[Effects of levamisole in the treatment of a group of patients with atopic asthma and depression cellular immunity]. We investigated the possibility of decreased cellular immunity (C.I.) in a substantial group of atopic asthmatic patients with respiratory tract infections during autumn and winter. Two-hundred and ten atopic asthmatic patients were selected, and the following tests for cellular immunity were performed. Skin tests with 11 bacterial and fungal antigens. Normal average value of the skin reactions is 2.5 mm. E rosettes with sheep erythrocytes. Normal value for patients of this age is 60 +/- 8%. Immunoglobulins A, G and M and complement fractions C3 and C4 were determined by radial immunodiffusion. IgE was determined using PRIST (Phadebas, Pharmacia). IgE was elevated in all except two of the patients. IgG, IgA and IgM, C3 and C4 were normal. Twenty five of the 85 patients had some depression in cellular immunity (decreased E rosettes and/or decreased skin reactions). Patients with depressed cellular immunity were given 2.5 mg Levamisol three times a week for three months. Their progress was evaluated clinically and immunologically and a positive correlation was found between clinical improvement and increased C.I. in 18 of the 25 patients. We consider Levamisol to be useful in approximately 8.5% of all asthmatic patients.


Specific desensitizing treatment in drug allergy. Fourteen patients with allergy to drugs (4 to synthetic corticotrophin, 3 to insulin, 4 to pyramidon, 2 to penicillin, and 1 to iodine-containing contrast media) were submitted to specific desensitizing treatment using graduated doses of the drug. Therapy was completely successful in 11 of 14 cases: in one case, the authors were forced to suspend treatment because the patient allergic to pyramidon had become pregnant; in the other cases (allergic to corticotrophin and to penicillin) the treatment was suspended because of severe adverse reactions. On the basis of the present findings, immunotherapy in drug allergy is possible and should not present any special problems: it is necessary that the treatment be carried out by highly qualified staff and preferably on hospitalized patients.


Breast cancer and histocompatibility antigens. HLA antigens and haplotypes were studied in 50 women with infiltrating ductal carcinoma of the breast, from the Basque provinces and Navarra, and in a comtrol group consisted of 166 healthy persons from the same geographical area. A greater incidence of HLA-B7 and B26 was observed in the breast cancer group if compared with the frequency of occurrence of these antigens in the Spanish population. However, when compared with Navarra-Basque population, no significant differences were observed. The study of the haplotype frequencies in breast cancer showed a greater incidence of the A9, B27 and A10, B14 haplotypes than in the normal population. However, the significance of D values disappeared after making the necessary correction for the number of antigens tested. The major histocompatibility system has a variety of functions which have not yet been documented but that might predispose to disease. It is certainly probable that there will be multiple mechanisms underlying HLA and cancer associations, however so far none of the data available suggest the presence of an immune response gene linked with breast cancer.


Levels of serum IgE in patients with Brazilian pemphigus foliaceus and pemphigus vulgaris. The level of serum IgE in thirty patients with pemphigus (19 with Brazilian pemphigus foliaceus (BPF) and 11 with pemphigus vulgaris (PV)) were determined by means of a solid phase radioimmunoassay. A significant (P less than 0.01) increase in the level of IgE was observed in BPF patients compared to the level of IgE in PV patients and healthy adults. The possible relationship of an elevated level of IgE with respect to other aberrations of immunologic responsiveness and the suggested infectious etiology of BPF are considered.


HLA and pollinosis.

HLA and pollinosis. Sixty-two patients were selected who suffered from seasonal pollen-induced bronchial asthma and rhinitis. Histocompatibility antigen typing was carried out with a panel of 70 antisera (Behringwerke) of 33 HLA specificities. The results obtained at locus A of the most representative by percent phenotypic frequency of the HLA studies shows a decreased frecuency of HLA-A11. The phenotyic frequencies of the most representative HLA of B locus in the group of patients shows an increase in the frequency of HLA-B8. This represents 22.6% compared with 9.1% of the controls, which is definitely significant. The results obtained in a study of the haplotype frequency of three combinations of HLA antigens, in a group of allergic patients compared with the controls shows that the frequency of the haplotype A1 B8 is greater in the allergic patients than in the control group, a statistically significant finding. As regards the other two haplotypes A2 B12 and A3 B7, the respective results of the comparison were not significant in the first and marginally significant in the second. Even these few studied cases demonstrate the predominance of HLA-B8 in atopic or hyperreactive states. As regards the A1 B8 haplotype, we also find a slightly increased occurrence, in agreement with the literature. This suggests that the hyperergic response might be associated with the presence of the A1 B8 haplotype.


Humoral and cellular immunity in chronic urticaria. In chronic recurrent urticaria of months' or years' duration, it is difficult to identify the causative factor. From an immunological point of view, various authors have attempted to demonstrate alterations in levels of immunoglobulins and complement fractions. We do not know of any previous studies of cellular immunity in this disorder. Fifty-one patients with chronic urticaria were studied, 22 females and 29 males, with ages ranging from 8 to 70 years. The patients were considered to be affected by recurrent or chronic urticaria with no clear allergic etiology. In all subjects a determination was made of serum levels of immunoglobulins G, A, M and E and of the complement fractions: C1 inhibitor, C1q, C3, C4 and C5. In addition, a study of cellular immunity was carried out on these patients. The results of tests of humoral immunity in the group of chronic urticarial patients studied showed only an increase of IgM in 41.7%. No significant changes were noted among the complement fractions. The study of cellular immunity gave normal figures for total and for B and T lymphocytes. The only finding which may be worthy of is a slight decrease in active T lymphocytes. The lymphocyte transformation test also gave a normal response to PHA and overall a normal cellular immunity was shown in these patients. At present we do not consider that the increased IgM in 40 to 45% of the cases has any pathogenic diagnostic value.


Study of humoral and cellular immunity in lobomycosis. Fourteen patients with lobomycosis from the Amazon Basin were studied in order to assess their humoral and cellular immunological responses. The humoral response was normal, as shown by the normal levels of serum immunoglovulins. The cellular immunity was depressed for recent sensitizations as measured by skin contact test with DNCB (negative in 83.3% of 12 patients). The intradermal reactions to PPD and fungal extracts suggested that all patients were able to respond to at least 2 of the antigens used. It was also observed that patients reacting to PPD did not become sensitized to DNCB. Conversely, some Mantoux negative patients had positive reactions to DNCB. Both tests were negative in 3 patients.


An evaluation of respirator canisters to acrylonitrile vapors. Experimental breakthrough times obtained from evaluating respiratory canisters to acrylonitrile vapors at various concentrations are presented and compared to estimated breakthrough times calculated from Nelson's equation for organic vapors adsorbed on activated carbon. The slope of the regression for breakthrough time vs. concentration of acrylonitrile was found to compare closely to that derived from Nelson's equation in the concentration range from 30 to 1000 ppm. This demonstrates that the equation is capable of predicting breakthrough times for organic compounds which, like acrylonitrile, have low molecular weights and boiling points. This ability to predict service life is also influenced by other important factors such as relative humidity and amount of activated carbon packed in a canister. Results of this evaluation illustrate the need to determine breakthrough times for compounds under controlled conditions similar to those encountered in the field, especially at low concentrations. Industrial hygienists should use experimentally derived breakthrough times to predict the service life of an air purifying device if they are available.


Relative ear protector performance in high vs low sound levels. The attenuation of one specific ear protector was determined for a group of five normal hearing subjects and a group of five hearing impaired subjects. The hearing impaired group yielded significantly less attentuation than the normal hearing group. Since the measuring sound intensity level was high for the hearing impaired listeners and low for the normal listeners, it appears that a threshold procedure using normal subjects, as presented in the American standard (ANSI S3.19-1974), may overestimate the actual attenuation of ear protectors in most noisy environments.


The efficiency of respiratory filters in a coke oven atmosphere. Several types of commercially available respiratory filter/sorbent combinations were tested in a coke oven environment. The percent penetration of benzene soluble particulate and benzo(a)pyrene through these filters was determined and was generally found to be less than ten percent. Degradation of filtering efficiency was noted with some types of filters. The use of a sorbent cartridge in conjunction with a covering filter did not significantly change penetration of the contaminants which were measured.


Two methods for establishing industrial hygiene priorities. There is a need for a method to establish industrial hygiene priorities so that our limited health resources can be directed to those chemicals and conditions of use that pose the greatest risk to employee health. The Health Team hazard rating method presented in this paper accomplishes this goal and has been used successfully for several years. Also presented is a proposed method for calculating hazard ratings for inhalation exposures to gases and vapors that may allow those responsible for promulgating standards to address the hazard rather than the toxicity of a regulated chemical.


Total elemental content passive personal monitors. The development of specific passive personal monitors for each volatile form of an element should ultimately lead to a common monitor which can detect any or all forms of that element. Such a device is presented here as a total elemental content passive personal monitor and depends upon diffusion to bring gaseous pollutants into its collecting matrices. The goal of this paper is to show how to compute and limit the ambient concentration error attributed to molecular diffusion approximations for such monitors. The error depends upon the value for the weighted diffusion coefficient used to convert the mass of element collected to ambient concentration. A computed average diffusion coefficient tends to be nonideal, because the relative concentrations of the volatile forms of an element entering the monitor are variable during the work day. Since it is not possible to calculate an exact diffusion coefficient, a finite error will exist between monitor and ambient concentration values. It is shown that total organic chlorine at a vinyl chloride plant can be estimated by use of an average diffusion coefficient without imparting significant error.


A model for deposition of stable and unstable aerosols in the human respiratory tract. A model has been developed for deposition of stable and unstable aerosols in the human respiratory tract. This model has the advantages of employing a realistic asymmetric lung model and utilizing actual breath curves. Results from the model are presented for normal and abnormal breath patterns for both stable and unstable particles. Insofar as comparison is possible, agreement between model calculations and experiment appears to be reasonable.


Predicint lifting capacity.

Predicint lifting capacity. As science and technology become more sophisticated and with the rapid computation capabilities of the modern computer available, it becomes both possible and economically feasible to scientifically study man and his interaction with his working environment. It is now possible for a person seeking employment to expect and obtain a position which will not be unnecessarily hazardous to his immediate health or have detrimental effects over the long run. Manual materials handling is the contributor of over 400,000 back injuries suffered in the U.S. each year. This research is directed at determining the appropriate operator variables to measure for predicting the permissible weight of lift for three ranges of lift: floor to knuckle height, knuckle height to shoulder height, and shoulder height to reach height. A modified psychophysical procedure was used during which the subjects were instructed to adjust the weight in a tote box to the maximum weight they could lift repetitively without excessive strain or fatique. The task consisted of lifting loads under different conditions of task variables, namely, height of lift, frequency of lift, and load size. Industrial workers as well as students of both sexes were used as subjects. Based on the data obtained, the lifting capacity of the worker was determined for the different ranges of lift. In addition, predictive models were developed based on the operator variables and the task variables investigated.


Lead determination in blood by atomic absorption spectroscopy. This paper describes a one-tube sample preparation method for blood lead determination which is relatively simple to perform and which does not require background correction for matrix effects. The red cells are lysed with a dilute potassium cyanide solution and heat. A citrate buffer is added, and the solution is then extracted with ammonium pyrrolidine dithiocarbamate and methyl isobutyl ketone. An aliquot of the MIBK layer is applied to a carbon rod atomizer and the peak at 217.0 nm is measured. The method demonstrates an overall in-run reproducibility of 1.39 microgram/100 mL blood standard deviation, a between-run standard deviation of 2.27 microgram/100 mL blood and a sensitivity of 0.012 microgram/mL/1% nm.


Applicability of activated carbon felt to the dosimetry of solvent vapor mixture. Affirmative results were obtained to prove that diffusion-absorption on carbon-desorption dosimetry is applicable to monitor exposure to mixed vapors of organic solvents (n-hexane:ethyl acetate:toluene=1:4:1). While most of seven carbon felt preparations tested failed to absorb n-hexane in humid air or the amounts absorbed were no longer proportional to vapor concentrations even in dry air when the sum of the three vapor concentrations were over 3 times workroom threshold limits, two preparations revealed capacity to absorb n-hexane even in the air with relative humidity of 95%. Furthermore, the amounts absorbed during four hour exposures were linearly related to the vapor concentrations of at least 4.5 times workroom threshold limits when the three vapor concentrations were summed up, and, at lower concentrations, the absorbed amounts were proportional to the exposure duration of up to eight hours. Short term peak exposure could also be detected; the ratio between the observed and the expected was about 80% at lowest.


Laboratory evaluation of permissible exposure limits for men in hot environments. Forty-six industrial workers completed a total of 653 one-hour work bouts requiring an average of 122-235 kcal/M2/hr in an environmental chamber maintained at heat stress levels ranging from 8-37 degrees C wet bulb globe temperature (WBGT). Heart rates (HR) and rectal temperatures (Tre) were measured at the end of each work bout. Environmental heat stress levels were divided into two groups - those above and those below the permissible exposure limits (PEL). The PEL is the proposed maximum environmental thermal stress to which industrial workers can be exposed without endangering their health. The number of observations in each of these regions was further divided into those which were above the recommended limits of a World Health Organization study group (HR less than or equal to 110 bpm, Tre less than or equal to 38.0 degrees C) and those which were not. The number of "safe" (HR less than or equal to 110 bpm, Tre less than or equal to 38.0 degrees C) observations in environments with heat stress less than or equal to the PEL ranged from 100% to 2.4% depending on subject acclimatization and work rate. The degree of protection was always less in the winter than in the summer and was less for higher work rates. Men who normally worked in hot environments had fewer "excessive" HR's and Tre's than those who did not.


Therapeutic community dropouts: criminal behavior five years after treatment. Two hundred and two male dropouts, mainly heroin abusers averaging 3 to 6 years out of treatment, were sampled from the 1970-1971 Phoenix House admissions by race and time in program (less than 1 month to more than 2 years). Criminal justice arrest records were compared between three pre- and all posttreatment years. Percent and rate of arrest declined significantly in followup. Magnitude of reductions was uniform across race and legal status, varied by age, but increased systematically by time in program. Results replicated and extended earlier findings, confirming long-term positive change in criminal behavior associated with length of stay in the therapeutic community.


Is phencyclidine (PCP) abuse associated with organic mental impairment?. The performance of sober (average length of abstinence = 27 months) phencyclidine (PCP) abusers on neuropsychological measures of organicity was compared to that of polydrug users who were not experienced with PCP, and to controls who were not alcohol or drug abusers. Six of 12 PCP users, five of 12 polydrug users, and none of the controls showed neuropsychological impairments. The deficits in PCP users occurred despite negative medical-neurological history, and even though the PCP group abused other drugs previously associated with neuropsychological impairment less than the polydrug group. Deficiencies in abstracting and in perceptual-motor integrative abilities were noted. The results suggest the possibility that PCP abuse might be associated with neuropsychological disturbance which persists for considerable time after PCP use ceases.


Changing orientations among cocaine users: consequences of involvement in community distribution networks. A study of 44 participants in a rural community cocaine network was conducted to determine the factors associated with increased expenditures for cocaine and the consequences of such involvement. Through correlational analysis techniques, four major categories of variables were shown to be strongly related to extent of involvement: demographic, purchasing ability, supply opportunities, and cost-reduction efforts. The major effects of increased involvement were an increase in egocentrism in relations with drug-using friends, a decline in self-control over administration, heightened concerns about possession, and strengthened justifications regarding drug use.


Adults' drug use: relationship to perceived drug use of parents, friends while growing up, and present friends. Results from a random household survey of the Boston Standard Metropolitan Statistical Area show a consistent and relatively strong association of adults' use of coffee, tobacco, alcohol, tranquilizers, and marijuana with their perceptions of present friends' use. Associations with parents' and past adolescent friends' use are much weaker. The results support efforts to explain illicit drug use with general theories of behavior acquisition and cast doubt on the utility of deviance theories.


Testing a causal model of environmental influences on the early drug involvement of inner city junior high school youths. The present study examines a causal model explaining inner city youths' drug involvement using environmental variables which previously have been investigated singly or in various combinations and shown to influence drug use: the availability of drugs in the neighborhood and at school, a view of the neighborhood as tough, the esteem given to drug using, gang-involved persons by peers, friends' substance use, and participation in drug/street culture spare-time activities. The results show friends' use of alcohol and marijuana and participation in drug/street culture out-of-school activities have strong direct effects on personal drug involvement for the Black and Puerto Rican junior high school males and females who were studied; further, friends' use of alcohol and marijuana and the status peers give to drug using, gang-involved persons have respectable indirect effects on drug involvement for the four groups. In addition to these common features, a number of differences in the factors relating to drug involvement are found in the four groups. Implications of the results for alternative methods of drug abuse prevention and treatment are discussed, as is the necessity of utilizing an environmental, sociocultural view of drug use to adequately explain youth drug taking.


Cultural implications in treating the Puerto Rican female. This paper presents an overview of Puerto Rican history, its traditional effect on Puerto Rican women, and its applicability in treating the Puerto Rican female drug user. The paper focuses on items of historical and cultural significance and includes data gathered from selected interviews of Puerto Rican females in treatment. What has been compiled here is a description of characteristics, traits, and attributes that distinguish Puerto Ricans from other ethnic groups and those traits traditionally attributed to their women. It takes into consideration such things as the role of the family, religious implications, "machismo" behavior exhibited by males upon females, attitudinal differences between mainland and island females, and changes undergone during migration. There currently exists a paucity of literature concerning the treatment of Puerto Ricans in general and even less exists with regard to Puerto Rican women. This paper, therefore, purports only to present preliminary findings in this area. Its intent is to serve as an initial research effort, to encourage further areas of study, and to contribute valuable information for those who currently treat ethnic populations.


Mortality rates of persons entering methadone maintenance: a seven-year study. An analysis of all deaths occurring over a 79-month period in patients enrolled in methadone maintenance (MM) revealed an overall mortality rate of 20/1,000. Over a similar period 510 persons were discharged from MM. Follow-up able to be performed in 80% revealed at least 22 deaths to have occurred subsequent to discharge. Survival curves calculated on the basis of these data indicate that even under the best possible assumption, age adjusted mortality rates of heroin addicts are not only above the national mean but are one and a half times that of the population in the community surrounding the clinic. None of the deaths could  be directly attributed to methadone. Alcohol was prominent in 60% of all deaths, being responsible for 89% of medical deaths and present in 35% of violent deaths. These findings emphasize the persistent risk associated with heroin addiction as well as the role of alcoholism in the production of excessive mortality.


Effects of contingent payment on compliance with a naltrexone regimen. The effects of several schedules of payment on duration and patterns of compliance with a naltrexone regimen were examined. Patients were paid under contingencies based on either number of doses ingested or on a fixed time schedule. Reinforcement schedules based on number of doses ingested produced more consistent treatment-oriented behavior than a time-based schedule. Covariation between behavior and alternating contingencies (A-B-A) indicated that the schedules contributed to increased duration of treatment compared to previous noncontingent payment. The issue of using extrinsic reinforcers such as monetary payment to enhance compliance is discussed and additional procedures are suggested.


Alcohol use in methadone maintenance clinics. A study was undertaken to determine the frequency of alcohol use and the amount consumed by methadone maintenance patients. In four clinics of the Beth Israel Medical Center Methadone Maintenance Treatment Program, every fifth patient from an alphabetical clinic list was selected for interview. Among the 101 patients who were interviewed, mean alcohol consumption was 1.2 ounces per day. Among those who drank, there was a continuum in terms of amount consumed. Forty-three percent had totally abstained from alcohol during the prior 3 months, and an additional 30% drank one or less ounces per day. Independently obtained staff rankings generally approximated interview results, and thus supported the reliability of the interview. Since staff rankings for participants and nonparticipants in the interview were similar, it appears that those who participated were typical of the group selected for study.


Use of Michigan Alcoholism Screening Test with hospitalized alcoholics, psychiatric patients, drinking drivers, and social drinkers in New Zealand. The Michigan Alcoholism Screening Test (MAST) has been validated on a wide range of American drinkers. In this study the MAST was administered to four groups of New Zealand males: 100 hospitalized alcoholics, 100 psychiatric inpatients, 70 convicted drinking drivers, and 55 social drinkers. All the diagnosed alcoholics scored in the test's alcoholic range, as did 83% of the drinking drivers. Seventy-six percent of psychiatric patients and 89% of social drinkers scored below 5. The MAST appears to be a valid instrument for use under New Zealand conditions, but the ability to discriminate between alcoholics and problem drinkers would be an added advantage.


Pseudosarcoma of the esophagus. Three new cases and review of the literature. Three newly found patients with an esophageal pseudosarcoma are described. The features of this unusual polypoid tumor are reviewed based on these three patients and 21 additional reported patients. The origin of the sarcomatous element as a metaplastic reaction to the underlying carcinoma is discussed. The exuberant growth may present with obstructive symptoms earlier than the usual carcinoma of the esophagus, permitting curative surgical resection in some patients.


Biliary scintigraphy with a new scanning agent, 99mTc-(SN)-pyridoxylidene-isoleucine. 99mTechnetium-pyridoxylidene-isoleucine (hereinafter referred to as 99mTc-PI) is a new biliary scintiscanning agent. It has been evaluated in both health volunteers and patients with known surgical biliary tract diseases. It results in imaging of the liver in three minutes and the common bile duct and duodenum in 10-20 minutes. Its advantages as a diagnostic tool in disease of the hepatobiliary systems are in reducing the amount of radiotracer required, in shortening examination time and in producing scintigrams of higher resolution.


Jejunal and ileal adenocarcinoma. Epidemiological considerations. Twenty-nine patients with jejunal and ileal adenocarcinoma were characterized by the demographic features of age, sex, ethnic group, residence occupation, religion and associated diseases. Comparison with the over all M. D. Anderson Hospital patient population did not identify any risk factors characteristic of this cancer.


Acetaminophen hepatotoxicity and malnutrition. A patient with severe anorexia nervosa, who ingested 15 gm. of acetaminophen, was treated with oral N-acetylcysteine. Contrary to suggestions in the literature that malnutrition increases the susceptibility of patients to the hepatotoxic effects of acetaminophen this patient survived without evidence of liver damage. Changes in the metabolism of acetaminophen secondary to poor nutrition may explain the benign course in this and similar patients.


Development of diverticular disease in the transplanted colon. A patient who had undergone an esophagogastrectomy and colon interposition for carcinoma subsequently developed diverticulosis in the graft years after. The pathogenesis is discussed.


Enterolithiasis associated with ileal perforation in Crohn's disease. Calcified enteroliths are an uncommon sign of stasis of intestinal contents in the distal small intestine, usually caused by Meckel's diverticulum, Crohn's disease or other stenosing lesion. Although enteroliths are occasionally associated with intestinal obstruction the clinical picture in this case was dominated by perforation of the ileum by a small enterolith. The relevant literature is discussed.


Spontaneous tuberculous enteroumbilical fistulas. Gastrointestinal tuberculosis in children is an uncommon condition. Obstruction and hemorrhage are the known common complications of tuberculous enteritis. Perforation is an uncommon complication whereas tubercular enterocutaneous fistula is a still rarer complication. Five children with spontaneous tubercular enteroumbilical fistulas are being reported. All were below the age of 10 years, the youngest being 15 months old. Four children had conservative treatment with antitubercular drugs and one had exploration, resection of gut and excision of fistula. All the children who had conservative treatment survived whereas the child who underwent surgery died in the postoperative period. We feel that the conservative management is the treatment of choice in cases of established tubercular enterocutaneous fistulas.


Bleeding time in uremia: a useful test to assess clinical bleeding. Modified Ivy bleeding time (template) and platelet aggregation to ADP, epinephrine, and collagen were studied in 26 uremic patients who had not recently ingested anti-platelet drugs. Regardless of the aggregating agent used, the abnormalities in platelet aggregation were often mild, even with advanced uremia, and frequently less severe than the effects of common anti-platelet drugs. The inhibition of collagen-induced aggregation was significantly correlated with both increased bleeding time and blood urea nitrogen. Platelet aggregation was not discriminative between clinically bleeding and non-bleeding groups of patients, but the bleeding time was helpful in this regard. In certain cases, the aggregometric patterns differed between drug-induced and uremic thrombocytopathies. Platelet aggregometry appears to be of little help clinically in assessing the severity of the uremic bleeding diathesis.


A new treatment strategy for hemophilia B: incorporation of factor IX into red cell ghosts. Although patients with severe hemophilia B have lifelong spontaneous hemorrhage and crippling hemarthroses, patients with 0.01--0.03 U/ml Factor IX activity have a milder disease state. The clinical condition of severely affected individuals could potentially be improved by prolonging the half-life of transfused Factor IX. The feasibility of incorporating Factor IX into red cell ghosts was suggested by resealing experiments with similar sized molecules such as albumin. We have prepared resealed red cell ghosts containing human Factor IX and X. Human red cells were subjected to hypotonic lysis at 0 degrees C, pH 6.0. Commercial prothrombin complex concentrate was dissolved in the lysing medium immediately prior to the addition of the red cells. After being returned to isotonicity, the red cell ghosts were annealed at 37 degrees C for 30 minutes and then washed extensively. When intact red cell ghosts were tested, no Factor IX or X activity could be demonstrated. After disruption of the red cell ghost membranes with 3M urea or 2% Triton X-100, the procoagulants could be quantitatively recovered. Similar recovery of the clotting factors could be demonstrated from the lysate and the early wash samples. Red cells from Factor IX and X deficient patients served equally well as those from normal subjects. Red cell ghosts prepared in similar fashion but not exposed to the procoagulants had negligible clotting activity. We have demonstrated that human clotting factors can be incorporated into red cell ghosts. The ability of this system to prolong the biological half-life of Factor IX is under investigation.


Host-tumor interactions: basis for the anemia in rats bearing the hepatoma 7777. A significant anemia develops in Buffalo rats bearing the Morris hepatoma 7777. By indiceal measurements the red blood cells (RBCs) appear to be microcytic and hypochromic. Ferrokinetic studies demonstrate a decreased uptake of iron in the bone marrow and an increased incorporation of iron in the spleens of the tumor-bearing animals. RBC survival studies indicate the presence of a hemolytic component which appears to contribute to the anemia. The RBCs from tumor-bearing animals (T-RBC) have a greatly increased fragility in sodium chloride solutions. Inspection of these T-RBCs by electron microscopy demonstrates significant echinocytosis when they are compared to normal cells. Electrophoretic separation of the hemoglobin from T-RBCs shows a pattern different from normal cells and consistent with the pattern described for hemoglobin from spleen and bone marrow. The findings are consistent with bone marrow inadequacy and an increased splenic erythropoiesis which is insufficient to maintain normal hematological values. The hypothesis is presented that the RBCs synthesized under these circumstances appear in the circulation with an "immature" hemoglobin pattern and are hemolyzed more readily. This process then contributes to the hemolytic component and development of the anemia.


Characterization of platelets from normal mink and mink with the Chediak-Higashi syndrome. Bleeding times of mink with the Chediak-Higashi (CH) syndrome was markedly prolonged. Platelet counts were normal but there was an impaired platelet aggregation response to collagen. The metabolic adenine nucleotide pool of platelets from normal and CH mink was labeled with 14C-adenine and the platelets were gel-filtered. Gel-filtered platelets (GFP) from CH mink contained only 37.9% of the adenosine triphosphate (ATP) and 9.6% of the adenosine diphosphate (ADP) found in normal platelets and the ATP/ADP ratio was similar to the 14C-ATP/14C-ADP ratio. Platelet content of Ca2+, Mg2+, and in particular 5-hydroxytryptamine was decreased. When GFP were incubated with thrombin to induce maximal secretion, only negligible amounts of ATP and ADP were released. The specific activity of the extracellular nucleotides approximated that within the platelet. These findings suggest that the stored nucleotide pool in CH platelets is virtually absent and that the abnormalities in platelet function may be due, in part, to the essential absence of secretable ADP and serotonin. The release of Ca2+ and Mg2+ by CH platelets was 56% and 27.8% of normal, respectively.


Autoimmune hemolytic anemia and the Kell blood groups. Approximately one in 250 people with autoimmunity involving their red cells have IgG autoantibodies with specificity in the Kell blood groups. Red cells of these individuals have an acquired temporary weakening of their Kell antigens. Some of the patients also have allo-anti-K in their serum. This report presents a case in which an IgG autoantibody may define a new high-incidence red cell antigen related to the Kell blood groups. The patient's Kell blood group antigens are depressed, and his serum contains allo-anti-K. It is postulated that reduced red cell Kell antigenicity is caused by enzymatic degradation, possibly of bacterial origin, and that the acquired loss of Kell antigens, the Kell-specific autoimmune state, and the serum all0-anti-K, are all related aspects of one phenomenon.


A factor V inhibitor: in vitro interference by calcium. A patient with a factor V inhibitor resistant to all standard methods of therapy was recently reported. Because of this resistance, further investigation of the inhibitor was carried out employing the inhibitory plasma, serum, and isofocused fraction. It has subsequently been shown in vitro by use of the prothrombin time, partial thromboplastin time, and Russell's viper venom time that the activity of the inhibitor is diminished by the addition of calcium chloride or calcium gluconate to the inhibitory plasma, serum, or isofocused fraction before the addition of normal pooled plasma. This inhibitor, an IgG4 (lambda) immunoglobulin appears to have a high calcium binding affinity and is markedly potentiated in acid pH. These findings suggest that there may be a role in vivo for calcium infusion as part of the clinical management of such an inhibitor and that the metabolic acidosis associated with hemorrhagic shock may potentiate this type of inhibitor.


Bone marrow necrosis.

Bone marrow necrosis. Bone marrow necrosis has been regarded as a rare entity in specimens obtained from living patients and has been associated with poor prognosis. In contrast, we believe that it is a commonplace finding in bone marrow specimens which is frequently overlooked and which occurs in patients with multiple acute and chronic disorders. It is postulated that bone marrow necrosis eventuates from vascular occlusion of small blood vessels as a result of a number of causes. When bone marrow necrosis is prolonged, it may be associated with the development of bone marrow fibrosis and serve as a predisposing lesion for idiopathic myelofibrosis. Additional investigation of this phenomenon is required to determine its usefulness in the diagnosis of disease states and its role in the pathophysiology of a number of disorders.


The effect of BCNU and adriamycin on normal and G6PD deficient erythrocytes. In cell free systems Adriamycin induces oxygen radicals. We have shown previously that Adriamycin generates peroxide in human erythrocytes. BCNU, by inhibiting glutathione reductase, interferes with the major erythrocyte pathway to degrade peroxide. In this investigation we looked at interactions of these drugs with normal and abnormal erythrocytes. In G6PD-deficient erythrocytes Adriamycin posed a significant oxidant stress as demonstrated by hexose monophosphate shunt (HMPS) activity, hydrogen peroxide (H2O2) production, and glutathione depletion. At similar molar concentrations Adriamycin was a stronger oxidant than acetylphenylhydrazine. BCNU=treated normal erythrocytes showed an enhanced susceptibility to oxidant stress as demonstrated by a lack of HMPS response to H2O2 and glutathione depletion during incubations with Adriamycin. The HMPS shunt of BCNU treated RBC was intact as shown by their nearly normal response to methylene blue stimulation. These BCNU studies also demonstrated the inability of H2O2 to react directly with NADPH. In conclusion Adriamycin poses a potent oxident stress to G6PD-deficient erythrocytes. BCNU promotes enhanced susceptibility of normal RBC to oxidant stress and BCNU can act as a probe to define drug interactions with the HMPS. These studies add to a growing body of evidence postulating the importance of oxygen radicals in the therapeutic and/or effects of Adriamycin.


Community participation in the certificate-of-need process: a look at ten-taxpayer groups in Massachusetts. Certificate-of-need statutes give designated state agencies veto power over investment in health care facilities. Some states have sought to temper the arbitrary character of this power by expanding the opportunities for community input into the certificate-of-need process. Massachusetts, for example, has enacted a statute that allows groups of ten taxpayers to petition for a public hearing on any certificate-of-need application. Some observers question whether the benefits of taxpayer-group participation are substantial enough to compensate for the delays and abuses that the statute allegedly invites. To help resolve this question, this Comment examines historical data on Massachusetts taxpayer groups and on their activities and assesses the significance of their composition and tactics to the certificate-of-need process. Although flaws exist in the Massachusetts ten-taxpayer mechanism, in this writer's view it has succeeded partially in making the certificate-of-need process responsive to community opinion. Many groups lack the skills and qualities needed to make constructive use of the ten-taxpayer mechanism. Nevertheless, it serves a valuable purpose by creating a public forum for and by encouraging public participation in the certificate-of-need process, especially by those who might otherwise try to circumvent that process through use of special legislation, of private pressure, or of other similar means.


Pentasomy X with multiple dislocations.

Pentasomy X with multiple dislocations. We describe a pentasomy X (49,XXXXX) patient whose multiple dislocations led to a consideration of the Larsen syndrome. Review of the 11 reported cases of pentasomy X showed that elbow dislocations are known to occur in this syndrome. Our patient is the first to present hypoplasia of the glenoid process with consequent should dislocation. Clinical and radiologic findings of previously reported cases of pentasomy X are reviewed.


Additive inhibition of in vitro rabbit reticulocyte heme and protein synthesis with combinations of isoniazid, chloramphenicol and ethanol. Isoniazid, chloramphenicol and ethanol are well known hematopoietic toxins. These agents inhibit in vitro rabbit reticulocyte heme synthesis and, as a result, inhibit protein synthesis. When combinations of isoniazid (2 x 10(-3)M) and ethanol (0.1M), isoniazid and chloramphenicol (10(-3)M) or ethanol and chloramphenicol were present in the same incubation, their inhibitory effects on heme and protein synthesis were additive. These results suggest that the development of clinical hematological toxicity in man may result from additive interaction of chemically unrelated compounds which inhibit the heme synthetic pathway.


Familial, balanced insertional translocation of chromosome 7 leading to offspring with deletion and duplication of the inserted segment, 7p15 leads to 7p21. We report an uncle and niece with duplication and deletion, respectively, of segment 7p15 leads to 7p21 originating from a balanced, intrachromosomal insertion in their mothers. The proposita had prenatal and postnatal growth deficiency, retarded psychomotor development, microcephaly, wide cranial sutures, ocular hypertelorism, small palpebral fissures, apparently low-set and malformed ears, cleft palate, congenital heart defect, hypoplasia of the distal phalanx of first fingers, rocker-bottom feet, persistent cloaca, and imperforate anus. She died at three months. Her maternal uncle has duplication of this segment and is alive at 32 years. He has severe mental deficiency, but normal growth; communicating hydrocephalus was diagnosed at three months.


In vitro sulfate turnover in osteogenesis imperfecta congenita and tarda. Sulfate (35SO4(-2)) uptake was studied in confluent skin fibroblasts from three patients with osteogenesis imperfecta "congenita," six patients with osteogenesis imperfecta "tarda," three clinically unaffected relatives of an osteogenesis imperfecta tarda patient, and four controls. Only two of the osteogenesis imperfecta congenita cell strains showed an increased uptake of sulfate, all other cell strains being comparable to the control group. The degradation rate of glycosaminolgycans in mutants as seen by the chase experimentas was comparable to that found in the normal control cell strains. Glucose oxidation was normal in the osteogenesis imperfecta cell strains having an abnormal sulfate uptake. This rules out the possibility of an hypermetabolic state of these cells. These findings do not warrant the use of 35SO4(-2) incorporation in cultured cells as a tool for prenatal diagnosis of osteogenesis imperfecta.


Combined effects of ticarcillin and cefazolin on blood coagulation and platelet function. Combined intravenous infusions of ticarcillin and cefazolin given to normal volunteers resulted in a functional platelet defect which appeared to be determined primarily by the dose and duration of treatment with the penicillin component. No effect on soluble blood coagulation factors was evident. Acute administration of corticosteroids did not influence the prolonged bleeding times induced by extended ticarcillin infusions.


Anatomical studies of a boy trisomic for the distal portion of 13q. A boy trisomic for the distal portion of 13q was dissected in detail and compared to 8 cases of complete trisomy 13 previously studied in our laboratory. The comparison shows that the partial trisomy 13q case did not correspond well to a muscle phenotype based on 6 variations common trisomy 13, but rather to a larger muscle phenotype that included variations less frequently observed in complete trisomy 13. Additional cases of partial trisomy 13 must be studied before these findings can be related to specific portions of chromosome 13.


Hyperparathyroidism after radiation of the head and neck: a case report and review of the literature. A 66-year-old woman presented with hypercalcemia and a past history of external radiation to the neck. Hyperparathyroidism in this patient was caused by a parathyroid adenoma. The literature associating hyerparathyroidism with prior radiation of the head and neck was reviewed and analyzed. Current evidence supports a relationship between external radiation of the head or neck and the development of hyperparathyroidism as a late complication. Analysis of data available suggests that radiation-association hyperparathyroidsim develops after an average latent period of 38 years. Parathyroid adenoma occurred more often than did hyperplasia. Parathyroid carcinoma has not been reported in irradiated patients with hyperparathyroidsim. Neither age at radiation exposure, age at diagnosis of hyperparathyroidsim, nor interval between exposure and diagnosis was associated with a specific histologic diagnosis (adenoma or hyperplasis).


Neurotropic melanoma. A variant of desmoplastic melanoma. We report a group of neuroid, cutaneous tumors that are usually associated with, or preceded by a melanocytic dysplasia. For this clinicopathologic entity we have chosen the term neurotropic melanoma. The neurotropic melanoma is a cutaneous fibrous tumor whose clinical course is characterized by local infiltration, multiple recurrences, and commonly by metastases. Its microscopic picture is characterized by atypical "neuroma-like" patterns, by poorly defined margins, and by neurotropism. Its early or precursory melanocytic dysplasias include lentigo maligna (actinic or lentigo maligna variant), and a melanoma with borderline cytologic characteristics (minimal deviation variant). A third type is not preceded by a recognizable melanocytic dysplasia: it has "neuroma-like" qualities at its inception (de novo variant). In our 22 cases, the preponderant sites were the head, neck, and lip. The patients were fair-faced, and 18 of the patients were over 40 years old. Seventeen patients had one or more recurrences. Of 16 patients with follow-up, nine died with evidence of disease, five are alive with active disease, and seven are apparently free of disease.


Glycogen in neuroblastomas. A light- and electron-microscopic study of 40 cases. A light- and electron-microscopic review of 40 cases diagnosed at Children's Hospital of Pittsburgh as ganglioneuroblastoma, neuroblastoma, or small round cell tumor-probably neuroblastoma disclosed four cases that contained abundant glycogen. Two were unquestionable neuroblastomas by electron microscopy; one was primary in the adrenal gland, the other in the mediastinum. In the third case, a paraspinal tumor, the light-microscopic appearance was suggestive or neuroblastoma, but no catecholamine granules or neural processes were demonstrated in the material available for electron microscopy. The fourth case was an undifferentiated malignant tumor in the pectoralis muscle of a 12-year-old girl. By electron microscopy, neural processes were demonstrated and the tumor was classified as peripheral neuroblastoma. Of the remaining 36 cases, electron microscopy readily indicated a diagnosis of neuroblastoma or glangioneuroblastoma in 35 of them. In the other case, the tissue had been fixed in formalin and only a few catecholamine granules were found after an extensive search.


Cavernous hemangioma of the superior mediastinum. Report of a case with electron microscopy and computerized tomography. An unusual case of cavernous hemangioma of the superior mediastinum in a 38-year-old male is presented. Mediastinal hemangiomas occur more often in children and are usually localized in the anterior-superior compartment in all age groups. Slow expansile growth, lack of infiltration of adjacent structures and microscopically mature cellular elements clearly marked the benign nature of the lesion. Vascular mesenchymal tumors in this location must be approached with caution because of the risks of hemorrhage or local infiltration of vital structures. Electron microscopy revealed active endothelial cells, smooth muscle cells, and intercellular matrix components suggestive of smooth muscle cell origin. Computerized tomography delineated the lesion clearly and demonstrated identical densities for the mass and adjacent blood vessels.


Soft tissue implantation of chondromyxoid fibroma. While chondroblastoma, a usually benign cartilaginous bone tumor that has histologic features in common with chondromyxoid fibroma, can invade or be accidentally implanted in the soft tissues, it is less well known that this may also occur with chondromyxoid fibroma. A patient is described in whom a chondromyxoid fibroma recurred in the superficial soft tissues following prosthetic replacement of the upper femur. This is only the second such case reported without a simultaneous recurrence within the adjacent bone. The close association of the soft tissue tumor with suture fragments is taken as evidence for implantation at the time of operation. A unique histologic feature was the presence of vascular invasion within the implant. The literature on soft tissue involvement by chondromyxoid fibroma is reviewed and the meaning of this in terms of malignancy is discussed.


Multiple choice questions for assessment of primary FFARCS course students. Multiple choice questions have been used to assess the progress of 105 postgraduate anaesthetic students over three successive academic years, at the University of Liverpool. Analysis of the results of these tests had revealed a good correlation existing between the MCQ scores obtained and success or failure in the Colleges' Primary FFARCS examinations. Both retrospective and prospective analyses are presented. The value of serial MCQ tests is discussed in relation to encouraging and discouraging students in sitting postgraduate examinations. Analyses of these tests are also of value in planning teaching programmes, assessment of teaching and predicting overall successes and failure of students.


Acute amphetamine abuse. Problems during general anaesthesia for neurosurgery. A case of unsuspected acute amphetamine abuse by a 22-year-old girl which led to serious intracranial hypertension during anaesthesia for a neurosurgical procedure is described. It was difficult to maintained anaesthesia with an intermittent positive-pressure ventilation technique using muscle relaxants, N2O and O2 and supplements of fentanyl despite large doses of pancuronium and fentanyl. The differing effects of chronic and acute amphetamine dosage on anaesthetic requirements are reviewed.


Bilateral vocal cord paralysis. Bilateral vocal cord paralysis following anterior cervical fusion. A case of bilateral vocal cord paralysis following anterior cervical fusion is described. Although previously documented, this complication does not appear to be widely recognised. An outline for the pathogenesis is suggested. Immediate postoperative vocal cord inspection by the anaesthetist is advocated.


Ablation of the brachial plexus. Control of intractable pain, due to a pathological fracture of the humerus. A case report is presented which illustrates the difficulties in providing control of intractable pain from pathological fractures of the humerus. Relief from large and frequent doses of systemic analgesics was found to be inadequate. Control was achieved using brachial plexus block with bupivacaine combined with absolute alcohol. The decision to partially ablate the plexus is considered to be justified by the improved quality of life which the patient enjoyed.


Cardiac arrest following a complication of internal jugular vein cannulation. Manula compression of the common carotid artery after a complication of the posterior approach to the internal jugular vein resulted in progressive AV block and cardiac arrest. Electrocardiographic monitoring is advocated as a routine.


Phenylbutazone self-poisoning treated by charcoal haemoperfusion. A case is presented of a patient who ingested a potentially fatal dose of phenylbutazone. Her clinical condition deteriorated despite adequate supportive therapy and the use of charcoal haemoperfusion proved life-saving.


The Hygroscopic Condenser Humidifier. A new device for general use in anaesthesia and intensive care. The design and performance of the Hygroscopic Condenser Humidifier (HCH) are described. In principle the HCH consists of two parts, a conventional Heat-Moisture-Exchanger (HME) and a hygroscopic unit. The hygroscopic action is shown to improve the water retention efficiency of the device by about a factor of two as compared with optimal HME designs. As a result, humidification levels corresponding to around 80% relative humidity at 37 degrees C are obtained in the trachea and this is also achieved when completely dry gases are delivered to the patient. The unit can therefore be used for all procedures in anaesthesia and in intensive care.


Coarctation in children. Controlled hypotension using labetalol and halothane. Hypotension was induced with halothane and labetalol, an alpha and beta adrenergic blocking agent, in nine children undergoing operation for postductal coarctation of the aorta. The mean arterial pressure decreased by an average of 30% following labetalol, and in six patients the initial halothane concentration (1%) had to be reduced during this period. The heart rate decreased by an average of 8% after labetalol. Profound beta-blockade did not occur, and operating conditions were considered satisfactory. The usefulness of labetalol in the postoperative period is suggested.


[The effect of hypothermia and methoxyflurane-anaesthesia on sympatho-neuronal and sympatho-adrenal activity in the course of cardiac surgery (author's transl)]. The concentrations of adrenaline and noradrenaline, and dopamine-beta-hydroxylase in the plasma, and certain haemodynamic parameters, were determined in 14 children undergoing surgical correction of congenital cardiac defects under hypothermia at 30 degrees C and methoxyflurane anaesthesia. During the pre-operative phase of hypothermia at 30 degrees C, the adrenaline levels rose to about 300% of the inital levels, and the noradrenaline levels to about 200%. During the postoperative phase of re-warming at 34 degrees C, a further dysregulative release of catecholamines led to an increase in adrenaline levels to a critical concentration of about 800% of the norm, and in noradrenaline levels of about 400% of the norm. No change was seen in dopamine-beta-hydroxylase activity. Hypothermia thus results in a massive activation of the sympatho-neuronal and sympatho-adrenal systems, which is not prevented by methoxyflurane anaesthesia, and which may endanger the recently operated heart, particularly during the early post-operative period, because of the increased oxygen requirements imposed on the myocardium. In normothermia, on the other hand, methoxyflurane anaesthesia results in only a slight degree of activation of the sympathetic nervous system, which increased only slightly during the post-operative period. Under these conditions, the plasma dopamine-beta-hydroxylase activity remains unchanged. Unlike the changes in plasma catecholamine levels, dopamine-beta-hydroxylase activity cannot be regarded as an index of changes in sympatho-neuronal activity.


[Circulatory changes in the sitting position during neurosurgical anaesthesia (NLA) (author's transl)]. In 23 neurosurgical patients with haemodynamic effects of neuroleptanaesthesia in the supine (13 patients) and upright position (10 patients) were studied. The patients in the upright position demonstrated an increase of the mean arterial pressure of 19% and the total peripheral resistance of 45%, and simultaneously a decreased stroke index of 20% and the cardiac index of 16%. The stability of the circulation was preserved due to the increase of heart rate (to 90 +/- 17 beats/min) and total peripheral resistance. In spite of the almost identical average total dose of fentanyl in both groups (4.72 +/- 2.2 mcg/kg/h), supine position) and 4.97 +/- 2.23 mcg/kg/h, (sitting position), only the patient group in the supine position demonstrated a decrease of pulse rate of 36% to 65 +/- 20 beats/min with a decline of the cardiac index of 33% and unchanged stroke index. Our clinical observations and the animal studies of other authors allow the conclusion that during neuroleptanaesthesia in the upright position the baroreceptor-activity and the catecholamine secretion is not markedly reduced and consequently circulatory stability obtained. We regard neuroleptanaesthesia as the method of choice for neurosurgical operations in the upright position.


[A comparison of two preoperative medications: responses in sedative, psychic and somatic effects (author's transl)]. The influence of two different premedication methods on the psychic reaction of the patient and their somatic-vegetative effect was tested in a controlled double-blind study. 96 patients between the ages of 20 and 40 took part in the study and were divided into two groups. Group 1 (n = 47) received meperidine (Alodan) and promethazine (Phenergan). Group 2 (n = 49) were given thalamonal. All patients underwent a personality test (Cattell 16 PF) a day prior to scheduled surgery. After administration of the respective pre-anaesthetic drugs, three different test methods were applied to determine their subjective state. Simultaneously, independent from the patients, their psychic reactions were determined by the anaesthetist. Premedication 2 effected less calm, i.e. decrease of fear, exhaustion and depression, than premedication 1. The somatic-vegetative region exhibited no significant difference except for increased cardiocirculatory symptoms in group 1. Based on the less favourable psychodynamics in patients who received thalamonal, it is not advised as pre-anaesthetic medication.


[Local myocardial necrosis and cardiac tamponade due to a central venous catheter (author's transl)]. A case of a paraventricular brain abscess, which favourably responded to conservative intensive therapy, is reported. A central venous catheter was the cause of myocardial necrosis leading to cardiac tamponade. In an attempt to tap the effusion, the partly necrotic cardiac wall was perforated. Only by recognition of the danger, by intensive clinical observation of a patient and by regular checkup of the catheter tip were the fatal complications following central venous catheterization avoided.


Quinine poisoning. An unusual indication for stellate ganglion blockade. The treatment of a case of quinine amblyopia by stellate ganglion blockade is described. The degree of restoration of vision confirms the experience of other workers and is attributable to relief of retinal vasoconstriction. The possibility is discussed that earlier and more prolonged use of the technique might improve results.


Medical aspects of fitness to drive.

Medical aspects of fitness to drive. The paper considers the question of fitness to drive after the use of anaesthetics and other drugs and makes suggestions concerning the advice which anaesthetists should give to patients beofre an anaesthetic is administered.


The extension of labour epidural analgesia for Caesarean section. Seven hundred and twenty-two patients who received epidural analgesia during labour were delivered by Caesarean section. The block was extended in 554 patients to provide analgesia for surgery. In twenty-one cases incomplete analgesia necessitated general anaesthesia. The main complications were maternal hypotension (15.9%) and vomiting (17.1%). Almost all patients expressed enthusiasm for the technique.


[Non-Hodgkin malignant lymphomas of the digestive tract]. Study of the histology, epidemiology and course of 106 non-Hodgkins malignant lymphomas of the digestive tract seen in Tunisia revealed the high incidence of these ML in comparison with other malignant tumours of the same site and their predominance above all in young male subjects. The classification of these lymphomas has shown that forms with a high degree of malignancy are seen much more often than forms with a low degree of malignancy: Centroblastic ML accounted for more than 50 p. 100 of the histological forms seen in the intestine. Intermediate centroblastic and immunoblastic ML predominated in the stomach. Nodular ML is very rare. Finally, an important feature in the course of these tumours is worthy of note, i.e. the prolonged survival of 9 of our patients. This survival would however appear to be related more to the stage of the disease than to the histological type and the nature of the treatment used.


[Liposarcoma of the pancreas. Study of a case including ultrastructure]. The authors report a case of polymorphous liposarcoma situated in the pancreas. Ultrastructural study of proliferation demonstrated two cell contingents which appeared to represent stages of varied differentiation in the elaboration of adipose cells. The marked preponderance in the case studied of clear and little organised cells would appear to justify the histological classification of the polymorphous liposarcoma as a relatively undifferentiated tumour. Furthermore, this study emphasised the value of electron microscopy in the diagnosis of neoplasms which are complex from a morphological standpoint.


[Mucinous adenocarcinomas of the scalp. Anatomo-clinical, histochemical and ultrastructural study of a case and a review of the literature]. The third recurrence of a primary mucinous adenocarcinoma of the right parietal scalp was studied by histochemistry and electron microscopy. Histochemically the mucin produced by this neoplasm was of the sialomucine type. Electron microscopy revealed a high differentiated tumour whose cells looked like eccrine mucinous ones. The natural history of this carcinoma is similar to that of 33 ones already published. The tumours, round and elevated, grow in 75 p. 100 of the cases in patients over 50 years of age. They are located on the face or the scalp and more rarely on the trunk. Such tumours are frequently misdiagnosed as carcinomas. But the knowledge of thier morphological and histochemical features should lead to the right diagnosis all the more since the various biological and radiological investigations do not discover other primary neoplasm. Besides if these neoplasms are not metastases they are quite different from the other sweat gland carcinomas. They have a better prognosis than these tumours. However they give local recurrences, lymph node or subcutaneous metastases and a fatal issue in 6 p. 100 of the cases.


[Kaposi's sarcoma simulating a splenolymphatic lymphoma, toxoplasmosis, and terminal cryptococcus infection (author's transl)]. The authors report a case of Kaposi's sarcome (K.S.) characterized by the small degree of cutaneous involvement as opposed to splenic and lymphatic invasion, lymphoplasmocytic infiltration of the bone marrow, and opportunistic infections (toxoplasmosis, and cryptococcosis). The rapid mortal outcome and the anatomoclinical characteristics of the K.S. enable this case to be classified as one of the rare types of malignant K.S. with pseudo-cryptoccosis features.


[Partial congenital deficiency in factor V associated with an intestinal malabsorption syndrome due to lambliasis. A familial survey (author's transl)]. Owren's disease is a rare hemorrhagic diathesis which can occur in infancy as a severe hemorrhagic disorder. It also appears in adult life when clinical manifestations are those of acquired deficiencies of other coagulation factors. A familial survey enables a definite diagnosis to be made as it demonstrates the presence of deficiency in factor V in one or several members of the family. Such a case is reported in a young adult with an associated intestinal malabsorption syndrome due to lambliasis. After administration of vitamin K the deficiency in factor V remained an isolated disorder, and the hemostatic anomaly was found in three other members of the family. The deficiency was a partial one, which explains why the Owren's disease only became evident during the course of the malabsorption syndrome due to lambliasis which caused a reduction in the level of vitamin K dependent factors II, VII, and X.


[Regressive dysautonomia associating orthostatic hypotension with an invariable pulse and choleriform diarrhea (author's transl)]. The authors describe a case of very severe orthostatic hypotension with an invariable pulse arising during the course of considerable motor diarrhea. The diagnosis of primary dysautonomia was made only after eliminating the many organic causes of diarrhea: microbial, toxic, tumoral endocrine including diabetes. Shy and Drager's syndrome was rejected because of the spontaneously regressive course after a period of 4 years, the patient having had no further signs of orthostatic hypotension.


[Growth hormone deficiency during the course of histiocytoses. A report on a case of Hand-Schuller-Christian disease (author's transl)]. Hand-Schuller-Christian disease frequently products histiocytic localization in the part of the posterior hypothalamus which is responsible for diabetes insipidus. Retarded growth is also relatively frequent and has multiple etiologies. An isolated deficiency in growth hormone (GH) which may be due to localization of the disease in the anterior hypothalamus is much rarer. In the case reported the possibility of this localization was only suspected because of the presence of a hyperprolactinemia. Retarded growth was obviously present but it was difficult to relate this to a GH defian 7 ng/ml. Follow-up examinations did however provide definite proof of a hormonal deficiency. This confirms the notion of partial growth hormone deficiency and the difficulty of providing proof during the usual stimulation tests in some cases.


[A case of mediastinal parathyroid adenoma visible on standard pulmonary radiography (author's transl)]. Mediastinal adenomas form about 10 % of all parathyroid adenomas, and are only very rarely visualized in standard pulmonary radiograms. This was the case however in a 54-year-old woman with hyperparathyroidism, chronic renal insufficiency, and an anterosuperior mediastinal tumor. After surgical excision by sternotomy the mass was found to be a large parathyroid adenoma weighing 105 g and measuring 8 cm in diameter. The authors discuss the problems raised by mediastinal adenomas and review the cases reported in the published literature.


[Diagnosis of interstitial pneumopathies in infants (author's transl)]. The authors discuss the etiological features of interstitial pneumopathies, with particular emphasis on their characteristics in the newborn and in immunodeficient children, and review the diagnostic findings : clinical and radiological signs, functional disturbances, and results of pulmonary biopsy. The results of 154 needle biopsies in 124 children aged 1 month to 16 years are described. In 103 cases a diffuse pneumopathy was present and 80 % of the biopsies were successful. Precise diagnosis could be made from the histology specimen in 22 cases out of the 82 examined, while in 60 of these cases the specimen could be identified.


[Total atrophy of the villi during primary agammaglobulinemia in adults. Therapeutic problems (author's transl)]. A 21-year-old man presented with a 10-year history of a malabsorption syndrome of moderate severity, splenomegaly, and recurrent respiratory infections. Investigations revealed total atrophy of the villi and primary agammaglobulinemia. A gluten-free diet was ineffective. In spite of the absence of lambliasis, treatment with metronidazole produced objective clinical improvement and biological signs of healing of the malabsorption syndrome, but no alteration in the agammaglobulinemia. The authors discuss the relationship between total villous atrophy and primary agammaglobulinemias and the mode of action of metronidazole.


[Papillary thyroid cancer lying within a toxic adenoma (author's transl)]. The association of hyperthyroidism and thyroid cancer is rare. The commonest finding is multilobular goitres. When a toxic adenoma is associated with a thyroid cancer they are usually clearly separate lesions. A thyroid cancer lying within a toxic adenoma, as in this case, is a much rarer occurrence, and a review of the published literature suggests that the relatively frequent association of the two lesions is fortuitous. The possibility of a cancer occurring near, or within a toxic adenoma, is an argument in of surgical treatment of these formations.


[Hemochromatosis and puryvate kinase deficiency (author's transl)]. A 25-year-old man with familial pyruvate kinase (PK) deficiency who have been given only 6 transfusions during his lifetime died of cardiac failure from hemochromatosis (HC). This previously unreported association of PK and HC deficiency does not appear to be fortuitous but to be related to possible early hemolysis and intramedullary destruction, features of ineffective erythropoiesis. The role of splenectomy in the progression of the HC could, as in some thalassemias, be an unfavourable factor. Serum iron levels should therefore be measured during the course of AHPK.


[Screening for diabetes during pregnancy (author's transl)]. Screening for diabetes, or more commonly the study of maternal glucose tolerance, a routine procedure during pregnancy. The first step consists of assessing the diabetic risk for the patient. Screening tests should be applied early if risk factors for diabetes are present, and/or at a later stage in all pregnant women. The initial test should always be provoked hyperglycemia by the intravenous route. According to the value of the glucose assimilation coefficient K, the test will be repeated using the oral route. Screening can only be effective if applied to all pregnant women.


[Ventilation mechanics as an aid to diagnosis of early emphysematous disease (author's transl)]. Respiratory function in 27 subjects with at least one anomaly in ventilation mechanics suggestive of emphysema was compared with that of a control population by means of plethysmographic indices. Results showed that static compliance to CRF and compliance for a volume nil for the elastic properties of the lung on the one hand and alveolar compression for dynamic properties on the other hand, appear to be valid criteria for early diagnosis of emphysema.


[Myocardiopathy from a new anthracyclic derivative (author's transl)]. A 58-year-old man with subcutaneous metastases from a naevocarcinoma was prescribed 1 138 mg/m2 of a new anthracylic derivative, dietoxy-acetoxy-daunorubicine, at doses of 180 mg every three weeks. Irreversible cardiac failure occurred nine months after starting treatment, and was considered to be due to the toxic effects of the compound. He improved for a short period after very high doses of vasodilatators but death occured very shortly afterwards. Histological examination revealed severe subendocardial fibrosis, disseminated interstitial fibrosis, and degenerative and necrotic lesions of the myocytes. The authors discuss the factors involved in the cardiotoxicity of the anthracyclines: total dose, intervals between doses, associated risk, factors (age, radiotherapy). Even at usual doses signs of myocardial dysfunction are found in one third of patients treated, with the presence of histological lesions in all these cases, but clinical cardiac failure is rarely observed.


Comparative studies of the strains PA and PN of Mycobacterium phlei leading to their reclassification: examination of lipids and DNA, biochemical tests and phage typing. Study of lipid and DNA, biochemical tests and phage typing performed on the strain PA previously labelled Mycobacterium phlei, lead to the conclusion that this strain belongs to the species M. smegmatis. Parallel studies performed on strain PN, isolated from a culture of strain PA, as well as DNA homology percentage of the two strains, do not support the assumption that strain PN could have resulted from a mutation of strain PA Strain PN produces mycolic acids similar to those found in Rhodococcus bronchialis; the few biological tests applied quite agree with such a classification.


[Shulman's syndrome: eosinophilic fasciitis (author's transl)]. A detailed report is made of the clinical, histological, biological manifestations of eosinophilic fasciitis, i. e. the Shulman's syndrome, about a 53-year-old man. An extreme induration of sub-cutaneous tissues from arms, legs and trunk, without involvement of the face and extremities, was associated with severe thickening of deep peri-muscular fascias. Raynaud's phenomenon was absent, as were morpheas and visceral involvement. Results of biopsies studied by standard, electron and I. F. microscopy, revealed sclerosis and cellular infiltrates (lymphocytes, plasma cells, histiocytes and eosinophils) in fascia and muscular septa; no changes were seen in epidermis, dermis or sub-cutaneous fat tissue. An elevated ESR, eosinophilia and hyperimmunoglobulinaemia with high levels of circulating immune complexes were the only biological abnormalities. A good response to systemic corticosteroid therapy was observed. These features were similar to those seen in other cases of eosinophilic fasciitis. The etiology and pathogenesis of the Shulman's syndrome remain unclear. A critical review of the literature suggests that eosinophilic fasciitis should be separated from scleroderma and pseudoscleroderma, although this opinion has been discussed.


[Tinea capitis: 73 cases observed in Bordeaux (author's transl)]. 73 cases of tinea capitis were observed in the "Hôpital des Enfants" in Bordeaux during these last five year. 71 children under 14 years of age and only 2 adults have seen. The dermatophytic spectrum transformation noticed in other parts of Western Europe is also encountered in Bordeaux. 83 p. 100 are affected by zoo-antropophilic dermatophytes, M. canis chiefly in town, T. mentagrophytes, T. verrucosum in rural aeras. The cases are often familial, from an infected animal, but without any interhuman transmission. Only 8 out of 73 cases are due to strict antropophilic dermatophytes and are found in newly arrived immigrants from North Africa (T. violaceum, T. schönleini) of from West Africa (M. langeroni, T. ferrugineum, T. soudanense). Not a single case of scholar transmission could be observed. Cure by micronised griseofulvine per os (15 mg/kg/day) associated with local care was effective in all cases.


[Lipids and lipopolysaccharides of "Micrococcus radiodurans" (author's transl)]. Studies were carried out on lipid composition of Micrococcus radiodurans. The polar lipid components were found to be 4 glycolipids, 3 phospholipids and 2 phosphoglycolipids. The major fraction belongs to the last group. Correlation between these components and lipoteichoic acid was not observed. A lipid-polysaccharidic complex was isolated. It was not of this type.


[Study and differentiation of some hydrolases active on triglycerides and esters, in anaerobic bacteria, using gas liquid chromatography (author's transl)]. Anaerobic bacteria are classified using presence or absence of phospholipase and lipase, among other criteria. Techniques are described for the qualitative and quantitative detection of bacterial esterases (carboxylic ester hydrolase) and lipases (triacylglycerol acyl hydrolase) endo- or -exocellular, using gas liquid chromatographic method. Results with representatives anaerobic species are briefly presented.


[On five new cases of association of basal cell carcinoma and multiple Pinkus fibroepithelial tumors on the spine following radiation damage to the skin (author's transl)]. The authors report five new cases associating basal cell epithelioma and multiple Pinkus fibro-epithelial tumors on the spine after radiation damage to the skin. One of them had previously published three similar observations: so his experience refers to eight cases. The authors recall similar cases of the literature, they discuss the relations between basal cell epitheliomas and Pinkus premalignant fibro-epithelial tumors of the skin. Histologically they saw several aspects of transition between the two types of tumors. They study the patterns of cancers found after radiation therapy, influence of type of radiations, dose, age, and intervals since X-rays. As regards such cases, the necessity of systematically searching for previous radiations by X-rays in the affected zone is emphasized.


[Comparative study of two dried intradermal BCG vaccines (author's transl)]. Two BCG vaccines prepared from the same strain were studied clinically in Indonesia and in France. The concentration in culturable particles was comparable. Observed differences in the Mantoux results are discussed. The French results, based on use in a temperate climate by a specialized team, on well nourished children, appear better than the Indonesian findings. Further steps should be undertaken to improve results in Indonesia.


[Lichen striatus with nail involvement. Report of 4 cases and review of the 4 cases in the literature (author's transl)]. Four cases of lichen striatus (L.S.) with nail involvement were studied and the four cases published previously reviewed. There are several types of nail dystrophy: fraying, longitudinal ridging, splitting and shredding, onycholysis, and total nail loss. All of them are transient and can be explained by the pathologic changes observed, particulary the transitory disruption of the basal layer. Lichen striatus must be differentiated from systematized eruptions such as lichen planus (the simultaneous occurrence of L.S. and lichen planus is extremely rare and the resemblance of one dermatosis to the other can be so pronounced that a differential diagnosis is difficult) linear localized neurodermatitis, linear psoriasis (almost always associated with more typical lesions of psoriasis elsewhere on the body), linear keratosis follicularis (histologically typical of Darier's disease) and linear epidermal nevus which occasionaly does not appear at birth but later in life and may present nail involvement. In some cases, however, clinical similarity of the inflammatory linear verrucose epidermal nevus to lichen striatus is striking.


[Kinetics of the reactions to experimental infection in mice after or without vaccination against rabies: study of etio-pathogenesis (author's transl)]. When challenged by intramuscular route with the rabies strain CVS, mice treated with cyclophosphamide and then vaccinated died during the four days following vaccination in larger numbers and earlier than controls which had been treated but not vaccinated. This phenomenon can be transferred, via splenocytes of mice treated with cyclophosphamide and then vaccinated, into syngenic mice infected 24 h earlier by a large amount of virus (10.000 LD50 by intracerebral route). On the other hand, mice infected with a small amount of virus (1 LD50 by intracerebral route) can be protected by transferred splenocytes. These data suggest that an immunopathological phenomenon is involved in experimental rabies of mice, supported by direct or indirect action of T lymphocytes against infected target cells. Possible implications of this hypothesis in pre- or post-exposure vaccination are discussed.


[Ultrastructural study of Mibelli's porokeratosis. Pathogenic and therapeutic considerations in three cases]. Report of three cases of porokeratosis Mibelli with emphasis on the ultrastructural changes of the entire epidermis underlying the cornoid lamella: autophagocytosis, filamentous degeneration, formation of "corps ronds". These phenomena are correlated with those of apoptosis (or intraepidermal cellular death with filamentous degeneration). Its role in the genesis of the cornoid lamella and in the degeneration of the lesions is discussed. In conclusion, on the basis of the reported observations and of the studies showing the action of retinoic acid and its derivatives on precancerous lesions, the authors propose to treat the actinic disseminated form of porokeratosis Mibelli with the aromatic derivative of retinoic acid (RO 10 9359).


[Knowledge of Solomon's epidermal nevus syndrome (author's transl)]. Solomon's epidermal nevus syndrome is a questionable entity, because of its clinical heterogeneity. Four cases are presented in this paper, with emphasis on the complex relationship between variable types of epidermal nevi and diverse kinds of associated nervous, ocular and bone abnormalities. Nevertheless, it is of practical interest to know the frequency and the variability of these ectodermal and mesodermal associated defects; whatever the epidermal nevus, a careful examination must be carried out, in search of ocular, nervous, bone and renal signs, and, less frequently, but more often than in other children, these patients seem to be exposed to visceral malignancies.


[Cross sensitivity between aminoside antibiotics (author's transl)]. The great number of topical preparation containing neomycin and their frequent use for a long period induce a lot of contact dermatitis. It is interesting to detect the importance of cross sensitivity between aminosides among the patients whose dermatitis was caused by neomycin. 15 neomycin eczematous patients were investigated. The research about cross-sensitivity concerned 6 antibiotics: streptomycin, framycetin, ribostamycin, gentamycin, kanamycin, tobramycin. Patch-tests (20 p. 100 in petrolatum) were used in order to show this cross-sensitivity. The results of these tests are nearly the same as in the other studies, as for 5 of the antibiotics; but it is the first time, to our knowledge, that a cross-sensitivity between ribostamycin and neomycin is observed. The cross-sensitivity between these two aminosides can be explained by their chemical structure. There are four rings in neomycin: the main components are neamin and neobiosamin. Only three rings are found in ribostamycin: ribostamycin is constitued of neomycin lacking neosamin of neobiosamin. Thus the structure of the 3 rings of ribostamycin is identical with the structure of 3 out of 4 rings of neomycin. The study about cross-sensitivity between aminosides suggests two conclusions: 1. The use of local antibiotics must be prescribed only when is it really necessary. 2. It seems wise to avoid all systemic aminosid antibiotics for patients who are sensitized by neomycin ointment.


A taxonomic reconsideration of some Plasmodium species from iguanid lizards. Saurian Plasmodium populations previously identified as P. tropiduri from Panama are described as subspecies or distinct species. The nominate subspecies, P. tropiduri tropiduri parasitizes Tropidurus species from Brazil, Guyana and Venezuela. Two other subspecies occur in Panama, P. tropiduri panamense from Anolis biporcatus and P. tropiduri aquaticum from the semi-aquatic lizards Anolis lionotus and A. poecilopus. Parasites found in Anolis frenatus are described as a distinct species, P. marginatum, while those from Anolis limifrons represent a third, un-named species. A parasite of Plica plica in Guyana, previously called P. cnemidophori, is designated P. guyannense, while identification of Plica umbra parasites as P. tropiduri is corrected to P. vacuolatum and Fallisia simplex.


[On the validity of Ichthyocotylurus variegatus (Creplin, 1825) and the species affiliation of Tetracotyle ovata (v. Linstow, 1877) (Trematoda: Strigeidae) (author's transl)]. Ichthyocotylurus variegatus (Creplin, 1825) is a species of its own, differing from Ichthyocotylurus platycephalus (Creplin, 1825). The distinct morphological difference between the metacercariae of the two species must be stressed (Tetracotyle percaefluviatilis v. Linstow, 1877 = I. variegatus Tetracotyle ovata v. Linstow, 1877 = "T. variegata" sensu Hughes, 1928 = "T. pileata" sensu Dubois, 1938, 1968 = T. communis Hughes, 1928 = I. platycephalus), as well as the different location of the maritae in the definitive host (I. variegatus in the posterior third of the small intestine, I. platycephalus in the region of the cloaca). A key for the determination, synonymes and diagnoses of the metacercariae of the 4 Ichthyocotylurus species are presented.


[Study of gametocytes from the Plasmodium "vivax" group: morphology, development in Anopheles and infectivity of Plasmodium yoelii microgametocytes]. The study of the gametocytes of Plasmodium yoelii enabled the differentiation of 4 morphological types: O, I, II and III (in a chronological order) and amongst each of these types the differentiation of healthy and altered gametocytes. These morphological data represent a tool for investigations on the biology of the gametocytes of the "vivax" group. Preliminary experiments bring informations on the evolution of gametocytes and the mechanisms of their infectivity. 1--In experimentaly infected white mice gametocytes of P.y. nigeriensis are infective up to the 3rd-4th day, those of P. y. yoelii until the 5th-6th days. These periods can be shorter when the infection is very virulent or longer when chronical. 2--The drop in infectivity coincides with the increase in number of the altered gametocytes. 3--The loss of infectivity is connected with the condition of the blood: when parasitaemiae are high, it becomes rapidly unsuitable to a normal evolution of the gametocytes: thus, non infective gametocytes acquire a good infectivity in less than two hours when transfered to a clean mouse. 4--The gametocytic composition of the blood taken up by the Anopheles in the capillaries can be very different from that taken at the tail of a Rodent. In the young parasitaemiae, when the Rodents are most infective to the Mosquitoes, there is a considerable enrichment in gametocytes O-I of the blood ingested by the Anopheles as compared to that taken from the Rodents by the usual techniques. This phenomenon could perhaps be explained by the larger size of gametocytes O and I and their retention in the capillaries of the host. 5--The strong infectivity of gametocytes O and I is confirmed by the fact that no infection develops in the Mosquitoes when no such gametocytes are present in the ingested blood. 6--The ageeing of gametocytes appears to be very rapid for gametocytes arising from exo-erythrocytic schizontes reach stage II, 29 hours and stage III, 35 hours, after the rupture of the very first schizonts.


[Trypanosoma (Megatrypanum) lizae n. sp.: a trypanosome with giant forms from the Michrochiroptera Hipposideros cyclops, in Gabon (author's transl)]. Trypanosoma (Megatrypanum) lizae n. sp.: trypanosome with giant forms reaching a length of 1400 micrometers from the Microchiroptera Hipposideros cyclops in Gabon. Because of the peculiar morphology of giant forms and the characteristics of small individuals it is placed in a new species within the subgenus Megatrypanum.


[Importance of the time of sample taking in order to follow the variations in corticosteronemy during parasitism of the rat by Stronglyoides ratti (author's transl)]. The variations in corticosteronemy induced by the development of Stronglyoides ratti in the Rat can be detected both in the afternoon, when corticosteronemy reaches its maximum, and in the morning when it is at its lowest rate. Nevertheless, hypercorticosteronemy, which is at its maximum 48 hours after infestation, is more sensible in the morning, whereas on the contrary hypocorticosteronemy is more significant in the afternoon and then shows a sudden and very important drop which seems to coincide with the beginning of the expulsion of the adult worms. According to previous results, inhibition of the secretion of gluco-cortico-steroids is caused by the worms; furthermore, Ogilvie and Jones show the determinant role of sensitized lymphocytes, for the expulsion of antibody-damaged worms, whereas some authors suggest that eosinophils act as cytotoxic cells on sensitized helminths; the hypothesis may therefore be put forward that hypocorticosteronemy liberates the intervention of active lymphocytes and eosinophils, triggering so the phenomenon of spontaneous deparasiting.


[Iconography of the differential characteristics of Fannia larvae (author's transl)]. The authors are showing the characteristics of Fannia larvae ventral and dorsal sides. They specify on figures the morphological characters that permit to distinguish the species scalaris, manicata and canicularis.


[Occurence of Onchocerca tarsicola Bain and Schulz-Key, 1974, in reindeer (author's transl)]. Onchocerca tarsicola is recorded from reindeer (Rangifer tarandus L.). This parasite is originally described from red deer (Cervus elaphus L.). There are indications that reindeer may not be the primary host of O. tarsicola: 1. Reindeer is parasitized only by O, tarsicola whereas red deer, due to speciations, is carrying three related Onchocerca species from the same line. 2. O. tarsicola, usually found along tendons distal of the tarsal and carpal joints, is in reindeer frequently found at aberrant locations which is commonly observed in connection with "transfuga" parasites. 3. Heavy infestations of O. tarsicola in reindeer seem to have started in the late sixties and since then have become more and more extensive.


Effect of copper on growth and serum constituents of immunized and non-immunized rabbits infected with Trypanosoma brucei. Seventy-two five-week-old New Zealand White rabbits were divided into three groups and fed a basal diet containing 0, 125 or 250 ppm supplemental Cu for 4 weeks before each Cu-group was further subdivided into three lots of 8 rabbits each. One subgroup was immunized with Trypanosoma brucei before being infected with the same parasite, another subgroup was infected without immunization while the third subgroup was neither immunized nor infected. Parasitemia slightly depressed growth and efficiency of feed utilization while supplemental Cu at 125 and 250 ppm improved both parameters in rabbits. Immunization conferred slight protection on body weight losses by the infected rabbits while supplemental Cu at 250 ppm alone or in combination with immunization completely obliterated the effects of infection on growth performance. Infection depressed haematocrit, haemoglobin, and serum glucose, while the alkaline phosphatase activity was increased. Supplemental Cu significantly increased both haemoglobin and serum glucose levels. Supplemental Cu reversed the effects of parasite infection on blood constituents. The study indicates that Cu may not only promote growth but will also suppress the effects of parasitemia on performance and serum profile of rabbits infected with trypanosomes.


[The helminthofauna of Teleostei from Madagascar. A review of the genus Pseudolamellodiscus Yamaguti, 1953 (Monogenea) (author's transl)]. Two new species of the genus Pseudolamellodiscus Yamaguti, 1953 (Monogenea, Diplectanidae): P. forsterii n. sp. and P. jelloi, branchial parasites of Sphyraena forsteri and Sphyraena jello respectively are described as well as two other species of the genus, P. pshyraenae Yamaguti, 1953 and P. nossibei Euzet and Razarihelisoa, 1959. The diagnosis of the genus has been modified.


A new family of Monostome flukes (Platyhelminths, Digenea) from the dugong, Dugong dugon (Müller). The family Labicolidae is erected to contain a new species of Monostome fluke occurring in abcesses in the upper lip of the dugong from northern Australia. Labicola elongata is described as a new species and figured.


[Evaluation of a trial to control Biomphalaria glabrata in Guadeloupe by using a sterilizing trematode (author's transl)]. A trial of biological control of Biomphalaria glabrata was carried out in Guadeloupe by using Ribeiroia marini guadeloupensis Nassi, 1978, an autochtonal Trematode which sterilizes the snail vector of Schistosoma mansoni. The trial took place in a pond in which the population of B. glabrata presents an annual demographic cycle related to the alternation of dry and rainy seasons. About 8 millions eggs of R. marini were introduced in 15 months into the biotope. Despite the low yield of these introductions, due particularly to the high turbidity of the water, this trial gave positive results in the disappearance of almost all the snails. The analysis of the results concerning the evolution of the levels of the snails and of the prevalence shows that a comparable efficiency could be obtained by massive introductions of eggs during short periods.


[On the morphology of the Rictularid, Pterygodermatites nycticebi (Mönnig, 1920) (Nematoda, Riculariidae) of the slow Loris (author's transl)]. Description of the male Pterygodermatites nycticebi (Mönnig, 1920) unknown until the present study, and a study of the cephalic and cuticular structures of the female. This rictularid has a morphological evolution comparable to that of other males of the Rictulariidae parasitic in viverrid carnivores and in primates.


[Ultrastructural study of Palavascia sphaeromae (Trichomycetes Eccrinales) parasite of the proctodeum of Sphaeroma serratum (Crustacea Isopoda) (author's transl)]. All stages of development of Palavascia sphaeromae parasite of the proctodeum of Sphaeroma serratum, are studied for the first time under the electron microscope. The formation of the holdfast, cell walls and septa is followed. In the coiled apex of the mature thalli, the septa form two catogeries of unisporates sporangia leading to two types of spores. Type 1, a multinucleate spore giving birth in situ to several microthalli. Type 2, a uninucleate at first and then quadrinucleate spore, representing the only propagative elements of the species. This study proves that the Palavasciae are well integrated among the Eccrinales order. It also opens a new discussion concerning the phyletic affinities that can exist between the Eccrinales and the other three orders of Trichomycetes.


A new species of Phalacrotophora (dipt. Phoridae) from France. A specimen attributed to Phalacrotophora fasciata (Fallén) by Dr. A. Delage (1974, Annales de Parasitologie 49 (4), 495-500) is recognised as a new species. It is described and named P. delageae and compared with P. fasciata and P. berolinensis Schmitz.


Lip adhesion--a passing fad?

Lip adhesion--a passing fad? Lip adhesion before a definitive cleft palate repair has received recent attention, and is being advocated for use in more cases. The presumed benefits are cited. Are these benefits exaggerated or misrepresented? What about the disadvantages? The author believes a more critical appraisal of the advantages and more awareness of the possible disadvantages are in order.


Simultaneous mastopexy and augmentation for correction of the small, ptotic breast. A technique for aesthetic reconstruction of the small ptotic breast is described. The procedure combines a mastopexy of the Aries-Pitanguy type, accomplished after retromammary pocket dissection, and placement of an inflatable silicone prosthesis. The method provides maximum flexibility in selecting the volume of augmentation and the subsequent appropriate contouring of the reconstructed breast.


Unexpected bleeding after elective nasal surgery. In 780 patients undergoing elective nasal surgery, the incidence of excessive bleeding was 3.6% (28 patients); of severe bleeding, 0.9% (7 patients). In most patients, effective treatment was to repack the nose and cauterize a bleeding site, or to suture an open area either in the incision or at the columella-septum junction. Contributing to the hemorrhage in 1 patient was aspirin ingestion, and in another, an unrecognized Factor XI deficiency. Although the excessive bleeding in these patients could probably have been prevented by obtaining a better history, in others it could not have been. Because of its unpredictability, bleeding as a complication must be discussed frankly with the patient.


A follow-up investigation of patients who have had parotid duct transplantation surgery to control drooling. Reports concerning surgical techniques to help combat the problem of drooling not only are new and limited, but few contain postsurgical follow-up information. In this study, the parents of parotid duct transplant patients rated or described particular aspects of their child's drooling or conditions associated with the drooling before and after surgery. Specific presurgical lingual patterns of these patients, as noted from cinefluorography analysis, are also reviewed.


Chemical peeling as a practical method for removing rhytides of the upper lip. Chemical peeling is a safe, effective method for removing upper lip lines, or rhytides, over a long period of time. While the predictable, undesirable sequela of loss of pigmentation occurs in a significant number of patients, the effectiveness and safety of the procedure seem to outweigh this problem. Chemical peeling has become an accepted and effective tool for eliminating upper lip lines due to aging, and should be considered by physicians undertaking treatment of the wrinkled upper lip.


Tomographic diagnosis of palatal defects. We present the results of a pilot study conducted to evaluate the effectiveness of palatal tomography in patients suspected of having palatal defects not detectable by other methods. Twelve patients were involved in the projects, ranging in age from 3 to 11 years. There were 8 boys and 4 girls. Each patient was evaluated with voice recordings, lateral cineradiographic x-rays, and palatal tomograms. Nine of the 12 patients were found by tomography to have palatal defects that had not been detected either by cineradiography or by clinical investigation, including physical examination of the palate. The results of this study are presented with clinical findings.