Adult respiratory distress syndrome in postoperative patients: study of pulmonary pathology in "shock lung" with prophylactic and therapeutic implications. Lungs of 44 patients who died after postoperative respiratory distress and shock had a significantly higher incidence of atelectasis and thromboembolism than did 31 control patients. However, both lesions were as inconstant in occurrence as all other 15 investigated pulmonary changes. Moreover, no clear correlation between lung pathology and duration of shock was found and the incidence of thromboembolism was too low (one clot for each 16 or more counted vessels) to generate any significant vascular obstruction. Furthermore, pulmonary pathology in patients with postoperative respiratory distress was independent of the presence or absence of shock and some of the most typical findings of "shock lung" were more often present in patients who did not have shock but died of aspiration pneumonia. While possibly a contributing factor, shock is not the most important cause of the pulmonary lesions in postoperative patients. The term "shock lung" should be eliminated and renewed emphasis should be placed on detection, prevention and treatment of the pathogenic mechanisms involved in each individual case.


A routine for safe, effective endotracheal suctioning. A routine for safe, effective endotracheal suctioning is delineated. This routine was established by correlating various periods of augmented tidal ventilation and endotracheal suctioning with continuous arterial oxygen tension measurements. Patients were evaluated at bronchography to determine the effect of head position on suction catheter placement. Inspired oxygen concentrations were measured via an intratracheal catheter during various forms of inhalation therapy and modes of breating. Using these observations, guidelines were established to maximize the benefits and minimize the risks of an endotracheal suction routine.


Traumatic nonpenetrating diaphragmatic hernia: report of 5 cases with a brief review of the literature. Five cases of nonpenetrating, traumatic diaphragmatic hernia collected from the records of Medical Center Hospitals, Norfolk, Virginia, are presented. Four cases involved the left side; one case involved the right side and is discussed in detail. A brief review of the literature, modes of presentation, diagnostic work-up, and theories of etiology are presented. The detailed report illustrates: (1) the frequently vague presenting symptoms, (2) the need for high index of suspicion in evaluating lesions associated with the diaphragmatic surface, (3) importance of a thorough history and physical, and (4) the invaluable aid of diagnostic pneumoperitoneum in establishing the diagnosis preoperatively, thereby allowing a completely planned surgical approach.


A threshold ambiguity problem involving a cardiac pacemaker. A case report of an apparently paradoxical electricl threshold required for cardiac "capture" based upon differences in construction in external as opposed to internal pulse generators is presented. The electrical characteristics of each type are discussed and recommendations made for more reliable determinations of cardiac "capture" thresholds.


Functioning metastatic parathyroid carcinoma. A case of 53-year-old woman with a parathyroid adenoma and a parathyroid carcinoma with functioning metastases to the lungs, mediastinum and pleura is reported. The administration of inorganic phosphate solution failed to control hypercalcemia. The therapeutic methods available to deal with metastases are discussed.


Surgery and acupuncture analgesia.

Surgery and acupuncture analgesia. In this paper are presented three case reports on the use of acupuncture as the sole means of intraoperative analgesia. The authors also discuss the present status of the possible indications, contraindications, advantages, disadvantages and future indications for its use. It also shows that the term anesthesia is a misnomer for this modality, and that it should be called acupuncture analgesia.


Ischemic colitis in esophageal substitution: an unusual and lethal complication of colon interposition. This is a report of one patient with the unusual complication of ischemic colitis in a segment of interposed right colon which was used for esophageal substitution. The presentation was unusual in that the patient had three episodes of massive lower gastrointestinal bleeding. The diagnosis was established by selective angiography and a barium contrast study.


Massive necrosis and perforation of the colon in amebiasis. A successfully treated case of acute fulminating necrotizing amebic colitis characterized by signs of toxemia, septicemia and peritonitis is reported. Early diagnosis and staged surgical procedures apparently lower the mortality. Intensive antiamebic therapy should be instituted as soon as amebiasis is confirmed, otherwise surgical therapy is likely to fail.


Reversed jejunal segment used to treat the short bowel syndrome. Two cases of antiperistaltic bowel segment in the treatment of the short bowel syndrome are presented here. We think that this is the best procedure for the treatment of this syndrome. The length of the reversed segment should be 9 cm.


Renal cyst causing afferent loop obstruction and acute pancreatitis. A patient with afferent loop obstruction caused by a right renal cyst who presented with acute pancreatitis has been described. The obstruction was successfully relieved at operation with resection of the portion of cyst wall extrinsic to the kidney and mobilization of the duodenal loop into its normal location.


Studies in burns. XIII. Effects of a topical lipid on burned subjects and their wounds. We evaluated ethyl linoleate (ethyl, (9, 12)-cic, cis-octadecadienoate), a naturally occurring cutaneous water-holding lipid, for its water-holding metabolic, healing and toxic properties in groups of unburned and burned rabbits and its toxic potentials in this species and mice. The lipid appears to reduce evaporative water loss in full-thickness burned rabbits. Associated with this effect is a proportional and related lowering of metabolic heat production. The topical application of the lipid at any time after burn appears to be associated with a significant healing in lesions that, histologically at least, would be interpreted as fullthickness. The material is highly toxic if applied daily to mice or rabbits. The details of the toxic effect (s) are being studied. The commerical-grade material (75 percent pure) contains a derivative of ricinoleci acid and chronic exposure of the EL to air may result in the formation of peroxides and epoxides. These materials exert well-defined toxicity. The obvious potential uses of this agent in treating human burn lesions need not be emphasized, but it does need to be stated categorically that, at present, (Feb 1974), the toxicity has not been defined enough for use except in experiments.


Acute postoperative wound complications after gastric surgery for morbid obesity. The acute postoperative wound complications of 225 morbidly obese patients undergoing gastric bypass were compared against the complications observed in 225 normal-sized individuals who underwent elective gastric resection for peptic ulcer disease. Not only were there more wound infections (8.9 percent to 5.3 percent) in the obese population, but these infections inflicted more serious complications and a significantly increased hospital stay. While the exact cause of the increase in infections in the obese patients is unclear, it is a real phenomenon to be dealt with in surgery for obesity.


Early formation of gallstones following jejunoileal bypass for treatment of morbid obesity. In this article the authors report a patient with cholesterol gallstone formation shortly after a jejunoileal bypass for treatment of morbid obesity. The etiological factors for gallstones in the general population as well as jejunoileal bypassed patients are reviewed and discussed.


Surgical management of pancreatic pseudocysts. Pancreatic pseudocyst is a complication of pancreatitis or pancreatic trauma. A review of the experience with surgical treatment of pseudocyst of the pancreas at the University of Iowa was carried out. Pancreatitis associated with alcoholism accounted for a smaller percentage of the pseudocysts than is usually reported and reflects the nature of the population. Internal drainage of the pseudocyst obviates the development of pancreatic fistula which is often associated with external drainage; however, the mortality for each method of drainage was comparable.


Late recurrent parathyroid adenoma.

Late recurrent parathyroid adenoma. A case history of recurrent hyperparathyroidism 17 years following removal of an adenoma is presented. Reference is made to possible familial implications noted in this instance. The rarity of recurrent hyperparathyroidism is attested to by the fact that less than 20 authenticated cases have been reported to 1974. Arteriography may be greatly helpful in localizing the recurrent or missed tumor. Etiologic factors possibly associated with recurrence are discussed.


Cigarette smoking and chest pain.

Cigarette smoking and chest pain. Analysis of questionnaire responses of 70208 persons undergoing multiphasic health checkups showed a greater proportion of cigarette smokers than nonsmokers (excesses averaging 1.6-fold in white men, 1.3-fold in white women) admitting to nine types of chest pain. This excess in smokers was greater in younger individuals, and applied about equally to anginalike and nonanginalike pain. The smoking/chest pain association was not explained by greater alcohol or coffee consumption, diminished pain tolerance, or less reliability among smokers; nor did it appear to be mediated chiefly by excess cough, shortness of breath, coronary disease, or musculoskeletal complaints in smokers. Although smokers averaged more complaints than nonsmokers, chest pain resembled clearly smoking-related symptoms, such as cough, when the number of each subject's complaints was considered. Although more smokers had chest pain no type of pain was unique to smokers, suggesting that the "tobacco angina" concept be discarded or reserved for rare patients with coronary heart disease in whom smoking clearly provokes angina pectoris.


Ouabain plasma level kinetics and removal by dialysis in chronic renal failure. A study in fourteen patients. Ouabain plasma level kinetics and removal by dialysis were studied in 14 dialysis-dependent patients with chronic renal failure. Each received one 400 mug intravenous dose of unlabeled ouabain (9 patients also received 83 muCi of 3-H-ouabain) at the onset of a routine 4-hour hemodialysis. Plasma concentration fell rapidly the first few hours, and after 5 to 10 hours declined exponentially with a mean half-life of 50 plus or minus 19 (SD) hours. Ouabain recovery in dialysis bath was 11.5% plus or minus 2.2% the first 2 hours and only 3.4% plus or minus 0.5% the next 2 hours after an intravenous dose, due to rapid removal of ouabain from the extracellular fluid compartment by tissue uptake. Hence, hemodialysis is relatively ineffective for reducing ouabain body stores. Ouabain elimination in patients with chronic renal failure is significantly slower than in normal subjects (P smaller than 0.01), but significantly more rapid than that reported for digoxin (P smaller than 0.01) and digitoxin (P smaller than 0.01) in patients with chronic renal failure, a potentially useful characteristic in treating acute cardiac problems among such patients.


Effects of hematin in hepatic porphyria. Further studies. The present study was carried out in five cases of hepatic porphyria, including three of acute intermittent porphyria, one of variegate porphyria, and one of porphyria cutanea tarda in clinical remission. In two cases of acute intermittent porphyria (in relapse), a marked lowering effect on serum and urine porphobilinogen and delta-aminolevulinic acic was observed, together with prompt and gratifying clinical improvement. In a third case, in chemical remission but with longstanding psychoneurosis, no significant effects were noted, nor were any observed in the case of porphyria cutanea tarda. Although clinical improvements occurred in the case of variegate porphyria, the results were inconclusive for reasons given. Hematin was generally well tolerated. Preliminary reference is made to a transitory renal injury, without sequelae, where an excess of hematin was given in relation to time. Limits of tolerance are proposed. In the light of these observations the basic mechanism of the acute attack is diccussed.


The American Burkitt Lymphoma Registry: a progress report. The American Burkitt Lymphoma Registry (ABLR) investigates the cause of Burkitt's lymphoma through comparative studies involving endemic and nonendemic regions. In 3 years 114 cases have been confirmed. Diagnosis was based on evaluation of pathologic materialy submitted to ABLR pathologists. Similarities between American and African patients included abrupt clinical presentation with involvement of the gastrointestinal tract, jaw, gonads, and central nervous system. Response to high-dose cyclophosphamide and an apparent high cure rate distinguish American Burkitt's lymphoma from poorly differentiated lymphocytic lymphoma (lymphosarcoma) of childhood. Time-space clustering and absence of cases in high-altitude regions are seen in American and African patients; young American patients resemble Africans in a predominance of men and high Epstein-Barr virus titers. American patients have bone-marrow and peripheral lymph-node involvement more frequently and are less likely to have Epstein-Barr virus genome in their tumors; most are white. Identification of specific causal factors requires the study of more cases and better pretreatment material for pathologic review.


Gout as a complication of Bartter's syndrome. A possible role for alkalosis in the decreased clearance of uric acid. A prevalence of hyperuricemia of 50% and of acute gouty arthritis of 20% has been observed in a group of patients with Bartter's syndrome. All patients except one presented initially with complaints unrelated to uric acid metabolism. The cause of their hyperuricemia and subnormal clearance of uric acid is unexplained. Systemic alkalosis, a prominent feature of Bartter's syndrome, can decrease the clearance of uric acid and may contribute to the hyperuricemia and gout that have been observed. Physicians should be aware of the possibility of gout as a clinical complication of Bartter's syndrome and of the inhibitory effects of alkalosis on urate clearance.


Familial hypokalemic periodic paralysis in blacks. Two cases of familial hypokalemic periodic paralysis in Negro brothers occurred, and--because this has been reported to be an unusual disease among blacks--the family pedigree was investigated. Histories were obtained on 79 family members in four generations. Twenty seven (34%) had symptoms of periodic paralysis or weakness. As far as we could determine, there were no Caucasian ancestors.


Laxative-induced hypokalemia, sodium depletion and hyperreninemia. Effects of potassium and sodium replacement on the renin-angiotensin-aldosterone system. A patients with marked chronic hypokalemia (potassium, 1.7 to 2;3 meg/litre) and sodium depletion secondary to lazative abuse and dietary inadequacy was studied with respect to the renin-aldosterone system during sequential potassium and potassium-plus-sodium replacement. Extreme hyperreninemia of 20 Goldblatt units X 10-minus 4 was reduced to 0.9 with potassium replacement alone. Aldosteron excretion (15.8 mug/24 h) was initially low for a sodium-deprived state and high for a potassium-deprived state; it increased with potassium administration, but this rise was opposed by decreases in renin secretion induced by potassium and sodium administration. The results provide clinical confirmation of a dual effect of potassium on aldosterone secretion, with renin as a mediator.


Pituitary stones.

Pituitary stones. Two cases of patients having calcification within the sella turcica (pituitary stones) have been studied and followed up, one patient for 18 years. A detailed analysis of the radiographic findings and endocrinologic profiles of these two patients is presented. The rarity of bona fide pituitary stones and their benign nature, as evidenced by the two cases reported here, are emphasized.


Disseminated MYycobacterium kansasii infection with pancytopenia and interstitial nephritis. Disseminated Mycobacterium kansasii infection associated with pancytopenia was diagnosed in a 40-year-old man found to have granulomata in kidney and liver biopsy specimens. The M. kansasii was isolated from the urine and tissue obtained by renal biopsy. Serial renal biopsies and renal tissue obtained at autopsy showed severe interstitial fibrosis which was thought to represent a tissue response to the M. kansasii infection. The periportal and parenchymal fibrosis found in the liver at autopsy were consistent with a similar response in the liver.


Fibrinogen survival in cirrhosis: improvement by "low dose" heparin. The effect of "low dose" heparin therapy on fibrinogen survival in patients with cirrhosis was studied in six patients. Survival of I-125 radiolabeled fibrinogen was measured using both autologous and homologous material. Average fibrinogen half-life before heparin therapy was 52 hours and after 3000 units of intravenous heparin every 6 hours was 101.8 hours. Median survival before heparin therapy was 56 hours and after therapy was 91 hours. In every instance fibrinogen survival was improved by heparin administration. These data indicate that "low dose" heparin improves fibrinogen survival in cirrhosis and suggest that disseminated intravascular coagulation is a primary process in the defibrination syndrome associated with cirrhosis.


Alcohol and its drug interactions.

Alcohol and its drug interactions. Alcohol interacts with a suprising number of commonly used drugs: antibiotics, anticoagulants, antihistamines, digitalis, monoamine oxidase inhibitors, nitroglycerine, diuretics, heavy metals, insulin, iron, puromycin C, and many others. It also interacts specifically with sedatives, opiates, phenothiazines, antidepressants, and other psychoactive drugs. This review calls attention to these interactions and what we know of their mechanisms. The physician is cautioned about the use of alcohol by his patients taking other medications and about the frequent difficulty of ascertaining the extent of the patient's alcohol ingestion.


Acute renal failure after excretory urography in diabetic patients. Currently used contrast media for excretory urography are generally considered safe even in the presence of renal insufficiency. Isolated reports of acute oliguric renal failure in diabetic patients after excretory urography have been documented. We describe eight such patients who developed this complication. The approximate incidence of recognized acute oliguric renal failure in diabetics undergoing excretory urography was 2 in 1000 as compared with none in more than 100 000 procedures done in nondiabetic patients. Six of the diabetic patients with acute renal failure recovered; two required hemodialysis, never regaining self-sustaining renal function. If detected early, acute renal failure in this setting can often be managed conservatively. Attempts to induce diuresis have been discouraging.


An approach to the performance of contrast studies in contrast material-reactive persons. A method of carrying out contrast studies was considered for use in 124 persons with past histories of adverse reactions to contrast media. High-dosage steroid treatment was given before and during the contrast study to 37 patients with previous rash responses and 9 with prior anaphylactoid reactions; only 3 and 1 patients, respectively, of these groups had mild adverse reactions. Patients with past reactions deemed "vasomotor" underwent contrast study without preparative drug therapy without significant adverse effects. Although uncontrolled, this study suggests a possible protective role of steroids in patients with certain previous reactions to contrast media. We do not wish to imply that this is the only approach that can be used in the kind of patients reported here.


Cerebral disorders of vision in systemic lupus erythematosus. Sensory neuroophthalmic abnormalities due to cerebral lupus erythematosus, with involvement of visual pathways posterior to the optic chiasm, occurred in 12 patients with systemic lupus erhthematosus. Five underwent detailed evaluation because of an hallucination, 4 for visual loss, and 3 for both. Hallucinations were either unformed (for example, bright lights, straight lines) or highly formed (for example, faces), in which case they were invariably recognized by the patient as inappropriate. In no instance did they occur in association with delirium, confusion, or use of hallucinogenic drugs. Patients with loss of vision had scotomas, homonymous field defects, and cortical blindness. These features indicate disease in the posterior cerebral artery circulation, a localization often supported by ancillary neurologic findings, for example, vocal cord paralysis, diminished gag reflex. Thus, various visual dysfunctions may occur in systemic lupus erythematosus due to cerebral vasculitis. At times they may be the most prominent and disabling feature of the disorder.


Thyroid autoimmunity: increased frequency in relatives of insulin-dependent diabetes patients. Thyroid antibodies were found significantly more often in insulin-dependent diabetics than in their spouses or in non-insulin-dependent diabetics. The poor correlation between presence of thyroid autoimmunity and duration of disease and the significantly increased prevalence of thyroid antibodies in first-degree relatives of insulin-dependent probands are interpreted to suggest that thyroid autoimmunity in probands with insulin-dependent diabetes is not secondary to diabetes. Since married couples in which both members had thyroid antibodies were not found more frequently than predicted by chance alone, acquired environmental factors are not the sole determinants of familial thyroid autoimmunity in diabetes; it is likely that inherited predisposition is of major importance. Relatives of probands with thyroid antibodies have significantly higher frequency of these antibodies than do relatives of negative probands. This finding suggests that there are several kinds of insulin-dependent diabetes, one of which may be an "autoimmune" disease.


Respiratory tract disease from thermosetting resins. Study of an outbreak in rubber tire workers. An outbreak of upper and lower respiratory tract inflammatory disease and conjunctivitis among synthetic rubber tire workers occurred. The outbreak began after the introduction of a new thermosetting resin, containing resorcinol and a trimere of methylene aminoacetronitrile, into the rubber tire carcass stock formulation. Two hundred ten workers were affected. Characteristically, symptoms improved during periods of sick leave or vacation, recurring upon the workers' return to the plant. Chest radiograms disclosed pneumonic infiltrates in about one fourth of the cases. Pulmonary function studies detected abnormal airways dynamics as well as abnormal diffusing capacity in more than one third of the workers tested. Lung biopsy showed evidence of focal interstitial fibrosis and peribronchiolar and perivascular chronic inflammatory reaction. The illness was ascribed to volatile products released during the manufacture of synthetic rubber tires. The exact chemical nature of these products is unknown.


The hypocalcemia of acute pancreatitis.

The hypocalcemia of acute pancreatitis. Variables of calcium metabolism were measured in 11 patients with clearly documented acute pancreatitis. Total and ionized calcium levels were either low or in the low-normal range as were phosphorus and total magnesium levels. Parathyroid hormone levels were high, and there was a significant inverse correlation with ionized calcium. Gastrin levels were normal, calcitonin values were uniformly below the detection limit of the assay, and pancreatic glucagon levels were elevated. The hypocalcemia of acute pancreatitis was probably not caused by abnormalities of glucagon, calcitonin, or gastrin secretion. Furthermore, parathyroid hormone secretion was apparently not impaired. Hypomagnesemia possibly played a minor role. This study suggests that the hypocalcemia of acute pancreatitis is secondary to extraskeletal calcium sequestration or an as yet unidentified defect of bone metabolism, or both.


Admissions screening: clinical benefits. One thousand patients admitted to a 575-bed general hospital during a 6-month period each underwent 20 chemical and hematologic tests. The potential clinical benefit was assessed. There were 2223 abnormal results found; 675 were predicted on clinical assessment, 1325 did not yield new diagnoses, and the remaining 223 led to 83 new diagnoses in 77 patients. On critical evaluation of the new diagnoses, none were unequivocally beneficial to the patient. Up to 30 patients might have benefited had these abnormal findings been followed up diligently, 39 others had findings or diagnoses of no lasting significance, and in 14 patients asymptomatic mild biochemical diabetes was discovered. Although screening may reveal many abnormal test results, the clinical benefits are not impressive.


Bacteremia with upper gastrointestinal endoscopy. Fifty patients undergoing upper gastrointestinal fiberoptic endoscopy were studied prospectively for the development of bacteremia by aerobic and anerobic blood cultures obtained before, during, and at 5 and 30 minutes after the procedure. Forty-six patients were culture negative; four had positive cultures at 5 or 30 minutes after the procedure, or at both times. The level of bacteremia as estimated by pour plates was very low. Bacteremia did not correlate with the performance of biopsy or the type of mucosal abnormality found. It is concluded that only very high-risk patients should receive antimicrobial prophylaxis before this procedure. The minor risk of this low-level bacteremia should not be considered a contraindication to the performance of upper gastrointestinal endoscopy.


Hemodialysis in diabetic patients with chronic renal failure. Eighteen male diabetic patients with a mean age of 48.5 years and end-stage renal disease were maintained on chronic hemodialysis for a mean duration of 15.2 months. The cumulative survival rate for the first year was 86%. Their diabetes was no more difficult to control after starting hemodialysis. Cardiovascular complications accounted for the two deaths and most of the management problems. Patient rehabilitation was considered to be satisfactory. It is concluded that chronic hemodialysis can be a suitable form of therapy in this group of patients.


Serious pulmonary hemorrhage, glomerulonephritis, and massive steroid therapy. A patient suffered from acute glomerulonephritis with modest renal impairment and life-threatening pulmonary hemorrhage. The pulmonary hemorrhage  caused severe hypoxia that necessitated artificial ventilation. As a last resort, 1 g/day of methylprednisolone was administered intravenously. Rapid cessation of pulmonary hemorrhage ensued with clearing of the lungs fields. We suggest that large doses of glucocorticosteroids should be administered to patients with life-threatening pulmonary hemorrhage before considering bilateral nephrectomy, especially if the renal function is still adequate. Bilateral nephrectomy is an irreversible approach and, as with massive doses of steroids, has yet to be proved to be a consistently effective mode of therapy.


Systemic amyloidosis in Behçet's disease. Clinical features in two patients with Behcet's disease were dominated by "minor" manifestations of the disease--arthritis and central nervous system involvement in one, chronic stasis ulcers complicating thrombosis of the inferior vena cava in the other. In a third patient, the dominant clinical features were coincidental obstructive airway disease and cor pulmonale. Two patients developed a nephrotic syndrome; the third had intermittent trace proteinuria. Amyloidosis was proved by histologic examination in all three. The two patients examined post-mortem had no focus of chronic suppuration. There is a possibility that systemic amyloidosis is an intrinsic feature of Behcet's disease.


Fatal self-administration of sodium azide. A 19-year old woman ingested an unknown amount of sodium azide (NaN3). The earliest symptoms were nausea and loss of vision. Within a few hours her clinical features were dominated by central nervous system signs, acute pulmonary edema, lactic acidosis, and hypothermia. The patient died within 12 hours, hypotension and shock occurring as preterminal events. This was the first recorded case in which antidotal methemoglobin production was attempted. Sodium nitrite administration resulted in methemoglobinemia but did not appreciably alter the clinical course and may not be of major benefit. Gross examination post-mortem showed marked pulmonary edema, visceral hemorrhage and congestion, and slight cerebral edema. Microscopically, the lungs showed alveolar and interstitial edema and a polymorphonuclear infiltrate. There were petechial hemorrhages and severe nonspecific changes in the brain.


Dilantin-induced disseminated intravascular coagulation with purpura fulminans. A case report. A patient developed disseminated intravascular coagulation with purpura fulminans 1 month after starting Dilantin therapy for a seizure disorder. In addition, the patient developed exfoliative dermatitis, hepatitis, cutaneous vasculitis, and microangiopathic hemolytic anemia. She was successfully treated with adrenal steroids and heparin for her purpura fulminans. The hepatitic dermatologic, along with hemorrhagic, complications of Dilantin are reviewed, and the possible origin of the vasculitis and disseminated intravascular coagulation is discussed.


Partial xenon coagulation of net in histoplasmic choroiditis. Ten patients with ocular histoplasmosis (photocoagulated 17 times) were retrospectively selected, in what was considered an unbiased manner, for examination of their response to partial xenon photocoagulation of their neovascular nets. Of the 17 photocoagulations, the part of the neovascular net not coagulated remained the same in 7, was stimulated in 5, and suppressed in 5. This distribution was not statistically different from a control group receiving corticosteroids alone. A direct relation of suppression of the uncoagulated part of the net with the distance of this coagulation from the fovea was demonstrated.


Degenerative choroidal sclerosis with a peculiar bilateral pattern. A 60 year-old black man when seen in consultation for foreign body sensation and presbyopic complaints was noted on ophthalmoscopy to have bilateral pigment epithelial defects. These defects were curiously symmetrical and there were visual field defects corresponding to the areas showing loss of pigment epithelium. The electrooculogram was abnormal and fluorescein angiography showed normal large choroidal vessels but totally absent choriocapillaris in the involved areas and abnormal pigment epithelium at the edge of the defect.


Intracanalicular meningioma with chronic optic disc edema. A patient with an intracanalicular meningioma is presented who had the clinical symptoms and signs of optic papillitis. All neuroradiologic examinations except for hypocycloidal polytomography of the optic canals were normal. Orbital pain, progressive decreasing visual acuity, visual fields showing an enlarging scotoma, and a failure to respond to steroid therapy or worsening of symptoms upon steroid withdrawal should alert the clinician to this diagnostic possibility despite normal radiographic studies.


Clinical experience with the therapeutic hydrophilic contact lens. Hydrophilic contact lenses were prescribed for 62 patients with a variety of corneal diseases. The lens was must successful for relief of pain in bullous keratropathy and in the healing of recurrent erosions. Its value in improving vision in bullous keratopathy depends on the stage of corneal edema and is not impressive in long-standing edema with scarring. The lens may be of value in patients with sterile indolent ulcers and in alkali-burned corneas with large epithelial defects after conventional therapy has failed. Caution is advised in fitting patients with the dry eye syndromes. Patients with minimal corneal scars due to keratoconus may benefit from a soft lens. Complications related to the use of hydrophilic lenses in this group of 62 patients are also discussed.


Intravenous diazepam as an adjunct to local anesthesia in ophthalmic surgery. The addition of intravenous diazepam to other, routinely employed preoperative medications prior to intraocular surgical procedures was evaluated to determine if symptoms of extreme apprehension and anxiety could be alleviated and the necessity to resort to general anesthesia reduced. It was observed that patients who were given intravenous diazepam preoperatively sleep or were drowsy during the procedure, tolerated the surgery uneventfully and did not manifest symptoms of apprehension. Also, they could be aroused without difficulty after the procedure and were responsive to questioning and routine aftercare. The only adverse reaction, difficulty in breathing because of airway obstruction due to the tongue falling backward into the throat as a result of the light anesthesia employed, can be easily handled by lifting the chin upward or, if necessary, the use of an airway.


Evaluation of Dexon suture in ophthalmic surgery. 6-0 Dexon (polyglycolic acid-PGA) suture was used in 30 eyes of 25 patients in surgical procedures which included cataract extraction, strabismus surgery, and ocular plastic surgery. The suture was found to hold the wound firmly, was not absorbed prematurely, was absorbed completely at a predicted time, was relatively easy to use although the knots were large, did not cause any infection or undue tissue reaction, and did not result in any wound dehiscence or vitreous loss.


Vitrectomy with an alternative instrument system. This is a description of an alternative type of vitrectomy instrument system which is characterized by specific advantages for mobilizing and removing sluggish intracapsular lens material, blood, debris, or plasmoid liquid pooled or sedimented at the posterior pole; and modular one-surgeon units adaptable to contemporary vitrectomy devices and techniques with a minimum of surgical or instrument modification. Electrovitreotomy for relaxing fixed folds due to taut opaque vasoproliferative bands inaccessible to or extremely hazardous with other cutting methods is a complementary procedure of value.


Limbal-based conjunctival flap retractor. A very simple tool has been devised from a standard Weck-Cel surgical spear which greatly facilitates the dissection of the limbal-based conjunctival flap in cataract and glaucoma surgery.


Current concepts in the management of strabismus in children with cerebral palsy. Few guidelines have been advanced for the management of brain damaged children with strabismus. Conservative therapy with lenses, prisms, occlusion, atropine and late surgery has been suggested but without specific methods or ages being advocated. The authors undertook the treatment of these children utilizing the standard principles of strabismus therapy as applied to neurologically normal children. A further consideration is a satisfactory cosmetic appearance which wins greater self, peer and parental acceptance in these handicapped children. The results of therapy of this series of patients with cerebral palsy indicates that satisfactory alignment can be achieved in the majority even in the presence of severe motor involvement and/or mental retardation. Ninety percent of those patients with treated accomodative esotropia achieved a satisfactory alignment. Those patients with non accommodative esotropia had a satisfactory alignment in 77% of the patients operated upon and those with exotropia achieved this result in 86% of the patients operated upon. Only five (2%) patients spontaneously reduced their angles to cosmetically acceptable ranges. Overcorrections occurred in 10 (11%) patients in the surgically treated nonaccommodative esotropes and 4 (3%) of these patients required further corrective surgery. Only one exotropic patient was rendered esotropic postoperatively. The average age of initial surgery in the esotropic patients was 3.9 years and 5.7 years in the exotropic patients. The older ages for surgical intervention reflects the more conservative approach to these neurologically abnormal children and allow an increased time interval for the development of a stable preoperative oculomotor alignment.


Experimental alphachymotrypsin glaucoma. Experimental glaucoma was produced in 50% of rabbit eyes by injecting 75 units of alphachymotrypsin into the posterior chamber. The elevation of intraocular pressure was stable, rarely exceeded 50 mm Hg, and lasted one year or longer. Progressive buphthalmos first appeared 2 to 3 weeks following injection of the enzyme. Ocular histologic changes included bullous keratopathy, iris and ciliary body atrophy, and cupping of the optic disc. The optic nerve became atrophic but no cavernous degeneration occurred. In the retina there was thinning of the nerve fiber layer and loss of ganglion cells with preservation of the other retinal elements. The mechanism leading to glaucoma following alphachymotrypsin injection is unclear. This study demonstrated formation of peripheral anterior synechiae and reduction of outflow facility within 2 weeks following injection and these factors may play a role.


Conjunctival temperature: a measure of ocular decongestant and anti-inflammatory activity. A new experimental method is presented that permits objective evaluation of ocular decongestant and anti-inflammatory activity following systemic or local administration of drugs to the rabbit eye inflamed with mustard oil. The inflammation produced by mustard oil is characterized by conjunctival hyperemia and chemosis and is measured by the conjunctival sac temperature. Although a 2% suspension of acetylsalicylic acid (0.1 ml) applied topically to the eye did not markedly reduce conjunctival temperature compared to the control eye, oral administration of 300 mg/kg showed a significant reduction throughout the duration of the experiment. In addition to the anti-inflammatory agent, acetylsalicylic acid, the antihistaminic, antazoline phosphate 0.5% and a vasoconstrictor or decongestant, naphazoline hydrochloride 0.05% were applied individually and in combination (Vasocon-A) locally in the conjunctival sac. Both antazoline phosphate and naphazoline hydrochloride reduced congestion and conjunctival sac temperature while the combination reflected the action of the individual ingredients. The palliative effect of antazoline phosphate indicates that this drug administered topically readily antagonizes histamine in the inflamed eye. There was no corneal anesthesia after instillation of Vasocon-A into the rabbit eye. Antazoline hydrochloride administered in up to 8 times the concentration in Vasocon-A did not induce corneal anesthesia which could be readily obtained with tetracaine hydrochloride.


Ophthalmic screening of the mentally defective. Rationale, technique, and equipment required for mass, but accurate, ophthalmic screening of mental defective children is described. A review of the various diagnoses of systemic and ocular diseases of children attending special retarded schools is presented. Conditions in which the author thought correction was warranted are discussed. The philosophy of dealing with such patients is presented.


Cryotreatment of toxoplasmosis retinochoroiditis. Cryotherapy was utilized in 5 eyes of 4 patients with recurrent toxoplasmosis retinochoroiditis. Each patient showed slow gradual improvement in vision over several months following cryotreatment where previous medical management had failed. No recurrences have been noted during the follow-up period of 3 months to 3 years.


Modified Krasnov's iridocycloretraction for aphakic glaucoma. To maintain the patency of the cleft created by the cyclodialysis operation, a trapezoid scleral pedicle is dissected near the limbus and then introduced through a sclerotomy and the cyclodialysis cleft into the anterior chamber angle. The method is indicated for treatment of chronic aphakic glaucoma and has been found useful in treatment of African patients.


Symptomatic floaters as a clue to vitreoretinal disease. One hundred consecutive patients with symptomatic floaters without previous ocular trauma or surgery are analyzed as to the underlying cause. The most common findings were posterior vitreous detachment with and without vitreous hemorrhage, vitreous syneresis with collagen fibril clumping, diabetic retinopathy with vitreous hemorrhage, retinal tears without retinal separation, and retinal separation. Significant vitreoretinal disease occurred in 36% of the patients.


Internal tarsus-orbicularis resection for senile spastic entropion. This report describes the surgical correction of senile spastic entropion by internally resecting tarsus and orbicularis muscle. A triangle of tarsus is removed with the apex at the margin and the base at the inferior border and a similar amount of orbicularis muscle is resected. Each layer is approximated separately. The shortened tarsus improves the apposition of the lid aagainst the globe and the tightened orbicularis aids in maintaining this stability.


Reusable self retaining iris retractor.

Reusable self retaining iris retractor. A resuable self retaining iris retractor is described. It is significantly less expensive than the disposable retractor and has a smaller vertical flap to facilitate lens delivery.


Cephaloridine-induced retinopathy by intravitreal injection: an ultrastructural study. We evaluated retinal toxicity produced by intravitreal injection of 25 mg cephaloridine, noting the progression of destruction over a 4 week period. Clinically, intravitreal injection of cephaloridine caused thrombosis of intravitreal vessels in the vascularized portion of the rabbit retina within 2 days. Ultrastructurally, 12 hours after injection there were membrane and cystoplasmic disturbances in the pigment epithelium. Degenerative changes in the outer and inner segments were first observed 48 hours after injection and continued until 120 hours. Phagocytic cells of pigment epithelial cell derivation responded to photoreceptor degeneration by phagocytosis of degenerated outer and inner segments. After 120 hours all outer segments were completely destroyed and all surviving inner segments appeared to be normal. Evidence for the regeneration of outer segments by remaining photoreceptor elements was not found. Hence, the irreversible nature of damage due to intravitreal injection of a toxic dose of an antibiotic is noted.


Delta(9)-tetrahydrocannabinol,, euphoria and intraocular pressure in man. Delta(9)-tetrahydrocannabinol (THC), an active narcotic principle of marijuana, was solubilized and administered intravenously to two male volunteers. Changes in intraocular pressure were recorded and compared to changes in the cortical effects of THC, as indicated by the subjects' report of degree of "high." The peak effect of THC on the central nervous system coincided well with the reduction of intraocular pressure induced by the drug; hypotony, however, outlasted euphoria. The results indicate that THC may have value as a hypotonizing ocular medicant.


A simplified B-Scan ultrasonoscope for ocular diagnosis. The use of B-can ultrasonography in ophthalmology is becoming increasingly important. There are several advantages of the Bronson-Turner system when compared with other B-scan instruments. The unit is quite compact and much less expensive. There is no need for a special laboratory and trained personnel, since it is operated easily by the ophthalmologist. Because a water bath is not necessary, uncooperative patients and children can be evluated. This instrument has been proven reliable and accurate in the diagnosis of retinal detachment, choroidal tumors, and intraocular foreign bodies, and is also capable of revealing more subtle abnormalities such as retinoschisis and vitreous membranes. The Bronson-Turner ultrasonoscope provides the clinician with a valuable instrument to evaluate ocular abnormalities in the presence of opaque media.


Clinical studies with a new steroid--fluorometholone. Thirty-four cases of uveitis, 26 anterior and 8 posterior, showed elevated intraocular pressure in 25 cases during treatment with local steroids as well as systemic steroids. The patients were treated with drugs to reduce the IOP, but this was not accomplished until the local steroids were stopped. Then a good anti-inflammatory response was obtained with fluorometholone, without further increase of the IOP during the whole treatment. Two cases of episcleritis and one case of allergic conjunctivitis that responded very well to local steroids but showed an increase of the intraocular pressure were treated with fluorometholone. The same anti-inflammatory response was obtained without any increase of the IOP. In our small series, a new steroid has been reviewed. No double-blind studies were done, and the series was not well controlled. But this preliminary result shows that fluorometholone can control inflammation in cases of uveitis, episcleritis, and allergic conjunctivitis as well as other steroids, but without increase of the IOP.


Retinal venous sheathing and neovascularization in disseminated sclerosis. A 54-year-old black woman with no significant visual complaint and a diagnosis of disseminated sclerosis of 18 years' duration is presented because of marked bilateral sheathing of the retinal veins, and previously unreported dilated collateral vessels and early neovasularization secondary to peripheral vein occlusion.


Intermittent Horner's syndrome: recurrent, alternate Horner's syndrome in cervical cord injury. Ten patients with functional transection of the lower cervical cord were noted to develop a transient, occasionally alternate Horner syndrome. The ocular signs were rarely complete, eyelid droop being the most constant and prominent symptom. Signs could be elicited by turning the patients from side to side. They disappeared gradually with patients lying recumbent or supine. Cocaine and Adrenalin in the presently used concentration are not useful in diagnosis, but cocaine may possibly be used to "bring out" a "latent Horner's syndrome." The appearance of eye symptoms is delayed from 2 months to 7 years and, although implicating cavitation within the central gray, is not necessarily associated with progression of cord destruction rostrally or loss of remaining function. Temporary interference with sympathetic stimulation along the lateral tectotegmental tracts discharging to the intermediolateralis sympathetic column supplying the eye is suggested as responsible for this phenomenon. Fluid withdrawal from these cysts has been reported to revert the eye findings to normal and possibly arrest further cavitation.


Acute onset of central retinal vein occlusion and retinal detachment. The simultaneous occurrence of a central retinal vein occlusion and retinal detachment has not been previously reported. Although both are well recognized entities with characteristic appearances, their simultaneous acute onset led to a misdiagnosis in our case report. The need for a complete eye examination in the face of obvious pathology is stressed.


Simultaneous (combined) operation for glaucoma with cataract. Henceforth we mention the observations of one of the authors (E.G.) which were made in 1949 and published in 1956. The author recommends iridectomy of one pillar, intracapsular extraction of the cataract and iridenclesis of the other pillar for the treatment of cases with glaucoma together with cataract. Between the years 1968 and 1976 in the Department of Ophthalmology of the Hospital Universitario de Caracas, 966 cataract extractions were performed; within these, 84 were performed in glaucomatous eyes. In 17 cases the procedure that is used today was performed: iridectomy of one pillar, sphincterotomy, intracapsular extraction and iridencleisis of the other pillar. In other cases, other procedures were used. From our observations we consider that this technique is the most recommended in cases of glaucoma together with cataract.


Phacolytic glaucoma secondary to ectopia lentis. This is a report of a 41-year-old woman who presented with a rare complication of congenitally dislocated lenses. Phacolytic glaucoma was found in one eye followed shortly by an attack of phacolytic glaucoma in the opposite eye. although phacolytic glaucoma is an absolute indication for surgery in these patients, surgery in general for dislocated lenses is still thought to be hazardous especially when dealing with a lens fixata as we did here, which is a lens being fixed in the vitreous with attachments to the retina. The cogenital ectopia lentis was believed to be on a hereditary basis since the father of the patient had worn aphakic lenses all his life without surgery and as none of the many other causes of ectopia lentis could be found.


Unresectable carcinoma of the oesophagus. One hundred and eighty-one patients with unresectable carcinoma of the oesophagus have been seen and treated during the past 10 years. When the general condition of the patient was judged to be such that he was able to withstand a major operation a bypass procedure was adopted. No cases were rejected, but when the patient was in extremis oesophagostomy and gastrostomy only were performed. The results of treatment are presented and the difficulties encountered discussed.


Traumatic intraperitoneal haemorrhage. Diagnosis by paracentesis and lavage. A method is described for detecting blood in the peritoneal cavity in cases of blunt abdominal trauma. It involves introducing a peritoneal dialysis catheter through a single puncture site in the anterior abdominal wall and in some cases performing lavage. Fifty cases have been investigated by this method and the results are presented.


The intestinal phase of gastric secretion. The intestinal phase hormone, elaborated by the jejunum in response to an intestinal meal or simple distension, produces profound gastric hypersecretion when it escapes hepatic degradation through a portacaval anastomosis. The hormone is released within 30 min of the application of the stimulus and rapidly reaches peak concentration in the portal blood. Intravenous infusion into a donor dog of active portal plasma from a shunted, intestinally fed dog stimulates gastric acid secretion after a delay of approximately 1 h, and requires a mean 1 1/2 h to stimulate peak secretion, which suggests that intermediate steps may be necessary before the hormone can effectively stimulate the parietal cell mass. The pig develops portacaval-shunt-related gastric acid hypersecretion in response to food comparable to that observed in the dog and in man. Porcine jejunal mucosa is thus an appropriate source for isolation of the intestinal phase hormone. Pig intestinal mucosal extract contains a heat-stable acidic peptide which is a potent stimulator of gastric acid secretion. Administration of crude intestinal mucosal extract elicits gastric acid secretion after a brief delay, again indicating that some intermediate reactions occur before the target organ--the parietal cell mass--is stimulated.


Cosmetic result in thyroid surgery,.

Cosmetic result in thyroid surgery,. In a series of 306 consecutive patients who had thyroid or parathyroid surgery for benign or malignant lesions attention was paid to a technique in which particular emphasis was laid on meticulous haemostasis and suction drainage of the postoperative serosanguineous fluid. This not only reduced the morbidity associated with haematoma formation and infection but also contributed to a good cosmetic result.


Battle casualities.

Battle casualities. Eighty casualities, mainly due to explosive devices, sustained over a period of 3 1/2 months by the armed forces of the Sultan of Oman in counterinsurgency operations are analysed and their management by a British field surgical team is described. Of the 73 who reached the surgical centre alive, 56 per cent had suffered major injuries, yet all but 2 survived, giving an overall survival rate of 88.75 per cent (71/80). The effects of first aid and rapid evacuation on survival and their influence on the surgical work load and on the facilities required for treatment are assessed, together with their relevance to the planning of military and civilian accident services.


Transplantation and regeneration of striated muscle. This lecture explores the factors controlling regeneration and reconstitution of skeletal muscle following vascular and neural injury by giving an account of some experimental work in this field, which is then linked to the problem of the use of whole-muscle transplants in clinical surgery.


Sphincter patency and hepatic BSP uptake after biliary sphincterotomy. An attempt has been made to assess the patency and function of the choledochoduodenal junction after biliary sphincterotomy by estimating the first arrival time of injected bromsulphalein (BSP) in duodenal aspirate and the effect of morphine on this. Studies on 49 patients 1--12 years after this operation showed the arrival time to be normal in 47, but in 2 cases there was delay, which suggests that stenosis may develop in time in abot 4 per cent of cases. This had not been detected clinically, radiologically, or by liver function testing. Although it did not effect the BSP arrival time in T-tube bile, morphine was found to prolong the duodenal arrival time in control patients and also after sphincterotomy of the type used, indicating that the protective mechanism of the sphincter region may not have been destroyed by this operation. Abnormal BSP retention in plasma has been reported up to 5 years afte supraduodenal exploration of the bile ducts in 30 per cent of cases. Similarly, in the present study after biliary sphincterotomy plasma BSP levels were above normal in 14 of 49 patients, suggesting that this abnormality reflects the original pathological condition rather than the type of operation used to deal with it.


Antibiotic susceptibility testing of gram-negative nonfermentative bacilli. A study was undertaken to determine if current methods of antibiotic susceptibility testing could be successfully applied to the gram-negative nonfermentative bacilli. Using clinical isolates and reference strains, experiments were conducted on the inherent reliability of the Bauer-Kirby method, as well as the effect of certain modifications on the method such as elimination of the 2- to 5-h incubation in broth and use of different agar media. Results obtained using these modifications were compared to the results obtained by the standard method. It was shown that the two modifications investigated had a significant effect on the interpretation of zone diameters. It was further shown that the standard Bauer-Kirby method with some exceptions correlates with minimal inhibitory concentrations as determined by broth dilution methods. Results suggest that the Bauer-Kirby method may be a reliable technique for testing the antibiotic susceptibility of the nonfermentative bacilli.


Effects of minocycline and other antibiotics on Fusobacterium necrophorum infections in mice. Several antibiotics were evaluated in model infections produced in mice with each of two strains of Fusobacterium necrophorum. In one model, local abscesses occurred at the site of subcutaneous injection; in another intra-abdominal abscesses were produced when the organisms were injected into the peritoneal cavity. Treatment with effective antibiotics prevented the formation of abscesses or minimized the size of the lesions. Several treatment schedules were used. Minocycline was the most active antibiotic of the seven agents tested against both strains and in both models. Clindamycin was equal to minocycline against one strain with certain multiple dose treatment schedules and less active with others. Protective effects in mice were achieved with serum levels of minocycline and clindamycin that appear to be clinically achievable. Doxycycline was less active than minocycline, and tetracycline was relatively ineffective, as were cephalexin, ampicillin and penicillin G.


Mechanism of action of anti-influenza benzamidine derivatives. Benzamidine derivatives exhibited a high antiviral effect in vivo against influenza virus strains A2/Adachi and B/Lee. The inhibiting properties of anti-influenza benzamidine derivatives on the virus-induced inflammation undoubtedly plays an important role in the clarification of the mechanism of action of these drugs.


Interactions of carbenicillin and ticarcillin with gentamicin. The in vitro inactivation of gentamicin by carbenicillin and a new semisynthetic penicillin, ticarcillin (BRL 2288), has been demonstrated. Gentamicin half-lives have been studied in eight patients with end-stage renal failure, and a 25 to 74% reduction in half-life has resulted from the concomitant administration of therapeutic doses of carbenicillin and ticarcillin.


Pipemidic acid: absorption, distribution, and excretion. Pipemidic acid was absorbed well by the oral route. Its peak levels in plasma ranged from 4 to 12 mug/ml at an oral dose of about 50 mg/kg in mice, rats, dogs, monkeys, and men. The protein binding of pipemidic acid was about 20% in dog plasma and about 30% in human serum. Pipemidic acid was distributed to most of the organs and tissues tested at the concentrations comparable to or higher than the plasma level. Its concentrations in bile and urine were much higher than the plasma level. About 25 to 88% of orally administered pipemidic acid was excreted into urine in a bacteriologically active form, the percentage depending on the animals and doses employed. The remainder was excreted into feces in men. The main active principle in vivo was unchanged pipemidic acid itself. The mean lethal dose of pipemidic acid after a single oral dose was more than 16,000 mg/kg in mice. No abnormalities were observed in mice orally receiving pipemidic acid once a day for 4 weeks at doses of 1,000, 2,000, and 4,000 mg/kg per day, and in rats orally receiving the drug once a day for 2 weeks at doses of 400 and 1,600 mg/kg per day.


New polyene antifungal antibiotic produced by a species of Actinoplanes. A new species of Actinoplanes, which has been deposited with the designation NRRL 5325 at the Northern Utilization Research and Development Division of the U. S. Department of Agriculture, produces a polyene antifungal complex designated as Sch 16656. The complex, consisting of one major and three minor components, is isolated from the fermentation broth by a solvent extraction procedure and purified by precipitation methods. The major component is a heptaene and is highly active in vitro and in vivo against Candida albicans. It is active also against strains of Torulopsis and is significantly more potent orally than candicidin in mice against Candida infections.


Laboratory evaluation of a rapid, automatic susceptibility testing system: report of a collaborative study. Seven laboratories participated in a collaborative study to evaluate the Autobac 1 system. Results obtained with this assay system were compared to those obtained by the standardized Bauer-Kirby disk diffusion test, and each of these two methods was compared to the agar dilution technique. Comparison of the Autobac 1 and the disk diffusion results from the seven laboratories showed an overall average of 91.5% interpretive agreement with the 17 antimicrobial agents tested. The distribution in the levels of Autobac 1/disk diffusion agreement was such that with 13 antimicrobial drugs agreement was 90% or higher; with three, between 85 and 90%; and with one, 77% (nitrofurantoin). Comparison of the Autobac 1 and disk diffusion tests with the International Collaborative Study agar dilution test showed that both methods gave levels of agreement with the International Collaborative Study agar dilution technique that were generally high and equivalent. The average overall agreement between the agar dilution test and each of the other two methods was approximately 90%. Disagreements that did occur tended to involve organisms that were drug susceptible by the Autobac 1 system but intermediate or resistant by the other two methods. This was in part due to the narrow intermediate interpretive zone of the Autobac 1 test. In reproducibility studies with the Autobac 1 and disk diffusion methods, no significant differences were observed between the interpretive reproducibility of the two methods.


Double-blind comparison of phlebitis produced by cefazolin versus cephalothin. In a double-blind study with each patient as his own control, 1 g of cefazolin and 2 g of cephalothin were administered intravenously every 6 h to 20 patients in opposite arms for a period of 48 h each. The degree of phlebitis was significantly more severe with cephalothin than with cefazolin (P < 0.05); however, neither the incidence of phlebitis nor the time of onset of phlebitis was significantly different between the two drugs.


In vitro evaluation of a new quinolone antibacterial. The activity of R-802, a quinolone antibacterial agent, was studied in vitro and found to be active against Enterobacteriaceae; less than 4 mug of drug per ml was required to inhibit most isolates. The majority of Pseudomonas aeruginosa grew in a concentration of 256 mug of R-802 per ml when studied in broth against an inoculum of 10(8) organisms per ml.


Antibacterial activity of tropolone.

Antibacterial activity of tropolone. Tropolone was shown to be bacteriostatic and bactericidal for a wide range of bacterial species. This antibacterial activity was quantitated using standard methods. Tropolone treatment of whole cells resulted in cell lysis characterized by bleb formation and subsequent loss of cell contents after rupture of the bleb. Although bleb formation and lysis did not occur in the presence of 20% sucrose, cell viability was lost. Spheroplasts and protoplasts also lysed in the presence of tropolone. These results indicate that tropolone acts on the cell wall or envelope and on the plasma membrane.


In vivo efficacy of 81.723 hfu, a new pleuromutilin derivative against experimentally induced airsacculitis in chicks and turkey poults. The efficacy of the pleuromutilin derivative 81.723 hfu was tested in chicks and turkey poults by experimentally infecting them with Mycoplasma gallisepticum. The data were treated to obtain the mean effective doses, and these were compared to those obtained with tylosin tartrate. The compounds were administered either by ingluvial catheter or via the drinking water. Therapy was started on the day of inoculation or 7 days thereafter, respectively. The experiments showed that the compound 81.723 hfu was significantly more active in chickens than tylosin tartrate by both methods of administration of drinking water. In turkey poults the pleuromutilin derivative and tylosin tartrate had comparable activity.


Rapid semiquantitative testing of antibiotic susceptibility: use of a multicell disk elution system. Semiquantitative data regarding antibiotic susceptibility of bacteria were obtained by measuring the growth of bacteria in several different compartments ("cells") of a plastic module. Each compartment contained an inoculum of the organism and various concentrations of antibiotics in broth, achieved by elution of antibiotic from paper disks placed into the individual cells. Growth of the organisms was measured using an automated monitor to detect the scattering of light. Susceptibility of 300 strains of gram-negative bacilli to multiple concentrations of nine antibiotics was determined by this disk elution system, and the results (expressed in terms of four clinical susceptibility groupings) were compared with those obtained by a quantitative agar dilution method. Results obtained by the two methods agreed completely in 78% of the 2,700 determinations. In evaluating whether individual strains would be susceptible to systemic therapy or not, results obtained by the two systems agreed in all except 149 of the tests. Results of testing by the disk elution method were available on the same day that testing was begun. A system of this type may prove useful, for it provides information of a semiquantitative nature and decreases the time between isolation of a bacterial pathogen and availability of susceptibility data to the clinician.


Stimulation of derepressed enzyme synthesis in bacteria by growth on sublethal concentrations of chloramphenicol. Culturing of Salmonella typhimurium or Escherichia coli cells in the presence of low concentrations (</=1 mug/ml) of chloramphenicol (CAP) permitted exponential growth, but at doubling times up to twice those of controls. When such cultures were subsequently starved for uracil or arginine, derepression of aspartate transcarbamylase (ATCase) or ornithine transcarbamylase, respectively, was enhanced three- to 10-fold as compared to cultures not exposed to CAP. Enhancement of beta-galactosidase synthesis by prior exposure to CAP was also observed in uracil-starved E. coli cultures. Stimulation of enzyme synthesis appeared to be a specific effect of CAP; low levels of erythromycin, puromycin, sparsomycin, tetracycline, and rifampin did not show such effects. Derepression of ATCase synthesis in exponentially growing cells in the presence of CAP did not result in stimulation of enzyme synthesis by CAP. A prior history of growth of a culture in the presence of CAP was shown to be necessary for enhancement of enzyme synthesis by CAP; furthermore, continued presence of CAP in the medium during starvation was not necessary for enhanced enzyme synthesis and inhibited it in some instances. Enhanced enzyme synthesis in starving, CAP-treated cultures could be blocked by rifampin, which suggested that CAP treatment allows prolonged or more extensive messenger ribonucleic acid synthesis.


Efficacy of 1-beta-D-ribofuranosyl-1,2,4-triazole-3-carboxamide against influenza virus infections in mice. 1-beta-d-Ribofuranosyl-1,2,4-triazole-3-carboxamide (ribavirin) was effective against strains of influenza virus types A and F, whereas amantadine hydrochloride was effective only against strains of influenza virus type A. Dose-related protective effects against lethal influenza infections in mice were obtained with single oral doses of 25 to 400 mg of ribavirin per kg administered at the time of virus inoculation or up to 24 h thereafter. Therapeutic indexes (maximum tolerated dose/median effective dose) against various strains of influenza virus ranged from 5 to 35. With multiple-dose treatment initiated immediately after virus inoculation, oral doses as low as 12 to 25 mg/kg twice daily also afforded significant protection. Treatment with ribavirin inhibited the growth of influenza virus in the lungs of mice and delayed by about 24 h the attainment of maximal viral titers, which in nontreated mice were reached within 24 to 48 h. Inhibition of viral growth was correlated with a suppression of lung consolidation. Ribavirin appears to exert its protective effects against influenza infections by inhibiting virus growth, thereby preventing virus titers from reaching levels that result in massive lung tissue destruction and death of the mice.


Herpesvirus hominis infection in newborn mice: comparison of the therapeutic efficacy of 1-beta-D-arabinofuranosylcytosine and 9-beta-D-arabinofuranosyladenine. Intranasal inoculation of newborn mice with Herpesvirus hominis type 2 provides an experimental infection that closely resembles disseminated herpesvirus infection of human newborn infants. After inoculation of mice, the virus multiplies in the respiratory tract and is disseminated through the blood to the liver and spleen and to the brain by both a viremia and nerve route transmission. Although therapy with 1-beta-d-arabinofuranosylcytosine (ara-C) did not reduce final mortality, it did increase the mean survival time by 1 day. This effect on the mean survival time was associated with a 1-day delay in the appearance of herpesvirus in the blood, liver, and spleen and a reduction of virus replication in lung and brain for 1 day as compared with untreated control animals. Treatment with 9-beta-d-arabinofuranosyladenine (ara-A) likewise had no effect on final mortality, but increased the mean survival time by 2 days. Therapy with ara-A delayed or suppressed virus replication in blood, lung, liver, spleen, and brain for 2 days. Although treatment with either ara-C or ara-A in this experimental H. hominis type 2 infection resulted in a temporary delay and/or suppression of viral replication in several target organs, neither compound was completely effective in inhibiting viral replication or in protecting animals from eventual death due to the infection.


Pharmacokinetic interpretation of blood levels and urinary excretion data for cefazolin and cephalothin after intravenous and intramuscular administration in humans. Blood levels of cefazolin and cephalothin were determined in two separate crossover studies in 20 healthy male adults, each after intravenous and intramuscular administration. Pharmacokinetic parameters were calculated from the intravenous data based upon a two-compartment open model. The rate constants controlling the distribution between the central and peripheral compartments, the overall elimination rate constants, the apparent volumes of distribution, and the fraction of the dose in the central and peripheral compartments were determined. The bioavailability was calculated to be 100% for cefazolin and cephalothin.


Epidemiology of antibiotic and heavy metal resistance in bacteria: resistance patterns in staphylococci isolated from populations not known to be exposed to heavy metals. Staphylococci were isolated from clinical specimens obtained from patients not known to be exposed to abnormal levels of heavy metals. The antibiotic and heavy metal resistance patterns of these strains were determined by using a disk diffusion test and computer sorting. Though not absolute, an association of resistance to mercury and tetracycline in coagulase-negative strains was found, in contrast to resistance to copper and penicillin in coagulase-producing strains. A high degree of correlation was observed between the resistance to phenyl mercury and inorganic mercury, but no correlation was obtained between resistance to methylmercury and other metals. In general, strains resistant to many agents were usually coagulase negative. A possible mechanism and implications of these associations are considered.


Epidemiology of antibiotic and heavy metal resistance in bacteria: resistance patterns in staphylococci isolated from populations in Iraq exposed and not exposed to heavy metals or antibiotics. Staphylococci were isolated from rural and urban populations in Iraq, which were not known to be exposed to either heavy metals or antibiotics. The antibiotic and heavy metal resistance patterns of these strains were analyzed in both mannitol-fermenting and nonfermenting strains. Over 90% of the strains were resistant to at least one of the following antibiotics: penicillin, chloramphenicol, erythromycin, tetracycline, cephalothin, lincomycin, or methicillin. In general, mannitol-fermenting strains were resistant to penicillin and cupric ions. Mannitol-negative strains were more frequently associated with mercuric ion and tetracycline resistance. Although resistance to penicillin and tetracycline can coexist, the combination of penicillin resistance and tetracycline resistance usually occurred in mannitol-negative strains. The possibility of selection of heavy metal-resistant strains due to exposure to toxic levels of methylmercury was examined. No significant increase in mercuric ion-resistant strains of staphylococci or Escherichia coli were detected in exposed populations as compared to control groups. The possible reasons for this result are discussed.


Study of the effects of ticarcillin on blood coagulation and platelet function. Ticarcillin is a new semisynthetic penicillin similar to carbenicillin. Since carbenicillin has been shown to inhibit platelet function to such an extent that bleeding may accompany its use, an investigation of the effects of ticarcillin on hemostasis was made. The drug was administered to 17 human volunteers for periods of 3 to 10 days in intravenous doses of 100, 200, or 300 mg/kg per day (7 to 21 g/day). Serial studies of blood coagulation and platelet function indicated that coagulation was unaffected by ticarcillin but that platelet function became defective in all subjects. Abnormal platelet function was evidenced by lengthening of bleeding time (17 of 17 volunteers), depressed adenosine diphosphate-induced platelet aggregation (17 of 17), defective collagen-induced aggregation (15 of 17), and abnormal epinephrine-induced aggregation (10 of 17). Prothrombin consumption, due to reduced platelet procoagulant activity, was significantly decreased with a dose of 300 mg/kg per day. Comparison of results from this study with those from an earlier carbenicillin study revealed that ticarcillin at 300 mg/kg per day produces the same defects in hemostasis as does carbenicillin at 300 mg/kg per day, but that lower doses (100 or 200 mg/kg per day) of ticarcillin result in only a mild defect in platelet function. If the effective dose of ticarcillin is proven to be lower than the doses of carbenicillin currently employed for treatment of certain gram-negative infections, bleeding should not be a frequent complication of ticarcillin administration, when the drug is given to patients with normal renal function.


Animal model for determining the no-effect level of an antimicrobial drug on drug resistance in the lactose-fermenting enteric flora. Mature beagles were fed a ground-meal diet containing 0, 2, or 10 mug of oxytetracycline per g for 44 days. The 10-mug/g diet resulted in a shift from a predominantly drug-susceptible population of enteric lactose-fermenting organisms to a multiply antibiotic-resistant population which peaked at 78% resistant organisms. Since a shift to drug-resistant organisms did not occur in the group fed 2 mug/g, the level of oxytetracycline that results in increased incidence of antibiotic resistance lies between 2 and 10 mug/g in this dog model. Rats and hamsters fed diets containing oxytetracycline (10 mug/g or greater) or dihydrostreptomycin (10 mug/g), and provided suspensions of drug-susceptible Escherichia coli, did not develop a population of antibiotic-resistant organisms.


Efficacy of combined furazolidone and neomycin in the control of contamination in Leptospira cultures. The in vitro effectiveness of furazolidone combined with neomycin for the control of contaminants in Leptospira cultures was investigated. Enhanced additive or synergistic bactericidal activity was apparent with the combination when it was compared with each agent used separately or when compared with 5-fluorouracil. Combined furazolidone and neomycin, at 5-mug/ml concentrations each in Fletcher medium or in implanted sensitivity disks of 50 mug and 10 mug, respectively, was effective in inhibiting contaminants and did not interfere with the growth of leptospira belonging to 66 leptospiral collection serotypes. A simple technique for decontaminating swine kidneys from an abattoir for cultural isolation of leptospiras is described. The method involves exposing renal tissue diluted in saline containing furazolidone and neomycin in combination (each in a concentration of 25 mug/ml) for 1 h prior to inoculating culture media. The method is suitable for routine use in the isolation of leptospiras from contaminated clinical or pathological specimens.


Economical agar dilution technique for susceptibility testing of anaerobes. A reliable agar dilution technique has been developed enabling the clinical laboratory to perform antibiotic susceptibility tests on significant anaerobes with ease and economy.


Effect of actinomycin D and oxygen on the ribonucleic acid synthesis of an anaerobic gram-negative bacterium. The synthesis of ribonucleic acid by whole cells of Bacteroides ruminicola is not sensitive to actinomycin D, but it is sensitive to actinomycin D in the presence of ethylenediaminetetraacetate. Ribonucleic acid synthesis by whole cells of this gram-negative anaerobic bacterium is also totally inhibited by oxygen.


Artificial elimination of drug resistance from group A beta-hemolytic streptococci. Ten strains of beta-hemolytic streptococci were tested for elimination of resistance to macrolide antibiotics, tetracycline, and chloramphenicol. Six of the strains lost resistance after cultivation at 41 C or addition of acriflavine (0.2 mug/ml). These results suggest that determinants governing resistance to these antibiotics are located on extrachromosomal genetic elements (plasmids) that are widely distributed in streptococci.


Taxonomic study of fusaria of the sporotrichiella section used in recent toxicological work. Eight isolates of Fusarium of the Sporotrichiella section were critically studied as to their taxonomic position. Most of these isolates had been used for comprehensive toxicological work on mycotoxin effects on animals, chiefly in the United States and Japan. Isolates NRRL 3299 and NRRL 3287, supplied from the United States, were determined to be Fusarium poae. Isolates NRRL 3249, NRRL 5908, 2061-C, and YN-13 from the United States and isolate T-2 from South Africa belonged to Fusarium sporotrichioides. Isolate NRRL 3509 belonged to F. sporotrichioides var. tricinctum. The relevance of recent toxicological work with these isolates on animals to earlier work on alimentary toxic aleukia is discussed in light of the above identifications.


Acetylene reduction assays for nitrogen fixation in freshwaters: a note of caution. Lake water samples were observed to transform [14-C]ethylene into water-soluble compounds that were undetectable by conventional acetylene reduction assay procedures. Methane oxidizing bacteria, which are known to be common in freshwaters, appeared to be responsible for this activity. As much as 28 percent of added ethylene has been observed to be transformed and this figure is probably an underestimate. It is suggested that acetylene reduction assays may not be accurately applied to samples containing methane oxidizing bacteria.


Egg production, shell thickness, and other physiological parameters of laying hens affected by T-2 toxin. T-2 toxin has been reported to cause severe oral lesions and neural disturbances in young broiler chickens. T-2 toxin, when added at a level of 20 mug per g of feed, caused oral lesions but no abnormal neural disturbances in young broiler chickens. T-2 toxin, when added at a level of 20 mug per g of feed, caused oral lesions but no abnormal neural symptoms in laying hens. T-2 toxin had no effect on either hemoglobin, hematocrit values, erythrocyte count, plasma glucose, prothrombin times, or the sizes of the liver, spleen, pancreas, and heart. Lipid content of the liver was not altered. Feed consumption, however, was reduced, as were the total plasma protein and lipid concentrations and the total leukocyte count. Most important economically was the lowered egg production and a thinner egg shell. The timing and severity of the symptoms suggest that T-2 toxin causes primary oral lesions that reduce feed consumption with a consequent reduction in serum proteins and lipids, which culminate in decreased egg production. The leucopenia and thinner egg shell may be independent systemic effects of T-2 toxin in laying hens.


Persistence and biodegradation of spilled residual fuel oil on an estuarine beach. The enrichment of hydrocarbon-degrading bacteria and the persistence of petroleum hydrocarbons on an estuarine beach after a spill of residual fuel oil on 11 April 1973 in Upper Narragansett Bay, R.I. was investigated. A rapid enrichment occurred during days 4 to 16 after the oil spill and a significant population of hydrocarbon-degrading bacteria was maintained in the beach sand for at least a year. The concentration of petroleum hydrocarbons in the mid-tide area declined rapidly during the bacterial enrichment period, remained fairly constant throughout the summer, and then declined to a low concentration after 1 year. An increased concentration of branched and cyclic aliphatic hydrocarbons in the low-tide sediment 128 days after the spill suggested a migration of hydrocarbons during the summer. Hydrocarbon biodegradation was apparent during the winter months at a rate of less than 1 mug of hydrocarbon per g of dry sediment per day.


Phosphoglycerides of Trichophyton terrestre and one phenotype selected from the Apollo 16 microbial ecology evaluation device. Total lipid extracted from wild-type Trichophyton terrestre CDC-X285 was found to be 2.0 percent of the dry cell weight. The total lipid contained the following phospholipid components identified by silicic acid-impregnated thin-layer and paper chromatography: phosphatidyl inositol, phosphatidyl choline, phosphatidyl serine, and phosphatidic acid. The total lipid extracted from the phenotype T. terrestre 7048-1 isolated from the Apollo 16 Microbial Ecology Evaluation Device (MEED) was found to vary according to the time at which the phospholipids were extracted. The Trichophyton phenotype was selected from a cuvette housed in the MEED exposed to specific space parameters including ultraviolet light of known wavelengths and energy levels in deep space. The phospholipid components, identified in the phenotype were phosphatidyl ethanolamine and cardiolipin. The major lipid fraction was composed of digalactosyl diglyceride and monogalactosyl diglyceride. An unusual lipid was detected in the phenotype, which appeared to be sterol glycoside.


Facultative anaerobic bacteria in the digestive tract of chum salmon (Oncorhynchus keta) maintained in fresh water under defined culture conditions. The bacterial flora in the digestive tract of chum salmon growing in fresh water under defined and controlled culture conditions was examined both qualitatively and quantitatively. The predominant species present in the digestive tract were identified as Aeromonas, with Aeromonas hydrophila being the most common isolate. These aeromonads were not isolated from the diet. Other bacterial species commonly isolated included Bacillus, Enterobacter, nonpigmented pseudomonads, Micrococcus, and Acinetobacter. These species were also isolated from the diet or tank water. As many as 10-8 viable bacteria per g (wet weight) of digestive tract plus contents were counted. After 75 days of starvation, 10-6 viable bacteria were counted, whereas fish fed a sterile feed contained 10-5 viable bacteria per g (wet weight) of digestive tract plus contents.


Interaction of lead and bacterial lipids. Studies on the interaction of lead with lipid components indicate that individual lipids do not provide specific stable binding sites for lead, but that natural membrane lipid mixtures may simply provide an environment suitable for nucleation of lead.


Lysis of Sphaerotilus natans swarm cells by Bdellovibrio bacteriovorus. Six strains of Sphaerotilus natans (smooth form) were lysed by five parasitic strains of Bdellovibrio bacteriovorus. The possible use of Bdellovibrio to control the proliferation of S. natans in the environment was hypothesized.


Production of 3-methyl-6-methoxy-8-hydroxy-3,4-dihydroisocoumarin by Aspergillus caespitosus. Aspergillus caepitosus Raper and Thom cultured on autoclaved cracked, yellow field corn produced 3-methyl-6-methoxy-8-hydroxy-3,4-dihydroisocoumarin which was extracted and then purified by silica gel columns. The physical and spectral properties of the colorless crystals from methylene chloride:hexane were consistent with those published for 3-methyl-6-methoxy-8-hydroxy-3,4-dihydroisocoumarin. Yield of high purity 3-methyl-6-methoxy-8-hydroxy-3,4-dihydroisocoumarin was about 140 mg of corn per kg.


Deterioration of high-moisture corn.

Deterioration of high-moisture corn. Two small, leaky silos were filled with normal high-moisture corn (HMC), and two with HMC severely infested by Helminthosporium maydis. Counts of mesophilic bacteria, lactobacilli, coliforms, yeasts, and molds were made on corn samples as received and periodically thereafter during 220 days of storage. Temperature and gas levels also were monitored. Sequential changes in the populations of lactobacilli, yeasts, and molds were determined during spoilage of HMC. These population changes were compared on the basis of the variables encountered in the present study as well as with the results of previous studies conducted on normal HMC stored under adequate conditions. Heavy infestation by H. maydis had no appreciable effect on HMC preservation.


Isolation of Aeromonas sp. ATCC 29063, a phenol-producing organism, from fresh haddock. Attempts to isolate phenol-producing organisms from stale haddock fillets failed. Several such isolates, however, were readily obtained from fresh haddock and were designated Aeromonas sp. Phenol was produced from L-tyrosine by these isolates.


An unstable strain of Aspergillus foetidus segregating proline auxotrophs. Two basic colony types have been obtained through single conidial isolation from the Bode strain of Aspergillus foetidus as well as from mutants of this unstable strain. Type I is prototrophic whereas type II is an auxotroph requiring proline. When a type I strain is grown on complex medium it gradually becomes overwhelmed by type II sectors of growth. However, essentially pure cultures of type I can be maintained on minimal medium (lacking proline). The yield of glucoamylase from type II cultures is less than half that obtained with type I cultures. The instability of type I cultures when grown on complex medium can not be explained by heterokaryosis or the presence of virus-like particles found in the original Bode strain and its derivatives. The isolation of five stable prototrophic strains obtained as more rapidly growing sectors from type I subcultures grown on complex medium suggests that the instability most probably results from a duplicated chromosomal segment or other chromosomal aberration analogous to those described in A. nidulans.


Types and distribution of obligate thermophilic bacteria in man-made and natural thermal gradients. The types and distribution of obligate thermophilic bacteria were found to be similar in a thermal gradient resulting from man-made thermal pollution and the thermal gradients of two natural hot springs located in Colorado.


Growth inhibition of Rhodopseudomonas capsulata by methylmercury acetate. Growth of Rhodopseudomonas capsulata was inhibited in a bacteriostatic manner by as little as 10-minus 8 M methylmercury acetate (MeHgAc) in unsupplemented synthetic liquid medium or when cells were exposed to 8.0 nm of MeHgAc per mg of cell protein in a single exposure.


Toxigenic fungi in food.

Toxigenic fungi in food. Forty-five fungal isolates from moldy supermarket foods were tested for toxicity to brine shrimp, and twenty-two of these isolates were subsequently tested for toxicity to chicken embryos. Highly toxigenic fungi were Cladosporium sphaerospermum from a bakery product, Fusarium oxysporum from carrots, F. solani from cabbage, Aspergillus niger and Penicillium corylophilum from bread, P. cyclopium and P. herguei from corn meal, P. lanosum from onions,P. steckii from chocolate syrup, Penicillium sp. from jelly, and Rhizopus nigricans isolates from sweet potato, applesauce, and strawberries. Approximately one-third of the fungal cultures were moderately to highly toxigenic to brine shrimp and chicken embryos, while several additional cultures were slightly toxigenic.


Physiology of sporeforming bacteria associated with insects: metabolism of Bacillus popilliae grown in third-instar Popillia japonica Newman larvae. The timing and relative participation of concurrent pathways of carbohydrate metabolism as well as the extent of terminal respiratory activity were determined by radiorespirometry with 14-C substrates and by enzyme assays for vegetative and sporulating cells of the bacterium Bacillus popilliae cultured in whole, intact Popillia japonica (Japanese beetle) larvae. During vegetative proliferation, the pentose phosphate pathway predominates in the bacterial cells with minor involvement of the Embden-Meyerhof-Parnas pathway. As the cells proceed through sporulation, pentose phosphate and Embden-Meyerhof-Parnas activity remains constant. No tricarboxylic cycle activity is evident during growth and sporulation of B. popilliae. The results demonstrate (i) predominantly aerobic metabolism for carbohydrate assimilation within in vivo sporulating cells, (ii) a major contrast to the metabolism of other aerobic sporeforming bacteria that exhibit derepression of tricarboxylic acid cycle enzymatic activity at the onset of sporulation, and (iii) no causal necessity of the cycle to B. popilliae sporogeny.


Emodin, a toxic metabolite of Aspergillus wentii isolated from weevil-damaged chestnuts. A diarrheagenic toxin from culture extracts of Aspergillus wentii Wehmer isolated from weevil-damaged Chinese chestnuts was identified as emodin (2-methyl-4,5,7-trihydroxyanthraquinone). The orange-red, crystalline toxin (mp 255 to 257 C) showed ultraviolet absorption maxima in ethyl alcohol at 223, 250, 267, 290, and 442 nm, and infrared absorption maxima at 3,400 cm-1 (OH), 1,635, and 1,625 CM-1. Chemical shifts and coupling constants of the proton magnetic resonance spectra of the A. wentii toxin and of authentic emodin agreed. Mean lethal dose of emodin orally administered to 1-day-old DeKalb cockerels was 3.7 mg/kg.


Assay and relationship of HT-2 toxin and T-2 toxin formation in liquid culture. Both T-2 toxin and HT-2 toxin can be conveniently quantitated in crude extracts by using a combination of thin-layer chromatography and fluorodensitometry. This technique was used to follow the production of these toxins by liquid cultures of Fusarium poae (NRRL 3287). T-2 toxin was produced prior to HT-2 toxin and hexadeuterio-T-2 toxin was converted by the culture to trideuterio-HT-2 toxin.


Comparative studies on microbial and chemical modifications of trichothecene mycotoxins. The microbial modification of several trichothecene mycotoxins by trichothecene-producing strains of Fusarium nivale and F. solani was studied. These results were compared with the corresponding chemical modifications. The growing mycelia of Fusarium spp. did not convert 4beta-acetoxy-3alpha,7alpha, 15-trihydroxy-12, 13-epoxytrichothec-9-en-8-one (fusarenon) into 3alpha,4beta, 7alpha,15-tetrahydroxy-12,13-epoxy-trichothec-9-en-8-one (nivalenol), whereas 3alpha,4beta,7alpha,15-tetracetoxy-12,13-epoxytrichothec-9-en-8-one (tetraacetylnivalenol) was deacetylated to yield 3alpha-hydroxy-4beta,7alpha,15-triacetoxy-12,13-epoxytrichothec-9-en-8-one (4,7,15-triae-tylnivalenol), which was resistant to further deacetylation. T-2 toxin was transformed intoHT-2 toxin, and 8alpha-(3-methylbutyryloxy)-3alpha,4beta,-15-triacetoxy-12,13-epoxytrichothec-9-en-8-one (T-2 acetate) was transformed into HT-2 toxin via T-2 toxin. Chemical modification with ammonium hydroxide converted tetraacetylnivalenol into fusarenon via 4,7,15-triacetylnivalenol. 3alpha-7alpha,15-Triacetoxy-12,13-epoxytrichothec-9-en-8-one (triacetyldeoxynivalenol) gave deacetylation products lacking the C-7 or c-15 acetyl group in addition to 7alpha,15- diacetoxy-3alpha-hydroxy-12, 13-epoxytrichothec-9-en-8-one (7,15-diacetyldeoxynivalenol). These results demonstrate the regio-selectivity in microbial modification of trichothecenes. Based on the results and available knowledge concerning the transformation of trichothecenes, mechanisms for biological modifications of these mycotoxins are postulated.


Production of trichothecene mycotoxins by Fusarium species in shake culture. Twelve T-2 toxin-producing isolates and four fusarenon-X-producing isolates of Fusarium species were examined for their ability to produce trichothecene mycotoxins in shake culture and jar fermentation. T-2 toxin producers such as Fusarium solani, F. sporotrichiodes, and F. tricinctum produced T-2 toxin and neosolaniol in semisynthetic medium. F. solani M-1-1 produced the largest amount of the mycotoxins in a nutrient medium consisting of 5% glucose (or sucrose), 0.1% peptone, and 0.1% yeast extract in either shake culture or jar fermentation at 24 to 27 C for 5 days. None of the isolates produced significant amount of fusarenon-X in shake cultures.


Nephrotoxicity of dietary ochratoxin A in broiler chickens. Graded doses of pure ochratoxin A (0,0.5,1.0,2.0,4.0, and 8.0 mug of toxin per g of feed) were incorporated into a commercial diet which was fed to chicks from 1 day to 3 weeks of age, at which time the experiments were terminated. Growth was inhibited at 2.0 4,0, and 8.0 mug/g, whereas the kidneys were enlarged at doses of 1.0 mug/g and above. Renal function as measured by clearance of phenol red was decreased 15 and 31% by doses of 4.0 and 8.0 mug/g, respectively. Uric acid was increased 38 and 48% over the control values by doses of 4.0 and 8.0 mug/g, respectively. The plasma electrolytes Na, Cl,Ca, and K were measured; however, only K was significantly ( P smaller than 0.05) altered, showing a decrease at doses of 4.0 and 8.0 mug/g. The percentage dry weight of the kidneys decreased significantly at dose levels of 4.0 and 8.0 mug/g, indicative of edema. Histological examination of kidney sections gave the impression of edema and some tubular necrosis. Pathological changes were observed at all dose levels. These data demonstrate that ochratoxin A is a severe nephrotoxin in young broiler chickens.


Degradation of petroleum by an alga, Prototheca zopfii. Prototheca zopfii is an achlorophyllous alga which degrades oil. It has been found to degrade 10 and 40% of a motor oil and crude oil, respectively, when tested under appropriate conditions. Degradation of the crude oil observed in this study compares well with the amount of degradation accomplished by bacteria. P. zopfii was found to degrade a greater percentage of the aromatic hydrocarbons in motor oil than of the saturated hydrocarbons and a greater percentage of saturated hydrocarbons in crude oil than of aromatic hydrocarbons. Resins and asphaltens were produced during degradation of motor oil, whereas these fractions in crude oil were degraded. P. zopfii did not demonstrate preferential utilization of lower homologues of cycloalkanes and aromatics as has been observed with bacteria.


Role of bacteria in bioaccumulation of mercury in the oyster Crassostrea virginica. An investigation of mercury-resistant bacteria was undertaken to determine their role in the accumulation of mercury in a simplified food chain. Oysters (Crassostrea virginica) were maintained in a closed system, sealed aquarium with stirred, aerated water containing 10 mug of 203-HgCl2 per liter. Uptake of 203-Hg by oysters held under control conditions was compared with that of 203-Hg uptake by oysters under similar conditions except that mercury-accumulating and mercury-metabolizing species of Pseudomonas, isolated from Chesapeake Bay, were added to the experimental oysters. After incubation for 4 days, the major portion ofthe 203-Hg in the water column was found to be associated with the microparticulate fraction, corresponding to a rise in total viable count. Mercury accumulation in the oysters was significantly higher in the gill and visceral tissue than other tissue. Mercury concentrations were 200 times greater in tissue fractions of oysters dosed with mercury-metabolizing bacteria compared with the oysters held under control conditions without mercury-metabolizing bacteria.


Results of aortic valve replacement with the Starr-Edwards and Björk-Shiley prostheses. A study has been made of the last 50 patients subjected to aortic valve replacement with a Starr-Edwards or a Björk-Shiley prosthesis. The surgical mortality was 6%, the late mortality was 4%. Postoperatively the vast majority of the patients were symptom-free. Paravalvular leakage was believed to be present in two patients, both of them free from symptoms.


Results of primary surgical treatment of gastric carcinoma. During the period 1958 to 1968 inclusive, 238 patients were subjected to primary surgical treatment for gastric carcinoma. On the basis of Hoerr's classification, this material has been subdivided into a group operated on with palliative intention and a group operated on with curative intention. The latter group accounted for only 31.5% of the entire series. The postoperative mortality rate in the series as a whole amounted to 18.5%, and the rate of five-year survival to 16.2%. The proportion of resectability was 53.8%. Sixty-four patients were subjected to total gastrectomy, and in 50% of them this was done with palliative intention. During the period 1964 to 1968 inclusive, postoperative mortality was 5.9% for subtotal and 8.8% for total gastrectomy. The rates of five-year survival during the entire period for the groups operated on with curative intention amounted to 46.5% and 40.6% respectively, postoperative mortality included. At the time of writing, 25 patients are still alive, with periods of survival of longer than 15 years.


Sphincterotomy.

Sphincterotomy. As a supplement to a theoretical study published in 1966, we now report the indications and results in nine cases, seen over a period of five years, in which papillotomy or a short sphincterotomy was performed for cholelithiasis. In six cases, the indication was based on the presence of low-seated calculi in the common bile duct or in the papilla, which calculi could not be removed via the supraduodenal choledochotomy; in two cases it was based on the presence of a stenosis of the papilla without choledocholithiasis. In seven patients the postoperative course was uneventful. One woman exhibited a complication not connected with the bile-duct operation, and one other patient showed leakage of the suture line in the duct, a complication that may also occur after simple choledochotomy and which accordingly is not attributable to the additional sphincterotomy. All the patients have remained symptom-free during the follow-up period. These results confirm the data in the international literature and prove that for the limited range of indications mentioned, sphincterotomy may be performed if it is considered necessary.