Intra-species tranduction with Proteus mirabilis high frequency transducing phages. The properties of three additional Proteus mirabilis hosts for the high frequency transducing (HET) phages 5006MHFTkappa and 5006MHFTak are described. The phages transduce resistance to kanamycin and to ampicillin plus kanamycin, respectively, and were produced by ultraviolet induction of derivatives of P. mirabilis strain PM5006. Strain PM804 could not be shown to adsorb the phages although it yielded a few transductants. All transductants, even those produced at low multiplicities of phage input were lysogenic and segregated markers at high frequency.  Ultraviolet induced phage lysates of these transductants transduced PM804 at higher frequencies and PM5006 at lower frequencies than the original phages. Strain PM804 or its derivatives did not adsorb phage from these lysates. Tranmission experiments through PM5006 of phage in the transductant lysates confirmed that PM804 had a host-controlled modification system which modified HFT phage from PM5006. That PM804 also possessed a restriction system was inferred from the greater numbers of transductants obtained with page which bore a compatible modification pattern. Strain N and a restrictionless mutant of it named NHI, adsorbed the HET phages avidly and failed to modify their host range. Transduction frequencies of the phage markers were about 10(-4)/p.f.u. adsorbed to strain NHI and only about tenfold lower to strain N which did not plate the phages. Tranductants also had the features of heterogenotes and those obtained at low multiplicites of infection were non-lysogenic. The latter transductants adsorbed homolgous phage while NHI transductants also plated the HFT lysates. Strain NHI, lysogenized by the parent phage 5006M, did not adsorb the HFT phages. These findings suggest that the HFT phages were most likely defective for lysogenic conversion to homologous phage non-adsorption. The postulated restriction enzymes of PM804 and strain N could not be shown to be thermolabile.


A taxonomic study of the genus Haemophilus, with the proposal of a new species. A collection of 426 Haemophilus strains isolated from people with infectious diseases and from the normal flora of mucous membranes in humans and various animal species was studied in an attempt to revise and improve the taxonomy of the genus Haemophilus. The examinations included the determination of a number of biochemical and physiological properties, of which several had not previously been applied to the taxonomy of haemophili. The resulting data reavealed many hitherto unrecognized characters of taxonomic significance and several of the species can now be more accurately defined. The classification presented is supported by the DNA base composition of a large number of representative strains. A  diagnostic key to the different taxa is presented. Haemophilus influenzae and H. parainfluenzae have been subdivided into a number of biotypes. It is possible to demonstrate a relationship between the individual biotypes of H. influenzae and the origin of the strains assigned to them. The results indicate that H. aegyptius, H. parahaemolyticus and H. paraphrohaemolyticus do not merit specific status. Four unnamed taxa of V-factor-dependent haemophili have been recognized. The name Haemophilus segnis is proposed for one of these taxa, which consists mainly of strains isolated from the human oral cavity. It is demonstrated that the name H. Ducreyi has been used for different groups of bacteria, and that only one of these groups can legitimately be assigned to the genus Haemophilus. Haemolytic V-factor-dependent strains from swine, previously included in H. parahaemolyticus, are significantly different from strains of human origin and should be named H. pleuropneumoniae. None of the strains from swine and fowls were haemin-dependent. The relationships of these strains to the species H. suis and H. gallinarum, and to H. parasuis and H. paragallinarum are discussed. Haemophilus piscium is shown not to belong to the genus Haemophilus. The taxonomic position of H. aphrophilus is uncertain and its possible relationship to Actinobacillus actinomycetemcomitans requires further study. The positive correlation found between the ecology of the strains studied and their affiliation with the different taxa is discussed.


Studies on phage internal proteins: formation of internal protein - T2 DNA complexes in vivo. Internal proteins, synthesized in T2-infected Escherichia coli B cells were recovered from bacterial membranes during the early stages of infection. Approx. 15 min after the onset of infection, T2 and T4 internal proteins were released from the bacterial membranes and sedimented along with newly synthesized phage DNA. Internal protein-DNA complexes were also obtained by chromatography on hydroxylapatite columns. Internal proteins were not released from bacterial membranes after infection with amber mutants defective in genes 21, 22 and 23. It has been suggested that these complexes are intermediates in T-even phage morphogenesis.


Effects of the phage P1 restriction system on coliphage phi W: degradation and complex formation of phage phi W DNA. Growth of phages phi W and T7 was restricted in Escherichia coli lysogenic for phage P1. Only a fraction of the infected cells gave burst of phages. Cells permitting phage growth gave normal burst size. Host strains carrying P1 mutants with defective endonuclease gave no restriction of phages T7 and phi 3, the latter a host-range mutant of phi W. Degradation but not modification of parental phage DNA could be demonstrated. Although no DNA, RNA or protein was synthesized in phi W infected P1 lysogenic cells, the parental phage DNA was found in increasingly larger complexes during the course of infection. At early times after infection, parental phage DNA was found to sediment about twice as fast as mature phage DNA. At later times during the infection the parental phage DNA was recovered as a very rapidly sedimenting material. Such material was also found in alkaline sucrose gradient centrifugation after treatment of the cell extract with sodium dodecyl sulphate, pronase digestion and phenol extractions.


A comparative study of art expression of schizophrenic, unipolar depressive, and bipolar manic-depressive patients. The literature on art productions from psychiatric patients consistently suggests that specific graphic characteristics distinguish among various major diagnostic groups. These hypothesized differences are summarized. Systematic collection of art productions as part of separate research programs studying affective psychoses and schizophrenia has enabled us to amass a collection of psychotic patients' drawings which are used in an attempt to evaluate these hypotheses empirically. Art sessions were held with 104 patients hospitalized for affective psychoses and with 62 patients hospitalized for acute schizophrenia at NIH's Clinical Center. Comparing these drawings across diagnostic groups revealed, to our surprise and contrary to extant hypotheses, considerable within-diagnostic group variability and between-group overlap. There were, nonetheless, some trends in the hypothesized directions. These differences, however, disappeared when comparisons were made on a subsample of age-matched patients. This discrepancy between this research and expectations based on the literature is discussed. Our studies indicate that pictorial characteristics are not closely associated with diagnosis. We have, however, found that individual patient's art productions, and their associations to the pictures, are of great value in arriving at a dynamic understanding of the patient, regardless of diagnosis.


Post-detoxification drug treatment of anxiety and depression in alcohol addicts. A study was undertaken to assess the effectiveness of treating alcoholics after detoxification for the very commonly observed syndrome of anxiety, depression, and somatic complaints. Previous studies had indicated that these patients generally respond quite well to drug treatment with the phenothiazine class of drugs. However, a double blind placebo-controlled study of adequate size had not been undertaken. Forty-five comparably addicted male alcoholics with anxiety or mixed anxiety-depression from an inpatient alcohol treatment ward comprised the treatment group. Twenty-three patients received thioridazine treatment and 22 received placebo treatment in a double blind fashion after acute withdrawal from alcohol. Progress over a 4-week period was measured with standard rating instruments--the Hamilton Rating Scale for Depression (by physician) and the Zung and Lipman Self-Rating Scales. Both placebo and active medication groups improved symptomatically during the 4-week program. The thioridazine group had significantly better improvement in sleep disturbance (early, middle, and late insomnia) than the placebo group. There was also significantly better improvement in anxiety with thioridazine as compared with placebo. Interestingly, the placebo group had significantly better work and activity (as appraised by the ward physician) than the thioridazine group. The authors note that active drug effect might actually hamper some patients in their rehabilitative effort, especially if phenothiazines of the more sedating variety are used. Since alcohol rehabilitation generally utilizes a wide range of activities (such as didactic sessions, occupation therapy, group therapy), alertness and performance ability appear to be important factors in the rehabilitation program. Although thioridazine treatment for some patients with anxiety and insomnia would appear to be quite helpful, its blanket use for the post-detoxification anxiety-depression of the alcoholic might be detrimental for others and cannot be recommended as a routine treatment strategy in an alcohol rehabilitation program.


Two minute slope inhalation technique for cerebral blood flow measurement in man. 1. Method. The two minute slope method of measuring cerebral blood flow (CBF) by inhalation of 133Xe is described. It requires the subject to remain still for only two minutes and is thus applicable to a wide variety of patients and to investigations involving brief physiological stimuli. The influence of extracerebral blood flow on CBF calculated by this method has been studied. Results from the two minute slope inhalation method using two minutes of data correlate well with those obtained by carotid injection using either two minutes or 10 minutes of data.


Two minute slope inhalation technique for cerebral blood flow measurement in man. 2. Clinical appraisal. The two minute slope technique for measuring CBF was devised primarily to study the response of the cerebral circulation to physiological stimuli. In this paper, measurements of the precision of the technique when applied to various groups of people are described, and measurements on normal subjects of the global and regional CBF changes in response to hyperventilation and hypercapnia are presented. It is shown that CBF measured using this technique during percutaneous carotid compression may prove useful in the prediction of cerebral ischaemia in patients who are candidates for carotid ligation.


Bromocriptine treatment in Parkinson's disease. Thirty-one patients with Parkinson's disease were treated with the ergot alkaloid bromocriptine, a drug which stimulates dopamine receptors. Bromocriptine had a slight therapeutic effect in patients on no other treatment and an additional effect in patients on levodopa. The mean optimum dosage of bromocriptine, established over a 12 week period, was 26 mg daily. In 20 patients bromocriptine was compared with placebo in a double-blind controlled trial. Active treatment caused a significant (P less than 0.02) reduction in total disability and akinesia scores. The least disabled patients showed the greatest response. Side-effects of bromocriptine--nausea, vomiting, hallucinations, and abnormal involuntary movements--were similar to nature to those of levodopa. In most normal subjects, bromocriptine causes an increase in plasma growth hormone concentration. This was determined in 20 patients with Parkinson's disease after 1-15 mg bromocriptine. Only a single patient showed an obvious increase up to 120 minutes after dosage. Bromocriptine was not effective treatment in two patients who had not previously responded to levodopa and replacement of this drug by bromocriptine in patients with end-of-dose akinesia after chronic levodopa treatment did not totally abolish response swings.


Multiple sclerosis and cell-mediated hypersensitivity to myelin A1 protein. Cellular hypersensitivity to myelin basic (A1) protein was evaluated using the MIF assay in 246 subjects. Of 100 with multiple sclerosis positive results are seen in relationship to acute exacerbations of illness. Normal control subjects gave a mean value of 100 +/- 9% whereas patients studied within 4 weeks of onset of illness gave a result of 59 +/- 12.5%. A convalescent group studied between 5 and 12 weeks after an attack gave results of 86 +/- 22.2%. A chronic group gave a mean of 91 +/- 8.2%. Positive values were also seen in a number of other patients with central or peripheral nervous system disease especially those with "autoimmune disease". However, results of this study clearly establish a temporal relationship between in vitro evidence of hypersensitivity to A1 protein and clinical expression of disease.


Studies to improve fixation of human nerves. V. Effect of temperature, fixative and CaCl2 on density of microtubules and neurofilaments. Utilizing morphometry of electron micrographs of nerves of rat fixed with different schedules of fixation it was concluded that: irrespective of the fixative, fixation at low temperature is associated with markedly low densities of microtubules (MT) of myelinated and of unmyelinated fibers; of the various fixatives tested 2% glutaraldehyde in 0.1 M cacodylate buffer without 0.025 M CaCl2 was associated with the highest density of MT of myelinated fibers and the addition of 0.025 M CaCl2 to a 2% glutaraldehyde fixative solution is associated with abnormally low densities of MT in myelinated and unmyelinated fibers. An effect of temperature, fixative and added CaCl2 on neurofilaments density was not demonstrated. Using the criterion of density of MT and assuming that these studies on rat nerves can be applied to biopsied nerve of man, fixation of human nerves should be at room or body temperature, and the fixative solution should not contain 0.025 M CaCl2.


Juxtasellar hyperostosis of non-meningiomatous origin. Seven patients are described who had juxtasellar hyperostosis with visual disturbance secondary to non-meningiomatous lesions. Two had chromophobe adenomas, one craniopharyngioma, one carcinoma of the sphenoid sinus, one a thrombosed aneurysm of the intracavernous portion of the internal carotid artery, one epidermoidoma of the orbit, and one chondroblastoma of the anterior clinoid process. The diagnosis of meningioma was entertained initially on the basis of hyperostosis plus visual impairment. Careful evaluation of hyperostosis is essential for correct diagnosis of meningioma, according to our experience. Suprasellar meningiomas almost invariably produce irregular hyperostosis of the planum sphenoidale, often associated with serration and blistering. Sphenoid meningioma, when it is sclerotic, always shows thickening or expansion of the sphenoid wings. Therefore, in the absence of typical meningiomatous hyperostosis, one can readily differentiate non-meningiomatous hyperostosis from true meningioma.


Long-distance transmission of digital scintillation camera signals. A system is described for the long-distance transmission of digital positional information from a scintillation camera to a computer through a shielded multiple-twisted-pair cable. Data errors caused by noise induction along the cable are completely eliminated. The operation of the complete interface and its routine testing are described.


Masticatory function - a review of the literature. III. Masticatory performance and efficiency. A review and evaluation of the literature on mastication has been undertaken. Part I discusses the form of the masticatory cycle in the natural and artificial dentitions, including the controversial question of whether tooth contact occurs during function. Part II reviews the literature concerning the speed of movement of the mandible, rate of chewing, and the forces developed in chewing. Part III describes masticatory efficiency and performance, the effect of food on masticatory function, and incorporates a summary of all these three papers.


Antiarthritic properties and unique pharmacologic profile of a potential chrysotherapeutic agent: S K & F D-30162. SK&F D-39162, a potential chrysotherapeutic agent, on oral administration was effective in suppressing the development of inflammatory lesions and 7S anti-sheep red blood cell antibody formation in adjuvant arthritic rats. Oral absorption of SK&F D-39162 was indicated by the presence of serum gold levels. In contrast to orally administered SK&F D-39162, gold sodium thiomalate administered intramuscularly at equivalent gold doses, appeared to be less effective in suppressing the primary and secondary lesions of adjuvant arthritis, produced relatively higher levels of gold in both serum and kidneys and produced marked toxicity. Other pharmacologic properties of SK&F D-39162 distinguishing it from gold sodium thiomalate which may have clinical significance include potent inhibitory activity on antibody-forming cells, immediate hypersensitivity reactions and extracellular release of lysosomal enzymes. In further contrast to gold sodium thiomalate, SK&F D-39162 is not a potent inhibitor of sulfhydryl group reactivity. In pharmacokinetic studies, the daily oral administration of SK&F D-39162 to normal rats produced greater stability of blood gold levels and less kidney gold accumulation than parenterally administered gold sodium thiomalate.


An analysis of the mechanism of local anesthetic inhibition of platelet aggregation and secretion. Aggregation induced in human platelets by thrombin (TH), collagen (COLL) or the Ca++ ionophore, A23187, was blocked by dibucaine and tetracaine. COLL-induced aggregation was blocked at lower concentrations of anesthetics (0.01-0.5 mM) than TH- or A23187-induced aggregation (0.2-2.0 mM). The rate and magnitude of the release of adenosine diphosphate, Ca++ and serotonin was also decreased by anesthetics. Secretion due to COLL, but not to TH, required extracellular Ca++ and was accompanied by increased uptake of 45Ca which was inhibited by local anesthetics. A23187-induced secretion was partially dependent upon external Ca++ and was accompanied by increased 45Ca uptake. Anesthetics increased 45Ca uptake when added before, but not after, A23187. This effect can be explained by postulating that the anesthetics prevent the release of an internal pool of Ca++, thereby affecting the Ca++ gradient between platelet cytoplasm and extracellular fluid. Platelets degramulated, but not aggregated, by exposure to TH in the presence of ethylene glycol bis(beta--aminoethyl ether)-N, N'-tetraacetic acid and plasmin were isolated by sepharose gel filtration. Such platelets did not aggregate with COLL or TH, but did aggregate with A23187-an effect blocked by local anesthetics. Thus platelet aggregation and secretion are independent Ca++-requiring processes, each of which is inhibitable by local anesthetics, presumable by blocking Ca++ influx or the mobilization of intracellular Ca++ stores.


[How the circannual sexual cycle of the malefield vole is determined (author's transl)]. Experiments were carried out on male field voles which have been captured in January. The resting sexual state of the animals at this time was determined by examination of the testis and of the genital tract during unilateral castration or by exploratory laparatomy. They were subsequently bred for 30 days in a climatic room, during which time they were fed on winter or spring grass, which has been preserved by freezing. 10 It was observed that a complete return to full sexual activity (from the winter resting state) could be produced by ad libitum winter feeding, provided that the minimum daily intake for each animal was 25 g of fresh forage (80% water content). This effect occured equally well, at constant temperature, in darkness and under natural lighting. The testicular development thus obtained was as important as the one which was observed in wild animals captured in the fields in March. 20 Neither the quality of the forages, nor variation in temperature or photoperiodism had any direct effect on the seasonal sexual cycle at critical periods winter and spring. 30 A caloric restriction of 25 to 35% in the ration inhibited the sexual development. 40 It is suggested that the circannual reproductive cycle of the vole is determined by the decrease in the quantity of food which is available in the fields in winter, and by its increase in spring. The water content of grass influences the intake.


Plasma and pituitary levels of LH in field voles, Microtus arvalis, reared under two different photoperiods. 10 Plasma LH levels were measured in voles reared under long (15 L: 9 D) or short (10 L: 14 D) light photoperiods by radioimmunoassay from a Rat LH-Anti Ovine LH system. 20 The number of animals exhibiting a detectable LH level (i.e. greater than 1 ng per ml) and the mean plasma LH values were higher for long days than for short days in spite of a very large variability between animals. 30 The sensitivity of the hypophysis towards LH. RH increased after gonadectomy, but is not controlled by the daily length of the light photoperiod even in the castrated animals.


Detection of blood pressure in general practice screening or case finding? An attempt has been made to show that there is still a need to evaluate screening for moderate hypertension (i.e. diastolic blood pressure equal or above 110 mm Hg). At present it has not been satisfactorily shown that treatment reduces mortality and morbidity. It is suggested that in the meantime individual general practitioners can be encouraged to find cases and that this method is probably the most suitable for identifying patients with diastolic blood pressure levels above 110 mm Hg (diastolic IV).In addition it has been indicated that at present we have little knowledge about how to make treatment acceptable and that this in itself needs further study. The question has also been raised as to who will do the work of screening and treating, and whether those earmarked to do this will find it acceptable. Finally, the need for accurate costing of the benefits and disadvantages before the wide-scale implementation of a screening service has been discussed.


Reduction of serum cholesterol and blood pressure in hypertensive patients by behaviour modification. In a pilot study, 14 pharmacologically treated hypertensive patients were given training in psychophysical relaxation exercises, reinforced by biofeedback instruments, for six weeks. The patients were asked to practise twice a day and also incorporate the exercises into everyday activities. In spite of their unchanged drug schedule, their mean blood pressure (B.P.) was reduced from 170.6/102.5 to 147.9/89.14 (P = < .001) while their mean (+/- S.D.) serum cholesterol level was reduced from 241.6 +/- 39.19 to 217.1 +/- 38.12 mg/100 ml (P = < .001). I believe the possibility of one therapy which can reduce two risk factors at the same time should be explored further in a controlled study.


Structural and functional abnormalities in the sex organs of male offspring of mothers treated with diethylstilbestrol (DES). The in utero effects of DES (Diethylstilbestrol) on the human male genital tract are reported in this follow-up study of male offspring of DES-treated mothers. Both anatomical and functional abnormalities were significantly greater in the DES-exposed males as compared to control males whose mothers were all participants in a prospective, randomized double blind study of the effects of DES on pregnancy at the Chicago Lying-in Hospital during the early 1950s. Epididymal cysts, hypotrophic testes and capsular induration of the testes were among the more common genital lesions found in 27% of 134 DES-exposed males as compared to a 7% incidence in 119 control males. Spermatozoa analyses revealed severely pathologic changes (Eliasson score greater than 10) in 29% of 28 DES-exposed males and 0% of 18 control males (with or without genital i.e., physical abnormalities). Abnormal findings on physical examination combined with sperm abnormalities (Eliasson score greater than or equal to 5) were found in 29% of DES-exposed males versus 0% of 18 control males. Cytologic examinations did not reveal malignant cells from the following materials: urines before and after prostatic massage or ejaculation, prostatic fluids and aspirates from epididymal cysts.


Endocoagulation: a new filed of endoscopic surgery. Pelviscopy was predominantly concerned with diagnostic procedures until recent years. Modern electronically controlled coagulation instruments, such as the crocodile forceps and the point coagulator, permit the application of destructive heat without any risk of electric current within the abdominal cavity. The electronically regulated apparatus for these coagulation instruments is the Endo-Coagulator, which indicates the coagulation temperature optically and acoustically. The endocoagulation technique opens a new area of operative gynecology. In the field of sterility operations, adhesion cuttings and the treatment of endometriotic and juvenile ovarian cysts, the application of modern endocoagulation has reduced the frequency of laparotomy by about 30% to 40%.


Recent advances in semen preservation.

Recent advances in semen preservation. While the horizons for cryobiology may be bright and granted, tremendous strides have been made in the area of artifical insemination(AI), it is evident that only dairy cattle AI with frozen semen has achieved industrial application. Beef cattle AI has been hampered by the lack of suitable techniques for oestrous control. However, with the advent of prostaglandin F2alpha, it may now be possible to make the genetic progress which has been accomplished through AI in dairy cattle. Genetic progress through AI is possible in all far species but the overriding influence has to be economic...


Gastric mucormycosis and moniliasis in an unimmunosuppressed pig following renal transplantation. Gastric ulcers frequently complicate experimental surgery in the pig. This report concerns a super-infection of such an ulcer with fungi of the Mucor and Candida groups.


Structure-activity relationships in luteinizing hormone-releasing hormone. Three analogs of luteinizing hormone-releasing hormone (LH-RH) of the structure less than Glu-His-Trp-Ser-Tyr-Gly-Gly-Leu-Arg-Pro-Gly-NH2, involving substitutions inpositions 1, 3, and 8 with nonprotein amino acids, have been synthesized by the solid-phase method. They are [pyro-L-alpha-(1-aminoadipic)]-LH-RH, [3-(2-naphthyl)-L-Ala3]-LH-RH, and [delta-N-i-Pr-L-Orn8]-LH-RH. Their LH-RH activities in vivo were 12.5, 51.8, and 3.7% that of LH-RH, respectively, in the assay using ovariectomized, estrogen- and progesterone-treated rats. In a test based upon subcutaneous injection into immature male rats, [3-(2-naphthyl)-Ala3]-LH-RH released 1.2 times as much LH and 0.8 times as much FSH as synthetic LH-RH.


3-Cyanocephems, and carbon-3 heterocyclic-substituted cephems via 1,3-dipolar cycloadditions. The transformation is described of 3-formylcephem 1 into its oxime, substituted oximes, and substituted hydrazones and, thence, into the 3-cyano, 3-diazomethyl, and 3-oxonitrilomethyl derivatives. These reactive 1,3-dipoles undergo 1,3-dipolar cycloadditions with various dipolarophiles to give C-3 heterocyclic-substituted cephems.


Alterations in small-bowel microflora in acute intestinal obstruction. Small-bowel content was examined bacteriologically whilst fresh and after storage for 24, 48, and 72 h in a modified Stuart's medium. There was little alteration in the viable count of individual intestinal organisms. For accurate quantitative analysis, 0-3 ml of intestinal content was enough. Specimens of small-bowel content were obtained by needle aspiration, and a qualitative and quantitative study was made of the microflora of patients with acute intestinal obstruction and of a control group of patients. Results in the control group confirmed the findings of the results of intubation studies by other workers, that a quantitative gradient of aerobic and anaerobic organisms exists from jejunum to distal ileum. In acute small-bowel obstruction and acute large-bowel obstruction there was a loss of the normal gradient and an increase in the absolute numbers of organisms present; this was particularly marked for anaerobic organisms in large-bowel obstruction.


Preparation of vascular endothelium for scanning electron microscopy: a comparison of the effects of perfusion and immersion fixation. A comparison of currently used methods of tissue fixation for scanning electron microscopic study of vascular endothelium revealed that in situ fixation by intravascular perfusion is superior to immersion for the preservation of endothelial surface morphology.


Frequency of insertion-deletion, transversion, and transition in the evolution of 5S ribosomal RNA. The problem of choosing an alignment of two or more nucleotide sequences is particularly difficult for nucleic acids, such as 5S ribosomal RNA, which do not code for protein and for which secondary structure is unknown. Given a set of 'costs' for the various types of replacement mutations and for base insertion or deletion, we present a dynamic programming algorithm which finds the optimal (least costly) alignment for a set of N sequences simultaneously, where each sequence is associated with one of the N tips of a given evolutionary tree. Concurrently, protosequences are constructed corresponding to the ancestral nodes of the tree. A version of this algorithm, modified to be computationally feasible, is implemented to align the sequences of 5S RNA from nine organisms. Complete sets of alignments and protosequence reconstructions are done for a large number of different configurations of mutation costs. Examination of the family of curbes of total replacements inferred versus the ratio of transitions/transversions inferred, each curve corresponding to a given number of insertions-deletions inferred, provides a method for estimating relative costs and relative frequencies for these different types of mutations.


The use of sex therapy in a patient with penile prosthesis. An implantable penile prosthesis is being used for treatment of erectile organic impotence. A patient treated in this manner required additional therapy for the maladaptive processes in the relationship. Sex therapy including supportive psychotherapy, sex education, relationship therapy, and behavior modification was ultilized for the relationship. This therapy is compatible with the penile prosthesis and may be imperative for some patients


Salvage of complicated open fractures by transfixation. The use of a commercially available Reduction-Retention apparatus for transfixation of nine cases of open fractures with severe soft-tissue damage is reported. Seven patients are walking, two with drop foot braces. Two required amputations, one because of infection and the other because he had suffered severe vascular injury. These two are walking on protheses and are able to work. Of the other seven, five have returned to their previous occupations; one is receiving a disability pension and the other is awaiting further surgery. The problems and advantages of this method of treatment are discussed.


Experience in the application of porcine xenografts to split-graft donor sites. We have described our experience in the treatment of 336 donor sites with porcine xenografts. We have found this technique simple and quick for achieving rapid healing of these donor areas in burn patients, trauma patients, granulating ulcer patients, patients with carcinoma, patients with crossed-leg flap procedures, and other reconstructive surgery cases, and in practically all of these excellent healing occurred within an average of 12 days. The exceptions have been described. It is the authors' feeling that this modality of donor site care is of the greatest significance and a great advance over previous techniques. It minimizes the previously required care of these donor areas and significantly has reduced the associated pain and distress which skin-graft patients have suffered in the past. In the few instances in which the lyophilized porcine xenograft was used, it was our impression that these grafts did not adhere to the donor site as well and did not have the hemostatic effect of the fresh-refrigerated or fresh-frozen porcine xenografts.


Discontinuity of the spinous process on standard roentgenographs as an aid in the diagnosis of unstable fractures of the spine. It has been observed that discontinuity in the outline of the spinous process on standard anteroposterior radiographs is a characteristic finding in some unstable spine fractures. Since the spinous processes are often not depicted clearly on lateral views of the trauma victim's spine, these are less reliable; however, if a transverse fracture through the spinous process at the level of, or adjacent to, an anterior compression fracture is demonstrable, this confirms the unstable nature of the injury. Recognition of this sign, when present, may eliminate excessive pretreatment manipulations in some patients who have sustained major trauma and are suspected of having unstable spine fractures.


Pseudomonas ulceration of the cornea following major total body burn: a clinical study. If periorbital or facial areas are involved in burn injury, the eyes must be given prophylactic care. The importance of these cases is not to point out the danger of corneal injury as a direct result of thermal trauma; rather, it is to emphasize the seriousness of corneal abrasions and the danger of subsequent Pseudomonas infection during convalescence of the postburn patient. Once the corneal epithelium is damaged, ulceration rapidly occurs and when infected with Pseudomonas aeruginosa presents one of the most difficult ophthalmologic situations. The convalescent burn patient is in jeopardy of corneal abrasion during general anesthesia for grafting or debridement. Neither of the patients who underwent anesthesia was noted to have corneal abrasion. Nor did either ectropion or lid contracture develop in the three patients described herein. Lid contracture may lead to corneal exposure and should be corrected by expeditious lid tarsorrhaphy. Once ulceration has occurred, as with these patients, corneal transplantation may be indicated.


Chloroquine-resistant falciparum malaria in East Kalimantan, Indonesia. Following the discovery of four imported chloroquine-resistant P. falciparum infections in the Province of Yogyakarta (Island of Java) sensitivity tests were carried out in the Province of East Kalimantan Island of Borneo). Twenty subjects were given 25 mg. of chloroquine base per kilogram of body weight over three days. Two infections were found resistant at the RII level and a third at the RI level with early recrudescence on day 7. In the other 17 cases followed up to day 21, six were found again with asexual parasites between day 9 and day 14 and a seventh on day 21. These results confirm the presence of chloroquine resistance in P. falciparum in East Kalimantan and, together with previous findings, suggest a widespread distribution of chloroquine-resistant falciparum malaria in this Province of Indonesia. It is particularly interesting to note that chloroquine-resistant falciparum malaria has now been detected in almost all the area of dispersion of A. balabacensis.


Urodynamics.

Urodynamics. The urinary tract is a hydrodynamic system whose components are in precise balance with each other and whose functioning depends on mechanical equilibrium. Alteration of the delicate balance between bladder and urethra means dysfunction in voiding or continence. Of greatest clinical interest at present is the bladder-urethra matching mechanism, which controls normal or abnormal voiding or continence. Since the matching combination of bladder and urethra must obey the same hydrodynamic laws that govern all fluid systems, it is obvious that measurement of fluid quantities and fluid porperties should correlate with function and dysfunction in the system. Urodynamics is the art of developing standard fluid-mechanical techniques that will be useful in routine clinical evaluation. Increasing experience with diagnostic urodynamic tests nurtures non-invasive, precise diagnosis of voiding dysfunction. Inexpensive, readily available and convenient techniques have been developed and are in clinical use. We can look forward to many more.


The antibacterial effect of the bladder surface: an electron microscopic study. To explore an intrinsic bladder defense mechanism we examined interaction between Escherichia coli and bacterial size particles (polystyrene latex balls) and the vesical luminal surface by scanning and transmission electron microscopy. The bacteria and the latex spheres were held in folds of the cellular luminal surface. Voiding (bladder contraction) resulted in the entrapment of a large number of bacteria and particles by these microplicae, with their apparent engulfment in vesicles below the cell surface. Some urine was probably contained in the folds and vesicles, thus reducing the volume of residual urine in the bladder. Since leukocytes were rarely seen in the model studied they presumably do not play an immediate role against acute infection in the normal bladder. These observations indicate that fixation of bacteria to the mucosa is 1 step in the mechanism whereby the normally functioning bladder resists infection.


Studies of introital colonization in women with recurrent urinary infections. IV. The role of local vaginal antibodies. Immunoglobulins IgG and IgA were determined in 94 collections of vaginal fluid from 10 patients before, during and after 17 episodes of bacteriuria. The results were compared to 49 collections from 6 volunteer controls who had never had bacteriuria. The mean IgG concentration in patients (48 plus or minus 54 mg. per cent) was no different from controls (50 plus or minus 33 mg. per cent). IgA concentrations were 2.6 plus or minus 2.1 and 2.6 plus or minus 2.4 mg. per cent, respectively. Bacterial agglutination titers in vaginal fluid to Escherichia coli colonizing the vaginal vestibule of the patients were no different (7.7 plus or minus 9.8, reciprocal tube titer) than the titers to be predominant Escherichia coli cultured from the rectum of the controls (9.7 plus or minus 5.0). Longitudinal studies in patients failed to show any relationship between vaginal colonization with changing serotypes of Escherichia coli and agglutination titers in vaginal fluid.


The influence of increased tubular hydrostatic pressure on renal function. The effect of tubular obstruction on renal function has been understood poorly at the tubular level and from the clinical standpoint. In our review the evidence for a direct influence of hydrostatic pressure on tubular transport and glomerular filtration is examined. The data generated to date indicate a direct influence of hydrostatic pressure on tubular transport only at the level of the distal convoluted tubule and collecting duct. With respect to glomerular filtration increased tubular pressure reduces the net driving force for filtration and reduces glomerular filtration rate in the absence of a compensatory increase in glomerular hydrostatic pressure. We next review physiological data concerning the mechanism of post-obstructive diuresis. Available information suggests 4 factors that play a significant role in the clinical syndrome of post-obstructive diuresis: 1) medullo-papillary washout, 2) decreased fractional and absolute salt and water reabsorption in the collecting duct, presumably secondary to direct influence of hydrostatic pressure on transport mechanisms, 3) osmotic diuresis secondary to retention of urea and other osmotic solutes during the period of obstruction and 4) prior salt and water administration in the absence of excretion, resulting in extracellular fluid volume expansion.


Renal transplantation. Effect on the ischemic heart disease of essential malignant hypertension. In 14 of 204 consecutive cadaveric renal allograft recipients, the primary diagnosis was essential hypertension. Four patients had manifest ischemic heart disease before transplantation. Three of these patients died within 31 months of transplantation from recurrent myocardial infarction, and the fourth experienced coronary insufficiency. Cadaveric renal transplantation does not prevent the progression of coronary artery disease in patients whose renal failure was due to essential hypertension. In the presence of angina or previous myocardial infarction, these patiemts may be better treated by maintenance hemodialysis.


[Experience in use of amoxicillin for treatment of acute cystitis (author's transl)]. Seventeen cases of acute simple cystitis were treated by oral administration of amoxicillin at a daily dose of 1.0 g (250 mg X 4 in a day) for consecutive 7 days, and the following results were obtained. 1. Amoxicillin was remarkably effective in 11 of total 17 cases, effective in 2, slightly effective in 2 and non-effective in 2. 2. In terms of effect against isolated bacteria, amoxicillin was remarkably effective against 6 of 11 strains of E. coli, effective against 2, slightly effective against 2 and non-effective against 1, remarkably effective against 2 of 3 strains of Proteus mirabilis and non-effective against 1, and remarkably effective against one strain of Staphylococcus epidermidis. 3. There was no severe side effect specially to be mentioned.


[Clinical studies with amoxicillin (Pasetocin) (author's transl)]. This paper describes briefly the results obtained with AMPC (Pasetocin) administered by oral route to 21 patients with infection of the respiratory tract. 1. There was no difference in therapeutic effect on infection of the respiratory tract between daily dosages of 1,000 mg and 750 mg (the former was orally given in 4 divided doses every 6 hours a day and the latter in 3 divided doses after meal). The response of the patients to AMPC was remarkable or satisfactory. 2. Acute aggravation symptoms associated with chronic infection of the respiratory tract showed similar improvement to single acute infection of the respiratory tract. 3. The patients presenting acute aggravation symptoms received treatment for chronic stage consisting of consecutive oral administration of AMPC (500 approximately 750 mg a day) and their prognosis was favorable. Side effects attributable to prolonged treatment were not noted. 4. The incidence of side effects can be reduced largely by rejecting form AMPC therapy the patients who are hypersensitive to drugs including penicillins.


Induction of phage production in the lysogenic Escherichia coli by hydroxyurea. 1) Hydroxyurea, a reversible DNA synthesis inhibitor, was used to study the mechanism of prophage lambda induction in Escherichia coli K12. Induction of prophage was judged on two criteria: increase of phage-producing cells and loss of colony-forming ability of the cells. 2) Hydroxyurea induced an increase of phage-producing cells only in lysogenic strains known to be inducible with ultraviolet irradiation for prophage development and not in strains such as E. coli K12 (lambdaind-) or E. coli K12 recA (lambda+). 3) When protein synthesis was inhibited, hydroxyurea did not increase phage-producing cells of lysogenic strains; it showed a bacteriocidal effect on lysogenic recA+ strains, but not on nonlysogenic strains. 4) The sensitivity of E. coli K12 recA to hydroxyurea was independent of whether or not the cells were lysogenic. 5) From the results it is suggested that certain steps leading to loss of colony-forming ability (i.e. prophage induction) do not require de novo protein synthesis but require the presence of the host recA+ gene.


Skin reaction and macrophage migration inhibition tests for polysaccharides from Aspergillus fumigatus and Candida albicans. Guinea pigs sensitized with purified galactomannan from Aspergillus fumigatus and mannan from Candida albicans, each containing negligible quantities of nitrogen, were examined for their immunological responses against the corresponding polysaccharides with respect to the delayed-type skin reaction and the macrophage migration inhibition phenomenon. In both cases, the delayed-type skin reaction test and the macrophage migration inhibition test showed positive results. The reactivity was stronger in animals sensitized with polysaccharides in Freund's complete adjuvant than those sensitized with the same polysaccharides in Freund's incomplete adjuvant. Polysaccharides chemically modified by partial acid degradation or by periodate oxidation were found to be completely incapable of eliciting such immune responses. These results are also discussed in relation to the antigenic determinant of the polysaccharides in such immune responses and the precipitin reaction previously observed by us and other investigators.


Mutants of Escherichia coli which block head formation of lambda. Five mutants of Escherichia coli K12 (lam 24, lam 25, lam 26, lam 27 and lam 646) that block head formation of lambda are described. In vitro complementation tests and electron microscopy demonstrated that in these bacteria phage tails were produced normally, whereas head formation was abnormal, aberrant head-related structures being produced. In lysates prepared from lam 24, lam 25 and lam 26, monsters and empty heads without tail were the predominant structures, whereas in lysates from lam 27 and lam 646, petit lambda and empty heads were the most common structures. The five lam mutations were located in two regions on the bacterial chromosome; lam 24, lam 25 and lam 26 were near the dnaB gene and lam 27 and lam 27 and lam 646 near the lac gene. It was suggested that the former three mutants are new isolates that belong to GroE mutants, whereas the latter two comprise a new group of mutants. Analyses of phage mutants (ov mutants) that overcome the interference by the lam 646 mutation revealed that this mutation blocks normal expression of the gene E of lambda.


Isolation and properties of Escherichia coli mutants which are nonpermissive for the growth of phage lambda. By selecting survivors of lambda phage infection, mutants of Escherichia coli K12 that block reproduction cycle of the phage have been isolated. Fourteen of these phage-tolerant mutants (lam mutants) were chosen and characterized biochemically and genetically. It was shown that these mutants were tolerant to infection by all the lambdoid phages, except for few cases, but they were susceptible to infection by a non-lambdoid temperate phage (phi299), P1 or T phages. The mutants can be divided into at least three groups: (1) A mutant (lam 16) strain that seems to block normal penetration of phage DNA: (2) Three mutant (lam 64, lam 67 and lam 71) strains that block an "early" step(s) of phage growth, including phage DNA synthesis: (3) Six mutant (lam 24, lam 25, lam 26, lam 27, lam 646 and lam 6) strains that block normal functioning of the gene E products and produce unusual head structures. Some lambdoid phages and lambda mutants that overcome the interference by the lam mutations have been obtained, and were used as tools for characterizing the host mutations. Two (lam 12 and lam 13) mutant strains and one (lam 1) mutant were inferred as affecting the expression of "late" genes, and early gene, respectively, by this test.


[Statistical analysis of cardiac rhythm with the use of moments of higher orders (asymetry and excess)]. The "Minsk-22" computer was used to study the rhythm of cardiac contractions. The R - R intervals of ECG tracings were studied in 1000 to 2000 cardiac cycles. The measurement of these intervals was performed automatically by means of a special device - intervalmeter. The data input was done from a punch tape. Mathematical analysis of the cardiac rhythm consisted in calculating the mathematical expectance, excess and asymmetry of the distribution of the R - R intervals of ECG. This method was employed for the analysis of the sinus rhythm in normal individuals and in patients with atherosclerosis and rheumatic heart diseases. The rhythm was recorded at rest and during functional tests (administration of nitroglycerine, or single breath holding at the peak of inspiration). The asymmetry of the R - R intervals distribution is an index that helps to reveal the dynamics of the transitory processes, being in this respect superior to the intervalgramme. The excess index permits to evaluate quantitatively the stability of the rhythm and the peculiarities of its regulation. Employment of the described methods of cardiac rhythm analysis is expedient for various functional tests and the assessment of the pharmacological effects.


[Algorhythm for automatic analysis of electrocardiograms in a special apparatus]. An algorhythm for an automatic analysis of the ECG by using a special device is proposed for the purpose of identifying patients suffering from diseases of the cardiovascular system. The algorhythm is based on the utilization of simple electrocardiographic indications measured with sufficient accuracy on a real time scale (PQ, QRS, T1 configuration, amplitude of the R, S, T waves). With the algorhythm analysis of the ECG taken in patients with primary rheumatic heart disease, complicated mitral lesion, hypertensive disease, myocardialinfarction the ECG changes helped identify 70 per cent of the patients. The algorhythm proved highly effective in recognizing patients with ischemic heart disease. A correlation between the stages of the affection and the frequency of detected pathological ECG was established. The results of automatic evaluation were contrasted against the data subsequent to an ECG analysis made by the physician, both of these being in good accord.


[The influence of the renin-angiotensin system on autoregulation of renal blood flow and intrarenal hemodynamics (author's transl)]. The discussion of renal hemodynamics has to include three phenomena: the autoregulation of renal blood flow, the existence of different intrarenal perfusion compartments, and the intrarenal renin-angiotensin-system. The autoregulation of renal blood flow is characterized by the constancy of renal blood flow inspite of a wide range of renal perfusion pressure (70-220 mm Hg). This is due to the ability of the kidney to adjust vascular resistance to pressure changes. Renal perfusion is not homogenous but consists of different perfusion compartments which may be distinguished according to characteristic anatomy, function and innervation. Autoregulation of renal blood flow and distribution of intrarenal perfusion to different compartments are interdependent and are shown to be both under the control of an intrarenal "local" renin-angiotensin system.


Salmonella typhimurium infection in guinea pigs: observations on monitoring and control. A spontaneous outbreak of salmonellosis in a guinea pig colony was caused by Salmonella typhimurium. A simple, comprehensive monitoring procedure, consisting of mass fecal sampling, was developed. Using the monitoring system described, the disease was eliminated by: 1) removal of animals in pens in contact with Salmonella, and 2) strict hygienic procedures. It was not necessary to depopulate the colony in order to control the disease.


Chemotaxis in bacteria.

Chemotaxis in bacteria. Bacterial chemotaxis, the movement of motile bacteria toward or away from chemicals, was discovered nearly a century ago by Engelmann (1) and Pfeffer (2,3). The subject was actively studied for about 50 years, but then there were very few reports until quite recently. For reviews of the literature up to about 1960, see Berg (4), Weibull (5), and Ziegler (6). The present review will restrict itself to the recent work on chemotaxis in Escherichia coli and Salmonella typhimurium. Some of this is also covered in Berg's review (4), and a review by Parkinson (7) should be consulted for a more complete treatment of the genetic aspects.


Studies of bacterial chemotaxis in defined concentration gradients. A model for chemotaxis toward L-serine. The details of the chemotactic response of Salmonella typhimurium to gradients of L-serine have been examined in some detail. Two relatively macroscopic techniques have been employed to measure the bacterial response. These include measurements of the average velocity as the bacterial population moves toward attractants, and measurement of the upward-to-downward flux ratio, R, in the stable preformed attractant gradients. The dependence of the average velocity on gradient appears to be hyperbolic in nature, while the flux ratio depends linearly on the gradient. These data suggest a microscopic model for the dependence of bacterial behavior on the serine gradient. The model involves a linear dependence of the mean lifetime of a bacterial trajectory on the gradient for those bacteria moving toward higher attractant concentration. Those moving toward low concentrations of attractant do not change the mean duration of their trajectories, or the speed at which a given bacterium swims through the solution. This model generates the observed dependences of the average velocity and flux ratio on gradient. Interpretation of the experimental data suggests that a gradient which increases serine concentration by a factor of 2 in 10 mm is sufficient to double the average duration of a trajectory for a bacterium moving directly up the gradient. The concentration dependence of the chemotactic response to serine is more complicated. It suggests that more than one receptor of serine may be involved in determining chemotactic behavior to this attractant.


Appearance of acetylcholine receptors in cultured myoblasts prior to fusion. The development of the acetylcholine receptors in chick embryo myoblasts from 11-day old embryos was studied in vitro. Using the purified alpha-bungarotoxin labeled with radioactive iodide, a high concentration of acetylcholine receptors was found in the prefusing myoblasts; most of these receptors were located in the interior of the myoblasts. However, upon the completion of myoblasts fusion, the majority of the acetylcholine receptors appeared on the external cell surface of the myotubes.


Orthotopic canine heart transplantation: left ventricular contractility during chronic rejection. Myocardial left ventricular contractility is assessed in 8 orthotopic heart-transplanted dogs during chronic rejection by a noninvasive method. The mean circumferential velocity of shortening (Vcf) is calculated from endocardial marker motion on cinefilms. A model for chronic rejection after cardiac transplantation was obtained by histocompatibility matching in DLA identical Beagle littermates. No immunosuppressive treatment was used. All dogs eventually died of chronic rejection; mean survival time was 112.5 days. LV contractility shows the following pattern: Chronic rejection causes an important contractility decrease (P less than 0.001) with two significant drops: (1) from the week preoperative to the first week after transplantation (P less than 0.02) and (2) from week terminal minus one to the terminal week (P less than 0.01). This study describes the technique and the changes in Vcf observed over a period of time in a predictable model.


Technical considerations in cardiovascular surgery for neonates. Cardiovascular surgical techniques used in neonatal patients demand that instruments of appropriate size and configuration be available. A specially designed set of small instruments has been developed to fulfill these needs.


Reduction of tension at the anastomosis following tracheal resection in puppies. Inlying tracheal "stay sutures" and submandibular sutures to prevent cervical hyperextension were used separately and in concert to limit anastomotic tension following tracheal resection in puppies. Study of the degrees of stenosis in the mature dogs indicates the effectiveness of the principle.


The centineurogenic etiology of the respiratory distress syndrome. Protection afforded by anemia and pulmonary denervation against lung lesions of oxygen toxicity. For beagles respiring 100 per cent oxygen at ambient pressure, anemia protected against the development of the lung lesions of oxygen toxicity. Similarly, unilateral pulmonary denervation was protective of the affected lung but not of the normally innervated, contralateral lung. This indicates that the lung lesions are triggered by the toxic effect of elevated PO2 at a remote site, most likely the sensitive central nervous system.


An analysis of direct and indirect measurements of left atrial filling pressure. Left ventricular function may be assessed by direct catheter measurements of left atrial pressure or by indirect measurements of pulmonary artery wedge pressure or pulmonary artery end-diastolic pressure. Controversy exists as to how closely the indirect measurements correlate with true left atrial pressure and to which is the most accurate. To clarify this probelm, we studied 43 patients undergoing cardiac surgical procedures with cardiopulmonary bypass. Both left atrial catheters for direct measurement and Swan-Ganz catheters were placed at the time of surgery. All patients were monitored continuously for 48 hours and hourly measurements were recorded. The resultant 1,620 left atrial pressure and pulmonary artery wedge pressure figures and 1,860 left atrial pressure and pulmonary artery end-diastolic wedge pressure measurements were subjected to computer analysis. The following conclusions have been found: (1) Pulmonary artery wedge pressure is a better indirect measure of left atrial pressure than is pulmonary artery end-diastolic wedge pressure (pooled correlation coefficient 0.629); (2) direct left atrial pressure measurement is more reliable and has fewer complications than indirect measurements; (3) there is no consistent correlation between left atrial pressure and central venous pressure (pooled correlation coefficient 0.3). A discussion of our results and the problems associated with left atrial catheters and Swan-Ganz catheters is presented.


Operative treatment of active endocarditis. During the past decade 44 patients with active endocarditis, defined as valvular infection requiring operative intervention before completion of a planned course of antibiotic therapy, have been treated at Stanford University Medical Center. Twenty-seven patients had infection of a native valve (primary endocarditis) and 17 had infection of a previously implanted intracardiac prosthesis. In 91 per cent of cases urgent valve replacement was dictated by rapid hemodynamic deterioration and in the remainder by recurrent macroemboli or persistent sepsis. Various species of Streptococcus were the most common organisms encountered, followed by Staphylococcus aureus. Unusual bacteria were mostly limited to patients with prosthetic infections; Candida was seen in both groups. Aortic valve replacement was required in 80 per cent of patients. Operative mortality rates were 30 per cent in the group with primary disease and 24 per cent in the group with disease of the prosthetic valve. Most deaths were attributable to multiple system complications generated preoperatively and were unrelated to duration of preoperative antibiotic administration. Five-year survival rates for operative survivors were 68 per cent (primary) and 54 per cent (prosthetic). This experience illustrates the potential therapeutic benefit of operative intervention during active infective endocarditis complicated by severe heart failure or other life-threatening events.


An analysis of potential physiological predictors of respiratory adequacy following cardiac surgery. More than 50 potential physiological and clinical predictors of postoperative respiratory adequacy were examined in an attempt to identify those few variables which, singly or in combination, best predicted the outcome of the first trial of spontaneous respiration following cardiac surgery. This trial was initiated when patients seemed hemodynamically stable and relatively alert following surgery. Analysis of data from 124 patients identified the following useful predictors: forced vital capacity, total lung capacity, and maximal mid-expiratory flow rate from preoperative pulmonary function tests; resting cardiac index from preoperative cardiac catheterization; postoperative compliance and resistance measured by a computer-based monitoring system; postoperative vital capacity per kilogram, and maximum inspiratory force, measured at the bedside prior to the weaning trial. Stepwise linear discriminant analysis indicated that vital capacity per kilogram and maximum inspiratory force were the most useful predictors, the dividing line between successes and failures being represented by a vital capacity per kilogram of 15 ml. and a maximum inspiratory force of 28 cm. H2O. Mean values of successes were 18.3 +/- 7 ml. per kilogram and 30.7 +/- 9 cm. H2O and, for failures, 11.9 +/- 4 ml. per kilogram and 24.3 +/- 8.4 cm H2O. These physiological variables assess patient effort acting upon an abnormal pulmonary system. Measurements of passive pulmonary mechanics, cardiac function, and the measurement of arterial blood gases were suprisingly poor predictors.


Angioimmunoblastic lymphadenopathy.

Angioimmunoblastic lymphadenopathy. Forteen cases of angioimmunoblastic lymphadenopathy were reviewed retrospectively, and histologic material was examined by various staining and histochemical techniques. The predominant morphologic features were effacement of nodal architecture, microvascular proliferation, and a polymorphous cellular infiltrate of immunoblasts, plasma cells, lymphocytes, and eosinophils. Immunofluorescence studies suggested the presence of cells elaborating a variety of immune globulins with an unpredictable pattern. The clinical course and treatment varied, perhaps partly reflecting the initial spectrum of diagnoses made in these cases before angioimmunoblastic lymphadenopathy was defined. Because systemic infection appears to be a major factor in the deaths of these patients whose immune competence is uncertain, the usual chemotherapy for malignant lymphomas may be too vigorous for this condition. At present, the cause of the condition is unknown.


The thyroid and audition.

The thyroid and audition. Hearing loss, both congenital and acquired, can be associated in a more than happenstance manner with disorders of almost every organ system; the thyroid gland being no exception. Although theliterature is replete with speculations and observations, complete understanding of the thyroid gland-auditory system relationship is lacking. Several known syndromes, seemingly unrelated except for the association of hearing loss and thyroid abnormalities, have been described and, from the standpoint of hearing loss, may be conveniently divided into four groups: 1. non-genetic congenital; 2. non-genetic acquired; 3. genetic congenital; and 4. genetic delayed.


Surgical management of bilateral vocal cord paralysis. Fifty-five patients with bilateral abductor paralysis of the vocal cords were managed surgically from 1957 to 1973. Initially, unilateral arytenoidectomy or arytenoidopexy was employed. If this was not satisfactory, a contralateral arytenoidectomy was performed 6 to 12 months later. If the patient's airway was still inadequate, then open unilateral submucous resection of the vocal cord was accomplished. Initial management was successful in 62 patient (34/55) of patients, and 50 to 55 patients (91 percent) were eventually decannulated. Failure of the arytenoidectomy appeared to be related to traumatic etiology of the bilateral paralysis presence of previous treatment, and technical problems of the procedure itself.


[Humoral and cellular immune phenomena in an acute viral hepatitis (author's transl)]. During the course of acute viral hepatitis A and B, several humoral and cellular immune phenomena have been observed, part of which is predominantly or even exclusively associated with hepatitis B: 1. Relative and absolute counts for T-lymphocytes depressed and for "null" -cells elevated; 2. mild elevation of serum globulin levels; 3. IgM augmentation occurring fastly, pronounced, and long lasting in typical cases; 4. IgG augmentation occurring later, less pronounced, and for a shorter period in typical cases; 5. autoantibodies to smooth muscles and mitochondria in low titers in some patients; 6. specific antibodies to "e" -antigen (early) and HB-Ag (later in the course) in part of the cases with hepatitis B; 7. immune complexes including HB-Ag, IgG and probably IgM (and IgA) as well as complement in some cases; 8. depressed levels of the fourth component of complement and - in cases complicated by "allergic" symptoms - of C3, C4, and total complement; 9. occurrence of activated lymphocytes ("virocytes") in peripheral blood; 10. enhanced spontaneous lymphocytic DNA-synthesis; 11. enchanced phytohaemagglutinin stimulation of lymphocytes; 12. mild lymphocyte proliferation to HB-Ag in part of the acute and convalescent cases of hepatitis B; 13. production of migration inhibition factor to liver specific protein (and HB-Ag) or lymphocytes in different percentages of patients with hepatitis B. Origin, diagnostic and prognostic importance, as well as pathogenetic revelance of the described immune phenomena are discussed.


Extraction of lipids from yeast.

Extraction of lipids from yeast. Several methods for the extraction of lipids from intact yeast cells have been compared. Extraction of intact cells with methanol followed by methanol: benzene (1:1, v/v) and benzene resulted in the recovery of equal or greater amounts of polar and nonpolar lipids than obtained by other methods. A preparative method involving preincubation of cells with aqueous KOH followed by the treatment of the cellular residue as described above yielded slightly more steryl esters than was extracted from broken cell preparations.


Bound hydroxyproline excretion following gelatin loading in prolidase deficiency. The excretion of peptide-bound hydroxyproline before and after gelatin loading was evaluated in two children with prolidase deficiency, two adult heterozygotes, and normal controls. On a low hydroxyproline diet, the patients with prolidase deficiency excreted 6.9 and 2.4 times more bound hydroxyproline than normal children. The bound hydroxyproline excretion for the heterozygotes was comparable to the adult controls. Children ingested 20 g of gelatin and adults 29 g. In the 24 hr following gelatin loading, the homozygotes excreted 14.4 and 17.3 times more of the ingested load of hydroxyproline than did normal children. This constituted 39% and 47% of the hydroxyproline ingested. Of the hydroxyproline excreted in 24 hr, 58%, and 61.4% was excreted in the first 6 hr. Over the 24 hr period, the normal children excreted 2.7% of the hydroxyproline ingested (97.8% in the first 6 hr). The heterozygotes excreted only slightly more than the adult controls. The normal adults excreted 6.0% of the ingested hydroxyproline (82.8% in the first 6 hr). In prolidase deficiency, large amounts of peptide-bound hydroxyproline can cross the intestinal wall unhydrolyzed. Prolidase appears to have an important role in normal hydrolysis of peptide-bound hydroxyproline.


A review of recent developments in human fertility control. Recent and significant developments in the field of fertility control are reviewed. Consideration is given to new aspects of existing methods, recent modifications to steroidal formulations and Intrauterine devices, increased utilization of older methods (abortion and sterilization) and evaluation of new fields (postcoital contraception, prostaglandins and immunological techniques). There is an increasing demand for better application of newly developed methods and a rational decision in the selection of appropriate methods.


Instrumentation for cardiopulmonary bypass--past, present, and future. Methods of extracorporeal circulation to permit intracardiac surgery still depend on the principles developed by John Gibbon in the early 1950s. This review traces Gibbon's early development, reviews the state of the art of instrumentation for extracorporeal circulation in the operating room today, and projects future changes in this instrumentation that will result in improvement in blood contact surfaces, automation and servo-regulation, and safety.


Perspectives in physiological monitoring. Clinical monitoring systems that have been developed in response to the need to acquire patient physiological data have only recently been accepted as standard equipment in the operating room, and burgeoned into the variety of sophisticated patient-monitoring equipment available today. This article traces the history of the recognition of the importance of physiological data in diagnosing and treating disease, the inclusion of the four vital signs on patient charts, and the first instrumental recording of these signs, all of which occurred before 1900. The earliest operating room monitoring system, which was not developed until the mid 1940s, is described.


Current dangers and problems in the topical use of steroids. The hazards of the topical use of steroids, especially the fluorinated steroids, are reviewed. Attention is drawn, especially to the site of application, the face and flexures. The masking of bacterial and fungal infection by topical corticosteroid preparations is mentioned, as are the possible dangers of using them in skin malignancy. The query is raised as to the value of topical use of antibiotics.


Eclectic relaxation therapy.

Eclectic relaxation therapy. This paper introduces a new method that is designed to facilitate muscular relaxation, enhance direct sensory reality and increase self-control over mental processes. The procedure consists of six sessions and requires minimal therapist involvement, the therapy being presented in a group setting by tape recordings. The advantages of this technique are suggested and the principles used in its construction are defined.


Dialysis in the home.

Dialysis in the home. Patients with impaired renal function require thorough evaluation at the time of diagnosis and careful supervision thereafter. If renal failure ensues, both dialysis and renal transplantation can be used to provide integrated and total care. The family physician has an important role to play in medical supervision of patients undertaking dialysis at home. Discussion and careful examination during routine visits can forestall complications and contribute to the patient's confidence and independence. There are few problems that cannot be sorted out by an interested family physician with support from the parent renal unit.


Thrombosis after central venous cannulation. A prospective investigation was undertaken to assess the incidence of thrombosis after central venous cannulation. There were 63 patients. The incidence of thrombus formation in the last 20 of our patients was 90%. In 13% of the 63 patients there were serious sequelae to thrombosis--pulmonary embolism, major vein occlusion and septicaemia. Factors responsible are discussed. Some are preventable whilst others need further research.


Renal transplantation.

Renal transplantation. Kidney transplantation is now a very acceptable form of treatment of end-stage renal failure. About 50% of kidney grafts are still functioning after five years. If the kidney graft fails, and failure is usually due to rejection, patients are returned to dialysis for definitive treatment or to await another transplant. Although kidneys from living related donors offer the best chance of success, most kidneys in Australia are transplanted from cadavers. A shortage of cadaver kidneys necessitates a wait of 6 to 12 months for a transplant.


[The effect of mesterolone in panmyelopathic anemia and anemia of renal failure]. A controlled randomized multicenter trial was carried out to examine the therapeutic value of the androgen mesterolone in aplastic anemia and anemia of renal failure. the drug was given in a dose of 2 mg/kg orally for 6 months. Control patients received no androgens but were otherwise similarily treated. 31 patients with aplastic anemia could be evaluated. No significant difference was found between androgen treated control cases in respect to bone marrow cellularity, improvement of peripheral blood cell counts or survival. In a group of 14 patients not being hemodialyzed with anemia from renal failure, 3 of the androgen treated and none of the control patients showed progressive and significant improvement of erythropoiesis; however, this was not a statistically significant difference when the both groups of patients were compared. The results do not suggest that the androgen mesterolone is of therapeutic value in the majority of adult patients with aplastic anemia. Possible reasons of the discrepancy to positive results reported in the literature are discussed.


A relaxed mutant with an altered ribosomal protein L11. Relaxed mutants of Escherichia coli have been isolated which have an altered electrophoretic mobility of ribosomal protein L11. It can be shown that reversion to stringency in one of these mutants occurs simultaneously with a reversion of L11 protein to tis normal mobility. The L11 structural gene, rplK, maping near rif, is carried by the bacteriophage lambdacI857S7drifd18, and is most likely identical with relC.


Isolation of transducing phage carrying rps T, the structural gene for ribosomal protein S20. Lambda transducing phages carrying segments of the Escherichia coli chromosome in the dapB region have been isolated in their in vivo gene products analyzed by two-dimensional gel electrophoresis. One of these phages, lambdaddapB-2, carries the structural genes for ribosomal protein S20 (rps T) and isoleucyltransfer RNA synthetase (ileS.) The most likely gene order is thr-rpsT-ileS-dapB-pyrA.


In vitro synthesis and repression of argininosuccinase in Escherichia coli K12; partial purification of the arginine repressor. Phi80dargECBH DNA has been used to direct cell-free synthesis of argininosuccinase, the argH gene product in Escherichia coli K12. In vitro enzyme synthesis is sensitive to repression by partially purified preparations from an argR+ strain but not by corresponding preparations from an argR- strain. Using DNA-cellulose chromatography, approximately seventyfold purification of repressor has been obtained. The partially purified preparation represses argininosuccinase synthesis but has no effect on beta-galactosidase synthesis.


Recombination and hydroxyurea inhibition of DNA synthesis in yeast meiosis. Hydroxyurea (HU) inhibits the premeiotic DNA replication and the meiotic events that followed, namely readiness, recombination commitment, haploidisation, sporulation commitment and ascus formation. Short incubations with HU (2-4 hrs) during the premeiotic replication (i.e. starting between 3 and 6.5 hrs in sporulation medium) allow the resumption of the replication at a normal rate following the removal of the drug. The other meiotic events are similarly delayed by the approximate length of the treatment. In these experiments, intragenic recombination in ade2 reached a higher level than in the controls (x 1.3-2.0 in one pair of heteroalleles and x 3.0-4.0 in another pair). The recombination response to short HU treatments was not observed for a pair of heteroalleles in ade2 that normally shows a high level of meiotic recombination (750 per 10(6) cells), nor was the response observed in a pair of heteroalleles in lys2. HU treatments have almost no effect on sporulating cells from 8 hrs onwards. At 7-7.5 hrs the meiotic cells are very sensitive to the drug and even short treatments cause cell death and massive DNA degradation.


A yeast mutant defective in the processing of 27S r-RNA precursor. Among a group of 31 ts- yeast mutants screened electrophoretically for heat-sensitive synthesis of each stable RNA species, only mutant ts351 failed to accumulate 25S RNA at 36 degrees C. Pulse-labeling experiments at 36 degrees C showed that 35S and 27S precursors RNA and mature 18S r-RNA molecules are synthetized by ts351 cells but that 25S and 5.8S RNA species are not made and new 60S ribosomal sub-units are not assembled. The mutant is blocked at a specific point in r-RNA processing: the cutting of 27S to form 25S and 5.8S r-RNA.


Mutagenic DNA repair in Escherichia coli. III. Requirement for a function of DNA polymerase III in ultraviolet-light mutagenesis. The polC (= dnaE) temperature-sensitive DNA polymerase III mutation from Escherichia coli BT1026 has been transduced into E. coli WP2 (to give CM731) and WP2 uvr A (to give CM741). In excision-deficient CM741 UV-induced Trp+ mutations progressively lost their photoreversibility during post-irradiation incubation at 34 degrees. Immediately after transfer to 43 degrees, however, there was no further loss of reversibility although post-replication strand joining still occurred and uptake of 3H-thymidine into DNA continued for 20 to 30 min. In excision-proficient CM731, UV lesions capable of leading to Strr mutations disappeared during post-irradiation incubation at restrictive temperature and there was no increase in the number remaining after exposure to photoreversing light. In contrast, at permissive temperature, premutational lesions were not lost and became progressively converted into non-photoreverisble mutations. It is concluded that a function of the polC gene is necessary for error-prone repair to occur and that this function is defective at 43 degrees in the enzyme specified by the polC allele from BT1026. This function seems not to be essential for most post-replication or excision repair or for normal DNA replication and may be particularly involved in the insertion of incorrect bases during error-prone repair.


Cooperative control of translational fidelity by ribosomal proteins in Escherichia coli. III. A ram mutation in the structural gene for protein S5 (rpx E). The effect on translational fidelity of a particular mutation in the gene coding for protein S5(rpxE) has been investigated. This mutation has the opposite effect of a restrictive strA mutation; in vivo, it relieves the restriction imposed by strA on the suppression of T4 nonsense mutants and results in hypersensitivity to streptomycin; in vitro, the presence of the altered S5 protein in 30S ribosomes results in increased intrinsic misreading. It is concluded that this mutation, ramC319, acts as a ribosomal ambiguity mutation similar to certain mutations of protein S4 (ramA).


Dependence of transfection efficiency of calcium treated Escherichia coli cells on bacterial genotype and form of Lambda DNA. The transfecting activity of linear lambda DNA is 100 times higher in calcium treated E. coli K12 (lambda i434) than in non-lysogenic strains: the levels of transfection are 1-2.10(7) and 1-2.10(5) infective centers per 1 mug of lambda DNA respectively. The high efficiency of lysogenic cells transfection is not due to the spontaneously liberated "helper" phage. Evidently, it is called forth by transfecting DNA-prophage recombination or/and by inhibition of nuclease activity in lysogenic cells. Both ring forms lambda DNA (supercoiled and open circles) show very low infectivity, if any, in calcinated cells.


The synthesis of S-adenosylmethionine by mutants with defects in S-adenosylmethionine synthetase. Some metK mutants of Salmonella typhimurium with constitutive methionine biosynthesis have no detectable S-adenosylmethionine (SAM) synthetase, the enzyme which converts methionine to SAM, the postulated corepressor of the methionine pathway. However, these mutants are not auxotrophic for SAM, an essential compound for many reactions.


The role of thiol groups in nucleoside transport. (1) The inactivation of various forms of nucleoside transport with reagents blocking thiol groups was studied in whole cells of E. coli B. No positive correlation between the efficiency of active transport and the extent or rate of inactivation could be demonstrated. (2) The most efficient constitutive nucleoside-transporting system was found to comprise a specific thiol component characterized by low rate of inactivation with N-ethylmaleimide; the less efficient inducible transport and the facilitated diffusion of guanosine require the integrity of another thiol component which is rapidly inactivated with N-ethylmaleimide. (3) The constitutive nucleoside-transporting system is completely inactivated with T4 phage, while other modes of nucleoside transport are much less affected. (4) Inactivation of constitutive transporting system in cells exposed to N-ethylmaleimide for a limited period of time continues long after the inhibitor has been removed, indicating storage of the inhibitor in some cellular compartment. Addition of dithiothreitol stops the inactivation immediately.


[Possibilities of species determination by immunofluorescence study of bone tissue]. By the aid of isocyanate-labelled anti-human-serum a new technique was worked out for the determination of the species-specificity of the bone tissue. The antigen-antibody reaction is labelled by the fluorchrom and visible in the UB-light.


Production of frameshift mutations in Salmonella by a light sensitive azide analog of ethidium. Frameshift mutations have been produced in specific repair-negative Salmonella tester strains by photoaffinity labeling technique using ethidium azide. Reversions requiring a +1 addition or a -2 deletion were specially sensitive. Mutagenesis was reduced by the simultaneous addition of non-mutagenic ethidium bromide, and was prevented by photolysis of the azide prior to culture addition. Identical tester strains active in DNA excision repaire were not mutagenized by the azide. These results are consistent with the interpretation that photolysis of the bound ethidium analog converts the drug from its noncovalent mode of binding (presumably intercalation) to a covalent complex with consequent production of frameshift mutations. Such photoaffinity labeling by drugs which bind to DNA not only confirms the importance of covalent drug attachment for frameshift mutagenesis, but also provides powerful techniques for studying the molecular deatils of a variety of genetic mechanisms.


Renin profiling in hypertension and its use in treatment with propranolol and chlorthalidone. We compared methods of classifying hypertension according to plasma renin activity in 54 patients with essential hypertension and examined the validity of using these classifications to choose between two hypotensive drugs. A prospective, double-blind crossover study was used. Normal values for plasma renin activity were established from 111 control subjects. Plasma renin activity was related to  race and inversely to age in hypertensive patients (P less than 0.05) but not in normal subjects. Three methods of classification correlated well but did not identify exactly the same renin-suppressed patients. Chlorthalidone produced a greater reduction in blood pressure and restored blood pressure to normal in a larger percentage of patients in both low-renin (59 per cent) and normal-renin (32 per cent) subgroups than propranolol (12 and 16 per cent). Renin determinations are of limited benefit in the choice of therapy for most patients with essential hypertension.


Foreign medical graduates and Maryland Medicaid. To determine whether foreign medical graduates provide a disproportionate share of medical care to the poor, Medicaid vendors in Maryland were compared with all licensed physicians in the State. Foreign medical graduates constitute 22 per cent of all physicians in Maryland but 36 per cent of the Medicaid vendors. In addition, of all the vendors for fiscal 1974, 94 per cent who were licensed in 1972 or 1973 were foreign medical graduates. This disproportional representation in the Medicaid program is concentrated in the specialties of general surgery, internal medicine and general practice. Thirty-two per cent of all foreign medical graduates in Maryland are board-certified physicians, but only 22 per cent of those who are Medicaid vendors are board certified. For United States medical graduates, 48 per cent of all physicians are board certified, but this figure increases to 52 per cent for the Medicaid vendors. Finally, representation of foreign medical graduates among Medicaid vendors tends to be highest in areas with the highest physician-to-population ratios and with the highest percentages of total Medicaid payments.


Effect of psychoprophylaxis (Lamaze preparation) on labor and delivery in primiparas. To investigate whether "prepared-childbirth" courses offer measurable physical advantages, we compared the labor and delivery characteristics of 129 primiparas who had completed ante-partum Lamaze-training psychoprophylaxis classes with an equal number of matched controls who had not. The former were given narcotics less frequently during labor (P less than 0.001), received conduction anesthesia less often (P less than 0.001), and had a higher frequency of spontaneous vaginal deliveries (P less than 0.001) than the control patients. However, these differences had no apparent effects on the length of labor, number or type of maternal complications, frequency of fetal distress, mean Apgar scored, or neonatal problems.


Massive resection and allograft transplantation in the treatment of malignant bone tumors. Nineteen massive resections and allograft transplantations have been performed for malignant or aggressive bone tumors. Allograft procurment technic uses freezing of the segment to decrease immunogenicity of the bony portion and glycinerization of the cartilage to maintain chondrocyte viability during freezing and thawing. Fifteen Fifteen of the patients have been followed for an average of almost two years and were evaluated for early results by serial follow-up studies, including clinical, laboratoy, x-ray and scan data. Despite numerous complications (related to both tumor and operation) none have metastases, local recurrence, or major functional impairment except for two whose grafts became infected. We conclude that, although still experimental, allograft replacement may in the future serve as an important approach to certain neoplastic conditions of bones and joints.


Travelers' diarrhea in Mexico. A prospective study of physicians and family members attending a congress. We conducted a prospective study of travelers' diarrhea on 73 physicians and 48 family members attending a medical congress in Mexico City, in October, 1974. Fecal and blood specimens were collected before, during and after their visit and examined for enteric bacterial pathogens, viruses and parasites. In 59 (49 per cent) participants travelers' diarrhea developed. Median duration of illness was five days. Onset occurred a median of six days after arrival. An etiologic agent was found in 63 per cent of ill participants. Enterotoxigenic Escherichia coli of different, non-"enteropathogenic" serotypes was the most common cause; other responsible pathogens included salmonellae, invasive Esch. coli., shigellae, Vibrio parahaemolyticus, Giardia lamblia and the human reovirus-like agent. Consumption of salads containing raw vegetables was associated with enterotoxigenic Esch. coli infection (P = 0.014). Travelers' diarrhea in Mexico is a syndrome caused by a variety of pathogens, the most common of which is enterotoxigenic Esch. col.


Nosocomial infections in a newborn intensive-care unit. Results of forty-one months of surveillance. We detected a 24.6 per cent nosocomial infection rate (222 infections in 138 infants) among 904 infants hospitalized for over 48 hours in a regional newborn intensive-care during 41 months of surveillance. Surface infections accounted for 40.1 per cent of the total, pneumonia for 29.3 per cent, bacteremia for 14.0 per cent, surgical-wound infection for 8.1 per cent, urinary-tract infection for 4.5 per cent, and meningitis for 4.0 per cent. Staphylococcus aureus (47.3 per cent) and gram-negative enteric bacilli (45.1 per cent) were the most common organisms recovered. Nosocomial infection rates were significantly higher in infants with a birth weight less than 1500 g (P less than 0.001). The mortality rate in infants with any nosocomial infection was 33 per cent in contrast to 14 per cent in non-infected babies (P less than 0.001). Nosocomial infections are a major problem in newborn intensive-care units.


Hypertyraminemia in cirrhotic patients.

Hypertyraminemia in cirrhotic patients. To evaluate the role of tyramine in hepatic disorders, we used a radioimmunoassay to study plasma concentration of tyramine in eight healthy subjects, 20 hospitalized patients without liver disease, and 13 cirrhotic patients of whom seven had hepatic encephalopathy. The effect of increasing dietary protein on tyramine level of cirrhotic patients was also assessed. No significant difference in plasma tyramine concentration was seen between normal subjects, 1.3 +/- 0.1 ng per milliliter (average +/- S.E.), hospitalized patients without hepatic disease (1.4 +/- 0.1 ng per milliliter) and cirrhotic patients without encephalopathy (2.7 +/- 0.5 ng per milliliter). However, the tyramine level in cirrhotic patients with encephalopathy, 6.4 +/- 0.1 ng per milliliter, was significantly (P less than 0.001) higher than in normal subjects or in cirrhotic patients without encephalopathy. Increasing dietary protein from 40 to 80 g per day raised fasting tyramine concentration by 30 to 70 per cent within three days in both encephalopathic and non-encephalopathic cirrhotic patients. Concentration of plasma tyramine in cirrhotic subjects was significantly correlated with that of plasma tyrosine (P less than 0.001).


Evolution of secondary hyperparathyroidism after renal transplantation. Parathormone levels were determined in 17 patients with functioning renal transplants. In 8 patients recently transplanted, very high serum levels of parathormone were found without obvious relation to the glomerular filtration rate. Hypophosphatemia was also present in these cases. In 9 other patients studied 2-7 years after transplantation the mean level of parathormone was lower than in the previous group but levels above normal were noted in half of the patients, some of which had perfect renal function and normal serum phosphorus. The response to induced hypercalcemia was used as a sensitive test to reveal abnormal responses even in cases which initially had normal peripheral levels of parathormone. From these results, tertiary hyperparathyroidism would appear to be rare although hyperfunctioning parathyroid glands can be demonstrated long after kidney transplantation, even when renal function is close to normal.


Classification and prognostic aspects of schizophrenia. The relation between initial clinical symptomatology and long-term course of illness appears to be reliable. Prognostic models, as well as an experienced physician, can predict long-term risk of schizophrenic defects from a few items. The prognostic models also seem to be valid for international comparisons of prognosis. The improved prognosis of schizophrenia over the last 30 years is ascertained. The series of about 4,500 cases provides a sufficiently large number of patients for the analyses of well-defined subgroups. This has been done especially for schizophrenia, using the Leonhard classification.


A study of congenital nystagmus: waveforms. Eighteen patients with congenital nystagmus were studied with the techniques of electronystagmography and computer analysis. We found several complex wave forms of congenital nystagmus in the primary position of gaze above those of jerk and pendular nystagmus as defined clinically. An etiologic classification of motor fixation defect and sensory fixation defect nystagmus based on waveforms is not justified. Ocular tracking studies demonstrate that the smooth pursuit system is operational in congenital nystagmus and substantiate the belief that the fast component of jerk nystagmus is a corrective movement generated by the saccadic system. Patients with congenital nystagmus are able to produce voluntary saccades with normal velocity-amplitude relationships.


An evaluation of baclofen treatment for certain symptoms in patients with spinal cord lesions. A double-blind, cross-over study. Baclofen (a gamma aminobutylic acid derivative) and a placebo were compared for their efficacy in relieving certain symptoms in patients with long-standing spinal cord lesions and "spinal spasticity." In a double-blind, cross-over clinical investigation, 22 patients with chronic spinal cord disease were studied. Baclofen regularly alleviated involuntary flexor or extensor spasms and increased resistance to passive movement of the legs but did not alter strength, gait, stretch reflexes, or clonus. Side effects were mild and transient. This study demonstrates that (1) baclofen is useful for the treatment of flexor spasms and (2) in evaluating a new mode of therapy, one must consider selectively the response of individual components of such global syndromes as "spasticity."


[Technical aspects of experimental reimplantation of limbs in the dog]. Reimplantation of traumatically amputated limbs or their part is now carried out with increasing success due to the perfection of surgical techniques, especially in the case of microsurgery. Experimental perfection of such techniques is clearly the first step towards the clinical employement of reimplantation. Amputation and reimplantation of the hind leg in five dogs is reported. The first objective was the establishment of the reimplantation technique, whose salient features included: perfusion with dextran 40 and Trasylol, Kunster's centromedullary nail for osteosynthesis, microneurorrhaphy to bring together individual nerve funiculi, and vascular microsurgery based on previous experimental work. The immediate results show that the steps of the technique have now been established. Confirmation of their long-term validity, especially as far as functional recovery is now awaited.


[Topical treatment of thrombophlebitis with feprazone and benzydamine. Controlled clinical study]. Topical anti-inflammatory management of superficial and deep phlebopathy with feprazone and benzidamine was compared in a double-blind test. Both drugs were active and well tolerated. Significantly less time was needed to obtain a cure with feprazone.


[Antigenic competition in rabbits submitted to skin allografts]. Antigenic competition was investigated in rabbits submitted to typhoid vaccine and skin allografts. While skin allografts were normally rejected, serum agglutinin responses to typhoid H and O antigens were lower than those of animals stimulated with thyphoid vaccine alone. It is concluded that the immune response to skin allograft resulted in antigenic competition for typhoid antigens.


[Course of skin allografts in rabbits immunized by heterologous red blood cells]. Skin allografts were done in rabbits previously immunized with sheep red blood cells at 1-10 day intervals. Results showed that mean allograft survival was not delayed, nor was accelerated rejection observed. It is concluded that antigenic competition between sheep erythrocytes and skin allografts does not exist.


The current status of intrapartum fetal monitoring. Intensive intrapartum fetal monitoring, using direct fetal EKG leads and intrauterine pressure sensing transducers, seems to add another level of care for the fetus. As with other laboratory aids or devices, fetal monitoring data should not be exclusively relied on in decision making processes. When used with other modern monitor aids, such as scalp pH, it can aid immensely in the management of both normal and complicated labors. When fetal heart rate patterns remain normal throughout labor there can be a high degree of confidence that the fetal outcome will be good. If abnormal patterns occur, however, great care should be taken in interpreting these data, and it should be combined with the overall status of the mother and the fetus, and used together with the clinical acumen of the physician in determining a method of approach to the management of intrapartum situations. Continuous monitoring techniques can and should be applied in the neonatal nursery for intensive neonatal management and care (79,80). As experience is gained in clinical fetal monitoring and as new techniques and methods become available, intensuve intrapartum fetal monitoring will become an increasingly important and significant technique for management of labor (4, 139).


Herpes type-2 virus antigens in human cervical carcinoma. Exfoliated cells from the cervices of 22 patients with histologically diagnosed squamous cell carcinoma of the cervix and from those of 24 control women were examined for herpes subtype 2 (HT-2) antigens by indirect immunofluorescence studies. This method demonstrated that cells from all the patients with carcinoma contained antigens related to HT-2 virus. In contrast, squamous cells from the cervices of 24 control women with no cervical disease and of 2 women with chronic cervicitis did not contain such HT-2 antigens. Although an etiologic role of HT-2 virus infection cannot yet be established, it is probable that such infection precedes neoplastic changes.


Monozygotic twins discordant for urinary tract anomalies and presenting as hydramnios. This report describes premature monozygotic twins, 1 of whom had an unusual clinical manifestation of a rare congenital anomaly, the other being normally developed. Hydramnios had been suspected during pregnancy and, because of the severity, amniocentesis was attempted. However, it became evident that the hugely distended abdomen did not indicate hydramnios, the pregnancy actually being complicated by oligohydramnios. Pulmonary hypoplasia was the cause of the immediate neonatal demise of 1 twin; the other expired after prolonged therapy for meconium aspiration. No similar cases have been reported in the literature which is reviewed briefly. Particular attention is given to discordant anomalies in monozygotic twins, the mode of their placentation, and the development of amnion nodosum.