Autoregulation of an antibody response via network-induced auto-anti-idiotype. The antibody response of a single outbred rabbit was studied throughout three rounds of injections with Micrococcus lysodeikticus vaccine over a 31-mo period. The first-round response was characterized by a vigorous anti- micrococcus response and a strong anti-IgG rheumatoid factor response. The second-round response consisted of a triad of interacting molecules: anti- micrococcal antibodies, autoanti-idiotypic antibodies specific for distinct clonotypes of the first-round anti-micrococcal antibodies, and Fc-specific anti-IgG rheumatoid factor. The interacting triple complex was detected because of the formation of an immune complex that became insoluble upon dilution of the serum. Complex formation was inhibited in the presence of saccharide compounds known to be major immunodominant determinants of the micrococcal cell-wall carbohydrate polymer. The same saccharides did not affect the reaction of rheumatoid factor with IgG. Direct-binding radioimmunoassays ruled out mediation of the dilution-precipitation reaction by soluble micrococcal antigens. Specific absorption of rheumatoid factor inhibited the dilution-precipitation reaction. Auto-anti-idiotypic antibodies were specifically purified from second-round sera, directly confirming the presence of these antibodies. Suppressive effects of auto-anti-idiotypic antibodies on distinct antibody clonotypes were shown by gel isoelectric focusing of first-, second-, and third-round sera. Clonotypes expressed in the first round of immunizations were reduced in quantity or absent when auto-anti-idiotypic antibodies were detectable. Greatly enhanced levels or initial synthesis of new clonotypes of anti-micrococcal antibodies were detected during the period of auto-anti-idiotype synthesis. The third-round sera, devoid of detectable auto-anti-idiotype, contained clonotypes characteristic of both first- and second-round antisera. Thus, auto-anti- idiotypic-mediated suppression appeared to be reversible. The data are interpreted as lending strong support for concepts of autoregulation of immune processes in normal outbred animals via an idiotypic network.


An integrated family-oriented problem-oriented medical record. A charting system has been developed that integrates in one place the master problems of individual members of the family whether they be physical, psychological, or socioeconomic. In addition to the Family Problem List, there is a geneology as well as a family profile. The use of the INFO-POMR helps the clinician approach the family as a unit of providing family information at the provider-patient interface.


The deficit of the isometric tetanic tension redeveloped after a release of frog muscle at a constant velocity. Frog sartorius muscles tetanized isometrically were released at a constant velocity from lengths lL to lS (delta l = lL -lS; Ls greater than lO). The tension PS redeveloped after the release was lower than the isometric tension PS at LS, and higher than the isometric tension PL at lL. The tension deficit D is defined as the difference PS-PS. The timing of the release during the tetanus did not influence D. D/PO was proportional to delta l/lO. The proportionality constant k was equal to 1.35 +/- 0.19 (n = 8) when the velocity of release was 2.5 mm/s. When the muscles were released the same delta l, D was found to be an exponential decreasing function of the velocity. The tension deficit was also found in experiments performed in the region lS less than lO. The proportionality constant k was smaller, but the influence of the velocity of the release on D was not modified. When the velocity of the release was changed during the release, D changed accordingly, showing that the effects of delta l and V are multiplicative. These facts suggest a working hypothesis based on the concept that the actin filaments which enter the overlap region during a release are strained by the tetanic stress and therefore unable to make normal cross-bridges.


Sodium-calcium exchange in regulation of cardiac contractility. Evidence for an electrogenic, voltage-dependent mechanism. The origin and regulatory mechanisms of tonic tension (Ca current-independent component of contractility) were investigated in frog atrial muscle under voltage-clamp conditions. Tonic tension was elicited by depolarizing pulses of 160 mV (Em = +90 mV, i.e., close to E ca) and 400--600 ms long. An application of Na-free (LiCl) or Ca-free Ringer's solutions resulted in a fast (less than 120 s), almost complete abolition of tonic tension. When [Na]o was reduced (with LiCl or sucrose as the substitutes), the peak tonic tension increased transiently and then decreased below the control level. The transient changes in tonic tension were prevented by using low-Na, low-Ca solutions where the ratios [Ca]0/[Na]40 to [Ca]o/[Na]4o were kept constant (1.1 X 10(-8) mM-3 to 8.7 X 10(-13) mM-5). Na-free (LiCl) solution elicited contractures accompanied by a membrane hyperpolarization or by an outward current even when the Na-K pump was inhibited. 15 mM MnCl2 (or 3 mM LaCl3) inhibited the development of the Na-free contracture and the related part of hyperpolarization or the outward current. In conclusion, our results indicate that tonic tension is regulated by a Na-Ca exchange mechanism. Furthermore, they suggest that this exchange could be electrogenic (exchanging three or more Na ions for one Ca ion) and thus voltage dependent. The possible contribution of an electrogenic Na-Ca exchange in the maintenance of cardiac membrane potential is discussed.


Blink reflexes in posterior fossa lesions. Blink reflexes obtained by electrical stimulation of the supraorbital nerve and electromyographic recording of the orbicularis oculi muscle proved useful as a preliminary method in diagnosis of lesions of the brainstem and the fifth and seventh cranial nerves, and in differentiating intrinsic lesions of the brainstem from extrinsic ones. It was noted that R1 and R2 reflexes were different in the two types of lesions.


Experimental allergic neuritis in the Lewis rat. Purified myelin from the peripheral nervous system of guinea pig, frog (Rana catesbeiana), rat, rabbit, beef, and human in Freund's adjuvant were injected into the Lewis rat. Groups of rats receiving injections of myelin from different species were examined for signs of dysfunction and lesions in the PNS and CNS. Injection of frog PNS myelin into the Lewis rat did not produce any clinical signs or lesions typical of experimental allergic neuritis (EAN) or experimental allergic encephalomyelitis (EAE). Injection of myelin from the PNS of rat, rabbit, beef, and human elicited clinical signs and lesions characteristic of EAN, while guinea pig myelin injection caused superimposed conditions of EAE and EAN. The myelin proteins from the various species were separated by polyacrylamide gel electrophoresis, the gels were scanned and the individual proteins measured. There did not appear to be a correlation between the amount of P2 protein contained in the different myelin species and the severity of the EAN symptoms and lesions produced. Although the Lewis rat is far more susceptible to EAE caused by guinea pig CNS myelin than by any other species, EAN can be easily induced in this animal by injection of PNS myelin from a number of species.


Double-contrast ventriculography with oxygen and water-soluble positive contrast medium, metrizamide (Amipaque). A technique for ventriculography using both gas and a positive contrast medium metrizamide (Amipaque) is presented. This ventriculographic method proved superior to computerized tomography (CT) scanning in revealing the cause of obstructive hydrocephalus. Small central tumors and intraventricular cysts, often missed with CT, were also well demonstrated. This technique has been used since 1975, and is simple and safe.


Posttraumatic meningitis due to ampicillin-resistant Hemophilus influenzae. Case report. Two men who sustained skull fractures secondary to blunt head trauma developed meningitis due to Hemophilus influenzae type b. The isolates in both cases were resistant to ampicillin but susceptible to chloramphenicol. Based of this experience, and recent epidemiological trends, it is suggested that chloramphenicol, rather than penicillin G, might be the initial therapy of choice for posttraumatic meningitis when no micro-organisms are recognized on Gram-stained smears of the cerebrospinal fluid.


Effects of essential fatty acid deficiency, and various levels of dietary polyunsaturated fatty acids, on humoral immunity in mice. Six experiments were conducted to determine the influence of an essential fatty acid deficient diet (EFAD), and various levels of dietary polyunsaturated fatty acids, on humoral immunity in mice. The results indicated that: 1) Consumption of diets deficient in essential fatty acids (0% corn oil) significantly reduced the humoral response. This reduction was demonstrated after feeding the essential fatty acid deficient diet for only 28 days; and preceded the effects of essential fatty acid deficiency on growth or appearance. 2) Reduced antibody response was demonstrated against T-cell dependent and T-cell independent antigens, and in both primary and secondary responses of mice fed the essential fatty acid deficient diet. 3) After 56 days of feeding the EFAD diet (0% corn oil), mice switched to the control diet (13% corn oil) for 7 days demonstrated full recovery of the humoral response. 4) Diets containing various levels of polyunsaturated fatty acids (from 2 to 70% of energy from corn oil) did not adversely affect the humoral response. The results support the hypothesis that essential fatty acids play a crucial role in maintaining the functional integrity of humoral immunity.


Fatality from central hemangioma of the mandible. Fatalities from central hemangiomas, including a new case, are reviewed. The importance of a thorough examination of young patients with suspicious gingival bleeding and mobile teeth before extraction is emphasized. The nature of the lesion and the methods of treatment are discussed. In the case reported, there were arteriovenous malformations in the soft tissues surrounding the mandible and a seemingly separate central mandibular lesion. The latter showed rapid growth throughout the mandible, ending fatally after spontaneous bleeding and extraction of the mandibular third molar. During the preceding three years, bilateral external carotid ligation had been performed and numerous conservative measures had been taken, including corticosteroid therapy, injections of Sotradecol, and telecobalt irradiation, all with little benefit.


Treatment of ampicillin-resistant Haemophilus influenzae in soft tissue infections with high doses of ampicillin. Six soft tissue infections (three epiglottitis, one cellulitis, one pneumonia, and one arthritis) with ampicillin-resistant Haemophilus influenzae were treated initially with high doses of ampicillin (200 to 400 mg/kg/day intravenously) alone and had good clinical responses. All had documented bacteremia with H. influenzae. One child was treated only with ampicillin; treatment in the remainder was changed to oral therapy with other antibiotics to facilitate discharge. There was no recurrence of disease. Disc diffusion studies done on clinical isolates of both resistant and sensitive organisms indicate a break point at which the resistant organism shows progressive sensitivity to increasingly higher concentrations of ampicillin.


Observations on spermatogenesis and inseminative behavior of Megalodiscus temperatus adults in frogs. Upon in vitro exposure to 3H-adenosine, spermatogonial cells in adult Megalodiscus temperatus were readily labeled on autoradiograms. At least 20 days were required for these cells to produce labeled sperm, the longest time reported so far for digenetic trematodes. Labelled worms transplanted to hosts for 24--31 days showed both self- and cross-insemination in multiple infections. When alone, half of the transplanted adults self-inseminated.


Fusion of photoreceptor membrane vesicles. The n-alkyl bromides with 6 to 10 carbons induce formation of vesicles of 5 to 100 micrometer diameter from the small vesicles (0.1 micrometer average diameter) produced by disruption of the discs from frog rod photoreceptors. The n-alkanes, n-alkyl iodides and n-alkyl chlorides are relatively ineffective. The formation of large vesicles is independent of calcium concentration and is distinguished from fusion processes previously reported by the large number of vesicles involved. The results reported here together with others suggest the occurrence of multiple fusion (and/or rupture-resealing) events between vesicles, induced by the n-alkyl bromides.


Surgery for variceal bleeding in cirrhosis: a review of our experience and present concepts. The major cause of portal hypertension in Western countries is nutritional cirrhosis (parenchymal block) related to alcoholism. A third of those patients die of variceal bleeding when increased pressure within the varices precipitates bleeding. Construction of portal systemic shunts is aimed at reducing the pressure within the varices and thereby decreasing the risk of bleeding. However, it increases the incidence of hepatic encephalopathy and hence should be used only in patients who have bled. The remaining function appears to be the main factor that determines survival and the incidence of encephalopathy in obese individuals. Portacaval shunts almost completely eliminate the risk of bleeding. There is a greater incidence of hepatic encephalopathy with this procedure than with other shunts. The splenorenal shunt and the distal splenorenal shunt appear to work well in selected patients. Technically, it is a more difficult procedure. The interposition mesocaval shunt is technically easier and is also helpful in patients with ascites. Its post-shunt encephalopathy rate, however, is higher than the splenorenal shunt or the distal splenorenal shunt, though less than the portacaval shunts. Experience with the newer arterialized portacaval and coronary caval shunts is limited. A non-shunt procedure, such as the one described by Sugiura, with impressive results and follow-up may become more acceptable as experience grows.


Influenza vaccination in patients with rheumatic diseases. Safety and efficacy. The safety and efficacy of influenza vaccination were studied in 32 healthy volunteers and in 62 patients with systemic lupus erythematosus (SLE), rheumatoid arthritis, degenerative joint disease, and other rheumatic diseases. These individuals, none of whom was acutely ill, were examined at the time of immunization and one week, three weeks, and four months later. Flare-ups of rheumatic disease following immunization were infrequent and usually minor. Seroconversion to A/New Jersey/76 developed in 62% to 87% of all individuals and to A/Victoria/75 in 62% to 69%. Antibody responses to A/New Jersey/76 were significantly lower in young patients taking glucocorticoids compared to those not taking glucocorticoids. The antibody responses to A/New Jersey/76 and A/Victoria/75 in patients with SLE were not different from normal responses. Administration of these vaccines was safe in these patients with stable disease and induced antibody responses in most individuals.


Localization of CO2 sensor related to the inhibition of the bullfrog respiration. CO2 sensitivity in the airways and the general skin surface of the bullfrog under urethane anesthesia or without anesthesia was investigated. Pressure in the buccal cavity as well as blood pressure in the sciatic artery were measured with a differential or a straingauge transducer. Air containing 2--14% CO2 was introduced into the regions as given below. (1) The nose and the body surface, both regions were separated from each other and independently exposed to CO2. (2) The larynx-lungs, the buccal cavity-lungs, the naso-buccal cavity separated from the airways at the glottis, and the internal or external nares, respectively. By analyzing the CO2 sensitivity of the respective regions mentioned above, both the nasal mucosa and the skin surface were found to be responsible for the respiratory inhibition by CO2. Sectioning both the olfactory and the trigeminal nerves abolished the CO2-induced inhibition mediated by the nasal mucosa and electrical stimulation of the proximal cut end of these nerves inhibited respiration. These findings suggested the existence of afferent reflex pathways from the nasal mucosa by these cranial nerves. Significance of this CO2-induced reflex was discussed.


The action of N-ethylmaleimide on the membrane currents and contractile tension in the bullfrog atrium. The effects of N-ethylmaleimide (NEM), a sulfhydryl blocking reagent, on the membrane currents, action potentials and contractile tension in bullfrog atrial muscle were studied by using the double sucrose gap technique. In concentrations of 10(-3) to 10(-4) M, NEM led to a transient enhancement of twitch contraction followed by a late inhibition, while 10(-2) M NEM merely produced an inhibitory effect. The positive inotropism was accompanied by a prolongation of action potential and the negative inotropism, by a depression of action potential. Under voltage clamp conditions, 10(-3) M NEM reduced the fast inward current and increased the steady state outward and background currents. The slow inward current and the inward Ca current in Na-free conditions were transiently increased by 10(-3) M NEM with an enhancement of contractile tension. In voltage-tension relationships, NEM-induced augmentation of tension appeared in depolarizing pulses of 60--70 mV. The results indicate that NEM increases transiently the Ca conductance of the cell membrane. Preincubation with L-cysteine blocked the production of positive inotropic effect by NEM, suggesting that the effects of NEM are due to the blockade of protein sulfhydryl group in the atrial muscle.


Recurrent synaptic activation of the bullfrog sympathetic ganglion cells by direct intracellular stimulation. In a certain group (type 2 cells) of bullfrog sympathetic ganglion cells, an action potential exhibiting a triphasic after-potential was produced when the cells were activated by direct intracellular stimulation. This triphasic after-potential consisted of two different potential components, namely, a depolarizing response (DR) and an after-hyperpolarization. The amplitude of DR was increased by increasing the interval between stimuli. Large DRs exceeded the threshold of the cell membrane and produced repetitive firings of spike potentials. The DR was selectively depressed and eventually eliminated in a low-Ca solution. Eserine (10(-5) M) reversibly increased both the amplitude and duration of the DR, and d-tubocurarine reversibly depressed it. These results indicate that the DR of type 2 cells is the EPSP mediated by the nicotinic action of acetylcholine released from preganglionic nerve terminals. Preganglionic nerve fibers innervating type 2 cells are activated through some kind of recurrent pathway formed between them. Recurrent activation of type 2 cells seems to be thus induced when the cells are activated by direct intracellular stimulation.


The slow P III response of the isolated frog retina. The slow PIII response of the electroretinogram (ERG) was studied in the isolated, aspartate-treated bullfrog retina. The slow PIII response reflected mainly rod activity in its time course and spectral response curve, and the ratio of the peak amplitude of the fast PIII response to the slow one remained almost constant within a scotopic range when rhodopsin was kept at a constant concentration. Reducing Na+ or K+ concentration in the extracellular fluid or decreasing the rhodopsin content in the retina, however, caused different influences on the fast and slow PIII responses, and, in particular, the reduction in amplitude of the slow PIII response was more marked than that of the fast PIII response. Under these circumstances, the log of the amplitude of the slow PIII response was in linear proportion to the amplitude of the fast PIII response. In addition, the amplitude reduction of the fast PIII response was not accompanied by a decrease in peak latency but that of the slow PIII response was. An explanation on the production of the slow PIII response was attempted with reference to other results related to the slow PIII response, ionic mechanism of the electrical activity of photoreceptor cells and their Na-K pump activity.


Demonstration of effective antitumor immunity in an autochthonous host bearing primary colon tumors induced by 1,2-dimethylhydrazine dihydrochloride. The role of host defense mechanisms in preventing the development of subclinical tumors into invasive tumors in an autochithonous host was studied in a model of rat colon carcinoma induced by 1,2-dimethylhydrazine dihydrochloride (DMH). Multiple gastrointestinal (GI) tumors were induced in inbred WF female rats exposed to DMH. In vitro and in vivo data suggested that the excision of the "first" GI tumor induced specific antitumor immune responses. After a complete excision of the first GI tumor, only 2 additional GI tumors were observed in 10 rats, whereas 13 and 12 additional GI tumors in 10 and 9 rats, respectively, were observed if the first GI tumor was left in situ or permitted to grow in an isolated segment of the colon. Furthermore, immunosuppression with antithymocyte globulin decreased the effectiveness of antitumor immunity induced by the immunizing first GI tumor. These experiments supported the view that an effective antitumor immunity is induced against successive tumors of an organ after a complete excision of a tumor originating in the same organ. The results of these experiments are discussed in relation to the observations of multiple primary neoplasms in humans.


An unusual type of alpha1-antitrypsin deficiency in a child. An unusual variant of serum alpha1-antitrypsin is described in a 15 5/6-year-old white male with a history of chronic pulmonary disease. The patient had a very low level of this protease inhibitor as demonstrated by tryptic inhibitory capacity and electroimmunoassay. Even though the patient's serum alpha1-antitrypsin was partially purified and concentrated, no phenotypic pattern was seen using conventional Pityping procedures (acid starch gel with crossed antigen-antibody electrophoresis or isoelectric focusing). Crossed antigen-antibody electrophoresis using agarose in both steps, immunoelectrophoresis, and agarose electrophoresis followed by immunofixation all revealed a slow-moving alpha1-antitrypsin, cathodal to the Pi Z region. Studies on sera from the patient's mother and two half-sibs showed that all three had clear Pi M phenotypic pattersn. Quantitative date on these sera suggested that the unusual variant may be inherited in a codominant fashion.


[A case of spontaneous remission of congenital histiocytosis X (author's transl)]. A Case of spontaneous remission of congenital histiocytosis X with solely skin involvement is described and the need for individualized therapeutic approach outlined.


The morphologic changes of the rat type II pneumocytes induced by oxytetracycline. Ultrastructural changes in pulmonary alveoli of adult Sprague-Dawley rats administered oxytetracycline (1 mg. per ml.) in their drinking water were compared with those of control rats whose drinking water contained no antibiotics. Groups of rats were sacrificed after 4 and 8 weeks of oxytetracycline treatment. Type II pneumocytes of oxytetracycline-treated rats showed an increase in size and number of lamellar bodies, as well as in their cell volume, when compared with controls. Electron microscopic morphometry confirmed these findings; the lamellar inclusion bodies increased 6 and 10 per cent and the cell volume increased 3 and 5 per cent at 4 and 8 weeks, respectively. The type I pneumocyte and alveolar macrophage showed engulfed myelin figures, and the Clara cells appeared quiescent. These findings suggest that the type II pneumocyte hypertrophy can be induced independently from the diffuse alveolar damage. The oxytetracycline treatment may provide a model system in which the pathologic morphology and function of the type II pneumocyte can be studied independently.


Effects of oral and parenteral corticosteroids on intestinal villous morphology and brush border enzymes in the rat. The effects of corticosteroid have been studied in rats submitted to oral administration of prednisone (5 mg. per kg. per day) during 8, 15, 30, and 90 days. The results were compared to those obtained after parenteral administration of hydrocortisone acetate (50 mg. per kg. per day intramuscularly). The morphometric changes of the villus-crypt axis and the brush border enzymic content of the mucosa (sucrase, enterokinase, alkaline phosphatase, and aminopeptidase) were the parameters investigated at the duodenal, jejunal, and ileal levels. Oral administration of prednisone resulted in a significant increase of the duodenal villous height at the 15th (+ 13 per cent, p less than 0.01), 30th (+ 33 per cent, p less than 0.001), and 90th day (+ 56 per cent, p less than 0.001), whereas in the jejunum a constant decrease of the villous height was noted. Parenteral hydrocortisone administration did not affect intestinal morphology. Effects of oral corticosteroids on the microvillous enzymic activities were related to both intestinal level and duration of corticoids administration: (1) in the duodenum increase of sucrase, alkaline phosphatase, and aminopeptidase during 30 days followed by normalization at the 90th day, (2) an initial increase of sucrase, alkaline phosphatase, and aminopeptidase limited to the first 8 days in the jejunum, and (3) a significant rise of alkaline phosphatase (greater than 100 per cent, p less than 0.001) and enterokinase (greater than 100 per cent, p less than 0.001) in the ileum at the 15th day of treatment. Parenteral corticosteroid administration was associated with a significant increase of both sucrase and enterokinase activities. The present study suggests that: (1) Corticosteroids exert a direct effect on the intestinal morphology varying with the intestinal level and duration of treatment. (2) No correlation could be established between anatomic and functional changes. (3) Oral corticosteroids exert an enhancing effect of the brush border enzymic activities, even in the adult mucosa and particularly at the ileal level where they stimulate significantly the enterokinase mucosal activity. (4) Parenteral corticosteroids exert a more specific effect limited to sucrase and enterokinase enhancement.


Prospective analysis of valvular replacement without venting the left ventricle. The present study is a prospective analysis of a series of consecutive valve replacement and combined (valvular plus coronary artery) operations performed without left ventricular decompression. Results indicate that left ventricular venting (direct or indirect) is unnecessary provided that cardioplegic arrest is used, that the venous line is positioned in the right atrium, and that left-sided pressures are monitored. Left ventricular distention, as measured by left ventricular pressure recording, did not occur; air embolism, as determined clinically and by electroencephalographic (EEG) monitoring, was not encountered. The routine use of a left ventricular vent has been abandoned in most intracardiac operations at our center.


Influence of alternate sources of bllod flow on the reactive hyperemia response in aorta-coronary saphenous vein bypass grafts in man. Reactive hyperemia responses (RHR) of various magnitudes were obtained after release of a brief occlusion in six of 10 coronary bypass grafts. All of the vein grafts responded to an injection of sodium nitroprusside (50 microgram) directly into the open graft with an increase in blood flow that was always greater than the flow recorded after release of the occlusion. This response indicates that there were no flow-limiting stenoses and that the distal vascular beds were responsive to vasodilator stimuli. RHR's, expressed as percent repayment of calculated flow debt, were correlated significantly (r = 0.96, p less than 0.01) with the magnitude of the decrease in vein graft pressure measured during occlusion of the graft. It is suggested that the decrease in pressure is related to the amount of blood flow from alternate sources to the vascular bed during occlusion of the graft, and that this collateral flow is an important determinant of the magnitude of RHR in bypass grafts.


Lymphocytopoietic factor in lymph.

Lymphocytopoietic factor in lymph. The evidences which suggest the presence of a lymphocytopietic factor in rat thoracic duct lymph are summarized briefly. The intravenous injections of the extracted materials from lymph plamsa into syngeneic recipient rats resulted in the massive proliferation of lymphoid cells predominantly in the thymus dependent areas and thymic cortex, suggesting that the target cells for the factor are not marrow-derived (B) cells, but thymus derived (T) cells. The existence of a thymus is not necessarily required for the production or secretion of the factor. The augmenting effect of the factor on T cell functions, eg. local graft-versus-host rection and helper activity of plaque forming response to sheep erythrocytes, is mentioned. The physicochemical characteristics of the factor are nondialysable and heat-stable glyco-protein molecules. The roles of lymph humoral factor in T cell-differentiation or proliferation are discussed.


Hypofibrinogenemia-dysfibrinogenemia and von Willebrand's disease in the same family. Two Puerto Rican families were studied. One family included a number of members with dysfibrinogenemia occasionally associated with hypofibrinogenemia. The second family had members with von Willebrand's disease. The two diseases merged in the proband's immediate family; the affected members of this family exhibited a mild bleeding disorder. Others in the two families had no obvious bleeding tendency.


Medical treatment of acute pancreatitis. Standard medical management of acute pancreatitis includes measures to relieve pain and maintain intravascular volume, nasogastric aspiration of gastric contents, and prompt recognition and treatment of complications. Despite many years of investigation, no specific drug or nonoperative procedure is of proven benefit in this common disease.


The value and cost analysis of the ENG as of 1978. The use of ENG in office practice and its use as a helpful, time-saving procedure is discussed. The following practical clinical questions are answered: 1. Is the vestibular mechanism normal or abnormal? 2. Is the vestibular pathology peripheral or central? 3. Is the peripheral disease right or left sided? Cost analysis of ENG in office practice is presented.


Total facial nerve exploration: transmastoid, extralabyrinthine, and subtemporal indications and results. Increasingly, surgeons are using a middle fossa approach though craniotomy to reach the labyrinthine segment of the facial nerve and geniculate ganglion in patients with intact hearing. This paper describes a transmastoid operation that provide exposure of the labyrinthine segment of the facial nerve without performance of a craniotomy. In this procedure the geniculate ganglion and labyrinthine segments of the facial nerve were exposed, while cochleovestibular function was spared; recovery of the facial nerve in patients with Bell's palsy or herpes zoster oticus (even the patients with a dry eye) was favourably influenced.


Abnormal factor VIII in chronic renal failure. Factor VIII procoagulant activity (VIII-C), related antigen (VIII-AG), and von Willebrand factor (VIII-vWf) were measured in 38 patients with chronic renal failure (CRF), in 19 patients with normal renal function from a general medical ward, and in 17 normal subjects. Wide variation in the levels of factor VIII (FVIII) functions were found in the group of CRF patients. There was no correlation between the levels of the three individual activities of FVIII in renal disease. The levels of the three functions were elevated in the patient controls and no significant differences were found between the two groups of patients, although both groups were significantly different from the normal subjects. Increased electrophoretic mobility (EM) was detected in 22 of the 38 patients with CRF (58%) compared to seven of the 19 patients controls (37%). These studies suggest caution in interpretation of changes in FVIII status in patients with other clinical disorders, such as liver disease.


Haemophilus influenzae meningitis. A national study of secondary spread in household contacts. To determine the risk of severe Haemophilus influenzae illness among household contacts of patients with H. influenzae meningitis, we studied prospective data obtained in 19 states from January 1, 1977, to June 30, 1978. H. influenzae meningitis was reported in 1403 patients, and 1147 (82 per cent) of the exposed families were investigated for the occurrence of H. influenzae disease within 30 days after its onset in the index patient. During this interval, nine of 1687 household contacts (0.5 per cent) under the age of six years had systemic disease confirmed to be caused by H. influenzae Type b. The risk in children less than one year of age was 6 per cent, and the risk in those less than four years of age was 2.1 per cent. None of 2624 contacts above the age of five was affected. In the 30 days after onset of meningitis, the risk of this infection alone, aside from other types of serious H. influenzae disease, is 585 times greater in household contacts than the age-adjusted risk in the general population. The risk of H. influenzae disease in household contacts under six years of age is similar to the risk of secondary meningococcal disease in all household contacts--indicating a need for effective antimicrobial prophylaxis.


Studies on T and B lymphocytes in rats bearing methylcholanthrene-induced tumor. The authors have studied the influence of primary, methylcholanthrene-induced tumor on T and B lymphocytes of spleen, thymus, draining lymph nodes and peripheral blood of rats. Differences in weight of tumors were found to correlate with changes in proportionality of T and B lymphocytes of followed organs. Small tumors induced but insignificant changes. There was increased trapping of T lymphocytes in spleen and lymph nodes with simultaneous decrease in peripheral blood. The authors noted a high percentage of blasts. B lymphocytes showed a tendency to compensate for the loss of T cells. Large, progressively growing tumors caused evident exhaustion in the number of both cell types in lymph nodes and peripheral blood. In the spleen there was slower exhaustion. Reduction in the number of B lymphocytes correlated with the size of tumor. Blasts disappeared. Proportionality of T and B lymphocytes in thymus did not appear to be influenced by the size of tumor.


The differential diagnosis of pontine angle meningioma and acoustic neuroma with computed tomography. Seven pontine angle meningiomas were examined with computed tomography (CT). The result was compared with that of a study of 61 acoustic neuromas. These two tumor types differ in manner of growth, volume, shape, attenuation, attachment to bone, cisternal deformation, frequency of calcification, peripheral edema, and bone changes.


Comparison of the measurements of the cerebral ventricles obtained by CT scanning and pneumoencephalography. This study was undertaken to compare the accuracy of measurements of the venticular system obtained by the CT scanner and pneumoencephalography (PEG). In it the ventricular system was evaluated in each case by measuring the span of the frontal horns, cellae mediae and third ventricle in relation to the diameter of the inner and outer tables of the skull from the PEG films. The indices of Evans, Schiersmann, and Schaltenbrand and Nürnberger were applied to these measurements. The same indices were obtained using the appropriate CT printouts. A very good measure of agreement was obtained with the indices arrived at from both the CT scan printouts and the pneumoencephalograms.


Neuroradiological aspects of suprasella germinoma. The plain skull roentgenography, angiography, air encephalography or positive contrast medium ventriculography and computed tomography (CT) of twelve cases of suprasella germinoma were reviewed. In over half of the cases, plain skull roentgenography and angiography showed some abnormalities suggesting a suprasella mass. CT was found to be the most appropriate for routine examination. And air encephalography or positive contrast medium ventriculography offered decisive information.


Congenital atresia of the foramen of Monro. Two cases of congenital atresia of the foramen of Monro are described, one 8 days old and the other 2 months old. Both are associated with a parieto-occipital paraventricular diverticulum and spontaneous ventriculostomy with the passing of the cerebrospinal fluid to the posterior fossa and the formation of a cyst in the supracerebella region which compressed and displaced the structures of the posterior fossa.


Ventricular differences between hydrostatic hydrocephalus and hydrocephalus ex vacuo by computed tomography. Transaxial CT scans of 100 patients with hydrostatic hydrocephalus and 50 patients with hydrocephalus ex vacuo have been reviewed with respect to measurements of: frontal horn ratio, width of the temporal horns, width of the third ventricle, width of cerebral fissures and sulci. The diagnosis of hydrostatic hydrocephalus is probable when (a) both temporal tips are visualized and measure 2 mm or greater in width and the sylvian and interhemispheric fissures and cerebral sulci are not visible, or (b) there is visualization of temporal horn tips measuring 2 mm or greater in width and the lateral ventricles are symmetrically enlarged with the frontal horn ratio 0.50 or more.


Reduced number of active T cells in cerebrospinal fluid in multiple sclerosis. Using a modification of the active rosette test of Wybran and Fudenberg, we found that the percentages of active T cells were significantly lower in the cerebrospinal fluid (CSF) of multiple sclerosis (MS) patients than in blood obtained simultaneously from these patients, or in the CSF or blood from patients with other neurologic diseases. These results suggest that in MS there may be a depression or deficiency of a functional subpopulation of T lymphocytes confined to the central nervous system.


[Scintiscanning with technetium-99m pertechnetate in the diagnosis of Meckel's diverticulum]. Personal experience with technetium99m pertecnetate scanning in the diagnosis of Meckel's diverticulum is reported. The data reported indicate that the scan can be considered positive when the lower right quadrant of the abdomen shows a definite accumulation of radioactivity. Of 12 children examined, 4 responses were positive. These 4 patients were submitted to surgery and this confirmed the presence of Meckel's diverticulum containing gastric mucosa, and of an ulcer in the adjacent ileal mucosa. After discussing the clinical value of the investigation and having examined the problem of false positives and false negatives, in relation to reported data, it is concluded that scanning with technetium has a vital role to play in the diagnosis of haemorrhage due to Meckel's diverticulum.


Menstrual dysfunction in distance runners. The problem of menstrual dysfunction in women who engage in endurance training for participation in distance running events has been studied. Through survey, selected aspects of the personal, training, menstrual, and contraceptive histories of 168 women who were defined as runners, joggers, or controls were evaluated. In addition, defined subsets of the study subjects were evaluated for serum levels of pituitary and ovarian hormones and determination of percentage body fat. The data show significant differences among the 3 groups. It is concluded that menstrual dysfunction in distance runners is a real phenomenon. Presumably this is related to decreased percentage of body fat and/or minimal ovarian function secondary to diminished hypothalamic or pituitary hormone secretion.


Possible nonspecific immunopotentiation by 2,4-dinitrochlorobenzene sensitization in patients with Hodgkin's disease. Various immunological parameters were evaluated in untreated Hodgkin's patients before and after sensitization with dinitrochlorobenzene (DNCB). The ratio (r) of these parameters after/before DNCB sensitization for patients and second/first samples in the controls were calculated. There were significantly more patients in the r greater than 1.1 group for PHA and Con A responses and for peripheral blood T cell percentages. These data suggest that DNCB sensitization may have a nonspecific immunopotentiation effect.


Timing of bilateral cerebellar output evoked by unilateral vestibular stimulation in the frog. Electrical stimulation of one VIIIth nerve evoked simple spike activity in Purkinje cells located on either side of the cerebellum. This cellebullar output was delayed by ca. 10 ms with respect to its mossy fiber-parallel fiber input. The onset of the cerebellar output occurs on the average simultaneously on either side of the corpus cerebelli. The delay is explained by slowly rising EPSPs in PC induced by primary afferent and by second and higher order vestibular fibers. The latter inputs are stronger and terminate ipsi- and contralaterally in the granular layer.


[Double contrast barium enema-colonoscopy. Comparative diagnostic value in 73 patients (author's transl)]. Double contrast barium enema and colonoscopy are great value in the diagnosis of lesions of the colon, especially polyps. This study involved 73 patients. The results were in agreement in 71,2% of cases and disagreed in 23,3%. In 5,5%, colonoscopy was technically inadequate. Classical barium enema remains indicated for the detection of carcinoma or in elderly or bedridden individuals. By contrast, barium enema should be replaced by double contrast study in the aetiological evaluation of rectal bleeding. In our own series, the diagnosis was positive in 92% of cases as long as both the radiological and endoscopic techniques were used.


[X-ray examination for the detection of complications after abdominal surgery (author's transl)]. The incidence of complications in a consecutive series of 515 abdominal surgical operations was studied. Abdominal complications of varying degree of severity were observed in 62 cases (16%). They were of four types: haemorrhage, ileus, peritonitis and complications on the part of the biliary tract and pancreas. The use of radiological methods for detecting these complications is reviewed. Direct roentgenography is the method of choice in cases of suspected ileus, perforation or foreign body. Administration of contrast media should be reserved almost entirely to cases of stress ulcer and to distinguish between incomplete and complete ileus. If perforation of penetration is suspected only water-soluble contrast media should be used. Detection of a leaking anastomosis or an abscess is by injection of the fistula. The value of angiography for  revealing a haemorrhage or embolism and for assessing the response to vasoactive agents is discussed.


Separation of human T lymphocyte subpopulations (Tmu, Tgamma) by density gradient electrophoresis. Purified human peripheral blood T lymphocytes were fractionated by density gradient electrophoresis on the basis of their surface charge. The high mobility cell fractions were found to be enriched in T cells having receptors for IgM (Tmu cells) with only minor proportions of T cells having receptors for IgG (Tgamma cells). In contrast, the low mobility cell fractions were enriched in Tgamma cells with very low numbers of contaminating Tmu cells. Both populations were of higher mobility than human peripheral blood B lymphocytes. High-affinity sheep erythrocyte resette-forming cells (E-RFC) were relatively enriched in the high and intermediate mobility fractions and appear to include the Tmu cells and the T cells without receptors for IgG or IgM (Tvarphi). The low affinity E-RFC were found only in the lower mobility fractions that included the Tgamma cell population. A direct correlation was observed between the number of Tgamma lymphocytes and the low affinity E-RFC in all the fractions. The separated cell fractions were treated in vitro with different concentrations of concanavalin A (Con A) and examined for the numbers of Tmu and Tgamma cells. Low concentrations of Con A (2.5 mug/ml) significantly increased the number of Tmu cells, whereas high concentrations of Con A (20 mug/ml and 40 mug/ml) markedly reduced the number of Tmu cells and increased the number of Tgamma cells. Furthermore, all fractions (both Tmu and Tgamma cell enriched) responded by proliferation to Con A, whereas only the high and intermediate mobility fractions (enriched in Tmu cells) responded to phytohemagglutinin. Fractions enriched in Tgamma cells responded very poorly to phytohemagglutinin. This method provides another technique for separating human Tmu- and Tgamma-enriched lymphocyte subpopulations and does not modulate the Fc receptors of the cells, in contrast to the rosetting techniques currently in use for the separation of these lymphocytes.


Enhancement of the primary cytotoxic response to membrane by a lymphokine costimulator. The primary and secondary cytotoxic T cell responses of C57Bl/6 (H-2b) mouse spleen cells to P-815 membrane fragments (H-2d) were examined. The primary response required the addition of a supernatant from mitogen-stimulated spleen cells, or costimulator, to the culture medium. Costimulator had little effect on the secondary response unless the spleen cells were first passed through a nylon wool column. Our data suggested that secondary cultures produced their own costimulator and that adherent cells were required for its production. The possibility that adherent cells are needed to activate helper cells is discussed.


Selective toxicity of purine deoxynucleosides for human lymphocyte growth and function. A role for the enzymes adenosine deaminase (adenosine aminohydrolase, EC 3.5.4.4) and purine-nucleoside phosphorylase (purine-nucleoside:orthophosphate ribosyl-transferase, EC 2.4.2.1) in the functional maturation of lymphoid cells has been revealed by the association of inherited deficiencies of these enzymes and profound immune deficiency. Previous studies have suggested that the selective toxicity for lymphocytes may be mediated by the accumulation of toxic deoxynucleoside metabolites, likely through the action of specific kinases enriched in lymphoid cells. In order to study possible mechanisms whereby lymphocyte function may be impaired in these disorders, we have studied the effect of nucleosides and their deoxy analogues on both T and B lymphocyte growth and function. In the presence of deoxyguanosine, there was marked inhibition of T lymphoblast growth, phytohem-agglutinin-induced cell proliferation, and T suppressor cell activity. T helper cell activity and the differentiation of B cells to an antibody-secreting stage were unaffected. Deoxyadenosine was much less inhibitory, but in the presence of an inhibitor of adenosine deaminase, its effects on lymphocyte growth and function were markedly potentiated. The addition of deoxycytidine prevented deoxyadenosine toxicity in all assays, whereas it only interfered with deoxyguanosine effects on T lymphoblast growth. These studies provide some initial understanding for the selective loss of specific lymphocyte functions in individuals with inborn errors of purine metabolism.


Induction of prostaglandin E synthesis in normal and neoplastic macrophages: role for colony-stimulating factor(s) distinct from effects on myeloid progenitor cell proliferation. The biosynthesis of prostaglandin E (PGE) by normal and neoplastic macrophages is intrinsically linked to their synthesis of, and exposure to, myeloid colony-stimulating factors (CS-factors). The defect in responsiveness to endotoxin lipopolysaccharide (LPS) by macrophages from C3H/HeJ mice extends equally to the synthesis of CS-factor and PGE. However, C3H/HeJ macrophages can be stimulated to synthesize PGE by treatment with agents other than LPS [zymosan, tuberculin purified protein derivative, concanavalin A, poly(I).poly(C)], which also stimulate CS-factor production, or by the addition of various preparations of soluble CS-factor. In peritoneal wash preparations, constitutive PGE synthesis occurred in rapidly sedimenting macrophage cells, whereas constitutive CS-factor production and inducible PGE synthesis occurred in slower sedimenting adherent cells. A similar functional heterogeneity in CS-factor and PGE production was found in neoplastic macrophagae cell lines. The association of elevated CS-factor levels and PGE synthesis by macrophages suggests a role for CS-factor in many of the physiological responses heretofore associated with elevated tissue levels of the E type prostaglandins.


Immunosuppression by Friend leukemia virus is H-2 restricted by alloreactive T lymphocytes. Friend leukemia virus suppresses mitogen-responsive cells in vitro by activating thymus-dependent suppressor cells. The interaction between T suppressor and mitogen-responsive cells is H-2D restricted by a third cell type, called an interfering cell. The interfering cells could be characterized as alloreactive T cells that functionally mature in the spleen at 2 weeks of age and that can be functionally inhibited by mitomycin C, irradiation, and cortisol. Interfering cells are stimulated by H-2D (and not H-2L) alloantigens of the mitogen-responsive cells. H-2D differences between interfering and T suppressor cells are unimportant. Induction of "tolerance" to H-2 alloantigens in semi-allogeneic radiation marrow chimeras resulted in the specific loss of interfering cell function. It is possible that interfering or similar cells participate in other forms of H-2 restriction.


Biochemical basis for the enhanced toxicity of deoxyribonucleosides toward malignant human T cell lines. Human malignant T cell lines have high levels of deoxyribonucleoside phosphorylating activity and low levels of deoxyribonucleotide dephosphorylating activity. When incubated with deoxyadenosine or thymidine, the malignant T cell lines rapidly accumulate toxic concentrations of dATP and dTTP, respectively. This unusual pattern of deoxyribonucleotide metabolism renders the malignant T cells especially vulnerable to the toxic effects of deoxyribonucleosides and related analogues.


Blood flow velocity in pulmonary microvessels of bullfrog. Flow velocity in the pulmonary microvessels of the exposed lung of bullfrogs was measured by means of a laser Doppler microscope of an oblique backward mode, together with a signal-analyzing system having a time sharing circuit triggered by the R-wave of the ECG. By these means, measurements of the changes of flow velocity contour in the cardiac cycle were made. Flow velocity was clearly pulsatile in response to cardiac cycles in all microvessels including capillaries. Flow velocities in the arteriole and venule consistently decreased for a short period after the R-wave (84 +/- 33 msec (mean +/- SD) in the arteriole and 130 +/- 31 msec in the venule, respectively) and rapidly increased up to a maximicronm value. The mean flow velocities in arterioles (diameter 50 +/- 17 micron) and venules (39 +/- 9 micronm) were 2.29 +/- 0.32 and 2.30 +/- 0.27 mm/sec. The amplitudes of pulsatile flow in these vessels were 0.83 +/- 0.31 and 0.63 +/- 0.16 mm/sec, respectively. In the capillary the times from the R-wave to the minimicronm and maximum values were variable. In some cases the velocity gradually increased without first decreasing and the increase sharply accelerated a certain time after the R-wave. The mean velocity in the pulmonary capillary and the amplitude of the pulsatile flow ere 1.78 +/- 0.31 and 0.37 +/- 0.12 mm/sec, resepctively. The ratios of the pulsatile amplitude to the mean velocity in the pulmonary capillary, venule and arteriole averaged 0.21, and 0.36, respectively.


B-cell acute lymphatic leukaemia: immunoglobulin synthesis, morphology and clinical features. A detailed case study of a B cell acute lymphocytic leukaemia (ALL) is described. Ultrastructurally the neoplastic cells resembled other cases of ALL studied. The majority of the neoplastic cells had detectable surface IgGlambda and receptors for Fcgamma while a majority of the cells had receptors for the C3 component of complement. Neoplastic cell preparations were able to synthesize IgGlambda with a surplus of free lambda chains. This case did not respond to treatment, and death ensued within 36 h of presentation. The clinical and laboratory findings are discussed with respect to other cases of ALL.


Endotoxin-induced colony stimulating activity in normal and myeloid leukaemic subjects. Low doses of endotoxin were administered to normal and acute anc chronic myeloid leukaemic subjects. Temperature, leucocyte count, blood colony stimulating activity and the number of circulating colony forming units were monitored. All subjects acquired fever while the leucocyte count remained unaltered. Blood CSA rose sharply in 6 normal individuals, but failed to increase in 4 acute leukaemic patients and in 2 patients with CML in blast crisis. 2 patients with CML in the chronic stage increased their blood CSA comparable to normal individuals. The number of circulating colony forming units rose following endotoxin with a peak at 30 min and declined subsequently. 4 patients with acute leukaemia showed no increase of circulating colony formers.


D-penicillamine treatment in rheumatoid arthritis monitored by plasma alfa-1-antitrypsin-IgA complexes and plasma and urinary sulphur containing aminoacids. D-Penicillamine treatment in rheumatoid arthritis resulted in a fall in plasma alfa-1-antitrypsin-IgA complexes which was significantly more pronounced among responders than among non-responders. Plasma free cystine levels also fell during D-penicillamine treatment, the fall being dose dependent up to a daily dose of 500 mg. Higher doses did not result in further lowering, and no difference was detected between responders and non responders. The dominating sulphur containing aminoacid excreted in the urine was penicillamine-cysteine disulphide, the concentration of which did not correlate to either toxicity or clinical effectiveness, but showed much individual variation. The slow kinetics of change in the complex concentration taken together with in vitro experiments, suggest that the effect of D-penicillamine is more likely to be on the de novo formation of the complexes, rather than on their reduction.


[Acupuncture-analgesia/anesthesia: placebo for physician and patient?]. Various non-pharmacological analgesic procedures are attracting interest as a means of treating chronic pain (acupuncture, transcutaneous nerve stimulation, dorsal column stimulation, subcortical stimulation). The gate-control theory and activation of endorphin mechanisms are discussed as explanatory hypotheses for the analgesic effect. The proof of analgesic action in addition to the ever-present placebo effect is difficult. However, in unconscious, superficially anesthetized patients undergoing hysterectomy an analgesic effect of electrostimulation has been demonstrated which resulted in a significant reduction in the need for additional anesthetics. Speculation regarding the future of this method is premature in view of many unanswered questions.


Eye movements initiate visual-motor development in the cat. Visually naïve kittens turn their eyes toward visual targets but lack other visual-motor coordinations. Light-reared animals were able to mediate guided behaviors with an immobilized eye, but animals with the eye immobilized before initial exposure to a lighted environment were not. Eye movement is implied to play an essential role in visual-motor development.


Preferential transmission of the Z deficient allele of alpha 1-antitrypsin. The transmission of the Z deficient allele of alpha 1-antitrypsin was studied in 23 families, each with a single parent heterozygous for this allele. When the mother carried the Z allele, the distribution of phenotypes in the children did not differ significantly from the expected frequency. In contrast, when the father was the carrier, a significant increase of heterozygous phenotypes was observed in the children. This observation suggests that a selective advantage is associated with the expression of the Z allele in male gametes.


Hemophilus influenzae septicemia and polyarthritis in multiple myeloma. Hemophilus influenzae sepsis, rare in adults, is reported for the first time in association with multiple myeloma. The patient developed fulminant septicemia involving multiple organs and disabling pyarthrosis due to nonencapsulated H influenzae, usually considered to be nonpathogenic. Early diagnosis and appropriate antibiotic therapy cured the infection and prevented permanent joint disease. Also illustrated is the problem of establishing a diagnosis of myclomatosis in patients with septicemia. The English language literature on H influenzae sepsis and polyarthritis in association with myeloma has been reviewed.


Mucocele of the appendix associated with hematochezia. A case is reported in which a mucocele of the appendix produced massive gastrointestinal bleeding. This has not previously been reported.


Exsanguination from esophageal rupture of an atherosclerotic aortic aneurysm in a patient with treated tuberculosis. An elderly man with previous tuberculosis exsanguinated from esophageal rupture of an atherosclerotic thoracic aneurysm. Because the patient refused angiography, the source of bleeding was discovered only at autopsy. Selected clinical and pathologic aspects of the case are discussed in relation to the different causes of thoracic aortic aneurysms. Because these lesions have a grave prognosis, the need for timely diagnostic evaluation and aggressive surgical management is emphasized.


Antidiuretic hormone effect of vasopressin therapy for gastrointestinal hemorrhage. Use of vasopressin injection (Pitressin) as an adjunct in the treatment of various types of gastrointestinal hemorrhage also produces an antidiuretic hormone effect of free water retention. This produces difficulties in fluid and electrolyte management and in the interpretation of changes in mental and hemodynamic status. This effect and its management are directly related to the total dose of the drug administered.


Management of concomitant, symptomatic surgical lesions of the coronary and carotid arteries. The surgical management of a patient with symptomatic lesions of the carotid and coronary arteries is presented. The association of these lesions is discussed along with the rationale of a combined surgical approach.


[Influence of x-rays on the B- and T-cells in the spleen of mice and their reaction on mitogenetic substances (author's transl)]. Total irradiation of mice with 100 R, 350 R and 600 R leads to a significant decrease of T- and B-cells which depends directly on the irradiation dose. This decrease can already be demonstrated on the first day after the irradiation, it reaches its culminating point on the tenth day after the irradiation. After an irradiation with 100 R, the cells of the spleen or irradiated mice show no reduced capacity of being stimulated by phytohemagglutinine, Pokeweed mitogen, and concanavalin A, in case of an irradiation with 350 R this capacity is significantly reduced only until the third day after the irradiation. The animals irradiated with 600 R show a decrease on the first day, then they have a phase of recovery on the third day which is followed by a second decrease (biphasic depression). Independently of the irradiation energy, the reduced number of B- and T-cells in the irradiated mice returns to normal values until the 48th day of observation. The functional activities, however, show a disturbance the  extension and duration of which are depending on the irradiation dose.


[Problem of oral surgical interventions during pregnancy, menstruation and under the intake of hormonal contraceptives]. Pregnancy, menstruation and hormonal contraceptives are no contraindications for necessary oral surgical procedures. If the pregnancy takes a normal course, surgical interventions with absolute indication are possible at any time. Surgical interventions with relative indication should be performed during the second trimester of pregnancy. The dental treatment of pregnant women should be terminated, as far as possible, by the 7th or 8th month of pregnancy. Metabolic imbalances, static loading and gingival changes deserve special attention.


Antitumor effect of whole-body X-irradiation: possible role of an X-ray-sensitive T suppressor cell population. Findings have been presented which support the concept that SBF and suppressor cells can modify immune responses to tumor antigens in vivo, and they indicate that some types of SBF act through a radiosensitive suppressor cell system. We believe that further understanding of the mechanisms involved will provide methods of manipulating the immune response to certain immunogenic tumors and may thereby help in the development of tumor immunotherapy.


Role of histocompatibility in graft rejection. Several modes of graft rejection are possible; to these can be added hyperacute rejection of kidney and skin grafts by cell-mediated mechanisms, which has been demonstrated in several different models. The complexity of the MHC in the mouse has been emphasized, with the description of possibly 12 H loci within this complex, including the new H gene, H-21J. The use of H-2 mutants in studying the H genes within the MHC has been emphasized, and by the use of such mutants five or six new gene loci have been defined, including a new region, H-2L; also, new complexities in the structure of the H-2K and H-2D genes have been recognized. The importance of the MHC is further emphasized in the finding that serum Ia measurements in the mouse may reflect the state of T cell activation, since the Ia levels rise prior to graft rejection and are suppressed in tumor-bearing mice.


Cyclophosphamide-sensitive and cyclophosphamide-resistant suppressor cells in the immune response to alloantigens. We have demonstrated that within a given system Cy may alter the immune response in different ways. It may augment the response by inactivating CSS cells or induce immunosuppression by activating CRS. Furthermore, our studies provide a means of analyzing the mechanism of suppression, that is, delineating the target cell for suppression, the properties and life span of the suppressed cells, and the nature of the cell interactions involved. Furthermore, with the available information on the immunosuppressive activity of Cy, clinical studies may be best monitored in transplantation immunology and tumor chemotherapy. It is possible that the induction of CRS cells, which are antigen-nonspecific and non-H-2-restricted, may be useful for inducing specific immunosuppression to alleviate GVH reactions. These studies are currently in progress.


Retrospective tests of B-cold lymphocytotoxins and transplant survival at a single center. Sera from 203 recipients prior to transplantation were examined against a panel of 30 T and B lymphocytes at 5 degrees C and 37 degrees C. Those patients classified as having B-cold cytotoxins only had higher 1-year transplant survival rates from cadaver donors (82%) than patients with no antibodies (58%) or patients with antibodies reactive to T and B lymphocytes in the warm (37%). These results based on transplants from a single center confirm earlier studies derived from patients in 27 centers.


Simple innocuous treatment of massive cyclophosphamide hemorrhagic cystitis. A rare complication of cyclophosphamide therapy is severe, protracted, and often life-threatening hemorrhagic cystitis. Many reports on the management of this problem have advocated invasive and in themselves dangerous methods. It is proposed that this condition can be managed by suprapubic cystotomy with the fulguration of obvious bleeding points and the placement of two suprapubic tubes. High-flow continuous bladder irrigation can then be instituted using cooled saline. In addition, the patient should be sedated and constipation avoided.


Inhibition of lymphocyte cytotoxicity by serum from patients with alcoholic liver disease: partial characterization of serum inhibitors. Studies were performed to explore the effect on normal lymphocyte function of serum derived from patients with alcohol-induced liver injury and healthy controls. We examined the effect of such serum on the generation of both spontaneous and Concanavalin A (Con A)-induced lymphocyte cytotoxicity for Chang target cells. Normal lymphocytes, when incubated in the presence of 5% serum from patients with alcoholic liver disease, showed a marked (20.75 ± 5.1% mean ± SEM) reduction in the capacity to generate spontaneously cytotoxic cells compared to 5% control serum (3.2 ± 1.9%) (p < 0.001). Similar results were found in studies of Con A-stimulated cytotoxicity (36 ± 7.2% vs. 5 ± 2.3%; p < 0.001). Fractionation of serum by gel chromatography demonstrated the presence of inhibitory activity of various molecular weights, although a major peak of inhibitory activity (approximately 270,000 daltons) was identified in severe alcoholic hepatitis. Thus, this study demonstrates the presence of serum inhibitors in alcoholic liver disease which influence normal lymphocyte function.


[Participation of suppressor cells in the depressing action of serotonin on immunogenesis]. The transfer of 20 x 10(6) T and B cells of lymphoid organs from the donors immunized with sheep erythrocytes and having elevated serotonin level to the recipients immunized with SRBC decreased the intensity of immune response (rosette formation and direct plaque formation). The elevation of serotonin level in the donors induced the appearance of T and B suppressors in the thymus and the bone marrow respectively and increased the population of T and B suppressors in the spleen and, to a lesser extent, in lymph nodes.


Polyadenylation of pea seed RNA at the early stages of germination. 1. The RNA polyadenylating activity was found in embryo axes of dry, as well as imbibed and germinated pea seeds, both in nucleus and cytoplasm. 2. The total enzymatic activity remains unchanged during germination, but the intracellular distribution is altered; the activity in nuclei is increased about four-fold at the expense of the postmitochondrial fraction. 3. Specificity towards RNA primers of the polyadenylating system from pea embryo axes is low. 4. Cordycepin inhibits RNA polyadenylation only when [14C]ATP is used as a nucleotide donor, and has no visible influence on the activity of the system utilizing [14C]oligo(A)-nucleotides. 5. It seems that RNA in the pea embryo axes is polyadenylated by a two-step mechanism: synthesis of oligo(A)-nucleotides, and their addition to RNA.


Treatment of vulval epithelial lesions by pulsed high-frequency therapy. The effect of pulsed high-frequency therapy has been investigated in 25 patients, who had various chronic vulval lesions resulting in continuous, annoying pruritus, smarting or pain, resistant to conventional therapy. The beneficial effect of pulsed high-frequency therapy was either definite or good in 80% of all the cases.


[Psychic and medical reactions in patients undergoing open heart surgery in relation to preoperative psychological condition]. This study reports some results on the postoperative psychological and medical condition of 72 open-heart surgery patients. Special emphasis is placed on the relationship between the postoperative reactions and the preoperative psychological condition of the patients as assessed by an interview. Patients whose postoperative reactions was of a psychotic paranoid type conceived the operation as a mainly technical event and had optimistic expectations for the future. Patients who reacted in a hostile aggressive manner after the operation were preoperatively emotionally withdrawn and depressive inhibited. As far as the postoperative physical condition is concerned it was found that patients with the best recovery in this respect were preoperatively characterized by alexithymia. The results are discussed under psychonalytical aspects. Special emphasis is placed on the preoperative condition of alexithymia.


[Role of the median forebrain bundle in organizing the electrical activity of the neocortex]. Bilateral coagulation of the forebrain medial bundle in the lateral hypothalamus enhances the formation of spontaneous spindles and facilitates the recruiting response in the neocortex. This combines with a defect of desynchronizing influences of the posterior hypothalamus and the concurrent dominance of synchronizing effects of the preoptic area (PA). PA stimulation enhances the slow wave and spindle activity in the ECoG of the intact brain. After disruption of PA connections with the bulbar synchronizing apparatus the stimulation effect is manifested only in enhanced spindle activity. It is assumed that in addition to hypnogenic influences which PA shares with the parasolitary apparatus, it maintains a definite level of cortical reactivity after the onset of sleep. Elimination of the orbito-frontal cortex, as well as PA coagulation, does not prevent the appearance of spindles in the ECoG of the preparation with an intersected medial bundle, only limiting them to some extent.


Typical and atypical monochromacy studied by specific quantitative perimetry. Two blue cone monochromats and four rod monochromats have been studied by increment threshold measurements applying the Stiles' principle. Some rudimentary colour discrimination was reported by the blue cone monochromats. One patient showed good discrimination between short- and middle-wavelength lights in matching experiments using the Nagel II apparatus. His neutral band in the spectrum was at lambda = 485--495 nm. Dichromatic vision could not be proved in the other patient. The blue cone monochromats also had good responding blue mechanism in the periphery. Indication of cone activity other than blue cones is found in both kinds of monochromats; these cones being probably of the rhodopsin-cone type (pi0 cones). The conclusions are drawn that the inhibitory effect of the pi0 cones upon the rod mechanism may account for the differences shown by our two blue cone monochromats as to visual acuity, nystagmus and photophobia. Likewise, their differences regarding dichromatic vision may be explained by an unequal number of pi0 cones in their retinas rather than by differences in their blue mechanisms.


Vestibular symptoms in mumps deafness.

Vestibular symptoms in mumps deafness. Deafness appears in as many as 4% of adult cases of epidemic parotitis. It is often severe, though reversible and is usually unilateral. Vertigo has been reported in mumps, as have occasional cases with impaired caloric reaction. Twenty cases of unilateral hearing impairment in mumps have been investigaed with audiometry and electronystagmography in order to determine the degree of permanent lesions. Nine of the patients had noted vertigo when falling ill with protitis. Five of these had normal calorics, 3 were impaired and one was without response in the deaf ear. No certain correlation between vertigo and permanent caloric impairment was found. An interesting finding was that 5 cases without vertigo showed an impaired or absent caloric responsiveness, which might confuse future diagnostics. Presumably, most patients with hearing impairment in mumps suffer vesticular damage, but the acute vertigo in early childhood is easily overlooked. No certain correlation between age at the onset of mumps and any permanent caloric disturbance was found. One mumps case is described, in which a severe hearing loss and caloric impairment returned to normal.


T cells as marked with acid alpha-naphthyl acetate esterase staining in secretory otitis media. Non-specific acid alpha-naphthyl acetate esterase (ANAE) activity of the lymphocytes was investigated in smears made of middle ear secretions and peripheral blood from 61 children with secretory otitis media. On the average, 20.1% (right ear) and 2.1% (left ear) of the lymphocytes in the ear samples showed distinctive ANAE-positive spots in their cytoplasms, by the method used. The mean percentage of ANAE-positive cells in the blood was 47.8 and it was significantly (P less than 0.001) higher than the respective percentages of the ear samples. In normal childrne, 54.9% of the lymphocytes, on the average, were ANAE-positive. This difference in blood between patients and control group was significant (P less than 0.001). Consequently, the present study suggests that the relationship of T- and non-T-lymphocytes, as a marked with ANAE, are disturbed in children suffering from secretory otitis media. The importance of this finding and the validity of the method are discussed.


Effects of 4-aminopyridine on the excitation-contraction coupling in frog and rat skeletal muscle. The effects of 4-aminopyridine (4-AP) were studied on isolated single muscle fibres of the frog and toe muscles of the rat. In both muscle preparations, 4-AP potentiated the twitch amplitude without significantly affecting the tetanus response. There was an increase of the time to peak tension and, in frog muscle, an increased time to half relaxation. 4-AP produced no change of the resting membrane potential. The rate of decay and, hence, the total duration of the action potential were markedly prolonged. 4-AP did not induce contractures by itself nor did it affect the contracture induced by caffeine. The mechanical threshold was determined by measuring the contracture response to various degrees of depolarization by potassium. This threshold was not affected by 4-AP. Twitch potentiation by 4-AP was independent of the extracellular calcium concentration. It is concluded that 4-AP potentiates the twitch response by increasing the release of activator calcium into the myofibrillar space by prolongation of the action potential. In addition, there may be a more direct inhibitory action of 4-AP on the calcium re-uptake by the sarcoplasmic reticulum in frog muscle.


Hyperglycemia following p-hydroxymercuribenzoate administration to mice. p-Hydroxymercuribenzoate (PMB) administration to fed mice induced transient hyperglycemia of a few hours' duration, and an increase in mitochondrial volume and pyroantimonate precipitation in the cytoplasmic ground substance of the pancreatic islet B-cells, whereas the secretory granules were unaffected. No significant blood glucose elevation or any obvious structural alterations were observed in starved mice treated with PMB. The serum inorganic phosphate concentration was unaffected in fed mice but decreased in starved mice 10 min after PMB injection, and increased in both fed and starved mice 2 h following PMB treatment, whereas the hydrogen ion concentration was increased in both fed and straved mice 10 min after PMB administration. Mitochondrial and ionic alterations, and possible inhibited insulin release may play a role in the development of hyperglycemia in PMB-treated mice.


Acquired hydrocephalus. I. A clinical analysis of 160 patients studied for hydrocephalus. A total of 160 patients suspected of having acquired hydrocephalus were studied either by quantitative isotope ventriculography (QIV) or by lumbar isotope cisternography (LIC). Of these patients, 56 had hydrocephalus. Mental deterioration, gait disturbances, ataxia, spasticity, and incontinence were most frequently present in the hydrocephalic patients, but none of the signs or combinations thereof are pathognomonic of acquired hydrocephalus. These signs are independent of the intracranial pressure (ICP) and the type of hydrocephalus. Surgical shunt procedures were in most cases followed by the disappearance of mental deterioration, gait disturbances, ataxia, and spasticity.


Persistent ST segment elevation in left ventricular aneurysm before and after surgery. Post-myocardial infarction aneurysms are often accompanied by persistent ST segment elevations. To determine whether or not these ST segments regress following successful surgery for left ventricular aneurysms, serial electrocardiograms were studied in 74 patients and compared to changes of heart size and NYHA Functional Class. The mean postoperative follow-up period was 18.2 months (range 3 to 52 months). The mean precordial sigma ST elevation preoperatively was 5.27 mm. and 4.71 mm. after surgery (P less than 0.025). For the highest ST segment of an individual lead, the mean values were 1.9 mm. before surgery and 1.88 mm. postoperatively (P less than 0.1). Although clinical improvement occurred in 66 (89.2 per cent) by NYHA class and x-ray evidence of improvement was seen in 46 (62.2 per cent), a degree of ST elevation remained in all cases and was less elevated in only 19 (25.7 per cent). After surgery for left ventricular aneurysm, ST segments tend to remain elevated with little apparent relation to reduction of heart size or clinical improvement.


Evaluation of aortocoronary venous bypass grafting for prevention of cardiac arrhythmias. The influence of ACB on cardiac arrhythmias was examined in 27 patients. Eight-hour Holter monitoring was performed 8 days preoperatively and 100 days postoperatively. Arrhythmias were divided into 3 groups (Class I: NSR +/- occasional APBs; Class II: less than five unifocal VPBs per minute; Class II: more than five VPBs per minute, multifocal VPBs, VPBs in a row or VT). Preoperative classification disclosed that 13 patients (48.1 per cent) were in Class I, six patients (22.2 per cent) were in Class II, and eight patients (29.6 per cent) were in Class III. The corresponding values after surgery were 10 patients (37.0 per cent), 13 patients (48.1 per cent), and four patients (14.8 per cent). These differences were not statistically significant (p less than 0.1). In view of the tendency of arrhythmias of Class III to improve after ACB, we feel that further investigations in this area are needed. At the present time ventricular arrhythmias alone constitute no indication for bypass surgery.


Effect of surgical versus medical therapy on return to work in patients with coronary artery disease. The proportion of medically and surgically treated patients with coronary artery disease working full time 1 year after cardiac catheterization or surgery, respectively, was assessed by questionnaire in a registry of patients who had had coronary angiography. The proportion of medically and surgically treated patients working 3 months before catheterization or surgery was 74 percent (148 of 201) and 75 percent (899 of 1,198), respectively, whereas 62 percent (125 of 201) and 62 percent (747 of 1,198), respectively, were working full time 1 year after catheterization or surgery. Multivariate analysis identified five variables predictive of return to work. In order of significance these were: working status 3 months before surgery or catheterization, years of education, age, functional class before surgery or catheterization and period of not working before surgery or catheterization. Work status 3 months before surgery or catheterization was clearly the best predictor of continued employment 15 months later. Surgical therapy was not more effective than medical therapy in maintaining full-time employment in this registry of patients with coronary artery disease.


Unstable angina pectoris: a comparison of the costs of medical and surgical treatment. This study compares the inpatient costs of therapy of patients with unstable angina pectoris randomized to surgical or medical therapy at the University of Alabama in Birmingham as part of the National Cooperative Study Group. For 74 patients followed up for 2 years, the mean inpatient charges were $4,728 for 22 medically treated patients, $9,528 for 34 surgically treated patients and $20,215 for 18 patients who crossed over from medical to surgical therapy. Differences among the three groups were statistically significant (P less than 0.001). Stepwise multiple regression analysis of total inpatient charges with medical and procedural factors as explanatory variables showed that a history of congestive heart failure, the number of infarctions during the period of the study, the duration of the longest anginal attack, the type of unstable angina and the type of treatment were significant predictors of total inpatient cost, with an R2 value of 0.829 (P less than 0.001). These variables explain the cost of treatment. One should not infer that they will also predict the appropriate type of treatment for patients with unstable angina. Although the cost of surgical therapy was double the cost of therapy for patients treated only medically, those medically treated patients whose therapy failed and who subsequently required surgery incurred mean costs twice those of the surgically treated patients and four times of patients who received only medical therapy. Reassessment of previous criticism of the high cost of surgical therapy is indicated.


Constrictive pericarditis after myocardial revascularization: report of three cases. Although postoperative constrictive pericarditis is rare, the diagnosis should be considered when unexplained right-sided heart failure develops after cardiac surgery. Within a 6 week interval, evidence of constrictive pericarditis developed in three patients who had recently undergone myocardial revascularization. One patient presented with biventricular failure, pericardial effusion and suspected tamponade. Severe constrictive pericarditis was demonstrated at subsequent operation. An apparent postpericardiotomy syndrome preceded evidence of right heart failure in the other two patients. Etiologic considerations include the possibility that pericardial irrigation with povidone-iodine (Betadine) solution may have contributed to subsequent fibrosis.


Hemorrhage due to retrograde prolapse of stomach. An endoscopic diagnosis. A case of recurrent hemorrhage due to localized gastric mucosal congestion from retrograde prolapse during severe retching is described. Historically, this condition may mimic the "Mallory-Weiss syndrome" and endoscopically, this lesion may be mistaken for "gastritis". This rarely recognized condition may be an explanation for some cases of cryptic hematemesis.


Peritoneal dialysis clearance of cimetidine. Peritoneal dialysis clearance of cimetidine was determined in two patients undergoing peritoneal dialysis treatment. The peritoneal dialysis clearance of cimetidine was approximately 10 ml./min. under optimal dialyzing conditions. The average cimetidine to creatinine extraction ratio was 0.45, which represents significant peritoneal dialyzability. The amount of cimetidine removed, however, constituted only a small fraction of the total administered dose. Therefore, only minor dose adjustments may be necessary during peritoneal dialysis treatment.


Implementation of the problem-oriented system in an optometric teaching clinic. Problem-oriented records, performance audit, and a clinical index were implemented in the eye-care service of the Dorchester House Multi-Service Center, a neighborhood health center and teaching affiliate of the New England College of Optometry. We found that problem-oriented records facilitate communication and encourage logical thinking, that audit helps assure the quality of care and teaching, and that a clinical index provides a perspective on the overall performance of the eye-care service.


Schistosoma mansoni infections in T-cell deprived mice, and the ameliorating effect of administering homologous chronic infection serum. II. Pathology. Liver changes occurring in mice deprived of their T-cells by a combination of thymectomy and anti-mouse thymocyte serum, and in immunologically intact control mice, were followed during the early stages of heavy Schistosoma mansoni infections. Lesions in both groups began developing by day 38 and were maximal by day 48. Hepatic changes in control mice culminated in large hypersensitivity granulomas, tissue eosinophilia, portal periphlebitis, fibrosis, vascular obstruction, and infarction leading to arterialization and preferential sinusoidal channeling. Deprived mice showed greatly reduced egg reactions composed principally of macrophages, monocytes, and occasional neutrophils, and only minimal alteration of liver architecture; however, focal and disseminated hepatocellular lesions became prominent as the infections progressed, and by day 48 virtually every hepatocyte was affected. Typically, hepatocytes showed microvesicular cytoplasmic damage (steatosis) or ballooning degeneration with accompanying nuclear pyknosis or karyorrhexis. This cellular pathology may be attributed to the direct or indirect effect of eggs or egg products on liver cells. The administration of chronic infection serum obtained from immunocompetent mice to T-cell deprived mice dramatically eliminated the hepatocellular lesions. It also increased eosinophil participation and fibrosis in the egg reactions but did not restore the size and other cellular features typical of egg hypersensitivity granulomas. Serum from uninfected normal mice was found to lack these effects.


Population dynamics of T and B lymphocytes in the lymphoid organs, circulation, and granulomas of mice infected with Schistosoma mansoni. The T and B lymphocyte composition of the lymphoid organs, peripheral blood, and hepatic granulomas was determined in mice lightly infected with Schistosoma mansoni. Apart from an increase of circulating B cells, no change was seen in the distribution of lymphocytes prior to oviposition. Thereafter (8-20 weeks), a pronounced trend toward increased B and increased T cell percentages occurred throughout the organs. This effect was largely due to marked increases in the B cell population which outweighed increases of T cells occurring at 8 and 16 weeks. By the late chronic period (32 weeks), an overall normalization of percentages was observed due to declining B and/or increasing T cell numbers. Hepatic granulomas also showed notable compositional changes. At the time of maximum granulomatous response (8 weeks), the lymphocyte population of these lesions consisted primarily of T cells. Subsequently, during the time of modulated granuloma formation (12-32 weeks), B-cells became a significant component, comprising 10% of the granuloma cell population. The appearance of B cells within granulomas may indicate that they play a role in modulating granulomatous hypersensitivity.


Particularity of local immunity in the nasopharynx. Parallel study of surface receptors and cell-mediated immune responses in cells derived from palatine or pharyngeal tonsils and blood. Immunological functions of the pharyngeal tonsil, palatine tonsils and blood leucocytes of children undergoing tonsillectomy were evaluated by determining T or B lymphocytes, the response to mitogens, and the cell-mediated immunological responses to tuberculin. In all the test systems used similar results were obtained with cells derived from either the palatine or pharyngeal tonsils. The mean percentage of T lymphocytes was significantly higher in the peripheral blood than in tonsils, but the reverse was true of B lymphocytes. The reaction to PHA was lower in tonsillar cell culture than in blood cell culture, but tonsillar cells reacted better to Con A than blood cells. In lymphocyte transformation tests tonsillar cells reacted to specific antigen (tuberculin) and this reaction was significantly higher than that of the parallelly tested blood lymphocytes. Further, in about 50% of the children tested, tuberculin caused migration inhibition of the mixture containing tonsillar cells and guinea pig peritoneal cells. Surprisingly, nearly identical results were obtained if migration inhibition test was performed with tonsillar cells alone. Consequently, poorly migrating tonsillar cells are nevertheless usable for direct migration inhibition testing.


Transcutaneous nerve stimulation for pain relief in labour. Transcutaneous nerve stimulation (TNS) was asessed for use on thirty-five patients in labour. It was of great benefit to 20% of patients and some benefit to a total of 82%. It was especially appreciated by those patients who complained of backache and further studies should be undertaken with the original idea of TNS in mind--stimulating those areas which feel most painful for the patient. If the method could be made more universally available and could be used by patients and midwives alone with the minimum of supervision and explanation, it would be a safe and useful addition to the present methods of pain relief in labour.


Transcutaneous nerve stimulation as a method of analgesia in labour. Transcutaneous Nerve Stimulation, which has been shown to be of value in certain painful conditions, has been used as a method of pain relief in labour. Of the 67 patients studied, 16 (23.5%) received considerable pain relief, 38 (55.9%) thought it was of some help, and five (7.4%) did not require any other form of analgesia. It is suggested that Transcutaneous Nerve Stimulation has a place in obstetric analgesia.


Protease inhibitor variants in children and young adults with chronic asthma. The results of systematic medical histories and pulmonary function tests on 26 children and young adults, 10 with Pi variant alpha1-antitrypsin phenotypes and 16 Pi normals, are reported. These subjects were selected from 57 consecutive patients who had chronic asthma. The incidence of Pi variants was 20.4% among 46 Caucasian subjects (ages seven to 21 years). The Pi variant patients required more bronchodilators and long-term corticosteroid therapy. Among the parents and siblings, 50% of those with abnormal Pi type had chronic obstructive lung disease. Grandparents of the Pi abnormal probands had greater incidence of chronic obstructive lung disease (P less than 0.05). Baseline specific airways conductance and maximal midexpiratory flow rates did not discriminat between the two groups. However, bronchodilator inhalation showed the Pi variant group to be significantly less responsive than the Pi normal group. Pi heterozygous state, particularly Pi MZ, should be considered when a young person with chronic asthma is unresponsive to adequate doses of bronchodilators and needs prolonged use of corticosteroids.


Assessment of immunologic alterations caused by halogenated aromatic hydrocarbons. The rational for employing a particular approach and some of the difficulties that can be encountered when adapting immune surveillance to toxicology studies in experimental animals are discussed. Detailed description of methodology will not be reviewed. In general, assays are selected for their reliability, i.e. fairly standard within a normal population; that are capable of detecting subtle differences in immune status; and are specific for particular aspects of the immune system. Since normal immune responses are directly dependent upon at least three distinct subpopulations of lymphocytes, macrophages and their cooperative interactions as well as a number of indirect factors, it is essential to study multiple parameters to properly evaluate the effects of environmental chemicals on the immune system. Immunologic assessment is further complicated by the fact that the immune effects will vary dependent upon the chemical and dosage level as well as the species and age of the experimental animals.


Anaerobic and aerobic bacteriology of acute conjunctivitis. Aerobic and anaerobic cultures and clinical data were obtained from 131 patients presenting with acute conjunctivitis. Similar cultures were obtained from 60 noninflamed individuals. Anaerobes were isolated from 66 patients, 51 times in mixed culture with aerobes and 15 times (11.5%) as the only isolates. Aerobes only were recovered in 54 patients. The organisms found to be statistically significantly more commonly recovered from eyes with conjunctivitis were Staphylococcus aureus, Hemophilus influenzae, Peptostreptococcus, and Propionibacterium acnes. No statistical difference was present between the bacterial flora of the eyes with unilateral conjunctivitis when compared to their uninvolved mates in 20 cases in which only one eye was involved.


Types and sensitivity patterns of ocular pathogens. The total number of specimens received for microbiologic examination and culture in a teaching hospital department of ophthalmology for the years 1974 and 1975 has been reviewed. The results have been analyzed, and information is presented on (a) the relative frequency of different types of bacteria, fungi, and viruses as causal agents of ocular inflammatory diseases and (b) the current pattern of antibiotic sensitivities.


Opto-chiasmatic arachnoiditis in brothers. Six patients (3 couples of brothers) with adhesive arachnoiditis of the opto-chiasmatic cistern, surgically verified, are presented. Only one couple of brothers offered a possible family history of a similar condition in one maternal uncle. The visual damage had almost constantly a sudden onset and was predominantly of the axial type. No gross pathology, other than the arachnoiditic involvement of the chiasmal cistern and alterations of the anterior optic pathways, was found at surgery. Pneumocisternoencephalographic findings did not prove constantly reliable for a preoperative diagnosis of the condition when compared with surgical pathology. The overall results of the neurosurgical operations (exploration of the chiasm and removal of the adhesions) can be considered as favorable and this type of treatment is once again recommended as the therapy of choice without undue delay when general or local medical treatment proves of no avail after a reasonable length of time.


On the nature of nontypable Haemophilus influenzae. 193 Haemophilus cultures, including 71 nontypable H. influenzae isolates, were examined with respect to phage HP1 sensitivity, lysogeny for this and for other phages and for excretion of bacteriocins. Fifty of the 71 nontypable cultures were sensitive to phage HP1 but only three produced plaques. The other 47 isolates were thus probably not non-encapsulated derivatives of H. influenzae serotypes a, b, d, and e, which have discrete and characteristic phage HP1 restriction and modification systems, or serotype c which appears to be restriction negative. They could be derivatives of serotype f which does not give plaques with phage HP1. The nontypable three cultures that plated phage HP1 efficiently could be non-encapsulated serotype c derivatives. Fourteen of the phage HP1 insentitive non-typable cultures were found to be defectively lysogenic for this phage. Five of these were genetically transformed to wild type lysogens. Their phage produced plaques efficiently only on Rc strains and on a restriction-negative mutant of serotype d. These lysogenic nontypable isolates are thus modification (and restriction) negative and they are thus probably not nonencapsulated derivatives of serotypes a, b, d, e, or f. Fifty three of 56 serotype b cultures were found to excrete a bacteriocin, to which all other nonproducing Haemophilus cultures were more or less sensitive. The three restriction-negative nontypable H. influenzae cultures also excreted this bacteriocin but the other cultures listed did not do this. The tentative conclusion from this study is that nontypable H. influenzae isolates are probably not derivatives of the six known encapsulated strains.


Effect of dorsal column stimulation on pain-induced intracerebral impulse patterns. Evoked electrical potentials were recorded via intracerebral electrodes in a patient with stump and phantom limb pain who had a previously implanted dorsal column stimulator. When pain was elicited by peripheral stimulation it was found that positive deflections appeared in the ventrolateral nucleus of the thalamus at time latencies corresponding to the propagation velocities of A delta- and C-fibres. Dorsal column stimulation completely eliminated the C-fibres. Dorsal column stimulation completely eliminated the C-fibre deflection and partially eliminated the A delta-fibre deflection.


Comparison of platelet glass bead retention techniques in patients with clinical bleeding disorders. Platelet glass bead retention by the Salzman and infusion pump techniques were compared in 36 control individuals, 10 patients with von Willebrand's syndrome and four patients with thrombocytopathies. No significant differences between the results of the two assays were observed. Eleven percent or less of the control individuals had diminished platelet glass bead retention. The mean percentage platelet retention of the von Willebrand's group and the thrombocytopathy group was less than the mean platelet retention of the control group. However, at least 50 percent of the patients with von Willebrand's syndrome had normal platelet retention by both methods. In the thrombocytopathy group, glass bead retention was more consistently diminished. Although an inverse correlation existed between the duration of bleeding time and the platelet retention assays, consistently diminished platelet retention results were observed only when the bleeding time was 18 minutes or longer. It has been concluded by us that while the glass bead retention assays may be helpful in characterizing certain types of platelet disorders, they are not useful screening assays in the diagnosis of von Willebrand's syndrome.


Operative risk in patients with previous coronary artery bypass. Noncoronary operations were performed in 358 patients who had undergone a previous coronary artery bypass grafting, with a mortality of 1.1%. In 70 patients (20%), the staged operation was planned and subsequent operation performed 6 to 12 weeks after bypass with no cardiac complications and 1 death. In the others, operation was performed 10 days to 89 months after bypass for either urgent reasons or new lesions. Three deaths and significant numbers of medical cardiac complications occurred in those patients subjected to operation within 30 days. The subsequent operation was vascular in 232 patients, with 3 deaths (1.3%); thoracic in 43, with no deaths; and general surgical in 113, with 1 death (0.9%). Follow-up study showed 307 patients (87%) still alive after 30 days to seven years. Late death was due to myocardial infarction in only 12 patients (3%). This study suggests that the risk of operation is as good in patients who have had successful coronary artery bypass as in those without coronary artery disease, and that the risk of subsequent myocardial infarction is small.