Comparative biological and antitoxoplasmic effects of particulate and water-soluble polysaccharides, in vitro. Mouse peritoneal macrophages, but not HeLa cells, presented many characteristics of activated cells following treatment in culture with LTN or PSK. Indeed, they demonstrated increase in size, spread, endocytic and antiparasitic activities. These data lead favorably to consider that among the five polysaccharides tested under the present experimental model LTN and PSK are the most potent activators of resident mouse peritoneal macrophages in vitro. The mechanism of macrophage activation by LTN and PSK should be different from that of Di Luzio glucans and SPG since activated macrophages can be induced by the latter two compounds in experimental animals but not in vitro in cell cultures.


[Treatment with carbamazepine of epilepsy with behavioral trouble in mentally retarded children in a medicopedagogic institution (author's transl)]. Thirty five mentally retarded girls, with epilepsy associated with behavioral troubles, were treated with carbamazepine in a medicopedagogic institution for 4 months to 7 years. Fifty percent got better, thirty percent showed a disappearance of the epileptic spells and 67% showed an aggravation of the EEG. Improvement of behavior and absence of spells are more frequent in primary generalized epilepsy as in secondary generalized epilepsy and even less frequent in secondary generalized epilepsy. Results are better in epileptics only showing tonicoclonic crises than in those with absences. They are also better in dementia epileptica than in epilepsy without dementia. The aggravation of EEG, consistent with the disappearance of epileptic crises and behavioral improvement, is most often observed in patients with epileptic absences or progressive dementia.


In vivo activation of murine peritoneal macrophages by Nocardia water soluble mitogen (NWSM). In vitro NWSM has been shown to be a B cell mitogen and a polyclonal activator. Although NWSM has been also shown to be adjuvant active in vivo, motogenicity and polyclonal activation are not observed when this fraction has been administered to mice. In contrast, the experiments reported here demonstrate that after in vivo administration several effects of NWSM on mouse peritoneal macrophages can be observed: NWSM was able to induce an important increase in the ability of peritoneal macrophages to inhibit in vitro growth of tumor cells, to increase their phagocytic activity and to enhance their ability to induce an immune response, following the incubation with an antigen NWSM was able to stimulate phagocytic activity of macrophages of C3H/He Orl. mice (LPS-resistant strain). Those findings suggest that the adjuvant activity of NWSM in vivo can be related to its capacity to activate macrophages.


Effects of pesticides on the reticuloendothelial system. The information available concerning the effects of compounds utilized as pesticides on functions of the reticuloendothelial system is quite limited. Review of selected examples of such studies in this and other reports (3) reveals considerable diversity in terms of species of experimental animal, purity and dose of pesticide, length of exposure, and class of pesticide employed. Observations include depression, enhancement, or no significant effect on the selected reticuloendothelial system function studies. With the present available information it is difficult to formulate general conclusions or to predict whether or not any individual pesticide will consistently and significantly alter any specific function of the reticuloendothelial system. At the present time, it is not known if pesticides within a single chemical class act in a similar manner in regard to their ability to influence reticuloendothelial system function. In addition, the relationship, if any, between the toxic, mutagenic teratogenic, or carcinogenic potential of any pesticide and its ability to alter the reticuloendothelial system is also unknown. More extensive systematic studies in experimental animal models would appear to be required before protocols to effectively evaluate the potential of pesticides to influence reticuloendothelial system function in man can be developed.


Positive direct antiglobulin test on thawed deglycerolized units of erythrocytes: prediction and prevention. Occasional units of red blood cells develop a positive direct antiglobulin test (DAT) when frozen and deglycerolyzed by the Meryman method. The presence of cold autoagglutinins with a high titer at 4 degrees C or autoreactivity at room temperature were generally predictive of which units would develop a positive DAT, but neither was reliable in all cases. An indicator system is presented in which a DAT is performed on a segment that has been glycerolized and deglycerolized in a manner similar to the Meryman method for freezing a donor unit. This system is extremely reliable in predicting which units will convert from DAT-negative to DAT-positive during processing. The positive DAT of deglycerolized red blood cells was due to C4 and weak C3d binding. This complement binding can be prevented by addition of ethylenediaminetetraacetic acid (EDTA) or removal of plasma before the addition of glycerol.


[A method of separation of antilipoprotein immunoglobulins by chromatography on glass beads (author's transl)]. In this method, under certain experimental conditions, the use of calibrated glass beads permitted the separation of lg with antilipoprotein antibody activity (HLAA). The sera are first precipitated on ammorium sulphate at 25 per cent, 30 per cent and 40 per cent saturation. The precipitates are then submitted to short ultracentrifugation and the product of ultra-entrifugation is fractionnated on a glass bead column, balanced then eluted with an acetate veronal buffer at pH 9. The eluted fraction in peak 1 contains antibodies (IgG or IgA) and albumin. Passive hemagglutination with red cells covered with beta and alpha-lipoproteins, through chromium chloride, together with inhibition of the reaction show that the activity of these Ig antibodies is directed against lipoprotein antigens.


The effect of focal twitching on the intracranial pressure during paralysis and mechanical ventilation. Three patients with head injuries developed minor facial twitching while their intracranial, intrathoracic and systemic arterial pressures were being monitored and they were on mechanical ventilation. These twitches were disclosed by the coincided great and damaging increases in the intracranial pressure, while the intrathoracic and arterial pressures were virtually unchanged. The intracranial hypertension was attributed to cerebral vasodilatation which was presumed to be due to the accumulation of cerebral metabolites since other causative factors such as systemic hypertension and hypoxia were under control. Cerebral elastance modulated the rise in intracranial pressure.


The non-Hodgkin's lymphomas.

The non-Hodgkin's lymphomas. This paper is a review of the pathology of non-Hodgkin's lymphomas. The various classifications proposed as alternatives to the Rappaport classification are briefly reviewed. The light microscopic morphology of the various sub-types are described, mentioning where possible the derivation of the tumour cell type as delineated by enzyme and immunological cell marker studies. The natural history and salient clinicopathological aspects of the disease entities are also described.


A response profile of 100 long-stay psychiatric patients. The responses of 100 male long-stay psychiatric patients in 1973 to 9 questions, mainly on their personal particulars, were noted. One patient gave the correct date, 10 patients gave their age correctly, 33 patients gave their address correctly, 55 patients gave the correct hospital ward they were in, 62 patients gave their marital status correctly, 86 patients gave their sex correctly and 87 patients gave their name correctly.


Work performance of rehabilitated psychiatric patients--a comparative study. View Road Hospital (VRH) was commissioned on 1st August 1975 with the main objective of providing intensive rehabilitation and training for male long-stay mental patients from Woodbridge Hospital. The aim was to train and prepare them for work outside the hospital. This paper examines the work performance of the 38 patients who have been phased out to work since the commissioning. A matched group of 38 male patients undergoing similar rehabilitative schemes in Woodbridge Hospital and placed in similar open employment was selected for comparison. Contrary to expectation, the VRH patients did not perform significantly better than the Woodbrige Hospital's patients. Some of the probable reasons for this discrepancy, and their implications for psychiatric rehabilitative services in general, are discussed.


[Purification of pineal antigonadotropic factor (author's transl)]. Pineal activity on hypothalamo-hypophyso genital axis is well established. The mechanism is not simple, since progonadotropic or/an antigonadotropic activity were described. The biochemical isolation of the potent factor has been assayed. Several substances: melatonin, AVT, peptides have antigonadotropic properties. In this paper, we report many experiments concerning isolation and purification by several chromatographies of the factor (probably peptidic), that we believe to be responsible of antigonadotropic activity. Biological activity of the substance is proved by "in vitro" methods and radio immunoassays. This component is quite pure because electrophoresis on gel polyacrylamid reveals only one strip. Gel Sephadex G10 chromatography indicates a probable MW is between 500 and 1,000. This component causes an important inhibition of pituitary LH discharge (in vitro methods).


[Familial case of male pseudohermaphroditism due to 17-ketoreductase defect: late diagnosis in the "aunt" of a patient with the same defect (author's transl)]. A 42 year old (46 XY) subject with 17-ketosteroid reductase deficiency was investigated. The patient reared as female, has developed masculine features (facial hair, male distribution of body hair, male body habitus, acne and clitoridomegaly) at about 15 years of age but never consulted. She married at 22 years and for 20 years thought to have a "normal" female sex life. Only when her 14 year old "niece" was investigated (1) and treated for similar problems she realized hers. She had a small phallus with perineal urethra, vaginal pouch absence of labia minora and undescended testis, no breast development. Baseline peripheral studies showed plasma testosterone (T) in the range of Tanner II stade of puberty (150 ng/dl), elevated delta 4-androstenedione (delta 4) (930 ng/dl) and estrone (E1) (33,5 NG/DL) LEVELS 6--8 times above normal, but subnormal estradiol levels. Increased basal gonadotropins showed an hyper-response to LHRH stimulation. Dynamic tests (ACTH test, Dexamethasone suppression, and hCG stimulation) showed that abnormal delta 4 and E1 were not of adrenal origin. In the spermatic veins delta 4 levels were extremely high (239 micrograms/dl) but T levels low (11.4 micrograms/dl). delta 4/T ratio in the spermatic vein was much higher than in the peripheral blood suggesting intact peripheral conversion of delta 4 to T. After castration all hormone levels returned to the range usually seen in agonadic male or female adults.


[Study of a new case of male pseudohermaphroditism due to 17-ketosteroid reductase deficiency (author's transl)]. We studied a 17 year old patient with primary amenorrhea, hirsutixm, clitoral enlargment, poor breast development and 46, XY karyotype. The results shown in table clearly indicate a 17-ketosteroid reductase deficiency. In the view of previously described patients we can conclude that: 1) intensity of virilisation depends on both plasma testosterone and androstenedione levels; 2) importance of gynecomastia depends on plasma E2 but not E1 levels; 3) FSH levels are not correlated with circulating androgens or estrogens but presumably depends on importance of seminiferous tubules' lesions.


[Preliminary results of an atiepizootic field test using EDTA-Na extract vaccine from Escherichia coli strains pathogenic to swine in swine production industrial units]. An anti-epizootic field test was applied to industrialised pig farms in the region of Wrocław, Poland, to test the effectiveness of a pentavalent EDTA (calcium disodium edetate)--sodium vaccine extracted from Escherichia coli strains with pathogenicity to swine. The vaccine had been received from a centre in Berlin-Buch, GDR. The vaccine failed to provide any protection, when orally applied to nursed piglets. However, both morbidity and mortality were reduced and, thus, an anti-epizootic effect on nursed piglets produced, when the vaccine had been injected intramuscularly to the pregnant mother animals, prior to farrowing. In weaned piglets morbidity was sucessfully reduced by both oral as well as intramuscular administration.


[Emergency treatment of inborn amino errors of amino acid metabolism detected in the neonatal period]. The indications and effects of exchange transfusion, peritoneal dialysis, osmotic diuresis and early feeding have been studied in 28 children with inborn errors of aminoacid metabolism presenting in the neonatal period. Exchange-transfusion has only a transitory and incomplete effect but it is simple and quick. Peritoneal dialysis has a remarkable and often life-saving effect because the blood levels of toxic metabolites are reduced very effectively in organic acidaemias. However the rate of removal may decline if plasma concentrations fall below a critical level (1.2 mmol/L foor leucine). If the dialysis is prolonged for more than 36 hours it may cause hypoprotidaemia. Osmotic diuresis increases the 45 ml/min. However it is of little elimination of methylmalonic acid because the renal clearance is between 15 and 45 ml/min. However it is of little value in maple syrup urine disease, propionic acidaemia or isovaleric acidaemia because the renal clearance of the toxic metabolites is so low. The early re-introduction of low protein high calorie of a low protein and high calorie diet by continuous intragastric feeding is very important. The authors propose a protocol for the treatment of babies presenting inborn errors of aminoacid metabolism in the neonatal period. Peritoneal dialysis should be started as soon as the diagnosis is considered and continued for 24 to 36 hours. An exchange of transfusion shold be undertaken before and after the dialysis, together with an osmotic diuresis if appropriate. Continuous enteral feeding should be given, the quantity being adjusted to the baby's requirements.


Determination of subclasses of myeloma proteins M-IgG by enzymatic hydrolysis. Several methods of determine M-IgG subclasses after hydrolysis with papain and pepsin were compared, and the results were checked by the passive hemagglutination test with erythrocytes using specific antisera. For practical purposes, the papain method was preferred to the pepsin method for recognition of IgG-3 subclass. A shortened method of digestion with papain which distinguishes between the papain-sensitive subclasses,  i.e. IgG-1 and IgG-3, is proposed. Apart from its diagnostic value in distinguishing between myeloma (monoclonal) protein subclasses, this work can serve as a basis for preparing protein antigens and production of specific antisera.


Influence of lipids from Listeria monocytogenes on the course of infections due to some gram-positive bacteria in mice. The influence of lipids from Listeria monocytogenes on the course of infections due to some gram-positive cocci Streptococcus pyogenes, Streptococcus faecalis and Staphylococcus aureus and L. monocytogenes was studied in white mice. Varying doses of the lipid preparation were administered before infection. Mortality of the animals and rate of elimination of the bacteria from the organs and blood circulation were recorded. In appropriate doses, the lipids markedly enhanced resistance to the aforementioned bacteria. Mortality was substantially reduced, and elimination of the infectious agent from tissues and blood was significantly accelerated.


[The protein digestibility and amino acid absorption in various segments of the digestive tract of pigs. 6. Results of the application of 15N-lysine]. From two fattening pigs (average live weight 63 kg) with re-entrance cannulae both in the duodenum and the ileocecal region, the intake, the excretion and the flow rates of nitrogen, 15N, lysine and 15N-lysine are measured after the oral application of 15N-lysine as supplement of a wheat-wheat gluten diet. A scheme of the lysine metabolism of pigs is drawn on the basis of the measured values. The absorption of synthetic and native lysine as well as the endogenous and exogenous lysine contents of the duodenal and ileum chyme are estimated.


[The metabolism of colostomised laying hens with 15N-labelled wheat. 4. 15N-Incorporation in the corpuscular components of blood, in the blood plasma and the basic amino acids]. Three colostomised Laying hybrids received over four days a dosage of 672 mg 15N-excess (15N'), 20.3 mg lysine 15N', 23.0 mg histidine-15N' and 66.7 mg arginine-15N' with a ration customary in production. After feeding the same nonlabelled ration for another four days the hens were killed and the N-content of the blood as well as of its fractions (corpuscular components, plasma, free amino acids of the plasma) was determined.


[Unusual location of extramedullary plasmacytomas (author's transl)]. Two cases of solitary extramedullary plasmacytoma, one of the nasopharynx and one of the tongue are reported. Although there was no paraprotein secretion present, we were able to demonstrate an intracytoplasmic monoclonal immunoglobulin (type IgG-kappa) by immunohistochemical methods. Twelve months following surgical treatment both patients locally and by serum controls are free of residual disease. We confirm former studies in the literature that the prognosis of solitary extramedullary plasmacytomas seems to be good after surgical or radiation therapy. Continuous individual follow-up including serum and X-ray controls are obligatory.


A comparison of four methods for the serotyping of group B streptococci. Group B streptococci are implicated in a wide range of clinical conditions in human adults and neonates. The Group is subdivided into five serotypes Ia, Ib, Ic, II and III, which are differentiated on the basis of capsular polysaccharides. In the interests of epidemiology and efficiency a cheap, rapid method which is easily interpreted would be advantageous. In this study four methods of serotyping, namely, counter-immunoelectrophoresis (CIEP), microimmunodiffusion (MID), coagglutination (COA), and the Lancefield capillary precipitin (CP) test were compared in terms of ease of operation and interpretation, accuracy and rapidity. Todd Hewitt Broth (THB) cultures and acid extracts of the group B streptococcal strains were used as antigens for these methods. It was concluded that COA using THB cultures allows cheap and rapid screening for presumptive serotyping, having a 93-96% correlation with the CP test. MID gives an accurate (100% correlation with the CP test) and unambiguous confirmatory diagnosis of serotype.


Studies on the incubation mixtures for the in vitro mutagenesis test with metabolic activation (microsomal assay). Behaviour of mixed function oxidase and lipid peroxidation in the presence of some xenobiotics. The effect of some xenobiotics on microsomal mixed function oxidase and lipid peroxidation, in mice, in incubation mixtures for the in vitro mutagenesis test with metabolic activation was studied. Aniline 1 or 2 mM and aminopyrine 0.38 or 8.33 mM completely inhibited the lipid peroxidation with small protection of the monooxygenase. Styrene 50 or 100 mM inhibited to a lesser extent the lipid peroxidation with marked increase in the inactivation of the monooxygenase. By a technique based on successive additions of fresh microsomes it was possible to evaluate the part of the inactivation due to enzyme denaturation and that due to inhibition. EDTA 40 mM was not able to protect from inactivation in the presence of aniline 1mM. Data of this type could be utilized to obtain more reliable results of in vitro mutagenesis tests with metabolic activation by suitably managing the enzyme activity in the incubation mixtures in order to keep it as constant as possible.


[Effects of octopamine on pulmonary circulation of the pig]. The perfusion of octopamine in pig produces an increase of cardiac output with decrease of pulmonary vascular resistances. The changes in lung circulation depend by a direct action of this drug on nervous control of vascular walls because when the pulmonary shunt increase the effect is not correlated to changes a pattern of breathing.


Influence of contractile state on the size of the extracellular space in isolated ventricular myocardium. A method is described with which the extracellular space of isolated ventricular muscle can be measured accurately and continuously in the same muscle. The size of the extracellular space is shown to vary with the contractile state of the myocardium. Interventions such as quiescence, manganese and acidosis reduce myocardial contractility and increase the size of the extracellular space. Barium, ouabain and hypoxia cause contracture and reduce the size of the extracellular space. These changes should be taken into account when measuring intracellular electrolytes in isolated ventricular preparations.


Cartilage and bone formation in arterial wall. 1. Morphological and histochemical aspects. Cartilaginous and/or osseous foci were observed in eight aortas from 20 rabbits immunized against heterologous aorta homogenates and sacrificed 11 to 24 months later. They were studied by means of histological and histochemical methods and compared with normal aortas, cartilage and bone. Some of the observed changes seemed to be true markers of these transformations. Chondroid metaplasia was characterized by 1) generalized increase in alcianophilic hyaluronidase sensitive substances. 2) Appearance of Dermatan and/or Keratan sulfates round some isolated cells. 3) Advent of G6 Pase and Alk. Phase activities in cells adjacent to osseous foci. Osteous metaplasia was characterized by 1) decrease, then disappearance of alcianophilic and PAS positive material, 2) increase in osteoblastic alkaline Pase-activities.


The bovine immune response to Brucella abortus. II. Elimination of some sporadic serological reactions by chelation of divalent cations. The standard agglutination tests for detecting antibody to Brucella abortus were modified by addition of chelating agents (EDTA and EGTA) to the antigens. Approximately 80% of "singleton" agglutination test reactions, negative on the diagnostic complement fixation test, obtained with cattle sera were eliminated while no decrease in titer was apparent when sera from B. abortus infected or vaccinated cattle were tested.


[Epigastric congenital diverticulum of the right ventricle. Resection during the neonatal period (author's transl)]. The authors relate a neo-natal case of cardiac diverticulum of the right ventricle, reaching the epigastric area and associated with several connected malformations : partial pericardial agenesis, anterior diaphagmatic breach, diastasis of Musc. recti abdominis, skin aplasia in the epigastric area, and, moreover, dextrocardia with Fallot tetralogy. The diverticulum was successful resected in emergency.


[Chemical reactivity of an essential arginine residue in substrate binding, reflecting the state of activation of glycogen phosphorylase in rabbit muscle]. Arginine residues have been shown to be present in the binding sites of both phosphorylated substrates and nucleotide activators of glycogen phosphorylase. The former residue can only be modified by arginine-directed reagents when the enzyme is activated, i. e. in phosphorylase a, or in phosphorylase b in the presence of activators. Conversely, after this residue has been modified, phosphorylase b is irreversibly blocked in an active conformation.


[Effect of alpha-tocopherol (vitamin E) on the utilization of vitamin A and induction of cytochrome P 450 in rats receiving DDT]. During detoxication processes of DDT, there is, in the Rat, interference between vitamins A and E (D.1.alpha-tocopherol acetate). Vitamin E spares retinal and has a slighter but significant influence on P 450 cytochrome induction. These results are discussed.


[Coagulation of hemolymph in Crustacea. Electrophoretic demonstration of a plasmatic component in the course of hemostasis in a group A crustacean (Cancer pagurus)]. Coagulation assays in vitro of plasmatic extract from Cancer pagurus reveal the existence of a plasmatic coagulation in this species which was considered as yet as lacking a such process. Electrophoretical analysis of this extract before and after coagulation shows the presence of a plasmatic component probably involved in the formation of the clot.


[Experimental reproduction of the mechanical process of dental attrition by abrasion: paleoecological implications to fossil man]. By microscopic examination we differentiated rays appearing on dental surfaces according to the geometry of abrasive grains which produced them. Since the aspect of particules originally relied on paleoecological conditions, this new research helps us to complete our knowledge of the bolus and of fossil environment.


[Two-step purification of estradiol calf uterine cytosol receptor]. The use of two affinity chromatography methods: heparin-Ultrogel and estradiol 7 alpha-(CH2)3-poly (alanine-lysine)-agarose, allows us to purify the calf uterine estradiol cytosol receptor with a 20% recovery. Electrophoresis under denaturing conditions allows us to estimate its molecular weight as 70 000 dalton.


[Preventive action of phenylalanine on acute intoxication of ochratoxin-A]. Ochratoxin-A, a mycotoxin causing kidney and liver damage, inhibits protein synthesis by competition with phenylalanine in the phenylalanyl-tRNA synthetase catalysed reaction. A dose of 0,8 mg ochratoxine per Mouse is 100% lethal within 24 hrs, when injected intraperitoneally. When phenylalanine is injected simultaneously with ochratoxine-A, the survival of the animals was 100% for 1 mg of phenylalanine per Mouse. Ten times higher doses of phenylalanine are necessary to obtain a 85% survival if the amino acid is injected 30 min. after the mycotoxin. Phenylalanine gives a very low protection if injected 1 hr or more ochratoxine-A.


[Cure of osteopetrosis by allogenic bone marrow injection in the double mutant "osteopetrosi-athymic" rat]. The cure of osteopetrosis by allogenic bone marrow injection has been obtained in homozygous rats for both mutations, osteopetrosis (op) and athymic nude (rnu). This new animal model will help in studying the eventual relationship between the bone resorption process and the immunological reconstitution.


[Increases in frequency of sister chromatid exchange following tumor grafts in different immunocompetent hosts]. Measurement of sister chromatid exchanges (SCEs) frequency of inbred Rat or nu/nu Mice bone marrow cells, following tumour grafts, have been developed. Increase of SCEs was observed in hosts which present or not metases and with reduced survival rates after malignant tumour grafts. These results suggest a remote control of tumoral tissue by a diffused matter effect.


[Gonadostatin and gonadocrinin, polypeptides of ovarian origin with hypophysiotropic activity]. Crude acetic acid extract of Rat ovaries pretreated with pregnant mare serum (PMSG) contains native peptides with two types of separable biological activities: one, molecular weight greater than 10,000 dalton inhibits the secretion of both LH and FSH as stimulated by luteinizing hormone releasing factor (LRF) in a pituitary monolayer culture system and is referred to as gonadostatin; the other, less than 3,500 dalton, stimulates the secretion of gonadotropins and is designated as gonadocrinin. The biological activities of ovarian gonadocrinin can be competitively inhibited by an LRF-analog-antagonist, D-Phe2, D-Trp6-LRF. These ovarian peptides may participate in physiological control of pituitary LH/FSH secretion.


[Ultrastructure of neurons of nucleus preopticus and pars lateralis of the nucleus lateralis tuberis in Gambusia (Teleosta poeciliidae)]. The nucleus preopticus (NPO) and the pars lateralis of the nucleus lateralis tuberis (NLT) have been examined at the ultrastructural level. In the NPO two types of large neurons occur, both containing 140-150 nm secretory granules. The pars lateralis of the NLT contains only one cell type with similar granules. Both of these nuclei may be the source of type A fibres innervating the gonadotropic cells of Gambusia.


[Changes in plasma levels of metabolites during long-term fasting in the goose]. In fed geese, plasma levels of glucose and alanine were 1.9 g.l-1 and 560 mumol.l-1, respectively. During a long fast (40 days), plasma glucose and alanine were maintained at a high level (1.5-1.8 g.l-1 and 370-540 mumol.l-1, respectively). Plasma level of acetoacetate was very low (40 mumol.l-1); by contrast, plasma level of beta hydroxybutyrate reached very high values (20 mmol.l-1) after about 20 days of fasting, then it decreased. Plasma levels of lactate and pyruvate decreased along the course of the fast, from 2 500 to 2 000 mumol.l-1 and 220 to 170 mumol.l-1, respectively.


[Epithelial localization of pyruvate kinase L (ATP pyruvate phosphotransferase EC 2.7.1.40) in rat liver]. Using three methods: histoenzymatic and immunoenzymatic, stained with tetrazolium salt, and immunofluorescence, we have localized PK "L" in hepatocytes. This localization in the cytoplasm of the cells differs widely in intensity with diet or hormone administration. Maximal with animals fed on high carbohydrate diet, still elevated with a subsequent insulin administration, it decreases with a normal diet to become weaker in animals, which have fasted for 48 hrs.


[Semi-synthesis and proposed structure of platelet-activating factor (P.A.F.): PAF-acether an alkyl ether analog of lysophosphatidylcholine]. We have studied the molecular structure of platelet-activating factor" (P.A.F.), a mediator of inflammation obtained from blood leukocytes, macrophages, and platelets themselves. We have semi-synthetized a substance that possesses all the known physicochemical and biological characteristics of P.A.F. from hog leukocytes. This was performed by successive methylation, hydrogenation, and acetylation of lysophosphatidylethanolamine plasmalogen. We therefore propose the following structure for P.A.F.: 1-0-alkyl-2-acetyl-glyceryl-3-phosphorylcholine. This molecular structure is not yet described among the numerous substances capable of inducing platelet aggregation and release.


[Stimulation of peripheral guinea pig blood lymphocytes by autologous epidermal cells]. Using a strictly autologous (and not syngeneic) mixed culture system in the guinea-pig, it was shown that Mitomycin C treated ear epidermal cells (E) were capable of stimulating peripheral blood lymphocytes (L) from the same animal. The proliferative response of the lymphocytes as measured by 3H thymidine incorporation, is optimal on the 5th day of culture, and when the ratio of the concentrations of the two cell populations (L : E) is 1 : 1. The autoreactivity of the lymphocytes varies with the animal.


[Effect of an acute inflammatory process on anti-infectious resistance in mice]. Acute Inflammatory reaction induced by intrapleural injection of calcium pyrophosphate increases the resistance of mice to Klebsiella pneumoniae infection. Transfer to mice of protection against Klebsiella pneumoniae is effected by injection of inflammation sera.


[Determination of free intracellular proline pool in fibroblast cultures]. By using a direct, rapid, sensitive colorimetric method, free intracellular proline pool from human adult skin fibroblasts in monolayer was determined. Thus under identical experimental conditions, free intracellular proline pool was about 20 pmol proline/micrograms cellular proteins, whatever the cell lines from human adult skin fibroblasts, the passage and the time of subculture. Besides, there was a poor correlation between collagen biosynthesis in fibroblast cultures and free intracellular proline pool.


[Perturbation of glycoregulation in irradiated rabbits]. Acute whole body gamma irradiation of the rabbit can induce a latent diabetes revealed by the stimulated hyperglycemia test. The manifestations of this state, and in particular the assimilation coefficient and the development of an insulino-resistance, vary greatly according to sex.


[Effect of neonatal unilateral enucleation on the development of orientation selectivity in kitten primary visual cortex]. In normally reared Kittens (6 weeks old), all orientations encoded by visual cells in the primary visual cortex are equally represented. In Kittens of the same age, unilaterally enucleated at birth and reared in identical conditions, 70% of orientation-selective cells preferentially respond to horizontal or vertical orientations.


[Veinous meningeal system in fossil man from Biache-Saint Vaast (Pas-de-Calais), established by the endocranial cast]. In fossil Man from Biache, the pattern of the middle meningeal veins studied by means of endocranial cast shows a sapiens pattern with many vascular anastomosis in the parietal region.


[Action and teleaction of specific ligands on DNA: a quantitative study with Azbel's model and an application to the regulatory mechanism of the lac operon]. Assuming that the action of specific ligands is transferred to DNA via the bases in close contact with the ligand, which are stabilized (or destablized) in this process, the local and more distant action of the ligand on DNA can be evaluated quantitatively with the aid of Azbel's model. An application to the system regulating the E. coli lac operon is presented.


[In vivo occupation of estrogen receptors by hydroxylated metabolites of tamoxifen]. We report that after in vivo administration of (3H) tamoxifen, the cytosol and nuclear estrogen receptor sites of Rat uterus and Chicken oviduct are mostly occupied by polar metabolites. One of the major metabolites is 4-hydroxy-tamoxifen which we have identified by cocrystallisation withe non radioactive compound and which is known to display a high affinity for the estrogen receptor. In the Rat uterus, the proportion of the metabolites versus tamoxifen, increases with time with a maximum at 8 hrs. for the 4-hydroxy-tamoxifen. Other hydroxylated metabolites (M2) became predominant after 24 hrs. We propose that in vivo, the synthetic antiestrogens act mostly via their transformation into hydroxylated metabolites.


[Interaction between an antifungal heptaene, amphotericin B and cholesterol in vitro, as detected by circular dichroism and absorption. Influence of temperature]. The polyene antibiotic "Amphotericin B" can interact with sterols, cholesterol or ergosterol in aqueous and hydroalcoholic media and a correlative striking spectral change appears between 300 and 420 nm in the CD and absorption spectra. Using these spectroscopic methods we have determined that the influence of temperature between 4 and 80 degrees C is very important. The higher the temperature the most rapid is the modification of the spectra. Thus, the "Amphotericin B"-sterol complex is more easily formed when heating. We have not found any reversibility at 80 degrees C.


[Modification of human adenovirus type 7 after culture in guinea pig brain cells in vitro]. Multiplication of human adenovirus 7 (Ad7) is restricted in subcultures of adult Guinea Pig brain cells. It was however possible to recover enough infectious virus to purify it, and to study its properties. Several properties are similar to that of Ad 7 produced in HeLa cells but differences in sensitivity to cesium chloride and in its polypeptide composition were found.


[Invariability of the H-Y antigen expression in the heterogametic sex of some amphbians and evidence for sexual dimophrism of the antigen expression in Pelodytes punctatus D (Amphibia, Anura)]. The H-Y antigen is studied in some Amphibians whose sexual genetic constitution is known. Thus, in Pelurodeles waltlii, Ambystoma mexicanum, Xenopus laevis and Rana ridibunda, the invariability of the H-Y antigen expression in the heterogametic, sex is confirmed. In Pelodytes punctatus the genetic sex is unknown but the existence of the H-Y antigen in phenotypic males leads to the conclusion of a male heterogamety of the XY type.


[Immunocytochemical anatomy of alpha granules in the human endocrine pancreas]. Using the sensitive protein A-gold technique for the demonstration of antigenic sites in thin section for electron microscopy it was found that in the alpha granules of human pancreas, glucagon immunoreactivity (specific, C-terminal) is restricted to the dense granule core while glicentin immunoreactivity predominates on the peripheral halo surrounding the dense core.


[Organization of reflex responses elicited in man by muscle stretch applied to uni- and bi-functional muscles]. The organization of human forearm reflexes following the application of extension torque perturbations has been studied in three flexors of the elbow: brachioradialis (BR), biceps (B), and pronator teres (PT). Two of these flexors are also involved in wrist supination: (B) and pronation (PT). During the perturbation, the wrist was fixed at various angles: from full supination to full pronation. The results show that the amplitude of the reflex responses of B and PT is highly dependent on wrist position. By eliminating biceps length changes as a source of observed reflex variation, it has been shown that the normalized reflex amplitude of B increases by 300% when the wrist position is varied from full pronation to full supination. In contrast, the BR muscle has a reflex response which is independent of wrist position. These results are discussed in relation to the role of reciprocal innervation and the possible action of receptors encoding wrist angle.


[Electron microscopic study of secretion of chylomicrons in the rat by enterocytes in lymphatic capillary lumen]. Rats were fed on a 20% fat diet; 30 min. or 2 hrs later intestinal jejunal cells were fixed in situ; samples were taken and processed for subsequent study by electron microscopy. Chylomicron secretion was followed from the enterocyte to the lymphatic capillary lumen. Chylomicrons entered the lamina propria through breaks in the basal membrane at intercellular space level. Their penetration into the lymphatic capillary lumen occurred through the open junctions of the endothelial cells normally kept closed by desmosomal formations.


Representation of reality in the perceptual world. What contribution can neurobiologists make to the philosophical issues involved in the Theory of Knowledge? The sensory physiologist or psychologist must start with the assumption (albeit philosophically naive) that the biological function of sense organs is to act as transducers of genuine events in the outside world, and thus to contribute to an internal description of external reality. Although visual perception seems to its introspecting owner to be a unitary process, involving an integrated and complete description of all the properties of the visual scene, there is now good evidence that sensory processing of messages from the eyes involves a great deal of filtering of information and anatomically segregated analysis of such features as shape, colour, movement and distance. Sensory neurobiology can say little about the way in which conscious perceptions are synthesized from the heap of features into which the sensory signals are shattered, about how the inherent ambiguity of messages from sensory neurons is overcome, or about how the ultimate percepts are externalized. Finally, the evidence that the nature of the sensory world varies from species to species forces us to re-examine the theory of solipsism in biological terms.


Triunism: a transmaterial train--mind theory. Triunism postulates that the mind is a unity with the following three structural elements so essential that the absence of any one will prevent its existence: (1) Brain cells and pathways possessing material and transmaterial properties. (2) A flow of environmental information, coded and transduced at the sensory receptors and forming part of the working brain through modifications of its anatomy and physiology. (3) Detectable manifestations derived from (1) and (2) which are expressed inward as perceptions and outward as behaviour. The outside world enters through the senses and becomes a material and functional part of the maturing brain. Without a brain, the mind cannot exist. Without sensory inputs, the mind will not be structured and cannot appear. Without manifestations of inner perceptions and outward motor expression, the mind cannot be recognized by the individual or the environment. Transmaterial entities require the existence of supporting matter and may be represented by patterns of material organization or by temporal or functional relations between parts of the material substratum. They may transcend the existence of specific materials, changing carriers while preserving their nonmaterial identity, but do not possess intrinsic properties of matter such as mass and energy. Transmaterial aspects of reality, including material substratum patterning, and relative temporal, and functional characteristics may be subjects of experimental research.


Phonation, emotion, cognition, with reference to the brain mechanisms involved. Phylogenetic steps in the evolution of vocal communication have a bearing on the brain mechanisms involved in the emergence of human language and speech. A schema of the neuronal organization of voicing in a hierarchical manner is presented. At the lowest mesencephalic level the movements of the vocal apparatus are coordinated and integrated into species-specific vocal gestures. At the middle level these signals are controlled by the anterior limbic cortex, which serves this function in primates only, and only in the human species is the highest level around the cortical larynx and facial area actively involved in the vocal signalling process. This functional schema is used to explain the sequential stages in the ontogenetic process of phonemicization in the human infant, and special emphasis is placed on vocal-auditory feedback mechanisms which come into play from the lowest to the highest level of the central nervous system during maturation. Even feedback loops of the lowest level enable the distinction to be made between self-produced vocalizations and those produced by others. These mechanisms are thought to be an early means for the development of self-awareness. If one grants that the human infant possesses self-awareness, one must concede that such stages of the mind were developed before the emergence of the human species.


The nature of genetic recombination near the third chromosome centromere or Drosophila melanogaster. Previous studies have indicated that recombination near the third chromosome centromere is associated with negative chromosome interference, a phenomenon for which Green (1975) and Sinclair (1975) suggested gene conversion as a possible mechanism. In this report, we demonstrate that negative chromosome interference is still observed when deficiencies or translocation breakpoints are scored as the middle markers in recombination experiments and the rate of recombination is increased by interchromosomal effect. We argue that these chromosomal rearrangement breakpoints are not subject to conversion. Since neither successive premeiotic and meiotic exchanges, nor negative chromatid interference, can by themselves account for the negative chromosome interference, we conclude that a greater than expected frequency of multiple exchanges actually occurs. We further suggest that negative chromosome interference may be characteristic of all chromosomal regions normally showing very little exchange in relation to physical length.


Non-Mendelian female sterility in Drosophila melanogaster: influence of aging and thermic treatments. III. Cumulative effects induced by these factors. Crosses between various strains of Drosophila melanogaster may give rise to a female sterility of non-Mendelian determination. Reduced fertility is observed in females, known as SF females, bred from crosses between females of "reactive" strains and males of "inducer" strains. The reduced fertility of the SF females is the result of an interaction between an extrachromosomal property varies considerably in its ability to reduce fertility. The fertility reduction of the SF females corresponds to what is known as the reactivity level of their reactive mothers. Two nongenetic factors can modify the level of reactivity: aging and temperature. The action of aging is cumulative. When the flies of a reactive strain are submitted at each generation to the action of this factor, the level of reactivity of this strain is gradually modified. The modifications induced are reversible. Indeed, when such a modified strain is returned to standard breeding conditions, the reactivity returns progressively to its initial level. The effect of thermic treatments also seems to be cumulative and reversible.


Correlation between hyperplastic scars, hyperplastic callus and heterotopic ossifications. Independently of the local and general physiopathological factors that influence the repair of skin and bone, there seems to be marked parallelism in the same subject between hyperplastic scars, exuberant callus formation, and heterotopic ossification. The writer describes his findings in a series of personal cases. Arising out of these observations, he discusses the probable pathogenesis of this parallelism of behaviour, and its practical implications. Subjects in whom hyperplastic scars are produced are constitutionally more predisposed to form rapid and exuberant callus, or heterotopic ossification, than normal subjects.


Differential mutagenicities of triamino benzenes against Salmonella typhimurium TA98 in the presence of S9 fractions from polychlorinated biphenyls-, phenobarbital- or 3-methylcholanthrene-pretreated rats, hamsters and mice. Mutagenicity of 6 aminobenzene derivatives against Salmonella typhimurium TA98 was studied in the presence of various S9 fractions. S9, which has been prepared form the livers of rats, hamsters and mice after pretreatment with different types of inducers; polychlorinated biphenyls, phenobarbital and 3-methylcholanthrene, was used as the methabolic activating enzyme in this mutation assay. The S9 fractions from 3-methylcholanthrene-treated rats and mice are most useful for mutation induction by the all aminobenzenes used. The mutagenic activity of the compounds was clearly correlated to 3-methylcholanthrene-induced cytochrome P-450. However, any significant correlation between aniline hydroxylase activity and the mutagenesis was not observed.


Cooxygenation by prostaglandin cyclooxygenase from rabbit inner medulla. The renal inner medulla may be exposed to high concentrations of organic compounds which are excreted into the urine. This report examines the capacity of the inner medulla to metabolize organic compounds both in vitro and in vivo. The compounds used were 1,3-diphenylisobenzofuran (DPBF), luminol, and benzidine. The inner medulla was shown to possess the capacity to oxidize each of these compounds. Microsomal oxygenation did not require NADPH. Cytochorome P-450 inhibitors carbon monoxide and metyrapone did not reduce DPBF metabolism. Lipoxygenase activity was not detected in inner medullary microsomes. Oxygenation of DPBF was demonstrated in inner medullary slices and was inhibited by indomethacin. The product of DPBF metabolism in renal slices and microsomes was identified as O-dibenzoylbenzene. In vivo experiments demonstrated benzidine metabolism, which was blocked by meclofenamic acid. On the basis of substrate specificity and inhibitor studies, it was concluded that oxygenation of DPBF, luminol, and benzidine was mediated by prostaglandin cyclooxygenase. These results are compatible with cooxygenation being a mechanism of inner medullary drug metabolism.


[Ophthalmologic symptoms in trisomy 22 (author's transl)]. After a brief description of the ophthalmological findings in the autosomal trisomies, a case of the extremely rare trisomy 22 is reported. Ophthalmological abnormalities seen were hypertelorism, epicanthus, antimongoloid slant, microphthalmus, microcornea, persistent pupillary membrane, lens opacities and chorioretinal colobomata.


Influence of buffer ions and divalent cations on coated vesicle disassembly and reassembly. Disruption of the coat of coated vesicles is accompanied by the release of clathrin and other proteins in soluble form. The ability of solubilized coated vesicle proteins to reassemble into empty coats is influenced by Mg2+, Tris ion concentration, pH, and ionic strength. The proteins solubilized by 2 M urea spontaneously reassemble into empty coats following dialysis into isolation buffer (0.1 M MES--1 m M EGTA--1 mM MgCl2--0.02% NaN3, pH 6.8). Such reassembled coats have sedimentation properties similar to untreated coated vesicles. Clathrin is the predominant protein of reassembled coats; most of the other proteins present in native coated vesicles are absent. We have found that Mg2+ is important in the coat assembly reaction. At pH 8 in 0.01 M or 0.1 M Tris, coats dissociate; however, 10 mM MgCl2 prevents dissociation. If the coats are first dissociated at pH 8 and then the MgCl2 is raised to 10 mM, reassembly occurs. The results suggest that Mg2+ stabilizes the coat lattice and promotes reassembly. This hypothesis is supported by our observations that increasing Mg2+ (10 microM--10 mM) increases reassembly whereas chelation of Mg2+ by (EGTA) inhibits reassembly. Coats reassembled in low-Tris (0.01 M, pH 8) supernatants containing 10 mM MgCl2 do not sediment, but upon dialysis into isolation buffer (pH 6.8), these coats become sedimentable. Nonsedimentable coats are noted also either when partially purified clathrin (peak I from Sepharose CL4B columns) is dialyzed into low-ionic-strength buffer or when peaks I and II are dialyzed into isolation buffer. Such nonsedimentable coats may represent intermediates in the assembly reaction which have normal morphology but lack some of the physical properties of native coats. We present a model suggesting that tightly intertwined antiparallel clathrin dimers form the edges of the coat lattice.


Dynamic electrocardiography. II. A crucial test of the electromechanical QRS wave theory. The dynamic electromechanical electrocardiogram hypothesis, that QRS voltage fluctuations can be used as a simple noninvasive transducer of cardiac mechanical function, has been subjected to a crucial experiment. Under direct vision, transient modifications of the end-diastolic volume of the baboon heart were produced and photographed. Sequential obstructions to filling (by vena caval compression) and to emptying (by aortic compression), and vice versa, significantly distorted the size and shape of the heart. The instantaneous effects of these manipulations on the amplitudes of the R and S waves were evaluated in electrocardiograms recorded from electrodes glued to selected pericardial and epicardial sites. Major QRS voltage deviations occurred in the perircardial leads. Manipulations increasing the left ventricular volume increased the S wave and reduced the R wave, while those decreasing heartsize had the opposite effect. These findings refute the null hypothesis, that the electrocardiogram is not an indicator of mechanical function. No changes of the QRS waves in the epicardial lead were detected, supporting the concept that displacement relative to the recording electrode is the basis of the QRS CHANGEs due to heartsize variation. The results negate the classical concept that the electrocardiogram does not reflect cardiac mechanical function, and strongly corroborate the dynamic electromechanical electrocardiogram hypothesis.


Choroidal edema associated with retinal detachment repair: experimental and clinical correlation. Experimental owl monkey data and prospective clinical data is presented, demonstrating the correlation of serous-choroidal edema with the extent of vortex obstruction and the additive factors of sudden hypotony from drainage and cryotherapy. Older eyes are more susceptible for developing this phenomenon of choroidal edema. The extreme extent of vortex venous stasis is that of venous stasis anterior segment ischemia demonstrated in two clinical cases.


Management of neonatal narcotic abstinence utilizing a phenobarbital loading dose method. A group of eighteen infants which experienced the neonatal abstinence syndrome due to prenatal maternal use of methadone responded adequately to phenobarbital with control of symptoms. By administering the phenobarbital as an initial single loading dose and closely monitoring the blood levels, maintenance dosing could easily be adjusted for variables in infant metabolism and pharmacologic effect. By use of a multifactorial abstinence scoring system, the pharmacologic effects on clinically observed abstinence symptomatology could be closely monitored and correlated with the blood levels. Serum levels of 20-30 mcg/ml were adequate to control all but one infant. Tapering the blood level of phenobarbital to 10-12 mcg/ml and observing no scores over 8 for 72 hours identified the place in time where abstinence was no longer significant and the infant could be discharged without medication.


Relative analgesic potency of intramuscular heroin and morphine in cancer patients with postoperative pain: a preliminary report. The results of this study in postoperative patients have, thus far, revealed little that was not expected from a review of the literature. Heroin hydrochloride appears to be about two to three times more potent than morphine sulfate as an analgesic, to act more promptly and to have a slightly shorter duration of action. There is a suggestion that heroin may have a somewhat different spectrum of side effects and mood effects compared to morphine, but the effects of both drugs on mood were inversely correlated with the patients' feelings at the time of drug administration. Regardless, as a group, patients responded to both drugs with significantly improved moods. A lag time between the peak intensity of analgesic and mood effects of both heroin and morphine suggest a dissociation between these effects. Whether or not these early impressions will be reinforced as this study proceeds, and whether or not the effects of the drugs in patients with chronic pain due to advanced cancer will be any different than in these patients with postoperative pain, remains to be seen.


Clinical analgesic assay of oral zomepirac and intramuscular morphine. Zomepirac appears to be an unexpectedly effective oral, non-opioid analgesic. The relative potency of oral zomepirac is roughly 1/5 to 1/8 that of intramuscular morphine. Visual analogues of pain relief offer a reliable alternative to verbal categorical scales, and may provide some advantages in assays of peak drug effect, and in relatively small patient populations.


The phase III clinical evaluation of LAAM: I. Comparative epidemiology of mortality in LAAM and methadone. Two essential points can be made: 1. Mortality  experience in the LAAM Phase II trial follows closely the experience of methadone maintenance though these data should be considered preliminary. 2. Generally, the influence of time in treatment on the probability of mortality is strong enough to warrant avoiding comparisons between mortality rates where this parameter is not controlled.


Histopathologic and clinical abnormalities of the respiratory system in chronic hashish smokers. Thirty chronic hashish smokers (mean age-20 years) with respiratory symptoms and six control subjects who were nonhashish smokers were evaluated by history, physical examination, bronchoscopy, and bronchial biopsy. Twenty-three (23) of 23 (100 percent) patients who smoked hashish plus cigarettes had one or more histopathologic abnormalities of basal cell hyperplasia, atypical cells, or squamous cell metaplasia. Only one of seven (28.6 percent) hashish smokers who smoked cigarettes, one of three (33.3 percent) cigarette smokers who smoked no hashish, and zero of three (0 percent) nonsmokers showed one or more of the same histopathologic lesions (p less than .05). Hashish smoking when combined with cigarette smoking appeared to have more deleterious pulmonary effects than either hashish or cigarettes smoked alone, and the abnormal histopathologic lesions found in these smokers are identical to those frequently associated with later development of emphysema and carcinoma of the lung.


Disinfection of sewage by ultraviolet irradiation. Disinfection of sewage from an activated sludge process, and of sewage from an activated sludge process followed by chemical precipitation, has given very high killing rates for the indicator organisms examined. For coliforms, Escherichia coli and faecal streptococci, a killing rate of more than 999.99% was usually obtained, and the residual number of microorganisms in the irradiated sewage was very low. The killing rate increased with the irradiation dosage, depending on the intensity of the irradiation, ie the water quality, and on the irradiation period, ie the water flow. The study demonstrates that ultraviolet irradiation may be an alternative method to chlorination of sewage.


The ultrastructural features of laser trabeculopuncture and cyclodialysis. Problems related to successful treatment of chronic simple glaucoma. Microexplosions induced by a Q-switched Nd:glass laser working above optical breakdown power density levels are able to destroy the inner wall of Schlemm's canal and to tear open both the supraciliary and suprachoroidal space. Furthermore, the ciliary muscles bundles may be disrupted, becoming subsequently permeable to the aqueous and thus also acting as a new outflow route. However, whereas breaks of the inner wall of Schlemm's canals are sealed in the monkey by the activity of endothelial cells forming a new Descemet membrane over the impact site, the supraciliary and suprachoroidal spaces remain open over an observation period of up to 480 days. Perfusion experiments with a HgS tracer substance have shown that these newly created, potential outflow routes may be considered as real additional filtration areas.


PSRO impact: are the statements valid?

PSRO impact: are the statements valid? The generation of PSRO impact statements cannot simply be a "fill in the formula" routine. A health care system is not a simple environment, and narrow approaches to documenting change usually will not suffice. Instead, one would hope that future PSRO impact studies will take into consideration at least the concerns discussed here, as well as many others. As demonstrated in the New Mexico PSRO experiment, PSROs may not be able to demonstrate cost savings given the enormity and fragmentation of the health care environment. Such a conclusion should not result in a declaration of the PSRO program's failure but, instead, should serve to redirect the program's emphasis toward quality assurance, for which even the OPEL study noted impact.


Assessing nutrition services in an alcohol rehabilitation unit: the role of the registered dietitian. Nutrition education and consultation can and should play an important role in the recovery process of the ARU patient. The registered dietitian, as a vital member of the ARU therapeutic program, has a challenging opportunity to become non-judgmentally involved in helping the recovering alcoholic achieve a quality life of long-term sobriety.


Evolution of quality assurance reflected in new standard. Staff, Joint Commission on Accreditation of Hospitals. The new quality assurance standard, which should help hospitals to identify optimum methods for improving patient care and clinical performance and to be recognized for all rational and purposeful efforts at improvement, will take time to implement. In its continuing effort to help hospitals upgrade the quality of patient care, the JCAH is committed to implementing the new quality assurance standard in a manner that will not be disruptive to participating hospitals. The JCAH is also committed to ascertaining that hospitals are making every effort to comply with the standard. The degree to which a hospital does comply with the standard will be a persuasive factor in determining accreditation status.


Assessing damage to the respiratory tract following thermal injury. Physicians may institute respiratory therapy at several points along the course of treatment of the burn patient. In the emergency room, they may have to introduce an airway before they can transport the patient to a burn unit. Physicians may have to administer oxygen or place the patient on mechanical ventilation to reverse ventilatory failure, start treatment of the damage to the airways, or prevent or respond to respiratory complications. Any time a physician must choose respiratory therapy, he must base his decision on accurate assessments of the upper and lower airways.


Risk management and quality assurance: integration for optimal effectiveness. The following is the second article in a two-part series examining the relationship between quality assurance and risk management functions. In part one, "Risk Management and Medical Malpractice: An Overview of the Issues," published in the April 1979 QRB, Dr. Fifer reviewed the problem of medical malpractice--the primary motivation for the present interest in risk management--and discussed the characteristics of current efforts in risk management, particularly their limitations in light of the facts about malpractice. In part two, Dr. Fifer first reviews the major quality assurance functions of the medical staff. He then focuses on methods for coordinating these quality assurance functions with the risk management function in a way that will utilize the expertise of the medical staff and create a unified, hospital-wide system intended to detect and prevent deviations from expected patient outcomes.


Models of patient care for operating room nurses. The focus of quality assurance programs in nursing is on improving the quality of care delivered to patients. Three methods of assesing quality of care for surgical patients are retrospective chart review, process audit, and expected patient outcomes as identified in models of patient care and individual care plans. Care plans specify nursing activities necessary to achieve established goals and, therefore, can be used in assessing the quality of care surgical patients receive.


An evaluation of the toxicity of cefaclor in laboratory animals. The toxicity of cefaclor, a new orally-administered cephalosporin, was evaluated in laboratory animals given single or multiple doses of the antibiotic. The acute toxicity data for cefaclor in mice, rats, dogs and monkeys were comparable to that previously reported for cephalexin. Rats were maintained on dietary mixtures of cefaclor which provided average daily doses of approximately 230 to 950 mg/kg for 28 days in subacute toxicity tests, and 160 to 675 mg/kg for 1 year in chronic toxicity tests. Treatment-related effects in the above studies were limited to soft stool excretion and caecal dilatation in the subacute test. Effects in dogs given daily oral doses of 50 to 200 mg/kg for 30 days were limited to a transient moderate fall in haemoglobin concentration in the two males at the highest dose. Soft stool excretion and occasional episodes of emesis were observed in dogs given cefaclor for 1 year at oral doses of 100 to 400 mg/kg/day. A reversible thrombocytopenia occurred in one animal at the highest dose. Analysis of various tissue fluids taken 2 hours after the last dose revealed that the concentration of cefaclor in the synovial fluid was approximatley one-half of that in serum. The results of these studies indicate that cefaclor has a low toxic potential in the species tested.


Cefaclor in the treatment of uncomplicated gonococcal urethritis. Cefaclor is a cephalosporin antibiotic whose chemical structure is similar to that of cephalexin. The substitution of a chloro group for the methyl group of cephalexin has produced a compound with markedly improved antibacterial activity, while retaining the property of gastrointestinal absorption. Cefaclor has shown good in vitro activity against Neisseria gonorrhoeae. In a controlled clinical trial, 40 men with uncomplicated gonococcal urethritis received cefaclor given as a one gram loading dose, followed by 500 mg 4 times daily for 3 days, for a total dose of 7 g. All patients were re-evaluated at 3 to 7 days following completion of therapy. Two patients did not complete the entire course of therapy and were eventually treated with another regimen. Of 38 men who took the full course of therapy, 35 were clinically and bacteriologically cured. Two men were clinically infected but had negative pretreatment cultures. Of 19 men with beta-lactamase-positive gonococcal urethritis, 18 were cured, whereas among 17 men with penicillin-sensitive strains, all were cured. There were no adverse reactions to the drug, and all patients expressed a preference for the oral regimen. The success of cefaclor in this pilot study suggests that additional clinical trials should be performed.


Glyceryl trinitrate ointment in angina pectoris. Skin absorption of glyceryl trinitrate (GTN) has been recognized for a long time. The effect of GTN and a placebo ointment in prevention of chest pain has been assessed and compared by studying the exercise capacity in 17 patients with angina pectoris. The placebo cream was ineffective but the GTN ointment was found to have beneficial effect in relief of pain in 16 cases. This was established by the patients' capacity to exercise on a bicycle ergometer without chest pain. The beneficial effect was sustained for up to 3 hr in 12 patients. This preparation appears to act as a long-acting nitrate and may be valuable for patients in whom beta-blocking agents are ineffective or contra-indicated, and surgery is not feasible.


Intracellular free amino acids in patients treated with regular haemodialysis (HD). Plasma and intracellular free amino acids were studied in seven haemodialysis patients with a protein and energy intake of greater than 1g/kg BW/day and greater than 145kJ/kg BW/day, respectively. Abnormalities in intracellular free amino acids known to be associated with uraemia, (low concentrations of threonine, valine and tyrosine) were not observed in the well-nourished haemodialysis patients. Other intracellular amino acid abnormalities were still present, suggesting that these are caused by uraemic factors not controlled by dialysis.


Reduction of unfavourable effects of heparin with use of gabexate mesilate in dialysis. Gabexate mesilate (GM), a potent synthetic proteinase inhibitor has been evaluated as an alternative anticoagulant to heparin for haemodialysis. GM haemodialysis was achieved at a dose of 1,600mg/hr. GM was found to be dialysable and so rapidly degraded that dialysis with GM anticoagulation was analogous to regional heparinisation. Although heparin induced considerable lipolytic activity, GM showed no particular effect on lipids. Some patients reported mild nausea and there was evidence of slight clot formation around the top of the venous drip chamber. GM anticoagulation is easier than the conventional unreliable techniques of regional heparinisation.


Non-A, non-B hepatitis: a new syndrome in uraemic patients. One hundred patients on chronic haemodialysis were studied prospectively over one year for evidence of hepatitis and of infection with hepatitis A or B virus. Five patients developed transient elevations of SGPT, accompanied by a consistent pattern of clinical manifestations, including low-grade fever, anorexia, nausea, hepatomegaly, and hypotension during dialysis. None of these patients had a positive test for A or B virus infection. Non-A non-B hepatitis appears to cause a specific syndrome in uraemic patients, and its transmission in a dialysis unit seems unrelated to blood transfusions.


Central and peripheral haemodynamics in longterm peritoneal dialysis patients. A study was undertaken in 11 longterm peritoneal dialysis (PD) patients to evaluate the acute haemodynamic effects of PD. After filling the abdomen with 1, 2 and 3L of dialysate, intra-abdominal pressure and inferior vena cava pressure increased up to 140 and 98% respectively, whereas central haemodynamic parameters were unchanged. Venous capacity decreased by 18%. Mean weight loss during PD was 1.6kg. The most striking post-PD changes were a significant 19% decrease of cardiac index and 18% decrease of pulmonary artery pressure. Heart rate and arterial pressure remained constant due to a 24% increase in total peripheral resistance.


Does gastrin (pentagastrin) act directly on the parietal cell in the isolated whole stomach of the mouse? Acid secretory effect of pentagastrin and compound 48/80 was studied in the isolated whole stomach of the mouse. Acid secretory response to compound 48/80 was inhibited by cimetidine, indicating histamine involvement in this reaction. Acid secretion stimulated by pentagastrin was not diminished after pre-treatment with compound 48/80 suggesting that gastrin releases non-mast cell histamine. Secretory response to pentagastrin was reduced in Ca++-free serosal media but not to histamine and compound 48/80. A possible pathway of gastrin will be discussed.


[Value of ventilatory assistance through the mouth in readaptation of patients with chronic respiratory insufficiency. Report of 20 cases (author's transl)]. Twenty patients with severe and chronic respiratory insufficiency (SaO2 less than or equal to 80% - PaCO2 greater than or equal to 50 mmHg) were treated with intermittent ventilatory assistance. They used volumetric apparatus 2 to 8 hours a day, during at least 6 months (22 months +/- 13). Respiratory status never improved strikingly, on the contrary most of the time it worsened and patients needed other ventilatory technics and/or died (11 of 20). This technic of ventilatory assistance does not seem to really change the prognosis of these patients in a severe and chronic state.


[Immediate effects and conditions of effectiveness of a session of mechanical assisted ventilation (M.A.V.) in severe respiratory insufficiency (PaCO2 greater than 50 mmHg) out of intensive care conditions (author's transl)]. Effectiveness and haemodynamic tolerance of M.A.V. in conscious patients with a severe respiratory insufficiency is mainly due to the proper adaptation to ventilator with low frequency and adequate V.T. Thus M.A.V. is an eventual complement to directed ventilation exercises which in addition reduce the "rebound" of hypoxia and hypercapnia after a M.A.V. session. A proper adaptation ensures haemodynamic tolerance. Expiratory time should be sufficient in such obstructive patients. A post inspiratory pause can improve V.C.O2. Nevertheless, it should not shorten inspiratory time to less than one second and for each patient the best ventilatory profile should be properly established taking into account blood gases, circulatory, expired CO2 and clinical monitoring.


[A control trial of home I.P.P.B. therapy in patients with chronic obstructive respiratory insufficiency. Protocol and state of the study (author's transl)]. Because a previous retrospective study did not allow any conclusion as to the efficacy of home IPPB therapy in patients with chronic airflow obstruction, a control trial has been started. The protocol includes definition of patients, modalities of treatment, criteria for evaluation. Among criteria for a patient to enter the trial is a chronic hypercapnia (with PaCO2 greater than or equal to 48 mmHg) observed over a preliminary period of 4 months. At the end of this period patients are allocated at random into two groups with and without IPPB at home (at least 1 to 2 hours daily through a mouthpiece); medical prescriptions are same in the 2 groups so as surveillance which is planned for 2 years. Evaluation should be based upon 5 predetermined criteria. This trial is in progress.


[Experimental study of extra-corporeal circulation with membrane oxygenators: effects on the lung structures of dogs and monkeys (author's transl)]. Six dogs and 5 monkeys underwent extra-corporeal circulations with membrane oxygenators for variable time periods (from 4 to 57 hours). The development and evolution of the lesions, which were similar in the two animal species, were controlled by electron microscopic examination of lung samples. From the 2nd h, abnormalities of the capillary endothelium were observed; but a 6 h, all the inner lung structures were reached and the lesions grew worse with time. Thus, the intrinsic toxicity of membrane oxygenators on lung structures emphasizes that this method should be used with utmost precaution in man.


[Experiments to establish the most suitable method for the production and control of conjugated sera]. Studies aiming to establish the most suitable method for conjugated serum production and control were carried out. Results obtained indicate that purest globulin fractions are obtained in case the serum is precipitated by 50% saturation with (NH4)2.SO4, then the sediment is washed with 50% (NH4)2SO4, dissolved in water and precipitated again by 50% saturation with (NH4)2SO4. Conjugated titer is highest when conjugation is performed at a 4:100 FITC (fluorescin-iso-thio-cyanate):protein ratio. The produced conjugated serums are specific and are release with a working titer not lower that 1:4.


[Acute and subchronic toxicity of 8-hydroxyquinolone derivatives in combined application]. The toxicity of combined application of broxychinoline and broxaldin (5:1) was investigated in experiments on white mice and white rats. The presence of higher species specific sensitivity was observed in white mice. LD50 was determined by intraperitoneal application of 0.125 (0.085 + 0.182)/kg body weight on white mice: 0.213 (0.167 + 0.270)/kg body weight on white rats, and by subcutaneous application of more than 1.0/kg body weight on white mice. After a 30-day peroral application of the named combination on white rats at a daily dose of 0.1 kg body weight/24 h no disturbances in the physical state and in the microstructure of the inner organs were scored. The use of a dose of 0.24 kg/kg t/24 h resulted in necrobiotic changes in the kidneys. A trend toward shortening the time of blood clotting and of reducing the relative weight of the kidneys, spleen, lungs and heart is established.


[Microbiological aspects of stored hard-boiled eggs]. Hard-bioled eggs in the shell were without any pretreatment stored in air at 20 degrees C and 4 degrees C. Furthermore the keeping quality of varnish-coated eggs stored in air at 20 degrees C and of untreated eggs stored in 100% carbon dioxide at the same temperature was studied. Hard-boiled eggs stored at 4 degrees C and varnish-coated eggs stored at 20 degrees C were of excellent bacteriological quality up to 5 weeks. Untreated eggs stored in air at 20 degrees C showed high microbiological contamination (more than 10(6)/g) already after one week. The CO2 storage atmosphere inhibited the growth of microorganisms during the first week of storage, but in the days to follow counts increased to more than 10(6)/g as well.


[Neurohormonal regulation of male gonad function]. In a survey the neurohormonal regulatory mechanisms are discussed which control the incretory and spermiogenetic function of the testicles in adulthood. The central position of LH-RH and the factors influencing its secretion, the negative feedback between the testicular hormones including inhibin and the hypophyseal gonadotropins as well as the periodic changes superimposed to the basal secretion of the sexual hormones are explained. Finally, the present knowledge is summarized on the cooperation of the different hormones and mechanisms in the regulation of the incretory and excretory testicular functions.


[Congenital spondylo-epiphysial dysplasia. A case with histological findings (author's transl)]. We have reported on an infant suffering from congenital spondylo-epiphysial dysplasia, in whom the autosomally dominant affliction could already be perceived in the baby's age by the relevant affection of the spine and of the proximal epiphyses. Firstly, it should be tried to stop the progredient kyphoscoliosis by a circular brace. A significantly increased mucopolysaccharide separation could biochemically not be stated in 24 h-urine. Gasser cells could not be found in the lymphocytes as proved by Spranger and Wiedmann in five of six patients. The histological investigation of the biopsy material, taken from the posterior iliac crest, resulted in a desmale ossification process which is atypical for this region.


Production and isolation of milk-clotting enzyme from Aspergillus versicolor. The production of a milk-clotting enzyme by Aspergillus versicolor in 19 different culture media was investigated. Considerable milk-clotting activity was achieved by supplying corn steep liquor with either glucose of maltose. Dephytinization of corn steep liquor had an adverse effect on the production of milk-clotting enzyme. The results indicated that complex organic compounds favoured the production of the enzyme. Precipitation with acetone or tannin was unsuitable, but ammonium sulphate and ethanol above certain concentration produced active fractions.


Glycosaminoglycan content in tissues and body fluids of rats treated with atherogenic diet. An increase of total glycosaminoglycan content in aortic wall and liver as well as changes in the concentration of glycosaminoglycan fractions in aorta, skin, liver, and blood serum were found in white rats fed with atherogenic diet. Urinary excretion of glycosaminoglycans was increased in experimental animals.


Semiquantitative determination of liver specific antigen in the urine or rats with toxic hepatic necrosis. Using Mancini's single radial immunodiffusion technique, the excretion of a liver specific saline soluble antigen was semiquantitatively assayed in the urine of rats with thioacetamine induced hepatic necrosis. The relative amounts of antigen detected in the urine were found to roughly correlate with the extent of necrotic liver parenchyma. It is suggested that a quantitative approach to histuria may provide clinically relevant information on the activity of pathologic processes associated with release of organ specific antigens from degenerative and necrotic lesions into the circulation (histemia) and thence into the urine.


Effect of tetrahydroaminoacridine and 4-aminopyridine on recovery from ketamine-diazepam anesthesia in the macacus rhesus monkey. Tetrahydroaminoacridine (T.H.A., Tacrine) 1 mg/kg, and 4-aminopyridine (Pymadin) 0.2 and 1.0 mg/kg i.v., significantly reduced the recovery time when the were administered after ketamine-diazepam anesthesia in Maccacus Rhesus monkeys. Anesthesia was induced with ketamine (50 mg), diazepam (1.2 mg) and sodium glycopyrrolate (0.02 mg) as a secretiondrying agent, as a single bolus injection. Anesthesia was continued with ketamine by constant infusion of a solution of 5 mg/ml, at a speed of 20 mg/ml, at a speed of 20 ml/hour, during 30 minutes. The 5 monkeys in the control group were allowed to recover spontaneously. The test series consisted of the same monkeys, with an adequate rest period of one or more weeks between anesthesias. Recovery was indicated by production of nystagmus, and by an awake pattern in the EEG. Clinical signs, restlessness and purposeful movements, were also used.


Comparative steady state serum levels of valproic acid administered as two different formulations--Deprakine and Orfiril. Plain tablets of sodium valproate (VPA), a useful antiepileptic drug, are bitter tasting and produce gastric irritation which leads to poor patient compliance. We have studied the steady state serum levels of VPA which can be produced in epileptic patients before and after a 1 week treatment with a plain tablet (Deprakine) versus an enteric coated tablet (Orfiril). The latter drug produced in most patients a higher drug fasting blood level than the uncoated preparation (22%). The enteric coated tablets appeared also better tolerated.


Tissue reaction to submerged ceramic tooth root implants. An experimental study in monkeys. Tooth root replica implants made from alumina ceramic material of solid structure coated with a porous layer, were used as dental implants in monkeys. The porous coating was 1/2 mm thick and had pore sizes within 50--200 microns range, with a 30% degrees of porosity. Tne implants were inserted into prepared sockets in the mandible of 5 Cercopithecus monkeys. After submerged implantation periods varying from 5 to 15 weeks, a perforating steel post was introduced through the covering gingiva into the artificial root canal of the implants. The animals were sacrificed after 6 weeks, 2, 3 and 4 months. Three out of the total number of 10 implants were lost. The remaining 7 specimens were retrieved for histologic and microradiographic examination. Fibrous and mineralized tissue ingrowth of the porous layer of the implants was found. No adverse reactions of the adjacent bone were demonstrable. The implants became anchored to the host and no epithelial downgrowth along the ceramic was found.


[Non-amyloid nephrotic syndrome: first isolated manifestation of a kappa light chain myeloma (author's transl)]. The authors describe a case which demonstrates that nephrotic syndromes occuring during the course of a myeloma are not always of the amyloid type. They emphasize the possibility of a dysglobulinemia being involved in a glomerular nephropathy syndrome, especially when there are histological lesions of a glomerulosclerosis. The published literature is reviewed and the possible pathogenesis of these nephropathies briefly discussed: either protein deposits, the nature of which has not been fully determined, or mesangial modifications induced by the filtered light chains.


[Blood prolactin levels in male hypogonadism (author's transl)]. Prolactin levels were measured in 84 patients aged 20 years with hypogonadism, both under baseline conditions and after stimulation with TRH. In those with impuberty from delayed puberty or gonadotropin insufficiency, baseline blood prolactin levels were normal but the response after stimulation was reduced in a significant manner. In patients with Klinefelter's syndrome, both baseline and reserve blood prolactin levels were increased. No correlation was observed between these abnormal levels and the usual clinical and biological disturbances found in this disorder (gynaecomastia, diabetes, hyperinsulinism, changes in 5-alpha-reduction). The significance of this hyperprolactinaemia remains obscure.


[Dynamic study of the coronary vascular bed by selective coronary scanning using hyperaemia]. Advantage may be taken of the hyperaemic response to the iodine contained in the contrast medium injected during coronary angiography to assess the functional value of the coronary tree using radioactive microspheres. This series comprises 73 selective coronary scans performed in the resting state (113 m In marked microspheres) and during the hyperaemic phase (99 m TC marked microspheres) in 70 patients. A positive hyperaemic response distal to severe truncular stenosis indicates a good distal arteriolar bed and collateral circulation for aorto-coronary bypass grafting. After aorto-coronary bypass (23 cases), the hyperaemic response gives an indication of the functional value of the revascularised myocardium. In 71% cases, the results correlate well with the measurement of the peroperative blood flow through the graft. It is usually positive when the bypass graft is implanted with good distal arterial run off.


[Remote results of ostial coronaritis surgically treated]. This study comprises 15 patients operated for syphilitic coronary ostial stenosis by Dubost's team between 1959 and 1975. Three operative deaths (20%) were observed. Three other late deaths occured, but only one of his coronary pathology. Of the nine survivors, seven have been reviewed and five have undergone control coronary angiography. The long term results of the 9 survivors, reviewed from 3 1/2 to 11 years after operation, illustrate the difficulties of disobliteration of the right coronary ostium, the necessity of changing the aortic valve systematically when incompetent and the maintenance of the good results obtained by this surgery.


[Short- and mean results of mitral and aortic valve replacement with a Björk-Shiley disc prosthesis. Thromboembolic and hemorrhagic complications]. 96 patients with a Björk aortic valve and 112 patients with a Björk mitral valve were followed up for four and a half years and five years after operation respectively. The actuarial survival rate was 82.5% in the aortic and 73% in the mitral patients. Late death was observed in 7.3% of mitral patients with thromboembolic complications and 4.2% of mitral patients with left ventricular dysfunction, compared to 2.6% of aortic patients with thromboembolism and 3.6% with left ventricular dysfunction. The incidence of thrombolic complications was three times as great with the prosthesis in the mitral position. The probability of absence of thromboembolic complications, studied by actuarial methods, was 93% at 4 1/2 years in aortic prostheses compared to 82% at 5 years in the mitral prostheses. 12 haemorrhagic complications (5.7%), with one fatality, were observed. Aortic valve replacement with a Björk prosthesis is a very satisfactory operation and the results compare favourably with other prostheses. However, the risk of thromboembolic complications should be seriously considered in the surgical indications when this prosthesis is to be used for mitral valve replacement.


[Triple-valve replacements].

[Triple-valve replacements]. 34 patients aged between 17 and 62 years underwent triple valve replacement, 14 of whom exclusively with Starr-Edwards prosthesis; 25 patients were operated at Stage III and 4 at Stage IV of the NYHA classification; the operative mortality was 14%, the late mortality 21%. The actuarial survival curve shows 66% survival at 5 years; in all, 21 good results were obtained with a follow-up ranging from 3 months to 11 years (average 41 months). A notable late complication specific to these patients was dysfunction of the tricuspid prosthesis; a gradient across the tricuspid prosthesis was observed in 14 postoperative catheter studies; one of these patients had to be reoperated for thrombosis of a Starr-Edwards tricuspid prosthesis. Analysis of the results of this series suggests that surgery is beneficial, especially when the very precarious preoperative state of these patients is taken into consideration.


Immunity against the venom of Mexican scorpion Centruroides lumpidus limpidus induced by some proteins from this venom. A protein fraction, which consisted of at least 12 proteins, was obtained from the venom of Mexican scorpion Centruroides limpidus limpidus. The molecular weights of these proteins ranged between 9,800 and 163,000 daltons. This fraction was separated from the rest of the venom components, which were almost all neurotoxins, by chromatographying the venom obtained by electrical stimulation through a Sephadex G-50M column. This fraction was non-toxic for mice, even at dose of 200 micrograms/mouse. The most important is that it was able to induce immunity against C. l. limpidus venom, since 92.8% of the animals inoculated with three doses survived after the challenge with 39.2 micrograms of venom (2 DL50 for mice of 20 g); on the contrary, 88 min after the challenge, 100% of the control mice had already died. In another experiment, this immunogen was inoculated into mice three times at variable doses. Seven days after the last injection, each mouse was challenged with 19.6 micrograms of venom. In all controls the typical envenomation picture produced by scorpion venom was developed, and death was registered in 19% of the animals. In contrast, 87% of mice immunized with the highest dose failed to show signs of envenomation or died throughout the observation time. Only two immunized animals (13%) showed mild tachycardia and hyperpnea at 120 min post-challenge. Immunoelectrophoresis and immunodiffusion tests revealed that these proteins induced antibodies against components of the most toxic fraction.


[Reintervention on heart valve prostheses. Apropos of 78 cases]. 78 patients with one or more prosthetic heart valves were reoperated on between 1972 and 1978, and comprised 12% of the work load of valvular surgery. There were two postoperative periods in which the incidence of reoperation was high: the first year, 38%, and the period between the 5th and the 8th year, 41%. The main causes of reoperation could be divided into two groups: those common to all valves with paravalvular leaks (25%), endocarditis (12%) being the principal causes, and those associated with particular valves: deterioration of Beall prosthesis 33%, and thrombosis mainly affecting the Bjork and Beall prostheses (25%). The operative mortality was 12%. The fact that urgent operation is required in severe cases is underlined. In the light of these results, the surgical indications of reoperation should be discussed at an earlier stage. These indications are based essentially on the clinical condition of the patient and objective confirmation by further investigation should not delay the operation, which, in our experience, has never been unnecessary.


[Increased catabolism of antigen and enhanced recruitment of antigen-sensitive cells by activation of macrophages with a bacterial phospholipid extract (EBP) (author's transl)]. Intravenous (IV) infection of a bacterial phospholipid extract (EBP) 24 H before IV immunization of mice with sheep red blood cells has modified the specific immune response. A decrease of the response evaluated by the number of rosette-forming cells was observed after the larger doses of EBP. This effect appeared secondarily to an increased catabolism of antigen. Infection of a medium sized dose of EBP directly into the portal vein induced a decreased response by enhancing antigen phogocytosis by liver macrophages. The same amount of EBP injected IV into a systemic vein increased the immune response. An enhanced phagocytosis by macrophages which do not act in the immune response appeared likely after the larger stimulation. Irradiated spleen cells when transferred into naive recipients showed a decreased immunogenicity when obtained from mice injected with antigen and previously treated by the larger doses of EBP. On the other hand, after treatment of mice with low of medium sized doses of EBP, the immune response was increased. Twice the number of rosette-forming cells was observed in treated mice on days 3, 4 and 5 after immunization. The number of B rosette-forming cells appeared higher than the T rosettes following this treatment. This effect appeared secondarily to an increased recruitment of precursor cells. Transfer into naive irradiated recipients of treated spleen cells mixed with antigen was without effect. On the contrary, an enhanced number of rosette-forming cells was detected after transfer of normal spleen cells into irradiated and EBP-treated recipients. This enhancement of response appeared to be produced by more efficient recruitment of precursor cells as demonstrated by an increased frequency of antibody-forming cells in an in vivo limiting dilution technique.


[Factor analysis fever in the early postoperative period following cardiopulmonary bypass surgery in adults. Correlation with bacteriological data. Statistical study of 518 case histories by computer]. The results of a continuous series of 518 adults undergoing cardiopulmonary bypass surgery, operated on by the same surgeon, comprising valvular replacement and aorto-coronary bypass surgery with a peroperative protocol of asepsis and a short prophylactic course of Penicillin and Streptomycin, a preoperative and postoperative bacteriological study, were treated by computer. The postoperative temperature chart showed a progressively decreasing pyrexia in the first 8 days after cardiopulmonary bypass. The nature of the operation, the bypass time, the quantity of blood used during operation and the blood loss were statistically significant factors. Patients with a clinical infection had significantly higher temperatures from the first on. 8,9% of patients had a febrile reaction which continued after the 10th day after cardiopulmonary bypass. The cause was not always apparent but the appearance of their temperature graphs was distinguishable after the first week. Analysis of the systematic bacterial specimens showed bacterial contamination of nearly 10% of drains, 10% of blood cultures, over 15% of intravenous infusion catheters and 70% of urinary catheters. The significance of these results is discussed. The normal appearance of the temperature chart after cardiopulmonary bypass surgery in the absence of clinical complications and bacterial contamination has been established.


[Traumatic myocardial infarct].

[Traumatic myocardial infarct]. Two cases of traumatic, closed chest, myocardial infarction in two young patients, aged 18 and 19 years respectively, are reported. They illustrate the two possible physiopathological mechanisms of this affection: in the first case, myocardial contusion after thoraco-abdominal trauma by crushing, probably complicated by a subendocardial tear of the inferior wall of the left ventricle, with a spontaneous favourable outcome; in the second case, a transmural myocardial infarction was observed secondary to a coronary lesion (? tearing of the adventitia of the left anterior descending artery) complicated by the early development of a large antero-apical aneurysm. Haemodynamic and arrhythmic complications necessitated infarctectomy and aorto coronary bypass surgery on the 35th day. The pathological lesions and their outcome are examined with respect to these two cases. The diagnostic, therapeutic and medieolegal problems associated with this condition are also discussed.


[Effects on the systemic and coronary circulation of 2 nitrate derivatives, intravenous trinitrin and sublingual isosorbide dinitrate, administered during atrial pacing]. The changes in the systemic and coronary circulations produced by intravenous trinitrin 0.38 +/- 0.125 mg/hour and sublingual isosorbide dinitrate 5 mg were studied in 24 patients with coronary artery disease. When given during rapid atrial pacing both drugs decreased pulmonary capillary pressures (p less than 0.001), cardiac and coronary output (p less than 0.001 and p less than 0.01) and myocardial oxygen consumption (p less than 0.01). At these dosages, intravenous trinitrin has no significant effect on average systemic blood pressure or left ventricular work index; the coronary arterial resistances increased (p less than 0.005). Isosorbide dinitrate significantly decreased average systemic blood pressure and the left ventricular work index (p less than 0.001); there was no significant difference in the coronary arterial resistances; the decrease in coronary blood flow observed after sublingual isosorbide dinitrate seems partly due to a decreased perfusion pressure. The beneficial effect of these nitrite derivatives seems to be mainly related to a reduced preload.


[Systolic time intervals in essential hypertension. I. Study of untreated patients]. 15 patients with Stage II (VHO Classification) hypertension were studied before treatment. The following systolic time intervals were measured: 1) total electromechanical systolic period (QS2); 2) left ventricular ejection time (LVET); 3) interval between the first and second sounds (S1 S2); 4) pre-ejection period (PEP); 5) interval between the start of QRS and the first sound (QS1); 6) isovolumetric contraction time (ICT); 7) PEP/LVET ratio. The values measured were compared to the theoretical values obtained by the Weissler regression methods, taking into consideration the sex of the patient and the heart rate. QS1 and the ICT were both a slightly longer than normal; the PEP was increased by 25.6% (26.8 ms), whilst the LVET was decreased by 7.9% (24.0 ms), both differences being significant; QS2 increased by 1.1% (to 4.9 ms) but this was not significant; the PEP/LVET ratio was 0.479 +/- 0.12. These results seem to characterise moderate systemic hypertension with a significant relation between the variations of PEP, LVET and PEP/LVET with the diastolic blood pressure; although they have no absolute value, these results may be used in a longitudinal study to follow the course of hypertension and to study the effects of treatment.


[Systolic time intervals in essential hypertension. II. Variations produced by treatment with labetalol]. Characteristic changes in the systolic time intervals in Stage II (WHO Classification) hypertension have been demonstrated comprising an increase in the pre ejection period (PEP), a decrease in the left ventricular ejection time (LVET) both statistically significant, and an increase in the PEP/LVET ratio. We have studied the variations brought about by effective hypotensive therapy with an alpha and beta blocking agent (Labetalol) in 15 patients over a period of 90 days, with an average dosage of 420 mg/day in three divided doses. There was no significant variations in the PEP, but the LVET which had been reduced by 7.9% returned to within 2.8% of normal, with a reduction in the PEP/LVET ratio. The variations of these systolic indices (generally considered to be the most sensitive assessment of left ventricular function) seem to show that the hypotensive effect of labetalol is not related to a reduction in cardiac efficiency.