Synthesis and analgesic activity of 1,3-dihydro-3-(substituted phenyl)imidazo[4,5-b]pyridin-2-ones and 3-(substituted phenyl)-1,2,3-triazolo[4,5-b]pyridines. In a study of nonsteroidal antiinflammatory and analgesic agents, a series of 1,3-dihydro-3-(substituted phenyl)imidazo[4,5-b]pyridin-2-ones-and 3-(substituted phenyl)triazolo[4,5-b]pyridines was prepared. Many of the imidazolones were alkylated on the free nitrogen. In a modified Randall-Selitto analgesic assay, the pain thresholds of both the inflamed and normal foot were elevated. This is not commonly observed with nonsteroidal antiinflammatory agents. The most active compounds were 1,3-dihydro-3[3,4-(methylenedioxy)phenyl]imidazo[4,5-b]pyridin-2-one (I-15) and its N-allyl (I-21) and N-isopropyl (I-121) derivatives. In the triazole series the 3-(2-fluoro- and 2,4-difluorophenyl)triazolo[4,5-b]pyridines (T-1 and T-8) were the best. The imidazole compounds were somewhat superior in analgesic activity to codeine and d-propoxyphene without showing any narcotic characteristics. Some of the compounds also possessed activity against carrageenan-induced foot edema in the rat, so these compounds represent a new class of nonnarcotic analgesic antiinflammatories, capable of producing a greater degree of analgesia than that obtainable with other nonsteroidal antiinflammatory agents.


Protease inhibitor profile of black Americans with and without chronic cardiopulmonary disease. An epidemiologic study of protease inhibitor (alpha(1)-antitrypsin) was undertaken among 599 ambulatory and hospitalized black American patients with chronic cardiopulmonary disease referred for pulmonary function testing, and 115 ethnically matched, healthy control subjects. Clinical evaluation consisted of respiratory questionnaire completion, physical examination, chest radiograph, and spirography. Protease inhibitor evaluation consisted of measurement of serum trypsin inhibitory capacity in all subjects corrected by comparison with control sera, while 200 of these subjects were phenotyped for alpha(1)-antitrypsin electrophoretic variants.Results showed mean serum trypsin inhibitory capacity for all subjects was 1.56, SD ± 0.47 mg/ml, while corrected values were 111.2, SD ± 30.5 percent of control. Acute phase reactivity was present for patients with heart disease, pulmonary malignancy, p<0.01 for both, and pulmonary fibrosis, p<0.05, when compared with controls. Prevalence of protease inhibitor variants in 29 controls was two heterozygotes for the Z variant (seven percent), and one homozygote for the S variant. Among 94 patients with chronic obstructive pulmonary disease, prevalence was 1.1 percent each for ZZ and SZ phenotypes, and 2.1 percent for MZ. Suprprisingly, the sole ZZ patient had asthmatic bronchitis rather than emphysema.Computed allele frequencies for Pi M and Z were comparable to those for a random sample of black Americans in St. Louis, but differed from a sample of black infants in Brooklyn, NY.These results indicate that protease inhibitor deficiency variants are not as uncommon among black Americans as the literature suggests. Furthermore, the heterozygous state is not necessarily a risk factor in development of chronic obstructive pulmonary disease. Protease inhibitor deficiency states therefore appear to play less important a role in etiology of chronic cardiopulmonary disease in black Americans than among their Caucasian counterparts.Preliminary work was published in abstract form.(1)


Inhibitory effects of cations on the Ca2+ response of water fibers in the frog tongue. The effects of various cations on water fibers in the frog (Rana catesbeiana) tongue were investigated. The following results were obtained. 1. Water fibers responded well to Ca2+ and Sr2+. 2. SO2-(4) did not inhibit the Ca2+ response. Cl- at high concentrations had an inhibitory effect on the response to high Ca2+ stimulation. However, when the Ca2+ concentration was low, Cl- did not induce any inhibition. Therefore, low Ca2+ stimulation (0.1 mM CaCl2) was used to examine the inhibitory effect of cation. 3. MgCl2 and MgSO4 strongly inhibited the response to low Ca2+ stimulation. The inhibition by Mg salts was not caused by anion but by Mg2+. 4. The Ca2+ response was inhibited by various cations. The order of the inhibitory effects of cations was as follows: La3+ greater than Mn2+ = Mg2+ greater than or equal to Ni2+ greater than Co2+ greater than monovalent cations (Na+, K+, NH4+ and choline+). 5. The Sr2+ response, as well as the Ca2+ response, was inhibited by Na+ and Mg2+.


Retinoic acid stimulation of the induction of mouse killer T-cells in allogeneic and syngeneic systems. The ability of retinoic acid (RA), a potent antitumor agent, to stimulate cell-mediated cytotoxicity (CMC) in mice was investigated. Low doses of RA (5-300 micrograms/mouse/day) administered ip into C57BL/6 mice for 5 days daily or for 1--3 months three times a week before immunization in vivo or in vitro with allogeneic BALB/c S194 myeloma cells led to an enhanced cytotoxic activity of their spleen effector cells. Similarly, in a syngeneic situation injection of RA into C57BL/6 or BALB/c mice before in vitro challenge with EL 4 (C57BL/6) or S194 (BALB/c) tumor cells strongly stimulated CMC. The enhanced cytotoxic activity was effected by thymus-derived lymphocytes (T-cells) and specific for the H-2 histocompatibility antigens in the case of the allogeneic sensitization or specific for tumor antigens in the case of the syngeneic sensitization. Because RA had no effect on the effector step of CMC, RA likely enhanced the induction step of T-CMC. The action of RA was antigen-dependent, and it is therefore a true adjuvant rather than a nonspecific stimulator or polyclonal activator of cytotoxic T-cells.


Pneumocystis pneumonia: a plague of the immunosuppressed. Pneumocystis carinii pneumonitis is a diffuse bilateral alveolopathy encountered in the immunocompromised host with cancer, a congenital immune deficiency disorder, an organ transplant, severe protein-energy malnutrition or recipients of immunosuppressive therapy for other conditions. The onset is abrupt with fever and tachypnea. No rales are heard and the roentgenogram reveals a diffuse alveolar disease. Once the pneumonitis is evident, the infection is usually fatal if no treatment is given. The diagnosis is best established by the demonstration of the causative organism in specimens obtained by open lung biopsy, or other invasive methods, and stained with Gomori's methenamine silver nitrate, toluidine blue O or polychrome stains. Of the two drugs available for treatment, trimethoprim-sulfamethoxazole is preferred over pentamidine isethionate because of relative difference in adverse effects. With either drug the recovery rate is about 75%. The infection can be prevented in high risk patients by the administration of trimethoprim-sulfamethoxazole prophylactically.


Mitogens for murine embryo cell lines.

Mitogens for murine embryo cell lines. The growth-promoting activities of fetal bovine serum, cortisol, phorbol myristate acetate, prostaglandin F2alpha, insulin, epidermal growth factor, and fibroblast growth factor were evaluated on four murine embryo cell lines (Swiss 3T3, Balb 3T3, M2, and C3H10T 1/2). Each cell has an unique response spectrum to this collection of reported mitogens. Phorbol myristate acetate and prostaglandin F2alpha were active only on selected cell lines; cortisol was inactive on all four lines. Serum, epidermal growth factor, and fibroblast growth factor were able to stimulate cell division in all four lines, albeit to varying degrees for the different target cells.


Regulation of hemopoietic cell differentiation and proliferation. Differentiation and proliferation of almost all hemopoietic cell lines can now be studied in vitro. Cloning techniques and suspension cultures allow the study of proliferation of the multipotential hemopoietic progenitor cell and the committed progenitors for granulocytes, macrophages, eosinophils, megakaryocytes, and erythrocytes. The proliferation of each of the committed progenitor cells is controlled by specific glycoproteins and two of these have recently been purified: granulocyte-macrophage colony-stimulating factor (GM-CSF) and erythropoietin. The rate of proliferation of the GM-progenitor cells and their pattern of differentiation depends on the concentration of the hormone. At low concentrations of GM-CSF (10(-11) M) fewer progenitor cells are stimulated and macrophage colonies rather than granulocyte colonies develop. The change in the direction of granulocyte-macrophage differentiation appears to be related to a) the concentration of GM- CSF and b) the different sensitivity of a subpopulation of monocyte colony-forming cells which are responsive to GM-CSF even at low concentrations of the regulator. Analysis of the rate of RNA synthesis by bone marrow cells has shown that GM-CSF stimulates the mature nondividing end cells of differentiation (ie, polymorphs) as well as the progenitor cells. Although GM-CSF and erythropoietin have been radiolabeled, binding studies have been hampered by the loss of biologic activity during the labeling procedure and the heterogeneity of the target cells to which the regulators bind. Surface proteins and receptors for erythrocytes have been well characterized but the relationships between these proteins and the cell surface proteins of nucleated blood cells is not well understood. It appears that some proteins are lost from the cell surface during the development of granulocytes, which are retained on the surface of the B lymphocyte. Other proteins such as chemotactic receptors and complement receptors only appear on the mature cells. External radiolabeling of the granulocyte surface using iodogen yielded a simple profile of 125I-labeled proteins when analyzed by sodium dodecyl sulphate polyacrylamide gel electrophoresis.


Selective arterialization of the coronary venous system. Encouraging long-term flow evaluation utilizing radioactive microspheres. The long-term effectiveness of a retrograde coronary venous bypass graft (CVBG) to an ischemic left ventricle was evaluated in 18 dogs. A saphenous vein was interposed between the aorta and left anterior descending (LAD) vein. The LAD vein was ligated cephalad to the CVBG to prevent an arteriovenous fistula. The LAD artery was ligated at its origin to create anterior wall ischemia. Operative graft flow averaged 53 ml. per minute. The 14 surviving dogs were catheterized 3 to 5 months later. Ten of the 14 CVBG's were patent angiographically. The chests were opened and graft flow now averaged 50 ml. per minute. 141Ce microspheres were injected into the left atrium to measure myocardial flow to the anterior wall. In the 10 dogs with patent grafts, transmural flow was 39 +/- 1 (S.E.M.) ml. per 100 Gm. of tissue per minute. The endocardial/epicardial flow ratio was 1.4/1, indicating that retrograde venous perfusion effectively delivered blood to the subendocardium. After ligation of the CVBG, microsphere measured flow dropped to 15 +/- 1 ml. per 100 Gm. per minute. In 15 control dogs, anterior wall flow was 100 +/- 3 ml. per 100 Gm. per minute, decreasing to 13 +/- 2 ml. 45 minutes after ligation of the LAD artery and vein. None of the eight control dogs with simple ligation of the LAD artery and vein survived more than 5 days. Histologic examination of the anterior wall of the left ventricle, the area served by the CVBG's for 3 to 5 months, disclosed no evidence of venous sclerosis or thrombosis and no evidence of interstitial edema or hemorrhage. Thus a CVBG permitted long-term survival in an otherwise nonviable anatomic preparation. Moreover, restoration of flow with a CVBG was effective because it perfused all layers of the myocardium, especially the subendocardium--the crucial layer of myocardial muscle.


Regional myocardial dimensions following coronary artery bypass grafting in patients. Relationship of functional deterioration to graft occlusion. The direct relationship between graft flow and regional midwall myocardial function has not been documented in patients. Therefore, the present study was designed to quantitate the effects of coronary artery bypass grafting on regional myocardial mechanics distal to a coronary artery obstruction. Twenty-one patients with subtotal or total occlusion of the left anterior descending (LAD) coronary artery underwent coronary artery bypass grafting. Following completion of the aortic and coronary anastomoses, two miniature ultrasonic dimension transducers (2.5 mm. diameter) were positioned within the minor axis of the anterior left ventricular free wall and were allowed complete freedom of movement. The transducers were placed at midwall depth, and areas of clinically apparent myocardial fibrosis were not utilized as sites of implantation. During control, 30 minutes following the termination of cardiopulmonary bypass, regional myocardial dimensions, pulmonary artery diastolic pressure, arterial pressure, and heart rate were recorded with all saphenous vein grafts open and after 30 seconds of single vein graft occlusion. These measurements were repeated during atrial pacing at a rate of 128 +/- 4 beats per minute. Data are mean +/- the standard error of the mean. During control, graft occlusion resulted in a regional decrease in systolic excursion from 1.3 +/- 0.1 to 1.0 +/- 0.2 mm. (p less than 0.01), as well as a decrease in the rate of shortening from 8.7 +/- 0.2 to 6.2 +/- 1.1 mm. per second (p less than 0.05); heart rate, mean arterial pressure, and diastolic pulmonary artery pressure remained unchanged. Graft occlusion with atrial pacing resulted in an exaggerated decrease in both regional systolic excursion, from 1.2 +/- 0.2 to 0.6 +/- 0.2 mm. (p less than 0.01), and rate of shortening, from 9.4 +/- 1.5 to 4.4 +/- 0.2 mm. per second (p less than 0.01). For the group of patients studied, end-diastolic lengths were unchanged with graft occlusion during control and atrial pacing. Moreover, with graft occlusion, isolated patients demonstrated regional dyskinesia as evidenced by holosystolic bulging. These studies in patients have documented for the first time that, despite a constant preload, afterload, and heart rate, regional myocardial function following coronary artery bypass grafting is dependent upon adequate graft flow, especially during stress.


Left ventricular aneurysm. Preoperative risk factors and long-term postoperative results. The results of operative treatment of postinfarction left ventricular aneurysm in 169 patients undergoing operation since 1970 are analyzed in this report. Maximum follow-up extended to 7 year (average 2.9 years). Average patient age was 56 years (range 34 to 82 years). Nearly all patients (94%) had left anterior descending coronary artery disease with anterior aneurysm formation and 73% had multivessel disease. Sixty-eight percent of patients underwent aorta-coronary bypass grafting (ACBG) and/or mitral valve replacement (MVR) concomitantly with aneurysmectomy. The over-all operative mortality rate was 17.8%. Preoperative factors that correlated significantly (p less than 0.05) with increased operative risk reflected primarily the quality of left ventricular function, and included functional classification, cardiac index, contractile function of residual myocardium not involved by aneurysm, and mitral regurgitation. Patients whose primary preoperative disability consisted of angina pectoris (42 patients) exhibited significantly higher over-all survival rates (actuarial 5 year survival 75%) than those undergoing operation because of congestive heart failure (86 patients) or ventricular tachyarrhythmias (38 patients), whose 5 year survival rates were 52 and 57%, respectively. Concomitant ACBG (+/- MVR) was associated with a higher operative mortality rate than aneurysmectomy alone (21.1 versus 10.9%), but late postoperative attrition was similar. The over-all 5 year survival rate, including operative death, was 60%, and 90% of surviving patients were in Functional Class I or II at follow-up evaluation. We conclude from this analysis that the long-term prognosis of patients with symptomatic postinfection left ventricular aneurysms, although determined importantly by preoperative left ventricular function, is enhanced by surgical treatment.


Regional myocardial shortening in relation to graft-reactive hyperemia and flow after coronary bypass surgery. Extent of regional shortening of myocardium in areas newly perfused by bypass grafting was determined in 56 patients by a new technique employing four to six radiopaque markers sutured in pairs to the epicardium near the coronary anastomosis. Paradoxical systolic expansion (PSE) was manifest in 16 regions (a 12% incidence) during the follow-up period, and six of these showed spontaneous remission. All cases of PSE were in the region of the left anterior descending artery. Correlation between graft flow measured during operation and regional shortening during the postoperative period revealed that the development of PSE could not be predicted from the hemodynamic measurements. In the majority of cases postoperative myocardial infarction could also be excluded as an explanation. At 1 year after operation most grafts were patent in PSE regions but collaterals, apparent preoperatively, could not be visualized. Excluding PSE, shortening fraction (ratio of shortening to maximum marker separation) for all graft regions at 1 week was 9.8%; 1 month, 12.8%; 3 months, 13.3%; and six months, 13.9%. Average graft flow was 56 ml. per minute and average reactive hyperemia was 25% with 37% of grafts showing no response. For those regions that did not develop PSE there was a positive correlation between shortening fraction and flow that became significant (null hypothesis: r = 0) when reactive hyperemia exceeded 20%. Correlation was greatest at 1 week and 1 month, but became nonsignificant at 6 months. These results are consistent with a simple interpretation of reactive hyperemia: Graft-reactive hyperemia is related to the dependence of viable tissue on the functioning of the graft.


[About rupture and lesion of the labyrinthine windows (author's transl)]. After the extensive discussion of the last published literature on the different possibilities of a lesion of the labyrinthine windows, four own cases are discussed. In case of a typical anamnesis of single patients with sudden deafness after sudden exertion or trauma prior to onset the surgical exploration is recommended. It is concluded that spontaneous labyrinthine window ruptures must be added to the etiologic factors in sudden hearing loss.


Third stage management: how important is it? The normal physiology of the third stage of labour and the effect of oxytocics at the end of the second stage have been discussed. An assessment of the results of different policies of third stage management has been made, including a comparison of the advantages and disadvantages of the traditional method versus the use of controlled cord traction. It is recommended that ergometrine (0.25 mg) be administered intravenously after delivery of the baby, and the exclusion of a second twin. Once the uterus has contracted the placenta should then be delivered by the technique of controlled cord traction.


Clinical analysis of colour vision deficiencies with The City University test. The City University colour vision test (CUCVT) was used for the examination of 158 subjects suffering from congenital colour vision defects (36 protanopes, 122 deutanopes) and its results were compared with that of an anomaloscope and of the panel D-15. 23% of the subjects classified as protanopes and 98% of the subjects classified as deuteranopes by means of the anomaloscope were also classified as such by means of the CUCVT, while 93% of the subjects classified as protanomalous and 90% of the subjects classified as deuteranomalous by means of the anomaloscope gave normal answers at the CUCVT. The results of the CUCVT were almost the same as with panel D-15 except protanopia. The colour spots of each plate of the CUCVT were plotted on a CIE chromaticity diagram and the results of this study are also reported.


Clinical experience with the Lovibond Colour Vision Analyser. Results from the examination of normal and congenital colour-deficient subjects. The Colour Vision Analyser was used for testing 98 persons of both sexes, aged from 10 to 70 years, and recognized as normal by means of pseudo-isochromatic plates and an anomaloscope. A drop of the saturation thresholds from yellow to green and from blue to purple was observed from the age of 40 years. The saturation thresholds from yellow to green was found lower in every age group than that from blue to purple. Congenital colour defects could be completely distinguished from normal subjects. As for the classification in types, those diagnosed as deutan by means of the anomaloscope were also diagnosed as deutan by the Analyser, however, there were, among those diagnosed as protan by the anomaloscope, some subjects who were diagnosed as deutan by the Analyser. Nearly all cases could be classified as anopia or anomaly.


Temporal variations in anomaloscope equations. Temporal variations in the value of blue/green derived from the equation: 'Blue' + 'Green' = 'Cyan' + 'Yellow', seem to be of two kinds. Those found in a cross-sectional study of 167 normal eyes in the age range 13--83 years could be attributed to progressive changes in lens absorbance. Individual cyclic variations in short-term (12 h) and long-term (11 months) longitudinal studies could not be attributed to the lens.


Flicker fusion thresholds of red-green dichromats. Measurements of the relative energies required for critical flicker fusion (CFF) at each of 14 wavelengths were obtained in normal, protanopic, and deuteranopic observers. Normals required more energy beyond 580 nm in going from 30 to 40 flashes per second than protanopes or deuteranopes. This suggests an adaptational collapse of the red-sensitive mechanism of normals which is not present in the red cones of deuteranopes or the green cones of protanopes over the same intensity range.


Incomplete achromatopsia in Bishnupur.

Incomplete achromatopsia in Bishnupur. Nine males and 2 females from the Shankhabanik Community in Bishnupur, provisionally diagnosed as incomplete rod achromats by Bose, Joardar and Sukul in 1968, with 2 new similar males, were tested more fully with six colour vision tests. All had photophobia, nystagmus of fixation, extremely low visual acuity and extreme loss of colour sense with shortened red spectrum. 40 other males and 24 females, relatives of the defectives, were also tested for comparison. The provisional diagnosis was confirmed, and the hypothesis of autosomal inheritance seemed most probably true. Various details about the relatives emerged.


Further observations on the extramacular chromatic mechanisms. Monochromatic targets presented at 30 degrees excentricity on orange, magenta and blue backgrouds are used. A small monochromatic light, 476 nm on orange, 551 nm on magenta and 621 nm on blue, is flashed at 3 cps-1 on the centre of the targets. The size of the targets is varied and their luminance adjusted using neutral filters until the flashing light is just not visible. This method allows the study of chromatic mechanism sensitivity and of retinal interactions (summation and inhibition). Some observations in normal as well as in pathological conditions are presented.


Acquired 'tritan' deficiencies in macular pathology. 14 patients with maculopathy (18 eyes affected, 10 eyes clinically normal) were examined using the HRR plates, the Farnsworth F2 (tritan) plate, the Farnsworth panel D15 test, the Nagel anomaloscope (model I) and on a 'blue-green' equation for 2 degrees and 11 degrees fields on the Moreland anomaloscope. The correlation of tritan-like responses to each test and the differences between the 2 degrees and 11 degrees equations are discussed.


Color matching and Stiles-Crawford effect in central serous choroidopathy. Color matching and Stiles-Crawford effect measurement were performed in 3 patients with central serous choroidopathy, 2 normal and 1 deuteranomalous trichromats. The color matches in the affected eye of each patient were displaced to red and could be explained by the hypothesis that the visual photopigments are in reduced optical density due to receptor disorientation caused by serous elevation of the sensory retina. The Stiles-Crawford effects of the affected eyes was abnormal confirming the hypothesis of receptor disorientation. The type III color defect accompanied by pseudo-protanomaly ascribable to receptor disorientation as occurs in central serous choroidopathy may be differentiated from the type III defect without pseudo-protanomaly.


Electroretinography as a diagnostic test in colour vision deficiencies. Colour vision defects were studied with an adapto-electroretinogram and with computer of average transients. ERG abnormalities were observed in achromatopsia, protanopia and protanomaly, which in deuteranopia and deuteranomaly the ERG was normal.


Diabetic retinopathy and colour discrimination under various illuminants. 25 patients suffering from diabetic retinopathy, examined with the aid of 100-hue test, show an acquired tritan-like deficiency. Colour discrimination impairment is found to run parallel to visual acuity deterioration. When tested under illumination produced by an Hg source, relatively poor of energy in the short wavelength range, an improvement in colour discrimination (decrease in total score) compared to C illumination is found.


Psychophysical flicker thresholds and ERG flicker responses in congenital and acquired vision deficiencies. Psychophysical flicker thresholds and ERG flicker responses were compared with Farnsworth's 100-hue colour test data in cases of congenital and acquired vision deficiences. The results, evaluated in term of sensitivity and specificity lead to some practical and theoretical suggestions. In most cases, flicker responses and colour tests results were better than other classical tests for evaluating the first signs or gravity importance of a macular disturbance. Relatively minor differences between the 3 tests may be related to the observed or supposed extension of lesion in the macular area, but in some cases the observed functional changes can be understood only by admitting some lateral effect from one area to another. Generally acquired colour differences are associated with flicker response changes. In congenital red-green blindness of different gravity, moderate abnormal white light flicker responses could be observed. But they do not seem to be associated clearly with a type and gravity of the deficiency. With coloured stimuli, the difference between normal and red-green colour-blindness is more clear-cut, and red-blind can be discriminated from green-blind. Subclinical retinal pathology as well as specific stimulus conditions in normal and red-green colour-blind subjects reveal some non-linear processes in the low-frequency range of the temporal attenuation characteristics.


Central representation of colour vision deduced from studies on a subject with a central colour vision defect. M.W.'s grossly defective responses to red light stimuli are caused by an abnormality of central vision which is highly specific in its action. The abnormal activity does not affect stereoscopic function and only partially modifies the parametric characteristics of the contrast threshold elevation effect. These experimental observations lend support to the concept of parallel processing of different attributes of the visual stimulus, possibly by different cortical areas. We suggest that understanding of central visual processes could be facilitated by further studies on subjects with malfunction of the visual cortex.


[Differential diagnosis between third-ventricle neoplasms and tumors of the posterior fossa based on clinical manifestations and results of contrast radiograms of the brain]. Differential diagnosis in the material was based on the neurological and radiological findings made in 45 patients with third-ventricle tumours and 133 with subtentorial tumours. No clinical syndrome has been found which could help in reliable diagnosis concerning either of these locations of the tumour. Of decisive significance for the correct localization of tumours was ventriculography which established the diagnosis in 42 cases of third-ventricle tumours and 103 cases of subtentorial tumours. The most difficult problem was recognition of the relation of the subtentorial tumours to the brain stem since this relation could not be indicated unequivocally neither by clinical findings nor by radiological examination. This required surgical revision of the posterior fossa in most cases with suspected brain stem tumours.


[Intraventricular extravasation of contrast media through ruptured intracranial aneurysm--report of two cases (author's transl)]. Extravasation of contrast media through ruptured intracranial aneurysm has been reported as an unusual case. Among the reported cases, a ventricular opacification is very rare, and in such cases, the prognosis is worst. In this paper, two cases with an aneurysm bleeding into the ventricular system were reported. Case 1. A 37-year-old woman was admitted because of severe headache and disturbance of consciousness. On admission, she was deeply comatose with decerebrate rigidity. Carotid angiogram taken 2 hours and 30 minutes after the attack revealed an aneurysm of the anterior communicating artery and an extravasation of contrast media into the lateral ventricle. Although a continuous ventricular drainage was instituted immediately, the patient died after five days. Case 2. A 33-year-old man suddenly developed severe headache with subsequent loss of consciousness. Two hours after the onset, the patient was admitted in comatose state. Angiography taken 3 hours after the attack demonstrated an aneurysm of the anterior communicating artery. The posterior horns of the lateral ventricles were opacificated. The patient died after 24 hours. In case 1, it was interesting that a remarkable stenosis of the cisternal portion of the internal carotid artery was demonstrated at the 2nd carotid angiography (lateral view), but the third carotid angiography taken after the continuous ventricular drainage showed a complete recovery from the stenosis. This stenosis was supposed to be caused by a compression of the internal carotid artery against the interclinoid ligamentum. Moreover, a rapid enlargement of the aneurysm was noticed by repeated angiography.


[Giant basilar aneurysm--a case report (author's transl)]. A case of a giant aneurysm arising from the basilar artery is presented. The patient a 41--year-old female, had recent memory disturbance, miscalculations and hemiparesis on admission. Vertebral angiograms displayed a giant aneurysm measuring approximately 66 mm in diameter arising from the basilar artery, a tortuous vertebral artery, an extremely dilated basilar artery and an agenesis of the left carotid artery. Due to the enormous size of the aneurysm and its location in the deep intracranial portion, radical surgery was abandoned. Six months following her discharge, she died. At autopsy, the giant aneurysm arising from the top of the basilar artery was found, existing just beneath the third ventricle and extending to the left basal ganglia. The lateral ventricle, the third ventricle and the Sylvian fissure were filled by hematoma resulting from the rupture of the aneurysm. It is possible that this giant aneurysm could be considered a vascular anomaly, and hence be distinguished from saccular aneurysms.


How should one investigate the posterior fossa? The case notes of 170 consecutive patients with a suggestive clinical history, or a proven final diagnosis of a posterior fossa lesion have been analyzed in order to determine the precise value of each radiological investigation. All had had CT scans. The patients have been grouped clinically according to their presenting signs and symptoms. The analysis suggests some well-defined regimes of investigation and indicates the successes and failures of radiology.


Computed tomography for small acoustic neuromas. The minimal size of acoustic neuromas detectable by computered tomography (CT) is, according to the available literature, 1.5 to 2 cm. The new otoneurosurgical technic using the transtemporal and translabyrinthine approach necessitates an early diagnosis of neuromas protruding 1 cm or less into the cerebellopontine angle cistern. This seemed impossible with the available CT equipment. Eight proven acoustic neuromas 1 cm or less in diameter, detected with CT, are reported. Diagnostic criteria are elaborated. The study shows that small cerebellopontine angle tumors can be detected by use of CT machines of the newer generation which perform scanning with thin and overlapping slices.


[Therapeutic efficacy and tolerance of a new drug, sodium diclofenac, in inflammatory and metabolic rheumatism]. A new antirheumatic, non-steroid drug, sodium diclofenac (Voltaren Geigy) has been experimented in 14 patients aged between 27 and 69 hospitalized at the IInd Medical Division of Enna Hospital. The patients were divided into three groups suffering from: rheumatoid arthritis, scapulohumeral periarthritis, uratic arthritis, and rheumatic carditis in active phase. In almost all treated cases, the drug proved to have good therapeutic effectiveness demonstrated by complete remission or attenuation of clinical symptomatology and by the return to normal or reduction in the various modified biohumoral indices; in all cases treated, good tolerance, absolute lack of side-effects and toxicity. Special attention has been paid to study of possible changes to gastric mucosa by means of careful evaluation of endoscopic and histological findings.


[Results of myocardial perfusion scintigraphy (author's transl)]. Myocardial perfusion scintigraphy by means of the microsphere technique is a valuable method for detecting regional myocardial scars. The use of the microsphere technique is indicated in all patients who have had myocardial infarction and before coronary bypass operations. In a certain group of patients with severe but atypical angina pectoris and a normal coronary arteriogram and in some arrhythmias the perfusion scintigram can provide information on changes coronary microcirculation. The assessment of myocardial blood flow redistribution under pharmacological intervention is a further indication for the microsphere technique.


Catabolism of 2-deoxyglucose by phagocytic leukocytes in the presence of 12-O-tetradecanoyl phorbol-13-acetate. We have found that phagocytic leukocytes exposed to the tumor-promoting agent, 12-O-tetradecanoyl phorbol-13-acetate, efficiently release carbon-1 of 2-deoxyglucose in the form of CO2 with concurrent intracellular accumulation of a phosphorylated 5-carbon intermediate. In the absence of 12-O-tetradecanoyl phorbol-13-acetate, these cells release barely detectable amounts of CO2 from 2-deoxyglucose. 12-O-Tetradecanoyl phorbol-13-acetate, at a concentration of 1 ng/ml, has an immediate effect on CO2 release, which is temperature-dependent and linear with time and cell number. The ability of a number of phorbol ester-like compounds to enhance this catabolic pathway for 2-deoxyglucose correlates with their ability to act as tumor promotors and inflammatory agents. Although this effect of phorbol esters appears to be restricted to granulocytes, monocytes, and macrophages, the possibility arises that other mammalian cells are capable of catabolizing or can be induced to catabolize-2-deoxyglucose. Thus, 2-deoxyglucose decarboxylation should be considered whenever this analog of mannose and glucose is used as an indicator for sugar transport, especially when pharmacodynamic agents are present.


Diamagnetic anisotropy and orientation of alpha helix in frog rhodopsin and meta II intermediate. The diamagnetic anisotropy of retinal rod outer segments, and its variation upon bleaching, have been measured with a rotating field device. A large molar diamagnetic asymmetry is found for rhodopsin. This cannot be explained by an anisotropy of the aromatic side chains of the protein, nor by the orientation of the retinal chromophore. However, it can be accounted for by an orientation perpendicular to the disc membrane of a major proportion of the alpha-helical segments of the protein. Upon bleaching a decrease of 9 +/- 2% of the diamagnetic asymmetry is observed when going to the meta II intermediate. This change is not mainly due to a reorientation of the retinal, since it is practically insensitive to detachment of the chromophore by addition of NH2OH. Comparison with recent UV linear dichroism results indicate that it may be due to the rotation of a trytophan residue in the bleaching sequence.


Regeneration of T-cell helper function in zinc-deficient adult mice. Diets deficient in zinc cause rapid atrophy of the thymus and loss of T-cell helper function in the young adult A/J mouse. Because zinc deficiency, as well as other nutritional deficiences, causes extensive damage to the immune system, the question arose as to whether zinc-deficient mice could repair the thymus and fully regenerate T-cell helper function if returned to diets containing adequate amounts of zinc. Five-week-old A/J female mice were fed either a zinc-deficient (<1 mug of Zn per g) or a zinc-adequate (50 mug of Zn per g) diet for 31 days. Histological examination of thymuses from the zinc-deficient mice revealed that the cortex was preferentially involuted and the thymus was about one-third of normal size. The direct plaque-forming cells produced per mouse spleen in response to immunization with sheep erythrocytes was 34% of normal; indirect plaque-forming cells were 18% of normal (Jerne plaque assay). After the deficient mice had been fed a zinc-adequate diet for 1 week, their response was nearly normal, except that the indirect response was 68% of controls; in this same period, the thymuses of these mice had quadrupled in size and exhibited a greatly enlarged cortex repopulated with immature thymocytes. By 2 weeks, the thymuses of the previously zinc-deficient mice were normal in size and appearance; however, there was a slight increases in numbers of indirect plaque-forming cells. By 4 weeks, the thymus weights, direct and indirect plaque-forming cell counts, and secondary response of the previously deficient mice were normal. Mice that were nearly athymic after 45 days of dietary zinc deficiency were also able to fully reconstruct the thymus and regenerate T-cell helper function. The data show that the zinc-deficient young adult mouse has the capacity to fully restore the T-cell-dependent antibody-mediated responses upon nutritional repletion.


Molecular association between transplantation antigens and cell surface antigen in adenovirus-transformed cell line. A rat cell line (A2T2C4) transformed with adenovirus type 2 elicited cytotoxic T lymphocytes in syngeneic rats. Cytotoxicity was abolished by a rabbit antiserum directed against the major histocompatibility (AgB) antigens and by a syngeneic rat antiserum raised against the virus-transformed cell line. The syngeneic antiserum immunoprecipitated surface proteins with apparent molecular weights of 45,000, 19,000, 17,000, and 12,000 from the A2T2C4 cells but it displayed no reactivity against primary rat fibroblasts and spleen cells. The rabbit antiserum against AgB antigens precipitated a 19,000-dalton component from the A2T2C4 cells which was not observed in primary rat fibroblasts. Sequential immunoprecipitation revealed identity between the major polypeptides recognized by the two antisera. Because the rabbit anti-AgB antigen serum was specific for the transplantation antigen subunits and because the syngeneic rat antiserum against the A2T2C4 cells failed to react with the AgB antigens in normal cells, it is concluded that the 19,000-dalton component is coprecipitated with the AgB antigens. Antisera directed specifically against beta2-microglobulin and the alloantigenic AgB antigen subunit also coprecipitated the 19,000-dalton component. These results indicate that the AgB antigen subunits form a ternary complex with a virus-coded protein on the surface of the virus-transformed A2T2C4 cells. This molecular complex may be recognized by the cytoloytic T lymphocytes


Cholesterol is a critical cellular component for T-lymphocyte cytotoxicity. Preincubation of cytolytic T lymphocytes (CTLs) generated in secondary C57BL/6 anti-DBA/2 mixed leukocyte cultures with an inhibitor of cellular cholesterol synthesis (25-OH-cholesterol) for 24 hr strongly depressed the cytolytic activity as determined in a 3-hr 51Cr assay. The effect of the inhibitor was reversed by the simultaneous addition of cholesterol or of mevalonic acid during the preincubation period (mevalonate is the product of the regulatory enzyme in the sterol synthesis pathway, 3-hydroxy-3-methylglutaryl-CoA reductase (NADP) [mevalonate:NADP+ oxidoreductase (CoA-acylating), EC 1.1.1.34]). Because, under the same culture conditions, inhibition of DNA synthesis had no effect on CTL activity, the experiments suggest that the effect of 25-OH-cholesterol is related to its inhibitory effect on sterol synthesis, resulting in decreased levels of membrane-bound cholesterol, rather than to inhibition of cellular proliferation.


Induction of secondary cytotoxic T lymphocytes by purified HLA-A and HLA-B antigens reconstituted into phospholipid vesicles. Mouse cytotoxic T lymphocytes were induced by culturing primed spleen cells with cells, membranes, or detergent-solubilized and dialyzed membranes from the human lymphoblastoid cell line JY. Cytotoxic T cells could also be induced by coculturing primed spleen cells with phospholipid vesicles containing purified HLA-A and -B antigens derived from JY cells. The induction of killer cells by all subcellular fractions demonstrated an optimal response as a function of the amount of material added and, in the case of HLA-containing liposomes, this optimum was dependent upon the density of the HLA molecules in the liposomes. In addition, the maximal level of cytotoxicity elicited was also dependent upon this density. Finally, the cytotoxic cells demonstrated specificity as judged by a lower level of lysis on an HLA-unrelated lymphoblastoid cell line than on the appropriate target, JY. These results suggest that major histocompatibility antigens alone are sufficient for the induction of a secondary cytotoxic T lymphocyte response. It is proposed that this system may be useful in defining possible sites on the HLA molecule recognized by cytolytic T lymphocytes.


[Spontaneous ventriculocisternostomies]. A pantopaque ventriculogram is used to demonstrate spontaneous ventriculocisternostomy over the r. suprapinealis in a patient with benign occlusion of the aqueduct. Clinical remission corresponds to sufficient spontaneous liquor drainage. Thus, a total of thirteen real perforations of the third ventricle have so far been described in the literature in addition to nine complete lateral ventricular ruptures. The differences between incomplete ventricular wall ruptures, ventricular diverticula, and ventriculocisternostomies are discussed.


Selective massive amyloidosis of the small intestine mimicking multiple tumors. Selective massive amyloidosis of the small intestine is uncommon. A patient is described who presented with abdominal pains and hematemesis. The small bowel series showed numerous discrete nodules, some with ulcerations. Biopsy demonstrated massive infiltration with amyloid.


Computed tomography of isoattenuating subdural hematomas. CT scans of 87 patients with subdural hematoma were compared to those of 393 patients with midline shift caused by other intracranial lesions with regard to attenuation changes in the lesion and the character of the ventricular deformity. Isoattenuating was exhibited by 25% of the subdural hematomas and 5% of the other lesions. In 70 to 80% of the isoattenuating hematomas, the diagnosis could be made on the basis of the characteristic ventricular deformity. Other diagnostic procedures are not necessary in these cases.


Attempts to infect T lymphocyte-deficient mice with Babesia species of cattle. Nu/nu, nu/+, splenectomised nu/nu and Lasat mice were inoculated with freshly collected bovine blood infected with Babesia divergens and B major. There was no evidence that either parasite became established in mice but B divergens persisted in mice up to 10 days whereas B major lasted only one day. B divergens infection generally persisted longer in splenectomised mice but absence of thymus made no apparent difference to persistence of infection. B divergens underwent morphological changes in mice to vacuolated and ring forms.


Monitoring adverse reactions to antirheumatic drugs. Drug monitoring systems have been developed in response to public concern over drug-related adverse events: no completely satisfactory method has yet been developed. Drug associated morbidity and mortality is a major problem in the treatment of rheumatic diseases. The damage to patients from recognized drug hazards can be reduced by close monitoring and sequential recording of results of investigations. Previously unrecognized drug-associated adverse events can best be identified by prospective surveillance of new drugs. Methodological problems are considerable but not insurmountable. Rheumatologists need to apply a variety of strategies to drug monitoring, some of them involving international cooperation.


Systemic lupus erythematosus and DNA antibodies in pleural effusions. The quantity of antibodies to double-stranded DNA (ds-DNA) in 53 pleural effusions from 48 patients was measured by means of a modified Farr technique. In 10 samples, binding of ds-DNA was greater than 5 mg/l (range 6--14 mg/l), five samples being from patients with systemic lupus erythematosus (SLE), four from patients with lung cancer, and one from a patient with pulmonary tuberculosis. After treatment of pleural effusion samples with DNase, there was a marked increase of ds-DNA binding in the SLE group (n = 5), but none in the lung cancer group (n = 7) or in 4 patients with pleural effusions of various origin. In pleural fluid, demonstration of antibodies to ds-DNA and anti-ds-DNA-ds-DNA complexes, unmasked by DNase, may prove valuable when differentiating clinical conditions with pleural effusions.


Incidence of inflammatory rheumatic diseases in Finland. The incidence of inflammatory joint diseases was estimated by using two patient series. Firstly, the total yearly incidence of all such diseases together was estimated in a population of 15 600 persons of 16 years of age or older. Secondly, this overall incidence was divided by the ratio of different diseases obtained from a larger series of patients. The incidence of all inflammatory joint diseases was 218/100 000/year, 182 in males and 250 in females. The incidence was highest in middle age and lowest in old age. The incidence of ill-defined arthritides was five times that of definite rheumatoid arthritis in the youngest age group but in the oldest their frequencies were equal. In the whole population, the proportion of ill-defined arthritides was 2/5, of definite RA 1/5, of HL-A B27 associated diseases 1/5, and of other diseases 1/5 of the total incidence of inflammatory joint diseases. Because the frequency of HL-A B27 in all patients surveyed was about 40%, only half of the patients with this antigen showed a clinical picture of ankylosing spondylitis, Reiter's disease, or reactive arthritis.


Aorto-coronary saphenous vein bypass graft. Peroperative flow studies related to late graft patency. In aorto-coronary saphenous bypass grafts, peroperative flows measured by electromagnetic flowmetry were studied at rest and after injection of papaverine to reduce vasomotor tone. The results were correlated to graft patency approximately 14 months after operation and showed that patent grafts had greater flow values, both at rest and after papaverine, than grafts which were occluded at the re-examination. There was, however, considerable overlapping between the two groups, and no clear distinction between flow values in successful and unsuccessful grafts either at rest or after papaverine was found. No correlations were demonstrated between peroperative graft flow on one hand and the presence or absence of ventricular dyskinesia or electrocardiographic evidence of previous transmural myocardial infarction on the other.


Influence of aorto-coronary saphenous vein bypass surgery on left ventricular function. Comparison before and one year after surgery in 80 patients. To assess the haemodynamic effects of aorto-coronary saphenous vein bypass grafting, pre- and post-angiographic left ventricular end-diastolic pressure (LVEDP) and ejection fraction (EF) were measured before and in average 14 months after surgery in 80 patients. Symptomatic improvement occurred in 91% (73 of 80). In 43 patients with patent graft(s), pre-angiographic LVEDP and EF were unchanged (p always greater than 0.05), while postangiographic LVEDP was significantly reduced. Unchanged pre- and postangiographic LVEDP and EF were observed in 28 patients with double or triple grafts, with at least one graft patent and the other(s) occluded. Unchanged pre- and postangiographic LVEDP and reduced EF were observed in 9 patients with occluded single, double or triple grafts. We conclude that successful aorto-coronary saphenous vein bypass surgery in general does not improve resting left ventricular performance, but that the beneficial effect on left ventricular function can be demonstrated after a stress test such as ventriculography. A single graft to the left anterior descending artery seems to be of particular importance in this connection. On the other hand, deterioration was evident after unsuccessful surgery, particularly in patients with occlusions of 2 or 3 grafts. Digitalis therapy after operation or electrocardiographic indices of postoperative myocardial infarction apparently did not influence left ventricular performance.


Cardiac surgery in extreme haemodilution without donor blood, blood products or artificial macromolecules. A triple aorto-coronary vein bypass was performed in a 56-year-old Jehovah's Witness. Neither donor blood, albumin nor artificial macromolecules were used. Ten litres of non-haemic fluid were given during surgery and an additional 4 litres during the first 18 postoperative hours. During perfusion the haematocrit fell to 19 vol% and total protein in serum to 29 g/l. Eighteen hours after surgery, the patient was extubated without any signs of oedema and with a positive water balance of only 2.2 l. Diuretics were not given. Acid-base and electrolyte values were within normal limits both during and after operation. This and similar cases reported in the literature show that during extracorporeal circulation it is possible to reduce the concentrations of red cells and plasma proteins to below 40% of pre-operative values without serious complications.


Alpha-1-antitrypsin deficiency and chest disease a clinical and physiological study. Four families with alpha-1-antitrypsin deficiency have been identified. Of 7 homozygous subjects 5 smoked and had chest disease while the 2 non-smokers were unaffected. Productive cough was a feature in 4 of the 5 affected homozygotes and symptoms commenced earlier than is usual with chronic bronchitis and emphysema. Of 11 heterozygous subjects only 5 who smoked had symptomatic or laboratory evidence of obstructive airways disease, in each case less marked than that of their homozygous smoking relatives. Severely affected subjects were underweight, the degree of weight loss being related to the measured severity of airways disease. A survey of emphsematous patients screened for alpha-1-antitrypsin deficiency is described. The natural course and significance of this enzyme deficiency are examined with reference to previous literature.


Treatment of otitis media caused by Hemophilus influenzae: evaluation of three antimicrobial regimens. Ninety young children with otitis media, proven by tympanocentesis culture to be due to Hemophilus influenzae, were treated in a prospective double-blind study with one of three antimicrobial regimens: ampicillin, erythromycin ethylsuccinate, or erythromycin ethylsuccinate with concomitant trisulfapyrimidines. Results of efficacy evaluation indicated that the combination was as effective as ampicillin and statistically superior to erythromycine alone. Of the strains of H influenzae identified, 15/9 were typable with 12/9, type b. In vitro sensitivity tests indicated that the strains were sensitive to the amtimicrobials studied in clinically attainable levels; however, comparison of individual efficacy ratings with sensitivity results indicated that some children in each treatment group failed to respond as predicted.


Evaluation of the indirect hemagglutination technique for study of Trichomonas vaginalis infections, particularly in men. The indirect hemagglutination (IHA) technique was evaluated for use in the serologic study of infection with Trichomonas vaginalis. The IHA test showed that sera from 88% of women attending a venereal disease clinic had antibody to T. vaginalis. The antibody frequency and titers were highest in women who had documented infections due to T. vaginalis. Serologic and cultural evidence of recent or active trichomonal infection was found in 11% of 85 men who had nongonococcal urethritis, but was absent in a control group of 27 men. Clinical findings in ten men with symptomatic genitourinary trichomoniasis are described; all but one had relatively high (greater than or equal to 1:80) IHA antibody titers. Antibody to T. vaginalis was found significantly (P less than 0.005) more often in sera from women than in sera from men in an apparently healthy group of individuals between the ages of 1 and 20 years. The IHA test appears potentially useful for the diagnosis of trichomoniasis in men and in the seroepidemiology of infections due to T. vaginalis.


Aneurysm of the main stem of the left coronary artery associated with aortic insufficiency and aneurysm of the ascending aorta. Report of a case with successful surgical repair. A case of aneurysm of the main stem of the left coronary artery associated with aortic insufficiency and an aneurysm of the ascending aorta is reported. The importance of coronary angiography in diagnosing this condition is illustrated. Surgical repair included isolation of the coronary aneurysm and replacement of the ascending aorta and aortic valve, combined with triple aortocoronary saphenous vein bypass grafts. A review of the aetiology, clinical features, and surgical management of coronary artery aneurysms is presented.


The origin of protein and fatty yolk in Rana pipiens. III. Intramitochondrial and primary vesicular yolk formation in frog oocytes. The precise origin of the primary yolk precursor complex or primary vesicular yolk is obscure but in its earliest recognizable stage it is a typical multivesicular body which first acquires a moderately electron-dark matrix. Following this, an extremely electron-dark amorphous material, the yolk protein, appears within the precursor. This yolk protein increases in amount as the yolk vesicle grows and by the time the precursors are about 1 micrometer in diameter this protein is partly to almost completely crystalline. Yolk originating within mitochondrial cristae unlike that in the yolk precursor complexes is crystalline from its earliest appearance. Intracristae mitochondrial yolk crystals have a spacing of 70--85 A. Their molecular organization appears in some sections as electron-dark lamellae and in others as light cylinders surrounded by an electron-dark matrix.


The origin of protein and fatty yolk in Rana pipiens. IV. Secondary vesicular yolk formation in frog oocytes. Secondary yolk precursor complexes are differentiated from primary yolk precursor complexes in that little or no background matrix or small vesicles are present and that electron-dark, amorphous yolk protein fills the precursor at a very early stage of growth. Secondary precursors are formed in two ways; from multivesicular bodies or from the fusion of smooth-surfaced endocytotic vesicles. Ultimately, fusion of secondary precursors with multivesicular bodies makes them indistinguishable from primary precursors. Precursors are called yolk platelets when they are mainly crystalline with only a small amount of amorphous yolk protein present. The structure of the crystal is particulate with a spacing of 70--85 A. At high resolution, the particles are seen to measure approximately 20 X 60 A. The chemical composition and interpretations of studies of the crystal structure are discussed.


The Mackenzie Memorial Lecture, 1977. Of divers colours. I shall discuss the nature of the sensation of colour and the reason for our colour vision, leading on to the existence of defects in that sense. I will consider the different kinds of such defects and the arguments for the use of particular tests in varying circumstances. I report the result of a recent survey of the value of a careers advisory service for "colour blind" school children seen between 1965 and 1977 (primarily red-green blind). This leads to examples of the value of these tests in genetics, and in the early diagnosis of disease or toxicity. I shall also describe the various modifications I have made to the 100-hue test, with its eventual automation both for computation and recording. Finally, the recommendations I make for future progress cover routine examination, both on starting primary education and on entering secondary education, analysis of the colour task at work, and the adoption of an enlightened system of colour coding.


[Changes in lactate dehydrogenase and glucose-6-phosphate dehydrogenase activity in the course of muscle alteration]. Changes of outflux, extractability and activity of lactate dehydrogenase (LDG) and glucose-6-phosphate dehydrogenase (G-6PhDG) of muscles under the action of heating (at 32--44 degrees for 15 min) and urea (1 M during 10 min, 30 min, 2 hr. and 9 hr.) on the skeletal muscles of R. temporaria L. were studied. Under the thermal action not accompanied by contracture and fall of the excitability (32--36 degrees), the increase of outflux of LDG out of muscles into surrounding solutions is observed. G-6-PhDG in the external medium under any heating action was not revealed. Extractibility of LDG  and G-6-PhDG did not change. Under the thermal action accompanied by the fall of excitability and by the contracture, along with the prolong increase of outflux of LDG, a decrease of extractability of LDG takes place. The decrease of G-6-PhDG is set at 42 degrees. Under the alteration of muscles by urea in the period of the temporary fall of excitability and contracture (10 and 30 min) an increase of the outflux of LDG out of muscles is observed. G-6PhDG in the surrounding medium was not revealed up to 9 hr. of incubation of muscle. In the period of the recovery of the excitability and relaxation of muscles (2hr.) the outflux of LDG approaches the control level. During the temporary loss and recovery of excitability, the extractability of LDG and G-6-PhDG does not change. In the period of irreversible contracture and loss of the excitability (6--10 hr.) a sharp increase of outflux of LDG out of muscles takes place. The extractability of the examined enzymes, especially of LDG, decreases.


[Rare complications with multiple hereditary cartilaginous exostosis (author's transl)]. A case of hereditary multiple cartilaginous exostosis is reported and the clinical symptoms are discussed. An exostosis of the distal femur was followed by an aneurysma spurium of the left femoral artery. Osteochondromas of the left ribs caused a hematothorax. Thoracotomy was necessary for treatment.


Development of peripheral B and T lymphocytes in piglets. The percentage of B and T lymphocytes in the peripheral blood of piglets during their first 35 days of life was estimated by means of the immunofluorescence-labelled anti-L chains sera and the spontaneous E-rosette techniques. The mean values obtained for adult pigs PBL were 23.8 +/- 10.2% of B and 38.0 +/- 8.4% of T lymphocytes. The piglets showed a linear increase for the B lymphocytes starting from a mean value of 4% observed for the newborns. The trend of the T lymphocytes was represented by a bimodal curve. It starts for newborns at 3% and shows a change in shape by the 10th day. It is suggested that the piglets have adult levels of B and T lymphocytes by the time of weaning.


Inhibition of a primary DNA-synthesis response by trinitrobenzosulfonate (TNBS)-activated suppressor cells; characterization of the inhibitory cells. Repeated intravenous injections of high doses of trinitrobenzosulfonate (TNBS) or dinitrobenzosulfonate (DNBS) activate suppressor cells which inhibit the in vivo activation of a primary DNA synthesis response against trinitrochlorobenzene (TNCB) and dinitrochlorobenzene (DNCB), respectively, almost completely and the delayed type hypersensitivity (DH) response only partially. When tested on the DNA-synthesis response, the suppressor cells show excellent specificity with little cross reactivity of TNBS (or DNBS) induced suppressor cells for DNCB- (or TNCB-) specific responses. TNBS- and DNBS-specific suppressor activity is found in spleen cells, mesenteric lymph nodes and peripheral lymph nodes. The activation of suppressor cells is resistant to the early effects of adult thymectomy (ATx), but sensitive to pretreatment with cyclophosphamide (CyP). The suppressor cells are not simply haptenated cells. They need several days for their activation and are inactivated by incubation for 30 minutes at 56 degrees C or by 2,000 R irradiation. Attempts to obtain soluble suppressor factors by in vitro incubation or extraction of these suppressor cells failed.


Effect of induced hypercalcemia on ultimobranchial gland of the lizard, Calotes versicolor. The ultimobranchial of the lizard Calotes consists of parenchymal patches and several follicles. After induced hypercalcemia, the gland became more active suggesting the hypocalcemic secretion from the gland.


[Experiences gained from the establishment of a complex physical therapy program for the management of female urinary incontinence]. Reported in this paper are preliminary experiences so far obtained from a complex physiotherapeutic programme for conservative and pre-operative treatment of functional urinary incontinence in women. Included in this pilot study were 82 patients of whom 23 (28 per cent) were continent on termination of the therapy, while another 38 (46 per cent) had improved to an extent where they abandoned their original intention to undergo surgery for incontinence. Complex physiotherapy may add favourably to the spectrum of possible therapeutic approaches, provided its proper and differentiated coordination with the generally known surgical approaches.


[Isolation of purified populations of T- and B-lymphocytes under clinical conditions]. The authors present comparative characteristics of the methods of isolation of T- and B-lymphocytes in patients with chronic renal insufficiency. T-lymphocytes were obtained on columns with neilon cotton wool. B-cells were fractionated by repeated centrifugation in the gradient of phycol-urotrast density after staging E-rosette formation with the total lymphocyte pool. Methodical peculiarities of single-stage and two-stage B-lymphocyte fractionation were revealed.


[State of the T- and B-system of immunity in normal cerebrospinal fluid from persons of different age groups]. The paper is concerned with studies of the T- and B-immunity systems in the CSF in 37 patients, in whom the CSF was extracted in order to perform spinal anesthesia. This was necessary for surgical operations because of cryptochidism (16 patients aged from 16--30) and hypertrophy of the prostate (21 patients aged from 60 and over). The patients of both groups showed no signs of nervous system lesions. A comprehensive immunomorphological analysis of the CSF cells permitted to detect the medium indices of the T- and B-immunocompetent cells of individuals depneding upon the age.


[Congenital color vision disorders in persons with mental disorders]. Colour vision was studied in 3000 mental patients (2000 males and 1000 females) with different diseases by means of polychromatic tables and a spectral anomaloscope AH-59. It was established that the frequency of genetically determined pathology of colour vision in patients (9,3% in males and 08,% in females) is similar to the pathology found in the general population and does not depend upon the clinical diagnosis. At the same time there was a large amount of patients with acquired disorders to colour perception (30% of the general pathology of colour vision).


[Early detection of colonic and rectal cancer; extensive study of occult blood]. Due to the high frequency and usually late diagnosis of cancer of colon and rectum the "haemoccult test" has been recommended as an easy, quick, and unexpensive method for stool determination of occult blood that will allow us to suspect the existence of these tumors in their early asymptomatic stages. The test was performed in 1437 patients attending the gastroenterology clinic which had no clinical evidence of bleeding, of these, 1150 returned the samples. In 52 (4,6%) the test was positive for occult blood. The studies performed revelated that 4 were upper gastrointestinal ilions, one ileal diverticulum and 40 (3,47%) patients had colonic disease of the latter 19 were diverticular disease, 1 crohnis disease of rectum, 2 adenomatous and 2 villous polips, 1 Hodkgin disease and 7 carcinomas. There were 6 false positive results. The high frequency of positive "haemoccult test" in colonic disease, specially benign and malignant tumors, make this test and appropiate method of this time in the detection for colo-rectal carcinoma.


Treatment of pain by transcutaneous electrical stimulation. Two hundred and ninety-two patients suffering from a wide range of pain syndromes were treated with transcutaneous electrical stimulation (TES). Electrical stimulation of the painful area was administered on the skin by externally applied electrodes, attached to a portable battery-operated apparatus. The results, determined according to a subjective scoring system, were good in 50.7%, moderate in 24.3% and poor in 25% of the patients. TES is a non-invasive technique, has no side effects and may easily be self-administered. It is concluded that it should be tried in pain syndromes for which no specific therapy is available.


Plasma free norepinephrine and epinephrine concentrations following diazepam-ketamine induction in patients undergoing cardiac surgery. Ketamine causes cardiovascular stimulation, presumably, by increasing central sympathetic activity. This study was undertaken to find out if diazepam in appropriate doses could abolish or moderate the central sympathetic and cardiovascular stimulation following ketamine in patients undergoing cardiac surgery. Twelve patients, scheduled for valvular replacement (8) and direct aortocoronary bypass graft operations (4) were studied. After premedication with diazepam 0.15 mg/kg orally and morphine sulphate 0.15 mg/kg i.m., they were induced with diazepam 0.3 mg/kg i.v., followed 10 min later by ketamine 2 mg/kg i.v. Direct arterial pressure by a strain gauge from the radial artery and heart rate by EKG were continuously recorded. Plasma free norepinephrine, measured by Vendsalu's method, in the arterial blood was 0.39 +/- 0.03 ng/ml prior to induction, 0.39 +/- 0.03 ng/ml 10 min after diazepam and 0.42 +/- 0.05 ng/ml (P greater than 0.05) 5 min after ketamine administration. Plasma free epinephrine concentrations were 0.10 +/- 0.04 ng/ml prior to induction, 0.06 +/- 0.03 ng/ml (P less than 0.05) 10 min after diazepam and 0.01 +/- 0.003 ng/ml (P less than 0.05) 5 min after ketamine. Heart rate and systolic pressure did not change significantly throughout the study period. Diastolic pressures were elevated significantly (P less than 0.05) 5 min after ketamine administration, amounting to a 12% increase over baseline. Diazepam-ketamine induction in cardiac surgical patients did not result in clinically significant central sympathetic or cardiovascular stimulation.


The clinical character of local anesthetics: a function of frequency-dependent conduction block. It is clinically recognized fact that some local anesthetics have a proclivity for inhibition of motor nerves, while others preferentially affect sensory and sympathetic fibers. On the basis that sensory fibers have a frequency threshold for transmission of nociceptive stimuli and that somatic motor fibers have no such frequency threshold, we hypothesized that this variation may be due to differences in the effect of local anesthetics on axonal refractory period. Frog sciatic nerves were partially blocked with lidocaine, bupivacaine, tetracaine and etidocaine, and then stimulated in trains of 17 pulses, at frequencies between 3 and 100 Hz. The height and area of the last action potential in a train were measured. At a comparable level of partial block (50% at 100 Hz), tetracaine and etidocaine showed only a 10% difference between 3 and 100 Hz, while with bupivacaine and lidocaine there was a 30% drop between these two frequencies. This excellent correlation between the laboratory and clinical phenomenon supports our hypothesis. Local anesthetics which have a minimal effect on the refractory period yield enhanced motor block; whereas local anesthetics with a large effect on the refractory period are relatively more potent blockers of sensory and sympathetic transmission.


Mononuclear cell migration inhibition in children with nephrotic syndrome. The relative number of T/B lymphocytes and the response of peripheral blood mononuclear cells to PHA in the migration inhibition test was studied in a group of patients with idiopathic nephrotic syndrome. It has been found that the level of T lymphocytes and the response to PHA was decreased in patients in particular those with frequent relapses. The possible implications of these finding for pathogenesis of idiopathic nephrotic syndrome is briefly discussed.


T-lymphocytes transfer streptozotocin induced diabetes mellitus in mice. Diabetes mellitus induced by low dose treatment with streptozotocin in BALB/c mice was passively transferred to syngeneic recipients with a predominantly T-lymphocyte fraction of spleen cells. This fraction was prepared by density centrifugation and passage through an antimouse immunoglobulin coated column. Variation in numbers of injected cells in the range of 10(3) to 10(7) showed that the smaller cell numbers gave the highest blood sugar values. Athymic nude recipients of BALB/c background also developed diabetes following similar transplants. A preliminary result was that the highest blood sugars were seen after transplantation of T-lymphocytes treated by low dose irradiation (200 R). This may reflect a specific effect on T-suppressor lymphocytes.


Cell surface markers in cord blood leucocytes after stimulation with lipopolysaccharide B. T- and B-lymphocyte markers were studied in cord blood cells cultured with lipopolysaccharide B (LPS). Cells cultured with leucoagglutinin (LA) and pokeweed mitogen (PWM) were used as controls. LPS-induced lymphoblasts were negative for surface Ig, positive for intracellular Ig and did not form rosettes with sheep red blood cells (SRBC). LA-activated cells formed rosettes with SRBC, while PWM cultures showed a varying proportion of surface Ig-positive or SRBC rosetting cells, dependent on the time of culture. About 50% of both LA- and LPS-activated lymphoblasts formed EA rosettes (specific for Fc receptors) and EAC rosettes (specific for complement receptors). The response of foetal cells to LPS was reduced when lymphocytes obtained from Isopaque-Ficoll gradients were passed through nylon wool columns, whereas this procedure led to an increased response to LA. Thus LPS-activated foetal leucocytes are B lymphocytes expressing intracellular but not surface Ig.


Unilateral stellate block in the treatment of hypertension after coronary bypass surgery. Implications of a new therapeutic approach. Unilateral stellate ganglion block (right or left) was achieved by local injection of 15 ml of lidocaine in 27 patients with hypertension after coronary bypass surgery. The stellate block led to rapid and sustained control of blood pressure in 18 patients (9 of 15 with right stellate block and 9 of 12 with left stellate block). The reduction in arterial pressure was associated with significant (P less than 0.01) reductions in total peripheral resistance and heart rate but no significant changes in cardiac output or central venous or left atrial pressures. This hemodynamic pattern as well as effectiveness of a unilateral approach suggests that the stellate block reduced arterial pressure by interrupting the afferent limb of a pressor reflex from the heart or great vessels, or both. The procedure was free from side effects and helped avoid prolonged parenteral administration of potent antihypertensive drugs.


Noninvasive assessment of aortocoronary bypass graft patency using pulsed Doppler echocardiography. To evaluate noninvasively aortocoronary bypass graft patency, pulsed Doppler echocardiography was performed at the time of postoperative coronary angiography in 120 consecutive patients. Ultrasonic examination of 163 vein grafts was possible. One hundred twenty-seven patent and 14 occluded grafts were correctly identified. Eleven patent grafts could not be recorded, and 11 occluded grafts were falsely diagnosed as patent. The method had an overall sensitivity of 92% and a specificity of 56%. This high sensitivity level may be increased to almost 100% by enhanced technical skill and experience. The low specificity level, although the method must be tested in a larger number of bypass grafts, stresses the importance of correctly identifying other sources of diastolic blood flow. Diastolic flows from the superior vena cava, internal mammary veins, tricuspid valve, mitral valve and right ventricle may be eliminated by careful adjustment of the depth, site and size of the pulsed Doppler electronic sampling gate. Standard echocardiographic landmarks for avoiding confusion with the coronary arteries are also described.


Left ventricular false aneurysm after coronary bypass surgery: radionuclide diagnosis and surgical resection. A patient with left ventricular pseudoaneurysm formation resulting from myocardial infarction 4 years after coronary bypass surgery is described. The pseudoaneurysm was diagnosed with gated cardiac blood pool imaging and was subsequently successfully surgically repaired. Postoperative pericardial abnormalities predisposing to the possible development of a false aneurysm are discussed. Also, clinical situations in which pseudoaneurysm should be suspected are described, and appropriate diagnostic approaches are outlined.


Blood pressure in Tokelauan children in two contrasting environments. To assess the influence of the environment on blood pressure levels in children, the patterns of blood pressure in Tokelauan children resident in the isolated atolls of Tokelau and in New Zealand are compared. Blood pressure was measured twice by one observer using a random zero sphygmomanometer on 571 (96% response) Tokelauan children resident on the atolls and on 856 (95% response) Tokelauan children resident in New Zealand. After adjusting for cuff size and controlling for age, weight and height, the systolic blood pressure of New Zealand resident children was found to be significantly higher in boys of all ages and in girls under the age of eight. The difference does not appear to be due to selective migration; the association of the heavier weight of the New Zealand resident children with part of this blood pressure difference may be important from a preventive viewpoint.


Night myopia at night automobile luminances: final report. One-hundred seventy-five persons viewed test letters of 35 and 11% contrast at 0.1 and 0.01 fL chart luminance while lenses (+0.25 to -1.50 D in 0.25-D steps) were placed before their eyes (and glasses, if they wore them). With one or more of the minus lenses, only 9% of the subjects obtained improved acuity by one or more lines on the chart. The most common optimum lens power was -0.75 D.


Serum protein levels as anthropological markers: a statistical analysis in Binga Pygmies and Italians. Data on serum protein levels in Binga Pygmies are presented, and these are compared with the levels in healthy Italians and in Italians suffering from liver diseases. Principal Component Analysis carried out on the three groups points out similarities in protein levels between the Pygmies and the Italian Hepatopaths on one hand and between healthy and liver diseased Italians on the other. Discriminant Analyses reveal the important differences between the populations. It is suggested that such analyses of protein levels could serve as tools in population biology.


Immunological features of kala-azar.

Immunological features of kala-azar. Serum immunoglobulins, complement C3c, percentage of T and B cells, and skin reactivity to Leishmania were studied in ten cases of kala-azar. Immunoglobulin G was increased in a majority of these patients. The C3c level in two out of six patients tested was lower than normal. The percentage of T cells in peripheral blood of nine patients tested was reduced and in seven of these patients the percentage of B cells was elevated. After a full course of anti-kala-azar therapy the percentage of T and B cells remained the same in five patients studied. All the patients showed a negative skin reaction when they were tested with Leishmania antigen.


Prospective comparative clinical trial with distal splenorenal and mesocaval shunts. In a randomized study, the rate of postshunt encephalopathy was significantly lower after distal splenorenal shunting than after mesocaval shunting. Either shunt can be performed electively with a low operative mortality. If initial hemorrhage cannot be controlled, mortality may be minimized by mesocaval shunting. Advanced cirrhosis is not a contraindication to elective or emergency portasystemic shunting.


Ultrastructural study of the cornea in the chick embryo. The study of the development of the cornea in the chick embryo by transmission and scanning electron microscopy allows us to observe the differences between the aspect of thin sections and the surface of the cells. When studied with the T.E.M. both endothelium and epithelium have a rather normal and mature aspects on the 9th day of development. Observed with the S.E.M., the aspect of the surface of the epithelium becomes mature no earlier than on the 19th day, whereas the development of the endothelium is completed only after hatching. The development of apical junctional complexes occurs at a later stage in the organisation of the endothelial layer.


Some aspects of radiant energy damage to the retina. The retinae of anaesthetised Dutch rabbits were exposed to white light of various intensities * (*67--235 mW/cm2 measured at 2.5 cms from the end plate of the light guide) for a period of one h. After this period the animals were killed and tissue taken for investigation by light and electron microscopy. The higher intensities produced marked disruption of the visual cell outer and inner segments as well as a variety of morphological changes in the pigment epithelium. The highest intensity produced severe disruption of the visual cells and pigment epithelium in addition to a general disruption of the other retinal layers. Accompanying the retinal damage there was an inflammatory response in the choroid of the experimental eyes and surprisingly, at some intensities, a similar inflammatory response in the choroid of the control eye.


Development and ultrastructure of peripheral subretinal neovascularizations. Anterior to the equator an additional vascular layer can regularly be found between peripheral retina and choroid. The vessels are located within Bruch's membrane, subjacent to the retinal pigment epithelium. Apparently, this layer is not present at birth and develops at a relatively young age. With the electron microscope all steps of vasculogenesis could be followed. The presence of such vessels also in the eye of a 29-year-old individual suggests that they represent a physiologic condition rather than an ageing change. In contrast to the subretinal neovascular membranes of the posterior fundus, these peripheral neovascularizations show no relation to any known fundus disease.


Hyperacute form of experimental autoimmune uveo-retinitis in Lewis rats; electron microscopic study. One systemic injection of retinal tissue or extract mixed with Freund's complete adjuvant induces uveo-retinitis in several animal species: guinea pig [6], rabbit [5, 7], monkey [4] and rat [8]. Rod outer segments may be used as the pathogenic antigenic preparation [1, 3, 9]. This study reports on the conditions of induction of experimental autoimmune uveo-retinitis (EAU) in rats (susceptible strains of rats, optimal doses of antigen and adjuvant) and the histopathological features of the lesions in the early stages of the disease.  In several species one systemic injection of retinal tissue or extract mixed with Freund's complete adjuvant induces an ocular inflammatory disease, whose main features are an inflammatory infiltration of the uvea and a destruction of the external layers of the retina. With adequate doses of guinea pig retinal extract and adjuvant, the disease was induced in all cases in albino rats of the Lewis strain. The vascular and tissular lesions, and the infiltrates with a predominance of PMN's and basophils seem to be the result of immune complexe deposition.


Comparative studies of erythrophagocytosis in the rabbit and human vitreous. The ultrastructural changes which occurred during red cell degradation in the vitreous were studied in rabbit and human eyes. The major pathway for red cell lysis was extracellular in both species, and this type of haemolysis was probably induced by the unfavourable environment in the vitreous and by age changes in the red cells themselves. The released red cell debris was then phagocytosed by invading macrophages. Intracellular lysis also occurred within the cytoplasm of large macrophages after ingestion of whole red cells by the phagocytes. Thus inflammatory cells were always ultimately involved in both forms of red cell lysis in the vitreous. Intracellular lysis appeared to be more common in human cases of recurrent intravitreal haemorrhage associated with intravitreal new vessel formation. In addition, a higher proportion of young macrophages was observed in the inflammatory cell exudates of recurrent haemorrhages, suggesting that macrophage turnover was more rapid in these cases.


Innervation of the conus papillaris in the eye of lacertilians. The autonomic innervation of the conus papillaris has been observed by electron microscopy in Lacerta viridis, muralis, Anguis fragilis and Zonosaurus ornatus. Bundles of nerve fibres accompanying blood vessels penetrate the conus at the level of the intraocular portion of the optic nerve.  Within the  conus proper, different aspects are described: bundles of fibres from which some axons can be separated, aggregates of axons with varicosities enclosed within the cytoplasm of pigmented cells, isolated preterminal axons or varicose terminals encircled by pigment cell cytoplasm or cytoplasmic processes, and naked terminals. The observed innervation is to be related to blood vessel vasomotor activity or to pigment cell motility. This problem remains unsolved.


Histological and ultrastructural studies on the ringbands in human extraocular muscles. Ringbands are a typical finding in the extraocular muscles of individuals of twenty years and older. The number of these structures increases distinctly after the 60th year of life. In optimally fixed muscles the ringbands are separated from the sarcolemma by a space containing the so-called sarcoplasmic masses. These masses were composed of vaculated mitochondria, dilated tubules of the sarcoplasmic system and, in some fibers, of fragments of myofibrils. Structures from which a neoformation of myofibrils as the origin of the ringbands could be concluded (as proposed by Jonecko, 1967), were never observed in this hypolemmal area. In contrast, the formation of the ringbands seems to be correlated to the ultrastructural alterations of the myofilaments and the looser arrangement of the myofibrils which can first be observed in extraocular muscles of 10-year-old patients and increasingly in older patients (Mühlendyck, 1977). These alterations lead to continous and repeated changes in the orientation of the myofibrils during the extension and contraction processes of the muscle fiber. Thus, the myofibrils undergo a constant mechanical stress which they cannot resist indefinetly, leading to disruption of some of the fibrils. The disrupted free end contracts, deviates almost at a right angle from its former course and, while the sarcolemma forms thread-like folds during the contraction of the muscle fiber, it is coiled around the longitudinal undisrupted fibrillar core. This leads to a disfunction of the muscle fiber and aids in explaining the steady decrease of the excursion of the eye after about 30 years of age.


Fine structure of palpebral molluscum contagiosum and its secondary conjunctival lesions. One case of molluscum contagiosum of the lid, which has been followed by follicular conjunctivitis and superficial punctate keratitis, has enabled us to compare the ultrastructure of the skin tumor and of the conjunctival lesion. Electron microscopic observation is the only way for discovering the causal Poxvirus. Up to now isolation of the viral strain has not been possible. Examination of the skin tumor showed different maturation forms of the virus and associated cell alterations. In the conjunctiva there was an inflammatory reaction, with exocytosis and infiltration of the chorion by lymphocytes and plasma cells. Intracytoplasmic organelles were formed in the superficial epithelial cells. Their size and structure resembled that of the immature virions found in the epidermic cells. The comparison between skin and conjunctival lesions suggests the following sequence of events in the pathogenesis: the virus, leaving the lid tumor, probably penetrates the conjunctival cells and, without finding the conditions necessary for its full development, produces abnormal viral inclusions unable to become a mature virus. The excision of skin nodules thus cures the infection, since it prevents further reinfection by the skin virus. The morphological criteria on which this hypothesis is based must be confirmed by chemical and morphometrical studies.


Reis-Bückler's dystrophy.

Reis-Bückler's dystrophy. A case of Reis-Bückler's dystrophy in a 36-year-old man is reported. Its clinical aspect is compared with its histological and ultrastructural features. The slight reticular opacities situated superficially in the central part of the cornea, immediately beneath the epithelium, correspond to dark, irregular deposits. These replaced the basal membrane and Bowman's membrane and are composed of granular material, glycogen granules, and short fibers. These short, curved, osmiophilic fibers whose diameter is approximately 130 A are also located inside the anterior stromal lamellae. These deposits seem to be the characteristic feature of this particular and rare dystrophy, stated as by Hogan. Their nature and origin are discussed.


Further observations on the process of haemophagocytosis in the human outflow system. The outflow system was studied in seven human traumatised eyes in which there was a hyphaema (injury-enucleation periods 7h to 35 days). Extracellular lysis of red cells was present, but lysed red cells were not found in the outer part of the meshwork. Exogenous macrophages and endogenous endothelial cells contained red cells and their breakdown products and evidence was obtained to indicate intracellular haemolysis as the cells passed through the meshwork. Penetration of the lining endothelium of Schlemm's canal by red cells and macrophages was a rare observation and this was attributed to the presence of a co-existing hypotonia.


Studies on the pseudo-exfoliation material: a review. Pseudo-exfoliation (PE) material may be found on several surfaces of the anterior segment of the eye. The material contains typical cross-banded PE fibrils distributed at random. These fibrils have been studied with transmission and scanning electron microscopy. Negative staining of dispersed PE fibrils indicated that the fibrils have a core consisting of a small number of filamentous subunits. The core is surrounded by a fuzzy material which protrudes from the fibrils at regular intervals. This is the basis of the cross-bands of the fibrils. Staining with ruthenium red and alcian blue indicates that glycosaminoglycans are present, mainly on the surface of the PE fibrils. Tracer particles have been applied in vitro on lenses with PE. The distribution of the tracers in the PE material indicates that the fibrils are embedded in an interfibrillar matrix consisting of filamentous units. It is concluded that the PE material is made up of filamentous proteo-glycosaminoglycans. The fibrils represent relatively dense aggregates of such filaments, while the interfibrillar matrix is a gel of the same filamentous units in a loose, random arrangement.


Endothelial cell junctions in the ciliary body microvasculature. A freeze-fracture study in the rabbit. Endothelial cells of the microvasculature (arterioles, fenestrated capillaries, and small venules) of the rabbit ciliary body have been examined in freeze-fracture replicas in ultrahigh vacuum and at very low temperatures, with special regard to their junctional boundaries. The junctional complexes of fenestrated capillaries and venular endothelium are discontinuous and do not seal the interendothelial clefts. They cannot be compared with zonulae occludentes or tight junctions, while the junctions in the arteriolar endothelium are continuous and well organized, suggesting a very low degree of paracellular permeability. It would be of interest to know if these structural differences at the junctional level in each segment of the microvasculature correspond to different paracellular permeability properties.


Communicating junctions of the human sensory retina. A freeze-fracture study. Using the freeze-fracture technique communicating junctions could be identified between the cells of the adult human sensory retina. Communicating junctions with particles arranged in linear or circular rows as well as in small aggregates were found between adjacent photoreceptor endings. Communicating junctions with particles forming plaques were localized in the inner plexiform layer. They were isolated between unidentified cell processes or lay close to active sites of chemical synapses, thus suggesting the occurrence of "mixed" (chemical and electrical) synapses in this layer. Furthermore, communicating junctions were detected between portions of Müller's cells.


Postnatal development of the cat's retina: a concept of maturation obtained by qualitative and quantitative examinations. From a coherent morphological and morphometrical investigation of the postnatal development of the cat's retina, some main aspects are presented concerning the structures lying outside the outer limiting membrane, the neuropile layers and the nuclear layers. It is shown by means of qualitative and quantitative results, that the maturation process of the various cellular elements in the cat's retina can be devided into three phases and is presumably finished between the 4th to the 5th month of life.


[The influence of changes in body position on intraocular pressure, episcleral venous pressure, and blood pressure (author's transl)]. The intraocular pressure, the ophthalmic artery pressure, and the episcleral venous pressure increased after changes from sitting to recumbent body position, whereas the subclavian artery pressure remained unchanged or decreased slightly. Changing from recumbent to sitting position was followed by a decrease in IOP, ophthalmic pressure, and subclavian artery pressure.  Comparing the last measurement in the first position to the first value after change, it was found that the IOP alters by about 20%, the ophthalmic artery pressure by 15%, and the episcleral venous pressure by 50%. In all series a decrease in subclavian artery pressure was observed during the first 15 min. The mean pressure in the ophthalmic artery diminished in the series that changed from sitting to recumbent position, whereas it increased in the other series during the first 15 min. The episcleral venous pressure increased more than the corresponding IOP after changing to the recumbent position.


Human leukocyte and fibroblast interferon in a combination therapy of dendritic keratitis. Thirty-eight patients with virologically proven dendritic keratitis were treated using either debridement plus human leukocyte interferon (HLI) or debridement plus human fibroblast interferon (HFI) in a randomized, double-blind study. We administered one drop of HLI or HFI (1 X 10(6) reference units/ml) daily and found no significant difference in the action of either type of interferon.


Penetration of atenolol in the rabbit eye. The ocular penetration of topically applied [14C]-atenolol in the rabbit was determined by means of liquid scintillation counting. Only one eye was treated, the fellow eye serving as a control. Blood plasma levels were measured as well. The absolute amount of atenolol which penetrated the eye was very low, but a relatively high concentration was achieved in the tissues of the nictitating membrane. We could only detect an increase in the amount of atenolol with time in the aqueous humor. In all other ocular tissues, including iris and ciliary body, the atenolol level remained constant with time. Hardly any atenolol could be detected in the untreated eye and none in the blood plasma. These findings suggest that the ocular penetration of atenolol administered as an eye drop is very poor. Ocular penetration, therefore, hardly seems to play a part in the antiglaucomatous effect of atenolol.


Orbital volume after enucleation and eye volume in the adult rabbit. Of 21 mature, fully grown Dutch rabbits, seven were controls separated into two groups in which eye and orbital volumes were determined at 10 and at 18 months of age respectively. In the 14 remaining rabbits, enucleation of one eye was done at 10 months of age. Immediately afterward the eye volume was determined. These animals were killed at 18 months of age at which time the volumes of the remaining eye and of both orbits were determined. Within the limits of this preliminary experiment the following were noted. The mean eye volume was slightly greater at 18 than at 10 months of age. This was statistically significant. After enucleation of the eye at 10 months of age orbital volume of that side was similar to the opposite side at 18 months of age in the male rabbits. In the female rabbits there was a small significant statistical difference. The conclusions however, are that in the Dutch rabbit there is not a meaningful clinical volumetric difference in either the eye from 10 to 18 months of age or the orbit from 10 to 18 months of age with or without enucleation at 10 months of age.


Bandpass measurements in the electroretinographic electrode circuit. In the experiments in this study band-pass measurements in electroretinographic electrode circuits were done for the first time, according to the information presently available to us. Our experiments show that in the much faster band-pass assessment by analysis of sawtooth and square waves no major error is involved. It may be concluded from our results that the recordings of ERG potentials are not changed by the characteristic properties of the electrode circuit in the frequency range of interest.


[The role of glycogen in the donor eye (author's transl)]. Bovine eyes were conserved under donor eye conditions in a moist chamber for 48 h. Metabolite levels of glucose, fructose, glucose (glycogen) were determined in corneal epithelium and aqueous humour at certain times by enzymatic optical tests. The role of fructuse and glycogen as a nutrient metabolite responsible for the transparency and structure of the cornea is discussed.


The rate of CSF formation in man: preliminary observations on metrizamide washout as a measure of CSF bulk flow. Metrizamide, a nonionic, water-soluble contrast agent, was injected into the ventricular system of 3 patients with indwelling ventricular catheters and subcutaneous cerebrospinal fluid reservoirs. A first-order rate constant, k, for metrizamide washout from the right lateral ventricle was determined with reference to mean ventricular metrizamide concentration on serial CAT scans; right ventricular volume, V, was estimated after metrizamide injection by multiplying the appropriate ventricular area on consecutive CAT slices by the nominal slice thickness. The rate of right lateral ventricular CSF formation, If, in our 3 patients was calculated as k X V and ranged from 0.083 to 0.103 ml per minute.


Clinical evaluation of metrizamide for neuroradiology in chilren. Metrizamide is a nonionic water-soluble contrast medium for neuroradiological studies that is less irritating to the nervous system than other water-soluble agents. Studies in adults have shown that metrizamide has advantages over currently available media, but experience with children has been limited. Sixty-two children have had myelography or ventriculography using metrizamide. The children ranged in age from 11 days to 22 years. Technically satisfactory studies were obtained in every patient. No major complications were encountered. Minor side-effects included headache in 11 children (18%), mild nausea or vomiting in 16 children (26%), and fever in 4 children (6%). Seizures did not occur. One infant in the study subsequently died of unrelated problems; there was no evidence of arachnoiditis at postmortem examination. Metrizamide is a safe, effective contrast medium for neuroradiological use in children.