Survival and complications in cervical cancer treated by pelvic and extended field radiation after paraaortic lymphadenectomy. Over a 3 year period, 49 patients with invasive cancer of the cervix underwent paraaortic lymphadenectomy. Of this group, 18 were stage lb, with cervix 3 cm or smaller, and were treated by radical hysterectomy. All had negative paraaortic nodes. The remaining 31 patients had more advanced disease and underwent radiation therapy in addition to the paraaortic lymphadenectomy. Thirteen patients with positive paraaortic nodes were treated with extended field radiation to the level of the diaphragms with 4,500 rad plus intracavitary radium applications. The remaining 18 patients with negative paraaortic nodes were treated to the fifth lumbar vertebra with 5,000 rad plus radium applications. The age of the patients and stage of the disease were similar for both groups. After 13-36 months of follow-up, the survival rate was 38% for patients with positive nodes compared to 72% for those with negative nodes. About half of both groups suffered complications. More study must be given to alternative treatments of advanced carcinoma of the cervix.


Alterations in whole saliva flow rate induced by fractionated radiotherapy. Sequential changes in flow rate of whole saliva are detailed in 13 patients. Samples were collected without exogneous stimulation during a course of fractionated radiotherapy involving major portions of the salivary glands. Flow rate decreased markedly during the initial 3 treatment days and gradually thereafter until a minimal flow rate was reached. Early in the treatment, variable degrees of recovery were seen on Mondays following a weekend (Friday-Sunday) without treatment. After a minimal flow rate was reached, no such recovery was observed. Radiation needed to produce minimal flow varied from 450 to 4,050 rad. Patients with higher initial flow rates required higher dosages to reach the minimum. No return of secretory function was noted after extended periods of time.


A study of dose distribution patterns from cobalt-60 and Varian Clinac-4 beams. Dose distribution patterns of 4 MV x-rays from a Varian Clinac 4 linear accelerator are compared with those from a 60Co teletherapy machine. Field flatteners of lead and depleted uranium were used. Dose distribution maps display the off-axis high dose or "horns" with lead filters and circular dose distribution patterns. The uranium field flattener clearly "clipped the horns" and eliminated circular dose distribution patterns with larger fields.


Popliteal vein thrombosis secondary to popliteal artery aneurysm. Two patients with popliteal vein thrombosis secondary to popliteal artery aneurysm are described. The association of venous abnormalities in 623 reported cases of popliteal artery aneurysm is reviewed. The high morbidity from popliteal vein thrombosis would seem to justify preoperative leg venography in patients with popliteal artery aneurysm.


Tantalum tracheography in upper airway obstruction: 100 experiences in adults. A total of 100 tantalum cine laryngotracheograms were performed in adults with documented or suspected upper airway obstruction. With appropriate precautions, tantalum powder proved to be a safe material for delineating tracheal and laryngeal abnormalities. A cine recording to document tracheomalacia as well as a careful evaluation of the larynx are useful extensions of examination of patients with suspected upper airway obstruction. Tracheomalacia was found in 35% of our series; 29% showed laryngeal abnormalities. With modifications to correct for magnification, the tantalum tracheogram gives the surgeon the exact length of trachea to be resected. When tantalum becomes approved by the Food and Drug Administration, we expect that tantalum cine laryngotracheography will be the preferred means for study of upper airway obstruction.


pH-tested reflux without hiatus hernia.

pH-tested reflux without hiatus hernia. Gastroesophageal reflux was tested for with a pH telemetry capsule. In 29 individuals in whom no hiatus hernia was demonstrated on barium esophagram, the transverse diameter of the intrahiatal esophagus was compared to that of the intrathoracic. When the width of the intrahiatal esophagus was two-thirds or less that of the intrathoracic, pH-proven reflux was an infrequent event. When wider, reflux occurred with high frequency.


Gastroesophageal reflux in infants and children: a useful classification and reliable physiologic technique for its demonstration. A radiologic method for the demonstration of gastroesophageal reflux in children is described, and, while recognizing limitations and pitfalls of any classification, a clinically useful system of grading of reflux is presented. The system is based primarily on the extent of retrograde flow of barium, ranging from reflux into the distal esophagus only (grade 1) to reflux with aspiration into the trachea or lungs (grade 5). The availability of a standardized radiologic technique for the demonstration of gastroesophageal reflux and a system for grading its severity may be useful in understanding the true incidence and significance of this disorder.


Lymphoid follicular pattern: a normal feature of the pediatric colon. Tiny nodular filling defects up to 2 mm in diameter were seen in 12 of 27 patients under the age of 15 years undergoing double contrast enema. The pattern was particularly common in children under 5 years in whom a good quality double contrast study was obtained. While this pattern has been termed lymphoid hyperplasia, we believe it represents a normal lymphoid follicular pattern in the pediatric colon. The term lymphoid hyperplasia should be reserved for cases in which the lymphoid follicles are greater than 2 mm in diameter; this will usually represent an abnormal condition in response to infection, allergy, or immunologic disorders. The differential diagnosis of the lymphoid follicular pattern and lymphoid hyperplasia is briefly discussed.


Transverse colon in adult umbilical hernia. The transverse colon may extend into an umbilical or other ventral hernia. An unusual configuration, extra anterior loops, outpouchings, narrowing, or nonmalignant-appearing obstruction in the involved segment of the colon should suggest possible herniation. Clinical or radiographic confirmation is easily accomplished. Five cases are presented to illustrate some of the deformities of the transverse colon due to involvement in an umbilical hernia.


New cholangiographic sign of common bile duct obstruction: initial opacification of intrahepatic ducts. A previously undescribed sign of common bile duct obstruction during intravenous cholangiography - initial visualization of proximal intrahepatic ducts - was observed in 26 patients with surgically proven obstructive disease of the distal common duct. In all cases, opacification of intrahepatic biliary radicles occurred on standard interval films prior to visualization of the extrahepatic common bile duct, the reverse of the normal sequence. The abnormal opacification pattern reflects stasis of bile flow in the presence of distal obstruction and seems analogous to the urographic finding of opacified intra-renal calyces as the initial manifestation of distal ureteral obstruction. Recognition of the alteration in the initial cholangiographic opacification sequence signals the need for delayed films to confirm the diagnosis of a distal choledochal obstruction.


Diagnosis of gangrene and perforation of the gallbladder by endoscopic retrograde cholangiography. Conventional radiographic procedures are not helpful in the preoperative documentation of gangrenous cholecystitis or gallbladder perforation. Three cases in which preoperative diagnosis was accomplished by endoscopic retrograde cholangiography are described. Gangrene was identified in all three by a shaggy outline of the gallbladder wall with amorphous debris and stones in the lumen. Perforation was identified in two of the cases by extravasation of contrast material into a pericholecystic abscess. This information, as well as the status of the common duct, was important to the surgeon.


Prostaglandin E1 (PGE1) in angiography of tumors of the extremities. Prostaglandin E1 (PGE1) is a potent vasodilator. The value of this agent as an adjuvant in angiography of tumors of the extremities was evaluated in 10 patients. Except in one case involving a hemangioma, the diagnostic information concerning tumor vascularity and delineation of the extent of disease decreased after the use of PGE1. The visualization of small normal muscular arteries was improved. Therefore, the effect of PGE1 may be to preferentially increase the blood flow in normal tissues relative to the tumor. PGE1 seems to be of little value in enhancing the angiographic demonstration of neoplasms of the extremity.


Percutaneous nephrostomy: a series and review of the literature. A series of 53 percutaneous nephrostomies and a literature review of 516 such procedures are presented. The selection of patients with supravesical urinary obstruction, urinary fistulas, and renal calculi is discussed, and the concept is advanced that percutaneous nephrostomy is more than a temporizing preoperative procedure. The available techniques are compared; modified instrumentation for balloon catheter insertion, a combination of fluoroscopic with real-time ultrasound guidance, and some additional principles of subsequent management are introduced. Successful results can be expected in over 90% of percutaneous nephrostomies, with major complications limited to 4% and minor complications to 15%. The limitations of percutaneous nephrostomy and the role of surgical nephrostomy are discussed.


Effect of screen/film combinations on diagnostic certainty: Hi-Plus/RPL versus Lanex/Ortho G in excretory urography. A method using radiologists' subjective judgments was developed to compare the quality of the diagnostic image information from two different screen/film combinations (Hi Plus/RPL versus Lanex/Ortho G). A sample of 148 comparison film pairs was obtained in the course of performing 74 urograms using the two film/screen combinations. Each film pair was evaluated by three radiologists, using a blind film-reading format, in regard to:(1) anatomic diagnostic criteria visualization; (2) radiologic diagnostic certainty; (3) presence or absence of quantum mottle; and (4) prediction of which film of a pair was the rare earth screen/film combination. There was a significant difference favoring Hi Plus/RPL in perceived quality of visualization of anatomic criteria. However, the difference was more of statistical rather than practical importance. Diagnostic certainty differed only marginally and slightly favored the Hi Plus/RPL combination. No signficant differences in perception of quantum mottle were attributable to either screen/film combination. Radiologists were able to correctly identify the screen/film combination a significant proportion of the time. Radiation exposure with the Lanex/Ortho G combination was about half that with the Hi Plus/RPL combination. In this study, this would seem to constitute the major factor in film/screen selection.


Intraarterial cyanoacrylate: an adjunct in the treatment of spinal/paraspinal arteriovenous malformations. Arteriovenous malformations are difficult lesions to treat whether surgical or catheter occlusive therapy is used. If the major feeders are ligated or blocked, other arteries open quickly to supply the malformation. Isobutyl 2-cyanoacrylate, deposited with a calibrated leak balloon microcatheter, has given satisfactory short term improvement in both the signs and symptoms of two patients with spinal arteriovenous malformations. Superselective placement of the catheter system, a provocative test perfusion of the arteriovenous malformation and its supplying vessels before the acutal occlusion, and high quality fluoroscopy and angiographic equipment added to the safety of the procedure. No long term results are available, but this system may prove itself another tool in the catheter therapist's armamentarium.


Magnesium supplementation in protein-calorie malnutrition. The widespread observation of magnesium depletion in edematous malnutrition has been confirmed in Guatemalan children. The magnesium requirement during initial stages of therapy has been estimated as 2.7 mEq/kg per day. This may be achieved by adding 0.5% MgSO4.7H2O to a solution containing 15% dextromaltase and 1.5% KCl which is used to dilute whole milk; two parts milk and one part dilution mixture. The replacement of magnesium deficits was not essential for recovery from edematous malnutrition, however, the present evidence suggested that the rate of recovery was accelerated by approximately 2 weeks in those children who received the supplement.


Body composition in chronic undernutrition. Anthropometric (height, weight, and skinfolds), biochemical (serum proteins, albumin, and cholesterol), metabolic (nitrogen balance and creatinine excretion), hematological (plasma volume, hemoglobin, hematocrit, bone marrow hemosiderin, percent transferrin saturation, vitamin B12, and folic acid) variables and body water compartments (total and extracellular) have been measured in 49 adult male subjects who exhibited a wide range of nutritional states from normal to severely undernourished. Changes in body composition associated with moderate degrees of nutritional compromise were related principally to decreases in body cell mass (-15%). Body fat was normal. With severe nutritional involvement, both fat depots (-29%) and body cell mass (-29%) were significantly diminished. Muscle cell mass was more affected than other cells in the body (-41%). These data could indicate that in the group with moderate compromise, energy reserves (and hence energy balance) were maintained but dietary protein deficiencies were not compensated for. Both calorie and protein deficiencies were evident in the subjects with severe undernutrition. Multiple regression equations (r greater than 0.8) were developed that allow prediction of muscle cell mass, fat-free weight, and body cell mass from simple anthropometry and serum albumin levels. Decreases in serum albumin concentration were best related to deficits in muscle mass (r = 0.77).


Protein-energy malnutrition and anemia in Kivu. Protein-energy malnutrition in Kivu is associated with a discrete normocytic, normochromic anemia. An attempt to define the physiopathology of this anemia disclosed the following results. As compared with local controls, both iron and total iron binding capacity were low, but with siderophilin saturation and sideroblast counts either normal or elevated; serum and erythrocyte folate was normal, plasma vitamin B12 was normal or elevated, and serum ascorbic acid was normal or elevated. The riboflavin nutritional status was normal. During refeeding, iron and riboflavin deficiencies became apparent. Characteristic findings on admission were the presence of giant erythroblasts and a diminished erythrocyte survival time implicated to an intracorpuscular hemolysis. Two results from the present study could contribute to explanation for the aforementioned abnormalities: low plasma vitamin E levels and, perhaps more importantly, low plasma selenium levels. In conclusion, the anemia of protein-energy malnutrition, as observed in Kivu, is a classifiable nonadaptive anemia that cannot be explained by isolated iron or vitamin deficiencies and whose physiopathology is distinct from that of the anemia of chronic disorders. It is suggested that a selenium deficiency may play an important role in the pathogenesis of this anemia.


A long-term study of the excretion of folate and pterins in a human subject after ingestion of 14C folic acid, with observations on the effect of diphenylhydantoin administration. After the administration of 2-14C folic acid to a human volunteer, urinary and fecal radioactivity, as well as urinary excretion of folate (Lactobacillus casei assay) and biopterin-like material (Crithidia fasciculata assay) were determined at intervals over a 129 day period of observation. From two 24 h urine samples erythroneopterin, bioterin, threoneopterin pterin, isoxanthopterin, and xanthopterin were isolated by chromatographic procedures, quantitated, and their specific activities were determined. The effect on the pattern of elimination of urinary radioactivity and biological activity resulting from the administration of diphenylhydantoin was studied on two occasions. Urinary radioactivity plots suggest the decay of two forms of folates with markedly different biological half lives. One short-lived (t 1/2 approximately 31.5 hr), corresponding to newly absorbed folate, and one long-lived (t 1/2 approximately 100 day) thought to represent the decay of body pools. Diphenylhydantoin does not alter the rate of elimination of the long-lived component but may accelerate losses of newly absorbed folate. The analysis of pterins does not support the hypothesis that diphenylhydantoin increases the breakdown of folates to pterins.


Immunofluorescent vascular pattern due to EVI antibody of Chagas' disease. Its diagnostic value. One hundred fifty-six of 1,250 sera from patients with presumed connective tissue and related diseases showed vascular staining on mouse liver cryostat sections when they were routinely checked for antinuclear factor by the indirect immunofluorescence test. In a third of the cases, the vascular immunofluorescent pattern was given by the EVI antibody reacting with the plasma membrane of striated muscle fibers and endothelial cells, as has been recently described to occur in Chagas' disease. This led to the detection of previously unsuspected Trypanosoma cruzi infection in 67.8% of the serum samples in which the EVI antibody was detected after observation of a positive vascular pattern with mouse liver cryostat sections. On the other hand, no significant relationship between Chagas infection and sera with other anti-striated-muscle immunofluorescent patterns that also showed a vascular staining on mouse liver cryostat sections was established. Consideration of the vascular pattern observed with the EVI antibody on mouse liver cryostat sections can be helpful in detection of previously ignored T. cruzi infection in patients who have connective-tissue diseases and related conditions. This is of interest in view of the fact that anergic immunodepressive therapy, often used in these patients, significantly alters the host-parasite relationship and may lead to severe dissemination of the parasite.


Ossifying fibroma of long bone: its distinction from fibrous dysplasia and its association with adamantinoma of long bone. Two cases of ossifying fibroma of long bones are presented. This tumor is confused with monostotic fibrous dysplasia, but can be distinguished by its intracortical location, as demonstrated radiographically, and by its histologic pattern. Distinction from fibrous dysplasia is important since ossifying fibroma of long bone is a more aggressive lesion with different therapeutic implications. It appears that ossifying fibroma and adamantinoma of long bones are somehow related, and that lesions resembling fibrous dysplasia in association with adamantinomas of long bones are actually ossifying fibromas.


Routine circumcision of the newborn infant: a reappraisal. Prompted by the continuing controversy over routine circumcision of the newborn infant, this review of the limited available literature suggests that the operation may facilitate hygiene of the penis and perhaps decrease the risk of carcinoma of the penis. On the the other hand, the operation frequently features illogical bases for patient selection, neglect of the requirement to obtain informed consent, an inappropriate operator, a needlessly radical technique, disregard for pain, dubious objectives, and unknown cost-effectiveness. Long-term prospective studies are needed to evaluate routine circumcision of the newborn infant. However, until the benefits of the procedure can be proved worth the risk and cost, medical resources should probably be allocated to health measures of demonstrated value.


Trifluorothymidine and idoxuridine therapy of ocular herpes. In a coded study, we treated 40 patients who had active herpes simplex corneal ulcers with either 1% trifluorothymidine (F3T) or 0.1% idoxuridine (IDU) drops; we treated 15 similarly afflicted patients, who had failed on IDU or vidarabine, with open 1% F3T drops. All dosages were at therapeutically recommended frequency. In the coded study there was no statistically significant difference between the drugs in rate of healing; mean initial ulcer size in both groups was approximately 7 mm2 and mean healing time was approximately 5.5 days. There was a significant difference, however, in the chances of successful healing; 96% of all F3T treated eyes and only 75% of IDU treated eyes healed completely within 14 days. In the open study, 87% of patients healed completely on F3T eyedrops. Although an insufficient number of patients were on concomitant coricosteroid therapy to provide statistical analysis, F3T-corticosteroid treated eyes (eight masked and open) all healed. The one IDU-corticosteroid treated eye in the masked study failed to heal.


Ocular findings in triploidy.

Ocular findings in triploidy. We studied the abnormal ocular and systemic findings in one case of true triploidy and two cases of triploid mosaicism. A liveborn triploid child 69,XXY, had abnormalities including cebocephaly, a single midline nostril, incomplete cleft palate, transverse palmar creases, partial syndactyly, and ambiguous genitalia. Ocular abnormalities included hypotelorism, blepharophimosis, microcornia, iris coloboma, cataract, persistent hyaloid vasculature, retinal dysplasia, and optic atrophy. A 16-year-old girl with triploid mosaicism had congenital left facial and body hemiatrophy, both growth and mental retardation, left-sided grand mal seizures, incontinentia pigmenti of both legs, partial syndactyly, and generalized weakness. Results of her ocular examination were within normal limits. A 13-year-old boy with triploid mosaicism exhibited both growth and mental retardation, truncal obesity, and required a brace to support his back. Ocular findings included synophrys, bilateral blepharoptosis, and abnormal results of Schirmer tear test. Studies indicate a wide spectrum of ocular and systemic abnormalities occur that are presumably associated with the chromosome error.


Hydrocephaly, congenital retinal nonattachment, and congenital falciform fold. A 6-year-old boy, whose parents were first cousins, had congenital retinal nonattachment in one eye and a falciform fold in the other. He had had a shunt operation for hydrocephaly. Oxygen was never administered and test results for rubella and toxoplasmosis were negative. The consanguinity in this case indicates the syndrome is an autosomal recessive trait. This and other hereditary disorders with congenital retinal nonattachment have previously been misinterpreted as retrolental fibroplasia occurring without oxygen treatment.


New and neglected nerve terminals in extrinsic eye muscles. Four forms of nerve terminals in extrinsic eye muscles are described: the Golgi tendon organ, the palisade sensory ending, the palisade motor ending, and the spiral ending. Sensory and motor functions are assigned to these endings based on morphological criteria.


Slow maxillary expansion: skeletal versus dental response to low magnitude force in Macaca mulatta. Low-magnitude continuous force (1 to 2 pounds) was applied in a transverse direction to the palatal vault and posterior teeth of three rhesus monkeys to assess linear and angular changes of the maxilla versus those of the maxillary posterior teeth.


Brain blood flow autoregulation and metabolism during halothane anesthesia in monkeys. Past studies suggest that halothane causes cerebrovascular dilatation and increased cerebral blood flow (CBF); these properties may be relevant to its use for neurosurgical procedures. We studied CBF autoregulation in monkeys during anesthesia with 66% N2O/33% O2 and with 0.5%, 1.0%, and 2.0% inspired halothane at various cerebral perfusion pressures (CPP) achieved by infusion of trimethaphan camsylate or phenylephrine. CBF was measured by monitoring brain xenon-133 clearance after intra-arterial injection of the isotope in saline. CBF autoregulation was intact during N2O/O2 and during 0.5% halothane/N2O/O2 anesthesia at CPPs ranging from 50 to 100 mmHg, but began to fail at 1.0% halothane. Complete loss of autoregulation occurred during 2% halothane/N2O/O2 anesthesia. Estimated brain O2 consumption fell by 30%, 40%, and 50% during 0.5%, 1.0%, and 2.0% halothane anesthesia, respectively, compared to O2 consumption during N2O/O2 anesthesia (100%).


Variations in utilization of a multi-state company dental plan. A study was conducted of family records and claim forms of a company-sponsored dental plan to determine the effects of several demographic variables on utilization of the plan and on patterns of expenditure. The plan was non-contributory on the part of the employees. Individual utilization of the plan (at least once during the study year) closely approximated the average for the entire U.S. population. Salaried employees, and families, were more likely to use the plan than hourly-paid employees and families. High income families were more likely than lower income families to use the plan. Most of the independent variables (income, age, hourly versus salaried) correlated with utilization patterns in a predictable manner. A notable exception was when one looked from one division of the corporation to another, with 25 per cent of families in one division using the plan in the study year, compared to 90 per cent at another division. The reasons for these dramatic differences may be related, at least in part, to institutional factors rather than to patient behavior, and further study is indicated.


Immunodiffusion, counterimmunoelectrophoresis and immunofluorescence in diagnosis of Sudan mucosal leishmaniasis. Sera from 16 patients suffering from oral, nasal, oro-nasal or laryngeal types of Sudan mucosal leishmaniasis were tested against leishmanial antigen by three immunodiagnostic methods. Reactive soluble antigen was prepared from sonicated promastigotes. When tested against undiluted sera, in all 16 cases it gave easily visible precipitin lines in agar gel in both immunodiffusion and counterimmunoelectrophoresis tests. In immunofluorescence tests, with promastigote slide antigen and using the indirect antibody technique, the sera were positive at serum dilutions ranging from 1:200 to 1:6,400. There was no correlation between fluorescent titer levels and the strength of precipitin reactions in the immunodiffusionand counterimmunoelectrophoresis tests. Sixteen normal sera gave negative results in all three tests.


A precipitin test for the diagnosis of human abdominal angiostrongyliasis. A precipitin reaction was observed when sera of cotton rats infected either naturally or experimentally with Angiostrongylus costaricensis were tested by gel double-diffusion against sera obtained from three biopsy-confirmed human cases of A. costaricensis. With immunoelectrophoresis, the antigen was demonstrated in the serum of infected rats. The antibody in the human serum was mostly of the IgG type. No cross reactions were seen with sera from individuals infected with the common intestinal helminths, or individuals serologically positive for Toxocara, A. cantonensis, Chagas' disease, amebiasis, leishmaniasis, toxoplasmosis, or syphilis.


Carotid-axillary bypass: clinical and experimental evaluation. Successful carotid-axillary bypasses have been performed nine times at Walter Reed Army Medical Center during a six year period starting in 1970. Although this approach has been of particular value in patients with symptomatic posttraumatic subclavian arterial occlusions, in whom local fibrosis creates additional problems is dissection and identification of important structures, carotid-axillary bypasses can also be used for lesions of the subclavian and/or axillary artery including aneurysms, ulcerations with distal embolism, and extensive arteriosclerotic occlusive disease. Our experimental data corroborate the clinical impression that carotid-axillary by-passing can be a safe and successful approach to surgical management of subclavian arterial lesions without creating any major significant hemodynamic derangements.


Intramembranous particle distribution in human erythrocytes: effects of lysis, glutaraldehyde, and poly-L-lysine. Freeze-fracture combined with quantitative electron microscopy of the intact human erythrocyte (RBC) and ghost revealed significant differences in their intramembranous particle coefficients. External (E) fracture-faces of unfixed ghost membranes were found to contain 40% fewer particles than those of intact unfixed RBC. The particle distribution of the intact RBC membrane depended on the use of glutaraldehyde fixation and glycerol cryoprotection. Whereas glutaraldehyde- and glycerol-treated cells disclosed 70% fewer E-face particles than did intact unfixed cells, poly-L-lysine-treated, intact, unfixed RBC showed no such differences. Treatment with a combination of poly-L-lysine and glutaraldehyde, however, increased the amount of E-face particles while reducing those of the protoplasmic (P) face. The poly-L-lysine effect varied with its concentration and was unaffected by previous application of neuraminidase. Nor did the lectin phytohemagglutinin induce particle rearrangement in intact cells. Our data demonstrate that the processes of glutaraldehyde fixation and glycerol cryoprotection modify the RBC membrane by decreasing the number of E-face particles present. In addition, the combination of poly-L-lysine and glutaraldehyde alters the affinity of some particles for one half of the membrane, suggesting that in freeze-fractured RBC, chemical bonds formed at the extracellular surface of the membrane can influence particle partitioning.


[Sarcosporidia of the cloven-hoofed game. III. Sarcosporidia in red deer and fallow deer]. The incidence of Sarcosporidia among red-deer and fallow-deer was investigated. The fallow-deer is less discussed because the low number of investigations. The red-deer shows with 15% the lowest incidence among the red-deer, fallow-deer and wild-boar investigated. The Sarcosporidia of the red-deer are smaller than those of the roe, therefore the identification in the trichinoscopic picture is more difficult. With regard to this it is recommended to name the Sarcosporidia of the red-deer Sarcocystis cervi (VON HESSLING, 1854), because their form is more similar to the cattle and not those of the roe. To be sure a greater number of investigations is necessary to detect all connections.


Percutaneous drainage of lung abscess.

Percutaneous drainage of lung abscess. The availability of effective antimicrobial agents has greatly decreased the need for surgical intervention in patients who have a pyogenic lung abscess. We describe 3 patients with lung abscesses caused by gram-negative bacteria who failed to respond to medical treatment and who were believed to be unable to withstand lobectomy. Percutaneous insertion of a drainage tube directly into the abscess brought about a dramatic clinical response, with prompt closure of the cavity. This procedure provides an alternative to thoracotomy and lobectomy in treating lung abscesses that fail to respond to medical therapy.


Effects of sputum from patients with cystic fibrosis on the activity in vitro of 5 antimicrobial drugs on Pseudomonas aeruginosa. By in vitro tests on 12 strains of Pseudomonas aeruginosa, sputum from patients with cystic fibrosis sharply increased the minimal bactericidal concentrations of polymyxin B and neomycin. Sputum had a lesser effect on tests with gentamicin and tobramycin and essentially none on tests with carbenicillin.


Insulin kinetics in hyperalimentation solution and routine intravenous therapy. Using intravenous saline as a control, the kinetics of insulin in protein hydrolysate (hyperalimentation) solutions in glass bottles with and without the addition of albumin were studied using double radioisotope tags. Albumin is not a necessary additive to the solution. A technique for providing constant, predictable delivery of insulin is described. Albumin, when added to hyperalimentation and saline solutions with insulin, does not protectively coat plastic tubing or glass bottle surfaces to prevent insulin adsorption; some other mechanism is responsible for the increased insulin concentrations in intravenous solutions with added albumin.


Monoclonal gammopathy in hereditary spherocytosis: a possible pathogenetic relation. Two cases of monoclonal gammopathy in patients with hereditary spherocytosis led us to consider the possible pathogenetic relation between these two disorders. Twelve adult patients with hereditary spherocytosis had significant hypergammaglobulinemia in comparison to normal subjects. Retrospective analysis of previous illness in 140 patients with multiple myeloma showed a significant association between IgA myeloma and previous gallbladder disease. We propose that the chronic reticuloendothelial stimulation due to extravascular hemolysis, possibly potentiated by the inflammation associated with cholelithiasis and cholecystitis, may foster neoplastic transformation of immunocytes in patients with hereditary spherocytosis, ultimately leading to the development of monoclonal gammopathy.


[Allergic diagnosis of bovine brucellosis. 1. Conditions for the use of a purified protein allergen: brucellin (author's transl)]. A protein allergen extracted from the rough strain Brucella melitensis B 115, prepared for the diagnosis of Brucellosis, has been evaluated in cows. Injected in non infected and non vaccinated cows, this allergen does not give any reaction, does not sensitize for subsequent injections, does not give rise to antibodies detected by routine serologic tests, and thus does not interfere with usual screening. In cows, sensitized by injections of H 38 or 45/20 vaccines, the intradermal injection produces a delayed hypersensitivity reaction. The recommanded dose was determined to be 100 microgram and the reaction must be read at 72 hours. The most suitable sites of injection are the neck or the tail fold. It appears likely that allergic testing could not be employed for diagnosis in cows vaccinated with H 38 or 45/20 vaccines. Allergic testing is useful in cows which have been given strain 19 vaccine at least two years previously.


Solitary diverticulum of the caecum and its complications. Solitary diverticulum of the caecum is very rare and assumes clinical interest only when inflamed. Preoperatively the condition is virtually impossible to distinguish from acute appendicitis, and even during operation its differentiation from carcinoma is difficult. It is also important to determine whether or not an underlying solitary diverticulum of the caecum is present. In the present series the symptoms and clinical examination as well as laboratory findings pointed to acute appendicitis, which was in fact the preoperative diagnosis in all our patients. In one case the operative findings were strongly suggestive of carcinoma, which was only excluded by inspection and histological examination of the specimen. The wall of the diverticulum was necrotic in all cases. It had already perforated in the previously mentioned case, and right hemicolectomy was performed. An inflamed, but recognizable, solitary diverticulum of the caecum was treated by excision, but the tumour-like mass produced by the diverticulum was removed by resection. In view of the considerable possibility of underlying carcinoma, the authors support an aggressive trend in the treatment of "inflammatory tumours" of the caecal wall.


Long-term stenting in the treatment of subglottic stenosis. Long-term stenting (3 to 12 months) with silicone rubber stents was found successful in 12 of 14 cases (86%) with severe subglottic stenosis. A new silicone rubber stent is described that is suitable for long-term stenting in infants or adults.


Cochlear prostheses. A state-of-the-art review. Work on cochlear prostheses for the auditory rehabilitation of the profoundly deaf represents a challenging problem. Some early, but perhaps premature, surgical attempts have helped to bring the entire issue into focus. Systemic studies are now under way in many different places. Although the purely engineering problems as well as the surgical ones appear solvable at this time, the remaining unsolved problems lie in two areas: 1) the bioengineering interfacing, i.e., the search for methods needed to connect an engineering (electronic) device to the neural auditory system in an efficient manner; and 2) clinical tests for the assessment of the functional state of the cochlear nerve.


A reassessment of 8-anilino-1-naphthalene sulphonic acid as a thyroxine binding inhibitor in the radioimmunoassay of thyroxine. The effectiveness of 8-anilino-1-naphthalene sulphonic acid (ANS) in the radioimmunoassay (RIA) of thyroxine (T4) as an inhibitor of the binding of T4 to serum T4-binding proteins is assessed. The optimum ANS concentration is dependent upon the antiserum and the method used for separating free and bound T4. If T4 binding to serum proteins is not completely inhibited, resin separation methods may yield low values, while polyethylene glycol and double-antibody methods may produce high values for T4 concentration. Even with optimum ANS concentration gross errors in measurement of T4 may occur in patients with high thyroxine-binding globulin (TBG) concentrations.


On the orientation of the Rh: El1 linkage group. A  family which segregates simultaneously for PGD, elliptocytosis, Rh, alphaFUC and PGM1 contains a recombinant suggesting that the loci lie in this order.


The tissue distribution of hexosaminidase S and hexosaminidase C. The proportion of hex S to hex C in normal and Sandhoff's fibroblasts was determined to be between 1:1 and 1:2 by differential staining of hex S at pH 4.4 with 4-methylumbelliferyl-beta-N-acetylgalactosaminide and of hex C at pH 7.0 with 4-methylumbelliferyl-beta-N-acetylglucosaminide. Hex S and hex C were also semi-quantitated in various normal tissues--brain, liver, spleen, heart, kidney, intestine, placenta, skeletal muscle and fibroblasts. Hex C was most prominent in brain and, somewhat less so, in liver, skeletal muscle and fibroblasts. The greatest amount of hex S activity was found in fibroblast, but it was also observed in lesser amounts in liver, kidney, intestine and placenta.


[Effect of the aeration and agitation states on tetracycline biosynthesis in semiproduction-capacity apparatus]. The results of the experiments on determination of the effect of aeration and agitation conditions on biosynthesis of tetracycline in the apparatus of semi-production capacity are discussed. It was shown that the antibiotic production level was not connected with the rate of oxygen solution expressed in the sulphite numbers, i.e. this parameter cannot be used as a scaling-up criterion. Accumulation of the antibiotic in the fermentation broth depended on the volume of the air supplied for aeration. It was determined that the level of CO2 dissolved in the fermentation broth did not reach the values having an inhibitory effect on the biosynthetic process.


[Antibiotic sensitivity and pyocin dependence of clinical strains of Ps. aeruginosa]. The effect of antibiotics on clinical strains of Ps. aeruginosa was analyzed. It shown that 92 per cent of the strains had multiple resistance to the most of the antibiotics used in the clinic. All the strains were sensitive to gentamicin and polymyxin. The apyocinogenic strains of Ps. aeruginosa were more sensitive to the effect of the antibiotics than the pyocinogenic ones.


Biosynthesis of the yeast cell wall: selective assays and regulation of some mannosyl transferase activities. Assays have been developed for some transfer reactions involved in the synthesis of Saccharomyces cerevisiae wall mannoproteins, both in a particulate preparation in the presence of EDTA or Triton X-100, and after lipid extraction with chloroform-methanol at -20 C. The mannosyl transferase activities were also studied in cells made permeable to GDP-mannose by toluene-ethanol treatment ("in situ"). In these permeabilized cells, the glycosylating reactions dependent on lipid carriers (dolichol derivatives) did not function, but those independent of them were unaffected. The lipid-independent mannosyl transferase activities were partially inhibited by nucleotide diphosphates probably in a competitive manner. Increase of the nucleotide diphosphate pool "in vivo" might slow down the speed of the transfer reactions carried out by the mannan synthetase system.


A taxonomic study of the Penicillium chrysogenum series. The taxonomy of the Penicillium chrysogenum series is reconsidered. On account of the observations of the available type strains and numerous isolates mainly obtained from food products, Penicillium notatum Westling, P. meleagrinum Biourge and P. cyaneofulyum Biourge are placed in synonymy with P. chrysogenum Thom. Synonymy and variability of the species are discussed.


Lipoquinones of some bacteria and mycoplasmas, with considerations on their functional significance. In a comparative study the lipoquinones of some chemoorganotrophic, facultatively aerobic bacteria, and representative Acholeplasma, Mycoplasma, Spiroplasma, and Thermoplasma strains were investigated. The quinones were partly purified by preparative thin layer chromatography of lipid extracts, and characterized by their difference spectra (reduced minus oxidized) and Rf values. Respiring bacteria expectedly contained benzoquinones and/or naphthoquinones in micromolar concentrations whereas some aerotolerant, cytochrome-less, gram-positive bacteria were found to contain menaquinones in nanomolar concentrations, or even no quinones; only Streptococcus faecalis, an organism supposed to use a rudimentary, flavin-terminated respiratory chain system produced desmethyl menaquinone in amounts ranging between "high" and "low" quinone contents. Among the mycoplasmas investigated, only Thermoplasma acidophilum was found to be capable of synthesizing quinones (MK-7) in the micromolar order of magnitude indicating a respiratory electron transport system. The presence of energetically useful respiratory chain systems in Acholeplasma, Mycoplasma, and Spiroplasma is questioned since these organisms contain quinones (MK-4) in nanomolar concentrations, or no quinones, depending on the presence of exogeneous MK-6 in the growth medium. The possible metabolite role of menaquinones present in "low" amounts, as well as the role of NADH oxidase systems more or less tightly bound to the cytoplasmic membrane with the mycoplasmas deserves further investigation.


On the morphology and ultrastructure of the cell wall of Spirulina platensis. The cell wall of the blue-green alga Spirulina platensis was studied with the electron microscope using ultra-thin sectioning, shadowing, carbon-replication or freeze-etching techniques for specimen preparation. The cell wall could be resolved into four layers, L-I through L-IV. The L-I and L-III layers contain fibrillar material. The septum is a three-layered wall: an L-II layer sandwiched between L-I layers. The shape in vitro of isolated septa might be an artifact due to the preparation technique used. Certain structural properties of the septum seem to allow tangential stretching; they might be reflected in the flexible gliding mobility of Spirulina species. The outer, L-IV layer contains material longitudinally arranged along the trichome axis.


Effects of long-term treatment with acetylene on nitrogen-fixing microorganisms. Long periods of experimental incubation with acetylene led to a multifold enhancement of acetylene-reducing activity in Anabaena cylindrica, Anabaenopsis circularis, Rhodospirillum rubrum, and Azotobacter vinelandii. Rates of acetylene reduction showed a gradual increase and reached a peak after 2 to 6 h of continuous incubation under acetylene. Thereafter, enzyme activity rapidly declined. A similar enhancement of ethylene production was observed when pretreatment with acetylene was interrupted periodically by a brief exposure to ambient (or oxygen-free) atmosphere without acetylene although the decline of acetylene-reducing activity was less rapid. Pretreatment with acetylene depressed photosynthetic 14CO2 fixation and 15N2 incorporation in Anabaena cylindrica. It is concluded that assessments based on long-term experimental incubation with acetylene may grossly overestimate the actual quantities of fixed nitrogen in the field.


Effects of lysine analogs on Penicillium chrysogenum. Compounds structurally related to lysine were tested against Penicillium chrysogenum Wis. 54-1255 for inhibition of growth, sporulation, and penicillin formation. This strain is relatively resistant to lysine analogs. The compounds that were the more active inhibitors of growth and whose activities were reversed by L-lysine were diaminohexynoic acid, N-epsilon-methyllysine, N-alpha-methyllysine, and diaminopimelic acid. These four compounds also inhibited sporulation, which was more sensitive to inhibition than growth was. Analogs strongly inhibiting benzyl-penicillin formation by resting mycelia were diaminohexynoic acid and N-epsilon-methyllysine. The action of the most active analog (diaminohexynoic acid) on penicillin synthesis was reversed by DL-alpha-aminoadipic acid.


Response to polychlorinated biphenyls of marine phytoplankton isolates cultured under natural conditions. Polychlorinated biphenyls (PCB) at a concentration of 10 mug/liter substantially but temporarily suppressed the growth rate and photosynthesis of two species of Thalassiosira recently isolated from Long Island Sound and grown in dialysis membrane bags suspended in the tidal channel of an estuarine marsh. Inhibition of carbon fixation was apparently due to reduced levels of chlorophyll a per PCB-treated cell, but no significant loss of function per unit of existing chlorophyll a was observed. Cell concentrations in all size classes (3.2- to 18.6-mum-equivalent spherical diameters) were markedly lower in PCB-treated cultures, with toal biomass equaling only 30% of that in control cultures throughout the experiment.


Preparation of mutants of Trichoderma reesei with enhanced cellulase production. The development of an agar plate screening technique has allowed the isolation of a range of mutants of Trichoderma reesei capable of synthesizing cellulase under conditions of high catabolite repression. The properties of one of these mutants (NG-14) is described to illustrate the use of this technique. NG-14 produced five times the filter paper-degrading activity per ml of culture medium and twice the specific activity per mg of excreted protein in submerged culture when compared with the best existing mutant, QM9414. NG-14 also showed enhanced endo-beta-glucanase and beta-glucosidase production. Although these mutants were isolated as cellulase producers in the presence of 5% glycerol on agar plates, in similar liquid medium, NG-14 exhibits only partial derepression of the cellulase complex. Since the proportions of filter paper activity, endo-beta-glucanase, and cellobiase were not the same in mutants NG-14 and QM9414, and the yields of each enzyme under conditions repressive for cellulase synthesis were different, differential control of each enzyme of the cellulase complex is implied. These initial results suggest that the selective technique for isolating hyper-cellulase-producing mutants of Trichoderma will be of considerable use in the development of commercially useful cellulolytic strains.


Production of geosmin in fermentors and extraction with an ion-exchange resin. A method for growing Streptomyces griseus LP-16 in fermentors and extracting and purifying geosmin, using an ion-exchange resin, is described.


Production of volatile sulfur compounds during the decomposition of algal mats. Blue-green algal mats incubated anaerobically rapidly produce large amounts of volatile sulfur compounds, including hydrogen sulfide, methyl mercaptan, and dimethyl sulfide. The major organic sulfur compound is methyl mercaptan, in contrast to previous results with marine eucaryotic algae. Light inhibited production of volatile sulfur compounds, apparently because the algae then produced O2, rendering the system aerobic.


Nebulized sodium cromoglycate in young asthmatic children. Double-blind trial. Seventeen asthmatic children under 5 years of age took part in a double-blind controlled trial of nebulized sodium cromoglycate solution. Daily symptom scores kept by the parents showed improvement in 11 children during active treatment, and a significant improvement in scores for cough by day and night was obtained for the group as a whole.


Bumetanide in heart failure in infancy.

Bumetanide in heart failure in infancy. The effect of bumetanide in infants with congenital heart disease presenting with cardiac failure was studied. The study was divided into acute (3 days) and long-term (mean 10.5 weeks) cases. A total of 12 male infants was included in the acute study and 13 cases were evaluated in the long-term study. The dose used in the acute study (0.015 mg/kg) was suboptimal; notwithstanding it was found to cause significant natriuresis and chloruresis. Bumetanide in doses varying in different infants from as little as 0.015 mg/kg on alternate days to as much as 0.10 mg/kg daily was shown to be an effective diuretic for long-term use. No side effects were observed in either study.


Cutaneous osteomas: a clinical and histopathologic review. In 20 000 consecutive skin biopsies we found 35 cutaneous osteomas. Ten were primary while 25 appeared secondary to another abnormality. Associated with ossification were Malherbe's calcifying epithelioma, basal cell carcinoma, nevus cell nevus, appendageal and fibrous proliferations, inflammation, trauma, and calcification. Cutaneous bone formation appears to be either a hamartomatous or metaplastic phenomenon.


Toxicity and persistence of low-level PCB in adult wistar rats, fetuses, and young. Aroclor 1254 was fed to female and male rats daily for 9 weeks at a dose of 6.4 mg/kg in their drinking water. Control animals received plain tap water plus the emulsified (0.15% Tween 80). Elevated mixed function oxidase (MFO) activity appeared to be due to 2,4,5,2',4',5'- and 2,4,5,2'3'4'-hexachlorobiphenyls, since only these compounds were present to any degree in the tissues of the animals when MFO activity persisted after termination of exposure. The placenta apparently is an effective barrier to PCB transfer.


Synthesis and spectroscopic characterization of acetyl-Clx (x = 0,1,2 or 3) and nitroso derivatives of carbaryl and three possible metabolites. Acetyl-Clx (x = 0,1,2 or 3) and nitroso derivatives of carbaryl, 1-naphthol. 5-hydroxycarbaryl, and 1,5-naphthalenediol were synthesized. Compounds were characterized by infrared, mass, and nuclear magnetic resonance spectroscopy. N-chloroacetylation (Cl = 0,1,2, or 3) of carbaryl was readily accomplished through the pyridine-catalyzed reaction of carbaryl with the appropriate acid chlorides. Trichloroacetylation was also possible through the pyridine-catalyzed reaction with the anhydride. N-nitrosation could also be done readily. N-nitroso- and N-trichloroacetyl carbaryl underwent decomposition to carbaryl on exposure to atmosphere moisture and could be maintained in the pure state only with difficulty. The other derivatives were stable under normal storage conditions.


Gas chromatographic evaluation of some N-derivatives of intact carbaryl. Gas chromatographic (GLC) detection of aryl N-methylcarbamates as the N-acetyl-Clx or N-nitroso derivatives of the intact molecule was explored using carbaryl as the model compound. These derivatives were designed for use with the microcoulometric detector for chlorine and the solution conductivity detector for nitrogen but response to the electron capture detector was also studied. GLC characteristics of the derivatives were evaluated in terms of thermal stability and detector response. N-Trichloracetyl and N-nitroso carbaryl underwent extensive decomposition in the GLC system. Although the N-monochloroacetyl derivatives were also subject to thermal decomposition, they gave sufficient linearity and sensitivity with the microcoulometric detector for analysis at the residue level. N-Acetyl carbaryl was thermally stable and the response of electrolytic conductivity and the electron capture detectors were adequate for residue analysis.


Immunofluorescence of the skin in gold rashes - with particular reference to IgE. Immunofluorescence studies have been carried out on rashes from 36 patients with rheumatoid arthritis receiving gold therapy. 24 of the rashes were clinically attributed to gold and 12 were diagnosed as coincidental rashes. IgE was found in 6 of the gold rashes and in 4 of the coincidental rashes. Immunofluorescence changes of immune complex vasculitis, lichen planus, or pemphigoid were found in 9 gold rashes while 2 coincidental rashes showed vascular fluorescence for immunoglobulins but nor for complement. Two definite gold rashes showing no changes on immunofluorescence showed perivascular infiltration with lymphocytes on light microscopy. Thus, while immunofluorescence is only marginally helpful in the diagnoses of gold rashes, evidence of an immunological reaction tends to favour a diagnosis of a gold-induced rash.


Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. A method of clinical staging for infants with necrotizing enterocolitis (NEC) is proposed. On the basis of assigned stage at the time of diagnosis, 48 infants were treated with graded intervention. For Stage I infants, vigorous diagnostic and supportive measures are appropriate. Stage II infants are treated medically, including parenteral and gavage aminoglycoside antibiotic, and Stage III patients require operation. All Stage I patients survived, and 32 of 38 Stage II and III patients (85%) survived the acute episode of NEC. Bacteriologic evaluation of the gastrointestinal microflora in these neonates has revealed a wide range of enteric organisms including anaerobes. Enteric organisms were cultured from the blood of four infants dying of NEC. Sequential cultures of enteric organisms reveal an alteration of flora during gavage antibiotic therapy. These studies support the use of combination antimicrobial therapy in the treatment of infants with NEC.


Endoscopic retrograde cholangiography (ERC) in surgical emergencies. Twelve patients, presenting with an acute abdomen of suspected biliary tract origin, had endoscopic retrograde cholangiography performed. Eight patients had either traumatic, spontaneous, or postoperative biliary tract fistulas with five leading to the peritoneal cavity, one to the colon, one to the bronchial tree, and one to the liver parenchyma from a ruptured gall-bladder. Each was confirmed by endoscopic retrograde cholangiography. Four patients with jaundice, following traumatic rupture of the liver, had a pathological communication between the intrahepatic biliary tracts and the hepatic vascular system. It is concluded that ERC is a reliable method for obtaining precise localization of biliary tract problems in surgical emergencies both pre- and post-operatively.


Oxygenation of the cerebral and coronary circulation with right axillary artery perfusion during venoarterial bypass in primates. The effectiveness of right axillary artery perform in delivering oxygenated blood to the cerebral and coronary circulation during venoarterial bypass in primates was studied. Both right and left common carotid flow measurements and arterial gas measurements revealed high flows and elevated PO2 levels. Incomplete mixing in the ascending aorta was observed from cineangiograms taken at various pump oxygenator flows in 1 animal. The results demonstrated that the brain receives excellent oxygenation at all bypass levels. However, the coronary circulation is perfused primarily by blood ejected from the left ventricle and receives only minimal contribution of well-oxygenated blood from the pump oxygenator circuit. Therefore, the heart may suffer prolonged hypoxemia during long-term venoarterial bypass for acute respiratory insufficiency.


Species differences in the hepatic microsomal oxidation of nalidixic acid. The kinetics of the conversion of nalidixic acid to the 7-hydroxymethyl derivative (M-HNA) by isolated liver microsomes of several common laboratory animal species was studied under optimal conditions. The order of activity was (from greatest activity to least): monkey greater than rabbit greater than mouse greater than rat greater than dog greater than cat. The formation of 7-HNA followed apparent Michaelis-Menton kinetics in all species except the cat; the substrate concentration at half-maximal velocity was highest with mouse microsomes, while the maximum velocity was greatest with monkey microsomes. Cat, dog, mouse and rabbit microsomes formed an additional metabolite, which was identified as 6-hydroxynalidixic acid, 1-ethyl-1,4-dihydro-6-hydroxy-7-methyl-4-oxo-1,8-naphthyridine-3-carboxylic acid (6-HNA); in the cat, this was the major microsomal metabolite.


Experience with low-dose insulin infusion in diabetic ketoacidosis and diabetic hyperosmolarity. Forty patients with diabetic ketoacidosis and eight patients with the diabetic hyperosmolar state were treated with low-dose insulin infusion in four teaching hospitals in the Cleveland area. The clinical and biochemical responses observed support previous favorable reports on this treatment modality. Two elderly patients with the hyperosmolar syndrome died. The advantages of this form of treatment over intermittent insulin schedules are emphasized. Early potassium administration, unless otherwise contraindicated, is recommended. Rarely, increasing doses of insulin may be required if insulin resistance is encountered.


Afferent fibers and sensory ganglion cells within the oculomotor nerve in some mammals and man. I. Anatomical investigations. The present research shows that sensory ganglion cells are located within the oculomotor nerve of monkeys and man. Furthermore, afferent fibers have been found in the IIIrd nerve of all the animals examined (lamb, pig, cat, dog and monkey). These fibers have their perikarya prevalently in the semilunar ganglion. Their pathway could be studied after section of either the trigeminal ophthalmic branch or of the intracranial portion of the IIIrd nerve. Following these operations, degenerating fibers were found entering the brain stem through the oculomotor nerve. In the brain stem, they were traced through the pons and the medulla and were seen to end in the spinal cord, within the subnucleus gelatinosus of the nucleus caudalis trigemini. Their degenerating endings found in the neuropil of the SG Rolandi, represented peripheral axonal endings of the glomeruli, rather than central axonal endings, as was the case after trigeminal rhizotomy. On the basis of these different degenerating patterns, the conclusion can be reached that the perikarya of the afferent fibers located in the semilunar ganglion represent, in reality, a ganglion of the IIIrd nerve.


[The end-diastolic pressure-volume relationship of the left ventricle. Significance for the indices of compliance and diastolic rigidity of the ventricle]. In order to evaluate the importance of the indices of ventricular rigidity and compliance (k=dP/dV.P and dV/dP), three groups of patients were studied and compared. A simplified method of calculating the diastolic compliance made use of the values of end-diastolic volume (EDV) measured by cineangiography, and of end-diastolic pressure (EDP), using the assumption that the relationship P-V is an exponential one arising from the ordinate: 0.43 mmHg. The correlation between EDP and EDV, which was positive in 19 coronary artery patients, was in fact negative in 11 patients with obstructive cardiomyopathy (OCM), and insignificant in 12 control patients. There were multiple correlations between k, EDPs and EDVs in 11 OCMs, and none in the two other groups. The ratio dV/dP decreased in end-diastole both in the OCM group and in the coronary group, and did not reflect the difference in pathology between these two groups. On the other hand k was increased in the patients with OCM, normal in the coronary patients, and represented in the former a primary modification in the relationship P-V and a primary increase in diastolic rigidity.


[The relationship between left ventricular end-systolic pressure and volume. Comparative study of changes in load and inotropism]. This work consists of a comparison of the indices of left ventricular performance measured during the isovolumic nad/or ejection period under changes in load and inotropism, and of the findings on measuring the pressure/volume ratio of the left ventricle. The indices of performance of the left ventricle. The indices of performance of the left ventricle during the ejection phase (ejection fraction, mean speed of fibre shortening, mean standardised speed of systolic ejection) and the ratio pressure/volume were listed for 36 patients, 21 of them before and after perfusion with nitroprussiate, in 6 before and after perfusion of angiotensine, and in 9 from the group before and after post-extra-systolic potentialisation. The indices of left ventricular performance during the isovolumic (formula see text) were measured in 24 of these patients, 15 of them before and after nitroprussiate, and 9 before and after post-extra-systolic potentialisation. These results show that the level of the pressure/volume ratio at the moment of end-systole is independent of the conditions of load--to a greater extent than any other index measured during the isovolumic period or ejectional period--and appears to be thoroughly related to the changes of inotropism.


[New data concerning hypothalamic cardiovascular regulation and its importance]. The regulation of cardiovascular function by the pressor centres of the hypothalamus located in the ventro-medical nucleus of the hypothalamus is discussed, together with the baro-receptor control, the part played by the release of catecholamines, and the limitations of this control. The depressor part of the hypothalamus, located in the paraventricular nucleus, is characterised by its haemodynamic and pharmacological properties. This study throws light on new areas of possible treatment of angina pectoris and so-called essential hypertension, which are more appropriate to the clinical findings.


[Complete auriculo-ventricular block. A study of supplemental pacemakers]. The following conclusions have been drawn from a study of 20 cases of total atrio-ventricular block, which were supra-His in 7 cases, intra-His in 4 cases, infra-His in 9 cases, and were with (11 cases) or without (8 cases) recent Stockes-Adams (1 case was excluded): resumption of the basal rhythm after the post-stimulatory pause is slower in cases of infra-His A-V block; automatic discharge from the focus is easily upset by rapid stimulation, whatever the site of the focus (ventricular or junctional); subsidiary foci of stimulation would behave from the electro-physiological standpoint like a sinus focus with reduced autonomy, and deprived of its peripheral zone of physiologically slow conduction; unfortunately electro-physiological investigation of this group does not allow us to separate with confidence those patients who have had Stockes-Adams attacks from those who have not.


[Exercise test after myocardial infarct. Correlations with data of coronary angiography and ventriculography]. The authors have studied the exercise test carried out at least three months (3-6 months: 52 cases; greater than  6 months: 48 cases) after myocardial infarction in the anterior position (50 cases), in the "inferior" position (42 cases), and of a diffuse type (8 cases), in patients who were taking no treatment which might interfere with interpretation of the test. For the anterior infarctions there was a good correlation between ST elevation (J max greater than or equal to 1 mm, or better than the sun of the J greater than or equal to 2 mm) and the presence of severe involvement of the left ventricle. A depressed ST segment beyond the area of necrosis corresponds to a stenosis greater than or equal to 75 p. 100 in 36 p. 100 of cases. In inferior infarctions, the correlation between ST elevation and left ventricular involvement is also specific but less sensitive. ST depression outside the area of necrosis corresponds to a stenosis greater than or equal to 75 p. 100 in 66 p. 100 of cases; it is then lateral, but may extend as far as V2. They also indicate a mirror image, especially when the depressed area slopes upwards, and is localised in V2-V3. The other changes which were found have no practical application.


[Exercise electrocardiogram coupled with right cardiac microcatheterization after myocardial infarct. Correlations with ventriculo-coronarography]. This work is based on the results of a systematic scheme of investigation consisting of an exercise  test on the bicycle ergometer with analysis of the ECG and of the pulmonary arterial pressure measured by cardiac micro-catheterisation, and of ventricular and coronary arteriography; 60 patients were investigated in this way after the third month following a myocardial infarction. After an anterior infarction, there is no significant correlation between the ECG changes and the coronary arteriogram. An elevation of the tracing is often (but not always) indicative of akinesia or dykinesia of the ventricle. After a posterior infarction, depression of the trace in leads which were initially normal indicates extension of the coronary lesions in 9 cases out of 10. It, is, however, possible for a tight stenosis on the anterior descending artery to exist with no changes on the ECG. A highly significant (p less than 0.001) and strong (r=0.83) correlation between an index of haemodynamic severity as defined by variations in the pulmonary arterial pressure on exercise and by the score on coronary arteriography, allows us to define certain indications for coronary arteriography and ventriculography after infarction.


[Electrocardiogram in the "typical angina of effort with normal arteriography" syndrome]. This study related to 163 cases of chest pain with the typical clinical features of angina of effort (AE) selected from a continuous series of patients who had carotid arteriography (CA) for anginal pain. These 163 cases were divided into two groups: a study group (SG) consisting of 44 patients with a normal CA, and a control group (CG) which, when patients with ECG evidence of transmural necrosis had been excluded, consisted of 119 cases of coronary artery stenosis, almost all amounting to more than 75 percent. Among those with typical AE (without ECG evidence of transmural necrosis), the proportion of normal CA was 27 percent. It was reduced to 17 percent when those patients with ECG evidence of transmural necrosis were added to the CG. The clinical features of the pain were noted for the SG and the CG, as well as the incidence of "risk factors". By contrast, the SG contained significantly more young subjects and females than the CG (P less than 0.001). The proportion with normal ECGs at reat was the same in the two groups (32 percent). The proportion of non-ischaemic abnormalities of repolarisation was 32 percent in the SG and 18 percent in the CG. Ischaemic abnormalities of repolarisation were present in 23 percent of cases in the SG, and in 49 percent in the CG (p less than 0.01). The exercise test on a bicycle ergometer was carried out for 16 cases in the SG was positive in 7 (44 percent: one male, six females). Of the 33 tests in the CG, a positive response was obtained in 20 (60 percent: 18 males, 2 females) (NS). 37 percent of patients in the SG showed an abnormality of volume or of left ventricular kinetics on arteriography (5 cases) and/or elevation of the end-diastolic pressure before and after arteriography (9 cases). These findings are not significantly different from those in the CG. 9 patients in the SG were studied for myocardial metabolism under pacing: 2 were found to have abnormalities in lactate production.


[Critical study of echocardiography in mitral cardiopathies]. The importance of the echocardiogram in a study of mitral disorders has been analysed by examining 107 echocardiograms set against a clinical examination, an investigation of haemodynamic function (57), left-sided angiography (42), and/or examination at the time of operation (40). This study confirms the great diagnostic value of the echocardiographic findings in mitral stenosis (56 patients): the amplitude DE, the slope EF, the percentage of mid-diastolic closure, the echo from the valves, and the dimension of the left atria (P less than 0.001). This association remains valid if there is mitral incomptence as well as stenosis, or if there is also an aortic lesion, provided all the parameters are used. The degree of stenosis of the mitral orifice cannot be determined with sufficient certainty to allow surgical exploration to be undertaken solely on echocardiographic results, however the patients are selected (sinus rhythm, absence of calcification, mobile valve...). The echocardiographic diagnosis of the 17 cases of mitral incompetence was incomplete (except for rupture of the chords); the volume of the regurgitation is poorly appreciated.


[Intramural anterior interventricular artery. Anatomical study]. In an anatomical study of 187 patients who had died from various heart disorders, the anterior descending artery (ADA) had an intra-mural course in 33 cases (17.65 p. 100). This abnormal course had had no correlation with the sex of the patients, the nature of the disease, length of the trunk of the left coronary artery, and to the relative sizes of the coronary vascular supply on the right and the left. It is associated, to a degree which may reach statistical significance, with certain abnormalities of distrubution of the ADA itself, of other pericardial arteries, and with a particularly short course which means that it does not reach the apex of the heart in more than a third of cases. The anatomical position of the intraparietal segment appears to be remarkably constant, and several anatomical landmarks (the origin of the second anterior septal artery and of the second diagonal artery, both collaterals of the anterior descending artery) may lead one to suspect the presence of an anomaly in the course of the artery when the coronary arteriogram is doubtful. The thickness of the muscular bridge is variable, but is not as a rule great. The most constant anatomical finding is that the anterior descending artery, in its intra-parietal segment, maintains a thin wall, and is never the seat of atheromatous deposits, whatever the age of the patient.


[Diagnosis of posterior infarction. Value of vectorcardiography. Apropos of 108 cases, 31 of which had exclusively posterior necrosis]. An analysis of the vectorcardiogram results (VCG) in 77 cases with a posterior extension of an infarct and 31 cases with an exclusively posterior infarction (EPI) has allowed us to distinguish some diagnostic criteria relative to the extension, or localisation, of an infarct in the posterior segment. The maximum anterior vector (MAV) appears late (36.5 ms +/- 5), and the amplitude of its projection onto Z is increased; the maximum vector (V max) appears early (41.5 ms +/- 4.5), and its orientation is anterior (+ 24 degrees +/- 11); the interval separating MAV from V max is reduced to 5 ms; the transition from before backwards is late (50 ms +/- 6); the ratio of anterior surface to posterior surface is increased (1.45); there is a terminal delay, most frequently occuring in the right posterior quadrant in 78 percent of cases; and finally, the T loop approaches the Z axis. Repeat electrocardiograms in patients with EPI show the most frequent changes to be represented (in 25 cases out of 31) by the following formula: AQRS " 0 degrees, R/S greater than or equal to 1 in V2, RV2 greater than RV6. The diagnosis of an exclusively posterior infarction can therefore be made with a high degree of certainty when these electrocardiographic abnormalities are associated with the clinical picture of coronary insufficiency.


[Biventricular massive infarction with rupture of a mitral papillary muscle and a tricuspid papillary muscle]. The authors report the case of a man of 62 who was admitted with a clinical and electrocardiographic picture of a posterior infarction which was very soon complicated by collapse and anuria. The findings on catheterisation of the right side of the heart were as expected. The cardiac index was very low, and the major abnormality was a type of adiastole with equal pressures in the right ventricle and the auricle of the right atrium. Despite an attempt to assist the circulation by an intra-aortic ballon, the patient died within a few hours. The postmortem examination confirmed the presence of a massive infarction of the left ventricle, but also of the right ventricle, together with rupture of the posterior papillary muscle of the mitral valve, and ischaemic rupture of one papillary muscle of the tricuspid valve.


[Familial myopathy with exclusively cardiac clinical expression]. A case is presented of a familial form of apparently primary cardio-myopathy with findings on investigation and histology which were in favour of a generalised subclinical muscular disorder: a raised serum creatinine phosphokinase, persistent carnosinuria on a vegetarian diet, and under the light microscope several features indicative of a myogenic dystrophic condition on deltoid biopsy. From their clinical features, these original cases may be classified somewhere between primary familial heart disease and the cardiac complications of myopathies. The value of the creatinine phosphokinase isoenzymes and of muscle biopsy in situations such as these is discussed.


[Familial long QT-syncope syndrome. 2 cases of Romano-Ward syndrome]. Two families with the Romano-Ward syndrome were studied; in family A there were 19 members from three generations, 11 of whom had the abnormality of a long QT interval, 2 of whom had fainting attacks, and 2 of whom died suddenly. In family B, comprising 5 members of two generations, 3 had the anomaly, one of these having fainting attacks, and also having an atrio-ventricular block. The bicycle ergometer test has an important part to play in decisions about treatment of the asymptomatic forms of the condition.


[Coronary occlusions associated with chronic arsenic poisoning. Apropos of 2 operated cases]. Examination was made of the clinical history, the results of laboratory tests, of coronary arteriography, and of a histological study of the coronary arterial walls in two young men who had a myocardial infarction. The two men lived in a district where the drinking water had a very high level of arsenic (0.8 parts per million). Neither of the patients presented the risk factors which are usually associated with coronary arteriosclerosis. Neither of the patients presented the risk factors which are usually associated with coronary arteriosclerosis. A histological study of the pathological left ventricular wall, which was removed at operation, showed very characteristic features of fibrous thickening of the intima, with preservation of the internal elastic lamina, of the medial and of the adventitia. Such an arterial abnormality may effect the larger coronary arteries just as well as the medium and small ones. Clinical presentation of this condition is often in young subjects.


Effect of temperature on the adsorption and one-step growth of the Nostoc virus N-1. This study was an attempt to observe the effects of temperature on adsorption and one-step growth of the virus N-1 infecting the nitrogen-fixing cyanobacterium Nostoc muscorum. Adsorption rate was found to maximum at 40 degrees C whereas no adsorption occurred at 10 degrees C. The Q10 value was about 2.03 and the energy of activation, Ea was 16.3 kcal/mole for the adsorption process. The development cycle of the virus was temperature sensitive. With increase in temperature, a gradual increase in inhibition of virus yield i.e. 8.33% at 30 degrees C, 35.3% at 35 degrees C and complete inhibition at 40 degrees C was observed. Out of 7 h latent period, the early 4 h were temperature sensitive and heat treatment had a reversible inhibitory effect on virus development. The temperature treatment did not affect the rise period but burst-size was reduced.


Glycogen synthase in Saccharomyces carlsbergensis cells capable of oscillatory glycolysis. 1. Saccharomyces carlsbergensis cells were found to store about 10% of the glucose taken up as glycogen during oscillatory glycolysis. 2. Under the same conditions and during all phases of carbohydrate limited growth, glycogen synthase (E.C. 2.4.1.11), in the absence of glucose 6-phosphate, had only 5--20% activity compared to the activity in the presence of 10 mM of the effector, indicative for the D-form of the enzyme. 3. Inorganic phosphate (intracellular concentration 19--23 mumoles/g yeast) strongly inhibited glycogen synthase both in the absence of glucose 6-phosphate and competitively to this effector. 4. In this yeast, the D-form of glycogen synthase had to be active to account for the high rate of glycogen synthesis. The resulting sensitivity to glucose 6-phosphate may lead to a pulsatory action of the enzyme during oscillatory glycolysis.


Effect of carbon dioxide on pigment and membrane content in Synechococcus lividus. The effect of carbon dioxide on pigment and membrane content in Synechococcus lividus was studied by depriving cells of CO2 and examining cell populations biochemically and by electron microscopy. After 120 h of CO2 deprivation, S. lividus lost all detectable chlorophyll a and C-phycocyanin. Such bleached cultures were "mustard yellow", the result of approximately 1.8 times more carotenoid per cell than green control cultures. Although cells from beached cultures appeared morphologically identical to control green cells when examined by light microscopy, electron microscopic examination revealed them to be devoid of detectable thylakoid membrane. Thylakoid membrane could not be recovered by physical isolation or revealed by freeze etching of bleached S. lividus. In addition, inclusion bodies characteristically found in S. lividus were also absent. Reintroduction of CO2 into bleached cultures resulted in a rapid resynthesis of both chlorophyll a and C-phycocyanin. Electron microscopic examination of these regreening cultures revealed that thylakoid membrane was also rapidly resynthesized. Growth of regreened cultures did not occur until there was the synthesis of a full complement of chlorophyll a, C-phycocyanin, and thylakoid membrane. A time course study of the cytological events occurring during bleaching and regreening is presented.


Effect of bacteriocins on interferon production. The level of interferon induced with NDV in human diploid cell cultures treated with pyocins was decreased compared with the control culture. This effect was maximal when pyocins were given simultaneously with interferon inducers. In experiments in vivo it was shown that pyocin itself induced very small amount if any of interferon, but administered together with NDV inhibited production of circulating interferone in mice. Similar decrease of interferon production was found when other bacteriocins, namely pneumocin 114 or E-47 aerocin, were used.


[Demonstration of zinc-metalloenzyme syntheses after zinc supplements for deficient animals by means of measurement of the incorporation of 65Zn in various organs]. For the purpose of detecting the synthesis of zinc metalloenzymes after zinc supplementation in an experiment using rats the animals were first depleted for 15 days and subsequently injected a labelled zinc salt solution (65Zn-ZnCl2) in a dosis of 0.4 mg (in terms of Zn) and with an activity of 3.0 muCi/100microliter. After a 5-day depletion period, the activity of the metallo-enzymes alkaline phosphatase in plasma and in the femur and carboxy-peptidase A and B in the pancreatic gland was found to rise at the same rate as the 65Zn-measuring rate in plasma, femur and pancreatic gland. By calculating correlations this interdependence was demonstrated. Thus the highly significant correlation coefficients prove for these metalloenzymes that a synthesis with the injected zinc salt has taken place whilst for carbo-anhydrase in blood this evidence was not furnished. As the zinc dosis is not exclusively used for the enzyme synthesis, but additional 65Zn is incorporated into the individual organs, it does not appear to be possible to draw conclusions from the 65 Zn-measuring rate in the individual organs on the intermediary availability.


Growth of Orungo virus in various tissue cultures. Monolayer cultures of cell strains derived from Cercopithicus kidney (Vero), baby hamster kidney (BHK-21), duck embryo (DE), new-born rabbit kidney (MA-111), and Aedes albopictus were tested for their ability to support the growth of Orungo virus. The virus multiplied to high titres with accompanying cytopathic effect (CPE) in Vero and BHK-21 cultures, but not in the other three culture systems. The yield of virus from infected Vero cell cultures incubated at 37 degrees C was 30 to 100 times greater than in infected cultures incubated at 23 degrees C. In addition, a CPE was observed earlier and reached completion at the higher incubating temperature. Tiny plaques 1 to 2 mm in diameter were produced only in Vero but not in BHK-21, MA-111, DE or Aedes albopictus systems.


Detection and transmission of 30 nm virus particles (astroviruses) in faeces of lambs with diarrhoea. An outbreak of diarrhoea in lambs was investigated, and electron microscopic examination revealed small round virus-like particles in the faeces from eight of seventeen lambs. A bacteria-free filtrate of faeces from one lamb was given orally to a gnotobiotic lamb, which subsequently excreted virus in faeces. Intestinal contents were collected from this lamb and a filtrate given orally to two further gnotobiotic lambs, which subsequently developed diarrhoea and excreted virus in faeces. The mean diameter of the virus particles was 29.7 nm, and 12 per cent of them showed their surface structure arranged in the form of a six-pointed or five-pointed star. They were similar to those particles previously observed in human infant faeces which were referred to as "astroviruses". The passage through gnotobiotic lambs with development of diarrhoea showed that these particles were animal viruses which were probably pathogenic for lambs.


[Connections of field 17 of the visual cortex with the mammillary nuclei in cats]. Using optical techniques by Nauta--Gygax, Wiitanen and Eager, degenerating nerve fibres and terminals were demonstrated to be present in the hypothalamic mammillary nuclei 9 days after a part of field 17 of the brain cortex was extirpated. Electron microscopic examination revealed different changes in large and small terminals of the boutons 5, 7 and 11 days after similar operations. The data represented demonstrate direct monosynaptic bilateral connections in field 17 of the optic cortex with the hypothalamic mammillary nuclei in cats. They are realized by fine fibrillae terminating mainly in large terminal boutons which form synapses on big and small dendritic branches. Thus, there is a structural base for the immediate influence of the optic cortex on the posterior hypothalamus.


St Louis encephalitis with particular involvement of the brain stem. We report a case of St Louis encephalitis in a 4-year-old child in which the main clinical features were dominated by brain stem dysfunction. We document an drome and present a review. We also discuss St Louis encephalitis, with special attention to the ocular manifestations.


Hypopharyngeal perforations in neonates. Hypopharyngeal perforations in the neonate have rarely been reported, although such a disorder may be a more common occurrence than suspected. The optimal therapy is controversial. A case is presented in which instrumentation of the upper airway led to a transmural hypopharyngeal perforation in a naonate. The infant did well with conservative therapy. The early recognition of hypopharyngeal lacerations is of great importance. When the correct diagnosis is made, the condition of infants with pseudodiverticulum of the hypopharynx can be managed successfully without surgery.


Recent advances in general surgery.

Recent advances in general surgery. In order to give an overview of recent advances in general surgery, it is necessary to define: (i) what is general surgery; (ii) what is recent; and (iii) what constitutes an advance. General surgery appears to have entered an era of conservatism. This is particularly evident in the surgery of breast cancer, peptic ulceration, varicose veins, liver trauma, portal hypertension, upper gastrointestinal bleeding, and hiatal hernia. Controlled clinical trials in surgery have become popular. The following are considered to be advances: parenteral nutrition, suction drainage, control of Gram-negative sepsis, bypass surgery for pathological obesity, and a discriminatory approach to transplant surgery.


Identification of a non-magnetic iron centre and an iron-storage or -transport material in blue--green algal membranes by Mössbauer spectroscopy. At least two species of iron were identified in crude membrane preparations of the blue-green algae Chlorogloea fritschii and Anacystis nidulans by Mössbauer spectroscopy. One species was non-magnetic with chemical shift more characteristic of a ferredoxin-like centre than of any known low-spin Fe(II) biological compounds. Studies on cells grown under depleted-iron conditions show the other iron species to be part of the system for iron metabolic transport and/or storage.


The histidine residues of phospholipase C from Bacillus cereus. The inactivation of phospholipase C from Bacillus cereus at pH6 by diethyl pyrocarbonate parallelled the N-ethoxyformylation of a single histidine residue in the enzyme. The inactivation arose from a decrease in the maximum velocity of the enzymic reaction with no effect on the Km value. The inactivation did not apparently alter the ability of the enzyme to bind to a substrate-based affinity gel. The native enzyme contained only one reactive histidine residue. Removal of the two zinc atoms from the enzyme increased the number of reactive histidine residues to five, whereas in the totally denatured enzyme nearly eight such residues were available for reaction with diethyl pyrocarbonate. The enzyme thus appears to contain one histidine residue that is essential for catalytic activity and four that may be involved in co-ordinating the zinc atoms in the structure.


Stimulation of steroid glucuronidation by uridine diphosphate N-acetylglucosamine and by microsomal disruption. Glucuronidation of oestrone and of oestradiol in microsomal fractions was markedly and significantly stimulated by UDP-N-acetylglucosamine and by ultrasonication: Triton X-100 also stimulated. This is consistent with compartmentation of UDP-glucuronyl-transferase. Stimulation by UDP-N-acetylglucosamine may be physiologically significant.


The respiratory chain of a newly isolated Methylomonas Pl1. 1. Whole cells of Methylomonas Pl1 contained ubiquinone, identified as ubiquinone-8. No naphthaquinone was detected. Ubiquinone was located predominantly in the particulate fraction, which also contained most of the NADH oxidase activity. 2. Aerobic incubation of cells with formaldehyde or methanol resulted in about 20% reduction of ubiquinone, irrespective of the presence or absence of dinitrophenol. On inhibition of the respiration by cyanide, ubiquinone became partly reduced by endogenous substrates (15--25%), and a further reduction occurred only in the presence of formaldehyde (up to 60%). When endogenous substrates were completely exhausted, then 44 and 23% of ubiquinone was reduced by formaldehyde or methanol respectively. 3. The difference spectra at room and liquid-N2 temperatures revealed the presence of cytochrome b and two cytochromes c (c-552.5 and c-549) all tightly bound to the membrane. Cytochrome c-552.5 was also found in the soluble fraction. 4. Redox changes of cytochromes b and c, with methanol or formaldehyde as substrates, respond to the aerobic and anaerobic states of the cell and to KCN inhibition in a manner characteristic of the electron carriers of the respiratory chain. 5. The merging point for electron transport from NADH dehydrogenase and formaldehyde dehydrogenase is suggested to be at the level of ubiquinone.


Transport of adenine, hypoxanthine and uracil into Escherichia coli. Uptake of adenine, hypoxanthine and uracil by an uncA strain of Escherichia coli is inhibited by uncouplers or when phosphate in the medium is replaced by less than 1 mM-arsenate, indicating a need for both a protonmotive force and phosphorylated metabolites. The rate of uptake of adenine or hypoxanthine was not markedly affected by a genetic deficiency of purine nucleoside phosphorylase. In two mutants with undetected adenine phosphoribosyltransferase, the rate of adenine uptake was about 30% of that in their parent strain, and evidence was obtained to confirm that adenine had then been utilized via purine nucleoside phosphorylase. In a strain deficient in both enzymes adenine uptake was about 1% of that shown by wild-type strains. Uptake of hypoxanthine was similarly limited in a strain lacking purine nucleoside phosphorylase, hypoxanthine phosphoribosyltransferase and guanine phosphoribosyltransferase. Deficiency of uracil phosphoribosyltransferase severely limits uracil uptake, but the defect can be circumvented by addition of inosine, which presumably provides ribose 1-phosphate for reversal of uridine phosphorylase. The results indicate that there are porter systems for adenine, hypoxanthine and uracil dependent on a protonmotive force and facilitated by intracellular metabolism of the free bases.


Cholesterol esters and membrane permeability. A nuclear magnetic resonance (MNR) study. Cholesteryl esters have been incorporated into phospholipid vesicles up to 5 mole percent. Excess ester separates out into a separate phase which resembles the mesomorphic droplets of atherosclerosis. The incorporation of 5 mole percent cholesteryl palmitate is shown by 31P NMR studies to increase the permeability of the model membranes to ions 10-fold. The same incorporation of cholesteryl linoleate does not affect the membrane permeability. Implications of these findings, and the significance of the cholesteryl ester/free cholesterol ratio upon atherosclerosis is discussed.


A counterimmunoelectrophoretic technique for the detection of HBeAg/anti-HBeAg (e antigen/antibody) in human sera. A counterimmunoelectrophoretic technique is presented for the serological detection of the e system. Counterimmunoelectrophoresis was found reproducible and easy to perform; it is quicker and more sensitive than immunodiffusion since out of 243 HBSAg positive carriers, it detected HBeAg or anti-HBe in other 42 (17.3%) sera in addition to the 96 positive by immundiffusion.


Ultrastructural and metabolic determinants of resistance to azo-dye susceptibility to nitrosamine carcinogenesis of the guinea-pig. During diethylnitrosamine (DEN) administration, a distinctive difference was observed between rats and guinea-pigs in the sequence of ultrastructural changes in the hepatic endoplasmic reticulum (ER). In DEN-induced hepatic tumour cells in the guinea-pig there was extensive proliferation of the rough ER, while the smooth ER was quite sparse; in the premalignant liver the opposite was noted. This is in contrast to the rat, in which administration of either DEN or 3'-methyl-4-dimethylaminoazobenzene (3'-Me-DAB) brings about, in both premalignant and malignant hepatic tissue, proliferation of the smooth ER and sparsity of the rough ER. Yet, as in the rat, the number of ribosomes on the outer surface of the guinea-pig liver rough ER is greatly reduced and this is paralleled by a 49% decrease of the RNA/protein ratio as early as 4 weeks of nitrosamine administration. The decrease of RNA/protein ratio and ultrastructurally observed loss of ribosomes from the ER, following nitrosamine administration, correlate with a decrease of photometric response of microsomal suspensions to the sulphydryl probe, p-chloromercuribenzoate. While azo-dye-reductase activity is higher in untreated rats than in untreated guinea-pigs, feeding 3'-Me-DAB for 6 weeks brings about a 76% decrease in the rat, but no significant decrease in the guinea-pig, which is refractory to azo-dye carcinogenesis. Thus, the ability of the liver to inactivate the dye is greatly decreased in the rat, but not in the guinea-pig, as administration progresses toward the threshold dose for tumorigenesis. On the other hand, constitutive levels of nitrosamine dealkylase are identical in the 2 species and remain essentially unchanged following administration of DEN for 10 weeks. Inasmuch as nitrosamine dealkylation represents activating metabolism, this provides a rationale for the comparable susceptibility of the rat and guinea-pig to DEN carcinogenesis. Of the 2 enzymes in the 2 species, it is only azo-dye reductase in the guinea-pig which appears to be unregulated by glucose repression, since starvation brings about no change in this activity. Starvation-induced increase of azo-dye reductase in the rat is not influenced by administration of 3'-Me-DAB and only slightly by DEN. The starvation-induced increase of nitrosamine dealkylation is abolished, however, in both species by administration of DEN but only slightly decreased by 3'-Me-DAB.


T and B lymphocytes in alpha-chain disease. The patients studied were diagnosed as suffering from alpha-chain disease by their clinicopathological features, malabsorption findings, X-ray, and presence of abnormal alpha-chain protein in their serum. The objective of the study was to determine any possible defect of the immune system in such patients. The rosette technique and surface immunofluorescence were used to enumerate the circulating T and B lymphocytes in these patients. They were also skin-tested with tuberculin and given sensitizing doses of dinitrochlorobenzene. Their serum immunoglobulins were also quantitated. It was found that the proportion of circulating B lymphocytes was much higher than normal, whereas that of T lymphocytes was lower than normal. Furthermore, they could not be sensitized to DNCB and their skin test to tuberculin was negative. It was concluded that the disease was a B-cell disease of IgA type, associated with low level of cellular immunity.


[Influence of the malnutrition-infection binomial in pediatric surgery]. Ecological, biological, psychological, sociological, economic and cultural conditions of the sick child and of his family restrict technical advances of pediatric surgery and must be known by the surgeon. Definition is made of malnutrition, infection, society and culture. Within this trilogy, clinical, paraclinical and experimental observations develop and a description is made as how they act. The interaction of the malnutrition-infection binomial is completely dynamic and characterized by a synergism between both factors.


A comparison of the changes induced in rat liver by feeding low levels of aflatoxin B1 or an azo dye. (1) Rats have been given 6 weeks' feeding with low levels of the hepatocarcinogens aflatoxin B1 and 2-methyl dimethyl aminoazobenzene (2-Me-DAB). (2) It has been confirmed that 3 weeks' feeding with either toxin is sub-carcinogenic, whereas 6 weeks' feeding results in a high incidence of hepatocarcinoma. (3) The changes occurring in the liver during this feeding have been monitored by histological examination and zonal rotor centrifugation. (4) Marked similarities have been observed between the time courses of development of changes induced in the liver by the two carcinogens. Little change is observed after 2 weeks' feeding with the toxins. The greatest change occurs after 3 weeks' feeding, which results in tissue necrosis and the loss of a large proportion of the tetraploid hepatocyte nuclei. (5) A compensatory proliferation of predominantly diploid hepatocytes takes place in the presence of a continuing supply of either of the carcinogens. This indicates that not only does feeding each carcinogen induce the production of a population of hepatocytes resistant to the cytotoxicity of the inducing agent, but that the population is also resistant to the cytotoxicity of the other carcinogen.


Purine nucleoside phosphorylase from human erythrocytes: physiocochemical properties of the crystalline enzyme. The major physicochemical properties of human erythrocytic purine nucleoside phosphorylase (PNPase) have been described. The molecular weight, estimated by ultracentrifugation, molecular sieving and sucrose density gradient centrifugation, ranged from 87 000 to 92 000. Other physical constants of erythrocytic PNPase were: sedimentation coefficent (s20, w), 5.4 S obtained by sedimentation analysis and 5.5 S by the sucrose density gradient procedure; Stokes radius, 38 A; calculated diffusion coefficient (D20, w), 5.7 X 10(-7) cm2 s-1; frictional ration, 1.29; and partial specific volume calculated from amino acid analysis, 0.73 cm3 g-1. The CD spectra of the human erythrocytic and bovine spleen PNPases were almost identical and indicated a very low alpha-helical content. Polyacrylamide gel electrophoresis in the presence of sodium dodecyl sulfate indicated that the molecular weight of the PNPase subunit is 30 000 +/- 500. These results corroborate earlier reports that the native enzyme is a homologous trimer. Comparative studies with crystalline bovine spleen PNPase confirmed that it is also a trimer but is somewhat smaller than the human erythrocytic enzyme with a molecular weight of about 86 000.