Transient visually evoked potential.

Transient visually evoked potential. A light delivered to the human eye will instigate changes in electrical potentials recorded over the visual cortex that last for some finite time, at least several hundred milliseconds. If the rate of stimulation is sufficiently low, the response is completed before the next visual stimulus arrives; the cortical potential is then called a transient evoked response. This review of the transient evoked potential describes the techniques by which the response is obtained, the problems inherent in its use, and procedures by which these difficulties can be overcome or minimized. A summary of the research results from the field enumerates those findings which have been well established and replicated by many investigators, those that are more controversial or as yet inconclusive, and the many practical applications of the technique for science and medicine. Finally, the needs for an underlying physiological theory and for future research are discussed.


Vitamin D therapy in hypoparathyroidism and pseudohypoparathyroidism: weight-related dosages for initiation of therapy and maintenance therapy. The aims of this study were to determine the dose of vitamin D2 that maintains the serum calcium level within the normal range in hypoparathyroid and pseudohypoparathyroid children and to establish a safe and quickly acting dose for initiating therapy in symptomatic patients. The dose requirement for maintenance therapy was studied in 11 patients and initiation therapy was studied in five newly diagnosed hypocalcemic patients. The results show that (1) the maintenance requirement of vitamin D2 is proportional to body weight and averages 2,000 IU (50 microgram)/kg/day for children of all ages and with all types of hypoparathyroid disorders and the (2) in newly diagnosed symptomatic patients, carefully controlled administration of 8,000 IU (200 microgram) vitamin D2/kg/day for the first one to two weeks corrects hypocalcemia quickly and safely.


Regeneration of rhodopsin in frog rod outer segments. 1. Bleaching/regeneration cycles were performed in perfused frog retina while the optical transmittance at suitable wave-lengths was measured continously. Rhodopsin was identified from its spectral absorbance, its photosensitivity and from the kinetics of its regeneration. 2. In the absence of the pigment epithelium regeneration was complete when not more than 2-5% of the rhodopsin initially present had been bleached. However, the cycles could be repeated to a total of regenerated rhodopsin exceeding that explicable on the utilization of stored chromophores. The rate of regeneration was fast, with 0-12 min-1 rate constant, following first order reaction kinetics. Under these conditions the cycle does not seem to involve stages beyond metarhodopsin II. With the moderate bleaching intensities used, half-time 53 min, the Bunsen-Roscoe law was obeyed up to 15 min, indicating a capacity for the photoproducts to be accomondated in situ for subsequent regeneration. 3. It is concluded that only substantial bleaches, which exceed that capacity, result in hydrolysed chromophores. These surplus chromophores become esterified and are temporarily taken up by the pigment epithelium to be re-entered into the visual cycle as fast as they can be processed by the regenerative machinery of the rod outer segments.


Membrane currents underlying activity in frog sinus venosus. 1. The spontaneous electrical activity of small strips of muscle from the sinus venosus region of the heart of Rana catesbeiana was investigated using the double sucrose gap technique. The voltage clamp was used to record the ionic currents underlying the pace-maker depolarization and the action potential.2. The records of spontaneous electrical activity are very similar to those obtained from the sinus venosus using micro-electrodes. Moreover, the pace-maker activity is almost completely insensitive to tetrodotoxin (TTX) at 2.0 x 10(-6) g/ml., which suggests that the pace-maker responses can be classified as primary, as opposed to follower pacing.3. In response to short rectangular depolarizing voltage clamp pulses, only one inward current is activated. This current is almost completely insensitive to TTX but can be blocked by manganese ions. It appears, therefore, to be equivalent to the slow inward (Ca(2+)/Na(+)) current, I(si), of other cardiac tissues. The threshold for I(si) is near to the maximum diastolic potential, indicating that it must be activated during the pace-maker depolarization.4. Interruption of the normal pace-maker depolarization by rapid activation of the voltage clamp circuit reveals the time-dependent decay of outward current. This current reverses between -75 and -90 mV and, therefore, is probably carried mainly by potassium ions.5. Outward current decay is not a simple exponential, and Hodgkin-Huxley analysis suggests that two distinct components of outward current may be present. One of these is activated in the potential range of the pace-maker depolarization and the other at more positive potentials. Both outward currents reach full, steady-state activation at about zero mV, i.e. within the ;plateau' range of the sinus action potential.6. These results are compared with other recently published voltage clamp data from the rabbit sino-atrial node.7. A hypothesis for the generation of pace-maker activity is presented which involves (i) decay of outward current and (ii) activation of the slow inward current, I(si).


Mapping of the trigeminal sensory complex of the cat. Characterization of its neurons by stimulations of peripheral field, dental pulp afferents and thalamic projections. From a new systematic investigation of the 4 divisions of the trigeminal sensory complex, the following points are emphasized: 1. The subnucleus oralis receives a large representation from the oral cavity, a region also represented in the three other divisions of the trigeminal sensory complex. 2. Units responding to noxious mechanical stimulation have been found in two different loci: the subnucleus caudalis for the whole trigeminal area, and the subnucleus oralis for the oral cavity. 3. The dental pulp projects to the four divisions of the trigeminal sensory complex, but the heaviest projection is found in its rostral part (the main nucleus and subnucleus oralis). 4. Three distinct types of responses were found following dental pulp stimulation: primary, non primary and responses strongly enhanced by an increase in stimulus parameters.


Predominance of autoimmune and rheumatic diseases in females. This paper offers an explanation for the higher female incidence found in many of the autoimmune and rheumatic diseases. A list of these diseases (Table 1) shows that half of them occur in three females for each male affected. Females are genetic and hence antigenic mosaics, half their somatic cells expressing antigens derived from the paternal X, half from the maternal X (female heterochromatinization). The Burnet-Jerne theory of somatic generation of antibody diversity and forbidden clone elimination states that lymphocytes under maturation in the thymus are killed or suppressed if they recognize and hence react to a histocompatibility antigen. If this were to hold for other self antigens as well, as recent models of clonal generation and selection mechanisms predict, then lymphocytes happening to pass the crucial stage in the thymus meeting only cells expressing one of the parental X's could be released still able to react to self i.e. those somatic cells expressing the other parental X with which the lymphocyte had not been in contact. Thus, self-tolerance would be more easily broken in females than in males.


Selective mobilization of specifically cytotoxic T-lymphocytes at sites of inflammation in relation to BCG-induced resistance to implants of syngeneic sarcoma in mice. The heightened and long-persisting resistance of BCG--immunized C57BL/6 mice (10-week-old males and females) to challenge with syngeneic sarcoma cells was largely restricted to the site of inoculation of the BCG. The specific cytotoxicity of peritoneal T-cells and the total number of T-cells that could be recovered from the peritoneal cavity were more than ten times greater in mice that had received BCG ip 2-4 weeks prior to inoculation of tumor than in non-BCG-treated mice. The specific T-cell-mediated cytotoxic potential of the peritoneal exudate of mice immunized with tumor was therefore at least 100 times greater in mice that had received BCG ip. This effect was detectable by 3 days after inoculation of BCG and reached a maximum 2-4 weeks later. The protection against tumor offered by pretreatment with BCG could be explained by the selective recruitment of committed T-lymphocytes to sites of chronic inflammation. The induction of nonspecifically cytotoxic macrophages and systemic changes such as generalized stimulation of the reticuloendothelial system were not contributing factors.


Interference of human spermatozoal motility by trichomonas vaginalis. Human spermatozoa were exposed to concentrations of live Trichomonas vaginalis varying from 10(4) to 10(7) organisms per ml. A striking decrease in spermatozoal motility ensued. The possible role of trichomoniasis in human reproductive failure is considered.


T and B lymphocyte levels in renal cancer patients: influence of preoperative transcatheter embolization and radical nephrectomy. The mean percentage of T and B lymphocytes in peripheral blood was tested in 6 patients with renal cancer before and after preoperative transcatheter embolization and radical nephrectomy. While no significant difference was found in B lymphocyte levels compared to those in healthy control subjects a clear impairment in circulating T lymphocyte levels was observed in renal cancer patients who had not been treated. This reduction in T lymphocyte levels persisted after embolization but there was a significant increase after radical nephrectomy.


Changes in hemodynamics and bradykinin concentration in coronary sinus blood in experimental coronary artery occlusion. The following parameters were studied before and after acute occlusion of the anterior descending branch of the left coronary artery in 17 dogs: bradykinin (BK) in the coronary sinus blood, heart rate (HR), left ventricular systolic pressure (LVSP), left ventricular end-diastolic pressure (LVEDP), left ventricular max dp/dt (LV max dp/dt), and an index of myocardial contractility (LV max dp/dt/IP). BK levels increased, reaching a maximum of 30 +/- 13 ng/ml 2 min after coronary ligation, accompanied by a significant elevation of LVEDP, and lowering of the myocardial contractility index. HR and LV max dp/dt showed no significant changes. A positive correlation obtained between the level of BK and LVEDP, as well as a negative correlation between the level of BK and of both LVSP and myocardial contractility index. Pretreatment with aprotinine (Trasylol), an inhibitor of kinin forming enzyme, prevented the increase in both BK and LVEDP after coronary artery ligation and caused an elevation of myocardial contractility index. These results suggest that BK formed within ischemic myocardium exerts a negative inotropic action on the heart.


Current operations for duodenal ulcer.

Current operations for duodenal ulcer. The surgical treatment of duodenal ulceration of the gastrointestinal tract is reserved for specific complications of the ulcer, namely perforation, hemorrhage, obstruction of the gastric outlet, intractability, and recurrence following previous surgery. Though all persons with an ulceration share at least one symptom of the ulcer diathesis, the treatment of a specific patient's problem demands individualization so that the best-suited operative procedure will be performed. If patients are appropriately selected for surgical procedures, the success ratio is maximized, and the frequency of undesirable side effects minimized. We view the surgical procedure for duodenal ulcer not as an indication of failure of medical therapy, but as an appropriate treatment for specific complications of the disease. When indicated, curative procedures can be performed routinely with minimal chance of recurrence. Whenever an ulcer recurs, a specific plan of investigation will help differentiate incomplete vagotomy, endocrine tumors, or other common reasons for ulcer recurrence.


Transthoracic cardiectomy with infraesophago-supragastric devascularization for bleeding esophageal varices. Based on the thoughts that transthoracic approaches give less load to liver than transabdominal ones, and that effectiveness for bleeding esophageal varices is secured by cardiectomy with complete devascularization of lower esophagus and upper stomach, a new operative procedure for esophageal varices is described which is more safely applicable to the risky patients. Twenty cases with portal hypertension were operated, including eight cirrhotic patients with severe hepatic dysfunction, six cases of emergency bleeding and six reoperated cases. No operative death was encountered, but three cirrhotic patients died during the late follow up period. The remaining 17 patients had uneventful postoperative courses without recurrence esophageal bleeding during 20 months follow up period. Thus this operation may eliminate the shortcoming of previous operative methods for portal hypertension.


[Evaluation of the indicators of acid-base equilibrium, oxygen and electrolyte blood levels for early diagnosis of hemodynamic disorders after heart surgery]. In 30 patients operated on under extracorporeal circulation the acid-base, oxygen and electrolytes balance parameters were studied in order to evaluate their potentials as additional diagnostic tests for various clinical forms of acute circulatory disorders in the early post-operative period. Cardiac insufficiency is predominantly characterized by a reduced oxygen saturation of mixed venous blood, an increased oxygen arterio-venous gradient and "lactate excess", hypokalemia and hypernatremia in plasma and erythrocytes. Metabolic and gas parameters of acid-base balance cannot be used for the diagnosis of postoperative cardiac insufficiency. In cases of hypovolemia the changes of the laboratory tests data are determined by the compensatory capacities of the human body in response to circulating blood volume deficit.


[Prognosis of life expectancy of patients with ischemic heart disease detected during mass screening]. Prospective 5-year follow-up was accomplished among males ranging in age between 50 and 59 and forming four random samples from the respective population of the Bauman region in Moscow subjected to primary cross-sectional epidemiologic survey. The results show that in primary survey general mortality and the mortality of ischemic heart disease were significantly higher among males with ischemic heart disease than among the rest of the individuals examined. The mortality of ischemic heart disease proved to be particularly high among individuals with a history of myocardial infarction (relative death risk 5.8) and among those with typical anginal pectoris (relative death risk 4.4). Ischemic heart disease mortality was lower (relative death risk 2.1) in the group of males who had suffered from silent myocardial infarction or had silent ischemic heart disease than among those who had had myocardial infarction or with angina pectoris, but higher among males who did not have these diseases. To study the prognostic value of atypical chest pain in angina pectoris, it is necessary that prospective follow-up be continued.


[Endophthalmitis haemo-granulomatosa (a special reaction form to intraocular bleedings) (author's transl)]. Among 81 eyes enucleated after severe trauma, two eyes showed a peculiar granulomatous reaction around a bloodcoagulum. The bloodcoagulum is surrounded by a granulomatous infiltration of epithelioid and giant cells containing haemotoidin; peripheral to this there are haemosiderin containing makrophages and granulation and scartissue as well as an unspecific lymphocytic infiltration of uvea and retina. There are also signs of persistent hypotony. The similarity to endophthalmitis phacoanaphylactica is stressed. It is postulated that the endophthalmitis haemo-granulomatosa is analogous to sympathetic uveitis, and phacoanaphylactica endophthalmitis represents a peculiar reaction to autologous intraocular tissue, which may occur in unspecific types of reaction, makrophagocytic reactions and as a granulomatous type. The differentialdiagnosis is discussed as well as possible clinical implications.


Systemic hypertension associated with coronary artery bypass surgery. Predisposing factors, hemodynamic characteristics, humoral profile, and treatment. Systemic hypertension occurs in more than one third of patients having coronary artery bypass graft (CABG) operations. This report describes our studies in 100 consecutive patients undergoing CABG. We found that certain preoperative clinical, angiographic, and biochemical factors predispose to the development of perioperative hypertension. These included a well-documented history of hypertension, an elevated blood pressure the day prior to operation, greater than 50 percent obstruction of the left main coronary artery, and increased levels of dopamine beta hydroxylase (DBH). The hemodynamic pattern of perioperative hypertension was that of an increased systemic vascular resistance which was associated with increased levels of plasma catecholamines and plasma renin activity (PRA). Nitroprusside was shown to be effective in managing  CABG hypertension, although other, more specific therapy may be preferable.


Fracture and embolization of a Björk-Shiley disc. Fatal failure of a prosthetic mitral valve. A case of fracture of the disc occluder of a Bjork-Shiley mitral prosthesis with embolization of the disc fragments to distal aorta is presented. The possibility of valve dysfunction and the diagnostic value of echocardiography should be considered whenever acute heart failure occurs in a patient with an artificial valve.


Antibiotic therapy for severe infections in infants and children. Guidelines for the use of antibiotics in infants and children must take into account drug absorption, distribution, metabolism, and excretion. In the developing human being, these factors may differ significantly from those in the adult, and so there are differences in therapeutic efficacy and toxicity. Certain drugs should be avoided in the neonate because of known toxicity; these include the sulfonamides, tetracycline, and high doses of chloramphenicol. Antibiotic therapy should be modified in neonates in several ways because of the biologic immaturity of systems important for the termination of drug action, such as the liver and kidney. Because of poor conjugation, inactivation, or excretion, the administration of many antibiotics results in higher and more prolonged serum levels than those produced in older infants. Thus, in the neonate, the dosages of many antibiotics have to be lower and intervals between administration longer. In the case of gentamicin, studies in the 6-month to adult age group have shown that children less than 5 years old require almost twice as much of the drug as do children older than 10 years or adults to achieve similar peak concentrations. The appearance throughout the United States of strains of Haemophilus influenzae, type b, that are resistant to ampicillin has necessitated a change in the initial antibiotic therapy given to children with bacterial meningitis. There are few uses for tetracycline in pediatric practice.


Relationship between process and outcome in ambulatory care. The outcomes of a series of some 410 acute episodes from two family practice centers were rated on the degree to which the patient regained his usual functional status and his satisfaction with the outcome and the process of care. A portion of outcomes (251) were then compared to process scores obtained using explicit criteria and the rest to implicit process ratings based on the problem-oriented record. In both instances those cases with good outcomes had better process scores than those with bad outcomes; neither measure of satisfaction had a consistent relationship with either process measure.


Comparison of caloric and sinusoidal tests in the vestibulotoxic cat. In order to evaluate the relative sensitivity of caloric and sinusoidal angular acceleration tests, thermal and rotational stimuli were administered to cats rendered vestibulotoxic with streptomycin sulfate. Three groups of six cats each, receiving daily subcutaneous injections of saline, 100 mg/kg streptomycin or 200 mg/kg streptomycin, were administered optokinetic, caloric and sinusoidal stimuli. Vestibular responses were evaluated by changes in the total slow phase displacement of the eyes and frequency of nystagmic beats. The results demonstrated that the saline treated animals had a decrease in response consistent with habituation; whereas, experimental animals showed a marked, rapid abolition of eye movement. The decrease in response was greater for the larger dose of streptomycin. Caloric or sinusoidal acceleration tests were equally sensitive in monitoring the degree of nystagmic depression. The data suggested that sinusoidal acceleration tests could be easily applied to the clinical vestibular assessment of ototoxicity.


[Problems of postthymectomy-syndromes, e.g. myasthenia gravis (author's transl)]. 6 years after resection and postirradiation of an "asymptomatic" thymoma, myasthenia gravis developed in a 46 year old man which improved within 6 months following initiation of immunosuppressive therapy with azathioprine. In a 28 year old man with incomplete operative removal of a metastasizing malignant thymoma, a myasthenia gravis appeared 8 weeks after surgery, i.e. before irradiation of the tumor relics. Myasthenia improved upon irradiation of the tumor relics and was no longer demonstrable one year after onset of its clinical signs. During the whole period of manifestation of the myasthenia, antibodies to skeletal muscle were deomonstrated in the first case, while, in the second case, in which antinuclear factors were present in the serum throughout the course of the myasthenia, muscular antibodies were detected only prefinally, i.e. in a stage without clinical symptoms of myasthenia. A review of the literature indicates that myasthenia gravis is a particularly frequent event in postthymectomy-syndromes (e.g. polymyositis, thyreoiditis, lupus erythematosus, hematological and dermatological syndromes). In postthymectomy-myasthenia, latency of manifestation, clinical distribution and its course may be rather variable. The problems of diagnosis, immunology and therapy of postthymectomy-myasthenia are discussed and general conclusions concerning postthymectomy-syndromes are drawn.


[Intestinal hemorrhage as cause of late death in a patient with abdominal aortic prosthesis]. Intestinal bleeding from abdominal aortic aneurysm is a rare complication; it represents an exceptional occurrence in patients with abdominal aortic prosthesis. The Authors report one case of intestinal hemorrhage caused by interruption in the posterior suture-line between prosthesis and aorta. The hemorrhage has been the cause of death in this patient 4 months after the operation; the exact diagnosis has been recognized only at autopsy, after a gastroduodenal resection performed for a suspected bleeding peptic ulcer. Pathology, ethiology and diagnosis of this case are commented and discussed.


[Diagnostic problems of simple and complicated Meckel's diverticulum in adults]. The literature data concerning the incidence of Meckel's diverticulum in the adult and the frequency of its complications are examined and problems associated with the preoperative diagnosis of this form are discussed. Reference is made to the limitations of abdominal scintiscanning and the encouraging results obtained with superior mesenteric arteriography in diverticular bleeding. Five cases of Meckel's diverticulum in the adult are presented. Stress is placed on the need to explore the ileum during appendicectomy to enable diverticula to be detected and removed, since they are often the cause or the site of complications, even in the adult.


[Intensive care in gastroenterology. 1st experiences and verification]. The history of intensive care in gastroenterology is briefly discussed. The insertion of intensive care units in the hospital scene is also examined and illustrative examples of emergency cases treated in recent years at the Rome United Hospitals gastroenterology division are presented. It is felt that centres tailored to hospital dimensions should be formed, though their cost is likely to prove a bar to their early institution. Intensive care can, it is urged, be furnished by specialist departments, provided they manage to find a new dimension in keeping with the more difficult tasks involved.


[The late results of aorto-coronary by-pass surgery. Minimum of 4 years follow-up (author's transl)]. Of 340 patients undergoing aorto-coronary surgery over a period of 6 years, the 136 cases in which there was a minimum follow-up of more than 4 years were analysed from the standpoint of the results. Overall amount annual postoperative mortality was low, less than 2,5%, even though the majority of patients undergoing surgery suffered from rest angina and had double or triple coronary stenoses. Analysis of prognostic parameters reveals the importance of the quality of the left ventricule, whilst age, sex, risk factors, the site of the bypass, the number of stenoses and the type of angina had little or no statistical influence on postoperative mortality. Six years after operation, there remained 66% of excellent results and 60% of the patients were able to work. One hundred and forty eight follow-up coronary arteriograms were carried out (including 33 repeated). During the first year after operation (184 by-passes examined) the percentage of permeability of the grafts was 84,8%. Later (86 bypasses examined) this fell significantly to 74,4% but 86,3% still had at least one permeable by-pass. Repeat late studies after four years showed the stability of the result. Investigation into the causes of postoperative infarctions ans analysis of the results in terms of the number of by-passes carried out in relation to the number of coronary stenoses, indicate that multiple by-passes should be avoided when technical conditions are difficult, with a narrowed coronary network and of little functional value.


Specific lysine labeling by 18OH- during alkaline cleavage of the alpha-1-antitrypsin-trypsin complex. alpha-1-Antitrypsin is a serum protein that inhibits many proteolytic enzymes. Recently, it was suggested that the alpha-1-antitrypsin-trypsin complex is an acyl ester analogous to the acyl intermediate that forms between trypsin and its substrates. In previous work we showed that the alpha-1-antitrypsin-trypsin complex can be split at high pH, releasing a component of alpha-1-antitrypsin. This component had a new carboxyl-terminal lysine, and it had lost a peptide of about 4000 daltons. In order to determine whether the alpha-1-antitrypsin is bound to trypsin through the new carboxy-terminal lysine, as would be expected if the above hypothesis is correct, we split the complex in the presence of 18OH-. When the new carboxy-terminal lysine was cleaved with carboxypeptidase B, singly labeled, doubly labeled, and unlabeled lysine were recovered. These data support the hypothesis that the alpha-1-antitrypsin-trypsin complex is an acyl ester or a tetrahedral precursor that is transformed into the acyl ester form at high pH. If other enzymes are bound by a similar mechanism, the methods used may be useful in determining which amino acids on alpha-1-antitrypsin bind covalently to each enzyme.


Ligand-independent cap formation: redistribution of surface receptors on mouse lymphocytes and thymocytes in hypertonic medium. Most of the mobile receptors on mouse lymphocytes and thymocytes, including immunoglobulins, H-2 antigens, Thy-1.2 antigens, some concanavalin A receptors, and some antigenic determinants detected by anti-thymocyte serum, were redistributed into caps when the cells were incubated in hypertonic medium (about 600 mOsM) in the absence of ligands. The caps reverted to the original distributions if the cells were transferred again to isotonic medium. The viability of the cells was not decreased after incubation in the hypertonic medium. Ligand-independent cap formation appeared to depend upon cellular metabolism. Different species of receptors appeared to move with different mobilities during the process of ligand-independent cap formation. Most microvilli on cells showing caps in hypertonic medium were associated with the regions of the caps. These results suggest that free receptors can be induced to form caps if the receptors are allowed to interact with the machinery of cap formation under special conditions.


Activation of cytotoxic T cells by nonstimulating tumor cells and spleen cell factor(s). The ability of three cultured mouse tumor lines to stimulate a cytotoxic response in 5-day cultures of allogeneic lymph node cells was studied with a 51Cr release assay. Two lines of mesenchymal origin, P815 and EL-4, were found to be highly stimulatory, whereas the third cell line, CaD2, a mammary gland epithelial tumor, did not stimulate over a wide range of cell concentration. CaD2 cells were shown to contain major antigens similar to those of P815 cells by the specific lysis of both cells by lymphocytes activated to H-2d-bearing peritoneal cells.UV-irradiated P815-cells, like gamma-irradiated CaD2 cells, did not stimulate a cytotoxic response, but both cell lines were found to stimulate a full and specific response to allogeneic lymph node cells if these mixed cultures were supplemented with a supernatant harvested from concanavalin A-stimulated spleen cells.


Alterations in insulin binding accompanying differentiation of 3T3-L1 preadipocytes. Expression of the adipocyte phenotype by differentiating 3T3-L1 preadipocytes occurs upon exposure of the cells to insulin. Differentiation-linked changes in 125I-labeled insulin binding to 3T3-L1 cells were monitored and compared with those in nondifferentiating 3T3-C2 controls treated similarly. Without chronic insulin treatment, 3T3-L1 cells failed to express the adipocyte phenotype but maintained a level of 25,000-35,000 insulin-binding sites per cell. Treatment of 3T3-L1 cells with insulin resulted in an initial suppression of insulin binding followed by a 12-fold increase that paralleled the appearance of differentiated cells. A maximum of 170,000 insulin-binding sites per cell was attained for a population in which greater than 75% of the cells had differentiated. The increase of insulin receptor level appears to be differentiation-dependent and is not a general response of cells to the culture conditions. 3T3-C2 cells maintained in the presence of insulin for 30 days exhibited the undifferentiated phenotype and suppressed levels of insulin binding (35,000 sites per cell). The binding capacity of 3T3-L1 cells for epidermal growth factor remained unchanged between 25,000 and 40;000  sites per cell and was independent of the state of differentiation. Thus, induction by insulin in receptor-specific changes. Insulin receptors increase in number but epidermal growth factor receptors remain constant.


Density-dependent regulation of growth of BSC-1 cells in cell culture: control of growth by serum factors. BSC-1 cells grow slowly, to high cell density, in medium with 0.1% calf serum. An increase in the serum concentration increases both the growth rate of the cells and the final cell density. The serum can be replaced to some extent by epidermal growth factor (EGF). Initiation of DNA synthesis in BSC-1 cells that have spread into a "wound" in a crowded cell layer requires the addition of a trace of serum or EGF, if the cells have previously been deprived of serum. The binding of 125I-labeled EGF to low-density and high-density BSC-1 cells has been studied. Binding is faster to low-density cells. Cells at low cell density also bind much more EGF per cell than cells at high cell density. The fraction of bound 125I-labeled EGF that is present on the cell surface as intact EGF is larger at low than at high cell density. The results indicate that the number of available EGF receptors per cell decreases drastically as the cell density increases. It is suggested that a decrease in the number of available EGF receptor sites per cell, and the accompanying decrease in sensitivity of the cells to EGF, contributes to density-dependent regulation of growth of these cells.


Idiotypic regulation of the immune system by the induction of antibodies against anti-idiotypic antibodies. Anticarbohydrate antibodies (Ab1) were isolated from a rabbit hyperimmunized with Micrococcus lysodeikticus and injected into allotype-matched rabbits in order to obtain specific anti-iodiotypic antibodies (Ab2). Ab2 was isolated by means of a Sepharose column coupled to the anticarbohydrate antibodies and was injected into two allotype-matched rabbits. These latter rabbits produced specific anti-anti-idiotypic antibodies (Ab3) probably sharing idiotypic specificities with Ab1. However, these Ab3 did not react with the antigenic carbohydrate moiety of bacteria. The two rabbits that had produced Ab3 were then immunized with M. lysodeikticus and synthesized anticarbohydrate antibodies (Ab1') bearing idiotypic specificities similar to those of Ab1. The immune repertoire which is effectively expressed in one individual depends not only on the antigenic stimulation but also on the previous idiotypic history of the individual. These data support the concept that the immune system is a functional idiotypic network.


Effectiveness of breathing exercises in preventing pulmonary complications following open heart surgery. The effectiveness of breathing exercises in preventing pulmonary complications was studied in 40 patients undergoing open-heart surgery. Both high- and low-risk patients in the experimental group received one preoperative teaching session and treatment twice a day for the first four days postextubation. Routine postoperative care was given to all 40 patients. Breathing exercises reduced the incidence of pulmonary complications and the necessity for percutaneous endotracheal catheters in the high-risk group. These results justify the use of breathing exercises with the high-risk open-heart surgical patient.


Angiographic demonstration of esophagogastric bleeding from the inferior phrenic artery. A case is reported of massive upper gastrointestinal bleeding in which the hemorrhage was demonstrated on left inferior phrenic angiography. The anatomy of the inferior phrenic artery is reviewed and it is emphasized that this artery should be studied if no bleeding source is seen on "routine" angiography, especially if a distal esophageal or a proximal gastric lesion is suspected.


[Role of an insoluble thymus fraction in the differentiation of T lymphocytes]. An insoluble thymic fraction, free of both thymocytes and thymic hormone, was injected intraperitoneally to C57B1/6 mice. Following this injection, marked changes were noted in thymocyte populations: these consisted mainly in a significant increase of subcapsular prothymocytes, peaking at day 7. These observations were made by histological examination and confirmed by a study of physical characteristics of thymocyte populations. The possibility that this insoluble thymic fraction might have a biologically active component responsible for prothymocytes recruitment is examined.


[X-ray diagnosis of interstitial lung disease (author's transl)]. Characteristic signs of interstitial lung disease can be identified by analysis of roentgenographic patterns of lung structure. Intralobular changes are visible only due to summation effects whereas extralobular changes render direct visibility. Different interstitial diseases show roentgenographic patterns which often become more marked during follow-up films.


The effect of loud noise on the vestibular system. The effect of a 2 sec 113--123 dB ISO pure tone stimulus on ENG was studied. The material consisted of patients with operated and unoperated otosclerosis, normal ears, patients with sensorineural defects, and cases of chronic otitis media. ENG changes were found in 45% of patients with sensorineural hearing loss, in 35% of operated otosclerotics, in 15% of unoperated otosclerotics, in 15% of patients with chronic media, but in none of the normal-hearing patients. Most of the patients showing ENG changes felt dizzy. These results seem to imply a possible risk to patients with sensorineural hearing loss working in high noise levels.


Operative results in portal hypertension with bleeding oesophageal varices. During a 15-year period 81 patients with bleeding oesophageal varices were admitted to our department. Nearly 90% had liver cirrhosis, 21% were alcoholics. 67 portosystemic shunts were performed in 63 patients, in 11 of these as an emergency shunt. Overall operative mortality in electively shunted patients was 10.7%. Even in those with the most severe liver insufficiency (Child's group C) operative mortality was below 20%. Operative mortality in elective cases was closely correlated to peroperative bleeding. Only 1 of 45 patients needing less than 10 units of blood peroperatively died, while mortality in the multitransfused group was 45.5%. Both patients surviving urgent shunt surgery were operated on early, i.e. before they had received 5 units of blood.


Oxygen consumption during phagocytosis by leukocytes in patients with rheumatic diseases. Oxygen consumption was investigated during phagocytosis by leukocytes in patients suffering from rheumatoid arthritis, juvenile rheumatoid arthritis, dermatomyositis, systemic lupus erythematosus and scleroderma. Compared with the situation in normal persons, the mean oxygen consumption in the total patient group was depressed.


Serum lysozyme, antinuclear factors and antibody to native DNA. This work was done in order to investigate the previously reported antinuclear property of lysozyme (LZM). Addition of human or hen egg white lysozyme (hLZM or eLZM) to normal serum and to 11 sera with different types of antinuclear factors (ANF) produced no consistent changes in ANF titre or type. Likewise, absorption of LZM from the sera with bentonite failed to influence ANF titre and, finally, hLZM and eLZM were incapable of binding native DNA (nDNA). Elevated serum lysozyme levels in rheumatic diseases are therefore unlikely to produce false-positive results in tests for antinuclear antibodies.


[Recent concepts in cell mediated immunity]. Following a brief review of recent advances in the field of immunology, the concept of cell-mediated immunity is discussed in relation to new findings regarding the induction and function of sensitized T cells. Cytotoxic T lymphocytes are taken as an example of effector cells involved in cell-mediated cytotoxicity. Due to the development of in vitro model systems, it is now feasible to study the various steps leading to the generation of cytotoxic lymphocytes as well as the mechanism of their activity. For comparative purposes, other models of cell-mediated cytotoxicity are briefly discussed.


[Antibody-deficiency syndrome].

[Antibody-deficiency syndrome]. Antibody deficiency syndromes (ADS) are defined by the inability of the organism to maintain sufficient concentrations of specific antibodies in circulation. The carriers of antibodies, the immunoglobulins, are a well-defined class of plasma proteins. Some of the pertinent knowledge on their structure and function is briefly summarized. Clinical classification of ADS may be based on different criteria: etiological and pathogenetic views are here used according to needs. Primary ADS are the result of deficient synthesis, and secondary ADS are due to increased catabolism and/or loss of antibodies. Etiological factors in primary ADS are congenital disturbances (hereditary deficiency, e.g. agammaglobulinemia), regulatory imbalances (e.g. infantile hypogammaglobulinemia) or acquired disease (e.g. malignant monoclonal lymphoma). Among the causes of acquired ADS as one example diseases leading to protein loss, are discussed. However, the whole problem may not be summarized so briefly, and this is exemplified in two illustrative examples of genetically determined diseases (hereditary deficiency of transcobalamin II and of adenosine deaminase). Patients with congenital metabolic deficiences may be considered as "experiments of nature". Their extensive study has essentially contributed to new knowledge and insights into normal physiological mechanisms. This is also true in immunology where the discovery of fundamental facts is connected with such studies.


[New immunologic perspectives on specific desensitization]. The development of objective techniques for the quantitative evaluation of synthesis and production of IgE in man and experimental animals and the sensitivity of basophils in interaction with allergen has made it possible to initiate studies on desensitization on a scientific and objective basis. Several new mechanisms influencing the regulation of antibody formation, including the production of IgE, have recently been discovered, such as suppressor T lymphocytes and autoanti-idiotypic antibodies. Although present empirical methods used for desensitization therapy provide appreciable results, it is to be expected that the emerging immunological knowledge about regulation of IgE production will markedly influence therapeutic approaches in the foreseeable future.


[Cellular immunity in sarcoidosis].

[Cellular immunity in sarcoidosis]. The characteristics of the circulating lymphocytes of 24 patients suffering from sarcoidosis were studied. The surface markers and the in vitro lymphocytic activity, both spontaneous and after stimulation with PHA, were assessed. Each culture was carried out in both homologous and autologous plasma. The stimulating ability of the plasma of sarcoidosis patients on normal lymphocytes was also evaluated. The patients were divided into two groups, i.e. acute sarcoidosis and sarcoidosis in remission. From this study it can be stated that depression of T-dependent immunity is particularly evident in patients with active disease. This depression seems to be mainly due to the presence in the plasms of factors which inhibit the cellular immune response.


[Immunological changes in the lymphocyte population with increasing age]. The lymphocytes of the peripheral blood of 90 clinically healthy persons aged between 9 months and 90 years have been investigated. Children up to the age of 10 showed the highest amount of absolute lymphocytes. The number of lymphocytes decreased continually with the test subject's increasing age. Persons between 80 and 90 years of age had the lowest counts. The reduction in old age in the number of lymphocytes as a whole is attributed to a significant drop in T-lymphocytes. On the other hand, the proportion of B-cells remains at an almost constant level in all age groups. The reduction of lymphocytes as a whole, as well as that of the absolute T-cells, are discussed as possible causes of impaired cellular immunity in old age.


Human factor VIII: morphometric analysis of purified material in solution. Study of purified human factor VIII in buffer by freeze-etch electron microscopy reveals rounded, rod-shaped particles measuring 22 by 42 nanometers. When thrombin was added to purified normal factor VIII, there was a rapid loss of rod-shaped particles during the first 15 minutes of incubation at 37 degrees C. Purified plasma from two patients with severe hemophilia contained spherical particles measuring 10 to 50 nanometers in diameter, with no evidence of significant numbers of rod-shaped forms. Negatively stained and unstained air-dried samples of factor VIII corroborate the relative shape and size differences between normal and hemophiliac material.


Treatment of massive gastrointestinal hemorrhage from aortoenteric fistula. Massive hemorrhage of the upper part of the gastrointestinal tract presents a formidable crisis in surgical management. The preoperative diagnosis should be suspected in patients with a vascular prosthesis or primary abdominal aortic aneurysm. The characteristic signs and symptoms represent the triad of a pulsatile mass in the upper part of the abdomen, intermittent hemorrhage in the upper part of the gastrointestinal tract and severe epigastralgia not relieved by antacids. No ideal operative technique has evolved for correcting the abnormal physiopathologic condition. Our recent experience with three patients highlights the problems of unremitting sepsis and recurrent fistulization.


A critical look at temporary ventricular pacing following cardiac surgery. The effect of atrial, ventricular, and atrioventricular (A-V) sequential pacing on cardiac output (CO) was evaluated in patients within 24 hours after cardiac surgery. In patients with normal sinus rhythm, ventricular pacing reduced CO by as much as 42% (average, 14%), whereas atrial and A-V sequential pacing at the same rate increased CO by averages of 13% and 19%, respectively. In patients with junctional rhythm, increase of the heart rate by ventricular pacing produced an increase in CO, however, and an additional 25% increase in CO could be obtained by atrial or A-V sequential pacing at the same rate. Atrial or A-V sequential pacing was superior to ventricular pacing at the same rate and they are the preferred methods for temporary carciac pacing in the postoperative period. In suitable cases elective A-V sequential pacing is an effective method for increasing CO after cardiac surgery.


Granuloma inguinale: a case report.

Granuloma inguinale: a case report. A 20-year-old woman developed bleeding because of a painless genital ulcer. The diagnosis of granuloma inguinale was proven by showing the presence of Donovan bodies in a biopsy of the lesion. Treatment with tetracycline was successful when given in adequate dosage. Granuloma inguinale, although rare, should be considered in the differential diagnosis of patients with asymptomatic genital ulcers. Multiple biopsies may have to be done and stained with fresh Giemsa to prove the diagnosis, as in this case.


[Experimental coronary bypass operation: distribution of myocardial blood flow early and after one year]. In 10 dogs a stenosis greater than 75% of the left circumflex coronary artery is induced (Ameroid) in the course of 40 days. Within 1 hour after coronary artery bypass operation (n = 6) maldistribution of myocardial blood flow (MBF), consisting of a subendocardial perfusion deficit, is improved but not completely abolished. One year after coronary bypass operation (n = 4) MBF and its endo/epi-distribution is normal. Bypass flow and its flow profile are useful indicators of MBF and its intramyocardial distribution only when coronary dilation is induced.


21-Hydroxylation of C-11-oxygenated and C-11-deoxysteroids by perfused dog adrenals. The left adrenal of two female dogs were perfused with either 3 muCi [4-14C]cpd. S (2) and 45 muCi [1, 2-3H] 21-deoxycortisone (Dog I), or with 1 muCi [4-14C] 17-hydroxyprogesterone and 65 muCi [1,2-3H] 21-deoxycortisone (Dog II). In Dog I, 40% of the perfused 21-deoxycortisone was converted to cortisone and 23% of cpd. S was converted to cortisol. In Dog II the percent conversion of 21-deoxycortisone to cortisone and of 17- hydroxyprogesterone to cortisol was 24% and 15% respectively. The results demonstrate that the dog adrenal has the capability of hydroxylating an 11-oxygenated steroid at C-21.


[Effect of low doses of sodium fluoride on the resistance of m. sartorius of frog to the injurious action of this substance]. A study was made of the effect of the preliminary maintenance of m. sartorius in 0.025 M NaF on their resistance to the injurious dose (0.12 M NaF). In the winter frogs, the muscle resistance to 0.12 M NaF increased statistically significant after 10 and 15 minutes maintenance in 0.25 M NaF by 27.8 and 34.6%, respectively. In spring frogs, the resistance increases as soon as after a 5 minutes preincubation by 22.5% (P less than 0.05). A 15 minutes incubation produced a similar effect as that observed in winter (32.8% P less than 0.05) A 15 minutes maintenance of muscles in a weak solution of NaF while increasing their resistance to the inhibitor was found to decrease their resistance to an injurious ethanol solution (3.48 M), and to 36 degrees, by 58 and 53%, respectively.


[Intensity of ultraviolet fluorescence of the cells depending on their size]. Using the light microscope, a correlation between ultra-violet fluorescence intensity of the cell and the cell area was established. This correlation does not depend on the large aperture of the microscope. A possible cause of this correlation is supposed to be either the proportionality between the mass of cytoplasmic protein and the squared cell radius, or a high optical density of cell elements.


[Effect of a low-molecular humoral factor of the thymus gland on the lymphocyte sensitivity to phytohemagglutinin]. The preincubation of mouse spleen lymphocytes with a low molecular lymphocytosis-stimulating substance from the thymus (LSS), or the addition of the LSS to the cultures caused inhibition of the mitotic response of lymphocytes to phytohemagglutinin (PHA). LSS induced transformation of murine thymocytes to the blast cells capable of mitotic division. This transformation was depressed by PHA. The lymphocytes of the mice injected LSS in vivo responded weakly to PHA at first, but in 5 days a significant intensification on the response to PHA was observed. It is concluded that LSS may activate the T-cells responding to PHA.


[Autoradiographic study of DNA metabolism in different populations of lymphocytes during chemical carcinogenesis is mice of the BALB/c strain]. A correlation between macro- and micronuclear lymphocytes and their DNA metabolism was studied in the lymph nodes of BALB/c mice during the growth of methylcholanthrene sarcoma. The number of macronuclear lymphocytes was seen reduced along with a simultaneous increase of 3H-thymidine indices in regional lymph nodes during the tumor growth. The number of micronuclear lymphocytes of these lymph nodes was accordingly increasing. In distant lymph nodes the reaction was significantly less expressed.


[Effect of proteases on sugar transport in muscle tissue]. Effects of trypsin and pronase on D-xylose uptake were studied on isolated frog sartorius muscle. Trypsin and pronase exerted insulin-like effects on the transport of sugar. The acceleration of xylose transport by insulin was reduced by a prior incubation of muscles with trypsin or pronase. The inhibition of insulin effect was not due to destruction of the hormone. Proteases had no effect upon the sugar transport stimulated by DNP or potassium contracture. A conclusion is made of the availability in the frog muscle membrane of some insulin receptor similar to that reported for muscle tissue and fat cells of mammals.


[Gastrointestinal hemorrhages as a consequence of the side effects of drug substances]. The authors observed 53 cases of profuse gastroinstestinal bleeding resulting from the use of "ulcerogenic" drugs (reserpine, prednisolone, butadione, acetylsalycylic acid) for hypertensive disease, bronchial asthma, infections polyarthritis, influenza etc. The active but temporizing therapeutic tactics was applied. Of 53 cases of profuse gastrointestinal bleeding 48 survived (90.6%) and 5 died (9.4%).


Requirement for interactions between two subpopulations of T cells for helper cell induction in vitro. The evidence for the interaction of 2 subpopulations of T cells, short-lived cells sensitive to adult thymectomy (T1 cells), and long-lived recirculating cells, sensitive to the action of antilymphocyte serum (T2 cells) in the induction of helper cells is presented. This T-T interaction occurred across a cell-impermeable nucleopore membrane, indicating that it did not depend on cell contact, but was mediated by subcellular factors. There was no genetic restriction on this T-T interaction, if it was performed across a nucleopore membrane. The implications of these results on our concepts of the mechanism of help are discussed.


Early kinetics of B cell memory and the influence of T cells on the expression in vitro. To study the early kinetics of B cell memory to sheep erythrocytes mouse spleen cells were cultured after short priming times in vivo. The influence of T cells on the expression of memory in vitro was investigated by treatment with anti-theta serum. Within 48 hours of in vivo priming part of the B cell population can differentiate into cells capable of IgG production after secondary antigen contact in vitro without the help of T cells. The presence of antigen was required for the in vitro development.


Tridacnin, a new mitogenic lectin from invertebrate sources. A new group of invertebrate lectins with anti-beta-galactosyl specificity, the so-called Tridacnins from the Tridacnid bivalve clams have been found to show not only agglutinating and precipitating properties, but also mitogenic activity as tested with human lymphocytes.


[The occurrence of neuraminidase and N-acetylneuraminate-pyruvate lyase in pathogenic haemophili of man (author's transl)]. We investigated the following six Haemophilus species from man for the both enzymes neuraminidase and N-acetylneuraminate pyruvate lyase: H. aegypticus, H. aphrophilus, H. influenzae. H. parahaemolyticus, H. parainfluenzae and H. vaginalis. It is shown that H. vaginalis does not produce either neuraminidase or N-acetylneuraminate pyruvate lyase. He differs, therefore, from all other investigated haemophili producing both enzymes, neuraminidase and N-acetylneuraminate pyruvate lyase. Colominic acid, Na-salt, is splitted better than N-acetylneuraminyllactose. It can be concluded, therefore, some substrate specificity of the neuramindase of Haemophili in the sense that the alpha, 2 leads to 8 linkage of neuraminic acid is cleaved quicker than the alpha, 2 leads to 3 linkage. The physiological and pathologenic role of the both enzymes is discussed.


[Diagnosis of formes frustes of a rheumatic lesion of the nervous system in children]. In 77,9 +/- 3,5% of the children with an active phase of rheumatic fever, developing with a prevalent lesion of the heart and joints, symptoms of animal and vegetative nervous system lesions were found. The neurological symptoms correlated with changes of the brain bioelectrical activity. The authors point to some dynamics of symptoms under the influence of anti-rheumatic treatment. Normalization of the brain bioelectrical activity, a regress of symptoms of the vegetative nervous system and muscular hypotonia are somewhat behind the clinical recovery. The existence of pathological activity on the EEG in children after an arrest of clinical symptoms of rheumatic fever may indicate to the possible subsequent development of chorea, the diencephalic syndrome, cerebrasthenic syndrome in these children.


[Epidemiology of rheumatic syndromes in Turkey. III. Incidence of rheumatic sacro-iliitis in men of 20-22 years]. 1436 young men were investigated clinically and radiologically for rheumatic sacro iliitis. In two men (1.4%) definite bilateral sacro iliitis was diagnosed. In 18 cases (12.5%) the signs were not sufficient to make a definite diagnosis. They were regarded as suspected iliitis. For comparison the cards of 6138 patients who had called at our outpatient clinic over a 5 years' period were checked. In 40 cases (0.65%) a definite diagnosis of bilateral sacro iliitis was made, in another 45 cases (0.73%) sacro iliitis was suspected, but definite proof was lacking. The group we investigated has two characteristics. As to sex and age our test subjects (recruits) represent a group in which bilateral sacro iliitis appears relatively often. Infections are reported to increase the frequency of bilateral sacro iliitis. Our test subjects were only investigated for tuberculos infection. Active tuberculosis was not found. Also factors which may have a negative influence on the frequency were investigated. First of all the soldiers had been examined by clinical committees before recruitment. Advanced and thus clinically typical cases were eliminated by these committees and the frequency rate in the remaining group thereby decreased. The recruits came from very different parts of the country and various geographic and social factors may influence the morbidity. The frequency rates obtained at the end of the investigation have therefore to be regarded as the result of various factors some with positive and some with negative influence.


Initial experience with coronary artery bypass graft surgery. A follow-up study. The preoperative, postoperative and late follow-up data of an initial series of two hundred patients with coronary artery disease, who underwent direct coronary artery surgery, were analyzed. With increasing experience operative mortality, postoperative complications, graft closure and perioperative myocardial infarction showed a definite decrease. Patency rate was definitely related to symptomatic relief, return to work, postoperative exercise tolerance, and the absence of perioperative myocardial infarction.


Antigenic spectrum of soluble serum glycoproteins in rheumatoid arthritis. Compared with healthy controls, rheumatoid arthritis patients were found to have higher serum (1 M) perchlorate filtrate (CHLF) levels of alpha-antitrypsin. In addition to orosomucoid, alpha2-HS-glycoprotein, haptoglobin, haemopexin and beta2-glycoprotein, the filtrate also contains detectable amounts of albumin, prealbumin and - in patients with high serum glycoprotein levels - also IgA. Serum sulphosalicylate filtrate (SF) contains chiefly orosomucoid, together with alpha1-antitrypsin, haptoglobin, haemopexin and beta2-glycoprotein. CHLF contains larger amounts of glycoprotein than SF. The glycoproteins of CHLF correlate with the patient's synovitis, while a high SF glycoprotein content, as estimated by the polarographic activity of the sulphydryl groups, tends to be indicative of visceral complications of RA.


[Hypertension and pregnancy].

[Hypertension and pregnancy]. Hypertension during pregnancy and its complications are the most important cause of maternal and foetal death and morbidity. The chronic primary hypertension can be differentiated from the dysgravidia by anamnestic, biological, clinical and technical investigations. However the diagnosis remains difficult and the renal needle biopsy can help to ascertain it. The pathogenesis of dysgravidia is still obscure: the placental ischemia leads to a slow disseminated intravascular coagulation state with renal injury, while a vascular hyperreactivity leads to an increase of the resistance, a relative hypovolemia and lowering of cardiac output. The treatment and remote prognosis of the hypertensive disease associated with the pregnancy are summarized. The antihypertensive drugs improve the maternal prognosis while jeopardize the foetal outcome.


False aneurysm of the ascending aorta following cannulation. The development of a false aneurysm of the ascending aorta following arteriotomy and cannulation of the aorta performed during closure of a ventricular septal defect is described. The evidence suggest that the sutures of the arteriotomy led to rupture of the aortic wall and secondarily late formation of a false aneurysm.


Angiography in hereditary hemorrhagic telangiectasia. Hereditary hemorrhagic telangiectasia is a vascular disorder with stigmata in any part of the body. The most frequently reported sites of internal lesions are the lungs, liver and gastrointestinal tract. When one lesion is observed on chest radiography or on splanchnic angiography there is reason to include other vascular areas in the investigation. A normal angiographic finding does not exclude the presence of telangiectasia.


New approaches in the management of hyperkinetic movement disorders. This review covers recent advances in a variety of dyskinesias. Introduction of new drugs for the treatment of myoclonus and sensory biofeedback therapy for focal dystonia are expanding our concepts of these types of movement disorders. Progress in the treatment of action myoclonus is especially noteworthy and has led to the implication of serotonin deficit in the pathophysiology of this syndrome. Knowledge of the biochemical pathology of Huntington's chorea has outpaced therapy for this disorder, but new forms of therapy have been proposed based on the chemical findings. Basic pharmacologic studies suggest pathophysiologic mechanisms for the syndrome known as tardive dyskinesia, but treatment is still far from ideal for this disorder. Other movement disorders with recent therapeutic advances include essential tremor and hemiballism. This review will cover only those dyskinesias in which new therapies have been advanced in the last few years. Aside from parkinsonism, which will not be discussed here, progress in the treatment of movement disorders has been slow, but steady. New drugs are being tested constantly, and the purpose of this review is to call attention to the ongoing evaluation in this field. Descriptions and etiologies for these dyskinesias are covered elsewhere (Fahn, 1976a) and therefore are not repeated here.


Experimental vitreous haemorrhage: echographic appearances. Vitreous haemorrhages were induced in rabbits and the echographic appearances of A and B scan were correlated with the gross and histologic appearances over a period of twenty weeks. In all cases, visible vitreous opacities produced distinct echo patterns. As the haemorrhages cleared, the echo amplitudes became progressively weaker. Several patterns of vitreous "membranes" on B scan were also observed. Pathological examination revealed that such membranes were composed of red cells, macrophages and condensed vitreous collagen. It is suggested that haematogenous vitreous membranes of this type are readily diagnosed by combined A- and B-scan ultrasonic examination, and are probably amenable to surgery.


[Experimental allergic chorioretinitis. Appearance and behavior of complement-fixing anti-ROS antibodies in the sera following immunization with retinal antigens (author's transl)]. The authors studied the appearance and behavior of complement-fixing anti-ROS antibodies in the sera of GrCh rabbits following one or two intracutaneous injections of retinal antigens emulsified in Freund's complete adjuvant (KFA). Fourteen different antigenic preparations from heterologous, homologous, and autologous retinal components incorporated in KFA were tested and compared. Apart from the supernatant of a centrifuged homogenized preparation of homologous retina, all immunogens generally induced anti-ROS antibodies. The antibody titers (reciprocal values) reached a maximum 4 to 8 weeks post injection, at only low levels. The changes in antibody concentrations showed some relationship to the quality and dose of the immunogens. Anamnestic effects following reinjection reached maximum values within as little as 5 to 14 days. Animals not developing chorioretinitic lesions showed higher antibody titers more frequently than rabbits with clinically confirmed disease. Provided there is sufficient relevance of the humoral reactions observed, the complement-fixing antibodies we found in our experiments are more likely to have protective than pathogenic functions.


[Contact biomicroscopy in examination of blood vessels of the eye (author's transl)]. The vessels of the conjunctiva and iris were studied in 20 gray and albino rabbits. The luminescent contact microscope (MLC-1) was used, at maximum magnification 174 x for visual observation and 33 x for photography. The particular advantage of contact biomicroscopy is that it makes possible detailed observation not only of the superficial network, but also of the deep network of conjunctival vessels. Both the blood flow and the distribution of formal elements in vessel lumina can be observed.


Compartmentation of redox metabolites in the anterior eye segment? In bovine corneal epithelium, stroma, and aqueous humor the levels of ascorbic acid (ASC) and dehydroascorbic acid (DHA) were investigated. Two methods were used, the photometric assay with 2,6-dichlorophenolindophenol and the formation of osazone by 2,4-dinitrophenylhydrazine. The ASC levels in the corneal epithelium and aqueous humor were found to be in the millimolar range, the ASC/DHA ratio being about 10. The stromal ASC and DHA levels were much lower, with a ratio of 0.7. ASC and DHA had similar levels and ratios to those of reduced and oxidized glutathione (GSH/GSSG) reported in the literature. In the corneal epithelium the redox ratio of glutathione was higher than that of ascorbic acid. Therefore, glutathione was supposed to reduce dehydroascorbic acid.


[Genetic differences in the eye manifestation of adjuvant arthritis in the rat. II. Histological investigations (author's transl)]. Hooded rats react to intracutaneous injections of complete Freund's adjuvant with an adjuvant disease, which is externally perceivable by massive polyarthritis, by skin and ear nodules, and by other known symptoms. In contrast to Wistar rats, however, they show no tendency to develop clinically or histologically provable eye manifestations such as an uveitis anterior (adjuvant uveitis). This fact has been connected with the genetic differences between the two strains of rats.


[Genetic differences in the eye-manifestation of adjuvant arthritis in the rat. III. Crossbreeding experiments (author's transl)]. The results of crossbreeding experiments between several strains of rats are reported. They show differences in the prevalence of iritis in the course of adjuvant disease as did the results we published in an earlier article. There are alterations which indicate a recessive heredity of the tendency to iritis. The contribution of genetic factors in the course of adjuvant arthritis has been confirmed by the present results.


Study on cellular immune response after complicated cataract operations and in sympathetic ophthalmia. The authors studied the development of the cellular immune response following extracapsular, traumatic and uveitic cataract extractions as well as in cases of sympathetic ophthalmia. In order to detect the cellular sensibility the blast transformation method and the migration test with lens and iris antigen were applied.


[Pharmacokinetics of an imidazoline derivate applied to the eye (author's transl)]. The absorption of a vasoconstrictive substance labeled with 14C, after application as eye-drops, was studied in animal experiments. After iatrogenous obstruction of the lacrimal punctum with tissue adhesive, a maximum of 6% of the substance could be measured in the total blood volume after an exposure time of 60 min. High relative concentration of the drug could be found in cornea, conjunctiva, and iris, while the concentration in lens, vitreous body, and the rest of the eye was low. The results represent the maximum values of resorption. Additional studies, made by 99mTc-pertechnetate microscintigraphy of the lacrimal drainage apparatus of the rabbit were also performed. The transport of an eye-drop from cornea and conjunctiva to the nasal cavum was found to be very rapid. Therefore it seems to be of little value to carry out investigations on the absorption of eye-drops over long time periods without prior occlusion of the lacrimal punctum.


Mathematical consideration of aqueous outflow after trabeculo-electropunture (TEP). The obtainable postoperative intraocular pressure following a TEP in a glaucoma patient with an intraocular pressure of 30 mm Hg is calculated in accordance with the concept that there is no outflow of aqueous humor along Schlemm's canal. If aqueous humor reaches all collector channel openings in the surgical area without resistance, the postoperative intraocular pressure reads 14.75 mm Hg. This intraocular pressure is obtained at a point when a collector channel of 1 mm length and of 32 mum in diameter or two collector channels of 27 mu in diameter or five collector channels of 22 mu in diameter establish connection with the trabecular opening.


Malignant lymphoma with B-lymphocyte characteristics in dogs. Cell surface membrane characteristics of B and T lymphocytes were demonstrated on cells from canine malignant lymphoma, and the results were compared with cytologic classification. Lymphoma in 4 of 5 dogs was found to have one or more characteristics of B lymphocytes. Correlation between the cytologic classification and the presence of B- and T-lymphocyte characteristics was not apparent.


An ultrastructure study of posterior polymorphous dystrophy of the cornea. The cornea from an early developing and uncomplicated case of posterior polymorphous dystrophy in a 15-year-old boy shows a thin abnormal Descemet's membrane and reduced number of endothelial cells as the primary findings. Ultrastructurally, the membrane was composed of a very thin, three-dimensional lattice pattern layer covered by layers of fibrous material. This lattice pattern is normally formed between late fetal and early adolescent life. The 3 previously reported histologic cases of this entity were from cases with long-standing corneal opacities in the late third to fifth decade of life with additional corneal changes. However, in each case the lattice pattern layer of the membrane was abnormally thin. This report suggests that a progressive form of posterior polymorphous dystrophy of the cornea is due to cells forming abnormal Descemet's membrane beginning in late fetal life to soon after birth.


Injection sclerotherapy in the emergency and elective treatment of oesophageal varices. Injection sclerotherapy with careful attention to initial diagnosis and technique is an effective way of stopping oesophageal variceal bleeding. It can also be used electively at 3-monthly intervals to obliterate varices after they have once bled. It is relatively safe and simple, but patients must be follwed up and reassessed at least every 6 months, when new varices may be injected if they occur. It is particularly suitable when the experience and facilities for emergency portacaval shunts are not available.


Quantitative inhibition of Haemophilus influenzae by trimethoprim/sulfamethoxazole. We evaluated the inhibitory effect of trimethoprim (TMP) and sulfamethoxazole (SMZ), alone and in combination, against 34 strains of Haemophilus influenzae. Growth inhibition was determined after incubation for 18 h by comparing viable counts of cultures in drug-containing medium with corresponding counts of control cultures in drug-free medium. In a modified, thymidine-deficient Levinthal broth, the numbers of colony-forming units of all the isolates tested were reduced 100-fold or more by TMP/SMZ (1.25/25 mug/ml) as compared with growth without drug. Inhibition was significantly greater with TMP/SMZ than with either TMP or SMZ alone. Ampicillin-susceptible and ampicillin-resistant strains were equally susceptible to TMP/SMZ. Growth of nontypable strains was inhibited more than growth of type b organisms.


Isolation and characterization of human fecal bacteria capable of 21-dehydroxylating corticoids. It has been known for a decade that human intestinal flora include organisms capable of 21-dehydroxylating corticoids. Yet the identity of the organisms synthesizing 21-dehydroxylase has remained unknown. Using diluted human feces, we determined the prevalence of colonies of 21-dehydroxylating organisms on a variety of media. Isolation from the medium of colonies with the highest prevalence yielded an obligate anaerobe capable of 21-dehydroxylating deoxycorticosterone and tetrahydrodeoxycorticosterone. This transformation could be carried out in a prereduced medium by the microbial culture alone or in an aerobic medium reduced by growth of Escherichia coli. The culture shares many characteristics with Eubacterium lentum, the neotype strain of which elaborated both 21-dehydroxylase and 3alpha-hydroxysteroid dehydrogenase.


[IgE and cellular immunity in cutaneous lymphomas (author's transl)]. Serum IgE levels were measured (radioactive radial diffusion or radioimmuno assay) in 21 patients (14 mycosis fungoides or premycosis fungoides and 7 other lymphomas) and 1,019 controls. Elevated IgE levels (greater than or equal to 500 UI/ml) were found in 57 p. 100 of patients and 8,1 p. 100 of controls. The most important increase was noted in mycosis fungoides. Moreover, some of these patients showed a cellular immunity impairment: negative delayed skin tests, low percentage of T-lymphocytes forming E rosettes (2 out of 4 patients), decreased mitogenic response to Con A and P.H.A. In one patient with Sézary syndrome there was a dissociation between E and E active rosettes (low values) and anti H.T.L.A. serum (high values). This result could indicate that the Sézary cell is a poorly differentiated T-lymphocyte.


[Effects of UV-C and of 8-MOP + UV-A on the T- and B-population of human lymphocytes in vitro (author's transl)]. The transformation of UV-C irradiated leucocytes and lymphocytes by the mitogens Con A, PHA and PWM is measured by the 3H-Tdr. incorporation after 72 h incubation. Furthermore T- and B-cells are determined by the method of rosette formation. A clear inhibition of the cell activity is seen after irradiation of leucocytes with 450 mJ/cm(2) and of a lymphocyte suspension with 5-10 mJ/cm(2). There are no significant differences between the effects of the various mitogens. The number of T-cells decreases proportionality to the various intensity, the number of B-cells remain constant. Irradiation with UV-A + 8-MOP cause, equally for all mitogens, a dosis dependent inhibition of thymidine incorporation.


B and T lymphocytes: methodology and normal ranges. B and T lymphocytes separation by use of various cell markers had been previously described. These differential lymphocyte subpopulation counts have been helpful in elucidating immunodeficiency, lymphoproliferative and other disease states. Expanding clinical utility has moved these assays into the general laboratory for routine determination. Specific methodology for differentiation of B and T cell subpopulations is described. The mean T cell population is 68.1 percent +/- 4.2 and the mean B cell population is 8.4 percent +/- 2.1 for 30 ambulatory normals. A bi-modal distribution of T and B lymphocyte cell lines is noted in a family with a high incidence of carcinoma. Preliminary data on patients in the diabetic clinic of the Medical University of South Carolina shows a statistically significant difference in the T cell population of diabetics versus normal.


Tumor induction by carcinogenic agents in anuran amphibian Rana temporaria. Effects of 12 chemical cancerogenic agents have been studied in 910 anuran amphibia of the grass frog Rana temporaria. Tumors developed by administration of 8 of the agents studied. Dimethyl, diethyl and dibutylnitrosamines dissolved in water induced tumors in 44.2, 43.6 and 50% of animals, respectively; benzidine and 2-acetylaminofluorene administered subcutaneously and per os--in 46.6 and 41.2%, respectively, whereas p-dimethylaminoazobenzene and orthoaminoazotoluene (per os and subcutaneously)-in 30--33.3% of cases. Diethylstilbestrol-propionate induced tumors in 21% of cases. All the tumors developed within relatively short periods of time (15.6--31.9 weeks) and were located in the liver (hepatocellular cancer, hepatoadenomas) and the haemopoetic system (hemocytoblastosis). In control group of animals 3 amphibia developed multiple tumors of skin-cystadenopapillomas. The results obtained testify to the common mechanism of cancerogenesis in classes of vertebrates. In addition, the findings presented indicate to the suitability of amphibia as a new experimental object in oncology as well as to the applicability of these animals for purposes of express diagnostics of cancerogenicity. It may successfully serve as a biological indicator of environmental pollution with blastomogenic agents.


The effect of trasylol (Trascolan "Polfa") and p-aminomethylbenzoic acid (Pamba "Germed") on the experimental metastases of transplantable melanotic melanoma in golden hamster (Mesocricetus auratus, Waterhouse). The influence of two proteinase inhibitors -- Trasylol (Trascolan "Polfa") and PAMBA ("Germed") -- on experimental metastases of melanotic melanoma has been studied in golden hamsters. Animals were injected intravenously with tumour cells (5x10(5) or 10(6) in 0.2 ml of saline). They obtained protease inhibitor intraperitoneally one hour prior, or one hour after melanoma cells injection. One group of hamsters were also inoculated with tumour cells preincubated 10 min. in saline containing Trasylol or PAMBA. A diminished number of experimental metastases to the lungs in each group has been observed.


[Trichomonas vaginalis and cytological findings (author's transl)]. The detection of Trichomonas vaginalis by the method of the Papanicolaou smear has proven as suitable. Alterations of surface cells in the presence of Trichomonas vaginalis are described, and causal relations between atypic cells and Trichomonas vaginalis are discussed. From a total of 13000 in investigations of cancer screening in 1975, an infection with Trichomonas vaginalis was found in 850 cases = 6,69 p.c. In contrast to this result 28 p.c. of the 116 patients with cancer of precancer of the cervix uteri had a simultaneous infection with Trichomonas vaginalis. These results suggest the possibility of a relationship between the incidence of Trichomonas vaginalis and atypic cell alterations. Therefore it is necessary for the cytologist to search for Trichomonas vaginalis in cancer-screenings and to inform the gynaecologist in case of a positive finding. All exact posttherapeutic control is indicated to find out the presence of a potentially malignant atypia of cells or of reversible reactive cell alterations.


Hepatitis associated antigen, autoantibodies and serum immunoglobulin levels in patients with liver injury following administration of antituberculosis drugs. 32 patients with liver injury following the administration of tuberculosis drugs were examined for HAA, ANA, SMA and serum immunoglobulin levels. HAA was found in 38-7% of patients. SMA were detected in some HAA positive as well as in HAA negative cases. ANA except in one case were found in the HAA negative group. Serum IgM levels are significantly higher in patients with liver injury as compared to the normal values. The highest levels of IgG and IgM were found in the ANA or/and SMA-positive cases.


Nonsyphilitic coronary ostial stenosis.

Nonsyphilitic coronary ostial stenosis. From October 1970 to June 1977, a total of 15 patients (12 women) were seen with atherosclerotic coronary ostial stenosis (14 left, one right). All patients had angina and two had aortic valve disease. Additional coronary arterial disease was present in nine. One patient declined surgery and died four months later after myocardial infarction. All patients had coronary bypass grafts and two had aortic valve replacement. One patient with valve replacement and one with preoperative cardiogenic shock died postoperatively. Angina recurred nine months postoperatively in one patient; the others (11) are free of angina. Postoperative catheterization from two weeks to 4.5 years in ten of 12 showed 11 of 13 vein grafts and eight of nine internal mammary artery grafts to be patent. In three patients, only a single left-sided coronary bypass was placed to the left anterior descending artery, because the circumflex branches were too small. Ideally, two left-sided bypass grafts should be placed for left ostial disease.


Bacillus laterosporus endophthalmitis.

Bacillus laterosporus endophthalmitis. A strain of Bacillus laterosporus was isolated from the aqueous and vitreous humors of a patient with endophthalmitis that developed after a penetrating injury of the cornea. Intravitreal inoculation of the isolate into rabbits produced severe panophthalmitis, corneal perforation, orbital cellulitis, and even meningitis. These observations suggest that B laterosporus, hitherto classified as nonpathogenic, is an opportunist that can cause disease when conditions are favorable.


A comparative analysis of the colour matching ability of dentists, dental students, and ceramic technicians. This paper compares the colour matching ability of dentists, dental students, and ceramic technicians. It examines the roles that experience and colour defective vision may also play in the correct matching of dental colours.


Alpha1-antitrypsin deficiency--a literature review and a case report of a patient with chronic obstructive airways disease and cirrhosis. A patient who manifested both pulmonary and hepatic disease associated with alpha1-antitrypsin deficiency is described. The biological function of alpha1-antitrypsin is discussed, as well as the inheritance of deficiency states and the spectrum of disorders which may ensue. Severe deficiency of alpha1-antitrypsin has been linked with pulmonary emphysema in adult life, progressive liver disease in childhood, adult cirrhosis but rarely with both pulmonary and liver disease.


An epidemiological analysis of factors influencing the increase in Taenia ovis prevalence during the New Zealand Echinococcus granulosus control program. There was an 8-fold increase in the national prevalence of Taenia ovis in dogs during the first decade of the New Zealand hydatid disease control program. The temporal patterns in the prevalence of T. ovis were similar in both rural working dogs and urban pet dogs, with the highest prevalence found in the sheep farming areas. The dramatic increase in the prevalence of T. ovis was a reflection of the change in source of food for many working dogs, from the traditional raw viscera to carcase meat of sheep, a change necessitated by hydatid disease control. Other factors influencing the rise in prevalence of T. ovis in rural dogs were investigated using stepwise multiple regression techniques. The results of the regression analyses suggested that the rate of increase in the prevalence of T. ovis was influenced by 4 major factors: Taenia hydatigena variables (initial prevalence and rate of progress in control), an ethnic variable (Maori proportion in local population), canine variables (numbers of dogs per farm and per owner), and animal husbandry variables (pasture type, sheep density and numbers of sheep per farm). The results were discussed in the light of present knowledge of the epidemiology and immunology of the taeniid cestodes.


Low-frequency, weak extradural stimulation in the management of intractable pain. Low-frequency (1.6-2.2 Hz) and weak-intensity electrical stimulation in the spinal extradural space produced complete to partial pain relief in a majority of patients (22 of 25) who suffered from intractable pain. Also it produced analgesia or hypoalgesia over a wide area of the body surface in 19 of the 25.


T and B lymphocytes in contact and atopic dermatitis. Twenty patients with contact dermatitis, eighteen with atopic dermatitis, two with mixed dermatitis, and 20 controls were examined for the number of T and B lymphocytes, and serum concentrations of IgD and IgE. Significantly higher counts of B lymphocytes bearing IgE and high serum IgE values were found in the atopic group. No other significant differences were found. In particular, we found a normal frequency of IgD bearing lymphocytes in contact dermatitis, and normal T lymphocyte counts in both groups of patients.


Autoimmune anti-T cell antibodies in the sera of patients with mycosis fungoides. The serum of persons with mycosis fungoides contains IgG antibody believed to be specific for T cells, similar to the auto-antibodies reported in patients with systemic lupus erythematosus, Hodgkin's disease and sarcoidosis. The antibody is present during the active, and disappears during the inactive, phase of the disease.


Heterogeneity of von Willebrand's disease: study of 40 Iranian cases. Forty Iranian patients with von Willebrand's disease were tested for bleeding time, platelet retention to glass beads, ristocetin-induced platelet aggregation, and assay of factor VIII procoagulant activity (VIII:C), Willebrand factor activity (VIIIR:WF), and factor VIII-related antigen (VIIIR:AG) by two methods (Laurell and immunoradiometric assay). In 22 cases from 11 families, levels of VIII:C, VIIIR:WF and VIIIR:AG (Laurell) were below 5% and the immunoradiometric assay showed total lack of VIIIR:AG in all cases (sensitivity of the method 0.01%). In 10 of these families, the parents were related, raising th;e possibility that these patients are homozygous. The occurrence of precipitating antibodies to factor VIII was demonstrated in one of these severe patients. In seven cases from five families the anomaly was less severe, with results of VIII:C between 5 and 17%. In 11 cases from six families VIII:C was normal or moderately decreased, contrasting with lower levels of VIIIR:WF and VIIIR:AG. The presence of an abnormal factor VIII/von Willebrand factor protein was assessed by double-cross immunoelectrophoresis and gel filtration.


Review of Binkhorst intraocular lenses.

Review of Binkhorst intraocular lenses. Experience is described of 150 cases in which an intraocular lens of the Binkhorst (iris clip and iridocapsular type) was introduced after cataract extraction. The most serious complications are dislocation and corneal dystrophy.


Increase in the frequency of Fc receptor (FcR) bearing cells in the mouse spleen following a single exposure of mice to 2450 MHz microwaves. A single 30-min exposure (13,7 +/- 1.2 mW/g) of mice to 2450 MHz microwaves produced a significant increase in the proportion of FcR+ cells in the spleen. This increase was due to a selective increase in FcR+ B cells. No changes in total B (Ig+) and T (theta+) cell frequency in the spleen were observed.


[Age and the response of peripheral blood lymphocytes to mitogens]. Reactions of the peripheral blood lymphocytes of normal persons from 19 to 49 years of age to the following mitogens was studied; phytohemagglutinin (PHA), concanavalin A (ConA), rabbit serum against human thymocytes (ATS). A significant reduction of the lymphocytes proliferative response to ConA was reported in persons above 30 years old. There was also demonstrated a significant negative correlation between the proliferative response indices and the donor's age (in ConA-stimulation-for the whole group examined, and in ATS-stimulation-for persons aged from 30 to 49 years only. Analysis of the intensity of thymidine-(3)H incorporation showed that with the advance of age there was a fall of the percentage of cells with an intensively labelled nuclei and an accumulation of cells with weakly labeled nuclei, this phenomenon was observed both when the proliferative response was decreased and when no significant differences were reported in these indices.


[Duration of mitosis in mouse thymus cortex cells under normal conditions and after antigen administration at different times of the day]. The influence of an antigen injected at different periods of the circadian mitotic activity on the cell proliferation in the thymus cortex was studied. The duration of mitosis and the number of cells entering division were determined. A pronounced stimulating effect of immunization with sheep red blood cells entering mitosis increased, while the duration of mitosis diminished (colchamine mitotic index was 29.79 percent in control mice, and 47.99 percent in the immunized ones. The duration of mitosis was 0.4 hours in control animals, and 0.24 hours in the immunized ones. When compared with intact mice, the animals immunized in the evening showed no significant changes in the parameters studied.


[Changes in the mitotic activity and destruction of rat thymus lymphocytes following hydrocortisone administration at different hours of the day]. The 24-hour rhythm of mitoses was identical in the thymus lymphocytes of 30-day rats in control and in experimental animals 4 hours after injection of hydrocortisone. In the control rats the number of degenerating lymphocytes failed to alter in the course of 24 hours. Four hours after the hydrocortisone injection of degenerated cells increased sharply; however, the rate of the lymphocyte destruction was more significant at night and early in the morning than during the day and the evening.


Hairy-cell leukemia with T-cell features. A case of clinically and hematologically typical hairy-cell leukemia has been presented in which, at the various times of testing, 52%-95% of peripheral blood and 73% of splenic mononuclear cells formed spontaneous sheep erythrocyte (E) rosettes. Many of the rosetting cells were shown to be typical morphologic hairy cells by light and electron microscopy. It was found that 70%-75% of peripheral blood mononuclear cells stained with an anti-T antiserum, and this antiserum also abolished E-rosette formation. A variable percentage of peripheral blood mononuclear cells was also shown to bear surface (IgDK) and internal (IgMK and IgGK) immunoglobulins. Additional B-cell features demonstrated included possession of the P29/34 la-like antigen and formation of mouse rosettes. It was demonstrated by a variety of blocking and inhibition studies that the E-rosette formation was not attributable to chance antigen specificity of the surface membrane immunoglobulin. These marker studies suggest that this is a case of true hybrid cell HCL. Despite these unusual marker characteristics, the patient showed no distinctive clinical or hematologic features.


T cells and protein nutrition in hospitalized surgical patients. Percentage and number of T cells in peripheral blood and severe indices of protein nutrition were assessed in a random sample of 51 hospitalized surgical patients. Whole blood counts of the patients' lymphocytes and E rosette tests (after separation of lymphocytes from whole blood on Ficoll-Metrizoate) showed no difference from a control group of well-nourished people attending hospital for minor complaints. In general there was no consistent relationship between the level of protein nutrition and low T cell numbers, except for 5 malnourished patients tested less than 1 week after major surgery. Although a group of 11 patients who fulfilled the criteria for 'malnutrition' had normal T cell numbers, the percentage of T cells was significantly higher and the number of total lymphocytes was significantly lower than in the controls.


Angiographic control of traumatic haemobilia by selective arterial embolization. Traumatic haemobilia was diagnosed and treated successfully by selective arterial catheterization and embolization with Gelfoam particles, thus avoiding the hazards of surgical intervention, in a 16-year-old boy with tuberculous peritonitis. No ill effects to the liver parenchyma were noticed as evidenced by liver function tests and liver scan.


Histamine synthesizing afferents within the amygdaloid complex and bed nucleus of the stria terminalis of the rat. The regional distribution of histidine decarboxylase (HD) activity has been studied in the amygdaloid complex and the bed nucleus of the stria terminalis (BST) of the rat. The central and medial nuclei of the amygdala had 2-fold higher HD activity levels than the remaining nuclei of the complex. HD activity was exceptionally high in the BST, particularly in its ventral part. A lesion of the stria terminalis had no effect on this distribution whereas a combined lesion of the stria terminalis and the so-called ventral pathway induced a decrease of approximately 60% in all the amygdaloid nuclei, but not in the BST. On the other hand, a lesion of the medial forebrain bundle (MFB) induced a similar decrease in both the amygdaloid nuclei and the BST. These results confirm that HD-containing fibres are present in the MFB. On the one hand these project massively to the BST and on the other penetrate in the amygdala ventromedially along the ansa peduncularis and preferentially innervate the more medially located nuclei.


Surgical management of malignant bone tumours. The evolution of treatment for osteogenic sarcoma at the Memorial Sloan-Kettering Cancer Center is reviewed. The possible control of micrometastases by chemotherapy and the excision of macrometastases at single or multiple thoracotomies by the thoracic surgeon have added greatly to the salvage rate of this tumour. Intensive chemotherapy has made possible en bloc resection of bones involved by tumour, with preservation of the limb. Despite advances, however, amputation or en bloc resection is still necessary to control the primary tumour.


Current concepts in the management of disseminated malignant bone disease in childhood. Disseminated malignant disease should be approached with the intention of curing the patient. This requires a multidisciplinary approach. Essential to the successful application of multidisciplinary treatment is the administration of effective chemotherapy, which may achieve reduction in both microscopic disease and overt tumour. In Ewing's sarcoma, the latter should be treated also by irradiation. Limited areas of bulk tumour that have failed to respond or have responded only partially may be removed surgically. Chemotherapy and radiation therapy should be used extensively for palliation; surgery may be required occasionally for control of pain. The decision to treat palliatively should be reached only after patients have received multidisciplinary consultation.


Pleomorphic B cell neoplasm with monoclonal IgA secretion: a case report. A case of non-myelomatous malignant disease with IgA paraproteinemia is described. A pleomorphic lymphoid/plasmacytoid infiltrate was found in the bone marrow. While the cells studied had some ultrastructural characteristics closer to myelomatosis than Waldenström's macroglobulinemia, immunofluorescence showed IgA in both the cytoplasm and at the cell surface, as seen with IgM in macroglobulinemia but not with IgA in typical IgA myelomatosis. This case illustrates that IgA paraproteinemia may be produced in association with pleomorphic B cell proliferative diseases as well as myelomatosis. There is probably a spectrum of disease states as with IgM paraproteinemia.


Abnormal lymphocyte protein synthesis in bronchogenic carcinoma. Phytohemagglutinin (PHA) stimulated lymphocyte protein synthesis was measured in vitro in 21 patients with recently diagnosed, untreated bronchogenic carcinoma and 11 control subjects. In the cancer group absolute protein synthesis was significantly decreased in both baseline and stimulated cultures. The abnormality in protein synthesis was observed despite the fact that there were no differences in vitro DNA synthesis between the two groups. In order to investigate the possibility that a decrease in the number of T-cells was the cause of the impaired protein synthesis in the lung cancer patients, the percentage of circulating E-rosetting forming cells was measured. The mean percentage of rosette forming cells in the cancer patients was 66.8 +/- 2.2 and in the control population was 68.3 +/- 2.6. Our results demonstrate that lymphocyte protein synthesis is abnormal in patients with bronchogenic carcinoma and that the abnormality in protein synthesis is not due to decreased numbers of T-cells. In addition our results suggest that measurement of protein synthesis is a more sensitive assay of lymphocyte function than other standard parameters of cellular immunity.


Impairment of Na+-dependent amino acid transport in a cultured human T-cell line by hyperthermia and irradiation. We have examined the effects of hyperthermia and radiation on the ability of a human T-leukemic lymphocyte line (Molt-4) to transport the Na+-dependent amino acid, 2-aminoisobutyrate (AIB). Heating Molt-4 at 43 degrees for 1 to 4 hr damages the ability of these cells to accumulate AIB. The damage to the transport system at 43 degrees impairs only the maximal rate of AIB uptake, i.e., Vmax. The thermal effect on AIB transport parallels the radiation effects observed for this system. Preliminary data indicate that heat and radiation may induce irreversible transitions in the tertiary or quaternary structure of a plasma membrane protein involved in regulating Na+-dependent amino acid transport. However, the mechanism by which heat and radiation damage this protein is different.


Experimental chemotherapy with 5-arylpyrimidine antifolates: Further studies on toxicity and the responsiveness of ascitic, solid, and intracranial sarcoma 180 to DDMP and DDMP with citrovorum factor. Multiple-dose toxicity of the 5-arylpyrimidine DDMP showed marked seasonal variation and sex dependence in BD2F1 mice. Considerable therapeutic activity against the ascitic, solid, and intracranial forms of Sarcoma 180 was demonstrated. Antitumor effects were highly schedule and dose dependent at a limited number of doses between 16 and 40 mg/kg. Antitumor activity (increase in lifespan) was approximately twofold greater against the ascitic tumor compared to the intracranial tumor at each dose level. The use of citrovorum factor rescue appeared to improve the therapeutic index of DDMP against intracranial Sarcoma 180 on specific multiple-dose schedules. Citrovorum factor rescue did not result in a greater initial antitumor effect of DDMP against the solid Sarcoma 180, but the effect was maintained for a longer period of time by allowing an increase in the number of doses which could be administered without toxicity.


Recent advances in understanding the invasion of erythrocytes by merozoites of Plasmodium knowlesi. Previous observations on the process of invasion by P. knowlesi are briefly reviewed and new findings concerning the adhesion of parasites to erythrocytes and their intracellular passage are reported. Merozoites adhere to erythrocytes by means of a well-defined coat with the cytochemical characteristics of glycoprotein. This coat has receptors that engage in at least three distinct types of attachment. The ensuing invagination of the erythrocyte surface has two phases, the first consisting of an inward buckling of the membrane to form a vacuole and the second a rapid expansion to create the final parasitophorous vacuole inhabited by the trophic parasite. Some cytochemical evidence concerning the nature of the rhoptry complex is discussed in relation to these changes.


Transport of carbohydrates by malarial parasites. The red cells of malaria-infected mice and ducks have an increased permeability to glucose.