Cytotoxic immune response of meningioma patients towards allogeneic and autologous tumour cells before and after surgery. Cell-mediated cytotoxicity (CTX) of meningioma patients towards meningioma cells and fibroblasts was studied in vitro before and after surgery, using the 3H-proline microcytotoxicity test. When incubated with allogeneic target cells before surgery, lymphocytes from three out of seven donors showed a specific destruction of meningioma tissue, and two were cytotoxic on both types of targets. Five patients were tested against their own tumour and against skin fibroblasts; this was feasible by keeping their lymphocytes frozen in liquid nitrogen until their target cells grew as suitable monolayers in vitro. Three patients showed a specific cytotoxic response. After excision of the tumour a gradual loss of this reactivity was observed in both allogeneic and autologous systems. Sera of three patients, whose lymphocytes were not reactive against their own tumour, induced antibody-dependent cellular cytotoxicity (ADCC) towards autologous tumours if normal effector cells were used. This type of response was detectable mainly in postoperative sera, and could not be elicited in autologous lymphocytes. On the contrary, autologous sera inhibited CTX of meningioma effector cells. The data suggest that meningiomas can induce a complex immunological response in the host, which is dependent on the presence or absence of a large tumour burden.


A new gearing approximator for microsurgical vascular anastomoses. A new gearing approximator for microsurgical vascular anastomoses is described. A highly precise and smoothly working robust gearing in connection with an asymmetrically notched key allows quick application of the approximator and an exactly adjustable interclip distance. By means of a combined handling and gearing screw and exchangeable 30 degrees-angled clips the instrument can easily be applied in narrow operating fields, and it can be handled under vision through the operating microscope without change in magnification adjustment. A quickly increasing platelt aggregation at the suture line and an early "slow flow" can be achieved by gradual opening of the clips. The ease of approximator application may contribute to shortening operation times.


Cerebral arteriovenous malformations; results of microsurgical management. A series of 63 patients with cerebral arteriovenous malformation (AVM) operated on during an eight-year period is presented. Indications for surgery and the timing of operation are discussed. Monitoring of epidural pressure was of help in assessing the intracranial pressure state, which is important in patient management in the acute stage, in timing of surgery, and in postoperative supervision. The operative mortality was one patient (1.6%). Two patients died due to incomplete resection and late rebleeding two years after operation. Among the others the overall result of surgery was good with respect to neurological deficit and working capacity.


The prognosis of intracranial saccular aneurysms when the surgeon refused surgery. Despite our basic policy of performing intracranial definitive surgery whenever possible in cases of intracranial saccular aneurysms, we have had 80 patients with non-radically treated aneurysms. This investigation is based on an analysis of the prognosis in 54 cases where we refused definitive surgery; it provides insight into the factors and circumstances leading to the use of treatment of secondary choice, conservative rather than definitive treatment.


Scanning electron microscopy of the subarachnoid macrophages after subarachnoid haemorrhage, and their possible role in the formation of subarachnoid fibrosis. Sixty dogs with experimental subarachnoid haemorrhage (SAH), repeated SAH, and subarachnoid fibrosis (examined three weeks and three months after SAH, and treated with urokinase or dexamethasone) were examined by scanning electron microscope (SEM). The authors observed the resting and activated macrophages, the erythrophagocytosis, and giant cells in the subarachnoid space after SAH. They consider that the macrophages play an important role in the formation of subarachnoid fibrosis, similar to the role of macrophages in fibrosis in other sites.


Vasoconstriction of external carotid arteries after rupture of intracranial aneurysms. Vasoconstriction of the external carotid arteries, which has not been previously reported, was investigated angiographically in 23 patients who had intracranial vasospasm after aneurysm rupture. In about 50% of these patients vasoconstrictive change in the external carotid arteries was also found. These changes were not seen in control cases without intracranial vasospasm. Pathogenesis of the vasoconstriction of the external carotid arteries was discussed with particular emphasis on the relationship with sympathetic nerves.


Treatment of experimental brain oedema following sudden decompression, surgical wound, and cold lesion with vasoprotective drugs and the proteinase inhibitor "Trasylol". The study was performed on 81 cats with three models of experimental brain oedema: sudden decompression, surgical wound, and cold injury. During the experiments blood pressure, central venous pressure, and intracranial pressure were recorded. The blood-brain-barrier was tested with Evans blue solution. The gray and white matter tissue was sampled at the end of the experiment, and the water content and sodium and potassium concentrations were determined. The animals with the same experimental model were divided into three groups: untreated, treated with the vasoprotective agents, and treated with the protease inhibitor Trasylol. In the sudden decompression model after balloon deflation, white matter haemorrhages and oedema development were found in gray matter and basal nuclei. In animals treated with the vasoprotective drugs, haemorrhages were not observed, and oedematous changes were less pronounced. The Trasylol effect on oedema development was not significant in this model. In the surgical wound model, oedematous changes were observed after 24 hours following the lesion. Oedema occurred in the white matter, as in the animals with cold lesions. In both models--surgical wound and cold lesion--the beneficial effect of Trasylol was shown, while the effect of Aescorin was less evident. The results obtained seemed to testify to the usefulness of both Trasylol and vasoprotective drugs in the prevention and treatment of brain oedema in neurosurgical patients.


Sodium nitroprusside (NPS) stimulates the lactate formation and causes intracellular electrolyte shifts in brain slices. Nitroprusside sodium (NPS) was added to slices from grey and white rabbit brain matter. The respiration, consumption of glucose, formation of lactate and pyruvate, water content, size of the extracellular space, and total and intracellular sodium and potassium concentrations were determined and calculated. 0.5 and 1 mM NPS stimulated the glycolytic glucose breakdown, and inhibited the respiration of grey and white slices. The respiration of white matter slices was stimulated by 0.05 and 0.01 mM NPS. The total and intracellular potassium concentrations in slices from grey and white matter were lowered markedly by 1 mM NPS. The total and the intracellular sodium concentrations in grey brain matter slices became higher in the presence of 1 mM NPS. A warning is given against uncritical clinical use of higher concentrations of NPS.


A teratoma of the third ventricle of the brain. A report is presented here of the total extirpation of a teratoma located in the third ventricle of a boy of eight. Since the tumour was made up of mature tissues (adult teratoma), its extirpation may be regarded as a cure. Although there are a few exceptions to the rule, other tumours located in the third ventricle of brain are mostly malignant, and they penetrate the tissues which constitute the wall of the third ventricle. For that reason the effects of a radical operation are doubtful. The adult teratoma is an exception. A tumour of this kind should be extirpated as a whole and removed from the third ventricle of brain.


School rebellion: a research note.

School rebellion: a research note. Pathanalysis is applied to survey data bearing on Arthur Stinchcombe's model of student rebellion. The linear causal model hypothesizes that school rebellion is due directly to expressive alienation and indirectly to strain in three systems: poor articulation regarding status allocation, claims to cultural symbols of adult rights, and unrealizable internal standards. Support for the model is not obtained. An alternate model is tested and verified in which political efficacy is an important antecedent of school disruption. The major implication is that school rebellion is not a response to the school experience itself. Other findings are presented concerning the scalability of school disruption items, the nature of expressive alienation and its components, and the impact of sex, race, and neighborhood on school rebellion.


The transmission and acquisition of values in the residential treatment of emotionally disturbed adolescents. A discussion about (1) the role of values in adolescent development and (2) the various value pathologies found in adolescents in residential treatment was presented. A descriptive study of the transmission and acquisition of three values described how values are not only transmitted by unvarying routines, decrees, traditions, and unspoken codes, but are also conveyed by certain child-care practices. The consistency and quality of these practices were found to be a significant factor for the three values studied.


A group behavior modification approach to adolescent obesity. This article describes a group weight control project with severely obese adolescent girls in a medical setting. Behavior modification and nutritional principles were utilized with peer group interaction. Significant others were included through separate group meetings. This approach produced small amounts of net weight loss for the girls. The drop-outs continued to have a net gain. As a treatment method, this program was more effective for these girls than previous individual clinic contacts had been. When losing weight, the girls tended to use behavior modification techniques more often, and their diets became more adequate nutritionally. Development of group cohesion was tenuous and temporary. Girls who were functioning more independently appeared to do better in weight loss. Disinterested significant others were preferable to nonsupportive ones. A predictive factor was identified, the girls' perception of control. This was measured by the I-E test. Those with a more internalized perception of control were more likely to continue with the program and more likely to lose weight. Because the patient group was small, findings are tentative. However, this program helped to define particular areas that deserve further exploration.


Implications of developmental theories for counseling adolescents in groups. This paper presents a rationale for the use of group techniques in counseling adolescents, based on selected developmental theories. In addition, it delineates specific practical implications and guidelines for group counselors to consider. Specifically, group selection, group size and composition, and topical content are discussed as they relate to developmental issues during adolescence.


A behavioral continuum synthesizing Neutralization Theory, situational ethics and juvenile delinquency. This paper develops some ideas in Matza's Neutralization theory into a continuum containing four categories ranging from extreme goodness to rebellion. We labeled these categories as Moral Absolute, Situational Ethic, Neutralization, and Rebellious Absolute. We discuss the percentages expected in each category and hypothesize that involvement in delinquency will increase progressively across these four categories. The rationale behind this hypothesis is that youth in the United States are viewed as being socialized to accept absolute norms but also to allow exceptions to these norms for particular situations, and that delinquent youth extend these exceptions to zones wider than are tolerated by law officers and wider than are generally accepted. A modified version of the Nye-Short self-reported delinquency scale and measures of normative oreintation which we constructed were used in a mail-out questionnaire to public school students (N = 351). We view our findings as being basically consistent with these expectations.


A behaviorally-oriented activities therapy for program for adolescents. A behaviorally-oriented activities therapy program was designed and implemented with adolescents who manifested problems in school, at home, and with peers. Baseline measures for target behaviors were taken within the activities therapy program and, after a behavioral analysis, specific techniques were chosen to remediate problems. Techniques employed included: contingency contracting, assertiveness training, relaxation training, and cognitive restructuring. Evaluation of the effectiveness of each program was performed through daily measurement of the frequency of the occurrence of the target behaviors. Three case studies are presented which are illustrative of the range of programs which can be successfully implemented with this population.


Bipolar depression (manic-depressive disease) in early adolescence. Bipolar Depression is rare in early adolescence. Since only rare cases were described in the literature, every case is important. In this article we described three cases of Bipolar Depression who were hospitalized in our Adolescent Unit during the past three years. All of them started at age 13--14. It is important to diagnose this illness in order to administer the required treatment in the acute phase and preventive treatment afterwards. Our experience indicates that treatment for early adolescents is identical with treatment for adults and calls for the same dosage.


Dextran-induced lowering of parameters of the kallikrein-kinin system in rat plasma. Pretreatment of rats with tranexamic acid inhibited the rapid lowering of the plasma levels of acetone/kaolin-activated prekallikrein proactivator and prekallikrein caused by intravenous injection of dextran, but did not inhibit the reduction in the level of plasminogen, and potentiated the lowering of high molecular weight kininogen. By acetone/kaolin activation of normal rat plasma a mixture of surface-bound factor XIIa and unbound XIIf was obtained, and a BAEe-esterase (MW about 47,000) possessing weak kininogenase activity was present in addition to kallikrein. In activated plasma from dextran-treated rats the cleavage of XIIa was strongly reduced, and the second esterase was almost absent. It is suggested that dextran induces the loss of a plasma factor which is important for the cleavage of factor XIIa in the adopted procedure. This factor was not high molecular weight kininogen, and the lowering of plasminogen was too small to account for the reduction in PKA-activity.


Substrate modulation as a control mechanism in the activation of plasma multienzyme systems. Since plasma is a homogenous fluid its biochemical systems need special control mechanisms to prevent their unlimited and continuous activity. In general, enzymic activity is not preformed but generated by trigger processes. Activation is then enhanced by cascade reactions. It can be controlled by enzyme inhibitors, by enzymes which destroy co-factors, or by spontaneous decay or enzyme complexes involved in the system. In addition, in some reactions of the complement and Hageman factor-dependent systems the necessity of substrate modulation controls the extent of activation. Thus, factor B of the properdin system is activatable by factor D only when bound to the activated third component of complement, and C3b fragment; similarly C2 is activated and forms the C3 converting complex, C42, only when bound to C4b prior to its cleavage by C1; C5 can be activated by either of the two convertases only when bound to surface-fixed C3b; and the mutural activation of Hageman factor and pre-kallikrein on surfaces proceeds efficiently only when HMW-kininogen is present which complexes with pre-kallikrein and possibly with Hageman factor.


Activation of human Hageman factor by a leukocytic protease. We earlier reported the IgE-mediated release of a basophil kallikrein of anaphylaxis (BK-A) which, like plasma kallikrein, is an arginine esterase and cleaves human plasma kininogen generating immunoreactive kinin. We herein report that, like plasma kallikrein, preparations rich in this basophil protease also activate human Hageman Factor by proteolytic cleavage of the zymogen molecule into light and heavy chains. These fragments of 28,000 and 52,000 daltons are similar in size to those produced during activation of Hageman Factor by plasma kallikrein. Exposure of Hageman Factor (bound to a negatively charged surface) to BK-A led to the proteolytic cleavage of Hageman Factor producing a 28,000 molecular weight fragment (HFa) which is functionally active and capable of activating prekallikrein to kallikrein. We conclude that, during anaphylaxis, basophils may release a protease that is capable of cleaving and activating Hageman Factor, thus providing a mechanism for initiating the in vivo activation of the Hageman Factor dependent systems.


Contact activation of plasma: structure-activity relationships of human high molecular weight kininogen. Human high MW kininogen can be isolated as a single polypeptide chain of 110,000 MW. Purified human plasma kallikrein cleaves this molecule to give a disulfide-linked, two chain molecule, free of kinin, that retains full clotting activity. Following reduction and carboxymethylation of the two chain molecule, a light chain can be isolated that quantitatively retains the full coagulant activity of the native molecule. During contact activation in normal human plasma a rapid cleavage of high MW kininogen along with kinin liberation occurs in a reaction that is dependent upon the presence of prekallikrein and Factor XII (Hageman factor).


The significant reduction of high molecular weight-kininogen in synovial fluid of patients with active rheumatoid arthritis. It has been proposed that kinin system was implicated in inflammatory joint diseases such as rheumatoid arthritis. Our present work provides further support on the involvement of the kinin system. In osteoarthritis patients, the total, high molecular weight (HMW)-, and low molecular weight (LMW)-kininogen levels in synovial fluid were not different from those in plasma. On the contrary, in rheumatoid patients, HMW-kininogen level in synovial fluid was significantly lower than that in plasma, whereas LMW-kininogen level in synovial fluid was not different from that in plasma. The reduction of HMW-kininogen level in synovial fluid was much more marked in active cases of those who showed high blood sedimentation rate and high C-reactive protein value. Furthermore, the reduction was closely related to the clinical severity. In active rheumatoid patients, HMW-kininogen level was further reduced in the synovial fluid after withdrawal of indomethacin.


The kinin-forming acid protease system in murine fibroblasts L-929. Components of an acid protease kinin-forming enzyme system were isolated and purified from the murine fibroblast L-929 cell line grown in stationary cell culture. The enzyme, was purified from the 10,000 g supernatant cell fraction by sequential passage through G-200 Sephadex, hydroxylapatite, DEAE-A50 Sephadex and affinity chromatography columns. The specific activity was determined on a rat plasma kininogen purified on DEAE and G-100 Sephadex columns as assayed for kinin-forming activity on the isolated perfused rat uterus. Both enzyme and substrate showed a single band pattern by disc gel electrophoresis technique. Optimum protease activity was obtained at pH 3.8, and kinin release was both time- and enzyme-dependent at 37 degrees. The molecular weight of the protease and kininogen, estimated on a G-200 Sephadex column, was 39,000 and 115,000 respectively. Two fibroblast kinins were isolated from a mixture of 12,000 g fraction of fibroblast homogenate and rat plasma incubated at 37 degrees, pH 4.0 for 92 hours. The two fibroblast kinins (I, II) were separated and purified on G-25 Sephadex, CM-C50 Sephadex, and Biogel P-4 columns. The purity of the kinins was ascertained by thin layer chromatography. The molecular weight of fibroblast kinin I was estimated to be 1450 with a 14-amino acid composition consisting of AspThrSerProGluGlyAlaVal-LeuTyrPheLysHisArg. Fibroblast kinin II had an estimated molecular weight of 1000 with a 12-amino acid composition that included AspSerProGluGlyAlaLeuTyrLysHisArg. The kinins were relatively rich in arginine and did not contain the bradykinin sequence.


Basophil kallikrein of anaphylaxis (BK-A)--purification and characterization. These studies describe the IgE-mediated release of a basophil kallikrein of anaphylaxis (BK-A) that has arginine esterase activity and is inhibited by plasma, DFP, and Trasylol. The interaction of BK-A active fractions from ion exchange (DEAE-Sephacel) and gel filtration (Sepharose 6B) chromatography, with human plasma kininogen generates immunoreactive kinin. The BK-A and kinin-generating activities co-chromatograph on DEAE-Sephacel and Sepharose 6B columns, and the quantity of kinin generated is, in general, proportional to the BK-A activity of the column fractions, suggesting that these two activities are subserved by the same protease. These data suggest that kallikrein-like activity can be generated from human basophils as a direct result of a primary IgE-mediated immune reaction, thus providing a potential link between reactions of immediate hypersensitivity and the plasma and/or tissue kinin-generating systems.


Effect of pancreatic kallikrein, sperm acrosin and high molecular weight (HMW) kininogen on cervical mucus penetration ability of seminal plasma-free human spermatozoa. Bradykinin is able to stimulate sperm migration of SPFS; HMW kininogen does not effect sperm migration of SPFS; Kallikrein and acrosin induce small stimulation of sperm migration of SPFS indicating traces of kininogen attached to the sperm surface enabling liberation of kinins; In the presence of kininogen, kallikrein and acrosin significantly improve cervical mucus penetration of SPFS; Lastly, from the presented studies there is experimental evidence that acrosin is involved in stimulation of sperm migration within the female genital tract due to liberation of kinins from kininogen (see Figure 7.).


Recent advances in microbial secondary metabolites: inhibitors of hydrolytic enzymes. We initiated the study of small molecular enzyme inhibitors produced by microorganisms and found about 50 new compounds. In this paper, the author reviewed our studies on inhibitors of various proteases and enzymes on the surface of animal cells. Small molecular inhibitors of cellular surface enzymes enhanced or suppressed immune response. Studies on kinin and its related areas are rapidly progressing as shown by papers presented in this symposium. Parallel to the progress in these areas, it will become possible to establish new screening methods and to find new compounds useful in the study of kinin and its related systems.


Molecular mechanisms of surface-dependent activation of Hageman factor (Factor XII). Based on studies using 3H-DFP as an active site titrant, it is suggested that surface binding in itself does not result in the formation of new active sites in the Hageman factor molecule. Moreover, it was found that surface-binding of human and bovine Hageman factor renders these molecules 100 to 1000 times more susceptible to proteolytic activation by kallikrein, plasmin, or other proteases. Initiation of contact activation may involve proteolytic activation of surface-bound Hageman factor by a number of different proteases. Both Hageman factor and prekallikrein react with DFP like weakly active zymogens. Initiation of contact activation may also involve the expression of low intrinsic catalytic activity of these zymogens.


Changes in blood level of kininogen, prostaglandin E and hemodynamics during experimental acute myocardial ischemia with and without FOY-007. Changes in kininogen, prostaglandin E and hemodynamics were studied during 2 hours after left anterior descending artery ligation in 19 anesthetized dogs with and without FOY-007, an inhibitor of kinin forming enzyme. Significant decrease in kininogen in aorta and great cardiac vein (aorta greater than great cardiac vein) and increase in prostaglandin E in great cardiac vein were observed after ligation, indicating release of kinin and prostaglandin E from ischemic area. Both kininogen and prostaglandin E changes were inhibited by FOY-007 but further decrease in cardiac output and increase in systemic vascular resistance were observed. In summary, myocardial release of both kinin and prostaglandin E was inhibited by FOY-007, with increase of afterload of the heart.


Partial purification of prorenin and activation by kallikreins: a possible new link between renin and kallikrein systems. With the objective of identifying prorenin and its physiological activation mechanism, human plasma prorenin was completely separated from active renin for the first time. It was shown that prorenin has no activity whereas active renin has no potential for further activation. Urinary kallikreins were found to activate prorenin fractions freed from kallikrein inhibitors by affinity chromatography and treatment at pH 3.3. Human plasma kallikrein also exhibited weak activation.


Renal kallikrein-kinin system and prostaglandin in hypertension: their relation to renin-angiotensin-aldosterone system. The present study was done to investigate the interrelationships between renal kallikrein-kinin, renal prostaglandin E and renin-angiotensin-aldosterone systems in normal subjects and in essential hypertension by means of measuring urinary excretion of kallikrein and prostaglandin E, plasma renin activity and plasma aldosterone concentration before and after stimulation or inhibition of the renin-angiotensin-aldosterone system and inhibition of renal prostaglandin E generation. Urinary kallikrein excretion was increased after the stimulation of the renin-angiotensin-aldosterone system by low Na diet or the administration of furosemide and upright posture, while it decreased after the inhibition of the action of aldosterone by spironolactone. These data show that the change in urinary kallikrein excretion was related to that in the renin-angiotensin-aldosterone system following various stimuli, suggesting that renal kallikrein-kinin system may regulate blood pressure by opposing the action of the renin-angiotensin-aldosterone system. Urinary PGE excretion was decreased after sodium depletion and increased after the administration of furosemide in spite of the augmentation of the renin-angiotensin-aldosterone system. The change in urinary PGE excretion was closely related to that in urinary Na output after various stimuli, and a significant positive correlation was found between basal levels of urinary PGE and those of urinary Na, suggesting that renal prostaglandin E may be involved in the regulation of blood pressure by affecting renal sodium handling. The present data show that basal level of urinary excretion of PGE and kallikrein was lower in essential hypertension than in normal subjects and that the release of renal kallikrein and PGE after the furosemide administration was also suppressed in patients with essential hypertension compared with that in normal subjects, suggesting that there exists, in this disease, an impaired defense mechanism against the renin-angiotensin-aldosterone system resulting in sodium retention.


A clinical study on urinary kallikrein in patients with renal diseases. The urinary kallikrein activity (KA) was measured to investigate its significance in the renal diseases by using tosyl-arginine methyl ester (TAME) as a substrate. The examinees were 94 patients with renal diseases and 25 normal persons. The daily urinary kallikrein excretion (KE, KE=KAxdaily urinary volume) is less in chronic glomerulonephritis and outstandingly less in chronic renal failure than in the normal controls. The KE also shows a positive correlation moderately to 15-min PSP excretion and relatively to creatinine clearance. KE is closely related to renal function and decreases with the degree of renal damage. KA has no relation to the concentration of urine protein, but it was parallel, in general, to the urokinase activity. In nephrotic syndrome, KA tends to show a negative correlation to the urinary alpha 1-antitrypsin. alpha 1-antitrypsin may have a function as an inhibitor to the urinary kallikrein.


Blood kinin system in renal hypertensive patients administered with SQ 20881. The i.v. administration of 0.25 mg/kg SQ 20881 to eight renal hypertensive patients caused blood pressure fall and in five of them also reduced heart rate. The latter was attributed to increase in vagal tone. Peripheral and renal blood samples taken at the nadir of the hypotensive response showed considerable inhibition of plasma kininase activity, rise in free kinin level and reduced kininogen content. This reduction was not due to increased consumption as shown by in vitro experiments. PGE2 and PGF2 alpha levels in kidney blood of three patients remained practically unchanged. Plasma renin activity was augmented to a larger extent in blood of kidney with stenotic artery than in the one with patent vessel. It is concluded that the action of SQ 20881 on human blood kinin system, besides inhibition of kininase, involves also reduction of kininogen, the mechanism of which remains to be clarified.


Interactions among Hageman factor (HG, Factor XII), plasma thromboplastin antecedent (PTA, Factor XI), plasma prekallikrein (PK, Fletcher factor) and high molecular weight kininogen (HMW-K, Fitzgerald factor) in blood coagulation. Studies of plasmas from individuals with Hageman trait (factor XII deficiency), plasma thromboplastin antecedent (PTA, factor XI) deficiency, Fletcher trait (plasma prekallikrein deficiency) and Fitzgerald trait (high molecular weight-kininogen deficiency) have revealed the importance of these proteins in blood coagulation. The interactions among them, however, are not fully elucidated. We have studied these reactions by two different approaches. (1) In a purified system, high molecular weight kininogen was absolutely required for activation of PTA by HF and ellagic acid (EA). The yield of activated PTA was proportional to the amount of HF, HMW-K, and PTA in the mixtures, suggesting that these three proteins may form a complex in the presence of EA. (2) In experiments with whole plasma, we took advantage of the adsorption of EA to Sephadex gels. When normal plasma or plasma deficient in HF, PK, HMW-K or PTA was exposed to Sephadex-EA and was separated by centrifugation, each supernatant plasma except that deficient in HF shortened the prolonged partial thromboplastin time (PTT) of HF-deficient plasma. Plasma simultaneously depleted of HMW-K, PK and PTA also shortened the PTT of HF-deficient plasma and of plasma depleted of HF and PK, but had virtually no procoagulant effect upon the PTT of plasma depleted of HF and MHW-K. Thus, exposure of HF in plasma to Sephadex-EA appeared to generate a clot-promoting form of HF in the absence of other clotting factors, but its expression required the presence of HMW-K.


Variation of urinary kallikrein excretion during pregnancy and the effects of hypertension. In normal pregnant women the excretion of urinary kallikrein diminishes between the second and the third trimester and such reduction is maintained during the first ten days of puerperium. A comparison between normal women and those suffering from hypertension during the first, second and third trimester of pregnancy shows that, except for the first trimester, there exists a significant net reduction of enzyme excretion in the hypertensive cases. Dividing the patients according to the type of hypertension, it reveals that this phenomenon is unaltered for subjects having essential hypertension, while those affected by secondary hypertension or gestosis do not show any statistically significant variation in enzyme excretion from normal subjects.


Altered urinary excretion of human kininase activity in hypertension. This study describes the levels of urinary kininase activity in hypertension. Urinary kininase activity in essential and secondary hypertensive patients was higher than in controls (1010.2 +/- 102.7 versus 114.4 +/- 23.1 ng destroyed bradykinin/min.; p less than 0.001). In a group of hypertensive diabetics without nephropathy kininase activity in urine was decreased (46.0 +/- 12.7 ng destroyed bradykinin/min.). This investigation shows that in hypertension urinary kininase activity reaches higher levels. An inverse correlation was found between urinary kallikrein and urinary kininase activity from essential hypertensive patients.


The specificity of potentiating effect of glutathione on the actions of bradykinin. Potentiating effects of GSH, a physiologic kininase inhibitor on the bradykinin actions on (a) blood pressure responses of rabbits, (b) acute inflammatory response in rat's hind paws and (c) the isolated guinea-pig ileum contractions were examined among the combinations between various active agents and thiols. The potentiation of the hypotensive response to bradykinin by GSH was highly specific compared with the other experimental models (B and C). Throughout these three experiments, specific relation between GSH and bradykinin was consistently observed.


Homologous insemination with the addition of pancreatic kallikrein. Hog pancreatic kallikrein does improve sperm motility and sperm migration in vitro. Kallikrein can be used for artificial insemination to improve cervical mucus sperm penetration ability of spermatozoa with reduced motility. Homologous insemination in 52 couples during a period of one year yields a conception rate of 38.5%. Insemination with kallikrein showed no side effects. Abortion rate with 15% was within the normal range. All delivered babies were healthy and showed no abnormalities.


Inhibition of the contractile action of bradykinin on isolated smooth muscle preparations by derivatives of low molecular weight peptides. The carbonyl terminal tripeptide sequence of bradykinin (Pro-Phe-Arg) is molecularly manipulated to obtain agents with potent antagonistic activity towards the smooth muscle contractile activity of bradykinin. Screening of various peptide derivatives revealed that heptyl amides or esters of H-D-Pro-Phe-Arg, and H-D-Phe-Phe-Arg possessed relatively stronger antibradykinin activity on the isolated smooth muscle preparation. The parent tripeptides, H-D-Pro-Phe-Arg-OH, and H-D-Phe-Phe-Arg-OH, and their amino acid components, i.e. D-Proline, D-Phenylalanine, L-Phenylalanine and Arginine, did not possess any antibradykinin activity in concentrations of up to 10(-4) M. When the heptyl derivatives of these peptides were incubated with either heparinized or citrated whole blood or plasma, the antibradykinin activity was not lost. Incubation of these peptide derivatives with either carboxypeptidase A or B did not result in any loss of the pharmacological effect. However, pancreatic protease extract produced a significant loss of the anti-oxytocic action on the isolated rat uterus preparation. H-D-Pro-Phe-Arg-NH-lauryl derivative also blocked the action of bradykinin and this effect sustained for a longer period of time comparative to the blockade with H-D-Pro-Phe-Arg-NH-heptyl derivative. In concentrations of 10(-7) M and 10(-8) M and 1 min incubation, which blocked the contractile action of bradykinin (1 nmole) on the isolated guinea pig ileum, these peptide derivatives did not block the action of acetylcholine, histamine, and serotonin. However, in concentrations of about 10(-6) M and higher with 5 min. incubation histamin is also blocked. On the isolated rat uterus preparation the contractile action of acetylcholine, angiotensin, oxytocin and vasopressin was blocked at concentrations of 10(-6) M. These findings warrant a differential pharmacological evaluation and in vivo testing of these peptide derivatives to investigate their therapeutic potential.


Fujiwara trait: the first case of kininogen deficiency in Japan. Asymptomatic identical twins were found to show the prolonged activated partial thromboplastin time, which was corrected by addition of normal, Hageman factor deficient or Fletcher trait plasma but not corrected by Fitzgerald or Williams plasma. The prolonged activated partial thromboplastin time was also corrected by addition of highly purified bovine high molecular weight kininogen but not by low molecular weight kininogen. When total kininogen was measured as the amount of bradykinin released by trypsin on acid treated plasma, only trace amount was detected in Fujiwara and Williams plasmas, although Fitzgerald plasma showed approximately 50% of the total kininogen of normal plasma level. Acetone-kaolin activated amidase activity of plasma kallikrein was not generated by Fujiwara plasma. Substitution with normal plasma in various ratios showed plasma kallikrein activity proportionally to the normal plasma contents. Extrapolation with the values at 120 min after activation gave the prekallikrein content of Fujiwara plasma as 30% of the normal value.


Autoradiographic studies on the cellular localization of GABA and beta-alanine uptake by neurones and glia in tissue culture. Nervous tissue cultures have proved to be an excellent tool for investigating the cellular localization of the uptake of transmitter substances using autoradiography. The uptake of [3H]GABA and [3H]beta-alanine was studied in cultures of cerebellum, brain stem, spinal cord and dorsal root ganglia (DRG) of the rat. In cultures of brain stem and spinal cord, [3H]GABA was taken up by a great number of neurones and by almost all glial cells, suggesting that glial elements might also be involved in the inactivation of this amino acid. In cerebellar cultures, [3H]GABA was accumulated by many interneurones, by Purkinje cells and by a great number of glial cells. The finding that cultured Purkinje cells accumulated [3H]GABA contrasts with observations made in the cerebellum in vivo or in slices where no labelling of Purkinje cells could be demonstrated. Since GABA is taken up to a great extent by Bergman glia which tightly surround Purkinje cells in vivo, it has been suggested that the barrier formed by these glial cells prevents the uptake of the amino acid into Purkinje cells. In cultured cerebellum this glial barrier might be disrupted or absent and therefore Purkinje cells are able to accumulate [3H]GABA. A similar glial barrier preventing the uptake of [3H]GABA might also exist in DRG, where neurones that were completely surrounded by satellite glial cells did not take up the amino acid, whereas isolated neurones that were deprived of their glial envelopments became intensely labelled. After incubation with [3H]beta-alanine, it was observed that only glial cells were labelled in cerebellar and DRG cultures, whereas in spinal cord and brain stem both neurones and glial cells took up the amino acid providing further evidence that beta-alanine might act as a transmitter substance in these two regions.


Peripheral sensory stimulation and the release of transmitter amino acids in vivo from specific regions of cerebral cortex. The effects of sensory stimulation on the release of amino acids from sensori-motor and visual cortices have been studied using a superfusion technique. Electrical stimulation of the brachial plexus contra-lateral to the superfusion cannula increased significantly the release of glutamate and glutamine from the sensori-motor cortex of anesthetized rats. No clear effect was observed with the other amino acids. Stimulation of the ipsi-lateral plexus had no effect on glutamate and glutamine release. In unanesthetized animals, stimulation of the contra-lateral brachial plexus raised the levels of all the amino acids in sensori-motor cortex superfusate. Weak photic stimulation of the eyes of dark-adapted rats increased glutamate release from the visual cortex but caused no significant change in the release of other amino acids. All evoked increases in amino acid release were reversible at the cessation of the stimuli.


Pre- and post-synaptic inhibition.

Pre- and post-synaptic inhibition. We now know a great deal about central inhibitory mechanisms: how they are organized in various neuronal circuits ("feed-forward" and "feed-back" inhibitions, inhibition of inhibitory cells giving "disinhibition" which releases neuronal activity in a finely graded and particularly safe manner); how they exercise a preponderant control over much of central neurl activity (9, 13, 14, 57); and of course, how inhibition operates at the cell membrane, by increasing Cl- permeability; this has a stabilizing action post-synaptically, but presynaptically, in afferent fibers, it depresses transmitter release from afferent terminals. In addition, there is some evidence that GABA transport may be electrogenic and therefore may significantly modulate membrane excitability, and that GABA may selectively depress Ca2+ influx in afferent terminals and thus inhibit transmitter release particularly effectively. However, it is by no means certain that we are fully aware of all the possible ways in which GABA affects neuronal excitability and synaptic transmission, and there may well be further exciting surprises in store.


Stoichiometry of GABA-receptor interactions: GABA modulates the glycine-receptor interaction allosterically in a vertebrate neuron. 1. Measurement of steady-state conductance changes provides a reliable method for determination of transmitter-receptor stoichiometry in general and for GABA and its receptor interactions in particular. Log-log plotting of steady-state conductance changes as a function of decreasing transmitter concentration gives the molecularity of the interaction as a limiting slope. 2. Suitable measurements of GABA action in locust muscle show a molecularity of 3 with strong positive cooperativity. One molecule of picrotoxin is sufficient to block this reaction. Kinetic studies reveal the presence of occult desensitization. Thermodynamic studies reveal strong negative heats of interaction compatible with conformational changes in a multi-subunit receptor. 3. Measurements in the lateral dendrite of the goldfish Mauthner cell reveal that glycine has a more powerful action than GABA. Both interactions, however, utilize 4 molecules of amino acid with strong positive cooperativity to activate its receptors. The receptors are apparently distinct and there appears to be a higher glycine-receptor density. 4. In addition to its action on its own receptor, GABA allosterically modulates the glycine-receptor interaction in the Mauthner cell by lowering the energy barrier for the binding of the first glycine molecule, thereby increasing the affinity of glycine for its receptor.


GABA binding processes in rat brain and liver. Although these studies have provided some further insight into GABA binding processes associated with transport and receptor-activation, such attempts remain limited due to the lack of specificity of the ligands used to displace these components. Thus, BMI appeared to interact with both transport and synaptic receptor sites for GABA. Perhaps certain GABA-agonists (e.g., muscimol, isoguvacine) will be shown to interact more specifically with synaptic GABA-receptors? So-called "specific" binding of GABA and its analogues, or antagonists might not be the issue to be kept in focus in this type of experiment, especially since it cannot be separated into presynaptic, postsynaptic and non-synaptic components. The specificity of an interaction of ligand with membrane site may be determined by other requirements of the particular system concerned. In any case, it seems essential to examine the binding sites, themselves, in order to define more clearly which of these are involved in receptor-activation and in uptake. An approach involving the isolation and purification of GABA-receptors should provide evidence for specific binding of GABA to its postsynaptic receptors.


Correlation of changes in the GABA-ergic system with the development of spasticity in paraplegic cats. Following spinal cord transection there occurred decreases in Km and Vmax of glutamate decarboxylase (GAD) both above and below the lesion, and an initial decrease in the concentration of GABA. Concomitantly, there was a gradual decrease in presynaptic inhibition. Eight to 12 weeks after spinal cord transection, Km and Vmax for GAD returned to control values, but the GABA content of the spinal cord below the lesion increased significantly and presynaptic inhibition became maximally depressed. These results suggested that during the chronic phase of spinal cord injury there is a decrease in release of GABA, the interneuronal inhibitory neurotransmitter which mediates presynaptic inhibition. Diazepam, a GABA enhancer, increased presynaptic inhibition in acute and chronic spinal cats, this being accompanied by a reduction in somatic muscular spasticity. The degree of this enhancement by diazepam, however, is attenuated with gradual loss of presynaptic inhibition. In the acute cat, a conditioning volley applied to cutaneous afferents blocked the inhibition of the monosynaptic response to extensor motoneurones. In contrast, in chronic spinal cats (eight to 12 weeks), the duration of complete blockade was markedly reduced and was followed by a prolonged period which cutaneous nerve stimulation potentiated the monosynaptic discharge. Similar to GABA, there also occurred an increase of substance P below the level of the lesion. Other neurotransmitters (e.g., norepinephrine, serotonin) accumulated above and disappeared below the transection level. Although somatic msucular spasticity appears to be, to some extent, due to GABA dysfunction in the spinal cord, alterations in "normal" functioning of other neurotransmitters and the loss of supraspinal control also contribute to this state.


Thinking about ageing: a critique of liberal social gerontology. The paper begins by comparing the modern view of ageing, which sees ageing as a social problem, with the ancient Stoic account of ageing, which sees ageing as a spiritual problem. This comparison allows us to see how modern gerontology has redefined ageing and has created a new context for its discussion. Through this comparison we find that gerontology today displays an affinity for scientific research methods and a liberal orientation to public policy and that on these two pillars, it rests its promise for creating a good old age. After analysing and providing a critique of gerontology's commitments, the paper concludes with a discussion of an alternative conception of good ageing and with a recommendation for the genesis of an alternative form of gerontology.


Screening for nutritional deficiencies in the elderly following gastric surgery. Following gastric resection a slightly reduced haemoglobin is common. The use of erythrocyte morphology as a screening test for deficient absorption of haematinics is unsatisfactory; false positive (42.8%) and false negative (41.6%) results are encountered too frequently to recommend its use. The elderly postgastrectomy patient with mild anaemia may have biochemical evidence of iron, folic acid, or vitamin B12 deficiency with normal erythrocyte morphology.


The prevalence of organic cerebral impairment and behavioural problems within local authority homes for the elderly. Ninety-six per cent of the residents occupying the 11 Local Authority Homes within the catchment area of one Scottish district psychiatric hospital were surveyed to estimate current levels of organic cerebral impairment and behavioural problems in the Homes. Clear evidence of dementia was shown by 27.1% of the residents but the actual prevalence of organic cerebral impairment could be as high as 66.4%. An excessively high level of socially disruptive behaviour was discovered. This study suggests that Local Authority Homes, with their present staffing levels, are having to cope with large numbers of dependent and behaviourally disturbed old people. Four possible solutions are outlined. Irrespective of what is adopted, it is essential that Health and Social Service developments are fully co-ordinated.


An outbreak of infection caused by trimethoprim-resistant coliform bacilli in a geriatric unit. An outbreak of infections, particularly of the urinary tract, caused by coliform bacilli resistant to trimethoprim, and originating in a geriatric unit, is described. The investigation of the outbreak and the analysis of factors predisposing to asymptomatic carriage of trimethoprim-resistant coliform bacilli enabled successful control measures to be initiated. The significance of geriatric units as sources of hospital infection is discussed. The importance of cooperation between geriatricians, infection control nurses and microbiologists is emphasized.


Problems associated with the development of a colony of aged mice for experimental purposes. Old animals are not commercially available in the U.K. The following problems associated with the supply of aged C57BL mice to an experimental group over a period of 12 years are discussed: the choice of animal, initial assumptions about management, and husbandry and its change with time. Finally, the recurrent problems which remain if valuable animals are to be kept disease-free yet available to experimentalists are listed.


Circadian rhythm in the elderly: a study using a cortisol-specific radio-immuno-assay. Plasma cortisol levels and diurnal variation have been examined in 30 elderly patients and compared with a control group of 29 middle-aged healthy subjects. The elderly patients had normal plasma cortisol levels which exhibited the diurnal variation seen in the younger age group. In spite of microscopic degenerative changes in the adrenals with age their secretory function and response to hypothalamic pituitary stimulation appear to remain normal.


A prospective study of fractured proximal femur: factors predisposing to survival. In a prospective study of patients with fractures of the proximal femur from a defined population it was found that age, mental test score, type of residence, place of injury and hospital of admission were all significantly associated with the likelihood of survival to six months. When these factors were taken into account no additional association between outcome and recorded associated disease, grade of surgeon operating, cigarette smoking, type of operation or social class was demonstrable. These findings have implications for the design of controlled trials of different types of treatment for fractures of the proximal femur.


Comparative metabolism of histamine in two Amphibia anura. The metabolism of histamine has been compared in Rana ridibunda and Discoglossus pictus, both Amphibia anura. An intralymphatic injection of 14C-histamine (5 microCi) was administered to the animals and the total radioactivity excreted in the urine was measured 24, 48, and 72 hours later. The metabolites excreted in the urine at 24 hours were analyzed by thin-layer chromatography and subsequent autoradiography. In both species approximately 60--70% of the injected dose was found in the urine by 72 hours. In Rana ridibunda two histamine metabolites were found: imidazoleacetic and methylimidazoleacetic acid. The present results suggest that the catabolism of histamine differs in the two species.


Protective role of ceruloplasmin in inflammation. Experimental inflammation in copper (Cu)-deficient rats is greater than that induced in controls eating normal diet. Cu-supplementation of the Cu-deficient diet results in a reduced swelling, down to normal levels. Injection of the naturally occurring acute phase reactant, ceruloplasmin (Cp) a Cu-bearing serum protein, also results in reduction of experimental inflammation. Since a rise in serum Cp occurs in normal pregnancy this protective anti-inflammatory action of Cp is proposed as an explanation for the widely-observed phenomenon of spontaneous control of rheumatoid arthritis in pregnancy.


A sensory-integrative approach to familial dysautonomia. Familial dysautonomia, a relatively rare hereditary condition, consists of a baffling array of nervous system malfunctions that seriously disturb the lives of the young victims and their families. Since several of the deficits can be identified as sensory-integrative and as such have been successfully treated in other contexts, it is suggested that sensory integration therapy may benefit these children. Results of a ten-month-old Isralei child appear to support this conjecture and suggest further exploration of the sensory integration approach in evaluation and treatment of dysautonomia and related conditions.


Identification and management of psychosocial and environmental problems of children with cancer. An occupational therapist working as a rehabilitation specialist on the hematology-oncology team for pediatric malignancy identified and sought solutions for problems encountered among 49 pediatric oncology patients and their families. The occupational therapist's role as "CARE (CAncer REhabilitation) counselor" involved working with the patient, family, and team members to meet needs and provide services other than direct medical treatment. A variety of environmental needs and psychosocial problems were identified and managed. Prospective interaction from the time of diagnosis, resulting in 63 percent solution of all problems, was more effective than intervention initiated at other stages of illness.


Nystagmus and ocular fixation difficulties in learning-disabled children. The visual fixation ability of learning-disabled children was evaluated after sensory integrative therapy had been administered for short or long periods of time. Children with hyporesponsive postrotary nystagmus displayed reduced oculomotor control skills, but the deficit was apparent only in those who had been in therapy for a shorter interval. These results present further support for the hypothesis that the learning disabled can be differentiated according to their nystagmus characteristics. In addition, very tentative evidence suggested that sensory integrative therapy may have been successful in ameliorating the fixation deficiency; however, further research into this possibility is needed. The data also indicate that oculomotor control dysfunction may be a mediating mechanism for at least part of the learning disabilities experienced by some learning-disabled children.


Therapy and function: an issue of professional direction. The author argues that occupational therapy is erring in its trends toward separating functional skills from overall well-being as therapeutic goals. Instead of only a means toward an end, task performance should be seen as a major factor, giving value to the life of either the disturbed or the healthy individual.


Myringotomy: a neglected office procedure. An office myringotomy is an easily performed, underused procedure which has definite clinical applications. The family physician should become familiar with the technique, its indications and its complications. Indications include otitis media with concomitant meningitis, with matoiditis or with cranial nerve involvement, and otitis media in an immunocompromised patient, in a neonate with signs of sepsis or in a very sick, toxic child. If the incision is made in the lower portion of the tympanic membrane, complications are rare.


Chancroid.

Chancroid. The mobility of our society may play an important part in  the epidemic proportions of sexually transmitter diseases in the United States. Chancroid, one of the major venereal diseases, is caused by Hemophilus ducreyi and can be recognized clinically. Because the morbidity of chancroid is related to delay in treatment, awareness of this disease is mandatory. Definitive laboratory proof can be obtained in only 50 percent of the cases. Sulfisoxazole is the drug of choice.


Reversible toxic psychosis.

Reversible toxic psychosis. Psychotropic medications may produce a toxic confusional state, especially in elderly patients. Tricylcic antidepressants particularly, and the phenothiazines to a lesser extent, may induce these behavioral changes by their anticholinergic activity. The situation may be compounded by the use of more than one psychotropic drug or the addition of an antihistamine or a belladonna alkaloid. Physostigmine can reverse the anticholinergic effects and clear the mental state.


Head and neck manifestations of SLE.

Head and neck manifestations of SLE. The records of 100 consecutive patients hospitalized with systemic lupus erythematosus were reviewed, and a 76 percent incidence of head and neck signs and symptoms was found. The findings of this study correlate with previous reports. Although no head and neck manifestations or combination of them is pathognomonic of the disease, the family physician should consider the diagnosis of systemic lupus erythematosus in young adults who present with otherwise unexplained and nonspecific head and neck findings.


Pneumoconiosis and fibrous glass.

Pneumoconiosis and fibrous glass. Reports have appeared in the public press suggesting that dust from fibrous glass may be responsible for causing a form of lung disease in workers similar to that produced by asbestos. These reports are attributed to information about a case of pneumoconiosis presented at a meeting held under the auspices of the National Cancer Institute on November 15, 1978. They have occasioned widespread concern among those who make and use fibrous glass. The purpose of this communication is to provide additional information which now shows that the case in question was almost certainly due to asbestos and not to exposure to fibrous glass.


Cyanide toxicity from the thermal degradation of rigid polyurethane foam. Thermal degradation products (tdp) from a model, rigid polyurethane foam were collected in such a manner as to eliminate carbon monoxide and other gases with low boiling points. The effects in rats resulting from intratracheal intubation (I.T.) of the tdp are discussed. Cyanide was found to be a major factor associated with severe toxic responses of the experimental rats.


A critical evaluation of the protection provided by common safety glasses from ultraviolet emissions in welding operations. The purpose of this investigation was to evaluate critically several brands of safety spectacle lens and side shield combinations to determine their attenuation characteristics for ultraviolet (UV) radiation. By combining the information developed in this investigation with field data on UV from arc welding operations, it was possible to draw the conclusion that under the conditions stated, ordinary safety glasses with solid side shields provided adequate eye protection from UV.


Inhalation toxicity studies with 1,3-butadiene -- 1. Atmosphere generation and control. 1,3-butadiene, which is used extensively in the synthetic rubber industry, is a highly reactive, potentially explosive compound, presenting particular problems for the design and execution of inhalation toxicity studies. Before undertaking inhalation studies with butadiene, it was necessary to develop safe systems for the generation and control of stable exposure chamber atmospheres. Infrared and gas chromatographic analytical methods were adapted for monitoring the concentration and distribution of butadiene in exposure chambers, and for analysis of known impurities, particularly, t-butyl catechol and 4-vinyl-1-cyclohexene, in atmospheres generated for inhalation tests.


Inhalation toxicity studies with 1,3-butadiene -- 2. 3 month toxicity study in rats. The available toxicological data for 1,3-butadiene are limited and contradictory. Three month toxicity and two year carcinogenicity studies have therefore been initiated to identify any potential hazard to occupationally exposed personnel. The results of the 3 month study are reported in this paper. Five groups of Sprague-Dawley rats were exposed to 1,3-butadiene gas at atmospheric concentrations of 0, 1000, 2000, 4000 and 8000 ppm v/v respectively, 6 hours/day, 5 days/week for 13 weeks. Forty male and forty female animals were used in each group, of which 10 of each sex were killed at 2 and 6 weeks. Exposure took place in 5 chambers, in an area prepared specifically for the handling of a potentially explosive gas-air mixture at concentrations just below the lower explosive limit. No untoward effects attributable to exposure were observed, except a moderately increased salivation, particularly in female animals during the last 5--8 weeks of exposure, at higher concentrations of butadiene. No effects considered to be attributable to treatment were seen in growth rate, food consumption, hematological and blood biochemical investigations or urine analysis after 2, 6 and 13 weeks exposure. Macroscopic and histopathological examination after 2, 6 and 13 weeks exposure showed no untoward changes related to exposure to butadiene gas. Erythrocyte and brain cholinesterase, erythrocyte osmotic fragility and neutrophil phagocytosis were also unaffected by treatment.


Sampling and analysis of acetic anhydride in air. This paper describes the development of a new method for monitoring acetic anhydride in the presence of acetic acid in the occupational environment. The method consisted of collecting airborne acetic anhydride on a solid sorbent, desorbing it with acetone and analyzing it by gas chromatography. During the development of this method various parameters such as selection of column, selection of solid sorbent, selection of desorber solvent, effects of humidity, flow rate, total sample volume, desorption efficiency, and shelf-life of samples were studied. Interference from methyl acetate, water, formic acid, and acetic acid was also tested with the determination of acetic anhydride.


Short-term in vitro bioassays: applicability to air monitoring in the coal conversion and shale oil industries. Short-termbioassays such as that of Ames and co-workers may be a practical method of monitoring industrial environments for the presence of biologically active and potentially hazardous materials. In general, these assays detect agents that cause damage to DNA which may lead to mutations, cancer, birth defects and to other diseases. Used to monitor industrial environments, such tests can indicate the presence of biologically active materials and can detect changes in the levels of these materials in the air. This paper reviews the types of bioassays which are presently available and considers their applicability to evaluation of occupational exposures in the coal conversion and oil shale industries. As no direct assessment of the degree of human health hazard can be made from the results of such tests, the choice of appropriate comparisons, such as ambient air, are discussed. The advantages and limitations of such systems are considered. Some research needs for the application of bioassays to industrial monitoring are also discussed.


Respirator use and protection from exposure to carbon monoxide. Investigations of the protective effect afforded by respirators in Baltimore firefighters are presented. The data indicates that the continuous use of respirators offers significant protection from exposure to carbon monoxide but that this protection is not absolute. A surprising finding is that the intermittent use of the face mask offers as little protection to the men as does non-use. These findings emphasize the difficulties in relying upon respiratory personal protective equipment for protection from exposure.


Binding of concanavalin-A to critical-point-dried and freeze-dried human lymphocytes. When human lymphocytes are treated with concanavalin-A (con A) and hemocyanin, the hemocyanin marker, which demonstrates con A binding sites, can be visualized by scanning (SEM) and transmission electron microscopy (TEM) on both critical-point-dried and freeze-dried cells. The ability to visualize the hemocyanin marker by SEM, its quantity and distribution, were all similar in lymphocytes prepared by both drying procedures. By TEM, hemocyanin was seen adjacent to the plasma membrane on critical-point-dried lymphocytes. In contrast, freeze-dried cells showed hemocyanin labeling at some distance from the plasma membrane (40-70 nm) as well as adjacent to it. The distribution of hemocyanin corresponded to the thickness of the amorphous coat seen on fixed, freeze-dried cells. Therefore, the extracellular coat on freeze-dried lymphocytes is a carbohydrate-containing glycocalyx.


Differential response of myofibrils and 10-nm filaments to a cocarcinogen. Multinucleated myotubes containing large numbers of striated myofibrils and large numbers of longitudinally-oriented 10-nm filaments were treated with the cocarcinogen phorbol-12-myristate-13-acetate (PMA) for 24, 48 or 72 hours. The inhibitory effects of PMA on the accumulation of myofibrils was evident within 24 hours, and by 72 hours virtually all striated myofibrils had disappeared. In contrast, the density of the 10-nm filaments was greatly enhanced in these myofibril-depleted myotubes. These effects were not due to a generalized cytotoxicity, for PMA stimulated the replication of the presumptive myoblasts and fibroblasts present in these cultures. 24 hours after removing the PMA, these myotubes assembled a new set of striated myofibrils and the density of 10-nm filaments diminished proportionately.


Inhomogeneous distribution of filipin-sterol complexes in the ciliary membrane of rat tracheal epithelium. Pieces of rat trachea fixed in a glutaraldehyde solution containing 300 muM filipin, a sterol-specific polyene antibiotic (Elias et al., '78), were freeze-fractured in order to study the distribution of cholesterol within the ciliary membrane. Filipin-sterol complexes, recognizable as 25-30-nm protrusions on fracture faces, appeared densely and uniformly distributed over most of the ciliary membrane, but were absent from the region of the ciliary necklace. It is possible, therefore, that the ciliary necklace represents a cholesterol-poor area of membrane.


The secretion of Mullerian inhibiting substance by cultured isolated Sertoli cells of the neonatal calf. Sertoli cells have been insolated from the newborn calf testis using a combination of mechanical and enzymatic disruption. Testicular fragments, previously chopped into 1-mm pieces, are digested in an enzyme mixture consisting of hyaluronidase, collagenase, trypsin and DNAse, followed by a second digestion in trypsin and DNAse. Isolation of the resulting cellular fractions by sedimentation with unit gravity produces an aliquot of Sertoli cells which is over 95% pure when examined by light and electron microscopy. Cultures of these cells grow rapidly and produce Mullerian Inhibiting Substance as evidenced by their ability to cause the involution of the Mullerian duct of the female fetal rat when co-cultured in an organ-culture assay system.


The regenerating liver: a site of erythropoiesis in the adult Long-Evans rat. Erythropoiesis, which is primarily hepatic in the rat during fetal and early neonatal life, shifts almost entirely to the bone marrow in the neonatal-adolescent stage of development. In the adult, extramedullary erythropoiesis has been demonstrated in the liver and spleen under certain pathological conditions when bone marrow red cell production is insufficient. In the present study, erythropoietic foci have been found in young-adult rat liver regenerating 24-72 hr after subtotal hepatectomy. This erythropoiesis is both extravascular and sinusoidal, with some erythroblastic islands noted. The centrolobular hepatic area contains the highest concentration of erythroblasts. Peripheral blood reticulocytosis coincides with the appearance of these cells and this is considered as an indicator of effective erythropoiesis. Liver regenerating after partial hepatectomy produces significant quantities of erythropoietin (Ep) in response to hypoxia. Subtotal hepatectomy may confer upon the adult liver the ability to revert to a fetal-like condition both in its ability to produce Ep and to function as a hematopoietic inductive microenvironment for erythropoiesis.


Origin of necklace particles in thymic ciliating cells. The formation of ciliary necklaces during ciliogenesis in a thymic cyst was observed in freeze-etched replicas. The necklaces first appear as clusters of particles arranged in concentric circles on a flat area of the cell membrane. As soon as the cilium begins to grow, the particles move to the periphery.


Establishment of an epithelial cell line from rat thymus. A cell line (IT-26R21), composed only of epithelial cells, was established from normal rat thymus. Thymuses were treated with both collagenase and trypsin. Four months after the initiation of cultures, epithelial cells in packed colonies formed a monolayer and no other cells were found in cultures. Thereafter, epithelial cells have been subcultured with trypsin and EDTA, and are currently at the 30th subculture. Based upon the fine structure of the thymus in vivo, IT-26R21 cells were identified as epithelial cells from the thymus, because of their mosaic-like arrangement, desmosomes and tonofilaments. Other features also supported their origin and identity.


Antileukocyte antibodies in patients refractory to platelet transfusions. Sera from 12 multitransfused patients who were refractory to random-donor platelets were tested for lymphocytotoxic and leukoagglutinating antibodies using panel cells from various volunteers whose HLA-A and -B antigens were known. All sera contained leukoagglutinins reactive with cells from at least one panel member, whereas only 33% had lymphocytotoxic antibodies. Patients whose sera reacted frequently with panel cells using the microcapillary agglutination technic seldom responded to HLA-matched paltelets, whereas those whose sera reacted infrequently usually responded satisfactorily. It is concluded that non-HLA antibodies may play a significant role in determining the responses to platelet transfusions in multi-transfused patients.


Whole-blood hemoglobin determinations: a comparison of methodologies. The Coulter Model S provides an accurate measurement of total hemoglobin (Hb) content in peripheral blood even when elevated levels of carboxyhemoglobin (HbCO) are present. Commercial standards and diluents for spectrophotometric determinations of cyanmethemoglobin (HiCN) are variable in quality. All diluents studied produce turbidity in some samples, and this may explain why manual Hb determinations tend to be higher than hemoglobin measurement on the Coulter S. The most reliable diluent was the reagent described by Van Kampen and Zijlstra. Its reliability is enhanced by centrifugation of sample in diluent. The use of a narrow-band-pass spectrophotometer for routine HiCN determinations in a clinical laboratory is not recommended because of its sensitivity to turbidity and HbCO.


Diagnostic yield of transbronchoscopic biopsies. Transbronchoscopic biopsies of lung (transbronchial) or bronchus (endobronchial) have a high diagnostic of yield when performed by a single expert bronchoscopist or a small group of expert bronchoscopists. This procedure's diagnostic yield was evaluated in a general hospital where biopsies are performed by a diverse group of individuals. One hundred fifty-one consecutive biopsies were reviewed, including 53 transbronchial biopsies and 98 endobronchial biopsies. Only 44% of endobronchial biopsies and 21% of transbronchial biopsies were diagnostic. The diagnostic yield was significantly greater in patients with suspected neoplasms (48%) than in patients with suspected infections (13%). Of 97 patients who ultimately had definitive diagnoses established, 43 (44%) had negative biopsy results, including 36% of those with cancers and 80% of those with infections. Failure to obtain alveolar parenchyma by transbronchial biopsy (probably related to the absence of fluoroscopic control) and failure to obtain multiple tissue fragments during each procedure contributed to the low diagnostic yield. The especially disappointing results of transbronchial biopsy for diagnosis of infection suggest that, in this hospital setting, open lung biopsy may be the procedure of choice when infection is suspected.


A comparison of hard and soft glass blood-drawing tubes. The authors examined both hard and soft glass evacuated blood-drawing tubes for possible effects on clinical chemistry measurements. Using routine laboratory procedures, no clinically or statistically significant difference could be detected in 34 analytes using 66 different methods. A special high-precision study utilizing an adaption of the NBS round-robin procedures for calcium, magnesium, sodium, and potassium detected no difference between paired sera when drawn or stored for 72 hours, or both, in the two types of glass. The authors conclude that the type of glass used in production of the evacuated blood-drawing tubes does not affect the clinical chemistry results obtained.


Neutrophil migration under agarose: quantitation and variables. Several variables have been evaluated for the in-vitro measurement of neutrophil migration under agarose. Commonly used anticoagulants do not alter migration. Cells may be collected in heparin, sodium citrate, or EDTA. Neither hypotonic or ammonium chloride lysis of erythrocytes affects chemotactic activity. Saponin, however, decreased both leukocytic viability and migration. Passage of neutrophils through a Hypaque-Ficoll density gradient improved migration scores, presumably by removing contaminating material and cells. Both lymphocyte and erythrocyte contamination decreased test scores. Platelets did not have a detrimental effect on neutrophil migration. Fresh serum was the most potent chemotactic agent. This was followed, in order, by zymosan-activated serum, N-formyl-L-methionyl-L-phenylalanine, casein, and Escherichia coli supernatant. A scoring method that combines features of both counting leukocytes and measuring the migration distance has been devised. The technic has a coefficient of variation of 9.2%. Scores for the normal adult population show a gaussian distribution.


Diagnostic value of candida precipitins determined by counterimmunoelectrophoresis in patients with acute leukemia: a prospective study. Thirty-nine patients receiving chemotherapy for acute leukemia had weekly determinations of Candida precipitins by use of counterimmunoelectrophoresis. The only two patients who had proven disseminated candidiasis both had diagnostic (greater than or equal to 1/8) titers. However, most patients with "possible" disseminated candidiasis did not have diagnostic titers. The test's specificity was high (90%), and only one of five patients infected with other fungi had diagnostic titers. However, because there were so few "true positives" in this small series, the relatively small number of "false positives" resulted in a low predictive value for this test. Based on a review of the literature and the authors' experience, the value of this test for patients who have acute leukemia does not appear to be well established.


Pericardial-fluid complement: normal values. Reports of low pericardial-fluid complement levels in systemic lupus erythematosus and rheumatoid arthritis have been difficult to interpret, as few data are available to describe complement concentrations in patients without pericardial disease. The authors therefore determined normal values under standardized conditions of collection, storage, and assay. The normal ranges for pericardial-fluid C3, C4, and total hemolytic complement were 35-127 mg/dl, 6.3-23 mg/dl, and 1.9-9.1 CH50 units, respectively. Storage at -20 C resulted in a 50% reduction in values. Hence, storage at -70 C is recommended. As the level of pericardial-fluid total hemolytic complement is normally low, caution is needed in interpreting its apparent reduction in various immunologic diseases.


Helping police officers to cope with stress: a cognitive--behavioral approach. Police Academy trainees participated in a stress management program which focused on developing skills for coping with anxiety and anger. Stress management training took place in six 2-hour sessions and included instruction and practice in the self-monitoring of reactions to stressful situations, muscular relaxation, and the development of adaptive self-statements. Self-report measures of anxiety and anger were obtained before and after the stress management program. In addition, self and observer ratings of trainees' performance in stressful simulated police activities were utilized as posttreatment dependent measures. In comparison to a control group of trainees, the performance of the treatment group was rated, by academy personnel, as superior in several of the simulated police activities. The results of the present study suggest that stress management with law enforcement officers may be most effective when the program focuses on the specific situations which are likely to be encountered by trainees. Limitations of the present program are examined and suggestions for future efforts with law enforcement personnel are discussed.


Hairdressers as caregivers. I. A descriptive profile of interpersonal help-giving involvements. The interpersonal help-giving behaviors of 90 hairdressers were explored in depth in an interview study. On the average, hairdressers saw 55 customers a week, and talked 25 minutes with each. About one-third of the talking time concerned clients' moderate to serious personal problems--particularly problems with children, physical health, marriage, depression, and anxiety. Hairdressers reported that offering sympathy and support, being lighthearted, just listening, and presenting alternatives were among their most frequent response strategies. Although they often enjoyed fielding clients' personal problems, at times they felt perplexed by them. Hairdressers perceived listening to customers' interpersonal problems to be an important part of their everyday function and expressed a need for professional inputs in that domain.


Grief intervention and sudden infant death syndrome. A program utilizing nurses to deliver grief intervention to parents losing a baby to Sudden Infant Death Syndrome (SIDS) is described. Because parents of SIDS victims experience profound feelings of guilt and especially servere crisis reactions, programs relieving guilt and providing additional support to them are felt to have significant preventive potential. Data are presented tentatively supporting the conclusion that the SIDS grief intervention program had a beneficial impact on the participants. Implications for crisis theory and preventive programming in general are also discussed.


Evaluation of two test-anxiety reduction treatments in a secondary prevention program. The study evaluated the effectiveness of both a new anxiety management training program and a cognitive modification procedure as part of a secondary prevention effort to identify and treat test anxiety early in the academic career of college students. Subjects were 40 college freshmen who had been identified as high test-anxious in an initial mail-out survey of the Test Anxiety scale. Subjects were randomly assigned to three experimental conditions: anxiety management training, a cognitive modification procedure, and a no-treatment control group. Results indicated that both the cognitive modification and anxiety management training treatments were effective in reducing test anxiety on a posttreatment administration of the Test Anxiety scale. Especially interesting, a significant difference in academic performance emerged between treatment and control groups three semesters after treatment, underscoring the preventive value of the program.


Further evaluation of the optimum age for rubella vaccine administration. The hemagglutination-inhibition (HI) antibody responses of 452 children to HPV-77, DE5 rubella vaccine were studied. Results indicated that seroconversion rates and geometric mean titers in infants inoculated at 12 through 14 months of age are comparable with those achieved in older children. "Vaccine failures" seem to occur randomly in vaccinees after 1 year of age; the infectivity of individual vaccines is questioned. The persistence of HI antibody was evaluated through serial sampling up to three years postinoculation.


Mucocutaneous lymph node syndrome. A cross-sectional echocardiographic diagnosis of coronary aneurysms. The cross-sectional echocardiographic technique for detecting coronary artery aneurysms of mucocutaneous lymph node syndrome (MLNS) was examined. When cutting the aortic root in round slices by the echocardiographic scanner, each of the right and left coronary arteries was imaged as a linear echo-free structure arising from the aortic root. Of 22 normal subjects, the left main coronary artery was imaged in all, the anterior descending branch in 18, the circumflex branch in six, and the right coronary artery in 18. Of 41 patients with MLNS, coronary artery aneurysms were detected as large echo-free spaces in four patients who were proved later to have these lesions by coronary angiography or autopsy. In addition, in four patients, whose echocardiograms demonstrated the coronary arteries to be normal, the angiographic studies showed that the coronary arteries were intact. These results suggest that the cross-sectional echocardiographic technique is a useful noninvasive diagnostic method for imaging the coronary arteries and the aneurysms in MLNS.


Sickle cell trait/hereditary persistence of fetal hemoglobin trait. Misdiagnosis as sickle cell anemia by newborn screening. A black female infant, reported as a result of mandatory newborn screening to have sickle cell anemia, was found at 8 months of age to have instead the entirely benign disorder sickle cell trait/hereditary persistence of fetal hemoglobin trait. The finding of hemoglobin S without Hb A does not suffice for the diagnosis of homozygous Hb S. Screening programs that diagnose sickle cell aneimia without first demonstrating sickle hemoglobin in both parents will consistently misdiagnose several more benign hemoglobin states as sickle cell anemia.


Immunological bases for superior survival of females. Evolutionary selection has equipped females with immunoregulatory genes on the X chromosome for coping with life-threatening illness. Five immunodeficiency syndromes occur solely in males, suggesting that they arise from mutant immunoregulatory genes located on the X chromosome. These syndromes, although rare, could contribute to poorer survival of males. Females have higher serum IgM concentrations, superior ability to form antibodies to infectious agents, and experience a lower incidence of viral and bacterial infectious diseases. Preponderance of autoimmune disorders in females could arise from modified immune responses owing to estrogens. Clinical and animal studies indicate that male hormones suppress autoantibody production whereas female hormones support their production. Superior immunocompetence and survival of females is based, in part, on their being protected from mutant immunoregulatory genes located on the X chromosome.


Periodic transfusions for sickle cell anemia and CNS infarction. Recurrences of CNS infarction often lead to progressive neurologic disability in sickle cell anemia. To prevent such reccurrence, a periodic blood transfusion program was begun in 1969. Currently, 27 patients are on this regimen. Before inclusion in the program, 12 patients had had one to nine CNS recurrences each. Since the program was started, two patients have had transient CNS ischemia. There were no other recurrences and none of the patients have shown progression of neurologic abnormalities. In addition, there was a striking decrease in bacterial infection and pain. We conclude that periodic transfusions are effective in preventing recurrent CNS infarction in sickle cell anemia. The benefits must be weighed against the potentially serious problem of iron overload, as evidenced by moderately elevated serum ferritin values.


Linear porokeratosis and other linear cutaneous eruptions of childhood. Several distinct linear cutaneous eruptions occur in childhood. They differ in natural history, response to therapy, and association with other abnormalities that may affect the child's general well-being.


Therapeutic communities, old and new.

Therapeutic communities, old and new. The author attempts to clarify two largely different uses of term, Therapeutic Community (TC). By "old" TC he describes a movement which originated in psychiatry in the United Kingdom at the end of World War II. This was an attempt to establish a democratic system in hospitals where the domination of the doctors was replaced by open communication of content and feeling, information sharing, shared decision making, and problem solving shared as far as possible with all patients and staff. Daily meetings of all patients and staff formed the nucleus of this process. In recent years developments in the areas of systems theory, learning theory, and organization development have contributed to a better understanding of social organization and change. The "new" TCs derive from the more recent developments in the treatment of substance abuse. Central to this movement is Synanon and its many modification which use the clients' peer group to solve their own problems, largely eliminating mental health professionals. Linked with these "new" TCs is the development of Asklepieion units in prisons, which use Synanon "games" along with transactional analysis. An attempt is made to distinguish the methodologies used in TCs, "old" and "new".


Changes in drug abuse clients--1972-1978: implications for revised treatment. Considerable anecdotal evidence at this hospital had suggested that the present population of drug abuse patients was qualitatively different from the population for which the original treatment program had been designed. In order to assess these suspected differences, samples of drug abuse clients from 1972 and 1978 were compared to terms of pattern of abuse, previous treatments, means of support, family background, and psychological status. Results suggested significant increases in symptom severity within the 1978 sample in all comparison areas, especially psychological status. The authors consider the possibility that therapeutic approaches which were previously effective may no longer be meeting the more extensive needs of the current population.


Angel dust use in an outpatient setting--clinical profile and implications for treatment. The study attempts to identify two populations of 20 young people who are self-reporting marijuana use in one group and angel dust in the other. We have examined these populations and evaluated them on a series of variables in an attempt to discover whether there are significant differences between them and, if so, whether there is in fact a clinical profile which may be descriptive of nonacute reactions to angel dust. Results indicate that there are significant differences on variables that distinguish angel dust users in an outpatient setting.


Parental correlates of drug use among young Puerto Rican adults. A study was conducted by interview with 635 young Puerto Rican adults in Puerto Rico. Half of the sample were selected as high risk of heroin involvement, half as low risk. Parent-child relationships and parental usage of alcohol and cigarettes were related to five indices of heroin involvement. For boys, maternal acceptance was negatively associated with having ever tried heroin. Higher levels of maternal control were associated with lesser heroin use, never having tried heroin, less knowledge of heroin-related vocabulary, and fewer friends who had used heroin. Being the mother's favorite child was associated with less approval of heroin use. For boys, paternal acceptance was related to less knowledge of heroin vocabulary. Higher levels of paternal control went with less heroin use, less knowledge of heroin vocabulary, never having tried heroin, and few friends who used heroin. Paternal discipline was related to fewer friends using heroin. For girls, maternal control was associated with less knowledge of heroin vocabulary, maternal discipline with fewer friends using heroin, and being the mother's favorite child went with low heroin use, low approval for heroin use, and few friends using heroin. For girls, paternal acceptance and paternal discipline were associated with fewer friends using heroin. Maternal smoking and drinking were associated with increased usage of heroin for her son.


Measurement of urine temperature as an alternative to observed urination in a narcotic treatment program. Upper and lower limits have been determined for the temperature of freshly voided ur;ne. When specified procedures are followed, more than 99% of measurements lie between 32.5 and 36.7 degrees C. This provides a basis for monitoring urine collection in a drug abuse treatment program in a manner that does not invade privacy. The method is not foolproof, but it provides sufficient control if there are no penalties for illicit drug use so that there is no strong incentive to turn in a fraudulent urine sample.


Evidence for the presence of two fundamentally different, age-independent characteriological types within unselected runs of male alcohol and drug abusers. Analyses of the MAC Scale scores of male substance abusers evidence the presence of two fundamentally different, age-independent characterological types within unselected runs of male alcohol and drug abusers. Examination of those items which best accomplish this discrimination indicates that the members of the majority type (approximately 85%, on average, over several studies) have disorders of character, while the members of the minority type (approximately 15%, on average, over several studies) are introverted neurotics. Since both types are also present, but in roughly opposite proportions, in the self-depictions of the members of unselected runs of nonsubstance-abusing male psychiatric outpatients, it is evident that neither type is comprised only of substance abusers.


Delay in seeking help and onset of crisis among Al-Anon wives. A survey of 123 Al-Anon wives in the Washington, D.C. area revealed that these women delayed an average of more than 7 years after the first occurrence of problem drinking before finally seeking help. The various drinking-related problems antecedent to the wives' seeking help clustered into four time periods composed of similar types of problems; (1) nonthreatening events, such as arrest, occurred 7 years prior to help seeking; (2) acts of physical violence, 5 years; (3) intervention by outside authorities, 3 years; and (4) recognition by significant others that the drinking was out of control, 2 years. The phenomenon of extended delay before recognition of the problem and help seeking is consistent with the paradigm developed from studies of mental patients and their families: pathological behavior becomes defined as a problem only after a long accumulation of bizarre episodes.


Rural vs urban problem drinker clients.

Rural vs urban problem drinker clients. The rural (n = 636) and urban (n = 3,294) clients served by the outpatient alcoholism service centers of Iowa during 1973-1974 are compared. More similarities than differences are observed. The implications for intervention and rehabilitation strategies are discussed.


Phycomycosis of the gastrointestinal tract. A case of gastrointestinal phycomycosis, a highly lethal fungal infection, is presented. Radiographic, operative and histopathologic features are discussed. Pathogenesis of the disease and the importance of underlying illness, malnutrition, immunosuppression and antibiotic therapy are considered. The literature is reviewed and current approaches to diagnosis and management are summarized. Greater awareness of the clinical setting in which gastrointestinal phycomycosis may develop and earlier consideration of the diagnosis are prerequisite to improved survival.


Effect of pancreatic stimulation on serum and urine amylase isoenzymes in man. Alpha amylase of pancreatic origin is cleared by the kidney more rapidly than the salivary isoamylase. To determine whether alterations in the ratio of pancreatic to salivary amylase in sera caused alterations in over all renal clearance, the clearance of amylase was measured before and after the exocrine pancreas was stimulated with a prolonged intravenous infusion of secretin plus cholecystokinin. Serum and urine samples collected prior to and following stimulation were analyzed for amylase activity and creatinine concentration. Amylase isoenzymes were separated using isoelectric focusing. Over all renal clearance of amylase and of the separated amylase isoenzymes were calculated as a percentage of the clearance of creatinine. The hormone infusion was associated with an increase in serum and urine amylase activities, this increase being mainly accounted for by pancreatic amylase. The renal clearance of the salivary and pancreatic isoamylases was not altered by the hormone infusion but the over all amylase clearance by the kidney rose from 2.31 +/- 0.74 to 3.42 +/- 1.46% of creatinine clearance. In some cases the renal clearance of amylase following stimulation entered the range considered diagnostic for acute pancreatitis.


Renal and gastric hamartomas.

Renal and gastric hamartomas. This report documents a patient with renal tumor which was originally diagnosed as "Wilms' tumor" and treated by irradiation and chemotherapy. Fifteen years later the patient was found to have gastric hamartomas. Reviews of the kidney tumor revealed it to be composed of morphologic features consistent with renal hamartoma rather than Wilms' tumor. We wish to report this extremely unusual association of renal and gastric hamartomas.


Cholesterol ascites in alcoholic cirrhosis. A 43-year old man with long-standing cirrhosis of the liver and ascites was found to have cholesterol crystals in his ascitic fluid. This unusual finding, not heretofore described in the medical literature, is reported and possible mechanisms for its production are discussed.


Radiation therapy of a pancreatic fistula. A patient with a pancreatic cutaneous fistula subsequent to laparotomy was unresponsive to medical management including intravenous hyperalimentation. Radiation therapy resulted in progressive diminution of volume from the fistula with subsequent complete closure. Radiation thus offers another therapeutic modality for pancreatic fistulas.


Intussusception of the by-passed segment after jejunoileal by-pass for obesity. A cryptic problem. Intussusception involving the excluded small bowel segment is an infrequent complication following intestinal by-pass procedures for morbid obesity. Because the intussusception involves bowel not in continuity with the alimentary stream, the usual diagnostic clinical and radiographic patterns fail to appear and recognition is usually delayed. This paper reports in detail such a patient, who was relieved of prolonged abdominal pain by operation. Previously reported patients are reviewed.


Effect of metoclopramide on gastric stasis after reversed jejunal loop for postvagotomy diarrhea. The effect of metoclopramide on gastric emptying in a patient with an antiperistaltic jejunal loop interposed between the stomach and duodenum because of postvagotomy dumping symdrome is studied. Solid particle emptying by 99mTc-labeled chicken liver revealed profound gastric stasis with resultant bezoar formation. Orally administered metoclopramide resulted in correction of the gastric emptying rate and dramatic symptomatic relief. The possible use of metoclopramide in patients with stasis following surgical intervention to correct postvagotomy dumping is suggested.


Biliary peritonitis following blunt abdominal trauma in children. Report of a case. Bile peritonitis, following blunt abdomen injury to the biliary tract, is not a very common condition. The clinical features, however, are typical, the treatment is delayed due to the quiescent interval between the symptoms. The operative treatment is simple draining of the area of perforation and the site of the collection of bile. A catheter in the gallbladder is helpful in assessing the stoppage of the leak and the restoration of biliary drainage. The prompt surgical treatment on diagnosis has good prognosis.


Transient hypertrophic gastropathy in childhood: a protein-losing gastropathy distinct from Menetrier's disease. Transient hypertrophic gastropathy in a child with similarity of radiographic and clinical features to Menetrier's disease is described. Distinction from Menetrier's disease is emphasized as the condition is characterized by abrupt onset, short duration, eosinophila and good prognosis. The association with hypersensitivity as a possible etiology is more suggestive in this condition. The radiographic changes will often provide the first clue to this condition and rapid reversal of the gastric changes is diagnostic.


Inherited deficiency of delta-aminolevulinic acid dehydratase. Delta-aminolevulinic acid dehydratase (ALA-D) is the second enzyme in the porphyrin-heme pathway and converts delta-aminolevulinc acid (ALA) to porphobilinogen (PBG). A family is reported with an inherited deficiency of red cell ALA-D activity occurring over three generations in an autosomal dominant pattern. Intial experiments support the hypothesis that the mutation in this family may affect a regulatory gene, but enzyme purification and further study are required. Although no clinical manifestations of deficient ALA-D activity have been found in affected persons, families such as this may be at increased risk for the serious consequences of lead poisoning, which produces marked inhibition of ALA-D activity.