Exocrine pancreas: evidence for topographic partition of secretory function. The pattern of amylase, lipase, and chymotrpsinogen content found in pancreatic exocrine tissue surrounding the islets of Langerhans (periinsular halos) differs from that of the rest, or teleinsular part, of the pancreas. Such a topographic partition of secretory function may play a role in the regulation of pancreatic juice composition.


Familial polycythemia.

Familial polycythemia. Since erythropoiesis is regulated at a number of steps, it seems likely that multiple genetically determined defects could result in polycythemia in families. These defects might be recognized by distinct patterns of marrow regulation--physiologic studies relating ESF production, oxygen transport, and red cell production in affected individuals. Defects in renal or extrarenal mechanisms of ESF production and release, oxygen sensing by the kidney, and in receptor site number or function on target cells within the marrow should be characterized by distinctive patterns of ESF production at rest and in response to altered oxygen supply. Continued study should allow the dissection of levels of regulation under genetic control and lead to a better understanding of the physiology of red cell production in normal man.


Pharmacology of ethaverine HC1: human and animal studies. The pharmacology of ethaverine hydrochloride has been studied in humans and animals. The studies determined that the drug was an effective smooth muscle relaxant. The ethaverine hydrochloride produced significant increase in peripheral blood flow in patients with occlusive artery disease. In longitudinal studies there was no evidence of toxic effects in patients receiving 100 mg ethaverine HCl three times a day.


Le Fort III osteotomy to correct dish-face deformity resulting from facial trauma. Untreated craniofacial fractures may result in a deformity similar to that which results from underdevelopment of the maxilla. Such a deformity can be corrected by osteotomy simulating Le Fort type III fracture lines. This operation necessitates careful pre-operative planning which incorporates a feasibility study with the combined use of dental study casts, cephalometric radiography and life-size photographic reproductions. A case history which describes the management of late complications of a malunited class III fracture is given.


Aneurysms of the renal artery with a case of extracorporeal repair. Four patients with aneurysms of the renal artery are presented. They underwent reconstructive vascular surgery with preservation of renal function. In 1 patient the extracorporeal or 'bench-top' surgical technique was used, with cold renal perfusion and autotransplantation of the kidney to the pelvis.


Cerclage in the treatment of incompetent cervix. A retrospective study was undertaken of 71 patients who underwent a postconceptional cervical cerclage operation. The previous pregnancy loss in these patients was 71,4% compared with an 84,5% success rate after the operation had been performed. The possible reasons for the failures are discussed. The incidence of immediate postoperative complications was 14%. Infection, probably as a result of insertion of the suture, occurred in 30% of the patients.


The autopsy findings in a case of heterotopic cardiac transplantation with left ventricular bypass for ischaemic heart failure. The autopsy findings in a White man aged 59 years are presented; he underwent heterotopic cardiac transplantation with left ventricular bypass for irreversible left ventricular failure caused by severe ischaemic heart disease. Microscopically, the donor heart showed mild signs of chronic rejection with negligible loss of functional myocardium, and no complications attributable to the surgical technique. Severe, generalised atherosclerosis had resulted in fibrous replacement of the recipient left ventricular myocardium and intra-operative atheromatous embolisation to the brain, the latter being the main contributory factor in the patient's death. Other significant findings were bilateral femoral vein thrombosis with recurrent pulmonary infarction, Aspergillus granulomata of the right lung, cytomegalovirus infection of lungs and oesophagus, Herpes simplex infection of the tongue and oesophagus, and duodenal ulceration with haemorrhage.


Preoperative preparation of the patients with carcinoma of the colon. The efficacy of the neomycin-erythromycin combination as prophylaxis before operation for carcinoma of the colon (3 gm. of each of the day preoperatively, plus mechanical cleansing) was evaluated in a study of 74 patients for whom primary operations for colon carcinoma were performed from January 1973 through June 1974. Twenty three other patients received other preparations. Of the 74 who received neomycin and erythromycin, 4 had postoperative infectious complications (5 per cent). Of the 23 patients who received other preparations, 8 had significant complications (35 per cent). Although operability, age, concurrent medical problems and surgical technique probably influence postoperative sepsis, the use of oral neomycin-erythromycin combination as preoperative prophylaxis appears satisfactory for prevention of infection after operations for colon carcinoma.


Oral bacille Calmette Guérin immunostimulation in malignant melanoma. Forty-seven patients representing all stages of malignant melanoma have been treated orally with bacille Calmette Guérin as an adjunct to standard treatment regimens. This is a preliminary study, but it appears that orally administered bacille Calmette Guérin in localized disease may delay the development of local recurrence and distant spread. In patients with disseminated melanoma but without intracranial metastases, the survival time is increased from 4.0 to 12.7 months. It has no effect on the progress of disease in patients with intracranial metastases or in those with hepatic metastases from intraocular melanoma.


A twenty year survey of arterial complications of renal transplantation. The significant arterial complications of renal transplantation are hemorrhage, infarction, stenosis and aneurysm formation. Hemorrhage is often associated with sepsis and may be lifethreatening. Large infarcts may be secondary to multiple small vessels or intraoperative hypotension with inadequate perfusion of the organ. Nephrectomy is invariably indicated in these situations. Renal artery stenosis with resultant hypertension may occur secondary to stenosis at the anastomosis, atherosclerotic plaque formation or intimal fibrosis of the renal artery. Operative reconstruction if the anastomotic site may relieve hypertension is selected patients but places the transplanted kidney greatly at risk. Aneurysm formation is often mycotic and is associated with multiple operations and wound sepsis. The iliac artery may be ligated without loss of limb, while the resultant claudication may be relieved by a surgical bypass procedure.


Dominant role of complement in the hyperacute xenograft rejection reaction. Xenotransplantation in distantly related donor-recipient systems is rejected within minutes. According to present theories, hyperacute rejection is due to preformed antibodies. However, our results suggest that a nonimmunologic reaction plays a dominant role in the hyperacute rejection reaction. To analyze the hyperacute rejection reaction, a previously described model of isolated in vitro xenohemoperfusion was used in which rat kidneys were perfused with dog blood at constant pressure. Rejection criterion was cessation of xenograft perfusion flow rate with constant perfusion pressure and histologic findings of aggregation of thrombocytes and endothelial lesions. In our experimental approach, the donor kidney was perfused with separate cellular and humoral components of the recipient blood with redetection of the rejection activity in one of the recipient blood components. Each blood component was tested for preformed antibody before hemoperfusion. In control studies, xenoperfusion of rat kidneys with whole blood from the dog always resulted in hyperacute rejection. In contrast, allogenic perfusion with whole blood caused no rejection. In three groups, typical hyperacute rejection occurred. Perfusion with whole blood from newborn dogs; no preformed antibodies in vitro; perfusion with reactivated dog whole blood containing no preformed xenohemoagglutinating antibodies, which had been eliminated by adsorption, and perfusion with reactivated dog whole blood containing no preformed xenocomplement fixing antibodies also eliminated by adsorption, all resulted in hyperacute rejection. Whole blood from newborn dogs and reactivated, adsorbed antibody-free whole blood from dogs contained active complement. Perfusion of rat kidneys with heat decomplemented, antibody-containing or antibody-free dog blood showed no hyperacute rejection reaction. The addition of fresh complement to these last two groups resulted in typical hyperacute rejection.


The effect of skin graft preparation on wound contraction. Both clinically and experimentally, full thickness skin grafts inhibit wound contraction better than do split thickness grafts. This occurs even if full thickness grafts are thinner than split grafts. Since inhibition of wound contraction does not depend on graft thickness alone, other differences should be sought between full and split grafts to explain this inhibition. One such difference is method of preparation. While full thickness grafts are cut with sharp dissection, split grafts are cut with mineral oil or with dermatome glue which is then stripped off. Both mineral oil and surface stripping in intact skin cause epidermal hyperplasia, more prominent in split grafts than in full thickness grafts. In this study, the effect of skin graft preparation on wound contraction and epidermal hyperplasia was tested. Seventy-four split thickness skin grafts were cut from Fischer rats with lubrication using mineral oil, Lubafax, normal saline solution or glue and a Padgett dermatome. Six full thickness grafts were treated with mineral oil. All grafts were placed on syngeneic rats; the area was measured with a planimeter, and biopsies were taken at zero, one, two, four, eight, 14 and 20 weeks. Mineral oil prepared split grafts lost 17.8 +/- 2.2 per cent area by one week, with a maximal loss of 38.8 +/- 4.8 per cent by four weeks. Split grafts cut with Lubafax, saline solution or glue plus drum dermatome lost similar area. Split grafts later enlarged as the rats grew, but in no group did split grafts surpass their original area. Full thickness grafts, even though treated with mineral oil, grew 3.9 +/- 4.3 per cent beyond their original area by four weeks and enlarged through 20 weeks. Histologic examination showed that all split skin grafts, regardless of surface preparation, had considerable epidermal hyperplasia and scarring in graft dermis and bed between one and four weeks. Thus, both skin graft contraction and epidermal hyperplasia occur independently of how grafts are prepared. The explantation of why full and split thickness grafts inhibit wound contraction differently must lie intrinsic rather than extrinsic to the skin.


Historical notes on gonioscopy.

Historical notes on gonioscopy. The evolution of gonioscopy is reviewed, beginning with the first in vivo examination of the angle of the anterior chamber in 1867. The people and events responsible for the successful development of this important technique are discussed.


Oculomotor paresis with cyclic spasms. A critical review of the literature and a new case. Oculomotor paresis with cyclic spasms is a rare syndrome, usually noticeable at birth or developing during the first year of life. On a background of oculomotor paresis, spastic movements occur at regular intervals: about every second minute the lid is raised, the globe wanders toward midline, the pupil contracts, and accomodation increases. These spasms last from 10 to 30 seconds, and then give way again to paresis. Since this phenomenon was first described, opinions were divided about its mechanism and about the site of the responsible defect. Based on a quantitative analysis of a new case, and of all previously published reports, a new theory is proposed which can account for all features of the syndrome.


Corneal edema: cause and treatment.

Corneal edema: cause and treatment. Corneal edema, adequately understood and appropriately treated, has a good prognosis. The pathophysiological bases and the various causes are considered. Goals and techniques of medical and surgical therapies are reviewed.


Problems of eye care delivery.

Problems of eye care delivery. The past 50 years have seen the development of ophthalmology as a sophisticated specialty with improved training programs, increased output of ophthalmologists and growth of knowledge and technology. In spite of this progress, serious problems and conflicts impair the delivery of eye care. One solution may be found in a cooperative Screening Consultation Team system, such as the one currently being evaluated at the University of Florida.


Surgical stabilization of traumatic flail chest. Since 1970 we have stabilized the ribs to correct paradoxical movement of the chest wall in chest injuries, using an original technique, in order to avoid as far as possible the need for long-term chest wall stabilization by intermittent positive pressure respiration (IPPR). The technical details of surgical stabilization are described, and the different types of stainless steel struts are shown. Type I was originally used either as an intramedullary nail or as an external brace. Types II and III were designed for external fixation of the strut to the rib. Treatment of 29 patients with severe flail chest, classified into four groups is shown: group I was treated by IPPR, group II by IPPR plus surgical stabilization, group III by surgical stabilization only, and group IV by surgical stabilization after exploratory thoracotomy. The clinical results are discussed. We conclude that surgical stabilization of the paradoxial movement of the chest wall can avoid the use of the respirator or at least reduce the interval of IPPR to a short period during the initial recovery from trauma. Using type III struts, we have obtained stabilization of the flail chest in all cases even in patients with severe anterior paradoxical movement. The patients' tolerance of surgical stainless steel struts was good.


[Evaluation of the interaction between blood and foreign material in the pump oxygenator during open-heart surgery in infants by scanning electron microscopy (author's transl)]. Scanning electron microscopy was used to elucidate the interaction between blood and foreign material in the pump oxygenator during open-heart surgery in 7 infants. The loss of platelets upstream of the blood pump is caused by thrombogenicity. The pump itself causes massive destruction of platelets and red blood cells; thromboembolie up to 100 mu and foreign body particles up to 200 mu are being detached from the wall of the tubing to a large extent. The particulate matter is trapped in arterial line filter. Particles up to 40 mu and cellular aggregates up to 60 mu can pass through the filter and enter the patient's systemic circulation.


An immunofluorescent and electron microscopic study of measles skin eruptions. Immunofluorescent study was attempted to determine whether or not virus antigen were present in the epidermis of measles eruptions. The electron microscopic observations of the same materials were also performed to detect viral localization in affected skins. The failure to detect any virus antigen in affected eipdermis throughout all eruptive stages seems to be sufficient evidence to conclude that measles rash is not a manifestation of viral replication in the epidermis. Dotted fluorescences were detected in a specimen taken at pre-eruptive day in capillary endothelium of dermis. At the same stage, microtubular structures which were probably identical with measles virus nucleocapsids occurred in capillary endothelium under the electron microscopic observations. It is concluded that measles rash is possibly caused by an antigen-antibody reaction of Arthus type. On very rare occasions, measles virus nucleocaspids were found in the cytoplasm of dermal fibroblast in the vicinity of dermal capillary. Ultrastructural features of these nucleocapsids were demonstrated to be identical to features of microtubular structures found in endothelial cells.


[Studies on the rationalization of prosthesdontic clinical and techincal work procedures]. Attempts to rationalize stomatological working processes are often associated with the acquisition of new methods and procedures. Some instances of model-cast crowns and bridges and of deep-drawn objects testify to the effects in the clinico-stomatological and technical fields as well as on the patients, the material consumption standards and the quality characteristics.


[Experiences in the use of Sanal-Silcoflex for the corrective or double casting method in stomatological practice]. The author describes a modification of the use of Sanal-Silcoflex for the double-impression method. Thus, it is possible to use the total work-time allocation in stomatological practice more rationally without reducing the quality of work. Six months of experience permit to recommend this method for stomatological practice.


Urinary bladder carcinogenesis in the dog: preliminary studies on cellular immunity. The immunologic status of dogs undergoing bladder carcinogenesis with 4-amino-biphenyl and normal littermate controls is being evaluated. Studies using blastogenic transformation, nonimmune cytotoxic reactions, and rosette formation have revealed that dogs possess lymphocytes that have some properties similar to those of B and T cells of other species. Since tumors are now just appearing and hence are not yet available for specific immunologic determinations, the assessments had to be limited for the present to other types of antigens and mitogens (yeast, red blood cells and plant lectins). No major changes in reactions of cells from the carcinogenized animals have yet been observed during the preneoplastic phase as measured by phagocytosis, migration inhibition, or cytotoxicity tests, although a trend to lower blastogenic responses was noted. It yet remains to be seen whether lower lymphocyte responses to mitogens in carcinogenized dogs are of prognostic value for the early detection of tumors of the bladder.


Prolongation of skin allograft survival by Valium (diazepam). The survival of rat skin allografts was significantly increased by repeated intraperitoneal injections of 2.5 mg Valium (diazepam) into hosts. In addition, in vivo pretreatment of the donor animals at this dose level decreased the intensity of the recipients' immune responses to skin allografts. In vitro exposure of skin grafts to Valium also prolonged allograft survival.


[Inactivation of hematopoietic stem cells by means of lymphocytes depending upon the genotype of the interacting cells]. Inoculation of a mixture of bone marrow cells with allogeneic lymphocytes into irradiated mice of inbred strains or into F1 hybrids results in the depression of bone marrow cell proliferation in the spleen of the recipient: the effect of inactivation of nonsyngeneic stem cells. The inactivation of stem cells by allogeneic lymphocytes can be detected in all tested combinations of mice strains - donors of lymphocytes and bone marrow cells and mice - recipients but the degree of inactivation differs and depends on the genotype of cell donors rather than on the genotype of the recipient. Lymphocytes of some mice strains (haplotypes H-2k and H-2a) are more active killers of bone marrow cells as compares with lymphocytes of other strains (hyplotypes H-2b and H-2d). Probably, the degree of stem cells inactivation by lymphocytes depends on the differences of their histocompatibility in H-2 system.


[Factors participating in regulation of protein biosynthesis]. Studies in the processes of protein biosynthesis regulation revealed a close dependence of the biosynthetic processes (synthesis of many precursors of proteins, nucleic acids, lipids, carbohydrates as well as of tricarboxylic cycle acids) on the processes of carboxylation in the organism. A possibility is shown of the biosynthetic processes stimulation by activating the carboxylation processes. On this bases a highly effective method to increase productivity of farm animals and poultry and that for considerable acceleration of the regeneration processes of the damaged tissues and blood with blood less were developed. It is also established that at extremal states of the organism (long complete fasting, late stages of cancer, thyreoid toxicosis, experimental atherosclerosis, etc.) in tissues there occurs biosynthesis of proteins with differing primary structure, physiochemical properties and enzymatic activity as compared to proteins of the normal animals. The same changes in the primary structure and properties of proteins in the process of their biosynthesis are observed with the surplus feeding the animals on certain amino acids aginst a background of protein free ration. Possible mechanisms of changes in the primary structure of proteins in the process of their biosynthesis at extremal states of the organism are under discussion. In experiments in vitro on the tissue preparations, on the cell-free protein-synthetizing systems as well as in experiments with animals in vivo the presence of synergic and antagonistic interrelation was established between certain amino acids in the process of their utilization for protein biosynthesis. These interrelations are established to take place at the stage of transfer ribonucleic acids aminoacylation. Some details of this phenomenon are found out. Amino acids are shown to play not only a substrate role but also the regulatory one in the process of protein biosynthesis.


Bladder inhibition with functional electrical stimulation. Spastic or hyperreflex bladder dysfunction can cause frequency, urgency, and incontinence. Detrusor activity was inhibited by FES (functional electrical stimulation) applied to the anal sphincter causing decreased bladder spasticity and increased bladder capacity. FES is indicated for incontinence not only because of weakness of the pelvic floor but also because of hyperreflex bladder.


[Studies in the field of chemistry, biochemistry and photobiochemistry of sterols]. The article deals with a review of the results of studies performed at the Department of photobiochemistry of the A. V. Palladin Institute of Biochemistry of the Academy of Sciences of the Ukrainian SSR. It is emphasized that beginning from the first product of squalene cyclization--lanosterol, all the sterols participating in cholesterol biosynthesis, besides playing the parts of its precursors, are ancestors of their own, derivatives which realize specific function in the organism. On the example of 7-dehydrocholesterol it is shown that it transforms in the animal organism into a series of biologically active products of oxidative transformation and photoisomerization. Much attention was also given to the studies in sterol composition of nonsaponifiable fraction of organs and tissues and their subcellular structures in norm and with pathology. Derivatives of cholesterol certain precursors possessing highly interesting biological properties are found in the nonsaponifiable fractions of some organs and tissues.


Effect of ureteral stent on urinary tract infections in renal transplantation. A retrospective study was carried out to determine the effect of ureteral intubation during renal transplantation. We noted urinary tract infections in 76 per cent of those patients whose ureters were intubated during transplantation, as opposed to 45 per cent in those transplant recipients without ureteral stents. The incidence of recurrent urinary tract infections also increased from 18 to 34 per cent with the use of ureteral catheters. Ten separate episodes of bacteremia, indirectly related to indwelling catheters, are noted.


Turner-Warwick urethroplasty and urethral stricture. Results in 60 patients. Sixty patients with urethral strictures at the bulbous and membranous levels were treated with Turner-Warwick urethroplasty. Initially, there were significant difficulties with restenosis of either the proximal or distal st-ma following the first-stage urethroplasty. Use of nitrofurazone-hydrocortisone (Furacin-Hc) urethral suppositories practically eliminated recurrent stomal stenosis after the first stage. Several additional modifications were made in the original technique; these included placement of urethral sutures prior to scrotal mobilization and abandonment of the suprapublic cystotomy for frainage at the second stage of the procedure. These modifications increased the chances of achieving a successful result while facilitating the actual surgery and improving the patients' comfort. The over-all success rate was approximately 90 per cent. Patients with urethral stricture surgery subsequent to prostatectomy had problems with urinary control, but not so if prostatectomy was done after the first stage of urethroplasty. It appears that the Turner-Warwick urethroplasty is good one, and predictably good results can be expected on selected patients with urethral strictures.


Microvascular surgery: adjunct to renal transplantation. A new technique for microvascular anastomosis of the polar artery to the renal artery, end to side, is presented. It was performed in 5 cases of renal transplantation with a successful result in all.


[Certain difficulties of diagnosis and treatment of patent ductus arteriosus]. The diagnosis of patent arterial duct (PAD) is not felt to be difficult in the presence of systolic-diastolic murmur, and in 91.7% of cases it would be established on general clinical investigations. In 8.3% of cases the main ausculatatory sign of this defect was distorted or utterly absent. In such cases the correct diagnosis was somewhat difficult. The absence of systolic-diastolic murmur in patients with PAD with conditioned by pulmonary hypertension, insufficiency of pulmonary artery valves, mitral defect, a small diameter of the duct, aneurysm-like changes in the aorta and pulmonary artery, decreased elastic properties of the latter walls, as well. In the absence of PAD pathognomonic signs catheterization of heart cavities and aortography should be employed. Surgical therapy for the lesion concerned in complicated cases shows some specificity. Utilization of the posterolateral approach, controlled hypotension, provisional application of holders to the aorta and below the duct, its being ligated on synthetic pads made it possible to improve the results of treatment of the lesion involved.


[Results of treatment of patients with deep burns]. The authors have studied the results of treatment in 615 patients who suffered deep burns. The disability in the late period was stated in 20 per cent of patients, but only 5% of those disabled patients fail to work. Radical necrectomy and skin plasty provide shorter terms of therapy and better results.


[Comparative assesment of methods for the operative treatment of dislocations of the acromial end of the clavicle]. During 20 years the authors observed 861 patients with dislocations of the clavicular acromial process, that made 14% in relation to all other types of dislocations. 252 patients (29.3%) were treated surgically. Capron tapes being used most frequently as an alloplastic material. Surgery was performed after the technic elaborated at the clinic. Late results of the treatment were studied in 202 patients within the terms from 1 to 15 years. Good issues were noted in 76.2%, satisfactory in 37%, poor in 5.5% of patients.


[Methodological characteristics of restorative surgery and orthodontic treatment in the correction of extensive defects of the tissues in the oral region and the anterior portion of the mandible]. In the paper, technical and tactical features while using reconstructive surgery and orthopedic therapy for liquidation of vast tissue defects in the adoral region and anterior mandibular portion are discussed. The importance of planning plastic operative procedures with optimum utilization of local tissues, especially in labioplasty, is substantiated, and some definite recommendations on using the pedicled graft tissue are given. A sequence of stages in replacement of soft tissues is described, as well as some features of elimination of the anterior mandibular defect by the iliac bone graft. It is for the first time that the importance of joint efforts of surgical and orthopedic specialists for providing a large scale complex therapy is emphasized, that may contribute to favourable anatomical, cosmetic and functional results in liquidation of vast tissue defects of the adoral region and anterior mandible.


[Prevention and treatment of postburn deformations of the breasts]. Twenty six girls with deep burns of the anterior and lateral surface of the chest were treated in Gorky Research Institute of Traumatology and Orthopedy. The obserrvations indicated that an early closure of burn wounds in this region with adequate skin grafts could prevent gross deformity of mammary glands. Moreover, 70 females with deformation of mammary glands were under observations. In 16 of them operative procedures were undertaken for isolated lesions of 22 mammary glands. Various methods of skin plasty were employed: local, free, combined. Good and satisfactory results were gained. In 54 female patients deformities in the region of 68 mammary glands were eliminated simultaneously during surgical procedures for cicatricial contractures of the brachial joint, coxa and neck. The results obtained are described.


[Lymphangioadenography in the diagnosis of retroperitoneal tumors]. A method of direct lymphangioadenography was employed in 18 patients with abdominal tumors of obscure origin. These were as follows: lymphogranuloma, splenic lymphosarcoma, tumors of the stomach, kidney, pancreas both benign and malignant, retroperitoneal cysts, fibroma, malignant periganglioma. Roentgenological symptoms of abdominal tumors of various localization are reported.


[Surgical treatment of elephantiasis of the upper extremities]. According to the author' data elephantiasis of the upper extremities was observed in 13 (6.2%) among 215 patients, operated upon for elephantiasis of the extremities. There were 3 males and 10 females. The patients' age ranged from 3 to 56 years. Five patients suffered elephantiasis of the upper extremity since their birth, 8 patients showed acquired elephantiasis, in particular after mastectomy and operative procedures in the axillary region. Late results of surgical treatment proved to be quite satisfactory.


[Origin and treatment of bone cysts].

[Origin and treatment of bone cysts]. Osteocyst is shown to be the resulting issue of a number of pathological processes in bones, its etiology could be determined only if tissues typical for some lesions are revealed in cystic walls. At the CITO department of bone pathology for adults the author observed 49 patients having cysts of the proximal femoral portion. Pathological fractures were noted in 16 of 49 patients. It is the author's opinion that a carefully selected anamnesis and clinico-roentgenological investigation are of great importance in establishing the diagnosis of an isolated osteocyst. The differential diagnosis is made between this lesion and tumors, inflammatory process, Recklinghausen disease, etc. All patients under investigation were treated surgically. The results of treatment are described.


The equine practice laboratory.

The equine practice laboratory. The authors discuss the value of a practice laboratory to the equine clinician and its priorities. Laboratory examinations of particular value are described in relation to their clinical application. The need to establish normal values according to laboratory and horse population is stressed. Tables of normal parameters related to age groups of horses in the authors' practice are presented.


[Typing of E. coli strains isolated from a turkey and a test of their sensitivity in relation to antibiotics]. The turkey-poults on an industrial turkey-breeding farm were studied. A total of 75 strains of Escherichia coli were isolated. Typing was performed by Sojka's method: serotype 0-2 was established in 42.2 percent of the cases, 0-71-- in 12.6 per cent, 0-78 (11.2%), and 0-1 (8.4%). The sensitivity of the typed strains was tested to 8 antibiotics and furazolidon. It was found that all strains possess certain amount of resistance to streptomycin, chloramphenicol, oxitetracycli, and spectam. The same strains proved sensitive to ampicillin, colimycin, tetraoleandomycin, and to a certain extent to kanamycin. It is concluded that prophylaxis and treatment should be carried out with the use of ampicillin, colimycin, furazolidon, and tetraloleandomycin.


[Study of the effectiveness of some new agents for the deep freezing of bull sperm]. Semen was used of four breeding bulls of the Bulgarian Red breed and the Alpine Brown one. A total of 26 ejaculates were subjected to 344 laboratory investigations. The semen was diluted in a yolk-lactose-glycerine medium and was frozen by the fast method of Nagase-Niwa. Studied were in dynamics some biologic and biochemical indexes, such as: heat resistance at 46 degrees C, percentage of dead and pathologic spermatozoa, intake of oxygen, and release of CO2. The respiratory coefficient was established by the direct method of Umbreit and coll. The survival rate proved better, lower was the number of dead and pathologic spermatozoa in a test medium containing slightly mineralized water. The consumption of oxygen and the amount of the CO2 released by spermatozoa showed a dependable decrease following equilibration and freezing. Similar, however, unreliable were the data of changes observed with the respiratory coefficient. The semen frozen in the new synthetic medium showed higher biologic value and higher fertilizing capacity (12.2 per cent) as compared with the control.


[Study of the fertility of bull sperm contaminated with Aspergillus fumigatus spores]. Tested was the penetrating capacity of 55 samples of bulls' semen, contaminated with Aspergillus fumigatus, so far as the estrous secretion of cows was concerned. A total of ten cows in heat were inseminated with spermatozoa carrying the Aspergillus spore infection. It was found that the contaminated semen was with deteriorated quality and a 50 per cent lowered penetrating capacity as against the controls. The inseminated cows conceived with difficulty, exhibited disturbances in their sexual cycle, and two of the animals showed data of early embryonal death.


[Data on animal husbandry and veterinary medicine in the middle of the 17th century in Bulgaria and neighboring countries based on a journey by Evliia Chelebi]. It has been established that Evliya Chelebby's travel notes contain valuable information about veterinary medicine. Evliya Chelebby himself was a Turkish traveller who had made a number of journeys throughout Bulgaria and its adjacent countries over the 1651-1655 period. According to the data found in these notes the ruined fortresses round the cities were used as folds for sheep and goats. During that period sheep-breeding was flourishing. Horse-breeding was concentrated in the various estates belonging to the Sultan, and was intended to supply the needs of the army and the administration. Information is also contained about the physiotherapy practised at that time on the territory of the enslaved peoples on the Balkan peninsula. Popular were the balneotherapy, mud-cure, spending the summer time up in the mountains, the alternation of warm and cold water procedures known as Scottish shower, etc. These procedures were likewise used in the treatment of domestic animals.


[Effect of guanine and guanosine-2',3' phosphate on sarcolysin-H3 binding to the DNA of rat liver]. Rats were injected sarcolysin-H3 in a dose of 200 or 500 mC per rat. In animals sacrificed 30, 60 and 90 minutes following sarcolysin-H3 injection an increased radioactivity of DNA was noted that indicates binding of sarcolysin-H3 or its labelled derivatives to DNA. Guanine or quanosine-2', 3' monophosphate injected in animals decreased binding of sarcolysin-H3 to the rat liver DNA (maximum reduction of DNA radioactivity in 47%). In the experiments in vitro guanosine-2', 3' phosphate inhibited sarcolysin-H3 binding to DNA isolated from E. coli. A protective effect of quanine and guanosine-2', 3' phosphate with respect to DNA alkylation seems to be considerably conditioned by a competitive action of these nucleophils.


[Stereotaxic biopsy of cerebral subcortical structures in parkinsonism]. The design-features of a stereotaxic cannula for biopsy of subcortical cerebral structures and the procedure for performing stereotaxic biopsy are described. A total of 9 stereotaxic biopsies of the ventro-lateral thalamic nucleus, median center and globus pallidus were effected. As illustrated by a number of electronograms the material obtained during operations proved to be completely intact and suitable for electron microscope examinations. Ways and objectives for analyzing the ultrastructure of subcortical formations in parkinsonism and other hyperkineses are outlined.


A new reversed passive hemagglutination test for detection of HBsAg. A new reversed passive hemagglutination test for HBsAg, termed Raphadex B, has been developed using immunochemically purified chimpanzee anti-HBs bound to stabilized human erythrocytes. The test has been found to have equivalent sensitivity to the Ausria 125I radioimmunoassay, and detected a similar number of HBsAg-containing specimens in screening of volunteer blood donors. This method offers an economical approach to third generation methodology for hepatitis B screening of blood donors.


[Recognition of the depth of tumor extent in the cerebral hemispheres by electroencephalographic signs using a computer]. To obtain electroencephalographic criteria for in-depth occurrence of supratentorial tumours the mathematical theory of image recognition has been used. A map of electroencephalographic signs has been drawn up and 182 patients were coded electroencephalographically. Six signs were obtained with the help of the linear minimax algorhythm and in constructing diagnostic combinations of sign gradations--20 syndromes were fixed with whose help it becomes possible to recognize the depth of the tumour occurrence. Both rules were applied in an examination sequence of 51 EEG. The reliability of the results is as high as 0.95.


Characterization of a stable spheroplast type L-form of Proteus mirabilis D 52 as cell envelope mutant. I. Isolation, growth characteristics, biochemical activities, and sensitivity to bacteriophages. A stable spheroplast type L-form could be isolated by transferring 627 single colonies and 195 agar blocks with several colonies of unstable L-forms of Proteus mirabilis D 52 on agar media without supplements of penicillin. The L-form grows well on complex and synthetic agar media, however, it failed to grow in any of the liquid media which have been proved. With one exception (formation of acid from maltose) the L-form shows the same bioche mical activities like the parent rod-shaped bacterium. However, the insensitivity for various phages and the failure of DAP in the envelopes demonstrate that there are profound alterations in the biosynthesis and structure of the murein and of the outer wall layers. The results of these investigations and an ultrastructural analysis (Gumpert and Taubeneck 1975) show that the stable spheroplast type L-form LD 52 B of Proteus mirabilis must be considered as a true cell envelope mutant.


Mode of growth and division of Salmonella typhimurium. A temperature-sensitive strain (HD 20) of Salmonella typhimurium is described. At restrictive temperature this strain shows an envelope alteration and a defect in division associated with an increase in cell diameter. On a shift to 42 degrees C there is residual division for ca. 30 min and then no further increase in cell number. In minimal medium (MM) at 42 degrees C cell diameter remains unchanged for about one mass doubling and then increases. From measurements of cell elongation, it is concluded that such increases in diameter occur because cell volume increases exponentially at 42 degrees C but increases in the rate of elongation occur for only a short period and then elongation rate becomes constant. This conclusion is supported by the observation that HD 20 cells show no increase in diameter at 42 degrees C when cultured in media supplemented with sucrose and Mg++; normal increases in elongation rate occur in such media. A model which fits the experimental data has been constructed. This model has two main features namely (1) the elongation of individual cells is linear with the rate of elongation doubling close to division and (2) such doublings in elongation rate are linked to division such that division cannot occur if elongation rate has not doubled shortly before. In the mutant it is proposed that only a few doublings in elongation rate occur at 42 degrees C and these are responsible for the residual division. The model fits the data for cultures shifted to 42 degrees C in MM or in yeast extract casamino acids MM (YE Cas MM) and for cultures shifted to 42 degrees C and shifted up from MM to YE Cas MM. The observations on these medium shifted cultures suggest that the activity of growth zones responsible for elongation is medium dependent.


[Haloprogin. Its effects in the presence of glucocorticoids and neomycin]. The problem was studied whether the activity of haloprogin is decreased in the presence of glucocorticoids (6-methyl-prednisolone hemisuccinate sodium; hydrocortisone) or in the presence of a bacteriostatic antibiotic (neomycin). Antifungal activity was determined by measuring changes in oxygen consumption of Saccharomyces cerevisiae in the resting phase. The results revealed that neither glucocorticoids in concentrations which activate yeast metabolism, nor neomycin impair the antifungal activity of haloprogin. Therefore, haloprogin may safely be used together with glucocorticoids and neomycin in topical therapy.


[An improved method for the preparation of histological sections for electron microscopy]. Unsatisfying cut and electronmicroscopical figures of liver- and kidney preparations after organophosphate poisoning with Vestopal W, could be removed by experiments with new mixtures consisting of Vestopal W and Mikropal, obtaining reproductable cut-thickness and contrasty pictures for electronmicroscopical exploration.


[Results of the Chiari pelvic osteotomy (author's transl)]. This is a report about 82 Chiari pelvic osteotomies, the functional and the x-ray results are demonstrated. On the x-rays of the hip the CE- und the ACM-angles were measured routinely. In opposite to satisfying results on the x-rays we did not find adequate functional results.


[The speed of nerve-conduction after micro-surgical suture of the tibial nerve of the rabbit (author's transl)]. Isolated division of the tibial nerve in the thigh preserving the peroneal and sural nerves does not cause loss of normal position of the animal, in particular of sitting. Nor does it lead to pressure sores. The animals are fitter then after division of the sciatic nerve. Microsurgical suture of the isolated tibial nerve in the thigh of the rabbit with 1 or 2 simple sutures with 10 x 0 thread show that an average recovery can be achieved in over 80 per cent. As few sutures as possible should be used. Otherwise there with be scarring and no return of function.


A comparison of staples and nylon closure in varicose vein surgery. This report describes our experience at wound closure using metallic staples and nylon sutures in 150 patients undergoing elective ligation and stripping for varicose veins. We compared the two methods for speed of closure and wound complications. Closure by Auto Suture is delightfully quick. Fewer patients developed complications from the staples as judged by wound sepsis, separation of the incision and keloid formation.


Pulmonary arteriovenous fistula. A review. A successfully treated case of an arteriovenous fistula of the lung is reported. An exhaustive review is made of the pertinent literature and the pathophysiology, embryology, clinical aspects, diagnosis and treatment are discussed.


[Mixed connective tissue disease. Clinical studies on a new group of collagenoses]. The clinical features of 6 patients with symptoms of various connective tissue diseases and rheumatoid arthritis are reported. The frequency of symptoms corresponded to that of the syndrome, which Sharp et al. (1971) termed mixed connective tissue disease. The antibodies to an extractable nuclear antigen are a characteristic feature. Moreover, one may detect a speckled staining pattern by indirect immunofluorescence. In addition, moderate immunoglobulin deposits were observed in the skin and kidneys of our patients. The pathomechanism of these deposits is discussed.


[Clinical study on a new acetylsalicylic acid/paracetamol preparation with gastric acid resistant coating (Safapryn), and on two various phenylbutazone dosages in patients with primary chronic polyarthritis as based on a new evaluation method]. The authors describe a simple non-crossover-blind test for the evaluation of subjective indices. A table for recording pains during the 14 days' study is described. The patient's satisfaction with the treatment and the number of days until withdrawal from the trial are recorded. The statistical procedure takes into consideration differences between the treatment groups and makes possible a valuable comparison with drugs tested in other clinical trials. The three dose schedules of antirheumatic treatment were tested on 122 patients and the results compared with those of 342 patients treated with the 6 other antirheumatic drugs (enteric-coated aspirin, paracetamol, indomethacin, flurbiprofen, mefenamic acid, and prednisolone) and those of 41 patients who received placebos. The results show that Safapryn (3,6 g aspirin + 3.0 g paracetamol daily) compared with 3.9 g enteric coated aspirin does not offer any advantage in its analgesic effect, although it gives rise to fewer side effects. Phenylbutazone (3000 mg) was almost as effective as 15 mg prednisolone daily. Between the effects of this dosage of phenylbutazone and other non-steroidal antirheumatic drugs, however, no significant difference could be detected. 50 mg phenylbutazone daily and placebo treatment could not be distinguished. The authors thank the Arthritis and Rheumatism Council for Research in Great Britain for its financial support. One of the authors (PL) was a Merck, Sharp, and Dohme Research Fellow and another one (PMB) received a Robins research scholarship.


The growth cycle of influenza viruses as studied in touch preparations of the allantoic layer of chick embryos. 3. The growth cycle of influenza A virus in allantoic cells as studied by immunofluorescence. The growth cycle of Influenza A virus has been studied in touch preparations of infected allantoic layers of the chick embryo using the immunofluorescence technique. Eggs incubated for 11 days were inoculated with either of two comparative doses: (A) 10(9)ID50 (high multiplicity) and (B) 200 ID50 (low multiplicity). (A) After inoculation of 10(9)ID50 (multiplicity: 100ID50 to 3 cells) into the allantoic cavity, two closely associated cycles of infection were observed. (a) A single cycle of multiplication which occurred simultaneously in all cells (those in contact with the allantoic fluid) of the surface stratum of the allantoic layer and terminated with their degeneration followed by desquamation at around the 18-21st hour after inoculation. Consequently, the cells of the deep stratum, denuded of surface stratum, came into contact with the allantoic fluid, a fluid heavily infectious. This first infectious process is termed the major growth cycle. (b) Multiple cycles of infection which occurred in only about 1-5% of cells of the deep stratum of the allantoic layer, the other 95% of deep cells remaining constantly free from infection. This condition is referred to as the minor growth cycle and it lasted until death of the embryos occurred within a maximum of 6-7 days after inoculation.


[Serotype 185 and E. coli O115 - two distinct bioseropathotypes (author's transl)]. E. coli O115 strain 27w and TRABULSI's serotype 185 have been subjected by us to comparing examinations of the serological behaviour of their cell wall and their protoplasmatic antigens, of their biochemical and cultural behaviour and their pathogenicity for the mucous membranes of guinea-pigs. As a result of this inquiry it was found, that E. coli O115 27w and the dysentery-provoking serotype 185 are biological distinct bacteria which only share a minor cross relationship of their O-antigens, and which should not be classified together.


[Occurrence of the cathode-bound group antigen of the dysentery bacilli in Escherichieae types of intermediate character (author's transl)]. Protoplasmatic antigens of 28 strains of 27 Escherichieae types not accepted as Shigellae have been examined for the occurrence of a cathode-bound group antigen (KGA). From the tested cultures of non-dysentery-provoking types E. coli O28 E1073(z) TAYLOR, E. coli O32, E. coli O115 (27w), Alkalescens-Dispar O1, A.-D. O1 var. Koji, A.-D. O2, A.-D. O3, A.-D. O4, A.-D. O5, A.-D. O6, A.-D. O7, and the intermediate serotypes H62 and 6275-52 no one possessed KGA, and likewise one of the two examined E. coli O136 cultures proved to be KGA-negative. In contrast, KGA was found in the dysentery types 147, 792, 185, Sh. guanabara, E. coli O124, E. coli O136 (one strain), E. coli O143, E. coli O144, and E. coli O152, in the Shigella-like serotypes 2044-54 and 1831, in the E. coli serotypes O112a,b:K68 and RUCHMAN, which have been suspected to provoke dysentery but are showing the biochemical behavior of typical E. coli, finally in Alkalescens-Dispar O8, which is known to be apathogenic for mucous membranes. After, all, KGA seems to be a constituent of all dysentery bacilli, but might be absent in individual cultures. On the other hand, KGA exceptionally seems to be found also in Escherichieae types not enteropathogenic for men.


[Protective oral immunization against coli enterotoxemia in swine (author's tranls)]. The issue of immunity in the case of enteric infections caused by bacteria is still widely unresolved. To clarify this, weaned piglets 6-7 weeks of age were used as a model, because of the particular susceptibility to colienterotoxemia shown by them at this particular age. The experimental design was as follows. The animals were immunized orally and parenterally (i.v. and i.p. routes) by means of a vaccine consisting of bacteria incapable of reproduction. 14 days later, the animals were challenged orally with virulent EC-O 141 B 85 and EC-O 139 B 82. The results have shown that a) parenteral immunization did not induce protection against oral infection with virulent E. coli; b) repeated oral immunization produced measurable immunity against oral infection; and c) 1 7-hour broth culture proved to be particularly suitable for oral infection. Results also point to the fact local immunity in the intestine as present after enteric infection by bacteria may be artificially induced only by protective oral immunization.


[Demonstration of antigen and production of interferon in rabbits infected with borna virus (author's transl)]. Examinations were carried out on the occurrence of active virus, antigen and antibodies in the brain blood, or resp. of rabbits which were infected intracerebrally with the virus of Borna disease as a model of slow viruses. The techniques of the complement fixation and the immunofluorescence were used. Furthermore, an attempt was made to demonstrate interferon in the blood serum of the infected rabbits. Virulent Boran virus was observed two days after the infection and complement fixing antigen from the 10th day on. The immunofluorescence technique gave positive results in the nucleus of ganglion cells eight days after infection. The production of interferon in the sera could not be demonstrated. The brains tested 2, 4, 8, and 20 days after infection were also negative.


[A method for routine identification of anaerobic bacteria, in particular of non-sporogenic forms (author's transl)]. In the Institute of Bacteriology of Allgemeines Krankenhaus St. Georg, Hamburg, all clinical specimens received (except stools, sputum, and vaginal swabs) have been studied for the presence of anaerobians since 1947. More than 25 years' experience has convinced the authors that not infrequently, non-sporogenic anaerobians occur as infectious agents. Statistical data compiled for the period 1956-1972 revealed that from a total of 71,973 specimens contaminated with bacteria, 7,047 (9.8%) were containing non-sporogenic anaerobians. Pure anaerobic cultures were obtained in 2.404 cases (3.3%) and mixed cultures of aerobic and anaerobic bacteria in 4,643 cases (6.5%). The pathogenic importance was revealed by identifications from osteomyelitis cases: 11-13.7% pure cultures and 17% mixed cultures (with aerobians). Also in cases of total endoprosthesis of complicated course they were detected in up to 23%. On account of the frequent cultures of non-sporogenic anaerobians obtained from clinical specimens, the authors demand a routine analysis of all clinical specimens for the presence of anerobians...


Selective involvement of the brain in experimental murine cryptococcosis. II. Histopathological observations. In the present communication the previously described cultural findings about the selective involvement of the central nervous system by C. neoformans, strain W 2/A 94, have been supplemented by the results of histopathological investigations. Attention has been paid to the organ specific tissue reaction during the course of infection, with special reference to the involvement of the brain. In agreement with former observations concerning the cryptococcoma in the muscle-tissue, the cryptococcal foci in the brain also showed the phenomenon of vascularisation. The results have been compared with those of the C. neoformans, strain W 71/A 117 which does not allow such a prolonged selective involvement of the central nervous system due to its high virulence for the white mice. These observations impressively demonstrate the significance of simultaneous microbiological and histopathological examinations for the detection of infections caused by such facultative pathogens.


Typing of Shigella sonnei colicins by means of specific indicators. An enlarged and perfected scheme of typing of Shigella sonnei colicins is based on the knowledge of types of colicins produced by Abbott's types as well as by newly discovered and determined colicin types. A set of specific indicators prepared from E. coli K13 HfrR, E. coli C6 and Shigella sonnei by a selection of suitable mutants and recombinations was used for the typing. Seven new colicin types were determined on typing shigellae found in the field. Type 9A produces colicins E3, Ia, Type 16 produces colicin B, Type 17 colicins B, Ib, Type 18 colicins E2+?, Type 19 colicins E2, Ia, Type 20 colicins E1, Ib, Type 21 colicins E2, ib. The present scheme can be enlarged, when new types are found.


Investigations on the efficacy of surface disinfection and surface cleaning procedures. 2. Laboratory testing of the efficacy under conditions simulating those of real-life. Using a standardised method (impression method by means of 'Rodac' plates and glass as well as ceramic surfaces as germ carriers) we tested for the efficacy of 3 surface disinfectants (aldehydes, aldehydes + detergent substances, phenol derivatives) and 3 disinfectant cleaning agents (aldehydes + detergent substances + wax) and 2 per cent soft soap solution on Staphylococcus aureus, Klebsiella pneumoniae and Sarcina lutea. The method enabled us to calculate the actual germ count reduction and also took account of the natural dying-rate of the test organisms. Their resistance to the different types of active substances varied greatly. Thus the 3 disinfectants had a better effect on Klebsiellae and Staphylococci than on Sarcinae. 2 of the 3 disinfectant cleaning agents, on the other hand, turned out to be less suitable for the elimination of Klebsiellae. It thus follows that Sarcina cannot be used as test organism for in-use tests (see Communication 1) unless the resistance of Staphylococci and Klebsiellae to the test preparation has first been established in laboratory experiments. The general question, namely whether in-use tests provide meaningful and accurate results remain to be elucidated. On the basis of our test results, the exclusive use of soap for cleaning floors, as a substitute of disinfection, should definitely be ruled out. Although soap reduces Gram-positive cocci well in actual practice, it is almost ineffective against problem germs such as Klebsiellae. What should be stipulated is the use of broad-spectrum disinfectants, i.e. they should, if possible, act equally well against different types of germs. From the commercially-available preparations that were tested, a phenol-base product gave the best results. On the basis of these results we venture to doubt that the use of aldehyde preparations which is customary at the moment, is the right approach to fight hospital infections.


Investigations on the efficacy of surface disinfection and surface cleaning procedures. 3. Evaluation of the results of in-use and laboratory tests. 3 disinfectants and 3 disinfectant cleaning agents were subjected to comparative tests as to their germicidal activity. These were (a) laboratory tests with germ carriers and (b) in-use tests with Sarcina-contaminated floor surfaces in a medical institute. The results, details of which are given in the two preceding publications, were assessed under the following angles: Validity of the test methods, requisite changes of the test procedures and practical usefulness of the different types of preparations. This assessment led to the following conclusions: New preparations should first be tested for their bacteriostatic activity according to DGHM and the neutralising agents should be determined. The suspensions tests - which remain to be standardised- provide information on the sensitivity to protein, hard water and detergent surface active substances. The germ carrier tests with operating-theatre tiles, carried out with at least 5 test germs, must result in a germ count reduction of more than 5 powers of ten (regardless of the elimination rate due to drying). In-use tests should stand at the end of the test series. Regular epidemiological studies are hardly feasible in all individual cases. An assessment on the basis of the behaviour of normal bacterial spores is likewise impracticable. The use of test germs cannot be dispensed with. Sarcina is a suitable species provided germ-carrier tests have first been carried out and have shown that Staphylococci, Klebsiellae and other high-risk germs are more sensitive to the preparation than Sarcina lutea. In the in-use tests, we consider a reduction by 2 to 3 powers of ten to be sufficient.


[Present-day status of the problem and the prospects for the development of the theory of the role of L-form bacteria and Mycoplasma in human urological diseases]. The authors consider the current state of the problem and personal data on the role of L-forms of bacteria and mycoplasma in human infectious pathology. L-forms of bacteria were isolated from the urine in 10% of the patients suffering from pyelonephritis and mycoplasmae--in over one third of all the patients both with pyelonephritis and with cystites and prostatitis. Some of the isolated strains of mycoplasmae produced a cytopathogenic effect on the cell cultures, whereas the rest caused a latent infection. Drug sensitivity determined to ten antibacterial preparations with a wide range of action differed in strains of the same species. The efficacy of treatment and the prospects of microbiological studies in cases with atypical and latent courses of inflammatory processes of the urogenital organs in discussed.


[Approximate assessment of the successfulness of bacteriological and serological methods of studying rodents in natural plague foci]. On the basis of the study of two mathematical models of the epizootics the authors suggest a criterion for the determination of the correlation of the value of the results of bacteriological and serological examination of rodents in the natural foci of plague. In accordance with the criteria obtained an evaluation was made of this correlation for Pallasiomys meridianus of the left and right banks of the Volga. It appeared that the calculated assessment of the value of the results of the two methods under study correlated satisfactorily with the data obtained in practice during the epizootologic examination of the Volgo-Urals natural focus of infection.


[Results of a study of some methods of differentiating M. pneumoniae strains by the virulence of the degree of attenuation]. Study of five M. pneumoniae strains by the intensity of hemolysis and hemadsorption demonstrated no definite differences between them. Experiments on Cricetus auratus W. showed a higher virulence of the strains isolated from the patients with pneumonia in comparison with the strains isolated in acute respiratory diseases of the upper respiratory tracts. Attenuated straines were characterized by a weak intensity to reproduction in the lung tissue of Cricetus auratus W. and mildness of the histopathological changes which they caused.


[Correlation of the antibody concentrations in the cells, subcellular structures and blood serum of rabbits immunized with cholera vaccine]. Experiments were conducted on animals. Following immunization with cholera vaccine there were revealed vibriocidal antibodies, sometimes -- agglutinating, but no vibriolysins in the cells of the mucosal epithelium of the small intestine, of the liver, the spleen and in the fractions obtained from the cells with the aid of differential centrifugation. This corresponds to the high titre of vibriocidal antibodies in the serum and a relatively low titre of the other types of antibodies. In parenteral immunization with various doses of cholera vaccine the concentration of vibriocidal antibodies reached 10(1)-10(7) per 1 mg of protein, which was millions of times less than in the blood serum.


[Epidemiology of El Tor cholera in Indonesia]. The authors analyze data on El Tor cholera morbidity in Indonesia in the past and at present. It was shown that before the year of 1961 the infection was limited to the Sulavesi island and was epidemic in character, but it differed from classic endemic cholera by a number of signs. In 1961 and 1970 the spread of El Tor cholera along Indonesia was practically synchronous with its spread along the vast territories of the world, this apparently pointing to the effect of some general factor which caused the activization of El Tor cholera in its various foci.


[Role of E. coli 06 in the epidemiology of acute intestinal diseases]. The authors demonstrated the etiological role of E. coli 06 in group acute intestinal diseases with the clinical picture of food poisoning. The leading role of the food factor in the spread of this infection was established. A study was made of 64 E. coli 06 cultures isolated from the patients in group infection and from the carriers examined by various indications. The cultures produced no keratoconjunctivitis in guinea pigs. The capacity to produce enterotoxin was revealed in 2 of 5 cultures tested in experiments with the intranasal infection of albino mice.


[Study of the virulence of Shigella sonnei isolated from persons with different forms of dysenteric infection]. Possible ranges of virulence of Sh. sonnei strains isolated from the patients and carriers in the foci of Sonne dysentery, supposedly with the same source of infection, were studied. Sh. sonnei strains isolated from carriers proved to be less virulent than the strains isolated from patients with the clinical manifestation of the infection. A hypothesis was put forward explaining some aspects of carrier state in Sonne dysentery, which most probably was explained by the refracterity of the macroorganism, not by the alterations in the genom of the causative agent.


[Utilization of a solid nutrient medium for the serological method of detecting the causative agent of typhoid in patients' feces]. The causative agent of typhoid fever can be revealed in feces of patients not only by the bacteriological, but also by the serological method, if the material is preliminarily grown on hard nutrient media; Ploskirev's medium proved to be the optimal. It is suggested that microbial cultures left on the ager in Petri dishes after the bacteriological study should be used for bacteriological analysis. In a number of cases it was possible to reveal the causative agent of typhoid fever in feces by the serological method, although no coproculture was isolated bacteriologically.


[Deaminase activity of Cl. botulinum type A, B, E and F cultures]. The authors present the results of a comparative study of desaminase activity in the suspensions of resting cells and in ultrasonic desintegrates of cells of Cl. botulinum types A, B, E and F against a number of amino acids and their amides. It was shown that types A, B, E and F possessed active desamination enzymes; this process, however coursed with a different degree of intensity depending on the substrate. Common for all the 4 types was the presence of desamidase L-asparaginase and L-glutaminase, and also of the desamination enzymes of the aspartic and glutamic acids. Strains of type B had the greatest set of enzymes, and of type A--the least; bacteria of types E and F occupied an intermediate position. None of the types studied contained tryptophandesaminase. Some of desaminases are bound to subcellular structures.


Antidotal therapy and changes of acetylcholinesterase activity following isopropyl methylphosphonofluoridate intoxication in mice. The antidotal action of atropine with trimedoxime, obidoxime or methoxime against isopropyl methylphosphonofluoridate intoxication in mice was studied. The best antidotal effect was demonstrated for the combination of atropine and methoxime (tested as therapeutic index or D50 index). The effect of atropine (constant dose) and methoxime (different doses) on acetylcholinesterase (AChE) activity in four parts of the mouse brain following isopropyl methylphosphonofluoridate intoxication was described. The therapeutic effect could be improved by increasing dose of methoxime. AChE activity in the pontomedullar area was increased on increasing the dose of methoxime (p less than 0.005). A correlation between residual AChE activity in the pontomedullar part of the mouse brain and mortality was demonstrated.


[Bronchussuture (author's transl)].

[Bronchussuture (author's transl)]. We describe the method of manual bronchussuture, used from 1968 until new, which gave us complete satisfaction. Many of the important factors are discussed. The results are analysed and concluding we expose the reasons why we found manual bronchussuture better than any automatic stapling device.


[Reconstruction of skin defects of the cheek with a large island flap (author's transl)]. An island skin flap sliding on its own subcutaneous tissue is described to replace large cheek wound defects after tumor resection in elderly patients. The simplicity of the method and the uniformly good results in 25 cases have led the author to prefer this flap to all other types of local flaps.


[Interfascicular dissection of peripheral nerve with a surgical microscope. A propos of one case of partial section of the median nerve (author's transl)]. The author reports a case of partial section of the median nerve treated by inlay graft performed under the microscope. He insists on the opportunities offered by microsurgery in the field of the peripheral nerve.


Septic candidasis with intrahepatic cholestasis and immunoglobuline deficiency after renal transplantation. Two renal allograft recipients with acquired immunoglobulin deficiency had a disseminated infection with candida albicans. Septic fever, intrahepatic cholestasis and pulmonary mycotic disease were the prominent clinical symptoms. Recurrence of septic fever during the clinical course was associated with increase of intrahepatic cholestasis. On the other hand there was an amelioration of cholestasis when effective antimycotic therapy was instituted. In our patients there was no evidence that intrahepatic cholestasis was drug-related. It was assumed that toxic metabolits of candida albicans were responsible for intrahepatic cholestasis.


Non-digestive functions of the intestinal hormones (enterines). New data and hypotheses based on experimental duodenectomy (Short review). In cats and dogs, total duodenectomy with transplantation of the papilla Vateri into the jejunum and gastroenteroanastomosis has been shown to result in the so-called "duodenal deficiency syndrome" which is characterized, in the first phase, by cachexia of the animals occurring within 6 weeks after operation followed by obesity in the second phase. In contrast, animals with preserved by isolated duodenum do not exhibit pronounced changes in body weight as compared to intact controls. Consequently, it is suggested that intestinal hormones (enterines) not only exert gastrointestinal effects but also systemic ones. Thus, duodenectomy has been shown to lead to disturbances of lipid and protein metabolism, decreased secretory activities of the thyroid gland and the hypothalamus. Due to these findings, -- in addition to the even well-known intestinal hormones -- the existence of enterines with thyrotropic, lipotropic, hypothalamotropic, and appetite-regulating functions can be assumed which may make the duodenum act as an "abdominal hypophysis".


An open assessment of becotide (beclomethasone dipropionate) nasal spray in seasonal allergic rhinitis. The effect of beclomethasone dipropionate (Becotide) intranasally on hay-fever has been studied in 38 adult volunteers with grass pollen allergy. The trial was carried out as an open assessment with simultaneous pollen count during the months of June and July, 1974. With the dose 300 mug/day intranasally, 95 per cent of the subjects regarded the treatment as successful for the nasal symptoms. No effect on eye symptoms was recorded, and no evident side-effects were noted.


Inhibition of human leukocyte migration inhibitory factor (LIF) by alpha-L-fucose. Peak leukocyte migration inhibitory activity was produced in vitro by human lymphocytes stimulated with concanavalin A and eluted from Sephadex G-100 gel columns in fractions containing molecules of mol. wt. 40,000-50,000 daltons. No activity was found in fractions containing molecules of mol. wt. 23,000 daltons which is the estimated size of the human macrophage migration inhibitory factor (MIF). In the present experiments migration inhibition was tested on human peripheral blood leukocytes migrating under agarose. Unconcentrated supernatant activity was reduced in a dose-related manner by alpha-L-fucose. At a concentration of 0.1 M alpha-L-fucose, the mediator activity was completely neutralized. The effect was reversible and specific for alpha-L-fucose. Concentrated supernatant activity, however, was only slightly reduced even in the presence of a higher concentration of sugar. The possible role of alpha-L-fucose as a part of a mediator receptor on the indicator cells is discussed.


Different methods of reconstruction after vulvectomies for cancer of the vulva. Direct wound closure with or without flap-plasty after vulvectomy gives satisfactory cosmetic and functional results. Split thickness skin-grafts seem to be of limited value in the repair of the defects.


Infantile cortical hyperostosis. Follow-up of 29 cases. Twenty-nine cases of infantile cortical hyperostosis with a wide range of bone involvement are reviewed. Soft tissue painful swellings began before roentgenographic changes appeared in the underlying bone. In 17 babies gradual involvement of different bones was noted. In seven cases lesions previously healed became reactivated. The disease is self-limiting and appears in a narrow age group. Mandibular involvement is most common. The clinical picture and laboratory data are reported. Differential diagnosis and possible etiological factors are discussed. The similarity of infantile cortical hyperostosis to extreme periosteal new bone formation in response to trauma in sensorily deprived children is suggested as a possible etiological factor.


Rapid identification of gram-negative rods using a three-tube method combined with a dichotomic key. A three-tube method combined with a dichotomic key is presented which will identify virtually all Enterobacteriaceae as well as a number of other frequently encountered Gram-negative rods at a genus or species level within 20 hours following the primary isolation. The method is shown to be reliable and simple, saving processing time and material.


Pleural effusion disease in rabbits, clinical and post mortem observations. In Denmark and probably in other countries as well, the infectious agent causing intercurrent death of rabbits by passages of Nichols pathogenic Treponema pallidum has been studied in rabbits in the absence of T. pallidum. This agent can be propagated in rabbits at intervals of 2 to 30 days and, depending on the interval between passages and the number of passages, the mortality may vary from zero to almost 70 per cent. Based on the post mortem findings in fatal cases, the name pleural effusion disease is suggested for this rabbit infection. Iridocyclitis, haematological and biochemical changes are signs of the disease not described previously. The source of the infectious agent is discussed.


Escherichia coli O:H serotypes isolated from human blood. Prevalence of the K1 antigen with technical details of O and H antigenic determination. Escherichia coli strains isolated from human blood obtained from 539 different patients all over Denmark were examined serologically for O and H antigesn. 425 strains could be O grouped with O sera 1 to 150. 90 strains were spontaneously agglutinable. Using O sera to the ten most frequent O groups: 2, 4, 6, 75, 9, 8, 18, 7, 22 and 1, 57 per cent of all strains could be grouped. Using sera corresponding to the ten most frequent O and the ten most frequent H sera, it was possible to O:H type 68 per cent of all O groupable strains. The K1 antigen was detected in 18 per cent of the strains.


Psychiatric epidemiology in Israel: an analysis of community studies. A review is presented of all psychiatric surveys conducted thus far in Israel. A brief description of these five epidemiological studies is followed by an analysis which focuses on the objectives of the studies, their respective methodology and data sources. The results obtained in these studies are discussed according to several parameters, i.e., the range of prevalence rates found, the differential distribution of rates among social groups and the relationship found between psychopathology and several variables such as age, country of origin, social class and area of residence. Suggestions for further epidemiological research are included.


Genetic effects of acute and chronic irradiation with 14 MeV neutrons. Male CBA mice were exposed to 14.5 MeV neutron, either in an acute (150 or 250 rad) or a chronic dose (250 rad) and the genetic effects of the irradiations were compared. No detectable difference in the rate of mutations existed between acute and chronic exposure, with these neutrons.


Survival of patients on hemodialysis after renal graft failure. The influence of kidney graft failure on the survival rate after reentering maintenance hemodialysis has been studied in 63 patients. Twenty-eight patients were observed for at least 12 months after a primary graft failure and 35 had a second transplant some time during this period. Patient survival 12 months after graft failure was 57%. This result was compared with the 1-year survival of 82% in 150 patients dialyzed prior to the first transplantation. The majority of the deaths on dialysis after graft failure were caused by infectious complications probably related to the immunosuppressive treatment. It is suggested that survival on dialysis after graft failure may be improved by an early reduction of the immunosuppressive treatment in patients with failing grafts.


Phylogeny of functional humoral transplantation immunity: comparative studies in amphibians and rodents. Remarkably comparable observations from parallel experiments in salamanders and mice utilizing three related model systems (implant-induced immunomanipulation; passive transfer; and putative B cell suppression) argue directly that functional humoral transplantation immunity is highly developed at the phylogenetic level of Amphibia and that it plays a major role in regulating graft survival in these species (Fig. 4). Although it is still conjectural whether such humoral immunity and weak H-antigens evolved concurrently, the argument that enhancing atibodies evolved exclusively in viviparous species to protect the fetus from potential rejection by the maternal immune system no longer seems tenable (1).


Body surface isopotential mapping in Wolff-Parkinson-White syndrome: noninvasive method to determine the localization of the accessory atrioventricular pathway. The body surface isopotential maps of 22 patients with WPM syndrome were obtained from the 85 unipolar lead ECG's using the on-line minicomputer system newly devised by the author's group. The map patterns were classified into three types-I, II, and III (Type I, eight; Type II, seven; Type III, three; and unclassified, four cases). In Type I, the back surface displayed the negative potential throughout the entire ventricular activation, and at the terminal stage the lower precordial area displayed the positive potential and the upper precordial area, the negative one. Type II was characterized by two longitudinal lines, one staying at its place on the back and the other moving right to left on the precordial area following the process of ventricular activation. In Type III, the right precordial area displayed negative potential in the early stage, and in the terminal stage the upper part of the right side of chest surface displayed positive potential and the lower part, negative potential. It was surmised from these patterns that the pre-excited area was located at the posterior region of the ventricles in Type I, at the right ventricle in Type II, and the right ventricular base near the posterior margin of the ventricular septum in Type III. Type A patients in the conventional ECG classification fell under Type I; Type C patients, under Type III; Type B patients under either Type I or Type II.


Changes in transthoracic electrical impedance during submaximal treadmill exercise in patients with ischemic heart disease--A preliminary report. Twenty normal subjects and 32 patients with ischemic heart disease (IHD) were subjected to submaximal treadmill exercise. The mean transthoracic electrical impedance (TEI) was measured with a tetrapolar lead system and the changes were correlated to the extent of ST depression observed on an on-line digital computer. Six subjects of pre-excitation syndrome with "false" ST depression were also studied. The normal subjects did not show a significant change of TEI during exercise. The patients with IHD showed a steady and significant decrease in TEI, correlating with the extent of ST depression. Recovery was slow after the cessation of exercise. The subjects with false ST changes showed no decrease of TEI. The changes were more profound in subjects who developed anginal pain during the test. These findings are attributed to an increase in the thoracic blood volume and pulmonary extravascular water due to transient left ventricular dysfunction in angina.


Risk factors and coronary heart disease--facts or fancy? The importance of the many well-published epidemiologic studies for the philosophy of prevention of ischemic heart disease has led to this analysis of the background design and early results of three such studies, i.e., the Framingham study, the National Pooling Project, and the Stockholm Prospective Study. Besides indicating certain flaws in the early design, it is demonstrated that the authors usually press their factual data to conclusions that are not only really valid, with some exceptions. This analysis leads to the conclusion that high blood pressure and cigarette smoking seem to be much more important for the development of ischemic heart disease than high serum lipids in the populations studied. They are, furthermore, selected in such a way that the results cannot have any bearing on the general population and, in particular, on its lower and higher social strata.


Electrophysiologic studies in the denervated transplanted human heart. II. Response to norepinephrine, isoproterenol and propranolol. Five patients who had received a transplanted human heart 1 to 3 years previously were studied to determine the effects of norepinephrine, isoproterenol and propranolol on the atrioventricular (A-V) conduction system. Using the His bundle technique, atrial, His bundle and ventricular electrograms were recorded, and central aortic pressure was monitored during the administration of these drugs. Norepinephrine was given by continuous infusion to four patients in doses ranging from 4 to 8 mug/min, with the systolic arterial pressure increasing by an average of 72 mm Hg. Concomitantly, there was an average increase in the rate of the donor atrium of 32 beats/min, and a reflex slowing of the recipient atrium of 23 beats/min. The A-H interval shortened by an average of 27 msec. Isoproterenol dose-response curves were performed in three patients, with the maximal dose being 5.2 mug by intravenous bolus infusion. The rate of the donor atrium increased by an average of 40 beats/min, and that of the recipient atrium by 18 beats/min. The A-H time shortened by an average of 25 msec, with a drop in systolic blood pressure averaging 23 mm Hg. Propranolol (7 mg intravenously) was given to three patients and the peak doses of norepinephrine and isoproterenol were again infused. Beta adrenergic blockade was achieved at this dose of propranolol since there was only a minimal increase in the donor atrial rate after infusion of the drug. The A-H interval was not altered by catecholamine infusion after achievement of beta blockade. However, the levels of systolic hypertension noted after infusion of norepinephrine was not altered by propranolol. The denervated transplanted human heart appears to respond normally to norepinephrine and isoproterenol, and the electrophysiologic effects of these agents are blocked by propranolol. Extensive investigative work in the denervated canine model has demonstrated the presence of the alpha and beta cardiovascular receptors. Although the automonic nervous system is important in cardiac performance, this work is the first validation in man that (1) the functional integrity of the beta receptor is maintained even when the autonomic nerves are absent, and (2) the intrinsic properties of the sinus and atrioventricular nodes are the keystone in stabilizing cardiac electrophysiology after denervation.


Metabolism of free fatty acids, glucose and catecholamines in acute myocardial infarction. Relation to myocardial ischemia and infarct size. The myocardial metabolism of free fatty acids, glucose and catecholamines is reviewed in relation to current trends in the therapy of experimental myocardial infarction. Major modifications in the metabolism of free fatty acids, glucose and catecholamines have already been found after acute myocardial infarction in man, and animal experimental data suggest that such metabolic changes might play a role in the modification of infarct size and sometimes in the development of arrhythmias. However, animal experiments often represent extreme situations and the therapeutic use in man of agents to modify the metabolism of free fatty acids, glucose or catecholamines after myocardial infarction needs intensive investigation before general application. The sum total of the evidence from animal experiments suggests that increased circulating concentrations of free fatty acids and catecholamines, if sufficiently high, may be harmful rather than helpful to the outcome of acute myocardial infarction, and that increased provision of glucose (as glucose, insulin and potassium) may be beneficial. Reservations to these conclusions are that the concentrations used appear to be important factors in catecholamine and free fatty acid effects, and that the mechanism of action of glucose-insulin-potassium is more complex than originally thought.


Cost of cardiac pacing.

Cost of cardiac pacing. The patient with a permanent pacemaker faces significant lifetime medical expenses. The financial records of 15 patients with more than 4 years' (average 73 months) of cardiac pacing were reviewed to establish the basic cost of pacing. Each pacemaker was electively replaced after 24 months of service. During the total of 1,096 months of pacing there were 65 hospital admissions. Medical expenses for the 15 patients totaled $112,160, of whic- $93,410 was for hospital expenses and $18,750 for physicians'fees. The average monthly cost per patient was $102 (range $84 to $130).


The hypothalamic magnocellular neurosecretory system of the guinea pig. I. Immunohistochemical localization of neurophysin in the adult. With the use of the unlabeled antibody enzyme technique and antiserum against bovine neurophysin I, neurophysin was localized in the hypothalamic magnocellular neurosecretory system of the adult guinea pig. Immunoreactive deposits were found in the perikarya of the supraoptic and paraventricular nuclei, their fiber projections and terminals in the posterior pituitary. No parvicellular neurophysin-positive components were observed. In the median eminence neurophysin was seen in the zona interna where axons of the supraoptico-hypophysial tract pass on their way to the neural lobe. The peptide was also present in axons projecting into zona externa which terminate on the primary portal plexus.


The hypothalamic magnocellular neurosecretory system of the guinea pig. II. Immunohistochemical localization of neurophysin and vasopressin in the fetus. The development of the hypothalamic magnocellular neurosecretory system of the fetal guinea pig was examined by immunohistochemistry. Neurophysin was first observed in the supraoptic nucleus (SON), median eminence (ME) and posterior pituitary (PP) on day 40 of gestation. It was not regularly present in the paraventricular nucleus (PVN) until day 47. Vasopressin was first observed in the SON, ME and PP on day 45. In the median eminence immunoreactive deposits indicative of both peptides were observed in both the fibers of the hypothalamo-hypophysial tract (H-HT) in the presumptive zona interna as well as in axons projecting to the developing primary portal plexus.


Structural modification of Schwann cells in the pancreatic islets of the dog. In dog pancreatic islets, Schwann cells not only ensheath autonomic nerves but also have cytoplasmic processes that are contiguous with large expanses of the islet surface. These processes are interposed between the islet basal lamina and the endocrine parenchyma. This structural modification of Schwann cells may play a role in the neural control of islet function.


Ultrastructural observation of anterior pituitary gonadotrophs following hypophysial portal vessel infusion of luteinizing hormone-releasing hormone. Luteinizing hormone-releasing hormone (LHRH) (50 ng) was infused with a microcannula into hypothalamo-hypophysial stalk portal vessels of adult male rats. Anterior pituitaries were prepared for electron microscopy at 1, 5, 10, 15, 30 and 60 minutes after infusion. Granule release (exocytosis) from gonadotrophs was stimulated within one minute. Evidence of increased protein synthesis began at 5-10 minutes but was not maximal until 15 minutes. The majority of new granules appeared in the Golgi apparatus at 15 and 30 minutes. This study provides morphological evidence for LHRH-induced hormone and synthesis release under physiological conditions.


Primary neonatal hyperparathyroidism. Report of a case and review of the literature. The seventh case in the world literature of primary hyperparathyroidism in a neonate is reported. This is the fifth case in which an autopsy was performed. The clinical and anatomic findings in all seven cases are reviewed and compared. Neonates with primary hyperparathyroidism show diffuse hyperplasia of the parathyroid glands. The bones show disturbed osteogenesis, bone resorption, and widespread fibrosis of the marrow cavities. Bony cysts are not appreciated. Pathologic fractures are common. Marked hypercalciuria or hyperphosphaturia is usually not observed, perhaps because the immature renal tubules fail to respond to the influence of excess parathormone. Aminoaciduria and anemia are commonly observed. The prognosis is grave, and the etiology of this syndrome remains unexplained.


An immunofluorescent procedure for detection of Hb F (gamma chain) in peripheral erythrocytes. A direct fluorescent method for the detection of the gamma chain of Hb F in erythrocytes is described. The method is easier to interpret and more sensitive than the classic Kleihauer-Betke procedure.


Nocardia asteroides bacteremia in an immunosuppressed renal-transplant patient. A patient with a polymicrobial bacteremia due to Nocardia asteroides and Escherichia coli is presented. Rapid overgrowth of all cultures with the E. coli necessitated the use of selective media containing antimicrobial agents to which the E. coli was sensitive. Only five previous cases of N. asteroides bacteremia have been reported.


Segmental mastectomy plus radiation therapy for stage I cancer of the breast. Segmental mastectomy (surgical removal of the palpable tumor mass with a shell of normal tissue) plus irradiation to the entire remaining breast and regional lymph nodes is commonly used in other countries as a treatment for Stage I cancer of the breast. It is not, however, generally practiced or accepted in the United States. Adequate postoperative irradiation consisting of 4,500-5,000 rads to regional lymph nodes and a slightly higher dose to the breast itself will eliminate more than 90% of remaining subclinical tumor, as evidence by very low local recurrence rates. Many patients having local recurrence may then be salvaged by mastectomy or axillary node dissection. Equal five- and ten-year survival rates are obtained compared with radical mastectomy with less physical and psychological morbidity for the patient. While this treatment is not suitable for all Stage I cases, its efficacy should be more widely recognized.


Paralysis of the diaphragm.

Paralysis of the diaphragm. Diaphragmatic paralysis has been mentioned infrequently as a cause of respiratory symptoms in children. During a three-year period, diaphragmatic paralysis has occurred in 12 neonates following birth trauma (six) or thoracotomy (six) and in four older children following thoracotomy. Spontaneous recovery occurred in all four older children and in five of the 12 neonates. Although two neonates became asymptomatic despite persistent paralysis, the remaining five neonates required prolonged intermittent positive-pressure breathing; two eventually died of secondary pneumonia, and three became asymptomatic only after plication of the affected diaphragm.


Prospective, randomized study of diagnosis and outcome in acute upper-gastrointestinal bleeding: endoscopy versus conventional radiography. Sixty patients with mild to moderate upper-gastrointestinal bleeding were admitted to a prospective, controlled study of diagnosis and management, and were randomized to endoscopy or upper-gastrointestinal (UGI) barium series as the initial study. Definitive localization of the source of bleeding was made initially in 69% of the endoscopy group and 21% of the UGI group (P less than 0.0005). Of 54 patients undergoing both studies, endoscopy was definitive in 67% and UGI series in 22%. Thus, endoscopy also made more diagnoses when used as the second study (P less than .01). The use of endoscopy as the initial procedure led to significantly more rapid diagnosis than with UGI series. However, there were no significant differences between the two groups in clinical outcome. Endoscopy is the initial diagnostic procedure of choice in patients with mild to moderate upper-gastrointestinal bleeding because it enables detection of superficial bleeding lesions and has significantly increased the speed of diagnosis.


Jejunal fluid and electrolyte secretion in carcinoid syndrome. To evaluate the pathogenesis of the diarrhea of carcinoid syndrome, triple-lumen jejunal-perfusion studies were performed in three patients with carcinoid syndrome and diarrhea and eleven control subjects. In contrast to the net absorption observed in the control subjects during perfusion with an isotonic mannitol-saline solution, net secretion occurred in two of the three carcinoid-syndrome patients. Glucose absorption and glucose-stimulated fluid absorption were normal in the carcinoid-syndrome patients. Methysergide controlled the diarrhea and in one patient net absorption was observed during methysergide therapy. These studies suggest that intestinal secretion may be one of the pathogenetic factors responsible for the diarrhea of carcinoid syndrome and provide additional evidence of the importance of intestinal electrolyte secretion in the genesis of many diarrheal states.


Metiamide in the Zollinger-Ellison syndrome. The histamine H2-receptor antagonist metiamide is an inhibitor of endogenous and stimulated gastric-acid secretion. It appears to have therapeutic possibilities in duodenal-ulcer disease. Three patients exhibiting the Zollinger-Ellison syndrome have been treated with this drug for six months or more. Rapid symptomatic improvement occurred in each case, followed by ulcer healing. There were also reductions in gastric secretion and consistent changes in the fasting serum-gastrin concentration. On patient relapsed temporarily during therapy. There have been no side effects. It is concluded that, in the short term, metiamide is of benefit in the Zollinger-Ellison syndrome.


Early clinical experience with metiamide, a histamine H2-receptor antagonist, in patients with duodenal ulcer. The clinical, endoscopic, and biochemical effects of metiamide, a histamine H2-receptor antagonist, in therapeutic dosage have been studied in a 28-day open trial in patients with duodenal ulcer disease. A good symptomatic response, combined with a 72% ulcer healing rate was observed. There were small but significant rises in plasma creatinine, serum glutamic oxaloacetic transaminase, and serum lactate dehydrogenase during treatment. Small quantities of amino acids appeared in the urine, and the heart size increased slightly. It is concluded that histamine H2-receptor antagonism may be an important therapeutic approach to duodenal ulcer disease.


Bile reflux gastritis. Analysis of fasting and postprandial gastric aspirates. Gastric aspirates from 11 patients with bile reflux gastritis were studied for pH, bacterial cultures, proteolytic acitivity and bile salt pattern. Hypochlorhydria, significant bacterial overgrowth and unconjugated bile salts were found in all gastric specimens tested. The presence of unconjugated bile salts may account for the severity of the gastritis seen in these patients.


Alveolar capillary basement membrane lesions in Goodpasture's syndrome and idiopathic pulmonary hemosiderosis. An ultrastructural study of lung distinguised between lesions of the alveolar capillary basement membrane in a case of Good pasture's syndrome and in three cases of idiopathic pulmonary hemosiderosis. In Goodpasture's syndrome, diffuse vascular injury with wide endothelial gaps, diffusely fragmented basement membranes and an electron dense layer on the basement membrane was found. In idiopathic pulmonary hemosiderosis, focal ruptures of the basement membrane were associated with hydropic changes in pneumocytes and, although fibroblasts were not seen, collagen deposition occurred within the basement membrane. immunofluorescent studies failed to show deposition of immunoglobulins G (IgG), A (IgA), M (IgM) or C3 in the lung in either disease. The ultrastructural lesions appear to separate these clinically similar entities.


The role of complement, immunoglobulin and bacterial antigen in coagulase-negative staphylococcal shunt nephritis. We describe three patients with arrested hydrocephalus in whom glomerulonephritis developed secondary to Staphylococcus epidermidis bacteremia from an infected ventriculoatrial shunt. Investigation of the immune-mediated renal disease associated with this chronic infection showed that (1) complement depletion during the acute phase of bacteremia and nephritis was predominantly via the classic pathway; (2) rheumatoid factor was associated with bacteremia, fever, proteinuria and low complement levels; (3) early complement components (C1q, C4, C3), immunoglobulin (predominantly immunoglobulin M [IgM], Staph. epidermidis antigen(s) and electron denxe subendothelial deposits were localized within the renal glomerulus; (4) C1q, and IgM derived from patient serums, were the most prominent in vitro immunoreactants to Staph. epidermidis cell walls; and (5) the causative organisms, Staph. epidermidis, shared common antigens with Staph. aureus, and antibody from patient serums cross reacted with extracts from both of these organisms.