Simultaneous left ventricular echocardiography and aortic blood velocity during rapid right ventricular pacing in man. Left ventricular echocardiograms and phasic instantaneous Doppler aortic blood velocities were simultaneously recorded during short paroxysms of rapid right ventricular pacing in 20 conscious subjects. Right ventricular pacing at rates of 100, 120, 140, 160 and 180/min produced stepwise reductions of mean estimates for diastolic (D) and systolic (S) left ventricular internal dimensions (LVID) along with a diminution of aortic blood velocity. Mean (X +/- 1 standard deviation) per cent decline of LVID-D, LVID-S and peak aortic blood velocities for the study group ranged from 8.9 +/- 6.1, 8.5 +/- 5.7 and 13.7 +/- 7.7 at 100 beats/min to 29.3 +/- 10.6, 25.2 +/- 10.5 and 55.2 +/- 13.1 at 180 beats/min, respectively. When LVID-D, LVID-S, and aortic blood velocity X % reductions were plotted for all heart rates there was a high degree of positive correlation (r = 0.99). Two types of abnormal septal motion were observed during rapid pacing: Type I--paradoxical septal motion at all pacing rates (n = 7, 6/7 with left coronary artery disease); Type II--hypokinetic septal motion at lower pacing rates with flat or paradoxical motion at rates greater than 140/min (n = 13, 10/13 with normal coronary arteries). It is concluded that short episodes of rapid right ventricular pacing result in reduced LVID and abnormal septal motion with the latter possibly related to septal ischemia. Such study provides insight into the untoward influence of rapid ventricular rhythms on cardiac performance.


Pituitary responses to synthetic luteinizing hormone-releasing hormone in thirty-four cases of amenorrhea or oligomenorrhea associated with galactorrhea. Pituitary responses to 100 mcg. of luteinizing hormone-releasing hormone (LH-RH) administered subcutaneously were studied in 34 cases of amenorrhea or anovulatory oligomenorrhea associated with galactorrhea. Twenty-six patients had pituitary prolactin-secreting tumors (group I); eight patients had a normal sella turcica and remission of the syndrome either spontaneously or after thyroid replacement therapy (group 2). Follicle-stimulating hormone (FSH) and luteinizing hormone (LH) responses to LH-RH were variable in each group of patients, ranging from poor to exaggerated, and no statistically significant difference could be observed between the groups. A positive correlation was found between FSH pituitary responses and basal FSH levels (r=0.50; P less than 0.01). No positive correlation was observed between either LH responses and basal LH levels or the gonadotropin responses and plasma estradiol levels, serum prolactin concentrations, duration of amenorrhea, or size of the tumor.


Cardiac performance and beta-adrenergic blockade in arterial hypertension. The purpose of the study was to evaluate the functional changes which may occur in the human hypertensive heart following treatment with beta-blocking agents. In 54 primary hypertensive men investigated in the control state and after three weeks of treatment with propranolol (320 mg/day) it was seen that: (a) beta-adrenergic blockade depresses the pre-ejection, and probably the ejection left ventricular function; (b) the former effect is unrelated to changes in peripheral circulation, while the latter result may be either potentiated or overcome, depending on the direction to which treatment shifts the vascular resistance; (c) variations of impedance, rather than of blood pressure, influence the ejection left ventricular function; and (d) withdrawal of the adrenergic support to the heart, due to beta-blockade, is probably the primary factor responsible for the abnormal ventricular adaptation to an augmented impedance.


The treatment of dysmenorrhea with naproxen sodium: a report on two independent double-blind trials. The efficacy of naproxen sodium (naproxen-Na) in dysmenorrhea has been established in two independent double-blind (placebo-controlled) studies. An initial dose of 550 mg. of naproxen-Na was followed by 275 mg. every six hours for a maximum of five days. Twenty patients were included in Study I (10 treated with naproxen-Na) and 23 patients in Study II (12 treated with naproxen-Na). Each patient received the medication during four dysmenorrheic episodes. Thus, a total of 172 treatment courses could be evaluated. A variety of efficacy criteria were measured: frequency of pill intake, changes in pain intensity, the degree of relief achieved by the medication, and need for additional analgesics. In both studies naproxen-Na was demonstrated to be superior to the placebo treatment with high statistical significance in each of these parameters.


Pupil size after use of marijuana and alcohol. In an experiment using ten subjects, marijuana produced a dose-related constriction of the pupil at low photopic light levels; alcohol produced no effect on pupil size. The two drugs in combination produced no change in pupil size.


Damage to epithelial basement membrane by thermokeratoplasty. To determine the effects of thermokeratoplasty (TKP) on the basement membrane complexes of the corneal epithelium, transmission electron microscopy was performed on the corneal buttons of five patients with failed TKP and on two normal corneas and five corneas with keratoconus that were immediately treated by TKP (acute TKP). The consistent findings of thermal dissolution of basement membrane after acute TKP and persistent defects of basement membrane complexes many months after therapeutic thermokeratoplasty were significant. Given the potentially damaging effects of thermokeratoplasty on the epithelial basement membrane, faulty epithelial adhesion should be anticipated after thermokeratoplasty and should be treated aggressively, possibly with careful prophylactic use of bandage hydrophilic contact lenses.


The magazine picture collage: development of an objective scoring system. A system for objectively scoring the magazine picture collage was developed and applied to the collages of 12 psychiatric inpatients and 12 paired controls. As a group, the patient collages had fewer cuttings, tended to lack an overall balance and central theme, and contained fewer pictures of people and more of animals. The results are consistent with those reported by other researchers as well as with general clinical experience, and as such, lend support to the construct validity of the scoring system.


The derailment of occupational therapy.

The derailment of occupational therapy. The derailment of occupational therapy, exemplified by the profession's symbiosis with the medical model, its alignment with the rehabilitation movement, and its devaluation of the arts and crafts is the central theme of this article. The occupational behavior paradigm, which represents a recommitment to the values and beliefs of the profession's founders, has emerged to arrest the derailment process and thereby reinstate the substantive goals of occupational therapy.


Midpalatal suture opening: a normative study. This study of the average response to midpalatal suture opening revealed the following significant results: 1. Maxillary expansion was effected in all fifty-six cases, but the older patients with more rigid skeletal components experienced little orthopedic change. 2. The maxilla always moves downward and moves varying degrees, from slightly backward to sometimes significantly forward during suture opening. Full recovery usually occurs during stabilization. 3. Maxillary skeletal width can be expanded with no relapse in younger patients. However, older patients often lose much of the width increase that is achieved through palatal expansion. 4. In younger patients, the mandible permanently rotates open less than 1 degree.


Clinical experience with direct-bonded orthodontic retainers. The experience obtained in clinical evaluation of forty-three direct-bonded mandibular canine-to-canine retainers after a minimum observation period of 1 year (range, 1 to 2.5 years) is summarized. Results indicate that the bonded retainer has all the advantages of a fixed soldered retainer, in addition to being invisible. Patient acceptance was excellent, and the failure rate in terms of loose retainers was low. Also, for a number of other retention problems, direct bonding with different types of lingual wire seems to open up a range of promising new possibilities.


Mineralization in the midpalatal suture after orthodontic expansion. A new method is described for an objective measurement of the mineralization in the anterior part of the midpalatal suture after its orthodontic expansion. The radioisotope 125I is used as radiation source and is placed intraorally in the same position on each measurement occasion. The extraoral part of the apparatus consisted of a scintillation crystal and a pulse-height analyzer to determine the number of roentgen quanta transmitted. The measurements showed that the mineral content within the suture rose rapidly during the first month after the completion of suture opening. In the bone beside the suture, the mineral content decreased sharply during the first month of measurement; later it returned to the initial level.


Immunopathology of early and clinically silent lupus nephropathy. Detailed immunopathologic studies of early or silent renal alterations in systemic lupus erythematosus have been sparse. The renal biopsies of 16 lupus patients with normal renal function, including 8 with hematuria and/or proteinuria of recent onset, and 8 without clinically detectable renal disease were investigated by light, immunofluorescence, and electron microscopy. Immunoglobulins, complement components, and electron-dense deposits were detected in glomeruli of all patients, regardless of morphologic appearance or lack of clinical evidence of renal involvement. Features of membranous glomerulonepritis were observed in 4 patients with substantial proteinuria. In the remaining 12 patients, including 3 with hematuria and 4 with slight proteinuria, either minimal glomerular alterations or features of mesangial proliferative glomerulonephritis were seen. Transformation of the original disease was demonstrated in 3 of 3 patients rebiopsied within 2 years. The significance of these findings is discussed in relation to a) the spectrum of clinical and immunopathologic alterations in lupus nephritis and b) transformation of the original disease.


Intimal healing. The pattern of reendothelialization and intimal thickening. Studies were undertaken to investigate further the basis of intimal proliferation and the identity of the surface lining cell in rabbit aortas subjected to extensive deendothelialization. Endothelial cells were selectively removed by passage of an inflated balloon catheter through the arterial lumen. The healing response was evaluated at intervals up to 36 weeks by several techniques: 1) permeability to Evans blue, 2) reappearance of endothelial cells as indicated by the specific marker, adsorbed goat anti-rabbit tissue factor-horseradish peroxidase, 3) planimetric measurements of intimal thickness, and 4) electron microscopy. The results indicate that endothelial cell recovery progressed slowly and that it extended only from areas spared denudation. The regions not covered by endothelial cells were lined by cells of smooth muscle cell origin. Such areas were permeable to Evans blue-protein complex, and their luminal smooth muscle cells were associated with connective tissue-like material at their luminal surface; this material apparently acted as a base for platelet accumulation. The present findings indicate that the lumen of the extensively denuded vessel is lined by either endothelial or smooth muscle cells and that intimal healing is related to restoration of endothelial cell cover. In addition, intimal thickening reached a maximum well before reendothelialization was complete.


Immunologic surface markers in non-Hodgkin's lymphomas. Tissues from 21 patients with non-Hodgkin's lymphomas were examined for immunologic cell surface markers. Patterns of distribution of complement receptor (CR) B lymphocytes and Fc receptor (FcR)-bearing histiocytes in tumor tissue were evaluated and compared to routine histologic preparations of the tumors and to normal tissue. The lymphomatous infiltrates from all 6 cases of nodular, poorly differentiated lymphocytic lymphoma (NPDLL) consisted of dense populations of CR B lymphocytes. Involved tissue from 7 of 8 patients with diffuse, poorly differentiated lymphocytic lymphoma (DPDLL) was predominately comprised of CR B lymphocytes. Discrete nodules of CR B cells were present in a lymph node replaced by DPDLL. FcR were identified on the cells from 1 of 3 cases of histiocytic lymphoma. None of the 4 cases of undifferentiated lymphoma possessed demonstrable surface markers in tissue section; however, the cell suspension from 1 case contained a high percentage of CR B cells. Both CR and T cell markers were present on the cells of DPDLL of childhood.


Reassortment of lymphocytes in lymph from normal and allografted sheep. The distribution and nature of surface immunoglobulin-bearing (SIg) cells were studied in various sources of lymph from normal sheep and from sheep bearing renal autografts and renal allografts. In normal sheep, 12.2% +/- 1.5 of all mononuclear cells in peripheral lymph SIg and, of these, more than 50% were monocytes and macrophages. Less than 6% of the lymphocytes in peripheral lymph carried SIg. In contrast, 24.7% +/- 1.3 of the mononuclear cells in central lymph had SIg, and all of the labeled cells were lymphocytes. The frequencies of SIg cells in peripheral lymph issuing from renal autografts and from renal allografts were 6.7% +/- 1.3 and 6.9% +/- 0.8, respectively, and the labeled cells were predominantly lymphocytes. The proportion of SIg cells in central lymph from graft-bearing sheep was similar to that from normal sheep. The differences between central lymph and peripheral lymph from both normal and graft-bearing sheep are thought to reflect a restriction on the passage of SIg cells through capillary endothelium in nonlymphoid tissues.


The differential mobilization of human neutrophil granules. Effects of phorbol myristate acetate and ionophore A23187. Phorbol myristate acetate (PMA, 2 to 100 ng/ml) and ionophore A23187 (10(-7) to 10(-6) M) cause human neutrophils to release up to 50% of the granule-associated enzyme lysozyme extracellularly without release of beta-glucuronidase or the cytoplasmic enzyme LDH. When azurophil and specific granules are separated from neutrophil lysates by sucrose density centrifugation, it is found that lysozyme release from neutrophils exposed to PMA or to A23187 reflects a selective disappearance of the small, peroxidase-negative (specific) granules from the cells. These studies demonstrate that neutrophils can mobilize the specific and azurophil granules independently. These studies also demonstrate that under certain conditions the specific granules of human neutrophils behave like the storage granules of secretory cells. Finally, these studies show that techniques of separating neutrophil granules according to their sedimentation characteristics successfully divide these granules into populations that are distinct not only by cytochemical and morphologic criteria but also according to their availability for mobilization and extracellular release. (APM J Pathol 87:273-284, 1977).


Studies on the pathogenesis of atheroarteriosclerosis induced in rabbit cardiac allografts by the synergy of graft rejection and hypercholesterolemia. Heterotopic cardiac allografts were placed in the necks of 48 rabbits. In rabbits that were not immunosuppressed, allografts beat as long as 12 days, while in immunosuppressed rabbits allografts beat as long as 101 days. Coronary arterial lesions in donor hearts of rabbits fed a lipid-poor diet were found in arteries of all sizes and were mainly proliferative without fatty change. In cholesterol-fed rabbits, arterial lesions were similarly distributed, but the majority of lesions in longer surviving transplants were fatty-proliferative and some bore close resemblance to chronic human coronary atheroselerosis. In contrast to findings in cardiac homotransplants, only occasional predominantly fatty lesions were induced in small intramyocardial arteries of cholesterol-fed recipients. By electron microscopy, early arterial lesions in allografts were characterized by platelet aggregates in widened junctions between endothelial cells, sloughing of endothelium without intimal thickening but with adherence of platelets to the denuded arterial wall, and platelets deep within essentially normal media. Platelets were also seen adhering to the lining cells overlying the thickened intima of more advanced arterial lesions. Results indicate that immunologic arterial injury due to allograft rejection acting in synergy with hypercholesterolemia resulting from a dietary supplement of cholesterol can lead to rapidly developing atherosclerosis. Observations of early and evolving lesions indicate that endothelial injury and platelet interaction with the arterial wall are early and continuing events and may be of primary importance in the pathogenesis of experimental graft-induced atheroarteriosclerosis. In man, similar mechanisms may be involved in the pathogenesis of graft-induced athererosclerosis and in other instances of atherosclerosis. (Am J Pathol 87:415-442, 1977).


Sensitivity and specificity of skin reactivity to Brugia malayi and Dirofilaria immitis antigens in Bancroftian and Malayan filariasis in the Philippines. Saline antigen extracts of microfilariae, adult worms and third-stage larvae of subperiodic Brugia malayi maintained in gerbils were prepared for use as skin test reagents. Patients were studied on three different islands in the Philippines, one endemic for Bancroftian filariasis (Sorsogon, Luzon), another endemic for Malayan filariasis (Palawan) and the third without endemic filariasis (Cebu). A dose-response curve was established initially in patients with Bancroftian filariasis: thereafter 1.0 microng of the B. malayi antigens and 0.05 microng of Dirofilaria immitis FST antigen (obtained from Dr. T. Sawada) were used. Sizes of reactions were measured by recording the diameters of wheals at 20 minutes, 24 and 48 hours. There was a very high correlation in immediate hypersensitivity reactions among the three B. malayi antigens. Reaction sizes followed a normal distribution. When an area of an antigen-induced wheal 3 X that of the saline control was considered a positive reaction, 99% of 150 patients with Bancroftian filariasis and 96% of 45 subjects with Malayan filariasis reacted to B. malayi larval antigen. Only 68% of patients with Bancroftian filariasis but 90% of those with Malayan filariasis reacted to D. immitis FST antigen. There was no relationship between skin reactivity and age, sex, microfilaremia or severity of clinical disease. Approximately half of 50 patients who lived in an endemic area for W. bancrofti but had neither patent infection nor clinical disease reacted to B. malayi antigens. A maximum of 7% of 120 age- and sex-matched controls from Cebu gave false positive reactions with any of the antigens. Only a small proportion of patients gave 24- and 48-hour reactions. It is concluded that the use of antigens prepared from a human parasite, subperiodic B. malayi, which is easily maintained in a laboratory animal host, improves the ability to diagnose filarial infections by immunological means.


Asymptomatic transient hyperamylasemia after a large intravenous dose of steroid hormone. Asymptomatic transient hyperamylasemia accompanied with hyperamylasuria immediately after an intravenous dose of 1 gm methylprednisolone has been observed in renal homotransplantation patients. Similar phenomena have also been seen in the other operative patients who received certain amounts of steroid hormone intravenously during their procedure. These cases of hyperamylasemia and hyperamylasuria were studied in detail including time-sequence observation, amylase-creatinine clearance ratio, and amylase isoenzyme analysis. The hyperamylasemia is not due to the general anesthesia or the surgical procedure. It is apparently not due to simple retention of enzyme from poor kidney function. The source of hyperamylasemia is the pancreas mediated by large intravenous doses of steroid hormone.


Finding the missing information in cancer statistics. The current cancer literature is imprecise and confusing. This hampers the ability to draw meaningful conclusions regarding diagnosis and treatment. It is suggested that all future reporting of statistics contain the following features: (1) discussion of case selection criteria; (2) use of TNM system for case classification; (3) listing of minimal treatment details; (4) explanation for length of follow-up used; (5) standardized terms for evaluation (relating these to individual TNM classification); and (6) listing of all failures by standardized terms. It is proposed that editors of journals and organizers of meetings reject all papers that do not meet these criteria.


Peritoneal lavage.

Peritoneal lavage. The concept of lavage as an effective means for detecting intraperitoneal injury secondary to trauma has been adequately demonstrated. The value of peritoneal lavage is especially reflected in the statistics reporting approximately 20 per cent incidence of unnecessary celiotomies when physical examination findings alone are used; whereas the number of false-positives and false-negatives may be lowered significantly. Not only does peritoneal lavage decrease the number of unnecessary celiotomies, but it also provides for a more rapid diagnosis that can prevent greater blood loss, thereby reducing the number of subsequent transfusions, minimizing chances of hepatitis, and lowering the incidence of shock with its coincident complications.


Prevention of postoperative thrombosis by aspirin. In a random double-blind trial monitored by 125I-fibrinogen leg scan, impedance plethysmography, and contrast phleobograms if impedance became abnormal, hydroxycholoroquine was shown to be no more effective than placebo for prevention of venous thrombosis after total hip replacement. Subsequently, the combination of hydroxychloroquine with aspirin was shown to be not significantly better than aspirin alone. Although the two parts of the trial were performed in an identical manner, comparison of the two sequential parts of this investigation, which provided a significant tread favoring aspirin, must be interpreted with caution. Further study including concurrent controls is needed.


Primary perineal closure after proctocolectomy for inflammatory bowel disease. Prevention of the persistent perineal sinus. In seventeen patients who had a proctocolectomy for ulcerative or granulomatous colitis, the levator muscles and perineal tissues were sutured primarily. In all patients the pelvic peritoneum was left open to allow the remaining intestine to fill the pelvic space. In eight patients in whom the pelvic space was not drained, uncomplicated healing occurred in five, but the other three patients developed infected pelvic collections leading to delayed perineal would healing. In the subsequent nine patients in whom the pelvic space was drained, all patients had uncomplicated healing. There has been no instance of perineal hernia or intestinal obstruction during four years' observation. This method of managing the pelvic space and perineal would, based upon obviating all blood or serum collections, has been simple, safe, comfortable, and effective in eliminating the prolonged morbidity of an unhealed perineal would.


Patterns of high tension electrical injury in children and adolescents and their management. High tension electrical burn injury occurred in twenty-nine patients over a period of seven years, causing two deaths, and demonstrating two reasonably distinct patterns. Major surface thermal burns from involvement in an electric arc, augmented by flame burns of ignited clothing, occurred in eleven patients. By contrast, eighteen children demonstrated wounds of entrance and exit of current and varying effects of deep thermal injury along the path of the maximally conductive blood vessels and nerves of extremities. An aggressive surgical approach was taken in patients with both types of injury, with the objective of prompt identification and excision of devitalized tissues and closure of thw wound. In the deep condictuve type of injury, frozen section and subsequent histologic study served as a guide to adequacy of excision and preservation of viable tissue. Even so, amputation of fifteen extremities and four other major excisions were required in twelve patients.


Surgical induction of corneal astigmatism. An experimental study. The aim of all ocular surgery is to preserve or restore optimal visual function. Reduction of excessive postoperative astigmatism after keratoplasty, cataract extraction, or other anterior segment operations has been obtained in clinical surgery by corneal wedge resection. The purpose of this experimental investigation was to quantify and evaluate the results of different microsurgical techniques in crescentic resection of a corneal wedge. Twenty-five rabbits were operated and the induced changes of corneal curvature measured by keratometry. The immediate and long-term results are presented. The effect of wedge resection was a steepening of the meridian perpendicular to the resection and a flattening of the meridian parallel to the resection. The astigmatism induced was less pronounced than the changes obtained in human surgery. There were no postoperative ocular complications and all corneas remained clear. It is suggested that the operation be performed in all cases of severe corneal astigmatism uncorrected by lenses.


[Experimentally induced immonological reaction of the eye after keratoplasty. I. Lightmicroscopy (author's transl)]. After sensitization of a rabbit with soluble human cornea proteins a hetero-keratoplasty (man-rabbit) is performed with exactly determined antibody titer. Light-microscopic investigations showed that the epithelium of the transplant is involved in this severe humoral immune-reaction mainly. In the area between receptor's and donor's cornea impressive changes could be observed.


[Experimentally induced immunological reaction of the eye after keratoplasty. II. Ultrastructural changes of the receptor's cornea (author's transl)]. Ultrastructural changes of the receptor's cornea of a rabbit by experimentally induced immune-reaction were communicated. The finding of plasma-cells proves the generation of humoral antibodies. Granulocytic elements are shown in the transplant or react with diffusing antigen-antibody-complexes already in the stroma of the receptor's cornea.


Vitamin C and post-suxamethonium pains.

Vitamin C and post-suxamethonium pains. A double-blind trial of the effects of vitamin C on the frequency, severity and duration of post-suxamethonium pains was performed. Fifty-three patients undergone bronchoscopy received either a placebo or 10 g of vitamin C. No beneficial effect was demonstrated. In 18 patients no relationship was found between pre-anaesthetic buffy layer vitamin C levels and the subsequent pains. Measurement of buffy layer and plasma vitamin C levels before and after anaesthesia did not suggest that vitamin C deficiency occurs during or immediately after administration of suxamethonium. It is concluded that the administration of vitamin C cannot be recommended as a means for prevention of suxamethonium pains.


Unrecognized tracheo-oesophageal fistula. A patient with a retropharyngeal carcinoma was anaesthetized for laryngoscopy, oesophagoscopy and biopsy. Suggestive symptoms of a tracheo-oesophageal fistula were absent and a barium swallow did not demonstrate its presence. Sign of an abnormal communication appeared for the first time after the patient had been intubated and positive airway pressure applied. Measures which might be taken to overcome this problem are suggested.


A ventilation monitor during demand flow CPAP. A commercially available pressure alarm monitor has been suitably modifed to provide audible warning of significant and critical changes in the respiratory patterns during demand flow spontaneous ventilation with CPAP. The alarm retains its originally intended function, i.e. detection of ventilation failure during controlled or assisted ventilation or both, with or without PEPP.


Intravenous sedation and regional analgesia. A double-blind study of 229 patients with the use of intravenous diazepam as compared with a placebo to produce sedation during local analgesia showed that significantly improved sedation occurred when diazepam was used. The diazepam was dissolved in cremophor and this reduced the pain of intravenous injection of the diazepam. One patient who received Cremophor only, showed a moderately severe allergic reaction. It is suggested that a small test dose should always be given before giving any drug which is dissolved in Cremophor.


Intermittent mandatory ventilation. A discussion and a description of necessary modifications to the Brompton Manley ventilator. The history and development of IMV have been reviewed. Special attention has been paid to the problems associated with the use of PEEP in combination with IMV. We have described a modification of the Brompton Manley ventilator for use with IMV and PEEP and we have investigated the performance of different types of inspiratory reservoirs.


Mandatory minute volume. A new concept in weaning from mechanical ventilation. The new concept of mandatory minute volume (MMV) is described. The system provides a preset minute volume to the patient, who breathes spontaneously from it as much as he is able, the remainder being delivered to him via a ventilator. The necessary apparatus has been constructed and has the additional facility of PEEP and/or CPAP up to a level of 15 cmH2O pressure. With possible exceptions, the apparatus allows simpler and more direct control over the patient's PaCO2 than with the IMV system and it ensures, without adjustment, a constant minute volume of fresh gas breathed by the patient, despite minute-to-minute changes in his ability to breathe. Use of the system in conjunction with two commonly used ventilators is described. It should not be difficult to build the facility for MMV into new versions of artificial ventilators.


The introduction of ether anaesthesia to Great Britain. 2. A biographical sketch of Dr. Francis Boott. The life of Francis Boott, instigator of the first ether anaesthetics in England is described. The reasons for his settling in Britain are explored and his friendship with Jacob Bigelow and his links with Robert Liston are explained.


Acute liver failure. Experience in a special unit. Acute liver failure involves disturbances of all major organ systems. The pathophysiology of these disturbances are reviewed and details of management for each system is discussed in clinical work in a special Liver Failure Unit is used to derive principles of treatment, and the use of extracorporeal charcoal haemoperfusion is outlined.


Prolonged curarisation following renal transplantation. A retrospective study. A retrospective study of postoperative respiratory morbidity in 247 patients requiring renal transplantation between 1955 and 1973 showed that 7 patients required postoperative controlled ventilation for up to 6 days. The nondepolarising relaxants tubocurarine and pancuronium were used in only 65 patients, but all 7 cases of respiratory failure occurred in this group. This suggests that the use of these drugsin anephric patients is potentially hazardous so far as postoperative respiratory insufficiency is concerned.


Postoperative analgesia with ketamine and pethidine. A double-blind trial compared ketamine with pethidine, pethidine alone at two dose levels and a placebo, in patients with postoperative pain. By assessment of pain intensity, observed relief and side-effects, the active drugs were clearly distinguishable from the placebo. With the doses used, however, the combination of ketamine with pethidine showed no advantage over pethidine alone.


Stimulation of cell division in ectopic kidney grafts following unilateral removal of the lung. Small fragments of kidney tissue were grafted into the right lung (Xenopus laevis) and the left lung was subsequently removed. This stimulated compensatory hyperplasia (increased mitotic rate) in alveolar tissue of the right lung and in the kidney graft. This suggests that the stimulus to compensatory hyperplasia is location-specific rather than tissue- or organ-specific. After implantation into the lung the kidney  grafts are revascularized by the surrounding pulmonary supply. Damage or functional impairment of an organ usually produces a localized increase in the rate of blood flow and we therefore propose that this may lead to an increased rate of cell division in one of two ways: by permitting an increased functional capacity in the tissue concerned, or by causing a more rapid local clearance of mitotic control factors.


Localization of actin and myosin in the rat oocyte and follicular wall by immunofluorescence. The distribution of actin and myosin in the rat ovary at different stages of postnatal development was studied by examination of cryostat sections treated with antibodies to chicken smooth muscle (gizzard) myosin or to chicken (pectoral muscle) actin and subsequently with fluoresceinated goat anti-rabbit gamma-globulins. Staining with either antiserum revealed several layers of intensely fluorescent elongated cells within the theca externa, forming a coherent band around the larger Graafian follicles. In smaller follicles, this band of fluorescent cells was incomplete, and ovaries of immature (6-day-old) rats were devoid of strongly fluorescent cells. Corpora lutea contained only scattered fluorescent cells at their circumference. Sections of mature ovaries incubated with antibodies raised against striated (pigeon pectoral) muscle myosin generated no significant fluorescence. Large oocytes stained with either anti-actin or anti-smooth muscle myosin showed a thin fluorescent band just beneath the zona pellucida, suggesting that actin and myosin are associated with the oolemma. The distribution of the two antigens in serial sections of follicles coincided, suggesting that the same cells contained both actin and myosin. It is suggested that follicular growth and maturation is attended by the development of a smooth muscle layer in the theca and that contraction of this layer in response to catecholamines and/or prostaglandins may play a role in the extrusion of the oocyte. The role of contractile elements in the oocyte remains to be elucidated.


The localization of articular cartilage proteoglycan by electron microscopy. Rabbit articular cartilage was fixed with glutaraldehyde containing Ruthenium Red or Safranin O proteoglycan localization is easily obtained. Ruthenium Red stained proteoglycan is easily visualized by electron microscopy. Previous digestion with papain prevented staining by either technique confirming that the material was indeed proteoglycan. Using these methods of proteoglycan identification the sites of attachment to collagen are shown as well as the deposition of proteoglycan about cells of differing vitality and the relationship of proteoglycan to cell membranes.


Where pulmonary arterial catheters go: intrathoracic distribution. Recent experimental evidence indicates that the position of a pulmonary arterial catheter within the thorax is important because vertical height gradients from catheter tip to main pulmonary artery and left atrium may alter the validity of the pressure measured. The authors therefore examined the intrathoracic distribution of 314 pulmonary arterial catheters which at insertion were advanced to the most proximal position from which pulmonary wedge pressure could be obtained. Five catheters (1.8 per cent) were 6 cm or more cephalad to the carina, and 16 (5.1 per cent) were 9 cm or more lateral to the midline. With peripheral catheters recordings of pulmonary arterial and wedge pressures may be erroneous because future patient position, initiation of positive end-expiratory pressure, and occurrence of low pulmonary arterial and left atrial pressures may convert the region of lung in which the catheter tip lies to a Zone 1 of the lung.


Pulmonary shunt and cardiovascular responses to CPAP during nitroprusside-induced hypotension. The effects of continuous positive airway pressure (CPAP) on cardiovascular dynamics and pulmonary shunt (QS/QT) were investigated in 12 dogs before and during sodium nitroprusside infusion that decreased mean arterial blood pressure 40-50 per cent. Before nitroprusside infusion, 5 cm H2O CPAP significantly, P less than .05, decreased arterial blood pressure, but did not significantly alter heart rate, cardiac output, systemic vascular resistance, or QS/QT. Ten cm H2O CPAP  before nitroprusside infusion produced a further decrease in arterial blood pressure and significantly increased heart rate and decreased cardiac output and QS/QT. Nitroprusside caused significant decreases in arterial blood pressure and systemic vascular resistance and increases in heart rate, but did not change cardiac output or QS/QT. Five cm H2O CPAP during nitroprusside did not further alter any of the above-mentioned variables. However, 10 cm H2O CPAP decreased arterial blood pressure, cardiac output, and QS/QT. These data indicate that nitroprusside infusion rates that decrease mean arterial blood pressure by 40-50 per cent do not change cardiac output or QS/QT. During nitroprusside infusion low levels of CPAP do not markedly alter cardiovascular dynamics, but high levels of CPAP (10 cm H2O), while decreasing QS/QT, produce marked decreases in arterial blood pressure and cardiac output.


A comparison of glycopyrrolate and atropine during reversal of nondepolarizing neuromuscular block with neostigmine. Glycopyrrolate and atropine were compared as to their effects on heart rate, arrhythmias, blood pressure, and volume of oropharyngeal secretions. Glycopyrrolate protects against neostigmine-induced bradycardia, produces less initial tachycardia, causes a lower incidence of cardiac arrhythmias, and is a superior oropharyngeal drying agent. Use of this drug instead of atropine should be considered during reversal of nondepolarizing neuromuscular block.


Evaluation of intravenous diazepam as a surgical premedicant. Intravenous diazepam was administered to 4 groups of 35 patients as a surgical premedicant, double blind and according to a randomized sequence. Four dosages were used: 2.5, 5, 10, and 20 mg. Amnesia, relief of anxiety, sedation, and patient acceptance were primarily evaluated. While a significant linear dose effect was found for sedation, anxiety releief, and patient acceptance, this was not true for anmesia, which was clinically present only with doses of 10 and 20 mg. No significant adverse effects were noted at any dosage, and vital signs remained stable in all patients studied.


Environmentally triggered small vessel vasculitis. Ten randomly selected patients with recurrent non-specific small vessel vasculitis (edema, petechiae, spontaneous bruising, peripheral cyanosis) were studied under rigid environmental control. All cleared their symptoms without medications. All patients had their vasculitis reproduced after direct challenge with numerous individual foods and chemicals. Multiple incitants were found in each patient.


Administration of ketamine or Innovar by the microdrip technic: a double blind study. This study of 40 healthy adults undergoing elective gynecologic procedures was undertaken to evaluate the microdrip technic of administering ketamine or Innovar slowly to induce anesthesia and to supplement N2O anesthesia. All patients were managed by the same anesthetist and surgeons and received 10 mg of diazepam and 0.4 mg of atropine IM for premedication. After injection of 10 mg of diazepam, anesthesia was induced by infusions containing either ketamine (2 mg/ml) or Innovar (0.1 ml/ml), at an average rate of 10 ml/min. The infusions were assigned to the patients randomly and their nature was disguised from the staff. After tracheal intubation, ventilation was mechanically supported and anesthesia maintained with N2O-O2 (2:1), by drip at a rate adjusted to the patient's vital signs, and by intermitten injections of 3 to 6 mg of d-tubocurarine. Special forms coded to suit computer use were used to collect data during induction, maintenance, and recovery, and standard mathematical tests were used for analysis. Results showed that (a) ketamine effects could not be differentiated clinically from those of Innovar; (b) ketamine dosage could be reduced to 0.3 to 0.5 the recommended bolus dosage; (c) pulse rates and incidence of mental aberrations during induction or recovery were equal in both groups; (d) blood pressure showed a modest but significant increase (10% from basal values) until 20 minutes of tracheal intubation only in the ketamine group; (e) mean Pao2 determined 30 minutes after tracheal intubation was significantly higher in the ketamine group; (f) ketamine administration by the slow (20 mg/min) microdrip technic reduces the incidence of side effects.


Lesions of experimentally induced colibacillosis in neonatal gnotobiotic pigs: a scanning electron microscopic study. Scanning electron and light microscopy were used in studies of stomach, duodenum, cranial, and caudal portions of the jejunum, ileum, cecum, and spiral colon from 18 gnotobiotic pigs. Five pigs were raised as controls and 13 were exposed at 6 days of age by oral administration of 1.6 X 10(6) colony-forming units of Escherichia coli O138:K81:NM. Infiltration of leukocytes into the mucosa of the stomach seen with the light microscope has not been previously reported. The irregular pattern of the mucosal surface of the stomach formed by the gastric pits and the mucosal extensions on the individual rugae revealed with scanning electron microscopy was different than anticipated. Sections of the ileum from control and infected pigs contained collapsed cells around the extrusion zone at the tips of the villi. These collapsed cells were more numerous in infected pigs and appeared to have sloughed from the area of the extrusion zone resulting in exposure of the lamina propria. Cecum and spinal colon were free of changes. Alterations of the mucosa of the intestinal tract of gnotobiotic pigs infected with E coli as visualized by scanning electron microscopy were considered too inconsistent to be of diagnostic significance.


Immunologic surface markers on nonhuman primate lymphocytes. Peripheral blood lymphocytes from 37 healthy rhesus macaques (Macaca mulatta) and thymocytes from 10 fetal and neonatal rhesus macaques were studied for membrane characteristics. Spontaneous rosette formation with sheep erythrocytes, a characteristic of human T lymphocytes, was evaluated. The presence of membrane-bound immunoglobulin and surface receptors for fixed complement was measured, using fluorescent antibody techniques and erythrocyte-antibody-complement rosettes, respectively. The mean percentages +/- 1 standard error of the lymphocyte markers in the peripheral blood lymphocytes from the macaques were: spontaneous rosettes, 63 +/- 1.0; erythrocyte-antibody-complement rosettes, 14.9 +/- 1.2; and membrane immunoglobulin-positive cells, 21.9 +/- 2.2. These values are very similar to values reported for human beings.


Chronology of development of serum antispirochete antibody in swine experimentally exposed to swine dysentery: preliminary report. By using an indirect fluorescent antibody test (with immunofluorescence of large spirochetes as positive), serum antispirochete antibodies were detected initially at 4 weeks after onset of diarrhea in swine exposed to infective swine dysentery inoculum. Antibodies continued to be present in serum of swine tested 5 months after onset of diarrhea.


Improved oxygenation in patients with acute respiratory failure: the prone position. To assess the potential benefits of the prone position for gas exchange in patients with acute respiratory failure, we turned 6 patients from supine to prone, supporting the upper thorax and pelvis and allowing the abdomen to protrude. Arterial PO2 increased by a mean of 69 mm Hg (range, 2 to 178 mm Hg) at the same tidal volume, same inspired oxygen concentration, and same level of positive end-expiratory pressure. The maneuver made it possible to reduce the inspired oxygen concentration in 4 of the 5 patients who required mechanical ventilation of the lungs and to defer intubation in the patient who was breathing spontaneously. After subsequent turns from supine to prone, arterial PO2 increased by a mean of 35 mm Hg (range, 4 to 110 mm Hg), permitting a decrease in inspired oxygen concentration or positive end-expiratory pressure when prone (4 patients); arterial PO2 decreased in 12 of 14 instances after the patient was turned from prone to supine. No significant change in mean arterial carbon dioxide tension, respiratory frequency, or effective compliance was observed.


Primary closure of pilonidal cystectomy. A method of primary closure following excision of pilonidal cysts and sinus was used in 38 cases. The criteria for patient selection are described as is the technique and procedure. Special attention must be placed on the obliteration of all "dead spaces" to eliminate accumulation of serum and blood. The dressing is not changed for a minimum of eight days, and pressure must be maintained for that time to assure success. In all cases complete closure was obtained. The advantages of this technique over the open procedure is explained.


The subclavian steal syndrome: a review. Proximal occlusions of the subclavian and innominate arteries may create a cerebrovascular insufficiency syndrome. The syndrome is generally characterized by neurologic symptoms of the vertebral-basilar arterial distribution. Blood is siphoned along the vertebral artery because of the low pressures distal to the occlusion. The clinical syndrome is best confirmed by a thoracic arch aortogram. Treatment is reserved for symptomatic patients. An extra-thoracic revascularization of the distal subclavian artery is the preferred operation.


Pseudoaneurysm of the left ventricle: an unusual echocardiographic presentation. Review of the literature. Echocardiography showed a large anterior chamber communicating with the left ventricle cavity through the interventricular septum in a patient with a previous left ventricular aneurysmectomy. At postmortem examination this chamber proved to be an 11-cm diameter pseudoaneurysm that opened into the left ventricle through a 3-cm orifice. A review of the literature showed 67 cases of histologically proven left ventricular pseudoaneurysm, most of which occurred after myocardial infarction and cardiac surgery. Twenty-six of 32 left ventricular pseudoaneurysms were successfully operated upon.  Among 35 patients with pseudoaneurysms not operated upon, rupture was a cause of death in 11.


Steroid-dependent asthma treated with inhaled beclomethasone dipropionate. A long-term study. The efficacy of inhaled beclomethasone dipropionate has been examined in 44 steroid-dependent asthmatics observed for 9 months to 2 years. A 3-month double-blind trial found that subjects treated with beclomethasone had a significant diminution in symptoms, were able to reduce their use of medication, and had improved maximum expiratory flow rates. Approximately one half were able to discontinue the use of oral prednisone within 9 months after starting beclomethasone, and a further one third reduced their dose by at least 50%. No characteristics could be defined to predict responsiveness to beclomethasone. The effectiveness of beclomethasone was sustained for as long as 2 years and was not associated with any abnormal urine, blood, or serum values or chest X-ray findings. Candidiasis of the palate appeared in approximately one third of the subjects and was usually transient. The chronic use of beclomethasone did not result in endocrine suppression.


Bacteroides fragilis subspecies in clinical isolates. Isolates of Bacteroides fragilis from 83 infected patients were collected during 2 years. Of 103 isolates, 68% were subspecies fragilis. This was the single most common subspecies isolated from blood (12/17), intra-abdominal (11/28), wound (17/20), perirectal (11/16), pelvic (6/10), and other (8/11) sites. Sixteen patients had B. fragilis isolated in pure culture. Of these, 9/12 blood cultures and 4/4 cultures from other sites were ss. fragilis. The recent observation that ss. fragilis organisms are encapsulated whereas the other subspecies are generally unencapsulated was supported by indirect fluorescent antibody studies using antibodies prepared to the capsular material of ss. fragilis. All 33 strains of ss. fragilis and none of 13 strains of other subspecies were positive. The predominance of ss. fragilis in clinical isolates compared to its relative infrequency in normal fecal flora and its predominance in pure cultures, especially of blood, indicate that this is the most virulent of B. fragilis subspecies. This virulence may be related to encapsulation.


Marital sexual dysfunction: female dysfunctions. The diagnosis, treatment, and referral of married women with sexual dysfunctions require information about the current physiologic deficit, previous sexual capacity, level of sexual desire, masturbatory experience, means of orgasmic attainment, preferred sexual partner, quality of marriage, husband's sexual capacities, and method of contraception. For classification purposes, the three basic physiologic deficits--excitement phase dysfunction, orgasmic phase dysfunction, and vaginismus--are subdivided into primary and secondary types. Primary dysfunctions represent longstanding developmental problems and are usually purely psychological in origin. Secondary dysfunctions occur after a period of normal sexual functioning and may be organic or psychological in origin. The actual determinants of dysfunctions are not well understood, but those factors commonly associated are discussed. The lack of knowledge about the nature of sexual desire, prevalence of dysfunctions, and significance of the inability to attain orgasm with coitus is emphasized. The physician's role in giving advice and treatment is defined.


Behavioral methods in the treatment of hypertension. A review of their clinical status. Behavioral methods to lower blood pressure include biofeedback, relaxation, psychotherapy, suggestion and placebo, and environmental modification. Reported data for each method have been examined applying the clinical pharmacologic format used to study other therapeutic agents. Most studies have been Phase I type, small numbers of subjects in acute (short-term) treatment situations. Phase II studies, controlled trials with comparison with known effective agents, are sparse, and Phase III studies are not yet appropriate. These Phase I studies indicate blood pressure effects that are small, with minimal data about their duration and their relation to the use of pharmacologic agents. The methods are adjunctive and not alternative, while the compliance problem is similar to that with pharmacologic agents. The major differences between the methods are the ease with which they can be used. Widespread application of the nonpharmacologic methods cannot currently be recommended, but further basic and clinical research into mechanisms and outcomes is encouraged.


Nasal decongestant activity of pseudoephedrine. The effectiveness of orally administered pseudoephedrine in patients with acute or chronic nonsuppurative rhinitis was evaluated under double-blind conditions. Intranasally administered ephedrine which was given to all patients at the end of this study served as the positive control. Marked nasal decongestant effects of a single oral dose of pseudoephedrine (60 mg tablet), as determined by a modified passive anterior, rhinometric technique occurred within 30 minutes and were maintained for at least four hours. The mean nasal decongestant response (delta % of baseline) of 57.2% was associated with a mean peak, plasma pseudoephedrine level of 274 ng/ml. In addition, the maximum response to oral pseudoephedrine treatment was equivalent to the response produced by ephedrine nasal spray. These results suggest that pseudoephedrine is an orally, effective nasal decongestant.


Enzyme patterns in cancer.

Enzyme patterns in cancer. The recent reports of the use of serum and tissue enzyme assays in primary diagnosis and then in following the course of the disease have been reviewed. These include use of bone marrow acid phosphatase, isoenzymes of both acid and alkaline phosphatase, LDH5/LDH1 ratios, sialyltransferase and the combination of carcinoembryonic antigen with serum enzyme assays to help in prediction of the occurrence of hepatic metastases.


[Immunological and immunocytochemical studies of the inflammatory infiltrating cells of cutaneous tumors]. The identication of mononuclear cells extracted from various inflammatory infiltrates of cutaneous tumours has been investigated and the relative amount of B and T cells determinated according to various assays. It has been found that there were two different patterns of distribution of the cells in the infiltrates: one with a E/EAC ratio similar 5 (squamous and basalcell carcinomas), the other with a E/EAC ratio similar 1(malignant melanoma). The identification in situ of Ig-producing cells has been developed in the same tissues fixed in Bouin's solution. The relative frequency of these cells has been determinated and appears very low in the malignant melanoma.


[Treatment of solid tumours by intratumoral injection of immunostimulants]. Intra-lesional injections of immunostimulants--BCG or Corynebacterium parpum--induced a local cure of the McFiFj2(S) tumour and a remote therapeutic effect. When applied to rats multigrafted with the McFiFi2(S) tumour, local and distant cures were obtained in some situations. This indicates the likely intervention of a specific immune mechanism. Quantilating the pulmonary metastasis in combination with local treatment of Lewis mouse tumours showed that BCG plus C. parvum injected into the tumour and followed by surgical resection was more efficient than either of these individual or otherwise associated antitumoural procedures.


[Immunotherapy of chemically induced rat colon cancer]. An experimental model of chemically induced or transplanted rat colon carcinoma has been used to test the effects of specific (cancer cells) or non specific (BCG) immunotherapy. According to the immunization technique and schedule experiemnts resulted in a partial inhibition or definite enhancement of tumour growth. These experimental data emphasize the possible hazards of human colon cancer immunotherapy.


[Asynchronism in the synthesis of antibodies directed against different antigenic sites of a macromolecule]. "Activating" and "precipitating" antibodies elicited by Escherichia coli beta-D-galactosidase can be isolated by assortment of the respective antibody-forming cells in vitro, showing that the two antibodies have different specificities. Both populations also segregate in vivo and are synthesized asynchronously. The interplay of different antibody species with the same immunogenic molecule and the role of these expected to be complex interactions in the regulation of the immune response is an area for further investigation.


[Two new peptic fragments of human IgA: F(abc)'2Alpha and [F(abc)'2]2alpha (author's transl)]. These experiments were undertaken to study the nature of the fragments produced by pepsin digestion of seric IgA. We describe a new fragment with a MW of 140,000 daltons. This fragment, the first produced during pepsin hydrolysis of monomeric IgA, corresponds to an IgA molecule which has lost its CH3 domain. We propose to call this fragment F(abc)'2alpha. It is gradually digested and transformed into an F(ab)'2alpha fragment. When polymeric IgA are digested, an extra fragment with a MW of 290,000 daltons is produced, which has kept its polymeric structure. It corresponds to a covalent [F(abc)'2]2alpha fragment. These findings suggest that there is an intersubunit disulfide bridge in the Calpha2 domain. These results also indicate that polymeric IgA proteins are more resistant to pepsin digestion than monomeric IgA proteins.


[Antigenic sites implicated in tumour allograft enhancement]. Allo-immune sera were prepared by injecting CBA mice with spleen or thymus cells, or by two consecutive skin grafts of A/Jax origin. When absorbed 6 to 8 times on glutaradahyde treated A/Jax red blood cells (RBC), these sera lost all their haemagglutinating activity (anti- "SD" antibodies, predominantly H-2D) While their cytotoxic activities on A/Jax lymphocytes (anti-LD antibodies, perdominantly Ia, H-2IC) were partially preserved. Antibodies (anti-"XD") eluted form A/Jax RBC treated with an 0.5 M NaCl--HCL glycincing activity of these preparations was tested using SaI (A/Jax) grafts in CBA mice. Our results suggest that SD antigens are the main target of the enhancing effect. Further results obtained with DBA/2 anti-EL4 (C57Bl/6) sera confirmed this interpretation. Experiments performed with anti-idiotype and anti-recognition structure sera using tumor allograft targets, did not reveal any clear cut effect. Their relevance in tumor enhancement appears therefore doubtful.


[Albumin secreting hepatocytes detected as plaque-forming cells in liquid medium]. Albumin-secretins hepatocytes were detected as plaque-forming cells when incubated in a complete culture medium containing sheep eythrocytes coated  with purified anti-albumin, plus anti-albumin serum and complement added at appropriate dilutions. Plaque-formation is observed after incubation at 37 degrees C for 1 h 1/2 between two properly spaced microscope slides sealed with paraffin. Plaque enumeration revealed that 17-18% of normal adult rat lover cells secreted albumin. The assay which is reproductible and highly sensitive is also done in a single step.


[Autoantigen T in guinea pig germinal cells: fine localization and ultrastructural lesions induced in vitro by specific anti-T autoantibody and complement]. Four autoantigens (S, P, T, Z), are known to be present in guinea pig spermatozoa. The only anti-T antibody is able to fix complement and is spermotoxic. Using immunoenzymatic technics, autoantigen T has been localized on the plasma membrane of spermatozoa and spermatids. A quantitative ultrastructural study has shown the anti-T induced irreversible, specific lesions on the germinal cells in presence of complement. A few minutes after addition of complement, almost all the cells are injured. Control sere (normal serum, anti-ova or anti-S or anti-P sera are inefficient. These findings are related to the mechanisms of autoimmune aspermatogenetic orchitis.


[Immunostimulating activities in vivo of extract from Klebsiella pneumoniae]. The adjuvant and immunostimulating activities of a glycoprotein preparation (GP) extracted from Klebsiella pneumoniae have been studied. When injeted with an ovalbumin in incomplet Freund adjuvant emulsion, the GP induces delayed hypersensitivity to the antigen and increases the level of antibody developed. When it is injected before the antigen to C57Bl/6 mice, the GP provokes an increase of plaque forming cells, rosette forming cells, and antibody responses. With the doses that are used, no mechanism can be detected which could be due to an antigenic activity of the GP. The immunostimulating properties decribed cannot be due to a lipopolysaccharide since the preparation contains less than 1 p. 100 of endotoxin.


[Mechanisms of action of levamisole, stimulating cellular immune responses]. Since LMS possesses a thiazole and an imidazole (IMZ) moiety, we compared in vivo activities of LMS and of IMZ on immune responses of mice, IMZ was unable to increase the number of direct or indirect plaque-forming spleen cells to sheep red blood cells (SRBC), the magnitude of delayed hypersensitivity to SRBC, and did not evoke the production of a serum factor which passively transferred the immune stimulation. LMS was repeatedly active in these three tests. In vivo activities of LMS appear to be linked to its sulphur moiety able to recruit and activate a new population of T cells, through serum mediators.


[Clinical significance of circulating autoantibodies]. Indirect immunofluorescence on cryostat sections of rat, baboon and human organs is the best technique for routin detection of organ specific antibodies. Most of these antibodies (antinuclear, antinucleolar, anti-mitochondria, anti-parietal cells, anti-microsomes, anti-reticulin, anti-thyroglobulin, anti-salivary gland) are detected in less than 1% of normal adults ar a titer of 1/5. Their detection at high titers is of high clinical significance.


[Involvement of lymphocyte populations in rheumatoid synovial lesions]. T and B lymphocyte proportions have been studied in synovial fluid and peripheral blood from 70 patients with classical or definite rheumatoid arthritis (RA). The results have shown that T-cell numbers assessed by E-rosettes and anti-HTLA antiserum, B-cell numbers detected by membrane immunofluorescence and EAC-rosettes from peripheral blood were similar in RA and in a control group. Conversely, "active" E-rosettes which detected a subset of mature T cells, were decreased in blood and very increased in synovial fluid. Furthermore, the percentages of mononuclear cells bearing a Fc-receptor for IgG (EA-rosettes) were higher in synovial fluid than in RA peripheral blood. These data could be in favour of the cell-mediated immunity in rheumatoid arthritis lesions.


[Immunofluorescent deposits in normal rheumatoid skin]. Predominantly IgM immunofluorescent deposits have been found in 30% of normal, non exposed skin in a group of rheumatoid arthritis patients. Neither clinical nor biological correlation have been found. Because one case with cryoglobulinemia was positive, study of other non lupus, cryoglobulinemic, immune complexe type of diseases has been done. The results were negative. Further investigations are needed to explain this observation.


[Purification and properties of non-specific streptococcal extracellular mitogens]. Two immunologically different mitogens have been purified from culture fluid of growingStreptococcus pyogenes (group A). These substances were shown to be highly active on human and rabbit lymphocytes from peripheral blood, thymus and spleen, and less active on AKR mice thymocytes and splenocytes as well as on Nude mice splenocytes. These substances therefore appear as T-cell mitogens. Their effect on B cells remains to be investigated.


[Functional studies of T and B lymphocytes]. The means for analysing T-cell activities are very limited. Indeed, the numerical estimation of the changes which take place in human T lymphocytes had to rely solely on the observation of transformed cells (blasts). However, even if various mitogens appear selective for either T of B cells, we know that both types of lymphocytes are ultimately transformed into blasts. This is particularly true in studies conducted on mixtures of T and B cells where stimulated T cells can release substances which act on B cells. On the other hand, studies with purified populations of T or B cells do not express the cellular interactions that occur naturally between these two types of lymphocytes. For all these reasons, it seemed that the estimation of " quanta " of activity unique to T lymphocytes would contribute significantly to our knowledge of this line of cells. We describe a new method of detecting the in vitro stimulation of lymphocytes based on the appearance of cells having the property to cluster several layers of sheep red blood cells (SRBC) around themselves, forming multilayer rosettes (CFC). This formation is temperature-dependent and requires trypanblue-excluding, metabolically active blastoid cells. Non-separated cells as well as purified T cells stimulated with allogeneic leucocytes (MLR), specific antigens or polyclonal mitogens (PWM, ConA) gave rise to CFC. Such multilayer rosettes were not formed by separated B cells. In the MLR, CFC were detected 48 h after beginning of cultures and increased in number thereafter just like thymidine incorporation. The response to ConA and PWM was detected earlier and gave rise to two or three peaks, the first rise in the number of CFC coinciding with the peak of thymidine incorporation, but the maximal increase occurring two or three days later. Treatment of blastoid cells with a serum specific for T cells--but not with an anti-immunoglobulin serum--abolished their ability to form ordinary or multilayer rosettes. When separated, however, on a nylon wool column, CFC were more adherent than the bulk of T cells. It is suggested that CFC form a subpopulation of T cells with distinct characteristics, allowing a direct assessment of membrane changes which take place when T lymphocytes are activated in vitro.


[Evaluation of thymic hormone and E-rosettes in patients with IgA deficiency]. We have investigated lymphocyte subpopulations and T cell functions, in particular E rosettes and serum level of thymic factor in ten young patients (aged 6 to 20) with partial and selective IgA deficiency. The control group included ten age-matched healthy subjects. Significantly depressed levels of serum thymic factor were found in six patients. These results were correlated with the decreased number of E rosettes found in five of them, and support a T-cell involvement in IgA deficiency.


[Increased autorosette levels with aging]. The autorosette levels studied in human peripheral blood of 115 normal subjects are shown to be higher in women than in men and to increase along with the age in both sexes. These autorosettes could belong to immature T-cells as they stick to nylon wool and they decreased after E-rosette depletion. The T-cell origin of autorosettes is confirmed by the existence of mixed rosettes using autologous erythrocytes and sheep red blood cells.


E1Cold cytotoxic antibodies in kidney graft recipients. Serial serum samples from 39 renal allograft recipients were screened for cold and warm cytotoxic antibodies before and after grafting. In the group of patients who developed antibodies only after grafting, 6 had cytotoxins reactive at 37 degree C and 5 had cytotoxins reactive at 15 degree. At one year, all the patients with cold alloantibodies has functioning grafts, but none of the patients with warm antibodies had kept their graft. In three patients with cold antibodies, the cytotoxins reacted with a subpopulation of cells enriched in B lymphocytes but not with T cells eluted from nylon wool columns. This suggests that certain kinds of antibodies which appear in the blood after grafting may have enhancing properties.


Heart: excitation-contraction coupling.

Heart: excitation-contraction coupling. The study of E-C coupling in heart muscle has been facilitated by the recent availability of reasonably reliable voltage clamp techniques and a method of "skinning" cardiac cells. We have also had the introduction of several new ideas, including a Na:Ca exchange pump, metabolically controlled Ca storage capacity of the SR, and length dependence of Ca release. Consideration of the mechanism of E-C coupling in striated muscle as a general model has enabled transfer of insights gained studying fast skeletal muscle to heart muscle. On the other hand, many of the complexities of regulation of heart muscle contraction are manifested in fast skeletal muscle, as investigators explore the details of E-C coupling. On the whole, it is interesting to be an investigator in this field, as the E-C coupling mechanisms under investigation are being located in many nonmuscle cells, for such varied functions as control of cell shape during growth and excitation-secretion coupling. The last few years have seen the establishment of the existence and importance of a channel in the membrane that admits Ca as a function of electric field. We remain uncertain, however, of the details of relation of this current to the size of contraction. We have begun to explore the characteristics and role of the Na:Ca exchange mechanism in regulating the magnitude of intracellular Ca stores. Most investigators feel that this finally represents the necessary link in understanding digitalis action. A powerful but technically demanding tool is available in the "skinned" cardiac cell, permitting direct studies of Ca release from the SR in more-or-less intact cells. One dramatic finding with that technique is the demonstration of length-dependence of Ca release. On the horizon are methods of monitoring any possible transient potentials across subcellular organelle membranes and directly determining transient changes in free Ca in the sarcoplasm. This reviewer cannot help but feel that the next three or four years will be exciting ones in this field, and that the next review of E-C coupling will make interesting reading.


[Polymorphic secretory antigens (WZ) of the human adult and fetal colon]. The present paper concerns further data about the WZ polymorphic antigens of the human colon. A population study conducted with the immunofluorescence technique on rectal biopsies from 150 subjects, confirmed the frequency of the three phenotypes : W+Z (0.65), W-Z+ (0;25), W-Z- (0.10). The same three phenotypes were observed with the immunofluorescence technique in the colon goblet cells of 20 foetuses ranging in ages from 20 to 36 weeks. In these foetuses a comparative study of the WZ and ABH antigens along the length of the gastrointestinal tract showed the same reverse distribution of the two kinds of antigens as previusly reported in the adult. The comparison of the inhibition activity of adult or foetal colon mucosa extracts in a radioimmunoassay test showed that the WZ antigens are similarly present in heated water, phenolalcohol, and perchloric acid extracts. The WZ antigens are present in the meconium.


Cardiac dynamics.

Cardiac dynamics. The studies reported here were selected because of renewed interest in these areas, particularly as they relate to the evaluation and management of patients with coronary artery disease and heart failure. The first section emphasized a new conceptual approach to changes in the diastolic pressure-volume relation of the left ventricle. Although previous studies have concentrated on mathematical models which describe wall stress and stiffness as derived from the pressure-volume relationship, this review emphasizes that hemodynamic factors are very important in acutely altering the pressure-volume relationship of the left ventricle. This is partly due to alterations in right ventricular pressure, which subsequently influence the left ventricular pressure-volume relationship. In addition, recent studies have pointed out that compliance indices measured at low end-diastolic pressures differ from the indices measured at high end-diastolic pressures, so that limited information from one portion of the curve may not be generalized to describe the entire curve. The section on afterload emphasized the importance of this factor in influencing cardiac function, particularly in the presence of heart failure. In patients with both acute and chronic heart failure, vasodilator drugs which reduce ventricular afterload have produced substantial hemodynamic benefit by reducing the filling pressures of the right and left ventricles and increasing forward cardiac output. This hemodynamic improvement in response to afterload reduction is predictable from the different quantitative descriptions of ventricular afterload. Nevertheless, it is still unclear which method best describes afterload. Although wall stress, impedance, vascular resistance, and aortic pressure have all been utilized as a measure of afterload, each has some shortcomings which may limit its applicability. The final section reviewed approaches to the measurement of regionally ischemic myocardium. Since current studies have emphasized the importance of identifying and preserving ischemic, but viable, myocardium, this section has reviewed techniques for measuring local mechanical performance. Previous studies with the Walton-Brodie strain gauge and epicardial length gauge did not appear to be as satisfactory as more recent measurements with ultrasonic crystals, which can simultaneously measure wall thickness and segment length. These methods form the basis for ongoing experiments designed to evaluate approaches for preserving ischemic myocardium in the setting of experimental myocardial infarction.


[Properties of a collagen and monomycin complex]. The prolonged effect of  a single application of a collagen-monomycin sponge was studied experimentally on albino rats on a model of a skin flat wound. The monomycin levels in the blood and tissues in  the area of the sponge application for 14 days were determined by the biological method. The therapeutically effective concentration of monomycin, i.e. 3.8 gemma/ml was maintained in the general blood flow for 2 weeks. During this period the local antibiotic concentration was almost 5 times higher. The toxic effect of the collagen-monomycin complex was studied on rabbits and albino rats for 2 months with respect to the indices of the protein metabolism and the content of residual nitrogen and urea. The activity of cholinestrerase and the content of histamine in the blood were determined. No significant changes in the studied tests were observed during the period of the chronic experiment. The microstructure of the organs of the test animals did not differ from that of the intact animals. The collagen-monomycin complex had a prolonged antibacterial effect and was not toxic with respect to the the test animal.


Pharmacological and clinical study of bacampicillin in acute peritonsillitis--a comparison with ampicillin. The pharmacological and clinical properties of bacampicillin in three dosage groups were studied in 66 hospitalized patients with unilateral acute peritonsillitis in a comparison with ampicillin. Bacampicillin is a new semisynthetic aminopenicillin which is rapidly converted to ampicillin but is better absorbed. Both drugs were given orally. The mean individual peak serum levels achieved with 200, 400, and 800 mg of bacampicillin in the first morning dose were 4.9, 6.8, and 11.9 mg/liter, respectively, with an almost linear dose response. The peak level of 800 mg of bacampicillin was significantly higher than the 6.8 mg/liter noted after a nearly equimolar dose of 500 mg of ampicillin. A linear relationship was also seen between dose and area under the serum concentration-time curve. Preliminary antibiotic concentration studies in five patients indicated therapeutic levels in peritonsillar pus. Beta-streptococci alone or in combination with anaerobes were isolated from about half of the abscesses, whereas anaerobes were isolated from the other half. Treatment was supplemented by surgical procedures in the majority of cases. The clinical effect was good in all treatment groups, with only one relapse. All beta-streptococci were eliminated during therapy. The total number of gastrointestinal side effects was significantly lower in patients treated with bacampicillin, although the difference in frequency of diarrhea alone was not significant.


Requirements of glucose and incubation under static conditions for optimal colicin E1 induction. A rapid rate and large amounts of colicin E1 synthesis were induced by incubating colicinogenic cells without aeration in the presence of glucose. The decrease in ability of colicin induction by aeration was not due to an ample supply of oxygen, but to the simple agitation of the bacterial suspension. Sugars other than glucose that support colicin synthesis were mannose, fructose, glucose-6-phosphate, and mannitol. The effect of sugars in mutants deficient in enzymes of glucose metabolism suggested that some intermediary metabolites between glucose and pyruvate are closely related to the stimulation of colicin synthesis under these conditions. Analyses of deoxyribonucleic acid replication indicated that the induced replication of the colicin E1 plasmid deoxyribonucleic acid occurred even under conditions in which colicin was not actively synthesized.


Rapid method for detection of urea hydrolysis by yeasts. A method is described for the rapid detection of urea hydrolysis by yeasts, using the Berthelot color reaction. The results could be determined within 30 to 50 min with this method, compared with 8 to 72 h usually required with Christensen urea agar.


Occurrence of human-associated yeasts in bivalve shellfish from Long Island Sound. Candida parapsilosis, C. tropicalis, and Torulopsis glabrata were the human-associated yeasts most frequently isolated from quahogs, oysters, and mussels collected from four estuarine areas along the northern shore of Long Island Sound. Some inconsistency and seasonal variation in the occurrence of these and other yeast species were noted. In particular, C. albicans densities were greatest during colder months in the more heavily polluted waters. A total of 347 yeasts were isolated and cultured at 37 degrees C and, of these, 219 of 62% were human-associated forms. Generally, these yeasts in the animals sampled reflected the overall pollution status of the estuary from which they were taken. This study represents a clear demonstration of potentially pathogenic yeasts in a valuable marine resource.


Generalized indicator plate for genetic, metabolic, and taxonomic studies with microorganisms. We have developed an indicator plate that works well for diverse types of substrates and microorganisms. The plates are inexpensive and easy to prepare. The essential components are agar, buffer, growth-supporting nutrients, a test substrate, and 2,3,5-triphenyl tetrazolium chloride (TTC). Using various strains of Salmonella typhimurium and Escherichia coli, we have studied and defined the contribution of each component to the satisfactory function of the plate. Colonies capable of catabolizing the test substrate reduce TTC and produce a deep red formazan, whereas colonies failing to catabolize the substrate remain uncoloured. Those with intermediate rates of catabolism differ in rate and/or extent of color formation. In all cases the color is stable because TTC reduction is essentially irreversible. Since the mode of action of these plates is fairly well understood, alternative formulations can be devised to meet specific needs. The general applicability of this TTC indicator system makes it an extremely useful tool in microbial genetics, metabolism, and taxonomy.


Continuous culture of mixed oral flora on hydroxyapatite-coated glass beads. Methods for initiating and perpetuating a culture of mixed oral flora on hydroxyapatite (HT)-coated glass beads are described. Preliminary characterization of the resultant flora showed that species common in human dental plaque were present. The composition of the flora could be manipulated by altering cultural conditions. Scanning electron micrographs demonstrated that the microbes grew in densely packed microcolonies on the surface of the HT bead. A procedure for continuous culture of colonized HT beads in glass columns is described. This technique should make it possible to utilize experimental protocols employing continuous or interrupted flow of materials.


Stable gas-liquid chromatography column for fatty acid analysis. A mixed gas-liquid chromatography column of FFAP and Apolar-7CP has excelelnt thermal stability and shows excellent characteristics for the separation of the methylesters of fatty acids from Salmonella enteritidis call wall lipids.


Correction for the inherent error in optical density readings. Except at very low levels, uncorrected photometric determination of bacterial cell densities showed a decreasing proportionally to actual cell density or dry weight. A standard curve was prepared to convert photometric readings to truly proportional optical density values. With one dry weight determination, optical density values may be converted to absolute dry weight values.


Ruptured aneurysm of the abdominal aorta with kidney autografting. The treatment is described of a man aged 54 with a ruptured aneurysm of the abdominal aorta extending to above the junction of the renal arteries. The procedure selected was introduction of a prosthetic aortic bifurcation, followed by autografting of one kidney after is extracorporeal refrigeration. The procedure is explained.


A new treatment of split-skin graft donor sites. Skin-graft donor sites covered with a sterile polyurethane drape that is permeable to water vapor, but not to bacteria, heal under a fluid exudate. Re-epithelialization occurs more rapidly and with less pain than under the conventional paraffin gauze dressing.


An early 19th century case of ameloblastoma of the jaw. A detailed case history and macroscopical description is given of a destructive tumour of the lower jaw, treated by the Utecht prosector Petrus Koning in the years 1811-1813. The macerated skull demonstrating the enormous cystic tumour is still preserved in the Pathological Institute of the State University, Utrecht, and shows unmistakable ameloblastoma. This case is one of the first-if not thĕ first-proven cases of ameloblastoma recorded in history. Some remarks on the conservative treatment which was used, the incidence of ameloblastoma in history and its nomenclature are included in this article.


Incidence of skin carcinoma after renal transplantation. The development of de novo malignant neoplasms after renal transplantation continues to be of importance. The incidence of skin cancer in the renal transplant population at the University of Minnesota Hospital is compared with that expected on the basis of rates from the special nonmelanoma part of the Third National Cancer Survey. Overall, the risk of skin cancer in the renal transplant population was 7.1 times that expected. This excess was due primarily to squamous cell carcinomas, which were 36.4 times as frequent as expected.


Vasculitis in granuloma annulare: histopathology and direct immunofluorescence. Biopsy specimens from patients with granuloma annulare were studied by conventional light and immunofluorescence microscopy. In six of 20 patients, IgM was present in blood vessels of involved skin, and C3 was present in blood vessels in ten of 20 patients. In addition, IgM, C3, or fibrinogen were observed at the dermal-epidermal junction of eight patients. Necrobiotic areas contained fibrinogen. A retrospective histopathologic study of 38 biopsy specimens from other patients with granuloma annulare showed blood vessels with vessel wall necrosis, fibrinoid change, thickening, or occlusion in most specimens. Nuclear dust and extravasation of RBCs were also noted. These findings suggest that an immunoglobulin-mediated vasculitis may be involved in the pathogenesis of granuloma annulare.


Serological studies on strains of Theileria mutans isolated in East Africa using the indirect fluorescent antibody technique. The serological response of cattle infected with Theileria mutans (Aitong) by cyclical and mechanical transmission was studied using the indirect fluorescent antibody technique with T. mutans piroplasm and schizont antigens. Cattle infected by either method show high antibody titres against piroplasm antigens which persist for periods of over one year. Only cattle with tick-induced infections had an antibody response to schizont antigen. The serological cross-reactions of T. mutans (Ationg) with other strains of T. mutans isolated in East and South Africa sere investigated as were the serological cross-reaction of T, mutans (Aitong) and other species of Theileria. It was concluded that isolated of Theileria in East Africa which behaved like T. mutans were serologically indistinguishable using the IFA technique while other species of Theileria were easily distinguishable from T. mutans.


Establishment and characterization of a cell line (BTC-32) from the triatomine bug, Triatoma infestans (Klug) (Hemiptera: Reduviidae). The establishment of a cell line from embryonic tissues of the triatomine bug, Triatoma infestans is described. The cell line consists of three cell types which are described, and has a population doubling time of 48 hours during the logarithmic phase of growth. A proportion of the cells remain in the medium as floaters. Of the chromosome preparations that could be counted, the majority contained the diploid (2n = 22) number. The cell line has undergone 129 subcultures and has been maintained for over three years. The potential use of these cells in the study of Trypanosoma cruzi is described.


Teflon embolization to pulmonary arteries. A previously unreported complication of cardiac surgery, embolization to the lungs from Teflon pledgets, is presented. The pathological changes found in the pulmonary arteries postmortem are described and their possible clinical significance is discussed. Properties inherent in Teflon are implication in the origin of the embolization.


Effects of antipyretic agents on fever and ruminal stasis induced by endotoxins in conscious goats. Intravenous injection of endotoxin (LPS) from S. typhimurium (3,3 microng per kg body weight) or E. coli O111B4 (0,1 microng per kg body weight) caused fever and stasis of the forestomach contractions in conscious goats. Pretreatment with non-steroidal anti-inflammatory agents only had a partial antagonistic influence upon endotoxin induced ruminal stasis. In this respect, acetaminophen was the most potent drug of all agents tested. In dependence of the doses used, the following rank order of potency can be given in relation to the antipyretic activity: sodium flurbiprofen, sodium meclofenamate, acetaminophen, sodium novaminsulphonum and phenylbutazone. In the goat, sodium flurbiprofen (2 mg per kg i.v.) is a very potent and long acting antipyretic agent. It seems unlikely that the inhibition of forestomach motility by endotoxins is simple due to a release of prostaglandins. Since the inhibition also occurred in absence of a febrile response, it is concluded that the inhibition is not primarily due to hyperthermia.


On-line computerized data handling system for treating patients with renal disease. Some patients with renal disease accrue 6,000 to 8,000 individual data items relating to symptoms, signs, laboratory information, and treatment in one year. To deal with the problem of handling so many data items, the following steps were taken: (1) a dictionary of terms peculiar to nephrology was created; (2) manual time-oriented records for nephrology were constructed; and (3) an on-line data processing system, using a PDP-11/70 computer and remote teleprocessing terminal, was developed. On the terminal screen, up to 11 consecutive patient visits can be displayed horizontally, with 18 data items displayed vertically. Up to 30 of the most recent patient visits are easily accessible. For patient treatment, a special feature allows a rearrangement and instantaneous display of any combination of data, thus permitting review of essential feedback relationships between clinical events and treatment.


Genetic, acquired, and related factors in the etiology of diabetes mellitus. Diabetes mellitus is not a single disease entity, but a heterogenous group of disorders with a striking diversity of etiopathogenetic mechanisms as well as clinical manifestations. Lack of a known genetic marker for the disease(s) and variable influences of environmental factors on the expression of a putative diabetic genome have resulted in considerable debate over its etiology. Over the past few years, systematic epidemiologic studies, along with knowledge gained from a close association of certain human-leukocyte-antigens with the diabetic diathesis and possible role of host-immune factors, and gene-virus interaction have led to considerable advancement in the understanding of the disease-complex. Pending the availability of definite genetic marker(s), we propose a new, tentative classification based on the etiologic mechanisms. We also suggest that the term "prediabetes" be abandoned as a prospective entity, since as presently employed, this connotation carries a risk probability no different than the terms like prehypertension or precoronary thrombosis.


[Ultramicroscopic study of the colonic mucosa infected by E. histolytica]. In eight guinea pigs, trophozoites of E. histolytica HM-2 IMSS strain grown in plurixenic conditions were inoculated in their cecum. Two died two days after inoculation; the remaining si- were sacrificed six days afterwards. Tissue samples were obtained from amebic lesions and nearby areas. At ultramicroscopic level it was observed that epithelial cells in contact with the parasite had short and/or scanty microvilli, swollen mitochondria, ER dilatation and absence of the terminal bar. When trophozoite was within the epithelium, cells in contact with it were destroyed; basement membrane was elongated before it was broken up by the parasite. In the lamina propria trophozoites were found close to glands, blood capillaries and in contact with macrophages, lymphocytes, and most cells. No polymorphonuclear cells were identified in all samples studied. Capillaries were congestive, lacking polymorphonuclear cells. It was postulated that probably initial colonic mucosa lesion in amebiasis depends solely upon parasite action.


[Coagulation analytical studies in coli enterotoxemia in swine]. Store pigs with spontaneous outbreaks and experimental endotoxin shock were kept under observation in the context of coagulation analysis. Heparin was applied to some of the animals to disrupt the plasmatic coagulation system. The thrombocyte count in animals with endotoxin infusion declined by some 50 to 65 percent of the original level. No statistically secured difference was found to exist between heparinised animals, on the one hand, and non-heparinised, on the other. The aggregation and adhesion of thrombocytes in all shock animals was more pronounced than that in the controls. The fibrinogen levels were lowered in both the animals with spontaneous outbreaks and the experimental animals. Thrombocyte alteration was not found to have been dependent on activation of the plasmatic coagulation system. In endotoxin shock cases activation of plasmatic coagulation proteins was found to be preceded by rise in thrombocyte aggregation.


[The evaluation of principles for the prevention and control of animal epidemics during the second half of the 18th century according to a contemporary monograph, from a current viewpoint]. Reference is made to the third edition of a handbook published 1800 in which experience in preventing and controlling animal diseases is given in the form of standards together with conclusions, the latter being related primarily to the incidence of cattle plague in the second half of the 18th century. The points made in the handbook are related to the history of veterinary medicine, with particular emphasis being laid on today's national veterinary services and the legal provisions which are now in effect for the prevention and control of high risk. Since production relations and productive forces were on a different level then, both the consequences of high-risk animal diseases and action for protection often had deterimental impact upon agricultural production and led to the ruin of many poorer farmers and dependent peasants. The substance of the prevention and control principles was not only adequate, but to some extent is valid even today, notwithstanding the much higher scientific basis on which many problems are tackled in our days. A set of strict rules had been established, and offenders had to expert severe punishment. Yet, in the class society of that time penalty rules differed for 'masters' and 'inferiors'. The handbook is of enlightening importance as a basisfor deliberate application of codes and standards.


[Chemically defined and partially defined media for pasteurella multocida and pateurella hemolytica]. Two culturing recipes were suggested for Pasteurella multocida and Pasteurella haemolytica, one partialy defined nutritive defined nutritive medium with 0.5 per cent yeast extract and one chemically defined medium. Both had been composed on the basis of studies into nutrient demand and into the effects of complex nutritive substrates. Both nutritive media are applicable also to culturing other bacterial species. (Among the strains tested so far were streptococci, staphylococci, Escherichia coli, pseudomonas, protest, Salmonella,, Shigella, and Haemophilus.)


The impact of a weekend group experience on individual therapy. Thirty-three patients in long-term individual therapy were referred to one of three weekend groups: two experimental (affect-arousing, gestalt therapy) groups and one control (meditation-Tai Chi) group. The impact of the weekend group experience (WGE) on individual therapy was examined six and 12 weeks later. At six weeks the patients in the experimental groups showed, on some measures, a significantly greater improvement in their individual therapy than did controls. By 12 weeks, there were no demonstrable differences. The WGE was not without risk: even though the group leaders were highly trained, responsible clinicians, two patients suffered considerable psychological damage. The control (meditation-Tai Chi) group offered a relatively innocuous experience; there was no risk, but few members found the specific procedures useful in their lives. Intense affect arousal in the WGE was not related to positive change in subsequent individual therapy. Those expressing the greatest affect in either experimental group were no more likely to have had a measurable positive impact on their subsequent individual therapy than patients expressing little or no measurable affect.


Lithium carbonate and ethanol induced "highs" in normal subjects. The responses of twenty-three normal male subjects to a standardized dose of 95% ethanol (1.32 ml/kg of body weight) were compared after two weeks of placebo and two weeks of therapeutic serum lithium ion levels (mean 0.91 mEq/liter). The study was a placebo controlled, split-half crossover, double-blind design. Prealcohol and postalcohol responses were assessed by self-rating scales of affect and mood, independent rater observation, perceptual-motor, and cognitive performance tasks. Pretreatment by lithium carbonate neither blocked nor dampened an alcohol-induced subjective "high" in normal subjects. A complex reciprocal interaction may exist between the effects of lithium and alcohol upon other behavioral attributes. Alcohol was seen to reverse aspects of lithium-induced dysphoria and there is a suggestion that lithium may attenuate alcohol-induced cognitive inefficiency.


The sudden infant death syndrome: a review of recent advances. When deaths during the first year of life are sudden, unexpected, and unexplained by any clinical or routine postmortem finding, they are placed in the category of sudden infant death syndrome (SIDS). The syndrome may have many causes, but there are probably only a few final pathways to death. Much recent evidence supports sleep apnea as the most common of these final pathways. Several SIDS victims have had reccurent episodes of sleep apnea prior to death. Such episodes are associated with chronic underventilation of the lungs in other disorders, and more than half of SIDS victims have postmortem markers of antecedent chronic underventilation and hypoxemia. The hypoventilation-apnea hypothesis is also attractive because it fits most of the unique epidemiologic features of SIDS.


Pancreatic islets of malnourished rats: quantitative histologic and electron microscopic findings. Young rats were maintained for three weeks on a low-protein diet. These animals developed many of the features of human protein-calorie deficiency, including dextrose intolerance and diminished insulin release. Quantitative histologic and ultrastructural studies showed that malnourished rats had (1) a reduced total pancreatic islet volume, and (2) a preponderance of pale granules in the B cells. It is suggested that pale B granules may contain increased amounts of insulin, which accumulate in the cells because of defective insulin release. The mechanism responsible for this has not been elucidated.


Aneurysm contents as a source of graft infection. During the past 5 1/2 years, cultures were taken from 68 to 151 surgically treated aortic aneurysms. These cultures were made from nonblood fluids, laminated clot, necrotic areas of the aneurysm wall, or ulcerated atheromatous plaques. Organisms were harvested from seven of the 68 cultures, including Staphylococcus, Escherichia coli, Pseudomonas, and hemolytic Streptococcus. Prophylactic antibiotics were used in all patients; however, the organisms cultured, excepting Streptococcus, were not sensitive to the chosen antibiotics. Three of the seven patients with a positive aneurysm culture died of causes unrelated to infection. Evidence of graft infection has not developed in four surviving patients with positive cultures. Knowledge of the presence of bacteria permitted massive antibiotic therapy based on organism sensitivity.


Surgical repair of a ruptured spleen in children: report of eight cases. Ten consecutive children with clinical evidence of splenic rupture underwent surgical exploration. In eight patients, all or part of the spleen could be preserved. The two patients requiring splenectomy had associated injury to the tail of the pancreas. Surgical techniques employed to preserve the injured spleen were those in common use to repair equivalent hepatic or renal injuries. There was no morbidity or mortality associated with the procedure. Splenic salvage protects the child from increased susceptibility to sepsis associated with splenectomy.