[Significance of kinetic abnormalities of erythrocyte pyruvate kinase in congenital deficiencies]. Kinetic studies of semi-purified pyruvate kinase were performed from the erythrocytes of 22 subjects with congenital non-spherocytic anemia with pyruvate kinase deficiency and 25 heterozygous relatives. The study of enzyme affinity for PEP with and without ligands fructose-diphosphate (FDP) and ATP allowed to separate three groups of patients: --in eight patients and their eleven heterozygous relatives, the PK kinetic characteristics were similar to those of controls. Allosteric properties of the enzyme were normal; --in three patients, PK was in an activated form, non sensitive to FDP activation and to ATP inhibition in the experimental conditions. The deficient enzyme seemed to be present in the "R" form; --in eleven patients affinity for PEP was decreased; the enzyme was in each case activated by FDP; however very high FDP concentrations did not allow to obtain a complete activation and an n Hill of 1. ATP inhibition was more important than in controls. Similar results were obtained in some heterozygous relatives. The pyruvate kineases of these patients seemed to be fixed in "T" form. Whatever may be the molecular abnormalities responsible for the PK deficiency, they seem to lead in many cases to a change in the enzyme allosteric properties.


[Relations between weight changes and various biological parameters. Results of a longitudinal epidemiological survey]. Weight changes over a three year period were measured on a group of about 1400 working men aged 46 to 52 years and related to several biological parameters (cholesterolemia, triglyceridemia, uricemia, glycemia and blood pressure). We observed: a) a slight increase in mean weight over the three year period; b) significant correlations between weight change and changes in these biological parameters. These results are compared to those found in cross sectional studies. Their implications for public health and prevention of ischemic heart disease are discussed.


[Study of the antibody-dependent lymphocytotoxicity test as a function of the nature of the antibodies]. It is well known that IgM antibodies are inactive for the LDA test. Moreover, this work showed 7 S IgM to be just as inactive as 19 S IgM. With HLA antibodies, usually IgG, this work showed that the LDA test was not inhibited by a temperature of + 15 instead of + 37 degrees C. With cold lymphocytotoxic antibodies 19 S and 7 S IgM the LDA test was negative even at + 15 degrees C (optimum temperature for these complement dependant lymphocytotoxic antibodies) with or without prolonged incubation. Under these same conditions, a negative result was obtained using auto-lymphocytes as a target. Finally, our results confirmed that IgM antibodies with anti-HLA activity could not act as mediators even for targets with corresponding HLA activity.


[Anticomplement activity of a polyanion: pentosan sulfuric polyester. III. Mechanism of functional inactivation of the different properdin and complement system fractions]. In vitro, the drug pentosan-poly-sulfoester (PPS) changes the electrophoretic migration of different proteins from the complement and properdin systems, such as native C3 (beta 1C globulin), C3c (beta-1A globulin), C3d (alpha-2D globulin), C1s inactivator (ClsINA), Clq and properdin factor B (B). Their more anodal migration is the consequence of a molecular alteration and persists after prolonged dialysis. These structural changes, yet undefined, explain the loss of functional activity of these proteins, and the anticomplementary activity of this drug. Moreover, PPS is able to block the alternate pathway activation by its action on properdin factor B (C3 proactivator). In fact, in presence of PPS, the activators of the properdin systems such as C3 nephritic factor are inactive. These altered mobilities are also responsible for the overestimation in the antigenic concentration of B (+ 45%), C4 (+27%) and C3/C3c (+ 14%), found in human serum containing 50 mg/ml of PPS. PPS has an original action upon the complement and properdin systems, which allows its clinical use as a potent inhibitor of the humoral mediators of inflammation.


[Immune sera, such as antilymphocyte serum, may contain antigen-antibody complexes]. Antilymphocyte sera, either allogeneic or xenogeneic, may retain the antigen used for the immunization of the animal producing the serum in the form of antigen-antibody complexes, at least when the animal is bled within the first two weeks following the last immunizing injection. Evidence for this has been obtained in vivo and in vitro (3). Thus, antilymphocyte injections may contain not only antibodies but the antigens used to prepare the serum as well, and active immunization to these antigens can result in the human or animal recipient. In the heart-allografted rat, pre-transplantation injection of immune complexes prepared from alloantisera prolongs graft survival. The filtrate from these complexes, presumably containing antigens, also prolongs graft survival when administered in conjunction with nonspecific immunosuppresive drugs after transplantation. These results, however, do not allow determination of whether the effect is active or passive, or perhaps both, nor what is the action of the complexes themselves.


[Rapid determination of serum iron concentration using bathophenanthroline sulfonate in a formate buffered system]. A simple accurate and very reproducible procedure for measuring serum iron concentration without precipitating serum proteins is described. In the same time, iron is released from serum transferrin, reduced and determined at 535 mn by incubation in a water bath at 55 degrees for five minutes within a formate buffered system (pH 2,6; i = 0,05) including bathophenanthroline sulfonate. This method yields values very similar to those obtained by that of the International Committee for Standardization in Hematology (ICSH).


Studies with a live influenza A vaccine in army personnel. A live attenuated influenza A vaccine, produced from an inhibitor-resistant recombinant strain, was administered intranasally to 46 volunteers from the Army during the southern winter of 1973. To compare the acceptibility, immunogenicity and efficacy of this vaccine, a killed subunit vaccine was administered to 20 volunteers, and an intranasal placebo to 45 others. Results indicate that the live intranasal vaccine was as well tolerated as the killed vaccine and that there was no evidence of shedding of virus from the nose in the 14 days following vaccination. Both the killed and the live vaccines stimulated the production of circulating haemagglutination-inhibition antibody, but antibody to neuraminidase was induced only by the live vaccine. No conclusions could be drawn about the efficacy of the two vaccines in producing local antibodies because these were largely undetectable by the methods used. Volunteers were followed for a 12-month period, which included the 1973 and 1974 influenza seasons, and an attempt was made to determine the virological aetiology of all their respiratory infections during this period. Epidemic influenza did not occur in thepopulation group from which these volunteers were drawn, so the comparative protection rates of the two vaccines could not be assessed.


Recent developments in hepatobiliary surgery. The surgical management of infants and children with hepatobiliary disorders has undergone some important advances in recent years. Careful assessment over long periods will be necessary to determine if the new procedures discussed will endow these children with a normal or near-normal life span, free of disease.


Primary deficiencies in humoral immunity. Patients with primary disorders of B lymphocytes and immunoglobulins usually display increased susceptibility to bacterial infections but atopic, autoimmune, and malignant disorders are also more common in these patients. The spectrum of these disorders ranges from a virtual absence of B cells and immunoglobulins to selective deficiencies of immunoglobulin subclasses. The diagnosis is dependent upon the demonstration of the immunologic deficits by specialized laboratory procedures which include the quantitation of immunoglobulins, the formation of antibodies in vivo and in vitro and the demonstration of B cells in the tissues or the peripheral blood. There are five major points in the management of these patients: (1) the delineation of the immunologic defects by laboratory testing, (2) the use of parenterally injected human immunoglobulins, (3) the rapid identification of infecting organisms and the prompt institution of appropriate antibiotic therapy, (4) screening the family for immunodeficiency in those cases which are of genetic origin, and (5) genetic counseling.


Disorders of leukocyte chemotaxis.

Disorders of leukocyte chemotaxis. The rapid accumulation of inflammatory cells at sites of microbial invasion or neoplastic transformation is a central event in immunologically-mediated host defense. The availability of methodology to accurately quantify leukocyte migration in vitro has allowed the disclosure of previously unrecognized clinical disorders, namely leukocyte dysmotility syndromes. Although this area of clinical investigation is in its infancy, one can identify several processes associated with abnormal leukocyte accumulation. Abnormalities of immune recognition, chemotactic factor production, cellular motility or inhibitors of chemotaxis have been identified in different human diseases. In the upcoming years, pharmacological intervention directed at correcting specific causes of leukocyte dysmotility may well enhance our ability to treat certain infectious, inflammatory, and neoplastic diseases.


Cutaneous manifestations of defective host defenses. Those caring for children should recognize that cutaneous findings are common in children with host defense defects. Atopic dermatitis, recurrent or persistent pyodermas, candidiasis and lupus-like syndromes, should signal the possibility of host defense deficiencies. Particularly the findings of atopic dermatitis and recurrent skin abscesses should alert the clinician to determine serum IgE levels and neutrophil chemotaxis in such patients. The triad of generalized seborrheic dermatitis, failure to thrive, and diarrhea in an infant should bring to mind Leiner disease or severe combined immunodeficiency disease.


Pulmonary single circulation dilution curves of T-1824, sodium, and tritiated water in intact piglets. In order to assess pulmonary endothelial permeability to sodium in the immature lung, 15 multiple indicator dilution curves were done in eight intact piglets. An indicator bolus consisting of T-1824, 22Na, and tritiated water (THO) was delivered into the right atrium and blood was sampled from the aorta. The concentration of sodium, expressed as a fraction of the quantity injected and of the corresponding fractional concentration of T-1824, was averaged for the samples prior to recirculation. The permeability-surface area product calculated from these data is 2.0 X 10(-5) cm sec-1, and is virtually identical with the value reported elsewhere for adult dogs. Extravascular lung water obtained from the triated water and T-1824 curves averaged 64%, whereas that obtained from the 22Na and T-1824 curves averaged 23% of blood-free lung water.


Nosocomial transmission of group B Streptococci in a newborn nursery. Group B streptococcal colonization of normal newborn infants increased from 22.5% within 20 hours of birth to 65.4% at the time of hospital discharge (P less than .001). In contrast, colonization in mothers did not change significantly between the time of admission to labor and delivery (27.7%) and the time of discharge (31.1%). Epidemiologic data suggested but did not prove that the mode of nosocomial transmission of group B streptococci among infants was cross colonization via personnel contact.


Trimethoprim-sulfamethoxazole compared to ampicillin in the treatment of shigellosis. Twenty hospitalized children between 1 and 11 years of age were enrolled in a comparative randomized evaluation of trimethoprim-sulfamethoxazole (TM-SM) and ampicillin for the treatment of shigellosis. Each drug was provided for five days. The group treated with ampicillin had significantly more stools per day (mean 21.25) compared to the TM-SM group (8.64). Treatment with TM-SM appeared to be associated with a more rapid reversion of stool cultures to normal, but these differences compared to ampicillin were not statistically significant. Review of all isolates of Shigella from our hospital revealed a marked decrease in sensitivity to ampicillin over the last six years. This pattern has been observed in other centers. TM-SM may be the best drug for the treatment of shigellosis in areas where multiple antibiotic-resistant organisms are common.


Fever produced in the rat by intracerebral E. coli endotoxin. E. coli endotoxin introduced into the brain ventricles or into various brain areas raises the body temperature of conscious rats. Endotoxin-sensitive sites were found within the anterior hypothalamus and the lower brainstem. The increase in temperature (delta T) after microinjection of endotoxin into the anterior hypothalamic nucleus was dose-dependent. Endotoxin injected into the ventricles produced monophasic hyperthermia, but microinjections into the anterior hypothalamus produced monophasic or biphasic types of hyperthermia. The second and third microinjections of endotoxin into the anterior hypothalamic nucleus subsequently caused higher responses in delta T, but not in the rate of temperature change. The effects of the fourth and furter microinjections were the same as those of the third, and no tolerance developed for 24 days. The observations of behaviour, vegetative reactions, skin temperature, and carbon dioxide production indicated that the rise in the rat body temperature induced by endotoxin represents fever and that the heat is gained, at an ambient temperature of 22 degrees C, mainly through skin vessel vasoconstriction. Aspirin abolished and reversed fever induced by endotoxin, while hydrocortisone was without effect.


Fever in rats after intravenous E. coli endotoxin administration. In conscious unrestrained rats, at an ambient temperature of 22 degrees C, oesophageal temperature was measured and temperature effect of single and repeated intravenous injection of E. coli endotoxin was examined. The first injection of endotoxin in a dose of 10.0 mug/rat did not change the rat body temperature. The second injection of this dose in the same animals repeated after 48 h produced fever. With following injections the fevers observed were less pronounced. The absence of fever after a single injection of endotoxin was accompanied by the rapid loss of pyretic activity of the rat plasma samples (bioassayed in rabbits). When fever was observed (48 h interval between endotoxin injections) the pyretic activity of the rat plasma remained unchanged for 90 min following endotoxin injection. It was concluded that after a single injection endotoxin is rapidly detoxified in the rat circulation while this process does not take place after the second endotoxin injection (48 h interval). The process of endotoxin detoxification can be depressed by the pretreatment with nitrogen mustard. Analysis of changes of skin temperature following endotoxin injections and the influence of aspirin on endotoxin-induced fever suggest that the fever observed was of central origin.


[Actinobacillus infections in swine (author's transl)]. Actinobacilli infections in pigs are relatively rare. Most cases were septicaemic in the first week of life. With increasing age manifestations after generalized infections were characteristic, such as arthritis, polyarthritis, endocarditis, nephritis, osteomyelitis and embolic pneumonia. Of 34 porcine strains 33 were identified as A. equuli and only one was identical with A. suis. The justification of retaining this species is discussed.


The urinary sodium: potassium ratio and response to diuretics in resistant oedema. Nineteen patients with severe oedema due to either cirrhosis of the liver or to congestive cardiac failure, who had failed to respond to previous diuretic therapy, were treated with either increasing doses of frusemide (Group A), or with frusemide in a fixed dose of 80 mg daily and increasing doses of spironolactone (Group B). In Group A there was an inverse correlation between the baseline 24-hr urinary sodium: potassium (Na : K) ratio and the 24-hr urinary potassium excretion during diuresis, and a direct correlation between the urinary Na : K ratio before and after diuresis. Thus, in patients of this group during diuresis, there was a significantly higher urinary potassium excretion in those with a baseline urinary Na : K ratio of less than 1, as compared with those with a ratio of greater than 1. In Group B a satisfactory diuresis was achieved without marked urinary potassium loss in those patients with a baseline urinary Na : K ratio of less than 1, whereas no diuresis was obtained in the two patients with a baseline urinary Na : K ratio of greater than 1. These results suggest that the measurement of the baseline urinary Na : K ratio is of help in determining the potential value of spironolactone in patients with resistant oedema.


A study of the effect of povidone-iodine on wound healing. The effect of dry powder povidone-iodine (Disadine D.P.) on wound healing was assessed experimentally and clinically. It did not interfere with wound healing macroscopically, histologically or mechanically in Wistar rats. One hundred and one patients undergoing 'clean' elective surgery were included in the controlled clinical study and povidone-iodine did not affect wound healing in any way. In the control group 4% of patients developed infection compared with none of those sprayed with povidone-iodine. No adverse reaction to povidone-iodine was seen in either study. This antiseptic offers a safe alternative to antibiotics for use at operation whenever there is risk of wound infection from operative bacterial contamination.


Zinc metabolism and thyroid status.

Zinc metabolism and thyroid status. Urinary zinc excretion was found to be increased in patients with thyrotoxicosis when compared to euthyroid individuals. This increase did not appear to be due to an increase in creatinine clearance and was found to be strongly correlated with an index designed to assess the severity and acuteness of the metabolic response of the body to hyperthyroidism. The potential clinical significance of this finding is discussed.


A new look at erythromycin.

A new look at erythromycin. This article reviews the current place of erythromycin in antibiotic therapy. Overall, erythromycin is thought to be underused because: (1) the fear of resistance has been exaggerated; (2) significant toxicity has been associated with only one derivative (the estolate); (3) newer antibiotics have very rarely been demonstrated to be superior to erythromycin. Erythromycin has an important place in treating acute upper and lower respiratory tract infections, acute otitis media, sinusitis, skin and soft tissue, osteomyelitis, prostatitis, infections due to Mycoplasma spp. and Chlamydia organisms, and infections due to anaerobes.


Barbiturates and serum calcium in the elderly. In a retrospective study, based on a biochemical survey of people aged 65 and over in a general practice, subjects taking a barbiturate preparation for indications other than epilepsy had a significantly lower serum calcium concentration than did those taking nitrazepam or diazepam. Ordinary doses of barbiturate may adversely affect vitamin D metabolism in the elderly.


Streptococcus agalactiae in urinary tract infections. Streptococcus agalactiae was found to be the cause of approximately 1% of urinary tract infections in a London teaching hospital in the 2 years studied. Of the forty-eight patients with this infection, forty-three were female. In nine patients  the infection followed renal transplantation while in nine others it occurred in the presence of chronic renal failure. The rest, who included seven females who developed the infection following hysterectomies, had other clinical conditions which could have predisposed to such infections. The rarity of urinary tract infection by S. agalactiae is in contrast to the high frequency with which the organism colonizes the normal urethra. Serotypes III and II were the predominant isolates in these patients with urinary tract infections; this corresponds to the distribution of the different serotypes in the genito-urinary tract of normal individuals.


Chromatin subunits from baker's yeast: isolation and partial characterization. The organization of proteins along DNA in chromatin of Saccharomyces cerevisiae (baker's yeast) was examined by analyzing the DNA and nucleoprotein products obtained after digestion of yeast nuclei with staphylococcal nuclease. Yeast DNA is digested in situ at regularly spaced cleavage sites about 160 base pairs apart. Nucleoprotein fragments were resolved and isolated by centrifugation on linear, 5-20% sucrose gradients. The predominant 11S component appears to be identical to chromatin "subunits" or "nucleosomes" isolated from higher eukaryotes, containing a 150-160 base pair length of DNA and approximately equimolar amounts of four proteins that coelectrophorese with calf histones H2A, H2B, H3, and H4, plus small amounts of three proteins that electrophorese similarly to H1 histones. Thus, the structural organization of the yeast genome is similar to that of more developed organisms, except for the smaller total repeat length. None of the yeast subunit proteins, including the possible H1 proteins, contains cysteine.


A bacteriophage system for screening and study of biologically active polycyclic aromatic hydrocarbons and related compounds. The usefulness of bacterial viruses for detecting substances that are potentially carcinogenic is reexamined as a model system for screening biologically active polycyclic aromatic hydrocarbons. A modification of the original assay procedure allows one to distinguish between aromatics that can modify the biological activity of infectious nucleic acids directly and those polycyclic aromatic hydrocarbons that require metabolic activation by Escherichia coli enzymes. The effect of chemical modification of several different polycyclic aromatic hydrocarbons, with respect to their biological activity in the phage assay system, is described. Among the 31 different compounds examined, (+/-)-anti-benzo[a]pyrene-7,8-diol-9,10-epoxide was the most potent inhibitor of infectious phage nucleic acid. The (+) and (-) isomers of the above racemic mixture did not differ significantly in their capacity to inhibit phage replication.


Biochemical characterization of a mutant lipoprotein of Escherichia coli. A lipoprotein mutant of E. coli K-12 has been characterized. The mutant lipoprotein was found to differ from the wild-type lipoprotein in the following respects: (i) it is present in an appreciable amount in the soluble fraction (275,000 X g supernatant); (ii) it lacks the covalently-linked diglyceride; (iii) it contains an unmodified cysteine which can be carboxymethylated in vitro; (iv) it undergoes dimerization and the dimer can be converted into monomeric form by reduction with 2-mercaptoethanol; (v) both the monomeric form and especially the dimeric form of the mutant lipoprotein migrate more slowly than the corresponding forms of wild-type lipoprotein in sodium dodecyl sulfate/urea polyacrylamide gel electrophoresis; and (vi) the mutant lipoprotein is not assembled into the murein sacculi, and this results in a greatly reduced amount of bound-form lipoprotein in the mutant. These data strongly suggest that the mutation has affected the primary structure of lipoprotein, in such a way that it is not modified normally, leading to the production of a structurally-altered lipoprotein deficient in covalently-linked lipid as well as a defective assembly of the altered lipoprotein into the rigid layer of the cell envelope.


Differential utilization of leucyl-tRNAs by Escherichia coli. The utilization of the isoaccepting species of leucyl-tRNA in protein synthesis has been examined in E. coli. Two minor leucyl-tRNA species, isoacceptors tRNA3Leu and tRNA4Leu, are the predominant species found bound to ribosomes during exponential growth in minimal medium. In rich medium, an increased proportion of tRNA1Leu is found bound to ribosomes. One species, tRNA5Leu, is always absent from ribosomes. In a mutant strain in which normal tRNA3Leu and tRNA5Leu are reduced or absent, tRNA1Leu is a major ribosome-bound species in minimal medium. Protein synthesis in vitro with RNA from E. coli further suggests that tRNA5Leu is rarely used for total protein synthesis; however, this species is active with RNA from MS2 phage. We propose that tRNA1Leu can substitute for tRNA3Leu under rapid growth conditions, and that tRNA5Leu is used minimally in total protein synthesis.


Rotational relaxation of 70S ribosomes by a depolarization method using triplet probes. Rotational relaxation on the microsecond time scale has been followed by a depolarization technique using the properties of the long-lived triplet state of covalently bound labels. Two triplet probes, which efficiently bind to ribosomal proteins, are described. The rotational correlation time of 70S ribosomes of Escherichia coli has been measured. The average hydrodynamic radius of the functionally active 70S particle in solution has been estimated to 147 A. A concentration dependence of the correlation time has been observed, which may result from an association of the 70S ribosomes to form 100S dimers.


On the process of cellular division in Escherichia coli: a mutant of E. coli lacking a murein-lipoprotein. A mutant of E. coli lacking a specific outer membrane lipoprotein was found. Both the free and the bound form have been lost in this mutant. No material that cross-reacted with antiserum against lipoprotein was detected by the Ouchterlony test. The mutant was defective in producing mRNA active for lipoprotein synthesis. The mutation leading to the loss of lipoprotein synthesis, referred to as lpo, seems to have arisen during production of an F'. The map position of lpo was at 36.5 min on the E. coli K12 map, in the order man, uidA, lpo, aroD, pps. The lpo mutant grew and divided normally and remained susceptible to bacteriophages lambda, phi80, P1, P2, the T series, and f1, f2, and MS2 in its male derivatives. The mutant was hypersensitive to EDTA and cationic dves and somewhat sensitive to detergents. There was considerable leakage of periplasmic enzymes but passive transport of beta-galactoside was unchanged. These physiological characteristics of the mutant suggest that lipoprotein is involved in maintaining the integrity of the outer envelope structure, by bridging the outer membrane and murein, but not in the vital processes of growth and division.


Synthesis and processing of an Escherichia coli alkaline phosphatase precursor in vitro. Alkaline phosphatase [orthophosphoric-monoester phosphohydrolase (alkaline optimum), EC 3.1.3.1] of E. coli was synthesized in a cell-free system, and the size of the direct translation product was analyzed. The product has a higher molecular weight than the mature alkaline phosphatase found in the periplasm. The direct translation product can be processed to the mature size by an E. coli membrane fraction; the processing activity copurifies with the outer-membrane fraction. The presumed precursor can dimerize to form active enzyme without being processed, and the resultant enzyme appears to be more hydrophobic than the mature enzyme. These findings are discussed in connection with the "signal hypothesis" proposed for the excretion of proteins across membranes.


Ribosome structure: localization of N6,N6-dimethyladenosine by electron microscopy of a ribosome-antibody complex. Antibodies to the minor nucleoside N6,N6-dimethyladenosine have been used to map a unique location of the nucleoside in the small subunit of the Escherichia coli ribosome. Antibodies were induced in rabbits by a nucleoside-bovine albumin conjugate and shown to be highly specific for the dimethyladenosine hapten. The antibodies were shown to interact with 30S ribosomal subunits from strain PR7, but not with subunits from its mutant strain TPR201, which is resistant to kasugamycin and lacks the two successive residues of dimethyladenosine normally found near the 3'-end of E. coli 16S ribosomal RNA. Electron micrographs of strain PR7 subunits, crosslinked by single IgG molecules, show a single binding site on the surface of the ribosome. This binding site is consistent with observations relating the 3'-end of the ribosomal RNA, binding of initiation factor IF-3 and messenger RNA, and mapping of specific ribosomal proteins.


The amino acid sequence of beta-galactosidase of Escherichia coli. The amino acid sequence of beta-galactosidase was determined. The protein contains 1021 amino acid residues in a single polypeptide chain. The subunit molecular weight calculated from the sequence is 116,248. The sequence determination, carried out mainly by conventional methods, was aided by complementation tests, by the use of termination mutant strains, and by a new immunochemical method. The five residue sequence Thr-Pro-His-Pro-Ala appears twice within the polypeptide chain, but no other striking homologous features are evident.


Replication of duplex DNA by bacteriophage T7 DNA polymerase and gene 4 protein is accompanied by hydrolysis of nucleoside 5'-triphosphates. Homogeneous preparations of phage T7 gene 4 protein catalyze the hydrolysis of dNTPs and rNTPs to NDPs and Pi in the presence of single-stranded DNA. Synthesis on single-stranded DNA by T7 DNA polymerase (DNA nucleotidyltransferase; deoxynucleosidetriphosphate:DNA deoxynucleotidyltransferase, EC 2.7.7.7) does not affect the hydrolysis of NTPs by the gene 4 protein. Gene 4 protein does not catalyze the hydrolysis of NTPs in the presence of duplex DNA, nor can T7 DNA polymerase use duplex DNA as a template. However, the two proteins together can replicate duplex DNA and, under these conditions, synthesis is accompanied by hydrolysis of NTPs. During synthesis on duplex templates in the presence of T7 DNA polymerase, gene 4 protein, dNTPs, and rNTPs, 4.2 NTPs are hydrolyzed for each dNMP polymerized. 2'3'-Dideoxy-TTP, an inhibitor of DNA synthesis, inhibits hydrolysis by the gene 4 protein during synthesis on duplex DNA, and beta, gamma-methylene-dTTP, an inhibitor of hydrolysis by the gene 4 protein, stops DNA synthesis on duplex DNA. The multiple activities of gene 4 protein are shown to reside in a single protein molecule.


Inhibition of histidyl-tRNA-adenosine triphosphate phosphoribosyltransferase complex formation by histidine and by guanosine tetraphosphate. Formation of the complex between the first enzyme of histidine biosynthesis from Salmonella typhimurium, ATP phosphoribosyltransferase [1-(5'-phosphoribosyl)-ATP: pyrophosphate phosphoribosyltransferase; EC 2.4.2.17], and histidyl-tRNA is shown to be inhibited by L-histidine and by guanosine-5'-diphosphate-3'-diphosphate in the presence of histidine. Higher histodine levels make guanosine tetraphosphate a more effective inhibitor. Relatively high concentrations of guanosine-5'-triphosphate also inhibit complex formation, but this inhibition is not enhanced by histidine. The possible implications of these observations with respect to the gene regulatory activity of this enzyme are discussed.


Hydrogen-bonded protons in the tertiary structure of yeast tRNAPhe in solution. Temperature-dependent lowfield proton magnetic resonance spectra of yeast tRNAPhe were recorded between 10 and 15 parts per million. Seven resonances of hydrogen-bonded protons disappeared reversibly under two sets of conditions where the selective broadening of tertiary structure resonances were predicted by temperature jump experiments. The seven resonances were assigned to the seven tertiary hydrogen bonds expected between 10 and 15 parts per million from the crystal structure of yeast tRNAPhe. Some of the non-Watson-Crick base pairs have unusual unshifted standard chemical shifts after the ring current contributions calculated from the crystal coordinates were subtracted. The differences of the chemical shifts of homologous tertiary structure base pairs in Escherichia coli tRNAfMet and yeast tRNAPhe give experimental evidence for details of the conformational differences postulated by model building on the basis of the x-ray coordinates of yeast tRNAPhe and sequence homologies.


An Escherichia coli mutant with a temperature-sensitive function affecting bacteriophage Qbeta RNA replication. We report the isolation of E. coli mutant capable of supporting replication of bacteriophage Qbeta at 33 degrees, but not at 40 degrees. Coliphages f2, R23, fd, and yamma formed plaques on mutant cells at both temperatures. Temperature-shift experiments showed that bacteriophage Q beta replication was blocked in the mutant within the first 20-30 min of infection. The defect did not prevent translation of the Qbeta polymerase gene or assembly of catalytically active Qbeta replicase molecules. In fact, mutant cells infected at 40 degrees hyperinduced replicase active both in vivo and in vitro. However, zone sedimentation of the in vivo RNA product showed it to consist of partially double-stranded material sedimenting at 9 S, with little or no viral 32S RNA. The 9S RNA was also found, along with a predominant peak of 32S RNA in parental cells infected at 40 degrees, but not in cells infected at 33 degrees. It thus appears that the temperature-sensitive component is required for viral RNA replication, but not for other RNA synthesis catalyzed by the replicase. Uninfected mutant cells grew normally at 40 degrees in nutrient broth, but not in glucose- or glycerol-minimal media. Revertants selected for their abillity to grow in minimal medium at 40 degrees also supported bacteriophage Qbeta replication at 40 degrees.


Genetic evidence for inducibility of recombination competence in yeast. Recombination between unirradiated chromosomes was induced by UV or x-ray irradiation of haploids followed by a mating with heteroallelic diploids of Saccharomyces cerevisiae. The selected event of intragenic recombination did not involve the participation of the irradiated chromosome and apparently was not caused by lesions introduced into the unirradiated chromosomes by some indirect process. The results favor the idea that recombination is repressed in the majority of vegetative cells and that one effect of radiation is the release of some factor(s) necessary for recombination. Consequently, the proportion of competent cells (i.e., cells able to recombine) in the population increases. This competent state seems necessary not only for the recombinational repair of radiation-induced lesions but also, since recombinants are produced in the absence of such lesions, for spontaneous recombination. Photoreactivation of the UV-irradiated haploids led to a decrease in the production of recombinants. Hence, lesions in the DNA appear to be responsible for the induction of the recombinational ability.


Brain protein metabolism and the acquisition of new patterns of behavior. Three cytoplasmic proteins (designated alpha, beta and gamma) in the goldfish brain consistently incorporated more labeled valine in animals that had acquired a new pattern of swimming behavior than in untrained animals. The changes were identified by double labeling techniques ([3H]valine injected into trained experimental animals and [14C]valine into untrained controls) and by gel-electrophoresis. Goldfish tested in a variety of control behavioral situations showed no detectable protein changes. The migration properties of alpha, beta, and gamma correspond to proteins having molecular weights of 37,000, 32,000, and 26,000, respectively. Two of the proteins (beta and gamma) were isolated, purified, and injected into rabbits. The antisera thus obtained were used: (i) to establish that the proteins are normal components of goldfish brain; (ii) to inhibit long-term retention of the behavior; and (iii) to demonstrate by immunofluorescence methods that the beta and gamma proteins are localized in certain cells at specific brain regions.


Disorders of phagocytic function: ultrastructural aspects. The electron microscopic changes in genetic and acquired disorders of granulocytes have been reviewed. In rare situations, such as the Chédiak-Higashi syndrome, there are bizarre giant lysosomes. In other conditions associated with abnormal phagocytic function, such as chronic granulomatous disease, there are no qualitative morphologic abnormalities. In chronic infection and in protein calorie malnutrition (kwashiorkor) granulocytes contain frequent Döhle bodies and cytoplasmic vacuolization. The development of new cytochemical methodology and the combination of electron microscopy with in vitro techniques offers the potential for further understanding of the relationship between cell structure and functional disorders of the granulocyte.


Free osteocutaneous flap from a rib to the tibia. A large bony defect of the tibia, covered with thin unstable scar, was repaired successfully with a free osteocutaneous flap composed of 10 cm of the ninth rib with a 9 X 6 cm area of overlying muscle and skin. Microvascular anatomoses were done between the intercostal vessels in the transplant and the anterior tibial vessels in the recipient area.


The preservation of close two-point discrimination in the interdigital transfer of neurovascular island flaps. Some possible reasons for the reported failures of digital neurovascular island flaps to provide normal (or near normal) tactile sensibility are discussed. Some technical variations which may improve the results are proposed. An illustrative case is reported in which there was transfer of intact two-point discrimination.


Successful treatment of Darier's disease by partial-thickness removal of skin. Excision of partial-thickness skin has resulted in definitive improvement in 3 patients with widespread Darier's disease. More than 3 years after surgery, the formerly pruritic and inflammatory areas which were malodorous and had pustular crusts with intertriginous vegetating growths, are now asymptomatic and apparently free of disease. The technical details of the procedure are described, and the results are interpreted in light of our ideas of the pathogenesis of the disease.


Deltovertebral flap to cover a large scalp defect: case report. A deltovertebral flap based on the perforating cutaneous branches of the posterior intercostal vessels (the exact opposite of the deltopectoral flap) was used successfully to cover a large scalp defect. The procedure is a rather hazardous one, due to the numerous stages and the awkward postoperative position. However, it may be used to repair the lateral aspect of the neck or the occipital region when a flap is necessary and other methods are not feasible.


Cross-arm triangular flaps for correction of adduction contracture of the first web space in the hand: case report. We describe the use of two oppositely-based, triangular, cross-arm flaps for primary coverage of a new first web space, created by releasing an abduction contracture of the thumb.


The significance of Jacques Lacan.

The significance of Jacques Lacan. The contemporary French psychoanalyst, Jacques Lacan, has offered a reinterpretation of basic Freudian concepts that is to a great extent based on the structural linguistics of F. de Saussure. Certain fundamental ideas of Lacan, such as his views that "the unconscious is structured like a language" and that "the unconscious is the discourse of the Other" are examined here, and an attempt is made to place them in perspective in psychoanalysis.


Brain damage in chronic alcoholism: a neuropathological, neuroradiological and psychological review. The review deals with the possibility of diffuse brain damage, not always clinically obvious, in chronic alcoholics. Some of its implications are discussed with special reference to the role of frontal lobe damage. The main areas of enquiry--neuropathological, neuroadiological and psychological - are considered in detail.


Noise, discomfort and mental health. A review of the socio-medical implications of disturbance by noise. The published work relating to effects of noice on man and animals is reviewed from the standpoint of mental health. Evidence from a number of different disciplines shows that the presence of meaning in the noise is of critical importance in determining the persistence of physical reactions to the noise. The existing evidence linking noise with mental illness is found to be unsatisfactory. The concept of annoyance and the relevance of noise annoyance to mental illness are discussed. Some specific suggestions for further work are put forward.


The stimulation of sheep monocyte mitosis in vitro by autologous plasma taken after surgery and the implantation of foreign material. When blood monocytes from sheep are grown upon glass in 100% autologous plasma they divide with low mitotic indices, but if the plasma is taken from the sheep three or four days after the implantation of a small Teflon or stainless steel cylinder, the maximum mitotic indices of the monocytes cultured in that plasma rise. Plasma collected from the sheep in the first two days after operation is often toxic to cultured autologous monocytes. An equivalent sham operation increases the mitogenicity of the plasma, but without a preceding toxic period. No consistent effects upon the numbers of circulating blood monocytes were noted following implantation operations. A hypothesis is presented which suggests that blood monocyte multiplication in vivo and in vitro is dependent upon (a) a lesion which causes cell attachment, and (b) a humoral component of the plasma which stimulates mitosis. Surgery, and the implantation of foreign materials will increase the concentration of such a substance in plasma.


Roentgen-tele-data: a radiodiagnostic recording system. A radiodiagnostic data-handling system with telephones connected to the hospital exchange is described. Time, date, and location of examination are automatically recorded. The system can deliver spoken instructions from the computer and warns if data are not valid. Diagnosis, their degree of verification, and cases of special interest are added at display terminals. Codes, equipment, and output are described. Costs represent 1% of the department's expenditures. Future plans include a booking sytem, rapid access, and on-line connection to the main data system.


Prostaglandin biosynthesis and catabolism in the developing fetal sheep lung. The prostaglandin biosynthetic and catabolic capacity of homogenates of lungs from fetal sheep of various gestational ages was measured. Prostaglandin biosynthesis was assayed by the deuterium-isotope dilution technique making use of mass fragmentography whereas prostaglandin catabolism was measured by the radioisotope-dilution method described previous (Pace-Asciak, C.R. and Rangaraj, G. (1976) J. Biol. Chem. 251, 3381-3385). Homogenates of lungs from fetuses of all ages tested (40 days to term) formed both prostaglandins E2 and F2alpha; although prostaglandin F2alpha was formed to a greater extent than prostaglandin E2 by the 40 days lung, prostaglandin E2 increased with increasing age until at term the ratio of both prostaglandins approached unity. Total prostaglandin biosynthesis (E2 + F2alpha) rose gradually with age (approx. 3 fold increase between 40 days and term). Prostaglandin F2alpha catabolism occurred mainly by the prostaglandin 15-hydroxy dehydrogenase pathway; this activity was detectable even at 40 days and remained unchanged up to 80 days. Prostaglandin catabolic activity rose sharply at 90 days (approx. 3 fold) with a maximum around 110 days (approx. 4 fold) decreasing back to 40 day levels by term (143 days). The increasing prostaglandin catabolic activity around 90-100 days in this species is discussed in relation to the hemodynamic changes in the lungs starting around this age and the appearance of surfactant. Prostaglandin catabolism might play an important role in the developing organ controlling steady state concentrations of prostaglandins during certain periods of organogenesis.


Distribution of T and B cells in thymus, blood and lymph nodes of the cat. The proportions of T and B cells in the thymus, blood and lymph nodes were estimated in cats from three months to three years of age. T cells were identified by formation of E rosettes with guinea-pig red blood cells and B cells by the presence of surface immunoglobulin (Ig) as shown by the mixed antiglobulin reaction. Using a double test, it was shown that these methods identify separate, non-overlapping cell populations. The proportions of T cells shown in the thymus ranged from 10-73 per cent, in the blood 5-62 per cent and in the nodes, 5-44 per cent. Cells with surface Ig ranged from 0-10 per cent in the thymus, 26-68 per cent in the blood and 32-18 per cent in the nodes. Two cats with lymphadenopathy had unusually high B cell counts and one cat with depletion of the thymus was deficient in peripheral T cells. Papain treatment reduced or abolished E rosette formation by T cells.


Some experimental surgical techniques on the alimentary tract of young pigs. The paper describes the surgical techniques used in the preparation of gastric, intestinal and caecal fistulae, intestinal re-entrant fistulae, gastric pouches and Thiry-Vella loops. A total of 189 pigs were used in the study ranging from 1 h to 16 weeks of age. All procedures were carried out under cyclopropane/oxygen anaesthesia.


[Surgical treatment of lumbosacral spondylolisthesis with gross displacement]. The authors studied the results of surgery for lombosacral spondylolisthesis with gross displacement. The technique of arthrodesis makes intersomatic fusion easy in displacement of grades II and III. This fusion, without reduction of the displacement, leads to good functional rsults climating low back pain, and most sciatic pain without which time would be necessary for posterior liberation at the olisthetic stage. The authors also believe that preliminary correction of displacement, although satisfying in orthopaedic terms but still difficult to achieve with current techniques, is at present rarely indicated.


[Superselective arteriography of the hip. Technic, normal appearance and 1st results in primary osteonecrosis of the femoral head]. The arteries vascularising the femoral head were selectively catheterised via the axillary, or left humeral route. Injection into the posterio circumflex artery revealed an interruption of the superior capsular branches in necroses of the femoral head at their onset. In the more develped lesions either a persistence of the obstruction of the capsular branches or a revascularisation was found.


[Ataxia telangiectasia (Louis-Bar syndrome)]. The Authors relate on a case of ataxia-telangiectasia, where appeared all the signs of this peculiar disease of the childhood. Finally they discuss on literature and pathogenesis.


Lymphocyte chimerism after bone marrow transplantation. Surface markers and in vitro function of donor and recipient lymphocyte subpopulations. Specific HLA antibodies were used to eliminate donor and recipient cells, respectively, from lymphocyte suspensions prepared from the blood of a child who had been transplanted with bone marrow from an HLA-A- and HLA-B-incompatible, HLA-D-compatible donor. About 70% of the lymphocytes were of donor HLA type, the remaining of recipient type. The phytohemagglutinin-responsive lymphocytes were exclusively limited to the lymphocyte population carrying donor-type HLA antigens. Membrane immunofluorescence investigations of the donor and recipient populations showed a low percentage of IgM-positive lymphocytes in the donor population and an extremely high proportion of IgM-positive lymphocytes in the recipient population. About 90% of the donor lymphocytes were T cells, as judged by their capacity to form rosettes between sheep erythrocytes and T lymphocytes; no cells in the recipient cell population expressed this ability.


[Progressive spinal amyotrophy. Nosographic problems]. After a bibliographical revue on progressive spinal amyotrophy the nosographical aspects of the various forms are discussed, above all the proximal ones. Considering personal observations, the conclusion is that a definite differences is the various forms of proximal spinal amyotrophy does not exist and today they are different expressions of the same illness.


A comparative study of the production of antibodies against human blood cells in animals of various species. In view of the importance of the species of animals used for the preparation of specific heteroantisera against human blood cells, comparative immunization experiments were carried out in goats, rabbit, chickens, guinea pigs, and rats, using lysates of leukocytes, granulocytes, lymphocytes, monocytes, and thrombocytes. The antisera obtained were tested by the indirect immunofluorescence technique. The strongest antisera were obtained in goats, but these antisera required extensive absorptions to make them specific for the immunizing cell, whereas rabbit antisera needed only few absorptions. Antisera from both of these animals could be rendered specific for lymphocytes, granulocytes and platelets. In the guinea pig only immunization with monocytes and granulocytes resulted in useful antisera, which were all specific for granulocytes after appropriate absorptions. Antisera obtained from rats could be rendered specific for granulocytes and lymphocytes by absorption. Antibodies against platelets could not be detected in any of the rat antisera. Chickens, however, produced strong anti-platelet antibodies. A specific anti-granulocyte antiserum could also be obtained in these animals. Specific anti-monocyte antisera could not be prepared from any of the animal sera. Immunizations with leukocyte lysate resulted in granulocyte-specific antisera in most animals but not in chickens. All antisera produced in chickens were specific for platelets. It can be concluded from these results that animals of different species may react very differenly to the antigens of some human blood cells.


The polyclonal B-cell-activating property of protein A is not due to its interaction with the FC part of immunoglobulin receptors. Protein A from Staphylococcus aureus bacteria was found to be a B-cell mitogen and a potent polyclonal B-cell activator (PBA) of antibody synthesis for murine lymphocytes in the absence of macrophages or T lymphocytes. It did not activate T lymphocytes. We investigated whether the interaction between protein A and the Fc part of Ig molecules was responsible for the PBA activity. Protein A failed to induce IgG synthesis in spleen cells from normal mice, even though it binds effectively to IgG molecules. Lymphocytes treated with anti-immunoglobulin antisera followed by protein A were not activated to a larger extent than non-pretreated cells, although only the former cells bound protein A. Finally, direct attempts to suppress the PBA property of protein A by blocking the Fc binding ability with serum or human gamma globulin failed. We concluded that protein A possesses two separate biological properties, namely to interact with the Fc receptor on Ig molecules and to act as a PBA, and these properties are carried out by different parts of the molecule. These findings confirm previous failures to find an active role of the Ig receptors on B lymphocytes in the triggering process.


[Report on the clinical testing of the delayed-action form of the neuroleptic agent moperone hydrochloride in 20 chronic psychotic patients]. The sustained release form of butyrophenone derivative moperone hydrochloride was tested within the scope of an open clinical study including 20 patients with mostly chronic, schizophrenic psychoses. Five patients were prematurely dropped from the trial for various reasons. Generally speaking, marked improvement was observed for the remaining 15 patients after the five-week test period as compared to previous neuroleptic medication. Three patients exhibited extrapyramidal reactions; no other side effects were observed. Gastric tolerance of the tablets was very good.


Pulmonary lymphangiomyomatosis. Demonstration of smooth muscle antigens by immunofluorescence technique. A case is reported of pulmonary lymphangiomyomatosis in 44-year-old woman presenting with progressive exertional dyspnoea, unproductive cough and haemoptysis. The patient showed no symptoms or signs of tuberous sclerosis, a condition often found in association with pulmonary lymphangiomyomatosis. A pulmonary biopsy specimen showed disruption of alveolar septa and fibrosis. Subpleural lymph vessels and pulmonary venules showed cuffs of spindle-shaped cells. The leiomyomatous nature of these cells was evident from their appearance and staining reactions with light microscopy, and the presence of smooth muscle antigens as demonstrated by immunofluorescence technique. Since the lesion is not restricted to lymphatics, but can also be present in blood vessels, the condition may more appropriately be designated as pulmonary angiomyomatosis.


Prolactin-like immunoreactivity: localization in nerve terminals of rat hypothalamus. Antibodies to rat prolactin were used in immunohistochemical studies of the hypothalamus and preoptic area of the rat. Evidence was obtained that a protein immunochemically related to prolactin was stored in networks of nerve terminals of many hypothalamic areas such as the arcuate nucleus, the dorsomedial hypothalamic nucleus, and periventricular regions of the hypothalamus and preoptic area. The neuronal storage of a prolactin-like protein in the hypothalamus was unaffected by hypophysectomy.


Mutagenic activity of nitrite-treated foods: human stomach cancer may be related to dietary factors. By the Salmonella typhimurium test, extracts of Japanese raw fish treated in the laboratory with nitrite showed mutagenic activity which is prevented by addition of ascorbate. Extracts from similarly treated beef and hot dogs were nonmutagenic. The data conform to a working concept that the high stomach cancer incidence in Japanese and certain other populations may be due to specific dietary factors of an alkylnitrosamide type.


Serum complement-like opsonic activities in human, animal, vegetable, and proprietary milks. Human, animal, proprietary, and soy milks are comparable to human serum C5 in opsonization of baker's yeast. Bovine milk and human serum opsonically reconstitute C5-deficient mouse serum. Such reconstitution is selectively inhibited by antiserum to human C5. Further characterization suggests that bovine milk contains material structurally and functionally similar, but not identical, to human C5.


Hemoglobin ontogenesis: test of the gene excision hypothesis. The gene excision hypothesis of hemoglobin ontogenesis was tested in persons with HbSC disease, with the use of monospecific fluorescent antibodies for the identification of hemoglobins S, C, and F in individual erythrocytes. The results are incompatible with the prediction that only one gamma- or beta-globin gene may be active in any single chromosome and provide further evidence for incomplete repression of gamma-globin genes lying cis to active beta-globin genes.


Experimental triggering of reproduction in a natural population of Microtus montanus. A nonbreeding winter population of Microtus montanus was given limited supplements of fresh green wheatgrass over a 2-week period. The population was sampled at the end of the feeding period and compared to an adjacent population receiving no grass supplements. All of the experimental females were pregnant, while animals from the control area remained in nonbreeding condition. Replication of the experiment during the next winter produced similar results. The data suggest that Microtus montanus cues reproductive effort from chemical signals in the plant food resources.


Maintenance dialysis and renal transplantation facilities in South Africa - July 1976. A survey undertaken at the end of July 1976 revealed that 22 hospital centres were treating 258 patients with chronic renal failure by haemodialysis, and 32 patients by peritoneal dialysis. In addition, 8 patients were receiving home dialysis. Five of the centres that had transplantation programmes were treating 224 survivors with functioning renal homografts.


Comparison of clofibrate with halofenate in diabetics with hyperlipidaemia. In a double-blind, randomized study which lasted 48 weeks the effects of clofibrate and halofenate were compared in maturity-onset diabetics with hyperlipidaemia. With the use of both clofibrate and halofenate serum cholesterol values were lowered only slightly. Both agents significantly reduced triglyceride values, but the decreases were modest and transient. Both drugs significantly lowered serum urate values, although the effect of halofenate was distinctly greater. Halofenate, but not clofibrate, had a considerable hypoglycaemic effect on the patients, most of whom were also receiving oral antidiabetic medicines. The drugs produced a number of clinical and biochemical adverse reactions, and in about 20% of all patients the trial had to be discontinued prematurely. The management of hyperlipidaemia in maturity-onset diabetics is briefly discussed, and it is concluded that neither clofibrate nor halofenate is to be recommended.


Modified techniques for the isolation of Dermatophilus spp. from infected material. Two improved techniques are described for the isolation of Dermatophilus spp. The first is suitable for samples of scab from lesions of the disease in animals, except for sheep affected with lumpy wool. The second is for the isolation of the organism from samples of lumpy wool in sheep. Both techniques are simple, rapid and reliable and are based on releasing the organism by pulverizing the scab and then by suppressing contaminants by including polymixin B sulphate in the medium. Excellent results are obtained with or without pre-incubation exposure to CO2.


Germination of Aspergillus fumigatus conidia in the lungs of normal and cortisone-treated mice. Inhaled conidia of Aspergillus fumigatus germinated in the lungs of mice at a low rate but both germinated and ungerminated spores were cleared. Spores germinated at a high rate in the lungs of cortisone-treated mice.


Aspergillosis in imported penguins.

Aspergillosis in imported penguins. An outbreak of aspergillosis in imported penguins caused by Aspergillus fumigatus is described. The birds probably acquired the infection from the country of origin or during their transportation. Predisposing circumstances are discussed.


[Electron microscopic presentation of immune reactions on Candida cells: asteroid bodies in Candida albicans from the urine of nephritis patients]. Candida albicans cells from the urine of two nephritis patients were concentrated and incubated with ferritin-labeled antihuman grammaglobulin (either anti-IgA, anti-IgG, or anti-IgM). Electron microscopy showed the electron-transparent yeast cell wall to be surrounded by an electron-dense capsule-like substance of remarkable volume. This must be regarded as an antigen-antibody precipitate corresponding to the "asteroid body" of previous authors. The antibodies involved in the formation of the precipitate are mainly those of the IgA and IgG classes. Considering the results of previous authors, the following definition is proposed: "Asteroid Bodies" are light microscopically visible antigen-antibody precipitates on the cell wall of fungi parasitic condition.


The wandering bullet.

The wandering bullet. Most bullets which enter the body usually exit or lodge within the soft tissues having traveled in a straight line. Management of such patients is usually a simple matter of repairing the injuries incurred during the passage of the bullet. Emphasis must be placed on the initial management of the patient and his life-threatening injuries. Secondly, localization of the bullet should be done. Lastly, determination as to whether the bullet should be removed should be based on the hazards of its staying in its present position versus the hazards of its attempted removal.


The predisposition to infection following hemorrhagic shock. Subsequent life threatening gram-negative infection in patients successfully resuscitated from hemorrhagic shock is becoming increasingly common. Following hemorrhagic shock and resuscitation, Sprague-Dawley rats were given Escherichia coli intraperitoneally to simulate the clinical setting in which peritoneal contamination and hypovolemic shock occur concurrently. A sublethal dosage of bacteria resulted in a 100 per cent mortality. This suggests that hemorrhagic shock, even when treated promptly and effectively, predisposes to infection.


Physiological considerations important for the management of vasospasm. The physiological mechanisms of known importance in the control of cerebral blood flow (CBF) and smooth muscle contraction and relaxation are reviewed. The pathophysiology of vasospasm following subarachnoid hemorrhage (SAH) is correlated with an alteration of these mechanisms. It is emphasized that smooth muscle relaxation is an energy-dependent process and that vasodilators require a functional smooth muscle membrane that may be severely impaired in ischemia or subarachnoid hemorrhage. The temporal profile of ischemia from spasm is correlated with the pathophysiology of altered metabolism of smooth muscle. The relevance of this complication to the timing of aneurysm surgery in 337 cases operated by one surgeon is considered along with various drug regimens suggested for its management.


Os odontoideum removed by a transoral approach. A case of atlanto-axial dislocation secondary to the presence of an "Os Odontoideum" is reported in which there was no history or evidence of trauma before the onset of symptoms. The treatment of this unusual clinical condition is discussed.


A new assay for T-cell mediated immunity to transplantation antigens. The kinetics of circulating antigen sensitive T-cells were studied in Hartley strain guinea pig recipients of Shorthair strain first- and second-set skin allografts. Peripheral blood donor antigen sensitive T-cells (AST) were quantitated by the antigen-stimulated active rosette-forming T-cell (AgARFC) assay by incubating lymphocytes in the presence and in the absence of soluble transplantation antigens. The number of circulating AST/cu mm rose to maximum levels (1,165 +/- 272 SEM) by day 3 and fell sharply before first-set graft rejection (453 +/- 117 SEM) on day 7 after transplant. In contrast, there were no detectable antigen-sensitive cells when lymphocytes from both recipient and control guinea pigs were stimulated with soluble recipient-strain antigen. Significant numbers (212 +/- 159 SEM) of circulating AST remained through day 68 after first-set grafts. Following placement of sencon-set allografts on day 73, the AST disappeared from the circulation for 2.5 days and then rose to peak levels (825 +/- 167 SEM) in circulating AST (579 +/- 327 SEM) preceded rejection of second-set skin allografts. When control guinea pigs were immunized with a single dose of soluble donor antigens, a progressive increase in circulating AST (579 +/- 327 SEM) was found through day 17 after sensitization without the fall associated with graft rejection. The antigen-stimulated, rosette-forming T-cell assay may prove useful in the detection of cellular presensitization and in the monitoring of graft rejection in clinical transplantation.


The effect of antibiotics on cell-mediated immunity. Normal human lymphocytes in culture were stimulated by the addition of phytohemagglutinin, and deoxyribonucleic acid (DNA) synthesis was measured by the incorporation of tritiated thymidine. The effect of 11 commonly used antibiotics on DNA synthesis then was measured by adding each antibiotic to the culture in concentrations ranging from 2 to 64 microng/ml, a range which covers the plasma levels obtained during customary clinical therapy. Severe dose-dependent suppression of DNA synthesis was found in the presence of two preparations of minocycline, oxytetracycline, and the ascorbic acid salt of tetracycline. Less severe but stil significant suppression was found in the presence of chloramphenicol, clindamycin, tetracycline, and ascorbic acid alone. No effect was noted when penicillin, carbenicillin, or cephalothin was added, and slight stimulation was found in the presence of gentamicin. It is postulated that these findings may help to explain fungal and viral superinfection following antibiotic therapy and that they may play a role in the failure of antibiotic therapy to eliminate some infections.


[Dextraposition of the aortic arch combined with atresia of the left brachiocephalic truncus, a contribution to the varieties of the aortic arch (author's transl)]. We report on a case of a 62-years old woman with dextroposition of the aortic arch and an atresia of the left brachiocephalic truncus. In opposite to the varieties of the supraaortic vessels, which are in most cases occasionally seen, this patient suffered from cerebrovascular insufficiency and subclavian-steal-syndrome. We suppose, that this late manifestation of a variety of the aortic arch with an atresia of a great supraaortic vessel is caused by the brain's physiosclerosis. The correction was made by a 8 mm dacron prosthesis from the ascending aorta to the left subclavian-carotid junction.


[Bronchospirometric results after single lung homotransplantation in dogs with experimentally induced pulmonary emphysema (author's transl)]. Pulmonary emphysema was induced in 8 bastard dogs by intratracheal instillation of Papain. Development of emphysema was documented by pulmonary function tests. The emphysematous animals underwent single lung homotransplantation. Postoperative bronchospirometric measurements revealed that up to the 6th week after transplantation there is no evidence of serious ventilation perfusion inbalance.


Involvement of MHC-linked hemopoietic-histocompatibility genes in allogeneic bone marrow transplantation in mice. Genes controlling resistance of irradiated mice of allogeneic hemopoietic cells were mapped within, or closely linked to the D region of MHC and were designated Hemopoietic-histocompatibility genes (Hha). Hhp genes responsible for resistance to parenteral hemopoietic cells had also previously been detected on the D-end of MHC. Hh genes are regarded as determinants of cell surface antigens (Hh antigens) phenotypically expressed, in contrast to Histocompatibility antigens (H antigens) only on blood-forming and leukemic cells. The inheritance of Hh genes is not codominant, unlike thformed on peripheral blood lymphocytes and platelets. Sixteen Tunisian families were typed with 37 patients and 108 relatives. Genetic transmission of the disease of the HLA system seemed to be independent in this study. Comparison of HLA gene frequencies (unrelated) parents of patients and a control population showed no difference, proving that there is no clear association in population between deleterious XP genes and a particular HLA gene. However, an excess of identical HLA among pairs of diseased siblings would suggest that the disease is polymorphic and a form of the XP could be linked to HLA.


Isomeric specificity of diphenylmethylpiperidine in the production of rat pancreatic islet cell toxicity. The relationship between chemical structure and the pancreotoxic potential of positional isomers of diphenylmethylpiperidine was investigated in rats. The chemical synthesis of these compounds and their N-methylated analogs is reported. Oral administration of 4-diphenylmethylpiperidine and its N-methylated derivative (130 and 260 micronmoles/kg) to rats for 14 days resulted in hyperglycemia, reduced pancreatic insulin content and the formation of large vacuoles in the cytoplasm of pancreatic islet cells. No effect on beta cell morphology or insulin content was observed after administration of 2- and 3-diphenylmethylpiperidine and their N-methylated analogs.


Electron microscopy of free-floating cells: thin-layering technique, and selection of individual cells for ultramicrotomy. A rapid and accurate procedure for electron microscopy of individual cells from suspensions (blood, peritoneal exudate, etc.) is described. After fixation of the sample with standard techniques, the particulate constituents are suspended in buffered 5% bovine serum albumin, thin-layered by gravity on clear supports (cover glasses or polyester slips) in which an orientation grid had been scored, and then immobilized by exposure of the preparations to acrolein vapors. The specimens are examined for cells of interest under a light microscope using interference or phase contrast; individual cells to be sectioned are documented in three photomicrographs taken at different magnifications. After this the specimens are embedded like ordinary cover slip preparations. When examining the face of the polymerized block under a light microscope, the position of the selected cell beneath the orientation grid relief can readily be relocated by the aid of the pre-embedding reference micrographs.


Better epoxy resin embedding for electron microscopy at low relative humidity. In the absence of other factors known to influence sectioning properties, high environmental relative humidity is shown to yield poorly embedded tissue. Humidity-related effects are avoided if the following embedding precedure is used; impregnate tissues using the following solutions 1) 70% alcohol - 5 minutes, 2) 95% alcohol - 2 x 15 minutes, 3) absolute alcohol - 3 x 20 minutes, 4) acetone - 2 x 15 minutes, 5) 1:1 mixture of acetone-epoxy resin (DDSA, 63.4 g; Araldite 502, 5.6 g; Epon 812, 39.4 g; DMP-30, 2.6 g) - 1 hour, 6) acetone-epoxy resin 1:3 - 1 hour, 7) epoxy resin - 1 hour; complete the preparation of blocks as follows 8) when tissues have been oriented in epoxy resin in flat embedding molds, place molds in one evacuated vacuum desiccator 10 cm above a 2 cm layer of Drierite for 24 hours at room temperature, 9) raise temperature to 60 C and maintain for 3 days to cure resin.


A modified techinque to study leaf epidermis in Triticeae. A rapid modified method is described to study stomata and other epidermal features without elaborate processing. The preparations are semipermanent and permit spatial relationship studies of both leaf surfaces from the same field. The cleared preparations are optically sectioned with brightfield or Nomarski interference contrast techniques without staining for contrast. The technique permits superior tissue resolution, clarity, minimal distortion of sections, and preservation of trichomes. The method is applicable to all species of Triticeae.


[Retrospective analysis of the clinical relevance of the Kiel classification of malignant non-Hodgkin's lymphomas (author's transl)]. 405 cases with non-Hodgkin's lymphomas have been diagnosed according to the Kiel classification and analysed retrospectively. 314 patients with non-Hodgkin's lymphomas of low-grade-malignancy (chronic lymphocytic leukemia, lymphoplasmacytoid, centrocytic, centrocytic, centroblastic-centrocytic lymphoma) manifested significantly higher median survival times than the 91 patients with non-Hodgkin's lymphomas of high-grade malignancy (lymphoblastic and immunoblastic lymphoma). Within the group of patients with low-grade malignant lymphomas distinct prognostic differences were found whereas survival times in patients with lymphoblastic or immunoblastic lymphomas were rather similar. The lymphoblastic lymphoma showed a bimodal curve of age distribution whilst all other lymphomas had a maximum of incidence in the seventh decade of life. Increased frequency of B-symptoms did not necessarily represent an unfavorable prognostic factor for the lymphoma entity concerned. Except for chronic lymphocytic leukemia the highest incidence of initial bone marrow involvement was seen in lymphoplasmacytoid, centrocytic and lymphoblastic lymphomas. Centrocytes have been observed in peripheral blood of patients with centrocytic and centroblastic-centrocytic lymphomas, even though lymphocytosis did not exist. Monoclonal hypergammaglobulinemia was found in only 43% of the sera from patients with lymphoplasmocytoid lymphoma. In this disease, it was possible to differentiate between a lymphonodal, a splenomegalic and an extranodal manifestation.


[Results of radiation therapy in Brill-Symmers' disease with special consideration to histological grading (author's transl)]. Histological preparations from 22 irradiated patients with gigantofollicular lymphoblastoma Brill-Symmers have been reviewed and graded in  accordance with the Kiel classification 1974. Corresponding to this, 19 patients had centroblastic-centrocytic lymphoma and three a centroblastic sarcoma. In the three sub-groups of centroblastic-centrocylic lymphomas, no essential differences were found in stages I-III with respect to anamnesis or clinical findings before the onset of treatment, or to the previous course of the disease. Centroblastic sarcoma, ranging among the lymphomas with a high degree of malignancy, has manifested unfavorable progressive courses in all patients.


[Prevention of recurrence in the treatment of flap fibroses]. Compared with the results of former follow-up examinations, the use of modern techniques of plastic surgery has resulted in reducing considerably the recurrence rate of flap fibroses. They permit to apply the principle of preventive transplantation of skin or mucosa to the whole of the denture-supporting area in danger of insult. The use of free mucosa grafts offers a number of advantages. Further reduction of the recurrence rate by this new technique may be expected from an improvement in prosthetic after-care and from a more generous excision of the mucosal areas in danger of insult.


[The problem of pre-prosthetic surgical procedures following neoplasm surgery in the maxillofacial area]. The author reports of 215 patients with oral malignant tumour of whom 21.5% needed preprosthetic-surgical measures. The indication for preprosthetic-surgical intervention is determined by the site and the size of the tumour and by the method used for the primary operation. Some preferred surgical techniques are discussed.


Simple hypothermic preservation for transporting human livers long distances for transplantation. Report of 12 cases. Since 1973, 12 patients in the Cambridge-King's College Hospital liver transplant programme have received livers from donors dying in hospitals considerable distances from the transplant centre in Cambridge. The method of preservation used to transport these livers from 35 to 110 miles was flush perfusion with plasma protein fraction and hypothermic storage in ice. The ischaemia times ranged from 2 hr and 42 min to 4 hr and 22 min. All of the recipients had good or excellent postoperative function of the grafts and 6 of the 12 recipients are alive, the longest survival being 29 months. The preservation technique is simple and easily portable and has given reliable 4-hr preservation of the human liver.


Controlled trial of aspirin in cerebral ischemia. Adouble-blind trial of aspirin for the treatment of cerebral ischemia was begun in 1972 and continued for 37 months. This was accomplished despite difficulties in controlling a long-term study of a drug which has widespread availability and consumption. The study design, criteria for selection of patients, follow-up surveillance, and methods of data analysis are presented. We report only subjects without carotid surgery before randomization. Patients (178) who had carotid transient ischemic attacks (TIAs) were randomly allocated to aspirin or placebo and followed to determine the incidence of subsequent TIAs,death, cerebral infarction or retinal infarction. Analysis of the first six months of follow-up revealed a statistically significant differential in favar of aspirin when death or cerebral or retinal infarction and the occurrence of TIAs were grouped and considered together as end points. Significance in favor of aspirin treatment was mainly revealed in patients with a history of multiple TIAs and was most evident in those individuals having carotid lesions appropriate to the TIA symptoms. It cannot be inferred from this study that aspirin prevents stroke because when end points were restriced to death or cerebral or retinal infarction, there was no statistically significant differential between the aspirin and placebo treatments.


Monitoring of cerebral perfusion during anesthesia by time-compressed Fourier analysis of the electroencephalogram. Time-compressed Fourier analysis of the electroencephalogram has proven to be a useful analytical procedure during anesthesia and surgery which simplifies data interpretation by presenting the EEG in a time-compressed frequency domain rather than the conventional time domain. This method of data analysis graphically accentuates the electroencephalographic correlates of ischemia-induced cerebral dysfunction and other cerebral oxygen consumption abnormalities. The ability to accentuate trends in frequency and power is derived from sequential plotting of spectra to produce a graph with three dimensional axes of frequency, time, and power. In carotid endarterectomies the system has proven more useful than the conventional EEG in assessing the need for a vascular shunt to maintain internal carotid flow during endarterectomy. In open-heart surgery time-compressed EEG spectral analysis has allowed early recognition of cerebral ischemia resulting from arterial hypotension and venous hypertension. Five cases are presented which demonstrate the ability of our system to reflect developing cerebral ischemia.


The alloantibody response and active enhancement of some rat renal allografts. Lewis rats that were given injections of 10(6) to 10(8) (Lewis X Brown Norway) F1 hybrid bone marrow cells produce predominantly, if not exclusively, 19S lymphocytotoxic antibodies. A number of Lewis rats that received transplants of perfused renal allografts from bone marrow donors at, or near, the peak of IgM response survival for well over 200 days with good renal function and no histological evidence of chronic rejection. All long-surviving rats had detectable lymphocytotoxic antibodies up to 120 days after allografting; late enhancing antibodies had the restricted specificity possibly identical or similar to anti-I region antisera. All rats bearing prolonged renal allografts were unable to accept donor-specific skin grafts or to respond with specific lymphocytotoxic antibodies following skin grafting. The possible involvement of non-complement-fixing 19S alloantibodies in active enhancement of rat renal allografts is discussed.


Secretory capacity and ultrastructure of rat pancreatic islets after preservation of pancreas in different conditions. Experiments were performed with rat pancreas to investigate optimum conditions for obtaining and preserving the pancreas for subsequent isolation of islets that were viable by both functional and morphological criteria. After only 30 min of warm ischaemia, the yield and viability of islets that could be isolated were poor. However, if the pancreas was removed and placed immediately in a cold bicarbonate-buffered medium, which was supplemented with HEPES to maintain the pH and Trasylol to inhibit proteolytic activity, then viable islets could be isolated consistently after over 8 hr of storage. These results demonstrate that even short periods of warm ischaemia will render the pancreas unsuitable for islet isolation. Once the pancreas is placed in a suitable cold medium, however, considerable delay may be permissible without adversely affecting the viability of the islets which can be obtained. The same conditions might prove to be applicable when human pancreas is obtained for the purpose of transplantation into diabetic subjects.


Allogeneic lymphocyte-dependent antibodies (LDA). Specificity of Fc receptors. Cellular receptors for the Fc fragment of IgG have been studied by the erythrocyte antibody (EA) rosette technique using either human red blood cells coated with anti-D IgG alloantibodies or pigeon red blood cells coated with aggregated IgG. Human lymphocytes were shown to form 4 to 35% of anti-D EA rosettes and 15% of E-aggregated IgG rosettes. Anti-D EA rosette values depended closely upon the amount and the source of anti-D antibodies, Ripley's type antisera giving the highest percentage of rosettes. Cell filtration through a nylon-wool column, a procedure known to remove B cells, caused a complete depletion of E-aggregated IgG rosettes and significant but only partial decrease of anti-D EA rosettes. A low but significant percentage of double rosettes were formed when anti-D-coated erythrocytes were mixed with aggregated IgG coated red blood cells or sheep red blood cells. Removal of EA-rosette-forming cells by passage on a Ficoll-Hypaque gradient K cell activity (assessed by lymphocyte-dependent antibody cytotoxicity using anti-HLA antibody-coated target cells) even when forming rosettes at low levels of erythrocyte sensitization with anti-D serum. Conversely, B cell markers (erythrocyte antibody complement rosettes or surface Ig) were only decreased at high levels of erythrocyte sensitization and remained unaffected after depletion of EA-rosette-forming cells formed at low levels of erythrocyte sensitization. These data suggest the existence of several populations of Fc receptor-bearing cells in human peripheral blood which may be differentiated according to the degree of erythrocyte IgG sensitization. Rosettes made with low concentrations of anti-D serum are mainly formed by non-B cells endowed with K cell activity, whereas those formed with high concentration of anti-D serum include B cells, monocytes, and K cells.


Lectin-dependent cellular cytotoxicity in man. Human peripheral blood leukocytes are cytotoxic to 51Cr-labeled target cells provided phytohemagglutinin is present in the reaction mixture. The lectin-dependent cellular cytotoxicity (LDCC) phenomenon is characterized by (1) the short duration of the assay (2 to 4 hr), (2) revealing potential cytotoxic cells present in the cell preparation and excluding participation of mitogen-induced polyclonal activation of effector cells generated during prolonged assays used in mitogen-induced cytotoxicity, and (3) using nonerythrocyte target cells. The effector cells that mediate LDCC were characterized by several cell fractionation procedures. Fractionation of Ficoll-Hypaque separated peripheral blood leukocytes on polystyrene bead columsn or on nylon fiber columns which remove monocytes, granulocytes, and immunoglobulin-bearing leukocytes did not remove the LDCC activity. Polymorphonuclear leukocytes preparations were devoid of LDCC activity. Enrichment for T cells by E rosette sedimentation demonstrated that LDCC activity is present in both the T cell-enriched fraction and the non-T cell fraction. Nylon column eluted non-Ig-bearing cells which were subsequently depeleted of T cells by E rosette separation were LDCC positive. Depletion of Fc-bearing leukocytes on EA monolayers removed the LDCC activity. These results demonstrated that two populations of Fc-bearing cells of thymus and nonthymus origin mediate LDCC. Normal and malignant cells of immune and human origin were good targets in LDCC. The wide range of sensitive target cells in LDCC makes this test feasible in a completely autologous or syngeneic system. The significance of the LDCC phenomenon in assessing cell-mediated immunity is discussed.


Correlation of spontaneous leukocyte blastogenesis with human renal allograft rejection. Spontaneous blastogenesis of peripheral blood mononuclear cells in recipients of renal allografts was studied by incorporation of 3H-thymidine. Three different levels of reactivity were observed that correlated with the patient's clinical course. Low levels of blast activity (i.e., median 680 dpm/million cells with 95% confidence interval (CI) of 480 to 880 dpm) were observed in pretransplant patients. A moderate elevation (median 3,00 dpm with CI of 2,300 to 5,300 dpm) was noted post-transplantation during quiescent intervals and following the onset of acute reversed rejection. Marked elevations, i.e., values greater than 10,000 dpm frequently were observed within 6 days prior to rejections (median 21,000 with CI of 7,400 to 34,000 dpm) and during sustained rejections (median 14,000 with CI of 8,800 to 19,600 dpm).


[Agglutination reaction of T. cruzi, T. cruzi like Strains, T. rangeli and T. conorhini with Soja hispida lectin and Aaptos papillata protectin (author's transl)]. Protectin from the sponge Aaptos papillata (Keller) was used in the characterization of five strains of T. cruzi (Venezuela, Guatemala, Y. Brasilien, Peru, Wien) and six T. cruzi like strains (Triatoma, Maryland, ITMAP 943, FH4, FH5, LN). Based upon their membrane receptors, these T. cruzi and T. cruzi like isolates could be differentiated from rangeli (Venezuela Strain) and T. conorhini (Hawai Strain) by agglutination reaction to the proctectin. Furthermore, after pronase treatment T.rangeli could also be distinguished from T. conorhini by agglutination test with A. papillata protectin and also Soja hispida lectin. It is not possible to differentiate the T. cruzi complex with S. hispida lectin, because it did not agglutinate T. cruzi (Vienna Strain) and T. cruzi like (Maryland Strain). However, after treating this human pathogenic strain with pronase the pseudocrypt antigen of the first order is made available to the S. hispida lecting thereby producing agglutination. The T. cruzi like strain however did not agglutinate with this treatment. On the other hand, while T. rangeli did not agglutinate even after pronase treatment, T. conorhini showed the agglutination reaction. This observed reaction is explained by the availability of the pseudocrypt antigens of the first order after pronase treatment.


Studies on Theileriidae (Sporozoa) in Tanzania. VI. Second field trial on immunization against cattle theileriosis. Nine cattle, immunized by an infection and treatment method with 3 strains of Theileria parva (Muguga, Kiambu 5 and Serengeti transformed) and nine controls, were exposed to natural tick infestation in Tanzania. All controls contracted fatal East Coast Fever within 2 months of exposure. All immunized animals survived the period of exposure (over 2 months), but later one died of ECF, one of heart-water, one of an undetermined cause (not a theileriosis), and one disappeared from the herd. The 5 remaining animals survived for over 3 months after exposure ended. It is thought that this method of immunization is of value in protecting valuable animals at risk. An attempt to immunize against pathogenic Theilereia mutans, by injecting blood containing an apathogenic strain of this parasite, gave inconclusive results as no pathogenic strains were encountered during the trial.


On the inheritance of susceptibility for infection with Wuchereria bancrofti in Culex pipiens fatigans. From a colony of C.p.fatigans from Monrovia showing 21.6% susceptibility of W. bancrofti a refractory strain could be selected but not a highly susceptible one. Experiments to select a refractory strain out of the highly susceptible colony from Delhi failed. From these results and those of the crossing experiments between the selected refractory strain from Monrovia and the Delhi colony it appears that in the mosquito population from Monrovia susceptibility for W. bancrofti is not dominating refractoriness while this is the case in the population from Delhi. Therefore, it is concluded that there will be at least two genetic factors controlling susceptibility for W. bancrofti in C.p.fatigans.


Epidemiological investigations of Bancroftian filariasis in the coastal zone Liberia. A survey in 5 study areas along the Liberian coast was conducted to gain information on the prevalence and importance of bancroftian filariasis. The examination of 2675 persons revealed prevalence rates between 2% and 37%. The median microfilarial densities (MfD50) ranged from 5 to 24 microfilariae in 20 mm3 capillary blood  taken between 20.30 hours and midnight. Catalytic curves fitted to age-specific infection rates were used to estimate incidence (1% to 3%) and recovery rates. It was extrapolated from the survey results that in a population of 71,0000 there are 16,0000 to 20,0000 infected with Wuchereria bancrofti. An estimated 2500 to 40000 men suffering from hydroceles and 3700 to 40000 elephantiasis patients demonstrate that bancroftian filariasis has to be regarded a health problem in rural coastal Liberia.


Anterior urethral injuries: secondary reconstruction. Secondary reconstruction of anterior urethral injuries should be delayed for 6 to 12 weeks after injury. Traumatic strictures of the urethra are repaired by application of full-thickness skin grafts by either incision of the stricture and patch graft or by excision of the urethra and tube graft, depending on the density of the urethral scar or defect.


[Report of 100 total prostatectomies (author's transl)]. A total retropubic prostatectomy is an exact, clearly defined operation, which, in our hands, has been extensively standardized: it lasts an average of 1 1/2 h, results in relatively little blood loss-in only 20% of the cases is one or more units of whole blood utilized-and is accompanied by complications that are kept within tolerable boundaries. Complete enuresis can be avoided by using a particular stitching technique for the outlet of the bladder. A considerable incontinence occurred in only one patient, who during the day was temporarily forced to wear a Cunningham clamp. In the postoperative stationary phase, mortality was 2%. A radical prostatectomy makes complete recovery from cancer of the prostate possible without mutilation and without aggravating functional injuries. It has, therefore, a secure place in the surgical therapy of cancer.


Gibbons ureteral stent in renal transplant recipients. The Gibbons indwelling ureteral stent was used in 5 renal recipients. Early  post-operative obstructions at the ureterovesical junction in 2 cases and 1 at the ureteroplevic junction were treated by placing the stent through an open cystostomy. Late strictures were treated in 2 patients by inserting the stent endoscopically. It was also used to stent a ureteroureterostomy. After removal of the stent in 2 of 3 patients, no further treatment of the obstriction was required. In the third case it provided time to allow the steroid dose to be lowered so definitive repair could be undertaken. One stent has remained patent for fourteen months. The Gibbons stent appears to be a valuable new tool in the treatment of post-transplant ureteral obstruction.


Experience with Devine-Horton dermal patch graft for Peyronie's disease. Peyronie's disease is a malady frequently seen by the urologist. Many conservative treatment modalities have yeilded successful alleviation of symptoms in a significant number of these patients. A number, however, do not respond and are left with penile curvature and pain on erection such that intercourse is severely impaired. Devine and Horton have proposed resection of the plaque with replacement of the defect with a full-thickness dermal graft. They reported excellent results with minimal complications. Five patients were treated by this technique with successful penile straightening and alleviation of pain. To date, follow-up results have been gratifying, and the Devine-Horton dermal graft technique is suggested for use in treatment of patients with disabling Peyronie's disease.


Post-transplant hypertension. Normoreninemic severe hypertension treated by bilateral nephrectomies. In a nineteen-year-old male in whom severe and protracted hypertension developed after a successful renal transplantation, the removal of the diseased kidneys resulted in restoration of normal blood pressure. Prenephrectomy blood samples obtained from the venous drainage of all three renal veins demonstrated no evidence for excessive renin secretion, nor was a significant difference in renin activity found between any two kidneys. It is postulated that the patient may be a clinical variant of the experimental form of renal hypertension with normoreninemia. Alternatively, the remnant kidneys may be implicated to produce a nonrenin pressor substance.


Late ureteral obstruction mimicking rejection after renal transplantation. Ureteral obstruction occurring five years or more after renal transplantation is uncommon and may mimic allograft rejection. In 2 patients who had received cadaveric renal allograft, ureteral obstruction was detected six and one-half and five and one-half years after transplantation. In both patients, surgery was needed to restore normal renal function and to prevent further renal damage. Excretory urography is important in the follow-up of patients who have undergone renal transplantation, and conditions such as ureteral obstruction should be ruled out before antirejection treatment is started.


Role of urothelial surface mucoprotein in intrinsic bladder defense. To implicate further the surface mucoprotein as the factor responsible for preventing bacterial attachment to the bladder mucosa, rabbit urothelium was severely disrupted and allowed to regenerate for varying periods of time. Quantitative measurements of the attachment of 14C-labeled Escherichia coli were correlated with the histologic presence of the surface mucoprotein. Control levels of bacterial attachment were observed only when the PAS-positive layer had regenerated, further supporting the role of this layer in the bladder's antibacterial defense.


Clinical and radiographic findings of focally infected polycystic kidneys. Three patients with localized polycystic kidney infections are presented with the pertinent clinical, laboratory, and radiographic findings. Gallium-67 citrate and angiography play an important role in evaluation of these patients. Angiography in particular is valuable in the diagnosis and the exact localization of the inflammatory disease. Localization is extremely important in planning surgical treatment should conservative therapy fail.


[Osteoplasty of the lower jaw with composite grafts]. Experimentally on 32 white rats of Wistar line and on 15 outbred dogs the authors studied plastic properties and healing processes of composite transplants, employed for replacement of mandibular defects. It was found that the composite transplant consisting of an allogenic lower jaw, treated according to "os purum" type, and an autobone was more resistant to infection, showed no rejection response and possessed adequate plastic properties. This enable the authors to apply the mentioned combination clinically in 7 patients with mandibular defects from 3.5 to 15 cm. Favourable results were obtained in every patient: the anatomical shape of the jaw and its functioning was restored, a good cosmetic effect was gained.


[Selection of the method of operation in duodenal ulcer complicated by perforation and hemorrhage]. Among 240 patients with perforated duodenal ulcers this complication was associated with hemorrhage in 4. In all these patients organ-preserving operations on the stomach associated with trunk vagotomy were successfully performed. In large callous perforated bleeding ulcers gastroduodenotomy and suturing of the bleeding ulcer was employed followed by Finney gastroduodenostomy.


[Practical use of external drainage of the pancreatic duct]. The authors have employed external drainage of the pancreatic duct in 96 patients. Pancreaticostomy was performed with prophylactic and therapeutic purposes. Prophylactic pancreaticostomy after the Doubilet technic was accomplished in all cases of papillosphincteroplasty. In case of evident stenosis of the pancreatic duct ostimum (6 patients) papillosphinctero-wirsungoplasty with external drainage of the duct was performed. In acute pancreatitis pancreaticostomy would contribute to prompt normalization of pancreatic enzymes and subsidence of the inflammatory process. In chronic pancreatitis with involvement of the duct system along with papillosphinctero-wirsungoplasty and transpapillary drainage of the pancreatic duct terminal portion also cystodigestive and pancreaticodigestive anastomoses were constructed with external transanastomosis transenteric (after the Folker technic) drainage of the cyst cavity of pancreatic duct.


[External intestinal fistulae and their treatment]. The results of treatment of 188 patients with different external fistulas of the intestine are reported. A detailed analysis of 23 observations of small intestine fistulas is given, including 16 cases with enterostomies complicated with phlegmon of the abdominal wall, emaciation and hemorrhage from acute intestinal ulcers. An early surgical treatment of such fistulas is recommended.


[Late result of the surgical treatment of focal lesions of the femur head by using figured bone-cartilage homografts]. The author reports late result of focal buried homoplasty of the femoral head performed after the author's technic in 84 patients: for tuberculous coxitis (72), aseptic necrosis of the femoral head (7) and other lesions of the coxa (5). The terms of the follow-up postoperatively in 78 patients are from 3 to 11 years. An estimation of functional result of treatment was made by a 4-grade system, adopted by the majority of authors. Excellent results were gained in 18 patients, good--in 26, satisfactory--in 29 and poor--in 11.


[Experience in using hexosephosphate in the surgical clinic]. The authors' experience with the clinical use of an antihypoxic substnace--hexosophosphate representing the complex of tetraphosphoric glucose and fructose esters is reported. The substance was studied experimentally on 20 dogs and clinically in 126 patients with diseases of vessels, abdominal organs and the kidneys. A positive effect was gained in peroral and intravenous use of the substance both with theaim of preparative management of patients to be subjected to major surgery and postoperatively. HP, being a readily absorbed energetic substance, renders a normalizing effect on the hemodynamics, the bowel activity, improves general patients'state, that is of special value in patients whose state is aggravated by concomitant lesions.