[Existence of triphasic flow pattern in regional cerebral blood flow of prolonged unconscious patients (author's transl)]. Anticipating to get some new informations about the cerebral circulations of the comatous patients, two kinds of radioisotopic techniques were combined and applied to twelve unconscious patients of various etiologies. The first step was the conventional gas clearance method using xenon 133 as the indicator. Regional cerebral blood flows were measured at the six areas over each hemisphere. Immediately following this procedure, about 150 muCi of I-131 MAA (I-31 macroaggregated human serum albumin) were injected into internal carotid artery via the same catheter inserted already for the first procedure. Radioactivities of the head and lungs were measured and the relative shunt flow was calculated based on the formula already described elsewhere. Profil scanning of the whole body of the patient was also performed after the intracarotid injection of I-131 MAA. Consciousness states of the ten patients were all severely damaged and causes of the disturbed consciousness were various, including 5 of subdural hematoma, 2 of occlusive cerebrovascular disease, 2 of brain tumor and 1 of ruptured intracranial aneurysm. This investigation revealed the following results; 1) In all patients, regional cerebral blood flows were shown decreased over all areas detected. The regional cerebral blood flows could not be increased by 5% carbon dioxide inhalation, suggesting angioparalysis in these areas. 2) Graphical analysis of the clearance curves revealed triphasic flow pattern in rCBF in four cases. In three cases among the four, the intracarotid injection of I-131 MAA showed the radioisotope labelled particles were captured not only in the brain, but also in the lungs and the relative shunt flow calculated increased up to twice as much as normal controls. It indicates that some of the particles larger than the cerebral capillary size passed through the brain and were captured by the capillary net work of the lungs. From the above described data, it might be concluded that the initial rapid component of triphasic flow pattern in rCBF measurement does not represent the hyperemia of luxury perfusion of metabolic origin, but arteriovenous shunting blood flow, probably, through the precapillary thoroughfare channels which have been anatomically demonstrated by Hasegawa et al.


Correlation between red cell and free plasma phenytoin levels in renal disease. Free phenytoin levels were determined in a group of patients with renal disease treated by hemodialysis or transplantation and in epileptic patients who were otherwise healthy. A highly significant correlation was observed between free drug levels and the phenytoin content of red blood cells in both groups. Considerable fluctuation in free phenytoin levels was observed during long-term maintenance hemodialysis. After transplantation, the degree of abnormality in plasma protein binding was not related to the functional adequacy of the cadaveric allografts. Free phenytoin levels must be monitored in patients with renal disease.


Neuroradiological diagnosis of intraspinal tumors in children. In the diagnosis of spinal and intraspinal space-occupying processes great importance attaches to radiologic plain film diagnosis, including special projections and tomography. Using refined evaluation methods, direct and indirect signs of tumors can be demonstrated in 30-50% of cases. Of decisive importance is the myelographic examination. It permits the determination of the exact localization and the size of a tumor. Contrast studies frequently allow an identification of the tumor type. Spinal arteriography and phlebography, on the other hand, are of secondary importance in the diagnosis of tumors of both spinal canal and spinal cord. In patients with bone infiltration they accomplish a valuable contribution to determine whether this expansion is directed towards the epidural space or the soft tissue structures of the back.


Successful pregnancy renal transplantation. Pregnancy in a renal homograft recipient resulted in the delivery of a 2770-g male fetus by classic cesarean section. Renal function remained stable throughout the gestation. The fetoplacental unit was monitored by the concurrent assay of 24-hour urinary estrogen excretion and human placental lactogen (hPL) in light of the spuriously low estrogen levels often found in these patients on chronic glucocorticoid immunosuppression.


Acute polyhydramnios recurrent in successive pregnancies. Management with multiple amniocenteses. A patient with acute polyhydramnios in two successive pregnancies is described. In both this case and the only previously reported similar one, management by frequent transabdominal removal of relatively small amniotic fluid volumes was associated with prolongation of pregnancy and a living infant, suggesting that multiple amniocenteses can improve the otherwise hopeless prognosis associated with acute polyhydramnois.


Association of E. coli sepsis in pregnancy with a CU-7 intrauterine device in place. Several reports of pregnancy and sepsis associated with an intrauterine device have been reported. A case of a CU-7 in utero with sepsis due to Escherichia coli in a 10-12 week gestation is presented.


Intraperitoneal rupture of benign cystic ovarian teratoma. Three patients are presented with the rare complication of intraperitoneal rupture of a benign cystic ovarian teratoma. Spillage of sebaceous material produces a chemical granulomatous peritonitis which may mimic the metastatic spread of ovarian carcinoma. The importance of a frozen-section examination prior to a definite procedure is stressed.


LHRH and steroid levels in normal ovulatory women. Synthetic LHRH was given intravenously in a dose of 250 mug to a group of 7 normal women in different phases of the menstrual cycle. The LH response was more pronounced in the preovulatory and luteal phase than in the follicular phase of the cycle. The FSH response was less than that of LH and was the same in all phases of the cycle. No significant changes were observed in the plasma levels of estradiol 17-beta, progesterone, or testosterone for up to 6 hours as well as 24 hours after LHRH administration in any of the subjects studied. In 2 of 3 subjects, administration of LHRH in the luteal phase resulted in the prolongation of the cycle. No effect on cycle length was observed when LHRH was given at other times of the cycle. LHRH did not affect the length of the subsequent cycle regardless of the day of administration.


Polymicrobial bacteremia in obstetric patients. Thirteen cases of polymicrobial bacteremia occurring in obstetric patients are reported. The most commonly occurring combination involved the Bacteriodeaceae, anaerobic streptococci, and Hemophilus vaginalis. In 3 cases the spectrum of bacterial isolates obtained from the intravascular compartment changed significantly.


Plasma insulin response following oral and intravenous glucose in pregnant diabetic women. The acute release of insulin in most pregnant diabetic patients is sluggish. A study was undertaken to determine whether this abnormality was due to a relative insensitivity of the beta cell to glucose or to an attenuation of the enteroinsular axis. The plasma insulin response to intravenous and oral glucose was studied in third trimester pregnant insulin-independent diabetic and normal control patients. The results suggest that the sensitivity of beta cell reaction to glucose in the diabetic group was reduced and that this may be related in part to a defective enteroinsular response. Quantitative endocrine hypofunction, as evidenced by lowered plasma insulin levels, was also noted among the pregnant diabetic patients. The results are discussed in relation to the pathogenesis of disturbed carbohydrate metabolism in insulin-independent pregnant diabetic patients.


Identification of an immunosuppressive factor in pregnancy serum. Complement-inactivated allogeneic serum was found to contain a factor capable of suppressing BCG-induced inhibition of leukocyte migration in vitro. Although serum from late pregnancy was the most potent in this context, the ability to antagonize the leukocyte response appears to be an intrinsic property of human serum. The inhibitory factor was purified by salf fractionation and gel chromatography and the effect found to be associated with alpha-globulins of high lipid content which are probably alpha-lipoproteins. Estrogens, progesterone, or corticosteroids, associated with the lipoprotein, did not appear to be the cause of the observed suppression. The factor appears to block the immune response at the level of the lymphocyte and its nonspecific immunosuppressive properties could contribute to acceptance of the fetus by the mother.


[New formation of the skeletal muscles and skeletal muscle and myocardial-like structures in rabbits in experiments with diffusion chambers]. The rabbit skeletal and cardiac muscles treated by 1% water solution of Trypan Blue for 48 hrs are necrotized and, having been transplanted under the skin in the diffusion chambers impermeable for cells, do not develop. When transplanting such necrotized muscles under the skin or in the abdominal cavity in the diffusion chambers permeable for cells (with pores of 1.5 mu in diameter), cells penetrate through the chamber wall and develop, under the influence of the products of decomposition of phagocytized transplant, into myoblasts, muscular tubes and differentiated cross-striated muscle fibers; undifferentiated muscle fibers of the skeletal type arise outside the chamber. The necrotized cardiac muscle did not induce the formation of muscle fibers after the transplantation under the skin or in the omentum. If they were transplanted together with the diffusion chambers containing the necrotized skeletal muscles, myocardium-like structures arose outside the chamber. The formation de novo of skeletal muscles and skeletal muscle- and myocardium-like structures under the influence of decomposition products released from the necrotized skeletal and cardiac muscles proceeds by means of induction; some pluripotent cells of the recipient, possibly polyblasts, are the source of de novo formation.


Innominate artery compression syndrome. Presentation of 16 cases. A series of 16 patients with tracheal compression by the innominate artery is presented. In more than half of the patients the symptoms began during the first few days of life with stridor varying severity, recurrent tracheobronchitis and apneic spells. In six cases requiring surgical treatment the immediate result was good. In ten mild cases treatment consisted of medical management and follow-up. The present study confirms that the great arteries can exert compression on the trachea, which can always be relieved by means of an operation which moves the arteries forward. Bronchoscopy is considered to be the only reliable means of diagnosis. This entity should be considered more often in the differential diagnosis in children less than 3 years of age with stridor, breathing difficulties, recurrent infections, apneic spells, and asthma.


[Mineral and crystal formation "in vitro" by lipids extracted from bovine compact bone]. In order to study the role of lipids in the calcification process of the bone tissue, lipids have been extracted from undecalcified compact bone of calves less than 6 months old and from cows or oxen more than 2 years of age. Lipids from each group have been fractionned in "polar" and "non polar" types. Each type of lipid was shown to promote the formation of calcium phosphate precipitates in vitro. But only the polar lipids from calves bone promoted the formation of crystallised calcium phosphates, similar to hydroxyapatite. The identification of both crystallised and amorphous precipitates has been achieved by X-ray diffraction and chemical analysis.


[Study of glycoprotein extracted from synovial membranes of oxen]. Authors describe a glycoprotein that they have extracted from synovial membrane of oxen. From a total extract CTC, the fraction is purified by precipitation with ethanol then by filtration on biogel. The composition and some physicochemical and immunogical characters are described.


[Effect of furosemide, potassium canrenoate and D-L-propranolol on blood pressure in spontaneously hypertensive rat]. Spontaneously hypertensive rats (japanese strain) have been treated with furosemide, potassium canrenoate or d-l-propranolol. Present results indicate that: 1)furosemide admiinistration, from the 3rd to the 15th week of life, does not prevent the development of hypertension but the blood pressure rises more slowly in treated rats. In the established phase of hypertension furosemide administration produces a decrease in blood pressure; the blood pressure increases rapidly after cessation of the treatment. 2) potassium canrenoate, injected from the 3rd to the 14th week of life, does not prevent the rise in blood pressure.3) d-l-propranolol, administered from the 5th to the 34th week of life, is without effect on the development of hypertension, though it significantly decreases heart rate.


[Gallium sulfate and skin allografts in the mouse]. Survival of skin allografts in mice are prolonged when these animals are injected subcutaneously with gallium sulfate before and after the grafting. The average survival is then 17, 2 days whereas it is 12,5 days for controls. For mice treated with an immunodepressive drug such as cortisone acetate average survival is 13,4 days; it is 17 days when cortisone has been added to the metallic salt.


[Chronic lathyrism, prolonged hyperlipidic diet, and atheroma in the rat]. Deep, constant, extensive atherosclerosis can be experimentally induced on rats that are atheroresistant. Two main factors are involved in this experimentation; parietal alteration following chronic intoxication with BAPN (9 weeks) and a metabolic factor with hyperlipidic diet, but this metabolic damage should be sustained for a long time (40 weeks).


[Classification of tailed enterobacteria phages]. Tailed phages of enterobacteria are classified by morphological and serological properties and by physico-chemical parameters of the virion and its nuecleic acid. Twenty-four species are described; they include 250 phages belonging to seven morphological groups. Type species are proposed. About 120 poorly known phages have not been classified. A case of phage evolution, the reliability of data and the value of taxonomical criteria are discussed.


Food additives and hyperkinesis: a controlled double-blind experiment. A double-blind crossover trial involving a control diet and a diet eliminating artificial flavors, colors, and natural salicylates as recommended by Feingold was conducted on 15 hyperkinetic children. Teachers and parents observed the children for one month prior to treatment, using standardized rating scales. Both parents and teachers reported fewer hyperkinetic symptoms on the K-P diet as compared to the pretreatment baseline. The teachers noted a highly significant reduction of symptoms on the K-P diet as compared to the control diet but the parents did not. The control diet ratings did not differ from the baseline period ratings for either parents or teachers. It is concluded that the K-P diet may reduce hyperkinetic symptoms, though this result is put forth with caution in view of several features inherent in the present study which need further evaluation, including objective measures of change, manipulation of the independent variable, and reducing the independent variable to more specific components.


[An evaluation of the PATHOTEC system for identification of Enterobacteriaceae (author's tranls)]. One hundred species of Enterobacteriaceae were examined according to the PathoTec Rapid I-D system, and the results were compared to the results obtained by conventional bacteriological methods. The results of the examinations are given in Tables II, III, and IV. It is concluded that 97% agreement between the results of biochemical reactions is excellent, whereas 81% agreement between the diagnoses is not quite satisfactory; but it can be improved to 90% fairly easily, which would be a satisfactory result.


[Mental anorexia: gonadotrophic response to clomifene citrate. Sixteen cases]. Sixteen patients with anorexia nervosa and secondary amenorrhoea received clomiphene citrate, eight before any other treatment (200 mg of clomiphene citrate per day for four days) and eight others after partial or total correction of weight loss (50 mg of clomiphene citrate per day for five days). Menstruation occurred in four patients of the second group. An elevation of plasma LH was demonstrated in 4 cases in the first group and 7 of the second group. Variation in FSH was not always parallel with LH. The authors discuss the physiopathological mechanism of gonadotrophic insufficiency in anorexia nervosa and define the role of clomiphene citrate in the treatment of this disorder.


Nuclear origin of specific yeast mitochondrial aminoacyl-tRNA synthetases. Hydroxylapatite chromatographies of mitochondrial and total enzymes from a rho+ yeast, or from the related rho degrees mitochondrial DNA-less mutant, show the occurrence in the mitochondrial enzyme of one Phe-, one Met-, one Leu-tRNA synthetase peak which elutes distinctly from the cytoplasmic counterpart and charges well mitochondrial tRNA, whereas the cytoplasmic enzyme does not. The measurement of the mitochondrial synthetases activities in various enzymatic extracts shows that they are not repressed in rho+ cells grown on 10% glucose and that they are concentrated in the mitochondria (Phe- and Met- tRNA synthetases) but are also present outside the mitochondria. It is concluded that yeast mitochondrial protein biosynthesis involves the nuclear coded mitochondrial specific Phe-, Met- and Leu-tRNA synthetases and that the entrance of the synthetases into the mitochondria needs no factor depending on the mitochondrial DNA.


The involvement of the anticodon adjacent modified nucleoside N-(9-(BETA-D-ribofuranosyl) purine-6-ylcarbamoyl)-threonine in the biological function of E. coli tRNAile. tRNAile was isolated from E. coli Cp 79 (leu-, arg-, thr-, his-, thiamin-, RCrel) which had been grown on a sub-optimal concentration of thr and was found to contain an average of 50% less N-[9-(beta-D-ribofuranosyl)- purin-6-ylcarbamoyl]threonine, t6Ado, than tRNAile from cells grown on an optimum concentration of thr and containing a normal complement of t6Ado. The two tRNA's were identical in their ability to be aminoacylated, to accept the 3'-terminal dinucleotide, and to form an ile-tRNAile-Tu-GTP complex. In contrast, the t6Ado-deficient-tRNA was significantly less efficient in binding to ribosomes compared to the normal tRNA. This difference was seen in the binding of deacylated tRNA and in the nonenzymatic and enzymatic binding of ile-tRNA, all in response to poly AUC. The t6Ado-deficient ile-tRNA demonstrated no binding at Mg2+ concentrations less than or equal to 10 mM, while the normal ile-tRNA bound at low Mg2+ concentrations. Tetracycline had the same effect on the normal as on the t6Ado-deficient ile-tRNA binding. As a control, the binding of phe-tRNA (which does not contain t6Ado) from normal and thr-starved cells in response to poly U was identical. It was concluded that t6Ado is required for proper codon-anticodon interaction.


Stimulation of transcription on chromatin by polar organic compounds. Polar organic compounds, including DMSO, increase RNA synthesis on isolated chromatin by E. coli RNA polymerase and RNA polymerase II from calf thymus. Transcription is stimulated on chromatin from Friend-virus-infected erythroleukemia cells and from various other sources. Using procedures which inhibit specifically the formation of a stable initiation complex, it is shown that the stimulation does not result from an increase in initiation of both E. coli and the eukaryotic RNA polymerase. After separation of chromatin into template active and inactive fractions, DMSO increases RNA synthesis by a factor of about 1.5 using the template inactive fraction, while stimulation of transcription on the template active portion is lower (factor of 1.2). It is suggested that the effect on RNA synthesis is mediated by a weakening of the apolar interactions between histones in chromatin subunits, releasing transcription partially from the constraints imposed by histones.


Fluorescent 2'(3')-O-aminoacylnucleosides-acceptor substrates for ribosomal peptidyltransferase+. 2'(3')-O-L-Phenylalanylderivatives of fluorescent 1,N6-ethenoadenosine and 3,N4-ethenocytidine were prepared by chemical synthesis. Both compounds are good acceptor substrates in ribosomal peptidyltransferase reactions. Since these compounds cannot form Watson-Crick base pairs, the results indicate that the terminal aminoacyladenosine unit of AA-tRNA is bound to ribosomal protein on the acceptor site of peptidyltransferase and not to rRNA.


Specific release of ribosomal proteins by nucleic acid-intercalating agents. Increasing concentrations of ethidium bromide cause progressive inactivation of ribosomes, apparently by binding to double-stranded regions of the rRNA. At low drug concentrations (10(-4)M) the partial inhibition detected is due to specific release of proteins L7 and L12; activity can be restored by addition of an excess of these two proteins. At higher concentrations the inactivation is not reversed by supplementation with released proteins. The presence of ethanol affects the extent of ethidium binding and also the release of ribosomal proteins. In all tests the proteins most sensitive to the presence of the drug are L7 and L12, followed by L8/9, L11, L27, L28, L29 and L30. Despite the fact that L7 and L12 are the first two proteins released by ethidium they are never totally missing from drug-treated ribosomes, though the other proteins can be displaced completely. About 50% of proteins L7 and L12 remain on the ribosomes at the highest drug concentrations tested, possibly indicating heterogeneity in the binding sites for the several copies present in the ribosome.


A restriction cleavage map of phiX 174 DNA by pulse-chase labelling using E. coli DNA polymerase. A pulse chase labelling technique using E. coli DNA polymerase I has been used to determine a number of restriction endonuclease cleavage maps of ØX 174 DNA. In addition to verifying the accuracy of the method by confirming some previously published maps, the Hha I and Alu I maps have also been constructed.Images


Cleavage of T4 species I ribonucleic acid by Escherichia coli ribonuclease III. T4 Species I RNA, a molecule 140 nucleotides in length with some structural features very much like a tRNA, is specifically cleaved by an enzymatic activity in Escherichia coli extracts to give three segments with 19, 48 and 73 nucleotides. We report the purification and characterization of the E. coli RNase which cleaves two 3' phosphodiester bonds of T4 Species I RNA. This reaction has many properties in common with those catalyzed by E. coli RNase III, although the optimal salt conditions for T4 Species I RNA cleavage differ significantly from those for other RNase III-catalyzed reactions. The reaction is not catalyzed by extracts from an E. coli strain lacking RNase III activity. Furthermore, T4 Species I RNA is cleaved by highly purified E. coli RNase III to yield the same three specific fragments. We conclude that this specific cleavage is due to the action of RNase III, and that the requirement for lower ionic strength may reveal further important properties about this RNA processing enzyme.


Patient selection for anticoagulant therapy in coronary heart disease. Short-term anticoagulant therapy given after an acute myocardial infarction is directed toward preventing thromboembolism and is fairly safe. Long-term anticoagulant therapy prevents coronary thrombosis in selected patients with coronary heart disease (CHD), but carries an appreciable risk of hemorrhage. A decision for or against short-term therapy should be based on an assessment of the immediate risk of thromboembolism. Similarly, the risk of coronary thrombosis should be the major determinant in a decision for or against long-term anticoagulation. The most important information emerging from the clinical trials of long-term anticoagulant therapy in CHD concerns the significant benefit observed among patients with advanced disease.


Effects on body temperature produced by micro-injection of Salmonella typhimurium lipopolysaccharide into the third cerebral ventricle of the chicken. Salmonella typhimurium lipopolysaccharide was injected into the third cerebral ventricle of the hen via a surgically implanted cannula. Hens injected with 20-80 mug. Salmonella typhimurium lipopolysaccharide had higher (P less than .01) rectal temperatures (42.3 degrees C. compared to 41.3 degrees C.) than uninjected hens. Those injected with 0.9% NaCl had significantly lower (P less than .01) rectal temperatures (41.8 degrees C. compared to 42.3 degrees C.) than hens injected with this bacterial pyrogen. There is an indicated function for bacterial pyrogen acting directly in the hypothalamic area of the chicken.


Phlebotomy and iron deficiency.

Phlebotomy and iron deficiency. Therapeutic and investigational phlebotomy can produce iron deficiency severe enough to warrant iron therapy or even replacement blood transfusion. This complication of modern medicine is not adequately recognized.


Fluocinonide compared with betamethasone in the treatment of eczema and psoriasis. Good results have been obtained with a single daily application of fluocinonide ('Metosyn') to one area as compared with a twic-daily application of betamethasone 17-valerate ('Betnovate') to a similar area on the opposite side in the treatment of eczema and psoriasis. These conditions are difficult to control even in favourable circumstances and have a tendency to relapse despite any form of treatment. Both creams were entirely acceptable to the patients involved and during the course of the trial no patient expressed dissatisfaction with either the mode of treatment or the preparation involved.


Structure of L-arabinose-binding protein from Escherichia coli at 5 A resolution and preliminary results at 3.5 A. The three-dimensional crystal structure of the L-arabinose-binding protein from E. coli, an essential component in the active transport of L-arabinose, has been solved at 5 A resolution using the method of multiple isomorphous replacement. Five heavy atom derivatives were used. A preliminary 3.5 A electron density map has also been calculated. The results indicate that the molecule is ellipsoidal with approximate dimensions 68 A X 38 A X 30 A. Two similar domains within the molecule (which is a single polypeptide chain) are related by an approximate noncrystallographic rotation-translation axis. This relationship involves approximately 20% of the structure.


Physical studies of denatured tRNA2Glu from Escherichia coli. We have examined the 270 MHz nuclear magnetic resonance spectrum and relaxation kinetic behavior of tRNA2Glu (E. coli) in the absence of Mg++, a condition which produces an inactive form of this tRNA. The results show that the denatured form has about five fewer proton resonances in the region from -12 to -15 ppm. Relaxation kinetic measurements reveal that the denatured conformer contains three separately melting helices. The results support a model in which the tertiary structure and dihydrouridine helix characteristic of the native form are unfolded in the denatured state, and are replaced by an altered tertiary structure. The acceptor stem, anticodon, and TpsiC helices are intact in this model for the denatured conformation. The optical changes that accompany melting of the denatured tertiary structure are faster than 10 musec.


Role of 5S RNA in assembly and function of the 50S subunit from Escherichia coli. Total reconstitution experiments performed under various conditions revealed that 5S RNA plays an important role during the last assembly step in vitro leading to an active 50S particle. For the preceding steps this RNA species is dispensable. However, 50S RNA can be integrated efficiently during any of the assembly steps in vitro. The 47S particle, reconstituted in two steps and lacking 5S RNA, shows low but significant activity in many functional tests. High activity could be obtained by incubating this particle with 5S RNA alone, demonstrating the importance of the 5S RNA in generating an active ribosomal conformation. In particular, the activity of the peptidyltransferase (peptidyl-tRNA:aminoacyl-tRNA N-peptidyltransferase; EC 2.3.2.12) center is drastically influenced by 5S RNA. No significant factor-dependent tRNA binding to the A-site was observed with the 47S particle, in contrast to the corresponding P-site binding. The elongation factor G dependent GTPase activity was not affected by the lack of 5S RNA.


Mutagenicity of aflatoxins related to their metabolism and carcinogenic potential. Aflatoxins and their animal biotransformation products were screened for carcinogenic potential using the Ames' in vitro microbial detection system for carcinogens as bacterial mutagens [B. N. Ames et al. (1973) Proc. Natl. Acad. Sci. USA 70,2281-2285]. Aflatoxicol, aflatoxins G1 and M1, aflatoxicol H1, and aflatoxins Q1, B2, P1, G2, B2a, and G2a, listed in order of decreasing mutagenic potency, were all less active than aflatoxin B1. No compound possesses activity in the absence of the rat liver preparation, and this indicates none of the animal metabolites are the ultimate mutagenic and/or carcinogenic species. The relative mutagenic potency observed with this in vitro system qualitatively correlates with in vivo carcinogenic data. Comparison of both methods indicates: (i) aflatoxin B1 possessed the structure optimal for both mutagenicity and carcinogenicity, (ii) the decreased carcinogenicity of various animal metabolites is associated with their decreased mutagenicity, and (iii) the 2,3-double bond is involved in both the mutagenic and carcinogenic activity of aflatoxins. The Ames' assay has been demonstrated to be an extremely promising (toxicological) tool for the analysis of mycotoxins for mutagenic and/or carcinogenic activity.


Regulation of transcription factor rho and  the alpha subunit of RNA polymerase in Escherichia coli B/r. Transcriptional termination factor rho, the alpha subunit of RNA polymerase (RNA nucleotidyltransferase nucleosidetriphosphate: RNA nucleotidyltransferase, EC 2.7.7.6), and ribosomal protein S6 were resolved from whole-cell extracts of E. coli B/r by a high-resolution, two-dimensional polyacrylamide gel electrophoretic technique, and were identified through coelectrophoresis with the purified proteins. The regulation of rho, alpha, and S6 was studied, in steady-state cultures of E. coli B/r growing at rates ranging from 0.6 to 2.1 generations per hr, through the use of this gel technique and a double radioisotope labeling procedure. The regulatory patterns of rho and alpha are distinct from, but similar to, one another. Neither rho nor alpha shows the sharply increasing levels with increasing growth rate shown by the ribosomal proteins was exemplified by S6. The difference between the levels of rho and alpha, on the one hand, and S6, on the other, is most pronounced during rapid growth. The regulatory pattern of alpha is interesting, given the recent suggestion that the gene coding for alpha is contranscribed with genes coding for ribosomal proteins.


Hybridization of RNA to double-stranded DNA: formation of R-loops. RNA can hybridize to double-stranded DNA in the presence of 70% formamide by displacing the identical DNA strand. The resulting structure, called an R-loop, is formed in formamide probably because of the greater thermodynamic stability of the RNA-DNA hybrid when it is near the denaturation temperature of duplex DNA. The rate of R-loop formation is maximal at the temperature at which half of the duplex DNA is irreversibly converted to single-stranded DNA (the strand separation temperature of tss) of the duplex DNA and falls precipitously a few degrees above or below that temperature. This maximal rate is similar to the rate of hybridization of RNA to single-stranded DNA under the same conditions. At temperatures above the tss the rate is proportional to the RNA concentration. However, at temperatures below tss the rate of R-loop formation is less dependent upon the RNA concentration. Once formed, the R-loops display considerable stability; the formamide can be removed and the DNA can be cleaved with restriction endonucleases without loss of R-loop structures.


Isolation of inverted repeat sequences, including IS1, IS2, and IS3, in Escherichia coli plasmids. A method is described for isolation of inverted repeat DNA sequences that occur in E. coli plasmids. The procedures of the isolation involved: (a) denaturation of intact plasmid DNA, (b) a rapid, 30 sec, renaturation of inverted-repeat sequences in the genome, (c) digestion of the single-stranded portion by S1 nuclease to recover duplex DNA, and (d) detection and purification of the duplexes using 1.4% agarose gel electrophoresis. If a plasmid DNA carried inverted repeats of either one type or two different types of special DNA sequences, these procedures enabled us to observe either one or two characteristic DNA bands, respectively, in the agarose gels. If a plasmid DNA did not carry any inverted repeats, or if the plasmid DNA only carried direct repeat sequences, no characteristic DNA bands were recovered. Cleavage of the spacer DNA between inverted repeat sequences generated no gel bands. This indicated that the inverted repeat sequences must be in the same strand. Using this method, we isolated and purified several repeated sequences, including IS1, IS2, and IS3, from derivatives of F and R plasmids.


New low resolution model for 50S subunit of Escherichia coli ribosomes. Neutron low angle scattering studies of the 50S subunit of E. coli ribosomes with the contrast variation method reveals large fluctuations in the scattering density. A region of relatively low scattering density, rich in proteins, surrounds an RNA-rich core of higher scattering density. The centers of mass of the RNA and protein parts of the 50S subunit are separated by a distance (20 A) that is considerably smaller than that reported in previous studies.


Detergent-soluble HLA antigens contain a hydrophilic region at the COOH-terminus and a penultimate hydrophobic region. Purified, detergent-soluble HLA antigens (p44,12) are composed of a glycoprotein of molecular weight 44,000 (p44) and a peptide of molecular weight 12,000 (p12), beta2-microglobulin. Upon digestion with papain, p44,12 is converted to p39,12, then to p34,12, which retains antigenic activity. The NH2-terminal amino acid sequences of p34 and p44 are identical. p44, p39, and p34 were purified, and comparison of their amino acid compositions showed that the COOH-terminal peptide removed by the first papain cleavage is hydrophilic and contains cysteine that can be alkylated after mild reduction. The penultimate COOH-terminal peptide removed by the second papain cleavage is hydrophobic, and presumably anchors HLA antigens to the membrane. This correlates with the observation that p44,12 and p39,12 bind detergent, while p34,12 does not. The orientation and integration of HLA antigens in the lymphocyte membrane were thus defined, and the structure suggests that HLA antigens span the plasma membrane.


Effects of amygdala lesions on taste aversions produced by amphetamine and LiCl. Rats which sustained bilateral damage to the amygdala were treated with one of two diversely acting agents (either d-amphetamine sulphate 4 mg/kg, or lithium chloride 0.24 M) in a taste aversion paradigm. Both groups of animals showed an attenuation of the aversion on the first test day after the initial pairing with the drug thus demonstrating that this effect of the lesion was not UCS specific. The implication of these findings for the hypothesis concerning the role of the amygdala in taste aversion conditioning is discussed.


Improved intracerebral chemitrode for chemical and electrical studies of the brain. An intracerebral chemitrode is described for infusion and recovery of solutes as well as stimulation and recording of discrete brain loci. The chemitrode consists of two insulated tubes in juxtaposition with implantable angular ends faced together and covered with a high porosity polycarbonate Nuclepore membrane so as to create a sealed, nonclogging, perfusion chamber. Electrical connectors are affixed directly to the tubes at the external end for stimulating and recording of the perfusion area. Experiments showing electrical stimulation of the chemitrode to produce epileptic foci at the site of perfusion, infusion of drugs to produce changes in brain activity and extraction of ethanol following peripheral injection demonstrate the potential utility of the chemitrode in a wide variety of neurobiological problems.


Functional aspects of reinnervation of free skin grafts. The reinnervation of full-thickness skin grafts has been studied with single mechanosensory unit recordings. Shortly after transplantation of the skin, most of the incoming fibers conduct impulses at slow velocities, which correspond to the unmyelinated group of sensory fibers. The older skin grafts demonstrated an increasing amount of myelinization as shown by the shorter latencies and faster conduction velocities. However, the critical balance between myelinated and unmyelinated fibers that characterizes normal cutaneous innervation was still disrupted in the grafted groups at 15 months. Whether this imbalance persists indefinitely is uncertain. The introduction of electrophysiological techniques into the study of peripheral nerve injuries, in experimental animals and in man, has given us some insight into the unexplored nature of this field of experimental and clinical investigation. The future promises to be exciting.


Vaginal reconstruction with gracilis myocutaneous flaps. The definition, history, experimental background, surgical technique, and clinical applications of compound gracilis myocutaneous flaps are presented. This flap has been our method of choice for neo-vaginal reconstruction after radical pelvic surgery.


Resurfacing large cheek defects with rotation flaps from the neck. A neck flap based on the midline many provide excellent cover for large cheek defects. The technical aspects of planning and replacement, with emphasis on positioning to prevent ectropion of the lower lid, are presented. Alone, or in conjunction with the multiple excision technique, this flap can produce a superior cheek surface.


Use of nasolabial skin flap to cover intraoral defects. Several fresh surgical defects of the maxillary alveolus, palate, and tonsillar area, resulting from the excision of cancer, have been repaired in a single operation by pulling through an inferiorly-based nasolabial flap with a subcutaneous pedicle. Patient rehabilitation has been rapid.


Splinting electrical burns of the mouth in children. A mouth splint has been designed tp be worn through the healing period of an electrical burn of the mouth. The splint is custom-fitted for each child, and it is easily removed. Six children have been so treated and followed up for 4 years. The results to date have been excellent in preventing microstomia.


The infectious diarrheas.

The infectious diarrheas. In most cases, the physical examination will not adequately differentiate between the various infectious entities, though a careful history may be helpful. A stool guaiac test can help differentiate between invasive organisms and toxigenic organisms. All the organisms described usually cause a self-limited illness, and therapy is directed toward the control of symptoms.


[Psychodiagnostic methods in neuropsychiatry and psychotherapy]. After a previous article had dealt with the general problems of psychodiagnostic procedures, this paper provides a critical presentation of different psychological test methods, classified according to groups of methods. The authors described some tests often applied in practical clinical diagnostics for the evaluation of development, intelligence and capacity, methods for measurement of special abilities and efforts, questionnaires and scales for self-evaluation, as well as developmental tests. Their diagnostic value and limits are emphasized; methods are dealt with in detail which have been designed or adapted in the G.D.R. or have recently been standardized.


[Neurology and the locomotor system: aspects of manual therapy]. The author gives a review on the relationship between neurology and the locomotory system, 2. the dysplasis and pathological processes of the locomotory system, which lead manual therapy is outlined. The presentation of clinical relations is subdivided into three groups: 1. the neurological diseases, which secondarily disturb the locomotory system, 2. the dysplasias and pathological processes of the locomotory system, which lead to a mechanical damage to the substance of the nervous system, and 3. the functional disturbances of the locomotory system, which are registered by the nervous system as a nociceptive stimulus causing segmental and suprasegmental reflexes and which may lead to pain. Within this context the arthrogenic, ligamental, muscular, and statistically induced pain syndromes are shortly discussed, their therapy is also mentioned.


The fathers (not the mothers): their importance and influence with infants and young children. This review is primarily concerned with the behavior and influence of fathers with respect to their infants and children in early childhood as a mediating variable in forms of psychopathology. Three developmental periods are surveyed in relation to what is known of paternal behavior and its influences on the child: pregnancy, infancy, and early childhood. Throughout, it is appreciated that influences may be bidirectional (i.e., father-child and child-father) and that behavior problems in children are usually determined by the coexistence of several factors. The objective here, however, is to examine the father-child relationship specificially as a possible early determinant of behavior deviance in children. Because the literature is sparse, it is necessary to carefully take into account manifestations of paternal behavioral deviance and behavioral deviance of children as they may influence each other.


The modification of the ethanol withdrawal syndrome in rats by di-n-propylacetate. Di-n-propylacetate (DPA), a drug known to increase brain gamma-aminobutyric acid (GABA) levels and to inhibit GABA-transamine (GABA-T) activity, was administered during the ethanol withdrawal period to rats made physically dependent upon ethanol. Under all conditions tested, 400 mg DPA/kg injected i.p. significantly reduced the withdrawal hyperexcitable state induced by acoustic stimulation. The effect was seen as early as 30 min after the administration of DPA and lasted for at least 2 hrs. Readministration of the same dose of DPA 6.5 hrs after its initial injection again mitigated withdrawal symptoms. A 200 mg/kg dose of DPA was significantly effective for only 1 hr after its administration. Neither dose led to mortality or observable tranquilization. The results suggest that DPA may be a useful agent in the control of the hyperexcitable state induced by ethanol withdrawal and that the GABA system may be involved in this state.


Congenital malformations in infants of diabetic mothers. In a series of 701 infants born to diabetic women between 1950 and 1974 ,57(8-1 percent) had congential malformations which is a rate three to four timeshigher than in the normal populations of Birmingham.. In 26 cases(3-8 per cent) the malformations were fatal and accounted for 26 per cent of the perinatal mortality in the series.  Central nervous system, cardiovascular and skeletal abnormalities were equally common and there was a high incidence of anencephalus, spina bifida, transposition of the great vessels and sacral dysgenesis...


[Contribution of the Aversa school to the birth and progress of criminal anthropology]. In this historical research the author highlights the contribution made by the Aversa school in the birth and progress of criminal Anthropology. He describes in particular the scientific work of Gaspare Virgilio who with his intuitions contributed to a notable extent in the evolution of the though of Lombroso, of whom he was a friend, and also the work of his successor, Fillipo Saporito, who, in dealing with the treatment of criminals, advocated the necessity of replacing the punishment-chastisement by the punishment-treatment, thus forestalling the principles set forth in the new prison reform.


Analysis of lymphoedema as first symptom of a neoplasm in a series of 650 patients with limb involvement. In a series of 650 patients with lymphoedema of the extremities, a clinically suspected primary lymphoedema in 60 patients was found upon roentgenological examination to be secondary lymphoedema. After lymphography, tomography and in some cases selective supplementary angiographic examination, the causitive factor for almost all patients could be established and was confirmed after biopsy/operation and pathological-anatomical-anatomical examination. This is a very important finding, because a developing lymphoedema may be the first symptom of a malignant process characterized by tumour infiltration into the lymph nodes. It is exactly in these patients that lymphography may often give rise to unexpected amazing findings, which in certain cases may contribute to the possibility of starting effective treatment.


Infantile cortical hyperostosis (Caffey's disease). Two case reports. Two cases of infantile cortical hyperostosis (Caffrey's disease) are presented. This syndrome is characterized by diaphyseal cortical swelling of flat bones as well as long bones, often polyostotic but sometimes confirmed to one bone, e.g. the mandible. Prominent clinical features are irritability and painful firm swelling of soft tissues, as well as pallor and subfebrile temperatures. Serological reactions and blood cultures are negative and histological findings are non-specific. Differential diagnosis should account for bone syphilis, hypervitaminosis A, battered child syndrome and osteomyelitis. The prognosis is favourable.


Computed tomography of the pancreas.

Computed tomography of the pancreas. Computed tomography (CT) has proven useful in diagnosing inflammatory and neoplastic disease of the pancreas. Neoplasms of the pancreas produce enlargement of the gland and loss of surrounding fat planes. Acute pancreatitis also produces enlargement but correct diagnosis can be made with the clinical correlation. The usefulness of CT in chronic pancreatitis depends upon the state of the disease. Distinction between an inflammatory and a neoplastic mass is not possible on the basis of a CT scan alone. CT is also useful for needle guidance for aspiration biopsy of the pancreas.


[A combined method of autologous bone grafts and collagen allografts for the prevention of bone pockets]. The use of autogenous bone for elimination of intrabony pockets is a well established procedure. With the use of "fill-in-techniques" three problems still remain: 1. the limited amount of bone that can be obtained, 2. the additional surgical intervention to obtain the bone graft, 3. the associated gingival recession, which especially in the front region challenges every intervention. A rather simple combined technique is described to eliminate these difficulties. The use of an allogenic filler compensates efficiently for the limited amount of bone material available. Lyophilized dura mater is a suitable allograft. Lyophilized dura mater is commercially available and the extended and prolonged use in general surgery has confirmed it as a very reliable substitute. Its adaptation to the complex morphology of intrabondy defects and surrounding structures is easily obtained by cutting it to the desired shape and compressing it with a gauze pad. The additional surgical intervention and trauma can often be eliminated by the autogenous osseous material which is obtained from an intra-oral source, usually from the area where hte surgery is being performed. By incorporation of a filter in the existing suction device the osseous coagulum can be collected permitting the utilization of a coolant. The use of several layers of the allogenic graftmaterial reduces the gingival recession to  a minimum and restores the interdental papilla. The small differences between this surgical technique and the classical one do not constitute a major problem. The case must be carefully selected and prescribed technique followed in every detail. The present results are substantiated only by clinical evaluation on a restricted number of patients and during a limited period of time.


[Use of rat glomerular basement membrane (GBM) as antigen in indirect imunofluorescence test for detection of human anti-GBM antibodies (author's transl)]. The purpose of this paper is to verify if we may use the rat glomerular basement membrane (GBM) as antigen, in indirect immunofluorescent test in isolated GBM (IIT-BGM) to detect human anti GBM antibodies. Rabbit anti-human GBM serum (A-H-GBMS) were obtained by rabbit's immunization with human GBM or rat GBM respectively. The content of anti-GBM antibodies in rabbit's sera was determined in IIT-GBM. The titer of the A-H-GBMS was 1/10 when determined in IIT-GBM performed in human GBM and only weakly positive in IIT-GBM performed in rat GBM. The titer of A-R-GBMS was 1/60 and 1/20 when determined respectively in rat GBM and in human GBM. All the reactions performed with sera absorbed with autologous GBM were negative; the absorption of sera with heterologous GBM reduced sera titer. a) rat and human GBM have common and different antigenic components; b) to detect human anti-GBM antibodies we must not employ rat GBM in IIT-GBM.


Induction of theta-positive murine lymphocytes by a thymic extract. Extracts of calf thymus were prepared using a modification of A. Goldstein's procedure for thymosin isolation. Several extracts were clearly active in inducing the formation of theta-antigen on the surface of immature murine lymphocytes. Surface theta-antigen was directly measured by using a live cell immunofluorescent technique. Some extracts were marginally active in affecting mitogen responsiveness, as measured by tritiated thymidine uptake. Sources of lymphocytes included adult bone marrow, spleen, thymus, lymph node and fetal liver cells.


Location of the source of the soluble skin surface proteins of cattle by immunofluorescence. The soluble skin surface proteins of cattle are located between the squames of the stratum corneum and are derived from sweat, sebum and the epidermis itself. However, the sweat gland, especially at high ambient temperatures, appears to be the most important source of at least some of these proteins.


Evaluation of the indirect fluorescent antibody test for detecting Trypanosoma vivax in South American cattle. The indirect fluorescent antibody test (IFAT) as used in Africa for detecting bovine trypanosomiasis was adapted for use in South America and evaluated. Antigen consisted of Trypanosoma vivax laden bovine blood fixed in a 60 : 40 : : acetone : methanol solution. The test detected initial titres of 1 : 50 and 1 : 100 at an average of 13.1 and 15.9 days post parasitaemia (PP). Maximum titres as high as 1 : 400 developed in eight calves at an average of 23.4 days PP. In another calf, 109 days PP were required. Efficacy in detecting sero-positive calves throughout the course of infection was 81.1 and 96.4 per cent at serum dilutions of 1 : 100 and 1 : 50 respectively. No false positive reactions occurred when sera from 36 haemoparasite-free calves were tested. Cross reactivity did not occur when sera from calves singularly infected with Trypanosoma theileri, T evansi, Anaplasma marginale, Babesia argentina, B bigemina and Eperythrozoon spp were similarly tested in the IFAT. No significant differences were found in IFAT results of surveys in which both conventional serum samples and sera eluted from dried blood samples on filter paper from the same calf were used.


The increased resistance of mice to experimental staphylococcal mastitis following inoculation of endotoxin. Intramammary inoculation of endotoxin in mice three days before intramammary challenge with staphylococci induced resistance to the staphylococci. Endotoxin given by the intraperitoneal route also induced resistance when inoculated three days before challenge. Resistance was not induced, however, if the mice were allowed to continue lactating during the induction period. Histological examination of mammary glands following different combinations of lactation/involution and endotoxin treatment indicated that endotoxin given by either the intramammary or the intraperitoneal route caused an accelerated involution of the mammary gland and suggested that the involuted gland was inherently more resistant. This was confirmed by demonstrating the same resistance in mice after five days of natural involution when the mammary glands had reached the degree of involution produced by endotoxin in three days.


[Etiopathogenesis of true male homosexuality (androgenic insufficiency?)]. Clinical and experimental studies have suggested the author the possibility that an androgenic insufficiency, during embryogenesis or the perinatal period, may be a determinant factor in the pathogenesis of the anomalies of homosexual behavior. In the author's opinion, the androgenic anomalies seen in the genuine male homosexual have no pathogenic significance, but are a repetition of what occured during embryogenesis of the perinatal period, at the time when these anomalies had a pathogenic role.


Reconstruction of the ala nasi and the lateral wall of the nose. With reference to the functional importance of the vestibular region, it is recommended that only such operative methods should be practiced for the reconstruction of the ala nasi as take into account the aerodynamics of the vestibular region. The reconstruction of the cartilaginous infrastructure should therefore be an integrading component of the ala replacement. Various possibilities for the fulfilling of these requirements are pointed out and a pedicled septal mucosa-skin-cartilage flap described by the author which, in conjunction with a frontal skin flap permits the repair of the ala nasi in a shorter time is described in more detail. For the treatment of defects of the lateral nasal wall, in addition to the insular flap operation from the nasolabial region and the forehead, the medial frontal flap technique as described by Kazanjian is particularly recommended. This method is also suitable very particularly for closure of perforating defects in conjunction with the split skin graft.


[The lymphocyte transformation test with the bedsonian antigen (bedsonian LTT) in old and recent Fiessinger-Leroy-Reiter syndromes and in ankylsoing spondylarthritis. Additional study]. The lymphoblastic transformation test in the presence of bedsonian antigen was positive in 72 per cent of the cases confirmed Fiessinger-Leroy-Reiter syndrome, while it was negative in all the controls. This test remains positive over a long period since it was found to be positive in 69.75 per cent of old cases of FLR syndrome diagnosed 13-17 years previously. In cases of post-Reiter ankylosing spondylarthritis (ASp), the bedonian LTT was positive with equal frequency as in cases of FLR syndrome not complicated by ASp (68.4 per cent). On the other hand, in the cases of ASp without known history of FLR the test was positive much less frequently (17.7 per cent). There was no significant difference between the positivity rate of the bedsosian LTT in cases of pure axial ASp and in cases of ASP with peripheral lesions, neither in the group with post-Reiter ASp nor in the group with idiopathic ASp. In addition to its diagnostic value, this test is of great value in the epidemiological study of the group of rheumatic diseases that includes the FLR syndrome and ASp.


[Induced hyperlipemia test during femur head osteonecrosis]. The authors studied disturbances of lipid clearance in cases of aseptic osteonecrosis of the femoral head by means of an induced intravenous hyperlipemia test. With reference to investigations in 19 patients, the authors first draw attention to the frequency of ethylism and of fatty degeneration of the liver (13 patients). A significant decrease was noted in the coefficient of lipid clearance in the 19 patients. This was particularly marked when fatty degeneration of the liver was present. The etiological role of these anomalies should be considered, as fatty degeneration and hyperlipaemia may also be found in other pathological conditions responsible for primary osteonecrosis of the femoral head (corticotherapy).


[Interaction of salicyl compounds and other non-steroidal anti-inflammatory agents: pharmacokinetic study of phenylbutazone-aspirin combination in man]. The pharmacodynamic interaction between phenybutazone and aspirin was studied in 9 patients. The levels of phenylbutazone were estimated by gas-chromatography and verified by mass-spectrometry. When phenylbutazone was administered together with salicylates a decrease in the bioavailability of phenylbutazone was demonstrated, but there was no significant variation in the absorption and elimination constants or in the half-life. The variations were much less than those observed with other nonsteroid anti-inflammatory drugs (indometacine, naproxen, fenoprofen). These interactions must be taken into account in the long-term treatment of cases of inflammatory rheumatism.


Respiratory sinus arrhythmia in man: relation to cardiovascular pressures. The relationship of repiratory sinus arrhythmia (RSA) to the accompanying oscillations of cardiovascular pressures has been studied in five healthy subjects. Tidal volumes (VT) of 1.0, 1.5, and 2.0 1 at a breathing rate of 6 c-min(-1) were used as reference. With identical VT, oesophageal pressure was varied by negative inspiratory pressure (NIP) and intermittent positive-pressure ventilation (IPPV). Compared with control, NIP with 1.01 significantly increased RSA, the oscillations of brachial artery pressures (PBA), and the net filling pressures of the ventricles. IPPV did not significantly change the variations of PBA but reduced RSA and the repiratory variations of the right ventricular end-diastolic net pressure. During control breathing and with NIP the acceleration of heart rate during inspiration was associated with rising PBA and rising net filling pressures of both ventricles. The results indicate that RSA may be elicited by cardiovascular reflexes due to changes in venous filling of the heart rather than by the variations in systemic arterial pressure.


The importance of perfusate content of free fatty acids for dog kidney preservation. Forty-eight-hour preservation of dog kidneys utilizing continuous hypothermic perfusion was carried out in two groups of dogs. In the first group an albumin electrolyte solution with a high content of free fatty acids was used as perfusate. In the second group the perfusate contained the same components as the first solution except that the fatty acids had been removed from the albumin before use. After preservation, the kidneys were reimplanted, and contralateral nephrectomy was immediately performed. The renal function was measured by serial creatinine determinations. The postoperative renal function was significantly better in the group perfused with fatty-acid-rich perfusate. The results suggest that the level of free fatty acids in the perfusion solution is of importance for kidney preservation.


The effect of chlorhexidine mouthrinse on healing after gingivectomy. The purpose of this investigation was to evaluate the effect of 0.2% chlorhexidine gluconate mouthrinse following gingivectomy on plague under the dressing and on healing. Twenty-eight patients with indications for gingivectomy were selected. Coe-Pak was used as surgical dressing. In addition to unsual home care, the patients rinsed twice daily with chlorhexidine or placebo for 21 d after surgery. The study followed a cross-over double-blind design. Gingival exudate was assessed and Pl I and G I were registered at 7, 14, and 21 d postsurgically. The study indicated that chlorhexidine did not influence the amount of plaque under the dressing, and it was uncertain whether chlorhexidine had any effect on the healing process when the surgical area was covered by Coe-Pak. However, (1) after the surgical dressing was removed, the chlorhexidine maintained plaque scores at the same low level as under the dressing, (2) healing was was promoted when chlorhexidine was used, and (3) the presence of a dressing in one side of the mouth did not prevent the patient from maintaining good oral hygiene.


The immunosuppressive effect of extracorporeal irradiation of the blood using a portable 90Sr-90Y source and small transit doses. The immunosuppressive effect of extracorporeal irradiation of the blood (ECIB) using small transit doses (TD) over a long time period was studied. The blood of 15 uremic patients undergoing hemodialysis in preparation for kidney transplantation was treated with15-, 25-, or 41-rad TDs for a total of 150 h, using the beta-emitting radioisotope 90Sr-90Y. The number of blood volumes (BV) irradiated ranged from 159 to 265. The irradiation resulted in selective lymphocytopenia, but the effect on the immune response of lymphocytes, as measured in vitro with lymphocyte transformation tests, varied. Six kidney transplantations were performed resulting in rejection in two cases, one which was easily reversed and one with many rejection episodes, ending in death. Thus treatment with small TDs over long periods can reduce lymphocyte counts, but any subsequent immunosuppressive effect is uncertain. Our results do not support the hypothesis that such irradiation can influence the immune response of lymphocytes without destroying the cells.


Microvascular surgery. Techniques and applications in plastic surgery. Methods of anastomosing small blood vessels are presented, together with an account of the authors' own experiences in the field of microvascular surgery. Practical suggestions are made to avoid pitfalls. The modern literature on experimental and clinical applications of microvascular technique in plastic and reconstructive surgery is reviewed. An extensive bibliography is offered as an aid to the interested reader.


The Shaw abdominal flap.

The Shaw abdominal flap. The results of using 28 abdominal Shaw flaps (tubed axial pattern flaps based upon the inferior superficial epigastric artery and vein, are reported. One flap was totally lost and 4 partially. The cosmetic results have been acceptable. This type of flap will still be our method of choice, partly because it is easy to apply, but particularly because it facilitates placing the hand in a position of function.


Anastomosis of small veins with suture or Nakayama's apparatus. A comparative study. In controlled experiments, the posterior facial veins in the rabbits neck (diameter 1.5-2.0 mm) were repaired, either by manual suture with 10-0 nylon or by the use of Nakayama's ring pin stapler. The so-called Nakayama "animal" rings, made from metal alloy, as well as the "human" rings, made from tantalum, were employed. A Nakayama anastomosis was performed in only one-third of the time required to complete a suture anastomosis. Evaluation of anastomotic patency was carried out after 7 days, and the vessels were examined histologically in serial sections. Veins anastomosed by the Nakayama technique had a statistically significant lower rate of early thrombosis than the sutured veins, while no difference was found in the occurrence of late thrombosis. The histological analysis showed a perfect endothelium-to-endothelium coaptation in the Nakayama anastomoses, and endothelium covered the anastomotic site in one week. In suture anastomoses the histological picture was more complex, with disintegration of the layers of the vessel wall and hyaline degeneration betweeen sutures. The "animal" rings almost constantly caused local phlebitis, but these changes were not reflected in the patency rates at one week.


Isotope nephrography in the evaluation of renal transplant recipients. 131I-hippuren nephrography (renography) has proved valuable in the assessment of function in renal transplants. Acute rejection can be detected at an early stage and the response to intensified immunosuppression can be followed. Renal circulation and urinary flow can also be studied. Serial examinations are important for the evaluation of early changes.


Shall poorly HL-A matched cadaveric kidneys be transplanted or discarded? The study comprises 101 cadaveric kidneys transplanted in the last three years (1971-1974). Twenty-one retransplantations were included since the graft and patient survival in this group were equivalent to primary transplantations. There were 13 compatible grafts (A and B matches), 29 displaying one incompatible antigen (C match), 35 with two (D match) and 24 with 3 or 4 mismatches (E and G matches). At 9 months, there was a significantly lower graft survival in the E and G match group (33%) compared to the rest (p less than 0.01). For reasons discussed we will, however, for the first time being continue to transplant also the badly matched cadaveric kidneys.


Aspects on the diagnosis of ureteric complications following renal transplantation. Among 108 cadaveric renal transplantations serious complications from the ureter were found in 10%. Another nine cases showed abnormal urograms and scintigrams of doubtful significance. Some of these are discussed.


Rehabilitation of haemodialysis and transplant patients in denmark. An evaluation of the extent of rehabilitation of 159 haemodialysis patients and 36 transplant patients from 6 of the 9 Danish nephrological centers was carried out. Half of the patients experienced their working capacity to be severely reduced prior to treatment and the percentage did not change during treatment. At the time of interview 88 percent of the patients received full disablement support and only ten per cent had retained their previous vocational position.


Workshop report: how can immunology (except by tissue typing) improve the results of kidney transplantation. The aim of the workshop was to discuss the various methods currently available in (cellular) immunology which could be applied to the problems of clinical kidney transplantation. The areas considered in the Workshop were divided into three categories: 1. Methods for immunological diagnosis of rejection, 2. Assays for quantitation of the biological effects of immunosuppressive drugs and 3. Prospects of transplantation tolerance, enhancement and related phenomena in kidney transplantation. As regards to the first topic, several immunological methods (most notably in the fine needle aspiration biopsy and tests for macrophage migration inhibition) were reported to be in use for this purpose. No one of the participants had personal experience of the second topic of the agenda, and the results of Bach and co-workers on the use of the mouse T-rosette inhibition test for this purpose were discussed. Almost half of the allotted time was used to discuss the anti-idiotype antibodies and their potential use for transplantation tolerance in immunologically mature graft recipients. Some results of the human kidney graft enhancement experiments were also discussed in this section.


Avascular necrosis of the bone in 99 renal allograft recipients. Avascular necrosis of bone is a serious complication associated with steroid therapy in high dose. Ninetynine patients with functioning renal allografts transplanted 1964-1973 and subjected to steroid therapy were examined with regard to this complication. Osteonecrosis developed in 8 patients afflicting 13 joints. The process was localized to the femoral head, the condyles of the femur, tibia and the head of the humerus. The symptoms became manifest 7-33 months after the first transplantation. The severity of the disorder in 3 patients did not allow rehabilitation by conservative means. The roentgenographic, scintigraphic and clinical findings are described and the orthopaedic treatment discussed.


Changes in renin and blood pressure levels during renal transplantation. Early in the transplant program we experienced difficulty in maintaining the blood pressure after bilateral nephrectomy of a proportion of recipients receiving kidneys from living donors. To our surprise this problem was much less marked in the less prepared recipients with cadaver donors. It seemed possible that this could be related to our practice of preceeding transplantation with bilateral nephrectomy in the same session when the donor was alive, but not after necrotransplantation. A typical blood pressure chart from an operation combining renal transplantation with bilateral nephrectomy is shown in fig. 1. Even where there is no blood loss the systolic and diastolic blood pressure falls with the central venous pressure so that perfusion of the donor kidney is at first poor. As soon as perfusion is established however, the blood pressure rises.


Erythropoietin and renin after renal transplantation. Serum concentration of erythropoietin (EP) was measured with a hemagglutination inhibition technique and plasma renin activity (PRA) with a radioimmunoassay for angiotensin I in 26 renal transplant recipients 2-54 months after renal transplantation. In all patients, the EP values were significantly correlated with the levels of PRA (r = 0.76 p less than 0.001) and hematocrit values (r = 0.72, p less than 0.001). In one patient, erythrocytosis and high blood pressure associated with high EP and PRA levels disappeared after bilateral nephrectomy of his own kidneys. The results indicate an as yet unidentified relationship between the production of EP and renin.


Results in necrokidney transplantation to pair recipients. Attempting to find out whether universal kidney donors exist in the same sense as do universal blood donors this investigation was performed on donors and recipients in 45 pair transplantations, or in other words on 90 recipients transplanted with kidneys from 45 donors (G.S. 6 months). The result of pair transplantation was the same in the two recipients in 23 instances; 15 pairs had successful transplantations while the grafts failed in 8 pairs. In 22 pair transplantations the two recipients had different postoperative records. The mean age of the donors was 32 years, the mean age of the recipients 42. The donor age was lower in the successful pair transplantations than in the failures. The duration of cold ischaemia ranged from 6.6 to 9 hours in the different groups. The results of transplantation were not influenced by the duration of ischaemia. A higher degree of histocompatibility and a greater number of shared haplotypes were features typical of the successful cases. Moreover, antibodies occurred less frequently in connection with successful transplantations. Absence of shared halotypes and/or incompatibility in locus B had an unfavourable effect on the course of grafting. By contrast, the presence of blood group O in both donor and recipient and even in donor alone had a favourable effect. HLA-A2 occurred less frequently and A1 and B8 more frequently in donors whose grafts failed than in the donors of successful pair transplants. The question of whether a universal kidney donor exists could not be definitely answered on the basis of this investigation.


Plasma renin activity in the evaluation of hypertension in renal transplant recipients. Plasma renin activity (PRA) was measured in nine renal transplant recipients, seven of which had transplant renal artery stenosis. Surgical correction of the stenosed renal transplant artery was performed in six patients. After corrective surgery of the stenosed artery hypertension (mean arterial pressure before operation 156 mmHg) improved (mean arterial pressure postoperatively 110 mmHg) in four patients with high peripheral PRA (17.3+/-3.9 ng/ml. hr). Two patients, one hypertensive, the other normotensive with low PRA (1.5+/-0.05 ng/ml. hr) had no change in their blood pressure after corrective surgery. In three hypertensive renal transplant recipients the PRA of the venous effluent of the own kidneys and the renal transplant were studied selectively. Selective PRA determinations revealed the source of inappropriate renin secretion offering a basis for surgical management of the assocaited hypertension.


Gastrointestinal complications in 248 kidney transplant recipients. In 248 kidney transplant recipients, 28 (11%) developed serious gastrointestinal complications after the transplantation. Upper gastrointestinal bleeding was the most common complication and accounted for 19 of the cases. Most of the haemorraging occurred during the first 6 months after transplantation and in conjunction with an episode of graft rejection. The mortality following upper gastrointestinal bleeding was 58%. Other serious complications encountered were lower gastrointestinal bleeding (4 cases), perforation of the colon (4 cases) and mesenteric vascular occlusion (1 case). Overall mortality was 43%.


Renal transplantation in patients with insulin requiring diabetes and renal failure. During a six year period twelve patients with insulin dependent diabetes and end-stage renal failure received cadaveric kidney grafts. Eleven of the patients have previous to this been hemodialysed, one patient was transplanted before hemodialysis was necessary. The cumulative two year survival was thirty-seven per cent for the patients, and twenty-nine per cent for the kidney grafts. The average time of observation was eleven months, the motality was fifty per cent. The causes of death were acute myocardial infarction in two cases, sepsis in two cases, severe hypoglycemia in one case and unexpected sudden death in one case. The most prominent problems in the treatment of the diabetic patients after the renal transplantation were difficulties in the regulation of the diabetes, rejections, infections, cardiac failure and aggravation in pre-existing hypertension.


Gastro-duodenal bleeding after renal transplantation. In a retrospective study of 468 patients treated with renal transplantation in Gothenburg from 1965 to 1974, gastro-duodenal perforations and/or significant bleedings were seen in a frequency of 10%. While half of these complications were seen in patients without previous history of gastro-duodenal disorder, positive history of such disorder increases the risk of post-transplant complications significantly. These complications have proved to be highly lethal, expecially when occurring early after transplantation, whereas prophylactic surgery in predisposed patients has been well tolerated by the uremic patient and followed by decreased frequency of post-transplant gastro-duodenal complications. It is concluded that gastro-duodenal complications remain a major hazard to transplanted paitents, especially with a previous history of gastro-duodenal ulcer. This increased risk can be abolished by prophylactic gastric surgery on wide indications before transplantation.


Effect of prophylactic gastric resection on upper gastrointestinal (GI) complications in uremic and transplanted patients. Among 125 consecutive transplant recipients 10 (8%) demonstrated previous or present peptic ulcer and 9 underwent prophylactic gastric resection before transplantation. Two of these patients experienced upper GI complications in the posttransplant period and 1 died. Another 7 patients without previous dyspepsia had similar problem after transplantation and 4 died. Prophylactic gastric resection is recommended in potential recipients with pretransplant ulcer disease.


Lymphocyte subpopulations in uremics and in transplanted patients. In 30 chronically uremics, 37 renal transplanted patients and 31 controls, the number of T- and B-cells was calculated as well as the lymphocyte response to the mitogens PHA, Con A and anti-B2m. In uremics the relative number of T-cells was normal, the number of B-cells was reduced and the response to mitogens was suppressed. During the early post transplantation period the relative number of both T- and B-cells was reduced as well as the mitogenic response. Following three months of successful transplantation the relative counts of T-cells and the response to mitogens returned to normal. The relative number of B-cells remained lowered however.


Preliminary results with passive enhancement in human kidney transplantation. Passive enhancement was attempted with F (ab') 2-fragments in six patients receiving their first and in one patient the second one haplotype mis-matched kidney graft. Administration of enhancing antibody in the first graft patients seemed safe, the group was however too small to determine whether the enhanced patients did better than those conventionally treated. The only pre-sensitized patient who received his second transplant rejected it during the first week, possibly due to a deleterious effect of the F (ab') 2-fragments.


A clinical attempt to avoid hyperacute rejection by F (ab') 2 organ pretreatment. An attempt was made to, in a controlled study, avoid hyperacute rejection by pretreatment of a renal graft pepsine digested anti-donor antibodies. It turned out to be unsuccessful, but there were some indications that the chain of events that leads to the destruction of the graft was delayed for some hours. There may be several reasons for this failure but we think it is possible to improve this method even if its importance in clinical use is still doubtful.


A technique for rapid harvesting of cadaveric renal and pancreatic grafts after circulatory arrest. In Sweden, organs for transplantation can not be removed from cadaver donors until cardiac arrest has occured. We describe a technique for removal of kidneys and pancreas in which the whole abdominal contents are freed and reflected so that the retroperitoneal organ lie uppermost. The aorta is opened longitudinally and the relevant arteries are cannulated via the orifices. Cold perfusion of the three organs can usually be initiated 5-15 min after cardiac arrest and significant ischaemia is avoided. The full length of the vascular pedicles can be preserved and the dissection of the retroperitoneal organs is greatly facilitated.


Surgical treatment of lymphoceles.

Surgical treatment of lymphoceles. Ten patients with lymphoceles after kidney transplantation are reported. Seven were treated with intraperitoneal drainage of the lymphocele, performed through a midline incision laparotomy. The postoperative course was uneventful, symptoms disappeared within 1 week. We consider this as the treatment of choice when lymphoceles develop after renal transplantation.


Triple arteries in renal transplantation - a preliminary report. Kidneys with triple arteries were transplanted to seven recipients. As no problems related to the reconstruction procedure were experienced it was deemed justifiable to accept grafts with triple arteries.


Transplantation of a duct-ligated pancreatic allograft to a diabetic patient. A 52-year-old man with an extremely instable insulin-treated diabetes mellitus, were transplanted with a duct-ligated pancreatic segment from a brain-dead donor. The graft showed immediately a satisfying endocrine function. The blood glucose levels were normalized and no exogenous insulin was administered. After five days a clear fluid with high contents of protein and high concentration of amylase started to drain from the wound. The drainage ceased spontaneously after 30 days. On day 41 after transplantation, the function of the graft suddenly stopped. At exploration, the graft was found thrombotized but with a well preserved architecture, and the oversewn end of the graft was intact. The patient is back on insulin treatment, and he is in the same condition as before the transplantation.


The effect of chlorpromazine pretreatment on tubular function in kidney preservation. The effect of Chlorpromazine pretreatment on tubular function was investigated. Hippuran uptake in cortex slices from rabbit kidneys was measured after one hour of incubation in a medium containing Hippuran. Before measurement the kidneys were exposed to varying periods of warm ischaemia or/and cooled and preserved for 24 hours in Collins solution. Chlorpromazine treated and untreated groups of animals were compared, the results obtained were identical in both groups. In contra distinction to these findings, addition of Chlorpromazine to the incubation fluid inhibited uptake of Hippuran in the kidney slices. The effects of pretreatment with Chlorpromazine on the kidney function after ischaemic damage were demonstrated. Serum-creatinine and survival were compared in a treated and an untreated group after 3 hours of temporary clamping of the renal artery. Pretreatment resulted in earlier onset of function and better survival. It is concluded that the antimetabolic effect of Chlorpromazine is opposed to its vasodilatory properties is of little practical importance for the viability of the kidney damaged by ischaemia.


Pancreatic transplantation for diabetes mellitus. Discussion of indications and surgical technique with reference to 3 cases. Three patients reveived segmental pancreatic transplants. In two the main indication was hyperlabile diabetes, and in the third progressive loss of vision. Vascular anastomoses were to the iliac vessels, the graft being placed extraperitoneally. The pancreatic duct was ligated in the first case, while the other two, the transected end of the pancreatic graft was implanted into a jejunal Roux-Y loop. Two of the patients had normal blood glucose levels without insulin administration for 40 and 35 days, respectively. The grafts then underwent rejection and were removed. In both cases the postoperative course was complicated by pancreatic fistulae. In the 3rd patient the graft failed on the day after operation, due to venous trombosis.


Experimental renal preservation with glucose-free perfusate. Dog kidneys were preserved for 48 hours by hypothermic perfusion with either a glucose-rich or a glucose-free albumin perfusate. After reimplantation and contralateral nephrectomy renal function was assessed by serum creatinine determinations. The kidneys showed normal function and no difference between the two groups was found. The results suggest that glucose is of minor importance as a metabolic substrate for dog kidney preservation.


LDH release into perfusates of preserved kidneys. The measurement of lactate dehydrogenase (LDH) release into perfusates after hypothermic storage was found to be a reliable index of ischemic injury of rabbit kidneys. Kidneys were exposed to warm and cold ischemia for varying periods. Each kidney was perfused before and after storage at simple hypothermia with 25 ml of a modified Collins solution. The venous effuent was collected in 5 ml fractions. Total LDH activity was measured in the first fraction after storage and used as a measure of ischemic tissue damage. It was confirmed that increasing the period of cold ischemia result in significant increases in LDH activity. The release of LDH into perfusates was then used to compare kidney damage after preservation with various fluids. With this method, it was not possible to demonstrate any difference in the extent of tissue damage after preservation with sodium-rich vs. potassium-rich perfusion fluid. Addition of steroids, vitamins and essential amino acids did not prevent or reduce tissue damage, estimated in this way. The effects of adding cryoprotectants to the perfusion fluid varied; LDH release following addition of 5% DMSO was significantly greater, and after addition of 5% glycerol smaller than the release after perfusion with a modified Collins solution alone. Stepwise addition of DMSO up to 20% resulted in serious tissue damage with a large LDH release into the perfusate.


Periactin (cyproheptadine hydrochloride) as a supplement to the immunosuppressive treatment in human cadaver kidney transplantation. The effect of Periactin on the rejection course was examined in 36 kidney allograft recipients. Half of the patients were given 32 mg of Periactin daily as a supplement to the immunosuppressive treatment consisting of prednisone and azathioprine. The other half was given only the latter two medicaments. Rejection crises were treated with intravenous infusion with methylprednisolone. No beneficial effect of the Periactin treatment was demonstrable. Graft survival and kidney functions thus did not differ between the two groups within the first 90 days after the transplantation. The frequency of rejection, on the other hand, was significantly higher in the group treated with Periactin, especially within the first postoperative week. Periactin, apparently, does not offer any advantage as a supplement to the immunosuppressive treatment in human kidney transplantation.


Angiographic evaluation of renal allografts. In a material of 128 kidneys transplanted to 112 patients 361 angiographies have been carried out in early, as well as in late course. The method is a valuable tool in the diagnosis of rejection, particularly in the early posttransplantation period when the kidney does not function due to tubular necrosis. Angiography also has prognostic significance, and can therefore be of value when deciding if a graft should be removed or if continuous efforts should be made to save it.


Lung complications during immunosuppressive treatment in renal transplant recipients. Pulmonary complications among 77 renal transplant recipients have been analysed. In the immediate postoperative period complications occurred with the same frequency as after other operations. Later on, usually within 6 months, pneumonia caused by bacteria, Pneumocystis carinii, cytomegalovirus and fungi occurred. The lung changes may indicate the underlying infecting organisms. Mortality from pneumonia was 14% (11/77) including two patients with lung aspiration following emergency surgery. Pulmonary complications were significantly higher in men.


The use of both kidneys obtained from pediatric donors as en bloc transplants into adult recipients. Surgical technics for the excision and transplantation of paired renal graft from pediatric donors to adult recipients is described. Experience based on literature and on two own transplantations speaks for the adoption of this policy. The operation is technically advantageous. The double transplant provides a greater functioning renal mass as compared with the use of a single pediatric graft. In case of a rejection which can result in loss of some renal capacity, the double transplant is more likely to be able to maintain sufficient fuction even in adult recipients. The importance of a properly performed donor operation is stressed.


Artery steonsis in renal transplantation. Twenty-two stenoses were discovered at a re-examination of 958 routine angiographies of 367 transplanted kidneys. Two separate types of stenosis could be distinguished- a short one localized to the anastomosis appearing immediately after the transplantation, and a long one distal to the anastomosis appearing three weeks or more after the operation. Hypertension did not appear until the stenosis had reduced the vascular diameter more than 60%. Severe hypertension requiring reconstructive surgery was caused by the long type of stenosis more often than by the short one.


Effect of bromhexine and guaiphenesine on clinical state, ventilatory capacity and sputum viscosity in chronic asthma. Thirty-four patients, 21 male and 13 female, with chronic asthma and tenacious mucoid expectoration were studied regarding clinical parameters, PEF, airway resistance and sputum viscosity measured according to the n.m.r. method (nuclear magnetic resonance); a technique for determination of the water phase viscosity. Using double-blind cross-over technique, oral treatment with the two drugs and placebo was given during three consecutive 12-day periods with 48-h intervals free of test drug. No significant improvement in clinical state, PEF or airway resistance could be demonstrated. Nor did the sputum viscosity show any significant change after treatment with the different preparations. However, regarding the patients' own preference of drug as to mucolytic effect, a significant difference in favour of bromhexine at the 0.1% level was shown.


The risk of renal allograft rejection following angiography. In a retrospective study of 173 immediately functioning primary kidney transplants correlation between angiography and renal allograft rejection was studied during the first 14 days. Rejection was more frequent in kidneys undergoing angiography compared to those not angiographied. In kidneys undergoing angiography an overwhelming number of rejections started the day after angiography. These differences could not be explained by differences in HL-A matching or the origin of the kidney. The findings indicate that angiography might elicite an acute rejection. A possible mechanism for starting this reaction might be activation of the complement system.


Pedicle thoracoplasty and free skin transplantations in the treatment of open postpneumonectomy cavity after empyema. The method of covering the open postpneumonectomy pleural cavity with skin is used when closure of the thoracostoma is not possible. The operation is performed with pedicles and free skin transplantations. The results in 16 patients treated this way are presented. This method makes it possible to cover the whole open pleural cavity with skin and to reach a satisfactory postpneumonectomy state.


Perforation of the intrathoracic oesophagus. A report of nineteen cases. A series of 19 patients with perforation of the intrathoracic oesophagus is presented. Recent perforations were treated by primary suture. All these patients survived, although the suture did not hold in all cases. Old perforations, together with recent ones that leaked after suturing, were treated by drainage and gastrostomy. Two of these patients died; they were the only patients in whom the first attempt at drainage was unsatisfactory and thus had to be revised. The treatment of oesophageal perforations seems to be in accordance with the long-established principles of treatment of other gastro-intestinal and genito-urinary fistulas: firstly to restrict primary suturing to non-inflammatory tissue, and secondly to apply the principles of secondary healing by means of decompression and drainage.


Radiation load of kidney transplant recipients caused by radiodiagnostics. The radiation dose from diagnostic procedures was estimated for 79 kidney transplant recipients. The mean bone marrow does was 4.8 rad, the mean gonad dose for men 16.5 rad, and for women 5.6 rad. A dose of this magnitude has no obvious immunological effect, whereas a canserogenic and a genetic effect must be taken into consideration.


Gamma-camera scintigraphy and renal angiography after transplantation. Gamma-camera scintigraphy with a 99Tcm-Fe-ascorbic acid complex was used routinely to study the graft in the course of kidney transplantations. Renal angiography was only performed when judged to be necessary for the evaluation of present complications. For comparison, between the findings obtained on the same clinical occasion by scintigraphy and angiography respectively, 39 angiographical studies were available. Early after transplantation scintigraphy better than angiography appeared to predict a poor prognosis of the graft. Both methods were able to detect major vascular occlusions. For the study of the renal vessels during a course of chronic rejection it was necessary to perform angiography as also for e.g. the recognition of renal artery stenosis or an arterial aneurysma.


Advances in the management of parkinson's disease. The treatment of Parkinson's disease today is complex, time-consuming, but rewarding. The introduction of levodopa has not cured the disease, but has provided the most powerful therapy available yet. Its use is limited by side effects and careful titration to optimum dosage, often in combination with other drugs, is required. Despite best therapy, some patients never respond, and others begin to lose benefit after some years of therapy. New problems, such as the "on-off" effect have appeared with long-term treatment, and require careful adjustment of dosage. As with any replacement therapy, a balance between sub-optimal benefit and side effects has to be discovered and maintained by careful and frequent review. New approaches to treatment may offer further improvement in the near future.


Human malaria parasites in continuous culture. Plasmodium falciparum can now be maintained in continuous culture in human erythrocytes incubated at 38 degrees C in RPMI 1640 medium with human serum under an atmosphere with 7 percent carbon dioxide and low oxygen (1 or 5 percent). The original parasite material, derived from an infected Aotus trivirgatus monkey, was diluted more than 100 million times by the addition of human erythrocytes at 3- or 4-day intervals. The parasites continued to reproduce in their normal asexual cycle of approximately 48 hours but were no longer highly synchronous. The have remained infective to Aotus.


Dental evidence on the origins of the Ainu and Japanese. New dental anthropological evidence on the questions of Ainu and Japanese origins illustrates the utility of diachronic dental information obtained from skeletal populations for microevolutionary and human origins investigations. Data from skeletal and dental collections of Shang Dynasty Chinese and from Jomon period and recent Ainu Japanese, together with information on recent Japanese dentition from published accounts, indicate a correlation between the ancient Chinese and modern Japanese and between the prehistoric Jomon people and the Ainu.


Concepts and clinical utility of the measurement of cerebral blood flow. Within the past several decades, techniques that accurately measure regional cerebral blood flow have been developed. At the present time, the inert gas washout technique using an intraarterial injection of 133Xe with the Anger scintillation camera or multiple probes as the external detector is the most established of these methods. While quantitative measures of cerebral blood flow have been important in elucidating the physiology of cerebral hemodynamics, the techniques are too invasive for routinely screening patients with cerebrovascular disease. As a result, less invasive methods have been sought for diagnostic screening. Because it requires only an intravenous injection of 99mTc-pertechnetate, the radionuclide cerebral angiogram has achieved some popularity as a semiquantitative measure of cerebral hemodynamics, particularly when coupled with static brain scintigraphy. This review examines our current understanding of cerebral hemodynamics and the advantages and limitations of techniques used to measure cerebral blood flow.


Radioactive tracers in peripheral vascular disease. The use of radioactive tracers in the diagnostic and therapeutic evaluation of the patient with peripheral arterial or venous disease has proven to be clinically useful. Their application has provided a means by which the regional distribution of perfusion at the level of the microcirculation, at rest and under various stresses, can be assessed. Graft patency can be determined simply and repeatedly, and the relative perfusion of "ischemic" ulcers can be used to assess their healing potential. The presence of arteriovenous shunts can be verified, localized, and quantified. Venous thrombi can be detected, and the competence of the venous valvular system and muscle pump as well as the hemodynamics of the venous system can be quantified.


Betamethasone dipropionate ointment in the treatment of psoriasis and atopic dermatitis: a double-blind study. This report describes the use of a new corticosteroid ointment in the treatment of psoriasis and atopic dermatitis. It further summarizes the results of treatment with the active medication versus the vehicle alone in these two disease categories. In the group with psoriasis 13 of 17 patients (76.4%) treated with the active drug showed either excellent or good clinical response (50% to 100% improvement) in three weeks. Five of 16 patients (31.2%) treated with the placebo showed excellent or good response. In the group with atopic dermatitis 16 of 17 patients (94.1%) treated with the active drug showed either excellent or good clinical response (50% to 100% improvement) in three weeks. Two of 16 (12.5%) treated with the placebo showed excellent or good response.


The embryology and management of vascular rings. Among 34 patients with vascular rings, symptoms of tracheal and esophageal compression or both occurred during the first six months of life in 24 (71%). Diagnosis was made in all cases on either plain x-ray film or esophagogram, and was confirmed by operation or angiogram. Associated defects were numerous, with ventricular septal defect (5) and Down's syndrome (3) most common. Operative intervention was required in 18 cases (53%), including 12 of the 14 double arches. Only one of the ten patients with symptomatic recurrent subclavian artery underwent operation. Fourteen of the 18 patients operated upon had early total relief of symptoms, and 17 had excellent late results. A simple system for describing the embryology of vascular rings is presented, and the embryologic relationship between vascular rings and interrupted aortic arches is described. Because of frequent delay in recognition of vascular rings and other surgically correctable lesions, the work-up of every child with two or more episodes of pneumonia should include barium swallow.


Necrotic arachnidism.

Necrotic arachnidism. Ten bites by Loxosceles reclusa, the North American brown recluse spider, are reported from South Carolina. Envenomation by the brown recluse spider is becoming a public health problem in the United States. The spider reportedly now is found from coast to coast in the southern half of the country and its range is probably increasing. The spider bite varies in intensity, causing reactions ranging from an area of severe necrosis to a mild cutaneous reaction. Treatment is unsatisfactory, and no antivenom is currently available. Even though a specific test is available for loxoscelism, diagnosis remains difficult.