Collagen antibodies and collagen- anticollagen immune complexes in rheumatoid arthritis. Serum, synovial fluid and synovial fluid cells of 14 patients with classic rheumatoid arthritis and of 5 controls were investigated serologically in regard to rheumatoid factors and collagen antibodies and by immunofluorescence double staining in regard to localization of collagen and gammaglobulin in fluid cells. Three patterns of staining were observed: a) gammaglobulin inclusions, b) gammaglobulin and collagen in identical localization, c) collagen inclusions. While distinct staining for gammaglobulin appeared only in seropositive cases, collagen inclusions were only observed in RA, however in seropositive and seronegative cases. In 5 RA cases collagen and gammaglobulin were demonstrated additionally in such identical localization that conclusion in regard to collagen-anticollagen immune complexes seems justified. 9 of 14 RA cases had collagen antibodies, all cases were collagen antibody positive which had collagen and gammaglobulin in identical localization in same inclusions.


[Characteristics of the immunomorphological substrate in secondary immunization as dependent on the functional state of the hypothalamic nuclei]. The authors traced the morphological and serological shifts occurring in secondary immunological response against the background of destruction of the posterior hypothalamic nuclei. It was revealed in experiments on rabbits that in primary and secondary immunization carried out against the background of bilateral coagulation of the posterior hypothalamic nucleus the secondary immunological response was reduced in comparison with control. Depression occurred both on account of reduction of the number of cells-precursors, and in connection with disturbances of differentiation of the antibody-forming cells. When the primary immunization was conducted against the background of the intact brain, and destruction of the posterior hyfothalamic nuclei preceded the secondary immunization there occurred a change in the number of cells-precursors involved in differentiation, without disturbance of the differentiation itself.


[Comparative characteristics of 2 methods of separating mouse T- and B-lymphocytes]. The results of separation of T- and B-cells of the C3H/Sn and AKR/j micr lymph nodes with AKR-anti-theta3H and C3H-thetaAKR isosera and cellular immunosorbents containing the antigen-antibody complexes were analyzed in this work. The strain differences in the theta+-cells (T-lymphocytes) level were demonstrated in the untreated mice of the noted strains. Populations enriched by B-lymphocytes under different methods of separation differed somewhat in composition. The cellular immunosorption had many advantages in comparison with the cytotoxic-immune sera used for the T- and B-cell separation.


[Detection of the causative agent of tularemia in the organs of animals in the early stages of development of the infection]. A study was made of a possibility of detection of the causative agent of tularemia in the organism of albino mice at early stages of development of the infection after subcutaneous infection with 1, 10 and 100 microbial cells of strains No. 503/834 (Holarctic race) and Schu (nearctic race). The following examinations were made: cultivation on nutrient media, immunofluorescent study, the antibody neutralization test and the passive hemagglutination test with erythrocytic diagnostic agents. The microbe could be regularly revealed three days after the infection. Detection of the causative agent was possible in individual cases at the earlier dates by seeding and by the fluorescent antibody method. Although by cultivation it is possible to reveal individual microbes, but the growth appears on the 3rd--5th day and later. The most rapid response (1.5--2 hours) results (on the presence of the microbe) can be obtained with the aid of the fluorescent antibody method. Application of the mentioned tests with the erythrocytic diagnostic agents permits to obtain data not only on the presence of the causative agent, but also on its quantity of the causative agent in the organism of the infected animal. The mentioned methods provide the most complete characteristics of the dynamics of the accumulation of the microbe in the animal organism.


[Use of the immunofluorescence method to detect the causative agent of tularemia in developing chick embryos]. There was shown a possibility of using the immunofluorescent method for detection of the causative agent of tularemia in the developing chick embryos, infected with the virulent strains 503 (holoarctic race) and Schu (nonarctic race). The greatest accumulation of bacteria was revealed in the yolk sacs, and the least--in the chorionallantoic fliud; the greatest accumulation of bacteria was observed on the 3rd--4th days after the infection. In infection with various doses of the causative agent--from 1 milliard to 1 microbial cell-positive results were noted in 92.3% of cases (according to the data of fluorescent microscopy) and in 77.3% of cases (according to the data of light microscopy), this pointing to a greater sensitivity of the method of fluorescent in comparison with the light microscopy. Immunofluorescent method can be recommended for detection of the causative agent of tularemia in the yolk sacs of chick embryos.


[Phagocytic activity of the neutrophils in tularemia in animals with varying infective sensitivity]. A study was made of the ingestive capacity of blood neutrophils; there were revealed no significant differences in the intact animals with a different infectious sensitivity to tularemia. With the development of infection the ingestive activity of leukocytes increased in the infected highly sensitive animals, but the digestive function was not manifest. In albino rats (with a low sensitivity to tularemia) the disease induced an intensification of the ingestive and the manifestation of the digestive function of neutrophils dynamically developing together with the specific immunity reactions.


[Production of antirickettsial sera by immunizing horses. II. Obtaining and testing an immune serum to D. sibericus]. The authors present the results of immunization of horses-producers with a commercial antigen and the yolk culture of the living R. sibericus (strain K1) for the purpose of obtaining specific immune sera for many purposes. It was shown that the original combined scheme of immunization and reimmunization of horses, successfully approved in the preparation of immune sera to Rickettsia prowazeki also proved to be highly effective for obtaining the antisera to R. sibericus. Sera obtained after the primary immunization of horses could be successfully used as diagnostic sera, but they were of no use for the preparation of fluorescent antibodies and the highly active hemosensitin; as to the sera obtained after the remote reimmunization--they were universal raw material. Dry fluorescent antibodies to R. sibericus were prepared of the horse sera (their stain titre was 1 : 256--1 : 512) a highly active hemosensitin, and also dry commercial diagnostic sera for the IHT, CFR and the immunofluorescent reaction of microagglutination.


[Effect of the economic activity of man on natural foci of plague]. Under the effect of human economic activity in the natural plague foci there occurred changes in the structures of local biocenoses. The extent and the direction of these changes were determined by the character and the scale of the economic activity. The final outcome of ploughing up, irrigation and supply with water of the vast areas is elimination of the focus or of its autonomic areas, but excessive exploitation of the desert pastures not infrequently leads to the opposite result. Large industrial construction and building of means of communications decreased the territories of the natural foci of plague only slightly, although no significant action was produced by them on the structure of biocenoses and the state of the foci.


[Interaction of the causative agent of pseudotuberculosis with the peritoneal macrophages from an immune and a nonimmune organism]. The role of phagocytosis in experimental pseudotuberculosis was demonstrated in vivo and in vitro. Virulent Y. pseudotuberculosis strain caused the death of the majority of the cells, whereas the weakly-virulent ones--degenerative changes and the death of but of few of them. The capacity of the causative agents of pseudotuberculosis to survive and to reproduce within the cells could be regarded as one of the significant factors of virulence of these microbes. The maximal immunizing effect was observed in infection of the animals with sublethal dose of the living Y. pseudotuberculosis culture. A somewhat lesser, but a sufficiently high, immunizing effect was produced by lipopolysaccharide. A method of macrophage culture can be used for the assessment of the immunogenicity of various antigenic complexes of the microbes.


[Effect of a mixed E. coli O-111 (RNA-azopositive and RNA-azonegative strains) and Coxsackie B3 viral infection on oxygen demand and on the succinate dehydrogenase activity of an HEp-2 cell culture according to polarographic study data]. The authors determined polarographically the intensity of oxygen consumption and the activity of succinic dehydrogenase of the HEp-2 cell culture infected with the association of the Cocksackie B3 with the RNA-asopositive and RNA-asonegative strains of E. coli O--111, in comparison with the uninfected and separately infected virus or control bacteria. The results were recorded 2, 6, 12, 18 and 24 hours after the infection of the cell cultures. Mixed virus-bacterial infection intensified the oxygen consumption and the activity of succinic dehydrogenase by the HEp-2 cells, followed by a profound respiratory depression. The same effect was produced by the infection of cells by the virus alone. Less pronounced was the action of bacterial component. A change in the cell repiration of the infected cultures was independent of the RNA-ase activity of bacteria. Under conditions of mixed infection the intensity of the changes in oxygen consumption and of the succinic dehydrogenase activity was determined by the viral component of the association.


[Antistaphylococcal bacteriostatic activity of the sera from surgical patients]. Blood serum was examined in 41 patients (operated for various forms of acute appendicitis) on the 5th--6th day after the operation when 10 of the patients developed purulent complications of staphylococcal etiology. A determination was made of the titres of beta-lysins and the bacteriostatic activity against 2 strains of S. aureus by the modified Ehrenkranz et al method. The mentioned indices were low in the great majority of cases; consequently, the appearance of purulent complications in the operated patients was independent of the antistaphylococcal bacteriostatic activity and the beta-lysin titres in their sera. Prophylactic express-immunization of a number of patients by crude staphylococcus toxoid did not influence the nonspecific humoral immunity factors.


[Effect of nucleic acids on the outcome of acute streptococcal infection]. The work is devoted to the experimental study of the effect of exogenous heterologous RNA and DNA on the outcome of infection caused by streptococci--virulent and of low virulence, of the 1st and 2nd serological types of group A, in mice. It was found that the severity of the outcomes of the infectious process was not associated with the type of nucleic acids, but was determined by the dose and the periods of their administration in relation to the time of infection of the animals and the streptococcus virulence. Aggravation of the outcomes of the infection under the effect of exogenous RNA and DNA was accompanied by an increase in the virulence of the causative agent.


[Genetic control of the capacity of Sh. flexneri to exert a lethal effect on macrophages. II. Mapping of the cyt-determinant on the Shigella chromosome]. Crossing experiments showed independence of the genetic determinants controlling the capacity of Sh. flexneri to synthesize the primary S-specific side chains (antigen 3,4) and to produce a lethal action on macrophages cultivated in vitro. Cytotoxicity was restored only in transmission to the R-strain of shigellae of the capacity to synthesize the antigenic factor 3,4 from the cyt+, but not from the cyt-- donor of Sh. flexneri. The determinant responsible for the synthesis of cytotoxin designated as cyt was mapped on the chromosome of shigellae near the rfb gene, controlling the synthesis of the group-specific factor 3,4. The rate of linkage of the cyt+ a 3,4+ was equal to 24.4%. Transductants of the his--cyt-- strain of Sh. flexneri of the S-chemotype acquired the capacity to produce a lethal action on the macrophages with the frequency of the contransduction his+cyt+ equal to 2%. Since the rough (his+R) hybrids of Sh. flexneri and the lysozyme spheroplasts obtained from the cytotoxic strain lost the cytotoxicity whereas the synthesis of the group-specific factor 3,4 provided by itself no lethal effect of the dysentery bacilli on the macrophages it could be supposed that cytotoxin represented an additional thermolabile (in connection with the sensitivity to the temperature action) part of the Sh. flexneri O-antigen.


[Palatine tonsils and immunity. IV. Lymphocyte blast transformation in various lymphoid organs of animals immunized with microbial antigens]. For the purpose of ascertaining the peculiarities of cellular differentiation of lymphoid cells of the palatine tonsils experiments were conducted on rabbits immunized intravenously and subcutaneously with streptococcus and paratyphoid B antigens; a study was made (in the blast-transformation reaction) of a comparative response of the lymphocytes of the palatine tonsils, the thymus, the spleen, the appendix and the regional lymph node. In case of stimulation with the specific microbial antigens and PHA the proliferative response was greater in the culture of the splenic lymphocytes and the regional lymph node than in the culture of the lymphocytes of the palatine tonsils and the appendix. The thymus lymphocytes responded to PHA only. A conclusion was drawn that the paratyphoid B and streptococcus antigens penetrating into the lymphoid tissue by hematogenic route stimulated a relatively low percentage of lymphocytes of the palatine tonsils and the appendix in comparison with the regional lymph node and the spleen.


[Study of the sensitivity of a morphological mutant of S. typhimurium to irradiation]. Morphological Salmonella typhimurium LT2 WT--ED 143 mutant was similar by the character of the UV-sensitivity to the lon-mutants of Escherichia coli K-12. The paper treats of the data on the UV-sensitivity of the mutant and the initial strains at various growth phases, by the capacity to restore the irradiated P22 and Felix O bacteriophages and by the effect of various postradiational treatment on the irradiated strains. Data are presented on densitometry of the membrane proteins of the initial and the mutant strains, permitting to associate the unusual morphology, disturbed division and increased UV-sensitivity with the state of the membrane components of the bacterial cell.


[Genetic determinants of the O-antigens of serologically typed E. coli]. A study was made of the genetic determinants of the O-antigenicity in the E. coli, O25 and O86 serological groups in experiments on conjugation and transduction. In analysis of genetic recombinants selected from the crosses of the serologically typed and nontyped bacteria there was revealed a relationship between the inheritance of the antigenic signs (O25+ and O86+) and the capacity of histidine to synthesis. The S-form and the O25-antigenicity signs were readily cotransduced with the his+ marker, this pointing to the close linking of the corresponding genes loci on the bacterial chromosome.


[Data on the biological characteristics of serological group O4 Escherichia isolated in acute intestinal diseases]. A study was made of 155 strains of E. coli of the O4 serological group isolated from sick children and adults during group and sporadic acute intestinal diseases), from persons who came in contact with them, and also from healthy persons during prophylactic examination; three standard cultures were examined as well. Along with strains with a typical enzymatic activity there were strains which produced retarded lactose fermentation and also gas-free, immobile and lysin-negative strains resembling Shigellae. Eight biochemical types were determined among E. coli 04. A study of the antigenic structure by cross agglutinin adsorption indicated identicity of the strains by O-antigen and their difference by the K- and H-antigens. Circulation of E. coli of serological types O4: K12(L): H1,O4: K3(L): H5,O4: K3(L): H12,04: K12(L): H40,04: K52(L): H4, and O4: K12(L) HII was revealed; the first two serological types prevailed. Serological types of O4: K3(L):H12, O4: K12(L): HI and O4: K12(L): H40, isolated in cases of group and sporadic acute intestinal diseases were described for the first time.


[Characteristics of serological group O144:K? Escherichia isolated in acute intestinal diseases]. A study of 14 strains of E. coli belonging to serological group O144: K? isolated in clinical dysentery (bacteriologically unconfirmed), from contacts in the foci of clinical dysentery and acute enteric disease of unknown etiology, and also in prophylactic examination, was made. Among these cultures there were strains with shigella characteristics. Along with the serological type O144: K?: H--described earlier there was determined serological type O144: K?: H4 differing in the enzymatic activity and the absence of the capacity to produce shigellae keratoconjunctivitis. The cultures of the given serological type were isolated in the focus of bacteriologically-undeciphered acute intestinal disease, this pointing to their possible etiological role. In the light of the aforesaid escherichia of the O144: K? serologically groups could be referred to the enteropathogenic ones; in this connection it is necessary to prepare preparations for their serological identification.


[Several aspects of the study of human embryo brains]. Using the Coons direct and indirect fluorescent antibody method, cryostatic sections and cultured neuroblasts of embryonic human brain were examined for the presence of intracellular antigens. The embryonic brain tissue was obtained from mentally healthy and schizophrenic women undergoing medically indicated, induced abortion during the first four months of pregnancy. As early as four weeks after the onset of embryonal development, positive cytoplasmatic and nuclear fluorescence were seen, with one exception, after incubation with gamma -- chain specific, anti-human IgG, and antirabbit immune globulin serum. More rarely, positive fluorescence was seen following incubation with alpha-chain specific anti-human IgA. Tests with anti-human IgM were persistently negative. The serum of two acutely ill, schizophrenic women contained a factor which --a) could easily be related to the cytoplasm of embryonic brain cells; b) could be absorbed out with whole thymocytes obtained post mortem from human newborn and c) produced positive cellular fluorescence when incubated with chain-specific antihuman IgG and IgA.


Differential diagnosis and treatment of gas-producing infections. During an 8-year period, 30 patients with gas-producing infections were admitted for treatment of hyperbaric oxygen. Infection was a consequence of trauma and operation in 26 cases and a complication of other diseases in 4 cases. The definitive diagnoses were clostridial myositis in 12 cases, clostridial cellulitis in 7, non-clostridial cellulitis in 9 (mainly E. coli infections); in 2 cases the diagnoses were uncertain. Six cases of E. coli infection were misinterpreted as myositis and were treated with hyperbaric oxygen at 3 atm. abs. without effect. Five of these cases were cured by antibiotic therapy and surgical drainage. The risk of hyperbaric oxygen at 3 atm. abs. necessitates a strong indication for this kind of treatment. Thirteen cases of clostridial infections (2 with cellulitis, 11 with myositis) were successfully treated with hyperbaric oxygen except in 2 cases of myositis. Helpful data for the plausible diagnosis clostridial myositis in the acute stage were: a typical clinical picture with rapid progress of the local necrosis and inflammatory reaction, roentgenographically demonstrable intramuscular gas, and abundance of gram-positive rods in exudate from the inflammation. Laboratory data had a limited value. In some cases of clostridial myositis, a fall of hemoglobin to low values (less than 7.5 g%) was seen in the first 24 hours and high values of hemoglobin/plasma were noted in 4 cases. Incidents of side-effects from hyperbaric oxygen treatment were frequent but only a few were serious and these subsided during a short interruption of the treatment.


Small heparin doses as prophylaxis against deep-vein thrombosis in major surgery. 100 patients were treated either with heparin 5,000 i.u. every 12 hours or placebo in a double-blind, randomized, prospective trial. The treatment was commenced 1-3 hours before surgery and was continued for 6 1/2 days. The criteria for the selection of patients and the principles on which the treatment and investigation schedules were based corresponded generally to those laid down by Kakkar et al. (1972). The incidence of deep-vein thrombosis of the lower extremities was 6% in the group treated with heparin and 20% in the placebo group. The decisive diagnosis of thrombosis was based on the scanning of the lower extremities after administration of I125-fibrinogen. No case of pulmonary embolism occurred and no complications because of the treatment were noted. We propose to institute investigations on a larger scale to evaluate the prophylactic value of small heparin doses with respect to pulmonary embolism.


Effect of actinomycin D on the pituitary response to LH-RH. The effect of Actinomycin D (Act D) on the release of LH and FSH induced by LH-RH was investigated in rats. Immature male rats received an iv infusion over a period of 3-4 h or a quick iv injection of synthetic LH-RH. Infusion of LH-RH significantly increased serum LH and FSH levels at 1, 2, 3 and 4 h after the initiation of infusion. Pre-treatment with 100 mug/100 g.b.w. Act D failed to affect the rise of serum LH and FSH levels 1 h after the infusion but significantly suppressed the response at 2, 3 and 4 h. The increase in serum LH and FSH levels after a quick injection of LH-RH was unaffected by pre-treatment with Act D whether the antibiotic was injected 1 or 2 h before LH-RH. The results suggest that the initial phase of the pituitary response to LH-RH does not require DNA-dependent RNA synthesis, whereas that in the later period does. RNA synthesis may be necessary only to maintain the increased secretion of both LH and FSH during a continuous stimulation with LH-RH.


Migration inhibition of human leukocytes mixed with phytohemagglutinin-preincubated mononuclear leukocytes. An in vitro test able to demonstrate phytohemagglutinin (PHA)-induced migration inhibition of human peripheral blood leukocytes was investigated. The migration inhibition was demonstrated by the agarose migration technique. Purified mononuclear leukocytes which had been incubated for 30 min with PHA, then washed and added to non-separated leukocytes induced migration inhibition of the mixed cell population. Since no PHA was added to the non-separated leukocytes, a direct PHA effect on polymorph migration was avoided. If the PHA-preincubated mononuclear leukocytes were heated at 56 degrees C for 30 min, their ability to cause migration inhibition was abolished. This suggests that the inhibition was caused by migration inhibitory factor (MIF) produced by the PHA-stimulated lymphocytes.


Beclomethasone dipropionate aerosol in reversible obstructive airways disease. A clinical evaluation of one year's treatment. Seven patients with reversible obstructive airways disease, who were unsatisfactorily relieved by conventional bronchodilating drugs, were admitted to a 1-year-long therapeutic trial with beclomethasone dipropionate aerosol, 400 mug a day. After 3 weeks of treatment the mean values of VC, FEV, and PEFR were increased by about 100 per cent of the pretreatmetn values, and the consumption of self-administered bronchodilators was markedly diminished. Throughout the trial the occupationa diability and need for hospitalization were negligible compared with the previous year. Development of tolerance to the drug was not observed during the trial. The adrenocortical function remained unaffected, as judged by the plasma cortisol levels and adrenocortical stimulation tests. Continuously low normal levels of excreted urinary 17-ketogenic-steroids might indicate a very slight adrenal suppression.


Side effects and skills related to driving after intramuscular administration of bupivacaine and etidocaine. Eleven healthy subjects were injected intramuscularly with a saline placebo, 1.3 mg/kg of 0.5% plain bupivacaine, or 2.6 mg/kg of 1.0% plain etidocaine in a double-blind cross-over fashion. Before and at 1/2, 2 and 4 h after injection, side effects were recorded, and psychomotor skills related to driving were measured. Fatigue, dizziness, and sore thighs were significantly more common with etidocaine than with bupivacaine or the saline solution. Bupivacaine significantly impaired eye-hand cooridination and flicker fusion discrimination during the whole observation period. Etidocaine impaired flicker fusion discrimination only. The subjects' adaption to darkness, sensitivity to brightness, and visual discrimination ability in bright counterlight remained unaltered after each treatment. The results suggest that such psychomotor performance as driving ability is impaired for at least 2 h after a patient receives 1.3 mg/kg of plain bupivacaine or 2.6 mg/kg of plain etidocaine intramuscularly.


Thoracic epidural analgesia I-a double-blind study between bupivacaine and etidocaine. A double-blind comparison was made in 40 patients undergoing thoracic epidural analgesia with either bupivacaine 0.5% or etidocaine 1.0%, both with adrenaline 5 mug/ml. All patients were undergoing elective upper abdominal surgery. They were studied both pre- and postoperatively. The parameters measured were: onset time, segmental spread and duration of analgesia; and also systolic blood pressure, heart rate and peak expiratory flow rate. In respect of these parameters, no major differences were found between the two solutions under the conditions of the study. The overall results, however, differ in many respects to those found when these agents are used in lumbar epidural analgesia.


Histopathology of the endocrine pancreas of a fresh-water fish, Clarias batrachus (L.). V. Effect of epinephrine administration. Intramuscular administration of epinephrine in 2 mg/kg and 5 mg/kg body weight doses to Clarias batrachus caused significant hyperglycemia between 12 and 18 h after treatment. The hormone produced a small decrease in the liver glycogen, but induced a notable fall in the glycogen of muscles and a transient increase in the brain glycogen. Light-microscopical examination of the pancreatic islets revealed degranulation and vacuolization of the beta-cells accompanied by acute necrosis. Damage to the alpha-cells was also noticed in hyperglycemic fish. The changes in the cellular configuration of the islets, blood glucose and on the tissue glycogen contents were dose-dependent. It is suggested that epinephrine alters the carbohydrate metabolism through the alpha-cells of the islets.


Inhibition by quinaldate of dehydrogenases. Quinaldate (quinoline-2-carboxylate) inhibits pyridine-, and flavin nucleotide-dependent dehydrogenases, both inside the mitochondria and in isolated form. Other mitochondrial functions and some other isolated enzymes (with one exception) are not influenced by quinaldate at all. Thus, quinaldate can be regarded as a specific "dehydrogenase inhibitor". The inhibition of alcohol dehydrogenase (EC 1.1.1.1) and lactate dehydrogenase (EC 1.1.1.27) by quinaldate is of mixed type, both with respect to NAD+ and ethanol or lactate, respectively. The Ki for alcohol dehydrogenase is 4.5 mM, that of lactate dehydrogenase 7.5 mM. It can be assumed that the inhibition by quinaldate of dehydrogenases is a consequence of its binding to that part of the active centre which takes part in the dehydrogenation itself and might possess very similar structure in all dehydrogenases.


Dark neurons: a significant artifact: the influence of the maturational state of neurons on the occurrence of the phenomenon. In cerebella of young rats, killed by decapitation, dark Purkinje cells were readily observed in animals from 16 days of age onward. In younger animals (from 0-12 days of age) these dark neurons were never observed. The author agrees with Cammermeyer and others that dark neurons are an avoidable artifact. The findings presented suggest, however, that the possibility of the occurrence of this type of artifact depends on the maturational state of the neurons concerned.


Eye injuries cuased by tear-gas hand weapons. Six patients hospitalized by eye injuries caused by tear-gas hand weapons are presented. Five of the lesions resulted from a short-distance shot of aerosol irritant projectors. Severe swelling and bloodshot of the lids and conjunctiva occurred in all cases. Epithelial defects, swelling and blurring of the parenchym were observed in the cornea. The treatment of each case took weeks, even months. Such an injury can because of scars in the cornea permanently lower the visual acuity.


The interstitial space of adipose tissue as determined by single injection and equilibration techniques. The interstitial 14C-sucrose space was determined in the subsutaneous adipose tissue of the dog using both a single injection-indicator dilution technique and an equilibration-tissue sampling method. 131I-albumin and 51Cr-labelled erythrocytes served as intravascular indicators. The conventional extrapolation method for single injection curves yielded space values several times lower than those measured by the equilibration technique, although sampling was continued until the venous outflow samples contained less than 1% of the peak 14C-sucrose activity. This discrepancy may be due to long transit times, for which the conventional extrapolation procedure does not account. An extrapolation procedure is proposed based on the assumption that the area under the normalized extra- and intravascular curves should be equal. By this procedure as well as by the equilibration technique the interstitial 14C-sucrose space in adipose tissue measures approximately 10 mlX100 g-1. The single injection technique does not appear applicable for space determinations in adipose tissue during sympathetic nerve stimulation (3-7 Hz), possibly due to "trapping" of the tracers within the tissue.


A controlled clinical trial of treatment with ALG in established rejection of renal allografts. A controlled clinical investigation of the effect of equine anti-human-lymphocyte globulin (ALG) on established rejection after transplantation has been carried out in a group of 31 patients. Compared with a control group, the treated group showed a significantly positive effect of ALG in the form of a faster reversal of rejection episodes (p less than 0.05). Leucocytes, lymphocytes, erythrocytes, thrombocytes and immunoglobulins were unaffected by the treatment, but there were signs of a complement-consuming process and an influence on blast transformation tests. No rise in antibody titre against equine globulin was seen.


Differential count of urinary leucocytes and renal epithelial cells by phase contrast microscopy. A total of 291 urine sediments from 255 patients with various renal or urinary tract diseases have been studied by phase contrast microscopy. Based upon morphological criteria, leucocytes were distinguished from renal epithelial cells and the white blood cells were classified either as mononuclear or polynuclear in 179 patients. The percentage of the different cell types varied considerably between and within the different diseases. The median values for polynuclear granulocytes were higher than 90% in bacterial renal or urinary tract disease and in polycystic kidney disease. In interstitial nephritis, nephrosclerosis and in renal transplanted patients the percentage of polynuclear granulocytes was somewhat lower, 76-85%. In diabetes, amyloidosis, tubular nephrosis (necrosis) glomerulonephritis, lupus nephritis and endemic benign nephropathy there were 14-66% polynuclear granulocytes. 29-33% mononuclear leucocytes were found in lupus nephritis and endemic benign nephropathy. The greatest proportion of renal epithelial cells was found in endemic benign nephropathy, namely 49%. 36% renal epithelial cells were found in tubular nephrosis (necrosis) and in glomerulonephritis. The technique is rapid and inexpensive. It facilitates differential diagnostics of urinary tract disease with pyuria.


Studies on cytochrome b2 synthesis in Saccharomyces cerevisiae. Synthesis of cytochrome b2 together with that of other hemoproteins is induced by oxygen. It is further stimulated by L-lactate. This is true for the enyzme in mitochondrial as well as cytoplasmic cell fractions. Chloramphenicol and erythromycin do not effect cytochrome b2 biosynthesis, whereas cycloheximide prevents it in aerobicallly adapting cells. Mutants lacking cytochrome b2 activity still exhibit the activities of D-lactate dehydrogenase and D-2hydroxyacid dehydrogenase.


Cysteine biosynthesis in Aspergillus nidulans. The existence of two postulated pathways of anabolic cysteine biosynthesis in Aspergillus midulans was investigated. No activities of the postulated pathway involving S-sulfocysteine as intermediate have been detected. Investigations on cyteine and methionine requiring mutants revealed independent regulation of O-acetylserine sulfhydrylase by endogeneous cysteine and methionine pools. The reaction catalysed by O-acetylserine sulfhydrylase is postulated as the only anabolic pathway of cysteine biosynthesis in A. nidulans.


Changes in the biochemical properties of Shigella flexneri la as a result of recombination with Escherichia coli K12. The fermentative properties of recombinants obtained after conjugation between E. coli K12 HfeC and S. flexneri la Lac Phe mutant were investigated. The recombinants showed the antigenic structure of S. flexneri but their biochemical characteristics differed from the properties typical for this genus. The recombinants were found to acquire the ability to ferment several carbohydrates not degraded by the S. flexneri recipient strain.


Central nervous structures participanting in the simple recognition of touch. Short review of a series of experiments in the dog aimed at studying the correlation between lesions of the two cerebral somatosensory areas or the different spinal pathways projecting to these areas and defects in tactile sensitivity.


Morphological examination of the juxtaglomerular apparatus following the fluorescence microscopic demonstration of sympathetic nerves. Several catecholamine demonstrating fluorescence techniques based on the formaldehyde-condensation principle have been examined for the possibility of application of juxtaglomerular granulum demonstrating methods. Freezing and thawing cause a distruption of juxtaglomerular granules. Short formalin fixation does not prevent this damage. Juxtaglomerular granules were successfully stained after freeze-drying. The adaptation of Endes's trichrome method on the basis of the classical catecholamine technique of Falck and Owman resulted in a reliable practical method. Procedures introduced into the trichrome methods to increase the colour and intensity contrast of the staining of juxtaglomerular granules and to stain the elastic membranes are described. Some aspects of the staining mechanism of juxtaglomerular specific granules are also discussed.


Dietary potassium deficiency in the elderly: a controlled trial. A controlled cross-over trial of supplementary potassium was conducted in 46 elderly people whose dietary intake of potassium appeared to be no more than 45 mEq per day. Their grip strength and mental function were no better after two weeks' treatment with 48 mEq than when they received placebo tablets. It was concluded that the possible benefits of widespread potassium supplementation do not justify the risks which would be incurred.


Electroencephalographic study in acute rheumatic carditis. Electroencephalographic studies were done in rheumatic fever patients in order to determine the distribution of normal and abnormal EEG patterns in different clinical forms. The duration of EEG abnormalities related to rheumatic activity was compared with the duration of increased sedimentation rate and tachycardia. Rheumatic fever cases were divided into four groups: (1) acute active rheumatic carditis, (2) acute polyarthritis without carditis, (3) nonactive old rheumatic valvular heart disease, and (4) Sydenham's chorea. EEG findings were within normal limits in acute polyarthritis and in nonactive rheumatic valvular heart disease, but there were abnormal EEG findings in 29 per cent of chorea and in 94 per cent of active carditis cases. In active carditis all EEG changes returned to normal approximately within 8 weeks, whereas the sedimentation rate and tachycardia returned to normal within a shorter period.


The effects of milling on diameters and lengths of fibrous glass and chrysotile asbestos fibers. An investigation on the ffects of milling on diameters and lengths of fibrous glass and chrysotile asbestos was performed. A wool type fibrous glass and chrysotile asbestos were ball milled, one at a time, for selected periods of time. After each milling time a sample was taken by using a special technique to obtain representative samples. The samples from all milling times were analyzed by phase contrast microscopy with a Zeiss phase contrast objective at  a total magnification of 625 X. Selected samples were observed and photographed in a Phillips EM 200 electron miscroscope. The results of examination by phase contrast microscopy showed that milling had no significant effect on diameters of fibrous glass fibers, but reduced the lengths of these fibers and reduced both diameters and lengths of chrysotile asbestos...


Clinical significance of coronary arterial ectasia. In a study group of 2,457 consecutive patients undergoing cardiac catheterization, 30 patients had coronary arterial ectasia, an irregular dilatation of major vessels up to seven times the diameter of branch vessels. The frequency of hypertension, abnormal electrocardiogram and history of myocardial infarction was greater than that in a control group with obstructive coronary artery disease. Patients with ectasia did not differ from patients with obstructive disease in sex, age, prevalence of angina or presence of metabolic abnormalities. Six deaths occurred in the group with ectasia during a mean follow-up period of 24 months (annual rate of 15 percent). Extensive destruction of the musculoelastic elements was evident, resulting in marked attenuation of the vessel wall. The short-term prognosis in this group is the same as in medically treated patients with three vessel obstructive coronary artery disease.


Hereditary prolongation of the Q-T interval. Genetic observations and management in three families with twelve affected members. Three families with the prolongation Q-T interval are described. Two demonstrated the nonsex-linked dominant mode of inheritance of the condition without neural deafness (the Romano-Ward syndrome). Family A had four affected members in three generations. Family B had three affected members in two generations, but the parents of the affected children were distant relatives. Family C had five affected members in three generations. Of the nine living affected members, seven were asymptomatic and never experienced syncope. The remaining two, aged 7 and 9 years, respectively, had multiple syncopal attacks. Of three affected members who died, two had electrocardiograms before death. The thirds, an apparently healthy boy of 14 years, had a single syncopal attack 13 months before he died in his sleep. The nature of the dysrhythmia causing syncope was documented in two cases. One of the affected children was treated successfully with a permanent demand pacemaker and propranolol, the other with propranolol alone. The electrophysiologic findings and the management of both symptomatic and asymptomatic patients are discussed.


Resolution problems in echocardiology: a source of interpretation errors. Resolution is the ability of the echocardiographic system to distinguish closely lying structures. This is usually defined in two directions: laterally (lateral resolution) and in depth (axial resolution). With use of short ultrasonic pulses, axial resolution is not a major problem. By far the more important problem is the limited lateral resolution that results from the finite beam width of current ultrasonic devices. This results in the display of echoes that originate from off-axis structures. How these off-axis or "spurious echoes" affect the display is a function of the way the echographic information is handled. In conventional M-mode tracings, spurious echoes are displayed at a site where there is no directly corresponding anatomic structure, whereas with two-dimensional imaging, these echoes may result in important distortions of structures. The underlying principles are illustrated by a clinical experiment wherein the ball of a Starr-Edwards mitral valve prosthesis serves as a target of known shape and dimensions. These data are used to elucidate some of the problems and potential errors encountered in the interpretation of clinical M-mode recordings of the aorta, mitral valve and the left ventricular endocardium as well as their cross-sectional analysis. They also explain the present limitations of quantification of left ventricular performance from cross-sectional images.


Isosorbide dinitrate for the relief of severe heart failure after myocardial infarction. Severe congestive heart failure secondary to myocardial infarction remains a difficult management problem. Although intravenous vasodilators and mechanical assist devices have been reported to improve the depressed hemodynamic function, these interventions are limited to the intensive care unit and cannot be used for long-term management. This study evaluates the hemodynamic and symptomatic response to sublingual administration to isosorbide dinitrate (5 to 10 mg) in seven consecutive patients with severe congestive heart failure after anterior wall myocardial infarction. Serial measurements of mean right atrial and pulmonary arterial end-diastolic pressure, mean blood pressure, heart rate and cardiac output were obtained during the control period and during the 4 hours after administration of isosorbide dinitrate. The peak response occurred approximately 30 minutes after drug administration with an 83 percent reduction in mean right atrial pressure (from 6 to 1 mm Hg, P less than 0.02), a 36 percent reduction in pulmonary arterial end-diastolic pressure (from 25 to 16 mm Hg, P less than 0.0001) and a 6 percent reduction in mean blood pressure (from 94 to 88 mm Hg (P less than 0.05). There were small but statistically not significant increases in cardiac index (from 2.3 to 2.6 liters/min per m2 and stroke work index (from 26 to 32 gm/beat per m2). The total systemic vascular resistance was reduced by 5 percent from 1,605 to 1,518 dynes sec cm-5 (P less than 0.10). The baseline heart rate of 105 beats/min was not significantly changed. The reduction in pulmonary arterial end-diastolic pressure became statistically significant (P less than 0.05) between 15 and 30 minutes after administration of isosorbide dinitrate and remained significant for 3 to 4 hours. This reduction of pulmonary arterial end-diastolic pressure to less than 22 mm Hg was associated with relief of the patients' pulmonary symptoms. The response to nitroglycerin (0.4 mg) was similar in magnitude but of much shorter duration (approximately 15 minutes for nitroglycerin versus 4 hours for isosorbide dinitrate in patients with and without congestive heart failure. The slope (calculated by dividing the change in cardiac index or stroke work index by the change in pulmonary arterial end-diastolic pressure) was significantly (P less than 0.05) depressed in the patients with congestive heart failure. These data demonstrate that the symptomatic pulmonary venous hypertension can be effectively relieved by isosorbide dinitrate without further compromising left ventricular function.


Localization of antisera to LHbeta and FSHbeta in the rat pituitary gland. Pituitary glands from adult male and female rats were stained by the immunocytochemical bridge technique with antisera to ovine LHbeta and human FSHbeta. Peroxidase reaction product was localized in the same PAS-positive cells with both antisera. The cells varied in size and topographical distribution within the pars distalis. These observations support the concept that a single cell type is responsible for the synthesis of both LH and FSH in the rat.


Scanning electron microscopic study of the effects of pressure on the luminal surface of the rabbit aorta. The effects of pressure on the luminal surface of the rabbit aorta were investigated using the scanning electron microscope. The method followed was perfusion under hydrostatic pressure of a section of thoracic aorta, in vitro. The characteristic ridged pattern seen in sections fixed at zero hydrostatic pressure was to a large extent eliminated when fixation occurred at pressures equivalent to those experienced by the aorta at systole or diastole. This study suggests that the spiral ridged pattern is dependent upon the fixation pressure and may not be present in a normally functioning artery. Any attempts to characterize or interpret the appearance of the luminal arterial wall must take into account the effects of pressure.


Hypothesis: energy wastage in alcoholism and drug abuse: possible role of hepatic microsomal enzymes. Hepatic microsomal drug oxidation appears to be an energy-wasteful process because it has no known link with energy-conserving mechanisms such as the synthesis of ATP, and in addition it requires the uncoupled oxidation of NADPH. It is postulated that this can appreciably alter the energy balance of the whole body under certain conditions. Such an imbalance would be favored by the repeated intake of drugs that induce hepatic microsomal enzymes and by the provision of ethanol as a major source of calories. The hypothesis is consistent with the changes in body weight in humans and animals after chronic ethanol intake. It is supported by observations of an increased oxygen consumption in rats given ethanol or barbiturates in doses that induce hepatic microsomal enzymes.


Metrication of clinical laboratory data in SI units. The development and general concepts of the Système International d'Unités (SI units) are discussed. The basic and derived quantities and units of the SI used for clinical laboratory data are reviewed. Ranges of normal values for a number of body fluid constituents are given in the units in current general use and in SI units, with corresponding conversion factors.


Evaluation of amniotic fluid for aerobic and anaerobic bacteria. Studies of 117 pregnant women, 83 at term, were instituted to determine the bacteriologic state of amniotic fluid, utilizing both standard aerobic and anaerobic technics. A high association of postpartum infection was found in women who had long periods of premature reptured membranes and many vaginal examinations. Significant organisms including anaerobes, were isolated in many of these instances. Based on the findings of these studies, it is recommended that amniocentesis for aerobic and anaerobic cultures be done when membranes have been ruptured for 8 hours or more, and when the patient has had seven or more vaginal examinations during the course of labor.


Clonorchis sinensis and pancreatitis. Twenty-five after endemic exposure. Clonorchis sinensis is an aften-cited but rarely reported cause of acute pancreatitis. We report a patient with Clonorchis infestation detected 24 years after leaving the endemic area, in whom the parasite is a likely cause of pancreatitis. Recognizing the popularity of the Cantonese style of Chinese cooking and noting relaxation of travel restrictions to the endemic areas, we feel Clonorchis should be sought in the obscure case of pancreatitis, especially in Orientals and travelers who have lived in the endemic area.


Age trends in human chiasma frequencies and recombination fractions. II. Method for analyzing recombination fractions and applications to the ABO:nail-patella linkage. A new method is presented for studying the relationship between human recombination fractions and parental age at the time of conception. Assuming the sex specific recombination fraction to be a linear function of age, a feasible computer algorithm is described whereby the likelihood of multigenerational families can be calculated. Using this method and the likelihood ratio test, it is found that for the ABO:nail-patella linkage age (P= .17)is more significant than sex (p= .23) in its effect on the recombination fraction. The age effect, if it is real, appears to be limited to males: the paternal recombination fraction decreases by .0062(+/- .0036) per year.


Drug default among schizophrenic patients. This study attempted to isolate the relationship of two variables that operate to influence drug compliance among schizophrenic patients: the patient's attitude toward his disturbance, and the treatment milieu employed during hospitalization. Schizophrenic patients were administered the Rorschach test upon admission to the psychiatric service of a general hospital to determine their perception of their disturbance. Results of this psychological test were used to randomly select 48 patients who were then randomly assigned to two treatment milius: self-medication during hospitalization and as an outpatient, and traditional drug administration during hospitalization and self-medication as an outpatient. Phenothiazine drugs were used, and compliance was determined by urinalysis. Patients who were generally realistic in their perception of their disorder were significantly more compliant during hospitalization and subsequent outpatient treatment. The treatment milieu variable was not a significant influence. Further analysis via a linear regression model confirmed the relationship of several other compliance factors previously reported in the literature. The role of the patient's attitude toward his illness and the importance of personal relationships are considered in terms of the role of the pharmacist in influencing compliance.


Vasodilator drugs in peripheral vascular disease. The use of vasodilator drugs in peripheral vascular disease is reviewed. Discussed are actions and efficacy of direct-acting drugs such as isoxsuprine, papaverinek niacin and cyclandelate; the beta-receptor stimulating drug, nylidrin; and drugs which affect the sympathetic nervous system, such as tolazoline, reserpine, guanethidine, methyldopa, ergot alkaloids and alcohol. Both animal and clinical studies reveal little evidence of the effectiveness of vasodilator drugs in the treatment of obstructive arterial disease. In some patients with vasospastic diseases, vasodilators which act upon the sympathetic nervous system (reserpine and guanethidine) may have an ameliorating effect by increasing cutaneous capillary blood flow.


A double-blind investigation into the effects of ritodrine on uterine blood flow during the third trimester of pregnancy. The object of this double-blind crossover study was to investigate the effect of a beta-mimetic agent-ritodrine-administered intravenously at increasing infusion rates on uterine blood flow and the maternal cardiovascular system during the third trimester of normal pregnancies and pregnancies complicated by intrauterine growth retardation and/or hypertension. Uterine blood flow, maternal arterial blood pressure, maternal and fetal heart rate, and uterine activity were simultaneously recorded throughout the study. In normal pregnancies the changes in different parameters during ritodrine and placebo administration were slight. In the "pathologic" pregnancies there was a highly significant increase in maternal heart rate, differential blood pressure, and uterine blood flow during ritodrine administration. The differences in response to ritodrine and placebo were statistically significant in this later group. This study demonstrates increased sensitivity of the maternal cardiovascular system to this beta-mimetic agent in certain categories of high-risk pregnancies and possibily an increase in uteroplacental blood flow.


Maternal endotoxemia, fetal anomalies, and central nervous system damage: a rat model of a human problem. Endotoxemia is a common consequence of the gram-negative urinary tract infections that complicate human pregnancies. Only rarely, however, have the effects of maternal endotoxemia been evaluated by animal experiments or by human investigations. Data of the Collaborative Perinatal Study suggest an association between maternal endotoxemia and fetal central nervous system damage. For these reasons we performed controlled studies of the fetal effects of treatment of pregnant rats, at appropriate gestational ages, with E. coli endotoxin. We found a maximum 7 per cent incidence of fetal anomalies in the treated animals but no anomalies in controls. Placental light microscopy examinations indicated the mechanism to include Shwartzman-lixemia produces periventricular leukomalacia. We obtained an incidence of neuronal necrosis in treated fetuses that was 10 times greater than in control fetuses. It is therefore of importance that additional studies of the pathologic effects of endotoxin be performed.


Amikacin therapy of infections in neutropenic patients. Amikacin, a new aminoglycoside antibiotic, was utilized in the treatment of 49 cases of infection which occurred in 39 neutropenic cancer patients. Thirty-four patients (69 per cent) responded to this antibiotic. Pneumonia and septicemia were the most common types of infection treated and the response rates were 65 per cent and 75 per cent, respectively. Gram-negative bacili were responsible for 93 per cent of the identified infections and 74 per cent responded. E. coli, Ps. aeruginosa, and organisms of the Klebsiella-Enterobacter-Serratia group were the most common gram-negative bacilli causing infection. Responses were more frequent among patients who maintained higher serum concentrations of antibiotic, but the differences were not statistically significant. Patients with severe neutropenia (less than 100 neutrophils/mm3) had a response rate of 68 per cent. Toxicity was manifested as azotemia and hearing loss which occurred in 13 per cent and 6 per cent, respectively. However, toxicity was directly related to serum concentration and to the number of treatments with amikacin. This antibiotic is of potential importance because of its efficacy against gram-negative bacilli infections. Best results were obtained when sufficient drug was given as a continuous intravenous infusion to maintain serum concentrations of about 15 mu g/ml.


Parathyroid hormone and the regulation of acid-base balance. Parathormone (PTH) excess limits renal bicarbonate reabsorption. This may aggravate the acidosis in patients with renal insufficiency and secondary hyperparathyroidism. Why parathormone, the primary action of which is thought to be stabilization of the inonized fraction of calcium, affects acid-base balance remains uncertain. Parathormone not only promotes the release of calcium from bone but also mobilizes salts, including bicarbonate and phosphate. Accumulation of these anions in the extracellular fluid would limit the ionization of calcium. Teleologically it is not unexpected to find that, coincident with evolution of a mechanism which permits rapid mobilization of calcium from bone, a system had to develop which removed the byproducts of bone dissolution. If this concept is valid, parathormone-induced depression of renal bicarbonate reabsorption in uremia represents an undesired side effect of an adaptive mechanism. This would extend Bricker's "trade-off" hypothesis which ascribes metabolic bone disease due to PTH-induced phosphate loss to include metabolic acidosis resulting from diminished renal bicarbonate regeneration. Parathyroidectomy or phosphate restriction have been proposed for correction of the side effects of secondary hyperparathyroidism. These therapeutic manipulations cannot be recommended for general use. A more rational apprach for prevention of secondary hyperparathyroidism is the combined use of phosphate restriction with a short-acting vitamin D derivative.


Policy development and strategy in the licensure of speech pathologists and audiologists. This article presents an account of the licensure movement in the professions of speech pathology and audiology and the role of the American Speech and Hearing Association (ASHA) in that movement. The introductory section relates the evolution of ASHA's position on licensure from one of opposition in the 1960's to the current position of active support, whereas the body of the article delineates the processes by which three state speech and hearing associations initiated and brought to fruition their licensure efforts. The conclusion of the article summarizes the legislative recommendations made by ASHA members from the 25 states that have enacted licensure laws. These recommendations cover such areas as organizing a licensure effort, garnering support from professional and other groups, and managing the bill in the state legislature. The author concludes that, while the profession has benefited from its licensure achievements, efforts to protect present gains and secure new ones must continue.


Clinical pathologic correlation in viral hepatitis. The effect of the virus on the liver. In clinical pathologic correlations, including the potential effect of the virus on the liver, the morphologic features of the various stages of viral hepatitis are the firm information available today. With acute hepatitis being an inflammatory reaction to cell injury and necrosis, and chronic hepatitis being sustained inflammation, correlation with clinical features and functional defects is good in acute hepatitis and less so in the chronic stages. The pathogenesis of the diseases-including cell necrosis, inflammation, fibrosis, and cirrhosis formation-is reasonably well understood, and this knowledge assists both in prognosis and in monitoring of therapy. The localization of the components of the hepatitis B antigen and their effects, including the nature of the immune response, is the most exciting aspect of the clinical pathologic problem. Today's interpretations offer, at best, a working hypothesis promising further understanding of the evolution of the disease.


Psychosocial development among black children and youth: a reexamination. The fundamental assumptions and empirical evidence, upon which are based conventional views of the nature and meaning of black self-esteem, are examined. Review of the literature reveals that a number of these assumptions and conclusions have been drawn from rather weak empirical data. Results of recent investigations, suggesting alternative interpretations and conclusions regarding the level and quality of black self-esteem, are presented.


Recent advances in the study of the epidemiology of hepatitis B. Recent advances in the study of hepatitis B shed much light on the basic epidemiologic patterns of this unique infection. The spectrum of host responses following exposure is unusually wide. Hepatitis B appears to be one of the most widespread infections; the total number of chronic carriers of the hepatitis B antigen has been estimated as at least 120 million. The following factors have been found to be closely associated with the risk of hepatitis B; geography, sex, age at testing, age at primary infection, socioeconomic status, ethnicity, occupation, sharing a household with a carrier, sexual promiscuity, and immunologic responsiveness. Data concerning the infectivity of an asymptomatic carrier are ambiguous; whether a carrier can transmit the virus by sexual intercourse also remains unknown. Available evidence seems to suggest that genetic factors may be of importance in the aggregation and segregation of hepatitis B.


Overview: maintenance therapy in psychiatry: II. Affective disorders. In the first part of this overview the author reviewed the clinical literature on prophylactic treatment of schizophrenia with maintenance antipsychotic drugs. In this second part he reviews the literature on maintenance treatment of affective disorders with lithium and tricyclics. He concludes that the growing realization that maintenance treatment is necessary to prevent recurrences of both mania and depression in bipolar disease and depression in unipolar disease is one of the most important advances in psychiatric therapeutics. The effectiveness of maintenance treatment provides the potential for a truly preventive approach to the treatment of affective disorders.


Community mental health center legislation: flight of the phoenix. The author describes the history and implications of recent legislation affecting community mental health centers. New legislative requirements will result in centers seeing typically underserved populations (children, the elderly, and drug and alcohol abusers) as part of 7 new essential services. The impact of new grant mechanisms and the role of the National Institute of Mental Health in assisting and evaluating centers are examined. The author concludes that as a result of legislative and other trends in mental health care, psychiatrists will be seeing sicker patients for shorter periods, role confusion in the mental health professions will lessen, and centers will be forced to devote much time and effort to financial concerns and appropriate allocation of manpower.


A note on some recent studies of released mental hospital patients in the community. The author conducted a literature search for follow-up studies of patients released from state mental hospitals to the community to assess the impact of released patients and the community on one another. She found that the follow-up studies lacked comparability in several ways and concludes that there is a need for greater comparability in future studies so that their validity as indicators of patients' postrelease functioning may be increased.


An eclectic approach to quality control in fee-for-service health care: The New York City Medicaid Experience. A computer-based system for evaluating the quality of fee-for-service health care in the New York City Medicaid Program is described. Specific information is sought for use in educational, enforcement and managerial activities to improve health care quality. The gathering of this information necessitates coordinated assessment of the structure, process and outcome of health care, through inspection of offices, computerized analysis of patterns of practice as revealed by billing forms, and reexamination of patients. The program's focus on patterns of practice, its use of multiple assessment techniques, and its concentration on unequivocally substandard care circumvent several limitations on current evaluation technology. Implications for Professional Standards Review Organizations and national health insurance are explored.


Canine salmonellosis: A review and report of dog to child transmission of Salmonella enteritidis. Dogs have been shown to harbor 53 salmonellae serotypes. Multiple simultaneous infections with 2  to 4 serotypes have been observed. The prevalence of canine salmonellosis may be a high as 27 per cent. Salmonella typhimurium and S. anatum are the most common etiologic agents. Dogs commonly experience a sub-clinical course of salmonellosis. Some investigators state that the dog may serve as a source of human infections. A few reports in the literature have documented this fact. The transmissions of S. enteritidis from dog to child is described in this article.


The paleoepidemiology of porotic hyperostosis in the American Southwest: Radiological and ecological considerations. Porotic hyperostosis was observed in 34 percent of 539 crania excavated from sites in Arizona and New Mexico. Common causes of this cranial pathology in the Old World (thalassemia, sickel cell anemia, and malargia) do not explain its occurrence in the American Southwest, as malaria and hemoglobinopathies are not known to have existed in the New World prior to European contact. Iron deficiency anemia which may also be assoicated with porotic hyperostosis occurs on a mass level only with hookworm infestation or nutritionally-related iron deficiency. Since hookworm infestation is rare in the American southwest and has not been reported in prehistoric southwestern American Indians, the hypothesis of nutritional anemia was examined. In canyon bottom sites where the diet was heavily dependent on maize, which is low in iron and also contains an inhibitor of iron absorption, significantly more crania had porotic hyperostosis than in sage plain sites, where the diet included ample animal protein rich in easily absorbable iron (p less than .001). Furthermore, canyon bottom children, who were more susceptible to iron deficiency anemia, had a higher incidence of porotic hyperostosis lesions than adults (p less than .0001).


Long-term exocrine function of the pancreas transplant. The long-term exocrine function of fifty-nine pancreaticoduodenal isografts was evaluated in rats for up to one year post transplantation. At one, three, six, nine, and twelve months after transplantation the grafts were cannulated and the exocrine secretion was collected. The volume, protein content, pH, amylase and trypsin concentrations, and electrolyte composition of the secretion were compared with those obtained from the host pancreas in nineteen control rats. Twenty-four hour secretion studies demonstrated normal basal function of the pancreas transplant when compared with that of the host. Pancreozymin stimulation caused an increase in volume, trypsin concentration, and amylase concentration of the graft pancreas secretion that was similar to those seen in the host. These studies indicate that there is normal exocrine secretion of pancreas transplants in the absence of rejection and that denervation of the gland has little direct effect on over-all pancreatic function.


Transplantation of the pancreas into a retroperitoneal jejunal loop. A new technic of pancreatic transplantation was developed and assessed in sixty-nine dog experiments. The body and tail of the pancreas were transplanted into the side of the Roux-en-Y retroperitoneal limb of jejunum. A dual venous anastomosis of the splenic vein to the vena cava was utilized to avoid venous congestion. Mean survival with normoglycemia was 32.4 days in thirty dogs with autografts and 24.6 days in twenty-seven dogs with allografts. Two dogs with autotransplants remain alive at 106 and 128 days, and the longest normoglycemic survival achieved with an allograft was 85 days. With experience the incidence of pancreatitis and abscess formation decreased. The problem of venous thrombosis was eliminated and the patency of the pancreatic duct was maintained.


Reflux gastritis: the consequences of intestinal juice in the stomach. The consequences of exposure of the intact stomach to intestinal contents were examined in six dogs. Diversion of duodenal contents through the stomach lead to the following changes: histologic gastritis in both antrum and corpus, increase in resting and postprandial serum gastrin levels, increased parietal cell density in four of six animals, and enhanced maximal acid secretory capacity in three of six animals. No significant changes were seen in insulin-stimulated acid secretion, insulin-stimulated pepsin secretion, antral gastrin levels, or G cell numbers. We conclude that chronic exposure of the intact stomach to duodenal contents results in gastritis and an amplified gastrin response to food. Parietal cell numbers and maximal acid secretory capacity are increased in some animals.


Prospective studies of gastric secretion in trauma patients. Patients who had cranial injuries and those who were less severely injured had a normal gastric acid output. Pepsin output decreased throughout the first 72 hours after trauma. Gastric juice protein output was slightly increased. Gastric mucosal cell renewal as estimated by gastric juice DNA was increased. Patients who were more severely injured and those with intra-abdominal trauma had markedly increased gastric acid, pepsin, and protein output after increased gastric mucosal cell exfoliation but a relatively decreased gastric mucosal cell renewal between 36 and 72 hours after trauma. It is concluded that the gastric mucosa must be protected by antacids and/or gastric aspiration before 24 hours after trauma and continued through at least 72 hours. This study supports the importance of acid-pepsin damage during gastric mucosal cell exfoliation and decreased renewal in trauma patients and indicates the timing and value of prophylactic treatment.


Lister on chloroform.

Lister on chloroform. The attitude of Joseph Lister (1827-1912) to chloroform is considered with particular reference to contemporary methods of administration and the effect of the agent on cardiac and respiratory function.


Prevention of headache consequent upon dural puncture in obstetric patient. Three consecutive groups of 50 obstetric patients received spinal anaesthesia. The control group received no prophylactic treatment for spinal headache, the second group were treated by the epidural injection of 20-25 ml of normal saline and the third group were treated by abdominal binder. There was no statistically significant difference between the two forms of treatment but the results show that the incidence of post spinal puncture headache can be significantly reduced by applying either of them.


Topical cocaine and general anaesthesia: an investigation of the efficacy and side effects of cocaine on the nasal mucosae. A double-blind investigation has been carried out using three different doses (20, 35 and 50 mg) of cocaine which were sprayed onto the nasal mucous membranes of forty-five patients for nasal surgery. The cocaine was administered after induction of general anaesthesia in all cases. The 20 mg dose of cocaine dissolved in 2 ml of saline without adrenaline was found to be safe and produced adequate nasal decongestion in the absence of other predominant factors. The efficacy of cocaine and its safety with regard to systemic absorption are assessed.


Errors in pneumotachography with intermittent positive pressure ventilation. Instrument errors that can occur when pneumotachography is used during Intermittedt Positive Pressure Ventilation (IPPV) have been described previously (Kafer 1973). Our efforts to eliminate these errors led to the discovery of further inaccuracies, which appear to be due to the design of the differential pressure transducers used with pneumotachograph head. A system was used in which a sine-wave pump delivered a constant tidal volume to a dummy lung, the tidal volume being measured by means of a pneumotachograph. Using Grass, Statham and Devices differential pressure transducers, the volume recorded as leaving the dummy lung was consistently greater than that recorded as entering, and changing the pneumatic polarity of the differential pressure transducer produced large differences in the recorded volume. In some cases the error was greater than the volume being measured. There would seem to be several causes of such errors. The Sanborn 270 differential pressure transducer and the Greer micromanometer appeared to be free of these artifacts. The results of this study throw into doubt much previously published work using pneumotachography during IPPV.


The peri-operative measurement of cardiac output in infancy by the thermodilution technique. Cardiac output has been measured in infants by thermodilution during and after surgery. A method employing commerically available equipment has been developed. An animal model has been devised whereby right heart outputs of 210 ml to 2240 ml, measured by thermodilution, could be compared with left heart outputs measured by an aortic by-pass. The results of this study suggest that thermodilution is a simple, accurate method for measurement of cardiac output in infancy.


The Geoffrey Kaye museum collection of portable ether inhalers. A collection of twenty nine portable "hold in hand" ether inhalers is housed in the Geoffrey Kaye Museum. These inhalers are briefly described together with some historical notes.


Delta-9-tetrahydrocannabinol and lysergic acid diethylamide: comparative changes in the supraoptic and paraventricular neurosecretory activities in rat hypothalamus. Acute delta-9-tetrahydrocannabinol (Delta-9-THC) administration (50 mg/kg, i.p.) produced accumulation of stainable neurosecretory materials (NSM) in the neural lobe (NL) region with a concomitant dispersion of stainable NSM in the neuronal perikarya of hypothalamic supraoptic nucleus (SON) and paraventricular nucleus (PVN) regions. Chronic treatment with delta-9-THC (10 mg/kg, 15 days) produced marked accumulation of NSM in the NL with more prominent degranulation of the neuronal perikarya of SON and PVN. Acute LSD treatment (50 mug/kg) caused accumulation of stainable NSM in the NL region, with unaltered perikaryal distribution pattern of both SON and PVN; chronic LSD treatment (10 mug/kg, 15 days), on the other hand, caused marked increase of NSM in the neuronal perikarya of SON and PVN with no prominent accumulation in the NL. Results indicated that chronic exposure of delta-9-THC lowered the functional activity of SON and PVN neurons while chronic LSD treatment stimulated the hypothalamo-neurohypophyseal neurosecretory system of rats.


Successful use of a reduced dose of protamine after cardiopulmonary bypass. The dose of protamine necessary to reverse heparin was examined in 60 patients. Half the patients (controls) received a reversal dose of protamine equal to the entire amount of heparin given them, while half received a reversal dose based on a heparin half-life of 2 hours. Postoperative chest drainage for the first 12 hours and for 48 hours was markedly reduced in patients given the reduced dose of protamine. Platelet counts were higher and postoperative clotting studies varied less from control in patients receiving the smaller dose of protamine. The authors suggest reevaluation of the dose of protamine necessary to reverse the anticoagulant effects of heparin in patients for cardiopulmonary bypass, since larger doses protamine may contribute to the conditions which increase postoperative bleeding.


Hemodynamic effects of isoflurane and halothane in patients with coronary artery disease. In 12 patients undergoing saphenous vein coronary artery bypass operations, cardiovascular hemodynamics were studied in the awake state (control) and during anesthesia with isoflurane (inspired concentration, 1.24%, 7 patients) or with halothane (inspired concentration, 0.77%, 5 patients). Isoflurane anesthesia was accompanied by decreases of 19% in the cardiac index (Q), 19% in mean arterial pressure (AP), and 16% in heart rate (HR). Only the change in AP was statistically significant. Halothane anesthesia was accompanied by decreases in Q (28%), AP (22%), and HR (10%). The changes in Q and AP were significant. HR did not change significantly following the induction of anesthesia with either agent. The decrease in AP was similar with both agents, and, in this regard, neither agent was clearly superior for patients with occlusive coronary artery disease.


Allergy of the nervous system: a review. Allergies of the nervous system cause diverse behavioral disturbances, including headaches, convulsions, learning disabilities, schizophrenia and depression. Some of the biological mechanisms have been established by research; others remain to be explored. Effective diagnosis and treatment include the elimination diet, followed by dietary rotation and avoidance of offending substances.


Changes in airway resistance following droperidol, hydroxyzine, and diazepam in normal volunteers. The effects of droperidol, hydroxyzine, and diazepam on airway resistance (AR), functional residual capacity (FRC), and thoracic gas volume (TGV) were compared, using a CPI model-2000 body plethysmograph. Significant decreases in AR were seen following droperidol and hydroxyzine at all time intervals. A significant increase in AR also was noted 90 minutes after diazepam injection. FRC significantly decreased at 60, 90, 120, and 150 minutes following droperidol, and at 90 minutes following hydroxyzine, while no change was seen following diazepam. No significant changes in TGV were seen following administration of any of the drugs.


Anesthesia for transcervical thymectomy in myasthenia gravis. This review of anesthetic experience in 100 cases of transcervical thymectomy for myasthenia gravis (MG) at The Mount Sinai Hospital (1970-1974) underlines current trends in the surgical management at Mount Sinai, where transcervical thymectomy is the procedure of choice for all patients with nonthymomatous MG and for selected patients with thymomatous MG. The transthoracic approach is now limited to malignant thymomas and tumors not accessible through the transcervical approach. Formerly, patients coming for thymectomy either already had a preexisting tracheostomy, or an elective tracheostomy was performed at the time of thymectomy. Since 1972, none of these patients has had elective tracheostomy at the time of operation, and only four were performed in the postoperative period, patients being intubated orotracheally at the time of operation. The tube is usually removed within 1 hour after completion of thymectomy. All patients are followed in the intensive care unit for 24 hours or longer, under close supervision of experienced personnel aware of the inherent problems and able to assist ventilation at any stage. This approach has greatly changed the postoperative course of this disease.


[Natural history of molecular pathology]. The author recalls the main stages of biosynthesis of proteins based on molecular pathology : transcription of DNA into messenger RNA, the genetic code, translation of protein molecules and regulation of their synthesis. Examples are then given of qualitative and quantitative disturbances. Qualitative disturbances with synthesis of abnormal proteins, or protein diseases of protein structure, together with their consequences. Quantitative disorders, with modified synthesis of normal proteins, result very often from abnormalities of structural genes, but also from abnormalities of transcription or translation. The author considers, in conclusion, pathological situations based on molecular abnormalities for mutations occur at random and it may be possible to correct them by genetic manipulation.


Effect of position (semirecumbent versus supine) on postoperative oxygenation in markedly obese subjects. In 22 markedly obese, otherwise healthy, women studied postoperatively on each of days 1 through 3 after intra-abdominal operation, the effect of position change on arterial oxygenation was assessed. There was a statistically significant decrease in PaO2, an increase in A-aDO2 and a simultaneous modest reduction in PaCO2 with the assumption of the supine position on postoperative days 1 and 2, but not positional difference demonstrable in any studied variable by day 3. This report suggests that during the first 48 hours after abdominal surgery in obese patients, assumption and maintenance of the semirecumbent posture is a valuable therapeutic modality to improve arterial oxygenation.


[Study of the transferable factors of antibiotic resistance in the enterobacteria isolated at the Regional Hospital Center of Nantes]. Characteristics of transferable resistance of 72 entero-bacteriaceae resistant to one more antibiotic, isolated from February to September 1972, showed that this was common. Multi-resistant strains permit one to obtain transfer of various characteristics either alone or together in 76 per cent of cases, whereas strains with less than three characteristics, transferred in only 9 per cent of cases. The transfers were uncommon in the case of Proteus compared with other enterobacteriaceae and, in particular, Klebsiella, Escherichia coli and Salmonella.


A regional anesthetic approach for renal transplantation. After consideration of surgical demands and patient condition, regional anesthesia is preferred for renal transplantation at the University of Rochester Medical Center. Of 75 consecutive cases, 64 were successfully managed with single high-dose spinal anesthesia (10 to 20 mg tetracaine, mean 16.5 mg). The technic avoids untoward effects of neuromuscular blocking drugs, iatrogenic pulmonary infection from anesthetic equipment, and problems with potent general and anesthetics. Patients are made comfortable by judicious low-dose sedation. Cardiovascular instability and blood loss are not troublesome. There have been no permanent neurologic sequelae or postspinal headaches. The authors believe this technic produces minimal biochemical and physiologic derangement for renal transplantation in the patient with chronic renal failure.


Pathogenesis of edema disease in swine: pathologic effects of hemolysin, autolysate, and endotoxin of Escherichia coli (O141). Hemolysin, cell-free autolysate, and lipopolysaccharide (LPS) prepared from Escherichia coli (O141) were parenterally administered to 113 weaned pigs. Both the hemolysin and the cell-free autolysate were crude preparations which probably contained several biologically active substances. Pigs in all groups which die less than 72 hours after injection had similar gross and microscopic lesions. The pigs which survived (chronically affected pigs) were killed 3 to 12 days after injection. Of the pigs that lived more than 72 hours after injection, those given hemolysin and autolysate had generalized vascular myolysis and fibrinoid necrosis, whereas those given LPS had morphologically normal blood vessels. The vascular changes produced by hemolysin and autolysates of E coli (O141) were the same as the histologic angiopathy of naturally occurring edema disease of pigs. The LPS produced acute lesions of endotoxin shock in the pigs, but did not produce the angiopathy characteristic of edema disease. Typical clinical signs of naturally occurring edema disease were not a consistent observation in any of the treatment groups.


Rapid anesthesia induction in combat casualties with full stomachs. A series of 50 combat-injured patients given crash intubation for rapid induction of anesthesia is presented. The technic consisted of injection of 3 mg of d-tubocurarine and 0.4 mg of atropine IV, preoxygenation by face mask for 3 minutes, and then injection of sodium thiopental or ketamine, followed immediately by 60 to 80 mg of succinylcholine IV. Intubation was performed with a cuffed tube after cessation of spontaneous respirations and relaxation of the jaw. In the entire series there was no vomiting or aspiration on induction. Thirty-six patients were induced with thiopental and 14 with ketamine. Three patients given thiopental and 2 given ketamine had a fall in blood pressure to below 100 torr systolic. The average BP change was in a positive direction with both agents.


Separation from whey of three growth factors for Streptococcus agalactiae. Wheys of milk and colostrum were treated with ethanol and the concentrated supernatant fluids were subjected to chromatographic procedures (anion exchange resin, using distilled water as eluent). The fractions were tested for capabilities to stimulate the growth of Streptococcus agalactiae in a mixture (1:32) of pasteurized milk and steamed milk. Three stimulatory factors (F), designated F-1, F-2, and F-3, were separated; F-1 was nonionic, and F-2 and F-3 were cationic. A mixture containing any 2 factors gave greater stimulation than either factor tested alone, and a mixture of all 3 gave the greatest stimulation. The F-2 activity was attributed to cystine.


N2O volumes absorbed and excreted during N2O anesthesia in children. Exhaled volumes were measured in 8 children during uptake and elimination of 3 percent and 75 percent N2O, using a volume-controlled ventilator. Absorption of 75 percent N2O during induction reduced the exhaled minute volume, which fell a mean of 16 percent in the 1st or 2nd minute and returned to normal by 15 to 20 minutes. Elimination was the mirror image of uptake; the mean increase in the exhaled minute volume was 13 percent. The concentration effect during uptake was measured (3 percent versus 75 percent N2O) and the data were used to calculate a fall in alveolar volume of at least 8 percent by the 2nd minute of uptake. The type of ventilation (volume-limited, pressure-limited, or spontaneous) was seen to have a modifying role on the respiratory pattern caused by the absorbed and excreted volume of N2O.


The effect of terbutaline in exercise-induced asthma. A double blind study of 5 asthmatic subjects in remission demonstrated that the severity of bronchoconstriction after exercise was decreased by a single oral dose of 5 mg of terbutaline. The effect lasted for at least 6 hours and was significantly better than the protection afforded by 20 mg of metaproterenol, which was itself more effective than a placebo. In these doses, neither terbutaline nor metaproterenol affected heart rate or blood pressure at rest or in exercise, and no drug-induced side effects were found.


Acute torsion of the gallbladder: review of the literature and report of a case. A case report is presented, and the literature reviewed, of acute torsion of the gallbladder. Originally described as a rare pathological entity, it is being witnessed more frequently as a probable concomitant of increasing life expectancy. Because it is a benign condition if diagnosed rapidly and treated surgically, it should be considered in differential diagnostic possibilities. When encountered intraoperatively, prompt recognition of the process should lead to detorsion of the organ and cholecystectomy as the procedure of choice.


Current status of lumbar sympathectomy.

Current status of lumbar sympathectomy. A review of a recent series of lumbar sympathectomies would appear to support the continued use of the procedure in the treatment of selected patients with localized pre-gangrenous lesions or superficial ischemic ulcerations in whom arterial reconstructive operation is not feasible. A conclusion regarding the use of the procedure in conjunction with bypass grafting or thromboendarterectomy cannot be made. Indications for the treatment of nonatherosclerotic disease are briefly mentioned. Nevertheless, the morbidity and mortality from the operation itself is significant and suggests that its use as a temporizing measure in highly doubtful cases is not warranted.


Therapeutic use of inducers of interferon on Herpes simplex keratitis in humans. The double-stranded RNA interferon inducer polyinosinic-polycytidylic acid (In-Cn) was used to treat acute dendritic keratitis in man in a double-blind manner with IDU. The success rate for this agent was similar to IDU and was found efficacious in cases not responsive to IDU. Prophylaxis with In-Cn did not prevent recurrences of epithelial herpes, but such recurrences were responsive to IDU or In-Cn.


[Studies on haemolysins of "enterobacteriaceae" (author's transl)]. Haemolysin production of 1,103 strains of Enterobacteriaceae was investigated on trypticase soja agar containing washed horse erythrocytes. Nearly all haemolytic strains belonged to the genus Escherichia (103 haemolytic strains out of 349 examined). The 3 remaining haemolytic strains belonged to the genus Serratia (of which 244 strains were examined). Plasmidic determinism of haemolysis was demonstrated for six of the Hly+ E. coli strains, and these plasmids were transferred to E. coli K12, Salmonella typhia and S. typhi-murium. Investigations about coexistence of four of these plasmids with "metabolic" plasmids and with representatives of the plasmids compatibility groups presently known, showed that two of these plasmids were fi+ and belonged to the FIII group, and that two other were fi- and related to the I2 group. Thus, different plasmids can determine haemolysin-production in E. coli strains.


The effect of 10-0 running nylon versus 8-0 silk on the healing of corneal gragts. A previously reported well standardized tensile strength model in rabbits was sued in order to answer whether or not monofilament nylon does in fact delay corneal wound healing in general, and in particular, in corneal grafts. The tensile strength of penetrating keratoplasty wounds closed with either 10-0 running monofilament nylon or 8-0 interrupted black silk was measured in rabbits. The tensile strength of wounds closed with either suture was comparable in all groups. The advantages of 10-0 nylon in corneal transplantation and cataract extraction was presented. In addition, the assumption that the tensile strength of linear central wounds parallels that of a circular trephine wound was proven to be correct.


Sythesis and turnover of phospholipids in Escherichia coli cells with inhibited DNA synthesis. The relative amounts of individual phospholipids are not greatly affected in E. coli B cells inhibited with mitomycin C, nalidixic acid or hydroxyurea. Turnover and synthesis of phospholipids continue in the first 40 minute period of treatment with nalidixic acid and then cease. Arrest of phospholipid synthesis is not coupled with protein synthesis since beta-galactosidase is still induced after cessation of phospholipid metabolism. The cells, washed free of drug, resume growth as well as synthesis and turnover of phospholipids. During the lag phase preceding the renewal of cell division, a decrease in phosphatidylglycerol content and an increase in cardiolipin content are observed. The ratio of these phospholipids is then comparable with that found in normal non-dividing cells. We suggest that the variation in the relative contents of cardiolipin and phosphatidylglycerol might be related to the cell division process.


[Sensitivity and resistance of pathogenic yeasts to 5-fluoropyrimidines. I.--Relation between the phenotypes of resistance to 5-fluorocytosine, the serotype of Candida albicans and the ecology of various species of Candida of human origin (author's transl)]. The sensitivity to 5-fluorocytosine (5-FC), 5-fluorouracil (5-FU) and 5-fluorouridine (5-FUri) of 583 strains of C. albicans of human origin shows a relationship between their ecology, their serotype and their sensitivity to 5-FC. The incidence of the primary resistant strains isolated from patients with systemic candidiasis is of 4%, and 88.8% of the resistant strains belong to serotype B. In a closed community of premature infants the only resistant isolate amongst 78 strains recovered during hospitalization also belong to the B serotype and was introduced from outside. African strains of vaginal origin showed a higher incidence (21.6%) of resistance than did the european strains (4.5%) and this resistance was related to the B serotype predominant in the African environment. This raises the problem of the structure of the cell wall in connection with the active sites, the antigenic determinants and the enzymatic equipment.


Corneal chromomycosis: double infection by Phialophora verrucosa (Medlar) and Cladosporium cladosporioides (Frescenius). Phialophora verrucosa and Cladosporium cladosporioides were isolated from a corneal ulcer. The lesion had been previously treated with antivirals and steroids and did not respond to Pimaricin therapy or conjunctival flap. A penetrating keratoplasty was performed with good functional and optical results. Chromomycosis of the cornea is an unusual infection. This is the second case of Phialophora in Florida and the first case of Cladosporium infection.


Importance of nasal lesions in early lepromatous leprosy. There are some 20 million people in the world with leprosy. In the lepromatous form of the illness the nose becomes infected very early in the disease process. The nasal discharge which occurs is heavily bacillated and is the most potent source of exit of Mycobacterium leprae from the body. The necessity for early diagnosis and treatment of leprosy in the absence of an effective vaccine is discussed and the pathological changes that occur in the nose are outlined. The roles which the leprologist and the rhinologist are able to play are mentioned.


Observations on a trypanosomatid flagellate in a flea, Peromyscopsylla silvatica spectabilis. The method of attachment of a trypanosomatid parasite to the cuticular epithelium of the hindgut of a flea Peromyscopsylla silvatica spectabilis by a desmosome-like structure is described; the flagella are modified and have enlarged intraflagellar areas which occupy the whole surface area of the gut, including clefts and folds of the epithelium. Unusual features of the parasite itself include a very much reduced flagellar pocket and pellicular microtubules which are made up of doublets and triplets. The problems of differentiation and characterisation of monogenetic insect flagellates are discussed in the light of these findings.


Treatment of post-prostatectomy urinary incontinence with heterologous bone implant. A description is given of an improvised method used in the treatment of post-prostatectomy urinary incontinence in a case in which a Kaufman 2 procedure had failed. At the second-operation, Kieler spongiosa bone packaged in a dacron net was used to support the bulbous urethra.


Loperamide in the symptomatic control of chronic diarrhoea. Double-blind placebo-controlled study. Fifteen patients (20-66 years) with persistent diarrhoea of varying aetiology were selected for an open trial of loperamide 2 mg capsules. The optimal daily dose for substantial reduction of the diarrhoea ranged from two to seven capsules. Eleven patients showed a significant improvement in stool consistency, a highly significant decrease in stool frequency and a decrease of abdominal cramps. One ileostomy patient with abundant ileostomy output and intermittent leaking of the ileosotmy appliance at night experienced a substantial reduction of the stoma output with virtual disappearance of soiling accidents as night. Loperamide appeared to be ineffective in two patients with cholerrhoeic diarrhoea; in one patient with laxative-induced diarrhoea and in one patient with probable nervous diarrhoea. The eleven successfully treated patients then entered a doubleblind placebo-controlled trial for ten days or util relaps, the daily dose being indentical to the optimal one previously determined in the open phase of the study. The investigator was able to guess the code correctly in ten out of eleven cases. The drug was well tolerated. Because of its considerable efficacy and low side-effect liability, loperamide has to be considered a promising drug in the treatment of chronic diarrhoea.


Quantitative antibiotic susceptibility testing: Haemophilus influenzae type B. Twelve strains of Haemophilus influenzae were tested for susceptibility to gentamicin, ampicillin, chloramphenicol and cephalothin using two methods, agar dilution and microdilution (broth). Although inocula and incubation conditions were standardized, significant differences in the minimal inhibitory concentration (MIC) were seen as a result of growth media. Method dependent differences were also observed for some antibiotics. Notwithstanding such variation, high level resistance of H. influenzae to ampicillin was readily detected by either broth or agar dilution tests.


Alpha-1-antitrypsin deficiency: a review; 1963-1975. Alpha-1-antitrypsin (A1AT) deficiency originally was recognized as a biochemical abnormality in patients with pulmonary emphysema. Studies of the protein nature of A1AT during attempts to help explain the disease, led to the recognition of a protein polymorphism which expressed itself in several different phenotypes. As investigative work progressed, the spectrum of diseases associated with a deficiency of A1AT increased. Methods for determination of quantitative levels have been developed but these have proved lacking for the discrimination of the various phenotypes, for which specialized testing is necessary. Of the clinical states associated with deficiencies of A1AT, pulmonary emphysema and hepatic disease are the best defined. Pathogenetic implications, however, remain elusive. As a consequence, preventive aspects are debatable and the usefulness of the determination of A1AT levels as screening measures is controversial.


Molecular and genetic recombination of bacteriophage T4. Most genetic characteristics of T4 recombination (the effects of chromosomal termini on recombination, heterozygosity, high negative interference, base mismatch repair, polarized segregation, and the stimulation or depression of recombination in response to phage mutations or external perturbations) can be expressed adequately in terms of our present understanding of the molecular events of T4 infection cycles. T4 DNA replication begins and ends with linear chromosomes and does not require a circular intermediate. Replication is bi-directional, possibly from multiple origins. Two phases of replication are distinguishable: (a) an early mode during which about 20 progeny copies of infecting chromosomes are made prior to (b) a recombination-dependent mode during which progeny molecules associate to form covalently joined linear concatemers. Further replication is generally arrested if concatemerization is prevented. T4 DNA recombination depends on the production of single-stranded gaps and termini. If replication is inhibited, the single-stranded regions are produced by deoxyribonuclease activities. In contrast, during partial replication of damaged chromosomes, during slow replication when enzymes or subtrates are limited, and during normal replication, they are formed by strand-displacement DNA polymerization. As a rule, any agents or perturbations that cause an accumulation of single-stranded regions stimulate recombination, whereas efficient repair of such regions depresses it. Both the preservation and pairing of single-stranded regions are facilitated by the gene-32 single-stranded DNA binding protein. Covalent repair of strand interruptions between recombined DNA segments requires polymerases or nucleases as well as ligases.