The hip in myelomeningocele. Management directed towards a minimum number of operations and a minimum period of immobilisation. The hip problems in 116 children with myelomeningocele are discussed. The management described stresses the importance of selection of the type of operation; major surgery is appropriate only for those children who benefit significantly, and this generally means only those with strong quadriceps muscles on both sides. Some children with acetabular dysplasia gain immediate stability if acetabuloplasty is combined with other hip operations. Children who lack strong quadriceps muscles are best served by simpler procedures, such as tendon excision, designed to rid them of fixed deformity and to prevent recurrent deformity. The operations described are performed whenever possible under one anaesthetic and are combined with any other limb operation that may be necessary. It is suggested that the aim in management is not the treatment of paralytic dislocation of the hip but the correction of fixed deformity so that the child can stand with a stable posture. Subluxation and dislocation are treated incidentally to procedures designed to prevent or correct fixed deformity.


Microvascular surgical techniques used to provide skin cover over an ununited tibial fracture. A case is described in which a large area of unstable skin overlying a tibial fracture was replaced by a single stage skin flap transfer, using microvascular surgical techniques. The shortening of treatment time and the improvement in the local blood supply compared to that provided by orthodox skin flaps are noted. The improved blood supply at the fracture site may have encouraged bony union.


Subtalar arthrodesis by cancellous grafts and metallic internal fixation. A technique of subtalar arthrodesis by means of metallic internal stabilisation and autogenous cancellous bone grafting is described. Of forty-eight feet with mobile pes planus treated by this method forty-five gained union after an average of seven and a half weeks in a below-knee weight-bearing plaster, and forty-three had satisfactory correction of the deformity.


A literature survey of the potentially adverse effects of the drugs commonly prescribed for the elderly. Part I: Hard data concerning adverse drug reactions are notoriously difficult to obtain. Some of the problems arise because of: --patient variables including age, sex, genetic differences, and current illness. --multiple drug use, continuation of smoking, and use of alcohol. --variations in dose, duration of treatment, and route of administration. --some effects are not reported but many reported effects are not truly due to the drug indicated. Nevertheless, we need to be aware of potential adverse reactions. Our ability to recognize drug side effects will be improved if we have some idea which kinds of reaction may occur. Part I deals with the analgesics, sedatives, laxatives, antacids, antidiabetic agents, antihypertensives and cardiovascular drugs. Potential systemic and ocular adverse reactions are listed.


Epineurial and perineurial fascicular nerve repairs: a critical comparison. To compare the results of epineurial and intrafascicular perineurial nerve repair techniques, ulnar nerves of 20 domestic cats were severed proximal to the medical humeral epicondyle. One nerve was repaired with No.8-O nylon by standard epineurial technique with the aid of three to five magnifications; the other nerve was repaired with No. 10-O nylon by intrafascicular perineurial technique under higher magnification. Four to five months following neurorrhaphies, the ambulation pattern, fanning of claws, and sensation were evaluated subjectively. Objective measurements included efficiency, absolute strength, and exact weight of the flexor carpi ulnaris muscle. Proximally and distally to each neurorrhaphy, complete axon counts were taken. Histochemically and histologic analyses were made on reinnervated muscles and neuromas. No statistically significant differences were detected between the results of epineurial and intrafascicular perineurial neurorrhaphies. These findings indicate that, following acute nerve laceration in the cat, epineurial neurorrhaphy is as satisfactory as is intrafascicular perineurial neurorrhaphy.


A study of nerve regeneration and neuroma formation after nerve suture by various techniques. The effectiveness of epineurial, perineurial, and a combined epiperineurial methods of nerve suture in the severed sciatic nerve of rabbits was studied by biochemical assay of the collagen just distal to the neuroma and the collagen and myelin of the posterior tibial nerve. Repairs were done both immediately after severance and in a separate group 3 weeks later. More collagen was found near the neuroma in the immediate epineurial group, but 60 per cent of the normal myelin was found in the posterior tibial nerve after the immediate epineural suture compared to 28.3 per cent in the immediate perineurial group.


Florian Znaniecki: creative evolution of a sociologist. Znaniecki devoted his creative life to a constant reexamination of the basic problems of sociology: its subject matter and that methodology through which it can be studied. The developments in his thought can be traced with the help of the prefaces to his books, in which he explains the location of that work in his over-all effort to develop a systematic sociology, the major influences on his thought and his arguments with other theories. Starting as a philosopher with a special interest in the evolution of values, he spent years as a result of Thomas's influence attempting to find a psychological base for human behavior, finally abandoning the attempt in favor of systems of social interaction. He focused on four such systems: social relation, social role, social groups, and societies.


The empiricist as rebel: Jung, Freud, and the burdens of discipleship. However little they share in common, both Freudian and Jungian commentators have long agreed that Jung's theoretical development in the years following his psychoanalytic affiliation prompted an open "split" with Freud and the psychoanalytic movement. Careful examination of Jung's principal "rebel" works does not sustain this thesis, however, but rather indicates Jung's honest belief that his limited appropriation of certain psychoanalytic mechanisms and attendant theoretical modifications constituted full-fledged loyalty to psychoanalysis as he understood it. This perception receives significant support from the Freud-Jung correspondence which reveals Jung openly articulating the ground rules defining his loyalty to psychoanalysis as early as 1906, and Freud accepting, and even approving, his protégé's empirical reservations over the course of the next five years.


Active power and causal flow in Aristotle's theory of vision. Aristotle's theory of vision has been characterized as naive, incommensurate with his theory of audition, and of historical interest only. This view is based on an analysis which fails to acknowledge the role of the concepts acting upon and active power in the theory. The meaning of these terms and the role Aristotle assigned them in vision and in sensation generally is demonstrated. It is argued that with the inclusion of these concepts (1) the theory of vision is sufficiently sophisticated and modern to be more than comparable with more recent perceptual theorizing, and (2) theoverall integrity of Aristotle's sensory philosophy is preserved. It is further argued that given the cohesiveness and comprehensiveness of Aristotle's psychological works, more attention should be given them by modern psychologists.


A new name for an old idea? A student of Harvey Carr reflects. My chief mentor in graduate school at Chicago was Harvey Carr, who spent most of his professional life at The University of Chicago as professor of experimental psychology. He was admired and loved by his graduate students not only as a masterly teacher and for his accumen in directing research, but also as a man of personal integrity. On the assumption that he is not as well known as he should be by the present generation of psychologists, this essay is presented. The paper reports on the testimonials of his many students on the occasion of his retirement, some reminiscences on the part of the essayist, and an analysis of Carr's systematic position.


Psychosomatic concepts in the works of Shakespere. Psychosomatic medical theory of the late European Renaissance is reflected in the works of Shakespere. The period's conceptions of cardiovascular involvement in emotion, experimental causation of psychosomatic disorders, and repression of emotion as pathogenic, are described with reference to quotations from the Shakesperian plays. It is concluded that the premodern holistic approach to organismic functioning lends itself well to interpreting psychophysiological phenomena, and that contemporaries could profit from a philosophical reorientation concerning mind-body relationships in the disease process.


Galton and sex differences: an historical note. The psychological study of sex differences is a special area of interest within differential psychology. Differential psychology was launched as a scientific field of research in the latter half of the nineteenth century by Sir Francis Galton. Galton's early research on sex differences in psychological traits gives him the distinction of being the "father" of the modern study of sex differences. Galton's empirical findings and his interpretation of sex differences were heavily influenced by his Victorian sexist attitudes. The early history of the modern study of sex differences exemplifies the intimate relation between facts and values.


The development of anthropology and colonial policy in the Netherlands: 1800-1960. Although there have been studies of both Dutch colonial policy in the Indies and the development of anthropology in the Netherlands, there has been no systematic examination of the historical relations between them. This paper attempts this for a period of 160 years from the collapse of the Dutch East India Company to the birth of an independent Indonesian state. During this time, the need of successive governments for information on subject peoples was matched by the requirements of scholars for suitable conditions and locations for their work. As Dutch anthropology emerged in the nineteenth century and developed in the twentieth it was closely related to the prevailing political climate--state capitalism, liberal, and ethical policies. The analysis shows how there is a 'fit' between these and certain dominant anthropological styles and interests, principally in the form of empiricism, customy law studies, "Leiden" structuralism, and functionalism.


Recognition of names of eminent psychologists. Faculty members, graduate students, undergraduate majors, and introductory psychology students checked those names they recognized in the list of 228 deceased psychologists, rated for eminence, provided by Annin, Boring, and Watson. Mean percentage recognition was less than 50% for the 128 American psychologists, and less than 25% for the 100 foreign psychologists, by the faculty subjects. The other three groups of subjects gave even lower recognition scores. Recognition was probably also influenced by recency; median year of death of the American psychologists was 1955, of the foreign psychologists, 1943. High recognition (defined as recognition by 80% or more of the faculty group) was achieved by only 34 psychologists, almost all of them American. These highly recognized psychologists also had high eminence ratings, but there was an equal number of psychologists with high eminence ratings that were poorly recognized.


Darwinism and positivism as methodological influences on the development of psychology. The methodological significance of evolutionary theory for psychology may be distinguished from its substantive or theoretical significance. The methodological significance was that evolutionay theory broadened the current conceptors of scientific method and rendered them relatively independent of physics. It thereby made the application of the "scientific method" to psychology much more feasible than it had been previously, and thus established the possibility of a wide-ranging scientific psychology for the first time. The methodological eclecticism that made scientific psychology possible did not, however, remain a feature of psychology for very long. Psychology's methodology rapidly became restricted and codified through the influence of, and in imitation of, the rigorously positivistic orientation of physics around the turn of the twentieth century.


The sociology of language in Johann David Michaelis's dissertation of 1760. In 1759 Johann David Michaelis won a prize from the Prussian Royal Academy for his essay Beantwortung der Frage von dem Einfluss der Meinungen in die Sprache, und der sprache in die Meinungen. The essay was published in the following year and translated into French in 1762, into English in 1769, and into Dutch in 1771. The work has two major themes--linguistic relativity and language change--with ancillary discussions of language in general and of homonymy. Its most significant contribution to the theory of language is its discussion of linguistic relativity, especially in its manifestations in the influence of language on thought. Given the intellectual milieu of the work where inquiry was centered on the origin of language and language universals, it stands as one of the few discussions of this topic and it is also one of the most fruitful discussions of linguistic relativity for any period of history.


The concept of suggestion in the early history of advertising psychology. As early as 1896, experimental psychologists began studying the mental processes involved in advertising. The first psychological theory of advertising maintained, in effect, that the consumer was a nonrational, suggestible creature under the hypnotic influence of the advertising copywriter. Walter Dill Scott was the major proponent of this theory, and it was largely through his writings that advertising men learned about the psychology of suggestion. Scott's theory was consistent with a growing trend in the advertising profession toward viewing consumer behavior as irrational. Scott's efforts might also be viewed as part of the trend in the advertising profession toward seeking a scientific basis for copywriting theory and practice.


Biopolitics: lessons from history.

Biopolitics: lessons from history. Biopolitics is an emerging subdiscipline within the field of political science. The essay examines historical antecendents and delineates three categories of such works: 1) metaphor, 2) evolutionary/genetic influences on behavior, and 3) public policy implications. A number of problems with these works are noted. Finally, suggestions for the current interest in biopolitics are outlines, based upon the historical analysis.


Two concepts of adaptation: Darwin's and psychology's. The paper takes issue with the traditional view of Darwin's influence on psychology; namely, that it is he who passed on to psychology the concept of individual adaptation. Three arguments are presented: a) that Darwin, qua scientist, was only interested in species adaptation, an entirely different concept from that of individual adaptation, b) that Darwin's writings on individual adaptation are so unexceptional that it is inconceivable that psychologists should have been influenced by them and c) that the two concepts are logically incompatible since species adaptation presupposes a strict hereditary determinism, while individual adaptation conceives of the organism either as free and undetermined or else as determined by the environment.


Beard's concept of neurasthenia and Freud's concept of the actual neuroses. Beard's concept of neurasthenia and Freud's concept of the actual neuroses are described and evaluated critically. Despite differences in the content of their theories, especially in the role of sexual factors and sexual mechanisms, there are important formal and logical similarities. Both Beard and Freud incorrectly identified the causes of the neuroses being studied; both used inadequate methods of assessing the strengths of the causal factors; and the central theoretical concepts of both were equally vacuous. Freud adopted the same method of study as did Beard, but does not seem to have been influenced directly by him.


Homosexuals and the death penalty in colonial America. This article traces the legislative history of statues prescribing the death penalty for sodomy in 17th-century New England and in the other American colonies. New England and some middle colonies broke with English legal tradition by adopting explicitly biblical language. After the Revolution, Pennsylvania took the lead, in 1786, in dropping the death penalty.


Sodomy in medieval secular law.

Sodomy in medieval secular law. In the 13th century, legislation dealing with sodomy and other moral crimes was strongly influences by the prevailing Catholic ideology. As a result, affenders were sought out by members of the lay confranternities, tried in the courts of the Inquisition, and generally punished with the death penalty.


Sodomy in ecclesiastical law and theory. In the 13th century, sodomy, which was classified among the various sins against mature, was regarded as a primarily clerical vice. In both systematic theology and canon law, the destruction of Sodom and Gomorrah was considered the just punishment for a sin that violated the natural procreative function of sexuality, was contrary to right reason and the natural order, and denied God's injunction to increase and multiply.


Continuous measurement of O2 consumption and CO2 elimination during a wakeful hypometabolic state. A previous investigation has demonstrated that the practice of a meditational technique elicits a wakeful, hypometabolic state. Measurement of O2 consumption and CO2 elimination was made by sampling techniques; mean values of these parameters were calculated from 6-10 minute samples. The present study extends this investigation, using a recently developed method of continuous measurement of O2 consumption and CO2 elimination. Continuous measurement of these parameters permitted the determination of mean values for the entire experimental periods as well as for selected intervals and permitted the examination of the sequence of respiratory changes. The present study reports statistically significant decreases in O2 consumption of 5 per cent and CO2 elimination of 6 percent for the entire 20 minutes of the mediation period. These are lower than the sample values of 16 percent and 15 percent reported in the previous study. However, when selected intervals of the mediation period are examined, decreases in O2 consumption and CO2 elimination are comparable to those previously reported. The results are consistent with the difference between the discontinuous sampling measurement method originally employed and the continuous measurement method of the present investigation.


A historical view of the stress field.

A historical view of the stress field. An analysis is presented of selected aspects of stress theory and research in biology and medicine, both before and after the introduction of Selye's stress formulations, which have been of major importance in the development and popularity of this research area. An attempt is made to explore some possible sources of present confusion and controversy in the stress field, with a view to the development of new research strategies that may enable us to clarify, update, and revise stress concepts and to facilitate future progress. In particular, it is suggested that an experimental reevaluation of the concept of the non-specificity of pituitary-adrenal cortical response is a matter of particular strategic importance, if we are to move out of the present prolonged period of stalemate and confusion over stress theory and terminology. Recent experimental studies which suggest that the nonspecificity concept may have been applied erroneously to lower level physiological mechanisms, rather than to higher level psychological processes, are reviewed. The possible implications of this development are discussed in terms of clarifying current concepts and providing guidelines for future lines of approach in stress research.


Life stress, depression and attempted suicide. This paper summarizes a series of controlled studies into the relationship of life events to depression and to suicide attempts. Life events, particularly exit events and events regarded as undesirable, tend to cluster prior to onset of depression. These findings are supported by comparisons with general population controls, depressives after recovery, other patient groups, and by studies of relapse. Interactions with predisposing and biological causes are probably of great importance. Suicide attempters are a rather different patient group and they experience a particularly striking accumulation of threatening events. There is a marked peaking of events in the month before the attempt, suggesting a crisis response and the potential relevance of crisis intervention techniques.


Ultrastructure and life cycle of the lipid-containing bacteriophage phi 6. An electron microscopic study of the lipid-containing bacteriophage phi 6 revealed an electron dense compact inner core of 30 nm in diam., which apparently contains the nucleic acid of the virus. This inner particle is surrounded by a complex polyhedral capsid with an outer diam. of 50 nm. Outside this is the envelope, which gives the virus a total diam. of 65 to 75 nm. The envelope, which has a thickness of a unit membrane, could be removed by treating the phage with Triton X-100. A definite structure is seen inside the envelope of the phage tail. In infection, phages are attached by their tails to the host cell pili. Occasional pili with a few attached phages were seen in a phage resistant mutant. In the course of the infection phages were also seen attached to the outer membrane of the cell. In a phage-tolerant mutant many normal-looking pili with adsorbed phages were visible, but we could never see phage-cell membrane associations. The membrane of the phage appears to fuse with the bacterial outer membrane and 50 nm virus particles could be seen in the periplasmic space of the bacterium, probably attached to the cytoplasmic membrane. Newly formed 50 nm particles appeared 45 min post infection (p.i.) cnetrally in the host cell. Assembly of the envelope also began at this time and by 80 minutes p.i. all the 50 nm particles were covered by the virus membrane. At no stage were phages seen in the periphery of the bacterium. Mature phages were finally released by a rupture of the host cell without spheroplast formation.


Further investigations on the mode of entry of vaccinia virus into cells. Earlier results indicating that vaccinia virus entered L cells by a process of direct fusion between the virus envelope and the plasma membrane of the cell have been confirmed and extended using immuno-ferritin conjugates to locate virus antigens on the host cell surface. After fusion, components of the virus envelope become rapidly dispersed in the plasma membrane. Fusion has also been observed as the predominant mode of entry of vaccinia virus into HeLa cells.


Improved resolution in cathodoluminescent microscopy of biological material. This paper continues work reported in an earlier paper on modification of a Cambridge Stereoscan Mk IIA to improve the quality of cathodoluminescent micrographs of biological material. In the work presently described the microscope gun has been offset laterally by 2 mm, to prevent light from the filament passing down through the column to the specimen chamber. The electron beam is brought onto the column axis by deflection coils. This modification effectively eliminates background light in the chamber, and a full parabolic mirror is fitted to maximize light collection. Results for yeasts and wheat seed sections are described.


Simple magnetic holders for critical point drying of microspecimen suspensions. Microspecimens can be critical point dried from suspension in holders consisting of three magnets and two filters. These holders are inexpensive, require no construction, and are easily assembled and disassembled.


Flat preparations of the retinal vessels in Coats' disease. Flat preparations of the retina were prepared by trypsin digestion in ten cases of Coats' disease. All of the patients were young males with advanced disease leading to enucleation. All eyes showed marked abnormalities in the arterioles, venules, and capillaries. The findings most characteristic of Coats' disease were large aneurysms and thick PAS positive deposits in vessel walls. The aneurysms ranged from 50 to 350 microns and frequently formed large sausage-like or beaded out-pouchings and were sometimes situated on shunt vessels. Other findings frequently seen, but not specific for Coats' disease, were capillary dilatation, small aneurysms, hypocellular vessel walls, and fibrous strands.


Organization and evolution of the mitochondrial genome of yeast. The mitochondrial genome of yeast (S. cerevisiae or S. carlsbergensis) appears to be formed by 60-70 genetic units, each one of which is formed by (1) a GC-rich sequence, possibly having a regulatory role; (2) a gene, and (3) an AT-rich spacer, which probably is not transcribed. Recombination in this genome appears to underlie a number of important phenomena. The organization of the mitochondrial genome of yeast and these recombinational events are discussed in relationship with the organization and evolution of the nuclear genome of eukaryotes.


Gene control in eukaryotes and the c-value paradox "excess" DNA as an impediment to transcription of coding sequences. Ways in which control of gene activity may lead to the observed high DNA content per haploid eukaryote genome are examined. It is proposed that deoxyribonucleoprotein (DNP) acts as a barrier to transcription at two distinct structural levels. At the lower level, melting of the nucleosome supercoil (quaternary structure) and of the nucleosomes (tertiary structure) might be brought about by the process of transcription itself. After unwinding the barrier section, the polymerase would eventually reach the structural gene. The transcripts of noncoding sequences, at least as far as their "unique" sequence components are concerned, may thus have filled their main function through the very process of transcription. The possibility of an inverse relationship between the length of the DNP barrier and the rates of transcription of the coding sequences is to some extent supported by available data. Different modes of coordination between the transcription of mRNA and of hnRNA from a single functional unit of gene action (funga) are considered. An analysis of gene control at high structural levels of DNP is made on the basis of other data, in relation to the concepts of eurygenic and stenogenic control. The concept of a euryon is introduced, namely of a set of linked fugas under common eurygenic control. Structure of order higher than quaternary can be inferred to exist in larger chromomeres of polytene chromosomes and in corresponding sections of ordinary chromosomes. Only moderate amounts of highest order interphase euchromatic structure are likely to be able to be accomodated in average chromomeres and none in very thin chromomeres. Puffs are interpreted as the melting of highest order interphase structure, and the absence of puffs during transcription as the absence of this highest order structure in the resting state of the chromomeres. Genes that are constantly active in all tissues may dispense with highest order interphase structure and with the corresponding control mechanism, and the fugas involved thus may not puff. Puffs, large chromomeres and highest order interphase euchromatic DNP structure seem to be correlated with genes that need to be transcribed only under certain developmental conditions. It is proposed that the function of high order structure is to sequester genetic material, namely mainly controller sequences. Since such high order structure, in most cases, would be built up to house the controller dependencies of just one structural gene, the amount of DNA per structural gene needed for gene control would be considerable, and the concept, if correct, would go a long way towards explaining the c-value paradox ("excess" DNA in eukaryotes). In eurygenic determination, the high order structure is thought to be conditioned for melting or to actually melt to an intermediate level of structure. From there, stenogenic control, leading to transcription, is considered to carry the melting process further to yet lower structural levels...


Epistaxis and the nasostat.

Epistaxis and the nasostat. The most effective method of treating epistaxis is to identify and cauterize the bleeding vessel. If this cannot be done, other methods must be used. Anterior packs without a choanal plug are not reliable. Gauze posterior packs are traumatic and should not be used. The Foley chatheter with anterior gauze packs is quite satisfactory but the Nasostat, which can also be used with anterior packing when necessary, will, in most cases, control the bleeding without subjecting the patient to the discomfort of nasal packs. In addition, when used properly, it is safe and easily tolerated. The technique and its complications are described.


Shock in the emergency department.

Shock in the emergency department. Shock continues to be associated with a high mortality rate primarily because of delays in diagnosis and therapy. To diagnose shock early, and thereby increase the chances of reversal before there is extensive deterioration of vital organs, one should look for any decrease in pulse pressure, urine output, urine sodium concentration, alertness or any increase in urine osmolarity, tachypnea or tachycardia. Systolic hypotension, oliguria, metabolic acidosis and a cold clammy skin are late signs of shock. The pathophysiology of early hypovolemic shock includes hyperventilation, vasoconstriction, cardiac stimulation, fluid shifts into the vascular system and platelet aggregation. Late shock is characterized by lysosomal breakdown, subsequent release of kinins (especially bradykinin), impaired cell metabolism and organ function, fluid shifts out of the vascular system because of capillary endothelial damage and intravascular coagulation. The primary cause of shock should not be neglected in favor of treating signs, symptoms, and laboratory data. The resuscitation from the shock process itself involves correction of pathophysiologic changes, based on objective trends and responses rather than isolated measurements. A suggested outline of therapies in order of their use includes: 1) correction of the primary problem; 2) ventilation and oxygen; 3) fluid-loading: 4) inotropic agents; 5) correction of acid-based and electrolyte abnormalities; 6) steroids ("physiologic" or "pharmacologic" doses); 7) vasopressors (especially in elderly, severely hypotensive patients); 8) vasodilators (if excess vasoconstriction); 9) diuretics (if oliguric in spite of the above), and 10) heparin (if DIC). The most common errors are 1) late diagnosis; 2) inadequate control of the primary problems; 3) inadequate fluid loading; 4) delayed ventilator assistance, and 5) excessive reliance on and use if vasopressors and diuretics.


[Evaluation of severity of primary rheumocarditis in children by means of mathematical methods]. Symptom-complexes typical of severe, moderate and mild carditis were defined on the basis of a comprehensive clinical and instrumental examination of 450 children with proven primary rheumocarditis, and with the aid of mathematical techniques. These complexes may be used in rheumatological practice for differential evaluation of the severity of cardiac lesions in cases of primary rheumocarditis in children.


[Dynamics of pulmonary hypertension after mitral valve prosthesis (late results)]. The presented analysis includes the haemodynamic parameters obtained during right and left heart catheterization in 51 patients following mitral valve prosthetic replacement for rheumatic mitral disease within 1 month to 8 years. In 30 patients the examination was conducted pre- and postoperatively, and in 21--postoperatively only. A comparative analysis of the pre- and postoperative haemodynamic indices has shown that when the effect of surgery is positive, the pressure in the pulmonary artery, the wedge pressure, the right atrial, and the end-diastolic pressures in the right and left ventricles decrease. A reduction is also noted in the pulmonary-arteriolar resistance, in the arterio-venous oxygen content gradient, and in the right ventricle work, and an increase in the cardiac output, cardiac index and effective work of the left ventricle. The dynamics of these parameters is especially dramatic in patients with severe pulmonary hypertension (the pulmonary artery pressure falls by 60%, and the pulmonary-arteriolar resistance--by 83%). When the operation fails to produce any haemodynamic effect, the intracardiac haemodynamics disorders persist along with those in the pulmonary circulation, which permits us to find the reason of the unsatisfactory result of surgery.


Whole blood leukocyte culture technique for mammalian cytogenetic analysis. In the past, the in vitro culture of leukocytes for cytogenetic analysis has required a slightly altered technique for each animal species. This study showed that a simple, yet standardized, in vitro culture system was readily applicable to growth of bovine, canine, equine, feline, ovine and porcine blood leukocytes. The major features of the standardized technique included: 1) the use of whole heparinized blood; 2) a minimum, unfortified culture medium; and 3) a vortex mixer for mixing materials during the hypotonic and fixative stages of the harvesting procedure.


[Chronic discoid lupus erythematosus of the mouth]. A description is given of the clinical and histologic characteristics of chronic discoid lupus erythematosus. At the same time the authors describe the results of the cytologic study carried out in keeping with the Papanicolau technique. Although no specifically indicated in the disease under consideration, the cytological method, added to the clinical study, enables a prompt presumptive diagnosis to be arrived at. However, under no circumstances does it exclude a biopsy study.


[Immunology of bullous diseases (pemphigus vulgaris and bullous pemphigus)]. The immunological aspects of pemphigus vulgaris and bullous pemphigoid are reviewed in this article. In the last few years, the immunoiogical research on these blistering diseases has contributed to a better understanding of the pathogenic mechanisms of these diseases.


[Therapy of chromoblastomycosis with a new method]. The author proposes a new method of treatment for chromoblastomycosis, using the association of two drugs of confirmed therapeutic activity: amphotericin B and 5-fluorocytosine. The aim was to obtain a synergistic action against the causative fungus. The method consists of the following: 50 mg. of amphotericin B is injected i.v. every other day --three times a week-- for three months. Total dosis: 36 ampoules. 5-fluorocytosine is simultaneously given orally --6 tablets of 500 mg. a day-- for three months in a total dosis of 540 tablets or 270 g. Seventeen patients were treated in this way up to now. Six interrupted the treatment on account of several reasons unrelated to treatment. The other 11 that completed this schedule, obtained clinical and histological cure. All were followed-up. No evidence of relapse was seen, even after 27 months of control. The safety of this method of treatment was demonstrated by the low incidence of side effects as inappetence, lassitude, nausea and weight loss. In these circumstances the discontinuance of the drugs for some days was sufficient to resume the treatment. Apparently this therapeutic schedule is the most effective up to now. It has the advantage of not causing resistance and by utilizing low concentrations of the drugs, protecting the patient against risks of toxicity.


Effect of anabolic steroid treatment on endurance. The effect of anabolic steriod treatment on maximum oxygen intake, mile run time, skin fold thickness, body weight, and elbow flexion and knee extension strength was studied. Twenty-one male college students, ages 19-33, engaged in an interval running program six days a week over a three week period. Each subject supplemented their diets with one half gram/kilogram of body weight of 90% protein powder. A double blind design was used for the administration of the steriod treatment with each of the subjects in the treatment group receiving six mg of stanozolol per day. Pre and post treatment tests were administered for each of the dependent variables. There was improvement at the .05 level in the oxygen uptake of both treatment and control groups. For the other dependent variables, the differences between pre-treatment and post-treatment values were not statistically significant. Differences between the steroid and the control groups were not statistically significant for any of the dependent variables. When young male adults are engaged in an endurance training program, steroid treatment does not appear to have any effect on the development of endurance or strength, or on the percent of body fat,


De Sade and Eichmann.

De Sade and Eichmann. The paper presents a comparison of de Sade and Eichmann - the latter having been examined in prison by the author. Eichmann is characterised by insatiable murderous impulses, insufficient defenses of the ego, lack of empathy and identification, depersonalisation, alienation and a bureaucratic administration of murder. De Sade, on the other hand, was imaginative, theatrical, trying to channel his aggressive impulses into erotic plays. A way is suggested to eroticize and sublimate aggression.


'The normal' as a culture-related concept: historical considerations. Three definitions of 'normal' are recognized: the normative or ideal, the average or statistical, and the medical or freedom from illness. We still retain from our historical past the notion that mental or emotional illness bespeaks, if not possession by spirits, at least an irreversible condition. A person who has once sought medical treatment for mental sickness is forever after viewed as suspect, as one who may relapse at any time. The modern norm of reason, as against unreason, reinforces distaste for mental illness. The withdrawal of the Eagleton candidacy in 1972 attests that our society is not yet ready to accept mental illness as treatable and curable. To aspire to the presidency or other high office is probably not 'normal' in the sense of not being 'average', and it is entirely possible that the norm of adaptive behavior is incongruent with ambition and exceptional ability. Should the eligibility requirement for leadership then be 'normal' in the sense of free from illness? Abraham Lincoln was subject to periods of acute depression, Winston Churchill was to a degree manic-depressive, and Woodrow Wilson suffered a series of 'nervous breakdowns' before serving as President. History has vindicated the mental ability and leadership qualities of these men. By modern psychiatric criteria for mental health, many creative scientists and artists would be considered abnormal. On the other hand, the concept of normalcy has recently been used to rationalize political misbehavior. Is it possible, then, to develop a viewpoint of 'normal' that is consistent with our culture, and yet at the same time is broad enough to encompass the uncommon?


[The different procedures for value collection in biological morphometry and stereology (author's transl)]. Each stereological or morphometrical investigation presumes a high experience in structure diagnosis. Therefore, a good contrast between the structures to be evaluated is necessary, especially when using automatic measuring systems. Furthermore, some suggestions are given to facilitate the object-evaluation. The stereological principles including pattern-recognition are mentioned briefly in order to understand some of the technical details. The techniques are divided into simple and advanced procedures. However, it is also possible to evaluate using a simple counter combined off- or on-line with a computer. The advanced system can be divided into tracing instruments and photometric- and television-scanning procedures. The first system which is manipulated by eye-control can also be called "optomanual devices". These are planimetry, a type of automatic point counting, and instruments which locate the coordinates by ultrasound or a magnetic tableau. With relatively inexpensive electronics the coordinates can be transformed into stereological values. The photometric instruments and the television devices "Scan-computers" discriminate only between gray-steps while measuring. The first group works by moving either the photometric spot (flying spot) or the microscopical object-stage. The second group is guided by its computer and the output immediately shows the stereological results. The discussion gives information about choosing the best instrument for investigation. The scientist should keep in mind that the size of the over-all procedure, the frequency of measuring, the time of object preparation, the possible difficulty in discrimination of the gray-steps and the extent of his scientific funds are important for his decision.


[Histomorphometric evaluation of bone biopsies; comparison of two methods (author's transl)]. Two methods for quantitative measurements of bone biopsies were compared and the reproducibility of results as well as the time required evaluated. The use of an eyepiece in order to perform point counting and registration of linear intersections seems to be accurate enough and much more rapid in comparison to the use of an electronically monitored x--y plotter.


[A simple opto-electronic device for morphometry of electron micrographs (author's transl)]. Morphometric investigations of light or electron microscopic photographs can be both time consuming and tedious when statistical results are to be obtained. Therefore, an opto-electrical morphometer has been developed to facilitate such investigations. The photograph is placed in between a light source and a grid, and the shape of the object in question is outlined with an electronic pencil. The impulses so produced can be converted into counts which may than be fed into a pocket-sized calculator or micro-computer for further analyses.


Angiographic methods for blood flow measurements. Radiopaque angiographic contrast agents are being used as indicators for the measurement of blood flow; the basic assumption for these measurements being that both blood and indicator flow nearly at the same rate. Indicators are injected into the circulation and recorded immediately by X-ray filming or video techniques; density changes at selected points along the recorded vessel are detected; dilution curves are plotted and blood flow is calculated graphically or by computer.


Pneumocystis carinii as the cause of human disease: historical perspective and magnitude of the problem: introductory remarks. The history of the discovery of Pneumocystis carinii as the cause of interstitial plasma cell pneumonia of infants and of opportunistic infection with this parasite in the lungs of immuno-suppressed or severely debilitated adults and children is summarized with an extensive bibliography of the world literature through 1959. The problem of incriminating a nearly ubiquitous saprophyte as the cause of a disease and of elucidating the factors responsible for its causing pathogenesis in certain individuals is reviewed with special reference to slow and latent virus infections. Although formerly there has been much discussion of other possible etiologies of the respiratory syndromes in premature and debilitated infants and in children and adults who are immunodeficient or immunosuppressed in whose lungs the parasite is found, there seems no longer to be any room for doubt that P. carinii is itself the cause of these respiratory disease. The need of determining the genetic constitutions and the specific immunologic deficiencies that render some persons victims to this usually innocuous saprophyte is compelling, and the in vitro cultivation of the organism may aid considerably in unraveling these problems.


Infections with Pneumocystis carinii.

Infections with Pneumocystis carinii. Studies were reviewed on attempts to apply serologic methods for the laboratoary diagnosis of pneumocystis pneumonia and for epidemiologic surveillance in outbreaks of this disease. At autopsy the parasite was found in 7.7% of patients with a clinically latent infection. In this series of patients, parasitologic findings were not correlated with the results of a complement fixation (CF) test or with those of an indirect fluorescent antibody test. The high incidence of serologic reactivity in the CF test in chronic obstructive lung disease was not related with special clinical symptoms. Longitudinally performed parasitologic and serologic observations will be needed to find out if Pneumocystis carinii is a pathogen and fulfills Koch's criteria. Preliminary data are given for such an experimental approach in a colony of rats.


Immunopathologic aspects of Pneumocystis carinii pneumonia in infants as revealed by immunofluorescence and electron microscopy. Lung tissue, lymph nodes, and spleen from infants 4-15 weeks old who died of Pneumocystis carinii pneumonia were studied by immunofluorescence and immunoelectron microscopy. The results strongly suggest that antibodies to P. carinii synthetized in lungs by inflammatory infiltrates and in regional lymph nodes are essential in the elimination of P. carinii from infected lungs through their opsonization of the P. carinii organisms. Disintegration of P. carinii conglomerates subsequent to the binding of complement preceded their phagocytosis by lung alveolar macrophages. The immunomorphologic findings strongly supported the hypothesis that the replication of P. carinii at the rate leading to clinical symptoms is due to impaired and delayed synthesis both of antibodies to P. carinii and of complement.


Pneumocystis carinii pneumonia in renal transplant recipients. Discussed are incidence, predisposing factors, presenting symptoms, diagnostic and isolation procedures, and therapy of Pneumocystis carinii pneumonia in renal transplant recipients. A case is reported of a 46-year-old recipient of a cadaveric kidney, who develop P. carinii infection and was successfully treated with pentamidine isethionate.


Elantrine in the treatment of parkinsonism. A new drug, elantrine, blocks the tremorogenic effect of exotremorine, nicotine and harmine in animals. A double blind study compared elantrine with trinhexyphenidyl and against a baseline placebo period, in a group of Parkinson patients. Both, elantrine and trihexyphenidyl treatment, reduced tremor scores at the conclusion of the respective treatment periods, but closer analysis revealed 65% of patients receiving elantrine had lower tremor scores compared to their baseline (placebo) opposed to only 53% receiving trihexyphenidyl. Both drugs produced aequal effect on rigidity. Another group of Parkinson patients receiving clinically optimal doses of L-dopa were treated with either elantrine or placebo, in blind fashion. Analysis of both tremor and rigidity revealed mean scores significantly lower (P less than 0.05) for those patients receiving elantrine than placebo. Also, there was a statistically significant difference in average total symptom scores favoring the elantrine group. Significant improvement with elantrine administration began after the second week for rigidity and after the third week for tremor. Elantrine is a safe, well tolerated agent which is effective alone in the treatment of parkinsonism but significantly enhances the effectiveness of L-dopa, particularly with respect to tremor and rigidity.


The L-dopa sparing effect of G 31,406 in the treatment of parkinson's disease. The AA. study 60 cases of Parkinsonism treated with levodopa associated to G31,406 (dibenzazepnic derivative), to amantadine and to a placebo. Drug-associations: 1) L-dopa + G 31.406, of anticataleptic effect, probably because of its anticholinergic activity and adrenergic central and/or dopaminergic stimulating action; 2) L-Dopa + chl. amantadine; 3) L-dopa + placebo. The patients were previously under exclusive use of L-dopa. The assay verifies: a) if there is any benefit with these associations and in what proportions; b) incidence and intensity of side effects; c) comparative study. The assay also intends to evaluate the effect of the G 31.406 on the depression which usually occur in Parkinsonians.


[Repair of recurrent osteo-meningeal lesions at the base of the skull]. Treatment of cerebro-spinal fluid rhinorrhea from traumatic or tumoral origin, by simple dural patching, is not always sufficient because of the possible necrosis of the patch, mainly in case of severe osteo-meningeal defects. After having pointed out the frequency of such recurrences (5 to 30%, according to the data of literature), the authors report 6 personal cases successfully reoperated in order to repair the osteo-dural lesions with autogenous aponeurosis and bone grafts. 4 were after traumatism and 2 after removal of a tumor, in fronto-ethmoido-sphenoidal base of the skull. The authors suggest to combine bone reconstruction by autograft to the dural repair, even in case of primary fistula, when there is a severe traumatic or tumoral bone defect, or when we are dealing with a spontaneous rhinorrhea which is known to be generally due to local C.S.F. hyperpressure.


New methods of skin replacement in leg injuries. Problems relating to the management of traumatic skin loss of the lower extremity and methods of replacement are discussed with emphasis on several new methods namely, muscle flaps. foot flaps carried on its own blood vessels are nerve as an island flap and free microvascular flaps. Cases treated by these methods are illustrated.


The groin flap in hand injuries.

The groin flap in hand injuries. The groin flap has been used as Burwood Hospital in 12 cases of hand injury. The types of injury, the variety of application and the complications are presented and the usefulness of the groin flap discussed in the light of this experience.


Effect of trimethylcolchicinic acid methyl ether d-tartrate (TMCA) on Hodgkin's and non-Hodgkin's lymphoma. Trimethylcolchicinic acid methyl ether d-tartrate (TMCA; NSC-36351) was administered daily by mouth to 71 patients with malignant lymphomas. Partical (greater than 50%) responses were observed in eleven of 37 patients with Hodgkin's disesse, two of 22 patients with lymphocytic lymphoma, and one of two patients with mixed cell lymphoma. One complete and three partial responses were noted in nine patients with histiocytic lymphoma. Responses lasted from one to 91+ months (median: four months) and occurred in patients whose disease was resistant to alkylating agents, vinblastine, vincristine, procarbazine, prednisone or BCNU. Toxic effects included leukopenia, thrombocytopenia, nausea, diarrhea, stomatitis, alopecia and dermatitis.


High dose imtermittent intravenous cyclophosphamide in non-Hodgkin's lymphomas: long-term patient follow-up. This report summarizes the clinical course of 17 patients with non-Hodgkin's lymphomas who were treated with high dose intermittent intravenous cyclophosphamide between 1966 and 1968. Diagnostic biopsies have been reclassified according to the Rappaport classification. Five patients were found to have diffuse lymphomas, none of whom experienced complete remission or prolonged survival. Twelve patients had nodular lymphomas, five of whom achieved complete remission lasting from 22 to 113+ months (mean 59+ months). Two patients survived 78 and 113+ months, respectively, with no sign of recurrence. High dose cyclophosphamide alone may provide long term control of some patients with nodular lymphomas.


Significance of vitamins in cancer.

Significance of vitamins in cancer. The relationship of vitamins to cancer is very complex. Three types of interactions are possible: the effect of vitamins on tumor growth, the effect of tumors on vitamin metabolism, and the effect of vitamins on chemical carcinogens and anti-tumor chemotherapeutic agents. The significance of vitamins with particular references to vitamins A,B-complex and C, in cancer has been reviewed.


Effect of dietary oxytetracycline on microorganisms in turkey feces. Thirty-six two-day old male turkey poults were divided into three groups and fed three levels of oxytetracycline; 0, 110 or 440 mg. per kg. of ration, respectively, for nine weeks. The poults were given an oral spectinomycin plus vitamin treatment at the hatchery but were not fed before the start of the experiment. Defecated feces from each group were sampled at weekly intervals and analyzed for bacteriological content, especially for members of the Enterobacteriaceae. Total aerobic counts of 3 x 10(8) and total anaerobic counts of 2 x 10(9) were obtained. The majority of the Enterobacteriaceae were Escherichia coli but some Klebsiella sp., the Bethesda-Ballerup group of paracolon bacteria and Arizona sp. were also isolated. Antibiograms of the enteric isolates indicated that an increase in multiple antibiotic resistance occurred when increased amounts of antibiotic were fed.


Effects of different levels of chlortetracycline in the diet of turkey poults artifically-infected with Salmonella typhimurium. Two separate experiments were conducted to assess the shed rate and duration of shed of S . typhimurium organisms from turkey poults orally infected with chlortetracycline-sensitive S. typhimurium in relation to chloretetracycline (CTC) given in the feed at 0, growth promotant, subtherapeutic and therapeutic levels; the emergence of resistant S. typhimurium organisms in reference to the diet given; in vitro transfer of drug resistance from thses resistant S. typhimurium donor cultures to multiply-sensitive E. coli recipients; and phage type changes, is any, of these S. typhimurium isolates. The results showed that increasing CTC in the diet from 0 to the three levels of antibiotic supplementation, appeared to (a) reduce shed and duration of shed corresponding to each level used; (b) cause a minimal development of drug resistance and its transfer (usually at sub-therapeutic levels of CTC supplementation) for the duration of the experiment; and (c) induce phage type changes in some of the S. typhimurium isolates. These phage type changes question the validity of using phage typing as a tool in epidemiological investigations.


Swab and excised tissue sampling for total and Enterobacteriaceae counts of fresh and surface-frozen broiler skin. Excised broiler skin tissue (12.3 cm 2 area) was (a) blended for various times up to 2 min. or (b) shaken 25, 50, or 75 times with or without sterile glass beads. Blending for 10 sec. or shaking 75 times with glass beads yielded the highest total plate count (TPC) and Enterobacteriaceae count (ENT). Counts did not significantly differ between these methods when freshly processed, unfrozen broiler skin was sampled. However, blending yielded significantly higher TPC and ENT than the conventional sampling procedure or swabbing a 12.3 cm. 2 area of the intact skin for 30 sec. with a calcium alginate swab. When sampling hard chilled (surface frozen) broiler skin, there was no significant difference between shaking and blending for TPC, but shaking gave a significantly higher ENT with less variation than blending. Blending, however, yielded significantly higher TPC and ENT counts than swabbing.


The influence of direct implantation of gold thioglucose into the brain of chickens on food consumption and weight gain. Placement of gold thioglucose-filled cannulas into various areas of the avian brain which have previously been shown to have an effect on food consumption did not result in any significant increases in food consumption or body weight gain. These results are contrary to those which have been reported for some mammals. These data also raise the question about the existence of a glucostatic food intake control mechanism in birds.


[Experimental aspects of the CNS-insular system]. The work was aimed at detection and precise localization of the hypothalamic nuclei sensitive to insulin deficiency. For this purpose nuclei of the whole hypothalamic area of the brain were examined in rats with experimentally-induced alloxan diabetes. Only individual nuclei, particularly the supraoptic nucleus of the anterior hypothalamus and the ventro-medial and the arcuate nuclei of the medial hypothalamus proved to react to insulin deficiency. The nuclei of the posterior hypothalamus failed to react to insulin deficiency. Possible ways and methods of participation of the insulin-dependent areas of the hypothalamus in the regulation of the endocrine function of the pancreas are discussed.


[Certain metabolic and vascular changes in the relatives of patients with diabetes mellitus]. On the basis of instrumental and biochemical study of 186 relatives suffering from diabetes mellitus it was revealed that the diabetic type of sugar curve was encountered in 17.2% of cases, doubltful--in 15.6%; at the same time there was revealed an increase in the immunoreactive insulin level both on fasting stomach and after the glucose load, and a distrubance of fat-lipoid metabolism. Functional changes in the vessels of different calibre independent of the GTT character, accompanied by a reduction of vascular permeability and tissue circulation were revealed in some of the persons examined.


[2 variants of the radioimmunochemical method of determination of LH-releasing factor (LH-RF). Distribution of LH-RF in various hypothalamic structures]. The authors elaborated two variants of the radioimmunochemical method of determination of the LH-releasing factor (LH-RF). Diluted antisera (AS) obtained by the immunization of rabbits with the LH-RF-ovalbumin were used in the first method; AS polymerized with isobutyl ester of chlorcarbonic acid were used in the second one. The minimal amount of the hormone determined in the I variant was 5 pg, and in the 11 one--20 to 30 pg. The method is highly specific, since the antisera gave no cross reaction with a wide set of protein-peptide hormones synthesized with the hypothalamus and the hypophysis. The presence in the samples of tissue components of the hypothalamus and of the cerebral cortex extractable with 2M CH3COOH failed to influence the precision of the test. In examining the LH-RF content in the brain structures there was revealed that in the sexually mature male rats the whole hypothalamus contained an average of 7.5 ng, the arcuate nuclei--1.5 ng and the medial eminence--2.5 ng of LH-RF; the supraoptic nuclei and the cerebral cortex contained no LH-RF determinable by the method described. Two weeks after the castration the mean content of the hormone in the whole hypothalamus decreased to 5.5 ng, in the medial eminence--to 0.6 ng, and showed no significant change in the arcuate nuclei.


Higher than usual dosage of haloperidol: a pilot study in chronic schizophrenics. The effect of higher than usual dosages of haloperidol was studied in 38 chronic institutionalized schizophrenic patients for whom any hope of discharge had been abandoned. In 23 patients (61%) a marked or moderate improvement was observed. No striking differences were seen between patients simultaneously receiving or not receiving group therapy. The 15 remaining patients put on haloperidol alone showed some increase in psychomotor alertness, according to the nurses' judgement. It is clear from these results can be safely administered and can be of considerable value in chronic institutionalized schizophrenic patients.


Higher than usual dosage of haloperidol: a pilot study in 'back ward' schizophrenics. A study was carried out in 39 severe, chronic psychotic patients of the effect of rapidly increasing and larger than usual doses of haloperidol in bringing about an improvement in their condition. Symptoms clearly improved in 10 patients. No improvement was observed in the other 29. However, such a success rate with chemotherapy alone, achieved under conditions where occupational or group therapy could not be given, clearly demonstrates the value of such drug administration. Haloperidol has proved to be remarkably safe in this high dose regimen. It should certainly form an integral part of the more comprehensive therapy programmes of the future.


Gemfibrozil as a lipid lowering compound in hyperlipoproteinaemia. A placebo-controlled cross-over trial. The efficacy of gemfibrozil in lowering increased serum lipoprotein concentrations was tested in a placebo-controlled cross-over trial on 30 patients. Administered in a dose of 1200 mg daily, gemfibrozil reduced increased serum triglyceride levels by approximately 50% and reduced increased serum cholesterol concentrations by about 20%. Elevated VLDL triglyceride levels were reduced by 60%, and increased LDL cholesterol concentrations were reduced by approximately 20%. The mean HDL cholesterol concentration increased during gemfibrozil treatment. No adverse reactions attributable to gemfibrozil were recorded during the trial.


A clofibrate controlled trial of gemfibrozil in the treatment of hyperlipidaemias. The efficacy of gemfibrozil as a hypolipidaemic agent was compared with that of clofibrate in a cohort of 80 subjects, half being treated with gemfibrozil and half with clofibrate. The majority of the subjects were either of the type IIa or IIb. Both drugs proved to be effective, though there were 13 non-responders in the clofibrate group, compared with 8 in the gemfibrozil group. The mean reduction in serum cholesterol induced by clofibrate was 23% and by gemfibrozil 19%. The corresponding falls in serum triglycerides were 36% and 43%. There were no serious side effects in either group. Analysed in this way, the relative efficiencies of gemfibrozil and clofibrate seem to be indistinguishable. Further studies are being directed towards evaluation of the individual responses to both treatments.


Angiotensin II blockade and the functions of the renin-angiotensin system. In anaesthetized dogs that were sodium-depleted or subjected to thoracic caval constriction, Sar1-Ala8-angiotensin II produced a striking decrease in aldosterone secretion; also, arterial pressure fell while plasma renin activity (PRA) increased. Recent preliminary observations in conscious dogs during angiotensin II blockade with measurements of the plasma aldosterone level, arterial pressure and PRA have confirmed these observations; a striking fall in plasma aldosterone and arterial pressure occurred while PRA increased. In the rat, sodium depletion produced a marked increase in PRA and aldosterone secretion; studies with angiotensin II blockade during administration of the nonapeptide converting enzyme inhibitor or Sar1-Ala8-angiotensin II demonstrated an important role for angiotensin II in mediating the increase in aldosterone secretion during sodium depletion in the rat. In experimental high output failure secondary to a large aortic-caval fistula, angiotensin II blockade revealed that angiotensin II decreases renal blood flow and helps to maintain the level of arterial pressure; thus, the kidney participates in the compensatory action of angiotensin II to increase total peripheral resistance. Angiotensin II blockade in both one and two-kidney renal hypertensive dogs revealed that angiotensin II was important in the pathogenesis of the acute phase, but in chronic renal hypertension the mechanisms appeared to be angiotensin II-dependent.


Angiotensin antagonists as diagnostic and pharmacologic tools. Angiotensin antagonists have become useful tools in studying pharmacologic and pathophysiologic roles of the renin-angiotensin axis. Several of these uses are described herein. Their value as t-ols in the diagnosis of renal artery stenosis is yet to be determined.


Antagonists, inhibitors and antisera in the evaluation of vascular renin activity. The role of local generation of angiotensin II. It is well established that the arterial wall contains renin-like material. It is suggested that this renin generates significant quantities of angiotensin II (AII) which occupy vascular AII receptors. This is important in determining the pressor response to exogenous AII and in the maintenance of blood pressure. Four lines of evidence support this view. (a) Prevention of AII generation by nephrectomy or converting enzyme inhibition increases the pressor response to AII which then becomes independent of sodium balance. (b) AII antagonists are more effective in renin-mediated hypertension than AII antisera. (c) Changes in renin-mediated pressor responsive to AII after bilateral nephrectomy take a much longer time to occur than can be explained in terms of changes in circulating renin activity: these changes are also observed in isolated vessels. (d) The depressor response to antagonist and inhibitors is preserved after bilateral nephrectomy for much longer periods than can be accounted for by circulating levels of renin.


Acute functional tolerance to the motor impairment effects of di-n-propylacetate. Rats were trained to run treadmill fashion along a moving belt to avoid electric shock. After stabilization of performance, the effects of the anticonvulsant di-n-propylacetate (DPA; 100, 200 and 400 mg/kg) on treadmill locomotion were measured. Disturbances in gait and balance were reflected by an increased time off belt in a dose-related manner. In addition, animals showed a progressive improvement over the 3 two-min trials. A second experiment which measured the effects of 300 mg/kg DPA either 5 or 20 min postinjection revealed that the progressive improvement noted in the first experiment was not due to a diminished drug concentration or to an increased exposure to the drug. Thus, acute functional tolerance to the performance decrement produced by DPA appears to depend upon behavioural processes which enable an animal to overcome the drug-induced functional deficit by practicing the task while in the drug state.


[Basic principles and application of cerebrospinal fluid immunoelectrophoresis]. The basic principles, prerequisites, and limitations of the immunoelectrophoresis of the cerebrospinal fluid are discussed. Major emphasis has been placed on the characteristics of normal and pathological immunoelectropherograms of the liquor cerebrospinalis as well as on the results of studies of inflammatory and neuroimmunological diseases. The detection of a barrier profile, the method of determining special qualitative alterations of immunoglobulins of the liquor cerebrospinalis due to neuroimmunological diseases, and additional applications are discussed in detail. The procedure has been critically reviewed because the results obtained are, for the most part, of a general and nonspecific character and the method cannot be standardized adequately and also does not yield sufficient quantitative data. The advantages (differentiated qualitative changes) and disadvantages (technique troubles) are pointed out.


[Immunofluorescence with incident light in syphilis serology. FTA-5-1 and FTA-ABS-1 reactions]. The FTA-5 and FTA-ABS reactions have been comparatively evaluated on human sera by two microscopic systems in incident and transmitted light. The results demonstrate that the sensitivity of the reactions is increased by employing the incident light microscopic system. Furthermore they demonstrate the opportunity of performing both reactions FTA-5-I and FTA-ABS-I on each serum in order to distinguish type-specific and genus-specific antibodies present in luetic sera.


[New methods of research in the field of bacteriuria: correlation between agar-bacteria and urotube-enterotube system (author's transl)]. Good results have been achieved through a comparative study carried out on a sample of 362 cultures in order to verify the attendibility of a new method of research on bacteriuria. The new Urotube system follows the theorical bases of dip-inoculum of a substratum of a medium of culture. The changes which were verified after the simultaneous use of the two methods on the same sample, were very slight and meaningless for the crossed calculation of the chi2. The second part of the research refers to the qualitative side and test out the bacterial species found out us the considered samples. There were no important varieties between the studies of the following AA. (Kass, Schito) and ours; most infectious processes have, as ethiological agents, gram-negative bacteria, named Enterobacteriacae, which are much more numerous than gram-positive bacteria. It seem however important to underline a slight change of this ratio; it was verified during our test, infact we recorded a percentage of gram-positive higher than the percentage recorded by Kass and Schito.


[Relations between social defense and criminological trends from the 1930s until today]. This study is intended to analyze the historical evolution of criminological schools, in the background, wider and more articulated, of a research by the National Council for Scientific Research directed to probing the outlines of the social defence concept. The work, then, proceeds in the field of criminology and, more particularly, of the evolution of criminological currents which, without defining aims, we will name classical to tell them from the original criminology, of positivistic imprint, and from the new criminology of critical, radical or marxist inspiration, whose examination in entrusted to another research unit. The method followed was that of the historical research with reference to the selected period and with a constant relation, in text and notes, to the enunciations of the examined Authors, considered essential. For such purpose, that is to say for more accuracy in references, it was considered convenient to have the text followed, not only by an ample bibliographical index, but also by an appendix of texts considered particularly significant in the documentation field.


[Research on personality and criminality: recent trends in the literature]. After Waldo and Dinitz published their analysis of researches of personality characteristics of offenders, several new tests and studies have appeared. In most cases new research has been bases on ill defined samples and on questionable control groups. Such studies have been eliminated from the present analysis. In approximately 80% of the studies examined in the present report significant differences have been found between delinquent and control groups of non-delinquents. However, a more careful analysis of the data indicates many differences within most of the main characteristics under examination. While it seems unnecessary to restate specific criticism of the comparative evaluations which have been carried out, it ought to be noted that these studies, once more, appear to present the same deffects already noted by Waldo and Dinitz and by Schluessler and Cressey.


[Monoblock excision of epitheliomas of the tongue and floor of the mouth. Apropos of 27 cases]. So-called "moniblock" excision, an attractive technique for the treatment of carcinomas of the tongue and floor of the mouth, benefits considerably from the use of pediculated flaps which ensure closure of the buccal cavity and thus diminish or even eliminate the risk of septic cervical cellulitis. The authors report 27 cases of carcinoma treated using this technique involving plastic repair using a temporo-frontal flap inserted in the buccal cavity via the temporal groove after resection of the coronal and the zygomatic arch.


The effects of Z plasty on hypertrophic scars. Hypertrophic scar tissue has been observed to soften and thin following Z plasty without removal of any of the scar tissue. Histochemical studies of tissue before and after Z plasty showed that abnormally sulfated mucopolysaccharides were replaced by normal acid mucopolysaccahrides within 14 days. Collagen in hypertrophic scar appeared in nodules and fibers perpendicular to the surface of the skin rather than as long straight fibers parallel to the skin surface as normally seen. Elastic fibers were reduced and scar was relatively avascular. Following Z plasty the amount of collagen decreased and fibers were oriented in bundles at right angles to each other, parallel to the surface. When tissue was examined by electron microscopy collagen fibers showed marked variation in diameter. Microfibrils were increased and there were aggregates of fibrils with periodicity of 1500 to 1600 A. Following Z plasty, areas which previously contained only microfibrils now had unit collagen fibers with normal periodicity. Urinary excretions of hydroxyproline and hydroxylysine, amino acids found only in collagen, were increased following Z plasty, coinciding with the softening of the scar. Excretion of the disaccharide, glucosylgalactosylhydroxylysine, predominantly found in skin, increased following Z plasty, while excretion of the monosaccharide, galactosyl-hydroxylysine, predominant in bone collagen, remained constant. Amino acid composition of collagen, remained constant. Amino acid composition of collagen isolated from hypertrophic scars was similar to that present in skin and tendon, and unlike that in cartilage or infant dermis. Hydroxyproline content was slightly decreased and hydroxylysine content slightly increased compared to skin or tendon. Histochemical, ultrastructural and biochemical studies of the same specimens suggested that collagen with disordered fibril formation was present in the hypertrophic scar and was degraded following Z plasty. Changes in the molecule which occurred after synthesis of the protein core might be responsible both for the failure of normal maturation of the scar and for its sensitivity to degradative enzymes following Z plasty.


The vascular anatomy of the dorsal part of the caudal ribs in the dog. A microangiographic study with special reference to the microvascular free transfer of living rib grafts. The arterial blood supply to the head, neck and tubercle of the caudal ribs in the adult dog was studied by means of microangiography. While the tubercle and the neck are supplied solely by medullary branches of the main nutrient artery, the rib head receives an additional supply via two groups of epiphyseal arteries. This vascular pattern is discussed with special reference to the free microvascular transfer of composite posterior rib grafts.


Resur-splint fixation for cross-leg flaps. Case report. Methods for the fixation of cross-leg flaps are reviewed, and an improved form of splint fixation is presented. The fixation is based on pre-operatively constructed splints of the plastic material Resur Trovidur PE. The splints can easily be removed and remounted, the material can be sterilized, the fixation can be employed and adjusted during the operation. The method has been used in 2 cases and proved applicable both during the operation and in the subsequent immobilization period.


Receptor for complement components and xenogeneic erythrocytes on human T- and B-lymphoid cells. Biological and molecular properties of receptors specific for human T- and B-lymphoid cells are discussed. Sensitive simple and reproducible methods to enumerate B- and T-lymphocytes are described: their possible application in clinical immunology is indicated. A new method to obtain enriched populations of human T- and B-lymphocytes from peripheral blood is described. This method appears to be suitable to investigate the properties of antigens specific for B- and T-lymphoid cells.


Subacromial triamcinolone mexacetonide and methylprednisolone injections in treatment of supra spinam tendinitis. A comparative trial. This statistical report describes a clinical trial on 60 patients with supraspinal tendinitis for the comparison of triamcinolone hexacetonide (in a 20 mg/cc suspension in 1 cc ampoules) with methylprednisolone acetate (in a 40 mg/cc suspension in 1 cc ampoules). The objective of the study was to determine the therapeutic activity, including onset and duration of relief, of triamcinolone hexacetonide as a subacromial injection, and to compare these results with those obtained with similar injections of methylprednisolone acetate. The following results were obtained. Triamcinolone hexacetonide reduced pain, local tenderness and functional impairment to a greater degree than did methylprednisolone acetate. A significantly smaller proportion of patients needed a second injection of triamcinolone hexacetonide (33%) than needed a second injection of methylprednisolone acetate (63%). Triamcinolone hexacetonide appears to have longer duration of activity than does methyl-prednisolone acetate, judging by the percentage of patients still getting relief from their first injection at the end of the study period. The drugs were similar as regards side effect incidence rates and time to onset of action.


Behavioral effects of long-term exposure to a mixture of organic solvents. The behavioral effects of long-term exposure to a mixture of organic solvents were investigated in a comparison of the test results of 100 car painters with those of a reference group. The test battery included tests for intelligence, memory, psychomotor performances, and personality. In addition to the comparison of the mean results, two discriminant function analyses were made. In one, only the performance test variables were used, but in the other personality variables were also included. The results indicated impairments in psychological performances, as well as personality changes in the exposed group. Impairments in visual intelligence and verbal memory and a reduction of emotional reactivity were the central features of the adverse effects of solvent exposure, but the behavioral disturbances also involved several other functions, including performance on a verbal intelligence test. The possible role of the differences in the initial intelligence levels were controlled with a separate comparison of the test results of 33 pairs of exposed and nonexposed subjects who were matched for age and for their intelligence level, measured during the military service. The discriminant function analyses were based on the results of these matched subgroups and tested in the rest of the material. According to the results the sensitivity of the psychological test methods was high, but the specificity somewhat low, with regard to solvent exposure. The concentration of various solvents included in the exposure of car painters were low, the summated exposure corresponding corresponding to 32% of the Finnish threshold limit value. The possible role of a potentiating effect of the solvent in the development of behavioral disturbances is discussed.


The effects of moderate heat stress on patients with ischemic heart disease. With the use of a climate chamber, the effects of a 3-h exposure to moderate heat stress (23 to 29 degrees C) on the physiology, comfort, and performance of 20 subjects, 10 with slight (group I) and 10 with moderate (group II) ischemic heart disease (IHD), were studied. Twenty matched control subjects were similarly exposed. All of the subjects performed sedentary, mental work throughout the exposure. Humidity was 9 mm Hg; air velocity, 10+/-3 cm per second; and thermal resistance of the clothing, 0.7 clo. Under identical conditions no significant differences in rectal, skin, and finger temperatures or weight loss existed between the three groups, but during heat stress the temperatures and weight loss were always significantly higher than under the control conditions, except for rectal temperatures during the first 2 h. There was no difference between the groups or the two sets of conditions in respiration rate and diastolic blood pressure, but the patients had a significantly lower systolic blood pressure in the third hour of heat stress than under the control conditions. Heart rate and the rate-pressure-product during heat stress were significantly higher in the controls than in the patients. A few patients experienced a slight retrosternal oppression during heat stress, but only one had ECG changes, and none of these symptoms or signs were present under control conditions. Under both sets of temperature conditions the patients were uncomfortable during a longer period of time than the controls, and they were more sensitive to temperature changes, group II being more sensitive than group I. The comfort distribution curve was very narrow for group II. The performance tests were numerical addition, card punching, cue-utilization and creative association. In numerical addition no temperature effect could be shown on the speed of working, but for the patients in group II during heat stress the level of accuracy in the second hour was lower than under control conditions; the trend was the opposite for control subjects. No differences occurred in the first or third hour. In card punching the patients in group II worked significantly more slowly during heat stress than did the control subjects, who improved their performance in heat, as did the paracy with which this task was performed, the patients in group II making significantly more errors in the heat than patients in group I. Cue-utilization did not differ between groups or conditions. Patients performing the creative association test under heat stress supplied significantly fewer unique answers than did patients working under control conditions; no such effect of heat was observed for control subjects. We conclude that patients with IHD are more sensitive to moderate heat stress than healthy control subjects in terms of mental performance and comfort. There are some differences in cardiopulmonary function but no differences in thermoregulation.


Studies on the prevention of respiratory distress syndrome of infants due to hyaline membrane disease with plasminogen. Hyaline membrane disease (HMD) is leading single cause of death of newborn, premature infants. The "hyaline membranes" consist chiefly of fibrin. The clinical manifestation of HMD is the respiratory distress syndrome (RDS). Infants with RDS were treated with urokinase-activated human plasmin in a previous clinical trial. Survival rate was increased in the plasmin treated group as compared to the placebo recipients. However, cost and difficulty in the preparation of the enzyme made this treatment impractical. We, as well as others, have shown the premature infants lack serum plasminogen; thus they are unable to develop effective fibrinolysis and are defenseless against pulmonary fibrin deposition. Therefore, plamsinogen was tested as a possible preventive agent in RDS due to HMD. In a double blind, randomized study, infants between 1 and 2.5 kg birth weight received plasminogen or placebo shortly after birth, and were then followed for development of RDS. After 100 infants were entered into the study, the code was broken and results were evaluated to assure safety of the procedure. Among the 100 infants, 51 received placebo, 49 received plasminogen. Among the infants who received placebo, seven developed mild, and ten developed severe respiratory distress; of these ten, five died with histopathologically documented HMD. Two infants died from causes other than HMD. Among the 49 infants treated with plasminogen, 13 developed mild and three developed severe respiratory distress. There was no death due to HMD. Two deaths were due to other causes. Factors placing the infant at risk from HMD (degree of prematurity, sex, cesarean section, bleeding episodes during pregnancy, maternal diabetes) were found to be evenly distributed between control and treated groups. Since completing the first phase of the study, data of an additional 277 infants has become available. Although the code was not broken in this series, a preliminary look at mortality data in comparison with mortality data of the first series of 100 (in which the code was broken) suggests that preventive activity of plasminogen has been maintained in the second phase of the study.


Prevention of venous thromboembolism.

Prevention of venous thromboembolism. Of the various prophylactic agents evaluated, four have been found to be effective. These are oral anticoagulants, low-dose heparin, mechanical devices which increase venous blood-flow in the leg, and Dextran. Oral anticoagulants have been shown to be effective in patients having abdominal, thoracic, or hip surgery, when treatment was started either before surgery or in the immediate postoperative period. They have also been shown to be effective in medical patients. The evidence derives from studies which showed that treatment can reduce total mortality, prevents venous thromboembolism detected clinically or at autopsy, and prevents thrombosis diagnosed with venography. On the other hand, the incidence of thrombosis diagnosed by 125I-fibrinogen scanning was not reduced when oral anticoagulants were started just before or just after surgery. This suggests that oral anticoagulant treatment starting in the immediate postoperative period may not prevent formation of the initial thrombotic nidus, but is clinically effective because it prevents extension of the nidus to form a significant thrombus. Bleeding has been a significant complication in almost all studies of surgical patients, and this is the major factor which has prevented widespread use of oral anticoagulant prophylaxis. In addition, the need for careful laboratory monitoring makes this approach inconvenient and adds to its expense. Low-dose heparin has been shown to be effective in general surgical and medical patients, but results have been inconclusive in patients having elective hip surgery, and this approach is probably ineffective in patients with hip fracture. In general surgical patients, low-dose heparin prophylaxis has been shown to prevent pulmonary embolism diagnosed at autopsy examination or with lung scanning, and calf and thigh vein thrombosis diagnosed with 125I-fibrinogen leg-scanning. A slight, but statistically significant, increase in the frequency of wound hematoma and a greater postoperative hematocrit fall have been reported when heparin was given three times daily, but not with the twice daily heparin injection regimen. In these studies, low-dose heparin was given without laboratory control of its anticoagulant effect, so that this prophylactic approach is simple, but the need for subcutaneous injections is a disadvantage of this approach. Results with methods which increase venous blood-flow in the leg have varied, depending on the technic used. Active measures, such as intermittent pneumatic calf compression or peroperative electrical calf muscle stimulation, have been shown to prevent thrombosis detected with 125I-fibrinogen leg-scanning. However, while the evidence suggests that both methods are effective in relatively low risk patients, they may have limited value in the high risk patient who is confined to bed for a long time. These methods are free of side effects and relatively inexpensive, but intermittent calf compression, in particular, is slightly cumbersome...


Alterations of hemostasis associated with cardiopulmonary bypass: pathophysiology, prevention, diagnosis, and management. This chapter has provided a review of available literature regarding alterations of hemostasis associated with CPB. The primary pathology of altered hemostasis during CPB appears to be two-fold: (1) a functional platelet defect of unclear etiology, which occurs in virtually all patients, and (2) a primary hyperfibino(geno)lytic defect which occurs in the majority of patients undergoing cardiopulmonary bypass. Significant thrombocytopenia does not appear to be a consistent problem, and is probably a function of perfusion technics; this may, however, be an important source of hemorrhage in some instances. Although hyperheparinemia, heparin rebound, and protamine excess have occasionally been incriminated as sources of hemorrhage during CPB, no well documented cases appear in the literature. Likewise, although DIC gained popularity in early reports of CPB hemorrahge, it appears that this syndrome rarely, if ever, arises as a consequence of CPB alone; it can be seen, however, in CPB patients who are provided a triggerin situation for DIC, such as shock, sepsis, or hemolytic transfusion reaction. It is likely that many reported alterations of hemostasis during CPB which were concluded to represent DIC actually were due to hyperfibino(geno)lysis. The key to prevention of CPB hemorrhage rests simply in obtaining an adequate preoperative workup. Of extreme importance is an adequate history with respect to bleeding tendencies in both patient and family; of equal importance is a careful history regarding antiplatelet drugs. A careful physical examination, searching for clues of a real or potential bleeding diathesis, also can often prevent catastrophic cases of CPB hemorrhage. Lastly, an adequate presurgical laboratory screen must be performed; in addition to the usual prothrombin time, partial thromboplastin time, and platelet count, a thrombin time and standardized template bleeding time must be added. The addition of these two simple modalities will insure against significant defects in fibrinogen, the fibrinolytic system, vascular function, and platelet function. When CPB hemorrhage occurs, simple laboratory screening will usually allow for a quick hemostasis evaluation. The parameters recommended in this review will distinguish between surgical and nonsurgical bleeding and should, therefore, allow for a quick decision regarding necessity for reexploration and the adequacy of hemostasis if reexploration is needed. In addition, this screen will distinguish between difficulties with heparin, protamine, and the fibrinolytic system. The vast majority of nonsurgical hemorrhages during CPB is due to a functional platlet defect, primary hyperfibrino(geno)lysis, or a combination of these. The quick administration of platelet concentrates, while awaiting laboratory evaluation, will control or significantly blunt most instances of CPB hemorrhage. If platelets fail to control bleeding, and reasonable laboratory evidence of primary hyperfibrino(geno)lysis is present, antifibrinolytics should then be used...


Management of facial lacerations.

Management of facial lacerations. The prevention of unsightly scars and functional loss after facial lacerations is accomplished by early, meticulous repair in layers without tension on the suture line. The interrupted subcuticular suture applied with a small full-curved cutting needle and with the aid of a skin hook is recommended to reach the goal of aesthetic and functional restoration.


A clinical evaluation of a screening (Microstix) for urinary tract infections. The effectiveness of a screening device for urinary tract infection (Microstix**) was compared to routine laboratory cultures, sensitivities, and colony counts. The Microstix were highly effective in determining the presence or absence of urinary tract infections. In addition, they could be subcultured to provide meaningful bacterial sensitivities. Microstix are economical, easy to use, and accurate. Their use in the diagnosis and follow-up of urinary tract infections is therefore recommended.


Infections of the urinary tract during pregnancy: use of fluorescent antibody technic as an aid in patient evaluation. Over a 22-month period, the fluorescent antibody (FA) technic was used to evaluate 195 patients with urinary tract infections (UTI) during pregnancy. Postpartum intravenous pyelograms (IVP) were obtained for 86 patients. The results were correlated as to the site (upper or lower urinary tract) of infection. Regardless of the result of the FA test, results of IVP were abnormal in 40% to 41% of patients witn antenatal pyelonephritis. This was in contrast to only 9.4% abnormalities in patients with asymptomatic bacteriuria and negative FA tests.


Vaginal hysterectomy be anterior delivery of the uterine corpus. Of 285 vaginal hysterectomies done by a modification of the Doderlein-Kronig technic, almost 70% of patients had an intraoperative blood loss of less than 200 ml. Only four required transfusions. A postoperative pelvic abscess was the only severe infection, and it responded to treatment. One patient had a ruptured ectopic pregnancy 46 days after hysterectomy. Advantages of this procedure are good anatomic exposure and minimal blood loss.


Roentgenographic recognition of bronchoceles. Bronchoceles often have characteristic plain film, tomographic, and bronchographic appearances, and they may trap air. Roentgenographic recognition of bronchoceles can allow them to be distinguished from neoplasms and sometimes help avoid unnecessary surgery.


Microvascular procedures in reconstructive surgery. The application of microvascular technics to problems in reconstructive surgery has enabled the surgeon to revascularize ischemic digits, replant amputated digits, and to transfer directly composite tissue from one area of the body to another for reconstructive purposes. The success of these procedures is directly dependent upon the ability to perform and maintain patent microvascular anastomoses. Representative cases are reported including the revascularization of an incompletely amputated digit, the replantation of an amputated thumb, the direct transfer of a toe to replace a missing thumb, and the transfer of a groin flap to cover a lower extremity defect. The principles of preoperative management, operative technics, and postoperative care are reviewed.


Acute pancreatitis, pancreatic pseudocyst, and Candida peritonitis in recipient of a kidney transplant. The case of a recipient of a kidney transplant who developed pancreatitis, complicated by pancreatic pseudocyst subsequently infected by Candidi from an infected parenteral alimentation line, is reported. The case was further complicated by rupture of the cyst leading to Candida peritonitis and development of multiple fistulous tracts between the stomach, ileum, and colon. Despite the 50% mortality of acute pancreatitis in patients with transplants and the 50% mortality reported in Candida peritonitis, the patient was successfully treated by cystogastrostomy, peritoneal lavage, and amphotericin B in association with administration of mannitol and reduction of immunosuppression to a minimal level. After eight weeks of total parenteral alimentation, the fistulous tracts spontaneously closed and the patient was discharged with normal renal function.


Dialysis and transplantation: a mothers' group. Two social workers are helping mothers of transplant and dialysis patients to deal with the multiple reality and feeling problems posed by the unique situations encountered in the parenting of children with end-stage renal disease. The commonality of these problems indicated a group approach. The mothers' natural grouping was formalized into an effective supportive, educational, and helping experience.


Electron microscopic observations on T and B lymphocytes from spleens of syngeneic radiation chimaeras. The ultrastructure of T and B lymphocytes has been examined in long-term syngeneic chimaeras and age-control mice. Spleen cell suspensions from these mice were passed through glass wool columns to obtain pure lymphocyte populations. These cells were then separated into T and B lymphocytes by nylon wool columns, and their purity was tested by cytotoxicity assays with anti-phi serum. Electron microscopic observations on such separated T and B lymphocytes did not reveal morphological differences except when the cells were fully differentiated, either as mature (T2) cells or plasmacells. In particular, T2 cells showed a very high cytoplasmic density, attributable to the presence of a larger number of microfilaments with respect to immature (T1) cells. In long-term chimaeras a significantly larger number of T2 cells was found as compared to age-control mice, and this morphological observation is correlated with the differences in immune reactivity and leukemia incidence previously described in these mice.


Clinical specular microscopy.

Clinical specular microscopy. This paper presents a clinical specular microscope for the examination and photography of endothelial cells at high magnification (X200). The instrument is used easily during routine examination without inconvenience or discomfort to the patient. We have found the specular microscope extremely useful clinically in the elucidation and documentation of corneal endothelial diseases in vivo. This instrument allows the detection of endothelial damage or disease which may not be seen by slitlamp examination. The effects of normal aging, endothelial dystrophies, trauma, and inflammation can be monitored. The instrument is especially useful in the evaluation of ocular surgical procedures. It can be used on the first postoperative day without inconvenience to the patient or damage to the eye. By the comparison of photographs taken before and after the operation, an estimate of endothelial cell loss may be made. Thus, the endothelial effects of different techniques of cataract extraction intraocular lens insertion, and penetrating keratoplasty can be observed and compared. This new technique for the clinical examination of corneal diseases has great promise in improving diagnosis as well as therapy.


Vidarabine therapy of simple and IDU-complicated herpetic keratitis. Large scale, multiclinic evaluations of vidarabine (Ara-A, Vira A, adenine arabinoside) for treating herpetic keratitis have been conducted as double-blind studies (169 patients) in comparison with IDU and open studies (146 patients). In the open studies, the disease in the majority of patients had been refractory to IDU. The effects of vidarabine and IDU were approximately the same in improvement of symptoms (lacrimination, photophobia, sensitivity) and percent of and time for corneal reepithelialization. With vidarabine, significantly more patients had improved distant visual acuity than did with IDU. In the open studies, vidarabine also was effective. Of 116 patients whose ulcers had not responded to IDU, 91 (78%) had reepithelialization within four weeks of treatment with vidarabine. On the basis of results from these studies, vidarabine appears to be a safe and effective drug for treating herpes simplex keratitis.