Experimental toxemia in the pregnant primate. In order to develop a model for the study of eclamptogenic toxemia, a series of experiments were carried out on 31 female baboons. In Group 1, consisting of 10 animals, metal clips were placed around the uterine arteries in order to partially occlude them, and the ovarian vessels were transected. The animals were subsequently mated. Nine developed hypertension and proteinuria, and one aborted. The renal lesions in these animals were indistinguishable from those described in human toxemia. Group 2 consisted of three of the 10 baboons from Group 1, which became pregnant a second time. They again developed hypertension and proteinuria. In Group 3, three baboons at 100 days of gestation were treated as in Group 1 with similar results. Groups 4 and 5 served as pregnant (3) and nonpregnant (15) controls. It is concluded that a toxemia model has been developed in a subhuman primate. This model will prove useful in the further study of eclamptogenic toxemia.


A comparison of two radiation therapy--treatment plans for carcinoma of the cervix. II. Complications and survival rates. One hundred and one cases of cervical cancer were randomized by a card selection system into two treatment groups. Group A patients (48) were treated according to the radiotherapy plans used at the University of Mississippi Medical Center. Group B patients (53) were treated according to the radiotherapy plan used at the M.D. Anderson Hospital and Tumor Insitute. The purpose was to evaluate these two different therapy programs in terms of survival, complications, and physician radiation exposure. The latter has been reported. Life-table techniques revealed an over-all five-year survival rate of 68.6 per cent in Group A and 86.7 per cent in Group B (statistically significant to P = 0.05). Over-all radiation complication rates were similar although there were four radiation-induced vaginal fistulas in Group A and one in Group B. Our institution has converted to the treatment plan represented in Group B.


An experimental study of increased vertical dimension in the growing face. Five juvenile rhesus monkeys were used in an experiment designed to study the structural adaptations in the craniofacial complex that resulted from increases in vertical dimension. The bite was opened 2,3,10, or 15 mm. by means of cast bite splints cemented on the maxillary arch. Adaptations were monitored in these animals by means of serial cephalometric radiography with metallic implants. The results of this study indicate that any change in the vertical dimension of the face results in specific structural adaptations throughout the craniofacial complex. The most significant adaptation occurred in the maxillary region, in which the normal downward displacement of this region was decrease and the anterior displacement was increased. Adaptation were less evident in the mandible, except in those animals in which a severe bite opening was produced; resorption in the region of the gonial angle was evident. Dentitional adaptations were of secondary importance. This study demonstrates that the maxillary complex is a very plastic structure which responds to changes in bite opening and altered muscle length. The clinician should be aware of the changes that result from various alterations of vertical dimension to make sure that these changes are not antagonistic to his over-all treatment goal. He may also take advantage of these changes when designing treatment strategies for certain clinical cases.


Specific identification of intracellular immunoglobulin in paraffin sections of multiple myeloma and macroglobulinemia using an immunoperoxidase technique. Paraffin-embedded tissues of 47 cases of multiple myeloma and 4 cases of macroglobulinemia were studied by the immunoperoxidase indirect sandwich technique for identification of intracytoplasmic immunoglobulin. Specific immunoglobulin with a single heavy and/or light chain was readily detected in the neoplastic cells. Studies were performed on iliac crest bone marrow biopsies which had been fixed and decalcified using Zenker's-acetic acid solution and on tissues from various sites which had been fixed in formalin. An excellent correlation was obtained between the specific immunoglobulin detected intracellularly in the plasma cells or lymphoplasmacytic cells and the monoclonal immunoglobulin found in serum or urine of these cases. The immunoperoxidase technique represents a sensitive and specific method for identifying intracellular immunoglobulin in paraffin-embedded tissues.


New fossil hominids from Laetolil, Tanzania. New fossil hominid specimens from the Laetolili fossil locality in Tanzania are described. The material includes mandibles and teeth derived from reliably-dated deposits of Pliocene age. Preliminary descriptions, measurements and illustrations are presented.


Social organization and food resources availability in primates: a socio-bioenergetic analysis of diet and disease hypotheses. Data obtained during a field study of two species of nonhuman primates (Alouatta villosa and Ateles geoffroyi) living in the Tikal National Park in Guatemala are used to suggest an answer to the question: To what extent is the existence of a particular form of social organization (group size, structure, and composition) an indication of the amount of energy in the form of food resources available to animals in a particular habitat? Seven researchers working in teams spent 2,318 hours in the field, 1,145 hours of which were in contact with the monkeys. Comparisons of dietary data, estimated energy expenditures, and habitat productivity provide indications of the degree to which a habitat is capable of supporting the energy and other nutritional requirements of howler and spider monkeys living within the study area. These data suggest that much larger populations and different forms of social organizations can be supported by resources available within the habitat.


Size and shape of the hominoid distal femur: fourier analysis. A quantitative description of the shape of the distal femur is provided by Fourier analysis. Fourier analysis also facilitates the separation of the size and shape components which allows the removal of the distorting effect of size. Hence, comparisons between the hominoid groups can be based solely on shape. A sample of 91 hominoid distal femora from the Cleveland Museum of Natural History was used to make comparisons based on size and shape as well as shape only. It is suggested that unless the effect of size is minimized or removed, generally not possible with the traditional metrical approach, measures of biological distance will be distorted.


Locomotor behavior and muscular anatomy of sympatric Malaysian leaf-monkeys (Presbytis obscura and Presbytis melalophos). Sympatric Malaysian leaf-monkeys, Presbytis obscura and Presbytis melalophos show quantitative differences in their use of different locomotor patterns during daily activities. P. obscura primarily moves quadrupedally along large boughs; P. melalophos relies more on leaping between smaller supports. P. melalophos also uses forelimb suspension more than does P. obscura. Comparison of the muscular anatomy of the shoulder, arm, trunk, hip and thigh show numerous statistically significant differences between the two species in relative mass of individual muscles and in details of muscular origin and insertion. In almost all instances these differences accord with the types of differences in muscular anatomy predictable from either biomechanical analyses of locomotor behavior or comparative anatomical studies of other mammalian species.


In vivo bone strain in the mandible of Galago crassicaudatus. Single element foil strain gages were bonded to mandibular cortical bone in eight specimens of Galago crassicaudatus. The gage was bonded below the Pm4 or M2 adjacent to the lower border of the mandible. The bonded strain gage was connected to form one arm of a Wheatstone bridge. Following recovery from the general anesthetic, the restrained Galago bit either a piece of wood, a food object, or a bite force transducer. During these biting episodes, mandibular bone strain deformed the strain gage and the resulting change in electrical resistance of the gage caused voltage changes across the Wheatstone bridge. These changes, directly proportional to the amount of bone strain along the gage site, were recovered by a strip chart recorder. Bone strain was measured on both the working and balancing sides of the jaws. Maximum values of bone strain and bite force were 435 microstrain (compression) and 8.2 kilograms respectively. During bending of the mandible, the correlation between bone strain (tension or compression) and bite force ranged from -0.893 (tension) to 0.997 (compression). The experiments reported here demonstrate that only a small percentage of the Galago bite force is due to balancing side muscle force during isometric unilateral molar biting. In addition, these experiments demonstrate that the Galago mandible is bent in a predictable manner during biting. The amount of apparent mandibular bone strain is dependent on (1) the magnitude of the bite force and (2) the position of the bite point.


Morphometric affinities of the human shoulder. A recent discussion by Corruccini and Ciochon ('76) implies that previous multivariate morphometric studies of the shoulder, reviewed in Oxnard ('73), have been misinterpreted because due allowance was not made for the overall sizes of the specimens. Results that were given functional significance in the earlier investigations are cited as being due at least in part to overall bodily size. Although examination of the range of genera selected for mention by corruccini and Ciochon seems superficially to support this view, it is demonstrated here that examination of the full range of genera in the earlier studies refutes, unequivocally, that suggestion. The discussion by Corruccini and Ciochon ('76) also implies that the more complex size correction applied in their study produces a result different from that of the previous workers. Again, although perusal of the particular part of the earlier study selected for discussion by Corruccini and Ciochon would appear to bear that out, it is demonstrated here that comparisons with all parts of the earlier results provide a different picture. Thus the main result of Corruccini and Ciochon replicates rather closely a more restricted part of the earlier result not mentioned by Corruccini and Ciochon. The difference between Corruccini and Ciochon's principal result and the main result of the prior authors is shown to rest upon the difference between the more restricted earlier study of "residual" shoulder dimensions and the other broader studies; i.e., not upon any multivariate manipulation, but upon the inclusion in the broader study of a wider range of information about the shape of the primate shoulder. Knowledge of these and other points is important in assessing the overall contribution of the discussion of Corruccini and Ciochon.


Calcium transport across avian uterus. III. Comparison of laying and nonlaying birds. Transepithelial calcium fluxes were measured across isolated uterus of laying, nonlaying, and molting quail under conditions where no electrochemical difference existed across the tissue. Net uterine transfer of calcium in molting and nonlaying birds occurs in the secretory direction and is approximately one-fifth the value obtained for laying birds. The carbonic anhydrase enzyme activity of uteri from laying birds is twice that of uteri from molting birds and five times greater than that of uteri from nonlaying birds. When measured in the presence and absence of 2-mercaptoethanol or dithiothreitol, no statistical difference exists in uterine carbonic anhydrase activities of laying birds or the inhibitory effect of acetazolamide. These results indicate that nonlaying and molting quail secrete calcium at a rate much lower than that of laying quail and that net uterine transfer of calcium exhibits varing degrees of dependence on bicarbonate ion in laying, nonlaying, and molting birds. Carbonic anhydrase data sugges that the activtiy of this enzyme in the quail uterus may be related to uterine calcium secretion.


Use of inhibitors in physiological studies of carbonic anhydrase. The appropriate use of acetazolamide in examining physiological function is based on the following: 1) the dissociation constant of the drug-carbonic anhydrase complex (10(-8) M); 2) the concentration needed to eliminate the catalyzed reaction (10(-4) M can be achieved readily in tissues by giving 20 mg/kg at no toxicity; and 4) the lack of known effects on any other systems at concentrations below 10(-3) M. Several problems have been identified and are analyzed concerning the use of acetazolamide and allied drugs. Concentrations greater than 10(-3) M have been used in vitro and occasionally in vivo, generating nonspecific effects. Experiments in which the substrate (CO2) is varied over a large range have been interpreted without regard to alteration in both the catalyzed and uncatalyzed rates, leading to conclusions that acetazolamide acts on a transport system other than carbonic anhydrase, while in reality the drug is acting on carbonic anhydrase at different levels of its catalytic rate. Since calculation of the uncatalyzed hydration of CO2 or dehydration of HCO3-in tissues involves some uncertainty, these rates are generally best defined by studying the dose-response curves of inhibitors and observing the residual activity after full inhibition. The kidney is an exception, since here the residual rate also involves an entirely separate process. Inhibitors other than acetazolamide are useful in ruling out nonspecific effects, and in gaining certainty of access to cells. Compounds closely akin to the inhibitors, but lacking action upon carbonic anhydrase, are also available as controls. It is emphasized that acetazolamide and other carbonic anhydrase inhibitors, when properly used, are highly specific probes of a single enzyme that has a wide variety of physiological functions.


Are breast patterns a risk index for breast cancer? A reappraisal. A retrospective study was designed to test J.N. Wolfe's theory that xeromammographic breast patterns can be used as a risk index for breast cancer. After analyzing breast types of all breast cancer patients over a 4 year period at the Jewish General Hospital, Montreal, who had xeromammography prior to surgery, we were unable to support Wolfe's hypothesis. We conclude that an inherent bias in the design of his experiment led to erroneous conclusions.


Diffuse finely nodular lesions of the esophagus. Double contrast study of the esophagus revealed a variety of diffuse finely nodular lesions, some of which have not been adequately reported. Acanthosis nigricans, superficial spreading esophageal cancer, leukoplakia, moniliasis, and esophagitis were found to produce this appearance. Typical cases of the first three diseases are demonstrated and the differential diagnosis discussed.


Control of variceal bleeding by superior mesenteric artery vasopressin infusion. Liver function and clotting tests were evaluated in 39 patients with variceal bleeding prior to superior mesenteric artery vasopressin infusion. In six patients with mild hepatic dysfunction (Child's class A), permanent control of hemorrhage was achieved in all six and all survived the hospitalization. In 21 patients with moderate dysfunction (Child's class B), permanent control of hemorrhage was achieved in 13 (62%) and temporary control for 24 hr or longer in the remaining eight (38%). Survival in class B was 67% (14 of 21). In only four of 12 patients with severe hepatic dysfunction (Child's class C) was control of hemorrhage achieved (33 percent). None of these patients survived. Therapeutic failure also was associated with clotting derangements and the initial bleeding rate. It is concluded that the effectiveness of vasopressin in variceal hemorrhage is a function of the underlying liver disease and derangements in clotting function.


Congenital cystic dilatation of the common bile duct: relationship to anomalous pancreaticobiliary ductal union. Thirty patients from 15 to 69 years of age with congenital cystic dilatation of the common bile duct were studied. The diagnosis was made by intravenous cholangiography in 70% of the patients and by percutaneous transhepatic cholangiography and/or endoscopic retrograde cholangiopancreatiography in the entire group. Cystic dilatation was also noted in the intraphepatic bile ducts in 12 patients. A union between the common bile and main pancreatic ducts occurred at a high position in 17 of 18 patients in whom both ducts were adequately opacified, forming an abnormally long common channel. One patient with choledochodele had a normal union. The anomalous unions were of two types: the pancreatic duct entering the common duct and the common duct entering the pancreatic duct. The mode of union was correlated with the degree of extrahepatic bile duct dilatation, age of onset, and frequency and severity of symptoms. It is postulated that the congenital anomaly in the union of the two duct systems is the cause of the disease and the congenital choledochocele has a different etiology.


Computed tomography of the liver.

Computed tomography of the liver. The diagnostic value of computed tomography (CT) of the liver depends on proper conduct of the examination, knowledgeable interpretation of findings, and an appreciation of the capabilities and limitations of the method. This report documents 10 months of experience with abdominal CT in more than 600 liver examinations using a system fast enough to eliminate respiratory motion. This experience supplied data on the CT appearance of the normal liver and its variations and of various hepatic abnormalities, on the conduct of the examination, including the appropriate of contrast material, and on some of the problems that reduce the technical quality of the examination. CT was highly accurate, but not infallible, in detecting and defining space-occupying lesions and in detecting fatty infiltration; it was less helpful in detecting diffuse hepatic disease. In bile duct obstruction, CT displayed not only the dilated ducts but often the obstructing lesion.


Ischemic colitis associated with sigmoid volvulus: new observations. Ischemic colitis following conservative management of sigmoid volvulus is documented in four cases. Repeat barium enema studies in these patients showed characteristic "thumbprinting", transverse ridging, and mucosal ulcerations within a segment or the entire length of the sigmoid, lasting up to 7 days after nonoperative decompression. The development, extent, and severity of the ischemic changes seem to correlate with the degree of volvulus, blockage of venous and arterial circulation in the sigmoid mesocolon, and increased intraluminal pressure.


Radiographic appearance of lliac marrow biopsy sites. Following biopsy of marrow from the iliac bone, a lytic lesion, circular and with a sclerotic border, will be seen at the site of the biopsy in the posterior-superior iliac spine. Knowledge of this iatrogenic lesion permits its differentiation from more significant conditions.


Vertebral end-plate depression: report of two patients without hemoglobinopathy. Center vertebral end-plate depression was originally reported to be pathognomonic for sickle cell disease. Two patients without hemoglobinopathy were found to have this deformity. One patient has congenital hereditary spherocytosis; the other has no blood dyscrasia but is osteopenic. Therefore, although this deformity is usually due to sickle cell disease, it is not pathognomonic.


Osteitis deformans of the hip joint.

Osteitis deformans of the hip joint. It is estimated that 66% of patients with Paget's disease have involvement of the pelvis and 46% of the proximal femur. Therefore, it is not unexpected that hip pain is one of the major presenting complaints. Analysis of the radiographs of 25 hips with one or more articular sufaces involved by Paget's disease demonstrated narrowing in 24. Unlike the findings in primary degenerative joint disease, the majority of cases had a radiographic pattern characterized by uniform narrowing of the articular cartilage and minimal hypertrophic changes. Pathologic correlation was obtained from specimens of four patients who underwent total hip replacements. The pathogenesis of arthritic changes associated with osteitis deformans is not established. The evidence presented suggest that cartilagenous narrowing results from a disturbance in endochondral bone formation related to the hyperemia of Paget's disease. Secondary deformities of bone produce further derangement of joint mechanics. The secondary degenerative changes which ensue differ mechanically, and therefore radiographically, from primary degenerative joint disease.


Pseudofracture of the dens: Mach bands.

Pseudofracture of the dens: Mach bands. Mach bands are an optical phenomenon in which dark and light lines appear at the borders of structures of different radiodensity on radiographs. In most instances they do not cause a diagnostic dilemma. However, in a patient who has sustained trauma to the cervical spine, the commonly occuring negative Mach band across the base of the dens may be mistaken for a fracture. Failure to recognize this optical illusion may result in unnecessary treatment by skeletal traction. The production of Mach bands, methods of proving their illusory nature, and several illustrative cases are presented.


Chondroblastoma of the calcaneus: radiographic features with emphasis on location. Fourteen cases of chondroblastoma of the calcaneus have been examined and the radiographic features described. Thirteen occured in males. In all but one case the location was either at the talocalcaneal articulation or adjacent to the posterior calcaneal cortex. A sclerotic margin was present in all instances. Occasionally calcifications and septations were seen.


The application of fast screen-film systems to excretory urography. Rare earth and barium fluorochloride screen-film combinations of different relative speeds were compared to conventional calcium tungstate systems in patients undergoing excretory urography under controlled conditions. Radiographs were ranked by subjective impressions of detail, contrast, mottle, motion unsharpness, overall quality, and acceptablility. Compared to a medium speed calcium tungstate screen/film combination (assigned a speed of 1), screen-film systems in the 2-5 speed range offered improvement in overall quality due to diminished respiratory motion unsharpness at the cost of some loss of detail and increase in mottle. Other advantages and disadvantages of fast screen-film systems are discussed.


CT-guided antegrade pyelography and percutaneous nephrostomy. Percutaneous antegrade pyelography and percutaneous nephrostomy can be easily performed using CT guidance. CT provides cross-sectional images which facilitate accurate needle placement into the renal pelvis. CT is capable of detecting subtle density differences within the tissues so that even renal pelvises which do not contain contrast material and are not dilated can be accurately punctured. In addition to these procedures, CT accurately displays the perinephric space so that assessment of complications is possible. Four of five attempted percutaneous nephrostomies and two antegrade pyelograms were successfully performed using CT gudance.


Differentiation between renal allograft rejection and acute tubular necrosis by renal scan. The usefulness of the renal scan in diagnosing technical complications in the transplant patient is well established. However, the ability of the renal scan to differentiate between acute rejection and acute tubular necrosis has remained uncertain. We have evaluated the effectiveness of the 99mTc DTPA computer-derived time-activity curve of renal cortical perfusion, as well as data obtained from scintillation camera images, in making such diagnoses. Fifteen patients with a clinical diagnosis of either acute rejection or acute tubular necrosis, or both, were studied retrospectively. Technetium scan diagnoses did not agree with the clinical assessment in nine of the patients. Thus selection of a course of treatment should not be based on data obtained from the scan alone.


Supracristal ventricular septal defects: spectrum of associated lesions and complications. The clinical records and radiographs of 46 patients with a supracristal ventricular septal defect are reviewed to illustrate the spectrum of associated lesions and complications seen with this defect. The presence of a supracristal ventricular septal defect compromises the normal conal muscular support of the aortic valve, usually in the region of the right sinus of Valsalva, and, consequently, complications involving the aortic valve are frequently noted. Decreased sinus support may lead progressively to prolapse of the right aortic cusp through the supracristal ventricular septal defect into the right ventricular infundibulum effecting sequentially aortic regurgitation, right ventricular outflow obstruction, and ultimately right sinus of Valsalva-right ventricular fistula. This potential progression is an indication for early recognition and repair of the supracristal ventricular septal defect. A supracristal ventricular septal defect is also an integral component of the Taussig-Bing malformation, is present in the majority of patients with aortic arch interruption, and may be seen in as many as 25% of Oriental patients with tetralogy of Fallot.


Intrapericardial installation of radioactive chromic phosphate in malignant effusion. Treatment of 28 patients with malignant pericardial effusion was accomplished primarily by intrapericardial instillation of radioactive chromic phosphate. At time of diagnosis of pericardial disease, 14 patients had major manifestations of tamponade; the rest had little or no clinical evidence of effusion. Only eight of the 28 patients had further problems with effusion after the initial pericardiocentesis and 32P instillation. Additional aspirations were done on those patients 2 weeks to 5 months later. The average survival was 9 months; seven patients lived more than 1 year.


Pulmonary venoocclusive disease: case report and review of the literature. A fatal case of pulmonary venoocclusive disease in a 4-year-old boy is reported, with emphasis on the radiologic features of this condition. The disease is characterized by fibrous intimal obliteration of the lumina of small pulmonary veins and venules leading to severe secondary pulmonary arterial hypertension. The clinical picture is usually indistinguishable from that of other forms of pulmonary arterial hypertnesion, but radiologic features of postcapillary pulmonary hypertension, in conjunction with a normal venoocclusive disease. The diagnosis is definitively established by lung biopsy.


Vocal cord paralysis: radiologic observations in 21 infants and young children. The diagnosis of vocal cord paralysis or paresis was made on direct laryngoscopic examination in 34 infants and children during the past 4 years. Twenty-one of the children were first examined radiographically and fluoroscopically, and the initial diagnosis of cord paralysis was suggested by the radiologist. Our experience suggest that vocal cord paralysis or paresis in an infant or young child is not the rare entity previously reported. In more than half of the children the vocal cord dysfuction was of a transient nature. Awareness of the radiographic and fluoroscopic signs that suggest the diagnosis will aid in the early institution of appropriate supportive therapy.


Intracranial cavernous angioma.

Intracranial cavernous angioma. Cavernous angiomas are a rare but important clinical entity because of their potential curability. Three patients who had intracranial cavernous angiomas confirmed at surgery are presented. Preoperative recognition is greatly aided by a tendency to calcify, as identified both by skull films and more sensitively by computed tomography. A well demarcated collection of rounded densities of CT scanning, showing mild contrast enhancement and no significant mass effect, should suggest the possibility of cavernous angioma. Conventional angiography characteristically reveals a hypovascular appearance without abnormal arterial feeding vessels. On films of high technical quality, a subtle vascular stain, possibly associated with a few large draining veins, may be detected. There is usually no mass effect unless there has been a previous episode of hemorrhage. Cavernous angiomas may manifest a pronounced increase in activity on radionuclide brain scanning.


Normal and abnormal upper abdominal venous structures as seen by ultrasound. Recent B-scan ultrasonic techniques have made possible the routine visualization of the major upper abdominal venous structures. Real-time scanning permits in vivo dynamic assessment of the upper abdominal veins. B-scan ultrasound allows optimal anatomic resolution and is superior for the establishment of intraluminal pathology and anatomic relationships with adjacent organs. The anatomic localization of the upper abdominal veins has proved of practical importance in several ways. Identification of the splenic and superior mesenteric veins allows localization of the pancreas and the enlarged common bile duct. Increased size of the upper abdominal venous structures can indicate certain pathological conditions, notably raised right heart pressure and portal hypertension. Intrinsic pathology within the inferior vena cava may be detected. Extrinsic distortion of veins by adjacent mass lesions is not uncommon, and if the venous structure is recognized, more precise anatomic localization of the mass is possible.


Further evidence for the parasitic origin of the surface coat on Malaria merozoites. It has been observed that a surface coat, 20 nm in thickness, extends from the plasma membrane of extracellular merozoites and that this coat contains strain-specific antigens. In the present study we determined the possible effect of protein in the culture medium on this structure. The surface coat on merozoites in culture medium devoid of protein was indistinguishable by transmission electron microscopy from the coat in a protein-containing medium. This supports the hypothesis that the surface coat originates from the parasite rather than from adsorbed serum protein.


Studies on the epidemiology of sandfly fever in Iran. III. Host-feeding patterns of Phlebotomus papatasi in an endemic area of the disease. Blood meals from 575 Phlebotomus papatasi collected in an Iranian village were identified by precipitin test. The majority of sandfly feedings (57.5%) were on birds, mainly chickens and pigeons. The remaining 42.5% were on mammals (humans, cows, mules, sheep, and goats) or were non-reactive. Calculation of forage ratios of each host species indicated that chickens, equines, and bovines were the preferred hosts of P. papatasi in the village. Results of this study demonstrate that P. papatasi has a much wider natural host range than indicated previously and suggest that this species is an opporunistic feeder and is not strongly anthropophilic. Observations on the diurnal activity of P. papatasi are also presented.


Survival of arboviruses in trypanosome-infected triatomines. The potential of triatomines to maintain arboviruses was demonstrated by the ability of Rhodinius prolixus with experimentally punctured abdomen to harbor Venezuelan equine encephalitis (VEE) virus for at least 4 months and St. Louis encephalitis virus for 1 month. At 30 days after infection VEE virus was found at low titers in Trypanosoma cruzi-infected R. prolixus and at moderate titers in T. rangeli-infected R. neglectus. Transmission of VEE virus by bite of punctured bugs was successful 2 weeks after virus ingestion; attempts at 30 days failed.


Dislocation of the peroneal tendons.

Dislocation of the peroneal tendons. It is our opinion that acute luxation of the peroneal tendons must be operated to prevent future disability. Chronic luxations of the peroneal tendons may be treated with a modified Kelly procedure, with anticipated excellent results. The diagnosis of acute luxations of the peroneal tendons continues to be difficult, and we hope that the guidelines listed in this paper will enable the clinician to be aware of this injury.


Parenteral solutions for nutritional support in surgical patients. A comparison of nitrogen gains employing 5 per cent and 10 per cent amino acid solutions. A 10 per cent amino acid solution accompanied by 10 per cent Intralipid and 50 per cent glucose could be infused by peripheral veins. This safe and practical method induced positive nitrogen balance of 7 to 8 gm daily in five of six septic patients.


Cost-benefit analysis of surgery. Current accomplishments and limitations. The general principles of cost-benefit analysis are applicable to health care issues, which are in particular need of carefully detailed study at a time when health care expenditures are increasing and when there is competition for scarce resources. There are limitations to such analyses, particularly in the evaluation of the many intangible values so important in the costs and benefits of health care. As examples of the methodology, a simplified cost-benefit analysis is presented for cholecystectomy for silent gallstones in terms of an individual patient, and a more complex analysis is presented for a national program for renal transplantation or chronic hemodialysis for end-stage renal disease. Finally, costs of intensive care support are presented. These examples illustrate advantages and disavantages of a revealing type of analysis that will be applied with increasing frequency to future health care issues.


Lateral ligamentous instability of the ankle: a method of surgical reconstruction by a modified Watson-Jones technique. Forty-nine cases of lateral ligamentous instability of the ankle have been reviewed. Forty-one have been personally examined. Eight have been evaluated by questionnaire follow-up. The end results have been universally good. The results have been based on a subjective evaluation by the patient, 92% regarding the end results of the procedure to be excellent. In regard to function, 92% of the patients have been able to resume their preinjury activity. The evidence of instability of the ankle joint can be determined by preoperative x-ray examination. However, careful history and physical examination obviate the need for x-ray studies in most cases. Operative findings have confirmed our preoperative evaluation in all cases. The modification of the Watson-Jones procedure, using the peroneus longus, enables the operating surgeon use of a much greater tendon in reconstruction of the lateral ligamentous structures. No change in the function of the foot has been noted in the reported cases.


Phenol oxidase activity of the iris and the ciliary body in rats. Phenol oxidase activity of the iris and the ciliary body in normal young rats of three differently pigmented strains, Lewis (albino), E3 (light brown, hooded), and BDE (black, hooded), was studied using DL-Dopa. Applicability of the histochemical method was controlled with skin samples taken from the necks of the animals. In the pigmented strains, the appearance of newly formed pigment at the pigmented epithelium and stroma of the iris and ciliary body was observed. In the E3 animals, the reaction was slightly positive, while in the BDE rats it was more pronounced. No phenol oxidase activity was detected in the ocular structures of the albinotic rats.


Dissociation of the vitreo-retinal junction following experimental embolization of retinal circulation. Spheric plastic beads (7-25 mu in diameter) were injected into the central retinal artery of the owl monkey (Aotus trivirgatus) using a micro-surgical technique. The occlusion of retinal arteriolar branches resulted in posterior vitreous detachment and microcystoid degeneration in inner retinal layers. The dissociation of the vitreoretinal junction showed three different entities: detachment of the vitreous from the basal lamina (inner limiting lamina of the retina), separation of the basal lamina from the retina, and detachment of shreds of glial cells and other degenerated retinal tissue (intraretinal schisis).


Myelinated granule cell bodies in the cerebellum of the monkey (Saimiri sciureus). Electronmicrographs of both the vermis and hemisphere of the cerebellum of the squirrel monkey (Saimiri sciureus) show numerous granule cell bodies partially or completely surrounded by myelin. The myelin is of the compact type and consists of 1 to 13 lamellae. In several cases of partially ensheathed cells the myelin is clearly derived from extensions of myelin sheaths that surround small caliber axons. Either all or only the outer lamellae surrounding the axon contribute to the extensions. In the first instance the myelin buckles at its mesaxon pole and the resulting doubled flap extends for a variable distance along the cell surface.


Enamel rod formation in the monkey observed by scanning electron microscopy. Scanning electron microscopy of permanent tooth buds of the monkey confirmed that mineralizing interrod enamel surrounds Tomes' processes on three sides, forming pits that restrict enamel rod formation. The forming face of the enamel rod, which is the floor of the pit, angled toward the tooth surface at the apical edge of the pit, the side nearest the cervical region of the tooth. Consequently, the apical edge of each pit was the only site where both rod and interrod enamel were formed at the nascent tooth surface. The ameloblasts had two secretory surfaces. One was the microvillous surface of the short Tomes' process abutting the forming face of the enamel rod. The other surface, closer to the ameloblast, was between Tomes' processes, abutting the crests of interrod enamel which formed the pits. At each site forming enamel crystallites had specific orientations. Due to the angle of the forming face of the rod and the short Tomes' process, crystallites with both rod and interrod orientation form at the same time and the same plane within the apical (cervical) margin of each rod. It is hypothesized that indistinct boundaries between rod and interrod enamel at the apical margin of each rod are due to both secretory surfaces of ameloblasts secreting at the same time and at the same site.


Comparative clinical pharmacology of amikacin and kanamycin in dairy calves. The in vitro susceptibility of Escherichia coli, Salmonella sp, Pasteurella multocida, and Pseudomonas aeruginosa strains isolated from young calves and their environment to kanamycin and its semisynthetic derivative--amikacin, was compared by the tube dilution method. The minimal inhibitory concentration of amikacin was two- to fourfold lower than the minimal inhibitory concentration of kanamycin for the Salmonella group B, Ps aeruginosa and P multocida strains examined, whereas the E coli and Salmonella group D strains were eqaully susceptible to the 2 antibiotics. The concentrations of amikacin and kanamycin in the serum of calves after single intramuscular injections at 10, 25, and 50 mg/kg were determined, and differences between the 2 antibiotics were not observed. Intramuscular dosage schedules were calculated, based on the sensitivity of the different bacterial strains and the duration of effective serum drug concentrations.


Alternative complement pathway in bovine serum: lysis of human erythrocytes. The hemolysis of unsensitized human erythrocytes by fresh bovine serums was investigated. Lysis occurred in ethylene glycol bis-amino tetraacetate buffers and with serums depleted of Clq. Serums extensively absorbed with packed human erythrocytes at 0 C effectively lysed human erythrocytes, but optimal lytic capacity required target cells "sensitized" with a heat-stable serum factor. Lysis did not occur with serums absorbed with zymosan at 17 C or heat inactivated at 50 C. These results indicate that human erythrocytes can activate the alternative pathway of complement in bovine serums. Lysis can proceed in the apparent absence of antibodies, although their presence may enhance the reaction.


Specific in vitro lymphocyte response of chickens injected with killed Mycobacterium tuberculosis. An in vitro microassay for lymphocyte transformation, using 3H-thymidine incorporated into avian peripheral blood leukocytes, is described. The transformation responses of 1 X 10(6) leukocytes stimulated by the nonspecific mitogen, phytohemagglutinin-M (PHA-M), were equivalent with 68- and 92-hour incubation durations. The PHA-M in concentration of 50 micronl/ml produced greater stimulation than did that of 25 or 100 micronl/ml. The transformation response to PHA-M was significantly affected by the lot of bovine fetal serum used to supplement the RPMI 1640 culture medium. The specific antigen, purified protein derivative (PPD) of tuberculin, stimulated significant transformation in cultures of 1 X 10(6) leukocytes from Mycobacterium tuberculosis-sensitized fowl. The PPD at concentration of 50 microng/ml was superior to 100 or 150 microng/ml, and 68-hour incubation was significantly better than 92-hour incubation. The magnitude of the in vitro transformation response to PPD was greater at 6 weeks after sensitization than at 2 or 4 weeks, and it was not directly related to the magnitude of the in vivo wattle test response in sensitized chickens.


Lymphoma associated with an epizootic of lymphocytic choriomeningitis in Syrian hamsters (Mesocricetus auratus). A hamster-associated epizootic of lymphocytic choriomeningitis (LCM) virus infection in medical center personnel at the University of Rochester in 1973 necessitated prompt termination of the Syrain hamster colony. Necropsies were performed on 130 hamsters, blood speciments were obtained from 60 for serotest, and viral isolation procedures were done on 47. Active virus infection, as shown by virus isolation, was associated with the presence of lymphoreticular infiltrate in liver and kidney. Intraabdominal lymphoma was seen only in groups of hamsters from which LCM virus was isolated, but LCM virus was not isolated from many of the hamsters with lymphoma. Although frequency of intraabdominal lymphoma could be markedly increased in LCM-positive hamsters treated with 7,12-dimethylbenz(a)anthracene, lymphoma was not induced in LCM-negative hamsters with this carcinogen.


Mycobacterial antigens relating to experimental pulmonary cavity formation. Lipid-protein mixtures were obtained from 2 strains of mycobacteria, and their cavity-forming activities were examined in rabbit lungs. The mixtures were separated into lipid and protein fractions by gel filtration on Sephadex LH-20 column. Neither lipid nor protein fraction alone had cavity-forming activity; however, restoration of the cavity-forming activity was observed by recombining the fractions. The activity was also reconstructed by combining the protein fraction with cell walls of bacille Calmette-Guérin. The protein fraction from Mycobacterium phlei was further separated into 2 fragments. The larger molecular fragment with a molecular weight of 10,000 daltons consisted of 60% protein and 40% carbohydrate and had cavity-forming activity in combination with the cell walls. The roles of lipid and protein of mycobacteria in cavity formation are discussed.


Acute leukemia in multiple myeloma.

Acute leukemia in multiple myeloma. Of 476 patients with multiple myeloma treated during a 9-year period, 11 developed acute myelogenous leukemia or sideroblastic anemia. In all, the myeloma was in remission from chemotherapy with melphalan-prednisone combinations that had been continued for a median duration of 3 years. The incidence of acute leukemia or sideroblastic anemia was about 100 times higher than found in normal individuals of the same age. In all patients studied, major cytogenetic abnormalities were present, with hypodiploidy and evidence of chromosomal damage being noted most frequently. The frequency and nature of the chromosome changes were attributed to effects resulting from the prolonged drug therapy. These findings supported the long-term follow-up of selected patients with myeloma without any chemotherapy when marked degrees of remission followed the initial treatment courses.


Gram-negative rod bacteremia: microbiologic, immunologic, and therapeutic considerations. During the last 2 decades, Gram-negative rod bacteremia has become the leading infectious disease problem in American hospitals. With improvements in conventional microbiologic techniques, bacteremic infection can be diagnosed reliably within 3 days using only three sets of cultures. Clinical management still requires aggressive, presumptive use of antimicrobials in patients with the most adverse host factors. In the latter group, the use of combinations of antibiotics that interact synergistically in vitro has improved clinical results. In bacteremia due to anaerobes, particularly Bacteroides species, drainage of infected sites is probably more important than specific drug therapy. Various host defects have been associated with Gram-negative bacteremia; the most common in the nonleukopenic patient is impaired opsonization. The evidence that endotoxins are involved in the pathophysiology of Gram-negative bacillemia is inferential. Nevertheless, both clinical and experimental evidence suggest that active or passive immunization with endotoxin components or antigens similar to Gram-negative polysaccharides may be protective.


An analysis of the cost-effectiveness of pharyngitis management and acute rheumatic fever prevention. The cost-effectivness of preventing primary acute rheumatic fever attacks by oral or benzathine penicillin treatment was analyzed for both epidemic and endemic streptococcal pharyngitis situations. Decision analysis was used: the probabilities and the outcome values were calculated from published data. Three penicillin strategies were compared: (A) treating only patients with group A streptococci-positive throat cultures; (B) treating all patients; (C) treating none of the patients. In the epidemic situation it is medically most effective and least costly to treat all patients with penicillin (Strategy B). In the endemic situation, Strategy B is also most cost-effective when oral penicillin is used in patient populations where the positive throat culture yield is at least 20%. Strategy A is optimal when the yield is between 5% and 20%; below a 5% yield, Strategy C is appropriate. For any individual patient, it is possible that choice of the most cost-effective treatment strategy could be based on the patient's clinical findings.


Plasma cell leukemia with excretion of half-molecules of immunoglobulin A (alpha1 lambda1). A patient with plasma cell leukemia and myelofibrosis excreted free immunoglobulin light chains and an abnormal monoclonal immunoglobulin (Ig) A in her urine. The IgA that was present in serum and urine had a sedimentation coefficient of 4.0 S. The molecule was comprised of both heavy and light chains but was antigenically deficient compared to normal IgA. As excreted in the urine, the protein appeared to be a half-molecule of IgA, with a partial deletion in the heavy chain, probably involving part or all of the C-terminal domain.


Twenty-five years of tympanoplasty: a critical evaluation. Twenty-five years of experience with tympanoplasty have demonstrated that the operation is not as safe as it is generally thought. Serious complications do occur. Many problems of middle ear reconstruction remain unsolved and more often than not results have not withstood the test of time. This paper attempts to answer the following questions. 1) What are the hazards in tympanoplasty surgery? 2) What are the complications of tympanoplasty? 3) What can tympanoplasty do for the welfare of the patient with reasonable certainty? 4) What has tympanoplasty been unable to do in spite of continued attempts and experimentation? 5) Why is tympanoplasty successful or unsuccessful in seemingly similar cases?


Enzymological approaches to the lipidoses. There are now ten known heritable disorders of lipid metabolism for which the nature of the underlying enzymological defect is conclusively established. In addition to devising procedures for successful enzyme replacement therapy, much current work deals with the development of convenient, effective methods for the rapid diagnosis of patients with these disorders, the detection of heterozygous carriers of these diseases, and the monitoring of pregnancies at risk for these conditions. Clinical enzymologists are required to assume increasing responsibilities in the performance of these tests, and the present contribution describes the application of fundamental principles and discusses recent developments along this line. In particular, the development of facile chromogenic reagents for the diagnosis of patients with Niemann-Pick disease and Krabbe's disease is delineated. Previously, the diagnosis of such patients required the use of radioactivity labeled compounds and such testing was limited to relatively few research laboratories. The novelty of these reagents and their application comprise the major aspect of this presentation.


[An immunological enhancement phenomenon in different experimental bacterial infections]. To demonstrate that an enhancement phenomenon might be involved during the development of bacterial infections, one has to establish that specific humoral antibodies protect, in some way, microorganisms against the defence reations of the host. This report presents the evidence that specific antibodies could be evolved in assuming a certain survival of bacterial cells in host's tissue. (1) Homologues antistaphylococcal sera passively potentiated the development of experimental staphylococcal synovitis infection of chickens. The enhancement activity of the antisera was associated with a relatively high level of immune adherence antibodies and seemed not be correlated with their agglutinin titers. (2) The passive transfer of chicken anti-Brucella immune globulins promote the survival of B. abortus in the spleen of chickens infected with these bacteria. This enhancing effect was reduced significantly when the immune globulins were absorbed with heat-killed Brucella cells to remove all the anti-Brucella agglutinins and immune adherence antibodies. (3) The passive transfer of rabbit antimycobacterial immunoglobulins directed against either living or soluble extracts of Mycobacterium tuberculosis strain H37Rv, promotes the multiplication of the BCG stain of M. tuberculosis in the spleen of mice infected with low doses of this latter strain. This enhancing effect was reduced significantly when antisera were absorbed with living BCG. Morever, such treatment led to the removal of all haemagglutinating antibodies when antisera were tested aganist either BCG or H37Rv soluble extracts.


[Characteristics of determining the microbial contamination of penicillin series antibiotic powders and tablets]. Optimal conditions for determination of microbial contamination of drugs were studied on artificially contaminated powders and tablets of phenoxymethylpenicillin, ampicillin, oxacillin and dicloxacillin. The method of membrane filtration was the best for determination of the microbial contamination of the powders. However, it was not possible to wash out completely the antibiotic from the membrane filter. To prevent this it was necessary to add penicillinase into the nutrient medium onto which the filter was put for providing the microbial growth. For determination of microbial contamination of tablets direct plating of 3 per cent suspension of the tablet mass onto the surface of the nutrient medium with penicillinase was the best.


[Sensitivity of the wound microflora of oncological patients to some new antibiotics]. Sensitivity of the microflora of the oncological patients' wounds to the new antibiotics, such as gentamicin, kanamycin, oxacillin, ampicillin and lincomycin was studied with the help of the disc method. The discs with the above antibiotics were prepared under laboratory conditions in accordance with the respective instructions in the WHO. Sensitivity of 429 bacterial cultures, including 98 cultures of pathogenic staphylocci, 45 cultures of Enterococci, 43 hemolytic streptococci, 143 cultures of Escherichia, 50 cultures of Ps. aeruginosa and 50 cultures of Proteus was determined. The studies showed that gentamicin was the most active antibiotic aganist all the microbial species isolated from the surgical and other wounds of oncological patients. It may be used in treatment of the infections caused by association of the microbes belonging to different species, as well as in treatment of purulent processes before elucidating their etiology, 16.7 per cent of the Enterococcal isolates were resistant to gentamicin. Monomycin, kanamycin, oxacillin, lincomycin and macrolide antibiotics at present are sufficiently active against pathogenic staphylococci and hemolytic streptococci.


[Insertion of mouse kappa light chain immunoglobulin gene sequences into a bacterial plasmid]. The 14S mRNA from MOPC 173 tumour has been transcribed into cDNA by AMV DNA polymerase and converted into a double stranded form by Escherichia coli DNA polymerase I. After addition of oligo-dG tracts at the 3'-OH ends by calf thymus terminal transferase this DNA was hybridized to an E. coli plasmid (pCR1) to which oligo-dG tracts had been similarly added. Circular molecules resulting from GC base pairing have been used to transform C 600 E. coli cells and to confer kanamycine resistance. Several recombinants have  been obtained containing the V+C regions and the C or V region alone. These recombinant molecules are being used to analyse the translocation of V and C genes and to purify V and C genes from DNA of germ line cells and of differentiated tumour.


[Heterogeneity of antibodies produced by individual cells]. Recent experimental findings indicate that individual B cells can produce simultaneously heterogeneous Ig molecules. Three orders of heterogeneity have been described. (1) In two published cases of human myeloma, individual malignant cells produced Igkappa and Iglambda (case Im) or IgMlambda and IgGkappa (case Br). (2) Immunofluorescence studies repeatedly showed that normal B cells may bear surface Ig of two different classes or cytoplasmic Ig of one class and surface Ig of another class. However, simultaneous production of two different CH chains by immunized B cells or myeloma cells appeared to be rather rare (1-3%). (3) Immunization of mice with two different antigens regularly results in the appearance of cells (1-3%) simultaneously reacting with both antigens. Specific inhibition of the one activity does not interfere with the other. Furthermore, bispecific cells cultured individually generate daughter cells, each producing antibody of only the one or the other specificity. It can be inferred from these findings that early B lymphocytes are pluripotential and that differentiation involves a process of phenotypical restriction directing the cell (plasma cell) to produce high quantities of one type of Ig molecule.


Tetracycline inhibits propagation of deoxyribonucleic acid replication and alters membrane properties. Tetracycline, at concentrations greater than required for inhibition of protein synthesis, rapidly and completely inhibits replication of deoxyribonucleic acid (DNA) in Escherichia coli and Bacillus subtilis. At these concentrations of tetracycline, synthesis of ribonucleic acid is not appreciably altered. In addition to inhibiting DNA replication, tetracycline causes alterations of the cytoplasmic membrane resulting in leakage of intracellular pools of nucleotides, amino acids, and the non-metabolizable sugar analogue, thiomethylgalactoside. As DNA is synthesized at a site on the membrane, alterations of membrane structure by tetracycline may be responsible for the observed inhibition of DNA replication.


[Evolution of the rabbit kappa light chain: multiple substitutions between allelic forms]. The partial amino acid sequence of the rabbit IgG light chain constant region of allotype b6 was determined by analyzing tryptic digests. The comparison of available data on b4, b5, b6 and b9 constant region sequences reveal multiple differences ranging from 35% between b4 and b9 or between b6 and b9 chains, to 24% between b4 and b6 chains. This large number of substitutions suggests an early divergence of the b constant region structural genes into to-day's four polymorphic forms.


Transfer of a plasmid-specified beta-lactamase gene from Haemophilus influenzae. A number of ampicillin-resistant strains of Haemophilus influenzae could donate a gene specifying the type IIIa (TEM) beta-lactamase to Haemophilus parainfluenzae, Escherichia coli, and Pseudomonas aeruginosa. Donor strains rapidly lost their ability to transfer ampicillin resistance on storage or subculture. Such strains also apparently contained a single species of covalently closed circular deoxyribonucleic acid of contour length 1.2 mum, equivalent to about 2.5 x 10(6) daltons. No species of plasmid deoxyribonucleic acid large enough to encode sex factor activity was detected. Despite this, transfer occurred to several bacterial genera in the presence of deoxyribonuclease, suggesting that transmissibility was by conjugation. The beta-lactamase gene was generally unstable after transfer and was lost in the absence of selection. Where stable transcipients were found, this was evidently by insertion of the beta-lactamase gene into the host chromosome. In P. aeruginosa insertion was always accompanied by induction of auxotrophy for adenine, suggesting insertion at a specific site. It is believed that insertion also occurred at one site on the chromosome of Escherichia coli. Crypticity measurements for beta-lactamase activity showed that there was little or no penetration barrier to beta-lactam drugs in Haemophilus. This may explain the long delay in the acquisition of ampicillin resistance by this organism.


Comparison of colicins B-K260 and D-CA23: purification and characterization of the colicins and examination of colicin immunity in the producing strains. Colicins B-K260 and D-CA23 were purified by ammonium sulfate precipitation, gel filtration, and ion-exchange chromatography and were compared with respect to a number of physical and chemical properties. Both colicins were shown to be proteins and were found to have similar molecular weights, isoelectric points and amino acid compositions. The two colicins also have substantial antigenic similarities but are distinguished by the presence of non-cross-reacting antigens and by differences in stability and in sensitivity to heat and reducing conditions. In addition, strains of Escherichia coli K-12 producing colicins B-K260 and D-CA23 are not cross-immune. The similarities noted between the two colicins are compatible with their use of a common cell surface receptor while having different modes of action.


Confirmation of the single-step membrane filtration procedure for estimating Pseudomonas aeruginosa densities in water. The efficiency of two procedures, membrane filtration and most probable number, to resuscitate and enumerate Pseudomonas aeruginosa have been compared at two temperatures and varying incubation periods. Data indicate that the membrane filtration procedure using mPA or mPA medium B is more efficient than the most-probable-number procedure in estimating P. aeruginosa populations. It was also found that the specificity of the membrane filtration procedure was such that 92 to 99% of the colonies counted as P. aeruginosa were confirmed, whereas only 2.7 to 10% of the nontypical colonies were confirmed as P. aeruginosa. Furthermore, the data indicate that mPA medium B combined with a 3- to 4-day incubation period at 4.15 degrees C is slightly more specific than mPA medium and is a valid single-step procedure for the resuscitation and enumeration of P. aeruginosa from water or sewage effluent.


Radiolabeling of and macromolecular syntheses in Neisseria gonorrhoeae types 1 and 4. Type 1 and type 4 cells of Neisseria gonorrhoeae were grown in a liquid medium that maintained colony type for several hours. Organisms from both types of colonies incorporated labeled glucose, as well as nucleic acid and protein precursors, into specific cellular fractions during growth in the medium. Ribonucleic acid and protein were synthesized actively by the bacteria, with incorporation of label chased by the addition of unlabeled precursors. The method can be used to label type 1 and type 4 cells of gonococci with specific isotopes for studies of metabolic and biochemical changes.


Effect of beef broth protein on the thermal inactivation of staphylococcal enterotoxin B1. Enterotoxin B produced by Staphylococus aureus 243 in brain heart infusion broth was concentrated by dialysis against 40% polyethylene glycol (20 M), partially purified on a Sephadex G-100 column and heated at 110 degrees C in thermal death time cans. Various heating menstrua included 0.04 M Veronal buffer (pH 7.4), beef broth, and fractions of beef broth obtained by ultrafiltration or precipitation with ammonium sulfate. The toxin was assayed serologically using the microslide gel double-diffusion method. The time requiring for 90% inactivation at 110 degrees C (D110 value) obtained in buffer and in beef broth was 18 and 60 min, respectively. When the concentration of beef broth was increased fivefold, the D110 increased to 78 min. The apparent protective effect or protein was further investigated using beef broth protein obtained by precipitation with (NH4)2SO4. The D110 values were 51 and 70 min when the protein concentration in the heating menstruum was 3.8 and 7.7 mg/ml, respectively. However, when the beef broth protein was dialyzed against buffer before use as a heating menstrum, the D110 was only 39 or 41 min at comparable protein concentrations. Results indicated a dialyzable factor, whose protective effect was partially destroyed by trypsin and chymotrypsin but did not by disodium ethylenediaminetetraacetate, was involved in the protection of enterotoxin B during heating.


Isolation and molecular size of Clostridium botulinum type C toxin. A procedure is described for the purification of hemagglutinin-free Clostridium botulinum type C toxin. The toxin was purified approximately 1,000-fold from the original culture supernatant in an overall yield of 60% to a final specific toxicity of 4.4 x 10(7) minimal lethal doses/mg of protein. The toxin had a molecular weight of 141,000 and consisted of a heavy and a light chain. The molecular weights of the subunits were approximately 98,000 and 53,000. When comparing the molecular size and composition of type C toxin to that of botulinum toxins of different types, some common features may be suggested; i.e., the toxin has a molecular weight between 141,000 to 160,000 and is comprised of a heavy and a light chain linked by disulfide bonds (or bond).


Spontaneous fits after convulsions with fever. 112 of an original sample of 134 children with febrile convulsions were reviewed between 8 years and 9 years 10 months after their initial attack. 17% of those followed up had had at least one spontaneous fit. A significant correlation was found with perinatal abnormalities. 12% had continuing recurrent fits. Persisting grand mal occurred most commonly in lower social class children who had had perinatal abnormalities and continued to have long-term neurological disorders. Psychomotor epilepsy correlated significantly with a prolonged or repeated initial convulsion with unilateral features. It is suggested that the development of grand mal and temporal lobe epilepsies after convulsions with fever are determined by different mechanisms.


Cephalothin Prophylaxis and valve replacement. In a study of antibiotic prophylaxis in adults undergoing heart valve replacement, we found that a 2 gm dose of cephalothin given intraoperatively produced adequate antimicrobial activity in the bloodstream throughout the period of cardiopulmonary bypass. A dosage of 1 gm every four hours postoperatively did not lead to significant accumulation of the antibiotic. With prophylaxis restricted to the intraoperative and early postoperative period, adverse drug reactions and superinfections were not a problem. Further, no cases of prosthetic valvulitis were encountered.


Local specificity in responses of canine coronary vessels to oxygen deficiency and antianginal drugs. Influence of oxygen deficiency and vasodilating drugs on coronary arterial tonus was investigated. In the fibrillating heart, hypoxia initially decreased total coronary resistance, later increased it, and exerted little effect on large coronary arteries. Dilation of helically cut specimens of the small coronary arteries occurred more readily than observed in large arteries in response to N2 bubbling or KCN. In the small arteries, the mitochondrial population was more numerous in cellular units and succinic dehydrogenase activity was greater, suggesting that these vessels are more dependent on aerobic metabolism for the maintenance of integrity. Nitrate vasodilators relaxed selectively the large arteries, while adenosine, prenylamine and carbochromen dilated preferentially the small arteries. Dipyridamole, iproveratril, papaverine and propranolol relaxed both arteries equally; however, except for propranolol, these drugs produced preferential relaxation of the small vessels in the fibrillating hearts.


Role of glucagon in diabetes.

Role of glucagon in diabetes. The glucagon-secreting A cell is a vital component of the organ system which regulates the distribution of fuel--the islets of Langerhans. Bihormonal control of glucoregulation through a push-pull system maintains the glucose concentration of extracellular fluid within narrow limits irrespective of glucose flux rates through relative equality of glucose influx and efflux. This equality requires appropriate secretion mixtures of the biologic antagonists, insulin and glucagon, directed by a glucose sensor. In severe diabetes, there are virtually no B cells and A cells are in contact largely with other A cells and their glucose-sensing capacity is lost. The A cell hypersecretes and in most juvenile type diabetics aggressive therapy with insulin fails to restore it to normal. Glucagon is a factor in the development of endogenous hyperglycemia, and ketoacidosis. Its suppression may provide a possible approach in the future pharmacologic management of diabetic hyperglycemia.


Hormonal control of ketogenesis. Biochemical considerations. A two-site, bihormonal concept for the control of ketone body production is proposed. Thus, ketosis is viewed as the result of increased mobilization of free fatty acids from adipose tissue (site 1) to the liver (site 2), coupled with simultaneous enhancement of the liver's capacity to convert these substrates into acetoacetic and beta-hydroxybutyric acids. The former event is believed to be triggered by a fall in plasma insulin levels while the latter is considered to be effected primarily by the concomitant glucagon excess characteristic of the ketotic state. Although the precise mechanism whereby elevation of the circulating [glucagon]:[insulin] ratio stimulates hepatic ketogenic potential is not known, activation of the carnitine acyltransferase reaction, the first step in the oxidation of fatty acids, is an essential feature. Two prerequisites for this metabolic adaptation in liver appear to be an elevation in its carnitine content and depletion of its glycogen stores. Despite present limitations the model (evolved mainly from rat studies) provides a framework for the description of various types of clinical ketosis in biochemical terms and may be useful for future studies.


Amino acid and protein metabolism in diabetes mellitus. In normal man, the fasting state is characterized by release of alanine and glutamine from muscle and in situ muscle catabolism of branched chain amino acids (lecucine, isoleucine, and valine). The alanine released by muscle is utilized by the liver for gluconeogenesis. Muscle nitrogen repletion occurs during protein feeding primarily by means of selective hepatic escape and muscle uptake of branched chain amino acids in ingested protein. In the diabetic, amino acid catabolism is exaggerated in the fasting state as reflected by increased uptake of alanine by the liver for gluconeogenesis and accelerated branched chain amino acid catabolism in muscle. After protein feeding, uptake of branched chain amino acids by muscle is reduced and these amino acids accumulate in increased amounts in arterial blood. Protein feeding also exaggerates the hyperglycemia of diabetes by causing an increase in hepatic glucose production. Diabetes is thus characterized by accelerated protein catabolism during fasting as well as diminished nitrogen repletion and hyperglycemia after protein feeding. The hyperketonemia of diabetes may however, have a restraining influence on protein catabolism thereby reducing alanine availability for gluconeogenesis.


Monomyelocytic leukemia in an untreated case of Waldenström macroglobulinemia. The development of acute leukemia occurring in the presence of Waldenström macroglobulinemia has been reported only twice, occurring once after many years of treatment, and on the second occasion, simultaneously. The intention of this report is to record a case of spontaneous onset of acute monomyelocytic leukemia occurring in an untreated patient with Waldenström macroglobulinemia after four years of observation without intervening chemotherapy or radioactive therapy, and without the influence of any known carcinogens.


Diffuse pulmonary ossification.

Diffuse pulmonary ossification. Diffuse pulmonary ossification (DPO) was a complication of "shock lung" after aortic valve replacement in a 52-year-old man. The relationship of DPO to shock lung is discussed. A possible mechanism for this complication is based on the development of a fibrin-platelet-fibroblastic interaction that may establish an intraalveolar lattice for collagen deposition by the fibroblast. The development of acidosis and mechanical forcer may potentiate fibroblastic transformation into an osteoblast. The mechanical forcer may influence the shape of the bone in the lung.


[Integral intravenous feeding in pediatric surgery]. Forty newborns bearing several gastrointestinal conditions (congenital malformations, intestinal bypass, postinflammatory obstruction, malabsorption and enteritis) were treated with long-term integral parenteral nutrition. A solution made up of synthetic aminoacids, emulsion of lipids, glucose, electrolytes, vitamins, plasma and whole blood was perfused through a catheter introduced into central or peripheral veins. Temporal glucosuria and anemia were observed in some cases. In all but three cases urinary alpha amino nitrogen was normal. In some infected patients leucocytosis or leucopenia was found. After treatment, all patients showed adequate nutritional conditions, manifested by increase in body weight and healing of damaged tissues.


[Fatty infiltration of the heart and Uhl's disease. Apropos of a case of cardiac lipomatosis]. A case is reported of gross lipomatosis of the heart which caused death by gross circulatory failure. The clinical, haemodynamic and angiographic diagnosis was Uhl's disease, and it was the post mortem examination which revealed the massive fatty infiltration of the heart; this involved mainly the right ventricle, but also affected the left ventricle to a major degree. Although fatty deposits in the heart have been recognised for some time, it is surprising to find that there have been extremely few publications on this subject during the last ten years; It is possible that a certain number of case reports of Uhl's disease in adults are really cases of lipomatosis of the heart which have not been recognised as such.


[Atrioventricular blocks of bacterial endocarditis. 8 cases comprising histological study of the conduction system]. The authors report 8 cases of complete atrio-ventricular block (AVB) which came on during bacterial endocarditis. The aortic valve was more frequently affected (6/8). The conduction disorder is necessarily unstable. The prognostic significance of AVB is always very grave--all the patients have died. The valve lesions are often severe. A histological study of the conducting pathways has been carried out. The classically described aneurysm of the membranous septum was not responsable for any cases of AVB in this series. The most frequent cause of the AVB (5/8) was an infiltration of the prenodal area and the A-V nod itself, starting from the posterior aortic cusp and, in one case, from the tricuspid valve. The bundle of His is affected either by extension of the A-V node lesion or by the focus on the right cusp. Strings of inflammatory cells may follow the sheath of the bundle branches. Haematogenous micro-abscesses are sometimes found in the conducting tissues.


[Changes in myocardial metabolism during atrial pacing and catecholamine stimulation in normal subjects and patients with angina]. 5 patients with angina had their threshold for angina evaluated by atrial pacing and by stimulation with catecholamine (dopamine). The authors then studied the metabolic changes induced by the two types of anginogenic load (AP and D-test) applied successively, and compared them with the post-ergometry ECG changes (lowering of the ST segment by at least 2 mm) and the findings on coronary arteriography (complete obstruction of at least 75% stenosis of a major branch vessel). The metabolic measurements were controlled against those of 5 normal subjects after standard ergometry. In the patients with angina, the AP test led to a constantly negative value for %. L. By contrast, the values of D(a-v)c and % O2 which were reduced in the normals, as indirect evidence of an increased coronary flow, remained practically static. During the dopamine infusion, although the % L was reduced, it remained essentially positive, while the D(a-v)c and % O2 were consistantly lowered.


[Orientation of indications for renal arteriography from arterial time in intravenous urography]. Measurement of the circulation time using dycholium allows us to estimate the arrival time of the opaque medium at the renal pedicle. Xrays taken at a very early stage will show up the abdominal aorta and renal arteries. The pictures can then be greatly clarified by a subtraction technique. In this way we have a method which, with but little change in the traditional technique for intravenous pyelography, enters into the question of whether renal arteriography is justified when it is required to demonstrate only the major arterial vessels.


[Applications of a minicomputer in an electrocadiography department]. The wide potential of minicomputers and their versatility have modified the traditional image of the computer, allowing it to gain a real foothold in a cardiological service. Examples of some original programmes are: the automatic assessment of a pacemaker on the test bench, the formation of programmed impulses for electrocardiographic investigation, the analysis of arrhythmias by a histogram of the RR interval of frequency analysis, the recording of isochrones in pericardial cartography.


[Negative retrograde P wave in D1, sign of left postero-lateral Kent bundle]. A negative P wave in D1 with a mean atrial vector which is horizontal or descending in the frontal plane, occurring during paroxysmal tachycardial due to reciprocal rhythm or after ventricular stimulation suggests atrial depolarisation which starts in the left auricle at some distance from the A-V node and near the pulmonary veins. In the absence of an external anterograde ventricular pre-excitation, such P waves may indicate the presence of a hidden bundle of Kent posterolaterally on the left, allowing retrograde conduction during the tachycardia by a reciprocal rhythm.


[Concealed permanent ventricular reentry and paroxysmal ventricular tachycardia by circulatory movement]. Endocavitary recording in a patient with attacks of ventricular tachycardia demonstrated a late potential which activated the bundle of His in a retrograde fashion, and the right bundle branch in a forwards direction. This late potential is evidence of a persistant ventricular microeentry which cannot be seen on the peripheral leads. In certain conditions which have been studied, this localised microreentry leads to ventricular tachycardia by macroreentry using the branches of the bundle of His. Tanks to this unusual case, we were able to study the effects of certain anti-arrhythmic drugs on the micro- and macroreentry circuits. By these means a therapeutic solution has been found for paroxysms of ventricular tachycardia.


[Corrected transposition of the great vessels and preexcitation syndrome (apropos of 2 cases)]. Two cases with treated transposition of the great vessels and incompetence of the left atrioventricular valve showed a type B preexcitation syndrome. In one case, this consisted of a typical W.P.W. syndrome in which the second PR interval was not shortened, but rather consisted of a delta wave and a widened QRS complex. Post mortem examination showed an abnormal connection between the bundle of His and the ventricular septum, and a low insertion of the inverted tricuspid valve. The published cases of W.P.W. syndrome in cases with treated transposition are reviewed, and the mechanism of preexciation discussed in the light of the anatomical peculiarities of the malformation and of the abnormalities which are a feature of Ebstein's syndrome.


[Aortic valve replacement. Apropos of a series of 117 patients]. With a series of 117 aortic valve replacements, the authors have examined the results in relation to the method of protecting the myocardium while the aorta is clamped off. There does not appear to be much difference between coronary perfusion and the technique of profound local hypothermia by the perfusion of a chilled solution into the pericardium. Because of this, the authors remain in favour of the latter technique, which provides effective protection of the myocardium during periods of aortic occlusion sufficient for monovalvular replacements. An occlusion time of up to 90 minutes has been achieved without any major problems. Nevertheless, perfusion of the two coronary arteries is sometimes indicated, notably when profound local hypothermia cannot be employed at revision surgery, feeling of the pericardial cavity being neither possible nor desirable.


[Familial mitral valve prolapse and syncopes caused by ventricular tachycardia]. The authors report the case of a female aged 40 who was subject to syncopal attacks, and had an apical end-systolic murmur. The presence of an idiopathic prolapse of the mitral valve was demonstrated, as well as the familial nature of the condition, and the fact that the syncopal attacks were caused by ventricular tachycardia, The case report is followed by a discussion of the cardiac arrhythmias which are likely to accompany this particular mitral lesion, the difficulties in treatment which arise, and finally the danger of sudden death by ventricular fibrillation inherent in this condition, a danger which it is stille difficult to quantify.


[Lesions of the right branch of the bundle of His. Clinical, electrocardiographic and histologic study of 33 cases]. The topography and severity of lesions of the right branch of the bundle of His have been studied as a function of the electrocardiographie changes and the associated heart disorder in 33 cases with more than 50% of the fibres destroyed. It appears that lesions of the right branch of the bundle of His, while severe and diffuse in cases of chronic complete right branch block, were severe but localised in 5 of the 6 cases with a stable incomplete right block. Total, subtotal or partial destruction of the right branch of the bundle of His was associated with lesions of the A-V node and/or the main truck of the bundle of His in the five cases with a complete atrio-ventricular block. The lesions of the right bundle branch involved the superior, middle and inferior portions in the case of aortic valve lesions, the middle portion in mitral valve disease, and the inferior portion in those with myocardial infarction. Ventricular hypertrophy seems to play an important in deciding whether the axis of the QRS, complex is left or right.


[Interventricular communication, aneurysm of the membranous septum and acquired atrioventricular block]. Over a ten year period of a man 40 had a progressively increasing atrioventricular conduction defect, resulting from a ventricular septal defect with eventual cardlac failure due to persistant bradycardia. Intracavitary recordings showed the block to be situated distally, below the bundle of His. Cineaarteriography, and subsequent operation, showed an aneurysm of the membranous septum lying above a fibrous-edged ventricular septal defect. The aetiology of the block is discussed in the light of these defects; Haemodynamic trauma to the conduction pathways exposed in the inferior edge of the septal defect seems to be the most likely cause.


[Hydatid cyst of the heart. Apropos of 9 cases]. The authors report 9 cases of hydatic cyst of the heart which they have encountered over an 8 year period. They illustrate the variable nature of  this parastic illness, which may stimulate almost and cardiovascular disorder. The various clinical presentations and the methods of diagnosis and treatment are presented: the clinical picture is of little help in establishing the diagnosis. This is made at three levels: the history (country of origin where the disease is endemic, or other associated cyst), the presence of Xray of a swelling of the heart which is later calcified, and the presence on the electrocardiograph of ischaemic changes, which may be severe enough for necrosis. They emphasise the importance of serological tests to make a formal diagnosis of the condition, and a repetition of such tests as part of the postoperative follow-up. Surgical treatment (usually by an open heart technique) is the rule. It may be coupled with medical treatment with anti-malarials (paludrin of flavoquin).


[Left ventricular aneurysm in the young African. Apropos of 23 cases]. A retrospective study allowed us to examine 23 cases with aneurysm of the left ventricle. The aneurysm was discovered incidentally in 6 patients, and as a result of cardiac symptoms in an other 14. The diagnosis made following a cerebrovascular accident and an episode of ventricular tachycardia respectively in two cases. Radiological and electrocardiographical investigation revealed the classical findings in 21 cases, while inflammatory changes were also present in 19. Tuberculosis was found to coexist in 4 patients, and was suspected in a further 4. The aetiology of these aneurysms has remained obscure until now. We feel that a debilitating conditions such as tuberculosis or late pregnancy, or perhaps a change in cardiac function, might lead to the development or enlargement of a sub-annular aneurysm in a predisposed subject. One of our patients presented with an apical aneurysm of the left ventricle in association with a complete situs inversus. A further patient had sustained a severe precordial ingiury 10 years previously, and 2 others had a past history of rheumatic joint disease many years previously. It appears to us that cases with calcification have a better prognosis.


[Myocardial infarction and heterozygous sickle cell anemia. Apropos of 2 cases]. Thromboses are a classical complication of sickle cell disease in the severe homozygous form. In the heterozygous individual, although the risk of severe thromobotic episodes is small, it must nevertheless be recognised. The authors report two cases of myocardial infarction in patients whose coronary arteries were relatively free from atherosclerosis; they were young men, with the heterozygous form of sickle cell disease AS. The part played by inheritance, the factors favouring vascular occlusion, and the possibility of preventing such episodes are all discussed.


[Fatal emboligenic ulcerative endomyocardial fibrosis in filariasis]. A man of 54 had been treated over a 15 month period for pulmonary tuberculosis when aged 41, and had lived on the Ivory Coast and then in the Cameroons for 20 years. Eye signs were discovered in January 1971, and these, together with an eosinophilia, pointed to a possible filariasis which was later confirmed by immunofluorescence and the fixation of complement. Three months later, the patient developed congestive cardiac failure. On the 4th day of treatment with Notizine, multiple systemic emboli occurred, leading to death. Autopsy showed endomyocardial fibrosis with multiple ulceration of the left ventricle, the site of the emboli. The aetiology from filariasis and the mechanism of ulceration of the parietal endocarditis are discussed.


[Constrictive fibrous endocarditis. Surgical treatment]. An anatomo-clinical entity, fibrous constrictive endocarditis can betreated srugically, and we carried out this procedure for the first time in 1971, since when we have used it seven times; it consists of an internal stripping of one or both centricles, with removal of one or both the mitral and tricuspid valves. The results were encouraging in the first two cases, and so good in the succeeding ones that this endocardial resection could be put forward as the treatment of choice for a condition whose aetiology is still unclear.


[Fibroblastic constrictive endocarditis. Apropos of a form localized in the left ventricle]. The authors report a case of a localised form of this strange disorder which was confined to the left ventricle, and in which the diagnosis was tentative for a long time. In this case it was possible to carry out a removal of the fibrous plaque after opening the apex of the left ventricle, the mitral valve being preserved, as described by Dubost; the functional and haemodynamic results of this procedure were very satisfactory.


[Endomyocardial biopsy: its value in tropical pathology. Apropos of 3 new cases]. The authors report their experience with three endomyocardial biopsies in cases of endomyocardial fibrosis; two of them were successful. The light and electron microscopical changes found were of two types: one showed the classical appearances of pure fibrosis, which was acellular and associated with degenerative changes in the heart muscle cell; the other type consisted of young fibrous tissue with numerous fibroblasts secreting a copious fibrillary substance which may have been the precursor of collagen fibres. Endomyocardial biopsy is, in experienced hand, a useful means of diagnosis in the field of tropical heart disease: it can be helpful in diagnosis, provided that the biopsy site is carefully controlled by anteriography and cathereisation; additionally, the opportunity to study the histological and electron microscopical changes which this technique affords should lead to a better understanding of  the pathogenesis of those tropical cardiac disorders whose aetiology is yet to be established.


[Rickettsial arteritis due to Coxiella Burnetii]. Case of an 48 year old man who has presented from 1968 to 1973 a lot of diseases such as: --mitral incompletence discovered in 1968 in Madagascar island in spite of many previous clinical examinations; --acute pneumonia and heart failure in January 1973. Serological reactions of Ricketsia were quite positive; --acute thrombosis of right humeral artery in May 1973. It has been treated by surgical way, bay "desobstruction" and by pass and medical treatment chloramphenicol). Pathologic endartery has been inoculated to an hamster, cobaye. These animal became feverish, and presented an inflammation of testis. A least serological reaction of Ricketsia became positive for all of them; --few weeks, thrombosis of left femoral and posterior tibial arteries treated by surgical and medical ways. Some commens are exposed about evolution of Coxiella Burneti infections, about the frequency of arterial and cardiac lesions, and about the effect of tifomycine which seems to be decreasing and the action of cycline (doxicycline).


[Study of 20 cases of apparently primary pulmonary arterial hypertension]. The authors have studied the clinical, electrocardiographic, radiological, phonomechanographic and haemodynamic features of 20 cases of apparently primary pulmonary hypertension of fairly severe degree. An attempt has been made to correlate on the one hand the haemodynamic values, and on the other the clinical findings, ECG signs of right-sided preponderance, the size of the artery to the right lower lobe on X ray, and the phonomechanographic results. Particular importance is given to a discussion on the aetiology. It is recalled that syphilis can be excluded, that it is possible the operate on thromboses, and that bilharzia and the haemoglobinopathies may play a part which is yet to be defined.


[Bouillaud's disease in Martinique. Epidemiological and nosological features]. From the epidemiological point of view there does not appear to be any particular geographical pattern of this disease. Indeed, it is poor living conditions, low family income, large family size and poor oro-dental hygiene which are responsable for the outbreak of small familial epidemics of acute rheumatic disease of the joints; from the clinical point of view, acute rheumatic joint disease presents no particular features in the Antilles. All the characteristics described in the classical works are found, including the malignant form, whose rarity is emphasised. A programme of prevention of rheumatic disease has yet to be started in the Antilles, and we feel that it should be a three-pronged attack: 1. More information to the general public on the necessity for rapid treatment of the symptoms; 2. Increased vigilance by the medical services in the fight against this disease of deprivation, and close collaboration with the social services; 3. Finally, the setting up of a specialised social cardiology service to supervise the young rheumatic patients, and to ensure that they are educated. Such arrangements would avoid the disorganisation sometimes experienced by the families and friends; it must be admitted that we sometimes have to prevail upon the family to allow the child to be transferred to a centre of social cardiology on the continent so that the young rheumatic patient may receive training for a career which is compatible with his or her handicap.


Isolation and characterization of gas vesicles from Microcyclus aquaticus. Intact gas vesicles of Microcyclus aquaticus S1 were isolated by using centrifugally accelerated flotation of vesicles and molecular sieve chromatography. Isolated gas vesicles were cylindrical organelles with biconical ends and measured 250x100nm. The gas vesicle membrane was composed almost entirely of protein; neither lipid nor carbohydrate was detected, although one mole of phosphate per mole of protein was found. Amino acid analysis indicated that the protein contained 54.6% hydrophobic amino acid residues, lacked sulfur-containing amino acids, and had a low aromatic amino acid content. The protein subunit composition of the vesicles was determined by gel electrophoresis in (i) 0.1% sodium dodecyl sulfate at pH 9.0 and (ii) 5 M urea at pH 2.0. The membrane appeared to consist of one protein subunit of MW 50000 daltons. Charge isomers of this subunit were not detected on urea gels. Antiserum prepared against purified gas vesicles of M. aquaticus S1 crossreacted with the gas vesicles of all other gas vacuolate strains of M. aquaticus, as well as those of Prosthecomicrobium pneumaticum, Nostoc muscorum, and Anabaena flos-aquae, indicating that the gas vesicles of these widely divergent organisms have some antigenic determinants in common.


Stability of symptom ratings for schizophrenic men. The long form of the Wittenborn Psychiatric Rating Scale was used every six months to rate the symptoms of a sample of 75 schizophrenic men during the 24-month period following their admission to the hospital. The greatest diminution of symptoms assessed in this manner occurred during the first six months of treatment, and rated symptom severity at the time of admission showed relatively little predictive promise for ratings of the respective symptoms at the end of six months. After the initial six-month period, however, the symptoms became increasingly stable and symptom ratings at 12 and 18 months had substantial predictive implications for respective symptom ratings for 24 months. Factor analyses of the intercorrelated scores showed that two transcending patterns were conspicuous throughout the 24-month period.


Experimental repair of orbital floor fractures. Eight rhesus monkeys (16 orbits) were used to evaluate the treatment of experimentally created orbital floor fractures. The fractures were repaired with antral bone, Silastic, and gelatin film implants and studied clinically and histologically. Four orbits were used as controls. All implants appeared to favorably influence healing by preventing entrapment of the orbital contents within the reparative tissue. Autogenous bone appeared to be the best implant. Silastic and gelatin film were also effective and well tolerated.


Selection against homozygotes in the ADH polymorphic system of Drosophila melanogaster associated with the lethal factor l(2) Stm. In the natrual populations +Tüb, +Prov, and +Rov, similar AdhF allele frequencies occur (qF = 0.11, 0.18, AND 0.08, respectively). However, there is a discrepancy in that the AdhF allele in +Tüb is closely linked to the lethal factor l(2)Stm, which reduces relative fitness of the F phenotype to zero. In spite of this, polymorphism is maintained also in +Tüb, because the heterozygotes are superior to the homozygous S type (relative fitness = 0.88). Under laboratory culture conditions, in +Tüb the relative fitness of the S genotype further decreases to 0.6. After outcrossing the lethal factor, relative fitnesses for S, FS, and F become 0.6, 1, and 0.48, respectively, implying that fitness for S remains the same. Relative values for S, FS, and F in +Prov, not affected by the lethal factor, are calculated by the maximum average fitness method to be 1, 1.2, and 0.2 under the assumption that heterozyglous FS are similarly superior to S as in the natural +Tüb population and all allele frequencies found are stable equilibrium values.


Amino components of the lipopolysaccharide from Pseudomonas aeruginosa N.C.T.C. 8505. Presence of 2,4-diamino-2,4,6-trideoxy-D-glucose. Configurations were determined for previously identified amino components of the lipopolysaccharide from Pseudomonas aeruginosa N.C.T.C. 8505. Glucosamine and galactosamine belong to the D-series, and alanine and aminogalacturonic acid to the L-series. An additional amino component was identified as 2,4-diamino-2,4,6-trideoxy-D-glucose. This compound may be a characteristic component of the O-specific chain in lipopolysaccharides of strains of Pseudomonas aeruginosa belonging to Habs sero-group 3.


Phospholipase C from Bacillus cereus. Evidence for essential lysine residues. 1. Phospholipase C was inactivated by exposure to the three amino-group reagents, ethyl acetamidate, 2,4,6-trinitrobenzensulphonic acid and pyridoxal 5'-phosphate plus reduction. 2. Inactivation by pyridoxal 5'-phosphate showed the characteristics of Schiff's base formation with the enzyme. The pyridoxal 5'-phosphate-treated enzyme after reduction had an absorbance maximum at 325 mm and 6-N-pyridoxyl-lysine was the only fluorescent component after acid hydrolysis. 3. For complete inactivation, 2 mol of pyridoxal 5'-phosphate or 7 mol of 2,4,6-trinitrophenyl were incorporated/mol of enzyme. 4. The two apparently essential lysine residues were much more reactive to pyridoxal 5'-phosphate than the other 19 lysine residues in the enzyme. 5. Binding of phospholipase C to a substrate-based affinity gel caused marked protection against inactivation by pyridoxal 5'-phosphate. For complete inactivation of the gel-bound enzyme, 5 mol of pyridoxal 5'-phosphate were incorporated/mol of enzyme and there was no evidence of two especially reactive lysine residues. 6. On application of pyridoxal 5'-phosphate-treated enzyme (remaining activity 30% of original) to a column of the affinity gel, some material bound and some did not. The latter contained very little enzyme activity and was heavily incorporated with reagent (9.06 mol/mol of enzyme). The former had a specific activity of 34% of that of the control and contained 1.29 mol of reagent/mol of enzyme. 7. Thus phospholipase C appears to contain two lysine residues that are essential for enzyme activity, but probably not for substrate binding.


Alternobaric effects on the endolymph.

Alternobaric effects on the endolymph. Hearing loss and vertigo experienced as a result of environmental pressure change has been the subject of many superficial inquiries. The mechanism of these conditions remains obscure. In human volunteers and a rhesus monkey, the effects of intratympanic as well as ear canal pressure changes on the endolymphatic system were measured using electronystagmography (ENG). For the monkey histological evaluation of the pressure effects on auditory structures was performed. We were unable to cause any ENG effects on the monkey neither did we produce intracochlear pathology. The data obtained in humans using a similar approach are presented and explanations for the mechanism related to hearing loss and vertigo in barotrauma are discussed.


An addition at the C-terminus of water-buffalo immunoglobin lambda chains. The amino acid sequence of the C-terminal tryptic peptide of pooled water-buffalo immunoglobulin lambda chains was determined as Thr-Val-Lys-Pro-Ser-Glu-Cys-Pro-Ser. This sequence is closely homologous to equivalent sequences from other species, but shows an additional amino acid on the C-terminal side of the interchain half-cystine residue.