Modification of periventricular hypodensity in hydrocephalus with ventricular reflux in metrizamide CT cisternography. An analysis of metrizamide computed tomography (CT) cisternographic findings in cases of communicating hydrocephalus has been carried out. Serial observations of the density in the periventricular area in 19 cases with metrizamide ventricular reflux have revealed the following different patterns: (a)  precontrast periventricular hypodensity diminishing after CT cisternography and possibly indicating transependymal metrizamide migration (two cases); (b) periventricular hypodensity unchanged (two cases); (c) minimal periventricular hypodensity with slight rise in its attenuation values after ventricular metrizamide reflux (four cases); and (d) no periventricular hypodensity and no change after reflux (six cases). Our preliminary experience indicates that the presence of periventricular hypodensity with an increase in its attenuation values following ventricular reflux of metrizamide is possibly a criterion that may be used in favor of a cerebrospinal fluid shunting operation.


Dynamics of cerebrospinal fluid circulation evaluated by metrizamide CT cisternography. Cerebrospinal fluid (CSF) circulation has been analyzed by metrizamide computed tomography (CT) cisternography in 46 patients. Included were 7 patients without any clinical evidence of impaired CSF circulation, and 39 with hydrocephalus due to various causes. CT cisternography delineated the anatomical structures of the CSF pathways clearly and accurately and enabled us to analyze ventricular filling in a quantitative manner. As a result, a new, more precise CT cisternographic classification of the CSF flow patterns has been established. On the basis of the presence of ventricular reflux and stasis, extent of ventricular filling, and convexity flow of metrizamide, seven groups of flow patterns have been defined.


Reye syndrome: computed tomographic documentation of disordered intracerebral structure. Four patients with well documented Reye syndrome were examined with noncontrast computed tomography. Acute findings are those of diffuse cerebral edema with low density in deep white matter, increased gray-white matter differentiation, and evidence of secondary ventricular compression. The diffuse nature of the changes is unlike the more focal pattern often seen in true viral encephalitis. Residual changes after severe diseases are those of nonspecific cerebral degeneration and are most pronounced in the frontal lobes. Atrophic ventricular dilatation was observed in two cases. Computed tomography findings correlate with all known pathologic studies and with the subsequent clinical courses in the patients examined.


A method of correcting for linear drift in computed tomography brain scans. Linear drift of X-ray attenuation coefficients must be corrected if quantitative comparisons are to be made between computed tomography (CT) brain scans of the same individual performed at different times. Such a correction is accomplished by comparing the low (cerebrospinal fluid) end of the attenuation coefficient frequency histograms using a percentile--percentile plot. A "drift correction" permits serial quantitative assessments of the progression or regression of white matter hypodensity, such as occurs in drug induced leukoencephalopathy.


Active rosette-forming T cells in the elderly. The numbers and percentages of active rosette-forming T cells were measured in two age groups, to assess the effects of aging. The study included 21 healthy persons in the 20--40 age group and 25 persons without major disease in the 60--85 age group. In the younger subjects the number of rosette-forming cells (RFC) averaged 1430 +/- 463/cu mm (mean and S.D.), a count not significantly different from that in the older subjects (1443 +/- 398/cu mm). Likewise, the active RFC count in the 20--40 age group (526 +/- 185/cu mm) and that in the 60--85 age group (558 +/- 197/cu mm) were not significantly different. There was no difference for the percentage total RFC (young 78 +/- 4%, elderly 78 +/- 6%) or the percentage active RFC (young 29 +/- 7%, elderly 30 +/- 6%). For the total lymphocyte count or the B lymphocyte count, there was no difference between the two groups of subjects. It is concluded that T lymphocytes, measured as total and active rosette-forming cells, are not decreased in healthy older persons.


[Demonstration of the oncogenic activity of cell cultures using antithymocytic serum]. The authors examined 10 cell strains of different origin as to their effect on mice by means of antithymocytic (ATC) serum. In dependence on the strain used the tumors developed in different number and with different growth tendency. In control animals not treated by the ATC serum, small ganglions developed in some cases which, however, disappeared in 2--3 days. Both strains of diploide cells WI 38 and LEP and primary cultures of chicken fibroblast from embryos of SPF chickens did not develop any tumors. The antithymocytic serums from calfs were found to be less toxic for mice than the rabbit sera.


Demonstration of a thymus derived, splenic suppressor cell responsible for the age-dependent decrease in contact hypersensitivity in the adult mouse. A suppression of contact hypersensitivity to picryl chloride has been demonstrated in adult thymectomized, 4 and 5 1/2 mo-old CBA mice after i.v. injection of spleen cells from intact CBA mice of the same age. The cells signifcantly suppressed the elicitation of the allergic contact sensitivity reaction and this effect could be inhibited by pretreating the cells with anti-Thy 1 serum and complements. The induction phase was found to be unaffected. However, spleen cells from donors which had received an i.v. injection of picryl sulfonic acid suppressed the induction as well as the elicitation phase of the contact dermatitis. On the basis of these results it appears reasonable to conclude that the decline in the ability to develop contact hypersensitivity in aging mice may be due to the development of a splenic suppressor T cell, mainly affecting the elicitation of the contact hypersensitivity reaction.


Studies on the mechanism of ristocetin-induced platelet agglutination: binding of ristocetin to platelets. Ristocetin was trace-labeled with [3H] by the reductive methylation method. It was shown to agglutinate human platelets in the presence of VIIIR:WF in a manner indistinguishable from unlabeled ristocetin. The binding of the labeled ristocetin to normal and enzyme-modified human platelets was studied both in the presence and absence of VIIIR:WF and at nonagglutinating and agglutinating concentrations of ristocetin. Virtually no difference in [3H]ristocetin binding was seen whether VIIIR:WF was present or not. Platelets treated with chymotrypsin, which destroys their ability to agglutinate to VIIIR:WF and ristocetin, did not bind less ristocetin than did control platelets. A pronounced, direct relationship was found between [3H]ristocetin bound by normal platelets and total ristocetin concentration. This implies that at the higher (agglutinating) concentrations of ristocetin either more binding sites are exposed or, more probably, aggregation of ristocetin occurs.


A simple radiometric assay for methotrexate and other folate antagonists. A rapid radiometric assay for the folate antagonist MTX, based on the inhibition of chicken liver dihydrofolate reductase activity, has been developed. In the system the inhibition by MTX of the reduction of tritiated FH2 is standardized and used to quantitate this antagonist in plasma of subjects receiving high-dose MTX therapy. The assay permits the detection of plasma MTX levels to 5 X 10(-9)M with a coefficient of variation of 15%. The predominating circulating folate, 5 methyltetrahydrofolate, or the rescue agent leucovorin (5 formyltetrahydrofolate) do not significantly interfere with the assay at concentrations attainable with current rescue programs. Analyses of multiple plasma samples with the present assay show close agreement with the competitive protein-binding assay.


Platelet membrane glycoproteins in normal dogs and dogs with hemostatic defects. Glycoproteins solubilized from membrane-enriched fractions of platelets from dogs with TT or VWD and from  normal controls were compared by SDS-PAGE. The results were similar to those for the analogous human disorders. Both normal and VWD canine platelet MPs contained three major glycoproteins as well as four smaller-molecular-weight proteins that stained for carbohydrate with the PAS  reagent. In contrast, MPs from dogs with TT had a higher concentration of GP I, a varied expression of GP II, and a lower concentration of GP III. The findings re-emphasize the value of comparative studies of these models of human hemostatic defects.


Neutrophil migration-inhibition activity produced by a unique T lymphoblast cell line. Fifteen lymphoblast cell lines, including B cell, T cell, Null cell, and myeloblast cells, were examined for the production of human neutrophil migration-inhibition activity. Only one T lymphoblast cell line established from a patient with hairy cell leukemia produced a neutrophil migration-inhibition factor spontaneously and after stimulation with Con A and PHA.


Histiocytosis X of the nose.

Histiocytosis X of the nose. A case of histiocytosis X of the nose in a 5-year-old Nigerian child has been described. This localization of the lesion with secondary involvement of the submandibular cervical nodes is quite unusual and no similar case has been so far reported in the literature. The difficulties encountered in the diagnosis, the aetiological factors and treatment are briefly discussed.


Circannual and circadian rhythms in the concentration of corticosterone in the plasma of the edible frog (Rana esculenta L.). For a period of 21 months between May 1974 and September 1976, circadian variations in the plasma concentration of corticosterone were studied by competitive protein-binding techniques in mature male and female edible frogs living in their natural environment. Blood samples were taken from 8 to 12 frogs six times daily and conventional and cosinor methods were used for statistical analysis. Circadian rhythms were not detected during February and March (time of hibernation). Circannual rhythms were detected in three parameters of the circadian rhythm. The mean concentration of corticosterone over a 24 h period (24 h mean) reached a peak on 1 May (between 15 April and 15 May; 95% limits of confidence); the annual mean value of the 24 h means was 1.97 +/- 0.25 (S.E.M.) microgram/100 ml, with an amplitude of 0.66 microgram/100 ml (0.53--0.79 microgram/100 ml; 95% limits of confidence). Circadian variations in the concentration of corticosterone were largest in May (peak of reproductive activity). The times at which the peak concentration of corticosterone occurred showed circannual variations: peak values were detected around 24.00 h in May, 19.00 h in July and 08.00 h in November. Both circadian and circannual variations have therefore been demonstrated in an endocrine function of an amphibian in its natural habitat.


Mitogen-activated B-cell blasts reactive to more than one mitogen. One of three splenic B cells of 2- to 3-mo-old C57BL/6J or C3H/Tif mice are activated either by lipopolysaccharide (LPS) or by lipoprotein (LP) to grow and to mature to IgM-secreting cells. When mitogen-activated blast cells, after a 2-d activation period, are separated from nonactivated, small cells by velocity sedimentation, and no mitogen is readded, the blasts do not continue to grow but do continue to secrete IgM for several days. When the homologous mitogen is added for restimulation, the blast cells continue for several days to divide every 18 h and to develop IgM-secreting, plaque-forming cells. Frequency analyses at limiting dilutions of reactive B-blasts show that one cell in approximately equal to 1.2--1.5 blasts continue to grow and mature in the presence of the homologous mitogen, either LPS or LP. When the B-cell blasts obtained in a first activation period with either LPS or LP are restimulated with a heterologous mitogen, LPS, LP, Nocardia mitogen or mitogens contained in fetal calf serum a high proportion of the blasts continue to grow and mature to IgM-secreting cells. Frequency analyses show for LPS- or LP-blasts, restimulated in a heterologous fashion with either LP or LPS, that one cell in 1.35--1.5 blasts continue to divide and to mature to IgM-secreting cells. C3H/HeJ-splenic B-cells, which are LPS nonresponders, can only be activated to blast cells by LP. These LP-activated blasts can be restimulated by the homologous LP and by Nocardia mitogen and mitogens of fetal calf serum, but not by LPS. The results indicate that the majority of splenic B cells of 2- to 3-mo-old C57BL/6J or C3H/Tif mice are reactive to more than one B-cell mitogen. B cells, therefore, can possess in their surface membrane multireactive mitogen-receptor complexes which regulate growth and maturation.


HLA-linked genetic control of the specicity of human cytotoxic T-cell responses to influenza virus. We have investigated elements of the genetic control of human in vitro cytotoxic T-cell responses to influenza virus-infected autologous cells by studies of a large family. The pattern of virus-immune cytotoxicity among siblings demonstrated T-cell recognition of influenza virus predominantly (greater than 90%) in association with determinants which are coded by genes linked to HLA (P less than 0.0002). Many family members consistently generated cytotoxic activity against influenza predominantly in association with antigens coded by genes of only one of their HLA haplotypes. Such haplotype preferences were consistent among HLA-identical siblings, indicating that the specificity of the T-cell response to influenza virus in association with HLA-A and -B antigens is controlled by genes linked to HLA.


Identification and unusual tissue distribution of the canine and human homologues of Thy-1 (theta). The tissue distribution of the canine and human homologues of Thy-1 were studied using quantitative absorption analyses of liver absorbed anti-brain xenosera assayed on thymus cells. Cross-reactivity studies with pure rat Thy-1 established that the assays were detecting the homologues of rat Thy-1. The results showed that the tissue distribution of Thy-1 varies remarkably between species. Canine Thy-1 was found in large amounts only on adult brain. It was present in much smaller amounts on thymus (8% compared with brain), and was also found on lymph node, spleen and bone marrow (3, 1 and 0.5%, respectively, compared with brain). Surprisingly, it was found on kidney in amounts equal to that on thymus. Studies with the fluorescence-activated cell sorter established that canine Thy-1 was present on all thymocytes and peripheral T lymphocytes. Neonatal thymus and kidney had adult levels of Thy-1, but only small amounts of Thy-1 were present on neonatal brain. In man, brain was again the only tissue to contain large amounts of Thy-1. Surprisingly, it was absent from human thymus, and present on human kidney in amounts roughly equivalent to that seen in the dog. It was absent from spleen, lymph node, bone marrow, liver, heart, erythrocytes, platelets, and serum. Cross-reactivity studies showed that dog and human Thy-1 showed extensive serological cross-reaction, and that the dog-rat and human-rat cross-reactive components were identical.


T-cell regulation of murine IgA synthesis. In studies reported here, the polyclonal activator lipopolysaccharide was used to stimulate the synthesis and secretion of IgM, IgA, and IgG in cultures of mouse lymphoid cells. The total immunoglobulin of each class which resulted was measured by specific double-antibody radioimmunoassays. The effect of Con A-activated T cells from various tissues on such immunoglobulin synthesis was then assessed. Variations in regulatory T-cell activity among the various lymphoid tissues for IgA but not for IgM or IgG was observed. In particular, Peyer's patches T cells were found to contain a high level of IgA T-cell helper activity compared to that of spleen or peripheral lymph node. The independent variation of T-cell regulatory activity for IgA as compared to that for IgM and IgG among the different tissues is most consistent with there being a separate subset of T cells specifically regulating IgA. The significance of these findings for the understanding of the secretory immune system is discussed.


Nonspecific activation of murine lymphocytes. VI. Mediation of synergistic interaction between T and B lymphocytes by a cell-associated, reciprocally acting lymphocyte proliferation helper. The mechanism by which B and T lymphocytes interact synergistically in the proliferative response to 2-mercaptoethanol (2-ME) as a mitogen was investigated in cultures of C3H/St spleen cells. The interaction between these cells required physical contact between the collaborating cell types, and was not mediated by the release of a soluble factor into the culture supernate. Sonicates of spleen cells which had been activated with optimal concentrations of 2-ME for 24 h and then washed extensively, stimulated the uptake of tritiated thymidine and morphological blast transformation of fresh, unstimulated cells. This activity was found to reside within the soluble fraction of the activated cells, and to activate cells optimally at a ratio of 1 naive cell: 1 activated cell-equivalent. This reciprocally-acting lymphocyte proliferation helper (RALPH) activity was produced by B cells as well as by T cells, with a kinetic peak at 48 h of culture. RALPH activity was produced by viable but not by nonviable cells incubated with 2-ME, and was nondialyzable. It could not be induced by the B-cell mitogens lipopolysaccharide, polyinosinic-polycytidilic acid, or purified protein derivative of tuberculin, or by the T-cell mitogen concanavalin A. RALPH isolated from T cells activated B cells exclusively, while that from B cells acted predominantly upon T cells, possibly with a nonspecific effect on B cells. A model for the cellular interactions involved in the amplification of the proliferative response to 2-ME is described.


Nature of T-cell macrophage interaction in helper-cell induction in vitro. II. Two stages of T-helper-cell differentiation analyzed in irradiation and allophenic chimeras. The genetic restriction in the T-cell-macrophage-like cell interaction in helper cell induction was investigated with allophenic and irradiation chimeras of various types. Using T cells from P leads to F1 chimeras, there was a restriction of cooperation with the parental haplotype accessory cells, unless the chimeric mice were repopulated with macrophages of the opposite haplotype before priming. T cells from primed or unprimed F1 leads to P chimeras only cooperated with recipient type accessory cells. These observations led to the hypothesis that there are two stages in the genesis of immunocompetence of T helper cells, one dependent on the thymus, and the other on peripheral macrophage-like cells. Purified T cells from P1 + P2 leads to F1 irradiation chimeras behaved in an unexpected manner in the unprimed state, preferring to cooperate with their own haplotype macrophages. This self preference was lost after antigen priming in vivo and was not noted in allophenic chimeras. This loss of self preference was restricted to the haplotypes represented in the chimeras, and did not extend to third party haplotypes. While these in vitro induced helper cells from chimeric mice show clear genetic restrictions at the T-cell macrophage-like cell interaction, there was no evidence for a matching T-B genetic restriction.


Endotoxin protein is a mitogen and polyclonal activator of human B lymphocytes. Endotoxin protein (EP) has been shown to be a mitogen and polyclonal activator of human peripheral blood lymphocytes. EP stimulates proliferation of B lymphoyctes in the absence of T cells, and this activation is nonspecific by a number of parameters. Additionally, EP mitogenesis, but not polyclonal activation, is inhibited in the presence of human serum, suggesting that these events are dissociable. In these studies, EP appears to be equivalent to or better than pokeweed mitogen in stimulating nonspecific antibody production in vitro.


The tumor dormant state. Quantitation of L5178Y cells and host immune responses during the establishment and course of dormancy in syngeneic DBA/2 mice. Subcutaneous implantation of DBA/2-derived L5178Y cells into DBA/2 mice followed 10 d later by nodule excision protected 100% of mice from the rapid outgrowth of an intraperitoneal challenge of L5178Y cells given 7 d postexcision. Challenged mice remained clinically normal for 48--250 d before onset of an ultimately fatal tumor outgrowth. The numbers of L5178Y cells in the peritoneal cavity increased logarithmically for  4 d after challenge and then declined to low but detectable levels which persisted throughout the clinically normal period. Cells active in 18-h in vitro cytolytic assays against 51Cr-labeled L5178Y target cells were found in the peritoneal cavity. The effector cells were determined to be Thy1.2 positive. Their activity was tumor specific and reached peak levels 4 d after tumor challenge and then gradually  declined to undectable levels during the following 70 d. Tumor emergence occurred most frequently during the period when CMC activity was no longer demonstrable in the remaining clinically normal mice. A transient peak of low level cytophilic antitumor antibody was detected about 30 d after tumor cell challenge. The temporal associations between the numbers of tumor cells and the levels of cell-mediated lysis against L5178Y cells indicate the importance of the cell-mediated cytolysis response in limiting initial tumor outgrowth and suggest its role as one of the factors responsible for long-term tumor suppression during tumor dormancy.


Continuously proliferating allospecific T cells. I. Specificity of cooperation with allogeneic B cells in the humoral antibody response to sheep erythrocytes. Allospecific mouse T cells, positively selected in one-way mixed lymphocyte culture were maintained for 3 yr in tissue culture by sequential restimulation. Such proliferating T cells were tested for their ability to induce a positive allogeneic effect: activating B cells in an in vitro primary humoral response to sheep erythrocytes. It was found that such T lymphocytes could function as helper cells. Helper activity was shown to be specific in that the B cells activated had to share major histocompatibility complex (H-2) antigens with the strain used for selection of the cell line. Intra H-2 mapping showed that antigens coded in the IAk subregion played an important role in the induction of the positive allogeneic effect. Supernatant factors could substitute for the allogeneic T cells in activation of the in vitro humoral response. However, such supernates exhibited no strain specificity. Therefore, the specificity seen in the positive allogeneic effect is presumably a consequence of the alloantigenic recognition receptors intrinsic to the T cells, and not to any biologically restricting properties of the allogeneic effect factor itself.


Specificity of cytotoxicity T cells directed to influenza virus hemagglutinin. Purified type A influenza viral hemagglutinin stimulates an in vitro cell-mediated cytotoxic cell response that exhibits a high degree of specificity for the immunizing hemagglutinin. The response magnitude is proportional to the hemagglutinin dose used for stimulation. The lytic activity of the effector cells is H-2 restricted. Analysis of the specificity of the response indicated that these cytotoxic T cells readily distinguish target cells expressing serologically unrelated hemagglutinin from target cells bearing hemagglutinins serologically related to the stimulating hemagglutinin. Further analysis of the fine specificity of cytotoxic T-cell recognition with serologically cross-reactive type A influenza hemagglutinins revealed a hierarchy of cross-reactivity among these hemagglutinins that was the converse of the serologic hierarchy. These results are discussed in terms of possible differences and similarities in the specificity repertoire of cytotoxic T cells and antibodies. Possible implications of these findings from the standpoint of cytotoxic T-cell induction are also discussed.


A dichotomy between the expression of IgD on B cells and its requirement for triggering such cells with two T-independent antigens. The majority of adult B lymphocytes in the mouse bear two immunoglobulin isotypes, IgM and IgD (mu(+)delta(+) cells) (1). A small population of IgM-bearing cells lacks, or expresses very low levels of IgD (mu- predominant [mup] cells) (1). These cells are believed to constitute a less mature subset of B cells analogous to neonatal B cells (2). Based on the time during ontogeny when responses to T-independent (TI) and T-dependent (TD) antigens appear (3, 4) and the ability to block in vitro responses with anti- mu or anti-delta (5, 6, D. Mosier, personal communication), it has been suggested that the precursors of two TI-1 responses, trinitrophenyl (TNP)- Brucella (TNP-BA) and TNP-lipopolysaccharide (TNP-LPS) are mup cells (5, 6), whereas the precursor for a TD response, TNP-sheep erythrocytes (TNP-SRBC), bears both IgM and IgD (6). However, the possibility cannot be excluded that IgD is present on some or all of the TI precursors, but that it is not obligatory for triggering. In the present experiments we have examined the phenotypes of TI and TD precursors by treating cells with C' and either anti-mu or anti-delta before stimulation with antigen. Our results suggest that the majority of B cells that respond to TNP-BA, TNP-LPS, and TNP-SRBC bear IgD, even though in the case of the two TI antigens, IgD is not required for triggering.


Immunoglobulin subclass-specific immunodeficiency in mice with an X-linked B-lymphocyte defect. CBA/N mice express an X-linked deficiency in their antibody response to many bacterial carbohydrates; we have shown recently that these antigens normally elicit antibody responses predominantly of the IgM and IgG3 isotypes. Here we demonstrate that mice, with the CBA/N phenotype have perferential deficiencies of IgM and IgG3 immunoglobulin expression, both when measured in serum and in cells secreting these isotypes, and that this deficiency is only partially corrected by polyclonal activation of B cells. This suggests that CBA/N mice may lack a subpopulation of B cells that contain most of the IgG3 precursors.


The role of upper gastrointestinal endoscopy in primary care. Upper gastrointestinal endoscopy has become a very useful procedure in detecting pathology and aiding the physician in the evaluation of a patient's problem. A review of one year's sample of 176 examinations performed by a family physician in a small rural hospital shows that there was an 83 percent correlation between pathologic diagnoses of directed biopsies and endoscopic diagnoses. However, there was only a 40 percent correlation between routine radiologic findings and endoscopic findings. Upper gastrointestinal endoscopy has also proven to be a safe procedure that can be used to detect cancer more accurately, locate bleeding sites, and remove foreign bodies. This service can easily be made available to most patients by interested physicians.


Infectious lymphocytes in lymphocytic choriomeningitis virus carrier mice. The infectivity of blood and lymphoid organs of mice persistently infected with lymphocytic choriomeningitis virus was found to be predominantly associated with lymphocytes and both T and B cells were infectious. A hypothesis is presented in which it is assumed that lymphocytes in carrier mice are infected via their LCM virus-specific antigen receptors, thereby leading to their antigen-triggered clonal expansion followed by infection and functional inactivation.


The responses of nude-athymic mice to nominally avirulent togavirus infections. Following intraperitoneal infection by an avirulent strain of Semliki Forest virus, athymic nude mice showed almost normal clearance of viraemia and a transitory peak of antibody activity at 5 to 9 days which fell to less than about 0.1% of the normal antibody activity from the 14th day. When nude mice received a transfer of normal spleen cells from sex-matched litter mates at 1 day before infection, a pattern of high and continous antibody synthesis was established for at least the following 7 weeks. This clear T-cell dependence of the regulation of serum antibody synthesis was unrelated to the development of regulatory (pre-challenge) or protective (post-challenge) immunity since, particularly for female nude mice, up to 60% were benignly and protectively infected in the absence of detectable antibody activity. The brains of such nude mice showed persistence of infectivity for at least 7 weeks at 10 to 10(4) p.f.u./brain after avirulent infection and at about 10(3) to 10(4) p.f.u./brain after virulent challenge. The prior transfer of normal spleen cells to nude mice enabled them to clear brain infectivity as efficiently as normal mice. These results are discussed in terms of the evident interplay of both T-lymphocyte dependent and T-lymphocyte independent functions in the control of brain infectivity, in the expression of virulence and in the stimulation of regulatory and protective immunity.


Encephalopathy and fatty metamorphosis of the liver associated with cold-agglutinin autoimmune hemolytic anemia. Three patients with encephalopathy clinically indistinguishable from Reye syndrome but associated with elevated cold-agglutinin titers and antiglobulin-I autoimmune hemolytic anemia are reported. The patients were treated with exchange transfusions, dexamethasone, controlled hyperventilation, and intracranial pressure monitoring. Liver biopsy specimens in two of the three patients showed fatty infiltration of the hepatocytes, but the light microscopic and electron microscopic appearance of the liver was not typical for Reye syndrome. These patients are reported to alert physicians to a metabolic encephalopathy in children which mimics Reye syndrome, but is distinctly different in clinical course and complicated by cold agglutinins and an autoimmune hemolytic anemia.


Dark-adaptation in frog rods: changes in the stimulus-response function. 1. Aspartate-isolated photoresponses of the frog's rods to weak and strong flashes have been recorded during dark-adaptation after bleaching a fraction of rhodopsin (generally 4--30%). Stimulus--response functions were measured before the bleach and in the steady state after dark-adaptation. 2. The movements of the operating curve, i.e. the stimulus--response function plotted in a log-log diagram, are interpreted in terms of a model of outer segment adaptation, where the adaptation processes are associated with the transmitter release (Q-adaptation), the number of active sodium channels and leakage channels in the plasma membrane of the outer segment (M-adaptation), and the transmitter background (c1-adaptation). 3. A small bleach in a fully dark-adapted, non-bleached retina brings about a displacement of the operating curve predominantly to the right. The shift back to the left is approximately exponential, typical time constants being 6--12 min. 4. A strong exposure (bleaching 15--30% of rhodopsin) in a previously partially bleached retina brings about a nearly vertical displacement of the operating curve: after the bleach the maximum photoresponse is strongly reduced, and during intermediate adaptation the operating curve returns mainly upwards. 5. Cumulatively increasing permanent displacements of the operating curve are observed in the steady states after successive dark-adaptation transients. The permanent displacements are predominantly to the right and they increase with increasing temperature. 6. The experimental results, as interpreted according to the model, indicate that the Q-adaptation process is dominant in physiological conditions (small or moderate bleaches), whereas the M-adaptation becomes important only after rather large bleaches and especially after several successive bleaches in an isolated retina.


Vestibulo-ocular function during co-ordinated head and eye movements to acquire visual targets. 1. Experiments have been conducted on human subjects in an attempt to establish the role of the vestibulo-ocular reflex in the co-ordination of head and eye movements during visual target acquisition. 2. When the subject moved head and eyes to acquire visual targets in the horizontal plane, the eye movement consisted of an initial saccade in the direction of head movement followed by a slower return towards orbital centre which compensated for remaining head movement. 3. When the head was moved either voluntarily or passively in the dark the pattern of eye movement was very similar to that seen during target acquisition. 4. The mean latency between the start of head acceleration and the onset of the saccadic eye movement was greater in the dark (108 msec, S.D. 85 msec) than for the visually induced responses (14 msec, S.D. 59 msec), in which eye movement often preceded head movement when moving to small ( less than 45 degrees) target offset angles. 5. In all experimental conditions gaze displacement at the end of the initial saccade was normally related in a predictive manner to final head position, but when fixating visual targets offset by more than 60 degrees from the central position there were often large errors, 22% of responses undershooting the target by more than 15 degrees. 6. A highly significant (P less than 0.001) linear relationship was found between gaze displacement and head velocity under all experimental conditions. During target acquisition head velocity was normally positively correlated with amplitude of target offset. The large errors in gaze displacement in response to the larger target offsets occurred at levels of head velocity lower than normally associated with such target offsets. 7. The results have led to the suggestion of a dual mode of control for head-eye co-ordination. In one mode, normally associated with small target offsets (less than 45 degrees), control is mediated by retinal error information. In the other mode, associated with larger target offsets, gaze displacement is generated as an automatic response to head turning. 8. The observation of similar relationships between head and eye movement during passive head turning implicates the vestibulo-ocular reflex in the secondary mode of control, and provides support for the hypothesis that the role of the vestibular saccade is to induce a rapid offset of the eyes in the direction of head movement, thus facilitating rapid search and target location.


Dark-adaptation of the aspartate-isolated rod receptor potential of the frog retina: threshold measurements. 1. The dark-adaptation of the aspartate-isolated rod receptor potential of the isolated and perfused frog retina has been measured after bleaching about 5-10% of the rhodopsin. The fraction bleached (DeltaR) and the decay of rhodopsin photoproducts were determined using alternating measurements with a photometric technique (Donner & Hemilä, 1975).2. The dark-adaptation time course of the log threshold elevation is exponential, log I(t)/I(0) = W exp (-t/tau)+P, where W is the extrapolated value for log I(t)/I(0)-P at t = 0 and P is log I(t)/I(0) for t = infinity. When DeltaR increases from 2 to 10% W increases from ca. 2.6 to ca. 5. The time constant tau is about 13 min at 9 degrees C and 7 min at 14 degrees C (DeltaR = 5-10%).3. When the bleaching period is extended, keeping the amount bleached (Ixt) constant, dark-adaptation is completed earlier.4. The time course of dark-adaptation and the decay of the photoproduct ;retinal' are similar, as is also their dependence on temperature (Q(10) approximately 3).5. The permanent log threshold rise P is approximately proportional to DeltaR after small bleaches; when more than about 10% is bleached the slope of the curve P(DeltaR) decreases. P is considerably larger (about 2.5-fold) for the same fraction bleached in experiments at 14 degrees C as compared to experiments at 9 degrees C.6. A comparison with previously obtained corresponding values for dark-adaptation after small bleaches at the ganglion cell level shows a close agreement between the time constants for the dark-adaptation curve, its range and the dependence of threshold on the fraction of rhodopsin bleached.


The occurrence of systemic lupus erythematosus in two kindreds in association with selective IGA deficiency. The families of two patients with SLE and IgA deficiency were examined. A study of the first patient's family revealed that IgA deficiency was determined by an incompletely penetrant autosomal dominant gene not linked to the HLA locus. Antinuclear antibodies, found in consanguineous and nonconsanguineous relatives were not related to the presence of IgA deficiency or any HLA haplotype. The second patient and his father with antinuclear, anti RBC, and antithyroid auto-antibodies shared an HLA haplotype not present in other sibs. IgA deficiency was not inherited in this family but may have influenced the expression of disease in the propositus or could have resulted from the disease itself.


Anti-inflammatory activity of sesquiterpene lactones and related compounds. Some sesquiterpene lactones and related compounds were tested for anti-inflammatory activity in rodents. In the edema-induced carrageenan inflammation screen, the alpha-methylene-gamma-lactone moiety  of the sesquiterpene lactones was required for inhibitory activity. The 6-hydroxy group of helenalin also was required for potency. In the tenulin series, the 2,3-epoxy derivatives were marginally active. The same structure was required for inhibition of the writhing reflex. In the chronic adjuvant arthritic screen, compounds containing the alpha-methylene-gamma-lactone moiety, the beta-unsubstituted cyclopentenone ring, and the alpha-epoxy cyclopentenone system afforded significant inhibition at 2.5 mg/kg/day. The sesquiterpene lactones were marginally effective against induced pleurisy. The delayed hypersensitivity was suppressed by these agents whereas immunoglobulin synthesis was slightly stimulated. No delerious side effects were observed with these agents from the limited tests performed.


The infant rat as a model for assessment of the attenuation of human influenza viruses. The intranasal infection of infant rats with Haemophilus influenzae type b can be considerably enhanced by prior infection of the rats with influenza virus. When influenza virus A/England/939/69 was used to infect the animals a minimum of 10(4-0) EID50 was required to enhance H. influenzae infection; infection with 4 x 10(6) H. influenzae bacteria was needed to reveal this enhancement and infant rats two days old at the time of virus inoculation had to be used. By this method, nine strains of influenza virus were assessed for their ability to enhance H. influenzae infection, and the results were compared with their known virulence for man. The results showed a close correlation in this respect for all of the viruses, except strain A/PR/8/34. The replication of these viruses in infant-rat turbinates and lungs was also studied; virus concentrations in turbinate tissues 48 h after infection showed a close correlation with virulence for man. Thus, three influenza virus strains known to be virulent for man reached concentrations in infant-rat turbinates ranging from 10(4-8) to 10(5-7) EBID50/0-05 ml at 48 h; the concentrations of six viruses known to be attenuated or non-infectious for man grew less well in infant rat turbinates, and reached concentrations at 48 h of 10(1-0) to 10(3-5) EBID50/0-05 ml. The results are discussed in relation to the use of the infant-rat model for assessment of the attenuation of candidate live influenza virus vaccine strains.


[Teratological study of 4-ethoxy-2-methyl 5-morpholino-3(2H)-pyridazinone (M73101) in mice and rats (author's transl)]. M73101 was given orally to pregnant mice (0, 100, 400 and 800 mg/kg/day) and rats (0, 100, 300 and 600mg/kg/day) during the major organogenesis to assess the influences of prenatal and postnatal development of progeny. There were no apparent effects of M73101 on litter size, fetal mortality or sex ratio in both species, although slight decrease in body weight occurred in fetuses of mice and rats exposed to the largest dose. No external, internal or skeletal malformations attributable to M73101 were observed in mouse and rat fetuses. No apparent influences of M73101 on postnatal development of mouse or rat offspring were seen.


Antigenic modulation in vitro. III. Failure to modulate H-2 antigens on several mouse tumors. The capacity of various malignant and normal mouse cells to acquire resistance to lysis by guinea pig complement during exposure to H-2 antisera in vitro at 37 degrees C (antigenic modulation) was examined. All tumors tested, including cell lines of the TL+ leukemias RADA1, ASL1, and RLmale1, the TL- leukemia EL 4, myelomas MOPC-70A and S194, and the sarcoma Meth A, failed to modulate when incubated with multispecific or monospecific H-2 antisera up to 24 hours, even though under comparable conditions thymus-leukemia (TL) antigens and surface IgG molecules modulated within several hours. Indirect sensitization of RADA1 leukemia cells with H-2 antisera followed by antiserum against mouse IgG also failed to induce H-2 antigen modulation. Normal peritoneal cells from certain mouse strains were partially modulated with H-2D-specific or H-2K-specific and monospecific antisera within several hours, but normal thymus and lymph node cells did not modulate. Modulation of peritoneal cells occurred without a complete loss of sensitizing H-2 antibody from the cell surface and required a cobra venom factor-sensitive activity that could be restored by human complement component C3. Modulation of TL antigens in vitro had previously been shown to have similar characteristics.


Immunity to a 3-methylcholanthrene-induced fibrosarcoma in the C57BL/6 mouse: in vivo analysis by the adoptive tumor neutralization test. Analyses of the adoptive tumor neutralization test (modified Winn test) in C57BL/6 mice made immune to a 3-methylcholantheene-induced fibrosarcoma showed that the reaction was mediated by a thymus-derived lymphocyte, it was tumor-specific, and the resistance of the immunized donor mouse to the challenge was strongly correlated with the protection of the recipient mouse. Proliferation of immune cells and close contact between tumor cells and immune T-cells were required. The hypothesis of a participation of the recipient in the reaction was considered because of the lack of adoptive protection of pangenic nude mice.


[Atrioventricular conductive disorders as a consequence of activation of the intracardiac reflex apparatus]. Experiments were conducted on isolated and vagotomized frog hearts (Rana temporaria). It is suggested that certain forms of disturbances of the atrioventricular node, the Wolff--Parkinson--White syndrome and parasystole, result from activation of the atrioventricular reflex mechanisms.


[The meaning of antinuclear antibodies and of the ASL O titer in rheumatic diseases (author's transl)]. Iritis, Iridocyclitis, Uveitis and Scleritis are sometimes caused by rheumatic diseases. Antinuclear antibodies of 64 patients with high ASL O titer and Antinuclear antibodies of 24 patients with negativ ASL O titer were investigated. The results demonstrate the existance of autoantibodies in many cases. These may be caused by autoimmuno-diseases or could be related directly to ophthalmic disorder.


Iatrogenic coronary artery stenosis following aortic valve replacement. Until recnetly, coronary arterial perfusion was one of the best methods to protect myocardium during aortic valve replacement. However, the insertion of perfusion cannulas may produce immediate traumatic lesions and late stenosis of the coronary arteries, with grave consequences. Two patients with normal coronary arteries prior to operation developed obstruction of the maximal left main coronary artery following aortic replacement. One of these patients represents the first case of iatrogenic coronary arterial stenosis in which the aortic valve was replaced with a porcine bioprosthesis. Accelerating angina pectoris and ventricular arrhythmias were the presenting clinical manifestations. Aorta-coronary bypass grafting to the left anterior descending and circumflex coronary arteries was successfully performed in one patient, while the other patient died before investigative procedures could be undertaken. Any patient whose aortic valve has been replaced and who develops angina pectoris a few months after operation should be suspected of having developed stenosis of the proximal coronary artery. Coronary angiography should be perfomed promptly. Once the lesion is recognized, the operaiton should be performed posthaste because these lesions are life threatening owing to their proximal location and rapid evolution.


[Chronic T-cell lymphocytic leukemia. Report of two cases (author's transl)]. Two patients with chronic lymphocytic leukemia of T-cell immunological origin are studied. One case was of the prolymphocytic variety, and the other corresponded to the "classical" type of chronic T-cell lymphocytic leukemia. From a morphological point of view what stood out was the hyperchromatic aspect of the cytoplasm of the lymphocytic proliferation. The high increase of acid hydrolases localized preferentially in the centrosomic area was the main cytochemical characteristic. Isoenzymatic study of leukocytic acid phosphatase showed a noticeable increase of band 3 and the absence of supernumerary band 3b. Immunological analysis revealed a significant decrease of the surface immunoglobulins and a rise in absolute terms in the number of lymphocytes forming spontaneous rosettes. In the case of the prolymphocytic variety what was particularly noticeable was the great number of lymphocytes bearing complement receptors. The combination of cytomorphologic, isoenzymatic and immunological data make it possible to differentiate between lymphoproliferative diseases of T and B-cell origin at the present time.


[Otological possibilities of conservation and reconstruction of facial function in operations within the internal auditory canal and the cerebellopontine angle (author's transl)]. Description of the possibilities of operations within the internal auditory canal and the cerebellopontine angle, especially of the removal of acoustic neuromas by transtemporal and translabyrinthine approach. Besides at the total removal of the tumor the operative technique aims at the conservation of the facial nerve and its function. The transtemporal approach is recommended only for the removal of small tumors limited to the internal auditory canal. If the tumor originates from the vestibular nerve, the facial and cochlear nerve can be preserved by this procedure. The translabyrinthine approach implicate the complete unilateral deafness but is available even for the removal of bigger tumors leaving the internal auditory canal in the direction of the cerebello-pontine angle. Sketches and operation slides illustrate details of the operative preparation. Special difficulties occuring in the cerebellopontine angle are demonstrated. Clinical and diagnostic problems in relation to the operation planning are discribed. The cooperation between otosurgeon and neurosurgeon is indispensable


[Audiological findings in cases of acoustic neuromas, cerebellopontine angle and brain tumors (author's transl)]. The study contributes to improve, audiological diagnostics of central auditory path lesions and attempts, through the comparison of audiological and neurosurgical findings of 15 patients, to refer certain auditory lesions caused by cerebral tumors to topodiagnostically characteristic audiological symptoms. The audiological findings obtained through 7 generally accepted test methods from 6 patients with an acusticus neurinoma indicate a labyrinthine but not a central symptomatic picture while 4 patients with a pontine-angle tumor present a chiefly central hearing defect which, as regards the constellation of findings, clearly differs from the central hearing defect of 3 patients with a pontine tumor. Two patients with tumors in the lateral ventricle area merely show, from the audiological point of view, a lack of contralateral dichotic discrimination.


[Radiodiagnosis of cerebellopontine-angle tumors (author's transl)]. The most important radiodiagnostic signs of cerebellopontine-angle tumors are demonstrated. The value of plain films and special projections is discussed. The use of recent diagnostic procedures like scintography, CT and cisternography with oily contrast medium is critically analyzed. The advantage and disadvantages of these procedures are discussed according to their usefullness in evaluating size, route of spread and localisation of cerebellopontine-angle tumors.


Cellular immunity in patients with epidermoid cancer of the head and neck. Forty-three patients with squamous cell carcinoma of the head and neck were evaluated immunologically at various times before and after treatment. Impaired DNCB skin reactivity was found in patients with more advanced disease (Stages II-IV). In the 24 patients evaluated prior to therapy, only the mean percentages of two subpopulation T-cell tests, T-RFC29 and "active" T-RFC and mean absolute T-RFC29 per mm3 and PHA responses were significantly depressed. These depressed values could not, however, be correlated with the stage of the disease. In patients with poorly to moderatley differentiated tumors there was a significant decrease in mean percentage of active T-RFC and PHA stimulation. A marked difference in mean percentages of T-RFC29 between pretreated patients without nodal involvement (40.5 +/- 2.1) and those with this complicity (58.1 +/- 4.9) suggests that this assay may be used to detect occult nodal involvement. A comparison of the effects of surgery, irradiation and the combination of the two no patients indicated that only radiation affected any of their immune parameters. Irradiated patients demonstrated a marked decline in the mean absolute level of lymphocytes, total T-RFC and mean PHA responsiveness within one month of the termination of therapy: however, these values returned to the pretreatment level within seven months. None of the treatments was effective in "curing" the immune deficits observed in pretreatment patients.


Predefinitive and postdefinitive chemotherapy for locally advanced squamous carcinoma of the head and neck. Advanced squamous carcinoma of the head and neck remains refractory to the best combinations of surgery and radiotherapy. Weekly methotrexate in high doses with leucovorin "rescue" is able to produce significant remissions in a majority of patients treated palliatively for recurrent disease yet is associated with little or no toxicity. We have attempted to improve the cure of patients with advanced disease by the use of high dose methotrexate (3-7.5 g/M2) and leucovorin prior to and following definitive surgery and/or radiotherapy. In a series of 24 patients we have achieved a response rate of 52%, with minimal toxicity during chemotherapy, and no apparent potentiation of toxicity with radiotherapy. Survival free of disease appears to be prolonged in patients with response to this chemotherapy. Multimodality approaches to locally advanced squamous carcinoma of the head and neck may soon yield improved cure rates.


Scanning electron microscopy of blood cells. Scanning electron microscopy (SEM) is an invaluable tool for studying the surface morphology of isolated blood cells. We have used a simple preparative technique for SEM to study the erythrocytes from a case of Congenital Dyserythropoietic Anaemia type II and the leucocytes from healthy individuals or patients with leukaemia or lymphoma. This rapid and inexpensive technique for fixation and dehydration of blood cells was found to be equally reliable for obtaining micrographs of healthy or diseased leucocytes or erythrocytes.


Differentiation of bone marrow-derived lymphocytes. Murine lymphocytes were enzymatically radioiodinated and the class of immunoglobulin (isotype) on the cell surface was studied as a function of differentiation and ontogeny. The results indicate that IgM is the first isotype to appear and that IgD is subsequently acquired. A proportion of IgM-bearing cells also bear IgD. The acquisition of IgD does not appear to be under the influence of the thymus or of exposure to antigen. The observations suggest a sequence of differentiation steps in which B-cells first express IgM then acquire IgD (to become "double bearers"), and eventually lose IgM. The relationship of the IgD-bearing cells to the IgG-bearing memory cells has not yet been established. The implications of these findings with regard to function and genetic organization are discussed.


Host immunocompetence in genitourinary cancer: relation to tumor stage and prognosis. We used delayed hypersensitivity skin testing, in vitro lymphocyte blastogenesis, and lymphocyte surface markers to examine the relationships among host immunologic competence, tumor type, tumor stage, prognosis, and the effects of cancer treatments in patients with genitourinary cancer. We found correlations between host immune competence and both tumor stage and prognosis among patients with bladder cancer, renal cell cancer, and those with advanced prostate cancer not receiving endocrine therapy, but not among patients with prostate cancer receiving endocrine therapy. Radiation and chemotherapy suppressed T-lymphocyte levels, but a chemotherapy-induced tumor remission resulted in a rebound of T-cell counts to above normal levels. In tissue sections of bladder cancers, regions of mononuclear infiltration were virtually devoid of cells with complement receptors or receptors for cytophilic antibody, which suggested that lymphocytes infiltrating bladder cancers are predominantly T-lymphocytes.


Effect of sera of patients with genitourinary tract cancers on transformation of lymphocytes stimulated with anti-thymocyte globulin. Serum from patients with genitourinary cancer was tested for ability to support transformation of autologous or normal lymphocytes stimulated with ATG. Selected for specificity for T-lymphocytes, ATG at times gave a more sensitive indication of a serum defect than did PHA. Although poor transformability in the presence of patient serum suggests an inhibitor, this test cannot rule out the possibility of a limitation of an essential nutrient usually supplied by serum. Presence of inhibitor(s) was more strongly indicated by contrasting transformation of normal lymphocytes with patient serum against a panel of normal sera. The presence of circulating inhibitor(s) was confirmed by demonstrating depression of transformation of normal lymphocytes in complete medium by chromatographic fractions from patient serum that did not support transformation. In several instances, patient serum was more inhibitory of autologous than normal lymphocytes, which suggested an additional way of examining host immune competence.


Immune function determination in patients with bladder cancer. Patients with bladder cancer were evaluated clinically for immune responsiveness and stage of disease. A battery of tests is described that attempts to correlate stage of disease with immune responsiveness.


Prostate carcinoma: intratumor BCG immunotherapy. Two groups of patients with advanced cancer of the prostate received adjuvant immunotherapy by direct intra-tumor injection of BCG. The first group had advanced metastatic disease that was failing to respond to conventional hormone therapy. The second group were new cases of stages III and IV tumor who were previously untreated and who had had a transurethral resection of the prostate and orchiectomy followed by BCG immunotherapy. The clinical and pathologic findings for both groups of patients are described.


Transitional cell carcinoma: lymphocyte-mediated cytotoxicity. A method of removing Fc+ lymphocytes from human peripheral blood was presented. Results upon testing the remaining cell populations for cytotoxicity against autochthonous and allogeneic target cell systems was presented.


Suppressor cells prevent host resistance to tumor growth. The role of immunosuppressor cells in preventing host immune rejection of tumor cells is described. The growth of Lewis lung carcinoma (3LL) in syngeneic C57BL mice is accompanied by a weak and transient anti-tumor cytotoxic response that is later on replaced by tumor-enhancing activity. This enhancing activity is correlated with the generation of suppressor cells in 3LL-bearing mice. Such suppressors were demonstrated in two ways: (a) Elimination of the hydrocortisone(HC)-sensitive lymphoid population from tumor-bearing mice (TBM) resulted in a significant increase in the anti-tumor cytotoxic response and in a marked delay in tumor development. It is assumed that HC inactivates precursors of suppressor lymphocytes whereas the mature suppressor cells themselves are HC-resistant. (b) The increased resistance against the tumor could be partially re-suppressed by restoring the HC-treated TBM with spleen or thymus cells from normal C57BL. Suppression, however, was more pronounced if the resistant mice were restored with spleen or thymus cells from TBM. HC-resistant spleen cells from TBM that appear to be enriched for mature suppressor cells were capable of suppressing in vitro the secondary sensitization of spleen cells from TBM against tumor cells.


Paracortical activity in the lymph nodes draining female breast carcinoma. Three hundred and two female breast carcinomas were assessed histologically with special attention focused on the nuclear grade of the tumor, the stromal lymphocyte reaction and the morphology of the paracortical areas of the regional lymph nodes. These morphologic parameters were correlated with the 5-year survival data of the patients. Nuclear grade of the primary tumor was directly positively related to the 5-year survival as was the paracortical activity of the regional lymph nodes. The paracortical activity was inversely related to the frequency of nodal metastases which were a sign of poor prognosis. The value of the morphology of the regional lymph node paracortex in evaluating the criteria of host resistance in association with breast carcinoma is emphasized.


[Fiberoptic endoscopic examination in the diagnosis and therapy of digestive hemorrhages of the supra-mesocolic tract. Retrospective analysis of 46 cases]. Forty-six cases of upper gastrointestinal haemorrhage examined during three years have been revised. The patients were 39 men and 7 women, from 22 to 73 years old: twenty-six of them were first examined by endoscopic technique, while in the other twenty-ones the first examination was a bariummeal X-ray. All the twenty-six patients of the first group were examined within 48 hours from admission to hospital while the twenty patients of the second group could be examined not before the third day from admission. The evaluation of our results has confirmed an overt superiority of endoscopic versus radiologic technique, mainly in detecting non-ulcerative mucosal alterations responsible of bleeding.


Tissue antibodies in a healthy New Zealand population. The occurrence of antinuclear, smooth muscle, parietal cell, reticulum, thyroid microsomal and mitochondrial autoantibodies in the sera of 1641 healthy males and 959 healthy females was investigated. Females were also treated for antibodies to adrenal cortex and salivary gland. A rising frequency of autoantibodies with increasing age was observed in both sexes with the average frequency being 19.3 percent for females and 15.9 percent for males. The most commonly detected autoantibodies were those directed against reticulin and thyroid microsomes. Mitochondrial, adrenal and salivary gland autoantibodies, and antinuclear antibody titres greater than 1:32 occurred so rarely in the healthy population that their appearance in patients should be regarded as a possible indication of clinical disease.


Electrical splinting of the knee in paraplegia. Two men with T7 and T12 complete traumatic lesions have received implants to stimulate the femoral nerves and (in the T7 case) the inferior and superior gluteal nerves. By using these continuously at 13 pulses/sec they can stand and walk, as other paraplegics do with calipers. Regular stimulation at 11 or 13 pulses/sec greatly increases the force exerted by the quadriceps femoris muscles and their resistance to fatigue, and this improvement is not lost during 2 months without stimulation.


Effect of epidermal growth factor on lung maturation in fetal rabbits. Injection of epidermal growth factor (EGF) into 24-day rabbit fetuses (5 microgram, im or ip) induced accelerated maturation of the lung. On sacrifice at day 27, there was greater distensibility and stability on deflation associated with the appearance of a complement of type II cells approaching that of the rabbit at term. EGF treatment had no demonstrable effect on body weight or lung weight in this group of animals. Saline-injected control fetuses were not affected significantly.


Rectal bleeding in the first month of life. Sixty-nine infants were examined who presented with rectal bleeding in the first month of life. In 64% of these children no cause was found. Infantile diarrhoea, haemorrhagic disease of the newborn and anal fissure were the most common diagnoses made. The mortality in the entire group was less than 3%. It is concluded that rectal bleeding in this age group is a relatively benign condition and in certain cases hospital admission may not be required.


Vestibular stimulation to improve ambulation after a cerebral vascular accident. A pilot study was undertaken to determine if vestibular stimulation could be a valuable therapeutic measure in rehabilitating the patient who has had a cerebral vascular accident. Twenty patients with cerebral vascular accidents were tested. Changes in functional ambulation abilities of 10 patients receiving a passive vestibular exercise were compared with those of 10 patients not receiving this exercise. The vestibular stimulation was provided through a rotary stimulus that emphasized angular acceleration and deceleration. Patients who received the vestibular stimulation demonstrated greater improvement in functional ambulation than did patients who did not receive the stimulation.


[Evolution of coronary occlusion in a patient with past myocardial infarction (author's transl)]. The case of a man suffering from an anterior myocardial infarction with complete occlusion of the left descendent coronary angiographically proved is reported: an angiographic control four months after aorto-coronary by-pass on right coronary, showed the recanalization of left anterior descendent coronary and occlusion of the by-pass.


[Study of a health indicator to assess effectiveness of a hospital outpatient department (author's transl)]. Evaluation of medical cares effectiveness needs health indices allowing the description of the severity of the disease and of the capacity of change. Disability seems a concept adapted to both challenges. It represents a disfunctional state continuum of which the levels are measurable, whatever the etiology or the diagnosis are. It also measures the variation of daily activities reduction, consequence of health disorders. From this concept, the authors have built, and applied to rheumatic patients seen at an outpatient department of gerontology, a seven levels scale. 480 consultations affecting 270 patients were carried out. The mean restriction of disability, at the time of the first referral was 2,9. The indice seems to be valid because it allows to classify the patients in 3 groups according to the severity of the involving disorder. The observed changes for 4 typical disorder groups agreed with what was expected. 122 patients were seen twice or more. The average of the difference between the grading of disability at the time of the first and the last consultation was--0,43, showing a significant improvement. After discussion of some shortcomings of their indice, the authors concluded that the scale used seems adapted to assess effectiveness of outpatient medical cares.


[Computerized cisternography with metrizamide]. Metrizamide, a new water-soluble contrast medium with low toxicity, was used for cranial computed tomography (computerized cisternography) in 26 patients. When injected by lumbar puncture, the pericerebral cisterns (posterior fossa and sella turcica especially), can be visualized with much greater precision than with classical computed tomography. It also allows the normal and pathological circulation of the CSF to be studied. The authors report on 6 cases of tumours of the posterior fossa, 10 cases of pituitary tumours, 2 cases of "empty" sella, 2 cases of CSF rhinorrhoea, 2 cases of normal pressure hydrocephalus, and 2 cases of syringomyelia, studied by this method. The examination was normal in 3 cases. The authors stress the rapidity, reliability, and good tolerance of this new method.


[Diagnosis of a Meckel's diverticulum (author's transl)]. In diagnosing a Meckel's diverticulum besides the conventional plain films of the abdomen with and without contrast and the angiographic special attention is called to the scanning with technetium. This examination can be very helpful in cases of children with gastrointestinal bleeding episodes in the diagnosis of a Meckel's diverticulum, if it contains ectopic gastric mucosa.


The diagnostic value of the oral pancreatic function test. An oral pancreatic function test (PFT) using the synthetic peptide N-benzoyl-L-tyrosyl-p-aminobenzoic acid can assess pancreatic exocrine function, since urinary recovery of the ingested dose is an indirect index of chymotryptic activity. We have studied 34 subjects using this oral PFT, which correctly distinguished the control group (8 subjects) from the pancreatitis group (10 patients), results correlating well with Lundh test findings. However, the test was falsely abnormal on 9 out of 16 occasions in patients with bowel or liver disease. We therefore conclude that the present test cannot distinguish small-bowel disease from pancreatic disease, which is often the diagnostic problem, and is also frequently falsely abnormal in the presence of chronic liver disease.


Adult acute lymphoblastic leukaemia: study of 32 patients and analysis of prognostic factors. The clinical and haematological characters and the response to therapy of 32 consecutive patients with acute lymphoblastic leukaemia, aged more than 12 years, were reviewed. All patients were given vincristine (V) and (6-methyl) prednisolone (P) for 6 weeks; daunomycin (D) was added in 9 cases, and cyclophosphamide (C) + D in another 10 cases. 3 patients died during induction. 4 patients failed to achieve remission. 25 patients (78%) achieved complete remission (CR). All of them but one received 'prophylactic' central nervous system (CNS) therapy with cranial irradiation and i.t. methotrexate (MTX) and arabinosyl cytosine. CR was maintained with daily 6-mercaptopurine and weekly MTX. Median duration of CR was of 22 months. 2 patients are currently disease-free and off-therapy, 78 and 53 months after diagnosis, respectively. Blast cell membrane markers were studied in 21 consecutive cases: 3 patients had T-cell leukaemia and 2 patients B-cell leukaemia. Prognostic factors were evaluated basing on the present series of 32 patients, and on further 106 cases reported by others. Age (under and above 40) influenced significantly both the CR rate and the length of survival. In patients aged under 40, a circulating blast cell count higher than 25,000/microliter, or a platelet count lower than 50,000/microliter, negatively affected the survival.


Some immunological and haematological aspects of human cyclic neutropenia. In addition to standard peripheral blood cell counts, sequential studies have been made of changes in the T-lymphocyte population and in the serum titres of the presumptive humoral regulators of haematopoiesis, Colony Stimulating Activity (CSA) and Erythroid Stimulating Activity (ESA), in a young woman with cyclic neutropenia (CN). In addition, serum immunoglobulins, C3 and total complement levels and serum protein concentrations were determined on several occasions during the study. Similar tests were done concomitantly on a haematologically normal, age and sex-matched control. Cell counts on peripheral blood from the subject with CN demonstrated a clearly defined periodicity in neutrophil and monocyte concentrations and equivocal fluctuations in reticulocyte numbers. There was no evidence of periodicity in the lymphocyte concentrations and the T-lymphocyte population appeared functionally normal. Spontaneous incorporation of tritiated thymidine into peripheral blood cells showed a highly significant correlation with the monocyte count, suggesting that these cells were responsible for the radioisotope uptake. CSA titres were elevated on all occasions tested and showed no evidence of periodicity. ESA showed some evidence of cycling with elevated levels being observed during the periods of neutropenia. Serum complement levels were within the normal range but all classes of immunoglobulins were elevated and albumin levels were depressed.


Natural cytotoxicity of human Fc gamma-receptor-positive T lymphocytes after surface modulation with immune complexes. In humans T cells with surface receptors for the Fc fragment of IgG (Fc gamma receptors) (TG cells) are effector cells in antibody-dependent cellular cytotoxicity (ADCC) and in natural cytotoxicity. While Fc gamma receptors are required to mediate ADCC, their role in natural cytotoxicity is unknown. To investigate this question, Fc gamma receptors on effector cells were modulated by interaction with IgG immune complexes. As a consequence of this modulation, TG cells lost most of their ADCC activity but retained a significant part of their natural killer activity. Thus, these experiments demonstrate that the cytotoxic mechanisms exerted by the same cell population can be dissociated experimentally. Furthermore, they suggest that the net natural cytotoxicity of normal human lymphocytes in certain effector cell-target cell combinations is the result of distinct types of reaction.


T and B lymphocytes in respiratory pollen allergies (bronchial pollen asthma and allergic rhinitis). The T and B lymphocytes were identified by means of the rosette tests in the peripheral blood of 79 patients with respiratory allergies of whom 41 with allergic rhinitis and 38 with bronchial pollen asthma, as well as in 16 control subjects. The results have shown a clear lessening of the T cells (both in per cent and absolute values) and a less significant decrease of the B cells (only in absolute values) in the patients as compared with the controls. These data suggest an immune deficiency which did not differ between the two groups of patients and was not influenced by the specific hyposensitizing treatment.


The effect of daily administration of naproxen on the prothrombin complex activity in patients under long-term therapy with phenprocoumon. Out of a total of 150 patients attending an out-patient clinic for anticoagulant therapy, 12 had disorders which normally would indicate a prolonged use of an antirheumatic drug. To 6 of these patients, naproxen (1/4 g twice daily) was given while anticoagulant treatment with phenprocoumon was continued in an unchanged dosage schedule (average dose 2.1 mg/day). On the average, the prothrombin complex activity (PP%) was reduced to a stable level 10--20% below that obtained during a 2-month period before the naproxen treatment was started. No bleeding episodes or other effects were observed. Thus the simultaneous administration of naproxen caused no problems for the maintenance of a stable anticoagulant therapy.


Asbestos exposure as a cause of immunological stimulation. Twenty immunological parameters were determined for 37 asbestos-exposed workers with no radiographic pulmonary fibrosis and 132 asbestosis patients, 37 of whom formed a matched referent group for the non-diseased workers. No clear differences between the matched groups were found for the autoantibodies tested, but the prevalence of autoantibodies was increased in both groups in comparison with the prevalence among Finnish blood donor candidates. This phenomenon may reflect a general immunological activity caused by asbestos dust, and this immunological activity may act as an adjuvant in immunisation. The patients revealed a high level of IgA, C3, C4 and alpha-1-antitrypsin. This result indicates that these factors may be related to the development of asbestosis, and could therefore be utilized in the evaluation of diffuse pulmonary fibrosis among workers with asbestos exposure.


Congenital atresia of the left main coronary artery ostium. Three patients with the rare anomaly of congenital absence of the ostium of the left main coronary artery are presented. In two of the patients, aged 50 and 52 respectively, the diagnosis was established during selective coronary cineangiography for a severe anginal syndrome. The third patient, a 16-year-old-girl, underwent cardiac catheterization for investigation of a congenital heart malformation, when a single right coronary artery was demonstrated with absence of the main coronary artery ostium. Two patients underwent successful aortocoronary bypass grafting. In view of the occurrence of sudden death and massive myocardial infarction in adult patients shown to have severe or complete obstruction of the left main coronary artery, it is suggested that adult patients with this condition, who require open-heart surgery for any other cardiac disorder, should undergo aortocoronary bypass grafting concurrently even prior to the development of anginal symptoms. Children shown to have this anomaly should be subjected to long-term follow-up and have an aortocoronary bypass graft performed when symptoms of coronary insufficiency develop.


Serum enzymes with special reference to CK-MB following coronary bypass surgery. In a consecutive series of 25 coronary bypass operations, the postoperative serum activity levels of total creatine kinase (CK) and its more heart-specific isoenzyme CK-MB were examined and related to the levels of aspartate aminotransferase (ASAT), alanine aminotransferase (ALAT) and thermostable lactate dehydrogenase (LD-T), to electrocardiographic (ECG) findings and to surgical characteristics. Detectable CK-MB activity was found in all patients, usually appearing while the operation was still in progress. Peak CK-MB occurred earlier than peak total CK. There was no ECG evidence of myocardial infarction in any patient. The degree of postoperative CK-MB elevation, however, correlated to the duration of extracorporeal circulation (ECC) and aortic cross-clamping (AC). After 120 min of ECC and 70 min of AC, release of CK-MB, as well as of the other enzymes studied, increased considerably. There was a significant correlation between high CK-MB activity and high early postoperative activities of total CK, ASAT and LD-T. When CK-MB determinations are not available, ASAT is preferable to total CK or LD-T in the early evaluation of operative myocardial injury. From the fourth postoperative day, only LD-T is informative in this respect; a second rise of ASAT and ALAT is probably of hepatic origin.


Serum CK-MB kinetics in acute myocardial infarction and after coronary bypass operations. Serum creatine kinase (CK) isoenzyme MB and total CK activity concentrations in 11 patients with acute myocardial infarction (AMI) were compared with the corresponding enzyme activities in 25 patients after coronary bypass surgery, not complicated clinically by AMI. Peak CK-MB occurred 2 +/- 0 (mean +/- SEM) hours after the end of surgery (mean duration of operation 6 hours), but 17 +/- 1 hours from the onset of symptoms in AMI. The plasma half"life for CK-MB was 11 +/- 1 hours under both conditions. Peak total CK was found after about 20 hours in both series of patients. Total CK half-life was 17 +/- 2 hours in AMI, but 30 +/- 3 hours following surgery. CK kinetics were thus different in these two situations, indicating different mechanisms for the elevations of serum CK-MB activity. In conclusion, the time course for the transient CK-MB elevation following bypass surgery should be considered in the diagnosis of peri operative infarction.


[Acute gastrointestinal bleeding: results of endoscopic sclerosing of esophageal varices]. The indications for, technic and results of endoscopic sclerosing of the esophageal mucosa above esophageal varices are discussed and the effect of sclerosis documented histologically. Given strict criteria for the indications, the short and long-term results are encouraging.


[PABA test versus chymotrypsin and fat determinations in the stool in pancreatic functional diagnosis]. 32 patients with proven chronic pancreatitis and 56 controls without evidence of pancreatic disease were studied by the PABA test, the fecal chymotrypsin method and the fecal fat method. The sensitivity of the fecal chymotrypsin method for detection of pancreatic disease was significantly higher (p less than 0.005). The sensitivity of the PABA test and the fecal fat method were comparable. The specificity of the PABA test and the fecal chymotrypsin method was of the same order.


[Large colonic polyp: endoscopic or surgical removal?]. 93 neoplastic polyps measuring more than 2 cm in diameter have been removed from the colon by endoscopy. 15% of the polyps showed severe atypia (focal carcinoma), and in 15% an invasive carcinoma was found. Polypectomy was complicated in 14 cases by bleeding, in 12 cases it was cured  by endoscopy. In 1 case in which the colon was injured by coagulation the lesion healed spontaneously. The surgery rate due to complications of the endoscopic removal procedure or due to invasive carcinoma was 7% for the polyps with a diameter of 2-3 cm, 15% for those of 3-5 cm and 50% for polyps with a diameter of more than 5 cm. It is therefore suggested that neoplastic polyps of more than 5 cm in diameter should be removed by endoscopy in high risk patients only.


X-ray absorption edge fine structure of potassium ions in various environments: application to frog blood cells. The edge spectrum is a sensitive probe of local chemistry. Edge spectra of potassium in various chemical environments were measured, and each environment gives a unique edge spectrum. Hydrated potassium has a unique spectrum that is insensitive to counterions. Comparison of the spectra shows that the chemical state of potassium in cells differs appreciably from that in aqueous solutions.


Late results of myocardial revascularization. Data are presented on 1,400 consecutive patients who had myocardial revascularization at our institution. The patients ranged in age from 33 to 80 years. Coronary bypass was done with an associated noncardiac procedure in 70 patients and with an associated cardiac procedure in 73 patients. The hospital mortality was 2.0%. Left ventricular function was a primary determinant of hospital mortality. With a 98% follow-up, survival was 93.1% at a mean of three years (range, six months to seven years). Ventricular function was the prime determinant of the overall long-term survival. These data indicate that myocardial revascularization, either alone or with an associated cardiac or noncardiac procedure, can be done with a low operative mortality. Because of the excellent five-year survival in our group of patients followed up for this length of time, we believe these data support the hypothesis that myocardial revascularization extends the life expectancy of patients with coronary artery disease.


Rubella antibody among Thai women of childbearing age. Result of rubella haemagglutination inhibition antibody test on 300 Thai women of childbearing age in upper socioeconomic group showed that 25% were susceptible to rubella. The high frequency of susceptibility in this group of women would be of considerable public health problem, should rubella become epidemic again. The introduction of immunization against rubella in this group of women was also discussed.


Management of upper gastro-intestinal tract bleeding. Approximately half the patients who die from peptic ulceration do so because of the complication of bleeding. Mortality can be reduced by earlier diagnosis and treatment. All patients with upper gastro-intestinal tract bleeding should be transferred as soon as possible to centres where the necessary diagnostic and operative facilities are available. Cimetidine plays a role in the management of certain types of gastro-intestinal tract bleeding and endoscopy has been a major breakthrough in terms of accurate and early diagnosis.


Vascular ectasias of the colon.

Vascular ectasias of the colon. Vascular ectasias are an acquired type of arteriovenous malformation distinct from neoplastic and congenital lesions. They can be the source of occult, recurrent or massive colonic bleeding usually in elderly patients but, occasionally, in younger adults. The vascular lesions are usually small but can be quite diffuse. The majority occurs in the right colon, but in our group of patients, a substantial number occurred distal to the hepatic flexure. The diagnosis can be made preoperatively, with colonoscopy but, more consistently, with arteriography. Therefore, arteriography should be performed in any patient with bleeding of the colon before surgical intervention. We recommend resection of the involved segment of the intestine as the treatment of choice.


Localization of bleeding small intestinal lesions using scanning techniques. Gastrointestinal bleeding remains a major diagnostic problem, and the commonly employed techniques of contrast radiography, endoscopy, and arteriography may not successfully localize the site and/or define the cause of gastrointestinal hemorrhage. Technetium-99m pertechnetate scanning has been useful in identifying Meckel's diverticula, and modifications of this technique may successfully identify highly vascular lesions responsible for gastrointestinal bleeding. A patient with recurrent hemorrhage from a leiomyosarcoma of the ileum is described. The lesion was identified with flow studies and immediate static imaging after injection of technetium-99m pertechnetate. In addition, the lesion was demonstrated by scanning using in vivo technetium-99m pertechnetate labelled autologous erythrocytes. The potential value of these scanning techniques as noninvasive tools for the localization and identification of lesions responsible for gastrointestinal bleeding is discussed.


Intraoperative Doppler localization of intestinal arteriovenous malformation. Arteriovenous malformations of the gastrointestinal tract have been identified as the cause of significant bleeding when other causes are obscure. A method of precise intraoperative localization using Doppler ultrasound technique is presented. The value of this method is shown in the management of an illustrative case of a rare arteriovenous malformation of the duodenum.


Transabdominal neurostimulation in acute spinal cord injuries. Transabdominal neurostimulation (TANS) is a new term and concept used in the prevention and treatment of adynamic or paralytic ileus. Though it may occur for other reasons, ileus is a frequent and common complication of acute spinal cord injuries. The calculated incidence of ileus in this study of 43 control acute spinal-injured patients at Northwestern University was 15%. Of 44 patients on whom the TANS procedure was used, none developed paralytic ileus. The primary advantages observed from the use of TANS were the following: the ease of application, the lack of major complications, and the prevention of ileus.


Immunological investigations in chronic simple glaucoma. Serum immunoglobulins and antinuclear antibodies were estimated in 225 patients, including cases of chronic simple glaucoma, "low tension glaucoma", and ocular hypertension. The results showed that, while the mean levels of immunoglobulins Ig A and Ig M were not significantly higher in patients with glaucoma than a control series of normal adults, the mean level of Ig G was higher in those with chronic simple glaucoma. There was no clear relationship between Ig G levels and the severity of the disease as judged by the visual fields and optic disc changes. Antinuclear antibodies were found in a larger proportion of patients with chronic simple glaucoma and ocular hypertension as compared to the normal population, but there was no correlation with the severity of the disease. The incidence of other non-organ-specific and organ-specific autoantibodies was not significantly different from that of the control group. Although these results suggest an association of raised levels of Ig G and a higher incidence of antinuclear antibodies in patients with glaucoma, the evidence is insufficient to suggest that disorders of the immune system have an aetiological significance in chronic simple glaucoma.


Closed intraocular microsurgery in ocular trauma. A series of 53 eyes that had suffered severe trauma was treated by closed intraocular microsurgery with vitreous cutters. The cases were divided into three categories: (a) anterior segment reconstruction for traumatic cataracts and post-traumatic pupillary membranes, (b) vitreous haemorrhage with and without retinal detachment, and (c) traumatically dislocated lenses.


[Immunological analysis of human lymphocytes bearing different surface receptors]. Cell surface receptors on human lymphocytes being studied, essential differences were revealed in a relative content of E-, EA- and EAC-rosette-forming cells in peripheral blood and tonsils. In tonsils, part of lymphocytes carrying receptors for sheep erythrocytes have been shown to possess C'3-receptors for sheep erythrocytes. Apparently, C'-receptor,--being B-lymphocyte surface marker,--may also appear at definite stages of T-cell differentiation.


[Failures and complications of direct mesenteric portography]. The direct mesentericoportography was carried out upon 179 patients with portal hypertension. Complications were observed in 28.5% of patients. Technical difficulties arose in 11 cases. Recommendations aimed at the stabilization of the results and decrease of the complication rate are given.


[Retention of the Newcastle disease virus in immunized poultry]. The period of virus harbouring was followed up in a total of 50 experimentally infected (Newcastle disease) birds. Two methodes were used to isolate the challenging virus: the ordinary virologic procedures and the method of tissue cultures. Studied was also the effect of the humoral immunity on the persistence of the virus. Investigations by the tissue culture method revealed a persisting latent infection in the course of 70 day, which in certain cases could assume an acute course and become apparent. The Newcastle disease virus was isolated from birds having either low or very high levels of serum agglutinins. The currently employed virologic methods failed to demonstrate the virus after the 16th day of infection.


[Exocrine pancreatic function test by N-benzoyl-L-tyrosyl-p-aminobenzoic acid (author's transl)]. Urinary excretion of p-aminobenzoic acid (PABA) within 6 h after oral administration of N-benzoyl-L-tyrosyl-P-aminobenzoic acid (Peptide-PABA) was measured. In healthy subjects PABA-excretion rate was not different after 150 mg and 1 g Peptide-PABA. PABA-recovery was significantly lower in patients with chronic pancreatitis. Seperation between healthy persons and patients with chronic pancreatic insufficiency was better with 1 g Peptide-PABA.


Ultrastructure of the joint receptors in the frog (Rana temporaria). The ultrastructure of sensory nerve endings was examined in joint capsules of large limb joints in three adult frogs (Rana temporaria). The joint receptors are represented by the only one kind of sensory nerve endings--by free nerve endings. The unmyelinized preterminal desintegrates into single terminals. This branching is bound on the most peripheral cell of the Schwann cell by means of mesaxons, they pass from the pericaryum of the Schwann cell peripherally. The branches of the nerve terminal are surrounded by a cover of 1...3 cytoplasmatic processes of the Schwann cell. The surface lamella is covered by a distinct basal membrane. Bundles of collagenous fibrils pass along the branches of the nerve terminal. Quite naked nerve endings were not observed. The axoplasma of the nerve terminal contains strikingly few cell organels. Besides axially passing neurofilaments and neurotubules only sporadic mitochondria and clear vesicles were observed. The accumulation of mitochondria, characteristic for the axoplasma of nerve terminals, was observed in no case. Free nerve endings which were found in the joint capsules of the frog belong among so called "free penicillate nerve endings".


[Splenic transposition for portal hypertension (author's transl)]. Operative techniques for splenic transposition are reviewed and operative indications discussed. Thoracic transposition of the spleen for treatment of oesophageal bleeding is indicated in children and in patients with portal thrombosis and, in addition, in cases of intractable ascites complicating posthepatic obstruction. Late results of 28 cirrhotics operated on after variceal bleedings are presented. Fatal bleeding recurrences were avoided in 83 per cent of the cases surviving six months and the mean survival is 7.5 years so far. In elective surgery of cirrhotics with well maintained portal flow the most rational operative procedures are distal spleno-renal shunt and thoracic transposition of the spleen.


[Immune structure of the population of Moscow to the strains of the influenza viruses A(H3N2), A(H1N1) and B circulating in 1977]. Examinations for the presence of antihemagglutinins to influenza A(H3N2), A(H1N1) and B virus strains in the sera from people of different ages collected in April-May and October-November, 1977, showed that influenza A(H1N1) virus began to circulate in the human population of Moscow before the onset of an overt epidemic, in the period between June and October, 1977. This conclusion has been drawn on the basis of the absence of antihemagglutinins to A(H1N1) virus in the sera from subjects of 16-20 years late in April and their detection in 25.9% of those examined on November 23, 1977. The lack of antibody both to the old A/FM/1/47 (H1N1) and a new A/USSR/90/77 (H1N1) strains of influenza A (H1N1) virus in this age group in April indirectly attests to the fact that influenza A virus of this subtype has not circulated among the population in the last 20 years. At the same time the observed significant (by 1.5-2.0 log2) rise in the geometric mean titers of antibody to A(H3N2) virus in May-October indicates its continued active circulation among the population in this period. Thermostable inhibitors of influenza A/USSR/90/77 (H1N1) virus in human sera may be most effectively removed by treatment of the sera with potassium periodate or RDE.


[Rosette formation test for evaluating the immunological state of serum hepatitis patients]. The number of T-lymphocytes was determined by the method of spontaneous rosette formation according to Bach et al., and of B-lymphocytes by the method of complementary rosette formation of Mendes et al. in 57 patients with serum hepatitis whose diagnosis had been confirmed by laboratory studies (HBsAg+) in the course of the disease. A decrease in the absolute and relative amount of T-lymphocytes was observed at the peak of the disease and was particularly marked in patients with severe disease. The values of B-lymphocytes did not change significantly in most patients throughout the disease but lower values of both relative and absolute numbers were observed in severe and fulminant forms. The amount of O-lymphocytes increased at the peak of the disease, particularly in severely ill patients. These results may be used as an additional test in the evaluation of the severity of a patient's condition.


R plasmids in vibrionaceae - beta-lactamases in Vibrio cholerae (NAG-Heiberg II) and A. hydrophyla. 290 natural isolates of Aeromonas, Plesiomonas and Vibrio strains isolated from surface waters have been tested for antibiotic resistance, and 123 have been found resistant to various drugs, mostly beta-lactam antibiotics. 14 of them, with high-level of resistances, transfered antibiotic resistance using three recipient strains of Enterobacteriaceae. One strain of Vibrio NAG (Heiberg II) transfered the resistance to ampicillin, carbenicillin and cephaloridin to both E. coli K12 3110 and S. typhimurium LT2 recipient, and further, in the second cycle of transfer, to E. coli K12 185 Nx strain. One additional strain of Aeromonas hydrophyla transfered a high-level ampicillin- and a low-level gentamicin resistance to E. coli K12 3110 only. Here, the resistances could not be transfered in the second cycle, and, they did not occur in the same exconjugant colony. This confirms previous reports that antibiotic resistance is widely distributed among strains found in wild nature.


Pharmacokinetics of intravenously administered L-5-hydroxytryptophan in man. The pharmacokinetics of 5-hydroxytryptophan were investigated in relation to intravenous administration of single doses of the amino acids (0.2 mg/kg b.wt.) to five patients pretreated for one week with carbidopa, an L-aromatic amino acid decarboxylase inhibitor. The plasma concentration/time lapse of 5-hydroxytryptophan exhibited bi-exponential disposition characteristics and the data obtained could be closely fitted to an open two compartment pharmacokinetic model with elimination taking place from the central compartment. The apparent composite 1. order rate constants alpha and beta were 1.433 hr-1 +/- 0.177 S.D. and 0.113 hr-1 +/- 0.012 hr-1 S.D., respectively. The biological half-life of 5-hydroxytryptophan under the experimental conditions was thus about 6 hours. The apparent volume of the central compartment, Vc, was found to be 0.336 1 kg-1 +/- 0.059 S.D. and the plasma clearance 0.105 1 hr-1 kg-1 +/- 0.015 S.D. The derived pharmacokinetic constants were used for doses regimen calculations and predetermination of the plasma concentration/time lapse, during continuous intravenous infusion therapy. Measured plasma concentrations of 5-hydroxytryptophan during infusion deviated by less than 10 per cent from the predicted values. However, the infusions had to be stopped in four of the experiments because the patients became nauseated and vomited after total doses of only 36--128 mg.


A comparison of duration of nystagmus as measured by the Southern California Postrotary Nystagmus Test and electronystagmography. The Southern California Postrotary Nystagmus Test (SCPNT) and electronystagmography are methods used to evaluate one aspect of vestibular function. The SCPNT is based on the examiner's observation of eye movements and is used in combination with other information as part of a diagnostic battery for children with learning disorders. Electronystagmography is the permanent recording of eye movements through the use of surface electrodes. In this study. The SCPNT and an electronystagmograph were used to record postrotary nystagmus in 20 normal females aged 25 to 30. A significant correlation was found between the two tests for both duration and excursion. In addition, scores of both tests were compared for four normal and for four learning-disabled girls aged 7 to 8. The only significant correlation found was in terms of duration in the normal girls. Results were discussed in terms of factors affecting observation of eye movement, and differences between the nystagmus response of adults and children.


Medically refractory unstable angina pectoris. I. Long-term follow-up of patients undergoing intraaortic balloon counterpulsation and operation. Of 82 patients with medically refractory unstable angina pectoris seen between October 1972 and January 1978, 60 patients underwent a combination of intraaortic balloon pump counterpulsation, cardiac catheterization and coronary revascularization. Most patients had atherosclerotic involvement of the vessels of the anterior left ventricular wall, 48 patients (80 percent) had abnormalities of left ventricular wall contraction and 22 patients (36 percent) had evidence of acute myocardial injury. One operative and one late death occurred. The perioperative infarction rate was 5 percent. Survivors, followed up for 3 to 63 months (mean 31 months), have done remarkably well; 77 percent are considered employable,and more than 90 percent are in functional class I or II.


Gastrointestinal bleeding in aortic stenosis. Gastrointestinal bleeding in aortic stenosis is an uncommon condition but when present it is often undiagnosed. The usual radiological proceedures fail to demonstrate the source of bleeding. Mesenteric angiography, however, will identify the lesion. The lesion is usually a vascular malformation located in the right colon. The angiodysplasia may also occur in other parts of the gastrointestinal tract. We have encountered five patients with aortic stenosis who had multiple massive hemorrhages of the lower gastrointestinal tract who defied diagnosis by the conventional methods. Mesenteric angiography, however, disclosed the orgin of the bleeding. In four patients vascular malformations were found in the right colon and one in the jejunum. Right hemicolectomy and partial jejunectomy resulted in a cure in all.


Exocrine pancreatic function test by a synthetic peptide. A new synthetic substance, N-Benzoyl-L-tyrosyl-p-aminobenzoic acid, is specially cleaved by pancreatic chymotrypsin after oral administration and the released p-aminobenzoic acid (P.A.B.A.) is absorbed and excreted in the urine. The P.A.B.A. recovery in the urine was examined to evaluate its diagnostic value as an exocrine pancreatic function test. The data permit the following conclusions: 1. There is a significant correlation between this test and maximal bicarbonate concentration, amylase output and volume of P.Z./C.C.K. secretin test. 2. More than one-half to two-thirds proximal or one-third distal of the pancreas must be removed before one can expect an abnormal result in this test. 3. This is a simple and useful test to detect exocrine pancreatic insufficiency of more than moderate degree but normal results may be obtained in minimal to mild exocrine pancreatic insufficiency. Only six of 11 cases (54.5%) with one abnormal factor of P-S test showed decreased P.A.B.A. recpvery, whereas 22 of 23 cases (95.7%) with two or three abnormal factors of P-S test showed decreased or borderline P.A.B.A. recovery.