Lancefield extract of group A streptococci type 15 acts like an anti-human IgG with restricted specificity. Lancefield extract of streptococci group A type 15 precipitates certain human sera and agglutinates red cells coated with some IgG anti-Rh antibodies. The frequency of precipitation varies between populations. The serum component in the precipitate is IgG. The results indicate that an iso-allotypic marker is detected by the extract.


Organochlorine compounds in Norwegian human fat and milk. Analyses were carried out in 1975/76 of samples of human, perirenal fatty tissue and 45 samples of human milk with regard to persistent organochlorine compounds. A corresponding investigation was carried out in 1969/70. A comparison of the results suggests that a decrease in the content of DDT and its metabolites occurs. The PCB content showed a significant increase as compared with 1969/70. HCB levels of approx. 0.25 ppm and 0.0054 ppm were demonstrated in fatty tissue and in human milk, respectively. Concentrations of DDT plus metabolites, PCB and HCB in older people were significantly higher than those found in younger subjects.


Effects of cortisol administration on components of the hepatic microsomal mixed function oxidase system (MFO) of immature rainbow trout (Salmo gairdnerii Rich.). The effects of cortisol on components of the liver microsomal mixed function oxidase system (MFO) of immature and starved rainbow trout, Salmo gairdnerii, Rich., were studied 3, 7 and 21 days after intraperitoneal implantation of cortisol-containing cholesterol pellets. The treatment resulted in significantly elevated NADPH cytochrome c reductase activities, concomitant with elevated plasma cortisol levels, at all sampling events, while no significant effects on either liver cytochrome P-450 or microsomal protein contents was observed. The cortisol-treated fish lost considerably more body weight than corresponding controls during the experimental period, while the effects on liver wet weight and liver somatic index were inconclusive.


Haemodynamic changes in the cerebral circulation of the cat during occlusion of the middle cerebral artery. In a group of 21 cats, the middle cerebral artery pressure (MCAP) was recorded by means of a catheter introduced into the artery at its origin, just distal to the occlusion. The effects of hypertension, hypercapnia, and hypocapnia were studied. In a group of five cats, both middle cerebral arteries (MCA) were catherized and the pressure was recorded simultaneously on both sides. In another group of five cats, O2 tension measurements were made with the aid of oxygen electrodes in the brain tissue, the occluded MCA, and the common carotid artery. Some of the results obtained in this study are compared with the results of a previous study where monkeys were used as experimental animals.


The influence of age and dementia of the neurone population of the mammillary bodies. In a study on the influence of age and senile dementia on the mammillary bodies, the medial mammillary nucleus was examined in 15 brains from young (control), normal aged and demented females. Neurone populations, volumes and cell densities were estimated. Individual variation was high in all the groups studied. Normal ageing and dementia were accompanied by a substantial loss of volume but no significant loss of neurones, resulting in a considerable increase in cell density. No significant differences were detectable between the normal aged group and the demented group. These findings are in agreement with other investigators who have found no neuronal loss with age in discrete nuclear structures.


Antibiotic-associated colitis: a retrospective study of fifteen cases. Fifteen cases of antibiotic-associated colitis were reviewed in a retrospective study of all the cases seen in a general hospital in the period 1970--7. Nine of these cases were diagnosed as pseudomembranous colitis. This was found mostly in patients over 65 years of age, where it resulted in severe illness with 70% mortality. The antibiotics involved included ampicillin, penicillin, clindamycin, erythromycin and co-trimoxazole (Septrin). Pseudomembranous colitis is a serious hazard in the elderly and may be caused by a wide range of antibiotics in common use.


Radium-induced malignant tumors of the mastoid and paranasal sinuses. In the records of 5,058 persons with therapeutic or occupational exposure to radium, 21 patients with carcinoma of the mastoid and 11 with malignant tumors of the paranasal sinuses were identified. Tumor induction times were 21-50 years for mastoid tumors (median, 33) and 19-52 years for paranasal sinus tumors (median, 34). Dosimetric data are given for the patients whose body burdens of radium have been measured. We found a high proportion of mucoepidermoid carcinoma, comprising 38% of the mastoid and 36% of the paranasal sinus tumors. Three patients had antecedent bone sarcoma at 20, 11, and 5 years, respectively, and a bone sarcoma was discovered at autopsy in a fourth patient. Radiographic changes in the mastoid and paranasal sinuses were similar to those seen in nonradium malignant tumors. More than 800 known persons exposed to radium before 1930 and another group of unknown size who received radium water or injections of radium from physicians are still alive and at risk of developing malignant tumors of the mastoid and paranasal sinuses.


Radiologic and clinical assessment of broad-spectrum antibiotic therapy in Crohn's disease. Continuous treatment with broad-spectrum antibiotics resulted in symptomatic improvement in 41 of 44 patients (93%) with Crohn's disease who were treated for 6 months or longer. Radiographic follow-up demonstrated evidence of improvement in 20 of 35 patients (57%) for whom posttherapy radiographs were available. Radiography demonstrated resolution of ulcerations, abdominal masses, stenosis, and in some patients restoration of a normal intestinal mucosal pattern. In some patients these changes occurred within weeks; in others, over a period of years. Patients with perianal fistulas and patients who had previously undergone surgery and had recurrence of their disease prior to treatment with antibiotics accounted for the therapy failures.


Cystic neoplasms of the pancreas: new angiographic and ultrasonographic findings. Cystic neoplasms of the pancreas (cystadenoma, cystadenocarcinoma) are rare tumors. Early diagnosis and differentiation from other pancreatic lesions are essential for appropriate management. Pancreatic angiography and gray scale ultrasonography facilitate rapid, accurate diagnosis and proper surgical therapy. In a 7 year period, eight patients were studied (one cystadenoma, seven cystadenocarcinoma); five had selective visceral angiography and six underwent abdominal ultrasonography. The ultrasonographic characteristics of these neoplasms and some new angiographic findings are presented. The sonographic findings for cystadenocarcinoma were similar to those of cystadenoma.


Lymphangiographic changes after radiation therapy. Lymphangiographic appearance following radiotherapy is described in 21 patients with pre- and posttherapy lymphangiograms. Following radiotherapy to normal lymphatics, decrease in nodal size and lymph vessel caliber is noted uniformly after 12 months. Before 12 months the development of these changes is variable and may not be seen, especially during the first several months. Following irradiation of abnormal lymph nodes, dilatation of the lymph vessels distal to the abnormal nodes may occur. These lymphangiographic findings can be related to histologic changes seen in lymph nodes after radiation therapy.


High-dose renal pharmacoangiography in the assessment of hypovascular renal neoplasms. From 6% to 25% of primary renal carcinomas are either hypovascular or avascular and are the major source of false negative angiography. High-dose renal pharmacoangiography, a valuable adjunct to conventional angiography, combines a renal vasodilator, acetylcholine, with a high dose of contrast medium. High-dose renal pharmacoangiography improves the diagnosis of hypovascular mass by enhancement of tumor vessels, increase of tumor stain, and better opacification of main and collateral renal veins. During a 4 year period, 20 hypovascular renal neoplasms were studied and successfully diagnosed preoperatively by this method.


Optimal technique of renal arteriography in living renal transplant donors. Sixty consecutive living related renal donors were evaluated retrospectively with regard to the adequacy of their preoperative angiograms. Comparison of the original radiologic reports and the surgical findings revealed no errors in the prediction of the number and length of renal arteries of the transplanted kidneys. The optimal arteriographic technique is defined in the context of the information required by the surgeon: it is concluded that selective renal arteriography, although often advocated, is seldom necessary if the standard anteroposterior view of the abdominal aortic injection is supplemented by oblique and occasionally other views in selected cases.


Complications in expanded polytetrafluoroethylene arteriovenous grafts: an angiographic study. Expanded polytetrafluoroethylene grafts were used for creation of arteriovenous shunts in 35 patients on chronic hemodialysis. When flow studies or mechanical factors indicated abnormal flow in the graft, angiography was performed. Detection of venous backflow or obstruction, arterial stenosis, aneurysm formation, or graft kinking facilitated correction and thus salvage of the grafts.


Complication rate with supine phlebography. The incidence of complications following supine phlebography was studied in 109 patients (142 legs) retrospectively and 89 patients (106 legs) prospectively. Virtually all patients had some discomfort during the procedure, while three patients had delayed pain for up to 4 days following examination. Three patients developed hives, one of whom also had bronchospasm. There were two cases with subcutaneous extravasation. The shorter endothelial contact time of supine phlebography compared to the semiupright technique might explain the reduced incidence of pain.


Flow-directed balloon catheterization for aortofemoral arteriography using the axillary artery approach. An axillary artery approach is occasionally necessary in the evaluation of the abdominal aorta and peripheral arteries in patients with severe and complicated arteriosclerotic disease. Difficulty may be encountered in directing the catheter into the descending aorta in patients with extremely tortuous and elongated aortic arches. Use of flow directed angiographic balloon catheters has made abdominal, pelvic, and lower extremity arteriography readily obtainable using an axillary approach when other methods failed and translumbar aortography was considered hazardous. This might be particularly useful in patients with high abdominal aortic occlusions, in anticoagulated patients, in patients with abdominal aortic grafts, and in some patients with small aortas displaced to the right.


A new noninvasive approach to peripheral vascular disease: thallium-201 leg scans. A new noninvasive technique to evaluate blood flow distribution to the legs is described. Intravenous thallium-201 is used during rest and exercise followed by scanning and point counting of the lower extremities. The normal blood flow distribution recorded in 30 patients with no known peripheral vascular disease was primarily proportional to muscle mass. Using both scans and point counting, normal intra- and interextremity ratios were qualitatively and quantitatively defined, and significant increases in muscular to nonmuscular perfusion with exercise were documented. The symmetry in perfusion in the contralateral muscle groups was verified for the first time.


Computed tomography in the detection of retroperitoneal hemorrhage after translumbar aortography. Direct imaging of retroperitoneal hemorrhage following translumbar aortography was performed using computed tomography. Seven patients were scanned over the area of aortic entry immediately after undergoing angiographic examination. In five cases, there was definite evidence of periaortic hematoma, most commonly seen as a discrete soft tissue density with absorption coefficients between +20 and +35 EMI units. Other signs of retroperitoneal bleeding were less consistently present (e.g., loss of aortic contour, aortic displacement, and thickening of diaphragmatic crura). The clinical implications of detecting significant hemorrhage following translumbar aortography are also discussed.


Detection of neoplastic involvement of the mesentery and omentum by computed tomography. A total of 39 patients undergoing abdominal computed tomography and subsequent surgical biopsy of the mesentery or omentum were studied to evaluate the sensitivity of CT in detecting metastases to those areas. Twelve patients had negative biopsies; there were no false positive CT interpretations in that group. Of the 27 patients with positive biopsies, 18 showed positive findings on CT scan. Those patterns of involvement are described and illustrated. The nine false negative cases related to very small metastatic foci, contiguity with the primary tumor, or paucity of intraabdominal fat.


Computed tomography of necrotic hepatic metastases. Seven patients with necrotic liver metastases were evaluated by computed tomography. The metastases demonstrated low attenuation areas varying from a small central portion to the entire lesion. Other findings included mural nodules and fluid-fluid levels. Possible etiologies for necrotic metastases are presented and their differential diagnosis is discussed.


CT diagnosis of tumor thrombosis of the renal vein and inferior vena cava. Four cases of tumor thrombosis of the inferior vena cava and renal veins were diagnosed by computed tomography. In two, the thrombus itself was demonstrated within the vascular lumen after intravenous injection of urographic contrast material. The diagnosis was made in the other two patients by identification of massive enlargement of the vascular diameter.


Diminished radiopacity of contrast material: a urographic sign of ureteral calculus. Eleven patients with unilateral ureteral calculus had excretory urography which showed the radiopacity of excreted contrast material to be diminished on the side of the calculus. This finding was of diagnostic importance in nine patients who demonstrated little or no dilatation of the urinary tract proximal to the calculus. Other forms of unilateral renal disease, such as acute pyelonephritis, can produce the same urographic finding.


Calcified bodies in popliteal cysts: a characteristic radiographic appearance. Calcified bodies in popliteal cysts have a characteristic radiographic appearance which can be confirmed by arthrography. Calcified bodies may arise in the true joint due to trauma, arthropathy resulting in joint destruction, or synovial osteochondromatosis. These calcified loose bodies may pass into a popliteal cyst through posterior joint-bursal communications or can arise in a popliteal cyst by chondrometaplasia. Correct radiographic interpretation will exclude soft tissue tumors and vascular lesions as differential considerations. Management of these patients will be determined by the clinical circumstances since neither popliteal cysts nor synovial osteochondromatosis are necessarily symptomatic.


Complications of catheter cerebral arteriography: analysis of 5,000 procedures. I. Criteria and incidence. Computer analysis of complications of 5,000 catheter cerebral arteriograms performed at four hospitals (two training and two nontraining) revealed a total of 68 complications (1.4%). Eight (0.16%) of these complications were major: five patients required thrombectomy or embolectomy, two had permanent neurologic deficits, and one patient died. The complication rate for the training hospitals (3.9%) was significantly higher than that for the nontraining hospitals (0.9%), but the rates of permanent complications were identical in both groups (0.1%). Reporting criteria and complication types are described.


Complications of catheter cerebral arteriography: analysis of 5,000 procedures. II. Relation of complication rates to clinical and arteriographic diagnoses. Clinical (prearteriographic) and arteriographic diagnoses were grouped into six categories each for analysis of central nervous system and systemic complications of 5,000 catheter cerebral arteriograms. Within each category, there was no significant difference in complication rate between clinical and arteriographic diagnoses. The highest complication rates (1.2%-1.9%) were in patients with cerebrovascular occlusive disease, posttraumatic or postoperative conditions, and subarachnoid hemorrhage. Significantly lower complication rates (0.2%-0.5%) were found in patients with tumor, seizure or headache, and patients with normal arteriographic findings.


Complications of catheter cerebral arteriography: analysis of 5,000 procedures. III. Assessment of arteries injected, contrast medium used, duration of procedure, and age of patient. Complication rates in 5,000 consecutive catheter cerebral arteriograms were assessed with regard to arteries injected, contrast medium used, patient age, and duration of procedure. No statistically significant difference was found between the complication rate when the carotid artery alone was injected and that when the carotid artery was injected in combination with the vertebral artery, the aortic arch, or both. There was also no significant difference between the total complication rates using Conray-60 and Renografin-60. However, although Conray-60 demonstrated no change in complication rate with increased volume, Renografin-60 showed a consistent and significant increase in complication rate with increased volume. Complication rates were also significantly higher when the procedure lasted more than 80 min and in patients more than 40 years old. As might be expected, nontraining hospitals used significantly less contrast material and had significantly shorter procedures than training hospitals.


Coronal computed tomography: indications and accuracy. The application of wide aperture scanners to neuroradiology permits improved anatomic definition and localization of intracranial and intraorbital lesions. Coronal scans are most useful in demonstrating lesions of the skull base and apex, distinguishing between infra- and supratentorial lesions, and in determining if a lesion is intra- or extraaxial. Limitations of coronal scans include discomfort in positioning, high spatial frequency artifacts, and additional radiation exposure.


CT contrast enhancement in cerebral infarction. Computed tomography was used to study 100 patients with ischemic cerebral infarcts. All cases were documented by autopsy, radionuclide imaging, cerebral angiography, or clinical course. Vascular distribution of infarcts was varied and included infarcts of cerebral hemispheres, basal ganglia, and cerebellum. Distinct patterns of enhancement are seen following administration of intravenous contrast material: predominantly peripheral, central, homogeneous, or heterogeneous. Enhancement of the infarcted area usually occurs 1-4 weeks after the onset of clinical symptoms, but was seen as early as the first day or as late as several months after the onset of symptoms. Infarcts showing contrast enhancement may or may not revert to a nonenhanced pattern on follow-up examination for several months. Lesions demonstrating contrast enhancement in cerebrovascular disease may at times be indistinguishable from tumor. Contrast enhancement was the only manifestation of infarction in some instances, and an infarcted area may be completely missed if a postcontrast examination is not performed.


Effect of propranolol and nitroglycerin plus methoxamine on transmural creatine kinase activity after acute coronary occlusion. Transmural creatine kinase activity was determined 5 hours after acute occlusion of the left anterior descending coronary artery in 27 open chest anesthetized dogs. In seven dogs, propranolol, 2 mg/kg, was given intravenously over a 10 minute period 10 minutes after occlusion. In 10 dogs, nitroglycerin, 300 microgram/min, was infused intravenously for 1 hour 10 minutes after occlusion. Methoxamine, 300 to 500 microgram, was administered to return blood pressure and heart rate to prenitroglycerin levels. In untreated dogs, there was a distinct transmural gradient of creatine kinase activity in the ischemic region from subepicardium to subendocardium: nonischemic subepicardium 1,187 +/- 50 international units (IU)/g versus ischemic subepicardium 1,054 +/- 46 IU/g and nonischemic subendocardium 1,170 +/- 53 IU/g versus ischemic subendocard;um 766 +/- 42 IU/g, respectively. Administration of propranolol did not affect the transmural creatine kinase gradient after 5 hours of occlusion. In contrast, nitroglycerin plus methoxamine significantly (P less than 0.05) decreased subendocardial creatine kinase depletion after 5 hours of occlusion (776 +/- 42 versus 978 +/- 47 IU/g). These findings demonstrate the unique capability of nitroglycerin plus methoxamine to protect the subendocardium during ischemic insult.


Descending monoaminergic pathways in the primate spinal cord. The distribution of monoamine axons and terminals within the spinal cord of a primate (Macaca mulatta) was studied with the Falck-Hillarp histofluorescence technique for the demonstration of biogenic amines. Catecholamine and indoleamine varicosities appeared qualitatively similar to those previously reported for the rat although the indoleamine terminals were difficult to visualize and were not studied in great detail. Catecholamine fibers innervate the substantia gelatinosa, marginal layer, intermediolateral cell column, ventral horn and the region surrounding the central canal. The location of monoamine axons, as revealed by spinal cord ligation, corresponds to that in the rat and cat with the exception of the dorsolateral region of white matter where fluorescent axons are not visible in the primate.


Total parenteral nutrition in the management of acute renal failure. Malnutrition is frequently present in patients with acute renal failure and may affect morbidity and mortality in this condition. When adequate nourishment cannot be given through the gastrointestinal tract, total parental nutrition with amino acids and hypertonic glucose may have beneficial results. Total parenteral nutrition has been reported to stabilize or reduce serum urea nitrogen, potassium and phosphorus levels, improve wound healing, enhance survival from acute renal failure, and possibly increase the rate of recovery of renal function. The optimal composition of the total parenteral nutrition infusate is unknown. Preliminary results of a double-blind study are reported in which one man received hypertonic glucose alone, two received glucose with essential amino acids (21 g/day), and three received glucose with essential (21 g/day) and nonessential (21 g/day) amino acids. All infusates were isocaloric. No differences were observed in serum urea nitrogen levels, serum urea nitrogen/creatinine ratios or urea appearance rates. Nitrogen balance was negative in all patients. The ratio of essential amino acids/nonessential amino acids were higher and the tyrosine/phenylalanine ratios were lower in plasma in the two patients receiving glucose with essential amino acids. No patient survived the hospitalization. In view of the markedly negative nitrogen balance frequently observed in these and earlier studies, the use of a different composition or quantity of amino acids, a higher energy intake, and anabolic hormones deserve further investigation.


Criteria for choosing amino acid therapy in acute renal failure. Metabolic studies were performed on 19 patients with acute renal failure. Therapy included intravenous hyperalimentation using 15 to 20 g of essential amino acids or 20 to 40 g of essential plus nonessential amino acids and hypertonic glucose (37 to 50%). The effect of this parenteral feeding appears to be primarily pharmacological. Hypertonic glucose promotes the hyperinsulinemia important to be membrane function, the operation of the sodium pump, and cell metabolism. Administration of high biological value crystalline amino acdis potentiates the effect of insulin by inhibiting protein breakdown and promoting protein synthesis, particularly in muscle. This reduces tissue catabolism and urea formation, and promotes potassium, magnesium, and phosphate homeostasis. The branched-chain ketogenic amino acids valine, leucine, and isoleucine may be of particular importance. When indicated, administration of renal failure hyperalimentation and peritoneal or hemodialysis can be expected to complement each other and accelerate recovery. This intravenous fluid therapy, in turn, must be coordinated with proper hemodynamics, usually requiring a colloidal solution to maintain intravascular volume, and cardiotrophic agents such as digitalis and dopamine. Early use of renal failure can be expected to demonstrate the most striking response in terms of survival, early recovery from acute renal failure, and the preservation of physiological homeostasis.


Influence of diet and age on fecal bacterial enzymes. The bacterial enzymes beta-glucuronidase, azoreductase, and nitroreductase, all implicated in the etiology of colon cancer, were measured in the fecal microflora of rats and humans. The effect of a high-beef diet and advanced age on the activities of these microbial enzymes were determined in the rat. Rats shifted from a grain to a meat diet showed a 1.5- to 2.5-fold increase in activity of all three fecal enzymes. Animals over 20 months of age, consuming a meat diet, showed a further increase in fecal beta-glucuronidase activity, while the levels of all three microbial enzymes increased in old rats fed a grain diet. Fecal microbial enzyme activities were also measured in humans eating a diet supplemented with bran or wheat germ. Humans receiving fiber supplements consisting of 30 g of bran or wheat germ added to their customary diets did not show significant changes in fecal enzyme activity.


The effects of dietary fiber on gastrointestinal motor function. For normal individuals and probably for persons with diverticular disease, dietary fiber affects stool bulk and decreases transit time. The unproven rationale for the use of fiber in irritable colon and diverticular disease assumes that these diseases are the result of increased intraluminal pressure caused by excessive segmentation over a period of years. In short-term experiments, certain fibrous materials do decrease intraluminal pressures, usually in response to a stimulus such as food but sometimes under resting conditions as well. It seems likely that the physical and probably chemical characteristics of fiber influence the motor responses of the alimentary tract. Anecdotal testimonials to the merits of fiber abound, but firm evidence that even wheat bran, the most commonly studied fiber, is effective is difficult to obtain. Controlled clinical trials have been attempted and to date have given conflicting results. Careful studies using a number of well-defined fibrous materials are urgently required to determine the physiological mechanisms of action of different fibers on gastrointestinal motor activity.


Fiber, lipids, and atherosclerosis.

Fiber, lipids, and atherosclerosis. The influence of dietary fiber on lipid metabolism and atherosclerosis in animals and on lipid metabolism in man is reviewed. Pectin, guar gum, and lignin lower serum and liver cholesterol in cholesterol-fed rats. Agar increases liver cholesterol in rats. Bran has no effect on serum lipid levels in rats or monkeys. Vegetarians have long been known to exhibit cholesterol levels lower than those of comparable populations who subsist on a mixed diet. Pectin and guar gum lower cholesterol levels in man whereas cellulose and bran have no effect. Rabbits fed a semipurified diet containing saturated fat become atherosclerotic, but addition of the same fat to laboratory ration has no effect; it has been shown that the residue in laboratory ration is the cause of the difference. Semipurified diets containing cellulose are more atherogenic than those containing wheat straw or alfalfa. The semipurified diets also cause aortic sudanophilia or atherosclerosis in baboons and vervet monkeys. One possible mechanism of hypolipemic action of fiber involves the binding of bile acids, which would result in reduced absorption of cholesterol, resulting in lower levels of serum cholesterol.


A comparison of genital infections caused by chlamydia trachomatis and by neisseria gonorrhoeae. Patients with culture-proven infections with Neisseria gonorrhoeae or Chlamydia trachomatis, or both, seen at the Olmsted County Health Department Sexually Transmitted Disease Clinic were evaluated for the presence of dysuria and exudate. Eighty-four patients (21%) had neither symptom. N. gonorrhoeae infection alone was most frequent (47%), but C. trachomatis predominated in men. Dysuria was most often detected in men infected with C. trachomatis, but exudate was most frequently found in men infected with N. gonorrhoeae alone or in mixed infections with C. trachomatis. The presence of both symptoms was more common in men than in women infected with N. gonorrhoeae or C. trachomatis. However, as the occurrence of dysuria and exudate was generally similar within the male and female groups, regardless of the organisms recovered, the type of infection cannot be accurately determined on the basis of symptomatology alone. The authors therefore believe that the diagnosis of genital infection by C. trachomatis or N. gonorrhoeae, or both, by culture technics is essential because effective treatment with antimicrobial therapy often requires this information.


Inability of the standardized disk agar-diffusion test to measure susceptibility of the fluorescent group of pseudomonads to gentamicin. Four hundred thirteen clinical isolates of fluorescent pseudomonads consisting of 286 Pseudomonas aeruginosa and 127 organisms of the Pseudomonas fluorescent group were tested for susceptibilities to gentamicin by the broth-dilution method and by the standardized disk agar-diffusion test, using Mueller-Hinton agar from three sources. Different regression lines and significantly different mean inhibition zone diameters were found for the three Mueller-Hinton agars. Single zone-diameter breakpoints of either 13 or 16 mm for the standardized disk agar-diffusion test produced unacceptable rates of false-sensitive and false-resistant interpretations. When error rates were limited by using zone-diameter breakpoints determined by the method of error rate-bound analysis, the percentage of indeterminate interpretations became so large as to make the standardized disk agar-diffusion test impractical. It is concluded that the standardized disk agar-diffusion test should not be used for testing susceptibility of the fluorescent pseudomonads to gentamicin, and presumably other aminoglycosides.


Measurement of serum folate by 75Se-selenofolate radioassay. Results of a multi-institutional clinical trial. The authors report the multi-institutional evaluation of a radioassay for serum folate utilizing a gamma-labeled folate analog (75Se-pteroyl-L-methylselenocysteine). The assay is run as a one-step simultaneous addition at ambient temperature and is completed within 45 minutes. The assay data were reproducible within four study centers and correlated with both the Lactobacillus casei diagnostic groups and the clinical pictures.


The Comprehensive Blood Bank Survey Program of the College of American Pathologists, 1976. The Comprehensive Blood Bank Survey Program for 1976 still shows that the participants are performing well on ABO and Rh typing (accuracy greater than 96.6%), antibody detection (greater than 97.0%), and crossmatching (greater than 97.3%). The only problem with less accuracy than that stated involved a specimen with an extremely weak antibody. Some errors are still due to failure to fill out results. In the 1976 survey, four ungraded problems were included as attempts to study the "state of the art." The problems consisted of an antibody whose titer was to be determined, a mixture of Rh+ and Rh-- cells to be detected, and two multiple-antibody problems. The results obtained in these studies are discussed. Finally, the participants were asked questions about the amount of Rh immune globulin used and the indications for its use, the incidence and types of transfusion reactions seen, and the notations used by laboratories to record results. The answers to these questions are also documented.


Antibody-dependent cell-mediated cytotoxicity to herpes simplex virus type 2 infected target cells in the course of cervical carcinoma. The antibody-dependent cell-mediated cytotoxicity (ADCC) assay was used as a sensitive instrument to study if specific antibodies acting synergistically with lymphocytes to induce target cell destruction, could be detected in sera from patients with cervical carcinoma. Significant cytotoxicity to herpes simplex type 2 (HSV-2) infected target cells was observed in sera of 17 out of 23 (74%) surviving patients with cervical cancer who were followed with at least two serum samples. A rise in cytolytic activity was also observed in 11 out of 23 cases. Seven out of 14 tumor-bearing cervical cancer patients with progressing cervical lesions showed significant cytotoxicity, but four of the seven had lost activity in later sera. When 43 patients surviving the observation period of 24--60 months with no signs of residual tumors were compared with 23 severely ill cervical cancer patients, patients with less advanced cancer had significantly higher cytolytic activity.


Monitoring bacterial resistance to restricted antibiotics. Data on patterns of resistance of eight strains of bacteria toward various restricted antibiotics were collected from 18 public health laboratories in Czechoslovakia. Development of bacterial resistance to gentamicin and colistin did not appear to follow the resistance patterns of bacteria toward more commonly used antibiotics, but there did appear to be a tendency of mutual coresistance to those two drugs in E. coli and Pseudomonas strains. Similarly, oxacillin coresistance was found in lincomycin-resistant staphylococcal strains. Computer-assisted analysis of resistant bacterial strains revealed otherwise-hidden tendencies and mutual relationships among drugs newly marketed in Czechoslovakia.


Plasma cortisol in the chronic rhesus monkey preparation (Macaca mulatta). The short- and long-term effects of surgical procedures and chair restraint on total plasma cortisol were assessed in the chronic rhesus monkey preparation. Three nonpregnant and six pregnant animals were sampled daily, morning and evening. Fetal plasma specimens were obtained simultaneously from the pregnant animals. In the nonpregnant rhesus monkey, a circadian rhythm is present the day following venous catheterization and chair restraint, with individual values similar to those in trained, unanesthetized animals. In the pregnant animals, a postoperative rise in cortisol is followed by a gradual decline to a plateau and a return of circadian rhythm. No consistent daily fluctuations are seen in fetal cortisol, and although correlated with maternal cortisol, the exact relationship is uncertain. The data indicate that operation, as expected, is stressful but acclimation to the chair occurs.


Use of a xenon flash tube as the excitation source in a new slit-lamp fluorophotometer. A new objective fluorophotometer measures fluorescein mass or concentration in the cornea or anterior chamber. The excitation source is a xenon flash tube that allows the measurement of fluorescence to be made rapidly and conveniently. The instrument is designed for use in clinical studies requiring quantitative measurements of fluorescence in the tears, the cornea, and the aqueous humor.


A marketplace model of consultation psychiatry in the general hospital. The manner in which internists and surgeons view potential psychiatric consultations is analogous to the way in which consumers evalute a service or product in the marketplace. Factors that determine a purchase or a consultation request include 1) perception of need, 2) prior attitude and experience, 3) projected image, 4) availability, and 5) cost/benefit ratio. The author presents a model of psychiatric consultation, with similarities between research and development, manufacturing and merchandising phases on the one hand, and negotiation, investigation, and implementation phases on the other.


Disodium cromoglycate and food allergy. The effect of oral and inhaled disodium cromoglycate in a food allergic patient. In a food allergic patient challenge evoked a dual asthmatic response. These reactions could be partly or completely blocked by pretreatment with disodium cromoglycate (Intal, Lomudal) orally, depending on the doses given. Pretreatment with inhalations of disodium cromoglycate gave no protection.


Repair of thelateral ligaments of the ankle. A brief review of the literature has been accomplished. A report is given on 32 ankles in 31 patients who had reconstruction of their lateral ligaments. The operative technique is described. A criteria for selection of patients is given.


The organization of area 18 in the monkey. A Golgi study. The organization of area 18 in monkey has been studied in Golgi preparations. In layer III large pyramidal cells with profusely ramified basal dendritic arbors are identified. They probably represent one of the major components originating association connections. Layer II and the upper part of layer III contain cells with spine-free dendrites having axons forming long bundles descending vertically to layers IV and V. Layer IV is characterized by the presence of granular cells with local axons and small pyramidal cells with ascending recurrent axons. Layer V contains various types of pyramidal cells including giant pyramidal neurons. The mean number and distribution of dendritic spines along apical shafts were computed in four varieties of pyramidal cells. Several neuronal parameters pertaining to the length of axons and dendrites were calculated. Three-dimensional aspects of cells were analyzed by means of a computer program which permits neurons to be displayed as perspective views from various positions. Attempts were made to correlate the present description with previous observations on this and other cortical visual areas.


A quantitative approach to cytoarchiterctonics. II. The allocortex of Tupaia belangeri. Fourteen allocortical areas of Tupaia belangeri are described after measuring the grey level index (Zilles et al., 1978b) with a new, automatic, high resolution measuring procedure. The laminar pattern of the cortical areas is quantitatively described after vertical changes in this index occurred from the pial surface to the white matter. The registered profiles show characteristic features for the different allocortical brain regions. The results are compared with lamination systems gained by comparative cytoarchitectonic studies using purely qualitative criteria.


New approaches in the therapy of the peripheral vascular ulcer. It can readily be seen that Debrisan represents a more effective mode of therapy for several groups of patients which tend to have chronic disabling ulcers of limbs of various etiologies, including venous stasis ulcers, chronic sickle-cell ulcers, decubiti, etc. The more effective treatment of this patient populations, which is provided by Debrisan, would provide a very significant decrease in the total cost of health care in the United States, approximating half a billion dollars per year.


Reverse arterial blood flow as a pathway for central nervous system toxic responses following injection of local anesthetics. In baboons, lidocaine HCl was injected into the lingual (3 mg/kg), brachial (7 mg/kg), or femoral (7 mg/kg) arteries. Blood samples were taken from the internal carotid artery (ICA), internal jugular (IJV), external jugular (EJV), brachial (BV), or femoral (FV) vein, depending on the injection site, 6, 30, and 180 seconds after injection. Subsequently, radioactive microspheres (20 micron in diameter) were injected into the lingual artery, and the brains were obtained 48 hours later at postmortem to locate the microspheres. Six seconds after injection into the lingual artery, lidocaine concentration in ICA was 28 microgram/ml, whereas peak levels in IJV and EJV occurred at 30 seconds, being 51 and 25.7 microgram/ml, respectively. After injection into the brachial artery, peak average ICA levels were 105.5 microgram/ml at 6 seconds, while only 20.6 microgram/ml concentration was noted in ICA after injection into the femoral artery. Seventy-four precent of the Sr90 labeled microspheres were found lodged in the ipsilateral cerebral hemisphere. Local anesthetic drugs accidentally injected into arteries may reach the cerebral circulation following a centripetal pathway and thus produce central nervous system toxic responses.


Characterization of antigens from Aspergillus fumigatus. I. Preparation of antigens from organisms grown in completely synthetic medium. Aspergillus fumigatus was found to grow well in completely synthetic asparagine glycerol medium. Four-day-old mycelia were totally disrupted by vigorous mechanical shaking with 0.45-micrometer glass beads. Such mechanically produced extracts contained at least 52 precipitating antigens. The number of protein and carbohydrate components was maximal in 4-day-old organisms and decreased in older cultures. Conversely, the number of components in culture filtrates increased with longer incubation periods, but was only approximately one-half that produced by the 4-day-old mycelial extracts.


Characterization of antigens from Aspergillus fumigatus. II. Fractionation and electrophoretic, immunologic, and biologic activity. Mycelial extracts of Aspergillus fumigatus grown in completely synthetic medium were fractionated by precipitation with ammonium sulfate, by ion-exchange chromatography, and by gel filtration. The fractions were characterized chemically, by analytic polyacrylamide gel electrophoresis, and by tests for serologic and biologic activity. The distribution of the antigens in the fractions was determined by double diffusion in gel and fused-rocket immunoelectrophoresis. Activity greater than that of the parent mycelial extract serologically, in guinea pig skin tests, and in in vitro lymphocyte transformation was observed with one fraction that was found in the 75 per cent ammonium sulfate precipitable portion and was eluted early by gel filtration. Another ammonium sulfate-precipitable component and one that was not precipitable at 75 per cent ammonium sulfate, but was firmly bound by ion-exchange columns, was found to have activity equal to unfractionated mycelial extract. These fractions were also active by a radioallergosorbent test for IgE. A carbohydrate component comprising almost 40 per cent of mycelial extract was found to be devoid of any immunologic activity.


Possible mechanisms of emphysema in smokers. In vitro suppression of serum elastase-inhibitory capacity by fresh cigarette smoke and its prevention by antioxidants. Freshly prepared, aqueous solutions of cigarette smoke suppressed the elastase-inhibitory capacity of human serum. Immunoelectrophoresis of mixtures of aqueous smoke solution, human serum, and pancreatic elastase showed decreased elastase/alpha1-proteinase inhibitor complexes and increased free, active protease. Phenolic antioxidants prevented the suppression of serum elastase-inhibition by cigarette smoke. By contrast, treatment of serum with model oxidants caused a similar suppression of elastase inhibition. These results suggested that emphysema in cigarette smokers might be due, in part, to the local suppression of alpha1-proteinase inhibitor in lung by oxidizing agents present in cigarette smoke.


Mucociliary transport in allergic patients with antigen-induced bronchospasm. Tracheal mucous velocity (TMV) and respiratory mechanics were measured in asymptomatic asthmatic patients with ragweed hypersensitivity before and after inhalation of specific antigen, and with or without cromolyn sodium pretreatment. TMV was measured radiographically, and the airway response to bronchial provocation was monitored by measurements of forced expiratory volume in one sec and specific airway conductance. TMV was significantly less (6.3 +/- 2.3 mm per min, mean +/- SD) in the 6 asymptomatic asthmatic patients than in 7 normal subjects (11.6 +/- 3.6 mm per min, mean +/- SD). In the asthmatic patients, mean TMV diminished to 72 per cent of baseline immediately after bronchial provocation when specific airway conductance was decreased to 65 per cent of baseline or less, with a further decrease in TMV to 47 per cent of baseline after one hour, at which time respiratory mechanics had returned to baseline values. Pretreatment with cromolyn sodium prevented the decrease in TMV after bronchial provocation. We concluded that in asymptomatic patients with allergic asthma, (1) baseline TMV is impaired, (2) inhalation of specific antigen causes a marked decrease in TMV independent of the degree of bronchospasm, and (3) the decrease in TMV may be related to the release of chemical mediators.


Primary antituberculous drug resistance in Hawaii, 1957 to 1977. A study of primary antituberculous drug resistance in Hawaii was conducted from 1957 to 1977 to determine the incidence of primary resistance with respect to time. A total of 1,869 initial cultures of Mycobacterium tuberculosis submitted to Leahi Hospital in Honolulu were screened to identify drug resistance. Of 256 patients who excreted resistant bacilli, only 55 had no history of previous antituberculous chemotherapy. The frequencies of primary drug resistance from July 1957 to July 1977 were as follows: streptomycin, 0.86 per cent; isoniazid, 1.2 per cent; para-aminosalicylic acid, 1.5 per cent. No strains were resistant to ethambutol or rifampin. A slight decrease in the incidence of drug resistance during a 20-year period was observed. This was especially significant because Hawaii's tuberculosis problem is principally confined to its foreighn-born population. Although no serious primary drug resistance problem was discovered, Hawaii possesses both the highest immigration rate and the highest incidence of tuberculosis in the United states. Therefore, there is a need for continued periodic monitoring of drug resistance in Hawaii.


Preoperative parenteral feeding in Crohn's disease: preoperatively, to induce remission, and at home. Extended courses of preoperative parenteral nutrition were used in eight cases of complicated Crohn's disease. Impressive gains in weight and strength were demonstrated, as well as radiologic improvement in the diseased bowel. It is recommended that preoperative parenteral feeding be carried out for a minimum of 20-30 days, in order that full nutritional benefits be realized, as well as the resolution of inflammatory changes in the bowel and supporting structures.


Aerosol therapy of influenza infections of mice and primates with rimantadine, ribavirin, and related compounds. Ribavirin administered as small-article aerosols had significant therapeutic effect in the treatment of viral respiratory infections induced by influenza virus. The preliminary experiment using ribavirin to treat influenza infection in the squirrel monkey is encouraging. We expect to extend these experiments by initiating therapy at a later time to investigate the potential value of ribavirin in a clinical situation. Several derivatives of ribavirin are effective antiviral compounds. The tri-O-acetyl derivative appears to offer a potential advantage over ribavirin, although this cannot be stated with certainty since the data were obtained from separate experiments. Radiolabeling has been used as a means of measuring tissue concentration and clearance rates of various drugs. It is hoped that the use of labeled ribavirin and the tri-O-acetyl derivative will assist us in determining whether a depot of antiviral drug is created in pulmonary tissues after administration as a small-particle aerosol. These experiments are now in progress.


Interaction of chemical pollutants and virus in a crustacean: a novel bioassay system. A large group of shrimp, 23.3% of which had light patent Baculovirus infections, was divided equally into two groups. One group was exposed to the chemical stressor Aroclor 1254 (a polychlorinated biphenyl) at 0.7 ppb  for 35 days in flowing seawater. The other group was maintained as a control group in flowing seawater. Viral prevalence in exposed shrimp samples increased with  time at a significantly greater rate than did viral frequency in control shrimp. Viral prevalence in Aroclor-exposed shrimp survivors was 75% after 35 days, whereas in control shrimp, only 45.7% had patent viral infections. This finding suggests an interaction among chemical stressor (Aroclor 1254), host, and virus. The nature or mechanism of this interaction has not been defined, but the shrimp-virus system shows, promise for future bioassays of influence of low concentrations of pollutants on natural pathogenhost interactions.


An assessment of hemispheric specialization in monkeys. Split-brain monkeys learned several sets of visual discriminations with each hemisphere. Some stimuli, such as photographs of monkey's faces, were intended to favor mechanisms similar to those of man's nondominant hemisphere, while other tasks, requiring sequential comparison of visual stimuli, should favor mechanisms similar to ones in the dominant hemisphere of man. The tests uniformly demonstrated hemispheric equivalence for solving all types of problems, regardless of handedness, sex, or side of surgical retraction. A review of the literature also offers little support for the concept of hemispheric specialization in infra-human mammals although a few leads still need to be explored before abandoning the hope of finding the roots of human cerebral dominance in monkeys.


Sensory discriminability comparisons in human and monkey with implications for the study of central nervous correlates. Psychophysical measurements of sensory discriminability were obtained from rhesus monkeys and humans to suprathreshold electrical cutaneous stimulation by employing a two-choice discrimination task and a signal detection theoretical analysis. Sensory discriminatory capacities were found to be similar for monkeys and humans. Choice-latency data permitted the construction of relative operating characteristic (ROC) functions for both groups. These functions provided similar descriptions of the hypothetical sensory process underlying the discrimination performance of both species. Theoretical predictions were made concerning characteristics of the underlying sensory activity and tested by a joint analysis of behavior and somatosensory evoked potentials obtained from monkeys. Results indicated that the magnitude of an average evoked component with peaks at 40 and 70 msec in one monkey, and 60 and 100 msec in the other, correlated well with behavioral choices and choice latencies. The evidence obtained in these studies was discussed in the context of neural coding of sensation in humans and monkeys.


The role of early left-brain injury in determining lateralization of cerebral speech functions. Preparatory to craniotomy for the relief of medically refractory focal epilepsy, the lateralization of cerebral speech functions was determined by the Wada intracarotid Amytal test in 134 patients with clinical and radiologic evidence of an early left-hemisphere lesion. Their results were compared with those for 262 patients (140 right-handed, 122 left-handed), who were tested in a similar way. One-third of the patients with early lesions were still right-handed, and 81% of these right-handers were left-hemisphere dominant for speech. In the non-right-handers, speech was represented in the left cerebral hemisphere in nearly a third of the group, in the right hemisphere in half the group, and bilaterally in the remainder. Bilateral speech representation was demonstrated in 15% of the non-right-handers without early left-brain injury and in 19% of those with evidence of such early injury, whereas it was extremely rare in the right-handed groups. In addition, nearly half the patients with bilateral speech representation exhibited a complete or partial dissociation between errors of naming and errors in the repetition of verbal sequences after Amytal injection into left or right hemispheres. This points to the possibility of a functionally asymmetric participation of the two hemispheres in the language processes of some normal left-handers. The results of the Amytal speech tests in this series of patients point to locus of lesion as one of the critical determinants in the lateralization of cerebral speech processes after early left-brain injury. It is argued that in such cases the continuing dominance of the left hemisphere for speech in largely contingent upon the integrity of the frontal and parietal speech zones.


[Hydrolyzed lactose contained in the ultrafiltrate of milk or milk products in an enzymatic membrane reactor]. Milk and milk by-products with a low lactose content, very interesting from a nutritional and technological point of view, were obtained by the application of the enzymatic membrane reactor technique. A previous separation of the aqueous phase of milk or ultrafiltrate was necessary and realized by ultrafiltration. The enzyme, a commercial beta-galactosidase, was maintained in solution in the retentate part of the membrane reactor. The optimal conditions of the lactose hydrolysis in milk and whey ultrafiltrates were determined. The behaviour of the aqueous phase of milk in membrane reactor, specially of mineral salts, was studied. Three possibilities were proposed to avoid a calcium-phosphate deposit on the surface of (and in) the reactor membranes: a precipitation of calcium salts by heating, a partial demineralization by electrodialysis or ion exchange, a calcium complexation by addition of sodium citrate. A continuous process for the lactose hydrolysis of milk and demineralized whey or milk ultrafiltrate was proposed. The organoleptic quality of low lactose milk, before and after heat treatment, was evaluated by a tasting panel. High sweeting syrup, were obtained by concentration of lactose hydrolyzed and demineralized ultrafiltrates. Nutritional aspects of these products are discussed specially from the toxicological point of view of galactose.


[Immunodiffusion and immunoelectrophoretic techniques applied to psoriasis (author's transl)]. Serum and scales of skin obtained from normal and psoriatic subjects are tested and estimated by immune diffusion and immune electrophoresis technics. The authors relate technics to produce rabbit's antibodies towards psoriatic serums and extracts of skin. Results coroborate the quantitative modifications of immunoglobulins and show in addition the presence of multiple precipitations lines in the alpha and gamma regions. Lastly, in psoriatic scales a globulin is found, which is not present in normal scales or normal serums.


Antimalarial activities of various 9-phenanthrenemethanols with special attention to WR-122,455 and WR-171,669. Pilot appraisals of the activities of 16 specially selected 9-phenanthrenemethanols against acute infections with Plasmodium falciparum in owl monkeys showed that all were more active than the reference compound, WR-33,063. WR-122,455, the most active derivative, and WR-171,669, ranked sixth, were selected for study in human volunteers. To assist this undertaking, appraisals of both compounds in owl monkeys infected with various strains of P. falciparum were expanded. These assessments showed: (i) that WR-122,455 was four times as active as chloroquine against infections with chloroquine-sensitive strains and that WR-171,669 equalled chloroquine in activity; (ii) that these compounds were fully active against infections with strains resistant to chloroquine, pyrimethamine, or quinine, or to all three standard drugs; (iii) that the activity of WR-122,455 was a function of total dose, single doses being as effective as the same amounts delivered in three or seven daily fractions; and (iv) that a single dose of WR-122,455 conferred extended, although only partial, protection against challenges with trophozoites. Complementary experiments in rhesus monkeys inoculated with sporozoites of P. cynomolgi showed that the activity of WR-122,455 was limited to blood schizonts and did not extend to early or late tissue schizonts. These evaluations were compatible with the results of preliminary studies of the activities of WR-122,455 and WR-171,669 in human volunteers.


beta-lactamase stability of HR 756, a novel cephalosporin, compared to that of cefuroxime and cefoxitin. The stability to beta-lactamase hydrolysis of HR 756, a new cephalosporin antibiotic, was compared to the beta-lactamase stability of cefoxitin and cefuroxime. HR 756, cefoxitin, and cefuroxime were not hydrolyzed by Richmond type I, III, IV, and V beta-lactamases. Antibacterial activity of HR 756 correlated well with resistance to beta-lactamase hydrolysis except against Pseudomonas aeruginosa. HR 756, cefoxitin, and cefuroxime inhibited type I beta-lactamases, but not type III, IV, or V enzymes. HR 756 was the most active inhibitor.


Patient variables associated with penicillin resistance in Neisseria gonorrhoeae. In an ongoing cooperative study of uncomplicated genital gonorrhea within the United States, 6,735 pretreatment gonococcal isolates were tested for their in vitro resistance to penicillin. By using a regression analysis technique, we examined 99 patient-associated variables which might be associated with penicillin resistance of the isolates. Patients were most likely to have relatively resistant isolates if they were black, had used antimicrobial agents within 2 weeks of treatment for gonorrhea, or were men with symptomatic urethritis.


Effect of different lots of Mueller-Hinton agar on the interpretation of the gentamicin susceptibility of Pseudomonas aeruginosa. Population distributions and quality control data for strains of Pseudomonas aeruginosa tested for gentamicin susceptibility on six lots of Mueller-Hinton agar were analyzed. The lots of agar were used in three University of Washington hospitals from April 1975 through October 1977. The analyses indicated that the performance of members of the P. aeruginosa populations in each hospital closely followed the performance of the quality control strain, P. aeruginosa ATCC 27853, when tested on each lot of Mueller-Hinton medium. The variability of zone diameters with the P. aeruginosa populations and the quality control strain indicated that a fixed indeterminate range (13 to 16 mm) of gentamicin susceptibility was not applicable to these organisms as it was with the Enterobacteriaceae. Variability in gentamicin susceptibility results was demonstrated in both minimal inhibitory concentration and disk diffusion tests when eight selected P. aeruginosa strains and the quality control strain were tested on each lot of medium. This variation in susceptibility to gentamicin was not related to the total Ca(2+), Mg(2+), or Zn(2+) content of each lot of medium. The data demonstrated that a moving indeterminate range of gentamicin susceptibility, 3 to 6 mm below the mean zone diameter of the quality control strain, was a suitable criterion for strains tested on a single medium lot. These results illustrate the importance of defining stringent performance standards for media used in the susceptibility testing of P. aeruginosa with gentamicin and other aminoglycoside antibiotics.


In vitro activity of 5-episisomicin in bacteria resistant to other aminoglycoside antibiotics. Eighty-seven isolates of Pseudomonas, Enterobacteriaceae, and Staphylococcus, chosen because of their resistance to other aminoglycosides, were tested for susceptibility to 5-episisomicin. Tests were performed in Mueller-Hinton agar and also, with 38 of these isolates, in Mueller-Hinton broth. Of Enterobacteriaceae, 85 and 95.5% were inhibited by 5 and 10 mug of 5-episisomicin per ml, respectively. Amikacin inhibited 74 and 91% of the strains at 10 and 20 mug/ml, respectively. Fifty-four percent of P. aeruginosa were inhibited by 5-episisomicin and amikacin. Eighty-three percent of S. aureus were inhibited by netilmicin and amikacin, whereas only 50% were inhibited by 5-episisomicin. Isolates resistant to 5-episisomicin were most often resistant to the other aminoglycosides and occurred in gram-negative bacilli that did not carry aminoglycoside-modifying enzymes. Five of 23 isolates that carried a 6'-N-acetyltransferase (AAC-6') and one of two that carried an aminoglycoside 3-acetyltransferase were resistant to and acetylate 5-episisomicin. Strains carrying other aminoglycoside-modifying enzymes were inhibited by 5-episisomicin. Thus, 5-episisomicin is a promising aminoglycoside not attacked by most aminoglycoside-modifying enzymes. Resistance will probably most often be based upon nonenzymatic mechanisms which will also affect other aminoglycosides.


Antimalarial activities of various 4-pyridinemethanols with special attention to WR-172,435 and WR-180,409. Pilot appraisals of the activities of 10 specially selected 2,6-substituted-4-pyridinemethanols against acute Plasmodium falciparum infections in owl monkeys identified three derivatives that were two to three times as active as chloroquine against infections with a 4-aminoquinoline-susceptible strain and, at the same doses, were equally effective against infections with a strain fully resistant to treatment with maximally tolerated doses of chloroquine, quinine, and pyrimethamine. Two of these derivatives, WR-172,435 and WR-180,409, deemed worthy of evaluation in human volunteers, were studied in greater depth in owl monkeys infected with either the multidrug-resistant Smith strain of P. falciparum or the pyrimethamine-resistant Palo Alto strain of P. vivax. These studies showed (i) that at the same total oral dose, 3-day and 7-day treatment schedules were equally effective and slightly superior to a single-dose schedule; (ii) that WR-172,435 was slightly more active than WR-180,409 in each treatment regimen; (iii) that intravenous delivery of WR-180,409 phosphate was feasible and effective; (iv) that both compounds effected control of parasitemia more rapidly than any standard or newly discovered antimalarial drug; and (v) that WR-172,435 and WR-180,409 had therapeutic indexes at least four to eight times those exhibited by chloroquine in infections with 4-aminoquinoline-susceptible strains, indexes retained by these pyridinemethanols against infections with various drug-resistant strains.


Surface immunoglobulin in immunoproliferative diseases. Malignant B cells may originate from any of the stages of differentiation of B cells, primarily from IgM bearing B cells. The malignant B cells maintain a limited potential for differentiation. In addition to surface immunoglobulins, various markers may be present on the B cell surface; when surface Ig cannot be identified, these markers are used to identify B cells. However, for practical purposes, the detection of surface Ig is most important in the identification of B cells in immunoproliferative diseases, particularly when the malignant cell population displays only one immunoglobulin light chain. The procedures used so far to detect surface Ig have several drawbacks regarding their sensitivity or their specificity. The advantages of new procedures which involve the identification of B cells by their natural binding of B. melitensis or the detection of surface Ig by antibody-coated E. coli are presented. Detection of changes in the percentage of B lymphocytes and in the ratio of kappa- to gamma-bearing B cells in blood smears or in lymphocyte suspensions may be helpful in the early diagnosis of immunoproliferative diseases.


Analysis of the interactions between piperacillin, ticarcillin, or carbenicillin and aminoglycoside antibiotics. Enhanced activity against clinical isolates of Pseudomonas aeruginosa was demonstrated with piperacillin, ticarcillin, and carbenicillin in combination with gentamicin, tobramycin, and amikacin.


Proposed ticarcillin disk control values for Escherichia coli and Pseudomonas aeruginosa: multicenter cooperative study. In a multicenter cooperative controlled study, individual test, accuracy, and precision control values were determined for 75-mug ticarcillin disks with Escherichia coli ATCC 25922 and Pseudomonas aeruginosa ATCC 27853.


In vitro comparison of kanamycin, kanendomycin, gentamicin, amikacin, sisomicin, and dibekacin against 200 strains of Pseudomonas aeruginosa. The antimicrobial activity of kanamycin, kanendomycin, gentamicin, amikacin, sisomicin, and dibekacin against 200 strains of Pseudomonas aeruginosa was compared. Dibekacin was found to be the most active against the tested organisms, whereas the other aminoglycoside antibiotics fell in the following order of diminishing antibacterial potency: amikacin, sisomicin, gentamicin, kanendomycin, and kanamycin. Seven strains showed high-level resistance to gentamicin (minimal inhibitory concentration, 400 mug/ml), and two of them were also resistant to amikacin and sisomicin (minimal inhibitory concentration, 75 mug/ml). The minimal inhibitory concentration of dibekacin for these seven strains was 0.625 mug/ml.


Microbial catabolism of vanillate: decarboxylation to guaiacol. A novel catabolic transformation of vanillic acid (4-hydroxy-3-methoxybenzoic acid) by microorganisms is reported. Several strains of Bacillus megaterium and a strain of Streptomyces are shown to convert vanillate to guaiacol (o-methoxyphenol) and CO2 by nonoxidative decarboxylation. Use of a modified most-probable-number procedure shows that numerous soils contain countable numbers (10(1) to 10(2) organisms per g of dry soil) of aerobic sporeformers able to convert vanillate to guaiacol. Conversion of vanillate to guaiacol by the microfloras of most-probable-number replicates was used as the criterion for scoring replicates positive or negative. Guaiacol was detected by thin-layer chromatography. These results indicate that the classic separations of catabolic pathways leading to specific ring-fashion substrates such as protocatechuate and catechol are often interconnectable by single enzymatic transformations, usually a decarboxylation.


Effect of hydrostatic tensile stress on the growth of Escherichia coli and Bacillus cereus. The specific growth rates of Escherichia coli and Bacillus cereus were measured for growth media in a flask, a lens-plate arrangement simulating an isolated capillary space, and a lens-plate arrangement under hydrostatic tensile stress. The specific growth rates of the bacteria were the same for the flask and lens-plate arrangement without hydrostatic tensile stress, but were enhanced when the growth media were subjected to hydrostatic tensile stress. The enhanced specific growth rates reached steady values at a tensile stress of 40 pascals. The effect was observed up to tensile stresses of around 100 pascals. The maximum increase in specific growth rate was 25% for E. coli and 22% for B. cereus.


Evaluation of electrode configurations in cerebellar implants. Capacitively coupled currents of 100 Hz, 0.25 msec duration, were applied to multielectrode arrays implanted upon the superior and posterior surfaces of the chimpanzee cerebellum. The current required for 90% reduction in the amplitude of the evoked potential was inversely proportional to the number of electrodes upon the cerebellar surface. A study of various waveforms showed that z Hz, 0.25 msec pulse duration is near optimal for reduction of amplitude of the somatosensory evoked potential. The current densities per electrode were 5--11 mA/cm2 with a charge per pulse of 0.04--0.08 muC in humans with 15--20 electrodes on each superior surface and 10 electrodes on each posterior cerebellar surface.


Physiological and histological effects of cerebellar stimulation. Cerebellar implants have been placed in 62 patients with postoperative follow-up of 4 months to 3 years. Initially currents were applied through electrodes of alternate polarity on the superior surface of the cerebellar hemispheres and subsequently through negative electrodes on the superior surface to positive electrodes on the posterior surface. The amount of current required for clinical improvement was approximately the same as that required to significantly reduce the amplitude of the somatosensory evoked potential. The clinical and electrophysiological effects were proportional to the intensity of current and to the number of electrodes through which the currents were applied. Currents applied through the cerebellum were more effective than those confined near the cerebellar surface. Histological examination of the cerebellum from the chimpanzees and from 1 patient who died of causes unrelated to stimulation failed to demonstrate any evidence of neuronal damage related to application of current.


Instrumentation, working hypotheses, and clinical aspects of neurostimulation. The paper describes instrumentation developed in our laboratory for the therapy of neurological disorders, including (a) hybrid stimulator for chronic use which retains constant current characteristics, providing a low resistance path during the quiescent phase between pulses to minimize the postpulse charge; (b) brain radio stimulators, crystal controlled, with digital logic section and an optoelectric sensor for telemetry of the intensity used; (c) external stimoceiver for experimental and clinical use, combining multichannel stimulator and EEG telemetric instrument; (d) transdermal stimoceivers, totally implantable for two-way communication with the brain through the intact skin; and (e) implantable microprocessor for detection of EEG signals which are used to trigger contingent brain stimulation. Our working hypotheses for chronic brain stimulation include (a) electrical modification of the functional set point of specific cerebral areas; (b) feedback-controlled stimulation; and (c) establishment of artificial neuronal links with the aide of the computer. The paper concludes with a discussion of the indications for therapeutic use of brain stimulation and criteria for patient selection.


Reverse triiodothyronine, thyroid hormone, and thyrotrophin concentrations in placental cord blood. Reverse triiodothyronine (rT3), triiodothyronine (T3), thyroxine (T4), thyroxine binding globulin (TBG), and thyrotrophin (TSH) were measured in sera from placental cord blood in an unselected series of 272 deliveries. In this series the concentrations of rT3 (mean 3.33 nmol/l, 95% confidence limits 1.6--7.0 nmol/l), were log normally distributed and did not overlap the adult normal range (0.11--0.44 nmol/l). There were no correlations between the cord blood concentrations of rT3, T3, T4, and TSH. The cord serum rT3 concentration was not influenced by maturity, birth-weight, or neonatal risk factors, whereas these factors did affect the concentrations of T3, T4, AND  TBG. There is no arteriovenous rT3 concentration difference across the placenta, therefore the cord rT3 reflects the systemic rT3 concentration in the baby at birth. As rT3 in the neonate largely, if not entirely, derives from thyroxine from the fetal thyroid, measurement of the cord rT3 concentration may be a good immediate screening test for neonatal hypothyroidism.


Gastric antisecretory effects of propantheline bromide and metiamide in rhesus monkeys. The effects of propantheline bromide (PB) and metiamide (M), two dissimilar classes of gastric secretory inhibitors, were studied in chronic gastric fistula rhesus monkeys. Basal and stimulated gastric secretory studies were conducted in conscious monkeys. Multiple s.c. injections of either histamine or pentagastrin were given hourly for four consecutive hours. One hour after the injection of the stimulants a constant plateau of gastric secretion was reached, and the test compounds were then administered as a single i.v. bolus dose. Propantheline bromide at doses of 0.03--0.3 mg/kg inhibited basal and pentagastrin stimulated gastric secretion, but had no effect on histamine stimulation. Total acid output paralleled inhibition of volume of secretion, while there was little or no effect on acid concentration. Metiamide at the doses of 1--10 mg/kg inhibited basal, pentagastrin and histamine stimulated gastric secretion. Metiamide was equally effective in inhibiting the volume of secretion and acid concentration. The scope of the gastric secretory inhibition in the rhesus monkey achieved with these pharmacological agents is very similar to man. These results suggest that the rhesus monkey is an important animal model for predicting clinically useful gastric secretory inhibitors.


Studies on the effect of tolbutamide, glibenclamide, HB 699, and glucose on serum insulin and blood glucose in gastro-enterectomized dogs. The influence of intravenously administered tolbutamide, glibenclamide, HB 699, and glucose on serum insulin and blood glucose kinetics was examined in 36 enterectomized dogs. The substances induced an immediate and long-lasting insulin release even in the absence of all insulinotropic intestinal mediators. Maximum and mean insulin concentrations after treatment, measured for 180 minutes, were markedly higher in resected dogs than in sham operated or non-operated animals. The data suggest that intestinal mediators might be of no importance in vivo for the insulin-releasing activity of the compounds examined, at least in dogs.


Exposure to dust-borne bacteria in agriculture. II. Immunological survey. In order to investigate whether high exposure to Erwinia herbicola causes sensitization in grain handlers, immunological tests (agargel precipitation, complement fixation, passive cutaneous anaphylaxis, and intradermal) with the extracts of these bacteria were performed in different groups of grain workers and in other groups of population. Tests with extracts of grain dust and other microorganisms were also performed. Grain workers showed in all the tests high incidence of positive reactions to E. herbicola, being significantly higher, as compared with unexposed subjects. Different actinomycetal and fungal extracts gave lower percentages of positive reactions. Skin reactions to E. herbicola were significantly correlated with the reactions to grain dust and showed a close relationship with the degree of exposure. The grain workers with respiratory symptoms reacted more frequently to E. herbicola than asymptomatic ones, both in intradermal and precipitation tests. Thus, these bacteria should be considered as a factor increasing risk of the respiratory disorders among grain handlers.


[Immunology of Chagas' disease].

[Immunology of Chagas' disease]. American trypanosoniasis or Chagas' Disease is a serious health problem in Latin America. Schizotrypanum (Trypanosome) cruzi infection produce an inmune response, cellular and humoral well identified in all mammals so far studied, including man. The initial parasistemic disease is brought promptly under control, maybe as result of such inmune response. Chronical disease result of individual responses, through inmune aberration as main pathogenic factor. There is not, and there is no probability to develop it in a short time, suitable inmunoprophylaxis for Chagas' disease.


[Valve replacement and aorto-coronary bypass]. Combined surgery on the valves and on the coronary arteries by bypass grafts has been carried out on 27 consecutive patients (1970 to 1976) and involved 18 aortic valve replacements, 8 mitral valve replacements, and one double mitro-aortic replacement; the mean duration of extra-corporeal circulation (145 mn) was significantly higher than that for valve replacements alone carried out during the same period (p less than 0.01). The five deaths occurring in hospital (18.5%) all occurred in the aortic valve group, and were amongst the first 15 cases operated on (1970 to 1974). The 4 post-mortem studies carried out showed similar findings, namely myocardial infarction and significant coronary lesions which had not been bypassed. Two secondary deaths due to infective complications occurred in the first six months. The 17 patients who were followed up after surgery and had a mean follow-up period of 24 months, were all substantially improved by comparison with their pre-operative state, despite certain complications affecting either the valves (1 requiring re-operation) or the coronary arteries (3 infarcts). The indications for coronary arteriography, which are related to the indications for surgery, are being enlarged so that they will include the majority of patients operated on excluding those of more than 65 to 70 years of age and also those aged less than 40 years who have no risk factors for atherosclerosis and no clinical or electrocardiographic signs suggesting a coronary lesion. A study of the operative risk factors has shown the importance of unsuspected coronary lesions, and would appear to indicate correction of all valvular and coronary lesions seen at the time of operation.


[Chagas' disease in Mexico. Report of 5 proven cases]. Seroepidemiologic studies demonstrated that American Trypanosomiasis is highly prevalent among rural communities in Mexico. However, Chagas' disease seems to be a rarity. That could be a wrong concept. In just a few months 5 patients with epidemiological, clinical and immunologic evidence for Chagasic miocardiopathy or miocarditis were identified in our Institution. Their cardiologic findings have been discussed, as well as diagnostic approaches in different stages of the disease.


[Electrocardiography of delayed potentials in post-excitation syndrome]. Electrophysiological investigation and pericardial mapping have succeeded in isolating a particular type of ventricular tachycardia occurring in young subjects with no coronary artery disease who have dysplasia of the right ventricle. When these patients are no longer controlled by medical treatment, they may benefit from surgery. This condition is characterised by the presence of delayed potentials which appear after the end of ventricular depolarisation as recorded by épicardial mapping. This post-excitation phenomenom may also be demonstrated either by an intracavitary electrode or sometimes on an amplified ECG. This study describes a new method using the techniques of signal averaging and summation technique to demonstrate the delayed potential in the post-excitation syndrome. It is non-invasive, and seems to give better results than those obtained from intracavitary exploration.


[Anterior and posterior myocardial infarct: clinical comparative study on its outcome]. A comparison of the short and long term outcome in two groups of patients admitted to hospital during the acute phase of their first myocardial infarction, an anterior group (123 cases) and a posterior group (147 cases) has produced the following results:--an immediate mortality which was significantly higher (identical cause of death) in the anterior infarct group (22.8%) than in the posterior infarct group (11.6%): p less than 0.02;--a very similar long term mortality (5 to 6% per year) in the two groups (the main causes for which cannot be equated) despite the fact that the initial destruction of muscle was usually greater when the infarct had been anterior. These results seem to lead to the following conclusion: a better overall prognosis seems to be related to efforts to limit the extent of an infarct, especially when it is anteriorly situated; sometime after the infarct, it is also linked to the improvement in vascularity of the regions which are not involved, especially in cases of posterior necrosis.


[Criteria of prognosis in apparently primary hypokinetic myocardiopathies (prospective study of 60 cases)]. The fate of 60 cases of apparently primary cardiomyopathy were studied by angiocardiography and coronary arteriography over a 2 to 6 year period, with a mean of 4 years. Correlations were established between the clinical, paraclinical, haemodynamic and angiocardiographic findings on the one hand, and the quality and length of survival on the other. Among the criteria leading to an improved prognosis, the most precise was the left ventricular ejection fraction.


[Myocardial perfusion in myocardiopathies: study at rest and during induced tachycardia]. The authors have compared myocardial perfusion, i.e. the coronary blood flow per unit of myocardial mass, in 9 patients with cardiomyopathy and 5 normal subjects, both at rest and during coronary sinus pacing-induced tachycardia at a rate of 150 beats/mn. In the cardiomyopathies, myocardial perfusion was found to be decreased at rest, and to remain abnormally low during induced tachycardia despite the evidence for a significant coronary reserve. During pacing there were, in addition to induced chest pain, indirect signs of sub-endocardial ischaemia which could explain the angina of effort found in certain cardiomyopathies, especially those of the obstructive hypertrophic type.


[Hemodynamic and coronary effects of atrial stimulation in normal subject and patients with coronary disease: correlation with coronary arteriography]. Thirty-two patients (group I: 7 normal subjects; group II: 25 coronary subjects) underwent coronary arteriography, and measurements were made both in normal rhythm and under atrial stimulation of the pulmonary capillary pressure and the pressure in the femoral artery, of cardiac output, of coronary sinus flow (by continuous thermodilution), of the coronary arterio-venous oxygen difference, of oxygen consumption, and in 28 of the patients of the coefficient of extraction of K lactates. During stimulation, the only differences to appear between the subjects of group I and group II were an increase in capillary pressure (p less than 0.01) and a decrease in the coefficient of extraction of lactates (p less than 0.001) in the coronary patients. Similar differences were found between coronary patients with a stenosis greater than 70% in the anterior descending or circumflex artery (group IIa) and those without it (group 11b), and between the patients with pain during atrial stimulation (n = 9) and those without it. There was a good correlation between a double score (IVA + circumflex artery, Rowe's method) and the coefficient of extraction of lactates during atrial stimulation (n = 28, p less than 0.01).


[Optimum flow of intravenous trinitrine during the acute stage of myocardial infarct with cardiac insufficiency: its effects on survival]. Twenty-one patients were treated during the acute stage of a myocardial infarction for failure of the left or right ventricle. The systematic use of varying rates of flow of intravenous trinitrin (between 0.6 and 4.8 mg/h) was designed to find out for each patient the optimal effect on the cardiac index. The fall in pulmonary capillary pressure, obtained within 10 to 15 minutes, is proportional to the flow rate of trinitrin, and reaches 48% of its original value at a perfusion rate of 4.8 mg/h. The lowering of systemic arterial pressure is also proportional to the flow rate, and reaches 13% at a flow of 4.8 mg/h. The cardiac index and systolic index were significantly improved at flow rates of 1.2 to 2.4 mg/h, and lowered the pulmonary capillary pressure to levels of 17.6 mm of mercury and 15.3 mm of mercury respectively. Trinitrin given intravenously is very well tolerated, but it often become less effective after 24 hours of treatment, which implies that haemodynamic measurements must be made several times a day, and the speed of infusion often increased. The improvement in immediate and late prognosis is discussed relative to the initial values and Weber's index of survival.


[Effects of intravenous trinitrine on myocardial function in left ventricular insufficiency]. The effects of intravenous trinitrin on myocardial function have been studied in 40 patients with heart failure (26 cases of coronary artery disease and 14 of apparently primary cardiomyopathy). Each patient had measurements made of left ventricular pressure, of cardiac output by the dye dilution method, of volume, of the left ventricular ejection fraction, and of the segmental parietal kinetics by means of left side ventriculography both before and after trinitrin. The following results were obtained after injection of trinitrin:--no change in rhythm and cardiac index;--an almost constant decrease in left ventricular end diastolic pressure (38 cases out of 40);--a decrease in arterial pressure and ventricular volume in about two thirds of cases;--improvement of the ejection fraction (25 cases out of 40), and of segmental parietal kinetics (26 cases out of 40) in the left ventricle. These findings were equally true in the patients with coronary artery disease and in the cardiomyopathies. In the light of these results, it appears that when used in left ventricular failure, trinitrin almost always decreases the load, but improves ventricular kinetics only in two thirds of cases, while it has no influence on cardiac output. In addition, given the difficulties in establishing a standard dose of trinitrin, the authors discuss the methods of establishing the optimal dose.


[Comparison of hemodynamic and coronary effects of 2 antianginal vasodilator drugs: nifedipine and trinitrine]. Twenty patients with coronary insufficiency had measurements taken while they were in normal rhythm (NR) and during atrial pacemaking (AP) before and after taking nifedipine (n: 12) or after intravenous perfusion of trinitrin (n: 8): measurements were taken of pulmonary capillary pressure (PCP), arterial femoral pressure (AFP), cardiac output (QC) and coronary sinus flow (QCS), coronary arterio-venous oxygen difference (DaVO2), myocardial oxygen consumption (MVO2) and the myocardial coefficient of extraction of lactates (K).--Under nifedipine in NR and AP, AFP was decreased and QC increased. QSC was increased in NR, but was not changed under AP. DaVO2 was shortened under both sets of conditions. MVO2 decreased only during AP. Nifedipine brought back to normal the lowering of K which occurred with pacemaking.--Under trinitrin, both in NR and under AP, AFP, PCP, QC, QSC and MVO2 were lowered. K and DaVO2 were unchanged.--A plethysmographic study in 13 patients showed that these haemodynamic effects could be explained by the arterial vasodilator action of nifedipine which occurred without changing the venous tone, and the mixed action of trinitrin.


[Incidence of hyperuricemia in atrioventricular block. Systematic study of 158 cases which required implantation of an isotopic cardiac pacemaker]. This is a study of 158 patients in whom the placement of an isotopic cardiac pacemaker was indicated; this procedure was carried out Broussais Hospital between 1970 and 1975. These patients, whose mean age was 39 (84 males, 47 females, 12 young men and 15 young women) were examined for uricaemia, and the levels compared with the mean for control population. The results were as follows: 91% had uricaemia at a level higher than the controls. Of these, 61% had uricaemia above 70 mg/l in the men and youths of over 15 years of age, and above 60 mg/l in the women and 50 mg/l in the adolescents. The highest uric acid levels were found in adults with post-operative atrio-ventricular block following surgical correction of a congenital cardiac abnormality, and also in children and adolescence with block which appeared to be congenital.


[The short PR syndrome: sino-atrial block with preservation of sino-nodal conduction]. From among the theories which have been advanced to explain the finding on ECG of a shorter than normal PR interval, in addition to the short circuit theory we should mention the explanation given by Condorelli before the first publication on the "short PR-normal QRS" syndrome appeared. While studying the mechanism of conduction of a stimulus in the atrial myocardium, he showed that a short PR may result from a conduction defect in the sino-atrial pathways, while sino-nodal conduction remains normal. In this report there is an example which supports the validity of Condorelli's hypothesis. It involves a female patient with mitral valve disease beginning to affect the tricuspid. Her rheumatic disease had just relapsed, and after this there was a long period of attacks of tachycardia with arrhythmia during the course of which the surface electrocardiogram showed a short PR and normal QRS. Electrophysiological investigations allowed us to interpret these findings in the light of Condorelli's hypothesis (sino-atrial block with normal sino-nodal conduction). This study suggests that it is useful to separate off those cases with a short PR and normal QRS to a clinical entity of their own, as this syndrome may have a different pathogenesis. Therefore, if there is no electrocardiographic evidence of an accessory pathway, far from indicating accelerated conduction, the short PR may be due to an isolated defect of conduction in the atrial myocardium, as Condorelli suggested. It is also correct that this author should be given credit for describing the first cases. To him also should go credit for first describing the short PR.


[Crenelation of Beall's prostheses in mitral position: apropos of 21 reoperated cases]. The authors report their experience of 21 revision operations for malfunction of the Beall Surgitool 104 prosthesis used in the mitral position. The incidence and uniformity of the disorders found in the prostheses suggest that these changes are produced inevitably usually during the fourth year. The disc becomes kinked, the mountings eroded, and the teflon ring torn. The clinical features are the onset of heart failure, anaemia, or a thrombo-embolic episode. These three findings may occur individually or in association. The authors do not advise systematic revision surgery, but conclude that close follow-up is essential in the case of all patients who have had a Beall prosthesis. Early signs of failure should be revealed by clinical examination, the level of LDH, and by phonocardiogram and echocardiogram studies. Leaving aside thrombo-embolic episodes and severe anaemia which themselves constitute indications for revision surgery, the decision to replace the damaged prosthesis should be taken as soon as the first signs of cardiac failure are detected.


[Total anomalous pulmonary venous return: apropos of an unusual case]. A case is reported in which the entire pulmonary venous return was abnormal, being retro-cardiac. Unusual features were the age at which the abnormality was discovered (14 years), and the anatomical type of abnormality of pulmonary venous return. The return effectively emptied into a posterior cavity which was "a diverticulum of the right atrium" which had a wide communication with the "normal" right atrium, which in turn communicated with the left atrium by a highly placed Ostium Secundum. The muscular septum which separated the highly placed auricle of the left atrium and the "diverticulum" was removed, and vertical partitioning allowed a right and left atrial cavity to be reconstituted. The post-operative progress was uneventful.


[Myxoma of the right ventricle in monozygotic twins: surgical ablation]. Monozygotic twins aged 23 underwent surgery, at an interval of 4 months from each other, for a myxomatous tumour of the right ventricle which had been completely asymptomatic until then. The authors present the clinical, electrocardiographic and angiographic findings, together with details of the operation and of the histological findings. They recall how rare a site this is, and summarise some of the observations which have been made on familial myxomas.


[Hypertensive cardiopathy: study of external tracings and noninvasive tests]. Hypertensive heart disease has been studied by means of the maximal exercise test, mechanographic techniques and echocardiography. The patients have been divided into three groups according to their electrocardiogram and the size of their heart as measured radiologically: I: normal ECG, normal size; II: ECG shows left atrial hypertrophy, heart of normal size; III: ECG shows left ventricular hypertrophy, heart is dilated. The total work on exercise decreases from group I to group III. The parameters of the pumping action (PEP/TEVG, VCF, FE) were identical in all three groups and were normal. The relationship A/H on the apexogram and the left ventricular mass/volume relationship on the echocardiogram increased from group I to group III. One possible interpretation of these findings suggests an alteration in diastolic compliance of the left ventricle in the early stages of hypertensive heart disease. The response to beta-blockers as measured on the echocardiogram also argue in favour of this theory.


[Arterial hypertension and maintenance hemodialysis: effects of specific inhibition of angiotensin II by saralasin acetate]. The "effective" contribution of angiotensin II in blood pressure regulation was investigated in 6 patients on maintenance hemodialysis who were hypertensive at the time of the study (MAP 133 +/- 5 mmHg). Saralasin, a specific angiotensin II inhibitor, was infused at 0.5 and 2.5 microgram/kg/mn three hours before andone hour after hemodialysis. Before hemodialysis, a mean arterial pressure decrease of 13.2 to 19 p. 100 was obtained in 5 patients, arterial pressure being normalized in three of them. After hemodialysis, saralasin induced a normalization of arterial pressure in these 5 subjects. One patient, who was resistant to the saralasin infusion before and after the hemodialysis procedure, can be considered as purely volume-dependent. The renin-angiotensin system is probably one of the primary determinant of dialysis-resistant hypertension. However, a negative response to saralasin should encourage to control hypertension by more vigorous ultrafiltration during dialysis.


[Arterial hypertension and mortality due to cardiovascular complications in patients on chronic hemodialysis]. Cardiovascular accidents are the commonest cause of death in patients on intermittent haemodialysis. Our study concerns 158 adult patients in terminal renal failure who were treated by periodic dialysis; it was carried out at Necker Hospital between January 1967 and December 1970. Between these dates, 35 patients died, 17 of the deaths being due to unequivocal or probable cardiovascular complications. The diagnosis of cerebrovascular accident was made in 13 cases. The mean age of the patients who died was 38 years. Fatal cerebrovascular accidents occurred especially during the first 12 to 24 months of treatment. The incidence of fatal vascular accidents is greatest in patients who were hypertensive at the beginning of periodic dialysis, and who remained so after six months of dialysis. Our study has therefore shown that hypertension in patients on chronic haemodialysis is a major vascular risk factors; other risk factors, especially metabolic ones, may also play a part.


[Arterial hypertension in pregnancy: current concepts]. Although the term hypertension in pregnancy is a simple and uncontroversial one, it unfortunately encompasses some ill defined clinical conditions as well as pre-eclampsia. The prime cause of pre-eclampsia is utero-placental ischaemia. Such utero-placental ischaemia is responsible for the hypothetical secretion of a vasopressor agent and for intravascular coagulation. An immunological cause should also be suspected: a study of the immune profile of the kidney has shown that the glomerular capillaries contain immunoglobulins G and M as well as the C3 fraction of complement. Renal biopsies carried out three months after delivery have shown deposits of C3 in the arteriolar walls. During normal pregnancy, there exists a state of stable equilibrium of hormonal, haemodynamic, haematological and immunological factors. It seems that all components of this equilibrium are disturbed in cases of hypertension in pregnancy.


[Role of diuretics in arterial hypertension]. The place of diuretics in the treatment of hypertension (HT) no longer requires to be proved, but their mode of action remains uncertain. Blood volume measurements allow us to distinguish the cases of HT which are volume-dependent, and which constitute the major indication for this type of treatment. The various groups of diuretics have a specific action on the renal tubule, but may all lead to complications, which imply that their use should be rational and that biochemical follow-up should be close when they are administered for a prolonged period. Used singly, diuretics effectively suppress HT in 40 per cent of cases, and when used in association with a beta-blocker, they produce normal blood pressure in 70 per cent of cases.


[Reproducibility of measurements of arterial pressure and heart rate during exercise test: its significance and application]. The authors report their findings from a study of the reproductibility of measurements of blood pressure and heart rate both at rest and during exercise (work on a bicycle ergometer) in 19 patients who were tested on two occasions with a mean interval of 9.8 days. A study of the correlations, of variability, and of the findings on applying Student's "t" test, have led us to the conclusion that these parameters are more reproduceable on exercise than at rest, and become increasingly reproduceable as exercise increases. These conclusions support the use of an induced hypertension test under exercise.


[Angina pectoris in a hypertensive patient with left ventricle hypertrophy: echo-angiographic comparisons]. Not every case of angina pectoris occurring in a hypertensive patient is indicative of coronary atherosclerosis. Nine patients with essential hypertension of moderate degree had attacks of angina of sufficient severity to require investigation by arteriography. In these patients, the coronary arteriogram was normal but ventriculography showed hypertrophy of the walls of the left ventricle of restrictive or obstructive type. These appearances were confirmed by echocardiography which also showed hypertrophy of the septum and, in certain cases, confirmed the involvement of the ventricle, while by contrast the electrocardiogram and radiological appearances of the heart were essentially normal. The beta-blockers may have an important part to play in such conditions, and echocardiography is suggested as part of the routine investigation in cases of hypertension.