Antibody response of young adults to experimental influenza A/New Jersey/76 virus vaccines. In military personnel aged 17-25 years, only one of four experimental influenza A/New Jersey/76 virus vaccines produced a satisfactory hemagglutination-inhibiting (HAI) antibody response when a dose of 200 chick cell-agglutinating (CCA) units was used. A second injection of 400 CCA units of vaccine caused seroconversion in all persons. Although an early comparison of experimental split-product and whole-virus vaccines suggested that the former were relatively ineffective, a later comparison with different lots of the vaccines showed no difference between vaccines of these two types. The influenza A/NJ/76 virus vaccine evoked a high HAI antibody response to influenza A/PR/8/34 (H0N1) virus but not to H1N1 or H3N2 strains.


The immunizing effect of influenza A/New Jersey/76 (Hsw1N1) virus vaccine administered intradermally and intramuscularly to adults. 2The immunogenicity and reactogenicity of inactivated influenza A/New Jersey/76 (Hsw1N1) whole-virus vaccine administered intradermally (40 chick cell-agglutinating units/0.1-ml dose) and intramuscularly (im; 200 chick cell-agglutinating units/0.5-ml dose) to human adults were evaluated. Among 18-24-year-old persons initially free of detectable antibody, intradermal vaccination induced lower titers of hemagglutination-inhibiting antibodies than did im vaccination, and a sequence of intradermal and im vaccinations did not offer any serologic advantage over one im dose. In contrast, persons over the age of 24 who initially lacked detectable antibody had as good a serologic response to intradermal vaccination as to im vaccination. Among individuals who had antibody before vaccination, immunization by either route induced greater increases in titers of hemagglutination-inhibiting antibody than occurred in initially antibody-negative persons, even when the latter were given two doses of vaccine. Somewhat fewer systemic reactions occurred after intradermal than after im vaccination, but the intradermal route was associated with local reactions in almost all vaccinees and with some residual pigmentary changes. These results suggest that intradermal vaccination should be used only in very selected circumstances.


Comparison of the hemagglutination-inhibiting and neutralizing antibody responses of volunteers given 400 chick cell-agglutinating units of influenza A/New Jersey/76 split-virus vaccine. Thirty-two volunteers 25 years of age or older who were employees of the Laboratory of Infectious Diseases (National Institute of Allergy and Infectious Diseases, Bethesda, Md.) were given 400 chick cell-agglutinating units of influenza A/New Jersey/76 virus vaccine (Wyeth Laboratories, Philadelphia, Pa.) intramuscularly. Sera were assayed for hemagglutination-inhibiting (HAI) and neutralizing antibody before and after inoculation. All 32 subjects had a fourfold rise in titer of HAI antibody, and 25 of 32 had a similar rise in titer of neutralizing antibody. The average log2 rise was 4.5 for HAI antibody and 4.1 for neutralizing antibody. Therefore, this vaccine is believed to be capable of stimulating HAI and neutralizing antibodies to an equal extent.


Acceptibility and antigenicity of influenza A/Victoria/75 virus vaccines in adults of different ages. Influenza A/Victoria/75 virus vaccines were tested for acceptability and antigenicity in adults of different ages. Whole-virus vaccines prepared by Merck Sharp and Dohme (West Point, Pa.) and Merrell-National Laboratories (Cincinnati, Ohio) and subunit vaccines prepared by Parke, Davis and Company (Detroit, Mich.) and Wyeth Laboratories (Philadelphia, Pa.) were given intramuscularly in concentrations of 800, 400, or 200 chick cell-agglutinating units per dose. Systemic and local side effects of all vaccine preparations were negligible. In volunteers with low or absent (less than or equal to 10) titers of hemagglutination-inhibiting antibody before vaccination, titers of greater than or equal to 40 were attained after vaccination in 43%-67%, 40%-58%, and 20%-38% of volunteers receiving the 800, 400, and 200 chick cell-agglutinating unit preparations, respectively.


Serologic responses after two sequential doses of influenza A/New Jersey/76 virus vaccine in normal young adults. The serologic responses after two sequential nonreactive doses of either chemically disrupted or whole-virus influenza A/New Jersey/76 virus vaccine were evaluated in 112 normal young adults. In general, levels of hemagglutination-inhibiting (HAI) antibody were low after the first dose of vaccine and increased significantly (P less than 0.05) in response to a second dose. Whereas one dose of the preparation from Merck Sharp and Dohme (West Point, Pa.) effectively vaccinated this population, two doses of the vaccines prepared by Parke, Davis and Company (Detroit, Mich.) and Merrell-National Laboratories (Cincinnati, Ohio) were required to produce a similar serologic response. The preparation from Wyeth Laboratories (Philadelphia, Pa.) produced low levels of HAI antibodies even after two doses. These different serologic responses correlated with the viral hemagglutinin content of each vaccine.


Sequential immunization of laboratory personnel with influenza A/New Jersey/76 split- and whole-virus vaccines. One hundred thirty-three healthy, at-risk Fort Detrick laboratory workers were inoculated with 400 chick cell-agglutinating (CCA) units of influenza A/New Jersey/76 split-virus vaccine (Wyeth Laboratories, Philadelphia, Pa.). Systemic and local reactions were infrequent, mild, and comparable to those of a sham-vaccinated group of volunteers. Only 28% of subjects 19-24 years old developed titers of hemagglutination-inhibiting (HAI) antibody of greater than or equal to 1:20, whereas titers of 91%-100% of subjects 25-62 years old reached this level. Thirty-one vaccinated subjects with no or low titers of antibody were given a booster dose (400 CCA units) of Wyeth vaccine six weeks after the first inoculation. Only 58%-67% of these vaccinees achieved HAI titers of greater than or equal to 1:20 after the booster. Fourteen persons required a second booster dose for protection; after vaccination with 400 CCA units of whole-virus vaccine from Merck Sharp and Dohme (West Point, Pa.), 89%-100% of the 14 vaccinees finally achieved HAI titers of greater than or equal to 1:20. The split-virus vaccine was safe, but it was poorly antigenic as a primary vaccine in persons 19-24 years old and as a booster in persons of all ages who have poor antibody responses in general.


Ether-treated, subunit Hsw1N1 influenza vaccines: response of immunologically primed subjects to two antigenic variants. Two bivalent, ether-treated, subunit influenza vaccines were compared in adults greater than or equal to 45 years old. Both vaccines contained 200 chick cell-agglutinating (CCA) units of A/Victoria/3/75 antigen/dose. The Hsw1N1 components, also at a level of 200 CCA units/dose and designated A/Shope and A/X-53, were antigenically representative of the A/swine/1976/31 and A/New Jersey/8/76 viruses, respectively. A/Shope virus possessed about 100 times more neuraminidase activity than A/X-53 virus. The two vaccine groups had equivalent geometric mean titers (GMTs) of antibody to A/NJ virus, with about 95% of each group having titers of greater than or equal to 1:40 after vaccination. Group GMTs of antibody to A/Vic virus were also equivalent. Failure of the A/X-53 vaccinees to respond according to the dogma of original antigenic sin and a highly significant between-group difference in response to A/PR/8/34 antigen are interpreted as due to a difference in vaccine neuraminidase levels. It is suggested that, although A/Shope was as serologically effective against A/NJ virus as A/X-53 in this age group, under similar conditions a recombinant with the A/NJ hemagglutinin and the stable A/swine neuraminidase antigens might be more effective against A/NJ than either of the present vaccines.


Single-dose trials of monovalent A/New Jersey/76 (Hsw1N1) influenza virus vaccine in children in Durham, North Carolina. Ninety-two children received single doses of one of 13 monovalent vaccines derived from influenza virus strain A/New Jersey/8/76 (A/NJ), and 18 children received placebo. Five influenza virus vaccines were whole-virus vaccines, and eight were split-product vaccines. Samples of sera were taken once three weeks after vaccination. All of the 29 children receiving whole-virus vaccines developed a titer of antibody to A/NJ virus of greater than or equal to 1:20, and the geometric mean titers were 1:14-1:45. One of the 60 children who received split-product vaccines developed a titer of antibody to A/NJ of greater than or equal to 1:20, and geometric mean titers were all less than 1:10. There was a trend toward correlation between titers of hemagglutination-inhibiting (HAI) antibody to A/NJ and titers of HAI antibody to A/Victoria/3/75 viruses, with a correlation coefficient of 0.40 for children who received whole-virus vaccines. Three of 60 recipients of split-product vaccines and two of 20 recipients of whole virus developed a fever of greater than or equal to 38 C. One of the two febrile children who had received whole-virus vaccine had otitis media. Therefore, reactogenicity of whole-virus vaccines and split-product vaccines appeared to be similar in these children.


Response of normal children to influenza A/New Jersey/76 virus vaccine administered by jet injector. Ninety-seven children six to 10 years old received monovalent influenza A/New Jersey/76 virus vaccine by jet injector. Comparison with groups receiving vaccine intramuscularly revealed that local reactions (tenderness and erythema) were more frequent and more severe in the group vaccinated by jet injector. Antibody response, however, was similar for all groups.


Safety and antigenicity of inactivated influenza virus vaccines in children: trials with monovalent and bivalent A/New Jersey/76 (HswN1) and A/Victoria/75 virus vaccines in Washington, D.C.. Safety and antigenicity of monovalent and bivalent A/New Jersey/NJ)/76 (HssN1) and A/Victoria/75 inactivated influenza virus vaccines were studied in 125 children aged three to 18 years. In recruitment, families who knew the study team, who were professionally involved, and/or who were under close continuing care were more likely to volunteer for such studies than those who were unfamiliar with the team or institution. Antibody responses and systemic reactions occurred more often after administration of inactivated whole-virus vaccine than after split-virus vaccine. Significant titers (greater than or equal to 1:40) of hemagglutination-inhibiting antibody to A/NJ/76 virus occurred in 95% of normal children three to 18 years of age who received two doses of the same vaccine (whole or split). However, insufficient numbers of children achieved a reasonable antibody titer (greater than or equal to 1:40) after one dose of vaccine.


Evaluation of influenza A/New Jersey/76 split-product virus vaccine in a summer camp. An evaluation of two doses of split-product A/New Jersey/76 virus vaccines was conducted at a boys' summer camp. Two doses of either 200 chick cell-agglutinating (CCA) or 400 CCA units of vaccine were administered four weeks apart. There were no significant side effects. Of 60 subjects, 59 developed a significant titer of serum antibody after two doses. There was no correlation between titer of antibody and total dose of vaccine. Younger subjects developed a higher titer than older subjects. A single dose of vaccine was insufficient to achieve a protective level of antibody.


A clinical trial with monovalent influenza A/New Jersey/76 virus vaccine in preschool and school-age children. One hundred thirty-three children in San Antonio, Texas, received intramuscular injections of split-virus or whole-virus preparations of killed, monovalent influenza A/New Jersey/76 virus vaccine or placebo. Thirty-three children were in the three- to five-year-old age group, and 100 were in the six- to 11-year-old group. A minimal antibody response occurred following injection of the first dose of vaccine. A second or booster dose that was administered approximately four months after the first dose resulted in a significant antibody response, even in children who developed a minimal or no detectable immune response to the initial dose. This improved immune response was observed following administration of two doses of either split-virus or whole-virus vaccines. Reactions by the vaccine recipients on the whole were minimal. Reaction indices determined in both age groups after administration of the booster dose were usually less than those after the first dose. The high prevalence, 78% overall, of antibodies to influenza A/Victoria/75 virus demonstrated that this virus was previously prevalent in our area.


Evaluation of a two-dose regimen of influenza A/New Jersey/76 subunit virus vaccine in three- to 10-year-old children. Fifty-one Caucasian, middle-class children (aged three to 10 years) from the suburbs of Hartford, Connecticut, were immunized with two subcutaneous doses each of 200 chick cell-agglutinating units of influenza A/New Jersey/76 subunit virus vaccine/0.5 ml. The reactivity of the vaccine was negligible, and there was no increase in reactivity with a second dose. Administration of a single dose resulted in seroconversion in one-third of the subjects. Two weeks following the second dose, 84% of the children had reciprocal titers of hemagglutination-inhibiting antibody of greater than or equal to 10, and the geometric mean titer was 51. There was no significant difference in antibody response according to age. We concluded that inoculation of two doses of subunit virus vaccine is a safe and effective means of inducing a significant antibody response. The levels of antibody required for protection and for duration of antibody response are not known.


Reactions and serologic responses after administration of inactivated monovalent influenza A/swine virus vaccines. I. Immunization of children and adults with influenza A/Shope virus vaccines. Reactivity and immunogenicity of three inactivated, zonally purified, monovalent influenza A/swine virus vaccines were studied in children and adults. Each dose of vaccine contained either 400 chick cell-agglutinating (CCA) units/0.5 ml or 200 CCA units/0.25 ml. The vaccines contained either whole virus or ether-extracted, subunit virus with or without 1.5 mg of A1PO4/0.5 ml. Children younger than 10 years of age received a half dose. Substantial system reactions, including temperature increases of 2.2 F-4.9 F, were observed in all children who received whole-virus vaccines. In contrast, ether-extracted, subunit vaccines (with or without A1PO4) were minimally pyrogenic in 185 subjects. Two doses of subunit vaccine in subjects younger than 25 years of age were immunologically equivalent to a single dose in older subjects. We concluded that two doses of ether-extracted, subunit virus vaccine with Hsw1N1 antigen, administered at least four weeks apart, are serologically effective for immunization of seronegative subjects of any age and that this dosage regimen should be used in young children in whom whole-virus vaccines are unacceptably reactive.


Reactions and serologic responses after administration of inactivated monovalent influenza A/swine virus vaccines. II. Immunization of children with influenza A/New Jersey/X-53 virus vaccines. Reactivity and immunogenicity of two inactivated, zonally purified, ether-extracted, influenza A/New Jersey/X-53 subunit virus vaccines were studied in 103 children three to 18 years of age. Children aged nine years of younger received doses of 100 or 200 chick cell-agglutinating (CCA) units, and those older than nine years received doses of 200 or 400 CCA units. Vaccines were given intramuscularly. Two doses were given at intervals of four weeks. The vaccines were minimally pyrogenic, causing only two instances of temperatures of greater than 100.0 F. Other systemic reactions were observed infrequently. Tenderness at the site of injection occurred relatively frequently but was of no medical consequence. The geometric mean titers of homologous antibody, which ranged from 1:52 to 1:75 after administration of two doses, were statistically equivalent in all treatment groups. Titers of antibody of greater than or equal to 1:40 to the influenza A/New Jersey/8/76 virus strain were achieved by 88% of the vaccinees. We concluded that two doses of ether-extracted, subunit influenza A/New Jersey/X-53 virus vaccine were well tolerated and, when given at least four weeks apart, were serologically effective for immunization of children aged three to 18 years.


Monovalent influenza A/New Jersey/76 virus vaccines in asthmatic children: pulmonary function and skin tests for allergy. Eighty-eight asthmatic children aged six to 16 years received monovalent influenza A/New Jersey/76 virus vaccines. Forty-one of these children were given skin tests for allergy to eggs and vaccines, and 57 were given pulmonary function tests before and after immunization. Only four children reacted to the vaccines in the skin tests, with three of these children reacting to only one of four test preparations. Only two of the four children showed a correlation between reactivity to vaccine and allergy to egg antigens. No significant changes in pulmonary function were demonstrated.


Clinical trials of bivalent A/New Jersey/76-A/Victoria/75 influenza vaccines in high-risk children. Various doses of two whole-virus and one split-product bivalent influenza A/New Jersey/76-A/Victoria/75 vaccines were administered to 253 children aged six to 18 years. There were no statistically significant differences in either reactivity or humoral antibody response among the 167 children in seven chronic disease categories and 86 healthy children. The whole-virus vaccines were associated with unacceptably high rates of reaction when given in sufficiently antigenic initial doses but were relatively nonreactive when used for booster immunization. Split-product vaccines were no more reactive than placebo. All vaccine preparations induced adequate seroconversion rates and protective titers of antibody to A/Victoria virus after one dose and to A/New Jersey virus after two doses.


Response of children with cardiac disease to the bivalent influenza A vaccines. During the recent nationwide trials of influenza vaccine, 121 children with cardiac disease, aged three to 18 years, were evaluated with respect to their immune response and reaction rate after administration of a whole-virus or split-virus bivalent influenza A/New Jersey/76-A/Victoria/75 vaccine given as a single dose or two divided doses. The serologic response of the cardiac children did not differ significantly from that of the total group of high-risk children or normal children who recived the same vaccine. The major reaction to the vaccines was fever, which occurred in one-fourth to one-half of children receiving the whole-virus vaccines. The split-virus vaccines were generally well tolerated. The reaction index of the cardiac children was slightly lower than that of the normal children receiving the same vaccine during the single-dose trial but higher during the two-dose trial. The second dose was generally better tolerated than the first dose. Reactions in the children with cardiac disease could not be adequately evaluated according to specific diagnoses or functional disabilities.


Reactivity and antibody response to vaccination with bivalent influenza A/Victoria/75-A/New Jersey/76 vaccines in children with chronic pulmonary diseases. Reactogenicity and antibody responses of high-risk children and adolescents (aged three to 18 years) to bivalent influenza A/Victoria/75-A/New Jersey/76 virus vaccine from nine participating centers were compared to the response of the total population of vaccinees in the multicenter study of the National Institute of Allergy and Infectious Diseases. Split-product vaccines given in two doses four weeks apart offered protection without a significant risk of side effects. Patients with chronic pulmonary disease did not differ from the total study population to antibody response or reactivity to vaccination with A/New Jersey strains.


Multicenter two-dose trials of bivalent influenza A vaccines in asthmatic children aged six to 18 years. Data from all of the vaccination centers that immunized asthmatic children six to 18 years old with bivalent influenza A/New Jersey/76 and A/Victoria/75 vaccines were analyzed. Systemic reaction indexes were somewhat higher in asthmatic children receiving the first dose of whole-virus vaccines than in similar vaccinees without asthma. Antibody levels after immunization, while different in some instances, did not show any significant trends toward either hypo- or hyperresponsiveness in the asthmatic children.


Trial of bivalent influenza A vaccine in high-risk infants. A vaccine trial involving 50 high-risk infants, aged six to 36 months, was performed for evaluation of the safety of a split-virus bivalent influenza A vaccine. After immunization, 18% of the infants developed a fever of greater than or equal to 100 F and 7% had fever of greater than or equal to 102 F. Other reactions to the vaccine were few. However, the reaction index of these high-risk infants to the bivalent vaccine was higher than those of older children receiving the same vaccine and normal infants receiving the monovalent vaccine. Forty-one percent of the infants responded with a titer of hemagglutination-inhibiting antibody of greater than or equal to 1:20 to the A/Victoria/75 component of the bivalent vaccine, and 35% responded to the A/New Jersey/8/76 component. This result suggested that this vaccine used in two doses would be an effective vaccine for infants. The infants generally tolerated the vaccine well. Nevertheless, the rapid development of fever would be of concern in the infant whose underlying disease was marginally compensated.


Bivalent influenza vaccine in children with cancer. Although it had been recommended that children with malignant diseases be immunized against influenza, few data were available to indicate the immune response or reactions that might be expected from this group. Forty-six children with malignant diseases received various dosages of killed split or whole bivalent (A/New Jersey/76-A/Victoria/75) influenza vaccine or a placebo by the intramuscular route. Two doses were administered four weeks apart. The children were receiving various regiments of cancer chemotherapy. The response to A/New Jersey/76 antigen in the children with malignant diseases was similar to that found in normal children who were immunized with bivalent or monovalent (A/New Jersey/76) vaccine in the National Influenza Immunization Trials. Fourteen of 26 children had antibodies to A/Victoria/75 before immunization; nine of the 12 children without these antibodies developed them after the first dose of vaccine. Adverse reactions after vaccination were minimal.


Reactogenicity and immunogenicity of bivalent influenza A and monovalent influenza B virus vaccines in high-risk children. Seventy-nine high-risk children were immunized with either commercial, bivalent, split-product influenza A vaccine or purified hemagglutinin-neuraminidase bivalent influenza A vaccine, and 78 of these subjects were immunized with commercial, monovalent, influenza B split-product vaccine. The reactogenicity of all three vaccines was low, and there were no severe reactions. Twenty-nine subjects who received hemagglutinin-neuraminidase vaccine as their initial dose and commercial split-product  vaccine as a booster dose had significantly lower antibody responses to influenza A/New Jersey/76 virus than subjects who received two doses of commercial split-product vaccine. The responses of the two groups to influenza A/Victoria/75 virus were comparable. Twenty-four subjects with malignancy who were receiving chemotherapy were compared with a group of subjects matched for age and vaccine preparation. Patients with cancer had significantly lower antibody responses to A/New Jersey/76 virus than patients without cancer. The ultimate responses of patients with cancer to A/Victoria/75 and B/Hong Kong/72 viruses were comparable to those of other patients, but early responses were lower.


Age-related heterologous antibody responses to influenza virus vaccination. Heterologous hemagglutination-inhibiting (HAI) antibody responses to influenza A/New Jersey/76 (Hsw1N1) virus vaccine were examined in individuals receiving doses of 200, 400, or 800 chick cell-agglutinating units of whole-virus or split-virus products during the 1976 National Influenza Vaccine Test Program. Vaccination with influenza A/New Jersey/76 virus produced a high rate of heterologous antibody response to influenza A/PR/8/34 (H0N1) and A/FM/1/47 (H1N1) viruses in persons whose original antigenic experience according to their age was with H0N1 or H1N1 strains, respectively. Vaccination with A/New Jersey/76 virus produced only low levels of HAI antibody to influenza A/Japan/305/57 (H2N2) and A/Victoria/3/75 (H3N2) viruses, and these responses were less clearly related to primary infections. Thus the greatest heterologous HAI antibody responses occurred when there were shared antigenic determinants between the hemagglutinins of the vaccine virus and the viruses that had caused the initial priming infection. However, when vaccinations or infections with H3N2 and Hsw1N1 strains may both be occurring in the population, even infrequent formation of heterologous antibody may make it difficult to interpret serologic data precisely.


Utilization and acceptability of influenza A/New Jersey/76 virus vaccine in Oakland County, Michigan. The program of mass inoculation of adults in Oakland County, Michigan, with monovalent influenza A/New Jersey/76 virus vaccine was monitored. A stratified random sample of participants was selected, and telephone interviews were conducted two days after inoculation. The group of vaccines differed from the overall county population in that it had a higher percentage of females and more of the vaccinees were older, better educated, and of higher income. Minor complaints following vaccination were relatively frequent, particularly sore arm. All complaints were significantly more frequent in females than in males, and among females, the group younger than 40 years reported these complaints most often. Since neither utilization of the vaccine nor complaints following vaccination were uniformly distributed, it was concluded that population-based studies are needed for proper assessment of vaccine-related effects.


Infection and vaccination of pigs with influenza A/New Jersey/8/76 (Hsw1N1) virus. Pigs were infected and had mild signs of illness when exposed to influenza A/New Jersey/8/76 (Hsw1N1) virus. Virus was recovered for up to eight days after exposure. The virus was readily transmitted to susceptible pen mates. Vaccination with inactivated whole-virus vaccine did not provide protection against infection or disease. There was some protection against challenge when the pigs were vaccinated with a temperature-sensitive strain of influenza A/New Jersey/8/76 virus.


Evaluation of A/New Jersey/76 influenza whole-virus vaccine in hysterectomy-derived pigs. Twenty-one pigs delivered by hysterectomy from three sows were used to evaluate influenza A/New Jersey/76 virus vaccine in neonatal pigs. Pigs were vaccinated on the day of birth or at three days of age with either 200 or 400 chick cell-agglutinating (CCA) units of vaccine, and pigs were bled two and four weeks after vaccination. The 21 vaccinated pigs and two unvaccinated control pigs were challenged intranasally at five weeks of age, and nasal swabs were obtained for six consecutive days after challenge. Two weeks after vaccination, only three pigs had reciprocal hemagglutination-inhibiting (HAI) antibody titers of greater than or equal to 20. Four weeks after vaccination, 11 pigs had HAI titers of greater than or equal to 20, and titers of virus-neutralizing antibody ranged from less than 10 to 1,000 among these same sera. On day 7 after challenge, 12 pigs had HAI titers of greater than or equal to 20. Swine-like influenza virus was isolated from nasal swabs from the controls and from four of the 21 vaccinated pigs. The results indicated that 80% of the vaccinated pigs were protected.


Effect of priming infection on serologic response to whole and subunit influenza virus vaccines in animals. Results from studies in humans demonstrated that the serologic responses to A/New Jersey (NJ)/76 virus vaccines varied according to the age of the vaccine and appeared to be related to previous exposure of vaccinees to the different strains and influenza A virus. Experiments in animals were therefore performed to investigate the role of previous infection on responses to A/NJ/76 virus vaccines. Mice were infected with influenza A viruses representative of the major strains (Hsw1N1, H0N1, H2N2, H3N2) and later inoculated with various doses of whole or subunit A/NJ/76 virus vaccines. Results from experiments in mice demonstrated a low antigenicity of the subunit vaccine in unprimed animals compared with that of whole-virus vaccine; however, the antigenicity of both vaccines was enhanced in mice primed by previous infection with H0 and H1 viruses. In hamsters previously infected with an H3N2 virus, however, the response to only the whole-virus vaccine was enhanced by the priming infection. The responses of the mice were qualitatively more similar to those of humans than were the responses of hamsters.


Summary of clinical trials of influenza virus vaccines in adults. Trials in approximately 3,900 adults were conducted with influenza A/New Jersey/76, A/Victoria/75, and B/Hong Kong/72 virus vaccines. Subjects were observed following a standard protocol, and serologic testing was performed in a single laboratory. The data indicate that prior experience of the population with earlier influenza viruses ("priming") is a determinant in response to vaccination. Thus, participants older than 25 years showed good serologic response following a single inoculation of A/New Jersey/76 virus, while younger persons responded poorly. Serological responses to A/Victoria/75 and B/Hong Kong/72 viruses were, in contrast, equally good in the younger and older adults. Whole-virus vaccines were measurably more reactive than split-virus vaccines, a finding more easily discernined in unprimed populations. In the unprimed persons, a single dose of split-virus vaccine was less immunogenic than a single dose of whole-virus vaccine. The presence of preexisting antibodies appeared to reduce systemic reactivity. For adequate immunization of a totally unprimed population, a single relatively large and reactive dose of whole-virus vaccine or two, properly spaced, smaller nonreactive doses of either whole-virus vaccine or split-virus vaccine would be required.


Trials of influenza A/New Jersey/76 virus vaccine in normal children: an overview of age-related antigenicity and reactogenicity. The total multicenter data from trials with inactivated monovalent influenza A/New Jersey/76 virus vaccine in 2,326 normal children were collected and summarized at Vanderbilt University (Nashville, Tenn.). These combined data provided the best measure of the relative antigenicity and reactogenicity of each manufacturer's vaccine. Children younger than 10 years of age were shown to have vaccine-associated reactions to doses of whole-virus vaccine containing as little as 50 chick cell-agglutinating units. Split-virus vaccines were well tolerated in doses eight times as high. No vaccine was satisfactorily antigenic in a single dose. A two-dose regimen of split-virus vaccine was antigenic, and this regimen was not associated with acute reactions.


Evaluation of membrane structure facts and artefacts produced during freeze-fracturing. The freeze-fracture technique is now widely used in the study of membranes, but it should be stressed that it shows internal hydrophobic planes of membranes, prepared under physical conditions far removed from those prevailing in vivo. Hence there is considerable potential for artefact. Work on the membrane lipid component, the intramembrane particles, and their aggregation under certain conditions, is reviewed in the context of fact versus artefact. Particular attention is paid to the results of complementary replica experiments, performed in the author's laboratory and elsewhere, which indicate that lipid collapse and protein particle deformation contribute to the appearance of the membrane fracture face seen in the final replica. A model, showing the effects of freeze-fracturing on membranes, is presented.


Interpreting the results of freeze-etching. Morphological data obtained by freeze-fracturing and other low temperature techniques must be interpreted in terms of molecular organization and function. Interpretation is aided by physical and biochemical approaches. Physical approaches such as rotary replication and ultralow temperature fracturing can improve resolution and preserve molecular arrangements which are difficult or impossible to observe with standard freeze-etching techniques. Biochemical approaches such as dissociation-reconstitution experiments can establish the molecular parameters underlying electron-microscopically visible forms. Both approaches are illustrated by investigations of the human erythrocyte membrane.


Frozen-surface replicas of rat bladder luminal membrane. A method for preparing replicas of the luminal surface of frozen, unfractured but deep-etched whole bladder tissue using a Bullivant type II device is described. A small piece of glutaraldehyde-fixed (uncryoprotected) rat bladder is rinsed in distilled water, mounted luminal side uppermost on a specimen holder and rapidly frozen by immersion in liquid nitrogen (cooled below its boiling point in a vacuum) or by contact with a copper block at liquid nitrogen temperature. The specimen is processed in the type II device without fracturing and 'deep-etched' by allowing a longer period than usual to elapse before shadowing. The results are assessed with reference to the appearance of the luminal membrane in standard freeze-fracture replicas, and some preliminary observations on the structure of the normal luminal membrane and its counterpart in bladder tumours are presented.


Cutting work in thick section cryomicrotomy. The forces during cryosectioning were measured using miniature strain gauges attached to a load cell fitted to the drive arm of the Porter-Blum MT-2 cryomicrotome. Work was calculated and the data normalized to a standard (1 mm X 1 mm X 0.5 micrometer) section. Thermal energy generated was also calculated. Five parameters were studied: cutting angle, thickness, temperature, hardness, and block shape. Force patterns could be divided into three major groups thought to represent cutting (Type I), large fracture planes greater than 10 micrometer in length (Type II), and small fracture planes less than 10 micrometer in length (Type III). Type I and Type II produced satisfactory sections. Work in cutting ranged from an average of 78.4 muJ to 568.8 muJ. Cutting angle and temperature had the greatest effect on sectioning. Heat generated would be sufficient to cause through-section melting for 0.5 micrometer thick sections assuming the worst possible case, namely that all heat went into the section without loss. Presence of a Type II pattern (large fracture pattern) is thought to be presumptive evidence against thawing.


Preparation of thin cryo-sections for electron probe analysis of calcifying cartilage. Conventional methods of fixation, dehydration, embedding and wet-sectioning can produce artefacts in the chemical composition of mineralizing tissues. Cryoultramicrotomy was adopted for a more reliable approach to electron probe analysis of initial apatite formation in calcifying cartilage. Fresh rabbit epiphyseal cartilage was mounted on silver pins, frozen by immersion in liquid nitrogen, and sectioned with the specimen temperature at 133 K and the knife temperature at 273 K. Dry cryo-sections (30-70 nm in thickness) were manipulated on to coated grids and examined the same day. These cryo-sections showed good morphological and cytoplasmic detail, with large areas relatively free of ice-crystal damage. Sections stained either with osmium vapour or negatively stained with silicotungstic acid showed areas with well-preserved mitochondria with granules and endoplasmic reticulum. Unstained sections also showed dense granules (50-120 nm in diameter) in the mitochondria of chondrocytes and preliminary electron probe analysis of these has indicated a Ca/P mass ratio of approximately 1.14. In the longitudinal septa, about 2 micrometer away from the chondrocytes, matrix-vesicle-like particles could be seen with crystal needles inside them. Micro-analysis of two of these gave a Ca/P mass ratio of 1.73 and 2.68. Cryo-ultramicrotomy appears to confirm a number of conclusions derived from conventional ultrastructural study of growth cartilage and suggests for the first time how amorphous calcium phosphate and crystalline apatite can be shown to exist in different organelles in the same cryo-section of the tissue.


Post-operative wound sepsis following obstetrical and gynaecological laparotomies in Nigeria. The results of a prospective survey of post-operative wound sepsis following obstetrical and gynaecological laparotomies at the University College Hospital, Ibadan, Nigeria are presented. The overall wound sepsis rate was 20.2 per cent, but the corresponding rates in the gynaecological, primary obstetrical and repeat obstetrical cases were 14.9 per cent, 7.0 per cent and 29.9 per cent respectively. Statistical tests indicate that these rates differ significantly. The rate among the gynaecological cases did not differ significantly from the primary obstetrical cases, but that of the repeat obstetrical cases was significantly higher than those of the other two groups. The poorer wound healing in the repeat obstetrical laparotomies is thought to be due to poor blood supply. The variables that correlated significantly with wound sepsis rate were: pre-operative anaemia, number of medical students in theatre, antibiotic chemoprophylaxis and excision of previous scar in repeat laparotomies. The commonest organism involved in the wound sepsis was staph pyogenes. The wound sepsis rate obtained in this survey was high and various preventive measures are discussed.


Some metal ion changes in plasma and erythrocytes following ether anaesthesia and surgery in bilharzial patients. Eight bilharzial patients with hepatosplenomegaly who underwent splenectomy under ether anaesthesia were studied. The levels of iron, zinc, titanium, aluminium, calcium, magnesium and phosphorus were determined in the plasmas and RBCs both preoperatively and up to four days postoperatively. Preoperatively the bilharzial patients were found to have subnormal levels of the studied elements except aluminium in plasma. The effect of ether anaesthesia and surgery (splenectomy) was marked on the second postoperative day. All the elements displayed a tendency towards reaching preoperative levels by the fourth day except titanium which was still elevated. Metal ions particularly zinc and magnesium should be monitored in bilharzial patients in general and in the advanced cases in particular, who are undergoing major surgery. This should be done as a precautionary measure especially since these patients have subnormal metal ion levels.


Hepatitis B surface antigen in various liver diseases in Iraq. In a series of 221 patients with various liver diseases studied in Iraq using counterimmunoelectrophoresis and passive haemagglutination techniques, HBsAg was detected in 40.8 per cent of cases with acute viral hepatitis, in 40 per cent in cryptogenic cirrhosis, in 50 per cent in chronic hepatitis, in 100 per cent in active cirrhosis and 71.4 per cent in hepatoma. In acute hepatitis the antigenaemia was highest early in the course of the disease. The duration of antigenaemia ranged from three to 16 weeks. In 3.4 per cent of cases the antigenaemia persisted for more than 35 weeks. In 31.3 per cent of acute hepatitis there was no evidence of parenteral infection.


Electron microscopic studies on the myofibrils in the epithelial cells of the Bowman's capsule and of proximal tubules in rat renal cortex (first report). Two kinds of filaments in parallel arrangement have been observed in the basal part of the cytoplasm in the epithelial cells of a Bowman's capsule and in the epithelial cells of a proximal tubule of a glycerinated rat kidney. The first was thin and linear in shape, 55-70 A in diameter and exhibited arrow-head structures upon treatment with heavy meromyosin (HMM). The other was rod shaped, with thick filaments, 110-130 A in diameter, 0.14-0.16 micrometer in length, few in number scattered among the thin filaments. From the non-glycerinated kidney, bundles of fibers were attached to some electron-dense regions inside the cell membrane. In highly magnified pictures, two kinds of filaments could be observed. One kind was thin, attached to dense regions, and the other thick, and not attached to dense regions. It is conceivable that these filaments correspond to myofibrils from their characteristic electron microscopical features. An electron microscopical analogy detected in both smooth muscle cells and renal cells leads us to speculate that these thin and thick filaments consisted of actin and myosin respectively.


Experimental ischemic heart disease induced by thromboxane A2 in rabbits. How an acute ischemic attack is induced in a patient with coronary atherosclerosis is unknown and we carried out studies using thromboxane A2 (TXA2) to determine if acute myocardial ischemia and necrosis could be induced in rabbits. TXA2 was perfused through the coronary artery for 5 seconds by means of a Swan-Ganz catheter through the right common carotid artery. Significant serial changes of ST-T on ECG and hypotension were observed from 1 minute to more than 1 day after the perfusion in all 22 rabbits. The TXA2 that was composed of both aggregated platelets and prostaglandin H2 induced the same response, and such was dose dependent. The inactivated TXA2 was without effect. Seventeen of the experimental rabbits were autopsied. Histological studies of the hearts showed focal myocardial ischemia and necrosis in all rabbits except one autopsided 10 minutes after the perfusion. TXA2 is apparently capable of inducing acute myocardial ischemia and necrosis.


Echocardiographic features, left heart events and the spatial ventricular gradient in a case with intermittent type A Wolff-Parkinson-White syndrome. In a patient with intermittent type A Wolff-Parkinson-White (WPW) syndrome, the echocardiogram revealed late "double peaked" anterior motions (the former in the late systole, the latter in the early diastole) of left ventricular posterior wall during WPW conduction. In the same condition, phonocardiographic and mechanocardiographic observations indicated a prolonged electromechanical interval, but the external isovolumic contraction time (EICT) and left ventricular ejection time/EICT ratio remained unaltered. In addition, definite but slight alteration in the spatial ventricular gradient was observed. These observations by non-invasive methods present additional informations supporting the concept that conduction abnormalities per se are not responsible for abnormalities of ventricular function unless there is severe underlying heart disease.


"Hypertrophy of the column of Bertin" in a could-be case of adolescent idiopathic hematuria. A typical case of hypertrophy of the column of Bertin is first documented in Japan, which is characterized with the adolescence (13-year-old), intermittent gross hematuria, and the confirmation and recovery by the segmental resection. Emphasis is placed on the possibility of its concealment in so-called idiopathic hematuria, and the necessity of the recognition earlier among children with unknown hematuria. The term "hypertrophy of the column of Bertin" was proposed to be used unifyingly henceforce, because it most well describes the pathoanatomy.


Significance of echocardiographic evaluation on surgery to mitral stenosis. 1) Diastolic descent rate (DDR) of the anterior mitral leaflet improved after the surgery. However, this improvement was not modified with a) atrial fibrillation b) damages of the subvalvular supporting tissue c) valvular calcification d) the method of the operation, namely the open or closed commissurotomy. 2) DDR was fairly well correlated with the mitral orifice area, the cardiac output and the pressure gradient across the mitral valve. Therefore, the echocardiographic diagnosis and the follow up evaluation of the mitral stenosis after the surgery were thought to be very reliable, considering the accuracy of this diagnosis as disclosed in this study. The contributory effect to DDR was discussed.


Clinical, electrocardiographic, and radiological evaluation of pulmonary hypertension in patients with mitral stenosis. Fifty-one patients with dominant rheumatic mitral stenosis were studied by clinical, electrocardiographic, and radiological criteria for evaluation of pulmonary hypertension. Predicted pulmonary artery pressure from these criteria were then compared with the pulmonary artery pressure measured during cardiac catheterization. In the first 31 patients, the assessment of pulmonary hypertension using combined clinical, electrocardiographic, and radiological methods gave better results than any one single method alone. On the basis of these observations, a composite criterion was arrived at. This new criterion was then prospectively applied to the next 20 consecutive patients with dominant mitral stenosis. In 14 of the 20 patients, the predicted pulmonary artery mean pressures were in the same range as the measured mean pulmonary artery pressures when the new composite criterion was used.


An analysis of Wenkebach periodicity during atrial pacing. Seventy-six atrial pacing induced Wenckebach periods in 20 patients were analyzed. They were divided into 5 types according to the manner of increment change of P'V prolongation. Fifty-four % of the periods were atypical (Types II-V). There was a significant increase in the incidence of atypical periods as the length of the periods increased. The recovery curve of the A-V node was obtained by plotting P'V against preceding VP'. The curve was convex and the slope became greater than 45 degrees near the absolute refractory period in the majority of the cases, although there was 1 case in which the slope was less than 45 degrees throughout the curve. The P'V interval was found to be determined mainly by the preceding VP' interval. The mechanism by which these different types of Wenckebach periods develop can be explained by the relationship between the shape of the recovery curve and the pacing rate. The types II, III, and IV periods which have been dealt with as atypical periods were understood to develop by the same mechanism as type I (typical) periods.


Clinical and electrophysiologic studies on the Wolff-Parkinson-White syndrome in aged cases. Clinical and electrophysiologic studies were performed in 10 aged cases (50-82 years of age) with WPW syndrome and following results were obtained: 1) Episodes of paroxysm of supraventricular tachyarrhythmias were observed in 7 and complication of sinus node dysfunction was noted in 3. 2) P-delta intervals on electrocardiogram exceeding 0.12 sec were observed in 4 cases. 3) Patterns of normalization of QRS complex in 4 cases were characterized by tachycardia-dependent in 2 and bradycardia-dependent in 2. 4) Effective refractory period of the accessory pathway (AP) in antegrade direction exceeded that of A-V node in 5 cases and the former exceeding 500 msec was observed in 2 cases. The relations between the changes of the electrophysiologic properties of the AP and altered clinical manifestations of the WPW syndrome in aged cases were discussed.


Small cardiac lesions. Fibrosis of papillary muscles and focal cardiac myocytolysis. Three types of small cardiac lesions were described and illustrated: (1) focal type of papillary muscle fibrosis, evidently a healed infarct of the papillary muscle present in 13% of autopsies, is a histologically characteristic lesion associated with coronary artery disease and healed myocardial infarction, (2) diffuse type of papillary muscle fibrosis, probably an aging change present in almost half of the autopsies, is associated with sclerosis of the arteries in the papillary muscle, is identifiable histologically, and apparently is not associated with any cardiac abnormality, and (3) focal cardiac myocytolysis, a unique histologic lesion, usually multifocal without predilection for any area of the heart, is associated with ischemic heard disease, death due to cancer complicated by nonbacterial thrombotic endocarditis and microthrombi in small cardiac arteries as well as with other diseases. Differentiation of the 2 types of papillary muscle fibrosis is important in the study of papillary muscle and mitral valve dysfunction. Focal cardiac myocytolysis may contribute to the fatal extension of myocardial infarcts.


Membrane current changes induced by acetylstrophanthidin in cardiac Purkinje fibers. Voltage clamp experiments were carried out with short Purkinje fibers exposed to acetylstrophanthidin. A consistent change in membrane current was an appearance of a transient inward current on repolarization to the resting potential from the preceding depolarization, when preparations were treated with sufficient concentration of acetylstrophanthidin to cause the transient depolarization. This transient inward current displayed voltage- and time-dependence on the preceding depolarization, of which kinetics were different from the pacemaker K+ current. The transient inward current was easily blocked by manganese ions. The results indicated that acetylstrophanthidin induced the transient inward current which was the basis of the transient depolarization and the current might represent an abnormal state of the slow inward current possibly related to the altered internal Na+ and Ca++ concentrations.


Echocardiogram in pulsus paradoxus. Respiration dependent cyclic changes in mitral and aortic valve motion: a case report. The mechanism of production of pulsus paradoxus was echocardiographically studied in a 74-year-old male with subacute effusive-constrictive pericarditis which developed to constrictive pericarditis under the observation. Echocardiography disclosed the following phenomena during inspiration: 1) mitral valve did not open until the atrial systole, probably because of the lack of antegrade mitral flow during rapid filling phase (the E wave was not observed), 2) concomitantly, aortic valve opening decreased markedly in its grade, and 3) left ventricular ejection time (LVET) decreased and pre-ejection period (PEP) increased, resulting in a higher PEP/LVET ratio (up to 1.32). The opposite was true during expiration (PEP/LVET ratio was 0.40). This is probably the first case, in which the mechanism of pulsus paradoxus was investigated by aortic and mitral valve echograms.


Myocardial protection during open-heart surgery: intermittent aortic crossclamping versus coronary perfusion. Twenty-seven patients undergoing open-heart surgery were divided into three groups, i.e., control, intermittent aortic crossclamping and coronary perfusion groups. Myocardial oxygen extraction, lactate extraction, arterial-coronary sinus hydrogen ion difference, potassium difference and glucose difference were determined during the operation, as well as, postoperative stroke and cardiac indices and comparisons were made. When the ascending aorta was not crossclamped, myocardial metabolism was well preserved during and after the perfusion at a flow rate of 2.0 L./min/m2. Intermittent aortic crossclamping for 15 minutes alternating with a period of perfusion for five minutes at 30 degrees C was sufficient to protect the myocardium from ischemia. Perfusion of the left coronary artery alone at a flow rate of six per cent of total body perfusion (150 to 200 ml per minute) at 30 degrees C was sufficient to protect the myocardium when the aorta was opened. Since intermittent perfusion of the left coronary artery may produce myocardial derangement, coronary perfusion should be continuous. Otherwise topical cardiac cooling or other means of myocardial protection should be used.


Studies on lipid and carbohydrate metabolism during surface-induced deep hypothermia with circulatory arrest for open-heart surgery. Plasma lipids, blood glucose, plasma insulin (IRI) and serum dopamine-beta-hydroxylase (DBH) were measured in 30 subjects undergoing surface-induced deep hypothermia with circulatory arrest for open-heart surgery. Non-esterified fatty acid (NEFA) in the plasma rapidly increased at the lowest temperature (23 degrees C) reached and other lipids in the plasma decreased during the cooling period. An increase of NEFA and a decrease of triglyceride have been attributed to the action of lipoprotein lipase activity stimulated by heparin. It is also likely that the decrease of other lipids and beta-lipoprotein in the plasma results from the transient hypofunction of the liver due to hypothermia. Blood glucose increased during the cooling period, while plasma insulin showed no significant change. Serum DBH reflecting catecholamine also showed no significant change during the cooling or rewarming periods. Therefore, hyperglycemia in hypothermic open-heart surgery may result from the decrease of peripheral utilization of glucose and from the inhibition of insulin secretion due to the transient pancreatic hypofunction.


Disseminated intravascular coagulation in the pathogenesis of adult respiratory distress syndrome: 1. Clinical study. The correlation between disseminated intravascular coagulation (DIC) and pulmonary insufficiency following trauma and shock was studied in patients. Serial coagulation tests were performed on nine patients suffering from adult respiratory distress syndrome (ARDS), and six of nine showed the evidence of consumption coagulopathy. Heparin infusion was effective in two patients with the improvement of platelet counts, other coagulation factors and the concomitant improvement of lung function.


Disseminated intravascular coagulation in the pathogenesis of adult respiratory distress syndrome: 2. Experimental study. The role of disseminated intravascular coagulation (DIC) in the pathogenesis of adult respiratory distress syndrome (ARDS) was studied in the experimental animals. ARDS was simulated in dogs by the administration of various doses of Escherichia coli endotoxin (Difco). The alveolar surface activity in the group which received lethal dose of endotoxin (3 mg/kg) exhibited no significant alterations with mild pulmonary insufficiency and little pathologic change five hours after the induction of shock. On the other hand, a significant decrease in alveolar surface activity was found to develop in the group which received sublethal dose of endotoxin (1 mg/kg) accompanying enlarged alveolar-arterial oxygen tension differences (A-aDO2) and elevated pulmonary vascular resistance after 24 hours. These changes occurred concomitantly with pathologic findings of DIC, interstitial edema and atelectasis. The disturbance in ventilatory function observed in prolonged shock appeared to be related to the impairment of pulmonary microcirculation caused by DIC and subsequent hypoxia of lung tissue which led to a loss of alveolar surfactant.


Epithelial cell kinetics in the crypts of familial polyposis of colon. Epithelial cell kinetics were examined in the uninvolved part of the rectal mucosa in nine cases of familial polyposis of colon, six cases of their first degree relatives, and six control cases. The biopsied specimen were incubated for two hours in the culture medium containing H3-thymidine. In the control cases, the proliferating zone was confined to the lower two thirds of the crypt in all except one case. Six of the nine cases of familial polyposis of colon had crypts with altered proliferating zone, i.e., incorporation of H3-thymidine was observed in the upper one third of the crypt as in the case of adenomatous polyps. Three of the six cases of the first degree relatives showed such change. There were significant differences in the incidence of such change between controls and familial polyposis of colon or their first degree relatives, whereas no significant differences between familial polyposis of colon and their first degree relatives.


Medullary thyroid carcinoma and pheochromocytoma accompanied with nodular hyperplasia in multiple endocrine neoplasia type 2. Three patients with familial multiple endocrine neoplasia type 2 underwent total adrenalectomy and subsequently near-total or total thyroidectomy. The overt pheochromocytomas were present bilaterally in two patients and unilaterally in another patient. In addition, multiple nodules measuring a few mm in diameter were demonstrated in all adrenal medullas examined. All patients exhibited bilateral medullary thyroid carcinomas which varied in size from a few minute nodules accompanied by the microscopic C-cell hyperplasia to distinct large tumors. The thyroid C-cell hyperplasia appeared to be confined to the upper and middle thirds of the lateral lobe, and micronodules of the C-cell hyperplasia enlarged to coalesce, forming one large carcinoma mass. On the other hand, nodular hyperplasia of the chromaffin cells was distributed diffusely throughout the adrenal medulla and each nodule appeared to develop individually into a large pheochromocytoma. These findings suggested that, at least in the family members at a high risk for multiple endocrine neoplasia type 2, the development of both medullary thyroid carcinoma and pheochromocytoma was always preceded by a multicentric nodular hyperplasia. On the basis of the pathogenesis of these tumors, the most rational surgical approach was presented.


Enhancing effect of thoracotomy and/or laparotomy on the growth of ascitic tumor in rats. To evaluate the effect of operative stress on a tumor growth, thoracotomy and/or laparotomy were performed 48 hours after the intraperitoneal inoculation of Sato lung cancer cells in Donryu rats. The survival time and the spread of the tumor were examined. Thoracotomy and laparothoracotomy reduced significantly the survival time of the inoculated rats as compared with the control but no significant difference was observed between the two test groups subjected to operative stress. No difference was observed in the spread of the tumor between the test groups and the control. These results indicated that the operative stress increased only the number of metastatic foci and did not change the characteristics of the tumor cells.


Enhancing effect of thoracotomy and/or laparotomy on the development of the lung metastases in rats after intravenous inoculation of tumor cells. To evaluate the effect of operative stress on the tumor growth, thoracotomy and/or laparotomy were performed 48 hours after the inoculation of Sato lung cancer cells in Donryu rats. The survival time, the number of metastatic foci on the surface of the lung and the per cent-area of metastatic foci in the frontal section through the pulmonary hilus were observed. Thoracotomy and laparothoracotomy reduced significantly the survival time as compared with the control but no significant difference was found between the two test groups subjected to operative stress. The number of percent-area of metastatic foci found were inversely related to the length of the survival time.


Experimental studies on etiology of portal hypertension in allergic aspect. To elucidate the mechanism of portal hypertension seen as a symptom of so-called Banti's syndrome (idiopathic portal hypertension), observation was made of rising of the portal pressure experimentally induced in sensitized rabbits. Intraintestinal injection of the same antigen as used for the sensitization resulted in elevation of the portal pressure. This phenomenon appears to be attributable to antigen-antibody reaction caused by the injected antigen absorbed from the intestine and entered thereby into the portal system while maintaining its antigenicity. From the phenomenon also, the site of the antigen-antibody reaction is estimated to be limited at least to the hepatic level. The portal pressure-rising phenomenon observed following intraintestinal introduction of antigen may suggest the possibility of entrance of the orally introduced antigen to the portal system, emphasizes importance of alimentary factors in the genesis of this syndrome.


[The combined operation for cataract and chronic glaucoma in adults in special cases (author's transl)]. The value of combined operation in cases where chronical glaucoma and cataract coexist needs no more demonstration. The best combined operation is trabeculectomy extraction. There are particular cases. Somes are easy like high degree myopia, transparent lens and ocular hypertony needing a trabeculectomy where the combined operation betters the refraction at the same time. Others are difficult like cataract extraction on an eye already having a filtring operation. We perform in these cases the combined operation through the lower way and it gives us very good results.


[Surgical therapy for glaucoma (author's transl)]. The various of primary glaucoma are described in the form of an atlas with regard to their anatomy and treatment after a basic treatment of the gonioscopic conditions. The single illustrations show the chamber angle in the various possibilities of the course of narrow-angle glaucoma (interval or pre-glaucoma, acute congestive glaucoma and chronic congestive glaucoma) and the appropriate medical and surgical suggestions for therapy. In the same way the special anatomical points of the anterior segment in wide-angle glaucoma and its therapy are described pictorially.


[Preferential screening to prevent glaucoma blindness (author's transl)]. The chief barrier to formulating an effective program of preventing glaucoma blindness is the difficulty of identifying those individuals in the population who have glaucoma but do not know it and those who are likely to develop the disease. Primary open-angle glaucoma (POAG), the most common tupe of glaucomatous disease, is an inherited disease. Fifty percent of all patients who have POAG also have a family history of glaucoma. Further, it is estimated that six to seven percent of the first degree relatives of POAG patients will develop POAG. This information suggests that for ophthalmologists who are likely to have limited time available for glaucoma screening, the most practical glaucoma screening program is that which is directed at those individuals who are first degree relatives of patients known to have glaucoma. For these people, the minimal screening tests should include tonometry, perimetry, and a meticulous examination of the optic discs. If tonometric testing reveals an intraocular pressure of 21-23 mmHg, tonometry should be repeated at different hours of the day. If results of these tests are negative, the patient then should be tested for increased sensitivity to corticosteroids and epinephrine. If all tests are negative, the patient still should be tested periodically. A relationship between HLA antigens and primary open-angle glaucoma has not been confirmed.


[Considerations on surgery of the iris (author's transl)]. Surgery of the iris is of essential importance in anterior segment surgery. In angle closure glaucoma a peripheral iridectomy performed early enough, when the trabeculum is not yet altered, is curative. In simple glaucoma if a filtering operation is performed, the iridectomy is fundamental in order to have a good communication between the posterior chamber and the filtering bleb and to avoid iris incarceration into the filtering wound. In cataract surgery iridectomy is mandatory, especially in intracapsular extraction. In penetrating corneal grafts a patent iridotomy or iridectomy, or several, is a safety factor avoiding the consequences of pupillary block, anterior synechiae and irreducible mydriasis. Another important problem is the surgery of the iris for optical purposes. Other indications which are not discussed in this paper are trauma of the anterior segment of the eye, the removal of benign or malignant tumors, epithelial cysts etc.


[A new syndrome: lachrymal hyposecretion, ocular hypotony, hypo-convergence (author's transl)]. A new syndrome is described, observed in patients with lachrymal hyposecretion without rheumatoid manifestations. It consists in the association of ocular hypotony, decrease of convergence, and in some cases vitreous retraction, to lachrymal hyposecretion. There is a predominance of this syndrome in females.


[Topographic study of angiographic lesions in central serous retinopathy (author's transl)]. The 595 angiographic lesions observed in 233 eyes of 169 patients affected with central serous retinopathy have been classified upon their localization. 498 angiographic lesions (83.7 percent) are located within a three optic disc diameter area centered by the foveola. Among them 20 are located right behind the foveola, 113 are located in the upper temporal quadrant, 166 in the upper nasal quadrant and 85 in the lower temporal quadrant. The relative density of the angiographic lesions decreases from the center of the macula to the periphery. 97 angiographic lesions (16.3 percent) are located beyond the three optic disc diameter central area. 41.1 percent of the lesions are situated behind the macula or/and behind the papillo-macular bundle. Therefore only 58.9 percent of the angiographic lesions observed in central serous retinopathy can be treated without any risk by means of photocoagulation.


[Reoperation for esotropia (author's transl)]. The authors describe 89 cases of esotropia which have been reoperated upon because of failure of the first operation; 57 cases consist in residual esotropia, 32 cases in secondary exotropia. Rules for reoperation are proposed, the general and particular rules according to the type of the first surgery.


[What does it mean to see? (author's transl)]. A short discussion is given of the phylogenesis of visual organ and what the word: "to see" can mean. The author concludes that we still have a long way to understand fully the very complicated mechanism of the vision.


[Congenital cataract in two families: Heredity and treatment (author's transl)]. A report is given on the inheritance of congenital cataract in two families. While in one family the males were mainly affected, in the second faimily the females were mainly affected with congenital cataract. In our experience an operation is only indicated if the visual acuity is no longer sufficient for day-to day living (less than 0.25).


[Toxaemia of pregnancy and the optic fundus (author's transl)]. Toxaemia of pregnancy in its various forms is the most dangerous complication of pregnancy. It threatens the life of the mother in up to 30 percent of cases, and of the infant in up to 50 percent of cases. The task of systematic medical examination and advice during pregnancy is the earliest possible diagnosis and treatment of symptoms of toxaemia. Generalised vascular spasms are at least in part responsible for the precipitation of toxaemia. Measurement of the vascular diameter in the retina which shows narrow vessels and tendency to spasms is a large advance in the ophthalmological diagnosis of a developing toxaemia of pregnancy.


[Simultaneous bilateral intraocular operations (author's transl)]. A report is given on the results in 98 eyes of 49 patients with simultaneous bilateral intraocular operation. The special indications and the positive and negative arguments concerning this kind of intraocular operation are discussed.


[On the clinical picture and therapy of arachnitis optico-chiasmatica (author's transl)]. From 20 cases of arachnitis optico-chiasmatica (a. o.) the symptoms of this relatively rare but pathologico-anatomically proved disuse of the brain base involving the optic nerves are described. In this description newer methods of investigation are mentioned which allow a differentiation of the clinical picture of o.a. from that of tumors of the middle cranial fossa. A single case is described in especial detail because a remarkable corneal cloudiness occured in it. The anatomical connection between this corneal cloudiness and vegetative nerve fibers in the region of the Gasserian ganglion is mentioned in honour of the theory of Speransky on nerve-directed tissue changes.


[To some aspects of iris morphology in vertebrates (author's transl)]. The multiplicity of colorations and patterns in the irides as well as the pupillary polymorphism in vertebrates are impressing. They show the iris as an ocular part especially inclined to evolutional modifications. Species from different classes of vertebrates not uncommonly show very similar characteristics of iris morphology provided their mode of life is comparable with regard to relevant factors. On the other hand there exist many examples of very differing iris characteristics in spite of seemingly well corresponding habits of life. These cases often enough pose problems concerning the biological value of a specific variant form. They point however to a multifactorial conditioning of these phenotypic characteristics indicating simultaneously possibilities to create identical effectivities by differing means.


[Experiences with the lengthening of the inferior oblique muscle (author's transl)]. After an introductory survey of the methods used up to now for lengthening the muscle the technique, dosage and indication of the method described by Gonin and Hollwich is described and the results obtained with it on 137 patients with hyperfunction of the inferior oblique muscle on adduction with associated and paralytic squint are communicated.


[Five years experience with lid magnet implantation for paretic lagophthalmos (author's transl)]. Five years' experience with the implantation of permanent magnets in the eye lids for reconstruction of dynamic lid closure for paretic lagophthalmos is presented. The patients followed up were 114 in number with unilateral and three with bilateral lagophthalmos due to complete facial palsy. In the majority of cases satisfactory to good eyelid function with complete protection for the eye could be obtained. In 15 cases rejection occurred usually because of deficient implantation technique. On the basis of these experiences we conclude that a good indication for lid magnet implantation is present for reversible facialis paralysis for a continuous solution, and also as a complement to other operative procedures which alone do not result in complete eyelid closure. Facial paralysis of long duration with atrophy of the lid structures and retraction or spasticity of the levator musculature is a relative contraindication.


[New spectacle lenses with variable progressive refractive power (author's transl)]. Spectacle lenses with variable optic power are indeed no replacement but are an interesting addition to the group of visual aids for correcting presbyopic patients. Since the first commericial lenses of this kind appeared in the year 1959, further sorts of glass with variable properties have been developed. These were evaluated and compared with each other.


[Unilateral exophthalmos and temporary ipsilateral oculomotor paresis and the only symptoms of an extensive chordoma of the base of the skull (author's transl)]. A case of histologically proved chordoma of the region of the base of the skull in an 18-year-old girl is described. In spite of great extension of the tumor from the clivus into the nasopharynx only a unilateral protrusio bulbi was apparent. The patient was treated with high-dose radiotherapy. Continual half-yearly follow-ups showed during 3 1/2 years no progression of the process.


[Further fields of application of the infrared false colour film in ophthalmological photography (author's transl)]. Aside from the distinction between old hemorrhages and pigmented changes of the ocular fundus, the use of metaspectrophotography of the eye with the Kodak Ektrachrome Infrared Film IE 135-20 can be extended successfully to other fields of ophthalmological photography. By shifting the spectral range used for photography towards near infrared and cutting off the short wavelenght part by a yellow filter, spoiling scattering is avoided up to 98 percent. Thus clear goniophotography is rendered possible even with higher magnification. Better pictures are achieved in photography of the periphery of the ocular fundus, of the fundus of eyes with moderate opacity of the cristalline lens, of juvenile macular degeneration, and of pigmented areas of the iris suspected to be tumorous.


[Changes in the subjective perception of daylight (author's transl)]. It is pointed out that the basic model of "artificial daylight" in the open is not appropriate for reading and writing. Man has become accustomed to reading with daylight coming from the side through a window. Daylight indoors differs from daylight outfoord through a yellowish tendency, to which the human eye is accustomed in the presence of the usual light intensity indoors. Fluorescent "daylight" or "neutral white" lights are therefore experienced by the human eye as too blue and should only be used for special purposes with very high luminous intensities. Daylight unfortunately cannot yet be completely imitated. Hence genuine daylight should still be used as long as possible and artificial light should even today be regarded only as a replacement. Practical advice is given on mixed light with incandescent and fluorescent lamps, and also on general illumination with additional illumination for the place of work.


[The modified performance of the goniotrepanation with scleral flap after J. Fronimopoulos (author's transl)]. In a small group of patients goinotrepanation was performed with the scleral flap shaped to include a scleral tag. This operation method has no disadvantages when compared to the classical methods. In addition, in some cases the diameter of the trepanation can be reduced by the use of a scleral tag because of the favourable flowing relationships for the filter fluid.


[The value of glaucoma screening (author's transl)]. During screening procedures in Nordrhein-Westfalen in 1976 more than 100,000 persons had their, i.o. pressure measured for the first time. The results are now available from 66,957 subjects. From these 59,037 had a normal i.o. pressure, 6.941 had raised i.o. pressure, and in 979 subjects the i.o. pressure was very high. This was the first time that screening procedures on a large scale were carried out exclusively with the applanation tonometer. This procedure was carried out as part of a campaign to make the illness of glaucoma better known to the public.


[The effect of the corneal epithelium on the biosynthesis of keratin sulphate in the stroma with regard to curvature variations important for wearing contact lenses (author's transl)]. Intact or denuded bovine corneas were incubated in the presence of 14lC GlcN and parts of the proteoglycan-glycoprotein complexes of the stroma were extracted by 0.15M NaCl and successively by 1.0M CaCl2. The specific activities of total GAG and KS were determined. In the presence of the epithelial layer the biosynthesis of total GAG and KS was found to be significant higher compared to denuded corneas when light influence was excluded during the incubation. The GAG and especially KS play a role in the regulation of the dehydratation of the corneal stroma. In the young myope dehydratation and flattening of corneas after contact lens wear is reported by several authors. It may be suggested that suppression of the activating effect of the epithelium on the KS biosynthesis in the central part of the cornea is involved in the changes of corneal curvature after prolonged wearing of hard contact lenses. Since visible light decreases the activating effect of the epithelium in our experiments it may be suggested that the wearing of dark coloured glasses my be contraindicated in the young myope who wears hard contact lenses.


[Short and long-term results after external Dacryocystorhinostomy by Kaleff-Hollwich's method (author's transl)]. By means of a short and long-term study the recanalising effect of Kaleff-Hollwich's (1977) Dacryocystorhinostomy was determined and compared with Ohm's (1921) and Dupuy-Dutemps (1921) methods. With both procedures a high percentage (75-85) of permanent patency of the tear ducts is obtained. With Kaleff-Hollwich's method a practically continuous mucosa anastomosis can be formed. Stenosis by insufficiency of the canaliculi can be avoided in the opinion of the authors by exact refixing of the medial palpebral ligament. Information in the literature of patency in over 90 percent of cases is revealed after critical evaluation in the great majority of such reports as post-operative ability to rinse the tear ducts in one direction and give no indication of the end result.


[The possible connection between the occurrence of embolism and thrombosis in the retinal vessels and the weather (author's transl)]. While in the comparatively short period of three months (middle Febraury to end of May 1976) embolisms and thromboses of the retinal vessels were suddenly observed much more commonly in the University Eye clinic in Münster we tried to discover a possible connection with the weather. All patients had conditions which predisposed to thrombo-embolic occlusive vascular disease. We use the decimal classification of weather, and on the basis of this we could prove a connection between the intensity of the start of the thromboembolic process and cyclonic and anticyclonic weather situations and situations which favour allergic-hyperergic reactions to inflammatory processes. In venous occlusion an increase in the impulse number in the area (0,02 V/m) and hence increased thrombocyte adhesion at the beginning of the thrombotic process seemed to be the deciding factor. We made comparisons with the literature. It seems to be ophthalmologically important that also increase in the light intensity can be associated with thrombo-embolic occlusions in the retinal vessels.


[On the photography of larger areas of the optic fundus-trials with the wide angle camera Clinitex CA-2 (author's transl)]. The wide angle fundus camera Clinitex CA-2 was tried out on patients and normal volunteers on evaluating the numerous photographs we found the three optic heads to deliver good results. The quality of the 60 degrees- and 100 degrees-pictures improved with the increasing dilatation of the pupil. Even retinal detachments and other changes with a different level were recoreded very well. In black-and-white- photography, uneven illumination of the fundus was successfully compensated by using a two-step developer with increased utilization of film speed. This procedure allowed good wide angle documentation of the fundus at comparatively low costs.


[Epidemiological examinations for peptic ulcer in miners of pit-coal mines. I. Effect of socioeconomic factors]. In 3-pit coal mines, all workers were examined by means of an inquiry. Apart from personal data the inquiry included information on the category of work performed, length of employment, family state and socio-living conditions as well as diseases of digestive tract. The diagnosis of peptic ulcer and data on its course were based on medical documentation of Plant Outpatient Departments. Collected material comprised 9361 persons, i.e. 95% of the whole population examined. After having excluded women, employed only on surface, results were worked out concerning the population of 8302 men employed both underground and on surface. In this mining population one found 7.92% persons suffering from peptic ulcer; thus the occurrence of the disease resembled that of general population. The rate of duodenal and gastric ulcer was identical. The studies indicated that the percentage of peptic ulcer was increased proportionally to age and number of children and was greater in married than in bachelors. No greater percentage was found in widowers and divorcees, or in those eating in canteens, partaking cold meals during work or drinking alcohol. Instead in smokers a greater percentage of peptic ulcer was found. The rate of the occurrence of peptic ulcer is greater with higher salaries, additional paid, or social, work, and in case of daily travelling on a motorcycle or bicycle. Finally it was indicated that those suffering from peptic ulcer limited smoking and drinking habits and endeavoured to be fed properly.


[Secretory function of the stomach in workers employed at petroleum prospecting]. A group of 100 petroleum miners exposed to noise and vibration at intensities surpassing admissible standards, were subjected to a study. In the subjects basic and maximum posthistamine gastric secretion was evaluated, then  stomach and duodenum were examined radiologically. Peptic ulcer was diagnosed in 10% examined, i.e., a percentage resembling the highest home data. It was found that mean values of maximum posthistamine secretion decreased with age. No influence of length of employment or accompanying chronic effect of noise, vibration and bad living conditions upon gastric secretion values (BAO and MAO), was found. Neither found one differences in the rate of occurrence of peptic ulcer and gastric secretion disturbances between the group of persons with diagnosed occupational diseases (vibration disease and occupational hearing impairment) and the group of the remaining subjects. Instead a significantly negative correlation between the age of workers with occupational hearing impairment and BAO and MAO values was observed.


[New method of determination of carboxyhemoglobin by the conductometric method of extraction of carbon monoxide from the blood]. The newly elaborated method consists in the gasometric CO determination in the blood. The extraction of CO from the blood sample (0,1-1,0 ml) is performed by means of a simple device designed by the authors. The extracted CO is determined by gas analyser ANKO-3 or Ultragas 5. The comparison between the new method and iodometric method showed very high correlation (r greater than 0,9). A discussion follows on the advantages of the new method (quick, easy, high-sensitive and precise), its use can be suggested to laboratories which are equipped with a gas analyser ANKO-3 for other purposes. The new method can be used for numerous routine analyses as well as for scientific studies.


[Gas chromatographic method for the determination of P-chlorphenol in the air]. The gas chromatographic method for determination of p-chlorophenol in the air in presence of phenol has been elaborated. A good separation of investigated compounds was achieved using 10% FFAP on Chromosorb W as a stationary phase. Air was sampled to water solution of sodium carbonate. The method enables determination of 0.25 mg/m3 of p-chlorophenol, and 2.5 mg/m3 of phenol at the air sample volume 10 dm3.


[Method of determination of ammonia in the air]. The method for determination of ammonia in the air that has been used so far, based on the reaction with Nessler reagent, is outdated. In this method the final colour solutions are not non-ideal solution (there occurs turbidity), which may result in smaller accuracy of determination. Besides this method is not sufficiently specific. A newly-worked out method for determining ammonia in the air is based on spectrophotometric measurement of the green product of ammonium ions reaction with sodium hypochlorite and sodium salicylate. This method is more sensitive, precise and specific than the method for determination with Nessler reagent.


[Analysis of lung function in workers exposed to irritants and gases]. Interview spirometric, and antrhopometric studies were carried out in 694 men exposed and non-exposed to the effect irritating gases and dusts at their work place, in some subjects symptoms of respiratory system disturbances were found. Results of FEV1 measurement were subjected to an analysis. Average values of FEV1 were considerably lower in persons suffering from dyspnoea and chronic bronchitis with complications. Occupational exposure, particularly to the action of dusts, ammonia, and nitric oxide, and, to a lesser degree, ammonia, only was connected with lowering of FEV1 value. No correlation was found between the exposure to phthalic acid and decreased ventilation efficiency of lungs. Smoking by itself was connected with decreased FeV1 value to the least degree. In the examined group there was joint action of smoking, occupational exposure, and the occurrence of symptoms in respiratory system, inducing a greater decrease in ventilation efficiency of lungs.


[Effects of small nitrogen compound concentrations on the upper respiratory tract]. The authors examined a group of 160 persons employed at an exposure to small concentration (below HAC) of nitrogen and ammonia oxides, and a group of 130 controls. It was found that in the group of subjects exposed to toxic compounds the percentage of persons suffering from inflammation of the upper respiratory tract was much higher (37.5%) than in the control group (13.1%). Olfactometric examinations indicated a disadvantageous effect of the mentioned compounds upon the acuity of the sense of smell, whereas rhinospirometric examination did not reveal any differences between the control group and the group of persons exposed to nitrogen and ammonia oxides.


[Correlation between work conditions and the occurrence of vibration disease in forestry workers II]. The frequency of occurrence of vibration disease in 460 randomly chosen sawworkers, from 20 to 65 years of age, working with motor-saws of the KBK-3a and Partner R-11 types was determined. The control group consisted of 136 forestry workers non-exposed to vibration. Vibration disease was observed in 22.6% of motor-sawers, and it was suspected in 6.7%. The occurrence of vibration disease is significantly dependent on the age, daily exposure to vibration, working period in years and--especially strongly--(p less than 0.001) on the amount of timber produced and fuel used for the saw. It was discovered that daily exposure to motor-saw vibration with the type BK-3a considered, should not exceed 2 hours a day. The amount of timber produced by the saw-worker as m3 of timber felled, should not exceed 5.000 m3 in a year and 40.000 m3 in the whole employment period.


[Effect of acoustic microclimate prevailing in shipyards on the health of workers]. Yearly measurements of external noise (Noise--Pollution--Level) in the shipyard in Stettin, indicated noise levels above 85 dBA, expressed in LqM. On the ground of documentation of periodic medical examinations of the staff, one compared the rate of occurrence of disturbances in health state, such as: hearing impairment, gastric and duodenal peptic ulcer, hypertension and psychic disturbances in two groups of employees: "A"--exposed during work to noise 85 dBA and "B"--employed at the area of LqM smaller by 20 dBA. Statistically significant differences in the rates of occurrence of disturbances in the health state were found, to the disadvantage of those exposed to noise effect. In these groups also the rate of sickness absenteeism was disadvantageous: in the last 14 years its average values for the shipyard surpassed the average rate for Stettin district and the whole country.


The effect of the DNA-suppressing factor (DSF) on host DNA synthesis in synchronized cell cultures. Purified host DNA-suppressing factor (DSF) produced into culture fluid of HeLa C-9 cells infected with measles virus inhibited cellular DNA synthesis in HeLa cells. When purified DSF was added into cultures of synchronous HeLa cells at the early G1-phase, cellular DNA synthesis was irreversibly inhibited. However, DSF did not affect the stability of native double-stranded DNA nor the chain-elongation of single-stranded DNA in cells of the S-phase.


Non-accidental childhood injury presenting at a hospital casualty department. One hundred children who attended a Sydney Paediatric Casualty Department with injuries, burns or ingestions of harmful substances were divided into two groups. One group (30 children) consisted of cases which were considered to be those of child abuse or neglect (CAN). In the other group (70 children) there was no suspicion of child abuse or neglect. This was regarded as the "simple accident" (SA) group. The 100 families were visited at home and interviewed about their child's health, child rearing practices, parental expectations for the child, and socioeconomic status. Factors which had a significant association with suspected child abuse and neglect were obstetric complications, prolonged stay in hospital in the first two years of life, low maternal regard for the child, unwed mother of Australian nationality, maternal social isolation, and family disruption during the parents' own childhood. These risk factors may enable the earlier identification of abused children.


An intensive support unit for parent-infant distress. Integration of the young infant with his parent(s), in the days and weeks after birth, should be as stress free as possible. In many families considerable distress is experienced in the parent-infant relationship. There is increasing evidence that distress of significant degree may have complex sequelae, particularly for the infant, and may affect growth and development in many areas. Child abuse is another expression of this distress. A unit aimed at providing intensive support for such distressed situations is described and evaluated on a short-term basis. The evaluation suggests that this unit is successful in alleviating many of the outcomes of such situations.


Death in a country area and its effect on the health of relatives. The histories of the persons dying in a country district during 1973 were examined. The number of visits to the doctors, and also the days spent in hospital by their close relatives in the two years before 1973 were compared with those in the two years that followed. A control group was also examined. There were significant differences in these figures. Analysis suggests that ill health in those aged 50 and over increases after the death of a close relative. A group which is "at risk" after bereavement appears to have been identified.


Ephedrine abuse psychosis.

Ephedrine abuse psychosis. Three patients who abused ephedrine are presented. The clinical picture resembled that of schizophrenia and amphetamine psychosis. Its relevance to current theories on the aetiology and understanding of schizophrenia is discussed.


The systemic involvement in scleroderma. A survey was made of the systemic involvement in 38 patients with scleroderma: 33 with the acrosclerotic form (Type 1, 18, Type 2, 15) and five with the diffuse form. The study comprised inquiry about symptoms, physical examination, and the laboratory tests, such as radiological examination of chest and hands, barium swallow and meal X-ray examination, electrocardiography, pulmonary function tests, haematology tests, examination for autoantibodies, and a battery of biochemical tests. Evidence of some systemic involvement (that is, in addition to skin) was almost universal. Similar disturbances occurred both in the acrosclerotic and in diffuse forms. The most common clinical involvement was that of the joints and gastrointestinal tract. The most common confirmatory signs were a positive "neck test" (tethering of the skin of the root of the neck and upper part of the chest on extending the head) and telangiectasia. The most common abnormalities in test results were those found in X-ray films of the hands (about 80%), and in pulmonary function, and barium swallow and meal X-ray studies (each about 70%). The most frequent abnormalities in the biochemical scan were increased levels of immunoglobulin M (IgM), and decreased creatine clearance.


Carcinoma of the lung: a two-year experience at the Austin Hospital, Victoria. All patients attending the Austin Hospital, Melbourne, with the diagnosis of carcinoma of the lung in the two year period 1974 to 1975 were reviewed. There 211 patients in the series, comprising 1.2% of all patients admitted to hospital, and the methods of diagnosis and management were reviewed. Squamous and anaplastic carcinomata were equally frequent, comprising 75% of all cases, and there was a significantly lower incidence of squamous cell carcinoma in females (6.3%) compared with other cell types (20% to 30%). Sputum cytology was the most rewarding single source of tissue diagnosis, and bronchoscopy and mediastinoscopy next most helpful. Only 25% of the patients were fit for surgical treatment, and only 20% of the carcinomata were able to be resected.


Respiratory obstruction due to relapsing polychondritis in a Chinese male. A case of relapsing polychondritis in a 30-year-old Chinese male is reported. The patient showed the following features: dyspnoea; hoarseness of voice; cauliflower deformity of the right ear; upper tracheal stenosis; swelling of the lower part of the sternum; pain in the costal cartilages. Airway obstruction as a presenting feature (as in this case) is unusual. The aetiology, clinical features and management of relapsing polychondritis are briefly discussed.


An evaluation of tinidazole as single-dose therapy for the treatment of Trichomonas vaginalis. Fifty patients suffering from Trichomonas vaginalis infection were treated with a single dose of four 500 mg tablets of tinidazole; 41 patients returned for follow-up, and 39 of these were judged to be cured by the results of microscopic examination and culture of vaginal secretion.


Plasmapheresis in the treatment of glomerulonephritis. Nine patients with various forms of glomerulonephritis were treated by repeated plasmapheresis which was combined with immunosuppression, and anticoagulant therapy. Improvement in renal function occurred in the seven patients in whom there had been rapid deterioration in renal function. Two patients with gradually deteriorating renal function failed to respond. Plasmapheresis may exert its beneficial effects both by depletion of circulating immune complexes or autoantibodies, and by depletion of important mediators of injury such as fibrinogen and complement.


A comparison of the accuracies of clinical and radiological assessment of gestational age. The accuracy of radiological and clinical assessment of gestational age was compared in a retrospective survey. The radiological assessment was found to be only marginally more accurate than clinical assessment.


Are swimming pools becoming more dangerous? The rate of childhood drowning and near-drowning accidents in home swimming pools has doubled over the last five years. A study has been undertaken to determine whether this is due simply to an absolute increase in the number of home swimming pools, or whether pools themselves are becoming intrinsically more dangerous, or both. Direct measurement of pool-house ratios has been undertaken by means of aerial photography. Supportive data have been obtained from municipal records. Pool-home ratios for the cities of Canberra and Brisbane are compared (estimated 1: 10.7, and 1:13.3 respectively). It is suggested that swimming pools are not becoming intrinsically more dangerous to children; the data suggest that effective pool legislation will prevent childhood drownings in spite of increasing trends in home pool ownership.


Meiosis in Schizophyllum commune: the effect of hydroxyurea on basidiospore sporulation, germination, and nuclear number. In a search for an experimental procedure to synchronize meiosis in fruit bodies of Schizophyllum commune, the effect of hydroxyurea on sporulation was tested. Results indicate that hydroxyurea has an immediate and reversible effect on basidiospore sporulation, germination, and nuclear number. A tentative time schedule for meiosis is presented.


[Nitrous oxide analgesia in myocardial infarction (author's transl)]. Inhalation of the equimolecular mixture N2O - O2 rapidly achieves good analgesia in cases of coronary occlusion. This mixture was used with 51 patients (37 to 85 years old) with beneficial results on pain in 4 cases out of 5. This effect can be improved by giving a small amount of pethidine with the inhalation. In this way the respiratory depression of the full dose of narcotic analgesics is avoided. In halation of the mixture does not produce undesirable cardio-circulatory or respiratory changes. The oxygen content of the mixture increases patients' PaO2 without the risk of hyperoxia.


Synthesis of some quinones of potential antitubercular activity. Certain phthiocol derivatives of expected bactericidal action have been synthesized. These include the phthiocol moiety condensed with p-hydrazino-salicylic and -benzoic acids and their ethyl esters; phthiocol thiosemicarbazone and isonicotinyl hydrazidehydrazone. In another similar series the methyl group of phthiocol was replaced by carbethoxy, ethyl, butyl and isobutyl groups. Allyl and 1.2-epoxypropyl ethers of phthiocol being of high lipid dispersion were also synthesized.


Synthesis of tenuazonic acid analogues.

Synthesis of tenuazonic acid analogues. The synthesis of two 1.5-diaryltetramic acids, aryl analogues of tenuazonic acid, is described. The reactivity of position 4 of these tetramic acids towards primary and secondary amines, and o-methylation led to the synthesis of 4-substituted-delta3-pyrroline-2-one. Further, reactivity of position 3 has been indicated by the formation of 3-arylidenepyrrolidine-2.4-diones and by diazo-coupling. The structures assigned to the new compounds are substantiated by IR and NMR data.


Synthesis, pharmacologic and toxicologic study of carbonic and carbamic acid esters. The results of the pharmacologic study of some synthesized derivatives of carbamic and carbonic acids show that the compounds are biologically active. They are less toxic than imipramine, and exert a marked excitation effect on the central nervous system. Some of the compounds (including PS-1, P-8-Y and PS-4) possess greater antidepressive action than imipramine.