Antagonism of skin conductance response (SCR) habituation during iterative photostimulation in mice: habituation test - a new psychopharmacological method for detecting and quantifying enhancement of psychic activity. A method (habituation test) for studying habituation of the palmar skin conductance response (SCR) during iterative photostimulation in mice is described. Twenty drugs known for their CNS stimulant activity and/or beneficial action on learning were tested for their antagonism toward habituation. With most of the drugs tested, the delay in SCR extinction was dose-dependent. From the corresponding regression equations, the standard delaying doses were computed and used for classification. Fenozolone was the most active product. In descending order follow dexamphetamine and piracetam, then other amphetamines. Locomotor activity tests were run in parallel with habituation tests and the two sets of results compared. Reliability of habituation test was checked. The responsiveness of the test and the significance of the results are discussed. The applicability of the habituation test in psychopharmacological research is argued by its sensitivity to piracetam, whose nootropic activity is not detectable by classic behavioral methods. The habituation test makes it possible to test drugs for their effects on the maintenance of attention during monotonous stimulation and, more generally, for their psychic enhancement activity whatever the mechanism involved. It is thus likely to be a suitable test for nooanaleptics (in the broad meaning of the term).


The capacity for computed tomography diagnosis of cerebral infarction. An experimental study in the nonhuman primate. The characteristic serial CT scan appearance of cerebral infarction created by embolization of the middle cerebral artery in the nonhuman primate (10 baboons) is defined. The earliest CT changes are noted by 12 to 24 hours and include generalized ventricular enlargement and a focal region of decreased absorption in the opercula-basal ganglia region. The area of diminished brain absorption is better circumscribed and of lower attenuation coefficient with increasing chronicity. Distinct hydrocephalus, unilateral exophthalmos and ventricular displacement occurred with increased intracranial pressure. Little additional diagnostic information was obtained via intravenous enhancement and care should be taken as mild enhancement may obscure an area of abnormality.


Cranial computed tomography in the baboon: normal anatomy. A simple, reliable, reproducible technique for performing CT scans on baboons is described. The normal morphologic appearance in 12 nonhuman primate (Papio cynocephalusl anubis) brains as defined by CT is correlated with the normal gross pathologic findings  on  postmortem examination. The orbital contents are also displayed with clarity equivalent to that obtained in man.


The central canal of the spinal cord in experimental hydrocephalus: preliminary results. The central canal of the spinal cord in certain animal species has been shown to be an alternative pathway of cerebrospinal fluid flow in experimentally induced hydrocephalus. Enlargement and increased movement of cerebrospinal fluid in the central canal has been proposed as a compensatory mechanism in hydrocephalus in humans. The central canal of the spinal cord was normal in 5 dogs and 2 primates made hydrocephalic by a relatively atraumatic experimental model which simulates the human disorder to chronic communicating hydrocephalus. Dilatation of the central canal is apparently not an important compensatory alternative pathway.


Myelographic features of mucopolysaccharidoses: a new sign. A new mechanism of myelopathic changes in patients with mucopolysaccharidosis is described. Two similar cases had myelographic evidence of marked concentric impingement of the cervical subarachnoid space and cord compression due to thickening of the dura. Myelography is indicated in the evaluation of these patients because surgical decompression may reverse the progressive neurological deficits.


Effects of PGF2alpha and PGF2alpha, 1-15 lactone on the corpus luteum and on early pregnancy in the rhesus monkey. The effects of prostaglandin (PG)F2alpha and PGF2alpha, 1-15 lactone were compared in luteal phase, non-pregnant and in early pregnant rhesus monkeys. Animals treated with either PG after pretreatment with human chorionic gonadotropin (hCG) had peripheral plasma progesterone concentrations that were not statistically different from those in animals treated with hCG and vehicle. However, menstrual cycle lengths in monkeys treated with PGF2alpha, 1-15 lactone were significantly (P less than 0.02) shorter than those in vehicle treated animals. In the absence of hCG pretreatment, plasma progesterone concentrations were significantly (P less than 0.008) lower by the second day after the initial treatment with either PGF2alpha or PGF2alpha, 1-15 lactone than in vehicle treated monkeys. Menstrual cycle lengths in monkeys treated with either PG were significantly (P less than 0.04) shorter than those in animals treated with vehicle. There were no changes in plasma progesterone concentrations in early pregnant monkeys treated with PGF2alpha, and pregnancy was not interrupted. In contrast, plasma progesterone declined and pregnancy was terminated in 5 of 6 early pregnant monkeys treated with PGF2alpha, 1-15 lactone. These data indicate that PGF2alpha, 1-15 lactone decreases menstrual cycle lengths in non-pregnant rhesus monkeys. More importantly, PGF2alpha, 1-15 lactone terminates early pregnancy in the monkey at a dose which is less than an ineffective dose of PGF2alpha.


[Leukocyte migration inhibition with soluble and particulate antigens (author's transl]. Studies were carried out with the leukocyte migration inhibition tests using soluble and particulate antigens (PPD, somatic antigens of T. cruzi, M. bovis (BCG) and leukocytes from patients sensitized to PPD and patients with chronic Chagas' disease. The results obtained showed that the stimulatory capacity of particulate antigens are greater than that of soluble antigens.


Intestinal oxalate absorption. I. Absorption in vitro. Enteric hyperoxaluria and oxalate urolithiasis in patients with ileal resection seem to be caused by intestinal hyperabsorption of oxalate. The mechanism responsible for hyperabsorption of oxalate is not known. Intestinal transport of oxalic acid was therefore examined by an in vitro technique in rat intestine. Oxalic acid was absorbed by a mechanism of simple passive diffusion. The rate of absorption decreased from the colon to the duodenum (colon greater than ileum greater than jejunum greater than duodenum). Bile acids enhanced oxalic acid absorption in the large and small intestine and increased extracellular space; calcium, however, markedly decreased mucosal-serosal transport of oxalic acid. Cholestyramine known to reduce oxalate excretion in hyperuxaluria associated with ileal resection did not directly affect absorption of oxalic acid, but decreased the enhanced absorption of oxalic acid induced by bile acids. The results suggest that the beneficial therapeutic effect of cholestyramine in hyperuxaluria is rather mediated by its bile acid binding activity than by direct binding of oxalic acid.


Human myoglobin: preparation, quantitation and standardization. The quantitation of myoglobin (Mb) in serum and urine is of clinical importance for the differentiation of myocardial infarction from degenerative cardiac disorders as well as for the detection of traumatic and atraumatic rhabdomyolysis, followed frequently by acute kidney failure. A simple method is described to prepare myoglobin from human muscle extract by negative pressure ultrafiltration and dialysis. By a combination of electrophoretic procedures, this preparation was analysed for purity. Saline myoglobin solutions after deep freezing loose rapidly their immunoreactive Mb content. By addition of pure albumin, not containing heme binding proteins, a stable Mb solution was obtained. This has been used as standard (5--50 microgram/ml) in radial immunodiffusion sensitive for detecting 0.2--1 microgram Mb/ml.


The presence and distribution of beta-galactosidases in the small intestinal mucosa of the neonatal dog. The beta-galactosidase activity of the small intestinal mucosa of the neonatal dog has been studied over the pH range 3-0 - 5-8 using different substrates and in the presence and absence of p-chloromercuribenzoate. Partial separation of two beta-galactosidases has been achieved by gel filtration. The results suggest that three beta-galactosidases, comparable with those in other mammals, exist in canine small intestinal mucosa.


Oligoclonal IgG and free light chains in the cerebrospinal fluid of patients with multiple sclerosis and infectious diseases of the central nervous system. Conventional and crossed immunoelectrophoresis were used to characterize oligoclonal gamma-globulin bands of the cerebrospinal fluid (CSF) of patients with multiple sclerosis (MS) or subacute sclerosing panencephalitis (SSPE) or other infections of the central nervous system. Most gamma-globulin bands were identified as IgG, but some bands were identified as kappa or lambda, or both, free light chains, Bands of IgG showed various degrees of light-chain diversity, and individual bands appeared in many instances to be derived from more than one clone of cells. Sequential changes of the oligoclonal IgG were observed in SSPE but not in MS. Oligoclonal IgG was detected in sera from most patients with SSPE and some patients with MS.


Septicaemia in the tropics. A prospective epidemiological study of 146 patients with a high case fatality rate. A prospective study showed that during the first 6 months of 1976, 146 patients out of a total of 3938 admitted to a hospital in Nigeria were suffering from septicaemia, or developed the condition while in hospital. Findings differed from those reported from developed countries in that the majority of infections were community acquired, those most frequently and severely affected were the very young, and salmonella spp. and Staphylococcus aureus were the most important pathogens. However, other gram-negative organisms, particularly klebsiella spp. and Pseudomonas aeruginosa also occurred frequently among the very young, in whom they produced a high mortality. The type of epidemiological pattern, and the bacteria responsible for the bloodstream infections reflect a differing age structure of the population in tropical countries from that in temperature developed countries, as well as the fact that bacterial infections are still one of the most important causes of illness and hospital admission among tropical communities.


The latex agglutination test for the diagnosis of meningococcal and haemophilus influenzae meningitis. 103 cerebrospinal fluid (CSF) samples from 55 patients with bacteriologically proven meningitis (caused mainly by Neisseria meningitidis group A and Haemophilus influenzae type b) and from 29 patients with unproved meningitis or other diseases were studied using the latex agglutination (LA) test to demonstrate bacterial antigen in CSF. The tests for N. meningitidis groups A and C and H. ineluenzae type b were found to be rapid, reliable and specific for the serological group of the organism. The demonstration of N. meningitidis group B antigen has not succeeded with the test. Negative results were obtained from culture-positive samples in 4 cases where the bacterial growth was scanty. On the other hand the LA test was clearly positive on 3 occasions in which meningococci did not grow in cultures because of initiated antibacterial therapy or delay before culturing. False-positive results were rare (2 cases). The LA test was found to be at least as sensitive as counterimmunoelectrophoresis in demonstrating bacterial antigens in CSF.


Assay of gentamicin concentrations in serum specimens by microbiological and radioenzymatic methods. Assay of gentamicin concentrations were performed on 167 patient sera by two methods in the routine work. A radioenzymatic method that measures the acetylation of getamicin by a bacterial enzyme extract and the overnight agar diffusion method, using cups as diffusion centres, were used. The methods correlated well (r = 0.87), although the results of the microbiological assay in some cases were higher than the results of the  enzymatic assay. When artificial samples were tested the microbiological methods gave variable results. Therefore careful standardization is necessary for accuracy and reproducibility. The enzymatic assay, however, offered advantages of specificity, reproducibility and rapidity.


A rapid semiautomated bioassay of gentamicin based on luciferase assay of bacterial adenosine triphosphate. A rapid semiautomated bioassay of gentamicin in serum based on the effect of gentamicin on intracellular adenosine triphosphate (ATP) levels in bacterial cultures is presented. The ATP assay was performed with the firefly luciferin/luciferase system and results were compared with an agar diffusion technique. The lower limit of detection was set at 1 microgram/ml. The accuracy of the ATP assay expressed as a recovery of gentamicin over the range 1--8 microgram/ml was 98--103% and S.D. varied between 11-15%. The reproducibility was approximately within the same limits. Other antibiotics tested did not interfere with the determination of gentamicin. 112 clinical serum specimens containing gentamicin alone (N = 55) or in combination with other antibiotics (N = 57) were assayed and results with the two methods compared (r = 0.94). Volumes required were 0.1 ml serum and results were available within 3 h.


Successful treatment of pseudomonas aeruginosa--ventriculitis with intraventricular gentamicin in a child with hydrocephalus. A hydrocephalic child, who was operated with a ventriculo-peritoneal shunt at the age of 1 month, developed ventriculitis due to Pseudomonas aeruginosa at 8 months. After removal of the shunt and successively increasing intramuscular and intraventricular doses of gentamicin the patient was cured and a new shunt could be inserted. As high 24-hour gentamicin level in the cerebrospinal fluid as 76 microgram/ml was reached without any apparent toxic signs.


Use of scanning electron microscopy for the study of human epidermal melanocytes. A method is presented which makes it possible to study melanocytes in situ in the human epidermis by means of scanning electron microscopy. Melanocytes are located both under and wedged between the basal epidermocytes. The dendrites describe a short course in the dermo-epidermal (d-e) junction and then ascend and disappear into the spaces between the epidermocytes. As a rule, the surface of the cells is smooth. However, proliferations such as blebs and microvilli can sometimes be observed on the surface, particularly on that of the round, adendritic cells. Contact between the melanocytes in the d-e junction is only occasionally seen.


[Hypoglycemic sulfonylurea metabolites: clinical interest. Experiences with glibenclamide in the rat]. Glibenclamide, a hypoglycemic sulfonylurea, is extensively metabolized by the body and eliminated primarily in the form of its hydroxylated derivatives. The major metabolite, 4-trans-hydroxy-glibenclamide, is usually cleared rapidly from the bloodstream, but in certain pathological states (e.g. renal failure) blood levels of this product may increase. A protocol therefore was designed to test the hypoglycemic potency of this important metabolite in rats. Various quantities were injected intraperitoneally, and alterations in blood glucose concentrations were measured during a 5-hour period and compared to those in animals similarly treated with glibenclamide and in saline-injected controls. Using the dose capable of decreasing blood glucose levels by 30% (ED30) as a comparative index, it was observed that the metabolic has a marked hypoglycemic activity; though 6--7 times less potent than the parent drug, 4-trans-hydroxy-glibenclamide is nevertheless more potent than tolbutamide. Thus, while the glibenclamide metabolite probably has little influence on blood glucose when its clearance is normal, this product may exert marked effects if allowed to accumulate in the blood, as for example in renal failure. Finally, the role of such sulfonylurea metabolites should be taken into account when attempting to explain the occasional excessive and sustained hypoglycemia which occurs in some diabetic patients treated with these drugs.


[Monostotic fibrous dysplasia of the ribs]. The clinical features, macroscopic and radiologic findings and typical histologic alterations in three cases of fibrous dysplasia of ribs are described. In one case the lesion presented as a tumor-like growth of a size unprecedented in previously reported cases. In differentiating this condition from ossifying fibroma, the pattern of distribution of newly formed bone to fibrous connective tissue is shown to be a valuable criterion. In fibrous dysplasia this ratio is constant for any given area, but varies considerably in ossifying fibroma.


Hippocampal efferents reach widespread areas of cerebral cortex and amygdala in the rhesus monkey. The subiculum of the primate hippocampal formation stands at the end of a polarized sequence of intrinsic hippocampal efferents and is the source of efferents to the medial frontal cortex, the caudal cingulate gyrus, and the parahippocampal area and amygdala in the temporal lobe. In addition, the subiculum sends subcortical efferents to the septum and diencephalon.


Premotor cortical ablations in monkeys: contralateral changes in visually guided reaching behavior. In rhesus monkeys (Macaca mulatta), ablation of the premotor and supplementary motor areas and the adjoining rostral half of the precentral gyrus impairs the capacity of the contralateral arm to reach around a transparent obstacle to a visible food reward, and results in a tendency of this arm to reach around a transparent obstacle to a visible food reward, and results in a tendency of this arm to reach straight to where the food is visible. This may reflect a disinhibition of brainstem pathways which steer the arm and hand straight ot a visual target.


Thyrotropin-releasing hormone: abundance in the skin of the frog, Rana pipiens. Thyrotropin-releasing hormone, a hypothalamic tripeptide that stimulates the secretion of pituitary thyroid-stimulating hormone in mammalian species and is widely distributed throughout the brain of vertebrates, is present in the skin of the frog (Rana pipiens) in concentrations twice that found in the hypothalamus of this amphibian. A skin extract shows biologic activity appropriate to its immunoreactive content. Apart from the brain and spinal cord, immunoreactive thyrotropin-releasing hormone is found only in the blood and retina in significant concentrations. The results imply that frog skin is a huge endocrine organ that synthesizes and secretes this hormone.


Operative treatment of the acutely ruptured lateral ligament of the ankle. Twenty-seven patients with acute inversion injuries of the ankle were treated surgically during the past ten years. Instability indicative of rupture of the lateral collateral ligament was demonstrated by anteroposterior stress inversion roentgenograms. Ruptures of a component or components of this ligament were found at operation in every case. The ligament and capsule were repaired and the ankle was immobilized by a plaster of Paris cast for six to eight weeks. Of 26 patients available for follow-up examination, none complained of instability although nine had minor residual symptoms. Postoperative stability was demonstrated by roentgenograms in 13 patients. In the other 13, clinical examination showed that the ankles were stable on forcible inversion of the foot and ankle. Our results indicate that surgical repair offers the best prospect for successful treatment when definite passive instability can be demonstrated by properly performed stress inversion roentgenograms.


Issues along the Potomac: "efficacy" and "technology transfer". "Efficacy" and "technology transfer" are currently subjects of intense interest to health-related agencies in Washington. These jargon terms refer to assuring that useful knowledge is applied to all who need it and that the application of ineffective technology is discouraged. There is no public or private institution responsible for either assembling data on efficacy or for quaranteeing that necessary studies are undertaken. The determination of efficacy is important for cost control, quality assurance, planning, and any national health insurance plan. Whether engaged principally in practice, teaching, or research, it is important for physicians not only to be conversant with these issues but to participate in the resolution of the questions involved.


Current status and future role of health screening. To date, screening has largely failed to fulfill the hope that early detection would lead to more effective early treatment and to improved health status in the population served. The future role of screening can be much more positive but only if (1) screening is directed only at diseases and conditions for which early intervention has proven benefits; (2) valid screening methods are developed and used; (3) screening is done in settings in which diagnosis and treatment are assured; and (4) there is continuing scientific evaluation of the benefits and costs of screening.


[Immunological defence mechanisms and inflammation (author's transl)]. The interaction of immunological defence mechanisms and inflammation is reviewed. To begin with, those cells are discussed, which play a role in the immunological response, viz. the cells by which antigen is recognized (macrophages, B and T lymphocytes) and the effector cells (macrophages, plasma cells and sensitized T cells) and their products. Then, the cells involved in an inflammatory response (neutrophilic, eosinophilic and basophilic granulocytes, mast cells) are discussed, attention also being paid to their products and functions. The fact is stressed that, initially, there is an inflammatory response, resulting in the formation of antigen-antibody complexes or interaction of antigens and lymphokines of sensitized T cells, inflammatory cells being subsequently attracted. Finally, a few instances are cited in support of the theory that both immunological defence mechanisms and the inflammatory response are important factors in the defences of the host against invading micro-organisms, parasites and tumour cells.


Rapid preparation of uncoated biological specimens for scanning electron microscopy. We have developed a relatively rapid glutaraldehyde-tannic acid (GTA) and osmium tetroxide (OsO4) fixation procedure which permits many types of uncoated biological specimens to be examined in the scanning electron microscope (SEM) at 20 kV without the occurrence of charging. Most specimens taken one day can be examined in the SEM the following afternoon. Types of specimens successfully treated were perfused adult and embryonic rat tissues, confluent human skin fibroblast tissue cultures, plant roots, flowers, seeds, some garden insects, and microcolonies of salivary streptococci. Cells in suspension and extracted human teeth did become electron conductive when treated with the GTA procedure. Most suspended cells must be centrifuged between each solution and the GTA procedure increases the preparation time for these cells. Extracted teeth are usually simply dried and coated. Therefore, the usual SEM preparation techniques are shorter and perhaps more useful for these types of specimens.


Modified immunofluorescence test for the serologic diagnosis of gonorrhea (FGT-ABS). Investigation of the source of false-positive reactions in the Fluorescent Gonococcal Test-Heated (FGT-H) implicated antibodies to antigens common to Neisseria gonorrhoeae and N. meningitidis. Absorption experiments proved that the fluorescence was due to both species-specific and common antigens and that in most cases the common antibodies could be successfully absorbed by a soluble protein extract of N. meningitidis. The value of such an absorption step was examined using sera from 500 women, 73 from bacteriologically confirmed cases of gonorrhea and 427 from bacteriologically and clinically negative cases. The absorption step reduced the false positivity rate by 58% without a significant change in sensitivity. The modified procedure, the Fluorescent Gonococcal Antibody Test-Absorbed (FGT-ABS), has a sensitivity similar to the Fluorescent Gonococcal Test-Heated (FGT-H) but has the advantage of higher specificity.


Biological spectrum of two spirolactone derivatives with some observations on anti-fertility activity. Bioassays were conducted to determine various endocrinological properties of two spirolactone derivatives, 4',5'-dihydrospiro-[estr-4-ene-17,2'(3'H)-furan]-3-one (Compound I) and dispiro[cyclopropane-1,6'-estr-4'-ene-17',2"(3"h)-furan]-3'-one (Compound II). They proved to be very potent estrogen antagonists in immature mice and castrate ewes and neither exhibited inherent estrogenicity. They were moderately active as progestins and gonadotropin inhibitors. Compound II possessed slight androgenic activity and was more active orally than I. Compound I underwent a limited amount of testing in normally cycling rhesus monkeys. It was found to increase viscosity of the cervical mucus and, in oral doses of 0.5 or 2.0 mg/day, prevented pregnancy. One animal given 0.5 mg/day did become pregnant in her first treatment cycle, probably before a drug effect had been established. The results obtained indicate both compounds have potential utility as low-dose oral contraceptives.


Measles and malnutrition in a West Bengal village. The occurrence of measles over a five year period (1970-1974) was observed in a West Bengal village. Measles occurred every year between May and August and remained confined each year to small clusters or play groups. Restricted movement of the children within their own playgroup limited the spread of the disease. Most of the cases occurred in children between 2-6 yrs and 91.5% were in children below 7 yrs of age. The disease was not very severe in spite of the widespread prevalence of protein-calorie malnutrition and mortality was low compared to rates from Africa. Of the 181 cases only two children, who had kwashiorkor and who also had measles, died. There was no mortality among the marasmic children, nor were there any serious complications among them. The incedence of clinically diagnosed measles was significantly lower in severely malnourished children than well nourished children. Comparatively, low severity of this disease in India, as against high mortality rates in parts of Africa, amy be due to relative prevalence of marasmic and kwashiorkor type of malnutrition in these geographic areas.


Global brain ischemia: a reproducible monkey model. We developed a monkey model of 16 minutes global brain ischemia (GBI) resulting in reproducible, severe, permanent functional neurologic deficit with long term (7 days) postischemic (PI) survival made possible by standardized intensive care with 24 hour coverage by trained personnel. Quantitated neurologic deficit (ND) and brain histopathological examinations were developed. Fifteen minutes GBI resulted in rapid recovery within12--24 hours PI without residual neurologic sequelae. Twenty minutes GBI caused severe neurologic deficit and within 4 days PI, a delayed Cushing response eventually leading to cardiac arrest. Sixteen minutes GBI resulted in severe neurologic deficit (monkeys unable to sit, stand, walk, or feed themselves), but with long term survival. Brain histopathological analyses revealed a combination of cortical and brainstem lesions. Severest changes were observed in the occipital (calcarine) cortex with less severe damage in the frontal and temporal regions. Oculomotor nuclei and medial longitudinal fasciculus in the midbrain were regularly affected. With this model we can test the efficacy of promising therapies in terms of clinically relevant variables.


Effects of antihypertensive drugs on blood velocity in rhesus monkeys. Increasing evidence suggests that higher blood velocity, by causing turbulence and high shear rates at the endothelial surfaces of arteries, may be important in the pathogenesis of atherosclerosis. In order to measure the effects of antihypertensive agents on blood velocity, an improved method has been developed for analysis of Doppler ultrasound velocity recordings. The audio signal from a Doppler velocity meter is subjected to spectral analysis; the sonagraph thus obtained is digitized with the use of a magnetic table on-line with a calculator. Four monkeys were maintained at a hypertensive baseline for six weeks by infusion of angiotensin and isoproterenol. The effects on blood velocity of 72-hour infusions of propranolol, clonidine, hydralazine, and methyldopa were studied. In doses that reduced diastolic pressure by 13--28%, propranolol decreased mean blood velocity (mv) by 17%, clonidine decreased mv by 14%, while methyldopa increased mv 12%, and hydralazine increased mv by 52% (p less than .00001). Antihypertensive drugs appear to have different effects on blood velocity; these differences may influence choice of antihypertensive drugs for the prevention of arterial disease.


Growth profile of preschool children from an urban low socio-economic community in India. A five years longitudinal study on the growth and development was carried out on 68 infants from a low-socio-economic urban community in India. Ninety four percent of them suffered from Protein Calorie Malnutrition of varying degree at some time or the other during their first six years and of them 30% suffered severe PCM. The effect on heights and head circumference followed the same pattern as body weight. Their developmental quotients correlated with the degree of PCM till age of four years. This observation brings into focus a growth profile of underprivileged toddlers which is far worse than what is brought out by cross sectionals surveys. The family at greatest risk is one with a young mother who is ill equipped with the techniques of successful breast feeding and supplemental feeding of her infant. Additional factor is early onset of diarrhoeal illnesses in these children. It is suggested that such a vulnerable family requires special support from the health delivery system planned for urban communities.


Studies on 4 C stored frozen-reconstituted red blood cells. I. Bacterial growth. A knowledge of the growth rates of various organisms at the storage temperature of 4 C in the different suspending media used for red blood cells would aid the extension of the thawed storage time of frozen-reconstituted blood beyond the 24 hours allowed by the Food and Drug Administration. Knowing these rates, a prediction could be made that the growth rate would be sufficiently slow and the unit (sterile or minimally contaminated) could be given safely after a longer storage period. The studies reported show that the pathogenic organisms S. aureus, Ps. aeruginosa, E. coli, Klebsiella sp. and Enterobacter sp. grow at such a slow rate at 4 C that they do not represent any great hazard to the recipient unless introduced in great numbers. The studies further show that in the process of washing frozen blood the number of organisms is reduced by between one and two orders of magnitude (base 10). Therefore, extension of frozen red blood cell storage life to at least 72 hours should be considered.


Studies on Theileriidae (Sporozoa) in Tanzania. VIII. Experiments with African buffalo (Syncerus caffer). It has been found that African buffalo may remain infective carriers of Theileria parva lawrencei for at least 5 years. This infection is now known to exist in buffalo in 3 sites in northern Tanzania. It was shown that buffalo can be infected with Haematoxenus veliferus and Theileria mutans of cattle and retransmission of these parasites from buffalo to cattle was successful. The species of Haematoxemus reported in wild buffalo in central and East Africa is likely to be H. veliferus, while the possibility that Theileria barnetti of buffalo is identical with T. mutans should be considered. African buffalo can also be infected with Babesia bigemina and Anaplasma marginale of cattle and although the infections are latent, their blood may remain infective for at least several months.


Studies on the methods of preparation of rinderpest hyperimmune sera in rabbits. The procedures for the preparation of the rinderpest hyperimmune sera in rabbits were studied by comparing the sera from rabbits immunised by three different schedules of inoculations. The best sera for use in immunodiffusion tests were obtained from rabbits inoculated first with rinderpest hyperimmune serum and lapinised virus, and then with lapinised virus mixed with oil adjuvant twice at weekly intervals. Those rabbits which received additional one or two intravenous inoculations with lapinised virus yielded satisfactory sera for use in the diagnosis of rinderpest by immunodiffusion technique.


Prevalence of bovine virus diarrhoea and infectious bovine rhinotracheitis antibodies in Nigerian sheep and goats. Neutralising antibodies to bovine virus diarrhoea virus were commoner in Nigerian sheep than goats while precipitating antibodies offered an alternative but less reliable indicator of previous infection. In contrast, neutralising antibodies to infectious bovine rhinotracheitis virus were more common in goats than sheep. These findings are discussed in relation to infectivity rates in cattle and general husbandry practices.


[Prostate carcinoma: determination of progression following high-voltage therapy (author's transl)]. The fourth report of our long-term study concerns 70 cases of primary radiotherapy. The side effects of our radiation technique are minimal and temporary; in over 80% of the cases, potency was not affected. The morphologically demonstrable changes in the tumor tissue, in the original glandular parenchyma, and in the fibromuscular stroma leading to the vessels following high-voltage therapy are described. Three types of progressive patterns, based on the grade of histologic regression, can be determined. In more than half of the cases, with increasing distance from the source of radiation, no tumor or only minimal residual tumor was demonstrable. Sensibility and resistance of carcinoma of the prostate are not dependent upon the grade of differentiation of the tumor. A prognostic statement concerning the success of radiation therapy from initial histologic findings is not possible here. The occurrence of metastases in 18% of the cases following radiation probably resulted from the inexactness of the purely clinical determination of the stage of the tumor. The isolated, local treatment of prostate carcinoma through radiotherapy is justified only after exact determination of the stage of the tumor, i.e., certain exclusion of metastases via a diagnostic lymphadenectomy.


The ultrastructure of the interfollicular epidermis of the hairless (hr/hr) mouse. V. The cytoplasm of the horny cells. The ultrastructure of horny cells in the interfollicular epidermis of the hairless mouse and in the mouse with hair has been studied with particular emphasis on changes in the cytoplasm through the horny layer. Horny cells from the two strains have a similar appearance, and the horny layer can be divided into three sublayers, each with a different ultrastructure. It is suggested that in vivo the same arrangement of densely packed filaments and fibrils which represents the keratin pattern in the basal sublayer is preserved throughout the horny layer. However, the filaments and interfilamentous substance seem to undergo a continuous transformation, which possibly results in a disintegration of the filaments when desquamation of the uppermost cell takes place.


Ultrastructural and functional changes in pancreatic acinar cells during autolysis. Effects of anoxemic cell injury on rat pancreatic acinar cells were studied in a preparation where tissue samples were incubated at temperature between 18-20 degrees C in a moist atmosphere for 0, 0.5, 1, 3, 6, 12, and 24 h in vitro. Electron microscopy revealed that disintegration of acinar cells began by swelling of various cell compartments and gradual breakdown of cell membranes. Zymogen granules remained morphologically intact for at least 3 h. There were no signs of increased autophagic activity during the period of observation. Myelin figures and other membranous remnants of disintegrated cells, together with individual cells and cell organelles whose morphology was relatively well preserved were seen even after w4 h incubation. The secretory response of acinar cells to pancreozymin stimulation, as measured by amylase release into the incubation medium in vitro, decreased progressively closer to zero during 12 h autolysis. No active trypsin could be detected in the tissue samples during the 24 h observation time. It was concluded that during hypoxic autolysis at room temperature between 18-20 degrees C in vitro: 1. Acinar cell disintegration results from breakdown of cellular membranes, 2. autophagocytosis is not involved, 3. most of zymogen granules remain morphologically intact even at the time when cell membranes show evidence of damage, 4. there is no trypsin activation taking place in the tissue, and 5. the acinar cells are capable of responding to secretory stimulation for 3 to 6 h after removal of the tissue from the experimental animal.


Cell proliferation kinetics in two human tumors grown in athymic nude mice. The technique of labelled mitoses was used to investigate the cell proliferation kinetics in two human neoplasms, one a malignant melanoma and one a fibrosarcoma, transplanted to and grown serially in the athymic nude mutant (ANM) mouse. The experimental data obtained codrealted well with a theoretical percentage labelled mitoses curve based on the assumption that the time spent by a cell in each of the phases M, G1, S and G2 is described by four independent log-normal distributions. However, no unique second wave was defined by the experimental results. This means that only the deductions made about the duration of the G2 and S phases are reliable. The median duration of tma and the fibrosarcoma, respectively. By comparing these results with results published on cell cycle studies of transplantable animal tumors and human tumors in situ, it is concluded that the cell cycle parameters of a human tumor grown in the ANM mouse are close to those of the same tumor in the donor patient.


Flow microfluorometric analysis of nuclear DNA in cells from solid tumors and cell suspensions. A new method for rapid isolation and straining of nuclei. A one-step procedure for the preparation of nuclei for flow microfluorometric DNA analysis is described. The membranes of the cells were lysed by the non-ionic detergent Nonidet P40. Single-cell suspensions, and specimens of solid tissues obtained with fine-needle biopsy, could be prepared equally well as the nuclei of solid tissue cells were released separately. Lysis was performed in the staining solution containing either ethidium bromide or propidium iodide. Fluorescence due to fluorochrome binding to RNA, was abolished instantaneously by the presence of RNA-se, and fluorochrome binding to secondary binding sites in DNA was inhibited with NaCl. The preparation time was 10 min and the samples were stable for a minimum of 12 h. With the basic version of the method, usable, but not always optimal, results were obtained in all the cell types tested: four different mouse ascites tumors, leucocytes, bone-marrow, liver cells, human lymphomas, human carcinomas of the breast and lung, mouse mammary carcinoma and solid JB-1 tumor. The method was further optimized for the JB-1 ascites tumour. The resulting two modified techniques are described. Differences in the staining of leucocytes with the analogues ethidium bromide and propidium iodide were demonstrated.


Nuclear non-histone protein content of G0/G1 cells as related to growth fraction in mouse mammary tumors. In eight mouse mammary tumors with varying growth fractions DNA and non-histone nuclear protein (NHNP) were determined by absorption cytophotometry of Feulgen-Naphthol Yellow S stained, isolated cells. It was found that: 1. The mean NHNP content of cells with postmitotic DNA content (G0 + G1) increased with increasing growth fraction. 2. The mean NHNP content of S and G2 cells in the eight tumors did not vary significantly with growth fraction. 3. The frequency distributions of NHNP in G0/G1 cells were unimodal and right-skewed. The results are interpreted as follows: A) G0 cells differ from G1 cells by their lower content of NHNP. B). If it is assumed that the G0 and G1 compartments are arranged in series, the cells in the transition from G0 to late G1 may account for the unimodality and skewedness of the NHNP frequency distributions of postmitotic cells.


Density-dependent cell division after cortisol treatment of rat thymus in relation to age involution. Cellular proliferation, in relation to cell density was investigated in the thymus of control and cortisol treated animals at 6 and 18 weeks of age. It was found that there was very little difference in the response of the two age groups to cortisol treatment. Cell density and cellular proliferation were markedly reduced 2 days after cortisol administration. From 4 days there was a rapid increase in cellular proliferation to triple the control rate. The mitotic index remained above normal until 12days then decreased to control values at 14 days. During this time the cell density of the thymus was being progressively restored. At all stages of regeneration, the mitotic index at first increased to a maximum at the mean cell density then decreased at the highest cell concentrations. A model system is discussed to account for this density dependent control of cellular proliferation in the thymus.


[Effect of DMBA and benz (alpha) anthracene on the biogenic amine level in the rat brain]. Thirty minutes after the administration of DMBA (5 mg i. v.) to rats the level of norepinephrine, dopamine, serotonine (5-HT) and 5-IIIAA in the hypothalamus was decreased, while monoamines levels in the brain stem and hemispheres was unchanged. After benz(a) anthracene (5 mg i.v.) treatment the level of 5-HT in rat hypothalamus was decreased, but catecholamines and 5-HIAA levels were not changed. Pretreatment with L-DOPA abolished the elevation of the threshold of hypothalamic sensitivity to estrogen suppression, induced by 20-methylcholanthrene in rats, and alpha-methyl-DOPA enhanced. It is suggested that the central (hypothalamic) mechanisms participate in the release of the carcinogenic effect of polycylic hydrocarbons in rats.


[Clinical dosimetric studies of lung tissue heterogenetiy in irradiation on the Rokus and B5M-25 machines]. As a result of measurements of radiation doses in the esophagus and of the emerging beam, which were made immediately during radiotherapy, the coefficients of heterogeneity and values of the effective lung density were determined. In mobile telegamma therapy of esophageal tumors the correction for heterogeneity was 1.26 for the upper third of the thoracic esophagus (angula deviation 120 degrees) and 1.44--for the median third (240 degrees). A calculation method is suggested for the medium heterogeneity to be taken into account in individual planning of radiotherapy of the esophagus and lung tumors.


[Assessment of the sensitivity of immunoprecipitation for the serodiagnosis of influenzal-bacterial pneumonias]. A comparative examination of 226 paired sera from patients with pneumonia was carried out by CFT, HI, neuraminidase activity inhibition (NI) and double immunodiffusion. A correlation of the results of agar gel precipitation and the CFT and HI tests was observed. Convalescent sera contained antibody to influenza virus ribonucleoprotein frequently, less so to its neuraminidase or hemagglutinin. The precipitation test was shown to be highly sensitive, easy to perform, and therefore should be used in examinations of sera from patients with influenza-bacterial pneumonia.


Surgical management of epilepsy.

Surgical management of epilepsy. Therapy with anticonvulsant drugs reduces the frequency and severity of seizures in many but not all epileptic patients. Unfortunately, in a significant number control remains poor even when maximal doses of multiple anticonvulsant drugs are given. Some of these patients are candidates for surgical treatment of epilepsy. The operative management of convulsive disorders is a well-established technique and is available in some centers. In selected cases, such operations are both safe and effective, with good longterm improvement or complete control in 76 percent of patients. We have summarized the 24-year experience with surgical operation for epilepsy at the University of Washington Medical Center.


[Suppressive effect of somatostatin on secretin-CCK-PZ-stimulated endocrine and exocrine pancreatic function in man (author's transl)]. With a view toward the therapeutic use of somatostatin in the treatment of acute pancreatitis, a preliminary investigation was conducted with 6 healthy volunteers, in which the suppressive effect of somatostatin on endocrine and exocrine pancreatic function was observed. A 30-minute baseline measurement period was followed by the administration of cyclic somatostatin (100 microgram by i.v. injection plus a 90-minute infusion at a rate of 200 microgram/hr). After the first 45 minutes of this infusion secretion was submaximally stimulated by the infusion of secretin-cholecystokinin-pancreozymin (CCK-PZ) (75 U each), over two hours. No decrease was observed in basal bicarbonate or enzyme concentration under somatostatin administration alone. However, secretion did not show the usual steep rise after the commencement of stimulation. After the somatostatin infusion was stopped, i.e. under secretin-CCK-PZ alone, a significant increase occurred in the values of secretin-induced volume, bicarbonate concentration and total bicarbonate contents of the duodenal aspirate, as well as in CCK-PZ-induced enzyme secretion. The release of insulin, both basal and stimulated, was also significantly decreased by somatostatin.


[A new type of ointment base: investigations on its antimicrobial properties (author's transl)]. A new ointment base (PEN 32) consisting of polyalcohols prevents the growth of bacteria and fungi in concentrations above 25% (mg/mg). In a concentrated form the ointment base exhibited excellent bactericidal and fungicidal effects in vitro. This property enables the ointment base to be employed without preservatives.


[Influence of a complex of poly(I). poly(C) and poly-l-lysine on the course of vaccinia in monkeys]. Experiments of 22 Macaca rhesus monkeys were carried out to study the interferon-inducing and antiviral activity of poly(I) - poly(C) and of its complex with poly-l-lysine. The complexed double-stranded polyribonucleotide induced active production of serum interferon and markedly protected the monkeys inoculated intradermally with vaccinia virus (10 monkey ID50 by intradermal inoculation). The effectiveness of the protective effect depended on the schedule and routes of administration of the preparation. The greatest prophylactic and therapeutic effect was achieved by local administration of the complex in a dose of 1 mg/1 kg of body weight. This also prolonged the incubation period by 2-3 times and reduced the duration of persistence of skin lesions approximately by half. By the intravenous route, the best protection was achieved by 2 injections of 2 mg/kg at an interval of 96 hours. Four daily injections of the complex exerted virtually no effect on the course of vaccinia infection. The animals receiving the complexed poly(I) - poly(C) developed virus-neutralizing antibody to the same titres as control animals and were resistant to reinfection with vaccinia virus. A second injection of the complexed poly(I)-poly(C) 96 hours after the primary inoculation induced the same interferon production as the initial administration of the preparation. The monkeys inoculated intravenously with 2 mg/kg poly(I) - poly(C) showed no interferon in their blood serum and were also poorly protected against vaccinia virus infection.


[Behavioral psychology of obesity].

[Behavioral psychology of obesity]. Increase in energy and release of energy are essentially regulated instinctively. The afferences from the exterior and interior milieu, the central impulse zones and the efferences form a system which may be affected by disturbances at different sites. In persons with an obesity of high degree in the majority of cases also other nervous and hormonal disturbances can be proved. The wide-spread obesity as a popular disease is based on unnatural impulses and inhibitions of the regulatory mechanisms. In this milieu the success of the treatment depends on the fact that the patient experiences greater promptings than pleasure in eating and comfort.


[Effect of vasoactive and coronary drugs on orthostasis in patients with constant-frequency cardiac pacemakers]. It is reported on a group of 31 patients with pacemakers who were exposed to an orthostasis load without additional therapy as well as after an administration of nitrangin, euphyllin, rocornal and ergocomb. The lacking regulation of frequency in these patients can only limitedly be compensated by a volume regulation. Thus the simple standing experiment is already a considerable stress for these patients. Single applications of nitrangin and ergocomb led to an additional orthostatic decrease of blood pressure. This is particularly characterized after application of nitragin and also accompanied by subjective appearances up to the collapse. In the not doubted necessity to treat patients with pacemakers also conserning the coronary blood supply it seems important to take into consideration an additional iatrogenic disturbance of the orthostatic regulation.


[Hemolytic disease of the newborn due to ABO incompatibility (author's transl)]. Up to now, the exact diagnosis of ABO hemolytic disease of the newborn cannot be made either clinically or serologically. Affected babies are almost all either group A or group B from mothers of group O. In contrast to Rh hemolytic disease the immunological findings do not correlate well with the severity of the clinical course. Sometimes, it is impossible to differentiate between ABO hemolytic disease and non-antibody mediated hyperbilirubinemia. Pathogenetic aspects are discussed which may explain the differences between ABO and Rh hemolytic disease of the newborn. Aids to immunological and clinical diagnosis are given. Ante-natal treatment is not necessary. Indications for and technique of phototherapy and exchange transfusion are presented. Early application of these therapeutical methods prevents bilirubin encephalopathy, kernicterus with subsequent death or development of severe neurological sequelae.


Praziquantel, a new board-spectrum antischistosomal agent. Praziquantel, (2-cyclohexylcarbonyl)-1,2,3,6,7,11b-hexa-hydro-2H pyrazino[2,1a]isoquinolin-4-one, belongs to a new series of antischistosomal compounds. The results of a detailed study of the efficacy of praziquantel on Schistosoma mansoni in mice, Mastomys and Syrian hamsters are described. Praziquantel is effective after oral and all parenteral routes of administration tested. The amount of praziquantel required to achieve parasite reductions of at least 95% depends on the host species and on the routes and schedules of administration. Total doses range from 200--1,000 mg/kg in mice and from 100--500 mg/kg for Mastomys and hamsters. In all three species, splitting of the total dose into 3 or more fractional doses given within 1 day approximately doubles the efficacy over that achieved after a single oral administration of the same total dose. A single subcutaneous dose is only slightly more effective, whilst a single intramuscular injection in olive oil is about twice as effective as a single oral administration. Praziquantel is very effective against the invading stages and slightly less against schistosomules up to an age of 7 days. It is less effective against 2- to 4-week-old juveniles, but is effective again against 5-week-old and older schistosomes. Praziquantel is equally effective against both sexes of S. mansoni. It is less effective against unpaired and therefore juvenile female worms, but fully effective against single male worms. The efficacy of praziquantel on S. mansoni in mice is not influenced by the strain or the sex of the host, the worm burden or the age of the infection. Considering all data available, praziquantel promises to be a very potent antischistosomal drug.


Experimental chemotherapy of schistosomiasis mansoni. XIII. Activity of praziquantel, an isoquinoline-pyrazino derivative, on mice, hamsters and Cebus monkeys. In mice experimentally infected with Schistosoma mansoni, praziquantel (2-cyclohexylcarbonyl-1,3,4,6,7,11b-hexahydro-2H-pyrazino[2,1-a]isoquinoline-4-one), administered orally at the levels of 100 and 50 mg/kg, for 5 consecutive days, produces oogram changes in all animals and a pronounced hepatic shift of schistosomes (97.1 and 89.1, respectively). At lowest levels (12.5 and 6.3 mg/kg), alterations in the oogram could still be detected, although hepatic shift of schistosomes was no more evident. After a single intramuscular injection, the results obtained paralleled those observed with a single-dose oral treatment. The hepatic shift was only moderate at 200 and 100 mg/kg and the percentages of worms retained in the liver, after perfusion, were particularly low. When nasal route in a 1-day regimen was used, the results obtained were slightly less evident as compared with those observed by oral route (5-day schedule). Considering the percentage of oogram changes, the degree of hepatic shift of schistosomes and the percentage of worms fixed in the liver, the antischistosomal activity of praziquantel was greater in hamsters than in mice. Actually, a daily dose as low as 12.5 mg/kg, administered for 5 consecutive days, was sufficient to shift 60.4% of the worms towards the liver and to produce alterations of the oogram in 60% of the animals. In Cebus monkeys orally treated with 10 and 20 mg/kg of praziquantel, given 3 times within a single day (total doses of 30 and 60 mg/kg, respectively), a remarkable reduction in worm burden was observed. A single oral or intramuscular dose of 100 mg/kg was found to be curative. One Cebus doses with 100 mg/kg, by nasal spray, was found to harbor only female worms at autopsy performed 69 days after treatment.


Ultrastructure of Sarcocystis sp. from the Malaysian house rat, Rattus rattus diardii. The ultrastructure of Sarcocystis sp. from the Malaysian house rat, Rattus rattus diardii, was studied with the electron microscope. The thin, uniformly-dense primary cyst wall had a row of vesicular invaginations which were also seen along the wall of the villi-like projections or cytophaneres. Within the villi were spherical bodies and hollow, curled structures. The ground substance beneath the primary cyst wall extended into the cyst as thin septa or trabeculae separating the tightly-packed zoites into compartments. Merozoites had a double-layered membrane, a conoid, 2 conoidal rings, 22 subpellicular microtubules, 6 rhoptries, 80-100 micronemes, scattered lipid droplets, and sac-like mitochrondrion, beside which was a Golgi apparatus. A micropore was occasionally seen at the anterior third of the zoite whereas the nucleus occupied the posterior third. Metrocytes were few in number and peripheral in location.


[On typing the C3-system: Inhibition of the conversion by EDTA-Na2 (chelaplex III) (author's transl)]. By addition of EDTA-Na2 (Chelaplex III) to fresh sera the possibility for typing of C3-polymorphism is prolonged. Using a final concentration of 45.6 mmol EDTA-Na2/l the conversion is inhibited, and the C3 determination in serum by means of high voltage electrophoresis succeeds even after storage at room temperature during 6 weeks.


[A fatal food poisoning caused by bacillus cereus (author's transl)]. The autopsy of a 37 year old man who had died under extraordinary circumstances showed a bromatoxism by bacillus cereus. The verification of the bacillus was possible although the man had already died 2-3 days before; and that in spite of the existence of early beginning rottenness. With the help of morphological findings the pathogenetic effect of the toxins (exotoxin and enterotoxin) of bacillus cereus is discussed. Blood cultures of the heart alone are not sufficient to prove a causal connexion between infection and death. For this purpose bacteriological examination of the organs (liver, spleen, kidney, lungs and brain) is at the same time necessary. An aseptic method, which is described in detail, is the absolute condition for useful results. The forensic value of proof of the bacteriological examination is secured and improved by an additional verification of bacteria in histological specimen coloured by Gram.


Antibiotic production by defective cytoplasmic membrane mutants of Bacillus subtilis. Eleven defective cytoplasmic membrane mutants of Bacillus subtilis were isolated. Their respective protoplasts presented different lytic behaviour when exposed to decreased concentrations of sucrose. Some relationship was found between the fragility of the protoplasts and the capacity of the mutants to produce antibiotic or to sporulate. The higher the fragility the lesser the capacity to produce antibiotic. The same applies to their amino acids requirements.


Comparative study of chromogenesis and endotoxin production from pathogenic Pseudomonas aeruginosa strains, isolated from neoplastic processes. Several differences in relation to the chromogenesis and the production of endotoxins were found in Ps. aeruginosa strains, isolated from tumors. The strains isolated from neoplastic processes showed a higher amount of chromogenic fractions as compared with the control strains. Phenazinic compounds presented the main differences. Using two common methods of isolation and purification of Gram-negative endotoxin, we found a higher yield of these molecules in the case of tumor-isolated strains.


[Surgery of the biliary tract in geriatric patients (author's transl)]. During 5 years 1311 operations for benign diseases of the biliary tract were performed. 281 patients were more than 70 years old, on the average 76,1 years. According to experience and the results the following is emphasized: 1. Complications of gallstones are relatively more frequent in old patients. 2. Cholecystectomy for chronic gall bladder disease should be performed even in old age. Our postoperative mortality rate was 2,5%, increasing to 15,1% when operation was done in a stage of complications. 3. Acute inflammatory cholecystitis should be treated by urgent operation, especially in old age. 4. Cholecystectomy is the method of choice for acute cholecystitis. Cholecystostomy is used only in few exceptional cases. 5. Cholangiometry and cholangiography are always executed, if the cystic duct can be cannulated, even in cases of acute inflammation. 6. If there are stones in the common duct or a stenosis of Oddi's sphineter is found, an acute inflammatory or perforated cholecystitis is no impediment for a one stage repair. 7. Cholangioscopy is the unsurpassable method for exploring the common duct, when it was opened or sphincterotomy was done. 8. Principally indications for transduodenal sphincterotomy are the same for all age groups. The postoperative mortality rate is not higher than after other operations involving the common duct. 9. In old age choledochoduodenostomy is sometimes a good alternative to sphicterotomy. 10. In cases of recurrent operation due to overlooked stones in the common duct or sclerosis of Oddi's sphincter the mortality rate is not higher than after primary interventions for such affections.


[Clinical, bacteriological and histological studies following several years of IUD use for contraception]. It is informed about clinical, bacteriological and histological examinations of 108 women who had used IUD's for 2 years. The examinations were carried out on the IUD and on the endometrium. We made use of the transcervical technic of taking out under sterile conditions. Pathological findings could only be fixed amongst 4 women in clinical view. In bacteriological view numerous germs of quite different kind were found at the same patient. Optional pathological germs as they also exist in the cervix were predominant. Of an infection was only spoken if in correspondence of the total material the same germ was found. This concerned only in 6% of the women. Histologically adequate findings resulted. Genuine inflammations were only considered in 6% of the examinated female patients.


[Studies of the heterogeneity of streptokinases of different origin (author's transl)]. Streptokinases of six different strains of group A streptococci (Strep. pyogenes), and of one strain each of streptococcal groups C and G were isolated from supernatants of the cultures. The purified or partial purified streptokinases were characterized by electrophoresis in agar-acrylamidgels, isoelectric focussing in acrylamide gel and by determinations of the molecular weights by means of sodium dodecylsulphate acrylamide electrophoresis and gel filtration on sephadex G-100. Furtheron these streptokinases were compared serologically using human antistreptokinase-antiserum. It was found that all of the streptokinases examined in this study were different in their isoelectric points (5.05-6.5) and that they showed serological cross-reactions. The molecular weights are not significantly different and were determined to about 45 000 daltons.


[Investigations on the antimicrobial activity of amin-aldehydecondensates. 1. (Communication:) Symmetrically substituted animals of formaldehyde (author's transl)]. In the scope of our research about the antimicrobial activity of aldehyde-amin-condenates a number of partly new aminals was synthesized by reaction of formaldehyde with various secondary amines. Structures and physically constants are shown in the tables 1 and 2. The antimicrobial activity is demonstrated by the results of the disk-test (table 3), of the minimal inhibition concentration (MIC, talbe 4) and the suspension and area disinfecting test following the method of the DGHM (tables 5 and 6). Standardized formulations were developed to eliminate the different solubility effects of the various aminals. These formulations do not influence the test results. It may be shown, that aminals have both germistatic activity mainly versus Staphylococcus aureus, Bacillus subtilis, Aspergillus niger and Penicillium glaucum and germicidal activity especially versus Pseudomonas aeruginosa, Trichophyton mentagrophytes and Microsporium gypseum.


[On the increase of phototoxic activities of polycyclic aromatic hydrocarbons produced by dish detergents (author's transl)]. Several bands of dish detergents were found in high dilutions to increase phototoxic cell damage produced by polycyclic hydrocarbons such as benzo(a)pyrene. A comparable increase in phototoxicity in the presence of detergents was observed following the phagocytic ingestion of photodynamically active soot particles by the test organisms, Tetrahymena pyriformis (ciliate). The results are considered in the light of earlier reports on increased carcinogenicity following detergent action of one of the brands used in this investigation (P) on benzo(a)-pyrene. Possible mechanisms of action of detergents producing the increase in respective activities are discussed.


[Examination of the growth of pathogenic organisms on the elastic joints made of plastic material in swimming baths (author's transl)]. Roughly three months after a swimming bath had been put into operation a growth was observed on the permanently elastic joints made of plastic material at the bottom of the pool. Samples were taken and examined and bacteria, fungi, green algae as well as many monocellular organisms were found. The repeated identification of a pathogenic dermatophyte and of P. aeruginosa was of hygienic significance.


[Human haptoglobin type and G-streptococci: a safe and unexpected relation]. By testing 167 human sera a surprising dimorphism could be found. All sera of the haptoglobin type hp 1-1 belong to the group with an anti-G streptococci titer in the range of 1:0 to 1:10 whereas sera of the types hp 2-1 and hp 2-2 do have titers in the range between 1:200 and 1:3200 or more. All tests are carried out in the double blind technique.


[Studies on the mechanism of action of vascular spasmolytics. 3. Effect of nitroprusside sodium, nitroglycerin, prenylamine and verapamil on the fluoride-induced contracture of the isolated coronary artery]. On isolated coronary arteries of cattle, nitroprusside-sodium, nitroglycerol, prenylamine, and verapamil were studied for their spasmolytic effects on a contracture induced by fluoride ions. With this contracture model, which is independent of extracellular calcium, nitroprosside-sodium and nitroglycerol showed strong spasmolytic action. Verapamil proved ineffective, and the effectiveness of prenylamine was strongly reduced. The results lend support to earlier findings suggesting that nitroglycerol and nitroprusside-sodium are endowed with a relaxation mechanism different from that of verapamil and analogously acting compounds.


[Studies on the activation of humoral defense factors against bacteria in larvae of the wax moth Galleria mellonella L]. The change of lysozyme activity in the hemolymph of the wax moth larvae caused by vaccination is influenced by the size and the dose of the injected particles. The rate of incorporation of those particles into phagocytes has no effect on this process. The change of lysozyme activity correlats negatively with the amount of granulocytes after vaccination. There were no correlations with the amount of other types of the hemocytes, neither with the resistance of the larvae against Pseudomonas aeruginosa nor with the survival of gram-negative bacteria within the hemocoelom. Origin, regulation and role of lysozyme are discussed regarding the defence against gram-negative bacteria. In the hemolymph of wax moth larvae after vaccination the formation of spheroblasts has been observed with all gram-negative strains of bacteria studied. The speed and extent of the formation of spheroblasts corresponded to the pathogenicity of these bacteria for the larvae as well as to the survival of the bacteria within the hemocoelom.


Lack of a circannual cycle of daytime serum prolactin in man and monkey. Serum samples were obtained from 7 subjects (6 men and 1 woman) in the morning (09.00 h) and in the afternoon (15.00 h) of each week for a period of 13 months and assayed for prolactin by RIA. In addition, 4 female monkeys were sampled once weekly in the afternoon for approximately two years. The data were analyzed for cyclicity by power spectrum analysis. In both species a serum prolactin circannual cycle was not obvious. In most subjects statistically significant (P less than 0.05) cycles were observed; however, there was considerable variability among individuals in the duration of the cycle, which ranged between 4 and 50 weeks. A similar result was also observed for the monkey data; here the cycles ranged between 7 and 51 weeks. The physiologic significance of these cycles is unknown at present. It is suggested that although there appears to be no diurnal serum prolactin circannual cycle, this does not rule out the possibility that there may be a nocturnal circannual cycle.


Immunochemical comparisons between a low molecular weight adenohypophyseal constituent and the gonadotrophins. A biologically active peptide (called sperm-releasing substance, abbreviated SRS) with a molecular weight of about 5000, prepared from bovine adenohypophyses, has been compared with the known adenohypophyseal glycoprotein hormones using immunological methods. By means of immunofluorescence it can be seen that antisera against SRS have an affinity for the gonadotrophic cells in the anterior pituitary. Using complement fixation assay and immunodiffusion, no similarity between SRS and FSH can be found, while there are great resemblances between the reactions of LH and those of SRS. From the radioimmunoassay studies, it can be seen that the alpha-subunit of LH reacts in the same way as SRS in the different systems. However, using immunofluorescence, the antiserum against SRS has an affinity for the gonadotrophic cells only, like anti-LHbeta, and not for the thyrotrophic cells, as has anti-LHalpha. The reasons for these different results are discussed.


Platelet antibodies in different forms of chronic thrombocytopenia. Three techniques have been employed for the in vitro detection of circulating platelet antibodies in thrombocytopenic patients affected by 'idiopathic' form or by lupus erythematosus (SLE), the complement fixation test, the platelet factor 3 availability test and the serotonin release test. 29 of the 35 sera tested (82.8%) gave positive results for antiplatelet activity. In particular the serotonin release test allows to distinguish 4 groups of patients: a first group affected by idiopathic form; two groups with autoimmune thrombocytopenia and various degrees of serotonin release, and finally a fourth group which comprises subjects affected by SLE, with circulating immunocomplexes.


Congenital deficiency of factor XIII with normal subunit S and lack of subunit A. Report of a new family. Two sisters born from a nonconsanguineous marriage were found to have congenital factor XIII deficiency. In the electroimmunoassay system, using an anti-subunit S antiserum, two distinct peaks or rockets were seen in normal plasma and serum whereas only one peak was present in the propositae plasma or serum. In the bidimensional immunoelectrophoresis system, using the anti-subunit S antiserum, two major peaks were seen in normal plasma whereas only one peak was seen in the propositae plasma. Using an anti-subunit A antiserum no peak or precipitate was seen in our propositae in the electroimmunoassay or in the bidimensional immunoelectrophoresis systems. Both the parents and the children of our two propositae showed a normal coagulation pattern. Therefore, the heredity appears to be autosomal recessive. These data indicate that the defect is characterized by a normal factor XIII subunit S (support) and a lack of factor XIII subunit A (activity).


Effect of bleeding on in vivo in vitro colony-forming hemopoietic cells. The effect of bleeding on spleen colony-forming units (CFU-S) and on in vitro colony-forming cells with colony-stimulating factor (CFU-C) and erythropoietin (CFU-E) has been evaluated. The in vivo and in vitro colony-forming cells of the bone marrow show a decrease which for the CFU-E, CFU-C follows a short-lived increase. In the spleen, all progenitor cells assayed have shown a significant and sustained increase.


In vitro labelling of platelets. Experimental study on splenectomized patients with lymphomas using two different incubation media. Duplicate platelet survival studies, using autologous platelets labelled in vitro with radioactive sodium chromate, were carried out on 5 lymphoma patients who had been splenectomized 14-21 months earlier. In the first experiment plasma was employed as the incubation medium and in the second a Ringer-citrate-dextrose (RCD) solution. The uptake of chromate by the platelets was 2.0 times higher in the RCD as compared to the plasma experiments. An identical pattern for the immediate behaviour of infused labelled platelets was observed in the duplicate studies, and the recovery of platelet-bound radioactivity remained stable at the 90% level during 2 h after infusion. In these experiments the means for platelet mean life span were almost identical, 5.4+/-0.6 and 5.3+/-0.5 days, respectively, and significantly (p less than 0.05) shorter than the mean for a control group consisting of 21 healthy males (6.9+/-0.3 days). It is concluded that RCD and plasma seem to serve equally well as incubation medium at the in vitro labelling of platelets.


Refractory anemia with hyperplastic bone marrow: subclassification based on responsiveness to erythropoietin in vitro. The responsivenes to erythropoietin of cultured bone marrow cells, obtained from 7 patients with refractory anemia with hyperplastic marrow, was studied. 5 of these patients' marrows also exhibited sideroblasti changes. Heme synthesis in cultured bone marow cells was either responsive to stimulation by erythropoietin, or completely refractory. The sensitivity of the bone marrow cells to the hormone was not related to either the clinical or laboratory findings.


Waldenström-like immunocytic lymphoma with IgG serum M component. A case of immunoproliferative disorder with clinical features of Waldenström's disease but with an IgG-k instead of IgM serum M component is described. The lymphocyte population in the bone marrow, blood and lymph nodes was studied by rosette test, culture with PHA and immunofluorescence staining. Most of the bone marrow lymphocytes had membrane IgG. This case represents an intermediate form between myeloma and Waldenström's disease, thus supporting the unitarian concept of all the immunoproliferative disorders.


Increased serum folate-binding capacity: a familial trait. This report describes increased folate-binding capacity (FABC) in the serum of 7 of 10 family members. Genetically controlled elevation of FABC in normal subjects needs to be distinguished from the acquired increase in bindings capacity which has been described in a number of disorders.


Sea-blue histiocyte syndrome in Thai siblings. We report two cases of sea-blue histiocyte syndrome in Thai siblings. The abnormal histiocytes were found in the bone marrow and liver of both patients, but none was found in the other members of the family. Cirrhosis and absence of axillary hair were present in both patients. One patient also had elephantiasis of the legs and Klinefelter's syndrome. Our studies support an autosomal recessive inheritance.


Transfer of bovine J blood-group activity to human erythrocytes in vitro. THe bovine J determinant is transferred from a bovine serum nonlipid fraction to a human erythrocyte membrane lipid by an incubation procedure. The transferred J determinant is detected in the total lipids extracted from transformed human erythrocytes by an inhibition test in the bovine J system. It is also detected by cross-reacting human anti-A sera after treatment of human cells with papain prior or subsequent to transformation.


Refractory sideroblastic anemia secondary to autoimmune hemolytic anemia. A 75-year-old woman was hospitalized with autoimmune hemolytic anemia. During a period of 22 months the patient had six hemolytic crises which responded to treatment with prednisone and azathioprine. During the last admission the patient presented a sideroblastic anemia with 98% of 'ring sideroblasts' in the bone marrow. This association has never, to our knowledge, been reported before. It is possible that the immunosuppression played a definite role in the development of this sideroblastic anemia.


A new approach to the diagnosis of beta-thalassaemia. By use of isoelectric focusing in polyacrylamide gel rods we were able to detect traces of HbA (approx. 1%) as a sharp and discrete band. By overloading the gel considerable amounts of HbA (slightly contaminated with HbF) could be detected and isolated. The focused HbA was retrieved from the gels, separated from the carrier-ampholytes and concentrated by a one-step electrophoresis technique. With 3H-leuci ne-labelled haemolysates, after globin chain separation on CM-cellulose, an increase of the beta-chain counts relative to gamma-chain counts was obtained. The study of two cases of high HbF homozygous beta-thalassaemia has demonstrated that this technique may be a valuable tool in detecting minute amounts of HbA mainly in high HbF beta-thalassaemias.


Haemoglobin H disease and pregnancy in a Malaysian woman. A case of haemoglobin H (HbH) disease associated with pregnancy is presented and discussed in the light of reports in the literature. The variable symptomatology is commented upon, although mild to moderate chronic haemolytic anaemia seems to be a constant feature. The roles of folic acid supplements and of splenectomy; the avoidance of oxidant drugs, and the mode of inheritance in HbH disease are briefly commented upon. Available reports indicate that HbH disease probably has no adverse effect on pregnancy. However, the association of the two conditions is uncommon, and reports are too few, therefore, to allow definite conclusions on the outcome in all instances.


Cytogenetic studies in acute leukaemias. Prognostic implications of chromosome imbalances. Consistent cytogenetic abnormalities have been detected in the bone marrow cells of 19 out of 33 patients (57.57%) with a recent diagnosis of acute leukaemia. Chromosome imbalances were apparently non-random, chromosomes 8, 17, 20 and 21 being more frequently involved. The median survival in the patients' group with abnormal metaphases was 55 vs. 210 days in patients with only normal metaphases. In the former group complete remission was obtained in 2 of 3 ALL patients and in 4 of 16 ANLL patients. Major karytypic abnormalities were consistently found in 5 subjects with EL. Peripheral blood culture lymphocytes showed a 9qh polymorphism in 2 of 35 patients and sporadic or consistent chromosome abnormalities in 6.


Circulating anticoagulant against factor XI and thrombocytopenia with platelet aggregation inhibition in systemic lupus erythematosus. In a patient with systemic lupus erythematosus, anticoagulant activity directed against factor XI was found together with thrombocytopenia. In the serum globulin fraction, antiplatelet antibodies and an activity-inhibiting platelet aggregation could also be found. A possible correlation between the inhibition of platelet aggregation and the anticoagulant activity directed against factor XI is discussed.


Combined factor VII and factor VIII deficiency due to a casual association of heterozygosis for factor VII deficiency and hemophilia A. A patient with combined factor VII and factor VIII deficiency is discussed. The propositus is a 21-year-old male who presented a mild bleeding tendency. The patient appears to be a hemophilia and at the same time heterozygote for factor VII deficiency. This conclusion is based on the fact that heterozygosis for factor VII deficiency was present in the father and in other relatives of the paternal side. On the contrary, no factor VII deficiency was present in the maternal side of the family. However, the maternal grandfather was known to have been a bleeder and the propositus' mother, his sister and his aunt had low-normal factor VIII levels and were probably hemophilia A carriers. This type of combined factor VII and factor VIII deficiency appears to be due to the casual association of two independently segregating defects.


Systemic and regional blood flow during epidural anesthesia with epinephrine in the Rhesus monkey. Hemodynamic and regional blood flow measurements were made in five rhesus monkeys before and 10, 20, 40 and 80 min after induction of high epidural anesthesia (T1) with lidocaine (1%) containing 1:200,000 epinephrine. Following induction of epidural anesthesia with epinephrine, there were significant decreases in heart rate, mean arterial pressure, cardiac output and myocardial and renal blood flow. The percentage of cardiac output received by the brain was significanly increased following epidural anesthesia with epinephrine, thus evidencing autoregulation to maintain cerebral blood flow. Vascular resistance in the lower extremity was significantly decreased during anesthesia, indicating arteriolar dilatation. Also, during anesthesia, the lungs received a significantly increased proportion of the microspheres, suggesting an increased peripheral arteriovenous shunting of microspheres due to the arteriolar dilatation.


Absence of restricted diffusion in adipose tissue capillaries. Capillary permeability in adipose tissue for 57Co-cyanocobalamin (57Co-B12) was determined by the single injection, external registration method. The capillary diffusion capacity, CDC, (the permeability-surface area product, PS) was 1.1 ml/100 g-min at a capillary extraction of 0.21 and a plasma flow of 6.7 ml/100 g-min. Results were compared to 51Cr-EDTA data from a previous study with similar method and preparation. As CDC(51Cr-EDTA)/CDC(57Co-B12) was 1.81 and as D(51Cr-EDTA)/D(57Co-B12), the ratio between the free diffusion coefficients in water at 37 degrees C, was 1.79, it is concluded that restricted diffusion does not occur in cutaneous tissue for 57Co-B12 as compared to 51Cr-EDTA, i.e., 51Cr-EDTA and 57Co-B12 diffuse across the capillary membrane of adipose tissue at rates proportional to their respective free diffusion coefficients in water. The Pappenheimer equivalent pore radius estimate of 30 A and the Karnovsky interendothelial 40 A slit width are both defective in explaining the experimental data. The transendothelial channel system of fused vesicles (Simionescu, Simionescu and Palade 1975) is a possible structural equivalent for the present findings. The results support the hypothesis that capillaries of continuous type exhibit similar permeation characteristics regardless of the tissue in which they are located.


Transcapillary exchange of 14C-inulin by free diffusion in channels of fused vesicles. Capillary permeability for the extracellular, hydrophilic indicator 14C-inulin, was determined in the autoperfused cat gastrocnemius muscle by bolus injection, venous sampling expts. The capillary diffusion capacity, CDC (the permeability-surface are product, PS), was 0.84 ml/100 g-min, and capillary extraction, E, was 0.307 at a plasma flow of 4.0 ml/100 g-min as average values of 7 expts. Results were compared with 51Cr-EDTA and 57Co-B12 data of previous studies. The findings imply that 14C-inulin is not subject to restricted diffusion across the continuous capillary membranes of skeletal muscle as compared to 51Cr-EDTA as well as 57Co-B12. These hydrophilic indicators pass the capillary barrier at rates proportional to their respective free diffusion coefficients in water. The Pappenheimer equivalent pore radius estimate of 30 A (or slit width of 37 A) and the Karnovsky 40 A interendothelial slit width are inconsistent with the present data which imply a much larger pore size. The transendothelial channel system of fused vesicles is a possible morphological equivalent for the present findings which support the general theory that capillaries of continuous type exhibit similar permeation characteristics regardless of the tissue in which they are located. By kinetic black-box analysis the extravascular distribution volume for 14C-inulin in skeletal muscle was found to be 13.0 ml/100 g. The data indicate that 51Cr-EDTA, which has about the same molecular radius as sucrose, and 14C-inulin have identical extravascular volumes of distribution and that both molecules presumably enter the sarcoplasmic reticulum.


Disodium cromoglycate nasal spray in the treatment of perennial rhinitis. In a double-blind crossover trial, 24 patients with perennial rhinitis have been treated with 2% disodium cromoglycate (DSCG) nasal spray. 15 patients preferred DSCG to placebo, 9 patients showed no preference. Analysis of the diary cards showed a significant preference of DSCG in the group which received placebo first for the symptoms blocking, secretion and sneezing (p less than 0.1), while no preference between the treatment periods occured in the group receiving DSCG first. A significantly higher IgG concentration in serum was found in 15 patients with preference for DSCG than with remainder (p less than 0.05). No other changes in immunoglobulin concentration in nasal secretion or serum were found, which could be related to the effect of DSCG. DSCG nasal spray is considered a valuable supplement in the treatment of perennial rhinitis.


Angiodysplasia of the right colon: a cause of gastrointestinal bleeding. Thirty-four patients with intermittent lower gastrointestinal bleeding were diagnosed angiographically as having angiodysplasia of the cecum and right colon. Repeated barium and endoscopic examinations were negative. Right colectomy was performed on 17 patients, who were followed postoperatively for up to 7 years. Of these, four patients rebled, two of whom had angiographic evidence of related lesions involving other parts of the colon and terminal ileum. Silicone rubber injection and tissue-clearing techniques on the specimens have facilitated the pathologic identification of these lesions. Histologically, they are dilated submucosal veins and arteries associated with areas of overlying mucosal thinning and occasional ulcerations. Although the pathogenesis of the lesion is unknown, we think they are acquired rather than congenital and result from chronic submucosal arteriovenous shunting secondary to mucosal ischemia. Of the 34 patients, 17 had a history of cardiac disease.


Transcatheter intravascular coil occlusion of experimental arteriovenous fistulas. Fistulas were surgically created between the carotid artery and jugular vein in dogs. They were successfully occluded by means of transcatheter placement of stainless steel coils with attached woolen strands. Angiographic studies performed prior to, immediately after, and 4 weeks after occlusion were used to evaluate the efficacy of the procedure. Specimens excised 4 weeks after occlusion revealed fibrotic encasement of the coil in the fistula, forming a permanent occlusion. The technique has clinical application, and suggestions concerning its clinical use are presented based on information gained from the animal study.


Nonsurgical splenectomy.

Nonsurgical splenectomy. Surgical removal of the spleen is a well established procedure which is indicated for various hematologic disorders. Patients who are poor surgical risks may be considered for nonsurgical "splenectomy* using an embolization technique. This new technique should only be performed in patients who represent high surgical risk. The possible effectiveness of this procedure should be previously tested with the use of intraarterial vasopressin infusion. The following conditions should be fulfilled: (1) small emboli should be used to eliminate collateral flow; (2) the procedure should be carried out in two or three stages to minimize flank pain and the risk of massive splenic necrosis; and (3) most important, the spleen should be surgically removed as soon as the hematologic condition has improved in order to prevent splenic abscess formation. Splenic embolization was carried out in three patients with hypersplenism. One survived but was not helped by the procedure. Two died, one definitely and the other possibly as a result of the embolization. These discouraging results were reproduced in the animal laboratory where 11 of 14 animals developed severe complications, six of which were acutely fatal. The high incidence of late complications precludes non-surgical splenectomy as a routine procedure, but it can be carried out provided the spleen can be removed surgically.


Angiocardiography of subaortic obstruction in infancy. There is considerable heterogeneity among pathologic mechanisms responsible for subaortic obstruction in infancy. Although the relatively discrete forms of subaortic stenosis are uncommon in this age group, conoventricular malalignment, maladherent mitral valve, accessory endocardial cushion tissue, restrictive bulboventricular foramen, and a poorly expanded suboartic conus are responsible for most types of subaortic stenosis in this age group. The angiocardiographic recognition of these types of subaortic obstruction is aided by awareness of the anatomic framework in which they are found. For example: (1) conoventricular malalignment is commonly noted in patients with complete interruption of the aortic arch; (2) restriction at bulboventricular foramen level results in functional subaortic stenosis in those patients whose transposed aorta originates above an infundibular chamber; and (3) a poorly expanded subaortic conus may result in subaortic stenosis in patients whose ventricular loop and conotruncus have twisted in opposite directions (the anatomically corrected malposition). Subaortic obstruction in infancy is not uncommon, occurring in 99 of 1,362 necropsied infants with congenital heart disease. Nearly 70% of the patients with subaortic stenosis had obstructive anomalies of the aortic arch. Subaortic obstruction can be demonstrated angiographically, but high quality angiocardiographic technique is a prerequisite.


Electrocardiographic response to intravenous urography: prospective evaluation of 275 patients. A total of 275 consecutive patients referred for intravenous urography were monitored for electrocardiographic changes during administration of Conray 400 or Renovist II in the form of either intravenous bolus or infusion. Three patients who received Conray (two bolus and one infusion) developed sustained ventricular tachycardia; they reverted to sinus rhythm with intravenous lidocaine. A statistically significant (P less than .05) number of patients developed a heart rate increase of 10 beats/min or more with bolus of either drug (65 of 128) compared to infusion (21 of 147). Depression of ST segment (greater than or equal to 0.5 mm) was encountered statistically more often (P less than .05) with bolus (20 of 128) compared to infusion (six of 147). Increase of corrected QT of 0.10 sec or more was observed more often (P less than .05) with bolus (43 of 128) compared to infusion (five of 147). Abnormal resting ECG, coronary artery disease, or congestive heart failure imposed a higher (P less than .05) risk for development of ventricular tachycardia, ST depression, or ectopic ventricular beats. It is concluded that a bolus injection be very cautiously administered to patients with risk factors such as abnormal ECG, coronary artery disease, or congestive heart failure during intravenous urography and that resuscitative facilities be available.


Ultrasonic demonstration of intrarenal anatomy. Intrarenal anatomy including cortex, medulla, and arcuate vessels can be demonstrated with gray scale ultrasonography by using higher frequencies, appropriately focused transducers, and simple sector scans. We have defined this anatomy in three cadaver kidneys, in in vivo normotopic and transplanted kidneys, and in a fetal kidney in utero. The normal cortex is echogenic. The normal medulla is sonolucent and has a characteristic appearance distinguishing it from renal cystic disease. The arcuate vessels can be recognized as a discrete high level echo at the corticomedullary junction and serve as a marker for the evaluation of renal cortical thickness. The ability to identify and characterize intrarenal anatomy should aid in the discovery of smaller renal lesions and in the diagnosis of medical renal disease.


Notching of the ureter and renal pelvis in children. The excretory urograms of 14 children with ureteral notching were reviewed. In 10 of 14 cases the vascular impressions on the ureters were due to either venous obstruction and dilated collaterals or to dilated noncollateral veins. In two cases the notching was associated with arterial collaterals in renal ischemia and in two with dilated lymphatic channels. The implications of notching in children and the differences and similarities of this urographic sign between children and adults are discussed.


Malposition of the colon in right renal agenesis, ectopia, and anterior nephrectomy. Right renal agenesis, ectopia, or anterior nephrectomy can be identified by a characteristic malposition of the right colon. Barium enemas show that the posterior portion of the right colic (hepatic) flexure occupies the area of the right renal fossa. This change in position of the right colon was not observed as a normal variant in 100 randomly selected patients but was present in each of eight patients with agenesis, ectopia, or anterior nephrectomy. This malposition should not be mistaken for internal hernia, malrotation, or displacement by tumor mass or organomegaly. Nonvisualization of the right kidney on excretory urography with normal position of the colon excludes agenesis or ectopia as diagnostic considerations.


Radiologic findings in renal amyloidosis. The radiologic findings in 35 patients with renal amyloidosis (six primary and 29 secondary) are presented. Twenty of the patients with secondary amyloidosis had rheumatoid arthritis. Four patients had enlarged kidneys, 19 had contracted kidneys, and in nine it was possible to follow the decrease in renal size by repeat examinations. Earlier concepts that renal enlargement is typical for amyloidosis cannot be supported; this is probably only seen in the acute stage of the disease. Of 10 renal angiograms performed, all were abnormal. Renal amyloidosis should be considered in the differential diagnosis of contracted kidneys, especially if there is a clinical history of a chronic condition such as rheumatoid arthritis.


Angiographic findings in renal amyloidosis. The renal angiographic and venographic findings in five patients with renal amyloidosis are described. The findings include (1) normal or slightly decreased main renal artery; (2) pruning, tortuosity, and irregularity of the distal interlobar arteries, associated with smooth cortical margin and relatively homogeneous nephrogram; (3) nonvisualization of interlobular arteries; (4) asymmetric and uneven involvement of the kidneys; (5) prominent extrarenal arteries; and (6) renal vein thrombosis, frequently involving segmental and interlobar veins. Angiographic differential points between renal amyloidosis and other chronic renal parenchymal diseases are discussed with emphasis on the clinical history.


Infiltrating neoplasms of the kidney.

Infiltrating neoplasms of the kidney. Some neoplastic processes which involve the kidney develop not as a distinct localized mass, but rather as an infiltrating process which replaces the renal parenchyma, causes little or no mass effect, and contains little if any neovascularity. These neoplasms include (1) carcinoma of the renal pelvis when it invades the parenchyma (transitional cell and squamous cell); (2) blood-borne metastatic squamous cell carcinoma to the kidney (most frequently from the lung): (3) renal lymphoma of the infiltrating variety; and (4) infiltrating sarcomatous type of hypernephroma. While the urographic and angiographic appearance of these infiltrating lesions can be similar, clinical aspects are usually sufficient to differentiate them. Radiographic findings include amputation of portions of the collecting system on urography and encasement of vessels with a loss of nephrogram on angiography.


Radiographic manifestations of acute smoke inhalation. Acute smoke inhalation may lead to serious pulmonary injury and contribute significantly to mortality of fire victims. The chest radiographic findings in 21 patients with acute smoke inhalation are analyzed, and possible pathophysiologic mechanisms responsible for the radiographic abnormalities noted are discussed. Patients with surface injury burns were intentionally eliminated from this study. Our findings indicate that the standard chest radiograph is an insensitive means of determining pulmonary injury by smoke inhalation. The importance of blood carboxyhemoglobin levels and arterial blood gas determinations in the clinical evaluation of patients with acute smoke inhalation is stressed.


Uptake of bone imaging agents by diffuse pulmonary metastatic calcification. Three cases of diffuse lung uptake of the bone scanning agent 99mTc diphosphonate, which appears to reflect metastatic pulmonary calcification, are described. Each patient had hypercalcemia and renal failure. Clinical features common to patients with this scan pattern were ascertained from a review of the literature. Renal failure was present in all, and the majority have had hypercalcemia. The bone scan may prove to be a valuable adjunct to the diagnosis of metastatic pulmonary calcification; this characteristic pattern should be more widely appreciated.


Radiographic findings of immunoblastic lymphadenopathy and related immunoblastic proliferations. Immunoblastic lymphadenopathy is a recently recognized disorder of unknown etiology accompanied by clinical manifestations similar to lymphoma. Radiographic examinations of nine patients revealed multisystemic involvement and findings similar to those of lymphomatous processes. The diagnosis of immunoblastic lymphadenopathy should be considered when lung involvement accompanies mediastinal adenopathy and when the anterior mediastinal nodes are spared. One of the patients developed allergic pneumonitis which is interesting in light of recognition of immunoblastic lymphadenopathy as a hyperimmune phenomenon.


Strontium-87m lung scans in pulmonary aspergillosis. Experimental observations have indicated that radioactive strontium localizes in lesions infected with Aspergillus species. Preliminary clinical studies have recommended use of strontium lung scanning to evaluate patients thought to have pulmonary manifestations of aspergillosis. In view of the difficulty in accurately interpreting the clinical significance of recovery of Aspergillus species from sputum of patients with pulmonary disorders as well as the varied clinical presentations of pulmonary aspergillosis, we have attempted to confirm these reports. Ten patients with proven pulmonary aspergillosis and five selected control subjects without aspergillosis but with other pulmonary disorders were scanned after the injection of 2-3 mCi 87mSr citrate. The strontium lung scan correlated with the chest radiograph in four of 10 patients with aspergillosis; false positive scans were found in three of five patients with other pulmonary disorders. We conclude that strontium lung scans at present have no role in the diagnostic evaluation of patients suspected of clinically significant infections with aspergillus.


The kinky chest tube: a sign of entrapment following median sternotomy. Entrapment of chest tubes under one or more sternal sutures is an uncommon complication of median sternotomy. Five cases occurred among 759 median sternotomies performed during a 2 year period. A radiographic sign of chest tube entrapment is presented. Early recognition may prevent a second surgical procedure.