B and T cell lymphomas. Analysis of blood and lymph nodes in 87 patients. B and T cell populations were studied in blood and neoplastic tissues from 64 untreated and 23 treated patients with non-Hodgkin's lymphoma. This study was undertaken primarily to evaluate the relation of B and T cell markers in various lymphomas to the currently accepted morphologic classifications and to determine the utility of various tissues in defining the cell of origin of a lymphoma. When histologically involved blood, bone marrow, lymph nodes or body fluids were studied, a B or T cell origin of the lymphoma was identified in 26 of 28 (68 per cent) patients. A B cell origin was found in 17 adults classified as having nodular (N) or diffuse (D) poorly differentiated lymphocytic lymphoma (PDLL). One lymphoma of T cell origin was observed in an adult with poorly differentiated lymphocytic lymphoma-diffuse (PDLL-D). In contrast, all cases of PDLL-D in children were T cell in origin. The origin of American Burkitt's (stem cell) lymphoma in two children was the B cell. When histologically involved blood was studied, a B or T cell origin was demonstrated in 10 of 21 (48 percent) adults. Evidence of a monoclonal proliferation of B lymphocytes in the blood was found two adults with more than 7 per cent lymphoma cells in Wright-Giemsa stained blood smears. When neoplastic lymph nodes were studied, the diagnosis of a B cell lymphoma was made in 8 of 12 (67 per cent) adults. Study of surface markers on malignant cells in cerebrospinal or serosal fluids frequently revealed a B or T cell origin of the lymphoma. B and T lymphocyte numbers in the blood did not correlate with immunoglobulin or skin test abnormalities. Abnormalities in circulating B or T cell percentages at diagnosis were a poor prognostic sign in patients with PDLL-D.


The responses to synthetic luteinizing hormone-releasing hormone in patients with primary selective pituitary deficiency in gonadotropins. Fifteen patients, 11 female and four male, with primary selective pituitary deficiency in gonadotropins were submitted to the subcutaneous administration of 100 to 400 mcg. of luteinizing hormone-releasing hormone (LH-RH). When compared to the effect of LH-RH in eight normal female subjects, two types of responses were observed: there were either small increments in both luteinizing hormone (LH) and follicle-stimulating hormone (FSH) or increases comparable to those observed in normal subjects. Five patients received 100 mcg. of LH-RH daily over four consecutive days. No additive nor depleting effects could be observed. The responses in seven patients given 400 mcg. were not significantly different from those obtained with 100 mcg. Our results indicate two possible etiologies of primary hypogonadotropic hypogonadism. A normal response in LH and FSH after administration of LH-RH assesses a selective hypothalamic deficit in releasing hormones, whereas a negative or low response suggests a dysfunction of the pituitary gonadotropic cell.


The effect of antibiotic prophylaxis on patients undergoing vaginal operations. II. Alterations of microbial flora. Preoperative and postoperative cultures of the upper vagina were taken from 48 women who underwent vaginal hysterectomy. They received a five-day course of either prophylactic cephalosporins or placebo. Comparisons of preoperative and postoperative flora in both the active-drug and placebo groups as well as comparisons between the postoperative flora of the drug group and that of the placebo group were made. Alterations of the bacterial flora occurred whether or not the patient received prophylactic antibiotics.


Antibodies to herpesvirus type 2 in carcinoma of the cervix uteri in Ibadan, Nigeria. Carcinoma of the cervix is by far the commonest gynecologic malignancy seen in Ibadan, Nigeria. In a study aimed at investigating the role of herpesvirus type 2 (HT-2) in its pathogenesis, antibodies to HT-2 were detected by immunofluorescence above a titer of 640 in 31 (70.5 percent) of 44 women with invasive carcinoma of the cervix as compared with five (11.1 percent) of 45 healthy women of the same age group. Analysis according to histologic types of growths showed that 31 (83.8 percent) of 37 cases of squamous-cell carcinoma had antibodies above a titer of 640, whereas none of the other types (one adenocarcinoma and six undifferentiated carcinoma of the cervix) had antibodies above this titer. It was concluded that the results of the present study support the hypothesis of an association between HT-2 and carcinoma of the cervix, most especially the squamous-cell type.


Studies of blood glucose and plasma insulin in "normal" women using mechanical contraception for 6 months. A prospective study of carbohydrate metabolism was done with 56 "normal"  women who were 4 to 11 weeks post partum. Each had a 3 hour oral glucose tolerance test performed before and after 6 months of using an intrauterine contraceptive device (IUCD). The results showed only slight changes in blood glucose and plasma insulin levels between the two tests. There were elevations of the fasting and 0.5 hour glucose values and the 2 hour plasma insulin value at the 6 month test. These data provide a further understanding of the changing metabolic parameters associated with pregnancy and they also give the "control" baseline information for comparison with other postpartum studies on the metabolic effects of contraceptive steriods.


Response of ovarian steroid secretion to the intrinsic gonadotropin release caused by the administration of synthetic luteinizing hormone-releasing hormone. During gynecologic laparotomies, both ovarian and peripheral venous blood specimens were collected simultaneously, and follicle-stimulating hormone (FSH), luteinizing hormone(LH), estradiol, and progesterone were measured in each sample by means of the radioimmunoassay technique before and after the administration of synthetic LH-releasing hormone (LH-RH). The FSH levels rose significantly 30 minutes after the LH-RH injection, while the LH values had already increased significantly at 15 minutes. A significant decrease of the average FSH AND LH levels during the follicular phase and the average LH levels during the luteal phase was observed in the ovarian as compared to the peripheral venous blood. The estradiol levels in the ovarian venous blood made a prompt and significant increase almost in parallel with the gonadotropin release. During the luteal phase, the progesterone concentrations in the ovarian and peripheral venous blood increased significantly. It is considered that the human ovary responds quite promptly to an abrupt release of intrinsic FSH and LH caused by the administration of synthetic LH-RH and secretes estradiol and progesterone immediately.


Maternal smoking and fetal breathing movements. Pregnant, habitually smoking women were studied during the last trimester when smoking a standard cigarette, smoking a nontobacco cigarette, or chewing a piece of chewing gum containing 2 or 4 mg. of nicotine. The effects of the experimental interventions were followed on the concentration of nicotine and the percentage of carboxyhemoglobin (COHb) in maternal blood, on the amount and pattern of the fetal breathing movements, and on the maternal heart rate, breathing rate, and blood glucose level. The maternal blood concentration of nicotine was increased by the standard cigarette, the 4 mg. nicotine chewing gum, and the 2 mg. nicotine chewing gum in descending order. The COHb percentage in maternal blood was increased by the standard cigarette and to a lower degree by the nontobacco cigarette. A significant increase of apnea and periodic breathing movements in the fetus followed the smoking of a standard cigarette; a similar but nonsignificant change occurred in a dose-related way after the 4 mg. and the 2 mg. chewing gum. The maternal heart rate was positively correlated to the level of blood breathing movements occurring after smoking one standard cigarette. The suppression of the fetal breathing movements in utero poses the question whether iterated maternal smoking might influence the prenatal assessment of fetal maturity using determination of pulmonary surfactants in the amniotic fluid.


Oral contraceptives and thromboembolism: a reassessment. The relationship between oral contraceptive usage and thromboembolism is controversial. Since thromboembolism is often undiagnosed, both clinically and at routine autopsy, most epidemiologic analyses rest or a very uncertain factual base. There are increases in blood coagulation factors in oral contraceptive users similar to, but less than, those seen in pregnancy, which is not associated with increased thromboembolism. Hematologists emphasize that these changes do not define a "hypercoagulable" state, and they do not define or predict the occurrence of thrombosis. Intrinsic vascular wall changes, unrelated to drug use, may play a role in sporadic cases of thromboembolism. When the incidence of thromboembolism in very large Phase III trials of conventional oral contraceptives is compared to that in other populations (patients admitted to the hospital, women who visit a physician, pregnant women, or users of nonestrogenic oral contraceptives), no difference is seen. Epidemiologic studies by the "case-control" ("trohoc") method consistently show an increase "relative risk" associated with oral contraceptive use in subjects with "idiopathic" thromboembolism but no increased risk in thromboembolism patients as a whole or in those with predisposing factors. This retrospective epidemiologic technique, its particular applications, and the inferences drawn are open to serious criticism, as are studies claiming a relationship between estrogen dose and thromboembolism incidence. An Australian prospective survey found no increased risk among users, and a large British study which initially reported an increased risk is currently undergoing recalculation. The only controlled clinical experiment (with random assignment of subjects to vaginal versus high-estrogen contraceptives) showed no increased incidence in the drug-treated group. Statistical associations derived from "trohoc" studies do not establish causal relationships; moreover, their risk estimates are in conflict with the findings of large Phase III clinical surveys including subjects using estrogen-free contraceptives, with at least one prospective clinical survey, and with a randomized, controlled clinical trial. The data relating estrogen dosage to thromboembolism incidence are ambiguous, at best. Thus, the claim of a causal relationship between oral contraceptive steroids and thromboembolism does not appear to be firmly founded, and the belief that predisposing factors increase the risk to contraceptive users is equally insubstantial.


Pituitary responses to LRH in the postpartum periods. Pituitary responses to luteinizing-hormone-releasing-hormone (LRH) in the postpartum periods were studied. Following a subcutaneous injection of 100 mug of synthetic LRH to postpartum subjects, no statistically significant changes in the levels of LH and FSH could be demonstrated in five subjects on postpartum day 1 or 3 and the three subjects on postpartum day 8. A normal elevation of LH and FSH following LRH was demonstrated in one subject 36 days post partum. The findings are in agreement with previous studies demonstrating a persistence of pituitary suppression during the early postpartum period. No correlation could be drawn between the pituitary responses to LRH and the plasma levels of estradiol-17 beta and progesterone.


Alcohol and marijuana effects on static visual acuity. Static visual acuity was measured at two contrast levels (12 and 49%) in ten subjects in a double blind experiment  involving five drug conditions of alcohol and marijuana (0.5 ml and 1.0 ml/kg body weight of 95% ethanol, 8 and 15 mg delta-9-tetrahydrocannabinol (THC), and a placebo). We found no statistically significant change in static visual acuity for any of the dose levels at any of the measurement time up to six hours following drug ingestion; this is sharply contrasted with the marked decrements in acuity which were found in the same subjects under the same drug conditions when the targets were in motion and required corrdinated eye movements for their resolution.


Computer-assisted eye examinations IV. "Additive" lens systems in eye refractors. After a brief introduction to the optical principles and terms, formulas are derived which demonstrate that with conventional methods and designs it is not possible to summate with accuracy the labeled power of three or more ophthalmic lenses in tandem. The effective power of sphero-cylindrical  combinations in all currently available eye refractors, when powers of eight to ten diopters are exceeded, may differ from the summated labeled power by a quarter diopter or more, which can be clinically significant. This error can be directly and readily eliminated only in computer-actuated refractors by including a computer program which calculates the effective power and makes the necessary correction.


Clinical experience with the acid-etch technique in orthodontics. The acid-etch technique and the development of improved composite resin systems have made the direct bonding of orthodontic attachments an accepted clinical procedure. This technique can be used with confidence as an adjunct in the armamentarium of the orthodontist.


Direct bonding on impacted teeth.

Direct bonding on impacted teeth. In eighteen patients twenty-three impacted teeth were surgically exposed and provided with Cuspid-Pull Brackets by the direct-bonding technique. Light orthodontic traction was applied after 10 minutes. Only three brackets were lost during the experiment. The experiment showed that sufficient bonding could be established on impacted teeth without pumicing the tooth surface and that phosphoric acid in minimal amounts causes no harm to the adjacent tissues but assists in preventing bleeding from the surrounding tissues. This made it possible to obtain the necessary dryness of the exposed tooth surface. The reasons for bond failure are discussed.


Patterns of muscular activity around the hip joint in ambulatory children with cerebral palsy. An electromyographic study. Effect of posture and voluntary movements on hip muclses in eithteen spastic ambulatory children with cerebral palsy were examined electromyographically. Five normal adults were also examined as controls. In each posture, subluxation hips showed greater activity than concentric and normal hips, and the activity pattern was mostly that of either the flexion or the extension synergies in voluntary movements. The concentric hips did not show the characteristic pattern.


Why a psychoanalytic core in psychiatric education? The author presents arguments for a historical psychogenetic approach to psychiatric education with a focus on psychodynamic understanding of behavior. Psychoanalysis provides a developmental psychology and a body of clinical data that are uniquely suited to this purpose. This focus is meant to be complemented by consideration of genetic, social, cultural, learning, and biophysiological forces. The author relates trends in psychiatric education to the changing identity of the psychiatrist and the history of the discipline.


A placebo-controlled study of lithium combined with neuroleptics in chronic schizophrenic patients. Lithium combined with major tranquilizers was administered to 22 hospitalized chronic schizophrenic patients with minimal neurotoxicity or other side effects. Moreover, 10 of the patients benefited significantly with lithium as compared to placebo in terms of blind psychiatric and nursing ratings and nonblind clinical judgments of outcome. These results contrast with previous negative reports in the literature and the generally poor prognosis in chronic schizophrenic patients. The authors suggest that a trial combining lithium with psychotropic drugs is warranted in schizophrenic patients who do not respond satisfactorily to conventional treatment


Blood pressure and pulse changes in hyperactive children treated with imipramine and methylphenidate. The authors found significant increases in systolic and diastolic blood pressure and pulse rate in hyperactive children treated with imipramine. Methylphenidate-treated children showed significant weight loss but no significant changes in blood pressure or pulse. The authors recommend caution in the use of imipramine and suggest the need for further study to determine short- and long-term effects of imipramine on blood pressure.


Family interactions as etiological factors in mental disorders: An analysis of the American Journal of Insanity, 1844-1848. A review of the first four volumes of the American Journal of Insanity indicated that the primary etiological factor noted by authors during that period was disturbed brain functioning, although emotional factors were often mentioned as additional explanations for mental illness. The influence of familial factors and interactions on the development of mental illness was rarely explored. The author concludes that psychiatry at this time did not yet recognize the importance of the dynamics of and interpersonal stresses within family relationships.


Current perspectives on giardiasis.

Current perspectives on giardiasis. Giardia lamblia infestation can cause severe diarrhea and malabsorption, and the diagnosis is usually made by identification of cysts in the feces, but small intestinal biopsy or smears may be required. A wide spectrum of roentgen changes may be seen. In patients with a normal immune status, the small bowel is normal or shows an inflammatory bowel disease pattern. Eradication of the parasite reverses these changes. In some patients with IgA deficiency, nodular lymphoid hyperplasia occurs, and this is usually not reversible. Other patients with hypogammaglobulinemia or dysgammaglobulinemia and giardiasis may show a sprue pattern. This pattern  most often persists after eradication of the parasite. Although the triad of giardiasis, IgA deficiency, and nodular lymphoid hyperplasia has a particularly high association, these, together with diarrhea, malabsorption, and various altered immune states may occur in any combination.


Esophageal moniliasis. A review of common and less frequent characteristics. Invasion of the esophagus by Candida albicans probably occurs more frequently than the reported cases suggest. The disease usually occurs following immunosuppression but may occur after antibiotic therapy. It is heralded by the sudden onset of severe pain and dysphagia, and recovery or death from dissemination may occur. Roentgenographically, impaired motility is much more prominent than disordered motility or spasm. Narrowing, a cobblestone epithelium, and later, erosions and ulcerations are seen. Antifungal agents are adequate therapy.


Angiography in expansile lesions of the spleen. The angiographic findings in a relatively large number of expansile lesions of the spleen are presented. In cysts our findings correspond to those in earlier reports, the hallmark being stretching of intrasplenic arteries and veins around an avascular espansile lesion. As to neoplasms (primary as well as secondary), however, our findings suggest that the criteria of malignancy, that is, neovascularity, vascular encasement, and arteriovenous shunting, may be more frequent than is evident from earlier reports.


Congenital avalvular pulmonary artery and infantile lobar emphysema. A diagnostic correlation. Some cardiovascular lesions may result in tracheobronchial obstruction and many of these will commonly be associated with infantile lobar emphysema (ILE). By contrast a relatively smaller percentage of cases of ILE results from vascular compression. We offer a new term, "congenital avalvular pulmonary artery (CAPA)," to describe the complex of the absent pulmonary valve and the concomitant marked pulmonary artery dilatation because CAPA is more descriptively inclusive of the abnormality of the artery beyond the valve. The diagnostic correlation of CAPA and ILE is of considerable importance since the initial presentation of CAPA is usually as ILE and the recognition of a triangular or rounded hilar density should raise suspicion for CAPA even before clinical signs become evident. Differential diagnosis must include other causes of ILE including infantile lobar emphysema with bronchial atresia.


Pulmonary venous air embolism in hyaline membrane disease. A newborn infant with the respiratory distress syndrome in whom pulmonary venous air embolism (PVAE) developed as a complication of positive pressure therapy is reported. The underlying pathophysiology in this disorder is probably the development of alveolar-capillary fistulae secondary to unduly high intrabronchial pressures. An increased awareness by radiologists and clinicians of PVAE as a potential complication of aggressive respiratory therapy will result in more frequent recognition of this uncommon but lethal disorder.


Pulmonary edema and continuous positive pressure breathing (CPPB). We have successfully treated severe pulmonary edema of various etiologies and the concomitant hypoxia in 17 infants and children with continuous positive pressure spontaneous breathing. The pressure used was 8 to 14 cm of water above atmospheric pressure. No significant changes occurred in arterial or central venous blood pressure, and no patient developed clinical evidence of peripheral venous engorgement. Pulmonary edema cleared within 24 hours in all cases. We believe this rapid clearing may differentiate pulmonary edema from pneumonia and pulmonary hemorrhage. The pathophysiology and the roentgenologic findings are presented.


Radionuclide studies in bronchogenic carcinoma of the Hilum. Scintigraphy and tomography: their complementary features. Thirty-eight cases with direct or indirect signs of hilar masses were investigated by roentgenologic, radioisotopic and surgical methods. Reasonable correlation between tomography and scintigraphy was confirmed, substantiating their complementary nature. Bronchogenic carcinoma of the central airways was most frequent among the hilar masses. Masses as well as other involvement of the bronchovascular structures of the hilum on conventional tomography were confirmed by the gallium-67 scan, and inhalation and perfusion scintigraphy. Some cases which simulated bronchogenic carcinoma were presented. Hilar masses without destruction of the bronchovascular structures showed normal inhalation and perfusion scintigrams with positive gallium-67 accumulation. These lesions were metastatic cancer, malignant lymphoma, and sarcoidosis. If these diseases involve the airways and the vessels of the hilum, differentiation from bronchogenic carcinoma may naturally be difficult.


Ileocolonic perforation. A complication following renal transplantation. During the decade, February, 1965, through February, 1975, 248 patients underwent renal transplantation at the Duke Medical Center. One hundred twenty-five were living related recipients, while 123 were cadaveric recipients. Eleven patients developed ileocolonic perforation. Six cases were felt to represent non-immunologic etiologies while the remaining 5 were felt to be associated with the allograft response and high dose steroid therapy. Only 3 of the patients survived this complication and in each case the perforation was localized. High dose steroid therapy interferes with prompt diagnosis and severely impairs successful treatment. Radiologists must be familiar with the problem of ileocolonic perforation in patients on steroid therapy, must have a high index of suspicion of the site of perforation, and must recommend and complete water soluble contrast examination for establishment of the diagnosis. Early diagnosis, prompt surgical intervention, and discontinuation of immunosuppressive therapy are recommended.


Chemosuppressive field trials in Thailand. II. The suppression of Plasmodium falciparum and Plasmodium vivax parasitemias by a diformyldapsone-pyrimethamine combination. In an area of Thailand where chloroquine-resistant falciparum malaria is known to exist, a chemosuppressive field trial was undertaken to test the efficacy of the preparation diformyldapsone (DFD) combined with pyrimethamine (Py) in suppressing falciparum and vivax parasitemias. Six hundred and fifty-nine Thai villagers were randomly assigned to one of five treatment groups: DFD-Py; dapsone (DDS)-Py; DFD alone; Py alone; and placebo. Five hundred and ninety-three study subjects completed the 26-week trial. The combination DFD-Py given weekly was shown to be an effective chemosuppressive against both falciparum and vivax parasitmias, causing a more than fourfold reduction in falciparum and an approximately threefold reduction in vivax parasitemias; however, this combination was not more efficacious than DDS-Py for the chemosuppression of falciparum malaria. DFD alone was only moderately effective, while there was no difference in chemosuppression between Py alone and placebo.


Isolation of La Crosse virus (California encephalitis group) from the chipmunk (Tamias striatus), an amplifier host. La Crosse (LAC) virus was isolated from the blood of seven chipmunks (Tamias striatus) captured during the summer of 1970 in southwestern Wisconsin. With the exception of the original isolate obtained from human brain after fatal encephalitis, these represent the first known isolations of LAC virus from a naturally infected free-living vertebrate. The chipmunks were trapped and periodically recaptured in two study areas where 59 chipmunks became infected and developed neutralizing antibody during the summer cycle of virus transmission. All isolates were obtained from blood samples collected within a 7 week period between 11 July and 23 August, and all were from seronegative chipmunks; 6 of these were recaptured and found to be seropositive 2 to 3 weeks later. The isolates proved identical to each other in comparative micro-neutralization tests using BHK21 cell cultures and immune chipmunk serum or hyperimmune mouse ascitic fluids. Neutralization tests showed the isolates to be different from snowshoe hare, trivittatus, and Jamestown Canyon prototype virus strains but indistinguishable from the LAC prototype. Findings demonstrate multiplication and transmissibility of LAC virus in a naturally infected host and are consistent with the thesis that chipmunks are important amplifying hosts for LAC virus and that Aedes triseriatus mosquitoes serve as vectors in transmitting their infections. Ecological significance of the findings are discussed in regard to current perspectives.


Prevention and management of contractures in patients with burns of the neck. Two hundred patients with neck burns were analyzed to determine the incidence of contractures. It was found that only 8 per cent of patients with second degree burns had contractures, all of which were mild. Both the overall incidence of cervical contractures in patients with third degree neck burns and their severity can be decreased by the use of a custom-formed isoprene splint. Splinting should begin as soon as possible after the burn and continue until scar maturation is complete.


Scanning electron microscopy of epithelia prepared by blunt dissection. Simple dissection techniques of samples to be examined in the scanning electron microscope allow one to visualize easily the three-dimensional shape of epithelial cells in situ. Such preparations reveal a complex system of ridges and folds on the lateral surface of the cells whose intricacy can best be appreciated with SEM. In many epithelia there is a smooth apical band which corresponds to the region occupied by the junctional complex previously identified with conventional EM techniques. The secretion of chylomicra that result from a fatty meal can be observed. It is possible to study the distribution of concanavalin A binding sites on the lateral surfaces of the cells utilizing hemocyanin as a marker. In the case of the proximal tubule epithelium, the apical cell surface has many more binding sites than the lateral cell surface and there is a sharp demarcation at the level of the apical band. After blunt dissection the relationship of the basal surface of the cells with the basement lamina and the basement membrane can be appreciated as well. Possible physiological meaning of the morphological features observed is briefly discussed.


Diagnosis of pneumothorax complicating mechanical ventilation. Pneumothorax developed in 4 patients as a complication of mechanical ventilation and the manifestations were different in each case. The first patient had had a previous pneumomediastinum with symptoms of chest pain and rise in blood pressure. The second became restless and "fought" the ventilator. The third had pneumothorax previously and developed tachycardia and arrhythmias, and the level of end-expiratory pressure in the manometer of the ventilator rose above the present level. In the fourth patient, subcutaneous and submucous emphysema were apparent before pneumothorax was diagnosed. Pneumothorax was diagnosed promptly in all these patients, permitting adequate management without additional complications.


The effect of repeated doses of succinylcholine on serum potsssium in patients with renal failure. The effect of 1 mg/kg of succinylcholine IV in repeated doses on serum potassium (K+) was studied in 11 patients with renal failure. Increases in K+ did not differ from those seen in patients with normal kidney function, the largest increase being 0.6 mEq/L. The authors conclude that succinylcholine administered repeatedly at this dosage is not contraindicated in patients with renal failure.


Relationship of B blood group locus to skin allograft in chickens. Skin grafts were exchanged among 21 genotypic pairs of B blood group locus in the non-inbred chicks of White Leghorn at 5-7 days of age. The mean percentages of B locus compatible pairs were 94.7, 84.2 and 56.8 at the 11th, 15th and 19th days after grafting, respectively. These percentages of survival grafts were significantly higher than those of incompatible pairs. The effects of three B alleles were investigated but the differences of effects of them were not found in this experiment. Two of the prolonged survival grafts survived for 35 days after grafting and all of the incompatible grafts were rejected the 20th day after grafting. The results of skin graft provided evidence that the B blood group locus was a histocompatibility locus or closely linked to such a locus.


Effects of stimuli emanating from the nest on the reproductive cycle in the ring dove. I: pre-laying behaviour. The course of several behavioural patterns could be influenced by controlling the state of the nest available to a pair of ring doves (Streptopelia risoria). These patterns were: wing-flipping, handling of nesting material, nest bowl occupancy, and nervous activities. In groups having to build nests, the onset of wing-flipping by the female occurred at a predictable time before egg-laying. It is argued that during nest-building a female influences the male to carry material to her by sitting in the nest bowl and wing-flipping. In pairs provided with a completed nest, the course of the pre-laying cycle was changed and the 'typical' sex roles did not emerge. The relationships between the male and female are discussed.


The effect of immune milk as a treatment for ragweed pollinosis. The effect of treating ragweed hay fever with oral hyperimmune milk globulin was evaluated in a double-blind study. Thirteen matched patient pairs were treated with capsules containing either specific protein isolated from the colostrum of cows that had been hyperimmunized with fall pollen allergens or with placebo. The results suggest that immune milk treatment did not alter IgE antibody response after pollen exposure; neither was immune milk markedly better than placebo in controlling symptoms.


[Microassay of adenine by an enzymatic isotope dilution kinetics method]. Owing to the very low levels of adenine in the intracellular and extracellular compartments and its low excretion by the kidney, no method of estimation was, until now, sufficiently specific and sensitive to determine precisely quantities of the order of 1 nanomole. The method of "isotopic enzymatic kinetic dilution" proposed by Newsholme et Taylor, has been used. The kinetic conditions of the reaction catalysed by adenine-phosphoribosyltransferase are favourable, [in particular KM (adenine) is very low, about 2.1(-6) M] and are not very sensitive to the action of other effectors. The technique proposed permits one to determine quantities of adenine between 0.05 and 1.2 nmole, i.e. 0.007 to 0.16 mug, with a precision of about 5 p. cent. Easy to carry out, it is useful in large series. Normal values in man of adenine thus measured (15 adult subjects) were as follows: Plasma: 1.13 +/- 0.41 nmoles.ml(-1), i.e. 0.152 +/-0 0.055 mug.ml(-1). Red cells: 3.65 +/- 0.87 nmoles.ml(-1), i.e. 0.493 +/- 0.117 mug.ml(-1). Urine (24 hour excretion): 11.41 +/- 1.24 mumoles, i.e. 1.54 +/- 0.17 mg.


[Demonstration by direct immunofluorescence of intracellular immunoglobulins on sections of tissues fixed in Bouin's fluid and embedded in paraplast]. Sections obtained from lymphoid tissues fixed immediately after biopsy in Bouin's fluid and embedded in paraplast may be used to visualize the immunosecretory cells with classical direct immunofluorescence. A comparative study of the same fragments processed according to the frozen section method followed by acetone fixation or according to Sainte-Marie's method confirms the value and the advantages of the proposed technique. Early fixation of thin fragments seems to be the main point.


General anesthesia and the lung.

General anesthesia and the lung. In this review, an attempt has been made to select, evaluate, and interpret the pertinent literature relative to general anesthesia and the lung. Concepts of intrapulmonary gas exchange and respiratory system mechanics were synthesized, emphasizing the importance of changes in intrapulmonary gas distribution that are induced by general anesthesia and exploring the possible underlying mechanisms of these changes. The area of control mechanisms and the effects of anesthesia on respiratory regulation were not discussed, nor was the distribution of pulmonary blood flow examined. The following general conclusions can be reached: (1) impaired gas exchange occurs during general anesthesia, with both impaired oxygenation and CO2 elimination; (2) increased venous admixture and increased alveolar dead space impair gas exchange; (3) the distribution of ventilation is changed during general anesthesia, and this change is related to a decrease in FRC in the recumbent positions and to altered chest-wall mechanics. Numerous questions regarding the effect of anesthesia on the lung remain unanswered. The close relationship between advances in pulmonary physiology and the pulmonary effects of anesthetic actions is increasingly apparent, as is the importance of this knowledge in applying mechanical ventilation and end-expiratory pressure to patients with pulmonary disease.


Azathioprine plus prednisone compared with prednisone alone in the treatment of systemic lupus erythematosus. Report of a prospective controlled trial in 24 patients. A prospective, randomized drug trial compared prednisone (60 mg per day initially) to azathioprine (3 to 4 mg/kg of body weight - day initially) plus prednisone in 24 patients with life-threatening systemic lupus erythematosus. Each group contained patients matched for age, sex, disease duration, previous therapy, and clinical and laboratory features of lupus erythematosus. During a mean follow-up period of 18 to 24 months, there were no significant differences between the two groups in number of deaths, renal or extrarenal manifestations of disease, serum complement levels, DNA antibodies, antinuclear antibody titers, lupus erythematosus cells, or Coombs' antibodies. There was no convincing evidence of a steroid-sparing effect of azathioprine. Side effects attributable to steroids were equally common in both groups; infections were not increased in the combination therapy group. Azathioprine was hepatotoxic in doses of 200 mg daily or more. Azathioprine was not a useful adjunct to corticosterolds in short-term therapy of a small number of patients with severe systemic lupus.


Cyclophosphamide or azathioprine in lupus glomerulonephritis. A controlled trial: results at 28 months. Thirty-eight patients with diffuse glomerulonephritis of systemic lupus erythematosus were randomly assigned to add cyclophosphamide, azathioprine, or nothing to low-dose corticosteroid treatment and have been followed for a mean of 21/3 years thereafter. Of the 11 patients with unfavorable outcomes (8 deaths and 2 beginning hemodialyses), 2 occurred on cyclophosphamide, 4 on azathioprine, and 5 on prednisone only. Deaths due to infection occurred on the cytotoxics, while deaths ascribed to central nervous system lupus erythematosus occurred exclusively on prednisone only. Gradual deterioration of renal function was observed in all three groups, most frequently on prednisone only. Undesirable events, some due to drugs, were observed. At the time of reporting, the cytotoxic agents seemed to add marginally to the control of the disease; other treatment schedules should be evaluated.


Renal transplantation in multiple myeloma. A case report. A patient with plasma cell myeloma presented in severe renal failure but was otherwise considered a good risk candidate for chemotherapy. Supported by hemodialysis she received intensive cyclophosphamide chemotherapy, resulting in a stabilization of all overt manifestations of her disease except for the renal failure. After 11 1/2 months of follow-up without showing any further progression of the myeloma process, she received a successful cadaveric renal transplant, which functioned well until the time of her death 15 months later. No evidence of recurrent myeloma kidney disease was found at postmortem examination.


Prevention of nosocomial viral hepatitis, type B (hepatitis B). Nosocomial viral hepatitis, type B, is assuming increasing importance in the United States. The keystone to an effective hepatitis control program is surveillance of patients and personnel, especially in high-risk areas, namely dialysis units, hematology-oncology units, and laboratories. Measures to control infection are outlined for specific areas of the hospital. Data currently available suggest that employees who have persisting hepatitis B surface antigen (HBSAg) need not be removed from their positions unless they have been proved to disseminate infection. Future investigations should include methods to study: [a] the mechanisms of nonpercutaneous spread of hepatitis B virus, [b] the role of the individual with persisting HBSAg in the dissemination of hepatitis B virus, [c] the efficacy of hepatitis B immune globulin in high-risk areas, and [d] the effectiveness of various chemical and physical procedures in use for inactivation of hepatitis B virus using animal model systems.


The laboratory diagnosis of syphilis. New concepts. Although new tests for syphilis, as well as new applications of standard tests, continue to appear, the usefulness of several of these procedures has not been determined. When the Fluorescent Treponemal Antibody-Absorption (FTA-ABS) test is used to screen for syphilis, the proportion of positive results that are true positives decreases. The value of modified FTA tests in the diagnosis of neurosyphilis and congenital syphilis remains unproved. Although not studied as extensively as the standard tests, several newer methods--the direct fluorescent antibody test for Treponema pallidum (DFATP), the Rapid Plasma Reagin (RPR) card test, and the microhemagglutination test for T. pallidum (MHA-TP)--may have certain advantages. To be of optimal diagnostic value, tests for syphilis must be selected according to the clinical situation.


Acute intermittent porphyria: clinical and selected research aspects. Acute intermittent porphyria is an inborn error of metabolism characterized by the excretion of excess porphyrin precursors (porphobilinogen and usually delta-aminolevulinic acid) in the urine, and by sporadic attacks of neurologic dysfunction. The disease is complex, involving variable patterns of autonomic and peripheral neuropathy as well as the central nervous system manifestations. There may be alterations in carbohydrate, lipid, water, and electrolyte metabolism in addition to clinically inapparent endocrine abnormalities. The fundamental defect is thought to be a 50% decrease of uroporphyrinogen I synthetase, the third enzyme of the heme biosynthetic pathway. This is associated with a marked increase of hepatic delta-aminolevulinic acid synthetase, the first and rate controlling enzyme of the pathway. The measurement of uroporphyrinogen I synthetase in erythrocytes now provides an enzyme diagnostic test for the disease. Two therapeutic approaches that may prove to reverse the fundamental disease process, at least in some patients, involve [1] a high carbohydrate intake, and [2] intravenous administration of hematin. The latter, only recently introduced, is now being investigated.


Immunologic benefits and hazards of milk in maternal-perinatal relationship. Aside from nutritional significance, milk affords infant mammals immunologic benefits. However, it is not without immunologically based hazards. These stem from its antigenicity and the fact that in certain species that receive their maternal immunologic endowment postpartum, hemolytic disease of the newborn may be mediated by colostral antibodies. Awareness that viable leukocytes are ingredients of colostrum and milk has stimulated interest in the significance of these cells. Skin grafting tests on foster-nursed rats and mice have given circumstantial evidence that, in these species, leukocytes may be transmitted naturally from the mother's blood stream to the suckling's blood stream through the milk, and that these cells may be beneficial (adoptive immunization) or, in some genetic contexts, harmful (initiating graft-versus-host disease). In man, too, studies on necrotizing enteritis and other disease provide increasing support for the thesis that leukocytes in milk fulfill a protective function, possibly as a consequence of their "natural" transplantation.


The remarkable Dr. Abildgaard and countershock. The bicentennial of his electrical experiments on animals. In 1775 Peter Christian Abildgaard, a Danish veterinarian and physician, conducted experiments on electrical countershock on animals. He succeeded in first rendering fowl lifeless by an electric shock and then reviving them by a countershock applied to the chest. Ventricular fibrillation and defibrillation were not known and could not be documented at that early date, but his report suggests he accomplished these changes long before other physiologists described them. Dr. Abildgaard's long and varied career included many significant contributions to veterinary and human medicine, biology, zoology, botany, physics, chemistry, and mineralogy. He also took an interest and was active in politics, economics, and community affairs. This short biography is intended as a fitting, though belated, tribute to his pioneer work on effects of electric shock.


Public health considerations in the management of meningococcal disease. We discuss chemoprophylaxis of household contacts of cases, the current status and use of meningococcal vaccine, and the role of surveillance of household contacts. Available data on secondary attack rates strongly support the need for chemoprophylaxis of household contacts of meningococcal disease cases. Until the current difficulties with side reactions to minocycline are resolved, we recommend the use of rifampin. Surveillance of household contacts alone is an untested, generally impractical, and probably ineffective method of preventing secondary cases of meningococcal disease, although it may have some effect in preventing death by encouraging prompt and appropriate treatment of cases. We recommend the use of serogroups A or C vaccine, or both, in populations experiencing an epidemic of serogroups A or C meningococcal disease. The use of serogroups A or C meningococcal polysaccharide vaccines should also be considered, along with chemoprophylaxis for household contacts of sporadic cases due to either of these organisms.


Management of type IV hyperlipoproteinemia. Evaluation of practical clinical approaches. A lipid intervention clinic screened 4000 employees (89% participation) and identified 150 type IV subjects (top 5 percentile triglyceride values, 100% initial participation, 6% drop out). The 150 healthy type IV subjects, ages 20 to 49, were randomly divided into treatment subgroups: A, treatment by clinic nutritionist and physician with the National Heart and Lung Institute's type IV diet for 6 weeks, then diet plus clofibrate for 18 weeks; B, same treatment by private physician; C, no intervention for 24 weeks, subjects advised of abnormality. The group A mean fasting serum triglyceride of 407 mg/dl declined 50% at 6 weeks, 61% at 12 weeks, and was unchanged at 24 weeks (P less than 0.0005 at 6, 12, 24 weeks). Group B triglyceride decreased 42%, 50%, 41% (P less than 0.0005 at 6, 12, 24 weeks). Group C triglyceride declined 20%, 1st to 24th week. Body weight decreased 8% (A) and 4% (B) at 6 weeks (P less than 0.0005) and was unchanged at 24 weeks. The maximum cholesterol decrease (A) was 11% (P less than 0.0005). Type IV hyperlipoproteinemia can readily be identified in a working population; treatment by clinic or private physician will markedly lower fasting serum triglyceride values in apparently healthy type IV subjects for at least 24 weeks.


Serratia marcescens endocarditis: a regional illness associated with intravenous drug abuse. From 1969 to 1974, 19 cases of Serratia marcescens endocarditis were observed in the San Francisco Bay Area. Seventeen patients were intravenous drug users, and Serratia caused 14% of all addict-associated endocarditis in San Francisco. Serratia strains were nonpigmented and had typical antibiotic sensitivities, except that 9 of the isolates exhibited colonial variation, with each variant having different antibiotic sensitivities. Aortic or mitral valves were involved in 13 patients, and heart failure developed in 9 of these. Twelve patients had embolic episodes to brain, iliofemoral arteries, or lung. Five of 6 patients with tricuspid valvulitis were cured by antibiotics either with (1) or without excision of the valve. All 12 patients with aortic or mitral valvulitis treated medically died; 11 had unremitting sepsis. Aortic valve replacement and antibiotics were effective in 1. Gentamicin combined with either carbenicillin or chloramphenicol was the most effective treatment regimen.


Dermatomyositis and malignancy. A review of the literature. Although there appears to be an increased incidence of malignancy among patients with dermatomyositis, demonstration of definitive statistical significance is precluded by the lack of large, controlled series. Patients with the two diseases tend to be older than the general dermatomyositis population and younger than those with cancer alone; and there is a preponderance of female patients. Tumors of the ovary and stomach are more frequently observed than in the general population, while colorectal malignancies are underrepresented. Most reported cases show development of the diseases within a year of one another, and, in some patients, the course of the myopathy follows that of the tumor. No definitive cause for the myopathy in these patients has been established.


Mammography: a contrary view.

Mammography: a contrary view. Experimental and clinical data on mammography as a tool for population screening are reviewed. The conclusions are that [1] there is good evidence that annual history, physical examination, and mammography can reduce short-term and midrange breast cancer mortality by about one third; [2] the evidence that mammography alone plays a significant role in this reduction is weak and indirect; [4] data on long-term effects of mammography are lacking; [4] no satisfactory investigations of associated radiation hazards have been published; and [5] the possible benefits of mammography have received more emphasis in the clinical literature than have its defects. Promotion of mammography as a general public health measure is premature.


[Genetic map and structure in "Escherichia coli" K12 of a resistance plasmid isolated from "Salmonella ordonez" (author's transl)]. A resistance plasmid called R IP173 has been transferred into E. coli K12 from a multiresistant strain of S. ordonez isolated during an epidemic in Dakar. This plasmid mediates for colicine Ib production and resistance to ampicillin, streptomycin, spectinomycin, kanamycin, chloramphenicol, tetracycline and sulfonamides. It is transducible "en bloc" by the phage P1-kc between strains of E. coli K12. Compatibility studies have shown that R IP173 belongs to the fi- class, I1 group. It is transferred "en bloc" in conjugation experiments between E. coli K12 strains. But during transfers from S. ordonez into E. coli, incomplete variants are obtained, lacking different markers. A deletion map was obtained after analysis of 19 different variants, and it is suggested that the loss of markers results from the loss of genetic material during transfer. In this particular case, the deletions observed in transduction or conjugation experiments lead to identical genetic maps.


The isolation and characterization of a strain of subacute sclerosing panencephalitis measles-related virus. The isolation of a measles-like virus in CV-1 cell cultures from a biopsy specimen obtained from a case of subacute sclerosing panencephalitis (SSPE) is reported. Evidence of the presence of cell-free virus was obtained from the fifth cell culture passage of the isolated virus. The virus was identified as measles-related by standard immune sera. IF study did not show relevant differences between the isolated virus and the Edmonston strain of measles virus, even though the proportion of cells showing nuclear antigen was higher following the infection with the isolated virus than with the Edmonston strain. Electron microscopy study failed to demonstrate viral structures in the cells from the brain biopsy, while numerous large aggregates of nucleocapsids were found in the cytoplasm of infected cells observed on the third and fourth passage in tissue culture. The neuropathogenicity assay carried out on newborn hamsters, rats and mice using a suspension of disrupted infected cells did not show any clinical pathological effect due to the SSPE strain. These results are partially in contrast with previous findings which indicate relevant differences in the morphology and pathogenicity of SSPE derived strains as compared to reference measles virus.


The effect of different modes of artificial ventilation and of some prophylactic means on the incidence of postoperative deep vein thrombosis. The occurrence of postoperative deep vein thrombosis (DVT) was studied in 209 elective surgery patients aged 40 years or over. Most of the operations were cholecystectomies or other major abdominal operations. In the detection of thrombosis the 125I-fibrinogen method was used. Of 209 patients, 51 (24.4%) developed postoperative DVT and of these 10 developed thrombosis in both legs. In 36% of the DVT cases the process started during the operation or on the first postoperative day. Clinical signs of DVT did not agree with the 125I-fibrinogen test very well, whereas the correlation of the 125I-fibrinogen test with phlebography was good: of the 17 patients with a postive 125I-fibrinogen test in whom a phlebography was done, the latter method revealed thrombosis in 14 patients (82.4%). The main purpose of the study was to determine whether the mode of mechanical ventilation used during anaesthesia has any effect on the occurrence of postoperative DVT. One hundred and nine patients received intermittent positive pressure ventilation (IPPV), whereas in 100 patients the intrathoracic pressure was decreased by applying intermittent positive-negative (--5 cmH2O) pressure ventilation (IPNPV). Ventilation was standardized in both groups by keeping the end-tidal CO2% at a constant level. Inspired oxygen concentration was the same in every patient. The decreasing effect of IPNPV on intrathoracic pressure and central venous pressure as compared with IPPV was confirmed in preliminary studies.


Injuries to the neonatal larynx from long-term endotracheal tube intubation and suggested tube modification for prevention. Since the early 1960's nasotracheal tubes have been used for neonates with primary respiratory diseases which necessitated positive pressure ventilation. This therapy may be required for extended periods of weeks to months meaning prolonged trauma to the neonatal larynx. The initial injury and long-term effects of the endotracheal tube in this age group have not been adequately investigated. The acute findings can be arytenoid and posterior commissure ulcerations and, in some cases, cartilage erosion. Long-term follow-up in these children to age 3.5 years showed a persistent arytenoid defect with chronic hoarseness. The consideration of a change in the structure of the endotracheal tube is suggested as a possible means of avoiding these injuries.


Frey's syndrome-a technical remedy.

Frey's syndrome-a technical remedy. The symptoms of Frey's syndrome are occasionally of sufficient magnitude to warrant curative treatment. In four patients, a fascia lata graft was placed under the involved skin in an attempt to offer permanent relief from the cutaneous discomfort suffered during eating. Two of these patients have excellent long-term results. The other two patients were lost to long-term follow-up but were asymptomatic several months following grafting.


Influence of coliform source on evaluation of membrane filters. Four brands of membrane filters were examined for total and fecal coliform recovery performance by two experimental approaches. Using diluted EC broth cultures of water samples, Johns-Manville filters were superior to Sartorius filters for fecal coliform but equivalent for total coliform recovery. Using river water samples, Johns-Manville filters were superior to Sartorius filters for total coliform but equivalent for fecal coliform recovery. No differences were observed between Johns-Manville and Millipore or Millipore and Sartorius filters for total or fecal coliform recoveries using either approach, nor was any difference observed between Millipore and Gelman filters for fecal coliform recovery from river water samples. These results indicate that the source of the coliform bacteria has an important influence on the conclusions of membrane filter evaluation studies.


Dection of salmonellae in the environment. The incidence of salmonellae in contrasting environments was compared in this study. Samples collected from or near surface waters in a lush hardwood forest yielded four salmonellae serotypes from six culturally positive samples. A total of 76 samples collected from the top of a granite outcropping over a 3-month period yielded 10 positive samples. Only two salmonellae serotypes were isolated, and one of these was isolated only once. The nature of the sample material had no significant effect on the detection of salmonellae from the two sampling sites. However, the presence or absence of visible moisture in the sample significantly affected the recovery of salmonellae. The results showed that even a harsh environment such as that found on top of Stone Moutain may serve as an ecological niche for the survival and transmission of salmonellae.


Effect of added iron on the formation of clostridial inhibitors. Inhibition of Clostridium botulinum by nitrite was potentiated by the addition of Fe(II) or Fe(III) to the culture medium. The effect of iron was more pronounced when nitrite was added after autoclaving.


Method for collecting naturally occurring airborne bacterial spores for determining their thermal resistance. The ability to determine the thermal resistance of naturally occurring airborne bacterial spores associated with spacecraft and their assembly areas has been hindered by lack of an effective collecting system. Efforts to collect and concentrate spores with air samplers or from air filters have not been successful. A fallout method was developed for this purpose and tested. Sterile Teflon ribbons (7.6 by 183 cm) were exposed in pertinent spacecraft assembly areas and subsequently treated with dry heat. Thermal inactivation experiments were conducted at 125 and 113 C. Heating intervals ranged from 1 to 12 h at 125 C and 6, 12, 18, and 24 h at 113 C. Eight hours was the longest heating time yielding survivors at 125 C, whereas survivors were recovered at all of the heating intervals at 113 C. D125C values were calculated using the fractional-replicate-unit-negative technique of Pflug and Schmidt (1968) and ranged from 25 to 126 min. This variation indicated that the most probable number of survivors at each heating interval did not fall on a straight line passing through the initial spore population. However, the most-probable-number values taken alone formed a straight line suggesting logarithmic thermal destruction of a subpopulation of spores with a D125C value of 6.3 h.


Effect of physical parameters on the in situ survival of Escherichia coli MC-6 in an estuarine environment. Survival of Escherichia coli MC-6 of fecal origin in an estuarine environment as affected by time, water temperature, dissolved oxygen, salinity, and montmorillonite in diffusion chambers has been elucidated. Several in situ physical parameters were recorded simultaneously, and viable cell numbers were estimated. The survival of the bacteria varied seasonally. Montmorillonite addition extended the time needed for a 50% reduction of the viable cell population (t1/2) of cells by 40% over the t1/2 of cells in Rhode River water alone. The effect of this clay was not significantly greater between 50- to 1,000 mug/ml montmorillonite concentrations. In all experiments, the relationships among pairs of variables were studied by regression and correlation analysis. The slope between viable cell numbers and water temperatures increased about 50% for each 10 C increment in temperature and gave a correlation coefficient r = 0.617, significant at 95% confidence level. A similar correlation coefficient, r = 0.670, was obtained between water temperature and t1/2 of the initial cell population. In all experiments regressions were performed considering all variables after bacteria had been in the Rhode River environment for 3 days. Coefficient of multiple determination was estimated as R2 = 0.756. Approximately 75.6% of the variance of viable cell numbers can be explained by variation in water temperature, dissolved oxygen, and salinity. Simple correlation coefficients within the regression steps were also computed. Survival of bacteria was closely and negatively correlated with increasing water temperature (r = -0.717). It is suggested that water temperature is the most important factor in predicting fecal coliform survival from point and nonpoint sources in assessing water quality in an estuarine ecosystem.


Low-temperature irradiation of beef and methods of evaluation of radappertization process. An inoculated, irradiated beef pack (1,240 cans) was conducted for the determination of microbiological safety for unrestricted human consumption. Each can contained a mixture of 10(6) spores of each of 10 strains of Clostridium botulinum (5 type A and 5 type B), or a total of 10(7) spores/can. The cans were irradiated to various doses (100 cans/dose) with 60Co gamma rays at -30 +/- 10 C, incubated at 30 +/- 2 C for 6 months, and examined for swelling, toxicity, and recoverable botulinal cells. The minimal experimental sterilizing dose based on nonswollen, nontoxic sterile cans were 2.2 less than experimental sterilizing dose based on nonswollen, nontoxic sterile cans was 2.2 less than experimental sterilizing dose less than or equal to 2.6 Mrad. Using recoverable cells as the most stringent criterion of spoilage, and assuming the conventional simple exponential (without an initial shoulder) rate of spore kill, the "12D" dose was 3.7 Mrad when estimated on the basis of mixture of 10 strains totaling 10(7) spores/can, and 4.3 Mrad if it is assumed that each can of beef contained 10(6) spores of a single most resistant strain and all of these spores were of identical resistances. However, an analysis of the data by extreme value statistics indicated with 90% confidence that the spore death rate was not a simple exponential but might be a shifted exponential (with an initial shoulder), Weibull, lognormal, or normal, with a "12D" equivalent of about 3.0 Mrad regardless of the initial spore density per can. There was an apparent antagonism between the irradiated type A and B strains in the cans. Some of the cans contained type B toxin but did not include type B viable cells. Other cans had a mixture of type A and B toxins, but a large number of these cans did not yield recoverable type B cells. However, type A viable cells could always be demonstrated in those cans containing type A toxin.


Development of a micromethod for identification of anaerobic bacteria. A microprocedure was described for determining the carbohydrate fermentation patterns of 48 anaerobic bacteria at one time in microtiter plates. The cultures were transferred into agar-filled wells of microtiter plates with a replicator inside an anaerobic glove box. Fermentation was measured both with a colorimetric indicator and with a small pH electrode. The method was approximately 97% accurate. It would be most useful for laboratories that need to  identify large numbers of anaerobes at one time.


Micromethod for identification of anaerobic bacteria: design and operation of apparatus. A replicator is described for transferring 48 bacterial cultures into separate wells of microtiter plates. The device was designed for determination of carbohydrate fermentation patterns of anaerobic bacteria but should be useful for other applications. A simple device for filling microtiter wells with media is also described.


Evaluation of coli-count samplers for possible use in standard couting of total and fecal coliforms in recreational waters. Millipore Coli-Count Samplers were used to enumerate colonies of laboratory cultureunts than standard membrane0filter procedures for both total and fecal coliforms. Althought the samplers are useful for semiquantitative analysis as indicated by the manufacturer, they are not suitable examinations of recreational waters.


Erythema nodosum leprosum in a general hospital. We report 32 patients with erythema nodosum leprosum (ENL). Twenty-two patients developed ENL before beginning chemotherapy. The recognition that ENL in the absence of chemotherapy is not an uncommon event is of importance, not simply as a fact in and of itself, but because this observation raises provocative questions when placed in the context of current ideas concerning ENL. ENL should be regarded as a manifestation of leprosy, not necessarily as a complication of its therapy.


The treatment of genetic disorders.

The treatment of genetic disorders. Dermatologists see many patients with disorders that have an important but variable genetic component. Conditions caused by multifactorial inheritance, which account for many patients seen in dermatologic practice, have a strong environmental component in their cause and are generally the most responsive to therapy. Treatment is also possible for many conditions of dermatologic importance that are caused by mutant genes of large effect. At this time, there is little chance of treating the patient in the sense of genetic engineering, but some understanding of the theoretic basis for laboratory manipulation of DNA is a prerequisite to understanding the possible potential of new forms of therapy.


Early neonatal hypocalcaemia.

Early neonatal hypocalcaemia. In our hospital early neonatal hypocalcaemia is now the major cause of low serum calcium in the neonatal period. Over a 2-year period, only 2 cases of hypocalcaemic convulsions were seen in a total of 8700 deliveries, though 51 infants had early neonatal hypocalcaemia. All sick low birth-weight infants should have daily serum calcium estimations carried out. Calcium supplements should be considered if symptoms of hypocalcaemia are present.


Hyperbilirubinaemia and bacterial infection in the newborn. A prospective study. The incidence of bacterial infection associated with unexplained hyperbilirubinaemia was determined prospectively in 69 infants under 2 weeks of age. Blood and urine cultures were obtained from all patients, and 22 patients had their CSF cultured. Bacterial infection was documented in only 2 infants, who had asymptomatic Gram-negative urinary tract infection.


Immunofluorescent investigations in cutaneous vasculitis. I. Histotopical demonstration of complement/complement factors. Using an indirect double layer immunofluorescence method, fresh skin lesions of 10 patients with different forms of cutaneous vasculitis were tested for the occurrence of complement-factors C1q (C1), alpha2D(C3) and beta1F (C5). In contrast to the irregularly found complement fixing immunoglobulins IgG and IgM, complement could be regularly seen bound to the cutaneous vessel walls; mostly the C3-factor alpha2D. C1q was demonstrable, combined with IgG and/or IgM only in 2 cases. In 5 patients there was a non-homogenous, roddy fluorescenece of the epidermal basal membrane zone and the cutaneous vessels, when alpha2D or beta1F were tested. Our findings suggest that the "alternate pathway" beginning with C3-activation is followed in most cases, whereas a typical "immune complex vasculitis" is obviously rare. The constant occurrence of complement in the cutaneous vessel walls of vascultis lesions is consistent with the known chemotactic and destructive role of complement factors in experimental models of angiitis, but it may not necessarily involve a specific immunological process.


Antibody suppression by cadmium.

Antibody suppression by cadmium. Mice exposed to subclinical doses of cadmium chloride for ten weeks and inoculated with antigen six weeks after discontinuance of exposure had a remarkable decrease in antibody-forming cells, particularly IgG. These results indicate that immunosuppression produced by environmental contaminants may persist for several months after exposure to the contaminant.


Quantitative nitro blue tetrazolium test in febrile patients. Correlation with diagnosis and bacterial activity of leukocytes. The quantitative nitro blue tetrazolium (NBT) test did not show increased NBT reduction in bacterial infections as frequently as has been reported with the qualitative NBT test in untreated infections. Lower than normal values were seen in septic shock and bacterial endocarditis, and normal results were seen in most other bacterial infections. Increased NBT reduction was seen with reticulum cell sarcoma, Hodgkin disease, postoperative wound infections, and upper respiratory tract infections. Thus, the quantitative NBT was of little use in diagnosis of acute infections. The correlation between quantitative tests and tests of bactericidal capacity of leukocytes was poor. These data suggest that NBT reduction and bactericidal activity are dissociative events within phagocytes. Patients with low NBT results usually had bactericidal activity within normal limits.


Wound infections in renal transplant wounds: pathogenetic and prognostic factors. The factors contributing to transplant wound infection, as well as those determining its outcome, have been reviewed in 27 transplant patients with wound infection. Unrelated cadaver kidneys, diabetes, urinary fistulas and wound hematomas are all factors predisposing to wound infection. Overall incidence of wound infection in this series was 6.1% (27/439). When infections secondary to known preventable causes (i.e. hematomas and fistulas) were excluded, the incidence of wound infection was only 1.6%. Furthermore, if diabetics and retransplanted patients were excluded, the incidence of wound infection in non-diabetic patients who had their first transplant was only 0.7%. Perinephric infections are much more serious and carry a worse prognosis than superficial infections. Overall mortality of wound infections was 40% (8/27), most deaths being caused by sepsis from deep infection. Only three patients (11%) healed their wounds and saved their kidneys, whereas the rest of the survivors (15/18) healed their wounds but lost their kidneys. It is emphasized that prevention of hematomas and urinary fistulas is the most important measure in the prevention of transplant wound infection.


Sexual differentiation in Aspergillus nidulans: the requirement for manganese and its effect on alpha-1,3 glucan synthesis and degradation. Aspergillus nidulans was grown on media with added amounts of manganese ranging from 0--2.5 muM. Manganese deficiency prevented cleistothecium development, although good vegetative growth was retained. Subsequent analysis of the mycelium produced under Mn2+ deficient growth revealed that alpha-1,3 glucan, the man carbon and energy source for fructification, was virtually absent from the cell wall. Several enzymes related to cell wall composition were investigated. Beta-1,3 glucanase, and very remarkably, alpha-1,3 glucanase reached about the same activity on the Mn2+ deficient and sufficient media, but amylase and protease were about 60 and 75% lower respectively on the Mn2+ deficient media and the correlation of these findings is discussed.


Reduction of tetrathionate, trithionate and thiosulphate, and oxidation of sulphide in proteus mirabilis. The reductase catalyzing the reduction of tetrathionate and thiosulphate in Proteus mirabilis is also concerned with the reduction of trithionate and the oxidation of sulphide. Tetrathionate is reduced to thiosulphate, thiosulphate to sulphite and sulphide, and trithionate is reduced to thiosulphate plus sulphite. The oxidation of sulphide in cell-free extracts proceeds most likely to polysulphanes or to elemental sulphur, depending on the conditions. The kinetics of the reduction of tetrathionate imply a simultaneous interaction of tetrathionate and thiosulphate on the reductase molecule. The reduction of tetrathionate is activated by thiosulphate causing a non-linear progress of this reaction. On the other hand the reduction of thiosulphate is completely blocked until tetrathionate has been depleted. The order of reduction in a mixture of thiosulphate and trithionate is imputed by the enzymatic constants of the reductase for both substrates. Therefore in cell-free extracts thiosulphate is reduced prior to trithionate and afterwards, when thiosulphate has been exhausted, trithionate and the produced thiosulphate are reduced simultaneously. Fast growing cells, however, reduce trithionate first since their intracellular redox potential is insufficiently low to permit the reduction of any thiosulphate.


Growth of escherichia coli B/r/1 in a semi-continuous system designed for the synchronization of cell division. Escherichia coli B/r/1 was grown under conditions of periodic feeding. Glucose, the only carbon source, was supplied at intervals longer than the generation time of the organism. Thus, each period of glucose availability was followed by a period of depletion. This process gave rise to two synchronous populations, one dividing shortly after a new supply of fresh medium and the other dividing at a later stage within the feeding cycle. Thymine incorporation experiments suggested that the double population emerged as the result of a discriminatory blockage of DNA replication.


Production of gluconic acid and 2-ketogluconic acid by Klebsiella aerogenes NCTA 418. 2-Ketogluconic acid and, to a lesser extent, gluconic acid were found to be major products of glucose catabolism by phosphate-limited cultures of Klebsiella aerogenes NCTC 418, and together accounted for up to 46% of the glucose carbon that was metabolized. Although the concentrations of both acids increased substantially at low growth rates, their specific rates of synthesis decreased markedly, ad did the proportion of glucose converted into these products. Determination of the affinity constant, for glucose, of phosphate-limited organisms showed it ot be not significantly different from that of glucose-limited organisms (KS less than or equal to 50 muM), indicative of the phosphotransferase uptake system. And since these organisms possessed an active glucose 6-phosphate dehydrogenase, and had no detectable glucose dehydrogenase activity, it was concluded that gluconic acid and 2-keto-gluconic acid arose from their corresponding phosphorylated metabolites, and not directly from glucose.


[Sensitivity of mastitis pathogens to antibiotics and chemotherapeutic agents]. Sensitivity of mastitis bacteria to antibiotics and chemotherapeutic agents. The author tested the following bacteria, isolated from milk: -2236 strains of streptococci (1384 of group B, 262 of group C, 62 of group D, 109 of E, 16 of F, 24 of G, 7 of H, 11 of K, 270 of L, 5 of M, 41 of N, 45 of P); 361 ungroupable streptococci; 18,481 CAMP-positve, 1,966 CAMP-negative beta-haemolytic streptococci; 5,403 CAMP-negative, non-haemolytic streptococci; 1,179 strains of staphylococci, 596 of coliforms, 477 Corynebacterium pyogenes. They were tested against penicillin, streptomycin, chloramphenicol, oxytetracycline, and some were also tested against Nifuzin, Suprazid and sulfadimidine. A high proportion of the streptococci, which were the dominant mastitis agents, was sensitive to penicillin: - 97.2% of group B, 99.2% of C, 96.3% of E, 99.6% of L, 98.7% of CAMP-positive strains, 99.6% of beta-haemolytic strains. Only 20 strains of streptococci (0.08%) were resistent to penicillin. More than half were resistent to streptomycin (52.19%) while 44.38% showed decreased sensitivity. Nearly all streptococci (98.53%) were susceptible to chloramphenicol. With oxytetracycline most CAMP-positive (96.4%) and group B streptococci (95.4%) were sensitive, but only 53.4% of groups C, G and L and 31.4% of beta-haemolytic streptococci were. Sensitivity to Nifuzin, Suprazid and sulfadimidine was variable: the proportion of streptococci sensitive to each drug was 75.32%, 58.51% and 66.05%. During the ten year period of testing (1963 to 1972) the only evidence of an increase in resistance was with oxytetracycline, involving streptococci of groups N and P, the ungroupable strains and above all the beta-haemolytic strains. 82% of the staphylococci were sensitive to penicillin, 89.6% to streptomycin, 95.5% to chloramphenicol and 96.2% to oxytetracycline. Between 1963/66 and 1972 the proportion of strains showing reduced sensitivity to penicillin rose by 28.1%. With sulphonamides, 80.4% were sensitive to Suprazid and 80.6% to sulfadimidine, showing that these drugs were less effective in vitro than antibiotics. 92% of staphylococcal strains were sensitive to Nifuzin. Among coliform bacteria the dominant pattern was sensitivity to streptomycin (96%-, chloramphenicol (97.3%), oxytetracycline (88%), Nifuzin (95%), Suprazid (92%) and sulfadimidine (91.3%). The only change between 1963 and 1972 was a 14% increase in strains resistant to oxytetracacline. Strains of Corynebacterium pyogenes were generally sensitive to penicillin (100%), chloramphenicol (100%) and oxytetracycline (99%); the proportion sensitive to streptomycin was 88%, to Nifuzin 84.8%, and to sulfadimidine only 36%. There was no change in the sensitivity pattern between 1963 and 1972.


[Experimental studies on the pathogenesis of coli enterotoxemia in swine. I. Comparison of toxin effect of 2 different E. coli serotypes following parenteral toxin administration]. Broth culture filtrate containing endotoxin, prepared from serotype O 139:K82(?):H1 was given by the intra-enteric route with and without dimethyl sulphoxide, and with or without blockade of the RES by intravenous injection of trypan blue, using about five piglets for each of the four combinations. Clinical signs, blood pressure, ECG, respiration, temperature, haematology and pathological findings were recorded. Coli enterotoxaemia manifested by fatal endotoxin shock developed in all ten piglets given toxin plus dimethyl sulphoxide, and in 4 of 5 similarly treated after RES blockade. The sondrmoe did not develop in piglets given large amounts of toxin without dimethyl sulphoxide, whether the RES was blocked or not. When enteric absorption of toxin was promoted by dimethyl sulphoxide, RES blockade increased the sensitivity of the animal to toxin (shortening of the time till death). The results show that there are two functional barriers to endotoxin: - the intestinal barrier, which normally prevents large amounts of toxin from entering the circulation; and RES, which plays a part in detoxifying and eliminating endotoxin which has been absorbed. Application of these findings to the pathogenesis of coli, enterotoxaemia is discussed.


[Infrared spectrophotometry of culture broth and toxins of enteropathogenic strains of Escherichia coli]. Lyophilized preparations of sterile broth, broth used for cultivation of enteropathogenic E. coli strains from which endotoxin and enterotoxin had been removed, were prepared for spectrophotometry by mixture with potassium bromide, and examined in heavy water. Despite basic biochemical differences, all the preparations showed similar or identical curves, with the same absorption maximum and wave length. The substances present in broth (proteins, lipids, sugars, etc.) were so dominant that that completely masked substances specific for E. coli and its toxins. Spectrophotometry revealed only the pattern belonging to broth, so that toxins can be only examined by this method after they have been separated from the broth. It is hoped to do this in the future.


[Sodium thiocyanate as a protective agent in intensive calf fattening. Brief report]. Daily administration of sodium thiocyanate at 750 mg a calf for the first three weeks in the fattening stalls reduced the occurrence of illness by 60%. This protective effect seemed to persist during the following weeks without additional treatment. Addition of the thiocyanate to the food may be beneficial through a nutritive effect.


Lithium carbonate in affective disorders. IV. A double-blind study of prophylaxis in unipolar recurrent depression. The prophylactic efficacy of lithium carbonate vs placebo was examined in a double-blind study in a carefully delineated group of 28 unipolar recurrent depressed patients followed up from three months to four years. Indexes of prophylactic efficacy revealed a statistically significant decrease in episode frequency, depth of global depression scores, and increased clinic attendance rate in the lithium carbonate group compared with the placebo group. Planned studies are now needed to determine which unipolar patients do best on a maintenance regimen of lithium carbonate alone, lithium carbonate plus tricyclic drugs, or tricyclic drugs alone.


[Comparative considerations on incidence of malignant neoplasms in the United States (White) 1969-1971 and in the German Democratic Republic 1971 (author's transl)]. An analysis of the incidence of malignant neoplasms in the GDR 1971 as compared with the United States 1969-1971 shows that in the USA, incidence of total cancer and of several individual sites is significantly higher than in the GDR. Possible reasons for this observation are discussed. The much higher incidence of nearly all malignant neoplasms in high age in the USA raises suspicion that cancer registration in the GDR for these age groups is incomplete. Wide differences in younger and middle age cannot be solely explained by underregistration in one country. Incidence of stomach cancer is much higher in the GDR than in the USA and incidence of malignant neoplasms of colon, breast (female), prostate, and urinary bladder is significantly higher in North America. Remarkable but not as big differences are observed for most cancer sites. Only part of these observations can be explained by different diagnostic criteria (e. g. acute leukosis). It is concluded that there is a real difference in cancer risk between the GDR and the USA. It is hoped that these results stimulate special studies in order to elucidate the causes of different cancer incidence and there by to gain more insight in factors which enhance the risk of cancer.


Contractile microfilaments in granulosa cells. An ultrastructural and immunochemical study. Electron microscope observations demonstrated bundles of microfilaments measuring 40-70 A in diameter in the granulosa cells of normal developing follicles of rabbit ovary. The microfilaments appeared concentrated in the cortical areas of the cytoplasm and within large evaginations and microvilli. In addition the filaments were particularly abundant in the granulosa cells of corona radiata and free cells in the cavity. Immunofluorescent staining on frozen sections of rabbit ovary demonstrated that the granulosa cells of developing follicles bind antimyosin-like antibodies (AMA). Considering the correspondence between the immunochemical and ultrastructural fingings it is suggested that the microfilaments contain a "myosin-like" protein. It seems then reasonable to suggest that the ovarian follicles are not kinetically passive organs, but they contain contractile filaments for their specific functions.


Discontinuance of immunosuprression in renal transplant patients. Immunosuppressive therapy was discontinued in six patients for an average of 27 months. In these six patients, only two rejections have occurred. A survey of other transplant centers showed that in such patients rejection was often delayed weeks or months after therapy was stopped. Once immunosuppressive therapy has been stopped, for whatever reason, and rejection has not occurred, consideration should be given to not resuming therapy unless signs of rejection appear.


Digitalis after two centuries (William Withering). It is the bicentennial anniversary of the introduction of digitalis into medicine. Digitalis is one of the most important drugs ever discovered, and after two centuries, it is still the most widely used drug in cardiology. However, it was at one time so badly abused that for nearly a century it was almost abandoned. Early in this century, the valuable effects of digitalis were once again recognized and extended. The molecular basis of action has been defined and now methods are available to detect early toxicity. Recent advances in combating toxic effects show considerable promise. Skillful administration of the drug, using purified standard tablets, careful monitoring by clinical electrocargiography, and analytical methods can secure the maximun benefits with the minimum degree of toxicity.


Growth of baby kidneys transplanted into adults. To determine whether the growth of a kidney is affected by the age of the host or is independently programmed, baby rat kidneys were isologously transplanted into adult rats that underwent unilateral or bilateral nephrectomies. The growth of these transplanted baby kidneys was compared to the growth of baby kidneys that were left intact in the growing baby rat. After allowing for compensatory hypertrophy, the kidneys, whether in babies or adults, were found to grow at the same rate and to the same ultimate size. Renal size could be predictably related to renal age, but not to the age of the host.


A new sutureless technique for skin closure. A sutureless wound-closure device was used in 150 patients. The average time spent to effect skin closure was reduced; removal was easy; skin apposition was satisfactory; and patient response was favorable. Sutureless tape closures eliminate the disadvantages of invasive skin closures. The device described provides secure tape adhesion to the skin and does not cover the wound. It can be easily applied, adjusted, and removed, in addition to serving as a protective splint to the healing wound. This method can reduce operative time of skin closure with highly satisfactory cosmetic results.


The nature of adenovirus persistence in human adenoid vegetations. Ninety-seven adenoid vegetations (AV) originating from children aged 2 to 11 years were examined for the presence of adenoviruses. No infectious virus was detected in cell-free homogenates. However, adenovirus was recovered in 30 instances from either fragment or trypsinized cell cultures, or both, of the same tissues. The viruses belonged to types 1, 2, 5 and 6. It was determined by the infectious center assay that the frequency of virus-producing cells in different AV varied between 1 of every 10(5) cells to 1 of every 10(7) cells. Cells reactive with hamster sera containing antibody against the adenovirus early ("T") antigen and with rabbit sera containing antibody against the virus structural antigens were detected in cell smears from trypsinized virus-positive AV. The frequency of positive cells was very low. Nearly 80 per cent of extracts from virus-positive AV contained substances neutralizing the homotypic viruses. Adenovirus-neutralizing substances were only rarely detected in extracts from virus-negative AV. The neutralizing substances could be removed from the extracts by absorbtion with concentrates of the homotypic viruses. Most of the subjects from whom AV containing neutralizing substances were obtained, possessed high levels of homotypic serum antibodies.


[Influence of cortisone on the implantation of skin allotransplants]. Skin transplants of CC57 Brown mice to CBA mice different in strong antigens controlled by H-2 locus of histocompatibility were studied with special attention given to the division of epithelial cells. Five-day-long injecting of cortisone (single dose 2,5 mg) was performed in 2 variants of experiments: 2 days before or 3 days after operation. The mean day of rejection of the graft after injection of the hormone was prolonged from 6,9 to 17,8--19,8 days. Cortisone retarded development of the inflammatory reaction, formation of the granular tissue and decreased mitotic activity in the recipient's epithelium delaying its growth and thus the transplant elimination. Degenerative changes in the transplant tissues diminished, while the mitotic activity kept its sufficiently high level until rejection.


[Intracellular parasitism of Shigella in patients with dysentery]. Bioptic specimens of the mucosa of the distal portion of the colon in patients with dysentery, caused by Flexner and Sonne shigellas, were studied by luminescent-serological and electron-microscopy methods. In the cells with unchanged ultrastructure no shigellas were detected. Intracellular localization of shigellas was observed only in cases of deep irreversible alterations in the ultrastructure of the cells.


[Current data on the functional morphology of granulation tissue cells in skin wounds]. The article summarizes the latest literature data on the morphology of the granulation tissue cells: neutrophils, monocytes, macrophages, mast cells and fibroblasts. In the majority of cases these cells were studied with the help of such methods as electron microscopy, histochemical analysis autoradiography. Sources of origin of these cells and dynamics of their development in the period of formation and maturation of the granulation tissue are considered. Findings of the current studies into the structure and functions of fibroblasts and their role in collagen formation, as well as the role of hormonal factors in these processes are analysed in detail.


Complications of dermal graft protection of carotid artery. The efficacy of autogenous dermal grafts for carotid artery protection in head and neck surgery has been investigated experimentally and propounded clinically. A review of 194 dermal grafts from 1966 to 1972 at the otolaryngology service of Washington University Medical Center revealed two broad categories of complications that were unique to dermal graft protection of the carotid artery. Two cases of inclusion cysts that developed two years after implantation of the dermal graft were classified as a complication secondary to technical problems of taking the graft. The second category of complications arose as a result of epithelialization of the exposed dermal graft. While the overall incidence of complications that were attributable to the dermal graft was approximately 6%, autogenous dermis continues to provide an excellent method for carotid artery protection.


Multiplicity of the tumor-directed immune response. Implications for immunotherapy. The host may generate several different types of immune response to a tumor. Some of these responses are advantageous to the host; others are not. There is evidence that several tumor-associated antigens, perhaps stimulating different facets of the immune response, are expressed by the tumor cell. We discuss the implications of this concept for immunotherapy.


Immunosuppression and cancer. Importance in head and neck surgery. The immune system is an important factor in the host's defenses against cancer. Immunosuppressive therapy associated with organ transplantation is accompanied by a substantially increased incidence of malignant neoplasms, many of which involve the head and neck. Treatment of carcinoma of the larynx by excision and laryngeal transplantation is not justified because of the complications,  including malignant neoplasm, that are associated with immunosuppressive therapy. Cancer chemotherapeutic agents have immunosuppressive side-effects, and patients have manifested new malignant neoplasms while their original tumors were controlled by the antineoplastic drugs. These findings have important implications for the management of patients with malignant neoplasms, since other forms of cancer treatment, such as radical surgical procedures and radiotherapy, may also impair the host's resistance to cancer. Therefore, we should reappraise our methods of cancer therapy and examine their effects on the host's resistance to his neoplasm.


Subglottic enlargement using cartilage-mucosa autograft. A preliminary experimental study. Subglottic stenosis in the infant currently has no well-accepted surgical correction. Our experimental study was designed to determine the effectiveness of a nasal septal cartilage-mucosa autograft in increasing the subglottic circumference and its effect on subsequent subglottic growth. Six pairs of matched mongrel puppy litter mates were used; one underwent surgery, the other served as a control. The cricoid and first tracheal rings were split anteriorly, and widened 5 mm to accept an autogenous nasal septal cartilage-mucosa graft. All animals were killed after six months of postoperative growth. The autografts appeared to be partially or completely replaced by fibrous tissue but a persistent enlargement in the subglottic airway was found in the animals that underwent surgery, with glottic measurements the same in both groups. Thus, a septal cartilage autograft to the subglottic larynx in puppies appears to result in persistent enlargement of the subglottic area, but produces no interference with subsequent normal laryngeal growth and development.


Innominate artery compression of the Trachea. We review innominate artery compression of the trachea in 60 surgically corrected patients and 30 in patients who did not undergo surgery. The symptoms and radiologic features are correlated with the degree of tracheal narrowing at bronchoscopy and with associated defects that may exist. From this study, a history of respiratory distress with "reflex apnea" associated with tracheal narrowing is a strong indication for surgery. Stridor and recurrent respiratory infections are not an indication in themselves, and must be assessed with the severity of tracheal narrowing and presence or absence of associated defects. Surgery resulted in complete or moderate relief in most patients, although the results were less gratifying when subglottic stenosis or a repaired tracheoesophageal fistula existed.


Bleeding following tonsillectomy. A study of electrocoagulation and ligation techniques. The efficiency of electrocoagulation (spot or zonal) and ligation for the control of bleeding was compared in 376 patients with tonsillectomy. Electrocoagulation and ligation was used in the same number of patients (188) in each group. A notable reduction in operative time (40%) was seen in cases in which spot or zonal electrocoagulation was employed. More morbidity was found in cases treated with zonal electrocoagulation. Both techniques were concluded to be equally effective in the control of bleeding following tonsillectomy.


The royal derwent hospital in tasmania: historical perspectives on the meaning of community psychiatry. Throughout the history of the hospital, local social institutions, formal and informal, tended to perform casualty and receiving functions so that the Royal Derwent has always served as institution of last resort. Case books show that both illnesses and treatment conformed to those familiar elsewhere in the British Empire and developed no local perculiarities. The records provide epidemiological evidence of a dramatic decline in incidence of first admission for psychosis after the period when convict transportation created a high rate of social dependency.


Guided fantasy as a treatment for childhood insomnia. A "guided fantasy" technique is described to relieve insomnia in children without the use of chemotherapy or the more conventional forms of hypnotherapy. In children at an age where fantasy is a spontaneous everyday response, relaxed sleep is induced through listening to a story from a tape that is created from the child's favourite fantasy figures and everyday likes and interests. The 'guided fantasy' is presented by the parents as a novel bedtime story rather than as a therapy procedure by the therapist. The child is allowed to feel he has a controlling influence in putting a favourite figure to sleep within the story, and so is gently led to accept sleep himself by choice. No active therapist is involved so there are no dangers of expected transference or abreaction.


Influence of age on the serological response of chickens to Salmonella typhimurium infection. After chickens 1-126 days old were infected orally with Salmonella typhimurium, antibody responses were determined by microagglutination (MA) and microantiglobulin (MAG) test procedures. In all groups six weeks old or older, a high and continuing level of salmonella group B antibody was demonstrated by the MAG test but not by the MA test. Serological response was maximal at about 15 weeks or later. Reinoculation with S. typhimurium 129 days after initial infection elevated antibody titers in all groups, and immunological paralysis was evident in only the two youngest groups. S. typhimurium-positive cloacal swabs tended to decline rapidly in all groups; although MAG agglutinin titers remained positive.


The molecular mechanism of benzimidazole mutagenicity: in vitro studies on transcription and translation. Benzimidazoles are weak mutagens acting through base substitutions; they are incorporated into nucleic acids. Experiments with deoxyribohomopolymers as templates demonstrated that benzimidazole nucleoside triphosphate is polymerized by RNA polymerase only in the presence of poly dC, i.e., instead of guanine. In plasmolyzed Escherichia coli cells, benzimidazole ribonucleoside diphosphate is polymerized by polynucleotide phosphorylase and can, after blocking of the normal mRNA synthesis with actinomycin D, be used as a messenger for polypeptide formation. The addition of radioactive amino acids to this system showed that benzimidazole is not read preferentially as guanine, as would have been expected from the RNA polymerase results. Instead, the reading was position dependent and brnzimidazole is recognized (1) in the first codon position as adenine, (2) in the second as purine, and (3) in the third possibly only as base. Benzimidazole mutagenicity is thus explained as a G in equilibrium A transition.


Messenger activity of ribonucleic acid form yeast mitochondria. Total yeast mitochondrial RNA was shown to possess messenger RNA activity when injected into oocytes of the frog Xenopus laevis. The specific polypeptides formed were precipitated by mitochondrial antisera. A comparison was made of the molecular weights of the proteins obtained form this system with those made by mitochondria in vivo in the presence of cycloheximide. No RNA containing poly(A) sequences was detected in yeast mitochondria.


Synthesis time of beta-galactosidase in Escherichia coli B/r as a function of growth rate. By analysing the kinetics of beta-galactosidase accumulation after induction, the synthesis time of beta-galactosidase in Escherichia coli B/r was found to be 75s in rapidly growing cells (1.36 and 2.1 doublings/h), and 90s in slowly growing cells (0.63 doubling/h). These values correspond to peptide-chain-elongation rates of 16 and 13 amino acids/s respectively, in agreement with previous findings, indicating that the peptide-chain growth rate is constant (presumably maximal) in fast-growing bacteria, but decreased in slowly growing bacteria [Forchhammer & Lindahl (1971) J. Mol. Biol. 55, 563-568].


Insulin and glucagon secretion from isolated islets of Langerhans. The effects of calcium ionophores. The role of Ca2+ in the secretion of insulin and glucagon was investigated by studying the effects of Ca2+ ionophores on hormone secretion from isolated perifused islets of Langerhans. Ionophore X537A (100 muM), which binds alkaline earth cations and also complexes some univalent cations, caused a rapid transient increase in insulin and glucagon secretion which was not dependent on the presence of Ca2+ in the perifusion medium. Ionophore A23187 (100 muM), which specifically binds bivalent cations at neutral pH values, similarly increased insulin secretion in complete and Ca2+-free medium, but only stimulated glucagon release in the presence of extracellular Ca2+. Since the stimulatory effects of both ionophores were associated with an increased Ca2+ flux in the islets, these experiments support the hypothesis that Ca2+ may trigger the release of insulin and suggest that it is also involved in the secretion of glucagon. The basal rate of both insulin and glucagon release was significantly increased when Ca2+ was omitted from the perifusion medium, but it is proposed that this finding may be due to adverse effects on cell-membrane function under these conditions.