Mutagenic evaluation of nitroparaffins in the Salmonella typhimurium/mammalian-microsome test and the micronucleus test. Three nitroparaffins (nitroethane, 1-nitropropane, and 2-nitropropane) were studied in the Salmonella typhimurium/mammalian microsome (Ames) test, with and without microsomal activation systems. Nitroethane and 2-nitropropane also were studied in an in vivo mutagenic (micronucleus) test. These studies were undertaken because these solvents are widely used in the chemical and pharmaceutical industries and 2-nitropropane was reported to cause liver cancer in rats exposed by the inhalation route. Neither nitroethane nor 1-nitropropane was active in the Ames test with Salmonella tester-strains TA1537, TA92, TA98, or TA100. However, 2-nitropropane produced a significant increase in revertants in all of these tester strains, particularly strain TA100, where 3 microliter/plate doubled the number of revertants in the presence of microsomal enzymes. Negative results were obtained with both nitroethane and 2-nitropropane in micronucleus tests. These studies have shown that 2-nitropropane has the potential for causing point mutations in a microbial test system. However, this compound probably will not cause a chromosome mutation of the clastogenic type.


In vitro mutagenicity and cell transformation screening of caprolactam. Caprolactam was tested for genetic activity in bacterial and mammalian screens. It was inactive in the following tests: a) Salmonella/microsome mutagenicity; b) Chinese hamster ovary cell mutagenicity (induction of 6-thioguanine mutants); c) Enhancement of SA7 virus transformation of primary hamster embryo cells, when administered before or after virus, and; d) Chemical transformation of secondary hamster embryo cells.


[S-Acyl derivatives of thiosalicylamides with antifungal activity. III]. Some S-acylderivatives of N-monosubstituted amides of thiosalicylic acid in which the N substituents were unsaturated alkyl groups, cyclic or branched saturated alkyl groups, aromatic or aralkyl groups, were prepared and tested for antifungal activity. The substances which were all new were prepared by condensation of 2-mercapto-N-alkylbenzamides with suitable acylating agents. The fungistatic activity of the products was tested in vitro against the following: Candida albicans and Trichophyton mentagrophytes. The results reported in Table I underline the importance of the S-acylderivatives of N-monosubstituted amides of thiosalicylic acid as antifungal agents. Study of the results in Table I has also given some insight on the structure-activity relationships. The S-acyl-N-aralkylthiosalicylamides proved the most active of the compounds tested.


QSAR in cancer chemotherapy.

QSAR in cancer chemotherapy. Interest in the formulation of quantitative structure-activity relationships (QSAR) for antitumor drugs has begun to develop in the past decade. The work in this area has been reviewed briefly, using as examples studies on nitrosoureas, aniline mustards, and aryl triazenes. A salient conclusion from this analysis is that the present drugs in clinical use are more hydrophilic than one might expect. The reason for this may be that they have been developed using leukemia as the test system which may in part account for the fact that while the currently used drugs are effective against leukemia, they are not effective in general against solid tumors.


Diethylaminoalkyloxycoumarin and -furocoumarin derivatives. Four series of diethylaminoalkoxyderivatives of coumarin (at the positions 4 and 7) and furocoumarin (at the positions 5 and 8) have been prepared, in order to study their complexing capacity with DNA, these compounds having a double possibility of interaction, that is intercalation of the aromatic moiety between two base pairs and formation of an electrostatic bond between their terminal amino group and a phosphoric group of DNA. Some biological effects connected with the interaction with DNA have also been studied. The results obtained showed that coumarin derivatives have a low complexing capacity and lack any biological activity. The furocoumarin derivatives showed a markedly increased complexing capacity both in respect to the coumarin derivatives and to the parent furocoumarin (psoralen, as well as its 5- and 8-methoxy derivatives) and proved able to inhibit DNA and RNA synthesis in Ehrlich ascites tumor cells, as well as the growth of Staphylococcus aureus and of various strains of Escherichia coli. This activity was generally low but was constantly higher in 5-than in 8-derivatives, the same behavior being found with regard to the complexing capacity with DNA. A good correlation between the ability to form complexes with DNA and the capacity to inhibit cells growth was clearly evidenced.


Arguments for an inhibiting role of prostaglandin E1 on insulin secretion in man. This study aimed at investigating the effect of exogenous prostaglandin E1 (PGE1) administration on both basal and glucose-stimulated insulin secretion in normal man. For this purpose, six normal subjects were submitted to an infusion of PGE1 (0.2 microgram/kg/min) over a period of 75 min. Plasma glucose exhibited a progressive increase whereas insulin did not show any significant change. In order to exclude the participation of endogenously released catecholamines in these responses to PGE1, six additional subjects received PGE1 60 min after the start of the infusion of the alpha-adrenergic blocking agent phentolamine. Hyperglycemia developed during the combined infusion of phentolamine plus PGE1, but plasma insulin remained essentially unchanged. In other six normal volunteers, PGE1 (0.5 microgram/kg/min) significantly reduced both insulin response to intravenous glucose and glucose tolerance. These results seen to indicate that an intraislet synthesis of prostaglandins is involved in the beta-cell regulation of insulin release.


[Synthesis and anti-fungal activity of 5-aminopyrazole derivatives]. 4-Thiocyanato-5-amino or acylaminopyrazoles were prepared and their antifungal activity was tested against Candida albicans and Trichophyton mentagrophytes: the 4-thiocyanato-5-aminopyrazoles were the most effective in both tests.


[S-acyl derivatives of thiosalicylamides and their anti-fungal activity. IV]. Some S-acyl derivatives of N-alkylthiosalicylamides [Table I, II: substances (I leads to XXXIII)] in which the acyl group on S in a carbamic or thiocarbamic N-monosubstituted group were prepared and tested in vitro for antifungal activity. All the substances which are not previously recorded were prepared by condensation of 2-mercapto-N-alkylbenzamides with suitable isocyanates or isothiocyanates. The fungistatic activity of the products prepared was tested in vitro against the two strains: Candida albicans and Trichophyton mentagrophytes. The results (Table I and II) show that the N-monosubstituted S-carbamoyl and S-thiocarbamoyl derivatives of N-monosubstituted amides of thiosalicyclic acid have marked in vitro antimycotic activity. Many derivatives have activity of the same order of magnitude as that of clotrimazole and of these the most active compound is 2-(N-phenylcarbamoylmercapto)-N,n-heptylbenzamide (XXVI).


[The behavior of the renin-angiotensin-aldosterone system in rats subject to audiogenic stress]. The behaviour of the renin-angiotensin-aldosterone system in adult albino rats was studied during audiogenic stress (92 dB - 2000 Hz) for different experimental times (4-8-12-16-20-24-28 min). The results show the two-phase behaviour of PRA (plasma renin activity), which is related to aldosterone levels. These changes do not appear to depend on plasma electrolytes (sodium and potassium), while a possible role of ACTH is suggested.


[Long term treatment with acebutolol in hypertension (author's transl)]. Acebutolol, a new cardioselective beta-adrenoceptor antagonist, has been studied in 40 hypertensive patients (pts.) for a period of 6 months, 25 patients (group A) had never taken any antihypertensive agent, 15 pts. (group B) were previously treated with antihypertensives. This two groups are statistically different for the age (39.8 y. group A; 49.6 y. group B) for the values of basal blood pressure (BP) (175/105 mmHg group A; 197/114 mmHg group B) and for disease duration (9.9 months group A; 39.0 months group B). A significant antihypertensive response was obtained already at the 15th therapy day for the two groups, treated with acebutolol. Further, a little reduction of BP was obtained at the 3rd month going on with therapy; then the BP values showed non significant variation till the end of the study. Orthostatic hypotension were not remarked. After 3 months, acebutolol treatment 41% pts. rised diastolic BP (DBP) below 90 mmHg and 35% pts. had a DBP between 90 and 100 mmHg. The average values of heart rate have been significantly reduced after 15 days of therapy with sligh variations during the following month. The optimal mean daily dosages of the drug were obtained with titration in three months (540 mg/day group A and 740 mg/day group B). Regarding side effects rised during therapy, one patient showed "paradox hypertension" and another bradycardia which justified the interruption of the treatment. In our opinion, on the basis of the results obtained acebutolol shows a good efficacy in the treatment of hypertension and a very high tollerability.


The treatment of infected pseudarthrosis. Modern tendencies in the treatment of infected pseudarthrosis are discussed and compared with the methods of the recent past. Seventy four cases are analysed in detail. Fifty three were in the tibia, twenty six of which were treated by a standard modern technique consisting of osteomuscular decortication, excision of infected tissues and necrotic bone, external fixation and if necessary the addition of autoplastic cancellous grafts. The main purpose of this study was to analyse these results and assess the validity of this method.


A case of tibial fracture with skin loss and bone infection treated by Papineau's method. A case of open fracture of the tibia with skin loss and osteitis is reported. It was successfully treated by Papineau's method, which deals with the infection and bone loss before restoring the skin cover.


[Does an immune reactivity to human laryngeal cancer exist?]. Authors reconsider the present state of knowledge about immunology of laryngeal cancer. Authors, besides, analyse, in a critical way, problems concerning immunological monitoring of patients bearing solid carcinomas. They conclude that, up to date, it is impossible to have a biological test which can concretely show the patient's immune state.


[Toxic activity of Legionella pneumophila: current findings and prospects]. The AA. report the personal contributions and the recent findings of other investigators dealing with the toxic activities of Legionella pneumophila, the causative agent of Legionnaires' Disease. From the results of some tests (particularly Limulus endotoxin assay, pyrogenic reaction, skin Shwartzman reaction) there is an increasing evidence that Legionella pneumophila possesses some of the in vitro and in vivo biological properties associated with endotoxins of Gram negative bacteria, even if to a different of potency in different strains. However, the exact roles of an endotoxin and other bacterial products (e.g. haemolysins) as a pathogenetic mediators of the pathophysiological events of the disease remain to be determined.


Micromethod for the assay of renin of seven species. Renin was extracted and purified from human, dog, hog, rat, beef, rabbit and sheep kidneys. The renin "concentration" of these preparations was determined and expressed in international (Goldblatt) units by measuring the pressor effect produced by intravascular injection into normal dogs of a permanent colony. The renin "activity" was determined by bioassay, in the rat, of the angiotensin produced by incubation in vitro with renin substrate prepared from the serum of nephrectomized dogs. The rate of angiotensin formation was proportional to the concentration of renin, independent of the substrate concentration, and rather similar for renin of all seven species (mean rate = 55 x 10(4) ng angiotensin/unit renin/16 hrs). Due to this uniformity, either of the two international reference preparations of renin (human or hog) from the World Health Organization can serve as an internal standard in the assay of reninof each of the seven species, to express their concentration in terms of the international unit. Renin substrate from hog plasma was suitable for the assay of human, dog and hog renin (mean rate = 55 x 10(4)). However, it reacted much more slowly with the renin of rat, beef, rabbit and sheep (mean rate = 9 x 10(4)) and was, therefore, less suitable for their assay.


Changes in plasma renin activity in cirrhosis: a reappraisal based on studies in 67 patients and "low-renin" cirrhosis. The generally held views that plasma renin activity (PRA) is increased in cirrhosis and that this is secondary to reductions in the "effective" blood or extracellular fluid (ECF) volumes, consequent on the effects of portal hypertension, were re-examined in the present study. Measurements of PRA in 67 patients representing different clinical stages of cirrhosis showed that the mean value in 15 patients without ascites was significantly reduced. In 21 of 35 with ascites, PRA was either reduced or within the normal range. A low plasma renin substrate concentration was not the cause for the low PRA. These findings are not in keeping with the concepts of reduced "effective" blood or ECF volumes at least for the majority of patients at these stages of cirrhosis under the conditions of the present study. The only group showing a significantly increased PRA had evidence of renal impairment. In these 17 patients the underlying reduction in renal perfusion may have been the stimulus to the kidney that led to an increase to renin secretion.


Adjuvant radiation therapy in colon cancer. The overall five year survival of patients with colorectal cancer is excellent compared with other major visceral malignancies. This is attributable to effect surgical treatment, yet the death rate per 100,000 population has improved little in recent decades, stimulating a search for adjuvant treatment modalities until a better understanding of etiology and pathogenesis results in prevention of earlier diagnosis. Combination of the known cancerocidal effect of ionizing radiation and surgical excision has been used sporadically for over six decades, but only recently has this combined modality therapy been studied in a scientific manner. Numerous variables such as source of radiation, total tumor dose, dose-time factors, location of portals of treatment, size and shape of radiation fields, and the radiation-surgery sequence are now being studied. Current information leaves little doubt of the effectiveness of this combined modality therapy in selected patients. Controlled clinical trials must continue in order to obtain more solid data, which hopefully will eventually result in substantially improved survival.


Racial differences in pressure, volume and renin interrelationships in essential hypertension. The interrelationships of arterial pressure, plasma volume (PV), and plasma renin activity were studied in 152 consecutive male patients with uncomplicated essential hypertension. Of these, 22 (17 white and 5 black) subjects had normal plasma volumes and because of the small number were not included in the analysis of results. The remaining 130 (35 black and 95 white) patients were classified as having either expanded or contracted plasma volume. A higher percentage of black (43%) than white (21%) subjects were volume expanded (PV > 19 ml/cm) and a lower percentage of blacks (57%) than whites (79%) were volume contracted (PV < 17 ml/cm). There was not significant difference in mean arterial pressure and plasma renin activity between the volume expanded and contracted black patients. In contrast, the white patients with contracted plasma volume had significantly higher arterial pressures (p < 0.05) and plasma renin activity (p < 0.001) than those with expanded plasma volume. More blacks than whites had low plasma renin activity and did not manifest the inverse relationship of plasma renin activity to plasma volume as did the whites. These data confirm and extend previous observations that the relationship between plasma volume and plasma renin activity (PRA) in the male patient with essential hypertension seems to differ between the black and white race. Efforts to explain the low PRA in black patients might be best directed toward those patients with suppressed PRA and with contracted intravascular volume.


Alterations in the responses of the sympathetic nervous system and renin in borderline hypertension. We investigated the effect of stimuli activate the sympathetic nervous system on plasma catecholamines, renin activity, urinary metanephrine and normetanephrine, and various hemodynamic parameters in normal subjects (NIs) and borderline hypertensive (BH) subjects. No differences were observed in sympathetic nervous system activity or renin activity when the subjects were in the resting state on a 150 mEq sodium diet. However, the BH group exhibited greater responses in terms of plasma catecholamines and plasma renin activity in response to sodium deprivation and treadmill exercise. Although hemodynamic differences in the cold pressor test and handgrip exercise did not emerge, the radio of atrial size decrement to venous tone increment during the Valsalva maneuver was significantly reduced in the BH group. The investigations suggest that in the basal state, BH subjects have appropriate levels of activation of the sympathetic and renin systems for a normal level of pressure but that perturbations of pressure and volume factors lead to unmasking of abnormalities in regulation of both systems. The data are also consistent with the suggestion that venous compliance is reduced in these patients.


Osteogenic sarcoma: the past, present, and future. The term osteogenic sarcoma (osteosarcoma) is applied to malignant bone-forming tumors, identifiable by the matrix produced, though the histologic pattern may differ greatly. Ths more cellular (osteolytic) forms of the tumor have the poorer prognosis. Other prognostic factors are 1) site of the primary tumor; 2) duration of symptoms; and 3) extent of disease and tumor size. The site of tumor origin is the metaphyseal side of the epiphyseal line. The histogenesis of the tumors accounts for this distribution. Following a diagnostic biopsy, amputation of the extremities remains the treatment of choice. In selected cases, a limb-saving radical en bloc resection may surface. Radiotherapy plays a lesser but important role as adjunctive treatment, and as primary definitive treatment in certain types of bone sarcoma (Ewing sarcoma and primary reticulum cell sarcoma of bone). Until recently, chemotherapeutic agents have been used for late palliation only. Advances in treatment, however, have resulted from the application of innovative postsurgical adjuvant chemotherapy in children. The various chemotherapeutic regimens following amputation in adults and in children are discussed. In most such series of cases following amputation alone, five-year survivals have not exceeded 15-20%, with recurrent disease appearing within 18 months in fatal cases. Current studies reflect more effective regimens of adjuvant chemotherapy, with improved palliative results in metastatic osteogenic sarcoma. Although survival is much prolonged, however, many patients show a recurrence of the disease after long intervals of control, suggesting that five-year survival may not indicate a complete cure. At M.D. Anderson Hospital, th projected overall survival rate at three years is 79% of all patients with nonmetastatic disease. These results have accrued from the use of Compadri-I and Compadri-II regimens of chemotherapy. More intensive therapy may yield higher survival rates. It is known that the immunologic status of a patient definitely relates to prognosis. Although most of the investigations with immunotherapy are preliminary, emphasis is placed on improving the immune system in immunodeficient patients.


Carcinoma of the penis: analysis of 192 consecutive cases at the Instituto Nacional de Enfermedades Neoplasicas. Between 1952 and 1976 192 consecutive cases of penile epidermoid carcinoma were seen at the Instituto Nacional de Enfermedades Neoplascias of Lima, Peru. The mean age when the disease developed was 60.5 years, with a peak incidence between 60 and 64 years (32 patients). No correlation was observed between extensive lesions of the shaft of the penis to high pathological staging. Clinical examination of the inguino-crural nodes is not a good criterion for staging. We wait six weeks after eradication of primary lesion before lymphadenectomy. No correlation exists between grade and pathological stage. When no lymph node was positive, the overall survival rate over five years was 90.69%; when lymph nodes were metastasized there was an overall survival rate over five years of only 9.39 percent. The coefficient of cancer versus noncancer cause of death was 1.25 for pathological stage I, 3.09 for pathological stage II, 4.83 for pathological stage III, and 10.000 for pathological stage IV. Our patients did have advanced disease, as 57.14% of deaths occurred at two years and 25.21% more at five years.


Circadian changes in plasma renin activity and plasma aldosterone concentration in two-kidney hypertension rats. Circadian changes in plasma renin activity (PRA) and plasma aldosterone concentration (PAC) in normal and hypertensive rats were determined by measurements at 8 a.m., 4 p.m. and 12 midnight (MN). For the normals, PRA and PAC were highest at 4 p.m. Animals made hypertensive by constriction one renal artery with the other kidney intact were studied after 4, 5, 7 and 10 weeks; the clear-cut circadian rhythm for PRA in normals had disappeared but for PAC the circadian rhythm was present in the 4-, 5- and 10-week groups. Both PRA and PAC were elevated in all four hypertensive groups compared with the normal controls and there was a highly significant correlation between PRA and PAC. The 4 p.m. peak value for PAC was much higher in relation to the 8 a.m. and 12 MN values values in the hypertensive animals than in the normals. Sodium balance studies failed to demonstrate any appreciable differences among the groups. When the hypertensive animals were divided into two groups on the basis of the level of hypertension, the rats with moderate hypertension showed an average elevation in PRA which was significant in only the 4- and 7-week groups whereas PRA was elevated in all four groups with severe hypertension. Thus, the present data help to define the activity of the renin-angiotensin-aldosterone system in two-kidney, one clip hypertension in the rat.


Combination of irradiation and surgery.

Combination of irradiation and surgery. Irradiation can eradicate the microscopic disease that radical surgical procedures cannot remove, but high doses of irradiation fail to control large volumes of cancer. The concept "either irradiation or surgery" for all clinical situations should be eliminated. If irradiation has no place as the sole treatment for a disease, for example soft-tissue sarcomas or parotid tumors, it does not mean that it has no place in the management of the disease. Conservatism in both disciplines is to be preferred. Not only are the chances for cure increased, but also the quality of life is improved. On theoretical grounds, preoperative irradiation is to be preferred, but the sequence of te modalities of treatment depends upon the structures involved, the extent of the surgical procedure, the dose of irradiation, and the volume irradiated. Examples and results of the combined treatment in various disease areas are given.


Perspectives on the surgical treatment of cancer. The surgical treatment of carcinoma has been likened by some to "a macroscopic attack on a microscopic disease." Until better alternatives of treatment emerge, our best hopes for cure and significant palliation lie in early detection of disease, accurate staging, and appropriate surgical intervention, the last selectively supplemented with irradiation or chemotherapy or both. Oncologic surgery must be guided by accurate staging. Radical resection is appropriate when performed to eradicate malignancy discovered early and when the surgery neither unnecessarily sacrifices organ function nor interferes with an acceptable quality of life. Radical surgery in the presence of distant spread of disease is not always warranted. Other choices exist that may better serve the interests of such direly affected patients.


A quantitative study of muscle nerve sympathetic activity in resting normotensive and hypertensive subjects. Recordings of multi-unit sympathetic activity were made from muscle branches of the peroneal or median nerves in 33 healthy and 12 hypertensive subjects resting in the recumbent position. Simultaneous recordings of intra-arterial blood pressure were made on 17 normotensive and all hypertensive subjects. The neural activity, quantified by counting the number of sympathetic pulse-synchronous impulse bursts in the mean voltage neurogram (burst incidence) was plotted against the age and the arterial blood pressure level of the subjects. Between different subjects there were marked differences in mean burst incidence, from less than 10 to more than 90 bursts/100 heart beats and there was a tendency for increasing values with increasing age. Taking the age differences into account there was no significant correlation between the amount of activity and the blood pressure level. The effect of spontaneous temporary blood pressure fluctuations was studied by correlation different pressure parameters of individual heart beats to the probability of occurrence of a sympathetic burst and to the mean voltage amplitude of the occurring burst. Irrespective of the mean burst incidence, the occurrence of the bursts and their mean voltage amplitudes were determined mainly by fluctuations of the diastolic blood pressure. The diastolic pressure threshold for sympathetic outflow was found to be reset to higher blood pressure values in the hypertensive subjects and the variability of their thresholds was also greater than for the normotensive controls. At a given diastolic blood pressure, more sympathetic activity occurred if diastolic blood pressure was falling than if it was rising, and this directional dependence was more pronounced in the hypertensive subjects. We suggest that the increased directional dependence accounts for the greater variability of the blood pressure threshold for sympathetic outflow in the hypertensive subjects. The differences can be expalined on the basis of findings in animals with experimental hypertension, and it appears that they are secondary to the hypertension.


Evidence against acetone-soluble renin inhibitors in normal human plasma. The presence of acetone-soluble renin inhibitors in normal plasma has been proposed to explain the variation of plasma reactivity (PRR) in samples from normotensive and hypertensive subjects. In our experience, acetone extraction decreased PRR in relation to unextracted control values, an observation which is not consistent with the circulating lipid-renin inhibitor hypothesis. Exposure to acetone at -40 degrees C for 1 minute invariably denatured some endogenous angiotensinogen. The PRR in extracted and unextracted plasma was positively correlated with the concentration of available angiotensinogen, r = 0.955 (p < 0.05), and r = 0.964 (p < 0.01), respectively, but the addition of exogenous substrate did not uniformly increase PRR in acetone-treated plasma above control values. These data argue against the use of acetone extraction to demonstrate the existence of circulating lipid-renin inhibitors. Acetone removed 14% to 25% of the normal plasma lipids and although the extract contained most of the major lipid classes, neutral lipids were the most abundant (73% by weight). The presence of acetone-soluble phospholipids appeared to increase angiotensin I formation in the partially purified renin-angiotensinogen system, but phospholipids interfered with the radioimmunoassay and resulted in an overestimation of angiotensin I. Plasma neutral lipids decreased in vitro renin activity by 13% (p < 0.025) but this degree of inhibition suggests that lipid-renin interactions may have minimal in vivo physiological significance. In contrast to previous reports, we found the correlation between PRR and endogenous angiotensinogen in normotensive and hypertensive plasmas to be statistically significant (r = 0.643, p < 0.01). Inactivated human angiotensinogen was also shown to be an inhibitor of renin in vitro. This effect could have possibly influenced PRR values that were determined by others in the presence of inactivated angiotensinogen.


An oxygen dependent X-ray lesion in Escherichia coli strain B/r detected by penicillin. Enhancement of lethal damage to E. coli B/r by penicillin was observed after X-irradiation under aerobic conditions but not after exposure to X-rays under anoxia or after U.V. (260 nm). No enhancement of damage occurred when incubation with penicillin was delayed for 2 hours after aerobic X-irradiation. This enhancing effect was only detected in this strain and not in the filamentous strain E. coli B. It is concluded that an X-ray induced lesion, sensitive to the presence of oxygen at the time of irradiation and probably located in the cell envelope, initiates filamentation in E. coli B/r, which results in lethal damage in this strain.


Oral decongestant in acute otitis media. Results of a double-blind trial. In order to investigate the influence of an orally administered decongestant, norephedrine, upon the clinical course of acute otitis media and tubal function, a double-blind trial was performed in Copenhagen in December, 1976-February, 1977, in which 93 patients, aged 6 months to 10 years, with 135 ears with acute otitis media, were treated either with norephedrine or placebo in a randomized order. Most other treatment was avoided except for pain-relieving baby aspirins. The effect of norephedrine seemed to be no other than that of placebo. Because of this inefficacy of norephedrine the authors have, therefore, a material of patients with acute otitis media where the main treatment was pain-relieving aspirin. The use and abuse of antibiotics in the treatment of this disease are discussed, and the authors stress the necessity of performing controlled studies of the efficacy of antibiotics in acute otitis media, since such studies do not exist.


Benign mucous membrane pemphigoid: immunopathological study of three cases. Three cases of benign mucous membrane pemphigoid were investigated by direct and indirect immunofluorescence. The findings of the direct immunofluorescent examination of perilesional tissue are studied in detail. Finally the relationships between bullous pemphigoid and benign mucous membrane pemphigoid are discussed.


Results of surgical treatment of idiopathic pes plano-valgus by means of Grice's operation combined with reconstruction of the glenoid (accessory plantar) ligament and anterior transposition of tibialis posterior. (A review of 90 cases). After an average follow up of six years, the writers reviewed the results of ninety operations for idiopathic flat foot treated by Grice's operation combined with reconstruction of the glenoid ligament and anterior transposition of the tibialis posterior. Eleven parameters (clinical, plantographic and radiographic) were used for objective assessment of the initial and residual deformity, a numerical code being given to each. The results were excellent or good in 88 per cent of the patients. The initial severity of the condition and the presence of ligamentous laxity either generalised or localised to the ankle joint, had an adverse effect on the results. The technique of Grice's operation is extremely important. The results are always excellent or good when the sinus tarsi is widely opened up and the bone graft correctly placed. Anterior transposition of the tibialis posterior improved the results in 26 per cent of cases: elongation of the Achilles tendon was only rarely necessary. The type of graft had no effect on the results: homoplastic grafts are therefore preferable since they cause less inconvenience. Surgical intervention before the age of four years is a mistake: the best results are obtained between nine and thirteen years.


Metabolic activation and deactivation of mutagens and carcinogens. The activity of some mutagens has been investigated in the Salmonella test either in the absence or in the presence of fortified rat liver microsomal fractions, together with an NADPH-generating system. With respect to their metabolic reactivity, the compounds tested could be distinguished according to four reproducible trends: (a) conversion of inert compounds into mutagenic metabolites (e.g. 2-aminofluorene and benzo(a)pyrene); (b) further enhancement of mutagenicity (e.g. 1,2-epoxybutane); (c) no effect on mutagenicity (e.g. glycidol, folpet, nitrofurantoin and 2-nitronaphtalene); (d) slight decrease (e.g. 1,1,1-trichlor 2,3-propenoxide), marked decrease (e.g. sodium nitrite, 5-nitro-2-furoic acid and captan) or even complete reversal of mutagenicity (e.g. styrene oxide, sodium azide, sodium dichromate and other Cr6+ compounds). The Salmonella/microsome test was effective in discriminating not only the mutagenic activity but also the metabolic reactivity of structurally related chemicals (e.g. the fungicides captan and folpet). In some cases, mutagens were tested also in the presence of other biological preparations (e.g. rat muscle or lung microsomal preparations, human gastric juice, serum, plasma or erythrocyte lysates). The mutagenic and metabolic properties of largely used products (e.g. an antibacterial drug containing nitrofurantoin and laboratory reagents containing sodium azide) have been also checked. The mechanisms underlying the metabolic behaviour of some of the mutagens tested have been reported. The results obtained have been correlated with the literature data on their carcinogenicity. Although these in vitro findings are only indicative of the possible metabolic fate of mutagens in the whole organism, the observed effects may be useful in order to explain the epidemiological data and the results of animal tests, and to assess the possible health hazards of mutagens.


Monovalent cations requirement of the fructose 1,6-bisphosphate-activated pyruvate kinase from E. coli. The fructose 1,6-bisphosphate-activated pyruvate kinase from Escherichia coli has been purified by a simplified procedure, which gives a homogeneous enzyme in approximately half the working time required by other methods and is suitable for large scale preparations. The activity of the enzyme is strictly dependent on the presence of monovalent cations. Enzyme activity is elicited by K+ and NH4+, but not by Na+. Homotropic cooperativity is displayed in the activation by K+ and NH4+ and heterotropic effects are reciprocally exerted by monovalent cations and other ligands, such as phosphoenolpyruvate and fructose 1,6-bisphosphate. The allosteric nature of such interactions is suggested by changes in heat stability of the enzyme induced by K+ and fructose 1,6-bisphosphate. NH4+, but not K+, at high concentrations, cause an inhibition of enzyme activity.


Ewing's sarcoma (a review of 195 cases). The authors discuss their findings resulting from an analysis of a large series (195 cases) of Ewing's sarcoma. In particular they compare the clinical and radiographic pictures and prognosis prior to and after the introduction of adjuvant chemotherapy. This reveals such marked differences in the past and present features of this neoplasm that some of our previous criteria and attitudes to diagnosis and treatment have undergone radical reappraisal.


The primary structure of mitochondrial aspartate aminotransferase from pig heart: peptides obtained by cleavage at basic residues. Results obtained as part of a study of the primary structure of mitochondrial aspartate aminotransferase from pig heart are described. In particular, the S-aminoethylated protein was digested with trypsin and with the lysine specific protease from A. mellea. In the first case peptides contained 221 out of the total of 401 amino acid residues in the protein were obtained. By contrast the digest with A. mellea protease was not examined exhaustively and six peptides containing 49 amino acid residues were isolated. Digestion of the trifluoroacetylated and S-aminoethylated protein with A. mellea protease yielded a mixture of large fragments three of which, containing 89 amino acid residues, are described here. The combined results of these three digests yielded 66.6% of the total structure, concentrated mainly in the N-terminal half of the protein.


Lumbo-sacral radiculography with a new, water-soluble contrast medium: myelografin (meglumine ioserinate, SSH 239 AB). The authors present the results of a clinical trial of a new water-soluble contrast medium for radiculography: meglumine ioserinate. This trial was conducted on eighty eight patients in the Orthopaedic Clinic of the University of Rome between 1975 and 1976. The patients were subdivided into two groups, one of fifty four in whom a single dose of 5 ml was injected, the other of thirty four who received a double dose of 10 ml of contrast medium. In the latter the medium was always injected undiluted. No disturbances following radiculography were reported by 58 per cent of the first group and 44 per cent of the second. The clinical side-effects encountered in the other patients are analysed. These side-effects were negligible in the majority of cases, and occurred less frequently than with meglumine iothalamate, and at least more often than with meglumine iocarmate. Finally, the findings in the cerebrospinal fluid are described, before and twenty four hours after the test, in a small group of these patients. The contrast and diffusibility were found to be excellent, as also was the tolerance, which has the advantage that the patient can be kept in the horizontal position after the examination. Despite this, because of some changes encountered in the cerebrospinal fluid, and because of a convulsive episode presented by one patient treated with the double dose, the authors advise diluting the contrast medium in distilled water, so as to lower the osmotic pressure.


Effect of prostaglandin I2 on ovine placental vasculature. The response of the placental circulations to prostaglandin I2 (maternal dose 20 microgram/kg, fetal dose 180 microgram/kg) was observed in 10 near-term sheep with chronically implanted vascular catheters. The blood flows before and 90 s after the injection of prostaglandin I2 were measured using radioactive microspheres. The injection of prostaglandin I2 to the mother decreased th blood pressure from 109 +/- 4 to 69 +/- 5 mmHg (P < 0.001) and increased the vascular resistance of the maternal cotyledons from 0.166 +/- 0.018 to 0.209 +/- 0.02 mmHg/(ml/min) (P < 0.001). The vascular bed of the non-cotyledonary uterus vasodilated as the resistance fell from 0.705 +/- 0.02 to 0.266 +/- 0.02 mmHg/(ml/min). (P < 0.001). Prostaglandin I2 caused the fetal arteriovenous pressure to fall from 37.6 +/- 1.35 to 26.0 +/- 1.6 mmHg. There was no significant change in the vascular resistance of the fetal cotyledons. We observed vasodilation in the fetal membranes as vascular resistance fell from 1.06 +/- 0.14 to 0.75 +/- 0.10 mmHg/(ml/min) (P < 0.001). The infusion of prostaglandin I2 significantly depressed the response of the placenta and uterus to norepinephrine. We have not proved that prostaglandin I2 plays a direct role in maintaining placental vascular homeostasis but it may modulate the response of this organ to exogenous vasoactive agents.


Disseminated intravascular coagulation: a review of its pathogenesis, manifestations and treatment. Disseminated intravascular coagulation is a clinicopathologic process of man and animals which occurs secondary to many diseases. The process may manifest in a variety of clinical syndromes including medical shock, haemorrhage, haemolysis and organ failure. A diagnosis can be confirmed by detecting a deficiency of several haemostatic components and the presence of raised levels of circulating fibrinogen (fibrin) degradation products. Therapy of the disorder includes the removal of the initiating factors which have provoked the clotting process together with the use of anticoagulants. The disease processes in which disseminated intravascular coagulation is implicated in the dog are enumerated.


Current anaplasmosis control techniques in the United States. A card test for detecting anaplasmosis, along with the complement-fixation test, has proved useful in identifying carrier animals. This identification, associated with treatment with tetracyclines, has been a basis for control in the southeast where anaplasmosis is endemic. The tetracyclines are used parenterally (terramycin 11 mg/kg, 10-14 days) or orally (2,2 to 11 mg/kg, 45-60 days). Notwithstanding these methods, anaplasmosis remains a problem and many animals require treatment to moderate the course of acute infection. A new drug, T-200 (a long-lasting terramycin), has been tested and found effective in treating acute infections (20 mg/kg, 1 time) and in cleaning carrier infections (20 mg/kg, 2 times at a 7-day interval). For several years, a killed adjuvant vaccine was extensively used to control anaplasmosis. The occurrence of neonatal isohemolytic anaemia in association with this vaccine has discouraged its use. This vaccine is still being marketed, but is usually used on selected animals. An attenuated Anaplasma vaccine of ovine origin has been developed, but is not licensed for use in the United States although it has been successfully used elsewhere.


Some aspects of the epidemiology and control of bovine babesiosis in Australia. A short account of the epidemiology and control of babesiosis in Australia is presented. Epidemiological topics discussed include differences in the transmission of Babesia bovis and B. bigemina by the cattle tick, Boophilus microplus and the relative prevalence, disease incidence and pathogenicity of B. bovis and B. bigemina. Circumstances under which babesiosis occurs in Australia are described. In the Section on control, only vaccination is discussed. Changes in the preparation of babesial vaccines, particularly those resulting in a highly infective vaccine containing relatively avirulent B. bovis are described. Fluctuations in demand, such as the increase from about 100,000 to over 1,000,000 doses in 4 years in the mid-1960s are shown. An unexpected increase in the use of A. centrale in 1973 is discussed, and the supply of B. bigemina for cattle exported from Australia reported.


Epizootiology and control of anaplasmosis in south africa. The history of bovine anaplasmosis, or tick-born gallsickness, since the discovery of Anaplasma marginale by Sir Arnold Theiler is briefly reviewed. The development of the Anaplasma centrale vaccine by Theiler, up to the composition of the present vaccine issued by Onderstepoort in which the original isolate is still passaged, is discussed in detail. Recent transmission studies at Onderstepoort have shown that 5 tick species are capable of transmitting anaplasmosis intrastadially, and intrastadial transmission, especially by adult male ticks, it is believed, could play an important role in the epizootiology of bovine anaplasmosis in South Africa. Disease incidence and tick distribution are discussed in relation to enzootic and epizootic conditions. Investigations have proved that the Onderstepoort A. centrale vaccine is not as avirulent in adult cattle as it was previously thought to be. The results of a field trial undertaken to test the infectivity of the vaccine, are given.


Ultrastructure of cel organelles by scanning electron microscopy of thick sections surface-etched by an oxygen plasma. Kidney tissue double fixed in glutaraldehyde and osmium tetroxide and embedded in epoxy resin by standard techniques used for transmission electron microscopy was cut into section 1 micron or more thick and surface-etched by an oxygen plasma. Etching caused ash residues (possibly composed partly or organo-metallic complexes) of membranes and other etch resistant cell components to emerge as recognizable structures projecting upward from the surrounding embedment which was combusted and removed as volatile products. using the secondary electron mode for image formation, structural features of cells which could be imaged with clarity with the scanning electron microscopy included: profiles of peripheral and in-folded plasma membranes, the nuclear envelope and profiles of cut mitochondrial matrix granules, cristae and the outer limiting membranes. Resolution was better than that  obtainable from most other methods of specimen preparation currently being used in scanning electron microscopy for viewing the internal structures of cells or organelles in bulk samples of tissue.


A simple vacuum pipette for processing groups of specimens for electron microscopy. A standard sink filter pump attached to a special glass adaptor, holding pipettes, enables groups of specimens to be fixed and dehydrated for electron microscopy with speed and safety.


A method for preparing and handling cross-sections from early chick embryos for scanning electron microscopy. A method is described for processing multiple cross-sections from early chick embryos for scanning electron microscopy. Embryos are cut through the desired regions. Sections are affixed to a coverslip with Duco cement and critical point dried by Freon 13 or liquid CO2. This method provides a reliable means for preparing multiple cross-sections from single embryos and eliminates the need for direct handling of brittle tissues after drying.


[Skin tests with Yersinia pseudotuberculosis antigen in Turkey (author's transl)]. Intradermal reactions to Yersinia pseudotuberculosis antigen are investigated on 2759 persons in different regions of Turkey (Samsun, Antalya, Urfa, Diyarbakir, Hakkâri, Ağri, Denizli and Ankara provinces). This test was found positive in 56 persons. The highest percentage of positive reactions was observed on the people from Samsun, Diyarbakir and Urfa. No positive tests were observed on the people from Hakkâri. The skin test results were also investigated and observed considering the time of the reaction as 20 min., 24 hours and 48 hours after injection of the antigen on the people from Urfa, Ağri and Hakkâri.


[Plasmodium malariae infection due to exchange transfusion (author's transl)]. A four month old baby with Plasmodium malariae infection thought to be due to exchange transfusion is presented.


[A Salmonella typhimurium epidemic in premature and newborn infants (author's transl)]. Salmonella typhimurium was isolated from a fatal epidemic among premature and newborn infants in the Children's Hospital of Hacettepe University. The epidemic showed gastroenteritis, sepsis and meningitis. Salmonella typhimurium were isolated from 17 of 65 infants. No salmonellae were isolated from the personnel of the unit and from the personnel of the related kitchen. The mothers could not be examined. Examinations are being continued with the collaboration of the said unit and a more detailed report is being prepared.


[Intraoral support prosthesis of the laryngohyoid complex and of the chin after complete removal of the mandible]. The various methods proposed to date for supporting the glossohyoid-laryngeal complex after removal of the mandibular arch have been examined. A new type of intra-oral maxillofacial prosthesis for supporting the soft lining tissues of the lower 3rd of the face is then described. This has made it possible to avoid final tracheostomy in spite of total mandible removal.


[Althesin or CT 1341 as a drug to induce balanced anesthesia with ethrane or fluothane associated with type II NLA in dental, maxillofacial and plastic surgery of the head area]. The Authors have tried Althesin as a medicine for the induction and maintainement of the narcosis in the stomatological, maxillo-facial and extra and intra-oral surgery. They have deduced that CT 1341 does not constitute to the anaesthetics Ethrane and Fluothane because of the anaesthetic-level instability (restlessness of the patient and clonic movements of the limbs during the most painful operations in particular). The Authors, supporters of the balanced anaesthesia, suggest using Althesin in the narcosis induction, the maintaining of which is carried on by the N.L.A. type II medicine and by the Ethrane or Fluothane. The latest ones are to be given in very small, not dangerous quantities. The Authors have so obtained a remarkable oxygenation of the patient, a ready, calm and lucid awakening without any collateral and dangerous consequences.


[Initial clinical results from the use of a new antibiotic, Zimox, in dentistry and maxillofacial surgery]. Zimox (amoxicillin) has been experimented in a variety of stomatological inflammatory forms and in maxillo-facial surgery. Results with respect to the type of inflammation, pain response, impaired function oedema and trismus in various forms of dysodontiasis are reported.


[Plasmodium ovale malaria in France. Probability of of genetic control of the incubation period (author's transl)]. Plasmodium ovale as the causative parasite in attacks of malaria is rare. Nevertheless, the number of cases seen in France would seem to be on the increase. In 137 attacks of malaria collected between 1967 and 1978, Plasmodium ovale was found on 13 occasions. The main characteristics of this form of malaria are, apart from its benign nature, the usual absence of any recurrence and a very variable incubation period, ranging from fifteen days to several months or even a year (with an average of 3.2 months). It is thus important to bear this diagnosis in mind, even if a long period elapsed since return from an endemic area, and it will be realised that adequate chemoprophylaxis using a schizonticide does not offer protection from forms with a long incubation period. Genetic control of the duration of the period of maturation of exo-erythrocytic forms, i.e. the incubation period, is suggested, identical to that recently advanced in the case of Plasmodium vivax. This would account for the variability and possible long duration of incubation periods. A usual monoclonal character of these infections could explain the virtual absence of recurrences.


[Acute respiratory failure: comparison of spontaneous ventilation with continuous positive airway pressure (CPAP) and mechanical ventilation with positive and expiratory pressure (CPPV) in 6 cases (author's transl)]. The hemodynamic and respiratory effects of spontaneous ventilation with continuous positive airway pressure (CPAP) and mechanical ventilation with positive and expiratory pressure (CPPV) were compared in six patients with acute respiratory failure. Arterial and mixed venous gases, cardiac output, oxygen delivery and consumption, airway and oesophageal pressures were measured, with each patient on intermittent positive pressure ventilation (IPPV), CPAP and CPPV with the same level of positive and expiratory pressure (PEEP = 20 cmH2O). CPAP was as efficient as CPPV for improving arterial oxygenation. Cardiac output was higher on CPAP than on CPPV due to a lower intra-thoracic pressure with spontaneous ventilation, thus oxygene transport was higher with this methode. However total oxygene consumption and PaCO2 were slightly increased with CPAP due to a higher breathing's work. So, CPAP is as efficient as CPPV at the same level of PEEP in improving intra-pulmonary shunt and PaO2, without adversely affecting cardiac output.


[A new vascular shunt catheter (author's transl)]. For over 10 years, many authors have attempted to obtain vascular exclusion by intubation with rigid catheters: rubber tube, Argyle is catheter, special catheters with 1, 2 or several full balloons. Owing to this regidity, introduction is difficult and this calibre of the catheter is limited, with reduction of the flow. The authors have developed a supple multitoric catheter which takes on its final form only at the desired site, at the time of inflation.


[Neonatal hyponatremia from maternal origin. Three cases (author's transl)]. The effect of the treatment was controlled by measurements of plasma renin activity and aldosterone concentration. These observations concern maternal toxemia treated by diuretic and dietary sodium restriction two weeks before delivery. In two cases, labor was augmented with oxytocin infusion. These cases illustrate the respective role of sodium depletion and hemodilution in the occurrence of maternal and neonatal hyponatremia. They emphasize the amount of sodium supplementation in these newborn infants.


[The detection of soluble immune complexes (author's transl)]. The detection and characterization of soluble immune complexes is complicated by the broad spectrum of complexes occurring in human pathology. Thus, differences in immune complex size, specificity and ability to interact with immunologic effector systems such as complement or cells, suggest variable pathogenic potential. Therefore, a variety of techniques for detection should be available. The introduction of radioimmunoassays and the recently improved knowledge of immune complex biochemistry have lead to the description of a large number of detection procedures, which in turn has widened the catalogue of diseases associated with immune complexes. Among 50 procedures known today, this article selects some pertinent tests which are critically discussed with respect to their specificity, sensitivity and possible interest in clinical medicine.


[Studies in the BALB/c mouse of the efficiency of spraying as compared to other inoculation ways for immunostimulant (author's transl)]. The of efficiency of spraying as compared to intranasal and digestive ways was tested on Balb/c mouse by using on the one hand an immunostimulant product and on the other various types of test : Myxovirus influenzae by aerosol, Streptococcus pyogenes intranasally, Klebsiella pneumoniae intraperitoneally. Results showed that in the case of influenza virus the immunostimulant inhaled as liquid aerosol or powder aerosol, or deposited on the nasal mucosa was very active. When the test germ was Streptococcus and the contamination intra-nasal, only the homologous way was efficient. When the test germ was Klebsiella pneumonia all inoculation forms except powder aerosol were effective. The comparative study of aerosols granulometry helps grasping this phenomenon.


[Bilateral primary pulmonary amyloidoma. Diagnostic contribution of subcutaneous needle-biopsy and of the digoxinemia test]. A case of bilateral neoplastic pulmonary amyloidosis is presented and discussed. The diagnosis was based on the results of a lung biopsy; and laboratory methods of great utility in this pathology were used. Of particular importance are the indications which can be obtained through subcutaneous biopsies and the biochemical test for digoxinemia.


[Creatinine clearance: indirect estimate (author's transl)]. The validity of some formulas proposed to estimate the creatunine clearance by values of serum creatinine and others non analytical parameters (sex, age, weight and height) was tested in a group of 200 adults (100 males and 100 females) and in a group of 134 children (80 males and 54 females). The age ranged from 1 month to 78 years; the values of serum creatinine varied from 0.3 to 10.0 mg/dl; the clearance value was calculated also in the usual way by the AutoAnalyzer (N-11 a Technicon method). The statistical analysis and the comparison of the data show good correlation between the clearance values calculated either by the direct or the indirect method. However the frequency of inacceptable disagreements does not allow the use of these formulas to evaluate the renal function and to regulate the administration of some drugs.


[Fundamental studies for the development of pancreas scanning agents--preparation of radioactive iodine-labeled amino acids and peptides and their distribution (author's transl)]. 75Se-Selenomethionine is often used for the isotope scanning of pancreas. However, it is desired to develop excellent pancreas scanning agens that give more specific distribution and less radiation hazards than the agents. Pancreas has a high ability to incorporate amino acids into its cells and to utilize the acids for the synthesis off proteins and enzymes. On the basis of this preferential uptake of amino acids, radioactive iodine-labeled amino acids and peptides, gamma-131I-iodo-alpha-aminobutyric acid, N-2-131I-monoiodoacetyl-L- and D-leucines, L- and D-leucine 2-131I-iodoethyl esters, 125I or 131I-labeled dipeptides, and insulin 125I-A and 131I-B chains, were prepared and assayed for their distribution in mouse organs and Ehrlich ascites tumor cells. Radioactivity of these labeled compounds incorporated into pancreas was almost the same as that of liver and spleen, and considerably smaller than that of stomach, duodenum and kidney. Since a high incorporation into stomach was seen also after the administration of 125I-sodium iodide, it was suggested that iodine ions were liberated in vivo from the labeled compounds within a short time.


[Multi-institution, multidisciplinary radiology and endoscopy trial of the diagnostic accuracy of the double contrast examination of the stomach surface]. In 12 X-ray and gastroenterology departments 1570 patients, clinically suspected to have a gastric pathology, have been examined by double contrast (surface) examination of the stomach followed by gastroscopy. Diagnostic accuracy was 93% in respect of endoscopic data, assumed correct by hypothesis. On the basis of a cost and benefit evaluation, made according to the well known criteria, a wider routine use of the double contrast technique is proposed.


[Erythrocyte blood groups and geographic pathology (author's transl)]. Blood groups are an obstacle to reproduction, transfusion and transplantation. There are immunological abortions due to the antibodies of "p" phenotype women; and Rh haemolytic disease of the new-born is in direct proportion to the frequency of the "r" gene in a given population; the problem of transfusional allo-immunisation is completely parallel. Certain membrane anomalies (due to exceptional erythrocyte blood groups--Rh null, Rh mod or McLeod, for example), can provoke hemolytic anaemias, but in these cases the subjects are scattered throughout the world. An important problem is that of the relationships between Duffy antigens and malaria: from what is known about plasmodium Knowlesi, Fya and Fyb antigens are related to the erythrocyte receptors for this plasmodium: the Fy(a-b-) red cells, even of exceptional non-blacks, are not infested with parasites. Two kinds of receptors are postulated: one for adherence and another for penetration. In contrast, plasmodium falciparum does not recognise the same receptors as plasmodium Knowlesi. Experiments carried out on man have led to the conclusion that plasmodium vivax also used Fya and Fyb antigens to penetrate the red cell. These recent facts give rise to the problem of a possible natural selection by plasmodium vivax, which would eradicate polymorphism, whilst until now, the facts concerning plasmodium falciparum have explained the balance of polymorphism.


[Alertness and attention: recent theoretical perspectives and new areas of exploration (author's transl)]. Long considered only under the aspects of a level of alertness, attention has also to be considered under its directional aspects which imply attentive focalization and selection of information. The present paper reviews data and hypotheses concerning attention as a level of alertness, selective attention, slow cortical phenomena (negative contingent variation and evoked potentials), and attention as a motor program.


[Event-related potentials and the evaluation of selective attention processes: a review of recent trends in this field (author's transl)]. The aim of this paper was to briefly review the use of normal human Event Related Potentials (ERP) in the evaluation of processes of diffuse and selective attention. The reviewed results from recent experiments concern the exogeneous components of the evoked potential (in particular N120-P200), the endogeneous components N200-P300, P600 (or the so called "Emitted Potentials"), the motor related potentials and the CNV. The behavioural correlates of each of these components, as well as their relationships with the various stages of information processing during perceptivo-motor tasks implying decision making, were emphasized. As a conclusion, the psychiatric applications of this type of electrophysiological research was discussed; moreover the need of its development in the field of neuro-psychology was underlined.


[Smoking and the cardiovascular system]. In this brief review the results of the most important studies about smoking and cardiovascular diseases are referred. Epidemiological, pathological, and clinical data show an higher mortality from coronary heart diseases in smokers, and an higher frequency of atherosclerothic lesions, affecting all types of sistemic vessels. By an analysis of the tobacco smoke composition, some of the effects and acting mechanism of nicotine and Carbone Monoxideon the cardiocirculatory system are treated. It is remarkable that cigarette smoke is only a "risk factor" and overall together other conditions as hypertension or dyslipidamia.


[Possibility of pulmonary circulation study with nongaseous radioactive isotopes]. This paper deales with the applications of radionuclides to the study of human pulmonary circulation for better knowledge of some morphological and dinamic functional aspects. At this time the methods used are divided in three groups in respect to the purpose. - Methods for static investigations of pulmonary perfusion, by scintigraphy with radioalbum aggregates. - Methods for dynamic investigation, general radiocardiography and selective right radiocardiography with radioalbum macroaggregates. - Methods for morpho-functional investigation, especially Isotopoangiocardiopneumography using gamma-camera and Tc99mO4. Here are treated the fields of applications, the purpose and the limits of these methods, used in a large number of and acquired pulmonary vascular diseases.


[Morphofunctional aspects of the pulmonary circulation in kyphoscoliosis; angiocardiopneumographic, scintigraphic and hemodynamic characteristics]. In a group of 30 patients suffering from kypphoscoliosis of different degrew was effected a series of researchs (investigations to value the morphological functional behaviour of the pulmonary circle. The used ways were: angiopneumography, pulmonary perfusional scintigraphy, cardiac catheterisation and radiocardiography. The achieved results allowed to single out interesting aspects both of pulmonary vascular bed compromission and of some haemodynamic parameters. These alterations show different degrees according to seriousness of the deformation and the presence or not of broncopneumonia complications in these patients.


[Controlled clinical trial of nomifensine in treatment of depression (author's transl)]. Therapeutic efficacy of Nomifensine and Nortriptyline was compared with a double blind study on 29 patients suffering from several kinds of depression. The patients were admitted to the Institute of Nervous and Mental Diseases of the University of Florence. Drugs were administered according to a flexible dosage varying from 50 mg to 125 mg/day, subdivided in 2-3 doses. The experiment is referred to the first 15 days of treatment. In order to estimate the effect of the drugs, the Hamilton's scale for depression was used. This scale was administered before treatment and on the 5th, 10th, 15th, day of therapy. Scores of Hamilton's scale and of some "Clusters" were computerized. It was found that Nomifensine has an antidepressant effect comparable to that of Nortriptyline. No relevant differences were noted in the range of action of these drugs. No side-effects were detected in the doses employed.


Preservation of pancreas for transplantation. For preservation of the pancreas, extracellular and intracellular solutions with aprotinin light microscopy showed both solutions to be suitable for a 3-hour preservation, though the intracellular solution appeared more suitable. Preservations for 6 and 24 hours have also been attempted, but these specimens showed fairly severe histological lesions.


Impaired plasms immunoreactive insulin response to glucose in elderly hypertensive patients with abnormal clucose tolerance. Oral glucose tolerance and the plasma immunoreactive insulin response to oral glucose were measured in 42 elderly hypertensive patients. Twenty-four of these patients showed abnormal glucose tolerance curves an 18 had normal curves. Patients with abnormal glucose tolerance showed significantly lower plasms immunoreactive insulin concentrations at 30 min and 60 min after the glucose load compared with patients with normal glucose tolerance. The patients in the two groups did not appear to differ in any other clinical or biochemical characteristics.


Low plasma renin concentration in patients with Meniere's disease (preliminary report). Endolymphatic hydrops is the histopathologic hallmark of Meniere's disease. The cause of excess inner ear fluid is unknown, but the possibility of a systemic abnormality of fluid-solute regulation has been considered. One indicator of systemic fluid and electrolyte balance is the enzyme renin. Plasma renin levels were measured in patients with a clinical diagnosis of Meniere's disease and compared to a group of patients who did not have Meniere's disease. The mean plasma renin concentration of patients with Meniere's disease was statistically lower than that of the other subjects. The study's results are consistent with a systemic abnormality in fluid and solute regulation in some patients with M eniere's disease, leading to abnormal expansion of the extracellular fluid volume, and possibly contributing to endolympathic hydrops.


[Temporal aspects of the function of the renin-angiotensin-aldosterone system. Contribution to the methodological standardization of explorative test (author's transl)]. The purpose of this study is to throw further light on the problem of the methodological standardization in the study of the renin-angiotensin-aldosterone system (RAAS). Thus, in 10 normal volunteers and 33 patients with moderate, recent and uncomplicated essential hypertension, divided into the subtypes with normal, high and low renin, it has been performed a timing analysis of the behaviour of plasma renin (PRA) and aldosterone (PA). PRA and PA were measured by radioimmunological methods in blood samples simultaneously collected in steady state conditions (study of circadian rhythmicity) and during the course of manipulative tests (orthostatism, dietary sodium restriction, orthostatism associated with sodium restriction, furosemide administration). The study revealed that each category of the present series of healthy and hypertensive individuals has an own temporal organization in the entire function of RAAS. This finding allowed to standardize the RIA reference indices as chronocorrelated intervals of normality and to establish the optimal criteria for the assessment of biochemical data and methodological study of hypertensive patients.


Cockayne syndrome: unusual neuropathological findings and review of the literature. Two siblings with Cockayne syndrome (CS) are described and the literature on the subject is briefly reviewed. Of particular interest were the unusual neuropathological findings in 1 of the patients. These included microcephaly, white matter atrophy with patchy loss of myelinated fibers, calcifications of the basal ganglia, occasional ferrugination of cerebral and cerebellar neurons, and severe cerebellar degeneration. Findings not previously reported in CS were proliferation of extremely bizarre astrocytes, neurofibrillary tnagles, and pigmentation of the globus pallidus. We conclude that brain involvement in CS is a result of primary degeneration in the central nervous system rather than being secondary to angiopathy or normal pressure hydrocephalus, as previously suggested.


Evaluation of some cold enrichment and isolation media for the recovery of Yersinia enterocolitica. An evaluation of several cold enrichment media for Yersinia enterocolitica showed that the enrichment quotient achieved after 3 weeks at 4 degrees C was highly dependent on the initial cell concentration and the medium used. The latter should be of high nutritional value, in order to allow sufficient growth of Yersinia enterocolitica at a low temperature. Enrichment in typtone--soya broth yielded better results than in--frequently used--phosphate buffer, pH 7.6. While comparing isolation media for Yersinia enterocoliica to be used after cold enrichment, DHL agar was most satisfactory: after 20 h incubation at 29 degrees C, colonies of Yersinia enterocolitica are easily distinguishable and the organisms fully recovered. An urea medium, containing novobiocin as selective agent, also yielded good results. It must be stressed that only human strains of serotypes 0:3 and 0:9 of Yersinia enterocolitica were studied.


Evaluation of the efficiency of extraction for the quantitative estimation of hydrogen bacteria in soil. The efficiency of extraction of hydrogen bacteria from soil for plate counting was evaluated by using pure cultures adsorbed to sterilized soil. The utilization of model materials which interact with bacteria by adhesive, capillary or electrostatic forces and the use of extraction fluids with buffering, detergent or chelating activity demonstrated the major importance of capillary forces for the retention of hydrogen bacteria. Utilization of Tris buffer (pH 7.5) as extraction fluid and separation of extracted bacteria from soil particles by sedimentation for 15 min resulted in the highest recovery. A second extraction step including sonication did not increase the efficiency. The extraction efficiency of 8 different strains of hydrogen bacteria adsorbed to 3 different soils demonstrated a high degree of variation wih respect to bacterial strains, but not to soil types. The recovery was inversely related to cell parameters such as size, motility and slime formation.


[Researches on some biochemical and serological properties and on the sensitivity to antibiotics of L-forms of "Proteus" (author's transl)]. The possibility to keep some biochemical reactions of the parent strains (urease-positive, glucose fermentation, phenylalanine-deaminase-positive, H2S but not indol production) was demonstrated in 5 L-forms, obtained from as many strains of Pr. mirabilis and in 1 L-form, isolated from a vaginal secretion and identified as belonging to the same species. The indirect hemagglutination technique, made by the sonicated antigen in 3 of the 6 L-forms with Proteus OXK antiserum, resulted positive in titers varying from 1:128 to 1:1024. Crossed tests made with antisera for different bacterial species (e. coli, Shigella, klebsiella, ecc.) and of Mycoplasma (M. hominis, M. orale, M. salivarium, M. fermentans, M. arthritidis) put in evidence aspecific reactions only in 1.3% of the bacterial antisera. On the contrary, all 5 antisera for Mycoplasma were able to agglutinate the sensitized erythrocytes at titers quite analogous to that of the homologous antiserum. The sensitivities to various antibiotics of the 6 L-forms and the parent strains has been determined. All of L-forms were more resistent to the tetracycline than L-forms of other bacterial species. On the basis of te results got by biochemical and serological tests, we confirm the necessity to make use of both the groups of tests, in order to identify the L-forms of recent isolation.


[Observations about the use of different types of enzymes in immunohistological diagnosis of autoimmune diseases. Comparative study with indirect immunofluorescence technique (author's transl)]. The Authors have evaluated the use of anti-human immunoglobulins conjugated with peroxidase, alkaline-phosphatase, glucose-oxidase as a diagnostic tool for assaying autoantibodies. A comparison study was done using the classical indirect immunofluorescence technique. Immunoenzymatic techniques, of minor cost compared to immunofluorescence, have revealed a better appreciation of global and particular structure of the tissue in examination. From the three enzymes examined peroxidase revealed itself as first choice, because, other than having on overlapping sensitivity to immunofluorescence, it can allow a further ultrastructural study.


[Pathogenicity and saprophytism of the "Candida" (author's transl)]. Many cases of bacterial turnover saprophyatism and pathogenicity are known in infectious clinic; these are variously explained on mutational basis or wandering conditions of the rapports host-agent. Transformation of Candida from saprophpyte to pathogenic organism seems, up to date, to be hardly explainable, and would represent an interesting research field.


[Co-agglutination as an alternative to precipitin testing in streptococcal grouping (author's transl)]. Grouping of beta-hemolytic streptococcal strains was performed over a six months period on a total of 102 isolates. The purpose was to compare the Lancefield method with three different possibilities offered by the Co-agglutination technique. The results show that the Co-agglutination is as reliable as precipitin testing but it can be much more sensitive and rapid than any other method.


The brain of the guinea pig in stereotaxic coordinates. The brain of the guinea pig in stereotaxic coordinates is proposed as a tool for neurophysiologists who are interested in the guinea pig as an experimental animal. The frontal sections of guinea pig brain in stereotaxic coordinates extend from anterior (A) 17.0 to posterior (P) 5.0. The frontal sections of the brain are reproduced as drawings in which brain contours as well as nuclear and fibre structures are outlined. The procedure used for setting the stereotaxic coordinates and zero planes is reported and the limitation of the use of the tables is discussed.


[Use of saliva in the diagnosis of natural canine rabies]. Rabies virus isolation was demonstrated in all of the 55 saliva samples of 40 rabid dogs by intracerebral inoculation of young adult mice. Identification of cellular inclusions in the encephalic impressions of the 55 inoculated mice groups by means of the technics of Sellers and fluorescent antibodies revealed the rabies infection nature. Thirteen dogs (32,5%) of the studied cases showed rabies virus regular excretion in harvested samples in the same animals 2 (11 dogs) and 3 (2 dogs).


[Technic for studying antitetanus immunity]. The Authors carried out a research work on problems relating to technical aspects to the tetanus immunity tests. Some interesting conclusions have been reached: - Purified and diluted tetanus toxin is best preserved at - 20 degrees C, in pH 7.4 physiological salt solution added with 1% peptone. - Vaccination in small laboratory animals must be done injecting adsorbed anatoxin by a microsyringe, in order to avoid dilution of the original compound. - Protection test using low, i.v. toxin doses is more reliable than serological tests in assessing the acquired resistance level in immuno-prophylaxed animals. - Passive haemagglutination test is much more sensitive when done with turkey instead of sheep red blood cells.


[Indirect immunoperoxidase technic in the biological diagnosis of human parasitic disease]. Two serological techniques, immunoperoxidase (IP) and immunofluorescence (IFI), were used for the detection of specific antibodies in 60 sera from patients with schistosomiasis, in 44 sera from patients with hydatidosis, and 28 sera from patients with intestinal amebiasis or liver amebic abscess. The IP test correlated well with IFI. The advantage of IP technique compared to IFI are that it is more rapid, less laborious and is performed without technical equipment.


[Antimicrobial drugs in poultry nutrition: resistance levels in Escherichia coli]. In a battery experiment, a hundred of day old broiler chicks (Hubbard) divided into ten groups, were fed for eight weeks with 50, 75 or 100mg/Kg of ration of chloramphenicol and tetraciclyne; 40, 80 or 120mg/ 2 liters of drinking water of nitrofurazone. During three months defecated feces from each bird were sampled and analysed at intervals of 15 days for the isolation of Escherichia coli strains which were submitted to the determination of drug resistance. The results showed that utilization of antimicrobial drugs selected a resistant population of Escherichia coli at 300 microgram/ml of chloramphenicol tetraciclyne and 30 microgram/ml of nitrofurazone, during the dietary period. In addition the characterization of the R factor made by conjugation against apropriated recepient strains, demonstrated it's presence in some of the tested strains has only been noted the mobilization of the tetraciclyne marker.


Morphological, immunohistological and clinical findings in renal amyloidosis: correlations with prognosis in 16 patients. Sixteen patients affected by renal amyloidosis (A.) and submitted to renal biopsy have been studied by light microscopy and immunofluorescence. Clinical manifestations at observation and follow up have been reviewed. Survival was 32% at ten years, lower than all other nephropathies except rapidly-progressive glomerulonephritis. Primary A. had a significantly worse survival rate than secondary A. An observation up to 6 years after biopsy allowed us to isolate a group of patients with a steady good renal function: this group is characterized by: a longer mean duration of nephropathy before observation, a lower incidence of nephrotic syndrome (NS), absence of renal failure at time of biopsy, a higher incidence of increased mesangial areas at light microscopy, a lower percentage of glomerular capillary walls thickening, a higher incidence of amyloid deposits on vessels but not on glomerular capillaries, a definite more elevated presence of Ig and C3 over mesangium and glomerular capillary walls. The possible role of the last findings is discussed.


[Hemodynamics in swine treated with PGI 2]. The hemodynamic response of pig perfused by PGI2 (2 micrograms/kg/mm/4 min) has been studied before and after vagosympathectomy. Prostacyclin produces hypotension, which depends to an reduction of total peripheral resistances, without cardiac involvement. A venous dilatation is also present with reduction of preload and of systolic volume. The authors conclude assessing that prostaciclyn act by peripheral mechanism.


[Interaction between alkaloids of Claviceps purpurea and development of some bacteria and bacteriophages. Preliminary experiments]. It has been tested the bacteriolytic activity and the interaction among the development of the bacteriophage T4 and Ergot alkaloids. It has been determined a bacteriolytic action on the bacterial stub "E. Coli host of bacteriophage T4. It exist an interaction also among such alkaloids and the development of the bacteriophage T4, which appears through an increase of the quantity of lysis areas, becoming evident in solid bodies containing the lysing bacterium. Further researches with other bacterial and virus stubs will be effected and mentioned afterward.


Inhaled beclomethasone dipropionate in allergic bronchopulmonary aspergillosis. Report to the Research Committee of the British Thoracic Association. A double-blind multi-centre study was carried out to assess the effects of beclomethasone dipropionate aerosol on the control of symptoms of asthma and on fungal colonization of the bronchi, in patients with allergic bronchopulmonary aspergillosis who had not been treated with an inhaled corticosteroid preparation for at least six months. Each of the 32 patients who completed the trial was treated with beclomethasone (100 microgram four times daily) or placebo aerosol for consecutive periods of six months without alteration of the pre-study maintenance therapy. Treatment of exacerbations of asthma and of pulmonary eosinophilia was left to the discretion of the participating physicians. The only statistically significant finding was an association between serum Aspergillus antibody levels and episodes of pulmonary eosinophilia diagnosed by radiography. During treatment with beclomethasone improvement occurred in ventilatory function and control of asthma, but Aspergillus fumigatus was detected in the sputum more frequently than during the placebo period. None of these trends attained statistical significance. Episodes of pulmonary eosinophilia were not reduced by beclomethasone and usually occurred without clinical deterioration of asthma.


Cefuroxime in severe respiratory infections: a double-blind comparison of two doses. Cefuroxime, a new cephalosporin, was given in doses of 750 mg and 1000 mg three times daily for 10 days to 99 patients in a double-blind comparison. Patients were moderately or severely ill with exacerbations of chronic bronchitis, often accompanied by pneumonia. Both doses were equally efficacious in improving the clinical state and sputum purulence and in maintaining the improvement.


[Acute renal insufficiency in elective surgery]. A summary of modern knowledge on etiopathogenesis; pathological anatomy and clinic of acute postoperative renal insufficiency. The results are further reported of an investigation of clearance of endogenous creatinine and of the number of cells in the sediment according the Addis during a normal postoperative course and after gastric resection (five cases) and cholecystectomy (five cases).


[Apropos of 80 cases of mesenteric infarction]. The Author considers 80 cases of mesenteric infarct which have been observed in the emergency Ward of the Milan Ospedale Maggiore. A discussion follows of the problem of etiology on hand of the literature and of the most recent views on the functional infarct. Attention is given to macroscopical and microscopical anatomy and pathogenetic interpretation is offered, basing upon the results of experimental investigation work. The Author underlines the most important characters of the clinical picture as derived from their experience, discusses the diagnosis and offers a schema for therapy on hand both of classical knowledge and of the new possibilities offered today by modern surgery and by the adoption of new drugs. It is concluded that the statistical data show a considerable decrease of recent operative mortality both compared to recent years and to percentages reported by other AA.


[Chylous ascites].

[Chylous ascites]. Starting from one case of chylous ascites of their own observation, the authors attempt an etiological classification of this clinical entity, taking into account pertinent published material and the fact that in many instances chylous ascites is nothing more than a symptom. The authors then proceeds to a critical review of diagnostic and therapeutical resources; in that respect, they stress the extreme difficulties often encountered both in diagnosing the condition and in trying to correct it.


[Diffuse peritonitis caused by peptic ulcer perforation in patients previously gastrectomized]. The Authors have collected during 28 years 26 cases of acute perforation, in free peritoneum, of gastrojejune ulcers in subjects who, in precedent times, had been operated for gastro-duodenal ulcer. In 24 cases the rafia has been practised, with 5 deceased: in two cases immediate resection has been practised, with two recoveries. The Authors do some considerations about the aetiopathogenesis of peptic post-resection ulcer and about its perforative complication, and also about the urgent surgical therapy that, except exceptional cases for special anatomic-pathological conditions, must be limited to the simple rafia, referring to futher time radical gastro-jejune-resection.


[The sulfamethoxazole-trimethoprim combination 1st survey into its in vitro activity in brazzaville, Congo Results of 780 bacterial strains isolated at the National Laboratory and the General Hospital in a single year]. The combination of SMZ-TMP has recently been introduced in Congo. This year (1978), it is very used by many Physicians. To help the congolese Physicians working without antibiogram frequently, we have tested 780 strains from August 1977 to August 78. The susceptibility of these strains was: for E. coli 90%, Klebsiella 69,20%, Staphylococcus 93% and for all strains studied Gram + and Gram - the percentage was 75,51. As many authors have showed, the strains of Pseudomonas, Streptococcus faecalis and Providencia are resistant. Our results remain similar to the results obtained by some french and african authors from 1970 to 1975.


[Anti-malaria chemical prophylaxis in Europeans and anti-Plasmodium fluorescence antibodies]. The authors recorded clinical histories and tested serum for the presence of malaria fluorescent antibodies in 160 healthy Europeans who had been living for more than 4 weeks in West or Central Africa. Malaria or fever of unknown origin occurred in 37 of 50 subjects who were careless about taking prophylactic drugs while abroad. Out of 110 people regularly taking suppressive amino-4-quinoline therapy, 21 had presented febrile attacks but serological tests were only positive in 8 cases. Positive serological reactions at low titers were obtained in 3 subjects with no history of past infection and who had faithfully taken suppressive medications. These results confirm the value of the malaria immunofluorescence test for the detection of occult malaria in blood donors outside endemic areas, and explain the necessity to consider previous regular, irregular or absent chemoprophylaxis before interpreting the serological results of a febrile patient returning from overseas.


[An ELISA technic for the diagnosis of human African trypanosomiasis]. The authors studied several factor influencing the serodiagnosis of human african trypanosomiasis using the microplate enzyme immunoassay ("micro E.L.I.S.A."). They used an antigenic extract obtained by sonic disruption of purified suspensions of trypanosomes of a Trypanosoma brucei brucei strain. the conjugate was a peroxidase-conjugate anti-human immunoglobulin and the chromogen was orthodianisidine. Spectrophotometric reading was used. Although this method may have some advantaged, its specificity needs further study because of few false positive and negative reactions. Moreover its reproducibility as quantitative reaction has proved to be delicate.


Long-term effects of pancreatic transplant function in patients with advanced juvenile-onset diabetes. Present methods of management of juvenile-onset diabetes mellitus do not prevent serious and debilitating complications affecting multiple organ systems. In an effort to reverse advanced forms of these complications, segmental transplantation of the pancreas has been performed on 10 patients, seven of whom simultaneously or subsequently received renal transplants. Long periods of normoglycemia (two to four and one-half years) were achieved in two patients who also maintained transplant kidney function. The course of these two patients is described to illustrate the possible value and limitations of the procedure. These patients had normal blood glucose levels, exhibited repeated normal intravenous glucose tolerance curves, and had repeated normal endogenous insulin levels. Their courses were characterized by (1) absence of problems related to pancreatic exocrine secretions into the bladder; (2) stable eye changes despite some episodes of hemorrhage from preexisting retinopathy; (3) vascular complications, including stroke and gangrene of extremities necessitating amputation despite successful femoropopliteal bypass grafting; (4) peripheral neuropathy; and (5) repeated infections. Both patients succumbed to vascular complications. Thus, pancreatic transplantation can maintain blood glucose and insulin at normal levels for extended periods of time. However, it does not reverse such complications as advanced retinopathy or atherosclerosis. Since the procedure may have value in preventing progression of these complications, it should be evaluated in patients with less advanced complications of diabetes.


Urine glucose tests for diabetic patients with impaired vision. A colorimetric test procedure called Mega-Diastix is described for detection and measurement of glucose in urine. The test is designed for use by diabetic patients with imparied vision. Data establishing the performance capabilities of this rapid, convenient test are presented. As an internal standard, the recommended procedure utilizes effervescent control tablets for preparation of simulated urine. Also described is a touch fermentation test for detection of urinary glucose by totally blind patients. Data are given that demonstrate the accuracy and ease of performance of this test, which entails a rapid yeast fermentation. An internal standard is also incorporated into the procedure for this test.


Performance of technical skills of diabetes management: increased independence after a camp experience. This study examines some educational effects of a camp experience on independent performance of tasks in the management of diabetes mellitus. One hundred and eleven children were studied with regard to insulin administration, urine glucose testing, recognition of hypoglycemic reactions, adherence to diet, and over-all independence. There was a significant increase in independent measurement of insulin dose, administration of insulin injections, and urine glucose testing. No significant differences were seen in dietary adherence of ability to recognize hypoglycemic reactions. Precamp data indicated that returning campers demonstrated greater independence in insulin administration prior to camp than did new campers. After camp, both new and returning campers showed significant increases in independent performance of dose measurement and injection. It is concluded that a camp educational experience contributes to both the knowledge and performance of self-care techniques required in the management of diabetes mellitus.


Jet injection of insulin during self-monitoring of blood glucose. Insulin-dependent diabetes mellitus has been treated with four jet injections of insulin (regular insulin before each meal and intermediate insulin at bedtime) during self-monitoring of blood glucose levels. The blood glucose levels generally remain within 60 and 150 mg/dl.


Diabetic glucose control: matching plasma insulin concentration to dietary and stress hyperglycemia. Optimal management of the diabetic patient includes normalization of plasma glucose concentration. Attainment of this goal is difficult because both food and stress result in acute elevations of blood glucose that cannot be matched with a single subcutaneous injection of NPH insulin. This paper examines the currently available methods for delivery of insulin to the diabetic subject and the degree of metabolic control attained. It suggests that optimal diabetic control will be achieved only when newer methods of insulin delivery are available to the clinician that match plasma insulin requirements to the simultaneous plasma glucose concentration.


The saccharin controversy.

The saccharin controversy. Saccharin and its salts are the most extensively consumed artificial sweeteners in the United States today. The current controversy about the risks of their use to human health has surfaced from research findings that report an increased incidence of cancer, primarily of the urinary bladder, in certain animal species and man chronically exposed to these agents. The April 1977 proposal by the Food and Drug Administration to restrict use of saccharin was based on these investigations. The intense public response against any ban has led to Congressional deliberations over the fate of saccharin during the present moratorium and information-gathering period. Since diabetic patients are among the principal users of this compound, it appears timely to review the evidence for and against its carcinogenic potential.


Use of fructose, xylitol, or sorbitol as a sweetener in diabetes mellitus. Nonnutritive sweeteners have been utilized in the diet of diabetic patients an an agent to replace glucose and sucrose. Since saccharin might be removed from the marketplace, the nutritive sweeteners fructose, xylitol, and sorbitol are being considered as possible alternatives for glucose and sucrose. This review considers the effects of these nutritive sweeteners on the main dietary concerns in the diabetic diet--control of blood glucose levels, obesity, and hyperlipidemia. The potential side effects of these agents are also reviewed.


Fructose as a dietary sweetener in diabetes mellitus. Human beings, including those with diabetes, have a desire for sweetness in the diet that cannot be ignored. The Food and Drug Administration ban of cyclamates and possible ban of saccharin have raised the question of alternative sweeteners for diabetic persons. Considerable interest has been focused on fructose, and both basic and clinical research has delineated its metabolic effects. This paper reviews the characteristics of fructose, as well as its physiology and metabolism in both normal and diabetic man. Findings seems to indicate that, in controlled diabetes, chronic or limited consumption of fructose at moderate doses has no adverse effects on the levels of blood glucose, cholesterol, or tryglycerides.


Nutritional management in diabetes and pregnancy. During pregnancy it is necessary for the mother with diabetes to maintain careful control of the diabetes in order to lessen both fetal and maternal morbidity and mortality. The diet must take into account not only the metabolic requirements of the mother, but also those of the developing fetus. A total weight gain of 22 to 26 pounds is recommended, with the pattern of weight gain being more important than the total amount. Pregnancy is not a time for weight reduction. Caloric requirements can be met by the addition of 300 kcal. per day to the prepregnancy meal plan, or about 36 kcal. per kilogram. This can be met by the addition of 50 gms., carbohydrate and 30 gms. protein. Diets will contain approximately 1800 to 2500 calories a day. Calcium, iron, folic acid, and sodium also require attention in meal planning. The importance of regular meals and snacks must be emphasized. In particular, bed-time snacks are important because of the tendency towards overnight hypoglycemia and ketosis.


The need for special foods and sugar substitutes by individuals with diabetes mellitus. The need for special dietary products marketed for use by individuals with diabetes mellitus and the safety and efficacy of certain nutritive sweetener substitutes for sucrose are reviewed. Special foods for individuals with diabetes mellitus are not necessary to achieve the dietary objectives recommended by leading United States and European authorities. They can be achieved conveniently and at minimum expense through enlightened choices of commonly available food items. At present, specific and unique characteristics of food products with special therapeutic properties for diets of diabetic individuals cannot be delineated or defined on rational nutritional grounds. Such terms as "diet", "dietetic", and "diabetic" on food labels have no uniform meaning for consumers, and diabetologists have observed that patients tend to consume such foods without regard to their energy content. Some consumers regard the reduced-calorie and low-calorie prepared food products as convenient in diets for weight reduction and diabetes although their use in dietary management of diabetes has no therapeutic basis other than weight reduction and maintenance. When fed as pure substances to fasted subjects, the nonglucose carbohydrate nutritive sweeteners, fructose, xylitol, and sorbitol, are absorbed relatively slowly and produce less postprandial hyperglycemia and insulin response than sucrose or glucose. Adequate studies of their long-term effectiveness when ingested as part of mixed meals have not been conducted. Although these sucrose substitutes are generally considered safe, the significance of recent information on possible carcinogenicity of oral xylitol in long-term feeding studies has not been fully evaluated. In view of the lack of certain essential information on the long-term effectiveness of various diets in preventing or mitigating the chronic debilitating complication of diabetes, suggestions for future research are included.


[Utilization of a microvascular synthetic prosthesis in microvascular surgery]. Both in replantation surgery and free vascular pedicled tissue transfer a vascular interposition graft is sometimes necessary. As an alternative to the vein a microvascular prosthesis for interposition is introduced. In rats the abdominal aorta was partly resected and the defect bridged by interposition of such a microvascular prosthesis. The technique of interposition and the results are shown.


[Bridge transplantation in "no man's land"]. From 1968 to 1976, 89 flexor tendon injuries were reconstructed with bridging (mini-)-tendon grafts. This technique was also applied to injuries in "no-man's land". The results were better than with traditional tendon grafts. According to the criteria of BUCK-GRAMCKO there were very good and good results in 65% as compared to 51% with traditional tendon grafting. The method is recommended only for experienced hand surgeons.


[Results of screw fixation of the scaphoid pseudarthrosis]. MATTI-RUSSE's cancellous graft is successful in the management of scaphoid pseudarthrosis. The necessity of post-operative immobilization of the wrist, usually previously immobilized, for up to 16 weeks is its disadvantage. Screw fixation including radial styloidectomy and a small cancellous graft is an alternative abbreviating immobilization to only 2 to 6 weeks. the follow-up of 26 patients thus operated revealed osseous union in 19 cases. The failures were due to lack of proper indication or faulty technique. In spite of the correct position of the scaphoid screw one pseudarthrosis did not heal, the clinical result being satisfactory. The procedure described permits early remobilization of the wrist. Failures, also described by other authors, can be avoided by proper indication and technique.