Effect of hyperoxia, hypoxia, and maturation on superoxide dismutase activity in isolated alveolar macrophages. The influence of ambient O2 tensions and of cell maturation on superoxide dismutase activity were studied in tissue culture--maintained mouse alveolar macrophages. Cultivation under hyperoxic conditions (PO2 about 640 mmHg) for 24 hours was associated with a significant increase in superoxide dismutase activity as compared with normoxic conditions (PO2 approximately 150 mmHg). (Hyperoxia: superoxide dismutase = 7.9 +/- 4.0 (SD); normoxia: superoxide dismutase = 4.4 +/- 1.7 units X mg cell protein-1 P less than 0.05). Hypoxic exposure (PO2 approximately 15 mmHg) was associated with a significant decrease in superoxide dismutase compared to normoxic controls (hypoxia: 2.2 +/- 0.6; normoxic: 3.8 +/- 0.6 units X mg protein-1 P less than 0.01). This decrease was found only after 168 hours of in vitro hypoxia. The in vitro maturation of alveolar macrophages cultivated in air was associated with a progressive increase in superoxide dismutase activity per 10(6) cells, although superoxide dismutase activity per unit protein remained constant. Molecular O2 may modify cell superoxide dismutase activity by altering intrinsic enzyme regulation. The increase in superoxide dismutase activity with hyperoxia and the decrease with hypoxia are consistent with but not unequivocally establish an important role for superoxide dismutase in protecting against cellular O2 toxicity.


Cell line A549: a model system for the study of alveolar type II cell function. Cell line A549, a continuously cultured line derived from a human pulmonary adenocarcinoma that has morphologic and biochemical features of the pulmonary alveolar type II cell, was studied with regard to saturated phosphatidylcholine synthesis and secretion. Evaluation of a number of culture media showed that those media that supported the most rapid rate of in vitro growth were least optimal for saturated phosphatidylcholine synthesis. Similarly, a labeled precursor (choline labeled with tritium) was most efficiently converted to saturated phosphatidylcholine when growth was slow or arrested, whereas during phases of active cellular proliferation a greater proportion was incorporated into unsaturated (structural) phosphatidylcholine. De novo synthesis of phosphatidylcholine was primarily via the cytidine diphosphate-choline pathway, because no incorporation of labeled methyl groups from S-adenosyl-L-methionine was observed. Cortisol stimulated tritium-labeled choline incorporation into saturated phosphatidylcholine in a manner that likely involed a steroid receptor system, whereas cortisone was inactive. The half-life of cellular saturated phosphatidylcholine was of the order of 100 hours and could be accounted for virtually entirely by release of this phospholipid into the medium unchanged. Both cholinergic and adrenergic agents in high doses modestly stimulated the release of pre-labeled saturated phosphatidylcholine from the cells, and the response to these secretagogues was significantly enhanced by cortisol. Cell line A 549 promises to be a useful model system for studies of the cellular events involved in pulmonary saturated phosphatidylcholine synthesis and secretion.


Chronic obstructive airway disease in patients with Sjögren's syndrome. To determine the incidence of airway disease in Sjögren's syndrome, respiratory function was evaluated in 13 patients with this disorder. Six patients had clear evidence of airway disease without overt evidence of loss of elastic recoil, and 7 patients had normal pulmonary function studies. Five of the 6 patients with abnormal pulmonary function studies had never smoked cigarettes. Of the patients with severe airway disease, all had exertional dyspnea but none had chronic cough with sputum production or recurrent bronchospasm. The 3 patients with the most severely impaired pulmonary function studies showed abnormal single-breath nitrogen curves, increased residual volumes, and hypoxemia, whereas static pressure-volume curves and maximal static elastic recoil at total lung capacity were within predicted norms. Lung biopsy of 2 patients showed mononuclear cell infiltration aroung narrowed small airways. We concluded that certain patients with Sjögren's syndrome develop an unusual type of chronic obstructive airway disease, which is probably a result of a chronic mononuclear cell inflammatory process similar to that seen in their salivary and lacrimal glands. The data suggest that human airways should be considered another target organ of Sjögren's syndrome. Earlier reports have stressed the association of a restrictive pulmonary defect with Sjögren's syndrome. Our data suggest that the restrictive pulmonary defect seen in patients with the complete variation of Sjögren's syndrome is probably the result of the associated connective tissue disorder, rather than the result in the sicca complex.


Mitochondria of the pulmonary granular pneumocyte in different species. We used stereologic methods to determine the surface density and surface-to-volume ratio of mitochondrial inner membranes and cristae in pulmonary granular pneumocytes of the mouse, rat, rabbit, and dog. We also measured mitochondrial length and width and calculated their volume. The surface density of the cristae and inner membrane and the mitochondrial volume have a direct linear correlation with the oxygen consumption of lung slices of the different species. We found an indirect linear correlation between the surface-to-volume ratio of the mitochondrial inner membrane and cristae and the lung's oxygen consumption in the different species.


The effect of atropine on acute antigen-mediated airway constriction in subjects with allergic asthma. Exposure to antigen by inhalation challenge may produce airway constriction in patients with allergic asthma. To examine the role of reflex bronchoconstriction mediated by the vagus nerve in the antigen-induced airway response, we compared the responses of 6 asthmatic volunteers to inhaled ragweed antigen alone and to antigen given after pretreatment with atropine sulfate, a parasympathetic blocking agent. We found significant increases in airway resistance, limitation of parasympathetic blocking agent. We found significant increases in airway resistance, limitation of forced expiratory flow, increases in lung volumes, and alterations in the distribution of inspired gas after antigen was given. When subjects were pretreated with atropine, we found a mean increase in the 1-sec forced expired volume of 0.380 liter (P less than 0.025) and a mean increase in specific airway conductance of 0.067 sec-1-cm H2O-1 (P less than 0.005). Atropine pretreatment did not prevent the responses to antigen in our subjects. After atropine pretreatment subjects began the antigen challenge with better pulmonary function and at a given antigen dose maintained a better level of function compared to when antigen was given alone. Differences in the absolute level of pulmonary function between the two challenges became smaller with the administration of larger antigen doses. We conclude that reflex bronchospasm involving postganglionic efferent parasympathetic nerve pathways is not a major component of the response to inhaled antigen in human allergic asthma.


Relationship between bronchial reactivity, airway caliber, and severity of asthma. Indices of bronchial reactivity were obtained in 11 asthmatic subjects. These were based on the responses of specific airway conductance to timed cumulative doses of methacholine aerosol. The relationship of bronchial reactivity both to initial airway caliber and to current severity of asthma was then assessed. There was no correlation between initial airway caliber and the degree of bronchial reactivity for the group. Furthermore, a subject's bronchial response to methacholine, when expressed as a percentage of initial specific airway conductance, remained stable, even in the presence of moderate fluctuations in initial specific airway conductance. There was also no correlation between bronchial reactivity and severity of asthma for the group. Each subject's bronchial responses remained stable, even in the presence of moderate fluctuations in severity of asthma. These data confirm that a simple relationship between intrinsic bronchial reactivity and the severity of clinical asthma is not apparent.


Pulmonary mechanics in patients with respiratory muscle weakness. Pulmonary mechanics and respiratory muscle pressures were studied in 7 patients with severe respiratory muscle weakness. Minimal pleural pressures were grossly abnormal and showed little variation with lung volume. Both the maximal transpulmonary pressure and static expiratory compliance were low; therefore, the pressure-volume curves of the lungs resembled those obtained after strapping the chest in normal subjects. The low compliance may result from either microatelectasis or a generalized alteration in alveolar elastic properties and is probably a major determinant of both the total lung capacity and the breathing pattern of patients with neuromuscular disease. Airway and gas exchange function were less abnormal than the elastic properties of the lungs.


Mechanics of breathing in patients with atrial septal defect. Mechanics of breathing and pulmonary diffusing properties were investigated in 24 adult patients with atrial septal defect. The patients were divided into 3 groups according to mean pulmonary artery pressure: less than 19 mm Hg (group I), 20 to 24 mm Hg (group II), and greater than 25 mm Hg (group III). The only change observed in group I was a marked increase in diffusing capacity. Patients of group II showed not only an increase in diffusing capacity, but also an overt decrease in maximal expiratory flow at all lung volumes and at any given driving pressure. For these two groups, a highly significant inverse correlation was found between changes in diffusing and elastic lung properties (r = -0.71; P less than 0.001). In patients of group III, the expiratory flow remained clearly decreased; furthermore, lung compliance and lung volumes were sharply reduced, airway resistance was elevated, and diffusing capacity was normal. Finally, from group I to group III, the lung elastic recoil became progressively diminished at small lung volumes. These results suggest that an increased pulmonary blood volume induces an increase in diffusing capacity and a slight decrease in lung compliance. Simultaneous existance of high intravascular pressure strengthens the effects of increased pulmonary blood volume on lung mechanics and results in significant abnormalities in the lung mechanical behavior. It is postulated that these effects are due to a competition for space between vessels and airways within the bronchovascular sheaths, with a subsequent compression of small airways.


The closing volume test: evaluation of nitrogen and bolus methods in a random population. The closing volume test, using helium bolus and nitrogen washout techniques simultaneously, was evaluated in more than 1,900 persons randomly selected as representative of the white population of Tucson, Arizona. Normal values were based on data obtained from those totally asymptomatic persons who had never smoked cigarettes. In the remaining population, the slope of Phase III appeared to be more sensitive than any other measurement in detecting abnormalities, but all measurements taken in conjunction were superior to any single parameter. Closing volumes measured by the bolus method were systematically greater than those obtained by resident nitrogen technique in normal subjects and were slightly more sensitive in detecting abnormalities in other population subgroups. Nevertheless, the single-breath test was of only limited value in distinguishing asymptomatic smokers from nonsmokers. Parameters used in conjunction revealed abnormalities in 36% of symptomatic subjects, many of whom already had physician-confirmed obstructive pulmonary disease. Our data suggest that, when applied to a randomly selected population, abnormalities in the closing volume test occur in only a very small proportion of persons in whom a respiratory disorder would not otherwise be suspected or already diagnosed.


Effect of increased static lung recoil on ventilation distribution in excised human lungs. The contour of a modified Fowler single-breath nitrogen washout was determined in 15 postmortem human lungs before and after static lung recoil had been increased by ventilation. Before ventilation, expiratory nitrogen versus volume curves exhibited the 4 phases similar to those seen in intact human lungs. The tests were repeated after ventilation with humidified air at room temperature for 3 hours at pleural pressures between -20 and +10 cm H2O at 15 breaths per min. After ventilation, the slope of the alveolar plateau (Phase III) decreased (P less than 0.01); the volume of Phase IV increased (P less than 0.01); and the closing capacity (Phase IV plus minimal volume) decreased (P less than 0.01). The data suggest that in the human lung the onset of Phase IV is not solely dependent on a pleural pressure gradient and that after ventilation, when static lung recoil is increased, the distribution of inspired gas in the excised human lung is more uniform, and at least some lung units empty more completely before zero transpulmonary pressure is reached.


Experimental emphysema induced with purified human neutrophil elastase: tissue localization of the instilled protease. Human neutrophilic polymorphonuclear leukocyte (PMN) elastase was purified by affinity chromatography to greater than 95% homogeneity as judged by disc-gel electrophoresis. Dog lung elastin was prepared from alveolar-enriched tissue by prior extraction of soluble and collagenous lung proteins with 0.1 M NaOH at 98 degrees C. Digestion of the remaining insoluble residue by the purified PMN enzyme was monitored by Lowry assay of acid-soluble peptides released. The PMN enzyme possessed 60% of the digestive activity of crystallized porcine pancreatic elastase (weight:weight comparison) when tested in vitro against this substrate in phosphate-NaCl buffer at pH 7.5. Whole tissue studies were then performed in lungs of laboratory animals. One-ml samples containing purified PMN elastase were instilled into lavaged and saline-perfused isolated dog lung at the level of the sixth to seventh generation bronchus. Treatment with 384 mug of the PMN enzyme produced anatomic emphysema after a 90-min incubation at room temperature, which was comparable to that produced by 100 mug of porcine pancreatic elastase. Frozen sections of treated and control lungs were examined for the presence of PMN elastase by the indirect immunoperoxidase method using a monospecific rabbit antiserum against PMN elastase as the primary stain. Light microscopy revealed elastase bound to connective tissue in the treated lungs, in close proximity to aldehyde-fuchsin-counterstained elastic fibers. A similar experiment was tn of enzyme solutions containing 1;0 mg of elastase per ml produced discrete lesions within 90 min, as before. Light microscopic studies in conjunction with the indirect immunoperoxidase staining method again demonstrated elastase in association with connective tissue elements in the lesion area. In addition, part of the instilled protease could be demonstrated within alveolar macrophages. Electron microscopy combined with immunoperoxidase staining revealed direct attachment of th einstilled enzyme to elastic fibers within alveolar septa. In enzyme-treated tissue, some septa showed severe depletion of intercellular structures with the exception of colalgen, which was generally preserved. These results show that human leukocyte elastase penetrated dog alveolar septal connective tissue after airway instillation and that the enzyme attaches to elastic fibers, inducing histologic changes comparable to thos seen in human emphysema.


Acute silicosis in tombstone sandblasters. Four men developed silicosis after sandblasting tombstones for an average of 35 months; 3 of them died an average of 59 months after their first exposure to sandblasting. Lung tissue demonstrated noncaseating granulomas and silicotic nodules involving small arteries and veins in 3 patients and alveolar proteinosis in 2. X-ray energy spectrometry showed primarily elemental silicon in the lung parenchyma. One patient developed lupus erythematosus and another focal glomerulonephritis. Two developed pneumothorax. None had cultural or morphologic evidence of tuberculosis. Pulmonary function studies in all 4 patients revealed a restrictive pattern. Industrial investigations revealed that the patients wore inadequate personal protection equipment and were exposed to 5 times the threshold limit value for respirable silica.


A rebreathing method for measuring carbon monoxide diffusing capacity. A supplement to the single-breath method. A rebreathing method for measuring carbon monoxide diffusing capacity is described. The method can be used in patients whose vital capacity is too small, or whose cooperation is inadequate, for the single-breath method. The apparatus is simple and the same gas mixtures are used as for the single-breath method. The results obtained by the rebreathing method are similar to those by the single-breath method (80% of the results by the rebreathing method lie within 20% of the value by the single-breath method). The rebreathing method also provides a measurement of the functional residual capacity.


Ischemic colitis.

Ischemic colitis. Fifteen patients with ischemic colitis were treated; in every case the diagnosis was made at operation or autopsy. Abdominal pain, tenderness, and distention were the most common findings. Five patients had the transient form of the disease, two stricturing, and eight gangrenous. Five patients were operated upon, two because of stricturing disease, three because of gangrene of the colon. Both of the former patients survived, one of the latter. Diagnosis of transient ischemic colitis can be made by barium enema studies. This form of the disease is self-limiting and recovery should be expected. Stricturing ischemic colitis may be diagnosed by barium enema, but doubtful cases will require laparotomy and resection. It is difficult, if not impossible, to differentiate the gangrenous form of the disease from other abdominal catastrophes without operation. When the condition is found at celiotomy, bowel resection without anastomosis is recommended.


Thyroid carcinoma in children.

Thyroid carcinoma in children. A study was made of 24 children under 15 years with thyroid cancer diagnosed during the years 1959-1967. None of the children had received irradiation treatment prior to diagnosis. Treatment took the form of surgery in combination with hormone and/or irradiation therapy. Of the 24 patients, only one died as a result of postoperative complications, even though 17% had lung metastases and 58% lymph gland metastases. The children were observed on average seven years, 10 months and the longest period of observation was 12 years, six months. The treatment recommended is total lobectomy on the affected side and subtotal on the opposite side. Cervical lymph glands with metastases are extirpated. Thyroid hormone treatment should be given immediately after surgery.


Penetrating torso injuries: the role of paracentesis and lavage. Controversy still exists regarding the proper approach to patients with penetrating torso injuries. Mandatory immediate celiotomy and selective observation both have associated risks. Paracentesis with lavage is a rapid, easily performed and readily available technique which can, with a high degree of accuracy, differentiate on initial evaluation those patients with penetrating visceral injuries from those without such injuries. Complications are minimal. The use of these two procedures in evaluating penetrating torso injuries has led to improved patient care and produced major lowering of medical and socioeconomic costs.


[Endocardial fibroelastosis. Pathologic and clinical findings in 20 cases (author's transl)]. Pathologic and clinical findings in 20 infants with Endocardial Fibroelastosis are reported. Ten cases were considered as secondary Fibroelastosis due to left heart structural anomalies. Purpose was to find some clinical criteria to establish differential diagnosis between primary and secondary forms. QRS voltages in electrocardiogram were higher in primary forms and QRS axis in the frontal plane had more rightward deviation in secondary ones.


[Beckwith's syndrome. Pathological aspects (author's transl)]. A new observation of Becwith's syndrome is presented. Being a still birth a pathological study could be accomplished. Pathologycal findings are commented.


[Dyschondrosteosis associated with turner's syndrome (author's transl)]. A case of Dyschondrosteosis associated with Turner's syndrome is presented. There is no evidence of an autosomal dominant inheritance. The patient shows the typical clinical and radiological aspects of this disease, with severe intensity. Mental retardation is also important.


[18 short arm deletion. Report of one case (author's transl)]. A two month old boy with multiple malformations: mental retardation, microcephaly, hyperterloism, displasic ears, hypospadias, unilateral cryptorchidism and holoprosencephaly is presented. In leukocytes culture, patient shows a deletion of the short arm of a 18 chromosome. This aberration apears "de novo" in this patient.


[Nezelof syndrome with secondary immunodeficiency (author's transl)]. A child with recurrent infections is presented. The frequent diarrhea leads to a severe malnutrition. The immunological work-up disclosed: absent IgA and low IgG serum levels, deficient cellular immunity and abnormal neutrophil chemotaxis. The cellular immunity and the neutrophil chemotaxis were improved with the nutritional status. At present the patient shows a partial combined immunodeficiency. The diagnosis of the case as a Nezelof's syndrome is discussed, as well as the addition of a secondary immunodeficiency caused by the recurrent infections and the malnutrition.


[Hypoglycemia. First manifestation of diabetes mellitus in children (author's transl)]. Nine children were sent to the authors for hypoglycemia and familial history of diabetes mellitus. After oral glucose load abnormal responses in insulin secretion were obtained in all of them, and in one patient blood glucose curve was consistent with probable chemical diabetes.


[E.E.G. in hydrocephalia with shunt (author's transl]. Twenty five cases of infantile non-tumoral hydocephalia that have been submitted to shunt therapy are presented. These cases presented EEG alterations of a focal character which were persistant or transitory at some point in their evolution. These alterations are attributed to lesions provoked by the catheter after perforating cerebral cortex or to intraventricular extreme in the same ventriculum where catheter was implanted or in contralateral ventriculum after performation of the septum pellucidum. These lesions can possibly provoke epileptical seizures and are more frequent in those cases with a larger number of surgical interventions secondary to obstructions of the shunt due to major trauma to which they have been submitted. It should be noted that the above facts need to be taken into account in order to realize an adequate therapy.


[Diabetes insipidus in infancy. II. Study of eleven cases (author's transl)]. Eleven cases of diabetes insipidus are revised and distributed in the following four groups: I. Idiopathic diabetes insipidus, three. II. Secondary diabetes insipidus, four. III. Nephrogenic diabetes insipidus, two. IV. Psychogenic diabetes insipidus, two. In all these cases, clinical parameters, general analysis, hydric metabolism (static and dinamic), are studied. The precocious beginning of psychogenic diabetes insipidus, and some conclusions, on a difficult case of hard diagnosis are emphasized.


[Neuroleptoanalgesia in pediatric anaesthesiology (author's transl)]. An anaesthetic technique based on the use of a neuroleptic agent (Droperidol) and an analgesic (Fentanest) called Neuroleptoanalgesia, applied to Pediatric Surgery is presentend. This technique has been used in a series of 33 infants undergoing various surgical procedures. Doses given, results obtained and possible complications are discussed. This anaesthetic technique is considered of election in high risk surgical pediatric patients.


[Cleido-cranial-pubic dysostosis (author's transl)]. Four cases of cleido-cranial dysostosis asociated to pubic dysostosis are presented in its' two forms; sporadic and familiar. Some chromosomal anomalies which have been described by several authors in the last years are pointed out. Denomination of pubic-cleido-cranial dysostosis as more appropiated for this entity is proposed.


[Blue rubber bleb nevus (author's transl)]. A case of Blue Rubber Bleb Nevus in a 11 year-old boy is reported. The patient exhibited characteristic hemangiomas of the skin and gastrointestinal tract with an iron deficiency anemia. Historical, clinical, pathological, and surgical features of the condition are discussed. Value of fibroscopic examination in delineation of the cause of persistent gastrointestinal bleeding is pointed out.


[Anomalous origin of the right pulmonary artery from ascending aorta (author's transl)]. One case of anomalous origin of the right pulmonary artery from ascending aorta is reported. The anomalies in the origin of the main pulmonary branches are classified in Type A: Anomalous origin of a pulmonary artery from ascending aorta; Type B: Anomalous origin of a pulmonary artery from the aortic arch through a ductus arteriosus, and Type C: Absence of a pulmonary artery with pulmonary vasculariation through systemic arteries arising from descending aorta. The normal embryology of the 6th. aortic arch and the pulmonary branches and the differents theories postulated about the embryopathogenesis of these malformations are reviewed. The outstanding clinical, hemodynamic, angiocardiographic and surgical features are also discussed.


[Thoracic asphyxiant dystrophy and renal disease (author's transl)]. The case of two brothers with thoracic asphyxiant dystrophy, associated with cystic renal dysplasia in one of them, is reported. Differential diagnosis with other chondrodystrophies, specially with the Ellis van Creveld Syndrome is made, and the influence of the nephropathy on the vital prognosis of the affection is pointed out. The photographs show the characteristic and differential signs of this entity.


[Desquamative interstitial pneumonia in a 3-month-old boy]. It is described a desquamative interstitial pneumonia in a three months old infant, in whom the diagnosis was established by necropsy. It is the 5th case younger than six months of age, published in the literature. The clinical and pathologic features of disease are briefly reviewed.


Detection of renovascular hypertension with angiotensin II blockade. Angiotensin II blockade with sarcosine 1-alanine 8-angiotensin II (saralasin, P-113) was done in 40 studies of 20 hypertensive patients. Eleven of 12 patients with a depressor response to angiotensin II blockade had significant renovascular or renal disease, and nine of 10 had renal vein renin measurements that lateralized to the abnormal kidney. In contrast, none of the patients without a depressor response had renovascular abnormalities. Plasma renin activity was usually high in responders to saralasin (18 ng/ml-h) when compared with nonresponders (0.5 ng/ml-h). In these studies a correlation between the fall in blood pressure and the rise in plasma renin activity during angiotensin II blockade was observed while renin was unchanged in the absence of depressor responses. In two renovascular renin-dependent hypertensive patients, treatment with diuretics induced severe hyperreninemia and a rise in blood pressure that was reversed by sodium loading.


Impaired renal tubular potassium secretion in systemic lupus erythematosus. Two patients with long-standing systemic lupus erythematosus were found to have persistent hyperkalemia. The hyperkalemia could not be explained by renal insufficiency, oliguria, diminished distal sodium delivery, acidemia, or hemolysis. After sodium depletion, urinary aldosterone excretion and plasma aldosterone concentration rose appropriately. No increase in urinary potassium excretion or decrease in serum potassium concentration was noted after fludrocortisone acetate, furosemide, or acetazolamide plus sodium bicarbonate. We conclude that these patients have a primary defect in renal tubular potassium secretion that may be related to an immune complex interstitial nephritis.


Celiac axis compression: experience with 20 patients and a critical appraisal of the syndrome. Twenty patients with celiac axis compression were treated surgically during a 5-year period. Fifteen remain asymptomatic, two are partially improved, two are unimproved, and one has been lost to follow-up. The main presenting symptom was upper abdominal pain--constant in some, intermittent in most--and the main diagnostic clue was a loud, localized systolic bruit in the midepigastrium. All had angiographic confirmation of the diagnosis. Ten had previous surgery (appendectomy, cholecystectomy, vagotomy, and pyloroplasty), without relief. The authenticity of celiac axis compression as a symptom-producing entity is difficult to establish objectively because the main treatable symptom is pain. However, eight of these patients gained weight, three have shown improvement in pancreatic function, and one of the unimproved patients still has an occluded celiac axis. A critical review of the literature of this controversial topic is included.


Pigmented corneal rings in non-Wilsonian liver disease. Kayser-Fleischer rings are pigmented corneal rings at the limbus of the cornea in Descemet's membrane that have been deemed pathognomonic of Wilson's disease. However, we have observed four exceptions in patients with non-Wilsonian liver disease. Three patients had primary biliary cirrhosis and one patient had chronic aggressive hepatitis with cirrhosis. Pigmented corneal rings were seen only by slit-lamp examination. Hepatic, serum, and urinary copper and serum ceruloplasmin levels were significantly elevated in the patients with primary biliary cirrhosis. Radiocopper (64Cu or 67Cu) studies in patients with primary biliary cirrhosis showed plasma disappearance curves which allowed a clear distinction from Wilson's disease in that all three patients with primary biliary cirrhosis showed a secondary rise in radiocopper that presumably represented copper incorporation into ceruloplasmin. In one patient, in whom 64Cu in ceruloplasmin was studied specifically, incorporation was found to be normal.


Abnormalities of circulating 25-OH vitamin D after jejunal-lleal bypass for obesity: evidence of an adaptive response. Circulating levels of 25-OH vitamin D were measured in 44 patients who had undergone small intestinal bypass for obesity. Sixty-one percent had low circulating levels of the metabolite, which tended to normalize with time. This adaptive response also occurred for circulating total calcium, magnesium, albumin, and alkaline phosphatase. Serum concentrations of 25-OH vitamin D were directly related to total serum calcium and albumin. Impaired intestinal absorption of 25-OH vitamin D was seen in two patients. Following correction of total serum calcium for attendant hypoalbuminemia, 27% of patients remained hypocalcemic. The bone densities of two of 32 patients were low. In addition, skeletal biopsies of three of six patients were abnormal. It is concluded that small intestinal bypass results in at least transient deficits of circulating 25-OH vitamin D. As this operation may be associated with abnormal bone morphology, clinically significant skeletal disease may become apparent with long-term follow-up.


Sporotrichosis arthritis: clinical features in seven patients. A review of the clinical features of seven patients with sporotrichosis arthritis showed that six had joint infection without previous skin or lung involvement and that one with myelofibrosis had joint and skin infection. The average time from onset of joint symptoms to diagnosis was 25 months, resulting in joint damage that required arthrodesis in four patients. Tissue from open synovial biopsy was superior to synovial fluid for obtaining a positive culture; concomitant synovial fluid and synovial tissue cultures were superior to either one alone. Granulomatous inflammation was seen in synovial tissue in six patients biopsied. Amphotericin B with surgical debridement of the affected joint was successful treatment in four patients. Although an uncommon cause of joint disease, sporotrichosis arthritis may go unrecognized and mimic other forms of arthritis, resulting in irreparable damage in an otherwise curable form of arthritis.


Acute intravascular hemolysis and acute liver failure associated as a first manifestation of Wilson's disease. In three patients, the first manifestation of Wilson's disease was a syndrome in which acute intravascular hemolysis and acute liver failure were associated. This syndrome developed in three periods; the first, lasting 3 to 14 days, was characterized by fatigue, fever, and jaundice; the second, lasting 1 or 2 days, by severe intravascular hemolysis; and the third, lasting 2 to 6 days, by hepatic encephalopathy. All of the patients died from liver failure 7 to 21 days after the onset of the syndrome. The association of acute intravascular hemolysis and acute live failure is a characteristic manifestation of Wilson's disease; it is rarely associated with other liver diseases. This association might result from hepatic cell necrosis due to accumulation of copper, the consequences being acute liver failure and destruction of erythrocytes by the large amounts of copper released from the necrotic hepatic cells to the plasma.


The anion gap in asymptomatic plasma cell dyscrasias. The presence of a low anion gap in patients with multiple myeloma has recently been emphasized. This has been related to the retention of chloride and bicarbonate anions to offset the cationic charge of the monoclonal immunoglobulins. We now report the presence of a low anion gap in 50 patients with asymptomatic plasma cell dyscrasias. No correlation was found between the size of the anion gap and the height of the paraprotein "spike" or the size of the anion gap and an index of the net cationic charge of the monoclonal immunoglobulins.


The myth of acute "mild" myocardial infarction. Patients with acute myocardial infarction and an uncomplicated early clinical course are often thought to have suffered a mild myocardial infarction. There is also a tendency to link ECG changes suggestive of nontransmural necrosis with such a benign clinical course. Recent work proves that such patients have the same short- and long-term prognosis, similar angiographic and hemodynamic patterns, and deserve management identical to that for patients with transmural myocardial infarction. It is hoped that by combining the older modalities with new diagnostic methods it will be possible to quantitate the magnitude of old and new myocardial ischemic necrosis on which prognosis to a great extent is based.


Simulated pituitary apoplexy: report of an unusual case due to hemorrhage into hypothalamic astrocytoma. An unusual case of acute bilateral loss of vision simulating pituitary apoplexy but due instead to a fatal hemorrhage into a hypothalamic glioma is reported. The clinician dealing with abrupt loss of vision must promptly rule out ocular and orbital causes and then proceed immediately to a consideration of the variety of intracranial lesions which may cause sudden visual loss. Uihlein and Rucker have listed them in descending order of frequency: pituitary adenoma, tumors of the optic nerve and chiasm, supraclinoid aneurysm, parasellar lesion, thrombosis of the carotid artery, hydrocephalus of the third ventricle, chiasmal arachnoiditis, fracture of the anterior cranial fossa, basofrontal tumor of the skull, and pseudotumor cerebri. Neurologic, ophthalmologic, and neuroradiologic evaluations should be obtained without delay and will usually define the lesion and point to the appropriate treatment.


Segmental retinal periarteritis as a complication of toxoplasmosis. Segmental retinal periarteritis is a relatively rare clinical entity with varied etiologies. This report describes a case of acute toxoplasmosis with segmental periarteritis without concomitant periphlebitis. To my knowledge this has never been reported previously. The diagnosis of toxoplasmosis was proven by both clinical findings and serology.


A retinal drawing teaching model for indirect ophthalmoscopy. A retinal drawing teaching model for indirect ophthalmoscopy is described. It can be made simply and inexpensively to help reduce some of the frustrations inherent in learning retinal drawing and indirect ophthalmoscopy.


Papillophlebitis associated with systemic thrombophlebitis: case report. This 36-year-old white man developed signs and symptoms of mild reversible papillophlebitis associated with calf thrombophlebitis and subsequent mammary and antecubital vein phlebitis after fluorescein angiography.This in flammatory process in conjunction with phlebitis elsewhere in the body strongly suggests that localized phlebitis of the central retinal vein, perhaps near its exit from the optic nerve, is etiologic in papillophlebitis. Response to corticosteroids tends to support this theory.


Hyaloid vascular remnants in human neonates. A consecutive series of 226 infants was examined within 36 to 48 hours of birth using direct and binocular indirect ophthalmoscopy. Hyaloid vessel remnants were observed in over 90% of infants of less than 36 weeks gestation and in over 95% of infants weighing less than 5 lbs at birth. The majority in these groups were complete remnants. The number of complete remnants in preterm and low birth-weight infants was significantly higher than previously reported. The distinctive and orderly changes in the premature eye were suggested as a possible method of gestational assessment.


Acute posterior multifocal placoid pigment epitheliopathy. A typical affection of the pigment epithelium was described for the first time by Scuderi and colleagues in 1948, characterized by visual loss and the ophthalmoscopic finding of exudative, yellowish white spots at the posterior pole, a favorable course and a quick healing, defined as "benign external exudative retinitis." We illustrate another 13 cases of this disease angiographically studied and define its characteristics, proposing the denomination of "acute posterior multifocal placoid pigment epitheliopathy." We underline that the multiple placoid pigment epitheliopathy described by Gass and co-workers in 1968 is identical to the disease described by Scuderi in 1948.


Symblepharon repair using a silicone sheet implant. A technique utilizing a thin silicone sheet and a polyethylene tube to surgically repair symblepharon is described. A summary of cases treated by this technique is reviewed and other areas for further study are discussed.


[Pseudo-late onset cutaneous parphyria in haemodialysis patients. Clinical and histological features. 9 cases (author's transl)]. In the context of a study of cutaneous problems seen in chronic renal failure patients on intermittent haemodialysis, the authors noted bullous eruptions very similar to late onset cutaneous porphyria. The bullae occur during the summer and are situated on exposed areas, in particular the head and neck. There is skin fragility and the bullae are transient, giving place to erosions and later to atrophic scarring. Even pseudo-miliary cysts have been observed. Histology reveals a sub-epidermal bulla, the basis of which consists of spiky papillary dermis. Immunofluorescence show immunoglobulin deposits in the vessels and basal membrane. All porphyrin measurements are negative. This disorder may be due to the presence of a non-porphyrinogenic photo-sensitising substance, found in certain types of plastic tubing.


[The difference forms of "parapsoriasis en plaques". A report of 90 cases (author's transl)]. The term parapsoriasis was used by Brocq (1902) to group a number of conditions previously described under different names. This group has since then been modified, the same conditions being described under separate names and these have led to a great confusion especially between countries. In this study of 90 cases, three types of parapsoriasis en plaques are distinguished. The "parapsoriasis digitiforme" (40 cases) or benign type, or xanthoerythrodermia perstans, or chronic superficial dermatitis is characterized by small, oval or finger-like, yellow or pink patches. The histology is frequently not characteristic, but in a few cases, there is an exocytosis localized "en flammèches" in the epidermis. The condition is usually permanent but none of these cases has progressed to mycosis fongoides. The parapsoriasis "en grandes plaques simples" (25 cases) is characterized by few pink patches (3 to 5), larger than in benign type. In our cases the transformation to poikiloderma atrophicans vasculare is not observed. One of these cases progressed to mycosis fongoides. The "parapsoriasis en grandes plaques poïkilodermiques" (25 cas), or poikiloderma atrophicans vasculare, prereticulotic poikiloderma, atrophic parapsoriasis, parapsoriasis lichenoides, is characterized by large patches, in limited number, showing a reticulated pigmentation and slight atrophy with telangiectasia. Five cases changed into mycosis fongoides and 4 cases showed some symptoms of malignancy; The histologic features are the same in the two last types: sometimes they are non-specific, in numerous cases the picture is characteristic with micro-abscesses or "flammèches"; in some cases there is a dense infiltrate with a clearly defined lower limit: this histologic appearance can be seen in cases without transformation into mycosis fongoides.


[Gunther's congenital erythropoietic porphyria in an 8-month old girl (author's transl)]. A typical case of congenital erythropoietic porphyria in a 8 month old girl is reported (photosensitive blistering syndrome, hypertrichosis; erythrodontia; fluorescence of urine, teeth, erythrocytes and myeloblasts; splenomegaly; anaemia). Porphyrins, isomers I, were present in urine and blood. In faeces a porphyrin-X-like substance migrating as PX was detected; this porphyrin was finally identified as CP I unusually difficult to extract because of the presence of a banding and fluorescence quenching agent probably of exogenous origin. The usual methods are not always able to extract and to identify the faecal porphyrins.


[Keratosis lichenoides striata associated with a pseudo-sinhum and a neurological picture (author's transl)]. The authors reported a case which does not seem to be possibly related to any known clinical entity; an aspect of keratosis lichenoides striata is associated with an ichthyosiform condition of the trunk and a pseudo-ainhum; there is also a neurological syndrome similar to a multilocular sclerosis. This patient resembles the previous cases of the literature; however there is neither erythema nor any striation at the back of the knees. There is also a pseudo-ainhumm. Concerning this observation, a review of the literature on keratosis lichenoides striata is presented.


[Cutaneous cholesterol emboli (author's transl)]. Fifty cases from the literature and one personal case of cutaneous cholesterol embioli are reviewed. These emboli come from abdominal atheromatous aotitis, sometimes complicated by aneurysm. The cholesterol micro-embolism is sometices induced by vascular surgery or arterial opacification. Male prevalence (47 cases) is evident. Alone or with visceral involvement, cutaneous lesions frequently simulate periarteritis nodosa: circumscribed to abdomen, thighs, legs, dorsum of the feet, the livedo reticularis is the most stricking feature associated or not with cutaneous nodes, purple toes, ulcers and gangrene. Histopathologic study is required for diagnosis: showing "negative" pictures of cholesterol cristals in an obliterating arteriolitis. Nevertheless special intetest is focused on a macrophagic granuloma centered in the vessel.


Day-stay surgery. Organization and teaching as applied to oral surgery. The administration of a day-stay oral surgery unit is described and applications discussed with special reference to senior dental students.


Intrabiliary rupture of hydatid cyst of the liver. Infestation with Echinococcus granulosus is common in Iraq, where a close relationship exists between dogs, the carnivorous definitive hosts, and sheep, the herbivorous hosts of the parasite. Plants contaminated by eggs of the tapeworm passed in the dog's faeces may be ingested by man, giving rise to hydatid disease. Of 136 cases of hydatid disease affecting various tissues and organs studied and treated during a 3-year period, the liver was involved in 94; intrabiliary rupture occurred in 15. Pain, hectic fever, and obstructive jaundice were invariable in these 15 cases but biliary obstruction became complete in only 7. A palpable mass in the liver was present in 10 cases. Mistaken preoperative diagnoses were made in 4 cases before the true nature of the disease was determined. In the light of our experience four main guidelines to operative management may be formulated: First, the mother cyst, daughter cysts, and debris must be evacuated. Second, the common bile duct must be explored and cleared of daughter cysts, membranous shreds, and hydatid stones and the ampulla of Vater must be dilated; however, sphincterotomy is rarely necessary and should not be performed as a routine. Third, unless there is clear evidence of inflammation or daughter cyst or stone formation in the gallbladder the organ should be preserved, since it may prove useful for future bypass procedures. Finally, the residual cavity of the mother cyst must be drained.


A new approach to the surgical treatment of hydatid cyst. Hydatid cysts of soft-tissue organs occur in five forms: univesicular, multivesicular, calcified (aborted), ruptured (into adjacent body cavities or host organ ducts), and infected. Each of these distinct forms requires an appropriate surgical approach. For uni- or multivesicular cysts uncontrolled spillage of fertile elements of the parasite is a major hazard. A new method using local freezing of the cyst's outer layer and 0.5% silver nitrate as a scolicidal agent effectively overcomes this problem. Calcified cysts can be left alone. Suppuration or rupture into adjacent body cavities or internal organ channels must be handled according to basic surgical principles and all of the parasitic material removed.


Scoliosis after termination of vertebral growth. A follow-up study of 34 cases shows that scoliosis after termination of vertebral growth is commonly a progressive condition. In the increase of scoliosis disc degeneration is the most important single factor. Further increase may result from lateral subluxation of the vertebra. Once disc degeneration is initiated further increase is inevitable. The results of the study also suggest that change in the disc is possibly more closely related to the nutritional and metabolic condition of the individual than to any other factor.


Necessity into choice. An appraisal of inguinal herniorrhaphy under local anaesthesia. A policy of using local anaesthesia whenever possible for the repair of inguinal hernias was adopted in Seychelles primarily because a constant supply of anaesthetic gases could not be depended upon. The technique adopted is described and the results obtained over an 18-month period are reported. Experience has shown that local anaesthesia for this operation has many advantages and few disadvantages and is now preferred to general anaesthesia except when contraindicated by special circumstances.


Peptic ulcer, pyloroplasty, and dietary fat. A new concept. The hypothesis that peptic ulcer is a manifestation of a generalized metabolic disorder caused by excess dietary fat intake is supported by the results in a series of 134 patients with proven gastric or duodenal ulcer treated with a simple 'fat-free' diet, together with pyloroplasty in 82 cases and simple suture of a perforated ulcer in 16. Relief of symptoms and healing of the ulcer resulted in the great majority of cases so long as the diet was strictly adhered to, and there have been no side effects or morbidity.


Intussusception in adults.

Intussusception in adults. A brief résumé of the important principles of diagnosis and treatment of intussusception in adults is presented, with 3 illustrative case histories.


Dissolution of retained choledochal calculi. The history of the technique of promoting dissolution of retained gallstones in the biliary tree is briefly reviewed. Present methods are described in detail and our own experience recorded. We have treated six patients with retained calculi by means of heparinized saline and sodium cholate infusions of the common bile duct. Successful dissolution of calculi was achieved in five cases, but one patient developed severe pancreatitis and renal failure which responded to peritoneal dialysis. We believe that the method is a valuable alternative to re-exploration of the common bile duct, particularly when calculi are situated in the distal part of the duct.


Development and application of a fully automated continuous flow radioimmunoassay system. A fully automated, continuous flow radioimmunoassay system is described. The antibodies are covalently linked to a magnetic cellulose solid phase and separation of bound and free antigen is achieved by applying an external electromagnetic field. The bound fraction, after washing, is counted in a flow-through gamma counter chamber. The system employing Auto Analyzer modules, is highly reproducible and allows assays to be performed without equilibrium being reached, and only 10 minutes incubation time is required. The method is universally applicable to the assay of ligands, either protein, hormone, or drug, and for obtaining information about binding proteins. A new approach to the latter has been developed and is illustrated by a fully automated thyroid hormone uptake test which gives better discrimination between normal and pathological states than existing assays. The system operates at 30 samples/h and is characterised by the high precision, speed, and minimal carry-over which can be achieved.


Simultaneous radioimmunoassay of thyroid hormones in unextracted serum. A combined radioimmunoassay for the two thyroid hormones is described which uses 125iodine labelled triiodothyronine and 131iodine labelled thyroxine. The assay employs a double antibody separation technique and is suitable for use with unextracted serum. The results from the simultaneous assay compare very well with the results obtained in the single assays, and the discriminating power and precision of the simultaneous assay is a least as good as in the single assays.


Flow cell modification of a filter fluorimeter producing improved throughput and precision. A modification of a Corning-EEL 244 filter fluorimeter to take a Hellma fluoronephelometric flow cell is described, and the characteristics of a standard flow cell and the Hellma flow cell are compared by the use of a continuous flow fluorimetric calcein-calcium method. The study shows that by this modification a considerable improvement in precision, carryover, and throughput is possible. The kinetically better Hellma flow cell enables speeds in excess of 70 per hour to be achieved with carryover and precision better than that obtained at 40 per hour with the standard flow cell. Curve regeneration of signals using the Hellma flow cell can also be carried out, enabling a further increase in analytical rate to be obtained.


Some physiological factors affecting the binding of cortisol by human plasma proteins. Steady-state gel filtration has been used to study the binding of cortisol to human plasma proteins in vitro. Raising the temperature from 37 degrees C to 41 degrees C results in the mean proportion of free (non-protein-bound) cortisol rising approximately from 7% to 11%. Addition of cortisol to plasma  identical to 275 nmol/l) also increased the proportion of free cortisol by approximately 50%. Cortisone is less strongly bound to plasma proteins than cortisol. The mean values (+/- S.D.) for five samples were free cortisol 8.4 +/- 1.1% and free cortisone 26.0 +/- 3.8%.


Differences in the calcium concentration of serum and plasma initially and after storage. Calcium concentrations of plasma and serum in glass and plastic containers initially and after storage for up to 8 months at--20 degrees C were compared. The mean initial calcium concentration of the plasma samples was 2.491 nnol/l and this was significantly higher than the mean serum concentration of 2.440 nnol/l. There were no significant differences in the mean calcium concentrations attributable to differences in glass or plastic as materials for storage containers for either serum or plasma. The mean calcium concentration of serum remained stable over the entire storage period, but that of the plasma samples fell significantly between one month and six months, with no further fall between six months and eight months.


Plasma calcium in acute myocardial infarction. Plasma calcium concentrations were measured in 18 patients suffering from acute myocardial infarction. Estimations were performed for several days after admission to hospital and a fall in plasma calcium was observed in 13 cases. Plasma albumin levels also decreased over this period, and correction of plasma calcium values to a fixed albumin level removed the apparent tendency to hypocalcaemia in these patients. Three patients with myocardial ischaemia showed similar decreases in plasma calcium and albumin. The observed changes are probably related to confinement to bed.


Inactivation in vitro of lactate dehydrogenase-5 in blood. During incubation with rabbit blood in vitro rabbit-muscle lactate dehydrogenase-5 was inactivated at a rate similar to that observed in vivo. By contrast plasma and plasma containing erythrocytes had no effect on the enzyme activity, but plasma containing leucocytes inactivated the enzyme at the same rate as whole blood. The results obtained support the concept that intravascular inactivation accounts for the diappearance of enzymes from the circulation.


Paracetamol estimation: comparison of a quick colorimetric method with a standard spectrophotometric method. A new colorimetric method for the estimation of plasma paracetamol was slightly modified and compared with a standard spectrophotometric method. Good correlation and no significant difference was found between results by the two procedures. Precision, accuracy, and recovery by the colorimetric method were acceptable. On the other hand it is less susceptible than the spectrophotometric method to interference by certain other drugs. The speed and simplicity of the colorimetric method, together with its satisfactory performance, make it a worthwile alternative to the spectrophotometric procedure.


Blood groups of the Irish.

Blood groups of the Irish. Some 1800 blood donors from the Republic of Ireland and Northern Ireland have been tested for the antigens A A1 B H; M N Ss Henshaw; C c Cw D Du E e Ce; Wra; P1; Lua; K k Kpa; Fya Fyb; and Rd (Radin). The results are compared with those already available for Ireland and an attempt is made to interpret them in terms of populations movements. With the exception of the high O frequency in the West, believed to represent the remnants of Mesolithic peoples, the blood groups are very similar to those in the rest of Europe, and show no significant differences between the different provinces in Ireland.


Red cell and serum proteins and enzymes of the Irish. The gene frequencies in a number of red cell and serum protein and enzyme polymorphisms were examined in blood specimens from some 1800 subjects in different parts of Ireland. In general, the gene frequencies are similar to other western European values, though AK2 and PGDC frequencies are slightly low and ADA2 slightly high. The populations of the different provinces of Ireland are generally similar in these polymorphic frequencies, though Ag, Lp and Gc suggest differences mainly involving the ancient province of Ulster.


Limb volume, composition, and maximum aerobic power output in relation to habitual 'preference' in young male subjects. Anthropometric data are presented for the preferred and non-preferred limbs of normal subjects together with measurements of one-limb maximum aerobic power output (V O2 max). The habitually preferred arms and legs were significantly larger in total volume (LV) when compared with the contralateral limbs (5 per cent, P less than 0-01; and 2 per cent, P less than 0-01 respectively). These differences were mainly attributable to variation in the size of the muscle component. Expressed in absolute terms, V O2 max achieved in exercise with the preferred legs was significantly larger than the non-preferred legs (2-84 cf. 2-74 l/min; P less than 0-01) and a similar but non-significant difference was found between the arms (1-10 cf. 1-05 l/min). If, however, V O2 max is standardized for the size of the active muscle mass (LV, muscle plus bone) these differences between the preferred and non-preferred limbs disappear. The implications of these observations are discussed.


Changes in morphology of human populations due to migration and selection. Anthropological characteristics of 115 young Israeli-born male Jews (18-25 years), offspring of immigrants from Russia and Poland, are described. The morphological changes in the young group are compared with a sample of 1914 from the "parent" group, and with two non-Jewish European groups--1547 in the 18-25 year age range and 3711 in the 40-60 age range. The results indicate a "migrational effect" acting in young migrant offspring as expressed in higher anthropological values. Statistically significant differences were observed among migrants and the original stationary population. A model is proposed for predicting the expected rate of variation of morphological parameters in the first generation of migrants.


A factor analysis of skeletal measurements in Warsaw students. Factor analysis by the Jöreskog method was applied to data obtained from measurements of 19 skeletal measurements of human physique, carried out in 1971 on 166 men and 122 women students of the Warsaw Technical University. Separate analyses were performed for three factors and four factors in both sexes. The basic three factors could be interpreted as: (i) Length of long bones (limb length), (ii) Size of hands and feet, (iii) Body breadth (skeletal frame size). In the four-factor analysis the fourth factor consisted of trunk length in both sexes, linked with head and neck length and biacromial diameter in men, but not in women.


[Oxygen demand of an Actinomyces rimosus culture dependent on  the composition of the medium]. Consumption of oxygen by Act. rimosus depending on the medium composition was studied. It was shown that the level of dissolved oxygen in the fermentation broth decreased as the level of carbohydrates in the fermentor increased from 6 to 7.5 per cent. Under such conditions oxytetracycline biosynthesis appeared to be limited by oxygen and the maximum level of the antibiotic was not attained. A 2-fold increase in the concentration of the medium components resulted in an almost 2-fold increase of the biomass, while the potency level increased only by 54 per cent. The oxygen deficiency lowered the mycelium productivity with respect to the antibiotic biosynthesis to a greater extent that the rate of the culture growth.


[Isolation of cephamycins from actinomycete cultures]. A method for isolation of cephamycins from culture fluids of actinomycetes was developed. It included the stage of effective purification of sulfocation exchange resin SDV-3 (H+) with water desorption. Further purificiation of the antibiotics was achieved with sorption on anion exchange resin and fractional precipitation. The method provided 95-96 per cent purity level of the preparations.


[Method of the spectrophotometric analysis of polyene antibiotics]. The method of quantitative spectrophotometric analysis of several substances in the presence of admixtures is described. The method is based on presentation of an unknown spectrum of the admixture absorption by the polyen of the 3rd or 4th power depending on the wave length. The optical density of the mixture of any wave length is expressed by the linear equation, including the Firord equation for the known components and the given polynome. The system of such equations for 10-15 analytical wave lengths may be solved with the method of the least squares using an electronic computer. The system solvations are the concentrations of the mixture components to be determined and the polynome coefficients. The method was tested on model mixtures composed of amphotercin B, myocheptin, nystatin and griseofulvin, as well as of isomeric nitroanilines playing the role of the admixture. The analysis error for the compounds of the polyenic structure having not less than 2 absorption maxima in the given spectral ranges did not exceed 1-3 per cent. As for the compounds with a single maximum or when the admixture included also polyenic compounds the analysis error increased up to 6--50 per cent.


[Biosynthesis of rubomycin. The glycosylation of exogenous rubomycin one and carminomycin one by a rubomycin-producing culture]. Production of rubomycin and carminomycinone glycosides by the rubomycin-producing organism was studied with the help of labeled rubomycin and carminomycinone. It was found that both substances were glycoxylized by the rubomycin-producing organism with production of the respective antibiotics. Non-labeled methionine did not decrease incorporation of rubomycinone labeled in the O-methy1 group into rubomycin. It is supposed that the methoxylic group of the latter is incorporated into its structure at early stages of its production, for example at the stage of polyketomethylen. Carminomycinone, which may be considered as desmethylrubomycinone not glycosylated by methylation.


[Variability of Act. noursei, the producer of nystatin, under the influence of the separate and combined actions of hydrogen peroxide and UV rays]. The lethal and mutagenic effect of hydrogen dioxide used alone and in combination with UV light on the nystatin-producing strain 408 of Act. noursei was studied. The spore survival decreased with an increase in the hydrogen dioxide concentration and the irradiation dose. When the above mutagens were used in combination the lethality was close to the expected one on the summation effect. Under the effect of hydrogen dioxide and most of its combinations with UV light the morphological variation of strain 408 was close to the natural variation or somewhat lower. This phenomenon was possibly associated with significant lethal effect of hydrogen dioxide on the morphologically changed forms of the strain. Variation of the nystatin-roducing strain with respect to nystatin production increased mainly at the account of higher rate of low active variants especially under combined effect of the mutagens. The lethal and mutagenic effect of the combined use of hydrogen dioxide and UV light on the nystatin-producing organism did not depend on the exposure sequence.


[Lincomycin concentration in human serum and pulmonary tissue]. Lincomycin levels in the blood serum and lung tissue were determined in 17 patients after surgical operations because of the lung diseases, the drug being administered in a dose of 500 mg. In 45 to 330 minutes after administration of the antibiotic its concentration in the blood serum and lung tissue was 4.6 +/- 10 lambda/ml(average 7.7 lambda/ml) and 1.4-8 lambda/gm (average 4.4 lambda/gm) respectively. The lincomycin level in the lung tissue amounted to 61 per cent of that in the blood setum. The concentration of lincomycin the lung tissue was several times higher than the minimum level necessary for inhibition of the strains included in the antibiotic antibacterial spectrum. Therefore, lincomycin is an important drug in the treatment of infections of the respiratory tract.


[Characteristics of streptomycin distribution and binding in the body of rabbits depending on their immunobiological state]. Some regularities of distribution and binding of streptomycin in the blood, organs and tissues of immunized rabbits werer studied. The leveles of the bound and free antibiotic in ther were determined. It was found that the immunobiological state of the rabbits had a definite effect on the distribution character and binding of streptomycin with proteins and cells in the animal organs and tissues. These changes were most pronounced in the organs and tissues of lymphoid and hematopoietic systems, the cells of which are indirect active participants of the immunity formation. As a result of proliferation of these cells the antibiotic was accumulated in higher amounts and bound more actively especially in the thymus gland and bone marrow, the central organs of the immunological reconstruction of the host. The studies are indicative of the presence of interaction between immunogenesis, distribution and binding of streptomycin in immunized animals.


[Effect of N-ethylenemaleimide on the inhibitory activity of cytostatics]. The cytostatic effect of endoxan, Tiotef, bleomycin and other drugs was increased by addition of a thioloprovic compound of N-ethylenmaleimide (N-EM) to the cultures of cancer cells in doses not affecting the synthesis of nucleic acids in these cultures. The sensibilizing effect of N-EM against the antitumor drugs was due to blocking of SH-enzymes responsible of synthesis or reparation of DNA. Thus, a simultaneous effect of N-EM on the thiol cycle and synthesis of nucleic acids was synergistic for a number of antitumor drugs. It provided an increased effect of the cytostatics in doses having no activity under conditions of routine in vitro tests.


Chemosurgery for melanoma.

Chemosurgery for melanoma. Microscopically controlled excision of melanoma by the chemosurgical method ensures complete eradication of any unsuspected outgrowths from the clinically observed tumor mass. The method differs from the chemosurgical techniques used for excision of cutaneous carcinomas in the following two respects: the tissues always are chemically fixed in situ before any incisions are made in order to minimize the chance of dissemination, and an extra margin of tissues is removed after reaching a microscopically melanoma-free plane in order to encompass possible outlying melanomatous satellites in the peritumoral lymphatics. In a series of 103 consecutive cases of melanomas of the nodular, superficial spreading, and lentigo maligna types, there were 86 determinate cases with a five-year cure rate of 50%. This is a high rate for a series in which 69% were nodular melanomas and 64% invaded to subcutaneous tissues (Clark's level 5).


Topical methoxsalen and blacklight in the treatment of psoriasis. Thirty patients with recalcitrant psoriasis were treated with topical methoxsalen and blacklight (UVA). A 1% concentration either in an acetone, alcohol, propylene glycol vehicle, or hydrophilic ointment, USP, applied two hours before light exposure was highly effective. Twelve patients were completely cleared and nine were markedly improved in three to five weeks. Plaque-type and guttate psoriasis responded best while exfoliative psoriasis benefitted less. Maintenance of a phototoxic reaction in the lesion was necessary for total resolution. Topical methoxsalen and blacklight is feasible for outpatient treatment of plaque-type psoriasis of limited extent.


Shortage of full-time faculty in dermatology. A persistent shortage of full-time faculty exists in dermatology. Despite the addition of 124 new full-time faculty since 1971 through 1972, 136 training programs in 1974 through 1975 were actively seeking 88 new full-time faculty and believed they needed 243. With a net gain of 30 new faculty a year, it will take 2.93 years to add 88 new faculty that are being actively sought and 5.16 years to add 155 more that are urgently needed. During this eight years, demand for new faculty will increase, so that figures of need may remain essentially unchanged in 1982 through 1983 and between 1971 through 1972 and 1974 through 1975. Expertise that was most needed was in immunology, electron microscopy, histopathology, microbiology, and biochemistry; many accept faculty in any area or with no special training. Measures should be taken to attract and retain more dermatologists in full-time academic positions.


Gastrointestinal absorption of griseofulvin from corn oil-in-water emulsions: effect of amount of corn oil ingested in man. The effect of the amount of emulsified corn oil ingested on the gastrointestinal absorption of griseofulvin in man was assessed after oral administration of 5, 10, 15, or 30 gm doses of a corn oil (40% w/w)-in-water emulsion dosage form, each containing 250 mg of microsize griseofulvin. For comparison, griseofulvin absorption from two-125 mg commercial tablets of ultramicrosize drug dispersed in polyethylene glycol 6;000 was also determined. Griseofulvin was almost completely absorbed from the microsize drug emulsions and ultramicrosize drug tablets, whereas 50% of an oral dose is absorbed from commercial microsize griseofulvin tablets. Only 4 gm of emulsified corn oil (as a 10-gm dose of emulsion) is required to maximize the uniformity and extent of griseofulvin absorptions. The emulsion dosage form is uniquely suited for pediatric use.


Giant basal cell carcinoma.

Giant basal cell carcinoma. Whereas basal cell carcinoma usually is a slow-growing tumor of the head and neck region, we have observed, over a 20-year period, three large, unique basal cell tumors of the back that were distinctive and presented clinical and histologic problems in diagnosis. They commonly formed exophytic, vegetative, flesh-colored to red, sessile plaques up to 20 cm in diameter. Ulceration was the principal feature of a fourth tumor, which destroyed the skin of the entire lumbar area and invaded the muscle. Regional-node metastases from this tumor showed basal cell carcinoma. Histologically, all the primary lesions were adenoid basal cell carcinomas with mucinous stroma. Histochemistry in two cases demonstrated minimal respiratory enzymes and no special esterolytic or lysosomal enzymes. Surgery was curative in three of these cases of rare, giant variant of basal cell carcinoma of the skin.


Pathologic findings in human scabies.

Pathologic findings in human scabies. The histologic findings in the papular, vesicular, nodular, and Norwegian variant of scabies have in common a superficial and deep perivascular mixed inflammatory cell infiltrate of lymphocytes, histiocytes, and numerous eosinophils. A spongiotic vesicle occurs in the papulovesicular type, a dense cellular infiltrate in the nodular type, and a hyperkeratotic psoriasiform dermatitis in the Norwegian type. Eggs, larvae, and adult mites are abundant in the cornified layer of Norwegian scabies, are practically never found in biopsy specimens from lesions of nodular scabies, and are discovered only episodically in papulovesicular lesions.


Pseudofolliculitis capitis.

Pseudofolliculitis capitis. Pseudofolliculitis of the bearded area is a common dermatoses among black men. Acne keloidalis probably represents this same condition, but is located in the nape area. Pseudofolliculitis of the pubic area (pseudofolliculitis pubis) has been reported. We wish to report pseudofolliculitis including the entire scalp and to add the term pseudofolliculitis capitis for this heretofore unreported entity.


Eruptions due to oral contraceptives.

Eruptions due to oral contraceptives. Three patients developed eruptions attributable to oral contraceptives. The eruptions of two of the patients resolved when the women discontinued the use of oral contraceptives. The third patient changed the type of oral contraceptive she was taking, and the eruption subsequently subsided.


Mucocutaneous lymph node syndrome.

Mucocutaneous lymph node syndrome. In 1967, Kawasaki reported an acute, febrile, mucocutaneous condition accompanied by swelling of cervical lymph nodes that afflicted infants and young children in Japan. He called the entity mucocutaneous lymph node syndrome. In 1974, the condition was reported in Hawaii, and several cases have been reported subsequently from  the continental United States and other countries. One percent to two % of patients had died suddenly of cardiac failure. Rickettsia-like bodies have been demonstrated from skin and lymph node biopsy specimens, and the pathologic features suggest a relationship to infantile periarteritis nodosa.


Cell-mediated immunity in rheumatoid arthritis. Cell-mediated immunity in rheumatoid arthritis (RA) was assessed by skin testing with six antigens in 107 patients, 94 of whom were age, sex, and race-matched with healthy individuals or patients with diseases unrelated to immunological abnormalities. 20% of RA patients were anergic. Impaired cell-mediated immunity in the RA patients was manifested by a decrease in the magnitude of skin reactivity as well as a decrease in the incidence of positive reactions to multiple antigens. Depression in cell-mediated immunity was related to age but not to sex, duration of disease, or disease activity. A slight correlation was found between absolute peripheral lymphocyte counts and the number of positive skin tests, and was confirmed by finding an association between lymphocyte counts and the size of skin reactions. A correlation was also found between lymphocyte counts and disease activity. Four explanations of the observed depression in cell-mediated immunity in RA were considered: (1) a preoccupation of the immune mechanism of the host with cell-mediated immunity reactions related to the pathogenesis of the disease; (2) a depression of cell-mediated immune reactivity by a virus infection; (3) depression of cell-mediated immunity by therapy; and (4) immune complex suppression of cell-mediated immunity. No effect of gold therapy was found. The near universal use of salicylates or other anti-inflammatory drugs did not permit investigation of the effect of these drugs on cell-mediated immunity.


Is persisting antigen responsible for the chronicity of experimental allergic arthritis? Animals were injected intra-articularly with antigen after prior immunization with that antigen in Freund's incomplete adjuvant in order to precipitate immune complexes in the surfaces of menisci, ligaments, and cartilage. On reimmunization with antigen in Freund's complete adjuvant 10 weeks later, generally an arthritis limited to the intercondylar fossa developed; but on intra-articular injection of antigen a second time a widespread arthritis developed in that joint. Thus immune deviation had not occurred and animals were in an immunological condition such as to be capable of developing widespread arthritis given the correct intra-articular stimulus. It is concluded that antigen, persisting as immune complexes, plays no part in maintaining widespread monarthritis, presumably owing to its inability to participate in a delayed hypersensitivity reaction as a result of sequestration.


Somatomedin activity in synovial fluid.

Somatomedin activity in synovial fluid. Abnormalities of synovial fluid, as a lubricant and nutrient, may have relevance to the causation of certain articular diseases. The somatomedin activity in normal synovial fluid obtained from the knee joint of the ox has been studied and compared with the activity in serum from the same animal. The porcine costal cartilage bioassay of Van den Brande and Du Caju (1974) has been used with the isotopes 35S-sulphate and 3H-thymidine. The mean potency ratio of ox synovial fluid in terms of ox serum for 35S-sulphate incorporation was 0-28 (range 0-19-0-47) and for 3H-thymidine incorporation 0-35 (range 0-21-0-63). A significant correlation was found between the somatomedin activity (as measured by 35S-sulphate incorporation) and the total protein and albumin concentrations in the ox synovial fluids and the ox sera, but there was no significant relationship between the somatomedin potency ratios and the globulin concentrations. The possible relevance of these findings to injury and disease in synovial joint is discussed.


Palindromic rheumatism. Clinical and serum complement study. A review of 39 patients diagnosed as suffering from palindromic rheumatism showed that 17 cases had evolved into typical rheumatoid arthritis (RA), while 22 had remained palindromic. The pattern of palindromic attacks in the two groups gave no grounds for regarding palindromic rheumatism as a separate condition from RA with palindromic onset. At the first attendance minor clinical or radiological changes, raised erythrocyte sedimentation rate, and positive serology were more common along those patients who were about to develop the picture of RA. Rheumatoid disease developing in patients with a palindromic onset was at least as severe as that among other patients with RA. 5 patients gave a history suggestive of fluid retention during the palindromic episodes, suggesting that attacks might be related to circulating immune complexes and altered vascular permeability. However, samples of blood obtained from 6 patients both during and between attacks showed no reduction in any of a variety of complement components tested.


Rheumatoid arthritis in a tribal Xhosa population in the Transkei, Southern Africa. An epidemiological survey of rheumatoid arthritis (RA) was undertaken in a tribal Xhosa community in the Transkei of Southern Africa. 577 respondents aged 18 and over were examined clinically and of these, 549 were investigated radiologically and 482 serologically. The presence of RA was then assessed by means of a modification of the Rome criteria, as used in previous comparable surveys. The prevalence of 'definite' RA in the adults aged 18 and over in this population was 0-68% and of 'probable' RA, 1-6%. The combined 'definite' and 'probable' prevalence was 2-2%. The relatively low prevalence of RA in this population is consistent with the results of other surveys in unsophisticated African Negro populations in West Africa and South Africa, and contrasts with the higher prevalence encountered in an urbanized South African Negro community and in populations in Europe and the USA.


Radiographic changes in early rheumatoid disease. We have studied the radiological features in 94 patients with early rheumatoid disease followed prospectively for 5 years. The changes appeared very early and occurred in up to 71-3% of patients. Erosive changes occurred in the feet much more commonly than in the hands and considerably earlier. Erosive changes were present before there was joint-space loss. Frequent x-ray examination of feet and hands in the first 2 years after presentation is required if we are to identify patients at risk for serious joint damage.


Multicentre trial of naproxen and phenylbutazone in acute gout. Naproxen 750 mg as a single dose followed by 250 mg three times daily has been compared with phenylbutazone 200 mg four times daily for 48 hours followed by 200 mg three times daily for treatment of acute gout in an open study on 41 patients. The drugs were equally effective with few and relatively mild side effects. Naproxen is a useful alternative agent for the treatment of acute gout.


HLA antigens in systemic lupus erythematosus. Forty-five patients suffering from systemic lupus erythematosus were studied in respect of their serologically defined HLA antigens. HLA-B8 antigen was found in 37-8% of patients as compared to 22% of controls. Individuals carrying the HLA-B8 antigen have a 2-15 times greater risk of developing systemic lupus erythematosus than those not carrying this antigen.


Distribution of HLA-B27 in patients with juvenile rheumatoid arthritis. HLA antigens were examined in 27 patients with juvenile rheumatoid arthritis. HLA-B27 was found in none. The result was different from most other previously reported studies. The most likely explanation for this difference is the possibility that some patients with juvenile ankylosing spondylitis may have been included among the patients in the other studies.


Development of giant cell (temporal) arteritis in a patient 'adequately' treated for polymyalgia rheumatica. A 70-year-old woman presenting with typical polymyalgia rheumatica (PMR) and a normal temporal artery biopsy appeared to respond completely to low-dose prednisone therapy. A subsequent biopsy showing temporal arteritis with a normal sedimentation rate and no recurrence of myalgic symptoms emphasizes the unpredictable course of treated PMR and the need for continued clinical as well as laboratory follow-up.


Dermatomyositis complicating penicillamine treatment. A case of dermatomyositis developing during the course of treatment with D-penicillamine in a patient with rheumatoid arthritis is described. Complete remission occurred on withdrawal of the drug. Possible alternative diagnoses are discussed.


Gangrene of toes with normal peripheral pulses. Ten patients with pregangrenous and gangrenous changes of the toes in the presence of normal peripheral pulses are described. In the absence of diabetes this is  an uncommon condition and is only rarely reported upon in the literature. Four patients had non occlusive arteriosclerotic changes in large arteries; three suffered from thrombocytosis and one from polycythemia vera; one patient had a monoclonal gamopathy and one was exposed to cold three months before the onset of gangrene. None of these patients smoked regularly. Severe pain usually preceded the gangrene. The process did not progress proximally in any patients, and in those who underwent toe amputations the healing was uneventful. Vasodilators and low-molecular dextran were not effective. Lumbar sympathectomy was performed in three patients, also with no effect on the course of the disease. Treatment of hematological disorders gave relief in three patients. Proximal arteriosclerotic changes should be corrected if possible to eliminate a source of emboli. In two patients anti-platelet aggregation agents provided relief. Toe amputation should be conservative and performed when definite demarcation appears between necrotic and viable tissue. This condition has a benign prognosis.


Simultaneous adrenal and cervical pheochromocytomas in childhood. Pheochromocytoma is an uncommon tumor in childhood. The simultaneous occurrence of adrenal and cervical pheochromocytomas is a rare phenomenon; to our knowledge, this combination has been reported in the literature only once. Cervical pheochromocytomas are more accurately termed "aorticosympathetic paragangliomas." In children, 50% of pheochromocytomas are bilateral, multiple, or extra-adrenal. An increased familial incidence in the form of simple mendelian dominance is also noted in the pediatric age group. Bolus nephrotomography is extremely effective in identifying adrenal pheochromocytomas in children. To prepare the patient for surgery, and alpha-adrenergic blocking agent is administered from 7 to 10 days before operation and a beta-blocking agent is administered 3 days before. A transabdominal approach is essential because of the frequent extra-adrenal sites and multicentricity of the tumor in children.


Evaluation of a breast cyst fluid protein detectable in the plasma of breast carcinoma patients. A radioimmunoassay has been developed for one of the major proteins isolated from human breast cyst fluid. Immunologically this protein is identical to a protein present in both human milk and saliva. Ninety-two normal women had plasma levels of this protein below 100 ng/ml (range 7-81 ng/ml; mean 31 ng/ml), and 85% had plasma levels below 50 ng/ml. More than one-half of the women with active gross cystic disease of the breast had plasma levels above 50 ng/ml. None of these women, however, had plasma levels above 150 ng/ml. A significant percentage of women with advanced breast carcinoma have been found to have plasma concentrations of this protein greater than 150 ng/ml.


The diagnosis of pancreatic cyst by endoscopic retrograde pancreatography and ultrasonic scanning. Fourteen patients with verified pancreatic cysts were examined by both preoperative endoscopic retrograde pancreatography (ERP) and ultrasonic scanning. ERP showed filling of a cyst in 4 patients and raised suspicion of a cyst in 8. In two patients it was not possible to visualize the pancreatic duct. Ultrasonic scanning showed a cyst in 12 patients. There were two false negative ultrasonic diagnoses. These two were correctly diagnosed by ERP. Ultrasonically guided percutaneous puncture was carried out on 19 occasions in 8 patients. Cysts down to 2 cm in diameter were punctured without difficulty. There were no clinically significant complications due to the punctures. One patient was followed for 20 months without ultrasonically demonstrable recurrence of a large cyst aspirated, showing that definite therapy is possible by this method. Puncture can be used to verify the diagnosis and as treatment in patients where surgery is contraindicated.


Surgery in patients with congenital disorders of blood coagulation. Surgical procedures on patients with congenital disorders of blood coagulation can be performed with a high degree of confidence and an acceptable incidence of complications. During the period 1960-1975, 42 patients with congenital disorders of blood coagulation underwent 94 operative procedures at the New York Hopital-Cornell Medical Center. The coagulation defect was diagnosed preoperatively, in nearly all patients. Careful hematologic management, including specific factor replacement, is essential. The importance of meticulous hemostasis at surgery and careful monitoring of blood coagulation in the postoperative period is strongly emphasized.


Sexual potency following surgery for rectal carcinoma. A followup of 44 patients. Of 157 patients operated upon for cancer of the rectum within the last 10 years, 44 were available for a followup study of sexual potency. After the anterior resection operation, sexual function for both men and women remained practically unchanged. Following the abdominoperineal operation, where the entire rectum was extirpated, the results differed for men and women. Sexual function in men was completely destroyed, but women were capable of continuing sexual enjoyment as before the operation. Anterior resection in both sexes, i.e., leaving 6 cm of the distal rectum, does not destroy nerve fibers or other structures vital to continuing normal sex activity. However, the abdominoperineal operation in men destroys the important parasympathetic fibers to the male genital system and renders the patient impotent. In women, the abdominoperineal operation for cancer spares most of the nerve supply, especially the important pudendal nerve, thus permitting the patient to continue sexual activity as before surgery.


Acute renal failure following blunt civilian trauma. Renal failure developed in 20 patients following blunt civilian trauma. Ten recovered normal renal function; 8 currently survive. Survivors and nonsurvivors did not differ in age, time from trauma to anuria, mean blood urea nitrogen or creatinine level prior to the first or to subsequent dialyses. However, there was an increased incidence of sepsis and liver failure in those who died. When outcome was related to site of injury, patients with closed head injury and/or intra-abdominal injury had a worse prognosis than those with thoracic or extremity injury only. Only 2 patients with perforated bowel survived; both had peritoneal dialysis combined with peritoneal lavage with antibiotic solutions. Mortality in patients with posttraumatic renal failure remains high; however, death is usually a result of associated complications rather than a result of the renal failure. Aggressive management of other complications of the trauma, especially sepsis or potential sepsis, is necessary. We recommend peritoneal dialysis combined with peritoneal antibiotic lavage where there is a potential for posttraumatic intra-abdominal sepsis associated with renal failure.


Microcirculatory changes in the lung of the hypoxic and hypovolemic puppy: an electron microscope study. The effect of systemic hypoxemia and hypovolemia on pulmonary fine structure was studied and compared in 12 Labrador puppies 6 days to 3 weeks old. Central venous and arterial pressures were monitored and arterial pH, PCO2 and PO2 recorded serially. In 4 puppies lung biopsies were taken after a two hour period of breathing 7% oxygen. Four other puppies were made hypovolemic by acute hemorrhage of 50% of the calculated blood volume and lung biopsies taken after one hour. Four control puppies were maintained under anesthesia for two hours, breathing an atmosphere of 20% oxygen before lung biopsies were taken. Both hypoxemia and hypovolemia resulted in similar pulmonary ultrastructural changes. These changes which occurred more frequently in areas where the air spaces and blood vessels were expanded, were characterized by aggregation of platelets and leucocytes in the vascular space, focal endothelial cell disruption, interstitial edema and type I epithelial cell discontinuities with exudation of plasma into the alveolar air spaces.


Autologous blood in the treatment of intraoperative hemorrhage. Severe hemorrhage associated with major trauma and vascular procedures is seen frequently in our operating rooms. Immediate autotransfusion has enabled us to safely and adquately correct blood losses without placing overwhelming demands on our blood bank. Since October 1973, a device capable of retrieving, filtering and reinfusing blood lost during operation has been used on 51 patients (major trauma, 20; ectopic pregnancy, 2; portacaval shunt, 9; peripheral vascular surgery, 20). From 700 to 20,000 cc's of blood were reinfused. Platelets, hematocrit, fibrinogen, free plasma hemoglobin, bilirubin, and creatinine showed no significant changes as compared to preoperative values in 39 survivors. There were 12 deaths. Eight died postoperatively as a result of their injuries, 3 of uncontrollable bleeding and one of renal failure. This study shows that autotransfusion, when used with proper operating technique, is a most satisfactory technique for restoring blood volume in severe trauma cases and elective vascular operations. This method provides a rapid, simple way of reinfusing fresh blood, free of hepatitis contamination with minimal derangement in cellular and plasma coagulation parameters.


Late complications of abdominal aortic reconstructive surgery: roentgen evaluation. During a 5-year period from 1969 to 1974, 53  (8.5%) of 631 patients developed late complications following abdominal aortic reconstructive surgery. Occlusion was the most frequent complication and occurred in 4%. Others included stenosis, false aneurysm, enteric fistula and infection. Late complications were demonstrated by roentgenographic methods. Angiography was the most valuable roentgen study. It is indicated in all patients suspected of having delayed complications except those with unstable life-threatening hemorrhage. Additional roentgenographic studies including the barium enema and barium meal may help make the diagnosis and exclude other entities. In any patient with an abdominal aortic graft and gastrointestinal bleeding, the diagnosis of an aorto-enteric fistula should be considered until otherwise proven.


Popliteal entrapment syndrome.

Popliteal entrapment syndrome. A probable cause of popliteal artery entrapment is proposed. The medial head of the gastrocnemius muscle during its embryological development crosses the popliteal fossa from lateral to medial. It is proposed that the migrating medial head carries the popliteal artery and vein across the fossa and entraps them against the medial condyle of the femur. Dissection of 86 anatomical specimens revealed two cases of unilateral and one case of bilateral entrapment of both popliteal vessels. Two surgical cases of popliteal entrapment are presented. This entrapment syndrome is a remedial cause of claudication and when considered, it is readily diagnosed and surgical correction is effective. Because of distal embolisation and occlusions, early recognition and treatment is desirable. Forty-seven cases from the literature are reviewed as to the entrapment type and the age and sex of the patients.


Jejunal intussusception following small bowel bypass for morbid obesity. In 600 patients who have undergone small bowel bypass for the treatment of morbid obesity, we have encountered three patients who developed intussusception in the bypassed intestine. Diagnosis in these cases has been difficult but in two patients with surgical marker clips applied to the transected fixed jejunum as well as to the adjacent mesocolon, diagnosis was made easier by the radiographic finding of separation of these clips. Clinical symptoms are difficult to evaluate and valuable time may be wasted before a diagnosis is arrived at. Once a diagnosis is made, operation with either reduction or resection of the area of intussusception should be carried out with refixation of the bowel to the mesocolon and reapplication of surgical marker clips. These marker clips are of great value in the diagnosis of intussusception occurring in the bypassed loop.


Respiratory characteristics of a microporous membrane oxygenator. A microporous membrane oxygenator has been used in 258 clinical perfusions for cardiac surgery. In 132 perfusions the oxygenator was ventilated with 100% O2, and in 126 perfusions 98% O2-2%CO2 was used. Patients' BSA was 0.4-2.3 M2. Bypass duration was up to 563 min. In the group ventilated with 100% O2, average PaCO2 was 30 mmHg, with arterial pH of 7.48. 98% O2-2% ventilation resulted in an average PaCO2 of 36 mmHg, with arterial pH of 7.41. CO2 transfer is influenced by gas flow rate, and data from selected cases demonstrate that increasing gas flow results in decreasing PaCO2, while decreasing gas flow increases PaCO2. The thickness of the blood film is decreased by increasing the "shim" pressure, so that increasing the "shim" presure results in higher PaO2. Oxygen saturation averaged 99% for the entire series. Addition of CO2 to the oxygen and appropriate changes in gas flow and "shim" pressure permit changes to be made in the ventilation of the device during perfusion to achieve desired levels of PaO2 and PaCO2 under widely disparate conditions of temperature and flow.


Diverticulitis in women: an unappreciated clinical presentation. A final diagnosis of diverticulosis or diverticulitis was made in 1,031 women over a 10 year period. The 69 patients who underwent abdominal operation for what proved to be diverticulitis are discussed in detail. Thirty-eight per cent of these women were believed to have gynecologic disease because of the presence of a pelvic mass. Diverticulitis is an important differential diagnosis of a pelvic mass with or without clinical and laboratory indications of infection and with or without history of diverticulosis or diverticulitis. The increasing awareness of ovarian carcinoma and its ominous prognosis make this differential diagnosis especially important. Diverticular disease should always be considered among such patients and preparations made to allow optimal treatment at that operation, whatever the ultimate cause of the mass.


Hypertension of aortic coarctation: the role of renal and other factors. In order to establish the relationship between the renal and other factors associated with the hypertension of coarctation of the aorta, aortic strictures were created in two groups of adult dogs (Groups A and B). Group B in addition had transference of total renal blood flow proximal to the stricture to eliminate the renal aspects of the hypertension. Carotid and femoral artery pressures were measured at monthly intervals for 24 weeks. Group A developed progressive generalised hypertension while Group B only developed hypertension proximal to the coarctation. The dominant role of a renal factor producing a generalised vascular response is confirmed, the localised proximal hypertension in Group B reflecting the mechanical obstruction imposed by the aortic stricture. There is no evidence to suggest that other organs distal to the coarctation are implicated in the development of arterial hypertension.


Enterocolitis with peritonitis in a child with pheochromocytoma. An 8-year-old boy presented at UCLA Hospital with a one month history of hypertension prior to suffering a sudden onset of acute abdominal pain, rectal bleeding, peritonitis, and shock. Sigmoidoscopy showed diffuse mucosal friability. At laparotomy, inflammation and edema of the entire colon and terminal ileum were detected with two necrotic areas on the cecum. A 5 cm right adrenal pheochromocytoma with a hemorrhagic center was removed and a diverting loop ileostomy with inversion of the necrotic cecal areas was performed. Postoperatively, the blood pressure gradually returned to normal, and the colitis improved. Serum calcium and T3 T4 levels were normal. Review of the literature demonstrates that in patients with pheochromocytoma, progression from colitis to necrosis can be precipitated by a hypotensive episode. This patient suggests an example of catecholamine induced enterocolitis.