Haemodialysis without heparin.

Haemodialysis without heparin. Despite the use of heparin, activation of platelets on the artificial surface of dialyser membranes results in thrombus formation, microembolisation and thrombocytopenia. To assess the effects on these events of prostacyclin, three groups of healthy greyhounds were dialysed with heparin, heparin plus prostacyclin or prostacyclin alone. The use of prostacyclin, either alone or with heparin, abolished microembolisation from the dialyser and prevented thrombbocytopenia. With prostacyclin dialysis could be carried out without heparin and there was no clotting of blood within the extracorporeal circuit nor any change in tests of haemostasis.


Androgen trial in renal anaemia.

Androgen trial in renal anaemia. A double blind cross-over trial of Nandrolone decanoate (Decadurabolin) was carried out in 27 patients with anaemia due to end stage renal disease, stabilised on regular haemodialysis. Sixteen patients completed the study, the other patients being excluded from the final analysis for a variety of reasons including side effects related to the androgen. There was no sustained significant rise in haemoglobin concentration or in red cell mass. Erythropoietin levels did not alter, they were within or below the normal range, but were lower than would be expected for the degree of anaemia. A majority of patients reported increased well-being including exercise tolerance, appetite and libido. Voice changes and hirsutism were noted, mainly in the females. Instability of anticoagulant therapy and abnormalities in liver function were found in some patients. The benefits, though real, were restricted essentially to the improvement in subjective findings and were unrelated to laboratory measurements. These effects might be obtained with a lower dosage of the drug.


Treatment of psoriasis with dialysis.

Treatment of psoriasis with dialysis. Five patients with psoriasis were treated with haemodialysis. Dialysis therapy was initiated for subsequent development of uraemia in three cases. All of these had successful renal transplants without recurrence of psoriasis while being maintained on post-transplant anti-rejection regimens. Two other cases were haemodialysed, not for uraemia but primarily for psoriasis. One case had moderate improvement of psoriasis after twice-weekly dialysis for two months while the second had no objective improvement up to one month after a single haemodialysis treatment.


Sex hormone changes underlying menstrual disturbances on haemodialysis. Sequential changes in luteinising hormone (LH), follicle stimulating hormone (FSH), oestradiol (E2), progesterone (PROG), prolactin (PRL) and testosterone (T) were studied throughout the menstrual cycle in ten women on regular haemodialysis. At the time of study seven women were menstruating and three had secondary amenorrhoea. Only one patient had regular menses. In none of the 15 cycles studied was there a normal luteal phase with an adequate PROG rise, although 9 cycles (4 patients) had E2 changes suggesting that ovulation may have occurred. Increased PRL and T levels were found in 9 and 6 women respectively. These hormonal abnormalities can be related to the menstrual disturbances and explain the low fertility seen in these patients. Bromocriptine or prednisolone may prove useful in their treatment.


A new predictive factor for the outcome of renal transplantation. The cell mediated immunity (CMI) of a group of patients on regular haemodialysis was measured using a modified dinitrochlorobenzene (DNCB) skin test. The strength of the reaction was graded from 0 to 15 on an objective scale which we called the DNCB index. This index was much reduced in the dialysis patients in comparison with a group of healthy controls. Thirty-six dialysis patients were subsequently transplanted and graft survival was assessed at six months. A significantly higher graft failure rate was observed in those with a strong skin reaction than in those with a weak or absent response (P less than 0.01). While the mean DNCB is much lower than normal in dialysis patients, there is a wide variation within this group. We have found that the DNCB index correlates well with renal allograft survival suggesting that this skin test has value in the prediction of transplant outcome.


Complement components, degradation products and immune complexes after kidney transplantation. Levels of complement components and the presence of immune complexes were determined in blood samples from 23 patients is a function of time after kidney transplantation. During the first three post-transplantation weeks a decrease in the concentration of plasma C3 with a simultaneous increase of one of its breakdown products (C3d) was generally observed. This pattern often accompanied acute rejection episodes beyond 4 weeks after transplantation, while in the absence of complications normal and stable levels prevailed. In contrast, the presence of circulating immune complexes appeared not to correlate with rejection reactions. All 7 cases with detectable immune complexes presented with various concomitant neoplastic (renal carcinoma, Kaposi sarcoma) or infectious diseases (pneumonia, septicaemia, Herpes zoster or Cytomegalovirus infection). Thus, monitoring of plasma C3 and C3d may represent a helpful additional criterion for the assessment of acute rejection in recipients of kidney allografts; the presence of circulating immune complexes, although not correlating with graft rejection, may be taken as a sign of complicating additional disease.


E antigen in the serum of HBs antigen-positive patients on maintenance dialysis and after transplantation. The 'e antigen' (eAg) is specifically associated with hepatitis B virus infections and appears to be a marker for the infectivity and a prognostic indicator of the chronicity of liver disease. Therefore we examined by immunodiffusion the presence of eAg in the seum of HBsAg-positive patients on maintenance dialysis. The dialysis patients had a significantly higher incidence of positive eAg compared with a group of unselected HBsAg-positive patients without renal failure. In most of the dialysis patients the microscopic findings in the liver revealed only 'minimal changes'. Three eAg-positive patients received a renal transplant. Afterwards they displayed an appreciably increased eAg-yield on immunodiffusion and histology revealed chronic persistent hepatitis. It is assumed therefore that the immunodeficiency of patients undergoing chronic haemodialysis is possibly a supporting factor in the synthesis of eAg, and will perhaps induce a more subscute and prolonged course of hepatitis. The synthesis of eAg after renal transplantation may be enhanced by the additional immunosuppressive therapy.


One thousand prospective cadaveric renal transplant donors. In a community where cadaveric renal transplantation is the mainstay for the treatment of chronic renal failure a review of 1,000 prospective cadaveric renal donors shows that failure by the medical and surgical teams in the intensive care units to notify the transplant team every time of a potential donor is the major cause for the lack of donor organs. Lack of consent by the donor's relatives is also a significant factor but is less common when the donor is brain dead on a ventilator than when they still have spontaneous respiration. Gradually the transplant team is persuading their colleagues in medicine and trauma to help but at the present rate of progress it will be another decade before enough kidneys are available.


Long-term results in children following dialysis and renal transplantation. Since 1966, 93 children in end-stage renal disease, aged between 5 and 16 years were treated by a combined programme of dialysis and transplantation. In 91 patients treatment of uraemia was started either as hospital or home haemodialysis, until now covering more than 90 dialysis years. Forty-one children were transplanted. Twenty children died during dialysis treatment, 7 after renal transplantation. Sixty-six children are currently alive, 25 with a functioning graft, 28 are treated by hospital dialysis, 13 by home haemodialysis. Eighty-three per cent of the patients on hospital dialysis are classified in rehabilitation category 2 according to the EDTA categories, and all children on home dialysis and those with functioning grafts, category 1.


Scanning electron microscopic study of hyperacute rejection in the inbred rat. Twenty skin-presensitised Lewis rats received kidney transplants from (Lewis X BN)f1 rats. Two grafts each were withdrawn at intervals from 1--120 min and examined using a scanning electron microscopic (SEM). A series of Lewis to Lewis isografts served as control. In hyperacute rejection at just 1 min spider-like fibrin fibres and platelets could be observed in small arteries, where the endothelium was severely altered. In these regions at 2 and particularly 5 min a fibrin network often contained platelet aggregates, mechanically altered erythrocytes as well as different kinds of leucocytes. This coagulation process progressed with time and resulted in a complete vascular occlusion at 30--60 min.


Fine-needle aspiration cytology in the prediction and diagnosis of acute rejection episodes in man. The rate of spontaneous proliferative activity of blood leucocytes, the presence of donor-directed cytotoxic cells in the circulation of transplant recipients and the fine-needle aspiration cytology of the transplant have been evaluated for the monitoring of acute rejection episodes in 8 recipients of cadaver kidney transplants. We could not find any correlation between the rate of proliferative activity of the appearance of cytotoxic cells in the recipients' circulation on the one hand, and the onset of rejection on the other hand. A detectable blast response, consisting of lymphoblasts and plasmablasts could, however, be seen inside the kidney parenchyma during the early stages of rejection. We propose that the blast response could be used for the monitoring of rejection episodes in kidney transplant recipients.


The significance of vascular anomalies in human renal transplantation. In a review of 250 consecutive human cadaveric kidney transplants the primary failure rate of donor kidneys with an anatomically abnormal blood supply was 36.7% as compared with 16.2% for kidneys with a single artery and vein (P less than 0.001). The incidence of primary failure due to renal vascular thrombosis in the abnormal group was 24.2%, compared with 4.1% in the normal group (P greater than 0.001). A significantly greater incidence of anastomotic haemorrhage and urinary leak was also associated with an abnormal blood supply in the donor kidney.


Prevention of upper gastrointestinal complications after kidney transplantation. In 94 renal transplant patients, the incidence and mortality rate of upper gastrointestinal complications was lower than in 11 other reports comprising over three thousand patients. This difference may be due to the smaller doses of prednisolone used. Duodenal ulcer and erosive gastritis were the commonest lesions and 73% occurred in the first 6 months after operation. In 131 transplant candidates, gastric assessment including endoscopy showed 34 (26%) had peptic ulceration prior to operation. In 130 subjects (38 renal transplant, 68 chronic uraemia, 24 controls), pentagastrin tests showed acid hypersecretion in uraemic patients undergoing dialysis (P less than 0.02) and a tendency for acid output to decrease after operation (P less than 0.005). In 8 transplant patients with duodenal ulcer, preliminary experience with prophylactic cimetidine has been favorable. Upper gastrointestinal complications after renal transplantation are likely to be lessened by, a) use of less prednisolone in the early post-transplant phase; b) pre-transplant gastric assessment and c) the use of a safe and effective antisecretory drug in those with duodenal ulcer.


Rupture of the allografted kidney--is repair possible? Allograft rupture after transplantation is an uncommon but serious complication. A review of the literature suggests a significant mortality and very high incidence of graft loss. Data will be presented which suggests that conservative management of the allograft rupture is possible.


Enhanced prostacyclin availability of blood vessels in uraemic humans and rats. Recently prostacyclin (PHI2), an unstable prostaglandin with a strong inhibitory effect on platelet aggregation, has been demonstrated in the wall of blood vessels. We estimated the PGI2 availability of arteries and veins in 10 uraemic patients and 12 nephrectomised rats. The production of PGI2 after long-term incubation of the vessels was markedly enhanced and prolonged. This alteration is probably one key mechanism for the deterioration of haemostasis in uraemics. Preliminary results of further studies indicate that substances in uraemic plasma--presumably middle molecules--may enhance the PGI2 availability of normal vessels in vitro.


Vascular factors in the pathogenesis of uraemic bleeding. To determine the possible role of vascular factors in the bleeding tendency of uraemic patients, three major factors of the haemostatic system normally present in vascular tissues were studied. Factor VIII-related protein (F VIII) was detected on the vascular intima of 13 patients and 10 normal subjects. Comparable values of plasminogen activator (PA) were found in tissue slices from 7 patients and 7 controls. In contrast, prostacyclin like (PGI2) activity, measured as platelet aggregation inhibitory potency, was significantly higher in specimens from 15 patients with either acute or chronic uraemia than in 10 controls. The latter abnormality, leading to impaired platelet-vessel wall interaction, might contribute to the disturbed haemostasis of uraemic patients.


Urinary fibrin degradation products--a three year comparative study. Urinary fibrin degradation products (FDP) were determined by Merskey's passive haemagglutination test in 115 patients with biopsy proven chronic proliferative glomerulonephritis (GN), 94 with urinary tract infection (UTI), and 23 transplanted patients. The active GN values (12.3 microgram/ml) are significantly higher than those for latent GN (0.3 microgram/ml). Those for acute UTI (9.2 microgram/ml) are significantly higher than for chronic UTI (1.3 microgram/ml). In contrast to the reports published by others, the numerous 'false positive' and 'false negative' values make diagnosis of the activity unreliable. Some prognostic value can be expected in GN with the nephrotic syndrome (NS): patients with steroid-sensitive NS excrete no FDP and patients with steroid-resistant NS excrete larger quantities of FDP. We have confirmed that a rise in FDP level following kidney transplantation is indicative of an acute rejection crisis. However, since 10 of 27 rejections were FDP negative, the absence of FDP in the urine does not preclude rejection, so that the diagnostic value is restricted.


HBsAg immune complex glomerulonephritis. Out of 97 patients with various forms of glomerulonephritis 10 were found to be HBsAg seropositive. None of these showed HBsAg immunodeposits within the kidney. Direct immunofluorescent kidney staining for HBsAg was observed in 4 out of 87 HBsAg seronegative patients. The HBsAg staining in kidneys was a false positive reaction due to binding of the Fc portion of the fluoresceinated IgG molecules to the IgM RF tissue deposits. The false positive reaction for HBsAg is not revealed by the usual specificity controls for fluorescence staining. The role of HBsAg in glomerulonephritis remains unproven.


Modulation of ornithine decarboxylase activity in Escherichia coli by positive and negative effectors. Two effectors of ornithine decarboxylase (ODC; L-ornithine carboxy-lyase, EC 4.1.1.17) have been extracted from an ODC- (speC-) mutant, Escherichia coli MA 255. One of these is an ODC inhibitor (Mr 15,000 +/- 2000) that is labile to trypsin; its activity increases 20-fold in response to increased polyamine levels in the growth medium. It has additional characteristics similar to those of the ODC antizyme of eukaryote cells: it is a noncompetitive inhibitor of ODC; the complex formed between ODC and the ODC inhibitor can be dissociated with salt to provide active ODC and active ODC inhibitor; furthermore, this E. coli ODC inhibitor is inhibitory to eukaryote ODC. A thermostable nondialyzable factor that activates ODC in vitro has also been extracted from MA255; increased polyamine levels in the growth medium caused a 1.6-fold increase in the activity of this ODC activator. Effectors with comparable activities have also been identified in the parent ODC+ (speC+) strain MA197. The fluctuations of the intracellular levels of these two ODC effectors during the growth of E. coli MA255 have been related to the temporal changes of the activity of ODC in the parent ODC+ MA197 strain. The mode of interaction of these three macromolecules, as reflected in the changes of the activity of ODC, appears to be complex. The results suggest that ODC activity may be controlled post-translationally by macromolecules that act as positive and negative effectors and whose levels fluctuate in response to the concentration of the end products of the reaction.


Escherichia coli recA gene product inactivates phage lambda repressor. Phage lambda repressor is inactivated and cleaved into two detectable fragments during incubation with purified Escherichia coli recA gene protein in vitro, in a reaction that requires ATP. This reaction reproduces the recA-dependent inactivation of repressor that occurs in vivo during induction of the SOS functions. The proteolytic activity may reside in the recA protein itself and may be a fundamental activity of it.


DNA sequence of the araBAD promoter in Escherichia coli B/r. The L-arabinose operon in Escherichia coli is a model system for the study of the control of gene expression. Maximal expression of the araBAD operon requires two positive control components: the araC protein-L-arabinose complex and the cyclic AMP receptor protein-cyclic AMP complex. Both araC protein and cyclic AMP receptor protein are required for the initiation of transcription of araBAD mRNA. We have used the plasmid pBR322 as a vector for cloning DNA fragments that contain the araBAD promoter. The cloned ara fragments were identified by both physical and genetic tests. A restriction map was constructed and the DNA sequence of the promoter was determined. The promoter contains a site that is similar to the RNA polymerase recognition sites in the galactose and lactose operons. It also contains a region similar to the known cyclic AMP receptor protein binding sites in the galactose and lactose operons.


Absolute configuration of the diastereomers of adenosine 5'-O-(1-thiotriphosphate): consequences for the stereochemistry of polymerization by DNA-dependent RNA polymerase from Escherichia coli. The diastereomers of uridyl-(3'-5')adenyl-O,O-phosphorothioate [Up(S)A] have been separated by high-performance liquid chromatography. Their identification as RP and SP follows from the RNase A digestion of these products. It was then shown, by the same method, that the R isomer is hydrolyzed by snake venom phosphodiesterase (PDEase) approximately 500 times faster than the S isomer. Similarly, the stereoisomer of adenosine 5'-O-(1-thiotriphosphate) (ATPalphaS), until now arbitrarily designated as isomer B, is hydrolyzed ca 400 times faster by PDEase than is isomer A. From these results it is concluded that the R isomers of Up(S)A and ATPalphaS, isomers B, have the same absolute configuration. It then follows that isomer A of ATPalphaS, the preferred of the two isomers as substrate for DNA-dependent RNA polymerase, has the S configuration. The implications for the stereochemistry of action of the latter enzyme are discussed.


Complete nucleotide sequence of a 16S ribosomal RNA gene from Escherichia coli. The complete nucleotide sequence of the 16S RNA gene from the rrnB cistron of Escherichia coli has been determined by using three rapid DNA sequencing methods. Nearly all of the structure has been confirmed by two to six independent sequence determinations on both DNA strands. The length of the 16S rRNA chain inferred from the DNA sequence is 1541 nucleotides, in close agreement with previous estimates. We note discrepancies between this sequence and the most recent version of it reported from direct RNA sequencing [Ehresmann, C., Stiegler, P., Carbon, P. & Ebel, J.P. (1977) FEBS Lett. 84, 337-341]. A few of these may be explained by heterogeneity among 16S rRNA sequences from different cistrons. No nucleotide sequences were found in the 16S rRNA gene that cannot be reconciled with RNase digestion products of mature 16S rRNA.


Single base-pair alterations in the Escherichia coli trp operon leader region that relieve transcription termination at the trp attenuator. We have isolated a set of regulatory mutants defective in transcription termination at the attenuator in the leader region of the Escherichia coli tryptophan (trp) operon. In vivo the mutants have 2- to 4-fold increased levels of expression of the trp operon above the level of the trpR parental strain. These levels are increased an additional 1.5- to 2-fold when the mutants are starved of tryptophan. Transcription termination at the trp attenuator was analyzed in vitro with DNA restriction fragments containing the termination-relief mutations. Whereas the frequency of readthrough transcription beyond the termination site is 5% with the wild-type DNA template, it is 46-76% when mutant DNAs are used as templates. The base change in the leader region of each mutant was determined by RNA and/or DNA sequencing. All the changes were between base pairs +116 and +132, in the G-C-rich segment of the leader region. The RNA residues between +114 and +134 of the leader transcript can form a stable stem and loop structure [deltaG approximately equal to -20 kcal (-84 kJ)]. All of the termination-relief mutations destabilize this structure (deltaG approximately equal to -9.0 to -10.5 kcal). These results suggest that the efficiency of transcription termination may be dependent on the integrity of the secondary structure of the above segment of the transcript of the leader region.


Energy coupling in DNA gyrase and the mechanism of action of novobiocin. Escherichia coli DNA gyrase catalyzes negative supercoiling of closed duplex DNA at the expense of ATP. Two additional activities of the enzyme that have illuminated the energy coupling component of the supercoiling reaction are the DNA-dependent hydrolysis of ATP to ADP and P(i) and the alteration by ATP of the DNA site specificity of the gyrase cleavage reaction. This cleavage of both DNA strands results from treatment with sodium dodecyl sulfate of the stable gyrase-DNA complex that is trapped by the inhibitor oxolinic acid. Either ATP or a nonhydrolyzable analogue, adenyl-5'-yl-imidodiphosphate (App[NH]p), shifts the primary cleavage site on ColE1 DNA. The prevention by novobiocin and coumermycin A(1) of this cleavage rearrangement places the site of action of the antibiotics at a reaction step prior to ATP hydrolysis. The step blocked is the binding of ATP because coumermycin A(1) and novobiocin interact competitively with ATP in the ATPase and supercoiling assays; the K(i) values are more than four orders of magnitude less than the K(m) for ATP. This simple mechanism accounts for all effects of the drugs on DNA gyrase. Studies with App[NH]p, another potent competitive inhibitor of reactions catalyzed by gyrase, show that cleavage of a high energy bond is not required for driving DNA into the higher energy supercoiled form. With substrate levels of gyrase, App[NH]p induces supercoiling that is proportional to the amount of enzyme; a -0.3 superhelical turn was introduced per gyrase protomer A. We postulate that ATP and App[NH]p are allosteric effectors of a conformational change of gyrase that leads to one round of supercoiling. Nucleotide dissociation favored by hydrolysis of ATP returns gyrase to its original conformation and thereby permits enzyme turnover. Such cyclic conformational changes accompanying alteration in nucleotide affinity also seem to be a common feature of energy transduction in other diverse processes including muscle contraction, protein synthesis, and oxidative phosphorylation.


Mechanism of action of the pyruvate dehydrogenase multienzyme complex from Escherichia coli. The extent of cooperativity among the polypeptide chain components in the overall reaction catalyzed by the pyruvate dehydrogenase multienzyme complex from Escherichia coli has been studied. Selective inactivation of the pyruvate dehydrogenase component with thiamin thiazolone pyrophosphate demonstrates that no cooperativity between this component and the overall catalytic reaction occurs: the amount of overall complex activity is directly proportional to the fraction of active pyruvate dehydrogenase component. The transacetylase component has two lipoic acid residues on each of its polypeptide chains that can be modified by N-[(3)H]ethylmaleimide in the presence of pyruvate and thiamin pyrophosphate. The kinetics of the loss of overall complex activity due to modification of the lipoyl residues on the transacetylase component by maleimide reagents shows that not all lipoic acids are coupled into the overall catalytic reaction and that acyl-group and electron pair transfer involving two or more lipoic acids per catalytic cycle must occur. Finally, full complex activity is found when only half the normal flavin content is present. The results indicate that extensive communication among lipoic acids in acyl-group and electron pair transfer must exist in the normal catalytic mechanism. These results are consistent with the average distances between catalytic sites measured by energy transfer experiments.


An Escherichia coli mutant with an amino acid alteration within the signal sequence of outer membrane prolipoprotein. Lipoprotein has been purified from an Escherichia coli strain carrying a mutation in the structural gene for murein lipoprotein (mlpA). Amino acid analysis of the purified mutant lipoprotein indicates that the mutant lipoprotein corresponds to the uncleaved prolipoprotein with a single amino acid replacement of glycine with aspartic acid. Automated Edman degradation has established the precise location of this amino acid substitution to be at the 14th residue of the prolipoprotein. This alteration in the signal sequence of prolipoprotein results in a failure of the mutated prolipoprotein to be processed. Furthermore, the structural alteration in the mutant lipoprotein appears also to have affected its topological localization in the mutant cell. Whereas lipoprotein in the wild-type strain is exclusively located in the outer membrane of the cell envelope, the membrane-bound lipoprotein in this mutant is recovered in both the inner and outer membranes of the cell envelope. The data suggest, however, that proteolytic cleavage of prolipoprotein to form mature lipoprotein is not essential for the translocation and assembly of lipoprotein into the outer membrane.


Laser Raman evidence for new cloverleaf secondary structures for eukaryotic 5.8S RNA and prokaryotic 5S RNA. Neither of the two previously proposed secondary structures for eukaryotic 5.8S RNA is consistent with the present laser Raman results. A new, highly stable "cloverleaf" secondary structure not only fits the Raman data but also accounts for previously determined enzymatic partial cleavage patterns, base sequence and pairing homologies, and G-C and A-U base pair numbers and ratios. The new cloverleaf model also conserves several structural features (constant loops, bulges, and stems) consistent with known 5.8S RNA functions. Finally, we propose a similar new cloverleaf secondary structure for Escherichia coli 5S RNA, consonant with many known properties of prokaryotic 5S RNA.


Identification of tubulin from the yeast Saccharomyces cerevisiae. A tubulin-like protein was identified in the lower eukaryote Saccharomyces cerevisiae. The following criteria were used: (i) copolymerization of the 35S-labeled yeast protein with porcine brain tubulin; (ii) immunoprecipitation of the 35S-labeled yeast protein with antiflagellar tubulin antibody; (iii) the presence of the yeast protein as a constituent of isolated yeast nuclei; and (iv) splitting of the yeast protein in a gel electrophoretic system containing sodium dodecyl sulfate that resolved the alpha- and beta-tubulin chains from other sources. This protein did not appear to have significant affinity for the plant alkaloid, Colcemid.


Different intermediate-sized filaments distinguished by immunofluorescence microscopy. The major protein of intermediate-sized filaments in mouse 3T3 cells, for which the name vimentin is proposed, has a molecular weight of 57,000. Antibodies against vimentin and antibodies against prekeratin have been used in parallel in immunofluorescence microscopy on a variety of cultured cells as well as on frozen tissue sections. Both antibodies decorate extended wavy arrays of filaments that are different from microfilaments and microtubules. Intermediate filament bundles decorated by antibodies against prekeratin are predominant in many epithelial cells, including epithelia-derived tumor cells, and are not decorated by antibodies to vimentin. In contrast, intermediate filaments decorated by antibodies against vimentin are widespread among nonmuscle cells of mesenchymal origin, including transformed cells, and also occur in other cells. Perinuclear whorls of aggregates of intermediate filaments induced by prolonged treatment with Colcemid generally show strong decoration with antibodies against vimentin. No significant reaction with either antiserum has been observed in muscle structures or in brain nerve tissue. These observations show that intermediate filaments with similar ultrastructure and solubility characteristics can be distinguished immunologically.


Biogenesis of peroxisomes: intracellular site of synthesis of catalase and uricase. The intracellular site of synthesis of two peroxisomal enzymes of rat liver, uricase (urate:oxygen oxidoreductase, EC 1.7.3.3) and catalase (hydrogen peroxide:hydrogen peroxide oxidoreductase, EC 1.11.1.6), has been localized on free ribosomes and not membrane-bound ribosomes. Free polysomes and membrane-bound polysomes, prepared by classical cell fractionation techniques from rat liver, were incubated for protein synthesis in a cell-free system derived from rabbit reticulocytes. Characterization of the total translation products by polyacrylamide gel electrophoresis in sodium dodecyl sulfate, as well as by immunoprecipitation with anti-rat albumin anti-serum, confirmed that good separation of the two polysome classes was achieved. Uricase and catalase were immunoprecipitable from translation products directed by free polysomes or phenol-extracted free polysomal mRNA but not from products of membrane-bound polysomes. Furthermore, unlike albumin, nascent uricase and catalase were not cotranslationally segregated by dog pancreas microsomal membranes. The results indicate that uricase and catalase are transferred to the interior of peroxisomes by a post-translational mechanism; an hypothesis is formulated here for the biogenesis of peroxisomes.


Bacteriophage lambda carrying the Escherichia coli chromosomal region of the replication origin. A transducing phage lambdaasn was isolated. The late gene region of its genome was found to have been substituted by an Escherichia coli chromosomal segment containing the genes bgIR, bgIC, glmS, uncA, and asn. Restriction endonuclease cleavage mapping and electron microscopic analysis of the lambdaasn DNA revealed that the size of the bacterial segment is approximately 1.75 X 10(7) daltons, corresponding to about 26.4 kilobases. The circular DNA of lambdaasn was digested with restriction endonuclease EcoRI, diluted, and sealed with DNA ligase. When the reaction mixture was used to transform a recipient E. coli strain, a small plasmid of about 1 X 10(7) daltons (named pMCR115) was obtained. Restriction endonuclease cleavage mapping of pMCR115 and other evidence suggested that it contained the replication origin (oriC) of the E. coli chromosome.


Two HLA-linked loci controlling the fourth component of human complement. An electrophoretic polymorphism of the fourth component of human complement (C4) is described. Three patterns of bands of C4 were observed in EDTA plasma from a panel of unrelated blood donors and family members by using the technique of immunofixation electrophoresis. These patterns consisted of four fast-moving anodal bands (F), four slow-moving cathodal bands (S), or a combination of both the F and S bands (FS). The C4 patterns of bands were observed in EDTA plasma and not in serum. Family studies showed that this polymorphism of C4 did not segregate with HLA histocompatibility genes in a fashion governed by two codominant alleles at a single genetic locus. The family data are in agreement with the hypothesis that two different genetic loci control the electrophoretic patterns of C4. One locus controls the presence (F) or absence (f0) of the four anodal (F) bands and the other controls the presence (S) or absence (s0) of the four cathodal (S) bands. The C4F and C4S loci are both closely linked to HLA-B.


Reversal of digitalis effects by specific antibodies. Highly digoxin-specific or ouabain-specific antibodies can readily be obtained by immunizing rabbits or sheep with repeated injections of the glycoside coupled to protein carriers. By virtue of their binding capacity digoxin-specific antibodies are capable of removing digoxin concentrations from red blood cells and renal tissue specimens. As evidenced by various experiments with human erythrocytes and isolated cardiac preparations in vitro, digoxin effects are rapidly reversible in the presence of digoxin-specific antibodies. In vivo antidigoxin antibodies can protect animals from digoxin effects and promptly abolish established toxic effects, associated with marked alterations of digoxin pharmacokinetics. However, due to the large molecular weight, complete antibodies cannot be eliminated via the renal route. The use of antigen-binding (Fab) fragments of digoxin-specific antibodies offer the advantage of rapid renal elimination of bound and inactivated digoxin. So far, due to potential immune reactions, the clinical use of purified digoxin-specific antibodies of Fab fragments is restricted to life-threatening accidental or suicidal digoxin or digitoxin poisoning.


Computer-aided classification and assessment of patients in multicenter trials. The automated diagnostic procedure appears to be particularly suitable for clinical psychopharmacological trials since it provides a diagnostic definition and a psychopathological profile of patients assessed by various investigators of different centers where a different kind of psychopathology as well as different cultural, clinical and psychopharmacological backgrounds may be present. Furthermore, this procedure offers the possibility of reexamining and analyzing the characteristics of the experimental sample as related to the responses to the drugs. It also provides a new approach for solving some of the problems which play an important role in determining divergent results in clinical psychopharmacology such as that of patients selection and diagnostic definition. In the present study the automated diagnostic procedure derived by the scores of each item of I.M.P.S. and by factor scores are evaluated comparatively. The data reported show that the automated diagnosis should be based on the scores of single aspects of the symptomatology rather than on the basis of the factor scores.


A multidimensional test approach for the description of the CNS activity of drugs in human pharmacology. In a double-blind cross-over trial ten healthy male volunteers were administered placebo as well as one representative of each of the four hypothetical psychotropic drug classes, antipsychotics, antidepressants, anxiolytics, and psychostimulants. The drugs were: 75 mg of chlorpromazine, 75 mg of amitriptyline, 10 mg of diazepam and 18 mg of dextroamphetamine sulfate. The effects of the compounds were assessed by pharmaco EEG, an adjective checklist, and a battery of psychological performance tests. The results demonstrate that the test model differentiates well between sedative and stimulatory drug effects. In addition, this multidimensional test approach discriminates adequately the effects of the various sedative drugs. The advantages and limitations of multidimensional test approaches for the description of psychotropic drugs along with the importance of employing such an approach for the development of psychotropic drugs are discussed.


Prejudices in pharmacology and pharmacotherapy: reserpine as a model for experimental research in depression. The choice of reserpine as practically the sole model substance used in research in depression over two decades was not dictated by rational considerations alone: hypothetical notions, prospects of the rapid realization of experimental research aims and the fascination of the exotic origin of this "natural" drug made a significant contribution.


Relationship of selected clinical variables to current delivered during transcutaneous electrical nerve stimulation. Nineteen normal subjects were given transcutaneous electrical nerve stimulation to the hypothenar eminence, back, or legs, using a selected constant-current device. Stimulation characteristics from this unit were measured. Stimulation, at 20- microsec or 80- microsec pulse widths, was provided at increasing strengths until subject tolerance or muscle contraction was reached. The current delivered at each stimulus setting for single or repeated intrasubject trials was reliable at each anatomical landmark. For intersubject single trials, current levels proved reliable in the hand and back but not at any of the three interelectrode distances evaluated in the leg. Possible explanations for this latter finding are offered. This study showed that, for those stimulation settings evaluated, at least one constant-current transcutaneous electrical nerve stimulation unit reliably delivers current of specific stimulus strengths to the hypothenar eminence or back.


Repairs in the lower abdomen, groin, or perineum with myocutaneous or omental flaps. Our experiences with omental and myocutaneous flaps for the closure of the lower abdomen, groin, and perineum are outlined. The relative advantages and disadvantages of the various flaps are discussed.


Use of the free dorsalis pedis flap in head and neck repairs. Many defects of the head and neck can be readily repaired with a free dorsalis pedis flap, and we report success with these flaps in 9 of 12 cases. A precise knowledge of the anatomy of the arterial supply of the flap is necessary. Preoperative arteriography is recommended  if the dorsalis pedis artery is not easily palpable, or if an anomalous distribution of the artery along the dorsum of the foot is sus pected. However, the transfer of the flap should be delayed for two weeks after preoperative arteriography is performed. The one-stage soft tissue reconstruction with a free dorsalis pedis flap has been associated with minimal morbidity and good acceptance by patients. A delay procedure for the flap seems to enhance the chances of complete survival which is so necessary in the repair of intraoral and pharyngeal defects. Careful attention to details and close monitoring of the flap will minimize morbidity. In case of an early failure of a flap, a secondary reconstruction by a different flap can be done in the first 48 to 72 hours. Early postoperative radiotherapy has been well tolerated over these free flaps.


[Errors of the placebo test].

[Errors of the placebo test]. The difficulties inherent in clinical experimentation in phlebology, stem from the fact that they concern highly subjective functional problems, and are thus difficult to measure. The answer to these difficulties seems to be found in the use of the double blind method. This method, however, contains numerous causes of errors in phlebology, since in order to be mathematically applied to computer use, it is too sketchy and does not take into account many additional factors, incidental parameters and unfavorable coincidences related either to chronobiology (weather, seasonal changes), to hormonal problems (periods of the cycle, pregnancies, contraception, menopause), to the environment (professional posture, ground heat, periods of vacation or work), or associated diseases (neuro-vegetative and rheumatic disorders, excessive weight, metabolic disorders), etc. It seems that in such cases, wide experimentation, with a very critical clinician, who attributes the improvement obtained to the drugs prescribed only when left with no other possibility and after having eliminated all the coincidental factors, gives results closer to reality than double blind experiments, behind whose pseudo-scientific appearance lies a sketchiness that is the cause of numerous errors.


Use of paired abdominal flaps for release of adduction contractures of the thumb. A method for correction of an adduction contracture of the thumb is presented. Paired flaps provide good cover to the palmar and dorsal sides of the web space. This method produces better cosmetic and functional results than the traditional methods.


[Very extensive ulcers in a case of mixed cryoglobulinemia]. A young girl suffering from mixed cryoglobulinemia had shown since puberty ulcers of the lower limbs. A first very serious occurrence of necrotic lesions of the feet was stopped through the use of bilateral lumbar sympathectomy and grafts. A second extremely serious onset was cured using peridural lumbar anesthesia maintained for six weeks. D-penicillamine proved inefficient.


Evaluation of tests for predicting the viability of axial pattern skin flaps in the pig. The viability of axial pattern skin flaps in pigs was assessed by the use of intravenous fluorescein, intradermal injection of 133Xe in saline, intravenous 51Cr tagged red cells, and angiography. The results were correlated with flap survival at 4 days postoperatively. Intravenous fluorescein provided the most accurate method for prediction of viable tissue at the time of operation. There was no evidence of vascular perfusion in the distal portions of these flaps. These axial pattern flaps differed in their viability from similar flaps in humans, and anastomoses between discrete vascular territories were infrequent in pigskin.


Clinical salvage of three failing skin flaps by treatment with a vasodilator drug. We present 3 clinical cases, one skin flap and two myocutaneous flaps, in which we believe postoperative treatment with isoxsuprine resulted in the salvage of considerable areas that would otherwise have necrosed.


Conservation of major leg arteries when used as recipient supply for a free flap. The potential hazards of using proximal segments of leg arteries for end-to-end anastomosis to vessels in free flaps are examined, and alternatives are proposed. The convservation of the major tibial arteries seems highly desirable, to minimize any subsequent development of ischemic complications. Turning a free flap upside down moves the anastomosis to the distal part of the extremity, thus conserving most of the muscular branches of the recipient artery. Cutting the recipient artery distally and bending it back in recurrent fashion also allows for easy end-to-end anastomosis, with many technical advantages.


Why do skin grafts fail?

Why do skin grafts fail? Fibrin is shown to be the agent responsible for the adherence of biological dressings and of autografts to wounds. Its presence is associated with graft success, and its absence with graft failure. The results suggest that the deposition of fibrin provides the basis for the anti-bacterial actions of biological dressings and for the sterilization of the wound under adherent autografts. The total number of bacteria per gram of tissue in the wound, though important, is not critical to the result of skin grafting. The mechanism by which different organisms cause grafts to fail is by the production of plasmin and proteolytic enzymes which dissolve the important fibrin scaffold--thus ensuring their own survival. Thus, it is the levels of these (and the numbers of organisms efficient in producing them) which cause success or failure of applied skin grafts.


Use of the temporalis muscule flap in blanking out orbits. We report the use of the temporalis muscle as a transposition flap to obliterate the orbit in 5 patients. In 4 of the cases we split the muscle coronally and passed the anterior part through a window in the lateral orbital wall. In two of these patients, skin grafts were put on both sides of the temporalis muscle-fascia flap, to restore nasal lining and to cover the facial surface simultaneously. In the remaining patients, the muscle was split sagittally to provide a large surface for coverage. The temporalis muscle flap is a versatile one for filling orbits after exenteration.


A new island flap transfer from the dorsum of the index to the thumb. We describe here a new island flap from the dorsum of the index finger, transferred on the first dorsal metacarpal artery with one or two veins and the terminal branches of the radial nerve. This vascular bundle is a reliable one, for we have had no necrosis in 12 consecutive cases. The quality of its venous outflow and the use of a dorsal donor site give it advantages over the Moberg-Littler island flap, unless a dorsal vein from the latter flap is preserved and sutured to a vein in the recipient site. The arterial vascularization without any skin pedicle makes this "kite" flap a more practical one than the "flag" flaps of Vilain or Holevitch or Kuhn. Finally, a one-stage transfer is usually preferable to a two-stage one (e.g. Adamson, Braillar). In a single operation, this transfer provides composite resurfacing of the thumb while bringing in new blood and nerve supply.


The value of angiography prior to use of the latissimus dorsi myocutaneous flap. In 5 patients studied, preoperative angiography showed the thoracodorsal artery to be patent in two--both of them then had successful transfers of latissimus dorsi myocutaneous flaps. Obliteration of this artery was apparent in 3 patients, precluding the operation. We suggest that selective preoperative angiography be performed in all patients in whom a latissimus dorsi myocutaneous flap transfer is being considered, as a patent thoracodorsal artery is essential to the success of this procedure.


Management of first trimester breast enlargement with necrosis. We describe our management of two patients who had massive breast enlargement with necrosis in the first trimester. First, a therapeutic abortion was done to stop the breast growth, then we skin grafted the large ulcerated areas on the breasts, and finally we did a simple mastectomy with silicone gel implants for reconstruction. The latter procedure was to prevent almost certain recurrence of the problem during any succeeding pregnancy.


Total rhinoplasty with a free osteocutaneous flap. A new approach to total rhinoplasty, using a free dorsalis pedis flap containing part of the second metatarsal bone, is reported.


Measuring tissue pressure to assess the severity of burn-induced ischemia. Circumferential burn injuries can produce severe ischemia in the underlying muscles by producing compartmental compression. The latter requires prompt decompression, but it is often difficult to diagnose. A simple, rapid, and accurate technique for the direct measurement of compartmental pressure is described. It may be used to determine the need for decompressive escharotomy or fasciotomy, and to intraoperatively assess its adequacy.


One-stage repair of a cervical esophagostome with two myocutaneous flaps from the neck and shoulder. A large esophagostome in a heavily radiated neck was reconstructed in one stage, using a sternocleidomastoid myocutaneous flap for lining and a trapezius myocutaneous flap for covering. The patient began eating on the seventh day and was discharged on the tenth day following the repair. Barium swallow studies demonstrated a widely patent esophagus, and the patient now has good esophageal speech.


Reconstruction of the oral mucocutaneous junction. An inset free skin graft from the postauricular area was used to create a natural appearing "white roll" mucocutaneous junction in a lip repair.


["Slow virus" infections and  degenerative diseases of the central nervous system]. Slow virus infections of the central nervous system are produced by both conventional and unconventional viruses. Diseases of the central nervous system which are produced by unconventional viruses are discussed. They are kuru and the Creutzfeldt-Jacob disease. Mention is also made of the fact that these disease may be transmitted to animals which allows an infectious genesis to be assumed. The author also discusses the clinical symptomatology, the results of anatomical and pathological examinations, and the mechanism of transmission of the disease from one human being to another. Slow virus infection as a cause of other neurological diseases is also dealt with by the author in her present paper.


[Personality diagnosis of school-age children]. This paper discusses some selected methodical and metric problems of psychological personality diagnosis in both childhood and the period of youth. In additon to discussing a number of important questions concerning psychometric methods, the author deals with problems associated with personality diagnosis, sociometric methods, and fictitious situational tests, analyzing them by reference to data reported in the literature.


'Positive and 'negative' aspects of the 'altered states of consciousness' induced by autogenic training, Zen and yoga. As practices of altered states of consciousness (ASC) have become more widely used among psychotherapists who have become aware of the limitations of psychoanalytic, educational and behavioral approaches, negative aspects ('Makyo') of ASC have drawn their special attention. For the purpose of controlling or preventing these side-effects, (1) the problem of indication is most important, (2) and evaluation of the patient's personality is indispensable, (3) preparatory education about ASC methods and (4) guidance by experienced leaders are most helpful, (5) appropriate use of tranquilizers and (6) the mere presence of a supportive therapist at the place of practice can also be helpful.


Role of the therapist in biofeedback training. The therapist in biofeedback training plays the role of a teacher or coach. This role, derived from learning theory and practiced in the classroom and playing field, imposes special constraints upon the psychotherapeutic situation. The therapist must be capable of physiological manipulation in self before attempting to teach this skill to another. The issue of transfer of training and maintenance of therapeutic gain are also discussed.


Self-control, biofeedback, and change in 'psychosomatic' approach. The new psychosomatic treatment modalities of biofeedback and relaxation techniques have in common an emphasis on self-control or self-regulation. The surging populatiry of the self-control techniques at present may reflect a change in the self-image of medicine, which emphasizes its role as a collaborator of the patient in his self-control of disease processes. Modern concept of psychosomatic medicine emphasizes a systems or field approach to evaluation and treatment rather than on 'psychogenic' causes of physical illness. The self-control treatment modalities form an important part of the armamentaria of a modern 'psychosomaticist'. We present preliminary data suggesting that 'potentiation' of biofeedback treatment may be useful. In borderline hypertensives, using pharmacologic means to reduce blood pressure during a biofeedback session may help subjects identify and re-create the 'low blood pressure states' without further aid by drugs. Hypertensives seeking biofeedback treatment are extremely internal in locus of control and tend to generalize their self-control to other areas of life to foster health and to prevent illness.


Treatment of anxiety: a comparison of the usefulness of self-hypnosis and a meditational relaxation technique. An overview. We have investigated prospectively the efficacy of two nonpharmacologic relaxation techniques in the therapy of anxiety. A simple, meditational relaxation technique (MT) that elicits the changes of decreased sympathetic nervous system activity was compared to a self-hypnosis technique (HT) in which relaxation, with or without altered perceptions, was suggested. 32 patients with anxiety neurosis were divided into 2 groups on the basis of their responsivity to hypnosis: moderate-high and low responsivity. The MT or HT was then randomly assigned separately to each member of the two responsivity groups. Thus, 4 treatment groups were studied: moderate-high responsivity MT; low responsivity MT; moderate-high responsivity HT; and low responsivity HT. The low responsivity HT group, by definition largely incapable of achieving the altered perceptions essential to hypnosis, was designed as the control group. Patients were instructed to practice the assigned technique daily for 8 weeks. Change in anxiety was determined by three types of evaluation: psychiatric assessment; physiologic testing; and self-assessment. There was essentially no difference between the two techniques in therapeutic efficacy according to these evaluations. Psychiatric assessment revealed overall improvement in 34% of the patients and the self-rating assessment indicated improvement in 63% of the population. Patients who had moderate-high hypnotic responsivity, independent of the technique used, significantly improved on psychiatric assessment (p = 0.05) and decreased average systolic blood pressure from 126.1 to 122.5 mm Hg over the 8-week period (p = 0.048). The responsivity scores at the higher end of the hypnotic responsivity spectrum were proportionately correlated to greater decreases in systolic blood pressure (p = 0.075) and to improvement by psychiatric assessment (p = 0.003). There was, however, no consistent relation between hypnotic responsivity and the other assessments made, such as diastolic blood pressure, oxygen consumption, heart rate and the self-rating questionnaires. The meditational and self-hypnosis techniques employed in this investigation are simple to use and effective in the therapy of anxiety.


[Morphologic consideration of heart failure (author's transl)]. The left ventricle in left heart failure can be elliptical, spherical or funnel shaped. There is no firm correlation between the different shapes and the hemodynamics. Left ventricular failure results in dilatation, deformation and loss of funnel function of the left atrium. In more advanced stages of left ventricular failure the pulmonary veins become coiled, dilated and narrow stepwise instead of the normal harmonic narrowing to the periphery. The pulmonary parenchyma exhibits fibrosis and septal siderosis at that stage. Heart failure cells can be observed frequently. In later stages, when pulmonary arteries and the right ventricle is involved, secondary global heart failure develops. Right ventricular failure may lead to necrosis of liver cells with jaundice and elevated levels of liver specific enzyms. Primary global failure has no hemodynamic consequences on the pulmonary circulation, as long as left and right ventricular failure are of equal severity. If one form prevails, the clinical picture will be that of left or right ventricular failure respectively.


[The differential diagnosis of heart failure (author's transl)]. The causes of heart failure may be classified into three groups, hemodynamic causes, disturbances of cardiac rhythm and conduction and diseases of the myocardium. Accordingly the different causes of heart failure are discussed and the technics for diagnosis reviewed. Particular diagnostic problems are mentioned, which may arise in connection with cardiac echinococcosis, atrial myxoma, sarcoid heart disease and myocardial aneurysm.


Treatment of Raynaud's disease: evaluation of a behavioral approach. Eight patients with Raynaud's disease were treated with a behavioral program which included skin temperature biofeedback, relaxation training and protocol individualization based on the investigators' psychological understanding of each patient. Three patients improved clinically, although only one learned self-control of skin temperature. Anxiety reduction, brought about by relaxation or changes in the program to suit individual needs, appeared to be an important aspect of the treatment program.


[Parasitism and allergy].

[Parasitism and allergy]. Relationship betwen parasitism and allergic diseases are briefly commented. The parasites which most frequently are involved in allergic conditions in our environment are pointed out. Some cases are reported and conclusions from the material reviewed are made.


[Chorioretinitis caused by toxoplasmosis: study of 65 cases]. Sixty five patients with an ophthalmoscopic diagnosis of chorioretinitis who, underwent complement fixation tests and intradermoreaction using Toxoplasma antigens were studied. 95,4% of them disclosed antibody titers with the former and 58,5% reactors were found with the latter. Sixty five individuals with neither backgrounds nor clinical symptoms of toxoplasmosis were used as control, and 27,7% of reactors in both tests were likewise found. The differences among results are highly statistically significant; this points out toxoplasmosis as an important cause of chorioretinitis in our patients. Complement fixation tests were more sensitive than intradermoreactions as well as specific as the latter. Results were correlated to age, sex and animal contacts.


[Determination of cholinesterase activity in Fasciola hepatica homogenates]. The cholinesterase activity in Fasciola hepatica homogenates was studied through biological techniques. Results depict that the contractile stimulating action of a constant acetylcholine dose on the isolated rat duodenum is withdrawn when the agent is previously incubated at 37 degrees C during 30 minutes with different dilutions (20%, 40% and 80%) of Fasciola hepatica homogenates. The action is recovered when an anticholinesterase, as neostigmine is previously added to the homogenate. Since these effects are similar to those obtained when different dilutions of human blood serum with a high content of cholinesterase are led to act upon the acetylcholine dose, it is concluded that the acetylcholine inactivation induced by Fasciola hepatica homogenates results from the existence of such enzyme within this parasite.


[Vaginal candidiasis].

[Vaginal candidiasis]. Three hundred and eighty eight patients from the out-patient service of the "10 de Octubre" Maternal-Infantile Hospital were studied and 126 (32,46%) out of them were infected with Candida genus organisms. Ninety nine (78,57%) patients had C. albicans; 16 (12,69%) patients had C. tropicalis; 9 (7,14%) patients had C. parakrusei; 1 (0,79%) patient had C. krusei; and 1 (0,79%) patient had C. guilliermondi. Leukorrhea predominated in 42% of patients; vaginal pruritus predominated in 22%; and low abdominal pain predominated in 16%. 80% of patients over 50 years had diabetes mellitus. The concurrent flora was as follows: flora 1 in 14,49% of patients; flora II in 2,91%; and flora III in 82,60%. 7,14% of the 126 infected women also had Trichomonas vaginalis.


[Cell mediated immunity in a group of lepers (leukocytes migration inhibition test)]. Ten lepers with the lepromin-negative lepromatous form and ten lepers with the lepromin-positive tuberculoid form who underwent the leukocyte migration inhibition test were studied. A market impairment of cell-mediated immunity in the lepromatous group as well as significative differences of the  average inhibition rates between both groups of patients were found. Results from this in vitro test were correlated to those from the lepromin skin test and a correspondence in 18 out of the 20 patients studied was obtained.


[Immunoelectrophoretic study of serum from patients with untreated recently adquired syphilis]. An immunoelectrophoretic study of serum from patients with non-treated recently acquired syphilis (RAS) is made for the first time in our country. Increases in IgM and IgG fractions were detected; the increase of the former exceeded to the latter in patients with cutaneous symptomatic recently acquired syphilis (CSRAS) in comparison with those having mucous cutaneous symptomatic recently acquired syphilis (MCSRAS). IgG were increased in 100% of patients with this latter disease, although both fractions were increased in patients with latent recently acquired syphilis (LRAS).


[Modified Lassen's method for the identification of gram negative bacilli]. A variation of the components of media used by Lassen for the identification of clinically significant gram-negative bacilli is performed in pursuit of an economically accessible method that can be introduced in daily laboratory work.


[Verification of Lassen's modified method for the identification of gram negative bacilli]. Eighty strains of gram-negative bacilli, according to Lassen's modified method, and the conventional methods for their identification are studied. Lassen's original dichotomic keys, with which satisfactory results were obtained in relation to conventional methods, are presented. Reliability and greater accurateness of such a modification were shown.


[Primary amebic meningoencephalitis. Report of a suspicious case and review of the medical literature]. The case of a 24-year old patient who, in July 1976, submerged into a canal of Guanimar river and, five days later, had a febrile meningoencephalitic clinical picture, is presented; he was in a very severe condition and recovered without sequelae with a treatment based on amphotericin B. The negative cultures for bacteria, fungi and viruses, the characteristics of cerebrospinal fluid and the observation of free-life amebae in the water of the wash of rhinopharynx and pharingeal cavity allowed to establish, with great accuracy, the presuntive diagnosis of primary amebic meningoencephalitis.


[Chromoblastomycosis in Cuba, retrospective clinical and epidemiologic studies of 72 patients]. A brief review of the prevalence of chromoblastomycosis in Latin America and specially, in our country is made. Seventy two patients who were clinically and epidemiologically diagnosed in the Havana province between 1963-1973 are studied, and epidemic variables of interest are analyzed. Hormodendrum pedrosoi was the prevalent pathogen. The creation of a national register for a better knowledge of the prevalence of this disease in our country is proposed. The training of mycologic dermatologist and their location in places in lack of this kind of specialist are suggested. The early diagnosis and treatment are emphasized.


Muscle activity during chest wall restriction and positive pressure breathing in man. The effects of sustained constriction of the rib cage (RCC), constriction of the abdomen (AC) and of breathing against a positive pressure of 10 cms of water (PPB) were studied in four normal subjects with moderate constant hypercapnia. Intercostal electrical activity (Eic) was measured by implanted wire electrodes and diaphragmatic electrical activity (Edia) by oesophageal electrodes. There was no fixed relation between Edia and VT. VT was unaltered during AC and RCC: Edia was unaltered during AC but increased during RCC. The response to PPB without constriction varied: three subjects increased end-expiratory VL with increase in Edia and inspiratory Eic. One subject initially, and one subject after training, maintained end-expiratory VL constant with no change in Edia and an increase in expiratory Eic. When PPB was applied during AC and RCC there was an increase in Edia proportional to end-expiratory lung volume. The overall response to distortion was determined by voluntary choice, but muscle electrical activity reflected chest wall configuration: when the diaphragm was shorter and at a mechanical disadvantage its electrical activity increased. This was compatible with a reflex with afferent information from diaphragm tendon organ and muscle spindle receptors.


[Antimicrobial properties of extracts from Rhizophora mangle L]. Aqueous and alcoholic extracts are obtained from the roots, leaves and stems of ruddy mangrove-tree (Rhizophora mangle L.), a very common plant in Cuban coasts and to which different curative properties are attributed in our popular medicine. The inhibitory activity of these extracts on the growth of different human pathogenic organisms, among which are bacteria, fungii and yeasts, is reported. For this determination, a method of diffusion in an agar medium with holes in which 50 ml of each extract in question were poured was used; the size in millimeters of the inhibitory halo found in each species and the concentration of the dilution in broth for Mycobacterium strains are reported.


Immersion vs pressure-breathing and diaphragmatic function in the upright position. In seven anesthetized dogs, immersion in the upright position to mid-neck level (IM) was compared to pressure breathing (PB) under dry conditions during constant-stimulus diaphragmatic contraction (EPS). The comparison was in terms of EPS-induced changes in alveolar pressure under static condition (Pmus); EPS-induced tidal volume (VT); and the VT/Pmus ratio (C'). It was found that at iso-lung volume (V): (a) Pmus was greater in IM than in PB, the difference increased at higher V; (b) VT was greater in IM than in PB, but the VT difference (deltaVT) did not parallel that in Pmus; VT was maximum at a V equal to approximately 90% of FRC in air (FRCd) and decreased below and above this volume; (c) during both IM and PB, the VT-V relationship reflected a biphasic relationship of C' to V and appeared to be inherent to the upright position.


[1st report of an intermediary host of Moniezia sp in Cuba]. The determination of an oribatid belonging to the Scheloribates genus as an intermediary host of the Moniezia sp. helminth is reported for the first time in Cuba. Photographs and measurements taken during the infecting larval state of Moniezia (cisticercoid) found are included, such as it is observed because of transparency in the interior of acarus and drew out from the Latter for its better identification.


[Preparation and evaluation of antibacterial activity of partial fractions of Vallesia antillana Wood]. A study on the antibacterial properties of alkaloidal fractions of Vallesia antillana Wood, a Cuban plant belonging to the Apocynaceae family, is performed for the first time. Four partial fractions from bark of stems were prepared according to a classical extraction of total alkaloids and a partial fractionation of these, with the use of tartaric acid and ethyl ether and by a pH gradient with values of 2.5, 5.0, 7.0 and alkaline one. Data from thin layer chromatography on the alkaloidal content of different fractions are added and an assessment of antibacterial activity was made; for this, a method of sections in agar medium with bacterial species of human clinical interest was used; inhibitory halos found within 24 hours of incubation at 37 degrees C are reported in millimeters.


[Parasitic duodenitis].

[Parasitic duodenitis]. A study on 100 patients bearing high-localization intestinal parasitism associated to clinical manifestations compatible with an ulcerous syndrome is performed. The frequency of the parasites found is outlined, and Giardia lamblia comes first in the order of appearance. The different tests used to reach the diagnosis of this entity are assessed and emphasis in laid on the value of biliary drainage, both in the detection of parasites and the biliary sepsis that frequently accompanies them. In testing different therapeutic schemes, the value of metronidazole associated to tetracycline for intestinal giardiasis and of Alcopar for Necator americanus in stressed.


[Local grafting as a simple method of treatment of pseudoarthrosis (author's transl)]. The authors present a new technique for the treatment of a pseudoarthrosis by local graft. The graft, taken from the basilar bone, is moved to the site of lost bone substance whilst retaining its internal muscular attachments. The result is very satisfactory and avoids the use of an iliac graft.


[Complete repair in one stage of the sequelae of unilateral total hare lip (author's transl)]. The sequelae of hare lip, of mixed origin, malformative and surgical, require careful analysis of the deformities present in order to ensure their correction. The basic concept is replacement of the cleft in its initial position, i.e.: --re-opening of the cleft, --exposure of the bony edges, --excision of scar tissue. Restoration is then performed starting deep and working upwards, with primary attention paid to the skeleton with the complex concern of: --normalisation of the underlying bone and of occlusion, --re-establishment of oro-nasal muscular equilibrium, --esnuring nasal ventilation. without neglecting the overall morphology. With this in mind, complete repair in one stage is most likely to result in a harmonious overall result.


Evaluation of urinary myoglobin assay test for myocardial infarction. Serial determinations of urinary myoglobulin, beta2-microglobulin and albumin, and of serum myoglobin, were performed in twenty-eight consecutive patients admitted to a coronary care unit. Patients with myocardial infarction (MI patients) all had higher serum levels of myoglobin then those with other diagnoses (OBS patients). Myoglobinuria occurred in 80% of MI patients and in half of the OBS patients. The appearance of myoglobin in urine was mainly accounted for by an impaired renal reabsorption of low molecular weight proteins. Measurement of urinary myoglobulin, in contrast to serum myoglobulin, is of little value for the diagnosis of myocardial infarction.


Immunoelectrophoretic studies on human small intestinal brush border proteins. A qualitative study of the protein composition. The human small intestinal brush border proteins were studied qualitatively by crossed immunoelectrophoresis. Brush border membranes were purified from human jejunum and the proteins released by Triton X-100. Rabbits were immunized with the released proteins and by using a double layer immunofluorescence technique the obtained antisera were shown to be specific against the brush border proteins. The precipitates obtained in crossed immunoelectrophoresis were identified by enzymatic staining techniques. Sucrase (EC 3.2.1.48), isomaltase EC 3.2.1.10), maltase (EC 3.2.1.20), phloretin-glucosidase (EC 3.2.1.62), lactase (EC3.2.1.23), microvillus aminopeptidase (aminopeptidase (microsomal), EC 3.4.11.2), dipeptidyl peptidase IV (EC 3.4.14.X), and alkaline phosphatase (EC 3.1.3.1) were identified while asparate aminopeptidase (EC 3.4.11.7), gamma-glutamyl transferase (EC 2.3.2.2) and trehalase (EC 3.2.1.28) could not be visualized. This work demonstrates that cross immunoelectrophoresis can be used in the study of human small intestinal brush border proteins.


Study of the EMIT method for determination of anti-epileptic drugs in serum using an LKB 2086 reaction rate analyzer. Phenemal, phenytoin and carbamazepine were determined by the EMIT method on an LKB 2086 Reaction Rate Analyzer and the results compared with routine results obtained for phenemal by gas chromatography and for phenytoin and carbamazepine by thin layer chromatography. Coefficients of variation for phenemal at the concentration 99 mumol/l in bovine serum were 3.1% within run and 10.8% between run. For phenytoin the coefficients of variation were respectively 13.1% and 15.4% for the same serum with a concentration of 99 mumol/l. For carbamazepine the coefficients of variation were estimated to be 14.1% within run and 10.4% between run for a human serum containing 25 mumol/l. With an LKB 2082 Kinetic Data System the coefficients of variation phenytoin and carbamazepine were reduced to 8% and the coefficients of correlation between the EMIT methods and the routine methods were at least 0.965 for all three drugs. The assay ranges were found to be satisfactory. The method allows assay down to 8.6, 4.0 and 2.1 mumol/l and up to 301, 198, and 51 mumol/l for phenemal, phenytoine and carbamazepine, respectively.


Detection of antibodies in human sera to streptococcal groups A and C carbohydrates by a radioimmunoassay. Human antibodies to streptococcal groups A and C carbohydrates were measured quantitatively with a radioimmunoassay using tyrosylated  125I carbohydrate. Analysis of acute and convalescent sera from people with groups A or C streptococcal pharyngeal infection or persistent carriage revealed a significant rise in antibodies. Inhibition reactions with the cold carbohydrate indicated the specificity of the elicited antibodies. In some instances, group C as well as group A antibodies occurred after group A pharyngeal infections. Further clinical and epidemiological studies are required to determine the significance of group-specific antibodies. Antistreptolysin-O (ASO) rises were observed in individuals with group C antibody responses after persistent group C pharyngeal carriage. For this reason, epidemiological surveys that rely primarily on ASO surveys to determine the incidence of group A streptococcal infections must be interpreted with caution, at least in the developing countries, where group C pharyngeal carriage is common.


Characterization of human lymphocytes bearing Fc receptors for IgE isolated from blood and lymphoid organs. Human lymphocytes isolated from adult peripheral blood and cord blood, tonsils, adenoids and spleens were analysed for Fc receptors for IgE (Fcepsilon) by rosette assays. The Fcepsilon+ cells were also characterized for their class of surface immunoglobulin (sIg), complement receptors, receptors for sheep erythrocytes (E), and Helix pomatia A haemagglutinin (HP), and their abilities to phagocytoze and adhere. The average number of Fcepsilon+ cells was in adult peripheral blood 1.2 +/- 0.4%, in cord blood 3.0 +/- 1.3%, in tonsils 4.2 +/- 5.2%, in adenoids 5.8 +/- 4.2%, and in spleens varied from 0.8% to 15.8% among individual patients. Overnight culturing of the lymphocytes under conditions that allowed detection of Fc receptors for IgM (Fcmu) usually lowered the number of Fcepsilon+ cells. Neuraminidase treatment caused no change. Rosette formation was inhibited by IgE myeloma proteins and their Fc fragments, but not by mildly reduced and alkylated and heated (56 degrees C) IgE, indicating that the receptors are specific for the native configuration of the IgE Fc fragment. Double cell surface marker analyses with fluoresceinated F(ab')2 fragments of purified anti-mu, delta, and gamma antibodies used to label the Fcepsilon rosette-forming lymphocytes from peripheral adult and cord blood showed that 50-80% were sIgM+ but only 0-28% were sIgD+. In contrast, approximately 80% of the Fcepsilon+ cells from tonsils, adenoids and spleens were sIgM+ and sIgD+. The Fcesilon+ lymphocytes represented 10-20% of the sIgM+ lymphocytes in both the peripheral adult and cord blood. Depletion and enrichment experiments indicated that most of the Fcepsilon+ cells bear complement receptors. Lymphocytes having both E and Fcepsilon receptors were not found. Furthermore, the lymphocytes with HP receptors, a marker for T cells and immature B cells, were Fcepsilon-. Monocytes and neutrophil granulocytes did not form Fcepsilon rosettes. These data indicated that a minor population of human B lymphocytes have Fcepsilon receptors. The majority of the Fcepsilon+ lymphocytes in the blood differ from those in tonsils, adenoids and spleen in that the majority of the former are sIgM+/sIgD- and the latter sIgM+/sIgD+. The sIgM+/sIgD- Fcepsilon+ cells in the blood are probably relatively mature lymphocytes since they lacked HP receptors, which are found on immature B cells.


Alternation of low and high affinities of secreted and cell-bound antibodies during the anamnestic response of rabbits to Salmonella senftenberg microorganisms. We have investigated at the cellular level the variations in affinities of secreted antibodies and of cell receptors during the anamnestic response of rabbits, by using an immunization schedule made up of administrations, over successive intervals of 40 days, of Salmonella senftenberg vaccine. Affinities of free and membrane-bound antibodies biosynthesized at a given time were measured by inhibition of haemolytic plaque-forming cells (PFC) and rosette-forming cells (RFC) with spleen, lymph node, and peripheral blood cells. The immunodominant monosaccharide, methyl-alpha-D-glucopyranoside (alpha-Me-Glc), was used as inhibitor, and the target cells were coated with the O-specific polysaccharide of the immunogenic microorganisms. We observed that the monosaccharide concentration causing a 50% inhibition (I50) alternated between low and high values in both PFC and RFC assays. Furthermore, when sheep erythrocytes were coated with polysaccharides from other strains of Salmonella bearing the determinants for serotypes 1 or 3 the percentage of cross-reactive PFC obtained exhibited a reverse oscillating pattern of variation. These results demonstrated that affinity of secreted antibodies or of antigen-receptors of cells, directed against different determinants of the antigenic polysaccharide, alternated between low and high values after each new vaccine administration. Possible mechanisms accounting for this phenomenon are discussed.


A simple method to detect complement receptors using baker's yeast: Y C rosettes. A technique is described to identify complement-receptor-bearing cells, using serum-treated baker's yeast as a ligand. The method consists of incubation of heat-killed baker's yeasts with fresh AB normal serum, freezing, thawing, and washing of the particles, followed by mixing with the cells. Serum is required to coat the yeasts for the rosette formation. Experiments designed to establish the serum factors responsible for the attachment of the particles to cells show that heat inactivation, chelating agents, or anti-C3 treatment prevent rosette formation. This is taken as evidence that yeasts (Y) are coated with complement (C) to compose the reagent for the YC rosette technique. The application of this technique to twenty-five normal individuals demonstrated that a mean of 11.6 per 100 lymphocytes (+/- 4.3) form rosettes; absolute number: 275 (+/- 160) rosette-forming lymphocytes per mm3. Either AB or autologous fresh serum can be used to coat the yeasts. A combined technique for YC plus E rosettes can be performed allowing the identification and enumeration of four populations of lymphocytes: (a) those having receptors for sheep erythrocytes, (b) complement-receptor-bearing lymphocytes, (c) those having both receptors (D lymphocytes), and (d) non-rosette-forming non-phagocytic cells.


Treatment of herpes zoster with idoxuridine ointment, including a multivariate analysis of symptoms and signs. A double-blind, random selection comparison was made of the therapeutic effects in acute herpes zoster of (A) 40% idoxuridine (IDU) dissolved in dimethyl sulphoxide (DMSO), or one of the following ointments: (B) a basis of polyethylene glycol, (C) a basis with 60% DMSO, (D)  a basis with 5% IDU and 60% DMSO, and (E) a basis with 40% IDU and 60% DMSO. Each group comprised 20 patients. The patients were evaluated daily until skin healing and then at 1,3, and 6 months by registering 4 neurological signs, 5 clinical evaluations of skin pathology and 4 photographic evaluations of the skin lesions. A 'profile' of the effect of each treatment was computed by calculating normalized means for each of the 13 variables. A non-random distribution of the clinical and photographic variables indicated a statistically significant, but small therapeutic effect of treatment A on skin healing, whereas no convincing effect on pain or sensitivity disturbances was established. Treatments B-E were without positive effects. The information given by the highly interdependent variables were computed for each variable and for groups of variables after appropriate scoring. It was found that the photographic evaluation contributed evidence independent of the clinical evaluation of skin pathology. A multiple correlation analysis revealed that age was positively correlated to the duration of pain and to delayed healing, that rapid healing was intimately connected to no or short-lived pain, and surprisingly that zoster in the trigeminal area healed faster than in other locations without being correlated to less pain. Treatment A must necessarily be reevaluated taking into account proper controls as well as age and affected dermatomes.


Recurrent group B streptococcal infections: Report of three cases. The group B streptococcus has become a leading cause of neonatal infection. Despite the increasing incidence of this infection, recurrence in the same patient is extremely uncommon. This report describes three infants with proved recurrent group B streptococcal disease. All patients were treated with benzylpenicillin for at least 10 days, but, after a symptom-free interval, each developed symptoms again. Whether the illness in these patients represents a relapse or a true reinfection is difficult to determine. Various possibilities are discussed. The development of a recurrent infection indicates that presently recommended therapy may be inadequate in certain instances. Comments about epidemiology, clinical picture, antibiotic sensitivity studies, and immunity are made along with speculations about possible approaches to treatment and prevention of this infection.


The nitroblue tetrazolium (NBT) reduction of neutrophil granulocytes from newborn infants and their mothers in relation to the occurrence of bacteria in amnion fluid and cord blood. The nitroblue tetrazolium (NBT) reduction of granulocytes from cord blood, when measured without in vitro stimulation with bacteria, was significantly higher than that of maternal granulocytes. This elevated activity may be an adequate response to the presence in cord blood of degradation products from the placenta but also of potentially pathogenic bacteria, found in cord blood of infants with high NBT values. On in vitro stimulation cord blood granulocytes displayed the same high NBT activity as those of the mothers and of healthy non-pregnant women. All but one blood culture from the infants 25--48 h after delivery were sterile. The only child with a low non-stimulated NBT activity of cord blood granulocytes was also the only one presenting a clinical picture of neonatal septicemia, though not bacteriologically verified.


An outbreak of hepatitis A investigated by immune electron microscopy and enzyme-linked immunosorbent assay. In a small outbreak of hepatitis A among members of a hospital staff, excretion of hepatitis A virus could be detected by immune electron microscopy (IEM) and enzyme-linked immunosorbent assay (ELISA) in 3 out of 3 cases tested. Significant increases in antibody titre could be shown in 4 out of 6 cases (IEM), and development of virus specific IgM was shown in all 6 cases (ELISA). Among these patients IgM could be detected after 3 months, while sera drawn after 10 months were negative.


The osteogenic capacity of tubular and membranous bone periosteum. A qualitative and quantitative experimental study in growing rabbits. A standardized model has been designed to qualitatively and quantitatively study new bone formation from isolated periosteum in situ. A total of 117 operations were performed on the tibia and skull of 92 growing rabbits. For qualitative studies ordinary histological methods were used. Already after two weeks tibial periosteum had formed woven bone. After eight weeks cortical bone and bone marrow of normal amount and almost normal structure had regenerated. The bone formation from the skull periosteum started later and seemed to be lesser in amount and without woven bone as an intermediate stage. After 15 weeks a structurally normal calvarial bone had developed, except for the inner theca. Thus it was found that isolated tibial and skull periosteum in situ give rise to tubular and membranous bone respectively, suggesting an environmental influence. For quantitative studies the newly formed periosteal bone was removed, dried, weighed and ashed. The ashes were dissolved in HCl for spectrophotometric determination of total Ca content and this was used as a quantitative measure of bone amount. After 6-7 weeks tibial periosteum had produced normal quantities of cortical bone and 7 times more bone than the same area of skull periosteum. Calvarial periosteum was not potent enough to restore a skull defect completely. Surgicel which has been used clinically in periosteal repair of maxillary clefts, quantitatively was found to diminish bone formation considerably. The supposed capacity of bone marrow to promote bone formation was not demonstrated in this study.


Osteogenic capacity of periosteal grafts. A qualitative and quantitative study of membranous and tubular bone periosteum in young rabbits. A standardized model, permitting only periosteal bone formation, has been applied for qualitative and quantitative studies on the osteogeneses from periosteal grafts. The periosteum from the tibia was grafted to the skull and vice versa. The investigation also included the study of periosteal bone formation combined with other osteogenic factors. A total of 78 operations were performed on the tibias and skulls of 43 growing rabbits. For qualitative studies ordinary histological methods were used. Tibial periosteal grafts to skull defects started bone formation already after 2 weeks and, via a very small amount of woven bone, compact bone and bone marrow was formed after 8-10 weeks. Combined epidural and subperiosteal bone formation gave a calvarial bone. Skull periosteal grafts to tibial defects started bone formation somewhat later, but, after more woven bone as an intermediate stage, the defect had healed with thick compact bone and bone marrow after about the same period. For quantitative studies the newly formed periosteal bone was removed, dry-weighted and ashed. The ashes were dissolved in HCl for spectrophotometric determination of total Ca content, which was used as a quantitative measure of bone amount. Tibial periosteum grafted to a calvarial defect halved its bone forming capacity but compared to the in situ skull periosteal potential, the capacity was tripled. This meant that the defect was completely healed. Calvarial periosteum was much less potent than was the tibial periosteum, when both were grafted to skull defects. However, when transplanted to a long bone defect the former increased its bone forming capacity 5 times compared to its original one as an in situ flap. Environmental functional demands seem to influence the type of bone formation and the final structure of the new bone. On the other hand, there are differences between long and membranous bone periosteum regarding the amount of bone formed.


The preformed autologous bone graft. An experimental study in the rabbit. The preformation of bone grafts involves a two-step procedure. Primarily a mould is inserted in the donor bone. After a healing period of about 6 weeks (rabbits) the mould is removed. The performed bone graft (PBG) consists of the former cortical bone that has remodelled according to the shape of the mould. PBGs are today used clinically in selected cases of mandibular reconstruction. The present paper is the first in an animal experiment series investigating the PBG. It is shown that the PBG vascular supply is rearranged towards a more marrow-dominated circulation. Six weeks after the mould installation the bone showed evidence of accretion in the form of new-developed bone protrusions along the inner mould walls. A histochemical investigation revealed that the PBG surface cells survived the surgical trauma in a higher percentage than was the case when corresponding control grafts were examined.


Integrated prosthetic and surgical treatment of malignant tumours of the maxilla. A new acrylic plate device. Surgery for malignant tumours involving the palate often leads to postoperative problems for the patient. Most commonly a stent or a tampon is used to fill the resection cavity. Both materials have disadvantages, however. To overcome these we have since 1972 used a preoperatively made acrylic plate to separate the oral cavity from the resection cavity in 20 patients. This plate is fixed to the mucosa or to the remaining teeth by sutures and is left in place for 10-14 days postoperatively.


A new and easier way to anastomose microvessels. An experimental study in rats. A new technique for microvascular anastomosis, telescoping one vessel into the other requiring only 2 sutures, is described. In 28 arterial and 15 venous anastomoses no failures were seen as recorded 3 weeks postoperatively by micro dissection, micro angiography, light microscopy and scanning electron microscopy. It is concluded, from this experimental study in rats, that the new anastomosis is faster and easier to perform and at least as reliable as the conventional end to end anastomosis.


Reconstruction of auricular defect with perichondrial graft: a new technique. Case report. A new technique is introduced to reconstruct defects of the auricle. The neochondrogenic capacity in a free graft of the auricular perichondrium is used to build the cartilaginous framework in the missing part of the auricle. By using local flaps and skin grafts for coverage of the newly formed cartilage the missing part of the auricle is satisfactorily reconstructed.


The influence of vitamin B6 supplementation on the bone marrow morphology in patients on regular haemodialysis treatment. A double-blind study. Bone marrow smears from 20 patients with chronic renal failure and on regular haemodialysis treatment (RDT) were morphologically analysed. A double-blind study of treatment with high doses of vitamin B6 showed that the patients receiving pyridoxine got raising frequencies of lymphocytes and monocytes in the bone marrow and there were morphologic signs of a normalization within the granulopoiesis. It is suggested that this is a sign of an enhancement of the immune response. The vitamin supplementation had no significant effects on the pronounced anemia of the patients.


Conduiturinary diversion and urinary-tract infection. I. Serum antibody titers against Escherichia coli and Proteus mirabilis in relation to urographic findings. The serum antibody titers against Escherichia coli and/or Proteus mirabilis were elevated in 26 of 80 patients (33%) with a conduit urinary diversion. Urographic findings were abnormal in 44 of these 80 patients (55%). Urography was normal in 59% of the patients with normal antibody titers, but in only 15% of those with elevated titers. Raised antibody levels against E. coli O antigen (greater than 256 before and/or greater than 32 after mercaptoethanol treatment of serum) were associated with wide upper urinary tract or calculi more often than were normal E. coli antibody titers. Raised titers against P. mirabilis (greater than 256 before and/or greater than 32 after mercaptoethanol treatment of serum) were associated with scarring of the renal parenchyma more frequently than were normal titers. A statistically significant association was found between "small" kidney area and raised serum antibody titers against E. coli or P. mirabilis. The frequency of "small" kidney increased with the time lapse after urinary diversion. At 3 to 11 months postoperatively it was 29%, but among the patients with urinary diversion for more than five years the corresponding frequency was 82%. When at least one kidney was "small", the serum creatinine was higher than when both kidneys were of normal size. Patients with raised antibody titers tended also to have high serum creatinine (greater than or equal to 124 mumol/l) more often than those with normal titers (23 vs. 10%). These observations imply a connection between elevation of the antibody titers and destruction of the renal parenchyma in patients with conduit urinary diversion. They illustrate the value of antibody titration in the follow-up of patients with urinary diversion.


Conduit urinary diversion and urinary-tract infection. II. Raised serum antibody titers against Escherichia coli and Proteus mirabilis in relation to bacteriologic findings. Elevated serum antibody titers against Escherichia coli and/or Proteus mirabilis were found in 35% of 89 patients with a conduit urinary diversion. Statistical analysis showed significant correlation between the titers and growth of E. coli or P. mirabilis in conduit urine. But 17 (24%) of 72 patients without E. coli in urine cultures had raised E. coli antibody titer. Only 3 (4%) of 68 patients without growth of P. mirabilis had raised P. mirabilis antibody titer. When the post-diversion observation period was more than five years, the frequency of antibody titer elevation was greater than in patients with shorter post-diversion follow-up. The volume of residual urine in the conduit showed statistically significant correlation with presence of bacteriuria and with the antibody titer level against P. mirabilis. Patients with high antibody titers tended to have high readings of serum creatinine. Antibiotic therapy reduced elevated E. coli and P. mirabilis antibody titers. Titration of antibodies to E. coli and P. mirabilis is recommended in the follow-up care of patients with conduit urinary diversion.


Extracorporeal surgery and autotransplantation for carcinoma of the pelvis and ureter. Multiple transitional cell tumours of the renal pelvis and proximal ureter of a solitary kidney were successfully managed by total ureterectomy, extracorporeal subtotal resection of the renal pelvis, autotransplantation, and calicovesicostomy. The method permits resection of a maximum of the uroepithelium of the upper urinary tract at the same time as it preserves available renal parenchyma. It also implies a new and exciting approach to the renal pelvis for endoscopic postoperative control and local treatment of the malignancy.


Skin necrosis after warfarin therapy.

Skin necrosis after warfarin therapy. A rare but potentially lethal complication of coumarin and its congeners is skin necrosis. A case of skin necrosis due to warfarin is reported and the literature is reviewed. It is suggested that if necrosis develops, the coumarin therapy should be terminated, and the patient should immediately be heparinized. Heparin, which never causes necrosis, can be used freely if further anticoagulation therapy is required, and may well prevent necrosis due to the thrombotic process.


The City Hospital for Infectious Diseases--conception and first years. Cape Town had no proper facilities for dealing with infectious disease when, in 1894, Dr Barney Fuller, city MOH, began a 6-year flight to establish the City Hospital for Infectious Diseases. The project was delayed, first by disputes between the city and the Colonial Government about paying for it, and then by the outbreak of the South African War. As a result, the hospital when built in 1900 was taken over by the military, and was only developed for its proper purpose by Dr Jasper Anderson in 1902.


Polyethylene-glycol-mediated cybrid formation: high-efficiency techniques and cybrid formation without enucleation. Polyethylene glycol (PEG) can be used to promote the fusion of enucleated cytoplasts from chloramphenicol (CAP)-resistant mouse cells with intact cells, resulting in the formation of viable cybrids. The techniques are simple and highly efficient, yielding up to one viable cybrid per 20 intact cells fused. It also seems that PEG can be used to induce cybrid formation without the necessity of prior enucleation of the CAP-resistant cells.


Necrotizing enterocolitis in the neonate. Necrotizing enterocolitis has become the most common condition requiring emergency surgical treatment in the newborn infant, far surpassing all major congenital anomalies in number of presentations and in deaths after surgical treatment. No single cause for the disease is known. Necrotizing enterocolitis is characterized by ischemic necrosis of the intestine, with minimal inflammation. In 25 of 50 per cent of patients, surgical resection of gangrenous bowel is necessary. Operation is reserved for infants with intestinal perforation or grangrene. Recent refinements of indications for operation often permit surgical intervention to coincide with the advent of intestinal gangrene. At operation, expeditious resection of frankly necrotic bowel and exteriorization of the marginally viable ends is all that should be attempted. Special problems postoperatively consist of management of sepsis, maintenance of nutrition and vigilant observation for early and late complications, particularly the development of ischemic intestinal stricture.


Complications in colonoscopy.

Complications in colonoscopy. Colonoscopy, when performed for appropriate indications and by experienced, competent personnel, is a remarkably safe procedure. The occasional complications which occur may be the result of pneumatic, mechanical or electrical injuries to the colon or may develop as secondary disorders involving other organ systems. Most complications can be successfully prevented by adequately preparing both the endoscopist and the patient and by avoiding colonoscopy when specific contraindications are present. Should complications occur, their management generally follows established surgical principles. Even though colonoscopy has made a dramatic impact upon the diagnosis of and therapy for disease of the large intestines, it is important for practitioners to be mindful of its limitations. Future developments, applied rationally, can be expected to extend its usefulness and further improve its safety.