V. Efforts at stabilization of rat liver phenylalanine hydroxylase. The best from a series of matrices for the covalent coupling of rat liver phenylalanine (Phe H) was activated thiol-Sepharose 4B. An average of 0.38 mumoles of enzyme thiol was coupled per mumole of matrix thiol, representing 21 mg of protein per g of carrier. After thiolation with N-acetylhomocysteine thiolactone the enzyme, bound to the same matrix, was thermally more stable with a broad pH range of optimal activity. Thiolation with S-acetylmercaptosuccinic anhydride markedly reduced hydroxylase activity whereas succinylation with succinic anhydride had little or no effect. Treatment of the thiolated enzyme with various oxidants to form disulfide bridges did not increase the thermal stability. Efforts to improve stability by formation of new linkages while the enzyme was still bound to the matrix were unsuccessful. The untreated or thiolated enzyme was inactivated upon reaction with glutaraldehyde.


Is there a place for chemical and radiation synovectomy in rheumatic diseases? Synoviorthesis has the same indications as surgical synovectomy. But it is easy to perform, can be repeated and does not leave any scars. It should be tied first. The choice of the product to be injected depends on the joint, the number of injections and the age of the patient. In all cases a long-acting local steroid should be tried first. In combination, osmic acid seems to potentiate the effect of the steroid. If osmium tetroxide damages the cartilage, it has been demonstrated that the damage is limited and superficial and as far as we know without clinical consequence. The fear of side-effects has limited the use of synoviortheses in the United States. Sledge et al. (1977), in animals, have used a new rare earth isotope, dysprosium-165, a beta-emitter with a maximum tissue penetrance of 5.7 mm and the advantage of a very short half-life of 140 minutes. In so far as systemic therapy is only partly successful there is still a place for chemical and radiation synovectomy in rheumatic diseases.


Retention in glass bead columns as a measure of leucocyte adhesiveness. I. Influence of sample size and erythrocyte sedimentation. Erythrocyte sedimentation significantly influenced test results when leucocyte retention in glass bead columns was used as a measure of leucocyte adhesiveness. In blood with elevated ESR, this influence was especially evident. Erythrocyte sedimentation highly increased leucocyte retention in vertical columns with a downward flow, whereas in slightly tilted columns with an upward flow, the retention was reduced. The error in measurements caused by erythrocyte sedimentation could be corrected by means of the haematocrit values in samples and eluates. Correction was better for results obtained with slightly elevated than with vertical columns. The granulocyte retention rates increased with increasing sample size, whereas lymphocyte retention remained constant.


Erythrocyte and leucocyte enzymes in a case of paroxysmal nocturnal haemoglobinuria. In a patient with paroxysmal nocturnal haemoglobinuria (PNH) enzymatic activities of erythrocytes and leucocytes were studied. Studies of autohaemolysis were also performed. The following erythrocytary enzymes were measured: Glucose-6-phosphate dehydrogenase (G-6-PD), pyruvate kinase (PK), glutathione reductase (GR), and acetylcholinesterase (AcChE). The following enzymes were measured in leucocytes: Adenosine deaminase, purine nucleoside phosphorylase, adenine phosphoribosyltransferase, hypoxanthine phosphoribosyltransferase and adenosine kinase. Normal activity of G-6-PD, GR and PK in erythrocytes was found. In leucocytes and lymphocytes activity of purine nucleoside phosphorylase was reduced. Auto-haemolysis in vitro was increased, which could not be compensated by addition of glucose or ATP.


Successful use of a bulk laxative to control the diarrhea of tube feeding. The greatly increased nutritional demands of the severely burned patient frequently require the use of tube feeding for enternal hyperalimentation. At a time when general patient morale is low and motivation needs to be maximally maintained, there is nothing so dispiriting as the distress of a painful perianal region and uncontrollable liquid stools. Attempts to control the diarrhea which frequently accompanies tube feeding by changing the formula or the method of administration or a wide variety of constipating drugs have all met with very limited success. Based on the clinical observation of a noted gastroenterologist (Bockus), we have administered a mucilagenous hydrophilic colloid bulk laxative (Metamucil) to patients on tube feeding formulae. The dosage and frequency are adjusted to individual patient needs, but average 7 g per liter of liquid formula. The results have been dramatic; namely, the virtual elimination of the diarrhea problem in our burn patients on enteral hyperalimentation by gastric tube feeding. Colonic transit time increases. The stools become formed but soft, cohesive but not adhesive. Perianal irritation does not occur. Neither does soilage of wound, dressings, or bed. No rebound constipation or obstructive symptoms have been encountered. We attribute this response to the same water binding mechanism that allows these colloids to prevent chronic constipation. Our patients may be given as much as 5,000 to 6,000 calories of tube feeding per day. Our patients are not distressed by diarrhea. Our nursing staff is relieved of the burden that entails.


Parenteral nutrition in severely burned children. In adults supplemental parenteral nutrition (PN) is advisable in burns over 40% especially when weight loss exceeds 10% of body weight. In children with smaller reserves and higher requirement of proteins and energy no rigid scheme for parenteral supplementation is used at our unit. In a young infant it may be added already at a 20-30% deep burn, especially with connected gastrointestinal tract problems, infection etc. Metabolic and protein requirements are estimated 50-100% in addition to their normal needs. Hypertonic glucose (gradually increased from 20-40%), covered with insulin in the early phase, is used as source of carbohydrates. L-amino acid mixture containing the "pediatric essential amino acids" histidine and cysteine is given as a nitrogen source. 20% Intralipid is given in a gradually increased amount of 2-4 g/kg per day to provide calories and essential fatty acids. Among electrolytes K, Ca, P and Mg must be added. Increased amounts of vitamin C and folate are needed by burned children. Vitamin E is also required during prolonged lipid administration. Trace elements (Zn. Fe, etc.) are supplied orally or i.v. with special solutions or fresh  plasma infusions. Our experience with parenteral nutrition in severely burned children will be presented. There were no severe metabolic side-effects but sepsis represented the major problem. The concomitant heat preservation by warming the room and use of infra-red heaters is emphasized.


Pseudomonas resistance to gentamicin.

Pseudomonas resistance to gentamicin. 66 burned patients admitted to the Burn Unit from Jan. to Sept., 1977, were studied. Topical therapy employed was mafenide or silver sulfadiazine. The most common pathogens isolated in 288 burn wound cultures were Pseudomonas aeruginosa (42%), Klebsiella-Enterobacter (16%), and Staph, aureus (13%). Pseudomonas was sensitive to gentamicin in only 36.2% of instances. In 1976, 42% of Pseudomonas isolates was sensitive. During the period 1969-1973, 85.7% of the Pseudomonas was sensitive to gentamicin.


Gold and thiol compounds in the treatment of rheumatoid arthritis: excretory fate and tissue distribution of thiomalate in relation to gold after administration of myocrisin (auro-thiomalate). Double isotope-labelled auro thiomalate (Au195-C14-thiomalate) has been administered to mice and rats, and the excretory fate and tissue distribution have been studied. The results show that the gold and the thiomalate separate in vivo resulting in protein-bound gold and release of free thiomalate. About half of this thiol is excreted in the urine during the first day and the remaining half is taken up by the tissues. Thiomalate penetrates cellular membranes poorly, but is able to interact slowly with proteins (mixed disulphide formation). Part of the thiomalate which remains in the body is membrane bound. In contrast to penicillamine little thiomalate remains in circulation a few hours after administration. Gas chromatography--mass spectrometry has been used to search for the presence of free thiomalate in rheumatoid arthritis patients on Myocrisin (auro thiomalate) therapy. Thiomalate was found in their urine, but not in serum and synovial fluid 20 hours after administration. As thiomalate is released in the body after administration of Myocrisin. the question arises whether this thiol, like penicillamine, may have a beneficial effect in the treatment of rheumatoid arthritis.


Pulmonary infiltrates associated with gold therapy. Report of a case. A case report is presented concerning diffuse pulmonary infiltrates due to sodium aurothiomalate therapy in a 67-year-old woman suffering from rheumatoid arthritis. After the gold treatment was stopped, prednisolone therapy produced complete remission of the pulmonary reaction.


[Protection from exertion-induced bronchial asthma with disodium cromoglycate (DSCG) (cromolyn, lomudal, intal) and with ketotifen (zaditen). Doubly crossed double-blind study ]. 16 cooperative asthmatic patients with exercise-induced asthma (with more than 15% decrease in FEV1 after strenuous work on a treadmill with 10% upward; pulse rates over 180 per minute during the work-phase) were selected to take part in a double-blind crossover trial. The 8 women and 8 men, with ages ranging from 15 to 57 years (mean 25) underwent 4 exercise tests. The effects on exercise-induced asthma of 20 mg disodium cromoglycate (DSCG) inhaled with a spinhaler 30 minutes before exercise were compared to 2 mg of ketotifen taken orally 3 hours before exercise, and likewise DSCG was compared to a placebo powder inhaled with a spinhaler, and ketotifen with placebo tablets. The whole study lasted from January to March. Ten minutes after exercise the following changes in FEV1 (in percent of control value measured before exercise) were seen: after inhalation of a placebo powder the FEV1 decreased to 66% with an almost equal decrease after taking placebo tablets (67%) (0.45 greater than p greater than 0.40) whereas, in comparison, the decrease in FEV1 after DSCG (84%) is smaller than that after inhalation of a placebo powder (66%) (p less than 0.0025). In contrast to these results was the equal decrease in FEV1 after ketotifen (70%) (0.35 greater than p greater than 0.30) and placebo tablets (67%). Although a relatively high chosen dosage of ketotifen was given, it does not seem capable of inhibiting mediator release from the bronchial mast-cells as DSCG does. It is concluded that ketotifen given orally 3 hours before the exercise test is not effective against exercise-induced asthma.


[Hyperventilation and oxygen supply of the myocardium. II. Effect of nitroglycerin and dipyridamole]. 1. Voluntary hyperventilation during rest in the recumbent position induces a fall in H+ concentration, PCO2 and PO2 in mixed venous blood and in the blood of the coronary sinus. 2. If the breathing volume is increased during voluntary hyperventilation between 2- and 2.5 fold above the volume at rest, O2 uptake increases by only 6% but CO2 excretion rises by 66%. 3. Cardiac output decreases by 8% and the O2 extraction of the myocard increases by 12%. There is a quantitative relationship between arterial pH or PCO2 and changes in the systemic and coronary circulation. Blood pressure decreases in the pulmonary circulation. 4. Nitroglycerin during hyperventilation produces an additional reduction in cardiac output but no effect on the O2 extractions of the myocard. 5. With dipyridamol, the O2 extraction of the myocard is reduced and the PO2 in the blood of the coronary sinus increases. 6. In the case of severe coronary obstruction, the effect of dipyridamol can cause acute angina pectoris and left heart insufficiency due to poststenotic ischemis (steal syndrome).


Nuclear transcripts of mouse heavy chain immunoglobulin genes contain only the expressed class of C-region sequences. In plasmacytoma cells producing IgG, IgA, or IgM immunoglobulin heavy chains, the large precursors of the heavy chain messenger RNA's contain nucleotide sequences that specify only the expressed class of constant region. This indicates that the switch from one class of heavy chain to another during B cell ontogeny does not occur by altered processing of a complex gene transcript.


Behavior maintained by termination of a schedule of self-administered cocaine. Squirrel monkeys self-administered cocaine by pressing a lever while under a variable-interval schedule of reinforcement. At the same time, they terminated the availability of self-administered cocaine by pressing a second lever while under a fixed-interval schedule of reinforcement. The maintenance of behavior by schedule drug injections and by termination of scheduled drug injections, usually considered to be processes associated with different classes of drugs, can occur simultaneously when behavior is controlled by different contingencies associated with a single drug.


Inhibitory, GABAergic nerve terminals decrease at sites of focal epilepsy. Using an immunocytochemical method for the localization of the gamma-aminobutyric acid (GABA) synthesizing enzyme, glutamic acid decarboxylase (GAD), we have observed GABAergic nerve terminals distributed throughout all layers of normal monkey sensorimotor cortex. These terminals displayed ultrastructural characteristics that suggested that they arose from aspinous and sparsely spinous stellate neurons. In monkeys (Macaca mulatta and M. fascicularis) made epileptic by cortical application of alumina gel, a highly significant numerical decrease of GAD-positive nerve terminals occurred at sites of seizure foci indicating a functional loss of GABAergic inhibitory synapses. A loss of such inhibition at seizure foci could lead to epileptic activity of cortical pyramidal neurons.


Orientation anisotropy of visual stimuli in rhesus monkey: a behavior study. The contrast sensitivity of the rhesus monkey was tested, according to a modified reaction-time paradigm, for sine-wave grating targets at different orientations. The monkey possesses an oblique effect slightly larger than that of humans. A reaction time analysis showed the oblique effect to be a suprathreshold as well as a threshold phenomenon. The presence of this effect further strengthens the use of the monkey as a model for the human visual system.


Stress and coping factors influence tumor growth. Growth of syngeneic P815 mastocytoma in DBA/2J male mice was evaluated as a result of various stress regimens. A single session of inescapable shock resulted in earlier tumor appearance, exaggeration of tumor size, and decreased survival time in recipient animals. Escapable shock had no such effects. The effects of the inescapable shock were mitigated if mice received long-term shock treatment.


Enchancement of luminance flicker by color-opponent mechanisms. Color-opponent ganglion cells in the monkey retina respond to luminance flicker at high temporal frequencies. Color opponency, which makes these cells so selective of wavelength at low temporal frequencies, is progressively lost at high frequencies. This loss is due to a frequency-dependent phase shift between the responses of spectrally different center and surround mechanisms in the receptive field of each of these cells. Center and surround responses, which are antagonistic at low temporal frequencies, become synergistic at high ones, making these cells most responsive at high frequencies to those wavelengths to which they are least responsive at low frequencies. This phenomenon can explain the differences between chromatic and luminance flicker in human vision.


Subicular input from temporal cortex in the rhesus monkey. The subicular cortices of the primate hippocampal formation form a physical and connectional link between the cortex of the temporal lobe and the hippocampus. Their direct connections with all classes of cortex in the temporal lobe except primary sensory cortex underscore the pivotal role of these areas in the potential interplay between the hippocampal formation and the association cortices.


Serological differences among the dermatophytes. Antigens were prepared from young mycelial growth of 20 species of dermatophytes, and tested by double diffusion against homologous and heterologous antisera raised in rabbits. 48 distinct antigens were recognised by the procedures used. Although there were a considerable number of common reactions, there were significant differences between species and groups. Species of Microsporum, with the exception of M. gypseum and M. persicolor, form a coherent group distinct from Epidermophyton and Trichophyton. All Trichophyton species investigated with the exception of T. ajelloi, were serologically closely related. M. gypseum, T. ajelloi and M. persicolor showed affinities with both Microsporum and Trichophyton, and possibly form an intermediate group. The system used does not permit differentiation of species by serological means, but gives a new dimension to the inter-relationships of these fungi.


Evaluation of purified H and M antigens of histoplasmin as reagents in the complement fixation test. Complement-fixation (CF) tests were performed with purified H and M antigens, histoplasmin, and Histoplasma capsulatum whole cell yeast phase antigen using sera of 126 patients with proven or suspected histoplasmosis. Specific titers for either H or for M antibody were obtained with the individual purified antigens; the highest titers were comparable to those obtained with histoplasmin. However, in sera containing only anti-M antibody, the titers obtained with the purified M antigen were 2 to 16 times those obtained with the histoplasmin or yeast phase antigens. The CF test for either H or M antibody was 4 to 32 times as reactive as the agar-gel microimmunodiffusion test; in general precipitin lines were obtained with either H or M antigens from sera with CF titers greater than or equal to 8. With sera containing H antibody, there was an excellent correlation between the CF titers obtained with purified M antigen and histoplasmin. The correlations of CF titers with H antigen and either histoplasmin or yeast phase antigen were very low.


Adrenalectomy-oophorectomy and combined chemotherapy for carcinoma of the breast with metastases. Thirty-one patients with carcinoma of the breast with metastases were treated by adrenalectomy-oophorectomy and randomized either for combined chemotherapy, vincristine, fluorouracil, methotrexate and thiotepa, beginning within one week after operation and continuing for three months or no chemotherapy. Statistical analyses were Gehan's modification of the Wilcoxon test for censored data, chi-square tests and life table analysis. Pretreatment characteristics--menopausal status, age, disease-free interval, prior hormone treatment and sites of metastases--of both groups were similar. Objective response occurred in 73 per cent of 11 patients in the treatment. A group compared with 47 per cent of 15 patients in the treatment B group, p greater than 0.50. Median duration to relapse in responders was 16 months in the treatment A group and 15 months in the treatment B group, p greater than 0.50. Median survival was 19 months in the treatment A group and 20 months in the treatment B group, p greater than 0.50. Results were not significant, and inclusion of five patients with less than three months of treatment, did not alter the results. Hence, the group receiving early symptomatic treatment did not show an improved response rate, improved duration of remission or enhanced survival time from ablative treatment.


Ectopic epidural calvarial meningioma.

Ectopic epidural calvarial meningioma. A rare case of ectopic epidural calvarial fibroblastic meningioma is reported in a 31-year-old male. Arising from the inner table of the skull, it produced an intracranial mass which resulted in hemiparesis and Jacksonian epilepsy.


The effect of septic shock on skeletal muscle action potentials in the primate. Techniques developed for the in vivo study of cellular physiology have been applied to septic shock in primates. Measurements of skeletal muscle transmembrane resting and action potentials were correlated with an analysis of fluid and electrolyte changes in the intracellular and extracellular compartments of skeletal muscle. The data obtained indicated a marked depletion of muscle extracellular water and an increase in intracellular sodium chloride and water content during shock. The significant decrease of resting membrane potential was associated with a decrease in amplitude of the action potential and prolongation of both the repolarization and depolarization time. In addition, there was a decrease of muscle intracellular potassium concentration during shock. This study demonstrates that the alterations in cellular membranes in hemorrhagic shock and septic shock are similar.


Steroid delta 4-5 beta-reductase in human mammary tumors. Steroid delta 4-5 alpha- and delta 4-5 beta-reductase activity was determined in 16 human mammary tumors and 8 DMBA-induced rat mammary tumors using a spectrophotometric assay. Steroid delta 4-5 alpha-reductase was present in all tumors investigated while delta 4-5 beta-reductase was detected in only 6 estrogen receptor negative human breast tumors and absent in all estrogen receptor positive human breast tumors as well as in all rat mammary tumors. Further support for the presence of delta 4-5 beta-reductase was established by using a dual-labelling technique consisting of incubating tumor slices with [14C] testosterone and adding [3H] etiocholanolone, [3H] testosterone and [3H]-5 alpha-dihydrotestosterone at the end of the reaction. Following extraction and chromic acid oxidation, 4-androstenedione, 5 beta-androstanedione and 5 alpha-androstanedione were isolated and purified, and the constancy of the 14C/3H ratio was used as proof of 5 alpha-reductase and 5 beta-reductase. These results were shown to be consistent with the data obtained using the spectrophotometric assay.


Chemical synthesis and bioassay of anordrin and dinordrin I and II. The chemical synthesis of 2 alpha, 17 alpha-diethynyl-A-nor-5 alpha-androstane-2 beta, 17 beta-diol dipropionate (Anordrin) and the corresponding diacetate is reported. Similarly, the preparation of the 2 alpha, 17 alpha-diethynyl-A-nor-5 alpha-estrane-2 beta, 17 beta-diol, its diacetate and dipropionate (Dinordrin I), along with the corresponding 2 beta-epimer (Dinordrin II) from 17 beta-hydroxy-A-nor-5 alpha=estran-2-one is described. In rat uterotrophic activity bioassay, the slope of ethynylestradiol differed significantly from the slopes of the other three compounds, thus vitiating potency estimates with this reference compound. Dinordrin I was 20 times more potent than Anordrin and considerably more potent then Dinordrin II. The single-dose oral antifertility effect in rats generally paralleled uterotrophic activity. Immediate postovulatory contraceptive effectiveness was assessed in adult cycling female baboons given two doses daily for 4 days. Both Anordrin and Dinordrin I showed antifertility activity worthy of further study. Moreover, a definite luteolytic effect, with depression of both plasma estrogen and progesterone levels, was observed with these two steroids.


Complement fixation by Rh blood group antibodies. Rh blood group antibodies normally do not fix complement. Rh positive intact red blood cells treated with papain do not lyse when incubated with corresponding antibody and complement. This study was done to determine if complement fixation occurs when antibodies were combined with Rh positive red blood cell ghosts untreated or treated with papain. Complement fixation was observed with IgG anti-D, anti-DC and anti-c when papain treated ghosts were used. No complement fixation or a smaller degree of it was observed in the case of untreated Rh positive red blood cell ghosts when incubated with similar anti-Rh antibodies. It is concluded that the papain treatment of Rh positive red blood cell ghosts, possibly by inducing aggregation of antigen sites, allowed complement binding by Rh antibodies.


Autoimmune hemolytic anemia associated exclusively with IgA of Rh specificity. A nine-year-old boy had typical clinical, hematologic and blood group serologic findings of autoimmune hemolytic anemia except for one important exception; with most commercially available broad spectrum anti-human sera the direct antiglobulin tests were negative. With reagents prepared in the laboratory which were found to be relatively less potent in and anti-IgG and IgM activity but which utilize a short period of incubation after mixing with the washed cells, the tests were all clearly positive. If incubation were employed with the commercial reagents, the tests were positive. Further studies showed that the patient's cells were coated exclusively with IgA and that a commercial reagent, although potent in anti-IgG and anti-IgM, was relatively deficient in anti-IgA. It is proposed that incubation compensates for the latter and is cautioned that incubation, with reagents potent in anti-IgG, could lead to false negative reactions with weakly IgG sensitized cells due to antibody surplus prozones of inhibition. This case illustrates that the rare instances of "Coombs negative immune hemolytic anemias" may be based on mechanisms such as those reported here and, that to be ideal, a broad spectrum anti-human serum should have balanced anti-immunoglobulin activities in relation to its incubation time.


Systematic survey of monoclonal gammapathies in the sera from blood donors. Routine screening of monoclonal gammapathies (M.G.) was performed on the serum of 13,914 blood donors by cellulose acetate electrophoresis. Twenty-six cases of M.G. were detected corresponding to a frequency of 0.19 per cent. The incidence of the M.G. progresses with increasing age comparatively to the age distribution of the blood donors under investigation. Most of the M.G. detected can be classified as "asymptomatic" M.G. (23 of the 26) and heavy chain classes are only IgG or IgM with a large predominance of IgG class (about 90%). It is suggested that donors in whom M.G. have been detected should not be eligible for blood donation. A yearly clinical, hematologic and  immunoglobulin checkup is recommended for these patients in order to detect a possible malignant transformation.


Liver transplantation--1978.

Liver transplantation--1978. The development of liver transplantation has been made difficult because of the enormous technical difficulties of the procedure and because the postoperative management in early cases was defective in many instances. With surgical and medical improvements, the prospects for success have markedly increased recently. The wider use of thoracic duct fistula as an adjuvant measure during the first 1 or 2 postoperative months is being explored.


[Immunofluorescent study of the basic chromosomal protein set of green algae and Euglena]. Using antisera to fractions H1, H2a, H3 and H4 of the calf thymus histones, a comparative immunofluorescent investigation of these proteins in the nuclei of Chlamydomonas reinhardii, Haematococcus pluvialis, Dunaliella salina and Euglena gracilis was carried out. It has been shown that according to the immunofluorescent test, the nuclei of these algae contain proteins close to fractions H2a, H3 and H4 of the calf thymus histones. H1 fraction in these algae is either absent or can be considered as a protein immunochemically non-related to H1 fraction of the calf thymus histone. For quantitative evaluation (in units of the immunological distance) of the difference between histones of the algae and of the calf thymus in situ by indirect immunofluorescence, it was suggested to use the ultimate dilutions of antisera to histones. It was shown that the ultimate dilutions were correlated with titres of antisera in the reaction of microcomplement fixation. Such an approach and the data obtained are of interest for studying into the evolution of nucleosome histones in unicellular and multicellular eukaryotes.


Direct migration inhibition test with leukocytes as indicator of mycobacterial antigens in the human body. In 32 patients with newly detected pulmonary tuberculosis positive on smear and culture, included in a controlled clinical trial, a significant correlation between diminishing inhibition of leukocyte migration (induced by PPD) and reduction of mycobacterial population in the sputum during the course of chemotherapy has been demonstrated. The changes of mycobacterial population in the host have been assessed in two ways: an indirect assessment was made from the time taken to achieve sputum smear and culture negativity; a direct assessment was based on repeated quantitative determinations of tubercle bacilli in the sputum. The direct migration inhibition test with peripheral buff-coated leukocytes, is an easy and reliable correlate of delayed hypersensitivity to mycobacterial antigens in the human body. It is suggested that its use in individual patients could indicate changes in mycobacterial population, particularly after microbiological negativity has been obtained, and thus could be helpful in estimating the optimum duration of chemotherapy.


Further studies of mycobacteriophage 33D (Warsaw) for differentiation of BCG from M. bovis and M. tubeculosis. Mycobacteriophage 33D (Warsaw) was used to differentiate Bacille Calmette-Guerin (BCG) strains from M. bovis and M. tuberculosis. Known strains as well as clinical strains of BCG were used in the study. Single plaque isolations and adsorption studies demonstrated that phage 33D (Warsaw) did not adsorb to BCG cultures.


Comparison of serum and prostatic levels of tobramycin. Tobramycin sulfate, an aminoglycoside antibiotic, has been shown to be effective in the treatment of complicated urinary tract infections. Because of this, a study was undertaken to determine the penetrance of tobramycin into the prostate gland. It was found that the drug is concentrated at inhibitory levels in the prostate gland after the routinely recommended administration and should be useful in the treatment of bacterial prostatic infection.


Spermatic granuloma of vas deferens after vasectomy in rhesus monkeys and men: light and electron microscopic study. Spermatic granuloma of the vas deferens is a common complication of vasectomy which has received scant morphologic study. This study investigated the light and electron microscopic structure of such granulomas detected in rhesus monkeys (Macaca mulatta) and man after various modes of vasectomy and postoperative periods. Unilateral experimental vasectomy in monkeys was performed by either silk ligation or clasp occlusion; in 4 of 13 ligated animals and 5 of 5 clasp vasectomized animals granulomas developed at the site of fasectomy. In man, portions of the vas deferens were excised adjacent to the site of vasectomy preparatory to vasovasostomy. Of 5 patients studied, unilateral spermatic granulomas developed in 3. Such granulomas in both monkey and man were characterized by (1) masses of sperm surrounded by epithelioid cells and connective tissue, and (2) multiple epithelial-lined channels which often contained sperm and spermiophages. In both species, fine structural characteristics of the epithelium lining such channels closely resembled those of the principal cells of the normal vas. Spermiophagic cells included macrophages, epithelioid cells, and, in the monkey only, neutrophils. Lymphocytic invasion was a common feature of the human granulomas but was found only occasionally in the monkey granulomas. As a greater number of granulomas are studied in humans and monkeys, it is hoped that the processes underlying granuloma formation and the role of such granulomas in the development of complications after vasectomy will be clarified.


[Use of amikin for the parenteral feeding of patients after surgical interventions on the gastrointestinal tract organs]. A comparative study of the effectiveness of a home-made amino acide drug for nitrous parenteral feeding--amikin and Swedixh drug--aminosol hydrolysate was corried out in 84 patients operated upon gastrointestinal ograns. The effectiveness of the parenteral feeding was estimated on the grounds of the clinical condition of patients, their weight, state of nitrous balance, urinary excretion, of total amino and peptide nitrogen, blood urea nitrogen and ammonia.


The role of Pityrosporum pachydermatis in otitis externa of dogs: evaluation of a treatment with miconazole. The bacterial and mycotic flora were assessed in 158 ears of dogs with otitis externa and in 101 ears of healthy control dogs. Pityrosporum pachydermatis occurred in 57 per cent of ears with otitis externa and in 17 per cent of clinically healthy ears. Staphylococci and Pseudomonas aeruginosa were the predominant bacteria in otitic ears, micrococci and Bacillus spp were the most frequent isolates from clinically healthy ears. P pachydermatis, Ps aeruginosa and Candida tropicalis occurred in monoculture in a significant number of mainly chronic cases of otitis externa. A combination preparation, containing miconazole, polymyzin B and prednisolone, was highly effective in controlling the clinical signs of otitis externa and eliminating flora from the affected ears. The data presented suggest that yeasts, and especially P pachydermatis, may be significant pathogens in otitis externa and that antimycotic treatment is an essential part of the treatment of otitis externa in dogs.


[The bismuth-encephalopathy - a new pathological syndrome (author's transl)]. The publications concerning cases of bismuthencephalopathy seen in Australia, France, Switzerland and the Federal Republic of Germany are reported. The potential mechanisms of the development of this "new disease" are discussed.


Muscular sarcosporidiosis in the common European weasel, Mustela nivalis. Muscular sarcosporidiosis is reported for the first time in the common European weasel, Mustela nivalis. The morphology of the sarcocysts is described from fresh and stained histological preparations. Attempts to complete the sexual cycle of this mustelid parasite in a tawny owl, Strix aluco, are reported and the results discussed in the light of hypothetically likely sources of infection with muscular sarcosporidiosis for carnivores or omnivores, including man and other primates.


[Immunoglobulin content of the amniotic fluid and umbilical cord blood]. The content of immunoglobulins IgG, IgA and IgM and total protein in amniotic fluid and foetal serum of healthy pregnant women and of pregnant women with anti-D-antibodies has been determined by the single radial immunodiffusion and biuret method. IgG and IgA was detectable in all samples of amniotic fluid, whereas IgM was only present in 10 p.c. IgA increased in amniotic fluid to the end of pregnancy and it can indicate the maturity of fetus. The pregnant women with anti-D-antibodies have high IgG values in the amniotic fluid with the begin of 34th week of pregnancy.


[Individual and species interhemispheric asymmetry in animals]. Evidence of individual and species functional interhemispheric asymmetry (FIA) in animals is presented. Individual FIA was found in the majority of the experimental cats. The characteristics of individual FIA are defined. Several cases of species FIA are analysed: the dominance of the right fore-leg in hybrid mice, the dominance of the right hemisphere in albinos rats in differentiation of geometrical forms and the dominance of the right hemisphere in the EP amplitude of the cat's visual cortex.


[Analysis of the trends in typhoid-paratyphoid morbidity in the USSR]. Mathematico-statistical analysis of typhoid-paratyphoid infection morbidity in the USSR during 1900--1940 revealed a regular many-year cyclic recurrence of the changes in the morbidity level. The intensity of the morbidity level reduction at the periods of decline--in 1900--1917, 1920--1928, and in 1932--1939--was similar. A successive reduction of morbidity of this group of infections, by 6.45% on the average, annually, occurred in 1930--1976. The character of reduction of typhoid-paratyphoid infections morbidity level in the USSR during that period is well described by the exponential function.


[Ribosomal dysentery vaccine. III. An immunochemical and serological study]. Sh. sonnei rib oscmes, isolated by differential centrifugation, were previously shown to be highly protect ive against experimental keratoconjunctivitis in guinea pigs. Immunochemical study showed that ribosomal preparations were not uniform in their antigenic composition: as a result of immunoelectrophoretic analysis with the use of anti-ribosomal hyperimmune rabbit antisera, these preparations were found to contain up to 4 antigenic components with different migration rate. The anodic component with the highest elections obtained by the method of Boivin and Grasset and could be inactivated at 60 degrees C or by treatment with trypsin or RNA-se, which suggested its ribonucleoprotein nature. The second thermolabile antigenic component was found to have a moderate anodic mobility and, judging by the results of enzymatic treatment, seemed to be protein. Other antigens with low mobility were resistant to trypsin and RNA-se; one of them, forming a weak precipitation line, could be identified as endotoxin by its antigenic specificity. The use of tanned and ribosome-coated erythrocytes allowed to determine the level of antiribosomal antibodies in the passive hemagglutination test and to evaluate the serological activity of ribosomal preparations in the hemagglutination inhibition test (the minimum inhibiting concentration of ribosomes was 1--2 microgram/ml). The specificity of serological reactions was mainly determined by a highly mobile nucleoproteid component.


[Importance of humoral immunity indices in determining the Rickettsia prowazekii carrier state]. Experiments showed the possibility of making indirect conclusions concerning rickettsial carrier state by the method of determination of complement-fixing antibodies to R. prowazeki in the blood serum. Though not indicative of carrier state in individual animals, these antibodies, their dynamics and titers gave the evidence of group carrier state in cotton rats in respect of the causative agent of typhus. The number of animals carrying R. prowazeki increased with the rise of antibody titers. Negative seroconversion indicated the elimination of the causative agent from the body of the animal. The experimental results were confirmed by the data on the dynamics of the immunological structure of population, as well as by information contained in the literature on this problem.


[Problems of the immunoprophylaxis of experimental Pseudomonas pyocyanea wound sepsis]. An experimental study showed that a multicomponent Pseudomonas aeruginosa preparation, developed by the authors and named "Pyoimmunogen", had a pronounced protective effect against the culture of P. aeruginosa, most frequently isolated in surgical clinics. The immunization of rats carried out in accordance with a specially devised scheme allowed to decrease mortality rate in experimental pyocyanic wound sepsis to 6.9%, whereas in the control animals mortality rate reached 91.5%.


[Biological characteristics and the morphology of human and animal central nervous system tissue in organ culture]. It is shown that in using the method of multiple organ cultivation, the tissues of the CNS in the human and animal embryo preserve their organotypical characteristics. The use of a cartilage plate increases the viability of the tissues and the duration of its maintenance in cultures. During the process of explantation the cultivated tissue undergoes some morphological modifications. The data obtained are discussed in the light of a possible use of the CNS cultures for experimental purposes.


Familial thyroxine-binding globulin deficiency in association with non-toxic goitre. A kindred is presented in which 4 members in 3 generations showed absent or reduced serum concentrations of thyroxine-binding globulin (TBG). TBG was undetectable by radioimmunoassay in one male and decreased to varying extent in 3 female patients (4.0, 4.2 and 8.6 microgram/ml; normal range 12.5--26.0 microgram/ml). Total thyroxine serum concentrations in the affected subjects were well in the hypothyroid range without clinical evidence of hypothyroidism. The mode of transmission of the trait was consistent with X-chromosome linkage. A high incidence of non-toxic goitre was also present in most of the family members examined irrespective of TBG levels. The transmission of the goitre trait was compatible with autosomal dominant inheritance. Thus its association with transmission of TBG deficiency was interpreted as not causal but coincidental.


[Hypothalamic peptide hormones].

[Hypothalamic peptide hormones]. After a review of the significance of the releasing and inhibiting polypeptide hormones of the hypothalamus, the clinical significance of the gonadotropin-releasing-hormone and the thyrotropin releasing hormone, is discussed in detail.


[Stimulation of prolactin secretion by drugs]. Intravenous administration of metaclopramide and cimetidine provokes an immediate rise in serum prolactin concentration. The results are compared with the response of serum prolactin to arginine, insulin and TRH.


Islet transplantation in diabetic rats. Long-term follow-up of glucose tolerance. Inbred Lewis rats made diabetic by streptozotocin were transplanted with 430-870 islets from syngenic donors via the portal vein. Though fasting plasma glucose was normal, the tolerance to glucose given intraperitoneally (IPGTT) or orally (OGTT) remained impaired one month after transplantation. The higher the number of islets, however, the better the glucose tolerance. The results of IPGTT and OGTT in each animal correlated. Fasting plasma insulin levels were within the normal range suggesting that the action of insulin on the liver and its degradation by the liver is impaired due to the limited number of hepatocytes subjected to high insulin concentrations. Eight months after transplantation, the plasma insulin and glucose responses to OGTT were still unchanged while those of the less physiological IPGTT were worse. Thus, the functional capacity of the transplanted endocrine tissue does not appear to change with time.


Disodium chromoglycate therapy in perennial rhinitis. DSCG was tested on 38 patients with perennial rhinitis in the form of a nasal spray (2%)in a double-blind cross-over trial. Few of the investigated parameters in the whole material showed any significant preference of DSCG. A marked drug order effect was shown; in the group receiving placebo first, most of the clinical parameters assessed both by the clinician and the patient were better for DSCG. A therapeutical trial with DSCG is worth trying in perennial rhinitis.


DSCG eye drops in allergic rhino-conjunctivitis. Thirty patients with allergic rhinoconjunctivitis were treated with eye drops containing 2% DSCG during the pollen season of 1977. Sixteen patients were treated with active substance and 14 with placebo. The results show a statistically significant difference in favour of the DSCG drops. DSCG in eye drops seems to be a valuable complement to the drugs available today for the treatment of allergic rhinoconjunctivitis.


Formation of cadaverine in the pregnant rat. The formation as well as the content of cadaverine were determined in different tissues of pregnant and non-pregnant rats. The placenta and ovary were most potent in the ability to form cadaverine. To our knowledge this is the first report of an in vitro formation of cadaverine linked to a normal physiological process, i.e. pregnancy. The highest concentration of cadaverine was found in the placenta and ovary of the pregnant rat. Treatment with aminoguanidine generally elevated the content of cadaverine, indicating a role of diamine oxidase as a regulator of diamine content.


Ossification of femoral head in infancy. II. Ossification in infants treated for congenital dislocation. A review of the films obtained in 124 infants conservatively treated for congenital dislocation of the hip revealed deviations from ordinary development of the femoral head before as well as after the treatment. Analysis of these deviations suggested initial acceleration of ossification, modified by retardation ipsilateral to dislocation and followed by bilateral deceleration of growth after treatment.


Hip joint instability after the neonatal period. I. Value of measuring the acetabular angle. The acetabular angle was measured by two independent observers in a consecutive series of 29 infants with idiopathic instability of the hip. The diagnosis was made at the age of 1 1/2 to 21 months, and was confirmed by arthrography. The average difference in the measurement values between the two observers was less than 2 degrees. In infants with unilateral instability the acetabular angle was always greater on the unstable side. This difference decreased after treatment. Criteria for pathologic angles are discussed. Measurement of the acetabular angle is of greatest value for assessing the effect of treatment, but is of limited usefulness in diagnosing instability, especially during the first 6 months of life, as the cartilaginous component of the joint is not included in the measurement. Arthrography is recommended in cases difficult to evaluate.


Spondylometaepiphyseal dysplasia in a mother and her child. Variant types of spondylometaepiphyseal dysplasia in a mother and her child is reported. Several stages of the disorder are presented, demonstrating the principal difficulties in distinguishing variant types of skeletal dysplasia.


Immunochemical studies in a patient with Waldenstrom's macroglobulinemia. Waldenstrom's macroglobulinemia was studied in a 46 year old Iranian male with anemia, bleeding, ecchymose and splenomegaly. The diagnosis of Macroglobulinemia was established by the presence of very high level of IgM paraprotein in sera which was detectable by immunoelectrophoresis and rocket immunoelectrophoresis, and by the presence of bone marrow infiltration of plasmocytes. Family studies revealed a high IgM level in one of the patient's daughters.


Percutaneous catheter drainage of abdominal abscesses guided by ultrasound and computed tomography. Ultrasonography and computed tomography were used to diagnose, localize, and guide the percutaneous drainage of 24 intraabdominal and retroperitoneal abscesses in 23 surgical and medical inpatients 16 of whom had abscess formation as a postoperative complication. On the basis of anatomic detail from sectional imaging, safe percutaneous drainage routes similar to surgical approaches were defined. After confirmation by needle aspiration, one of two methods of percutaneous catheter introduction were used: (1) a modified Seldinger technique for placement of an 8 French pigtail catheter and (2) a trocar catheter technique for placement of a 12 or 16 French catheter. Once in position, the catheters were managed as a surgically placed drain. In 22 of 24 cases, percutaneous catheter drainage was curative with no surgery required. There were no deaths or recurrences with an average follow-up period of 12 months ranging from 1 week to 3 years. Percutaneous aspiration and drainage should be considered as an alternative to surgery in the treatment of intraabdominal or retroperitoneal abscess.


Gray scale ultrasound: evaluation of iliopsoas hematomas in hemophiliacs. Because of its insidious nature, intramuscular bleeding, in contrast to hemarthrosis, is missed or belatedly recognized in hemophiliacs. Sixteen patients with suspected iliopsoas bleeding were studied by gray scale ultrasonography. In 12 patients it was possible to confirm the diagnosis of iliopsoas hematoma because of enlargement and rounding of the psoas muscle.


Ultrasonic differentiation of types of ascitic fluid. A review of 65 cases of proven ascites was done to assess the accuracy of ultrasound in distinguishing transudates from exudates. In 10 patients with malignant ascites, ultrasound suggested this in six by showing matted bowel loops, loculation, or hepatic metastasis. In each of the five patients with peritonitis, infected ascites was suggested by observing septations or debris within the fluid. A sonographic diagnosis of exudate was not made in any of the 50 confirmed transudates. The echographic characteristics which may suggest infected or malignant ascites are discussed.


Fine needle aspiration biopsy of osteolytic metastatic lesions. The use of fine needle aspiration biopsy of solitary osteolytic-type bone metastases in 24 patients is described. A positive diagnosis of malignancy was obtained in 21 patients, as the softness of the osteolytic lesion yielded enough cell material for cytologic examination. No complications were encountered. The procedure can be performed with ease, even on an outpatient basis, without discomfort to the patient.


Accuracy of ultrasonography in diagnosis of hepatocellular disease. Retrospective evaluations were made of abdominal echograms in 61 patients who underwent liver biopsy within 3 weeks after ultrasound study. Without knowledge of clinical or biopsy data, determinations were made by two independent observers of: (1) liver size, (2) beam penetration, (3) echogenicity, (4) vascularity, (5) ancillary abnormality, and (6) diagnostic impression. Using these parameters, the presence of generalized parenchymal disease was identified in 81% of reviews of patients with cirrhosis. Thus, in patients with known cirrhosis, there was a 19% false negative rate. In normal patients, 76% were correctly called normal by the reviewers. However, in 24% generalized parenchymal disease was suggested (24% false positive). Patients with fatty liver could not be reliably distinguished from patients with cirrhosis, nor could patients with hepatitis be easily separated from those with normal livers. In all of these determinations, the combination of several features provided more diagnostic accuracy than any single echographic finding.


Terminal phalangeal tufts: earliest site of renal osteodystrophy findings in hemodialysis patients. Direct magnificaiton of the hands of 44 patients on maintenance hemodialysis showed that the earliest unequivocal changes of renal osteodystrophy occur in the tufts. Some workers made a similar observation, but no previous objective study confirmed or refuted the sensitivity of the tufts in the diagnosis of renal osteodystrophy. The macroradiograph is consistently reproducible and serves as an excellent visual record of subtle changes.


Orbital venography in painful ophthalmoplegia (Tolosa-Hunt syndrome). Twenty-six patients with painful ophthalmoplegia were classified as having the Tolosa-Hunt syndrome on the basis of their clinical findings and response to steroid therapy. All patients underwent orbital venography, a review of which forms the contents of this investigation. Orbital venography, a review of which forms the contents of this investigation. Orbital venograms were normal in 16 patients and abnormal in 10. The major abnormalities were (1) obstruction of the superior ophthalmic vein in its third segment without displacement; (2) collateral venous flow through small venous channels or collateral veins; and (3) poor opacification of the ipsilateral cavernous sinus.


Simplified plain film screening examination for erosive otitis media. A simplified plain film examination for erosive otitis media was evaluated in 202 ears. In most of the operated cases (86.5%), a perorbital anteroposterior and an oblique lateral were sufficiency for diagnosis. Considerable attention should be paid to the configuration of the attic-antrum area, and in particular the presence or absence of Körner's septum (the petrosquamous suture).


Initial chest radiography in the neonatal intensive care unit: value of the lateral view. This study was designed to assess the diagnostic efficacy of the routine lateral chest film in symptomatic newborn infants. The initial anteroposterior chest film was supplemented by alateral view in 53 consecutive patients on admission to the newborn intensive care unit. Subsequently three radiologists and two neonatologists performed independent analysis of the anterposterior films with and without the lateral view. A total of 530 observations were tabulated. Assessment of degree of lung inflation and discovery of abnormalities of the heart, mediastinum, and trachea were unaffected by the use of the lateral radiograph. A correct primary diagnosis was made in 74% of all cases by the anteroposterior chest film alone and in 71% by the anteroposterior/lateral series. Degree of confidence in the primary diagnosis did not change when the lateral chest radiograph was added. There was no appreciable difference in detection of complicatins of the primary disease in either series. We conclude that the risks (e.g., radiation and environmental disturbance) of the routine admission lateral chest radiograph are substantially greater than any benefits to be gained.


Reduced lung volume associated with acquired pulmonary artery obstruction in children. The effect of postnatal pulmonary artery obstruction on lung growth has not previously been reported. This report describes two patients in whom pulmonary artery banding in early infancy was complicated by complete occlusion of the right pulmonary arter. In each case, the right lung became less voluminous than the left. In one patient, the alevoli of the affected lung were found to be smaller than normal at autopsy. In the other patient, surgical reconstitution of pulmonary arterial flow resulted in a return to normal volume of the affected lung. Observations suggest that pulmonary arterial flow should be restored as early as possible to minimize impairment of lung growth and to avoid irreversible pulmonary hypertension in the opposite lung.


Membranous laryngotracheobronchitis (membranous croup). Membranous laryngotracheobronchitis (membranous croup), not previously described as a distinct entity, is characterized by diffuse inflammation of the larynx, trachea, and bronchi with adherent or semiadherent mucopurulent membranes in the subglottic trachea (conus elasticus) and in the upper trachea distal to the conus elasticus. We reviewed 28 cases of membranous croup diagnosed by endoscopy and/or radiographic examination. The importance of the recognition of membranous croup as a distinct entity is discussed. The characteristic radiologic findings consist of subglottic tracheal narrowing, irregularity of contour of the proximal tracheal mucosa, and sometimes detached or partially detached proximal tracheal membranes, which can be mistaken for tracheal foreign bodies.


Pulmonary manifestations of Mycobacterium intracellularis. Pulmonary manifestations in 114 patients with at least two sputum cultures positive for M. intracellularis, no history of any kind of tuberculosis, and not other potential pathogen are described. Even with these stringent diagnostic criteria, seven patients had normal chest radiographs and another seven had reticulonodular-appearing disease without a definite focus of infection. In the other 100 patients, 92% had infiltrates in the apical and/or posterior segments of the upper lobes, and 88% had cavitary disease. The cavities were usually multiple and frequently measured over 4 cm. Scarring and volume loss were common, occurring to some degree in 70% of upper lobe foci. Pleural effusions were uncommon (5%) and usually small. Adenopathy was less common (4%) and usually occurred with upper lobe disease in younger patients. Most patients had some degree of endobronchial spread (81%). The radiographic characteristics of Mycobacterium intracellularis are not believed distinctive enought to differentiate it from Mycobacterium tuberculosis.


CT demonstration of cardiac structures.

CT demonstration of cardiac structures. Cross-sectional cardiac anatomy was studied by computed tomography (CT) in normal patients and in patients with well documented cardiac pathology. Specific cardiac chambers, aortic and pulmonary artery enlargement, ventricular aneurysms, coronary artery, and intracardiac calcifications were demonstrated using a 3 sec scan time with and without intravenous iodinated contrast media. Although CT imaging of the heart is in its infancy, the clarity with which cardiac chambers and other structures were visualized is encouraging and suggests the potential value of CT scanning for detecting significant intracardiac pathology on routine thoracic CT scans.


The hypernephroma halo.

The hypernephroma halo. Most renal adenocarcinomas (hypernephromas) are characterized histologically by a dense, avascular, fibrous capsule. This capsule is rare or nonexistent in other benign or malignant renal tumors. The capsule was identified as a thin radiolucent stripe surrounding parts of the tumor periphery in 30 renal angiograms performed on a group of 70 patients with pathologically proven hypernephromas. Only one of 65 normal kidneys and 137 other benign or malignant renal tumors or pseudotumors exhibited angiographic evidence of this lucent stripe. This stripe is therefore referred to as the "hypernephroma halo." Its identification on an excretory urogram is occasionally possible; in five patients it was recognized prior to angiography suggesting the lesion causing it is a hypernephroma.


Intraabdominal abscess: current concepts in radiologic evaluation. Forty patients with suspected abdominal abscess had computed tomography (CT) and plain film examinations; 15 also had ultrasound study. CT was found to be the most consistently accurate examination, both for the detection of abscess and evaluation of its extent. Ultrasound was positive in a high percentage of cases in which it was used. Although plain films correctly suggested the presence of an abscess in over half the proven cases, confirmatory evidence from CT or ultrasound was often required to persuade clinicians of the presence of an abscess and to provide detailed information regarding its extent and configuration.


Evaluation of nuclear imaging for detecting posttransplant fluid collection. A series of 26 renal allograft recipients studied by both B-mode gray scale ultrasonography and 99mTc DTPA renal nuclear imaging was reviewed. All conclusions were based on written reports generated at the original examination, and B-mode gray scale ultrasonography was considered the definitive examination for fluid collection detection. Sensitivity of nuclear imaging for the detection of fluid was 73%; however, it becomes 85% when fluid collections in close proximity to the bladder are excluded. Renal allograft nuclear imaging is a useful examination for primary detection of lymphoceles and also for demonstrating abnormalities in renal dynamics and drainage.


"Contrast buttle": a sign indicating perforation of the digestive tract. Bubble formation outside the digestive tract that correlated with small perforations was observed in two infants during water-soluble contrast material studies using a 50% solution of Gastrografin in water. The causes of extraluminal bubbles are discussed; in vitro experiments demonstrated the mechanism of formation and the radiographic characteristics of the various types of bubbles. Extraluminal bubbles appearing during a water-soluble contrast material examination actually represent contrast bubbles. The radiographic density of the bubble walls varies. When the bubbles are small and diluted contrast material is used, it is not possible to detect the presence of contrast material radiographically. Contrast material bubbles are likely to be observed only if a low surface tension contrast agent is used, such as Gastrografin full- or half-strength in water). Extraluminal contrast material bubble formation may identify and localize a small perforation of the gut when other findings are inconclusive.


A new look at pattern recognition of diffuse pulmonary disease. The common practice of describing the histologic distribution of pulmonary lesions from their radiographic patterns is often inaccurate. Recognition of disease entities is more successful if a given pattern is analyzed for its probable causes, rather than by attempting to predict its microscopic distribution. This represents a change in attitude toward the correlation of the radiographic and pathologic findings in disseminated diseases of the lung. The objective of this communication is to enable radiologists to become more secure in recognizing diffuse pulmonary patterns, to understand the shortcomings of this approach, and to stop trying to predict microscopic distribution from the chest radiograph.


Radiographic features of recurrent intrathoracic Hodgkin's disease following radiation therapy. Of 254 consecutive, surgically staged, IA-IIIB Hodgkin's disease patients treated at the Joint Center for Radiation Therapy between April 1969 and July 1976, 21 developed intrathoracic relapses. This study evaluated the radiographic features of relapse in these 21 patients. The superior mediastinum (nine patients) and the lung parenchyma (10) were the most frequent sites of involvement. In contrast to patients who initially had Hodgkin's disease, extranodal lung relapses were not associated with radiographically detectable relapses in the hilum or mediastinum. The appearance of the pulmonary relapses included both single and multiple nodules, with or without cavitation, and with both sharp and irregular margins. Due to this nonspecific appearance at relapse, tissue should be obtained in patients suspected of having recurrent Hodgkin's disease.


Fatty tumors of the thorax demonstrated by CT. The radiographic signs previously described for fatty tumors of the thorax although helpful are nonspecific. In the past, the diagnosis of benign fatty tumors of the chest in asymptomatic patients required surgical intervention. This report illustrates the gamut of fat-containing tumors of the thorax encountered over a recent 1 year period. CT proved to be helpful in the diagnosis and management on these cases. When the CT numbers of the fatty lesion was around -55 EMI units, intervention was felt to be unnecessary. However, when the CT number of the mass ranged from --10 to--20 EMI units, intervention was felt to be necessary since a malignancy could not be excluded on the basis of the CT findings alone.


Upper airway obstruction during sleep in children. Cinefluoroscopic findings are described in nine children with sleep-related upper airway obstruction who are asymptomatic while awake. Asleep, these patients show strikingly similar changes in the region of the hypopharynx. During inspiration, the tongue and hypopharyngeal soft tissues are approximate, obliterating the hypopharyngeal air space causing intermittent and almost complete obstruction to air flow. The value of cinefluoroscopic studies on sleeping children with clinical symptoms of airway obstruction during sleep is emphasized.


Plain film diaphragm view as adjunct to full lung tomography. Full lung tomography with the addition of a plain film diaphragm view was performed on 319 patients. Information not evident on tomography was found on the additional view in 13% of the cases. The plain film diaphragm view is recommended as a simple and inexpensive adjunct to linear and pluridirectional full lung tomography.


Intraperitoneal contrast infusion for assessment of intraperitoneal fluid dynamics. For patients undergoing intraperitoneal ("belly bath") chemotherapy, it is useful to verify the distribution of infusion fluid. For this reason, 10 patients were examined by computed tomography (CT) after intraperitoneal instillation of dialysate mixed with water soluble contrast material. The extent of intraperitoneal distribution was assessed, and in two patients filling defects, presumably representing tumor, were identified.


Significance of a dilated pancreatic duct on CT examination. The infrequency of reports demonstrating dilatation of the pancreatic ducts in patients with chronic pancreatitis by CT, despite its frequent demonstration on endoscopic retrograde cholangiopancreatography (ERCP), prompted a review of 500 cases performed at the University of Miami School of Medicine/Jackson Memorial Hospital for suspected pancreatic disease. Pancreatic duct dilatation was demonstrated in 10 patients. An equal occurrence was documented in patients with chronic pancreatitis and with carcinoma. Therefore, the presence of dilated pancreatic duct only confirms the presence of pancreatic disease. No etiology should be favored by the isolated finding of a dilated duct on CT scanning.


Tuberculosis of the transverse colon.

Tuberculosis of the transverse colon. Segmental tuberculosis of the transverse colon is very rare and when present is usually associated with active pulmonary tuberculosis. These patients may have initial symptoms suggestive of neoplasm or of Crohn's disease. Radiographically the lesion manifests itself as a fairly long area of narrowing with nodular and ulcerated mucosa. Sinuses and fistulae may arise from the area of involvement. These changes are not specific for tuberculosis. The lesion is unpredictable. It may respond to medical therapy, but complications such as bleeding and sinus tract formation may require surgical intervention.


Medial indentation of the duodenal sweep by common bile duct dilatation. The dilated common bile duct has long been recognized as a cause for a smooth, tubular impression across the duodenal bulb or immediate postbulbar duodenum. Only scattered references suggest that a smooth indentation on the medial aspect of the descending duodenum might also be due to an enlarged, tortuous common duct. Three cases of this condition are reported. The dilated common duct impression can mimic a pancreatic mass. While computed tomography, ultrasonography, or transhepatic cholangiography readily suggest the true diagnosis, potential pitfalls in patient management are possible when the first radiographic procedure is an upper gastrointestinal series.


Retroperitoneal fibrosis: ultrasound and CT features. The sonographic and computed tomographic (CT) findings in three cases of retroperitoneal fibrosis are illustrated. Its clinical, laboratory, and conventional radiographic findings are often nonspecific. The sonographic findings consist of an extensive retroperitoneal, extrarenal, anechoic, well marginated, and irregularly contoured mass. Computed tomography depicts a paraspinal, extrarenal, and well marginated lesion that is isodense with the surrounding muscles. Through other abnormalities present similar sonographic and CT findings, the differential diagnosis is limited so that correlation of the clinical and radiographic changes allows a preoperative diagnosis with high confidence.


Transvenous xeroarteriography: noninvasive method for demonstrating peripheral arteries. Xeroradiography allows visualization of peripheral arteries after intravenous injection of relatively low quantities of contrast medium. By means of a special changer, several exposures are chosen according to standardized programs. Determination of the arrival time of the contrast medium after its passage through the heart and the lungs is not necessary. The method has proved effective in demonstration of localized vascular lesions and evaluation of postoperative status and soft tissue tumors. Transvenous examinations of 237 patients are reported.


Double aortic arch anomalies: diagnosis by countercurrent right brachial arteriography. The clinical, radiologic, angiographic, and operative findings in 15 patients with double aortic arch are described. In five patients, both arches were functional; in the other 10, a portion of the left arch was atretic. Depending on the location of the atretic segment, the anomalies were classified into types A, B, and C double aortic arch. We considered an additional type D double aortic arch which as yet remains a theoretical possibility. With the help of refined angiographic signs obtained by countercurrent right brachial angiography and on the basis of clinical and radiologic signs of tracheoesophageal compression, the differential diagnosis among various types of double aortic arch and right aortic arch anomalies was improved.


Diverticulosis of the left ventricle.

Diverticulosis of the left ventricle. Nine patients, 4--60 years old, had single or multiple left ventricular outpouchings, best seen during diastole, and believed to represent congenital diverticula. The 14 diverticula, 5--28 mm long, were either along the diaphragmatic or anterior ventricular wall. Only one patient had his diverticulum surgically removed; the wall was lined by thick endocardium surrounded by normal myocardium. The lesions did not produce local or systemic complications. All patients had normal chest radiographs. The material suggests that left ventricular diverticula not associated with midline anomalies are perhaps not very rare and should be distinguished from cardiac aneurysm.


Incidence and distribution of venous extension in 70 hypernephromas. Angiographic, surgical, and pathologic observations of 70 patients with single hypervascular renal cell carcinomas were reviewed. To correlate size and location with extension into the renal veins or inferior vena cava, the tumors were divided into three groups on the basis of size. Of the 32 group 1 tumors (3--5 cm), four showed venous extension. Three involved only the right renal vein, while one extended through the right renal vein into the inferior vena cava. Of the 24 group II tumors (5--7cm), 12 showed venous extension. Only one of these was confined to the right renal vein, while 11 extended through the renal vein into the inferior vena cava. Eight of the 13 group III tumors (greater than 7 cm) showed venous extension. Three of these were confined to the renal vein, while five extended through the right renal vein into the inferior vena cava. This investigation indicates that venous extension is more frequent with tumors of the right kidney and with tumors of larger size.


Spinal computed tomography: limitations and applications. A comprehensive review of 188 spinal computed tomography (CT) scans done over a 9-month period was performed to establish both the shortcomings and applications of the technique. The value of intrathecal enhancement was reviewed in an attempt to establish indications for its use. The data base comprised 51 abnormal scans including cases of spinal trauma, dysraphism, intra- and extraspinal neoplasm, and spinal stenosis. Results indicate that: (1) the introduction of intrathecal contrast media greatly extends the morphologic capabilities of spinal CT in practically all cases where altered anatomy of the spinal canal and its contents is suspected; (2) conventional screening procedures such as plain films of the spine and myelography should be obtained prior to spinal CT in most cases because of their value in defining the location and longitudinal extent of the pathologic process; (3) spinal CT examinations tailored to specific areas of interest result in better characterization of traumatic, dysraphic, and stenotic conditions conceivably leading to better surgical management and more accurate prognosis. At present, spinal CT has its greatest diagnostic usefulness in the evaluation of trauma and its sequela.


Anterior cervical subluxation: an unstable position. The radiologic signs of cervical anterior subluxation are subtle. Even when recognized, the injury may not be considered significant. However, anterior subluxation is the most unstable cervical spinal injury. The two case histories illustrate instability of the cervical spine in this type of injury. The radiologically diagnostic features on the lateral radiograph are described and the recognition of instability on mobility studies is discussed.


Synovial hyperemia in giant cell tumor of bone: angiographic pitfall. Arteriography has been found useful in the clinical staging of giant cell tumors of bone in its capacity to demonstrate the presence and extent of soft tissue, extraosseous extension of the tumor. A potential source of error is the presence of hyperemic synovial tissue that may closely resemble tumor vascularity, and therefore be confused with tumor extraosseous extension. Of the 48 giant cell tumors in this series, 21 demonstrated extraosseous vascularity representing synovial hyperemia. Two patients were considered to have extraosseous tumor extent but only hypertrophic synovial tissue was found at surgery. The angiographic features of synovial hyperemia are outlined.


Choroid plexus of the fourth ventricle: a useful CT landmark. The choroid plexus of the fourth ventricle is a sensitive, symmetrical CT landmark which can often be visualized in overlapped scans performed in the orbital plane during rapid infusion of a high dose of iodinated contrast substance. Normal and pertinent abnormal plexus configurations are described and illustrated.


Uterine cervical cancer: treatment with megavoltage radiation results and afterloading intracavitary techniques. Results were evaluated for 651 consecutive patients with invasive cancer of the intact uterine cervix. From 1963 through 1967 319 patients were treated primarily with the older Los Angeles County Hospital system of orthovoltage radiation and intracavitary radium therapy. Thereafter, 1968--1974, 332 patients were treated primarily with a newer modified M. D. Anderson Tumor Institute system of megavoltage radiation and afterloading intracavitary radium therapy. Age distribution and histology were similar for both groups, but clinical stage was slightly more advanced for patients treated earlier. Crude and net 5 year survival rates were 36% and 49% for the early group and 54% and 67% for the later group. Net 5 year survival rates for the earlier group by stage were: stage I, 74%; II, 62%; III, 23%; and IV, 6%. Survival rates for the later group were: I, 81%; II 76%; III, 50%; and IV, 15%. We believe this improvement can be attributed to more effective intracavitary radium therapy for handling local cancer and to delivery of cancericidal doses of radiation to regional nodes with the megavoltage radiation apparatus, as well as to the greater cooperative efforts put forth in the management of County Hospital patients.


Occult thyrotoxicosis: a correctable cause of "idiopathic" atrial fibrillation. Serum total thyroxine, triiodothyronine and thyrotropin response to thyrotropin-releasing hormone were measured in 75 consecutive patients presenting to a cardiology clinic with atrial fibrillation with no obvious cardiovascular cause. A lack of response of serum thyrotropin to thyrotropin-releasing hormone, indicative of thyrotoxicosis, was found in 10 patients (13 percent), not all whom had raised serum thyroid hormone levels. These 10 patients were predominantly male, had no clinical signs of thyrotoxicosis and a relative excess of nonpalpable autonomous thyroid nodules demonstrated with scintigraphy. Eight of the 10 patients had reversion to stable sinus rhythm after treatment with iodine-131 or carbimazole, either spontaneously or after direct current cardioversion. It would appear that clinically occult thyrotoxicosis can be identified consistently only with the thyrotropin-releasing hormone test and is the cause of "idiopathic" atrial fibrillation in a significant proportion of patients.


Body composition in middle-aged women with special reference to the correlation between body fat mass and anthropometric data. A variety of anthropometric measurements was made in a randomized population sample of middle-aged women in five age strata in whom body composition was estimated from total body potassium and total body water determined by whole body counting and isotope dilution technique, respectively. No significant differences with age were found for total body potassium or total body water. A significant age difference was found for body fat mass. Simple linear correlations between anthropometric variables and body fat mass estimates were found to be 0.90, 0.86, 0.77 for body weight, buttock circumference, and sum of triceps and subscapular skinfold thicknesses, respectively. Multiple regression analysis showed that these three variables accounted for 80 to 91% of the variation in body fat in the different age strata studied. Multiple regression equations for prediction of body fat from anthropometric variables are given. In about two-thirds of the subjects, the difference between predicted body fat mass and estimated body fat mass was found to be less than +/- 2.5 kg.


Blood selenium and glutathione peroxidase activity in normal subjects and in surgical patients with and without cancer in New Zealand. This study was carried out in Otago, South Island, where most arable land has a low soil selenium content (less than 0.5 microgram/g) and where selenium (Se) responsive diseases in livestock are common. Se concentration in whole blood, erythrocytes and plasma, and activity of glutathione peroxidase (EC 1.11.1.9) were measured in blood from 104 healthy Otago residents, 80 patients with cancer and 66 noncancer surgical patients. The older residents over 60 years had lower blood Se levels (0.047 +/- 0.010 microgram Se/ml blood) than the young and middle-aged (0.060 +/- 0.012 microgram Se/ml). Blood Se levels of cancer patients were no lower than those of elderly subjects and patients without cancer, and were less than half comparable United States values. Blood Se levels were decreasing in two cancer patients, and the lowest values (less than 0.03 microgram Se/ml blood) were obtained for five cancer patients, and two noncancer patients after a long period of inanition; these were similar to values for patients on parenteral nutrition with negligible intakes. Lower blood Se levels were associated with lower serum albumin and enzyme activities. It is suggested that low Se status of cancer patients was more likely a consequence of their illness than the cause of the cancer.


A comparison of essential and general amino acid infusions in protein-depleted patients receiving parenteral alimentation. Six malnourished patients were studied during intravenous nutrition therapy to compare the efficiency of essential and general amino acids when given as the sole nitrogen source during intravenous nitrogen therapy. A cross-over design was used so that each patient received both essential amino acids plus arginine and histidine and a general amino acid solution in random order. Glucose provided the remainder of the energy and both infusions contained 2 g of amino acid per 100 kcal. Each patient's daily urea nitrogen production was greater during infusion of the general amino acid solution. Consequently, nitrogen intake minus urea nitrogen production was significantly greater when the essential amino acid solution was infused. Plasma amino acid levels were determined on each patient during both essential and general amino acid infusion. Abnormalities tend to reflect the composition of the amino acid solutions as well as their administration directly into the systemic circulation bypassing the portal circulation.


Simultaneous and consecutive administration of nutrients in parenteral nutrition. In seven patients, six with Crohn's disease and one with pancreatitis, two methods of parenteral nutrition were compared: the partial consecutive administration of the components of a parenteral nutrition regimen versus the administration of all nutrients simultaneously. With respect to the consecutive regimen, the simultaneous infusion regimen gave an improvement in the nitrogen balance of 13% and a decrease in urinary lactic acid of about 50%. Urinary excretion of alpha-amino nitrogen, glucose, and fructose was very small in both cases but was slightly lower during the simultaneous infusion regimen. The improvement in the nitrogen balance attained with the simultaneous infusion regimen can be explained by the fact that infused nutrients, especially carbohydrates, cause fewer metabolic disturbances. The simultaneous infusion regimen has three other advantages. The patients rarely complain of headache and nausea, the infusion regimen is markedly simplified and the risk of contamination when nutrients are added to the infusion bottles in the ward is considerably diminished.


Assessment of protein nutrition in surgical patients--the value of anthropometrics. In order to evaluate the reliability of anthropometry in assessing protein stores we have compared, in 10 normal adults and 82 surgical patients with varying degrees of weight loss, measurements of weight/height, arm circumference, arm muscle circumference, and arm muscle area with direct measurements of body nitrogen using in vivo neutron activation analysis. Anthropometry is reliable for the assessment of protein nutrition in groups of patients (for 100 patients 95% confidence limits are +/- 30 g nitrogen) but the magnitude of variance shown makes it inappropriate for assessing the individual as a single measurement (95% confidence limits are +/- 300 g nitrogen). Repeat measurements were made after 2 weeks on 35 patients and there was no correlation between changes in body nitrogen and changes in the anthropometric measurements. Anthropometry is not reliable in following changes in body nitrogen in individual patients over short periods of time.


Properties of a cytotoxic kidney antibody associated with human renal transplantation. A technic for demonstrating a complement-dependent cytotoxic response specific for human kidney cells was developed. Positive and negative sera from kidney-transplant recipients were subjected to several assay and adsorption procedures. The cytotoxic antibody reaction appeared to be specific against human kidney in tests with a variety of target cells. Manifestation of the typical cytotoxic effect depended on kidney explant target-cell surface changes following attachment, outgrowth, and dispersion of the first passage monolayer. A comparison of serum responses to lymphocytes and to kidney cells indicated that the cytotoxic response by human kidney cells is not related to the lymphocytotoxic antibodies associated with the HLA system.


An investigation into the distribution of radial immunodiffusion quality control data. Quality control data from routine radial immunodiffusion assays for IgG, IgA, IgM, C3, C4 and alpha1-antitrypsin were tested by the Kolmogorov--Smirnov procedure for gaussian distribution. All but alpha1-antitrypsin were nongaussian in type. Further analysis of these date by plotting on log-normal probability paper showed them to have a log-normal distribution. Treatment of the date by either gaussian or nonparametric statistical methods produced little difference in confidence limits. It does not appear necessary to use nonparametric methods to calculate confidence limits from quality control data for the procedures studied.


The type and antibody screen, revisited. The type and antibody screen is a safe, economical substitute for "routine" two-unit crossmatch in those elective surgical procedures rarely necessitating blood transfusion. This report confirms a previous finding that the type and antibody screen is 99.99% effective in preventing the transfusion of incompatible blood. The type and antibody screen is even safer than the stated 99.99%, when the immediate spin, saline and albumin procedures (the initial portion of the authors' complete crossmatch) are performed prior to releasing blood in an emergency situation. The immediate spin procedures not only verify the ABO compatibility but also detect any high-titer antibodies directed against low-incidence antigens that might not have been present on the screening reagent erythrocytes. The use of the type and antibody screen is applicable only in those medical facilities that have moderate reserves of blood readily available for transfusion.


A guideline for anticipated blood usage during elective surgical procedures. A realistic guideline for transfusion therapy was prepared, with the cooperation of the departments of anesthesiology and surgery, in order to reduce excessive crossmatching. The guideline recommends an ABO-Rh type and an antibody screen, instead of the ""routine'' two-unit crossmatch, for elective surgical procedures where blood is seldom used. For those operations normally necessitating hemotherapy, the number of units suggested for the preoperative crossmatch was determined by examination of the average number of units transfused in the past for that particular procedure. The guideline provides the anesthesiologic and surgical staff with the knowledge of how much blood was usually used during a particular elective surgical procedure and therefore how much blood should be preoperatively crossmatched for that procedure. Implementation of this guideline allows the blood bank to distribute its limited blood resources more efficiently and also decreases patient and laboratory costs.


Theoretic and experimental analysis of the ability of a commercially prepared system to detect mixtures of bacteria. The validity of the biochemical identification of bacteria presumes that the inoculum consists of a pure growth of bacteria. The detection of mixtures of bacteria with the Analytab Enteric (API 20E) system was tested. Using a computer to predict the response of the API 20E system to mixed cultures, the presence of a mixture was not detected in 15% of all pairwise combinations of 324 common organisms of the Enterobacteriaceae family and in 19% of all pairwise combinations of Enterobacteriaceae with four gram-positive cocci. These theoretic predictions were confirmed experimentally for selected mixtures in which the bacteria were combined in equal concentrations. These results indicate that a purity subculture plate must be used to insure the detection of mixtures of bacteria, because the API 20E system fails to detect a large number of mixtures and may erroneously identify the organisms in such mixtures.


Study of gammopathies with immunofixation electrophoresis. Immunofixation electrophoresis and immunoelectrophoresis were compared in 60 samples (51 sera and 9 urines) containing apparently homogenous bands, detected by electrophoresis. To determine the correlation with clinical findings, the patients were divided into three groups: (1) symptomatic with monoclonal immunoelectrophoretic patterns; (2) asymptomatic with monoclonal immunoelectrophoretic patterns; (3) asymptomatic with polyclonal immunoelectrophoretic patterns. The results from immunoelectrophoresis and immunofixation electrophoresis were consistent with each other in all cases of Groups I and III in terms of clonality (i.e., whether monoclonal or polyclonal) and immunoglobulin class; whereas in Group II, which was composed of asymptomatic patients, two sera and three urines were identified to have monoclonal changes by immunoelectrophoresis but polyclonal changes by immunofixation  electrophoresis. It is recommended that immunoelectrophoresis still be used for routine clinical service, but supplemented by immunofixation electrophoresis in equivocal cases, namely: (1) light-chain changes masked by an umbrella effect of immunoglobulin G (IgG); (2) abnormal bands located in atypical areas or overlapped with a normal serum protein; (3) a normal-looking "free" light chain present in the urine, mimicking Bence Jones protein; (4) controversial cases of biclonal gammopathy; (5) mini-monoclonal or oligoclonal protein bands; (6) immune complexes.


Subclinical hemolytic disease of the newborn due to anti-e. A case of subclinical hemolytic disease of the newborn resulting in reticulocytosis and positive direct and indirect antiglobulin tests in an infant both ABO- and Rh(D)-compatible with its mother is reported. The antibody was an IgG, non-complement-binding molecule present in low titer with a low avidity for the antigen, acted optimally in enzyme systems, did not manifest dosage effect, and caused slight extravascular destruction of fetal erythrocytes. Routine antibody screening of all pregnant women should be performed and neonatal cord blood specimens analyzed to avoid unexpected infant morbidity and mortality, and to characterize hemolytic disease of the newborn due to rare atypical antibodies more fully.


Effect of medium temperature on recovery of gonococci. The temperature of the isolation medium exerted no significant effect on the rate of positive cultures for Neisseria gonorrhoeae. However, significantly more colonies were obtained on ambient-temperature medium than on cold (4C) medium. A small number of specimens (six) failed to grow on cold medium but grew on ambient-temperature medium. Viable counts showed essentially no effect of medium temperature on the nondiscriminating strain, a 90% reduction on the cold medium for the cold-intolerant strain, and for the strains with warm medium preference, about twice as many colonies on warm as on cold or ambient-temperature medium.


Ileovesical fistula. Failure of T.P.N. role of oral 14C PEG (polyethylene glycol) and charcoal in diagnosis. A patient with regional enteritis presenting with symptoms of fecaluria and pneumaturia is presented. Most of the established technics such as upper gastrointestinal series, cystography, cystoscopy and colonoscopy failed to demonstrate the fistula in this patient. 14C PEG as a nonabsorbable marker was given by mouth and a seven-fold increase in the counts at the fourth hour of urine collection confirmed the presence of an ileovesical fistula. This increase in counts was not seen when 14C PEG test was repeated after closure of this fistula surgically and was also not seen in a similar disease control patient and a healthy normal volunteer. Total parenteral nutrition with intralipids, Freamine II and glucose given in a peripheral vein for 45 days failed to close this fistula.


Meningococcal colonization and infection in children and their household contacts. A bacteriologic survey was performed to estimate the prevalence and duration of meningococcal carriage in children in Montreal, Canada. Infants and children with proven meningococcal infection, or with asymptomatic meningococcal nasopharyngeal (NP) carriage, and their household contacts, were also studied to define communicability. N. meningitidis was present in 30 (2.4%) of the NP cultures from 1238 asymptomatic infants and children in this civilian population during a non-epidemic period. Meningococcal carriage was not found in 278 subjects 1--60 days of age; there was no difference in carriage rates between the sexes and between hospitalized and non-hospitalized children in all age groups. Meningococci were initially isolated from 11 of 106 household contacts of 29 ill index cases and from 15 of 104 contacts of 29 asymptomatic carriers; 35% of all contacts (index cases and carriers) were colonized by the eighth week of surveillance. Duration of NP carriage was longer (mean 15.2 weeks) in disease-free families than in families of ill patients (mean 5.5 weeks). Serogroups B and C were most commonly isolated from both ill and asymptomatic subjects. Resistance to sulfadiazine (MIC greater than or equal to mg/100 ml) was present in 6.5% and 39.4% of group B and group C strains, respectively. Although chemoprophylaxis was not used, there were no secondary cases among the 29 families of index cases.


The epidemiology of influenza B in a rural setting in 1977. An epidemic of influenza B began in January, 1977, in two rural parishes in northeastern Louisiana and quickly spread to involve 29% of their population with clinical influenza. This epidemic was investigated using a standard questionnaire and a random sample of 4.2% of the population. The clinical illness was typical of influenza, with predominant fever, cough, malaise and headache. Gastrointestinal symptoms were part of the clinical syndrome. Rhinitis and diarrhea were significantly more common in children aged five years or less. Clinical attack rates increased with larger household size. The youngest age groups had clinical attack rate of 40--55%, but the elderly had very low attack rates. The direct cost of influenza-like illness during the epidemic averaged almost $30.00 per case. Knowledge of the cost of influenza-like illness and age-specific attack rates should be useful in planning future control efforts for influenza B.


Pharmacist as team leader for total parenteral nutrition therapy. A total parenteral nutrition program in a 635-bed private nonteaching institution which uses the pharmacist as team leader is described. To initiate TPN therapy, the attending physician writes a request for a consulation with the pharmacist. Prior to initiation of TPN therapy, the pharmacist reviews the chart, conducts a physical and nutritional assessment of the patient, orders any laboratory tests needed for further assessment of the patient and uses these results to classify the patient's nutritional status. The pharmacist then writes all TPN-related orders, including orders for laboratory tests and nursing care. Communications between the pharmacist and the attending physician concerning the progress of the patient and TPN changes are conducted orally on rounds and via chart notes. The number of patients receiving TPN therapy has increased each year--from six patients during 1976, to 19 patients during 1977 and 54 in 1978. Of the two preventable complications that developed in these 79 patients, both were quickly resolved by the pharmacist. Physicians who, in the past, opted not to place patients on TPN because of lack knowledge or lack of a TPN consultant, now rely on the pharmacist for this service.


Diagnosis of lymphomatous leptomeningitis by cerebrospinal fluid lymphocyte cell surface markers. We present a patient with metastatic lymphomatous leptomeningitis in whom the diagnosis was made on the basis of cerebrospinal fluid lymphocyte surface markers and later confirmed by cerebrospinal fluid cytology. The diagnosis of metastatic leptomeningitis can be elusive, and the differential includes a wide variety of infectious and noninfectious processes. We propose that lymphocyte surface marker studies can be a useful technique in expediting the evaluation of certain patients with lymphoma who have evidence of central nervous sytem involvement.


The baboon as a primate model for the study of endometrium. A series of transcervical uterine biopsy specimens were obtained at various stages of the menstrual cycle from a colony of 11 normally cycling female baboons, Papio anubis and Papio cynocephalus. Morphologically, baboon endometrium appeared to be similar to human endometrium. Alkaline phosphatase activity was maximal throughout the preovulatory phase and during the late postovulatory period. During the preovulatory phase acid phosphatase was not demonstrable but increased after ovulation to reach maximal activity prior to menstruation. While differences exist between human and baboon endometria, the overall morphologic and histochemical changes are similar. In addition, the baboon's endometrium is readily accessible by transcervical uterine biopsy, thus making these animals valuable primate models for study of human reproductive problems.


Thyrotropin-releasing hormone and thyroid hormones in amniotic fluid. Immunoassayable TRH (iTRH) was measured in 50 amniotic fluid specimens with a mean concentration of 207 +/- 26 (SE) pg/ml. This iTRH demonstrates parallelism with the standard curve for synthetic TRH. With increasing gestational age there is an increase in iTRH levels in amniotic fluid with a decrease in 3,3',5'-triiodothyronine levels (rT3), while thyroxine levels (T4) remain unaltered. Preliminary data suggest that iTRH levels in amniotic fluid that are less than 150 pg/ml after 32 weeks of gestation may correlate well with low Apgar scores at birth. There was no correlation of rT3 or T4 amniotic fluid levels with the Apgar scores.


Radionuclide methods in the assessment of left ventricular function. The recent introduction of newer scintillation cameras, convenient radiopharmaceuticals and innovative data-processing systems has hastened the use of radionuclide methods in the evaluation of cardiac function. This review familiarizes the primary internist with physics and instrumentation required in understanding cardiovascular nuclear images. Basic principles underlying the gated cardiac blood-pool scan and the first-pass study are described. Authoritative references are given to readers seeking more complete information. The major emphasis of the review, however, is on the clinical applications of these techniques. The role of these noninvasive methods in myocardial infarction, diagnosis and prognosis of ischemic heart disease, assessment of cardiomyopathies, study of idiopathic hypertrophic subaortic stenosis and left atrial myxoma is discussed. Finally, mention is made of newer applications: evaluation of nitroglycerin action on viable but ischemic myocardium and determination of the hemodynamic effects of propranolol in patients with coronary-artery disease.


Intraocular penetration of trifluridine. We studied intraocular penetration of topically applied trifluridine in five patients with herpetic keratitis undergoing penetrating keratoplasty. We compared the concentration of trifluridine and its metabolite 5-carboxy 2'-deoxyuridine in the aqueous humor to those of normal control patients undergoing routine cataract extraction without preoperative antiviral therapy. Significant concentrations of intact trifluridine were achieved in the acqueous humor after topical application of 1% trifluridine ophthalmic drops. The metabolite, 5-carboxy 2'-deoxyuridine, was not found in the aqueous humor. Unlike idoxuridine and vidarabine, it is possible to achieve therapeutic levels of trifluridine at intraocular sites that would be advantageous in the treatment of deep herpetic disease involving the stroma and iris.


Galactorrhea in sarcoidosis: dynamic studies of prolactin, growth and gonadotropic hormone levels. Five of 300 women with sarcoidosis had galactorrhea. Basal prolactin levels were mildly but significantly elevated when compared to controls and sarcoidosis patients without galactorrhea. Prolactin levels responded to thyrotropin releasing hormone and L-dopa administration, but not chlorpromazine. Luteinizing hormone and follicle-stimulating hormone concentrations responded normally to luteinizing hormone-releasing hormone in all sarcoidosis patients studied, as did growth hormone to insulin hypoglycemia. These results indicate that galactorrhea in sarcoidosis is an uncommon phenomenon, probably due to hypothalamic dysfunction and associated with mildly elevated prolactin levels.