Pharmacotherapy of Parkinson's disease.

Pharmacotherapy of Parkinson's disease. The pathophysiology, anticholinergic therapy and dopaminergic therapy of Parkinson's disease are reviewed; an emphasis is placed on the structure and function of the basal ganglia because of their importance in understanding the pharmacotherapy of parkinsonism. The pharmacologic management of Parkinson's disease is limited primarily to manipulation of the dopamine-acetylcholine system. Levodopa, with or without a peripheral dopa decarboxylase inhibitor, is the current drug of choice in the management of idiopathic and postencephalitic Parkinson's disease. Modification of the serotonin-histamine system via the use of antihistamines may be useful in some patients. There are also many adjunctive agents which may be employed in combination with or in place of levodopa. Levodopa clearly has no place in the treatment of neuroleptic-induced Parkinson's disease; anticholinergics and antihistamines are the agents of choice.


Amikacin therapy of patients with multiply antibiotic-resistant Serratia marcescens infections: development of increasing resistance during therapy. Over a recent 22 month period, 222 patients in two adjacent hospitals became infected with a multiply antibiotic-resistant strain of Serratia marcescens; 13 were bacteremic. Nineteen patients with clinically significant infections received amikacin. Nine of 11 patients with urinary tract infections were cured. In contrast, only one of eight patients with pneumonia or other deep tissue infections was cured and four died. These eight patients were severely ill; many had infections with multiple microorganisms. In four of five patients in whom the infection failed to clear promptly. Serratia strains became increasingly resistant to amikacin during therapy and these strains contributed to the death of two of these patients. Amikacin proved useful in treating patients with infections due to gentamicin-resistant S. marcescens organisms, especially urinary tract infections. However, the capacity of some strains of S. marcescens to develop resistance to amikacin may limit the usefulness of this antibiotic in the treatment of deep tissue infections which involve this microorganism.


A comparison of methods for quantitating fetal heart rate variability. Fetal heart rate (FHR) variability is thought to be an important index of fetal health. In the presence of normal variability, the fetus is vigorous, but lack of beat-to-beat variability may be associated with fetal compromise. A distinction between short-term variability (STV) (beat-to-beat changes between successive beats) and long-term variability (LTV) (rhythmic fluctuations in FHR) has not been made to date. We have utilized computer programs to compare three pairs of mathematical indices and one visual index of FHR variability. Among the three pairs of indices designed for detection of STV and LTV, de Haan's short-term and long-term indices exhibited the least interdependence, and the long-term index was completely insensitive to artifically generated pure STV. Yeh's short-term and long-term indices exhibited substantial positive interdependence. Hon's visual index appears to detect LTV primarily rather than STV. When the effect of progression of labor on FHR variability was examined, no conclusions were possible because of inconsistencies between patients. Ultimately, the clinical value of any one of these indices awaits testing of their ability to define fetal well-being or fetal distress.


Lamellar transplants in keratoconus.

Lamellar transplants in keratoconus. Lamellar keratoplasty was done in 18 eyes with keratoconus in an attempt to obtain a more satisfactory postoperative refractive error than that after penetrating keratoplasty. The refractive error after lamellar keratoplasty was better than that after 7.5-mm penetrating keratoplasties, but the vision was not as good. Because of the poorer vision, lamellar keratoplasty should probably be reserved for those with large eccentric cones and patients who are not good candidates for penetrating transplants.


Postoperative complications with protruding monofilament nylon sutures. Cut ends of 10-0 monofilament nylon sutures protruded and caused various combinations of severe pain, conjunctival inflammation, tarsal conjunctival ulcerations, eyelid edema, and corneal epithelial erosions in six patients postoperatively. These changes occurred one to three weeks after keratoplasty and one to three months after cataract surgery. In all six patients the signs and symptoms cleared after we trimmed or removed the offending sutures.


The effect of acetazolamide on early increased intraocular pressure after cataract extraction. Increased intraocular pressure in the immediate postoperative period commonly occurs after cataract extraction. We administered acetazolamide (Diamox) to 24 of 49 eyes with increased IOP in 49 patients. All pressures returned to normal within six to eight days. No difference was found between treated and untreated eyes.


Uses of RTV silicone in orbital reconstruction. In a five-year follow-up of 42 patients with unsatisfactory cosmetic results after enulceation, room-temperature vulcanizing (RTV) silicone was used in the surgical correction of enophthalmos and superior sulcus depression. RTV silicone with a catalyst was placed in a dissected pocket subperiosteally along the floor and lateral wall of the orbit to correct the volume deficit. When vulcanizing in situ into soft silicone rubber, the implant conformed to the orbital wall and did not migrate. We determined tissue tolerance to in situ vulcanizing silicone histologically in 30 rats by inserting prevulcanized and in situ vulcanized material in paired subcutaneous pockets. No statistical difference was noted between the two methods. In 11 cases, the same material was used as a convenient stent to maintain the pressure over a graft and to maintain socket size after the reconstruction of a contrated socket, by filling the socket with RTV silicone which surrounded a Kirschner wire drilled through the lateral orbital rim.


Combined scleral ring and blepharostat.

Combined scleral ring and blepharostat. A modified Legrand scleral ring served three important functions: it prevented anterior scleral buckling and collapse, it separated the eyelids to give good surgical field exposure, and it provided firm fixation for the globe during trephining and suturing.


Corneal penetration of rifampin.

Corneal penetration of rifampin. We tested the corneal penetration of rifampin in four vehicles: dimethylsulfoxide, polyethylene glycol, an ocular lubricant, and as rifampin ointment. We measured drug concentrations in the aqueous humor in rabbits after topical instillation of 1 and 2.5% rifampin according to two dosage schedules. Drug concentrations in the aqueous humor were bactericidal to Mycobacterium leprae. Since leprosy of the cornea, iris, and ciliary body may develop despite standard systemic bacteriostatic treatment, treatment of leprotic involvement of the anterior eye may be enhanced by intensive topical application of rifampin.


Relative risk factors in chronic open-angle glaucoma: an epidemiological study. Some hypothesized risk factors in chronic open-angle glaucoma were investigated in a sample of 87 patinets with glaucoma and 87 matched controls. A significant positive association was found with diabetes, a systolic blood pressure/intraocular pressure (BP/IOP) ratio less than 5.75, and the taking of medication for systemic hypertension. No significant association was found with a history of smoking or an elevated systemic blood pressure. Analysis indicates that the systolic BP/IOP index may be useful as a screening test for the detection of glaucoma in samples where the prevalence of glaucoma is high.


Effectiveness of an enzyme in removing deposits from hydrophilic lenses. Bausch and Lomb Soflens contact lenses with various types of deposits were cleaned with the Allergan Enzymatic Contact Lens Cleaner. Its effectiveness in removing the deposits varied with the type of deposit. Effectiveness of the cleaner can be predicted from the initial appearance of the deposit.


Use of the Bausch & Lomb Soflens Plano T contact lens as a bandage. Twenty patients with corneal disease were treated with a recently released soft lens specifically designed for use as a bandage. Patients wore their lenses continuously 24 hr a day. The results were similar to those of previous studies conducted with other lens designs. Improvement was frequent (10 of 12 cases) for bullous keratopathy and corneal graft, burn, or neuroparalytic lesion; limited (1 of 4 cases) for dry-eye syndrome; and absent (4 cases) for irregular cornea and vernal keratoconjunctivitis. No difficulties were found with the concurrent use of medication.


Residual acrylic adhesive after removal of plastic orthodontic brackets: a scanning electron microscopic study. After etching for one minute with 35 per cent phosphoric acid, thirty-eight permanent teeth were furnished with plastic brackets. An additional twelve teeth were used as references and were etched but were not furnished with brackets. Four teeth served as untreated controls. Eight brackets had fallen off one week later. The remaining brackets were removed with various instruments. All the teeth were extracted and examined by scanning electron microscopy (SEM). On all of the teeth originally furnished with brackets, residual acrylic was found on the tooth surface. The SEM examination was supplemented with energy-dispersive x-ray analysis (ED) which confirmed that the observed residues differed in their chemical composition from the dental substance.


Microscopic evaluation of enamel after debonding: clinical application. Enamel surfaces were debonded by methods recommended in the literature and found to be problematic. A new method, not previously recommended, involving the use of a green rubber wheel followed by pumice or composite finishing paste was similarly examined and found to come closest to restoring the original, natural enamel surface. A step-by-step clinical procedure was described for highly filled, lightly filled, and unfilled adhesives.


Images of the mind: psychiatry in the commercial film. There are many striking temporal and cultural parallels in the development of commercial films and psychiatry. The psychiatrist has been depicted in widely varying ways--as madman, as a powerful force for tinkering with the soul, and as a wonder worker who cures patients by uncovering a single traumatic event. The early years, in which psychiatric issues were often treated simplistically or sensationally, were followed by a "latency period". After the war there was a deluge of psychological films, which also began to deal with emerging social issues. Contemporary films tend to focus on madness as a metaphor or on the struggle of seemingly normal, successful people to find fulfillment. Psychiatry and film are "toys that have grown up together," along with the consumers of both.


Behavioral toxicity and equivocal suicide associated with chloroquine and its derivatives. Although the antimalarial agents chloroquine, hydroxychloroquine, and amodiaquine are widely used to treat a variety of medical conditions, their behavioral toxicity and lethality are not generally recognized. Therapeutic doses sometimes cause psychosis, delirium, personality change, and depression. Since moderately low overdoses of chloroquine can result in rapid death, such behavioral effects could lead to accidental or state-dependent overdosage and death.


Delayed immune reactions in mice immunized with malarial antigen. Mice were immunized subcutaneously, intravenously or in a footpad with antigens prepared from a lethal strain of Plasmodium berghei yoelii. A delayed footpad swelling (DFS) reaction was observed 4 days after immunization, and was detectable at least 42 days after immunization. However, IV immunization was the least efficacious is producing hypersensitivity. Regardless of the type of antigen used for immunization, mice responded similarly when live parasites were used to elicit DFS. This study revealed that hypersensitivity depended on route of immunization and type of antigen.


Immunological studies in human schistosomiasis. III. Immunoglobulin levels, antibodies, and delayed hypersensitivity. Levels of IgG, IgE, IgM, and IgA were determined, specific antibodies were detected by the fluorescent antibody test, hemagglutination test, complement fixation test and immunoelectrophoresis, and intradermal tests for delayed hypersensitivity to Schistosoma mansoni antigens were performed in Brazilian patients with schistosomiasis mansoni. The results were compared according to the clinical forms of the disease. IgG levels and antibody titers increased progressively in the subclinical, hepatomegalic, and hepatosplenic forms and there was a statistical relationship between IgG levels and the intensity of responses to the four serological tests; Delayed hypersensitivity (DHS) was found more frequently in hepatosplenic patients and more particularly in those with splenomegaly. DHS also correlated with age, but not with sex or with skin color. The strongest DHS reactions were observed in patients 20 to 34 years old, and in those having the highest fecal egg output. IgG levels, antibody titers, and DHS responses decreased after splenectomy and portal filtration of the worms. No significant variation was observed between untreated subjects, patients who were splenectomized and a group not subject to reinfection for 4 yearsk0


T and B rosetting lymphocytes in the blood of smallpox patients. The proportion of T and B cells in the peripheral blood of smallpox patients was determined. The average initial percentage of T cells was depressed (41 +/- 8.4%) in comparison with uninfected controls (65 +/- 7.6%), while the initial B cell counts averaged 26 +/- 11.4% and 28 +/- 5.1%, respectively. However, initial B cell percentages in four infected patients (two of whom died) were between 9 and 14, which are considerably lower than any control value, the lowest of which was 19%. Review of the literature emphasizes the both cellular and serological immunity play a role in recovery from pox disease; the two patients who had the highest initial nul cell (lymphocytes not identified as either T or B cells) counts died, while none of five patients who had consistently low nul cell counts died.


A simple technique for the detection of dengue antigen in mosquitoes by immunofluorescence. Dengue antigen could be demonstrated by a direct fluorescent antibody technique in simple head squashes of either male or female Aedes albopictus mosquitoes infected with any of the four dengue serotypes. Dengue viruses can be isolated rapidly and simply by combining this technique with that of parenteral inoculation of mosquitoes with test material.


Radical cure of Chesson strain vivax malaria in man by 7, not 14, days of treatment with primaquine. Glucose-6-phosphate dehydrogenase-normal adult volunteers infected with mosquito-bone Chesson strain vivax malaria were treated with chloroquine and primaquine during the initial attack. Administration of 60 mg (base) of primaquine daily for 7 days was as effective in preventing relapse as is the regimen customarily used for the radical cure of infections produced by this strain, namely, 30 mg daily for 14 days. However, it is stressed that because of the risk of primaquine-induced hemolysis in individuals having genetically-transmitted erythrocyte abnormalities this high dosage should not be used routinely.


Improving cholecystectomy.

Improving cholecystectomy. Bacteriologic study of bile in 100 patients undergoing cholecystectomy for various manifestations of choletithiasis yielded 36 per cent positive cultures, with greater frequency in older individuals and those with acute cholecystitis and common duct stone; these results are comparable to those in previous studies and reaffirm the septicity of the bile. Incidence of wound infection, averanging 10 per cent in published series of cholecystectomies, was 0.5 per cent in 200 patients in whom a water-impermeable wound drape was sewn to the peritoneum to prevent contamination by potentially infected bile. This result, in patients with an infectious risk comparable to that in other series, establishes the value of meticulous wound isolation in preventing wound infection.


Mechanical performance of sutures in surgery. In this study, we have compared the recommended configuration of a knot with specified sutures as ascertained by mechanical performance tests to that employed by a group of board-certified surgeons. Agreement between the surgeon and the results of the test was encountered in only one fourth of the instances. In another one fourth of the cases the surgeon overestimated the number of throws required for a knot to reach knot break. This additional suture material further handicaps the host's defenses, thereby inviting infection. Surgeons employed knots that untied without reaching knot break in the remaining half of the cases. The holding power of many of the knots that untied was substantially less than that of knots reaching knot break. On the basis of the study, it is recommended that results of the mechanical performance tests be made readily available to the surgeon so that his patient can receive maximal benefits from the knotted suture with the least damage to the host's defenses.


Foley catheter tip cultures: a valuable diagnostic aid in the immunosuppressed patient. Cultures of forty-three Foley catheter tips from immunosuppressed renal transplant patients have been analyzed and correlated with the subsequent development of urinary tract infection. Fifteen cultures produced no growth and two showed only coagulase-negative staphylococci; none of these patients subsequently developed a urinary tract infection. Twenty-four of the cultures showed at least one organism known to be a frequent urinary pathogen; sixteen (67 per cent) of these patients developed a urinary tract infection within ten days of the culture, and all sixteen had an infection caused by an organism present on the Foley tip. None of the organisms were identified by simultaneous catheter specimen urine cultures. Foley tip cultures in the immunosuppressed renal transplant patients are predictive of urinary sepsis and diagnostic of the causative organism.


The value of lactic dehydrogenase as a predictor of early allograft survival. Levels of serum lactic dehydrogenase (LDH) were determined in renal transplant recipients to assess their value as consistent predictors of acute allograft rejection. Although serum LDH levels of more than 250 U/l were in most cases associated with irreversible graft rejection, they were unreliable as a predictor or as an early indication of allograft rejection. Their chief value appears to be as an aid in determining when to discontinue high dose immunosuppression in an attempt to save an allograft that is most probably doomed to ultimate failure.


Evarts A. Graham (1883--1957), surgeon and educator. Evarts A. Graham achieved greatness through his many contributions to the art and science of surgery. He was also outstanding in promulgating the highest standards possible in areas of surgical education and ethics. The qualities of charcter that made him such an outstanding leader affected all who worked with him and helped immeasurably in the further evolution of surgery into a productive and valuable discipline.


Renal transplantation for progressive systemic sclerosis with renal failure: case report and review of previous experience. Renal transplantation for terminal renal failure as a result of scleroderma (progressive systemic sclerosis [PSS]) seems justified if other organs have not been severely damaged by the disease. The recurrence of PSS in the graft, not observed in early reports, appears to have caused the rapid failure of a cadaveric graft in a forty year old woman with acute PSS. A similar case of rapid PSS recurrence in the transplant has been recently reported by others [7]. A more aggressive pattern of PSS seems to differentiate these two patients in whom recurrence was observed from four previous patients with long-term graft functions. The possibility of rapid renal transplant loss should be considered in the selection and prognosis of acute PSS patients.


Microsurgical composite tissue transplantation: a new method of immediate reconstruction of extensive defects. Of thirty-five cases of microsurgical composite tissue transplantation, twenty-five (71 per cent) were completely successful, four (11 per cent), were partially successful, and six (17 per cent) failed. If a microvascular flap should fail, older but more lengthy methods of reconstruction may be employed with a reasonable chance for success. The advantages of the donor groin flap are discussed. Operative technic and management are outlined.


A rapid technic for quantitating wound bacterial count. An improved technic has been developed to predict rapidly the critical number of bacteria in tissues. This technic gave reliable and accurate measurements for wounds containing more than 2 X 10(5) organisms per gram of tissue. It is fortuitous that 10(6) bacteria is the critical number of bacteria that will induced clinical infection in experimental animals and humans. The rapid slide technic is now being utilized routinely in our medical center to determine graft bed receptiveness, predict the safety of wound closure, and monitor the course of burns.


Minimally invasive technic for construction of a cervical esophageal conduit. Most technics of cervical esophageal reconstruction involve extensive surgical dissection with its attendant hazards. The present report describes a simplified technic that causes minimal trauma to the patient. A partially deepithelialized, superficial skin tube is created without elevation of flaps and joined to the existing stomata. The technic was succesfully used in a frail, five year old patient who had three previous unsuccessful attempts at colonic interposition for a tracheo esophageal fistula.


Treatment of a flail injury of the chest. A case report with consideration of the evolution of therapy. A patient with flail-chest injury, and associated abdominal and musculo-skeletal trauma, required several modes of mechanical ventilation in the Surgical Intensive Care Unit Ventilator modalities included mechanical ventilation with positive end-expiratory pressure (PEEP) and intermittent mandatory ventilation (IMV) with continuous positive airway pressure (CPAP) during 12 days of intensive respiratory care. This treatment has resulted from an evolution of ideas about pathophysiology and treatment of the flail-chest injury. Future developments portend a shorter duration of ventilatory support; alternatively, a radically new mode of therapy may simplify the care of the flail-chest injured patient.


A multiclinic double-blind trial of pyridinolcarbamate and inositol niacinate in ischemic ulcer due to chronic arterial occlusion. A double-blind multiclinic trial compared the efficacies of pyridinolcarbamate and inositol niacinate in the patients with the ischemic ulcer due to chronic arterial occlusion. A thrice-daily dose of 1.5 g of pyridinolcarbamate or 1.2 g of inositol niacinate was given at random to the patients during cold seasons, and the effectiveness of treatment was assessed mainly on the basis of the clinical course of the ischemic ulcer and the rest pain. The patients were classified into 4- and 6-week groups. Beneficial results were recorded in 16 of 32 cases (50.0%) of the 4-week pyridinolcarbamate group, and in 24 of 42 cases (57.1%) of the 4-week inositol niacinate group. In the 6-week group favorable results were observed in 54 of 79 cases (68.4%) on pyridinolcarbamate, and in 36 of 74 cases (48.6%) on inositol niacinate. Although sympathectomy is currently indicated for these ischemic lesions, long-term treatment with pyridinolcarbamate is recommended on the basis of the finding that the 6-week treatment appears superior to the 4-week treatment and also to the 6-week treatment with inositiol niacinate.


Use of laminar air flow portable filter in asthmatic children. A new, portable laminar air-flow filter (Enviracaire) was tested on 13 asthmatic children, using a double-blind single crossover study. There was a statistical improvement in symptom scores during filter use; however, peak flows did not improve significantly. The authors feel this method of avoiding indoor airborne irritants is useful and warrants further study.


Flunisolide aerosol in the treatment of perennial allergic rhinitis. A double-blind, crossover study was performed with a new topical aerosol steroid, flunisolide, administered every 12 hours over a period of eight weeks to 36 adult patients with perennial allergic rhinitis. During the treatment period the majority of patients had significant relief of symptoms as compared with the placebo period. Most prominent improvement occurred with the symptoms of nasal stuffiness, sneezing, rhinorrhea and the number of times patients had to blow their noses. Best results were obtained in patients with higher degrees of atopy. Side effects were minimal and limited to nasal irritation in some patients. Criteria for optimal patient selection are discussed and an explanation for the lack of systemic effects of aerosolized use of the newer corticosteroids is given.


Albuterol and ephedrine in patients with reversible obstructive airway disease. This study evaluated the cardiac, pulmonary and neuromuscular effects of albuterol and ephedrine. The pulmonary effects of albuterol occurred earlier, lasted longer and were greater in degree. The cardiac effects of both drugs were virtually non-existent. Tremor was recorded with the higher doses of albuterol.


Epidemic diarrhea at Crater Lake from enterotoxigenic Escherichia coli. A large waterborne outbreak. In June and July 1975, Gastrointestinal illness occurred in more than 200 staff members and 2000 visitors to an American national park. In was characterized by prolonged diarrhea, cramps, nausea, and vomiting, lasted a median duration of 8 days, and was significantly associated with consumption of park water (P less than 0.001), which had been contaminated by raw sewage. Enterotoxigenic Escherichia coli serotype 06:K15:H16 was isolated from 20 of 49 ill park residents and from the park's water supply, but not from 71 residents who had never been ill or had been well for at least 4 days. No other bacterial, viral, or parasitic pathogens were isolated from ill or well persons. This outbreak is the first waterborne epidemic of diarrheal illness shown to be due to enterotoxigenic. E. coli, and this study documents one mode of transmission of this pathogen. This investigation also suggests the relative insensitivity of current methods for identifying persons infected with this organism, either by the culturing of randomly selected isolates or by measuring serologic responses.


Cis-diamminedichloroplatinum (II). A new anticancer drug. Cis-diamminedichloroplatinum (II) (DDP) leads the series of platinum coordination complexes, a new class of cytotoxic agents. The antitumor and toxic effects of this drug are discussed. It has displayed encouraging results in testicular tumors. The drug's therapeutic effectiveness has also been recognized in a variety of other solid tumors, particularly ovarian, bladder, and head and neck malignancies. Gastrointestinal, renal, audiologic, and relatively minor hematologic toxicities may be encountered, but promising methods have been developed to increase the therapeutic index of DDP.


[Study of a "RFA" locus coding for cell wall lipopolysaccharide core biosynthesis in "Shigella flexneri" F6S (author's transl)]. The rfa-7 lipopolysaccharide core mutation carried by the R mutant F680, derived from Shigella flexneri F6S serotype 5b, has been mapped by conjugation and transduction experiments. The results show a chromosomal distance of about 1 min between rfa-7 and mtl. Such a position would be similar to those of rfa genes in Escherichia coli K12 and Salmonella typhi-murium LT2. Conjugational transfer of E. coli K12 rfa+ genes to mutant F680 restored S. flexneri O-specificity. Chemical analyses performed on the lipopolysaccharide of such a rfa+ hybrid suggest that this strain can attach the S. flexneri serotype 5b O-specific polysaccharide to the E. coli K12 core.


Yeast protoplasts from stationary and starved cells: preparation, ultrastructure and vacuolar development. The conversion of stationary and starved yeast cells into protoplasts is described. The method is rapid, simple and can be applied to a variety of stationary yeast cells. Preincubation of yeast cells in the presence of pronase was essential for effective conversion into protoplasts. Baker's yeast and seven defined yeast strains, including one "petite", were studied. All of them were efficiently transformed into protoplasts in 60 to 90 min, depending on the strain culture conditions and the age of the culture. Protoplasts may be obtained even from late-stationary cells which contain spores. Saccharomyces cerevisiae cells subjected to complete starvation conditions in water, could also be completely transformed into protoplasts, even after 48 h of starvation. Electron microscope examination of stationary protoplasts from three different yeast strains showed no evidence of a remaining cell-wall. S. cerevisiae stationary cells show a very developed vacuolar system, a number of "lipid granules" and a few altered mitochondria. Endomycopsis fibuligera and Candida tropicalis stationary protoplasts show a similar fine structure, but "lipid granules" were completely absent.


Behavior of skin grafts in treatment of recurrent pterygium. The use of split-thickness skin grafts affords a means of treating recurrent pterygiums and also presents an acceptable "white" eye. The additional application of beta ray therapy on the junction between the limbus and the skin graft will increase the percentage of success.


Intraocular reticulum cell sarcoma: its dramatic response to systemic chemotherapy and its angiogenic potential. A 77-year-old woman with reticulum cell sarcoma in apparent remission presented with neovascular glaucoma. Ultrasonography demonstrated a 360 degree ring tumor of the ciliary body which totally regressed in 3 weeks after reinsitution of systemic chemotherapy. This appears to be a ring reticulum cell sarcoma of the ciliary body and is apparently the first reported case of an intraocular reticulum cell sarcoma which has undergone such a dramatic response to combined chemotherapy. A review of the English literature of all published cases of ocular reticulum cell sarcoma (16 cases) discloses no similar case, and emphasizes for the first time the angiogenic potential of this tumor. Secondary glaucoma was found to be associated with intraocular reticulum cell sarcoma in approximately two-thirds of the reported cases, and neovascular glaucoma in about one-quarter of these cases.


Pneumococcal endophthalmitis following grafting of corneal tissue from a (cadaver) kidney donor. In order to stress the need for continued vigilance in maintaining the highest standards of quality control for corneal tissue used for transplantation, we are presenting 2 cases of pneumococcal endophthalmitis which occurred in tissue transplanted from a young donor who died following acute trauma. The patient had been on cardiovascular support for over 26 hours and had suffered from a febrile illness which on autopsy revealed bronchial pneumonia. Both kidney recipients from the same donor died of myocardial infarctions on the same day in separate cities, 2 days after kidney transplantation surgery. Several recommendations are made which should assist all eye banks in providing the highest quality tissue and in preventing the occurrence of infection transmitted donor tissue.


Ocular complications after renal transplantation. The ocular complications in 78 renal transplant patients were evaluated. Fifty-eight (74%) showed some ocular abnormality. Forty-one patients (53%) were found to have various degrees of cataracts. The duration of hemodialysis, the age of the patients, and daily dosage of prednisone did not seem to influence the development of cataracts. Correlation was found between the total dosage of prednisone and the cataract formation. Mild and moderated hypertensive fundus changes were found in 15 patients. Severe progression of diabetic retinopathy was observed in 2 diabetic patients. For the first time focal hemorrhagic necrosis of the eyelid as a result of cryptococcus septicemia was noted. Other ocular complications include one case of ocular hypertension and one case of herpetic keratitis. Although the incidence of ocular complications was high, the severity of ocular pathology seemed to be relatively mild.


Intraocular lens implantation in combination with keratoplasty. Intraocular lenses were implanted in combination with penetrating keratoplasty in a series of patients followed for up to 2 years. During this period of observation there was little or no evidence that the simultaneous implantation of an intraocular implant adversely affected the corneal graft. Technique and results are described.


[Anticytoplasmic antibodies of human epidermal cells (author's transl)]. Antibodies reacting with the cytoplasm of epidermal cells (E. C. A.) were defected by indirect immunofluorescence (I.I.F.) studies of 255 sera in various dermatoses (8 p. 100) and significantly more frequently (46 p. 100) in bone marrow transplanted patients having skin lesions. Bound E.C.A. were only found in two cases. E.C.A. were found to be devoided of any diagnostic value. E.C.A. were interpreted as the result of a skin injury liberating skin antigens which stimulated their production. The reaction of E.C.A. in I.I.F. on human skins substrates showed three different patterns; in some cases only the basal cell layer was stained; in others only the supra basal layers were stained; in other all the layers were stained. A serum was shown to be able to give the three patterns of reaction (or no reaction at all) if different human skins were used as substrate. Autologous skins never gave a basal cell layer staining. These findings support the facts that (I) there is antigenic differences between the basal cell layer and the supra basal layers (with regard to the cytoplasmic antigens) (II) these antigens may be different from one subject to the other, supporting the allogeneic nature of this system. Therefore, E.C.A. are regarded as a useful marker of the human skin cytoplasmic antigens.


[Immunopathological study of Gougerot-Ruiter's vasculitis (author's transl)]. The authors report 10 cases of selected Gougerot-Ruiter's disease and 13 cases of various vasculitis. Direct immunofluorescence studies were performed on the skin lesions and the results were correlated to various biological parameters such as dosage of serum IgA, IgG and IgM, antinuclear antibodies, Australia antigen. Complement (beta-1-C/beta-1-A) deposition was found in 9 out of 10 cases of Gougerot-Ruiter's disease as opposed to immunoglobulin deposition found only in 4 out of 10 cases. Both C3 and immunoglobin were regularly found in the vessel walls of 2 cases of cryoglobulinemia and 1 case of SLE. In the cases of thrombopenic purpura, simplex purpura. Schoenlein Henoch purpura and drug induced purpura, complement (beta-1-C/beta-1-A) and immunoglobulin were absent in the lesions. The authors discuss the different physiopathological mechanisms which may be involved in the development of Gougerot-Ruiter's vasculitis.


Blood supply to the nape-of-the-neck flap: implications from a fetal anatomical study. The blood supply to the nape-of-the-neck flap was studied in 11 18-week-old fetuses by infusion of methyl methacrolate into the vascular system. Dissection of the posterior cervical region showed that the  major blood supply to this area was through perforating vessels from the superficial portion of the ramus decendens of the occipital artery and the posterior auricular artery. Since a "named artery" was not found in the longitudinal axis of the flap, as is reported in the literature, it should be considered a cutaneous rather than an arterial flap. The findings of this study are consisted with classical anatomical descriptions about blood supply to this region. Collateral vascular pathways from the occipital artery and the corticervical trunk are discussed.


[Study of the role of Candida albicans infection in different infant conditions including a diaper rash (64 cases)]. The pathogenic role of Candida albicans has been determined by performing: skin scrapings, mouth swabs, faecal specimens and serology from 64 infants and very young children affected with different conditions including a napkin dermatitis, divided into 4 groups. 1) 7 patients affected with true or presumed candidiasis, 2) 53 patients with different manifestations of diaper dermatitis, 3) 3 patients with papulo-erosive dermatitis of the diaper area, 4) 1 congenital ichthosiform erythrodermia. Candida albicans is the only responsible agent of the granulomatous candidiasis, it is constant but appeared lately in acropathia enteropathica. It is one of the major agents of the trichophytoid dermatitis (2 cases out of 4 cases). Candida albicans has been recovered from the skin of 33 infants out of 53 patients affected with all types of napkin eruption (62 p. 100) and from faecal specimens of 43 patients (81 p. 100). Though Candida albicans has often been considered as an opportunistic organism, even in infants, this percentage is greatly higher than that of the normal infant that is about 4p. 100, and consequently has a real pathogenic value. Species of yeasts different from Candida albicans have been recovered from faecal specimens of 3 infants affected with papulo-erosive dermatitis of the napkin area: parapsilosis, macedoniensis, deformans which are not generally considered as pathogenic agents. Serology is positive only in 3 infants or young children affected with a real chronical candidosis: 1 granulomatous candidosis, 1 acropathia enteropathia, 1 erythrodermia, the faecal specimen of whom contained a great nomber of Candida albicans.


Peroperative infusion of dextran 70 and dextran 40 in the prevention of postoperative deep venous thrombosis as confirmed by the I-125-labelled fibrinogen uptake method. The antithrombotic effect of dextran 70 and dextran 40 was studied by a double blind trial in 235 patients with major or medium sized elective procedures. 6% dextran 70 (Macrodex) or 10% dextran 40 (Rhemacrodex) or 5% dextrose in 0.9% saline were given in a double blind manner in 500 ml quantities over 30 minutes starting with the induction of anaesthesia. The diagnosis of deep venous thrombosis was confirmed objectively by the I-125-labelled fibrinogen uptake method. Statistically significant differences in the incidence of deep venous thrombosis between the controls and the dextran groups were not found.


Some problems in the correction for intrinsic light-scattering of samples in specific protein analysis by automated immunoprecipitation. Heparinised plasma samples have falsely high blank values in the automated immunoprecipitation system when blanks are measured by omitting antiserum from the assay. This is probably due to an interaction of heparin and serum proteins, together with either fibrinogen or polyethylene glycol. A more accurate estimate of the blank of heparinised plasma samples is obtained by measuring it with a solution of nonimmune serum substituted for the antiserum.


Chronic tympanomastoiditis with formation of calculi. Numerous calculi of varying sizes and shapes were discovered in the mastoid, antrum, and attic during mastoid surgery for persistent chronic suppurative inflammation of the middle ear cleft with retroauricular and external meatal fistulas in an 8-year-old boy. Light microscopic and scanning electron microscopic examinations and x-ray microanalysis revealed the calculi to consist of masses of crystals containing calcium-oxalate and calcium- and magnesium-phosphate. No signs of tuberculosis were found. Since the patient had multiple dysplasias, including ipsilateral macrotia, in addition to chronic otitis media and mastoiditis, it is suggested that the formation of the calculi may have been due to congenital predisposition.


Interference between two immune responses. I.--Modification of the kinetics of the mouse response to SRBC by responses to heterologous RBC. Influence of a preceding immunization with HoRBC on the immune response to SRBC was studied in Swiss and CBA inbred mice. In Swiss mice, a short interval (1day) between the two immunizations produced an acceleration of anti-SRBC response, while a longer interval (4-7 days) inhibited this response. This was interpreted as manifestations of nonspecific helper and suppressor activities triggered by the previous challenge. At any time of a response, there would exist a variable ratio of these two opposite activities. The helper activity was radiation-resistant while the suppressor one was radiation-sensitive at the time of its appearance and was effective on the IgG as well as on the IgM response. CBA mice response to SRBC was only influenced by the suppressor and not by the helper component of the preceding challenge with HoRBC. These CBA mice were very good responders to this antigen, and this may be the cause of their strain particularities. If we consider that each individual is permanently submitted to natural immunizations, the ratio of the resulting non-specific activities must be esentially variable with time; it can partly account for the individual amplitude variation of an engaged immune response.


Experimental approaches to embryonic erythropoiesis. Erythroid systems in several developing organisms (including the human foetus and neonate, the chick embryo, the mouse embryo and the metamorphosing tadpole) have changing erythroid cell populations, changing haemoglobins and changing sites of erythropoiesis. The first two characteristics can be studied in vitro through organ cultures and cell cultures derived from early chick embryos. The prevention of early globin synthesis by specific inhibitors helps to define the mechanisms. There are interesting changes in the histone patterns during embryonic erythroid development and maturation. Changes in the composition and modification or erythroid chromatin proteins in the developing chick embryo and in the stimulated Friend erythroleukaemic system are discussed.


The use of bile - esculin agar for the taxonomic classification of the family Enterobacteriaceae. Bile-esculin medium has been used for many years for the presumptive identification of group D Streptococcus. The test is based on the ability of a bacterium to grow in the presence of 40% bile and produce esculinase. 2935 strains of Enterobacteriaceae were inoculated onto bile-esculin agar slants and incubated at 35 C. Esculin hydrolysis was determined after 24 and 48 hours. At 24 hours of incubation esculin hydrolysis was limited to the genera Klebsiella, Enterobacter, Serratia, and the species P. vulgaris, P. rettgeri, and C. diversus. Not all strains of these species were positive, however. All other members of the family were negative. At 48 hours of incubation 37% of E. coli gave a positive reaction; all other Enterobacteriaceae which were negative at 24 hours remained negative. Esculin hydrolysis is a valuable test for the taxonomic classification of the family Enterobacteriaceae.


Genetics of colicin E susceptibility in citrobacter freundii. The insensitivity of Citrobacter freundii to the E colicins is based on tolerance to colicin E1 and resistance to colicins E2 and E3. Spontaneous colicin A resistant mutants of C. freundii also lost their colicin E1 receptor function. Sensitivity to colicin E1 can be induced by F'gal+tol+ plasmids, the tol A+ gene product of which is responsible for this effect. Receptor function for colicins E2 and E3 is induced by the E. coli F'14 bfe+ plasmid, which is also able to enhance notably the receptor capacity for colicin E1. The bfe+ gene product of E. coli, which is responsible for these phenomena, also restores the receptor function for colicin A and E1 in colicin A resistant mutants of C. freundii. All results show that there is a remarkable difference between the E. coli bfe+ gene product and the bfe+ gene product of C. freundii and also between the tol A+ gene products of these strains. The sensitivity to phage BF23 parallels the sensitivity to colicins E2 and E3 and is also induced by the F'14 bfe+ plasmid.


Inactivation by ionizing radiation of Salmonella enteritidis serotype montevideo grown in composed sewage sludge. S. enteritidis ser. montevideo were grown in composted sewage sludge to levels of approximately 10(9)/g. These bacteria were found to be inactivated by ionizing radiation at approximately the same rate (30 krads/log) as Salmonella species in liquid digested sludge.


Salmonella in surface waters of central New York state. Six tributary streams and southern Cayuga Lake in central New York state were sampled for the presence of Salmonella on swabs immersed for 4 days. Of a total of 322 swabs, 39% yielded salmonellae. Swabs were cultured in tetrathionate enrichment at 41.5 degrees C. Isolations were made from brilliant green agar. Salmonellae were isolated from many sites on the streams and from some lake sites. Twenty-five serotypes (11 somatic antigen groups) and a distinct biotype of S. typhimurium (H2S negative) were found. Most frequent isolates, in order of decreasing occurrence, were S. typhimurium, S. thompson, S. oranienburg, and S. enteritidis. Several uncommon isolates also appeared. When tested for mouse infectivity, the isolates generally showed little or no virulence. The incidence of clinical salmonellosis among humans was low in the area and the variety of serotypes had not been noted among cattle. The presence of Salmonella in waters ranging in classification from potable to agricultural and industrial indicated the existence of a low level and undefined reservoirs of the bacteria in the region.


Toxicity and mutagenicity of hexavalent chromium on Salmonella typhimurium. Four hexavalent and two trivalent chromium compounds were tested for toxicity and mutagenicity by means of the Salmonella typhimurium/mammalian-microsome test. All hexavalent compounds yielded a complete inhibition of bacterial growth at doses of 400 to 800 mug/plate, a significant increase of his(+) revertant colonies at doses ranging from 10 to 200 mug, and no effect at doses of less than 10 mug. The distinctive sensitivity of the four Salmonella strains tested (TA1535, TA1537, TA98, and TA100) suggested that hexavalent chromium directly interacts with bacterial deoxyribonucleic acid by causing both frameshift mutations and basepair substitutions. The latter mutations, which are prevalent, are amplified by an error-prone recombinational repair of the damaged deoxyribonucleic acid. On the average, 1 mumol of hexavalent chromium yielded approximately 500 revertants of the TA100 strain, irrespective of the compound tested (sodium dichromate, calcium chromate, potassium chromate, or chromic acid). The mutagenic potency of the hexavalent metal was not enhanced by adding the microsomal fraction of rat hepatocytes, induced either with sodium barbital or with Aroclor 1254. The two trivalent compounds (chromium potassium sulfate and chromic chloride), with or without the microsomal fraction, were neither toxic nor mutagenic for the bacterial tester strains.


Succession of Streptococcus bovis strains with differing bacteriophage sensitivities in the rumens of two fistulated sheep. The bacteriophage sensitivity of the Streptococcus bovis population resident in the rumens of two fistulated sheep was monitored for 112 days. During this time, three changes in the bacteriophage sensitivity of S. bovis occurred in the absence of detectable bacteriophages. Identical changes in bacteriophage sensitivity occurred simultaneously in both animals and, except for the relatively short periods of changeover in phage sensitivity, the S. bovis population in the rumens of the two sheep was homogeneous with respect to phage sensitivity.


Alternative model and approach for determining microbial heterotrophic activities in aquatic systems. Increasing amounts of high-specific-activity tritiated organic compounds were added to samples of several natural waters such that in situ substrate concentrations might be approximated. The uptake responses by the native heterotrophic microflora suggested that (i) heterotrophic populations metabolize the added nutrients, but (ii) these responses are not necessarily a reflection of Michaelis-Menten enzyme kinetics. The uptake kinetics appeared to be due to dilution of the naturally occurring metabolite by added radioactive substrate and physiological responses of the microflora to organic enrichment.


Ambient-temperature primary nonselective enrichment for isolation of Salmonella spp. from an estuarine environment. A primary, nonselective, ambient-temperature enrichment procedure for isolation of Salmonella spp. is described. The procedure was superior to elevated-temperature selective enrichment for Salmonella when estuarine water samples were examined. Five Chesapeake Bay stations were monitored, over an 8-month period, for the presence of salmonellae. Of 72 water and sediment samples collected, 17 (23.6%) yielded Salmonella spp. Seven serotypes were identified among the isolates. A seasonal pattern was noted for the incidence of the salmonellae. A most probable number procedure, performed by membrane filtration and nonselective enrichment, yielded Salmonella most probable number indices as high as 110 per 100 g of sediment. The results suggest that new methods, such as the one described in this report, are required for isolation of human intestinal pathogens from estuaries and coastal waters.


Maintenance procedures for the curtailment of genetic instability: Xanthomonas campestris NRRL B-1459. Characteristics are described of small-colony variants of Xanthomonas campestris NRRL B-1459 which are frequently encountered when routine culture maintenance procedures are employed. In contrast to the parental type, smallcolony variants were shown to be resistant to a number of antibiotics, to acridine orange, and to phage which are virulent for the parent colony type. Sensitivity to ultraviolet radiation was similar in both colony types. A simple method for preservation of viable cells is described. The suitability of the method for providing reproducible inocula free from variant cell types is examined.


Klebsielleae in drinking water emanating from redwood tanks. A survey was made of the bacteriological quality and chlorine content of 33 public and private water systems that utilize redwood storage tanks. Coliforms of the genera Klebsiella and Enterobacter were isolated from 9 of 10 private drinking water systems and from 11 of 23 water systems in state and federal parks. Total coliform counts in the private systems exceeded federal membrane filter guidelines by as much as 10-to 40-fold. Coliform counts were highest in the newer reservoirs. Factors contributing to poor water quality are: lack of automated chlorination equipment or an insufficient supply to maintain a residual, common inlet/outlet plumbing design, and lengthy average retention periods. The latter two factors contribute to improper mixing and stagnation of the water, whereas the former allows microbes to multiply on the water-soluble nutrients that leach from the wood. Wooden reservoirs exert a high chlorine demand, and 0.4 ppm of chlorine residual in the incoming tank water proves inadequate. It is suggested that specific water-soluble nutrients in redwood (and in numerous other types of botanical material) induce a natural nutritional selection for coliforms of the tribe Klebsielleae.


Amino acid profiles and presumptive nutritional assessment of single-cell protein from certain lactobacilli. The amino acid profiles, modified essential amino acid (MEAA) indexes, and in vitro pepsin digestibilities were determined for single-cell protein (SCP) from certain industrially important lactobacilli. For the three parameters examined, substantial differences were seen between different Lactobacillus species and between strains with a given species. SCP from all of the lactobacilli examined appeared relatively high in MEAA indexes and pepsin digestibility. SCP from L. acidophilus 3205 and L. fermenti 3954 had the highest MEAA indexes, whereas L. bulgaricus 2217 and L. thermophilus 3863 had the highest percentage of digestible crude protein. SCP from L. plantarum strains had the lowest MEAA indexes. The essential amino acid compositions of SCP from different lactobacilli appear comparable to that of Food and Agriculture Organization reference protein and SCP from other sources.


Continuous-flow system for large-scale ultraviolet irradiation of bacterial cells. A quartz-flow-cell system for irradiation of large volumes of Escherichia coli cultures with ultraviolet light is described. With this system kilogram quantities of irradiated cells can be obtained for biochemical studies. Changes in respiration and in specific activities of superoxide dismutase and catalase, after an ultraviolet treatment that reduced viability of culture samples to 0.2%, were in good agreement with those for cultures irradiated (52J/m2) by a conventional small-scale method to produce the same reduction in viability.


Determination of bacterial number and biomass in the marine environment. Three techniques for the measurement of bacterial numbers and biomass in the marine environment are described. Two are direct methods for counting bacteria. The first employs an epifluorescence microscope to view bacteria that have been concentrated on membrane filters and stained with acridine orange. The second uses a transmission electron microscope for observing replicas of bacteria that are concentrated on membrane filters. The other technique uses Limulus amebocyte lysate, an aqueous extract from the amebocytes of the horseshoe crab, Limulus polyphemus, to quantitate lipopolysaccharide (LPS) in seawater samples. The biomass of gram-negative (LPS containing) bacteria was shown to be related to the LPS content of the samples. A factor of 6.35 was determined for converting LPS to bacterial carbon.


Use of enzyme-labeled antibodies to detect Salmonella in foods. An indirect enzyme-labeled antibody technique (ELAT), in which Salmonella typhimurium was used as a model, was developed as a method to detect Salmonella in food samples. A cellulose-acetate membrane filter, the matrix for detection, was placed on a membrane-filter base and overlaid with a multiwelled lucite template. Mixed broth enrichment cultures were dispensed in the template wells, and cells were spotted onto the membrane via suction. After fixation, the membranes were immersed in rabbit anti-S. typhimurium flagella antibody, washed, immersed in goat anti-rabbit antibody conjugated to peroxidase, and washed. Exposure of membranes to the substrates 3,3'-diaminobenzidine or benzidine resulted in development of brown or blue macroscopic reaction products, respectively, on spots containing S. typhimurium. ELAT results agreed with those of enrichment serology and cultural procedures on three food products containing known levels of S. typhimurium. Because of the magnification effect of the enzyme-substrate reaction, fewer cells were needed for detection than with enrichment serology, thereby reducing the total analysis time. The ability to test 14 or more samples simultaneously on a 47-mm membrane filter would facilitate screening large number of samples. Pending the development of a pure H antisera pool for the common Salmonella serotypes free from O antibodies, the ELAT demonstrated potential as a Salmonella detection methodology.


Unusual variant of lupus erythematosus or lichen planus. Clinical, histopathologic, and immunofluorescent studies. Eleven patients with a skin disorder in which clinical, histopathologic, and immunofluorescent findings showed overlap features of both lupus erythematosus (LE) and lichen planus (LP) were observed for several years. Clinical lesions were extremely long-term and consisted primarily of livid red to violaceous atrophic patches and plaques, most common on acral aspects of the extremities. Nails were also commonly involved, often showing anonychia. Histologic changes combined cell-rich and cell-poor lichenoid patterns in the papillary dermis, suggesting both LP and LE. The major immunofluorescent finding in all patients was the presence of ovoid bodies at the dermal-epidermal (D-E) junction and in the upper dermis. Most patients showed both a linear arrangement and a clustering pattern of these bodies. Four patients also had coexistant but poorly developed linear deposits of immunoglobulins and complement at the D-E junction.


Lupus band test.

Lupus band test. The lupus band test (LBT) is a direct immunofluorescent technique for demonstrating a band of localized immunoglobulins at the dermal-epidermal junction in the skin of patients with lupus erythematosus (LE). Studies have shown immunoglobulins and complement at the  dermal-epidermal junction in systemic (involved and uninvolved skin) and in discoid (involved skin only) LE. It is essential that the appropriate skin site be selected for biopsy; ie, involved or uninvolved skin, light-exposed or light-protected skin. The proper location of the biopsy site is determined by whether the LBT is intended for diagnostic or prognostic purposes. From a diagnostic standpoint, the LBT is a very sensitive and specific test for LE. In addition, this procedure has considerable value as a prognostic test for a patient with an established diagnosis of LE.


Controlled trial of continuous positive airway pressure given by face mask for hyaline membrane disease. A controlled trial of elective intervention with continuous positive airway pressure (CPAP) was performed on 24 infants with hyaline membrane disease whose arterial oxygen tension (Pao2) fell below 8kPa (60 mmHg) while they were breathing a fractional inspired oxygen concentration (F1O2) greater than 0.60. A face mask was used to apply the CPAP. The progress of the 12 infants who were treated on entry to the trial was compared with that of 12 infants who were treated later. All 12 infants in the early-intervention group and 8 infants in the late-intervention group survived. When CPAP was started, Pao2 increased and the early-treated infants breathed high concentrations of oxygen for a shorter period than the late-treated infants. The 4 infants in the early-intervention group who required mechanical ventilation needed lower mean airway pressures to achieve satisfactory gas exchange than the 7 ventilated infants in the late-intervention group. We conclude that a Pao2 less than 8 kPa while breathing an F1o2 greater than 0.60 is an adequate indication for giving CPAP in hyaline membrane disease, and that early intervention with CPAP allows infants who go on to require mechanical ventilation to be ventilated at lower pressures.


Chronic lymphoglandular enlargement and toxoplasmosis in children. Serum antitoxoplasma titres were determined simultaneously by the direct agglutination and the indirect immunofluorescent tests in 52 children aged 2 to 16 years having chronic lymph node enlargement, mainly cervical. Direct agglutination titres were raised (64 to 4096) in 22 children (42%), but rarely in the control groups of children with acute suppurative lymphadenitis, and healthy children, adults, nurses, and physicians. It is concluded that toxoplasmosis is commoner in Greek children than previously believed, and that it should be included in the differential diagnosis of lymphoglandular enlargement. Clinically the condition is mild and may be self-limited, but it should be treated promptly with trimethoprim-sulphamethoxazole, in order to prevent reactivation in adult life.


Congenital absence of islets of Langerhans. A small-for-dates male infant who developed acute metabolic acidosis shortly after birth had diabetes and died aged 40 hours. At necropsy there was an absence of any recognizable islets of Langerhans though lymphorecticular aggregates were found. This was the fourth child of healthy unrelated parents whose first child, also a male, died at 48 hours under similar circumstances. It is suggested that both boys had the same underlying pathology and this might be a previously undescribed recessive or x-linked inherited condition.


[Influence of autologous serum on leucocyte-migration-inhibition-test in melanomalignoma (author's transl)]. Influence of autologous serum on cellular immunological reactivity to melanomalignoma (MM)-associated antigens was examined on 20 patients have MM at different clinical stages, using the Leucocyte-Migration-Inhibition-Test (MIT). These 20 patients were referring to this till now not investigated. When heterologous serum (horse serum) was supplemented, an inhibition of cell-migration could be established in 15/20 cases, whereas a cell-migration inhibition in 14/20 cases was absent if autologous serum was added to culture medium. No correlation could be found between our test results and the clinical stage of the disease. Our results suggests urgently that blocking factors are present in serum of MM-patients. There is reason to believe that this factors will be active in lymphocyte level.


Pathogenesis of pemphigus erythematosus. Immunofluorescence studies were made by the indirect method in 54 cases of pemphigus erythematosus, in 50 of which skin specimens from light-exposed and unexposed regions were investigated also by the direct IF method. IF Band was shown to be demonstrable in skin specimens from exposed regions in 81% of cases and from unexposed regions in 23%. ANA were found in some 31% of patients, though usually in titers below those of IC antibodies. There were 2 cases each of coexistence with myastenia gravis and thymoma and with SLE. Virus-like particles, however, were found by electron microscopy only in 1 case with coexisting SLE. Detection of IF Band in skin specimens from a significant majority of patients with pemphigus erythematosus, presence of ANA in some, and occasional coexistence of SLE suggest some relation of the disease with lupus erythematosus.


Experimental studies of the potentiation of proguanil and pyrimethamine by dapsone using Plasmodium berghei in white mice. An accurate system with stringent criteria has been established to test antimalarial drugs and drug combinations against Plasmodium berghei in mice. Minimum effective doses for a number of antimalarial drugs have been determined when used in this system. Considerable potentiation of the activity of pyrimethamine and to a somewhat less extent of proguanil by dapsone has been demonstrated. The need to extend studies of these combinations to the parasites of human malaria is discussed in terms of establishing a safe chemoprophylactic regime in the presence of drug-resistant strains of parasites.


Trypanosomal antigen on macrophages cultivated in vitro with Trypanosoma (Schizotrypanum) dionisii. The indirect fluorescent antibody test has demonstrated the presence of trypanosomal antigen on the surface of mouse peritoneal macrophages cultivated in vitro in the presence of Trypanosoma (Schizotrypanum) dionisii.


Schistosoma haematobium in a Gambian community. IV. Antibody levels and change in egg output. The indirect fluorescent antibody (FAT) and indirect haemagglutination (IHA) tests were used to study the serological response to Schistosoma haematobium in a Gambian community. The FAT was frequently positive in very young children and also in adults, in whom urine examination did not show ova. This was much less often the case with the IHA although this test sometimes gave negative results in heavily infected children. Examination of paired sera taken at six month intervals apart showed that titres changed in some subjects and that overall there was a slight change in antibody level. Correlation of antibody level with subsequent changes in egg output showed that high titres were associated with a tendency for the egg output to fall. This effect was most obvious over a period of 16 months' follow up and was not explicable solely in terms of a coincidental relationship with age or intensity of infection. It is suggested that serological parameters may have some relation to protective immunity and that the immune response must be considered as a factor in the epidemiology of the infection.


Effects of PEEP on cardiovascular dynamics after open-heart surgery: a new postoperative monitoring technique. The circulatory effects of incremental increases in positive end-expiratory pressure ventilation (PEEP) were assessed on 11 occasions in post-operative cardiac surgical patients by phasic aortic blood flow measurements and high-fidelity pressure recordings from which flow and pressure-flow derivatives of cardiac performance were calculated. At 15 cm H2O PEEP, mean arterial blood pressure was decreased by 10%, stroke volume and cardiac output by 15%, and peak left ventricular power by 21%. Although these indices promptly returned to control levels when PEEP was discontinued, levels of PEEP above 10 cm H2O should be used with caution for this group of patients.


Hypersensititivity of rats to anorectic agents after lesions in the ventromedial hypothalamus. Anorectic agents such as d-amphetamine and fenfluramine showed a remarkably higher effect in rats with hyperphagia after lesioning the ventromedial hypothalamus. A persistence and even a further increase of the hypersensitivity to anorectics was observed in animals which, eight months after ventromedial hypothalamus-lesioning, resumed almost normal eating patterns. The appearance of the hypersensitivity to anorectic agents after lesioning and its persistence or enhancement in long-term operated animals are interpreted in terms of the mechanisms contributing to the neural reorganization of the control of the feeding center after suppression of ventromedial inhibitory influences.


Cardioinhibitory carotid sinus hypersensitivity. Intracardiac recordings and clinical assessment. Cardioinhibitory carotid sinus hypersensitivity most frequently occurs in elderly men, predominantly during right carotid massage. Resting sinus bradycardia and aortic stenosis may be unusually prevalent in this subgroup of patients. Ventricular arrest occurs abruptly and may be preceded by brief prolongation of sinus cycle lengths and atrioventricular nodal conduction times. Gradual recovery of the sinoatrial rate follows resumption of sinus rhythm and is preceded by atrioventricular nodal recovery. His bundle electrocardiography is valuable in excluding other potential causes of syncope in patients with carotid sinus hypersensitivity. Despite a history of syncope, permanent pacing may not be indicated in the management of patients with carotid sinus hypersensitivity and otherwise normal electrophysiologic study.


Differentiation of cell-mediated and humoral rejection by orthoiodohippurate kinetics. The differentiation of two types of renal graft rejection may be made early in incipient stages by means of a comprehensive renal function study. In the acute cell-mediated form, prolongation of orthoiodohippurate renal transit time as reflected in a diminished excretory index (El) is first observed, followed by a diminution in the effective renal plasma flow (ERPF). On reversal of the process, El precedes ERPF in returning to normal. In chronic humoral rejection, the principle feature is simple reduction of ERPF; transit time within the kidney appears normal. No reversal processes have been observed, although the process may be decelerated. At approximately 100 ml/min ERPF, these kidneys may undergo an acceleration of the clinical failure with rapid deterioration in El and in ERPF. At this point, surgical removal of the kidney has been carried out.


Histiocytic lymphoma of B cell origin.

Histiocytic lymphoma of B cell origin. A histiocytic lymphoma with a terminal leukemic phase occurred in a 50-year-old man. Immunologic studies indicated that neoplastic cells from the peripheral blood sample, bone marrow aspirate, and lymph node carried surface immunoglobulin. Cytochemical and immunohistochemical analysis of this histiocytic lymphoma and its subsequent leukemic phase displayed a profile consistent with a lymphocytic rather than a histiocytic origin of the neoplastic cell.


Phenothiazine effects on psychological and psychophysiological dysfunction in chronic schizophrenics. This study examined the effects of phenothiazine treatment on attentional-perceptual, cognitive, and psychophysiological dysfunction in chronic schizophrenics. Under double-blind conditions, 20 patients receiving chlorpromazine and 20 receiving placebo for eight weeks were tested by performance measures, clinically rated, and monitored for skin resistance and heart rate on four occasions. Phenothiazine effects on measures of attention-perception and on psychophysiological response were demonstrable, but not on tests and ratings of cognitive dysfunction. The direction of effects was toward normalization of function. Drug treatment tended to improve ability to sustain set, to increase efficiency of selective attention, and to increase rate of information processing. Autonomic reactivity was reduced and a deactivation effect suggested. Clinical improvement was correlated with reduction in attentional dysfunction. The results are discussed in terms of their implications for hypothesized behavioral mechanisms of drug action, primary "behavioral site" of drug action, therapeutic response measurement, and functional theories of schizophrenic psychopathology.


The long-term patient in the era of community treatment. Post hospital follow-up studies do not encompass the total population of long-term, psychiatrically disabled patients in the community, because a large proportion (in this study, 64%) have not had a recent hospitalization, either state or local. The authors identified a population of long-term, psychiatrically disabled patients in the community, all of whom carried functional psychotic diagnoses. Long-term disabled patients generally lead inactive lives, but in California seldom return to state hospitals. One third have been hospitalized locally within the past two years-younger patients much more than older patients. Almost half use private (Medicaid) outpatient services, but one fourth receive no mental health services at all. Less than a third live in board and care homes or cheap hotels; most live in nonsegregated, noninsitutional settings. The role of Supplemental Security Income (SSI) in enhancing adaptation of the chronically disabled was impressive to the research team.


The mentally ill in nursing homes. New back wards in the community. The reduction in state hospital populations in the last two decades is most often attributed to psychotropic medication and community mental health centers. The role the proprietary nursing home has played in this reduction has not been adequately studied. Using data routinely collected for Medicaid utilization review, we studied characteristics of psychiatric nursing home patients in  Utah. One third of the nursing home patients had a psychiatric diagnosis; more than half of this group were classified as psychotic. Most psychotic patients were significantly younger than their nonpsychiatric counterparts. Nonpsychiatric patients received a higher mean number of psychoactive drugs than did psychiatric or mentally retarded patients. Over time, all groups of patients showed an increase in prescribed psychoactive medication and a decrease in activity. The consequence of this pattern of care raise serious questions about our current reliance on nursing homes for the care of the psychiatric patient.


A double-blind comparative evaluation of aspirin, paracetamol and paracetamol + caffeine (finimal) for their analgesic effectiveness. A double-blind, cross-over trial was made of three analgesic preparations--paracetamol, paracetamol with caffeine (Finimal) and aspirin in the relief of postoperative pain in 72 orthopedic inpatients and in 144 ambulatory outpatients suffering form common idiopathic headache. The combination of paracetamol and caffeine (Finimal) in this study shows the greatest pain relief in both groups of patients. This evaluation supports the results of BOOY3 demonstrating the superiority of the paracetamol-caffeine combination to paracetamol alone or aspirin.


Investigatiaons on drug-resistance of Shigella sonnei bacilli isolated in Poland in the years 1959-1972. 2538 strains of Shigella sonnei bacilli, isolated from patients in the years 1959-1972, have been tested for drug-resistance. The strains examined came from different regions of Poland. Drug-resistance has been determined by the method of "multi-arm" disks of filter-paper. In investigations 12 chemotherapeutics have been employed. The tests performed have shown that 63% of strains were resistant to one or more chemotherapeutics. The percentage of streptomycin-resistant strains, found in the investigations, was higher than that found by other authors. In the material examined 24% of strains were resistant to antibiotics, and sensitive to sulfathiazole. No strains resistant to eight or more chemotherapeutics applied have been found.


Antibiotics produced by Streptomyces olivaceus 142. II. Isolation, purification and activity spectrum of antibiotic WR 142-FPG. A method of isolating antibiotic Wr 142-FPG from the fermentation broth and mycelium of mutant FPG of the strain Streptomyces olivaceus 142 has been developed. The method of purification of the active substance and activity spectrum agains microorganisms are described. Some of the basic properties of two preparations are given: a) the preparation designed I, partly purified, containing a peptide moetye and b) the preparation designed II, which is a homogeneous chromatographically preparation with mol. wt. about 510, obtained from preparation I by separation on silica gel. Both preparations are active against the same spectrum of microorganisms and are similarly cytotoxic for normal and neoplastic cells. They differ from each other in specific activity and toxicity. LD50 of preparation I for white mice i.p. is about 240 mg/kg and LD50 of preparation II about 5 mg/kg. Comparison of the activity of the purified preparation of WR 142-FPG with that of known anti-fungal antibiotics showed that Wr 142-FPG inhibits growth of Candida albicans and other pathogenic yeasts at concentrations 10--100 times lower than amphotericin B, antimycin A, nystatin and primaricin.


Immunohistologic features of minimal-change nephrotic syndrome. To assess the role of immune mechanisms in the pathogenesis of minimal-change nephrotic syndrome (MCNS), immunohistologic studies were performed on renal biopsy specimens from 31 patients. Glomerular immunoglobulin and/or complement (C3) deposition was present in 20 specimens. Deposits were usually minimal to moderate, granular, and focal in nature. IgM was present in 17 specimens, C3 in 10, IgG in 8 and IgA in only 3. With a mean follow-up of 5 1/2 years, there is no difference in the response to therapy of patients with no glomerular immunoglobulin or C3, those with glomerular immunoglobulin without C3, and those with glomerular C3. These findings indicate that glomerular immune deposits can be seen in a substantial percentage of patients with MCNS, but the minimal and focal nature of the deposits and lack of correlation with response to therapy suggest that immunoglobulin and C3 deposits are nonspecific and have no pathogenetic role.


Immunofluorescence skin test for lupus erythematosus. A correlative study between frequency and patterns of skin test results, glomerular pathologic abnormalities, and immunologic findings. We undertook a correlative study between the frequency and patterns of immunoglobulin deposits at the dermoepidermal junction of clinically normal skin and the morphologic features (histopathologic and immunopathologic) of the glomerular lesions and various immunologic measurements in 38 patients with systemic lupus erythematosus. Thirty-five (92.1%) showed a positive immunoglobulin band at the skin. A statistically significant (P less than .001) correlation was observed between the pattern of deposit and the duration of disease. The stippled pattern was found to be more common in those cases of less than one year's duration, while the thready pattern was more common in those cases lasting longer than one year. There seemed to be no significant relationship between either the frequency (P greater than .100) and pattern (P greater than 0.25) of the immunoglobulin band and the glomerular pathologic or other immunologic measurements.


Warthin tumor. B-lymphocytes within the lymphoid infiltrate. The lymphoid stroma in Warthin tumor is predominantly composed of complement receptor B-lymphocytes. These lymphocytes are present in a pattern similar to that observed in reactive lymph nodes. The B-lymphocytes may be residual lymph node elements exhibiting reactivity directed toward the epithelial component of the tumor.


[Morphology of the endocrine part of the pancreas of birds]. Methods of light and electron microscopy were used to study the structural organization of the endocrinous part of the pancreas in birds (domestic ducks and chickens). It has been established that the endocrinous part is formed by three types of pancreatic islands: dark, light and mixed islands. "Dark" islands consist of A- and D-cells, "light" ones--of B and D-cells and "mixed" islands--of A-, B- and D-cells. The index of B/A-cell ratio is equal to 0,39--0,4. This shows that each B-cell corresponds to 4 A-cells. On this basis one can say that the counterinsular apparatus of birds became stronger in the process of evolution and due to this a comparatively high level of glycemia is sustained in them. Availability of "dark" and "light" pancreatic islands also points out that in birds there occurred a partial disconnection of insular and counterinsular components of the endocrinous part of the pancreas, necessary for adaptation to principally new conditions of the environment.


[Histochemical study of carbohydrate metabolism in the pancreas in experimental venous congestion]. Experimental venous congestion caused by a 50% constriction of the posterior vena cava results in a shift of some parameters of the carbohydrate metabolism in the rat's pancreas: the content of catecholamines, zinc and ascorbic acid as well as insulin in pancreatic islands. Changes in the content of zinc and ascorbic acid were most demonstrative. Their amount sharply increased within a month from the beginning of experiment.


[Method of determination of specific length of histological specimens with the aid of square-net eyeglass]. The author has analytically expressed the relationship between the inaccessible for measurement total length of non-randomly oriented stretched objects and the sum of lengths of their projections on the longitudinal axis of the preparation (or another line). The sum of their projection lengths can be measured by means of a square-net ocular. The specific length of objects on a histological section is proportional to the number of their intersections with the transversal lines of the net and the value of its division and inversly proportional to the cosine of the average meaning of angles between the longitudinal axis of the preparation and the objects under study. Verification of the validity of the formula deduced was carried on in the histological section model prepared by the author. The proposed method ensures determination of the specific length of stretched histological preparations with a no more than 3% error.


[Blastomycotic granuloma of the cervical spine. Report of a case]. A case of blastomycotic granuloma of the spinal cord is reported. The patient had a Brown-Séquard syndrome. He was submitted to myelography and he was underwent a cervical laminectomy. The mass was removed being lately confirmed by histology as a blastomycotic granuloma. Despite the medical treatment with Amphotericin B and physical therapy there was no improvement of the condition.


Correction of the over-projecting nasal tip by the suture technique. A simple method can be used for correctingan excessively projecting nasal tip. The technique involves suturing the anterior part of the medial crura of the alar cartilages to the posterior part of thecaudal end of the septal cartilage through a transfixion incision using permanent suture material. This technique is not applicable in cases where the integrity of the caudal end of the septum is compromised. Application of this procedure may, at times, result in an undesirable widening of the alae. In such cases, full-thickness resection of the alar bases is necessary. This method of nasal tip reduction has been used in 14 cases of rhinoplasty with a follow-up period of seven to 28 months. The results generally have been satisfactory, with few complications.


Some aspects of non-precious metal alloys for ceramic restorations. Comment is made regarding the cost, related to working properties, of non-precious metal alloys compared to precious metal alloys for ceramics and their possible potential for the production of allergic response.


Post core systems in crown and bridgework. Pulpless teeth require reinforcement if they are to act as supports for crown and bridgework restorations. Post core reinforcements can be accomplished by utilization of post core systems which offer the clinician a broad range of techniques. The mechanical procedures involved should be biologically oriented and related to stress distribution to the tooth root.


Evidence for the transmissibility of human dental caries. Strains of Streptococcus mutans, an organism strongly implicated in the aetiology of human dental caries, have been identified by means of a bacteriocin typing technique. Examination of family groups suggests that the organism can be transmitted intrafamiliarly thus supporting the notion that human dental caries is an infectious transmissible disease.


Comparison of terbutaline and salbutamol aerosols. The bronchodilator effects of terbutaline, 500 microng, and salbutamol, 200 microng, by pressurised aerosol were compared in 16 patients (eight asthma, eight chronic bronchitis with asthma). Salbutamol produced greater bronchodilatation than terbutaline for the initial hour after inhalation. Thereafter, there was no difference in action and an effective bronchodilator response was maintained by each drug for at least four hours. beta2-adrenoceptor stimulating drugs by inhalation are widely used in the treatment of asthma. The purpose of this study was to compare the bronchodilator efficacies of two of these drugs, terbutaline and salbutamol by pressurised aerosol, in patients with partially reversible airways obstruction.


Use of a computer-based postal questionnaire for the detection of hypothyroidism following radioiodine therapy for thyrotoxicosis. A computer-processed postal questionnaire was devised to detect hypothyroidism in patients treated previously for thyrotoxicosis with radioiodine. In a study of 232 patients treated with 131I at the Royal Melbourne Hospital between four and ten years previously, the sum of symptomatic answers in the questionnaire was a sensitive discriminator of hypothyroidism, and allowed 80% of euthyroid patients to be excluded from further assessment. Questions concerned with general well-being and energy, voice and skin changes, showed the highest sensitivity and specificity. The combination of these questions alone was an effective means of identifying hypothyroidism, with a sensitivity and specificity comparable to the more sophisticated technique of discriminant function analysis. Hypothyroidism had an incidence of between 20% and 35% six to eight years after 131I therapy and was related to a smaller initial goitre size for a given dose of 131I. This postal questionnaire, in conjunction with a computer-based automatic recall system, promises to be an efficient and reliable screening tool for the detection of hypothyroidism in the increasing number of patients "at risk" following 131I therapy.


Carcinoembryonic antigen in renal allograft recipients and immunosuppressed renal patients. Carcinoembryonic antigen (CEA) was estimated in plasma from 70 patients with a renal transplant, 105 patients with glomerulonephritis who had received immunosuppressive therapy, and 124 healthy controls. There were raised levels in 30% of those with a renal transplant, 10% of those with glomerulonephritis and 2% of controls, and levels were higher in current smokers. CEA levels did not correlate with pre-transplant dialysis time nor with serum creatinine levels, but tended to fall with increasing time after transplantation, especially in non-smokers. CEA levels did not correlate with prednisolone dosage nor with number of rejection episodes, after allowing for time after transplantation and smoking habit. Nine of 70 patients with a renal transplant and three of 105 with glomerulonephritis had cancer, of skin in seven, cervix uteri in four, and colon in one. CEA was raised in all four transplant recipients with a visceral cancer (cervix three and colon one), but in none of the five with cutaneous cancer. Raised CEA levels occurring late after a renal allograft should prompt a careful search for visceral cancer.


Proline excretion in Escherichia coli: a comparison of an argD+ strain and a proline-excreting argD- derivative. In an attempt to deduce the physiological basis of proline excretion in argD- strains of Escherichia coli K12, several properties of an argD+ (nonexcreting) and an argD- (excreting) derivative were compared. No difference was found in the transport or in the utilization of either proline or its immediate precursor, delta1-pyrroline-5-carboxylate (PCA). Furthermore, no differences were found in the physical or kinetic properties of partially purified preparations of the enzyme mediating the final step in proline biosynthesis, PCA reductase. The specific activity of PCA reductase was, however, consistently higher in crude extracts prepared from the argD- mutant.


The Dillon Beach Project--a five-year epidemiological study of naturally occurring salmonella infection in turkeys and their environment. A 5-year epidemiological study of naturally occurring salmonella infection 2 basic strains of turkeys and their environment was completed. Multiple generations of these turkeys, free from salmonella infection, were raised on a new commercial breeding ranch (the Dillon Beach Ranch) in California during a 31/2-year period. Eight salmonella serotypes eventually gained access to the ranch. Egg transmission and prior contamination of the premises were ruled out as the source of these infections. The most likely means of their introduction was physical transport into the ranch by contaminated feed, personnel, and/or equipment. Several serotypes of salmonella were isolated from pelleted feed delivered to the ranch, demonstrating its role in introducing infection. The low isolation rate from feed samples and environmental samples taken from many buildings indicates the need for intensive sampling as a reliable indicator of infection. The most severe and consistently detected infection occurred in young birds grown in forced-air-ventilated buildings. A total of 17,858 bacteriological cultures representing about 102,756 environmental, feed, and bird samples, and 93,930 serological tests on 46,977 serum samples, were run during the study.


The dissociation of sigma-factor from ribonucleic acid polymerase. The sigma-factor of Escherichia coli RNA polymerase was shown to dissociate from the core enzyme as a function of absolute concentration. The association constant is in the range 10(6)-10(8) litre/mol. This implies that the amount of holoenzyme, core enzyme and sigma-factor in RNA polymerase assays may vary according to the absolute concentration of the enzyme.


The absorption of protons with alpha-methyl glucoside and alpha-thioethyl glucoside by the yeast N.C.Y.C. 240. Evidence against the phosphorylation hypothesis. 1. When yeast N.C.Y.C. 240 was grown with maltose in a complex medium based on yeast extract and peptone, washed cell preparations fermented alpha-methyl glucoside much more slowly than maltose. 2. The yeast absorbed alpha-methyl[14C]glucoside from a 10mM solution in the presence of antimycin and iodoacetamide, producing [14C]glucose, which accumulated outside the cells. The yeast itself contained hexose phosphates, trehalose, alpha-methyl glucoside and other products labelled with 14C, but no alpha-methyl glucoside phosphate. 3. About 1 equiv. of protons was absorbed with each equivalent of alpha-methylglucoside, and 1 equiv. of K+ ions left the yeast. 4. alpha-Thioethyl glucoside was also absorbed along with protons. Studies by g.l.c. showed that the yeast concentrated the compound without metabolizing it. 5. The presence of trehalose, sucrose, maltose, L-sorbose, glucose or alpha-phenyl glucoside in each case immediately stimulated proton uptake, whereas fructose, 3-O-methylglucose and 2-deoxyglucose failed to do so. 6. The observations support the conclusion that alpha-thioethyl glucoside, alpha-methyl glucoside and maltose are substrates of one or more proton symports, whereas they seem inconsistent with the notion that the absorption of alpha-methyl glucoside involves the phosphorylation of the carbohydrate [Van Stevenick (1970) Biochim. Biophys. Acta 203, 376-384].


Bone marrow transplantation in patients with gold-induced marrow aplasia. Aplastic anemia is a rare but usually fatal complication of gold salt therapy for rheumatoid arthritis. This report describes 3 patients who developed aplastic anemia while receiving gold salts, and a fourth patient who developed aplastic anemia after receiving gold and then cytotoxic agents. These patients failed to respond to conventional therapy for aplastic anemia and subsequently received bone marrow transplants from HLA-matched siblings. Engraftment occurred in all 4 patients. One patient is alive 2 years after transplantation, and 3 patients died of complications following transplantation.


[Piprozoline in clinical trials (author's transl)]. The tolerance and efficacy of ethyl (Z)-(3-ethyl-4-oxo-5-piperidino-thiazolidin-2-ylidene) acetate (piprozoline, Gö 919, Problin) were investigated in open and controlled clinical trials involving a total of 1545 patients and 1807 courses of therapy. The objective of this paper is to compare the experimental findings, some of which have already been published, with the results of the extensive clinical investigations. Despite the well-known problems associated with obtaining precise data on upper abdominal disorders, the evaluation of the available comprehensive clinical data has shown that probiline possesses definite therapeutic benefits confirming the experimental findings. Individual complaints such as bloating, upper abdominal pressure, meteorism and flatulence, nausea and vomiting, constipation, anorexia, and fat intolerance improved significantly under probiline therapy. Taking all the criteria into consideration, the overall results of the studies with probiline versus placebo in patients with gall-bladder diseases and intestinal disorders have proved that this choleretic substance is of therapeutic benefit. Serum bilirubin and alkaline phosphatase showed a significantly greater tendency to return to normal levels under probiline therapy than with placebo. The majority of conditions treated were of biliary origin. Aside from establishing the drug's therapeutic profile, the data published also show that the rate of side-effects was insignificant.


A new centrally action antihypertensive agent guanfacine (BS 100-141). In 21 patients with essential hypertension, all of whom completed the study, marked reductions in systolic and diastolic blood pressure were achieved under therapy withN-amidino-2-(2,6-dichlorophenyl)-acetamide hydrochloride (guanfacine, BS 100-141) administered 3 times daily in small to medium, gradually increasing doses. The lowest daily dose was 1 mg, the highest 10 mg, the average being 4 mg. Despite the low initial dosage and subsequent slow progression--designed to keep side effects within limits--BS 100-141 had a rapid and significant antihypertensive effect on both systolic and diastolic blood pressure. Habituation, with consequent loss of effect, was not observed. Laboratory parameters did not change, although blood sugar was reported to have shown a general tendency to rise in the study. Renal function and electrolytes remained normal. This new anithypertensive should probably be classified, as regards efficacy, alongside clonidine and methyldopa; it would also seem to be about as well tolerated as these two compounds. In order to prevent side effects, a gradually increasing low-dose regimen is recommended.


Quantitative structure-activity relationships. V. A simple simple algorithm for Fujita-Ban and Free-Wilson analyses. For quantitative structure-activity analyses a simple algorithm for the calculation of de novo group contributions by Fujita-Ban analysis is given. This algorithm corresponds in all details to a computer program for linear multiple regression analysis. However, the transformation of the original matrix to the normal equations matrix is easily achieved without a computer. The normal equations matrix can be solved with a modern desk calculator being equipped with a matrix ROM. Two examples are given to explain the algorithm; the calculation of all important statistical parameters is illustrated. As for quantitative structure-activity analyses this algorithm can be applied as well for the calculation of other additive parameters, such as pi from log P-values or omega from equilibrium constants.


[Double-blind long-term study on a combination of tetracycline, theophylline, doxylamine succinate, etafedrine, phenylephedrine and guaifenesine in chronic bronchitis (author's transl)]. The investigations presented were undertaken to find out whether a long-term treatment of chronic bronchitis with a combination of tetracycline, theophylline, doxylamine succinate, etafedrine, phenylephrine and guaifenesine could reduce the frequency of recurrent infections of the respiratory system. Out of 57 patients who all had suffered from at least one exacerbation in the year preceding the trial only 12 showed clinical signs of an ixacerbation during the study. 12 exacerbations occurred during the placebo phase, 6 during the treatment with Ditenate Tetra. It is specified why such a long-term treatment with an antibiotic should be reserved only for patients who are especially endangered by the exacerbation. The results of numerous microbiological investigations of sputa, nose and throat swabs before and during the long-term study are interpreted under certain aspects and questioning.


[Treponemal hemagglutination test (TPHA). Validity of the micromethod using dilutions of sera 1/20-1/40]. The Authors studied the possibility to use, for the carrying out of the TPHA micromethod, higher serum dilutions, as preliminary investigations had pointed out an insufficient sensitivity of the reaction performed at the 1:80 - 1:160 dilutions, particularly in the primary-secondary phase of the luetic infection. The Authors controlled, preliminarily, that at the dilutions studied, no unacceptable increase of spontaneous hemagglutinations and false positive reactions took place in the test sera. The investigation stressed the acceptability of the methodological modification set forth.


[Detection of hepatitis B antigens by use of the immunoenzymatic method (ELISA)]. The Authors investigated HBs antigen with an immunoenzymatic method (E.L.I.S.A.) in the sera of RIA and I.H. HBsAg positive hepatitis patients, in the sera of RIA and I.H. HBsAg-negative hepatitis patients and in those of normal subjects. E.L.I.S.A. test supplied results almost superposable to those obtained by RIA and therefore it seems worthy to be included among the most reliable techniques to detect hepatitis B surface antigen.


Leukocyte inhibitory factor (LIF) production from lymphocytes stimulated by leucogenenol. It has been demonstrated that human peripheral lymphocytes incubated in a tissue culture medium containing 0.04, 0.1, or 0.15 microgram/ml of leucogenenol form or release a factor that inhibits the migration of human peripheral PMN leukocyte. The factor is chromatographed of Sephadex G-100 and migrates on electrophoresis as an albumin, thus suggesting that it has the electric charge of an albumin. The factor is stable to neuraminidase and to heating at 56 degrees C for 30 min, but it is inactivated by heating at 80 degrees C for 60 min. Its physical and biological properties suggest that the factor is identical to the LIF reported by Rocklin.


Localization of carcinoembryogenic antigen (CEA) in normal, inflammatory and neoplastic colonic mucosa by immunofluorescence. To evaluate the role of tissutal carcinoembryonic antigen (CEA) in different types of colonic mucosae specimens from normal, inflammatory and neoplastic tissues were examined in immunofluorescence (IFL) with a monospecific CEA antiserum. Neither the pattern of IFL nor the amount of antigen in the tissue (defined as the antiserum dilution beyond which CEA staining was no longer visible), could reliably distinguish any histological entity a consistent overlap being observed between positive and negative results in malignant and non malignant mucosa. No correlation was found betwen IFL and the level of serum CEA. It is concluded that the tissutal localization of CEA by immunohistochemistry plays no role in the differential diagnosis of different types of colonic mucosa.


[Effect of sera from patients with Graves' disease on the E-rosette function of normal lymphocytes]. Sera from 9 of 12 patients with untreated Graves' disease were able to inhibit E-rosette function of T lymphocytes collected from peripheral blood of normal donors. In the same sera thyroid antibodies were detected.


In vitro effect of insulin on peripheral T-lymphocyte E-rosette function from normal and diabetic subjects. Juvenile-onset diabetics (JOD) have a significantly low peripheral T-lymphocyte count. In vitro exposure of diabetic lymphocyte cultures to insulin causes a significant T-cells count increase and thereafter no significant difference is detectable among JOD, maturity-onset diabetics (MOD) and normal subjects (NS) T-cells counts. This finding supports the hypothesis that the T-lymphocyte depressed function present in JOD is a secondary phenomenon due to in vivo insulin deficiency. Possible mechanisms of insulin action in restoring E-rosette function are discussed.