The late phase of the immediate wheal and flare skin reaction. Its dependence upon IgE antibodies. IgE antibodies are usually thought to induce only immediate skin reactions. We have shown that the intradermal injection of a number of different allergens can produce a prolonged inflammatory reaction after the immediate wheal and flare in most sensitive subjects. This late inflammatory response occurs 6-12 h after challenge and is characterized by diffuse edema, erythema, pruritus, and heat. Both immediate and late responses can also be seen after passive sensitization of skin sites in nonatopic subjects. That IgE is involved in inducing the reaction was shown by the abolition of both immediate and late responses by passive transfer tests in the following experiments: (a) heating atopic serum at 56degreesC for 4 h, (b) removing IgE from the atopic serum by a solid phase anti-IgE immunoabsorbent, and (c) competitively inhibiting the binding of IgE antibodies to cells by an IgE myeloma protein. In addition, both responses were induced by affinity chromatography-purified IgE antibody, followed by antigenic challenge. Very similar lesions could also be induced by intradermal injection of Compound 48/80, thus suggesting a central role in the reaction for the mast cell or basophil. Histologically, the late phase is characterized by edema and a mixed cellular infiltration, predominantly lymphocytic but also containing eosinophils, neutrophils and basophils. Direct immunofluorescent staining did not show deposition of immunoglobulins or complement components, except IgM in 2 of 15 and C3 in 1 of 15 patients. This finding indicates that the late phase does not depend on the deposition of immune complexes. The results of the study suggest that IgE-allergen interaction on the surfaces of mast cells or on infiltrating basophils causes both immediate and late cutaneous responses.


Impaired renal conservation of sodium and chloride during sustained correction of systemic acidosis in patients with type 1, classic renal tubular acidosis. In 10 patients with classic renal tubular acidosis in whom correction of acidosis was sustained with orally administered potassium bicarbonate, renal conservation of sodium was evaluated when dietary intake of sodium was restricted to 9--13 meq/day. In five patients, renal conservation of sodium was impaired by at least one criterion of impairment. In the remaining patients, renal conservation of sodium appeared to be relatively well-maintained, but an impairment could not be excluded. In each of six patients studied during induced water diuresis, including two in whom renal conservation of sodium was not unequivocally impaired, the minimal urinary concentrations of sodium were inappropriately high and the urinary excretion rates of sodium were flow-dependent. These results provide direct evidence that an abnormality in renal transport of sodium can occur in classic renal tubular acidosis, and compel a reconsideration of the pathophysiology of disordered renal transport of sodium in this disorder. The results indicate that in at least some patients with classic renal tubular acidosis impaired renal conservation of sodium is not exclusively a reversible consequence of the renal acidification defect. These findings raise the question whether renal transport of sodium is unimpaired in any patients with classic renal tubular acidosis. In the presently studied patients, the impairment in renal conservation of sodium appeared to be in part the consequence of an impaired ability of the vasopressin-responsive segments of the distal nephron to generate and maintain appropriately steep transepithelial sodium concentration gradients.


Arginine-stimulated acute phase of insulin and glucagon secretion in diabetic subjects. To determine if both phases of glucagon secretion are excessive in diabetes, arginine was admimistered intravenously as pulses and as infusions to normal subjects, insulin-dependent diabetics, and noninsulin-requiring diabetics. The acute phase of glucagon secretion, in response to arginine pulses at four different doses (submaximal to maximal alpha-cell stimulating), was indistinguishable in terms of timing, peak levels attained, and total increments comparing controls and diabetics. During the first half of the arginine infusion (500 mg/kg over 30 min) the glucagon rise in controls and diabetics was similar (P greater than 0.1), whereas during the last half of the infusion excessive glucagon levels were seen in the diabetics. No difference in the glucagon responses to arginine administered as either a pulse or an infusion was observed between the two types of diabetics. The acute phase responses of insulin to intravenous, maximal stimulating doses of glucose (20 g) and arginine (2.5 g) were measured in five insulin-independent diabetics. Although the acute insulin response to arginine was normal, there was marked attentuation of the early beta-cell response upon stimulation by glucose. From these results we conclude that although in diabetes excessive glucagon levels are observed with chronic arginine stimulation, the acute phase of glucagon secretion in response to arginine is normal. In addition, the beta-cell in noninsulin-requiring diabetics, although acutely hyporesponsive to glucose, remains normally responsive to another stimulus, arginine.


Malignant lymphoma of the cervix uteri: histology and ultrastructure. Two cases of primary lymphoma of the cervix uteri are described. Both responded to radiotherapy; both were composed at the ultrastructural level of mature macrophages and immature, apparently neoplastic lymphoreticular cells and are classified as reticulum cell lymphoma.


Presumptive identification and antibiotic susceptibility of group B streptococci. The comparative performance of three presumptive identification tests for group B haemolytic streptococci was investigated, using 371 different clinical isolates of group B streptococci. Hippurate was hydrolysed by 96-1%, the CAMP reaction was positive in 95-0%, and pigment was produced by 97-3%. A combination of any two tests would have detected over 99-8%. On bile esculin agar 99-0% were able to grow, but non hydrolysed esculin; 5-1% were susceptible to bacitracin. The minimum inhibitory concentrations of five antibiotics for 279 group B streptococci were determined. All were susceptible to penicillin G, ampicillin, cephalothin, and erythromycin, while 80% were resistant to tetracycline. The MIC distributions were independent of the results of any identification test.


Variations in the susceptibility of lactating and non-lactating bovine udders to infection when infused with Escherichia coli. Small numbers of Escherichia coli were infused into both lactating and non-lactating udders. Twelve of the 17 lactating quarters infused became infected, and all 12 showed clinical symptoms of udder disease. The 5 lactating quarters which did not become infected all had pre-infusion somatic cell counts greater than 300000 cells/ml milk, whilst all the quarters which became infected had cell counts less than 300000 cells/ml milk. E. coli was subsequently recovered from only 6 of the 16 non-lactating quarters infused. In only 2 of these quarters did clinical infection follow, both quarters being in a cow infused 2 d before calving. The remaining 4 quarters from which E. coli was recovered were all negative within 5 d of infusion. These differences in susceptibility are discussed, particularly with reference to the frequent occurrence of coliform mastitis at and shortly after calving.


Rennin and pepsin in stomachs of rats (Rattus norvegicus). The predominant protease in adult rat stomachs has a pH optimum of 2.0 to 2.3 which corresponds almost exactly to that of porcine pepsin. One-day-old rats have a protease with a pH optimum of 3.8 to 4.2 similar to that of calf rennin. The pH optimum of rat stomach proteases decreases with age, and at 28 days it is similar to that of the adult. The pH of stomach contents of rats decreases with age from pH 5.8 to pH 4.6. These data support the contention by other workers that the onset of pepsin secretion is a prerequisite for weaning and that rennin-like enzymes are not unique to ruminant species.


Technique for restoring endodontically treated anterior teeth with precision posts and porcelain-bonded-to-gold crowns. A full crown with porcelain bonded to gold and a precision post and sleeve are used in a method to restore endodontically treated anterior teeth. Advantages include protection of the tooth from fracture in the future and utilization of the same sleeve later should another crown be needed.


The behavior modification of a  dentally disabled child. Parents of children afflicted with a dental handicap may experience difficulty in finding a dentist to treat their child. The dentist may be expected to assume the role of family confidant, because of the family's reluctance to seek other professional help. It is important to gain the early confidence and trust of the patient by techniques known to reduce the patient's fear. The patient can now interact more freely with his peers, because of the dental treatment which he has received. His trust, selfesteem, and confidence are much improved.


Evaluation and restoration of endodontically treated posterior teeth. The increasing acceptance and utilization of endodontic therapy for the preservation of broken-down posterior teeth presents the practitioner with many difficult restoration problems. If 25% or more of the coronal tooth structure is lost, some form of artificial dentin augmentation is required to provide adequate support and retention for the final restoration. Criteria to be used in the prerestorative evaluation of endodontically treated teeth are presented. Various methods and techniques to protect the remaining toth structure from fracture and to provide support and retention for the final restoration are described.


Congenital anomalies and inhalation anesthetics. Nitrous oxide and halothane, alone and in combination, have been repeatedly shown to cause fetal anomalies and increased fetal death rates in experimental animals. Epidemiologic studies dealing with pregnant operating room personnel who were chronically exposed to trace amounts of nitrous oxide and halothane have indicated an increased number of miscarriages amoung these women compared with women employed outside the operating room. Dental personnel are exposed to even higher concentrations of nitrous oxide in the dental operatory than those levels foun in the operating room. More numerous and more encompassing studies are required. Meanwhile, the dentist has a primary responsibility to give careful consideration to the use of inhalation anesthetics when planning or administering treatment to a pregnant patient, especially one in the first trimester. In addition, the profession must recognize the potential hazard to both pregnant dentists and pregnant dental assistants in this early stage of pregnancy. Of course, the dentist should always consider the developing fetus before using or prescribing any pharmacologic agents.


Evaluation of alternative alloys to type III gold for use in fixed prosthodontics. A study was done to evaluate the fit of castings made from commercially available alloys promoted by their manufacturers as cheaper alternatives to type III gold for use in fixed prosthodontics. Two nickel-chromium alloys, two silver-palladium alloys, two gold-silver-palladium alloys, a 50% gold alloy, and a type III conventional gold alloy (used as a basis of comparison) were evaluated. After optimum conditions for waxing, investing, and casting were determined experimentally, four crowns (two full crowns and two three quarter crowns) were cast from each alloy. The castings were cleaned by pickling or sandblasting and placed on their respective dies. Only one casting was made from each die. Ten judges were asked to evaluate the marginal fit and completeness of each casting on its die. The judges rated each casting and the ratings were converted into rankings. Type III gold and Forticast tied and were ranked first; Paliney CB was ranked second; Alborium and Albacast tied and ranked third; Aurolite CB was ranked fourth; and Jelenko Experimental and Howmedica III tied and ranked fifth. It was found that the nickel-chromium alloys produced castings that had a tight fit and showed marginal discrepancies even under conditions designed to yield maximum expansion of the investment. These nonprecious metal castings were judged inferior in terms of fit when compared with castings made from noble metal-and precious metal-containing alloys. Existing investments and techniques were adequate for all castings except those made from the nonprecious alloys. It was concluded that low (approximately lambda 50%) gold alloys and palladium-silver-gold alloys that are commerically available can be used as substitutes for type III gold alloy without any loss inthe quality of casting fit.


Informed consent--the doctrine evolves.

Informed consent--the doctrine evolves. The physician or the dentist must obtain the informed consent of the patient to perform treatment. The consent obtained should be based on disclosure of those risks sufficiently serious and likely to occur in the contemplated procedure, which, as a reasonable physician or dentist, the practitioner should realize and the patient does not, but which the patient needs to realize to determine whether or not to consent to the procedure.


Cutaneous basophil hypersensitivity.

Cutaneous basophil hypersensitivity. Cutaneous basophil hypersensitivity (CBH) is a distinct form of lymphocyte-mediated hypersensitivity in guinea pigs, separate both from classic delayed hypersensitivity (DH) and from the well-known antibody-mediated reactions. CBH, not DH, is the usual cellular immune response of this species to a wide variety of immunogens (e.g., allografts, certain parasites, and viruses) when these are presented in native form without supplementation with mycobacteria-containing adjuvants, thus attesting to the importance of this response in the guinea pig's overall immune defense mechanism. Basophil-containing, cell-mediated, delayed-onset reactions occur in other species, including man, as well.


Sociologic study of food habits--a review. I. Diversity in diet and scalogram analysis. Scalogram analysis (Guttman scaling) organizes descriptive data into a form which is meaningful to the nutritionist and the sociologist in the study of the diversity in, and variation of, family food patterns. Scalogram analysis avoids the use of measures that are "description bound" or culturally biased by providing a means of using a higher level of abstraction in studying food habits. Scalogram analysis can be useful, both in planning and in evaluating programs of nutrition education, but until this tool becomes more familiar to nutrition educators and its effectiveness is evaluated in actual situations, it will remain only potentially useful.


[Biologic bases of the treatment of diffuse benign breast diseases]. An analysis is made of the contributions that animal experiments have made to the understanding of diffuse benign mastopathies. By the use of epidemiological studies and the examination of biopsy material, from women using hormones, in a histo-pathological way conclusions could be drawn as to the effect of these steroids on the human mammary gland. Consideration has been given to the action of oestrogens and progestogens used alone or in combination.


Immunohistochemical localization of hypothalamic hormones. Using an immunoperoxidase technique at the light and electron microscope levels, the localization of somatostatin and luteinizing hormone-releasing hormone (LH-RH) has been performed in the brain, as well as the pancreas and stomach. The following generalizations may be drawn on the localization of LH-RH and somatostatin. (a) LH-RH and somatostatin are contained in axons and nerve endings of the median eminence and organum vasculosum of the lamina terminalis. (b) LH-RH and somatostatin are present in different nerve endings. (c) In the subcommissural organ, subfornical organ and area postrema, the two neurohormones are present in the cytoplasm of ependyman and subependymal cells. (d) In the endocrine pancreas and gastric mucosa, somatostatin is localized within the secretory granules of specific endocrine cells.


[Synapse density determination in brain structures based on phosphotungstic acid contrast]. Using the E-PTA procedure of Aghajanian and Bloom we determined the numerical density of synapses in the stratum lacunosun-modeculare of the CA1-region in the hippocampus of male albino rats. On this occasion the sources of error both the natural and the methodical were investigated. As natural causes of remarkable scattering and failing correspondence in the findings the individual variability of the synaptic density and the inhomogeneous distribution of synapses must be taken into consideration. Concerning the methodical sources of error the differences in tissue shrinkage become apparent. But faults resulting from applying morphometric methods are the most serious. The counting of synaptic profiles is based on defined morphological criteria. The portion of the synaptic profiles recorded in this way in relation to all those present in the section depends beside other things on the section thickness. Accordingly the correction factors are in correlation with section thickness. The application of the Floderus correction presupposes the determination of the minimum length of the counted profiles. As a result of these investigated the possibilities for reducing the error have been demonstrated.


[Analysis of intrauterine sounds and their tranquillizing effects on the newborn infant]. The authors have made a piezo-electric microphone in order to tap and analyse intrauterine sounds. The band that is used ranges from 3 - 700 Hz. A sound that has a small microphone at its tip is introduced into the uterus and then relayed to an amplifier. The sound mainly comes from the blood vessels  and their frequency ranges between a few Hz and a thous and Hz. The acoustic pressure is big for low frequencies and weak for high frequencies. The sounds that are heard in the uterus have a calming effect on new-born children and stop them crying in 86% of cases where it has been tried. It sends them to sleep in 30% and this has been confirmed by E.E.G. This method is more effective than the older ones which used "slumber tone". The reason is that the product is the same as that which has been experienced by the fetus in utero.


C4 synthesis in C4-deficient guinea pig radiation chimeras: restoration of the classic complement pathway. Bone marrow transplants from normal Albany strain guinea pigs established a functional classical pathway of complement (C) in C4-deficient (C4D) guinea pigs. Seventeen days after transplant the Albany leads to C4D chimeras had detectable C4 and total hemolytic C activities. Maximum C4 levels (2 to 8% of normal were reachered by day 73 and restored total C to 40% of normal. Classical pathway function persisted for about 150 days and, thereafter, declined to undetectable levels by day 385. In contrast, Albany guinea pigs transplanted with C4D marrow maintained normal C4 levels throughout the experiment, suggesting that the C4-producing cells are radioresistant and long-lived. Unlike unmanipulated C4D animals, Albany leads to C4D chimeras were unable to produce antibodies to guinea pig C4 when immunized with normal guinea pig serum. These experiments suggest that bone marrow cell progeny produce C4 in vivo.


An in vitro immuno-enzymatic assay of tumor antigens in the mouse with beta-galactosidase. A method for detection of the primary binding of soluble tumor-associated antigens by antibodies has been developed by using an enzyme immunoassay (EIA). A heteroantiserum was produced by injecting tumor cells from a chemically induced murine sarcoma into rabbits, and antibodies reacting with most normal tissue components were removed by exhaustive in vivo absorption. A soluble preparation of tumor cells, obtained by 3 M KCl extraction, was conjugated to beta-galactosidase from Escherichia coli. The antibody binding was measured by determining the enzyme activity that could be separated by anti-antibody coprecepitation. The reaction follows saturation kinetics, and nonlabeled antigen can be readily quantitated by inhibition. The present method detects determinants common to several MC-induced tumors on the same mouse strain but absent in normal cells and nonrelated tumors in addition to individual tumor-specific transplantation antigens. The sensitivity and simplicity of the new method compare favorably with a binding assay that utilizes radioactive iodine as a label. Thus, EIA becomes a flexible tool for the further characterization and purification of these antigens.


Different mechanisms for the modulation of TL antigens on murine lymphoid cells. An indirect radioimmunoassay has been used to study the antibody-induced changes in expression of TL antigens on mouse thymus and leukemia cells. The results obtained indicate that the incubation of TL+ cells in relatively high concentrations of anti-TL antisera results in a detectable, but not major, loss in the quantity of antigen detected in the plasma membranes. This decrease is not inhibited by azide. Although the antigen loss seems to coincide with the appearance of patching of membrane TL antigens on leukemia cells observed in indirect immunofluorescence microscopy, this is not the case when thymocytes are used as targets. Fab fragments prepared from anti-TL antibodies can also induce a quantitative decrease in antigen expression. The major mechanism involved in membrane antigen loss seems to be endocytosis, although some shedding may also occur. Resistance to immune cytolysis (antigenic modulation) occurs during incubation in anti-TL antibodies before either endocytosis or antigen redistribution has progressed enough to be directly responsible. Since antigenic modulation does not represent a depletion in TL antigens being expressed on the cell surfaces, another mechanism must account for the failure of guinea pig complement to achieve cell lysis.


An improved autoradiographic technique for the detection of antibody-forming cells. An authoradiographic technique for the detection of antibody-forming cells has been developed for the assay of anti-DNP responses. The lymphoid cell suspension to be assayed was allowed to a glass slide coated with DNP-conjugated gelatin to which the secreted antibody bound during subsequent incubation. The bound antibody and its Ig class was revealed by a second incubation using 125I-anti-immunoglobulin reagents followed by autoradiography. Studies on the sensitivity and specificity of the method are presented and its advantages over other techniques described. The technique should be readily applicable to other haptens.


Affinity-immunoadsorbent fractionation of rat anti-streptococcal A carbohydrate antibodies of restricted heterogeneity. Antisera obtained from selectively bred Sprague-Dawley rats after a primary series of immunization with group A streptococcal vaccine exhibit specific anti-carbohydrate antibodies of restricted heterogeneity. Separation of anti-carbohydrate antibodies was achieved on the basis of differences in the relative binding affinities of the antibodies for an insoluble, hapten (N-acetyl-D-glucosamine) immunoadsorbent. Evaluation of several eluting reagents including hapten, thiocyanate, urea and acid-salt demonstrated the chaotropic ion thiocyanate to be most effective in separating anti-hapten populations of individual affinity characteristics. In general, there was no consistent relationship between the net electrical charge of an antibody and its relative binding affinity for the immunoadsorbent. Furthermore, non-precipitating rat anti-streptococcal A carbohydrate antibodies were characterized as antibodies of relatively low binding affinity for the hapten immunoadsorbent. From a practical point of view, thiocyanate is recommended for the routine elution of anti-carbohydrate antibodies from innumoadsorbents.


Microfluorometric evaluation of the specificity of fluorescent antisera against mouse immunoglobulins with the defined antigen substrate spheres (DASS) system. Highly purified MOPC-21 IgG1, MOPC-173 IgG2a, MOPC-195 IgG2b, MOPC-104 E IgM, and MOPC-315 IgA paraproteins, heterogeneous mouse IgG, Fab and Fc fragments of heterogeneous IgG were prepared and coupled to Sepharose beads. These beads were then used as artificial substrates to test the specificity of fluorescent antisera against mouse immunoglobulins by microflurometry. By comparing the visual evaluation of strained plasma cells and measurements on beads, the highest permissible percentage (FITC) and 6% for a tetramethyl rhodamine iso thiocyanate (TRITC) conjugate. By application of these criteria, 1 out of 7 tested commercial antisera and 6 out of 8 conjugates prepared in this laboratory proved to be satisfactory. The most common impurities were anti-light chain antibodies, as revealed by their reaction with Fab. With the bead system, a good impression of the specificity of an antiserum can be obtained. It gives, however, only approximate information on whether the conjugate will cause a high background staining in the biological specimen.


Quantitation of immunoglobulin adsorption to plastics. Adsorption of 125I-labelled rabbit IgG to plastics (cellulose nitrate, polyallomer, polystyrene, polyvinyl) was primarily dependent on initial antibody concentration and, to a lesser extent, on time allowed for adsorption. The highest concentration tested (100 mug/ml) gave the highest quantities adsorbed after 18 h at room temperature. This concentration, however, gave the lowest percent adsorption (6.5 to 12.0%) of the initial amount. IgG concentration of 10 mug/ml resulted in 25.0 to 65.1% adsorption over the same time period; at 1 mug/ml, 47.0 to 96.6% of the initial amount was adsorbed. All of the plastics tested adsorbed IgG to approximately the same degree, with the exception of cellulose nitrate. This plastic adsorbed 32 to 49% less than the others, under maximal adsorption conditions.


A raft technique for chemotaxis: a versatile method suitable for clinical studies. We describe a raft technique for the study of chemotaxis which possesses a number of advantages over the use of chambers. Membranes are laid on pads soaked in chemotactic agent and cells are contained in plastic cups, which are inverted on to the membrane. This method gives results which are similar to those obtained in conventional vessels. It would seem well suited to comparative measurements of chemotaxis in clinical series, for it avoids the use of special chambers, minimises the number of membranes and their handling and more than one cell suspension can be placed on a membrane. In addition, the method is experimentally versatile: simple manipulations allow work with cells adherent to other surfaces, studies of the effect of substituting a new agent or of reversing the gradient during an experiment, migration against gravity, and of the effect of non-adherent cells on migrating cells.


[An experimental study of the effects of drilling with dental high speed turbine on culture cells (in vitro) (author's transl)]. A drilling at 500 000 R.P.M. with a dental high speed turbine was made either to a tissue culture bottle or to a test tube, in which mouse L fibroblasts were grown for 2 days with YLH medium supplemented with 10% bovine serum, in order to examine the effects of high speed drilling to the cells in vitro, Experiments were carried out with the following three conditions; (1) Drilling of outer surface of the glasswares at the inner surface on which the cells were attached, with a water coolant, (2) Drilling of the same place without a water coolant, and (3) Drilling of a remote area of the glasswares where no cells were grown. The last experimental condition permitted to give a sole effect of vibration accompanied with the drilling. Rates of cell multiplication and morphological observation were obtained on 2 days and 5 days after the glasswares were drilled. Rates of cell multiplication showed no change between the experimental conditions and control. This means that heat generation, vibration and/or their compound effects during drilling did not deter cells from growing. Morphological change of the cells due to the drilling was parallel to the results of cell multiplication except the drilling without a water coolant. When drilled without a water coolant, the cells around the drilled area was deteriorated and died after 24 hours. However, most of the cells away from the drilled area were not affected. The present results can not directly apply to the drilling in dental clinic, since in vivo condition has more complicated situation, some of which can not be simulated in in vitro environment. However, the in vitro results can surely be important information in resolving drilling effects in vivo.


[Bond strength between nonprecious metal alloy and porcelain. Part (1). Bond strength with press condensing method (author's transl)]. For the purpose of finding out the method which is able to evaluate nonprecious metal/porcelain bond strength easily, Ceramco procelain was fused to casted Wiron "S" (3 mm diameter), by means of 5 types of press condensing methods; the bond strength was measured by pull out method and these condensing methods were compared. Results are follows: (1) No significant difference was observed between conventional condensing method and press condensing method (condensing pressure; 472-1 415 kg/cm2), and the bond strength of Ceramco Paint-O-Pake porcelain to Wiron "S" was about 245-369 kg/cm2. (2) Bond strength was decreased with the decrease of the fused length of procelain. (3) Bond strength was increased approximately three times, when specimens were mounted by dental stone.


Neutrophil function in children with kwashiorkor. Peripheral blood polymorphonuclear neutrophil (PMN) function has been investigated for 46 children with kwashiorkor (without overt infection) in the Ivory Coast, West Africa. In vitro chemotactic response, candidacidal activity, and kinetic studies of metabolism during phagocytosis have been performed. Postphagocytic morphological events were evaluated by electron microscopy. The reduction of nitroblue tetrazolium (NBT), measurement of enzyme activities, activity of glycolysis, and hexose monophosphate shunt (HMS) activity were assessed. The extent of iodide incorporation into trichloracetic acid (TCA)-precipitable protein by phagocytizing PMN'S and thyroid hormone degradation were measured. Chemotactic response was reduced at early time intervals (30, 60, and 120 minutes) and reached control values after 180 minutes. Whereas PMN's of controls killed 32.13 +/- 11.10 per cent of Candida albicans after 60 minutes, PMN's from kwashiorkor patients killed 18.55 +/- 7.74 per cent (p less than 0.01). HMS activity for resting PMN's of kwashiorkor children was higher than for controls, and during particle ingestion the extent of stimulation was comparable to controls. Electron microscopic assessment of phagocytic vacuole formation and degranulation showed no difference between PMN's from kwashiorkor and and control subjects. Incorporation of 131 I into TCA-precipitable proteins by phagocytizing PMN's from kwashiorkor children was reduced in compraison to controls, with either viable or heat-killed lactobacilli. No impairment in thyroxine (T4) degradation was observed for PMN's from kwashiorkor cases. PMS's from kwashiorkor patients show toxic granules, Dohle bodies, evidence of high baseline NBT reduction, and glucose decarboxylation. Functional studies indicate impaired kinetics of chemotaxis, diminished candidacidal activity, and reduced iodination. Enzymatic activities of resting cells are normal. Lactate production, HMS activity during phagocytosis, and morphological events are not impaired. Thus, impaired in vitro microbicidal activity, increased resting metabolism, and decreases iodination by PMN's may be related to the high incidence of infection in kwashiorkor.


Tympanic reconstruction. Fifteen year report on tympanoplasty. Part II. This survey was carried out to evaluate techniques in current use for the treatment of chronic suppurative otitis media. Part I concerns the incidence of cholesteatomatous complications following combined approach tympanoplasty (CAT). Residual and Recurrent cholesteatoma occurred much more frequently than had been expected or reported elsewhere. Although the incidence of Recurrent cholesteatoma has been markedly reduced by technical modifications, Residual cholesteatoma was discovered inadvertently in one out of every seven previously cholesteatomatous ears in which a second operation for ossicular reconstruction was performed. In at least one-third the disease had been left in the epitympanum. Although many cholesteatomatous cysts might lie dormant for years, and possibly never give rise to serious consequences, it can no longer be claimed that CAT provides a satisfactory means of eradicating cholesteatoma unless re-exploration operations were continued until eventually the tubotympanic cleft could be shown free of cholesteatoma.


Activation of human B lymphocytes. I. Direct plaque-forming cell assay for the measurement of polyclonal activation and antigenic stimulation of human B lymphocytes. A model for the detection of single cell antibody production by human tonsillar lymphocytes after stimulation with either sheep red blood cells (SRBC) or polyclonal B-cell activators has been described. The culture system is a modified Mishell-Dutton technique with certain critical factors identified. The assay is a sensitive and resproducible hemolysis-in-gel system employing an ultra-thin layer gel technique measuring plaque-forming cells (PFC) against SRBC targets. Several factors essential for optimal responses are described, but the critical feature of the culture system is the use of selected lots of human AB serum supplements which are extensively absorbed with SRBC. This removes a blocking factor present in most human serum which suppresses the B-cell response to SRBC targets after stimulation with either SRBC or several polyclonal B-cell activators. In addition, absorption of serum with SRBC eliminates the presence of artifactual plaques. Background PFC are extremely low and stimulated cultures show significant and reproducible responses. These studies provide a simple, sensitive, and reproducible model for probing the complex events associated with activation of human B lymphocytes.


The effect of allogeneic presensitization on H-Y graft survival and in vitro cell-mediated responses to H-y antigen. C57BL/6 and C57BL/10 female mice were grafted with skin from male or female donors incompatible for H-2 and/or non-H-2 antigens. Syngeneic male grafts applied after the rejection of primary allografts or syngeneic male grafts were rejected in accelerated (second set) fashion, whereas male grafts applied after primary female grafts were not. In addition, C57BL/10 female spleen cells, primed in vivo with an allogeneic (BALB/c, CBA, or B10.BR) male graft and challenged in vitro in mixed lymphocyte culture with syngeneic (C57BL/10) male cells, produced cytotoxic cells specific for syngeneic male target cells. We conclude that at least some component of H-Y is detected by female responder cells on allogeneic male cells, and that the second set cell mediated response to H-Y is not necessarily restricted by the H-2 haplotype of the primary sensitizing strain. Moreover, (CBA X B10) F1 females, primed in vivo with male cells of one parental haplotype (B10 or CBA) and challenged in vitro with male cells of the other parental haplotype (CBA or B10), fail to lyse male target cells of either parental haplotype. It therefore seems unlikely that a helper determinant shared between B10 and CBA is sufficient to explain the ability of CBA male cells to prime H-2-restricted T-cell cytotoxic responses by B10 females.


Endotoxin protein: a B-cell mitogen and polyclonal activator of C3H/HeJ lymphocytes. A cell wall protein that is ordinarily complexed to the lipopolysaccharide endotoxin in gram-negative bacteria has been separated by the use of aqueous phenol. The protein is active as a B-cell mitogen and polyclonal activator of murine lymphocytes including the C3H/HeJ strain which is a nonresponder to lipoplysaccharide or lipid A.


Some new approaches to the individualization of fresh and dried bloodstains. The individualization of human beings by biochemical "fingerprinting" is yet a goal of the future. However, recent progress in methods and instruments permits the forensic analyst to use the available techniques for partial individualization. For practical purposes, it is sufficient to demonstrate the capability of discriminating one human blood among a thousand others. The combination of some of the methods described makes such a discrimination possible. It is critical that both instruments and methods be standard so that two or more laboratories may obtain the identical results from analyses of the same questioned specimen. Only then can such evidence be presented with a high degree of reliability in medicolegal cases. The objective of the studies described is to develop an immunohematological and biochemical analysis for individual blood samples from human beings to resolve and define phenotypic components of the blood to the maximum extent in the smallest volume. The result of this work is expected to permit the objective characterization of individuals in terms of their own unique genetic constitution; it will permit comparison of individuals as to degrees of similarity or dissimilarity of their genetically determined blood protein composition.


Fatal consequences of local anesthesia: report of five cases and a review of the literature. The possible hazards of local anesthetic agents in either moderate or large doses are not always fully appreciated. The toxic side effects following rapid systemic absorption may be the unsuspected cause of death following the clinical use of these substances. Data on 15 deaths after the administration of local anesthetic substances are summarized. Five case histories involving lidocaine (lignocaine, Xylocaine) and cocaine are presented in detail, including the results of toxicologic analysis. The literature relevant to similar fatalities is reviewed but contains little information relating to blood and tissue concentrations in fatal cases. It is hoped that this paper may assist in clarifying the cause of death in some previously problematic situations.


DNA restriction and modification systems in Salmonella. SQ, a new system derived by recombination between the SB system of Salmonella typhimurium and the SP system of Salmonella potsdam. As the result of P1-mediated cotransduction with serB from Salmonella potsdam to the Escherichia coli/Salmonella typhimurium hybird 4617, one recombinant, L4004, was isolated which had a restriction-modification (R--M) system different from the SB and SP systems of its parents, and was designated SQ. The genes of SQ were allelic to those of the SB system of S. typhimurium and were shown by complementation experiments to be functionally related to those of the K system of E. coli. Evidence that the SQ system in L4004 arose as the result of a recombination event within the hsdS genes of SB and SP is discussed.


Numerical taxonomy of aquatic Acinetobacter isolates. Two hundred and seventy Gram-negative strains, representing aquatic members of the genus acinetobacter, were isolated and compared with 48 related clinical isolates and reference strains from a variety of genera. For each isolate, a total of 96 coded characters derived from 89 characteristics was determined using morphological, physiological, nutritional and biochemical features, in addition to sensitivities to several antibiotics and inhibitory agents. The data were analysed by computer to obtain a simple matching coefficient for each pair of strains. Clustering was performed by the unweighted pair-group method of association. Two major phenons were formed which excluded the oxidase-positive, motile or facultatively anaerobic strains. Within each phenon, three 'subphenons' were delimited. The two phenons, comprising 291 isolates, were tentatively differentiated at the species level, while their shared characteristics indicated that both phenons should be included in the genus Acinetobacter. Phenon 2 contained most of the clinical isolates and corresponded to the type species Aci. calcoaceticus as described originally by Baumann, Doudoroff & Stanier (1968). Phenon 1 was composed almost entirely of aquatic isolates and may prove to represent a second species of a less biochemically-active nature. Distinguishing characters have been suggested as diagnostic criteria for the differentiation of these two phenons.


The apparent ATP requirement for nitrogen fixation in growing Klebsiella pneumoniae. The apparent ATP requirement for N2 fixation in Klebsiella pneumoniae was high (the ATP/N2 molar ratio was 29 when estimated in anaerobic glucose-limited chemostat cultures) compared with that determined previously in Azotobacter chroococcum and in Clostridium pasteurianum. The high value was probably not due to unfavourable temperature, phosphate concentration or pH. The apparent ATP requirement for N2 fixation was probably no lower in 02-limited chemostat cultures than in anaerobic glucose-limited chemostat cultures. When hydrogen was introduced into the atmosphere over the anaerobic glucose-limited chemostate culture, there was an increase in the apparent ATP requirement for N2 fixation and in the activity of nitrogenase in intact organisms. A comparison of these increases suggests that some ATP is wasted by the ATP-dependent H2-evolving activity of nitrogenase.


Changes in the cell surface of the dimorphic forms of Candida albicans by treatment with hydrolytic enzymes. The release of acid phosphatase and polysaccharide-peptide complexes by hydrolytic enzymes from the surface of the blastospore and mycelial forms of Candida albicans has been examined in cells from 4 h and 18 h cultures and the results correlated with the appearance of the treated cells in the electron microscope. Treatment with dithiothreitol was necessary for the degradative action of the enzymes to occur. Material released by all the treatments used had a similar qualitative composition, but the proportions of mannan, glucan, peptide and acid phosphatase varied with different treatments and with the type of cell examined. I,3-beta-Glucanase was required for major changes in the cell wall to be effected, but a significant amount of material was released with a chitinase preparation containing some protease activity. Protoplasts were obtained from all types of cell using Cytophaga lytic enzyme L1 which had I,3-beta-glucanase and protease activity, but the purified I,3-beta-glucanase and protease prepared from Streptomyces violaceus cultures required the presence of a chitinase before protoplasts were released. The bonding association between the major components which comprise the cell wall, and the spatial distribution of these macromolecules, varies appreciably between the two dimorphic forms and with the age of the culture.


Issues at the clinical-research interface: placebo effect control groups. At the clinical-research interface, controls are a significant issue in group therapy evaluation. The authors describe and analyze their unique experience with placebo effect control groups conducted prior to brief, group psychotherapy for married couples. Procedures are outlined and participant reactions noted. Solicited ratings and spontaneous comments provide assessment data. The evidence suggests the feasibility of placebo effect control groups in the context studied. Proposed methodological refinements and clinical implications may be useful for future research efforts.


Physiological and pathological changes in tissue monoamine oxidase activity. This article explores the possibility that malfunction of the enzyme monoamine oxidase (E.C. 1.4.3.4., MAO) could lead to aberrations in the catabolism of biogenic amines in the central nervous system and give rise to certain mental abnormalities. No conclusive evidence could be presented to substantiate this. Data on the normal function of the enyzme (for example its existence in multiple forms, the control of MAO activity by hormones or the independent development of MAO activities towards different substrates during maturation) are reviewed.


Medicine through untinted glasses. The 1976 Harvey Cushing oration. The 1976 Cushing orator takes a critical look at federal medical programs today, and at the health desires and needs of the public. He outlines the possible future roles of federal and state government and of the medical profession itself.


Lung uptake of 99mTc-sulfur colloid in falciparum malaria: case report. Increased lung uptake of 99mTc-sulfur colloid was seen during liver scanning in a patient with falciparum malaria. This finding was due to the enhanced activity of the phagocytic cells of the reticuloendothelial system in the liver, spleen, and lung found in human and experimental malaria. Similar findings in other clinical situations and the relevant literature are reviewed.


Effect of reductones on glyoxalase I1.

Effect of reductones on glyoxalase I1. The effect of some reductones on glyoxalase I prepared from animal and microbial origins has been studied. The enzyme was extracted from ox liver or baker's yeast and partially purified by ammonium sulfate fractionation, gel filtration and ion exchange chromatography. Aliphatic reductones such as ascorbic acid, ascorbic acid 3-phosphate and triose reductone showed strong to medium inhibition, while dehydroascorbic acid showed no inhibition. Kinetic analysis indicated that the inhibition mechanism of ascorbic acid was uncompetitive. Varying extents of inhibition were observed among three kinds of diphenols belonging to aromatic reductones. They were in the order of increasing inhibitory power resorcinol, hydroquinone and catechol for the ox liver enzyme, and catechol, resorcinol and hydroquinone for the yeast enzyme. p-Benzoquinone, an oxidized reductone, exhibited marked inhibition on both enzymes. Its action seemed due to reaction with amino and/or sulfhydryl functions of enzyme protein and those of glutathione, one of the substrates.


Studies on biological functions of 5'-methylthioadenosine vitamin B12-replacing effect for Ochromonas malhamensis. An unidentified factor which can completely replace the vitamin B12 requirement of a protozoan, Ochromonas malhamensis, was found in commercial yeast extract powder. The factor showed a positive sugar test with orcinol reagent. The presence of sulfur was demonstrated with platinic iodide reagent. The molecular weight, 297, and the chemical formula, C11H15O3N5S, were determined by mass spectrometry and elemental analysis. Infra-red and nuclear magnetic resonance studies indicated the presence of a thiomethyl group. The factor was hydrolyzed by treatment with acid into adenine and 5-methylthioribose, i.e., the sugar constituent of 5'-methylthioadenosine. The factor was identified as 5'-methylthioadenosine from the behavior exhibited in thin-layer chromatography and from microbiological tests for its vitamin B12-replacing effect.


Etching of enamel prior to application of fissure sealants. Acid etching has been shown to be necessary to increase the bond strength of the polymeric fissure sealants Epoxylite 9075 and Nuva Seal to enamel. For Nuva Seal or Epoxylite 9075 it would appear that it does not matter which concentration between the concentration levels of 30 and 70% is used.


A biochemical profile of glass-adherent cell populations containing multinucleated foreign body giant cells. Some biochemical characteristics of peritoneal macrophages, subcutaneous macrophages and subcutaneous cell populations containing multinucleate giant cells were compared. Subcutaneous macrophages possessed higher concentrations of succinate dehydrogenase, acid phosphatase, aryl hydroxylase, free RNase II, lecithin and free fatty acids than peritoneal macrophages, while the latter had higher concentrations of 5' -nucleotidase esterified cholesterol. These differences may be due to environmental variations depending on their anatomical position or more likely to their degree of activation. As significant numbers of multinucleate giant cells appear in the subcutaneous population the concentration aryl hydroxylase, 5' -nucleotidase lactate dehydrogenase, acid phosphatase, free ribonuclease II and esterified cholesterol falls. The concentration of succinate dehydrogenase decreases but then rises while the concentration of glucose-6-phosphate dehydrogenase increases. These highlight the differences between cell populations containing multinucleated giant cells and those composed from their precursor mononuclear phagocytes only.


Gentamicin and albumin-bilirubin binding. An in vivo study. Ten newborn infants were given gentamicin intramuscularly. Over a postinjection interval of 12 hours, no significant change occurred in the total binding capacity of serum albumin for bilirubin or in concentrations of serum bilirubin levels. There was no correlation between concentrations of serum gentamicin and the total binding capacity or serum bilirubin. This study provides in vivo data that supports recent in vitro experiments showing that gentamicin does not alter bilirubin-albumin binding.


Bacitracin differentiation for presumptive identification of group A beta-hemolytic streptococci: comparison of primary and purified plate testing. The detection of group A beta-hemolytic streptococci by bacitracin susceptibility was examined, with the presumptive identification on primary blood agar plates compared with that on pure subcultured plates. A total of 638 group A streptococcus isolates was recovered from 4,632 throat swab specimens. Only about half of these isolates were identifiable on the primary plate, compared with 96% identifiable on pure subcultured plates. The unreliable results with bacitracin disk testing on primary plates were due to (1) too few colonies present in the vicinity of the disk or (2) colonies overgrown by oropharyngeal flora.


Successful retransplantation of bone marrow following failure of initial engraftment in a patient with aplastic anemia. Histobompatible sibling bone marrow was transplanted to a patient withsevere aplastic anemia.  The first transplant failed, but a second transplantfrom the same donor was successfully performed with a new and more potentimmunosuppressive regimen.  Successful retransplantation after marrow graftrejection is now possible.


Persistent pulmonary hypertension of the newborn infant. Persistent pulmonary hypertension of the newborn infant can be difficult to distinguish from other cardiopulmonary causes of cyanosis during the newborn period. Infants with PPHN have cyanosis, tachypnea, acidemia, normal pulmonary parenchymal markings on the chest radiography, and anatomically normal hearts. We have identified and treated 11 infants and have noted several signs and symptoms not previously emphasized. These are cineangiocardiographic evidence of atrioventricular valve insufficiency in association with systolic murmurs and slow ventricular emptying, apnea, hypocalcemia, only a small rise in abdominal aortic blood oxygen tension during breathing of 100% oxygen, and no response to continuous positive airway pressure. Right-to-left shunting through the patent ductus arteriosus was documented in nine infants: in all six of those in whom simultaneous temporal and abdominal aortic blood oxygen tension measurements were made; in three by means of cardiac catheterization. Ten infants survived after variable courses and treatments which makes it difficult to ascribe improvement to any one therapy. The distinct increase in blood oxygen tension with tolazoline HCl and curare in some instances is discussed.


Rorschach records of the Nazi war criminals: an experimental study after thirty years. The Rorschach records of 17 Nazi war criminals (administered in 1946 by Kelley and Gilbert) were subjected to an experimental procedure wherein eight Nazi records and eight controls (matched for levels of mental health potential) were assessed blind by ten Rorschach experts. Multiple choice options allowed for classification on the basis of group characteristics or degree of potential. Nazi records were not identified as such; selection related to the cross-section of adjustment or inadequacy as reflected in both Nazi and control groups.


The facade compulsive: a diagnostic formulation derived from projective testing. A psychological "type" characterized by repetitive and compulsive action tendencies but not by obsessive thoughts was delineated. It was shown how this syndrome could be identified through differential inter-test patterning on projective techniques. The possibility of improving psychodiagnostic accuracy by stipulating expected configurations among tests in a battery was noted.


Figure drawing as an expression of self-esteem. Figure drawings were obtained from 97 preadolescent males who differed in self and behavioral assessments of self-esteem. These subjects had been selected from a much larger sample and represented five different types of self-esteem. The figure drawings were scored for 15 variables, dealing with formal characteristics, content, and global-interpretations of the total drawings. Five significant differences were obtained, with the content and global-interpretative categories proving more differentiating between self-esteem groups than did the formal characteristics. Behavioral expressions of self-esteem were more associated with figure drawing characteristics than were subjective evaluations. Discussion focuses on the nature of self-concept and self-esteem in children as a sensorimotor rather than symbolic expression.


First-drawn pictures: a cross-cultural investigation. Fifty Jordanian male and female students at the University of Jordan, Jordan were asked to draw a person. A significantly larger number of women than men drew a picture of the opposite-sex first. This appears in line with Craddick's finding for American college students. The frequency of drawing opposite-sex pictures first as a phenomenon characteristic of Jordanian and American female college students was discussed in terms of sociocultural factors and considered in the sex-role frame of reference. Suggestions for future research were presented.


Predicting clinical judgment for a primary grade apperception battery. A six-card Primary Grade Apperception Battery (three cards from the CAT and three from the SAM) was administered to one group of first grade children on a 4 month test-retest schedule and to a new group of first graders 1 year later. Two clinical psychologists read the protocols and made clinical judgments regarding home and school adjustment on a four-point scale. An initial regression formula to predict clinical judgment from objective apperception score data was derived. The formula was validated on the retest data and the new sample. The results indicate the derived apperception score reliably predicted clinical judgment. In general, the results also suggest the six card apperception battery may be a useful screening test for school and home adjustment for first and second grade children.


Relationships among measures of managerial personality traits. Comparisons were made to determine the degree of convergence among three measures associated with leadership success in large, hierarchic organizations in the business sector: the Miner Sentence Completion Scale; the Ghiselli Self-Description Inventory; and the F-Scale, Correlational analyses and comparisons between means were made using college students and business manager samples. The results indicated considerable convergence for the first two measures, but not for the F-Scale. The F-Scale was related to the Miner Sentence Completion Scale in the student group, but relationships were nonexistent among the managers. Analyses of the individual F-Scale items which produced the relationship among the students suggested that early family-related experiences and attitudes may contribute to the development of motivation to manage, but lose their relevance for it later, under the onslaught of actual managerial experience.


Sociopathy, self-actualization, and time. Male sociopaths (n = 15), and self-actualizers (n = 15) ages 18-30, were compared on 18 measures of temporal behavior obtained from estimation, projective, and questionnaire techniques. Subjects differed significantly on half of these measures including time accuracy, delay, dominance, relatedness, and evaluation of the various time modes. Results are discussed in terms of theoretical notions of time, positive levels of coping, and therapeutic modifications of time-linked behavior.


[Activity of the expiratory laryngeal motor neurons]. The activity of the whole recurrent nerve branch to expiratory laryngeal muscles, along with unitary activity of fibres from this branch were studied in cats.  Conduction velocities of fibres ranged between 19.5-93 m/s.  We used two types of preparations: low "encephale isole " (at C7 level) cats with concomitant light Dial anesthesia or without any anesthesia, or cats deeply anesthetized with Dial or chloralose-urethane.  The vagus nerves were preserved.                                  Under normocapnic conditions, the delay of recruitment (i.e. the lag between the interruption of phrenic nerve activity and the start of unitary expiratory recurrent nerve activity) increases as the residual phrenic nerve activity increases; in fact, the delay is nearly zero with unanesthetized or lightly anesthetized preparations (small residual phrenic activity), but can extend up to 800 ms with deeply anesthetized preparations (large and long-lasting residual activity) (fig. 4).  Recurrent nerve units show a maximum firing rate at the beginning of a discharge; the rate then decreases (fig. 5).  The maximum frequency is strongly reduced when residual phrenic activity is present (fig. 7).  The discharge duration does not reach the expiratory pause duration.  Rapidly conducting fibres are the firs ones to cease activity (fig. 5)...


Removable partial overdentures.

Removable partial overdentures. A technique for applying the overdenture concept to removable partial denture construction has been presented. Endodontically treated abutments are prepared with cast gold posts and copings over which removable partial dentures with conventional components are fabricated. No special materials or complicated laboratory techniques are required, and the maintenance and repair problems of precision attachments are avoided. A variety of potential uses and advantages of the technique are discussed.


The influence of fixed splints on mandibular flexure. The degree of mandibular flexure during forced opening of the jaws with various fixed splints in place was measured. Significant results indicate that: (1) all splints tested reduce the amount of mandibular flexure; (2) the reduction of measured mandibular flexure cannot be explained solely by tooth movement, rather it is indicative of a limitation of bony flexure by fixed splints; (3) extensive mandibular splints flex during forced opening; and (4) fixed prostheses involving many teeth do not completely inhibit mandibular flexure. Inhibition of mandibular flexure apparently increases as more teeth are splinted and more rigid attachments are used.


An analysis of mesial rest-I-bar clasp designs. The mesial rest-I-bar concept is the most important contribution to clasp partial denture design in the last 30 to 40 years. When used with discernment in situations where it is not contraindicated, it constitutes an excellent design for extension-base removable partial dentures. It has become the design of choice for an increasing number of dentists. Use of the three elements that make up the clasp assembly does not necessarily insure that the clasp will function as intended. There are situations for which it should not be used. Unless adequately adjusted after framework construction as well as during the maintenance program, the beneficial effects may be more imaginary than actual. Strict adherence to the mesial position for the rest is not rational for toothsupported dentures and may be questioned for some extension-base prostheses. I-bars have several advantages as direct retainers. However, no single type of retainer is applicable for all retentive situations, and other types should be selected where conditions are unfavorable for I-bar use. A framework which permits a slight amount of movement toward the edentulous residual ridge is an important consideration in design of extension-base removable partial dentures, particularly for those of the mandibular arch. However, compromise of this principle is sometimes necessary to satisfy other design requirements. Design of the framework is only one of the factors that contribute to a successful removable partial denture. Of at least equal importance is the adequacy of support provided by the denture base and the nature of the occlusion. If meticulous attention is directed to these two factors, the forces transmitted to the teeth through the framework can be kept to a minimum and within physiologic tolerance. Conversely, neglect of these considerations may cause a framework of any design to become destructive.


Observations on cavity liners for composite resin restorations. Adhesion or surface roughness and discoloration at the interface between pulpinsulating materials and composite resins were taken as indications for interaction between the resins and the insulating materials. Some interaction occurred between all insulating materials and resins investigated. After separation of the restorative resins, the interaction of Dycal with the different composite resins varied considerably and decreased in the following sequence: Opotow, Natural, and Adaptic. The  interactions of ZOE with Natural and with Adaptic were similar and more pronounced than the interaction at the Adaptic-Dycal interface but less pronounced than at the Dycal-Natural interface. A very thin film of Tubulitec was found to adhere to the composite resins in some areas. The adherence of liners containing calcium hydroxide to dentin was found to be generally stronger than the bond between these liners and composite resins. Separation of the composite resins caused tears in the varnishes and frequently in Hydroxyline. Almost completely intact layers of the varnish Copalite were observed on dentin, but Zahnlack apparently dissolved to a great extent in the resins. Among the liners containing calcium hydroxide, Dycal and Tubulitec were found to give rise to a high pH in samples of saliva, but Hydroxyline did not. Porosity and a folded surface were observed for Hydroxyline, indicating the entrapment of the solvent beneath a dry superficial layer.


The bonding properties of elastomer tray adhesives. 1. The surface yielded by the acrylic resin formed against tinfoil provided better retention for the rubber base than any other surface tested. 2. Wax consistently gave the worst results in spite of careful boiling out. 3. The use of wax or asbestos spacers would not degrade the resin surface if tinfoil, or presumably the more easily obtainable aluminum foil, were used as a separating medium. 4. For drying times of between 15 minutes and 72 hours, no significant change was found in bond strength of elastomer to tray material. 5. Drying times of less than 15 minutes were found to be inadequate and to decrease bond strength; they are clinically inadvisable. 6. If, as a result of unavoidable delay, a tray is painted and then left for a number of days prior to making the impression, satisfactory bonding will still occur. However, if the dentist wishes to apply a second coat and dry it for 15 minutes, an increase in bond strength is likely to occur. 7. In the six systems tested, failure occurred at varied levels, from a low of 20 p.s.i. to a high of 80 p.s.i. 8. In the silicone and polyether systems, cohesive failure of the elastomer occurred before the adhesive bond between elastomer and tray failed. This finding correlates with the clinical observation that silicones and polyethers are more difficult to remove completely from acrylic resin trays when an impression has to be repeated.


Comparative stability of two removable die systems. The comparative stability of two removable die systems was evaluated. Under controlled conditions, ten casts, each with two removable dies, were constructed for each system for a total of 20 casts and 40 removable dies. Base-line pre- and postsectioning measurements to within 0.0001 inch in horizontal and vertical planes were recorded and differences calculated. Each die was removed and re-placed 30 times prior to any postsectioning measurement. The results indicated small inconsistent horizontal deviations and consistent vertical deviations for both systems. The Pindex system deviations were slightly less than those of the Di-Lok system, although t test values preclude any conclusion of significance. The results of this investigation indicate the need for dentists and dental laboratory technicians to exercise care in the utilization of any removable die system so as to obtain optimum accuracy and stability in the relationships of the components of that system.


An individualized impression tray utilizing the patient's existing denture. This technique utilizes patients' existing dentures to construct individualized impression trays. Some of the advantages are: (1) the trays are made within 30 minutes; (2) final impressions may be made at the first appointment; (3)it is an inexpensive and uncomplicated laboratory procedure readily taught to dental auxiliaries. (4) chair time is better utilized by both the dentist and patient.


The nature of information used in making clinical decisions in general practice. This preliminary study indicates that in general practice:(1) Acquisition of appropriate clinical information is more often than not dependent on prior information of a highly selected kind available economically only to a personal doctor.(2) The amount of previous information which could be stored outside the brains of a personal doctor and his patient is relatively enormous and almost unlimited.(3) But, the amount of this externally stored previous information which will ever be used, referred to, or be clinically useful is minimal.(4) Logic branching systems for obtaining this essential clinical information for each episode are of two kinds. There is first the system which is universally appropriate to all patients and all diseases as a whole, a field in which the computer is becoming pre-eminent, but which also has its limitations. Secondly there is the highly personalised system, constituted by the clinical dialogue of the patient and his personal doctor, the structure of which, at present, defies any simplification and which we abandon at our peril.(5) Continuing care by group-practice teams operating under one roof eliminates the need for fragmentation of primary clinical records.(6) A simple up-dated manually-prepared paper summary of clinical problems encountered and therapeutic activity taken, may well be the essential core of this shared record. This would be backed up by the ad hoc clinical records of each health care professional as accessible, second level archives, conforming to some simple, systematic and universally accepted structure (Bjorn and Cross, 1970).It would be of great interest to know whether or not the same conclusions would be drawn from a similar study of the selected clinical problems which are dealt with by the hospital-based specialist services.


[Esophageal atresia, brachio-cephalic arterial trunk and tracheomalacia (author's transl)]. The case of 6 children operated for type III esophageal atresia with re-establishment of continuity is reported owing to the association with anterior tracheal compression by the brachio-cephalic arterial trunk. In the 5 cases, control radiography after the intervention showed a tracheotomy opposite the superior esophageal pouch and sometimes a notch in the anterior trachea. In all of the cases, endoscopy confirmed the presence of compression of the anterior aspect of the trachea by the brachio-cephalic arterial trunk. In 2 cases, esophageal transit was normal, the signs of tracheal compression disappeared after section-reimplantation of the brachio-cephalic trunk. In the other cases esophageal complications existed: stenosis, choking during swallowing, reflux. The surgical treatment of these complications led to the disappearance of the respiratory disorders.


Congenital malformations associated with anencephaly and iniencephaly. The necropsy reports of 294 cases of anencephaly and 50 cases of iniencephaly have been examined, and a tubulated list of associated malformations produced. Cases were divided by sex and the presence or absence of spina bifida. Forty-one per cent of the series had other malformations, and other malformations were more common in those cases with spina bifida than in those without. The most frequent single malformations were: hydronephrosis (8%), cleft palate (8%), diaphragmatic hernia (5%), exomphalos (5%), hare lip (4%), and horseshoe kidney (4%). It is suggested that the presence of other malformations in anencephaly or iniencephaly may imply some aetiological heterogeneity.


[Substraction in gastrointestinal angiography (author's transl)]. On the basis of a comparative study of 100 angiograms, the authors stress the value of photographic substraction in gastrointestinal angiography. From a technical viewpoint, after a brief review of the theoretical background, the authors emphasise the need to use reproductions of different tonality, and the problems of blurring due to movement, which may be overcome by the use of an effective premedication (diazepam) and by limiting the substraction to a very limited arca. From the standpoint of results, photographic substraction gives improved radiological data in the arterial phase in 60% of cases. This improvement concerns the prevertebral vessels. During the venous phase, in all cases there is an improvement in mesenterico-portal return and the visualisation of oesophageal varices. In all, photographic substraction, a simple technique, appears to be of value in gastrointestinal angiography essentially in the arteriographic study of the pancreas and of spleno-portal and mesenterico-portal venous return.


Computer-based instruction and the health sciences library. Computer-assisted instruction (CAI) is being used or considered at a growing number of medical institutions. The health sciences library, in its role as the learning resource center, can provide long hours of supervised access and more efficient sharing of resources if the CAI terminals are located there. Placing terminals in the library does, however, incur costs of training library personnel and of space and equipment and presents new problems in cataloging and maintenance. Budgetary and curriculum design considerations must be addressed in advance of adopting CAI, but those are not primarily library decisions. It is concluded that if an instution integrates CAI into its educational program, CAI does belong in the health sciences library and is fully compatible with the media already in use and that projected for the future.


Streptococci and aerococci associated with systemic infection in man. A collection of 820 isolates of streptococci and aerococci from human blood or internal organs was classified by means of a set of cultural and biochemical tests. Of these, 719 (712 streptococci and 7 aerococci) were from patients believed to be suffering from a systemic infection: endocarditis 317; a purulent lesion in an internal organ ("purulent disease") 152; bacteriaemia 250. The endocarditis streptococci included members of all recognisable taxa, but only certain of these were common: Streptococcus sanguis, 16-4%; dextran-positive and usually mannitol-fermenting strains of S. bovis (S. bovis I), 15-1%; S. mutans, 14-2%; S. mitior, 13-2%. Streptococci of the "alpha-haemolytic" taxa (S. sanguis, S. mitior and related strains) formed only 44-8% of the total. When the percentage frequency of streptococcal taxa among the endocarditis and "non-endocarditis" isolates was compared, the dextran-forming taxa (S. mutans, S. bovis I, S. sanguis, and dextran-positive streptococci otherwise resembling S. mitior) all had higher "endocarditis : non-endocarditis" ratios than did any of the non-dextran-producing taxa. Endocarditis increased in frequency with age, and showed an excess of males over females up to the age of 65 years. In young patients (less than 35 years), "alpha-haemolytic" streptococci predominated; with increasing age, the proportion of other streptococci increased progressively but the absolute numbers of isolations of "alpha-haemolytic" streptococci did not fall. Infections with S. mutans were prominent in the age-group 35-54 years and with S. bovis I at ages greater than or equal to 55 years. A history of previous heart disease was more often obtained in endocarditis due to "alpha-haemolytic" streptococci than in other streptococcal endocarditis. The streptococcus most often isolated from purulent lesions in internal organs was S. milleri (29-3%). It was associated with brain abscess, meningitis, pleural empyema and a variety of intra-abdominal abscesses. The only common predisposing factor in endocarditis was previous heart damage. In other systemic streptococcal diseases, other general or local predisposing causes could be observed, mainly in infections with the "pyogenic" groupable streptococci, the enterococci and S. milleri.


Antibodies to Candida after operations on the heart. The occurrence of yeasts and antibodies to yeasts was studied in patients undergoing open-heart surgery without antifungal prophylaxis, and in a similar group receiving antifungal prophylaxis. An association was demonstrated between the occurrence of commensal yeasts and the appearance of antibodies. None of the patients developed overt systemic or superficial yeast infection. The antigenic stimulus for the post-operative production of antibodies appeared to be the increase in the yeast flora that occurred shortly after operation. When the commensal yeast population was suppressed by antifungal antibiotics, the antibody response was also reduced. The implications of these findings in the interpretation of serological tests for diagnosis of systemic yeast infections are discussed.


The infection of rat tongue mucosa in vitro with five species of Candida. Orthokeratinised mucosa from the dorsal surface of neonatal rat tongue was maintained in culture and then infected with Candida albicans, C. tropicalis C. krusei, C. parapsilosis or C. guilliermondii for up to 45 h. The five species showed varying abilities to invade the tissues, which appeared to reflect their different pathogenicities. C. albicans was the only species able to invade all the tissues present, including the stratum corneum. C. tropicalis and C. krusei were able to invade connective tissue and the deeper nucleated cells of the epithelium but failed to penetrate the keratin layer, while C. parapsilosis and C. guilliermondii showed only slight invasion of the connective tissue. The keratin layer of rat tongue mucosa thus appeared to act as a barrier to invasion of the epithelium by anything but virulent species of candidal fungi. The results suggest that oral mucosa in vitro retains its structural integrity and that the tissues do not act solely as a passive growth medium through which any fungal strain might proliferate. It seems that this in-vitro system is representative of the in-vivo situation and forms a useful experimental model in which to investigate the host-fungal relationship in mucosal candidiasis.


The relevance of growth rates in urine to the pathogenesis of urinary-tract infections due to Micrococcus subgroup 3 (Staphylococcus saprophyticus biotype 3). A novobiocin-resistant "biotype" of Micrococcus subgroup 3 (Staphylococcus saprophyticus) is known to be a primary pathogen of the female urinary tract and to cause infections as severe as those produced by Escherichia coli. The growth characteristics of this virulent biotype were compared in vitro with those of other Micrococcaceae and of E. coli to determine whether rapid growth explains the virulence of the biotype. Nutrient broth was shown to have growth-supporting qualities that differed from those of urine and it was therefore unsuitable for these studies. In urine, the virulent biotype grew more slowly, had a longer lag period, and reached much lower final viable counts than did Escherichia coli. Surprisingly, the virulent biotype also grew more slowly and reached a lower final viable count than did several other Micrococcaceae isolated from the urinary tract of healthy women. Urine from women who had suffered a recent infection with the virulent biotype had growth-supporting properties similar to those of urine from healthy women. Experiments with filtered forestream urine suggested that urethral secretions do not contain a factor determining growth rates of this organism in urine. The possibility that virulent strains adapt to rapid growth in urine was excluded. No evidence was obtained that the virulent biotype inhibits the growth of other Micrococcaceae in urine. Ability to grow rapidly in urine does not therefore explain the virulence of novobiocin-resistant strains of subgroup-3 micrococci.


Antacid control of complications from acute gastroduodenal disease after burns. To determine the effectiveness of hydrogen ion neutralization in preventing the clinical complications (hemmorrhage and perforation) of acute gastroduodenal disease after thermal injury, 48 patients with burns of greater than 35% total body surface were evaluated within 72 hours after injury. In a prospective, randomized fashion, patients were chosen to receive antacid or no-antacid therapy. An established lithiumflux technique was utilized to determine the integrity of the gastric mucosal barrier (GMB) before group selection. Only one of the 24 patients receiving antacid developed significant upper gastrointestinal bleeding; however, seven of 24 patients receiving no antacid experienced hemorrhage and gastric ulcer perforation (p less than 0.02). None of seven patients with GMB disruption who received antacid developed a clinical complication; however, six of 15 patients with GMB disruption receiving no antacid experienced clinical complications (p less than 0.05). Neutralization of gastric acid offers protection against the development of clinically significant ulcer complications in the burn patient.


Origin of the phospholipids of a lipid-containing virus that replicates in Escherichia coli: bacteriophage PR4. Bacteriophage PR4 contains lipid and can reproduce in strains of Escherichia coli that carry an appropriate drug-resistance plasmid. Cultivated in either of two E. coli strains, PR4 acquires a lipid region that contains a relatively high level of phosphatidylglycerol and significant amounts of three phospholipids, including phosphatidylserine, which are present in only very low levels in the host cell membranes. To do this, however, PR4 does not significantly alter the relative levels of synthesis of the various E. coli phospholipids after infection. Production of PR4 virions from E. coli cultures labeled with 32PO4 either before or after infection showed that about two-thirds of the viral phospholipid is synthesized after infection. The use of E. coli as the host organism for PR4 should allow a detailed understanding of the assembly process of this lipid-containing virus due to the wealth of biochemical and genetic techniques available.


Genetic characterization of a phi80 transducing bacteriophage carrying the histidine operon of Salmonella typhimurium. A phi 80 transducing phage, phi 80imm lambdadhis, carrying the Salmonella his-gnd region, was characterized by immunity studies, tonB deletion analysis, and marker rescue analysis. Phi 80imm lambdadhis retains the phage immunity region of the phi 80-lambda hybrid phage from which it was derived. Bacterial genes replace most late phage genes. Deletion analysis shows the prophage gene order to be immlambda-his-gnd and indicates the orientation of the his operon to be hisOGDCBHAFIE-gnd. The structure of phi 80imm lambdadhis is remarkably similar to two independently isolated phi 80 phages that carry the his-gnd region of Escherichia coli and that, like phi80imm lambdahis, were derived by directed gene transposition to the tonB locus. A derivative of phi 80imm lambdadhis that is phi 80 immune is also reported.


Replication of bacteriophage T4 DNA in vitro. I. Basic properties of the system. A new in vitro system for T4 DNA replication was developed by concentrating cell lysates on cellophane disks. The time course of [3H]dTTP incorporation into DNA by the system was separated into two phases: one was a very rapid incorporation which was terminated within 2 min (phase I reaction), and the other was a slow but continuous incorporation thereafter (phase II reaction). More than half of the phase I reaction product was Escherichia coli DNA, but the phase II reaction was mostly T4 DNA. Phase II reaction required four deoxyribonucleoside triphosphates, ATP, Mg2+, and KCl. 5-Hydroxymethyldeoxycytidine triphosphate was essential for the reaction and not substitutable by dCTP. The presence of KCN or NaN3 in the reaction mixture did not interfere with [3H]dTTP incorporation, but the addition of deoxyribonuclease completely degraded the system. Alkaline sucrose sedimentation analysis of phage II reaction product revealed that phase II reaction proceeded by the discontinuous mode of DNA replication as in vivo. After T4 infection, the activity for phase II reaction appeared in parallel with the activity of T4 phage DNA replication in vivo.


Membrane protein biosynthesis in bacteriophage BF23-infected Escherichia coli. When Escherichia coli is infected with bacteriophage BF23, two new proteins with molecular weights greater than 10,000, as indicated by polyacrylamide gel electrophoresis, are found associated with the cells' membranes. One of these, found associated with both the inner and outer membrane, has a molecular weight of about 55,000 and is regulated by the A1 gene of this phage, a gene found on the spontaneously injected 8% piece of BF23 DNA, DNA that codes for the synthesis of proteins necessary for the injection of the whole phage genome. The other protein, often undetected in whole membrane preparations, is found exclusively associated with the inner membrane. Evidence indicates that this protein is also regulated by the initially injected 8% piece of the DNA.


Process of infection with bacteriophage phi X174 XLI. Synthesis of defective phi X particles at 15 degrees C. At 15 degrees C, phi X174-infected cells make single-stranded viral DNA fragments, varying in size from 0.2 to 0.9 times that of phi X DNA. In non-deproteinized lysates, this single-stranded DNA is found associated with proteins in particles sedimenting heterogeneously with an S20, w average of 80 to 90S. These particles do not differ appreciably from mature virus in polypeptide composition. Chase experiments, at 37 degrees C, of the label incorporated into this DNA at 15 degrees C suggest that both the single-stranded DNA fragments and the 80 to 90S particles are not precursors of virions but are defective end products.


Genetic analysis of heterogeneous DNA circles formed after prophage Mu induction. Induction of a Mu prophage in Escherichia coli Hfr strains lyosgenic for Mu cts62 leads to the generation of F' episomes. Each episome thus formed carries at least one copy of the Mu genome. These results suggest that integration of Mu is mandatory for the formation of the heterogeneous circles during the lytic cycle. The circles may be precursors for phage maturation.


Individual renal plasma flow determination in 2 minutes. A method is described for determining effective renal plasma flow, using the renal counts 1 to 2 minutes after injection and applying background subtraction as a ratio to the total amount of radio-activity injected intravenously with appropriate correction for kidney depth. It appears that this simple approach for determination of effective renal plasma flow within a matter of 2 minutes is accurate and reliable, and should be useful for a number of applications when it is important to determine total and individual renal plasma flow. The approach is recommended as a screening procedure in lieu of the determination of blood urea nitrogen and serum creatinine, with the additional advantages of gross morphology and determination of individual renal plasma flow in an absolute as well as relative manner.


Influence of rejection on graft survival after renal transplantation. The clinical course was reviewed of 102 renal allograft recipients between December 1967 and December 1973. Only 4 of 21 patients (19 per cent) who had 2 or more episodes of rejection during the first 2 months had a functioning graft at the end of 1 year, compared to 24 of 30 patients (83 per cent) who had no rejection episodes. A similar trend was seen 2 to 6 months after transplantation. During the first 2 years vigorous immunosuppressive therapy for rejection in the first few months resulted in 12 deaths (44 per cent) of 27 patients. Subsequent to this immunosuppressive therapy was modified and grafts were removed if there was not a prompt recovery of function after treatment, which resulted in a significant decrease in mortality rate to 16 per cent. There also was improvement in the over-all survival of patients with functioning grafts from 37 to 56 per cent. Serious complications and mortality could be related to high dosage of steroids and severe leukopenia. A white blood count of less than 1,000 mm.3 on 3 successive days was associated with a mortality rate of 52 per cent, compared to 15 per cent in those without leukopenia. Serious consideration should be given to early graft removal in patients who have 2 or more episodes of rejection in the first few months after transplantation, particularly when there is not a prompt improvement in renal function after immunosuppressive therapy. High doses of steroids (greater than 1 mg. per kg. for more than 26 days during the first 60 days) should be avoided to decrease morbidity and mortality rates from serious infections. The results of histocompatibility (HL-A) matching in 72 donor-recipient pairs indicated an improved graft survival when there was a match of 2 or more antigens, which is supported by the results recently reported by the Transplant Registry. The results of mixed lymphocyte reactions in 20 live donor-recipient pairs showed a marked improvement in graft survival when there was less than 20 per cent stimulation and it appeared that this reaction was of more important prognostic significance than the results of histocompatibility (HL-A) matching in these patients.


Related living donor nephrectomy.

Related living donor nephrectomy. The improved survival figures for living related grafts suggest that this is an important source of kidneys in a renal allotransplant program. There is need to review repeatedly this source of kidneys and to evaluate the results and techniques. The supracostal incision best provides exposure for removal of the kidney without traumatic hilar dissection.


Meatal reconstruction.

Meatal reconstruction. A technique for repair of fossa navicularis and distal pendulous urethral strictures includes elevation of a ventral flap of penile skin, which is inverted and interposed into a distal urethrotomy. Epithelial strips created on the ventral penile skin and on the glans penis are sutured face-to-face permitting a directable urinary stream and cosmetically fine result. Results of a personal series of 7 patients are uniformly good.


The use of the omental pedicle graft in urinary tract reconstruction-. The omentum is unique in that it is the only body tissue specifically developed for the resolution of infected process; it also regains its suppleness once healing has taken place. The characteristics are not shared by the periureteral and perivesical tissues so that a properly mobilized pedicle graft is valuable adjunct to be more difficult repairs and reconstructions of the urinary tract.


Acute pyelonephritis in a transplant patient with an ileal loop mimicking rejection. The clinical picture of an enlargement in kidney size, a decrease in renal function and an increase in temperature in a patient with a transplanted kidney into an ileal loop presents a problem in differential diagnosis among rejection, acute tubular necrosis and acute pyelonephritis.


Gram-negative bacillary meningitis therapy. Polyradiculitis following intralumbar aminoglycoside administration. Gram-negative bacillary meningitis is a serious threat to patients with head trauma or altered immune systems, or those who have had neurosurgical procedures. The aminoglycoside antibiotics administered systemically and into the cerebrospinal fluid (CSF) have proved useful in the treatment of these infections. Intralumbar and parenteral gentamicin sulfate and tobramycin sulfate were administered to an acromegalic woman with Klebsiella meningitis. She had objective evidence of adhesive arachnoiditis and symptoms of polyradiculitis. Cessation of the aminoglycoside administration resulted in symptomatic improvement, and reinstitution of therapy caused a recurrence of neurologic symptoms. Polyradiculitis may be a complication of the intralumbar administration of aminoglycosides.


Lessons learned from a patient. Changing concepts rather than facts. Many concepts pertaining to urinary tract infections and considered to be established or dogma are, in fact, incorrect or subject to modification. The physician should not be too rigid in his thinking regarding this disorder, as new knowledge constantly becomes available, disproving previously cherished beliefs. The case described appears to underscore this better than any hypothetical situation.


Positive end-expiratory pressure (PEEP) ventilation. A review of mechanisms and actions. In situations characterized by a substantial decrease in lung compliance and a large alveolar-arterial oxygen tension gradient, positive end-expiratory pressure (PEEP) ventilation is often effective in enhancing arterial oxygen content. It may have a variable effect on cardiac output based in part on the level of end-expiratory pressure, the state of intravascular volume, and the pathophysiology of the underlying pulmonary abnormality. It is most beneficial in conditions manifesting diminished lung compliance. Evidence is clear that PEEP may decrease expiratory shunting by maintaining alveolar patency, thereby increasing functional residual capacity. It may not prevent and may actually favor accumulation of interstitial lung water. Commonly employed levels of PEEP result in a 7% incidence of pneumothorax. The most advantageous level of PEEP is variable and is determined by sequential monitoring of multiple physiologic indexes.


Susceptibility to murine leprosy bacilli of nude mice. Comparative observations were made on the development of experimental murine leprosy in various inbred strains of mice, including nude mice of congenital thymic aplasia. The susceptibility of these strains of mice to murine leprosy bacilli was evaluated by the development of leproma at the subcutaneous infection site and also by the involvement of visceral organs. Nude mice developed a much more severe disease than C3H mice which is the representative of the malignant type. Their high sensitivity was also demonstrated in the case of intraperitoneal infection. The observations in nude mice and other mouse strains confirmed our concept that experimental mouse leprosy can be classified into three clinical types, benign, intermediate and malignant, and suggested that such mouse strain differences are related with their cell-mediated immunity.


Persistence of mumps viral antigens in mouse brain. Newborn mice were infected intracerebrally with a fresh isolate of mumps virus. Although infectious virus could not be recovered after the acute infection, direct immunofluorescence demonstrated the persistence of mumps antigens for up to 100 days after the initial infection.


Further studies on the lethal effect of long-chain fatty acids on mycobacteria. Mycobactericidal activity of long-chain fatty acids was confirmed by in vitro exposure of BCG. The killing effect was accompanied by inhibition of the membrane-bound acid phosphatase activity. Such active fatty acids were those having a stronger hemolytic activity (e.g., C12:0, C14:0, C18:1, C18:2). Heat-killed BCG cells or their cell walls adsorbed the toxic fatty acids, whereas the fatty acid-insensitive E. coli cells did not. It was suggested that the mycobactericidal action of long-chain fatty acids is due to their detergent-like action on the cytoplasmic membrane, and that the determinant factor for the fatty acid-sensitivitiy of bacteria is the property of the cell wall by which fatty acids are adsorbed so that the active site is brought into contact with the inner membrane.


[Is a medical treatment of glaucomatous field defects possible? Results of a double blind study (author's transl)]. 46 patients with field defects due to simple glaucoma were treated with beta-Acetyldigoxin (given as "Placebo") or with beta-acetyldigoxin and Bencyclan (given as Verum) in tablets over 6 months, under strict double-blind conditions and after the elimination of the learning effect of perimetry. 56 out of the 69 eyes which could be evaluated, showed no change of the field during that period, in spite of increasing field defects during the preceeding months in some of them. A deterioration of the field was observed in 3 eyes treated with placebo, 10 eyes became better, one with placebo and 9 with Verum. Digitalis can evidently stop a deterioration and, in exceptional cases, even enlarge the field. Bencyclan with digitalis was found to have a definitely better effect and enlarged field in 9 out of 41 eyes which were treated with the drug, probably by the change of viscosity of the blood perhaps in addition to vasodilation and a better action of the heart. The effect is statistically-significant (p less than 5%).


[Closure of eyelid defects by transplantation of lid margin and tarsus (author's transl)]. An excellent repair of large eyelid defects can be obtained by the following procedure: reconstruction of the skin-surface by a sliding or rotating graft, while the lid margin and tarsus are rebuilt by a free transplant from the opposite lower lid. For upper eyelid defects a special incision was developed.


[Urgent keratoplasty for a corneal infection by actinomyces (author's transl)]. A 41-year-old man suffering from an actinomyces infection of the cornea of his right eye, was treated unsuccessfully with antibiotics especially intensive local and systematic therapy with penicillin, paracentesis of the anterior chamber with penicillin irrigation, and cautery of the corneal ulcer were fruitless. Finally, the corneal infection was cured by an urgent perforating keratoplasty.


[Human ethanol-induced hyperlipoproteinemia (author's transl)]. Reversible hyperlipoproteinemia may be observed after ethanol loads in healthy man before any ethanol-induced disease is being established. Different pathogenetic ways to this acute ethanol-induced hyperlipoproteinemia have been investigated or postulated in recent years. Two main sites have appeared: changes in the metabolism of lipids and their precursors which depend from acutal oxidation of ethanol in the liver, and ethanol-induced activation of lipolysis in adipose tissue, transmitted by the sympathico-adrenal system. The changes in liver metabolism during ethanol oxidation have been well confirmed in many experiments, they nevertheless do not seem to lead to hyperlipoproteinemia in many experimental designs in animals and after drinkable amounts of ethanol in healthy man when lipolysis of adipose tissue is blocked and no food is ingested. After the intake of a fatty meal these triglycerides are becoming importance as a source of fatty acids. A possible increased de novo synthesis of palmitic acid may to a minor degree contribute to hypertriglyceridemia.


The kidney in progressive systemic sclerosis: immunohistochemical and antibody elution studies. Immunologic studies were performed on 11 renal specimens from seven patients with progressive systemic sclerosis (PSS). Two patients had the chronic renal lesions of PSS and five had acute PSS renal disease. One of the latter patients underwent renal transplantation after developing acute renal failure with recurrence of lesions in the allograft. The lesions in the allograft were morphologically indistinguishable from the renal lesions of acute PSS. Immunofluorescence microscopy revealed vascular localization of IgM along with early and late acting complement components C1Q, C4, and C3 in all specimens including the allograft. Fibrinogen localization was observed in the vasculature of patients with the acute form of the disease. Antiglobulin, detected by fluorescein-labeled, heat-aggregated gamma-globulin, was also present in vascular lesions from two of the specimens; Eluates of four of the kidneys including the allograft contained antinuclear antibodies. In addition, antiglobulin activity was present in eluates from three of the four kidneys, The findings suggest that (1) renal vascular lesions in PSS may result from injury via immune complexes composed of nuclear antigens and antibody, (2) the predominance of IgM in the vascular lesions may reflect the presence of rheumatoid factor in the immune complexes, and (3) a similar pathogenetic mechanism may have resulted in allograft failure following renal transplantation of a patient with PSS.