Significant new observations on cervical spine trauma. The results of a computer analysis of 399 patients with documented fractures and/or dislocations of the cervical spine are summarized. Vertebral arch fractures were present in half of all patients with radiographic evidence of cervical spine trauma. Two-thirds of the patients had two or more injuries. Isolated disk injuries were rare and, when present, were characterized by a vacuum sign. The dens fracture, with or without atlantoaxial dislocation, was rarely associated with injury elsewhere in the cervical spine. The study suggests that the routine five-film cervical spine examination is inadequate to detect the most common traumatic lesions. Thus vertebral arch views (pillar views) should be obtained if there is evidence to suggest hyperextension as the mechanism of injury. In addition, the study underscores the importance of aggressively searching for multiple abnormalities.


Multiple level spinal injuries: importance of early recognition. Patients with severe trauma may simultaneously sustain more than one level of spinal injury. Often, the second or third levels of injury are not recognized early enough to prevent clinically significant extension of the neurologic deficit, pain pattern, spinal instability, and/or deformity. A review of 710 spinal injury patients admitted to the Midwest Regional Spinal Cord Injury Care System yielded 4.5% multiple noncontiguous vertebral injuries. Thirty cases were studied in respect to location and type of primary and secondary injury. Of the secondary lesions, 40% occurred above and 60% below the primary lesion. In half of the patients, there was a mean of 52.6 days delay in diagnosis of the secondary lesion. Three major patterns of injury emerged from this analysis. Knowledge of these patterns and careful total spine radiography in patients with severe trauma may be a significant aid in early recognition of multiple level injuries and possible prevention of their complication.


Bone mineral in Vilcabamba, Ecuador.

Bone mineral in Vilcabamba, Ecuador. Bone mineral content was measured by photon absorptiometry of the radius in an Ecuadorian population noted for longevity and for rarity of fractures and spinal curvature in the elderly. Bone mass, after covariance adjustment for age, height, weight, and bone width, was 15% below values for U.S. whites, indicating that the rarity of skeletal problems was not due to high bone mass or diminution of aging bone loss.


The pedicle in neurofibromatosis.

The pedicle in neurofibromatosis. Three cases of von Recklinghausen's disease (neurofibromatosis) are described, one with agenesis of a pedicle, another with multiple hypoplastic pedicles, and a third with bilateral hypoplastic pedicles producing a spondylolistesis. These peidcle deficiencies are manifestations of mesodermal dysplasia. Agenesis of the pedicle most likely represents a defect in chondrification. Hypoplasia probably represents a partial lack of development of the pedicle and the ipsilateral arch. Hypoplasia or agenesis of a pedicle should suggest the possibility of underlying neurofibromatosis.


Evaluation of endoscopic retrograde cholangiopancreatography and angiography in the diagnosis of pancreatic carcinoma. A series of 118 patients with suspected pancreatic disease was studied by endoscopic retrograde cholangiopancreatography (ERCP). Angiography was subsequently performed in 30 of these patients. ERCP was 95% accurate in the prospective diagnosis of pancreatic carcinoma. This study suggests that angiography is valuable in determining tumor resectability following ERCP diagnosis of pancreatic carcinoma. Angiography may obviate the need for exploratory laparotomy in patients with unresectable tumors and encourage aggressive treatment of resectable lesions. Patients with a high clinical suspicion of pancreatic disease should have angiography if the ERCP is normal, equivocal, or there is a cannulation failure.


Barium duodenography as an adjunct to percutaneous transhepatic cholangiography. Performance of barium duodenography at the end of transhepatic cholangiography improves visualization of the anatomy of the porta hepatis and lower common bile duct. The relationships of C loop, common the bile duct, and ampulla are clearly demonstrated. Without the barium study, the variability of the relationship between the biliary tree and the duodenum may not be appreciated. The technique is described and illustrated by four cases.


Fine needle cholangiography in postcholecystectomy patients. Thirteen cholecystectomized patients with postcholecystectomy symptoms are described. The patients were investigated with a combination of intravenous cholangiography and fine needle cholangiography. Fine needle cholangiography was found useful in patients with nonvisualized or questionably abnormal bile ducts on intravenous cholangiography. In one patient the intravenous cholangiogram was normal, but percutaneous cholangiography demonstrated calculi.


Bacteremia during barium enema study.

Bacteremia during barium enema study. The occurrence of bacteremia was studied in patients undergoing barium enema. Blood cultures were done on 34 patients before, during, and after the procedure using two schedules. Cultures were obtained once during the procedure in the first schedule and four times in the second. None of the cultures were positive by the first schedule, while 23% of patients studied by the second schedule had one or more positive cultures. Organisms isolated were anaerobes. The bacteremia was transient and self-limited, without serious clinical sequelae. The incidence of bacteremia during barium enema examination was statistically indistinguishable from bacteremia previously reported during colonscopy. It is concluded that antibiotic prophylaxis is not indicated in most patients undergoing colonic diagnostic procedures. Prophylaxis in selected high-risk patients requires further study.


Angiography of abdominal leiomyosarcoma. The spectrum of angiographic findings of abdominal leiomyosarcoma in 33 cases is presented, and the value of angiography in the diagnosis and management of such patients is discussed. Angiographic features of abdominal leiomyosarcomas are different depending upon the site of origin. Small bowel lesions are hypervascular, and those in the stomach and colon moderately vascular. Well circumscribed masses with enlarged feeding arteries and draining veins form the predominant presentation of small bowel leiomyosarcoma. In the retroperitoneum these neoplasms are usually hypovascular to moderately vascular, and displacement of major vessels, particularly the inferior vena cava, is the most common angiographic finding. Bladder leiomyosarcoma can be either moderately vascular or hypervascular. Vascularity of metastases is usually similar to that of the primary lesion.


Sensitivity of gray scale ultrasound in detecting urinary tract obstruction. To determine the reliability of gray scale ultrasound in detecting urinary tract obstruction, a prospective study of 67 patients examined by both excretory urography and ultrasound was undertaken. The degree of hydronephrosis was defined by urographic criteria, and the corresponding echograms were analyzed without knowledge of the urographic results. Hydronephrosis was correctly diagnosed by ultrasound in 46 of 47 kidneys shown to be obstructed on urography, for a sensitivity of 98%. Our results show that when obstruction is the sole clinical question, ultrasound is an effective screening test. Thus many patients with a variety of medical diseases of the kidney can be spared excretory urography.


Accuracy of CT staging of bladder neoplasms using the gas-filled method: report of 21 patients with surgical confirmation. CT staging of bladder neoplasms is a highly accurate procedure with a proven accuracy rate of 81% and a potential accuracy rate probably above 90%. At this institution, CT staging has become a routine procedure for all patients with bladder neoplasms prior to surgery or radiotherapy as well as to follow the progress of therapy. Staging of bladder carcinoma is performed by cystoscopy with biopsy, intravenous urography, and CT of the gas-filled bladder. Of 21 patients with surgical confirmation, 17 were correctly staged solely from the CT image. Overstaging in the four errors resulted from confusion produced by normal contiguous extravesical structures and by tangential viewing of the normal bladder wall. Negative contrast allowed precise demonstration of the morphology of the intravesical portion of the tumor.


Gray scale ultrasonography of adrenal neoplasms. Ultrasonic characteristics of 21 adrenal neoplasms (19 patients) examined by gray scale ultrasonography are reviewed. The significance of the adrenal-renal cleavage plane is discussed. In our experience the cleavage plane only has definite localization value when it separates the adrenal gland from the kidney on all ultrasonographic sections. Compression of the posterior wall and/or anterior displacement of the inferior vena cava was seen in about two-thirds of the right adrenal tumors. The difficulty in examining left adrenal masses is emphasized. Ultrasonography has proved to be an excellent screening procedure for adrenal tumors.


The suprasternal fossa on chest radiographs in newborns. Visualization of the suprasternal fossa in the newborn is due to suprasternal retraction. It is seen in 59% of patients with respiratory distress syndrome of the premature prior to intubation, and in 5% of patients with conditions such as pneumonia, meconium aspiration, and transient tachypnea of the newborn. The lower compliance of the lungs in patients with respiratory distress syndrome and increased compliance of the chest wall in premature infants accounts for the higher incidence of accentuation of the fossa. Visualization of the suprasternal fossa can simulate the distended proximal pouch of esophageal atresia. The two can be differentiated in the lateral view where the pretracheal location of the fossa can be appreciated.


Tween 80/diatrizoate enemas in bowel obstruction. Although successful treatment of meconium ileus with Gastrografin enema has been attributed to the hypertonicity of this material, Tween 80, present in a 0.75% concentration, may be its most effective component. Tween 80 acts as a surface-active substance and stool emulsifier. An enema solution of 1%-2% Tween 80 and isotonic sodium diatrizoate has been effective in the relief of meconium or fecal mass obstruction in infants and children.


A phlebographic study of the incidence and significance of venous thrombosis in the foot. A total of 188 foot phelbograms in 100 patients with suspected venous thrombosis or pulmonary embolism were studied. Thrombus was demonstrated in 59 (31%) of the foot phlebograms. It is concluded that foot vein thrombosis is common, that it may be a source of pulmonary embolism, and that venous thrombus may start in the foot veins and spread into the calf. Foot phlebography should become part of the routine examination of patients with suspected deep venous thrombosis or pulmonary embolism.


Diagnosis of ascending transtentorial herniation by cranial computed tomography. The secondary effects of large infratentorial masses may include ascending transtentorial herniation. Rostral displacement of the superior vermis through the tentorial incisura can be accurately detected by cranial computed tomography. Signs of early or impending upward herniation are compression and slight posterior flattening of the quadrigeminal plate cistern. Progressively more severe herniation produces amputation of the peritcetal cerebrospinal fluid diamond, leading to a triangle or "squared off" appearance of the confluent quadrigeminal and superior cerebellar cisterns. When the disorder is severe, the herniated vermis plugs the incisura, completely effacing these cisterns and flattening the posterior third ventricle. Obstructive hydrocephalus may also occur with moderate or severe herniation.


Computed tomography and skull radiography in the diagnosis of calcified brain tumor. Among 104 consecutive patients with verified brain tumor, 13 (12.5%) had histologic evidence for calcification. Skull radiographs and CT scans of those cases revealed that in most instances calcification detected by CT was also present on skull radiographs. In cases with a high density lesion present on CT and normal skull radiography, the maximum density on CT was below that which characterizes calcification. The study suggests a complementary role of the two modalities in investigating intracranial calcification.


The vertex scan: an important component of cranial computed tomography. Physicians who monitor cranial computed tomography occasionally omit the most superior aspects of the brain and calvarium because of time limitations and overloaded scanning schedules. In addition, standardized CT reporting forms as well training literature distributed by some manufacturers support the concept that a complete CT series consists of three scan pairs. Omission of a vertex scan pair results in failure to visualize 10%-15% of the brain volume. We have reviewed the results of 2,000 consecutive CT studies to determine the number and variety of pathologic entities that would have been missed had a vertex scan not been obtained. The most significant or sole abnormality was present on the vertex scan alone in 3% of the cases. Examples are presented. A true vertex levels should be obtained in every routine CT examination.


Computed tomography in cranial tuberculosis. Twelve patients with proven tuberculosis were studied by computed tomography. Three had tuberculomas and nine had tuberculous meningitis. Although a definite diagnosis is often not possible on CT, the method is of value in determining number, location and extent of lesions. In patients with tuberculous meningitis, CT is helpful in assessing the degree of hydrocephalus and in evaluating the effectiveness of antituberculous therapy.


Electrocardiographic changes simulating acute myocardial infarction caused by hyperkalemia: report of a patient with normal coronary arteriograms. A patient is described with severe diabetic ketoacidosis and hyperkalemia who presented with an ECG resembling an acute anterior wall myocardial infarction. Treatment of hyperkalemia resulted in prompt return of the ECG towards normal. Subsequent work-up including exercise testing and selective coronary arteriography ruled out any significant coronary artery disease suggesting that the ECG changes were probably caused by hyperkalemia. While similar changes have rarely been described in the past, this would appear to be the first such case in whom coronary artery disease was ruled out by a negative exercise testing and coronary arteriography.


Changes in the red blood cell membrane in protein-calorie malnutrition. Ten children with protein-calorie malnutrition (five with kwashiorkor, three with marasmus, and two with marasmic-kwashiorkor) were studied at hospital admission and during recovery for evidence of changes in red blood cell lipids, osmotic fragility, and chromium survival. On admission, the children had significantly higher-than-normal red blood cell membrane cholesterol and phospholipid, and an elevated cholesterol:phospholipid ratio. Both red blood cell osmotic fragility and red cell survivals were depressed. These measurements returned to normal limits with recovery.


Respiratory hydrogen excretion as a parameter for lactose malabsorption in children. Respiratory hydrogen excretion was measured during tolerance tests with lactose, glucose plus galactose, and skim milk in 52 children, 4 to 15 years of age. Ten children appeared to be lactose-malabsorbers, as reflected by increased respiratory hydrogen excretion after administration of 2 g lactose per kilogram, maximum 50 g. Skim milk, equivalent to 0.5 g lactose per kilogram was administered to all lactose-malabsorbers. Eight children were tolerant and two children were "intolerant" for this physiological amount of lactose when administered as skim milk. Disaccharidase activities of jejunal biopsies were determined in all 10 children with lactose malabsorption. Lactase activity was deficient in nine children and normal in one child. The increase of blood glucose during the lactose tolerance test did reflect lactose malabsorption less accurately than the respiratory hydrogen excretion.


Carnitine metabolism in human subjects. III. Metabolism in disease. Carnitine metabolism is reviewed in lipid storage myopathies, diabetes, vomiting sickness of Jamaica, malnutrition, hyperthyrodism, Duchenne dystrophy, and a few other disease states.


Vitamin B12-binding proteins in serum and plasma in various disorders. Effect of anticoagulants. Because of recent developments in the study of vitamin B12-binding proteins, the levels of the three serum binders were compared in serum and plasma samples from subjects with various disorders. The results allow the following conclusions: (1) As previously reported, transcobalamin (TC) III and to a lesser extent TC I are artifactually elevated in serum. The appear to be released in vitro during the clotting process, presumably from granulocytes. (2) Blood cells of patients with polycythemia vera release exceedingly large amounts of TC I and TC III in vitro. (3) The above findings support, but do not prove, at least a partial granulocytic source of TC I. Nevertheless, factors other than granulocytes influence TC I levels, as disorders characterized by increased TC I (most prominently chronic myelogenous leukemia but also several cases of cancer) manifest relatively little cellular release of TC I in vitro. (4) Despite the serum artifact, the serum abnormalities described in various conditions were seen in plasma also, even though the actual values of themselves were lower in plasma. The chief exception was TC III, which was elevated in plasma only in polycythemia vera (and in a few cases of leukocytosis). (5) EDTA-NaF anticoagulant is not suitable, as it causes plasma dilution, thus explaining previous reports of TC II level differences between serum and plasma. EDTA is therefore a preferable anticoagulant for vitamin B12-binding protein studies, although it too may not be ideal.


Immunochemical detection of human blood in feces. Current methods for testing stool samples for hemoglobin utilize peroxidase oxidation of chemical indicators such as guaiac or benzidine. These tests have frequent false-positive and false-negative results, complicating random screening for occult gastrointestinal bleeding. The authors have developed an immunochemical test for human blood in feces using goat antibodies to hemoglobin. When employed in radial immunoassay the test is uncomplicated by cross-reaction with common human foods or other nonhemorrhagic fecal fecal constitutents. The lower limit of sensitivity for hemoglobin in stool samples is 10 mg/dl, compared with a commonly reported threshold of 100 mg/dl for peroxidase tests. The test accurately detects hemoglobin in mixtures of human blood and feces. Immunochemical identification of human blood in stool offers improved detection of lower gastrointestinal bleeding.


Lymphoproliferative disease with IgM lambda monoclonal protein and autoimmune hemolytic anemia. A report of four cases and a review of the literature. Four patients with lymphoproliferative disease with immunoglobulin M lambda (IgMlambda) monoclonal proteins and severe autoimmune hemolytic anemia are described. These patients had many features in common that may warrant their recognition as a specific entity within the lymphoproliferative spectrum. In each case, a wide thermal range low titer cold agglutinin was present. The association of cold autoimmune hemolytic anemia with IgMlambda monoclonal protein and lymphoproliferative disease is unusual. The literature on IgM monoclonal proteins associated with lymphoproliferative disease is reviewed with emphasis on the presence of direct antiglobulin test positive autoimmune hemolytic anemia.


The trisomy 4p syndrome: case report and review. We report a further case of trisomy 4p: a 5-year-old mentally retarded boy with characteristic facial features, eye abnormalities, flexion contractures, several bone anomalies, and hyperactivity. In a review of 27 cases (11 male, 16 female, 22 families) the cytogenetic and clinical data were tabulated and analyzed. Diagnosis is established by karyotype: there is always partial or apparently "total" trisomy of the short term arm of chromosome 4. In 19 families a parent carried either a balanced translocation (16 times) or a pericentric inversion (3 times); 3 patients had de novo duplication of 4p. In several cases, additional deletions or trisomies were present. From the analysis of all cases, but particularly of the "pure" trisomies, the phenotypic spectrum of this condition was observed and found to be a specific multiple congenital anomaly/mental retardation (MCA/MR) syndrome. Its main features are a characteristic facial appearance, postnatal growth retardation, severe psychomotor retardation with or without seizures, microcephaly, and various major and minor anomalies.


Morquio-like syndrome with beta galactosidase deficiency and normal hexosamine sulfatase activity: mucopolysacchariodosis IVB. A 14-year-old white girl with mild dysostosis multiplex, odontoid hypoplasia, short stature, cloudy corneas, keratansulfaturia, but without detectable central nervous system abnormalities was referred with the diagnosis of Morquio syndrome. Clinical and roentgenographic findings were minimal compared to those of typical patients with the Morquio syndrome, MPS IV. Beta-Galactosidase activity in extracts of the patient's cultured fibroblasts was deficient, while that of galactosamine-6-sulfate sulfatase was normal. Conjunctival biopsy revealed intracytoplasmic vacuoles typical of lysosomal storage diseases. It is postulated that in this patient the deficiency of a beta-galactosidase is responsible for inadequate degradation of keratan sulfate and the appearance of a mild form of the  Morquio syndrome (MPS IVB).


Response of immature baboon fetal lung to intra-amniotic betamethasone. Intra-amniotic betamethasone (6 mg.) given to six immature fetal baboons, at four and again at three days prior to delivery by cesarean section, between 147 and 158 days' gestation (term = 180 days), significantly increased the amniotic fluid lecithin/sphingomyelin (L/S) ratio. At delivery, treated animal lungs were more mature in that they had a significantly  increased deflation stability and significantly decreased minimum surface tension in minced lung when compared to five control animals. Changes in maximum air distensibility lagged behind changes in deflation stability. The major molecular species of pulmonary phosphatidylcholine were analyzed by gas liquid chromatography as the diacylglycerol derivatives. The proportions of 14:0/16:0, 16:0/16:0, and 16:0/18:0, were significantly increased over control proportions while unsaturated species tended to decrease in animals exposed to intra-amniotic betamethasone. The immature fetal baboon pulmonary system responded to intra-amniotic betamethasone with a synchronous increase in the L/S ratio, improved pulmonary stability, and a more mature pulmonary lecithin composition, but did not demonstrate a synchronous increase in tissue distensibility.


Serologic and animal inoculation studies of a communal outbreak of viral hepatitis, type A. Sera from individuals in an outbreak of viral hepatitis in a multifamily household, probably spread by contaminated food, were studied for antibodies to hepatitis A virus (anti-HAV), and selected acute phase sera were inoculated into marmosets. Significant rises in anti-HAV titers between acute and convalescent sera occurred in all of 15 individuals in the outbreak who experienced serum enzyme elevations and in one of 14 individuals whose serum enzyme levels remained normal. The remaining 13 individuals in the latter group had antibody levels in both early and late sera compatible with residual immunity from prior HAV infections and correlating with resistance to reinfection. Groups of marmosets were infected with acute phase sera from two of the cases; in both instances the inoculated sera contained substantial levels of anti-HAV. The marmosets developed specific anti-HAV seroconversions as well as enzyme elevations.


Temporal relationships of estrogen, progesterone, and luteinizing hormone levels to ovulation in women and infrahuman primates. These studies were undertaken to ascertain the interval between the estrogen and LH peaks and ovulation in women, rhesus monkeys, and baboons. Estrogen, progesterone, and LH were measured by RIA. Ovulation was documented by visual examination of the ovaries, histology of the corpora lutea, and recovery of ova. The data for human subjects was based on a group of 23 normal women scheduled for surgical sterilization. Blood was drawn daily between 8:30 and 10:30 P.M. beginning on day 10 of the cycle. Surgery was performed 1 to 5 days after the LH peak. The hormonal findings were correlated with the histology of the corpus luteum. The mean interval from the estrogen peak to ovulation was 34 hours, the interval from the estrogen peak to the LH peak was 24 hours, and that from the LH peak to ovulation was 9 hours. In 46 rhesus monkey cycles and in 53 baboon cycles diagnostic serial laparoscopic examinations were initiated following the estrogen peak and repeated every 24 hours until ovulation was confirmed. The mean interval between the estrogen peak and ovulation was 34 hours in the monkey and 41 hours in the baboon. The intervals from the estrogen peaks to the LH peaks were 12 hours in the monkey and 23 hours in the baboon. The intervals from LH peak to ovulation were 22 hours in the monkey and 18 hours in the baboon. Plasma progesterone levels were significantly increased prior to the LH peak in all three species.


Glucocorticoids and the rhesus fetal lung. The effects of glucocorticoids on primate fetal lung function have not been clearly delineated. In this prospective study of preterm rhesus fetuses exposed in utero to betamethasone for 72 hours, the most significant alteration was a striking increase in maximum lung volumes. Functionally less significant increases in residual lung volumes were also noted. The lungs of the treated fetuses did not exhibit lower extract surface tensions or increased phospholipid concentrations. These findings suggest that the major effect of betamethasone is on lung connective tissue elements, with minimal effects on alveolar surfactant. Additional evidence of the multisystemic effects of glucocorticoids was obtained in that significant differences in fetal, adrenal, hepatic, and placental weights also were observed.


Analysis of the hominoid os coxae by Cartesian coordinates. This study is based upon 48 3-dimensional coordinates taken on 4 fossil hominid and 127 extant hominoid coxal bones. The follis include Sts 14, SK 3155, MLD 7, and MLD 25. The comparative sample consists of 42 Homo sapiens, 27 Pan troglodytes, 29 Gorilla gorilla and 29 Pongo pygmaeus. The coordinates improve the metrical representation of the bone beyond what can be done with linear measurements because the shape complexity of the os coxae is so great. The coordinates are rotated and translated so that all bones are in a standard position. The coordinates are then standardized for each specimen by dividing all coordinates by the pooled standard deviation of X, Y, and Z coordinates. These data are treated to standard statistical analyses including analysis of variance, Penrose size and shape statistics, principal coordinates and components, and canonical variates analysis. The data are then further altered by using some specimen as a standard and rotating each specimen until the total squared distance between its coordinates and those of the standard are minimized. The same statistics are applied to these "best fit" data. The results show a high degree of agreement between the methods. The hominid os coxae are dundamentally different from the other hominoids and the fossil hominids share the basic hominid configuration but with some unique differences.


Blood groups of pig-tailed macaques (Macaca nemestrina). The human-type A-B-O blood groups of 57 pig-tailed macaques (Macaca nemestrina) were determined and the calculated gene frequencies, O = 0.8908, A = 0.0825 and B = 0.0267, gave excellent fit with the hypothesis of inheritance by triple allelic genes. In tests for simian-type blood groups with rhesus, baboon and crab-eating macaque immune antisera, it was shown that the red cells of pig-tailed macaques are polymorphic for several simian-type specificities defined by those cross-reacting sera. Pig-tailed macaques share with other macaque species the complex Drh-graded blood group system, which seems to occupy a special role among red cell antigens of macaques. Normal sera of three female macaques contained spontaneous isoagglutinins which selectively agglutinated the red cells of some pig-tailed as well as stump-tailed macaques.


Change in the management of adult groin hernia. Three hundred fifty-seven groin hernia repairs were performed under local anesthesia using a long-lasting local anesthetic agent. An ilioinguinal, iliohypogastric, and twelfth intercostal nerve block was carried out initially, followed by regional infiltration of the agent, using a technic first described by Ponka [8] with several modifications. This technic can be employed suffessfully in the majority of groin hernia repairs. It requires careful attention to detail in the administration of preoperative sedation and analgesia and the use of sharp dissection only and greater gentleness in the handling of tissue. We have observed a significant reduction in postoperative discomfort and the virtual elimination of urinary retention, urinary sepsis, atelectasis, and phlebitis in these cases. All patients are fully ambulatory, without assistance immediately after surgery and the majority are discharged the same day or the following morning. This results in a marked reduction in the total cost of repairing a groin hernia.


[Eigen-frequencies and lines of nodes from skulls (author's transl)]. The skull has a system of vibration with characteristic Eigen-frequencies and oscillation modes. Macereted and non-macereted skulls showed lines of nodes of a typical manner which is specific for the hominides. Specially the mod of vibration of the 2. Eigen-frequency is strongly correlated with the state of the skull. Defined fractures of the base causes the Eigen-frequency shifting in rostral direction. Patterns of fracture, diaphanoscopic and x-ray investigation showed no correlations to the mod of vibration of all the Eigen-frequencies. In the clinical practice this findings give a diagnostic possibility in immediate identification of the fractures and infractures.


A (comparative study on the nasal fossae of Tupaia glis and four insectivores. The macro- and microscopic anatomy of the nasal fossa of Tupaia glis was compared with those of some insectivores. No significant group differences were found as far as the intranasal structures are concerned. Since the number of receptor cells in the olfactory epithelium of Tupaia glis and Talpa europaea is smaller than in the other species studied, a slight reduction of the sense of smell is suggested.


Disodium cromoglycate in anaphylaxis and pollinois. Because disodium cromoglycate is being used in treating the symptoms of allergic patients and its mode of action remains uncertain, morphological experiments were conducted in an attempt to further elucidate this compound's mode of action. Rabbits with an ear chamber underwent anaphylaxis, lethal or sublethal, with microscopic observations of the microcirculation during anaphylaxis. At death or a chosen interval tissue of the ear chamber was secured for histological examination. The mast cells and the state of their granules were counted for each section. In no instance did disodium cromoglycate have any effect in preventing the gross or microscopic changes and disodium cromoglycate did not protect mast cells in passive anaphylaxis. The nasal mucosa of a subject sensitive to ragweed pollen was exposed to ragweed pollen in a non-pollen season and the gross symptoms of hay fever were noted. When the nasal mucosa was pre-treated with disodium cromoglycate, however, no symptoms were observed and biopsies of nasal mucosa showed more normal mast cells and fewer degranulated mast cells.


Occupational asthma of bakers.

Occupational asthma of bakers. Two cases of bakers with asthma are discussed. The etiologic mechanisms which play a role in baker's asthma are reviewed. Disodium cromoglycate may be used to minimize symptoms in this disease entity.


Cellular immunologic studies of malignant lymphoma in rhesus macaques. Cells from malignant lymphoma in 10 rhesus macaques were examined for lymphocyte surface markers. Three had features of T cells, 5 had features of B cells, and 2 lacked evidence of either B- or T-cell differentiation. Correlation between the histologic classification of cell type and the B- or T-cell nature of the neoplasms was not evident. Evaluation of serum electrophoresis, mitogen responses tests, and previous histologic studies suggest that the development of the neoplastic lymphocyte proliferation occurred following or during an abnormal immunologic response.


Tuberculosis screening for hospital employees. A five-year experience in a large community hospital. A 5-year experience in developing an annual tuberculosis screening program for employees of a 570-bed community hospital in a state with a low endemic rate of tuberculosis is described. Using a computerized payroll system to notify employees and the incentive of free lunch tickets, the program reached more than 95 per cent of the eligible employees. No active cases and only 7 skin test conversions (0.11 per cent) were found during the 5-year period; only 3 of the 7 converters worked in patient care. Three other converters (1.03 per cent) were found among the 291 employee contracts of 20 patients who were initially undiagnosed. The costs for comprehensive screening were high in relation to the low conversion rates found, and more selective screening may be justified in similar hospitals where the risk of acquiring tuberculosis is low. Nonetheless, because the problem of poor compliance was managed successfully, the program has provided an effective measure of protection for both patients and personnel.


[Four new pyocine types of "Pseudomonas aeruginosa": epidemiological significance (author's transl)]. The pyocin-typing of 448 Ps. aeruginosa from several Hospitals in Lisbonne has been done with the Gillies and Govan method; 69% Portuguese strains are in pyocinotypes n degrees 1, 3, 5 and 7; 16 % are in 24 other pyocinotypes. Four new pyocinotypes were found in a group of 34 atypical strains. The relationship between serotype and pyocinotype was investigated and the most frequent serotypes in Portugal (0:11; 0:6; 0:3) has been subdivided into numerous pyocinotypes with epidemiological significance.


[Studies on the bactericidal activity of glutaraldehyde (author's transl)]. Bactericidal activity of aqueous glutaraldehyde has been determined in comparison with aqueous sodium hypochlorite. Several bacterial strains have been tested and it was found that the activity of the glutaraldehyde solution was superior or equal to that of the hypochlorite solution with the exception of the action on mycobacteria.


[Slightly active Actinomyces streptomycini (Streptomyces griseus) mutants having a protein in the biosynthesis of the streptidine portion of the streptomycin molecule]. Twelve mutants having a block in biosynthesis of the streptidine part of the streptomyciu molecule were selected under the effect of nitrozomethylbiuret. These 12 strains responded by an increase in the level of the antibiotic production to the addition of streptidine to the cultivation medium. The complementation analysis showed that every streptidine-dependent mutant interacted at least with 2 other mutants. On the basis of the data obtained it is possible to conclude that all 12 mutants had blocks in streptidine biosynthesis but at different stages of this complicated process.


Studies on the differential inhibition by azide on the nitrite/nitrous oxide level of denitrification. A gas chromatographic method was used to demonstrate that nitrite can counteract the inhibition by azide of nitrous oxide reductase activity in denitrifiers. This effect explains why azide (and cyanide) can inhibit nitrogen production from nitrous oxide in these organisms but have little effect on nitrogen production from nitrite. Although the physiological basis by which nitrite opposes the action of azide remains unknown, extensive destruction of azide by nitrite can be ruled out as an explanation.


Survival and resistance of Trichophyton mentagrophytes arthrospores. The effects of several physical and chemical agents on the survival of Trichophyton mentagrophytes arthrospores were investigated. Although arthrospores of this dermatophyte were highly resistant to chilling and freezing, they were extremely susceptible to moderate heat (above 50 degrees C) and desiccation. This high susceptibility could be significantly reduced when they were dried in the presence of exogenous proteins. These arthrospores were markedly susceptible to glutaraldehyde. They appeared to be significantly more resistant than their hyphal counterparts to common antimycotics such as clotrimazole, griseofulvin, miconazole nitrate, and nystatin. Clinical and epidemiological implications of these observations are discussed.


Production of penicillic acid and patulin by an atypical Penicillium roqueforti isolate. Simultaneous production of penicillic acid and patulin by an atypical strain of Penicillium roqueforti isolated from cheddar cheese is reported. Mycotoxin production was confirmed by thin-layer and gas-liquid chromatography and by ultraviolet, infrared, and mass spectral analyses. Culture extracts were toxic to Bacillus megaterium and chicken embryos. Commercial strains of P. roqueoforti used in production of blue-veined cheeses were shown not to produce penicillic acid and patulin.


Determination of fatty acid compositions of Bacillus cereus and related bacteria: a rapid gas chromatographic method using a glass capillary column. A rapid gas chromatographic method for the determination of fatty acid compositions of Bacillus cereus and related bacteria is presented. By the use of a free fatty acid phase-coated glass capillary column, the complete separation of fatty acids, including the branched ones, was achieved. The method enables a more distinct differentiation of Bacillus species than can be obtained with packed columns.


Maintenance of a certain rumen protozoal population in a continuous in vitro fermentation system. A continuous culture system suitable for maintaining certain rumen protozoa was developed by modifying the procedure of Walter and Pilgrim (R.A. Weller and A.F. Pilgrim, Br. J. Nutr. 32:341-351, 1974) to include a dialyzing system. The concentration of ciliate protozoa, the pH value, and concentrations of volatile fatty acid and ammonia-N could be maintained within normal rumen limits for more than 15 days by appropriate choice of mechanical agitation and of the amount of substrate and physical form of the substrate bags. The average concentration of protozoa in the free fluid around the substrate was about 10% that in the fluid squeezed from solid digesta residues. More than 10(6) protozoa per ml was present in the fresh substrates only 2 h after supplying the substrate. These facts suggest that sequestration of the protozoa among particulate digesta is an important factor in maintaining the concentration of protozoa.


Changes in photosynthetic rate and pigment content of blue-green algae in Lake Mendota. Blue-green algal blooms were present in Lake Mendota (Dane County, Wis.) from June to November 1976. Concentrations of total algal biomass and of particular algal species were monitored and compared with the pigment contents (chlorophyll a and phycocyanin) and photosynthetic rate of the algal populations. The specific photosynthetic rate (micrograms of C fixed per microgram of chlorophyll a per hour) was a good measure of the physiological state of the algae because this quantity increased just before each population increase and decreased before algal densities diminished. Since the quantity of light in the epilimnion which was available for photosynthesis by algal cells decreased in summer when the high algal densities attenuated incoming radiation, we investigated the possibility that the organisms would utilize lower light intensities more efficiently by increasing their pigment contents. Although some evidence of enhanced utilization of low light levels was found in the period from July to October, this result was not due to increasing chlorophyll and phycocyanin contents. There was a decrease in the phycocyanin content of the algae during this period, perhaps related to the availability of inorganic nitrogen.


Gentamicin-based medium for the isolation of group D streptococci and application of the medium to water analysis. Gentamicin-thallous-carbonate (GTC) medium contained (per liter): 40.0 g of Trypticase soy agar, 5.0 g of KH(2)PO(4), 2.0 g of NaHCO(2), 1.0 g of glucose, 1.0 g of esculin, 0.5 g of thallous acetate (TA), 0.5 g of ferric citrate, 0.75 ml of Tween 80, and 2.5 mg of gentamicin sulfate. The NaHCO(3) (20 ml of a 10% solution that had been heated to boiling) was added after sterilization of the basal medium. The spread plate technique was used to compare GTC agar with Pfizer selective enterococcus, TA, and KF agars by using sewage as well as bovine and swine fecal samples. Significantly greater numbers of group D streptococci were recovered on GTC agar than on Pfizer selective enterococcus or KF agars, within and over all samples. Higher counts also were obtained on GTC than on TA agar, but the differences were not statistically significant. The percentage of false positives was about the same for all four media. Samples of riverwater also were plated on GTC, TA, and KF agars, and significantly higher recoveries were obtained with GTC agar. GTC agar was superior to the other media examined primarily because of increased recoveries of Streptococcus bovis and S. equinus; other advantages of GTC agar were large colony size and short (24-h) incubation period. The percentage of false positives from riverwater was 13% for GTC agar and 0% for TA and KF agars; therefore, confirmation would be necessary when GTC agar is used with some types of environmental samples.


Improved lysis of group N streptococci for isolation and rapid characterization of plasmid deoxyribonucleic acid. Procedures for effective cellular lysis and plasmid deoxyribonucleic acid (DNA) isolation from group N streptococci were developed. Cells were grown at 32 degrees C for 4 h in a modified Elliker broth containing 20 mM DL-threonine. After cellular digestion with 2 mg of lysozyme per ml for 7 min at 37 degrees C, 1% sodium dodecyl sulfate exposure resulted in complete and immediate lysis. Lactose (Lac) plasmid species in Streptococcus lactis C2 and S. cremoris B1 (30 and 37 megadaltons, respectively) were demonstrated upon examination of DNA from the cleared lysates by agarose gel electrophoresis. Increasing the lysozyme treatment to 20 min or more resulted in loss of the Lac plasmid, whereas other resident plasmids were unaffected and demonstrable in agarose gels. Diethylpyrocarbonate added before lysis prevented Lac plasmid loss in 20-min lysozyme-treated cells, but was not effective after 40 min of lysozyme treatment. The results suggested that endogenous nuclease activity during the lysozyme treatment period initiated Lac plasmid DNA loss. The development of an efficient lysis procedure for the group N streptococci allowed rapid identification and characterization of plasmid DNA by agarose gel electrophoresis. The plasmid composition of S. lactis C2 and S. cremoris B1, as determined by agarose gel electrophoresis, compared favorably to previous electron microscopic observations.


Incidence of airborne Aspergillus flavus spores in cornfields of five states. Airborne Aspergillus flavus spores were rarely detected throughout the 1975 growing season by the agar plate method at cornfield sites in Georgia, Illinois, Maryland, South Carolina, and Virginia.


To pulse or not to pulse.

To pulse or not to pulse. Pulsatile and nonpulsatile blood flow have been intensely studied for cardiopulmonary bypass (CPB), isolated organ perfusion, and myocardial preservation. Although early studies differed, later ones have shown the benefits of pulsatile flow. Kidney function, lymph flow, and oxygen consumption are increased during pulsatile perfusion. Also, nonpulsatile CPB increases total peripheral resistance and mean arterial pressure, which are related to time of perfusion. Theories to account for the superiority of pulsatile flow include: (1) "vascular shocks" causing physical displacement of tissues, which changes the boundary layer of interstitial fluid around cell membranes and enhances diffusion ;(2) increased lymph movement during pulsatile flow; and (3) pulsatile energy ensuring the patency of the vascular beds and preventing shunting. New methods to create pulsatile flow and their adaptation to the standard roller pump are discussed.


Glucagon vs anticholinergics in the treatment of acute pancreatitis. A double-blind controlled trial. Sixty-two cases of acute pancreatitis, evaluated for severity according to uniform standards, were treated identically except that patients in one group received glucagon hydrochloride (group A) and those in the other oxyphenonium bromomethylate (group B). Each of the two homologous series comprise 31 patients, and mortality was the same for both groups (3/31, 10%). Statistical comparison of both series showed no significant differences in frequency of expected complications nor in fall of serum amylase levels. During treatment, serum calcium levels were significantly reduced in group A (P less than .005), and the duration of the abdominal pain was shortened (P less than .05). The volume of gastric aspirate was smaller in group B (P less than .005), and vesical catheterization proved necessary more frequently (P less than .005). Thus, similar results are obtained when glucagon or anticholinergics are employed in the treatment of acute pancreatitis, although secondary effects differ.


[A new anatomo-clinical entity? The left superior vena cava obstructing the interior of the left atrium in association with a left-right shunt. Apropos of 2 cases]. The association of a left-right shunt with obstruction to the pulmonary venous return must not be ignored. Failure to recognise this may be fatal post-operatively. We have described here what we believe to be a new cause of supra-mitral obstruction: an abnormal left superior vena cava. The echocardiogram was essential in the diagnosis, and allowed us to establish, after surgical correction, that all abnormalities of the left auricle had disappeared.


[Electrophysiological study of a Portuguese case of amyloidosis with conduction disorders]. Cardiac involvement in the course of familial Portuguese amyloidosis, as apart from the other primary amyloidosis, is characterised by the early and wide-spread intracardiac conduction disorders, and the contrasting late presentation of the clinical signs. A case is presented of Portuguese amyloidosis which was typical from the viewpoint of the neurological disorders, the familial characteristics, and the positive biopsy; the main conduction defects found in primitive amyloidoses are also recalled. The patient described had for many years suffered from first degree heart block, and then presented with lipid changes with syncopal attacks which led to electrophysiological investigation of the conduction defect, no similar example of which has been found in the literature. The severity and widespread nature of the disorders which were found, together with the localisation of a sub-His block led us to implant the pacemaker. We have only found two other patients who had implants for disorders of conduction secondary to cardiac amyloidosis. Emphasis has been laid on the importance of this investigation which, when it leads to the positioning of a pacemaker, should avoid the onset of syncopal attacks and sudden death which together constitute one of the primary causes of mortality in primary amyloidosis. The length of follow-up in our case has been 14 months (April 1977).


[Pseudoaneuysms of the heart after myocardial infarct. Apropos of 5 operated cases]. The authors base themselves on 5 personal cases and a review of the literature to summarise the clinical and paraclinical features of false aneurysms of the heart. The clinical features differ from those of true aneurysms only slightly. It is only arteriography, which shows up the collar and the slow evacuation of the cavity, which makes the real distinction and argues in favour of operation. The results of surgical treatment have been satisfactory, especially considering the natural outcome, which is always death from rupture.


[Acquired interventricular communications in bacterial endocarditis. Apropos of a case with review of the literature]. The case reported here concerns a female of 33 who presented, during the course of an acute bacterial aortitis which had been treated, with an inflammatory perforation of the membranous septum. The clinical picture consisted of an association of very severe heart failure with severe aortic incompetence, an apical pansystolic murmur, and atrioventricular conduction defects. Although it was carried out in the presence of active endocarditis (valve cultures positive for streptococci), operative intervention (Patch + Starr) allowed rapid healing and excellent cardiovascular function after a 30 month follow-up period. Careful study of this case and of the eleven others in the literature has enabled us to underline the following points:--the sudden appearance, in a case with infective aortic incompetence, of a gross pansystolic murmur associated with atrial or intraventricular conduction defects, should be taken as suggesting a septal perforation;--examination of the haemodynamic system in such a case runs certain risks, and should never be allowed to delay the operation, which must always be carried out urgently;--despite the unfavourable operative conditions, the results strongly support the need for surgical intervention in these patients in good time.


[Hypoplastic syndrome of the left heart. Anatomo-echocardiographic correlations]. The findings on echocardiography and their anatomical correlations are reported in a group of 15 neonates with the syndrome of hypoplasia of the left side of the heart. The lesions which make up this syndrome could be defined precisely using echocardiography. In the major forms of this syndrome (10 cases), the correlation between the clinical and the echocardiographical findings was sufficient to establish the diagnosis, and to avoid the necessity for cardiac catheterisation without prejudice to the treatment plan. Characteristic findings in the major types were: --an aortic diameter less than or equal to 5 mm; --a left ventricle which was absent or had a diameter of less than 11 mm with an LV/RV ratio of less than 0.6; --a mitral valve which was absent or had a very abnormal form with multiple echoes. The differential diagnosis on echocardiography and the limitations of the method are discussed.


[Complete bundle-branch block and myocardial infarct. Natural history. Comparative study]. Myocardial infarction (MI), (and especially anteriorly situated necrosis) was complicated by complete branch block (CBB) in 9.7% of cases (45 patients out of 462). A comparison of the short- and long-term outcome in two groups of patients (group A: 45 cases of MI complicated by CBB; group B: 45 cases of MI with no atrio-ventricular or intra-ventricular conduction defects) showed that there was a much bigger immediate mortality in group A, which was not changed by temporary cardiac pacemaking, and depended on the extent of myocardial destruction. A study of the long-term outcome showed that there were more deaths in group A (recurrence of MI, intractable cardiac failure). However, the incidence of sudden death was equal in the two groups (group A 15%, group B 13%), and there was no obvious explanation in the absence of electrocardiographic tracings. Therefore this study lends no support to the argument which favours prophylactic implantation of a cardiac pacemaker during the course of MI complicated by CBB.


[Vasodilator treatment of the acute phase of myocardial infarct with phentolamine. Analysis of hemodynamic results and therapeutic indications]. Treatment by phentolamine was carried out in 30 patients presenting with an acute myocardial infarction complicated by left ventricular failure, 8 of which had cardiogenic shock. The response to treatment was closely related to the level of overload of the left ventricle. Significant improvement in the haemodynamic state was only observed in the most severe cases of cardiac failure, and in these cases was accompanied by only a minimal and insignificant change in mean arterial pressure and heart rate.


[Severe tricuspid insufficiency and primary carcinoid tumor of the ovary. Long term success after valve replacement. Apropos of a case]. The case is reported of carcinoid heart disease in a lady of 70 with intractable congestive cardiac failure 5 years after the removal of a primary carcinoid tumour of the ovary. The special features of primary carcinoid tumours of the ovary are recalled, with emphasis on their rarity and of the absence of liver metastases. The various features of carcinoid syndrome are recalled in the light of current knowledge of the pathogenesis. A review of the literature on cardiac involvement in primary carcinoid tumours of the ovary, amounting to 10 cases, is included. The possibility of surgical cure of the heart lesions in carcinoid tumour by a prosthetic tricuspid valve are discussed, in the light of the 6 reported cases and the present one. Our report is the first one of replacement of the valve after removal of a primary ovarien carcinoid tumour, and the excellent result has been maintained after three years.


[Arterial pressure changes during exertion in the normal subject]. The exercice electrocardiogram, carried out in 160 normal subjects, has allowed us to witness the physiological mechanisms of adaptation to exercise as a function of age and sex. The relationship between systolic arterial pressure (SAP) and cardiac rate (CR) is very narrow (R = 0.97), and is a linear function. Its slope increases with age in both sexes, and differs significantly in the male and female (P less than 0.001). Systolic pressure is related to the relative cardiac rate (CR%) by the formula SAP = 1.55.CR% + 70.


[Paradoxical displacement of the interventricular septum with impairment of filling of the left ventricle. Echocardiographic and hemodynamic diagnosis. Apropos of 3 cases]. An unusual type of displacement of interventricular septum, the inverse of that found normally, was found by echocardiography in 3 cases: 2 with pulmonary arterial hypertension and 1 with constrictive pericarditis. In two cases catheterisation showed the haemodynamic picture of mitral obstruction, and in 1 case the typical findings on auscultation of mitral stenosis were present. The echocardiogram and anatomical studies showed that the mitral valve was normal. The obstruction was due to displacement of the septum towards the left ventricle during diastole. Because of this displacement, the septum came into contact with the mitral valve, and caused impairment of the filling of the left ventricle.


[Echography after regularization of atrial fibrillation]. An echographic study was carried out on 17 patients before and after conversion of atrial fibrillation to normal rhythm. It showed up the moment of return of atrial contraction as a movement of the posterior wall of the left auricle and a reappearance of the 'a' wave or the anterior cusp of the mitral valve. The contraction can appear immediately after the electric shock, or may be delayed.


[The electrocardiogram during bilharziosis caused by Schistosoma mansoni]. The electrocardiographic abnormalities associated with bilharziasis are not well-known. This study, carried out in Guadeloupe, involved 220 cases of both sexes with bilharziasis, and 157 control subjects. The changes on the electrocardiogram were: an ST elevation of 0.1 to 0.5 mV associated with a large T wave in the intermediate and left precordial leads (16.8%), flattening of the T wave (13%) in V1 to V3 and beyond, a negative T wave (10.8% in the right precordial leads V1, V2, V3, and left ventricular hypertrophy (10%). The abnormalities which were found were identical to those described in the "normal" black person, and led us to discuss whether there was really a characteristic ECG for the black races. Additionally we were able to conclude that these abnormalities were unrelated to anaemia or to therapy against bilharziasis, and that there was no abnormal sex distribution. Moreover this study has revealed that the population of Guadeloupe who have no parasitic infection have ECG abnormalities (4.8%) more commonly than the white races, and has led us to suspect the possibilities of as yet underfined abnormalities which cannot be regarded as "normal".


[Recording the electrogram of the sinus node. Effects of the injection of tetrodotoxin into the artery of the sinus]. The cells of the SA node (SAN) are very resistant to the action of tetrodotoxine (TTX), a drug which. paradoxically, blocks depolarisation of the outer myocardial cells. Injection of TTX into the artery of the SAN brings about asystole; bur regular electrical activity, consisting of a slow wave of 200 to 300 ms duration, can still be picked up by an electrode placed on the SAN. This electrical activity, which can only be picked up over the SAN, and is resistant to TTX but blocked by acetylcholine, is interpretated as being the electrogram of the SAN. After the artery has been washed out by normal saline, the effect of TTX becomes progressively less; under these conditions, all degrees of sino-atrial block can be observed. Arising from a study of the phenomena of capture of the SA and AV nodes, of the effect of artrial stimulation, and of the time relationships between the various electrical events recorded, some hypotheses of the electrophysiology of the SAN and the sino-atrial conduction are put forward.


[Comparative study of left ventricular kinetics by gamma-cinecardiography and ventriculography]. 50 patients were investigated by both left ventricular cine-angiography, and "balanced" gamma-cine-cardiography in the frontal and LAO positions. Measurements of the ejection fraction and the mean and maximal speeds of contraction were made by the two techniques. The correlation was good (r = 0.89 for the ejection fraction). A morphological analysis of the dynamic findings in the two methods in the 12 cases with discordered left ventricular kinetics showed that once again the results were very similar. A numerical presentation of the data from the radioisotope studies was made either as a group of sequential ventricular contours successively from diastole to systole, or to give a functional picture which would provide the value for one kinetic paramter at any one time (for example, the regional equivalent of the ejection fraction). To overcome the problems of superimposition in the RAO position in the "balanced" technique, the recordings of the first radioisotope study in RAO were combined with a study of balance in 50 other patients, and the correlation was excellent. These two isotope techniques, which can be carried out in the same examination and which may be repeated without risk, perfectly complement each other, and very few of the results were incapable of interpretation.


[Contribution of echocardiography to the study of stenotic mitral valve diseases in adults]. The "time motion" echocardiographic findings in 133 patients, with stenotic mitral valve defects were compared with the anatomical and haemodynamic findings. The information was derived either by monosound, or after a multiscan survey, selecting the lines in two perpendicular planes. A morphological analysis of VMA has allowed us to define a statistical profile according to the type of valve defect: a single diastolic slope in the pure uncalcified stenoses, 2 slopes with the first being more rapid than the second, in other mitral conditions. The cinetics of VMP were related to the presence of associated regurgitation and to the type of fusion. In cases with multiple diastolic slopes, the degree of stenosis was correlated only with the first slope, whilst the second was fairly closely related to the left ventricular end-diastolic pressure. The degree of valvular involvement can be predicted on the coexistence of a thick contour with multiple images, or in their absence on the diminution of amplitude of opening (less than 12 mm) and on the maximum speed of opening (less than 250 mm/s). By contrast, the sub-valvular lesions are underestimated whichever technique is used.


[The double ventricular response phenomenon in 2 cases of Wolff-Parkinson-White syndrome]. The authors report two cases of "true" consecutive double ventricular response caused by a single premature atrial stimulation; both were young men with Wolff-Parkinson-White syndrome. In both cases, the presence of a bundle of Kent was confirmed. The phenomenon of double ventricular response arising successively from the bundle of Kent and node-His pathway is rare, being mentioned in only two cases in the literature. It is only found when there is the combination of a good bundle of Kent, fair forward conduction, and a relative ventricle-His retrograde block. Amongst the other mechanisms for double ventricular repsonse, re-entry from branch to branch presents the most difficult differential diagnosis. From our observations, the forward characteristics of the spread through the bundle of His which always procedes the bundle of His which always precedes the second ventricular complex have been confirmed, especially in view of the freat variation in the position of this potential which can easily be explained by variations in intra-nodal conduction. In one of these cases, the atriogram, taken after the second ventriculogram, was provided by retrograde activity in the bundle of Kent.


[Resections of the left ventricle in the surgical treatment of parietal sequelae of myocardial infarct]. Resection of left ventricular tissue seems to be playing an increasing part in the treatment of the sequelae of myocardial infarction. In a total of 700 patients who underwent surgery for some aspect of coronary atherosclerosis, 40 underwent resection of left ventricular tissue. In the majority of cases, diagnosis rested on left ventricular cine-angiography and in 3 cases this had to be carried out as an urgent procedure with circulatory assistance using diastolic counter-pressure (DCP) from an intra-aortic balloon. A selective contrast technique for the two coronary arteries was used whenever possible. The surgical anatomy of the lesions indicates a difference between a localised dyskinesia and diffuse dyskinesia, the latter having a severe effect on left ventricular function. In a group of localised dyskinesias, the territory supplied by the anterior descending artery was by far the most frequently affected. Resection of left ventricular tissue was associated with a myocardial bypass revascularisation procedure in 9 cases, valve repair in 7 cases, and closure of a septal perforation in 3 cases. The total inpatient mortality rate is still quite high (23.1%) because of the severity and widespread nature of the coronary disease. However, the mid-and long-term results are good, the criteria being functional improvement and the actuarial 4-year survival rate.


[Early surgical treatment of a septal perforation complicating a posterior infarct. Value of the diaphragmatic left ventricular approach]. The authors report the case of a 53 year old patient who required operation on the 5th day after postero-inferior myocardical infarction for a poorly tolerated perforation of the ventricular septum. In discussing this case, they recall that the results for surgical repair of septal perforations complicating myocardial infarction are poorer when the infarction is posterior than when it is anterior. They suggest that this difference in prognosis is in large part due to the customary use in postero-inferior infarcts, of the right transventricular approach, which does not allow the infarct to be resected at the same time as the septum is closed. They finish by recommending the systematic use of a diaphragmatic approach to the left ventricle, including resection of the infarct, for all cases of septal perforations with posterior infarction in which surgery is necessary.


[Remote results of the surgical correction of aortic coarctation. Study of 90 patients operated on 11 to 15 years earlier]. An 11 to 15 year follow up (mean 12.7 years) of 90 patients undergoing surgery for coarctation of the isthmus of the aorta is reported. There were 7 late deaths. Of the survivors 87% were normotensive (B.P. less than or equal to 160/100 mmHg) and 90% were asymptomatic and leading a normal life. Five cases-all with an aortic prosthesis-had to be reoperated for recurrent coarctation. These figures are comparable with those found in the literature. The best long-term results are obtained in patients who have the operation while young (less than 20 years), who have no associated abnormality, and whose coarctation can be treated by resection with direct anastamosis.


[Treatment of acute arterial occulusions with streptokinase]. Of the patients treated within the first week after thrombo-embolic occulusion of the arteries of the lower limb 45% achieve total disobliteration with thrombolytic therapy. The authors discuss the factors influencing disobliteration, as well as the mortality and complications of thrombolytic treatment using streptokinase. Surgical treatment (the Fogarty catheter) is complementary. Choice of treatment is made by a combination of factors which include the age of the patient, the site and extent of the block, the amount of neuro-muscular ischaemia, and the general condition of the patient.


[Extensive aortic dissection and aneurysm of the left coronary trunk. 20-year spontaneous development]. A case is reported of dissection of the aorta in a lady of 35. The condition was complicated first by myocardial infarction and secondly by severe aortic incompetence which led, 20 years after the onset of the dissection, to the death of the patient from intractable heart failure. At post-mortem, an extensive dissection was found to involve the whole of the aorta and several of its branches, but did not involve the coronary arteries, which were normal except for the trunk of the left coronary; this was dilated. The natural history of dissections of the aorta is reviewed. The incidence, course and etiology of coronary aneurysms are also discussed.


[Pseudotumor of the right atrium caused by hernia of the valve of Vieussens]. A round swelling was on the substraction films of the right side of the heart taken during angiocardiographic examination of a patient with mitral valve disease; this suggested a mass attached to the inter-atrial septum, and prolapsing into the auricle of the right atrium. Initial diagnsosi was of atrial thrombosis, but this was disproved at operation. An aneurysm of the membrane of the fossa ovalis was found, being caused by overstretching of the auricle of the left atrium under the increased pressure of the valve defect. The aneurysm was resected and the septum simply repositioned as part of the mitral valve replacement. A search of the literature shows how rare this disorder is, and that it should be reclassified with the abnormalities of the inter-atrial septum which are found only rarely in cases of mitral valve disease.


[A case of subannular aneurysm of the left ventricle]. The authors present a case of sub-annular aneurysm of the left ventricle in a child of 7. It was associated with aortic incompetence, a ventricular septal defect, and coarctation of the aorta which were discovered during investigation of streptococcal septicaemia. As a first stage procedure, the aortic valve was repaired, the aneurysm was excised, and the ventricular septal defect closed. At a later stage, the coarctation was resected. The question of whether this lesion was congenital or acquired is discussed. After one year, the result remains satisfactory.


[Nodo-ventricular accessory pathway unmasked by a block in the trunk of the bundle of His]. A case is reported in which, contrary to the unusual finding, conduction was slower in an accessory pathway than in the node-His pathway. Only when this latter became blocked (in the trunk of the bundle of His) following on the longest refractory period, was a pre-excitation syndrome unmasked related to the right nodo-ventricular fibres (the fibres of Mahaim).


[Posttraumatic true aneurysm of the left ventricle caused by a shotgun wound]. An asymptomatic aneurysm of the left ventricle was discovered incidentally in a policeman aged 25, who had a history of a severe thoracic injury from a shotgun wound at the age of 15. Electrocardiography showed a transmural antero-lateral infarct; this was later confirmed at ventriculography. Coronary arteriography showed a narrowed anterior descending artery which crossed over the surface of the aneurysm. The cardiac status remained unchanged over an 8 year follow up period. The pathogenesis is discussed: a fold of contused myocardium, or immediate or late traumatic obstruction of the anterior descending artery, or both factors at the same time?


Haemodynamic effects of isosorbide dinitrate in patients with congestive cardiac failure at rest and during submaximal supine exercise. Eight patients with chronic congestive cardiac failure secondary to ischaemic heart disease performed submaximal supine exercise before and after 5 mg sublingual isosorbide dinitrate (ISDN) at the time of cardiac catheterisation. Exercise before ISDN produced a poor response in left ventricular performance. After ISDN this response was significantly improved. Compared with the control exercise period cardiac index (CI) increased from mean 2.9 to 3.5 l/mn/m2 (p = less than 0.0025), stroke volume index (SVI) from mean 24 to 29 ml/m2 (p = less than 0.0005) and left ventricular stroke work index (LVSWI) from mean 22 to 28 g-m/m2 (p = less than 0.0025). Although ISDN reduced LVEDP significantly at rest, there were associated small but significant falls in CI, SVI and LVSWI. The improvement in exercise cardiac index was related to the ejection fraction, or the ejection fraction of the contractile section where a left ventricular aneurysm was present. ISDN may be effective in improving exercise tolerance in ambulant patients with chronic congestive cardiac failure.


[Angina pectoris and muscular bridges on the anterior interventricular artery. Apropos of 3 operated cases]. A relationship between ischaemia of the myocardium and a muscular bridge over the anterios descending artery has now been demonstrated. The authors report three cases in which the severity of the clinical features was sufficient to justify surgical division of the muscular bridge without touching the underlying artery. Progress remained satisfactory after a follow-up period of 1.5 to 3 years. The opportunity is taken to discuss the role of the muscle bridge in causing pathology in the coronary arterial system.


The relationship between myocardial ischaemia and cell death during acute myocardial infarction. Praecordial mapping of the electrocardiogram (ECG) demonstrated the natural history of ST segment elevation, loss of R and appearance of Q waves in 50 patients suffering uncomplicated anterior myocardial infarction. The results showed that ST segment elevation has a complicated natural history. The loss of R wave electromotive force and development of Q waves were complete by 12 h following the onset of chest pain. This evidence for the loss of viable myocardium was complete before the MB-isoenzyme of creatine kinase (MBCK) was detected in the plasma. Regression analysis of these results showed a direct relationship between the praecordial area of ST segment elevation at 2 h (myocardial ischaemia) and the praecordial area of Q waves at 24 h after the onset of symptoms (cell death). The efficacy of interventions on the natural history of myocardial infarction might be assessed by their effects on the relationship between myocardial ischaemia and cell death.


[Assessment of the myocardial infarct size and kinetic study of the necrosis process by serial determinations of creatine kinase]. Assessment of the size of a myocardial infarct is important from a prognostic point of view, given the opportunities for surgical and pharmacological limitation of the process of necrosis. Serial doses of creatine kinase and its isoenzyme MB given every 4 hours for the first 48 hours of the infarct have allowed us to estimate the size of the infarct and to study the kinetics of enzyme liberation during necrosis. Unknown factors limit the sensitivity of this means of assessing the size of an infarct. The kinetic study showed that the enzyme is liberated by differing mechanisms.


The relationship between posture, blood pressure and electrophysiological properties in patients with paroxysmal supraventricular tachycardia. In 9 patients with paroxysmal supraventricular tachycardia the effects of tilting the body on the blood pressure and on responses during tachycardia or pacing revealed important effects that could influence the clinical presentation and the treatment required. Assessment of these reflex responses adds a major dimension to the understanding of the patient with supraventricular tachycardia.


Pulmonary vein blood flow velocity in pulsus paradoxus. The effect of inspiration on pulmonary vein blood flow velocity and forward pressure gradient from pulmonary vein to left atrium was studied in seven patients with chronic constrictive pericarditis, five of whom had clinically obvious pulsus paradoxus. Compared to patients without pericardial disease, where inspiration produced no change, patients with pericardial disease showed an inspiratory fall in the forward pressure gradient and forward blood flow velocity in the pulmonary veins on inspiration. The mechanism of pulsus paradoxus in these patients can be explained by incomplete transmission of the inspiratory fall of intrathoracic pressure to the left atrium.


Diastolic changes in left ventricular wall thickness studied by echocardiography. In order to study factors influencing posterior wall thickness during diastole, echocardiograms showing the septum, mitral valve and posterior wall endocardium and epicardium in 15 normal subjects and 49 patients with heart disease were digitized. Maximum wall thickness, minimum cavity dimension and the onset of mitral valve opening are normally synchronous, and an early period of rapid wall thinning, at a peak rate of 10.7 +/- 1.7 cm/sec corresponds closely to rapid filling. In patients with ischaemic heart disease the peak rate and duration of rapid thinning were normal, but thinning preceded mitral valve opening (mean 50 msec). In 11 of 17 patients with hypertrophic cardiomyopathy the peak rate of thinning was reduced and in 2 it was increased. There was a close correlation between the peak thinning rate in this group and the peak rate of increase in dimension. In mitral stenosis peak thinning rate was frequently reduced but in some patients was normal, with the reduced rate of increase in cavity dimension maintained by reversal of septal movement. We conclude that rapid thinning is an intrinsic property of the ventricular wall which is normally associated with rapid filling, but which may be dissociated from filling by asynchronous relaxation or inflow obstruction, or may be modified by myocardial disease.


Complex pulmonary atresia with congenital systemic collaterals. Classification and management. 80 patients with pulmonary atresia and subaortic ventricular septal defect had complete angiography with right ventricular, aortic and selective arterial angiograms to delineate the anatomy of the central pulmonary arteries and the systemic supply to the lungs, as correct management of the patient depends on this. In 67 (85 p. 100) there were 1-5 large congenital systemic collateral arteries mainly arising at or below the aortic isthmus. This group, referred to as "complex pulmonary atresia" with right aortic arch in 30, had variable central pulmonary artery development, either completely absent in 17, hypoplastic in 33 (49 p. 100) appearing as a "seagull" (une mouette) in the mediastinum on late films or large well developed vessels in 17. Patients with hypoplastic central arteries require special management. We now perform a two stage procedure, initially placing a conduit containing a homograft aortic valve between the right ventricle and small central pulmonary arteries in order to develop them and leaving the ventricular septal defect open. Initial results in 6 patients treated this way are encouraging and it is proposed to close the defect later after enlargment of the pulmonary arteries has occurred.


[Identification of the sino-atrial potential in the dog by epicardial electrocardiography]. The electrical activity of the sino-atrial node has been recorded in the dog through a thoracotomy and using both unipolar and bipolar electrodes. Amiodarone was used to establish that the pre-artial potential which was registered was indeed originating in the sinus, as it allowed us to produce various degrees of sino-atrial block in a reliable and reproducable manner. The fact that the sinus potential can be recorded in the presence of intermittent abnormalities of the surface P wave suggests that the abnormalities may be associated with intra-sinus displacement of the pacemaker and not with ectopic depolarisation of the atrium.


[Changes in the subvalvular apparatus and left ventricular function in pure mitral stenosis]. Disordered left ventricular function and changes in the sub-valvular apparatus appear to be associated in patients with isolated mitral stenosis (MS). Left ventricular cine-angiography has demonstrated two groups of patients, according to the presence (group II) or absence (group I) of changes in the sub-valvular apparatus. There was no significant difference between the two groups in terms of age, heart rate, left ventricular end diastolic pressure, surface area of the mitral valve, or ventricular ejection time. However, group II patients had a lowered ejection fraction (EF), systolic ejection volume (SEB), speed of shortening of circular fibres (VCF), and systolic work index (SWI) compared with group I cases (respectively 0.49 +/- 0.06 and 0.58 +/- 0.04 for the EF, 36 +/- 7 ml.m-2 and 41 +/- 7 ml.m-2 for the SEV, 0.85 +/- 0.12 circ.s-1 and 1.09 +/- 0.16 circ.s-1 for the VCF, 45 +/- 11 gm.m-2 and 57 +/- 11 gm.m-2 for the SWI. Nevertheless, it appears that changes in the sub-valvular apparatus indicate rather than cause dysfunction of the left ventricle, which occurs in a certain number of patients who have a normal sub-valvular apparatus.


Age and sexual behavior of Japanese macaques (Macaca fuscata). The sexual behavior of the Arashiyama West troop, a natural semi-free-ranging troop of Japanese macaques, was studied during the 1973-1974 and 1974-1975 breeding seasons. The troop was transported intact from Japan to its current location in South Texas. There they have been free to move about in a 42.2-hectare electric fence enclosure. This report describes the relationships among age, aging, and sexual behavior. Males beginning at the age of 2.5 years were observed to series-mount estrous females in the double foot clasp mount position. Mounting in series in the double foot position is the normal pattern for Japanese macaque males. The ejaculation of semen with concomitant body movements indicative of orgasm begins at age 4.5 years at the earliest and continues until death. Males 4.5 and 5.5 years of age, sexually mature in the physiological sense, were not consistently sexually mature in the behavioral sense. The oldest male displayed traits that appear analogous to traits observed in aging human males. Females begin to experience estrus at 3.5 years of age. However, like pubescent males, pubescent females display behavioral patterns of sexual immaturity. The oldest female of the troop has remained sexually active. The attainment of sexual maturity by adulthood can be viewed as a learned process leading to efficiency and prowess, followed in old age by sexual involution.


Hepatic dysfunction during hyperalimentation. Liver biopsy specimens were studied in 26 patients in whom liver function abnormalities developed during intravenous hyperalimentation (IVH). The clinical manifestations and duration of IVH were evaluated in relation to the morphological changes seen in the liver. Early hepatic changes consisted of fatty metamorphosis, and progressive intrahepatic cholestasis developed as IVH was continued. Essential fatty acid deficiency, amino acid imbalance, caloric excess, and toxic manifestations of certain amino acids are postulated as causative factors. The hepatic steatosis secondary to IVH may be treated by lowering the dextrose concentration of the infusion or by administering dextrose-free amino acid solutions. The clinical importance of this common complication of IVH is the difficulty in distinguishing it from other causes of cholestasis in seriously ill patients.


Latent measles virus infection in Vero cells depending on a temperature-sensitive phenomenon. A latent infection by measles virus in a line of Vero cells could be maintained only at 37 degrees C. The conditions of temperature nonpermissiveness were associated with some block in virus production and/or release and with the establishment of an autointerference phenomenon. Reduction of the incubation temperature to 33.5 degrees C induced a rather rapid transition from the latent to a lytical infection with a recue of virus. The rescued virus exhibited a restricted capacity to grow at 37 degrees C.


The last segregation: systems of care for the aged and chronically ill. Adequate criteria are needed before patients are admitted to nursing homes. Separation of categories of patients is desirable. Thos with rehabilitation potential should have greater certainty of receiving therapy. Demented patients should be separated from the mentally intace. We need to give serious thought to the quality of life for patients who are permanently placed.


Extended care: medical care of the elderly disabled. Geriatric medicine has now been practised as a specialty for 30 years; there is still argument as to its usefulness, and it is not regarded as an attractive career. At the same time there is a large gap between the standard of acute medicine an that offered to people with continuing disabilities, most of whom are elderly. If this area of medicine is to become more effective, it should be an extension of the responsibilities and activities of the medical centre, practised by a hospital based team, complementing the existing activities of the family doctor and the acute hospital. This method would not only raise the standard, but provide opportunity for a reasonable career. Medical care should be arranged according to disability--not according to age. The name 'extended care' referring to the method of practice, could well replace the worn out label of 'geriatric', which gives unnecessary emphasis to old age. But more important than what it is called, is how it is performed.


Oxygen-induced brain vacuolation in Drosophila and a possible threshold for this response. Wild type populations of Drosophila melanogaster were exposed to 21%, 33%, 45%, and 55% oxygen at normal atmospheric pressures. Individuals were selected randomly at 5-d intervals and inspected for vacuolation of the forebrain. Longevity of the populations was also measured. Flies in 21% and 33% oxygen had identical survivorship and even after 50 d showed little vacuolation. Flies maintained in 45% oxygen showed rapid mortality between 30-40 d and were found to have vacuolated forebrains. Populations treated in 55% oxygen declined rapidly in numbers between 20-30 d and showed severe vacuolation of the forebrain. It was considered important that normal longevity and normal aging of brain cells in 33% oxygen at standard pressure were found because similar partial pressures of pure oxygen were reported to significantly reduce longevity. It is suggested that, because insects are known to be tolerant to fairly extreme changes in total atmospheric pressure, a partial pressure of nitrogen as a diluent gas is the important factor in the toxic effects of a given pressure of oxygen. The study indicates that in a nitrogen/oxygen mix at 760 torr total pressure, the threshold to toxicity lies near, or just beyond, 300 torr oxygen. The authors indicate that preliminary findings in their current work show that if a small partial pressure of nitrogen is maintained, the total pressure can be reduced considerably without affecting this threshold level.


A chromosome substitution analysis of geotactic maze behavior in Drosophila melanogaster. Positive and negative geotactic maze behaviors were selected in strains of Drosophila melanogaster, for over 40 generations on 15-unit classification mazes. A chromosome substition analysis of these behaviors was undertaken to determine which of the three major chromosomes is most important in causing the differences in geotactic maze behavior between the divergent strains. By following the appropriate mating scheme, every possible homozygous chromosomal combination of the X, II, and III chromosomes from the geopositive and geonegative strain was produced. Heterozygous combinations were also produced to test for dominance and interchromosomal interactions. The results indicate that all three chromosomes are involved in geotactic behavior. The order of importance was II greater than III greater than X. Dominance effects were found in females of the X chromosome from the geopositive strain and for the III chromosome from the geonegative strain. No evidence for interchromosomal interactions was uncovered.


Thrombocytosis and platelet aggregates in the circulation of adjuvant arthritic rats. A marked increase in platelet count was observed in adjuvant-induced polyarthritic rats. Elevation of platelet count was still significant 3 months after onset of disease. Increased number and larger size of platelets reflect an increase in the rate of platelet production. By means of the platelet-count ratio technique, circulating platelet aggregates were demonstrated in rats with severe arthritis. Aspirin treatment prevented thrombocytosis and formation of platelet aggregates.


Vertebral sarcoidosis with paravertebral ossification. A young black male with sarcoidosis developed quadriplegia after a fall. Roentgenograms of the spine revealed extensive lytic and scierotic changes with paravertebral bony bridges simulating ankylosing spondylitis. He recovered on corticosteroid therapy after laminectomy and cervical fusion. Review of the literature suggests that this case of vertebral sarcoidosis is the most severe yet reported and the first with paravertebral ossification.


The reversible biotransformation of N-acetylprocainamide in the rhesus monkey. The specific activity of 14C-N-acetylprocainamide (14C-NAPA) was measured in the 24-h urine of two rhesus monkeys given the labelled drug i.v. Specific activity was found to decrease by 15.8% from the original value. This was attributed to an in vivo biotransformation of NAPA to procainamide (PCA) and reacetylation of PCA back to NAPA before it was eliminated in the urine. The major fraction of NAPA, 72.1% of the dose, was found to be excreted in the urine of monkeys in 48 h.


[Clinical and therapeutic aspects of duodenal diverticula]. The Authors present 33 cases of duodenal diverticula, 12 of which underwent surgical therapy. They analyse the clinical and therapeutic problems entailed in this surgica entity with particular reference to the frequency and gravity of emorrhagis complication. Concerning the surgical approach of ampullar and iuxta ampullar diverticula, Authors experience seems to advise indirect operations.


The regulation of erythropoiesis in protein-energy-malnutrition. The erythropoietin (ESF) content of plasma and urine has been studied in children with protein-energy-malnutrition (PEM) living in the Kivu province at an altitude of 1467--2000 m. On admission, packed cell volume (PCV) was moderately reduced; after 2 months of refeeding PCV had increased but was still lower than in the controls. Plasma ESF was increased on admission and in patients refed for 2 months. The expected positive correlation between serum and urine ESF levels was found after refeeding but not on admission; the last finding could not be explained by the presence of erythropoiesis inhibiting factor(s) in the urine. In spite of the normal 2,3-DPG and P50 previously described in PEM in Kivu, the anaemia associated with this disease is not merely an adaptation to lowered oxygen consumption and there must be some disturbances in the responsiveness of bone marrow to ESF. The high ESF values observed after 2 months of refeeding confirm that the restoration of the red cell volume proceeds slowly.


Critical re-examination of the specificity of auto-anti-Rh antibodies in patients with a positive direct antiglobulin test. Forty-eight autoantibodies with apparent 'simple' anti-Rh specificity (anti-e, -E, -c, -D, -C, -Ce, -G), have been studied by means of multiple absorption tests. The finding that 34 (70.8%) of these antibodies could bind to red blood cells lacking the antigens that the antibodies appeared to define, indicated that the antibodies had different specificities than seemed to be the case in initial antibody identification tests. Those autoantibodies that at first appeared to be directed against the Rh antigens e, E or c, most often had anti-Hr or anti-Hro specificity. These data explain why some apparent anti-Rh autoantibodies can be eluted from the red blood cells of patients negative for the antigens that the antibodi:s appear to define. However, they also illustrate that the phenomenon of autoantibodies mimicking specificities that they do not possess is common in patients positive for the antigens against which their autoantibodies appear to be directed. An explanation for the mode of action of these autoantibodies in complexing with the Rh agglutinogen is proposed, and the significance of the antibodies in transfusion therapy is considered.


International collaborative study of assay of anti-D (anti-Rh) immunoglobulin. An international collaborative study of anti-D assays has been carried out by 21 laboratories in 11 countries. Samples of anti-D immunoglobulin assayed in this study included two dilutions of a preparation used in clinical trials to determine a dose-protection relation, a national standard, commercial clinical preparations and the proposed international reference preparation in coded ampoules. Manual, automated haemagglutination and isotope labelling methods all gave similar relative potencies. Several of these estimates were significantly (P=0.95) heterogeneous and some modifications to improve assay design and procedure are suggested. The coded preparation was shown to be stable and suitable for comparative assays. It was estimated to contain 60 microgram of of anti-D IgG immunoglobulin per ampoule, and 150 i.u./ampoule when assayed against the International Standard for Incomplete Anti-D Blood Typing Serum. Thus for this preparation 1 microgram of IgG anti-D immunoglobulin identical to 2.5 i.u. anti-D antibody. At its 28th meeting the Expert Committee on Biological Standardization of WHO established the preparation 68/419 as the International Reference Preparation of Anti-D Immunoglobulin and assigned to it a potency of 150 i.u. per ampoule. The Preparation has been widely used (with a nominal content of 60 microgram of IgG anti-D immunoglobulin) for control of clinical preparations.


Measurement by a flow dialysis technique of the steady-state proton-motive force in chromatophores from Rhodospirillum rubrum. Comparison with phosphorylation potential. 1. In the light a transmembrane electrical potential of 100 mV has been estimated to occur in chromatophores from Rhodospirillum rubrum. The potential was determined by measuring the steady-state distribution of the permeant SCN- across the chromatophore membrane using a flow dialysis technique. The potential was not observed in the dark, nor in the presence of antimycin. It was dissipated on the addition of carbonyl cyanide p-trifluoromethoxyphenylhydrazone. The potential was reduced by between 15 and 20 mV when ADP and Pi were added. Hydrolysis of ATP by the chromatophores generated a membrane potential of about 80 mV. 2. Using a flow dialysis technique light-dependent uptake of methylamine was observed only in the presence of concentrations of SCN- that were 500-fold higher than were used to measure the membrane potential. It is concluded that the pH gradient across the illuminated chromatophore membrane is insignificant except in the presence of relatively high concentrations of a permeant anion like thiocyanate. Further evidence that a negligible pH gradient was generated by the chromatophores is that addition of K+ and nigericin to illuminated chromatophores did not stimulate uptake of SCN-. 3. In the light of chromatophores established and maintained a phosphorylation potential of up to 14 kcal/mol. If a phosphorylation potential of this magnitude is to be poised against a proton-motive force that comprises solely a membrane potential of approx. 100 mV, then at least five protons must be translocated for each ATP synthesised via a chemiosmotic mechanism.


On the relationship between glycerophosphoglycolipids and lipoteichoic acids in Gram-positive bacteria. II. Structures of glycerophosphoglycolipids. 1. Eight glycerophosphoglycolipids were isolated from six Gram-positive bacteria. Besides sn-glycero-1-phospho-beta-gentiobiosyldiacylglycerol (i) and sn-glycero-1-phospho-alpha-kojibiosyldiacylglycerol (ii), three novel structures have been established: 1,2-di-O-acyl-3-O-[6-(sn-glycero-1-phospho)-alpha-D-glucopyranosyl-(1 leads to 2)-(6-O-acyl-alpha-D-glucopyranosyl)]glycerol (iii), 1,2-di-O-acyl-3-O-[6-(sn-glycero-1-phospho)-beta-D-glucopyranosyl-(1 leads to 6)-alpha-D-galactopyranosyl-(1 leads to 2)-alpha-D-glucopyranosyl]glycerol (iv), and 1,2-di-O-acyl-3-O-[6-(sn-glycero-1-phospho)-beta-D-glucopyranosyl-(1 leads to 6)-alpha-D-galactopyranosyl-(1 leads to 2)-(6-O-acyl-alpha-D-glucopyranosyl)]glycerol (v). 2. Compound i was isolated from Bacillus licheniformis, Bacillus subtilis and Staphylococcus aureus, compound ii from a group B Streptococcus, compounds ii and iii from Streptococcus lactis, compounds iv and v from Lactobacillus casei. Lactobacillus plantarum contained besides compounds iv and v a glycerophosphate derivative of 1,2-di-O-acyl-3-O-[alpha-D-galactopyranosyl (1 leads to 2)-alpha-D-glucopyranosyl]glycerol. 3. Identical structural features of the described glycerophosphoglycolipids and the corresponding lipoteichoic acids are discussed.


Control of phosphonic acid and phosphonolipid synthesis in Tetrahymena. The phosphonolipid content of the protozoan Tetrahymena pyriformis was increased by growing the organism on a medium containing increasing amounts of 2-aminoethylphosphonic acid. With levels of 0, 1, 5 and 10 mM 2-amino-ethylphosphonic acid, the phosphonolipid content was 23, 25, 31 and 37% of the total cellular phospholipids, respectively. This increase was accompanied by a reciprocal decrease in phosphatidylethanolamine. With 32Pi in the growth medium along with the 2-aminoethylphosphonic acid, the incorporation of the radioactivity into new molecules of 2-aminoethylphosphonic acid was almost totally inhibited, indicating a feedback control on phosphonic acid synthesis.


Mechanism of thermal adaptation of membrane lipids in Tetrahymena pyriformis NT-1. Possible evidence for temperature-mediated induction of palmitoyl-CoA desaturase. The regulatory mechanism of a key enzyme, palmitoyl-CoA desaturase, involved in the adaptation to temperature shift was investigated by labeling Tetrahymena pyriformis cells with [14C]palmitic acid. The rate of conversion of [14C]palmitate to [14C]palmitoleate was shown to be dependent on incubation temperature and also to be maximal at 2 h after the shift 39.5 to 15 degrees C. Addition of cycloheximide before the temperature shift produced no increase in desaturation of [14C]palmitate after the shift. These data would provide evidence for temperature-triggered increase of palmitoyl-CoA desaturase level and are also discussed in relation to membrane fluidity.


Amino acid sequence of rabbit carbonic anhydrase II. The amino acid sequence of the high activity form of erythrocyte carbonic anhydrase, carbonic anhydrase II, purified from rabbit erythrocytes has been determined. This sequence was determined primarily from the cyanogen bromide and tryptic peptides through use of automated Edman degradation procedures. The ordering of the peptides from rabbit carbonic anhydrase II was based on the high degree of homology between the rabbit enzyme and the homologous enzymes derived from sheep, bovine, and human erythrocytes. The function of certain residues is discussed in the context of these three known sequences and the previously reported three-dimensional structure of human carbonic anhydrase II. Possible microheterogeneity of rabbit carbonic anhydrase II is also discussed.