Immunocytochemical localization of lysozymes in respiratory and other tissues. Immunostaining paraffin sections of appropriately fixed tissues with an antiserum to human urinary lysozyme as the primary step in an immunoglobulin-peroxidase bridge method has localized lysozyme in previously recognized sites such as Paneth cells, renal tubules, and lymph node macrophages in several species. In addition, lysozyme was demonstrated in the ciliary layer of the trachea, and type II pneumocytes, as well as cells of presumed mucoid nature in laryngotracheal glands. Large stellate cells in follicle centers in the lymph nodes and spleen and in the medulla of the thymus evidenced strong lysozyme reactivity. Granular pneumocytes disclosed immunoreactivity for lysozyme also at the ultrastructural level. Lysoplate assay demonstrated lysozyme in abundance in both the cellular pellet and acellular supernatant of rat alveolar wash fluid and in rat lung after repeated washing of alveoli. Hamster lung differed from the others in failing to immunostain for lysozyme and affording no evidence for content of lysozyme as determined by lysoplate assay. Sites stained with antiserum to human urinary lysozyme failed to stain with antiserum to egg white lysozyme. However, the pyloric glands, Golgi elements in intestinal epithelium, the surface of the colon, and the proximal straight renal tubule of the mouse stained exclusively with the antiserum to hen egg white lysozyme. Many sites staining with antiserum to urinary lysozyme in respiratory, renal, and lymphoid tissue lacked reactivity in control sections exposed to this antiserum after it was absorbed with purified urinary lysozyme. However, mucous acini in submandibular glands, although failing to stain with other control procedures, retained towared the absorbed antiserum, possibly through reacting with an antibody other than that for human urinary lysozyme. A number of cell types containing proteinaceous cytoplasmic granules stained in control sections exposed to normal serum in place of antilysozyme serum in the immunoglobulin-peroxidase bridge procedure and, thus, possessed selective, but nonimmunospecific affinity for immunoglobulin. Cell types that stained with antiserum to hen egg white lysozyme lost affinity for the antiserum after its absorption with egg white lysozyme but retained the affinity after absorption with urinary lysozyme.


Antigenic and morphologic regeneration of epidermal basement membrane in short term organ culture of human skin. In fetal life the development of bullous pemphigoid antigen is preceded by a morphologically detectable basement membrane zone (BMZ). The present study investigated the possibility that similar morphologic and antigenic changes of the BMZ occur in short term organ culture of human skin. Twenty small pieces from each of four neonatal foreskin specimens were cultured under standard conditions. At regular intervals two pieces from each specimen were removed. One piece was frozen and cryostat sections were processed for indirect immunofluorescence using a patient's serum that was proven to have circulating pemphigoid IgG antibodies. Additional sections were stained with periodic acid-Schiff and hematoxylin and eosin. The other piece was processed for electron microscopic examination. Morphologically the BMZ started degenerating after 24 hours. Regeneration started on the 4th day and reached an optimal level on the 5th day. Chance of the immunofluorescence line at the BMZ began with a slight weakening at 24 hours followed by progressive widening and breakage until the 4th day when fluorescence was no longer detectable. Except for a few punctate areas immunofluorescence remained absent on the 5th day. Sixth day specimens, however, revealed reappearance of the immunofluorescence line in a continuous pattern. By the 7th day a second morphologic and antigenic degeneration started at the BMZ. This lag between the morphologic and antigenic regeneration of the BMZ in organ culture although shorter is comparable to the one observed during the development of the BMZ in fetal life.


The functional capacity of guinea pig megakaryocytes. II. The uptake of particles and macromolecules and the effect of rabbit antiguinea pig platelet antiserum. The capacity of megakaryocytes to take up particles and macromolecules was tested by exposing them to homologous erythrocytes, latex particles, Micrococcus lysodeikticus, and horseradish peroxidase. Uptake of particles 1.1 to 7 mum. in size was extensive under the experimental conditions employed. After uptake of each of the three particles the addition of tannic acid and calcium to the fixative produced electron-dense deposits within the vacuole surrounding the particle; therefore, the vacuole was not closed off. This finding indicates that many of the particles could be actually trapped within the preformed elements of the demarcating membrane system. Horseradish peroxidase was concentrated within cytoplasmic vacuoles after 2 hours of exposure to 0.1 mg. per ml. The presence of surface membrane receptors was determined by the sheep cell rosette method. The presence of the C3b receptor for complement was determined by the sheep cell rosette method. The presence of the C3b receptor for complement produced rosette formation. The functional capacity of megakaryocytes to react like platelets was also tested by observing cell lytic changes and determining that there was approximately 40% release of 3H-serotonin produced by specific rabbit antiguinea pig platelet antiserum in the presence of complement. These studies demonstrate several functional capacities of megakaryocytes: the uptake of particles, pinocytosis, and the cell lytic response to specific antibody.


[Nutritional hygiene of flight personnel on long flights]. Progress in the adequate nutrition of pilots during long-term flights since 1935 is discussed. Special attention is given to the arrangement of meals inflight. The nutritive value of the flight rations and methods of maintaining high quality of diets inflight are described. The hygienic estimate of diets and their efficiency is given. Attention is paid to the development of the main method of nutrition in long-term flights--diets consumed by pilots with an oxygen mask on. Nutrition in high altitude flights is discussed. The development of flight diets from "sandwich rations" (1935-1958) to up-to-date food products and polyvitamins (since 1958) is described. Further pathways for the study and improvement of flight rations are outlined.


Trans--pulmonary artery repair of ventricular septal defect associated with congenitally corrected transposition of the great arteries. This report documents successful trans-pulmonary artery repair of ventricular septal defect (VSD) in 2 patients with congenitally corrected transposition of the great arteries, one patient having associated subpulmonic stenosis. In selected cases, the method of repair that is described offers significant advantages over techniques employing transventricular or transatrial access to the VSD.


Ventricular septal defect and aortic insufficiency. Surgical treatment. Twenty-five patients with ventricular septal defect (VSD) associated with aortic insufficiency (AI) have been since 1964. Of these patients, one died suddenly without operation; in 2 patients, AI developed in the late postoperative period following VSD closure; and in 3 others, AI developed shortly after VSD closure. The remaining 19 patients are discussed in detail. The VSD was subpulmonic in 13 (68 per cent) and subcristal in 6 (32 per cent). Primary suture of the VSD was undertaken in 13 patients and patch closure in 6. Seven patients had aortic valvuloplasty and 2 had aortic valve replacement. There were no surgical deaths, and the long-term follow-up shows that VSD closure alone has been sufficient to arrest progression of AI in patients with mild insufficiency, particularly in those with subpulmonic VSD. Valvuloplasty, when necessary, was more effective when done at an early age.


Results of the use of the TDMAC-heparin shung in the surgery of aneurysms of the descending thoracic aorta. Results in 23 patients operated upon for the repair of aneurysms of the descending thoracic aorta with a TDMAC-heparin-bonded shunt are reported. The results with particular reference to paraplegia are compared with those in 365 patients operated upon by members of The Samson Thoracic Surgical Society utilizing this and other techniques. No technique completely prevented paraplegia.


Surgical correction of double-outlet right ventricule with noncommitted ventricular septal defect. A 3-year-old boy underwent successful surgical correction of double-outlet right ventricle (S, D, D), noncommitted ventricular septal defect (VSD) of the endocardial cushion type, and pulmonary stenosis. The operation consisted of an internal baffle connecting the left ventricle to the aorta through the VSD. The pulmonary outflow tract was widened with a Dacron patch. Surgical options in this and other subsets of DORV are discussed.


Retention of pacemaker electrode complicated by Serratia marcescens septicemia. Removal with total cardiopulmonary bypass. A case in which Serratia marcescens septicemia complicated the insertion of a transvernous pacemaker unit is reported. Appropriate antibiotic therapy and removal of the pacemaker electrode are two essential steps to achieve a complete cure in this stimulation. Open cardiotomy with total cardiopulmonary bypass provides a safe approach for withdrawal of an incarcerated electrode and is justified because of the lethal potential of systemic Serratia infections, particularly those superimposed on intracardiac prostheses.


Patterns of patency of 596 vein grafts up to seven years after aorta-coronary bypass. The long-term behavior of vein grafts and their effect on the native circulation were studied by examining 596 vein grafts in 343 patients at a mean follow-up of 15.4 months, range zero to 84 months. Serial studies were performed on 27 patients with 38 grafts. The over-all graft patency rate was 84 per cent, and the rate after more than 5 years was 89 per cent. The patency rate in asymptomatic patients was 91 per cent compared with 81 per cent in the remainder. The patency of grafts attached distal to total occlusions was 82 per cent (78/82). The angle of origin of the grafts from the aorta did not appear to influence patency or the severity of intimal proliferative changes. In 76 patients with 126 grafts, pre- and postoperative cineangiograms were compared, and changes in the graft and underlying coronary artery classified as Groups 1 to to 6: Group 1, patent graft, bidirectional flow in the grafted vessel, proximal lesion unchanged; Group 2, patent graft, bidirectional flow, proximal lesion progressed to occlusion locally; Group 3; patent graft, distal flow only, occlusion of lesion and segment between graft and lesion; Group 4, graft occluded, native artery unaltered; Group 5, graft occluded, native artery now occluded at lesion and region of anastomosis; Group 6, new distal lesion. Results were as follows; Group 1, 58 per cent; Group 2, 21.2 per cent; Group 3, 5 per cent, Group 4, 12.5 per cent; Group 5, 2.5 per cent; and Group 6, 0.8 per cent. Native coronary arteries undergoing closure (Group 2) had lesions 95 per cent or greater in 93 per cent of patients. The rate of closure of ungrafted lesions was 2 per cent. We believe these results encourage the continued used of vein bypass grafts.


Monitoring of cardiac output by thermodilution after open-heart surgery. One hundred twenty-five separate cardiac output determinations were obtained after open-heart surgery in 10 patients by simultaneous use of thermodilution and dye-dilution techniques. Mean thermodilution cardiac output was 1.6 per cent greater than mean dye-dilution cardiac output (5.24 versus 5.16 L. per minute). Reproducibility of thermodilution cardiac output (coefficient of variation, 8.6 per cent) was superior to that of dye-dilution cardiac output (coefficient of variation, 12.3 per cent) for outputs ranging from 2.5 to 8.7 L. per minute (p less than 0.001). Linear regression analysis revealed a correlation showing that COtd = 0.86 COdye + 0.80 (r = 0.9, p less than 0.001) and indicating a similarity between thermodilution and dye-dilution output figures except in extremely low output states. In such cases, thermodilution cardiac output becomes progressively larger than dye-dilution cardiac output. The results indicate that thermodilution cardiac output is a valid method for determining cardiac output in the rapidly changing clinical setting following cardiopulmonary bypass. Clinical applications of this technique include evaluation of the efficacy of inotropic agents, effectiveness of intra-aortic balloon counterpulsation, and status of the low output syndrome postoperatively. Routine use in patients with Class III or IV cardiac disease appears justified.


Surgical treatment of supraventricular tachyarrhythmias. In this report, we have outlined our experiences with the direct surgical treatment of 16 patients with supraventricular tachyarrhythmias (SVTA). Re-entry supraventricular tachycardia (SVT) was demonstrated by the 4 patients who had retrograde-conducting Kent pathways. The SVT was corrected by the successful division of the Kent bundle in 3 and a partially successful His bundle division in one patient. The remaining 9 patients with re-entry, which included 6 with Kent pathways and WPW, all had His bundle section. The remaining 3 with His interruption had focal tachycardias associated with dysfunction of the atrioventricular (AV) node. Of the 13 His bundle interruptions, nine were successful, three resulted in questionable AV conduction, and one failed. Problems with suture ligation and cautery explained the failures. Cryothermia was the most successful procedure used. However, excision of that portion of the atrium containing the AV node shows promise of being satisfactory. The possibility is discussed of using measures much more precise and less destructive than His bundle interruption for SVTA.


Pulmonary blood volume and its significance in pulmonary hemodynamics immediately after mitral commissurotomy. Immediately after mitral commissurotomy, we measured pulmonary blood volume by dye-dilution method and investigated the relationships between pulmonary blood volume and other hemodynamic parameters. Pulmonary blood volume correlated directly to pulmonary mean transit time, cardiac index, stroke volume index, and mean left atrial pressure. Pulmonary blood volume increased with mean pulmonary arterial pressures up to 35 mm. Hg but decreased with elevation above this level. The same patterns were observed in the correlations between pulmonary blood volume and both pulmonary distending pressure and pulmonary vascular resistance. These observations suggest that the changes of the pulmonary vessels begin with the elevation of mean pulmonary arterial pressure above 35 mm. Hg, pulmonary distending pressure above 25 mm. Hg or pulmonary vascular resistance above 5 units. Therefore, it is desirable to maintain mean pulmonary arterial pressure below 35 mm. Hg in patients immediately after mitral commissurotomy.


The mitral plication suture: a new technique of mitral valve repair. During 1975, 67 patients underwent attempted repair of mixed mitral valve disease by use of the new mitral plication suture (MPS) technique. Ninety per cent had successful repair and 10 par cent required valve replacement. The MPS is a double, semicircular, buttressed annuloplasty suture that constricts the enlarged mitral annulus to correct mitral regurgitation (MR), supports mitral subunit repair procedures, and yet maintains the flexibility of the mitral annulus. The hospital mortality rate was 6 per cent. There were no late deaths during 10.4 months of follow-up. Six per cent of the patients who had valve repair required subsequent MVR. Their repair operations are considered late failures. Echocardiography, a useful technique for assessing the status of the patients postoperatively, demonstrated normal mitral valve and left ventricular function in the majority of patients; comparisons with replacement valves are documented. Death and morbidity was less frequent than in patients with MVR, both in the hospital and during follow-up. The aggressive policy of mitral valve repair has reduced the number of MVR's from 95 during 1974 to 52 in 1975. Although follow-up is short, we conclude that the new MPS is a valid surgical adjunct to the complete repair of the mitral valve.


Clinical evaluation of computerized tomographic mammography. This is an initial report of the first clinical study using computerized tomographic mammography (CTM). A study is being conducted comparing CTM and conventional mammographic techniques in patients who subsequently undergo breast biopsy. This report analyzes the experience with 160 breast lesions found in patients who were examined using CTM without contrast material. One hundred lesions were benign and 60 were malignant. Mammography correctly identified 54 of the malignant lesions while CTM identified 41. Five lesions were missed by both modalities. The report also analyzes results experienced with 79 lesions found in patients who were examined with CTM both before and after the intravenous injection of contrast material. Forty-six of these lesions were benign and 33 were malignant. Mammography correctly identified 28 of the malignant lesions while CTM identified 27. Only one lesion was missed by both modalities. It is planned to continue this study, especially to enlarge our experience with the use of contrast material in breast scanning.


Malignant melanoma in the resident population of Rochester, Minnesota. The incidence of malignant melanoma in the population of Rochester, Minnesota, was studied through use of the countywide diagnostic indexing system at the Mayo Clinic. The average annual incidence of cutaneous melanoma (4.0/100,000 creude, 4.2 adjusted to the age structure of the US 1950 population) was similar to that reported by the Third National Cancer Survey for 1969 through 1971 for locations in the United States at the approximate latitude of Rochester. Unlike reports from other studies, no change in incidence rate during the 25 years 1950 through 1974 was detjected in Rochester. The crude annual incidence of malignant melanoma of the eye, also determined for the same period, was 1.3/100,000.


The middle cranial fossa approach to the internal auditory canal -- an anatomical study stressing critical distances between surgical landmarks. The middle cranial fossa approach to the internal auditory canal and petrous apex has proven to be an extremely useful otologic surgical procedure. Ths historical evolution of this approach and its present day application were reviewed. The purpose of the study was to describe the normal anatomical variations encountered during the course of the middle cranial fossa approach to the internal auditory canal. Measurements between surgical landmarks were made on 20 dissected, and 41 histologically sectioned temporal bones. The values obtained were statistically analyzed. Finally, the practical implication of the observed anatomical measurements and of the statistical evaluations were discussed.


[Current concepts in the pathophysiology of the diarrhea (author's transl)]. Diarrhea can be defined as increased frequency of bowel movements (greater than 3 per day) plus decreased consistency of stools (volume greater than 200 ml per defecation). Two pathogenetic mechanisms have been intensively investigated and partially elucidated within the last years: 1. Secretion of electrolytes and water by way of induction of an augmented synthesis of cAMP in the mucosa cell. Cholera enterotoxin and other bacterial toxins as well as VIP (vasoactive intestinal peptide) cause diarrhea by this mechanism. 2. Certain substances such as dihydroxylated bile acids, diphenolic laxatives and probably fatty acids cause leakage of the tight junctions between mucosal cells and cause leakage of electrolytes and water back into the intestinal lumen.


The use of porous plastic filters in the preparation of cell suspensions. Suspensions of cells were prepared by dissociation of various tissues with the proteolytic enzyme pronase. Debris, undisrupted tissue and cell clumps were effectively removed from the suspensions by passage through VYON F porous plastic filters whereas isolated cells were recovered without significant losses. The viability of the cells, as judged by dye exclusion and subsequent behavior in tissue culture, was not affected by the treatment.


[Comparison of the antibacterial efficacy of doxycycline and tetracycline (author's transl)]. In order to explain the mechanism of resistance within the tetracycline group, the minimal inhibitory concentration of tetracycline HCl was compared with that of doxycycline in the micro dilution test for bacterial collectives of 48 strains each from the groups of gram-negative and gram-positive cocci, resp. There was no significant difference between the inhibitory effect of doxycycline and tetracycline HCl for the bacterial collectives of E. coli, Klebsiella, Proteus and Staphylococcus aureus heamolyticus strains which were inhibited by a relatively low concentration of tetracycline HCl and doxycycline, respectively. On the other hand a significant difference in inhibitory effect was observed the calculation was made according to the Kolmogoroff-Smirnov test for the bacterial collectives of Enterococci and Staphylococcus aureus haemolyticus strains which were tetracycline resistant or only inhibited by higher concentrations. These results also have a practical importance, because a further testing against doxycycline can bring about a sensitivity to this substance in case of tetracycline resistant grampositive cocci. Possible explanations for the higher efficacy of doxycycline on these bacterial collectives will be discussed.


The emergence of gentamicin-resistant klebsiellae in a large general hospital. Between March and December, 1975, an outbreak of infection with gentamicin-resistant Klebsiella pneumoniae (klebsiella (Gmr)) occurred at the Royal Melbourne Hospital. The klebsiellae were considered to be causing significant infection in 24 of 42 patients harbouring the microorganism. Commonest culture sources were urine and sputum, all but one of the significant urinary infections being associated with indwelling bladder catheters. Antibiotic therapy had been given to 40 patients before the isolation of klebsiella (Gmr), and of these 22 had received gentamicin. Cross infection was a major factor in the outbreak, and control measures (to limit this aspect and curtail the usage of gentamicin) have prevented wider spread within the hospital; at the time of writing the microorganism had been eradicated from all but one of the infected patients. It was shown that klebsiella (Gmr) carry an R-factor capable of transferring gentamicin resistance. Of 22 isolates tested quantitatively, 20 were resistant to 10 mug/ml of gentamicin.


Chloroquine-resistant falciparum malaria from Papua New Guinea and its implications for Australia. There is need for effective chemoprophylaxis against chloroquine-resistant falciparum malaria, and for a safe and effective drug to be readily available for the treatment of that condition. Experience with the cases cited in this study indicates that Fansidar should be made available for treatment and it is suggested that Maloprim be made available as a prophylactic agent.


[Use of pocket calculators in stereotactic operations (author's transl)]. We report a pocket calculator program which performs the calculation of the target parameters for a stereotactic apparatus (System Riechert-Mundinger).


Combination of cyclophosphamide, vincristine, and prednisone, followed by maintenance chemotherapy, with and without radiotherapy, in the management of patients with non-Hodgkin's lymphomas. Sixty patients with non-Hodgkin's lymphomas were treated with a cyclophosphamide, vincristine, and prednisone (CVP) induction regimen, either alone (stage IV) or in combination with radiotherapy (stages I, II, III). The response rates for lymphocytic and histiocytic lymphomas were 82 and 86%. The complete remission (CR) rates were 66 and 71% with a median duration of 13 and 5.5 months respectively. Nodular types responded better than diffuse ones in both lymphocytic (CR rate 85% vs 45%; median duration 24+ months vs 2.5 months) and histiocytic lymphoma (CR rate 100% vs 0%). In lymphocytic lymphomas, survival in the responder group was 90% at 24 months vs only 20% in the nonresponder group (median survival 14.2 months). In the group with nodular lymphocytic lymphoma responding to therapy, there was a 100% survival rate at 24 months. The median survival for patients treated with chemotherapy alone (stage IV) and not responding to therapy, was 22 months vs 14.5 months in the whole nonresponder group (stages I, II, III, IV), suggesting a detremental effect of rediotherapy in the nonresponder group. In histiocytic lymphomas, the median survivals in the responder and nonresponder groups were 19 months and 3 months respectively. These results corroborate the excellent efficacy of the CVP regimen. They also indicate that, after CVP induction, 2 major prognostic factors are the histologic type and the nature of the response to therapy.


Evidence for joint genic control of spontaneous mutation and genetic recombination during mitosis in Saccharomyces. A procedure for detection of mutants exhibiting either enhanced or reduced spontaneous mutation during mitosis and/or meiosis has been developed to probe the joint genic control of spontaneous mutation and recombination in yeast. A semidominant mutator, rem1-1, recovered by this technique, exhibits enhanced spontaneous mutation,intragenic recombination, and intergenic recombination during mitosis. Diploids homozygous for rem1-1 exhibit normal levels of meiotic intragenic and intergenic recombination and diminished ascospore viability.


Role of dnaB43 in F'-plasmid incompatibility. In order to perform complementation tests with mutations of DNA replication of F'-plasmids incompatibility must overcome. We report out in ability to duplicate the results presented by Palchoudhury and Iyer (1971) and Bezanson and Iyer (1975) who have claimed to demonstrate the autonomous replication two incompatible F'-plasmids in a strain carrying the temperature sensitive dna B43 allele. In addition, we describe experiments designed to measured complementation using transient heterozygotes and compatible plasmids. Assessment of our data and those of others in the light of a recent report by Uhlin and Nordström (1975) suggests that new approaches will have to be developed for the successful employment of complementation analysis in F-plasmid genetics.


Plasmid replication and Hfr formation in strains of Escherichia coli carrying seg mutations. Several conditional-lethal mutantions that do not permit the replication of F-factors of Escherichia coli K-12 are located at a site called seg. This gene is located on the E. coli chromosome between ser B and thr. It is unrelated to other known genes involved in DNA replication. Strains carrying seg mutations were unable to replicate F'-lac+, several F'-gal+s, F'-his+ and bacteriophage gamma at 42 degrees. However, neither phage T4, ColE1, nor any of the R factors tested were prevented from replicating at 42 degrees C. When the kinetics of the loss of F-primes is studied in seg strains, it is found that the rate of curing depends on the size of the plasmid, larger F factors curing faster than smaller ones, and that Hfrs are formed at high frequencies. The Hfrs showed both F-genote enlargement and normal transfer of chromosomal markers. The F-genotes are unstable and segregate chromosomal markers at high frequencies. Some orthodox Hfrs were examined, and two that were known to revert to the F+ condition relatively frequently were found to generate enlarged F-genotes on mating, whereas two strains that were very stable with respect to the F+ state did not show F-genote formation. F-genote formation from seg Hfr stains is dependent on a functional recA gene, as F-genote formation was not seen with a seg-2, recA-1 Hfr. This is in contrast to F-genote enlargement shown by both orthodox Hfrs and an Hfr strain constructed by integration of a temperature-sensitive F'-gal+, whose F-genote enlargement is Rec-independent. Thus there may be more than one mechanism for the formation of enlarged F-genotes.


Transcription of ribosomal protein genes carried on F' plasmids of Escherichia coli. The transcriptional activity of the DNA sequences coding for certain ribosomal proteins has been measured in Escherichia coli. Two partial diploid strains were isolated from mating of a recA, argD, aroE recipient and an Hfr with an origin at 69.5 min. One contained an F' element carrying the genes from 69.5 to 72.7 min including the rpsL locus (72.4) and the second was diploid for the genes from 69.5 to 71.5 min but did not include any mapped ribosomal protein loci. The molecular weights of the plasmids were estimated to be 140 and 110 x 10(6) daltons, respectively. The extent of in vivo transcription of the chromosomal genes on the plasmid and the ribosomal protein mRNA fraction of the total cellular RNA weer calculated from DNA-RNA liquid hybridization experiments using both DNA and RNA excess procedures. The results indicated a high degree of transcriptional activity concentrated in the ribosomal protein sequences with 83% of the F' chromosomal sequences transcribed into mRNA products representing about 0.12% of the total cellular RNA.


Pleiotropic mutants of Aspergillus nidulans altered in carbon metabolism. Mutants altered in carbon catabolite regulation have been isolated by selecting for mutants of the areA217 strain capable of using acetamide as the sole nitrogen source in the presence of sucrose. In addition to creA mutants described previously be Arst and Cove, strains with mutations in two new genes, creB and cre C, have been found. The creB and creC mutants grow poorly on some sole carbon sources and have low levels of some enzymes of carbon catabolism e.g. beta-galactosidase and D-quinate dehydrogenase. The creB and creC mutants are hypersensitive to fluoroacetate, fluoroacetamide and allyl alcohol in the presence of glucose or sucrose but not glycerol; and the enzymes, acetamidase and alcohol dehydrogenase, are less sensitive to carbon catabolite repression than the wild-type strain. Extracellular protease and alpha-glucosidase enzyme activities are elevated in creB and creC mutants, while L-proline and L-glutamate uptake capacities are lower in both the presence and absence of glucose. Interactions between creA, B and C mutations have been investigated in double mutants, and the dominance properties of creB and creC mutants determined. The results indicate that the creB and creC genes may have a regulatory role in the control of carbon catabolism.


Isolation and characterization of catalase deficient mutants of Salmonella typhimurium. Catalase deficient mutants (kat) of Salmonella typhimurium have been isolated. The mutantions katA1, katC6 and katD9 appear to map at about minute 10 on the Salmonella chromosome. The katC6 and katD9 lesions are complemented by the E. coli F'128 (lac + pro +) episome but the katA1 lesion is not. KatB2 maps at about minute 100. None of the mutants are oxygen sensitive; they grow as well as wild bacteria, even when aerated.


A suitable method for construction and cloning hybrid plasmids containing EcoRI-fragments of E. coli genome. A convenient procedure for the isolation of specific EcoRI-fragments of E. coli genome and their amplification on Km-resistance plasmid victor CK delta11 is described. The hybrid molecules were constructued in vitro using EcoRI-digestion, followed by ligation. Then appropriated E. coli strain was transformed with ligated DNA mixture and hybrid plasmids CK delta11-arg+, CK delta11-his+, CK delta11-thr+ and CK delta11-leu+ containing loci of E. coli genome were selected by molecular cloning. The hybrid plasmids obtained consisted of one EcoRI-fragment of initial plasmid CK delta11 and one respective specific portion of E. coli genome.


[Alternative ways of fluoride supplementation in childhood (author's transl)]. Fluorine is a nutritionally essential trace element. Fluoride concentration in drinking water of West Germany is very low, with rare exceptions. Fluoride intake with food therefore is inadequate. Consequently, for maintenance of normal dental health, fluoride has to be supplemented by some way. A number of methods of fluoride supplementation are being discussed in this paper and compared to drinking waster fluoridation.


[Monitoring of side effects in patients treated with corticosteroids of cytotoxic drugs (author's transl)]. Side effects have to be monitored carefully in all patients receiving drugs profoundly affecting their metabolism. Corticosteroids produce the well-known Cushing's syndrome. Children rarely develop gastric ulcers or disturbances of haemostasis. If steroids are administered for more than one year, the eyes have to be examined for signs of cataract. Rarely, the pseudotumor cerebri syndrome (increased intracranial pressure) may be observed. A monitoring schedule adapted from adult medicine for paediatric purposes is proposed in the text. Nowadays, mostly combinations of cytotoxic drugs are used. Often, doses are as high as the patient can tolerate them. Effects of these drugs are especially marked upon rapidly proliferating tissues such as the haematopoietic system and gastrointestinal mucosa. Immunosuppression may have very serious consequences. Infections caused by organisms usually considered as little pathogenic (e.g., pneumocystis carinii) may become deleterious; some infections may remain concealed or produce fever as the only symptom. Particular side effects of certain cytotoxic drugs are described in the text. Many therapeutic regimens are now standardized, as are monitoring schedules. Frequency and nature of the necessary controls depend upon the disease treated and the kind of therapy applied, as well as on its intensity. Both hospital and family doctors are indispensable for this surveillance; they must remain in close contact with each other.


[The importance of early recognition of impeded cranial migration of the spinal cord]. Impeded cranial migration of the spinal cord is described in five cases which initially were not recognized. The aetiology, symptomatology and differential diagnosis are presented. The clinical manifestations are signaled by skin lesions typical for dysraphic lesions, signs of urinary and rectal incontinence, deformity or weakness of the feet, impaired gait, motor reflex and sensory changes, and occasionally trophic changes. The restriction in cranial migration of the spinal cord can only be proved by myelography. The importance of early neurosurgical intervention to prevent irreversible deterioration of the motor, sensory or urinary system is particularly emphasized. Improvement after surgery can be achieved in at least 30% of the patients who already developed neurological deficits.


Sulphydryl-mediated DNA breakage by phlemomycin in Escherichia coli. Sulphydryl-mediated DNA breakage, which is induced by the antibiotic phleomycin in vitro, has been found to contribute significantly to the DNA damage produced by phleomycin in Escherichia coli. The effect of pleomycin was inhibited in vivo, as in vitro, by chelating agents, sulphydryl blocking agents and antioxidants. An increase in the intracellular concentration of free sulphydryl resulted in an increased response to phleomycin, while mutants containing very low levels of free sulphydryl due to a defect in glutathione synthesis showed greatly reduced DNA breakage, particularly at low phleomycin concentrations. In spheroplasts of these gshA mutants, restoration of the response to phleomycin of dithiothreitol. Sulphydryl-mediated breakage appears to be the principal mechanism for DNA damage in E. coli at libly enzymic, operates at higher phleomycin concentrations.


Lethla effect of nitrous acid on Escherichia coli. The effect of nitrous acid (NA) on viability, integrity of cellular DNA and on membrane transport were studied in 5 strains of Escherichia coli. Stationary phase cells, grown on mineral salts medium, were exposed to NA. The viability of strains decreased in thefollowing order: W3110 wild-type greater than WP2 wild-type, WP2 uvrA greater than NG30 recA greater than P3478 polA. Alterations were found in the DNA sedimentation profile in alkaline sucrose gradient. Disturbance of DNA synthesis was measured by 3H-labelled thymidine ([3H]Thd) incorporation. No degradation of DNA was found after NA treatment. Low doses of NA caused significant inhibition of leucine and glucose transport into whole cells. The results are interpreted in terms of the multi-target action of NA causing the death of cells.


Induced reactivity of UV-damaged phage gamma in E. coli K12 host cells treated with aflatoxin B1 metabolites. The metabolites of aflatoxin B1, the most potent hepatocarcinogen so far known, promote in E. coli K12 cells the reactivation of phage lambda damaged by ultraviolet (UV) radiation. This reactivation process is error prone; 25% of the phage DNA lesions are repaired, but mutagenesis, scored as clear plaque formation, is increased as much as 10-fold. Such reactivation of UV-damaged phage lambda, which occurs in wild-type and in uvrA but not in recA bacteria, is inducible: phage reactivation is obtained even after a long delay following treatment of the host by the short-lived metabolites. This induced reactivation of UV-damaged phage in hosts treated with metabolites of aflatoxin B1 is similar to direct of indirect UV reactivation. Metabolites of aflatoxin B1 produce induced phage reactivation as well as prophage lambda induction in lysogens and cell filamentation in non-lysogens. These cellular events are also triggered by DNA lesions caused by UV radiation and result from the induction of a metabolic pathway (SOS functions). We postulate that, in eucaryotes, carcinogens may induce cellular SOS functions similar to those in E. coli. Induction of such functions might be responsible for the transformation of mammalian cells.


Optimal conditions for selecting specific auxotrophs of Saccharomyces cerevisiae using temperature-sensitive suicide mutants. Of 48 temperature-sensitive mutants of Saccharomyces cerevisiae examined, five belonging to the same complementation group were found to undergo extensive loss of viability at the restrictive temperature. These mutants were protected from the lethal effects of exposure to a non-permissive temperature by starving for an auxotrophic requirement. By analogy with the method described by Littlewood [6] for selecting antibiotic-sensitive mutants, these temperature-sensitive mutants were found suitable in enriching for specific auxotrophs. Optimal conditions have been determined for selecting specific auxotrophs after mutagenesis by N-methyl-N'-nitro-N-nitrosoguanidine. These enable 20-fold enrichment and at least in the case of mutation to adenine dependence the method does not appear to favour mutations at any particular locus.


Molecular specificity of x-radiation and its repair in Saccharomyces cerevisiae. Molecular specificity of soft X-radiation has been studied in yeast by analyzing the transitions UAA in equilibrium UAG and nonsense leads to sense mutations in the codon tyr7-1. Synchronized cell populations in the most radiosensitive and radioresistant stages were compared: they did not show any qualitative or quantitative differences in their sensitivities to the mutagenic action of X-rays. We conclude that repair mechanisms, which remain unexpressed in the sensitive cells, do not affect point mutations of the base-substitution type.


Physiological modification of alkylating-agent induced mutagenesis. I. Effect of growth rate and repair capacity on nitrosomethylurea-induced mutation of Escharichia coli. The effects of repair capacity and growth rate on the induction of mutations by N-methyl-N-nitosourea (MNUA) was investigated using the trpE reversion system of Escherichia coli WP2 and some repair-deficient derivatives isogenic for this gene. In all these strains reducing the growth rate prior to MNUA-treatment caused a reduction in the mutational response, however major differences were observed between strains. In exrA and recA- bacteria stationary phase cells were 100 times less mutable than cells grown at a mean generation time (m.g.t.) of 30 min, whereas reductions of 12 and 25 times were observed in the uvrA- and wild-type strains respectively. In contrast the mutational response of the polA- mutant varied only slightly with growth rate; the increases at high MNUA concentrations being equal to the increase in the trpE gene number. These results show the increasing importance of the error-prone exrA+/recA+-dependent repair system in mutation-induction by MNUA as the growth rate of the culture is reduced and its relative unimportance for mutation induction in nutrient broth-grown cells (m.g.t. 30 min).


Comparative mutagenicity of ICR-191 to S. typhimurium and diploid human lymphoblasts. Concentration-dependent mutagenicity of ICR-191 has been measured in Salmonella typhimurium strain TA98 and in a diploid human cell line. In both cell systems, approximately equigenerational exposure produced mutation linearly related to concentration in the lower range of ICR-191 concentrations tested. Saturation behavior was observed in the human cell assay but not in the bacterial assay. However, a 25-fold greater concentration of ICR-191 was required to induce a significant rise in the mutant fraction in the S. typhimurium assay than in the human cell assay. These differences may be linked to the differences in the biochemical events required for mutation or in the time of exposure to ICR-191.


Successful granulocyte transfusion therapy for gram-negative septicemia. A prospectively randomized controlled study. We prospectively randomized 27 granulocytopenic patients who experienced a total of 30 episodes of gram-negative septicemia. The control group received an appropriate antibiotic regimen alone, whereas the "transfusion" group received infusions of granulocytes in addition to the antibiotics. Five of 14 controls survived, and 12 of 16 in the transfusion group survived, and 12 of 16 in the transfusion group survived (P less than 0.04). An important factor in the outcome of treatment was the recovery of bone-marrow function (return of peripheral granulocyte count greater than or equal to 1000 per microliter). Eighty-three per cent (five of six) of the control group and all (four of four) of the transfusion group with recovery of granulocyte levels survived the episode of sepsis. In contrast, none of the eight control patients, as compared to 67 per cent (eight of 12) of the transfusion group, survived persistent granulocytopenia (P less than 0.005). Granulocyte transfusions appear to complement appropriate antibiotic treatment of gram-negative-septicemia due to granulocytopenia.


A randomized clinical trial of granulocyte transfusions for infection in acute leukemia. In a prospective, controlled, randomized study to evaluate the efficacy of filtration-leukapheresis granulocytes in granulocytopenic, febrile patients with leukemia, 19 patients received antibiotics alone, and 12 received antibiotics plus daily granulocyte transfusions from ABO-matched donors. In skin-chamber studies the granulocytes appeared at sites of inflammation for at least six hours after transfusion. Infected subjects survived longer if they received granulocytes. Differences between control and transfused patients were greatest in patients with persistent bone-marrow failure, the 21-day survival being 20 per cent in controls, and 75 per cent in transfused patients. Granulocytes appeared to have no effect on the outcome of febrile episodes in which infection was not documented, the 21-day survival being 79 per cent for controls and 88 per cent for transfused patients. The transfusion of granulocytes thus appears to offer a survival advantage to infected, persistently granulocytopenic patients.


Dextroamphetamine with morphine for the treatment of postoperative pain. In a double-blind, single-dose study, dextroamphetamine combined with morphine was compared with morphine alone to determine the relative efficacy of the combination given intramuscularly for postoperative pain. Each of 450 patients received one treatment of morphine sulfate (3, 6 or 12 mg) with dextroamphetamine (0, 5 or 10 mg). Analgesia, as measured by the patients' subjective responses to questions about relief of pain, was augmented when dextroamphetamine was given with morphine; the combination of dextroamphetamine, 10 mg, with morphine was twice as potent as morphine alone, and the combination with 5 mg was 1 1/2 times as potent as morphine. In simple performance tests, and in measures of side effects, dextroamphetamine generally offset undesirable effects of morphine (sedation and loss of alertness) while increasing analgesia. Effects on blood pressure, pulse and respiratory rate were minimal.


Prophylactic efficacy of nitrofurantoin macrocrystals and trimethoprim-sulfamethoxazole in urinary infections. Biologic effects on the vaginal and rectal flora. We examined bacterial persistence and resistance in the vaginal and fecal flora of 28 women who received a total of 253 months of daily low-dosage prophylaxis with nitrofurantoin macrocystals (100 mg per day) or trimethoprim-sulfamethoxazole (40 and 200 mg respectively). During trimethoprim-sulfamehtoxazole prophylaxis, 8.5% of monthly vaginal and 27% of monthly fecal cultures grew Escherichia coli, as compared to 36 and 96%, respectively for nitrofurantoin macrocrystals. Esch. coli resistant to nitrofurantoin occurred in two of 95 fecal cultures during therapy, and Esch. coli resistant to trimethoprim-sulfamethoxazole in 16 of 182 (8.8%) fecal cultures. In the 12 months before treatment, 92 episodes of recurrent urinary infection occurred, as compared to six during treatment (none occurred on trimethoprim-sulfamethoxazole). These results confirm the value of trimethoprim-sulfamethoxazole prophylaxis for high-risk patient with recurrent urinary infections. Prophylaxis with nitrofurantoin macrocrystals seems adequate for less severe problems of reinfection.


Interaction of tetanus toxin and toxoid with cultured neuroblastoma cells. Analysis by immunofluorescence. The primary interaction of tetanus toxin and toxoid with mouse neuroblastoma cells (C 1300, clone NB2A) in tissue culture was studied using direct immunofluorescence. Experiments were done in standard routine cultures and also those influenced by chemical modulators. There is a difference in the characteristic binding response between the growth culture cells (grown in presence of fetal calf serum) and differentiating culture cells (grown in absence of serum). Exposure to the toxin gives no visible effect on the cell division or viability in growth cultures; whereas in differentiating cells the processes are shortened and the adherence to the glass is diminished without involving significant cell death. The toxoid did not bind at all under the same experimental conditions. Since there was no biological effect in growth cultures we have called this binding ineffective, and in the case of the differentiating cells, effective binding. Stimulation of pinocytosis increases the uptake of toxin in both cultures. Presence of some surface bound toxin still remaining on the differentiating cells indicates the possibility of another sort of mechanism for internalization. Pre-treatment of the cells with neuraminidase or beta-galactosidase to alter the membrane gangliosides eliminates binding in growth cultures but not in differentiating cultures. From these results we suggest that even though the toxin may well bind to gangliosides, at least in the differentiating cultures they are not solely responsible for the fixation. The morphologically observed effective binding is probably that not related to gangliosides.


Immunological response of patients with tumors of the urogenital tract: a follow-up of cell-mediated antitumor immunity by the LAI test. Antigen-induced inhibition of leukocyte adherence is a suitable method providing information on immunological response of the tumor bearers. Leukocytes from patients' blood were tested by an in vitro method to detect cell-mediated antitumor immunity. Positive reactions of leukocytes to the specific antigen were found in carcinoma of the uterine cervix, vulva and ovary in 13 patients. The modified LAI test evaluated on the basis of free cells in Eagle's medium using the specific antigen is a simplified reversed method which, however, keeps the specificity.


[Physical and mental development after early surgery of myeloceles]. These investigations are based on 143 myelocele operations (=93 % spina bifida cystica), with a follow-up period of 3-15 years. There was an associated hydrocephalus in 88%. In 114 (89%) of the children with hydrocephalus a ventriculo-atrial shunt was inserted. In three quarters of the cases this was done within the first three months of life. In general the chindren remained "shunt-dependent" and only in 9% was it possible to remove it later. Of the surviving children about 25% were restricted to a wheel-chair and of them 7% had severe mental defects. Their physical state as regards head growth,height and weight showed about 70% of average values. Neurogenic disturbances of bladder emptying were present in 90% of the children. The expectation of survival to age 13 was 65%. Using the Hamburg Wechsler Intelligence Test for Children (Hawik) the intellectual development showed an average of 97 +/- 15-219 With only a trifling deviation this corresponds to the normal mean. The Bühler-Hetzer test also showed normal values in 70%. All the children are able to receive some training, which ranged from special schools right up to grammar school. We have particularly gone into the problem of the social rehabilitation of these children.


[Dantrium in the treatment of increased muscle tonus in patients with multiple sclerosis]. In 19 patients with multiple sclerosis and 1 with subacute sclerosing panencephalitis the mean increase in muscle tonus was found to be 3.1 (range 1--4 according to Burke-Ashwort). In 10 controls with multiple sclerosis the mean spasticity was 2.4. Dantrium was given in doses up to 800 mg for 14--16 days and it caused a greater reduction of spasticity than placebo (p less than 0.05). In 12 patients (60%) varying degrees of muscle tonus reduction was observed. In 11 patients the efect of Dantrium was compared with that of other drugs (Clonazepam, Tetradiazepam, Carisoprodol and Lyoresal). In 6 cases Dantrium was a more effective drug than other muscle relaxants and in 5 cases no difference was observed or other drugs were superior to Dantrium.


[Hormonal therapy with androgenic steroids in diffuse malignant neoplasms of the breast]. 2-alpha-methyl-17-beta hydroxy-androstan-3-one was given to advanced breast cancer patients whose general condition (preterminal in many cases) or haematological picture precluded other cytostatic management. Rapid progression of the tumour was noted in 65%, improvement in 15% and no change in 20%. It is felt that androgens alone should only be given where other more effective treatments are contraindicated. They can be associated with polychemotherapeutic courses to exploit their anabolising and antianaemic activity.


[25 years of caring for epileptics in the Greater Poland region]. On the basis of an analysis of experiences in 25 years of health care of epileptic patients in the Great Poland region the author discusses the mean elements of outpatient health care and resocialization treatment which include the classification concept and the therapeutic system. The author describes a schema of selective treatment in various clinical syndromes, results of conservative and surgical treatment, prophylactic management and most frequent sociomedical problems. The schema is outlined in form of theses with a list of papers in which they had been discussed in more detail. Conclusions have been put forward for further organization of treatment of epileptic patients.


[Depletive treatment of uncompensated liver cirrhosis with high doses of spirolactone only]. In most regimens proposed for the depletive management of cirrhosis of the liver, spirolactone is associated with other diuretics. Treatment of 28 patients with uncompensated forms by means of spirolactone only, using high, protracted doses determined essentially in accordance with the depletion obtained, is described. The disappearance of signs of water retention was gradual and unattended by difficulties. Normalisation of the urinary Na/K ratio preceded the diuretic response; Increased diuresis led to a slight increase in urinary potassium/day. Higher doses were used in patients with lower urinary Na/K ratios. Here a critical diuretic response was only obtained around the 5th day. Transient low blood sodium and chlorine and high blood potassium were noted; the last parameter was not related to the drug dose, nor to changes in Bun; No marked changes in blood uric acid, calcium, ammonium, bilirubin or sugar were observed.


Short-term versus continuous antimicrobial therapy for asymptomatic bacteriuria in pregnancy. Asymptomatic bacteriuria was identified in 300 pregnant women prior to the 28th week of gestation. In one group of 200 women short-term treatment with either nitrofurantoin or sulfamethizole was given for 14 days, and in another group of 100 women continuous therapy with one of these drugs was given for the remainder of gestation. Weekly urine cultures were obtained from all the women. Of the women treated with short-term therapy, 65% were abacteriuric for the remainder of pregnancy following one course of therapy, 24% became abacteriuric but subsequently relapsed, 2% had reinfection after becoming abacteriuric, and 9% demonstrated no response. Following treatment with a second course of short-term therapy, another 19% of these women were cured for the remainder of their pregnancy, and 3.5% responded to a third course. In the continuous therapy group, 88% of the women became abacteriuric for the remainder of the gestation, 3% demonstrated relapse, 2% developed reinfection, and 7% had no response to the first drug given. These data demonstrate that short-term administration of antimicrobials, when combined with surveillance for recurrent bacteriuria, is effective for the management of the pregnant woman with asymptomatic bacteriuria.


The split thickness graft technic for vaginal agenesis. A heterogenous group of patients with agenesis of the vagina treated at The Johns Hopkins Hospital between 1956 and 1975 is reported. The split thickness autogenous skin graft technic of McIndoe was used in 44 patients with Rokitansky-Kuster-Hauser syndrome, 9 male hermaphrodites, 7 patients with the testicular feminization syndrome, and in 4 male transsexual patients. Urinary tract abnormalities were found in 49% of patients with the Rokitansky syndrome. The functional results were quite satisfactory. The graft was satisfactory in all but 3 patients who required a partial second skin graft. Rectovaginal fistula with spontaneous closure occurred in 1 patient, and a transsexual patient developed a urethrovaginal fistula which was repaired surgically. Better results with the take of the skin graft have been obtained since a foam rubber vaginal form has been used and routine prophylactic antibiotics administered. Severe condylomata acuminata of the neovagina developed in 3 patients.


Dermal graft--a versatile technique for oral surgery. This is the first report of dermal grafting to the oral cavity for vestibuloplasty and lingual reconstruction. A 3 1/2-year follow-up of patients suggests that it is a useful, well-tolerated technique. The method of obtaining the dermal graft is simple and results in much less morbidity to the patient than does the split-thickness skin graft. It survives as a true tissue transplant and undergoes self-epithelization. Histologic sections show that metaplasia of the graft leads to tissue resembling normal mucosa.


Autogenous cancellous-marrow bone grafts in irradiated dog mandibles. A pilot study was conducted to investigate the osteogenic potential of autogenous cancellous-marrow grafts placed in irradiated tissue. Three dogs received 4,100 rads in ten treatments ooer 32 days. Postirradiation discontinuity mandibular defects were created. These defects were restored with cancellous-marrow autogenous bone supported in position by a titanium mesh basket. Bony union occurred in all the mandibles. The titanium mesh partially eroded through the oral mucosa in two animals. The quantity of new bone formed in the surgical defect varied. Two dogs had complete restoration of the resected mandible. Histologic observations were documented in both the graft area and the surgically uninvolved contralateral side of the mandible.


Histiocytic lymphoma (reticulum-cell sarcoma). Report of five cases. The subject of lymphomas is discussed and five cases seen in our Oral Surgery Department are Presented. Histiocytic lymphoma, especially of the oral regions, can present with a variety of clinical manifestations. The signs and symptoms, diagnostic modalities, and treatment are discussed and the most recent classification is included.


Immunologic aspects of pulpal-periapical diseases. A review. The relationship of immunologic concepts to endodontic diseases is discussed. Immunologic mechanisms are considered, including antigens, haptens, antibodies, and cell-mediated responses. Studies of immunologic manifestations in endodontic diseases are given. These include (1) localization of plasma proteins in inflammed human dental pulp, (2) introduction of microbes into animal root canals, (3) introduction of non-microbial antigens into animal root canals, (4) introduction of root canal antigens into human beings, (5) introduction of root canal antigens into animals, (6) studies of "focal" infection, (7) examination of serum antibodies, (8) examination of periapical lesions, and (9) a cell-mediated study. Next, immunologic concepts related to periapical pathosis are considered. Finally, preventive and treatment concepts are reviewed.


Plasmodium falciparum gametocytes: their longevity and infectivity. The longevity and infectivity of isolated populations of Plasmodium falciparum gametocytes were studied. Following chloroquine treatment gametocyte numbers fell with a constant rate of loss over a period of 16-24 days; the populations had a half-life of 2-4 days. The sex ratio stayed constant throughout at 4 female: 1 male. The ability of the microgametocytes to exflagellate and the infectivity of the population to mosquitoes persisted for 3 weeks. Antibodies to the gametocytes were detected but not in every patient studied. It was concluded that the gametocytes of P. falciparum are both long-lived and show persistent infectivity to mosquitoes. They can stimulate antibody production but the immune response appears to play no part in their elimination, which probably takes place in the spleen as a part of the normal process of removing old, damaged and malformed red cells.


Schistosoma mansoni: a comparative study of artificially transformed schistosomula and schistosomula recovered after cercarial penetration of isolated skin. A comparison was made of the ultrastructure, development and antigenic nature of the surfaces and of the viability of three types of Schistosoma mansoni: schistosomula formed after cercariae had penetrated isolated skin (SS) schistosomula produced after mechanical separation of cercarial tails from bodies (MS), and schistosomula transformed from cercariae after incubation in fresh rat serum (RS). Within 2h of transformation, the surface membranes of all three types of schistosomula had changed from trilaminate to heptalaminate structures and SS and MS had lost their cercarial glycocalyx. Initially a dense amorphous material was demonstrated on the surfaces of RS, which was thought to be the result of an interaction between a factor in rat serum and the glycocalyx; this material was greatly reduced within 2 h of transformation. The pre-acetabular glands of SS were emptied while those of MS and RS retained their contents. Immunofluorescent studies showed that all schistosomula bound serum from mice immune to S. mansoni, but the binding was stronger with MS and RS. The mixed agglutination reaction demonstrated the presence of human A and B blood group-like antigenic determinants on approximately 30% of 3h old SS; these determinants were not detected on MS or RS. In vitro, the development of MS and RS was similar to SS; the first schistosomula reached the "gut-closed" stage by day 10; 50-70% of SS reached this stage by day 12, in contrast to only 25-50% of MS and RS. Between 28 and 45% of all schistosomula developed to maturity when injected intravenously into mice. It was concluded that the two types of artificially prepared schistosomula fulfil the main criteria of transformation from cercaria to schistosomulum. Further, it is suggested that MS are the most appropriate source of material for immunochemical and physiological studies.


Protection of mice against Babesia spp. and Plasmodium spp. with killed Corynebacterium parvum. Mice which had been pre-treated with killed Corynebacterium parvum given intravenously or intraperitoneally, but not subcutaneously, were completely resistant to infection with Babesia microti or B. rodhaini, and were protected from death caused by Plasmodium vinckei or P. chabaudi infection. There is evidence that the parasites died within circulating erythrocytes. This occurred much too soon for a specific antibody response to be evoked, and no antibody could be detected by the indirect fluorescent-antibody technique. Thus it is suggested that a non-specific soluble mediator may play an important role in the protection observed.


Complement and Fc receptors on cord blood and adult neutrophils. The percentage of neutrophils forming erythrocyte-antibody-complement complex (EAC) and with erythrocyte-antibody complex (EAG) was determined for 30 normal newborns and 10 normal adults. The cord values ranged from 84-100% EAC binding cells with a mean of 95%. The adult values ranged from 89-100% EAG binding cells with a mean of 96% rosetted neutrophils. The mean percentage of EAG binding cells in the cord samples was 81%, whereas in the seven adult samples the mean was 87%.


Focal glomerular sclerosis.

Focal glomerular sclerosis. There seems to be little doubt that FGS is a nonspecific lesion that represents one way in which the renal glomerulus responds to a variety of injuries. This is illustrated by the large number of diverse conditions with which the lesion is associated including various forms of glomerulonephritis, pyelonephritis, hereditary nephritis, and heroin usage. Nevertheless, there remains a relatively large isiopathic group which, though possibly heterogeneous, displays a number of characteristic clinical and pathologic features including the following: 1. Steroid-resistant nephrotic syndrome; 2. Hematuria and hypertension; 3. Normal serum complement; 4. Progressive renal insufficiency; 5. Typical pathologic lesion most common in or restricted to juxtamedullary cortex; 6. Absence of clearly defined evidence of immune complex deposition by immunofluorescent or electron microscopic studies; 7. Recurrence of the lesion following renal transplantation. The pathogenesis of these changes is unclear, the evidence for an immune complex mechanism meager, and the suggestion that the disease is mediated by a humoral mechanism remains to be explored. The potential recurrence of this lesion in the transplanted kidney affords a unique opportunity to study the disease early in its course by a variety of techniques that may help to clarify this still poorly understood entity.


[Reimplantation and autotransplantation of teeth. Review of the literature]. The most important factor for a favorable long-time prognosis of replanted and autotransplanted teeth is a short extra-alveolar periode. Implanted teeth should be followed radiographically with special attention to external resorptions as these correspond well with the histological picture. Avulsed teeth replanted within 30 minutes have a fairly good long-time prognosis. A little less than half of the teeth are still in place after five years. In international replantation the procedure can be performed with a short extraalveolar periode. By using the methods giving the shortest extraalveolar periods during autotransplantation a favorable long-time prognosis is to be expected in most of the cases. Implantation can be performed with all teeth at any developmental stage. However, a favorable long-time prognosis can only be expected where the teeth are removed from their alveoli without severe damage to the periodontal membrane. Compared to the altenative treatments which often are removable or fixed appliances or artificial implants, the prognosis for implanted teeth is sufficient good to accept the treatment as lege artis.


[Antigonadotropic actions of prolactin. Study of 10 cases of women with hyperprolactinemia]. In order to determine the pituitary or ovarian site of the anti-gonadotrophic action of prolactin (PRL), ten women with hyperprolactinaemia were studied in the following way: 1) Repeated estimations of PRL, gonadotrophins (LH and FSH), plasma estradiol and progesterone during six weeks of treatment with bromocriptine. 2) Verification of the effects of estradiol benzoate on LH and FSH levels before and after normalisation of prolactin. 3) Exploration of the ovarian response to the administration of human menopausal gonadotrophin. Without it being possible to exclude any direct effect of prolactin on the ovary, it may be affirmed that the hormone decreases the sensitivity of the gonadotrophic cells to the positive feedback mechanism exerted by plasma estradiol.


On the mechanism of oligonucleotide-primed RNA synthesis. I. Model studies with deoxyhomopolymer templates and Escherichia coli RNA polymerase. We have studied the effect of temperature, primer chain length and primer concentration on the oligonucleotide-primed transcription by Escherichia coli RNA polymerase. Our experiments with the homopolymer model systems poly(dT) .oligo(A)n, poly(dA) .oligo(U)n and poly(dA) .oligo(dT)n lead to three main conclusions. First, de novo chain initiation on single-stranded templates is preferentially suppressed at higher temperatures. Second, stable annealing of template and primer is neither a prerequisite nor does it stimulate the primer-dependent transcription. Third, formation of the ternary enzyme-template-primer complex is a rate-limiting step in the oligonucleotide-primed RNA synthesis. The maximal rate of primer-stimulated RNA synthesis, moreover, is strongly dependent on the nature of the primer and decreases in the order oligo(A)-primed poly(A) synthesis greater than oligo(U)-primed poly(U) synthesis greater than oligo(dT)-primed poly(U) synthesis. We attribute this to differences in the rate at which the first nucleotide is added to the primer. Raising temperature and primer concentration renders transcription in the model systems almost completely primer-dependent. This can be useful in a transcription approach to DNA sequence analysis.


On the mechanism of oligonucleotide-primed RNA synthesis. II. Synthesis of specific primer-initiated RNA copies suitable for DNA sequence analysis. The effect of temperature and primer concentration on oligonucleotide-primed transcription has been studied using the separated strands of a well-defined natural DNA as template. Results were similar to those obtained in the homopolymer-directed model systems. At high temperature and excess primer concentration mainly primer-initiated RNA copies are synthesized. Omission of one ribonucleoside triphosphate also makes the termination specific. The unique RNA fragments thus obtained have been used to determine the perfectly-repeated sequence of 68 base pairs in this DNA.


Isolation of ribosomal protein-RNA complexes by nitrocellulose membrane filtration: equilibrium binding studies. E. coli ribosomal proteins are retained by nitrocellulose filters. In contrast, 16S RNA passes through nitrocellulose filters. We have found that specific protein-RNA complexes involving single proteins also pass through nitrocellulose filters. Thus, by utilizing radioactively labeled r-proteins, nitrocellulose filtration can be used to study directly and sensitively the stoichiometry of r-protein-RNA association. The filtration process maintains near equilibrium conditions, making it applicable to weak as well as strong protein-RNA associations. We have used nitrocellulose filtration to obtain saturation binding curves for the association of proteins S4, S7, S8 and S20 with 16S RNA. In each case, the stoichiometry of binding was one mole of protein or less per mole of RNA. The stoichiometry of protein S8 binding to 16S RNA measured by filtration is comparable to that observed by sucrose gradient centrifugation. Association constants for the binding of proteins S4, S8 and S20 to 16S RNA have been determined by analysis of the saturation binding curves and were found to range from .3-6 X 10(7)M-1.


Florence Nightingale: reformer, reactionary, researcher. This article discusses the development and significant aspects of Florence Nightingale's beliefs and philosophy as they contributed to her character formation and the roles through which she has been historically recognized. Her beliefs about God and man, explored against a backdrop of the Victorian world, are shown as the essence of her philosophy out of which she initiated major changes in the social life of England. Nightingale's substantive corrective reforms, reflected in attitudinal, educational, organizational, and sociopolitical changes, and her system for effecting them are presented. Chief among these reforms were the system of initiation of nursing as a service and an education: constructive social utilization of women; education for women; national health, hospital and military medical reform for the British Empire, including India. Nightingale's ability to react to and obstruct progressive movement with which she disagreed is also review. The research capacities and contributions of Nightingale as an avenue through which she advocated and documented the changes and reforms proposed and executed are also discussed.


Synthesis and pharmacological screening of certain spiro compounds. The synthesis of certain azaspirodione, azaspirane and bis-azaspirodione derivatives is described. Fusing equimolecular amounts of 3-oxaspiro[5.5]undecane-2.4-dione with certain amino compounds afforded the corresponding N-substituted azaspirodiones. Reduction of the N-harolaryl azaspirodiones gave the oxygen-free analogues. Reacting 3-azaspiro[5.5]undecane-2.4-dione with certain secondary amines under the Mannich conditions yielded the expected bases. Reacting one equivalent of ethylene-diamine with two equivalents of 2-oxaspiro[4.4]nonane-1.3-dione and the next higher homologues, viz, the decane and undecane afforded the respective ethylene bis-azaspirodiones. Likewise, on applying the Mannich conditions to the nitrogen analogues of the before-mentioned oxaspirodiones using piperazine as the secondary amine, bis-azaspirodions were obtained. The result of the pharmacological screening of some of the synthesized spiro compounds is included.


Interaction between thiamine hydrochloride and lipoic acid. An interaction between thiamine hydrochloride and DL-alpha-lipoic acid in aqueous solution was depicted. Evidence is presented through spectrophotometric as well as vapour pressure measurements to show that thiamine hydrochloride and DL-alpha-lipoic acid form a single 1:1 complex. The stability constant and the molar extinction coefficient of the complex (at 244 nm) were determined at 25 degrees C and found to be 3.1-10(4) and 970, respectively. Vapour pressure measurements at 60 degrees C reveal that more or less complete dissociation of the complete takes place at this temperature.


delta1-tetrahydrocannabinol, cannabidiol and cannabinol effects on the immune response of mice. delta1-tetrahydrocannabinol (THC) elicited a dose-dependent (1, 5, 10 mg/kg) depression of the immune response, of immature mice, stimulated with sheep red blood cells. The impairment of humoral immunity was specific for THC but not for cannabidiol at 25 mg/kg or cannabinol at 25 mg/kg. The mice were given four daily doses (i.p.) of either drug or vehicle (Tween 80-propylene glycol in 1% saline) or a single injection (i.p.) of sheep red blood cells in addition to four daily doses (i.p.) of drug or vehicle. Suppression of the antigenic response by THC was reflected as a reduction of splenic weight, reduction in the number of splenic antibody-forming cells, lowered hemagglutination titer and reduction in the percentage of splenic white pulp of total spleen volume.


The epigastric island flap.

The epigastric island flap. We describe a paramedian epigastric island flap fed by the perforators of the superior-inferior epigastric vessels. It is transferred with an intervening strip of muscle and fascia. A case is reported and the future possibilities of the flap are discussed.


Severe traumatic oculo-orbital displacement. Diagnosis and secondary treatment. We have treated 12 patients with severe oculo-orbital trauma during the past 3 years. The structural problems, produced by disruption or displacement of the orbital cone, were treated effectively (and, on occasion, preferentially) with onlay bone grafts. For an effective correction, we advise radical mobilization of the soft tissue and simultaneous correction on the ocular adnexal deformities. Ocular muscle problems are produced by direct injury to the extraocular muscles, or oculomotor nerve, and were possible these should be corrected early. The structural damage to the eye and orbit falls into certain patterns, related to weak points about the orbit. These have been described.


Experience with the deltopectoral flap.

Experience with the deltopectoral flap. The deltopectoral flap is a most versatile source of skin coverage or mucosal lining (or both). There is remarkable safety in the use of this flap in relation to its size, and there is only limited need for delay--because it pedicle is an axial flap. Nonetheless, the terminal part requires the attention to detail which any random flap requires--such as the avoidance of hematoma and infection and the prevention of tension, kinking, and angulation. This not only will ensure the safety of the flap, but also will prevent the rather common and annoying minor complications that delay the patient's convalescence.


Reconstruction of the floor of the mouth with a free Dorsalis pedis flap. The dorsalis pedis flap used for immediate reconstruction in two patients after resection of cancers of the floor of the mouth. The procedure has much to recommend it in the immediate repair of such defects.


Experimental use of a gastric flap on an omental pedicle to close defects in the trachea, pharynx, or cervical esophagus. The use of local or regional skin flaps for repairs after head and neck cancer surgery often increases the deformity of the patient. We present a new procedure using a gastric flap on an omental pedicle. It has been successful in dog experiments where we transferred it to the head and neck region, to serve as a substitute for the standard skin flaps.


Exposed cranial implants--a salvage operation. We present our rationale for attempting to cover some exposed cranial implants by tissue transfers. We have tried this in 9 patients, and we have had success in 5.


A psychoanalytic view of mental health. Samuel Pepys and his diary. It has been difficult to illustrate specific criteria for mental health, largely because of the lack of adequately documented examples. The Diary of Samuel Pepys is a unique soure of data about a man who was not only exceptionally interesting, but was relatively healthy as well.


Anomalous pulmonary venous connection of entire left lung with intact atrial septum. Three cases of total unilateral pulmonary venous connection of the left lung with intact atrial septum are described. All patients were acyanotic and had findings of volume overload of the right side of the heart. An anomalous vertical vein in the superior mediastinum and large pulmonary arteries were visible on the plain chest radiograph, similar to what is seen in cases of total anomalous pulmonary venous connection. Selective pulmonary angiography delineated the anomalous connection of the left pulmonary veins and documented the absence of an atrial septal defect.


The effect of naproxen-sodium on the intrauterine pressure and menstrual pain of dysmenorrheic patients. The Prostaglandin-synthesis inhibitor: Naproxen-Sodium (NS) (an analgesic agent) very significantly (P less than 0.001) reduced the "resting" and "active" pressures and the frequency of cyclic uterine activity of 10 dysmenorrheic patients. It also highly significantly reduced (P less than 0.001) menstrual pain. Since these effects were observed after a single oral dose of 1100 mg NS, without side effects or complications, extensive field trials are recommended for assessing therapeutic benefits of this treatment.


Enzyme immunoassay of hepatitis associated antigen (HAA). Due to its high sensitivity, radioimmunoassay has become of great importance in the detection and measurement of levels of proteins and steroids in body fluids. However, this method involves the use of expensive equipment and radioactive material. Herein is described an alternate method to radioimmunoassay, which uses an enzyme-labeled rather than a radioactively-labeled antibody. An enzyme immunoassay procedure, the Cordia HAA-enzyme Immunoassay, for the detection of hepatitis-associated antigen has been evaluated. With this technique a sandwich type immunoassay with an alkaline phosphatase tagged second antibody is used. The presence of antigen is detected by the p-nitrophenyl phosphotase activity of the bound enzyme. In 1083 clinical samples from patients of Jackson Memorial Hospital, only 19 discrepant results were found when tested by both the Cordia and the Ausria II methods. Eight had sufficient sera for retesting, yielding two positive Cordia, negative Austia; one negative Cordia, positive Ausria; one borderline positive; and four unconfirmed false positives by Cordia.


[Immunsuppression under vitamin B6 deficiency (author's transl)]. The influence of a Vitamin B6 free diet and the effect of Desoxipyridoxin (a potent Vitamin B6 Antagonist) on the immunesystem of mice was investigated in several experimental setups. Rejection times of skintransplants from inbred strains (129 J) on C57bl/6J mice served as a model for immunosuppression. Rejection times under alimentary Vitamin B6 deficiency did not exceed those under hypocaloric nutrition associated with comparable weight loss. Immunosuppression with the Vitamin B6 antagonist Desoxipyridoxin was much more pronounced. The effect was related to the duration of treatment. Desoxipyridoxin offers the possibility of effective immunsuppression, which is readily reversible.


[High-voltage electrophoresis of dihydrofolate reductase from Escherichia coli W 3110 (author's transl)]. A method for the high-voltage electrophoresis of dihydrofolate reductase from Escherichia coli W 3110 is described. Dihydrofolate reductase catalyses the reduction of dihydrofolic acid to tetrahydrofolic acid. By addition of a tetrazolium salt, tetrahydrofolic acid reacts by formation of a violet water insoluble formazane which is an indicator for the enzyme. Besides several unspecific bands, two isoenzymes of the dihydrofolate reductase from Escherichia coli W 3110 are found which are specificially inhibited by the folate antagonists methotrexate and trimethoprime in a concentration of 0, 1muM, 1 muM respectively.


Leptospires isolated from wild mammals caught in the south west of England. Leptospires of the serogroups Australis, Icterohaemorrhagiae, Hebdomadis, Javanica and Pomona were isolated from wildlife caught in the south west of England.


Preventive practices in schoolchildren in Oppegard, Norway, related to some background factors. As part of a clinical trial among schoolchildren in a suburban community just outside Oslo, dental preventive behavior was studied by means of mailed questionnaires. In all, 340 mothers, i.e. 95% of the sample, filled out and returned the forms. The results indicate a distinct and improving preventive attitude in the target population. The age of the family was the most influential background variable.


Metabolic disturbances of the lymphoid cells and their significance for clinical pathology. The presentation and discussion of the metabolic disturbances of lymphoid cells is preceded by some brief data on their nomenclature, philogeny, morphology and methodology (some regarding T and B lymphocytes). The most noteworthy results of cytochemical investigations are those concerning cellular biochemical components such as DNA, RNA, glycogen and lipids. Emphasis is layed on the results of optic and electronic cytoautoradiographic investigations. The cytoenzymologic explorations have shown the necessity of determining the activity of certain enzymes such as acid phosphatases, beta-glucuronidase, aryl-sulphatase, succin-dehydrogenase (SDH), lactic and malate dehydrogenases (LDH and MDH), glucose-6-phosphate-dehydrogenase (G-6-PD), DNA- and RNA-polymerases, certain proteases, dihydrofolate-reductase, a.o. The author insists on the value of the data obtained by the above mentioned investigations for the diagnosis, prognosis and therapy of acute and chronic leukemias, various lymphomas, Waldenström's macroglobulinemia, rheumatoid arthritis, chronic hepatitis, systemic lupus erythematosus, myasthenia gravis, a.o.


DNA synthesis in unstimulated blood lymphocytes of patients with untreated malignant lymphomas or other malignant tumors. Blood lymphocyte DNA synthesis, as expressed by 24-h uptake of 3H-thymidine in culture of mononuclear peripheral blood leucocytes has been reduced prior to treatment in 18 patients with Hodgkin's disease, 11 with non-leukaemic lymphosarcoma, 13 with reticulosarcoma and 20 with various solid tumors, and compared to 37 normal control subjects.The 3H-thymidine uptake was significantly increased in all the patient groups, but no significant difference existed between them. Increased uptake of 3H-thymidine did not appear to correlate with the degree of dissemination in any of the patient groups or with the presence or absence of general symptoms in malignant lymphoma. It is concluded that increased DNA synthesis in peripheral blood lymphocytes is a feature not limited to Hodgkin's disease, but found in non-Hodgkin's malignant lymphomas and other malignancies to about the same extent.


Peripheral blood lymphocyte populations in influenza patients. The peripheral blood lymphocyte populations were determined in 10 patients during the acute phase of influenza and 6-8 weeks after recovery. The percentage of T-lymphocytes, demonstrated by their binding sheep erythrocytes non-specifically (E-rosette forming cells), was decreased during influenza. A relative and absolute increase of non-T-lymphocytes could be shown by the determination on these cells of receptors for activiated C'3 (EAC-rosette forming cells).


Group B beta-hemolytic streptococci as an important cause of perinatal mortality. Bacteriological and pathological examinations of all 73 stillborn infants and 96 infants dying soon after delivery in Västerås, Sweden during the period 1971-1974 are reported. 35 infants had a severe infection. Beta-hemolytic streptococci group B were isolated in 7 cases from different organs. Intrauterine death occurred in 2 cases; 4 liveborn infants showed early signs of respiratory distress, apneic episodes and cyanosis; 1 infant showed signs of intrauterine asphyxia and was severely asphyctic at birth. Thus, infection with group B streptococci occurred in 20% of the infants who succumbed to infections during this period.


Serum antibodies to plaque bacteria in subjects with dental caries and gingivitis. Correlations were sought between indices of gingival inflammation and dental caries experience and serum antibody titers to five species of oral bacteria. The material comprised 53 young adult males. A statistically significant, negative correlation was observed between the antibody titer to a pool of Veillonella strains and dental caries experience. Multiple regression analyses failed to reveal significant associations between periodontal disease and serum antibody titers. However, the data suggested a combined association of the titers to the strains of Veillonella and a strain of Fusobacterium with the periodontal index.


Staphylococcus aureus in the throat: A saprophyte or a pathogen? 144 industrial workers were investigated for the presence of Staphylococcus aureus in the upper respiratory tract because 53 of them had complained of chronic throat discomfort. Significantly more patients with subjective throat complaints harboured Staph. aureus in the nose (49.1%) and throat (32.1%) than patients without such symptoms (27.4% and 9.9%, respectively). No Staph. aureus were found in throat swab cultures from 21 randomly selected individuals working in a similar factory where no chronic throat discomfort was reported and only 2 throat carriers of Staph. aureus were found among 66 medical undergraduates investigated. The staphylocci belonged to several different phage type patterns and could not be recovered on sedimentation plates or from machines or products. In the light of these and other findings it was suggested that the staphylocci accentuated an already existing damage of the mucous membrane of the throat, but seemed not to be the primary cause of the discomfort.


The predominant cultivable microflora of advanced periodontitis. A study on the predominant cultivable microorganisms harbored in the base of deep periodontal pockets of eight patients aged 34-48 years was carried out using the roll tube culture technique. From a total of 475 isolates, 425 (89.5%) were obligate anaerobes, 356(74.9%) were Gram-negative, and 441(92.8%) were categorized as rods. Bacteroides melaninogenicus and Fusobacterium nucleatum constituted the majority of the isolates in seven samples, but their mutual proportions differed considerably between the samples. One sample was dominated by Actinomyces species. Some periodontopathic potentials of the predominating Gram-negative rods are summarized.


Ampicillin and pivampicillin in the treatment of urinary tract infection in children. 16 children, aged 1-10 years, suffering from urinary tract infection were randomly divided into two groups. Ten children were treated with ampicillin pediatric suspension in a dose of 100 mg ampicillin/kg/24 hours divided in 4 doses, and 6 children with pivampicillin base pediatric suspension in a dose of 64.8 mg/kg/24 hours divided in 4 doses (approximately 50 mg ampicillin/kg). The treatment period was 14 days with all infections being cured. Despite the fact that pivampicillin was administered in half of the dosage of ampicillin the resulting peak serum concentration was 65% higher and was achieved more rapidly. The bioavailability and urine concentration were also greater. A marked change in the rectal aerobic bacterial flora occurred during both treatment regimens. In 13 children (81%) a shift took place from ampicillin-sensitive E. coli to ampicillin-resistant Klebsiella strains as the predominating microbe, equally often in both groups of treatment. Ampicillin-resistant E. coli appeared in one child in each group.


Ubiquity of R factor-mediated antibiotic resistance in the healthy population. An attempt was made to assess the occurrence of R factor-mediated antibiotic resistance in the healthy population. Samples of aerobic, gram-negative intestinal bacteria from men from various parts of the country at military conscription were analysed for transferable drug resistance. The obtained frequency, about 15% of R factor carriers in the studied group, was interpreted to reflect the existence of a reservoir of R factors, from which resistant, pathogenic bacteria could be selected under antibiotic therapy. Resistance to tetracycline, streptomycin and sulfonamides dominated among the identified R factor-borne resistance traits.


The effect of eight antibacterial agents on the phagocytosis of 32P-labelled Escherichia coli by rat polymorphonuclear cells. Using 32P-labelled Escherichia coli, the effect of 8 antibacterial agents on the ability of rat polymorphonuclear cells to ingest the labelled bacteria was studied with and without serum present during the ingestion phase. No impairment of ingestion was observed when testing gentamicin, cephalothin and trimethoprim. High doses of oxytetracycline, doxycycline, colistin, erythromycin and chloramphenicol seemed to impair ingestion. The effect was most pronounced when applying 100 mug/ml of doxycycline: the ingestive capability was reduced to 25% without serum and 24% with serum present compared to untreated controls. 83 mug/ml of colistin reduced theingestion to 39% without serum present, this effect being totally eliminated when serum was present during the ingestion phase.


Chromosome analysis and cell cytology in effusions. A comparative study. Chromosome analysis and conventional cytology have been done on serous effusions from 35 patients, 21 of whom had a final clinical diagnosis of malignant disease and 14 of non-malignant disease. Sixteen of the malignant cases were previously untreated. Cytology disclosed nine cases as malignant, three as suspect malignant and nine as normal. The comparable figures for chromosome analysis were 14 malignant, two suspect malignant, and five normal. Neither of the methods gave false positive results in the small series of non-malignant disease. In the present study chromosome analysis has thus provided greater diagnostic accuracy than cytology on serous effusions of malignant disorders.


Control of influenza and poliomyelitis with killed virus vaccines. The requirements for inducing immunity against an infectious disease are outlined, and the application of these requirements to the development of effective vaccines (vaccinology) is discussed. Influenza and poliomyelitis are examined from this viewpoint, and data are presented that demonstrate the effectiveness of killed virus vaccines against these diseases. A comparison between live and killed poliovirus vaccines suggests the desirability of returning to the use of a killed virus vaccine for the eradication of polio. The natural history of influenza and experience with vaccination suggest that influenza might be brought under effective control by routine immunization in childhood with a polyvalent killed virus vaccine potentiated by an immunologic adjuvant.


H-Y antigen: behavior and function.

H-Y antigen: behavior and function. The factors are reviewed which affect the expression of H-Y antigen, a cell surface component that has been extensively analyzed in mice but which may be ubiquitous in all vertebrates. The phylogenetic stability of this antigen and its association with the Y chromosome indicate an important role in primary sex determination.


Functional specificity of thymus- dependent lymphocytes. Thymus-dependent lymphocytes display a restricted range of specificity when compared to thymus-independent (B) lymphocytes. They react particularly to thymus-dependent protein and cell surface antigens and to products of genes encoded in the MHC. In addition, T lymphocytes have important functions in regulating the immune response and in discriminating of self from nonself. Recent work indicates that individual T lymphocytes possess receptors that interact with both thymus-dependent antigens and MHC gene products, either independently or as associated structures. We attempt to relate this complex specificity pattern to the regulatory and surveillance functions of T lymphocytes.


Nosocomial Klebsiella infections in an intensive care nursery. Nosocomial infections in an intensive care nursery (ICN) due to kanamycin-resistant Klebsiella pneumoniae during a four-month period with an infection rate of 12% and mortality of 47% are reported. Emergence of this organism was thought to be due to the widespread use of kanamycin. Transmission probably occurred via hands of personnel contaminated during care of colonized or infected infants. Control measures advocated are better handwashing technic and discriminate use of antibiotics. This report emphasizes the need for awareness of this continuous threat and for infection surveillance in an ICN.


Topical clotrimazole in tinea pedis.

Topical clotrimazole in tinea pedis. Clotrimazole is a new antifungal agent which is effective topically in dermatophytosis, cutaneous candidiasis, and tinea vesicolor. The authors performed a controlled double-blind clinical trial comparing topical clotrimazole with its vehicle in the treatment of 66 patients with dermatophytic infections of the skin of the feet. Clotrimazole proved to be effective in the treatment of tinea pedis of both the interdigital and the plantar hyperkeratotic types.


Ibuprofen in osteoarthritis.

Ibuprofen in osteoarthritis. In a double-blind, multiclinic study, 437 patients with osteoarthritis were treated sequentially with ibuprofen, 1,800 mg/day, and placebo, or with aspirin, 3,600 mg/day, and placebo. Each treatment was given for four weeks. Considering relief of pain, ability to function, and general well-being, the patients preferred drug to placebo, usually by a statistically significant margin. Combined results showed no significant differences between ibuprofen and aspirin. Patients' evaluations of exercise-related pain, ability to perform a selected activity, and total discomfort and disability, and physicians' evaluations of discomfort and disability, all favored drug over placebo, and the differences were significant for a number of endpoints. The results indicated ibuprofen, 1,800 mg/day, offers about the same antiarthritic benefit as aspirin, 3,600 mg/day. Both drugs are superior to placebo. The incidence of gastrointestinal complaints with ibuprofen was similar to that with placebo and significantly lower than that with aspirin.


Type A botulism from commercially canned beef stew. Two of three persons who ate lunch together became ill with symptoms characteristic of botulism. One died before botulism was suspected and before specimens could be collected for laboratory testing, but a serum specimen from the other patient, who survived, yielded botulinal toxin, type A. The third person remained asymptomatic, but Clostridium botulinum type A was cultured from his stool. The three persons had shared two canned foods: home-canned green beans and commercially canned beef stew. The green beans were initially assumed to be the cause of the outbreak. However, the empty stew can was recovered from the garbage, and washings from the can yielded C botulinum, type A, and its toxin.


Coal workers' pneumoconiosis.

Coal workers' pneumoconiosis. Pathologic features and pathogenesis of coal workers' pneumoconiosis are reviewed. Roentenographic aspects of CWP have been examined; it is concluded that there is little or no correlation with physiologic abnormalities, and no abnormality is pathognomonic of this condition. It is suggested that coal workers who are physiologically disabled by any condition, usually heart disease or chronic obstructive pulmonary disease or both, be retired via an industry-government compensation plan. Chest roentgenograms should serve only to identify and retire those miners who have progressive massive fibrosis, and to identify those who have simple CWP; thus they may be moved to jobs in areas of the mine where dust concentrations are lower.


Clinical use of echocardiography: a review. The clinical usefulness of echocardiography can be considered under a few broad categories: (a) measurement of internal structures and their changing relationships to each other throughout the cardiac cycle; (b) demonstration of abnormalities of function which are dependent on motion--for example, the prolapsing mitral leaflet or the paradoxical septal motion in right ventricular volume overload; and (c) changes within the heart such as pericardial effusion which lead to the development of echo-free spaces or the appearance of echo within a normally echo-free chamber as in myxoma.


Pancreatic encephalopathy.

Pancreatic encephalopathy. Cerebral fat embolism was established as the cause of death in a 34-year-old man with acute pancreatitis. Encephalopathy complicating pancreatitis may be due to hypoxia secondary to pulmonary fat embolism, cerebral fat embolism, or the complicating syndromes of disseminated intravascular coagulation or hyperosmolality.


Medical education: retrospective and prospective observations. Significant advances in medicine have occurred in the past 50 years. Medical education, too, has undergone many changes, and is due for an in-depth study and appraisal similar to that of the 1910 Flexner report. Some of the changes in medical education discussed include excessive emphasis on incurable diseases and scientific minutiae instead of practical clinical problems, changes in the roles and images of clinical teachers, importance placed on faculty research, decline in actual patient care, and a new and welcome proliferation of training programs for family physicians. Suggestions are offered for reducing the duration of medical training, and for improving the curriculum and the education of students in medical schools today.


Evaluation of autosutures in gastrointestinal surgery. Autosuture surgical instruments were used in over 300 gastrointestinal operations including 60 gastric resections. The technic and its advantages and disadvantages are reviewed, specifically for gastric surgery. Operating time required has been decreased, and results have been good. The instruments have wide application, and their safety has been proved.


Fatal sepsis associated with an intrauterine device and pregnancy. The 15th case of maternal death associated with sepsis in pregnancy in a patient using the Dalkon Shield intrauterine device is reported. Intrauterine sepsis appears to be a complication of the use of this device. B acteria enter the uterus during pregnancy through the multifilament tail of the device. The management of sepsis during pregnancy associated with an in situ IUD often requires a combined medical and obstetrical approach. The removal of all Dalkon Shields is strongly recomended.