Ankle arthrography and ankle distortion. A ligament rupture is found in some 60% of patients with ankle distortion. The rupture usually involves the anterior talofibular ligament, and there may be associated ruptures of other ankle ligaments. Clinical findings and conventional radiological examination (including stress exposures) are insufficiently reliable for demonstration or exclusion of a ligament lesion. Ankle arthography is a relatively simple method of investigation; interpretation of the images obtained is generally no problem. Surgical exploration has nearly always confirmed the arthrographic diagnosis 'ligament lesion'.


Comparative study of superficial whole-body radiotherapeutic techniques using a 4-MeV nonangulated electron beam. Various whole-body, multiple-field, electron-beam therapy techniques are analyzed. Accelerator characteristics, various dosimetric techniques, and experimental setup are described. A flattening filter was constructed which produced an uncollimated electron-beam profile (4 MeV) with a uniformity of +/- 8% across a 200-cm diameter area at 7 m from the source. Irradiation techniques include 2-, 4-, 6-, and 8-field therapy and rotation. Conclusive evidence is presented to support adoption of either the 8-field technique or rotation as the methods of choice for superficial whole-body treatments.


An evaluation of the in vivo properties of 99mTc-HEDP. The in vitro properties of lyophilized 99mTc stannous diphosphonate bone-scanning agent have been studied with particular reference to those properties which are of relevance to its routine clinical use. The results of quantitative studies in patients with bony tumors indicate that reliable reproducible bone scans will be obtained despite the variations in technetium presentation, labelling and injection procedures which may be anticipated in any department of nuclear medicine.


Labeling of the releasable adenine nucleotides of washed human platelets. In rabbit platelets, the metabolically active ATP pool equilibrates with the releasable ATP pool within 1 day. The studies showing this have now been extended to human platelets. Human platelets labeled with 14C-adenosine or 14C-adenine were incubated for up to 10 hr in vitro at 37 degrees C. After 10 hr, about 12% of the total platelet 14C-ATP and 14C-ADP had become releasable with thrombin (4.2 units/ml). Lysis of platelets did not occur, since less than 1% of the platelet-bound 51Cr from platelets labeled with this radioisotope appeared in the ambient fluid upon thrombin treatment. The 14C-ATP/14C-ADP ratio of the released adenine nucleotides (7.6) was similar to the 14C-ATP/14C-ADP ratio of the nonreleasable adenine nucleotides (7.1) 2 hr after the labeling with 14C-adenosine. However, upon prolonged incubation (10 hr) in vitro, the 14C-ATP/14C-ADP ratio of the releasable adenine nucleotides decreased to 2.7. The adenylate energy charge and the 14C-ATP/14C-ADP ratio of the metabolic adenine nucleotide pool did not change significantly during the time of observation. The 14C-ATP content of the platelets decreased by less than 1% hr of incubation at 37 degrees C. These observations are interpreted to mean that the 14C is transferred from the metabolically active, nonreleasable adenine nucleotide pool of human platelets into the releasable adenine nucleotide pool as ATP and is partially hydrolyzed there to yield ADP. The transfer of ATP across the storage organelle membrane of platelets may be similar to transport processes in the chromaffin cells of the adrenal medulla and may represent a general phenomenon in cells that possess storage organelles containing adenine nucleotides.


Localization and characterization of phenylethanolamine N-methyl transferase in the brain of various mammalian species. The distribution of PNMT activity in various regions and nuclei of the rat, monkey and human brain was investigated. The distribution of PNMT activity in the rat brain correlates with the distribution of PNMT immunofluorescence. The PNMT activity in the primate brain is more widely distributed than in the rat brain. High and intermediate enzyme activity values were dound in the same regions of the primate brain as in the rat brain. Intermediate or low levels were also found in various other regions of the primate brain, e.g., basal ganglia, amygdala, septum, habenula. The brain PNMT has the same substrate specificity and similar kinetic properties as the adrenal enzyme. Immunotitration studies revealed cross-reactivity between the homologous adrenal and brain PNMT.


Pathways in the forebrain of the rat concerned with the release of prolactin. Circulating prolactin levels were measured by radioimmunoassay after electrical stimulation of discrete sites in the forebrain of 420 lactating rats. The animals were prepared under initial anaesthesia, were decorticated except for frontal cortex and their brain stems were transected at the mid-collicular level.


Frontal decortication in rhesus monkeys: a test of the interference hypothesis. Four monkeys with dorsolateral frontal ablations and 3 unoperated controls were run on discrimination problems which sequentially presented both relevant and irrelevant visual stimuli prior to the opportunity for a choice response. As previously reported, monkeys with undamaged brains performed significantly better on those problems presenting relevant information first, being unaffected by later occurring irrelevant stimuli. Contrary to the behavior of the normal monkeys, monkeys with lesions of the dorsolateral frontal cortex were severely impaired when irrelevant stimuli were presented after the relevant stimuli had been processed, but before the opportunity to respond had occurred. In other words, the frontal monkeys performed just the opposite of the normals in these procedures, even though the relevant and irrelevant stimuli were manipulated within the usual temporal definitions of the two-choice discrimination trial. These data demonstrate that the presentation of irrelevant stimuli before the choice response can significantly impair frontally decorticated monkeys and that this impairment does not require the use of a long temporal delay preceding the opportunity to respond. For this reason the data were interpreted as rather direct support of the interference hypothesis of frontal dysfunction. On the basis of these and other data discussed, it was concluded that one function of the dorsolated frontal cortex involves the suppression of interfering stimulus events interposed between the information necessary to guide behavior and the behavior itself.


Morphological organization of catecholamine terminals in the diencephalon of the rhesus monkey. The hypothalamus and thalamus of the rhesus monkey were investigated using the fluorescence histochemical method of Falck and Hillarp. The hypothalamus was found to be richly supplied with catecholamine fluorescent nerve terminals with many thick and a few varicosities, whereas nerve terminals with fine varicosities were found to be distributed over the thalamus except for the midline and medial nuclei which were innervated by nerve terminals with thicker and more intense fluorescent varicosities. The morphological characteristics and distribution pattern of catecholamine terminals were similar between the rhesus monkey and the rat. However, some species differences were noted in the suprachiasmatic nucleus, arcuate nucleus and internal layer of infundibulum in the hypothalamus. The pulvinar, which was nonexistent in the rat, had fine terminals.


Central vision of man and macaque: cone and rod sensitivity. The distribution of photopic and scotopic sensitivity of the rhesus monkey has been described for central vision and compared to sensitivities of human observers. For small, brief, greeen and red test flashes the monkey's sensitivity was comparable to man, but was considerably more sensitive than man's to small, blue (450 nm) test flashes. This superior photopic sensitivity to blue was correlated with a low density of macular pigment. The scotopic sensitivities of man and monkey were comparable with the distribution of central sensitivity of the monkey being demonstrated to be related to the density of rods around the center fovea.


Inhibition of the tumor-initiating ability of the potent carcinogen 7,12-dimethylbenz(a)anthracene by the weak tumor initiator 1,2,3,4-dibenzanthracene. ARyl hydrocarbon hydroxylase (AHH) in mouse epidermis was inducible by topical application of several tumor-initiating polycylic aromatic hydrocarbons. The weak tumor initiator 1,2,3,4-dibenazanthracene (1,2,3,4-DBA), at dose level of 200 nmoles, increased AHH activity more than 10-fold over that of the acetone controls at 12 hr after treatment. Administration of the same quantity of the potent initiator 7,12-dimethylbenz(a)anthracene (DMBA) increased AHH activity approximately 4-fold over that of the control at 12 hr after treatment. Simultaneous treatment with 200 or 100 nmoles of DMBA and 1,2,3,4-DBA resulted in AHH activity that was 546 and 732% that of the controls, respectively, 12 hr after treatment: this was less AHH activity than was observed when 1,2,3,4-DBA was administered alone. Doses of 20 nmoles or more of 1,2,3,4-DBA, when given at about the same time as DMBA, effectively inhibited DMBA initiation of skin tumors in a two stage system of tumorigenesis. The results suggest that the weak initiator 1,2,3,4-DBA may program the epidermal AHH system to metabolize the strong carcinogen DMBA to noncarcinogenic intermediate(s).


Distribution and degradation of [3H]methotrexate after intravenous and cerebral intraventricular injection in primates. Four hr after either a single injection or continuous infusion of methotrexate (MTX) plus purified [3',5',9(n)-3H]MTX in cynomolgus or rhesus monkeys, 80 to 98% of the 3H radioactivity present in the plasma was found not to represent intact MTX. The percentage of 3H-containing MTX products in the urine after 4 hr was considerably less, although more variable. This variability seemed to be related to variability in the amount of the total dose excreted. Non-MTX products were also found in selected tissues and the percentage of intact MTX found 4 hr after i.v. injection varied from 2 to 26%. The percentage of intact MTX was routinely measured by comparing the values obtained using the dihydrofolate reductase assay with values based on the specific activity of [3',5',9(n)-3H]MTX. Results obtained by diethylaminoethyl column chromatography on a few samples, however, showed good agreement with results from the reductase assay. [3',5',9(n)-3H]MTX products appeared in peaks eluting from the diethylaminoethyl column both earlier and later than the MTX peak, with the earlier peaks being present in only small amounts in the urine. After continuous i.v. infusion, only 2% or less of the radioactivity found in the cerebrospinal fluid after 4 hr represented intact MTX, with the remaining radioactivity eluting much earlier than MTX. In contrast, after direct injection into the left lateral ventricel, all the 3H radioactivity in both cerebrospinal fluid and brain tissue represented intact MTX for up to 4 hr after injection. The appearance of MTX products in the plasma and selected tissues of these primates a short time after i.v. injection is compared to other work in experimental animals and man and suggests a greater metabolism of MTX than was previously suspected.


High-pressure liquid chromatography analysis of benzo(a)pyrene metabolism by microsomal enzymes from rhesus liver and lung. The metabolism of benzo(a)pyrene was determined, using rhesus monkey hepatic and pulmonary microsomal enzymes. Metabolites were separated by high-pressure liquid chromatography and identified using known reference standards. Metabolites were quantitated by scintillation spectrometry. Both liver and lung microsomes metabolized benzo(a)pyrene to the following metabolites: 9,10-, 7,8-, and 4,5-dihydrodihydroxybenzo(a)pyrene; benzo(a)pyrene-1,6-dione, -3,6-dione, and -6,12-dione; and 9- and 3-hydroxybenzo(a)pyrene. Two unidentified metabolites and one metabolite region which chromatographed prior to 9,10-dihydrodihydroxybenzo(a)pyrene were produced by both liver and lung microsomes. The two unknown peaks were located between, 9,10- and 4,5-dihydrohidroxybenzo(a)pyrene. Two additional unknown metabolites were produced only in the liver and had retention times slightly greater than the 4,5- and 7,8-dihydrodihydroxybenzo(a)pyrene metabolites, respectively. Quantitative determination of benzo(a)pyrene metabolism revealed large differences for the three monkeys and the respective tissue activities. Liver activity for each animal was substantially higher than lung activity for all benzo(a)pyrene metabolites. The ratio of the metabolites also differed between the liver and lung. 3-Hdyroxybenzo(a) pyrene represented over 60% of the total liver metabolite fraction and 30% of the total lung metabolite fraction. The total quinone fraction represented between 7 and 13% of the total metabolites in the liver and comprised over 40% of the total lung metabolites. The metabolite ratios for the dihydrodiols were very similar for both tissues.


Stimulation of growth of carcinogen-induced mammary cancers in rats by thyrotropin-releasing hormone. Twice-daily injections of three different doses of synthetic thyrotropin-releasing hormone (TRH), a hormone normally produced by the hypothalamus, produced significant increases in size and number of 7,12-dimethylbenz(a)anthracene-induced mammary cancers over 0.87% NaCl solution-injected control rats. When thyroidectomized rats, bearing 7,12-dimethylbenz(a)anthracene-induced mammary tumors were given the same twice-daily injections of TRH, mammary tumor growth was increased to the same extent as in intact rats given TRH, showing that the effects of TRH were not exerted via stimulation of thyroid function. The TRH-induced increments in mammary tumor growth were accompanied by significant increases in serum prolactin levels over 0.87% NaCl solution-injected controls. A single daily injection of 2-bromo-alpha-ergocryptine (CB-154), a prolactin-release inhibitor completely blocked TRH-induced mammary tumor growth and reduced serum prolactin values. These results indicate that a twice-daily pulse of TRH can stimulate mammary tumor growth by releasing prolactin from the anterior pituitary.


Mitochondrial degeneration after organic phosphate poisoning in prosimian primates. The degenerative reaction of mitochondria to tricresylphosphate (TCP) poisoning in spinal ganglion cells of Slow Loris (Nycticebus coucang coucang) were studied with the electron microscope. In neurones of animals treated with TCP, mitochondria display various stages of alterations which confirm mitochondrial involvement in TCP poisoning. The role of degenerated mitochondria in the formation of neuronal lipofuscin is discussed. It is suggested that the lipofuscin granule is a metabolic product inherently related to mitochondrial degeneration, irrespective of the primary cause: ageing or intoxication.


Peroxisomes (microbodies) in the myocardium of rodents and primates. A comparative Ultrastructural cytochemical study. The occurrence of peroxisomes (microbodies), their cytochemical characteristics and their ultrastructural relationship to the neighboring organelles were investigated in the ventricular myocardium of four rodent (rat, rabbit, gerbil, and guinea pig) and two primate (Macaca java and Tupaya) species. The hearts were fixed by vascular perfusion with glutaraldehyde and incubated in alkaline diaminobenzidine media for visualization of catalase. The electron-dense reaction product of catalase was found in the myocardium of all examined species and was localized in 0.2--0.5 mum oval particles, surrounded by a single limiting membrane and located usually at the junction of I and A bands. The peroxisomes in the hearts of gerbil and Macaca java were especially long and tortuous. A close spatial association was found between the myocardial peroxisomes and mitochondria, lipid droplets, and the membranes of sarcoplasmic reticulum, especially the so-called junctional sarcoplasmic reticulum. These observations demonstrate the consistent occurrence of peroxisomes in the heart of various mammalian species and suggest that peroxisomes have important metabolic and physiological functions in myocardium.


Nager acrofacial dysostosis: early intervention and long-term planning. Nager acrofacial dysostosis is an extremely rare syndrome combining craniofacial features similar to Treacher Collins mandibulofacial dysostosis with the additional features of thumb and radial bone hypoplasia. The clinical and prognostic aspects of two unrelated infants with Nager acrofacila dysostosis are presented. A vigorous early intervention program of habilitation is described with emphasis on the facilitation of speech and language development in children with multiple morphological and developmental problems.


Absence of clinical pneumonia following bronchoscopy with contaminated and clean bronchofiberscopes. Two hundred forty-nine fiberoptic bronchoscopy procedures were surveyed for the presence of bronchoscopy-related pneumonia. The first 103 procedures were performed during a period when the fiberscope was presemably contaminated with Pseudomonas aeruginosa. Chart review of these 103 procedures and prospective epidemiologic surveillance of the remaining 146 procedures revealed no cases of bronchoscopy-related pneumonia.


Regulation of folliculogenesis in the cycling rhesus monkey: selection of the dominant follicle. To identify factors regulating the initiation of follicle growth in adult primates, the ovarian cycle of sexually mature rhesus monkeys was interrupted by surgical ablation of the preovulatory follicle or functioning corpus luteum (CL). In 10 of 10 animals, cautery of the largest visible follicle on Day 8-12 of the cycle blocked ovulation, and in all but one abolished the expected midcycle surges of gonadotropin secretion. In 8 monkeys of this group, surges of LH and FSH release occurred 12.4 +/- 0.9 days (d) (mean +/- SE) after cautery, coincident with elevations in serum estrogens, and succeeded by typical luteal phase patterns of circulating progesterone (P). No gonadotropin or estrogen surges were observed during the next 32 days of sampling in the remaining pair, despite visible new vesicular follicles. Removal of the CL in 5 of 5 monkeys 4-6 days after the midcycle LH surge was followed by a reduction in serum P to less than 0.25 ng/ml within 24 h and by the onset of menses within 3-4 days. After luteectomy in 4 of the 5 animals, preoperative levels of LH and FSH were maintained until 12.8 +/- 0.9 days, when typical surges of gonadotropin secretion occurred, followed by a normal luteal phase pattern of P. The fifth luteectomized monkey menstruated again 25 days after ablation without intervening surges of estrogen or gonadotropin release and did not ovulate. Sham follicle cautery did not block ipsilaternal ovulation or impair progesterone secretion by the CL in 2 of 2 monkeys. These observations indicate that, by the middle of the follicular phase, the follicle destined to ovulate had been selected, and that no other follicles were soon competent to mature. That the interval from ablation, at either phase of the cycle, until the next ovulation was the same indicates: a) that the prevailing ovarian steroidal milieu at ablation had no discernible differential effect on the time-course of resumed ovarian activity, and b) that midcycle surges of estrogen or gonadotropin secretion were not required either to initiate or synchronize subsequent follicle growth.


Induction of hypothyroidism and hypoprolactinemia by growth hormone producing rat pituitary tumors. The GH3 rat pituitary tumor cell line which secretes both growth hormone (GH) and prolactin (PRL) stopped releasing PRL when transplanted to animals; furthermore, it suppressed PRL production by the hosts' pituitary glands. When the same tumor was transferred back to cell culture, PRL production resumed. The PRL to GH ratio in cell culture medium and cells ranged from 5 to 1 while in the tumor and serum of the host animals it averaged 0.09 and 0.001, respectively. To investigate further this phenomenon, female rats were transplanted with GH3 tumors (T) and compared to intact normal (N) and to thyroidectomized (Tx) rats. T animals were larger and had splanchnomegaly but smaller pituitaries and thyroids. Serum PRL concentrations in the basal state were decreased, as were levels of triiodothyronine (T3), thyroxine (T4), and free T4 index. Despite reduced serum thyroid hormone concentrations, and in contrast to Tx animals, the serum thyrotropin (TSH) level in T rats was not elevated and they did not show a supranormal TSH response to thyrotropin-releasing hormone (TRH) administration. The PRL response to TRH in T animals was completely abolished while all N and Tx animals responded by a significant increase in serum PRL. Serum corticosteroids and estrogens were normal in T rats. Pituitary content of PRL was decreased and that of TSH increased in T rats. Tx animals, however, had a reduced pituitary content of PRL, TSH, and GH. When GH3 cells were grown in cell culture media containing serum from T animals, there was a reduction of PRL content in cells and released in the medium. Addition of T3 to the T serum did not alter its suppressive effect on PRL nor did rat GH added to N serum alter PRL production and release in vitro. In a preliminary experiment, rats injected ip with 50 mug hGH in two divided doses for eighteen days, suppressed serum T4 and T3 concentrations; pituitary content of TSH was significantly increased and that of PRL slightly decreased. Injection with 250 mug oPRL or saline, on the same schedule and for the same length of time, had no significant effect on the levels of serum thyroid hormones. Thus, GH, but also possibly other substance(s) secreted by GH3 tumors in vivo a) suppress the production of tumor and pituitary PRL; b) suppress the release of TSH, causing mild hypothyroidism; c) inhibit the PRL and TSH responses to TRH; and d) decrease the production of PRL in tissue culture. Although no simple and unifying theory could explain these findings, an hypothesis implicating somatomedin is presented.


Effects of estrogen on thyroxine-binding globulin metabolism in rhesus monkeys. To investigate the effects of estrogen on thyroxine-binding globulin (TBG) metabolism, 4 female Rhesus monkeys were studied before and 3-4 weeks after implantation of beta-estradiol (E2)-containing capsules. In addition, 2 of the animals were also studied for the first 7 days after the start of E2. Serum E2 increased 10-fold from 20 +/- 7 to 212 +/- 41 pg/ml. Serum TBG, initially 20.2 +/- 6 mug/ml, was elevated by 24 h after E2 implantation, and reached a steady level of 46.8 +/- 5.0 mug/ml by 7-10 days. For the turnover studies, highly purified [125I]iodo-TBG was injected iv and serum [125I]PBI and urinary 125I excretion were measured daily. TBG kinetics were evaluated by use of a compartmental model. Although a 2-compartment model was sufficient to fit the control and late E2 data, a 3-compartment model was developed in order to account for the modifications observed during the early E2 period. The final decay rate (k) of TBG was 0.26 +/- 0.01/day during the control period and was slightly lower after E2 (0.23 +/- 0.01/day). In the 2 monkeys studied during the early E2 period, the major effect of E2 was a stimulation of the TBG production rate. This was simulated in the model by a stepwise increase occurring in the last quarter of the first day after E2. There was also an abrupt redistribution of TBG in the compartments defined by the model. The total distribution or serum equivalent volume of TBG after 3-4 weeks of E2 increased 1.4-fold, from 338 +/- 37 ml to 458 +/- 22 ml, and the metabolic clearance rate increased 1.3-fold, from 90 +/- 10 ml/d to 113 +/- 12 ml/d. The increase in the final TBG production rate (2.9-fold) was only slightly greater than the rate calculated for the early E2 period, and was similar to the increase we have recently found in monkey hepatocytes studied in vitro after isolation from E2-treated animals. It appears that stimulation of hepatic synthesis of TBG accounts for the elevated serum levels of TBG observed after estrogen.


Thyrotropin releasing hormone (TRH) in pineal and hypothalamus of the frog: effect of season and illumination. The influence of photo-illumination and season on the pineal and hypothalamic content of TRH in the leopard frog (Rana pipiens) was studied. Animals (4-6 in each group) were exposed to constant light or darkness for 72 h and then sacrificed. The pineal and hypothalamus from each frog were extracted for TRH measurement by radioimmunoassay. The experiment was performed in spring, autumn, early winter and mid-winter. In early winter, mid-winter and spring the pineal content of TRH ranged from 0.14-0.70 ng. Significant differences between groups due to season and illumination were recorded. In autumn, mean levels of TRH were 12.95 ng (dark exposed) and 4.19 ng (light exposed)-values 10-20 times higher than at other times of the year (P less than 0.001). The hypothalamic content of TRH ranged from 11.4 ng in spring to 19.5 ng in autumn. Seasonal differences were present, but no effect of light or darkness was found. There was no definite relation between the TRH levels in hypothalamus and pineal. The alteration in pineal and hypothalamic TRH produced by season, and the effect of illumination on pineal TRH content, support the view that TRH has a neuronal function in vertebrates, possibly as a neurotransmitter.


Subtyping of hepatitis B surface antigen and antibody by radioimmunoassay. The hepatitis B surface antigen (HBSAg) has been shown to possess distinct subtypes adw, ayw, adr, and ayr). A commercially available solid phase radioimmunoassay for antibody to HBSAg (Ausab, Abbott Laboratories North Chicago, Ill.) has been modified to detect the subtypes of HBSAg as well as the subtype-specific anti-HBS reactivities to detect the subtypes of HBSAg as well as the subtype-specific anti-HBS reactivities (anti-d, anti-y, and anti-w). This method has the advantages of general availability, ease of performance, and increased sensitivity over conventional subtyping methods of agar gel diffusion and counterelectrophoresis.


Amino acid chemoreceptors of Bacillus subtilis. Specificities of chemoreceptors for the 20 common amino acids, toward which Bacillus subtilis shows chemotaxis, were assessed by competition ("jamming") experiments using a modification of the traditional capillary assay, called the "sensitivity capillary assay." Many amino acids were sensed by at least two chemoreceptors. All the highest affinity chemoreceptors for the amino acids were distinct, except glutamate and aspartate, which may share one chemoreceptor, and tyrosine, for which the data could not be collected due to low solubility. The data suggest the hypothesis that each amino acid-chemoreceptor complex binds to a different signaler (from each amino acid-chemoreceptor complex binds to a different signaler (from which signals travel to the flagella to modify behavior appropriately), and that many of the signalers can also bind other attractant-chemoreceptor complexes as antagonists (no signals to flagella).


Role of sugar uptake and metabolic intermediates on catabolite repression in Bacillus subtilis. Many phosphorylated intermediates exert catabolite repression on the enzyme acetoin dehydrogenase in Bacillus subtilis. This was shown with strains that are blocked at different positions in central metabolism when they receive sugars that cannot be metabolized past enzymatic block(s). In the case of sorbitol, transport events were not involved in catabolite repression, for this sugar cannot repress acetoin dehydrogenase in a strain lacking sorbitol dehydrogenase but otherwise able to take up sorbitol. The presence of glucose did not markedly influence the uptake of acetoin.


Biosynthesis of bacterial glycogen: genetic and allosteric regulation of glycogen biosynthesis in Salmonella typhimurium LT-2. Structural gene mutants of the glycogen biosynthetic enzymes adenosine diphosphate glucose pyrophosphorylase (glgC) and glycogen synthase (glgA) were isolated and partially characterized. The cotransduction frequencies of these genes with the aspartic semialdehyde dehydrogenase (asd) and glycerol-3-phosphate dehydrogenase (glpD) genes suggested the unambiguous gene order of glpD glgA glgC asd. The results of the three-factor cross glpD- glgA- glgC+ X glpD+ glgA+ glgC- were consistent with the proposed order. A simultaneous and approximately equivalent derepression of the glgC, glgA, and glgB (branching enzyme) gene products was observed in the late logarithmic-early stationary phase of growth on enriched media. These results are consistent with the coordinately regulated synthesis of the three glycogen biosynthetic enzymes in Salmonella typhimurium.


Plasmid-determined resistance to tellurium compounds. Transferable plasmids in gram-negative bacteria that confer resistance to potassium tellurite or tellurate were found. This re-istance was distinct from resistance to mercury, silver, or arsenic compounds and was unrelated to antibiotic resistance. In Escherichia coli, plasmids determine a 100-fold increase in the minimal inhibitory concentration for tellurite and a 10-fold increase in tellurate resistance. Many, but not all, of the plasmids belong to incompatibility group S. In Pseudomonas aeruginosa, tellurium resistance is specifically associated with incompatibility group P-2 and involves a 5- to 10-fold increase in tellurite or tellurate resistance.


Growth pattern and cell division in Neisseria gonorrhoeae. The gram-negative coccus Neisseria gonorrhoeae was found to grow regularly in at least two dimensions. Growth proceeded at a linear rate sequentially in each dimension. Growth in the second dimension (former width) was initiated slightly before the pole-division plane distance equalled the cell width. Penicillin treatment localized presumptive growth zones to the existing septum region. It was suggested that new growth zones were always formed perpendicular to the longitudinal axis created in the incipient daughter cells of a dividing coccus. Neither penicillin nor nalidixic acid induced filaments of N. gonorrhoeae. Such structures could nevertheless be formed in the rod-shaped species Neisseria elongata. N. gonorrhoeae divides by septation; however, complete septal structures with separated cytoplasms were rather infrequent. It is proposed that N. gonorrhoeae be regarded as a short rod which always extends parallel to the actual longitudinal axis and which never undergoes a rod-sphere-rod transition.


Identification and characterization of a small sequence located at two sites on the amplifiable tetracycline resistance plasmid pAMalpha1 in Streptococcus faecalis. Streptococcus faecalis DT-11 harbors the 6.0-megadalton plasmid pAMalpha1, which determines resistance to tetracycline (TC). When this strain is grown in the presence of TC for a number of generations, a reversible gene amplification occurs, generating tandem repeats of a 2.65-megadalton segment of the plasmid. On the basis of heteroduplex studies between various forms of pAMalpha1 and fragments generated by the Escherichia coli restriction endonuclease EcoRI, we have obtained direct evidence for the presence of a small sequence designated RS1 (for recombination sequence) located on both sides of the TC resistance determinant. Corresponding points on the two sequences are separated by 2.65 megadaltons of deoxyribonucleic acid. The two RS1 sequences have the same polarity and are of a size corresponding to about 380 nucleotide base pairs. The data presented serve as strong support for amplification models that are based on recombinational events involving the RS1 sequences.


Quaternary structure and oxygenase activity of D-ribulose-1,5-bisphosphate carboxylase from Hydrogenomonas eutropha. Electrophoretically homogeneous ribulose-1,5-bisphosphate (RuBP) carboxylase was obtained from autotropically grown Hydrogenomonas eutropha by sedimentation of the 105,000 X g supernatant in a discontinuous sucrose gradient and by ammonium sulfate fractionation followed by another sucrose gradient centrifugation. The molecular weight of the enzyme determined by light scattering was 490,000 +/- 15,000. The enzyme could be dissociated by sodium dodecyl sulfate into three types of subunits, and the molecular weights (+/- 10%) could be measured. There were two species of large subunits, L and L' (molecular weight 56,000 and 52,000, respectively) and one species of small subunits (molecular weight, 15,000). The mole ratio of L to L' was 5:3, and the overall mole ratio of the small to large subunits was 1.08. The simplest quaternary structure of the enzyme is L5L'3S8. The enzyme contained RuBP oxygenase activity as evidenced by the O2-dependent production of phosphoglycolate and 3-phosphoglyceric acid in equimolar quantities from RuBP.


Two polypeptides associated with the ribonucleic acid polymerase core of Bacillus subtilis during sporulation. The ribonucleic acid (RNA) polymerase from log-phase and sporulating cells of Bacillus subtilis was analyzed to determine whether any structural changes occurred during sporulation. The elution pattern of RNA polymerase from a deoxyribonucleic acid (DNA)-cellulose column revealed that sporulating cells at stages III and IV contained a new RNA polymerase fraction in addition to the vegetative holoenzyme (alpha2betabeta'sigma). Stage III cells contained the vegetative holoenzyme and a new enzyme with the composition alpha2betabeta'delta1; the molecular weight of delta1 was 28,000. Stage IV cells contained the vegetative holoenzyme, the delta1-containing enzyme, and another enzyme with the composition alpha2betabeta'delta2. The delta2 factor had a molecular weight of around 20,000. The delta-containing enzymes have a higher affinity for the DNA-cellulose column and a higher specific activity on various templates than vegetative holoenzyme. The simultaneous appearance of these enzymes with vegetative holoenzymes in sporulating cells is consistent with the data found previously with DNA-RNA hybridization studies, which showed that sporulating cells contained both vegetative and sporulation messenger RNAs.


Bacillus subtilis ribonucleic acid polymerase mutants conditionally temperature sensitive at various stages of sporulation. Rifampin-resistant mutants of Bacillus subtilis that are conditionally temperature sensitive during sporulation have been isolated and characterized. The mutants can grow at the same rate as the wild type at the nonpermissive temperature but cannot sporulate. Depending on the mutation, they are blocked at either stage 0 to I, II, II to III, or IV of sporulation. The mutants showed an altered pattern of RNA synthesis after the stage at which they were blocked. The effect of rifampin on the activity of enzymes from mutant vegetative cells and sporulating cells was significantly different, suggesting that the RNA polymerase from sporulating cells was different from the RNA polymerase of vegetative cells. These results suggest that the conformation of the RNA polymerase core plays an important role in determining correct transcription during sporulation.


Two-dimensional restriction analysis of the Bacillus subtilis genome: gene purification and ribosomal ribonucleic acid gene organization. With two-dimensional restriction enzyme analysis we have been able to cleave the Bacillus subtilis genome and resolve the resulting deoxyribonucleic acid (DNA) segments into discrete bands on agarose gels. A general procedure for gene purification has been developed by coupling multidimensional restriction analysis with a biological assay for gene detection. The organization of ribosomal ribonucleic acid (rRNA) genes was studied by hybridizing 16S and 23S rRNA probes to the two-dimensional DNA banding patterns.


Electron microscope histochemical localization of alkaline phosphatase(s) in Bacillus licheniformis. Sites of alkaline phosphatase (APase) activity in a facultative thermophilic strain of Bacillus licheniformis MC14 have been localized by electron microscope histochemistry, using a lead capture method. The effects of 3% glutaraldehyde and 3.0 mM lead on APase activity were investigated, and these compounds were found to significantly inhibit enzyme activity, 68 and 18%, respectively. A number of parameters were varied in studies to localize APase activity, including: growth temperature (55 and 37 degrees C); substrate concentration in the histochemical mixture (0.06, 0.15, 0.30, 1.00 mM); fixatives; protoplast preparations and whole cells; phosphate-repressed and -derepressed cells; and age of vegetative cells (mid-log and late log). These variations affected the number but not the location of lead phosphate deposits, which appeared at discrete sites along the inner side of the cytoplasmic membrane. Control cells incubated in histochemical mixtures lacking substrate, lead, or both exhibited no lead phosphate depositis. The histochemical localization at membrane sites correlated well with biochemical localization data, which indicated that greater than 80% of the APase activity was associated with the membrane fraction in logarithmically growing cells.


Appearance of straight flagellar filaments in the presence of p-fluorophenylalanine in Pseudomonas aeruginosa. In the presence of p-fluorophenylalanine, a normally flagellated strain of Pseudomonas aeruginosa produced straight flagellar filaments at the distal ends of preexisting flagella, indicating polar growth on its flagella.


Cell wall protein in Bacillus subtilis.

Cell wall protein in Bacillus subtilis. The cell wall of Bacillus subtilis 168 contains protein that is refractory to removal by salts, detergents, and denaturants.


Incorporation of 3,4-dihydroxybutyl-1-phosphonate, a glycerol 3-phosphate analogue, into the cell wall of Bacillus subtilis. 3,4-Dihydroxybutyl-1-phosphonate, a bacteriostatic agent toward Bacillus subtilus 168 and a bactericidal agent toward strain W 23, is incorporated into cell walls and phospholipids of each strain.


Bacillus subtilis bacteriophage SPbeta: localization of the prophage attachment site, and specialized transduction. The attachment site for the prophage of SPbeta lies between ilvA and kauA on the chromosome of Bacillus subtilis strain 168. Specialized transduction of citK and kauA can be carried out by certain lysates of SPbeta.


Freeze-fracture studies of nexuses between smooth muscle cells. Close relationship to sarcoplasmic reticulum. The freeze-fracture appearance of the nexus was compared in the smooth muscle of guinea pig sphincter pupillac, portal vein, pulmonary artery, taenia coli, uretzr, and vas diferens, mouse vas deferens, chicken gizzard and anterior mesenteric artery, and toad stomach. Nexuses are particularly numerous in the guinea pig sphincter pupillae; they are usually oval and their average area is 0.15 mum2, although some as large as 0.6 mum2 were seen. Small aggregations of particles were observed which would not be recognizable as nexuses in thin section. What constitutes the minimum size of a nexus is discussed. It is estimated that the number of nexuses per cell in this preparation is of the order of tens rather than hundreds. All nexuses examined had 6-9-nm particles in the PF face, with corresponding 3-4-nm pits on the EF face forming a polygonal tending towards a hexagonal lattice. The nexuses are arranged in rows parallel to the main axis of the cell, usually alternating with longitudinal rows of plasmalemmal vesicles. Many nexuses in the guinea pig sphincter pupillae, chicken gizzard, and toad stomach show a close relationship with sarcoplasmic reticulum. The possibility that this may have some role in current flow across this specialized junction is discussed.


Inhibition of adherence of Neisseria gonorrhoeae by human genital secretions. Local genital antibodies to the infecting strains of Neisseria gonorrhoeae were demonstrated by indirect immunofluorescence (binding antibody) and by their ability to inhibit the attachment of gonococci to epithelial cells (functional antibody). Both IgG and IgA classes of immunoglobulin were involved, and the IgA component were primarily of a secreting (11S) nature. The ability of local genital antibody to inhibit attachment appears to persist for at least a short period of time and to be relatively strain specific.


Human beta-glucuronidase deficiency mucopolysaccharidosis: identification of cross-reactive antigen in cultured fibroblasts of deficient patients by enzyme immunoassay. An enzyme immunoassay for human beta-glucuronidase was developed to determine the presence or absence of antigenically cross-reactive material (CRM) in patients with beta-glucuronidase deficiency mucopolysaccharidosis. This assay provided a sensitive means of measuring the primary interaction between the enzyme molecule and antibody but required neither pure antigen nor monospecific antiserum, an important consideration, since neither of these was available. Goat antiserum to partially purified human placenta beta-glucuronidase did not recognize differences in normal enzyme from human placenta, liver, fibroblasts, or blood platelets. CRM was identified in fibroblast extracts from all four of the unrelated beta-glucuronidase-deficient patients studied, but titration patterns indicated genetic heterogeneity among these four mutant proteins. Fibroblast enzymes from two obligate heterozygotes were distinguishable immunologically from normal enzyme. The enzyme immunoassay was also used to compare human enzyme with liver enzyme from other mammalian species. CRM was present in liver extracts of all species tested, but the liver enzymes, except for the rabbit, were weakly cross-reactive. We conclude that despite certain limitations, the enzyme immunoassay for human beta-glucuronidase is useful and that all four beta-glucuronidase-deficient patients studied possess CRM.


Organization of auditory cortex in the owl monkey (Aotus trivirgatus). The region of cerebral cortex in the owl monkey that is responsive to acoustic stimulation is located on the dorsal and lateral surfaces of the rostral half of the superior temporal gyrus. Systematic microelectrode mapping of this area has revealed multiple frequency representations. The boundaries of these fields determined electrophysiologically correlate with the architectural boundaries apparent in Nissl stained material. On the basis of combined cytoarchitectonic and electrophysiological maps we have divided auditory cortex into five fields. Two of them, the primary field (AI) and the field rostral to it (R) are somewhat similar architectonically and constitute the central core of auditory cortex. Each of these two fields has a complete and orderly representation of the audible frequency spectrum within it. Surrounding these fields is a belt of cortex in which units are generally less responsive to acoustic stimulation and the frequency organization is more complex than in AI or R. Electrophysiological and cytoarchitectonic evidence suggest that this belt is composed of at least three and possibly four separate auditory fields.


Effect of sensitization with Propionibacterium acnes on the growth of Listeria monocytogenes and Treponema pallidum in rabbits. Sensitization of rabbits with Propionibacterium acnes, a nonspecific stimulant of the reticuloendothelial system, was investigated as a means of enhancing resistance to Treponema pallidum. A single i.v. dose of P. acnes given 3 or 7 days before challenge with Listeria monocytogenes was capable of suppressing the growth of the heterologous organism, whereas a single i.v. dose 24 hr or 14 days before challenge was not. Reactivation via i.v. elicitation with P. acnes 14 days after sensitization (1 day before challenge) caused significant suppression of listerial growth in the major organs 30 hr after i.v. challenge. A series of similar experiments was designed with T. pallidum as the challenge organism. Sensitization and repetitive elicitation with P. acnes did not change the time of appearance or progression of syphilitic chancres after i.v or i.d. challenge. Injection of P. acnes into sites of intradermal T. pallidum challenge in previously sensitized rabbits also failed to alter the evolution of syphilitic lesions. These results suggest that macrophage activation does not alter the host's ability to suppress the growth of T. pallidum.


Defense mechanisms against primary influenza virus infection in mice. I. The roles of interferon and neutralizing antibodies and thymus dependence of interferon and antibody production. To investigate the defensive roles and production of interferon and antibodies, C3H/He mice were subjected to various immunosuppressive treatments and infected with influenza virus. In infected normal control mice the pattern of pulmonary viral growth can be divided into three phases. The first phase is characterized by an exponential increase of virus titer, the second by a rapid decrease, and the third by a moderate decrease. At the time of transition from the first phase to the second in pulmonary virus growth, interferon could be detected in the tracheobronchial washings of infected mice, but neutralizing antibodies could not. In infected B cell-deprived mice and infected anti-mu-treated mice, the transition from the first phase to the second occurred without any detectable antibody production, and interferon could be induced in the early stage of infection. However, the pulmonary virus in these mice increased again exponentially until the death of the mice. In infected T cell-deprived mice which could not induce interferon, but produced IgM-neutralizing antibodies, the second phase was not observed after the first phase, but a transient plateau phase could be demonstrated, and then the pulmonary virus increased again exponentially until the death of the mice. In anti-gamma-treated infected mice, pulmonary virus growth and production of interferon and neutralizing antibody were almost similar to those of infected normal control mice except for the absence of IgG neutralizing antibody production. Although anti-alpha-treated infected mice produced interferon and no IgA antibody, the transition from the first exponential increase of pulmonary virus to the second rapid decrease was seen, but then the virus increased exponentially again until the death of the mice. These results suggest that interferon plays an important role in the transition from the first phase to the second, and that T cells are required for interferon induction in mice infected with influenza virus. These data also suggest that IgA antibodies play an important role in the inhibition of virus propagation in the lungs after the disappearance of interferon. Moreover, infected T cell-deprived mice could produce only IgM neutralizing antibodies, but not IgG and IgA antibodies. Therefore, T cells are required for the production of IgG and IgA antibodies and even


Generation of human plaque-forming cells in culture: tissue distribution, antigenic and cellular requirements. A system for the induction of specific, hemolytic plaque-forming cells from normal human lymphocytes in vitro (HcPFC) has been established and cells from various normal lymphoid tissues have been investigated. Normal values for anti-SRBC HcPFC responses in cultures of 107 Ficoll-Hypaque separated lymphocytes range from 2000 (bone marrow) to 7000 (spleen) and 15,000 (tonsillar and peripheral blood lymphocytes). HcPFC responses to ovalbumin were lower by factor of 2 to 4. Anti-SRBC as well as anti-ovalbumin responses required the cooperation of T lymphocytes and IgM-bearing B lymphocytes and the magnitude of the response was antigen dose dependent. Addition of adherent cells as well as of 2-mercaptoethanol enhanced the response. On the basis of the data obtained in experiments examining the role of B and T lymphocytes, a tentative model of cellular interaction has been postulated, suggesting a major role for antigen concentration in the modulation of the response via reactive T lymphocytes.


Structural analysis of the peptides derived from specific acid-catalyzed hydrolysis at aspartylprolyl peptide bonds in human J chain. Human J chain from IgM has been selectively cleaved at three aspartylprolyl peptide bonds to yield four fragments containing 62, 20, 25, and 22 amino acids, respectively. The amino acid sequence of each peptide has been partially determined, (59 of a total of 129 residues) and its position in the J chain ascertained. There were no obvious similarities to known sequences in other immunoglobulin polypeptide chains.


Hemoperfusion through albumin-conjugated agarose gel for the treatment of neonatal jaundice in premature rhesus monkeys. Hemoperfusion through albumin-conjugated agarose gel (AAG) effectively removes bilirubin (BR) and other albumin-bound materials from whole blood or plasma. We have used this technique to treat neonatal jaundice in premature rhesus monkeys with a specially designated apparatus which permits continuous perfusion through one of four columns arranged in parallel while the others are sequentially washed with saline and regenerated with ethanol. Less than 15 per cent of the animal's blood volume is required in the extracorporeal circuit at any time. Results indicate that (1) compared with five control monkeys which had a peak BR concentration ([BR]) averaging approximately 4 mg./100 ml., six experimental monkeys showed a significant (p less than 0.01) reduction, averaging 60 per cent, in [BR] after each of two perfusions at approximately 20 and 26 hours of age; (2) AAG hemoperfusion was even more effective in lowering [BR] in monkeys with higher preperfusion concentrations produced by BR infusion (average reduction = 68 and 87 per cent at preperfusion concentrations of 11.9 and 24.2 mg./100 ml., respectively); and (3) overall, BR eluted from the column averaged 93 per cent of the estimated preperfusion plasma BR pool. Unlike previous studies in rats, perfused monkeys showed significant platelet losses, although it was possible to prevent these losses by the use of "regional citrate" during perfusion. These studies suggest that AAG hemoperfusion is effective in the treatment of neonatal jaundice, although potential problems such as sterility and platelet loss need further evaluation before it can be considered for human use.


The use of calcium chelating agents and prostaglandin E to eliminate platelet and white blood cell losses resulting from hemoperfusion through uncoated charcoal, albumin-agarose gel, and neutral and cation exchange resins. Hemoperfusion through adsorbents such as charcoal, cation exchange (e.g., AG 50W-X8) and uncharged (e.g., XAD-2) resins, and albumin-agarose gel (AAG) has been proposed for use in patients with hepatic failure. However, the loss of white blood cells and, particularly, platelets caused by each of these adsorbents remains a major deterrent to their clinical use. In vitro studies demonstrate that addition of citrate, ethylenediamine tetraacetate (EDTA), or oxalate to heparinized human blood eliminated this loss of formed blood elements during hemoperfusion. The improvement in postperfusion platelet counts (per cent of preperfusion values) produced by citrate were XAD-2, 13 leads to 95 per cent; AG 50W-X8, 10 leads to 94 per cent; AAG, 17 leads to 94 per cent; and charcoal, 44 leads to 96 per cent. Prostaglandin E1 in high doses (5 mug/ml.) markedly reduced platelet losses. Lower doses were less uniformly effective. Three young rhesus monkeys were hemoperfused for 160 minutes with columns containing AAG, XAD-2, and charcoal. During the first 80 minutes, citrate and calcium were infused into the column inflow and outflow lines respectively. For all three adsorbents, average platelet counts in the monkeys (115 per cent) and column effluent (95 per cent) were unchanged from preperfusion control values during the first 80 minutes but fell promptly to 13 and 7 per cent, respectively, after the citrate infusion was stopped. Each of the monkeys tolerated the procedure without ill effects. Use of a system analogous to that described here may facilitate clinical application of the technique of hemoperfusion through a variety of adsorbents.


Comparison of  phagocytic and chemiluminescence response of human polymorphonuclear neutrophils. The phagocytic activity and the chemiluminescence response of human polymorphonuclear neutrophils were studied with normal human serum used as opsonin for S. typhimurium and S. aureus. When serum was heated, chelated with ethyleneglycol tetraacetic acid (EGTA), or absorbed with zymosan, there were reduction of phagocytic activity for S. aureus and a comparable reduction of chemiluminescence; a 50 per cent decrease in phagocytosis by neutrophils corresponded to a 50 per cent reduction in the chemiluminescence response. In contrast, S. typhimurium was successfully phagocytized in serum treated with MgEGTA (complement--alternate pathway intact; classic pathway blocked), and chemiluminescence was reduced by only 20 per cent  under the same conditions. Both neutrophil phagocytic and chemiluminescence responses for S. typhimurium were abolished when serum was heated at 56 degrees C. or adsorbed with zymosan. These findings suggest that both phagocytosis and chemiluminescence in neutrophils are interrelated, and the chemiluminescence response of neutrophils may be a reliable assay for measuring serum opsonic activity.


Glycoproteinuria as an indicator of glomerular basement membrane damage. Urinary glycoprotein was isolated from human urine by the use of the same procedures as those used for isolation of human renal glycoprotein from the glomerular basement membrane (GBM). In Ouchterlony plates and immunoelectrophoretically, human urinary glycoprotein has a common structural component with human renal glycoprotein isolated from GBM. Massive excretion of the glycoprotein in the urine was associated with only two diseases, systemic lupus erythematosus (membranous type) and membranous glomerulonephritis, although it was isolated from the urine of patients with renal as well as nonrenal diseases and normal subjects. In these two membranous diseases, the glycoprotein of GBM could be intensively liberated into the urinary space, as the result of extensive damage of GBM that is initiated by immune-complex deposit. It is discussed that urinary content of this glycoprotein may indicate the degree of the GBM damage in these diseases.


Indium-111-labeled leukocytes for the localization of abscesses: preparation, analysis, tissue distribution, and comparison with gallium-67 citrate in dogs. Leukocytes have been labeled with indium-111-8-hydroxyquinoline complex. Seventy-five to 85 per cent of the initial activity has been obtained in the complex form of which 75 to 95 per cent is incorportaed with leukocytes. The polymophonuclear leukocytes are predominantly labeled, and the label has been found stable for at least 27 hours after invivo administration. The radioactivity clears from the circulating blood with a half time of 8 to 9-hours and accumulates in normal liver and spleen and in experimentally induced abscesses. The cells which have been labeled and damaged by heat concentrate mainly in the lungs. The in vivo distribution of the indium-111 labeled cells has been compared with the gallium-67 administered as citrate. The abscess to blood ratios of the indium-111 activity varied between 35 to 117, compared to 1.2 to 8 of the gallium-67. The abscess to liver, spleen, and kidney ratios are several fold higher with indium-111 leukocytes than with gallium=67 citrate. These results plus the suitable physical characteristics of indium-111 make the labeled leukocytes a better agent for the localization of abscesses.


Experimental intraoperative localization of retained intracerebral bone fragments using transdural ultrasound. Precise intraoperative localization of retained bone fragments and foreign bodies avoids extensive brain disseciton, cerebral edema, damage to vital structures, incomplete debridement, and prolonged surgical procedures. Such localization after head trauma is often hampered by cerebral distortion, previous incomplete debridement, fragment migration, and surgical draping. Our intraoperative technique of transdural A-scanning using aspiration-biopsy transducers precisely localized 3.5-mm fragments without damage to underlying cortical tissue and vessles. Transdural A-mode echoencephalography was found to be more reliable for intracerebral depth estimations but epidural B-mode sonography was more useful for determining the size of fragments. Transdural ultrasound offered an intraoperative alternative to stereotaxic localization of retained bone fragments in experimental head trauma.


Treatment of pulmonary infections in patients with cystic fibrosis: a comparative study of ticarcillin and gentamicin. The effectiveness of ticarcillin against Pseudomonas aeruginosa in acute exacerbations of pulmonary infection in patients with cystic fibrosis was evaluated. Seventy-one percent of patients treated with ticarcillin alone responded favorably. The response rate was similar in patients treated with a combination of ticarcillin plus gentamicin or with gentamicin alone. Severity of the underlying disease was the most important determinant of response to treatment. Ticarcillin-resistant organisms were recovered during treatment in 50% of patients who received this drug; recovery of them was not prevented by the inclusion of gentamicin in the therapeutic regimen nor did they interfere with clinical improvement. The ticarcillin-resistant strains persisted at follow-up, two to six months after completion of therapy, in only one of ten patients. No serious toxicity to ticarcillin was noted during the study period.


Delayed nerve conduction velocities in children with protein-calorie malnutrition. Protein-calorie malnutrition in human beings and animals affects the myelination and growth of the nervous system. The effects of PCM on the developing nervous system were evaluated by measuring the nerve conduction velocities in 93 (38 marasmus, 13 kwashiorkor, and 42 control) children in ulnar, median, peroneal, and posterior tibial nerves. The children were divided into three age groups: Group I, six to 12 months; Group II, 13 to 24 months; Group III, 25 to 48 months. All 13 children with kwashiorkor demonstrated irritability, delayed milestones, and muscular wasting; and six also had hypoactive muscle reflexes. Conduction velocities were reduced in each type of malnutrition, with statistically significant differences in the three groups of marasmic children and in Group III kwashiorkor children. Children with kwashiorkor in Group II had significantly reduced velocities only in the nerves of the lower extremities. These data suggest PCM, when it occurs during the development of the nervous system, affects myelination of the peripheral nerves.


Pulp response to Enamelite restorations in teeth of rhesus monkeys. The average magnitudes of cellular displacements, superficial responses, and deep responses were less for specimens restored with ZOE than for Enamelite specimens at the 1 week postoperative period. Of 20 teeth treated, three abscesses were found in the 1 week Enamelite postoperative period when the remaining dentin was 0.3 mm. or less. This indicates the presence of ingredients that are toxic to the pulp when there is little remaining dentin or when the material is placed directly over an exposure. Teeth restored with Enamelite in the 6 week group had values comparable to the ZOE teeth for the same time period.


Short term morphologic effects of high ambient levels of ozone on lungs of rhesus monkeys. Groups of laboratory-reared, young adult rhesus monkeys were exposed to 0.8 p.p.m. or 0.5 p.p.m. of ozone for 8 hours a day on 7 consecutive days. Lesions were studied using correlated techniques which permitted examination of specified levels of airways and adjacent lung parenchyma by light microscopy, scanning electron microscopy, and transmission electron microscopy. Lesions were observed in the trachea and lungs of all exposed animals. The extent and severity of damage, but not its nature, varied with exposure concentration. Damage was most severe in respiratory bronchioles and more distal parenchymal regions were unaffected. Major features of the response within respiratory bronchioles were hyperplasia and hypertrophy of nonciliated bronchiolar epithelial cells and intraluminal accumulations of macrophages. Replacement of type 1 epithelium in alveoli by type 2 cells and forms intermediate between types 1 and 2 were also observed. In large conducting airways, damage to ciliated cells was observed but mlcus-producing cells were morphologically unaltered. Two gradients in severity of ozone-induced lesions were appreciable in the trachea and lungs. The most obvious gradient was in respiratory bronchioles where the degree of damage was most severe in proximal locations. A second gradient in severity was noted in conducting airways in which more severe and extensive lesions occurred in the trachea and major bronchi than in small bronchi and terminal bronchioles.


Section of tissue or prosthetic valve. A five-year prospective, randomized comparison. After considerable experience, controversy persists between the selection of a tissue or prosthetic valve. In order to provide a nonbiased comparison, we designed a prospective, randomized study in September of 1970. Ninety-nine consecutive patients with isolated primary single valve replacement were randomized to tissue or prosthetic valves. The Tissue Bank supplied homografts which were either mounted for mitral replacement or used as free grafts for patients with small aortic roots. Starr-Edwards clot-covered prostheses were used for comparison. There was an even distribution of patients by age, sex, valve lesion, and New York Heart Classification attesting to the accuracy of the random selection. Anticoagulants were used in 33 patients who had operative or embolic evidence of atrial cloth or else history of thromboembolism. Thirty-five patients have undergone postoperative catheterization. Causes of death and valve failure are presented on an actuarial basis. Death in the Starr-Edwards patient group was sudden or due to fabric wear with subsequent thromboembolism, hemorrhage, or infection. We conclude that the tissue valve is a better choice for valve replacement. While there is no significant functional or hemodynamic apparent difference between the tissue and prosthetic valve, there is improvement in patient morbidity and mortality rate with the use of homografts, particularly in the aortic position. The primary cause of complications in the homograft is tissue deterioration, and this problem has been markedly reduced with advent of glutaraldehyde fixation. No such advance in solving the problem of host incompatability with the prosthesis has been forthcoming.


Prolactin deficiency in pseudohypoparathyroidism. Because thyrotropin deficiency may occur in pseudohypoparathyroidism, we studied pituitary function in two families with this condition. Six of eight patients had impaired pituitary prolactin secretion after administration of thyrotropin-releasing hormone and chlorpromazine, with preservation of other anterior pituitary functions. Peak serum prolactin levels after thyrotropin-releasing hormone and chlorpromazine in the prolactin-deficient patients were significantly lower than normal. Administration of diethylstilbestrol for five days, which normally enhances prolactin responses to thyrotropin-releasing hormone, had no effect on prolactin secretion in these patients. Although antilactotroph antibodies were not demonstrable, hypothyroidism or decreased thyroid reserve in four and antithyroid and antiparietal-cell antibodies in several family members suggest that an associated autoimmune process may be responsible for the prolactin deficiency.


Effect of amniotic fluid on bacterial growth. The bacteriostatic effect of amniotic fluid was studied using four pathogenic organisms which are encountered in the perinatal period, E. coli, S. aureus, L. monocytogenes, and Group B beta hemolytic streptococci. Amniotic fluid inhibited the growth of all four organisms, with a wide degree of individual variation among specimens. The greatest degree of inhibition was noted for L. monocytogenes and the least for E. coli. The time in gestation in which the amniotic fluid sample was obtained did not appear to be related to its bacteriostatic capacity. The ability of amniotic fluid to inhibit the growth of certain pathogenic organisms may be significant in prevention of perinatal infection.


Pathogenesis of Rh immunization in primigravidas. Fetomaternal versus maternofetal bleeding. Rh immunization occurring during a first pregnancy with no history of preceding abortion or transfusion may result when Rh incompatible fetal to maternal bleeding ensues early enough in the gestation to initiate a maternal immune response before parturition. Alternatively, the initial antigenic stimulus could be the consequence of maternal to fetal transfer of Rh-incompatible erythrocytes while the patient herself was in utero or at the time of her own delivery. These hypotheses were tested by 1) analysis of the blood group and Rh of 22 Rh-immunized primigravidas, their infants, and their own mothers; 2) comparison of the number of fetal cells in the maternal circulation during the antepartum period in 20 women at high risk for fetal to maternal bleeding with their matched controls; and 3) Rho (D) antibody determinations in 70 Rh-negative infants born to Rh-positive mothers. The results indicate that antepartum fetal to maternal bleeding is the usual cause of Rh immunization in primigravidas, and the Rh-negative woman with blood group A, B, or AB who gestates an ABO-compatible Rh-positive male is at highest risk. The antepartum use of anti-Rho (D) immune globulin has potential prophylactic value in this situation.


Galactorrhea associated with primary hypothyroidism. Report of two cases. Two patients with primary hypothyroidism and galactorrhea are described. Elevated serum prolactin and thyroid-stimulating hormone levels were present. Following adequate thyroid hormone replacement restoration of clinical euthyroidism and cessation of galactorrhea occurred with a fall of both TSH and prolactin levels to normal.


A special report: four-year study of a boy with combined immune deficiency maintained in strict reverse isolation from birth. A 4-year study of a boy with combined immune deficiency is presented, and the impact of this disease on various aspects of his growth and development is examined. There is no evidence of immune deficiency in either parent or in the genetic background on the maternal side. Three children of a brother of the mother's father may have had immune deficiencies but two have grown to be teenagers with no problems. Another died. At autopsy, however, lymph nodes appeared normal. The deceased older brother had severe combined immune deficiency (SCID). The autopsy findings showed Pneumocystis carinii pneumonia to be the direct cause of death and these findings contributed to the diagnosis of SCID. After a successful germ-free birth, the male infant (DV) was placed in the isolator. Laboratory tests were normal except that the x-rays showed no thymic shadow, his absolute lymphocyte count ranged from 399-440/mm and the lymphocytes showed no proliferative response to phytohemagglutinin (PHA). Specific tests showed the antibody-producing immune system and the cell-mediated immune system to be severely defective. The patient's lymphocytes elicited positive responses by lymphocytes from father, mother, and sister. Subsequent search in national and international tissue-typing laboratories has shown four HLA matches but none has been nonreactive in mixed lymphocyte culture (MLC). therefore, this patient has remained in isolation to the present; now he is 4 years old. Approximately 35 species of microorganisms, mostly transient contaminants, have been isolated, taking into account that the same organism may have been identified under different names in different laboratories. Those isolated frequently and in sufficiently high concentration to indicate colonization have been speciated as follows: anaerobes-Propionibacterium acnes, Lactobacillus catenaforme (disappeared spontaneously), Bacteroides oralis ss. elongatus, Clostridium (perenne, hastiforme, bifermentans), Bacteroides clostridiiformis ss. clostridiiformis; aerobes-Alcaligenes faecalis (eradicated by antibiotics), Staphylococcus epidermidis, Enterobacter agglomerans, Microcossu sp. subgroup 1, Bacillus pulvifaciens (disappeared spontaneously); yeasts-Candida (tropicalis, parapsilosis). Seven are considered to be probable components of the current autoflora: P. acnes, C. bifermentans, B. clostridiiformis ss. clostridiiformis, S. epidermidis, Micrococcus sp. subgroup 1, E. agglomerans, C. parapsilosis. No viruses or protozoa have been isolated. At age 3 years, the mean quantitation of anaerobic cells was 7.9 X 10(7) viable cells/g feces; this falls short of the mean anaerobic load from normal children. The mean aerobic concentration was 1.2 X 10(8) viable cells/g feces, not unlike normal children. Qualitatively his flora has abnormally few species and lacks those most common in normal subjects. This child has had no evidence of infection and has always been in excellent health even though some organisms which could be pathogenic under some circumstances have been isolated...


[Prevention of meningococcal meningitis]. Meningococcal meningitis as well as meningococcal sepsis must be regarded as complications of an otherwise mild meningococcal infection of the nasopharynx. Only individuals without antibodies against a given meningococcal type will contract the above-mentioned diseases. Causal prophylactic measures have proved to be ineffective because of the great number of "carriers" of meningococci. Immunprophylaxis with specific polysaccharides is effective and presently available for use against types A and C but not against type B. Chemoprophylaxis is most effective when administered to those living in close quarters. Sulfonamides are the prophylaxis of choice agianst meningococci sensitive to sulfonamides. With the appearance of sulfonamide-resistant meningococci, the sulfonamide must be replaced by rifamycin or minocyclin. Though treatment with penicillin gives protection against infection, it does not eradicate the carrier state.


Insulin, glucagon, and glucose exhibit synchronous, sustained oscillations in fasting monkeys. In overnight fasted rhesus monkeys, synchronous, regular oscillations occurred in the plasma concentrations of glucose, insulin, and glucagon. The oscillations displayed a period averaging 9 minutes. The amplitudes for insulin and glucagon were ten and five times greater than for glucose. Insulin cycled in and glucagon out of phase with glucose. In baboons, oscillations of glucose and insulin were smaller than in rhesus monkeys, while in man, regular oscillations were not observed.


Diabetic cataracts and flavonoids.

Diabetic cataracts and flavonoids. Oral administration of quercitrin, an inhibitor of aldose reductase, leads to a significant decrease in the accumulation of sorbitol in the lens of diabetic Octodon degus. The onset of cataract is effectively delayed when quercitrin is continuously administered. Thus in these diabetic animals, as in galactosemic rats, the use of an effective aldose reductase inhibitor impedes the course of cataract development. These observations support the hypothesis that in diabetes, as in galactosemia, aldose reductase plays a key role in initiating the formation of lens opacity.


Isolation of eukaryotic DNA fragments containing structural genes and the adjacent sequences. In Drosophila melanogaster structural genes are located close to moderately reiterated sequences. One of the clones obtained contains the DNA related to intercalary heterochromatin of D. melanogaster. These are individual differences in the distribution of genetic material in polytenic chromosomes of different stocks of D. melanogaster. The techniques that allow isolation of DNA fragments containing structural genes at the beginning, in the middle, or the end of the coding strand have been elaborated.


The role of vasodilator therapy in heart failure. This article has attempted to summarize the current status of the therapeutic use of vasodilator drugs in acute and chronic heart failure. It is apparent from the increasing number of publications in this area that this alternative to more standard forms of therapy is likely to find a permanent and important place in the management of patients with heart disease. It should also be apparent that ideal drugs for the therapy of chronic heart failure are not yet available. Nevertheless, it is probable that such drugs will emerge and become at least as important as the routine use of digitalis in such patients.


Congenital transmission of a papovavirus of the stump-tailed macaque. Stump-tailed macaque virus, a newly recognized papovavirus of the SV40 polyoma subgroup, was demonstrated in kidney cultures from each of five stump-tailed macaque fetuses in the second half of gestation and from six adult stump-tailed macaques. Such regular presence of virus in the fetus is an unusual feature for a papovavirus.


Congenital anomalies induced in hamster embryos with ribavirin. Ribavirin, when given to pregnant hamsters in relatively small single doses, induces congenital anomalies of limbs, ribs, eyes, and central nervous system, as well as fetal deaths. On the basis of these findings, caution should be used in giving ribavrin to women of child-bearing age.


Inhibition of nonspecific defenses by soil infection potentiating factors. This study was undertaken to examine the effect of soil infection potentiating factors on the defense system of the tissue. Using an in vitro model, leukocyte phite. This damaging effect on leukocyte function was a result of an interaction between the leukocyte and the clay particles. Montmorillonite also interfered with nonspecific humoral defenses. Exposure of serum to clay rapidly eliminated its bactericidal bodies occurred without any damage to the serum opsonins.


[Pets and zoonoses (author's transl)].

[Pets and zoonoses (author's transl)]. What can be the views held by a veterinarain on zoonoses when he acknowledges that a relationship between man and pets has a definitely positive value? The first question is: is an animal suited to serve as a pet? This may be answered by the following question: which are the risks involved when man takes a pet into his home?


Serum thyrotrophin, prolactin and growth hormone, response to TRH during oestrogen treatment. The serum levels of thyrotrophin (TSH), prolactin (PRL) and growth hormone (GH) and the response of these hormones to 500 mug thyrotrophin-releasing hormone (TRH) iv were studied in menstruating women, in post-menopausal women before and after 2 mg oestradiol valerate for 5 consecutive days, and in men on long term oestrogen treatment. Oestrogen treatment had no effect on basal serum TSH levels, which were within the normal range in all groups. The TSH response to TRH was not different in menstruating and post-menopausal women and was not changed in the latter group after oestrogen treatment. In men treated chronically with oestrogens, the TSH response to TRH was similar to that found in normal male subjects.


The pituitary-thyroid axis in Klinefelter's syndrome. Conventional thyroid function indices (serum T4, T3, TSH and thyroidal RAIU before and after TSH) appeared to be normal in most of 25 clinically euthyroid patients with chromatine positive Klinefelter's syndrome. Administration of TRH, however, revealed a decreased TSH reserve in the Klinefelter patients, both off or on testosterone treatment, in comparison to euthyroidal eugondal male controls. Preliminary data suggest that this blunted TSH respnse to TRH is not a characteristic of Klinefelter's syndrome per se but might be caused by the concurrent hypergonadotrophism. Despite the blunted TSH response, the TRH mediated T3 response in the Klinefelter patients was about equal to that in the male controls.


Medium chain triglycerides for treatment of spontaneous, neonatal chylothorax. Lipid analysis of the chyle. Volume and contents of lipid and protein in the pleural fluid from a three weeks old girl with spontaneous chylothorax were studied (a) during parenteral, nonfatty nutrition and later (b) during administration of a formula (Biosorbin) containing medium chain triglycerides (MCT). The pleural fluid production could not be correlated to the treatment employed but suddenly ceased after 20 days management. Triglyceride and total esterified fatty acid concentrations in pleural fluid were high on admission when feeded with human milk, and chylomicrons and other lipoproteins were present in the chyle. During parenteral treatment a pronounced decrease in pleural fluid concentrations of triglyceride and total fatty acids occurred concomitant with a disappearance of the chylomicrons. During the following MCT diet a pronounced increase in triglyceride and total fatty acids concentrations appeared and the chylomicrons reappeared in the chyle. The cholesterol and phospholipid concentrations in the pleural fluid showed only small changes during the different treatments. No significant changes in protein and albumin concentrations of chyle were observed. It is concluded, that administration of the Biosorbin MCT formula, containing 871/2% of the fat as MCT, seems without value ih the treatment of spontaneous, neonatal chylothorax.


Effect of oral amino acid supplementation on liver disease after jejunoileal bypass for morbid obesity. Previous work in our laboratory and others suggests that protein malnutrition plays an important role in the pathogenesis of hepatic steatosis and dysfunction which characteristically appears after jejunoileal bypass for morbid obesity. Postoperative protein-calorie malnutrition is at least in part a consequence of diminished intestinal absorption of free amino acids. In an attempt to prevent liver disease, six morbidly obese patients were orally supplemented with essential amino acids for 4 months after surgery. Oral amino acid supplementation only partially influenced protein malnutrition and had no effect on deterioration of hepatic morphology and dysfunction. Although this mode of therapy appears to be ineffective in preventing postoperative liver abnormalities, other studies suggest that oral oligopeptide supplementation and parenteral administration of amino acids are beneficial. In addition to protein deificiency, other factors which may contribute to the development of liver disease are reviewed.


The urometer as a reservoir of infectious organisms. With the aid of epidemiologic tools such as serotyping and bacteriocin typing, organisms involved in hospital-acquired infections were traced to their hospital reservoir. One of these reservoirs was an instrument used to measure specific gravity of urine, the urometer.


Measurement of complement components in systemic lupus erythematosus by radial immunodiffusion. Total hemolytic complement activity (CH50) and levels of C4, C5, and Factor B determined by commercially available radial immunodiffusion plates were compared in sera from patients with systemic lupus erythematosus. There was a significant correlation between CH50, C4 and C5, but no correlation between Factor B and any of the other indices of complement activity measured.


A  comparison of serologic methods for diagnosis of Rocky Mountain spotted fever. Sera referred to the North Carolina Division of Health Services for rickettsial serology in 1974 were tested by complement fixation (CF), microimmunofluorescence (micro-IF), microagglutination (MA) and hemagglutination (HA) for antibodies against Rickettsia rickettsii. There was good agreement among micro-IF,MA and HA tests in detecting antibody responses to this agent, but the CF test was definitely less sensitive than the others, even in illnesses with classical clinical manifestations of Rocky Mountain spotted fever (RMSF). Some variables that seemed to influence the CF result were the slow rate of increase in antibody titers, timing of serum collection, early antibiotic treatment and possibly, the particular association of CF antibody response with the IgG immunoliobulin class. Greater use of these newer, but relatively untried, serodiagnostic procedures is recommended infuture studies of RMSF.


Problems in analyzing the comparative costs of private versus public psychiatric care. The authors outline the difficulties in attempting to compare the costs of service in various mental health settings, especially private practice and community mental health centers. Contributing to the difficulties are the differences in the populations served, differences in treatment modalities employed, and the different economic incentives operating in each setting. The authors stress the need for research on cost effectiveness as the basis for valid comparisons of various care settings.


Peripheral opacities in chronic eosinophilic pneumonia: the photographic negative of pulmonary edema. To test whether there is a radiographic pattern diagnostic for chronic eosinophilic pneumonia (CEP), radiographs of 591 patients with interstitial lung disease (2,852 films) were reviewed. A peripheral ground glass pattern was seen in 24 individuals (4.1%). Lung biopsies in 16 of these patients revealed CEP. The remaining eight bad all the clinical features of CEP. In a separate study, pathologic featues of 350 patients with interstitial disease were coded: CEP was the principal diagnosis in 21 (5.7%). Sixteen of the 21 had typical peripheral radiographic opacities. Review of published chest radiographs of 81 patients with CEP showed characteristic peripheral opacities in 53 cases (65%). Typically, dense opacities with ill-defined margins and without lobar or segmental distribution are seen arranged peripherally apposed to the pleura. The opacities are usually in an apical or axillary location, but are sometimes basal when they mimic loculated effusion. When the opacities surround the lung, the appearance is that of a photographic negative or reversal of the shadows usually seen in pulmonary edema. The opacities sometimes disappear and recur in exactly the same locations. Peculiar oblique or vertical lines without reference to hilus or anatomic divisions occasionally appear during resolution. Response to corticosteroid treatment is dramatic, with clinical improvement in hours and disappearance of radiographic shadows within a few days. The typical radiographic pattern is virtually diagnostic even without other information. In this series all patients with characteristic radiographs had CEP. Blood eosinophilia is confirmatory, but its absence does not exclude the diagnosis.


Macrodystrophia lipomatosa: radiographic diagnosis. Macrodystrophia lipomatosa is a rare form of localized gigantism characterized by progressive overgrowth of all the mesenchymal elements with a disaproportionate increase in the fibroadipose tissues. This congenital abnormality occurs most frequently in the distribution of the median nerve in the upper extremity and in the distribution of the planter nerves in the lower extremity. It is usually recognized at birth or in the neonatal period. As the patient grows, the deformity begins to mechanically interfere with joint function, vascular supply, and innervation. Six cases are described with emphasis on the radiographic findings which differentiate this entity from other forms of local gigantism. These findings include a predominately distal involvement, enlargement of the phalanges and soft tissue elements of the digit, and lucencies within the soft tissues.


The Dyggve-Melchio-Clausen syndrome.

The Dyggve-Melchio-Clausen syndrome. Two families with Dyggve-Melchior-Clausen syndrome are reported. In the first family, Jews from Morocco, six of 10 siblings are affected. In the second family, a consanguineous marriage of Arabs from Gaza, two of three children are affected. A description of the skeletal changes in patients ranging in age from 4 to 25 years is presented. The radiologic signs of generalized platyspondyly with double humped end plates and the lace-like appearance of thickened iliac crests are pathognomonic and distinctive of the syndrome. The diagnostic features of the disease are compared to those of Morguio's disease, spondyloepiphyseal dysplasia tarda, and spondylometaphyseal dysplasia.


The anatomic splenic flexure: an ultrasonic renal impostor. The anatomic splenic flexure of the colon occupies the left renal fossa in patients with agensis or ectopic of the left kidney. On ultrasonic scans, the colon filled with stool or fluid may simulate a kidney or mass. This mass is often comma shaped on the transverse scans and lacks good definition of its inferior margin on longitudinal scans. An evaluation of a patient with only right renal function should combine radiologic techniques with ultrasonography to establish the correct diagnosis.


B-mode ultrasound and the nonvisualizing kidney in pediatrics. Ultrasonic definition of the kidney is independent of renal function and therefore capable of imaging impaired or dysplastic renal tissue, In 28 cases, B-mode scanning delineated one or both kidneys which failed to visualize during intravenous pyelography. Similar imaging of both kidneys was obtained in 10 cases of renal failure in which intravenous pyelography was not attempted. The presence and relative severity of hydronephrosis was established. In three cases of multicystic kidney, a diagnostic appearance was elicited. In these instances, in one additional case of renal dysplasia, and in three cases of severe obstructive uropathy, sonography provided the only presurgical definition of the abnormal kidney. Suspected kidney enlargement was rapidly confirmed in a case of renal vein thrombosis and excluded in a case of chronic renal failure. In both instances hydronephrosis was excluded. In 12 of the 38 cases, ultrasonic guidance was utilized for percutaneous renal biopsy.


Differential diagnostic features of the radionuclide scrotal image. Differential diagnosis of scrotal lesions is aided by correlating radionuclide images with clinical findings. Subacute torsion is associated with peripheral hyperemia and can be mistaken for an inflammatory process; however, in a review of 128 studies, torsion and orchiectomy were the only processes encountered which had a center truly devoid of activity on the tissue phase compared to the normal side. Other lesions such as acute inflammation, abscess, hematoma, and hemorrhagic tumor may superficially appear to lack central activity but invariably contain at least as much activity when compared to the normal side.


Fatal radiation pneumonia following subclinical busulfin injury. A patient with polycythemia vera received a moderate dose (480 mg) of busulfan intermittently over a 6 year period and later developed Hodgkin's disease. Following split-course upper mantle, chest irradiation, he developed rapidly progressive, fatal pneumonia and bone marrow hypoplasia. It is postulated that the hyperacute organ failures (lung and bone marrow) resulted from augmentation of subclinical busulfan-induced damage of these organs by additive radiation effect. It is recommended that in patients who have had antineoplastic chemotherapy, major radiotherapy to the cervicothoracic region be accompanied by careful monitoring of respiratory and hematopoietic function, both before and during radiotherapy.


Passage of feeding catheters into the pleural space: a radiographic sign of trauma to the pharynx and esophagus in the newborn. Although rarely recognized, traumatic pharyngeal and cervical esophageal pseudodiverticula are probably not infrequent in newborns who have undergone vigorous oropharyngeal suctioning and endotracheal intubation. This report describes four premature infants with clinically unsuspected retroesophageal false passages incidentally discovered on chest radiographs. Differentiation of pseudodiverticula from spontaneous rupture of the middle or distal esophagus can be achieved by careful inspection of the course of the feeding catheter in frontal and lateral projections and by partial withdrawal of the catheter to permit injection of the retroesophageal false passage with a small volume of water-soluble contrast material.


Diagnosis of pericardial effusion in children: a new radiographic sign. A band of increased density paralleling the left lower border of the cardio-pericardial silhouette is seen on anteroposterior chest films in some children with pericardial effusions. To analyze the incidence and accuracy of this sign, films of children with pericardial effusions and controls were compared. Among 17 children with proved pericardial effusion, bands of density within the cardio-pericardial silhouette were seen in six films, while positive epicardial fat pad signs were seen on four. When three radiologists without experience in use of the sign evaluated radiographs of the six patients with the sign and six controls without pericardial effusion, the sign was detected in most instances in the children with effusions (specificity and sensitivity, 83%). In vitro studies of unpreserved hearts in baths of solutions of varying osmolarity failed to show detectable differences in density between myocardium and any of the solutions. We conclude that the new sign may be produced by epicardial fat adjacent to pericardial fluid.


Eccentric pericardial effusion after radiation therapy of left breast carcinoma. Pericardial damage is one of the consequences of cardiac radiation and may lead to chronic pericarditis and/or tamponade. In three patients treated with radiation for carcinoma of the left breast, the effusions were loculated on the right side of the pericardium resulting in a peculiar cardiac silhouette. The importance of recognizing this entity and possible treatment is stressed.


Use of Fogarty catheter tamponade for ruptured abdominal aortic aneurysms. A simple rapid potentially life-serving aid in the treatment of ruptured abdominal aortic aneurysms by the use of a Fogarty no. 8 French catheter is presented. In five cases at high surgical risk, further bleeding was successfully controlled by occluding the aorta proximal to the site of the ruptured aneurysm, making operative procedure easier. Four of the five patients survived the procedure. The technique of inserting the catheter via a left axillary arteriotomy and the solutions to certain technical difficulties are discussed.


The role of angiography in the diagnosis of tracheal--innominate artery fistula. When a tracheal-innominate artery fistula is suspected, angiography is essential if the patient's condition is stable. An aggressive  angiographic approach is needed to demonstrate the fistulous tract. Multiple injections in different degrees of obliquity and subtraction views should be obtained for early accurate diagnosis and for optimal demonstration of the pathologic anatomy.


Inferior vena caval occlusion: characteristic radiographic changes on excretory urography and barium enema examination. Acute occlusion of the inferior vena cava produces characteristic radiographic findings on intravenous urogram and barium enema examination. The urinary bladder is compressed anteriorly  and superiorly giving an inverted pear-shaped appearance, and the distal ureters are medially displaced. Barium enema examinations demonstrate narrowing and elevation of the rectosigmoid region along with an increase in the presacral space. Four cases are described to illustrate the usefulness of these findings in suggesting the correct diagnosis.


Complications of lymphangiography in patients of advanced age. The case records of 81 patients over the age of 60 were reviewed with respect to complications following lymphangiography. Adverse prognostic factors and complications were studied. Of the 81 patients, 48 were 60-69 years old and 33 were 70 or older; 19 patients had mild risk factors and 16 had severe risk factors. There were only six complications secondary to lymphangiography--two moderate and four mild. No severe complications were noted. This study suggests that age in itself is not a contraindication to lymphangiography.


Endoscopic retrograde intrahepatic cholangiogram: radiographic findings in intrahepatic disease. Endoscopic retrograde intrahepatic cholangiograms were evaluated in 107 patients and correlated with intrahepatic diagnoses determined by liver biopsy. Included were normal livers (six), cirrhosis (38) portal fibrosis (14), cholangitis (22), metastases (11), and miscellaneous diagnoses (16). Results suggest that differentiation of the normal from the abnormal intrahepatic biliary system using the endoscopic retrograde intrahepatic cholangiogram is possible, and that certain patterns of abnormality prevail within given disease categories. The cholangiogram in cirrhosis is marked by ductular stenosis, diminished arborization, tortuosity, and approximation of the intrahepatic ducts. Sclerosing cholangitis demonstrates focal stenoses with concomitant ectasias and frequent similar involvement of the extrahepatic system. Chronic cholangitis and portal fibrosis are frequently associated with extrahepatic obstructing lesions and increased intrahepatic ductal caliber, but demonstrate no distinguishing intrahepatic characteristics. Intrahepatic metastases, polycystic liver disease, and primary hepatic neoplasm produce mass effects consisting of ductal displacement, narrowing, and obstruction. The potential of endoscopic retrograde intrahepatic cholangiography in evaluating the intraheptic biliary tree is significant; specifically in separating normal from abnormal, in distinguishing between intrahepatic processes, and as an adjunct to liver biopsy in determining the extent and location of intrahepatic abnormalities.


Fiberoptic endoscopy and upper gastrointestinal series: comparative analysis in infants and children. Fiberoptic endoscopy is a new and highly efficient diagnostic tool which is being increasingly used in the pediatric age group. Its use in children requires general anesthesia, special facilities, and technical expertise. We have compared the results of upper gastrointestinal barium studies and fiberoptic endoscopy in 75 cases. Results agreed in approximately two-thirds of the cases; in one-third there was disagreement. Superficial lesions in the esophagus, stomach, and duodenum were most often missed by conventional barium studies. False positive radiologic reports were primarily related to the region of the duodenum.


An evaluation of colon cleansing regimens. To study the efficacy of colon cleansing regimens, 500 hospital outpatients were randomly assigned to one of four regimens. Two featured castor oil followed by phosphate enema and two used magnesium citrate and bisacodyl. For the 349 patients who completed all components of the regimens, quality of the subsequent barium enema examination was scored by three radiologists in a blind manner. Regimens featuring magnesium citrate and bisacodyl were found to be significantly superior to those featuring castor oil. Calcium bisdiocytl sulfosuccinate did not improve the quality of colon cleansing but appeared to decrease the incidence of abdominal cramping in patients receiving magnesium citrate and bisacodyl. It is hoped that the investigative approach used in this study may serve as a model for future testing of colon cleansing regimens.


The neonatal colon: an anatomic approach to plain films. An appreciation of haustral anatomy as well as the anatomic relationships of the colon serve as the basis of plain film colon identification in the patient beyond infancy. An evaluation of the newborn colon in the normal state and with low colonic obstruction indicates that these principles apply here as well. Newborns with suspected intestinal obstruction should be studied in multiple projections early in their clinical course. A search should be made for haustrations and characteristic anatomic relationships of the colon, as well as gas in the rectum. Although clear differentiation of large from small bowel obstruction may not always be possible, these principles should serve as a basis for a systematic approach to the newborn abdominal plain film.


Megacolon associated with celiac sprue: report of four cases and review of the literature. Four cases of megacolon associated with celiac sprue are described and the literature reviewed. On barium enema examination, the colon is dilated and redundant with normal evacuation. Dilatation may be related to increased stool bulk delivered to the colon and/or to an intrinsic colonic abnormality in celiac sprue.


Transverse colon volvulus: case reports and review. Volvulus of the transverse colon is an uncommon event but results in mortality or significant morbidity relatively more often than cecal or sigmoid volvulus. Two cases are presented with emphasis on incidence, predisposing factors, clinical presentation, and radiologic examination. The need for early diagnosis and surgical intervention is stressed.


Radiographic features of gastric polyps in familial adenomatosis coli. Recent reports have noted a high frequency of elevated mucosal lesions of the stomach in patients with familial adenomatosis coli. This paper describes an additional 10 cases from six different families. Nine patients had sessile polyps in various portions of the stomach. Six of these have been examined histologically; two were adenomatous and four hyperplastic. The need for meticulous examination of the stomach in patients with multiple colonic polyposis is emphasized.


Ileocecocystoplasty: some radiologic observations. Ileocecocystoplasty was used in eight carefully selected patients to enlarge diseases urinary bladders. Postoperative radiologic evaluation often demonstrates bizarre findings, requiring knowlege of the surgically created anatomy and physiology of the ileocecal segment for accurate interpretation. Details of the surgical manipulations and pertinent radiographic observations following this operation are presented.


Lamellated periosteal reactions: a radiologic and histologic investigation. The lamellated periosteal reaction produced in the hind limbs of seven beagle puppies following ligation of the femoral vein was used as a model for studying the mechanism of lamellated new bone formation. Rather than resulting from alternating periods of slow and fast growth, this lamellated periosteal reaction was caused by acceleration of the normal process of periosteal bone growth. This involvement is thought to explain the "physiologic" periosteal new bone of early infancy.