Development of Meissner corpuscle of mouse toe pad. The cytologic development of Meissner corpuscles of the mouse toe pad has been studied using light and electron microscopy, and correlated with silver impregnations of frozen sections. By 18 days of gestation, neurites are seen near the epidermis, but intraepidermal neurites are few. One day after birth, the number of intraepidermal neurites increases, and some accompanying Schwann cells extend their cytoplasmic processes penetrating the basal lamina of the epidermis. Four days after birth, Schwann cells invade the epidermis further, extending many cytoplasmic processes which are intimately associated with basal cells of epidermis. These specialized Schwann cells which contact the epidermis proper also begin to develop cytoplasmic lamellae and thus denote the onset of lamellar cell development. By eight days after birth, the developing lamellar cells become more elaborated, and their cytoplasmic processes contain caveolae and filaments, characteristic features of lamellar cells. This developmental sequence supports the concept that lamellar cells are derived from Schwann cells. Through all stages of development, neurites and Schwann cells interact closely with epidermal cells. Epidermal cells may be essential for corpuscle formation. By 20 to 25 days after birth, mouse toe pad Meissner corpuscles are cytologically mature.


Cell kinetics in the small intestine of suckling rats. I. Influence of hypophysectomy. Cell kinetics have been examined in the duodena of intact rats at 6, 16, and 22 days of age, and of hypophysectomized rats at 22 days. In intact rats the crypt population per villus increases more than 10-fold, the greater part of the increase occurring late in the third week. The labelling index does not differ between 6 (28.3%) and 16 (27.6%) days, but increases to 37.8% at 22 days. Generation time also does not differ between 6 (18.0 hours) and 16 (17.7 hours) days, but falls to 10.8 hours at 22 days by shortening of both the presynthetic and synthetic phases. Acceleration of cell migration rate between 18 and 19 days of age results in shortening of cell transit time from seven days in rats younger than 18 days to two days in those older than 18 days. When rats are hypophysectomized at six days, the duodenal crypt population per villus at 22 days is comparable to that of intact rats at 16 days. The labelling index at 22 days is 19% below that of intact rats at six days. Generation time at 22 days is slightly shortened by  a decrease of the presynthetic phase, but the duration of 15.5 hours is 43% longer than in intact rats at the same age. Despite the small crypt population and the low cell production rate, the cell-transient time in 22-day-old hypophysectomized animals is only three days.


Alterations in the endoplasmic reticulum and Golgi complex of intestinal epithelial cells during fat absorption and after termination of this process: a morphological and morphometric study. Earlier investigations of intestinal fat-absorption have stressed the importance of continued protein synthesis to provide membranes which are utilized for the intracellular transport of resynthesized lipid. The resulting membranes, when incorporated into the endoplasmic reticulum (ER) and Golgi complex, serve as vehicles for the movement of fat within the cell and for its release to the extracellular space. In the current study, attention was focused on the morphological changes in the ER and Golgi complex both during fat absorption and at successive time intervals after fat-absorption termination. Morphological interpretations were confirmed by morphometric analysis. This investigation supports the interpretation that during fat absorption, membrane synthesis by the rough endoplasmic reticulum (RER) is insufficient to accomodate membrane utilization and intraconversion, resulting in a decrease of both ER and Golgi complex components. However, following fat-absorption termination, and cell is able to replace previously depleted components of the ER and Golgi complex and regain the full membrane complement of the fasted state. Replenishment of cellular membranes is postulated as resulting from a continued synthesis of new membranes by the RER which eventually exceeds membrane utilized during lipid transport.


Location of progenitor cells in periodontal ligament of mouse molar stimulated by wounding. Wounds were made in the alveolar process overlying the mesial root of the mandibular first molar of 35-g mice to expose periodontal ligament. Dividing cells were arrested in metaphase by injection of vinblastine sulphate three hours before death three, five and seven days after wounding. Serial 1-micron plastic sections of the wound were stained with hematoxylin and eosin. The distance between the mitotic figures and the nearest blood vessel, bone and cementum was measured in every fourth section. No mitotic figure was measured twice. The distances of at least 500 interphase cells from the closest blood vessel were measured in each wound. At all time periods the distribution of mitotic cells was significantly closer to blood vessels than that of interphase cells (p less than 0.01). From three days to seven days after wounding there was a significant shift of mitotic activity away from the bone side of the ligament, but not away from blood vessels (p less than 0.05). Approximately 10% of all mitotic cells lay close to cementum, but not close to blood vessels. The majority of the dividing cells were confirmed to be paravascular, and appeared to belong to two populations, one adjacent to bone, the other in the body of the ligament. A third population, not paravascular, lay adjacent to cementum.


Myogenic cell formation in regenerating rat skeletal muscle injured by mincing. I. A fine structural study. The degenerative and early regenerative events following mincing and autotransplantation of rat skeletal muscle were examined at the ultrastructural level. During the first eight hours after injury, myonuclei undergo pyknosis, mitochondria become enlarged and vesiculated, myofilaments appear less distinct than normal and the sarcolemmata either disappear or become extensively fragmented. Further degeneration of the myofibers progresses slowly until macrophages and polymorphonuclear neutrophils invade the degenerating sarcoplasm between one to four days after mincing. Scattered throughout the minced muscle implant during the first 24 hours after injury are small, viable-appearing, undifferentiated cells located between the external lamina and degenerating sarcoplasm. Such cells, which are structurally similar to satellite cells seen in uninjured muscle, are believed to be regenerating presumptive myoblasts due to their mesenchymal-like morphology and sublaminar position. External laminae of the injured muscle fibers do not undergo immediate degenerative changes, but rather persist during the first three to six days as laminar tubes within which spindle-shaped myoblasts and newly formed myotubes are frequently observed. Examples of regenerating myoblasts in the process of budding-off from damaged muscle fibers were not observed in this study. Therefore, the evidence suggests that satellite cells are the major source of regenerating myoblasts in skeletal muscle of the rat.


Myogenic cell formation in regenerating rat skeletal muscle injured by mincing. II. An autoradiographic study. Myonuclei and satellite cell nuclei were differentially labelled with 3H-thymidine in uninjured skeletal muscle of young rats and then traced autoradiographically at intervals after mincing the radioactive hindlimb muscles to determine the source of regenerating presumptive myoblasts. Labelled nuclei were detected by light microscopic examination of 1-micron thick autoradiographs and identified by electron microscopic examination of an adjacent section. Repeated injections of 3H-thymidine during fetal and neonatal development, followed by a 4- to 5-week maturation period, resulted in labelling of 20% of the myonuclei. Satellite cells were not observed to be labelled in this series. Eight to sixteen hours after mincing, 20% of the pyknotic myonuclei were labelled, whereas none of the regenerating presumptive myoblasts appeared labelled. A single injection of 3H-thymidine administered to 18-day-old rats, followed by sacrifice within ten hours, resulted in labelling of 23% of the satellite cell nuclei. Myonuclei were not observed to be labelled in this series. Eight to sixteen hours after mincing, silver grains were detected over both pyknotic and regenerating cell nuclei. These experiments indicate that many satellite cells survive muscle injury and transplantation to become regenerating myogenic cells at a time when most, if not all, myonuclei are undergoing pyknosis.


Intraperitoneal transplants of taste buds in the newt. Autografts of tongue onto the liver contained taste buds without nerves for up to 30 days. However, these denervated taste buds were generally smaller than normal and distorted in structure. Nerve fibers invaded the graft from the liver and after 30 days normal appearing taste buds were found only in implants of tongue which contained extensive nerve fibers. Thus it appears that certain visceral nerves can maintain and possibly induce taste bud formation in implants of tongue. This is interpreted as additional evidence for the trophic influence of nerves upon taste buds. Moreover, this ability to maintain taste buds is not restricted to gustatory nerves in the newt.


Innervation of the rat Harderian gland by adrenergic and cholinergic nerve fibres. The innervation of the rat Harderian gland was studied using histochemical methods for catecholamines and acetylcholinesterase (AChE). Selective denervations were performed to investigate the neural connections of this gland with various ganglia. Light microscopically the AChE-positive nerves seemed to run as thick bundles in the intertubular connective tissue. These bundles sent finer branches around the acini. The blood vessels, localized in the connective tissue septa, were surrounded by a dense plexus of AChE-containing fibres. By electron microscopy, the AChE-positive fibres were seen to terminate near the myoepithelial cells surrounding secretory cells. These fibres were also observed in contact with the blood vessels and occasionally close to the secretory cells. Fluorescent adrenergic nerves surrounded the blood vessels. Some fibres were also observed in the interlobular tissue. All the AChE-containing nerves degenerated after cutting the zygomatic nerve. On the other hand, removal of the ciliary ganglion or the superior cervical ganglion, or stereotactic coagulation of the ophthalmic nerve did not affect these nerves. The fluorescent adrenergic fibres disappeared following both removal of the superior cervical ganglion and coagulation of the ophthalmic nerve. These fibres were intact after removal of the ciliary ganglion.


A method for quantitative histological evaluation of neural cell populations. In an attempt to facilitate quantitative analysis of neural perikarya, an inexpensive system of gridded coverslips has been developed to permanently map sections of tissue on microscopic slides. Utilizing common photographic copying techniques with Kodalith film, a mylar coverslip is produced which is imprinted with a grid of known dimensions. The exact scale of the grid can be varied precisely for compatibility with a particular field of magnification. The versatility and economy of this technique make it useful in many microscopic studies requiring superimposition of discrete landmarks.


The actions of neuromuscular relaxants at hyperbaric pressures. Previous studies have shown that high pressures increase the twitch tension of directly or indirectly stimulated mammalian muscle, while depressing transmission at the neuromuscular junction. The present paper explores the interaction between high pressures and muscle relaxants on the indirectly stimulated rat phrenic nerve--diaphragm preparation. Two muscle relaxants, d-tubocurarine and succinylcholine, were studied. Measurements of the electromyogram and twitch tension amplitudes were made before and after application of the muscle relaxants and compared with results of measurements of those two variables under hyperbaric conditions. High pressures tended to enhance neuromuscular blockade by d-tubocurarine more than that by succinylcholine, as indicated by electromyographic suppression, and high pressures tended to antagonize the succinylcholine effect on twitch tension more than that of d-tubocurarine. The findings are in agreement with previous observations that high pressures increase muscular twitch tension and depress excitatory synapses. They further demonstrate a complex interaction between hyperbaric pressures and neuromuscular blocking drugs.


Cerebral blood flow and metabolism during morphine--nitrous oxide anesthesia in man. The effects of two levels of morphine-nitrous oxide anesthesia on cerebral blood flow (CBF) and cerebral metabolism (CMRO2) were measured in healthy male volunteers. CBF and metabolic measurements were made in the awake control state, after morphine, 1 mg/kg, with 70 per cent nitrous oxide and 30 per cent oxygen, and at a total dose of 3 mg/kg morphine with the same concentrations of nitrous oxide and oxygen. Ventilation was controlled and carbon dioxide added to inspired gas to maintain PaCO2 constant at 40 torr. CBF was 48.2 +/- 4.4 (SEM) ml/100 g/min during the control phase; 45.7 +/- 6.4 ml/100 g/min after 1 mg/kg morphine, and 44.3 +/- 4.9 ml/100 g/min after 3 mg/kg morphine. The latter values are not significantly different from control. Cerebral metabolic rates for oxygen, glucose, and lactate were normal in the control phase and did not change significantly when morphine was present at either level. It is concluded that morphine-nitrous oxide anesthesia produces no alteration of cerebral blood flow or metabolism in normal man at the two dose levels studies.


Effects of trimethaphan and sodium nitroprusside on hydrolysis of succinylcholine in vitro. The use of hypotensive agents in combination with succinylcholine may be necessary. Since trimethaphan has been reported to prolong the action of succinylcholine, the authors studied the abilities of trimethaphan and sodium nitroprusside to inhibit hydrolysis of succinylcholine by pseudocholinesterase in vitro. Trimethaphan was found to be a potent noncompetitive inhibitor of pseudocholinesterase (KI = 0.24 micronM). It could be calculated that a typical dose of trimethaphan would approximately double the duration of paralysis produced by the usual dose of succinylcholine. Nitroprusside had no inhibitory effect in vitro. It is concluded that nitroprusside is preferable when a hypotensive agent must be used in conjunction with succinylcholine.


Potencies of neuromuscular blocking agents at the receptors of the atrial pacemaker and the motor endplate of the guinea pig. Drug receptor dissociation constants (KB) were determined for four neuromuscular relaxants at the cardiac pacemaker as well as at the motor endplate. The ratios KB(atrium)/KB(lumbrical) were found to be high for d-tubocurarine and dimethyltubocurarine, 264 and 136, respectively. Thus, interaction at muscarinic sites would occur only with large doses of these drugs. In contrast, the ratios were low for pancuronium and gallamine, 5.3 and 2.4, respectively. Hence, the concentrations of these drugs needed for clinical neuromuscular blockade would occupy appreciable fractions of cardiac muscarinic receptors, and thus might produce vagal blockade and thereby produce the tachycardia seen clinically with these two agents.


Radial arterial function following percutaneous cannulation with 18- and 20-gauge catheters. Radial arterial function was evaluated in 108 patients following 24 hours of percutaneous cannulation with either 18- or 20-gauge cannulas. Arteriography, Doppler ultrasound examination, and Allen's test disclosed an 8 per cent incidence of radial-artery occlusion following cannulation with 20-gauge cannulas, compared with a 34 per cent incidence of occlusion with 18-gauge cannulas (P less than .05). Vessels that occluded were significantly smaller in diameter than were patent vessels (mean 2.00 +/- .09 mm SE vs. 2.22 +/- .05 mm, P less than .05). Occluded vessels also contained significantly greater amounts of thrombotic material (0-3+) just prior to decannulation than those that remained patent (2.42 +/- .13 vs. 1.20 +/- .11,P less than .001). The incidence of arterial occlusion increases linearly as the ratio of cannula outer diameter to vessel-lumen diameter increases.


Partition coefficients of volatile anesthetics in Kreb's solution. Partition coefficients of volatile anesthetics between Krebs' solution and air were determined at 37 C. The mean values obtained were: enflurane, 0.74; diethyl ether, 11.9; fluroxene, 0.81; halothane, 0.75; isoflurane, 0.55; methoxyflurane, 3.8.


Slow ventricular tachycardia complicating acute myocardial infarction. Among 200 consecutive cases of acute myocardial infarction (AMI) treated in a CCU, 117 episodes of slow ventricular tachycardia were observed in 72 patients. This figure represents a 36% rate of incidence. It is a relatively high figure because of the close monitoring to which the patient is submitted and because of the early admission to the unit. There were no significant differences of age, sex, or localization of the myocardial necrosis between patients with SVT and those without it. The different mechanisms of production described support an active origin in most of the patients for the following reasons: (1) coexistence of SVT and PVT in 51.3% of the patients; (2) identical QRS morphology in both rhythms; (3) onset of the SVT after a nonprolonged diastole in 70% of the tracings; (4) inhibition of the SVT after increase of the sinus discharge in only 14 occasions; and (5) irregular SVT rhythm in 76.9% of the recordings and ectopic mechanisms with different degrees of exit block. Because of the potential hazard of the SVT, especially if it is assumed to be of an active origin, we recommend lidocaine for patients with a sinus rate faster than 60 per minute or coexisting PVT. Atropine should be used when the sinus rate is slower than 60 per minute assuming a possible escape or passive origin.


Diagnosis of ventricular conduction defects. A total of 1342 electrocardiograms demonstrating intraventricular conduction defects were reviewed. Criteria for distinguishing different types of conduction defects and combinations of such defects are presented. The time of intrinsicoid deflection was of great value and may be used to distinguish lesions of the main fascicles and peripheral Purkinje conduction defects. However multiple peripheral defects affecting a large area of myocardium can produce a pattern identical to left bundle branch block. It is suggested that intrinsicoid deflection time should be measured from the beginning of the QRS to the onset of the longest downslope at or after the peak of the R wave. It should be carefully related to the voltage of the dominant wave of the QRS complex in each lead. If intrinsicoid deflection is delayed in a limb lead that does not show the maximum voltage of the QRS, a peripheral left ventricular conduction defect is present; but if the lead does show the maximum voltage of the QRS, the defect may be central or peripheral. Another useful electrocardiographic feature was the direction of both the initial and terminal QRS forces in the 12-lead electrocardiogram. Such analysis often resolved the diagnosis of hemiblocks when the axis was indeterminate.


The central venous O2 saturation test in acute pulmonary fat embolism. 1. The central venous oxygen saturation appears to be a reliable method of assessing the prognosis of patients with pulmonary fat embolism. 2. There was an inverse relationship to the A-a gradient and A-V oxygen difference in this group of patients. Further additional hemodynamic studies concomitantly with central venous oxygen saturation are being investigated. 3. The patients with depressed central venous oxygen saturation should be closely observed and diligently treated earlier, with combined respiratory and pharmacological therapy. 4. Such an approach might prevent the development of pulmonary fat embolism in traumatic patients.


Death due to gross vascular perforation by pulmonary carcinoma. This brief historical data of a patient dying of severe hematemesis as a result of broncho-esophago-aortal fistula in primary pulmonary cavitating carcinoma is presented. It indicates that the elastic wall of the arteries even that of the aorta, is not a barrier to the penetration of the malignant cells. The neoplasm was in an advanced stage with gross vascular involvement but distant metastases did not occur even in microscopic examination. Liomyoma of the uterus was associated with lung carcinoma.


Arteriosclerotic coronary arterial aneurysms in a 49-year-old man with crescendo angina: family history, natural course and prevalence. In a 49-year-old man with crescendo angina, elevated serum cholesterol level and an old posterior myocardial infarction, selective coronary arteriography showed multiple arteriosclerotic aneurysms of the right coronary artery associated with extensive and severe arteriosclerotic disease of the left coronary artery. The patient's mother and brother have both died of a myocardial infarction. Another brother suffers from angina and has documented arteriosclerotic coronary artery disease. Two sisters suffer from angina as well. The possibility of embolization of distal vessels from a friable clot of the aneurysms as a cause of the patient's infarction is discussed. To the best of our knowledge, this is the tenth patient with nonfistulous arteriosclerotic coronary artery aneurysm diagnosed and documented angiographically ante mortem. Including the present case and reviewing the literature, the prevalence of this condition among nonfistulous coronary aneurysms diagnosed ante mortem is 35 per cent and henceforth cannot be regarded as an incidental autopsy finding in cardiac asymptomatic patients.


Isolated T wave alternans progressing to QRS-T alternation after ventricular defibrillation. A 54-year-old woman underwent replacement of a thrombosed Björk-Shiley aortic valve prosthesis. Post operative electrical defibrillation resulted in isolated T wave alternation which progressed to total QRS-T electrical alternans. This report represents the first description of such a phenomenon.


Graphic findings in acute aortic regurgitation caused by destruction of aortic cusp. The origin of first heart sound. The diagnosis of ruptured aortic cusp leading to acute aortic insufficiency was made by echophonocardiographic techniques in a patient with nonvegetative aortic valvular endocarditis and a negative clinical history. Early closure of the mitral valve, weak first heart sound, tall A wave of apexcardiogram, and early diastolic murmur indicated acute aortic regurgitation. Fine high frequency echoes of the aortic root and aortic leaflets suggested ruptured aortic leafet unlike that reported in the presence of vegetations. Timing of S1 in acute aortic regurgitation by phonocardiogram, echocardiogram, and pulse techniques could not establish a single causative valvular relation in the genesis of this sound.


Oxygen pressure in ischemic muscle tissue of patients with chronic occlusive arterial diseases. Local tissue oxygen pressure was measured with micro-Pt-electrodes in the resting tibialis anterior muscles of 10 patients with chronic occlusive arterial disease and in 9 healthy subjects. The mean pO2 values in the patient group was 13.3 +/- 5.4 Torr, and 27.2 +/- 4.4 Torr in the control group. The difference is highly statistically significant. Preliminary results of treatment of 10 patients with the rheologically-active drug Ancrod show a statistically significant increase of oxygen pressure in the ischemic muscle tissue. Measurement of muscle tissue pO2 with microelectrodes seems to be an objective and quantitative method to investigate the oxygen supply to ischemic muscles and to judge the effects of therapeutic measures.


Systolic pressure slope: system for automated display and calculation. The rate of rise of arterial blood pressure--the systolic pressure slope--has been measured noninvasively at the ankle and has been shown to be reduced by minor degrees of peripheral arterial stenosis. This report describes an electronic system used to display the systolic part of the arterial pressure wave. The system uses noninvasive data from an ECG, a blood pressure cuff, and a Doppler ultrasound detector. From these data the systolic pressure slope is measured automatically. One hundred and sixty-eight recordings from the limbs of 10 normal subjects were analyzed in detail and confirmed the reproducibility of the system. The points used to calculate the systolic slope fell close to a straight line, with correlation coefficients averaging 0.96. An average of eight repeat measurements were made per limb, and the coefficients of variation averaged 6.5%. Mean values for the normalized systolic pressure slope agreed with previously published data.


Double mitral valve. Report of a case and review of the literature. A case of double mitral valve orifice associated with atrioventricular canal was found at operation. These two anomalies are frequently associated. Double mitral valve is usually subclinical and does not necessarily need to be corrected, depending on the associated anomalies, the extent of the defect, and the personal experience of the surgeon. The embryology of double mitral valve is complicated and still needs to be clarified.


New approaches to resolving diagnostic problems in patients with angina pectoris. Several new noninvasive techniques are now available to evaluate the patient with chest pain to determine if myocardial ischemia is present. Continuous ambulatory ECG monitoring can detect myocardial ischemia in some patients who have normal ECG responses to graded exercise tests. Defects in myocardial perfusion can be visualized by radionuclide imaging at rest and after exercise. Also, abnormal left ventricular wall motion due to myocardial ischemia can be detected by gated blood pool scanning at the same time. Other techniques can olso be valuable in evaluating wall motion. Standard M-mode echocardiography can detect anteroseptal and posteroinferior wall motion abnormalities with remarkable anatomic detail, and newer echo techniques are promising for delineating the motion of other parts of the left ventricle. Finally, abnormal contractile areas can be assessed by videotracking the fluoroscopic cardiac silhouette and by a new noninvasive technique, the displacement cardiograph, which does not involve radiation exposure. Although none of these tests are both highly sensitive and highly specific for myocardial ischemia, their combined application in a symptomatic patient may provide considerable useful information which will help to determine who should be subjected to the risk and expense of coronary arteriography.


Stress testing in the prognosis and management of ischemic heart disease. Stress testing is by no means perfect as far diagnosing coronary artery disease, but at this time it is the single best noninvasive method for establishing the presence of ischemic heart disease. From the data shown here, one can see that it adds some important prognostic features as well. The American Heart Association has published a "Coronary Risk Handbook" which can be used to predict the likelihood of a future coronary event by means of accepted risk factors such as hypertension, cholesterol level, and smoking. If we include a positive stress test as a risk factor and compare it to the others, it is clear that a positive stress test has a much higher correlation with future coronary events than any of the other risk factors alone or in combination (Figure 12). Physicians should pay close attention to all of the mentioned factors while carrying out a stress test rather than just looking for ST depression alone. The occurrence of anginal pain, the time of onset, the degree of ST depression, and the patient's pulse and blood pressure response are all useful in assessing the degree of coronary involvement and in predicting an individual's chances of suffering some form of coronary event.


Long-term results of the medical treatment of coronary artery disease. The natural history of patients with ischemic heart disease varies widely depending upon the anatomic lesion and extent of left ventricular dysfunction. Several clinical variables may also be used to help determine the likelihood of long-term survival. Individuals with high-grade isolated disease of the left anterior descending coronary artery, without significant impairment of ventricular function, have little morbidity and mortality for the 2-year period after arteriography. At the other end of the spectrum, medically treated patients with stenosis of the left main coronary artery or three-vessel disease without such involvement have a reduced life expectancy compared with patients treated surgically. Global judgments on long-term results of the medical treatment of coronary artery disease are meaningless. Efforts should be made to delineate optimal treatment for various subgroups of patients under the broad rubric of ischemic heart disease.


Fibromuscular dysplasia of the superior mesenteric artery and coexisting cerebral berry aneurysms. Fibromuscular dysplasia of the systemic artery and cerebral "berry" (saccular) aneurysm are nonatheromatous lesions of uncertain etiology. The coexistence of these vascular disorders in the individual reported here is unusual and may provide a possible explanation of their pathogenesis.


Utilization of a tomographic attachment for "moving band" arteriography. By using a slit plate, scanographic arterial studies can be performed with a tomographic attachment of an X-ray unit that is normally used for routine radiographic examinations. The expense is minimal and no structural changes are necessary.


Clinical experience with pentoxifylline in occlusive cerebrovascular disorders. Pentoxifylline--3,7-dimethyl-1(5-oxo-hexyl) xanthine--a new vasodilator compound, was tried in 28 cases of occlusive cerebrovascular disease. A similar group of 24 patients were given xanthinol nicotinate. Although in terms of degree of improvement there was no significant difference in the two treatment groups, improvement was earlier in the group treated with pentoxifylline. No significant side effects were observed with any of the two drugs used in the present study.


Hypereosinophilic multiple thrombosis. A proposal of a new designation of disseminated eosinophilic "collagen disease". A case of marked chronic mature eosinophilia associated with multiple thrombosis in 30-year-old male is presented. Hitherto this sort of the disease has been categorized as DECD. Reviewing the autopsied cases of DECD, including our own case, DECD should not be categorized as a collagen disease because of the absent connective tissue degeneration and absent connective tissue degeneration and absent serological abnormalities. We rather noticed a certain relation between marked chronic mature eosinophilia and thrombus formation. Therefore, we propose here the term hypereosinophilic multiple thrombosis to express the pathomorphogenesis more precisely.


The inside-out electrocardiographic stress test: a view from the left ventricular cavity. A new method is described for measuring the unipolar left ventricular cavitary electrogram by means of a standard pigtail ventriculography catheter. Experiences with this technique in 30 patients are described with particular reference to changes in the S-T segment of the cavitary electrogram during cardiac stress by atrial pacing. This method allows convenient recording of His bundle potentials from the left ventricular outflow tract in most patients.


Angiographic manifestations of renal hamartoma. Two types of renal hamartoma (angiomyolipoma) are presented with emphasis on angiographic findings. Careful analysis of the angiograms can suggest a specific diagnosis. Two important considerations other than angiographic findings are (1) multiplicity of tumors in patients with tuberous sclerosis, and (2) a solitary mass in 40-60-year-old women.


Choice of ophthalmic artery branch for Doppler cerebrovascular examination: advantages of the frontal artery. One hundred normal young adult volunteers were assessed by directional Doppler ultrasound to determine which branch of the ophthalmic artery was most suitable for assessment of the patency of the extracranial internal carotid artery. Each frontal artery of all subjects had normal flow direction and response to compression of the temporal, facial, and common carotid arteries. One supraorbital artery of 2 subjects had reversed flow supplied by the ipsilateral temporal artery and was probably a palpebral artery in each of these individuals. The nasal artery carried reversed flow in 39% of the individuals and was undetectable unilaterally in 2 subjects. From these data we conclude that the frontal artery is the most suitable branch of the ophthalmic artery for Doppler ultrasonic examination. Evaluation of directional flow in the frontal artery and of the influence of compression of all branches of the external carotid artery as well as the common carotid artery is a highly reliable technique to identify significant obstruction of the extracranial internal carotid artery.


Aspects of humoral and cellular immunity in asthmatics. Grove et al of Australia studied humoral and cellular immunity in 91 asthmatic patients and found that 18% failed to have an adequate humoral response to a booster dose of tetanus and 9% failed to react to five delayed type hypersensitivity testing antigens. The authors, Gaillard and Larkin, were unable to corroborate these results in their office.


Serum IgE levels in forty families studied for two or three years. Serum IgE levels have been measured over two to three years in 210 individuals. In one-fifth IgE levels remained remarkably constant, in one-quarter they rose and in half they fell. A rise was usually associated with the development of fresh atopic disease, exacerbation of established disease or dependence on symptomatic treatment. A fall was associated with a diminution in the severity of symptoms occurring spontaneously as a result of good environmental control or of appropriate immunotherapy. Sequential IgE levels provide confirmatory evidence of the success of either environmental control or of immunotherapy.


Pulsus paradoxus in childhood asthma--its prognostic value. One hundred asthmatic children were examined for pulsus paradoxus, a palpable diminution or obliteration of the peripheral pulse during inspiration, while in bronchospasm. Pulsus was measured with a sphygmomanometer and the difference in systolic pressure between inspiration and expiration was noted. Seventy-five children with mild asthma had no palpable pulsus and responded with complete subsidence of symptoms with one or two injections of aqueous epinephrine, 1-1000. Twenty-five children had palpable pulsus ranging from 10 mm to 30 mm. Five patients with pulsus between 10 and 15 mm were admitted to the hospital with status asthmaticus and pneumonia; eight other patients responded to parenteral epinephrine. Twelve children had pulsus of 20 mm or greater and all were hospitalized for uncomplicated status asthmaticus. Pulsus paradoxus may be found in acute exacerbation of childhood asthma and its degree correlates with both the severity and response to bronchodilating agents.


The identification of mild and severe strains of tobacco mosaic virus in doubly inoculated tomato plants. Using specific antisera, it was possible to identify mild (MII-I6) and the O and I strains of tobacco mosaic virus (TMV) in tomato plants infected with the mild strain following challenge inoculation with the wild strains. In addition, with single lesion isolates of the MII-I6 and O strains it has been shown that both strains can be assayed simultaneously in mixed isolates on Nicotiana glutinisa based on differences in local lesion size. The accuracy of this differential local lesion assay was c. 90% as determined by back inoculation of single lesion isolates into susceptible tomato cultivars.


Changing patterns of abdominal aortic aneurysm operation in a community hospital. Careful analysis of results of abdominal aortic aneurysm surgery in a community hospital over a 10-year period demonstrates results that are comparable to major centers. In addition, continued improvement in the care of patients with nonruptured aneurysms is well documented as experience is gained and techniques are standardized. The continued poor results in those patients with ruptured aneurysms once again emphasizes the need for definitive surgical care before rupture. The decreasing number of ruptured aneurysms and the relative increase in elective cases indicate that a greater percentage of these patients are being referred before rupture. This probably is due to the improvement in results which this study certainly substantiates.


Asymptomatic angiographic occlusion of the internal carotid artery: an indication for emergency endarterectomy. A 56-year-old man had retinal artery embolization from a carotid artery atheroma. Complete occlusion of the internal carotid artery occurred during cerebral angiography, but the patient developed no acute symptoms of cerebral ischemia. The patient immediately underwent emergency carotid endarterectomy which he tolerated well, and follow-up angiography nine days later demonstrated continued patency. The patient has remained neurologically unchanged.


Uses of mediastinoscopy.

Uses of mediastinoscopy. The value of mediastinoscopy based on experience gained in over 100 patients is reviewed. Reasons for the routine use of mediastinoscopy in the preoperative evaluation of carcinoma of the lung are presented. This modality is useful in the diagnosis of other nonvascular superior mediastinal masses, especially sarcoidosis and the lymphomas.


Long-term morbidity of jejunoileal bypass. A total of 169 patients who had jejunoileal bypass for morbid obesity were available for study more than 24 months after operation. Continuing high morbidity, especially "the bloats" and the regaining of weight, are arguments against the use of jejunoileal bypass unless clear medical indications exist.


Acute appendicitis associated with pregnancy, labor and the puerperium. Eleven patients were operated on for acute appendicitis during pregnancy, in labor or during the puerperium. All patients had acute, gangrenous or perforated appendicitis. There was no fetal or maternal mortality, although three patients developed postoperative pneumonia, pelvic phlegmon or wound infection. The physical findings of appendicitis are altered by the displacement of the appendix by the uterus. The white blood counts must be interpreted with the leukocytosis of pregnancy in mind.


Morbidity of appendectomy in patients with acute salpingitis. Diagnosis of right lower quadrant pain in a woman is frequently confusing. The course of 53 patients who had operation with a normal appendix and no other intra-abdominal pathology is compared with a group of 50 patients with a normal appendix and acute salpingitis. Appendectomies were performed in all cases and there was a lower mortality and morbidity rate in the group of patients with salpingitis. It is, therefore, concluded that appendectomy is a safe procedure in patients with acute salpingitis.


Management of noncalcified aneurysms of the abdominal aorta. Occasionally a previously undiagnosed aneurysm of the abdominal aorta will be found during the course of surgical procedure. When circumstances prevent extending the procedure to include resection and grafting of the aneurysm, the proper placement of silver clips as radiopaque markers may be of substantial benefit in managing this patient until definitive therapy can be instituted.


Carcinoembryonic antigen levels in pancreatic carcinoma. Plasma carcinoembryonic antigen (CEA) levels were correlated with the stage of the tumor in 43 patients who underwent laparotomy for histologically proven pancreatic adenocarcinoma. Elevated CEA levels were noted in one third of the patients with tumors localized to the pancreas. When the carcinoma had extended beyond the pancreas or distant metastases were present, 78% of patients had elevated levels. Of the entire group of patients, 72% had elevated CEA levels.


Convulsions associated with sodium cefazolin: a case report. Our patient was severely injured, and had a prolonged period of hypotension. After operation she received moderate doses of cefazolin, intravenously, in the face of acute renal failure. Seizures associated with a serum cefazolin level of 455 mg/ml were observed. Although a cause and effect relationship between high cefazolin levels and neurotoxicity cannot be proven conclusively, the implication of this relationship exists. The clinician should be aware of the potential neurotoxicity of this commonly used drug. The importance of adjusting the dose in patients with renal failure is re-emphasized.


Extraperitoneal inguinal endometriosis.

Extraperitoneal inguinal endometriosis. Two instances of extraperitoneal inguinal endometriosis are presented with a review of the previous reports of proven diagnosis. A high index of suspicion is needed to avoid needless prolonged observation. The diagnosis must be considered in any woman of childbearing age especially if the groin mass is associated with menstrual variability in size and in tenderness of the mass. Excision is curative and should result in permanent relief of pain.


[Intestinal immunity system and alimentary allergy (author's transl)]. Thirty seven intestinal biopsies from twenty-one food-allergic and sixteen control children were studied by immunofluorescence and the density of IgA, IgM, IgG and IgE forming cells (F.C.) in the lamina propria determined. In order to compare the results in allergic and normals the authors establish three age-groups: under 9 mo., 9 to 24 mo. and older than 24 mo. A higher density of IgM F.C. were found in allergic patients from the first group. Allergic children from all groups had more IgE F.C. but the figures were only significant for children older these two years. IgA F.C./IgE F.C. ratio was bover in allergic than in controls (p than less 0.02) after the age of 10 mo. Sone comments on these findings are made.


[Bone scanning in the diagnosis of infection bone disease (author's transl)]. Authors report their experience in bone scanning in patients with a diagnosis of osteomyelitis. Classical X-Ray and bacteriologic studies are of poor diagnostic value in cases early diagnosed and treated. Bone scanning is certainly a valuable alternative, but since gammagraphic pictures are not specific, they must be interpreted together with the clinical and analytical date.


[Toxic hepatitis caused by rifampin and isoniazid in treatment of tuberculosis (author's transl)]. Five children with tuberculosis were treated with isoniazid (20 mg./Kg./day) and rifampin (15 mg./Kg./day). After five to twenty seven days of treatment they presented anorexia, vomiting and jaundice. Hepatomegaly was found in two of them. High indirect bilirubin, S.G.O.T. and S.G.P.T. and low prothrombin levels were present in all of them. Eight to thirty one days after withdrawal of rifampin, all patients were well and their laboratory data was normal.


[Duodenal stenosis in the newborn (author's transl)]. Authors review fourteen cases of duodenal stenosis. A close observation can disclose early signs and enable an early diagnosis. A comment of the surgical technique is made.


[Alport-Perkoff's syndrome (two cases report)]. Two patients affected with Alport's syndrome belonging respectively to two families with a high incidence of urinary, auditive and ocular symtoms, are described. The most relevant features are commented pointing out that Alport's syndrome could be a structural malformation of the whole or only one part of a type of colagen probably specific of the basal membrane of the glomerulus which could be more easily affected forming toxic metabolites. Finally a reference to the histologic study is made.


[West's syndrome after Reye's syndrome (author's transl)]. A four month old boy with typical clinical, biochemical and pathological picture of Reye's syndrome is reported. He was treated with peritoneal dialysis and survived. He presented flexor-spasms with hipsarrythmic E.E.G. one month after the beginning of the clinical picture. Some coments are made on the relation of both conditions and prognostic data on the Reve's syndrome.


[Tanatophoric dwarfism. A case report (author's transl)]. A new case of atipic chondrodystrophies classified as tanatophoric dwarfism, with pathologic studies is presented. At the same time a revision of the most important works of literature is made. Genetic, clinic and pathologic aspects of the picture have being studied, presenting the differential diagnosis with other osteochondrodysplasias of the newborn.


Erythema chronicum migrans and Lyme arthritis. The enlarging clinical spectrum. Thirty-two patients with the onset of erythema chronicum migrans, Lyme arthritis, or both in mid-1976 were studied prospectively. The skin lesion (24 patients) typically lasted about 3 weeks, beginning as a red macule or papule that expanded to form a large ring with central clearing. Associated symptoms ranged from none to malaise, fatigue, chills and fever, headache, stiff neck, backache, myalgias, nausea, vomiting, and sore throat. Three patients had been bitten by ticks at the site of the initial lesion 4 to 20 days before its onset. Nineteen patients suddenly developed a monoarticular or oligoarticular arthritis 4 days to 22 weeks (median, 4 weeks) after onset of the skin lesion; eight developed arthritis without a preceding skin lesion. Seven of these 27 experienced migratory joint pains. Arthritis attacks, most commonly in the knee, were typically short (median, 8 days) but sometimes persisted for months. Other manifestations included neurologic abnormalties, myocardial conduction abnormalities, serum cryoprecipitates, elevated serum IgM levels, and elevated erythrocyte sedimentation rates. The diagnostic marker is the skin lesion; without it, geographic clustering is the most important clue.


HLA B27 in rheumatoid factor-negative polyarthritis. Eighty-three consecutive patients with rheumatoid factor-negative polyarthritis seen during a 1-year period were evaluated clinically, radiologically, and with the B27 test. Patients with definite spondylitis, juvenile chronic polyarthritis, a collagen disease, a known metabolic arthropathy, or primary generalized osteoarthritis were excluded. The patients could be classified into two groups independent of any knowledge of B27 testing. Twenty-five had a spondylitic "variant" syndrome. These could be diagnosed on clinical grounds, and included a male preponderance and a high frequency of B27 positivity. Fifty-eight patients, who could generally be classified by American Rheumatism Association criteria as having definite or classic rheumatoid arthritis, included a female preponderance and a normal prevalence of B27. Thus the B27 test was not more helpful than clinical diagnosis in the classic spondylitic variant syndromes, nor did it separate out a population of patients from among the seronegative rheumatoid arthritis group.


Liver biopsy in hemophilia A.

Liver biopsy in hemophilia A. Hepatitis is a significant complication of the treatment of hemophilia A with factor VIII concentrates. Chronic liver disease in these patients is infrequently documented in the literature. The results of percutaneous liver biopsy, under the coverage of glycine-precipitated factor VIII, in six patients with hemophilia A who had the persistence of abnormal liver-function tests for at least 6 months, are described. Three patients had chronic active hepatitis, and three had chronic persistent hepatitis. No complications were encountered as a result of the biopsy procedure. These results suggest that percutaneous liver biopsy should be considered in patients with hemophilia A with continuously abnormal liver-function tests to establish a histologic diagnosis and to guide further therapy.


Antibiotic concentrations in ascitic fluid of patients with ascites and bacterial peritonitis. Thirty-six paired specimens of serum and ascitic fluid from 21 patients with peritonitis and ascites, most with sponetaneous bacterial peritonitis and alcoholic cirrhosis, were assayed for antibiotic content. Antibiotics assayed and number of determinations were gentamicin, 14; tobramycin, 7; ampicillin, 5; clindamycin, 3; penicillin G, 2; cephalothin, 2; chloramphenico, 2; and cefazolin, 1. In 31 pared specimens the ascitic fluid antibiotic concentration was about one half or more of the simultaneous serum level and in 17 assays exceeded 90% of the serum level. All antibiotics studied penetrated ascitic fluid equally well. Clinical response to antibiotic therapy was good in 12 of 16 patients with culture-proven bacterial peritonitis. Antibiotic levels in ascitic fluid exceeded the minimal inhibitory concentration of the infecting organisms in all but one patient who responded. Direct intraperitoneal instillation of antibiotics does not appear to be necessary routinely; however, there may be an initial lag of several hours before antibiotic concentrations is ascites achieve therapeutic levels.


Continuous in-vivo monitoring of arterial oxygenation in chronic obstructive lung disease. We monitored arterial oxygen saturation (SaO2) in 10 patients with severe chronic obstructive lung disease during 24 h of breathing room air followed by 24 h of breathing two litres of oxygen per minute. Three subjects without chronic obstructive lung disease were monitored while breathing room air. Greatest declines in SaO2 occurred during sleep, with intermittent decreases as great as 44% saturation (range, 12% to 44% saturation. Baseline SaO2 was significantly higher while patients breathed low-flow oxygen (94% versus 86% saturated), and declines in SaO2 during sleep were less noteworthy (1% to 27% saturation). Subjects without chronic obstructive lung disease showed declines in SaO2 of much lesser magnitude (3% to 11% saturation) with sleep. These declines were not primarily due to alveolar hypoventilation. Our data indicate that there are patients with chronic airways obstruction who suffer profound intermittent desaturation at night that can readily be relieved with low-flow oxygen administration.


Accumulation of normeperidine, an active metabolite of meperidine, in patients with renal failure of cancer. Concentrations of meperidine and its active metabolite, normeperidine, were measured in plasma of patients receiving the drug for analgesia. Meperidine levels in cancer patients were 0.10 to 0.55 microng/ml 1 h after a dose and were 0.05 to 0.14 in patients in the oliguric period after renal transplantation. Normeperidine levels were 0.05 to 0.28 microng/ml in the cancer patients and 0.13 to 0.36 in the renal failure patients. The ratio of normeperidine to meperidine levels was always higher in the renal failure patients than in the cancer patients. Additionally, two patients receiving multiple doses of meperidine had high normeperidine levels and very high normeperidine/meperidine ratios when they showed signs of central nervous system excitation. These data indicate that normeperidine can contribute to the excitatory effects seen after multiple doses of meperidine and suggest that patients with renal failure are particularly susceptible to this problem.


Guidelines for drug therapy in renal failure. Five tables are presented that provide guidelines for drug usage in patients with renal insufficiency. The data are derived from the current medical literature. If specific information about a drug is unavailable, emphasis is given to normal pharmacokinetic variables in arriving at recommendations for therapy. Nephrotoxicity of adverse effects in patients with renal disease are noted and adjustments for dialysis suggested.


Perspectives in the treatment of breast cancer: 1976. Breast cancer is the major cancer killer of women in the United States. Recent advances in therapy promise more effective control of this illness. The development of hormone receptor analysis permits us to better understand the mechanisms of action of steroid and peptide hormones and increases the likelihood of using there hormonal agents effectively. Prospective surgical and surgical adjuvant trials offer the opportunity to define accurately the appropriate surgical procedure and most effective postoperative therapy after initial surgery. The development of chemotherapy, first singly and now in combination, has led to improved treatment of patients with advanced disease and defined better chemotherapy for use in adjuvant settings. The investigation of a matrix of marker substances in breast cancer may uncover new methods to assess residual disease and to monitor disease recurrence.


Treatment of tuberculosis by the nonpulmonary physician. Because tuberculosis is currently being treated in many instances by the nonpulmonary physician, an evaluation of the skill with which he performs in this capacity was made. A group of 130 patients who had been treated by such physicians was analyzed, using generally accepted criteria for appropriate therapy. Seventy-three of the group were found to have been treated inappropriately. The use of isoniazid in those likely to be resistant to that drug, the use of a single drug in bacteriologically positive disease, and inadequate or excessive drug dosages were among the more common errors. Two thirds of the physicians caring for these patients were internal medicine specialists, half of them board certified. Increased education efforts in regard to this disease at all levels of training must be made.


How to be a clinician in a socialist country. Some of the events that have contributed to the development of the present Swedish health care system are reviewed. Although there are several useful elements in system--and these are the ones usually presented by official channels--the impact on the freedom of the medical profession and on the patient-physician relationship is considerable and destructive to the concepts of a free profession. It is necessary to take such effects into account in the planning for nationalized health services anywhere in the world.


[Diagnostic approach to prolonged fever (apropos of 72 cases)]. A report of 72 case histories of prolonged feven (more than three weeks, diagnosis not obvious on admission). The writers review the frequency of occurrence of the various etiologies. Infections are the most frequent cause (43 cases). A good number of them are easy to diagnose based on clinical exams and routine tests. Others are a great deal more difficult to diagnose, and in particular deep, suppurative foci. Collagen diseases then follow with 10 cases, the diagnosis of which is made by immunology and histology. Cancers are not very numerous (4 cases) and poorly represent the usual breakdown (kidney, lungs, liver, colon, pancreas). There were no cases of involvement of the blood and reticuloendothelial systems. With regard to examination of these patients, the writers discuss the merits of lymphography and laparatomies, and they set limits to therapeutic tests.


[Determination of first signs of pacemaker failure. Oscilloscopic study before and after removal]. An oscilloscopic study aimed at determining the first signs of pacemaker failure was carried out in vitro after removal in 95 cases. Using a differential apparatus with a 1 megahertz passing band, the following parameters were measured: interspike interval, amplitude, duration and morphology of the spike. During the course of the study, signs of pacemaker failure were seen in 66 cases. It may be concluded that the interspike interval represents the easiest and most precise measurement, making it possible alone to detect dysfunction in 70 per 100 of cases. However, in 30 per 100 of cases, represented by certain types of pacemaker, its alteration is preceded by a decrease in voltage. Whilst the latter may be precisely and easily measured in vitro, the same does not apply when the pacemaker is in situ and only large changes may be taken to be significant and interpreted in relation to the number of batteries in the model studied. Study of the vectrocardiogram should be added to the measurements mentioned above, any sudden change in axis of the spike being an argument in favour of a fault in the conductor. In the future, measurement of the area of the spike, a reflection of the energy delivered the histogram of the RR intervals giving an idea of the respective durations of function and of inhibition in demand models will provide additional information.


[Systemic mastocytosis with myeloid splenomegaly type hematological manifestations]. The authors report the case of a patient suffering from systemic mastocytosis with cutaneous, medullary, bone, hepatic and splenic involvement, the clinical and haematological picture of which was that of myeloid splenomegaly. Furthermore, this picture included hypersplenism, clearly demonstrated by isotopic study and the successful results of splenectomy. Blood histamine levels were normal though urinary excretion of histamine was increased. Histamine levels in the spleen were greatly increased. Serotonin levels in the blood and its urinary metabolites were normal. Heparin activity was demonstrated in the spleen, but not in the blood.


[About the infection of Drosophila female germ line cells by sigma virus (author's transl)]. The results which have been presented by Bregliano (1973) and Bregliano et Fleuriet (1975) in this "Annales" are discussed. The author's conclusion is that there are two distinct mechanisms for contamination of the cysts of non-stabilized females (in stabilized females, all cells, including oogonial cells, are infected in carrier state by sigma). Hypotheses are discussed.


Amino sugar contents and phage inactivating properties of lipopolysaccharide from cholera and El Tor vibrios. Cholera and El Tor lipopolysaccharide (LPS) were identical in respect of chemical composition except that the hexosamine content was significantly lower and galactosamine was absent in El Tor LPS. Mukerjee's group IV cholera phage phi149 was inactivated by cholera LPS but was resistant to El Tor LPS.


[Trimethoprim resistance plasmids: transferability and incompatibility groups (author's transl)]. Over a three year period, 119 strains of enterobacteria isolated from patients have been found resistant to trimethoprim (TMP) and sulfonamides (Su); 11 strains were resistant to TMP only. MIC of TMP were between 32 and 2048 microng/ml. Three groups of strains are described: (1) thymineless variants (2 strains); (2) TMP resistance non-transferable into Escherichia coli K12 (95 strains); (3) TMP resistance transferable into E. coli K12 (33 strains). TMP marker and Su marker have been transferred independantly from 13 strains; they were cotransferred from 20 strains. The incompatibility group of 31 plasmids has been determined: 10 belong to the fi+ type, group FII; 21 belong to the fi--type, group 6, group 7, group 10, group N and group I1. Epidemiological implications of such a wide range of incompatibility groups among a small number of plasmids specifying TMP resistance are discussed.


[Study of a "Rickettsiella" (Rickettsia) pathogen of the spider "Pisaura mirabilis" (author's transl)]. A rickettsiella-like organism has been described in the spider Pisaura mirabilis Cl., and placed into the genus Rickettsiella on the basis of its cycle and ultrastructure. A chlamydial cycle takes place in the digestive cells and becomes more complex in the interstitial cells where giant bodies appear. The latter have been considered up to now as caracteristic of the genus Rickettsiella but, in fact, seem to be in relation with the metabolism of the parasitized cell. Consequently their presence and structure can no longer be retained as specific characters. A study of the host and tissue specificity of the various Rickettsiella actually known must be defined forehand the impact of the metabolism of host cells on the appearance and structure of these bodies.


Six new Salmonella sub-genus III serotypes isolated from snakes in Israel. Six new Salmonella sub-genus III serotypes (Arizona) were isolated from snakes in Israel. Their antigenic structure was established as follows: S. arizonae 16:Z52:Z35 (Ar.25:26-21); S. arizonae 18:1,v:e,n,x,z15 (Ar.7a,7b:23-28); S. arizonae 21:i:1,5(7) (Ar.22:33-30); S. arizonae 41:c:e,n,x,z15 (Ar.13:32-28); S. arizonae 51:k:z35 (Ar.1,2:29-21); and S. arizonae 53:1,v:z35 (Ar.1,4:23-21).


[Study of 14 denitrifying soil bacteria of the "pseudomonas stutzeri" group isolated by enrichment culture in the presence of nitrous oxide (author's transl)]. The strains were isolated from soil by enrichment in a liquid minimal medium containing ethanol, acetate, succinate, L-malate or tartrate, under an N2O atmosphere at 32 degrees C. All fourteen strains can use the following 25 sources of carbon and energy under aerobic conditions: glycerate, ethanol, propanol, acetate, butyrate, malonate, succinate, glutarate, sebacate, glycollate, L-lactate, D-lactate, L-malate, DL-3-hydroxybutyrate, pyruvate, fumarate, itaconate, mesaconate, crotonate, L-alpha-alanine, D-alpha-alanine, L-leucine, asparagine, L-tyrosine, and L-proline. They hydrolyze Tween 80 but not gelatin. Nitrate is used as nitrogen source. Nitrate reductase A and respiratory nitrite reductase are present. Four of the strains are clearly and easily distinguishable from the others on the basis of six characters: special morphology of colonies; in ability to use isovalerate and DL-valine, inability to use glucose, absence of exocellular amylase, and high level of metapyrocatechase. Their G + C content is 66-67%. One of the strains is distinct from the others by the yellow pigmentation of its colonies, its ability to use D-glucuronate, trehalose, D-sorbitol and citraconate, ability to grow at 4 degrees but not at 40 degrees, and a lower G + C content: 63%. One strain accumulates poly-beta-hydroxybutyrate. This work confirms the well-known, wide variability of the bacteria belonging to the P. stutzeri group. Denitrification by two of the strains was quantitatively studied using cell suspensions. Cells from NO-3-containing anaerobic cultures reduce NO-3, NO-2 and NO to N2O and N2; they reduce slowly N2O to N2. Cells grown in anaerobic cultures under N2O also reduce NO-3, NO-2 and NO to N2O and N2 but they reduce N2O rapidly to N2.


Immune responses to influenza virus in rabbits after local immunization. i.--Local and systemic humoral response. IgA was found to be the predominant immunoglobulin in the bronchoalveolar secretions of rabbits. Significant quantities of IgG antibodies were also present in these secretions after intratracheal immunization with live influenza virus, but IgA/IgG ratios in the secretions were always higher than in corresponding sera, whether the rabbits were immunized or not. The relative excretion coefficients of IgA in these secretions were also found to be higher. In vitro culture of broncho-alveolar wash cells showed active synthesis of all the three major immunoglobulins with IgG as the predominant one. Immunization with live influenza virus induced a higher and more persistant antibody response in the respiratory secretions than the inactivated virus. A rapid and more intense production of IgA and IgG antibodies in these secretions after intratracheal booster antigen strongly suggests the presence of immunological memory in the secretory immune system of the respiratory tract. The role of secretory antiviral antibodies in protection against respiratory infections is also discussed.


Fungus implantation with wooden intraocular foreign bodies. Four cases of wooden intraocular foreign bodies are presented. In each case the foreign body was found to be contaminated by fungi which may have contributed to the intraocular inflammatory response but did not actively invade ocular tissues. Tolerance of the eyes to the retained wooden material was very poor.


Prophylactic cryotherapy of retinal breaks. All 100 eyes treated with transconjunctival cryotherapy to seal peripheral retinal breaks had a final vision as good or better than when they were first seen. Three of the 100 eyes developed clinical retinal detachments subsequent to the initial cryotherapy, necessitating scleral buckling procedures; all 3 had a final vision of 6/6 in the involved eye. No other complications occurred. Indications for treating retinal breaks or for not treating, are presented. In general, all symptomatic retinal breaks and asymptomatic ones if in aphakic eyes, when crescentic or linear at the margin of lattice, or if horseshoe, are treated. Other instances in which asymptomatic retinal breaks are treated are the following: (1) eyes on long-term miotics: (2) cases in which a retinal detachment is present in the fellow eye: (3) the break(s) are in an only eye; (4) cataract extraction is being considered; (5) 4 diopters of myopia or greater are present; or (6) subretinal fluid of more than 1 but less than 2 disc diameters in size is noted. Other retinal breaks not associated with subclinical or clinical retinal detachments are placed under observation at periodic intervals.


A simplified technique for macrodacryocystography. A simple method for radiographic visualization of the lacrimal drainage apparatus is presented. Equipment necessary is explained and normal radiographic anatomy of the system illustrated. Several cases of high- and mid-level obstructions are shown via this technique and a discussion follows.


Anterior chamber depths of Nigerians.

Anterior chamber depths of Nigerians. Anterior chamber depths of 1,646 eyes of 823 Nigerians were measured to determine the distribution of chamber depths in Nigerians, and to compare the findings with previous observations in Caucasians. The persons examined included normal subjects and other groups with ocular pathology, such as glaucoma. The mean chamber depth in normal persons was 3.23 mm. Anterior chambers were deeper in males than females and significant shallowing occurred with age. Mean chamber depths were less in glaucomatous eyes than normotensive eyes. When compared with previous studies in Caucasians no significant differences could be found in the two ethnic groups. It was concluded that the alleged differences in the incidence of angle closure glaucoma in Caucasians and Negroes is not due to differences in the anterior chamber depths in the two groups.


Use of drugs in ointment for routine mydriasis. The mydriatic effect produced by ointment preparations of cyclopentolate 1%, tropicamide 1%, and phenylephrine hydrochloride 10% was compared to the mydriasis elicited by the aqueous solutions of the same concentrations of drugs in children and adults. There was no difference in the amount of mydriasis produced by one instillation of a very small volume of the drug in ointment in one eye when compared to multiple instillations of the aqueous solution of the same drug in the contralateral eye in 30 minutes. There were no complaints of ocular irritation when the ointment preparations were instilled into the eye; however, there were frequent complaints with the use of these drugs in aqueous solutions.


Retinal detachment following branch vein occlusion: case report. A case is presented of a patient with the unusual situation of a rhegmatogenous retinal detachment from an old branch vein occlusion, who in addition, had a macular hole. The detachment was cured by a scleral buckle involving the peripheral hole only.


Unsafe without a hole: a dangerous cryoextractor. Due to the absence of an exhaust hole for the expanding gas, a disposable cryoextractor shot its activator button like a bullet out of its top against the ceiling--barely missing the head of the assisting surgeon.


Visual recovery after central retinal artery occlusion: two cases. Two cases of central retinal artery occlusion of prolonged duration (greater than 6 hours) were treated with retrobulbar anesthesia, anterior chamber paracentesis, and high-dose carbon dioxide and oxygen inhalation. Both cases recovered excellent vision and illustrate that visual recovery after relatively prolonged central retinal artery occlusion is possible.


A possible cause of chronic cystic maculopathy. An apparent increase in incidence of chronic cystic maculopathy following cataract surgery in our patients prompted an analysis of changes in surgical procedure. The important change was in the increased amount and duration of exposure to the operating lights. Previous animal research by various authors suggested to us the precipitating factor was a photic maculopathy. Various methods of avoiding excessive exposure of the patient's eye to the operating lights are discussed.


The office retinal electrophysiology laboratory. The "Visual Retinal Profile" can be obtained in the complete office evaluation of patients with night vision disorders, unexplained poor visual acuity, or undiagnosed retinal and/or choroidal diseases. This profile allows later follow-up evaluations and comparisons of previous tests to document improvement or progression of disease. The profile consists of the usual ophthalmologic evaluation plus color vision testing Amsler grid, stereoacuity, visual fields, electroretinogram (ERG), and electrooculogram (EOG). This entire set of tests, though time consuming, can be performed in the office by an ophthalmic assistant and greatly add to the ophthalmologists ability to evaluate and diagnose subtle retinal and/or choroidal diseases. A portable ERG/EOG and light source will be described that can be used in the office, clinic, nursing home, or operating room by trained office personnel.


Massive cataract relief in eye camps.

Massive cataract relief in eye camps. The concept of "eye camp" represents a revolutionary approach to the massive problem of cataract-related blindness and visual disability. The "eye camp" involves comprehensive cooperative relief efforts on a large scale to combat the widespread incidence of cataract as it affects residents of rural areas, especially in developing nations. We worked in an eye camp in Johilpatti, India, in the rural province of Tamil Nadu. On this site, 216 cataract operations were performed in one morning by 8 doctors and 16 nurses. In this province alone, an estimated 700,000 persons have cataract requiring operation. However, presently existing facilities are equipped to handle a maximum of only 20,000 cases annually. But from June 1972 to June 1973, approximately 50,000 cataract operations were performed in the eye camps. Evidently, the eye camp idea has great potential to significantly reduce the incidence of untreated cataract in rural areas where there are chronic shortages of treatment facilities and medical personnel.


Lash excision in trichiasis.

Lash excision in trichiasis. A simple technique for lash excision in the surgical management of trichiasis is described. Of 13 patients treated with this technique, 11 had complete relief of symptoms and 2 had significant improvement in symptoms with the remaining symptoms attributable to other manifestations of their underlying disease. There were no complications in any of the cases from the surgical procedure itself. This procedure is quickly and easily performed and has been found to be particularly useful in elderly and debilitated patients, and in those patients whose trichiasis is associated with conjunctival scarring.


Sudden deafness: histopathologic correlation in temporal bone. The histopathological study of two cases of sudden deafness is presented. The temporal bones showed cochleosaccular abnormality. The most striking pathological changes were collapse of the organ of Corti, atrophy of the tectorial membrane, atrophy of the stria vascularis, decrease in the number of the cochlear nerves, collapse of the saccular membrane and partial absence of the sensory epithelial layer in the saccular macula. These changes are quite similar in type to those occurring in labyrinthitis of known viral etiology and to those in previously reported cases of sudden deafness which were assumed to be of viral origin. This evidence suggests that a viral infection was the most probable etiology of sudden deafness in these ears. In addition, unusual findings of endolymphatic hydrops limited to the extreme basal end of the cochlear duct were found in Case 1. A patent cochlear aqueduct and circumscribed perilymphatic labyrinthine ossification in  the superior seimicircular canal were also observed. With these histopathological findings, the possibility of viral infection via the meninges as well as via the hematogenous route into the inner ear is proposed.


Immunological concept for Bell's palsy: further experimental study. This report concerns itself with additional experimental evidence to support the immunologic concept for the pathogenesis of Bell's palsy, using the mast cell as an index of immunological activity. In a previous experimental study, we postulated that degranulation of mast cells activated by complement or specific allergens with release of histamine and other substances may be the mechanism leading to nerve edema, ischemia, and paralysis. In this study we observed a loss of granulated mast cells in the more severely damaged facial nerves of immunized dogs after the intrafallopian canal injection of various substances, in contrast with the relative abundance of these cells in nerves that showed little or no evidence of injury. In addition, we demonstrated that cromolyn sodium, a mast cell degranulation inhibitor, when infused intravenously at the time of the intrafacial canal injection of horse serum, very effectively lessened the degree of experimental paralysis and histologic nerve injury.


Primary carcinoma of the mastoid bone.

Primary carcinoma of the mastoid bone. The diagnosis of carcinoma primary in the mastoid bone is usually made while performing a mastoidectomy in an effort to control presumed chronic mastoiditis. The association of chronic infection, serosanguineous otorrhea, and severe otalgia, common warning signs of carcinoma of the middle ear or external auditory canal, may or may not be present with a carcinoma primary in the mastoid bone. If the amount of bony mastoid destruction seen by roentgenography is out of proportion to the degree of clinical infection, malignancy should be strongly suspected. The authors present a case of primary carcinoma of the mastoid bone, and review the diagnosis and treatment.


Equilibrium disorder in carbamazepine toxicity. Three cases of acute carbamazepine intoxication were evaluated neurotologically and neurologically. Findings included symptoms of equilibrium, gait and speech disorders, drowsiness, gaze nystagmus, depressed optokinetic nystagmus and disturbances of smooth pursuit eye movement. These findings, suggestive of a space-occupying lesion, disappeared after the cessation of the medication. On the basis of the clinical findings it is felt that carbamazepine affects structures within the brain stem and the cerebellum. It is well known that equilibrium disorders caused by anticonvulsant intoxication are due to cerebellar disorders, but from our present study it should be noted that they originate not only from cerebellar lesions but also from brain stem lesions.


Hearing loss from acute carbon monoxide intoxication. A case of fluctuating sensorineural hearing loss from acute carbon monoxide (CO) poisoning with presentation of a U-shaped audiogram is reported. Acute CO intoxication seems to involve vestibular function more frequently than auditory function. Hearing loss is uncommon, but when present, may often display a U-shaped audiometric curve. Decrease in hearing sensitivity probably results from hypoxia to the cochlea, VIII nerve and brain stem nuclei. Fluctuation in hearing sensitivity may be an early manifestation of acute CO exposure, and requires periodic audiometric examination until the hearing has stabilized.


Middle components of the auditory evoked potentials in infants. Middle components of the averaged auditory evoked potentials (AEP) were recorded from 18 infants, 6 each at one, four and eight months of age, during natural sleep, Tone bursts centered at 1000 Hz were presented from a loudspeaker at 15, 30, 45 and 60 dB HL (re: normal adult tone burst threshold). In addition, an equal duration no stimulus control AEP was also obtained. Each averaged response consisted of the sum of 400 stimuli presented at a rate of about 6/sec. Latencies and amplitudes of the three peaks, Na, Pa and Nb, were analyzed as a function of age and intensity. There were no significant differences in latency as a function of age, and only peak Pa showed a significant increase in amplitude as a function of increasing age. The latency of peak Pa decreased significantly as a function of intensity, while the amplitude of all three peaks showed significant differences as a function of intensity. Judges' scores of the presence of responses showed that at 60 dB HL, all infants yielded patterns which were scored as "response present." Smaller percentages of "response present" were scored for the successively lower intensity levels. The results from the 18 infants in this study were similar to those obtained from six normal, sleeping adults tested under identical stimulating and recording conditions in this laboratory.


Differential diagnosis of xerostomia by quantitative salivary gland scintigraphy. A new and rapid method of quantitative salivary gland scintigraphy has been developed. The uptake of pertechnetate in the glandular tissue and in a reference area in the neck are measured. The ratio between these measurements gives an index of salivary gland activity. By using this activity index, quantitative information on the functional state of the parotid and submandibular glands can be obtained. In cases of xerostomia such measurements may be particularly helpful in differentiating Sjögren's syndrome and sialosis and hence in the choice of appropriate treatment.


Properties of acoustic reflex adaptation. The dynamic behavior of the acoustic reflex to continuous sinusoidal stimuli was investigated. The major purpose was to determine the temporal characteristics of reflex adaptation as frequency (0.5, 1.0, 2.0, 3.0, 4.0 kHz) and suprathreshold level (6, +12, +18 dB re reflex threshold) were systematically varied. Repeated measurements were made with an impedance bridge on six normal listeners. Both relative and absolute impedance changes were analyzed. The results revealed large intersubject variability. Four general conclusions were reached regarding the effect of stimulus frequency and suprathreshold level on adaptation: 1) as the stimulus frequency increases, the rate of adaptation increases; 2) the adaptation curves appear to form distinct groups, at the low frequencies adaptation rates are significantly slower than those at 2.0 kHz and above; 3) the onset of adaptation occurs at an earlier time for the higher frequencies; and 4) the rate of adaptation was found to be independent of suprathreshold level. The changes in adaptation with frequency of the stimulus may be expressed by an equation involving inter-related time constants for the growth and adaptation portions of the reflex curve in accordance with a descriptive model suggested by Tietze.


Hearing aids & hearing deterioration.

Hearing aids & hearing deterioration. The literature contains articles which report that the deterioration of hearing is increased by the use of hearing aids, and others which show that there is no increase. The results of our experience with 261 patients over a ten-year period show that there is no increase in hearing loss in the aided ear which can be attributed to the use of a hearing aid.


Dilator naris muscle.

Dilator naris muscle. The human nose is an important organ of respiration which by virtue of its valvular influence becomes a significant effector of respiratory resistance over a wide range of ventilatory requirements. In man its effectiveness in this regard is related to its flow limiting segment (FLS) located at the limen nasi. Its passive valvular effect is additionally modified by active respiratory contractions of the dilator naris muscle (DNM) controlled through the VII cranial nerve by the brain stem respiratory center. Its behavior, quantitatively determined in human beings and experimental animals, is summarized. 1) In man, phasic DNM activity operates during eupneic nasal breathing and varies directly with  ventilatory resistance. 2) The elimination of all measurable ventilatory resistance results in complete cessation of DNM activity. 3) Over time, reduced resistance produces difficulty in reestablishing dilator function once it is physiologically lost. 4) DNM respiratory activity is modified by pulmonary mechano- and pressure-receptors via afferent vagal pathways. The response of nasal dilators in valvular control, therefore, appears dependent on the physiologic integrity of the vagus nerves. It is our belief that nasal valvular control has not previously been appreciated in this context.


Impression materials for removal of aural foreign bodies. A new method for removal of aural foreign bodies is introduced, employing the injection of a semifluid impression material into the external auditory canal, and its removal after curing with the engulfed foreign matter. This technique obviated the need for a general anesthetic in some pediatric cases, while in others it was just a more pleasant experience.


[Hereditary Sipple syndrome (author's transl)]. This entity, isolated by Gorlin, is characterized by the presence of cutaneous and mucous neuromas, facial disfiguration resembling acromegalia as well as morphological changes to the extremities similar to those produced by Marfan's disease. These factors are also associated with multiple endocrinological neoplasms type II of Sipple's syndrome. In other words, malignant tumors developing from thyroid "C" cells as well as from bilateral benign pheochromocytoma (neoplasias which derive from the A.P.U.D. system). It is considered to be hereditary in nature and transmitted as a dominant trait. Its evolution is triphasic, and the prognosis is extremely dismal. There may exist incomplete or benign forms, in the course of which the endocrinological neoplasms may appear very late or not at all. Generally, the diagnosis is easy. This entity can be calssified with other diseases stemming from the neural ridge, in other words "neurocristopathies" but in spite of these similarities with disease of the same embryological origin, it would seem that this particular entity is genetically autonomous. The only effective treatment is surgical, for thyroid neoplasms, as well as neoplasms occurring in the medullo-adrenal glands. It should be noted that this line of treatment must be undertaken with the utmost precaution.


Temporal bone showing otosclerosis, paget's disease and adenocarcinoma. In a pair of temporal bones serial sectioning revealed widespread Paget's disease with otosclerosis on both sides and, at the right side, adenocarcinoma added. Stapedial fixation was produced on the right by otosclerosis, and on the left by Paget's disease. In the contest to reach the inner cochlear space, Paget was the winner on the left, where, at the tympanic scala, otosclerosis and Paget's disease almost met, while the immediately adjacent organ o Corti was uninvolved.


[Cutaneous symptoms of thrombocytemia (author's transl)]. By the study of 4 personal cases and a review of the literature, the authors describe the symptoms which may complicate and even reveal an essential thrombocythemia. They are: painful symptoms which indicate a permanent or paroxystic vasculomotor syndrome by their localization and their course: -erythematous lesions of an inflammatory livedo type located on the legs and blue-red reticular spots on the sole of the foot: --occurrence of gangrene on finger ends or of necrotic ulcerations of the legs. Etiological conditions, exploration of primary hemostasis, physiopathology of the troubles are described. As for therapeutics the antiaggregants have a suspensive effect on the symptoms but only the control of the hematological status may allow recovery.


[Plasmocytic proliferative lesions of the foreskin. A variety of Zoon's benign circumscribed balanitis (author's transl)]. A peculiar anatomoclinic form is described about the Balanoposthite chronique circonscrite bénigne à plasmocytes (Zoon): the pimpled, erosive, nodular and pseudoangiomatous form. Clinically this balantis realizes a pseudo-oedematous infiltration (which belongs to the usual form) and especially botriomycome-like nodules (obs. 2) or pseudo-neoplastic tumors (obs. 1). Histologically, the lesions consist of a pure plasmocytar infiltration, with total disappearance of the epithelium. In spite of its pseudo-tumoral aspect and of the abundance of plasmocytes, this kind of balanitis is quite benign and chronic, may persist many years without transformation, and is never a sign of dysglobulinemia.


Metabolism of intranasally applied cocaine. Surprisingly little is known about the metabolism and toxicity of cocaine in man. In this study serum obtained following nasal surgery was assayed for benzoylecgonine (the major metabolite of cocaine) by radioimmunoassay. It was found that cocaine was rapidly hydrolyzed in the serum. Benzoylecgonine was detectable in the serum at 15 minutes. The peak blood level of the metabolite appeared at 4.5 hours with a peak concentrations of 872.9 ng/ml. The half time clearance of the metabolite from the serum was 5.5 hours. A discussion of variables which must be considered in deriving, by a scientific method, a maximum safe clinical dose is presented.


[Lichen striatus; histologic features (author's transl)]. The histologic picture of lichen striatus is not uniform and changes, as it seems, with the "oldness" of the lesion; showing: sometimes a dense lympho-histiocytic infiltrate of the papillary dermis and epidermis, sometimes features of atypical lichen planus. The existence of spongiotic vesicles in the low epidermis and in certain late forms, pictures of disruption of the basal layer with residual cavities compose particular data of the disease.


[Teutschlaender lipo-calcino-granulomatosis or tumoral calcinosis of Inclan (author's transl)]. The present report describes a typical case of tumoral calcinosis. Differential diagnosis was initially directed towards sarcoma suggested by fibrous connective tissue surrounding cystlike cavities. The course of this disease led to chronic multiple fistulae with secondary infection in spite of two attempts of surgical excision. This case adds further support to the results of earlier reports showing no specific biological abnormalities. The present sutyd indicates otherwise that tumoral calcinosis and lipo-calcino-granulomatosis of Teutschlaender are the same condition. The pathogenesis of this affection remains enigmatic; there is no evidence that the lipidic excess should be the beginning of the process, but this disease must be considered as a distinctive form of calcinosis. The surgical exeresis is the only possible treatment, even if it doesn't prevent recurrence.


[Multiple, continuous and progressive fibromatosis (author's transl)]. Fibromatoses--a subgroup within the group formed by various disorders of fibroblastic origin--have been reviewed. The existence of cases which defy an easy classification has been pointed out. The case of a patient, aged 44, in whom multiple, continuous and progressive tumours, some with considerable invagination, have kept appearing since the age of 10, has been reported.


[Follicular tumidus retro-auricular lichen planus (author's transl)]. Referring to three comparable cases, a new form of lichen planus is described. This form is characterized by a prominent lesion, violaceus in color or pigmented, with white yellowish specks mimicking milia. The histologic picture of lichen follicularis, the presence of typical papules of lichen distant from the retro-auricular lesion make it possible to consider this clinical aspect as a variety of lichen planus.


Proplast tracheal prosthesis: a preliminary report. Proplast, a recently developed biologically acceptable synthetic polymer has been utilized in replacement of the cervical tracheas of five dogs. The results of this initial study are encouraging and, in the opinion of the authors, justify further experimentation with this refined prosthetic model.


[Keratoacanthomas and xeroderma pigmentosum (author's transl)]. A girl with xeroderma pigmentosum has developed seven successive keratoacanthomas on the face, since the age of 5, during a period of two and a half years. The clinical diagnosis of keratoacanthoma was obvious for most lesions. Three keratoacanthomas have been removed and the diagnosis has been confirmed histologically. The four more recent lesions have regressed without any surgical treatment. No impairment of the cell-mediated immune function has been noticed (there is no failure in D.N.C.B. sensitization; the level of the blastogenic transformation after phytohaemagglutinin stimulation lies within limits of normal values obtained from control subjects). Keratoacanthoma is an uncommon complication of xeroderma pigmentosum, since only 15 other cases (2 of them are successive keratoacanthomas) have been reported in the literature. In a recent publication, it has been stressed that a deficit of cell mediated immunity can be associated with xeroderma pigmentosum. Such a deficit has also been observed in a patient with multiple keratoacanthomas. In contrast with those reports, no failure of cell mediated immunity has been observed in our patient, as far as provocative tests are concerned.


[Essential melanic pigmentation of the mouth and the lips]. Lenticular or linear, buccal or labial, slate-coloured or melanic black spots are noticed in healthy subjects with no racial, hormonal or drug factor. Histological examination shows a pigmentary excess of the basement membrane without anomaly or dystrophy or nevus cells. Ultrastructural study shows a great number of intracyto-plasmic melanosomes, isolated or in group in all the keratinocytes in the third inferior part of the epidermis. No explanation can be given to this melanocyte hyperactivity. An excision can be done without danger for esthetical purpose.


[Adult papular acrodermatitis (Gianotti's disease). Report of 3 cases]. The authors report three cases of adult papular acrodermatitis with circulating HBs antigen. The eruption was followed by a benign icteric hepatitis which lasted from 30 to 45 days. In two cases, HBs antigen disappeared in a one month period, in one case the antigen has been present for more than three months. Direct immunofluorescence staining exhibits c3 deposits in the vessels of the dermal lesions, without any deposition of immunoglobulins or fibrinogen. We were unable to demonstrate the presence of HBs and " e " antigens in the skin lesions (using FITC conjugated specific antiserums). Serum protein concentrations of complement components C1q, C4,C3, C3PA were normal as measured by radial immunodiffusion. The percentage of circulating B and T cells was normal, as essayed by E-RFC, EAC-RFC and sIg. Thus, adult papular acrodermatitis, as well as the infantile form, does represent a sign of invasion of a benign viral hepatitis.


[Hyperkeratosis punctata of the palmar creases]. The authors have collected 6 cases (one personal case and 5 cases from the literature) of hyperkeratosis punctata of the palmar creases, an affection which seems to be a new type of keratosis punctata. It is characterized by the development of small horny plugs in small cup-like depressions which are electively and exclusively found in the palmar flexion creases of the fingers. Histological examination shows a plug-like hyperkeratosis penetrating, more or less deeply, the depressed, funnel-like Malpighi's mucous layer which sometimes consists of one layer of cells. This affection might be compared to Kyrle's disease (and the hyperkeratotic plugs of mechanical origin). The histological evidence of non-rupture of the dermis by the horny plugs may not be considered as a sufficient factor of differentiation: however, other clinical criteria differentiate these various affections. In the absence of a known etiology we must conclude that this type of keratosis punctata confined to the palmar creases is an autonomous disease.


[Serum IgE levels in scabies. Study about 100 cases]. IgE levels were determinated in 100 cases of human scabies. In 85 cases, the values are normal (mean value =160 UI/ml, 2 S.D.=528). In 15 cases with raised values, an associated disease (cirrhosis, atopic dermatitis) was always found. The results were compared with those of other authors.


[Familial epithelioma of Ferguson-Smith about two familial cases]. Two cases of multiple self-healing epithelioma (Ferguson-Smith) are reported in a French family. This dermatosis has been present since the age of 30 in both father and son. The father aged 66 years, farmer, had suffered since 1939 from recurrent spontaneously healing tumors of the face and neck, with deeply pitted scars on the face. He was treated during fifteen years in a cancer institute for multiple well-differentiated " squamous cell carcinoma " on the neck, face, and tongue; local recurrence did not occur after treatment of the active tumors and there was no clinical evidence of secondary lymphnode involvement. His son, aged 30, teacher, came in July with a papular active tumour on the cheek, which was surgically removed; his face and ears soon became affected. In the two cases, numerous biopsies showed in the early stage a great down growth of the epidermis with a central horny plug, like in keratotic papules or small kerato-acan-thomas and in more active lesions, typical appearances of squamous cell epithelioma grade I. The familial incidence is proved in the majority of the 30 cases reported since the first description by Ferguson-Smith in 1934. Only caucasians are concerned, most of them being Scottish. There is no sex predominance. First changes generally occur in young adults on light exposed areas but mucous membranes can be affected. The individual lesions last for several months, but fresh ones appear continuously, so that the disease remains extensive. The cause of these tumors is still unknown; histological and ultrastructural findings cannot explain this condition. Our ultrastructural study is parallel to previous works and fails to find viral particles in keratinocyte nuclei or cytoplasma.


[Centrifugal annular erythema of Colcott-Fox type (erythema gyratum perstans)]. The case of a child with Colcott-Fox type of centrifugal annular chronic erythema is reported. It is a sporadic, non-familial form, associated with a bullous eruption, and an atrophic conjonctivitis with trichiasis. A review is made of 11 previously published cases, allowing a synthesis of their essential features. The action played by the slow reactive substances (S. R. S. A.) in the extension of the erythematous margin is discussed. The clinical diagnosis of centrifugal annular erythema is exposed.


[Lymphomatoid granulomatosis: cyclic nodular lymphomatoid panniculitis with immunologic deficiency]. The case of a 66 years old woman having presented an unusual cyclic dermatosis of 11 months duration is reported. The cutaneous elements were successively located in a subcutaneous, dermal and epidermal situation, and presented a spontaneous healing with sometimes deep retractive residual scars after an ulceration or not. Pathologically, the lesions consisted in dense mononuclear infiltrates and vascular lesions. This disease was associated with an immuno-deficiency state characterized by extremely low levels of circulating IgM. This deficit was found to be persistant as it was still present two years later. However during this lapse of observation no cutaneous lesions recurred. The possible connexions of such a case with those of lymphomatous granulomatosis are discussed. In the absence of pulmonary lesion in the case reported here, no identification to the syndrome isolated by Liebow seems permitted. The authors offer a new denomination for this unusual entity.


[Erythrosis interfollicularis colli de Leder]. The authors have studied clinically and histologically two cases of " erythrosis interfollicularis colli de Leder ". It's a frequent affection, principally between 40 and 50 years of age but not very known because the patients rarely consult for it. Clinically they insist on the respect of a triangulary and lozengical median zone, and on the sight in "plucked chicken skin"; histologically on the dilatation of sebaceous glands, the frequency of a folliculary corneous plug and the elastic tissue alterations. On the etiological plan, the part of the age, the sun exposure, and in their two cases on the possible photosensibilisative part of the scents.


Secondary amyloidosis developing after pancreaticoduodenal resection. Necropsy of a 34-year-old women four years after she had undergone pancreaticoduodenal resection showed amyloidosis, fatty liver, and cachexia. In life a malabsorption syndrome had been diagnosed two years after the resection, but at this stage tests for amyloidosis were still negative. Besides the fatty liver, positive histochemical tests for lipids (lipoproteins) in amyloid deposits were also found. Taken together with other findings these features reinforce the suggestion that lipprotein accumulation plays an essential part in the formation of amyloid.


Surgical treatment of peptic oesophageal stricture with Nissen fundoplication and intraoperative dilatation. 6 patients whose peptic oesophageal stricture caused by reflux oesophagitis was treated surgically with Nissen fundoplication and oesophageal dilatation are reported. In 5 patients oesophageal dilatation was performed intraoperatively and in one postoperatively 2 months after Nissen fundoplication. One patient whose stricture had been treated for 12 years with repeated dilatation required several dilatations postoperatively as well, but now, 6 months after operation, the need and frequency of dilatations are definitely decreasing. Our results of the Nissen fundoplication operation and simultaneous oesophageal dilatation are very promising. We feel that in the surgical treatment of benign peptic oesophageal stricture, particularly if the aetiology of the stricture isgastro-oesophageal reflux, more conservative operations of this type will displace other procedures consisting of resection of the stricture with or without intestinal interposition.