[The thermophilic streptomycetes flora in milk powders and condensed milk products (author's transl)]. 247 specimens of powdered milk and 165 of condensed milk were tested for their contamination with thermophile Streptomycetes. Colonies of these contaminants were isolated from all specimens of powdered milk and from 73 samples of condensed sweeted milk. The isolated strains corresponded with the following species of thermophilic Streptomycetes: Thermoactinomyces vulgaris, Tsiklinsky 1899, Thermoactinomyces vulgaris, Tsiklinsky 1899 "giant colonies", Micromonospora sp. (Agre et al., 1).


Occurrence and thermoresistance of thermophilic streptomycetes spores in milk. 200 samples of raw milk and 100 samples of pasteurized milk were tested for the presence of thermophilic streptomycetes. One ml of raw and pasteurized milk contained mean 8.42 and 14.95 thermophilic streptomycetes, respectively. The isolated strains belonging to the species Thermoactinomyces vulgaris Tsiklinsky 1899 and Micromonospore sp. (Agre et al., 1972) were identified. To determine the survival of spores of these thermophiles after pasteurization, samples of milk were heated at 63.5 degrees C/30 min and at 75 degrees C/15 s. Ampouls with this milk, dairy pasteurized milk and raw milk were heated for the same time intervals at 100, 105, 110 and 120 degrees C. Thermophilic streptomycetes spores contained in the investigated milk samples survived the both of pasteurization temperatures. A relative high number of thermophilic streptomycetes spores survive the heat treatment at 100 degrees C. The heat resistance at 105, 110 and 120 degrees C is distinctly lower. The most resistant in the range of the testet temperatures proved spores of the species Thermoactinomyces vulgaris Tsiklinsky 1899.


Intrathecal neurolysis.

Intrathecal neurolysis. The present status of intrathecal neurolysis with phenol, alcohol, chlorocresol and saline in the management of chronic pain has been discussed and the results of treatment reviewed. The particular use of these techniques in the therapy of pain due to malignant conditions has been stressed.


Ultrastructural localization of phospholipases in the Clara cell of the rat bronchiole. The Clara cell of the bronchiole is unique to the lung; the cell's function is not clear. The localization of the lipid-hydrolase enzymes phospholipase, lysophospholipase, and lipase was examined ultrastructurally in the Clara cell of the rat bronchiole. The secretory granules of the Clara cell showed a strong reaction of lysophospholipase and a weak reaction of lipase. Phospholipase activity was not detected intracellularly. These findings suggest that the Clara cell secretes lipase-phospholipase into the bronchiolar lumen, thus catabolizing the pulmonary surfactant phospholipids.


The role of sensitizing proteins in milk allergy. In clinical allergology and particularly during childhood, we quite frequently encounter patients who are allergic to milk. This has usually been confirmed by the clinical history and by skin testing. Statistics show a sensitization to cows' milk of between 0.3 and 7% of the world's population. In view of the diversity of opinions about an immunological problem of such clinical importance, we decided to carry out a clinical study to determine the sensitization to different fractions in patients allergic to milk. For this study, 82 patients were selected with a history of milk allergy together with strongly positive (++++) skin tests. Simultaneous intracutaneous tests were also performed with Alpha-lactalbumin, Beta-Lactoglobulin and Casein. The following points summarize our conclusions. 1. In milk allergy, lactoglobulin is the fraction with the greatest sensitizing potential (76.8% of our cases). 2. The alpha-lactalbumin fraction sensitized 59.7% of our cases, but gave weaker positive reactions. 3. Casein is the least sensitizing of the fractions studied, affecting 42% of the patients. 4. Taking into account that many patients with a positive history of milk allergy may show negative reactions when tested with whole milk and positive reactions to one of the three fractions discussed, it would be advisable to test routinely with these three fractions as well as with whole milk.


False diagnosis of orbital apex tumor by CAT scan in thyroid eye disease. Computerized transaxial tomography is now the procedure of choice in diagnosing exophthalmos. Caution must be exercised, however, in interpreting the results. The patient reported here had a swollen inferior rectus muscle that simulated an orbital apex tumor on CAT scan.


[Antitumor properties and toxicity of a carminomycin and protein complex]. The properties of carminomycin complexes with protein, a bovine serum albumin prepared with two different methods using glutaraldehyde or carbodiimine were studied. The complex prepared with the use of carbodiimine was biologically inactive. The complex prepared with the use of glutaraldehyde had a molecular mass of about 15 000 000 dalton, was more toxic than carminomycin and possessed proportionally higher antitumor activity and a wider antitumor spectrum. The studies on the use of the method of carminomycin complex formation with antitumor immunoglobulins are promising.


[Interaction of sibiromycin with soluble chromatin from the cells of murine NK/LI lymphadenosis]. Interaction of sibiromycin with chromatin from NK/Li cells was studied. It was shown that the chromatin proteins had no significant effect on the amount of the antibiotic firmly bound with DNA. The difference observed in the kinetics of the sibiromycin interaction with chromatin and DNA from NK/Li cells was not induced by replacement of a part of the DNA bound proteins. Possibly the chromatin proteins hampered formation of DNA conformation necessary for sibiromycin binding.


[Humoral immune response--cervical cancer patients: lymphocytotoxic antibodies (author's transl)]. Sera of 120 cervical cancer patients as well as that of 116 healthy control persons were screened for lymphocytotoxic antibodies using microlymphocytotoxic tests variated in temperature and incubation time. In 76 of 120 cancer-sera (63.3%) lymphocytotoxic antibodies could be detected in comparison with 26 sera of 116 controls (22.4%); p less than 0.0005. With the differentiation into the stages of the disease the highest percentage of lymphocytotoxic antibodies was found in patients with stage 0 of cervical cancer. The presence of lymphocytotoxic antibodies in sera of cervical cancer patients suggest the possibility that this disease is an allotransplant as well as expression of an autoimmune process.


[The application of a radionuclide technique for uroflowmetry and determination of residual urine in gynecology (author's transl)]. The micturition of 74 female patients with different disturbances of bladder voiding was studied using 99mTc-DTPA and a gamma camera connected to a cinescintigraphic system and a small computer. The urinary flow and the residual urine were determined from the voided urine volume and from the time-activity curves and the residual counting rate respectively recorded over the bladder region. The values of normals are compared with those found in different types of incontinence and neurogenic micturition disorders. The method provides important parameters of the dynamics of bladder voiding without unphysiologic manipulations. The costs are very low if the standard equipment of a nuclear medicine department can be used.


[Urethro-cystometry: a comparison between open-end catheters with flow and microtransducer catheters (author's transl)]. In 40 women a comparative urethrocystometric study between microtransducer catheters and open-end catheters was performed. Analysis of resting and cough urethrapressure profile concerned clinical and practical value as well as reproducibility. All of these aspects can better be achieved by microtransducer catheters compared to the open-end catheter system. Best results were obtained when measuring with microtransducers in standing position.


[Endocervical form of the vaginal adenosis (author's transl)]. Vaginal adenosis is a rare kind of disease without specific symptoms and does not represent a very serious disorder from the beginning. Concerning the etiology teratogenetic dependencies are known which still are interpreted in different ways in the recent literature. The increased number of cases, including those with clear-cell-carcinoma of the vagina, in juveniles after exposition to DES during the early embryonal development shows in particular (Central index for the stilbestrol-adenosis-carcinoma-syndrome in the USA, since 1971) a wrong pathway in the organogenesis of cervix and vagina. This occurs at the interference zone between the epithelium of the Müllerian ducts and the epithelium of the sinus urogenitalis of the female fetus and in so far constitutes the origin of vaginal adenosis. The basics of the possibility of the development of such irregular differentiation and heterotopic dissemination are proven again by the case report of a vaginal adenosis showing the highly differentiated endocervical type. Not every case of vaginal adenosis does signify a precancerous lesion. The separation of the most frequently endocervical manifestation observed from endometrial and intermediate forms might be difficult. A positive distinction is prognostically essential, however, since clear-cell-carcinomas of the vagina are known in occurence with the endometrial type of vaginal adenosis only. Scanning electron microscopy as a method to follow tissue organization reveals the way of differentiation between the various types via ultrastructural analysis for vaginal adenosis is an example for failures of developmental organization. The same analysis is feasible in cytological smears also. The therapeutic requirements of vaginal adenosis depend on the tissular differentiation and the given local extent of the adenomatous lesions.


[Determination of the heart minute volume by impedance cardiography: a way to prophylaxis of premature birth? (author's transl)]. 30 gravid women between the ages of 18 and 38 years who had gone into premature labour of unknown etiology were examined with respect to cardiac output and various other cardiovascular parameters in the standing, supine and left lateral positions. Measurements were carried out using an impedance-cardiography. A group of 30 women of similar age and duration of pregnancy but not in premature labour was also tested as controls. In the standing position, the test group showed a cardiac output which was 15% less than that of the controls. Statistically this was highly significant (p less than 0.005). No difference was found in the supine and left lateral positions. These results are in agreement with the literature, but with the method used in this study, an invasive, or X-Ray procedure is avoided. The physiology of the cardiovascular system in pregnancy and the means by which premature labour may be prevented, are discussed.


Systemic amyloidosis and hypogammaglobulinemia. Small deposits of amyloid were found at autopsy in the kidneys, liver, spleen, and blood vessels of the intestines of a patient known to have primary acquired hypogammaglobulinemia. Previously described cases of hypogammaglobulinemia-associated amyloid are reviewed and possible pathogenetic mechanisms are discussed. The pathogenesis of amyloidosis in this patient is not known.


Histiocytic medullary reticulosis: association with myeloproliferative state and desmoplasia. A patient with histiocytic medullary reticulosis also had two unusual associations: myeloproliferative state and desmoplastic reaction. These alterations appear to be more than mere chance associations, ie, they seem to be intimately involved with the histiocytic proliferation.


Acute myelofibrosis with peripheral myeloblastosis: an acute myeloproliferative disorder. Acute myelofibrosis is an uncommon fulminant disorder characterized by pancytopenia, premature myeloid elements in the peripheral blood, and bone marrow fibrosis. We report the case of a 59-year-old man who had acute myelofibrosis and peripheral myeloblastosis clinically suggesting the diagnosis of acute granulocytic leukemia. The disease was unresponsive to cytotoxic drugs or androgens and the patient died five months later. The association of bone marrow fibrosis with large numbers of myeloblasts in the peripheral blood has rarely been reported and suggests a spectrum of morphological changes in acute myeloproliferative disorders, analogous to the merging of chronic myeloproliferative disorders into one another and into leukemic blast crisis.


Xanthomatosis resembling scleroderma in multiple myeloma. A patient with multiple myeloma had severe cutaneous and gastrointestinal xanthomatization and symptoms characteristic of systemic sclerosis. Clinical findings included thickened sclerotic skin, dysphagia associated with an akinetic esophagus, and abnormal findings on roentgenograms of the upper and lower gastrointestinal tract. Biopsy specimens obtained from the skin and the gastrointestinal tract studied by light and electron microscopy showed thickening, hyalinization, and xanthomatization of the subepithelial connective tissue. Macrophages containing lipid vacuoles were shown to assume a perivascular orientation on ultrastructural study. Our case appears to be unique since this combination of findings has not been reported previuosly. In addition, our electron micrographs may help to define better the pathogenetic process involved in the association between myeloma and plane xanthomata.


Focal glomerular sclerosis and sarcoidosis. Idiopathic nephrotic syndrome occurred in a patient with sarcoidosis. Typical features of focal segmental glomerulosclerosis were present on kidney biopsy. A unique finding was the occurrence of IgA in blood vessels of the skin and lymph node. Whereas the sarcoid hilar adenopathy responded to steroid therapy, the nephrotic syndrome was resistant to steroids and immunosuppression. Evaluation of humoral and cellular immune responsiveness showed no abnormalities except cutaneous anergy. Glomerulonephritis is uncommon in sarcoidosis, and a brief outline of this association is included. This patient is of importance in view of the unexplained relationship between idiopathic nephrotic syndrome and T lymphocyte abnormalities.


The Churg-Strauss granuloma: cutaneous, necrotizing, palisading granuloma in vasculitis syndromes. The cutaneous, necrotizing, palisading granuloma (Churg-Strauss granuloma) was observed on histopathologic study of skin specimens from seven patients. Two patients had Wegener's granulomatosis and one patient each had allergic granulomatosis, limited Wegener's granulomatosis, bacterial endocarditis, systemic lupus erythematosus, and rheumatoid arthritis. The microscopic picture consists of extravascular, palisading, dermal granuloma. The center of the granuloma consists of basophilic fibrillar necrosis in which linear bands of destroyed tissue are interspersed with masses of polymorphonuclear leukocytes and leukocytoclastic debris. This necrotic leukocytic mass is surrounded by histiocytes and some lymphocytes. The clinical lesions are symmetric, erythematous papules or nodules on the extremities. The histopathologic picture of the Churg-Strauss granuloma is unique and, as demonstrated in these cases, indicates the presence of systemic vasculitis.


Renal cysts in premature children: occurrence in a family with polycystic kidney disease. Discrete but typical renal lesions, probably representing the first stage of familial adult-type polycystic kidney disease, were found in two premature still-born daughters of a woman whose family had many cases of this autosomal dominant disease. Apparently, enough cysts were present to form polycystic kidneys of adult size solely by cyst dilation, without additional cyst formation.


Giant cell transformation cerebrohepatorenal syndrome. An infant with cerebrohepatorenal syndrome of Zellweger had extensive hepatic giant cell transformation at 6 1/2 weeks of age. At 16 weeks the liver showed early cirrhosis and rare giant cells. Changes previously described have ranged from no abnormality in the neonate to cirrhosis at 20 weeks of age and indicate progression of liver disease in affected patients.


Mucolipidosis IV: ultrastructural diagnosis of a recently defined genetic disorder. In nine cases of a new genetic disorder mucolipidosis IV clinical findings included early or congenital corneal cloudiness and mild to severe psychomotor retardation in all patients. The diagnosis can be established by electron microscopy of the conjunctiva, which along with several other tissues shows typical ultrastructural changes. All of the known patients described were descendants of parents of Jewish-Ashkenazi origin, and it seems that mucolipidosis IV is another "Jewish" genetic disease. Prenatal diagnosis can be made by finding the typical ultrastructural changes in cells of the amniotic fluid. Biochemical abnormalities are inconspicuous, but there is evidence that the storage materials are gangliosides and hyaluronic acid.


Ultrastructure of the proliferating cells in pulmonary lymphangiomyomatosis. Pulmonary lymphangiomyomatosis occurs almost exclusively in women and is characterized by a widespread proliferation of spindle-shaped cells within the lung. Although these cells have been considered to be vessel-associated smooth muscle cells, their origin remains undefined. In this case of pulmonary lymphangiomyomatosis studied by electron microscopy, the proliferating cells were found to vary morphologically and to differ from typical smooth muscle cells. The ultrastructure suggests that the cell of origin might be the pulmonary interstitial cell rather than vascular smooth muscle. It is also possible that the cells are derived from pericytes. Accumulations of glycogen were seen in the proliferating cells and are suggested to be a reflection of an estrogenic hormonal dominance.


Clinical and pathological effects of cigarette smoke exposure in beagle dogs. To compare the clinical and pathological effects of high and low nicotine cigarette smoke 12 young adult male beagles were separated into four equal groups and exposed to smoke from high (4.6 mg) or low (1.4 mg) nicotine cigarettes, administered in six or 12 cigarettes per day. Two control groups, sham-exposed and nontracheostomized, consisted of three dogs each. The dogs were exposed seven days per week for five months. Tracheobronchitis developed in smoke-exposed dogs; gross lesions were generally confined to the lungs and tracheobronchial lymph nodes. Histopathological changes were found in all smoke-exposed dogs, with slightly more severe or extensive lesions in the dogs exposed to 12 cigarettes per day. The incidence and severity of rhinitis, turbinate basal epithelial cell hyperplasia, and squamous metaplasia were increased among dogs in the high nicotine cigarette groups.


Tracheobronchial cytologic changes in malignant melanoma. Histiocytes counted in smears made from the tracheobronchial washings of 208 patients with malignant melanomas were found to be 3.12 times more numerous than in a control group comparable in sex, age (decades), and smoking habit but without any type of prediagnosed malignant lesion. The discovery of this phenomenon may lead to the development of a new method for the evaluation of therapeutic methods in patients with melanotic lesions. It may open novel pathways for the investigation of cell-mediated immunity in patients with certain forms of malignant disease.


Nucleolar abnormalities in human papillary thyroid carcinomas. The nuclei of 17 occult and common papillary thyroid carcinomas were studied with an electron microscope. In most of the nuclei, numerous clusters of large interchromatin granules were seen. Nucleoli with a microfibrillar cortex and segregation of their components were observed in some tumors. Dense RNA containing microspherules were found in altered nucleoli and in complex nuclear bodies. These ultrastructural features seem to reinforce the advanced involvement of a disturbed RNA metabolism in human papillary thyroid carcinomas.


Vasitis nodosa. Two cases.

Vasitis nodosa. Two cases. Two cases of vasitis nodosa, one typical example and one unusual case, are presented. The first case was a complication of a previous vasectomy, manifested as a painful nodule at the site of previous surgery, and was associated with sperm granulomas. In the second case, no antecedent vasectomy had been performed, the lesion was located deep in the scrotum, and inflammation was scant. The clinical diagnosis of adenomatoid tumor was also consistent with some aspects of the histopathologic picture. In such cases, the diagnosis of vasitis nodosa can be resolved by finding spermatozoa within the proliferating ductules and individual epithelial cells. Electron microscopy can also be useful in eliminating the possibility that the nature of the proliferating cells is mesothelial. However, the etiology of vasitis nodosa in the absence of previous local traumatic or inflammatory insults remains obscure.


The Arias-Stella reaction revisited.

The Arias-Stella reaction revisited. The Arias-Stella reaction was observed in five cases of normal human gestational endometrium. The earliest case was in the endometrium lodging an ovum having an estimate age of 17 days. The Hertig collection at the Carnegie Institute constitutes the basis of the present study. This finding further supports the belief that the Arias-Stella reaction is a physiologic endometrial response to viable trophoblastic tissue.


Hepatic granulomas following ileal bypass for obesity. A review of liver biopsy specimens from patients undergoing ileojejunal bypass for obesity showed granulomas in follow-up biopsy specimens from six of 25 patients (24%) three months to four years after the procedure. The incidence was significantly greater than that seen in obese patients at the time of surgery (4%), (P less than .02). Their origin could not be attributed to systemic infections, medications, or nutritional factors. It would seem that hepatic granulomas in such patients may be due to factors associated with the surgical procedure.


Acute retrolental fibroplasia. II. Treatment by cryosurgery. Fourteen eyes of 12 infants with acute retrolental fibroplasia were treated with cryotherapy. In only one or possibly two cases was treatment considered to be of positive value. Treatment in the remaining 12 cases was either ineffective or deleterlous. Surgical treatment is rarely, if ever, indicated and spontaneous resolution of retinopathic changes is still the most common course of the natural history of the disease. The role of the ophthalmologist in the perinatal intensive care nursery remains one of advisor to pediatricians and informant to parents of affected children.


Phase behavior of lipids from Halobacterium halobium. Mixtures of dipalmitoylphosphatidylcholine with purple membrane lipids, red membrane lipids, or total lipids of Halobacterium halobium have been studied with differential scanning calorimetry. A comparison of red and purple membrane lipids reveals no difference in their phase behavior, indicating that lipid phase behavior plays no role in the in vivo separation of red and purple membranes. The effects of variation of the salt content of the suspending solution have also been examined. Studies of the melting behavior of these mixtures as H. halobium lipid content is varied suggest that the gel to liquid-crystal transition does not occur in the lipids of H. halobium.


Fluorescence and calorimetric studies of phase transitions in phosphatidylcholine multilayers: kinetics of the pretransition. Discrepancies between calorimetric and fluorescence depolarization monitoring of the pretransition in multilamellar vesicles of synthetic phosphatidylcholines are shown to result primarily from the slow rate of this transition. The depolarization of fluorescence of the membrane-associated dye 1,6-diphenyl-1,3,5-hexatriene was used to determine the temperature of the pretransition for a series of heating and cooling scan rates. These temperatures, when plotted vs. scan rate, extrapolated linearly to the transition temperature at zero-scan rate, Tm = 29.8 +/- 0.8 degrees C. The slopes obtained from these plots yielded characteristic times for the transition of 8 to 30 min. In addition, analysis of temperature-jump experiments, assuming first-order kinetics, gave characteristic times in the range 4--8 min. The data are taken to suggest a most likely value for the pretransition characteristic time of 5 +/- 2 min, with larger values possibly explainable by supercooling effects. Slight differences between the calorimetrically and fluorimetrically determined main transition temperatures appear to result from perturbation of the phosphatidylcholine bilayer by the fluorescent probe.


Estimation of molecular averages and equilibrium fluctuations in lipid bilayer systems from the excess heat capacity function. It is demonstrated that the bilayer partition function can be numerically obtained from scanning calorimetric data without assuming a particular model for the gel-liquid crystalline transition. From this partition function, the enthalpy, entropy and volume changes accompanying the transition can be calculated. In the limit of very large systems, the method of the grand partition function allows calculation of cluster model distribution functions from which average sizes of gel and liquid-crystal clusters, cluster densities and equilibrium fluctuations are obtained. These results indicate that the main transition in phospholipid bilayers proceeds through the formation of clusters and that these clusters are not static domains but highly fluctuating entities. These fluctuations in cluster size are approximately equal to the average cluster size and give rise to localized density and volume fluctuations. The magnitude of these fluctuations is affected by the radius of curvature of the bilayer and by the addition of small molecular weight compounds to the system.


Zwitterionic dipoles as a dielectric probe for investigating head group mobility in phospholipid membranes. For phospholipid membranes with zwitterionic head groups, the dipole can be considered as a specific label for tracing the changes in the dynamic behaviour of this region of the bilayer in its various phases. Measurements of the dielectric properties of fully hydrated 1,2-dipalmitoyl-sn-glycero-3-phosphocholine bilayers in the frequency range 1--50 MHz show a dispersion which is attributed to the motion of the phosphocholine dipoles in the plane of the bilayers. When the temperature is varied, both the permittivity and loss factor increase  sharply at the pretransition (35 degrees C) and the main transition (42 degress C). The relaxation time and amplitude were also determined for this dispersion and these further reflect the structural changes occurring with temperature. The relaxation times varied between 4 ns at 30 degrees C and 2.3 ns at 50 degrees C. Due to steric hindrances a restriction in the angle of head group rotation occurs at lower temperatures but is greatly reduced above the main transition.


Effects of charged drugs on the phase transition temperatures of phospholipid bilayers. An approach is presented which allows the description of drug binding to lipid bilayers, when the drug is present in both charged and uncharged forms. Binding is described by Langmuir adsorption isotherms, with the maximum number of binding sites being 1/60 A2. An estimate of the change in drug pK on binding is necessary, and is close to zero for most drugs binding to dipalmitoyl phosphatidylcholine, although delta pK = 1.0 for procaine. From the binding curves it is possible to calculate the drug-induced decreases in lipid phase transition temperature, assuming ideal behaviour. Good fits between experiment and theory are possible, giving values for the dissociation constant describing drug binding to the membrane.


The ultrastructure of multilamellar bodies and surfactant in the human lung. Normal tissues from human lungs were dehydrated through Epon 812 resin to retain many of the lipids and carbohydrates in thin section. The three-dimensional structure of the multilamellar body was determined. The paired layer of phospholipid heads (PH) is 36 A thick; the layer of fatty-acid tails (FA) is 31 A, the same as reported previously for non-human primates and rodents. The human multilamellar body is apparently unique: the lamellae of the major focus divide into two or three lamellae; the matrix material of the core is without vesicular bodies and a projection core is present. When compared with those of the rat, human tissues contain a greater number of lamellar foci and fewer lamellae per focus. The presence of a peripheral layer of lamellae, an ever-present external limiting membrane, and the fusion of multilamellar bodies are also characteristic. Tubular myelin surfactant has the same appearance as in other mammals. Multilamellar bodies were observed in direct communication with Golgi vesicles. Their origin from multivesicular bodies and their maturation through secretion and exocytosis were demonstrated. Untransformed multilamellar bodies in the alveolar space demonstrated three periodicities (P): (1) compact regular lamellae, PH = 36 A, FA = 36 A, FA = 31 A, P = 66 A; (2) compact broad lamellae, PH = 72 A, FA = 22 A, P = 94 A; (3) loose lamellae, PH = 36 A, FA = 31 A with a variable interlamellar space.


Direct sagittal scans in computed tomography of the orbits. Sagittal scans of the brain and orbits can be performed with the Varian body scanner and an accessory table. These scans are obtained directly, with no image reconstruction from scans in other planes. A case of Graves' ophthalmopathy is presented which demonstrates the potential advantage of sagittal images in showing abnormalities near the orbital roof and floor. Sagittal scans complement coronal and axial views in CT evaluation of the orbits.


Radioimmunoassay for partially degraded thyrotropin. A radioimmunoassay for partially pepsin degraded bovine thyrotropin (bTSH) was developed and used to examine human thyrotropin (hTSH) preparations and sera obtained from patients with Graves' ophthalmopathy for the presence of cross-reactivity. As little as 4 microunits of the hTSH (68/38) reference preparation produced inhibition of binding in the radioimmunoassay, but none of the sera obtained from patients with Graves' disease (n = 26) contained detectable cross-reactivity. These data indicate that there is a substantial amount of partially degraded thyrotropin in human pituitary extracts, but none detectable in the sera of patients with Graves' ophthalmopathy.


[Lung alterations after paraquat poisoning (author's transl)]. After one application of paraquat (35 mg/kg body weight) studies of the changes in lung structure in phospholipid content of the alveolar wash as well as in the static pV-curves are performed on adult hooded rats. Pathomorphologically 2, 4, 8, 16, 24 and 48 h after the paraquat intoxication focal atelectases, circumscribed inflammatory infiltrations of the interstitium are predominant as well as an accumulation of macrophages in the interstitium and in the alveolar space. Initially granulocytes dominate in the inflammatory infiltrates; after 8 h lymphoid elements and histiocytes became more and more apparent. 24 an 48 h after the paraquat injection there is a degradation of the alveolar epithelium. After 8-48 h the phospholipid content of the alveolar wash and after 2-48 h the hysteresis loop of the pV-curves are statistically significantly decreased in comparison with control animals. It is assumed, that the paraquat mediated dearrangement of the surfactant system of the lung is caused by an increased degradation in consequence of liberated phospholipases as well as by a decreased or ceased synthesis of the surfactant. The latter may be the consequence of an autooxydative membrane alteration of the endoplasmatic reticulum, the toxic action of the hydrogen peroxide originated by the autooxydation but also of the loss of energy rich substrates.


[Analysis of the dynamics of the facilitation of end-plate potentials in frogs]. Within 60 msec after presentation of conditioned stimulus the facilitation of the e.p.p. second response declined by two phases. The 1st phase corresponded to the 1st component of facilitation while the 2nd phase followed in 5--10 msec reaching the maximum within 15 msec and then declining with the time constant of 20--50 msec. During repeated stimulation the 1st phase accumulated linearly while the 2nd one exponentially. Tetraethylammonium and three-ethylcholine increased the quantum content e.p.p. and the facilitation but had no effect upon the time constant of the facilitation decline.


[Pathogenesis of Basedow's disease].

[Pathogenesis of Basedow's disease]. Thyroid antibodies and thyroid-stimulating factors (LATS and LATS-Protector) have been controlled 53 patients with Graves' disease during antithyroid drug treatment. It has been demonstrated that dosage is higher and duration of treatment has been more protracted in antibody-positive thyrotoxicosis than in patients without these antibodies. Thyroid antibodis have been found only in patients with detectable thyroid-stimulating factors, which are identified as immunglobulins. These results indicate the importance of immunologic processes. Suppressibility of thyroid function proved 2 months after stopping medical treatment, was negative in 19 and positive in 17 patients. Thyroid-stimulating factors remained positive up to this time in 20 patients and disappeared in 18. In 8 patients the suppression-test was positive indicating a normal function of the thyroid stimulating hormone (TSH), but thyroid-stimulating factors still have been detected in these patients. These results are controversial to the autoimmune-concept of the pathogenesis of Graves' disease. As this concept cannot be refused, changes in the effectivity of LATS or LATS protector by crude serum factors or by changes of the receptor structures are discussed.


[Analgesic activity of probon compared to morphine]. The analgetic action of probone as compared to that of morphine was studied in chronic tests on cats. Changes in individual signs of a complex reaction in response to a graded stimulation of the cutaneous nerve were assessed. Probone in doses of 50--150 mg/kg and morphine in doses of 2--4 mg/kg raised the threshold of the flexor reflex and reduced manifestations of the emotional-behavioral and vegeto-motor reactions of the animals. But unlike morphine probone did not suppress the vocal reaction, this being a specific component of the response to pain. It is assumed that the change in the response reaction occurring under the effect of probone is due not so much to its analgetic action, but rather to the myorelax and tranquilizing effects.


Using the PAS system for hospital drug utilization review. The PAS system, subscribed to by many hospitals, is readily adaptable to drug usage review. Useful for this purpose are PAS data on drug usage according to (1) drug type, (2) diagnosis, and (3) information supplied at patient admission. The PAS system also permits "special coding," or "targeting," of other data for review. Whatever the drug utilization system used, pharmacist input into the process is highly important.


The role of diabetic control in diabetic retinopathy. In spite of the continuing debate, it is possible to summarize the present state of our knowledge and to draw the following conclusions: 1. Microangiopathy of diabetes can be produced by pure insulin-deficiency in human subjects and experimental animals. 2. Evidence supports the concept that the pathology is due mainly to the deranged metabolism following insulin deprivation. 3. Repair of the insulin deficiency in animals has been shown to prevent the vascular damage associated with insulin deficiency. 4. Present methods of therapy have not been successful in preventing vascular complications in the noninsulin-dependent middle-aged diabetic patient; and, based on the findings of the University Group Diabetes Program, there is reason to believe that new methods of therapy must be realized to improve this outlook. 5. The efficacy of "compulsive control" for prevention of microangiopathy in insulin-dependent diabetic patients has not been adequately studied. Based on the results of animal experiments, the prudent physician should make every attempt to restore a normal physiological cellular environment in these patients with the expectation that this will offer the patient the best opportunity to minimize degenerative complications. Prospective observations are needed on the effects of hypoglycemic episodes which may be inevitable under these circumstances, but there is no evidence at present to suggest that mild hypoglycemia is of itself detrimental. 6. All individuals interested in the prevention of the complications of diabetes using available therapeutic methods should work to encourage a prospective clinical trial carefully designed from both an ethical and scientific point of view to obtain answers to the questions raised here.


[Meniscal injuries and associated lesions seen in the light of long-term results after meniscectomy]. The authors have put together their experience of the long-term results after meniscectomy. They came to the following conclusions: 1. A knee joint does not become unstable after removal of a cartilage unless there is another connected lesion. 2. X-ray modifications are to be found on the majority of the patients after meniscectomy, but very often without any clinical sign. 3. The sooner meniscectomy is practiced the better the long-term results are to be expected. 4. A good operative technique is most important to get satisfactory long-term results.


Analytical methodology and the interface with animal drug approval. FDA is engaged in a systematic review of approved animal drugs to determine whether upgrading of safety data is required to provide continuing assurance that the approved uses for these drugs are safe. These reviews will be undertaken on the basis of a priority of anticipated human health significance.


Study of lung surfactant activity in guinea pigs after vagotomy. Vagotomy in guinea-pigs reduces the pulmonary surfactant activity. Unilateral vagotomy brings about a similar reduction in the lung on the same side. The findings indicate that surfactant reduction may be an important causative factor in the initiation of pulmonary edema in vagotomised guinea-pigs. It is suggested that surfactant synthesis or release may be affected by alterations in the pulmonary blood flow or removal of the effect of neuro-secretory fibres, following vagotomy.


Bioavailability of sulfadiazine solutions, suspensions, and tablets in humans. A four-way crossover sulfadiazine bioavailability study was conducted in 16 normal healthy male volunteers. The subjects were divided into groups of eight. Each group received four different oral dosage forms of sulfadiazine at 1-week intervals: a solution as a reference, a suspension, and two different tablets. All dosage forms were equivalent to 500 mg of sulfadiazine. Blood samples were obtained at 0, 0.5, 1.0, 2.0, 3.0, 4.0, 6.0, 8.0, 10.0, 25.0, 33.0, and 49.0 hr. Analysis of variance indicated no statistically significant difference (p more than 0.05) between the dosage forms in terms of area under the plasma level--time curve, peak plasma concentration, and time of peak plasma concentration. In both groups, there were differences between products at isolated sampling times. It was concluded that the four tablet formulations of sulfadiazine exhibited bioavailability characteristics equivalent to those of the solution and the suspension.


GI absorption of beta-lactam antibiotics I: kinetic assessment of competing absorption and degradation in GI tract. An equation was derived for the simultaneous assessment of rate constatns for absorption and nonenzymatic degradation of unstable drugs in in situ absorption experiments. The equation was substantiated by using a variety of beta-lactam antibiotics in the recirculation technique through the rat small intestine. Plots of the apparent first-order rate constant for the disappearance of the drug from the gut lumen versus the reciprocal of the volume of recirculating solution yielded a straight line with a slope equal to the intrinsic absorption rate constant and with an intercept equal to the nonenzymatic degradation rate constant in the GI lumen. The kinetic method for evaluation of the absorption rate constant also was developed for a more complex situation in the GI lumen involving absorption, nonenzymatic degradation, and enzymatic metabolism. The proposed method was confirmed with carbenicillin indanyl, which was metabolized rapidly to carbenicillin by the action of nonspecific esterase in the intestine. In the absence of information of Michaelis--Menten kinetic parameters, the present method is advantageous for evaluation of the intrinsic absorption rate of all unstable drugs.


Acute toxicity of aflatoxin B1 and rubratoxin B in dogs. The effect of ip administrated aflatoxin B1 and rubratoxin B, singly and in combination, on dogs was determined by serum tests, by observations of clinical signs and survival times, and by evaluation of gross and microscopic lesions. The dog is sensitive to the toxic effects of both mycotoxins. Glutamic-oxaloacetic transaminase, lactic dehydrogenase and alkaline phosphatase activities and survival time varied in relation to dose and to the mycotoxin(s) administered. All three plasma enzymes were elevated regardless of dose with the combination of aflatoxin B1/rubratoxin B at 24 hr after dosing, except LDH, which was within the normal range but only at the lowest dose level. Several serum constituents including BUN, cholesterol, uric acid, and total bilirubin were elevated, whereas serum glucose was depressed in dogs treated with the multiple-toxin regimen; these changes were not seen in dogs given only aflatoxin B1 but were characteristic in rubratoxin-treated animals. In general, gross findings at necropsy were similar in all dogs regardless of the dose regimen. A striking similarity existed in the histologic changes observed between lesions experimentally induced by the mycotoxin combination and those lesions reported for dogs fed toxic feed in laboratory studies or in natural cases of hepatitis X. Of particular similarity were the severe kidney lesions observed in dogs exposed to the mycotoxin combination and kidney lesions reported in natural outbreaks of hepatitis X. There can be little doubt of an association between hepatitis X and aflatoxin B1, although it is apparent that the disease probably involves more than a single toxic factor. Our results suggest that hepatitis X in dogs includes aflatoxin B1 as a primary etiological factor but that rubratoxin B also may be involved.


In-vitro development of preimplantation embryos recovered from IUD-bearing mice. Embryos were collected from the oviducts and uterine horns of mice bearing a unilateral IUD and of non-IUD control mice at various times p.c., examined for the presence or absence of polymorphonuclear leukocytes (PMNLs) and cultured. Normal numbers of embryos were obtained on the IUD side at 48 h p.c., but reduced numbers were recovered at 60-66 and 72 h p.c. The numbers of embryos that hatched from those collected from control, IUD-bearing and contralateral non-IUD bearing tracts were, respectively, 81, 29 and 36% for 48-h embryos, 78, 47 and 51% for 60-66-h embryos, and 88, 47 and 54% for 72-h embryos. At 48 h and 60-66 h p.c. the arrest of development occurred at the expanded blastocyst stage, but at 72 h p.c. some compacted morulae were affected. Some embryos associated with PMNLs at collection developed normally when the PMNLs were dispersed before culture. An initial association with leukocytes is therefore not necessarily detrimental to the subsequent in-vitro development of the embryo in mice.


Purulent rectal discharge associated with a nontreponemal spirochete. A nontreponemal spirochete was isolated from the rectum of a homosexual man with a chronic purulent discharge. Known infectious causes of the disease were excluded. Although the pathogenicity of the organism was not proved, the patient's symptoms rapidly resolved following penicillin G benzathine therapy. When culture of a nonhemorrhagic, purulent rectal discharge fails to verify Neisseria gonorrhoeae, health care personnel are encouraged to carefully examine a Gram's-stained smear of the discharge for spiral-shaped organisms.


Penile veneral edema.

Penile veneral edema. A one-year epidemiologic study of penile venereal edema in a clinic for sexually transmitted diseases identified 25 cases, a rate of 1.7 per 1,000 male visits. Twenty-four patients had coexisting urethritis (36%), infected penile lesions (36%), or both (24%). Men with penile edema were significantly more likely to have gonococcal urethritis (40%), genital scabies (12%), genital herpes (12%), and inguinal adenopathy (52%) than men without penile edema. Penile edema is self-limited and seems to resolve along with the underlying penile disease. Lymphatic involvement may be the final common factor.


Interaction of rubratoxin B and pentobarbital in mice. Rubratoxin B, a metabolite of Penicillium rubrum, is a potent mycotoxin that produces hepatic mid-zonal necrosis. Using propylene glycol as the solvent, the acute LD50 (i.p.) in male mice was estimated at 1.42 mg/kg. Pretreatment with s.c. pellets of pentobarbital reduced this toxicity approximately 42 percent, while castration and SKF 525A pretreatment enhanced toxicity approximately 20 percent and 60 percent, respectively. These studies also demonstrated that rubratoxin B potentiated pentobarbital-induced narcosis and enhanced pentobarbital hypothermia. The effect of SKF-525A and pentobarbital on the LD50 value of rubratoxin B suggests that the toxicity of this mycotoxin in mice does not arise from a toxic metabolite but from the parent compound.


Late isolated left ventricular tamponade. Clinical, hemodynamic, and echocardiographic manifestations of a previously unreported postoperative complication. A unique case of late postoperative left ventricular tamponade, hemodynamically indistinguishable from severe left ventricular failure, is reported in a patient 1 month after an apparently uncomplicated aortic valve replacement. An echo-free space behind the left ventricle led to surgical exploration and successful resolution of the disease process. To our knowledge, this is the first documented case of isolated left ventricular tamponade in the literature. The findings highlight the importance of postoperative echocardiography in the evaluation of the patient having cardiac surgery.


Sequential changes of surfactant phosphatidylcholine in hyaline-membrane disease of the newborn. Although reduced levels of lung surfactant are known to predispose to hyaline-membrane disease, the role of biochemical changes in surfactant composition has not been defined. We found that surfactant isolated from pharyngeal and tracheal aspirates of newborns with hyaline-membrane disease had a distinctly different phosphatidylcholine fatty acid composition from surfactant of control infants. Surfactant phosphatidylcholine from newborns with hyaline-membrane disease had a lower percentage of palmitic acid and higher percentages of the 18-carbon and 20-carbon fatty acids, irrespective of gestational age. Evaluation of serial aspirates for 18 days revealed that in hyaline-membrane disease the surfactant phosphatidylcholine fatty acids followed a predictable pattern of change, gradually becoming similar to those of the control group. Evaluation of surfactant from tracheal and pharyngeal aspirates effectively monitors the biochemical maturation of the surfactant system in hyaline-membrane disease.


[Clinico-diagnostic considerations on lymphocytic thyroiditis. Presentation of clinical cases]. Personal experience with autoimmune lymphocyte thyroiditis, represented by 11 cases observed between 1972 and today, is reported. After some brief aetiopathogenetic notes on the lesions in question, the problems of diagnosing the nature of the thyropathy are stressed. After reviewing the examinations that have been proposed in the literature, it is noted that the preoperative recognition of a thyroiditis with autoimmune genesis is still problematical. The institution of a diagnostic protocol based on the systematic search for antibodies, the perchlorate test, the thyrostimulation test, ESR study, the search for alpha2 and gamma-globulins, scintigraphy with positive indicators and needle biopsy as well as on scintigraphy and thyrometabolic tests (T3-T4-TSH-TRH test) is proposed. Even when such a protocol is adopted, however, it should be mentioned that only in 18% of the personal cases was it possible to diagnose thyroiditis, in the other subjects this being merely an occasional post-operative finding. In confirming the personal therapeutic approach, which at least initially is medical, for recognized forms, it is pointed out that surgical treatment is to be preferred in certain cases because of the presence of compressive phenomena, and in others it appears capable of relieving, in follow-up, the thyroiditic process, probably as a result of the removal of the antigenic tissue.


Pharmacologic evaluation of orally administered antibiotics in infants and children: effect of feeding on bioavailability. The clinical pharmacology of orally administered antibiotics was investigated in 106 infants and children. The antibiotic suspensions studied were ampicillin, cephalexin, erythromycin estolate, erythromycin ethylsuccinate, penicillin G, and penicillin V. The feeding status of the patients was evaluated in relation to the concentrations of drugs in serum, saliva, and tears. Peak concentrations and area-under-the-curve values of cephalexin, penicillin V, and penicillin G were reduced 40% to 60% in patients given milk and drug concurrently. Absorption was enhanced when erythromycin ethylsuccinate was given milk. After administration of both erythromycin formulations, penicillin V and ampicillin, salivary concentrations exceeded the minimal inhibitory concentrations for most pneumococci and group A streptococci and for many meningococci. The clinical implications of these pharmacokinetic data are discussed.


Spontaneous osteonecrosis of the knee and medial meniscal tears. Several factors may play a role in the etiology of "spontaneous" osteonecrosis of the medial femoral condyle. Corticosteroids are known to induce osteonecrosis, and 45% of the patients in this study received steroids parenterally or by intra-articular injection. Another factor, heretofore given little attention, is the association of medial meniscal tears and "spontaneous" osteonecrosis. Twenty-one (78%) of 27 knees examined by arthrography demonstrated meniscal tears. Stress concentration over the edge of the meniscal fragment may result in ischemic necrosis of the femoral condyle. Early detection of a medial meniscal tear by arthrography in older patients and prompt treatment may be important in avoiding the late changes of "spontaneous" osteonecrosis.


[Tolerance and contrast density in intravenous cholangiography and cholecystography using a new contrast medium (author's transl)]. The tolerance and diagnostic usefulness of the new intravenous bile contrast medium Endomirabil were subjected to clinical radiological testing. Endomirabil is well tolerated. It is our impression that it has a lower side effect quota than the other contrast media used so far. Diagnostic results in injection cholangiography and cholecystography with 30 ml Endomirabil were good. In more than 80% of the cases the bile ducts were well demonstrated. The diagnostic evaluation was fully satisfactory. In most cases both the bile ducts and the gallbladder showed up very well within 60 minutes after completion of the injection. This means both film material and time are saved.


[Lipolytic activity of microorganisms isolated from different sources]. From different natural sources (samples of raw and pasteurized milk, fresh and melted butter, cheese, industrial and nonindustrial sewage containing fats and surface active substances) 650 microorganisms were isolated. Measurements of their lipolytic activity on milk fat (20% cream), tristearin and olive oil indicated that 27 microorganisms had no lipolytic activity on either substrate. A hundred cultures showed the highest activity. Out of them 40 most active cultures belonging to different systematic groups (fungi, yeast, bacteria) were identified as representatives of certain genera or species. Lipolytic activity varied significantly in microorganisms belonging to the same species. The use of several substrates (cream, tristearin, olive oil) helped to discriminate microorganisms that preferentially hydrolyzed either substrate.


Potential for improving cottonseed quality by genetic and agronomic practices. Potential utilization of cottonseeds as edible food sources accentuated the need for research on their composition. Studies included evaluation of cottonseed composition; e.g., seed grade, protein, amino acids free fatty acids, oil, fatty acids, cyclopropenoid fatty acids, total gossypol, differential settling as an indicator of potential performance of cottonseed in the liquid cyclone process, and extractability of nonstorage and storage proteins and their gel electrophoretic properties. These extended studies were used to develop a data base on composition of various cottonseed cultivars grown in different locations of Texas that resemble environmentally most of the regions of the United States cotton belt. Tests showed that most constituents of cottonseed vary; statistically significant variables include cultivar, location, and their interaction term, cultivar x location. These data suggest that breeding and agronomic practices could be used to alter cottonseed composition. Although protein quantity of cottonseed from various cultivars differ and can be influenced by agronomic practices, this variability is not reflected in quality of cottonseed protein as detected by gel electrophoretic techniques. Analyses showed that both genetic and agronomic factors influenced formation of edible flour with high protein and low free gossypol content.


Phenothiazine effect on gastrointestinal tract function. Clinical evidence indicates that phenothiazines, specifically chlorpromazine (CPZ), used extensively in the treatment of patients with mental and/or neurologic disorders produce an ileus characterized by pseudoobstruction with an extended barium transit time of eight to ten days. Postoperatively, these patients have a protracted ileus, lasting from ten to fourteen days. In our present study we investigated the mechanism of action by which phenothiazines block gastrointestinal tract function as well as the possible reversal of this effect by pharmacologic agents. Guinea pigs were injected intraperitoneally with CPZ at a dose of 30 mg/kg/day for five to seventeen days. This caused deleterious effects in the gastrointestinal tract, such as cessation of peristalsis of small intestine and colon, and marked distension of the cecum. In vitro pharmacologic studies were performed on the electrically stimulated longitudinal muscle-myenteric plexus of the guinea pigs. We found that phenothiazines interfered with the neuromuscular mechanism of the intestine, as exemplified by a lack of response to electrical current stimulation. The effect was protracted, lasting at least 24 hours. These effects were reversed by the administration of the anticholinesterase, physostigmine (PGM), provided the block was less than 80 per cent. The paralytic ileus produced was similar to that found in man.


Case report. Simultaneous fungal and viral infection of the central nervous system. A patient with lymphoma developed central nervous system dysfunction and the diagnosis of cryptococcal meningitis was made. Because of discordant clinical and laboratory responses to appropriate treatment, further investigations were performed and the additional diagnosis of progressive multifocal leukoencephalopathy (PML) was established. Computerized axial tomography (CT scanning) proved helpful in pointing toward the latter disorder. Clinical, neuropathological, and microbiologic features are presented. The diagnostic approach to central nervous system illness in patients with impaired immunocompetence should include consideration of simultaneous infection with multiple agents.


Clinical studies of intrathecal autologous lymphocyte infusions in patients with malignant glioma: a toxicity study. The feasibility and toxicity of intrathecal lymphoid cell infusions in patients with glioma were examined in this study. Blood rich in lymphoid cells was obtained using the Haemonetics Model 30 cell separator; the lymphoid cells extracted were further purified on Ficoll-Hypaque gradients. Four patients received a total of eighteen autologous lymphoid cell infusions, with between 1 X 10(6) and 5 X 10(9) lymphoid cells being infused on each occasion. No toxicity was observed, but the CSF glucose declined in 2 patients. In 1 patient examined at autopsy the lymphoid cells appeared to have gained access to the tumor bed as well as to the rest of the subarachnoid space.


Nemaline (rod) myopathy: a possible cause of rapidly fatal infantile hypotonia. Two infant siblings (male and female) manifested extreme hypotonia and flaccidity at birth and had a rapidly fatal course. In each, rod-like structures were demonstrated within a variety of skeletal muscles, and accumulations of thin filaments were seen in numerous muscle fibers. The possibility exists that this represents a severe and rapidly fatal form of nemaline myopathy that should be included in the differential diagnosis of infantile hypotonias.


Massive ovarian edema: a nonneoplastic pelvic mass of young women. Two cases of massive ovarian edema are reported in addition to the eight previous cases published in the English literature. The predominance of the right-sided involvement and the histopathological characteristics of this lesion support the hypothesis that the basic pathogenetic mechanism is an impairment of the venous and lymphatic drainage of the ovary, triggered by recurrent partial torsion of the mesovarium. This nonneoplastic lesion should be recognized as a distinct entity in ovarian disease and treated conservatively.


Intrauterine death from umbilical cord hematoma. Umbilical cord hematoma is a rare cause of intrauterine morbidity and mortality. There have been many theories about the etiology of this entity, but its cause remains unknown. Intrauterine death occurred in a postmature (44 weeks) fetus and was associated with an umbilical cord hematoma. Histologic examination of the cord showed a thinning of the wall of the umbilical vein with splitting of the elastic membrane.


[Mycotic anuerysm secondary to bacterial endocarditis. Review apropos of a case]. A case is presented of Subacute Bacterial Endocarditis on a biological Duramater Prosthesis. In the evolution curse, the patient presented an intraparenchimal cerebral haemorrhage, where--upon the angiographic studies demonstrated the existence of a mycotic aneurysm in the left median cerebral arterial territory. With specific antibiotic therapy and replacement of the prosthesis, the clinical evolution of the case, was positive, and later angiographies evidenced the disappearance of the aneurysm. The incidence of intracranial mycotic aneurysm complicating bacterial endocarditis is relatively high (up to 4% in post-mortem series). There have been very few cases communicated up to now with angiographic demonstration. Mortality is similar in patients under surgical or medical treatment. The aetipothogenic aspects are discussed, as well as the recommended therapeutic measures.


[Morphogenetic processes and seasonal changes in the anatomic and histological organization of the Barents Sea sponge Halichondria panicea (Pallas)]. As a result of histological investigations of seasonal dynamics in the anatomical-tissue organization of the litoral sponge Halichondria panicea (Pallas), morphogenetical processes during different periods of its life cycle are described in detail. Correlations between different phases of sexual reproduction and conditions of anatomical and tissue organization in the maternal organism are stated. It is noted that tissue reduction of the definitive sponge Halichondria panicea during autumn--winter season is a natural phenomenon, regularly repeating in the life of the litoral sponge investigated, as a result of the maternal organism's "exhaustion" in the period of sexual embryogenesis.


Taurocholate--sodium co-transport by brush-border membrane vesicles isolated from rat ileum. Uptake of taurocholate into brush-border membrane vesicles isolated from rat small intestine by a Ca(2+) -precipitation method was investigated by using a rapid-filtration technique. Uptake of taurocholate by ileal brush-border membranes consisted of three phenomena: binding to the outside of the vesicles, transfer across the vesicle membrane and binding to the intravesicular compartment. The transport of taurocholate across the brush-border membranes was stimulated in the presence of Na(+) compared with the presence of K(+); stimulation was about 11-fold in the presence of a NaCl gradient (Na(o)>Na(i)), where the subscripts refer to ;outside' and ;inside' respectively, and 4-fold under equilibrium conditions for Na(+) (Na(o)=Na(i)). In the presence of a Na(+) gradient a typical ;overshoot' phenomenon was observed. Membranes preloaded with unlabelled taurocholate showed an accelerated entry of labelled taurocholate (tracer exchange) in the presence of Na(+) compared with the presence of K(+). The stimulation by Na(+) was observed only in membrane preparations from the ileum. Addition of monactin, an ionophore for univalent cations, decreased the Na(+)-gradient-driven taurocholate uptake. The Na(+)-dependent taurocholate transport showed saturation kinetics and the phenomenon of counterflow and was inhibited by glycocholate. Other cations such as Li(+), Rb(+) and Cs(+) could not replace Na(+) in its stimulatory action. When the electrical potential difference across the vesicle membrane was altered by establishing different diffusion potentials (anion replacement; K(+) gradient+/-valinomycin) a more-negative potential inside stimulated Na(+)-dependent taurocholate transport. These data demonstrate the presence of a rheogenic (potential sensitive) Na(+)-taurocholate co-transport system in ileal brush-border membranes and support the hypothesis that the reabsorption of bile acids in the ileum is a secondary active uptake.


[Intrathecal gentamicin in the treatment of meningitis--clinical case study (author's transl)]. The authors report 33 cases of meningitis treated with intrathecally administered gentamicin (GM) and examine it's effectiveness for meningitis side effects and optimum dose. Of 33 cases 15 cases (group I1 were treated with GM alone 7 cases (group IIa) with GM combined with SB--PC or CP. In 8 cases of the other 11 cases (group IIb) GM was changed for SB--PC or CP because of it's inefficiency and side effects (6 cases) and other reasons (2 cases). In the remaining three cases of group IIb SB--PC or CP was changed for GM due to their inefficiecy. Maximum intrathecal dose is shown below : 4 mg--7 cases, 8 mg--5 cases, 10 mg--15 cases, 20 mg--4cases, 40 mg--2 cases. In all cases GM was not administered systemically, but each of CP, CB--PC, SB--PC and TC was administereed systemically. In group I, only one case did not G--I tract bleeding but the others were cured. In group IIa all but one case was cured. In group IIb one case of cyptococcosis was dead. Total effective cases of intrathecal GM were 17 of 24 cases excluding group IIa (7 cases) and 3 cases of group IIb. There was no side effect in cases of which maximum dose was 4--20 mg, but in one of 40 mg administered cases in which GM was injected from cisternal puncture hearing, vestibular and visual function were disturbed permanently. Therefore GM should not be injected into the cistern. In our conclusion intrathecal GM is thought to be effective in the treatment of meningitis without systemic GM. Effective optimum dose in 4--8 mg/day day in adult and if ineffective after 7--10 days GM should be changed for other antibiotics.


Fatty acyl chain order in lecithin model membranes determined from proton magnetic resonance. Proton magnetic resonance (1H NMR) has been used to compare the local orientational order of acyl chains in phospholipid bilayers of multilamellar and small sonicated vesicular membranes of dipalmitoyllecithin (DPL) at 50 degrees C and egg yolk lecithin (EYL) at 31 degrees C. The orientational order of the multilamellar systems was characterized using deuterium magnetic resonance order parameters and 1H NMR second moments. 1H NMR line shapes in the vesicle samples were calculated using vesicle size distributions, determined directly using electron microscopy, and a theory of motional narrowing, which takes into account the symmetry properties of the bilayer systems. The predicted non-Lorentzian line shapes and widths were found to be in good agreement with experimental results, indicating that the local orientational order (called "packing" by many workers) in the bilayers of small vesicles and in multilamellar membranes is substantially the same. This results was found to be true not only for the largest 1H NMR line associated with the nonterminal methylene protons but also for the resolved 1H NMR lines due to the alpha-CH2 and the terminal CH3 positions on the acyl chain. Analysis of the vesicle 1H NMR spectra of EYL taken with different medium viscosities yielded a value of approximately 4 X 10(-8) cm2 s-1 for the lateral diffusion constant of the phospholipid molecules at 31 degrees C.


Ultrasonic studies of lipid bilayer. Phase transition in synthetic phosphatidylcholine liposomes. The ultrasonic velocity at 3 MHz and the density in the nonsonicated and sonicated liposomes of dipalmitoylphosphatidylcholine have been measured in the temperature range from 0 degrees C to 55 degrees C. The results indicate that nonsonicated multilamellar vesicles undergo a weak first order transition which is analogous to the nematic-isotropic transition of liquid crystals. A sharp change in the ultrasonic velocity associated with the first order transition disappears when the multilamellar vesicles are sonicated. The bulk modulus of the lipid bilayer calculated from the ultrasonic velocity and the density of sonicated liposomes has a value of 3.0 X 10(10) dyne/cm2 at 20 degrees C, reaches a minimum value of 2.1 X 10(10) dyne/cm2 at its transition temperature and increases slightly to 2.2 X 10(10) dyne/cm2 at 50 degrees C.


Electron-capture gas-liquid chromatographic determination of ethosuximide and desmethylmethsuximide in plasma or serum. We describe the determination of ethosuximide and desmethylmethsuximide, simultaneously or separately, in 50 to 100 microliter of plasma or serum. Derivatives of ethosuximide and desmethylmethsuximide formed by reaction with pentafluorobenzoyl chloride are extremely sensitive to the electron-capture detector of a gas-liquid chromatograph. The sample, with added internal standard and ammonium sulfate as a pH-adjusting and salting-out agent, is extracted with ethyl acetate/benzene (20/80 by vol). The extract is evaporated and the derivatives are formed. Analytical recoveries of ethosuximide and desmethylmethsuximide exceed 99%, and the relative standard deviation (CV) between analyses is usually less than 4.0%. alpha-Methyl-alpha-propylsuccinimide is used as the internal standard for ethosuximide, 2-phenylsuccinimide as the internal standard for desmethylmethsuximide.


Retained posterior horn of the medial meniscus. The incidence of a symptomatic retained posterior fragment of the medial meniscus in 2 different groups of patients with medial meniscectomy is compared. If the original surgery was done through one capsular incision, there was a 9.5% incidence of symptomatic retained posterior fragment as compared to 0.2% incidence if the original surgery was performed through 2 capsular incisions. For total excision of the meniscus medial meniscectomy should be performed through 2 capsular incisions.


Lymphosarcoma in an ectopic pelvic spleen. Wandering spleen is a rare condition which can be diagnosed with facility by conventional nuclear medicine imaging techniques. We present one case in which generalized lymphosarcoma involving a wandering spleen was proved by percutaneous aspiration biopsy. Evaluation of a liver-spleen scan in which the normal splenic image is not definitely seen should include extension of the scan field to include the lower abdomen, because of the possibility of ectopic splenic position.


Mother's assessments of term and pre-term infants with respiratory distress syndrome: reliability and predictive validity. Assessments of term and preterm RDS infants were made by mothers on an adaptation of the Brazelton scale. The mother's assessments were not significantly different from those assessments made by trained clinicians, and both mothers and clinicians assigned less optimal ratings to the preterm infants. These ratings were correlated with Bayley motor scores at eight months. Mothers' assessments of infant temperament were made at four and eight months. These temperament ratings were significantly correlated with each other and with clinicians' ratings on the Brazelton neonatal and eight-month-Bayley Scales. These findings suggest that mothers' assessments are reliable and have some predictive validity during early infancy.


Clinical studies on sporotrichosis in Taiwan. A total of 59 cases, who visited the Dermatological Clinic of National Taiwan University Hospital in the past 27 years, was proved to be Sporotrichosis. The diagnostic criteria were the suggestive clinical pictures with any one of the following points: (1) positive fungal culture with characteristic colonies of Sporotrichum schenckii, (2) good therapeutic response to potassium iodide, (3) demonstration of fungal elements in the suggested pathological tissues or (4) demonstration of fungal elements in pus or tissue using direct immunofluorescence. All the informations concerning the clinical pictures and epidemiological points of view of these 59 patients were analysed. The chief cutaneous lesions were composed of nodules, ulcers or infiltrated plaques in linear arrangement on the exposed areas especially arms, legs or face. Thirty eight cases were male and 21 female. It affected peoples of the age between 4 to 70 years old, and their occupations were mainly outside workers such as agriculturist, worker, etc. Most of the affected people lived in the suburban areas of Taipei city such as Taoyuan and Taipei county. Serological tests such as precipitation, complement fixation and hemagglutination tests were performed in 12 cases, yet no reliable results were got.


Case report. Cervical carcinoma with selective IgA deficiency. A patient with cervical carcinoma was found to have selective IgA deficiency. The intact cell-mediated immunity, normal levels of IgG and IgM, and the absence of serum and salivary IgA established the diagnosis. Contrary to those of normal persons, salivary IgM was elevated and salivary IgA was not detectable in this patient. The patient had no signs attributable to IgA deficiency, but she always had dryness of the mouth. The association between cervical carcinoma and selective IgA deficiency was discussed.


Updating the side effects of the penicillins. Use of the penicillins in patients may result in a variety of side effects in addition to the well known occasional allergic reactions. Some of these side effects may be quite serious. Treatment with the various penicillins, expecially in the large amounts presently prescribed, may be attended by immunologic reactions, such as nephritis, and by direct toxic effects which may involve the blood platelets, the neurones of the central nervous system, and perhaps the parenchymal cells of the liver.


[Study on the rapid, secondary-growth mutants of Staphylococcus epidermidis (author's transl)]. According to colony type, growth rate and development of secondary growth on the proteose-peptone No. 3 mannitol salt agar (PMS) and the nutrient agar (NA) media, Staphylococcus epidermidis may be classified into three groups. Group I includes strains which develop smooth colonies on both media. Group II consists of those which show rapid propagation of entire clones and develop secondary growth on the PMS medium, but grow only smooth colonies on the NA medium, and which may be called reversible mutants. Group III includes thoes which show secondary growth on both PMS and NA as well as other media, which may be called irreversible mutants. One percent proteose-peptone No. 3 and 5--7% NaCl are the essential ingredients for the induction of mutation, and mannitol can enhance it. Except the high sensitivity of the reversible mutants of human origin, the three groups of chicken origin showed similar drug susceptibility to biosynthesis inhibitors of protein and cell wall. On the HI medium, chloramphenicol inhibited secondary growth of irreversible mutants at 25.0 microgram/ml minimal antimutagenesis concentration (MAC), whereas streptomycin, penicillin, erythromycin and oxytetracycline did not at all. The irreversible mutants had higher resistance to biosynthesis inhibitors of DNA or RNA, e.g. mitomycin C (MMC), novobiocin (NOV) and rifampicin (RIF), than the other two groups. On the HI medium, MMC at the MAC of 0.16 microgram/ml, NA at 25.0 microgram/ml and NOV at 2.5 microgram/ml inhibited the secondary growth of irreversible mutants, but RIF did not. To the irreversible mutants, the MIC and MAC of NA on the PMS medium were both higher than those on the HI medium. The MACs of MMC and NOV on the PMS medium were also higher than those on the HI medium, but their geometric mean MIC remained almost unchanged on both media. Because the MACs of MMC (0.31 microgram/ml) and NA (100.0 microgram/ml) to the reversible mutants on the PMS medium were much similar to those of the irreversible mutants, it suggests that both groups had the similar mutation mechanism.


Survey of Salmonellae in mesenteric lymph nodes, gallbladder wall and jejunum from healthy pigs slaughtered in Taiwan. A study made in Taiwan showed that 23.3 per cent of healthy slaughter pigs were infected with salmonellae. Samples of gallbladder wall/liver, mesenteric lymph nodes and jejunum wall were found to yield salmonellae in 16.4, 5.2 and 11.6 per cent of cases respectively. Salmonellae isolated belonged to nine different serotypes, S. london being the serotype most frequently isolated (26.8%) followed by S. anatum, S. panama (16.1% each) and S. typhimurium (12.5%). Of the total number of salmonellae isolated 68.5 per cent were detected simultaneously on brilliant-green phenol-red lactose sucrose agar (BGA) and desoxycholate agar (DCA), whilst 18.5 per cent were detected only on DCA and 13 per cent only on BGA plates.


Antibiotic resistance of vibrio cholerae: special considerations of R-plasmids. Studies on the transmission of R plasmid by conjugation between enterobacteria and vibrio or related bacteria were reviewed. The majority of the reports confirmed successful transmission from enterobacteria to Vibrio cholerae and related species, although the transmission frequencies were extremely low and the transmitted R plasmid was very unstable except for thermosensitive kanamycin plasmid and usual R plasmid coexisting with P plasmid. Strains of V. cholerae and Aeromonas liquefaciens as well as A. salmonicida bearing R plasmid were detected in nature. R plasmid was relatively unstable in V. cholerae strains with which transmission of R plasmid to enterobacteria was confirmed. At present, only 3 R plasmids have been obtained from naturally occurring strains of V. cholerae. Although the 2 European plasmids belong to the C incompatibility group with 98 megadalton closed covalent circular DNA molecule, one plasmid belongs to the J group with more than 25 megadalton molecular weight, and no CCC of satelite DNA was detected in bacteria harboring this plasmid.


Parenchymal mechanics at the alveolar level. Three current questions about alveolar mechanics are discussed: how is the liquid lining of the alveolus maintained, how does surface tension affect alveolar geometry and lung recoil, and how does the parenchyma respond to nonuniform deformations? Modeling the parenchyma as an interconnected network of alveolar walls is emphasized and modifications that are needed to make the models quantitatively successful are suggested.--Wilson, T. A. Parenchymal mechanics at the alveolar level.


[Cardiac and vascular components of the systemic circulatory reaction to orthostasis]. The orthostatic test (OT) induced regular constrictor responses of the resistance vessels and less regular those of the capacitance vessels under conditions of extracorporeal circulation (by passing the left ventricle) in anesthetized cats. Responses of the resistance vessels were eliminated by ganglionic blockade, while blood pooling rised only in half of experiments under these conditions. In case of natural circulation, the ganglionic blockade entailed an obvious initial hypotension followed by lowering of compensatory elevation of arterial pressure (AP) while responses of the cardiac output to OT remained unchanged. By the method of extracorporeal circulation combined with the "working" heart significant lowering of the cardiac output to OT was achieved; this response was accompanied by constrictor responses of the resistance vessels. Compensatory responses of AP reveal themselves mainly by the vascular component of the systemic reaction.


Adverse effects of milk formula ingestion on the gastrointestinal tract. An update. The large-scale use of cow's milk in infant feeding is less than one hundred years old. Much progress has been made by the manufacturers of proprietary formulas during this period to make their products safer. Although the current formulas provide an excellent "substitute" for the majority of infants, problems still remain, and it is necessary for every pediatrician and gastroenterologist to be aware of these. The purposes of this article are to review the adverse effects of nonhuman milk on the gastrointestinal tract, to examine the underlying mechanisms, and hopefully to stimulate further thought and research. Particular emphasis will be placed on hypersensitivity reactions, because there now appears to be a swing back to this diagnosis as a result of more sophisticated immunologic investigations. The arguments in favor of breast-feeding, the systemic biochemical differences resulting from different formulas, and the indications for specialized formula feeding are all beyond the scope of this review.


Hospitals meet space and HSA criteria through merger. Building a new hospital on a new site was considered a far better alternative than expanding or recycling another facility.


Therapeutic arthroscopy of the knee.

Therapeutic arthroscopy of the knee. This paper describes transcutaneous therapeutic procedures performed during arthroscopy. Sixty-six patients were treated. Small loose bodies were flushed out through the arthroscope in 7 cases. In 19 of 24 knees a loose body 0.5-2 cm in size was extracted either with a Dormia stone-dislodger or a pituitary rongeur. In 5 patients we failed to remove the loose body transcutaneously and arthrotomy was performed. A meniscus was resected in 17 patients using a pituitary rongeur alone or in combination with some other instrument. The late result was good in 14, but 3 subsequently underwent arthrotomy. Various procedures such as lateral release of the patella by a special technique, removal of intra-articular sutures and other measures were also undertaken. No complications occurred and the duration of sick leave was usually short. Before arthrotomy for removal of loose bodies or resection of ruptured menisci is performed, we feel that an attempt at transcutaneous therapy under arthroscopy should be made.


Tear of the anterior cruciate ligament as a late complication of meniscectomy. During the years 1973-5 we performed 190 meniscectomies. We report 4 cases of tears of the anterior cruciate ligament after meniscectomy. Although this complication is mentioned in the literature, very few orthopaedic surgeons are familiar with it.


Mechanisms of immunity in typhus infection: some characteristics of intradermal Rickettsia mooseri infection in normal and immune guinea pigs. Rickettsia mooseri infection in skin at sites of intradermal inoculation was studied in nonimmune and immune guinea pigs with respect to dynamics of infection, localization of rickettsiae within tissues, and gross and microscopic pathology. Intradermal inoculation of R. mooseri into nonimmune guinea pigs resulted in gross lesions which, in magnitude, were directly related to the number of rickettsiae inoculated. The lesions progressively enlarged through 3 or 4 days and remained enlarged through at least 7 days. Histological examination revealed an early acute inflammation which progressed to a predominantly monocyte-macrophage inflammation and subsequently condensed into lymphocyte-containing granulomatous foci. Rickettsiae in the skin at sites of inoculation increased in numbers from 6 h through 3 days, in parallel with the increasing diffuse monocyte-macrophage inflammatory response, and then declined markedly on days 4 or 5 as ganulomatous foci appeared. Some rickettsiae, however, persisted through at least day 7. Fluorescent-antibody studies suggested that R. mooseri infected only a subset of cells available, i.e., cells associated with the microvascular system. Dissemination of infection was demonstrated by the presence of rickettsiae in the skin at sites distant from the point of inoculation. Immune guinea pigs, made immune by intradermal infection with R. mooseri 12 days before intradermal challenge, displayed an accelerated response. The lesions were maximal by 24 to 48 h and subsequently regressed. The inflammatory response of immune guinea pigs was a greater magnitude than the response of similarly challenged nonimmune guinea pigs, and the respose from acute inflammation through the formation of granulomatous lesions was accelerated. The number of rickettsiae in the skin of immune guinea pigs declined steadily from the time of inoculation, until no rickettsiae were recovered on or after day 3. Furthermore, dissemination of rickettsiae to sites in skin distant from the site of inoculation was not demonstrable. The results are discussed in terms of pathogenesis and of immunity to typhus.


Separation testing of hemodialysis shunts using dynamic and static forces in a controlled environment. Analytical methods are presented for determining the longitudinal dynamic and static forces needed to overcome the transverse frictional forces and effect the separation of hemodialysis shunt connections under controlled environmental conditions. Results for different types of shunts and their associated connectors are reported along with the factors that affect the separation force and separation times.


Homologous and heterologous antibody responses to subunit influenza virus vaccine. In a group of 32 adult volunteers given subunit influenza virus vaccine containing 250 international units (i.u.) of A/Victoria/3/75, 250 i.u. of A/Scotland/840/74 and 300 i.u. of B/Hong Kong/8/73, there were substantial increases in the geometric mean homologous haemagglutination-inhibiting (HI) antibody titres. There was also substantial boosting of the antibodies to the earlier variants of the Hong Kong (H3N2) series and to a later variant of the Asian (H2N2) series. There was no boosting of antibodies to the A/FM/1/47 strain, a representative member of the H1N1 series, but two individuals showed substantial rises to A/PR/8/34 (HON1). There were increases in the HI titre of antibodies cross reactive with two recent isolations, A/Texas/1/77, and A/Victoria/35/77, but the majority of vaccinees failed to reach antibody titres likely to be protective against such strains.


Pharmacokinetics of benzquinamide in man. Using a newly developed sensitive gas chromatograph-mass spectrometer assay for benzquinamide, pharmacokinetics have been determined in man following the administration of intramuscular, oral, and rectal suppository doses. Drug is absorbed most rapidly from the intramuscular dose and least rapidly from suppositories. The mean apparent elimination half-life is 1.0-1.6 hr from all formulations. Benzquinamide is 33-39% bioavailable from the capsule and suppository formulations, relative to the intramuscular formulation. A high correlation between capsule and suppository bioavailabilities suggests that first-pass metabolism may account for at least part of the incomplete availability.


Leaking mycotic aneurysm of renal artery in a child. A case of staphylococcal endocarditis, complicated by a leaking mycotic aneurysm of the right artery in a boy is presented. An emergency nephrectomy was lifesaving. The clinical course and pathology are discussed and the literature is reviewed.


[Surgery of hyperthyroidism: introduction (author's transl)]. Of the patients operated upon for goiter (n = 1891) within the last 10 years, 625 had hyperthyroidism. Exophthalmia was present in 22.7% toxic nodular goiter in 26.5%; the remaining patients had autonomous adenoma. The different prognosis and treatment of Graves' disease in contrast to other kinds of hyperthyroidism is discussed. The importance of radioimmunoassays and scintigraphic methods as a basis of differentiated and functional surgical treatment is emphasized. Close cooperation among all medical branches involved in the treatment of goiter is recommended.


[Hyperthyroidism (author's transl)].

[Hyperthyroidism (author's transl)]. Surgical cure of hyperthyroidism aims at removing enough functioning follicles to prevent hyperthyroidism while leaving sufficient tissue to maintain euthyroidism. In the case of Graves' disease the surgeon is faced with a goiter consisting of uniformly hyperstimulated follicles that are but one of the multiple targets of an immunologic attack. In contrast, autonomous follicles with an intrinsic functional abnormality are the hallmark of multinodular toxic goiter. These follicles may be clustered (toxic adenoma) or spread in different patterns throughout the gland. Partial thyroidectomy provides definite cure. While operating, the surgeon is unable to appreciate the functional quality of the tissue left behind. Thus, both postoperative hypo- and hyperthyroidism may occur independently of the surgical technique.


[Postoperative intestinal obstruction: introduction (author's transl)]. Postoperative intestinal obstruction is the indication for one-third of early reoperations. Mortality increases with age and time interval. Operations on the lower intestinal tract are predominant among the primary procedures. The main causes of obstruction are adhesions involving the small intestine. Diagnosis requires differentiation from paralytic ileus and physiologic postoperative paralysis. The outcome depends on early recognition, immediate reoperation, and adequate surgical management.


[Closed intestinal decompression in postoperative paralysis: intestinal intubation (author's transl)]. Paralytic distension is a causative or important factor in the pathogenesis of early postoperative intestinal obstruction. The elimination of intestinal distension initiates a decisive change in the course of this disease. The long intestinal tube--comparable to an "intraluminary stoma"--renders the necessary intestinal decompression. The controlled placement of the tube using a gastroscope rules out technical problems. The procedure is highly effective, contributes to the reduction of relaparotomies, and avoids enterotomies with all their inherent risks in the state of ileus.


[Use of stoma for decompression of the paralytic ileus (author's transl)]. Indications for the construction of a stoma in the handling of paralytic ileus caused by peritonitis should be ascertained early and completely, since this method is probably the safest and fastest way to relieve advanced intestinal paralysis. There is no need for a secondary laparotomy in order to close the stoma when a catheter-entero- or colostomy is performed. Replacement of lost fluid and electrolytes through the stoma should no longer present serious problems because of the possibilities offered by modern intensive care treatment.


Results of reconstructive mastoidectomy with homograft knee cartilage. The technique of reconstructing the posterior canal wall with homograft knee cartilage originally described in 1972 is reviewed and refinements are presented along with additional cases. The homograft knee cartilage is used in conjunction with the homograft tympanic membrane and ossicles to rebuild the middle ear and mastoid as near as possible to anatomical configuration and function. Anatomical follow-up of one year or more is reported on 63 ears. Satisfactory results were obtained in 36 of these ears or 57% of the total. Hearing results are reported overall and in relation to different types of reconstruction. One year or more follow-up demonstrates satisfactory hearing with an air-bone gap of 20 db or less in 77% of the postoperative ears.


Very low birthweight infants: a follow-up study. This study was undertaken to determine the outcome of infants delivered at the Royal Hospital for Women during the years 1971 to 1975 who weighed 1500 g or less at birth and who survived the first 28 days of life. Of the 104 neonatal survivors, 79 were seen by one of the writers, nine were seen by other medical practitioners, four had died after the neonatal period, the parents of two children could not be induced to bring their child to be examined, and the remaining ten could not be traced. Abnormalities were found in 15 of the 88 children examined. Three had major physical handicaps (problems causing a restriction of normal lifestyle), 11 had minor handicaps (problems which did not restrict normal lifestyle), and eight had evidence of developmental delay. Infants who were small for gestational age tended to be below the 10th percentile for height or weight at follow-up more often than infants of the appropriate weight for gestational age.


Grey scale ultrasonic examination of the thyroid gland. High resolution grey scale echography is an accurate, non-invasive means of investigating thyroid lesions. The structural information which it provides complements that of the functional status of the gland obtained from radionuclide scanning. The principles and practice of the technique are discussed and clinical examples are presented.


Assessing fetal lung maturation by the foam stability index test. An assay has been developed and evaluated that quantifies the surface tension lowering ability of amniotic fluid surfactant. The formation of stable foam following vigorous shaking of amniotic fluid was evaluated by the addition of various amounts of dipalmitoyl lecithin in a solution of ethanol and saline and by fine adjustments of the ethanol volume fraction in the final assay mixture. The foam stability index (FSI) for a particular sample of amniotic fluid was defined as the highest ethanol volume fraction that would permit the formation of stable foam after vigorously shaking a mixture of ethanol and amniotic fluid. The assay is referred to as the FSI test. We report the FSI values in amniotic fluid specimens from 59 patients obtained within 72 hours of delivery. The L/S ratio was measured in 50 of the same 59 specimens. We observed 6 cases of neonatal hyaline membrane disease (HMD) and 2 cases of transient tachypnea of the newborn (TTNB) in this study. No cases of HMD or TTNB occurred with FSI values of greater than 0.47, while 2 cases of HMD were recorded in association with L/S ratios of 2.5 and 2.8, respectively. The potential clinical value of the FSI test is discussed.


Plasma amino acid response to single test meals in humans. III. Supplementary effect of dried skim milk and L-methionine on a vegetable protein mixture. The plasma amino acid response to single test meals in young adults was used for human biological evaluation of the supplementary effect of dried skim milk powder (DSM) and synthetic L-methionine on a vegetable protein mixture. The protein sources in the vegetable mixture were wheat flour, defatted soya bean flour and pea flour. The plasma amino acid responses were evaluated both as PAA ratios (a modification of the Longenecker and Hause method), and as delta MR% (percentage change in the postprandial essential amino acid molar ratios according to Graham and Placko). Both evaluation methods indicated that there was an adequate supply of all the essential amino acids in the basic vegetable mixture, except for a small deficit of methionine. Supplementation (5% and 10%) with DSM did not significantly improve the low plasma amino acid response of methionine. The addition of synthetic L-methionine proved to be very effective in this respect. 1 g of L-methionine per 100 g of proteins from the vegetable mixture gave a plasma methionine response similar to that of the other essential amino acids. This implies that the deficit of methionine in the basic wheat/soya bean/pea mixture was about 30%.


Growth-retarded fetuses and pulmonary maturity. The amniotic fluid of 250 patients in the third trimester of pregnancy was examined for surfactant content by means of the bubble test and total phospholipid estimation. No evidence was found that intra-uterine growth retardation accelerates pulmonary maturity in the fetus, and the finding of early pulmonary maturity does not indicate intrauterine growth retardation.


The bubble test as a measure of amniotic fluid surfactant and as a predictor of hyaline membrane disease. The bubble test was compared with the lecithin-sphingomyelin (L/S) ratio and total phospholipids (TPL) test as a measure of fetal lung surfactant in the amniotic fluid. Of 161 patients, all but 1 with a bubble score of 2 + or more also had mature L/S ratios and TPL values, whereas those with a bubble score of  0 - 1 + had L/S ratios and TPL values ranging from immature to mature. A total of 161 patients who delivered within 72 hours of TPL test and bubble test were assessed for the presence of hyaline membrane disease (HMD). No cases of HMD were associated with a bubble score of 2+ or more. However, the fetuses of 10 of 66 patients with a bubble score of 0 or 1 + developed HMD.


The association between the fat cell count of amniotic fluid and tests of fetal lung maturity. The fat cell count in amniotic fluid samples from 100 patients was compared with the lecithin-sphingomyelin (L/S) ratio and total phospholipid content. When the fat cell count was over 10%, the L/S ratio indicated maturity in all cases and the total phospholipids indicated maturity in all but 1 case. When the presence of blood or meconium in the amniotic fluid renders lung surfactant tests unreliable, an indication for the fat cell count exists.


Modifications of dermatoglyphics in thyreopathy. Examination of the digito-palmar and plantar dermatoglyphics of 50 thyreopathic women revealed no statistically significant variations depending on the clinical form of thyreopathy, for the quantitative aspects of digito-palmar and plantar dermatoglyphics. Qualitative determatoglyphic differences were found (reoccurrence of the patterns on areas of the palm and plant) according to the clinical form of thyreopathy. These differences are more obvious in Graves's disease patients which may support the idea of a hereditary factor implied in the disease.


[The use of direct and indirect parasympathomimetics in poisonings with tricyclic antidepressive agents]. The use of cholinesterase inhibitors in poisonings with potentially lethal doses of tricyclic antidepressive drugs seems to be indicated on account of clinical experiences and own experimental investigations on animals. An uncritical use of these substances which have considerable side-effects must be warned of. A mixed intoxication with several drugs effecting on the central nervous system is only a relative indication for the use of indirect parasympathicomimetics of the cholinesterase type. They should be used only then, when the picture of poisoning is unequivocally determined by the thymoleptics. When cholinesterase inhibitors are used the physostigmine salicylate should be preferred, since at present it is sufficiently accessible to the central nervous system and with the slightest peripheral effects as the only representative of this group of substances, above all with regard to the gastrointestinal motility. Later investigations shall show, whether also other groups of substances which develop an antagonistic effect to the tricyclic antidepressive drugs may be of use in the treatment of the acute poisoning.


[Danger of iodine drugs in the pregnant woman]. The authors draw attention to the fact that the possible effects of drugs containing iodine are often neglected during pregnancy. As an example, they report the following observation : "A young woman with benign asthma, treated for 14 years Asthmasedine and Asthmaligne, gave birth, on the 36th week of pregnancy, to a child apparenty dead but who was able to be reanimated. The child showed two types of signs : respiratory distress due to higher neurological disorders and a multinodular, non-compressing goiter. These two complications were caused by a congenital hypothyroidism corroborated by laboratory tests and due to the prolonged absorption of iodinated drugs by the mother". In conclusion, in cases of women receiving during pregnancy high doses of drugs containing iodine (250 such drugs are recorded in the Vidal), it is desirable to control the effect on the fetus and to propose an intra-amniotic therapy with L-Thyroxine, thus allowing a cerebral development close to normal.