Free-water clearance patterns as predictors and therapeutic guides in acute renal failure. Sequential changes in renal function were studied in a series of 114 postoperative patients who developed acute renal failure. The loss of concentrating ability, manifest by a change from strongly negative free-water clearances to values near zero, occurred 24 to 48 hours before the onset of blood urea nitrogen (BUN) and creatinine elevations. In 15 patients a transient period of positive free-water clearance was documented just before these values approached zero. Criteria were proposed for early diagnosis of acute renal failure (ARF) based upon description of the temporal pattern of free-water clearance values. The loss of concentration ability occurred with decreased urinary Na+ concentration unless patients were given large amounts of saline solution prior to the development of ARF. This was followed by gradually increasing urinary Na+ concentrations. Changes in K+ concentrations were not significant until the late stage of renal failure. Recovery patterns in 46 of these patients who survived demonstrated an early return of negative free-water clearance followed by gradually decreasing BUN and serum creatinine values. During this period recovery of the ability of Na reabsorption and excretion of K+ was indicated by decreased urinary Na+ concentrations and increased urinary K+ concentrations.


The early acidosis of burns: its relationship to extent of burn and management. Acid-base studies were carried out on 76 consecutive burn patients admitted within 36 hours of injury. Admission blood pH and base excess (BE) values all decreased in a linear relationship to the extent of the burn. Blood Pco-2 changes were unrelated to the extent of the burn. Significant acidosis developed within 2 hours of burn injury. Base requirements for the first two 24 hour periods after burn were linearly proportional to the extent of burn. Base requirements for these two periods were determined and were expressed as: (1) base needed the first 24 hours (milliequivalents per kilogram) equals percent of body surface burned/8; and (2) base needed the second 24 hours (milliequivalents per kilogram) equals base needed the first 24 hours/4. These formulas were found to work satisfactorily in a prospectively treated series of patients.


The negative feedback mechanism of gastric acid secretion: Significance of acid in the gastric juice in man and dog. As reported previously, gastrin-stimulated gastric secretion in the dog and in man was suppressed by an intravenous infusion of secretin, These results, both in the dog and in man, also were obtained by introduction of acid into the duodenum, which indicated that both endogenous and exogenous secretion inhibit gastrin-stimulated gastric secretion at the oxyntic cell level. Feeding a test meal in man gave rise to an increase of plasma gastrin, reaching a peak of 120 pg. per milliliter at 15 minutes after feeding and remaining above control level for 2 to 3 hours. Is was found that plasma gastrin was suppressed greatly during the intravenous infusion of pure secretin. In animal experiments endogenous gastrin release produced by irrigation of the antral pouch also inhibited both endogenous and exogenous secretin. These results indicate that secretin inhibits gastrin release at the G-cell level in the antrum. On the other hand, it also was observed that endogenous gastrin release ceased when the pH of the perfusate dropped below 2.5. The following conclusions are drawn from the above findings. (1) Gastrin release is suppressed primarily by direct contact of acid with the antrum. The feedback mechanism in this case operates intraluminally in the stomach. (2) The low pH content of the stomach stimulates the release of secretin from the duodenum. The secretin released in this way not only inhibits gastric acid secretion at the oxyntic cell secretin released in this way not only inhibits gastric acid secretion at the oxyntic cell secretin released of gastrin at the G-cell level in the antrum. The level but also blocks the release of gastrin at the G-cell level in the antrum. The feedback mechanism brought about by acid of gastric origin occurs through the general circulation.


Normocalcemic hyperparathyroidism, kidney stones, and idiopathic hypercalciuria. Eighty-four patients with recurrent kidney stones, serum calcium levels in the upper normal quartile, and most of whom with hypercalciuria had their parathyroids surgically explored. Parathyroid adenomata were found in 19 patients, hyperplasia in 39, and normal parathyroids in 26. Postoperatively there was a significant fall in serum calcium and urinary calcium excretion in all three groups. At clinical follow-up 2 to 5 years postoperatively there was no case of kidney stone recurrence among the adenoma patients. In the hyerplasia group there were recurrences tn 25 percent. The corresponding figure for the patients with normal parathyroids was 48 percent. The concept of normocalcemic primary hyperparathyroidism and the relationship between this syndrome and idiopathic hypercalciuria are discussed. Some prinicpal therapeutic measures are recommended.


Perineal anal transplant in anorectal malformation in female patients. Results of perineal anal transplant in 25 patients with anorectal malformations in female children have been analyzed. The present study shows that the operation is ill advised in patients with intermediate anomalies but can be undertaken safely in patients with low anomalies. In our series best results were obtained when the transplant was performed in patients who were past 5 years of age. Colostomy, though helpful in reducing the severity of the immediate complications, does not influence the late results.


The effect of carbenoxolone on changes in canine and human gastric mucosa caused by taurocholate and ethanol. The effect of carbenoxolone on taurocholate-induced changes in gastric mucosal permeabiity was assessed in three dogs, each of which was prepared with an antrectomy and a vagally denervated gastric pouch. Perfusion of the canine pouches with sodium taurocholate (40 mM) was associated with an increase in hydrogen ion back diffusion. This effect was not diminished by 10 days of carbenoxolone treatment. The effect of carbenoxolone on ethanol-induced changes in gastric mucosal permeability was assessed in six normal human subjects. A significant increase of gastric mucosal permeability was observed in six normal human subjects after instillation of ethanol (20 percent v/v). After 3 weeks of oral ingestion of carbenoxolone, there was inconsistent protection against ethanol-induced increases in gastric mucosal permeability. Basal secretion of hydrogen ion and postethanol hydrogen ion secretion appear to be diminished by carbenoxolone. These studies suggest that carbenoxolone does not protect against taurocholate- and ethanol-induced increases in gastric mucosal permeability in the dog and in man. It seems unlikely that carbenoxolone exerts its beneficial effect on the healing of gastric ulcers in man by an effect on gastric mucosal permeability.


Congenital intrapericardial aneurysms of the left atrium. A patient with congenital intrapericardial aneurysm/diverticulum of the left atrium diagnosed preoperatively is described. A review of the 16 previously reported cases revealed that the majority of the patients present with palpitation and are found to have an abnormal cardiac shadow on chest radiography, as did this patient. The aneurysm appears to cause systemic emboli and paroxysmal or persistent atrial tachyarrhythmias which are often resistant to medical therapy. The presence of the aneurysm is suggested by an abnormal contour of the left cardiac border in the postero-anterior chest radiograph and this can be confirmed by angiocardiography. Surgical excision of the aneurysm is indicated in all patients to prevent the occurrence or recurrence of systemic emboli and atrial arrhythmias. Our patient has remained free of symptoms since her operation 14 months ago.


Chylothorax after high translumbar aortography. Two patients who had high translumbar aortograms for suspected arterial disease developed shortness of breath 48 hours after aortography and were found to have chylothoraces. Conservative management was initially adopted for both, but surgery had to be resorted to, although the first patient died before arriving in the operating theatre. The literature and the management of this condition are reviewed.


Isolated chylopericardium due to mediastinal lymphangiomatous hamartoma;. Isolated chylopericardium is a rare cause of pericardial effusion. Intrapericardial chyle was first noticed by Hasebroek (1888) at necropsy. Twenty years ago Groves and Effler (1954) first reported a clinical case of isolated chylopericardium. The present case is similar to theirs in several respects, and is the nineteenth case to be reported. To our knowledge this is the first British report of an isolated chylopericardium and is the fourth case of isolated chylopericardium due to a mediastinal lymphangiomatous hamartoma to be successfully treated.


Left ventricular to right atrial shunt resulting from infective endocarditis. A unique case is described in which infective endocarditis of the aortic valve led to intractable heart failure and necropsy examination showed that the patient had developed a communication between the left ventricle and right atrium.


Tumours of the thymic region. Symptomatology, diagnosis, treatment, and prognosis. Fifty-three patients operated on between 1952 and 1971 were originally diagnosed as having thymoma. Re-examination of the material shows that only half of these tumours were true thymomas. The rest were classified as malignant lymphomas, primary and secondary carcinomas, and a few haemangiomas. Half of the patients had symptoms at the time of diagnosis. However, in half of the asymptomatic cases the tumours had penetrated the capsule. Decisive in prognosis are the macroscopic findings around the capsule. Of 33 patients with infiltration of the capsule, 30 had died at the time of investigation. Twenty-five patients died within two years of operation, Twenty-five patients had thymomas, of which 14 were well defined. Twelve patients with thymomas suffered from myasthenia gravis. The treatment of choice of thymoma is total excision, if necessary enbloc, and if there is penetration of the capsule, radiotherapy should be given. None of the patients with a well-defined thymoma had died from their tumour while only two patients with infiltrating thymomas are still alive, Of eight patients with Hodgkin's disease located in the thymus, six had penetration of the capsule, and of these only one patient is still alive. Two patients with well-defined tumours are both alive. The treatment of localized Hodgkin's disease is excision and irradiation. The prognosis for patients with other malignant tumours was bad, the mean time of survival being less than six months.


Surgical correction of pectus excavatum using a retrosternal bar. Pectus excavatum is a progressive congenital deformity for which surgical correction is an established procedure. The method of correction using a stainless steel retrosternal bar to maintain the sternum elevated is, in our experience, the most successful procedure. Successful surgical correction usually requires resection of all deformed costal cartilages with transverse osteotomy of the anterior table of the sternum and internal fixation using a bar anterior to the rib cage but behind the sternum. In the last 13 years 118 patients with this deformity have been evaluated and 72 patients have been surgically corrected by the described procedure. Of these 72 patients, 65 (90 percent) have had excellent or good cosmetic and functional results. The best results were obtained when the child was operated on between the ages of 6 and 10 years, the poorest results in those operated on under the age of 3 or over the age of 20. For a satisfactory result the bar must be left in for at least six months; the best results were obtained in those patients in whom the bar was left in for at least one year. No serious complications have followed the use of this technique.


Re-expansion pulmonary oedema.

Re-expansion pulmonary oedema. Clinical details are given of two patients who developed ipsilateral pulmonary oedema following re-expansion of their spontaneous pneumothoraces by intercostal drainage of air. The possible mechanisms underlying the oedema are discussed, and prior literature is analysed. Reference is made particularly to its predictability and to precautions recommended to minimize the frequency of this potentially fatal complication in the management of spontaneous pneumothorax.


Prevalence of chronic bronchitis in an industrial population in North India. A survey for the prevalence of chronic bronchitis in an industrial population in North India is reported. The prevalence of chronic bronchitis is 12.5 percent in 473 subjects between the ages of 17 and 64 years. The prevalence rate of chronic bronchitis is comparable to that observed in areas of low community air pollution in Europe and North America. There is no age-related rise in the frequency of respiratory symptoms. The consumption of tobacco in these subjects is low and is comparable to tobacco consumption of light smokers. The prevalence of chronic bronchitis in smokers is five times the prevalence in non-smokers and is similar to the values reported for light smokers in other surveys. These observations suggest that cigarette smoking is associated with the development of chronic bronchitis, and the differences in the prevalence rate of chronic bronchitis between this survey and other surveys conducted in Europe and North America are mainly due to differences in smoking habits. Air pollution has a minor effect only and ethnic differences do not appear to play any part. Forced expired volume in one second shows a negative correlation with age. It is lower in asymptomatic smokers than in non-smokers and is lower in chronic bronchitis than in controls.


Absorption of ampicillin from the human lung. The absorption of ampicillin from the lungs after intratracheal administration was studied in a healthy human. Doses of 50 mg, 250 mg, and 1,250 mg were given by intratracheal injection, and absorption of ampicillin from the lungs was assessed by measuring plasma levels, the area under the plasma level-time curve, and urinary excretion. All these indices of absorption increased with the dose of ampicillin. An intratracheal dose of 100 mg of probenecid together with 250 mg of ampicillin failed to reduce the absorption of ampicillin from the lungs. The uptake of ampicillin by human foetal bronchial slices in vitro was also studied; although viable, they did not accumulate ampicillin. These preliminary results suggest that ampicillin is absorbed from the lungs by passive diffusion.


A trial of oral delta-1-(trans)-tetrahydrocannabinol in reversible airways obstruction. Sixteen patients with proven reversible airways obstruction were admitted to a double-blind study to compare the bronchodilator effects of oral delta-1-(trans)-tetrahydrocannabinol (delta-1-THC) and salbutamol. Measurements of forced vital capacity, forced expired volume in one second, peak expiratory flow rate, and maximum expiratory flow rate at 50 percent vital capacity after 10 mg oral delta-1-THC did not differ significantly from the effect of placebo, whereas increases after salbutamol were significant. Analyses of mood, pulse rate, blood pressure, and electrocardiogram showed no important changes after oral delta-1-THC. In vitro studies with isolated tracheal muscle indicate that the activity of delta-1-THC is 1,000 times less than the equivalent dose of isoprenaline, and the effect of delta-1-THC is not abolished by beta-adrenoreceptor blocking agents. It is concluded that oral delta-1-THC, at a dose of 10 mg, does not produce clinically significant bronchodilatation in patients with reversible airways obstruction.


Serial measurement of plasma cortisol in lung cancer. Serial plasma cortisol estimations were carried out in 81 male lung cancer patients and in a control group of 50 male subjects with conditions other than lung cancer. It was found that group mean plasma cortisol levels, both in the morning and in the afternoon, were greater in the lung cancer patients than in the no-cancer control group. However, long-term assessment four years after the beginning of the study showed that high plasma cortisol levels were found predominantly in cancer patients within six months of death. If such patients are excluded from the study, there is no significant difference in group mean plasma cortisol levels between male lung cancer patients and a male control group.


Pleural effusion in sarcoidosis: a report of six cases. Six (4 percent) of 150 patients with sarcoidosis had a pleural effusion. A review of the literature revealed seven more patients with pleural sarcoidosis. Analysis of the 13 patients reported so far did not reveal any clinical, radiological, or laboratory feature which may be of diagnostic significance. The diagnosis of pleural sarcoidosis was based on clinical or radiographic grounds and histological evidence of noncaseating granulomata. In three of the patients pleural fluid resolved spontaneously; the other three were treated with corticosteroids. It is suggested that pleural involvement in sarcoidosis, especially in Negroes, may be more frequent than is generally realized and the effusion may occur either at the time of initial presentation or later in the course of the disease.


The toxicity of dimethyl sulphoxide (DMSO) for the dog, pig, rat and rabbit. Dimethyl sulphoxide (DMSO) was tested for oral toxicity in rats and dogs, and dermal toxicity in rabbits and pigs. Oral administration was by gastric intubation as a 50% equeous solution, 5 days/week at levels equivalent to 9.0, 3.0 or 1.0 ml undiluted DMSO/hg/day. For dermal application 50% and 90% equeous solutions were used to give levels equivalent to 8.1, 4.5, 2.7 or 1.5 ml DMSO/hg/day, as one daily application for rabbits, and divided into two applications/day for pigs. Dogs were dosed for approximately 2 years and pigs for 1 year, although half the animals of both species were dosed for only 18 weeks. Rats were dosed for 18 months, but some were used for interim sacrifice after a year. Rabbits received applications to normal and abraded skin for 6 months. Minor changes in bodyweight and haematological values were observed, together with a physiological diuretic response to DMSO, but the target organ was the eye, principally the lenticular nucleus. Ocular effects in dogs started after 5-10 weeks dosing at 9 ml/kg and consisted of central (nuclear) lens changes with alteration of the refractive index (myopia); transitory equatorial opacities during the 5th month; central (nuclear) opalescence; and changes in the vitreous humour. Similar changes occurred more slowly at 3 ml/kg, the alterations to the vitreous being first observed after 9-10 months at this level. Progressive nuclear refractive changes occurred after dosing for considerably longer than 6 months at 1ml/kg, but none of the animals in this group manifested the opalescence. Biochemical investigation of the lenses revealed reduction of soluble protein (mainly alpha-crystallin), glutathione and water levels, and an increase of insoluble protein. Evidence of recovery was limited mainly to a reduction in the number of dioptres needed to correct nuclear refractive change. Cessation of dosing led to regression of refractive nuclear changes but did not prevent the appearance of opalescence at 3 ml/kg and above. Dogs were the most severely affected of the 4 species, with nuclear effects at 1ml/kg, extensive changes in the lens, and involvement of the vitreous. Pigs and rabbits were affected by dose levels of 2.7 ml/kg and 1.5 ml/kg respectively. Rats occasionally showed minimal changes at 9 ml/kg. The importance of the findings in dogs is discussed in relation to general toxicological protocols. It is emphasised that reversibility of signs, and adequate duration of administration, must both be considered when ascertaining whether changes occur at levels approximating to those of human intake.


Comparative histopathological effects of aflatoxin B1 and palmotoxins B0 and G0 on some organs of different strains of the newly hatched chick (Gallus domesticus). Aflatoxin B1 and palmotoxin B0 are equitoxic to the developing chick-embryo (Gallus domesticus) whilst palmotoxin G0 is relatively non-toxic. Toxic lesions are present in the heart, liver, skeletal muscle, brain and cartilage in varying severities. The liver and skeletal muscle show fatty change and toxic myositis, respectively. Lesions in the heart, brain and cartilage are relatively mild. The endocardial cushion-like plaques at the base of the atrioventricular valves are lesions peculiar to aflatoxin B1 and palmotoxin B0-induced cardiac damage. It appears that these mycotoxins are not selectively tissue specific in inducing organ damage in the chick-embryo. An ultrastructural study of these lesions in the chick and other species may help to elucidate the molecular mechanism of the toxicity of these mycotoxins which are suspected to be very potent human hepatocarcinogens in certain parts of the tropics. Their acute phase effects in man are, however, unknown.


Effects of prenatal administration of acetylsalicylic acid in rats. Acetylsalicylic acid (ASA) administration (200 mg/kg/day) during the last six days of pregnancy in the rat has been observed to result in: (a) a prolongation of the duration of pregnancy; (b) a prolongation of the parturition time; (c) the appearance, in some individuals, of dystocia with possible secondary death of foetuses in utero.


Toxicity of aerosol propellants in the respiratory and circulatory systems. VIII. Respiration and circulation in primates. The low-pressure propellants influence predominantly the circulation, whereas the high pressure propellants affect the respiration in anesthetized monkeys. There are four groups according to the level of toxicity: Class 1, low-pressure propellants of high toxicity that cause tachycardia and hypotension; Class 2, low-pressure propellants of intermediate toxicity that influence either circulation or respiration or both; Class 3, high-pressure propellants of intermediate toxicity that cause bronchoconstriction; and Class 4, high-pressure propellants of low toxicity that do not influence respiration or circulation even when inhaled at levels of up to 20 percent concentration.


Skin deposition and penetration of trichlorocarbanilide. Studies are reported on the localization and quantitative distribution of 3,4,4'-trichloro[14C]carbanilide([14C]TCC) in guinea-pig and human skin, and on the percutaneous absorption of TCC following topical application to guinea pigs. [14C]TCC was applied to guinea-pig skin in various vehicles (conventional, superfatted, 10 percent non-soap detergent (NSD) and 30 percent NSD soap suspensions or in N,N-dimethylformamide [DMF]) and under various conditions (e.g. freshly prepared or equilibrated suspensions; single or multiple washes). Most of the amount of TCC remaining in the skin after rinsing was deposited on the skin surface and only relatively minute amounts actually penetrated through the epidermis into the dermis. Whereas conventional soap facilitated a greater deposition of TCC on the skin surface than NSD, the latter caused greater amounts of TCC to be deposited in the pilosebaceous system and lower dermis than conventional soap. The absence of TCC in the blood and tissues of guinea pigs given topical applications of TCC lends further support to the very low order of percutaneous absorption of TCC. The localisation of TCC followed a similar pattern in human skin as in guinea-pig skin, but the amount deposited was less and the rate of disappearance was more for human than for guinea-pig skin.


Uptake of carbon monoxide in blood of miniture pigs and other mammals. Different affinities of blood for CO were observed in in vivo and in vitro experiments. Hamsters showed the greatest relative affinity (1.0), the corresponding value for rats was 0.8, for pigs 0.74 and for rabbits 0.58. The upward shift of the saturation curves was dependent on the rate of respiratory exchange per unit of body weight, e.g. the curves were less steep for pigs than for rabbits. After increased motor activity the equilibrium saturation of CO in blood is reached more rapidly. From the results of in vitro experiments the following affinity constants for the blood of different species could be calculated: pig K = 130, hamster K = 181, rat I = 141, rabbit K = 109. For equal atmospheric CO concentrations the saturation values were lower (37-40%) in experiments in vitro than in vivo. Similar saturation values were obtained with light excluded, when O2 concentration was decreased to the level of alveolar oxygen concentration. With regard to the affinity of blood for CO, the blood of domestic pigs did not differ from that of minature pigs in in vitro experiments.


Long-term feeding study on disodium 5-ribonucleotide in dogs. Groups of 4 male and 4 female Beagle dogs were fed for 2 years on diets containing 0 (control), 0.1, 1.0 and 2.0%, respectively, of disodium 5'-ribonucleotide (a 50 : 50 mixture of disodium 5'-inosinate and disodium 5'-guanylate). The mean daily intakes of the 3 test groups ranged during the experiment from 0.04-0.03, 0.48-0.26 and 0.93-0.51 g/kg, respectively. No effects attributable to treatment were found in mortality, food consumption, water consumption, bodyweight gain, ophthalmoscopy, clinical signs, haematology, serum chemistry (other than allantoin levels), organ weights, macroscopic pathology or histology, Small differences were observed between mean values in treatment and control dogs for serum allantoin but there was no indication of any persistent significant difference throughout the 2-year study. In a 6-week preliminary test, dietary levels of up to 10% disodium 5'-ribonucleotide were without detectable adverse effect upon beagle dogs of either sex.


[Toxicity by relay. II. A method for the asessment of safety to human consumers of carbadox, a growth-promoting additive to the feed of slaughter pigs]. A toxicity by relay. II. A method for the assessment of safety to human consumers of carbadox, a growth-promoting additive to the feed of slaughter pigs. A new methodology called "toxicity by relay" has been used to assess the potential hazard to humans of incorporating an additive into animal feeds. This methodology considers a farm-reared animal as a "relay" between the food additive and the human consumer, and employs laboratory animals as "pseudo-consumers". These laboratory animals are fed throughout their entire lives with the meat or organs of the "relay" animals which have been reared on feeds supplemented with various levels of the additive. In the present study, the toxicity of carbadox was assessed in this way. In pigs, where it is used as a growth promoter, carbadox is metabolised into serveal different products, and so an assessment of its safety using traditional methods of studying the toxicity of a substance and tis known metabolites, would perhaps be subject to error. A safety factor for man, in relation to the safety factors for rats and dogs, was calculated using (a) the comparative consumption of the laboratory animals and man; (b) an assessment of the highest dosage likely to be consumed in normal circumstances compared to the laboratory dosage, and (c) the consideration that in the laboratory there is no period of withdrawal from feeding before sacrifice as is the case with animals for slaughter. Pigs were used as "relays" in the present study by supplementing their feed with carbadox. The meat and/or livers of these animals were then fed daily to (a) rats for a period of 3 generations; (b) rats for 24-25 months, and (c) dogs for 60 months. No abnormalities were observed at the termination of the experiments. We may therefore conclude that there is no hazard for the human consumer from the use of carbadox as a pig-feed additive.


[Indications for and results of percutaneous radiotherapy of malignant melanoma]. Malignant melanomas may develop from naevoblasts by way of the junctional naevus; from melanoblasts by way of melanocytes or by way of melanosis circumscripta praeblastomatosa. It is reasonably certain that there is no direct malignant degeneration of a naevus-cell-naevus as a result of acute or chronic irritation, but most authors reject sample excision nevertheless. Malignant melanomas from naevoblasts are relatively insensitive to radiation and dangerous, whereas those developing from melanoblasts are relatively sensitive to radiation and grow slowly. Melanomas which have developed on an unchanged skin are critical because they metastasize fast and take a rapid course. 29% of 237 stage-I patients out of a total of 680 developed metastases during the first year following surgery and irradiation, and 14% after 2-9 years. Radical removal of lymph nodes results in congestion combined with oedema, and involves the risk of melanoma cells being carried into the perilymphatic tissue. Early irradiation of regions involving metastatic risk seems to be preferable over idssection of lymph nodes. Experience has shown that surgery preceded and followed by radiotherapy, and additional surgical or radiological treatment of regional lymph-nodes should be recommended at this time. Evidence concerning the effects of endolymphatic, cytostatic, and immunotherapy is as yet incomplete. The five-year survival rate in state I is said to be 71% following surgery, up to 80% following irradiation and subsequent surgery, up to 78% following surgery and subsequent radiotherapy, and up to 72% following radiotherapy alone. Survival rates are about 14% higher following surgery and electron irradiation.


[The influence of high-frequency hyperthermia on Ehrlich-ascites carcinoma in the mouse]. On 988 NMRI-mice the influence of a single high-frequency hyperthermia of differing intensity in the decimeter-wave field was investigated regarding the course of the Ehrlich's-ascites carcinoma. The application of high frequency (461,04 MHz) was made with an electrode on an induction field of 3,8 cm diameter, and covers the whole peritoneal cavity. No significant prolongation of the survival time was achieved, neither by increasing the intensity up to the final rectal temperature of 40 degrees-43 degrees C, nor by selecting different therapeutic periods during the growth of the tumor (1, 3, 6, and 10 days after inoculation). In contrast to local tumors which can be cured solely by high frequency treatment in the chosen model of a generalized tumor (in which the tumor tissue cannot be separated), no significant therapeutic effect can be reached by sole thermotherapy--not even with the risk of extremous therapy-induced complication rates. An interesting field for research seems to exist as to what extent tumor proliferation kinetics can be influenced by high frequency.


[Effect of high-dose preoperative intracavitary radiotherapy on uterine size and early operability in patients with corpus carcinoma]. 22 patients with corpus carcinoma were treated by intracavitary irradiation by the after-loading technique (Cathetron) during three sessions separated by one-week intervals. The weeks after radiotherapy, hysterectomy and bilateral salpingo-oophorectomy were performed. Changes in uterine size were observed during and after radiotherapy with the help of an uterine probe and by ultrasound-B-examination. The uterus was found to increase in size during radiotherapy. Measurement with the probe showed an average longitudinal increase of 1.2 cm, whereas ultrasonic examination revealed an increase in length by 1.7 cm and an anteroposterior distension of the fundus uteri by 0.9 cm. No technical difficulties were encountered during early surgery preceded by radiotherapy. Ehin, readily removable adhesions were found in six cases, and symptoms of irritation were seen in the rectal wall and in the peritoneum in one. No postoperative complications occurred in any of the patients.


[Dose distribution and irradiation technique in the radiotherapy of breast cancer stage I]. A method for homogenous irradiation of the breast by means of opposite standing fields, with the use of wedge filters, is described here. The field is focussed so that the interior thoracic wall under symmetric position of the mamma is still completely situated in the irradiation field, and the lateral area of the ray beam passes 1-2 cm into the pulmonary tissue. On a series of typical breast models, made under consideration of the irradiation position, the isodose distributions were determined by film-dosimetry. The therapeutically most important 80%-isodose corresponds in practically every case with the mamma contour. Peak doses or areas of underdosage were not observed. The thoracic wall is still exposed to about 75% of the maximum dose. In order to reach a more accurate irradiation by the desired maximum dose of, for example, 250 r, the deviation of which does not exceed plus or minus 7%, it is necessary, at the beginning of an irradiation series, to use ionisation chamber measurements with an intensifying hood on the surface of the mamma, 1.5 cm above the border of the field. In the case of lateral irradiation, the measurement need only be made laterally, in medial irradiation it is only necessary on the medial side. The portion of the dose affecting the opposite field on the measuring place can be calculated by the use of depth dose tables. From the values so gained the desired maximum dose within the mamma may be ascertained by multiplication by the factor 1.03.


[Experiences with radioactive phosphorus therapy in cases of polycythemia vera (author's transl)]. Retrospective studies were carried out in 52 patients with polycythemia vera who were treated with radioactive phosphorus (32-P) over periods ranging between 4 and 24 years. Control of hematopoiesis was achieved in all patients. Duration of the remission induced differed considerably in the individual patients. Mean remission lasted 3-4 years. After 13 years of 32-P treatment, the mean duration of remission lengthened due to gradual transition of some cases into "spent" polycythemia. The mean annual dose of 32-P was about 2.4 mCi. In patients with long-term remissions, the dose accumulated per year was markedly less. These patients probably represent optimal preconditions for 32-P therapy. Mean survival was 12.5 years. The majority of the patients died from thorombo-embolie events or hemorrhage; incidence of acute leukemia was about 4%.


Aspects of timing and selection of cases in radioiodine therapy and percutaneous irradiation of well differentiated carcinoma of the thyroid. 142 patients with well differentiated carcinoma of the thyroid were treated postoperatively by radioiodine and percutaneous irradiation according to a fixed schedule. Institution of radioiodine treatment and percutaneous irradiation within 6 months after surgery resulted in a low incidence of local tumor recurrences or of newly formed metastases, and in a high survival rate. Criteria are given, by which postoperative percutaneous irradiation may be omitted without risking impairment of therapeutical results.


[The dose-volume factor in radiotherapy. Significance of the focal or tumor volume for the evaluation of radiotherapeutic effect]. The absorbed energy dose, in dependence on the irradiated tissue volume or tumor volume (dose-volume-relations) has great significance for the valuation of radiation injuries and of the prognosis of the disease. The present paper includes an analysis, formal demonstrations and interpretation of these relations. Clinical observations and radiobiological experiments in literature were the basis of the present investigation. The assessment is kept simple, the models derived from it interprete well the clinical findings. Through these models, radiobiological findings and clinical experimental principles are connected. This results in a clear conception of the future development of irradiation planning, and the application technique of radiation. The range of validity of the cited models includes the treated volumes usual in radiotherapy. An extrapolation to the cellulary area or to the whole body may only be made with great reservations.


[Optimation of irradiation planning in deep therapy. Outline of the chance of survival of tumor patients]. Simple model conceptions are used for the demonstration of the chance of survival of tumor patients. The systematic judgement of therapy is possible after the adaptation to known survival curves for patients in different stages. The ascertainment of the tumor duplication period for primary tumor and--on principle--also for metastases, permits of conclusions on the recuperative capacity and radioresistance of the exposed normal tissue and of the tumor. It was seen that the values found can lie in the range of the data known from radiobiology. Vice versa, it is possible in principle by means of derived relation to optimate dose distribution, fractionation and total dose of the radiotherapy. Moreover, the systematic analysis of the known survival curves of tumor patients within the frame of model conception allows of the expectation that also influences of therapy on the tumor duplication time, and possibly the dissemination capacity of the tumor, can be analysed. These values reflect the tumor-host-relations and seem to be of decisive significance for future successful concepts of therapy.


A new case of recombination within the HL-A system. We report another case of recombination within the HL-A system between the first and second segregant series of antigens. The recombination frequency is 0.8%.


The effects of preservation methods on homologous incus transplants in cats. Experimental incus transplants were performed in cats. The gross findings and histologic data were recorded and correlated to the use of four preservation methods for homografts (alcohol, Cialit, formalin, and freezing). The formalin preserved incudes produced the least middle ear reaction and ossicular fixation. These incudes also exhibited a uniform perivascular bone remodeling throughout the homograft while the bones preserved in Cialit and alcohol were replaced much faster and ossicular chain fixation occurred. The incus bones preserved by freezing were better tolerated than the Cialit and alcohol ones but not as well as the formalin ones.


[Investigations of serum levels of drugs in children receiving anticonvulsant medication. I. General evaluation of serum concentrations of diphenylhydantoin, primidone and phenobarbitone (author's transl)]. With the aid of our own method of gas chromatography we determined serum concentrations of anticonvulsants in a large number of children who were being treated with diphenylhydantoin, primidone and phenobarbitone. The drugs were being prescribed either as monotherapy, or in combination with each other, or with other substances which have anticonvulsive activity. Regression lines showed good correlations between the quantity of drugs administered (total daily dose) and serum concentrations. The regression lines for diphenylhydantoin and primidone, however, showed no differences, irrespective of whether they were being given alone or in combination. In view of the frequency of symptoms of intoxication and of non-responders, we established a therapeutic range for diphenylhydantoin and primidone (diphenylhydantoin: 5--16 mcg/ml; primidone: 4--14 mcg/ml). The required serum concentrations could be obtained by giving 8--12 mg/kg of diphenylhydantoin, and  15-22 mg/kg of primidone. In spite of the satisfactory correlation between total daily dose and serum concentrations, however, many patients showed departures from this normal behaviour, especially where combination treatments were being conducted. This demonstrates the necessity for routine controls of serum levels.


[Investigations of serum levels of drugs in children receiving anticonvulsant medication. II. Clinical observations (author's transl)]. Although good correlation can be obtained between total daily dose and serum concentration in treatment with anticonvulsant drugs, many patients still show departures from this relation. The various factors which can influence serum concentrations of the administered drugs were to be domonstrated in a number of children who were receiving anticonvulsants at average dose levels and who developed evidence of overdose, or who failed to respond to therapy. The most important feature is that combined adminstration of several drugs may increase or inhibit metabolisation of the various substances, so that inadequate or excessively high serum concentrations result. Furthermore, irregular intake of the necessary medication must always be taken into account in the case of treatment on an out patient basis. Routine determinations of serum levels of anticonvulsant drugs in these patients are called for because of this.


[A kin with a "silent" pseudocholinesterase gene (author's transl)]. After injection of short acting muscle relaxant suxamethonium on a 5-year-old boy during bronchography he was suffering from prolonged apnoe. Although using acetylthiocholin, butyrylthiocholin and benzoylcholin for tests we were not able to detect any activity of pseudocholinesterase in the patient's serum, Since there was no evidence of hepatic disease or hypoproteinemia, we supposed a genetically caused deficiency of serumcholinesterase. Examinations done on 18 members of this kin showed a complete absence of serumcholinesterase on 3 children (homozoygotes for "silent gene") and a significant decrease of pseudocholinesterase on 6 persons. It was not possible to detect the "silent gene" by counter immunelectrophoresis. The half value time after injection of purified human serumcholinesterase was between 8 to 9 days. Genetic aspects and clinical problems of the serumcholinesterase  deficiency are discussed.


[Peroral intestinal mucosal biopsies. Comparative studies on the histological and the dissecting microscope findings (author's transl)]. From 1969 to 1973 171 peroral intestinal biopsies were carried out at the Children's Hospital Tübingen using the Crosby-Kugler capsule and the Watson intestinal biopsy capsule of paediatric size. The dissecting microscope findings were compared with the histological findings. The former correlated in stage II and III, according to the Shmerling scale, with the histological findings. Findings under the dissecting microscope, stage I, did not correlate in all cases with the histological findings. It is supposed that this results from either an inaccurate orientation or from inadequate sectioning. The plane of sectioning must be parallel to the villi. If the plane of sectioning is not parallel to the villi, the slender villi under the dissecting microscope look like plump villi when examined histologically. It is supposed that this results in a greater number of plump villi and a smaller number of slender villi in the histological findings compared with the dissecting microscope findings. The correspondence of slender villi examined under the dissecting microscope and those which are histologically examined in about 25 to 100%.


[Chromosome studies in children treated with bactrim (author's transl)]. Chromosome studies were performed in cultures of peripheral blood lymphocytes drawn from 10 children before and after a therapy with Bactrim (Eusaprim). No significant difference was found between the rate of structural chromosome aberrations, especially the breakage rate, before and after treatment.


Growth hormone and cortisol in neonates during phototherapy. In 22 neonates plasma growth hormone (GH) and cortisol concentrations were measured during phototherapy which was administered because of hyperbilrubinemia. These values were compared to the hormone levels before and after therapy and to control values taken from healthy nursery infants. Phototherapy significantly increased GH concentrations to 195% plus or minus 108 (SD)(healthy control group = 100%). Cortisol was not found to be augmented. There was no correlation between GH and cortisol, nor between bilirubin and GH or cortisol. The mechanisms by which phototherapy induces GH increase are not evident. However, this may be due to constant covering of the eyes, deprivation of the day-night rhythm, or other environmental alterations that are brought about by incubator care.


Electron microscopic findings in a case of systemic mastocytosis. For several decades urticaria pigmentosa had been considered to be a benign and purely cutaneous disease, caused by infiltrations of tissue mast cells in the skin. Yet until 1962 at least 24 cases of systemic mastocytosis had been published. Sagher estimated the incidence of systemic mastocytosis as being in the region of about 10% of all cases of urticaria pigmentosa. A case of systemic mastocytosis in a 4-year-old child is described. Biopsy specimens were examined by electron microscopy to study the process of degranulation of tissue mast cells during which histamine and heparin are released.


Symptomatic aneurysm of the abdominal aorta: successful surgery in elderly patients, one with a massive aneurysm. Three cases of symptomatic aneurysm of the abdominal aorta are presented. One patient age 96, described with this condition, is perhaps the oldest patient in the literature. In another patient the aneurysm measured two feet in length, extending from the diaphragm to the pelvic outlet. This was perhaps the biggest aneurysm yet recorded. All three patients presented difficult medical problems, withstood the operaion, and were discharged from the hospitals with successful results. Aneurysm of the abdominal aorta is a serious condition. It is commonly found in patients in their seventh decade. The condition carries a high mortality with advancing age, especially when associated with other diseases. In symptomatic aneurysms where expansion, dissection or frank hemorrhage is suspected, emergency resection and replacement with dacron graft is carried out.


The advantages of automated blood alcohol determination by head space analysis. Precision, specificity and interpretation of the results are reported. Using only few different columns all volatile substances of importance are detected specifically, With new developed stationary phases, graphite as support, the analysis could be done with a sufficient resolution in 1 min. The absolute peak height of the internal standard or the amount of acetaldehyde determines the status of the sample and enables a very precise analysis of alcohol in blood


[Would a crash helmet have been life-saving? An analysis of 188 fatal motor scooter accidents (author's transl)]. In both Germany and Denmark bills have been passed, that mopedists and motorcyclists should wear crash helmets in traffic. In an effort to elucidate the practical life-saving effect of such measures, this investigation has been performed in The Institute of Forensic Medicine, University of Aarhus, Denmark. Within the period 1959-1973 in all 188 mopedists killed in traffic accidents were submitted to medico-legal examination at the institute. All documents, including the police reports, photographs, the detailed autopsy-reports and medical case records were scrutinized in order to elucidate whether a crash helmet had been used during the accident, and if not, whether such use would have been life-saving. In 4 cases only, a crash helmet was used. Of the 188 moped drivers 54.2% died of scull-brain injuries, 33% of other injuries, while 12.8% died of combined scull-brain and other injuries. Following a thorough consideration of the circumstances and findings in each case, the authors in a retrospective judgment concluded, that 51% of the killed moped drivers probably should have survived the accident if they had worn an appropriate crash helmet. A further 8.5% might have survived. The authors admit that their material was selected and the results could hardly be considered indicative for the traffic in general, but are indicative of a tendency.


Surgical treatment of occlusive arterial disease of the legs. During the period 1959-68, a total of 982 patients were submitted to treatment for arteriosclerotic vascular lesions in the lower limbs in Department M, Bispebjerg Hospital, Copenhagen. Conservative treatment solely was undertaken in 425 cases, while in addition 271 limbs were amputated after varying periods of conservative therapy or observation. Primary lumbar sympathectomy was undertaken in 25 patients. In the remaining 261 patients, indications were found for arterial reconstruction. In 25 cases explorative intervention only was undertaken. In the remaining 236 patients, 255 reconstructive interventions were undertaken during the period. These comprised 113 thrombendarterectomies, 71 of which were in vessels distal to the inguinal ligament, and 142 by-pass operations. In the latter procedures, five bifurcation prostheses were introduced, 40 simple prostheses with proximal anastomosis to the aorta or the iliac arteries, and 53 synthetic prostheses and 44 venous prostheses with proximal anastomoses to the femoral artery. Eight patients (3.4 percent) died postoperatively, while amputation had to be resorted to in 20 (8 percent). On discharge, pulsation distal to the site of operation was found in 61 percent of the patients discharged, one year later in 44 percent of the survivors and five years later in 23 percent. A total of 62 (24 percent) limbs were amputated on an average of 14 months after operation. 224 cases could be assessed after an average of 4 4/12 years. In 58 cases there was definite clinical improvement and pulsation distal to the site of operation. In 44 cases, pulsation had been present after operation and definite clinical improvement, but no pulsation distal to the reconstructed vessel was found at the follow-up examination. In 122 cases no evident beneficial effect of operation could be demonstrated at follow-up examination. The indications for operation and the incidence of operation are discussed, and the results compared with those of previous publications.


Electrocardiographic changes in coronary care unit patients during defecation. Fifty-one consecutive patients admitted to a coronary care unit were monitored for ECG changes while having a total of 63 bowel movements (BM's). Twenty-three patients had proven myocardial infarction while 28 had no acute cardiac disease. ECG changes in patients using either commode or bedpan facilities were compared during defecation. Patients using the commode were found to have a greater increase in heart rate and other nonspecific ECG abnormalities compared to those using the bedpan.


[Contribution to the morphometry of coronary arteriosclerosis (author's transl)]. In 94 cases with and without coronary arteriosclerosis or various cardiac diseases the coronary arteries were pressure fixed, filled with a mixture of barium sulfate and gelatine for coronary angiography and dissected in 1 cm long segments for morphometry. On consecutive cross sections of the three main branches of the coronary arteries the absolute area of lumen, intima and media as well as of the thickness of the intima and media were measured. From the numerous data of the coronary arteries different indices on coronary arteriosclerosis and by correlation to the heart weight also on coronary insufficiency had been calculated. Using these quantitative data age dependent intimal changes could be distinguished convincingly from cases with uncomplicated coronary arteriosclerosis and cases with hypertension or infarcts. Thus in forensic pathology comparative evaluations can be made in regard to the extent, severity and significance of acute and chronic coronary insufficiency.


[The influence of soil differences in determining the quantity and recognizability of serological properties of blood traces in the earth (author's transl)]. In order to test the influence of soil differences in determining the quantity and recognizability of serological properties of blood traces in the earth 6 different pedologically examined soil samples of the area of Lower Saxony were impregnated with human blood and tested in two series with reference to the passage of time in dry and damp conditions. The determination of blood quantity by the protein-elution method of Schulz and the cyan-methaemoglobin method of Schleyer was basically possible in all soils. The results of the colour method were more constant and less subject to interference. Decreasing values from 100 down to 13% in the order: sand--Rendsina chalk--garden soil--water meadow loam--clay--humus were to be found, chiefly depending on the size of the particles in the various samples. In damp condition the values dropped to zero after 3 days already. The immediate determination of the ABO blood groups with the absorption technique only proved possible in the case of blood traces in washed sand procesures. One might take NaCl extraction and ascending chromatography on strips of filterpaper or (preferably!) concentrate an initially large quantity of elution fluid. A determination of the Gm factors, however, is only possible on unprepared material. The enrichment procedures often lead to a falsely positive determination of the factors; Testing of ABO groups was most unfavourably influenced by loam, that of Gm by clay and chalk soils. All results may be distrubed by humin-and non-humin substances and any metabolism of microorganisms, which of course is especially noticable in damp humas soil. In practice therefore the samples must be dried as soon as possible.


Acquired coarctation of the abdominal aorta. An unusual case of aortic obstruction, not heretofore described, is presented. This obstruction consisted of a perforate diaphragm which occurred in the abdominal portion of the aorta below the renal arteries. Diagnosis and operative method are discussed with several references to the literature.


Lethal intoxications with centrally stimulating amines in Sweden 1966-1973. Fatal intoxications with centrally stimulating amines (CSA) have become increasingly common in Sweden. Toxicological data and pathological findings of 32 cases of amphetamine and phenmetrazine intoxications which occurred from 1966-1973 in Sweden are described. Furthermore, 13 cases where these drugs were not the cause of death, but found in urine and organs, are reported.


Insulin in post-mortem blood.

Insulin in post-mortem blood. In 29 cases of sudden death the insulin concentration in blood from the right heart and the femoral vein was determined by a radioimmunological method. The concentrations in the femoral venous blood were below 60 muU/ml serum (mean 23 muU/ml), i.e. in the same order of magnitude as in living persons. In right heart blood the insulin values were about 10 times higher, probably due to post-mortal diffusion of insulin via the portal vein. In suspected hyperinsulinism the measurements should therefore be made on peripheral venous blood.


[The relation between genotypical and phenotypical plausibilities of paternity (author's transl)]. Applying the formula of Okajima [2,3] to the genotypical possibilities of a given phenotypical child-mother-putativ father constellation one can compute for each of these possibilities a genotypical probability of paternity. It is possible to determine the discrete distribution function, the mean value, and the variance of these genotypical probabilities of paternity and it is shown that the phenotypical probability of paternity is equal to the mean value of the genotypical probabilities of paternity.


[Dynamics of manual stabbing tests. Contribution to the understanding of the "Outer stabbing dynamics" (author's transl)]. The following questions were considered: What were the manual stabbing-energies and -velocities achieved by test persons (50 men and 50 women); what was the sex specific difference in performance; were there differences between the "work-hand" and the "non-work-hand". Five single stabs were carried out with each hand. The impact-energy and the impact-velocity were measured for each stab. Significant differences were shown between the values of men and women, as well as between "work-hand" and "non-work-hand". For forensic purposes the "outer stabbing-dynamics"--demonstrated by the subject--can also be assessed in foro. The quantitative relations between stab-wound and necessary stabbing-energy and demonstrated "outer stabbing-dynamics" give an indication of the intention of the subject.


[Medical opinions on fatal auto-erotic accidents for insurance purposes (author's transl)]. The problematic nature of medico-legal opinions on fatal auto-erotic accidents made for private accident insurance companies is outlined in a survey based on our own records. Taking the "General Insuranc Terms for Accident Insurance" (AUB) into consideration, guidelines for the forming of such opinions are given. One is warned not to form summary opinions. Decisive is the insured's state of conciousness when the accident was triggered. Only in exceptional cases can an insurance covered accident be rejected because of a body injury inflicted by the insured on himself (see article). These actions do not usually result in external injury to the body. Experience proves that "ideal conditions" for forming an opinion are rarely given. Also, the nature of the death situation is such that often the corpse is discovered only days after death. From the outset, forming a medical opinion is beset with varying degrees of difficulty depending upon which category of auto-erotic activities the accident falls into: 1. direct stimulation of the erotic regions, 2. stimulation of sexual centers in the central nervous system, 3. the creation of fear and anguish in the context of masochistic perversion. According the presently valid insurance terms (AUB), cases of auto-erotic electrocution are to be regarded as covered. A disturbance of consciousness--with the exception of such disturbances following the influence of alcohol, medicines or narcotics--cannot be assumed for the moment in which the accident was triggered. At this moment body "integrity" was also intact. Accidents through strangulation, respectively asphyxiation (plastic bags etc.), usually occur during a disturbance of consciousness of the victim. This disturbance is the result of cerebral hypoxia, that is a result of strangulation, respectively external respiratory obstruction. The forming of a medical opinion for insurance purposes on auto-erotic accidents with clearly recognizable masochistic tendency is particularly difficult. A medical decision is only possible when an exact examination and description of the scene of the accident are available. In these instances, mechanical devices rigged by the victim often do not permit with sufficient probability to exclude the possibility of an accident without disturbance of consciousness on the part of the insured.


[Purpose and utilization of a medical legal institute in catastrophelike cases (author's transl)]. Catastrophes and catastrophelike mass disasters happen suddenly without announcement. This kind of accident take place rarely, but in case of emergency every institute of legal medical should be prepared. A plan for institute mobilization, working with dissection teams and by a phaseplan is helpful.


[Serum immunoglobulin content in blood donors]. The content of IgG, IgM and IgA was studied in the blood serum of 408 donors aged from 18 to 46 years and older (217 men and 191 women). The results obtained were expressed in the IU and in absolute values by protein. It was established that the quantity of immunoglobulins of all the three classes increased with the advance of age. There was no strict correlation between the immunoglobulin level depending on sex, although for some individual age groups there was noted a statistically sinificant difference in the IgA and IgG content.


[Study of specific cellular receptors in delayed type hypersensitivity]. The effect of immunosera (rabbit) against the lymphoid cells of mice sensitized with antigens causing development of hypersensitivity of delayed type (tuberculosis bacillus, tissue antigen from rabbit kidney) on the specific activity of lymphoid cells of guinea pigs was tested. The mentioned sera blocked the capacity of lymphoid cells of guinea pigs to transfer the state of sensitization from the sensitized donors to the intact recipients. Blocking was strictly specific and this capacity was absent in the immunosera against the normal lymphoid cells.


[Comparative assessment of the activity of nonspecific humoral factors of natural body resistance in subjects with different blood groups (ABO system)]. Significant differences were revealed in the content of the complement, beta-lysins and bactericidal activity in persons belonging to different isoantigenic groups in studying 647 donor blood sera. The maximal level of all the three inaices was revealed in of persons belonging to the III group. However, further accumulation of analogous data and their comparison with results of observations of other investigators in various geographical regions is necessary to assess the significance of the results obtained.


[Immunodepressive activity of glycoproteins]. Glycoprotein fraction of the blood serum of cattle depressed both the primary and the secondary immune response in case of mouse inoculation 24 hours before the immunization with sheep erythrocytes. The use of this fraction coincidently with the antigenic stimulus or after it was ineffective. Analogous fractions from the thymus and the liver of cattle produced a similar action. Glycoprotein fraction of the serum, thymus and liver depressing the immunological reactions possessed a marked ribonuclease activity.


[Analysis of spleen polyribosomal RNA during primary and secondary immune responses]. Synthesis of polyribosomal RNA was studied in the cells of mouse spleen, primarily and secondarily immunized with rat erythrocytes. In development of the immune response there was observed an increase in the number of polyribosomes which could occur first of all on account of intensification of their synthesis and secondly on account of their stabilization with the new informative RNA. Polyribosomal RNA labeled with P32 was analyzed in polyacrylamide gel. Electrophoresis of polyribosome preparations treated with a 2% SDS was conducted. It was found that in the secondary immune response in the 18S--4S there were revealed two principal activity peaks; other iRNA, which participated in the cellular growth of the organ realizing the antibody production, were synthesized during the primary immune response.


[Immunological efficacy of smallpox vaccination in children with relative contraindications to vaccination]. Children (aged from 3 to 9 years) vaccinated against smallpox by multiple puncture (3 punctures by bifurcation needle), by a single cut and with vaccine diluted with a double dose of the solvent were observed. Vaccination by the methods tested considerably diminished the vaccinal reactions and failed to influence appreciably the formation of a full-value humoral immunity; only dilution of the vaccination material reduced the dynamics of the immunogenesis at the early periods after the vaccination. In children aged 3--5 and 6--9 years general vaccinal reactions were of the same character, whereas local reactions and immunological response were more pronounced in older children. A method of multiple puncture is recommended for mass vaccinations and also for vaccination of children with relative contraindications to the vaccinations.


[Effect of monoamine oxidase inhibitors on the phagocytic activity of macrophages]. Preparations studied in this work with the properties of monoaminoxidase (MAO) inhibitors caused a reduction of the phagocytic activity of cells and degeneration of the cell culture. By the extent of the toxic action on the macrophage culture the preparations could be distributed in the following order: chloracizine, chlorpromazine, vetrazine, indopan; biogenic amine serotonin influenced the phagocytic activity of cells only in very high concentrations. Macrophage cultivation in a medium containing MAO inhibitors led to quantitative and qualitative changes in the acid phosphatase granules. Reduction of the phagocytic capacity of macrophages and the changes in the lysosomal apparatus of the cells proved to depend on the increase in the concentration of the inhibitors in the culture medium and the duration of their action on the macrophage cells.


[Preparation and comparative evaluation of experimental anthrax diagnostic sera in experiments on animals]. The authors present the results of studies on obtaining and comparative assessment of experimental anthrax diagnostic sera in experiments on various animals. Donkeys, sheep, horses, rabbits and monkeys (Papio hamadryas) were immunized with the STI-I vaccine by a single scheme. The activity of the obtained sera was tested in the diffuse precipitation reaction by the amount of the detected antibodies and the titre. The most active sera were obtained from donkeys and sheep: their titre was 5.5 and 4 times greater and amount of the detected antibodies 2.6--2 times greater than in the sera of horses used up to the present time as producers of diagnostic anthrax preparations. The least active sera were obtained from monkeys.


[More precise identification of the systematic position of marine bacteria by the method of DNA-DNA hybridization]. In the present work by the method of molecular DNA hybridization there was shown a low degree of affinity of the standard museum strains of cholera vibrios to the respresentatives of the sea species V. parahaemolyticus and V. alginolyticus, and also halophilic vibrios identified earlier on the basis of phenotypical characteristics of the nucleotide DNA composition as Marinovibrio. The presence of only 20--30% of homology in the DNA successiveness in cholera vibrios and the mentioned sea bacteria pointed to the necessity of exclusion of the latter from the Vibrio genus.


[Production of a lysozyme-like enzyme by various representatives of the genus Staphylococcus]. On the basis of studying 855 strains of various staphylococci it was shown that production of a lysozyme-like enzyme (LLE) failed to serve as a characteristic sign for all the representatives of Staphylococcus genus. It was mostly observed in S. aureus (in 85% of the strains). In nonpathogenic strains of S. epidermidis LLE could not be revealed either by the dish or by affine chromatography on chitin; among S. epidermidis, isolated from the patients there were cultures which did or did not form the LLE. Cultures occupying an intermediate position (coagulase-negative or mannite-negative) formed the LLE in 66.9% of cases. It was shown that the virulence and the general biological activity of the lysozyme-positive intermediate strains were higher than in the lysozyme-negative ones.


[Typing of vibrions by specific O-sera]. Vibrios which were not agglutinated with cholera O-serum in various areas of the USSR from persons suffering from intestinal diseases, carriers, from the water and hydrobionts (550 in all) were typed serologically. Forty three specific O-sera were used ofr serological typing. A determination was made of the serological type in 93% of the strains of vibrios isolated from humans. The given sera were also capable of typing 87% of vibrio strains belonging to the I group Heiberg, isolated from water and hydrobionts, 56% of the strains of the II group and individual strains of the III group, whereas cultures belonging to the IV-VIII groups were not agglutinated by these sera. Circulation of 33 serological types of vibrios not agglutinable by cholera O-serum was revealed in the Soviet Union.


[Long-term observation of E1-Tor cholera vibrions in waste waters from public baths]. Prolonged (for a period of one year) isolation of cholera vibrios from the sewage of a bath-house was observed. Sewage proved to serve as a favourable medium for preservation and reproduction of cholera vibrios. The data obtained pointed to the capacity of El Tor cholera vibrio to exist outside the human organism for a long time.


[Possibility of the occurrence of the Shwartzman phenomenon during administration of a reacting dose of typhoid antigen through the respiratory tracts]. This work is devoted to the study of possible vaccinal complications of Schwartzmann's phenomenon type following subcutaneous injection to rabbits, sensitized by typhoid antigen, of a reacting dose of the same antigen through the respiratory tracts. The reacting dose of the antigen of 0.5; 1.0, 1.5 ml was injected to the rabbits in the form of a dry and liquid aerosol intratracheally intrapulmonary and subcutaneously. Animals to which the reacting dose of the same antigen (0.1; 0.25; 0.5; 1.0 mg) was injected intravenously served as control. Local Schwartzmann's phenomenon was reproduced after administration of all the reacting doses of typhoid antigen tested by intravenous method only. Administration of the reacting dose of the same antigen through the respiratory tracts failed to produce local Schwartzmann's phenomenon, this pointing to the difference in the reaction of rabbit organism sensitized with typhoid antigen to the administration of a reacting dose of the same antigen through the respiratory tracts, in comparison with the intravenous method.


[Intrageneric O-antigenic relations of Providencia bacteria]. The authors present literature and personal data on the intragenera O-antigenic relations of the strains of a collection of bacteria belonging to Providencia genus, including standard strains of 53 serological O-groups whose antigenic interrelations were studied serologically in the tests of agglutination and adsorption of agglutinins. Experimental results confirmed the presence of unilateral relations by the O-antigen between the serological groups 01-021, 03-021 and bilateral relations between the serological groups 01-03; there were also revealed relations by the O-antigens between the serological groups 09-036, 014-023, 018-035, 039-053, and 039-027 of a unilateral character. The data obtained added information to the antigenic structure of Providencia and were of significance for the preparation of diagnostic O-sera of Providencia.


[Experimental study of the role of L-forms of hemolytic streptococci in infectious pathology]. Rabbits were infected by intraperitoneal implantation of a chamber with the L-forms of hemolytic streptococcus. Experiments demonstrated that no symptoms of an acute disease followed. Antibodies against the L-form was revealed in the blood serum in low titres. Cardiac valves, particularly the mitral, were affected in all the experiments animals. Histological study showed that changes in the tissues of the heart approched the rheumatic ones by special signs. L-forms were isolated (in the cultures) from the implanted chamber and the blood for up to 15 days after the infection.


[Experimental study of the general serology of immunopathological processes]. Serological criteria for detection of the circulating immune complexes and for a possible evaluation of a comparative expression of the corresponding pathological process were investigated. Foreign serum was repeatedly administered to rabbits against the background [corrected] of the circulating anyibodies. A study was made of the three serological indices (changes in the complement titre, and increase in the anticomplementary properties of the sera, the apperance in the blood and titres of immunoconglutinin) and the data of biological activity of the sera (an increase of total toxicity and the capacity to induce local reaction in the intradermal test on guinea pigs and adrenalectomized albino mice). It was shown that the serological indices under study, together and in combination with the data on biological activity of the sera could serve as a sufficiently reliable criterion for evaluation of the circulating immune complexes: in using all the 5 serum indices the positive ones, even by one of them only constituted 96%. At the same time some of the indices (an increase in the anticomplementary capacity of the sera, the appearance of immunoconglutinin in the blood, an increase of total serum toxicity) could apparently be used for comparative assessment of the extent of the pathological process, since they occurred with a lower intensity of the immune complex formation (reduction of the dose of the antigen administered.


[Detoxification of a purified concentrated C1. oedematiens toxin]. One of the stages of a new technological scheme for obtaining C1. oedematiens toxoid (detoxication with formaldehyde of a purified concentrated toxin) was elaborated under experimental conditions. It was found that under the effect of increased formalin concentrations (0.4--0.2%) or of prolonged action of heat there developed in the toxin a reduction of antigenic activity, expressed on immunoelectrophoregrams in the form of a change of surface potential of one of the electrophoretic fractions. Detoxication of the purified concentrated C1. oedematients toxin occurred in the course of 3 days without any losses of its antigenic activity under the following conditions: formalin concentration 0.1%, temperature 37-38 degrees C, pH L.7--6.9. No reversion of toxicity of the preparations detoxified under the mentioned conditions was revealed under the action of formalin-binding agent (sodium sulfite) on them.


[Correlation analysis of indices of toxin-neutralizing activity of sera and antibody titers in the passive hemagglutination reaction]. The authors compared the results of 20 experiments of titration of 1588 sera of children with different vaccination anamnesis by Jensen's method in the passive hemagglutination test with a stable erythrocytic diagnostic agent. In 18 of 20 experiments was established a mean and a high correlational association between the indices of antitoxic diphtheria immunity obtained by two methods. In macro- and micromodifications the passive hemagglutination test proved to be a highly effective method of rapid mass analysis and could be used in epidemiological studies.


[Rosette-formation phenomenon in autocultures of human venous blood leukocytes]. A method of human venous blood leukocyte culture permits to model immunological processes of an intact organism. Aggregation with lymphoid elements of the central target cell serves as a morphological expression of complicated cell interrelations under conditions of their extracorporeal cultivation. It may be that such interaction of mononuclears in the culture was caused by a special humoral factor generated by lymphocytes. The occurrence of the "rosette" phenomenon in the autoculture permits to suppose that there is a possibility of obtaining an antigenic information by lymphoid elements in the intact organism. The existence of a correlation between the processes of formation of intercellular associations in vitro and the severity of the disease in persons with allergy confirms this supposition.


[Increasing the non-specific resistance of animals to staphylococcus with official RNA preparations]. A single or double parenteral injection to mice of sodium nucleinate considerably elevated their nonspecific resistance to the virulent staphylococcus as soon as in four hours; the resistance remained marked for four days. Daily prolonged injection of the stimulant also proved to be very effective. In the simulated organism there occurred a significant depression of reproduction of the virulent staphylococci and an increase in the amount of phagocytic cells and their digestive activity. The latter served as a material basis for induced nonspecific resistance. The data obtained substantiated a possibility of using sodium nucleinate as an antibacterial nonspecific stimulant under clinical conditions.


[The influence of anterior and posterior hypothalamic structures on the engulfment and digestion of an antigen by macrophages and on India ink clearance]. Bilateral electrolytic coagulation of the posterior and supraoptic hypothalamic nuclei of rabbits had practically no effect on the engulfment of sheep erythrocytes labeled with radioactive sodium chromate retarding chiefly the rate of the antigen catabolism and promoting its retention in the subcellular fractions of the macrophages function than injury of the anterior one. Coagulation of the supraoptic nucleus accelerated India ink clearance at all the periods of investigation, whereas injury of the posterior hypothalamus failed to influence this process.


[Teichoic acids as possible acridine orange acceptors on the surface of staphylococcal cell walls]. A study was made of acridine orange adsorption by the surface structures of intact Staphylococcus aureus (209-P strain) cells and their cellular walls. Acridine orange sorption by the cells and the cellular wall of staphylococcus depended on the content of teichoic acids in the object under study. A conclusion was drawn that teichoic acids of the cellular walls of Staph. aureus were responsible for the binding of the acridine orange stain.


[The functional activity of microphages and cation protein in experimental allergic arthritis]. A reduction of the content of cation protein in microphages was revealed in experimental allergic arthritis with the aid of the fluorescent-microscopic method of cation protein detection and objective recording of its content. Phagocytic activity of these cells diminished in parallel with reduction of the cation protein content. Protective properties of microphages were possibly reduced as a result of allergic alteration of cells leading to their structural and functional reconstruction.


[The effect of diphtheria toxin on proliferation of a transplantable culture of human amnion cells]. Cytoxic effect (CTE) of diphtheria toxin (DT) is preceded by disturbances of proliferation process, this being expressed in reduction of the proliferation index (PI) and of mitotic index (MI) before the appearance of the CTE. The effect of the toxin on the proliferation and mitoses of the cell culture is expressed after the incubation period of about 3 hours. The extent and the rate of reduction of the indices directly depended on the dose of the toxin whose low doses at the early periods stimulated the proliferation. The maximum of all the manifestations of the toxin action coincided with the period of increased proliferation in control. On the basis of investigations carried out a hypothesis was put forward that the CTE of diphtheria toxin developed with the entrance of the cells into mitosis.


[Fractionation of staphyococcal allergens on sephadex]. Allergens obtained from seven strains of staphylococcus cultures (with and without any toxigenic and hemolytic properties) were subjected to fractionation on Sephadexes. It was shown that allergens from strains 209, 3a, 977 contained one protein-polysaccharide, component with molecular weight of 600 000--900 000. Allergens from strains Wood-46, 150a, r-7, O15 were characterized by the presence of two protein-polysaccharide fractions with molecular weight of 800 000--900 000 (I) and 20 000--100 000 (II). There was revealed the influence of lyphilization on the separation of nucleic acids in the preparations not subjected to lyophilization; nucleic acid fractions were separated in gel filtration; no separation of nucleic acids from the protein-polysaccharide fractions followed lyophilization.


[Course of chronic lymphatic leukemia in 2 age groups: older and younger patients]. The authors analysed 202 cases of chronic lymphatic leukaemia comparing the course of this disease in patients above and below 60 years of age. The observation included patients with various forms of this disease--with morphological and clinical findings compatible with mild disease and cases with severe course with complications. It was observed that in severe form of lymphatic leukaemia the course of the disease is similar in both groups of patients and the shorter survival of patients in the older group is frequently due to coexistence of other diseases impairing the general condition and changes connected age. On the other hand, a mild, oligosymptomatic course of the disease was observed more frequently in older patients who did not require intense treatment in hospitals.


The role of parathyroids for the adaptation to a low calcium intake. One-year-old selectively parathyroidectomized rats were found to have lost the ability to adapt themselves to a reduced calcium intake. Of importance in this respect was certainly the demonstrated inability to mobilize skeletal calcium to the blood. Thus, when the normal intake of calcium in the diet is reduced in the adult intact rat, skeletal calcium reserves must become mobilized with resulting osteoporosis. Histological and morphometric analyses of the adrenal glands showed no apparent effect of the parathyroidectomy upon the functional state of the adrenal cortex.


[Clinical and pathological analysis of patients with chronic lymphatic leukemia and long survival]. Investigations were carried out on 261 patients with chronic lymphatic leukaemia with survival over 4 years. The following problems were discussed: age and sex of patients, presenting symptoms, organ changes, laboratory investigations, infectious complications, coexistence of malignant tumours. Correlations were established between various parameters and the length of survival. It was demonstrated that patients without palpable lymph nodes and spleen at the beginning of the diseases and with leucocyte counts ranging from 10,000 to 100,000/1 mm-3 have a better prognosis, while thrombocytopenia even without haemorrhagic diathesis is a poor prognostic sign. Infections were observed in 50 percent of cases, more frequently in patients with hypogammaglobulinaemia. Coexistence of malignant tumours was found in 5.4 percent of cases. Pathological examinations including organ biopsy and autopsy failed to demonstrate characteristic features of lymphatic system proliferation as compared with patients with short survival.


Structure of the adrenal glands in mice with the obese-hyperglycaemic syndrome (gene symbol ob). Quantitative histological methods were used to study the adrenal glands of obese-hyperglycaemic mice and their lean litter mates of various ages. Five weeks old obese mice had significantly enlarged adrenals, due to increased volumes of the zona fasciculata and a persistent cortical X-zone. The enlarged zona fasciculata persisted also in the 5- and 18-month-old obese mice whereas the X-zone had disappeared at these ages. Further, the adrenals of 18-month-old obese mice showed deposits of amyloid in the juxtamedullary cortical zone. It is apparent that the adrenal cortical enlargement coincides in time with the appearance of the other manifestations of the obese-hyperglycaemic syndrome. This further emphasizes that also the adrenal cortical enlargement is an integral part of the syndrome and may contribute to the insulin resistance already at an early stage in the development of the syndrome. The more pronouced weight gain of the adrenal glands of the obese mice together with the morphological changes of the adrenal cortex further suggest an increased ACTH stimulation in these animals. The delayed disappearance of the adrenal X-zone probably reflects the hypogonadism previously demonstrated in these animals.


Atypical germ cells in the adjacent "normal" tissue of testicular tumours. Recently a possible intratubular carcinoma-in-situ of the human testis was described. The same histological picture has been found in the residual testicular tissue in 17 out of 22 men with either seminoma, embryonal carcinoma or terato-carcinoma. The hypothesis is put forward that the described cells may represent malignant germ cells from which testicular germ cell tumours of different types may originate.


The role of the parathyroids for the adaptation to a low calcium intake. The effects of selective parathyroidectomy on the adaptation to a low calcium intake were studied in one-year-old male rats. Parathyroidectomized animals showed increased net absorption of intestinal calcium compared to that of intact animals both at a normal and at a low intake of dietary calcium. The difference was highly significant on the low level of dietary calcium. In the parathyroidectomized animals, significantly higher values were found in the group of rats fed the low calcium diet than in those supplied the calcium supplemented diet. Urinary calcium excretion was reduced because of the reduced plasma calcium level. While there was no disturbance of intestinal calcium absorption, selective parathyroidectomy resulted in a reduced ability to mobilize skeletal calcium as shown in a previous study. This was found to be necessary for the adaptation to a low calcium intake in the adult animal.


[Role of spleen in leukocyte kinetics in dog]. In 9 dogs blood samples were obtained from the splenic vein and artery under general anaesthesia with Eunarcon, the quantitative and qualitative composition of white blood cells was compared and it was found that canine spleen can release or retain granulocytes and mononuclear cells simultaneously or any of these cells separately.


Renal morphology in pigs with experimental hyperparathyroidism. Light-microscopic findings and some functional aspects. Light-microscopic examinations were performed in three groups of pigs; one sham-operated control group, one group subjected to thyroidectomy (TX), and one group injected with parat-hormone (PTH) after thyroidectomy (TK + PTH). The kidneys of the sham-operated animals were normal, whereas slight to moderate dilatation of some tubules was seen in the TX group. The most prominent changes in the TX + PTH group were calcium deposition, tubular dilatation and degeneration, inflammation, and hyperaemia. In addition there were hyaline casts, PAS-positive globules and mitotic figures in the tubules. It is suggested that the calcium deposition caused by the PTH administration plays a major role in the development of degeneration in the tubular epithelium, and that these structural lesions are of importance in the development of reduced renal function.


[Studies on the thrombocytopoietic factor. II. Determination of thrombocytopoietic activity in patients with hematological syndromes (preliminary study)]. Using the biological test on rats the thrombocytopoietic activity (AT) was determined in sera of 13 patients with idiopathic thrombocytopenia (ITP), 5 patients with pancytopenia and bone marrow hypoplasia, 18 with thrombocytopenia developing during proliferative diseases of the haemopoietic system, and 4 patients with erythremia vera. A high mean thrombocytopoietic activity was demonstrated in ITP and this high activity was accounted for by significantly raised AT in acute thrombocytopenia. Increased AT was observed also in myeloproliferative syndromes associated with thrombocytopenia, while in pancytopenia with bone marrow hypoplasia and in erythremia vera AT seemed not increased independently of the stage of the disease. Greater number of cases will be necessary for drawing reliable conclusions.


Renal morphology in pigs with experimental hyperparathyroidism. Ultrastructural findings. Ultrastructural examinations were performed in three groups of pigs; one sham-operated control group, one group subjected to thyroidectomy, and another group injected with parathormone after thyroidectomy (TX + PTH). Attention was mainly paid to the localization and structural details of the calcium deposits which were found in the TX + PTH group 78 and 150 hours after the first PTH injection. Calcium deposits were found in the epithelial cells and lumina of the tubular system, especially in the proximal convoluted tubules. It is suggested that calcium first is deposited in mitochondria and cytoplasmic vacuoles and that larger calcific bodies, occasionally with concentric lamellation, are formed by coalescence of small calcific particles, and that the calcium deposits induce degenerative changes in the tubular epithelium which may lead to discharge of calcific material into the lumina.


[Studies on the thrombocytopoietic factor. I. Elaboration of investigative methods]. The authors present a method of determination of the activity of the thrombocytopoietic factor (AT) by means of biological test on rats using 75-Se-selenomethionine for in vivo labelling of platelets. For suppression of endogenous thrombocytopoiesis the rats received antiplatelet rabbit serum which was used for investigations in the period of reactive hyperthrombocytosis. The thrombocytopoietic activity was expressed in radioactivity impulses per 1 mg of platelet protein of rats which permitted to eliminate the error-fraught determination of platelet count. A statistically significant rise in the thrombocytopoietic activity was demonstrated in rabbits with experimental thrombocytopenia as compared with the AT in healthy rabbits. The error of the method was 9.6-9.8 percent (P less than 0.05).


Enzymatic heterogeneity of granules in human leucocytes. Homogenates of highly purified polymorphonuclear leucocytes and of a mixture of mononuclear leucocytes and platelets from human blood were separated by differential and isopyknic centrifugation. A heterogeneity in granules containing digesting enzymes was found in both cell preparations. Enzymes typical of lysosomes were found in the two cell preparations in a similar density gradient. Granules of low density were indicated in polymorphonuclear leucocytes by alkaline phosphatase. In both cell preparations a third granule, of lower density, seemed to exist enriched in amino acid naphthylamidase, acid hydrolases and in polymorphonuclear leucocytes also alkaline phosphatase and lysozyme. A remarkable difference between the two cell preparations was the occurrence of amino acid napthylamidase in denser granules of polymorphonuclear only, although the nature of these granules could not be determined.


Proliferating and non-proliferating compartments in cervical dysplasia and carcinoma in situ. The existence of proliferating and non-proliferating compartments in atypical cervical epithelium is suggested by autoradiographical investigations and studies on the topographical distribution of mitosis performed on human cervical cones and on cervices of mice following carcinogenic treatment.


7,12-DMBA-induced rat mammary tumour studied for hormonal responsiveness in vitro. 1. Short-term incubations of cell suspensions. The effect of testosterone, progesterone, and 17-beta-oestradiol on the incorporation of tritiated thymidine into DNA was studied in vitro using cell suspensions from DMBA-induced rat mammary carcinomas and subcutaneous sarcomas. Both stimulatory and inhibitory effects of the hormones were seen. The two types of tumour reacted similarly. The validity of hormonal responsiveness in vitro compared with in vivo is discussed.


[Selective aplasia of erythropoietic system following viral hepatitis]. The author observed a 20-year-old patient with selective aplasia of the erythrocytopoietic system developing during virus hepatitis and disappearing completely after one year.


7,12-DMBA induced rat mammary tumour studied for hormonal responsiveness in vitro. 2. Organ cultures. Specimens of DMBA-induced mammary tumour, DMBA-induced subcutaneous sarcomas, and virus induced sarcomas in the rat were incubated for 24-72 hours as organ cultures. The effect of various concentrations of testosterone, progesterone, and 17-beta-oestradiol on cell survival and multiplication was measured as changes in incorporation of H3-TdR into DNA. All three types of tumour reacted to the hormones. Statistical analysis of data demonstrated possible influence of factors other than hormone treatment. The specificity of hormone sensitivity assays in vitro is questioned.


Oral giant cell granulomas. An ultrastructural study of the vessels. Eight peripheral and 2 central oral giant cell granulomas have been studied in the electron microscope in order to examine the structure and nature of the vessels. The vascular wall was composed of a continous layer of endothelial cells resting on a basal lamina, which was frequently multilayered. The lamina also surrounded scattered subjacent pericytes. The endothelial cells overlapped slightly so as to form narrow intercellular spaces. Based on these observations the vessels are supposed to be postcapillary venules. Dark cells exhibiting degenerative features were encountered in the endothelial lining of most vessels. Small gaps and larger defects in the vascular lining allowed direct continuity between the lumen and the perivascular tissue. It is suggested that the extreme extravasation of red blood cells frequently observed in oral giant cell granulomas may be mediated through this incomplete lining.


Subclinical elastofibromas in the scapular region in an autopsy series. In a series of 235 autopsies, changes in the subcapscular thoracic fascia similar to elastofibroma dorsi (Järvi & Saxen 1959, -et al. 1969) were found in 39 cases, all at least 58 years old. In people over 55 years, the frequency was 24.4 per cent in females and 11.2 per cent in males. In addition to hypertrophy and secondary degeneration of elastic fibres, necrosis of collagenous-, adipose-, muscular-, and nervous tissue, as well as formation of clefts, cysts and bursae was found in 85 per cent of cases presenting elastic changes--both in connection with them and outside the degenerated areas--as well as in 39 per cent of cases where no elastic degeneration occurred. Other changes included extensive scarring of the tissue, followed by reduction of fat and, more seldom, oedema and inflammatory infiltration. Breaks in the elastic cage, necrosis and fibrosis of arterial walls were found in 44 per cent of cases of elastic degeneration and in 14 per cent of cases without degeneration. In veins, more extensive wall fibrosis occurred, leading to necrosis; in cases of elastic degeneration the adventitial elastic network was also involved. Venous changes were found in 90 per cent of the cases of elastic degeneration and in 30 per cent of cases without degeneration. Direct mechanical stress on elastic tissue may be an important cause of hypertrophy and secondary degeneration of elastic fibres, and also of diffuse increase of collagenous tissue. On the other hand, nutritional deficiency due to failing resistance of the vascular system against friction of the scapula and streching movements of the upper extremities may play a main part in necrotic tissue changes.


Insulin release in fasting man induced by impure but not by pure preparations of cholecystokinin. Most preparations of cholecystokinin reported to release insulin have been impure. When highly purified preparations of extracted cholecystokinin and also the synthetic C-terminal octapeptide of the hormone became available for use in humans, we investigated their insulinotropic activity in comparison with a cruder preparation of cholecystokinin in 10 fasting non-diabetic subjects. The doses employed were 75 Ivy dog units, except for the synthetic C-terminal octapeptide of cholecystokinin that was given in a dose of 200 Ivy dog units to compensate for a shorter hawn every minute during 10 min after each injection, thereafter at intervals of 5 min. The mean plasma insulin level increased significantly, reaching a peak 4-5 min after iv injection of the cruder cholecystokinin preparation, but after the other two preparations the plasma insulin level was not significantly changed. The blood glucose level was not significantly changed by any of the preparations used. It is concluded that the plasma insulin peak seen in man after i.v. injection of the less highly purified preparation was due not to cholecystokinin but to some other agent present in this less pure preparation. The identity of this factor is discussed.


Studies of urinary bladder dysfunction in amyloidosis with polyneuropathy. Eight male patients with amyloid polyneuropathy, seven of whom had symptoms of dysfunction of the urinary bladder, were studied by cystometry and micturition analysis and compared with eight male controls. Most of the patients with amyloidosis had an increased bladder capacity. The need to micturate was reduced, and urine retention was common. In most of them detrusor function could not be demonstrated. The maximal flow rate was usually diminished and the resistance to flow elevated. In some of the patients there was increased rigidity of the bladder wall.


The adhesiveness of human blood platelets and thyroid function. Hypothyroidism is associated with severe coronary atherosclerosis. In spite of this the reported incidence of angina pectoris and myocardial infarction in untreated hypothyroidism is small. Since many authors consider the formation of a thrombus in coronary arteries to be the final event of the process which leads to myocardial infarction, changes in the platelet function may explain the paradoxical rarity of myocardial infarction in untreated hypothyroidism. To evaluate this hypothesis, platelet adhesiveness has been estimated before and after treatment in 9 hypothyroid and 16 thyrotoxic patients. In thyrotoxicosis the platelet adhesiveness was significantly increased, but decreased to normal after treatment. In hypothyroidism platelet adhesiveness was abnormally low but increased to normal value after thyroid hormone replacement. This may be an important factor in precipitating myocardial infarction in patients with hypothyroidism and coronary artery atherosclerosis.


Thalassaemia minor. Twelve patients in two Norwegian families. Thalassaemia minor has been diagnosed in 12 members of two Norwegian families. Haematological data from 23 family members are reported. The diagnosis was based on estimation of Hb A(2) by polyacrylamide gel disc electrophoresis. All patients having high Hb A(2) levels had confirmatory evidence of thalassaemia minor (hypochromic anaemia, marked variation in size and shape of the red cells, target cells, basophilic stippling, decreased osmotic fragility, normal or high serum iron level). The majority of the patients had previously been treated with iron without effect.