Jejunitis with malaborption. A quantitative study of the gastric and intestinal handling of a meal during malabsorption and after recovery. The gastric and intestinal response to a standard meal was examined with a quantitative multiple indicator dilution technique in a patient with jejunitis and malabsorption. Examinations were made during and after recovery from disease. The malabsorptive state was associated with a marked delay of the gastric emptying paralleled by a low gastric secretion rate. Despite the low delivery rate from the stomach, large fluid volumes passed at the investigated level 70 cm distal to the pyloric sphincter. This was due to a reduced absorption of nutrients and water during a rapid transit of the proximal intestine and to persistently high pancreatic and intestinal secretion rates. A comparison with data from the healthy experiment suggests that the strong gastric inhibition during malabsorption works as an effective compensation for the decreased absorptive capacity after the second hour from meal intake and onwards.


Serum tryptophan in Crohn's disease.

Serum tryptophan in Crohn's disease. Tryptophan absorption was studied in 32 patients with Crohn's disease and 16 healthy controls. A non-parametric sorting process identified two distinct groups of patients; 19 with normal tryptophan absorption values and 13 with distinctly subnormal results. The patients with impaired tryptophan absorption ate less, had lost more weight, and had lower serum albumin levels and greater intestinal protein loss than the group with normal absorption. Bacterial colonization of the jejunum, liver disease, and steroid therapy did not seem to influence tryptophan values in these patients.


Inhibition of bile formation by high doses of taurocholate in the perfused rat liver. Sodium taurocholate was administered to the in situ perfused liver of male Sprague Dawley rats at various rates below (57 and 114 nmol/min -g liver) and above (228 and 456 nmol/min -g liver) its biliary transport maximum (Tm) to study its effect on bile formation. As expected, bile flow increased with increasing dose until maximal bile salt excretion was reached. By contrast, during taurocholate infusions exceeding the taurocholate-Tm, bile flow and bile salt excretion decreased. Under those conditions, a given bile salt excretion was associated with a smaller volume of bile. A relationship between these effects and the concentration of taurocholate in the perfusate (160 to 860 nmol/ml) was suggested by the observation that bile formation returned toward normal when the taurocholate concentration was lowered by exchange of the perfusate.


Autopsy findings in leukaemia.

Autopsy findings in leukaemia. Out of 38 leukaemic cases only 16 had extensive leukaemic infiltration at death. 15 patients had slight or moderate and 7 no infiltration at all. 12 of the 15, and 5 of the 7 died with septicaemia. The latter patients must have died of complications rather than of the leukaemia itself. Although it has been possible to reduce the incidence of septicaemia during life, terminal septicaemia does not yet seem to be preventable. Septicaemia was revealed at autopsy in 27 of 38 patients; 25 of these also had clinical signs of septicaemia before death. Necrotizing gastrointestinal lesions may cause endogenous infection. In the present material, almost every second patient had fungal septicaemia. Out of 7 patients having oral candidiasis in vivo 5 had systemic candidiasis at autopsy, but only half of the patients with systemic candidiasis had visible oral growth. Modern treatment of leukaemia seems to be able to prevent intracranial haemorrhage in 90% of the cases. On the other hand, vacuolization of muscle and liver tissue was a frequent finding in leukaemia. It is suggested as being caused by fatty degeneration. Vacuolization of myocardial cells was found in 7 out of 13 cases. Among these 7, 4 had had intermittent hypokalaemia.


Adenylate-rich sequences of heterogeneous nuclear RNA from normal and chronic lymphocytic leukaemia lymphocytes. Rapidly labelled high molecular weight heterogeneous nuclear RNA (Hn RNA) from normal and chronic lymphocytic leukaemia (CLL) lymphocytes has been fractionated into two classes by chromatography on poly (U) sephasose. The (+) Hn RNA is bound to poly (U) sepharose and contains both a long poly (A) segment (100-200 nucleotides) and shorter (A) rich sequences (approximately 20-30 nucleotides. (-) Hn RNA is not bound to poly (U) sepharose and lacks the longer poly (A) segment but does contain shorter (A) rich sequences. Partial association of the short (A) rich segments with double-stranded regions was found for both classes of Hn RNA but was most pronounced in (-) Hn RNA from high WBC cases of CLL. Both classes of Hn RNA from CLL lymphocytes contain varying but generally higher amounts of the short (A) rich fraction than those in normals. Similar amounts of the longer poly (A) segments were found in (+) Hn RNA from both CLL and normal lymphocytes.


Platelet production capacity at intervals after acute thrombocytopenia. Platelet producing capacity was examined at intervals after acute platelet depletion by reinduction of acute thrombocytopenia and assessment of the subsequent platelet recovery rates of 35S-sulfate incorporation into platelets. Platelet producing capacity was increased on days 1 and 2, somewhat decreased on days 3 and 4 and had returned to baseline by day 5. These studies suggest that there is an initial increase followed by a decrease on days 3 and 4 in cells which can respond to thrombopoietic stimulating factor after induction of acute thrombocytopenia.


Erythropoiesis inhibiting factor(s) (EIF). The specificity and toxicity of urinary EIF studied in vivo and in vitro. The specificity and toxicity of the urinary erythropoiesis inhibiting factor (EIF) has been tested both in vivo and in vitro. When EIF was given to ESF stimulated erythropoietically suppressed polycythaemic mice and to mice at maximal endogenous erythropoietic stimulation, a reduction of the erythroid bone marrow cells, the erythropoietic 3H-TdR L.I. and the total number of bone marrow cells were observed. No effect was seen on the myelopoietic bone marrow cells. An unspecific toxic effect was unlikely, since addition of EIF did not alter the proliferation of lymphoblastic cells nor change the glucose utilization of bone marrow cells in vitro. Neither did the amount of dead bone marrow cells increase after being incubated with EIF for 72 h. The results indicate that the urinary EIF is a non-toxic, cell specific inhibitor on erythropoiesis.


Lymphocyte purification from normal human peripheral blood by filtration through columns of cotton wool. With a view to simplifying the separation of haemopoietic stem cell concentrates from human peripheral blood, in preparation for their clinical use, the production of lymphocyte concentrates by cotton wool filtration has been investigated. Using the method which is described in detail, highly purified suspensions may be prepared without the selective loss of thymus-independent lymphocytes. Optimal operating conditions are defined. Haemopoietic stem cell concentrates may thereby be harvested, and are shown to be capable of proliferation and differentiation on subsequent culture in vivo.


Peyer's-patch-associated synthesis of immunoglobulin in germ-free, specific-pathogen-free, and conventional mice. The synthesis of immunoglobulins G, A, and M has been studied in Peyer's patches together with closely associated intestinal mucosa and in small intestine distant from Peyer's patches in specific-pathogen-free (SPF) Swiss mice and conventional and germ-free C3H mice. Thissue fragments were cultured in vitro in medium containing 14C-labelled amino acids, and newly synthesized proteins were detected by radioimmunoelectrophoresis. Small intestine from SPF and conventional animals synthesized almost exclusively IgA. No immunoglobulin synthesis was detectable in germ-free intestine. In contrast, the Peyer's patches and associated mucosa of all the groups of mice synthesized IgG, IgA, and IgM. This observation is discussed in relation to the possible role of the Peyer's patches as a source of precursors for immunoglobulin-producing cells in the intestine.


Two populations of lymphocytes involved in phytohaemagglutinin-induced cytotoxicity of a dividing target cell. A quantitative study of the surface characteristics of cells cytotoxic against Chang cells permits the following conclusions: [1] In the presence of phytohaemagglutinin two types of cell are involved; one has Fc receptors and the other does not. Approximately two thirds of the cytotoxic activity is lost if the Fc-receptor-bearing cells are removed. [2] Both spontaneous and antibody-induced cytotoxicity is almost completely abolished by removal of Fc-receptor-bearing cells. [3] None of the cytotoxic activity, spontaneous or induced, appears to be mediated by cells that are plastic-adherent or bear surface immunoglobulin. These results are compared with similar studies by other authors.


Effects of hypophysectomy on DNCB-induced contact sensitivity in rats. Cell-mediated immunity in hypophysectomized (HYX) and non-hypophysectomized (NHYX) rats was assessed by measuring lymph node weight and lymph node cellular proliferation responses to cutaneous application of the skin sensitizer dinitrochlorobenzene (DNCB). Differences were found in the lymph node weight assay, with the responses of the HYX rats being significantly lower than the responses of the NHYX rats. There were, however, no significant differences as measured by the lymph node cellular proliferation assay. An explanation for these contradictory results was sought by examining dose-responsiveness to DNCB. It was found that, over a range of doses of DNCB, HYX rats showed a linear dose-response relationship in terms of both lymph node weight and lymph node cellular proliferation. No dose-responsiveness was observed in NHYX rats. Since HYX rats required a greater degree of antigenic stimulation to achieve a response level equivalent to that of NHYX rats, it may be concluded that HYX rats are immunodeficient at lower antigen levels.


Specificity of Fcgamma receptors in human malignant tissue and normal lymphoreticular tissue. The specificity of the Fcgamma receptors in normal spleen and liver and in malignant tissues was studied using hemadsorption to cryostat sections. Indicator cells (EA) were sheep erythrocytes (E) sensitized with rabbit IgG antibody (A). The binding of EA to sections of normal and malignant tissues was inhibited by pooled IgG of human, rabbit, and guinea pig origin and by human IgG1, and IgG3, and IgG4 myeloma proteins. Heat-aggregated IgG inhibited the binding to sections of liver and some malignant tissues more effectively than monomeric IgG. The Fc fragments of IgG were also inhibitory, but not the F(ab')2, Fab', and Facb fragments. The inhibition obtained increased with decreasing amounts of A used for sensitization of E. The inhibitory activity of IgG was abolished after partial reduction and alkylation. No inhibition was obtained with IgG2, IgM, IgA, or albumin. E sensitized with Facb or F(ab')2 fragments of A did not bind to normal or malignant tissues. The specificity of the Fc receptors in normal spleen and liver and in malignant tissues is apparently very similar.


Measles virus-induced migration inhibition of human leukocytes in vitro: an expression of cell-mediated immunity? Attempts were made to establish measles virus-induced migration inhibition of human leukocytes as an in vitro test of cell-mediated immunity to the virus. Crude material from cell cultures infected with two different strains of measles virus was used as antigen in the capillary modification of the test. Both virus preparations induced migration inhibition. Incubation with puromycin indicated that the inhibition was dependent on protein synthesis, which has been regarded as a characteristic feature of an immunologically specific inhibition. However, no difference was found when the migration inhibition of leukocytes from donors without clinical and serological evidence of previous measles infection was compared with that of leukocytes from donors with such evidence. It is concluded that the migration inhibition induced by crude measles virus material does not necessarily measure cell-mediated immunity to the virus.


Oligoclonal measles virus-specific IgG antibodies isolated from cerebrospinal fluids, brain extracts, and sera from patients with subacute sclerosing panencephalitis and multiple sclerosis. Measles virus-specific antibodies were isolated from sera, cerebrospinal fluids (CSF), and brain extracts of patients with subacute sclerosing panencephalitis (SSPE) and multiple sclerosis (MS) by absorption with measles antigens and subsequent acid elution of the antigen-antibody precipitates. Electrophoretically homogeneous measles antibodies were isolated from CSF or brain extracts in five patients with SSPE and in five out of seven patients with MS. Homogeneous IgG antibodies were also demonstrated in the sera from all SSPE patients and from three of the MS patients. The antibodies isolated from various control sera and from pooled CSF were electrophoretically heterogeneous. The results support the concept of a local synthesis in the nervous system of oligoclonal IgG antibodies to measles virus in all patients with SSPE and in some patients with MS. In SSPE, most or all oligoclonal IgG proteins of the CSF or brain carry measles antibody activities. In MS, only part of the oligoclonal IgG appears to be associated with measles antibody activity.


Renal function in experimental chronic hydronephrosis. IV. Renal handling of sodium and water. The reabsorption and excretion of sodium, chloride, potassium and water were investigated subsequent to loading with saline solution before and after unilateral hydronephrosis with partial obstruction to flow had been induced in 23 dogs by ligation of the ureter over an indwelling catheter. In the experimental kidney the increase in the total excretion of sodium and chloride and of water in per cent of GFR and the decrease in the reabsorption of sodium, chloride and potassium in per cent of the filtered loads were statistically significant. The glomerulotubular balance was altered statistically probably significantly, but the relation between the capacities for reabsorption of sodium and glucose was maintained. The renal pelvic dilatation was measured and plotted against the degree of renal functional impairment. A statistically significant inverse correlation was noted between renal pelvic volume and reabsorption of sodium and of chloride in per cent of the filtered loads. The osmolality of the urine was the parameter showing the most marked difference between the hydronephrotic and the contralateral kidney. For sodium and chloride the difference between the two sides in the reabsorbed amount in per cent of the filtered load was correlated probably significantly to the degree of renal pelvic dilatation.


Renal function in experimental chronic hydronephrosis. III. Glomerular and tubular functions in relation to renal pelvic volume. Studies of renal function comprising determination of exogenous creatinine clearance, urinary osmolality and TmG were performed on 23 dogs, for each kidney separately, after hydronephrosis with partial ureteric obstruction had been produced by ligation of one ureter over an indwelling catheter. A method for determining the volume of the hydronephrotic renal pelvis was developed and the degree of functional reduction was correlated to the degree of pelvic dilatation. In 11 cases the renal blood flow was determined by direct measurement. Statistically significant reductions of the glomerular and tubular functions were noted on the hydronephrotic side. TmG and the urinary osmolality showed the greatest percentual decreases and the TmG/GFR ratio the smallest. The decrease in this ratio was due to greater deterioration of tubular than of glomerular function. The renal blood flow was reduced on the hydronephrotic side in comparison with the intact side, but seemed relatively less affected than the glomerular and tubular functions. Compensation by the intact kidney resulted in masking of the deterioration on the hydronephrotic side; thus for the whole material the mean GFR and urinary osmolality for the two kidneys together remained essentially unchanged. No statistically significant correlation between the degree of functional reduction and the degree of pelvic dilatation was found. Such a correlation could therefore not be used in the individual case as an indication of the functional capacity of a kidney.


Aids for speech-handicapped.

Aids for speech-handicapped. An improved electrolarynx is described. It provides handcontrolled fundamental frequency which enables the user to approximate natural intonation patterns, thus overcoming the monotony of speech with conventional aids. Training experiments with normal and with laryngectomized subjects have given promising results. A voice amplifier has been developed. Special care has been taken to minimize acoustic feedback problems. It is used for compensation of any weak voice, including esophageal speech and as a supplement to the electrolarynx for increasing the sound output and improving the signal-to-noise ratio. The use of synthetic speech in aids for anarthric patients is discussed.


Discrimination between subsequent sudden and non-sudden death by postinfarction exercise testing. An analysis was made of differences in response to postinfarction exercise testing between patients with subsequent sudden and non-sudden death occurring during a 6-year follow-up period after acute myocardial infarction. In the 21 patients who died suddenly the ST-segment depression appeared earlier during exercise and was greater at the end of exercise than in those 25 patients whose death was not sudden (p-values less than 0.025). The physical working capacity of the sudden death group was insignificantly better and the work was performed with an insignificantly higher heart rate and lower systolic blood pressure than in the other group. The heart rate-blood pressure product during maximal work load was the same in both groups. The T-wave depression and P-terminal force negativity after exercise were greater in the sudden death group than in the non-sudden death group (p-values less than 0.025, less than 0.001, respectively). Ventricular ectopic beats, especially after exercise, were also more common in the sudden death group.


Psychological perception of nursing aides' work. An attitude study in a geriatric hospital. To evaluate the psychological perception of nursing aides' work a questionnaire study was performed in a long-term care (geriatric) hospital. 233 out of 273 nursing aides participated (85.4%). Seven scales were obtained: relation with supervisors and workmates, perceived need for information, satisfaction with the work itself, perceived need for education, perceived demand for physical and psychic strength, perceived strain, adjustment to geriatric work. Differences were found between young and older nursing aides, e.g. the young nursing aides percerived less demand for physical and psychic strength and the older nursing aides had a better adjustment to geriatric work. The most important factors for the overall satisfaction with the work were satisfaction with the work itself, perceived strain, and adjustment to geriatric work. Comparisons were also made between the nursing aides and industrial workers and employees.


Symptoms, disablement and treatment during two years after myocardial infarction. Invalidism after myocardial infarction was elucidated by assessing chest pain, dyspnoea, need for cardiac medication, and the extent to which patients returned to work during the first two years after myocardial infarction. The patients in the study were obtained from the Myocardial Infarction Register in Göteborg and were followed at the Post-MI Clinic. Standardized criteria were used for handling of symptoms, signs, risk factors and complications. The prevalence of various symptoms was registered at regular intervals and the findings at 3 months and one year infarction are presented. The prevalence of symptoms was determined by means of questionnaires. Three months and one year after infarction the prevalence of effort-induced chest pain was 53 and 44%, respectively. There was no age correlation. The comparable figues for dyspnoea on exertion were 47 and 41%, respectively. The proportion of patients with dyspnoea tended to rise with increasing age. Dyspnoea on exertion was more prevalent at 3 months than at 12 months after infarction. About 60% of the patients had experienced some of the symptoms before acute infarction and this proportion increased to about 70% during the follow-up period. This rise is caused by an increase of patients with solitary dyspnoea. Only a few patients received treatment with digitalis and diuretics prior to onset of symptoms. Three and 12 months after infarction the prevalence of patients treated with digitalis was 36 and 39%, respectively. The corresponding figures for diuretics were 15 and 20%, respectively. Both digitalis and diuretic therapy were more frequent at 12 months than at 3 months after infarction. Diuretic therapy increased significantly with age. Three months after infarction 17% of the patients were back at work. After 12 and 24 months the corresponding figures were 63 and 70%, respectively. The tendency for resumption of work at all intervals during the follow-up decreased with advancing age. During the first year after myocardial infarction 30% of the patients were readmitted to hospital. The chief reason for readmission to hospital was suspected (but later not verified) reinfarction.


Tuberculosis in BCG-vaccinated and unvaccinated young Swedish Men. A comparative study. Tuberculosis causing exemption from military service was studied in 47,791 tuberculin-tested military recruits between 1941 and 1946. A total of 46.6% were tuberculin negative, and two-thirds were BCG vaccinated. An analysis was made of 304 cases of tuberculosis discovered from 6 months after the test up to the end of 1960. It has been calculated that 69% of "expected cases" of tuberculosis were in the BCG-vaccinated men during the 5-year period after the test, and 20% during the following period; 46% of "expected cases" of post-primary pulmonary tuberculosis and 83% of "expected" deaths were prevented. The differences on which these percentages are based were statistically significant. The efficacy of BCG vaccination was lower in areas with widespread cattle tuberculosis than in areas where cattle tuberculosis is less frequent; this is explained by the influence of previously acquired immunity.


A follow-up examination of patients with pulmonary tuberculosis resected on suspicion of tumour. Thoracotomy was performed in 91 patients who proved to have pulmonary tuberculosis. A short course of antituberculous chemotherapy was given preoperatively in 66 cases. The surviving 89 patients received antituberculous chemotherapy postoperatively, and were-re-examined from 1 to 14 years after the operation. No signs of dissemination or other tuberculous manifestations were found 1 year after termination of chemotherapy, even if preoperative treatment had not been given. One recurrence was seen 7 years after operation despite 9 months postoperative antituberculous chemotherapy. This was the only tuberculous manifestation. The survival rate was normal in the first 3 years compared with a corresponding Danish population, but became slightly reduced 10 years after operation. The quality of life did not seem to be significantly changed as estimated by the degree of disablement which could be correlated to the operation.


Life changes and myocardial infarction. How useful are life change measurements? Although statistically significant, the relation between certain life changes and imminent myocardial infarction appears to be quantitatively weak. Of particular importance are events connected with employment. However, the summation of life changes has not proved to be of use in the prediction of imminent myocardial infarction. For patients with ischemic heart disease, variations in life change measures have proved to be of use in the prediction of changes in catecholamine output and in prognosis. When genetic factors are held constant, as in monozygotic twin pairs vulnerable to ischemic heart disease, more life changes in one partner may indicate a greater risk of unexpected sudden cardiac death in this partner than in the other twin. The self-rating of the severity of each experienced event has proved more useful than "standard weights" in the retrospective discrimination of myocardial infarction patients. Further clinical and epidemiological studies are needed in this field. For the future, the following recommendations are made: The studies should be prospective. The individual's habitual level and actual level of the change should be recorded. The severity of events should be self-rated. Risk variables, known to be of importance to the development of MI should be recorded. They are for instance smoking habits, blood pressure, serum lipids and genetic predisposition. Psychological variables should be mentioned separately in this connection.


What middle-aged men know of their parents' cause of death and age at death. A comparison between history and death certificate. Middle-aged men's knowledge of the circumstances of their parents' diseases and death is reliable to such an extent that it can be used when appropriate for therapeutic purposes in familial diseases. This conclusion is based on findings in a health examination survey of 441 middle-aged men in Uppsala, Sweden where the men were asked whether their parents were dead and, if so, the known cause of death and at what age they had died. The information reported was then compared with the official data kept by the authorities. In 87% of cases it was possible to perform such a comparison. The study showed good conformity of the two sources, in general.


Visits to a small coastal communities of Northern Norway by a doctor and a health insurance officer. What can we learn by visiting small remote communities, giving information about health insurance and social allowances, assisting clients in completing application forms, etc.? In the present study we met attitudes that made some people bear numet needs instead of craving their legal rights. Our visits improved the communication between the people concerned and the Local Health Insurance Office. The officer realized what impairment might mean for working capacity in such communities, and got in a better position to handle various applications.


The effect of religious factors on intoxicant use. To examine cigarette, alcohol and drug use among undergraduates in Cork a precoded questionnaire was mailed to one in seven (458) students, chosen systematically. The response rate was 97%. Religious belief and practice was significantly associated with pattern of drinking behaviour, attitude to alcohol use, marijuana, L.S.D., barbiturate or amphetamine experience and cigarette smoking. It is suggested that current uncertainty of belief in a God and infrequent attendance at religious services are more important factors in promoting alcohol use than being brought up a Roman Catholic. The nature of practices considered serious misdemeanours was significantly associated with religious belief and practice, pattern of drinking behaviour, attitude to alcohol use, marijuana, cigarette smoking. These associations allowed separation of two overlapping groups, one of which was tradition-directed and other which swung towards a more liberal and unstructured life style.


Alcohol problems among female gonorrhoea patients. The proband group consists of the 286 women who, in 1960, were treated for gonorrhoea in the Out-patient Clinic for Venereological Diseases in Malmö. During the years 1932 and 1973, they were responsible for 119 convictions for drunkeness, the expected number of convictions being 4, as calculated from an age- and calendar year specific risk table for Swedish women. The difference between numbers observed and those expected increased with age. Of the 82 patients aged 25 years or over in 1960, one in ten had previously been convicted for drunkenness, and one in seven, 13 years later. During the years 1939 to 1973, 12 gonorrhoea patients were subjected to compulsory treatment by the Temperance Boards. Of the patients aged 15 years or over in 1960, one in twenty had earlier been subjected to such treatment, and one in ten, 13 years later. It is concluded that gonorrhoeal infections, particularly in women 25 years and over, can constitute a "symptom" of alcohol problems.


Services to pensioners and how they might be improved. A report from Malmö. As a follow-up to a previous article, the authors present an analysis of the services to pensioners in the 4th Welfare District of Malmö, as shown by their survey in 1972-1973, along with suggestions for improvement in various respects. They point to the importance of acquiring a general view of the individual and his situation. Various functions within the society's welfare program must be essentially improved, field work and adequate information being among the most important. Integration and coordination between the functional units must be operational concepts.


Pathophysiological basis of tachyarrhythmias--re-entry. A description is given of the principles of re-entry and circus movement, which were originally formulated on the basis of experiments on jellyfish and play an important role in cardiac arrhythmias. The essential features of re-entry are 1) the existence of two conducting pathways which communicate at their proximal and distal ends, and 2) the occurrence of uni-directional block in one pathway while conduction is maintained in the other. A retrograde wavefront may then be set up in the pathway where block was present, and the tissue from which the impulse came may be re-excited. Once this sequence is set up it may continue as a circus movement leading to tachycardia. Long re-entry circuits are present in Wolff-Parkinson-White syndrome, in which two connections between atria and ventricles exist. Micro-re-entry may occur in a variety of cardiac tissues. An example of supraventricular tachycardia due to micro-re-entry in the atrio-ventricular node of an isolated rabbit heart is shown, in which simultaneous recording of transmembrane potentials of AV nodal cells unraveled the events. The principles of the termination of circus movement tachycardias by electrically induced premature beats are discussed.


[The behavior of the general practitioner in dealing with tachycardia]. In medical practice the physician may face 3 situations when dealing with tachycardia or arrhythmia: 1) when seen, the patient has tachycardia and the physician has no electrocardiograph: 2) the patient has tachycardia and the physician can take an electrocardiogramm; 3) the patient discloses a history suggestive of tachycardia or arrhythmia. In the first situation the heart rate and rhythm must be carefully observed immediately, as well as jugular venous pulse and heart sounds and murmurs; then the effects of respiration, change in posture, and carotid sinus pressure should be evaluated; finally, a complete physical examination should be carried out and the patient's history taken; for the latter, questions should be asked concerning past episodes, intake of digitalis or other drugs, possible reasons for hypokalemia, and presence of any disease that might play a role. In the second situation, the ECG should be recorded at once by the physician himself (first V1-2 and DII); the subsequent workup is the same as for the first situation. In the third situation a highly detailed patient's history is of the utmost importance. If recurring episodes take place, their ECG recording should be tried by all possible means: the most important factor is the physicians readiness to do so. A hospital stay for observation of an epidose is usually fruitless, as is an exercise ECG. 24 h recording may be useful, as may endocavitary recording and stimulation tests. Any tachycardia should be correctly related to the natural history of the patient's disease.


[Drug therapy of tachycardial arrhythmias]. In recent years the antiarrhythmic armamentarium has been widened by several new drugs. The effects and side effects of amiodarone, verapamil, prenylamine and prajmalium bitartrate are described. With the introduction of the newer drugs, new recommendations have to some extent emerged with regard to treatment of tachyarrhythmias. For a national understanding of antiarrhythmic agents, regard must be had to their effects on both normal and damaged cells.


[Diagnosis and therapy of bradycardial arrhythmias (round table conference)]. In recent years a growing number of pacemakers have been implanted in Switzerland. An indication for this treatment, in addition to AV block with or without syncope, is now sick sinus syndrome. Intracardiac ECG recording is demonstrated, in view of the fact that this technic has made it possible to differentiate blocks in the bundle of His and in the fascicles. The pacemaker systems most used in Switzerland are described, with comparison of the new lithium cells and mercury batteries. The importance of follow-up in these patients is stressed. Finally, reference is made to the ECG alterations in pacemaker carriers which may cause difficulties of interpretation.


[Lesion of the ramus profundus of the radial nerve (supinator syndrome). Dissociated radial paralysis of the proximal under arm type]. Anatomy and clinical patterns of dissociated distal paralysis of the radial nerve ("supinator syndrome" or paralysis of posterior interosseous nerve) due to trauma, tumors, rheumatic diseases and with spontaneous onset are discussed in the light of the literature and 6 personally observed cases, 5 of them with traumatic lesions. Surgical exploration and intraneural neurolysis resulted in total or partial remission in 5 instances. In our experience surgical exploration should be performed at the earliest moment after spontaneous recovery is no longer to be expected.


[Ovulation inhibitors from a neurological viewpoint]. It is increasingly accepted that oral contraceptives foster thromboembolic diseases (chiefly cerebral ictus) by affecting hemostatic mechanisms causing intimal proliferation. Since 1968 the antithrombotic activity of Aspirin has been under study, and Aspirin has proven effective in preventing arterial thrombosis. Therefore, if oral contraceptives foster arterial thrombosis, Aspirin may prevent cerebral thrombosis in women on oral contraceptives. Six women with cerebral ictus (the  incidence is 10 times higher than in men of the same age and in women not on oral contraceptives) have undergone chest X-ray and ECG. Two underwent pulmonary scintigraphy and 1 pulmonary arteriography. They did not exhibit signs of thrombosis in pulmonary veins or in the heart, a fact which suggested primary cerebral thrombosis. This was verified by cerebral arteriography. Accordingly, Aspirin in a dose not exceeding 1 g per day may be effective in the prevention of ictus. In vizw of the well known side effects of Aspirin, this hypothesis would need to be tested in a prospective study.


[Imported pulmonary coccidiodomycosis apropos of an anatomo-clinical study]. The case is reported of a 41-year-old Arizona woman who, during a European tour, consulted a Lausanne (Switzerland) physician to whom she reported poor general health and, in particular, localized pains in the right thorax. Although the clinical condition appeared normal, radiology of the thorax revealed a round, hollow shadow in the right lung. Since tuberculosis seemed the most likely diagnosis, the patient underwent antibacillary treatment. Three months later the lesion appeared to have increased in volume, and exploratory thoracotomy was performed with removal of the inferior lobe of the right lung. In the pulmonary parenchyma three greyish, well-defined nodules were found. Exhaustive research disclosed the fungal nature of these lesions through the demonstration of parasitic elements typical of Coccidioides immitis.


[Possible causative factors in epidemic incidence of plantar warts]. A locally increased incidence of plantar warts in schoolchildren was demonstrated statistically, although the origins and causes of the epidemic remain unclear. Excessively sweating feet rather than barefoot gymnastics in school, and perhaps the wearing of rubber boots or nylon stockings appear to facilitate the infection. The use of a public swimming pool may be a possible cause, but could not be proven. It seems that an intact, thickened, dry horny layer provides some protection whereas a softened, moistened and macerated horny layer promotes the spread of plantar warts.


[Freshly frozen preserved plasma for the treatment of intravascular coagulation in polytraumatized patients]. Coagulation disorders in hemorrhagic shock need not represent an isolated intravascular coagulation. They may also occur as a complex of local disseminated intravascular consumption, extravascular consumption, dilution, and reduced synthesis of coagulation factors. In the severely bleeding patient with hemorrhagic diathesis heparin is contraindicated because it does not normalize coagulability. Therefore, it fails to stop hemorrhage and shock remains untreatable. Fresh frozen plasma, however, has proved to be suitable as simultaneous substitution therapy of coagulopathy and of hypovolemic shock. 11 patients suffering from traumatic-hemorrhagic shock associated with intravascular coagulation and hemorrhagic diathesis were successfully treated with fresh frozen plasma, after conventional shock therapy had failed over a period of hours.


[Tritium panmyelopathy in the luminescent dye industry]. A case of reversible panmyelopathy in the luminous paint industry is reported. The 52-year-old male patient had a long history of exposure to radium 226, strontium 90, thorium 228 and tritium.


[Curative aspects of modern combination chemotherapy in generalized malignant lymphomas]. 102 patients with disseminated stage III B and IV malignant lymphoma (52 with Hodgkin's disease and 50 with non-Hodgkin lymphoma) at the same hospital center were analysed with respect to remission rate, quality and duration of remission, survival, and therapeutic toxicity. The patient group was subdivided into two consecutive 3-year groups (1966-1968 and 1969-1971). While the 1966-1968 group was mainly treated by "simple", individually tailored monochemotherapy, supplemented if necessary by local irradiation, the 1969-1971 group was systematically treated by intensive combination-chemotherapy programs based on multiinstitutional studies. The following conclusions could be drawn: 1. Remission rate, especially the percentage of complete remissions, and remission duration greatly increased in a comparable group of patients and in both types of lymphoma during the period 1969-1971 as compared to earlier experience from 1966-1968. 2. An increasing proportion of patients with disseminated Hodgkin's disease and non-Hodgkin lymphoma experienced (partly calculated) longterm survival of 5 or more years after the start of chemotherapy or after widespread dissemination of the disease. 3. The probability of longterm survival of females with Hodgkin's disease in our patient group was significantly better than for male patients. This prognostic sex-dependence was not found in the patients with non-Hodgkin lymphoma. 4. Quality and duration of the first induced remission seems to have an important bearing on longterm survival and correlates positively with the life expectancy of the patients with all forms of lymphoma.


[The clinical significance of granulocyte colonies in bone marrow cultures]. The culture system for in vitro evaluation of "colony forming units - culture (CFU-c)" is briefly outlined. This method offers a new approach to studies of proliferation and differentiation of hemopoietic progenitor cells, especially in disorders of granulopoiesis. From available published data it is evident that quantitation of CFU-c is also an indicator of diagnostic and prognostic value for assessment of various types of leukemia. The CFU-c assay has furthermore been introduced to test the viability and proliferating capacity of cryopreserved bone marrow, especially with a view to possible transfusion of stored autologous bone marrow as an adjuvant to cytostatic therapy.


[The so-called white Burkitt's lymphoma]. A case of histopathologically proven Burkitt's lymphoma is described with special reference to clinical, serological and immunological features. This case report is followed by a review of the literature on the problem of American and African Burkitt's lymphoma. We can state that there is good correspondence between the white and black Burkitt's lymphomas with regard to epidemiology, histopathology, therapy and some immunological aspects. The two groups differ from each other in age, primary tumor manifestation, involvement of the bone marrow at time of diagnosis and quantitatively in the positive EBNA-test. It is therefore suggested that black and white Burkitt's lymphoma are not different diseases but different patterns of one disease.


[First therapeutic experience with cis-platinum(II)diamindichloride (NSC 119875) in metastasizing ovarian and testicular carcinoma]. Ten patients with metastatic testicular or ovarian carcinoma were treated with cis-platinum II diaminedichloride. All had received prior chemotherapy with other agents. A therapeutic effect was seen in 7 cases, though it was of short duration in all instances. The drug proved to be very nephrotoxic and caused marked bone marrow depression. The future of this highly effective cytostatic agent, either with different dosage schedules or in combination with other drugs, is discussed. The possibility of new platinum derivatives with a better therapeutic index is also mentioned.


[Cytodiagnosis by puncture-aspiration of cancer metastases and recurrences]. Aspiration biopsy is a very useful method of obtaining morphologic evidence of metastasis and recurrences in surgical and/or irradiated cancer patients. The merits of the technic are ease of performance and rapidity of diagnosis. Moreover, it does not leave a scar which may delay the commencement of radiation therapy if required. Histologic typing of metastasis is not always possible in cytologic material, but comparison with the usually known structure of the primary tumor and evaluation of the clinical state affords sufficient evidence, for practical purposes, of the origin of the metastasis. Some aspects of 709 positive aspiration biopsies carried out in a radiotherapy department are discussed.


[Chorea minor under ovulation inhibitors]. Three weeks after commencing oral contraception for the first time, a 26-year-old woman with a history of rheumatic carditis and chorea minor presented with sudden recurrence of hyperkinesis. Withdrawal of the contraceptive agent was followed by rapid remission of the hyperkinesis, which suggests a casual relationship between the contraceptive and this condition and an analogy between this case and so-called chorea gravidarum. A young non-pregnant woman presenting with chorea minor should be specifically questioned by ingestion of oral contraceptives. If there is a past history of rheumatic fever with or without chorea, oral contraceptives are contraindicated.


[Esophageal function after fundoplication (Nissen)]. Manometric, pH-metric, radiological and histological examinations were performed in 15 of 18 consecutive patients with gastro-esophageal reflux before and after fundoplication. In 13 of these 15 patients, reflux symptoms largely or completely disappeared after the operation. In the successfully operated patients, the reflux provocation test markedly improved but lower esophageal sphincter pressure did not rise. Six successfully operated patients in whom hiatus hernia was present after the operation and 7 patients without hernia had similar esophageal function tests. Therefore, success of surgery does not depend on resting pressure and position of the lower esophageal sphincter.


[Amebic liver abscess of unusual presentation]. A 35-year-old male who had travelled extensively in the tropics presented with severe anorexia and vomiting associated with fever of 39-40 degrees C during a 4-day period. The clinical findings were entirely negative. In 1973, he had been given metronidazole for amebic dysentery, since when recurrent attacks of diarrhea and abdominal pain had been treated with iodoquinoleines. Stool examination was negative for amebae. Liver scan revealed a suspect "expansive process" in the right lobe. The presumptive diagnosis of amebic abscess was made and metronidazole therapy was started. In less than 24 h the patient became afebrile. The abscess was confirmed by a further liver scan. The definitive diagnosis of amebiasis was established 16 days later when the immunofluorescence level, which had been previously negative, became positive 1/480. This case demonstrates the dangers of the indiscriminate use of iodoquinoleines in patients who have travelled in tropical countries. The amebic liver abscess may be silent locally while causing systemic manifestations such as fever. Early treatment of hepatic amebiasis is recommended even with a presumptive diagnosis. Serological tests during the development of an amebic abscess may be negative and should be repeated after several days of therapy.


[Blood pressure and renin activity in essential hypertension under pindolol]. 20 essential hypertension patients with diastolic blood pressure of 100-140 mm Hg were treated with increasing doses (15-45 mg/day by mouth) of pindolol for 14 weeks after an initial placebo period of 5 weeks. Systolic and diastolic blood pressure decreased significantly with as little as 15 mg of pindolol (p less than 0.001). No further changes in systolic and diastolic blood pressure were observed when the doses of pindolol were increased. Plasma renin activity (PRA) determined by radioimmunoassay did not change under increasing doses of pindolol. The blood pressure changes did not correlate with initial PRA or with individual changes in PRA under increasing doses with individual changes in PRA under increasing doses of pindolol. These results do not afford evidence for a renin-dependent hypotensive effect of pindolol.


["Fetal monitoring" within the framework of actual obstetric monitoring]. The introduction of fetal monitoring and its use in high-risk patients was followed in the period 1971-1973 by the first-ever drop in perinatal mortality below 2%. Total monitoring brought about a further reduction in perinatal mortality to 0.95% (1974-1975). This decrease is statistically highly significant. It suggests that among all intensive care methods continuous fetal heart-rate monitoring plays the main contributory role in the early detection of fetal distress. We found that selection of high-risk patients was not sufficient to achieve a drastic reduction in the incidence of acidosis. Only with total fetal monitoring was it possible to effect a significant decrease (from 2.41% to 0.51%) in the number of infants with acidosis (pH less than 7.10).


[The role of the costo-clavicular compression syndrome within the framework of fibrinolytic therapy of deep arm-vein thrombosis]. Eight patients with upper extremity deep-vein thrombosis were treated with thrombolytic agents. The role of a compression syndrome of the costo-clavicular space (found in 5 out of 7 cases) as a probably thrombogenetic factor is discussed. The complications of the therapy were considerable, despite frequent laboratory controls. In one thrombosis of more than 6 months' standing the treatment was ineffective. In the other 7 cases the early clinical results were good. At follow-up 14 to 57 months after thrombolytic therapy, 5 out of 7 cases had residual symptoms (rethrombosis in 2 cases). This may be due to the fact that the compression syndrome was not initially treated, with resultant persistence of the chronic trauma to the vein. Better results can be expected from fibrinolytic therapy in combination with surgical correction of any anatomical narrowing.


[The genetics of Gilbert syndrome].

[The genetics of Gilbert syndrome]. Investigation of 19 unrelated patients with Gilbert's syndrome and family studies in 21 first degree relatives of 7 of these patients are in agreement with an autosomal-dominant mode of inheritance with incomplete penetrance. The calculated penetrance in our study is 57%. HLA typing (locus A, B, C) showed a slight, insignificant increase in antigens A11 and BW35. Furthermore, this syndrome did not segregate in parallel with certain haplotypes within families.


[The non-surgical treatment of postoperatively retained hepato-choledochal calculi]. Postoperatively retained stones in the extrahepatic bile ducts can be chemically dissolved or removed mechanically. One method of chemically dissolving stones is sodium cholate perfusion through the T-tube. In the light of one personal case of successful treatment with sodium cholate, this relatively little-used method is described and recommended as a useful alternative to reoperation. Before reoperation for residual cholesterol gallstones in the extrahepatic bile ducts, dissolving of stones with sodium cholate should at least be attempted.


[Pseudo-pseudo-hypoparathyroidism (PPH) in a family: rheumatic manifestations in 3 cases, one of which associated with a tricho-rhino-phalangial syndrome (Giedion)]. Three cases of familial pseudo-pseudohypoparathyroidism (PPH) are described. Two patients presented the essential features of this rare syndrome, while the third had the signs of PPH associated with those of tricho-rhino-phalangeal dysplasia (GIEDION). All of our patients had spondylolisthesis of L5 as well as arthrosis of the hips (secondary to coxa plana in two subjects and to coxa vara in one). The phosphocalcic metabolism and determinations of serum immunoreactive parathyroid hormone were normal. The autosomal dominant genetic transmission is in agreement with observations in the literature.


[Multiple adenomatous papillary colonic polyps in a family with frequent cases of stomach carcinoma--a new phenotype of familial colonic polyposis]. A kindred of "minor adenomatous polyposis" associated with a high incidence of gastric cancer is described. Five out of 14 mainly asymptomatic individuals in 2 generations of kindred examined clinically, by panendoscopy and coloscopy exhibited multiple polyps of colon or/and stomach and jejunum. Single or multiple papillary adenomas were detected mainly in the right or middle colon (3 times or in the jejunum (once). Hyperplastic polyps were found in the stomach (3 times) and in the colon (twice of these 5 individuals. Our findings suggest that "minor adenomatous polyposis" associated with gastric cancer may represent another, hitherto unrecognized, phenotype of familial multiple polyposis.


[Serum concentration of digitalis glycosides as a therapeutic guide]. The concentration of digitalis glycosides in serum may serve as a useful guide in adjusting digitalis glycoside dosage to individual needs. Radio-immunological determination of digoxin is mainly indicated when patients with renal failure, hypothyroidism or hyperthyroidism or elderly subjects are treated with digoxin, when signs of digitalis intoxication are present or when patient compliance has to be assessed. However, factors which alter myocardial sensitivity to digitalis glycosides must be considered in the interpretation of serum concentrations of digitalis glycosides.


[Determination of plasma phenytoine and treatment of epileptics]. In the diagnosis of epilepsy the prior approach will be to decide whether it is an epileptic attack or not. If so, is the epilepsy the primary disease or the symptom of an evolving cerebral affection or of a toxic or metabolic disorder? The causes of failure with phenytoin treatment are discussed. They may be exogenous, i.e. prescribing too low a dosage (the average dose in the adult is 5 mg/kg/day) or lack of cooperation by the patient who either takes the drug irregularly or fails to take it at all. The endogenous causes are harder to determine. Plasma phenytoin determination (therapeutic values from [5] to 10 to 20 mug/ml) makes it possible to adapt the dosage to the individual metabolism and sometimes to detect a drug interaction which lowers, and in rarer cases raises, plasma DPH levels. Toxic levels are rarely asymptomatic. In this condition repeated determinations may help to decide when the treatment is to be resumed and thus to avoid recurrence of attacks during or shortly after DPH withdrawal. Finally, plasma determination makes clear the extreme difficulty of adapting the dosage in the rare patients who react to a minimal of dose by a shift in blood level from insufficient to toxic values, or vice versa.


[Usefulness of early detection of uterine collum carcinoma]. Systematic screening of preinvasive and invasive lesions of uterine cervix by exfoliative cytology is justified by present morphologic and physiologic knowledge of the cervical epithelium. This technically easy screening procedure should be performed by the family doctor. If the result is positive, the case should be turned over to the gynecologist. Systematic repeated screening permits nearly complete eradication of invasive cervical carcinoma.


[Usefulness of detection of breast cancer: the part played by the internist]. The prognosis of breast cancer is the result of many factors, among which the mass of the tumor at the time of diagnosis remains the most significant: small tumors have a better prognosis than larger ones and are less often accompanied by positive lymph nodes. It is therefore justifiable to search for them systematically by breast examination of all patients over 30. Large-scale mass screening campains in the USA, with clinical and mammographic examination of tens of thousands of women, have proven that it is possible to detect more "early" cancers and reduce general mortality in the groups studied. The number of cancers thus detected is nevertheless so small that it does not justify the investment of so much labour and money in this kind of campaign. Systematic breast examination at regular intervals (6 months to 1 year) with regular mammographies should be confined to patients in the high risk groups: women who have already undergone surgery for cancer of one breast, and patients with a marked family history of breast cancer. For the rest of the female population, the solution seems obvious: every physician should get into the habit of performing regular clinical examination of the breasts. Most gynecologists are already doing so, but they only examine a small part of the population. The most important role in the detection of breast cancer falls to the internists and the general practitioners: they should assume responsibility for all their patients' breasts, in the same manner as they do for heart and lung examinations. They will then request additional examinations (mammography, thermography) as soon as clinical examination reveals a pathological finding. The results of GILBERTSEN [5] confirm that clinical examination remains the most valuable and least expensive method for breast cancer detection.


[Early diagnosis of bronchial cancer: its usefulness]. Incidence of and mortality from bronchial carcinoma are reviewed. The advantages of early recognition of the disease and the favourable role of early recognition as a factor in the therapeutic outcome are stressed. Etiologic factors and diagnostic procedures are summarized. The need for a public education program is emphasized.


[Therapeutic approach to a cerebrovascular accident]. The therapeutic approach to vascular lesions, which in fact represents the effective prevention of potential or recurrent brain damage, is discussed. The following problems are considered: asymptomatic localized vascular bruit; transient ischemic attack; minor strokes; progressive strokes; total strokes; and hemorrhages. Supportive therapy in the patient with brain damage is presented.


[Results of psychotherapeutic quality control and their consequences for the general practitioner]. The evaluation of psychotherapeutic procedures has been rendered possible by comparing treated and untreated randomized groups. An analysis of expected and unexpected results shows that precisely those elements of psychotherapy which can be applied by practitioners are successful.


[The premature infant below 1000 g].

[The premature infant below 1000 g]. 74 premature infants with a birth weight of 1000 g or less were hospitalized in the period 1963-1975. 20 babies survived the first 4 weeks of life and 2 died during the second month of life from progressive lung disease. 77% of all patients were mechanically ventilated and 9 ventilated patients survived. The main causes of death were cerebral hemorrhage, severe asphyxia and septicemia. Prognosis was impaired by hypothermia, IRDS, gestational age below 27 weeks and premature rupture of membranes with bacterial infection. At the age of 1 year 8 out of 12 survivors followed up showed normal mental and motoric development. 3 children had minor or obvious signs of cerebral paresis and one further child has partial retrolental fibroplasia. Due to modern intensive care the survival rate of these very small premature babies has now reached 40%. The prognosis is favourably influenced by optimal obstetric and neonatal care, while special precautions should be undertaken to avoid hypothermia. Our results with mechanical ventilation justify the administration of full intensive care to these very small premature babies.


[Morphological studies on the human heart conduction system]. An attempt has been made to demonstrate morphological equivalents of electrocardiographically determined conduction disturbances in the human heart. In 50% of our cases an authentic morphological change was found. In 25% the correlation remained doubtful, and in another 25% there was no connection. The highest coincidence was found in chronic left bundle branch block and in dissecting aneurysms causing hemopericardium. The correlation between function and morphology is very loose in patients who have undergone cardiac surgery. Etiology is discussed only marginally; ischemia is the predominant feature.


[Myocardial infarct after gastroscopy. Case report and pathogenetic considerations]. Three cases are reported of myocardial infarction and severe myocardial ischemia following gastroscopy in patients with coronary heart disease. These cases demonstrate the high risk of endoscopy in such patients. It is assumed that the main pathogenetic factors are catecholamine-mediated tachycardia and the close vicinity of the lower esophagus to the right coronary artery, with its tendency to coronary spasmus.


[Malignant hyperthermia: attempt at an early diagnosis by means of determination of creatine phosphokinase (CPK) and its isoenzymes]. Creatinphosphokinase (CPK) was elevated in sera of patients with malignant hyperthermia and in sera of some of their relatives. Only the MM-isoenzyme (but not the MB- or the BB-isoenzyme) could be detected by paperchromatographic analysis. In some of the patients elevation of muscle aldolase was also observed. Thus, the appearance of the BB-isoenzyme in sera of patients with malignant hyperthermia, as described by another group of investigators, was not confirmed. No specific screening method exists as yet to detect patients with a high risk of developing this often lethal reaction to anesthesia. However, in patients without muscle disease or trauma and without prior i.m. injections, myocardial infarction or major physical strain, elevation of CPK in serum should be interpreted as meaning that malignant hyperthermia may develop during anesthesia. The pathophysiology of malignant hyperthermia is discussed.


[Bochdalek's hernia with pseudopleuritic and abdominal symptoms in the adult. Apropos of 1 case]. A case of Bochdalek diaphragmatic defect in a 48-year-old man is reported. Previous failure to diagnose the condition had resulted in a variety of diagnostic errors and associated inappropriate treatment. Diagnosis of this malformation, which is rarely encountered in the adult, presents no particular difficulty if care is taken to look for it by appropriate radiologic study. Surgical repair is usually an easy matter.


[Myasthenia gravis in old age. A retrospective study of 58 patients]. The course in 58 cases of myasthenia gravis in subjects over 50 years of age is reported. They total about 30% of cases in all age-groups. 36.2% of the patients died after an average period of illness of 3.4 years. 58.6% initially showed only ocular symptoms and in 58.8% of these the myasthenia was likewise located only in the eyes in the further course of the illness. The prognosis of ocular myasthenia is very good if the myasthenic process does not extend to other muscle groups in the first or second year of illness. 41.2% of primary ocular myasthenia turned into other types, in most cases a generalized type, and these had a poor prognosis. 69.2% of these patients died after an average period of illness of 1.5 years due to myasthenia-induced complications. Cases of myasthenia which initially are of the generalized type, in which the average duration is only 2.7 years until death, and to some extent the bulbar types, also have a poor prognosis. Ocular myasthenic cases generally need only small doses of cholinesterase inhibitors. Some patients had no medical treatment because there was no subjective or objective need for it. Several patients were given doses of cholinesterase inhibitors which were too large; excessive doses are to be avoided because of the proven negative influence of cholinesterase inhibitors on the myoneural system. It is recommended that types of myasthenia with a poor prognosis be treated early with corticoids, ACTH or azathioprin, if the cholinesterase inhibitors have proved ineffective or it their effect is unsatisfactory. Thymectomy is advisable only in patients under 60 years of age.


[Myoclonic encephalopathy due to bismuth salts. Negative search for an associated toxic element]. Five cases of bismuth associated encephalopathy have been observed in the area of Geneva (Switzerland). Thy typical clinical picture is described and the blood and urinary bismuth levels are analyzed in comparison with a group of patients on bismuth treatment but without encephalopathy. A link is established between these observations and previously reported cases of bismuth toxicity, and also with other toxic encephalopathies. With regard to pathogenesis, two hypotheses are discussed: alkylation of bismuth in vivo, and association with another neurotoxic element. With this in view, the urinary excretion of arsenic, lead and mercury was measured. The results were within normal limits.


[Laxative induced diarrhea- -a form of self-mutilation]. In the differential diagnosis of gastrointestinal disturbances the possibility of laxative abuse is considered either too late or not at all. The sequel is a protracted course of illness with a series of expensive and fruitless investigations. On the basis of three recently observed cases of laxative-induced diarrhea the problems of diagnosis and management are discussed. Methods of securing early diagnosis are mentioned. The overall prognosis must be considered unfavorable. The importance is stressed of long-term follow-up of these patients at community level, to ensure timely intervention should complications arise and to prevent further unnecessary investigations.


[Primary extranodal lymphogranulomatosis of the flexura dodenal-jejunalis]. A primary extranodal lymphogranuloma of Hodgkin was found in the small bowel (PS II AE) of a 34-year-old man. Two years after radical surgery followed by local telecobalt therapy, the patient is in good health. The symptomatology, therapy and prognosis of this rare form of Hodgkin's lymphogranuloma are briefly reviewed.


[Diabetic retinopathy; facts and speculations]. Our knowledge of the etiology of diabetic retinopathy is very limited. Correlation of the time interval between onset of diabetes and diabetic retinopathy as a function of age makes it possible to estimate the degree of resistance of the small vessels to the microangiopathy-inducing agent for the various age groups. Epidemiologic data reveal that, viewed statistically, malignant diabetic retinopathy is relatively rare, and that the life expectancy of blind diabetics is longer than is commonly assumed.


[Diabetic retinopathy: documentation, evaluation of its course and possibilities of treatment by photocoagulation]. Optimal documentation of retinal lesions by panorama fundus photographs is required for evaluation of the course of diabetic retinopathy (DR). The data are prepared for automatic storage and computation. The natural course of DR is occasionally characterized by remarkable spontaneous remissions. Therefore, unilateral treatment is needed to evaluate the efficacy of photocoagulation. The following preliminary results on 215 patients treated unilaterally with Xenon photocoagulation, and followed up for 6 months to 6 years, were statistically significant: marked decrease of intra- and epiretinal vessel new formations, prophylaxis of retinal neovascularization and vitreous hemorrhages, preservation of the macula and retention of visual acuity in diabetics below 60 years of age. The unpredictable rate of progression of DR in individual cases is responsible for occasional failures of photocoagulation.


[Correlations between clinical findings and therapeutic measures and the course of diabetic retinopathy]. A review is presented of recent literature on clinical findings and therapy in relation to the course of diabetic retinopathy. A report is then given on personal results with hypophysectomy in 15 diabetics with progressive retinopathy. The observation period is 16 years. The course of retinopathy is related to growth hormone findings, which have been determined in a longterm program. Mean survival after trans-sphenoidal hypophysectomy was 4 1/3 years (1 8/12 to 8). There is no clear evidence that impending blindness could be arrested in the whole group, but there was a temporary halt in individual diabetics. In one patient, growth hormone treatment was investigated as a means of improving renal function. The diabetic retinopathy findings did not change during growth hormone treatment.


[Long term control of diabetes in general practice]. Longterm follow-up and counselling of the diabetic patient faces the family doctor with highly specific tasks. The importance of optimum cooperation from the patient is stressed and the method of carrying out periodic checkups is described. The doctor should obtain information about the carbohydrate metabolism from urinary tests performed by the patient himself. Also, the symptoms of late diabetic syndrome should be detected as early as possible.


[How do we counsel our diabetic patients?]. Successful treatment of the diabetic patient is possible only if the patient himself takes an interest in his disease and also an active part in treating it, i.e. by adherence to diet, testing of urinary sugar and insulin administration. The precondition for cooperation is intensive medical advice covering the following three aspects: 1. education, 2. motivation to put the acquired knowledge into practice, 3. practicability of the advice given. Our program covers 5 points: 1. basic education on the nature of diabetes, 2. diet instructions, 3. testing of urinary sugar, 4. instruction on insulin administration, 5. oral hypoglycemic agents. Special instructions must be given to motorists and all other types of driver, and also for emergency situations (vomiting, fever etc.). An instruction sheet carrying the key points in helpful. The results of this educational scheme are regularly checked by questionnaire. Refresher courses have been found to be necessary at regular intervals. The permanent educational efforts of regional Diabetic Associations and appropriate literature (D-Journal) are also recommended. The time-consuming effort of achieving the goals associated with education of the diabetic calls for teamwork between general practitioner and teaching center, e.g. the hospital with its facilities (audiovisual program, dieteticians etc.). However, the crucial factor remains the physician's commitment to his patient and his disease, since education and treatment must be geared to the needs of the individual patient.


[Hirsutism].

[Hirsutism]. Hirsutism (increased masculine-type sexual hair growth) is to be distinguished from hypertrichosis (generalized increase of body hair) and from virilism (organ changes tending towards masculinity) in which marked hormonal changes are alwasy observable. Hirsutism depends on age, race, heredity, hairfolicle sensitivity to testosterone, and on circulating testosterone and its precursors. The main source of testosterone and androstanedione formation is not the adrenal cortex, as previously assumed, but, as catheterization has demonstrated, the ovary. Mild forms can best be treated externally by plucking, shaving or electrolysis. In forms associated with amenorrhea the amenorrhea responds to corticoids but over a prolonged period of treatment the maximum regression of hirsutism is one-third. Good results are obtainable by reverse-sequence therapy with the competitive androgen antagonists cyproterone acetate and ethinyl estradiol (100 mg cyproterone acetate from 5th-14th day of menstrual cycle and 50 mug ethinyl estradiol from 5th-21st day). This therapy is however costly and not without side effects; it should therefore be used only for particularly troublesome cases.


[Purity and antigenicity of the new insulin preparations]. A short review on new types of insulin preparations purified by chromatography is presented. The purity of these new chromatographed insulins, which have almost completely replaced the conventional types of insulin, has been considerably improved. Our own investigations have revealed significantly lower antigenicity of porcine depot preparations compared with beef or mixed beef-pork insulins. By means of gel filtration and additional anion exchange chromatography the antigenicity of porcine insulin can be significantly reduced. Monocomponent insulins prepared by these methods produce low titers of insulin antibodies in only one third of diabetics treated by insulin for the first time. Mixed beef-pork Lente Insulin purified by single chromatography is also less antigenic than Lente Insulin of conventional purity, but more antigenic than pork insulin (e.g. Monotard). Pork insulin purified by chromatography is indicated in cases of insulin allergy, insulin resistance and lipoatrophy, and also for first insulin treatment in younger and middle-aged diabetics.


The medico-social aspects of liquor licensing. The present Licensing Law has failed in its stated purpose of diminishing the misuse of alcohol. On the contrary the misuse of alcohol is increasing year by year. The recommendations of the Scottish Departmental Committee (1971-1973) would, if fully implemented, go far to remedying this defect by providing effective legislative support encouraging improved social attitudes to drink. The Licensing (Scotland) Bill 1976 will, from a technical point of view, discard much that was obsolete and promote much that is wise in the practice of licensing, but if passed into law unchanged the Bill will not have the full social impact on drinking habits and, therefore, on the misuse of alcohol for which we had hoped.


Reconstructive surgery in gangrene.

Reconstructive surgery in gangrene. The results of reconstructive arterial surgery in 113 critically ischaemic limbs during 1958 to 1972 are presented. There were 61 aorto-iliac reconstructions with 4 operative deaths (6.5%), resulting in a limb salvage rate of 75.4 per cent and 49 femoro-popliteal operations with 3 deaths (6.1%) and a limb salvage rate of 73.5 per cent.


The penetration of minocycline into human sinus secretions. The mean minocycline content of sinus secretions aspirated during antral wash-out in 8 patients sinusitis was found to be 1.06 mug. per ml. (SD.1.03). This exceeds the M.I.C. for most strains of bacteria likely to be found in sinusitis. The mean minocycline serum level in these 8 patients was 3.16 mug. per ml. (S.D. 1.64). The sinus secretion to serum level ratio was therefore 0.34:1. No correlation was found between serum level and sinus secretion level, nor could any of the factors looked at in this study be correlated with the degree to which minocycline penetrated the sinus secretion.


Villous papilloma of the rectum presenting as infective gastro-enteritis. Three elderly patients have recently been admitted as emergencies to the Infection Unit of the Aberdeen Hospitals as presumed cases of infective gastro-enteritis. Investigation revealed the presence of a villous papilloma of the rectum in each case.


The state of the environment 1976.

The state of the environment 1976. One of the main points made recently by the Executive Director of the United Nations Environment Programme, in describing the state of the current environment in the world, was that the present nuclear arms race is a potential environmental hazard, larger than any other created. It was pointed out that the nuclear stockpiles of the major powers in 1974, amounting to 30,000 megatons, were two million times the destructive capacity of the Hiroshima bomb. The State of the Environment report continues to examine also the conventional arms race, pointing out that the combined military expenditure by developing countries has increased by the rate of ten per cent a year since 1960, taking scarce foreign exchange to build up arsenals, rather than developing the environment of these countries or alleviating the poverty of the people living in these countries. Other major points described in the report: 1. In terms of pollution, even a relatively small change in one of the controlling factors of the world climate would have serious consequences for mankind, hampering the increase in world food. 2. It is still not known what the earth's real "carrying capacity" is, and all that is known is that the earth can meet only the basic needs of a finite number of people. 3. Hunger is the main problem in the world today and can only be solved through wise development and the doubling of global food production. 4. Almost half of the 7,000 million people expected to be alive in the year 2,000 will live in towns and cities, more than 64 per cent of these people in developing countries. 5. On a positive note, there is a much greater awareness on the part of the people of the world, a greater reduction of pollution  in many parts of the world, and a co-operation among governments-and a marked progress in the field of international environmental law. The report concludes by warning the world that it must consume less resources less wastefully and that without political will science can do nothing. The essence of the environmental challenge, therefore, is political rather than technical.


Cold shock: biological implications and a method for approximating transient environmental temperatures in the near-field region of a thermal discharge. Biological data on the temperature preferences of fish indicate that, in general, they will be attracted to thermal discharges in the winter. This attraction to warmer temperatures increases their vulnerability to cold shock if the discharge heat source is discontinued. A scheme is proposed to predict the near-field thermal plume environmental temperatures during a power transient. This method can be applied to any jet discharge for which a steady-state model exists. The proposed transient model has been applied to an operating reactor. The predicted results illustrate how very rapidly the maximum temperatures decrease after an abrupt shutdown. This model can be employed to help assess the impact where cold shock may be a problem. Such predictions could also be the basis for restrictions on scheduled midwinter plant shutdowns.


The influence of dietary minerals and fat on the absorption of lead. The nutritional factors influencing the absorption of lead from the gut have been studied using both intact animals and ligated gut loop preparation. Short-term feeding studies have been made in groups of six animals using diets of constant lead content (0.075%) but in which the nutritional components were varied sequentially. Dietary lead was labelled with 203Pb. Absorption was determined in the carcass and individual organs by means of a small-animal wholebody counter. The results showed that absorption was enhanced to twenty-times control value by diets deficient in minerals and seven-fold by diets of high fat content. Conversely, high mineral diets have been shown to result in a two-fold reduction in lead absorption. The interaction of lead with individual dietary components has been further studied under controlled conditions using ligated gut loop preparations. Using this technique the relative roles of luminal interaction and tissue response for lead absorption have been explored and the kinetics of lead absorption determined.


Lead levels in Birmingham dust.

Lead levels in Birmingham dust. Dust is important as a factor affecting amenity and there are suggestions that it can make a significant contribution to the exposure of children to toxic materials and particularly to lead. The results are presented of an investigation into the lead concentrations in dust collected in Birmingham. Relationships are shown to exist between samples from similar areas and the distributions of lead concentrations throughout the City are shown. However, interpretations must be made with caution and this is illustrated by referring to some of the problems involved in the collection and chemical analysis of the samples.


Hypoxanthine-guanine phosphoribosyltransferase mutant glioma cells: diminished monamine oxidase activity. A defective capability of cultured rat glioma cells to reutilize purine bases (hypoxanthine-guanine phosphoribosyltransferase deficiency) was associated with a reduced capacity to oxidatively deaminate serotonin and tryptamine. The mutant glioma cells were also more sensitive to the cytotoxic effects of serotonin than were normal cells


Is there selection against wobble in codon-anticodon pairing? Among amino acid codons that require a third-position pyrimidine, there is a significant bias favoring the use of cytidine over uracil in MS2 phage RNA. This could arise from selection against wobble pairing in the interaction of transfer RNA and messenger RNA. Among amino acid codons with fourfold degeneracy, there is a bias favoring pyrimidines over purines.


Cones survive rods in the light-damaged eye of the albino rat. Exposure to constant light causes extensive rod photoreceptor damage but spares the photopic system in albino rats. The rod branch of the dark-adaptation curve shows considerable elevation in threshold; the cone branch is hardly affected. Longer exposure and chromatic adaptation suggest that there are three cone mechanisms with peaks near wavelengths of 450,520, and 560 nanometers.


Bone compressive strength: the influence of density and strain rate. The compressive strength of bone is proportional to the square of the apparent density and to the strain rate raised to the 0.06 power. This relationship is applicable to trabecular and compact bone, and provides clinical guidelines for predicting bone strength on the basis of x-ray and densitometric examination.


Low-risk cigarettes: a prescription.

Low-risk cigarettes: a prescription. Antismoking education campaigns in out society have met with only partial success: today 55 to 60 million Americans smoke, and the habit is increasing among teenagers and women. It is important to protect individuals who continue to smoke despite all warnings. There is evidence that this can be accomplished in at least two ways. First, it may be possible to remove toxic smoke components and thus reduce specific hazards. Second, the doseresponse evidence suggests that, if the total intake of smoke can be reduced, after an appropriate time a reduction in disease incidence should occur. The technology to achieve these results has been developed and can be applied to the manufacture of commercial cigarettes. These cigarettes will not conform to traditional flavour patterns, but consumer perception can be made to change and compensating flavours and fragrances can be added. The feasibility of less hazardous cigarettes raises the question of whether there are limits of cigarette and smoke composition that may approach relative safety. These limits can be defined as the smoke intake doses at which the risk of disease in smokers approaches that in nonsmokers. Such values can be extimated by dose-response analysis of several epidemiological studies and by extrapolation of blood concentrations at different rates of intake for certain smoke components, such as carbon monoxide. Critical values determined by these methods should not be interpreted as indicators of safe smoking levels; they do imply, however, that a rapid shift in cigarette consumption habits toward the proposed range of values will make possible a substantial reduction in the current epidemic proportions of smoking-related diseases.


The use of an elemental diet in gastro-intestinal diseases. An elemental diet containing predigested protein, a high content of predigested fat and carhobydrate, trace elements and vitamins, was administered as the only form of nutrition to 9 adult patients with chlonic, ileal and pancreatic fistulae, Crohn's disease, ulcerative colitis, malabsorption states and abdominal lymphoma, and to 4 children with protracted diarrhoea. The diet was administered orally through a nasogastric tube for 1 - 8 weeks. Two patients were treated on an outpatient basis. There was considrable clinical improvement in 6 adults and in 3 children. Two adults and 1 child did not respond and 1 adult did not co-operate. The results justify the use of this elemental diet in carefully selected patients under strict medical supervision.


Pseudocyesis in Blacks.

Pseudocyesis in Blacks. Twenty-one Balck women with pseudocyesis were seen over a 4-month period at the Baragwanath Hospital antenatal clinic. The psychological backgrounds of 9 of the 21 women were assessed in detail. That Blacks are unable to cope with and sublimate a stressful "infertility" adequately is suggested as the aetiological factor which leads to the high incidence of this psychosomatic disorder in Blacks.


Transcultural factors in child abuse.

Transcultural factors in child abuse. A transcultural analysis of 54 cases of child abuse that were consecutively referred to the psychiatric clinic of the Red Cross War Memorial Children's Hospital is presented. Among the data studied were the legal status of the abused child, the nature of the injuries received and the characteristics of the abusers. It is stressed that this was a pilot investigation, and that there is a need for better reporting and further research.


Tuberculosis of the vulva: case reports. Tuberculosis of the vulva in 3 patients is reported. The difficulty in clinical differentiation of this condition from carcinoma of the vulva is stressed. The literature is reviewed and current management is discussed.


Pesticides and the South African population. Legislation which has a bearing on pesticides, and its current implementation by the State departments of Agricultural Technical Services and Health, are discussed. Organophosphate compounds account for about 80% of all deaths from pesticides and for about 60% of non-fatal cases of intoxication. In South Africa, levels of lipophilic organochlorine compounds in human adipose tissue are generally well under the world average and are demonstrating a progressive downward trend.


[The origin and development of reconstructive surgery]. The history of plastic and reconstructive surgery through the ages is reviewed and the modern developments in this field are mentioned in relation to this history. The development of plastic  surgery in South Africa is also briefly referred to.


Defective leucocyte inhibitory factor (LIF) production by lymphocytes in children with kwashiorkor. Production of the lymphokine leucocyte inhibitory factor (LIF) by phytohaemagglutinin (PHA)-stimulated lymphocytes was assessed in 25 children with kwashiorkor. Although the lymphocytes of 12 of these patients produced adequate amounts of LIF, the rest of the group failed to produce lymphokine after PHA activation. There was no correlation between the ability to produce LIF and the age, severity of malnutrition or any other clinical parameters assessed in these patients. This finding confirms the presence of defective cell-mediated immunity observed in a substantial proportion of kwashiorkor children.


Lower oesophageal sphincter resting pressures in achalasia and the response of the sphincter to swallowing and drugs. Previous reports on the profile of lower oesophageal sphincter (LOS) pressures and swallow responses in achalasia have been conflicting. Both normal and high resting pressures have been reported. Many reports have noted a failure of relaxation of the LOS in response to swallowing. Manometric studies were performed on 17 untreated patients with achalasia, of whom 76% were found to have a resting peak end-inspiratory pressure significantly greater than normal (P = 0,001). Nine patients showed relaxation of the LOS in response to swallowing but this relaxation was usually inadequate and of brief duration. Contractions were premature in 16 patients. One patient showed a manometric pattern closely simulating a Mobitz type 1 atrioventricular block in response to repeated swallows. A common pathophysiological process is postulated. In one patient an injection of secretin reduced the high resting LOS pressure. This supports previous evidence that a hypersensitive sphincter in achalasia is due to a hypersensitivity to gastrin. Hyoscine-N-butylbromide (Buscopan) caused a significant reduction in LOS pressure in all patients in whom it was used.


The effect of zinc sulphate and of bicitropeptide on tetracycline absorption. The interaction between tetracyclines and di- and trivalent ions such as are contained in aluminium, magnesium, calcium, iron and zinc-containing salts or complexes or antacids is well documented. The potential for interaction between tetracyclines and zinc and bismuth salts is often not realised, but is emphasised by the findings reported here. The absorption of 250 mg phosphate-potentiated tetracycline hydrochloride was reduced by 75% when administered concurrently with 220 mg zinc sulphate. The absorption of 250 mg phosphate-potentiated tetracycline hydrochloride was reduced by 50% when administered concurrently with 10 ml bicitropeptide, a bismuth-protein complex. Tetracyclines should thus not be administered concurrently with zinc salts or bicitropeptide.


Binding of sodium taurocholate by cereal products. The in vitro binding of sodium taurocholate to various cereal products was determined. Maize meal bound significantly more bile salt than maize rice or samp and significantly less than minitmeal or minitsamp.


An integrated cardiorespiratory pathology information system. An integrated computer system which is in its initial year of implementation has been developed to handle pathological data of cardiorespiratory organs. On the single entry of data captured at the source, the interactive computer system generates reports for administrative requirements by law, updates a data base of cardiorespiratory histopathological data for research purposes and facilitates inquiry for periodical management reports. The system is based on multiple-source documents which have numerically precoded choice option statements as well as free text provision for those statements where precoded options are not provided. The computer system has replaced manual system procedures most effectively in terms of cost.


Ventricular ectopic activity in chronic ischaemic heart disease. Ventricular ectopic activity in 116 consecutive postmyocardial infarction patients was studied. The study extended over a period of 5 years and 700 periodic 6-7-hour Holter tape recordings were perfomred. A classification of ectopic activity is presented and it is suggested that patients be classified into group I with few, i.e. less than 8, and group II with multiple, i.e. 8 or more, ectopic beats per hour. It was found that the frequency of ventricular ectopic activity tends to remain constant over prolonged periods of time, and that repetitive firing as well as multiformity are functions of the absolute number of ventricular ectopic beats (VEB) present. A 6-7-hour sample of ventricular ectopic activity gives only marginally more information than a 1-hour recording, and the presence of VEB on a resting ECG correlates well with a frequency of more than 8 VEB per hour (group II) on extended monitoring.


Dose-finding trials of oral oxamniquine in Rhodesia. Oral oxamniquine at a total dose of 60 mg/kg (given in 4 equal doses morning and evening over 2 days, after food) is an efficient and apparently very safe drug for the treatment of Schistosoma mansoni infections. Lower doses, or shorter schedules of treatment, are less efficient. The drug has little or no effect on S. haematobium infections. Side-effects are mild and infrequent.


A survey of snakebit in the Johannesburg area. Case records of persons with snakebite treated at the Johannesburg General Hospital and the Transvaal Memorial Children's Hospital during the 10-year period 1963-1972 were investigated. It was concluded that (i) snakebites were rare, since only 39 cases were recorded, none of which ended fatally; (ii) 86% of patients were men (mean age was 24 years); (iii) 80% of bites were on the hand and arm; (iv) 28% of patients had had previous snakebites; and (v) 60% of bites were 'illegitimate', i.e. they occurred in snake handlers. Apart from occasional bites by exotic snakes in collections, the venomous snakes responsible for the majority of bites were, in order; ringhals, puff adder, and burrowing adder. The first two snakes are common in the region, while amateur herpetologists are at particular risk of being bitten by burrowing adders because of the snake's ability to bite even when held by the back of the neck. Ringhals bites, although the most common, caused virtually no morbidity. Bites  by other venomous snakes showed considerable variation in morbidity, suggesting that many different factors must be taken into account when the nature and effects of snakebite are assessed. Eighty-five per cent of snakes were positively identified, mostly by the snake fanciers they had bitten. This permitted specific treatment.


Contact sensitizing properties of some fatty acids in dermatophytes. The predominant fatty acids (C10-C18) of dermatophytes were investigated by the Landsteiner-Draize test to establish their allergenicity. It was demonstrated that fatty acids can give rise to sensitization of delayed type in guinea pigs. The middle-chain fatty acids (C10-C12) showed a high allergenicity compared to the (C13-C18) acids with moderate to weak contact sensitizing properties. The fatty acids may act as contact sensitizers and, at least sometimes, be responsible for the skin lesions in dermatophytosis.


Isolation of Candida viswanathii from cerebrospinal fluid. Candida viswanathii has been isolated from the cerebrospinal fluid of a 20 year old male patient suffering from meningitis which ended fatally. The fungus proved pathogenic to cortisone treated mice but was poorly so to the normal mice challenged intravenously.


[Preparation and study of a Paracoccidioides antigen needed for skin tests]. A cellular antigen from Paracoccidioides brasiliensis, obtained from the supernate of the disrupted yeast phase, was studied. It was prepared by a method similar to that for obtaining the spherulin from Coccidioides immitis. This antigen is composed of 55 mug/mg of polysaccharides, determined by the phenol method, and 7-8 mug/mg of protein, determined by Folin-Ciocalteu's technique. In vitro tests of antigenicity were done by immunodiffusion and complement fixation. The optimum dilution of the antigen was 0-5 mg/ml determined by microtiter complement fixation. The in vivo standardization of the cellular paracoccidioidin was performed on three groups of patients. The first was composed of 56 patients with mycologically proved paracoccidioidomycosis. The disease was active in 32 and clinically healed in 24 of this group. The second was composed of 15 cases of histoplasmosis with strong histoplasmin skin tests. The third group were 70 patients with no mycotic pulmonary diseases who had come from different zones in Argentina. Each individual was injected with 0-1 ml cellular paracoccidioidin (3 mg/ml), 0-1 ml of Fava Netto's antigen diluted 1/10, and 0-1 ml histoplasmin L48, diluted 1/100. The cellular paracoccidioidin skin test was positive in 44/56 (78.5%) patients with paracoccidioidomycosis. The Fava Netto's antigen gave 42 (75%) positive results and the histoplasmin skin tests gave 28 (50%) in the same group. Twenty-eight (50%) presented positive histoplasmin skin tests. The paracoccidioidin skin test was positive in 2 of the histoplasmosis group (13-3%) and the Fava Netto's antigen gave 3 positive results in the same group (20%). The histoplasmin skin test was positive in 32% of the individuals with no mycotic disease. Ten per cent of these exhibited positive reaction with both P. brasiliensis antigens. Of those paracoccidioidomycosis cases (Group 1) who had negative skin tests with 3 mg/ml of the cellular paracoccidioidin 7/10 gave positive skin tests when tested at a concentration of 8 mg/ml. Characteristic changes of cell medicated hypersensitivity were observed in the histopathological studies of the cellular paracoccidioidin skin test.


Isolation of a specific antigen with alkaline phosphatase activity from soluble extracts of Paracoccidioides brasiliensis. A specific antigen of Paracoccidioides brasiliensis was isolated from a metabolic extract of the fungus. The extraction was made by specific adsorption to and subsequent elution from a column containing a cross linked polymer to which the antibodies of a monospecific rabbit serum had been covalently attached. The purity of the final product was demonstrated by immunodiffusion analysis of the eluate using immune serum produced in a sensitized rabbit. The purified antigen was shown to have cationic electrophoretic mobility and alkaline phosphatase activity.


Protothecosis in a cat: first recorded case. A 12-year-old Domestic Shorthair cat with a soft, fluctuant, subcutaneous mass, approximately 5 cm in diameter on the posterior aspect of the left tarsus was diagnosed as having protothecosis. Cultures, histopathology, and fluorescent antibody reagents were used to identify Prototheca wickerhamii as the etiologic agent. Protothecosis has not previously been recorded in cats.


An automated radiometric microassay of fungal growth: quantitation of growth of T. mentagrophytes. An automated radiometric microassay of the growth of Trichophyton mentagrophytes and other filamentous fungi is described. The assay is based upon the incorporation of 14C(U) glucose into the organism. Fractionation studies indicate that 73% of the label is found in trichloroacetic acid-insoluble macromolecular components of the mycelium. Incorporation of label directly correlated with growth as estimated by visual scoring of turbidity and as recorded in photomicrographs. Incorporation of 14C(U) glucose delineated a lag, exponential and stationary or plateau phase of growth. These phases could be completely inhibited by the antifungal agent tolnaftate. It was concluded that the growth of filamentous fungi can be successfully monitored by the radiometric method described. Moreover, this method is sensitive, accurate, reproducible, rapid and free of the variability inherent in many traditional estimates growth.


[Experimental paracoccidioidomycosis in the mice induced intransally]. A study was undertaken to determine the possibility of inducing paracoccidioidomycosis in mice exposed to the mycelial phase of P. brasiliensis. Two strains of the fungus, designated FG and LA, were grown separately in media favoring the production of spores by the mycelial phase. These were collected and used for nasal instillation of 328 cortisone treated-mice. Animals were observed for a period of 16 weeks and sacrificed periodically. Pulmonary infection was obtained in 38.1% of the animals, with dissemination to spleen and liver occurring in 14.3% of the cases. The infection was not lethal. One of the strains (LA) proved to be move virulent than the other inducing a more severe type of pulmonary infection. The result of the study indicate that the mycelial phase of P. brasiliensis can give rise, by the inhalatory route, to active murine infections.


Acremonium falciforme as a cause of mycetoma in California. Three cases of mycetoma were studied in the San Francisco Bay area of northern California during the period from 1960 to 1973. In each case the causal agent was identified on the basis of the histological structure of the granules and by isolation of the etiological agent in pure culture. The fungus in all cases was found to be Acremonium falciforme. This is the first report of A. falciforme occurring as a disease agent in the United States.


Tinea nigra infection in Canada.

Tinea nigra infection in Canada. The first infection of tinea nigra known to occur in Canada is reported. The infection occurred on the palm of a Canadian boy, 6 years of age, while he was visiting in the Bahamas. Cultural studies identified the causative fungus to be Cladosporium werneckii.


Obstructing duodenal ulcer.

Obstructing duodenal ulcer. The incidence, pathogenesis, symptoms, roentgenographic, and endoscopic findings of patients with gastric outlet obstruction from a chronic duodenal ulcer have been reviewed. In the experience of many surgeons, including myself, vagotomy and an adequate drainage procedure (Finney pyloroplasty, gastrojejunostomy, or gastroduodenostomy) provide excellent decompression of the obstructed stomach. as well as excellent control of the ulcer disease in most patients. Postvagotomy gastric atony has not been a problem.