Studies on mechanisms of immobilization of mononuclear cells in the delayed hypersensitivity (DH) reaction. Migration inhibitory (MI) activity in exudates, and 'migration' and 'inhibition of migration' of exudate cells was investigated in the delayed hypersensitivity (DH) reaction induced by intrapleural injection of PPD into complete Freund's adjuvant(CFA)-sensitized guinea-pigs. During the initial reaction (6-hour), two types of antigen-dependent MI activity were detected in serum and cell free exudate. One was a high molecular weight material associated with immunoglobulin, and the other was a low molecular weight material and appeared to be so-called antigen-dependent migration inhibitory factor (MIF). As the reaction progressed (i.e. 12-24-hour), two types of antigen-independent MI activity were revealed in exudate, but not in serum. One of these was a high molecular weight material, and the other was a low molecular weight material and thought to be so-called antigen-independent MIF. Similar experiments were performed on the reversed passive Arthus (RPA) reaction in the pleural cavity of guinea-pigs. A high molecular weight substance having MI activity was detected in 6-hour cell free exudate and was found to be antigen-independent. So-called MIF was not found in this reaction. Migration of unseparated exudate cells from the 18-hour DH reaction was less extensive than that of 6-hour unseparated cells. Addition of antigen caused further inhibition, the effect on 18-hour exudate cells being more pronounced. These results were further examined, using mononuclear cells separated on a Ficoll-Isopaque gradient. The migration area of the mononuclear cells was reduced as the DH reaction progressed. Mononuclear cells from the DH reaction gave a smaller migration area throughout the reaction in comparison with blood mononuclear cells. The migration area of the RPA exudate mononuclear cells was also reduced as the reaction progressed. However 6-hour RPA exudate mononuclear cells gave a larger migration area than blood mononuclear cells. The migration of mononuclear cells from DH exudate was inhibited by addition of antigen. A greater degree of inhibition of migration was induced by addition of antigen to mononuclear cells from 18- and 24-hour exudate cells in  comparison with 6- and 12-hour exudates. The migration of mononuclear cells from normal blood (i.e. unsensitized animals) and RPA exudate (6- and 18-hour) was unaffected by addition of antigen. Similar results were obtained for blood of complete Freund's adjuvant sensitized animals from 0- to 18-hour. Adherent (A) and nonadherent (NA) mononuclear cells from 18-hour DH exudate were separated through a glass bead column. The migration of adherent cells from 6-hour exudates was not significantly inhibited whereas that of 18-hour mononuclear cells was markedly inhibited. The effect on migration of each mononuclear cell fraction was detected by mixing with peritoneal exudate cells (used as indicator cells). The effect of the A cells from 18-hour mononuclear cell exudates on peritoneal exudate cells was strong, whereas that of 6-hour exudates was less marked...


In vivo and in vitro macrophage activation by systemic adjuvants. Six systemic adjuvants of immunity were tested for their ability to induce macrophage activation. Four of them: living BCG, hydrosoluble extracts from BCG (HIU II) and from M.smegmatis (IPM), and lipopolysaccharide from E.coli (LPS), when administered to normal mice render macrophages non-specifically cytotoxic for tumor cells in vitro. The intensity of this phenomenon varied according to the route and time of adjuvant administration. In contrast, lentinan extracted from Lentinus edodes, and levamisole which is a synthetic chemical compound, depressed macrophage cytotoxic potential. BCG, IPM and LPS were shown to have a direct action on macrophages. After in vitro exposure to these agents, the cytotoxic potential of normal macrophages was greatly increased. Levamisole was unable to stimulate this macrophage function directly in vitro. On the other hand, such a macrophage activation has been induced in vitro when normal macrophages were cultivated in the presence of MIF coming from the supernatant of human lymphoblastoid cell lines.


Studies on the regulation of the neutrophil chemotactic response using a rapid and reliable method for measuring random migration and chemotaxis of neutrophil granulocytes. An economic and sensitive test system for measuring random and directional migration of human neutrophils is described. The technique, based on a modified Boyden chamber equipped with a two-filter system, permits a substantial reduction of both incubation time and sample volume. The influence of various technical factors such as the neutrophil concentration in the cell suspension, the incubation time of the chambers, the test concentration of activated plasma or serum, the presence of heparin, and the procedure for separating neutrophils from human peripheral blood, was investigated. Standardized procedures for measuring and reporting neutrophil chemotaxis are proposed. The method has been used to study the significance of factors regulating neutrophil migration such as cytotaxin inactivators and neutrophil immobilizing factors (NIF). Activity of cytotaxin inactivators as assessed in undiluted serum or plasma at pH 7.4, 6.0 or 4.0 was very low. In contrast, potent neutrophil immobilizing activity was found in human serum or diluted plasma. These factors which inhibit migration were accordingly termed neutrophil immobilizing factors of plasma (NIF-P) and neutrophil immobilizing factor of serum (NIF-S). These factors are heat-stable, non-dialysable and of high molecular weight.


The differential effects of cyclophosphamide and 6-mercaptopurine on the renal disease and skin immunoglobulin deposits of the NZB-NZW F1 hybrid mice. The following differential effects of immunosuppressive therapy with Cyclophosphamide (CYCLOPH) and 6-mercaptopurine (6-MP) in the female NZB-NZW F1 hybrid strain have been observed: (1) CYCLOPH but not 6-MP significantly decreased antinuclear antibody level. (2) Both CYCLOPH and 6-MP significantly decreased glomerular cell proliferation. (3) Both CYCLOPH and 6-MP significantly arrested progression of glomerulosclerosis. (4) While CYCLOPH significantly diminished Ig deposition in the glomeruli, 6-MP had no effect on this phenomenon. (5) While CYCLOPH decreased subepidermal globulin deposition in the skin, 6-MP appeared actually to enhance subepidermal staining. Thus, the present studies demonstrated that CYCLOPH was superior to 6-MP in four of the five parameters studied. In the case of one parameter, Ig staining of the skin, 6-MP actually produced enhancement of the staining. Both CYCLOPH and azathioprine which is a derivative of 6-MP, are currently being used for the treatment of human SLE. The present findings suggest that of the two, CYCLOPH may be the drug of choice.


Bacteriological quality control in laboratory animals. For monitoring health status of conventional laboratory animals, weekly samples should be examined of at least 2-5% of animals of each room. Dissecting method, bacteriological cultural technique and different selective media have been described. The significance of microorganisms and their relation to clinical signs, mode of infection and animals affected have been summarised in tabulated form.


Hemodynamic effects of steroids in cardiac disease. The hemodynamic effects of intravenous methylprednisolone were documented by right heart catheterization in seven patients with an acute uncomplicated transmural myocardial infarction 1 to 9 days after the onset of symptoms. Intracardiac pressures, brachial artery pressure, and cardiac output were determined before and 1 hour after the termination of the methylprednisolone infusion. Two grams of methylprednisolone were infused over a 20 minute period. The brachial pressure rose from a mean of 82 to 90 mm. Hq (N.S.). The brachial artery mean pressure fell in the one patient with a 1-day-old infarction, and it rose in the six patients with an older infarction, from 83 to 94 mm. Hg (p less than 0.01). As the brachial artery pressure rose in one patient, chest pain and marked ST-segment elevation occurred which were relieved by nitroglycerin. This experience promoted us to terminate the steroid study. There was a nonsignificant increase in the cardiac index and wedge pressure. The raise in the brachial artery pressure with an infarction older than 1 day was an unexpected finding, since steroids are presumed to be vasodilating agents.


Characteristics and coexistence of two forms of ventricular echo phenomena. During the scanning of paced basic ventricular cycle lengths (V1V1) with extrastimulus method (V2) two forms of ventricular echo phenomena (Ve) were recognized. The Ve resulting from A-V nodal re-entry (VeAVN) occurred in 12 of 45 patients, from re-entry in the His-Purkinje system (Ve-HPS) in 20 of 45 patients, and simultaneous dual re-entry (Ve-AVN and Ve-HPS) occurred in five of 45 patients. The Ve-AVN (1) appeared at longer V1V2 intervals, (2) was dependent on retrograde A-V nodal conduction delay, (3) had normal QRS complexes and H-V intervals, and (4) did not occur when V2 blocked in the A-V node. (5) Ve-AVN had aberrant QRS complexes when preceded by Ve-HPS. The Ve-HPS (1) appeared at shorter V1V2 intervals, (2) was dependent upon retrograde conduction delay in the HPS, (3) its QRS morphology and axis orientation resembled V2, i.e., left bundle branch block pattern, when right ventricular apex was the site of stimulation, (4) persisted when V2 blocked in the A-V node and was abolished when V2 blocked below the bundle of His, and (5) rarely occurred in patients with pre-existing right bundle branch block. It is concluded that (1) at least two forms of Ve can result from induced premature ventricular beats, (2) Ve-HPS is more common than Ve-AVN in the presence of normal QRS complexes, and (3) coexistence of Ve-AVN and Ve-HPS can give rise to complex ECG pattern mimicking multiple multifocal premature ventricular beats.


Systemic and renal hemodynamic effects of bupicomide: a new vasodilator. The systemic and renal hemodyanmic effects of bupicomide were studied in 10 male patients with uncomplicated essential hypertension of moderate severity. Bupicomide significantly reduced systolic, diastolic, and mean arterial pressure and peripheral vascular resistance and this hypotensive effect was associated with a reflexive increase in heart rate, left ventricular ejection rate, and cardiac index; it had no effect upon other reflexive sympathetic adjustments induced by upright tilt and the Valsalva maneuver. Bupicomide also increased renal blood flow and decreased renal vascular resistance, but it had no effect upon the glomerular filtration rate. The hypotensive mechanism of bupicomide therefore is mediated by peripheral arteriolar dilation, through vascular smooth muscle relaxation. The more immediate clinical side effects of bupicomide are related to its strong vasodialting action and include headaches, cutaneous flushing, and tachycardia.


Unstable angina pectoris.

Unstable angina pectoris. Unstable angina is a syndrome which comprises a spectrum of symptomatic manifestations of coronary artery disease which lies between stable angina pectoris and acute myocardial infarction. Patients fall into three groups: angina of recent onset (4 weeks), angina of changing pattern, and angina occurring at rest (longer than 15 minutes). The syndrome may presage acute myocardial infarction or sudden death, or may itself be the manifestation of a myocardial infarction. The pathophysiology may involve primary cardiac events or extracardiac precipitating factors, and does not appear to be the consequence of a particular anatomic pattern of coronary artery disease. Pain may occur as a result of regional reduction of coronary flow to pressure-dependent areas of myocardium during states of increased myocardial oxygen demand. Persisting ischemia leads to infarction via a series of events which may include myocardial edema formation, increased beta-sympathetic tone, and others which have been experimentally modified by interventions designed to limit infarct size. Although the incidence of acute myocardial infarction and death was high in early studies, in recent reports acute infarction occurs in under 15.5 per cent and death in under 2 per cent. Patients at high risk are those pain persists with bed rest, and those with preceding stable angina pectoris or myocardial infarction. Prognostic differences among Groups 1, 2, and 3 may exist but cannot be assessed from available studies. Studies of the management of unstable angina have generally been uncontrolled. Hospitalization, bed rest, and short- and long-acting nitrates are generally employed in Groups 2 and 3 patients and the marked reduction in myocardial infarction rates from early to recent studies tends to support these approaches. Anticoagulants are less used now than formerly. Propranolol can produce a significant reduction of myocardial oxygen consumption and may redirect coronary flow to ischemic areas. The drug has effectively controlled pain in several studies and is now widely used to manage unstable angina. Aortocoronary bypass surgery has been extensively employed but there is only one preliminary report of a controlled study available. The role of surgery is not yet defined. The optimal approach to therapy may eventually involve the use of medical therapy, including beta-blockade to stabilize patients, with delayed semielective coronary angiography and surgery in those who respond. Emergency angiography and surgery might then be reserved for the high-risk group of patients whose pain persists during optimal medical therapy.


Genetic spina bifida occulta in the mouse. Spina bifida occulta is one of the major effects of the recessive mutant "snubnose" (symbol sno). Linkage tests have located this mutant in chromosome 4. Defective spinal arch formation typically includes the lumbar and often the posterior thoracic and sacral vertebrae. There is great variation in detail, from nearly normal closure to a trough-like spinal column. Causes of the variation are not understood. Severely affected specimens may also have defective anterior thoracic vertebrae and reduced size of the sacral vertebrae, with kyphosis. The tail is essentially normal. No external lesion or myelomeningocele has been found, but there have been some instances of paralysis of the hind limbs, possibly from injury. The spinal cord seems normal as a rule, and pigmentation is normal. Embryological study has not been attempted, but the condition seems to be primarily osteogenic in origin.


Anti-kidney cytotoxic antibodies in human renal allografts. Periodic comparisons were made of sera from two groups of patients, ten who rejected their renal transplants within a year after transplantation and ten who successfully maintained their transplanted kidneys for five years or more. What appeared to be anti-kidney cytotoxic antibodies were found in much higher levels in the sera of those patients with the short-lived transplants, the difference in titer levels between the two groups being significant at the .0001 levels. This antibody showed no correlation with either the presence or the absence of lymphocytotoxic antibodies, nor did it appear to have any relationship to the HL-A antigens or the previous renal disease of the recipient patient. While it was cytotoxic to tissue cultures of cells obtained from random human kidneys, human kidney tumor cells (Wilms), and human embryonic kidneys, this antibody did not react with non-renal human tissues (lung, spleen, deltoid muscle, foreskin). It did not react with nonhuman (simian) kidney tissue culture cells. The findings suggest the appearance of an organ-specific, cytotoxic anti-kidney antibody in patients undergoing renal homograft rejection.


A regional quality control program in microbiology. II. Advantages of simulated clinical specimens. A regional quality control program was established using simulated clinical specimens introduced into the routine workload of participating laboratories in such a way that they were not detected as quality control specimens. Comparison of performance between these specimens and lyophilized cultures showed that additional information was obtainable with the former. In particular, it was observed that common pathogens such as Escherichia coli are poorly identified in clinical material. The examination of urines was inferior to examination of other types of specimens. The implications of these findings for the practice of diagnostic bacteriology are discussed.


The training of paraprofessionals as behavior modifiers: a review. Paraprofessionals are increasingly being employed in the mental health field. While much interest has focused on their roles and functioning, little systematic attention has been devoted to an examination of training practices. Because a particularly compatible relationship may exist between paraprofessionals and the behavioral model of intervention, this review focuses on the training and use of paraprofessionals as behavior modifiers. Paraprofessional populations reviewed include psychiatric aides and nurses, college students, inpatients, and community and indigenous workers. The review concludes that a strong case can be made for the administrative feasibility of training and utilizing diverse groups of paraprofessionals as behavior modifiers. The lack of consistent, solid outcome evidence prohibits a conclusion relative to the effectiveness of these paraprofessionals at this point in time. Numerous researchable questions concerning the effectiveness of various forms of training with paraprofessionals, optimal length of training for various purposes, training resistances, etc., are unanswered. Beyond this, a serious lack of communication of the basic process of training is revealed, and the perhpas questionable roles paraprofessionals are being trained for is discussed.


The first urinary tract infection in male children. In a prospective study of urinary tract infection in 57 boys, diagnosis in 50 patients was based on the presence of more than 10(5) organisms per milliliter of urine. Gram-positive cocci were more prevalent, and Escherichia coli was less prevalent than previously reported in girls. Fever and urinary tract abnormalities were frequent in boys younger than 10 years of age; less common in boys 10 to 14 years old. Excretory urography and voiding cystourethrography were performed in 30 boys. In 15, one or both showed abnormalities, usually vesicoureteral reflux. Most of the abnormalities, and all of those that necessitated surgical correction, were in boys under 10 years old. In the remaining seven patients, less than 10(3) organisms per milliliter grew on urine culture. All of the seven were younger than 10 years of age, and all had serious renal abnormalities, three requiring surgical correction.


Sweat gland reactivity to local thermal stimulation in dysautonomia. An attempt has been made to elucidate the cause of hyperhidrosis in dysautonomia by testing sweat gland responsiveness to local application of heat. Heat was applied to the volar surface of the forearm with temperatures of 41.5 C and less for one to ten minutes. For each subject, the minimal duration of heating at the lowest temperature capable of evoking sweating was determined (threshold). Thresholds were significantly lower in all subjects with dysautonomia. Since one control subject, the father of a dysautonomia subject, had the highest threshold, these tests do not permit detection of the heterozygote. A reasonable explanation for enhanced sweating reactivity to local heat application is an increased excitatory state of reflex centers. These patients appear permanently on the verge of generalized sweating likely to result from minimal additional stimulation.


Factors relating to intelligence in treated cases of spina bifida cystica. Analysis of results on 83 survivors of spina bifida cystica showed the following: (1) in the seven children who had had central nervous system (CNS) infection, intelligence was impaired, six being severely retarded. (2) In the nine children who did not suffer CNS infection or require a shunt, intelligence was normal. The need for a shunt was related to radiological appearance (craniolacunae) and to the sensory level at birth. (3) In the 67 children who did not suffer CNS infection but did require a shunt, intelligence was related to sensory level found at birth and to thickness of the pallium measured within four weeks of birth. Their intelligence did not relate to the occipitofrontal circumference at birth, or to its increase before the insertion of the shunt. Intelligence did not relate to the function of the shunt at the time of assessment or to the number of times it had been revised.


Inhibition of basal and stimulated gastric H+ and pepsin secretion in duodenal ulcer patients by metiamide, an H-2 histamine antagonist. Metiamide was given orally in one dose of 200 mg in 23 sutdies in patients with duodenal ulcer, 4 in the basal state, 11 during histamine infusion, and 8 before insulin hypoglycemia stimulation. In the latter 8 patients insulin was given at another time without metiamide. In 17 studies acid secretion was suppressed by metiamide--up to 75% in the basal state, 53% after histamine, and 80% after insulin. Pepsin secretion was reduced to the same extent as H+ in the histamine studies but not in the basal (57%) or insulin (44%) studies, so that in the latter pepsin/acid ratios were 3-fold greater than in controls. Blood levels of metiamide were measured in 17 studies. In 10 out of 11 who showed inhibition of 40% or more, peak blood levels of metiamide were 0.45 mug/ml to 1.25 mug/ml. In 5 of 6 who did not show inhibition, blood levels were 0.05-0.4 mug/ml; in the sixth it was 0.8 mug/ml. Therefore a critical blood level for suppression of basal or stimulated secretion appears to be approximately 0.45 mug/ml.


Pharmacists at America's first hospital, 1752-1841. The development of the role of the apothecary at America's first hospital, the Pennsylvania Hospital, is presented. The first salaried apothecary, Jonathan Roberts, was hired in 1752. Subsequent apothecaries included students of medicine and surgery, some of whom worked for the benefit of experience, plus room and board. In an attempt to upgrade the position, an apothecary from England, with training in chemistry, was hired in 1768. During the Colonial period, the hospital pharmacist, in addition to preparing drugs, sometimes acted as resident physician, steward and even as an instructor to the apprentices. Drugs for the hospital were purchased from England until the American Revolution. While the function of the apothecary was absorbed by the resident apprentices during the post-Revolutionary War period, the early 19th century brought the return of the professional apothecary whose sole function was to prepare prescriptions under the direction of the physicians.


Drug therapy in colonial and revolutionary America. Drug therapy during the Colonial and Revolutionary War period in America is discussed. Therapy in the 17th and 18th centuries remained largely symptomatic rather than curative. Treatment included such "depletion" measures as purging, sweating, bleeding, blistering and vomiting. Purgatives, emetics, opium, cinchona bark, camphor, potassium nitrate and mercury were among the most widely used drugs. European herbals, dispensatories and textbooks were used in the American colonies, and beginning in the early 18th century, British "patent medicines" were imported. During the Revolutionary War, the supply of drugs from Britain was cut off. The Continental Congress established laboratories and storehouses to serve the needs of the army.


Pharmacotherapy of inflammatory bowel disease. The etiology, pharmacotherapy and management of the two major types of inflammatory bowel disease--ulcerative colitis and Crohn's disease--are reviewed. Sulfasalazine and topical corticosteroids (i.e., hydrocortisone, hydrocortisone acetate or methylprednisolone acetate) are effective in many patients with mild distal ulcerative colitis. Maintenance sulfasalazine therapy significantly reduces the relapse rate in ulcerative colitis. Systemic corticosteroids (i.e., prednisone, prednisolone or methylprednisolone) have improved the survival rate of patients with moderate and severe ulcerative colitis. Antacids should be given regularly during high-dose steroid therapy to prevent gastritis. If oral steroids are ineffective, the use of parenteral corticosteroids (hydrocortisone sodium succinate or methylprednisolone sodium succinate) is suggested. Both sulfasalazine and corticosteroids appear to be effective in the treatment of Crohn's disease but require further investigation, however, if patients fail to respond to this therapy, oral corticosteriods, in low dosages, given concomitantly with azathioprine (currently under evaluation) is suggested.


Malaria - the mime. Recent lessons from a group of civilian travellers. Clinical data on 24 civilian patients hospitalized for malaria in The New York Hospital were analyzed. Of 16 patients infected with Plasmodium falciparum, 14 acquired the disease in West Africa. Only three of the 24 had taken recommended courses of prophylaxis. Diagnosis was invariably, and often dangerously, delayed because physicians often made diagnoses of viral syndromes or used antibiotics; only one patient had a blood smear taken by a personal physician. Although all patients had fever and chills, classic malarial fever was seen in only seven patients; nausea, vomiting and diarrhea were common. Hepatomegaly and splenomegaly occurred in about half the patients. Blood smears stained in routine fashion by Wright's stain were positive in 23 of 24 patients. A normal leukocyte count was present in 19 of the 24 patients and thrombocytopenia in 16 of 23. The most frequent complications were those of central nervous system involvement. Therapy consisted mainly of chloroquine phosphate but other drugs, including quinine, pyrimethamine, sulfonamides and primaquine, were used in special situations. Suggestions for prophylaxis, diagnosis and therapy were made.


Etiology and prognosis in acute post-transplant renal failure. During the last seven years we encountered 117 cases of acute renal failure after 492 renal transplants. The affected patients fall into two general groups that can be broadly identified by an 131I-Hippuran renogram: Those in whom low or no uptake is evident on the renogram (group 1) and those in whom good uptake is evident on the renogram (group 2). Fifty per cent of the patients in group 1 have renal arterial thrombosis or hyperacute rejection. These patients should have a renal arteriogram, and immediate nephrectomy may be necessary. The prognosis in these patients is very grave. In group 2, 89 per cent of the patients have acute tubular necrosis, and they do not differ prognostically from patients who experience immediate renal function. Invasive diagnostic procedures should be avoided in this group because they may increase the mortality rate. We believe that repeated renograms, a reduction in azathioprine dosage and careful dialysis is the only treatment necessary.


Recurrent nephrolithiasis: natural history and effect of phosphate therapy. A double-blind controlled study. In a double-blind controlled clinical study, 71 patients with recurrent calcium oxalate stones were divided into three treatment groups: those who received potassium acid phosphate, those who received an inert placebo, and those who received a low calcium diet only. Follow-up periods averaged 2.9 years. Although the mean urinary calcium level of the patients who received phosphate was reduced 33 per cent, their renal stone disease did not diminish. Mean urinary phosphorus increased 88 per cent with phosphate treatment but did not correlate with the decrease in urinary calcium, or with treatment success. The data did not suggest that phosphorus and its metabolites retard calcium oxalate crystallization in urine. No evidence appeared for an association of hypercalciuria with severe stone disease, or with a specific clinical or chemical response to phosphate therapy. Patients whose urinary calcium level fell more than 25 percent when dietary calcium was reduced may have excessive gastrointestinal calcium absorption, which appears to be associated with improved chemical response to phosphate therapy.


Idiopathic late-onset immunoglobulin deficiency. Clinical observations in 50 patients. Fifty patients with late-onset idiopathic immunoglobulin deficiency were studied and the frequency of various clinical associations and complications was observed. Men and women were equally affected, although the age at onset in men peaked in the third decade whereas it was more uniformly distributed in women. Sinobronchopulmonary infections were common and were caused by Haemophilus influenzae. Diplococcus pneumoniae, Streptococcus pyogenes and Staphylococcus aureus: bronchiectasis occurred in 28 per cent. Thirty patients (60 per cent) had diarrhea, which was often associated with steatorrhea, giardiasis, achlorhydria, abnormal Schilling tests and morphologic abnormalities on small bowel biopsy specimens, including nodular lymphoid hyperplasia; three patients had pernicious anemia. In the 20 patients without diarrhea these abnormalities were not observed except for giardiasis in one patient and achlorhydria in two patients. Cholelithiasis occurred in both groups in about a third of the patients tested. A high degree of susceptibility to neoplasia was noted. Thyroid abnormalities, including primary hypothyroidism and Graves' disease, were observed in six patients. Additional occasional findings were vitiligo, keratoconjunctivitis sicca and arthritis. Splenomegaly occurred in 14 (28 per cent) patients. The percentage of B lymphocytes in the blood was determined in 10 patients; it was normal or slightly decreased in eight patients and low in two patients.


A case of bilateral Escherichia coli endogenous endophthalmitis. The first reported case of bilateral endogenous endophthalmitis is presented and discussed with reference to pertinent literature. Diagnostic and therapeutic recommendations for suspected gram-negative endophthalmitis are presented and include: immediate paracentesis of the eye for gram stain and culture, systemic therapy with an antibiotic such as gentamicin and either subconjunctival, subtenon or intraocular injection of antibiotics. Despite these measures vision may be lost, and, as in this case, enucleation necessary.


A modified plate holding system for anaerobic cultures. A modified plate holding system for anaerobes has been developed which: 1) effectively reduces the volume of oxygen-free gas required, 2) promotes earlier bacterial growth, and 3) monitors the anaerobic atmosphere of the holding vessel and the rate of gas flow. Cultures of Bacteroides fragilis, Clostridium perfringens, C. septicum, Fusobacterium nucleatum, Peptococcus sp. and Propionibacterium sp. were evaluated for optimal growth. All cultures grew as well as or better when preincubated in the holding system for one to three hours then incubated in a GasPak system for the remainder of the 24 hours, as compared to incubation only in the GasPak or holding system for the entire 24-hour period.


Solving complex perceptual discrimination problems: techniques for the development of problem-solving strategies. Techniques for developing problem-solving strategies in handicapped children when they are faced with complex perceptual discriminations were investigated. Specifically, the effectiveness of feedback, modeling, and self-instruction were compared with each other and a control condition on a specially designed matching-to-sample task. The task was designed so that the distinctive features of the stimuli could be identified for instructional purposes. The results indicated that only the self-instruction technique facilitated performance on the posttest. In addition, these skills generalized to a new set of forms but not to the Matching Familiar Figures test. These findings were further related to the development of observational skills.


Bacterial growth inhibition by amniotic fluid. V. Phosphate-to-zinc ratio as a predictor of bacterial growth-inhibitory activity. Human amniotic fluid has been shown to contain an inorganic bacterial growth-inhibitory component, zinc. The average zinc concentration in amniotic fluid was 0.44 mug per milliliter. The phosphate concentration of amniotic fluid appears to determine the expression of zinc inhibitory activity. The average phosphate concentration was 92 mug per milliliter. For 22 fluid samples tested, a phosphate-to-zinc ratio of 100 or less predicted a bactericidal fluid. A ratio between 100 and 200 predicted a bacteriostatic fluid. A ratio of greater than 200 predicted a noninhibitory fluid. The possible clinical significance of the ratio is discussed.


Bacterial growth inhibition by amniotic fluid. VI. Evidence for a zinc-peptide antibacterial system. The zinc bacterial inhibitory activity of amniotic fluid is dependent on the presence of a second, organic component contained in amniotic fluid. The second component is heat stable, resists proteolytic digestion, and is present in amniotic fluid throughout pregnancy. Further, the component may be a peptide with a molecular weight of less than 5,000 daltons. Phosphate reversal of amniotic fluid inhibitory activity may result from interference with the organic component rather than zinc.


Action of midcycle contraceptive (R 2323) on the human endometrium. Over 2,148 cycles of midcycle oral administration of R 2323 (50 mg. per day on Days 15,16, and 17), the authors recorded a drug-failure pregnancy rate of 5 per cent and an unusually regular cycle length of 28 +/- 2 days. During this trial, endometrial biopsies obtained in the luteal phase were examined by light and electron microscopy and compared to pretreatment biopsies. Light microscopy indicated a weakly secretory endometrium suggestive of some, albeit low, progesterone impregnation. Ultrastructural examination revealed deleterious changes in the development of the nucleolar channel system and giant mitochondria and a delay in the migration of glycogen granules. This low progesterone impregnation could be explained either by a direct effect of R 2323 on cell ultrastructure or by interference with progesterone availability. It would appear that R 2323 acts as a temporary substitute for progesterone at the receptor level but that it does not induce all the biological manifestations of this hormone, in particular, the endometrial changes required for implantation.


Positive FTA-ABS tests in subjects with corticosteroid-induced uveitis. Of 17 subjects who developed severe anterior nongranulomatous uveitis during or immediatelyy after testing with topical corticosteroid preparations, 14 (82%) had a positive fluorescent-treponemal-antibody absorption (FTA-ABS) test. No association was found between corticosteroid-induced uveitis and any specific HL-A locus.


Induced ocular pseudopemphigoid.

Induced ocular pseudopemphigoid. Two patients with a clinical picture identical to idiopathic ocular cicatricial pemphigoid had received long-term (six to nine years) echothiophate iodide treatment for control of glaucoma in the affected eyes after cataract extraction. Basement membrane zone staining for IgG was seen in the conjunctiva of one affected eye. Decreased or absent goblet cells, epidermalization of the conjunctiva, fibroses, and abnormal numbers of inflammatory cells were seen in both affected eyes.


A selected review of current retinal research and study. The present paper reviews recent studies of retinal pathology from the American and British Journals of Ophthalmology during a one-year period (1973-1974). Selection is on the basis of potential value to clinical optometrists. Certain underlying factors in several types of retinal degeneration are first discussed, followed by characteristics of diabetic maculopathy and of other types of macular degeneration including that due to aging. Some material is presented on retinopathies related to sickle cell traits, to viral and worm infections, and to injury. Following a review of certain recent studies of retinoschisis, retinoblastoma, and retrolental fibroplasia, a concluding section deals with retinal detachments and breaks.


Combined orthodontic-surgical management of residual palato-alveolar cleft defects. These cases are presented in detail from a series of fifteen cases treated in the described manner, with follow-up orthodontic documentation 2 to 5 years after PMCB grafts. The long-term results in all of the cases were excellent. Late or secondary bony reconstruction of the osseous alveolar and anterior palatal clefts may be accomplished with either an essentially nonviable autogenous graft or an autogenous particulate marrow and cancellous bone graft. The differences essentially are as follows: 1. In the nonviable graft, orthodontic movement of teeth adjacent to the cleft is undertaken at some time prior to the grafting procedure. This is opposed to the use of the autogenous PMCB graft in which active orthodontic treatment may be undertaken within 2 months after the osseous grafting procedure. 2. In the use of nonviable autogenous bone, presurgical orthopedic treatment to expand the arch is usually essential since extensive arch expansion is not usually possible after grafting. With PMCB grafts , postsurgical arch expansion may be routinely undertaken. 3. It is thought that the use of rib, solid one-piece grafts from the ilium, and other types of nonviable graft is warrented only after major growth and development of the premaxillary region has occurred. This is due to lack of ability of such a grafted area to keep pace with the growth of adjacent bone segments. This would mean that secondary grafting with such grafts would be restricted to patients over 15 years of age. This is opposed to the PMCB technique, in which the next procedure may be undertaken at any time from the age of mixed dentition to adulthood but preferably earlier than the age of 7, before the lateral incisor has erupted and been lost through exfoliation into the cleft area. Thus with these two techniques, there is a marked difference in the philosophy of grafting and a marked difference in the overall results. There is, in addition, an altered philosophical effect upon the total maxillofacial cleft palate team, with a marked difference in the type of treatment and prognosis which can be offered in terms of social rehabilitation of the patient. While the team approcah to the treatment of the cleft palate patient has done much to advance rehabilitation in terms of social and psychological problem areas, speech correction, and soft-palate and cosmetic lip restoration, much needs to be done to rehabilitate the patient completely from a dental standpoint. We believe that the prognosis of dental rehabilitation without appropraite bone-grafting procedures of the alvolar and prepalatal cleft is unfavorable. The use of the PMCB procedure in conjunction with orthondotic therapy opens new avenues to the total rehabilitation of the patient with an anterior maxillary cleft.


Geriatric day hospitals: a golden opportunity for therapists. The geriatric day care or day hospital program is an exciting new movement designed to aid the impaired elderly in the community. Federal legislation has made public financing of these programs possible under Title 18 and Title 19 of the Social Security Act. The potential for funding as a demonstration grant exists in a variety of Federal agencies. In spite of these funding possibilities, occupational therapists seem only marginally involved in the development of day care services for adults. Therapists must become more knowledgeable about health and social planning for the geriatric population and must become more assertive in seeking funding for new programs. Opportunities to play a role in these programs are available, and occupational therapists should become more alert to them and become leaders in developing new programs.


Occupational therapists as state surveyors of nursing homes under Medicare/Medicaid programs. To be eligible for Medicare and Medicaid funds, a skilled nursing facility must meet specific standards set by the Department of Health, Education, and Welfare (DHEW). Responsibility has been delegated to the state surveyor for evaluating, consulting with, and reporting on the provider's compliance with these standards. Nurses, sanitarians, and others who become surveyors are required to participate in a four-to-six month survey orientation and training period before attending a three-week university-based course sponsored by DHEW. As the need for survey specialists increases, more occupational therapists can assume this role, described in more detail in this article.


Lithium prophylaxis of depression in bipolar I, bipolar II, and unipolar patients. The authors investigated lithium prophylaxis of depression in bipolar I (N=35), bipolar II (N=18), and unipolar I (N=28) outpatients. Depression indices included frequency of depressive episodes, three measures of severity, dropouts due to depression, and time in study. There were significantly fewer episodes and dropouts due to depression in the lithium-treated than in the placebo-treated bipolar I patients. Lithium was superior to placebo on all indices in the bipolar II group (although the sample size did not permit statistical analysis) and on 3 indices in the unipolar group. The authors believe that lithium prophylaxis of depression has been demonstrated in these three subtypes but note the need for further research particularly in the use of tricyclic antidepressants.


Amantadine versus trihexyphenidyl in the treatment of neuroleptic-induced parkinsonism. Amantadine is a putative dopaminergic compound known to be therapeutically effective in idiopathic and postencephalitic Parkinson's disease. In a double-blind placebo-controlled crossover study of 39 psychiatric inpatients, amantadine and trihexyphenidyl were equally effective in treating drug-induced parkinsonism, and amantadine produced fewer and less severe side effects. The authors suggest that amantadine is an effective alternative to atropine-like agents, with fewer implications for long-term risk of tardive dyskinesia.


Repair of recurrent ventral hernias by an internal "binder". A technic for the repair of massive recurrent incisional hernia is described. Use of a polypropylene mesh prosthesis as an intraperitoneal "binder" permits reconstruction of the abdominal wall when primary closure is impossible. Intraoperative testing of the repair provides reassurance that unrestricted postoperative activity will not invite recurrence.


Local delayed cutaneous hypersensitivity reactions in breast cancer patients with and without removal of axillary lymph nodes. Fifty-five patients were sensitized to dinitrochlorobenzene (DNCB). Two weeks later they were challenged. The minimal concentration yielding 2+ reactivity and one dilution above and below were then applied to the anterior chest wall on both the operated and nonoperated sides. Using multinomial chi-square statistical analysis, we found that the operated and nonoperated sides evidenced equal reactivity. Futhermore, the absence of axillary lymph nodes did not diminish the reactivity in the operated area. These data support the contention that maintenance of local cellular immunity, as assessed by DNCB skin test reactivity, is systemic and counters the argument that regional lymphadenectomy impairs local and/or systemic cellular immunity.


Delayed hypersensitivity and local control of patients treated by radiotherapy for head and neck cancer. Delayed hypersensitivity of sixty-three patients with head and neck cancer treated by radiotherapy was correlated with short-term tumor control. Of eighteen patients with early disease, sixteen were DNCB-reactive and all were controlled and one of the two nonreactors was controlled. Thirty-three of forty-five patients with advanced tumors were reactive and nineteen were controlled. Only two of the twelve nonreactors were controlled.


Prevention of wound infections. A case for closed suction drainage to remove wound fluids deficient in opsonic proteins. Fluids collecting in surgical wounds in both dogs and man have been shown to lose progressively the ability to opsonize bacteria for phagocytosis and killing of bacteria by normal neutrophils. Since the collection of fluids in potentially contaminated wounds also interferes with access of phagocytic cells to contaminating bacteria and provides a pablum for growth, their removal seems to be indicated to minimize the risk of infection. This can be accomplished easily and safely with the use of closed suction drainage as demonstrated in 100 patients undergoing bilateral nephrectomy, splenectomy, and renal transplantation.


Carl Langenbuch and the first cholecystectomy. Cholecystectomy is the second most common operation performed today, but its founder, Carl Langenbuch, has received little recognition. The evolution of biliary surgery to the first cholecystectomy is traced. Contributions of von der Wiel, Petit, and Thudicum are reviewed. The cases of the first cholecystotomy by John Stough Bobbs, the first cholecystostomy by Marion Sims, and the first cholecystectomy of Carl Langenbuch are described.


Pharmacokinetics of a new skin wound cleanser. Iodophors are effective germicidal agents that have prolonged antiseptic activity in contaminated wounds. A nontoxic surfactant, Pluronic F-68, has been used to formulate a safe and effective iodophor. The parameters necessary to regulate the activity of the iodophor were studied to develop a potent, yet safe bactericidal solution for use in human subjects. The parameters found to be most important were the pH of the solution and the concentration of sodium iodide. Lowering the pH of iodophors increased their stability and antiseptic activity. The free iodine in iodophor solutions prepared with a low pH is predominantly the highly biocidal diatomic iodine (I2). The concentration of iodide regulated the equilbrium of the dissolved iodine between its free and complexed form. Increasing the concentration of iodide in the iodophor lowered the amount of free iodine in solution and enhanced the concentration of the complexed iodide. It is the level of free iodine in an iodophor that determines its antiseptic activity. Low levels of free iodine yielded iodophors that had a slow bacterial kill rate but a prolonged duration of action. Manipulation of these variables permitted the generation of iodophors that varied considerably in their kill rates of bacteria and their duration of antibacterial activity. Iodophors tested in this study demonstrated a distinct superiority to noncomplexed iodine solutions (tincture and aqueous iodine solutions) as wound and skin cleansers.


Hypercalcemia of seven years' duration after kidney transplantation. A case is reported of hypercalcemia persisting for seven years after kidney transplantation, with normocalcemia being achieved after subtotal parathyriodectomy. The finding of post-transplantation hyperparathyroidism of this extreme duration, in association with several other reports of hyperparathyroidism persisting for years after kidney transplantation, raises serious questions about the completeness of parathyroid involution after kidney transplantation. Extensive review of the literature reveals that little is really known about the natural history of parathyroid function and involution after kidney transplantation.


Renal transplantation with blood supply by axillofemoral bypass graft. An axillofemoral bypass was used to preserve a functioning renal allograft after excision of a mycotic abdominal aortic aneurysm in a diabetic patient. In the presence of continued immunosuppression the aortic wall infection progressed and the patient expired after rupture of the proximal aortic closure.


Pharyngoesophageal caustic stricture. Treatment by pharyngogastrostomy compared to colon interposition combined with free bowel graft. Four cases of combined hypopharyngeal and cervical esophageal stricture secondary to caustic ingestion are presented. Although gastropharyngostomy has rarely been used for treatment of patients with caustic stricture of the pharynx and cervical esophagus, we believe that it is a useful procedure and has several advantages over use of the colon. We prefer total esophagectomy and posterior mediastinal transposition of the stomach to the neck followed by gastropharyngostomy in those patients who have minimal stomach involvement.


A measure of competence. The first Mushin lecture. The process by which an individual is finally recognised as a physician and licensed to practice medicine is long and complicated. The physician who chooses to specialise pursues additional study and after successfully completing both written and oral examinations may be certified by a 'specialty board'. Such certification is looked upon as evidence that the physician is competent to practice at the consultant level. The competent clinician possesses the intellectual capacity to make valid medical judgments and the technical expertise in his own special field to implement or to direct the implementation of such judgments. The written examination measures the pool of information essential for the individual to make valid medical judgments in the area tested. The oral examination examines attributes difficult to evaluate by other techniques since attributes demand both observation of the candidate and interaction with him. The oral exam is probably a better way to evaluate a candidate's ability to make clinical judgments, to synthesize information, to relate specific basis information to clinical problems presented and, to some extent, to test the ability of the candidate to react in stressful situations. Inadequacies of the oral examination continue to include a lack of objectivity and the potential for bias. Some specialty boards require certificates of clinical competence issued by the faculty of the training programme on behalf of applicants who seek certification in their specialty. In addition to such judgments of clinical competence, the concepts of peer review, licensure, recertification and continuing education all play a role in the elusive objective of assessing clinical competence.


[The supraclavicular approach to the V. Anonyma (author's transl)]. Experience gained with supraclavicular anonyma (brachiocephalica) catherizations carried out on more than 2,500 patients in an emergency and for prolonged infusion therapy is explained and discussed in the following on the bases of 800 registered tappings. A detailed description and discussion is given of the technical and methodical aspects of applying the Seldinger method and a constant catheter length, and in using a recently developed catheter which has the advantage of letter fixation; The only clinical complications observed during an average infusion time of six days was pneumothorax in 1.2% of the tappings and phlebitis in 0.9% of the catherizations. For vena anonyma tapping, the particular advantages are the easy accessibility of the vessel in every state of blood circulation at a high rate of 95%, the non-existence of false positions, the excellent catheter compatibility, the possibility of recatheterization, the possibility of optimum fixation, the safety in nursing, and the unrestricted mobility of the patient.


Localization of low molecular weight acrosin-trypsin inhibitors in the boar genital tract by immunofluorescence. Using the indirect immunofluorescent technique, the occurrence and distribution of the low molecular weight acid-stable acrosin inhibitors from boar seminal plasma (BSAI) in the boar genital tract was studied applying specific inhibitor-directed rabbit-immunoglobulins. The acrosin inhibitors are localized in the mucosa cells of the cauda epididymis, the vas deferens, the seminal vesicles, the urethra  and distinct glandular units of the prostate. The wide distribution of the acrosin inhibitors within the boar genital tract indicates a protective function towards the destructive proteolytic potential of acrosin liberated e.g. during sperm aging from desintegrating spermatozoa.


House dust mite and house dust allergy.

House dust mite and house dust allergy. Skin testing and the radioallergosorbent test (RAST) with extracts of house dust and mite (D. farinae) were performed on 100 patients. Correlation between positive prick tests with the two antigens was low, many more reactions being obtained with the house dust antigen in patients clinically positive to house dust. Also, for both antigens, the degree of reactivity was higher with the prick test than with RAST. It is concluded that, in this geographic area, house dust extract is more suitable than mite extract for skin testing and, by inference, for hyposensitization therapy of house dust-sensitive patients.


Hypoxemia and hypocarbia following intermittent positive-pressure breathing. The authors determined the effects of short-term, vigorous intermittent positive-pressure breathing (IPPB) on arterial blood O2 tension (Pao2) in 10 unmedicated preoperative adult patients (ASA class I). Arterial blood was analyzed before and 0.5, 5, 15, and 40 minutes after 12 minutes of IPPB with nebulized 0.9% HaCl and room air. Pao2 increased from 89.1 +/- 11 torr (mean +/- SD) to 102.1 +/- 13.9 torr, and arterial CO2 tension decreased from 29.5 +/- 4 torr to 18.4 +/- 3 torr, causing significant respiratory alkalosis (pHa 7.62 +/- 0.05). Five minutes after IPPB, Pao2 decreased to 69.2 +/- 8 torr; alveolar-arterial Po2 difference, breathing 21% O2, increased significantly; and serum K+ concentration decreased significantly. All these values returned to baseline levels within 40 minutes. The authors, acknowledging the value of IPPB when specifically indicated, counsel caution in patients with borderline pulmonary reserve and arterial oxygenation.


An up-to-date look at mold allergy.

An up-to-date look at mold allergy. The general distribution of the more frequently encountered airborne molds is reviewed. Improved diagnostic and therapeutic mold allergens, a knowledge of botanical relationships among molds and new injection techniques facilitate handling of clinical problems caused by molds.


Serum antibody to Escherichia coli heat-labile enterotoxin in cattle and swine. Antibody titers to Escherichia coli heat-labile enterotoxin (LT) were measured in serum samples collected from mature cows, butcher pigs, mature sows and adult sheep, horses, dogs, cats, turkeys, and chickens. The frequency of LT antitoxin titers was greatest in sows (94%) and less in cows (38%). Titers were higher in swine than in cattle. There were no LT antitoxin titers in serums from sheep, horses, dogs, cats, turkeys, and chickens. It was concluded that LT-producing Escherichia coli are prevalent in the swine population, but much less so in cattle and the other species examined.


Ideal laparotomy closure: comparison of retention sutures with new retention bridging devices. Three techniques of retention suture application are compared for inflammatory complications. The conventional technique is compared with two new devices. Using the derivation for pressure generation, reasons are provided for the varying degree of inflammation found. Advantages of the nonspan bridging device, which allows for more precise control of applied force, are emphasized.


[Histiocytosis X. Three cases treated with prednisone and vinblastine (author's transl)]. Three cases of histiocytosis X treated along six years with a combined doses of vinblastine (0.1-0.3 mg./Kg./day, weekly doses) and prednisone (20 mg./48 hours) are commented.


[Multiple agent cyclic chemotherapy in the treatment of acute lymphoblastic leukemia of children ("C"-protocol) (author's transl)]. 61 consecutive children having A.L.L., were treated, between 1970 and 1974, according to a chemotherapy protocol including: 1. Induction treatment with prednisolone, vincristine and daunorubicine. 2. Maintenance therapy using three types of two drugs combinations, administered by cycles of three months duration each one. The associations were: mercaptopurine-methotrexate, mercaptopurine-cytosine arabinoside and methotrexate-cyclophosphamide. Between cycles, "reinductions" with prednisolone and vincristine of two weeks duration were given. 3. "Prophylactic" treatment of CNS leukemia was administered according to two modalities: a) In group named C-1, 32 patients received one dose of i.t. methotrexate at the end of the induction treatment and every three months. b) The other 29 patients (C-2 group) were treated by cranial irradiation (2400 r.) and five doses of i.t. methotrexate, after the induction of remission (C.R.). 57 out of 61 patients (93%) attained C.R. Twelve months after induction of C.R., in C-1 group, one patient died by infectious disease and eight relapsed. Twenty (68%) remained in C.R. The number of CNS relapses in this period was six (20%). In C-2 group, from 21 evaluable cases, 18 children (85%) were in C.R. at the end of first year and relapses in CNS were only two (9%). The median duration of remission in the first group was about three years. Percentage of cases with CNS relapses in three years was 35%. At the end of 4 th. year 37% remained in the initial C.R.-80% of the evaluable patients receiving cranial irradiation persisted in remission at the end of the second year. Efficacity of the prophylactic treatment of CNS infiltration, by cranial irradiation and i.t. chemotherapy is confirmed. Cyclic use of several combinations of drugs don't appear to be superior to the use of one single association (MP-MTX), but other combinations used here may be taken in account in cases of severe intolerance to one of these drugs.


[Cytosine arabinoside in the treatment of varicella in lymphoblastic leukemia or lymphosarcoma (author's transl)]. Nine children with acute lymphoblastic leukemia or lymphosarcoma adquired varicella and were treated with cytosine arabinoside. There was a progression of the varicellous lesions which in some cases became hemorrhagic. In four occasions disease became disseminated. Two children died. The hematologic toxicity was tolerable.


[Diagnostic criteria of rickets: an historic study (author's transl)]. This paper presents an historic study of the medical criteria used for the diagnosis of rickets up to the present time. It mainly refers to diagnosis at very early stages. The publications edited in Spain were chiefly used as source material. Attention is drawn to the progress in clinical and differential diagnosis in each historic period. The physiopathological mentality tried to discover biochemical sings at early stages which were characteristic of the illness. These data later suffered a progressive devaluation so that nowadays the early diagnosis of the illness represents an almost identical challenge to that of the XIXth century.


Sequential nonsurgical and surgical staging of non-Hodgkin's lymphoma. The yield of specific diagnostic procedures in the staging of non-Hodgkin's lymphoma was assessed in 170 consecutive patients who were evaluated with a sequence of diagnostic procedures. Stage III or Stage IV disease was established in 141 of 170 patients (80%) by nonsurgical procedures, including lymphangiography (positive in 78%), bone-marrow biopsy (positive in 39%), percutaneous liver biopsy (positive in 21%), and peritoneoscopy-directed liver biopsy (positive in 29% of those tested). Staging laparotomy showed disease outside conventional nodal irradiation fields in 21 of 26 patients with a positive lymphangiogram, but in only three of 17 patients with a negative lymphangiogram. The yield of staging procedures was highest in patients with nodular lymphomas, only 6% of whom were Stage I or Stage II after staging, but was lowest in patients with histiocytic lymphoma, 30% of whom had localized disease. This study shows that the presence of disseminated disease can be detected in the majority of patients with non-Hodgkin's lymphoma without the use of staging laparotomy.


Amantadine effect on peripheral airways abnormalities in influenza. A study in 15 students with natural influenza A infection. Amantadine HCl administration has resulted in accelerated resolution of influenza A illness. Prolonged abnormalities in pulmonary function have been described in uncomplicated influenza A. To study the effect of amantadine on these changes, we evaluated young adults with documented natural influenza A with clear chest examinations and X rays. Subjects received placebo or amantadine in random, double-blind fashion. Physiologic studies included maximal expiratory flow volume curves with air and helium-oxygen mixtures. Air flow rates were unchanged in all subjects throughout. Initially, both groups showed comparable decreases in mean helium-oxygen maximal expiratory flow rates. The amantadine group showed accelerated physiologic improvement: significant increase in helium-oxygen flow rates occurred within 7 days (P less than 0.05). The rate of improvement in the helium-oxygen flow rates in the placebo group was not statistically significant. These studies confirm peripheral airways dysfunction after uncomplicated influenza A and suggest that amantadine is associated with accelerated resolution of this dysfunction.


Successful renal transplantation in progressive systemic sclerosis. Hemodialysis and renal transplantation were done in a patient with progressive systemic sclerosis and renal failure. The patient's clinical course following transplantation was uncomplicated, and a biopsy of the renal allograft done 14 months after transplantation did not show recurrence of the original disease. These observations favor the consideration of early renal transplantation in patients with scleroderma and renal failure.


NIH conference. Dopamine- -hydroxylase. Basic and clinical studies. Dopamine-beta-hydroxylase, the enzyme responsible for conversion of dopamine to norepinephrine, is released along with catecholamines from the adrenal medulla and from sympathetic nerve endings. The properties and mechanisms of the enzyme's action are discussed and its distribution described. Dopamine-beta-hydroxylase is a valuable indicator of exocytosis as a mechanism for neurotransmitter release. The enzyme is present in plasma, but its levels vary widely between individuals. This variation seems to be related more to genetic factors than to sympathetic nerve activity. Abnormally high or low plasma levels are associated with several diseases. However, the relation of these levels to disease pathogenesis rather than to genetic determinants is unclear. Levels of the enzyme are elevated in patients with pheochromocytoma and decline after removal of the tumor. Dopamine-beta-hydroxylase levels seem to be normal in hypertensive patients. Inhibition of dopamine-beta-hydroxylase provides a useful pharmacologic approach to evaluating the role of norepinephrine in psychiatric disorders.


Congenital absence of the vagina. The Mayer-Rokitansky-Kuster-Hauser syndrome. We describe 14 patients with congenital absence of the vagina associated with a variable abnormality of the uterus and review the literature. Associated developmental anomalies of the urinary tract and skeleton are common. As a result of the analysis of two affected families, we believe that the disorder may represent the variable manifestation of a single underlying genetic defect that can be expressed alone or in any combination of vertebral, renal, and genital abnormalities. Some affected persons may have lethal manifestations such as absence of both kidneys, and some cases may result from multifactoral causes rather than a single gene defect. Whatever the cause, the defect involves mesodermal development and the mesonephric kidney, the latter resulting in abnormalities in the paramesonephros (uterus and vagina) and in the metanephric kidney. Both nonoperative and surgical treatments are generally successful in repairing the vaginal abnormality.


Hyperparathyroidism: retrospect and prospect. The history of hyperparathyroidism is outlined and the diagnosis and treatment of its various causes reviewed with reference to a series of 153 patients operated on for hyperparathyroidism in the past 20 years. In 119 cases the condition was primary, being due to a tumour or hyperplasia. Future developments in this field are briefly considered.


Bilateral abductor paralysis: 30 years experience with arytenoidectomy. Modifications of the technique originally reported in 1946 are presented, which may help in improving the percentage of successful decannulations. The importance of a change in the level of the vocal cord by this procedure is emphasized. The ten cautions to be followed are reviewed in doing this procedure.


Nonoxidative enzymes in the metabolism of insecticides. Two major classes of enzymes, i.e., hydrolases and transferases, comprise all the nonoxidative enzymes, and together these enzymes catalyze a wide variety of biotransformations of insecticides. The hydrolytic enzymes involved in insecticide metabolism are carboxylesterase (EC 3.1.1.1), arylesterase alkylamidase, and DFPase (EC 3.8.2.1). Recent experimental evidence suggests that carboxylesterase enzyme(s), formerly known to hydrolyze malathion-type insecticides, can also catalyze hydrolysis of a variety of diversified insecticidal esters such as benzilic acid derivatives, carbanilate compounds, and pyrethroids. These organophosphate-sensitive esterases, with the exception of the enzyme which hydrolyzes malathion, are all present in microsomes. Similarly, the action of amidases now extends to those insecticidal compounds of their intermediates which contain an aminoformyl (N-CHO) moiety. Arylesterase and DFPase catalyze the P-anhydride bond cleavage of the leaving group, a major hydrolytic pathyway for organophosphate insecticides. Transferal enzymes which are presently know to metabolize insecticidal organophosphates are GSH-S-alkyltransferase (EC 2.5.1.12) and GSH-S-aryltransferase (EC 2.5.1.13). These enzymes cleave P-O-R (R = alkyl) or P-0-X (X = aromatic), with subsequent transfer of the R or X group to glutathione. Regarding the other conjugating enzymes, UDP-glucuronyltransferase (EC 2.4.L.17), UDP-glucosyltransferase (EC 2.4.1.35), and arylamine acetyltransferase (EC 2.3.1.5), much work is needed to understand their interactions with insecticidal compounds. There is some evidence that arylsulfotransferase (EC 2.8.2.1) MAY PLAY A PROMINENT ROLE IN THE CONJUGATIVE MECHANISMS OF INSECTS.


The distributions of subunit numbers and subunit sizes of enzymes: a study of the products of 100 human gene loci. 1. A tabulation of subunit numbers and subunit sizes of a series of enzymes which have been studied electrophoretically in man is presented. The series of subunit numbers cover the isozyme products of 100 distinct gene loci. For 99 of these, estimates of subunit size are given. 2. The distribution of subunit numbers in the whole series is as follows: monomers, 28; dimers, 43; trimers, 4; tetramers, 24; octamers, 1. 3. The subunit sizes range from 13,000 to 116,000. The average subunit size for the whole series is close to 45,800. This corresponds to an average polypeptide chain length of about 425 amino acids. 4. No significant differences were found between the average subunit sizes for the separate classes of enzyme with different subunit numbers. 5. The enzymes were categorized in six different types according to the classification of the International Enzyme Commission. It was found that the oxido-reductases differed from the other types (transferases, hydrolases, lyases, isomerases, ligases) in showing a much greater proportion of multimeric enzymes. Only 1 out of 24 oxido-reductases appeared to be a monomer, whereas in the other enzyme types approximately one-third of the enzymes considered appeared to be monomers. No significant differences in subunit size were found between the various enzyme types. 6. It was found that, in general, where two or more separate gene loci are concerned in determining sets of isozymes with the same or very similar enzyme characteristics, there is a close correlation in subunit size and in most, though not all, cases the subunit numbers are the same.


Causative agents in the induction of bladder cancer. A survey of many of the known or suspected causative agents in the etiology of bladder cancer is presented. In several instances, a comparison of the epidemiological evidence and the results of animal bioassays is made. Difficulties in the interpretation of animal studies and the extrapolation of animal data to estimate human risk is discussed. Each class of chemicals, such as the aromatic aminatic amines or the non-nutritive sweetners, presents its unique problems when attempts are made to evaluate its potential as a causative agent in the etiology of bladder cancer.


Spontaneous conversion of precursor cells into cells producing antibodies against sheep erythrocytes in cultures of mouse peritoneal cells. The role of cell division in the spontaneous development of antisheep PFC in cultures of mouse peritoneal cells has been studied. Mitotic index measurement showed that most PFC were not recruited by division. LPS (a blastogenic and mitogenic substance) increased the number of PFC much more than it increased the number of mitosis. X-ray-irradiation of the donor mice did not affect the kinetics of PFC development. It was, therefore, concluded that PFC recruitment in mouse PC in culture was essentially related to cell differentiation, cell division playing only a minor role.


In vitro growth of colonies from human peripheral blood lymphocytes stimulated by phytohemagglutinin. Normal peripheral human white blood cels (WBC) plated in agar culture generate colonies of blastoid cells when stimulated in vitro by phytohemagglutinin (PHA). Aggregates of PHA transformed cells are first visible by day 3-4. By day 7, the morphology of colonies becomes typical as clear discoid raspberry-like aggregates of 50-200 cells or more growing at or near the surface of the agar plate. Their dense arrangement and the coexistence within individual colonies of large and smaller cells are two main characterisitcs of these colonies. Wright-Giemsa stained preparations from cytocentrifuged colonies show cells at different stages of "lymphocyte transformation". These cells are PAS and peroxidase negative. They do not bear surface immunoglobulins but most of them form rosettes with sheep red blood cells. These observations strongly suggest that these colonies are made of T-lymphocytes. However, in view of the number of isolated transformed cells which do not form colonies, the possibility is raised that the cells which generate these colonies may represent a subset of PHA sensitive cells.


[Utilization of yeast mutants with a defect in the cellular membrane in the search for anticancer antibiotics]. The mutants of Saccharomyces cerevisiae, strain FL 599-I B with defect cell membranes are selectively inhibited by anticancer antibiotics with different molecular mechanisms of action on DNA. At the same time they are insensitive to antibacterial antibiotics. Such mutants may be used as test-cultures in isolation of active agents with antitumor effect from complex mixtures of natural substances. The above test-object makes it easier to perform separation of antimour antibiotics from accompanying bacterial inhibitors.


[Production of phage-resistant mutants of E. coli, producers of penicillin acylase]. Full resistance to the virulent phage C1 in E. coli N68 is usually accompanied by decreased capacity for penicillinacylase production. For rapid selection of phage resistant mutants possessing penicillinacylase activity comparable with that of the initial bacteria a method was proposed. The method provided comparison of the penicillinacylase activity of the bacterial colonies grown on solid media with addition of phenylacetic acid as the enzyme inductor. A great number of mutants forming colonies on the solid medium in the presence of phage C1 was compared with the use of the above method and a mutant of E. coli N68-PR-I resistant to the phage with penicillinacylase activity equal to 68 per cent of that of the bacteria of the wild type was selected. Mutant N68-R-5 with increased resistance to phage CI was selected among the mutants of E. coli N68 resistant to rifampicin. The penicillinacylase activity of this mutant was not less than of E. coli N68. Phage CI can lyse the cells of strain N68-R-5. Still these bacteria possess a markedly decreased capacity for the phage reproduction.


[Study of the antitumor activity of carminomycin in malignant tumors in children (a preliminary report)]. Side reactions and therapeutic effect of carminomycin were studied in 21 children with various malignant tumors. Carminomycin was administered intravenously in doses of 0.15-0.2 mg/kg twice a week for 2-3 weeks. The treatment courses were repeated in a month. The drug was better tolerated by children than by adults. After the treatment course leucopenia may develop. When used alone or in combination with vincristin or cyclophosphan carminomycin proved to be effective in treatment of sarcoma of the soft tissues (liposarcoma, synovial sarcoma), chondrosarcoma and reticulosarcoma.


[Therapeutic use of carminomycin in soft tissue sarcomas]. A total of 39 patients with sarcoma of the soft tissues were treated with carminomycin administered intravenously in doses of 10-15 mg twice a week, the total dose being 60-70 mg. The intervals between the courses were 1 month. The objective effect was observed in 17 out of 39 patients, i. e. 43.6%. The tumor decrease was registered in 6 out of 15 patients with leuomyosarcoma, in 3 out of 6 patients with synovial sarcoma, in 2 out of 4 patients with robdomyosarcoma, in 1 out of 4 patients with angiosarcoma, in 1 out of 3 patients with fibrosarcoma, in 1 patient with liposarcoma and in 3 out of 5 patients with stromal sarcoma of the uterus. A necessity for repeated treatment courses in spite of a positive effect or absence of the disease progress is underlined.


Beta-lactamase activity in Shigella sonnei. The basis of ampicillin resistance in Shigella sonnei was analyzed for a number of isolates. Most isolates that were resistant to ampicillin and cephalothin failed to transfer resistance. Isolates resistant to cephalothin and ampicillin were inhibited by mecillinam, cefamandole, and cefoxitin. Six strains were selected for study. These differed on the basis of inhibition by 10 beta-lactam antibiotics and on differences in beta-lactamase activity. There was no correlation between the inhibitory concentration of antibiotic and the amount of antibiotic hydrolyzed. Use of sodium chloride and cloxacillin inhibition and acrylamide electrophoresis demonstrated that ampicillin resistance in Shigella is mediated by a number of different beta-lactamases. Organisms can contain more than one type of beta-lactamase.


Colonization of the intestinal tract of conventional mice with Candida albicans and treatment with antifungal  agents. Conventional mice inoculated with Candida albicans per os were unable to maintain this organism in the intestinal tract as judged by decreasing numbers of yeast recoverable from feces. After inoculation with 10(7) cells/mouse, fecal counts ranged from 10(5) cells per g of feces to 5 x 10(3) cells per g of feces during a 12-day experimental period. Addition of various antibiotics to the drinking water did not result in any improvement in maintenance or stability of the gut population. A combination of X irradiation and administration of tobramycin or gentamicin, however, resulted in a stable population of C. albicans in the intestinal tract, with cell counts in the feces remaining constant at a level of about 10(6)/g of feces for a period of 10 to 15 days. The usefulness of this model in assessing the effect of experimental drugs on C. albicans infections of the gut was demonstrated by the fact that treatment with a new antifungal antibiotic (A9145), amphotericin B, 5-fluorocytosine, or nystatin resulted in a reduction in the fecal counts of C. albicans from experimentally infected animals.


Sensitivity of yeasts to lithium.

Sensitivity of yeasts to lithium. A wide range of tolerance to Li+ has been found among 12 different yeasts. Concentrations that do not allow long-term growth of an actively growing culture within 2-5 hr. At the same concentrations protein and RNA synthesis are inhibited with little or no lag period (less than 50 min) but respiration is not affected at these concentrations. Lower concentrations that do not inhibit growth, may impair sporulation. For given extracellular conditions, intracellular Li+ concentrations are lower in the more tolerant yeast strains.


Use of the Hungate anaerobic technique in the isolation of phloroglucinol-negative mutants of Coprococcus species. The Hungate anaerobic technique was used with a standard procedure for bacterial mutagenesis employing N-methyl-N-nitro-N'-nitrosoguanidine to obtain mutants of an obligate anaerobe. Three mutant strains were derived from a Coprococcus sp., strain Pe15, a rumen anaerobe capable of growing on phloroglucinol. The mutants did not grow on phloroglucinol but did degrade the compound in anaerobic washed-cell suspensions, producing the same end products in approximately the same proportions as the wild type. It was concluded that the mutants were blocked in a unique step or steps necessary for carbon skeleton or energy synthesis from phloroglucinol and not in formation of an enzyme involved in the pathway of phloroglucinol degradation.


Macromolecular syntheses during biosynthesis of prodigiosin by Serratia marcescens. Amino acids that were utilized as sole sources of carbon and nitrogen for growth of Serratia marcescens Nima resulted in biosynthesis of prodigiosin in non-proliferating bacteria. Addition of alanine, proline, or histidine to non-proliferating cells incubated at 27 C increased the rate of protein synthesis and also caused biosynthesis of prodigiosin. No increase in the rate of protein synthesis was observed upon the addition of amino acids that did not stimulate prodigiosin biosynthesis. Increased rates of synthesis of ribonucleic acid (RNA) and of deoxyribonucleic acid (DNA) (a small amount) also occurred after addition of amino acids that resulted in biosynthesis of prodigiosin. After incubation of 24 h, the total amount of protein in suspensions of bacteria to which alanine or proline was added increased 67 and 98%, respectively. Total amounts of DNA and of RNA also increased before synthesis of prodigiosin. The amounts of these macromolecules did not increase after addition of amino acids that did not induce biosynthesis of progidiosin. However, macromolecular synthesis was not related only to prodigiosin biosynthesis because the rates of DNA, RNA, and protein synthesis also increased in suspensions of bacteria incubated with proline at 39 C, at which temperature no prodigiosin was synthesized. The quantities of DNA, RNA, and protein synthesized were lower in non-proliferating cells than in growing cells. The data indicated that amino acids causing biosynthesis of prodigiosin in non-proliferating cells must be metabolized and serve as sources of carbon and of nitrogen for synthesis of macromolecules and intermediates. Prodigiosin was synthesized secondarily to these primary metabolic events.


Cutaneous protothecosis in a patient receiving immunosuppressive therapy. A 30-year-old recipient of a renal transplant, who was receiving immunosuppressive therapy, developed cutaneous abscesses from which an organism of the genus Prototheca was cultured. The patient died of Klebsiella septicemia. At the time of death, pure cultures of Prototheca and Candida organisms were grown from separate skin lesions. Prototheca is a genus of achloric algae. Cultural, microscopical, and staining characteristics separate these organisms from the yeast and fungi. Cutaneous protothecosis was first described in 1964 by Davies et al in an otherwise healthy African rice farmer. Since that time, nine other cases have been reported. However, only a single case has been described in a patient receiving immunosuppressive drugs, a woman with carcinoma of the breast who was receiving chemotherapy with multiple agents.


Benign chronic bullous dermatosis of childhood. Linear IgA and C3 deposition on the basement membrane. Benign chronic bullous dermatosis of childhood (BCBDC) is characterized by predominantly monomorphous, large, tense bullae with a predilection for the lower part of the trunk, the pelvic region, and the lower extremities. Most patients have blisters for two to three years and experience spontaneous exacerbations and remissions. We report the first case known to us in which a linear bank of IgA (but no lgG or lgM) and complement was found at the epidermal basal lamina as demonstrated by immunofluorescence studies.


IgA deficiency and systemic lupus erythematosus. Occurrence in an oriental woman with idiopathic epilepsy. A 25-year-old Oriental woman developed systemic lupus erythematosus during a course of treatment with carbamazepine for long-standing idiopathic epilepsy. Serum IgA was virtually absent, while secretory IgA was quantitated in a small amount in the saliva and gastric juice. Results of immunofluorescent studies on the rectal mucosa and bone marrow did not show any IgA-producing plasma cells. Antibodies against IgA, IgM, milk protein, and bovine serum were detected in the serum. The ability to develop both circulating antibodies and delayed hypersensitivity against test antigens was suppressed. Enumerations of T lymphocytes and IgG and IgM B lymphocytes were within normal limits, whereas IgA B lymphocytes were decreased in number. Results of chromosomal analyses disclosed various abnormalities.


Bullous impetigo. Occurrence of localized scalded skin syndrome in an adult. The localized form of staphylococcal scalded skin syndrome, bullous impetigo, occurs commonly in children but rarely in adults. We will describe a case of bullous impetigo in an adult which developed while the patient was receiving short-term therapy with orally administered corticosteriods. Scalded skin syndrome in this case was characterized by isolation of phage group 2 staphylococci from intact bullae and by the presence of an intraepidermal, subgranular cleavage plane in histological sections. Features that differentiate the localized form of scalded skin syndrome from generalized forms include the presence of dermal infiltrate and the absence of cutaneous erythema and tenderness. On the basis of available experimental evidence, the rarity of both localized and generalized scalded skin syndrome in adults can be attributed to immunologic competence or enhanced capacity of adults to metabolize the staphylococcal exfoliatin.


T and B lymphocytes in contact and atopic dermatitis. The pattern of distribution of T and B lymphocytes was investigated in a group of patients with contact, atopic, and mixed dermatitis by means of immunofluorescence and T-cell rosette tests. A significant increase (P less than .001) in B lymphocytes with surface IgD but without changes in the lymphocytes bearing other immunoglobulins or C3 and T cells was noted in patients with contact dermatitis when compared with a control group. A significant increase (P less than .001) in B lymphocytes carrying IgE and a significant decrease (P less than .001) in the total numbers of T cells were noted in patients with atopic dermatitis, and a significant increase in B lymphocytes positive for IgD (P less than .001) and IgE (P less than .003) with a decrease in the number of lymphocytes bearing IgG were the most important changes observed in patients with mixed contact and atopic dermatitis.


Herpes gestations with identical lesions in the newborn. Passive transfer of the disease? Cutaneous lesions of herpes gestation is developed in a newborn on the fifth day of life and disappeared spontaneously after three weeks. The immunologic phenomena were analogous in the mother and child. No circulating or in vivo-bound immunoglobulins were demonstrated, but components 3 and 4 of complement were present at the basement membrane zone. We discuss a possible passive transfer of the disease to the newborn, and a supposedly pathogenetic role of immunologic phenomena in herpes gestationis.


Annular atrophic plaques of the face. A variety of atrophic discoid lupus erythematosus? In a patient whose condition was diagnosed clinically and pathologically as annular atrophic plaques, the lesions bore some resemblance to morphea, lichen sclerosus et atrophicus, and discoid lupus erythematosus (DLE). In a lesion that appeared recently, which was not DLE clinically, the histological characteristics were consistent with DLE, and immunofluorescence examination disclosed an immunofluorescent band at the epidermal-dermal zone. We suggest that annular atrophic plaques may be an atypical variant of DLE, with a tendency to sclerosing.


Continuous postive airways pressure treatment by a face chamber in idiopathic respiratory distress syndrome. Continuous positive airways pressure treatment by a face chamber in idiopathic respiratory distress syndrome. During a 3-year period 45 infants with idiopathic respiratory distress syndrome (IRDS) requiring ventilatory support were treated in the neonatal unit. Continuous positive airways pressure (CPAP) via the face chamber was applied as initial therapy in 39 infants and during weaning from initial intermittent positive pressure ventilation (IPPV) treatment in 5 infants, whereas 1 infant received IPPV only. Among the 39 infants initially treated with CPAP 9 required IPPV as well. The overall survival rate was 37/45 or 82%. Incapacity to hyperoxygenate while breathing 100% oxygen was the indication for CPAP while occurrence of apnoeic attacks was the indication for IPPV. Pao2 during the hyperoxia test before ventilatory support was less than 50 mmHg in 10 infants and between 50 and 105 mmHg in 35 infants. Surviving infants were followed up with neurological and developmental control examinations as well as chest x-ray, and in several infants pulmonary function tests. 3/37 infants had moderate neurological sequelae and only 1/37 infants developed bronchopulmonary dysplasia. No deleterious effects of the face chamber were seen. As the face chamber is a noninvasive and easily applied technique for CPAP therapy without hazards, it is proposed that it should be used at a still earlier stage of IRDS in order to lesson the need for IPPV treatment and to increase the neurological and lung functional quality of survival.


Controlled trial of continuous inflating pressure for hyaline membrane disease. A controlled trial of elective intervention with continuous inflating pressure (CIP) was performed in infants with severe hyaline membrane disease who weighed more than 1000 g at birth. Infants entered the trial if their arterial oxygen tension (PaO2) fell below 60 mmHg while breathing a fractional inspired oxygen concentration (F1O2) greater than 0-95. 11 out of 12 infants in the CIP-treated group and 10 out of 12 in the control group survived. 7 treated and 6 control infants required mechanical ventilation. When CIP was started the Pao2 of the treated infants increased, and they breathed high concentrations of oxygen for a significantly shorter period than the control infants. During the 31-month duration of the trial 107 other infants with severe hyaline membrane disease were admitted who did not meet the criteria for entry to the trial. 37 survived after breathing high concentrations of oxygen (F1O2 greater than 0-60) spontaneously without any ventilatory assistance, and the remaining 70 infants were already being ventilated on their arrival in the unit, usually because they had required mechanical ventilation during transfer from other hospitals. The neonatal survival rate for those infants born in this hospital during the study period was 88% (50 out of 57 infants) and for those referred from other hospitals it was 69% (51 out of 74 infants). The maximum further increase in overall survival rate that might have been achieved in our population of infants if CIP had been initiated very early in the course of the illness was 5%--i.e. from 77% (101/131) to 82% (107/131).


Effects of swimming training on children with asthma. In a programme to examine the effect of 5 months of swimming training on school-children with asthma, 46 children swam a total distance of 3608 km (2242 miles) during 2806 training sessions. On post-training re-examination, nonspecific effects of physical conditioning were detected including improved posture and fitness, reduced fat folds, and enhanced swimming ability. Continuous monitoring of asthma and medication showed significant decreases in both parameters during the final phases of the study between children who continued to swim regularly and those who did not. The frequency and severity of exercise-induced asthma (after running) was unchanged by swimming training. Post-training questionnaires indicated a high degree of enthusiasm and acceptance of the programme by children and parents. No significant adverse effects were observed or reported during the study.


Application of immunofluorescence to a study of measles. A new and rapid method for the laboratory diagnosis of measles, using the fluorescent antibody technique applied to nasopharyngeal secretions is described. The reliability of the method was best shown by correlation with clinical diagnosis, which gave an overall agreement of 95% in 53 cases of typical clinical measles and 72 control children. Correlation with results of tissue culture and serology was also good, though these methods are in practice too infrequently successful to be used as the main standards of reliability. The antiserum used for immunoflorescence showed no cross-reactivity with other viruses. Viruses could be identified by the fluorescent antibody technique from 4 days before to 10 days after the onset of the rash in a high proportion of cases. The wider applications of this method include rapid diagnosis of measles before the rash has appeared; in cases where clinical diagnosis is in doubt, especially in dark-skinned children, or when the illness has been modified by previous vaccination; prevention of cross-infection by early detection of measles; and investigation of the immune response and its relationship to nutritional status.


Adolescents with spina bifida. How they see their situation. Forty-six adolescents with spina bifida were interviewed at home to find out how they felt about their situation. Some degree of misery was very common indeed but was more likely to be severe in girls than in boys. About half the girls had, on some occasion in the past year, felt that life was hopeless or not worth living. Since these feelings are related to their social isolation outside school, they might be alleviated by improved opportunities for contract with peers. This seems particularly important in view of the capacity of most teenagers to make reasonable relationships where the opportunity exists, e.g. at school or within the family. Over half those who had left school were either unemployed or very dissatisfied with their job. In addition to worries about work, preoccupations about sexual relatinships, sexual function, and marriage were common. About two-thirds of the teenagers hoped to get married and half of these thought they could have children. Girls were particularly worried about their capacity to conceive and boys had understandable concerns about potency. Very few had consulted anyone about this or had had advice about the genetic aspects of the condition and there is a clear need for adequate counseling to help such teenagers to distinguish between real and imagined fears about the consequences of their condition.


[Studies of cellular sensitization to BCG and PPD using leukocyte cell migration inhibition]. Leucocyte inhibition migration test (LMT) with BCG and PPD was applied in pulmonary tuberculosis, lung cancer and sarcoidosis. No significant differences were noticed in the results obtained with each of the two antigenic materials; nevertheless, one case lobectomized of lung cancer successively treated with chemiotherapie and immunostimulation with BCG presented LMT positivity with BCG and negativity with PPD. The unpublished results of the former investigations carried out with brute tuberculin (LMT) on patients with pulmonary tuberculosis are here reported no significant difference was noticed between the results obtained with brute tuberculin, and the results with PPD. The still unsettled problem presented by the lack of inhibition in the presence of PPD in leucocyte migration test in patients with areactive (AA) and intermediate areactive (AI) tuberculosis is also briefly discussed. Finally, the existence of a dissociation between the cutaneous delayed test and the in vitro test for the detection of cellular sensibilisation is confirmed even when LMT is applied either in the presence of BCG or of PPD.


[Microbiological control of edible Mollusca in Milan's trade in 1971-1974]. A microbiological control of edible Mollusca in trade of Milan Market and coming from Adriatic's cultivation basins during 1971-1974 was performed. During 1971-1973 anterior to choleric epidemy of 1973, alot of 2680 mussel's specimens were examined with the ACIS 1949 method, of which 60% (1611) favorable and 39.9% (1069) contrary; a single semple presented a S. paratyphi B germ. During 1974 with a new regulamentation 111 mussel's specimens were examined with M.S. 1973 more restrictive method (Colonbacterial titre). With that method 41 samples were not favorable which were favorable with ACIS method. A new hygienic angayement results therefore necessary.


Factors related to success or failure of second renal transplants. From January 1, 1968 to December 31, 1973, 50 patients received two or more kidney transplants. Patient and graft survival was highly dependent upon the source of the donor and to a lesser extent the functional duration of the first transplant and the elapsed time between first and second graft. Survival (patient and graft) was best in patients receiving two related grafts and worst in patients receiving two sequential cadaver grafts. Intermediate rates of success followed cadaver transplantation after rejection of a related graft. The highest failure rate was encountered when those patients who sustained an early loss of the first cadaver graft received a subsequent cadaver graft within a few months. We recommended removal of the acutely rejected graft and delay prior to retransplantation of patients who rapidly reject cadaver grafts in the face of maximal doses of immunosuppression. A delay will permit recovery from both the immunosuppression and any underlying subclinical infections, and will permit the recognition of anti-HL-A antibodies which may not be manifest soon after rejection. Retransplantation of the patient who is slowly rejecting the first kidney does not require prior removal of the rejected graft or delay in retransplantation.


Prevention of lymphoceles following renal transplantation. Lymphoceles occur follow 1.2 to 18.1% of renal transplants. Of 543 kidney transplants performed at the University of Minnesota, lymphoceles occured in three (an incidence of 0.6%). These three patients are described. We believe lymphoceles can be prevented by ligation of all lymphatic channels around the iliac artery and vein as these structures are dissected. Also the lymphatics of the donor kidney should be ligated before division. Lymphoceles are best treated by drainage into the peritoneal cavity after excision of as much of the cyst wall as possible.


The influence of clinically undetectable pulmonary edema on small airway closure in the dog. The relationship between elevated pulmonary extravascular water volume(PEWV)and small airway closure was examined. The slow accumulation of lung water was achieved by a combination of pulmonary venous hypertension and mild hemodilution. PEWV was measured using a double indicator method based on the differential right to left transit time for simultaneously injected Evans blue dye and tritiated water. Trapped gas volume (VTG) was measured by the helium equilibration technique. Clinically undetectable levels of pulmonary engorgement and edema were reproducibly associated with an increase in gas trapping. Positive end expiratory pressure reduced, but did not abolish, edema formation. Evaluation of airway closure, with consequent gas trapping and pulmonary shunting, is currently non-invasive, simple and safe. Determination of gas trapping or closing volume should be incorporated into the rountine pre-operative evaluation of patients prior to major surgery.


Tracheo-innominate artery erosion: Successful surgical management of a devastating complication. Successful management of a patient with tracheo-innominate artery erosion requires the rapid institution of specific resuscitative and operative measures. Ten patients seen at the Charity Hospital of Louisiana in New Orleans and 127 documented cases from the world literature were analyzed regarding predisposing factors, diagnostic features, resuscitative measures and operative treatment. Diagnoses associated with abnormal neck positioning were seen in 48% of patients with tracheo-innominate erosions. In 69% of 96 instances, the site of erosion was located at the cannula end and implicates excessive anterior pressure. Caution is recommended in those patients with abnormal neck positions, low placed tracheostomy stomas and individuals with asthenic habitus. Resuscitative measures were highly successful when the tracheal ballon was inflated or when the method of retrosternal finger pressure was used. All personnel providing care for patients with tracheostomies should be aware of the initial measure of ballon inflation. Operative measures which permanently interrupted the innominate artery in the area of possible future erosion were the most successful. Of the 22 cases in which the innominate artery was sacrificed, only one had evidence of cerebral ischemia. Timely institution of proper measures can result in salvage of an unexpected number of these otherwise dramatic fatalities.