[Results of determination of plasma methoxydopa in parkinsonian patients with or without dyskinesia induced by L-Dopa]. Horary plasmatic dosages of Dopa and metabolites in 30 treated parkinsonian patients have shown that, within the group of patients treated with L-Dopa combined with an extracerebral decarboxylase inhibitor, highly significant by increased plasmatic O-methyl-dopa levels can be found in patients with dyskinesias compared with those without dyskinesias. On the contrary, in these two subgroups of patients, plasmatic Dopa levels are not significantly different. By comparing some favoured Dopa and O-methyl-dopa levels between these two subgroups of patients, it seems more likely, that the elevated plasmatic O-methyl-dopa levels are due to an progressive accumulation on of its compound than to an excessive formation from Dopa.


[Clinical and ultrastructural study of a case of human rabies]. A patient of Morracan origin, aged 26 years, who died as a result of rabies after a 15 day illness in August 1976 in Bordeaux. No evidence of contamination was found by history from the patient and his family and friends nor by examination. A cerebral biopsy carried out a few hours before death confirmed the diagnosis by immunofluorescence, whilst examination under the optical microscope demonstrated Negri bodies and ultrastructural studies revealed rabies virus. These findings are discussed and compared with a few other cases reported in the literature with electron microscope studies.


[Quantitative and thermodynamic study of B antigen in a family including individuals with phenotypes B 3 and AB 3]. Four B3 and one A1B3 erythrocyte samples belonging to the same family were studied using several series of quantitative measurements: percentage of agglutination, agglutination kinetics and thermodynamic methods. For this last assay the erythrocytes were used fresh and after treatment by formalin. From the obtained results evidence was given that while B antigen density was lower in A1B3 than in B3O cells, the reactive structure is qualitatively the same in these two kinds of cells. The enthalpy change of the reaction of this B3 antigen with a non stimulated anti-B from A1O individual was -- 5,000 cal/mole, i.e. weaker than when normal B cells were concerned (-- 16,000 cal/mole).


[Frequency of genes corresponding to adenosine deaminase, 6-phosphogluconate dehydrogenase and esterase D polymorphism in the Parisian population]. The frequencies of the genes expressing the variation of erythrocytic enzymes ADA, 6PGD and esterase D have been estimated in Paris population. These results are as follows: (formula see text). These are compared to those of other european populations. Although ADA shows the lowest frequency in the french population, the distribution is not significantly different from the whole european distribution. No difference is noticeable for 6PGD and esterase D.


[In vitro and in vivo study of a hemoglobin solution used as a blood substitute]. In vitro studies of a stroma free haemoglobin solution of human origin (Wx B 8326, Warner-Lambert) in comparison with fresh and stored low DPG whole human blood, was undertaken with regard to the fixation. of oxygen. Such an hemoglobin solution was shown to exhibit a high affinity for oxygen and a low Bohr effect (assessed from the delta log Po2/delta pH ratio). The specific effect of Co2 (assessed from the delta log Po2/delta log. Pco2 ratio) appeared to be increased as compared to fresh whole blood. This hemoglobin solution was tested as a blood substitute in two in vivo experimental situations: exsanguino transfusion on rabbits (n = 6) and closed-chest extracorporeal circulation on dogs (n = 6). In order to evaluate the part taken by the tested Hb solution in arterial O2 carrying capacity and in O2 delivery, two ratios were calculated: arterial plasmatic O2 content/arterial circulating blood O2 content and arterio-venous plasmatic O2 difference/arterio-venous circulating blood O2 difference. These two ratios amounted 28,2 +/- 2,5% (rabbits) and 47,0 +/- 6% (dogs) for the arterial O2 carrying capacity and 13,8 +/- 3,0% (rabbits) and 25,8 +/- 5,0% (dogs) for the tissular O2 delivery. Among the properties of the tested stroma free hemoglobin solution its low contribution to the tissular O2 delivery, its high affinity for oxygen, its low Bohr effect and its short half-life as compared to whole blood are not favouring its use in clinical practice.


The relationship between host factors of allergic nature and respiratory symptoms. Respiratory symptoms and personal history of allergy were examined in 1659 children, including the entire elementary school population of four villages of the Belgian Ardennes. Levels of atmospheric pollution were monitored during the survey and proved to be very low. It is suggested that socio-economic factors produce a small increase in respiratory symptoms, particularly in cough symptoms. A personal history of eczema and of hay fever was highly associated with dyspnea and wheezing.


[Prevention of methane emission by pre-tele-injection of water into the layer]. This paper describes trials of pre-tele-infusion carried out at Zolder mine, of the Kempense Steenkolenmijnen, as part of a research project on the control of methane emission. An increase in output of more than 25% (accompanied by a reduction in dust concentration) with no significant increase in total methane emission is reported. Furthermore, a reduction in total emission of between 13 and 22% was observed when an infused panel was worked above a coal seam which had also been infused.


A clinical and prospective chromosomal study of yttrium-90 synovectomy. Yttrium-90 synovectomy resulted in complete resolution of chronic knee synovitis in 40% of a group of 15 patients. These patients would have otherwise required surgical synovectomy. The number of chromosomal aberrations detected in 30 patients after yttrium-90 synovectomy showed a statistically significant increase over the pre-treatment analysis, and, following treatment, chromosomal damage was noted in nine patients who had no damage before treatment. The risk arising from this chromosomal damage is uncertain but, while the long-term implications of the chromosomal aberrations are investigated in those who have already been treated, this therapy should be reserved for the older patient.


Penicillamine in rheumatoid arthritis: wound healing, skin thickness and osteoporosis. D-Penicillamine alters the normal metabolism of collagen by inhibiting cross-linking and protein synthesis. This could affect wound healing, accelerate skin thinning and possibly exaggerate the osteoporosis of rheumatoid disease. The mean time to wound healing after 42 orthopaedic surgical operations in 21 patients treated with penicillamine was 19.8 (+/- 13.1) days. Compared with an earlier study, these results suggest that the drug has a comparable effect on would healing to corticosteroids given for three years. Skinfold thickness over the fourth metacarpal of the dominant hand was measured in 28 cases before and during penicillamine treatment. There was a significant decrease both in the first and second four-month periods of treatment (P less than 0.005 and P less than 0.01). Corticosteroids in constant dose did not have an additive effect. In view of the wound healing findings the significance of these results must await further sequential measurements. The normal progression of osteoporosis over three years was documented in 70 patients who had not received penicillamine. Penicillamine reversed this trend in 35 patients after one year of treatment (P less than 0.005). The results confirm that the osteoporosis is related to disease severity rather than drug therapy.


Low back injury in sport.

Low back injury in sport. Low back injuries are shown to present a serious hazard to sportsmen and women, and may lead to long-term disability in relation to their sport. Training methods, particularly weight training, led to many of the injuries and it is recommended that personnel involved in training become more aware of these dangers. Spondylolysis was found in 18% of cases and it is suggested that the full investigation of low back pain in a sportsman is incomplete until this lesion has been excluded.


Preliminary experience with the geomedic total knee replacement. This paper reports preliminary experience with the Geomedic total knee replacement prosthesis. Forty-five prostheses were inserted into the severely damaged knees of 38 patients. Forty-one knees (35 rheumatoid, 6 osteoarthrotic) in 34 patients were available for review by an independent observer, a mean of 18 months (range 4--38 months) post-operatively. The assessment concentrated upon changes in function, pain relief and patient satisfaction, but objective parameters of range of movement and stability were also recorded. There were 23 excellent results, 15 good, 1 fair, and 2 poor. Thus, 93% of operations resulted in definite improvement. Complications occurred following 16 operations, but were mostly minor. One prosthesis dislocated, and there was one case of late infection which was treated successfully.


A double-glind comparative trial of naproxen and indomethacin in sports injuries. Fifty patients suffering from sports injuries were included in a double-blind trial comparing the efficacy and side-effects of naproxen and indomethacin. The patients' daily record cards showed that the number of patients whose paine cleared in less than seven days was statistically significantly greater in the naproxen grout (P = 0.03). Overall change at the seven-day follow-up visit, changes in the degree of pain, swelling and limitation of movement, as well as the number of patients ready for full activity at seven days were also greater in the naproxen group. However, the differences between the two groups of treatment did not reach statistical significance. The number of side-effects was equal in both treatment groups. One patient on indomethacin had to be withdrawn from the trial after two days' treatment, because of severe gastric pains.


Functional aspects in septal plasty.

Functional aspects in septal plasty. Some remarks are made about the statical and dynamical function of the septum. Septum corrections should be carried out according to the complaints and to the clinical findings in the nose. Septum surgery can never be a routine procedure like the classical submucous resection. The pathological symptoms are outlined related to deformities in different septal areas.


Septal plasty in children: influence on nasal growth. The results of a septoplasty because of a nasal obstruction were studied in 261 children, their ages ranging from 4 to 14. No arrest of nasal growth after the septoplasty and osteotomies was recorded. Histological examination revealed a cartilaginous regeneration at the borders of the resected septal cartilage in 15 cases in which a second rhinoplasty was necessary because of a new nasal obstruction. Often the cartilaginous growth was undirected and excessive leading to a new septal deviation. In 80 per cent of our cases good functional long-term results were obtained by one rhinoplasty only which was performed according to the techniques of Cottle and Masing.


[Etiopathogenesis of arthrosis; nosological consequences]. A nosological classification of arthrosis is proposed, consisting of two groups depending on whether the cartilage is intact (mechanical chondrosis) or altered (structural chondrosis). For both categories the principal aetiologies are mentioned. This aetiological differentiation has the aim of counteracting the facile diagnosis of primary arthrosis and is based on more elaborate diagnostic methods concerning the condition of the bone and cartilage.


[The effect of osmic acid on synovial and serum beta-glucuronidase activity]. The authors report that osmic acid, in vitro, increases the activity of beta-glucuronidase in serum and synovial, ascitic and pleural fluids, whereas five other metals of similar molecular weight (platinum, gold, mercury, thallium and lead) are either inactive or inhibitory. By contrast the osmium diminishes the activity of LDH and acid phosphatases in serum and synovial fluid. This effect on beta-glucuronidase is thought to be due to inhibition of a natural inhibitor present in biological fluids, a protein found by several authors.


[Sciatica caused by massive herniated disk]. On the basis of the surgical findings in 10 cases a description is given of a massive form of disc hernia corresponding to posterolateral displacement of the entire disc with the fibrous ring and cartilaginous surfaces. Such hernias were found in 7 cases of severe lumbar sciatica, including 3 with the cauda equina hemisyndrome and in 3 cases of simple lumbar sciatica operated on for their severe and refractory nature. It is useful to know this variety of hernia so that its uncommon aspect is not surprising on surgery. The term of massive hernia is proposed exclusively for these forms.


Radioimmunoassay of thyroxine and triiodothyronine in urine using extraction and separation of Sephadex columns. Radioimmunological methods for the determination of thyroxine (T4) and triiodothyronine (T3) in urine have been developed. The methods are based on trapping of T4 and T3 from unextracted urine, followed by separation between free and antibody bound hormone on the same Sephadex column. The T4 method has been compared to a competitive protein binding (CPB) assay using ethyl acetate extraction. The methods are evaluated in sixty-seven euthyroid controls, twenty-four hyperthyroid and seven hypothyroid patients. In the T4 RIA detection limit was 3.9 pg, intra-assay coefficient of variation (cv) was 5.2% and inter-assay cv was 6.9%. In the T3 RIA detection limit was 7.2 ng, intra-assay cv 3.9% and inter-assay cv 10.8%. Recovery of added amounts of hormones and serial dilutions gave satisfactory results. The CPB assay was found unreliable with unspecific and false high values. In euthyroid controls 24 h urinary T4 excretion as measured by RIA was 1.8 +/- 0.5 nmol, and urinary T3 excretion was 0.7 +/- 0.3 nmol. T4 and T3 excretion was greatly elevated in hyperthyroid patients and decreased in hypothyroidism.


Extracellular fluid volume determined by a single injection of inulin in men with untreated essential hypertension. The extracellular volume (ECV) and plasma volume (PV) were determined simultaneously in nine men with untreated essential hypertension and in nine healthy matched control subjects, using a single injection of inulin and of 131I-labelled human serum albumin, respectively. The average mean arterial blood pressure in the hypertensive group was 178/118 mmHg. ECV was nearly the same in the two groups, viz. 151 ml/kg body weight (SD 17) in the hypertensive group compared to 147 ml/kg (SD 16) in the control group. The corresponding figures for PV were 38.2 ml/kg body weight (SD 4.7) and 43.7 ml/kg (SD 7.9) respectively (P less than 0.1). The calculated interstitial fluid volume (IV) was 113 ml/kg (SD 16) and 103 ml/kg (SD 10) (P less than 0.2). The PV/IV ratio was significantly lower (P less than 0.02) in the hypertensive group (0.34, SD 0.06) than in the normal group (0.42, SD 0.06). The difference might suggest increased transcapillary water filtration in hypertension.


Distribution of coronary blood flow during acute coronary occlusion in dogs. Effect of nicotinic acid and sodium salicylate. The effects of the antilipolytic agents nicotinic acid (NA) and sodium salicylate (SS) on the distribution of coronary blood flow during acute myocardial ischaemia were studied in open chest dogs. Fifteen min following experimental coronary artery occlusion, blood flow in the ischaemic myocardium was on average 28% of flow in the non-ischaemic myocardium. The reduction in blood flow in the ischaemic mycardium was more pronounced in the endocardial than in epicardial halves of the myocardium. No significant change in blood flow was observed after administration of NA or SS in either the ischemic or nonischemic part of the myocardium. Both drugs reduced the extent of myocardial ischaemic injury as shown by reduced epicardial ST-segment elevations. Arterial concentrations of fatty acids were lowered by NA or SS, whereas the mechanical activity of the heart remained unchanged. It is concluded that the reduction of acute myocardial ischaemic injury effected by NA or SS is not due to changes in myocardial blood flow, but more likely to lower myocardial oxygen demand related to reduced fatty acid utilization.


Comparison of the effect of glucose and fructose on the recovery of the heart preparation. Reactions of the cardiac muscle of the rat in vitro were investigated in the present study. Cardiac muscle was perfused by Langendorf's method; perfusion pressure was 80 cm H2O and the temperature of the perfusion solution 37 degrees C. The perfusion solution was aerated with a gas mixture of oxygen (95%) and carbon dioxide (5%). Potassium citrate solution was used for heart arrest, and heart function was recovered by infusion of Locke's solution, plus glucose, fructose or sucrose. During recovery the amplitude and frequenty of heart beats, the lactic acid in the drained perfusion solution, pH and potassium concentration were measured. The use of glucose, fructose or sucrose made no significant difference to any of these parameters. Next, the metabolism of glucose and fructose in the heart was investigated by means of D(U-14C)-glucose nad D(U-14C)-fructose. Radioactive lactic acid was detected in the drained perfusion solution with D(U-14C)-glucose, but not when D(U-14C)-fructose was used. The radioactivity incorporated into glycogen by the heart was also larger with D(U-14C)-glucose than with D(U-14C)-fructose. On a metabolic basis the use of glucose for resuscitation would seem to be more appropriate than fructose.


Increase in renal blood flow in acute renal failure following intra-arterial infusion of acetylcholine. The renal blood flow and intrarenal blood flow distribution were measured with the 133Xe technique before and after infusion of 1 mg/min acetylcholine into the renal artery for 10 min in four patients with acute interstitial nephritis and six patients with acute renal failure from other disorders. All patients with acute interstitial nephritis and three of the patients with other types of renal failure showed a marked increase in cortical renal blood flow, following the infusion. Thus vasoconstriction is present in acute renal failure, and may be a factor in the pathogenesis of severely inpaired renal function.


Serum tyrosine within the first hour after an oral load of phenylalanine. Twenty-seven heterozygotes for phenylketonuria (PKU) and sixteen normal homozygotes were loaded with an amount of L-phenylalanine per body mass = 0.6 mmol/kg. Serum tyrosine concentration increased significantly within 15 min after the intake and the increase was rectilinear within the first 30 min. The initial rate of increase in serum tyrosine in heterozygotes was 0.47 mumol/l/min (range 0.20-0.98 mumol/l/min) and in normal homozygotes 1.2 mumol/l/min (range 0.80-1.9 mumol/l/min). The median serum tyrosine concentration increased within the first hour after an oral phenylalanine load (0.6 mmol/kg) of twelve infants with persistent hyperphenylalaninaemia (HPA), whereas serum tyrosine showed a decrease in forty infants with classical PKU. In ninetten infants with mild PKU serum tyrosine remained unchanged within the first hour after the load and then declined.


Unsaturated and cobalamin saturated transcobalamin I and II in normal human plasma. Insolubilized antibody against human transcobalamin I has been used as a specific and precise tool for the separation of transcobalamin I (and III) from transcobalamin II. Range and mean (in parentheses) for the unsaturated binding capacity for twenty samples are 40-190 (90) pmol/l and 220-1170 (560) pmol/l for transcobalamin I (and III) and transcobalamin II, respectively. The similar figures for the cobalamin saturated transcobalamins are 200-549 (320) pmol/l and 75-475 (160 pmol/l. On analyses of the cobalamins attached to each of the transcobalamins, it is shown that methylcobalamin accounts for most of the cobalamins attached to transcobalamin I whereas transcobalamin II carries most of the 5'-deoxyadenosylcobalamin.


Radioimmunological determination of reverse triiodothyronine in unextracted serum and serum dialysates. A sensitive radioimmunoassay for measurements of 3,3'-5'-triiodothyronine (reverse T3, rT3) in small amounts of unextracted serum is described. The interference of rT3 binding proteins in serum was precluded by addition of 8-anilino-1-naphthalene sulphonic acid (ANS). The cross reaction of T4 with the rT3 anti-serum varied with the concentration of T4 in the samples. At 50 per cent inhibition of [125I]rT3 binding, the T4 cross reaction was 0.075% (mol/mol). All values were corrected for T4 cross reaction. By the present method total rT3 averaged 0.37 nmol/l in thirty-two normal subjects. Higher values (0.81-1.98 nmol/l) were obtained in seventeen thyrotoxic patients, while the rT3 was very low (less than or equal to 0.046 nmol/l) in ten patients with severe primary hypothyroidism. A modification of the total rT3 assay was used for measurements of rT3 in serum dialysates (free rT3). The sensitivity was 0.46 pmol/l. This sensitivity did not allow detection of free rT3 in all normal subjects.


An analysis of data on human hepatic bile. Relationship between main bile components, serum cholesterol and serum triglycerides. Hepatic bile samples were taken from the common duct during interval operations for gallstone disease, performed under standardized conditions. Prior to operation serum cholesterol and triglycerides levels were determined. The concentrations of Cholesterol (Chol), phospholipids (Lip P) and of the three major bile acids (BA) were determined in ninety-seven samples. The data were subjected to statistical analysis. A highly significant rank correlation was found between the Chol- and the Lip P molar fractions. The rank correlation between the Chol molar fraction and the BA/Lip P ratio was highly significantly negative. Reasons are given why the observed intraindividual differences are interpreted as reflecting interindividual changes. The conclusion is that just as in the animal model, a rise of Chol in human hepatic bile is accompanied by a decrease of the BA/Lip P ratio. A significant correlation was found between chenodeoxycholic acid (CDCA), and the ratio between the two other main bile acids (CA/DCA). High lithogenicity was associated with low CDCA- and high DCA values. In a mathematical representation valid in the sense of a rank correlation, the bile/serum Chol ratio rose with increasing DCA values combined with increasing absolute differences between the other acids. Serum triglycerides were negatively correlated with the BA molar fraction and with the absolute concentration of BA. As a result there was an association between serum triglycerides and lithogenicity.


Ornithosis as a nosocomial infection.

Ornithosis as a nosocomial infection. An outbreak of ornithosis in the department of infectious diseases of a general hospital is described. The outbreak comprised 12 cases aged 18-80 years. The index case had a history of contact with birds. He developed a serious illness and died. 11 persons contracted the disease after contact with the index case; 8 of them were personnel of the clinic of infectious diseases and 1 case was a patient hospitalized in the same room as the index case. All of the patients showed a typical pneumonia and one of them had symptoms of encephalitis. Treatment with doxycycline was successful. 200 healthy contacts were treated prophylactically with doxycycline. None of these displayed any symptoms of disease.


Pneumococcal antibodies in maxillary sinus secretion. Resistance to and recovery from mucosal surface infections may be better correlated to the presence of local antibodies than to serum antibodies. In 14 patients with maxillary sinusitis due to pneumococci, IgA, IgG and IgM antibodies to the isolated pneumococci were quantified in sinus secretion and serum by indirect immunofluorescence technique. Most secretions contained type specific pneumococcal antibodies, mainly of IgA class. The frequent lack of demonstrable type specific IgA antibodies in serum indicates their local synthesis. After drainage of purulent sinus secretion, as in 5 patients, a local increase of antibodies was observed.


Nitroblue tetrazolium test in bacterial and viral infections. The reduction of nitroblue tetrazolium (NBT) dye by neutrophils from 379 patients with infectious diseases and 268 controls has been examined. The mean NBT score was 29.8% (72.3% positive tests) in the 231 patients with non-tuberculous bacterial infections, 9.7% (28.1% positive tests) in the 135 patients with viral infections 5.3% (1.5% positive tests) in the controls. Positive tests were demonstrated in 1 of 7 patients with tuberculosis and in 4 of 6 with mycoplasma pneumonia. Patients with urinary tract infections or septicemia had the highest percentage of positive tests, particularly when the infections were caused by gram-negative bacteria. In acute bacterial infection, the 176 patients who had not received any antibacterial therapy prior to testing had a significantly higher mean NBT score and proportion (77.8%) of positive tests than the remaining 55 pretreated patients (54.5%). Recent antibiotic treatment seriously invalidates the NBT test results. In acute viral infection, 29 of the 38 positive tests were obtained from patients with acute hepatitis (mean score 20.0%) or infectious mononucleosis (mean score 9.3%). When evaluating the test results, special attention should be paid to patients with hepatitis. Endotoxin stimulated NBT tests disclosed normal enhancement of NBT reduction by neutrophils from the patients and the controls. Cautiously interpreted, the NBT reduction by neutrophils from the patients and the controls. Cautiously interpreted, the NBT test results may be useful as an adjunct in the differential diagnosis of major bacterial and viral infections.


Surveillance of hospital infections: at the bedside or at the bacteriological laboratory? A prevalence study concerning wound infections in the surgical service at a university hospital was made during a 7-month period. One ward was visited every week during the wound dressing rounds and samples for bacteriologic culture were taken from clinical infections. The prevalence of infection varied between 0 and 21% (median value 8.2%) for surgical wounds and between 0 and 47% (median value 5.3%) for other wounds. Staphylococcus aureus made up 16% of the bacteria isolated from surgical wounds and the Enterobacteriacae 32.6%. For other wounds Staph. aureus and the Enterobacteriacae made up 22.6% each. A comparison of the number of cultures taken by investigators and that taken by the ward showed that the culturing frequency by the ward staff was so high that surveillance of infection by review of bacteriological culture records only, would give an almost equivalent degree of information concerning infection rates. This system is less time consuming and also has the advantage of giving epidemiological information. The drawback with the system is that little or no patient data are given on the requisitions from the ward. This makes it impossible to know from what kind of infections samples are taken.


Long-term co- trimoxazole treatment of chronic Salmonella carriers. Long-term co-trimoxazole treatment (4-6 months) was tried in 7 chronic carriers of mainly Salmonella typhi and S. paratyphi B. No one had positive faecal cultures during treatment. Four faecal carriers were followed-up with regular cultures for at least 1 year after treatment and 3 of them remained negative. Long-term co-trimoxazole treatment seems to be well tolerated also in very old patients and may be worth trying also in cases where other antibiotics have failed.


Pharmacokinetic aspects of streptomycin treatment of neonatal septicemia. Patients with suspected neonatal septicemia were treated with ampicillin, cloxacillin, and streptomycin. The plasma concentrations of streptomycin were followed. First, the levels were determined during a full dose interval (12 h) in 11 infants. The results were used for development of a routine system for monitoring the plasma levels in all streptomycin treated newborns. This system, the "3-point check", involved blood sampling at 1, 3, and 5 h after administration during every second dose interval. The results of this routine procedure were evaluated both in a retrospective and prospective study. The "3-point check" gave a sufficient description of the total exposure to streptomycin under routine clinical conditions and continuous information to the physician in charge of the patient about the drug level. In 9 cases of 50, the report from the laboratory resulted in dose change for correction of a too low or too high plasma concentration. The dosage used, 7.5 mg streptomycin intramuscularly every 12th hour, appeared to be satisfactory in most patients. Peak values rarely exceeded 30 microgram/ml and were usually lower than 25 microgram/ml. Almost half of the children had plasma levels below 5 microgram/ml at the end of the dose interval (after 12 h). Although the correlation between pharmacokinetics and clinical outcome is difficult to establish in neonatal sepsis, we suggest that our guiding principle to avoid plasma levels above 25 microliter/ml is reasonable. In 35 out of 78 patients an otological examination of the newborns was performed within 13 months after streptomycin treatment and no signs of hearing defects were noted.


[Pathogenesis of focal, transitory cerebral ischemic accidents]. Transient ischaemic focal cerebral attacks (TIA's) are due to: 1) atherosclerosis when embolism may take place or perhaps transient occlusion of the internal carotid artery or mural or transiently occlusive thrombus of an intracranial artery stenosis or transient systemic hypotension. In recent years embolism may have been overdiagnosed; 2) cardiac embolism due to dysrythmias, myocardial infarction, endocarditis, valvular prosthesis, etc.; 3) miscellaneous causes, often difficult to demonstrate such as tortuosity of the extracranial cerebral arteries, dissecting aneurysms, changes in cerebrovascular resistance; 4) not unfrequently no cause is found, especially in young patients.


[The psychiatrist and stress, or the psychiatrist's stress...]. Today's popular image of the psychiatrist is often that of a specialist capable of analysing, with a sort of bewildering power, all of his patients's reactions and psychological problems. The patient's capacity to unfold appears to increase almost as a result of the psychiatrist's control over his own emotions. The author, who is here referring to Epinal's image of the infallible psychiatrist, believes that the psychiatrist, in moments of privacy can observe the effects of his own emotional stress and how they often relate to his unresolved neurotic problems. It is in his practice, nevertheless, that the psychiatrist can privilege and give meaning to his own emotional stress in order to gain deeper insight in his mode of relating to his patient. Such additional awarness should then permit a more careful and satisfying analysis of what is experienced in a two person or group relationship. The acknowledgment of physical state resulting from emotional stress precedes an insight which always corresponds to a signifier leading to a signified which is then to be decoded.


[Stress or trigger situation. 2 notions illustrated by a comparison of stress ulcer to triggering of attacks of gastroduodenal ulcer disease]. The author attempts to show the fundamental difference existing between the two often confused concepts of "stress" and "trigger-situation", using the example of "stress ulcer" and "trigger-situation" of the outbursts of the ulcer disease. The stress ulcer or acute ulcer is compared to a door forcefully kicked in. It is unspecific like the adaptation syndrome of Selye. The trigger-situation as we understand it is a current conflict situation, i.e. a well-defined and specific event that is only conflictual for a very specific personality structure (one of the four psychosomatic types according to M'Uzan). In contrast to the picture of the door forcefully kicked in as in the stress ulcer, for the trigger-situation of the outbursts of the ulcer disease, we have used a picture of Beck: a key perfectly fitting the lock. All case records show that while an event can become the trigger-situation for one of the four psychosomatic types according to M'Uzan, it will not be for a different type. The specificity resides in the fact that this trigger-situation is a current conflict situation. The present conflict corresponds to a transfer of the infantile intra-psychic conflict to the present situation. When this current conflict reaches a sufficient intensity, the defence system built up by the patient is thereby decompensated--through frustration either of the neurotic activity or passivity desire of the patient and the conflict triggers the symptom, the ulcer attack.


Psychiatric aspects of stress in children and adolescents. The notion of "stress", the concepts of normal or pathological adaptability are applicable to child and adolescent. The stress is not a fixed value and depends on the personality of the child, on his degree of development and on his environment. Each educator ought to know the difference between a stimulus necessary to the development and a harmful and dangerous stress, especially when the latter is very intense and repeated to an extent which does not permit a normal adaptability. These basic notions can be applied to different stages of development as well as to extraordinary situations (divorce, death of a parent, illness of the child, etc.) which may arise.


[Social-political aspects of psychological stress]. Emotional stress is often based on defective social conditions like social isolation or the urge for maximal efficiency in production and consumption. The improvement of these social conditions and the elimination of the resulting pathogenic stress is a political task. There is a curious and unrealistic separation of responsibilities which is justified by tradition only: the social part of the therapy is abandoned to political institutions and groups whereas the psychiatrist whose therapy should be comprehensive concerns himself with individual problems only. As he neglects the noxious social circumstances and aims entirely at the social adaptation of the patient the psychiatrist denies the defectiveness of the social conditions as they are and corroborates a system which is the true cause of numerous psychiatric disturbances.


[The long-term Alpendorf study. Paradigm for the study of long-acting psychosocial stressors]. The follow-up study Alpendorf is presented as a paradigm for the observation of long-acting psycho-social stressors. Stressors can be observed directly or we infer to their existence from the observation of indicators of stress. There are methodological difficulties in differentiating stressors, indicators of stress and indicators of coping processes within a social field. The reductionist approach, which eliminates variables, is useful in the laboratory situation, it has, however, to be discarded in the investigations of a social field. Rapid social change in a mountain village of the Swiss Alps radically transformed the socio-economic basis and the socio-cultural super-structure, thus producing a field of stressors, leading to stress, observable on the level of the population. The amount of stress can be measured indirectly by the existence of indicators of stress: consumption of alcohol, alcoholism, psychosomatic symptoms and syndrome, consumption of drugs and tobacco, incidence and prevalence of neurotic and psychotic disorders, criminality.


[Syndrome of senile dementia with dilatation of the cerebral ventricles without other lesions (apropos of 18 observations anatomo-clinical)]. Study of 18 anatomo-clinical observations with dilatation of the cerebral ventricles (without vascular, degenerative or other cerebral lesions), and neuropsychiatric syydrome during the senile period of life. In the morphological and pathogenetic point of view, for one half of these cases a traumatic, microhemorrhagic, or inflammatory aetiology could be taken into consideration; for the other half, the hydrocephalus could be considered as idiopathic.


[Psychopathology of schizophrenias].

[Psychopathology of schizophrenias]. Introducing representation of some aspects of the idea of Schizophrenia. Reference to the fact, that the description of acute status makes use of psychopathological marks belonging to another level of description than those being used to indicate chronical states. Doubt on the possibility to talk about a psychopathology including all types of Schizophrenia. Instead of describing different syndromes appearing during the course we are noting the change of mental attitude of psychiatrist being confronted with Schizophrenia.


[Disorders of time perception in endogenous psychoses]. Already in the normal state of health often there are alterations of subjective time experience both as acceleration and delay of the lapse of time. These impairments of time perception are more important in the psychopathological field. Except during organic brain disease disturbances of time experience are observed especially during endogenous psychoses. Depressed men usually feel an unpleasant extension of subjective time experience. In schizophrenia there is a specific distorsion of time, characterized by troubles of the biographic orientation, by magic connexion-thinking with regard to time, or by a "collapse" of the chronological order. Somatic as well as psychological conditions seem to cause these disturbances.


[Value of the symptom in depression].

[Value of the symptom in depression]. In the present paper the author tries to consider some of the variables that influence the symptomatological expression of depression, namely the social-cultural factors, the age or the personality of the patient. Considering works of other authors and personal works, analysing also the data that the epidemiological studies have revealed, he points out the importance of the biological symptoms of the clinical picture of depression, such as disturbances of sleep, weight, appetite, libido and diurnal mood swing. These symptoms seem to be a "common denominator" not influenced by the social-cultural environment of the patient with a real meaning as advising signals of the presence of a depression. They correspond to disturbances of phylogenetically old functions, what explains its general presence in the human beings. On the other hand, the other symptoms of depression are linked to the personality of the patient and are determined by learning factors to which the individual has been submitted.


[Body--life--soul--spirit].

[Body--life--soul--spirit]. In every psychic disturbance "lived body", gesture, mimic, mood, strength of mind, emotion, word and spirit characterize the picture of the disease in a slightly different way and thus make it possible for the doctor to recognize not only the psychiatric diagnosis but also the being and the personality of the patient.


[Christian religiosity and psychothematics]. Correlations of (christian) religiosity and religious thematization in functional psychoses with paranoid syndromes (60 pat.) were studied by an extensive questionnaire. In regard of the frequency of religious themes in the paranoid syndromes there was no difference between catholic and protestant confession. Probands with religious experiences in their psychoses had other religious socialization (a home with special interest in religious subjects). They are themselves more active in regard to religious practices, more interested in religious problems, refer more often to fear of devil and hell, feel themselves more frequently close bound to the church. The premorbid religious activity increased in the period of 6 months before hospitalisation. They judge their fathers retrospectively more often as permissive. Concerning psychopathology probands with religious thematization in their psychosis had higher values of "grandiosity" in the IMPS (LORR), had more often experiences of immediate inspiration, evidence and clearness. They were hospitalized for a longer period than probands without religious thematization.


Absorption of rifampicin in gastrectomized patients. Effect of meals. Rifampicin absorption was studied in six gastrectomized and six non-gastrectomized tuberculous patients who had been on continuous rifampicin therapy for more than 4 weeks. A dose of 450 mg was given on two occasions, first immediately after breakfast and, 2 days later, 1 h before breakfast. In all the gastrectomized and control patients a serum level well above the MIC for M. tuberculosis (0.2-0.5 microgram/ml) was achieved irrespective  of whether rifampicin was administered after the meal or during fasting. Gastrectomized patients tended to have more delayed serum concentration peaks postprandially than when fasting. The differences in absorption were not statistically significant, and the serum concentrations remained above the MIC for M. tuberculosis for similar lenghts of time. Individual serum concentrations varied greatly, and this variation may represent a greater problem in the routine monitoring of rifampicin serum levels than administration of the drug with food.


Lung function and long-term exposure to cement dust. In a cross-sectional epidemiological survey a selected group of former and present cement factory workers and a random sample of the corresponding urban population underwent dynamic spirometry. Based upon life experience the subjects were grouped into four occupational categories. Three hundred and one men were grouped as cement factory workers, 649 were grouped as blue collar workers, 218 as white collar workers and 102 men had predominantly been occupied in farming, forestry and fishing. On the average the investigated men had spent more than 75% of their total occupational life in their main occupational category. Each occupational category was further subdivided according to smoking habits and in all categories the well-known association between tobacco consumption and decrease in ventilatory capacity was found. White collar workers, who smoke less and had experienced better housing conditions throughout life had better ventilatory lung function than any of the other three occupational categories. No significant differences in lung function between cement factory workers and other blue collar workers with comparable smoking habits could be demonstrated by use of the maximal midexpiratory flow (MMEF), or any other of the calculated indices from the dynamic spirometry, when standardized for age, height and body weight.


Hypersomnia and periodic breathing. Report of a case and review of the literature. A patient with hypersomnia and periodic breathing has been studied. Both airflow obstruction and an abnormally of the respiratory control mechanism were implicated in the pathogenesis of the ventilatory arrhythmia. It is suggested that the older terms "Pickwick" syndrome and primary alveolar hypoventilation are abandoned for more descriptive terms, e.g. "hypersomnia with periodic breathing".


A new ear oximeter for assessment of exercise-induced arterial desaturation in patients with pulmonary diseases. Changes in arterial oxygen saturation during exercise were measured with a new eight-wavelength ear oximeter and calculated from blood gas measurements on simultaneously drawn arterial blood samples from 48 patients with pulmonary diseases. When the calculated oxygen saturation during exercise was more than 80% there change in oxygen saturation (SEE 1.0%). This non-invasive, simple and rapid method seems to be clinically useful for detecting the development of significant arterial hypoxaemia during exercise in patients with pulmonary diseases.


Treatment of chronic airways obstruction with indomethacin. The effect of indomethacin is reported in five patients with chronic asthma. There was both subjective and objective improvment and, in three of the patients, a reduction in steroid dosage. The results suggest that the drug may be of value in the treatment of this condition.


Erythromycin resistance in neonatal staphylococcal infection: a long-term survey. Twenty years ago staphylococcal infection was a major problem among newborn infants in hospitals. Hygienic measures had not proved very effective and the use of antibiotics, although clearly open to question, seemed a possible method of control. Erythromycin, a new antibiotic effective against staphylococci, had just been introduced but reports from the United States suggested that resistance could occur within months of usage. In trials in two hospitals in which erythromycin was not being used elsewhere, erythromycin resistance developed but took years to do so. The longer the period of usage was extended the greater the resistance. Withdrawal of the drug resulted ultimately in the disappearance of resistance. The resistant staphylococci spread throughout the hospital. The staphylococcal infection rate in the units where erythromycin was used did not fall but the mortality rate from staphylococcal infection did.


Erythromycin and anaerobic infection.

Erythromycin and anaerobic infection. The theoretical basis of the use of erythromycin in peri-operative prophylaxis after bowel surgery will be discussed and the results of the use of erythromycin in such patients and the sensitivity to the antibiotic of isolates from human peritonitis described. This work will be related to results obtained in a rabbit experimental model for the study of peritonitis.


The use of erythromycin in a general practice. It would appear that erythromycin is a safe drug to use in general practice; it is indicated, and has advantages, in the treatment of infections of both the upper and lower respiratory tracts.


[Delinquency in the sniffing-type of toxicomaniacs]. The present investigation has been based on the study of 33 toxicomaniacs (average age 18 yrs 3 mos) who had committed a total of 156 delicts. A high percentage of injury to the central nervous system in infancy (84.8%) and disharmony of family and social environment (81.8% of cases), can be regarded as partially responsible for the low education of the whole group (45.55% of toxicomanics had not completed their basic education, only 18,2% were skilled workmen but also for the affinity to delinquency and toxicomany. The authors recognize two types of delinquency in toxicomaniacs. In the case of so-called purposive delinquency delicts are usually not committed under a direct influence of psychotropic drugs. The purpose is to obtain a new dose of the relevant drug, and the delicts include, e.g. breaking in drug-stores, stealing and falsification of medical prescriptions etc. Non-purposive delinquency of toxicomaniacs includes arson, affray, group delicts, agressive violence etc. Such delicts are committed under the direct influence of psychotropic drugs with the motivation of "harsh play" when the transpassers do not care the consequences of their delict.


[Detalocohol test following the use of deodorants]. The oral deodorants of Czechoslovak production (Dezodor spray, For men spray Carlotherm, Fluora, Herbadent, Polana, Stoma, Viskadon) have been demonstrated to contain 45 to 73.5 vol. per cent of ethylalcohol. After using such oral deodorants the tubes for detecting ethyl-alcohol in exspired air react for periods approximately 5 minutes. Similar results were also obtained by analysing the exspired air by gas chromatography.


Haemolytic anaemia due to erythrocyte pyrimidine 5'-nucleotidase deficiency. Report of the first South African family. The first South African case of haemolytic anaemia due to erythrocyte pyrimidine 5'-nucleotidase deficiency is reported. The anaemia is characterized by the presence of high erythrocyte pyrimidine nucleotide levels and marked basophilic stippling. The enzyme levels in 20 family members confirm an autosomal recessive mode of inheritance and illustrate the difficulty of diagnosing the carrier state.


Talking to patients with arthritis.

Talking to patients with arthritis. Two hundred and fourteen patients attending an arthritis clinic were asked to complete a questionnaire in which their knowledge of medical terms, surface anatomy and rheumatic disease was evaluated. The responses were compared with those from a group of physiotherapists. An average of 50% correct responses was obtained for the whole group, and the educational status of the patients was shown to influence the results. The problem of communication in medicine and its relationship with adherence to therapeutic regimens is briefly discussed.


Gastro-intestinal transit time and serum lipid levels in Black schoolchildren. Gastro-intestinal transit time was measured in 150-200 Black schoolchildren, aged 10-12 years, at each of 3 schools in country areas of South Africa. Pupils were accustomed to a low fat/high crude fibre diet. At each centre, a selection was made of 50 children with fast transit times (9 hours or less), and 50 with relatively slow times (roughly 24 hours or more). Fasting levels of serum cholesterol and triglyceride were determined in these subjects. At two schools there were no significant differences in mean lipid levels between subjects with fast and slow transit: only at the third school were mean lipid levels of pupils slightly, but significantly lower in those with fast transit times. These observations agree with those on White adults, that an increase in intake of fibre-containing foods, and a decrease in transit time, have very little effect on serum lipid levels. The low values in Black children are believed to be due primarily to their low intakes of fat and cholesterol.


Medical management of the trapped patient. This article deals with some of the unique problems encountered when people, injured in road traffic or industrial accidents, are trapped as a result of the accident. Mining accidents are specifically excluded because I have no personal experience of them and also because they occur in circumscribed conditions which the average practitioner does not encounter. Dealing with trapped and seriously injured patients is a very harrowing experience for all concerned, and it is as well to examine factors which contribute to this as it is the doctor who can introduce a measure of calm into these situations.


Adjuvant chemotherapy for breast cancer. Prolonged chemotherapy has been used as an adjuvant to mastectomy in women with involved axillary nodes, in an attempt to ablate or suppress subclinical, micrometastatic disease. The preliminary results and surrounding controversies are reviewed. It is concluded that at this time there is a decreased relapse rate but no increase in survival, and it is in this light that adjuvant chemotherapy cannot be endorsed outside of well-conducted clinical trials.


The role of mastectomy in locally advanced breast cancer. The role of mastectomy in locally advanced breast cancer remains to be established. Experience at the Breast Clinic at the Provincial Hospital, Port Elizabeth, strongly suggests that mastectomy improves local control. The addition of mastectomy to a basic regimen of radiotherapy and adjuvant chemotherapy now forms the basis of a prospective clinical trial.


Breast cancer and hormone receptors: a preliminary report. An assay is available to determine the presence or absence of oestrogen receptors in breast cancer cells. The presence of oestrogen receptors predicts a 60% response rate to empirical hormonal therapy, and the absence a 10% response rate. Early evidence suggests that the additional presence of other hormone receptors in breast cancer cells will improve this response rate.


Malignant melanoma of the skin in Johannesburg Whites. One hundred and thirty patients with malignant melanoma, of whom 108 could be followed up, are reviewed. Malignant melanoma of the skin in South African Whites kills 2,2 per 100 000 population per annum and its incidence increases with age. The tumour was commoner in females, but has a better prognosis than in males. The overall 5-year survival rate was 43% (46 out of 108 patients). The bigger lesions have a worse outlook.


The giant duodenal ulcer syndrome.

The giant duodenal ulcer syndrome. Thirteen patients with giant duodenal ulcer manifested with a distinct clinical syndrome. The condition has a characteristic clinical, radiological and endoscopic presentation. It is associated with a high mortality when treated medically, and constitutes a definite indication for surgery. The giant duodenal ulcer forms a high proportion of duodenal ulcers in a recently urbanized Black community, and may be one of the dramatic and significant presentations of this disease in the developing countries.


Anxiety and the general practitioner--a psychotherapeutic approach. Much of the general practitioner's work is concerned with emotional problems, yet his undergraduate training does not equip him adequately for this purpose. Four theories of personality, each of which has contributed to modern psychotherapeutic practice, are reviewed, with specific reference to their formulations on the causation and treatment of anxiety, and the application of each of these viewpoints to specific problems in general practice. Finally, a plea is made for much greater provision for the teaching of psychology (especially therapeutic psychology) in the undergraduate medical curriculum.


Myelography with a water-soluble contrast medium: a revision of technique and a review of results. Experience with Dimer-X myelography in 3000 patients provides some indication of the scope of examination of the lumbar, thoracic and cervical segments of the spinal canal with a water-soluble contrast medium. Myelography with any contrast medium should only be applied for serious indications, and never as an outpatient procedure, for the patient requires careful after-treatment. However, the routine use of myelography may offer the best insurance against the disappointment and embarrassment of surgery by trial and error. The application of a careful, standardized technique makes it possible to obtain accurate information about the whole spinal canal and to avoid the danger of the false results to which examination with oily media are liable at all levels. The development of ever safer contrast media may help to limit the problem of spinal fibrosis, which is not a rare complication of myelography and spinal surgery.


Health implications of fibre-depleted diets. In many different parts of the world the pattern of diseases has changed or is changing from one mainly of infections to one of degenerative diseases. Simultaneously, alterations in the pattern of diet have occurred or are occurring. A major alteration is depletion of fibre-containing foods of high bulk-forming capacity. Epidemiological evidence, short-term studies on man and experimental investigations on animals suggest that fibre-depleted diets are a major, or perhaps even the basic cause of the increasing prevalence of several degenerative diseases. Although much further research is essential, available evidence warrants recommending an increase in the intake of fibre-containing foods, especially those of cereal origin.


The prevention and treatment of pressure sores in the sitting paraplegic. Pressure sores in the sitting paraplegic patient can delay rehabilitation by weeks or months, or can lead to the patient's permanent confinement to bed. This paper describes a method of redistributing the pressure loading on the sitting area so that pressure sores are unlikely to occur. In addition, a clinical approach which increases the patient's awareness of the problem is outlined and case histories and clinical results are described.


The training and evaluation of clinical nurse, with special reference to paediatrics and child health. There is an urgent need to train nurses to assist with the provision of health services for children in the Republic at a clinical level as opposed to their traditional nursing role. Aspects of paediatric training and evaluation of the clinical nurse are discussed. The need for flexibility in training programmes and in their evaluation, without in any way affecting the minimum standards required by the Nursing Council and the South African Medical and Dental Council, is stressed. Steps should be taken to give recognition to the advanced and primary paediatric clinical nurse by defining her function, training and evaluation, designation and status within the health services and the community.


The transport of dimer-X to the subarachnoid cisterns and convexity of the brain in normal people: case reports. Computerized axial tomographic scans were performed on 7 patients, 3, 8 and 20 hours after lumbar myelography with Dimer-X. This contrast agent was seen in the subarachnoid cisterns 3 and 8 hours after injection, and 24 hours after injection it had completely disappeared.


Austin flint murmur associated with a disc mitral valve prosthesis. A case report. A case is discussed in which the movements of a Björk-Shiley disc valve, inserted in the mitral position, were hampered by an aortic insufficiency. Probably because of the improved haemodynamics after mitral valve replacement, the aortic insufficiency became significant. The regurgitant jet prevented the disc from functioning normally, causing Austin Flint and systolic murmurs as well as a haemolytic anaemia. Echocardiography as a non-invasive examination helped correlate disc movements with opening and closure sounds.


Cerebral aspergillosis: report of two cases. Two cases of cerebral aspergillosis in Tamilians presenting as intracranial space-occupying lesions are reported. The first patient had a left frontal lobe abscess and a specific diagnosis was made by histopathology and isolation of Aspergillus versicolor. He responded well to excision followed by anticonvulsant therapy. In the other, the diagnosis was based on histopathology alone and she died after surgery. These are the first cases reported from Tamil Nadu and probably only one similar case has been reported from India so far.


Trichophyton fischeri sp. nov.: a saprophyte resembling Trichophyton rubrum. A new species Trichophyton fischeri was isolated as a contaminant on blood agar plates. This fungus is believed to be a saprophyte. It may be confused with T. rubrum. On peptone dextrose agar plate, the growth is white and velvety to cottony. It occasionally forms furrows. The underside of the mature colony is brownish red. Clavate microaleuriospores are common. Trichophyton-type macroaleuriospores are produced occasionally on blood agar and potato dextrose agar. Erythritol does not stimulate T. fischeri to produce a red color on casamino erythritol albumen agar. Closterospore-like projections may be produced on the main filaments on peptone dextrose and potato dextrose agar.


Inhibition of isolated yeast and mycelial phase RNA polymerases of Histoplasma capsulatum by rifamycin derivatives. Various derivatives of rifamycin were shown to inhibit the RNA polymerases of the yeast and mycelial phases of Histoplasma capsulatum. The relative potency of each of the derivatives against the isolated polymerases was the same as the potency of each against the viable organism. RNA polymerase PC III from the yeast phase was more susceptible to the rifamycin derivatives than yeast phase polymerases PC I and PC II and the biggest differences in susceptibility were seen with the derivative AF/ABDP (2,6-dimethyl-4-benzyl-4-demethyl-rifamycin). The susceptibility pattern of the mycelial polymerase activity was identical to the yeast polymerase PC III.


Role of bats in the ecology of Paracoccidioides brasiliensis: the survival of Paracoccidioides brasiliensis in the intestinal tract of frugivorous bat, Artibeus lituratus. The fruit-eating bat, Artibeus lituratus, was fed known quantities of viable yeast cells and mycelial particles of Paracoccidioides brasiliensis in an attempt to assess the role of this animal in the distribution of this agent in nature. Results of mycosal cultures of the stomach, upper intestine, lower intestine and rectum clearly showed that the fungal cells were unable to survive more than 8 hours in the digestive tract of the bat. The mycelial particles were more susceptible than the yeast and were killed before passing to the rectum. The fungus died rapidly in the voided fecal material. These findings indicate the improbability of isolating P. brasiliensis from the digestive tract of wild captured bats and show that A. lituratus probably plays no role in the distribution of this fungus in nature.


Cell wall analysis of an adenine-requiring mutant of the yeast-like form of Paracoccidioides brasiliensis strain IVIC Pb9. An adenine-requiring mutant of Paracoccidioides brasiliensis strain IVIC Pb9 was isolated after treatment of the yeast-like (Y) form with nitrosoguanidine. Cell wall analysis of this mutant (strain IVIC Pb141) showed an increase in the amount of alpha-1,3-glucan and a virtual disappearance of the antigenic galactomannan. At the same time, a higher degree of virulence was observed for the mutant. These results agree with the hypothesis presented before (16) about a relationship between cell wall polysaccharides and pathogenicity in P. brasiliensis.


A clinical study of Pityriasis versicolor in Madras. One hundred subjects with extensive pityriasis versicolor determined clinically and confirmed by wet preparations (potassium hydroxide positive) were studied. Its incidence in relation to sex, seasons and age groups was analyzed. More than fifty patients sought medical advice on grounds of cosmetic handicap. The most pronounced clinical feature was to be found on the trunk. One case was Confluent and Reticulated Papillomatosis of Gugerot-Carteaud (CRP) (16). Among the factors of susceptibility, pulmonary tuberculosis (P.T.) emerged statistically significant.


Enigmatic relationship of two Microsporum species. Unusual cultures of a Microsporum species were isolated from eleven patients who had either tinea capitis or tinea corporis or both. Although the macroconidia produced in the primary cultures resembled those of M. canis, hyphal morphology and colony characteristics were different from any of the more commonly occurring Microsporum species. Careful examination of subcultures showed that the isolates were composed of two species; M. canis and M. distortum, whose relationship remains enigmatic.


Expression of androgen-responsive properties in human skin fibroblast strains of genital and nongenital origin. Specific 5alpha-dihydrotestosterone (DHT) binding capacity (Bmax) has been determined for human skin fibroblast strains from non-genital areas of males and females (N = 8), as well as prepuce and labium majus (N = 9). Genital strains had a mean three times that of non-genital ones (32 vs. 11 fmol/mg cell protein). There were no sex differences. Variation among strains was not simply correlated with donor age; that within strains was unrelated to in vitro age. The lowest values for genital strains overlapped the nongenital ones; those of the nongenital strains approached the limit of detectability. These results parallel those for delta4-3-ketosteroid 5alpha-reductase activity. Thus, serially cultured genital and nongenital skin fibroblasts express their relative differentiative ancestry as androgen target cells. This expression may affect the diagnosis of androgen insensitivity and certain inborn errors of metabolism; its variability is discussed in terms of clonal heterogeneity.


Chromosome stability in CHO cells.

Chromosome stability in CHO cells. The established cell line derived many years ago from Chinese hamster ovary (CHO cells) has been studied for the extent of chromosomal variation. Because this cell line is used extensively for genetic studies, the contribution of chromosome variability to genetic variability has also been examined. The quasidiploid CHO cells were found to have a banded karyotype somewhat altered from that of the Chinese hamster from which the line was derived. However, most of the genome could be accounted for among the rearranged marker chromosomes. In addition, the CHO line was found to have a relatively stable karyotype, the same basic karyotype being found in a majority of the uncloned cells, as well as in most cells of several but not all independent clones. Many, but not all, mutant cell lines derived from CHO also showed the same basic karyotype. Quasitetraploid cells, derived either spontaneously or by Sendai-virus-induced fusion, showed considerably more variation resulting in loss or gain of whole chromosomes, rearrangement of chromosomes, and appearance of new "marker" chromosomes.


Mitotic segregation of cytoplasmic determinants for chloramphenicol resistance in mammalian cells II: Fusions with human cell lines. Cytoplasmically inherited chloramphenicol (CAP) resistance in human cells has been used to study the interaction between sensitive and resistant mitochondria. Cybrids between two HeLa cells were stable for resistance, grew rapidly and cloned well in CAP, and were O2 tolerant. HeLa-HeLa hybrids were also stable up to 70 doublings in the absence of CAP. Cybrids between HeLa and WI-L2 cells were unstable for resistance for up to 40 doublings, grew slowly and cloned poorly in CAP, and were O2 sensitive (S phase). The growth rate then increased and the cells became stable for resistance, cloned well, and were not O2 sensitive (F phase). Doubling time for S but not F phase cells was proportional to CAP concentration, indicating that both kinds of mitochondria were present and functioning. The instability of CAP resistance in many interstrain but not in intrastrain mouse and human cybrids and hybrids is interpreted in relation to lower eukaryotes.


Complementation between mutants of CHO cells resistant to a variety of plant lectins. Chinese hamster cell mutants resistant to the lectins PHA, WGA, RIC, LCA, and CON A were previously grouped into 8--10 distinct phenotypes on the basis of their unique patterns of lectin resistance and lectin-binding properties. All but one of these classes of lectin-resistant (LecR) mutants behave recessively in somatic cell hybrids. One ricin-resistant class (RicRII) behaves dominantly. Tests for complementation, by measuring the lectin-resistant properties of appropriate hybrids, show that seven distinct complimentation groups can be delineated among the phenotypically recessive mutants.


Genetics of cell-surface antigens: regional mapping of three components of the human cell-surface antigen complex, AL, on chromosome 11. Cytogenetic analysis has been performed on a series of deletion mutations on human chromosome 11 of AL hybrid clones in which specific markers have been lost as a result of treatment with mutagenic agents. Such analysis has localized the three previously identified components of the AL cell-surface antigen complex to the indicated regions of chromosome 11: a1 and a3:11p13 leads to 11pter; a2:11q13 leads to 11qter. Using these methodologies human lactic dehydrogenase A localization on the short arm as reported by others has been confirmed. Evidence is presented provisionally assigning this gene to 11p13 leads to 11pter.


Chemically facilitated microinjection of proteins into intact monolayers of tissue culture cells. Microinjection of physiologic quantities of macromolecules into tissue culture cells can facilitate the study of the biological effects of such macromolecules. In this communication, we describe a chemical technique which can be used to microinject proteins into monolayers of intact cells. Protein is loaded into erthrocyte ghosts, and the ghosts are then fused to the monolayer with polyethylene glycol 1000. Receipient cells can be injected with an efficiency of greater than 90% and contain an average of 3.8 X 10(6) microinjected molecules per cell. This technique circumvents certain problems encountered in virus-induced microinjection.


Carbomycin resistance in mouse L cells.

Carbomycin resistance in mouse L cells. A mutant has been isolated from the mouse cell line LM(TK-) which is stably resistant to the macrolide antibiotic, carbomycin. Mitochondrial protein synthesis in this mutant was carbomycin resistant and chloramphenicol sensitive. Fusions between carbomycin-resistant and -sensitive cells produced hybrids, most of which were sensitive to 10 microgram/ml carbomycin. At 7.5 microgram carbomycin/ml, the average population resistance is low initially but increases with time. Carbomycin-resistant cells were enucleated and fused with carbomycin-sensitive cells under a variety of selective regimes designed to allow growth of carbomycin-resistant cytoplasmic hybrids (cybrids). No transfer of carbomycin resistance via the cytoplasm was detected. Karyoplasts from carbomycin-resistant cells showed a low transfer of resistance to 7.5 microgram carbomycin/ml in karyoplast-cell fusions. Carbomycin resistance in this mutant is therefore most likely encoded in a nuclear gene.


Regional mapping of human genes for hexosaminidase B and diphtheria toxin sensitivity on chromosome 5 using mouse X human hybrid cells. Mouse 3T3 (TK-) cells were fused to human leukocytes containing a balanced translocation [ins(3;5) (q27;q13q15)] in which part of the long arm of a chromosome 5 has been inserted into the long arm of a chromosome 3. Two independent, primary hybrid clones (XVI-10C;XVI-18A) retained the deleted chromosome 5 [del(5) (q13q15)] translocation product and were informative for regional mapping on chromosome 5 of genes involved in expression of hexosaminidase B (HEXB) and diphtheria toxin sensitivity (DTS). Both XVI-10C and XVI-18A clones were sensitive to diphtheria toxin. Toxin-resistant derivatives of these clones (XVI-10C DTR; XVI-18A DTR) were analyzed for chromosome content and expression of Hex B activity, as were XVI-10C and XVI-18A cells which had not been exposed to diphtheria toxin. The results of this study provide evidence for localization of DTS to region 5q15 leads to 5 qter on the long arm of chromosome 5, and localization of HEXB to region 5pter leads to 5q13.


Effects of thymidine analogs on Syrian hamster melanoma cells: phenotypes arising from selection for analog resistance. In order to compare the biological effects of different thymidine (dT) analogs, two unusual cell lines (B-4 and HAB) previously isolated from a Syrian hamster melanoma line by selection with 5-bromodeoxyuridine (BrdU) were analyzed for their response to other analogs. B-4 cells require high concentrations of BrdU for optimal growth, and it was seen that the requirement for BrdU could be satisfied partially by 5-chlorodeoxyuridine (CldU) but not by the other dT analogs tested. HAB cells are able to grow with all the dT residues in nuclear DNA replaced by BrdU, and it was found that they could also grow with essentially all the dT residues in nuclear DNA replaced by CldU but not by other analogs. New cell lines resistant to 100 micrometer concentrations of CldU, 5-iododeoxyuridine (IdU), and 5-hydroxymethyldeoxyuridine (HMdU) were isolated from the melanoma line and tested for cross-resistance to the other dT analogs. A high level of cross-resistance was observed only with BrdU and CldU. The ability of the cell lines resistant to BrdU, CldU, and IdU to incorporate these analogs into nuclear DNA also was determined. BrdU and CldU were incorporated efficiently by all of the lines tested, but the IdU-resistant cells seemed to preferentially exclude IdU.


Lung involvement in Hodgkin's disease.

Lung involvement in Hodgkin's disease. Lung involvement occurred in 43% of 284 patients with Hodgkin's disease in Nottingham during 1960-75. It was commoner than pleural, hilar or mediastinal node involvement, although over three-quarters of patients with any other thoracic manifestation subsequently developed pulmonary involvement. The patients with pulmonary involvement contained significantly fewer with the histological feature of lymphocyte predominance. The commonest radiographic type, peribronchial infiltration, tended to occur early in the course of the disease while less common types, homogeneous or pneumonic infiltrates and nodules, occurred later. Modern chemotherapy was very effective in the treatment of pulmonary Hodgkin's disease. Since two-thirds of the patients who developed lung involvement already had stage IIIB or IV disease, the early use of chemotherapy should reduce the incidence of this common complication.


Intracavity suction and drainage in the treatment of emphysematous bullae. Patients with large intrapulmonary emphysematous bullae present a considerable therapeutic problem, particularly if their respiratory reserve is low, because of the risks of open operation. The method of draining intrapulmonary cavities, pioneered by Monaldi for the treatment of tuberculosis, is here described as applied to emphysematous bullae. Thirty-one patients were treated by intracavity suction and drainage. There were two operative deaths (6.5%). Apart from infection, no other significant postoperative complications ensued. Radiographic improvement occurred in all patients but one (96.7%). Where forced expiratory volume in one second and vital capacity were measured improvement was obtained in five out of six patients. Symptomatic improvement, which generally corresponded well to improvement in respiratory function tests, occurred in 28 patients (90.3%), all but one of whom survived.


Pulmonary hypertension in mitral valve disease: 56 surgical patients reviewed. A total of 392 patients have undergone prosthetic valve surgery including the mitral valve over a four-year period (1972-76). Of these patients 56 (14%) had a pulmonary artery systolic pressure of 70 mmHg or more during preoperative cardiac catheterisation and the hospital mortality of this group was 5.4%. Similarly, the hospital mortality of the remaining 336 patients with a pulmonary artery pressure below 70 mmHg was 5.4%. The presence of pulmonary hypertension in patients with valve disease including the mitral valve does not therefore indicate that the risk of dying in hospital as a consequence of corrective surgery is increased. The absence of a raised hospital mortality in this recent series may be attributed to improved surgical techniques and materials, while the use of droperidol and pentolinium which may reduce pulmonary vascular resistance as well as systemic resistance during surgery could be contributory.


Oesophageal reconstruction for complete stenosis due to dystrophic epidermolysis bullosa. Oesophageal involvement in epidermolysis bullosa is discussed. Two patients, a brother and sister, with stricture of the oesophagus due to the disease are described. The strictures were treated by resection and end-to-end oesophageal anastomosis and the patients have been relieved of dysphagia for the subsequent three years.


A study of pulmonary artery pressure, electrocardiography, and mechanocardiography in thoracic scoliosis. Cardiac catheterisation was carried out in 40 patients with thoracic scoliosis in order to measure the pulmonary artery pressure. Statistical correlations were calculated between these results and the electrocardiographic and mechanocardiographic findings determined on a separate occasion. The pulmonary artery pressure was normal in 72% of subjects. It was inversely correlated with arterial oxygen tension but not with the aetiology, severity, or age at onset of the scoliosis. The accuracy of electrocardiography and mechanocardiography in predicting the pulmonary artery pressure was assessed. The closet correlates were found to be a tall P wave in lead II or III and a prolonged interval between pulmonary valve closure and tricuspid valve opening.


Exertion of stairclimbing in normal subjects and in patients with chronic obstructive bronchitis. The exertion of stairclimbing has been studied in 10 normal young men, 10 healthy middle-aged men, and 10 middle-aged men with chronic bronchitis. Subjects climbed a staircase with a total vertical ascent of 40.8 m. They were allowed to adopt the most comfortable pattern of ascent, the patients having to stop at intervales for rest pauses. Work rate was determined by timing the raising body weight over measured sections of the staircase. Perception of exertion estimated with a numerical scale, heart rate, and increase of blood lactate concentration were closely similar in all three groups at the top of the staircase. In the patients, average power output was directly dependent on lung function, as indicated by the forced expired volume in 1 second. Stairclimbing offers a simple way of studying a patient's spontaneous activity pattern in a 'real life' environment. Studies of the kind described here could usefully complement formal exercise testing in the laboratory.


Ventilation and perfusion scans in the preoperative assessment of bronchial carcinoma. Ventilation (krypton -81m) and perfusion (technetium -99m) lung scans were obtained in a consecutive series of 21 patients shortly before thoracotomy for proven or suspected carcinoma of the bronchus. In most patients ventilation and perfusion were impaired equally and the scan abnormality corresponded to the bronchoscopic and radiological findings. Unexpectedly large defects in the perfusion scan were seen in three patients, all of whom had extensive neoplastic involvement of the mediastinum at thoracotomy, but 11 other patients had mediastinal involvement which was not suspected from the scan. Ventilation scanning was useful in the prediction of postoperative ventilatory capacity in two patients who underwent pneumonectomy. We conclude that ventilation and perfusion scans are not sensitive indicators of neoplastic involvement of the mediastinum but they are valuable for the prediction of postoperative lung function.


Studies with live attenuated influenza virus in chronic bronchitis. The use of live, recombinant virus for immunisation against influenza produced a number of respiratory illnesses, some severe, in patients with chronic obstructive airways disease. These patients are probably more susceptible to the influenza virus than are normal subjects. Special care will be needed in testing these viruses on patients with respiratory disease.


Total bypass of the oesophagus for benign strictures using a reversed gastric tube. Four cases of benign stricture of the oesophagus treated by reversed gastric tube oesophagoplasty are presented. The technique used is described in detail, and the advantages of this method over other ways of bypassing the oesophagus are discussed. The most important advantage is the restoration of normal deglutition with only one extrathoracic anasthomosis.


Bronchial secretion from normal human airways after inhalation of prostaglandin F2alpha, acetylcholine, histamine, and citric acid. Sputum produced by normal subjects after inhalation of prostaglandin F2alpha, acetylcholine, histamine, and citric acid has been analysed. Prostaglandin F2alpha was the most effective of the drugs in promoting sputum production. The material expectorated after inhalation of prostaglandin F2alpha shows the characteristics of mucoid sputum from patients with chronic bronchitis. The apparent viscosity and the concentration of marker substances for bronchial glycoprotein was in the lower part of the range found in mucoid chronic bronchitic sputum. The concentration of marker substances for serum glycoproteins and tissue fluid transudate were below the range found in chronic bronchitis, indicating that, in disease states, in addition to bronchial mucus there is a marked tissue fluid transudate component. Sputum produced after inhalation of acetylcholine and histamine contained relatively more tissue fluid transudate than sputum produced after inhalation of prostaglandin F2alpha, Sputum produced after inhalation of prostaglandin F2alpha, is of special value in indicating the nature of secretion from normal airways.


A re-evaluation of antibiotic sterilisation of heart valve allografts. Six different mixtures of antibiotics used for treating heart valve allografts at the National Heart Hospital have been compared and the formulation of the medium in current use is described. The abilities of antibiotic-resistant bacteria, and of fungi with low sensitivities to antifungal agents, to survive treatment are also described. These abilities emphasise the need for routine microbiological screening of every valve.


Delayed non-mycotic false aneurysm of ascending aortic cannulation site. Two cases of delayed non-mycotic false aneurysm arising from ascending aortic cannulation site, presenting one-and-a-hald years and seven years after cardiopulmonary bypass, are described. These two cases represent an incidence of 0.12% of this complication. Repair using profound hypothermia and circulatory arrest with femoral artery and femoral vein cannulation for cardiopulmonary bypass is recommended. The advantages and complications of aortic cannulation are discussed and recommendations to minimise the complications of cannulation are made. The clinical presentation and diagnosis of non-mycotic false aneurysms arising from the aortic cannulation site are described. In addition one delayed and two early cases of non-mycotic cannulation site false aneurysms previously published are analysed. Surgeons should be alert to the possibility of this complication in all patients who have had aortic cannulation for cardiopulmonary bypass even in the distant past. Unexpected symptoms such as constant anterior chest pain, dysphagia, hoarseness, and increasing widening of the superior mediastinum on the chest radiograph warrant prompt investigation.


Incidence of decompression-induced pulmonary haemorrhage in young and old rats. Seventeen young rats (40-52 days of age) and 17 old rats (545-702 days of age) were decompressed from one atmospheric pressure to an ambient pressure of 30 mmHg in 0.25 second. It was found that 11 of 34 young lungs (32%) and 23 of 34 old lungs (68%) showed decompression-induced pulmonary haemorrhage. The difference was statistically significant. The pulmonary haemorrhage of the old rats was markedly more severe than that of the young rats.


Second closed mitral valvotomy for recurrent mitral stenosis. Sixty-seven patients undergoing a second closed mitral valvotomy between 1957 and 1974 have been reviewed. Since 1951, 510 patients have had a primary closed valvotomy in the same unit. The incidence of restenosis severe enough to warrant further surgery is higher after a finger fracture procedure (40%) than after a Tubbs dilator valvotomy (9.2%). There is an operative mortality of 10.4%, and a further late mortality of 23.8% after a second closed valvotomy. Of the surviving patients, 70.5% have had a good or excellent result. The group with poor results is characterised by the presence of a calcified fixed valve, making valvotomy difficult and incomplete. In the presence of a non-calcified valve, a second valvotomy still has a place when surgery for restenosis is required.


Familial pulmonary veno-occlusive disease: a case report. A case of pulmonary veno-occlusive disease in a male infant who died at the age of 3 months is presented. Both intra- and extrapulmonary veins were involved. Two years earlier a brother had died of the same disease at the age of 8 weeks, but, in that case, the disease was restricted to the intrapulmonary veins. It is suggested that the disease may have been caused by a viral infection, the mother acting as a carrier. The simultaneous occurrence of intra- and extraparenchymal pulmonary vein occlusion indicates that some instances of isolated extraparenchymal pulmonary vein atresia or obstruction may also have been examples of pulmonary veno-occlusive disease.


Progressive systemic sclerosis complicated by diffuse pulmonary haemorrhage. A case is reported of progressive systemic sclerosis with pulmonary fibrosis which was complicated by recurrent haemoptyses due to diffuse pulmonary haemorrhage. We have found no other report of this association. The haemorrhage finally remitted after treatment was started with 40 mg prednisone daily, though previously spontaneous remissions had occurred.


Carcinoid tumour of possible thymic origin: case report. A case of carcinoid tumour of possible thymic origin in a 43-year-old man is presented. Carcinoid tumour arising in the anterior mediastinum (thymus) is a rare condition and only 26 cases have been reported in the past. A review of the literature showed that three-quarters of the reported cases were asymptomatic but the remainder of patients presented with various endocrine symptoms. Ultrastructurally the thymic carcinoid is similar to those found in other organs and also appears to be derived from Kultschitsky cells of the thymus gland.


Permanent right ventricular pacing through an anomalous left superior vena cava. A persistent left superior vena cava can complicate the implantation of a transvenous pacemaker. In a patient who required a permanent pacemaker, this venous anomaly was discovered during the insertion of the electrode but it did not prevent long-term right ventricular pacing. This was achieved after the electrode had been manipulated through the coronary sinus and right atrium. A plan of management is proposed for dealing with this unexpected problem.


[Functional examination findings after parietal pleurectomy in patients with recurrent of spontaneous pneumothorax (author's transl)]. Eight patients with recurrent of spontaneous pneumothorax were re-examined sixteen months or more after a total parietal pleurectomy had been carried out. This re-examination included: 1. Detailed case history with emphasis on physical performance; 2. clinical findings; 3. Thorax x-ray at two planes; 4. Lungscintigraphy; 5. Spirometry. Following parietal pleurectomy, none of the patients exhibited any functional disturbance worthy of mention. This operative technique, perhaps modified as a partial parietal pleurectomy, can be recommended at this time as the method of choice for treating recurrent spontaneous pneumothorax.


[Transvenous extraction of venous katheter by Simmons-katheter (sidewinder I) (author's transl)]. Report about successful extraction of cutoff embolised venous katheter from V. jugularis with help of a SIMMONS-catheter. Further possibilities of use of superselective arteriography catheters in this connection are mentioned.


[Implantation of formalin-preserved umbilical veins as dialysis shunts--a new method of allogenic blood vessel graft (author's transl)]. Allogenous venous umbilical implants can be used for successful vascular reconstructions and for the establishment of dialysis shunts. Presently 15 patients were treated with venous umbilical implants, in two of which a thrombosis of the implant occurred, one of them showed slight dilatation. In the case of dialysis shunts, implants serve exceptionally well. Especially the fixation in formalin can be especially recommended for preservation due to the fact that the umbilical veins can be obtained under non-sterile conditions, the immunological rejections are omitted. According to the present observations the mechanical properties are favourably influenced. At the time of the operation the umbilical veins do not possess an endothelium, nevertheless their functions are thereby affected. The results up to present time are favourable, nevertheless further investigations are necessitated.


[Artery end to end anastomoses with screw-dense-fixation-rings (author's transl)]. In study of screw-dense-fixation-ring method in 15 cases of a dog's femoral artery, end to end, was reconstructed. The anastomoses is achieved by vessels of 3 - 6 mm diameter. Within a period of 1 - 6 months post-operatively, average of 3 months, angiographic control of all cases showed no complications such as aneurysm or stricture. The construction of screw-dense-fixation-ring seems to give a considerable result, because the power which is keeping the rings together, can be controlled.


[Postoperative control of blood flow in arterial surgery: results of electromagnetic blood flow measurement (author's transl)]. An electromagnetic blood flow cuff probe was implanted up to 4 days in 50 patients to control basal blood flow through a femoro-popliteal vein graft. Patent grafts showed increasing blood flow due to hyperemia with maximum on the 2. p. op. day. The level of the postoperative hyperemia and the increase of blood flow caused by intraarterial papaverine injection during operation were in the same range. The method and the extension of analgesia influenced the degree of postoperative hyperemia. Pain and blood loss diminuished graft flow. Patients with epidural block and sufficient blood volume produced a significant higher graft flow than patients with morphine analgesia. 2 patients had early occlusion of the graft, 2 others showed occlusion at the distal anastomosis. These complications could be easily detected by blood flow measurement and were successfully corrected in two patients. Moreover, electromagnetic postoperative blood flow control may be helpful in patients with proximal a.v. shunt for hemodialysis.


[Partial anomalous right pulmonary venous return into the coronary sinus without atrial septal defect (author's transl)]. Drainage of right pulmonary vein into the coronary sinus. A case of anomalous drainage of the right pulmonary vein into the coronary sinus in a boy of 6 years is presented. There was no associated atrial septal defect. Flow from the right pulmonary vein was directed into the left atrium by using a teflon patch, while maintaining coronary venous return to the right atrium.


[Loss of thrombocytes in heart surgery with membrane and bubble oxygenators (author's transl)]. Thrombocyte levels of patients undergoing open heart surgery were studied to compare effects of a bubble with a membrane oxygenator. Loss of platelets, which is not explained by hemodilution, is smaller in membrane oxygenation and normal level of platelets is readily established postoperatively compared to conventional bubble oxygenation.


[Diagnosis and surgical treatment of aneurysms of the sinus of Valsalva (author's transl)]. Among a total of 6000 patients of the Herzchirurgische Klinik of the University of Munich, 16 patients had an aneurysm of the sinus of Valsalva. Mostly, this was localized in the right sinus, less often in the non-coronary sinus, and only in one case in the left sinus. In 9 patients the aneurysm had ruptured into the right ventricle or into the right atrium. In 2/3 of the cases the aneurysm was associated with a VSD or an acquired malformation of the aortic valve. The diagnosis in part was based on the typical history with a sudden begin of cardiac symptoms secondary to rupture of the aneurysm; however, the most useful diagnostic procedure was the heart catheterization including an angiogram of the aortic root. Surgical treatment led to good early and late results; there was a low operative risk, and complications were rare; however, the prognosis may be less favorable in the presence of an acquired malformation of the aortic valve.


[Cardioplegia according to Bretschneider for valve replacement: clinical experiences and electronmicroscopical results (author's transl)]. We report about clinical experiences with the cardioplegia according to Bretschneider combined with deep selective hypothermia of the heart in 44 patients. Before, during and after cardioplegia we made biopsies from the left ventricle of 6 patients for electronmicroscopical examinations. Besides the mitochondrial changes already known we saw a break-down of the nexuses. We discuss the importance if these changes for the action of the cardioplegia. Both changes seemed to be reversible. The clinical results and the immediate and later postoperative follow-up demonstrate, that with the described technique a good myocardial protection can be done. This procedure allows operating with a low risk at a completely arrested and relaxed heart until 130 minutes.


The dependence of finger tip touch-pressure upon the condition of Braille reading. The finger motions and quickness of braille reading were investigated by way of recording the finger tip pressure on the braille and its time process. Subjects were separated into two groups. One group consisted of 5 experienced blinds and the other group consisted of 5 blinds who were beginners in braille reading. The comparison of obtained results from two groups gave some evidence for the following conclusion. The finger tip pressure was considerably increased for careful or difficult reading.


A patient with recurrent hepatic encephalopathy and chronic renal failure treated successfully with long-term hemodialysis. A 38-year-old man suffering from chronic recurrent hepatic enchephalopathy due to liver cirrhosis complicated with chronic renal failure had been maintained well by regular hemodialysis treatment for 14 months. Only four episodes of hepatic encephalopathy occurred in that period. Each of four episodes of disturbed consciousness was accompanied by slightly elevated blood ammonia levels. Energetic serial dialysis for 5-7 days was necessary for its recovery. The factors causing hepatic encephalopathy did not appear to be easily dialysable as compared with those of uremic coma. It is concluded that the hemodialysis is quite an effective treatment for the recurrent type of hepatic encephalopathy.


Serial alveolography-preliminary report. Serial alveolography using a contrast medium for indirect lymphography was developed at our department. With this technique radiograms comparable to so-called barium-imbibed preparations of resected lung are possible. Furthermore, the procedure has the advantage of demonstrating serial radiographic changes as well as the local contrast medium wash-out or clearance, a local functional aspect of the lung, successively in a very short time. It is practical to accomplish simultaneous examinations in both morphological and functional (most probably concerned with the local pulmonary lymph) aspects with the new procedure. Significant differences in radiographic features have been demonstrated between the normal lung and chronic pulmonary emphysema or fibrotic pulmonary diseases.


Association of human leukocyte antigen (HLA)-B5 and -BW22-J with hepatic cirrhosis of apparently unknown etiology. The majority of patients with hepatic cirrhosis in Japan do not have a history of acute hepatitis or alcoholism. Twenty-nine patients with hepatic cirrhosis which were thought as random samples from cirrhotic patients without a history of acute hepatitis or alcoholism were Human Leukocyte Antigen (HLA) typed. Association of HLA-B5 and -BW22-J with hepatic cirrhosis of apparently unknown etiology was found in p less than 0.003, and p less than 0.01, respectively (128 controls). A predisposition linked to HLA-B5 or -BW22-J related gene or genes seems to play a role in the development of hepatic cirrhosis, at least in a substantial part of patients with hepatic cirrhosis of apparently unknown etiology in Japan.


Serum zinc and copper levels in healthy Japanese infants. The serum zinc and copper concentrations were measured in 45 healthy Japanese infants with age ranging from 5 days to 12 months. At one month of age there was a significant decrease in serum zinc concentration, and this low level persisted until 6 months of age when a significant increase in serum zinc concentration was observed. Serum zinc concentrations remained relatively stable between 6 and 12 months of age. The concentration of serum copper in newborn infants was significantly lower than in healthy children (age: 6 to 12 years), but had risen by 5 months of age to the same levels. There were no significant differences in serum zinc and copper concentrations between male and female infants. However, there was a tendency for serum zinc levels in exclusively breastfed infants to be higher than those in bottlefed infants at 3 months of age and for serum copper levels in exclusively or partially breastfed infants to be higher than those in bottlefed infants at one month of age.


Effects of 1-Sar-8-Ile-angiotensin II on urinary prostaglandin excretion in patients with essential hypertension. To investigate the interaction between the renin angiotensin aldosterone system and the renal prostaglandin (PG), urinary excretion of PGE, urinary excretion of main urinary metabolite (MUM) of PGF2a, urinary excretion of aldosterone, and plasma renin activity were measured before and after infusion of 1-Sar-8-Ile-Angiotensin II, a specific competitive inhibitor of angiotensin II, in 18 patients with essential hypertension under normal and low sodium diets. The values of urinary sodium excretion in these patients before the infusion of the peptide were 160.8 +/- 13.3 and 27.0 +/- 2.7 mEq per day on normal and low sodium diet, respectively. On normal sodium diet, urinary excretion of PGE was found to correlate with the level of plasma renin activity before the infusion (r = 0.6977, p less than 0.01), and it was decreased slightly from 0.37 +/- 0.05 ng/min to 0.26 +/- 0.04 ng/min after the infusion of the antagonist. On low sodium diet, urinary excretion of PGE was not significantly changed by the infusion of the peptide and showed no correlation with the level of plasma renin activity before the infusion, while urinary excretion of PGE showed a significant correlation with the excretion of urinary aldosterone (r = 0.6719, p less than 0.02). Excretion of PGF2aMUM decreased after the infusion of this peptide on both sodium diets, but the changes were not statistically significant. The present data suggest that angiotensin II influences the synthesis or release of renal PG in patients with essential hypertension on normal sodium diet, but not when they are on low sodium diet.