The risk of abbreviating the major crossmatch in urgent or massive transfusion. The risk of abbreviating the major crossmatch in urgent situations by issuing blood after an "immediate spin" phase was evaluated by a retrospective study of 82,647 crossmatches performed on serum from approximately 13,950 patients. Although the initial screening test for unexpected antibodies for all patients failed to show agglutination or hemolysis of the reagent red blood cells, agglutination was subsequently noted during at least one crossmatch performed for 148 of them. Further evaluation of these patients' serums indicated that most positive reactions were due to weakly reactive low thermal amplitude antibodies. Eight of the incompatible crossmatches were related to antibodies in the Kell, Kidd or Rh systems, and a ninth antibody, anti-E, was identified through subsequent evaluation of a cold antibody-induced crossmatch incompatibility. Issuance of blood in urgent situations after an "immediate spin" phase of the crossmatch, for patients whose red blood cells have been typed, and whose serums have been screened for unexpected antibodies, has a low level of risk.


Granulocyte transfusions for patients with severe thermal burns. Ten severely burned (greater than 50% BSA) pediatric and young adult patients developed 19 episodes of clinical sepsis of four or more days duration. During eight of the 19 septic episodes the patients received granulocyte transfusions (median, four; range, two to seven). Risk variables, types and prevalence of infections, mainly Pseudomonas aeruginosa and antibiotic regimens were similar for all the septic episodes studied. All eight episodes (100%) resolved in the transfused group while eight of 11 (72%) episodes resolved in the nontransfused group. Patients survived four episodes of ecthyma gangrenosum when granulocyte transfusions were used and the single episode in which they were not used was fatal. Granulocyte transfusions may be helpful in severely burned patients with sepsis.


Quantitative studies of specific and nonspecific second antibody uptake by sensitized erythrocytes. Experiments were conducted using the technique of quantitative hemagglutination with an electronic particle counter to study the specific and nonspecific uptake of blood group antibodies by previously sensitized erythrocytes. Specific attachment of a second antibody was impaired by prior RBC sensitization. It was found possible to quantitate simultaneously the amount of both specific and nonspecific second antibody uptake.


The effect of an immune RNA (RNAi) against Trypanosoma cruzi infection in mice. Immune ribonucleic acid (RNAi) was extracted with phenol from the spleen of mice immunized with the avirulent PF strain of Trypanosoma cruzi. These preparations were able to induce immunocompetent cells to answer as a secondary response to later challenges with the virulent Y strain of the same parasite. The preparations of RNAi were"immunogenic" and free of proteins. The RNAi preparations were sensitive to pancreatic RNAase and lost their immune effect when pretreated with this enzyme. The injections of normal RNA (RNAn) obtained by the same method showed that this polymer acts as an immuno supressor or competitive agent. The electrophoretic profiles of the RNAi preparations in polyacrylamide gels showed normal and characteristic migration patterns (28S, 18S and 4.5S). These results demonstrate the development of an immune state against T. cruzi infection in mice injected with RNAi, in the absence of living parasites.


T cell-specific activity in rabbit anti-human thymocyte globulin. Correlation with immunosuppresive activity in nonhuman primates. Spotaneous E rosette-forming (T) lymphocytes were monitored in the peripheral blood of rhesus monkeys receiving a 5-day course of rabbit anti-human thymocyte globulin (RATG) after skin allotransplantation. Mean graft survival in RATG-treated recipients was 32.3 +/- 7.6 (SD) days compared with 8.2 +/- 1.7 (SD) days in controls. The percentage and total number of circulating T cells fell precipitously after RATG treatment and recovered slowly. Linear regression analysis showed that the recovery pattern of the total number of circulating T cells, but not the percentage of T cells, was significantly correlated with rejection. Specific antihuman T cell antibody was detected in RATG preparations after extensive absorption with human erythrocytes, platelets, and B lymphoblastoid cells. The cytotoxic titers of B cell-absorbed RATG preparations to human peripheral blood lymphocytes showed a significant correlation with the mean skin allograft survival times obtained in RATG-treated primates. Overall the data suggest that the immunosuppressive potency of RATG in the primate skin graft assay is related in large part to its anti-T cell activity.


Matuhasi-Ogata phenomenon involving anti-ampicillin. A 47-year-old group A, Rh1Rh1 woman treated with intravenous ampicillin for chronic pyelonephritis received two units of blood and also received oral cephalexin. Three months after the transfusions she was noted to have allo-anti-E and anti-c, and a 2+ positive direct antiglobulin test. Anti-E and anti-c could be eluted from her cells, yet neither antigen could be demonstrated on the patient's circulating red blood cells. Also present in the serum and in the eluate was anti-ampicillin antibody. Studies of the patient's red blood cell eluates using ampicillin-treated R1R1 and untreated R2R2 cells demonstrated anti-E complexed with anti-ampicillin in a drug-related example of the Matuhasi-Ogata phenomenon. Artificially created mixtures of anti-E and drug antibody could reproduce the effect in vitro. No effect of cephalexin could be demonstrated. The variability of the Matuhasi-Ogata phenomenon is discussed with regard to the sequence of antibody attachment, and the possible relationship to cephalexin is discussed. Drug antibodies may be involved in the Matuhasi-Ogata phenomenon in cases where another red blood cell antibody cannot be shown to be present.


Specific IgM and IgGAntibodies in cattle immunized or infected with Theileria annulata. Antibodies of the IgM and IgG classes were detected in cattle inoculated with living or dead Theileria annulata. Both types of antibody appeared from 18 to 36 days after inoculation and persisted for up to 120 days, the longest period tested. No diagnostic application could be assigned to the differentiation of the 2 classes of antibody.


Procainamide-induced hemolytic anemia.

Procainamide-induced hemolytic anemia. The paper reports a case of hemolytic anemia induced by procainamide hydrochloride treatment. Decreases in hemoglobin concentration are correlated with 11 months of procainamide treatment along with a marked increase in hemoglobin following cessation of the drug. The patient exhibited no symptoms suggestive of drug-induced Lupus Erythematosus that has been frequently reported as a sequela of procainamide therapy. Direct antiglobulin tests were consistently positive throughout the clinical course, and an ether-eluate prepared from the patient's red blood cells showed panagglutinability. The antibody in the eluate reacted with Rhnull, D--, LW negative, and U negative red blood cells without addition of procainamide or pretreatment of red blood cells with the drug. It is noted that this antibody reacts similarly to the antibody produced as a consequence of alpha-methyl-dopa therapy.


Abnormalities of the ureteral bud.

Abnormalities of the ureteral bud. The development and incorporation of the ureteric bud into the developing bladder is a complex process, and it is influenced by events occurring at the same time in the development of other systems in the perineum. Knowledge of the embryology of the ureteric bud and associated wolffian duct is the key to understanding the development of the entire genitourinary system. If the normal embryology is understood, the dysembryogenesis that results in many of the common anomalies of the lower urinary system is simplified. Many of the concepts proposed in this discussion are well substantiated, others are more difficult to prove conclusively. It is believed, however, that the embryologic approach provides a simplified understanding of many of the common problems encountered in pediatric urology. The key in clinical practice to the diagnosis and understanding of these defects is the cystoscopic examination. Careful assessment of the orifice's position, appearance, and tunnel length will allow the interpretation of how the abnormality came about, and also provides valuable information concerning the state of the associated renal segment. This in turn allow better therapeutic management of the problem based on the knowledge of the severity of the renal anomaly associated with the abnormality found in the bladder.


The acute effects of various cytotoxic compounds injected into the prostate glands of dogs. The acute effects of direct injections with various cytotoxic compounds into the prostates of adult dogs were studied microscopically. The effects remained localised to the site of injection, with no diffusion of the agents into other areas of the prostate. No systemic effects were observed despite the high concentrations used. The main histological changes consisted of local aseptic necrosis at the injection site surrounded by atrophy of the acinar epithelium.


Immunoglobulin production by human-mouse somatic cell hybrids. Studies on immunoglobulin production in human-mouse somatic cell hybrids suggest: 1. The structural genes for heavy chain immunoglobulins are carried on chromsome 6, probably on the short arm or the proximal half of the long arm of the chromosome. 2. The structural gene for kappa light chain immunoglobulin may be carried on chromsome 11. 3. The occurrence of immunoglobulin molecules on the cell surface requires the presence of chromosome 2.


[Complications after total endoprosthesis of the hip joint]. On the grounds of the literature data and his own findings the author analyzes the complications occurring in total endoprothetics of the hip joint. The following complications were observed: formation of para-articular ossifications (7), wound infection (1), dislocation of the endoprothesis socket from the acetabulum (1), fracture of the femur (2), laxity of the prothesis pedicle (1), thrombophlebitis (2), postoperative bleeding (1). Various aspects of this problem are covered in the article.


Recovery of Brucella abortus in culture from a 5 ml sample of bovine blood. Calvings in a herd infected by Brucella abortus were monitored by cultural examination of milk and mucus and by serological and cultural examination of 5 ml samples of the blood. Out of 129 samples from which culture of B abortus was attempted, only one yielded a positive result.


Cell kinetics of mouse urinary bladder epithelium. VI. Changes in the proportions of cells with various nuclear DNA content after repeated doses of propylene glycol (1,2 propanediol). A dose of 0.2 ml propylene glycol (1,2 propanediol) was injected subcutaneously into 12 hairless mice three times a week for three months. Four animals were killed at 1, 2 and 3 months and micro-flow fluorometric histograms of the bladder epithelial cells were made. The proportion of cells in diploid S phase was not much altered, but the proportion of tetraploid S-phase cells was significantly reduced and at three months DNA synthesis in tetraploid cells completely disappeared. The proportion of diploid cells increased, the proportion of tetraploids was slightly reduced and almost all octoploid cells disappeared. The changes are qualitatively similar to those seen after the bladder carcinogen dibutylnitrosamine, and after repeated injections of cyclophosphamide, but quantitatively much less pronounced. They can be explained as a result of cell toxicity whereby propylene glycol kills some bladder epithelial cells and disturbs the mechanism of repeated DNA synthesis. Propylene glycol is thus not a completely harmless solvent and when the kinetic effects of bladder carcinogens dissolved in propylene glycol are studied, the effect of the solvent alone must be accounted for.


Hodgkin's disease in the spleen. Investigation of Hodgkin foci and areas for the immune response. Spleens with proven though small Hodgkin lesions were examined expecially in relation to the lymphoid tissue normally engaged in the immune response. These Hodgkin foci were always very close to small arteries and surrounded by a lymphocyte corona. Most of the red and white pulp seemed normal, but in some instances abnormal looking large and also multinucleated cells were found scattered through the p.a.l.s. and especially through some follicles. It is considered possible that these isolated cellular abnormalities in the white pulp, when associated with pre-existent Hodgkin foci, represent early Hodgkin lesions. The implications for the dissemination of the disease are discussed. Spread of malignant cells to the spleen is only acceptable within the concept of a homing principle. It is also possible that the lesions arise "de novo". The nature of the observed abnormal cells is not clear. An explanation for the origin of these Sternberg-Reed-like cells from B-lymphocytes would be in accordance with recent data, but another possibility still is that they originate from antigen trapping cells.


The in vivo differentiation of murine neuroblastoma. C1300 neuroblastoma was implanted with regenerating skeletal muscle to study the role of tissue interactions during tumor cell differentiation. Combined tumor-muscle implants, placed subcutaneously or within diffusion chambers were compared with control tumors implanted without muscle. Neuroblastoma implanted with injured muscle undergoes a partial neuronal differentiation. The tumor cells lose their normal round cell configuration and develop numerous cytoplasmic processes. Accompanying these outward changes are an increased content of microtubules in the neuritic processes; the appearance of glial-like processes containing abundant microfilaments; and the occurrence of growth vesicles identical to those of the growth cones of normal neurites. Although the implants usually contain large numbers of regenerated myofibers, tumor cell differentiation is not dependent upon the presence of these newly formed fibers. Tumor differentiation occurs equally well on the surfaces of degenerating muscle fragments, fibrin deposits and on the membrane surfaces of the diffusion chambers. These observations suggest that non-specific cell surface phenomena, rather than neuromuscular interactions were primarily responsible for the tumor cell differentiation in vivo.


Morphogenesis and significance of fibrous bodies in human pituitary adenomas. In the course of light and electron microscopic studies of 142 surgically-removed human pituitary adenomas, 28 tumors were found containing fibrous bodies composed of type II microfilaments with an average width of 115A. These spherical structures, measuring up to 4-5 micrometer occur exclusively in sparsely granulated growth hormone cells and acidophil stem cells, but as revealed by the immunoperoxidase technique, contain no growth hormone. Fibrous bodies are located in the Golgi region and are consistently associated with Golgi membranes and smooth-surfaced endoplasmic reticulum. Their association with centrioles is thought to be anatomical rather than functional. Several adenoma cells possess spherical formations composed entirely of smooth-walled membranes or transitional forms between smooth tubules and type II microfilaments, suggesting that smooth membranes may play a key role in the production of fibrillar substance. Fibrous bodies appear to be reliable morphologic markers and are valuable in the differential diagnosis of pituitary adenomas.


Morphology of the rectinal pigment epithelium in the vitamin A deficient rat. Ultrastructural changes in the retinal pigment epithelium (RPE) and adjacent photoreceptor cells have been followed in the Wistar rat during the course of long-term vitamin A deficiency. Of particular interest has been the discovery of unusual concentric aggregates within the photoreceptor outer segments and the inner cytoplasm of the RPE. The aggregates were present throughout the course of the retinal degeneration induced by vitamin A deficiency and could be identified in the RPE either by themselves in the apical cytoplasm or within phagolysosomes. It is postulated that the concentric aggregates result initially from abnormal formation or condensation of outer segment membranes and are then slowly degraded by lysosomal action in the RPE cytoplasm. In addition, acid phosphatase activity and typical phagosomes (shed outer segment packets) have been demonstrated in the cytoplasm of the RPE of the vitamin A deficient rats. The latter findings indicate that, at least to some extent, the normal phagocytic and lytic processes of the RPE are retained in this nutritional disorder.


Effects of antimitotic agents either free or bound to DNA on mouse peritoneal macrophages cultivated in vitro. Mouse peritoneal macrophages were cultivated in vitro and treated with ethidium bromide (EB) or with cis-dichloro-diammine platinum (II) (cis-Pt). EB provokes strong cytological alterations and cell degeneration; cis-Pt was not toxic under our experimental contitions. EB-DNA complex penetrates into the macrophages, is liberated from DNA in vacuoles, then diffuses into the cell and is highly cytotoxic. Cis-Pt-DNA complex also penetrates into the cells, but cis-Pt cannot be released from DNA, cis-Pt-DNA complex accumulates inside cytoplasmic vacuoles but has no cytotoxic activity.


Ultrastructural changes of human sural nerves in the neuropathy induced by intrauterine methylmercury poisoning (so-called fetal Minamata disease). Biopsy of the sural nerve was performed on three patients with severe Minamata disease of more than 10 years duration. There were so many unmyelinated and poorly myelinated nerve fibers that myelinated fibers scattered irregularly in small numbers or in groups of peculiar features in the intraneural bundle. Abnormaly thin or poorly formed myelin sheaths were noticed. Incomplete myelination and abnormal myelination varied in size and shape appeared as fetal anomaly. Regenerated axons extremely small in size remained singly or in groups following regenerative sprouting. Sometimes, extremely small axons with normal myelination were noticeable, while the axons were lost, leaving myelin sheaths. Axons occasionally contained increased neurofilaments. Schwann cells were not so increased as in adult Minamata disease. Degenerative changes of nerve fibers still proceeded, presumably because the patients lived in the mercury-contaminated district. Myelin degenerations and glycogen deposits in the axoplasm were identified.


C3b and c3d receptor sites on human fibroblasts derived from several human tissues. The C3b and C3d receptor sites on one cell line of human diploid fibroblasts (WI-38) were reported in previous papers [3, 4]. In this paper we describe that C3b and C3d receptor sites can also be detected in fibroblast cell lines derived from other human tissues. We consider that C3b and C3d receptors are normally found on the cell surfaces of all human fibroblasts.


C-cell in vestiges of the ultimobranchial body in human thyroid glands. Calcitonin-containing cells were demonstrated in the so-called solid cell nests of three human thyroid glands, which supports the theory of the ultimobranchial origin of these cell nests.


[Comparative study of the action of carcinogenic substances that induce transplacental blastomogenesis in rabbits]. The injection of blastomogenic agents--ENM, MNM, DMBA and BP in rabbits during the last third of the pregnancy period would induce in their offspring tumors mostly of peripheral nerves and kidney. Ethylnitrosourea shows the highest blastomogenic activity in rabbits than other carcinogens; it also exhibits a rather pronounced neurotropic blastomogenic effect. Relative tropism to different organs and tissues characteristic of carcinogens in their effect on the adult organism is not always manifested in transplacental blastomogenesis. Transplacental tumors induced in rabbits are of special importance, since thus the model of a neoplasm, most frequently observed in children, may be obtained.


[Thyroid gland function in obesity].

[Thyroid gland function in obesity]. It is reported on in vitro tests of the thyroid gland in 7 males with normal weight and 9 adipose ones. No clear difference was found in the two groups. The TSH level, too, after TRH stimulation is not significantly different so that a latent primary hypothyroidism cannot be ascertained.


[Fragmentation of DNA of monkey adenovirus type 7 by specific endonucleases R. SalI and R. BamI]. The effect of restrictive endonucleases R. Ecor I, R. Bam I, and R. Sal I on simian adenovirus type 7 (SA7) genome was studied. Because of the occurrence of the only recognition site, the R. EcoR I enzyme cuts SA7 DNA into two fragments with molecular mass of 12 and 10 X 10(6) daltons. R. Ram I cuts this DNA in 6 sites producing 7 fragments with molecular mass 6.6, 5.9, 3.8, 2.7, 1.3, 0.7 and 0.6 X 10(6) daltons. Treatment with R. Sal I gives 6 fragments with molecular mass of 8.1, 5.5, 4.3, 2.45, 1.2, and 0.6 X 10(6) daltons R. Bam I and R. Sal I fragments form the sequence E--A--D--F--C--G--B and A--B--D--F--E--C, respectively. The only recognition site of R. EcoR I is localized in the C fragment of R. Bam I and B fragment of R. Sal I.


[Intramural diverticulosis and adenomyomatosis of the gallbladder]. Issuing from an own observation the clinical picture of the adenomyomatosis and the intramural diverticulosis of the gall bladder is considered from the clinical, radiological and pathologo-anatomical point of view. The opinions which are not homogeneous are explained and discussed. Also abortive forms may radiologically be proved with probability.


[Infections model involving the mouse in experimental burns]. By help of four differently virulent strains of pycocyanic pseudomonas standardized infections were induced, which may be the basis for further immunologic investigations.


[Effect of infection on the immune system in burns in animal experiments]. After discussing a model of infection in mice and the possibility of active immunization against pyocyanic pseudomonas, the authors describe the effect of a lipid-protein-complex achieved from isolated burnt mouse skin on pseudomonas infection. First results showed that sublethal amounts of that complex at otherwise less pathogenic suspension of pseudomonas cause a lethality of 100 per cent. This effect can partially inhibited by application of antitoxic IgG. The lethal course was not primarily caused by the infection but by the above mentioned complex which significantly lowers the resistance against pyocyanic pseudomonas.


Sensory nerve endings in the penis in green monkey (Cercopithecus aethiops sabaeus). The authors examined the sensory innervation of the skin in the penis in green monkey in four adult individuals both in the light and in the elctron microscope. They found 3 kings of nerve endings. The free nerve endings were the most frequently occurring kind of nerve endings in the superficial layers of the corium--altogether 6,444 in number. The second kind of sensory nerve endings is represented by the glomerular endings out of which 96 per cent were found in the papillae. The typical Meissner's endings were observed in the light microscopy only rarely. Deeper in the corium the authors also found single simple sensory corpuscles and Pacinian corpuscles. Studying the ultrastructure the authors found in the papillae of the corium 4 types of glomerular endings: quite simple glomerular endings with irregularly arranged Schwann cells, larger and more complicated glomerular endings having a thicker capsule, endings with lamellar system around the terminals and typical Meissner's endings. In the epidermis the authors observed naked axons which passed in the spaces among the epidermal cells. They contained an accumulation of mitochondria. In the basal cell layer of the epidermis there was a small amount of Langerhans cells.


Studies on Sarcocystis in Malaysia. I. Sarcocystis levinei n. sp. from the water buffalo Bubalus bubalis. Light and electron microscopic studies and feeding experiments have confirmed the presence of two species of Sarcocystis in the water buffalo Bubalus bubalis. One is the already known species with large macroscopic sarcocysts, Sarcocystis fusiformia (Railliet, 1897) Bernard and Bauche, 1912 and the other is S. levinei n. sp. which is being described in detail. The sarcocysts of S. levinei are 0.9 x 0.1 mm and the zoites in them 17.8 x 4.2 micrometer. Ultrastructurally, the primary cyst wall shows sloping villi with irregular wavy outlines. Within the villi are coarse granules and annulated fibrils. Trabeculae are present. The sexual stages of S. levinei occur in the subepithelial tissue of the small intestine of the dog and sporocysts shed by this definitive host are 15-16 by 10 micrometer.


[The efficacy of praziquantel against experimental cysticercosis and hydatidosis (author's transl)]. Praziquantel is active against cysticerci in experimentally infected mice, rabbits, sheep and cattle. After single or repeated application the infectious stages of Hymenolepis nana, Cysticercus fasciolaris, C. pisiformis, C. tennuicollis and C. bovis were killed. The compound is more active against older than against younger stages as demonstrated with H. nana-cystecercoids and C. fasciolaris in mice. Against the tetrahyridia of Mesocestoides corti in mice praziquantel is only effective after an intraperitoneal application of an oily suspension. Praziquantel shows also activity in rodents against the infectious protoscolices of Echinococcus multilocularis but failed to inhibit the growth of the hydatid cysts.


Development of listeria monocytogenes in monoxenic and polyxenic beef minces. The objective of this study was to determine the multiplication possibilities of Listeria monocytogenes in beef minces with a defined microflora (gnotoxenic). Selective counts were made for each species and each bacterial association for a period of 17 days after inoculation of the axenic meat. The concentration of L. monocytogenes did not increase, but remained constant in monoxenic meats. Associated with Lactobacillus plantarum, the number of Listeria tended to decrease. Conversely, in association with P. fluorescens, L. monocytogenes definitely multiplied, especially in polyxenic meats, the microflora of which is similar to that of conventional meats. Consequently, it seems that meat might constitute a source of L. monocytogenes infection.


[Participating therapy of a compulsive neurosis. The history of a monastery student]. The case represented above reminds the description of Freud concerning the special relationship in obsessive neurosis to the theme of death, i.e. that these patients find a constant preoccupation in reflecting over the duration of life as well as of the possibility of death of those who are in close relationship to them. Furthermore, the world in which our patient lives, has the quality of threatening and rejecting ("Drohung und Abstossung") described by von Gebsattel in his study on the phenomenology of the obsessional.--The young special-school teacher who was 24 years old in the beginning of the therapy, suffered not only from depression, but from obsessions in thinking certain thoughts, and compulsions, mainly controls. The facts in his fate: early death of the mother, sickness of the father, a congenital abnormity of one eye which demanded several operations, and, last not least, school-years passed in a college of Benedictine monchs, created the roots of his neurosis. And when, in the age of 20 years, he fell in love with a girl, he had to discover that she was suffering from Hodgkin disease, which put him in the dilemma whether to stay with her or to seperate. In this situation he asked for therapeutic help which proceedings were reflected in a rich material of dreams.


[Effect of single impulses on cochlear microphone potentials of the guinea-pig cochlea]. The influence of highly intensive single impulses on the cochlea of guinea pig was studied in an acute experiment. Very short impulses of less than or equal to 0.1 ms duration were produced by a sparknoise generator. The cochlear microphonics (CM) to a test stimulus (sinus tone, 3150 Hz) were recorded from the round window and measured prior to, during, and following impulse treatment. During the impulse treatment, the greatest amplitude reduction of CM occurred after the first impulse, while the further impulses caused a decreasing reduction. At first the number of impulses was varied: 1, 3, and 5 impulses were applied at intervals of 15 s each, at an impulse sound level of 164 dB sound pressure level re. 0.002 mubar (SPL). After these impulse treatments, in all cases a continual decrease of CM amplitudes up to a constant end value without recovery was found within a 2-hrs period of observation. The height of the end value depends on the number of impulses applied. Subsequently, at an exposure to 5 impluses the impulse sound level was stepwise reduced (164, 153, 144, 139 and 133 dB SPL). Again, a characteristic decrease of CM amplitudes was observed during the 2-hrs period of observation. The height of the end value is now dependent on the impluse sound level. Impulses of 164, 153 and 144 dB SPL cause a strong decrease of CM while the effect of impulses of 139 and 133 dB SPL is distinctly lower.


[Experiments on the mechanism of action of vascular spasmolytics. 4. Effect of nitroprusside sodium, nitroglycerin, prenylamine and verapamil on the calcium uptake of microsomes of the smooth bascular muscles]. Nitroprusside-sodium, nitroglycerol, and verapamil had no effect on the calcium uptake by microsomes from the carotid artery of cattle. Prenylamine reduced the passive binding and the active uptake and released already bound calcium. The basal Mg-dependendent ATPase and Ca-stimulatable Mg-ATPase were inhibited by prenylamine.


[Mechanism of action of the inhibition of pyridine-nucleotide-dependent flavine enzymes using the systemic fungicide Dexon]. The actions of Dexon on the NADH-ferricyanide oxidoreductase and the NADPH oxidase system of electron transfer particles (ETP) from beef heart as well as on the NADPH-cytochrome c oxidoreductase from brewer's yeast (Saccharomyces carlsbergensis Hansen) were investigated. The inhibition of the NADH dehydrogenase activity of ETP and that of the yeast enzyme correspond with respect to the following characteristics: 1) increase in the inhibition, 2) enhancement of the Dexon sensitivity by one order of magnitude after preincubation in the presence of NAD(P)H, 3) irreversibility of the inhibition, 4) no detectable changes in the spectral properties and in coenzyme activity of FMN after acid extraction from Dexon-treated enzyme. The inhibition of the NADH dehydrogenase activity of ETP is diminished by both NAD+ and FMN. However, no interaction of Dexon with NAD(P)H or FMN could be detected in the absence of enzyme or apoenzyme. The concentration of half-inhibition by Dexon for the yeast enzyme corresponds with its FMN concentration. It is proposed that both apoenzyme, NAD(P)H and FMN are involved in the interaction with Dexon. Possible mechanisms of binding are both complanar complexations of the ring systems and a triazene formation between FMNH2 and Dexon. The NADPH oxidase activity of the ETP is partly inhibited; the share inhibited by Dexon may represent the pathway via the transhydrogenase reaction.


Long-term treatment of acromegaly with bromocriptine. Treatment with bromocriptine, 30-55 mg daily, in 13 acromegalics for 1-15 months, resulted in a 60% decrease in growth hormone secretion, as judged from the excretion of growth hormone in 24-h urine. Normal excretion was obtained in 10 patients, while 1 patient showed no response. The plasma growth hormone response to O-GTT was improved, but not normalized, in 4 of 7 patients treated for more than 6 months, and marked glucosuria disappeared in two diabetics. While the secretion of TSH, LH and FSH was unchanged, the prolactin secretion was inhibited. The urine excretion of free cortisol showed a 30% decrease, possibly due to a direct effect of bromocriptine on the ACTH-secretion. Hypercalcaemia was never seen, but the initial hypercalcuria showed a modest decrease without measurable changes in the creatinine clearance. The subjective relief during long-term treatment was marked in 10 of 11 patients and the dominating symptoms disappeared in 40-67%, whereas heal-pad thickness, enlarged sellae, and visual fields remained unchanged. No serious side effects were observed. Treatment with bromocriptine seems effective and should be considered as a remedy amongst others, in suitable cases of acromegaly.


Intracerebral calcifications in childhood lymphoblastic leukemia. A new iatrogenic disease? A 3-year-old child diagnosed as having acute lymphatic leukemia (ALL), developed meningeal leukemia 36 months after the onset of the disease. He was twice subjected to cranial irradiation plus intrathecal methotrexate (i.t. MTX). Skull radiology showed bilateral gyriform calcification of both cerebral hemispheres. Hematological relapse was first detected 5 years after diagnosis and the child died 5 months later. The most striking findings of a right frontal lobe biopsy and the postmortem examination were wide calcium deposits located in the cortex and in the adjacent white matter. Intense demyelination as well as areas of neuron poverty were apparent in the necropsy but in the biopsy specimen. The possible interrelationship between such deposition and cranial irradiation and/or i.t. MTX suggests a new iatrogenic disorder.


Sequential therapy with daunorubicin and L-asparaginase in relapses of acute lymphoblastic leukemia in children. 13 children affected by acute lymphoblastic leukemia in advanced stage of illness received a sequential therapy with daunorubicin and L-asparaginase. During daunorubicin therapy a significant decrease of bone hypercellularity as well as circulating cells occurred, a further cycle with a scarcely myelotoxic drug, L-asparaginase, was administered: a 10/13 (76.9%) remission of the disease was then achieved. This therapeutic trial was well accepted and could be more extensively used in the patients in relapse. A remission lasting between 4 and 28 weeks was observed.


Cryoimmunoglobulinemia in four sisters.

Cryoimmunoglobulinemia in four sisters. Mixed-typed cryoproteins, consisting of IgG and IgM, were demonstrated in the sera of four sisters. While the IgG component was polyclonal in every instance, in two of them the IgM component was found to be monoclonal with type chi light chains. Clinical diagnoses included the purpura-weakness-arthralgias syndrome, posthepatitis cirrhosis, congestive heart failure and mitral stenosis. The cryocrit differed in the four sisters, ranging from 3 to 16%; in addition, rheumatoid factor activity was consistently associated with both washed cryoprecipitates and their isolated IgM components. Endomembraneous deposits of IgG and IgM were revealed by immunofluorescent studies of the renal biopsy specimen from one patient. A genetic abnormality, possibly of the autosomal recessive type, is suggested in this instance of familial cryoglobulinemia.


Separation of erythropoietin responsive cells in fetal mouse liver. The erythropoietin responsive cells (ERC) in suspension cultures (ERCSC) of fetal mouse liver and the cells producing erythroid colonies in 2-day plasma clot cultures (CFU-E) sediment at similar rates. However, the sedimented fractions containing the majority of nucleated cells show minimal sensivitity to erythropoietin (Ep) and these cells sediment at a slower rate than the ERCSC. The studies suggest that in short-term suspension cultures of fetal mouse liver, Ep acts on morphologically unrecognizable cells to increase the number of hemoglobin-synthesizing cells rather than by increasing the quantity of hemoglobin synthesized per cell. This effect is similar to the principal in vivo action of Ep.


Different composition of the erythropoietic tissue in bone marrow, spleen and liver in myelofibrosis. Aspirates from bone marrow, spleen and liver were analysed in 10 untreated patients with idiopathic myelofibrosis (MF). The proportion of erythroblasts was higher in the spleen and the liver than in the bone marrow. The mitotic indices of the erythropoietic precursor cells were subnormal in the extramedullary sites and significantly lower in the liver compared with the spleen. There was a "shift to the left" within the liver erythropoiesis and a significant megaloblastosis in the spleen. The same tendencies have formerly been found in patients with chronic myeloid leukemia and it is suggested that the discrepancies may be due to differences in the microenvironment of the erythropoietic cells.


Benign sickle cell anemia in Israeli-Arabs with high red cell 2,3 diphosphoglycerate. Arabs living near the Sea of Galilee were found to be homozygous for hemoglobin S. Studies of solubility, mechanical precipitability, electrophoretic mobility on starch-gel and citrate agar media, minimum gelling concentration, and peptide mapping of the hemoglobin beta-chain confirmed complete identity of the hemoglobin with that found in Afro-American hemoglobin S homozygotes. A comparison of Arab Hb S homozygotes with Afro-American Hb S patients showed no significant differences in hemoglobin levels, red cell indices or morphology. Hb F averaged 4.4% in Arab patients. The 2,3 diphosphoglycerate levels were increased approximately twofold in Arabs, whereas in Afro-Americans, it was increased by only 7% in females and 20% in males.


Waldenström's macroglobulinaemia presented as pleurisy of unknown origin. A case report. This report describes an unusual case of Waldenström's macroglobulinaemia, in which the sole demonstrable clinical manifestations were pleural effusion and ascites. Bone marrow aspirates and bone biopsy revealed no increase in lymphocytes. The case responded to a combination therapy of melphalan, cyclophosphamide and prednisolone.


A new case of gamma-heavy chain disease. The first case of gamma-heavy chain disease described in Spain is here reported. The patient, a 36-year-old woman, presented fever, enlarged regional lymph nodes, and hepatosplenomegaly, without bone marrow abnormalities but with lymphopenia. Serum electrophoresis did not disclose any M-component. The abnormal gamma-chain protein had a alpha2-globulin mobility and was immunochemically related to the Fc fragment. It belonged to the IgG 4 subclass, its molecular weight was about 60,000. Proteinuria was minimal but the electrophoresis of concentrated urine showed a homogeneous peak of alpha2-globulin mobility constituted by the gamma-chain fragment. Biopsy of an axillary lymph node disclosed features of immunoblastic sarcoma. The course was malignant, resulting in death in 8 months.


Acquired C1-inhibitor deficiency in essential cryoglobulinemia and macrocryoglobulinemia. In 5 patients with mixed cryoglobulinemia, 3 with Waldenström's disease and 2 with essential cryoglobulinemia, a C1-inhibitor (C1-INH) deficiency was discovered. The complement profile was characteristic of the acquired type: the total hemolytic activity and the early components were reduced, C3 was diminished in 1 patient only, C5 and C9 were normal or elevated. 1 atient with Waldenström's disease and 1 with essential cryoglobulinemia experienced episodes of angioedema. Circulating immune complexes were found in all patients' sera by the 125I-radiolabelled C1q binding activity (C1q BA) test. The values of the C1q binding activity were correlated with the depletion of the early complement components and that of C1-inh. 4 patients showed circulating 7S IgM. Our data support the hypothesis of a complement activation by the cryoprecipitating immune complexes; the C1-INH depletion is secondary to its consumption following C1 activation.


Acid hydrolases in normal B and T blood lymphocytes. B and T lymphocytes were separated by means of the spontaneous sheep red blood cell rosette formation technique from 3 normal donors. The following acid hydrolases were biochemically determined on separated B and T lymphocytes: acid phosphatase, beta-glucuronidase, beta-galactosidase, beta-hexosaminidase, alpha-arabinosidase, alpha-galactosidase, alpha-mannosidase, alpha-glucosidase, and pH 4.0 and pH 5.0 beta-glucosidase. The activities of most of the acid hydrolases including acid phosphatase and beta-glucuronidase were found to be slightly decreased in B lymphocytes when compared to T lymphocytes. However, alpha-mannosidase activity was found to be significantly higher in the B lymphocytes than in the T lymphocytes and offers the possibility of using this enzyme as a B lymphocyte marker.


Survival and significance of PNH erythrocytes: a scanning study. The SEM study of PNH erthrocytes which survived incubations with decreasing dilutions (from 1:640 to 1:20) of fresh compatible serum in isotonic sucrose has indirectly evidenced that spherocytes and spherostomatocytes are the most sensitive population to the complement lytic action; swelling is an osmotic consequence of their membrane hypersusceptibility. In such functional abnormality the swollen red cells are closely followed by the cribrous and pitted erythrocytes. A relationship has been found between percentage of the swollen cells and frequency of PNH haemolytic bouts: these are most likely to occur when spherocytes and spherostomatocytes are above 40% of cells. On the contrary, SEM evaluation of swollen erthrocytes does not allow to express any longer-term prognosis about the severity and the course of PNH, owing to the constantly variable marrow production of abnormal erythrocytes.


Enzymatic abnormalities in erythroleukemia. Enzymatic studies were performed on erythroblasts obtained from marrows of 2 patients with untreated erythroleukemia. Cytochemically, erythroblasts showed abnormalities of several enzymes involved in carbohydrate metabolism, as well as abnormalities of specific and nonspecific esterases. Electrophoretic analysis of esterases extracted from predominatly erythroid marrows showed strong moderately fluoride-resistant nonspecific esterase activity with alpha-naphthyl acetate, and weak activity with alpha-naphthyl butyrate. Isoenzymatic patterns of specific esterase activity in erythroleukemia were indistinguishable from those found in myeloblastic leukemia. The results are consistent with the concept of the Di Guglielmo syndrome in which a preleukemic erythroid disorder may precede the emergence of acute myeloblastic or myelomonocytic leukemia.


Experimental protein malnutrition in squirrel monkeys: cytochemical interaction of nucleolus and cytoplasm in the anterior horn cells of the spinal cord of Saimiri sciureus. Nuecleolo-cytoplasmic relationships have been studied using histochemical techniques in the spinal cord of healthy neonates compared with those born to mothers malnourished through most of the gestation period, and healthy and severely protein-malnourished young adult squirrel monkeys. Formaldehyde-fixed as well as fresh frozen tissues were used for histological study and for histochemical techniques to demonstrate lipids, carbohydrates, nucleic acids and enzymes of various metabolic cycles. Changes in the neuronal cytoplasm of the low protein animals appear to be related to impaired protein metabolism and energy transport. The nucleolus reacts to cytoplasmic changes by enlarging its size and by active synthesis of secretion of nucleolar material, which is then passed into the cytoplasm through an evagination of the nuclear envelope. The greater the degree of chromatolysis in the cytoplasm, the more active the nucleolus appears to be in terms of its enlarged size and transfer of secretion products into the cytoplasm. It is believed that the perinuclear accumulation of secretion products in the neuronal cytoplasm of the protein-deficient animals has its origin in the nucleolus. Such an accumulation in the severely malnourished animals appears to be a compensatory mechanism for the increased cytoplasmic catabolism and loss of ribonucleoprotein material in order to facilitate additional protein synthesis for cell survival.


Macroglobulinaemia in an Icelandic family. Macroglobulinaemia in an Icelandic family is presented. A woman had Waldenström's macroglobulinaemia, and two of her brothers had monoclonal macroglobulinaemia of the benign form. One was asymptomatic, but the other had polyneuropathy and IgM deposits in peripheral nerves. A third brother of these siblings died of a lymphoreticular disease, which presented with a widespread neuropathy. A second sister had polyclonal increase in serum IgA and two other brothers of this sibship had IgM slightly elevated. A study of all descendants (45 in all and 19 spouses) revealed seven individuals with elevated IgM levels. No other immunoglobulin abnormalities were detected.


Shape regulation capacity during development: recovering capacity of embryos developing notwithstanding dramatic deformations. 1. The development was studied of embryos in which dramatic deformations were produced by physical means during the period in which they are highly susceptible to teratogenesis. 2. In spite of the deformations histogenesis as a whole as well as cytodifferentiation seems to be normal. 3. With only few exceptions the embryos showing dramatic deformations ultimately recover a normal morphology. 4. The shape recovering capacity raises the question whether morphogenesis and shape are not in fact more or less independent phenomena.


Neuroendocrine effects of bromperidol.

Neuroendocrine effects of bromperidol. In the present study we have considered the influence of various antipsychotic drugs (mostly butyrophenones) on some neuroendocrine axes (hypothalamic-hypophyseal-gonadal, hypothalamic-hypophyseal-thyroidal and hypothalamic-hypophyseal-prolactin axes). The antagonistic activity of bromperidol on DA receptors regulating the hypothalamic LH-RH release was compared in vitro to that of haloperidol. To support the possible inhibitory role of DA neurons on HHTA activity, we have evaluated the capacity of bromperidol to remove the apomorphine induced blockade of cold stress-stimulated TSH release. Finally, to evaluate the influence of the drug on prolactin release, bromperidol was compared with haloperidol and pimozide in adult male rats. The results obtained show that bromperidol is able to antagonize as well as haloperidol the DA-induced LH-RH release. The butyrophenone partially remove, in contrast to pimozide, the inhibitory effect of L-DOPA and apomorphine on TSH release. In in vivo and in vitro experiements the antidopaminergic action of bromperidol, evaluated by PRL release, can be considered intermediate between pimozide and haloperidol.


Chronic ulcerative colitis and colon cancer: can radiographic appearance predict survival patterns? Twenty-four patients with chronic ulcerative colitis and colon carcinoma who underwent barium enema examination prior to the diagnosis of cancer were studied in an attempt to correlate the radiographic appearance of the tumors with their biologic behavior, as well as to assess the accuracy of the barium enema in detection. Of the radiographically detected tumors, 65% displayed an annular infiltrative appearance, with the prime radiographic manifestation being relative nondistensibility of the involved segment. The remaining tumors had various appearances more typical of noncolitic colon cancer. Patients with infiltrative lesions had a much poorer prognosis than those with noninfiltrative lesions. Of 33 gross tumors described pathologically and/or surgically, only 70% were correctly detected by barium enema. It is suggested that periodic barium enema examinations are an unreliable means of following patients with ulcerative colitis if malignant degeneration is to be detected at an early and curative stage. Prophylactic proctocolectomy may be the best therapeutic approach.


High density, low viscosity barium for fine mucosal detail on double-contrast upper gastrointestinal examinations. A high-density, low viscosity barium suspension was developed to maximize demonstration of very small mucosal details on double-contrast upper gastrointestinal examinations. The suspension is capable of 250% wt/vol densities without mechanical mixing, while retaining a low viscosity. In vitro tests showed the material to be superior to suspensions of greater viscosity and/or more moderate density in demonstrating fine surface detail. Clinical experience with more than 3,000 examinations with the 250% wt/vol barium suspension has shown the material to be capable of demonstrating areae gastricae or similar fine nodular patterns in approximately 70% of studies.


Strangulating obstruction of the bowel: a reevaluation of radiographic criteria. Fifty consecutive cases of strangulating obstruction were compared with 100 consecutive cases of surgically proven simple obstruction due to adhesions or hernia. All cases were studied by the usual supine and either erect or decubitus abdominal films, and by two successive supine films made at 5 min intervals. Radiographic criteria previously described as signs of possible strangulation were evaluated in the two series. Reduced activity of the small bowel loops on the successive supine films was the only frequent sign (58% of the cases with strangulating obstruction) which showed a statistically significant difference in incidence between the two groups. Other signs seen with some frequency (22%-28% of the group with strangulation) were long air-fluid levels, loss of valvulae conniventes, retention of bubbly fecal matter in the right colon, and predominance of fluid-filled loops; however, they occurred with the same frequency in simple obstruction. The more specific signs of bowel congestion and necrosis (i.e., a narrow rigid loop or intramural gas) were seen in 10% and 2% of the cases, respectively. Only the incidence of a narrow rigid loop in strangulation reached statistical significance. This study confirms the difficulty of diagnosing strangulating obstruction using plain films of the abdomen. Successive abdominal films were shown to be valuable in providing information about small bowel activity, which can help in the differential diagnosis.


A new contrast agent for oral cholecystography: iopronic acid (Oravue). In a preliminary study to determine the safety and minimal effective dose in patients with impaired hepatic function, the cholecystographic agent iopronic acid (Oravue, research contrast material from Squibb) was well tolerated in single oral doses of 1.5, 3.0, 4.5, or 6.0 g. None of the patients experienced clinical adverse reactions. The radiologic results were generally poor, as anticipated for patients with total serum bilirubin concentrations of 2.0-11.4 mg/100 ml. In a subsequent double-blind controlled study in patients without hapatic dysfunction, 4.5 g of iopronic acid or 3.0 g of iopanoic acid (Telepaque, Winthrop) was given to two groups of 90 patients each. Serial radiographs were obtained 13, 14, 15, and 16 hr after ingestion of the drug. Both drugs were highly effective cholecystographic agents, producing visualization in 88% of the patients. Although not statistically significant, a repeat dose was required for visualization in only 4% of the patients given iopronic acid compared to 9% of the patients given iopanoic acid. Visualization was nearly always observed on the first film obtained 13 hr after drug administration. The contrast agents were similar in terms of safety.


Gray scale ultrasonographic evaluation of hepatic cystic disease. Eight patients with various forms of hepatic cystic disease studied with gray scale ultrasonography are described. Four had solitary cysts, two had multiple simple liver cysts, and two had congenital polycystic liver and kidney disease. The spectrum of ultrasonographic features in benign cystic disease of the liver is discussed. All eight patients were felt to have malignant disease in the liver prior to ultrasonographic evaluation. The value of gray scale ultrasound as a noninvasive means of differentiating cystic disease from suspected metastatic disease is emphasized.


Giant cystic abdominal masses in children and adolescents: ultrasonic differential diagnosis. Twelve children and adolescents with a variety of giant cystic abdominal masses are described. These masses are easily evaluated by ultrasonic scanning. Information regarding location, size, origin, and internal structure aid in the differential diagnosis. A correct diagnosis was made in a high percentage of the cases, obviating the need for more invasive studies. Ultrasound examinations at appropriate intervals during patient management can document change in position and/or size.


350 kVp chest radiography: review and comparison with 120 kVp. High kilovoltage radiography had its beginning with super-voltage technique and is presently accomplished with the 350 KV chest x-ray system. The physical reasons to explain the improved visibility with this technique are: (1) absorption coefficients of bone and soft tissue, (2) more uniform bone visibility, (3) x-ray spectrum, (4) visual responses, and (5) depth resolution. In this study, 350 kV and 120 kV chest x-ray techniques were compared by evaluating 15 parameters. Based on our data and the results of previous large clinical studies, a list of disadvantages and advantages is offered. The entrance dose for an average 350 kV posteroanterior chest radiograph is 8 mR, or about one-third that with 90 kV technique.


Tuberculosis: frequency of unusual radiographic findings. The changing pattern of the radiologic presentation of tuberculosis was noted in a review of 100 consecutive cases of pulmonary tuberculosis. Active tuberculosis was not suggested as a radiologic diagnosis in 43% of the patients. Of the 100 cases, only 66 had characteristics of reactivation tuberculosis (i.e., minimal upper lobe infiltrate or more advanced cavitary disease). Of the other 34 patients, 18 had less usual presentations, making the radiographic diagnosis difficult. The remaining 16 patients had radiographic patterns quite unusual for tuberculosis, including masslike densities resembling carcinoma; chronic infiltrates in a lower lobe; miliary tuberculosis, either superimposed on diffuse interstitial lung disease or associated with a diffuse lung pattern atypical for miliary disease; and normal chest radiograph.


Thoracic effects of therapeutic irradiation for breast carcinoma. Therapeutic irradiation produces alterations in normal tissue which, when visible on diagnostic x-ray examinations, may be confused with recurrent tumor or other unrelated conditions. Therapeutic irradiation of breast carcinoma may produce gross effects in the lungs, bone, breast, heart and great vessels, esophagus, liver, and spinal cord. The radiographic appearance of such changes is presented and contrasted with changes secondary to the malignancy itself or benign inflammatory processes. Recognition is imperative for proper management.


Pediatric tracheostomy. I. Radiographic features of normal healing. Serial radiographic studies were used in a prospective study of tracheostomy healing in 30 consecutive infants and children. The examinations were simple, required no anesthesia or sedation, and were coordinated with decannulation of the tracheostomy. In 22 of 30, the tracheostomy site healed normally; in four of these 22 patients the primary cause for obstruction persisted. In 19 of 22 the radiologic study served as an alternative to bronchoscopy before decannulation. Particularly in small infants, the features of normal healing vary in the first days; temporary narrowing of the tracheal lumen can occur at the stomal site and mimic early granulations. After 1 month the trachea is normal except for minor changes at the previous site of the tracheostomy.


Pediatric tracheostomy. II. Radiographic features of difficult decannulations. A difficult decannulation was the principal complication in 12 of 30 consecutive infants and children with tracheostomies. Simple radiographic studies permitted accurate diagnoses which correlated with bronchoscopy. In eight patients an endotracheal lesion was caused directly by the tracheostomy, a risk of complication higher than expected. These obstructions were usually granulomas at the superior margin of the stoma; resectable and nonresectable granulomas could not be differentiated radiographically. Four patients had a primary tracheal or laryngeal obstruction which preceded the tracheostomy and complicated decannulation; these included adhesions of the vocal cords and subglottic trachea and posed difficulties in radiographic diagnosis. In no case was dependency on tracheostomy entirely due to emotional causes.


A specially designed cutting aspiration needle for lung biopsy. The results of 166 lung biopsy procedures performed on 151 patients using a specially designed cutting aspiration needle are summarized. Excellent tissue cores and fragments of tissue were obtained providing a pathologic diagnosis in 85.5% of attempts. A correspondingly low overall complication rate of 12.7% was obtained.


Variation in measurement of coronary lesions on 35 and 70 mm angiograms. Inter- and intraobserver variability in the measurement of coronary artery stenosis using 35 mm cine and 70 mm spot film angiography was examined. Three experienced observers measured 52 lesions on two occasions. The 35 mm cine was evaluated visually, and a single 70 mm frame demonstrating the stenosis was assessed both visually and with a calibrated magnifying device (jeweler's eyepiece). Higher correlation coefficients within and between observers were obtained using the cine method compared to the 70 mm visual and eyepiece techniques. Observer variability was decreased further by using an average of several readings from the 35 mm cine to assess the degree of stenosis. The data suggest that neither higher resolution film (70 mm) nor calibrated magnifying devices diminish observer variability in the measurement of coronary artery lesions.


Left aortic arch with right descending aorta. A left aortic arch with a right descending aorta is a rare congenital anomaly. The radiographic findings in 13 previously described cases and three additional cases are discussed. Characteristic findings on the plain radiograph and esophagram can usually obviate the need for aortography. The anomaly was associated with a vascular ring in at least four and probably five of the 16 patients. Additional and more complex studies may be needed in patients with suspected symptomatic vascular rings.


The Dominican Republic conjoined twins: ischiopagus, tetrapus, omphalophagus. Alta and Clara, the Dominican Republic conjoined twins (ischiopagus, omphalopagus, tetrapus) were evaluated prior to separation with plain films, vaginograms, arteriograms, intravenous pyelogram, barium enema, and upper gastrointestinal series with small bowel follow-through. The clear demonstration of their internal anatomy allowed the surgeons to plan the operative approach and to make a reasonable judgment regarding viability of each baby. Each twin had a semicircular pelvis which joined the other to form a complete ring. There were a few hepatic arterial twigs from Alta which crossed the midline, proving at surgery to be a small bridge of tissue connecting the two livers. Clara's superior mesenteric arteries supplied the majority of the small bowel. Portal venous drainage was separate for each twin. Each baby had two kidneys in normal position with the bladders laterally placed. Each bladder received one ureter from each twin. Two separate small bowels joined proximal to the single colon which terminated in an anus related to Clara's pelvic structures. Following separation, each baby did well. Their postoperative anatomy is described.


Renal vein valves.

Renal vein valves. A total of 33 renal venograms were reviewed to determine the incidence of radiographically demonstrable valves. Valves were identified in five of 22 left renal venograms and two of 11 right renal venograms. On the right side in both patients the valve was located at the junction of the renal vein with the inferior vena cava. On the left, valves were located in the main renal vein proximal or distal to the gonadal vein and in one patient in a segmental upper pole tributary. These valves are significant because of the technical difficulties they can create during renal venography and their possible usefulness in selecting the site of anastomosis in patients undergoing distal splenorenal shunts.


Computed tomography of cerebellar astrocytoma. Analysis of CT scans of 25 patients with cerebellar astrocytoma indicates that a typical spectrum of findings exists for the cerebellar astrocytomas. CT is highly accurate in delineation and characterization of new and recurrent tumors. Recurrences may be demonstrated long before symptoms occur. The density of the fluid in the tumor cyst is twice that of cerebrospinal fluid. Thus differentiation from nonneoplastic cystic lesions and postoperative defects is possible. CT findings of solid or cystic tumor frequently correlate with histologic categorization, and in such cases prognostic information can be derived from the CT appearance.


Resolving intracerebral hematoma: alteration of the "ring sign" with steroids. A ring of contrast enhancement is seen on CT scans of resolving intracerebral hematomas. This ring can be modified with steroid administration in the early stages; however, enhancement seen in the later stages is not affected. Evidence suggests that the early ring is due to blood-brain barrier breakdown, and the later enhancement is due to vascular granulation tissue. The following six stages of hematoma resorption were identified depending on the hematoma density, the presence or absence of a ring of enhancement, and the response of the ring to steroid administration: I = dense hematoma without enhancement; II = decreasing density, enhancement, modification of enhancement with steroid; III = isodense hematoma, enhancement, modification with steroid; IV = lucent hematoma, enhancement, modification with steroid; V = lucent hematoma, enhancement, no modification with steroid; and VI = healed, no enhancement.


Sialography of salivary gland tumors with fluoroscopy and tomography. Sialography with fluoroscopy and tomography has increased the accuracy of detecting and delineating mass lesions of the parotid gland. Lesions which are small, at the periphery of the gland, or in the deep lobe are often most clearly visualized on tomographic sections. Often differentiation of benign from malignant tumors is not possible.


Acute chondrolysis complicating slipped capital femoral epiphysis. Radiographs of 20 patients with acute chondrolysis complicating a slipped capital femoral epiphysis were reviewed with emphasis on the radiographic features and differential diagnosis. There was bilateral disease in five instances; radiographic follow-up ranged from 6 months to 5 years. The onset of chondrolysis occurred after surgery in 18 of the 25 abnormal hips. Acute necrosis of the articular cartilage is characterized radiographically by (1) persistent juxtaarticular osteoporosis; (2) progressive narrowing of all or a portion of the cartilage space; and (3) erosion of the subchondral cortices of the femoral head and acetabulum. The radiographic differential diagnosis varies with the stage of disease. The initial osteoporosis is indistinguishable from disuse. The rapid loss of the joint space, accompanied by destruction of the central portions of the subchondral bone, makes differentiation from postoperative infection a common problem. Late changes may resemble either degenerative joint disease or a chronic inflammatory arthritis. The accurate diagnosis of acute chondrolysis depends on correlation of the clinical history and radiographic findings.


The trough line: a radiographic sign of posterior shoulder dislocation. Over 50% of posterior dislocations of the shoulder are not recognized initially because of failure to appreciate the subtle clues available on the standard frontal projection. In 15 of 20 cases of posterior dislocation, two parallel lines of cortical bone were identified on the medial aspect of the humeral head. One line represents the medial cortex of the humeral head. The other was found to represent the margin of a troughlike impaction fracture. This is designated the "trough line". This line proved to be an important clue in the recognition of posterior dislocations of the shoulder.


Congenital pseudarthrosis of the radius. Five children with six congenital pseudarthroses of the long bones of the forearm are described. Four cases were the result of neurofibromatosis, one was related to fibrous dysplasia, and one appears to be idiopathic. Whereas congenital pseudarthrosis of the leg primarily involves the tibia, congenital pseudarthrosis of the forearm primarily involves the radius. Four of the children were treated with bone grafts of the radius, three requiring repeated grafting. The etiology, differential diagnosis, long term prognosis, and treatment correlate with the data of similar lesions in the tibia. Thus the reason for poor fusion is probably unrelated to weight bearing but is rather the result of underlying bone pathology.


Urography in the child who wets.

Urography in the child who wets. Most children who wet have no underlying structural abnormality and will not benefit from urography. However, several conditions may mimic simple enuresis, and in children with clinical clues that suggest these diagnoses, urography can be confirmatory. The urogram should be conducted so as to exclude an anatomic cause for wetting. This is likely in females in the presence of a duplex collecting system, a nonfunctioning kidney, marked vaginal reflux, or a widened interpublic distance. In the urogram of a child of either sex, a spinal anomaly should be sought.


Computed tomography of the normal adrenal glands. CT body scans of 60 random patients without evidence of adrenal disease were reviewed to determine the location, size, and shape of both normal adrenal glands. Both glands were clearly delineated in 78% of the patients evaluated. The length, width, and thickness of adrenal glands as measured by computed tomography were similar to comparable measurements from surgical and autopsy studies.


Hydronephrosis of the lower pole of the duplex kidney: another renal pseudotumor. Obstruction and reflux occur fairly commonly in the duplex kidney. Although obstruction with attendant hydronephrosis is more frequently seen in the upper pole of a duplex system, a similar process involving the lower pole should be considered in the differential diagnosis of renal mass lesions. Four cases are described in which lower pole hydronephrosis simulated neoplasm.


Effect of fatigue and alcohol on observer perception. A test series of chest radiographs containing pseudonodules was used to establish baseline sensitivity, specificity, and accuracy rates for individual observers. This experiment studies the effect of fatigue (as subjectively measured) and alcohol (as measured by blood alcohol levels) on observer perception and performance. The results indicate that the fatigue encountered in the course of ordinary professional activities has no significant effect on diagnostic accuracy. Modest quantities of alcohol may adversely influence diagnostic sensitivity, but the effect is unpredictable. Subjective estimates of the influence of fatigue or alcohol on performance by individual observers are frequently erroneous.


Treatment of obesity: cost-benefit assessment of behavioral therapy, placebo, and two anorectic drugs. Mazindol, diethylpropion, and a placebo were compared with behavioral therapy for effectiveness in producing weight reduction in an outpatient obesity clinic. Each method was also compared in cost and harmful side effects. The patients were recruited from the middle and lower socioeconomic groups. Of the 120 patients beginning treatment, only 33 completed the entire 14-week study. There was no statistically significant difference in the weight loss among the treatment groups. The program of behavioral therapy was administered by a dietitian who as experienced in the techniques of behavior modification; the drug treatment groups were seen by physicians. We conclude that behavioral therapy may be the treatment of choice in an outpatient obese population since it requires little physician time, is less expensive, and avoids the side effects of anorectic drugs.


Prevention of hypercholesterolemia in monkeys (Macaca fascicularis) by digitonin. Digitonin mixed in the diet was well tolerated by rats and cynomolgus monkeys (Macaca fascicularis), and prevented the expected rise in plasma cholesterol in monkeys fed a diet containing butter and cholesterol. Both digitonin and mildly hydrolyzed digitonin precipitated cholesterol dispersed in micellar suspensions and decreased intestinal absorption of cholesterol in rats, but only digitonin bound cholesterol in vitro. The hypocholesterolemic effect of digitonin may be secondary to decreased intestinal absorption of cholesterol associated with a disturbance in the micellar suspension of cholesterol in the intestinal content. Modification of other mechanisms that may be involved in membrane transport of cholesterol through the intestinal epithelium is not ruled out by the present findings.


Zinc deficiency in pregnant rhesus monkeys: effects on behavior of infants. Zinc deprivation from day 110 to 150 of gestation in rhesus monkeys resulted in rash, alopecia, anorexia, decreased feed efficiency, and low plasma zinc in the mothers. Infants of the dams that had been deprived of zinc during gestation displayed a more rapid postnatal growth rate than infants of the control mothers. Infants of the zinc-deprived dams played and explored less than the control infants. They also associated with their mothers a greater percentage of the time and were less active. This study has shown that third trimester maternal zinc deprivation in nonhuman primates can impair behavioral development of offspring.


Evaluation of methods to detect antibodies against Aspergillus fumigatus. Seventy-five sera, including sera from 23 patients with aspergillosis, 17 with tuberculosis, asthma or carcinoma, and 35 normal controls, were studied for antibody activity against Aspergillus fumigatus by agar gel double diffusion (DD), counterimmunoelectrophoresis (CIE), indirect hemagglutination (IHA) and indirect immunofluorescence (IF). Metabolic antigens produced from a selected strain of A. fumigatus were used for DD, CIE and IHA, while slide cultures of the same organism were used for IF. The results indicated that sera from the patients with aspergillosis had high IHA and IF titers, while only 91 and 87% were positive for CIE and DD methods, respectively. IHA was more sensitive than DD and CIE, and IF was equally sensitive but had false-positive reactions. CIE was simple and fast, but had false-negative and occasionally false-positive results.


Screening test for complement activation by counterimmunoelectrophoresis. This report describes the use of counterimmunoelectrophoresis (CIE) as a method of detecting activation of the complement system. With this technic small amounts of C3 split products (C3c/d) can be detected in plasma samples by specific precipitation with antiserum in less than two hours. The CIE technic is a highly sensitive, rapid method for detecting activation of the complement system in the presence of normal concentrations of C3 measured hemolytically or by radial immunodiffusion (RID) in human disease. A clinical investigation was carried out in 40 patients with systemic rheumatic diseases and 116 normal healthy individuals. The following observations were made: (1) plasmas and sera from normal individuals had normal total complement hemolytic activity (CH50), hemolytic active C4 (C4H50) and C3 (C3H50); (2) in 30% of the serum samples it was possible to identify the presence of C3 split products, in contrast to only 2.5% of the plasma samples obtained simultaneously; (3) in the specimens from patients who had rheumatic disease activity, C3 split products were identified by CIE in all cases except one in the presence of normal C3 protein measured by RID.


Severe toxicity and lethality in some monkeys following chronic administration of levo-alpha-acetylmethadol (LAAM). Recurrent episodes of mild to severe opiate-like toxic effects were observed in 3 of 18 monkeys maintained on 2 mg/kg p.o. dose of LAAM on alternate days 3 times a week for up to one year. Despite antagonist administration and artificial respiration, the final toxic reaction in 3 LAAM sensitive monkeys progressed rapidly to cardio-respiratory arrest and death 3, 6, and 12 months after LAAM treatment. The blood chemistry and hematology were not significantly altered during chronic LAAM administration. Necropsy did not reveal any aberrant gross, histological or neuropathological features other than pulmonary edema. Differential rates of formation and elimination of active metabolites of LAAM may play a significant role in this potentially lethal toxicity. These findings may have important clinical implications for LAAM maintenance treatment programs.


Guidelines in the management of patients with pancreatic abscess. A systematic approach to the management of patients with pancreatic abscess is presented. The method includes an aggressive diagnostic approach relying on radiographic and ultrasound examinations, adequate transperitoneal drainage of the abscess, coupled with gastrostomy and feeding jejunostomy. The importance of nutritional support using an elemental diet administered through a jejunostomy is emphasized.


Exploitation of the medical care dollar. Review of and commentary on health care expenditures in the United States are presented. The growth of medical expenditures over recent years is chronicled, and reasons for the upsurge are given. Aspects of good health are enumerated, and the economics of the medical care industry are explained. Health insurance in general, and national health insurance in particular, are reviewed. Methods of curtailing unnecessary use of expensive medical care need to be aimed at two targets: (1) the extensive supply of goods and services that continues to grow independently of consumer demand, and (2) the uninformed status of consumers who somewhat blindly use the questionably effective services offered by physicians and hospitals.


Diverticulum of the left ventricle in hypertrophic cardiomyopathy. An unusual case of diverticulum of the left ventricle is presented. The most distinctive feature was the presence of a circumferential mid-ventricular contraction ring with histologic abnormalities similar to those described in patients with asymmetric septal hypertrophy. This abnormal ring of tissue obstructed emptying of the ventricular apex and isolated it from the rest of the ventricle. The obstructed apex assumed the appearance of a muscular diverticulum, and the residual portion of the ventricle was markedly diminished in volume. In addition, the abnormal mid-ventricular hypertrophy interfered with papillary muscle function, producing mitral valve prolapse and mitral regurgitation. The patient's age was equally unusual; she was 65 at the time of diagnosis, probably the oldest known patient with ventricular diverticulum. She was treated surgically by transapical myotomy and myectomy of the mid-ventricular contraction ring, in order to increase effective ventricular volume. The relationship of this entity to other types of ventricular deiverticula and aneurysms, and to hypertrophic cardiomyopathy, is discussed.


Autoimmune hemolytic anemia in association with monoclonal IgM(kappa) with anti-i activity. A patient with a warm autoimmune hemolytic anemia with an immunoglobulin G (IgG) panagglutinin, also had monocional IgM(kappa) cold agglutinin with anti-i activity. Ninety per cent of the peripheral blood lymphocytes had surface immunoglobulin and the number of T cells was diminished. A subpopulation of the patient's lymphocytes formed rosettes with cord (i) erythrocytes and not with adult (l) erythrocytes. The finding of increased lymphocytes bearing i-binding sites and a monoclonal antibody with anti-i activity could be related to shared idiotypic determinants between antigen-binding sites and serum antibody. The occurrence of two autoantibodies in this patient suggests an immune regulatory disorder.


Cryocoagulation of the endometrium at the uterine cornua. A cryoprobe that will produce coagulation necrosis and subsequent scar formation of the cornual areas of the uterus has been tested. A discussion is made of the developmental program, including the design of the instrument, efficacy and safety testing in baboons, and preliminary investigations of the safety of this procedure in man.


Autoimmune and virus-induced demyelinating diseases. A review. Patterns of demyelination are described in several autoimmune and virus-induced demyelinating diseases of the peripheral and central nervous system. Myelin can be destroyed by injuries that affect either the myelin-supporting cells and/or the myelin lamellae. After destruction of the supporting cells, the related disintegrating sheaths are stripped off axons by invading phagocytes. Virus-induced cytolysis can occur with or without participation of immune responses, as demonstrated in subacute sclerosing panencephalitis and progressive mutlifocal leukoencephalopathy, respectively. Autoimmune demyelination is characterized by disintegration of myelin sheaths in periventular, mononuclear cell infiltrates. Myelin lamellae rather than the myelin-supporting cells are the target of the allergic reaction. The lamellae are lysed in focal areas when in contact with presumably sensitized mononuclear cells. The damaged sheaths are then removed in a nonspecific manner by invading macrophages that strip the myelin remnant off the axons. This sequence of changes is best revealed in experimental and human autoimmune demyelination of peripheral nerves, ie, allergic neuritis and idiopathic polyneutris (the Guillain-Barré syndrome). Autoimmune demyelination triggered by virus infection is described in Marek's disease and postinfectious Theiler's virus myelitis. Changes in canine distemper are discussed with reference to both autoimmune and virus-induced demyelination. The observations are compared with lesions in multiple sclerosis, the most common human demyelinating disease of unknown etiology.


Effect of indomethacin on pulmonary vascular response to ventilation of fetal goats. The effect of indomethacin treatment of the pulmonary vasodilation caused by ventilation of the fetal lung with air was evaluated in anesthetized, exteriorized, fetal goats by means of an open-chest, pump-perfused lung preparation. The decrease in pulmonary vascular resistance that occurs when the fetal lung is ventilated with air consists of two components: 1) a rapid decrease in pulmonary vascular resistance during the first 30 s of ventilation; 2) a slower decline, which continues through the first 10-20 min or more of ventilation. Indomethacin has no effect on the first component. The second component is absent following indomethacin pretreatment. The effect of indomethacin treatment is more pronounced in immature fetuses (less than 90% gestation) than in mature fetuses. Prostaglandin synthase activity appears to be important in the pulmonary vasodilation caused by ventilation of the fetal lungs with air.


Prostaglandins: renal vascular responses to bradykinin, histamine, and nitroglycerine. A study was undertaken to evaluate the effects of inhibitors of prostaglandin (PG) synthesis on renal vascular responses to several renal vasodilators in anesthetized dogs. Indomethacin (IND) and meclofenamate (MEC), two dissimilar cyclooxygenase inhibitors were used. An electromagnetic flow probe was placed on the renal artery and a needle was inserted proximal to the probe. Injections of bradykinin, histamine, nitroglycerine, and arachidonic acid (AA) were given before and after administration of IND or MEC, 2.5 mg/kg body wt. In each experiment, inhibition of PG synthesis was estimated by reduction of vasodilator activity following AA injection. Although renal vascular resistance increased slightly after IND or MEC, elevations of renal blood flow in response to injections of bradykinin and nitroglycerine were not affected by PG synthesis inhibitors, whereas percent responses to histamine were enhanced by IND but not MEC. In addition, the action of 5 mg/kg IND on responses to injections and infusions of bradykinin was evaluated. No decrease in vasodilator activity following the kinin was detected in these studies. These results demonstrate that renal vascular responses to bradykinin, histamine, and nitroglycerine were not dependent on endogenously produced products of cyclooxygenase (e.g., prostaglandins) in the kidney of the anesthetized dog.


Alterations in steroid binding plasma proteins in Macaca nemestrina during pregnancy. We measured the corticosterone and dihydrotestosterone steroid binding capacities of corticosteroid-binding globulin (CBG) and sex steroid plasma binding protein (SBP) throughout pregnancy in seven Macaca nemestrina. The nSBP binding capacity rises significantly by 28 days of pregnancy, remains elevated through 56 days, tends to fall through midpregnancy, and then decreases dramatically to very low values 130-153 days after conception. In contrast, nCBG rises slightly (1.2-fold) in early pregnancy, is elevated in midpregnancy, but is similar to nonpregnant values during the last trimester of pregnancy. Our data indicate that factors controlling the plasma concentration of nCBG and nSBP are not identical. The results are in sharp contrast to those observed in human pregnancies in which both hSBP and hCBG are increased severalfold during pregnancy, including at term. Because the changes of nCBG and nSBP during pregnancy do not paralle the changes observed in human beings even though their steroid binding characteristics are similar, the M. nemestrina may serve as a valuable model for defining the physiologic function of SBP and CBG and the mechanism(s) controlling their concentrations in blood.


Postnatal development of circadian rhythms in disaccharidase activities in rat small intestine. The circadian rhythms in the activities of maltase and lactase of the small intestine were examined at various stages of postnatal development in rats. When the rats were fed ad libitum, no circadian change in the enzyme activities was found during the suckling period or the weaning period. However, several days after the time of weaning, the enzymes showed the same circadian changes as in adult rats with higher activities at night. After weaning, when the rats were fed only during the daytime, the phase of the enzyme rhythm shifted about half a day, and the highest activity was observed around feeding time. However, during the suckling period, no circadian rhythm in the enzyme acvities was found, even when the rats were allowed to feed only during a restricted time of the day.


The effects of phenylethylamine in rhesus monkeys. In controlled experiments rhesus monkeys that had received phenylethylamine (PEA) demonstrated behavior similar to that reported after the administration of amphetamines, except that tolerance to PEA did not develop. These findings are of psychiatric interest because PEA is found in the human body and is a specific substrate for type B MAO, which is found in decreased quantities in certain schizophrenic patients.


Triatomines as experimental vectors of trypanosomes of Asian monkeys. Systematic surveys of the wild macaques of South Asia by blood culture resulted in the discovery that trypanosomiasis is enzootic in the simians of Indonesia, Malaysia, India, and Thailand. The isolates obtained differ in morphology, metabolism, and ability to multiply in arthropods. Following this discovery, interest focused on possible transmissions of these trypanosomiases. Laboratory-reared and wild-caught insects were studied to determine which are satisfactory intermediate hosts and potential natural vectors. Successful results were obtained with insectary-reared reduviids and Indonesian isolates. In Rhodnius prolixus and Triatoma rubrofasciata the Indonesian trypanosomes multiply for periods which can exceed 40 days. The flagellate infections are in the digestive tract, whereas trypanosomes have never been seen in the salivary glands or in the hemolymph. The feces of trypanosome-carrying reduviids are infective, suggesting a stercoreal method of infection of mammals, and infection was produced in experiments in which feeding by the insects was not possible. The relevance of these findings to natural transmission in Indonesia is not known. Experiments with insects and all other trypanosomal isolates have been negative. The natural transmission mechanism(s) of the simian trypanosomiases in South Asia remains an unsolved problem.


The Schistosoma japonicum egg granuloma. II. Cellular composition, granuloma size, and immunologic concomitants. Studies of granulomatous hypersensitivity to Schistosoma japonicum eggs were performed at various time periods up to 20 wk after the induction of light infections in mice. Cell populations which were determined in granulomas isolated from the livers revealed a maximum in the total number of cells at 6 wk with a decline of 36% by 20 wk. Large mononuclear cells were predominant at all time periods, with eosinophils being the second most common cell. Measurements of granuloma diameters around single viable eggs in the livers also revealed peak size at 6 wk with a decline of 51% between 16 and 24 wk. Immunodiffusion analysis demonstrated the presence of precipitating antibodies as early as 7 wk after infection. Investigations of lymphocyte blastogenesis revealed a profound depression in response to T-cell mitogens by 8 wk of infection. Studies of footpad swelling to soluble S. japonicum egg antigens revealed massive immediate reactions starting at 6 wk. but no delayed reactivity over a period from 3 to 20 wk. All of these results are related to differences in the biology of S. japonicum in comparison with S. mansoni with respect to the earlier onset of egg production, the much larger numbers of eggs produced, and the possibility of differences in the antigens emitted by the eggs.


Cholecystohepatic duct.

Cholecystohepatic duct. Review of embryologic and surgical literature emphasizes the great variability in biliary ducts. Major cholecystohepatic ducts are rare, although accessory bile ducts are common. A rare case of intrahepatic junction of right and left hepatic ducts providing drainage through a single cholecystohepatic duct is presented. Chlolecystectomy and primary anastomosis of hepatic ducts and duodenum was successful. We know of no report of a precisely similar case. Awareness of the possibility of these anomalies should increase their reported incidence and decrease the severe morbidity and mortality attending failure of recognition.


Ophthalmic terminals in the iris and the ciliary body of monkeys. An electron microscopical study. Recent studies have indicated that sensory terminals can be recognized by the presence of an accumulation of mitochondria. By inducing changes in uveal ophthalmic nerve fibers it was shown that an accumulation of mitochondria also occurs in autonomic terminals. Although an aggregation of mitochondria may occur in sensory terminals, it is not a feature unique to them. The ophthalmic fibers in the iris and the ciliary body appeared to terminate as free nerve endings without characteristics peculiar to them.


[Changes of the essential fatty acids in plasmalipid fractions of polytraumatized patients with different parenteral nutrition (author's transl)]. In two groups of polytraumatized patients we investigated changes in the fatty acid pattern of plasma-lipids during the phase of total parenteral nutrition. For parenteral nutrition we gave L-amino acid solutions in a dose of 0.24 g N/kg body weight/day. In addition, we administered in the first group glucose and fructose and in the second group glucose, fructose and fat emulsions in a total dose of 30 kcal/kg body weight/day. In the latter group, the proportion of the fat emulsions was 30-40% of the administered calories. We compared the achieved results with the values of a group of control persons. The most essential findings of these studies were the striking decrease of the essential fatty acids with regard to the phospholipid fraction in the early post-traumatic phase. In the first group we observed a further reduction of essential fatty acids during the period of observation. This could be avoided by administering fat emulsions of the same type as we gave in the case of the second group of patients. The functions of essential fatty acids in membranes and in intermediary metabolism are discussed.


[Immunosecretory cells in human bone marrow. Immunofluorescence study on histological sections]. The authors report on a method for studies using immunofluorescence with total and anti-light chain anti-immunoglobuline immune serums of bone marrow specimens previously fixed, decalcified, and embedded in paraffin. The semi-quantitative counts of plasmocytes on histological sections are in agreement with those performed by other authors on smears of bone marrow punctures. The results of this method are in agreement with those of serum electrophoresis. It provides a distinction between polyclonal and monoclonal plasmocytosis and an exact identification of clonal proliferation of a frank tumorous nature (myeloma and Waldenström). Applicable to autopsies performed within 24 hours, it reveals the existance in the vast majority of amyloid diseases of monoclonal dysglobulinemia, without the abnormal clone being necessarily present in the other immunocyte area (spleen and ganglions).


Specific lymphocyte stimulation in cattle naturally infected with strains of Brucella abortus and cattle vaccinated with Brucella abortus strain 19. Cell-mediated immune responses in cattle naturally infected with strains of Brucella abortus and in cattle vaccinated with B abortus strain 19 during calfhood were studied by an in vitro lymphocyte-stimulation procedure. Lymphocytes were prepared from peripheral bovine blood by the Ficoll-diatrizoate technique, suspended in RPMI-1640 medium (1.5 X 10(6) lymphocytes/ml), cultured with B abortus-soluble antigen or phytohemagglutinin, and incubated for 6 days. Sixteen hours prior to termination of incubation, cultures were labeled with 1 muCi of [3H]thymidine (3HdT) and, after harvesting, assayed for 3HdT incorporation into DNA by liquid scintillation spectrometry. Lymphocytes from cattle with bacteriologically confirmed isolation of B abortus underwent a significantly higher lymphocyte stimulation with B abortus-soluble antigen than did cattle vaccinated with B abortus strain 19 during calfhood (P less than 0.005). Standard seroagglutination tests were conducted simultaneously with lymphocyte-stimulation tests, but there was no apparent correlation between levels of humoral antibodies and the cell-mediated immune responses as measured by in vitro specific lymphocyte stimulation.


In vitro lymphocyte transformation as a herd survey method for bovine paratuberculosis. The lymphocyte-transformation (LT) test was evaluated for its potential application as a field test for bovine paratuberculosis. Using a whole blood technique, samples from 3 consecutive collection periods were subjected to 3 mycobacterial antigens and to phytohemagglutinin. The results obtained from LT were compared with conventional serologic and cultural methods. A positive LT response to johnin purified-protein derivative (PPD) or avian PPD (or both) was noted in 40% to 60% of the animals tested. The complement-fixation test yielded 4% to 6.7% positive results, the immunodiffusion test between 1.2% and 1.4%, and the direct fecal culture between 2.4% and 6%. The mean of the stimulation indices of all positively responding animals was highest with johnin PPD. Specific stimulation to mammalian PPD occurred between 2.4% and 6% of the animals. The efficacy of the LT test for determining the incidence of infection with Mycobacterium paratuberculosis is discussed.


Rapid radiometric susceptibility testing of Mycobacterium tuberculosis. A 48-hour radiometric test for determining the drug susceptibility of Mycobacterium tuberculosis has been developed. The test is based on the measurement of 14CO2 produced by the oxidation of formate labeled with carbon-14. The test system uses 5 X 10(7) organisms in 1 ml of Middlebrook 7H9 medium plus albumin-dextrose-catalase enrichment and 1 muCi of [14C]formate. The 14CO2 produced is measured in an ionization chamber at 24-, 48-, and 72-hour intervals, with and without the addition of antituberculous drugs. Isoniazid, streptomycin, rifampin, and ethambutol were each tested at 3 concentrations by the radiometric method and the reference (agar dilution) method. Six standard strains and 21 patient isolates were compared by both methods. Production of 14CO2 was quantitatively decreased in the presence of drugs that inhibit the organism. The radiometric method requires 2 days; the agar dilution, 14 to 21 days.


Diabetic ketoacidosis: new concepts and trends in pathogenesis and treatment. New concepts concerning the pathogenesis and therapy of diabetic ketoacidosis are reviewed. The regulation of ketogenesis by intrahepatic enzymic processes and the roles of insulin deficiency or glucagon or other counterregulatory hormone excess are summarized. Major emphasis is placed on an analysis of the use of low-dose insulin regimens for the treatment of ketoacidosis. Most patients with diabetic ketoacidosis will respond to low-dose, hourly, intravenous or intramuscular regular insulin. Low doses of insulin are as effective as high doses and have fewer associated complications of hypoglycemia and hypokalemia. Phosphorus deficiency is common in diabetic ketoacidosis and hypophosphatemia usually becomes manifest within 4 to 12 h of institution of therapy. Phosphorus supplementation is now generally recommended to replete erythrocyte 2,3-diphosphoglycerate and improve oxygen delivery to tissues. Coexistent and biochemically significant lactic acidosis is a relatively infrequent complication of diabetic ketoacidosis and when present is usually due to underlying disorders associated with poor tissue perfusion.


[Morphology of Sarcoptes Scabiei (variety hominis) under scanning electron microscopy]. Some morphologic aspects of S. S. by SEM in twelve parasites (female) extracted from the lesions with a pin are studied. We think that the extraction method and the posterior colocation of the parasite has contributed to its better understanding. We describe the dorsal cleft, a characteristic formation of the sarcoptidos, tapered on both sides with thorns in the form of shark's teeth. We analyze the details of the Ambulacro, constituted by the cut or the strait Pedicelo, with a distal extremity in the form of Condyl in which the suction cups are articulated. We can see, in the anogenital portion, two independent anal and genital orificius and, in the ventral area, the tocostoma, or cleft, where the eggs are deposited. Finally we analyze the bucal organs, the Pedipulpos, the morphology and disposition of the hipostoma and the queliceros.


Salivary bypass tube.

Salivary bypass tube. A silicone salivary bypass tube is introduced as an adjuvant to the therapy of the following clinical entities: advanced carcinoma of the pharynx complicated by stricture and/or pharyngocutaneous fistula, traumatic stricture of the cervical esophagus or tracheoesophageal fistula, a stricture of the hypopharynx or cervical esophagus following ingestion of a caustic material, and a stricture of the cervical esophagus following laryngoesophagectomy. The salivary bypass tube is described and illustrated in detail along with the technique for its insertion and removal. Examples of its usage are illustrated by x-rays.


[Systematized papulosis of the lower scapular areas with ultrastructural anhist bodies: specific cutaneous symptoms of Hunter's disease (author's transl)]. Papulosis of the scapular areas is a characteristic dermatologic sign of Hunter's disease. It has not been described in the other mucopolysaccharidoses. This sign had been detailed by Hunter in 1917 in his princeps observation. We noted it in two cases of the disease. The ultrastructural study showed an accumulation in the connective interstitial substance of anhist bodies of intra-cellular origin.


Cochlear and vestibular lesions in capsular otosclerosis as seen in microdissection. In 24 temporal bones from patients with otosclerosis prepared by the method of microdissection and surface preparations, otosclerotic foci could be clearly seen during removal of the otic capsule. The state of activity of each focus was estimated on the basis of its consistency and vascularity. Small anterior foci constituted the most common form of involvement of the otic capsule. All were judged to be inactive, and none of them appeared to have caused obvious sensorineural degeneration. No cases of "pure cochlear otosclerosis" were seen. Sensorineural degeneration was associated with large anterior foci which reached the upper basal turn. One specimen displayed a circumscribed sensorineural degeneration in the upper basal turn, with an almost exact correspondence between the location and extent of the cochlear lesion and the site of invasion by the otosclerotic process in the bone and endosteum bordering on scala media and scala tympani. It is postulated that a toxic factor had diffused from the focus and acted directly on the organ of Corti. When multiple foci were present they were usually poorly defined. The otosclerotic process involved the round window, with new lamellar bone formation in the scala tympant of the lower half of the basal turn. The most extensive sensorineural degeneration in the entire material was seen in this group. One specimen also had severe cochlear hydrops. In three specimens large shunts were observed to connect the otosclerotic foci with the cochlear vasculature, which was severely dilated. Where otosclerosis involved the endosteum of the scala tympani, loss of vessels was observed. One specimum with extensive active capsular otosclerosis had severe sensorineural degeneration of the vestibular system. Vestibular pathology in fenestrated ears is also described. In a specimen from a patient with no caloric reaction, numerous hair cells were present in the macular organs.