Pseudomonas pneumonia with bacteraemia.

Pseudomonas pneumonia with bacteraemia. A previously healthy man developed fulminating pneumonia and bacteraemia due to Pseudomonas aeruginosa. This organism was isolated from sputum and blood before death, and from the lung, liver and spleen at autopsy. Bacteraemic psuedomonas pneumonia is rare, carries a high mortality, and is usually associated with serious underlying disease.


Foot lesions in diabetic patients: pathogenesis and management. Vascular disease is the major factor in the development of many lesions in diabetics, although the independent role of neuropathy has been increasingly recognized. The major problem in assessment is to decide the severity of ischaemia and neuropathy present in a particular patient. Healing after local surgery can be expected in those lesions which are painless, and peripheral (that is, are situated on the toes or forefoot), especially if the ankle pulses are present. Operation must provide adequate drainage and wound care must be meticulous. The problem of prevention of recurrences remains unsolved, but recurrences can probably be delayed or prevented by a careful follow-up.


The work load and distribution of obstetricians and gynaecologists. A questionnaire to members of the College was returned, completed, by over half the members. It appears that very heavy work loads are carried by many members, and 44% of those in private practice consider themselves overworked. The opinion of 18% of the respondents is that too few specialists are being trained, and 61% of them said that too few general practitioner obstetricians are being trained. Eighty per cent believe that specialists and trained practitioners should practise obstetrics. Recertification is thought desirable by 79%, and continuing education by every respondent.


A survey of epidemic polyarthritis in the Riverland area, 1976. In a survey of 93 cases of epidemic polyarthritis which occurred in South Australia in 1976, 77 patients suffered from a rash, and 87 patients had joint pains. Forty-five patients had positive serological results. In a control group, only eight of 34 controls had positive serological results. The distributions of rash and joint pains, together with those of other symptoms, are presented. Forty-five patients were unable to work during their illness. The incidence of doctor contact and the drugs taken are given.


Dopamine hydrochloride (Intropin) and open-heart surgery: results of a clinical trial. Dopamine hydrochloride (Intropin) has been used in the postoperative management of open-heart surgical patients, both children and adults. It has been associated with a very low incidence of undesirable responses and a high frequency of circulatory improvement associated with diuresis. Its administration requires careful control of infusion rate and measurement of response. In the dosages employed, it has been free of most of the undesirable side effects of other commonly used catecholamines.


Hypnosis in a treatment programme for alcoholism. This is a report on a pilot study of the use of hypnosis in the treatment of alcoholism at an outpatient clinic. It describes the characteristic features of the sample of patients who seem to have responded to treatment and gives an account of the therapeutic programme.


Family response to loss of a child by sudden infant death syndrome. Nineteen families were interviewed after their loss of an infant by sudden infant death syndrome. Their bereavement responses are described. The outcome after 13 months is studied in terms of resumption of normal living, and health changes. The parents' perceptions of intervention are discussed, and recommendations are made about how best to help such families.


Rebound hypertension after sudden discontinuation of methyldopa therapy. A case of "rebound hypertension" resulting from the sudden cessation of methyldopa (Aldomet) therapy is described. The importance of educating patients about the possible outcome of abruptly withdrawing antihypertensive medication is emphasized.


Do support systems prevent psychiatric disorders? "Support" is a concept which is widely used by clinicians and laymen. What it consists of, though, is quite unclear. The proposition is examined, that just as certain components of the psychosocial environment are noxious, so other parts may cushion or protect the individual against adversity. Such an hypothesis would go some way towards understanding the sex distribution of neurosis, the active ingredient in Caplan's "psychosocial supplies", the presence for most adults of a principal attachment figure, the cohesion of the social network and the affectional function of the medical consultation. The development of this concept provides a new dimension for research in social psychiatry.


Neonatal necrotizing enterocolitis: 1. Clinical aspects. Forty-infants were diagnosed as having necrotizing enterocolitis (NEC) during a 33 months' period; these represented 4% of all neonatal admissions. Pathological confirmation was obtained at surgery in 12 cases and at autopsy in 11, In the case of 21 infants who recovered without operation, the diagnosis was based on clinical and radiological criteria inculding the presence of intramural gas. NEC occurred primarily, though not exclusively , in low-birth-weight infants. Two-thirds of the infants developed NEC in the first week of life. Clinical features attributable to gastrointestinal malfunction as well as a systemic illness could be defined. Complications included pneumoperitoneum (34%), localized peritonitis as suggested by the development of an abdominal mass (11%) and intestinal obstruction (25%). Fourteen of the 15 cases of pneumoperitoneum were diagnosed within 24 hours after the onset of NEC. The 5 infants were localized peritonitis, who were managed conservatively initially, developed intestinal obstruction during recovery. Intestinal obstruction presented between 2 and 7 weeks after the onset of NEC. The overally mortality was 25%, infants with intestinal perforation or obstruction having and increased mortality of 38%.


Artificial insemination with donor semen. Fifty-three consecutive couples requesting artificial insemination with donor semen are presented. Insemination was carried out with fresh semen. Forty-three proven pregnancies were achieved with a mean of 3-4 treatment cycles per pregnancy. Psychological and legal aspects relating to this method of treatment are discussed.


Present prognosis in neonatal meningitis. A retrospective study of neonatal meningitis for a period of 6 years (1970 to 1975) is described. It was found that though the survival rate had increased since the introduction of the aminoglycosides, it was at the expense of major neurological sequelae in the survivors. It is suggested that breast feeding of all infants in the first few days of life will reduce the incidence of neonatatl meningitis. It is recommended that pooled human breast milk should not be heat-sterilized as this destroys anti-Escherichia coli immunoglobulin A.


Some atypical features of Still's disease. Still's disease can no longer be considered a rare disorder. Although the onset usually follows one of several definable patterns, some patients may present with features at variance with classical descriptions of the disease. Four such patients are described to illustrate some of the diagnostic problems which may arise.


Aboriginal versus non-aboriginal alcoholics in an alcohol withdrawal unit. Fifty-five Aboriginal alcoholic males were compared with ninety non-Aboriginal alcoholic males, presenting voluntarily for treatment at an alcohol withdrawal unit. Although the chronological development of excessive drinking habits was similar, significant differences in drinking patterns and social backgrounds were found. Aboriginal patients consumed more alcohol, had lower levels of education and vocational achievement and were more often homeless. However, physical condition was similar in both groups. It was suggested that treatment of both groups should be similar in the acute withdrawal phase and that there was need for more rehabilitation and after-care facilities for Aboriginal alcoholics rather than for more medical units.


Human artificial insemination: some social and legal issues. The demand for human artificial insemination (AI) is increasing as a function of declining numbers of babies available for adoption and greater community awareness. This paper reviews some of the social and legal issues associated with the practice of AI: prevalence of marital infertility; demand for AI; moral objections; effect on marriage; legality of practice; legal position of all the parties to the practice; legislation proposed to regulate the practice; and payment of medical benefits.


The control of hydatid disease and ovine cysticercoses in the Australian Capital Territory and southern New South Wales. A survey of human hydatid disease in New South Wales and the Australian Capital Territory over the period 1968 to 1973 was made from hospital records in Sydney and Canberra. The 162 new cases found represent an incidence, of 0-57 per 100,000 per annum, but the 20 patients living in the Central West Statistical Division of New South Wales at the time of admission to hospital represent an incidence of 12-6 per 100,000 per annum in that area. A survey of A.C.T. farms revealed dogs carrying the causative parasite Echinococcus granulosus on five out of 44 properties (11-4%). Community attitudes favoured control measures but displayed a misplaced faith in anthelmintic drugs. The high regional prevalence on the Australian mainland reveals a need to restrict availability of anthelmintics and extend the vigorous control measures employed successfully in Tasmania.


Neonates at risk. Screening for deafness--practical or not? Over a six-year period, 3,507 neonates in King George V Memorial Hospital, classified as being at risk for deafness, were screened for hearing. Although 144 failed to respond in the nurseries, 88 of them were cleared at a later test. The remainder, whether suspect, untraceable or still to return, would all be outside the neonatal period by now. No sensorineural impairment of hearing was detected in all neonates in the programme.


Varihesive sealed dressing for indolent leg ulcers. Forty-three patients with indolent leg ulcers that were resistant to a wide variety of treatment methods for an average period of 353 weeks, were treated by the application of sealed dressings with Varihesive (a compound of gelatin, pectin, sodium carboxymethyl-cellulose and polyisobutylene) a non-allergenic wafer which sticks to a moist surface. Varihesive dressings proved to be effective both in affording pain relief, and in allowing healing of 36 out of 43 ulcers (84%) in a mean time of 10 weeks. It is concluded that such a non-allergenic seal provides optimum conditions for reepithelialization of chronic ulcers and that Varihesive dressings are a valuable adjunct in the local treatment of skin ulceration.


Pregnancy after jejunoileal shunt.

Pregnancy after jejunoileal shunt. This report describes an unsuccessful pregnancy after a jejunoileal bypass operation that produced a severe secondary malabsorption syndrome with superimposed mechanical and metabolic effects of pregnancy to which the patient nearly succumbed.


[Relapsing polychondritis (author's transl)]. Report about a case of relapsing polychondritis in a woman aged 60 years, which was proofed through autopsy. There was involvement of the trachea, the bronchial system and the cartilages of the ribs. The cartilages of nose and ear did not show any typical changes; therefore the diagnosis could not be established during life. The pecularities of the clinical picture and the pathohistological findings are reported in detail. It seems that the polychondritis is related in it's pathogenesis to the rheumatic disorders. tthe etiology, however, remains obscure.


[Heart and pericardial metastases resulting from bronchial carcinoma. Side effects of radiotherapy (author's transl)]. A brief survey of bibliography on heart and pericardial metastases resulting from bronchial carcinoma is followed by a report on our autopsy findings in 110 patients suffering from bronchial carcinoma. In 29 cases, i.e. 26 p.c., heart and pericardial metastases were found. In three cases, only the heart was affected, in 16 cases only the pericardium, and in 10 cases both heart and pericardium were involved. In 27 cases, they were spread by way of the blood and were mostly part of a general formation of hematogenous metastases. In-growth exclusively from primary tumour regions was found only in two cases. In 19 cases, metastases were both hematogenous and grown-in per continuitatem. Anatomicopathologically, 18 patients had a small cell carcinoma, 10 a squamous cell carcinoma, and one showed an adenocarcinoma. While 15, i.e. 14%, of our 110 patients, on whom we performed an autopsy, had died from arrosion bleeding, this was true only in one case in the group of 29 patients with heart and pericardial metastases. Radiation side effects in the form of lung and pericardial fibroses in the patients, who had generally been treated with cobalt 60 gamma rays, were confirmed by autopsy findings only in one third in both cases as compared with the findings by X-ray diagnosis during life. Lung fibroses were found in 16 cases (14%), and pericardial fibroses in 6 cases (5.5%). They were not strictly dependent on the dose.


[T1 carcinoma of the stomach in endoscopy and microscopy (author's transl)]. After intensification of our gastroscopic examinations in 15 cases of early stage T1-carcinoma of the stomach was found by biopsy and proven in the resection specimen. Further, 144 advanced carcinomata of type T2 and T3 were detected. The incidence was 0,42% of all gastroscopies and 9,3% of all assessed carcinomata. The discovery of 284 high risk patients is of special importance and it is expected that intensive follow-up examinations of this group will enable the early detection and surgical cure of gastric carcinoma. We are not agreeing with pessimistic authors believing that the early diagnosis of the wide spread gastric carcinoma may not be improved. The main problem seems to us the too great time delay until diagnosis. As it is valid in general for the early detection of cancer it has to be an important task for the practizing physician to recognize the very first gastric symptoms in order to admit the patient as early as possible to gastroenteroscopy.


[Diagnosis of skeletal metastases in prostatic cancer using gamma camera (author's transl)]. On 170 patients with histologically proven carcinoma of the prostate scintigraphic studies of the skeleton using gamma camera and follow-up examinations were performed and compared with x-ray as well as serum alkaline and acid phosphatase. Osseous metastases in 47% had no radiological evidence and were only scintigraphically detectable. Positive scans were registered in 48% of the patients with prostatic cancer, 20% of them were positive due to metastases and 28% were false positive caused by osteoarthrotic and arthritic changes, sporadically by post-traumatic lesions and in 3 cases by Paget's disease. At the time of the initial diagnosis of prostatic cancer 21% of 159 patients studied scintigraphically had radiological or scan  evidence of osseous metastases. Analyses corresponding stages of tumor revealed an unequivocal dependance of the frequency of metastases upon the extent of the primary tumor. The successful treatment is characterized by the decreased uptake of radioactivity primarily accumulated in skeletal metastases.


[Germ cell tumours in gonadal dysgenesis (author's transl)]. In a 17-year-old patient gonadal dysgenesis with a XY-karyotype was diagnosed by laparoscopy and chromosomal analysis. Two years later, the patient came again to the hospital because of a large tumour which proved to be a dysgerminoma. Except dysgerminomas, other germ cell tumours are also found in gonadal dysgenesis, for example gonadoblastomas, which consist of germinal cells, Sertoli-granulosa-cells and interstitial cells. In most cases of gonadal dysgenesis with a germ cell tumour a Y-chromosome is present. The risk of a gonadal tumour in such cases is estimated to be 25%. In gonadal dysgenesis with a Y-chromosome a prophylactic extirpation of the gonads is necessary, which should be combined with a hysterectomy.


[Treatment of glomerulonephritis with heparin (author's transl)]. 32 patients with different histologically proven forms of glomerulonephritis were treated with heparin for an average of 31 days. A dosage of heparin was chosen, which allowed an increase in thrombin time to 20-40 seconds. Histological findings alone do not allow any prediction concerning the therapeutic success of heparin treatment in glomerulonephritis. According to our results and comparable information given in the literature, the following therapeutic scheme can be recommended: Best results are seen in patients with a slow decrease of GFR (i.e. less than 30 ml/min) during the year preceding the beginning of the treatment. In rapid progredient glomerulonephritis, however, as in patients without any changes of GFR during this time, predictions as to the course of illness cannot be made. A high level of fibrin split products in serum may be expected to be the most valuable sign of therapeutic effect, as could be documented in 7 out of 8 successfully treated patients. Hypertension and proteinuria were not influenced by the treatment. Because of severe side effects the heparin treatment of glomerulonephritis should not be initiated in patients with severe hypertension.


[Folic acid substitution in advanced renal disease (author's transl)]. The plasma content of folic acid was evaluated in 27 patients with advanced renal disease. There were no significant morphologic changes within the erythrocyts of the peripheral blood and bone marrow. The hematologic response of the reticulocyts, hemoglobin and hematokrit were studied after oral treatment with folic acid. There was a significant reticulocytosis at the 5th to the 8th day after initiating the oral treatment. This reaction underlines a definite, mainly nutritional (latent) folic acid deficiency being one cause for the renal anemia in these patients. A subsequent rise of the hemoglobin or hematocrit did not occur. Further possible causes for these clinical data are being discussed.


[Kinetics and differentiation of monocytes in man (author's transl)]. This paper gives a short review of the monocytopoiesis in the bone marrow, the kinetics of monocytes in the blood, the differentiation of monocytes in the tissue and presents new data on monocyte transit time through the peripheral blood. Monocyte kinetics were studied in three hematologically normal persons, four patients with Hodgkin's disease and four patients with chroniclymphocytic leukemia using 3H-TdR-pulse-injection or 3H-TdR continuous infusion. The average value of the mean blood monocyte transit time was 25.1 hours. The mean blood transit times of haematologically normal persons and patients with lymphatic disorders did not differ significantly.


A staphylococcal radioimmunoassay for detection of antibodies to Mycoplasma pneumoniae. A radioimmunoassay (RIA) which depends on the property of protein A of Stapbylococcus aureus to combine with the Fc-fragment of immunoblobulins was developed. This technique was employed to measure antibodies in human and various animal sera. It coulb be demonstrated that the staphylococcal RIA was at least as sensitive as the previously decribed radioimmunoprecipitation technique in detecting antibodies to M.pneumoniae in human sera. In addition, antibodies to M. pneumoniae could be demonstrated in sera of hamsters intranasally inoculated with the organisms. Antibodies could also be demonstrated in rabbit sera after immunization with M.pneumoniae. The test proved to the considerably more sensitive than conventional tests for detection of antibodies to the organisms. The test requires only small amounts of reagents and is relatively inexpensive.


The use of RD cells in the isolation of Echo type 30 virus from patients with aseptic meningitis. Between early July and August 1976, 60 cases of aseptic meningitis and pharyngitis in children from various parts of West Germany were reported to this institute. Successful virus isolation from spinal fluid in 12 out of 36 cases was greatly facilitated by the use of RD cell tissue cultures, whereas isolation attempts in HEL, Vero, and HFDK cells were unsuccessful. In all cases, the isolated virus was identified as ECHO type 30. Neutralization studies with sera of 48 remaining cases also using RD cells clearly indicated that the epidemic outbreak was caused by ECHO type 30 virus.


Action of some pancreatic enzymes on Vibrio cholerae. The action of pancreatic amylase, trypsin, lipase, and whole pancreatin was tested on five strains of Bibrio cholerae. Amylase did not act on any strain in concentrations to 10,000 IU/ml whereas trypsin increased vacuolization and lipase enhanced retraction of the protoplasm particularly in 2 of the 5 tested vibrio strains. Pancreatin caused damage hoth of the cell wall and the cytoplasm. It is suggested that these enzymes may play a role in the defense of the body against cholera vibrios.


Anti-staphylococcal gamma hemolysin antibodies in rabbits with staphylococcal osteomyelitis. Titers of antibodies against staphylococcal gamma hemolysin were estimated in 23 rabbits with experimental staphylococcal osteomyelitis and in 32 control animals. In all but three infected animals from 2- to 64-fold increases of the antibody titers were detected. Most of the control animals showed no changes in anti-gamma toxin antibody titers, but in two animals some increase was noted. The possible significance of these differences is discussed.


Radioimmunoassay for LCM virus antigens and anti-LCM virus antibodies and its application in an epidemiologic survey of people exposed to syrian hamsters. A specific and sensitive solid-phase radioimmunoassay has been developed for the detection of LCM virus antigens and anti-LCM virus antibodies. The test was performed in a microtiter system using polyvinylcholoride wells coated with anti-LCM virus rabbit hyperimmune serum. LCM virus antigens were allowed to bind to this antibody and afterwards detected by 125J-labeled anti-LCM virus-gamma-globulin. Anti-LCM virus antibodies were assayed by specific inhibition of these bound antigens. Since this technique is rapid and easy to perform the solid-phase radioimmunoassay is a valuable test for detecting LCM virus infections. Selected at random, 208 girls with, and 208 girls without, contact to Syrian hamsters were investigated for anti-LCM virus antibodies. Five (2.4%) of the hamster-exposed girls had anti-LCM virus antibodies (RIA-titer 1:8-1:32) in contrast to none of the control group (P=0.03).


Ethical issues in investigation of screening strategies. Screening programs can be designed to be useful for data collection to study effectiveness of screening. High-risk populations may be identified, and screening techniques applied to a randomly selected subgroup with another subgroup serving as controls. This raises the ethical question of not applying helpful surveillance to individuals known to be at high-risk. Attention should be paid to management of controls, for example, to screen them less frequently, or at least to inform them of their increased risk and advise periodic exams. Against such recommendations is that differences between test and control groups would be minimized and the study less conclusive. Another approach is to use adaptive design, selecting the study group for a large population which is being subject to medical surveillance for some other reason. As in other clinical trails, studies of screening programs must include appropriate surveillance for controls to properly safeguard their rights and medical needs.


Social and ethical implications of claims for cancer hazards. Current data show that about 80% of human cancers can be traced to environmental causes. The majority of human cancers are associated with two main etiologic factors: smoking of cigarettes and diet, which account for most of the cancers in the respiratory tract, in the digestive tract, and in the endocrine sensitive and reproductive organs. The evidence for these multifactorial causes is both ipidemiologic and experimental. In recent years a number of lay and professional groups have expressed concern that the microcontaminants in our environment are responsible for cancer in man. Agitation, press releases, and statements before legislative and excutive government departments have made claims for cancer hazards which do not appear to rest on sound epidemiologic or experimental bases, yet these claims hav alarmed and indeed scared the public. Government agencies and industry have spent funds to investigate such claims. It appears that such actions not only divert valuable research funds and efforts into lines which do not seem to be fruitful in leading to a reduction in cancer risk for the main human cancers, but by falsely alarming the public, dilute serious efforts of cancer prevention with respect to the experimentally and epidemiologically established cancer risk.


Releasing carcinogenesis test results: timing and extent of reporting. A carcinogenic in an animal bioassay is usually characterized by gradaul accumulation of a tumor incidence significantly in excess in the treated versus the control animals. In some cases, a definite response is realized relatively early, prior to planned sacrifice. In others, positive results are found at termination. In both cases, a long delay may occur before the information is ready to reach the public due to the time needed to complete pathology, data analysis, publication of a report. Since the finding that a chemical is carcinogenic may have serious implications for public health and technology, reports of carcinogenesis bioassays should be thoroughly and critically reviewed before being issued. A delicate ethical dilemma confronts scientists in selecting the proper timing and extent for the release of carcinogenesis test results. Early findings may not be confirmed and may cause technological and economic problems and unnecessary anxiety. On the other hand, delaying public notification of highly suspicious findings until a final, detailed report is published, may delay preventive actions that could protect exposed populations from unnecessary risks. To meet differing requirements in regard to timing and extent of reporting, procedures were developed to issue reports on National Cancer Institute (NCI) carcinogenesis bioassays when the findings are clearly identified and well documented in the following forms: a) reports of preliminary findings, when the evidence is strongly suggestive; b) summary reports of completed bioassays; and c) detailed technical reports. Availability of such reports, particularly for preliminary findings, will be announced in the Federal Register and in a press release. The reports will be submitted for publication in the scientific literature.


Estimation of risks due to environmental carcinogenesis. Several Federal agencies share responsibility for enforcing laws designed to control human exposures to carcinogens. This enforcement activity often has immense effects on other factors of our environment. Absolute safety is not possible, but increased protection is obtainable. Improvements are urgently needed in our ability not only to detect but also to quantify relative risk. Resources should be directed for maximum overall effect. Relative risk must be quantified if we are to reasonably compare risk and benefit. Examples of the inexactness of current toxicological, epidemiological, and mathematical models for estimating risk due to exposures to DDT, aflatoxinb1, DES, and benzidine are presented. The impact of different laws and regulations applicable to the control of these agents is compared. Reference is made to major programs in toxicological methods for risk estimation.


Kinetics of Mu DNA synthesis.

Kinetics of Mu DNA synthesis. Mu specific DNA synthesis starts at 10 min after infection. All essentail amber mutants of Mu were tested for the ability to replicate in a non permissive host. Except for the amber mutants A and B, which were already known to be blocked in Mu DNA synthesis (Wijffelman et al., 1974), all the other mutants showed normal Mu DNA replication. Using mitomycin C-treated cells Mu DNA synthesis was found to start at about 20 min after induction. However using the much more sensitive method of DNA-RNA hybridization, it was found that the DNA synthesis starts already at 10 min after induction, and that at 20 min after induction about 7 copies of the Mu DNA are present per cell.


Rapid screening for plasmid DNA.

Rapid screening for plasmid DNA. A procedure is described for demonstrating plasmid DNA and its molecular weight, based on rate zonal centrifugation of unlabelled DNA in neutral sucrose gradients containing a low concentration of ethidium bromide. Each DNA species is then visualized as a discrete fluorescent band when the centrifuge tube is illuminated with ultra-violet light. Plasmids exist as closed circular and as relaxed circular molecules, which sediment separately, but during preparation of lysates, closed circular molecules are nicked so that each plasmid forms only a single band of relaxed circles within the gradient.


The isolation and genetic characterization of extrachromosomal chloramphenicol and oligomycin-resistant mutants from the petite-negative yeast Kluyveromyces lactis. Spontaneous mutants of the petite-negative yeast Kluyveromyces lactis, resistant to the antibiotics chloramphenicol and oligomycin, were isolated and genetically characterized. Three chloramphenicol-resistant mutants showed non-Mendelian inheritance when crossed to sensitive parents. Of 5 oligomycin-resistant strains studied, three exhibited resistance due to the presence of an extrachromosomal mutation. The resistance of the other two deriving from a nuclear and recessive mutation. When two factor crosses in trans configuration were performed between two of the chloramphenicol and the five oligomycin-resistant mutants a polarity in recombination was observed with a predominance of sensitive (OSCS) over resistant (ORCR) reciprocal recombinants. Allelism tests carried out among the oligomycin-resistant mutants indicated the presence of at least two distinct extrachromosomal regions responsible for the resistance.


Rolling circle replicative structure of bacteriophage lambda DNA in a recombination deficient system. Rolling-circle replicating structures which represent late stage lambda DNA replication can be detected among intracellular phage lambda DNA molecules under recombination deficient conditions as well as in wild-type infections. Furthermore, if initiation of lambda replication is delayed until the late stage of lambda infection, then nearly all replicating molecules are rolling-circle, even in the first round. Thus neither genetic recombination nor termination of a round of replication are required for generation of rolling-circle replicating molecules of lambda DNA.


Phosphorylation of ribosomal protein S6 in suspension cultured HeLa cells. HeLa cell ribosomal protein S6, and the increase in its phosphorylation level that occurs after resuspending cells in fresh medium plus serum, were studied using two-dimensional gel electrophoresis. The maximum level of S6 phosphorylation occurs about 2 h after adding fresh medium and seum to cells that have been allowed to grow to high density; this results in an almost complete shift of the spot representing S6 in two-dimensional polacrylamide gels to a new location. Mixing experiments showed that the differences in the level of phosphorylation occur in vivo and are not an artifact of in vitro sample preparation. This method of stimulating S6 phosphorylation provides a convenient system for studying the functional significance of the phenomenon. Only one other ribosomal protein was detectably phosphorylated using [32P]-labeling and autoradiography of dried two-dimensional gels. The level of phosphorylation of this protein, L14, does not change after serum stimulation.


A new nucleic acid-protein cross-linking reagent. A new photoactivable reagent is described, which allows the formation of RNA-protein cross-links via disulfide bridges in combination with mercaptobutyrimidate. The reconstituted L24 protein-23S RNA complex from the large subunit of E. coli ribosomes has been used as a model system for the cross-linking. The main advantages of the reagent are the absence of U.V. generated cross-links, since photoactivation is carried out at 360 nm, on one hand and the ease of cleavage of the cross-link by mild reduction (beta-mercaptoethanol) on the other.


DNA synthesis during meiosis of eight-spored strains of Chlamydomonas reinhardi. In strain 137F of Chlamydomonas reinhardi, the zygospores undergo one round of nuclear DNA replication followed by three divisions to produce octospores. The third division without replication has been interpreted by Sueoka et al. (1967, 1969) to mean that the gametes and vegetative cells have at least binemic chromosomes. We have repeated their experiments using the same strain. However, the meiotic products were inviable--unable to undergo postmeiotic vegetative growth, DNA replication or division. On the other hand, using a variant of strain 137C which also has three divisions during germination we have shown that meiosis is normal. Zygospores from this strain undergo two rounds of nuclear DNA replication prior to the formation of octospores. These meiotic products are viable and capable of postmeiotic vegetative growth, replication and division. Since the third division without DNA replication subsequent to the two meiotic divisions leads to inviable products, and the strain which has viable products after three divisions does not lack the additional replication, meiosis in Chlamydomonas reinhardi provides no evidence of a bineme chromosome structure.


Extrachromosomal inheritance in Schizosaccharomyces pombe. III. Isolation and characterization of paromomycin-resistant mutants. In the antimycin--resistant mutant anar-8 of the fission yeast Schizosaccharomyces pombe (Sch.p.) spontaneous mutants were isolated showing high resistance to the aminoglycoside antibiotic paromomycin. All mutants were resistant to the structurally related antibiotic neomycin. Tetrad analysis, mitotic segregation analysis, and mitotic haploidization revealed extrachromosomal, very likely mitochondrial inheritance. In contrast to the rapid segregation of mitochondrial markers in zygotic clones of Saccharomyces cerevisiae (S.c.) the heteroplasmic state of diploids proved to persist for at least 50 generations after zygote formation. Stationary cultures of the paromomycin-resistant mutants parr-106 and parr-112 contain up to 6% respiratory-deficient mutants, but no reversion to paromomycin-sensitivity was observed among 1700-1800 colonies tested. The ability of mutant anar-8 to produce spontaneously respiratory-deficient mutants could be separated from the antimycin-resistant phenotype of anar-8.


Chromosomal and extrachromosomal inheritance of erythromycin-resistance in the "petite-negative" yeast Kluyveromyces lactis. Spontaneously arising erythromycin-resistant mutants were isolated in the "petite-negative" yeast Kluyveromyces lactis. Two independently arising mutants were studied, in one erythromycin-resistance was conferred by a single dominant nuclear gene, and in the other the resistance was extrachromosomally inherited. In fermentable medium growth of sensitive and resistant strains in presence or absence of erythromycin does not qualitatively change the cytochrome absorption spectra, whereas oxygen uptake of parental strains growing in glucose-medium is affected by the drug. The importance of "petite-negative" yeasts like Kluyveromyces lactis for the study of nucleo-cytoplasmic interrelations is discussed.


Management of retinoblastoma.

Management of retinoblastoma. The management of 499 cases attending Moorfields Eye Hospital and St Bartholomew's Hospital, London, is described. The method of examination and differential diagnoses, together with the indications for treatment with light coagulation, cryosurgical techniques, cobalt plaque applications, cobalt beam therapy or the linear accelerator and chemotherapy, are listed in terms of the experience gained with this number of cases. Nowadays, the survival rate is approximately 90%.


[Treatment of retinoblastoma by radioactive cobalt and xenon photocoagulation]. During the years 1961-1975, 50 cases of retinoblastoma in 31 boys and 19 girls from all parts of Poland were under treatment in the Ophthalmological Clinic in Cracow. The ages of the children at the time of diagnosis ranged from a few months to 10 years. The largest group included children between 1 and 3 years. In the majority of patients, neoplasm affected both eyes. The eye with the most advanced changes was enucleated, and the other subjected to treatment if the size of the tumor gave a prognosis of at least partial preservation of vision. In the case of unilateral tumors, treatment was undertaken if the changes were not too advanced. In the patients under treatment, 60Co according to themethod of Stallard and xenon light coagulation was applied. The observation period varied between 0.5 and 15 years. In our work, a correlation was found between the results and the size of the tumors, their localization, and postoperative complications. Our treatments proved successful in 70% (50.0-90.9%) of the cases.


Combined B- and  A-scan ultrasonography in the management and preoperative assessment of vitreo retinal pathology. Newer surgical techniques such as vitrectomy instrumentation and microsurgery now allow us to take a full advantage of ultrasonic evaluation of vitreal-retinal pathology. The ultrasonic techniques of A- and B-scan as well as M-scan allow us to more adequately evaluate the opaque vitreous, retinal detachment, traumatic changes to the globe, thus directing the newer surgical techniques to achieve therapeutic results never previously possible.


[50 years of treatment of retinal tumors at the Curie Foundation]. During the past 50 years, technical changes have led to an undeniable improvement of the lesions and the percentage of cures. Systematic treatment of the orbital cavity and optic nerve is indispensable in the case of a unilateral tumour where the optic nerve has been affected. The surveillance of a unilateral tumour must continue for a long time because bilateralisation can intervene 5 or 6 years later. One must never make a double enucleation, but always attempt a conservative treatment, on the least affected eye.  Cases which are very advanced in appearence can have a favourable development and provide a useful vision.


beta-Irradiation of retinoblastoma with 106Ru/106Rh applicators. Therapeutic results after beta-irradiation suggest that 106Ru/106Rh applicators have become an acceptable means of radiotherapy in patients suffering from retinoblastoma with a height of not exceeding 5 mm. Because of the rapid fall-off radiation dose it is possible to deliver a high dosage to the tumor without danger of radiogenic damage to the whole globe. Out of 22 children suffering from retinoblastoma a complete destruction and scarification of the tumor could be obtained in 18 eyes with sufficient vision acuity over a follow-up period of more than 5 years. In 4 cases an additional photocoagulation was necessary. beta-Irradiation avoids an undesirable high-volume dose. It may, therefore, be regarded as a useful contribution to radiotherapy of retinoblastoma.


Diagnosis of retinoblastoma by cytologic examination of the aqueous and the vitreous. Cytological examination by aspiration of the aqueous and the vitreous can be an additional useful technique to aid in the diagnosis of certain anteriorly located unusual appearances of retinoblastoma with opaque media, particularly if the information from ultrasound is not available or is unsatisfactory. A positive cytological diagnosis should be immediately followed by enucleation. Personal experience is presented.


[A typical treatment of a case of bilateral retinoblastoma]. The treatment of bilateral retinal tumors requires very delicate decisions. The author used to follow the same procedures as his colleagues, that is enucleation of the worse eye and conservative treatment of the other eye. But the case he presents induced him to modigy his view. Enucleation of the right eye was planned. Prior to enucleation it was irradiated prophylactically together with the left eye. A few days after irradiation, the tumor became inexpectedly smaller and could be destructed by photocoagulation. The left eye was treated in the same way. The girl has now been followed for 5 years. Her visual acuity is reduced to peripheral vision on the right eye and to 0.7 on the left eye. Upon the last control in May 1976 no new lesions or recurrences were observed.


Analysis of misdiagnosed retinoblastoma in a series of 726 enucleated eyes. Of 726 eyes consecutively enucleated at the Mayo Clinic from 1954 through 1974, 41 contained retinoblastoma. In no instance was unsuspected retinoblastoma identified, nor could retinoblastoma be confirmed pathologically in an additional eight eyes in which retinoblastoma was considered in the differential diagnosis. In each of our eight misdiagnosed cases, the eyes were already blind and were cosmetically defective. The frequency of clinical misdiagnosis of retinoblastoma is high in part because it must be considered in every case of leukokoria. Although every effort was made to arrive at an accurate clinical diagnosis, the clinical misdiagnosis of retinoblastoma in a blind eye is of far less serious consequence than the clinical misdiagnosis of a tumor in a seeing eye.


[Retinoblastoma and transmission of balanced chromosomal modifications]. Two cases of retinoblastoma in two children showing a chromosomal rearrangement in the karyotype  were reported. In the first case, a pericentric inversion of chromosome 9 was observed both in the child and his father. In the second case, a reciprocal translocation t (3;12)(q29;q15) present also in the paternal karyotype was identified. A strict connection cannot be established between the tumour itself and the family chromosomal aberrations, but these observations raise the problem of a possible "interchromosomal effect".


Is the procedure of vitreous suction out of date since introduction of vitrectomy? Vitreous suction is still a useful procedure in cases of severe vitreous opacification. In spite of the technical perfection and good results of vitrectomy, the chances of a vitreous suction should be taken into consideration before a definite decision is made. The surgical technique of vitreous suction is very simple, lensectomy is never required, and the possibility of a subsequent vitrectomy is not impaired of the suction manoeuvre has failed. The frequency of complications, namely retinal detachment and bacterial intraocular infection, is reasonable if the almost hopeless condition of the affected eyes, and the severe general diabetic angiopathy and poor resistance are considered, which in individuals with postoperative endophthalmitis usually are found. Vitreous suction is still acceptable as a minor sort of vitrectomy.


What is the present status of pars plana vitreous surgery in Zurich? Although we have not changed the principles of our technique, increasing experience has made it possible to refine some details of the instrument set and the surgical technique. The electrical part of the vitreous stripper is safer, and a diathermy source for endodiathermy belonging to theinstrument set has been developed. Not only the slit lamp for the microscope, but also the fibre-optic illumination are in their final form. A new contract lens facilitates bimanual operation in the vitreous space. Progress in surgical technique has been made in the simultaneous extraction of the cataract in diabetic patients, in the extraction of non-magnetic foreign bodies, and in the combined vitreous-retinal detachment surgery.


An ocular fixation device for freehand pars plana vitrectomy. An adaptation of the stereotaxic micromanipulator is described which provides ocular support and stabilization during freehand vitrectomy. It consists of a baseplate for immobilization of the patient's head and an ocular fixation arm assembly which connects to the eye by grasping a special Flieringa ring sewed to the postlimbal sclera. The ocular fixation arm can be made alternately flexible or rigid, thereby providing needed ocular mobility or stability during the operation as is desired by the surgeon.


Combined A- and B-scan echography. Preoperative evaluation of vitrectomy patients. The preoperative ultrasound evaluation of vitrectomy patients is of great value. The combined use of an optimized and standardized A-scan and B-contact scan echography gives good results. While the A-scan echography gives information about the quantitative and kinetic characteristics of the examined structures, B-scan echography demonstrates, in addition, the shape and topographic relationship of the investigated structures. The combination of A-scan and B-scan echography is not time-consuming and does not inconvenience the patient as does the use of an immersion water bath. The results of 105 echographically evaluated vitrectomy patients are presented.


New developments in instrumentation for vitreous surgery. The paper describes new instruments for cutting of vitreous strands (vibrotome) and for removal of vitreous tissue (hyalophage). In addition, a motorized stereotaxic micromanipulator is presented.


"Arlene"--the electronic Roto-Extractor assistant. Using an analysis of the surgical assistant's manual aspiration functions as a guide, an electronic Roto-Extractor surgical assistant has been developed that is entirely subservient to the surgeon's foot control. The electronic assistant communicates audibly to the surgeon regarding the interplay of actual fluid flow and the accumulation or build up of vacuum in the aspiration lines of infusion-aspiration-cutting instruments.


Incisional complications in pars plana vitrectomy. Four cases of incisional complications following pars plana vitrectomy are presented. In each instance, excessive fibrosis occurred at the wound site. In one patient, the disorder was mild and did not lead to clinical difficulties during his lifetime, however, in the three severe cases the eyes were lost secondary to intraocular organization and phthisis bulbi. Possible contributing factors include diabetes mellitus, excessive trauma and necrosis at the wound site, postoperative inflammation, and vitreous involvement in the wound. Since no treatment is known, atraumatic management of the incision using microsurgical techniques is strongly recommended.


Vitreolysis.

Vitreolysis. Pars plana vitreolysis appears to be a promising procedure and should be investigated more thoroughly during the years ahead. 22 cases are reported, which showed maintenance of the visual acuity in 20 eyes over a follow-up period averaging 13 months. The technique and indications have been discussed for this new procedure.


Prophylactic vitrectomy in proliferative diabetic retinopathy. Ten eyes with proliferative diabetic retinopathy but good visual function had pars plana viterectomies in an attempt to limit the future progression of the disease and maintain the good preoperative visual acuities. This goal was successfully achieved in nine of the eyes with no evidence of new proliferations after the vitrectomy procedure.


Results of primary vitrectomy in severe perforating ocular injuries. Vitrectomy in the initial treatment of perforating injuries is indicated when lens damage involves the posterior capsule, when anterior segment disruption involves vitreous, with extensive vitreous haemorrhage and overt or suspected retinal damage, in removal of a non-magnetic intraocular foreign body and in perforating  injury with endophthalmitis. The visual results in 72 eyes followed for up to 6 years are: blind or enucleated 19 (26%), acuity less than 0.1 in 14 (19%), 0.1-0.4 in 18 (25%) and 0.5 or better in 21 (30%). Retinal detachment occurred in 27 eyes with successful reattachment in 18 (66%).


The insufflation of freon in vitreoretinal surgery. Among the various gases recommended for intravitreal injection, sulfur hexafluoride (SF6) and octafluorocyclobutane (C4F8) are the most commonly used. The purpose of the injection is to restore the vitreous chamber after drainage of subretinal fluid or after vitrectomy. Some of the fluorinated hydrocarbons which belong to the group known as Freon (a registered trademark) have previously been used in the animal with the same end in view. Of these, Freon-12 and Freon-114 were selected on account of their physical properties, the fact that they remain in the vitreous cavity for 4-14 days, their availability and their innocuousness, and used in humans as an adjunct to vitreoretinal surgery. The results are compared to those obtained with other halogenated gases.


Intravitreal gas- an asset or debit in retinal detachment surgery? 38 retinal detachment cases in which intravitreal gas was injected were compared to 156 cases without intravitreal gas injection to determine if intraocular gas had deleterious effects upon the visual and surgical results. No differences were found in either group. Intraocular gas enhances the technical aspects in retinal detachment surgery.


Vitreous inflammatory reaction. Vitreous inflammation in rabbits, induced by saline, air, or sodium salt of hyaluronic acid. Inflammation of the vitreous body of rabbits after the injection of normal saline, sterile air, or SSHA was studied over a period of 30 days. The course of the inflammation follows a definite pattern: it shows an exacerbation 24 h after injection, an abrupt regression 48 h after injection, a new peak on the 8th day and subsequently a gradual regression until the 30th day. Although the course of the inflammation is approximately the same for the three vitreous substitutes, the reaction they provoke varies in intensity. The inflammation is most intense after the injection of SSHA and mildest after saline injection, while the intensity of the reaction caused by air lies between the two. The reaction was assessed by measuring the number and types of vitreous cells and the changes in the percentual proportions of globulin and albumin in the vitreous body, as well as by ascertaining the alterations of the vitreous structure.


[Echoculmetry in ablation surgery without subretinal drainage]. Based on echo-oculometric measurements of the maximum height of retinal detachments during the first hours and days after surgery without subretinal drainage, using a sound frequency of 12 MHz, final success (24 cases) or failure (2 cases) could be predicted within 24 h at the latest.


Ectopia lentis: management by combined lensectomy and vitrectomy. A technique is presented for removal of subluxated or dislocated lenses (ectopia lentis), along with performance of vitrectomy. It is believed that this method permits avoidance or reduction of the hazards and complications of techniques used in the past.


The effect of translatory and rotatory movements upon the eye. Their significance in the development of retinal detachment. It was shown in experimental models that translational movements of a closed chamber do not induce liquid flow in the chamber, but rotational movements do induce a current. It was also demonstrated in the experiments that rotational currents are able to elevate a rubber membrane if there is a hole and that a liquid flow is then passing through the opening. These observations initiated the idea of fixation of the eye in cases of retinal detachment in order to promote a reattachment.


Active immobilization of the eye in the treatment of retinal detachment. 40 eyes with retinal detachment were immobilized by traction sutures under the inferior and medial rectus muscles in order to study the rate of "spontaneous" reattachment following such fixation. There was an almost complete reattachment in 45% of cases, and partial reattachment (at least half of the detached area) in 40%. Little or no reattachment was observed in 15% of cases. Reattachment of the retina prior to the operation is considered advantageous for the success of surgery.


[Ultrasonics in the diagnosis of retinal detachment]. With the help of ultrasonography, 360 cases of opaque anterior segment of the eye have been examined. In these, 99 cases (27%) of retinal detachment have been found. Also in 200 cases of opaque media of the posterior segment, 61 cases (30%) of retinal detachment were present.


The natural history of senile retinoschisis. The natural history of senile retinoschisis was studied in 193 eyes of 108 non-referred patients while refraining from the use of any prophylactic intervention, over follow-up periods ranging from 2 to 11 years. No case of clinical symptomatic retinal detachment occurred. 2 cases of small localized subclinical retinal detachment  occurred, but these did not progress. 9 eyes showed new retinal holes. 11 showed increase in extent, and 7 showed spontaneous regression of lesions. An estimated risk of clinical detachment is calculated and four indications for treatment are given.


Clinical classification and quantitative surgery of retinal detachment. Rhegmatogenous retinal detachments were divided into four groups according to the location of the retinal breaks. The periphery group which had retinal breaks between the line of 17-19 mm from the limbus and the posterior margin of the vitreous base comprised about three quarters of the total rhegmatogenic retinal detachments. Lattice degeneration was the most important causal lesion of retinal breaks in this group. The periphery group was subdivided into the peripheral hole and the peripheral tear subgroup. The former was typical of young myopes, and the latter of elderly pwople suffering from posterior vitreous detachment. For treatment, the eyes of the periphery group could be classified according to the amount of subretinal fluid residue which was estimated after 24-48 h bed rest with binocular bandages. The quantitative surgery was planned and performed and the amount of eyeball volume lessened by the operation was equalized with the volume of subretinal fluid residue.


360-degree buckling as the procedure of choice in cases of retinal detachment with poor prognosis. A 360-degree scleral buckling procedure was used 82 cases of retinal detachment with poor prognosis. This procedure was successful in 58.6% of the cases after one operation and 76.8% after two operations. Because the complications observed were partially attributed to the extensiveness of the operation, it is proposed that this procedure be reserved for certain cases of retinal detachment with poor prognosis.


[Microsurgical experiences in retinal detachment]. For many years, the microscope has played an increasingly front-line role in surgery. Five years of experience with the microscope in retinal detachments are now reported both in ophthalmoscopy - under the microscope with the help of Goldmann's three-mirror contact glass - and for episcleral preparation. Since this time, the microscope has been used exclusively for operations. The technical conditions, and advantages and disadvantages of the new technique are discussed.


Geometry of intraocular gas used in retinal surgery. The relationship between the volume of an intraocular gas bubble and the area of retina covered by the bubble was studied using both a transparent model and a mathematical model of the vitreous cavity. The arc of contact of intraocular bubbles was calculated for vitreous cavities of various diameters. A 0.28-cm3 bubble will cover 90 degrees of retina and be of sufficient size to manage the majority of problems for which an internal retinal tamponade would be useful. Larger retinal tears require disproportionately large increases in bubble volume to achieve modest increases in the area of retina covered. Estimating bubble volume by observing the height of the bubble meniscus in the dilated pupil is subjected to errors induced by small shifts in the angle of observation. A correct evaluation requires that the plan of observation be adjusted so that it coincides with the plane of the meniscus.


Microsurgical technique for drainage of subretinal fluid with the aid of a sclerotomy retractor. In order to open the scleral incision during the whole length of microsurgical drainage of the subretinal fluid, a simple retractor was designed which allows the edges of the sclerotomy wound to spread out without the additional help of the surgeon's or  assistant's hands. By elevating the instrument, traction release of subretinal fluid is also possible, even in areas far behind the equator.


Factors influencing absorption of subretinal fluid. In 200 cases of retinal detachment successfully treated without drainage of subretinal fluid, complete reattachment of the retina was achieved in the first post-operative week in 76% of cases. Delay in subretinal fluid absorption in the remaining 24% of cases was directly related to the duration of the retinal detachment, but was not influenced by the patients age, refractive error or the characteristics of the detachment.


[Current technics in surgery of retinal detachment in children. Surgical and anesthesiologic aspects]. After some premises on the etiology of retinal detachment in children, the authors report their own surgical procedures. The indications, the advantages and disadvantages of the use of plastic or organic substances, with the effects of transitory or permanent plombages are discussed. Moreover, the anesthesiological problems concerning the preparation of young patients, the intraoperative phase and often numerous postoperative diagnostic controls are examined.


Long-term follow-up of scleral buckling procedures with sickle cell disease and retinal detachment treated with the use of hyperbaric oxygen. We have presenteed a late follow-up study of 8 eyes previously presented which were treated with scleral buckling procedures under hyperbaric oxygen conditions for repair of rhegmatogenous retinal detachments complicating sickle cell disease. In addition, we have presented a patient treated under similar conditions with a scleral shortening procedure and drainage of subretinal fluid for repair of a non-rhegmatogenous traction detachment secondary to diabetic retinopathy and sickle disease. We feel that our successful results in these cases and our lack of the usually reported complications merits the continued use of this technique in these difficult cases of detachment of the retina.


[Possibilities and limits of echographic examination of retinal detachment before and after surgery]. Ultrasonography can provide priceless information about a retinal detachment when the fundus is invisible because of a cataract or an unclear vitreous. The exploration of an eye with A-scan ultrasonography is a long and careful procedure which is made step by step along the meridians, then along the parallels of the eyeball. Quantitative ultrasonography is necessary to separate the echoes of the vitreous opacities and of the detached retina. The B-scan gives the same information - except the biometric data - in a much shorter time and is now available without the interposition of water between the patient and the probe. It also permits an easy diagnosis of the choroidal detachment. After the operation, when the media are not clear, A-and B-scan ultrasonography can give an early indication of whether the retina is reattached or not. But at that time a mistake may be made due to the edge of buckling and everyone should be aware of this.


[Advantages of microsurgery of retinal detachment]. The precision of adjustment, of control of indentation, and above all of cryocoagulation made under microscopic control with Goldman's glass, allows us to improve our anatomical and functional results in the surgical treatment of retinal detachment.


[Scleral control of cryotherapy in the treatment of retinal detachment]. The necessary condition for the creation of a chorioretinal scar is the freezing of the pigment epithelium (associated with that of the choroid during cryoapplication). In the case of retinal detachment, when the indentation of the cryode permits one to reach the detached retina, one can use the retinal control of the cryoapplication, i.e. the whitening of the retina. When the cryode indentation does not reach the detached retina, one must not wait for the retinal whitening for it produces a considerable over-application to the choroid during the time it takes for the ice to go through the subretinal fluid. In these cases, it is proposed to observe the development of the freezing area in the sclera on each side of the cryode. When it reaches 1 mm, it has the depth required to freeze the choroid and pigment epithelium. During this procudure, the sclera must not be indented. One is therefore certain thanks to the scleral control, not to freeze the retina or the vitreous and thus secondary retinal-vitreal complications.


Cryopexy of the reattached retina.

Cryopexy of the reattached retina. Light coagulation of a retinal defect or of the whole buckle following successful retinal detachment surgery, can be replaced by cryopexy. This is particularly useful in the case of opacity of the refracting media, or where too contracted a pupil hinders light coagulation. The technique and advantages of this proceeding are discussed.


Ultrasonography of subretinal space in rhegmatogenous retinal detachment. Ultrasonographic analysis of cases with pathological echoes from the subretinal space was made. An A-scan technique was used. Special attention was given to rhegmatogenous detachments. The results of the examinations, among others, were compared with the retinal detachment duration, with the state of the vitreous, and the state of the uveal tract, and with the type of the retinal holes.


Macular morphology in the re-attached retina. A sequential study of the macula using biomicroscopy and fluorescein angiography in patients who had undergone successful retinal re-attachment procedures is reported. The purpose of this study is to identify the morphological changes which occur at the macula following retinal re-attachment surgery, and to relate these changes to the post-operative visual function.


Motility disturbances induced by operations for retinal detachment. Study of the incidence and  characteristics of motility alterations following various operations for retinal detachment. Diplopia and asthenopia following retinal surgery are rare, despite relatively frequent muscular imbalance, because of: (a) suppresion (which war frequently found even in orthophorics with good postoperative vision in both eyes); (b) compensation owing to fusional power, and (c) probable role of the sensory factor for the compensation of the subjective experience of cyclotropia. However, asthenopia and diplopia may occur and may be hard to deal with. It is felt that these disorders could be avoided in many cases since they are frequently the result of technical errors.


Prognosis of return of macular function after retinal reattachment. A prospective analysis of macular function in 266 retinal detachment patients has been made. All of the patients were reattached by using cryopexy, and an external sponge technique. No drainage was done in 90% of the cases. To correlate the preoperative detachment with the postoperative function, the area of detachment in the posterior pole was measured and divided into five groups on the basis of the extension of the detached retina in the area of the macula and around the disc. The validity of this presurgical grouping was tested by postsurgical evaluation of visual acuity, light-sensitivity threshold, and metamorphopsia. Visual acuity was tested over a period of 1 year. Recovery of macular function appears to be dependent upon (1) presurgical extension and elevation of the macular detachment; (2) it duration; (3) the age of the patient, and (4) the degree of myopia.


The influence of changing cataract techniques on the ophthalmologist concerned with retinal diseases. This paper briefly presents a review of some of the retinal problems the ophthalmologist faces because of changing techniques in cataract surgery. It emphasizes the need for controlled clinical trials to properly evaluate the benefits or disadvantages of these changing techniques.


Cataract operations in a retina centre.

Cataract operations in a retina centre. The position of the cataract surgeon in a retinal surgical centre is a particular one. Close collaboration with the retinal specialist obliges him never to lose sight of the judgement of the latter. The retinal surgeon does not judge the success of a cataract operation by the consequent visual acuteness obtained, but must wait to see the fundus of the eye, and in particular the retinal periphery. This is a problem with which we are occupied. We have studied from the point of view of the cataract specialist the modifications and retinal complications occurring in 2000 cataract operations. In addition, we have tried to make, from the point of view of the retina specialist, an analysis of detachments of the aphakia which occurred in relation to the cataract operations during the same period of time.


Ultrasound in the differential diagnosis of juvenile retinal detachment. 495 ultrasonograms were performed on children with intraocular pathology. In this report 66 eyes with juvenile retinal detachment are reviewed and exemplary cases are presented. The most common indications for ultrasound in eyes with juvenile retinal detachment were opaque media due to trauma first and leucocoria second.


[Aphakic retinal detachment as a function of the technic and course of cataract extraction]. Myopic patients, in particular, should be carefully observed by contactglass examination prior to and after cataract surgery, in order to be able to perform prophylactic photocoagulation. In cases of vitreous  loss, the risk of having an aphakic retinal detachment will be 20 times as high; that is to say, in one of every five cases cataract extraction with vitreous loss can be expected to produce a retinal detachment. It can be said, therefore, that the best cataract procedure- as far as aphakic retinal detachment is concerned-will be that in which we can expect the lowest rate of vitreous loss. Whether an extensive anterior vitrectomy will reduce the number of aphakic detachments, we cannot yet say defintely, because in these cases we have only routinely performed vitrectomy during the past 2 years.


Number and shape of tears in aphakic retinal detachment: its relationship with different surgical techniques of cataract extraction. An analysis is made of retinal detachments which occurred in patients operated upon for cataract with different surgical techniques, as well as the degree of operating experience of the surgeons. The main clinical features of the detachments are recorded such as number, shape, localization of retinal tears, type and extension. The different surgical techniques are explained and a statistical comparison of the incidence of detachments is set up.


Preludes to retinal detachment in the aphakic eye. The author reviews the characteristic differences in primary rhegmatogenous retina detachment occurring in phakic eyes and in aphakic eyes. The preoperative findings in aphakic detachment are explained on the basis of two factors: surgical trauma during cataract extraction and postoperative changes in the macromolecular compostion of the vitreous.


[Structure of the vitreous body in the aphakic eye]. The structure of the vitreous body and the retinal periphery have been examined in 180 eyes after the use of different extraction methods of the lens. The smallest changes have been observed after cryoextraction without alpha-chymotrypsine. The investigations have been conducted using the three-mirror contact glass of Goldmann and concerned early observations.


[Prevention of retinal detachment in subjects before and after being operated on for cataract]. Some premises on the clinical aspects of retinal detachment in patients operated upon for cataract and in conditions of lens dislocation are made. The different aspects of the preoperative prophylaxis (indications, techniques, application time) are dealt with, and the technical procedures used during operation for cataract are described. The authors point out the necessity of a postoperative control of the aphakic eyes, at short-or long-term in order to avoid vitreo retinal alterations.


Cataract operation and retinal detachment. (1) 36 patients with a certified retinal detachment and a dense senile cataract who underwent cataract surgery prior to retinal surgery, (2) 32 patients with a history of detachment of one eye and a senile cataract of the other eye, who suffered a retinal detachment after cataract surgery. Discussion of the results of retinal surgery in the first group and on the incidence of retinal detachment and results of retinal surgery in the second group.


[Indications, technics and results of cataract surgery on an eye effected with healed or present retinal detachment or predisposed to detachment]. This communication is a survey of 53 cataract operations followed up during a period of 1-6 years, with an average of 4 years, and performed on patients who had a high risk of subsequent retinal detachment because of a preceding detachment on the fellow eye or on the cataractous eye, because of peripheral retinal degenerations, or a history of hereditary retinal detachment. Most of the operations were performed under general anesthesia and ocular hypotony. In all the cases, a limbal-based conjonctival flap with a double line of sutures (scleral and conjonctival), an iridectomy in segment, a zonulolysis and a cryoextraction, were done. As for the retina, 18 eyes received a coagulation before the cataract extraction by galvano- or cryocoagulation or even by  xenon photocoagulation. Among them 3 had a detachment after the cataract extraction, but 2 of them were cured by a new operation. 15 eyes had peripheral retinal lesions which were coagulated after the cataract extraction by cryo-, laser or xenon coagulation. Nevertheless 2 had a detachment. 13 patients with a detachment on the fellow eye or in the family, had no peripheral lesion and were not coagulated. None of them had a retinal detachment after the cataract extraction. Finally the eyes operated upon a short time after the  cataract extraction suffered severe complications: reopening of the cataract incision, loss of vitreous and finally loss of 2 eyes out of 3.


Results in cataract extraction after retinal detachment surgery. Out of 58 eyes in which a cataract extraction followed a successful detachment operation, only 8, or 15.5%, developed a detachment of the retina after the cataract operation and, of these 8 eyes, 7 were cured with further retinal detachment operation. Thus, in 58 healed detachment eyes, only 1 (1.7%) lost useful vision because of incurable retinal detachment following cataract extraction. Therefore, one may conclude that, in a patient definitely handicapped by poor vision due to a cataract in an eye with a healed retinal detachment, extraction of this cataract is justified and carries a good prognosis.


The treatment of 4 cases of retinal detachment following insertion of an intraocular lens. 4 cases of retinal detachment following the use of an intraocular lens have been described. Each offered a different problem in management, the results being satisfactory in 3 out of 4 cases. The ability to dilate the pupil and the clarity of the media, along with the maintenance of the proper position of the lens seem to be the most important factors in the treatment of these cases.


Intraocular lenses and retinal detachment. IOL are a new challenge to the retina surgeon. 32 eyes with pseudophakia and retinal detachment were examined. ICCE and ECCE had been performed and different types of lenses had been implanted. The single most important factor for the successful repair of these pseudophakic detachments was the clarity of the media.


Pseudophakic retinal detachment.

Pseudophakic retinal detachment. Our experiences with a small group of patients who had intraocular lens implants performed at the time of cataract extraction, and who subsequently developed retinal detachment are reviewed. The technical problems related to retinal detachment surgery in the presence of intraocular lenses and the results of this surgery are summarized.


Retinal detachment following cataract extraction by phacoemulsification. A review of 1,107 cases of cataract extraction by phacoemulsification is presented. The incidence of retinal detachment in this group was found to be 1,7%. This incidence of retinal detachment following phacoemulsification appears to be favorable compared to that following conventional cataract extraction. It is hoped that this report will encourage others to study this important subject.


Phacoemulsification and retinal detachment. Retinal detachment is not eliminated nor decreased to a rare complication after PE. There were 94 eyes with retinal detachments after PE examined and the majority operated. The fundus view might be hampered and some areas of the retina obscured by this form of lens extraction. There are, however, some cases where the small incision and relative clarity of the media, soon after cataract surgery, offer an advantage.


The influence of new surgical procedures on retinal pathology in aphakia after congenital cataract surgery. After reviewing the incidence of aphakic retinal detachment more specifically on eyes that have been submitted to surgery for congenital cataracts, the authors make some remarks and discuss the value, the advantages, and the yet unknown risks that the new methods of lens removal may have as regards retinal pathology. Special consideration is given to the balance of the advantages: more complete elimination of the opacities, lower incidence of immediate morbidity, better visual results and postoperative possibilities of retinal examinations; against the, as yet unknown, late retinal complications with new procedures such as ultrasonics, phacoemulsification, pars plana approach for lens removal, etc. Moreover, bearing in mind the typical late onset of retinal detachment in aphakic eyes after congenital cataract surgery with the older methods, such as linear extraction and multiple discussions, special attention is given to this feature as a comparative landmark for a prospective evaluation of recent methods of extracapsular lens surgery.


Incidence of cystoid macular edema after different cataract operations. With the development of new cataract surgical techniques, the question has arisen of whether the incidence of cystoid macular edema has actually increased, decreased or remained unchanged. A control study to determine the incidence of persistent cystoid edema following extracapsular cataract extraction and artificial lens implantation versus a similar age-group is being done in Miami using the traditional intracapsular cataract technique. The incidence of cystoid edema among patients submitted for phacoemulsification with or without lens implantation are also discussed.


[Role of anterior vitrectomy in the prevention of retinal detachment after vitreous loss]. A study was performed in two series of patients on whom lens extraction was done. Congenital cataracts were excluded from this study. In one series. the closure of the wounds was satisfactory; in the other, large anterior vitrectomy was carried out. The frequency of detachment (about 4%) seems to be approximately the same in the two series, but inflammatory signs and hypertony are more frequent when vitrectomy is not done.


Exudative retinal detachment secondary to dislocated lenses. 2 cases of retinal detachment with ectopia lentis are described. In each, the retinal elevations had surface features consistent with exudative detachments. Following removal of the posteriorly displaced lenses spontaneous retinal attachment was noted. The clinical and surgical course of these patients suggest a diagnosis of lens-induced exudative retinal detachment.


Prevention of aphakic retinal detachment by circumferential cryotherapy. In a series of ARD'S, the incidence of bilaterality was 35%, as opposed to an incidence of bilaterality of 12% in patients with PRDs. The purpose of this communication is to determine whether the very high incidence of bilaterality in patients with ARDs can be reduced significantly by prophylactic treatment of the fellow eye. The fellow eye of patients who had suffered a unilateral ARDs were treated by prophylactic circumferential equatorial cryopexy irrespective of whether or not predisposing lesions were present. The eyes were treated either prior to lens extraction or following lens extraction. The techniques, complications and results of treatment are discussed.


[Preventive treatment of retinal detachment in aphakic eyes]. We have examined 243 cases with retinal detachment occurring within 6 months following cataract surgery. In 92 of them retinal tear was due to lattice degeneration, in 66 to snail track degeneration and in 17 to equatorial degeneration. 290 other patients had preventive treatments. In this group, there were only 10 cases of retinal detachment. 9 out of 22 patients who had no preventive treatment suffered retinal detachments. There are two reasons for the occurrence of this retinal detachment in the 6 months following cataract surgery in eyes where retinal degenerations are found: (1) surgical trauma even with cryoextraction is responsible for traction of the vitreous base, (2) rapid disappearance of the hyaluronic acid in the aphakic vitreous is responsible for the degradation of the vitreous with formation of large zones of liquid vitreous. When adhesion between the vitreous and the retinal degeneration area remains, the traction is responsible for retinal tear or retinal detachment. The importance of the preventive treatment of retinal lesions prior to cataract surgery should be stressed.


[Biometric modification of the eyeball in chorioretinal surgery by Lincoff's indentation method]. Biometric modifications were observed on eyeballs operated upon using the indentation method of Lincoff. The biometric modification of the anteroposterieur axis of the eye was studied by an opticoechographic method. 30 eyeballs with retinal detachment were operated upon using the Lincoff method with silastic implants. The length of the eyeball is not modified. But the analysis of the results indicates a significant reduction of the depth of the anterior chamber. This is entirely neutralized by a slight augmentation of the axial length of the vitreous body. The orientation of the implant has an influence on the biometric data. If it is a radial one, the anteriorposterior axis is lengthened; when it is parallel to the limbus, there a shortening with a reduction in the depth of the anterior chamber.


B-scan ultrasonography of lesions simulating choroidal melanomas. The B-scan ultrasonographic features of a number of well-known fundus lesions have been described. Emphasis has been placed upon those features which help to differentiate choroidal melanomas from lesions which sometimes clinically simulate melanomas.


[Can the lifting of heavy weights provoke a spasm of ciliary muscles conducive in turn to retinal detachment?]. It was reported by Harms (discussion remark 62, DOG Heidelberg 1959, p. 234) that, during the lifting of a heavy weight, excessive accommodation occurs. If this is the case, the causing ciliary spasm could possibly be regarded as a predisposing factor in the pathogenesis of a retinal detachment. To obtain objective data whether there is an accommodative spasm under the above mentioned condition, the thickness of the lens of emmetropic young persons was measured by ultrasound. Three series of measurement were performed: (1) during accommodation; (2) during the lifting of a 25-kg-heavy weight without excluding the possibility of focusing nearer objects at the same time, and (3) during lifting of the same weight with the exclusion of any possibility of focusing nearer objects at the same time. According to the results of these experiments, there is only very little likelihood that the lifting of heavy weights could provoke a considerable ciliary spasm.


Triangle retinal detachment- ultrasonic identification of massive periretinal proliferation in eyes with opaque media. The demonstration of a triangle configuration retinal detachment by B-scan ultrasonography in eyes with opaque media is diagnostic of advanced massive periretinal proliferation. Eyes with this type of retinal detachment have a very poor surgical prognosis even with modern vitrectomy techniques.


Clinical experience with the 32P test and the semiconductor probe in diagnosis of intraocular tumors. The ultrasonic examination gives no answer as to the metabolic activity of pathological intraocular tissue. Therefore, the combination with the 32P uptake test is great clinical value. The diagnosis of intraocular tumors is possible with a 95% certainty. A new probe with a Si(Li) semiconductor detector is presented.


Ultrasonic control of ocular dimensions and surgical indentations in retinal detachment. Ultrasonography is a useful procedure to evaluate volumetric changes in the eye before and after retinal detachment surgery. We found myopic eyes to be variable in shape, most of them ovoidal, and some of them nearly spherical. Given a similar anteroposterior diameter, a spherical eye will have a larger volume than an ovoidal one, and a circling operation will produce a greater reduction than the same procedure in an ovoidal eye. Ultrasonography has been used also to measure the indentation produced by retinal surgery and to follow up its variations through the years.


[Reliability of electrophysiologic examinations for cataract surgery in cases of suspected retinal detachment]. Justification for cataract surgery obviously depends on retinal efficiency. The study of light projections makes it sometimes possible to suspect a retinal detachment. We are, therefore, trying to check for retinal detachment by means of the various exploration processes now available. Results of echography, electroretinography, electro-oculography, and visual evoked potentials are discussed according to the exper-ence gained.


Retinoblastoma.

Retinoblastoma. Newer concepts in the diagnosis and treatment of retinoblastoma are briefly discussed. The role of ultrasonography, EMI scanning and LDH assays in the anterior chamber are evaluated. The greatest problems in differential diagnosis in recent years have been larval granulomatosis caused by Toxicara canis, Coat's disease and unclassifiable retinal dysplasias. The Ellsworth-Reese classification is discussed. The "cure rate" has been widely misinterpreted as survival and has led to many misapprehensions in the treatment of unilateral disease. The cases in group IV now do better for a variety of reasons and the results in orbital cases have been more extensively studied. The genetics of retinoblastoma have been intensively studied in our laboratory along with Dr. Kitchin and some newer concepts are briefly discussed. The relative roles of orthovoltage, external beam 60Co, linear accelerators and betatron are presented. Dosage level is distinctly related to radiation complications, especially retinal vascular necrosis and fatal radiation-induced neoplasms. The relationship of the latter to the pattern of inheritance is to be stressed. Chemotherapy has been used both as an adjuvant to radiation and for the destruction of micrometastases and a new protocol is described. The results of treatment are presented to update the 1966 report at the Gonin Club Meeting in Munich.


'Mapping' of postulated Ir genes within HLA by studies in allergic populations. Analysis of specific IgE responses to highly purified allergens provides a particularly good model to study the genetics of human immune response. The use of this model is illustrated by studies of large populations of allergic individuals in terms of their HLA phenotype, basal total IgE level and specific IgE-mediated sensitivities to rye grass group I (Rye I) and to ragweed Ra3. We find significant associations between HLA-B8 and Rye I response and HLA-A2 and Ra3 response, which become more striking in those atypical allergic subjects who have low total IgE levels. Our studies point to the importance of genetic regulation of basal IgE level in determining specific IgE response. Also, they suggest possible approaches toward a tentative 'mapping' of postulated Ir genes based on the linkage disequilibrium existing within the HLA complex.


Evaluation of genetic control of the immune response to penicillin in man. HLA typing of 46 patients with demonstrated penicillin allergy did not show significant correlation of hypersensitivity to the penicilloyl group with any HLA antigens. On the other hand, lymphocytes from penicillin-sensitive patients generated nonspecific cytotoxic cells (e.g., cytotoxic for P 815 mastocytoma mouse cells or chicken red blood cells) when cultured in vitro together with penicillin. Under similar conditions, only some lymphocyte populations from nonpenicillin-sensitive normal individuals showed cytotoxicity. Although family studies are required to demonstrate that differences in the generation of cytotoxic cells by penicillin in nonsensitive populations are due to genetic factors, it is obvious that attempts to achieve primary sensitization in vitro is the most rational approach to a study of Ir genes in man.


HLA antigens and atopic dermatitis.

HLA antigens and atopic dermatitis. The frequency of HLA antigens was determined in 27 unrelated children and 44 of their parents, compared to 326 healthy controls. HLA-BW35 frequency is significantly increased in the patients (37 instead of 11.6%; Pc less than 0.01) and in the parents (34 instead of 11.6%; Pc less than 0.05). However HLA segregation was not disturbed in 23 families with 33 patients and 24 healthy siblings. These data confirm the hereditary character of atopy but does not allow the exclusion of the hypothesis of a linkage between a HLA-B gene and an Ir gene conditioning abnormal humoral response to several allergens.


HLA in asthma.

HLA in asthma. 100 adult patients with asthma were typed for HLA. These patients were skin tested with a panel of allergens and divided into skin test positive (61) and skin test negative (39) patients. There was a decreased frequency of HLA-B12 in the negative skin test group (18%) compared to the skin test positive group (43%) and the controls (36%). A further subdivision of these patients into extrinsic asthma (positive skin tests and/or allergic history) and intrinsic asthma (negative skin tests and no allergic history) was made. There was an increased frequency in the extrinsic asthmatics of HLA-B8 (37 compared to 28% in normals) and a decreased frequency of B12 in the intrinsic asthmatics (13 compared to 36% in normals). 4 or 5 patients who had negative skin tests but gave a history of asthma following exposure to specific allergens, suggesting a type III immune complex asthma, were both A1 and B8.


HLA antigens and susceptibility to atopic dermatitis. The possible association between peculiar HLA antigens ant atopic dermatitis associated allergic rhinitis and/or bronchial asthma was investigated. (1) Atopic dermatitis (no deviation in HLA), complicating allergic rhinitis (HLA-BW40), and bronchial asthma (HLA-B12) are associated by different HLA antigens. (2) The diseases are associated through the same antigen (HLA-BW15), if the concept of disease resistant antigen is accepted. (3) No association is found between HLA antigens and serum IgE levels in patients.


HLA and bird breeder's hypersensitivity pneumonitis. HLA antigen status was assessed in non-related individuals and related family members with bird breeder's hypersensitivity pneumonitis (HP). 35% of 20 non-related patients carried HLABW40 compared to 10% of 861 normal controls (p less than 0.001, Pc less than 0.05, respectively). A consistent association of an HLA haplotype with disease was demonstrated in three of four families. Selected HLA antisera contained antibodies which blocked the blastogenic response to bird antigen. This study suggests the existence of an HLA associated Ir gene in bird breeder's HP.


HLA and the sudden infant death syndrome. HLA phenotypes of 66 parents of 33 infants succumbing to the sudden infant death syndrome (SIDS) were determined using a standard microlymphocytotoxicity method. Heterogeneity testing over all  locus antigens revealed a significant difference between the parents and a control group consisting of blood donors and healthy unrelated volunteers. This heterogeneity was still evident when maternal and paternal groups were considered separately with the controls and when compared with each other. Individual A locus antigens displaying frequency deviation from control values included A9 (decreased in husbands), A10 (increased in wives and total parent group), and A28 (increased in wives). The increase in frequency of A10 became highly significant when only parents of children with evidence of laryngitis at post mortem were used for comparison with control values. No difference in B locus antigens between any of the groups was observed. The results obtained are compatible with the view that SIDS is the result of a hypersensitivity reaction to one or more allergens and that genes coding for these specific responses are linked to the HLA complex. Differences observed between the maternal and paternal groups may be explained on the basis of maternal antibody, passively acquired by the infant, which serves a protective role in the respiratory tract, prior to the development of immunocompetence. The production of these antibodies is also dependent on genes linked to the maternal HLA complex.


Search for a correlation between familial allergy to cocksfoot pollen and HLA antigens. Twelve families comprising 62 individuals, 31 allergic to grasses, were examined. No significant correlation between pollinosis and the HLA system was observed. However, there was a close correlation between cocksfoot skin tests and the RAST (p less than 10(-6)).


HLA antigens in grass pollinosis.

HLA antigens in grass pollinosis. 48 patients with grass pollinosis and strongly positive skin tests to crude timothy pollen extract, as well as the relatives of 11 of the, were typed for 26 HLA antigens of the A and B loci. No significant alteration in the frequencies of any particular antigen was observed, except for an increase of HLA-A1 and B8 in patients with multiple manifestations of reaginic disease. In the 11 families investigated, susceptibility to grass pollinosis and IgE levels did not appear to be linked to HLA haplotypes. Preliminary studies with anti-lymphocyte B sera did not reveal any significant alteration in the frequency of positive reactions, using enriched population of B lymphocytes from 16 patients.


HLA-B7 cross-reacting group and human IgE-mediated sensitivity to ragweed allergen Ra5. HLA typing and cutaneous testing for allergen sensitivity of 76 ragweed allergic patients confirmed previous findings of a significant association between sensitivity to ragweed allergen Ra5 and possession of one or other of the HLA-B7 cross-reacting group of antigens.


HLA and ragweed allergy.

HLA and ragweed allergy. In summary, two large families were subjected to genetic analysis of the distribution of the immune response. S linkage analysis indicated that this locus for positive skin test reaction to antigen E and/or personal history or seasonal allergy is linked to HLA-B. The maximum likelihood estimate of the recombination frequency is 0.13 in males and 0.53 in females, with a lod score of 2.53.


Family study HLA antigen and Ir gene linkage in ragweed and dust allergy. A family was studied for HLA antigen Ir-gene linkage in ragweed and dust allergy by clinical history, skin test, mixed lymphocyte cultures, lymphocyte culture for cellular immunity to antigen E and dust allergens, RAST  assay for ragweed and dust antigens and HLA typing. These results confirm previous observations that ragweed Ir genes are linked to the inheritance of the HLA complex. The Ir genes may map at some distance from the closely linked HLA and MLC genes. It is also of interest that Ir genes for dust allergy in this family appear closely associated with ragweed genes. The set of twins with identical HLA complexes but different expression of presumably identical Ir genes will bear watching.


HLA-B7 associated tuberculin hyporesponsiveness in BCG treated melanoma patients. Cutaneous responses to tuberculin and control antigens were measured in 24 HLA-B7 and 39 non-B7 patients before and 5-44 (average 10.5) weeks after BCG immunotherapy for malignant melanoma. Delayed tuberculin hypersensitivity increased after immunotherapy (p less than or equal 0.0001). The averaged area of induration (48 h) detected in HLA-B7 patients was half the area of induration of non-B7 patients before (p less than or equal to 0.0184) and after (p less than or equal to 0.0007) BCG treatment. Cutaneous anaphylactic hypersensitivity (0.25 h) responses to 19 of 22 antigens were significantly smaller (p less than 0.05) in HLA-B7 patients after BCG immunotherapy (p less than or equal to 0.0001). HLA-B7 patients had specific delayed cutaneous hyporesponsiveness to tuberculin and nonspecific cutaneous anaphylactic hyporesponsiveness after BCG immunotherapy.


[Unstructured congenital myopathies (author's transl)]. Nonprogressive congenital myopathies are usually classified according to structural or ultrastructural changes in the muscle fibres. In our material cases without specific structural characteristics but with an abnormal distribution and size of one fibre type, and dystrophic changes with or without fibre type changes are far more numerous. 15 cases are reviewed: Congenital dystrophy (4 cases); congenital dystrophy with complete lack of type II fibres [1]; fibre type disproportion with predominance of abnormally small type I fibres [5]; fibre type disproportion with predominance of small and large type I fibres and rare small type II fibres (1); type II hypotrophy with cardiomyopathy [3]; type II hypotrophy without cardiac or cerebral abnormalities [1]. Ultrastructural investigation shows unspecific changes mainly of myofilaments. The EMG is "myopathic" with normal interference pattern and short polyphasic unit potentials.


[Hepatitis B virus components and cytoplasmic virus-like corpuscles in chronic hepatitis (electron microscopic study)]. Author in the needle-biopsy specimen of the liver of a HBsAg positive patient previously treated with immunosupressive preparates (Corticosteroid + Imuran) in the nuclei of hepatocytes by the aid of electron microscope revealed ring-shaped particula of 20-25 nm in diameter (core), in the cytoplasma of ground-glass hepatocytes in the canals of the rough-surfaced endoplasmic reticulum filamentous formations in average of 23nm in diameter (surface antigen). In addition in a few number cytoplasmic core particula have also been revealed. Dane-particula were not seen. Further in the cytoplasma round or ring-shaped virus-like bodies of unknown origin of 80 nm in diameter were found. These particula could be easily distinguished from the Dane particula and from the B virus components (a second virus infection?). Author believe, that the immunsupressive therapy could play some role in the occurrence of the B virus components, since before the therapy with Imuran they could not be detected in the liver.


[Submicroscopic structure of the jejunal mucosa of human fetuses]. Authors investigated the submicroscopic structure of the jejunal mucosa of 6--12 week old human foetuses, obtained from arteficial abortions. It was established, that in this age the jejunal mucosa differentiates and develops intensively. In the third month it is build up of morphological units enterocytes. Their structure is morphologically similar to that of the enterocytes of the adult, although in this age they have no function at all.


[Antenatal thrombosis of renal veins and hemorrhagic renal necrosis]. One case of symmetrical, synchron, antenatal thrombosis of the renal veins and haemorrhagic necosis of the kidneys in a 4 hours-old newborn is reported. In the pathomechanism of the process in addition to perinatal shock, asphyxia-hypoxia Schwartzmann's phenomenon may also play a part.


[Pulmonary fibrosis following nitrous gas poisoning]. Authors in the autopsy material of the Department of Forensic Medicine of Semmelweis Medical University analysed nitrous-gas-poisoning cases. In the period of 1971--1975 out of 22 223 autopsy cases one case of nitrous gas-poisoning occurred. Data of the literature are summarized. Possible pathomechanism of the nitrous gas poisoning is also discussed.


[Ahaptoglobinemia (hypohaptoglobinemia), its incidence, etiology and significance in paternity serology]. Frequency of ahaptoglobinaemia (ahp) in adult population (on the base of investigation of 4000 cases) was found 0.225 per cent, in children (on the base of investigation of 119 children younger than 2 years) 0.94 per cent. Frequency of ahp among children younger 4 months 44 per cent. These observations support the hypothesis, on the role of a mutagen allel (Hp2m) in the origin of the ahp. If in cases of discussed paternity in the child ahp was revealed and the Hp constellation of the mother: putative father was: Hp 1--1 X 1--1 or 2--2 X 2--2--provided that the paternity with the testing of other blood-group systems could not be excluded--it's necessary to try to identify the true Hp type of the child--since it might give the possibility for exclusion of paternity.