Giant recurrent desmoid tumor: a case report. A case of giant recurrent intra-abdominal desmoid tumor is presented. A history of childbirth, antecedent surgery, multiple episodes of recurrence, resistance to excisional and radiation therapy, represent common features of desmoid tumors. The size of the recurrence (15.4 kg), the intra-abdominal presentation of the tumor, involvement of the chest wall and focal infiltration of the small bowel are unusual features of this case.


Multiple nevoid basal cell carcinoma syndrome. A review of the literature and a case report of the multiple nevoid basal cell carcinoma syndrome is presented. A new finding related to the skeletal system is reported; this is radiolucent deformities of the parietal bone.


Hernia reduction en masse.

Hernia reduction en masse. A case of hernia reduction en masse is reviewed. Discussion of the pathogenesis, diagnosis, and operative approach suggests that the use of taxis in the reduction of incarcerated hernia should be tempered by awareness of potential complications including mass reduction. Diagnosis is by history with the persistence of intestinal obstruction after reduction is a key feature. A preperitoneal approach is recommended for facility of reduction, resection, and anatomic hernia repair.


[Sociocultural factors and nutrition (author's transl)]. A schematic review of some of the most significant sociocultural factors related to food intake throught life, either in developing or developed societies is presented. In both societies, sociocultural factors are of fundamental importance on the determination of feeding practices, thus its excess or deficit are of great relevance to physical growth, possibly mental development as well as on morbidty and mortality. In developing societies low social class and poor education are sinonimous of poor nutrition. However, if the whole population in developed societies are studied, it is proven once again that nutritional deficiencies do also exist among marginal groups of people, which are mainly produced by poor education, erroneous feeding practices, nutritional taboos during health and disease, byas and prejudices. It must follows that in these societies, relative large group of children are poorly fed during the critical periods of growth and development due to sociocultural factors. Only through the appropiate and enforced nutrition educational programs at all learning levels, primarw and higher education, as well as better and more complete nutritional curriculum at Medical and Public Health Schools could perhaps solve, the problem, or at least significant alleviated it. This is the hope.


[Height alterations and calcium metabolism after prolongated phenobarbital treatment (author's transl)]. In order to know if small children subjected to a long-term treatment with phenobarbital can suffer some alterations in their lineal growth or in their osseous maturity in the same way as those showed by epileptical mother's sons, 85 patients between six months and three years old, who had suffered fit convulsions during a fever process, 20 of them subjected to antithermic treatment, and the 65 left who received a phenobarbital treatment in doses of 5 mg./kg./day have been controlled. In each child, at the beginning of the control and after 12 months, their height, diaphysial diameter and cortical thickness of the metacarpal bones, and bone age is valued. At the same time a calcium, phosphorous and phosphatase-alcaline control was done. The group who had received anti-convulsivants  drugs, showed a significant decrease in their lineal growth and in calcium concentration in blood. The control group didn't present any significant variation in any of the controls performed.


[Cerebral tumours in infancy (author's transl)]. 37 cases of cerebral hemispheric tumours are presented. These make up 23,1% of all the intracranial tumours observed over a period of 11 years in a Child Neurology Service. 19 cases were males and 18 females. Their ages were between 16 days and 7 1/2 years. Vomiting and headache were usually the first symptoms followed by seizures, frequently of the focal kind. Motor difficulties used to appear later. 69.6% of the cases presented a malfunctioning focus on the E.E.G. on the side of the tumor. The simple cranial X-Rays showed firstly widening of the fronto-parietal sutures, intracranial calcifications were seen in some of the cases with ependymonas and piloid astrocytoma in patients with Bourneville's disease. Pneumoencephalography as well as carotid angiography, radioisotope examination and computerized tomography gave us very positive results in the localization and determination of the size of the tumor. The ependymomas showed pathological vascularization regularly. The nature of the tumours corresponded to: 14 cases of ependymoma, 8 cases of astrocytoma I and II types, 1 case of astrocytoma of types III and IV, 3 cases of plexus papilloma, 2 cases of meningioma, 1 case of sarcoma of the basal ganglia, 1 case of teratoma, 3 cases of indifferentiated malignant tumours, 4 cases not proven. There was a 20% survival of patients five years later.


[Turner's syndrome (author's transl)].

[Turner's syndrome (author's transl)]. Twenty cases of Turner's syndrome are presented. Ten cases showed cariotype XO, nine XO/XX and one case showed mosaicism with three cell lines one of which showed a ring chromosome (XO/XX/XXr). The clinical characteristics of syndrome and the associated malformations are appraised. Commentaries are made about ultimate height attained by this patients.


[Acute gastroenteritis. Clinical evolution without use of antibiotics (author's transl)]. Authors present a prospective study upon 193 cases of acute gastroenteritis in infants 1 to 24 months of age, giving special attention to clinical evolution of the disease without any use of therapy of either antibiotics or other antidiarrheal agents. Data on epidemiology and etiology of this series are similar to those previously reported by other authors. Mean duration of diarrhea was 2,5 days, whereas mean hospital stay was 7,5 days. The number of cases of prolonged diarrhea was 13, from which six were cases of lactose intolerance, six were cases of cow's milk protein intolerance and one was a case of intractable diarrhea. The little use fulness of antibiotics in the treatment of acute diarrhea is commented and also a discussion is made of the different factors involved in the onset of the complications above mentioned.


[Pneumopericardium in the newborn (author's transl)]. A case of pneumopericardium in a newborn affected of hyaline membrane disease, and undergoing assisted ventilación is presented. Literature is reviewed. Physiopatology, morbidity, mortality, and predispossing factors are described. Knowledge of the clinical simptomatology is essential in order to perform the prompt pericardiocentesis, should cardiac tamponade be present.


[Pyloric stenosis: An unfrequent complication (author's transl)]. We present one case of pyloric stenosis with hematemesis caused by a necrotizing gastritis that evolved to a gastric stenosis which had to be reoperated, having a favorable outcome.


[Shwachman's syndrome: pancreatic exocrine insufficiency retarded growth, metaphyseal dysostosis and neutropenia (author's transl)]. A boy of 5 8/12 years of age affected with Shwachman's Syndrome is presented. He showed frequent respiratory infections that can be in order with a low account in T-lymphocytes found on immunological study. A cytoplasmic degenerative process was found after microscopical and ultrastructural vision of osteoid tissue, which is compatible with biochemical alterations.


Fine-needle aspiration cytology in the preoperative diagnosis of thyroid nodules. Fifty consecutive patients were studied to assess the utility of fine-needle aspiration cytology for the diagnosis of hypofunctioning thyroid nodules. In two patients, cysts were evacuated and did not recur. Thirty-three patients underwent excisional biopsy; the aspiration biopsy result was not a criterion for surgery. Satisfactory aspiration specimens were obtained in 32 patients (97%). The diagnosis in nine aspiration specimens was malignant; of these seven (78%) were correct and there was one false-positive and one occult carcinoma unrelated to the clinically detected nodule. Five aspirations showed suspected malignancy; of these, two were carcinoma, one was an occult carcinoma, and two were benign. Eighteen aspirations were interpreted as benign; of these, 17 (94%) were correct and the one false-negative diagnosis was a well-differentiated follicular carcinoma. The procedure is useful in assessing the need for surgery in high-risk patients and in selecting patients for thyroid-suppression therapy.


Combined ultrasound and needle aspiration cytology in the assessment and management of hypofunctioning thyroid nodule. We evaluated the efficacy of combining B-scan bistable and gray-scale ultrasound with needle aspiration cytology in assessing and managing solitary hypofunctioning solid and cystic nodules. Of the 150 cases surveyed, 90 had surgical follow-up histology for comparison to preoperative aspiration cytology results. Overall neoplasm rate in these 90 cases was 66%, increasing to 93% if colloid nodules were included. Adequate material for cytology preoperatively was obtained in 83 (92%). In cases with adequate preoperative needle aspiration cytology, there were 66 solid and 17 cystic or mixed lesions. Overall accuracy for differentiating benign from malignant nodules for solid lesions was 63 of 66 (95%), compared to 15 of 17 (88%) for predominantly cystic or mixed lesions. Of the 17 cases of proven carcinoma, correct preoperative cytology diagnosis for malignancy was obtained in 12 (71%). Malignancy was most often correctly diagnosed for solid papillary and metastatic cancer lesions. No false-positives were noted and atypical adenomas and Hürthle-cell adenomas have been correctly diagnosed. The simplicity and safety of these diagnostic procedures justify their use for "selective" surgery and particularly for those cases that have been initially assigned to conservative, nonsurgical therapy.


Sites of conduction disease in aortic stenosis: significance of valve gradient and calcification. Electrophysiologic studies were done in 32 patients with aortic stenosis. In 24 patients with intact A-V conduction, A-H intervals ranged from 55 to 145 msec and were prolonged in two. Two had split His bundle potentials. The H-V intervals ranged from 25 to 94 msec and were prolonged in 12. The mean H-V interval was 63 +/- 2.6 msec in 12 patients with calcific aortic stenosis compared with 50 +/- 4.9 msec in 12 without calcification (P less than 0.05). The mean H-V in 10 patients with aortic gradients greater than 40 mm Hg was 62 +/- 5.6 msec compared with 47 +/- 3.1 msec in nine with gradients less than 40 (P less than 0.05). In patients with aortic stenosis and A-V block, the site of the block was distal to the His bundle in three and within the His bundle in five. All eight had calcified valves. Aortic stenosis was commonly associated with latent and manifest conduction disease in the His bundle and the trifascicular conduction system. Conduction disease was more extensive with calcified valves and greater valve obstruction.


Bartter's syndrome: urinary prostaglandin E-like material and kallikrein; indomethacin effects. The urinary excretions of prostaglandin E-like material (iPGE) and kallikrein were measured in two children with Bartter's syndrome. Urinary iPGE excretion was three and 10 times greater than normal, and urinary kallikrein was five and 10 times greater than normal in the two subjects. Furthermore, excretions of iPGE and kallikrein were highly correlated (P less than 0.005) with each other before and during treatment with indomethacin, a prostaglandin synthetase inhibitor. Indomethacin significantly (P less than 0.001) reduced urinary iPGE, urinary kallikrein, and plasma renin activity, while increasing the sensitivity to intravenous angiotensin II and the serum potassium to normal. The results confirm that renal prostaglandins may be involved in the pathogenesis of Bartter's syndrome and suggest that renal prostaglandins and the kallikrein-kinin system are linked.


Liver involvement in the syndrome of mixed cryoglobulinemia. A study of liver abnormalities in 36 patients with mixed cryoglobulinemia in the absence of underlying infectious, connective tissue, or lymphoproliferative disorders revealed clinical or biochemical evidence of liver dysfunction in 84%. Hepatomegaly was detected in 77%, splenomegaly in 54%, and abnormalities in bilirubin, alkaline phosphatase, or serum glutamic oxalacetic transaminase in 77%. Only four of the patients had overt liver disease. Of 15 biopsies from 12 patients, there was normal tissue structure in two, minimal nonspecific changes in one, portal fibrosis in three, chronic persistent hepatitis in one, chronic active hepatitis in two, chronic active hepatitis with cirrhosis in four, and postnecrotic cirrhosis in two. These findings, together with the previously reported high incidence of serologic evidence of hepatitis B virus (HBV) infection, support the view that the syndrome of purpura, arthritis, and nephritis is often a consequence of immune-complex vasculitis secondary to HBV infection.


Chronic excessive acetaminophen use and liver damage. Severe, often fatal liver damage results from extreme overdosage with acetaminophen. In usual dosage, it is considered harmless. We describe three cases of toxic hepatitis associated with the chronic ingestion of excessive doses of acetaminophen. Each patient took approximately 5 to 8 g of acetaminophen per day during a period of several weeks. The transient elevations of serum hepatocellular enzyme concentrations and the histologic evidence of a toxic hepatitis suggest the liver damage was related to the use of acetaminophen. Alcohol abuse in one patient and negative nitrogen balance in another may have increased the susceptibility to acetaminophen toxicity. With the increasing popularity of acetaminophen for mild pain relief, hepatotoxicity from acute or chronic ingestion may be more common than previously recognized, especially in those patients with predisposing conditions.


Chronic liver disease and acetaminophen. A 59-year-old female patient with arthritis developed liver function abnormalities while taking therapeutic doses of acetaminophen. Liver biopsy showed evidence of acute and chronic liver damage. Rechallenge with acetaminophen induced abnormal liver functions almost immediately. The patient has been followed for 2 years since that challenge and remains asymptomatic. Biochemical tests of liver function have returned to normal.


Antibiotic treatment of renal carbuncle. Renal carbuncles in seven young males were successfully treated with long-term administration of penicillinase-resistant antibiotics. Selective renal arteriography provided an accurate means of diagnosis and permitted a trial of medical therapy. All patients experienced a prompt and sustained clincial remission; surigical exploration was thus obviated in all but one instance, in which post-treatment radiographic changes persisted.


Nafcillin concentration in cerebrospinal fluid during treatment of staphylococcal infections. The nafcillin concentration of simultaneous cerebrospinal fluid (CSF) and serum specimens from nine patients being treated with parenteral nafcillin for staphylococcal infection were measured. Marked variations in the ratio of CSF/serum nafcillin concentration were observed. However, the concentration of nafcillin in the CSF was greater than the minimum lethal concentration (MLC) for Staphylococcus aureus in eight of the nine patients. In five patients with CSF pleocytosis, the nafcillin concentration was three to 100 times the MLC. These results support the recommendation to use nafcillin in doses of at least 100 to 200 mg/kg body weight-day for treatment of meningitis caused by S. aureus.


Phenformin and hyperamylasemia in lactic acidosis. All cases of lactic acidosis occurring during a 23-month period in a metropolitan teaching hospital were reviewed to ascertain the frequency of hyperamylasemia. Serum amylase activity had been measured in 12 of 26 patients and was elevated in eight (67%). Hyperamylasemia was not significantly more frequent in patients with phenformin-associated lactic acidosis than in patients with lactic acidosis who had not received phenformin. Serum amylase activity did not correlate with the severity of acidosis (arterial pH) or with renal function (serum creatinine).


Phenformin-associated pancreatitis.

Phenformin-associated pancreatitis. Although phenformin has been previously reported to be associated with acute pancreatitis, little emphasis of this association has been made in the literature. We report the case of a 70-year-old diabetic man who developed acute hemorrhagic pancreatitis and severe lactic acidosis while taking phenformin. The patient was not taking any other medications, nor did he have any of the known metabolic conditions associated with pancreatitis. We review the four previously published cases of patients who developed acute pancreatitis while taking phenformin. Three of those patients also developed lactic acidosis, a well-known complication of phenformin therapy. Although phenformin has been reported to increase the serum amylase activity and to alter the content of the pancreatic secretions in response to various stimuli, the manner in which the drug might cause acute pancreatitis remains completely unknown.


Influenza vaccine: recommendations of the Public Health Service Advisory Committee on Immunization Practices, Center for Disease Control, U.S. Department of Health, Education, and Welfare; Atlanta, Georgia. The bivalent influenza vaccines for the 1977-1978 immunization period will contain inactivated influenza A and B viruses representing currently prevalent strains and will be available in "split-virus" and "whole-virus" preparations, which differ in side-effects and immunogenicity. Annual vaccination is recommended for adults and children of all ages with chronic diseases, especially diabetes mellitus or cardiac, pulmonary, or renal disease. Vaccination is also recommended for persons over age 65 years and persons in vital community services. Age-related doses are specified in a table, and side-effects and use in pregnancy are discussed in the text.


Primary care residency training: the first five years. The training of physicians for the delivery of primary care is becoming a national priority. The period of residency training is viewed by many as the focal point for educational change to meet this demand. The Residency Program in Social Medicine at Montefiore Hospital and Medical Center was begun in 1970 and offers primary care residency training toward board eligibility in internal medicine, pediatrics, or family practice. The pairing concept of scheduling guarantees the resident a continuity of care experience for his own panel of patients at the ambulatory site. The hospital and the ambulatory site share the cost of residents' salaries. Primary care curriculum for clinical and clinical-support areas, delivery-site design, and faculty-utilization models must all be uniquely suited to the training of the future primary care practitioner. Resident recruitment and selection and the involvement of residents in the management of the residency program are crucial features of program success and training for future practice.


Bartter's syndrome results from an imbalance of vasoactive hormones. Bartter's syndrome may result from a disturbance of the interrelations of three vasoactive hormonal systems: the kallikrein-kinin, renin-angiotensin, and prostaglandin systems. Although kinin and angiotensin have opposing effects on renal function, each hormone increases the levels of prostaglandins within the kidney. Elevated renal prostaglandin levels are primarily responsible for some of the major features of the syndrome. The effectiveness of indomethacin in the treatment of Bartter's syndrome derives in large part from the ability of the drug to inhibit prostaglandin production. Indomethacin also decreases the activity of the renin-angiotensin system and the excretion of renal kallikrein, perhaps related to inhibition of prostaglandin mechanisms that may participate in the release of renin and kallikrein. However, additional actions of indomethacin must be considered, such as an effect of the drug on a naturally occurring renin inhibitor.


[In favor of a scientific psychiatry. Attempted formalization and operative model]. In giving due consideration to the heterogeneous nature of psychiatry, and its several trends with their inability rightly to state the many varieties of mental disorders, we may well ask whether this department of knowledge may not now be directed into strictly scientific channels. In the present state of things, the conditions suitable for the research of a scientific modus operandi are now fulfilled. That it may be placed on a more scientific footing, psychiatry must not only be able to overcome the epistemological obstacles and take into account the latest elements brought in by contemporary epistemology; it must also give us modes and patterns brought forth from clinical experience and experimentation. Constant exchanges between scientifically critical and purely clinical data is leading us to a pattern or mode of increasingly generalised scope which is based on functional notions and which permits us to answer the question raised in the affirmative.


The fine structure of microconidial germination and vegetative cells of Histoplasma capsulatum. Aspects of the fine structure of germinating microconidia (spore less than 5 micron in diameter) and vegetative hyphal cells of Histoplasma capsulatum were examined by electron microscopy. When grown on a soil extract medium, three strains produced masses of smooth-walled conidia when the conidia were examined by light microscopy. Electron microscopy showed the presence of short tuberculations arising as part of the outer layer of the microconidial wall. Within 48 h of incubation at 25 degrees C, germination was initiated by the emergence of a short germ tube whose wall was derived from an inner layer(s) of the cell wall of the germinant. Germ tube formation was occasionally multipolar. Following the initiation of germination, organeller migration and septation, the microcondium rapidly lost its morphological identity. The cytoplasm of the vegetative hyphal cell was observed to contain typical fungal organelles. The septal area was characteristic of that of a ascomycetous fungus.


[Pathways of benzoic acid dissimilation in "enterobacteriaceae" (author's transl)]. The Enterobacteriaceae can be divided into two groups with respect to the benzoic acids metabolism. In the first group, benzoate and/or p-hydroxybenzoate are dissimilated through the beta-ketoadipate pathway and m-hydroxybenzoate through the gentisate pathway; in the second one, are clustered species which do not dissimilate these aromatic acids. The possible taxonomic significance of this divergence is discussed.


[Characteristics of "Streptococcus mutans" from endocarditis and susceptibility to antimicrobial agents (author's transl)]. Strains of Streptococcus mutans were isolated from blood cultures of ten patients with endocarditis. Nine of these patients had a typical clinical picture of subacute bacterial endocarditis, with fever, weakness, heart murmur and multiple positive blood cultures. All the patients had previous valvular heart diseases; only in three cases the initiating event involved some type of dental manipulations which where supposed as the source of infection. The major criteria for recognizing S. mutans were colony morphology on blood agar, characteristic extracellular polysaccharide production in 5% sucrose broth, acid formation in mannitol and sorbitol broth, and the failure of antigenic extracts of S. mutans to react with streptococcal group antisera. The susceptibility to antimicrobial agents was tested by the diffusimetric method with susceptibility disks. All the strains were susceptible to penicillin G, erythromycin, pristinamycin, lincomycin and tetracycline, and resistant to streptomycin and gentamicine.


The effect of antibiotics on the infective viability of an alder (Alnus glutinosa L. Gaertn.) crushed nodule inoculum. The effect of various antibiotic substances, mainly penicillin, streptomycin, tetracycline and chloramphenicol respectively, on the infective viability of an alder crushed nodule inoculum towards the host plant has been studied. Penicillin was inocuous in respect of both plant and nodule endophyte. Its use did not prevent the formation of nitrogen-fixing partnership. The other antibiotics tested showed a harmful effect either inhibiting infection (streptomycin) or causing death in most plants (tetracycline and chloramphenicol). The use of penicillin in isolation trials of the alder nodule endophyte is suggested.


Long-term handling of open-angle glaucoma: tonography and other prognostic aids. Data from 132 primary open-angle glaucoma cases and from 6 combined open and closed-angle cases, taken from a group of 254 cases with extensively documented material from 10 year or longer follow-up, are used to show that tonographic data are more helpful than other criteria in predicting which cases can be expected to show deterioration, although careful visual field testing and optic disc evaluation remain the ultimate guides.


Ectopic lacrimal gland in the orbit identified by computerized axial transverse tomography. A case of ectopic lacrimal gland within the orbit causing progressive exophthalmos and visual loss is presented. The orbital mass, identified by computerized axial transverse tomography, had characteristics which were different from other orbital tumors identified to date by this technique.


Angle-closure secondary to ciliary body swelling. A 44-year-old man had unilateral closure of the anterior chamber angle associated with ciliary body swelling. He was treated with topical cycloplegics and corticosteroids. The shallow chamber deepended to equal the fellow eye in 6 days, and no recurrence has been noted.


Retinitis pigmentosa associated with nevus flammeus and unilateral glaucoma. A 53-year-old white man was noted to have bilateral retinitis pigmentosa associated with a left nevus flammeus, a left choroidal hemangioma and unilateral glaucoma. No central nervous system manifestations of Sturge-Weber syndrome were noted. The association of retinitis pigmentosa and the nevus flammeus is probably a chance occurrence.


Sebaceous carcinoma of the eyelid.

Sebaceous carcinoma of the eyelid. An unusual case of sebaceous carcinoma of the eyelid is described. Site of the lesion and noninvolvement of the lid margin or the skin suggest that it arose from meibomian glands. A complete excision and not partial biopsy of the suspected lesions is advised for histopathologic studies. It is suggested also that the specimen must be examined by an ophthalmic pathologist.


Toxicity of selected antibiotics in vitreous replacement fluid. Experiments with rabbits demonstrated no toxic effects on the retina after vitrectomy when the infusion fluid contained either 20 microgram/ml chloramphenicol saline, 10 microgram/ml amikacin saline, 10 microgram/ml tobramycin saline, or 10 microgram/ml clindamycin saline. We found abnormal electroretinograms and abnormal histologic findings in eyes receiving vitreous replacement with these same drugs in higher concentrations.


Histoplasma capsulatum in vessels of the choroid. In a 3-year-old boy disseminated histoplasmosis was recognized from a liver biopsy. The patient died shortly afterwards and had foci of the disease in liver, spleen, and kidneys. Large numbers of yeast cells of Histoplasma capsulatum were found within histiocytes in other organs including the eye. This rare finding is remarkable in view of the search for Histoplasma capsulatum in the syndrome known as "so-called histoplasmosis of the choroid."


Retinal pigment epitheliitis.

Retinal pigment epitheliitis. Sixty-one patients with retinal pigment epitheliitis were studied. Fifty-two eyes in 40 patients were followed for 2 years. Good central visual acuity was maintained in more than 80% of these eyes. The differential diagnosis of retinal pigment epitheliitis and the characteristic findings are described.


Idiopathic chorioretinal effusion: An analysis of extracellular fluids. A case of nonrhegmatogenous retinal detachment with choroidal detachment was seen 3 weeks after onset and was evaluated clinically with emphasis on the fluid contents from one eye. The right eye showed slight subretinal fluid and minimal RPE pigmentary mottling. The left eye was severely involved with a near flat anterior chamber, a 360 degrees peripheral serous retinal detachment with shifting fluid and 360 degrees choroidal separations. Fluorescein showed mottled retinal pigment epithelium changes in each eye. Cell free samples of the subretinal fluid were high in protein (16.5 gm/100 ml) with a near absence of the alpha-2 fraction. Epichoroidal fluid from the choroidal detachments exhibited a protein content and makeup similar to that of normal plasma. The concentration of protein in the cerebrospinal fluid was elevated (0.096 gm/100 ml) without evidence of inflammatory changes. Ultrastructural examinations of sclera revealed a normal structure. There was no indication of the cause of the elevated protein content of the subretinal and spinal fluids. Following subretinal and epichoroidal fluid evacuation, the patient was treated with systemic steroids. The retinal and choroidal separations subsided slowly over several months, leaving multiple retinal pigment epithelial pigmentary clumps with drusen-like centers. A more appropriate name for this entity is idiopathic chorioretinal effusion.


Conjunctival biopsy in sarcoidosis: A simple, safe, and specific diagnostic procedure. A prospective study was undertaken to determine the prevalence and specificity of granulomatous conjunctivitis in sarcoidosis. One hundred conjunctival biopsies were performed on patients with histologically confirmed sarcoidosis (60), pulmonary tuberculosis (25), and several nonspecific inflammatory diseases of the lung and eye (15). A positive biopsy was present in 33% of the patients with sarcoidosis, but in none of the other disease processes. Great care was taken to exclude the possibility of these granulomas being secondary to foreign body reaction or infection with tuberculosis or fungi. No predictive relationship could be established between eye symptoms or slit lamp findings in the conjunctiva and uveal tract, and the finding of positive conjunctival biopsies. Thus, it is suggested that this procedure, due to its ease, safety, and specificity, be the first biopsy performed in patients with clinical or chest x-ray abnormalities suggesting sarcoidosis.


Simplified soft contact lens treatment in corneal diseases. The advantages and disadvantages of the newly introduced Plano-T soft contact lens for the treatment of corneal diseases were evaluated. The physical characteristics, base curve, diameter, and thickness account for the fitting advantages which make it a versatile lens. The assumption that one lens fits almost any eye and that it may be used in most instances where a bandage lens is indicated proved correct, except for corneas of extreme measurements as in keratoconus. The results obtained compare very favorably with the results of the more conventional lathe cut lenses for the treatment of corneal diseases. Visual improvement does not seem as dramatic as in the latter, but some of the most common side effects are almost eliminated. Its physical characteristics and actions are reviewed. The corneal diseases for which it has been used are mentioned and the results discussed.


Voluntary nystagmus.

Voluntary nystagmus. Voluntary nystagmus is a pendular, rapid, conjugate, primarily horizontal, benign nystagmus initiated and maintained by voluntary effort. The amplitude is variable, but always low. The rate is constant and rapid. Convergence is variable--apparently essential in some, nonessential in others, but related in all of our cases. This condition appears to have a familial component and is more common than originally thought. Voluntary nystagmus should be considered when dealing with any patient exhibiting nystagmus in order to minimize the possibility of misdiagnosis as occurred in one of our cases.


Retinoblastoma simulating Coats' disease: a clinicopathologic report. A case report of a male infant with leukocoria and a clinical picture of Coats' disease is presented. The correct diagnosis was suggested by contact B-scan ultrasonography, which demonstrated an exophytic mass with calcification compatible with retinoblastoma. The value of this technique in the differential diagnosis of retinoblastoma is discussed.


Adenoacanthoma of lacrimal sac.

Adenoacanthoma of lacrimal sac. A case of adenoacanthoma of the lacrimal sac is presented. The problems of the site of origin and change of behavior of the tumor is discussed. Radical surgery with subsequent radiotherapy is advocated at an early stage to avoid local recurrence. Topical application of a chemotherapeutic agent may be worthwhile in small local recurrence.


Cryoextraction of cataract under general anesthesia. Five hundred unselected cataracts were extracted under general anesthesia using Sudarsky cryoprobe. The technique has been described and the results tabulated. The visual results and complications and discussed in detail.


Experiences with some modifications of cyclodialysis for aphakic glaucoma. Continued attempts to improve the success rate with modifications of the cyclodialysis procedure have been made and described here. The results with a scleral pedicle insertion and with a long scleral incision parallel to the limbus were very poor. As a result of improvements in the technique of separating the ciliary body from the scleral spur by depressing the former mechanically and of using of meridional incision to avoid a scar barrier, I have returned to a modified Blaskovics procedure. Further use of this procedure with continued follow-up is planned. However, I invite you to try the various procedures described here, including Aviner's, so that we may find ways of improving our results with this potentially excellent operations, especially in aphakic glaucoma as primary procedures.


Inverted follicular keratosis clinically mimicking malignant melanoma. A 70-year-old man had a rapid growth of a pigmented eyelid lesion, previously stationary for at least 50 years. Because of the suspicion of malignant melanoma, the lesion which resembled a cutaneous horn was excised. Histologic examination demonstrated a benign epithelial tumor, inverted follicular keratosis.


The incidence of sickle trait in Blacks requiring filtering surgery. Open-angle glaucoma in the blacks is generally thought to be a more malignant disease than in whites in terms of response to therapy and subsequent visual loss. An increased incidence of unsuspected sickle trait and undetected sickling may have contributed to these patients' optic nerve ischemia, progressive field loss and need for surgery. A homoglobin electrophoresis was done on 40 black patients who required filtering surgery for uncontrolled open-angle glaucoma. Only 2 of the 40 patients (5%) had sickle trait as determined by the hemoglobin electrophoresis. In a matched group of 40 controls, only 3 patients (7.5%) had sickle trait. Therefore, there does not appear to be an increased incidence of sickle trait in black patients requireing filtering surgery.


Gas-permeable cellulose acetate butyrate (CAB) contact lenses. Gas-permeable cellulose acetate butyrate (CAB) contact lenses may often be worn succesfully by aphakic and other patients who are unable to wear hard contact lenses. The comfort characteristics of the CAB lenses are betweeen those of hard and soft contact lenses. They are much more permeable to O2 and CO2  than soft lenses and thus are less apt to cause edema. They are more flexible and more wettable than hard lenses. This study presents 50 patients who, having had to discontinue wearing hard contact lenses because of discomfort, diffuse central corneal edema, or visual problems, were fitted with CAB contact lenses. Thirty of the fifty were able to wear the CAB lenses successfully.


Electron microscopy of epithelial downgrowth. Four cases of epithelial downgrowth following cataract surgery were studied by electron microscopy. The invading epithelium was excised by posterior keratectomy, iridectomy, and vitrectomy. Diagnostic photocoagulation on the iris was performed before the operations in all cases. Multilayered epithelium on these tissues showed ultrastructural features similar to conjunctival epithelium, and in the cornea no intact endothelial cells were identified. A subepithelial connective tissue of varying grades of development was present between the downgrowth epithelium and Descemet's membrane. The basal epithelial cells on the vitreous contained numerous dense granules, and a thick basement membrane-like layer was found underneath. Changes attributable to photocoagulation included partial replacement of the iris pigment epithelium with macrophages, degeneration of blood vessels, and marked swelling and dissociation of collagen fibrils in the iris stroma due to splitting into longitudinal filamentous components. Identical changes of collagen fibrils could be reproduced in the rabbits iris after experimental photocoagulation.


Miochol-induced transient cataract.

Miochol-induced transient cataract. Acute transient lens opacity occurred in a patient with ruptured cornea following injection of Miochol into the anterior chamber. It is postulated that the lens changes were due to osmotic effect of the hypertonic Miochol solution.


Anticipatory guidance in elective ophthalmic surgery. With respect to the preoperative ophthalmic patient, anticipatory guidance is a technique of informing the patient in a detailed way about all aspects of the upcoming intervention, including the need for surgery, the degree of pain and disability to be expected, type of anesthesia to be used, some information about the postoperative course, and the expected disability following surgery on either a temporary or a permanent basis. The purpose of anticipatory guidance is to permit the patient to make a better psychologic adaptation to a crisis situation and to relieve preoperative anxiety through information, resulting in easier postoperative recovery. In addition, anticipatory guidance and improved understanding between physician and patient may go far to reduce those misunderstandings that lead to malpractice actions subsequent to surgical procedures.


Evaluation of DEXON suture in cataract surgery: a study using a finer gauge material. Gauge 7-0 DEXON polyglycolic acid sutures were used in 25 cataract extractions. The suture material handled well, formed small knots, and gave excellent results in all cases. The fine gauge suture is well suited for use in intraocular surgery.


Unusual complication of orbital floor blow-out fracture repair. An unusual complication of repair of orbital floor blow-out fracture is reported. The supramid plate eroded partially through the orbital floor into the maxillary sinus creating a springboard-like mechanism. When the pressure in the maxillary sinus increased, the posterior portion of the supramid plate was pushed upward. This motion of the plate displaced the eye forward and somewhat outward as well as upward. Following the resection of the portion of the plate protruding into the orbit, the symptoms disappeared.


Trabeculectomy as treatment for glaucoma: a preliminary report. This preliminary report concerns 22 patients (36 eyes with glaucoma) who had trabeculectomy. Results are successful in 32 eyes, failures in 4 eyes. Patients ranged in age from 10 years to 78 years and their clinical courses have been followed from 1 year to 2 1/2 years. Postoperative complications were minimal: a shallow chamber that spontaneously reformed; vitreous loss, which did not affect the outcome; and breakdown of the conjunctival flap, which resulted in loss of the bleb. The factors of age, sex, race (white and black) have no great significance, although more female patients formed blebs and had control of intraocular pressure without medication than did male patients. The bleb is believed to be primarily a filtering structure. The trabeculectomy appears to be an effective surgical approach to the treatment of glaucoma. The surgical technique is described.


Surgical revision of the oriental lid.

Surgical revision of the oriental lid. In many oriental upper lids the levator aponeurosis does not insert into the skin as it does in the occidental lid. The upper lid fold is therefore absent in these oriental eyes. In addition, epicanthus tarsalis is common in the oriental, and the caruncle is often hidden. In the revision of the oriental lid any one of a number of medial canthoplasty techniques may be used in conjunction with the surgical formation of an upper lid fold. A double Z-plasty for the epicanthus revision combined with the formation of the lid fold by attaching the levator aponeurosis to the skin is technically simple and yields cosmetically acceptable results.


[Impedancemetric monitoring of sulphurated crenotherapy in tubal dysfunction (author's transl)]. A projection study of comparative impedancemetric curves at the beinning and the end of a course of treatment was carried out during two hydrotherapeutic seasons (1974 and 1975); out of 237 cases which were relevant, only 24.4 per cent showed any improvement in tympanometry following sulphurated crounotherapy, further confirmation of the fact that this therapy is slow acting, as was already known. The major importance of respiratory allergy (84.6 per cent) in this group of tubal dysfunction disorders may partially explain the poor results; discrepancies in some results obtained by comparing impedancemetry, the pneumophonic index and audiometry are more difficult to interpret according to various theories.


[Radiological examination of the eustachian tube. Radiomanometry technique (author's transl)]. Radiomanometry is a modified technique for visualisation of the auditory tube. The contrast material is injected through a perforated tympanic membrane with control of injection pressure. Three positions are recommended: sub-mento-vertical, Worms, and modified Stenvers. The normal aspect of the tube is described with variations. Some pathological obstructtions are demonstrated. However, it must be underlined that many tubes with abnormal manometric test were not abnormal at the radiological evaluation: fonctionnal aspect is more important than anatomical one in the inflammatory pathology of the tube.


[Physiological exploration of the eustachian tube using labeled compounds. Applications in the control of treatment (author's transl)]. Sequential scintigraphy enables the qualitative and quantitative study of the drainage function of the Eustachian tube. Use is made of serum albumin labeled with technetium 99 m. After reviewing the various methods employed in an exploration of the functions of the Eustachian tube, and in particular the drainage function, the writers explain the method in detail (indicator, detection system, examination procedure, normal scintigraphic aspects) while stressing the control factors (onset of passage, speed and intensity of passage, length of time for the appearance of a trace on the pharynx, eventual aspects of blocking) and giving the basic characteristics; persistant spotting of the drum, transient image of the tube, partial stoppage at the ostium, and traces along the pharynx. The role of swallowing and the position of the head appear to be essential. Results obtained in various disorders of the middle ear, accessory cavities, the tube and the cavum are given in the form of tables. The writers then indicate the principal merits of the method: demonstration of the pathological role of the Eustachian tube in a work-up of transmission deafness, with its impact on treatment, the role of a deficient drainage function in surgical failures, and control of the efficacy of treatment, in particular crenotherapy. A study of the drainage function of the Eustachian tube, as a complement to the function of equalizing pressure, in an essential factor in formulating indications and in establishing the prognosis for tympanoplasties.


[Impedance measurement in the diagnosis of otitis serosa. Description of a new test: star (author's transl)]. A new presentation is given providing an overview of impedance measurement and audiometric examinations and one that makes it possible to determine at a glance the functional status of the middle and inner ear (presence or otherwise of complete recruitment). In the impedance measurement diagnosis of otitis serosa it is also necessary to compare the state of the stapedial reflex with the tympanometric curve. In particular, attention is drawn to a new technique in which the amplitude of the stapedial reflex is measured at 10 dB above the trigger threshold of this reflex (Star). If this amplitude is greater than 2 Madsen units at sensivity  3, ther is not fluid in the middle ear. Finally, the impedance manometer can be used, according to Holmquis'ts technique, to monitor the permeability of the trans-tympanic drain and the recovery or otherwise of tubal permeability.


[Costa's acrokerato-elastoidosis. Ultrastructural study (author's transl)]. Acrokerato-elastoidosis described by Costa is characterized by numerous little keratotic points and translucent horny wheals on the dorsal aspect of hands and (or) feets. The ultrastructural study shows lesions of the elastic tissue which is very rarefied with an abnormal structure, but also demonstrates alterations of the fibroblasts that contain dense granules at the periphery of their cytoplasm without elastic extracellular fibers, suggesting a trouble in the secretion or the excretion of the elastic material.


[Physiopathology of acetylcholine delayed blanch in atopics. thermographic study (author's transl)]. Controversy subsists about interpretations of "delayed cholinergic blanch" in atopic dermatitis. A physical approach of this vasomotor phenomenon using infrared and cholesteric thermography and direct recording of skin temperature shows that the delayed blanch is hyperthermic and cannot be the effect of a paradoxal cholinergic vasoconstriction. In the light of the beta-adrenergic blockade theory of Szentivanyi a new physiopathological interpretation is proposed.


[IgG levels in the sera of melanoma patients (author's transl)]. 397 sera from 185 melanoma patients have been tested. We classified our subjects into three groups, according to the stage of disease. An alteration of the level of IgG 4 sub-class was found and related to the extension of the disease. The percentage of abnormalities was more frequent in stage II and III (55 p. 100 and 53 p. 100) than in stage I (19 p. 100). High titers of IgG 4 subclass were essentially detected in advanced disease. The biological significance is discussed.


[Papulo-vesicular endogenous eruptions induced by methyldopa and clofibrate (author's transl)]. 3 induced eczemas during systemic drug administration are reported: 2 were caused by methyldopa, 1 by clofibrate. The relationship is established either by patch-tests or by administration of the drug.


[Epithelioma occurring on chronic leg ulcers (author's transl)]. The authors report nine cases of epithelioma occuring on chronic leg ulcers of venous origin (6), or on fistula from chronic osteitis (3). Compared with the other trophic leg ulcers observed during the same period, the risk of malignant change approximatly is of 0,3 p. 100. It always concerns aged caucasian subjects (about 70 years old) and the evolution last long (5/20 years), except in one of the case. The first symptoms are hard, bleeding and exuberant granulation either on the edge of the ulcer, or on the ulcer itself. It is often necessary to repeat the biopsies to obtain histological corroboration of the diagnosis. Prognosis is severe (2 lung metastasis) and amputation seems to be the best treatment.


[Oncicola venezuelensis n. sp. (Archiacanthocephala-Oligacanthorhynchida), a parasite of the ocelot (Felis pardalis L.) (author's transl)]. Oncicola venezuelensis n. sp. is described from the Ocelot, Felis pardalis L. from Venezuela. It differs from other species of the genus mainly by it's longer lemnisci. The lemnisci have six nuclei. O. venezuelensis n. sp. is compared to the twenty one species of the genus Oncicola and the main distinctive characteristics are given.


[Intermediary hosts of Dicrocoelium lanceolatum in Lebanon and Syria (author's transl)]. The authors describe the biological cycle of the Trematoda Dicrocoelium lanceolatum in Lebanon and in Syria: two principal first hosts are the Gastropoda: Theba syriaca and Xerophila vestalis; the second intermediate host is the ant Formica (S.) rufibarbis var. clarorufibarbis very common near fresh water in herbous lands, over 1,000 m of altitude. The last host is the Sheep, the Cow and probably the Goat. A humain case is commented.


[Pseudophysaloptera kahmanni n. sp. (Nematoda: Physalopteridae), a parasite of the stomach of the dormouse Eliomys quercinus ophiusae Thomas, 1925 (Rodentia: Gliridae) in Formentera (Balearic Islands) (author's transl)]. A new Nematode Physalopteridae, Pseudophysaloptera kahmanni n. sp., parasitizing the stomach of the dormouse Eliomys quercinus ophiusae Thomas, 1925 (Rodentia: Gliridae) in Formentera (Balearic Islands, Spain) is described. It is the first and only species of the genus Pseudophysaloptera Baylis, 1934 to be known parasitizing Rodents in the nature.


[Sergentomyia (Sergentomyia) bedfordi firmatus Parrot and Malbrant, 1945 and Sergentomyia (Sergentomyia) bedfordi medius Kirk and Lewis, 1950 (Diptera, Phlebotomidae). Morphology of immature stages and bioecological accounts (author's transl)]. Immature stages of S. bedfordi firmatus and S. bedfordi medius have been obtained in laboratory culture. The morphological characters of egg, larva and pupa are studied, the duration of post-embryonic development and the conditions of colonization are specified.


[Research of the life cycle of a Paramphistomidae (Trematoda) of amphibians in Africa (author's transl)]. The intermediate hosts of Diplodiscus subclavatus are in Togo, Bulinus forskalii and Segmentorbis kinisaensis. The cercariae, amphistome, leave soon the rediae to achieve their development at the top of the hepatopancreas of the mollusc. The usual infestation of the definitive host occurs by penetration of cercariae into tadpoles with the water flood. Secondary ways of infestation keep up the prevalence near a high level.


Wound healing.

Wound healing. An account is given of the methods used and the results obtained in a series of experimental studies, carried out over the past 15 years, of the effects of various factors on the healing of abdominal wounds in animals. The factors examined include uraemia, jaundice, infections, and the technique of wound closure. The preliminary findings in a comparison now in progress of the results of one- and two-layer closure of laparotomy wounds in human patients are also given. The relative neglect of the study of wound healing in the past is emphasized and some aspects that are in urgent need of further investigation are mentioned.


Hydronephrosis.

Hydronephrosis. It is essential to distinguish between an obstructed and an unobstructed hydronephrosis as the management of the two types is quite different. Some of the radiographic and isotopic methods of distinguishing these two leave much to be desired and the place of dynamic studies is discussed. The aetiology of pelviureteric junction obstruction remains uncertain, but it is probable that one or more of several factors may be involved and these are discussed. The types of hydroenphrosis are classified as chronic, intermittent, unsuspected, equivocal, and reflux-induced.


Whole-muscle reimplantation with microneurovascular anastomoses. A functional and histological study. Whole tibialis anterior muscles were removed from a number of dogs and were then reimplanted in the original sites. Microsurgical anastomoses of the major nerve, artery, and vein were performed. Biopsy revealed some minor regenerative changes in the muscle a few weeks after the operation. Electromyographic recordings 6-9 months after implantation showed near-complete functional recovery of the muscles. This was confirmed histologically. The study demonstrates not only that whole-muscle reimplantation is technically feasible but that a functionally satisfactory result may be expected.


Effect of renal ischaemia in rats with obstructive jaundice. The ability of kidneys to withstand renal ischaemia has been tested in jaundiced and non-jaundiced rats. No significant difference could be demonstrated between the two groups of animals except that renal weight increased greatly in the presence of jaundice. Both jaundiced and non-jaundiced animals showed a median lethal dose of renal ischaemia of approximately 120 min when renal function was tested by delayed opposite nephrectomy. It was shown that a recent laparotomy renders the kidney more susceptible to renal ischaemia.


Carcinoma of the large bowel in Uganda.

Carcinoma of the large bowel in Uganda. A personal series of 41 cases of carcinoma of the large bowel seen in Uganda during 7 years is presented. The relatively young age of the patients compared with the patients in Western countries is discussed. Diet probably played no role in the aetiology of the disease in this series. It is observed that in carcinoma of the rectum the lesion is usually low, necessitating resection of the rectum, which the patients frequently refuse.


Therapeutic comparison of thiol compounds in severe paracetamol poisoning. Twelve patients with toxic blood concentrations of paracetamol were treated with either cysteamine or amino-acid solution. None of the patients developed severe liver damage, although transient mild biochemical abnormalities developed in three. None of the patients treated with amino-acid solution had side effects due to therapy, whereas all those treated with cysteamine did. It is recommended that amino-acid solutions be used as a temporary measure in patients suspected of massive paracetamol overdose while awaiting estimation of blood paracetamol concentration.


Urinary free 11-hydroxycorticosteroid/creatinine ratios in early morning urine samples as an index of adrenal function. Urinary free 11-hydroxycorticosteroid/creatinine ratios were determined in early morning urine samples from 113 females (age range 20-45 years) and 65 males (age range 22-45 years). Basal values in normal subjects fluctuated between 5 and 55 mumol/mol creatinine. In four patients in whom Cushing's syndrome was diagnosed, urinary free 11-hydroxycorticosteroid/creatinine ratios were greater than 85 mumol/mol creatinine. Administration of dexamethasone (0.5 mg/q.i.d.) to nine normal laboratory staff for two days resulted in a suppression of the urinary free 11-hydroxycorticosteroid/creatinine ratio to less than 50% of the mean basal value in all cases. This degree of suppression did not occur in two cases of Cushing's syndrome due to adrenal tumours.


A simple radioimmunoassay for plasma cortisol: comparison with the fluorimetric method of determination. A quick and simple method for the radioimmunoassay of plasma cortisol is described. The mean morning plasma cortisol concentration in 43 normal subjects was 9.8 +/- 3.1 (S.D.) microgram/100 ml with a range of 5.0-19.5 microgram/100 ml. Mean midnight concentration in 24 normal subjects was 4.3 +/- 2.3 (S.D.) microgram/100 ml with a range of 1.4-9.6 microgram/100 ml. When compared with the fluorimetric method the mean results by radioimmunoassay of 154 routine specimens were 23% lower. In samples from unstimulated patients, regression analysis of results obtained by the two methods gave a correlation coefficient (r) of 0.93, regression line slope of 1.1, and intercept of 1.4 microgram. Mean radioimmunoassay results were 15% lower. When plasma cortisol concentration was above the normal range (greater than 30 microgram/100 ml) the regression line slope was 0.87, the intercept 17.9 microgram, r = 0.87 and mean radio immunoassay results were 37% lower. Plasma cortisol concentration in patients after insulin or Synacthen stimulation exhibited similar responses when measured by either method. Plasma cortisol concentration in normal subjects given metyrapone was lower when measured by radioimmunoassay (mean +/- S.D. = 8.7 +/- 2.7 microgram/100 ml) than when measured by fluorimetry (18.5 +/- 10.8 microgram/100 ml). The diagnostic usefulness of the two methods, ease of assay, and costs are compared.


An investigation into the immunochemical properties of the isoenzymes of human alkaline phosphatase. A study was carried out to investigate the immunochemical properties of the alkaline phosphatases present in liver, placenta, intestine, and kidney. Butanol extracts of the tissues were examined by antigen-antibody crossed electrophoresis, and the immunoprecipitates formed by the enzymes were identified by use of a specific stain for alkaline phosphatase. The results obtained revealed three immuno-chemical types of alkaline phosphatase, designated L, P, and PI respectively. The distribution of these enzymes among the tissues examined was as follows: type L was the only enzyme detected in liver extract and type P the only one detected in placental extract. The extracts of intestine and kidney both contained two isoenzymes, one of which was type L and the other type PI.


A modification of the Trinder AutoAnalyzer method for glucose. This paper describes the application of the sulphonated 2,4-dichlorophenol/glucose oxidase method of Barham and Trinder for the estimation of blood glucose to the AutoAnalyzer I and AutoAnalyzer II. Use has been made of the increased sensitivity achieved with this reagent to (1) increase sampling rates, with concomitant reduction in sample volume, (2) reduce the consumption of enzymes required, and (3) reduce carryover, all without significant loss of precision.


A simplified procedure for the isolation of bile acids from serum based on a batch extraction with the non-ionic resin--Amberlite XAD-7. A simple and reproducible method using the non-ionic resin, Amberlite XAD-7, for the isolation of bile acids from serum by a batch procedure is described. Recoveries were greater than 95% for the non-sulphated bile acids and greater than 70% for the sulphate esters of bile acids. By using 1 g of resin, recoveries were independent of the mass (0.1-5 mumol) of the bile acid present. Up to 35 samples a day can be extracted without requiring dedication of the operator. When serum extracts were analysed by the 3alpha-hydroxysteroid dehydrogenase procedure for estimation of bile acids, virtually all the background fluorescence was eliminated. These extracts were also suitable for gas liquid chromatography, thin layer chromatography, and radioimmunoassay.


Human pancreatic alpha-amylase. I. Purification and characterization. alpha-Amylase was extracted from human pancreas and purified by using ammonium sulfate fractionation, Sephadex G-100 and DEAE-Sephadex A-50 column chromatography. The enzyme was shown to be homogenous by three different criteria: polyacrylamide disc gel electrophoresis, SDS polyacrylamide gel electrophoresis and analytical ultracentrifugation. The values of SO20,w, D20,w, v, and frictional ration of the enzyme were calculated to be 5.01S, 7.56D, 0.718 ml g-1 and 1.10, respectively. The molecular weight of the alpha-amylase was determined by three different methods: sedimentation velocity-diffusion, conventional sedimentation equilibrium and SDS polyacrylamide gel electrophoresis and was found to be 57,850; 50,100 and 53,200 g mole-1, respectively (average value 53,700). The amino acid composition of the enzyme was determined and compared with those of alpha-amylases from various other sources.


Comparison of zeta sedimentation ratio with Westergren sedimentation rate. Zeta sedimentation ratio (ZSR) is a simple, rapid and reproducible test which is not influenced by variables like sex and anemia. There is good correlation with Westergren erythrocyte sedimentation ratio (ESR) in normal and hospital population. Limitation of packing force affects the use of the procedure in polycythemia and in patients with ZSR greater than 80%.


Acquired pyruvate kinase deficiency.

Acquired pyruvate kinase deficiency. Pyruvate kinase (PK) is an enzyme of critical importance in the glycolytic pathway of the red cells, deficiency of which, whether congenital or acquired, results in a hemolytic anemia. Measurement of the enzyme is now rapid and simple utilizing preprepared substrate and reagents. Some caution must be taken, however, in both measurement and interpretation. Red cells must be separated from other blood cells, particularly granulocytes, since the PK of white cells is different from that of red cells and is present in much higher activity per cell. Sometimes the use of special techniques of measurement [low substrate concentration (phospho-enolpyruvate, known as PEP, 0.4 mM in place of 2 mM) or heating at 53 degrees C for 60 minutes, (to test thermostability)] are necessary to detect abnormal molecular characteristics of PK, particularly in the acquired form of deficiency. Evidence recently presented suggests that the acquired form of PK deficiency may sometimes be due to inhibitors which oxidize sulfhydril bonds in the enzyme or alter its substrate binding properties or other molecular characteristics.


Release of enzymes from cells: transport and distribution within the extracellular space. The distribution in the extracellular space of enzymes released from organ cells was investigated using three models: (1) comparison of enzyme activities in blood plasma and lymph of the ductus thoracicus (dog) and plasma and intestinal lymph (rat); (2) i.v. injection of heterologous, homologous and autologous enzymes in order to increase acutely the activities and to measure the rate constants for the distribution and elimination of the enzymes (rat); or (3) plasmapheresis in order to create an enzyme activity gradient from the interstitial space and to determine the rate constants for the reestablishment of the equilibrium between the extra and intravascular compartments (rat). The results suggest that the enzymes are mainly released into the interstitial fluid and transported via the lymph into the intravascular compartment. From there the enzymes diffuse back into the interstitial compartment and are eliminated by a yet unknown mechanism. Transport of enzymes across the capillary membranes in both directions depends on (1) the permeability of the capillary membranes, which varies from region to region and (2) the molecular seizes of the enzymes.


[Metastatic thyroid carcinoma with hyperthyroidism (author's transl)]. Eight years after subtotal thyroidectomy for thyroid carcinoma, a patient developped multiple metastasis in bones and liver with high radioiodine uptake. This patient had clinical and biological thyrotoxicosis with low iodine uptake in the cervical remaining thyroid tissue and TSH secretion was not stimulated by TRH. Administration of 240 millicuries of 131 I led to hypothyroidism, to clinical regression of liver metastasis and to disappearance of extra-cervical iodine uptake. Eleven similar case have been reported in the literature.


[Water and electrolytes disorders in apudocarcinomas (author's transl)]. The authors report an analytic study of hydroelectrolytic disorders in patients with APUD tumors. In most of the cases a diarrhea occurs. The type of this diarrhea is: -- a motrice diarrhea (in the great majority of carcinoid tumor and medullary carcinoma of the thyroid); -- a secretory diarrhea (W.D.H.A.): it is the case in gastrinoma (gastric hypersecretion), in secretinoma (pancreatic hypersecretion) and in vipoma (intestinal hypersecretion). The others disorders could be no diarrhea dependant (hyponatremia by ADH hypersecretion, hypercalcemia). The personal cases of the authors are: 12 medullary carcinoma of the thyroid, 19 enteraminoma and 2 others apudomas.


Enzymes in benign and malignant effusions. A critical review of the work done in this area indicates that, of the available enzyme systems now used in clinical diagnosis, the LDH system is the only one of significant value in the examination of pleural and peritoneal effusions. In terms of differential diagnosis, estimation of pleural or peritoneal fluid LDH levels will enable the examiner to distinguish between poorly cellular vs. abundantly cellular effusions. In the abundantly cellular effusions, estimation of levels of LDH do not distinguish with any degree of accuracy between those effusions due to inflammatory processes vs. neoplastic processes. Results of studies of LDH isoenzymes are at variance and require more study.


Clinical significance of the isomorphic pattern of the isoenzymes of serum lactate dehydrogenase. Five hundred patients with the isomorphic pattern of the isoenzymes of serum lactate dehydrogenase (LDH) were surveyed. The isomorphic pattern of LDH isoenzymes is defined as a significant increase of total LDH with normal or low percentage of individual fractions, but with the LDH1:2 ratio less than unity. Diagnoses were, in descending order of frequency, cardiorespiratory diseases, malignancy, fracture, diseases of the central nervous system, infection/inflammation, hepatic cirrhosis and/or alcoholism, trauma without fracture, infectious mononucleosis, hypothyroidism, uremia, necrosis, pseudomononucleosis, viremia and intestinal obstruction. Incidence of increased serum activity in individuals without evidence of disease or drug explanation was 3 percent. Low PaO2 was observed in 88 percent of the 67 patients in whom it was measured.


[Valuation of the methods of investigation in topographic diagnosis of Conn Adenoma (author's transl)]. Five case of primary aldosteronism are reported. The authors analyse the place of each method able to localize adenoma: arteriography, phlebography and scintigraphy. Even if adrenal gland phlebography is faithful, it can involve hemorrhage. Then it is quite sure that scintigraphy will be soon able to take her place. The surgical approach must be performed on both sides. The authors describe an original exposure of left adrenal gland through anterior incision.


[Vasoactive intestinal polypeptide (VIP) tissue distribution in the rat as measured by radioimmunoassay and by radioreceptorassay (author's transl)]. A new radioimmunoassay which allows the measurement of the rat vasoactive intestinal polypeptide, was performed. VIP is present in the whole digestive tract of rat, mainly between the duodenum and the colon. 1.5% of the total VIP is present in brain. The VIP-like immunoreactivity appears to correspond to biologically active molecule since a radioreceptorassay using liver plasma membranes as the target tissue, gives the same results as the radioimmunoassay.


[Prolactin secretion and synthesis by human somatotropin adenomas: in vitro effect of somatostatin (SRIF) (author's transl)]. Human somatotropin secreting adenomas removed from acromegalic patients were submitted to organ culture for periods of up 1 to 4 hours and 1 to 2 weeks. Prolactin (PRL) secretion increased in most of the experiments during the different culture times while growth hormone (GH) secretion decreased slowly in some of them. After incorporation of 3H leucine, 3H GH and 3H PRL were obtained in short and long term organ culture giving evidence for "de novo" synthesis. SRIF inhibited PRL as well as GH secretion after 1 to 4 hours incubation.


[Clinical and electrophysiological study of voice changes in thyrotoxicosis (author's transl)]. Changes in the voice are described in 10 thyrotoxic patients. The quality in tone is altered, and frequently, the volume of the voice is diminished. Electrophysiological studies of the speech and of the laryngeal motility have been performed. These changes, which seem to be relatively common, may result from a mild bulbar muscle dysfunction.


[Biological aspects of endemic goiter in the Pyrennes Atlantiques (author's transl)]. In an endemical goiterous area (Oloron Sainte-Marie 64, France) a thyroid investigation has been realised on a certain number of people having a goiter (G) and those without goiter (N.G.). Various explorations such as T4 D, R T3 U, TSH RIA, T3 RIA. Achilles' Reflex, cholesterol have shown no significant difference nor any abnormality inspite of a global deficit in iodine (35 ng/24 h). It can only be retained an absence in negative corelation T3 TSH (P less than 0.05).


[Plasma growth hormone in obese patients. Comparison of response to arginine and L-dopa (author's transl)]. The present study aimed at testing the hypothesis that l-dopa could obtain a better growth hormone (G.H.) stimulation than metabolic stimuli in obese patients. Arginine (30 g i-v) and l-dopa (1 g per os) were used in 12 obese, non diabetic, female in patients. No significant difference of plasma G.H. peak level (arginine : 11,3 ng/ml +/- 8.6. L-dopa : 9.2 +/- 5.6) appeared between these two types of stimulation


[Renin plasmatic activity and plasma aldosterone in three cases of pheochromocytoma (author's transl)]. Renin Plasmatic Activity (R.P.A.) was increased in three cases of Pheochromocytoma Plasmatic aldosterone (A), measured in one patient, was high in the supine position and increased considerably in orthostatism. This was not observed with the R.P.A.7. Urine Tetra Hydroaldosterone (T.H.A.) was increased in two of the three patients and this increase corresponded to the Pheochromocytoma in which the V.M.A. concentrations were the highest. P.R.A., T.H.A. and V.M.A. regained normal values after surgery. We suggest that there is a certain parrallelism between the increase in the excretion of A. and the importance of the catécholamine release from the Pheocchromocytoma.


[Value of the study of plasma estrogens in the exploration of gynecomastia. Apropos of 48 cases]. Starting from 48 cases of gynecomastia, the authors report the following findings: -- Impairment of the testis function, as assessed by a low plasma level of testosterone, is rare. -- Basal values of gonadotropins are generally normal. -- Increased oestrogen urinary excretion and blood level are rarely found but, when present, they tend to decrease at successive evaluations. -- In six cases, plasmatic oestradiol can be suppressed by dexamethasone; although the small number of cases does not allow a definite conclusion, one might suggest a predominant adrenal source of plasmatic oestradiol.


[Determination of intra-uterine oxygen tension in rats after biovariectomy between the 7th and 12th day of gestation]. In pregnant female rat, oxygen tension was measured in vivo with an oxygen microelectrode and the following statistically significant data (Student's test) were obtained: -- not significant variability in four groups of six control rats; -- highly significant decrease of oxygen tension twenty-four hours after biovariectomy in four groups of six operated rats; -- in twelve operated and treated by substitutive hormonotherapy rats, pO2 was at the same level than in control rats; -- in eighteen operated rats, the oxygen tension measured after embryonic death was identical to control rats. These experiments clearly demonstrate twenty four hours after biovariectomy a decreased oxygen tension. Simultaneously to this decrease, a diminution of uterine blood flow takes place. This pO2 diminution should be dependent on decrease of ovarian hormones since the substitutive hormonotherapy prevents its appearance. A good explanation of this phenomenon is the high requirement of hypoxic embryo for oxygen; moreover after the embryonic death, the intra-uterine pO2 increases.


Genetic variation in some Oxfordshire villages. The patterns of serological polymorphic variety in a group of Oxfordshire populations are related to previously made demographic predictions that the different villages and social classes might be expected to be genetically homogeneous if movement were the main factor determining genetic structure. The predictions are largely fulfilled though there remains a residual pattern of variety which is detectable when all the systems tested are considered together by "genetic distance" examination, and in the case of the geographic variation this pattern reflects the comparative magnitude of the exchanges between the different villages.


[Action of androgens and one anti-androgen on the genital ducts of young discoglosses. Early development of seminal vesicles and inhibition of mullerian ducts (author's transl)]. Young Discoglossus pictus Otth (Amphibian, Anura) received either male hormone (testosterone or testosterone propionate) or the anti-steroid anti-androgen cyproterone acetate. The male hormone had a masculinizing effect on the genital tract when observed four months later and, paradoxically, the anti-androgen had the same effect: -- Hypertrophy of the posterior segment of the Wolffian ducts yields seminal vesicles, whose wall is covered with a flat epithelium after androgen treatment. Cyproterone acetate treatment, however, results in the cytological differentiation of this epithelium. -- Müllerian ducts persist in a vestigial form. In this respect, the inhibitory action of cyproterone acetate is stronger than that of the male hormone.


Inbreeding, marital movement, and genetic isolation of a rural Appalachian population. Genealogical, marital, birthplace and age-at-marriage data were collected on a random sample of 275 reproducing couples from the population of a rural Appalachian county in north-eastern Tennessee. Genealogies covering the three extant generations provided the data for a surname isonymy analysis to determine the amount of inbreeding prevalent, while the marital, birthplace and age at marriage data were used to ascertain the components of marital movement, i.e., marital distance, orientation of marital movement, spatial exogamy, and "diffusion". The effective breeding population and effective immigration rate were calculated for the county population and these in turn were used to compute the coefficient of breeding isolation for the currently reproduction population. Our conclusions agree with those of an earlier genetic and demographic study on one segment of the same population. The more extensive demographic analysis illustrates the value of such studies as this for providing background for interpretations of genetic variation.


The inbreeding coefficients of the Hadza. A systematic tabulation is provided of the frequency of different types of inbreeding in the Hadza. Genealogical information was obtained for 931 individuals, alive and dead. Inbreeding was encountered with 165 individuals. There were 49 different types of inbred genealogy. No attempt was made to calculate an average inbreeding coefficient and the reasons for this are given in the text.


The two triiodothyronines (T3 and rT3). Thyroid biosynthesis of T3 and rT3 and peripheral metabolism of thyroxine (author's transl). Thirty per cent of the iodine in thyroglobulin is present as iodothyronines. L-thyroxine (T4) represents 90-95% of hormonal iodine, 3,5,3'-triodo-L-thyronine (T3) contains at the most two per cent of it, 3,3'5'-triodo-L-thyronine (rT3) even less, as well as traces of 3,3'-diodo-L-thyronine. The plasma concentration of T4 is about 8 microgram per 100 ml, in the case of T3 it is 120 ng and 25 ng for rT3. The cell nucleus preferentially binds T3 and rT3 and there are also some specific mitochondrial proteins which possess a high affinity for T3. L-thyroxine is dehalogenated peripherically to T3, to take care of most of the requirements in T3. The enrichment of the plasma in rT3 has been shown to occur under various experimental and pathological conditoins. The blood level of T3 varies in inverse ratio to the level of rT3 and it shows that the peripheral formation of one is compensated for by the other. The excess of the prehormone T4 is metabolised as 3,5,3',5'-tetraiodothyroacetic acid (TetrAc); its level in the blood varies in the same way as the level of T3, in particular it decreases during starvation.


[Kinetics of sodium thiosulfate-35S fixation and effect of some sulfur compounds on iodine-131 fixation in ray thyroid gland]. In order to invalidate or confirm the affirmation that non antithyroid sulphide molecules alter the measure of the thyroid fixation rate of iodine 131 we undertook on the rat: on one hand a kinetic study of thyroid fixation of sodium thiosulfate labelled with sulphur 35, which showed a very low captation not exceeding 0,01% of injected radioactivity; on the other hand the study of the effects of some sulphide molecules on thyroid fixation of iodine 131 in the rat: sodium thiosulfate, association of sodium thiosulfate + metalloidal sulphur + methionine, carbutamide and dimethylsulfoxyde in various kinds of dose administration and periods. None of the products used in our work conditions produced a significant decrease of the fixation rate of iodine 131. In three different experimental protocols (sulfur association and dimethylsulfoxide), we showed a significant light increase of the fixation rate.


Red cell enzyme polymorphisms in different populations of Afghanistan. In four population groups of Afghanistan, the Pushtu, Tajik, Hazara, and Usbek, the red cell enzymes EsD, GPT, AcP, PGM1, ADA, AK, and 6PGD were studied. Significant differences in frequency occurred between the Hazara and others in 6PGD, PGM1, and AK system, and between the Pushtu and others in the ADA system.


Genetic polymorphisms in Afghanistan.

Genetic polymorphisms in Afghanistan. The gene frequencies in samples of two language groups from Afghanistan, comprising 104 Pushtu and 179 Dari subjects living in Kabul, have been examined for 24 loci. Some systems suggest greater affinity to the west (e.g. the MS gene combination, the esterase D2 allele), some to the east (e.g. the K blood group), while others are intermediate between those of India and the Orient on the one hand, and Europe and the West on the other. In general, the gene frequency levels are much as would be expected from the geographical position of the country. The two language samples are essentially similar in gene frequency, so any earlier gene frequency differences that may have existed between the language groups are no longer distinguishable. However, the amount of heterozygosity shows that the Kabul population is not yet homogeneous and that the two endogamous linguistic groups remain disparate to some extent.


Amenorrhoea, sterility and hyperprolactinaemia. Importance of complex movement tomographic x-ray study and follow-up of the sella turcica. In a 24 y.o. woman complaining of primary amenorrhoea and infertility, hyperprolactinaemia and clearly enlarged sella turcica on standard x-rays in 1975 led to the diagnosis of a pituitary prolactin-producing adenoma, later confirmed surgically. Galactorrhoea never occurred spontaneously and could not be provoked at physical examination. In the course of a previous investigation in 1967, the standard x-ray of the sella turcica, although showing already a minor duplication of the anterior wall of the sella, had been misinterpreted as being normal. It is clear from the present observation that repeated, for example at yearly intervals, radiological examinations and prolactin determinations (not available before 1971) would allow an early diagnosis. It is furthermore stressed that a tomographic radiological examination using complex movement (spiral or hypocycloidal) should be mandatory in any case of amenorrhoea with hyperprolactinaemia in order to assess or not the possible existence of a prolactin-producing pituitary adenoma. Indeed, dynamic studies of anterior pituitary secretions cannot allow a differential diagnosis between tumoural and functional hyperprolactinaemia.


[46 XX karyotype men (author's transl)]. 85 cases of this syndrom have been published since the original case in 1964. The main clinical symptoms are those of Klinefelter's disease from which it differs by the caryotype only. Azoospermie is the rule. 3 mechanisms can be implicated: Mosaic 46 XX/47 XY with secondary loss of Y chromosome; Translocation of a part of Y chromosome upon an autosome or Y chromosome; Autosomal mutant gene acting upon the masculinizing site of X chromosome and inducing the primitive development of the testis as the short arm and proximal part of the long arm of Y chromosome normally do. These mechanisms perhaps are distinct origins of a syndrom which clinic alone cannot dissociate.


A five-year follow-up study of bone mass in older people. Bone mass was estimated in a simple random sample of older people from Edinburgh (215 men and 272 women aged 62-90 years), by measuring metacarpal cortical thickness and by measuring the optical density of the radius compared with that of a metal wedge on an X-ray. Information was also collected about diet, energy expenditure and anthropometric variables. The two bone mass estimations were moderately correlated (0-47 in men, 0-53 in women). Both showed decrease as age increased. Estimates of bone mass increased as body size or activity increased, but were unrelated to dietary intakes of calcium or vitamin D. Five years later the cortical thickness was remeasured in 111 men and 141 women. Loss of bone was not uniform, and some subjects actually showed a gain. The mean loss was 0-27 mm (SD 0-41) in men and 0-28 (SD 0-40) in women. This loss was unrelated to body size or to intake of calcium and vitamin D.


Evidence for a secular increase in human brain weight during the  past century. 7397 post-mortem records have been studied. These comphrhend all 20- to 50-year old men and women who had been autopsied in The London Hospital since 1907. Fresh brain weight, body weight and height were abstracted and analysed statistically according to sex and to year of birth, any person with a cerebral or skeletal abnormality having been excluded. Fresh brain weight in men increased gradually by an average of 0-66 g per year from a mean of 1372 g for those born in 1860 to 1424 g in 1940-a total of 52 g. The weight of the female brain increased by 0-28 g per year from 1242 g to 1265 g over the same period. No appreciable rise in fresh brain weight occurred in women until 1900, after which date the increase was of the same order in the two sexes. Evidence of secular increases in body height and in body weight is also given.


The blood groups and other heriditary blood factors of Yemenite and Kurdish Jews. Blood specimens collected fro Yemenite and Kurdish Jews living in Israel were tested for 11 blood group systems 5 plasma protein systems and 9 systems of red-cell enzymes. The results of these tests were combined with those of tests on other Yemenite and Kurdish Jews, reported by Godber et al. (1973), the total data sorted according to the place of origin of the subjects or their parents in the Yemen Arab Republic and Kurdistan respectively. Gene frequencies were calculated for each of the local populations so defined. It is confirmed that the Yemenite Jews show a close relationship to the Yemenite Arabs, but those from the southern part of the Yemen Arab Republic have a higher frequency of African marker genes than those in the north. The Habbanite Jews have a similar rather high frequency of African genes (Bonné et al., 1970). The Kurdish Jews from Iran and northern-western Iraq show a moderate genetic resemblance to the indigenous Kurds of Iran, while those from south-eastern Iraq differ considerably, especially in their low frequency of A1, high B, high CDe (R1) and low cde (r).


Variation in allele frequencies among caste groups of the Dhangars of Maharashtra, India: an analysis with Wright's Fst statistic. Variations in allelle frequencies at 11 serological and biochemical loci among 21 endogamous Dhangar castes of Maharashtra, India, have been studied using Wright's FST statistic. Gene differentiation among these castes is only about 4 per cent at these polymorphic loci. The distributional form of FST is explicable by random genetic drift at this early stage of differentiation of these caste groups. The empirical relationship between the average allele frequencies and the ration of within to total gene diversity of the caste groups is also studied.


Tissue factor activity of rabbit peritoneal macrophages: influence of immune stimulation. Rabbit peritoneal macrophages exhibit a potent tissue factor activity able to trigger the extrinsic pathway of blood coagulation. This activity is elicited by the inflammatory reaction. Local injection of antigen in immunized animals leads to a lowering of the macrophage procoagulant activity. The mechanism of this phenomenon was investigated in cell culture. After a 24 hour culture, sticking macrophages as well as the culture supernatant exhibit a potent tissue factor activity, both closely related to the initial cell concentration. When the cells are collected from immunized rabbits the presence of the antigen in culture medium is able to significantly enhance the procoagulant activity of the supernatant. These data allow to propose a mechanism for the "macrophage disappearance reaction" and some related phenomena.


High resistance induced by young live Bacillus Calmette-Guérin (BCG) to Schistosoma mansoni infection in mice. Intravenous inoculation of "young" bacilli of Calmette-Guérin 14 days before challenge with Schistosoma mansoni highly protect the mice against this infection.


Autoimmunity and absence of rheumatoid factors in experimental Trypanosoma (Trypanozoon) equiperdum infections in the rabbit. The serum levels of IgM and IgG have been shown to increase approximately 7 to 10 times during the development of Trupanosoma equiperdum infection in the rabbit. After separation of the 7 S and 19 S fractions by density gradient centrifugation, both fractions were found by complement fixation tests to contain anti-trypanosome antibodies. The 19 S fraction also contained autoantibodies reacting with tissue antigens of rabbit liver, kidney and heart. Results of passive haemagglutination and latex fixation tests could not confirm earlier reports of the presence of rheumatoid factors in infected rabbits.


Distribution of cells mediating delayed type hypersensitivity responses of mice to sheep red blood cells. Jones-Mote type delayed hypersensitivity (DTH) was elicited in mice by intravenous (i.v.) or subcutaneous (s.c.) injection of sheep red blood cells (SRBC) in saline. The state of DTH was measured by means of a footpad swelling test. Splenectomy at different intervals after i.v. immunization with 3 X 10(5) SRBC abolished the generalized state of DTH almost completely, even when splenectomy was performed as late as 6 days after immunization. Excision of the popliteal lymph node on the fifth day after s.c. immunization with 3 X 10(6) SRBC prevented footpad swelling after administration of a challenge dose of SRBC. These experiments suggest that Jones-Mote type DTH responsiveness to SRBC remains dependent on the presence of the initially reactive lymphoid organ, provided the dose of antigen is too low to evoke the generation of DTH-reactive cells in other lymphoid organs.


[Biological and immunological researches on snake venom. V. Application of the immunochemical technics to the titration of specific antibodies to the alpha toxin of Naja nigricollis venom (author's transl)]. In order to establish a simple method to titrate antitoxin antibodies in the antivenom sera, we suggest a new immunochemical technic. To a constant dose of a pure toxin extracted from a snake venom, increasing volumes of specific immune serum are added so as an excess of toxin remains free. This residual toxin is titrated by electroimmunodiffusion technic according to Laurell or by radial immunodiffusion method of Mancini. The experimental results in vitro are compared to those obtained in vivo. If a given volume of immune serum neutralize X microgram of toxin by the in vivo technic it will combine in vitro to 2 X or 1.2 X of the same toxin, respectively if we refer to electroimmunodiffusion or to radial immunodiffusion technic results.


Cerebral hypnogenic centers.

Cerebral hypnogenic centers. Active cerebral processes can initiate and maintain sleep in mammals. Two distinct hypnogenic structures have been documented in the cat: the nucleus of the solitary tract in the medulla and a region in the basal preoptic area. Their electrical or pharmacological activation results in behavioral and EEG sleep. Both can be activated an inhibited in relation to circulatory or thermic homeostasis and to endocrine regulations, or in conditioned paradigms. Bilateral destruction or functional elimination of either hypnogenic region is followed by increased vigilance and insomnia. The tonic influence so revealed is increased by the serotonergic raphe nuclei of the pontine region, which is considered to be hypnotonic rather than hypnogenic. Postsynaptic inhibition of the ascending activating reticular system by the hypnogenic centers is involved in sleep onset and maintenance. Electrophysiological evidence is presented that indicates a mutual tonic inhibitory interaction between the brainstem arousal system and the preoptic hypnogenic center. Such reciprocal inhibitory interaction can facilitate the onset of sleep by a positive-feedback mechanism. In spite of the fact that this retroaction results in break of physiological equilibrium, it should be considered a homeostatic process aimed at maintaining the functional fitness of the forebrain neuronal circuits.


Thymus development in amphibians: colonization by thymic endodermal rudiments by lymphoid stem-cells of mesenchymal origin in the urodele Pleurodeles waltlii Michah. Pleurodeles waltlii thymus morphogenesis was studied by serial semi-thin sections and by electron microscopy. Thymus endodermal buds were first seen 9 days after fertilization. From 12 to 16 days, these rudiments are invaded by a small number of cells moving from the cephalic mesenchyme environment. These cells have the ultrastructural morphology of lymphoid stem-cells. Cytologic transitional forms from endodermal to lymphoid-like cells are never observed. These results clearly indicate that in amphibians the thymus lymphocytes are not derived from the initial endodermal rudiments.


Metastic tumor of the brain: development of an experimental model. The injection of a suspension of Walker 256 carcinoma cells into the carotid artery of rats produced a model of hematogenously spread cerebral metastases. Most animals died from massive extracerebral tumors of the head and jaw; brain tumors were present in only one-quarter. External carotid artery ligation prior to tumor inoculation did not increase the incidence of fatal brain tumor. When cyclophosphamide, 15 mg/kg, was injected as a single dose on the fourteenth day after tumor inoculation, most of the extracerebral tumor disappeared. Fifty percent of the animals so treated were cured of tumor, but 90% of the remainder died of large intracerebral tumors. Severe cytopathic changes resulting from cyclophosphamide were present in extracerebral or choroid plexus tumors but were mild or nonexistent in intracerebral tumors. These selective effects of cyclophosphamide suggest that water-soluble agents are less effective against tumor in the brain than against extracerebral tumors despite the fact that metastatic tumor breaks down the blood-brain barrier.


[Nuclear proteins of stimulated lymphocytes (author's transl)]. Lymphocytes activated by phytohaemagglutinin (PHA) change from a resting state (GO) to an actively growing one (G1). To investigate the role of growth regulatory protein in this process we have determined the patterns of synthesis of acidic (non-histone, NHCP) and basic (histone) nuclear chromatin proteins, and of cytoplasmic proteins during PHA activation of human lymphocytes, Protein fractions isolated from a mixture of stimulated (pulse-labelled with 14C leucine) and unstimulated (labelled with 3H-leucine) lymphocytes were separated on SDS-polyacrylamide gel electrophoresis and the ratio of 14C/3H determined on 1 mm gel slices. Several peaks of increased synthesis of specific peptides are detected in all fractions within 12 h of activation. When activation is blocked by an amino acid deficiency, the pattern of label upon release of the inhibition by addition of the missing amino acid is different from that of uninhibited lymphcytes.


[Haptenic function and metabolism of the disaccharides of the glomerular basement membrane in heterologous nephrotoxic antibody-induced glomerulonephritis in rats]. The disaccharide unit Glc-gal-hyl represents 6% of dry weight of the rat glomerular basement membrane. It has been shown to be a haptenic determinant of this membrane. It appears to be one of the targets of the lesions induced by nephrotoxic antibodies in the rat: the urinary excretion of Glc-gal-hyl (as well as of Gal-hyl and Hyl which may derive from Glc-gal-hyl by degradation) during the autologous phase of the rat glomerulonephritis is significantly increased. Simultaneously the biosynthesis of Glc-gal-hyl, as measured by the glomerular glucosyltransferase activity, is elevated by 72%.


[Kinetics of reappearance of suppressed allotypes in multiheterozygous rabbits (author's transl)]. Heterozygous rabbits of genotype a1n81f73g74/a2n82f71g75 were injected at birth with anti-al antiserum. The suppression of the VHa1 allotype resulted in a similar concommitant suppression of the constant region allotypes coded by genes of the same allogroup as a1. After 3 to 4 months the suppressed allotypes were re-expressed in measurable amounts. At 6 months in the 3 suppressed animals, the proportion of suppressed allotypes (S) to the non-suppressed ones (NS) was higher among colostrum and serum IgA (50% S, 50% NS) than among IgG for IgM. Among these two latter classes the proportion S/(S + NS) remained low (about 15% S, 85% NS) over an 18 month period in two out of three suppressed rabbits. In the third one, the proportion S/(S + NS) among IgG molecules increased to increasing concentration of S allotypes is not compensated by a decrease in concentrations of NS allotypes. The study of these phenomena could bring a better understanding of mechanisms involved in regulation of Ig synthesis and in allotype suppression.


Episodic nocturnal wanderings responsive to anticonvulsant drug therapy. Six patients between the ages of 17 and 32 years presented with unusual sleep-walking epidodes characterized by screaming or unintelligible vocalizations; complex, often violent automatisms; and ambulation. Two or more attacks could occur in a single night and were most common in the early morning hours. Family and personal histories did not show epilepsy, psychiatric disorders, or (with 1 exception) previous somnambulism. Electrographic investigation revealed that all patients had normal waking-sleep cycles but that 4 of them had epileptiform abnormalities on their electroencephalograms. All patients were treated with either phenytoin or carbamazepine, with cessation of the abnormal nocturnal behavior during follow-up periods ranging from 9 to 48 months. This syndrome appears to be distinct from more typical non-rapid eye movement dyssomnias and suggests an atypical form of epilepsy.


Peripheral nerve abnormality in multiple sclerosis. Biopsy specimens of sural nerve from 10 patients with multiple sclerosis (MS), of whom only 1 was severely disabled, were assessed by morphometric techniques and compared to nerves from age-matched controls. The frequency of abnormal teased fibers was increased in MS nerve, with many internodes showing at least a 50% reduction in myelin thickness. Myelinated nerve fiber densities were not significantly different in MS and control nerves. Regression analysis of axonal area on number of myelin lamellae indicated a generalized reduction of myelin lamellae in this disorder. It is suggested that peripheral myelin may be involved in multiple sclerosis.


[Inflammation and host resistance against tumours. I. Delayed growth of Lewis tumour and inhibition of lung metastasis in mice having an inflammatory reaction distant from the inoculation site of tumour cells (author's transl)]. Following the inflammatory reaction induced in mice by subcutaneous implantation into the dorsal area of talc embeded in a calcium phosphate gel, the growth of the Lewis tumour was found to be delayed. This delay was observed even with inocula 1,000 times higher than the minimum required for the development in tumours in all animals. When 10(6) tumour cells were inoculated subcutaneously into the footpad, in contrast with normal animals, no metastases were found in the lungs if inflammatory reactions were induced 4 days before or 1 day after the inoculation of tumour cells.


"Inverse latent" macro square-wave jerks and macro saccadic oscillations. A patient recovering from an acute encephalopathy demonstrated several ocular motor disturbances reflecting cerebellar and brainstem dysfunction. Two of these, macro square-wave jerks and macro saccadic oscillations, have never been reported in the same patient. The macro square-wave jerks disappeared with monocular viewing, a previously undescribed "inverse latent" characteristic.


Fisher's syndrome: a pharmacological study of the pupils. A pharmacological study was performed in the involved pupils to demonstrate the site of lesion in a patient with Fisher's syndrome who showed marked ptosis, complete external ophthalmoplegia, pupillary involvement with anisocoria, facial paresis, ataxia, areflexia, and albuminocytological dissociation in the cerebrospinal fluid. The instillation of 2.5% methacholine produced mild constriction of one pupil. This response was not detectable in the recovery stage. The instillation of 1.25% l-epinephrine produced marked bilateral dilation of the pupils, in both the early and recovery stages. Instillation of 5% tyramine produced pupillary dilation as in the normal pupil. The response to 5% cocaine, tested only in the recovery stage, was weak in one pupil. These results imply that the pupillary involvement was due to peripheral involvement of the sympathetic and parasympathetic nervous systems. The lesion in the sympathetic nervous system was preganglionic, but in the parasympathetic nervous system the precise localization could not be determined.