and were seriously ill. Major  contributing factors to the development of candidal infections included the extensive use of multiple antibiotics, multiple operations, advanced age, and debility. Thirty additional patients had cultures positive for candida from skin and subcutaneous isolates. Candida appeared to contribute to the poor healing of wounds in some of these patients, particularly those with peripheral vascular ischemic lesions and decubitus ulcers. Antibiotics and concurrent diseases, such as diabetes, cancer, renal failure, and cardiovascular disease, were common factors relating to the development and growth of candida in these patients. There is often considerable difficulty in determing whether or not candida is only a contaminant or is an infectious agent contributing to the illness of the patient. This must be determined in each individual instance. In spite of the fact that candida appeared to be a significant infectious agent in many of these patients, specific antifungal therapy was used sparsely. It is suggested that appropriate antifungal drugs be used in patients with significant disease and that there should be greater awareness of the factors leading to the development of these extremely serious candidal infections.


Separate inguinal incisions in the treatment of carcinoma of the vulva. A modified surgical technique, using separate incisions for vulvectomy and for each groin, resulted in a low morbidity rate, with no increase in tumor recurrence and no reduction in length of survival time in comparison with previously reported methods of treatment of invasive squamous carcinoma of the vulva. The clinical staging adopted by the International Federation of Gynaecology and Obstetrics accurately predicted survival time for patients in this series as in others. However, in instances in which the histologic status of the nodes differs from the clinical assessment, postsurgical staging with primary importance attached to the histologic evaluation more accurately predicts prognosis.


Data favoring biopsy of the breast under local anesthesia. Experience with 184 consecutive biopsies of the breast for 147 benign lesions and 37 carcinomas over an 18 month period has been reviewed. Local anesthesia was used in 78 per cent of the patients, and it was the method of choice whenever the preoperative diagnosis was benign. General anesthesia was used when the lesion was thought likely to be malignant. Anesthesia within these guidelines was used in 88 per cent of patients with correct preoperative diagnoses. Exceptions were made primarily, but not exclusively, because of patient preference. The preoperative diagnoses were correct in 168 patients, unstated in five, and incorrect in 11. Six women erroneously were thought to have carcinoma, and five others unexpectedly had malignant disease. Although biopsy remains mandatory, the preoperative diagnosis of carcinoma of the breast can currently be made with sufficient accuracy to justify restricting recommendation for general anesthesia to those patients thought likely to have carcinoma of the breast.


The use of the inferior cornu of the thyroid cartilage in identifying the recurrent laryngeal nerve. The inferior thyroid artery, traditionally used as a guide in identifying the recurrent laryngeal nerve, is not wholly reliable because of two factors which affect the constancy of the relation between nerve and artery. One is the variability of the anatomic pattern of tbe inferior thyroid artery, and the other is the occasional incidence of a nonrecurrent inferior laryngeal nerve. In a study of 500 recurrent laryngeal nerves, the inferior cornu of the thyroid cartilage was more reliable than the inferior thyroid artery in identifying the recurrent laryngeal nerve. The anatomic relation between the recurrent laryngeal nerve and the inferior cornu of the thyroid cartilage was constant in all patients, except those in whom there was displacement of the nerve resulting from lesions of the thyroid or the parathyroid glands. Operations upon the neck require understanding of the anatomic characteristics of the recurrent laryngeal nerve and of possible involvement of the nerve with the pathologic process involvement of the nerve with the pathologic process as well as fastidious operative technique.


Renal hypertension.

Renal hypertension. Continuing interest in the mechanism of hypertension have produced considerable new information on the underlying pathophysiologic processes involved. Elucidation of the role of renal malperfusion, the renin-angiotensin-aldosterone mechanism, and renal medullary antihypertensive substances continues to clarify our understanding of renal hypertension. Current evidence suggests that angiotensin can produce hypertension by a direct effect on peripheral blood vessels in malignant hypertension and in renin-secreting renal tumors and by an intrarenal mechanism influencing intrarenal distribution of blood flow, and, thereby, sodium resorption in chronic renovascular hypertension. The current diagnostic techniques used to determine the presence of renal atery stenosis and its functional significance are reviewed. Arteriographic evidence of renal artery collaterals and a positive differential venous renin ratio are the two parameters whose usefulness and practicality have been best documented in recent years. The results of surgical procedures reported in the world literature show a 50 per cent rate with a further 30 per cent improvement rate in terms of control of hypertension. When functional significance of stenosis is demonstrated before surgical procedures, cure rates of the order of 80 per cent can be achieved. Recent developments of technique of operating room upon less extensive lesions of the renal artery branch extend the possibilities of surgical benefit which should also be considered in the presence of renal failure of renovascular origin.


Determination of human fibrinopeptide A by radioimmunoassay in purified systems and in the blood. The formation of fibrin clots or circulating soluble fibrin is accompanied by the appearance of fibrinopeptides. Measurement of the fibrinopeptide concentration in plasma can provide important information on the rate of conversion of fibrinogen to fibrin by thrombin. This rate varies under different physiologic and pathologic conditions. Fibrinopeptide A is a better molecular marker of the conversion than fibrinopeptide B since it is the first peptide to be cleaved by thrombin. A radioimmunoassay technique has been developed for the quantitative determination of human fibrinopeptide A. The procedure detects human fibrinopeptide A at a concentration of approximately 0.05 ng/ml. The variation of fibrinopeptide A content in normal persons may reflect its rapid formation and catabolism. A significantly increased concentration of this peptide was found in a patient during defibrination therapy with a purified enzyme from the venom of Agkistrodon rhodostoma and in patients suffering from retinal vascular occlusions.


Maternal serum FDP and circulating fetal red cells throughout pregnancy. A longitudinal study. The presence of fetal red cells in the maternal circulation and the serum FDP content of 73 women was followed serially throughout a normal pregnancy. There was a signigicant increase in the mean serum FDP levels in late pregnancy, which was due to episodic elevations occurring in approximately 65% of women. These transient elevations appeared to increase in frequency and severity as pregnancy progressed. There was also an increase in the number of occasions fetal red cells were detected in the maternal circulation in the later months of pregnancy, but his phenomenon did not appear to be associated in any way to the serum FDP elevations. It is concluded that the episodic rises in serum FDP occurring in normal pregnancy are not related to episodes of occult disseminated intravascular coagulation secondary to placental haemorrhage as was previously hypothesized. Their etiology and clinical significance remain unknown.


Calculation of predictive odds for possible carriers of heamophilia. Betting odds for possible carriers of haemophilia have been calculated using data derived from normal and known carrier populations. For each possible carrier the concentration of factor VIII-related antigen and factor VIII biological activity was measured and used to determine the probability of the individual being a carrier. The calculations indicated that, of the 32 possible carriers, 11 were likely to be normal (odds of more than 5:1) while 11 were likely to be haemophilia carriers (again odds of more than 5:1).


Adverse effect of heparin in thrombin-antithrombin III interaction. Thrombin, while reacting in the presence of hepatin, impairs the inhibitory capacity of antithrombin III so that subsequent inhibition of thrombin or factor Xa is decreased or abolished. This adverse effect of hepatin has been observed directly with at least 1.5 Iowa units of thrombin per each unit of purified human antithrombin III participating in the reaction. The inhibitory capacity was then totally destroyed and some residual thrombin remained in the active form. With a lower enzyme/inhibitor ratio inactivation of thrombin in the presence of hepatin was fast and complete, however, a significant decrease of inhibitory capacity below that found in reaction without heparin, has been established by measuring the residual antithrombin III activity. In defibrinated human plasma at least 2 units of thrombin per each antithrombin III unit were required to demonstrate directly the adverse effect of heparin but a fast depletion of inhibitory capacity has been also observed after repeated additions of small thrombin portions into plasma heparinized in vitro or in vivo. Portions of enzyme initially added disappeared with great velocity; subsequent portions, however, accumulated building up a high thrombin level not seen in the absence of heparin. The accumulation of residual enzyme was more extensive in plasma containing about 1 heparin unit per ml than anticoagulant at lower concentrations and was particularly noticeable in antithrombin III deficient plasma. These results may have some bearings on the approach to heparin therapy in the event when thrombin continuously generates or when a marked deficiency of antithrombin III exists.


Potato inhibitors of intrinsic prothrombin activators. The potato protease inhibitors inhibit intrinsic prothrombin activators and trypsin activation of prothrombin. The inhibitors 5a and 5b are responsible for the intrinsic prothrombin activator inhibition. This inhibition is progressive. No inhibition by these inhibitors of tissue thromboplastin activation of prothrombin or thrombin activity was observed.


Study of aggregate formation in region of separated blood flow. The formation of platelet aggregates which embolize to the peripheral circulation has previously been noted as a significant deleterious effect resulting from both intra- and extracorporeal artificial circulatory devices. Utilizing the stagnation point flow experiment, which permits visualization during flow of aggregate formation on first contact of blood with an artificial surface, the formation of freely floating aggregates has been observed in separated flow regions. Embolization from the separated flow has also been noted. Comparison of observed growth rates with a hydrodynamic model suggests that sufficient activation has occurred within the separated region so that platelets stick on virtually every collision. Some criteria are also suggested which correlate with the flow conditions affecting aggregate formation. At high flow rates, where freely floating aggregates do not form, significant surface thrombi are found.


Hemophilia A and hemophilia B in a family of French bulldogs. A congenital coagulation defect was suspected in 10 male French bulldogs, independently referred to the Small Animal Clinic of the Utrecht State University by private pet owners from all over the country. The cases are described in this report. Coagulation studies, performed in 8 of these dogs, revealed a factor VIII (anti-hemophilic globulin) deficiency in 5, and a factor IX (Christmas factor) deficiency in 3 propositi. A pedigree analysis revealed that all of the 10 propositi were lineal descendants, in the female line, of one and the same female ancestor. An inquiry by letter among the owners of 210 male descendants, in the female line, of this common ancestor revealed hemorrhagic episodes in at least another 10 male offspirng. The presence of a large number of carriers can be expected among the French bulldog population in the Netherlands, since the officially registered female offspring in the female line of the ancestor bitch, comprised over 170 dogs as of January, 1971. The possible mechanisms responsible for the simultaneous occurrence of hemophilia A and B in one canine family are discussed.


An ultrastructural study of acid phosphatase localization in cells of Phaseolus vulgaris phloem by the use of the azo dye method. The localization of acid phosphatase was studied in the sieve elements and companion cells in the phloem tissue of the bean, Phaseolus vulgaris L. The various organelles in the two kinds of cell showed fine granules of the azo dye as the final reaction product. The aggregated smooth endoplasmic reticulum displayed the dye particularly consistently. The dye was also present in the plasmodesmata and in the contents of the sieve plate pores. The reaction product was conspicuous in the cell walls and tended to be concentrated in the middle lamella and in the nacreous wall layer of the differentiating sieve elements.


A radioautographic study of collagen synthesis by earthworm epidermis. Secreation by the epidermis of two oligochaetes (Eisenia and Enchytraeus) was investigated radioautographically following administration of 3H-proline, 3H-tryptophan or Na2(35)SO4. Regionally epidermal columnar cells of Enchytraeus synthesize the overlying, probably collagenous, cuticle. Eisenia epidermis does not recordably synthesize the cuticle until after wounding (first eight segments removed). By two days postoperative the epidermal columnar cells of Eisenia synthesize the collagenous cuticle and, later in regeneration, the epidermis may simultaneously synthesize the different collagen of the underlying basement lamella. The epidermis of Enchytraeus, but not of Eisenia, synthesizes some sulfated material associated with the cuticle surface.


[Variations in the structure of the abdominal cuticle of Tenebrio molitor L]. The ultrastructure of the adult abdominal cuticle of Tenebrio is described and special attention is given to the intersegmental zone in which the cuticle presents several architectural types, i.e. helicoidal, preferred and 'plywood' cuticle (Neville's terminology). This architectural polymorphism of the adult cuticle contrasts with the uniformity of larval and pupal cuticle architecture, which is entirely helicoidal.


A freeze-fracture study of adult Calliphora salivary glands. A freeze-fracture study of adult Calliphora salivary glands has revealed a high density (approx. 4500/mu2) of intramembraneous particles (80-110 A) in both the apical and basal membranes. Most of the particles were associated with the A face. The density of the stalked surface particles which coat the cytoplasmic surface of the apical membrane. The possible significance of these particles in ion transport is discussed.


A light and electron microscope study of intra-epithelial putative mechanoreceptors in squid suckers. Putative mechanoreceptor neurons in the cuticularized epithelium of the suckers of the squid Lolliguncula brevis, were investigated using light and electron microscope techniques. These neurons were found to have a multipolar shape, thick unbranched axon, glial cell ensheathment, and accessory nerve fiber innervation. The need for electrophysiological and/or behavioral studies on these putative mechanoreceptors is emphasized.


Ultrastructural studies of development and light-dark adaptation of the eye of Coccinella septempunctata L., with particular reference to ciliary structures. On dark-adaptation of the 11-day adult eye, the rhabdomers move towards the cuticle. Each c-c-r array (of tandem centrioles and ciliary root) maintains its position relative to the rhabdomere, and the length of the root is apparently unchanged. The close association of the array with the rhabdomere is not established until after the first day of adult life. The array is already present at the time of pupation. The distal centriole subsequently becomes the basal body of a transitory ciliary bud, whole formation apparently precedes the onset of rhabdomere differentiation.


The fine structure of epidermal glands of regenerating and mature globiferous pedicellariae of a sea urchin (Lytechinus pictus). After a globiferous pedicellaria is lost from a sea urchin, a new appendage of the same kind is usually regenerated in the weeks that follow. During the latter part of regeneration, head glands and stalk glands, both of epidermal origin, develop from undifferentiated cells. Head gland cells begin morphological differentiation in the epidermis and then delaminate into the underlying dermis. In the formation of the stalk gland, by contrast, undifferentiated cells delaminate from the epidermis and then begin morphological differentiation in the dermis. During late regeneration, cells in the head and stalk glands are characterized by extensive rough endoplasmic reticulum distended with intracisternal material; moreover, the Golgi complex is closely associated with some of the large cytoplasmic vacuoles. The accumulating secretions of the two glands differ both in fine structure and in site of storage. Head gland secretions are stored intracellularly in the cytoplasmic vacuoles, while stalk gland secretions leave the gland cells in an apocrine fashion and are stored in an extracellular lumen. After regeneration, the mature cells of the head glands and stalk glands contain relatively little distended endoplasmic reticulum, although a Golgi complex is still present. Presumably, mature gland cells, in comparison to regenerating gland cells, produce relatively little secretion; instead, the glandular products elaborated during regeneration are probably stored in the mature glands with little augmentation or turnover.


Scanning electron microscopy of the electric tissue of Narcine brasiliensis. The anatomy of electroplaques of Narcine brasiliensis has been studied by scanning electron microscopy. The ventral faces of the plaques are innervated with an abundance of branching nerves in close contact with the underlying (postsynaptic) membrane. Large numbers of troughs and evaginations of the postsynaptic membrane serve to increase its surface area. Fibroblasts are closely associated with the dorsal faces which appear covered with a matrix of fibrous material. Well-washed dorsal surfaces of single electroplaques are free of this matrix. The dorsal surface area is considerably increased by tubules extending into, and projections out of, the surface.


Effects of change in frequency of stimulation on myocardial depression produced by thiamylal and halothane. The effects of change in the frequency of stimulation on the myocardial contractility depressed by thiamylal and halothane were studied in isolated dog heart muscle. An increase in the frequency of stimulation from 0.1 to 0.6 cps resulted in a progressive in increase in net-shortening (delta1) and maximum velocity of shortening at 0.4 g preload (V'max), namely a positive staircase. The myocardium previously depressed to a similar degree by thiamylal or halothane still showed a positive staircase. This result indicates that the mechanism to produce the myocardial depression by thiamylal or halothane is not a complete inhibition of Ca++ influx across the cell membrane. The time to reach a steady state of contraction following an increase in the frequency of stimulation was longer in the presence than in the absence of these anesthetics. The degree of recovery from the myocardial depression by increasing the frequency of stimulation was much higher in the presence of thiamylal than in the presence of halothane. This fact suggests that the mechanism to produce the myocardial depression may be different in there two anesthetics.


Leukocyte adenyl cyclase activity in human bronchial asthma. Changes in adenyl cyclase activity of the peripheral blood leukocytes were investigated in patients with bronchial asthma. Estimation of the leukocyte adenyl cyclase activity was carried out following in vitro stimulation by sodium fluoride (NaF) or metaproternol. The NaF-stimulated adenyl cyclase activity was significantly lower during asthmatic attacks. An oral administration of metaproterenol to patients during an attack was found to enhance the activity back to the control levels. Off-attack asthmatic patients showed a normal value which was again elevated considerably when they were administered metaproterenol. In contrast, measurements of adenyl cyclase activity using metaproterenol stimulation showed little change in patients in spite of asthmatic attacks or metaproterenol regimen. The lowering of the NaF-stimulated leukocyte adenyl cyclase activity was inversely proportional to the degree of lymphopenia during attacks and positively correlated with an increasing percentage of neutrophils.


Effects of isolation on mice in relation to age and sex. Isolated-housing conditions (a single mouse in cage) have been reported to induce various changes in physiological and behavioral characters of mice comparing with collective-housing conditions. However, the effect of age and sex has not been studied in detail. In this report, the young (8 or 11 weeks old) and the mature (29 weeks old for male and 32 weeks for female) of both sexes were comparatively studied on the response to isolation. The duration of isolation was 12-13 weeks. Significant differences were seen in body weight, weights of fur and interscapular adipose tissue, and weight of adrenals in male, and the difference in weight of adrenals was more outstanding in the young than in the mature. In female, only weight of ovaries differed significantly between the isolation and the collective groups, and the difference prevailed in the young than in the mature. The heavy body weight with fat deposition and small adrenals in the isolated male is not consistent with the results on the isolated male rat (Hatch et al. 1965). Small ovary in the isolated female is a similar finding to reports on mice (Weltman et al. 1962) and on rats (Hatch et al. 1965).


Studies on the experimental phenylketonuria in rats. Wister albino pregnant rats were fed on pellets containing 3.5% L-phenylalanine (Phe) from 10 days before the expected date of birth. The diet was then switched to 7% Phe pellets at the third week after birth. Baby rats were reared with breast milk, and weaned at the end of the 4th week after birth; thereafter, they were reared with a normal diet for one week at the 5th week, and then were given 7% Phe diet from the 6th week. These rats, which were reared with a diet of high Phe, showed a similar metabolic pattern to that of human phenylketonuria (PKU) in the following aspects: definite suppression of the liver Phe hydroxylase activity, excretion of a large amount of phenylpyruvic acid (PPA) and phenyllactic acid (PLA) into urine, and an elvated level of blood Phe content. But, they had an excessive amount of blood tyrosine (Tyr), and concurrently excreted massive homogentisic acid (HGA) in urine just as in human tyrosinemia alkaptonuria. The absence of urinary o-hydroxyphenylacetic acid (o-HPAA) was also a distinct difference from human PKU. In some rats, mild inhibition of the liver Phe hydroxylase activity was observed. In other rats, there was no excretion of PPA into urine as in human hyperphenylalaninemia. Further, the regulatory mechanism of Phe catabolism of experimental PKU was discussed by analysing the enzyme activity of the liver Phe hydroxylase, phenylalanine-pyruvate (Phe-Pyr) transaminase and tyrosine alpha-ketoglutarate (Tyr-alpha-Kg) transaminase at different developmental stages of the rats.


Electrophoretic, immunologic and kinetic characterization of erythrocyte pyruvate kinase in the Basenji dog with pyruvate kinase deficiency. The electrophoretic mobility and the immunologic specificity of erythrocyte pyruvate kinase (PK) of the homozygous Basenji dog with PK deficiency were identical to those of normal M2-type PK isozyme seen in the white cell but not to those of the erythrocyte PK isozyme. Kinetic properties and stability were also consistent with the M2-type PK isozyme. Defective PK in the homozygous red cell was due to the absence of the erythrocyte PK isozyme and the compensatory presence of M2-type PK isozyme, as seen in the severe classical type PK deficiency in man.


Exertional hemoglobinuria.

Exertional hemoglobinuria. A 16 years old boy had a typical exertional hemoglobinuria after walking with his new leather shoes on. The attacks of hemoglobinuria were associated with the appearance of an unstable hemoglobin in red cells. A slightly decreased fragility curve by 24 hr incubated red cells, the increase of autohemolysis and the appearance of heat labile hemoglobin were observed after exertion. These findings support that exertional hemoglobinuria may be regarded as a transitory erythropathia.


Three GM1-gangliosidoses and a variant of beta-galactosidase deficiency. The clinical, pathological, chemical and enzymatic differences between three types of GM1-gangliosidosis and a variant of beta-galactosidase deficiency were described.


Effect of morphine on PHA-stimulated human lymphocyte transformation. The effect of morphine on lymphocyte blastoid transformation induced by PHA was studied in vitro by observing the uptake of 3H-thymidine into nucleic acid of the lymphocytes. Morphine at the estimated clinical blood concentrations did not inhibit lymphocyte blastoid transformation.


Inhibitory substance (substance I) in rat liver of dopamine-beta-hydroxylase and its effect on the rat blood pressure. In a series of experiments undertaken to investigate the naturally occurring inhibitors of dopamine-beta-hydroxylase, we extracted some active substance from rat liver. This substance was named "substance I" because of its inhibitory effect on the dopamine-beta-hydroxylase. Substance I had some hypotensive effect on the rat blood pressure.


Analysis of diastolic pressure-volume relation of the canine left ventricle: half-inflation pressure as an index of left ventricular compliance. A sensitive index was proposed for the determination of left ventricular compliance. In the isolated potassium-arrested canine left ventricle, the pressure-volume (P-V) relationship was expressed as deltaV=a-be-cP throughout the range of filling pressure from 0 to 40 cmH2O, where deltaV and P were the actual volume change and intraventricular pressure, and a, b and c were constants. Then, half-inflation pressure (h) was calculated from h=[ln(2b/a)]/c. Left ventricular weight (LVW), intraventricular volume (LVV), ventricular external radius (ro) and internal radius (ri) were obtained from the measurements on the left ventricle, fixed at a filling pressure of 10 cmH2O. Then, LVVp=h, ro and ri at h were calculated. In the normal canine hearts, h was well correlated to LVW/LVVp=h and [(ro-ri)/ri]p=h. On the other hand, h/LVW/LVVp=h and h/[(ro-ri)/ri]p=h were constant and independent of LVW within a range of 40 to 150 g. These ratios rose markedly in the state of rigor mortis. From these results, it was concluded that h/LVW/LVVp=h and h/[(ro-ri)/ri]p=h depended on the left ventricular wall stiffness. And h was influenced by changes in LVW/LVVp=h and [(ro-ri)/ri]p=h in the absence of changes in intrinsic muscle stiffness.


Acoustical studies on respiratory sounds in asthmatic patients. Changes in the breathing sounds such as stridor and dry and wet rales in asthmatic patients were studied. The breathing sounds were recorded with the small transistor warp type microphone inserted through the nasal orifice into the trachea, main bronchi and segmental bronchi, and were analyzed with sound analyzer. The results were as follows: The whistling rales were caused by the resonance of the bronchial wall, when the vibrating frequency was coincident with its specific frequency. Snoring rales were explained as the sound caused by the air flow passing promptly through contracted bronchi with little secretion. Resonance of either bronchial wall or highly viscous sputum was considered to be responsible for the sonorous rales. Sibilant rales were audible when bronchi promptly repeated dilation and contraction. Stridor was picked up at the upper part of the air tract, from the main bronchus to the trachea, and noise was the main component on the sonogram, presumably caused by the air turbulence due to the narrowing and deformity of bronchial tube or to the sputum adhering to the inner surface of the air tract.


Metabolism of short chain fatty acid in rat liver in biliary obstruction. In an attempt to clarify the hepatic insufficiency in obstructive jaundice, hepatic metabolic rate of n-butyric acid, ketogenesis and CO2 formation from butyric acid were investigated using liver slices obtained from rats subjected to choledochal ligation or carbon tetrachloride (CCl4) injection. The hepatic metabolic rate of n-butyric acid was reduced with the prolongation of biliary obstruction, and the reduction was presumed to be caused for the most part by the reduced ketogenesis and in part by the impairment of the citric acid cycle (TCA-cycle). In 3approximately4 weeks after biliary obstruction, the metabolic rate reduced to a level comparable to liver necrosis produced by CCl4. This reduction of the metabolic rate of n-butyric acid is postulated as one of the pathogenic factors for fatal liver insufficiency in many cases of obstructive jaundice. While the reduction is mild and mobile in the early stage of jaundice, it may be of significance for preventing fatal liver insufficiency to relieve the obstruction as early as possible.


Cat scratch disease.

Cat scratch disease. Cat scratch disease developed on a 40-year-old wife was reported. Umbilicated papules closely resembling those in herpetic skin infection development on the areas which had been scratched by a cat a week ago. Obtained findings in the present case led us to a speculation that this disease was caused by herpes virus.  72 cases of this disease have been reported in Japan, and they were reviewed in the present paper.


Studies on the fibercolonoscopy: with special reference to the latest procedures. The Machida type fibercolonoscope, or FCS, devised by us is an anterior direct vision type of fiberscope. The most important feature of this new fiberscope consists of a tip of 5 cm size which is capable of being directed by flection up to 120 degrees in any direction and the tip up to 30 cm possessing a fishing-rod-like flexibility and elasticity by means of a special spiral spring. This angle-regulating mechanism makes it possible to insert this instrument along the course of the intestine under direct visual control. The fishing-rod-like construction where the maximal flexibility is greatest at the tip makes it considerably easier to pass sites of marked flexure in the colon. At examination the insertion of the instrument is guided by direct observation and by roentgenoscopy. The results in 200 cases in 1970 and thereafter, when operative techniques No. I, II and III devised previously by us were used, showed that successful insertion into the cecum was possible in 139 out of 173 cases (80%) except 27 cases of pathological stenosis due to cancer and other reasons. Thus fibercolonoscopy now enables the direct observation of the colon beyond the reach of the signoidoscope, providing a useful diagnostic procedure. Furthermore, a medium-long fibercolonoscope or FCS-M has been produced by us for examination of the lower portion of the large intestine. This is used in the inverted position without roentgenoscopic guidance as in conventional sigmoidoscopy. When this method, fibersigmoidoscopy, was used in 120 cases, it was possible to examine up to the transverse colon in 19 cases, the splenic flexure in 22 cases and the descending colon in 39 cases without the use of special techniques I, II and III. Thus in the majority of cases it is possible to carry out the examination of the left colon in this manner. The usefulness of fibersigmoidoscopy in the practical clinic is, therefore, rather larger than that of fibercolonoscopy.


Desquamation of renal epithelial cells as a route of mercury excretion in man: a preliminary study. Urine of mercury-exposed workers in a chlorine manufacturing factory and of staffs of our laboratory was separated in the supernatant solution and the precipitate by a centrifugation of 105,000 Xg for 60 min. The ratio of the amount of inorganic mercury in the precipitate to that in the supernatant solution ranged from 0.23 to 4.84, and was dependent upon the level of urinary mercury. The role of the desquamation of tubular cells is suggested as a possible route of urinary excretion of mercury.


Neuromuscular blocking properties of some antibiotics in man. Neuromuscular blocking properties of ribostamycin (1 gm), dibecacin (100 mg) and tobramycin (60 mg) were studied in a man during anesthesia and surgery by observing the effects of these antibiotics on muscle twitch tension. These drugs alone did not show any neuromuscular blocking action in those therapeutic doses. However, during the recovery phase of d-tubocurarine block the intravenous administration of 1 gm of ribostamycin caused a fairly rapid decrease in twitch tension. Tobramycin 60 mg did not show any remarkable effect, but dibecacin 100 mg produced a slight potentiating effect on the action of d-tubocurarine. The enhancement of the action of d-tubocurarine was antagonized promptly by edrophonium and more slowly by calcium.


Hemodynamic effects of aerosol propellants. I. Cardiac depression in the dog. The inhalation of fluorocarbons caused a depression of myocardial contractility, aortic hypotension, a decrease in cardiac output and an increase in pulmonary vascular resistance. The minimal concentrations that elicited these changes are as follows: 1% trichlorofluoromethane (FC11); 2.5% dichlorotetrafluoroethane (FC114); and 10% dichlorodifluoromethane (FC12). Inhalation of 20% octafluorocyclobutane (FC318) and difluoroethane (FC152a) did not influence these hemodynamic parameters. As in previous comparisons, the most widely used aerosol propellants are potentially cardiotoxic in the anesthetized dog.


The effect of massive transplacental iron loading. Intravenous injection of three doses of 50 mg Fe/kg (total dose 150 mg Fe/kg) as iron dextran into rabbits late in pregnancy (days 26, 28, and 30 of gestation) reduced the weight gain of the dams and increased fetal mortality. Three doses of 20 mg Fe/kg also increased fetal mortality, while three doses of 5 mg Fe/kg were without effect. Liver and kidney iron concentrations of the dams and offspring were markedly increased at the time of parturition by treatment with a total dose of 150 mg Fe/kg. At 6 weeks after birth the liver and kidney iron concentrations of offspring from treated dams were comparable to those from control dams. The liver and kidney iron concentrations of the treated dams were significantly reduced from the levels found immediately post-partum. In the rat, four i.v. doses of 200 mg Fe/kg as iron dextran on days 17, 18, 19, and 20 of gestation (total dose 800 mg Fe/kg) produced tremors, reduced body weight gain, and reduced food consumption in the dams. The growth and survival of the offspring were adversely influenced by these effects on the dam. The liver iron concentration in offspring of rats treated with 800 and 400 mg Fe/kg was increased at parturition, but had returned to normal at 4 weeks of age. No iron-induced pathology was evident in the offspring of either rabbits or rats after 14 and 18 weeks, respectively.


Lead and active calcium transfer through the intestinal wall in rats. 5-week-old female albino rats were given daily doses of lead as acetate ranging from 2 mug to 20 mg by gastric intubation for 1 week. The animals were sacrificed on the 8th day of the experiment. Calcium-45 and (in some experiments) strontium-85 were used as markers to assess their active transfer through the duodenal wall by the everted gut sac method of Wilson and Wiseman. The active transport ratios of both calcium and strontium, as well as their retention in the intestinal wall were unaffected by the lead treatment of the animals. As the total calcium transport was found earlier to be diminished by lead treatment it is concluded that lead influences the passive transport, possibly by fixation to the intestinal wall.


Reversible inhibition of DNA, RNA and protein synthesis in human cells by lead chloride. An acute intoxication by lead chloride (conc. 2.5 - 10(-4)M) produces a temporary reduction of macromolecular syntheses in HeLa cells growing asynchronously. The reduction is similar for DNA, RNA and proteins and differs only in the intensity. After a one-day intoxication, if the cells are put back in a fresh medium, the syntheses return to normal within 10 h. The histochemical sulphide-silver method shows that lead is present in the cells during the inhibition.


Effect of intratracheal injection of mica dust on the lymph nodes of guinea pigs. Histopathological changes in the tracheo-bronchial lymph nodes were studied up to 365 days in guinea pigs following intratracheal injection of a suspension of mica dust. In general, the cytotoxic effect provoked by dust was not pronounced as the majority of the swollen dust-laden macrophages retained their normal structure at the termination of the experiment and fibrotic lesions were limited to the formation of thick reticulin fibers. The poor fibrogenic response of mica dust has been attributed to its low cytotoxicity.


A study of the embryotoxicity of the food colour Ponceau 4 R in rats. An embryotoxicity study on Ponceau 4 R was carried out in SPF Wistar rats. The substance was given by gavage from day 1 to 20 of the gestation period in doses of 0, 1000, 2000, and 4000 mg/kg bw per day, dissolved in distilled water. The foetuses were removed on day 21. No effect due to the treatment with the dye was observed with regard to the number of corpora luteae (CL), of implantations, of foetuses dead or alive with regard to gross malformations, to skeletal and internal malformations or to the weight of the foetuses.