Computed tomography of angiographically occult cerebral vascular malformations. Although some cerebral vascular malformations are angiographically occult, the correct diagnosis may be suggested by their appearance on computed tomography (CT). The authors advise caution in assuming that angiographically avascular lesions which show contrast enhancement on CT represent neoplasms rather than vascular malformations.


Bone scanning in the evaluation of exercise-related stress injuries. Bone scintigraphy was used to evaluate 34 patients with the physical findings and history of stress fracture of the lower extremity. Of the 34, 21 had abnormal studies, 11 involving the femoral neck, 9 the tibia, and 1 the femur. All of these had abnormal scintiscans prior to or at the time of the appearance of radiographic changes. Of the 9 with abnormal tibial studies, radiographic changes never evolved in 3. No false negatives were found among the 13 with normal scintiscans.


The pattern of shortening of the bones of the hand in PHP and PPHP--A comparison with brachydactyly E, Turner Syndrome, and acrodysostosis. The patterns of length alterations in the hand bones in cases of pseudohypoparathyroidism (PHP), pseudopseudohypoparathyroidism (PPHP), and acrodysostosis were evaluated. The length of each of the hand bones was measured and compared to appropriate means for age and sex. The pattern profiles thus generated showed that those for PHP and PPHP are almost identical, and are similar to that seen in acrodysostosis, except for the much smaller size of the bones seen in the latter condition. PHP and PPHP are probably differend manifestations of the same entity, and acrodysostosis may also be related to them. Brachydactyly E is indistinguishable radiologically from the PHP-PPHP syndrome.


Gray scale patterns of pelvic disease in the male. Pelvic fluid collections, solid masses, extrinsic or intrinsic vesicular masses, and abnormal distension of the bladder due to obstruction can be demonstrated by sonic scanning. Accurate diagnosis is based on the recognition of certain sonographic patterns, in addition to the clinical history and physical findings. These patterns include: (a) internal echo pattern, (b) external contour of the mass, (c) location within the pelvis, and (d) relationship to other pelvic structures.


Thyroid cancer following scalp irradiation. A sixfole increase in the risk of thyroid cancer was observed among 10,902 persons irradiated for scalp tinea in childhood as compared to two matched control groups. The dosimetry studies demonstrated that the original mean dose given to the thyroid was less than 9 rads, yielding a risk of 6.3/10(6)/year. This carcinogenic effect of low-level radiation must be considered in the planning of safety measures against potential public health hazards.


Effects of motion on the radiological image. A method to study the loss of resolution of radiological images caused by patient motion is presented. Optical transfer functions (OTF) are computed for motion with uniform velocity and with simple harmonic oscillation. The line spread function (LSF) of a pattern of motion can be generated from the image of a long, narrow moving slit. Once the LSF is known the OTF of the motion can be obtained by Fourier transform.


The effects of vasopressin on the radiation response of cultured mammalian cells. Since vasopressin is known to exert radioprotective effects in vivo, its effects on mammalian cells in vitro were examined. No toxicity or changes in cellular plating efficiency were observed at concentrations up to 10 units/ml. There was no direct radioprotective effect attributable to exposure of the cells to vasopressin prior to and during irradiation.


In vitro computed tomography of the human heart. In vitro computed tomography (CT) was performed on nine human hearts. Mean attenuation coefficients from a 2.5 X 2.5-cm area of the left ventricular wall were determined from a 160 X 160 computer printout before and after formalin fixation in five hearts. These values averaged 27.1 and 24.7 units, respectively (p less than 0.05). The absorption characteristics of normal human myocardium do not differ from those observed in animals and the potential of CT application to ischemic heart disease can be assessed by this mehtodology applied to postmortem hearts of patients with myocardial infarction of varying duration.


111In-phenolphthalexon, a new chelate for extended cholescintigraphy: formulation and preclinical characterization. The first 111In chelate exhibiting hepatobiliary excretion, a 111In-phenolphthalexon, has been formulated and tested in rats. The preparation of the chelate is simple, reflecting its inherently high stability. Its capability for extended cholescintigraphy allowed distinct visualization of the gallbladder and the bowel to the level of the rectosigmoid in dogs. No lethality or acute toxicity was induced by administration of the chelate.


Simultaneous electronic and small format photofluorographic angiography. Monitoring the image on the television screen during photofluorographic angiography is frequently difficult due to the short exposure times. A disk recorder has been integrated with a 100mm rapid-sequence photofluorographic camera for use during selected angiographic procedures. Each flashing image is automatically recorded on the disk recorder and is then immediately replayed during the interval between exposures. It is these considerably longer, although minimally delayed images, that are viewed during the study instead of the short live image. "Panning" to follow the progression of the contrast bolus is facilitated. The recorded angiographic series may be instantly replayed in stop motion for immediate review.


Photographic method of recording radiation fields using the localizer light for illumination. By interposing a camera with a fish-eye lens between the collimator and the illuminated field, radiotherapy ports can be recorded using the localizer light for illumination. An acrylic mold of the camera was used to maintain alignment and immobilization during the necessarily long exposures. The authors consider this a very objective and accurate method of recording the topography of radiation ports.


Informed consent: a dialogue.

Informed consent: a dialogue. Legal precedents and current approaches of the courts to the issue of informed consent in cases of urographic contrast media injection are considered. Radiologists ought to inform their patients of the possibility of an idiosyncratic reaction to contrast medium injection.


Resistance to blockade of vasodepressor responses to tolazoline by chlorpheniramine and metiamide in rabbit hindlimb vasculature. In perfused hindquarters of anesthetized rabbits, metiamide alone and a combination of metiamide and chlorpheniramine failed to modify tolazoline-induced depressor responses, indicating a lack of histamine H1 and H2-receptor involvement. Failure of atropine and propranolol to alter tolazoline responses precludes cholinergic and beta-adrenergic mechanisms. On the other hand, graded pressor responses to histamine were reversed to depressor responses by chlorpheniramine, whereas a combination of chlorpheniramine and metiamide completely abolished the effects of histamine. The latter results confirm that in the rabbit hindlimb vasculature histamine H1 and H2-receptors mediate pressor and depressor responses, respectively.


The specific interaction between LSD and serotonin-binding protein. In this report, we describe the chemical interaction between lysergic acid (LSD) and serotonin-binding protein (SBP) by a three-dimensional spectroscopic technique. This instrument records simultaneously the activation and fluorescence spectra, and plots fluorescence intensity level by a series of isointensity contours. Free LSD exhibits maximum fluorescence at 435 nm with excitation maximum at 330 nm. While SBP-bound LSD shifted its fluoresence and excitation maximum to 465 nm and 375 nm respectively. These results suggest that the drug-protein interaction caused an extensive delocalization of the molecular orbital electrons and thereby lengthen the electronic conjugation of the drug molecule. Such shift was not observed when LSD was incubated with bovine serum albumin under the same condition. This technique is sensitive and requires a small volume of samples. It permits us to determine both free and bound drug in the same sample and provides us specific information about the drug and protein interaction.


The influence of 3,4-dihydroxyphenylacetic acid on the accumulation of 5-hydroxyindoleacetic acid in the choroid plexus and kidney cortex slices of rats. In vitro, the choroid plexus of rats accumulates 5-hydroxyindoleacetic acid (5-HIAA) by active transport. In the experiments presented here, the kidney cortex slices also showed active accumulation of this organic acid, which proved to be inhibited by most of the organic acids tested. In the choroid plexus 3,4-dihydroxyphenylacetic acid (DOPAC), a metabolite of dopamine, stimulated the accumulation of 5-HIAA, whereas in the kidney slices DOPAC was inhibitory. This stimulating effect of DOPAC was blocked by homovanillic acid and probenecid. Metabolic inhibitors such as 2,4-dinitrophenol and N-ethylmaleimide also blocked the stimulation, but sodium fluoride was ineffective. Omission of calcium, but not magnesium ion in the incubation medium depressed the accumulation of 5-HIAA. DOPAC still produced the stimulating action in calcium-free medium. The release of 5-HIAA from choroid plexus was retarded by DOPAC. These results suggest that the stimulating action of DOPAC may be due to a calcium-dependent active transport system and delay of 5-HIAA release.


Suppression of the primary immune response by chemical sympathectomy. The effects of general sympathectomy with 6-hydroxydopamine (6-OHDA) on antibody production to sheep red cells (SRBC) were studied in mice. Intraperitoneal administration of 6-OHDA in a dose of 1 to 300mg/kg resulted in a significant decrease in hemagglutinin titer and number of direct plaque-forming cells which were observed only in the early period of the primary immune response. Following treatment with 6-OHDA 10mg/kg i.p., the noradrenaline content in murine spleen was significantly reduced from 63 to 42% of control value between 2 and 10 days after injection indicating that chemical sympathectomy suppresses the primary immune response.


Comparison of live Newcastle disease vaccines in a simple vaccination and challenge experiment. Groups of day-old chicks with haemagglutination inhibiting antibodies (HIA) were exposed by the spray method to equal doses of three different live Newcastle disease (ND) commercial vaccines and allantoic preparations of them. After three weeks the HIA response was measured and the chicks were challenged with a pathogenic strain of Newcastle disease virus (NDV). The degree of protection of each bird was compared with its HIA response. The commercial vaccines all provided good protection at identical levels, but significant differences were detected between the allantoic fluid preparations. Two of the commercial vaccines produced significantly better protection than the allantoic fluid preparations. In addition to the protection conferred by HIA antibody, other mechanisms of protection apparently played a part.


Enhancement of survival in acute experimental fowl typhoid in chicks by the administration of iron dextran. Chicks aged 15 days were infected orally with 10(6-4) living Salmonella gallinarum. Iron from iron dextran or ferric ammonium citrate (DFe and CFe respectively), in doses of 2-0 or 0-4 mg/kg given intramuscularly at the time of infection, had no effect on subsequent mortality compared with infected controls. Increasing the amount of CFe to the maximum (20 mg/kg) that was non-toxic intramuscularly was also ineffective but when the dose of DFe was increased to 20 or 50 mg/kg the survival rate rose sharply. If given at other times in relation to the time of infection, or more frequently, 50 mg/kg or more of DFe was less active. The increased survival rate among infected chicks given 50 mg/kg of DFe at the time of infection was accompanied by decreases in the severity of the morbid changes in the disease, and by reductions of between c 10- to 100-fold in the numbers of viable S gallinarum in the liver, spleen or blood at the height of the acute infection. DFe (50 mg/kg) given at the time of infection also eliminated the difference in the survival rate noted previously between infected chicks fed respectively with diets containing fish or meat meal as the sole source of supplementary protein.


Effect of the uterus on induced cystic ovarian follicles in the sow. Large multiple cystic ovarian follicles were induced in 16 sows and small multiple cystic ovarian follicles were induced in five sows by daily injections of adrenocorticotrophic hormone during the follicular phase of the oestrous cycle. Large ovarian cysts persisted until euthanasia at 35 to 51 days after complete bilateral hysterectomy between days 5 and 10 in four sows. Atresia of large cysts was seen about days 15-18 in a sham-hysterectomy experiment. Unilateral hysterectomy of three sows resulted in persistence of large cysts on the ovary adjacent to uterine horn removal and atresia in the contralateral ovary. Lutein patches developed on the follicular wall of persistent cysts between the time of hysterectomy and autopsy. Atresia did not occur after hysterectomy in three sows with small cystic follicles, nor did sham hysterectomy of a sow with small ovarian cysts result in cyst atresia. A pronounced reduction in the size of large cysts occurred in three of four sows after the intrauterine injection of prostaglandin F2a. When a prostaglandin inhibitor, indomethacin, was injected into one uterine horn, the adjacent ovarian cysts persisted while those on the ovary next to the uterine horn receiving saline solution underwent atresia. Daily urinary oestrogen values from a hysterectomised sow with large cysts were initially high but subsequently fell to values between 30 and 60 microng/ml, except for several high values when signs of oestrus were observed. Oestrogen values in urine from a hysterectomised sow with small cysts were comparatively lower, and rose to high values only once in the 50-day period studied. Plasma oestrogen values in a hysterectomised sow with large cysts were high, although considerable day-to-day variation occurred. Plasma progesterone values were also high in this sow. In a sow with small cystic follicles for a 50-day period, oestrogen values in plasma were relatively low, but higher values were obtained occasionally. Plasma progesterone levels remained consistently low in this sow.


Distribution of lactate dehydrogenase isoenzymes in normal and inflamed bovine udders and milk. The patterns of distribution of lactate dehydrogenase (LDH) isoenzymes were determined in normal and inflamed bovine udder tissues, in normal and mastitic milk-leucocytes and serum. LDH1 was the most common isoenzyme found in all the types of tissues examined, normal tissues contained the lowest proportions of LDH5 whereas the inflamed tissues and leucocytes from mastitic milk showed a higher proportion of LDH4 and LDH5. It seems that the origin of the elevated LDH in mastitic milk is the leucocytes and the parenchyma cells of the udder. The significance of the shift in the molecular forms of LDH isoenzymes is discussed in relation to possible alternations in energy metabolism in the inflamed bovine mammary gland.


The transfer of circulating 131I IgG1 and 125I IgG2 to the nasal secretions of sheep. Ovine IgG1 and IgG2 labelled with 131I and 125I respectively were injected intravenously into four sheep. Serum and nasal secretion samples were collected and fractionated by gel filtration on columns of Sephadex G100. Results showed that in serum more than 95 per cent of the radioactivity was associated with intact IgG molecules whereas in nasal secretion samples the percentage varied from five to 47. It was found that the concentrations of IgG1 and IgG2 in the nasal secretions were similar and were approximately 2 per cent of the serum concentrations. This finding indicates a lack of selective transfer of either IgG1 or IgG2 from blood to nasal secretions in sheep.


Lysosomal enzyme activities in sheep plasma and lymph. The activities of acid phosphatase, beta-glucuronidase and N-acetyl-beta-glucosaminidase were measured in blood plasma, afferent and efferent popliteal lymph, intestinal lymph and in four different organs of the sheep. Acid phosphatase had an optimum activity at pH 4-5 while beta-glucuronidase and N-acetyl-beta-glucosaminidase had optimal activities at pH 5-0 and pH 4-5-5-0, respectively. Comparative studies showed that the sheep had very low activities of acid phosphatase and relatively low activities of N-acetyl-beta-glucosaminidase in the blood plasma compartment in relation to the activities of these enzymes in the plasma of the rabbit and the rat. The tissue activities of all three enzymes were relatively high when compared with those in the two non-ruminant species. It is considered that the low plasma activities of acid phosphatase in the sheep reflect a rapid turnover of this enzyme in the plasma compartment. The activities of the three enzymes in regional lymph indicated that acid phosphatase was being added to the capillary filtrate at a regional tissue level, whereas beta-glucuronidase and N-acetyl-beta-glucosaminidase in lymph were derived from filtration from the blood plasma compartment on a molecular weight basis. The high lymph: plasma ratios observed for acid phosphatase activity in intestinal lymph may indicate a function of this enzyme in lipid absorption in the sheep.


Biological and serological comparison of two embryo-lethal mycoplasmas isolated from turkeys. Two uncharacterised, independently isolated, embryo-lethal mycoplasmas obtained from turkeys and designated W8 and CT were compared with each other and with a third, culturally similar, embryo-lethal turkey mycoplasma, Iowa 695, by cultural and serological methods. The three mycoplasma isolates were serologically distinct and CT could be differentiated from W8 by its ability to reduce 2,3,5-triphenyltetrazolium chloride under aerobic conditions.


A cause of misleading serum amylase concentrations in acute pancreatitis. The operative discovery of acute pancreatitis associated with gross hyperlipidaemia but a normal or high elevated serum amylase concentration has been described. We report a case of acute pancreatitis in which serial dilutions of serum resulted in a 338% rise in the serum amylase concentrations. The importance of appreciating this effect of hyperlipidaemia on the serum level measurements in patients with acute pancreatitis is re-emphasised.


Newly evolved repeated DNA sequences in primates. Repeated DNA sequences in primates having identical or nearly identical members and exhibiting unusual phylogenetic specificity were analyzed. They appeared in repeated DNA sequences in each group of primates, probably within the last 10 to 15 million years, and are conserved to the same extent as unique DNA sequences. The finding allows a new approach to the construction of evolutionary trees.


Mouse chromosome translocations: visualization and analysis by electron microscopy of the synaptonemal complex. Pachytene chromosomes of mice heterozygous for known translocations are clearly depicted by configurations of the synaptonemal complexes in spread (whole mount) preparations. In one autosomal and two X-autosome translocations analyzed, breakpoints are identifiable; localization by measurement agrees with mitotic data and shows the translocations to be reciprocal. Synapsis with the Y is inhibited in one translocation in which the breakpoint is the pairing region of the X.


Controlling the pink bollworm by disrupting sex pheromone communication between adult moths. The synthetic sex pheromone (gossyplure) of the pink bollworm was evaporated into the atmosphere of three cotton fields during an entire growing season. The resulting disruption of premating pheromone communication between male and female moths led to a reduction in the population of larvae infesting cotton bolls. This larval control was comparable, in terms of both effectiveness and expense of materials used, to the control achieved in ten comparison fields by growers using conventional insecticide applications.


[Pathobiology of deficiencies of the nervous system: apropos of cobalt and copper metalloprotein deficiency]. The Author debate a new concept and classification of neurologic nutritional disorders, according with pathobiological data. Cobalt and copper nutritional syndroms are exposed.


Legionnaires' disease: nickel levels.

Legionnaires' disease: nickel levels. Nickel concentrations in  lung tissues of nine deceased Legionnaire victims average nine times that of controls. There is a significant correlation between the nickel levels in the lungs of the Legionnaire victims and the weights of the lung specimens. No similar correlation is  evident in the study of the victims' kidney tissues or tissues from the controls.


A response regulator model in a simple sensory system. Bacterial behavior is shown to be modulated through a simple on-off switching device which directs migration toward favorable conditions and away from unfavorable ones. The behavioral response is controlled by a rudimentary memory which allows the bacteria to sense gradients over time. The memory can be explained by a biochemical system involving a response regulator whose level relative to a threshold controls flagellar function. The level of the response regulator is itself controlled by factors such as enzyme levels and environmental stimuli. The molecular basis of the model appears to be relevant to more complex hormonal and neural signaling systems.


Asymmetric structure of the purple membrane. There is both functional and structural evidence that bacteriorhodopsin is oriented asymmetrically across the purple membrane of Halobacterium halobium. To assess the degree of asymmetry, the x-ray diffraction data from the membrane have been analyzed for possible electron-density profiles. A recent theory predicts that only a limited number of profiles are consistent with the continuous diffraction data, and two possible profiles have been found. Both profiles indicate that the protein molecules span a lipid bilayer in the membrane. Both profiles are asymmetric; there are more lipid molecules in one half of the membrane than in the other, and the bacteriorhodopsin molecule shows a slight complementary asymmetry.


Growth hormone: species-specific stimulation of erythropoiesis in vitro. The effects of purifed bovine and human growth hormone were tested in vitro with murine and human bone marrow by means of granulocyte-monocyte and erythroid progenitor cloning techniques. Nanogram concentrations of the growth hormones potentiated erythropoietin-stimulated erythropoiesis, but not granulopoiesis, in a species-specific manner.


Hypoxanthine phosphoribosyltransferase: two-dimensional gels from normal and Lesch-Nyhan hemolyzates. Immunoprecipitated hypoxanthine phosphoribosyltransferase (HPRT) from hemolyzates displays two major spots after two-dimensional polyacrylamide gel electrophoresis. HeLa cells or human lymphoblasts display only a single HPRT spot located at the same position as the most basic of the hemolyzate HPRT spots. This suggests that the most basic spot is the form initially synthesized, and the more acidic hemolyzate HPRT spot (a pseudoisozyme) is probably derived from the first by an age-related modification (for example, deamidation). The HPRT pattern of the hemolyzate from a Lesch-Nyhan patient was shifted to a more basic isoelectric pH, implying the mutation of a structural gene.


Erythema chronicum migrans and Lyme arthritis: cryoimmunoglobulins and clinical activity of skin and joints. We report the presence of serum cryoimmunoglobulins in patients with attacks of a newly described epidemic arthritis--Lyme arthritis--and in some patients with a characteristic skin lesion--erythema chronicum migrans--that sometimes precedes the onset of the arthritis. Seven patients who had cryoimmunoglobulins at the time of the skin lesion have developed arthritis; four patients without them have not. The cryoglobulins in patients with the skin lesion consisted primarily of immunoglobulin M (IgM); those in patients with arthritis often included both IgM and IgG. These findings support the hypothesis that a common origin exists for the skin and joint lesions and suggest that circulating immune complexes may have a pathogenetic role in Lyme arthritis.


Classical nictitating membrane conditioning in the awake, normal, restrained cat. Present knowledge of its central nervous system makes the cat a desirable subject for studies of brain-behavior relationships. Response frequencies and latency characteristics in conditioning and control groups indicate that the response of the nictitating membrane can be classically conditioned in a new restraint system in which detailed brain and behavior measures can be easily obtained.


Benzo[a]pyrene diol epoxides: mechanism of enzymatic formation and optically active intermediates. Studies of the mechanism of benzo[a]pyrene metabolism to reactive diol epoxides and of their disposition indicate that the metabolic intermediates of the activation pathways, 7,8-epoxide and trans-7,8-diol, as well as the two stereoisomeric diol epoxides are all optically active. Benzo[a]pyrene is converted to optically active 9,10-epoxides of (-)trans-7,8-diol by three enzymatic steps: (i) stereospecific oxygenation at the 7,8 double bond of benzo[a]pyrene by the mixed-function oxidases to essentially a single enantiomer of 7,8-epoxide, (ii) hydration of the 7,8-epoxide by epoxide hydratase to an optically pure (-)trans-7,8-diol, and (iii) stereoselective oxygenation by the mixed-function oxidases at the 9,10 double bond of the (-) trans-7,8-diol to optically active r-7,t-8-dihydroxy-t-9,10-oxy-7,8,9,10-tetrahydrobenzo[a]pyrene and optically active r-7,t-8-dihydroxy-c-9,10-oxy-7,8,9,10-tetrahydrobenzo[a]pyrene in a ratio of approximately 10 to 1.


Sickle hemoglobin aggregation: a new class of inhibitors. A number of tri- and tetrapeptides have been found to inhibit aggregation and gelation of deoxygenated sickle cell hemoglobin. These inhibitors have hydrophobic phenylalanine residues at one end and hydrogen bonding lysine or arginine side chains at the other end. The backbone is not very specific. The inhibitors do not modify the oxygen carrying properties of hemoglobin. When the inhibitor and sickle hemoglobin are put inside reconstituted cells, the erythrocytes do not sickle upon deoxygenation. Compounds of this type may develop useful agents in the therapy of sickle cell anemia.


Sickle cell hepatopathy.

Sickle cell hepatopathy. Hepatic dysfunction is a common finding in patients with sickle cell disease but viral hepatitis appears to be an unusual complication in the adult SS patient. Only five cases of viral hepatitis were recorded in 378 admissions for SS crisis. In contrast, hepatic crisis occurred as a distinct event in 9% of 88 patients with sickle cell anemia. This entity must be differentiated from acute cholecystitis or viral hepatitis. Transiently abnormal results of hepatitic function tests were observed in another 26 patients with extrahepatic crisis. Cirrhosis is relatively common and often the terminal event in SS disease. Choledocholithiasis and cholecystitis are infrequent complications despite the prevalence of gallstones in SS anemia.


Chemical treatment of external otitis.

Chemical treatment of external otitis. From 1962 through 1969, 2,008 cases of external otitis were treated chemically. The auditory canal was cleaned and a gauze wick saturated with 20% silver nitrate solution was introduced. The next day the wick was replaced with one saturated with Burow's solution. After two to three days, this wick was removed and the canal cleaned. Results were excellent in 1,593 cases, good in 398 cases, and poor in 17 cases.


A multifaceted approach to prevention of thromboembolism: a report of 529 cases. The morbidity and incidence of thromboembolic complications can be reduced by patient awareness, nursing staff concern, and physician responsibility using mechanical measures and drugs. Preoperative exercise instrutions, early ambulation, calf exercise, antiembolism hose, postoperative circle-bed turning and use of the Trendelenburg position, the use of intravenous dextran postoperatively and, in selected cases, low doses of sodium warfarin (Coumadin) form the foundation of our approach to the prophylaxis of thromboembolic phenomena. In the presence of thrombophlebitis, phenylbutazone (Butazolidin) is used. Dextran is used with caution in the presence of diminished biliary function. Heparin is avoided except in proven pulmonary embolism. No complications have resulted from this regimen.


Routine upper gastrointestinal examinational examination in preoperative cholecystectomy patients. The charts of 663 patients who had cholecystectomy were reviewed to determine the usefulness of preoperative radiologic examination of the upper gastrointestinal tract. In 14% of the patients a positive finding was reported. However, slightly less than half of these findings were confirmed at surgery. Only 2.9% of the patients had a procedure in addition to cholecystectomy. It is felt that routine examination of the upper GI tract is not indicated in the preoperative evaluation of patients with gallbladder disease unless the clinical history is equivocal and one suspects coincidental disease.


Zinc sulfate supplementation for treatment of recurring oral ulcers. Use of zinc sulfate in promotion of wound healing and in maintenance of epithelial integrity suggested its possible use in the treatment or prevention of recurrent oral ulcers. In a series of 32 patients with recurrent aphthous ulcers (RAU), serum zinc levels were observed. Seventeen patients, eight with initial serum zinc levels above 110microng/dl and nine with serum zinc levels below 110microng/dl, were provided zinc sulfate supplementation up to a total of 660 mg/day. All patients with initial serum zinc levels less than or equal to 110 microng/dl showed improvement; three of the eight patients with initial serum zinc levels above 110 microng/dl improved, five did not. Improvement consisted of 50% to 100% reduction in frequency of episodes. This suggests a combination of causes of RAU, one of which may be a local or general deficiency of zinc or a defect in metabolism, perhaps at the cellular level, related to zinc.


Total hip replacement in the previously infected hip. Ten patients with a history of previous hip joint sepsis including one with active tuberculosis of the hip have had total hip replacement using acrylic cement. With duration of follow-up ranging from six months to over three years, all but one have had satisfactory results with no evidence of persistent or recurrent infection. When preceded by thorough evaluation and eradication of hip sepsis, total hip arthroplasty appears to be an acceptable procedure for restoring a functional hip joint in patients with this difficult problem.


Routine chest roentgenograms on hospital admission do not discover tuberculosis. Of 95 cases of tuberculosis diagnosed at Grady Memorial Hospital in 1972, only six patients were not already diagnosed or suspected of having TB at the time of admission to the hospital. In only two of these cases was the diagnosis of TB made because of the routine admission chest roentgenogram (out of a total of 39,017 hospital admissions for the year). Both of these patients had respiratory symptoms for which a diagnostic chest film was indicated. On the basis of this review, routine chest films for all hospital admissions are not of significant value in discovering unsuspected tuberculosis.


Traumatic left anterior descending coronary artery to right ventricle fistula: report of two cases. Two cases of traumatic fistulas between the left anterior descending coronary artery and right ventricular outflow tract are presented. One was due to a stab wound and the other to blunt chest trauma. Both patients had small left-to-right shunts. The first patient had surgical closure of the fistula, but it recurred postoperatively. His murmur subsequently disappeared spontaneously four months later. The second patient is being treated medically. Based upon review of the available data, we believe that surgical therapy should be individualized, that asymptomatic individuals with small shunts may be treated conservatively, and that this entity may be more common than previously thought.


Cervical spondylotic dysphagia.

Cervical spondylotic dysphagia. Reported is a patient who had severe dysphagia caused by cervical osteophytes. Both of the cervical vertebral spurs were excised, and anterior interbody stabilization was unnecessary. In the diagnosis of such patients, esophagoscopy is recommended, but it must be done with extreme care because of the increased risk of esophageal perforation. Treatment may consist of reassurance and a trial of anti-inflammatory agents if the symptoms are minimal, but definitive treatment, usually associated with complete recovery, is surgical excision.


Fatal colitis in a hemophilic patient with inhibitor. A severe colitis developed in a hemophilic patient following an antibiotic regimen which included clindamycin. A surgical procedure, total hip replacement, had been complicated by the appearance of a powerful factor VIII inhibitor and a Bacteroides fragilis infection. The resulting bleeding diathesis was successfully managed with the use of an "activated prothrombin complex"; however, the occurrence of colitis following intravenous clindamycin therapy proved to be fatal. Clindamycin, like the related antibiotic lincomycin, appears to have significant intestinal toxicity and should be restricted to the treatment of life-threatening proven Bacteroides infections.


Cardiac arrhythmia and hypopotassemia in association with lithium carbonate overdose. Cardiac arrhythmia and electrolyte disturbances can occur as a complication of toxic serum levels of lithium salts. In this report, the development of sinus bradycardia and idioventricular rhythm with severe hypokalemia following an overdose ingestion of lithium carbonate was presented. Possible mechanisms and precautionary measures were discussed.


Systemic lupus erythematosus in Black and Indian patients in Natal. Seventeen Indian and 13 Black patients were studied. From hospital admission data, systemic lupus erythematosus (SLE) appeared to be more common in Indians than in Blacks in Natal. Renal biopsy specimens were taken from 27 patients and histological examination showed renal changes to be present in 26 patients. The high incidence of renal involvement may be due to the patients presenting at a late stage. Histological examination revealed severe renal changes which correlated with albuminuria, low serum complement and raised blood urea values. Tuberculosis is still a very common disease in Blacks and various matters arose in this connection: (a) the development of tuberculosis as a complication of corticosteroid therapy in an unduly high number (3/30) of our patients suggests that routine isoniazid (INH) prophylaxis is warranted, particularly if the tuberculin skin test is positive, (b) patients presenting with serositis are usually considered to have tuberculosis; the diagnosis of SLE is therefore sometimes initially overlooked, and (c) despite the very widespread use of INH in Blacks, we encountered no case of drug-induced lupus erythematosus.


Pathogenesis of neural manifestations in acute porphyria. At least 4 possible mechanisms may be postulated to explain the neural manifestations of acute porphyria in the hereditary hepatic porphyrias. These are (i) excessive amounts of porphyrins or porphyrin precursors produced in the liver during acute attacks are transported to the central and peripheral nervous system, where they exert neurotoxic effects; (ii) unidentified metabolites of the aforementioned compounds may be responsible; (iii) in patients with these diseases there may be a metabolic defect in neural haem biosynthesis which is aggravated by precipitating factors, thereby leading to acute neural manifestations; and (iv) the hepatic and nervous system lesions may be metabolically quite unrelated. Each of these possibilities is considered, and evidence is adduced that a genetic defect in haem biosynthesis in the nervous system is the most plausible hypothesis.


Western psychiatry and the Xhosa patient. The difficulties of the Western-trained psychiatrist in dealing with Xhosa patients are threefold; the language and intricacies of its usage, the cultural beliefs, customs and rituals and the inapplicability of the Western psychiatric model to people of a different culture. To a lesser extent, all White medical staff experience the same problems.


Peripheral cerebral arterial aneurysms caused by stabbing. Aneurysms of peripheral cerebral arteries caused by stabs of the vault are described in 2 patient. The importance of early recognition of this potentially fatal complication of an apparently benign injury of the head is emphasized.


Rugby injuries to the cervical spinal cord. An analysis of the orthopaedic injuries in 20 patients who sustained injury to the cervical spinal cord while playing rugby has been made. Eight (40%) of the players were injured during scrums and the remainder were injured during tackling. The incidence of and mortality due to spinal cord injuries sustained during rugby are discussed. Analysis of the scrum injuries shows a specific type of orthopaedic injury indicating a flexion-rotation mechanism. No specific mechanism of injury in the group injured during tackling could by demonstrated. It is concluded that the rugby scrum provides an ideal occasion for dislocation of the cervical spine and is potentially the most hazardous facet of the game.


Perforated duodenal ulcer: is the distinction between acute and chronic valid? Perforations of acute and chronic duodenal ulcers were compared in 70 patients by analysis of the age and racial incidence, the acid output and the histology of the ulcer edge at the time of perforation. There was no significant difference between the ulcer types when these variables were considered. It is suggested that the only difference is the perseverance of symptoms and likelihood of relapse in the chronic group, and that in pathological terms the only true acute ulcer is the rare stress ulcer.


The health handicap of schistosomiasis to children in Southern Africa. To find out more about the health handicap caused by schistosomiasis the most meaningful approach lies in comparing populations with and without the infection. Several studies on appropriately matched groups of South African Black children have failed to reveal clear-cut disadvantages in the infected. Limited studies on White children have shown impairment in the infected. Among Black adults, the very few studies made have shown reduction of working capacity to be slight. Obviously, further comparative studies are required, more particularly on adults. Knowledge of the precise public health burden of schistosomiasis remains unsatisfactory, and a large amount of further research is required to secure the requisite information on morbidity and mortality.


Lympho-epithelioid cellular lymphoma (Lennert's lymphoma): a case report. A patient with Lennert's lymphoma (malignant lymphoma with a high content of epithelioid histiocytes) is described. The case is unique in that hepatosplenomegaly was the presenting feature, the diagnosis was made on bone marrow biopsy and the disorder appears to have run a benign course.


Treatment of the ruptured abdominal aorta. Prompt, well-conceived surgical intervention during the critical early minutes after rupture of the abdominal aorta is capable of increasing the salvage of this not uncommon emergency. The demanding intraoperative and postoperative complications must be anticipated and coped with effectively if the present plateau of survival is to be improved. Alternative technical approaches in controlling exsanguinating aortic blood flow are available and are worthwhile additions to the armamentarium of the surgeon. The advantages of the transthoracic approach for control of hemorrhage are emphasized and should be resorted to in selected patients.


The occlusive competence of the duodenal orifice of the canine pancreatic duct. Observations by scanning electron microscopy indicate that the mucosa of the terminal part of the major pancreatic duct of the dog is organized into numerous, highly convoluted folds. The individual mucosal cells are tall, columnar and studded with numerous microvilli. These folds are highly vascularized. The intraluminal administration of bethanechol and norepinephrine is associated with subsequent increases and decreases of mean opening pressures. Mean opening pressures were not observed to be associated with autonomic nervous activity that was unaccompanied by changes in systemic arterial pressure. It is concluded that the terminal portion of the canine major pancreatic duct probably acts as a passive valve, the occlusive competence of which is influenced by the status of the vasculature of the lining mucosa in this region.


Combined irradiation and extensive operations in the treatment of stages I and II carcinoma of the cervix uteri. Since 1947, carcinoma of the cervix uteri, Stage I, has been treated at the Ochsner Clinic with intracavitary irradiation and a radical hysterectomy--Wertheim type--and pelvic node dissection. If metastasis to the lymph node is demonstrated, external irradiation is administered postoperatively. Carcinoma of the cervix uteri, Stage II, has been treated with intracavitary radium and external radiation, followed by the same surgical procedure. All patients were treated surgically, except those with medical conditions precluding extensive operation. Five and ten year survival rates for Stage I cancer were 81.5 and 68.7 per cent, respectively; for Stage II, these rates were 64.5 per cent and 54.0 per cent, respectively. There were moderate complications from the combined therapy, with a ureteral fistula rate of 1.9 per cent. Although the combined use of irradiation and operation for carcinoma of the cervix uteri has been looked upon in this country with disfavor because of poor healing and complications, we have not found this to be so. With improvement of both radiation therapy and surgical management, these patients can be offered treatment based upon sound physiologic principles and can live in freedom from fear of recurrence in later years. The outlook is good for continued improvement in the complication rate, surgical technique and possibly, chemotherapy.


Tuberculous peritonitis.

Tuberculous peritonitis. The records of 40 patients with tuberculous peritonitis treated at Charity Hospitals in Louisiana were reviewed. Thirty-nine patients were Negroes and 24, males. The average age was 36.5 years, with 22 of the patients being between the ages of 20 and 39 years. The most common symptoms were fever, abdominal pain, weight loss and abdominal swelling. The most frequent physical signs were abdominal tenderness, fever and ascites. Diagnosis was made by laparotomy in 24, peritoneoscopy in two, paracentesis in eight, autopsy in four and upon elective hernial repair in two. Four had a previous history of extra-abdominal tuberculous, four were known to have extra-abdominal tuberculosis at the time of diagnosis and four were found to have extra-abdominal tuberculous after the diagnosis of tuberculous peritonitis had been established. The follow-up interval averaged six and one-half years. Six patients died prior to discharge, and six patients died after discharge, none of the latter deaths was established as being due to tuberculosis. Twenty-two patients were alive at the end of the follow-up interval.


Splenorenal bypass in the treatment of stenosis of the renal artery. The over-all results obtained with splenorenal bypass in the treatment of 32 patients with renovascular hypertension were 17 patients cured, nine patients improved and six failures. Improved results were noted when splenorenal bypass was performed in relation to specific operative indications. The results were somewhat better for men than for women; however, poor results were obtained in children. Intraoperative and early postoperative complications were minimal, and there were two postoperative deaths. Late complications were limited to stenoses of the splenic artery graft which developed in three patients. When performed in relation to specific clinical and operative indications, splenorenal bypass represents an excellent means of achieving safe and effective renal revascularization.


Accuracy of roentgenograms of the chest in metastases to the lungs. The findings on roentgenographic and tomographic examination of the chest were compared in 63 instances of suspected pulmonary metastases. These were further compared with the findings at thoracotomy in 41 instances. Of the 60 patients, 30 had soft tissue or bone sarcomas and 30 had carcinomas arising from colon, ovary or breast, and it also included five with malignant melanoma. Three patients with sarcomas had more than one thoracotomy. The diagnosis of pulmonary metastases by roentgenography of the chest was correct in 60 of 63 instances. Tomograms showed more lesions in 14 of 33 instances of sarcomas and 14 of 30 instances of carcinomas. Thoracotomy revealed even more lesions than were detected by tomography in 21 out of 26 instances with sarcomas and eight of 15 instances of carcinomas. Of the 37 patients with a solitary metastasis detected on roentgenograms of the chest, 22 were found to have additional lesions on the tomograms, 11 of 16 sarcomas and 11 of 21 carcinomas. At thoracotomy, however, nine of ten patients with a single metastasis from sarcomas were found to have even more lesions, while, in patients with carcinomas, tomograms were found to be accurate. Routinely, prior to major ablative operations for sarcomas and before excision of pulmonary metastases, it is suggested that tomography be carried out.


Relative hemodynamic effectiveness of whole blood and plasma expanders in burned patients. In a series of nine fatally burned patients, hemodynamic and oxygen transport measurements were made before, during and after 56 administrations of 500 milliliters of whole blood or colloids and 1,000 milliliters of crystalloids. To enhance comparability, 38 of these studies were conducted at intervals on the same patient, the patient serving as his own control. The data indicate greater hemodynamic responses to colloids than to whole blood and greater responses to whole blood than to crystalloids when the latter was given at twice the volume as well as at four times the volume of the colloid. The data suggest that, in addition to replenishing salt and water, restoration of hemodynamic and oxygen transport variables may be accomplished by expansion of plasma volume with colloids and whole blood. Adequate nutrition is also needed for the increased metabolic needs of the burned patient. Without supplemental nutrition, high grade plasma proteins and tissue proteins may be expended as energy substrates; the lowering of plasma proteins tends to redistribute water from the plasma to the interstitial phase, which increases further the peripheral edema.


Aortocaval fistula detection using a Swan-Ganz catheter. The placement of a Swan-Ganz catheter into the abdominal vena cava by the femoral route is recommended for all patients presenting with severe congestive heart failure and an abdominal aortic aneurysm. If an aortocaval fistula exists, its presence can be determined immediately by noting increased vena caval pressure and higher than normal oxygen content. Immediate recognition of this condition is essential. Fluid overloading is avoided, immediate surgical treatment is instituted and the defect is closed. Minimal manipulation is done in an effort to prevent pulmonary embolization. If the results of catheter studies show no evidence of an aortocaval communication, it may be advisable to make an effort to correct the congestive heart failure before surgically correcting the aneurysm.


Traumatic intracerebral hematoma with stable neurological deficit. The possibility of an intracerebral hematoma may be overlooked in the presence of a "fixed" neurologic deficit. The clinical complex that is emphasized is composed of (a) ipsilateral cranial trauma, (b) early development of focal neurological deficit, (c) a plateau in the subsequent course of the disease, (d) the delayed appearance of a positive radioactive isotope scan, and (e) a focal area of distorted vessels in angiographic studies. The availability of the computer tomographic scan has made the diagnosis of intracerebral hematomas more certain but it is important that the possibility of a hematoma be considered and pertinent investigations be performed. Even after diagnosis, an operative procedure may be delayed in patients who are neurologically stable. In the five cases presented, the diagnosis of cerebral contusion led to a delay in operative evacuation which was associated with improvement in the previously stable neurological deficit.


Durometer for measurement of intracranial pressure. The tensity of the skin over a supratentorial craniectomy was measured with a durometer placed on the skin flap. Tensity values were obtained on 124 occasions in 28 patients in whom lumbar or intracranial pressure was being recorded simultaneously. Corrections were made for differences in the level of the durometer and the level at which the device measuring lumbar or intracranial pressure was placed. The skin tensity and lumbar or intracranial pressure were then correlated and the correlation studied statistically. It was found that the durometer could be used to predict quantitatively the intracranial pressure with a very low standard error (estimation of +/- 28 mmH2O). An experimental model confirmed these findings. The system was less accurate at pressure below 68 mmH2O and above 680 mmH2O.


Computerized tomography in Moyamoya syndrome. Twelve patients with Moyamoya syndrome were examined by computerized tomography (CT); nine children and three adults. In one patient, CT was normal. Significant abnormalities on the precontrast CT in the remaining 11 patients were: cortical atrophy with or without varying degree of ventricular dilatation, and irregularly shaped, various sized, often multiple or bilateral lucent foci in the cortex, subcortical white matter and the central gray matter. After contrast enhancement, no significant increase in the attenuation number was observed in and around the lucent foci except in one patient. In three patients, there was a slight increase in density in the central gray matter, however the increase in density was slight when the dense angiographic vascular networks in the basal ganglia were considered.


Motivation of university surgeons to achieve excellence in teaching. In view of the recent focus on the accountability of their commitment to teaching, university surgeons will have to rearrange their academic priorities to place teaching at the top of the list. Since excellence in medical teaching appears to be directly related not only to the motivation of the educator but to knowledge of the subject, we must retain our superiority as clinical surgeons and continue to pursue new scientific information by investigation. Inasmuch as the major reason for the low priority of teaching in our busy academic schedules is the difficulty of quantifying teaching excellence, I hope that the members of this Society will direct further attention to developing new evaluative approaches. The worthiness of our efforts toward motivating university surgeons of achieve excellence in teaching will be rewarded by the enhanced quality of the students into whose hands we place the future of surgery. I greatly appreciate this opportunity to express some of my concerns about the teaching effectiveness of university surgeons and hope that it may stimulate and challenge you to give a new vitality to teaching and to consider new approaches in surgical education. I believe that we should inspire each other to strive for excellence in education as well as in research and clinical care and to develop a deeper commitment and genuine concern for assuring that our students and residents learn what we have to teach.


Effect of proximal gastric vagotomy on gastric acid hypersecretion and hypergastrinemia after massive small bowel resection in dogs. Fasting and postprandial gastric acid secretion and gastrin were determined in Heidenhain pouch dogs before (C) and after (R) massive enterectomy (five dogs) and after additional proximal gastric vagotomy (PGV) in three dogs. Basal acid output was unchanged (C = 7 +/- 2 microneq/hour; R = 11 +/- 4 microneq/hour), but postprandially the hourly (third through eighth hour) and cumulative acid outputs (C = 3.6 +/- 0.3 mEq/8 hour; R = 7.2 +/- 0.4 MEq/8 hour) were significantly increased by resection (P less than 0.001). Similarly, fasting gastrin was unaltered by resection (C = 41 +/- 2 pg/ml; R = 46 +/- 8 pg/ml), whereas hourly gastrin concentrations significantly (P less than 0.05) exceeded control values. Increased gastrin correlated linearly (P less than 0.02) with increased acid output. After PGV, basal acid levels remained unchanged (R = 4 +/- 2 micronEq/hour; PGV = 9 +/- 4 micronEq/hour), but postprandial acid output significantly exceeded prevagotomy values at all time periods (P less than 0.05). Cumulative acid output also was increased (R = 6.8 +/- 0.6 MEq/8 hour; PGV = 11.2 +/- 0.6 mEq/8 hour; P less than 0.001). Serum gastrin, however, remained unchanged. Hypersecretion of acid from Heidenhain pouches after massive enterectomy is increased further by PGV without a concomitant increase in serum gastrin.


Effect of sodium ortho-iodobenzoate on oxygen transport and erythropoiesis in hypoxemic dogs with a right-to-left cardiac shunt. Eight dogs were made hypoxemic by surgical construction of a right-to-left cardiac shunt; and they were given sodium ortho-iodobenzoate (OISB) before and for 3 months after operation. The P(50) at 50% saturation) rose from 27.2 +/- 0.7 to 31.2 +/- 0.6 mm Hg (p less than 0.001) during OLSB treatment before operation and increased further to 32.2 +/- 0.8 mm Hg 3 months after creation of hypoxemia. The P(50) remained elevated for an additional 3 months after OISB was stopped. Administration of OISB before operation did not alter the red blood cell 2,3-diphosphoglycreate concentration. Hypoxemia caused an increase of this metabolite from 0.91 +/- 0.21 to 1.50 +/- 0.28 moles/moles of hemoglobin (p less than 0.05); the rise was not as great as that observed in hypoxemic dogs without OISB treatment. In spite of significant hypoxemia, hematocrit rose only slightly during the period of OISB infusion. OISB increased P50 and prevented the compensatory polycythemia regularly seen when dogs are made hypoxemic. Altering oxygen transport in this fashion may increase tissue oxygen delivery in patients with conditions which result in tissue hypoxia.


Independent preclerkship study: a five year experience. An independent study program (ISP) was instituted in 1970 for a group of 32 preclerkship medical students picked randomly from a group of 64 volunteers. The academic achievements of these classes, as measured by mean National Board scores, is compared with their classmates in the lecture discussion (LD) program where possible. The significant differences noted obtain even when the ISP students are compared only with LD students matched for premedical point-hour ratios and Medical College Admissions Test scores. These data attest to the overall success of the ISP program. The differences appear to us to be due mainly to factors related to motivation and maturity. The ease of preparations, convenience, and economy of the associated computer-assisted instruction make these methods attractive for use in residency training and continuing medical education where maturity and motivation may well be presumed.


Effect of alcohol on the release of secretin and pancreatic secretion. The effect of alcohol on the release of secretin was studied in man by radioimmunoassay, and in dogs and cats by radioimmunoassay and bioassay (secretion of water and bicarbonate by the pancreas). In man plasma secretin levels increased significantly from a basal of 121 +/- 14 to 164 +/- 24 pg/ml at 60 minutes after oral ingestion of alcohol. Intraduodenal administration of alcohol in man, dogs, and cats did not release secretin or affect pancreatic water and bicarbonate secretion in dogs and cats, but a moderate increase in pancreatic protein output was observed in these two species. Plasma gastrin levels rose significantly from a basal of 52 +/- 4 to 64 +/- 3 pg/ml after ingestion of alcohol in man and from 33 +/- 5 to 51 +/- 8 pg/ml after administration of alcohol into the stomach of dogs. Administration of alcohol into the duodenum in man, dogs, and cats did not release gastrin. We conclude that alcohol probably does not release secretin directly. The mechanism of release of secretin in man is unknown; it clearly involves the stomach and may be mediated via the release of gastric acid.


Prolongation of survival of rat parathyroid allografts by enhancing serum and tissue culture. To determine whether survival of allografted rat parathyroid tissue could be enhanced either by the administration of antidonor serum (enhancing serum) or by tissue culture of the graft, parathyroids from Lewis x Brown Norway F1 (LBNF1) rats were transplanted beneath the fascia and between hamstring muscle fibers of hypocalcemic parathyroidectomized Lewis recipients (serum calcium 4.3 +/- 0.13mg%--mean +/- SEM). A drop in serum calcium below 7.5 mg% indicated rejection. Seven group 1 rats that received isogeneic parathyroids recovered from their hypocalcemic state and remained normocalcemic indefinitely. Seven group 2 rats that received LBNF(1) parathyroids experienced a reduced mean maximal response (MMR) of calcium increase of 4.1 +/- 0.2 mg% and the grafts had a median survival time (MST) of 16.0 +/- 1.32 days. Group 3 rats that received 1 ml of enhancing serum by intraperiotoneal injection, cytotoxic titer 1:128, on alternate days for five doses experienced an MMR of 5.0 +/- 0.7 mg% and had an MST of 19.3 +/- 1.07 days. When enhancing serum, cytotoxic titer 1:256, was administered to group 4, the MST of the grafts was increased to 29.7 +/- 1.19 days. When LBNF(1) parathyroid tissue was preserved in tissue culture for 14 to 21 days and then transplanted into Lewis recipients, the MST was 22.5 +/- 1.48 days. The administration of enhancing serum to recipients of cultured parathyroids further extended graft survival, MST 57.5 +/- 2.32 days. In summary, survival of allografted parathyroid tissue can be prolonged by the administration of enchancing serum or tissue culture of the graft. When enhancing serum was administered to recipients of cultured allografted parathyroid tissue, survival was further increased.


Pathophysiology and significance of malabsorption after Roux-en-Y reconstruction. Extensive metabolic studies were conducted in five normal controls and in five study patients after total gastric resection with Roux-en-Y (RY) reconstruction to determine the nutritional consequences of this particular technique of restoring gastrointestinal continuity. Although malabsorption of fat (19.2 +/- 2.2%) and nitrogen (22 +/- 2.5%) demonstrated in the study patients was moderate, it was significantly greater than normal ( less than 0.01). In spite of the demonstrated malabsorption, however, positive nitrogen balances (+ 0.33 +/- 0.18 gm/day) were maintained in the RY patients throughout the investigative period. These observations suggest that malabsorption after RY is infrequently of clinical significance, even in this "worst-case" situation characterized by complete removal of gastric tissue. Malnutrition should occur in only those patients with more limited gastric resections and RY reconstruction who are unable to increase caloric intake to cover losses due to malabsorption. A significant decrease in both trypsin and lipase concentrations and a marked delay in secretion of these enzymes was noted in the RY patients in response to a test meal (p less than 0.01). Malabsorption of fat and nitrogen in RY patients improved after exogenous pancreatic enzymes, but not after administration of tetracycline. Bacterial overgrowth as a cause of postoperative malabsorption may be less important than previously thought. Malabsorption after RY is due primarily to maldigestion brought about by duodenal bypass which, in turn, results in either an absolute or a relative pancreatic enzyme insufficiency.


Increased hepatic synthesis of cholesterol following jejunoileal bypass. Fatty infiltration of liver and formation of cholesterol stones are significant problems following jejunoileal bypass for morbid obesity. This report evaluates hepatic lipid metabolism and fat absorption in genetically obese, bypassed, and lean Zucker rats. Ninety percent jejunoileal bypass was performed in 12 (500 grams) obese rats (BP). Similar numbers of unoperated "fat rats" (FR) and lean litter mates (LR) were controls. Food consumption, weight gain or loss, and fecal fat were evaluated. At 4 weeks serum triglycerides, hepatic cholesterol, total lipids, triglycerides, and hepatic synthesis of fatty acids and cholesterol were measured in vivo. Food intake was excessive in FR's (23.8 +/- 0.7 gm/day), decreased in BP (18.3 +/- 2.3 gm/day), and lowest in LRss ( less than 0.05) and excessive fecal fat excretion (p less than 0.05). Serum triglycerides were elevated in FR's (284 +/- 32 mg/dl), reduced in BP rats (148 +/- 20 mg/dl) (p less than 0.05), and low in LR's (86 +/- 16 mg/dl). Total hepatic lipids, triglycerides, and hepatic synthesis of fatty acids were elevated in FR's (p less than 0.05) and were unchanged by bypass. Hepatic cholesterol was similar in all groups. Hepatic synthesis of cholesterol, however, was increased significantly in bypassed rats (p less than 0.05), (BP--102 +/- 22 micronnmole/"C2"/minute/gm, FR--39 +/- 6.0, LR--30 +/- 4.0). Jejunolileal bypass in FR's results in weight loss, decreased food intake, increased fecal fat, decreased serum triglycerides, and increased hepatic synthesis of cholesterol. Bypass had little effect on reducing elevated hepatic lipids, triglycerides, or fatty acid synthesis in FR's. These data suggest that following bypass increased hepatic cholesterol synthesis (as a precursor for bile acids) is related to interruption of the enterohepatic circulation and bile salt pool depletion. This implies that excess synthesis of hepatic cholesterol results in supersaturation of bile which is choletithocenic and may explein in part the increased incidence of gall stones observed following jejunoileal bypass.


Fate of prostaglandins E(1) and A(1) in the human pulmonary circulation. It is recognized that the lung extracts norepinephrine and 5-hydroxytryptamine from the pulmonary circulation and that this process is affected by cardiopulmonary bypass. Since alterations in the lung's processing of vasoactive substances may be a mechanism of pulmonary injury sustained during operation, we investigated the lung's ability to extract or metabolize prostaglandin A1 (ga1) and prostaglandin E1 (PGE 1). Sixteen patients undergoing cardiac surgery were studied. In five patients, just before going on bypass, a 10 ml of blood was withdrawn at a constant rate, simultaneously from the pulmonary artery and left atrium. In 11 patients, 3H-PGE1 was injected just prior to bypass and, in five of these, again after coming off bypass. Extraction was calculated from tritium activity in the samples. Metabolites were quantitated by thin-layer chromatography after being identified by marker compounds run simultaneously in each chromatogram. The pulmonary extraction of PGA1 was 11.3 +/- 2.3% and there were no detectable metabolites in left atrial blood. Before bypass the extraction of PGE1 was 42.3 +/- 14.3% and after bypass 24.8 +/- 10.0% (P less than 0.005; Student's paired t test). PGE1 was extensively metabolized with 79.7 +/- 7.1% of total radioactivity appearing in the left atrium as metabolites before bypass and 89.1 +/- 2.0% appearing after bypass. This study indicates that PGA(1) is not metabolized by the lung and is only slightly extracted. On the other hand, PGE(1) is extensively extracted and metabolized. While the rate of metabolism is not significantly affected by cardiopulmonary bypass, the extractiom before bypass was significantly greater than after bypass.


[Displacement of the bovine abomasum: effect of the diet on the composition of the rumen fluid and that of the contents of the abomasum and duodenum (author's transl)]. High-concentrate diets apparently inhibit abomasal motility by increasing the amount of volatile fatty acids (VFFA) which enter the abomasum. This report is concerned with a study of cows fitted with ruminal, abomasal and duodenal cannulae after feeding hay ad lib. and a diet consisting of hay and concentrates. Ruminal, abomasal and duodenal samples were analyzed before and after feeding. It was shown that a considerable increase in ruminal VFFA concentrations was not followed by a subsequent increase in abomasal VFFA concentrations. Differences in abomasal VFFA levels between the two rations were not observed. The VFFA concentrations in the duodenal fluid continued to be low and did not attain levels capable of affecting abomasal motility. The changes in pH level and in the sodium, potassium and chloride concentrations after feeding were also recorded. There were significant differences in the electrolyte concentrations of the ruminal, abomasal and duodenal contents between the rations before and after feeding. Part of these differences could be accounted for by findings reported in the literature.


[Marginal notes on the paper on tuberculosis among Japanese deer in a deer-park in Goes (author's transl)]. A few marginal notes and a review of the literature on tuberculosis among Cervidae with reference to the outbreak of tuberculosis among Japanese deer in a deer-park recently established in Goes, which was detected by the Animal Health Service in the Province of Zealand in 1971. Particular attention is paid to recent enzootics of bovine as well as of avian tuberculosis. This shows that restrictions on commercial and barter transactions, to be imposed by the authorities, are required. The fact is also stressed that methods of prevention and treatment adopted in ruminants in zoological gardens are contra-indicated. If the breeding of particular species of deer should expand because of the growing demand for venison, some supervision by or in behalf of the authorities would appear to be essential. As the method adopted in the treatment of ruminants is not sure to be definitely successful, this procedure, like vaccination, should be dispensed with.


Radioimmunoassay for etiocholanolone.

Radioimmunoassay for etiocholanolone. A sensitive and reliable radioimmunoassay for serum unconjugated etiocholanolone (3alpha-hydroxy-5beta-androstan-17-one) is reported. The antiserum was obtained from rabbits by immunization of etiocholanolone-17-(O-carboxymethyl) oxime [CMO]-bovine serum albumin [BSA]. Two ml of serum with 3H-etiocholanolone added for recovery was extracted with ether, and etiocholanolone was separated from cross-reacting steroids by Sephadex LH-20 column chromatography. The mean recovery after extraction and chromatography was 80.7 +/- 6.8 (S.D.)%. The sensitivity of the assay was less than 40 pg. The intraassay and interassay coefficients of variation were 9.2% and 10.9%, respectively. The mean of serum unconjugated etiocholanolone concentration determined by the present method was 0.39 +/- 0.10 (S.D.) ng/ml (n = 50) in normal men and 0.36 +/- 0.08 (S.D.) ng/ml (n = 20) in women in the follicular phase of the menstrual cycle.


Binding of glucocorticoids to liver nuclei and chromatin of fetal, immature and adult rats. The interaction of dexamethasone with nuclei and chromatin was investigated following incubation of liver slices from fetal, immature (6-day-old) and adult rats with the labeled steroid at 37 degrees. The number of specific binding sites for dexamethasone in purified liver nuclei increases with the age of the animal in a manner similar to that previously reported for the cytoplasmic receptor. The high affinity nuclear binding approaches saturation at 40 and 500 nM dexamethasone in fetal and adult liver, respectively. In comparison with dexamethasone, the relative efficiency of corticosterone to accumulate in the nucleus is 9 percent in fetal liver and only 1 percent in adult liver. Specifically bound dexamethasone in adult nuclei exists in at least three forms; a Tris-soluble, a KC1-soluble, and a residual (non-extractable with KC1 or DNase) form. Part of the Tris-soluble steroid is associated with macromolecules sedimenting at about 4 S both in the presence and absence of 0.4 M KC1. This form of the receptor was not detected in fetal liver nuclei. In liver chromatin, bound dexamethasone exists in a KC1-soluble and a residual form, the latter comprising the major fraction of steroid associated with chromatin from both fetal and adult tissue (60 and 75 percent, respectively). Treatment with Triton X-100 releases about 20 percent of the radioactivity in adult liver nuclei, but has no effect on fetal liver nuclei. In contrast with the above observations in the intact tissue, the major fraction of steroid bound to chromatin in cell-free systems is KC1- and DNase-soluble, only 30 percent remaining in the residual pellet.


Evidence for macromolecular synthesis in stimulation of the estrogen synthesizing system of the immature rat ovary by PMS. Exposure of immature rat ovaries to pregnant mare's serum gonadotropin (PMS) results in a prompt increase in testosterone and progesterone output but synthesis of estradiol (E2) increases only after a lag period of several hours. Actinomycin D (Act-D) given with PMS did not inhibit testosterone or progesterone production but the estrogenic response was prevented. Delay in administration of the Act-D until 12 hr after PMS resulted in a transient increase in E2 secretion lasting less than 12 hrs. When Act-D was given 12, 16 or 20 hrs after PMS, and ovarian steroid production measured by a one hr incubation, no inhibition of progesterone, testosterone or E2 was found; the synthesis of the latter two steroids was increased by the drug. Cycloheximide, on the other hand, was most effective at inhibiting testosterone and E2 production when it was given at 12 hrs; the drug was progressively less effective in lowering production of these steroids when it was given at 16 or 20 hrs. Cycloheximide did not alter progesterone production unless it was given at the same time as PMS. The results are consistent with the view that the induction of the estrogen synthesizing system of the immature rat ovary by gonadotropin involves, during the first 12 hrs, production of a material sensitive to Act-D inhibition (mRNA?) and then production of a material sensitive to cycloheximide inhibition (protein-enzymes?). The continued production of both of these materials appears to require the continual presence of gonadotropin.


A radioimmunoassay for 11-oxotestosterone: its application in the measurement of levels in blood serum of rainbow trout (S. Gairdneri). 17beta-Hydroxyandrost-4-ene-3,11-dione was linked via its 3-(O-carboxymethyl) oxime to bovine serum albumin to give a conjugate which was used to generate antiserum in rabbits. The antiserum, at an overall dilution of 1 in 16,000, together with [1,2-3H] 17beta-hydroxyandrost-4-ene-3,11-dione synthesized from [1,2-3H] cortisone have been used to develop a radioimmunoassay for the parent steroid. The assay incorporates a purification step in which serum or plasma extracts are chromatographed on silica gel layers bound to plastic or aluminum sheets and the steroid containing zones cut out and eluted directly with assay buffer. The cross-reactivities of several steroids with the antiserum and the specificity, sensitivity, accuracy and precision of the assay are described. Blood sera from immature male rainbow trout contain ca 0.2-0.4 mature, serum levels rise sharply to reach values of 2 to greater than 9 microng/100 ml of 17beta-hydroxyandrost-4-ene-3,11 dione. As male fish mature, serum levels rise sharply to reach values of 2 to greater than 9 microng/100 ml. Levels in immature females rarely exceeded the assay sensitivity but serum from three ripe females showed low but detectable levels (ca 0.2 microng/100 ml) of steroid. The assay has found application in sexing live fish for experimental purposes.


Epidemiological investigation of cerebrovascular disease in Iceland, 1958-1968 (ages 0-35 years): a total population survey. This study was undertaken to estimate the incidence of cerebrovascular disease in the age group 0-35 years in the population of Iceland during the 11 year period 1958 through 1968. The incidence for the whole country was 7.9/100,000-- males 7.5 and females 8.4. The incidence in Reykjavik, 8.3/100,000, was not significantly different from the rest of the country (7.2/100,000)nor was there any significant difference between the sexes. Comparison is made with similar studies.


Use of hydrogen for measurement of regional cerebral blood flow: problem of intercompartmental diffusion. The extreme diffusibility of hydrogen, compared with xenon or krypton, may create serious artifacts when it is used to measure local blood flow with a tissue electrode. The errors are greatest when hydrogen is given by intra-arterial slug injection, and when the electrode is within 2mm of another tissue compartment, CSF,  or air. These all appear to be a consequence of intercompartmental diffusion which can occur at rates of the same order of magnitude as clearance from the tissue by blood flow. No matter how small the electrode, the ultimate spatial resolution of the method appears to be about 2mm unless quantitative account is taken of diffusion. An important precaution in use of the method is to obtain homogeneous tissue saturation by prolonged inhalation administration.


Study of blood pyruvic acid levels in pellagrins with and without neurological manifestations and response to nicotinic acid therapy. In 25 cases of pellagra and 10 healthy controls, the blood pyruvic acid levels in the fasting stage and after 60 and 90 minutes of glucose load were estimated by the technique of Friedmann & Haugen (1943). The blood pyruvic acid levels after 60 and 90 minutes of glucose load were significantly higher in pellagrins as compared to controls. The following conclusions were drawn from this study: (i) that there is impairment of pyruvic acid metabolism in cases of pellagra, which is more marked in pellagrins with neurological manifestations than in those without; (ii) that after administration of nicotinic acid alone for 15 days the pyruvic acid levels returned to normal, thereby indicating that nicotinic acid deficiency is the cause of deranged pyruvate metabolism; (iii) that there is significant improvement in neurological status after nicotinic acid therapy.


Skin tests in Nigerian asthmatics from the equatorial forest zone in Benin, Nigeria. Forty-two patients with bronchial asthma from the Benin area and 32 control subjects were subjected to skin prick tests for groups of allergens. There was a significant excess of reactions of 5 mm or over to Dermatophagoides farinae amongst the asthmatics. This was the most commonly detected allergen. There was an overall excess in asthmatics of positive reactions of over 5 mm in the other groups although there was no significant excess in any single group. There was no significant difference in the weaker skin reactions (less than 5 mm between) asthmatics and controls. From clinical histories most precipitating factors known to patients were probably non-allergic in origin, exercise, irritant odours, dust and climatic changes being the commonest. Sets of allergens specially prepared for West Africa would be valuable for skin testing asthmatics in this environment.


Spectrum subtraction technique for minimizing extracranial influence on cerebral blood flow measurements by 133xenon inhalation. Estimates of regional cerebral blood flow (rCBF) by the 133Xe inhalation method are influenced by isotope contamination from slow clearing extracerebral tissues. Subtraction of x-ray (31 kev) from gamma-ray counts (81 kev) has been suggested as a means of yielding clearance curves that are relatively free of such contamination. In the present study, rCBF measurements based on the total 133Xe spectrum (x-ray plus gamma) were compared with those derived from the subtracted spectrum (x-ray minus gamma) in 20 young controls, using a two-compartmental analysis of the clearance curves. In comparison with addition, the subtraction data gave substantially higher estimates of blood flow for the slow (second) compartment. This, along with a shift in the relative weights of the two compartments, indicated a decreased contribution of slow tissue components, consistent with a reduction in extracerebral contamination. Blood flow values obtained by subtraction were in good agreement with those reported for the intracarotid injection method. A limitation of the subtraction technique, however, is the relatively high dose of isotope required for adequate signal-to-noise ratios.


Louse-borne relapsing fever: I. A clinical and laboratory study of 363 cases in the Sudan. Louse-borne relapsing fever seems to have become endemic in the southern Sudan. The epidemic history of the disease in the Sudan is reviewed. We have studied 363 Sudanese patients involved in an outbreak of louse-borne relapsing fever in Khartoum (Sudan) between January and June 1974. 318 of the 363 patients were new immigrants from the soughern Sudan to Khartoum. The clinical presentation varied. The common clinical fetures of the disease were: fever (94%), headache (85%), hepatosplenomegaly (74%), body and joint pains (66%), abdominal pain and tenderness (63%), jaundice (46%) and epistaxis (40%). Thrombocytopenia was common. Biochemical evidence of hepatocellular and renal damage was present in most patients. The mortality rate was 5-5% with treatment. Post-mortem examination was performed on six cases. The organs predominantly involved were the liver, spleen, brain and lungs. The common causes of death were severe hepatic damage, lobar pneumonia, subarachnoid haemorrhage and splenic rupture.


Louse-borne relapsing fever: II. Combined penicillin and tetracycline therapy in 160 Sudanese patients. One hundred and sixty patients with louse-borne relapsing fever were treated with a combination therapy of procaine penicillin and tetracycline. Fortified procaine penicillin B.P. was given as 400,000 units in the first day. This was followed the next day by 2 g tetracycline orally in divided doses for seven days. A mild rise in temperature was observed in 22 (13-7%) patients within four hours of administering penicillin. Rigors and hypotension occurred in one patient. Relapse occurred in two patients, of whom one had concomitant typhoid and one visceral leishmaniasis. The combined therapy has been found to be effective and safe. It lacks the disadvantages of penicillin (relapses) and tetracycline (severe reaction), when each drug is used alone.


Possible prevention of brain stem stroke by microvascular anastomosis in the vertebrobasilar system. Four patients with symptoms and signs of brain stem ischemia due to occlusive disease of the vertebrobasilar system and one patient with similar cerebrovascular disease who was thought to be prone to brain stem stroke underwent a microvascular anastomosis between the occipital artery and the caudal loop of the posterior inferior cerebellar artery. There was no morbidity of mortality and neurologically all patients improved. Post-operative angiograms showed patent anastomosis in all the patients and improved circulation in three. This new operation may prove beneficial in a selected group of stroke patients who suffer from vertebrobasilar insufficiency and cannot be treated with gross surgical techniques.


Sudden death from stroke.

Sudden death from stroke. Sudden death is defined as any death that occurs less than 24 hours after the onset of first symptoms. Strokes account for 10 to 20% of all sudden deaths. The records of all residents of Rochester, Minn., who had their first stroke during the period 1955 through 1969 were analyzed. Among 255 deaths caused by the first stroke, 52 were sudden. Twenty-six of the deaths were due to primary intracerebral hemorrhage, and 20 to primary subarachnoid hemorrhage. Only two of the sudden deaths were caused by infarction: one by pontine and cerebellar infarct and the second by a cortical infarct, which resulted in death from status epilepticus. Among the nine patients who died within 2 hours of the onset of symptoms, six had primary subarachnoid hemorrhage. Hypertension was noted in 23 of the 26 patients (88%) who died of primary intracerebral hemorrhage; 8 patients with primary intracerebral hemorrhage were on long-term oral anticoagulant therapy, and all 8 were hypertensive.


Cardiac and pulmonary involvement in leptospirosis. The clinico-pathological features of cardiac and pulmonary involvement were studied in seven cases of fatal leptospirosis. Petechial haemorrhages occurred in the heart and pericardium in all cases with blood-stained pericardial effusions in five. Interstitial myocarditis was noted in five patients and probably caused the changing electrocardiographic abnormalities and clinical cardiovascular effects during the illness. Sub-pleural and intrapulmonary haemorrhages occurred in all seven cases with pleural effusions in four. Pulmonary oedema was a striking feature during the early stages of the illness, while in patients surviving the first week of the disease infiltrative and proliferative lesions were common. The latter type of pulmonary changes occurred at a stage when acute renal failure was improving and were not related to the presence and severity of jaundice. The clinico-pathological profile of pulmonary involvement in leptospirosis appears to fall into an adult respiratory distress syndrome and, when present, carries a serious prognosis and would then be a prime factor in mortality. As clinical manifestations of pulmonary involvement appear late during the clinical illness and may be of abrupt onset, auscultatory and radiological surveillance becomes mandatory in severe leptospiral infections.


Effect of sulfinpyrazone on platelet survival time in patients with transient cerebral ischemic attacks. Platelet suppressant drugs have been suggested as beneficial for patients with transient cerebral ischemic attacks and these drugs have been shown to lengthen shortened platelet survival time. In the present study platelet survival time (autologous labeling with 51Chromium) was measured in 25 patients with transient cerebral ischemia involving a carotid distribution. Platelet survival was shortened in all patients (2.5 +/- 0.10 days; AVE t 1/2 +/- SEM; Normal 3.7 +/- 0.04 days P less than 0.001). Sulfinpyrazone increased platelet survival in 9 of 19 (47%) of patients (2.4 +/- 0.10 to 2.8 +/- 0.16 days; P less than 0.01). Of the 19 treated with sulfinpyrazone, 10 had a marked reduction in the frequency of transient ischemic episodes and an increased in platelet survival (2.6 +/- 0.16 to 3.1 +/- 0.22 days; P less than 0.01) was observed in all patients. Three patients had no benefit from sulfinpyrazone and alteration of platelet survival did not occur. Results suggest that platelet survival is shortened in patients with transient cerebral ischemia, that sulfinpyrazone increases platelet curvival and may decrease the frequency of ischemic episodes, and that there may be a relationship between clinical benefit and alteration of platelet survival time.


Studies on Mediterranean leishmaniasis: V.A. preliminary epidemiological survey of human leishmaniasis in Tuscany. Leishmanin skin testing was performed on 1,285 people in the Tuscany region of Italy. In a known endemic area for leishmaniasis there was an increasing positivity with age, while in another area the curve was bell-shaped suggesting an interruption of transmission in the recent past. In all areas the positivity rate for males was higher than for females, but it was not possible to distinguish between areas of cutaneous and visceral disease.


Central dual innervation of arterioles and capillaries in the brain. Fluorescence-and electron-microscopic studies were performed on nerve terminals close to intracerebral blood vessels in the rat. For the electron microscope subdural perfusion fixation with potassium permanganate was used. In the rat cerebral cortex deprived of the bilateral superior cervical ganglion some aminergic terminal boutons containing large and small core vesicles were observed contiguous to blood vessels. These terminals abutted on the capillary basement membrane. Since these terminals are found in the rat after bilateral superior cervical ganglion exision, they probably originate from central catecholaminergic neurons in the brain stem. These findings suggest that central aminergic neurons might play some role in cerebral blood flow regulation. In addition to aminergic terminal boutons, non-aminergic nerve terminals containing non-core vesicles also ended in the capillaries. Cerebral capillaries also have central dual innervation, aminergic and cholinergic, and dual peripheral innervation by sympathetic and parasympathetic fibers.


[On the distribution of the lung flukes, Paragonimus africanus and P. uterobilateralis, in the South West Province of Cameroon and in Eastern Nigeria as determined by examination of the intermediate crab hosts for infection with metacercariae (author's transl)]. During 1973-75 the distribution of the lung flukes, Paragonimus africanus and P. uterobilateralis, was studied in South West-Cameroon and in Eastern Nigeria, on the basis of parasitological examinations of the intermediate crab hosts Sudanonautes africanus, S. pelii, and S. aubryi, belonging to the family Potamonidae. 1000 freashwater crabs from 80 localities were examined for prevalence and intensity of infection with Paragonimus methacercariae. In Cameroon S. pelii was found to be a new intermediate host for P. uterobilateralis, and S. aubryi a new host for P. africanus. The morphology, behavior, and habitats of the crabs are summarized. In Eastern Nigeria only metacercariae of P. uterobilateralis were found. The main endemic area was located in the basin of the upper Imo River. Outside this area infected crabs were found only in and around Arochukwu, in the lower tributaries of the Cross River. This distribution differs from that given by Nwokolo (1974), which was based on the origin of clinical cases. These differences are discussed. In South West-Cameroon both Paragonimus species were found. The highest prevalence and intensity of metacercariae of P. africanus was seen in certain tributaries of the Mungo River in the area of Lower Bakossi. Proceeding northwards towards Mamfe, infections with P. africanus decreased steadily, whereas infections with P. uterobilateralis increased. On the upper reaches of the Cross River from the region around Mamfe and extending as far as the Nigerian fronter at Ekok, the crabs were infected exclusively with P. uterobilateralis. The unexplored mildle reaches of the Cross River may form a bridge between the endemic areas of this lung fluke in Nigeria and Cameroon.


Electrophoretic characterization of small free-living Amoebae. Disc electrophoresis was employed in an attempt to determine its usefulness as a means of differentiating and classifying some free-living species of amoebae. The Rp values and the percentage of similarity of the protein bands were used as taxonomic criteria. Some species of the genera Hartmanella and Naegleria were examined. The protein patterns of all species studied were highly reproducible. Four strains of Hartmannella castellanii showed an absolute identity to the original H. castellanii strain. One strain isolated by Neff and H. rhysodes were similar to all the other strains although their protein patten were not completely identical. On the other hand, H. culbertsoni, H. astronyxis and H. lammellipodia were different from all the other examined species of Hartmannella. Pathogenic N. fowleri-strains were identical to each other and were different in their protein patterns from non-pathogenic N. gruberi strain. The similarities and differences of protein bands of strains of ameobae and their correlations with other attributes were discussed. The results have shown that the disc electrophoresis appears useful in differentiating between species of Hartmannella and Naegleria.


Comparison of nerves to cerebral and extracerebral blood vessels: a differential effect of alpha methyl tyrosine on norepinephrine content. Alpha methyl tryosine (AMT), and inhibitor of norepinephrine (NOR) synthesis, was injected intraperitoneally (200 mg/kg) in Sprague Dawley rats, kept in a cold room, or at room temperature for 16 hours. Using formaldehyde induced NOR fluorescence, nerve counts were made on whole mounts of cerebral and femoral arterioles 14-300 micronm in diameter, utilizing a grid superimposed on the vessels. Cold had no effect on the number of visible (i.e. fluorescing) nerves. AMT had an appreciable effect but only on nerves to femoral arterioles, where a significant reduction in nerve count was observed in both cold stressed and non stressed rates, when compared with animals not given AMT. Since the counting technique is sensitive only to large depletions of NOR, we cannot conclude that AMT failed to affect NOR content in cerebrovascular nerves. However, if such an effect was present, it was much less than the effect of AMT on nerves to femoral vessels. We suggest that the differential effect of AMT on these 2 vascular beds may indicate a lower basal level of NOR release from cerebrovascular nerves, which would correlate with the difficulty of demonstrating basal sympathetic tone in this vascular bed.


Autogeny in diverse populations of Aedes aegypti from East Africa. Autogeny in Aedes aegypti was found in many diverse populations throughout the range of East Africa. Degree of autogeny is proposed to be measured either by a relative method using an autogeny index (AIX), or by direct count of eggs in dissected ovaries and expressed in percentage. Degree of autogeny varied from population to population but it was always higher in the dark feral Ae. aegypti formosus than in the domestic Ae. aegypti aegypti form. The highest degree of autogeny occurred in the dark form frm Uganda, where in some populations it was as high as 34%. Some autogenous females have a tendency to retain fully developed eggs in their ovaries up to 4 weeks for later oviposition. At the beginning of oogenesis, the autogenous females deposit yolk granuli in many follicles. As soon as the follicles reach the resting stage, translocation of yolk from many to few follicles takes place. The number of eggs developed autogenously depends on the level of nutritional reserves carried by the females from the larval stage. Autogeny could possible serve as one of the preservation mechanisms of haematophagous species when hosts are not available. The vectorial capacity of autogenous populations of Ae. aegypti for transmission of pathogens is substantially lower than anautogenous ones because of their nonhaematophagous feeding behavior at the first gonotrophic cycle and shorter survival of females.


Studies on the attraction of Simulium damnosum s.l. (Diptera: Simuliidae) to its hosts. II. The nature of substances on the human skin responsible for atrractant olfactory stimuli. In the Cameroon rain-forest, electric fan traps, baited with trousers which had been worn by men for several days, captured more females of S. damnosum s.l. than did traps baited with worn shirts of similar material. A number of human body fluids were used as bait, but only sweat appeared to contain the olfactory attractant(s). The fluid portion of filtered arm sweat attracted more flies than did the residue. The attractant substances from human skin would not dissolve directly in organic solvents, but when an artificial sweat solution was used to swab men's arms and legs, and this was then saturated with salt and shaken with an organic solvent, the extract was attractive to S. damnosum. Treatment of attractive worn cloths with dilute aqueous solutions of hydrochloric acid, sodium hydroxide or mercuric chloride greatly reduced their attractiveness. A number of organic compounds which occur on the human skin were found to be ineffective as attractants.


Spectral analysis of Doppler ultrasonic decompression data. Several aspects of spectral analysis of bubble transients in Doppler ultrasonic decompression data are discussed. The computation of energy density spectra, using fast Fourier transform techniques for analyzing bubble transients, is described. Spectral analysis of data from probes implanted within animals, using a conventional Fourier analyzer, provided good visual indications of bubble events and interesting changes in spectral structure. A new transient spectral analysis technique that is suitable for quantitative real-time monitoring of small decompression bubbles is described. In a feasibility study using data from an implanted probe, an increase of 900% in bubble signal/noise ratio was observed.


The aqueduct echo method applied to brain stem tumours. Echoencephalography of the posterior fossa was performed in nine cases of brain stem lesion. In all instances a dorsal displacement of the cerebral aqueduct was disclosed by means of the aqueduct echo method. The quantitative displacement was expressed by the A:B ratio method and found to agree well with calculations from corresponding pneumoencephalography.


Penetrating high-velocity genitourinary injuries. Part II: Ureteral, lower tract, and genital wounds. Penetrating ureteral wounds appear to occur at a constant low rate and demand internal splinting without ureterotomy drainage in the multiple-injured patient. Concomitant upper urinary tract and colonic or pancreatic injury absolutely requires the use of nephrostomy drainage. Most prostatic or prostatomembranous rupture can be approached retropubically, or if extensive tissue damage and uncontrollable hemorrhage are present, by transpubic methods. Intravesical fixation of the prostatomembranous rupture provides the best anchorage and approximation. Rectoprostatic-bladder wounds should be approached suprapubically and may be drained transcoccygeally also. Section of the obturator nerve may provide postoperative pain relief in severe pubic ramus fractures. Small high-velocity entrance wounds in the external genitalia warrant exploration because of great internal disruption. The skin of the external genitalia should be closed primarily.


Follow-up of patients after nephrectomy for renal cell carcinoma. Follow-up of patients after nephrectomy for renal cell carcinoma is often inadequate. The sooner secondary lesions are identified and treated the better. Routine annual admission of these patients is urged for abdominal angiography, bone scan, chest roentgenograms, and specialized diagnostic procedures as indicated.


Polyglactin 910 suture in urinary tract. Cystotomies in guinea pigs and ureteral anastomoses in dogs were sutured with polyglactin 910. Silk and chromic catgut were used as control sutures in the bladders and chromic catgut in the ureters. Three months postoperatively in bladders sutured with polyglactin 910 small epithelial cysts were noted, which increased in size with time. In ureters sutured with polyglactin 910 cystic diverticula were observed eight months postoperatively. Because of the difference of tissue reaction to polyglactin 910 compared with catgut, further long-term studies are urged in different species of animals, prior to the clinical use of polyglactin 910 in the urinary tract.


Urinary amino acid excretion: comparison of normal individuals and patients with bladder cancer. The excretion levels of urinary amino acids obtained from acid hydrolysates were studied by gas chromatographic analysis in 29 normal individuals and 118 patients with bladder carcinoma. Leucine and isoleucine excretion were elevated in patients with bladder carcinoma as compared with normal subjects under the same experimental condition. Mathematical computer-assisted programs developed to aid in determining clusters of amino acid variables suggested that excretion of glycine, leucine, proline, and glutamic acid in men and concentrations of valine, serine, aspartic acid, phenylalanine, and lysine in women vary according to the invasiveness of the disease. These findings suggest that measurements of urinary amino acids may provide a useful parameter for the detection and aid in the staging of bladder carcinoma.


Small vesicovaginal fistula.

Small vesicovaginal fistula. A simple method of curettage of the fistulous tract, using an ordinary metal screw, has been successful in the cure of certain types of vesicovaginal fistulas. This technique applies to small, high, usually postoperative vesicovaginal fistulas in which the tissue appears normal and in which there is good blood supply and no evidence of scarring or inflammatory reaction. By curetting and removing the epithelium of the fistulous tract, the tissues will follow their normal tendency toward healing and a good chance of closure of the fistula is thereby present. The main virtues of this procedure are its simplicity, the minimal risk involved, the short hospitalization time, and the fact that there is no delay in the performance of the standard type of excisional operation in case of failure. Three cases are reported.


Traumatic vesicourethral fistula: unusual case of male urinary incontinence. The usual cause of urinary incontinence secondary to pelvic trauma is damage to the sphincter mechanism in the prostatic urethra. A case is presented of an unusual and correctable cause of incontinence, vesicourethral fistula. This complication can probably be prevented by adequate debridement, drainage, and diversion.