Febrile illnesses resulting in hospital admission: a bacteriological and serological study in Jakarta, Indonesia. A study of 741 Indonesian patients with fever was carried out in order to determine what serious febrile illnesses are prevalent in Jakarta. All patients were hospitalized primarily because of fever and were studied by bacteriological and serological methods. Bacteremia due to Salmonella typhi (150 cases), S. enteritidis (36 cases), or both (2 cases) was common in both children and adults. One S. enteritidis isolate was chloramphenicol resistant. Serological evidence of Salmonella infection was found in 130 additional cases without bacteremia. Serological evidence of arbovirus infection (94 cases) was common in children. Malaria was found in 12 adults, most of whom were probably infected outside Jakarta. Little serological evidence was found for rickettsial, leptospiral, Brucella, Toxoplasma gondii or a number of other infections. Clinical signs and symptoms in the febrile patients studed were generally nonspecific, and laboratory results reported were very helpful in establishing more accurate diagnoses.


Single-dose therapy of Falciparum malaria using pyrimethamine in combination with diformyldapsone or sulfadoxine. Patients with naturally acquired chloroquine-resistant falciparum malaria were studied in Thailand. The fixed combination of pyrimethamine 75 mg and sulfadoxine 1,500 mg (adult dose) cured 85% of patients with an average pretreatment parasite count of 60,000 per mm(3). The fixed combination of pyrimethamine 50 mg and 800 mg diformyldapsone (DFD) cured 43% of patients with an average pretreatment parasite count of only 17,000 per mm(3). The difference in cure rates was statistically significant (p less than 0.01). Pyrimethamine alone was ineffective. Pyrimethamine-DFD, in the dose tested, was not sufficiently active for the treatment of established infections. Pyrimethamine-sulfadoxine did produce an acceptable cure rate but clinical improvement was often slow. We do not recommend that pyrimethamine-sulfadoxine be administered alone. Optimal results are obtained when a short course of quinine (2 to 6 days) is given until parasitemia has been eliminated, then a dose of pyrimethamine-sulfadoxine to assist in the radical cure of the falciparum infection. A modification to the W.H.O. classification is suggested. An RIII response (early treatment failure) is diagnosed if the patient's clinical condition and/or parsite density worsens within a few hours after administration of the test regimen; distinct improvement occurring within a few hours of the subsequent initiation of an intravenous infusion of quinine confirms the diagnosis of an RIII response. The RII response has been defined as marked reduction, but not clearance of asexual parasitemia. It is suggested that an RII response may be diagnosed before 7 days have elapsed.


The seroepidemiology of malaria in Middle America. III. Serologic assessment of localized Plasmodium falciparum epidemics. Epidemiologic studies were done in two localities, one in Panama and one in El Salvador, where outbreaks of Plasmodium falciparum malaria occurred. The indirect fluorescent antibody (IFA) method was helpful in defining the intensity of the outbreaks, the species of parasite involved, and, through parallel surveys of adjacent localities, the localized character of outbreaks. In Escobal, Panama 71 (34%) of 211 persons examined were IFA-positive for P. falciparum, although only 1 positive blood film was seen in this survey. In Jocomontique, El Salvador, 15 (28%) of 53 persons examined were IFA-positive for P. falciparum; 6 persons were parasite-positive. In the Panama study a number of children with positive IFA titers at the time of the epidemic had reverted to negative 6 months later. This lability of titers, in children, probably resulting from very early treatment of their first infection and, thus, a very brief exposure to the parasite antigen, suggests the need for caution in interpreting such negative serologic findings. Serologic studies provide valuable information in malaria epidemics, but must be interpreted in association with other known epidemiologic factors in the area concerned.


Chloroquine sensitivity of Plasmodium falciparum in Ethiopia. I. Results of an in vivo test. The in vivo response of Plasmodium falciparum to the WHO single test dose (10 mg/kg body weight) of chloroquine base was examined in Ethiopia at four localities where malaria was meso- or hyperendemic. Parasitemias cleared by the 3rd day after chloroquine administration in all of the 150 test subjects. No recrudescences were detected during the 6-day or 11-day follow-up periods. The value of the in vivo test was severely limited by the inability to quarantine subjects and follow them for the 28-day period recommended by the World Health Organization.


Clinical manifestations of Bancroftian filariasis in a suburb of Calcutta, India. Interviews and physical examinations for filarial disease were conducted in Howrah near Calcutta, West Bengal, India, in a study area where long term quantitative entomological studies have disclosed high intensity, year round exposure to Wuchereria bancrofti. Little elephantiasis or other serious filariasis-related disease was noted, but half the males over 20 years of age had genital lesions of various types. Ninety-two percent of households had at least one resident with microfilaremia or presumptive clinical evidence of filarial disease.


Malarial antibodies measured by the indirect hemagglutination test in West African children. The indirect hemagglutination test with Plasmodium falciparum antigen was used to measure malarial antibodies in filter paper blood specimens from 527 West African children. A slight decline in antibodies was noted in 6- to 8-month-old children wh o had no malaria parasites in their blood smears. Children older than 10 months had similar antibody levels regardless of the presence or absence of demonstrated parasites in blood smears.


A temporal relationship between reticuloendothelial system phagocytic alterations and antibody responses in mice infected with Plasmodium berghei (NYU-2 strain). Malaria-induced immunosuppression has been demonstrated in humans and experimental animals. The suppressed immune response has been suggested to be primarily humoral and not cellular in nature, since classical lymphocytic cell-mediated responses have been reported to be normal. Since previous results have demonstrated that an impairment in macrophage antigen processing may be a contributing factor in malaria-induced immunosuppression, the present studies were conducted to determine if the macrophage/reticuloendothelial system (RES) alteration occurs parallel to the course of the malarial infection and if the impairment in antibody formation is temporally related to the RES alteration. The present study has demonstrated that a profound impairment in splenic direct plaque forming cell (PFC) formation occurs in malaria-infected Balb/c mice which had been immunized with sheep erythrocytes (SRBC) either 2 or 4 days after inoculation with Plasmodium berghei, NYU-2 strain. Serum hemagglutinin titers were significantly depressed in mice which received the SRBC 4 days post-inoculation; however, no alterations in antibody titers were observed in mice immunized with SRBC 2 days post-inoculation. Coincident with the depression of serum antibody titers at the day 4 immunization period was a profound increase in the vascular clearance of 51Cr-SRBC with an enhanced hepatic uptake of the 51Cr-SRBC and a decreased splenic localization of the labelled erythrocytes. It is suggested that a direct vascular exposure of the splenic lymphoid-macrophage elements to the parasite may be responsible for the initial early alterations in the PFC response while the impairment in serum antibody titers and splenic phagocytic activity may be a result of the pathological alterations occurring later in the infection, e.g., tissue anoxia, anemia, and hemolysis.


Bancroftian filariasis and membrane filters: are night surveys necessary? Paired day and night blood specimens from 41 persons living in a hyperendemic Wuchereria bancrofti area of southwestern Ethiopia were examined for microfilariae by Nuclepore filter, thick film, and counting chamber techniques. Filtering techniques were so highly sensitive that more infected persons were identified by filtering day blood than by examining night blood by conventional methods. Increasing the volume of blood filtered from 1 ml to 5 ml increased the number of positives identified during the day. Filtering 5 ml of day blood obviated the need for examining night blood, even though a high proportion of infected persons had very low numbers of circulating microfilariae.


Dipetalonema perstans and Mansonella ozzardi in Indians of southern Venezuela. Microfilariae were observed in 25 of 187 blood leucocyte-culture preparations made for chromosome studies on 28 Piaroa and 159 Yanomama Indians living near the Brazilian border of Amazonas, Venezuela. Among the Yanomama, 17 (10.7%) were infected, all with Mansonella ozzardi. Among the Piaroa, 8 (28.6%) were infected--3 with M. ozzardi, 4 with Dipetalonema perstans, and 1 with both species.


Study of the circumoval precipitate in Schistosomiasis japonica by immunofluorescent technic. The 48-hour circumoval precipitates formed by infected human and rabbit sera on lyophilized Schistosoma japonicum eggs were stained with the corresponding fluorescein-labelled monospecific goat antisera for study under a fluorescent microscope. The three major Ig classes were found to participate in the formation of the precipitate, with major components being IgG and IgM; IgA participated least. IgE and C3 also contributed to the precipitate. The circumoval precipitate on S. japonicum eggs is therefore a complex of different immunoglobulins reactive with antigen(s) from the egg.


Unusual abscesses in perforating colorectal cancer. Perforating colorectal carcinomas may be complicated by abscess formation. If unchecked, the abscess may subsequently extend to a number of sites thus requiring emergency medical attention. The cases of five such patients treated at Massachusetts General Hospital are reported. Sepsis may spread in a short period of time over a considerable area in anatomic spaces such as the retroperitoneal space. Recognition of the source of abscess may be difficult. At times, the abscess may be accompanied by subcutaneous emphysema. Prompt diagnosis and elimination of the source of sepsis may be lifesaving.


Fatal complications of tracheotomy.

Fatal complications of tracheotomy. Thirty-six of 403 deaths after tracheotomy were direct complications of that procedure. Arterial hemorrhage caused three deaths, venous bleeding, seven. Airway obstruction resulted in six fatalities. Tracheoesophageal fistula caused five deaths. Eight deaths were due to infection and sepsis. Tension pneumothorax developed in one patient and the remaining six deaths were due to cardiopulmonary collapse. Many of the complications of tracheotomy can be avoided with accurate knowledge of anatomic variations, ideal operating conditions, proper technic, careful arterial and venous hemostasis, routine postoperative chest x-ray films, sterile suction technic, proper use of soft cuffed tracheotomy tubes, adequate humidification, and careful postoperative blood gas monitoring.


Hyperparathyroidism during pregnancy.

Hyperparathyroidism during pregnancy. Hyperparathyroidism during pregnancy is clearly associated with an increased incidence of neonatal morbidity and mortality. Although it is impossible to define the precise incidence of this entity, we believe that its occurrence will be seen more frequently with the increasing numbers of female patients who have successfully received renal transplants and with the routine determination of serum chemistries in the nontransplanted pregnant patient. A review of case reports since 1962 of women known to be hyperparathyroid during pregnancy revealed 80 per cent of these pregnancies to be complicated by neonatal tetany, death, or abortion. This review substantiates Ludwig's earlier report [1], which noted a 50 per cent incidence of neonatal complications despite the advances of prenatal and postnatal medical care. There have been only eight reported cases in which parathyroid resection was performed during pregnancy. Successful operation dramatically reduced the incidence of neonatal complications. An adaptive normocalcemic hyperparathyroidism occurs routinely during pregnancy. However, in the hypercalcemic hyperparathyroid pregnancy, transplacental passage of calcium leads to a profound hypercalcemia in the fetus. Since the fetal parathyroid glands are functionally responsive, parathyroid suppression is thought to occur in utero due to high calcium levels. This can lead to neonatal tetany or perhaps permanent neonatal hypoparathyroidism. When a patient presents with significant hypercalcemic hyperparathyroidism during pregnancy, we suggest that an explorative parathyroid operation be performed during the second trimester of pregnancy. After delivery, the baby's course should be carefully monitored with frequent calcium determinations. Cow's milk or other formula feedings high in phosphate content should be avoided in favor of feedings with a calcium:phosphorus ratio similar to that of human milk.


Cerebral hemodynamic crisis. Physiology, pathophysiology, and approach to therapy. The physiology and pathophysiology of the cerebral circulation have been discussed in relation to treatment of the cerebral hemodynamic crisis. Data are presented to show how cerebral vascular resistance, the intracranial compartments, and brain metabolic demand may be manipulated to effect internal decompression and raise local perfusion pressures. It is quite apparent that irreversibility occurs rapidly in cases of complete ischemia and therapeutic success is often limited by this fact. Application of sound therapeutic principles will limit the extent of cellular destruction. Of particular importance to the general surgeon treating the multiply injured patient, is the effect of anesthesia on intracranial pressure in patients with compromised intracranial volume reserve.


Successful transplantation of ectopic kidneys from living related donors. Two ectopic pelvic kidneys were transplanted from living donors into well matched recipients. Both kidneys have good function at two and four years post transplantation and there has been no evidence of infection post transplantation. Such kidneys can be utilized when there is no evidence of obstruction or infection in the donor and when the contralateral kidney is normal.


Gastrointestinal hemorrhage secondary to cytomegalovirus after renal transplantation. A case report and review of the problem. Generalized cytomegalovirus infection was associated with massive and ultimately fatal upper gastrointestinal bleeding in a renal allograft recepient and persisted even after subtotal gastric resection. The surgical specimen and the remaining stomach at autopsy revealed multiple superficial ulcerations with cytomegalic inclusion bodies within the gastric mucosa. Renal failure in the terminal stages of the patient's illness required hemodialysis but did not seem to be the sole result of allograft rejection, suggesting that the renal dysfunction may be caused by the systemic viral infection.


A salvage technic for extruded arteriovenous shunts. In view of the often prolonged periods of pretransplantation and chronic dialysis, every effort should be made to maintain existing arteriovenous shunts or fistulas and to salvage eroded ones when possible. The transposition of unwounded bipedicle flaps or small regional rotation advancement flaps over exposed cannulas is a surgical technic that can salvage eroded shunts and prevent their extrusion and removal.


Dysrhythmias associated with oral surgery. Seventy-eight fit adult patients undergoing minor oral surgery received one of three intravenous premedications or were unpremedicated. Cardiac rhythm was monitored during surgery. A significantly higher incidence of dysrhythmias was associated with intravenous atropine 0-3 mg/given prior to surgery. Droperidol 0-1 mg/kg did not act prophylactically as an anti-dysthythmic agent in comparison with the control group. A further trial of eighteen cases suggested that atropine 0-6 mg intramuscularly followed by controlled ventilation may be effective in preventing dysrhythmias.


Intermittent assisted ventilation. An assessment using the Retec breathing assistor. A simple ventilator assistor was utilised in three of six patients after transthoracic repair of hiatus hernia. The device was found to be easy and convenient to use but in the pilot study produced no demonstrable improvement in respiratory function. At 10 days postoperation, the arterial oxygen tension had not risen to a preoperative level in five patients, and the FVC and FEVI were less than the values obtained before surgery in every patient.


Thiopentone and suxamethonium crash induction. An assessment of the potential hazards. A technique of 'crash induction' using thiopentone and suxamethonium with cricoid pressure was studied in 100 unselected patients at risk from vomiting or regurgitation. No episode of regurgitation occurred. There was difficulty with intubation due to poor relaxation in 7 patients and, in 61 cases, it was believed that there was some evidence of a potential hazard from raised intra-abdominal pressure other than due to fasciculation. Systolic blood pressure rose more than 20% in 19 patients, and fell more than 20% in 9 patients.


Death in Bristol. An exchange of views between Augustin Prichard and John Snow. An exchange of views is presented that took place in the British Medical Journal of 1858, between Augustin Prichard, a Bristol Surgeon, and John Snow, relating to an anaesthetic death that occurred in Bristol that year.


Intra-arterial pressure monitoring. An alternative technique using winged needles. The use of 21 gauge winged needles for direct arterial pressure monitoring is described. The results obtained with this technique compare favourably with those obtained from direct cannulation of major vessels. The use of winged needles sometimes makes arterial cannulatiin possible when other, more conventional, methods may fail.


Antagonism of neuromuscular blockade.

Antagonism of neuromuscular blockade. Although acetylcholinesterase inhibitors are accepted antagonists of nondepolarizing neuromuscular blockade, many basic questions are still unanswered. What is the relationship between receptor occupancy and adequate ventilation? What are the effects of changes in acid-base balance and temperature? What are the mechanisms of the various antibiotic-induced neuromuscular blockades, and what antagonizes them? This review is an attempt to summarize the known factors infuencing relaxant blocks and to identify the unknown factors. The need for further studies is obvious.


Cardiovascular effects of cannabinol during oral surgery. Fifty-five clinical trials were conducted to determine the cardiovascular combined effects of stressful oral surgery and systemic cannabinols. In a first study, delta9-tetrahydrocannabinol (THC) was given IV as a premedicant and compared with diazepam and with a placebo. A classic dose-related tachycardia followed THC injection. The peak heart rate response of patients premedicated with 0.044 mg/kg THC was 24.1% higher (p less than 0.05) than the peak effect for a nonsurgerized control group, suggesting a synergistic effect between THC and surgical stress. A predisposition to syncopal hypotension followed THC premedication, and antiarrhythmic effects were observed after large doses. The injection of local anesthetic preparations containing epinephrine did not alter THC cardiovascular response. An apparent drug interaction was observed, however, in a second study, in patients given general anesthesia within 72 hours after smoking marijuana. These patients demonstrated sustained abnormal postoperative tachycardia when compared with control nonsmokers, an effect which may have resulted from an interaction between stored cannabinol metabolites and atropine administered as part of the anesthetic technic. It was concluded that THC had no particular advantage over diazepam or placebo as a premedicant. Further, THC altered the patients' adaptivity to stress and interacted undesirably with other anesthetic medications.


Effect of gonadotropin-releasing hormone and human chorionic gonadotropin on cows with ovarian follicular cysts. Ovarian follicular cysts of cattle were defined as follicular structures (larger than or equal to 2.5 cm, diameter) which persisted for 10 days or longer in the absence of functional luteal tissue. Thirty dairy cows with ovarian follicular cysts were allotted to 6 groups (5 cows per group) and each was given 0 (saline solution), 25, 50, 100, 150, or 250 mug of gonadotropin-releasing hormone (GnRH) by intramuscular (IM) injection. Samples of blood were collected before GnRH was injected (0 hour), at 0.25, 0.50, 0.75, 1, 2, 3, and 4 hours, and at 1, 7, 11, 15, and 20 days after treatment. Five additional cows with follicular cysts were treated IM with 10,000 units of human chorionic gonadotropin (HCG), and blood sample collections were made before treatment (0 hour) and on days 1, 7, 11, 15, and 20 after treatment. Serum luteinizing hormone (LH) concentration was not altered in cows given saline solution, but was increased significantly in cows given any of the doses of GnRH (in a dose-related manner). Peak LH responses occurred about 2 hours after GnRH was given, and by 4 hours LH was beginning to decrease. Serum progesterone concentrations increased by more than 2.0 ng/ml by day 11 after treatment in 18 of 20 cows treated with 50, 100, 150, or 250 mug of GnRH. Progesterone responses in these cows were greater (P less than 0.05) than in cows given saline solution or a 25-mug dose of GnRH. Mean progesterone response to the 4 large doses of GnRH was similar in magnitude and duration to serum progesterone changes during the leutal phase of the bovine estrous cycle. After cows were treated with HCG, serum progesterone values were similar to those in cows given GnRH (50 to 250 mug).


Local immune responses in the bovine fetus vaccinated in utero with Escherichia coli antigen. Using specific immunofluorescent examinations, the local immune responses were studied in 14 calves prenatally vaccinated (10 to 50 days before birth) with Escherichia coli (O26:K60:NM) antigen or sterile saline solution. All calves were colostrum-deprived, were given oral doses of homologous organisms (killed or live), and were necropsied either at birth or within 12 days after birth. Immunofluorescent plasma cells were not seen in duodenum, jejunum, jejunal lymph nodes, ileum, ileal lymph node, or spleen of control calves prenatally vaccinated with sterile saline solution. All of these tissues, except ileal lymph node, from calves vaccinated in utero with E coli showed fluorescence. Jejunum, jejunal lymph node, and ileum had the greatest number of immunofluorescent plasma cells. There were more immunoglobulin G2-than immunoglobulin M-producing cells. The cells producing specific antibodies against E coli (1 calf studied) comprised approximately 33% of the total number of immunofluorescent cells.


Effects of age and cold on pulmonary bacterial clearance in the young pig. Young pigs (1, 6, 18, or 26 days of age) were exposed to an aerosol of a nonpathogenic strain of Escherichia coli and then held for a 3-hour clearance period in either a thermoneutral (32 C environmental temperature at 1 or 6 days of age, 24 C at 18 or 26 days of age) or a cold (6 C) environment. Pigs were then killed and pulmonary bacterial clearance was determined. There appeared to be an age dependent improvement in the capability of the pig to clear its lungs of the bacterial load. Cold appeared to inhibit pulmonary bacterial clearance, but this inhibitory effect became progressively less as the pigs became older. In a supplementary experiment conducted to assess the effect of age-within-litter (2 and 14 days of age) on pulmonary bacterial clearance, it was confirmed that young pigs were less able to clear nonpathogenic E coli from the lungs.


T and B lymphocytes in porcine blood.

T and B lymphocytes in porcine blood. Two subpopulations of lymphocytes in the peripheral blood of young, conventionally reared Tamworth pigs had the following cell-surface markers analogous to those of human lymphocytes; (1) T cells--receptor(s) for ovine and caprine erythrocytes, permitting spontaneous formation of rosettes and the presence of the thymus-derived antigen; and (2) B cells--membrane-associated immunoglobulin and receptor(s) for complement. The T cells could be identified by either the erythrocyte rosettes or the cytotoxicity test, and the B cells could be identified by either the erythrocyte-antibody-complement rosette test or the immunofluorescence test for surface immunoglobulin. Because of simplicity, the cytotoxicity and immunofluorescence tests are recommended. The cell losses in ficoll-diatrizoate gradient centrifugation were studied with 9 blood samples. Of the total T and B cells, 71.7% were in fraction 1, and 28.3% were in erythrocyte fraction 2. Recovery rates of total leukocytes varied widely in relation to leukocyte numbers present in the original blood; the range was between 52.6 and 93.8%. Moreover, evidence did not indicate that either T or B cells were selectively sedimented in fraction 2. Analysis of the lymphocyte-rich fractions (fraction 1) from 37 blood samples by ficoll-diatrizoate gradient centrifugation indicated the following: (1) Approximately 2.7 X 10(6) T cells and 0.9 X 10(6) B cells could be obtained in the fraction from 1 ml of peripheral blood; (2) T and B cell populations were independently distributed; hence, no definite ratio between T and B cells applied to an individual animal; (3) approximately 20% of the lymphocytes did not have markers as either T or B cells; and (4) an average of 26% cells were peroxidase-positive leukocytes, chiefly monocytes.


Effect of resistance possessed by certain enteric microorganisms upon orally inoculated Salmonella. Mice shedding aerobic gram-negative microorganisms with high levels of resistance to tetracycline were orally inoculated with Salmonella typhimurium. Levels of resistance of salmonella isolated from tissue were shown not to be increased and, in most instances, were lower than preinoculation levels.


Sarcoid lymphocytes: spontaneous transformation and release of macrophage migration inhibition activity. A group of 26 untreated patients with histologically confirmed sarcoidosis were studied. Multiple immunologic parameters were defined, including spontaneous morphologic lymphoblastic transformation, spontaneous production of macrophage inhibitory factor activity, 8-day cell culture lymphocyte count, phytohemagglutinin-induced lymphoblastic transformation, and cutaneous reactivity to a battery of recall antigens. The in vitro impairment of phytohemagglutinin-induced lymphoblastic transformation occurred only in patients with more disseminated disease (Group II). Cutaneous anergy did not correlate either with the degree of in vitro phytohemagglutinin-induced lymphoblastic transformation or with the extent and known duration of disease. The in vitro occurrence of enhanced spontaneous morphologic lymphoblastic transformation and spontaneous release of macrophage inhibitory factor activity were demonstrated, but these did not always occur in the same lymphocyte cultures and appeared to be independent parameters of immunologic activity. In conclusion, it is suggested that, contrary to the previously held view of general depression of delayed hypersensitivity in sarcoidosis, the immune apparatus of patients with sarcoidosis may be hyperreactive. Further, it proposed that determination of the macrophage migration index may prove valuable in evaluating the activity of the disease.


Mechanism of uptake of strontium isotopes in aspergillus lesions. Observations on experimental aspergillosis of chorioallantoic membranes confirmed that strontium-85 uptake in aspergillus lesions was directly due to infection by the fungus. Such uptake was not found in normal or in Toxoplasma gondii-infected control membranes. Further, the avidity of radionuclide uptake was proportional to the mycelial mass, as previously observed clinically. Investigations on 85Sr containing malt extract broth Aspergillus fumigatus cultures revealed that fungal hyphas did not contain the major proportion of radioactivity, but culture filtrates did, and suggested that a fungal metabolite may be responsible for radiostrontium binding. Subsequent radiochromatography of filtrates obtained from A. fumigatus cultures confirmed the existence of such a metabolite. Several clinical and laboratory observations support the concept that an aspergillus metabolite at foci of infection binds 85Sr and 87mSr.


Renal transplantation: an analysis of operative complications. Review of 112 renal transplants in 95 patients with end-stage renal disease revealed a wound infection rate of 18 percent. The incidence of infection was unquestionably greater if drains were placed in the wound. An 8.8 per cent incidence of pulmonary infection was represented by lung abscess, bronchopneumonia and necrotizing pneumonitis. Three deaths were attributable to fungal infections-candida sepsis, cryptococcal sepsis, and Nocardia brain abscess. In 14 per cent of this series vascular anastomotic complications occurred, and were attributable to stenosis, thrombosis, or hemorrhage. The complications of ureterovesical anastomosis include urinary fistulas and ureteral obstruction.


Renovascular hypertension and acute aortic dissection in a patient with renal transplant. The late results of renal transplantation are very encouraging. Apart from the more common complications, such as the rejection phenomenon and recurrent infections, occasionally renovascular hypertension may occur as a late complication. This is, to our knowledge, the first reported case of acute dissecting aortic aneurysm in a young man who had received a renal transplant six years earlier and later developed renovascular hypertension. All patients with renal transplant who develop severe hypertension which is refractory to medical management should be considered for renal arteriogaphy and correction of stenosis, if it is present.


Acalculous clonorchiasis obstructing the common 3ile duct: a case report and review of the literature. Clonorchis sinensis has a minor incidence in Western countries and most commonly manifests as cholangiohepatitis with secondary bacterial infection. This parasite rarely obstructs the common bile duct without associated biliary stricture, stones or tumor. This paper documents the fourth reported case of acalculous C, sinensis biliary tract obstruction and reviews the world literature.


Prescribing of chloramphenicol in ambulatory practice. An epidemiologic study among Tennessee Medicaid recipients. During the 1-year period from July 1973 through June 1974, 1761 chloramphenicol prescriptions were written for 992 outpatients in the Tennessee Medicaid program. Sxi percent (250 of 3409) of participating physicians prescribed chloramphenicol; 20 physicians wrote 55% of the prescription. Both family practice and rural location were independently associated with increased rates of prescribing chloramphenicol for outpatients. Among rural family practitioners, 21% prescribed chloramphenicol. Physicians graduating since 1955 were as likely to have prescribed chloramphenicol as were earlier graduates. Almost half the adult patients received 6 grams or less, while 2 received more than 250 grams. Approximately half of the prescriptions were for treatment of upper respiratory infections. Most prescriptions were interdicted by good medical practice. Analysis of the  prescribing of chloramphenicol (and perhaps other drugs) in ambulatory practice will help identify those physicians most in need or remedial medical education.


Glucocorticosteroid therapy: mechanisms of action and clinical considerations. The administration of glucocorticosteroids results in a wide range of effects on inflammatory and immunologically mediated disease processes. Glucocorticosteroids cause neutrophilic leukocytosis together with eosinopenia, monocytopenia, and lymphocytopenia. A principal mechanism whereby corticosteroids suppress inflammation is their impeding the access of neutrophils and monocytes to an inflammatory site. Granulocyte function is relatively refractory, whereas monocyte-macrophage function seems to be particularly sensitive to corticosteroids. Corticosteroid administration causes a transient lymphocytopenia of all detectable lymphocyte subpopulations, particularly the recirculating thymus-derived lymphocyte. The mechanism of this lymphocytopenia is probably a redistribution of circulating cells to other body compartments. There is considerable disagreement about the direct effects of corticosteroid administration on human lymphocyte function. The corticosteroid regimen should be adjusted to attain maximal therapeutic benefit with minimal adverse side effects. Often, alternate-day dosage regimens effectively maintain disease remission with minimization or lack of Cushingoid and infectious complications.


Diastolic properties of the left ventricle. Left ventricular pressure and volume during diastole reflect the interaction of ventricular elastic, viscous, and inertial properties, and the completeness of myocardial relazation. Myocardial relaxation may be impaired in the acutely ischemic ventricle, partly accounting for the abnormal diastolic pressure-volume relation in this condition. Altered elasticity of its wall can cause increased stiffness of the ventricular chamber, as in aortic stenosis, coronary heart disease, and infiltrative cardiomyopathies. In aortic stenosis, increased left ventricular stiffness results in an increase in pressure increment associated with left atrial contraction. Generation of such a high filling pressure is critical in maintaining adequate end diastolic sarcomere stretch in the left ventricle and probably accounts for the frequent deterioration of patients with aortic stenosis after development of atrial fibrillation or nodal rhythm. Many signs and symptoms of cardiac failure, previously attributed to impaired systolic performance, may be due to partly to altered diastolic properties of the ventricular chambers.


Acupuncture for chronic shoulder pain. An experimental study with attention to the role of placebo and hypnotic susceptibility. One half of 42 subjects treated for painful shoulders received classic acupuncture, and one half received a placebo in which the needles did not penetrate the skin. Half of each of these groups was treated in a positive setting to encourage the subject, and half in a negative setting designed to keep encouragement at a minimum. All patients were independently rated for susceptibility to hypnosis. Although  range of motion did not improve, the majority of patients reported significant improvement in shoulder discomfort to a blind evaluator after treatment; placebo and acupuncture groups did not differ in this respect, however. The positive and negative settings did not affect treatment outcome. In all groups, those who were not rated as highly susceptible to hypnosis tended to fail to achieve the highest levels of relief, but such differences were not statistically significant.


Leukotactic dystunction in sarcoidosis.

Leukotactic dystunction in sarcoidosis. The leukotactic function of patients with sarcoidosis was studied. A defect was found in 19 of the 20 patients tested and was due to moderately elevated serum levels of the chemotactic factor inactivator. The chemotactic factor inactivator levels were not as high as those previously reported in patients with Hodgkin's disease or cirrhosis of the liver. The effect of the inactivator was irreversible and was directed toward all three of the chemotactic factors tested. The physicochemical characteristics of chemotactic factor inactivator in serum from sarcoid patients resembled in most respects the features of chemotactic factor inactivator in normal serum. As expected, the generation of chemotactic activity in some sarcoid serums by zymosan was impaired. The results of this study may relate to some of the reported defects in expression of immunity in sarcoid patients.


Normal disposition of oxazepam in acute viral hepatitis and cirrhosis. Oxazepam (Serax) is a tranquilizer-sedative of the benzodiazepine group that is predominantly metabolized to a pharmacologically inactive glucuronide and subsequently excreted by way of the kidneys. We administered this drug as a single oral dose to seven patients with acute viral hepatitis, to six with cirrhosis, and to age-matched control subjects. Elimination half-life (T1/2) and the apparent oral plasma clearance for the drug in patients with hepatitis and cirrhosis were comparable to values obtained in age-matched controls (P greater than 0.05). In addition, the apparent volume of distribution of oxazepam, its plasma binding, blood/plasma ratio, and the rate of urinary excretion of oxazepam, predominantly as the glucuronide, were comparable (p greater than 0.05) in the two groups of patients with liver disease and their respective controls. Unlike many other sedatives, oxazepam is eliminated normally in patients with parenchymal liver disease an therefore, on pharmacokinetic grounds, seems to be an excellent sedative for use in such persons.


Acute hyperkalemia induced by hyperglycemia: hormonal mechanisms. Two insulin-requiring diabetics with isolated hyporeninemic hypoaldosteronism cpontaneously developed hyperkalemia that was aggravated whenever blood glucose concentration rose. Acute glucose infusions raised the serum potassium concentration in these patients with combined insulin and aldosterone deficiency but lowered, or did not change, the serum potassium concentration in normal subjects and in patients with either aldosterone or insulin deficiency alone. The paradoxical hyperkalemic response to glucose in patients with combined hormonal deficiency was blunted by prior administration of desoxycorticosterone acetate and abolished by prior administration of insulin. Our studies emphasize the crucial roles played by insulin and aldosterone in regulating the serum potassium concentration in man, and the need to avoid hyperglycemia in patients with combined insulin and aldosterone deficiency.


Ionic mechanisms in excitation of photoreceptors. Both measurements and rough theoretical calculations suggest that both sites in the plasma membrane where the dark current enters and the mechanism that produces the intracellular excitatory transmitter of rod vision operate via ionophoric mechanisms with very low specific conductivities and high ionic specificities properties similar to those of carriers in artificial and natural membranes.


Binding proteins and membrane transport. The recent studies have clearly established two types of active transport systems. One type is membrane-bound and can be observed in membrane vesicles and the other type is osmotic-shock-sensitive and requires binding proteins to produce active transport. It appears that the membrane-bound systems derive cellular energy from the energy-rich membrane state which can be formed from respiration or ATP-hydrolysis, while the binding protein systems are more directly coupled to phosphate bond energy derived from glycolysis or oxidative phosphorylation. The following conclusions concerning the role of the binding proteins are offered: 1. The binding proteins are present in relatively large amounts (approximately 10(-6) or 10%-5) M) and appear to reside in the periplasmic space. 2. They do not appear to be involved in solute translocation steps, although they cantain a second binding site that could interact with membrane components. 3. The binding proteins appear to increase the affinity of the transport system for the solute by interacting with a membrane component. This may substrate for the membrane transport system.


[Denaturation and enzymatic proteolysis in vitro of protein fractions of soya flour]. Soya, in spite of its high nutritional value and moderate cost, possesses certain undesirable qualities which limit its use in animal and human nutrition. The amendment of these qualities has resulted in much work. In this study the effects of technological treatments on the properties of certain protein fractions capable of being produced industrially were observed. Three fractions were prepared from defatted soybean flour of the "Harosoy 63" variety: an acid-precipitated fraction, a cold-insoluble fraction at 0-3 degrees C, and a water-soluble fraction. The properties of the fractions were studied both before denaturation and after denaturation by either heat or alcohol. The degree of proteolysis of each fraction by two digestive enzymes, pepsin and trypsin, was measured by the increase of non-protein nitrogen as a function of time. Several methods were used for electrophoretic analysis. The results showed that the thermal treatment at 100 degrees C and the treatment with varying concentrations of ethanol (from 10 to 100 p. 100) modified electrophoretic diagrams and the solubility of the proteins in trichloracetic acid. Moderate, moist heating of the protein fractions (100 degrees C, 20 mn) before proteolysis by pepsin and trypsin, in general, favored proteolysis. The most marked effect observed was in the acid-precipitated fraction (in which Kunitz inhibitor was concentrated treated by trypsin. Heating the fractions beyond thirty minutes had a negative effect on proteolysis: the level of proteolysis was the same, or in some cases, lower than before denaturation, especially on subsequent treatment with pepsin. The effects of the ethanol treatment were different from that of heat: the proteolysis was accelerated only with the acid-precipitated fraction.


Human vitreous transplantation.

Human vitreous transplantation. This lecture presents the experience in 200 implantations of human eye-bank vitreous through the pars plana of eyes with complicated retinal detachments. Though the success rate was modest, it shows that a large-bore instrument can be passed into the vitreous cavity of the eye with relative impunity and sets the stage for the present popular machine vitrectomy. In addition, the paper presents the author's experience with human vitreous transplantation by the 'open sky' transcorneal technique for otherwise hopeless vitreous opacities.


The role of the skin bank.

The role of the skin bank. The use of a skin bank is discussed and various indications for the use of viable homografts and lyophilized skin as a temporary biological cover for open wounds are described.


Neurotrophic relations.

Neurotrophic relations. Increasing evidence for the existence of neurotrophic (non-impulse) mechanisms, especially in nerve-muscle cell relations, has been discussed. Studies on axoplasmic transport, release of agents (other than transmitter) from the nerve, and possible transfer of macromolecules at the NMJ and on differentiation of impulse and non-impulse (neurotrophic) activities have advanced, but not solved, the basic questions. Progress has been slowed because often less than adequate indicators of neurotrophic functions have been used and because only a single neurotrophic agent was generally assumed. Neurotrophic actions are best understood as components of multiple regulation in the context of general intercellular relations. The analysis of neurotrophic regulations will become clear only after chemical definition of the neurotrophic agents. Until then, study of the differentiation and interaction of neuronal impulse and non-impulse activities is, and will remain, an important problem for an understanding of the plasticity of the NMJ and muscle.


Cerebral blood flow and brain function during hypotension and shock. In conclusion, the reviewed results clearly suggest that vital functions of the brain -in spite of the well-developed autoregulatory mechanisms-are impaired during long-lasting hypovolemic and other shock conditions. The insufficiency of the cerebrocortical and hypothalamic regulatory mechanisms can contribute to the development of the irreversible shock. In other words, failure of the body suffering from shock to restore the homeostatic equilibrium can be attributed to the inadequacy of the central nervous servocontrol system. According to the available results, the regional cerebral microcirculatory defect develops through sludge formation. The unevenly distributed local brain damage could be the background of the functional impairment. The focal appearance suggest that, in addition to generalized (bloody borne) changes, local factors play an important role in the production of patchy ischemic areas in the brain.


Distribution of R plasmids among the Q-antigen types of Escherichia coli isolated from various clinical sources. A total of 655 Escherichia coli strains from various clinical sources were O-antigen typed, and the serological properties were correlated with R-plasmid carriage. Of the 655 strains, 224 were resistant to one or more antibiotics and 148 of these carried R plasmids. The distribution of O-antigen types among the susceptible strains was similar to that reported previously by others in England. The O-antigen types among the R(+) strains showed some similarities to those found in susceptible strains, but O-antigen types O8, O9, O17, O18 and, perhaps, O101 and O107 were more common in the R(+) than in the susceptible series. There is therefore some overlap between the O-antigen types of E. coli prevalent in R(+) strains from clinical cases and from human and animal fecal sources.


Susceptibility of Mycobacterium leprae to dapsone as a determinant of patient response to acedapsone. In the course of a clinical trial of acedapsone therapy in 17 patients with lepromatous leprosy, the rate of response to therapy was measured by inoculation of mice with Mycobacterium leprae recovered from biopsy specimens of skin lesions obtained before treatment and at intervals of 4, 12, and 24 weeks after institution of treatment. The susceptibility of each isolate of M. leprae to dapsone (4,4'-diaminodiphenylsulfone [DDS]) was measured by passaging organisms that had multiplied in mice to new groups of untreated mice and to mice treated with DDS incorporated in the mouse chow in concentrations of 10(-5), 3 x 10(-5), and 10(-4) g/100 ml. The rate of response to acedapsone therapy and the susceptibility of patient strains of M. leprae to DDS varied widely among patients. All isolates were inhibited from multiplication by treatment of mice with 10(-4) g of DDS per 100 ml; all but two isolates were susceptible to 3 x 10(-5) g of DDS per 100 ml; and 17 of 36 isolates, representing nine patient strains, were susceptible to 10(-5) g of DDS per 100 ml. Plasma levels of DDS measured in the mice administered these diets show that the minimal inhibitory concentration of DDS for M. leprae isolated from untreated patients is about 3 ng/ml. No relationship could be demonstrated between DDS susceptibility of pretreatment isolates of M. leprae and the rate at which patients responded to acedapsone therapy. Neither acedapsone treatment of patients nor DDS treatment of mice appeared to select genotypically more resistant M. leprae.


Binding of N-substituted  erythromycyclamines to ribosomes. Several N-substituted erythromycylamines were evaluated for their ability to inhibit the binding of [(14)C]erythromycin to ribosomes. The association and dissociation constants for the binding of each compound to Escherichia coli ribosomes were determined. These studies have resulted in the development of three types of probes for topological studies of the erythromycin-binding site and the ribosome: the chemically reactive bromoacetamido, the photoreactive N-(2)-nitro-4-azidophenyl)glycinamido, and the fluorescent fluorescein isothiocyanate derivatives of 9(S)-erythromycylamine.


Inactivation of lambda phage infectivity and lambda deoxyribonucleic acid transfection by N-methyl-isatin beta-thiosemicarbazone-copper complexes. The infectivity of intact lambda phage and transfection by lambda deoxyribonucleic acid were inactivated by exposure to the copper complexes of N-methyl-isatin beta-thiosemicarbazone, thiosemicarbazide, and semicarbazide, but not methyl-isatin. No inactivation was observed when these compounds were used in the absence of copper sulfate. This confirms our previous observation that the activity of N-methyl-isatin beta-thiosemicarbazone is mediated by its thiosemicarbazone moiety and that the presence of copper is required for action. This represents the first time, to our knowledge, that semicarbazide has been found to possess antiviral activity. It is clear that these compounds act directly on deoxyribonucleic acid; whether the compounds also act on proteins has not been determined.


Effect of virginiamycin on the growth cycle of Bdellovibrio. The two components of virginiamycin, virginiamycin M (VM) and virginiamycin S (VS), were used to explore the life cycle of symbiosis-dependent and -independent strains of Bdellovibrio bacteriovorus during multiplication in a two-membered system with either living or heat-inactivated Escherichia coli or in axenic cultures. Relatively high concentrations of these inhibitors separately were required to stop growth under all the conditions, but the minimum inhibitory concentration of the single components was reduced 1,000-fold by the association of VM and VS. No dissociation between mass growth and cell division was observed with VM; VS specifically halted cell division without affecting the kinetics of macromolecules formation and overall growth. This effect on cell division was only obtained when the antibiotic was added during the first half of the multiplication cycle and was reversible at any time.


Chelocardin-inducible resistance in Escherichia coli bearing R plasmids. Two plasmid-linked tetracycline resistance characters, tet A and tet B, were distinguishable in part, according to the level of resistance they conferred to minocycline (<3 mug/ml for tet A; >6 mug/ml for tet B). Escherichia coli K-12 strains that harbored the tet B character were also resistant to tetracycline but susceptible to chelocardin. In such tet B strains, subinhibitory concentrations of tetracycline could induce resistance to chelocardin as well as to otherwise inhibitory concentrations of tetracyclines. Chelocardin itself was ineffective as an inducer and therefore could be used to select constitutively resistant mutants. E. coli K-12 strains harboring the tet A character were also resistant to tetracycline and susceptible to chelocardin; tetracycline did not induce resistance to chelocardin in these strains.


Inhibition of sporulation by cerulenin and its reversion by exogenous fatty acids in Saccharomyces cerevisiae. Sporulation of Saccharomyces cerevisiae G2-2 was inhibited by the antibiotic cerulenin which is known to be a specific inhibitor of fatty acid and sterol synthesis. This inhibition was reversed by various fatty acids, especially by oleic acid (C(18:1)) and pentadecanoic acid (C(15:0)). Ergosterol showed only slight reversibility of this inhibition. When cerulenin was added to the sporulation medium later than 12 h after the start of incubation, the marked inhibition disappeared. When the fatty acid fraction extracted from the sporulated yeasts was added to the cells pretreated with cerulenin for more than 6 h, sporulation became evident 6 h after the fatty acid fraction addition. Therefore, sufficient synthesis of fatty acids required for sporulation was assumed to occur during the first 6 h in phase I of yeast sporulation.


R-factor-mediated resistance to sulfonamides by a plasmid-borne, drug-resistant dihydropteroate synthase. Evidence was found for the existence of an episome-specified variant of the enzyme dihydropteroate synthase involved in folic acid formation. Since the plasmid-borne enzyme showed a decreased susceptibility for sulfonamide inhibition and was transferable together with resistance to this drug, it is proposed that diploidy for the target enzyme in some cases could be the mechanism of R-factor-mediated resistance to sulfonamides. Two types of evidence were obtained. One was the rescue from temperature sensitivity of bacterial mutants with a lesion in the chromosomal dihydropteroate synthase by the R factor R1dr19 mediating sulfonamide resistance. The other evidence was found by the determination of dihydropteroate forming activity in extracts from R(-) and R(+) bacteria. Cells harboring R1dr19 were found to contain an enzyme activity which was far less susceptible to sulfonamide inhibition than the corresponding activity from R(-) cells.


Antibiotic resistance and Hly plasmids in serotypes of Escherichia coli associated with porcine enteric disease. A total of 359 hemolytic Escherichia coli strains, representing eight pig pathogenic serotypes and isolated from pigs with enteric disease, was tested for transferable resistance to eight antibiotics. The co-transfer of plasmids controlling hemolysin production (Hly) with antibiotic resistance plasmids (R-factors) was evaluated. Transferable resistance to tetracycline, streptomycin, and/or sulfonamides was found in 47% of the total number of strains and 80% of the resistant ones. Chloramphenicol resistance was seldom seen. Co-transfer of Hly with R-factors occurred in 22.5% of the strains, generally to a degree excluding a genetic linkage. Stable coexistence of two R-factors in a cell was indicated by transfer patterns in 29 of the strains.


Elimination of resistance determinants from R-factor R1 by intercalative compounds. Eighteen deoxyribonucleic acid (DNA)-complexing compounds, among them 15 intercalative substances, and, additionally, nalidixic acid eliminated with different frequencies four antibiotic resistance determinants from the R-factor R1, carried by Salmonella typhimurium. Eliminating concentrations did not inhibit growth of the bacteria. The most active compound was "nitroacridine II" {1-diethylamino-3-[(6-nitro-9-acridinyl)amino]propanol}. When 14 compounds which had been tested at a standard concentration of 10(-4) M were listed according to decreasing activities of elimination of the four resistance determinants, a nearly consistent activity sequence was revealed. Frequencies of elimination of the kanamycin resistance determinant correlated directly with the binding of compounds to DNA, i.e., with end points of their displacement of methyl green from the methyl green-DNA complex. We propose that the observed eliminations resulted from selective toxicity for plasmidic template DNA and inhibitions of R-factor replication.


Clinical and pharmacological studies of ticarcillin in gram-negative infections. Twenty-seven patients with serious gram-negative infections were treated with ticarcillin in an average daily dosage of 237 mg/kg (range, 174 to 307 mg/kg). Ticarcillin was bactericidal for all infecting organisms in concentrations ranging from 31.2 to 125 mug/ml. Five of 8 patients (62%) with overwhelming Pseudomonas pneumonia were cured or improved, and 9 of 12 (75%) were cured of pneumonia caused by other gram-negative organisms. Of six extrapulmonary infections caused by Pseudomonas, five (83%) were cured or improved. In seven cases, the infecting organism reisolated during therapy was more resistant to ticarcillin than the primary isolate. The serum half-life of ticarcillin in three patients with renal failure was 11.2 +/- 1.0 h, and during hemodialysis it decreased to 6.3 +/- 1.8 h. There were two episodes of superinfection with resistant organisms. Thirteen patients (48%) manifested eosinophilia, one of whom had severe urticaria. Prolongation of bleeding time was attributable to ticarcillin in two patients. Ticarcillin appears to be effective for therapy of serious gram-negative infections in dosages 30 to 50% less than those recommended for carbenicillin.


Simple assay for 5-fluorocytosine in the presence of amphotericin B. A simple method for the measurement of 5-fluorocytosine in the presence of amphotericin B is described. The antifungal activity of amphotericin B is abolished by heating serum at 100 C for 45 min. 5-Fluorocytosine is unaffected by this treatment, and serum levels can be subsequently assayed by either tube dilution or disk diffusion methods.


Suppressive activity of mefloquine in sporozoite-induced human malaria. Mefloquine hydrochloride [WR 142,490; alpha-(2-piperidyl)-2,8-bis(trifluoromethyl)-4-quinolinemethanol hydrochloride] was tested for suppressive effect on sporozoite-induced malaria in nonimmune volunteers living in an area where malaria is not naturally transmitted. Single doses of 250 mg were given at weekly intervals, 500 mg at intervals of 2 weeks and 1,000 mg at intervals of 4 weeks, to men bitten by 10 to 15 mosquitoes heavily infected with a chloroquine- and pyrimethamine-resistant strain of Plasmodium falciparum. None of the individuals so treated developed infections during the period of drug delivery or during the follow-up period of 60 days. Doses of 250 or 500 mg produced no adverse reactions; mild epigastric discomfort occurred in all three men given 1,000 mg. Sporozoite-induced P. vivax infections were suppressed by single doses of 250 mg of mefloquine given at weekly intervals, but malaria developed after completion of the course. At treatment intervals longer than 1 week, vivax malaria was not suppressed.


In vitro studies of cefamandole.

In vitro studies of cefamandole. Cefamandole is a new cephalosporin antibiotic that was tested in vitro against 540 clinical isolates of gram-positive cocci and gram-negative bacilli. A concentration of 0.39 mug/ml inhibited 95% of the isolates of Staphylococcus aureus. A concentration of 6.25 mug/ml inhibited over 90% of the isolates of Proteus mirabilis and Escherichia coli, 69% of the isolates of Klebsiella pneumoniae, and 31% of the isolates of indole-positive Proteus spp. and Enterobacter spp. It was active against most cephalothin-resistant isolates of E. coli but not of K. pneumoniae.


Toxicity of nalidixic acid on candida albicans, Saccharomyces cerevisiae, and Kluyveromyces lactis. The antibacterial drug nalidixic acid (Nal) can suppress the growth of Candida albicans at levels of the drug normally found in urine. Growth suppression increases as drug levels are increased, and Nal also causes a similar proportional inhibition of the synthesis of all cellular macromolecules. However, growth temperature (25 versus 37 C) and the divalent cations Mg(2+) and Mn(2+) can increase C. albicans resistance to Nal. Also, nitrogen depletion of Candida shows that Nal-treated and untreated cells exhibit no difference in leucine uptake during readaptation to nitrogen. In Nal-treated, nitrogen-starved cells, ribonucleic acid and deoxyribonucleic acid (DNA) biosynthesis are less affected than in unstarved Nal-treated cells, but of the two nucleic acids DNA synthesis is the most affected. Nal-resistant strains of C. albicans exhibit a slight toxicity for macromolecular synthesis. Nal treatment of a synchronized population of Saccharomyces cerevisiae results in an increase in the culture mean doubling time of, at most, 20%, but Nal causes the loss of synchronous cell division. With a synchronized population of Kluyveromyces lactis, Nal causes an increase in the mean doubling time of upwards of 300%, with synchrony of cell division being maintained. It is known that S. cerevisiae asynchronously synthesizes mitochondrial DNA during the cell cycle, whereas with K. lactis it is synchronous. Thus, with C. albicans Nal toxicity is dependent both on the dose and the physiological state of the cell. Furthermore, Nal inhibits growth of yeast with synchronous mitochondrial DNA synthesis more adversely than yeast with asynchronous mitochondrial DNA synthesis.


Isolation and characterization of tetracycline resistance proteins from Staphylococcus aureus and Escherichia coli. Immunoglobulin (adsorbed resistance antiserum) reacting specifically with antigens from tetracycline (Tc)-resistant Staphylcoccus aureus or Escherichia coli was produced by adsorbing immunoglobulin against cell envelopes of resistant strains with envelope extracts from the respective isogenic susceptible strains. Adsorbed resistance antiserum against S. aureus reacted with envelope extracts from 32 Tc-resistant strains and failed to react with similar extracts from 76 Tc-susceptible strains of S. aureus. An antigen (Tc resistance antigen [TRA]) found only in Tc-resistant strains was produced by adsorbing envelope extracts from these strains with immunoglobulin against envelopes from isogenic Tc-susceptible strains. On immunodiffusion no cross-reactivity between TRAs from S. aureus and E. coli was observed. The TRAs behaved as proteins. The molecular weight of TRA from S. aureus was determined to be 32,000 and from E. coli to be 50,000. Data obtained by preliminary amino acid analysis of the TRAs are presented.


Chemical nature of a substance isolated from a group B streptococcus causing the "CAMP" reaction. A purification method for the "CAMP" factor is described. The purified preparation obtained is a peptide with a molecular weight of about 15 000. Amino acid analysis has shown that this peptide contains an appreciable amount of hydroxyproline.


Metabolism of glycerol-3-phosphate and phospholipids in a temperature-sensitive lysis mutant of Escherichia coli. Phospholipid metabolism in a temperature-sensitive lysis mutant of Escherichia coli has been investigated. The incorporation of 32P into the phospholipids of this mutant was negligible, not only at the non-permissive temperature, as was demonstrated earlier, but also at 30C. Furthermore, cultivation of the cells at the non-permissive temperature during 90 min, which is the time required to induce lysis, did not alter the amount of phospholipid per cell. In vitro experiments demonstrated that the enzymes involved in phospholipid biosynthesis are fully active at 42C. Lysis therefore is not directly caused by a defect in phospholipid synthesis. Evidence is presented that the low 32P incorporation is the result of a defective glycerol-3-phosphate dehydrogenase which determines the turnover of the immediate lipid percursor, glycerol-3-phosphate.


Mating reaction in Saccharomyces cerevisiae. VIII. Mating-type-specific substances responsible for sexual cell agglutination. The agglutination factors of a and alpha mating types of Saccharomyces cerevisiae were solubilized from isolated cell-wall fractions by treatment with snail enzyme (Glusulase) and shown to be adsorbed specifically by cells of the opposite mating type, resulting in the loss of agglutinability of these cells. The agglutination factors of a and alpha types adsorbed by cells of the opposite mating type at pH 5.5 were eluted at pH 9.0. These factors were further purified on Sepharose 4B. From the elution pattern on Sepharose 4B, the molecular weights of the solubilized agglutination factors are estimated to be about one million. Thus purified agglutination factors contained carbohydrate and protein and were considerably resistant to heat treatment. Neutral protease of Bacillus subtilis inactivated both a and alpha type agglutination factors. Trypsin inactivated the alpha type agglutination factor only.


Method of determining topometric values of some structures of the human spinal cord. A method of measuring the cross-section areas of some structures of the human spinal cord is described for the purpose of obtaining the coordinate values by means of simultaneously photographing the transverse section of the spinal cord, together with a microscopic objective square raster. The obtained coordinate values have been processed by means of a computer and represent the statistical model map of some structures of the human spinal cord. By means of the present method, the classic anatomical and topometrical figure of the spinal cord is converted to a coordinate system that may be defined mathematically.


Effects of stereotactic lesions of the dentate nucleus of the cerebellum in man. In a series of 50 patients, 94 stereotactic lesions involving different parts of the dentate nuclei of the cerebellum were performed. 47 patients exhibited various dyskinetic syndromes; among these, 7 were also affected by epilepsy. In 3 patients epileptic disorders were exclusively present. Favourable results were obtained in dystonic and dystonic-athetoid infantile syndromes, more than in spastic syndromes. Some interesting effects on the epilepsy and ocular motility are also noted.


Tele-Autotomogram and Application of the Pneumoencephalographic Chair in Stereotactic Operations. In order to obtain clearly demonstrated reference points in a preliminary air study for target calculations in stereotactic brain operations, a tele-autotomogram taken with the rotating pneumoencephalographic chair has been used with excellent results. By means of multiaxial rotations of the chair, tele-roentgenograms, including an autotomogram with a constant small magnification, can be obtained easily at any position of the patient with one floor X-ray tube. The same chair, modified to support the stereotactic base ring, can serve as an excellent stereotactic operating table with good maneuverability, offering wide adjustment of the patient's position suitable for various operative approaches. Simultaneously, it produces identical tele-roentgenograms with the same magnification as in the preliminary study, which economizes calculation time and avoids possible measurment error during stereotactic operations.


Effects of stereotactic cingulumotomy on a sequential motor task in man. The effect of bilateral cingulumotomy on sequential tapping behavior was investigated in 6 patients, Contrary to previous clinical studies and predictions derived from data on cingulate lesions in the rat, a consistent decrement in postoperative performance was not found. Temporal integration of behavior in man, as measured in terms of accuracy of sequential motor performance, does not appear to be critically dependent upon the integrity of the cingulum bundle at the level of interruption investigated in the present study.


Clinical evaluation of clotrimazole. A broad-spectrum antifungal agent. The efficacy and safety of the broad-spectrum, topically applied antifungal agent clotrimazole were evaluated in two double-blind, multicentric trials. Ten investigators reported on a total of 1,361 cases in which a 1% solution or a 1% cream formulation was compared with its respective vehicle. Clotrimazole was therapeutically effective, as confirmed by mycological cure (negative microscopy and culture) and clinical improvement, in tinea pedis, tinea cruris, tinea corporis, pityriasis versicolor, and cutaneous candidasis. Furthermore, species identification established the efficacy of clotrimazole against Trichophyton rubrum, T mentagrophytes, Epidermophyton floccosum, Microsporum canis, Malassezia furfur (Pityrosporum orbiculare), and Candida albicans. Safety was demonstrated by the low incidence of possibly drug-related adverse experiences, namely, 19 (2.7%) of 699 patients who were treated with clotrimazole, of whom four (0.6%) discontinued treatment.


Transcutaneous PO2 measurements in seriously ill newborn infants. Continuous monitoring of oxygen tension using the transcutaneous electrode developed by Huch and co-workers was studied in severely ill newborn infants. Acceptable results were obtained despite the theoretical possibility that vasoconstriction might interfere with the method when used in the very ill. The reliability and clinical usefulness of the method is illustrated in 4 cases of severely ill newborn infants.


Recurrent urinary tract infection in girls. Group with lower tract findings and a benign course. A group of girls is described with recurrent urinary tract infections characterized by predominantly lower tract symptoms. Clinical, laboratory, and radiography findings during the period of follow-up are presented. Infection persisted in most patients over several years. Response to medical and surgical treatment was unsatisfactory. The mean interval between the initial and most recent radiological study was 6 1/2 years. No case of renal parenchymal scarring was seen.


Thoughts on treatment of strawberry naevi. Published reports on the treatment of large strawberry naevi have been reviewed. It is suggested that they should normally be left untreated, and that corticosteroids, given for a short period only, should be reserved for massive naevi close to the eye, or interfering with respiration or suckling, or associated with thrombocytopenia. Serial colour photographs of one child illustrate the good result of inactivity.


Defective opsonization. A common immunity deficiency. Serum opsonization of yeasts for phagocytosis by normal polymorphonuclear leucocytes was defective in 11 of 43 children with unexplained frequent infections. The children had a range of infections, largely bacterial, and only 3 had diarrhoea and rash in infancy. A similar defect in at least 6 of the 9 mothers of these children (of either sex), with normal function in the fathers, suggests that the defect was primary and was transmitted by an unusual form of dominant inheritance. Four of 72 healthy adults and 1 of 11 children with unrelated disease showed similar defective function, but the incidence of the defect in the patients with frequent infection was significantly greater than this. The defective function can be corrected, in vitro and in vivo, by normal plasma at concentrations too low to be effective alone. This suggests that there is a defective factor rather than an inhibitor, and that different factors are limiting in normal and in defective plasma. Sera from affected members of the same family do not correct each other, but defective sera from different families usually do.


[Lymphokine activity in mercury stimulated leucocyte cultures (author's transl)]. Blood-lymphocytes from 42 persons reacted, as expected, in the leucocyte-culture with an increased DNA-synthesis, measured by the uptake of tritiated thymidine during the last 16 h of a five days culture, if mercurybichloride was added at the onset of culture. The logarithms of the activity-indices were nearly symmetrically distributed. When the lymphokine-activity in the culture supernatants was studied with the indirect leucocyte-migration-test, using autologues leucocytes, there was a bimodal distribution of the logarithmic migrationindices with a high top in the negative area (migration-inhibition) and a lower one in the positive area (migration-stimulation). These phenomena had no detectable correlations to sex, age, or dermatosis of the patients.


Laboratory diagnosis of rheumatoid arthritis. Prospective study of 85 patients. Because early diagnosis of rheumatoid arthritis is difficult increasingly important, we have assessed the value of laboratory investigation in 85 patients with knee effusions studied from presentation and followed for sufficiently long periods to allow a definite diagnosis. Histopathology on needle biopsy specimens narrowed the differential diagnosis to rheumatoid arthritis and closely related conditions even at an early stage of disease and also allowed recognition of other conditions which would not otherwise have been detected. Immunofluorescence on similar specimens further narrowed differential diagnosis since the presence of IgM was found to be very suggestive of rheumatoid arthritis. Other tests were of less value. It is concluded that laboratory investigation can improve diagnostic sensitivity and specificity in relatively early rheumatoid arthritis.


Phenylbutazone and chromosomal damage.

Phenylbutazone and chromosomal damage. Investigation of 44 paired test and control patients, all suffering from rheumatoid arthritis, following exposure to phenylbutazone (PBZ) and/or oxyphenbutazone (OPB), suggests that there is no significant increase in the level of chromosomal damage in lymphocytes. The control subjects comprised two series, one previously exposed to PBZ and/or OPB, but not for at least 1-5 years, and the other never exposed to PBZ or OPB. No significant difference in the level of chromosome damage was found between patients never exposed, previously exposed, or now receiving PBZ and/or OPB.


Synthetic D(-)penicillamine in rheumatoid arthritis. Double-blind controlled study of a high and low dosage regimen. Doses of 600 mg and 1200 mg of D(-)penicillamine daily were superior to a standard regimen of therapy in rheumatoid arthritis. The higher dose did not produce significantly greater therapeutic benefit in the group of patients so treated, although individual patients sometimes improved more. The frequency of rashes, blood dyscrasias, and withdrawals from the trial increased withe dosage. It is concluded that D(-)penicillamine is a useful treatment that the daily dose should be as low as possible, and that it should be increased at infrequent intervals only, with due regard to the likelihood of further improvement in relation to an increased risk of adverse reactions.


The biologic categorization of inhaled fiber glass dust. A critical review of pertinent studies and reports. Data obtained from animal models of fiber glass pneumoconiosis in which the fiber glass dust was inhaled indicate that fiber glass dust is nonfibrogenic and should be classified as a nuisance-type dust. Fiber glass dust, when inhaled even in high concentrations during much of the animal's lifetime, does not stimulate the production of neoplastic tissue. Epidemiologic data and pathologic examination of the lungs of long-term fiber glass workers indicate that fiber glass dust evokes no recognizable anatomic or functional changes. The development of tumors in the chest and abdominal cavities of rats as a result of the implantation of mineral fibers of diverse composition, including glass, has no relevance to man. The implication derived from such experimental results in rats that inhaled glass fibers are potentially carcinogenic for man, is therefore an inappropriate extrapolation of misinterpreted data.


Hyperbasophilic immunoblasts in circulating blood in chronic inflammatory rheumatic and collagen diseases. The number of large circulating hyperbasophilic mononuclear cells - referred to as hyperbasophilic immunoblasts (HBI)- is often increased in collagen disease and rheumatoid arthritis (RA) and grossly reflects the degree of disease activity. In contrast, in psoriatic arthropathy the percentage of (HBI) is within the normal range. HBI are mainly involved in immune reactions and may provide a valuable routine test for the assessment of the latter in disease states and for the predicition of relapse in chronic collagen diseases. Immunofluorescent techniques applied to samples from active autoimmune diseases have shown that a number of HBI are Ig-producing B-blasts. Moreover, in a few cases these intracytoplasmic immunoglobulins exhibited a rheumatoid factor-like activity, a finding which promises to yield additional information on the immunopathogenesis of RA.


Persistence of antigen in nonarthritic joints. The presence of antigen, IgG and C3 was shown by radioautography and immunofluorescence in the collagenous tissues of the joints of animals injected intra-articularly with antigen after having been previously immunized with that antigen in Freund's incomplete adjuvant. Since these joints were shown to be virtually free of inflammatory reactions, we suggest that the persistence of immune complexes activating complement cannot fully explain the chronicity of experimental allergic arthritis.


Structure-biodegradability relationships in pyrethroid insecticides. The metabolism of 20 pyrethroids has been examined to evaluate the contribution of detoxification in their selective action between insects and mammals. The studies utilized living houseflies, mice, or rats, or esterase and oxidase systems derived from these organisms. Pyrethroid-hydrolyzing esterases cleave the primary alcohol trans-substituted-cyclopropanecarboxylates much faster than the corresponding cis-isomers but are ineffective in hydrolyzing secondary alcohol esters. Microsomal enzymes oxidize the (+)-trans-chrysanthemate moiety at the trans-methyl group of the isobutenyl substituent and at one of the gem-dimethyl groups whereas the (+)-cis-isomer is attacked at either of the isobutenyl methyl groups. Products isomerized at C3 of the cyclopropane are also detected but only after ester cleavage and oxidation of an isobutenyl methyl group. Each alcohol moiety has its own unique sites for oxidation involving pentadienyl, allyl, benzylic methylene, and aromatic substituents. An enhancement of insecticidal activity is expected on replacement of the biodegradable groupings with substituents relatively resistant to metabolism but this may also increase the mammalian toxicity.


Elective and emergency surgery in renal transplant patients. Additional operations were necessary in 67 (41%) of 162 renal allograft patients. General anesthesia was employed in all but 5 patients with no morbidity  or mortality. All patients were immunosuppressed and no additional steroids were used before, during, or after the procedure. The source of the donor kidney made no difference in predicting if a recipient would require post-transplantation surgery or if an emergency or elective operation was required. Oerations were necessary to correct complications either directly related to the transplant procedure (71%), or medical problems of immunosuppression or uremia (21%). Nine patients (6%) required operations unrelated to transplantation. The data indicate that transplant patients frequently need additional procedures which are directly related to the transplant operation, immunosuppression, or metabolic alterations of their past uremic condition. Mortality is related to the degree of toxicity from the immunosuppressive therapy.


The surgical management of bacterial endocarditis: a review. A total of 239 surgically treated patients with primary endocarditis were reviewed both from the literature and from our own experience. The age range was 10 to 74 years with a male to female ratio of 3:1. A wide variety of organisms was found. However, as a group, gram positive organisms predominate. The onset of congestive failure was the major indication for surgery. The aortic valve was predominantly involved with the mitral valve running a distant second. The hospital mortality rate was 20% and the late mortality rate was 6.7% with an overall mortality of 26.7%. The prognosis in infective endocarditis when congestive failure develops, even in the presence of antibiotic therapy, is poor (79-89% mortality). In view of this poor prognosis, an aggressive attitude with regard to early surgical intervention can greatly improve the outcome of valvular endocarditis.


Clamp for wire closure of sternum.

Clamp for wire closure of sternum. A modification of the Kocher clamp used for wire closure of the sternum is described. With the clamp applied securely to the individual strands, the wire can be readily twisted; the shorter length of the clamp allows the surgeon a much firmer grip on the wire and saves considerable time during closure.


Immunology and lung cancer.

Immunology and lung cancer. Carcinoma of the lung is the number one cancer killer in the United States. The overall cure rate is about 10%, and although resection is the best treatment available, five-year survival following operation is only 25%. Recent studies have shown that patients with lung cancer are immunosuppressed but that pulmonary tumors do contain tumor-associated antigens. Studies of other human tumors indicate that immunotherapy can augment tumor immunity and can be an effective surgical adjuvant. This communication reviews the basic principles of tumor immunology, with emphasis on the immunology of lung cancer, and discusses how these principles may be applied to the therapy of lung cancer.


Fever of unknown origin secondary to brewer's yeast ingestion. A 68-year-old man with intermittent fever of unknown origin was found to have a systemic Saccharomyces infection, probably as a result of daily oral ingestion of the organism as brewer's yeast, a nutritional supplement. The case illustrates the potential dangers that may occur secondary to the oral ingestion of viable microorganisms, and the disease-producing potential of Saccharomyces is reaffirmed. Once again, a thorough and complete medical history was the key to resolving an unusual fever of unknown origin.


[Identification and lesion of prelemniscal radiation in the surgical treatment of tremor]. In a group of 40 patients operated on for the relief of tremor using stereotaxic techniques, the radiological location and electrophysiological characteristics of the optimum target were studied. The optimum target was defined as the place where the minimal lesion produced by the insertion of a 1.5 mm diameter electrode produced immediate cessation of tremor in the contralateral extremities. It was found that the optimum target is located in the subthalamus. Within this area electrical stimulation did not elicit sensory of pyramidal responses, but increased the amplitude of tremor. The study of somatic evoked potentials produced by stimulation of contralateral median nerve confirmed that the area does not correspond to a specific sensory system (medial lemniscus). By recording multiple unit activity a spontaneous 5 cycle per second rhythmic pattern, similar to that described for the VL thalamic nucleus, was occasionally seen. Finally, through an IBM 1130 computer the radiological location of those electrodes in the target area was approximated to a line, representing a vector whose orientation in space could be compared with that of different anatomical structures, and corresponded to the prelemniscal radiation. We concluded that the target area herein described is part of a reticulothalamic system that conveys tremogrogenic impulses to the pyramidal system and from here to the periphery.


Long-acting luteinizing homone-releasing hormone (LH-RH) analogs in the treatment of female infertility. Induction of ovulation in 20 infertile women was attempted by the use of two synthetic analogs of LH-RH, D-ALA6-Des-Gly10-ethylamide and D-Leu6-Des-Gly10-ethylamide. Ovulation was obtained in five out of the 16 in whom D-Leu6-Des-Gly10-LH-RH ethylamide was administered intramuscularly. Two of the five women received the LH-RH analog additioned of polysaturated gelatines as carrier medium. None of these women got pregnant. It is concluded that better therapeutic results might be expected when a suitable LH-RH vehicle allowing a gradual release of LH-RH analog is obtained.


Induction and stabilization of synchrony in the cell division of Escherichia coli. Escherichia coli strains B5 and B/r/l were grown under conditions of periodic glucose starvation in a minimal medium. Such conditions of growth give rise to two synchronous populations that are out of phase regarding their time of division, one dividing shortly after a new supply of fresh medium and the other at a later stage of the feeding cycle. Preferential selection of one of the two populations using heat treatment resulted in a homogeneous synchronized culture that exhibited in a non-limiting medium of a high degree of synchrony that was long lasting. Synchrony and its persistence could survive preservation of such a synchronized culture by freeze drying. An explanation of the synchrony persistence was put forward and the practical implications of these findings were discussed.


Free tryptophan pool and tryptophan biosynthetic enzymes in Saccharomyces cerevisiae. The free tryptophan pool and the levels of two enzymes of tryptophan biosynthesis (anthranilate synthase and indoleglycerolphosphate synthase)have been determined in a wild type strain of Saccharomyces cerevisiae and in mutants with altered regulatory properties.


Levoamphetamine vs dextroamphetamine in minimal brain dysfunction. Replication, time response, and differential effect by diagnostic group and family rating. Double-blind crossover randomized Latin square comparison of placebo, dextroamphetamine, and levoamphetamine in 31 consecutively diagnosed children with minimal brain dysfunction (MBD) replicated a smaller nonrandom study. Both isomers showed significantly more benefit than placebo but were not significantly different from each other. Dextroamphetamine showed a nonsignificant trend of superiority over levoamphetamine. Of 25 subjects who responded well to drugs, three responded only to levoamphetamine, five only to dextroamphetamine, and 17 to both. This study seems to confirm the efficacy of levoamphetamine in MBD. An unsocialized aggressive subgroup (308.4) showed a nonsignificant trend for levoamphetamine superiority, in contrast to the hyperkinetic (308.0) and overanxious (308.2) subgroups. Those who responded best to levoamphetamine tended (not significantly) to be from poorer functioning families. Parents' ratings, but not teachers' or psychiatrists' ratings, showed significant placebo effect.


Methylphenidate, dextroamphetamine, and levamfetamine. Effects on schizophrenic symptoms. Methylphenidate hydrochloride dextroamphetamine sulfate, and levamfetamine succinate have potential as pharmacologic tools for the indirect evaluation of the role of neurotransmitters in schizophrenia. In actively ill schizophrenic patients, methylphenidate administered intravenously causes a brief but clear intensification of preexisting psychotic symptoms, such as hallucinations and delusions. In our study, methylphenidate, dextroamphetamine, and levamfetamine were administered in equimolar doses to schizophrenic patients. Methylphenidate was a more effective activator of symptoms than dextroamphetamine, which in turn was more effective than levamfetamine. Levodopa (L-dopa) given orally also reportedly produces a temporary worsening of schizophrenic symptoms. While these findings augment a body of information suggesting that dopamine and norepinephrine may play a role in the activation  of schizophrenic symptoms, our findings with methylphenidate (reportedly weak in eliciting stereotyped behaviour in rat) and our review of the literature indicate complexities that remain to be resolved. There is some utility of the procedure for differential diagnosis and selective therapy, but this is still of occasional and limited potential.


The effectiveness of group psychotherapy with children. Review of empirical outcome research on children's activity, behavior modification, play, and verbal therapy groups reveals unconvincing evidence of their effectiveness. An approximately equivalent number of studies yielded generally positive, mixed, and null results. Little evidence of deterioration was found. On a comparative basis, the results tend to favor behavioral as opposed to other approaches. This article includes recommendations for improving the quality of the data base and increasing its potential for influencing practice.


Prophylaxis of affective disorders. Current status of knowledge. A review of all properly controlled studies clearly indicates that lithium carbonate is prophylactic for mania in bipolar patients; it is suggestive of prophylaxis for depression in both bipolar and unipolar patients. Studies are outlined that would clarify lithium carbonate's prophylactic effect for depression in these two patient groups. Continuation therapy with antidepressants reduces incidences of recurrence in unipolar depressives. The only controlled study indicates that tricyclic antidepressants may have prophylactic effect in unipolar patients. This finding needs confirmation. Data are insufficient for conclusions on prophylactic treatment for schizoaffective disorders.


A multiple-dose, controlled study of phenelzine in depression-anxiety states. In a double-blind, controlled experiment, 62 outpatients with symptoms of depression with anxiety were selected for treatment with phenelzine sulfate, 60 mg daily, phenelzine sulfate, 30 mg daily, or placebo for six weeks. Forty-nine patients (79%) completed the experiment. Phenelzine sulfate, 60 mg daily, was significantly more effective than placebo in relieving symptoms of both depression and anxiety. Phenelzine sulfate, 30 mg daily, did not differ from the placebo. Only phenelzine sulfate, 60 mg daily, resulted in a median inhibition of platelet monoamine oxidase that exceded 80%. The results confirm a previous study that found phenelzine to be effective in the treatment of outpatients with depressive-anxiety states. Drug dosage is an important variable influencing clinical outcome in this patient group.


Influence of imipramine on the circulatory system in the course of endogenous depressive syndromes. I. Evaluation of the basic parameters of the circulatory system. In patients with endogenous depression, imipramine exerts a regulative effect in both directions on blood pressure and pulse rate, dependent on the starting levels. In a majority of patients treated with imipramine, after 14 days blood pressure dropped and pulse rate was slowed. Remission of endogenous depression was statistically significantly more frequent in patients treated with imipramine in whom pressure and pulse rate underwent normalization. Early appearance of these effects of imipramine in patients with endogenous depression seems to be a good prognostic index.


Immunologic phenomena in experimental rodentiosis. I. Development of delayed skin reactions and peritoneal macrophage migration inhibition in guinea pigs infected with Yersinia pseudotuberculosis. Hypersensitivity in guinea pigs infected with Yersinia pseudotuberculosis was studied by means of skin tests and the migration inhibition test using peritoneal macrophages. Delayed hypersensitivity developed in the course of rodentiosis. Intensity of delayed skin reactions and degree of migration inhibition of peritoneal macrophages in the presence of specific antigen were strictly correlated.


Immunologic phenomena in experimental rodentiosis. II. Cellular and humoral factors in immunity to infection with Yersinia pseudotuberculosis. Humoral and cellular mechanisms of immunity to infection with Y. pseudotuberculosis bacilli in mice were studied. Development of delayed hypersensitivity, measured by the footpad test and macrophage migration inhibition test, was significantly correlated with immunity, expressed by elimination of Y. pseudotuberculosis cells from the organs of infected mice. Passive transfer of hypersensitivity and immunity was possible only by using peritoneal cells, while specific serum was inactive in this respect. Macrophages from immunized animals were more active in limiting intracellular multiplication of rodentiosis macroorganisms than macrophages from sensitive animals. Immunity in rodentiosis appears to be associated mainly with activation of cellular mechanisms.


[Micromotor recording of writing pressure during intracerevral stimulation at stereotactic operations (author's transl)]. Eight cases of spastic torticollis were examined during the course of stereotactic operations with the writing pressure apparatus of Steinwachs while the ventrolateral thalamus was stimulated. When 50 stimuli per sec are given, the significant changes of motor function in writing are the following: slowing of writing speed, an increase in writing pressure, greater changes of pressure amplitude with tendences to parallel course. With 25 stimuli per sec, simular results may appear, but smaller amplitude changes and lowering of writing pressure may also occur. When 8 stimuli per sec are given, no changes of pressure patterns in writing were found. Three typical cases are described. It is concluded that the recording of fine pressure changes in writing may indicate alterations of cerebral motor regulations although specific changes for certain thalamic stimulus locations were lacking.


The effect of air embolism on renal preservation. Air embolism to the kidneys was induced in dogs during an ex vivo perfusion preservation period using cryoprecipitated plasma to demonstrate the effect of air embolism on the function of the preserved kidneys. A sharp decline in plasma flow rate was observed after air was infused, but the rate returned to the preembolism range in 60 minutes. Differences in posttransplant serum creatinine levels between the control and air embolism groups were not statistically significant. No deleterious effect was demonstrated on the final function of preserved kidneys by infusion of air. Three cadaver kidneys that accidentally sustained air embolism during the perfusion preservation period were transplanted. Although an initial period of acute tubular necrosis developed in these three kidneys, two kidneys regained good renal function and the third kidney was removed because of irreversible rejction. This study demonstrates that kidneys that sustain air embolism can be used for clinical transplantation.


In defense of the open wound.

In defense of the open wound. In a case of bilateral five-finger Dupuytren contracture, one hand was treated by open excision of the contracutred fascia and shortened skin with application of skin graft. The opposite hand was treated by the "open-palm" technique for comparison. There was no observable difference in the ranges of motion at the end of the two months following surgery. The open-palm technique continues to be simple alternative for the advanced cases requiring extensive excision of the palmar fascia leaving wide gaps in the palmar skin.


Gastrointestinal complications after renal transplantation: predictive factors and morbidity. In a ten-year study involving 109 renal transplant patients, 37 (34%) developed gastrointestinal complications. The immediate mortality from these complications was 27%. Three of four patients with erosive gastritis died. Five deaths occurred among 17 patients who developed ulcers after transplantation. Emergency surgery for ulcers resulted in two deaths. Patients with peptic ulcer disease, esophagitis, or bleeding before transplantation were much more likely to develop recurrences that patients not so affected. Peptic ulcer occurred notably more often in recipients whose kidneys came from cadavers than from related donors. Experience with gastrointestinal bleeding or its absence during a first transplant is a useful predictor of the results after a second transplant. The high recurrence rate and high mortality suggest that patients with ulcer disease demonstrated before kidney transplantation should either undergo elective surgery for ulcer disease or not be accepted for transplantation. Patients in whom ulcer disease develops after a kidney transplant shoud undergo early elective surgery.


Mycotic aneurysms in transplant patients. Eight cases of mycotic aneurysm occurred in seven transplant patients. Perinephric wound infection involving the iliac arteries was the cause of at least seven aneurysms. Simple ligation of the iliac artery proximal and distal to the aneurysm without grafting was effective therapy in all but one patient with an aortic aneurysm who required an axillofemoral bypass graft prior to excision of the aneurysm. There were no instances of ischemia to the involved extremities, and only two patients died as a result of the aneurysm. This dangerous complication can be avoided by preventing wound infections. In established perinephric abscesses, the kidney should be removed and the wound kept as clean as possible in order to prevent this complication. Arteriograms may be useful in the early detection of these aneurysms, before they rupture.


Influence of operating room surface contamination on surgical wounds: a prospective study. The influence of operating room contamination on wound infection rates in clean, clean-contaminated, contaminated, and septid procedures was studied by a prospective randomized study of 2,020 surgical wounds. Operating room surface contamination was assessed by the RODAC bacterial plate method. Control rooms uniformly received Wet-Vac cleaning between operations. Experimental rooms were not cleaned between consecutive clean operations, but were cleaned after contaminated operations. The difference in surface contamination between groups of experimental and control rooms was found to be significant at the P less than .05 level. Patients operated on in experimental and control rooms were followed up postoperatively to assess whether they experienced wound infection. No statistically significant differences in wound infection rates were found between experimental and control room operations as total groups, clean procedures, or operations of long duration.


[Mast cells in the laryngeal papillomatosis of the child]. Mast cells are probably involved in the immunitary phenomena thought to be responsible for the evolution of laryngeal papillomatosis in children, particularly as a consequence of the correlation between such cells and eosinophile granulocytes. A morphological study of 9 cases in subjects aged between 2 and 9 yr is reported. The mean number of mast cells in the various phases of the diseases was assessed. There was a significant decrease in mast cell numbers right from the first stages of the lesion to the terminal stage prior to regression.


A rapid method for quantitative assay of poliovirus from water with the aid of the fluorescent antibody technique. A method is described for the rapid quantitative demonstration of polioviruses in water with the aid of the fluorescent antibody technique. Identification of the virus is possible after 18--24 hours as compared to 3--5 days required with the plaque count method. Approximately 10 plaque forming units, concentrated from a volume of 40 liters of seeded tap water could be demonstrated by the rapid method. Positive cells were already seen after 6--9 hours; the results were, however, not sufficiently quantitative. The method also showed itself to be less susceptible to bacterial contamination than the current isolation methods. Its possible utilization as a rapid, primary test for viral contamination of potable water is discussed.