Hereditary spherocytosis: a study of splenectomized persons. Sixty-one persons splenectomized for hereditary spherocytosis have been studied and compared to 36 nonsplenectomized clinically affected and to 77 nonaffected family members. Serum IgM levels were reduced by 25% and IgD levels were nearly doubled in the splenectomized group. No fatal bacterial infection was identified by history covering a total of 800 postsplenectomy years. Platelet counts remained elevated for many years after removal of the spleen, as did the number of leukocytes, lymphocytes, and monocytes. Heinz bodies were seen in 3% of red cells after splenectomy. Though within the range of "normal," reticulocyte levels and serum bilirubin levels were satistically higher in the splenectomized group than in the nonaffected persons. Hemoglobin levels were higher in splenectomized affected persons than in matched controls of the same sex and maturity.


Hepatic adenoma: a possible complication of oral contraceptive therapy. Three cases of hepatic adenoma occurred in women, two of whom were taking oral contraceptive medication. The clinical and pathologic data from these and previously reported cases are reviewed. The possible causal relationship between the development of hepatic adenomas and the use of oral contraceptives is explored.


Impact of intensive newborn care on neonatal mortality in a community hospital. Development of a Perinatal Center delivering Level 3 intensive care in a community hospital is described. The inborn neonatal mortality at the hospital in which the Center is located, as well as that of the 13 surrounding counties, has diminished more rapidly than the state neonatal mortality. This has coincided with an almost constant delivery rate, increased proportion of staff patients, relatively constant rate of low birth weight, and declining total perinatal mortality. Our experience suggests that appropriately trained and motivated people, not equipment or geographic location, represent the key factor in the development of such a center.


Colposcopic management of abnormal cervical cytology during pregnancy. A total of 104 pregnant patients with abnormal cervical cells were referred to the Dysplasia Clinic for evaluation and management by colposcopy. Seventy-one pregnant patients presenting with basal cell atypia on cytologic examination had colposcopically directed biopsy revealing 8.45% severe dysplasia and 1.41% carcinoma in situ. Cytologic study in 31 pregnant patients with basal cell dysplasia revealed severe dysplasia in 29% and carcinoma in situ in 12.9% of the colposcopic biopsies. Cervical cytology revealed carcinoma in situ in two patients. Directed biopsy in both cases revealed carcinoma in situ with one case of questionable microinvasion. Colposcopically observed normal and abnormal physiologic findings and the pregnant cervix, complications after conization during pregnancy, and the impact of colposcopy in the management of the cytologically abnormal cervix during pregnancy are discussed.


Associated systemic factors in cerebrovascular ischemia. Systemic disorders (eg, cardiac, hematologic) are commonly recognized as predisposing and sometimes actual precipitating events in cerebral ischemia. From available studies, the incidence of precipitation is not clear. To determine this, we undertook a comprehensive investigation of all patients with ischemic brain disease for a one-year period. Results reveal that brain ischemia is more commonly precipitated by systemic illness than usually supposed, particularly transient ischemic attacks of the vertebrobasilar circulation and completed infarcts in the carotid distribution. Cardiac disorders outnumber all other precipitating events. As they are more amenable to therapy than atherosclerosis, a diligent search for such precipitating events is warranted in patients with ischemic symptoms.


Transient ischemic attacks not produced by extracranial vascular disease: a plea for complete and early angiographic investigation. Six patients with classical transient ischemic attacks that were not directly related to extracranial carotid disease are presented. These cases were selected to include a variety of pathologic conditions: one case each of brain tumor, arteriovenous malformation, chronic subdural hematoma, cervical spondylosis, and two cases of giant intracranial aneurysms. These case histories are significant because they illustrate that without complete angiographic investigation, tragic results could have and did occur in some cases. Transient ischemic attacks should be considered as a symptom of various possible pathologic conditions, and a careful search for the cause must be pursued aggressively.


Diet and dermatosis.

Diet and dermatosis. Diet and medical history of 1,058 physicians and dentists and their wives were analyzed. Five parameters of refined carbohydrate consumption were found to be significantly (p less than 0.010 to less than 0.001) related to the incidence of skin symptoms and signs. Those subjects reporting one or more symptoms and signs (versus none) consumed a significantly greater quantity of refined carbohydrates as measured by each parameter--total calories, calories from refined carbohydrate, percentage of calories from refined carbohydrate, grams of refined carbohydrate, and teaspoonfuls of sugar.


Small-bowel obstruction: a review of 465 cases. A retrospective review of experience with small-bowel obstruction at the University Hospital in Birmingham for a ten-year period (January 1963 through December 1972) revealed 465 episodes of obstruction in 415 patients. The mortality was 4% in obstruction due to adhesions, and 28% in obstruction caused by carcinoma; overall mortality was 8%. Intra-abdominal adhesions were the cause of 69% of cases. Malignant obstruction (mostly from metastatic disease) was the second most common cause of obstruction, and external hernia was third. Delay in diagnosis and inappropriately prolonged used of long intestinal tubes added to the mortality and can be avoided. We suggest a plan for prompt, consistent diagnosis and recommend more liberal use of the barium meal in questionable cases.


Late pulmonary function in survivors of adult respiratory distress syndrome. Early recognition and improvements in treatment have brought an appreciable decline in mortality from the adult respiratory distress syndrome. Physiologic changes during the acute illness include restriction of lung volumes and a defect in gas transfer. Until recently, pulmonary function of long-term survivors has not been discussed. This report concerns the pulmonary function of two patients studied 19 and 22 months, respectively, after surviving an episode. No residual changes in lung volume or compliance were found. A mild decrease in diffusing capacity was noted, and alveolar-arterial oxygen gradients were at the upper limit of normal in both.


Outpatient chemotherapy of advanced breast cancer in a community setting: a five-drug regimen. Forty-two (37 evaluable) unselected women with advanced breast carcinoma were treated with a modified "Cooper regimen" in a community setting. After 12 weeks of induction therapy, the patients were evaluated for response and toxicity. The 74% overall response rate (78% in the evaluable group) compares favorably with that of other series. The median duration of remission was 13.7 months. The median survival was 17 months for the evaluable patients and 14 months for the entire group. Twenty-two percent of the patients required hospitalization during the induction phase, and 35% were treated exclusively as outpatients during all phases of therapy. There was only one drug-related death. It is concluded that a complex chemotherapeutic regimen can be managed adequately by physicians experienced in chemotherapy in a community setting with results comparable to those from cancer centers.


Vaginal hysterectomy by an anterior colpotomy technic. A simple, relatively unknown technic of vaginal hysterectomy using the anterior colpotomy approach is presented. Experience with this procedure at a small Naval hospital is described. Morbidity occurred in 6.6% of the patients. The advantages of this method of vaginal hysterectomy are summarized.


Treatment of chronic unilateral frontal sinusitis by removal of the interfrontal septum. External surgical treatment of unilateral chronic frontal sinusitis by removal of the interfrontal septum is described. Eleven patients were treated by this method with excellent cosmetic results and only one transient recurrence.


Transabdominal gunshot wounds of the hip. Experience with two cases of transabdominal gunshot wounds of the hip in nonmilitary circumstances indicated delayed recognition of the hip involvement. This delay resulted in compromised end results in both cases. The wartime principles of early recognition and prompt surgical management are recommended for civilian settings.


A diphtheria outbreak in Dade County, Florida. During a 16-week period in late 1969, 11 cases of diphtheria (three fatal) were reported from Miami, Dade County, Florida. For each of ten previous years, two cases at most had been reported. All patients resided in a predominantly black, low socioeconomic community within the 7-square-mile Model City area. Nine patients had positive cultures for toxigenic Corynebacterium diphtheriae, mitis strain. None of the 11 patients or 22 culture-positive household contacts had been vaccinated against diphtheria. During the outbreak, one dose of diphtheria-tetanus-pertussis vaccine or tetanus-diphtheria toxoid was given to more than 90,000 residents of Model City (95%) and to more than 200,000 residents of Dade County (16%). A state law was passed in June 1971 requiring all children to be vaccinated before entering school. No subsequent cases of diphtheria were reported in the ensuing five-year period. The Miami experience suggests that prompt mass vaccination will abort the spread of epidemic diphtheria and emphasizes the need for routine vaccination to minimize morbidity and mortality.


Malpractice liability of physicians to nonpatients. Sometimes physicians assume responsibilities to third parties when undertaking the care of patients. Physicians have been held liable to third parties, though strangers to the patients, for failing to warn regarding the communicability of contagious diseases. Two suits have been allowed against physicians by third parties who were injured by drivers of vehicles who had not been warned by the physician of the danger of driving caused by their medical problem. Hospitals and psychiatrists have been held liable to injured third parties for failing to warn of the dangerous propensities of their patients under psychotherapy. Courts have held that such disclosures do not violate the patient's right to privacy and confidentiality. However, physicians may exercise professional discretion and need not warn if, in their judgment, that would be unreasonable, unnecessary, or harmful. Nevertheless, rights of patients must yield to the public interest when it collides with public safety and welfare.


The lower cervical spine in trauma: a study of false-negative and false-positive findings. Evaluation of roentgenographic studies of the lower cervical spine may be complicated by posttraumatic immobility, certain body types, and technical factors which produce equivocal findings. False-positive and false-negative findings are reported, with suggestions for additional views and more diagnostic evaluation.


A modified solid ankle brace for the treatment of arthritides. A modified solid ankle short leg brace is presented for use in patients with ankle joint and hind foot arthritides. Thirty-five patients were followed up for an average of 2 1/2 years. Thirty patients had marked relief of pain; three, moderate relief; and two, no relief. Thirty-two patients had improved cosmesis of their gait patterns.


Statistical manipulation for normalization of data: in vitro thyroid function tests. Interest in chemical and statistical methods chosen to define "normal" populations for the clinical significance of tests has grown recently. Because few clinical values are distributed in gaussian fashion, recommendations for smoothing of data by transforms have been prepared. In this paper we examine mathematical transformations as they are applied to in vitro tests of thyroid function and evaluate the use of multivariate regression analysis. Mathematical transforms used included square root, two parameter log, three parameter log, and inverse hyperbolic sine methods. Multivariate regression analysis was obtained by comparing test data for the T3 uptake, T4, and effective thyroxine ratio with clinical diagnoses as individual and aggregate weighting values for decision. None of the mathematical transforms resulted in complete elimination of diagnostic errors when compared with clinical diagnoses. The effective thyroxine ratio by itself had the highest correlation with patient findings. Additions of other commonly used in vitro function tests added little diagnostic accuracy.


Duodenal crypts.

Duodenal crypts. During the course of 2,340 barium examinations of the upper gastrointestinal tract, four male patients were found to have multiple small outpouchings on the surface of the duodenal bulb. These findings, designated duodenal crypts, are considered to be asymptomatic and are not to be confused with inflammatory changes. The endoscopic and roentgenologic appearances are illustrated.


Treatment of intestinal parasitic disease. Although improved sanitation in the United States has resulted in a general diminution in the prevalence of intestinal parasitic infections, some, such as enterobiasis, are not reduced by improved environmental or water sanitation and others, such as amebiasis and hookworm infection, persist in foci. Other infections, notably giardiasis, have increased due to the travels of American tourists in other countries where environmental sanitation is poor. North American physicians, therefore, may expect at some time to have to treat parasitic infections. Favored chemotherapeutic agents currently are: for amebiasis--metronidazole and diiodohydroxyquin; for giardiasis--metronidazole; for tapeworm infections--niclosamide; for enterobiasis--pyrantel pamoate, piperazine citrate, or pyrvinium pamoate; for ascariasis--piperazine citrate; for stronglyoidiasis--thiabendazole; for trichuriasis--mebendazole; for hookworm infection--pyrantel pamoate; for schistosomiasis japonica--tartar emetic; and for schistosomiasis mansoni--niridazole.


Cystic hemangioma of the spleen in a schizophrenic patient. We have presented a single case of cavernous hemangioma of the spleen with cystic formation. We believe this is the first reported case associated with schizophrenia. Splenic scan demonstrated only a thin rim of functioning tissue. In the absence of a reliable history, celiac angiography provided the most important preoperative information on this large, barely functioning cystic spleen. A generous incision gave the required exposure for removal. The size of the cyst and the amount of compression and deviation of the splenic artery encouraged us to use a thoracoabdominal incision. We believe this is the 75th case of cystic hemangioma of the spleen reported in the literature.


Peroneal spastic flatfoot syndrome.

Peroneal spastic flatfoot syndrome. Tarsal coalitions are not the sole cause of peroneal spastic flatfoot, and any irritative lesion in the peritalar area can induce protective contraction of any or all of the muscles bridging the peritalar joints. True muscular peroneal spasm has been shown to be present on a clinical basis in this entity where tarsal coalitions are not present. Neoplasm should be included in the differential diagnosis of the rigid flatfoot deformity.


Carpal tunnel syndrome: discussion of operating technics. A case of carpal tunnel syndrome's is presented. Histologic examination of the volar carpal ligament showed fibrocartilaginous changes suggesting a progressive degenerative phenomenon. Operative intervention relieved the pain and disability. It is implied that biopsy of the carpal ligament and/or the synovial sheath often will be helpful in making a complete diagnosis. The results of this simple operating technic are contrasted with other procedures.


Artificial feeding of Black infants.

Artificial feeding of Black infants. Analysis of milk formula feeds in a community where infant malnutrition is common, showed that overdilution of feeds is less frequent than expected. Many feeds were too concentrated. Modified and 'humanised' milks were more often and more seriously too strong than unmodified milks. An inadequate number and volume of milk feeds per day was probably more important in causing malnutrition than the strength of the feeds.


The prognostic significance of the viscerocardiac reflex phenomenon. The acid perfusion test, combined with manometric studies of the oesophagus and serial electrocardiography, has been utilised to determine the incidence of ischaemic ST-segment depression and of significant arrhythmias during acid-induced oesophageal pain. Eight per cent of patients with oesophagitis and coexistent ischaemic heart disease manifest significant ECG changes during oesophageal acid perfusion. The follow-up period of 5 years indicates that these patients have a high incidence of recurrent myocardial infarction.


The determinants of pelvic brim morphology in the female. There is a significant positive correlation between the brim index and the conjugate dimension (r = 0,66). The latter also shows a high degree of correlation with stature (r = 0,58). The inverse covariability between the transverse inlet diameter and the brim index is weak (r = -0,17). The larger brim areas and brim indices of taller women are due to their greater sagittal inlet measurements.


Proplast implants used in otology and in facial reconstructive surgery. Proplast, a self-stabilising alloplastic material, was evaluated in ear surgery and in facial reconstructive surgery. Proplast implants were used on 33 patients to reconstruct the ossicular chain (total or partial ossicular replacement prosthesis), or to rebuild the mastoid cavity. The lack of extrusion over a 24-month period is encouraging. In facial reconstructive surgery 11 patients received Proplast implants to augment and restore facial contours. Contamination with saliva remains a problem, owing to the high porosity of Proplast, which could harbour infection. When Proplast was sterile when implanted, no extrusion appeared over a 12-month period. Although the patients presented here were followed up for a relatively short time, they provide reason for some optimism that the vexed question of alloplastics applied in the field of ear, nose and throat surgery may be solved.


Minimal brain dysfunction.

Minimal brain dysfunction. The syndrome of minimal brain dysfunction is found in at least 5% of South African schoolchildren. The aetiology and pathology of this entity are uncertain. Presenting features include hyperactive behaviour, problems of fine motor co-ordination, learning disabilities and certain 'soft' neurological signs. Skilled remedial teaching is the mainstay of successful management.


Follow-up of five severely deprived and malnourished siblings, after their placement in foster care. Five siblings, neglected and malnourished to the extent that they had become nutritional dwarfs, were placed in foster care. Their weights and heights were recorded at the time of placement, and at intervals for the following 6 years. In all cases there was an initial spurt in weight, which lasted for 1 to 2 years. Thereafer, the gains in weight and height continued on lines parallel with, but below the centile lines, except in the cases of the 2 youngest children, both of whom achieved the 3rd centile for weight and approached it for height. The eldest sibling was the most severely dwarfed.


Stoma care.

Stoma care. Without doubt a most, if not the most, spectacular advance in the surgery of the colon and rectum in the last decade has been the vastly improved management of abdominal stomas and fistulas. This has been accomplished by a re-organisation of stoma care, aceptance by surgeons of the need to site their stomas with more precision and better apparatus.


Stomatherapy and the stomatherapist.

Stomatherapy and the stomatherapist. Stomatherapy can be defined as specialist care given to patients who undergo surgery with construction of a colostomy, ileostomy or urinary conduit. The role of the stomatherapist is outlined and the stomatherapy techniques and appliances used by the Groote Schuur Hospital Stomatherapy Service are described.


Stomas in children.

Stomas in children. During a 2-year period 176 stoma operations were performed at the Red Cross War Memorial Children's Hospital, for various conditions. About 50% were performed on neonates and a further 30% on infants under 1 year of age. The majority of stoma operations in this age group are performed as emergencies and the stomas are temporary. Only 10% are permanent. The specific stomas, the indications for these, some special points in technique, and the complications are considered and discussed. The management of an infant or child with a stoma is reviewed and the value of a stomatherapist in a surgical unit is stressed.


The treatment of cerebral aneurysms. A report on 51 cases. The treatment of 51 patients with proven cerebral aneurysms is reviewed. The management is discussed and the relative safety of the microneurosurgical operation is stressed.


Fine-needle aspiration cytopathology in breast disease. The cytopathology of benign and malignant breast lesions is described and correlated with the histopathology. Problems in diagnosis and the advantages of fine-needle aspiration are discussed. The diagnostic accuracy is approximately 93% with this technique.


Ketamine for anaesthetic induction at Caesarean section. Fifty healthy mothers, with normal placental function, were anaesthetised with ketamine (2 mg/kg body mass) for Caesarean section. Surgery was conducted with the patient in the lateral tilt position and anaesthesia was maintained with nitrous oxide, oxygen, muscle relaxants and controlled ventilation. Eight of the 50 infants delivered were clinically depressed, judged on the basis of the modified Apgar score at 2 minutes after delivery. The average time to sustained respiration was 58, 1 minutes. Studies of maternal blood gases before induction and at delivery revealed mild respiratory alkalosis, associated with an appropriate degree of compensatory metabolic acidosis. Umbilical cord blood gas analysis showed the presence of a fetal respiratory acidosis. The average derived fetal base excess levels were similar to those obtained in a previous study with thiopentone anaesthesia, but calculated mean maternal-to-fetal pH and base excess gradients were slightly greater in the present study. Prolonged induction-to-delivery intervals were associated with an increase in maternal metabolic and fetal respiratory acidosis. Slow delivery of the infant after invasion of the uterus magnified the degree of fetal metabolic acidosis, and widened the maternal-to-fetal acid-base gradients. Convincing evidence of maternal awareness during surgery was not obtained in this study. Five patients had hallucinations in the immediate postanaesthetic period. Unpleasant dreams were reported by 10% of patients. Delirium on emergence from anesthesia was not encountered. In this study, ketamine appeared to maintain fetoplacental exchange adequately, but may have been responsible for some degree of drug-induced neonatal depression. It is suggested that ketamine should be re-evaluated, using a lower dosage schedule, for Caesarean section.


Effect of a histamine H2-receptor antagonist and an anticholinergic on gastric acid secretion in man. Metiamide (a histamine H2-receptor antagonist) and propantheline (an anticholinergic) are both inhibitors of gastric acid secretion. We have investigated the effect of gastric acid secretion of blocking the histamine and acetylcholine receptor sites separately and together. There was a statistically significant additive inhibitory effect on pentagastrin-stimulated volume secretion when both drugs were given together. The inhibition of acid output was slightly but insignificantly greater with the combination of drugs than when they were given separately.


Congenital adrenal hyperplasia in Blacks. Two patients with salt-losing adrenal hyperplasia are reported. The occurrence of this condition among Blacks in Southern Africa has not yet been recorded. Both patients presented in the first month of life with dehydration, although they did not have diarrhoea. One was a boy, and the other a girl who had signs of virilisation. The typical biochemical changes of this condition were demonstrated. Congenital adrenal hyperplasia appears to be less common in Blacks than in Whites.


Pharmacotherapy of opiate addiction.

Pharmacotherapy of opiate addiction. Addiction to opioids has become a widespread disorder, particularly in the USA. The following review indicates experiences of the author among opiate addicts and summarises in particular the "heroin drug scene" and certain recent innovations in the pharmacotherapy of opiate dependence.


A manual system for patients' accounting records. A medical practitioner's formalised education and practical training prior to private practice does not usually include methodology in keeping patients' accounting records. This article is directed at assisting practitioners to implement a suitable system, as well as to provide standards against which they can assess their current procedures.


Transnasal hypophysectomy.

Transnasal hypophysectomy. A transnasal trans-sphenoidal surgical approach to the pituitary gland is described. The operative and post-operative experiences with the use of this technique on 21 patients with hormone-dependent malignant disease are reported. In 2 patients the procedure was abandoned because of intrasellar haemorrhage and in 1 an empty sella was found. Fifteen patients developed diabetes insipidus and 1 patient died in the postoperative period.


Control of bleb fibrosis after glaucoma surgery by anti-inflammatory agents. The methods used to identify and evaluate anti-inflammatory agents, and the effects of a triple drug regimen, consisting of oral prednisone and flufenamic acid and topical l-adrenaline in controlling bleb inflammation and fibrosis around drainage implants in patients with terminal glaucoma are described. The benefits of anti-inflammatory agents in other surgical glaucoma procedures are suggested.


A silastic prosthesis for laryngeal stenosis. A Silastic prosthesis anchored to a tracheostomy tube was used in the treatment of 5 children with subglottic stenosis. It did not cause any significant tissue reaction and obviated the problems of transfixion sutures. We treated 3 children successfully. Another died from complications owing to the tracheostomy. In the fifth patient the prosthesis was replaced by a Silastic T-tube. The use of the Silastic prosthesis is advocated for tough, dilatable laryngeal strictures, for which a T-tube is unsuitable. The advantages, disadvantages, method of manufacture and technique of insertion are discussed.


APUD cells, apudomas and the neural crest. The most characteristic feature of the APUD cell series is the ability to take up and decarboxylate amine precursors. Other features, regarded as characteristic by Pearse, are the secretion of polypeptide hormones and their origin from the neural crest. An increasing number of APUD cells is being shown to elaborate polypeptide hormones. It is acknowledged that some members are derived from the neural crest, but there is a good reason to believe that others are not, and no good reason to believe that yet others are so derived. It is therefore suggested that the common factor sought in the genesis of the APUD cell, and perhaps other tumours, may be the biochemical, rather than the embryological, relationship of the progenitor cell types.


Reduction of porphyrin excretion in porphyria variegata by propranolol. A case report. DL-Propranolol was shown to reduce the elevated urinary excretion of porphyrins and their precursors in a patient with variegate porphyria and to improve the patient's symptoms during attacks of the disease.


Nutrition knowledge in urban Blacks.

Nutrition knowledge in urban Blacks. A simple questionnaire has been presented to Blacks at Baragwanath Hospital and in Soweto to test their current knowledge of basic nutrition and some related attitudes. The survey of 400 persons included nurses, schoolchildren, and a group of others whose standard of general education was lower. The vast majority had received nutrition instruction, were aware of basic requirements, and, given a free choice, could select reasonable diets. Fatness is no longer considered a desirable attribute in these urban Blacks but reasons for this vary.


Classification of hyperlipidaemias - a time for review? Evidence is presented to show that the classical diagnosis of disturbances in lipid metabolism in terms of lipoprotein phenotypes should now be replaced by a more simple one based on evaluation of plasma lipids alone. This is because of the chemical heterogeneity of the lipoproteins, the clinical, biochemical, pathogenic and genetic heterogeneity of hyperlipoproteinaemias, and the questionable value of 'typing' of the secondary disorders.


Serological studies on human plague in Southern Africa. Part II. A bubonic/pneumonic plague epidemic in Lesotho. A description is given of an outbreak of human plague in Lesotho in 1968 which was preceded by, and merged with, a typhoid epidemic. This circumstance was responsible for a diagnosis of typhoid fever being made in the earliest plague cases, especially as the clinical presentation was similar to that of the typhoid patients. Consequently, the plague epidemic ran its natural course and with the onset of winter the pneumonic form appeared. Serological follow-up studies of recovered patients were carried out up to 4 years after the outbreak.


A review of orthopaedic and accident surgery at a rural mission hospital. All orthopaedic and trauma patients admitted to Holy Cross Hospital in the Transkei during the year 1974 have been surveyed and classified by disease type. These patients formed 8% of all admissions but occupied 16% of the beds and contributed 26% of the procedures in the main operating theatre. The significance of these findings is considered briefly.


Notifications of diseases in the Republic of South Africa, 1971-1974. Statistics of notifiable diseases in South Africa during the period 1971-1974 are presented, with brief comments on tuberculosis, typhoid fever and malaria.


Residual biliary tract stones: nonoperative treatment of 570 patients. A nonperative method has been employed over a period of 11 years in the treatment of 570 patients with residual biliary duct lithiasis. A successful instrumental extraction was accomplished in 543 of these patients (95.3%). These extractions were performed via the transcholedochal and the transcholecystic routes, the latter being used both for choledochal and gallbladder stones. The high percentage of successes, the extremely few complications, and the good long-term results turn this method into a definitely useful adjunct to the conventional therapy for biliary pathology.


Disability after gastric surgery.

Disability after gastric surgery. Partial gastrectomy, truncal vagotomy, pyloroplasty, and gastrojejunostomy, singly and in combination, produce clinical disturbances in gastric reservoir function, gastric emptying, gastric mucosal integrity, small intestinal motility, and small intestinal fluids shifts. Ordinarily, these disturbances are of minor clinical importance and respond readily to conservative management. However, postoperative gastric surgical symptoms are, at times, annoying or disabling to the patient. Some of these clinical states are amenable to surgical treatment, and in others, operative intervention is definitely contraindicated. Therefore, it is important to recognize those syndromes which are amenable to an operative procedure. Alkaline gastritis, a syndrome of postcibal pain and diffuse endoscopic gastritis with or without vomiting of bile, is best treated by vagotomy and Roux-en-Y gastrojejunostomy. The afferent loop syndrome of relief of pain by vomiting and the demonstration of a dilated or tortuous afferent loop is likewise best treated by vagotomy and Roux-en-Y gastrojejunostomy or enteroenterostomy. Efferent loop obstruction causing vomiting and gastric distention requires a revision of the gastrojejunostomy. The dumping syndrome is best treated conservatively for at least a year. If this approach fails, loop reversal at the stoma or conversion of a Billroth II to a Billroth I anastomosis is effective. For postvagotomy diarrhea, loop reversal in the distal jejunum gives relief, and for the postvagotomy atonic stomach, a subtotal gastrectomy should be performed after failure of conservative management, although there is not enough experience with this condition to make accurate prognoses. Beware of the patient who does not fit any of these syndromes. A poor result is likely to follow attempts at surgical correction.


Ulcerative colitis or Crohn's colitis. Is differentiation necessary? Three types of colitis are now recognized. In the late 1950's and early 1960's, 51 per cent of our patients having colectomy had classic chronic ulcerative colitis. Of our patients operated on at that time, 39 per cent had Crohn's colitis and 10 per cent had colitis of indeterminate type. These three types of colitis should be differentiated because of the high risk of cancer of the colon in patients with long-standing chronic ulcerative colitis. We have not seen an increased risk of carcinoma associated with Crohn's colitis. We performed resection with anastomosis in approximately one third of patients with Crohn's colitis, but recurrent disease developed in two thirds. In contrast, recurrent Crohn's disease developed in only 5.7 per cent of patients having colectomy with ileostomy. Toxic megacolon associated with Crohn's colitis has been seen only in the early clinical stage of the disease. From the standpoint of management and prognosis, attempts to differentiate between the two major types of colitis are appropriate. We have outlined some of the basic clinical and pathologic differences between these two types of colitis.


Infected aortic grafts and aortic fistulas. Infection in prosthetic grafts of the aorta and in the groin present different problems. Retroperitoneal sepsis must be treated by total removal of the graft. This is probably equally true for acutely infected grafts seen in enteric fistula. The surgical technique described can be performed in one stage. The principles of treatment for groin infections are the same as for infections associated with prosthetic grafts. The hazard is more to limb than to life, since the infection tends to point outward in the groin and thus be confined. The technique for dealing with groin infections, as presented, is straightforward.


Revision of intestinal bypass procedures. The results of jejunoileal bypass have been satisfactory in 80 per cent of the patients. In the remaining 20 per cent, one or more problems eventually may require revision of the bypass. These problems fall into four categories: inadequate weight loss; excessive weight loss; persistent uncontrollable diarrhea or associated severe anorectal problems, or both, and severe unmanageable electrolyte and metabolic imbalance with or without liver failure. In our series, 108 patients were observed for one to five years, and ten patients required revision, one revision for every 12 bypass operations performed. The preoperative evaluation and management and the options available to the surgeon in correcting the abnormalities are evaluated. The results of ten patients who underwent revision of the bypass and the rationale for the revision are outlined. Criteria for an ideal operation have not as yet been attained.


The role of angioplasty of the profunda femoris artery in revascularization of the ischemic limb. Angioplasty of the profunda femoris should be the primary approach to revascularization of the limb whenever it is feasible. Claudication distance can be significantly improved in almost all patients and prolonged limb salvage achieved in the majority of patients. In some high risk patients, the entire procedure can be accomplished expeditiously and atraumatically under local anesthesia, using a single groin incision. When the pattern of distribution of atherosclerosis provides the surgeon with the choice of performing either angioplasty of the profunda femoris or femoral popliteal bypass, the former option should be tried initially with resort to the latter if ischemia is not adequately relieved. In many instances when distal bypass is not possible or is unlikely to function effectively, angioplasty of the profunda femoris may provide the only opportunity to relieve ischemic symptoms. Operative blood flow measurements support the thesis that the collateral function of the profunda femoris artery is able to compensate for extensive obstructive disease in both the superficial femoral and popliteal segments.


Hemodialysis versus cross hemodialysis in experimental hepatic coma. In this study, the effects of conventional hemodialysis on experimental hepatic coma have been compared with those of hemodialysis against blood from a normal donor which allows exchanges without mixing of blood. cuprophan and polyacrylonitrile membranes were compared. Cross hemodialysis with a donor resulted in rpompt but transient recovery of consciousness, whichever membrane was used. Cuprophan hemodialysis without donor had no effect. Polacrylonitrile hemodialysis without donor allowed progressive and prolonged improvement in the consciusness level and the electroencephalograms. Therefore, clearance of middle molecular weight substances was more effective than exchange with a donor. Preliminary results in man showed total recovery of consciousness in six of ten patients with acute liver failure and coma and partial recovery from complete grade IV coma to grade II encephalopathy in two patients. These two patients reacted when called by their name by opening their eyes and obeying simple orders.


Significance of hyperbilirubinemia in acute cholecystitis. The incidence and significant of hyperbilirubinemia were examined in 110 consecutive patients who entered the hospital with signs and symptoms of acute cholecystitis and underwent laparotomy. Thirty-two or 29 per cent were found to have abnormally elevated serum bilirubin levels on admission. Surgical or roentgenographic examination of the common duct, or both, in 19 of these patients disclosed stones in 13. Serum levels of bilirubin averaged 6.1 milligrams per cent in those with stones and 2.7 milligrams per cent in the others. In the remaining 13 patients, the common duct was not examined, but elevated bilirubin levels, averaging 2.6 milligrams per cent, quickly returned to normal values, and the subsequent course was uneventful. Hyperbilirubinemia significantly increases the likelihood of finding common duct stones in patients with acute cholecystitis, although it also occurs frequently in patients with acute cholecystitis without common duct stones. The underlying mechanism in the latter situation is still oscure but may depend on an alteration in the normal impermeability of epithelium of the gallbladder to conjugated bilirubin.


Primary neoplasms of the duodenum.

Primary neoplasms of the duodenum. The records of 12 patients with primary malignant neoplasms of the duodenum, excluding ampullary lesions, have been studied. There were eight adenocarcinomas and four leiomyosarcomas. The second portion of the duodenum was the most common site for these neoplasms. Common symptoms were epigastric pain; obstructive symptoms, such as nausea and vomiting; obstructive jaundice, and hematemesis. Hematemesis is the most common symptom in leiomyosarcoma of the duodenum. The mean duration of symptoms was six months for leiomyosarcoma and 3.2 months for adenocarcinoma. In five patients, excision of the tumor was carried out more frequently for those in the distal portion of the duodenum. More radical procedures, such as pancreaticoduodenectomy, are the treatment of choice in neoplasms of the second portion of the duodenum. A bypass procedure is done for palliation of intestinal obstruction. Three patients with leiomyosarcomas that were resected had a mean survival time of 51 months. On the other hand, patients with adenocarcinomas that were resected had a mean survival time of nine months, while patients with unresectable tumors had a mean survival time of 2.3 months.


Critique of the Allen test for continuity of the palmar arch assessed by doppler ultrasound. The arterial circulation of both hands of 128 adults was assessed by the Allen test, a modified Allen test emphasizing proper hand position and by Doppler ultrasound. Full extension of the fingers during the Allen test resulted incomplete capillary refilling of the hand in 73 per cent of the patients. The modified Allen test, avoiding hyperextension of the wrist and fingers, revealed interruption of the palmar arch in only one patient with absence of the left radialy artery. There was complete concordance of findings by Doppler ultrasound and the modified Allen test, emphasizing the importance of maintaining proper hand position to avoid false interpretations of incomplete circulation of the palmar arch.


Indications, clinical value and complications of endoscopic retrograde cholangiopancreatography. Endoscopy combined with endoscopic retrograde cholangiopancreatography is a unique tool providing a broad, precise yield of diagnostic information about diseases of the upper gastrointestinal tract. In the absence of gross anatomic disease, its diagnostic accuracy should exceed 90 per cent and risk be minuscule. The incidence of complications and, therefore, risk to the patient and proportional to the magnitude and remedial nature of the disease processes found. In the absence of diagnostic procedures for diseases of the biliary tree and pancreas that are riskless, the relationship of endoscopic retrograde cholangiopancreatography risk to diagnostic value and patient salvage emphasizes the value of endoscopy combined with endoscopic retrograde cholangiopancreatography as the diagnostic procedure of choice for patients with suspected disease of the biliary tract or pancreas. The unique value of endoscopic retrograde cholangiopancreatography in providing rapid visualization of diseases of the upper gastrointestinal tract mucosa combined with cholangiography and pancreatography is dramatized in the patient with upper abdominal pain syndrome with or without jaundice. In the face of a rapidly evolving illness and the potential need for early surgical intervention, barium studies are relatively contraindicated and have a poor diagnostic yield. By contrast, endoscopic retrograde cholangiopancreatography combined with endoscopy rapidly rules out, or, in the presence of disease of the upper gastrointestinal tract, permits the immediate use of subsequent diagnostic procedures. An experience with more than 1,000 procedures reveals that endoscopic retrograde cholangiopancreatography is an invaluable tool for the diagnosis and management of disease of the pancreas and biliary tract.


The effect of dopamine on renal microcirculation in hemorrhagic shock in dogs. Dopamine, a naturally occuring catecholamine, was infused at the rate of 6 micrograms per kilogram per minute on an hemorrhagic shock model in dogs. Urinary output was continuously recorded, with arterial pressure being maintained at 50 millimeters of mercury. At the termination of the experiment, the dogs were sacrificed, and renal microcirculation was studied by an angiomicrohistologic technique. There was a dramatic increase in urinary output following the infusion of dopamine. Results of the microcirculatory study of the renal vasculature showed markedly increased cortical perfusion and dilation of vessels, particularly at a level of afferent arterioles; however, findings on efferent arterioles were inconsistent. Also, changes in the microvasculature of the medulla were less striking than those of the cortex following the administration of dopamine.


The incidence of male hermaphroditism in girls with inguinal hernia. The incidence of male hermaphroditism in girls with inguinal hernias is estimated to be 1.4 per cent. From 1961 to 1972, 340 girls were admitted to the Department of Surgery at St. Josephs Hospital for hernial repair. One hundred and two patients had menstruated prior to the follow-up study. Buccal smears from the remaining patients were examined for Y chromatin-positive cells. We observed a zero per cent rate of male hermaphroditism, which is not significantly different from the aforementioned frequency, p greater than 0.05. Large scale prospective studies must be available before any conclusion can be drawn as to whether or not determination of the genetic gender prior to hernial repair in girls should be conducted as a routine procedure.


Effective colostomy irrigation.

Effective colostomy irrigation. The ultimate goal of the cone method of colostomy irrigation is to return patients with colostomies to their former role in society with confidence in themselves to the extent that having a colostomy is not considered a handicap. The results have generally been excellent. We believe all patients with stomas should be afforded the opportunity to attempt colostomy irrigation.


Use of a U tube in the treatment of biliary disease. This surgical technique has permitted re-entry into the intrahepatic and extrahepatic biliary tree for the purpose of dilatation and the manual propulsion of debris through a ductal anastomosis. The method undoubtedly has other applications in the treatment of complicated biliary duct problems.


Preoperative localization of occult lesions of the breast. An outpatient procedure that accurately localizes occult lesions of the breast has been used in 26 patients. A small biopsy is performed using local anesthesia, the excised specimen is xerographed and, if necessary, bread-loafed to identify the involved specimen. This has corroborated the xeromammographic diagnosis of cancer in six patients in whom the lesions were clinically not detectable.


The effect of fundoplication on the lower esophageal sphincter. Fundoplication restores normal length and amplitude of pressure to the hypotensive lower esophageal sphincter. If the procedure is properly performed, symptomatic reflux is almost uniformly prevented. The operation is less successful in patients with esophageal stricture and in those without normal esophageal peristalsis. The effect of fundoplication on the lower sphincter is by mechanical restoration of sphincter strength and the normal physiologic neural response of the sphincter to increases in intragastric pressure.


Temporary axillary-carotid shunting for unusual instances of carotid stenosis. A method has been developed which entails the introduction of the larger end of a Javid shunt tube in the axillary artery and the other in the internal carotid with only momentary interruption of blood flow. The method of closing the incision after the thromboendarterectomy almost entirely eliminates a second period of carotid occlusion. This procedure may be useful in unusual instances in which it is believed advantageous to avoid even the relatively short occlusion periods usually necessary when using the standard intraluminal shunt technique.


A method of intermittent occlusion and chemotherapy infusion of the hepatic artery. A method of intermittent occlusion of the hepatic artery and chemotherapy infusion has been developed using a catheter introduced into the hepatic artery, with interruption of the blood flow accomplished by inflation of the balloon. This method is less likely than ligation of the hepatic artery to produce massive liver necrosis, and it ensures adequate perfusion of the tumor tissue with the chemotherapeutic agents.


The critical relationship of intravascular blood volume and vascular capacitance in sepsis. The present article represents a more detailed study of the septic leg models used in our previous work on sepsis and septic shock. An improvement in this model is described, and the period of maximum hyperdynamic response is delineated. An attempt was made to measure changes in the rate of swelling of the septic leg in responding and nonresponding dogs. The exquisitely sensitive response of the dog with sepsis to minor reductions in blood volume was demonstrated. Results of our previous studies concerning the redistribution of blood flow in sepsis were extended using radioactively labeled microspheres.


Differentiation of superficial thrombophlebitis from lymphangitis by doppler ultrasound. Of 61 patients examined by Doppler ultrasound, only 23 were found to have superficial venous thrombosis. The remaining 38 patients were considered to have lymphangitis or cellulitis. An algorithm of diagnostic and therapeutic pathways has been developed for the management of the patient who has suspected superficial thrombophlebitis.


Current surgical approach to toxic megacolon. Presented evidence illustrates that proctocolectomy performed as an emergency procedure is frequently less than adequate in salvaging patients with toxic megacolon, and a current mortality of 27 per cent is recorded. The mortality and morbidity of this disease are directly related to the delay in recognition and treatment of this complication and to iatrogenic perforation of the colon during colectomy, which results in fecal peritonitis. This is particularly evident when definitive operation is postponed for more than five days after the initial diagnosis of toxic megacolon. The rationale of current adherence to proctocolectomy for this complication is questioned, and a plea is made for the recognition of the life-saving potential for ileostomy-colostomy for selected patients and also for closer and earlier collaboration between surgeon and internist during the management of these patients.


Short term hypothermic perfusion for intestinal preservation with dimethyl sulfoxide. Morphologic changes, resulting from intracellular or extracellular perfusates with dimethyl sulfoxide as a cryophylactic agent, are similar and probably due to the anoxic period, after short term perfusion. These changes are temporary and are followed by complete recovery. No statistically significant changes in disaccharidase activity between intracellular and extracellular perfusates are found in the jejunal mucosa. No differences are found between normal disaccharidase activity and values obtained experimentally. Results of this study support the suggestion that vascular endothelial damage, as observed in evaluations utilizing the electron microscope, is certainly an important factor in the limitation of perfusion techniques of the intestine.


5-Hydroxytryptamine extraction by the lung. Both 5-hydroxytryptamine and norepinephrine are removed from blood during a single passage through the pulmonary vasculature of the dog; 5-hydroxytryptamine is removed to a greater degree than is norepinephrine. The magnitude of extraction of both 5-hydroxytryptamine and norepinephrine is similar to that previously determined in man. In the intact dog, imipramine inhibits the uptake of 5-hydroxytryptamine by the lung in a dose-dependent manner.


Acute cholecystitis.

Acute cholecystitis. Two thousand and twenty-one patients treated surgically for acute cholecystitis over a 42 year period with a mortality of 3.4 per cent are reported. This experience reveals that acute cholecystitis among patients 65 years of age and older is a serious condition and is associated with an appreciable operative mortality. However, nonsurgical management results in an even greater mortality. An aggressive surgical approach, cholecystectomy without prolonged delay after the demonstration of calculous disease of the biliary tract, is urged. In the future, this should diminish the proportion of patients 65 years of age and older with acute cholecystitis.


The role of clean air in wound infection acquired during operation. A wound isolator was used to perform 109 total arthroplasties of the hip, while 108 similar operations were done in a plenum ventilated operating room. Extensive bacteriologic studies of all patients were carried out before, during and after operation. Despite sterility of the air around the wound in the isolator group of patients, two major wound infections occurred in each of the two groups. Five minor wound infections occurred in the isolator and three in the nonisolator group of patients. All wound infections appeared to be secondarily acquired. No evidence was obtained to indicate that primary wound infection occurred during operation. The need for ultraclean air in operating rooms is deemed to be less urgent than the need to prevent secondary infection after operation.


Fibrinolytic activity of carcinoma of the colorectum. Twenty patients with carcinoma, mostly of the colorectum, and five without malignant tumors who were used as controls, have been investigated to elucidate the relationship between tumor fibrinolytic activity and the release of circulating malignant cells. The nature of the tumor fibrinolytic activity has been considered. The most significant fibrinolytic activity was seen in blood draining from the tumors and was evident in 80 per cent. Circulating malignant cells were recovered from half the patients, and in those with significant blood fibrinolysis, recovery from the draining vein reached 89 per cent. The most undifferentiated tumors appeared to be more active and released more cells. Fibrinolytic activity of tumor tissue derives from inflammatory cells, dead tumor cells, avascular areas of the tumor and vascular endothelium and is probably proteolytic as well as purely fibrinolytic.


A simple method of intraoperative autotransfusion. A new method of intraoperative blood collection and autotransfusion can be incorporated into an available suction system. It combines systemic heparinization with immediate extracorporeal citrate phosphate dextrose anticoagulation. Analysis of the autologous blood collected and its recipients indicates that it is safe. The preservation of platelets, coagulation factors and erythrocyte oxygen carrying capacity is better in this autologous blood than in homologous banked units. Potential problems of autotransfusion exist, but they are minimized when this system is used.


Diagnosis and management of colovesical fistulas. Diagnosis and management may present difficult problems in patients with colovesical fistulas. Symptoms in the urinary tract are most common, and cystoscopy, and cystography are the most valuable diagnostic procedures. It may not always be possible to demonstrate the fistula by diagnostic tests, and a high index of suspicion should be maintained in patients with inflammatory or neoplastic disease of the rectosigmoid area or bladder with recurrent cystitis. Definitive treatment should include resection of the fistula and diseased segment of the intestine. Both one stage and multistage procedures have their place in the treatment of this condition. There are specific criteria for success for a one stage procedure.


Neck dissection in the treatment of carcinoma of the anterior two-thirds of the tongue. The records of 340 patients treated surgically over the 20 year period 1950 through 1969 at this clinic for primary epidermoid carcinoma of the anterior two-thirds of the tongue were reviewed to evaluate the effectiveness of elective versus therapeutic radical neck dissection in their treatment. There has been a change in the clinical presentation of this disease, with more people presenting at an earlier stage, with a smaller primary lesion and fewer cervical node metastases. The over-all survival rate has shown a marked improvement to 69 per cent at five years. The proportion of women afflicted has increased. The status of the cervical nodes is a major prognostic factor, the determining five year survival rate being reduced from 78 to 26 per cent if the nodes are metastatically involved. It cannot be directly proved that removal of occult metastasis to the neck by elective radical neck dissection before nodes are clinically detectable leads to a better survival rate partly because the two groups being compared are selected and not randomly assigned. However, the marked tendency for carcinoma of the tongue to metastasize regionally at some time in its course, the significant error in clinical evaluation of the neck, the significant conversion of clinically negative nodes to positive in patients not treated with radical neck dissection, the poor prognosis after treatment of conversion from clinically negative into positive and the fact that more than half of the deaths are due to uncontrolled disease of the neck alone, make us strongly favor the principle of elective radical neck dissection to enhance the survival time in the group of patients without clinical evidence of nodal involvement. With current surgical expertise, the mortality and morbidity rates of simultaneous radical neck dissection are low, and the potential benefit of the procedure outweighs its potential risks. Obviously, elective radical neck dissection, if beneficial, would most likely be so in patients with the highest likelihood of having occult metastasis.


The mechanism of impaired coagulation after partial hepatectomy in the dog. Coagulation mechanisms were examined in the dog after a 70 per cent hepatectomy and the additional effect of varying periods of ischemia on the liver remnant. Dogs were submitted to a 70 per cent partial hepatectomy, and the liver remnant was rendered ischemic by occluding the vascular inflow. Portal decompression during ischemia was accomplished by allowing portal venous flow through the lobes subsequently resected. Dogs in the control group, those undergoing hepatectomy alone and those undergoing hepatectomy together with 60 minutes of ischemia time exhibited a fall in hemoglobin and hematocrit values, a transient leukocytosis, a small increase in kaolincephalin clotting time and a decline in platelet count but no significant thrombocytopenia. Prothrombin time was changed in dogs undergoing hepatectomy, but this was not affected by ischemia. The characteristic rise in plasma fibrinogen postoperatively was abolished, and fibrinogen levels were lower in dogs undergoing hepatectomy alone and fell significantly in dogs subjected to 30 to 60 minutes of ischemia of the liver remnant. Factors V and VII were decreased after hepatectomy, and Factor V was more severely reduced after 30 to 60 minutes of ischemia. There was no overt bleeding tendency. In ten dogs, the liver remnant was subjected to ischemia for 75 minutes. Four of these died within three days of operation, two with severe hypoglycemia and two with postoperative bleeding. All six surviving dogs exhibited gross coagulation defects. Prothrombin time rose, kaolin-cephalin clotting time increased and platelets fell to a greater degree than in any of the other dogs. Plasma fibrinogen level showed a profound fall, as did Factor V, the magnitude of these changes being greater than after a shorter period of ischemia. Factor VII was also decreased, but this did not appear to be related to the ischemic interval. In the clinical situation in which intrinsic coagulation mechanisms are shown to be impaired, treatment with Factor V and VII concentrates may be the best way of correcting the coagulation defect.


Dissection of the posterior part of the neck. The operation described consists of an anatomic en bloc dissection of posterior and deep cervical lymphatic channels and nodes. The procedure is cosmetically and functionally acceptable and provides adequate clearance of lymphatics from the posterior part of the neck. It is recommended for selected cutaneous lesions of the parietal, occipital and mastoid scalp as well as of the skin of the posterior part of the neck.


Intramedullary cysticercosis.

Intramedullary cysticercosis. An unusual case of intremedullary cysticerosis in a 22-year-old Mexican female is presented. The patient had a marked paraparesis with a D12 sensory level, absent deep tendon reflexes and no sphincteric disturbances. Pain in the spine was a prominent feature. A complete myelographic block opposite D12 proved at laminectomy to be due to a solitary cysticercus vesicle. It was removed from the conus medullaris through a right ventro-lateral myelotomy. The patient recovered.


Epidermoid tumor of the lateral ventricle. The authors present a case report of the successful removal of an epidermoid tumor of the temporal horn of the lateral ventricle. The tumor was confined to the ventricular cavity and was not adherent or connected to the choroid plexus. Spilling of tumor material during surgery was presumed to have contributed to the development of a postoperative acute hydrocephalus, either by obstructing the cerebospinal fluid pathways or by causing an aseptic meningitis in conjunction with cholesterol in the ventricular fluid in the postoperative period.


[Simple amputation above the coronet as a possible method of treatment in arthritis of the pedal joint (author's transl)]. One of the possible methods of treatment in arthritis of the pedal joint in cattle consists in simple amputation above the coronet. The surgical procedure in the standing animal is described and the results of this operation are reported.


[Testing two simple photometers (Lange) for use in small animal practice (author's transl)]. Two simple photometers were tested for their suitability for use in veterinary practice. Determinations of haemoglobin, glucose and total serum protein were studied using specially designed testing kits. The methods were found to be rapid, simple and reliable. Comparison of the results with those obtained using known standard methods showed a satisfactory correlation for haemoglobin and total serum protein. The results obtained on determination of glucose showed some minor differences which were possibly due to the different chemical methods used. Instruments as well as the methods used in testing are recommended.


Coexistence in human sera of a cell (membrane?) ANTIGEN AND Of autoantibodies directed against it. Antibodies purified from sera of patients with Burkitt's lymphoma by absorption onto and elution from cultured lymphoblastoid cells, were labeled with 125I and repurified by repeating the absorption-elution procedure. The doubly purified antibodies could bound with a high degree of efficiency to immunoadsorbents prepared by entrapping in polyacrylamide gel normal human serum or exudate fluids from patients with ovarian or breast cancer. Binding was specific, as it could be inhibited by high dilutions of human sera but not by animal sera. Globulin fractions of human sera were strongly inhibitory. Their capacity to inhibit was lost after treatment with rabbit anti-human IgG serum, indicating that at least part of the inhibition could be ascribed to antibodies. Some inhibitory activity was also found, however, in the "albumin" fractions of sera, suggesting that an antigen was also involved. It appears, therefore, that practically all human sera contain antibodies reacting with an antigen(s) which is present on human cells and is also circulating freely in serum and other body fluids. Sera of patients with Burkitt's lymphoma contained, on the average higher concentrations of these antibodies, as compared to sera of individuals not suffering from this disease. This antigen is thought to be associated with the cell membrane and has been identified in cells of widely differing origin.


HL-A frequencies in Crohn's disease and ulcerative colitis. Sixty-two patients with Crohn's disease and 51 with ulcerative colitis were HL-A typed. Phenotype frequencies were calculated and compared with those of a control group of 335 individuals. A higher frequency of HL-A17 was found among the Crohn's disease patient but this was not significant. However, HL-A17 has been included in two studies on Crohn's disease and the combined relative risk is 3.24 which significantly deviates from 1 unity. No statistically significant differences in the HL-A antigen distribution were found among the patients with ulcerative colitis.


Isoelectric focusing of an anti-HL-A2 antiserum cross-reacting with W28. The cytotoxicity activity of an anti-HL-A2 antiserum cross-reactive with W28 appeared in three distinct peaks after the serum was subjected to isoelectric focusing. The pH at which the peaks formed was reproducible using pH 5-8 or pH 3.5-10 gradients. Anti-HL-A2 activity occurred in each peak, but the cross-reactive anti-W28 cytotoxicity appeared to be largely confined to the second and third peaks. The first peak was exclusively IgG, the second contained IgG and IgM, and the third contained IgG, IgA, and IgM.


Quantitative isolation of mouse thymus leukemia antigen, TL. This report describes the purification of TL from papain digests of a tumor line (ASL1) and of an established cell line (L251A). Through the use of gel filtration and ion-exchange chromatography, the TL was purified approximately 100-fold with respect to the original digest. It was noted that the TL isolated from ASL1 had a specific activity 1.4 times higher than that isolated from L251A. The reason for this anomaly is unexplained. However, this work indicates that classical methods of protein chemistry can be used in the purification of these membrane components which are present in only small amounts on the cell surface.


Histocompatibility antigens and myocardial infarction. The incidence of histocompatibility (HLA) antigens in 100 men with myocardial infarction was compared with the incidence in 500 healthy controls. No significant difference was found, providing no support for either a genetic or an immunological basis for myocardial infarction.


Linkage of the pig main histocompatibility complex and the J blood group system. Linkage of the main histocompatibility complex (MHC) and the J blood locus was demonstrated in pgis by means of segregation data in families of double back-cross matings. A recombination frequency of 9.82% was estimated. No evidence of close association with the blood group systems A, B, D, E, F, G, H, I, K, L, M, N and O was found.


The mixed kidney cell-lymphocyte reaction in rats. Optimal conditions for obtaining the proliverative response in mixed kidney cell-lymphocyte culture (MKLC) have been determined in rats. The addition of 2-mercaptoethanol to the culture medium was essential for successful stimulation of lymphocytes by allogeneic kidney cells. Proliferative responses by standard MLC and MKLC were compared in rats with the same or a different Ag-B locus. In most strain combinations, there was a significant correlation between MLC and MKLC reactions, However, the DA-ACI combination, compatible at the Ag-B locus, consistently showed negative MLC and positive MKLC reactions. This suggested the possibility that this technique allowed the expression of kidney specific antigens.


Regional difference of respiratory changes in pleural pressure between left and right thoraxes in dogs. Respiratory changes in pleural pressure were recorded simultaneously from the left and right pleural spaces in 6 anesthetized closed-chest dogs in the supine, prone, left lateral and right lateral positions. Saline-filled radiopaque catheters connected to strain-gauge manometers were inserted percutaneously in the left and right pleural spaces by an air tight technique and their tips were placed in the mid-thoracic plane. The esophageal pressure was also recorded with the saline-filled system. The value of respiratory pressure amplitude (deltap, the difference between end-expiratory and minimal inspiratory pressures) in the pleural spaces was significantly greater in the left thorax than in the right in the supine, prone and right lateral positions. In 4 body positions, deltap in pleural pressure was significantly greater than in esophageal pressure. It is concluded that respiratory variations in pleural pressure of the left and right thorax are not the same and that postural change does not produce significant regional difference of the respiratory variations.


A prospective survey on chest malignancies following multiple fluroscopies during artificial pneumothorax therapy for pulmonary tuberculosis. Patients with pulmonary tuberculosis treated in 4 sanatoria in Niigata prefecture during the period from 1941 to 1961 were followed up. Of 2,756 patients, 1,193 responded and sent us effective information. However, 1,224 did not come into contact because of changed and unknown adress, 326 did not respond, and 13 were omitted because of incomplete answers. Of 1,193 effective responders, 568 had been treated by artificial pneumothorax (the pneumothorax group), and 552 had been treated by the other measures than pneumothorax (the control group). There were 65 deaths in the pneumothorax, group, and 40 deaths in the control group. No deaths from chest malignancies were reported in the pneumothorax group, while 4 chest malignancies in the control. In this survey, no evidence of increased frequency of chest malignancies including leukemia following multiple fluoroscopies during artificial pneumothorax was detected.


Prenatal diagnosis and fetal pathology of Tay-Sachs disease. In 6 cases of high risk pregnancies for Tay-Sachs disease, prenatal diagnosis was successfully carried out by examining hexosaminidase A activity in the supernatant of amniotic fluid and the uncultured and cultured amniotic fluid cells. In 5 out of 6 cases, the activity of hexosaminidase A was found to be within normal or heterozygous levels. They continued their pregnancies and were delivered of healthy children. In the remaining 1 case, the activity was undetected. Her pregnancy was terminated at the 23rd week of gestation. There was no activity of hexosamindase A in the brain and liver from the aborted fetus. A moderate increase in GM2 ganglioside was found in the brain. Electron-microscopic findings revealed membranous cytoplasmic bodies in the spinal ganglion cells as well as in the nerve cells of the retina. These biochemical and histological findings of Tay-Sachs fetus suggest that the disease proceeds early in fetal period. It was found that the cultured amniotic fluid cells was the most reliable material for the prenatal diagnosis of Tay-Sachs disease, because the values of hexoxaminidase A in the cultured cells were well in accord with those in serum from the consequently bord children. Hexosaminidase pattern in the supernatant of amniotic fluid on DEAE-cellulose columnchromatogram showed a distinct difference between homozygote, heterozygote and normal. This procedure also may be useful for prenatal diagnosis of Tay-Sachs disease.


Electrophoretic analysis of acid proteolytic zymogens in mucosa surrounding gastric ulcer. Acid proteolytic zymogens contained in biopsy specimens obtained from the area surrounding peptic ulcers of the stomach were analyzed by means of agar gel electrophoresis and compared with histopathological findings. It was demonstrated that the specimens obtained from the base of ulcer contained only slow moving protease (SMP) while mucosa located near the margin of ulcer showed the pyloric mucosal type of electrophoretic pattern and increase in distance between the margin of ulcer and the site of biopsy changed the electrophoretic pattern of specimens to the fundic mucosal type. The electrophoretic findings of acid proteolytic zymogens were found to be correlated closely to histological findings, and these changes were found to distribute in a patchy form around the ulcer. It was also found that endoscopically healed scared was covered with regenerated epithelium containing parietal and chief cells of which the electrophoretic pattern of acid proteolytic zymogens was of a fundic mucosal type.


A substrain mouse serologically classified in ddN strain and its behavioral characteristics. A special substrain mouse in ddN strain was classified by cross agglutination reaction of the red blood cells with anti-ddN mice red blood cells rabbit immune serume. The agglutination reactivity in the full-grown substrain mouse was as high as in an infant ddN mouse. Incidence of the substrain mouse in ddN strain aged older than 9 weeks was about 10%. The full-grown substrain mouse revealed a form of excitation after long-term administration of methamphetamine while other mice in the same strain were depressed. The behavioral and serological properties of histocompatible strain mice such as C57Bl and C3/ were studied to compare with those of the ddN substrain mouse.


Further studies on irreversible inhibition of dopamine-beta-hydroxylase by cysteine. In the process of studying the inhibition of dopamine-beta-hydroxylase by cysteine, we observed an interesting relationship between cysteine and catalase. This suggests that two different patterns of the inhibition of dopamine-beta-hydroxylase exist; the one is reversible inhibition, the other is irreversible inhibition. In the present experiments, we have particularly investigated the irreversible inhibition of dopamine-beta-hydroxylase by cysteine, and the following conclusions were drawn: (a) The rate of the inhibitory effect of cysteine pretreatment on dopamine-beta-hydroxylase is independent of a function of the temperature, while at temperature above 20 degrees C the extent of the reversibility of cysteine inhibition by N-ethylmaleimide is temperature dependent. (b) The rate of inhibitory effect is dependent on the time of cysteine pretreatment at 37 degrees C, and the ability of N-ethylmaleimide to reverse the cystine-induced inhibition is gradually diminished by increasing the time of cysteine pretreatment. (c) The inhibitory effect of cysteine pretreatment (37 degrees C, 10 min) is not reversed by the addition of Cu++. (d) In the presence of higher concentrations of catalase, the cystein-induced inhibition is recovered after the addition of equimolar concentration of N-ethylmaleimide. (e) Both inhibitions of cysteine on dopamine-beta-hydroxylase with and without pretreatment were the noncompetitive type to the substrate, tyramine.


An evaluation of the function of new special equipment for transrectal ultrasonotomography. A new type of equipment for transrectal ultrasonotomography was described in a previous paper. This equipment was evaluated from the data obtained from 205 cases in which examinations were performed. Tomograms were successfully recorded in 94% of cases. Tomograms sufficiently useful for diagnosis and the measurement of organs were obtained in 89% of cases for the prostate, 78% for the urinary bladder, and 80% for the seminal vesicles. No basic problems in the procedure were found, although hypotension of unknown origin was observed during the examination in a few cases.


Non-invasive detection of ultrasonic Doppler signals from renal vessels. We successfully obtained ultrasonic Doppler signals, presumably caused by the renal vessels, through the body surface without invasion. An outline of the method and several results are presented in this preliminary report.


Specimen holders for simultaneous critical point drying of multiple biological specimens. Specimen holders were developed for simultaneous critical point drying of multiple specimens of monolayer cell cultures grown on Leighton tube glass cover slips or for specimens of cells collected on silver or cellulose membrane filters. The use of these multiple specimen holders makes it possible to process several specimens in parallel and thus significantly reduce the time required for handling large numbers of samples and also eliminate the possible variations that occur in processing individual samples one at a time in series.


Device for manual trimming of tissue blocks for ultramicrotomy. An instrument for the precise trimming of flat or cylindrical embedded specimens to be sectioned in an ultramicrotome is described. It will produce the required truncated pyramid accurately by hand slicing. A simple modification to the LKB specimen holder allows it to be used with the Reichert ultramicrotome as well.


Radiation exposure of the breast in film- and xero-mammography. In addition to other advantages, xeoradiography, compared with film-mammography, seems to result in a lower radiation dosage to the breast. In order to get some valid information concerning this point, depth dose measurements, were carried out in a plexiglas phantom for the different radiographic factors used in film- and xero-mammography. It could be shown that the exposure of the skin and the mean exposure of the breast are generally lower in xero-mammography than in film-mammography, and that this difference increased with increasing thickness of the breast. Therefore it can be concluded that xero-mammography should be preferred on account of its lower radiation exposure, whenever it is possible from the diagnostic point of view.


[Dose-response relationship in radioiodine therapy of hyperthyroidism]. For the analysis of the dose-response relationship during radioiodine therapy, the effective dose was calculated based on measurements in 1171 patients in the course of treatment. Early results of the radioiodine therapy of these cases were checked up from six to nine months afterwards. The probability of incidence of a residual hyperthyroidism or of the induction of hypothyroidism respectively, in dependence on dosage, is represented by a dose-response curve. The dose-response curve for residual hyperthyreoses shows an exponential shape, whereas the curve of induced hypothyroidism is sigmoidally shaped. The results of experimental biophysics concerning dose-response curves allow the statement that there is no reactivity of the thyroid gland in cases of residual hyperthyroidism, whereas distinct compensation mechanisms are counteracting the induction of hypothyroidism. Thus, the conception of fractionated radioiodine therapy is supported by the shape of dose-response curves. The fractionation of the dose leads to accumulated inactivation effects on the hyperthyroidism, while the compensational mechanisms against hypothyroidism are strengthening by intermittent recovery and the rate of induced hypothyroidism is decreasing. The favorable effect of multiple treatment on the number of induced hypothyreoses could be verified by our own material. During the radioiodine therapy of hyperthyroidism, a defined interrelation is found between the effective dose, the thyroid mass and the effect of the dose. A formula of the isoeffective dose in dependence of the thyroid mass is derived analogically to percutaneous radiation therapy. The deviation of the effective dose from the dose previously calculated is represented as a distribution function. The mean value of this distribution function can be regarded as an expectation of the effective dose. Hence, a previous calculation of the dose is considered useful also in future. The isoeffective dose is proposed to be chosen in dependence on the thyroid mass according to a fifty-per-cent-probability of residual hyperthyroidism. Relative to the intensity of residual hyperthyroidism, a second treatment considering the same standards should be performed after four to nine months. The number of reiterated treatments needed depends on individual radiation sensitivity resulting from biological factors.


Intestinal ultrastructure after prolonged use of an elemental diet. The role of 3 diets (Purina, whole casein and hydrolyzed casein) on the morphological aspect of the intestinal mucosa has been studied in adult mice, irradiated with a single dose of 950 R or with 4 doses of 600 R. The experimental group receiving the hydrolyzed casein exhibited always the fastest recovery. 45 days after a single irradiation, some alterations of columnar cells were still noted in the other groups. The prolonged use of an hydrolyzed casein (6 months) did not alter the structure of the mucosal cells.


[Influence of 2-mercaptoethylguanidine on blood pressure reaction to bradykinine and kallidine in normal and spinal rats]. 2-Mercaptoethylguanidine (MEG) enhances the hypotension reaction to bradykinine and kallidine injections. In normal and spinal rats the secondary rise of the blood pressure after bradykinine, caused by catecholamine liberation, was transformed into a hypotension through MEG. These effects are partially interpreted as sympatholytic effects of MEG.


Effect of whole body gamma irradiation on fatty acid composition of liver lipids of female rats and radioprotection by cystamine. Effect of whole body gamma irradiation (1200 R) on the fatty acid composition of liver lipids and its triglycerides (TG), phosphatidyl ethanolamine (PE) and phosphatidyl choline (PC) has been studied in female rats. Radioprotective effect of cystamine on radiation-induced alterations in fatty acid composition of above liver lipid fractions has been studied by giving crystamine 15 min before irradiation. Irradiation increased palmitic acid levels in liver total lipids, and PE and decreased in TG. Cystamine prevented these changes. Irradiation increased palmitoleic acid levels in liver total lipids, total phospholipids and PC and these were prevented by prior administration of cystamine. Linoleic acid was decreased in liver total lipids, TG, total phospholipids and increased in PE and PC of irradiated rats. Administration of cystamine before irradiation partially protected these changes. Arachidonic acid was reduced in all liver lipid fractions of irradiated rats and this was only partially protected by cystamine, which itself reduced its levels in the control animals. Irradiation increased the levels of eicosatrienoic acid and these were not prevented by cystamine.


An approach to the analysis of menstrual patterns in the critical evaluation of contraceptives. An approach to a standardized analysis of menstrual bleeding patterns is presented. The method utilizes a prospective bleeding record and characterizes the menstrual pattern of a woman according to bleeding and nonbleeding events without imposing definitions of cycle or intermenstrual bleeding. Further, the analysis is done within a time reference period similar to life-table analysis, with the experience of each woman having equal value. The method is thus applicable to the study of menstrual patterns of both normal, untreated women, and women on experimental contraceptive regimens in which expected bleeding patterns are disrupted. The methodology is aided by computer programs to process the data and by the use of standard statistical packages for comparison of output data of different groups.


China's population figures: can the contradictions be resolved? In recent years, the government of the People's Republic of China has been reporting the country's population as "nearly 800 million." A variety of evidence suggests that this approximation is the best currently available in China, and that it may be some time before further, more accurate, demographic data are produced. The paper presents and discusses alternate population estimates and projections by UN, US, and USSR specialists.


Participative style of management in a family planning program. In 1973, a small-scale project to involve family planning staff in program management was introduced in the Sangam primary health center in Andhra Pradesh by the Adminstrative Staff College of India, Hyderabad. Through group meetings, involving all levels of health center personnel, problem areas were identified and analysed and solutions sought. On the basis of recommendations made by the groups, a work plan was drawn up. Monthly review meetings were held to discuss progress in implementing the plan. The project was found to have a positive effect on staff morale and commitment, and program acceptance levels increased. In light of the success of the project at Sangam, a proposal has been submitted to the government to expand the project to other primary health centers in the district.


A report on a contraceptive social marketing experiment in rural Kenya. There is a recognized need for the development of nonmedical, grassroots family planning delivery systems. This report describes the results of a two-year experiment in rural Kenya in which local marketing resources were utilized to promote and distribute condoms through village stores. The impact of the extensive advertising campaign on the test market area was measured by comparison with a control area and by before, during, and after sample surveys. In addition to achieving a condom sales level of 0.21 pieces per capita after 12 months, the program had a marked impact on family planning knowledge  and practice, although not on attitudes. The authors assess the program's performance in relation to its goals and suggest how such social marketing programs could have far-reaching significance in most developing countries.


Some aspects of health care in rural Nigeria. 1973 and 1974 surveys of Ibo women of childbearing age were undertaken in order to obtain baseline information for developing a community health program. Findings from the village of Ebendo show extremely high fertility rates and infant and maternal mortality levels as well as high desired family size. An examination of the traditional health care and family planning attitudes suggests that a health program offering family planning services in this region should consider offering subfertility counseling; providing services free or nearly free; and focusing on the younger women who are more receptive to family planning.


A comparison of the copper T-200 and the Lippes Loop in four countries. A comparative field trial of the Copper TCu-200 and the Lippes loop was conducted in Colombia, Iran, Korea, and Thailand from 1971 to 1973. The study, involving 7,400 women, provided two-year first segment continuation and termination rates. In three countries, TCu-200 expulsion rates were significantly below Lippes loop expulsion rates. For women with three or fewer living children, TCu-200 expulsion rates were markedly below Lippes loop rates in all four countries. The comparative advantage accruing to the TCu-200 in this characteristic did not extend to the two-year continuation rates.


Interactions between health and population. Both health and population have multiple direct and indirect, as well as positive and negative, influences on each other and on the development process. There is much evidence to show that high fertility produces multiple health hazards and that family planning is one of the most effective health measures available. Conversely, there are also multiple ways in which health influences fertility. Whereas health services resulting in reduced morbidity and mortality have often been considered a major cause of population growth, the authors argue that health programs can also contribute to a more rapid decline in birth rates by facilitating the increased practice of family planning. Evidence is reviewed to support the position that family planning services can be more effective, efficient, and acceptable when combined with maternal and child health and nutrition programs.


The changing African family project: a report with special reference to the Nigerian segment. The Changing African Family Project was begun in 1973 as a cooperative venture of the Sociology Department of the University of Ibadan and the Demography Department of the Australian National University, with research institutes and individual researchers in 11 representative countries of Africa, to investigate the preconditions for fertility decline. This paper reports initial initial findings from the large Nigerian segment of the project, which was used as a laboratory, and presents technical information about the surveys, as well as findings on economic supports for high fertility, factors affecting fertility, the role of sexual abstinence in determining fertility levels, the increase in contraception and its relation to family size limitation, and the incidence and nature of achieved small families. Information is also provided on the projects in Cameroon, the Congo (Brazzaville), Ghana, and the Sudan.


Preferences for sex of children in Thailand: a comparison of husbands' and wives' attitudes. Findings on sex preference for children from a Thai national survey show substantial differences for men and women. Married women appear to have a weak or moderate preference for sons, coexisting with a desire to have at least one child of each sex. Their husbands' preference for sons is noticeably more pronounced. Son preference is strongest among urban ethnic Chinese men but is also substantial among ethnic Thai men. There is also some evidence that men like to have at least one daughter. The contrasting patterns of sex preferences found for men and women in Thailand suggest that results can be misleading if studies of sex preferences for children are based exclusively on samples of married women.


Family planning in Pakistan: an analysis of some factors constraining use. Family planning efforts by the Pakistan government were greatly expanded during its third Five-Year Plan (1965-70). Cross-sectional data obtained from the 1968-1969 IMPACT Survey are analyzed to determine the relative importance of demand and availability factors in explaining the response of Pakistani couples to the program's efforts. The findings indicate that the proportion of couples who express interest in controlling their fertility in the future is larger than the proportion who report current use of a family planning method. The analysis, however, shows that the program delivery system did not reach most of those who indicated they were potential users. When adequate availability was reported, family planning was adopted despite existing traditional social constraints; nonetheless, the analysis also points out that the potential of the program was severely limited by these constraints.


Survival of transfused factor VIII in hemophilic patients treated with epsilon aminocaproic acid. The effect of EACA (epsilon aminocaproic acid) on the survival of factor VIII (F. VIII, antihemophilic factor, AHF) concentrates after infusion in hemophilic subjects was studied using two F. VIII preparations: an intermediate purity "cryoglobulin" and a high purity glycine-precipitated concentrate. In vivo recoveries of F. VIII with both concentrates were found to be close to the values predicted on the basis of concentrate potencies assayed prior to infusion, but not if the labeled potency was used in the calculation. Control studies showed similar first and second phase half-life times and half-disappearance times when the two F. VIII preparations were infused, and both preparations were found to follow a biphasic disappearance curve. The biological half-life (second phase rate of disappearance) was 12 to 13 hours. The administration of EACA in conjunction with the F. VIII concentrates did not prolong the half-life times (first or second phase) or the half-disappearance times.


The fate of bacteria in frozen red cells. Units of blood were intentionally contaiminated with suspensions of either Aerobacter aerogenes, Escherichia coli, Bacillus subtilis, Enterobacter cloacae, Pseudomonas aeruginosa, Sarcina lutea, Seratia marcesens, Staphylococcus epidermidis, Streptococcus faecalis, Paracolabacterum aerogenoides (Enterobacter hafriae), Mima polymorpha or Acinetobacter- calcoaceticus. When inoculation was made prior to glycerolization, the subsequent glycerolization, freezing, thawing, and deglycerolization resulted in roughly a two log reduction in the number of bacteria. When inoculation was made with a final concentration of between 10(1) and 10(5) organisms per milliliter, immediately following deglycerolization or following washing without glycerolization and freezing, no increase in the number of bacteria was seen after 72 hours storage at 4 C. Three of the 12 organisms studied decreased in number during 72 hours of storage. These data suggest that the current 24-hour limit on the post-thaw storage of frozen red blood cells may be unnecessarily restrictive.


The acquisition of granylocytes by leukapheresis: a comparison of continuous flow centrifugation and filtration leukapheresis in normal and corticosteroid-stimulated donors. Leukapheresis by continuous flow centrifugation (CFC) or filtration (FL) were compared in untreated and corticosteroid-treated donors. The administration of prednisone 60 mg orally 10 to 12 hours before leukapheresis increased significantly both the donor's prepheresis WBC counts and the total granulocyte yields by CFC or FL. Dexamethasone 6 mg iv at the start of FL did not increase granulocyte yields significantly. In untreated donors FL yielded 0.25 x 10(10) granulocytes per liter donor blood processed as compared with 0.05 x 10(10) per liter in CFC donors. Corticosteroid premedication has a greater relative effect in increasing yields by CFC than by FL. Donor reaction rates were between 4 and 6 per cent for both procedures.


Platelets and factor VIII as functions of blood collection time. Plasma and platelet concentrates were prepared from whole blood collected in less than eight minutes, and from blood collected in 8 to 12 minutes. Comparison was made between the two collection groups of Factor VIII activity in fresh plasma, and of Factor VIII activity in fresh frozen plasma. Using the rank sum test, no significant difference was found between Factor VIII activities in either fresh or fresh frozen plasma. The number of platelets in concentrates prepared from blood collected in less than eight minutes were compared with those in concentrates from blood collected in 8 to 12 minutes. Mean numbers of platelets were 6.89 x 10(10) and 7.12 x 10(10),respectively. No significant difference was found between the two groups when compared by the rank sum test, or the "t" test. Current guidelines recommending maximum eight-minute collection for component preparation may be inappropriately restrictive.


Selective elimination of the delayed-type hypersensitivity response by extracorporeal thoracic duct filtration. Calves were sensitized to tuberculin and histoplasmin. The delayed-type hypersensitivity skin response to these antigens was produced and the diameter of induration measured. Repeated skin tests prior to filtration demonstrated that the amount of induration produced by these skin tests was closely reproducible. Histoplasmin or tuberculin-coated columns were then introduced into a closed circuit extracorporeal thoracic duct circulation. A significant (P is less than 0.01) reduction or ablation of the delayed-type hypersensitivity response was obtained to the antigen used to coat the column. In contrast, no significant reduction occurred in the skin test response to the other antigen. Repeated skin tests to both antigens after the cessation of filtration showed a gradual rise toward prefiltration levels in the skin test to the filtered antigen. The results of these experiments indicate that a selective population of T lymphocytes can be removed from an in vivo system. The removal of these cells can selectively reduce a delayed-type hypersensitivity skin test response to a particular antigen. These results are consistent with the hypothesis that a type of in vivo selective immunosuppression can be produced by antigen-coated columns when they are placed in an extracorporeal thoracic duct lymph circulation system.


Increasing whole blood oxygen affinity during rapid exchange transfusion: a potential hazard. Whole blood cell separators are being used to achieve partial exchange transfusions in patients with hemoglobin S. The rate and extent of the alteration of whole blood oxygen affinity, incurred by this procedure, has been determined in a patient with Hb S/C disease. The implications in terms of oxygen delivery to the tissues are described for this patient and also for patients with the more severe disease associated with Hb S/S. It is concluded that whole blood cell separators should be used with an awareness of the possible detrimental effects of acute increases of whole blood oxygen affinity in these patients.


72-hr canine kidney preservation without continuous perfusion. A new flushing solution consisting of electrolytes and mannitol has provided successful 3 day canine kidney preservation evidenced by immediate life-supporting renal function. In our experiments the solutions described by Sacks and Collins have failed to achieve this prolonged renal storage but have been successful in storing canine kidneys for 2 days. This relatively simple new hypertonic solution does not require additives and has been successfully used in clinical renal transplantation.


The effect of X-irradiation upon the fate of cancellous bone allografts in inbred rats. The effect of two doses of X-irradiation upon the osteogenesis in isografts or allografts of cancellous bone has been studied. Exposure of rats to 500 rads of X-irradiation caused a transient depression in osteogenesis in the skeleton. This depression was more marked, however, after 600 rads of X-ray. Five hundred rads of X-ray had no effect upon the level of osteogenesis in isografts 2 weeks after grafting, but did depress new bone formation in 3-week-old grafts. The higher dose of X-rays caused a more profound depression in new bone formation at both 2 and 3 weeks. Both 500 rads and 600 rads of X-ray had little effect upon the degree of first phase osteogenesis in H-1 disparate allografts. However, there was some improvement in late phase new bone formation in recipients treated with 600 rads. Both doses of X-rays markedly improved the amount of first phase osteogenesis in H-1 identical allografts. There was also a significant improvement in the new bone formation in grafts in the second phase. The significance of these findings is discussed.


The distribution of effector cells for antibody-dependent cytotoxicity is species dependent. Murine lymphoma cells were lysed by using either an allogeneic or a xenogeneic (rat) antiserum and antibody-dependent effectors from mice and rats. It was found that murine spleens were poorly antibody-dependent effectors against this target. The peritoneal cavities of mice were a good source of effectors. In rats, the spleen contained effectors, whereas adherent cells from the peritoneal cavity were comparatively ineffective. Cells from both rat and murine spleens lysed sheep erythrocytes in conjunction with an appropriate antiserum. The data emphasize that there is a difference in the antibody-dependent lysis of erythrocytes compared to nucleated mammalian cells. They also demonstrate that the distribution of antibody-dependent effectors is species dependent.