Left main coronary artery spasm. A potential cause for angiographic misdiagnosis of severe coronary artery disease. Two patients had catheter-induced spasm of the left main coronary artery during diagnostic coronary arteriography. One patient had no coronary artery disease, and the other had minimal disease of the right coronary artery. Spasm was relieved by nitrates; however, in one patient several doses were needed over 35 minutes. Catheter-induced spasm must be considered in the diagnosis of left main coronary artery disease, particularly on a patient with isolated left main coronary artery disease.


The Jewish Hospital of St Louis Therapeutic Grand Rounds No. 14. Hypersensitivity pneumonitis. Two examples of immunologically mediated diseases of the lung have been discussed. The first, extrinsic allergic alveolitis, is caused by sensitivity to inhalation of an organic dust. It is largely a restrictive type of lung disease and is probably caused by a combination of type 3 and type 4 allergic reactions. The second disease, allergic bronchopulmonary aspergillosis, is caused by a type 1 and type 3 allergic response to Aspergillus antigen in a basically atopic, generally asthmatic individual. It is vital to keep the diagnostic index of suspicion high so as to recognize these diseases early enough to prevent irreparable tissue damage. Extrinsic allergic alveolitis may masquerade as idopathic pulmonary fibrosis or Hamman-Rich syndrome. Allergic aspergillosis may be called Loeffler pneumonia or PIE syndrome (pulmonary infiltrates with eosiniphilia). Failure to diagnose properly may result in extensive pulmonary fibrosis or bronchiectasis and condemn the patient to a lifetime as a pulmonary cripple.


Self-hemodialysis. The optimal mode of dialytic therapy. Maintenance hemodialysis is presently the mainstay of treatment for the majority of patients with end-stage renal disease. There has been disagreement, however, as to what form the delivery of dialysis should take-self-dialysis, at home, or in-center, as opposed to in-center, limited-care dialysis. This review of the recent literature strongly supports self-dialysis as the optimal form of therapy, since the cost is less, and survival and rehabilation are better than with limited-care dialysis. We conclude that a greater effort should be expended to encourage and even direct patients toward this form of therapy.


[Antibodies in venereal sarcoma in dogs]. Neoplastic cell suspensions prepared from fourteen spontaneous and three transplanted vereal sarcomas of the dog were studied by microcytotoxicity and immunofluorescence tests. Serum and cell-surface antibodies were found in all cases. These antibodies were not capable of activating canine complement. Most likely these antibodies are not cytotoxic in vivo, but rather act by enhancing tumor growth.


[Distribution of a cell with intracytoplasmic crystal and crystaloid material in the small and large intestine of the rat and mouse]. In suckling and adult rats, distribution in the small and large intestine of crystal-like containing cell was studied and was compared with that of crystal containing cell in the mouse. In the former, cell predominates in cecum and in the latter in the ileum. Numerical differences were statistical significant. It was postulated that these cells might be different. Up to date, they have been regarded as the same cell by other authors and are known as globular leucocyte.


[Depression and Herpex simplex infections]. It has been mentioned that herpes simplex antibodies are increased in depressed patients. In the present study, serums from 21 patients with reactive depressions, nine with psychotic depression, 33 schizophrenic and 15 normal controls were studied, and herpes simplex antibodies were measured. Neither was statistically significant difference found between any of the groups nor could antibody titres be correlated with severity of depression measured by a psychiatric rating scale. The authors review the pertinent literature, and state that although antibody tires do not correlated with psychiatric diagnosis, there still exists the possibility that latent brain viral infections might trigger depressive episodes in some cases.


[Type A and C viruses particles in murine lymphoma L 5178Y]. The presence of virus particles and their possible mechanism of excretion was studied in cells of murine lymphoma L 5178Y grown intraperitoneally. Malignant cells obtained from 10 mice bearing this lymphoma were studied with the electron microscope. In 96% of the cells 1 to 30 viroid particles (VP) type C (VP-C) clumped or isolated, averaging six per cell were observed. Isolated VP-C were commonly seen within endoplasmic reticulum or budding off from cell surface. Such a finding was regarded as the mechanism of excretion. However, with the present findings it is not possible to draw any conclusions upon the oncogenic nature of the virus particles described herein.


Isolation and growth rates of methanol utilizing Rhodospirillaceae. 38 pure culture strains belonging to seven species of the Rhodospirillaceae were isolated from 39 methanol enrichment cultures inoculated with water and mud samples of different habitats. None of the strains exhibited doubling times shorter than 10 h in methanol-bicarbonate media.


Preparation and partial characterization of a Lactobacillus lactis bacteriophage. High-titer lysates of a bacteriophage active against Lactobacillus lactis were prepared from liquid cultures as well as from areas of confluent lysis in soft-agar overlayers. Phage concentration and purification were accomplished by means of polyethylene glycol precipitation, differential centrifugation. The buoyant density of this phage in cesium chloride was 1.4795 g/ml. Characterization of phage growth cycle by one-step growth experiments under optimal conditions showed that the latent period was about 120 min, that the rise period lasted approx. 130 min, and that the average burst-size was about 80.


Studies on utilization of 2-ketoglutarate, glutamate and other amino acids by the unicellular alga Cyanidium caldarium. Two strains of Cyandium caladarium which possess different biochemical and nutritional characteristics were examined with respect to their ability to utilize amino acids or 2-ketoglutarate as substrates. One strain utilizes alanine, glutamate or aspartate as nitrogen sources, and glutamate, alanine, or 2-ketoglutarate as carbon and energy sources for growth in the dark. The growth rate in the dark on 2-ketoglutarate is almost twice as high or higher than that on glutamate or alanine. During growth or incubation of this alga on amino acids, large amounts of ammonia are formed; however, ammonia formation is strongly inhibited by 2-ketoglutarate. The capacity of the alga and develops fully only when the cells are grown or incubated in the presence of glutamate.


Enrichment and isolation of nitrogen fixing hydrogen bacteria. An enrichment method for nitrogen fixing hydrogen bacteria is described. The procedure invariably resulted in the isolation of yellow-pigmented coryneform bacterial strains assigned to Corynebacterium autotrophicum. The procedure included a serial transfer in an ammonium-free mineral liquid medium under an atmosphere of 10% hydrogen, 5% oxygen, 10% carbon dioxide and 75% nitrogen, followed by a short alkali treatment and by streaking on nutrient broth-succinate agar. The ability to fix nitrogen was confirmed by the acetylene reduction test and by 15N2 incorporation.


Stoffwechselprodukte von mikroorganismen. 154. Mitteilung. Nikkomycin, ein neuer hemmstoff der chitinsynthese bei pilzen. From the fermentation broth of Streptomyces tendae Tü 901 a substance was isolated which inhibits the growth of several fungi. The new antibiotic affects the chitchin biosynthesis. Its structure was identified by mass spectrometry of the products obtained after chemical degradation. Nikkomycin is a nucleoside-peptide antibiotic consisting of uracil, an amino hexuronic acid and a new amino acid containing a pyridin ring.


Occurrence of pppApp-synthesizing activity in actinomycetes and isolation of purine nucleotide pyrophosphotransferase. The occurrence of adenosine 5'-triphosphate-3'diphosphate-synthesizing activity was detected in five strains of actinomycetes; Streptomyces morookaensis, Streptomyces aspergilloides, Streptomyces hachijoensis, tactinomyces violascens and Streptoverticillium septatum, out of 825 strains of actinomycetes, bacteria, fungi and fungi imperficti. Purine nucleotide pyrophosphotransferase were extracellularly excreted associating with the cell growth, and were purified partially or to apparent homogeneiety from the culture filtrate. The enzymes are a monomeric protein with molecular weight of 18,000-26,000 and synthesize adenosine, guanosine and inosine 5'-phosphate (mono, di or tri)-3'-diphosphate such as pApp, ppA pp, pppApp, pGpp, ppGpp, pppGpp, and pppIpp by transferring a pyrophosphoryl group from the 5'-position of ATP, dATP and ppApp to the 3'-position of purine nucleotides in the presence of a divalent cation and in alkaline state.


Structure and composition of intracytoplasmic membranes of Ectothiorhodospira mobilis. The lamellar membrane stacks of Ectothiorhodospira mobilis were isolated and purified by a combination of lysozyme and osmotic shock treatment, followed by differential and density gradient centrifugation. Preparations of lamellar membranes were enriched at least 2.4-fold in the ratio of bacteriochlorophyll a to protein. Thin-sectioning, negative staining, platinum-carbon shadowing and freeze-etching were used to study the architecture of the membrane units. Both platinum-carbon shadowing and freeze-etching showed the outer-surfaces of the isolated lamellar membrane stacks to be relatively smooth. Particles averaging 7 nm in diameter were seen on several faces following freeze-etching.


Torulopsis spandovensis sp. n., a new yeast from beer. A new species of the genus Torulopsis has been isolated from several different samples of German Pilsener Beer. A description of the new species is given.


Bioenergetic aspects of aerobic growth of Klebsiella aerogenes NCTC 418 in carbon-limited and carbon-sufficient chemostat culture. Carbon-limited chemostat cultures of Klebsiella aerogenes NCTC 418 consumed more oxygen per unit of cell synthesis when growing on mannitol or glycerol than when growing on glucose; and since the "maintenance" requirements were similar, this suggested that the extra reducing equivalents present in these compounds were oxidized wastefully. By comparison with carbon-limited cultures, carbon-sufficient cultures that were ammonia-, sulphate- or phosphate-limited generally consumed considerably more oxygen per unit of cell synthesis, particularly at low growth rates. Thus, according to the theory of Pirt, these carbon-sufficient cultures had a greatly increased "maintenance energy" requirement but nevertheless used the remaining energy with a much increased efficiency compared with carbon-limited cultures. This, we suggest, is a false conclusion which stems from the basic assumption that the maintenance requirement does not change with growth rate.


Isolation of regulatory mutants of Pseudomonas acidovorans by use of amino acid analogs. Mutants resistance to various combinations of threonine, lysine and/or their analogs were obtained and characterized in Pseudomonas acidovorans. In particular, mutants resistant to aminoethylcysteine had a dihydrodipicolinate synthetase insensitive to lysine inhibition whereas mutants resistant to threonine plus a low concentration of aminoethylcysteine had a feedback-insensitive aspartokinase.


The effect of neuroleptics on serum prolactin in schizophrenic patients. Serum prolactin levels were studied before and during long-term administration of phenothiazines on a twice daily schedule to 27 newly admitted schizophrenic patients. An increase in serum prolactin is believed to be a reflection of inhibition of dopamine receptors in the hypothalamopituitary axis. By 72 hours after the initiation of treatment, all 27 patients had persistently elevated serum prolactin levels averaging 3.2-fold and 3.8-fold in men and women, respectively. There was a lag between clinical response and dopamine blockade, as indicated by serum prolactin levels in most patients. Serum prolactin levels remained elevated during the one- to three-month period subjects were studied, suggesting there was no tolerance to this effect of phenothiazines. Serum prolactin levels tended to be higher with thioridazine than on equivalent doses of chlorpromazine or trifluoperazine hydrochloride. There was some evidence that the magnitude of the serum prolactin elevation correlated with clinical response. After cessation of phenothiazines, serum prolactin levels rapidly reverted to normal within 48 to 96 hours.


Children of psychotic mothers. An evaluation of 1-year-olds on a test of object permanence. Fifteen 1-year-old infants at high risk for later psychopathologic behavior were tested on the Piaget Object Scale. Their performance was compared to that of a matched group of controls at low risk. Results indicate a trend in the high-risk group toward lowered object scale performance. Affective styles were found to vary between the groups. The high-risk infants, particularly those with low scores on the object scale, demonstrated more intense anxiety.


Depressed 5-hydroxyindole levels associated with hyperactive and aggressive behavior. Relationship to drug response. Monitoring of 5-hydroxyindole (5-HI) levels in blood in hyperactive institutionalized mentally retarded patients before and after drug therapy revealed depression of 5-HI levels in 83% of hyperactive patients. In these patients with low serotonin levels, elevation of 5-HI levels in blood into the normal range by administration of a variety of psychoactive agents was associated with the disappearance of the hyperkinetic syndrome. Patients who remained hyperactive continued to have low 5-HI levels. Return of hyperactivity upon withdrawal of meidication in patients who were previously well controlled was associated with a fall in 5-HI levels. Adverse responses were seen in these patients when they were treated with medications usually tending to lower 5-HI levels in blood. Medications used in the treatment of hyperactivity may be classified as to whether they usually elevate, lower, or have no significant effect on 5-HI levels in blood.


Heroin addiction. Sequential treatment employing pharmacologic supports. A system of treatment for heroin addiction is proposed under the acronym STEPS (sequential treatment employing pharmacologic supports). Small steps characterized by decreasing narcotic-induced euphoria and increasing social rehabilitation are expected eventually to bring the addict to an abstinent and well-functioning state, if that is possible. The dichotomous assessment of "success" or "failure" is rejected in favor of the expectation of partial and temporary improvements, as with any chronic relapsing disease.


Behavioral and social effects of heroin self-administration and withdrawal. Behavioral and social reactions to intravenously administered heroin were studied during a 33-day experimental addiction cycle. Three groups of four subject volunteers were allowed to self-administer heroin for a ten-day period as part of a longer study of oplate antagonists. Data relevant to sleep patterns, energy expenditure, social interaction, and other observable behaviors were collected during hourly observations. Comparison of behavioral differences before and after drug administration indicated few significant acute reactions. Reactions to long-term heroin self-administration were most pronounced in the areas of sleep behavior and social interaction. Subjects tended to sleep less, especially during the initial period of acquisition, and to withdraw more from social contact. No changes were noted in energy expenditure during waking hours. The results were interpreted in terms of physiological tolerance, central nervous system arousal, and sleep deprivation.


Cannabis psychosis and paranoid schizophrenia. The initial clinical symptoms of 25 consecutive cases of cannabis psychosis of the paranoid type and 25 consecutive cases of paranoid schizophrenia were studied and compared, in order to delineate features that would enable a differentiation of the two conditions. It was observed that the patients with cannabis psychosis substantially differed in terms of behavioral manifestations. Most of these patients were violent and panicky and demonstrated bizzare behavior, but they possessed some insight into the nature of their illness. Schizophrenic patients manifested these disturbances and characteristics less frequently. Subjects with cannabis psychosis showed rapid ideation and flight of ideas, whereas the characteristic schizophrenic thought-disorder was found mostly in schizophrenic patients.


The medical safety of the combined usage of disulfiram and methadone. Pharmacological treatment for alcoholic heroin addicts. The results of hematology and blood chemistry tests were examined in eight methadone maintenance patients who had been treated concurrently for alcoholism with disulfiram (Antabuse). There were no apparent major differences between the results of tests run prior to the initiation of the disulfiram treatment and subsequent tests run up to 16 months after treatment was begun. There was a trend toward normalization of serum glutamic oxaloacetic transaminase (SGOT) values. The results suggested no contraindications to this combined pharmacological treatment.


Development of reference systems for automatic identification of clinical isolates of bacteria. The reported work describes experiments on automatic identification based on a material of 636 clinical isolates of bacteria. It is shown that three different and mutually independent automatic identification principles produce almost identical identification conclusions. It is also shown that an automatic procedure which continuously corrects the basic classification gives results which are independent of the classification background. Automatic correction logics develop conventionally-based, as well as numerically-based initial reference systems toward almost similar solutions. This may indicate that automated identification methods based on numerical classifications possess general validity.


Antibiotic action of beta-ursolic acid.

Antibiotic action of beta-ursolic acid. The antimicrobial action of beta-ursolic acid (triterpenoid sapogenin from the ursan group) has been studied. At the concentration of 300 mug/ml, this substance inhibited growth of all strains of staphylococci investigated. MIC for Gram-positive bacteria ranged between 50 and 500 mug/ml, and 100 to 800 mug/ml for Gram-negative bacteria and yeasts. Acquired resistance to beta-ursolic acid was transient.


A trial of using antibodies as carriers of alkylating agents. II. Evaluation of ability to form 32P-cyclophosphamide + immune antibody complexes with homologous antigen. 32P-cyclophosphamide was found to combine with gamma-globulin fractions of immune sera. Immune sera incubated with 32P-cyclophosphamide retained ability to react specifically with homologous antigen in  vitro in the system: MN antigens of human erythrocytes + rabbit anti-MN antibody, and probably reacted selectively with target antigens in vivo in the system: antigens of guinea pig kidney tissue + rabbit antibodies against these antigens. Hemagglutination, passive hemagglutination and precipitation in agar gel tests were used in the experiments. Ability to combine of the immune antibody + 32P-cyclophosphamide complex with homologous antigens was evaluated by measurements of radioactivity of studied materials (erythrocyte agglutinates and organ homogenates). The results indicate feasibility of using immune antibodies as carriers of cytostatic agents.


Blastic transformation of lymphocytes in in vitro cultures under the influence of phytohemagglutinin and pokeweek mitogen in patients with glomerulonephritis treated over long periods of time with immunosuppressive drugs. In vitro reactivity of lymphocytes to phytohemagglutinin (PHA) and pokeweek mitogen (PWM) was studied in 17 patients with chronic glomerulonephritis treated systematically over many months (average, 23 months) with immunosuppressive drugs (prednisone, indomethacin, azathioprine, cyclophosphamide). Blastic transformation of lymphocytes in cultures stimulated with PHA was tested three times: before beginning of treatment, during the course of therapy with full doses, and after prolonged ambulatory treatment with maintenance doses. The degree of blastic transformation under the influence of PWM was determined only after periods of many months of treatment with chemical immunosuppresors. The results showed that neither treatment of chronic glomerulonephritis for several weeks with full doses, nor subsequent prolonged administration (for periods of tens of months) of maintenance doses of immunosuppresors regularly inhibit blastic transformation of lymphocytes stimulated with PHA. Similar observations were made using PWM after many months of immunosuppressive therapy. Reactivity of lymphocytes to PWM in all patients resembled reactivity to PHA.


Influence of immunosuppressive drugs on activity of lymph node permeability factor (LNPF). The influence of selected immunosuppressive drugs on development of local inflammation induced by injection of LNPF in rats was studied. The factor was obtained from guinea pig lymph nodes stimulated with Freund's complete adjuvant. The cell-free extract was obtained by disintegrating the cells, dialysis and lyophilization of the material. Preventive action of the drugs was dose-related. Strongest protection against the effect of LNPF was observed after administration of 6-MP and cyclophosphamide (100 mg/kh). Methotrexate (20 mg/kg) caused a reduction of the surface area of the inflammatory reaction by 70-90%, and 5-fluorouracil (50 mg/kg) by 35%-60%. Specific heterologous anti-LNPF serum was the most effective protective agent in rats; administered before the test, it prevented appearance of an inflammatory reaction altogether.


Immunologic evaluation of beta-lipoprotein antigen in the serum of men exposed to carbon disulfide over protracted periods of time. beta-Lipoprotein was isolated by the precipitation method from collective serum of 47 men aged 27-49 years (mean 42-1 years) exposed to carbon disulfide during work over long periods of time. Significantly elevated levels of serum beta-lipoprotein, clinical and polycardiographic symptoms were found in 85-1% of subjects. Antibodies to beta-lipoprotein obtained by immunizing rabbits intravenously were compared with similar antibodies in healthy subjects by double immunodiffusion in agar and by the passive hemagglutination test. Both tests showed identical antigens.


Morphologic homogeneity of bacteriophages and their biological activity. Lytic activity of morphologically homogeneous phage lysates, obtained from lysates containing morphologically inhomogeneous virions, was studied. Five series of phage lysates found to contain morphologically inhomogeneous virions were investigated. By selecting suitable hosts from each series, two or three lines were obtained which reproduced morphologically homogeneous virions. Morphologic homogeneity of these phage lines was determined by electron microscopy. In the course of this study it was found that phages with different morphologic appearance can produce similar plaques. Hence, appearance of plaques is not an adequate criterion of homogeneity of the phage. The isolated phages differed in biological activity from the original morphologically inhomogeneous bacteriophage. It was concluded that morphology is an important, and the most reliable at present, criterion of homogeneity of bacteriophages.


The effect of gradual mild acid hydrolysis on serologic activities of glycoproteins from human erythrocytes. M and N blood group glycoproteins from O group erythrocytes were hydrolyzed with acid under various conditions that produced a gradual release of sialic acid. The preparations desialized to different degree were tested for M, N, NVg and AHp activities. M and N blood group activity was decreased upon release of sialic acid, and AHp activity was exposed "de novo" and increased upon desialization. NVg activity always increased during the initial period of acid hydrolysis, but prolonged heating in acid solution caused subsequent partial inactivation of glycoprotein. This decrease in NHp activity was not related either to the extent of desialization, or to fragmentation of the glycoprotein molecule.


Molecular size and amino acid composition of H-2d antigen solubilized in Nonidet P-40. H-2d antigenic material solubilized by the detergent Nonidet P-40 from L-1210 mouse leukemia cells was isolated by gel filtration on Bio-Gel P-100. A single peak eluted in the void volume consisted of about 90% protein, 8% hexose and traces of sialic acids. In sedimentation velocity runs, the antigen sedimented as a single peak of 3-1 S. Molecular weight determined by sedimentation equilibrium as well as calculated from amino acid composition was found to be in the range of 53,000 daltons and approx. 45,000-51,000 when calculated from sodium dodecyl sulfate polyacrylamide gel electrophoresis. Secondary structure of H-2d glycoprotein was predicted from the amino acid composition. For NP-40-solubilized H-2d antigen, about 34% of helix, 13% beta sheet and 41% turns was found.


Observations of absorption of immunolactoglobulins in calves. The aim of this study was to ascertain whether administration of one liter of stilulated saliva from a healthy cow as first food to newborn calves blocks absorption of immunolactoglobulins administered later in colostrum or milk. The study material consisted of 12 calves, divided into two groups, one of which received colostrum, and the other milk. Blood samples were drawn immediately after birth and 3 and 6 hours after administration of saliva and 3 and 6 hours after administration of colostrum (group I) or milk (group II). Only some of the calves of each group absorbed immunolactoglobulins from colostrum or milk. In these calves, immunoglobulins could be demonstrated in their serum as early as 3 hours after birth. Absorption of immunolactoglobulins was independent of their concentration in food as their levels were similar in calves fed colostrum or milk. The experiment failed, however, to give an unequivocal answer to the question whether feeding calves before the first administration of colostrum restricts or inhibits absorption of immunolactoglobulins from colostrum.


Evaluation of measurements of infectious titers of the vaccinia virus in passaged human embryonic fibroblasts. Measurements of infectivity of the vaccinia virus on 11 cell lines derived from human embryos and passaged several times were analyzed statistically. Various cell lines showed different sensitivity and differentiated response in various passages.


Concerning cellular defense in carcinoma of the larynx. In the search of microscopic manifestations of cellular defense in tumor disease, larynx specimens removed surgically for carcinoma of the larynx and neighboring lymph nodes were studied morphologically. Blastic transformation of lymphocytes from the lymph nodes was also investigated. Activity of nuclear chromatin of these cells was assessed on the basis of its sensitivity to acid hydrolysis in the reaction of Feulgen and incorporation of labeled 3H-actinomycin D. The results indicate existence of cellular defense reaction in carcinoma of the larynx, around the primary tumor as well as in neighboring lymph nodes. Intensity of the reaction in lymph nodes increases with growth of the primary tumor.


In vitro response of lymphocytes to phytohemagglutinin (PHA) and serum levels of immunoglobulins during remission of acute leukemia. The study group consisted of 13 patients, including 5 in complete remission and 8 in incomplete hematologic remission. Six patients had a pause in therapy, and the remaining ones were continuing maintenance therapy. In all cases production of IgG, IgA and IgM immunoglobulins was maintained. Response of lymphocytes to PHA in vitro was normal in 7 patients, mainly in those who had a pause in treatment. The test results were uncorrelated with hematologic status. Both tests showed preserved humoral immunity and delyed hypersensitivity in the early period of remission and had no prognositc value.


Stimulation of blastic transformation of rabbit lymphocytes by means of endotoxins of Bacteroides fragilis. Blastic transformation of lymphocytes from peripheral blood of rabbits immunized with formolized suspensions of Bacteroides fragilis was obtained. Stimulation was accomplished by means of endotoxins extracted from the strain with which the animals were immunized, and from a related serotype. Blastic transformation was obtained 21 days after the start of immunization of the animals, and maximum response after 4-5 weeks. Humoral response, checked by the passive hemagglutination test, preceded cellular response by 14 days.


EMG feedback therapy: review of treatment of 114 patients. Advances in the understanding of the relationship of proprioceptive (kinesthetic) feedback to motor physiology have prompted the study of therapeutic effects of audiovisual displays of EMG activity. Patients with various manifestations of disturbed neuromotor control were studied prospectively for three years. This group included 114 patients with hemiparesis, torticollis, dystonia, and spinal cord or peripheral nerve injury. Initially, all but one of these patients had some residual volitional motor activity, which was insufficient for adequate function, and all patients had had conventional therapy with little or no functional recovery. Prior to EMG feedback therapy, the duration of illness was from three months to 35 years. The shaping of a patient's motor responses usually occurred gradually, often over an 8 to 12 week period. This modification was accomplished by feeding processed audio-visual signals back to the patient. These signals were proportional to the degree of activity of the muscles responsible for the defective function. The concept of microvolt-second, as a unit of muscle activity, is introduced and defined. Patterned movements, which were previously defective were observed to improve to varying degrees. Following the initial course of treatment, reinforcement was required by some patients. The mechanisms of improvement after EMG feeback therapy are not well understood; however, some hypotheses are presented. The results of this study indicate that EMG feedback therapy may induce significant functional recovery in patients with disturbed neuromotor control.


Electrodiagnostic evidence of subclinical disease states in drug abusers. One hundred drug abusers, free of clinical signs or symptoms of disease, were examined by electrodiagnostic techniques. Sensory conduction of median, ulnar and sural nerves was evaluated in terms of latency, velocity and amplitude of evoked potential. Motor nerve latencies and conduction velocities of median, ulnar and personeal nerves were determined. Definite changes in the evoked sensory potentials of median and sural nerves of subjects using heroin or LSD were demonstrated. The sensory amplitude changes were suggestive of axonal degreneration because of normal duration. Maximum motor conduction velocity was abnormal in one patient who admitted using a variety of drugs; five heroin and two barbiturate users showed dispersed motor responses suggesting small fiber involvement. No abnormality could be shown in marjuana smokers. Signifcance of these findings is explained, emphasizing important potential for recognition of subclinical abnormalities and the opportunity for disease prevention.


Clinical electromyography of the hand.

Clinical electromyography of the hand. The anatomically oriented electromyographer has much to offer in the solution of clinical problems relating to dysfunctional states of the hand. Because of the frequency of variations in innervation, it is often necessary to examine more of the specific intrinsic muscles than is customary. To do this with confidence, a practical method of electrode placement and localization is necessary. The technique described is offered as such a method.


Electrophysiological studies in the assessment of spinal cord lesions. Electromyography is a valuable tool in the diagnosis of neuromuscular disorders. In this study, detailed electrophysiological studies were performed on all recent traumatic quadriplegic and paraplegic patients admitted to a spinal cord unit. The data obtained supplemented the clinical information in the assessment of individual patients. Certain patterns of abnormalities emerged, and attempts were made to relate these patterns to the pathology of the various lesions.


Acetylcholinesterase in abnormal human muscle. Fifty human muscle biopsies were examined for histochemical localization of acetylcholinesterase (AChE) activity. Six normal muscle samples had AChE at the myoneural junctions and around the periphery of many fibers. The AChE within the sarcoplasm itself was found in only a few atrophied fibers. However, 21 of 44 biopsies of abnormal muscles had  sarcoplasmic AChE in more than 10% of their fibers. Such cases included Duchenne, limb-girdle and facio-scapulo-humeral dystrophy, neurogenic and spinal muscle atrophy, spinal cord injury, peripheral nerve injury, Schwartz-Jampel syndrome and myasthenic syndrome. Sarcoplasmic AChE is found in embryo muscle and usually declines after birth. It appears after denervation in the chicken but not the rat and remains in muscles of chickens with an inherited muscular dystrophy. The results of the human muscle study support the idea that in the human, as in the chicken, interruption of a neurally-mediated regulation of AChE results in the reappearance of high AChE activity in the sarcoplasm of the muscle fibers.


Electromyographic findings in the extensor digitorum brevis in a normal population. Some electromyographers suggest the diagnosis of radiculopathy when electromyographic examination reveals abnormalities in only one muscle, the extensor digitorum brevis. We studied 70 volunteers free of neuromuscular disease and found electromyographic abnormalities in 11. We conclude that abnormal electrical activities found solely in the extensor digitorum brevis may not be diagnostically signifcant for lumbosacral radiculopathy.


Brothel prostitution in Columbia.

Brothel prostitution in Columbia. Peculiarities of Colombian brothel prostitution as well as its similarities to that practiced elsewhere are reported. Data gathered through interviews with a group of brothel residents in Manizales, and by means of participant observations in the brothels of several Colombian cities, indicate that economic factors play an important role in its etiology and maintenance. Incomplete "commercialization" of this prostitution system is described along with the negligible role played by pimps and the freedom Colombian prostitutes have to dispose of their earnings. Misconceptions about prostitutes pointed out by other authors (Pomeroy, 1965; Gebhard, 1969), such as marked infertility, irreligiousness, and homosexuality, are also contested by this study. Pomeroy's and Gebhard's findings of the prostitute's lack of regret about her trade are not confirmed. It is the authors' contention that prostitution shows ample sociocultural variations and that theoretical generalizations regarding it do not apply to different cultural milieus.


Male homosexuality, psychiatric patient status, and psychological masculinity and femininity. The personality dynamics of homosexuality, psychiatric patient status, and psychological masculinity and femininity were assessed for four groups of 45 male subjects in a full factorial comparison. Results show that homosexuality can be significantly characterized by the Dynamic Personality Inventory independently of psychiatric attendance and that aspects of sex role, considered both normatively and within the sample, are especially effective in that respect. Emphasis is laid on a multidimensional approach to masculinity and femininity. Results are further interpreted with regard to parental relations and the minority status of male homosexuals.


Premarital sexual attitudes of unmarried university students: 1968 vs. 1972. Information on premarital sexual attitudes of unmarried undergraduates was obtained from random samples on the same campus in 1968 and 1972. Students in 1972, compared with those in 1968, reported (1) more permissive attitudes toward premarital sexual behavior (both men and women), (2) fewer differences in attitudes between men and women, and (3) less adherence to the "double standard." In contrast to earlier research on premarital sexual attitudes, these differences need not be due to the markedly different populations compared, or generalizable only to sociology and psychology students, or indicative of only those who chose to volunteer for study (volunteer bias).


Formal and informal sex education as determinants of premarital sexual behavior. Controversies exist regarding the effects of sex education in the schools and informal sex education obtained from parents, peers, the mass media, and other sources. Similarly, there is widespread interest in premarital sexual behavior, especially its determinants. This study presents several issues reflecting these concerns which have been the subject of much speculation but which have received little attention by researchers. The purpose of this study was to investigate--through the use of respondent reports--how formal and informal sex education influences premarital sexual behavior during college. A national probability sample of 1177 college students was studied using face-to-face interviews with approximately equal numbers of males and females. These interviews, which were conducted for the Institute for Sex Research, included questions about past and present sexual involvement and other attitudinal, behavioral and background variables. Accordingly, the data about sexual behavior and attitudes are based on the interviewees' self-reports. Indices were created which operationalized independent variables such as familial sexual conservatism, exposure to eroticism, perceived sex knowledge, and sexual exposure and assault during childhood and adolescence. Individual items reflecting childhood sex play, masturbation, current religiosity, religiosity while growing up, social class, sources of sex information, sex education in classrooms, and high school and college dating were used. The dependent variable, premarital sociosexual involvement, is a composite measure of incidence and prevalence of premarital heterosexual involvement which meets Guttman scaling criteria. An Automatic Interaction Detector analysis was used to determine the relative influences of reported sexualization variables on premarital sexual behavior. Major findings can be summarized as follows: Heterosexual behavior progresses in stepwise fashion from elementary to advanced levels of involvement, with each level representing a threshold. Reports of current influences and pressures explain more variance in premarital sexual behavior than reports of past informal sexualization influences, which, in turn, explain more variance than reported formal sex-education experiences. Limited success was reported with the use of a four-stage AID analysis which attempted to ascertain whether variables represented in later stages of the sexualization process "mask" the effects of variables in earlier stages and whether a development process can be identified. It may be concluded that these data do not support the belief that exposure to sexuality through formal sex education influences premarital sexual behavior. Informal sex education has significantly more impact on premarital sexual behavior, but there are indications that pressures and experiences confronting young people in a given dating or peer group situation take precedence over all past sexual socialization influences.


Mother-father and daughter-male relationships: a comparison. A two-generation study of pregnant nulliparous women (daughters) and their mothers is presented. The women in both generations were interviewed. Daughters from homes characterized by marital discord between the parents (as judged from the report of the mother) were compared to daughters from harmonious homes. Daughters from discordant homes reported a poor emotional relationship with their father. In contrast, the emotional relationship with the mother was little influenced by parental discord. Daughters from discordant homes reported less stable and gratifying relationships with male partners and more sex partners than daughters from harmonious homes. At the time of their first pregnancy, daughters from discordant homes received little support from the father of the child. They more often described unsatisfactory housing and financial conditions. Poor parental interralations may impair the daughter's ability to establish gratifying relationships with men. One explanation is the daughter's identification with her parents. During the identification process, the daughter of discordant parents assimilates her parents' negative patterns of relating to each other. These unsuccessful patterns may later undermine her ability to establish positive relationships with men.


Behavioral differences and emotional conflict among male-to-female transsexuals. Salient differences in behavior between two groups of male transsexuals have been studied. Topics investigated are transsexualism and homosexuality, prostitution and employment, affectlessness, need for reassurance, and deprecation of others. The hypothesis is advanced that those who are leading more stable lives and who are working in gainful employment have developed a stronger self-system which has enabled them to come to terms more effectively with the basic emotional conflict underlying transsexualism than have those who are and have been engaged in homosexuality and prostitution.


Written descriptions of orgasm: a study of sex differences. It has generally been assumed that a male's experience of orgasm is different from a female's experience of orgasm. In this study, a questionnaire consisting of 48 description of orgasm (24 male and 24 female) was submitted to 70 judges. These professionals (obstetrician-gynecologists, psychologists and medical students) were to sex-identify the description to discover whether sex differences could be detected. The judges could not correctly identify the sex of the person describing an orgasm. Furthermore, none of the three professional groups represented in the sample of judges did better than any of the other groups. Male judges did no better than female judges and vice versa. These findings suggest that the experience of orgasm for males and females is essentially the same.


Tibial artery bypass.

Tibial artery bypass. Experience with 29 tibial bypasses is presented. Twenty-one have remained patent for an average time of 13.2 months. There were two hospital deaths and five additional late ones. Autogenous saphenous vein was used in 27. Electromagnetic flowmeter studies were useful in assessment of patency, but intraoperative arteriography was of limited value only. The use of peroneal artery had equivalent results to anterior and posterior tibial arteries. It is concluded that a reasonable limb prognosis may be offered to the patient with advanced ischemic disease and one or more open tibial vessels. The late mortality in this group is appreciable.


Gastric acid secretion and acute gastroduodenal disease after burns. Total titratable acidity of fasting gastric secretion was determined in 34 hemodynamically stable patients within five days after burn. Acid output was not predictive of disease; acute duodenal ulcers, however, were not discovered in patients with acid secretion of less than 3.11 mEq/hr. Patients with both gastric and duodenal disease secreted significantly (P less than .05) more acid than patients without duodenal involvement and complications were more likely to develop, especially from acute ulcerations. Hemorrhage or perforation occurred in nine patients whose acid output was significantly (P less than .05) greater than that of asymptomatic patients. Duodenal regulation and neutralization of acid secretion may be impaired in patients with early duodenal injury, resulting in a relative increase in acid output and enhanced potential for complications. A controlled evaluation of antacid therapy in the prevention of disease complications seems justified in these patients.


Canine small bowel transplantation. A study of the immunological responses. A canine small bowel allograft model was used to determine the effects of radiation to the graft in modifying the immunological effects of the passenger leukocytes. When untreated allografts were transplanted, death of the recipient animals occurred at a mean of nine days. The allograft was well-preserved and showed no signs of rejection. The reasons for attributing death to graft-versus-host (GVH) disease are discussed. When allografts were treated with 150 rads prior to transplantation, allograft rejection occurred, with death of the recipient animals at a mean of 9.2 days. This was the only group in which cell-mediated immunity developed. When allografts were treated with 50 rads, prolonged survival of the recipients to a mean of 28 days was noted. It is postulated that in this group a balance was struck between the allograft rejection reaction and GVH disease, with prolongation of allograft survival.


Preservation of canine small bowel by freezing. A total of 133 canine small bowel segments were isolated in 51 dogs according to a previously described technique that permits an in vivo freeze-thaw experiment to be carried out after perfusion with various cryoprotective agents. All control segments (33) survived. One hundred segments were frozen with cold intra-arterial helium and ambient cold nitrogen gas after perfusion with dimethyl sulfoxide (DMSO), inositol, or glycerol in 5% and 10% concentrations, alone, or combined, and with chlorpromazine and hydrocortisone added. Inositol had no cryoprotective effect. Approximately one half of segments frozen after protection with DMSO and with glycerol alone or combined with inositol survived the freeze-thaw injury and were intact on long-term follow-up.


Small vessel replacement with gore-tex (expanded polytetrafluoroethylene). Conduits of expanded, fibrillated polytetrafluoroethylene (PTFE [Gore-tex]) have been evaluated as small vessel prostheses in dogs during a 6-month period. A configuration of high porosity and low density, long fibril Gore-tex was found to yield the best patency in canine arteries (femoral and carotid) and veins (femoral) as compared with more dense, less porous PTFE with shorter fibrils. Host tissue reaction showed minimal inflammation, excellent infiltration, and formation of a smooth neointima, which suggested satisfactory acceptance of the prosthesis.


Spontaneous perforation of the cervical esophagus. A rare case of spontaneous rupture of the cervical esophagus occurred during vomiting after eating. The plain x-ray film showed air in the neck, but barium swallow did not reveal the perforation. Operation performed two days later because of bleeding consisted of suturing two rents in the anterior wall of the cervical esophagus distal to the cricopharyngeus muscle, and the patient did well. The mechanism causing such a perforation is not well understood. With the absence of bleeding, treatment would ordinarily consist of drainage without suture.


Crossed double internal mammary-to-coronary artery grafts. Crossed double internal mammary (IMA)-coronary artery grafts (the left to the left anterior descending artery [LAD], the right to a diagonal or marginal coronary branch) were used without mortality and with excellent functional results in 36 patients requiring separate grafts to these vessels (22% of patients undergoing coronary revascularization). Flows were 70 +/- 9 ml/min in the left and 50 +/- 7 ml/min in the right IMA, respectively. All revisualized grafts remained patient. The location and direction of the LAD and of diagonal and marginal branches allow excellent alignment of these shorter and wider double IMA grafts. The left IMA is the graft of choice for the LAD, and the right IMA is the choice for a high diagonal or early arising marginal branch that requires an additional separate graft. The right IMA is not satisfactory for right coronary or LAD bypass.


Endoscopic removal of bleeding brunner gland adenoma. A 36-year-old man had a major hematemesis because of a Brunner gland adenoma in the postbulbar portion of the duodenum. Three months later, the adenoma was successfully removed electively via endoscopic polypectomy. This is the first patient reported, to our knowledge, to have this technique for a bleeding Brunner gland adenoma. Endoscopic surgery is a relatively new development, and the technique of polypectomy has been used primarily in the colon. Surgery via upper gastrointestinal endoscopy promises to be as useful, although a somewhat different set of precautions applies.


An experience with a LeVeen ascites shunt. A patient with intractable ascites was treated by placement of the LeVeen peritoneovenous shunt. Shunt failure was caused by malpositioning of the venous limb in the inferior vena cava. This was demonstrated by injection of water-soluble contrast material into the venous limb. Revision of the shunt led to diuresis, weight loss, and reduction of ascites. The physiologic process of the LeVeen shunt is reviewed and we suggest placement of a radiopaque marker into the tubing.


Local recurrence of breast cancer.

Local recurrence of breast cancer. Pathologic and surgical aspects of 1,027 breast cancer cases treated between 1961 and 1972 were reviewed. Sixty-eight (7%) of the cases recurred locally. This low rate of recurrence is associated with the small average diameter of 2.7 cm of all carcinomas and the correspondingly low rate of axillary lymph node metastasis of 40%. Subsequently recurring tumors had a higher incidence of axillary lymph node metastasis (68%). Eight hundred eighty-eight infiltrating duct carcinomas represented the largest group of cases and had a recurrence rate of 5.7%. Comedo, infiltrating papillary, and infiltrating lobular carcinomas recurred locally more frequently, but none of 26 mucinous carcinomas recurred. In eight cases, the recurrent tumor was of a more malignant histologic type than the primary lesion. The average width of the excised segments of skin decreased from 9.8 cm during the first three-year period (1961 to 1963) to 8.4 cm during the last period (1970 to 1972). The average width for the entire period was 9.1 cm, identical for locally recurring and nonrecurring tumors.


Implications of precancerous rectal biopsy in patients with inflammatory bowel disease. Sixty-five patients with an initial diagnosis of ulcerative colitis who underwent total proctocolectomy between 1955 and 1973 were studied retrospectively. Rectal mucosa in each patient was examined microscopically for the presence or absence of "precancerous" alterations as described by Morson and Pang. Histologic examination was made with no knowledge of concomitant colon carcinoma or the patients' clinical courses. Three of ten patients with precancerous rectal mucosa had invasive colon carcinoma, while none of the 55 patients without such changes had colon cancer (P less than .05, Fischer exact test). The duration of disease was significantly greater in those patients with rectal precancer (P less than .05). Reexamination changed the pathologic diagnosis in 15 patients from ulcerative colitis to granulomatous or "mixed" colitis. Two of three invasive cancers occurred in the reclassified group. Results support previous contentions that careful histologic evaluation of rectal biopsy specimens from individuals with inflammatory bowel disease may better define that population of patients with an increased risk of colonic carcinoma.


Surgical treatment of hepatic metastases from colorectal cancers. Follow-up data covering periods of two to 23 years have been collected on 60 patients who had resection of hepatic metastases for colorectal cancer. Multiple lesions were removed from 20 patients, and solitary lesions were excised from the other 40 patients. Only one patient died during hospital convalescence. No patient who had multiple lesions excised lived for five years. In contrast, 15 of the 36 patients eligible for five-year survival study who had resection of apparent solitary lesions lived for five years or more, and eight patients were alive without evidence of recurrence ten years or more after operation. These surprisingly favorable results of surgical treatment were analyzed in relation to results in patients who had biopsy specimens taken of lesions of comparable size and number, but no removal at the time of colonic resection. No patient in this control group lived for five years. Aggressive surgical treatment of apparent solitary hepatic metastatic lesions from colorectal cancer seems to be justified by the survival rate of surgically treated patients.


Aneurysms of extracranial carotid arteries. Twenty-three extracranial carotid artery aneurysms were encountered in 19 patients. Arteriosclerosis was evident in 16 aneurysms. Severe arterial hypertension affected all patients with arteriosclerotic lesions. Trauma, penetrating neck injury once, and blunt neck injury three times caused four aneurysms. Three aneurysms resulted from earlier carotid artery operations. All 19 patients were symptomatic. Neurologic symptoms affected 13 individuals. Local symptoms referable to the aneurysmal mass troubled 15 patients. Twenty-one aneurysms were treated operatively. There was no operative mortality. Aneurysmectomy with arterial reconstruction was performed 16 times. Aneurysmorrhaphy was undertaken on four occasions and carotid ligation once. Two strokes and multiple cranial nerve injury accounted for three operative complications. No neurologic complications occurred during follow-up totaling 360 man-months. These lesions may be successfully treated by a carefully performed, properly selected operation.


Carotid body tumor: resection or reflection. We have studied a series of 24 cases of carotid body tumor, comprising our total experience during the past two decades. Twelve patients had symptoms related to compression or invasion of the surrounding structures. Two patients had malignant changes, while three individuals had bilateral lesions. Thirteen patients underwent neck exploration for diagnosis or attempt at surgical removal of the tumor prior to admission to our institution. Definitive procedures in 24 cases resulted in one postoperative death, a rate of 4%. Internal carotid flow was preserved in every case. Intraluminal shunting was employed during the last decade, and no instance of cerebral damage was encountered. It is our intention to emphasize the importance of an accurate diagnosis by carotid angiography prior to surgical management. We also wish to encourage routine excision of these tumors as they are diagnosed, before they reach an enormous size.


Transcervical thymectomy: an integral part of neck exploration for hyperparathyroidism. Thirty-two neck explorations for hyperparathyroidism were done in 18 months. The indication for transcervical thymectomy was a failure to locate either inferior gland. Six of eight patients had adenomatous or hyperplastic glands located within or adjacent to the thymus. One infrathymic lesion was a parathyroid carcinoma and the other was a functioning parathyroid cyst. The abnormal parathyroid gland was not visible in any of these six patients until the thymus had been removed. Had this step been omitted, a sternotomy would probably have been required. Two patients had bilateral normal parathyroid glands within or deep to the thymus. Unless some normal parathyroid tissue has been identified and preserved, the indiscriminate use of transcervical thymectomy could result in the inadvertent excision of both inferior glands and possible iatrogenic hypoparathyroidism.


Parietal cell vagotomy without drainage for treatment of duodenal ulcer. A two- to three-year follow-up report. Parietal cell vagotomy (PCV) without drainage was performed on 35 patients. Three patients died during the study from causes unrelated to duodenal ulcer. Thirty-one (97%) of the remaining patients were followed up for two years; 66% have been studied after three years. At the end of two years, the mean basal acid output and peak hourly basal secretion rate were 43% and 47% less than the preoperative values, respectively. The number of patients with a negative insulin test result postoperatively fell from 64% of patients tested at two months to 44% at two years. The number of patients with an early positive insulin test result rose from 13% at two months to 28% at two years after operation. There were two recurrent duodenal ulcers; one required reoperation. A gastric ulcer developed in one patient who was taking massive doses of aspirin; the ulcer healed after aspirin withdrawal. One patient required operation for pyloric obstruction. Both dumping and diarrhea were reported by 7% of patients. These results suggest that PCV without drainage is an acceptable procedure for treatment of duodenal ulcer.


A plasma scalpel: comparison of tissue damage and wound healing with electrosurgical and steel scalpels. We have been evaluating a plasma scalpel (the term has no relation to blood plasma) for four years that, with the generation of a small, hot gas jet (3,000 C), can cut tissue and simultaneously cauterize blood vessels of 3 mm in diameter. Twenty-nine plasma scalpel hepatectomies in dogs and comparative skin wound healing (with steel and electrosurgical scalpels) in 90 mice showed that bleeding was reduced, and the thermal insult in liver tissue was limited to 2 mm from the incision; both liver and mouse skin incisions healed without complication. The completion of epithelization of mouse skin wounds occurred at 2 to 6, 6 to 14, and 6 to 18 days, and the average scar width was 0.8, 1.4, and 2.1 mm for the steel, electrosurgical, and plasma scalpels, respectively. The plasma scalpel effectively cauterizes blood vessels as it cuts, leaving limited damaged tissue. We have recently begun human trials, and the device shows promise as a clinical tool.


The spectrum of pulmonary embolism: twenty years later. A ten-year analysis of the prevalence of pulmonary embolism found at autopsy examination has been repeated 20 years after a prior study. The frequency of all pulmonary embolism (12.3%) and of "major" pulmonary emboli (7.1%) remains essentially unchanged from that detected 20 years previously (13.6% and 8.6%). Less than 10% of patients had the clinical diagnosis of deep leg vein thrombosis, and only 9.3% had a definitive diagnosis of pulmonary embolism made during life. A sixfold variation in quarterly frequency and a twofold variation in annual prevalence were noted. Since these wide fluctuations in frequency are present, any assumptions regarding a changing disease pattern must be made with great caution. There is no evidence that fatal pulmonary embolism has decreased in frequency in recent years. An effort should be made to increase rate of detection of thromboembolic disease by more widespread use of one or more of the recently developed diagnostic procedures, or a larger segment of the hospital population at risk should receive prophylactic therapy with "low-dose" heparin sodium.


Kinetics of heparin administration.

Kinetics of heparin administration. Many clinicians prefer intravenous administration of heparin sodium because of unpredictable absorption from extravascular sites. In this experimental study, large doses of heparin labeled with sulfur 35 were injected into 34 dogs separated in groups according to dosage and route of administration. Anticoagulation and plasma heparin levels were assessed at half-hour intervals. Intravenous injection produced immediate anticoagulation followed by a predictable decline. Subcutaneous or intramuscular injection resulted in delayed onset and variable levels of anticoagulant activity. The wide range of response following intermittent injection suggests that continuous intravenous infusion offers a more reliable method of treatment.


A retrospective study of regional perfusion for melanoma. Regional perfusion has been utilized in the treatment of accessible melanomas for many years. This series of 245 patients, which encompasses over ten years of experience, is presented to reevaluate the results of regional perfusions in melanomas, and perhaps to redefine the indications for such a procedure. Fifty-nine patients died from three months to over five years following the procedure, and six of the deaths were from diseases other than melanoma. The overall survival in stage I disease was 93%; stage II, 68%; and stage III, 41%. There were no survivors in stage IV. Nearly all of the recurrences and deaths from disease were seen within two years of the perfusion. These results are similar to others, and 10% to 15% better than those of conventional methods. Indications are now more definite, and include most invasive melanomas in an area accessible to perfusion technique, except in very elderly and poor risk patients, those with severe arteriosclerosis in the area concerned, and those with widespread metastases.


Congenital arteriovenous anomalies of the limbs. Observations in 33 patients with congenital arteriovenous fistulas described ten years ago have been extended with the addition of 49 other cases; the clinical, pathologic, and roentgenographic characteristics of these lesions in the entire group of 82 patients have been summarized. The findings in the entire group over the additional observation period have confirmed the conclusions previously reached, namely, that (1) these clinically extremely varied lesions have a unitary (developmental) cause; (2) for rational management, angiographic investigation is indispensable to establish their extent and complexity; (3) with few exceptions, their radical cure by surgical means is impossible; and (4) the large majority of patients do well on a carefully supervised conservative regimen, with surgical intervention reserved for individually defined instances.


Pancreatic ascites: recognition and management. In a patient with chronic ascites, an abnormally raised ascitic fluid amylase concentration and a protein content above 2.5 gm/100 ml is diagnostic of pancreatic ascites. Thirty-one episodes in 26 patients treated between 1958 and 1975 have been analyzed. Twenty patients (65%) experienced abdominal pain and ten (32%) had concomitant pleural effusions roentgenographically. Although a leaking pancreatic pseudocyst was the cause of ascites in at least 21 episodes (70%), an abdominal mass could only be palpated in two of 26 patients. Roentgenographic series of the upper part of the gastrointestinal tract failed to demonstrate pancreatic pseudocyst in 7 of 21 episodes (33%). Endoscopic retrograde pancreatography is invaluable in delineating the pancreatic ductal system and, in conjunction with intraoperative pancreatography, makes a vital contribution to rational surgical therapy. Medical treatment or external drainage during 18 episodes resulted in death in four (22%) and recurrences of ascites or pancreatic pseudocyst in nine (64%). Since routine pancreatography followed by pancreatic resection or internal drainage has been instituted, mortality and recurrence have been reduced to zero.


Nonoperative extraction of retained common duct stones. Nonoperative extraction of retained common duct stones was successful in 17 patients during the past two years. Eleven required only one manipulation; the largest number of manipulations required was five. The Burhenne catheter and Dormia basket were employed frequently, but were not always effective. When difficulties occurred with their use, Mazzariello biliary forceps resulted in successful stone extraction, particularly in the management of impacted stones. Extraction procedures were performed under fluoroscopic control, usually on an outpatient basis. Recently, we have employed a flexible fiberoptic endoscope that allows visual investigation of suspected defects and decreases fluoroscopic exposure. These results indicate that all patients with retained common duct stones are candidates for sinus tract manipulation six weeks after common duct exploration. It is recommended that secondary operations for retained common duct calculi not be performed until nonoperative extraction has been given an appropriate trial.


Custom implants for reconstruction of craniofacial defects. This method deals with the fabrication of a custom silicone implant using Dow Corning Medical Grade Elastomer 382 (room-temperature vulcanizing silicone). The technique has been utilized in 34 cases during the past five years with a satisfactory end result in 33 of the 34 cases. This method, which appears to be quite accurate in obliterating the obvious defect, is simple in its execution and reduces the overall amount of operative time, since no carving or manipulation is necessary. It avoids unsightly "donor scars," and in some instances, the surgery can be done on an outpatient basis.


Anterior approach to the thoracolumbar spine: technical considerations. Forty-five patients, of whom most were children, underwent extensive exposure of the thoracolumbar spine to correct serious orthopedic abnormalities. The spine was exposed through a combined thoracotomy and retroperitoneal approach that gave excellent access with minimal morbidity. The diaphragm was opened circumferentially after the peritoneum had been dissected from its muscular portion. This permitted repair of the diaphragm with no detectable loss of function. Although this approach was developed for exposure of the spine, it can also be utilized to expose the entire aorta, both kidneys and their blood supply, and the retroperitoneal area for possible excision of large tumors.


A neuromuscular basis for development of indirect inguinal hernia. Specialized portions of the transversus abdominus muscles act on the internal inguinal rings and produce a closure mechanism during voluntary abdominal muscular activity. Abdominal muscular contractions may have a protective influence against development of indirect inguinal hernia. It follows, therefore, that injury or inactivation of this mechanism may be an etiologic factor in the development of indirect inguinal hernia. One cause of injury to this mechanism is by denervation and regional muscle paralysis occurring during a surgical procedure. Surgical denervation appears to have caused an indirect inguinal hernia in one of the authors.


The treatment of incidental thyroid cancer. Thirty-eight patients with incidental thyroid carcinoma were reviewed. Thyroid lobectomy was adequate therapy in 15 to 17 patients. Both patients in whom lobectomy alone was inadequate had received prior irradiation. Five patients had antecedent head and neck irradiation, and in three of them, multicentric foci of tumor developed. Lobectomy alone was inadequate in three of these patients; they required thyroidectomy. A clinical recurrence developed in only two of 38 patients, and both of them had received previous irradiation. Reoperation in previously dissected areas was associated with an increased rate of complications. Lobectomy in nonirradiated and total thyroidectomy in irradiated patients cured the majority of patients suffering from incidental carcinoma of the thyroid.


Blunt abdominal trauma: a prospective study with selective peritoneal lavage. To determine the effectiveness of clinical evaluation and peritoneal lavage in blunt abdominal trauma, a prospective study was undertaken in 315 consecutive patients suspected of having this injury. Conscious patients with obvious physical findings were operated on without peritoneal lavage, and a diagnostic accuracy of 96% was achieved. In patients with altered states of consciousness, peritoneal lavage was studied prospectively for equivocal physical findings. An overall accuracy of 97% was achieved in such patients by peritoneal lavage. Peritoneal lavage was helpful in reducing the rate of normal findings at laparotomy by 50% in patients with altered states of consciousness and equivocal physical findings. Patients with normal findings on peritoneal lavage and subsequent deterioration had normal findings at laparotomy, which points to the value of further evaluation in such patients before laparotomy is carried out. Mortality is ultimately determined by the severity of the injury, despite early and definitive diagnosis and aggressive management.


Management of 1,590 consecutive cases of liver trauma. Between 1939 and 1974, more than 1,500 patients have been treated for penetrating or blunt liver trauma at our institution. Gunshot wounds and major blunt trauma have increased, stab wounds decreased, as percent of total. In most cases techniques other than partial hepatic resection were used, although this was performed in 49 instances. Choledochostomy was infrequently employed. Intracaval shunts were useful in 15 selected patients with massive hepatic, concomitant suprarenal vena caval, or hepatic vein injuries. The overall mortality of this group was 13.1%. The improvement in mortality from liver injuries is attributable to (1) early exploration for suspected intra-abdominal traumatic injury, (2) a conservative approach to the liver injury, and (3) the limitation of lobar resection, vascular cannulae, and afferent vascular compression to highly selected cases.


The structural polypeptides of sowthistle yellow vein virus (SYVV). The four structural polypeptides of SYYV have molecular weights of 71,000, 60,000, 42,000 and 36,000 daltons. The virus was shown colorimetrically to contain RNA.


Isolation and characterization of double stranded RNA containing infectious viral genome RNA from cells infected with Semliki Forest virus. A double stranded virus specific RNA sedimenting at about 19S on sucrose density gradients has been isolated from BHK-21 cells infected with Semliki Forest virus (SFV). The molecule consists of double stranded RNA (ds RNA) since it is labeled with 3H-uridine, is soluble in 2 M LiCl, resistant against treatment with DNase and RNase at 2 X SSC, hydrolyzed by alkali treatment, has a sharp thermal melting point at 89 degrees in 1/10SSC, and an extended appearance under non denaturing conditions in the electronmicroscope. The following findings show that it consists of intact, infectious 42S RNA similar or identical to the genome RNA of SFV complexed to a complementary 42S minus strand RNA: 1. Denaturation converts the ds RNA into molecules cosedimenting with 42S RNA isolated from SFV particles. 2. About 50% of the radioactivity of 3H-uridine labeled 42S RNA molecules generated from 19S ds RNA by denaturation hybridizes to 42S viral RNA. 3. The specific infectivity of denatured 19S ds RNA is about half of that of similarly treated viral 42S RNA. Further properties of this molecule are discussed.


Kinetics of reactions of antihemagglutinin and antineuraminidase antibodies with H2N2 and H3N2 influenza virus strains and description of a modification of the photometric ACU method for titration of antineuraminidase antibodies. The isotherms describing the reactions of selected H2N2 and H3N2 virus strains with antihemagglutinin (AH) and antineuraminidase (AN) antibodies were established by use of a photometric hemagglutination inhibition test [antibody concentration unit (ACU) method]. It was found that the AN antibody isotherms had significantly higher values of the constant 1/N than did the AH antibody isotherms. This finding confirms for further virus strains the conclusion that the photometric ACU method can discriminate objectively between AN and AH antibodies. The results obtained when determining by use of the photometric ACU method the kinetics of reactions of AN antibodies oriented to A/Bel (HO)-A/Sing (N2) virus with the neuraminidases of H2N2 and H3N2 strains, and vice versa, indicated that the N2 neuraminidases of the test strains could be divided into the following groups: One group comprising the strains A/Sing/1/57 and A/AA/1/65, a second comprising the strains A/Hong Kong/1/68 and A/England/42/72 and a third represented by A/Port Chalmers/1/73. This finding indicated progressive antigenic variation of the neuraminidases of the strains tested. A modification of the photometric ACU method for the titration of AN antibodies oriented to N2 strains has been developed. The modified technique was found to be more sensitive and accurate than was AN antibody titration by means of enzyme inhibition and HI pattern test.


Genetic exclusion and stable complementation of Sindbis virus. In an effort to enhance genetic interactions by eliminating spatial or physical barriers between variants of Sindbis virus MgCl2 was used to aggregate infecting viral particles. Mixing viral samples in a 1:1 ratio with 0.5 M MgCl2 produced maximal reduction in plaque forming units (PFU) with minimal cell damage due to MgCl2. Aggregate size was determined to be about 7 PFU. Samples taken at 3,5 and 10 hours after infection with mixed aggregates composed of large and small plaque forming virus indicated that only one type of genome was represented among the progeny particles. In addition, aggregation enhanced complementation and the progeny were stable after several cycles of sonication and passage.


Efficacy and immune response to rubella subunits vaccines. Antibody and cell-mediated immunity (CMI) was measured in rabbits immunized with wild or attenuated virus and in rabbits vaccinated with a rubella subunit vaccine containing the viral envelope or nucleocapsid. The data presented show that a subunit vaccine containing the envelope proteins could induce a good antibody and CMI response. The results also suggest that such a vaccine was highly effective since 60 per cent of the rabbits immunized with the envelope proteins were protected when challenged with wild virus. This protection rate was identical as the protection achieved with a live attenuated vaccine.


[Maturation and fertilization of human ova outside of the body]. The egg-cells were obtained from ovaries removed for different clinical reasons and cultivated after Edward's technique with modifications to complete the maturation division. The process of fecundation, formation of pronucleuses, separation of the 2nd pole body and the first stage of egg-cell cleavage (up to the stage of 3 blastomeres). Non-fertilized egg-cells underwent random fragmentation into blastomere-like nucleus-free particles.


[Morphofunctional characteristics of the lipids in the early embryogeny of placental mammals]. The comparative cytological study of lipids points to species specific character of lipid metabolism in early embryogenesis of placentate mammals. The general level of lipid metabolism is genetically determined in oogenesis being expressed by different loading of the ooplasm with substances of lipoid nature. At the cleavage stage lipids play a plastic role. Their significance as functionally active complexes is manifested in the period of the blastocyst formation, which is dependent on morphological differentiation and the beginning of the trophoblast functioning as an early metabolic organ.


[Trace element content in the internal female genitalia of the fetus in the 2d half of pregnancy]. The dynamics of increasing the concentration of microelements in the ovary, uterine tubes, uterus and vagina in the second half of intrauterine life were studied. Changes in the concentration of microelements depend on increasing the weight of the organs in question beginning from the 4th up to the 10th month of the fetal period. Hence, copper, zinc, manganese, titanium, lead, molybdenum are necessary for development and formation of internal female genitalia.


[Collagen synthesis by osteoblasts in the maxilla in rats during the embryonic period]. Under study was the intensity of the collagen synthesis by osteoblasts of the primordium of the rat's maxilla at different terms of embryogenesis. Autoradiographic method revealed that the greatest part of incorporated glycin was used for construction of collagenous molecules, and the least part--for the synthesis of other cytoplasmic proteins of osteoblast. Different intensity of the synthesis of de novo collagen was established at different stages of embryogenesis. The most intensive synthesis of collagen was found to begin from the 18th day of the maxillary bone primordium development.


[Development of the neural and tissue components of the excretory ducts of the liver, pancreas and Odd's sphincter in human embryogeny]. The development of pancreatic, hepatic, cystic, common bile ducts, the Oddi's sphincter and their nervous apparatus were studied during prenatal human ontogenesis of fetuses and newborns. The process of formation of the nervous apparatus corresponds to the development of tissue structures of the ducts and the sphincter. The distinctions in the organization of nervous elements which are noted in adult humans are laid in the process of embryogenesis. These distinctions are especially pronounced in the structure of nervous plexuses and receptory endings. The nervous apparatus of the Oddi's sphincter region has a complex arrangement. This is the site of concentration of nerve nodules and receptory endings as well as abundant nervous connections between plexuses of the pancreatic head, duodenum and orifice zones of the both ducts. The receptors in nerve nodules and pericellular apparatuses on the bodies of ganglionic neurons were revealed.


[Reaction of the peripheral nervous system elements to the action of laser irradiation]. The effect of light of the helium neon laser LG-75 with the output power 25mvt and the generated wave length 6328 A upon reparative processes in the neuromuscular apparatus was studied in rats in dynamics after neurotomy of the ischiatic nerve. Neurohistological (staining after Bielschowski-Gross, Spielmeier, Weigert-Pal) and electrophysiological (chronaximetry, "force-duration" index, electromyography) methods were used. The material was processed in a computer. A stimulating effect of the applied low-energy laser radiation on the regeneration of the ischiatic nerve was established.


[Morphological analysis of the adaptive changes in the myocardium under individually measured physical load]. Studying morphological changes of the myocardium in the organic, cellular and subcellular levels of experimental animals (dogs) has shown that standard physical load on tradmill band graded only by external parameters of work (time of running, its speed etc.) causes different changes in different animals. In contrast to it, the method of individually graded physical load proposed by the author (1970, 1972) considers the depth of myocardium responses, the degree of its morphofunctional changes corresponding to certain stages of changes in the parameters of cardio-vascular activity and respiratory system. Using the relationship of pulse rate and frequency of respiration as a diagnostic test made it possible to establish 6 stages of myocardium responses to physical load. Each of these stages has a complex of morpho-functional changes in the myocardium and corresponds to certain adaptive shifts on the organism level. On these foundations one can prognoze the depth of morphological changes in the myocardium basing upon diagnostic tests. So, the proposed experimental model of individual selection of the value of physical load according to responses of the organism rather than to external parameters of work as well as the established principle of the stage character of adaptive responses may be used in the practice of investigators for directed influence on the myocardium to form its certain qualities.


[Morphological changes in the anterior lobe of the hypophysis in allotransplantation]. Under study were histological changes resulting from rejection of adenohypophysis allotransplantat without special influence upon the recipient immunity. The allotransplantat rejection was established to be accompanied by pronounced morphological changes in the adenohypophysis. Delta-basophils were the first to loose their granules, and beta-basophils showed more moderate degranulation. Acidophils were preserved for a longer period. The chromophobes were more resistant cellular elements. Simultaneously the cells were dying at all stages of their conversion. The fibrous connective tissue alone was observed at the site of allotransplantat 32-35 days after transplantation.


[Kinetics of chondrocyte proliferation in cartilaginous anlagen and in forming skeletal metaepiphyseal cartilage of mammalian extremities]. Changes of proliferative properties of the cartilage cells were observed from the beginning of the formation of chondroblastema till the formation of the joint and metaepiphysial cartilages by the method of autoradiography with H3-thymidin. The greatest amount of dividing chondrocytes is localized  in intermediate zones. In the metaepiphysial cartilage such cells form the proliferation zone and the duration of the mitotic cycle does not substantially differ from that of differentiating embryonic cells. The cells of the reserve zone of the metaepiphysial cartilage which are being formed are shown to be quite differentiated and to be at rest (phase G0). They can recommence division and stimulate general metabolic activity, replenishing the pool of proliferating chondrocytes. The duration of separate periods of the mitotic cycle for differentiating cells of different parts of the cartilage is calculated.


[Changes in the thyrocytes to the administration of intermedin under conditions of the aminazine-altered functional state of the nervous system]. Histological and electron microscopial investigations of the thyroid gland were performed in white mice after exogeneous administration of intermedin (MSH) and intermedin against the background of aminasin. It may be concluded that while a prolonged injection of MSH results in the stimulation of the thyroid gland, the administration of the hormone in question against the background of aminasin results in the same ultramorphological structural changes of the gland which are observed after injection of aminasin alone, causing a decreased functional activity of the thyroid gland. The effect of intermedin upon the thyroid is supposed to be realized through those hypothalamus structures which are responsible for the regulation of the thyrotropic function of the hypophysis.


[Histological aspects of posttraumatic regeneration]. A number of histological aspects (regeneration capacity, origins of regeneration, means of reparation) are discussed on the example of the reparative regeneration of the adrenal cortex. The adrenal cortex is found to possess high regeneration capacity after a traumatic injury of the organ. Realization of this capacity is dependent on general and local conditions, the character and the volume of the injury and the degree of involvment of cambial zones being of substantial significance. Among these zones are the glomerular zone and the external part of the bundle zone, whose proliferating cells are the source of the reparative regeneration of the cortical substance. The reparation of the functioning mass of the adrenal cortex is performed by the type of regenerative hypertrophy or the reparative regeneration depending on the character of the trauma. After the first type, the division of cells and their differentiation occur within the limits of the available structural elements, after the second type- of the newly formed ones. Both types are evolutionally conditioned and are definitely similar eather to postnatal growth and physiological regeneration (regenerative hypertrophy), or to the embryonic histogenesis of the definitive adrenal cortex (reparative regeneration).


[Melatonin synthesis in enterochromaffin cells]. An active synthesis of melatonin which formerly was considered as a specific hormon of the epophysis, in the enterochromaffin cells of the gastro-intestinal tract was demonstrated using a combination of histochemical, biochemical and physiological methods. Biosynthesis of melatonin and serotonin by pinealocytes of the epiphysis and by enterochromaffin cells justifies the inclusion of them into one functional active neuro-endocrine cellular system playing a very important role in the maintaining of homeostasis of the organism.


[A morphologic analysis of the manifestations of the effects of myelotransplantation]. The positive direct curative effect of grafting of the bone marrow in aplastic conditions of hemopoiesis is associated with rapid restoration of the myeloid tissue. Normalization of the hemopoiesis organs of recipients depends on the cellular mechanism of action of transplanted hemopoietic cells and a humoral stimulating effect of life-activity products of the survived transplanted cells. Widespread application of transplantation of allogenic heterologous bone marrow under clinical conditions is hindered by the development of secondary disease, frequently fatal for recipients. The major part of morphological changes in secondary disease are non-specific. Pathologo-anatomic diagnosis of chronic secondary disease may be established only with due regard for a compex analysis of the measures applied, clinical, hematological, immunological and morphological data.


[Ultrastructural changes in the myocardial capillaries of rats following local irradiation of the heart region]. It was shown that single irradiation of the heart region in rats in doses 600, 900 and 2000 r could bring about congestion phenomena in the myocardium blood capillaries and drastic destructive alterations in the endothelial cells; these changes were noted in all time periods under study following the exposure (2 hr., 1, 5, 10 days, 1, 3, 6 and 12 months) the gravity of lesions being directly proportional to the dose rate. Irradiation led to the breakdown of the integrity of the endothelial wall due to formation of defects and delatation of the intercellular fissures, which results in a considerable rise in permeability. Due to perish of some part of capillaries diminishing of the capillary bed of the myocardium took place, particularly in remote periods. The irradiated animals showed an intensive overgrowth of the connective-tissue stroma in the intercellular and pericapillary spaces.


[Morphologic features of pneumonia in young children of the Northeast USSR]. Post-mortem investigations of the lungs of 160 children below 2 years of age who had died of acute pneumonia in Magadan were carried out with the use of histological, histochemical, histotopographic, macro- and micromorphometric methods. As to duration of the disease, pneumonias were divided arbitrarily into acute (up to 21 days) and protracted one (from 3 weeks to 2 months). It was established that acute pneumonia in children in Magadan were of polysegmentary character, with involvement in the process of 3-7 segments of each lung and with exclusion from the act of breathing up to 80-90% of the lung's surface. Most often the pathological process was localized in the posterior and postero-inferior segments. Along with pneumonia, which was of interstitial, focal or mixed character, atelectasis and acute emphysema developed. Histologically described acute pneumonias were characterized by pronounced lesions of the tracheobronchial tree, drastic circulatory disorders with formation of "garland-like" structures from the expanded capillary network of the lungs, the presence of hyaline membranes and large hyperchromic conglomerates. In protracted pneumonias in addition lesions of the argyrophilic and elastic carcass of the lungs were observed.


[Morphologic correlations of changes in the skeletal muscles and kidneys in several variants of the myorenal syndrome]. In 18 section observations of the myorenal syndrome (grave trauma, crash-syndrome, nontraumatic mascular ischemia) in skeletal muscles and the kidneys were investigated. In the skeletal muscles necrobiosis, necrosis with subsequent lysis or calcification of their sarcoplasm, edema of the intermuscular layers with subsequent multiplication of the stroma cells were noted. The kidneys revealed changes typical of a grave acute renal insufficiency. Ischemia of the cortex with atelectasis of glomerular capillaries and their increased permeability were evident. In the proximal tubules there were detected dystrophic changes of the type of granular degeneration and pronounced edema, these changes showing no tendency to reverse development and precluding regeneration of the epithelium. Acute renal insufficiency is closely connected with deep cortical blood flow reduction, the latter acting like a trigger.


[Several clinic-morphologic aspects and problems concerning the pathogenesis of the Marchiafava-Miche li syndrome (paroxysmal nocturnal hemoglobinuria]. The authors present a broad pathoanatomic picture and concise clinical-laboratory characteristics of Marchiafava-Micheli's disease on the basis of their studies of case record date of 31 patients, data of 13 autopsies and findings of 27 treanobiopsies.  Changes in the organs observed in Marchiafava-Micheli's disease were first of all morphological manifestations of massive intravascular hemolysis and associated with latter complications  The most characteristic pathoanatomic feature was changes in the bone marrow which manifested themselves in hyperplasis of nuclear forms of the red series  and in drastically pronounced disorders of the microcirculation.  Necrobiotic changes in the kidney accompanied by massive hemosiderosis, dystrophic changes in the liver with the development of cirrhosis, inhibition of lymphopoiesiis in the spleen and lymph nodes were detected most often...


[Morphologic reflection of protein biosynthesis disorders in the myocardial cells of rabbits with acute diphtheritic intoxication]. The lethal dose of diphtheria toxin (IDLM per 1 kg of body weight) was injected to Chinchilla line adult rabbits. Histological and electron-microscopy investigations were carried out in time periods from 3 to 24 hours following the administration of the toxin. Degenerative and necrotic changes in the myocardial cells under conditions of the given experiment were not observed. In many muscular cells dilatation of the perinuclear spaces due to the thinning of the myofibrila layer moved to the periphery of the cell was noted. Electron-microscopy investigation of the perinuclear spaces showed a decrease in the number of mitochondria, reduction of the elements of sarcoplasmatic reticulum and disappearance of ribosomes. Cytochemically, in the opened cytoplasmatic matrix there were revealed numerous beta-granules of glycogen. In nuclei fragmentation of nucleoli with reduction of their granular component was observed. The changes described justify the conclusion that acute diphtheria intoxication at early stages of exposure to the toxin brings about impairment of the protein synthesis not only at the level of translation on cytoplasmatic ribosomes, as was suggested before, but at the level of ribosome formation in the nucleus as well.


[A histotopographic study of the pancreas in lipomatosis]. Histotopographic investigations of the pancreas in lipomatosis were carried out and results obtained were collated with clinical data. It was established that diminution of the exocrine parenchyma in this case may be quite considerable-in some cases only 9.9-12% of its amount remained. Despite the considerable diminishing of the exocrine parenchyma in lipomatosis, no clinical manifestations of the disorder of the exocrine function may be observed. Experimental data showed that loss of the exocrine parenchyma of the pancreas may be compensated in other parts of the gastro-intestinal tract, in the stomach in particular.


[Chronic primary tuberculosis disguised as asthmatic bronchitis]. An observation over a chronic course of primary tuberculosis of the lung in a 78-year-old female patient with involvement of the perihilar lymph nodes, development of periadenitis, ingrowth of tuberculous granulations into the lumen of bronchi and with formation of fistulas is described.  Clinically the disease proceeded as asthmatic bronchitis.


[Determination of the quantity of cells in different organs and tissues following alkaline dissociation]. A tissue following fixation for 10-15 days with formalin was treated with 50% KOH aqueous solution during 18 hours, which led to complete dissociation of the tissue into cells. Suspension of cells was placed into the counter of Fuchs-Rosenthal and numbers of nuclei in cells of definite tissues were counted. On preparations of the same suspension in 1000 cells distribution of the latter according to the number of nuclei was determined. Then a number of cells in 1 mg of tissue and in the organ were estimated. The count of muscular cells in the heart of a mouse showed that the relative error of the determination of the number of cells did not exceed 2.0%.


[Electromyographic and neurological aspects of leprosy. Study of 100 cases]. By the neurological, electromyographic, anatomopathological and bacterioscopic examinations of 100 pacients with leprosy the following conclusions have been drawn: There was a high incidence of reflex abnormalities. The proprioceptive reflexes were abnormal in 64.5% and the superficial reflexes in 70.8% of the cases. According to the topography of the segments examined, the deep reflexes showed the following abnormal values: 25.3% in the cephalic segment; 69.1% in the upper limbs and 74.5% in the lower limbs. Of the 2,289 reflexes investigated, abnormalities were found in 773 superficial reflexes (70.8%), while in relation to the proprioceptive reflexes the figures rose to 901 (64.5%). In the early stages of the infirmity, the reflexes were normal in 41.2% of the cases examined, and in all the stages of the evolution of the disease those numbers were always high. Also in the first stage, whose average duration was of 4.9 years, several alternations were noted, although there was a predominance of brisk reflexes (25.1%) over diminshed reflexes (17%), followed by hyperactive (8.6%) and absent reflexes (8%). In the final stage of the infirmity there was a decrease of normal reflexes, in contrast to absent and decreased reflexes, whose rates increased to 32.7% and 30.6% respectively. The disappearance of hyperactive reflexes and the clear decrease of brisk reflexes should also be noted. There was a high percentage of patients (31%) who suffered agression of the eighth nerve, 17 of which (54.8%) were found to suffer from neural deafness. The values related to hearing deficit were rarely in accordance with the histopathological and bacterioscopic positive results. The indexes of abnormalities found out in the examination of the fifth and of the seven nerve (7% and 5% respectively) were much lower in relation to the eighth nerve. These results are in contradiction with the ones stated in the literature. In some of the patients, hyperesthesia of the skin of the plantar region prognosticated the appearance of the infirmity. Among the objective changes, anesthesia of superficial sensibilities combined with deep hyperesthesia and anesthesia of superficial sensibilities with abolition of profound sensibilities were rarely observed. No case was found with exclusive alterations of deep sensibilities. Peripheral motor neuron lesions demonstrable by electromyography were observed in 82 patients (82%)...


Cervical spondylosis. Prognostic value of preoperative signs and symptoms. One hundred and forty-one patients with cervical spondylosis were studied, looking for a possible prognostic value in preoperative signs and symptoms. Duration of symptoms lasting from one month to five years until surgical treatment and spinal fluid protein level had no prognostic value in these patients. In those with radiculopathy, the degree of upper limb pareses, muscle atrophy, absent or diminished reflexes, sensory involvement, number of myelographic defects and age had prognostic value. In those with myelopathy, the degree of lower limbs pareses and spasticity, sensory involvement, number of myelographic defects and age had prognostic value. Surgery is a definite method of treatment for patients with progressive signs and symptoms due to cervical spondylosis; some of the preoperative signs and symptoms are valuable in establishing their prognosis.


Cerebrospinal fluid immunoglobulins in cysticercosis of the central nervous system. Investigation on the behavior of immunoglobulins IGG, IGA and IGM in the CSF in cases of cysticercosis of the CNS, based on data pertaining to two different series of cases. The first series comprises 30 samples of CSF, and the second one, 5 samples. It was demonstrated that IGG is the one representing the largest contingent. IGG concentration keeps in proportion with the gamma globulin concentration, of which it represented an 88% average in the cases studied. Participation of IGG in the protein profile of the CSF is greater than the usually referred; the results for the material analyzed showed 16%. It was verified a proporcionality also between IGG concentration and the titer of positive complement fixation test for cysticercosis; there is a positive correlation, whose numerical expression was found to be significant in the samples studied.


Copper and ceruloplasmin contents in the blood serum of peripheral and pre-hepatic veins. Cooper and ceruloplasmin contents were determined in samples of peripheral and pre-hepatic venous blood of 11 patients with Manson's schistosomiasis and one patient with hepatolenticular degeneration, all of çhich submitted either to porto-caval or spleno-renal shunt. Individual difference were not significant in any of the non-Wilsonian patients. The results are discussed in regard to the current knowledge on the pathogenesis of Wilson's disease.