[Deafness and Paget's disease].

[Deafness and Paget's disease]. Cases of deafness due to Paget's disease can be separated into two types : (1) deafness of a mainly mixed type in which progressive aggravation occurs particularly in the inner ear, and (2) perceptional deafness which progresses without involvement of the transmission apparatus. Among 35 hospitalized patients with Paget's disease, 21 of whom suffered cranial involvement, 18 cases of deafness related to the bone disease were discovered by means of systematic examinations. The deafness was of the mixed type in 11 cases and of the perceptional type in the other 7. Of the 11 patients with the mixed type of deafness with an ankylosis syndrome of the ossicles, 3 were operated upon : one of them underwent an operation to mobilize the stapes, and the two others underwent total stapedectomy followed by venous interposition and the positioning of a Teflon piston. The long-term results were frankly disappointing and did not suggest that these attempts at surgical treatment should be followed up. Calcitonin was employed in 9 patients (6 with mixed deafness and 3 with perception type deafness), with comparative audiograms in 5 cases, and was also not very effective : this lack of effect was a result of the long duration of the Paget's disease and of the deafness in the patients treated. The value of hormonal treatment in cases of deafness associated with Paget's disease will probably be in the prevention of this complication.


[Problems posed during surgical repair of a gunshot wound in the mandible]. The authors present a case of a balistic lesion of the labio-mental region after attempted suicide. They expose the different procedures used for its repair and attempt to analyze the problems which arose from the therapeutic standpoint. They lay stress on the necessity to immobilize these mandibular fragments in good occlusion, as rapidly as possibly.


[Midfacial necrosis: a propos of 2 cases and review of the literature]. Two patients presenting the clinical characteristics of the "Lethal Midline Granuloma" are discussed. In the first case, the autopsy allowed the final diagnosis of a histiocytic medullary reticulosis (Robb-Smith). For the second patient the late evolution and the final biopsy gave the diagnosis of malignant reticulosis without further detail. These two cases prove that for a midface necrosis no final diagnosis can be obtained without an extensive clinical examination and autopsy material. There are numerous arguments to consider the "Lethal Midline Granuloma" as a clinical term which can cover several pathological entities. A classification is proposed.


[An original method of plastic surgery after treatment of cancer of the lower lip by resection]. Oncological surgery leads to tissue loss which must be urgently compensated for in the facial region. Thus oncological facial surgery is the result of two components: excision surgery and restorative surgery which are in continuous contradiction, but which must attain perfect unity. By the method described, it is possible to carry out at a single intervention, scraping, excision and plastic repair, in this order, with maximum sparing of the other topographical regions of the face. It is indicated in limited lesions or on the contrary very wide-spread lesions of the lower lip, ensuring good anatomical and functional results.


Noise reduction of ECG by averaging. An experimental study of the procedure and a validated method. Electrical noise often hampers the interpretation of ECG and other heart-synchronous signals. Time-coherent averaging is a commonly used method to reduce the noise. This method has been implemented on a computer with 12,000 12-bit words of core memory, suitable for on-line use in any clinical laboratory. An analysis was made of which demands apply to the exactness of synchronization of added heart cycles. The method was tested with respect to these demands and also, on a limited scale, for its efficiency in eliminating ectopic beats from the average.


Selective culturing of Yersinia enterocolitica at a low temperature. Stool specimens from patients with suspected Yersinia enterocolitica (Y. ent.) infection were cultured at +4 degrees C in a nutrient broth for 5 days and at the same time the same stool specimens were cultured by the routine method of the laboratory. The routine method gave 34 Y. ent. isolations. Selective culturing at +4 degrees C succeeded in isolation of the same 34 Y. ent. strains but also 15 further strains or a 44% increase in yield. Serial dilutions in broth of 34 strains of Y. ent., 7 strains of Y. pseudotuberculosis and 14 strains of other gram-negative enterobacteria were cultured at +4 degrees C. Colony counts were performed from each dilution after 2 and 5 days. Human pathogenic strains of Y. ent. (serotype 3, 8, 9) increased markedly at +4 degrees C in contrast to the other gram-negative enterobacteria.


The effect of doxycycline and tetracycline hydrochloride on the aerobic fecal flora, with special reference to Escherichia coli. The effect on the aerobic faecal flora of a 10-day course of doxycycline or tetracycline hydrochloride was compared in 36 patients with acute infections mainly of respiratory origin. The patients were treated in hospital with a well-developed barrier nursing technique. The proportions of isolates of Escherichia coli resistant to tetracyclines were significantly lower after 10 days' treatment with doxycycline (80%) as well as one month later (24%), compared to the figures for tetracycline HCI (100% and 46%, respectively). The resistant strains selected during therapy probably represented the community flora. Only a small increase in multiresistant strains occurred and no identical strains were found in different patients. Thus, it seems possible to limit the biological side-effects of tetracyclines by a good barrier nursing technique. An increase in the number of E. coli resistant to tetracyclines cannot be avoided, but is more limited when doxycycline is used.


Complications of transrectal aspiration biopsy of the prostate. Four cases of coli-sepsis, one with a fatal outcome have been observed after more than 14 000 transrectal aspiration biopsies (TAB) of the prostate performed at Karolinska Sjukhuset with Franzén's apparatus. A few cases of transient febrile reaction and urinary contamination after TAB of the prostate have also been recognised. One of the patients with sepsis and two with febrile reactions belonged to a relatively small group of patients referred from the Department of Rheumatology. These observations prompted the present study. The records of all the patients referred for TAB of the prostate from the Department of Rheumatology were reviewed. Four complications (three patients with febrile reaction and growth of E. coli in the urine and one case of sepsis) were observed after 63 biopsies in 51 patients (6.3%). The patient with sepsis and two other patients with complications belonged to a group of 32 patients with proven rheumatic disease (chronic polyarthritis): 42 biopsies had been performed in this particular group of patients, bringing the incidence of complication to 7.1%. For comparison the records of 294 patients from the Department of Urology submitted to TAB of the prostate were also reviewed. Complications in the form of transient febrile reactions were found in five cases after 508 biopsies (1.0%). In addition, three cases of coli-sepsis not belonging to the above-mentioned groups are briefly described as case reports. Patients with rheumatic disease (chronic polyarthritis) seem to run a higher risk of complications after TAB of the prostate. Sepsis from E. coli is a rare but serious complication which can develop into, often fatal, endotoxin shock. TAB of the prostate should therefore be restricted to cases with clinical suspicion of prostatic malignancy.


A modified nephrostomy in the management of urinary fistula after renal transplantation. A technique for complete urinary diversion was used in the management of urinary fistula following renal transplantation. Nephrostomy was modified by closing the renal pelvis at the ureteropelvic junction. No impairment of renal function occurred. In the presence of infection, it is reasonable first to treat the infection and postpone the reconstructive procedure until the infection has subsided.


Sudden massive hemorrhage after renal transplantation. Five cases of sudden massive hemorrhage after renal transplantation are reported. It is supposed that an infective arteritis with damage of the artery wall caused the observed disruption of the arteries. Prompt ligation far from the infected site is recommended as necessary to prevent recurrence of the bleeding and to afford the best possibility for survival.


The effects of beta-adrenergic agents on the contractility of transplanted canine heart. The effects of isoprenaline and adrenalin on the myocardial contractility of transplanted heart were studied in 6 mongrel dogs which had undergone orthotopic cardiac transplantation. Isoprenaline and adrenaline produced a fall in end-diastolic and end-systolic volumes, and an increase in stroke volume, cardiac output and velocity of contraction when the heart rate was increased. Similar changes were observed in 4 mongrel dogs tested as controls, with the exception of a less pronounced increase of cardiac output after administration of isoprenaline and adrenalin and a fall in stroke volume associated with a higher acceleration of heart rate after administration of isoprenaline. These minor differences between the transplanted and intact heart were thought to be a reflexion of the increased blood volume following heart transplantation.


Oscillography and digital pulse plethysmography in occlusive disease of the subclavian artery and the brachiocephalic trunk. A pre- and postoperative study. Patients with occlusive disease of the subclavian artery or brachiocephalic trunk were examined by oscillography (17 cases) and digital pulse plethysmography (19 cases) before and after reconstruction of the occluded vessel. Before surgery the oscillographic amplitudes were significantly lower on the occluded than the contralateral arm, with no difference between the registration levels. Shape analysis of the digital pulse curve recordings gave significant differences in all variables, between the occluded and the contralateral arm, inclination time and RAMP25 being most sensitive. Idential studies repeated up to 6 months after surgery demonstrated a marked increase in oscillometric amplitudes at all levels on the operated side. In the digital pulse-curve recordings the greatest improvement was found in inclination time and RAMP25.


[Experiences with allogeneic and isogeneic bone marrow transplantations in aplastic anemia and acute leukemia]. A report is presented on 13 clinical bone marrow transplantations (BMT). Six of 6 patients with refractory aplastic anemia are presently alive with partial to complete hemopoetic reconstitution now lasting up to 3 years and more. It is shown that after immunosuppression with ALG and cyclophosphamide, followed by BMT, the patient's own hemopoetic system can recover. Two failures occurred in patients over 50 years of age and in one who had donor transfusions before the graft. Two of 4 patients grafted for acute refractory leukemia are alive, one being in complete remission on day 140. One died from interstitial pneumonia and one had no take although the donor was an identical twin. This patient had been on a maintenance program which included active immunotherapy.


[Evaluation of new histocompatibility tests for bone marrow transplantation]. Histocompatibility testing has been performed in the families of 20 patients with aplastic anemia or acute leukemia, in order to identify a compatible donor for marrow transplantation. In several cases, the interpretation of the tests has been difficult because of abnormalities in the immune reactivity of patients' lymphocytes. Humoral or cellular immunization against donor incompatible antigens seems to prevent a "take" of the graft or a subsequent hematological remission.


[Neutropenia in disorders of the neutrophil motility]. A 51-year-old patient exhibited severe neutropenia over a period of 12 months following lobectomy for carcinoma of the lung. Marrow neutrophil mass and marrow neutrophil production were measured quantitatively and were within normal limits. Mobilization into a skin window was absent. A defect in neutrophil motility could be demonstrated in vitro and was confirmed in vivo by poor neutrophil release from the marrow following injection of hydrocortisone; it thus represented a lazy leukocyte syndrome of the adult.


[Connective tissue suspension in blade implantations. Preliminary report]. An investigation on blade implants is in process. These implants represent endstanding abutments of fixed bridgework. It was found that the implants, adapting to heavy masticatory stresses, show a response in the bone representing a connective tissue suspension.


[Problems of prosthetic treatment following preprosthetic measures in the maxilla]. The experiences with prosthetic treatment of the maxilla, following praeprosthetic surgery have been examined. It is of significance that this surgical intervention does not always result in a more favorable jawform and interalveolar relationship, factors which help determine the stability of the denture during mastication. The postoperative prosthodontic treatment of maxillary resorption remains problematical quite often becoming still more complicated because of additional problems in part undiagnosed by the dentist. Some of these problems and their solutions are discussed in a clinical case. The importance of denture stability during mastication independent of other retentive factors is emphasized as well as an occlusion coordinated with the "condyle in fossacentric" and the chewing strokes. The disregard of these stabilizing and retentive factors is too frequently the cause of praeoperative as well as postoperative failure in addition to contributing to accelerated residual ridge resorption.


Microtubule assembly and the intracellular transport of secretory granules in pancreatic islets. Polymerized and depolymerized tubulin were measured in pancreatic islets under various physiological and pharmacological conditions. Variations in insulin release from islets of fed or fasted rats were accompanied by concomitant changes in tubulin polymerization. Glucose induced the formation of microtubules in vitro independent of extracellular calcium. Total and polymerized tubulin content were decreased by fasting and restored by glucose feeding.


The neural crest and the origin of the insulin-producing and other gastrointestinal hormone-producing cells. It has been proposed that the endocrine cells of the digestive tract derive from the neuroectoderm (neural crest). To test this hypothesis we removed the entire ectoderm, the precursor of the neural crest, of embryonic rats prior to the formation of the neural crest and cultured the mesoendoderm for 11 days. In every case where a pancreas developed, insulin was detected or B cells were observed. Thus, a neural crest origin for these cells is eiliminated.


Blockage of ovulation in rats by inhibitory analogs of luteinizing hormones-releasing hormone. An antagonist of luteinizing hormone-releasing hormone (LH-RH). [D-Phe2-Phe3-D-Phe6]-LH-RH (Phe, phenylalanine), suppressed luteinizing hormone (LH) and follicle-stimulating hormone (FSH) release in male rats in response to LH-RH for at least 4 hours. Three subcutaneous injection of 1 milligram of this antagonist into rats during proestrus completely suppressed ovulation, while a single injection of 1.5 milligrams per rat inhibited 95.3 percent of the preovulatory surge of LH, 84.2 percent of the FSH surge, and suppressed ovulation by 86.4 percent.


Haploidploidy and the evolution of the social insect. Halminton (1) was apparently the first to appreciate that the synthesis of Mendelian genetics with Darwin's theory of natural selection had profound implications for social theory. In particular, insofar as almost all social behavior is either selfish or altruistic (or has such effects), genetical reasoning suggests that an individual's social behavior should be adjusted to his or her degree of relatedness, r, to all individuals affected by the behavior. We call this theory kinship theory. The social insects provide a critical test of Hamilton's kinship theory. When such theory is combined with the sex ratio theory of Fisher (9), a body of consistent predictions emerges regarding the haplodiploid Hymenoptera. The evolution of female workers helping their mother reproduce is more likely in the Hymenoptera than in diploid groups, provided that such workers lay some of the male-producing eggs or bias the ratio of investment toward reproductive females. Once eusocial colonies appear, certain biases by sex in these colonies are expected to evolve. In general, but especially in eusocial ants, the ratio of investment should be biased in favor of females, and in it is expected to equilibrate at 1 : 3 (male to female). We present evidence from 20 species that the ratio of investment in monogynous ants is, indeed, about 1 : 3, and we subject this discovery to a series of tests. As expected, the slave-making ants produce a ratio of investment of 1 : 1, polygynoys ants produce many more males than expected on the basis of relative dry weight alone, solitary bees and wasps produce a ratio of investment near 1 : 1 (and no greater than 1 : 2), and the social bumblebees produce ratios of investment between 1 : 1 and 1 : 3. In addition, sex ratios in monogynous ants and in trapnested wasps are, as predicted by Fisher, inversely related to the relative cost in these species of producing a male instead of a female. Taken together, these data provide quantitative evidence in support of kinship theory, sex ratio theory, the assumption that the offspring is capable of acting counter to its parents' best interests, and the supposition that haplodiploidy has played a unique role in the evolution of the social insects. Finally, we outline a theory for the evolution of worker-queen conflict, a theory which explains the queen's advantage in competition over male-producing workers and the workers' advantage regarding the ratio of investment. The theory uses the asymmetries of haplodiploidy to explain how the evolved outcome of parent-offspring conflict in the social Hymenoptera is expected to be a function of certain social and life history parameters.


BCG inhibition of murine leudemia: local suppression and systemic tumor immunity require different doses. The quantitative relationship between bacillus Calmette-Guérin (BCG) and tumor cells which are optimal for suppressing the growth of tumor cells in BCG-tumor cell mixtures are detrimental to the development of a sustained, systemic tumor rejection immunity in the LSTRA murine leukemia.


Melatonin inhibition of the neonatal pituitary response to luteinizing hormone-releasing factor. Neonatal rat anterior pituitary glands treated in organ culture with 1 nanomolar luteinzing hormone-releasing factor (LRF) showed a tenfold increase in medium luteinizing hormone (LH) concentrations over control values. Simultaneous treatment of the glands with 1 nanomolar melatonin significantly reduced the stimulatory effect of LRF on release of LH. This finding indicates that melatonin can act directly on the neonatal pituitary to inhibit the LH response to LRF.


Sleep during transcendental meditation.

Sleep during transcendental meditation. Five experienced practitioners of transcendental meditation spent appreciable parts of meditation sesions in sleep stages 2, 3, and 4. Time spent in each sleep stage varied both between sessions for a given subject and between subjects. In addition, we compare electroencephalogram records made during meditation with those made during naps taken at the same time of day. The range of states observed during meditation does not support the view that meditation produces a single, unique state of consciousness.


Influence of brain and behavior on the immune system. It has been shown experimentally that psychosocial processes influence the susceptibility to some infections, to some neoplastic processes, and to some aspects of humoral and cell-mediated immune responses. These psychosocial effects may be related to hypothalamic activity. Reviewing the mechanisms that may be involved in the role of the hypothalamus in immune responses indicates that there is no single mediating factor. Various processes may participate, including the autonomic nervous system and neuroendocrine activity. The research reviewed has been limited primarily to a consideration of the effect of hypothalamic lesions on humoral immune responses. There is some evidence (45, 80) indicating that hypothalamic lesions also modify cell-mediated immune responses. Further research is required to evaluate the effect of the hypothalamus on cell-mediated immunity.


Characterization of a cell-lethal product from the photooxidation of tryptophan: hydrogen peroxide. Near-ultraviolet (300 to 400 nanometers) irradiation of saturated, oxygenated solutions of tryptophan in the absence of added sensitizer gives rise to substances that have various biological effects on isolated cells, including mutagenicity and selective lethality to recombination-deficient bacterial mutants. One of these biologically active products has been identified as H2O2, on the basis of spectrometric, chromatographic, chemical, and biological properties. Now H2O2 has been shown to account for the biological activities mentioned above.


Combined use of ultrasound and nuclear medicine techniques in kidney disease. Combined ultrasound and nuclear medicine procedures in the evaluation of urinary-tract disease are essentially limited to the kidneys. They are useful in the evaluation of patients with masses, renal failure, unilateral nonfunctioning kidney, trauma, and transplants. In our experience the combined use of these techniques has increased diagnostic accuracy and in many cases has obviated the need for more complex procedures associated with higher radiation doses. This is an especially important factor in children and in adults in the childbearing age group. We have achieved success with these modalities because of the constant communication between the referring physicians and the ultrasound and nuclear medicine divisions.


Applications of diagnostic ultrasound and radionuclides to cardiovascular diagnosis. Part II. Cardiovascular disease in the young. Echocardiography (ECHO) and radionuclide cardiography have had a significant impact on pediatric cardiology because they have proved to be sensitive enough to permit early diagnosis of many forms of heart disease and in some cases to estimate its severity and to provide information concerning ventricular performance. An overview of the anatomic and functional information that can be obtained from these two methods will be presented first, followed by details concerning the indications for their use and their relative clinical value in various acquired and congenital heart diseases. We have stressed particularly those facets of pediatric cardiac disease that differ most from those in the adult.


Nuclear medicine and ultrasound in the evaluation of neurologic diseases. Echoencephalography and radionuclide brain imaging are used to aid in the diagnosis of a variety of intracranial abnormalities. Because of technical considerations, A-mode rather than B-mode echography must, under most circumstances, be employed for examination of the head. There are technical limitations to echoencephalography, and it tends to be relatively subjective and dependent on the skill of the sonographer. These factors have, to some extent, been responsible for the more limited application of ultrasound to neurologic diagnosis, as compared to the application of radionuclides. The most common use of echoencephalography is in the detection of midline shifts associated with various sequelae of head trauma. Ultrasound has also been used to detect space-occupying lesions, either directly or more usually by determing associated midline displacements. The characterization and follow-up of known lesions with ultrasound has also been described. In the above instances its usefulness is usually as a noninvasive technique complementary to nuclear medicine studies, which under most circumstances are more effective than ultrasound. The evaluation of ventricular enlargement, which is not usually possible per se with radionuclides, is possible with ultrasound. Computerized transverse tomography (CTT) can be applied more efficiently in a routine way in many of the above circumstances, including evaluation of ventricular size. The combination of CTT and nuclear medicine procedures in the brain area is so effective and comprehensive that where these are both available the demand for ultrasound will probably decrease but will not be eliminated.


Comparison of 99mTc-labeled phosphate and phosphonate agents for skeletal imaging. The use of 99mTc-labeled phosphate and phosphonate compounds in place of 18F, 85Sr, and 87Sr for bone scintigraphy has become commonplace throughout the world in a relatively short time. The labeling of polyphosphate with 99mTc 4 years ago, followed rapidly by the introduction of 99mTc-labeled pyrophosphate for skeletal imaging, must therefore be regarded as a major contribution to the practice of diagnostic nuclear medicine. The markedly reduced patient radiation exposure and concomitant increase in photon detection efficiency derived from the more favorable physical decay characteristics of 99mTc led to increased sensitivity and resolution and in turn to improved diagnostic efficacy. The subsequent clinical use of the phosphonate complex 99mTc-HEDP represented a further modification of the same basic approach. Current clinical trials with 99mTc-labeled methylene diphosphonic acid (MDP), which appears to demonstrate enhanced biologic properties for scintigraphy of the osseous structures, is the latest example in this series of refinements. This article compares the technetium-labeled agents already in clinical use and, using animal data, contrasts them with several new multifunctional phosphonates and the novel inorganic compound sodium imidodiphosphate (IDP). In addition, an attempt is made to clarify the conflicting evidence in the nuclear medicine literature regarding the relationship between polyphosphate chain length and skeletal uptake.


Paget's disease of bone.

Paget's disease of bone. Nuclear medicine techniques are currently playing an important complementary role in the evaluation, management, and follow-up of the patient who is suspected of having Paget's disease of bone. The earlier diagnoses made possible by some of the described techniques should lead to a better understanding of the basic pathophysiology and, in addition, result in improved therapeutic modalities.


Bone and marrow imaging in sickle cell disease: diagnosis of infarction. Sickling of erythrocytes in patients with S-hemoglobin causes marrow and bone infarction. The former can be demonstrated as a lack of 99mTc-sulfur colloid uptake on marrow imaging examination. These defects may resolve or persist long after the acute episode. If the bone is involved in the acute episode, imaging within the first few days of onset of symptoms can show lack of 99mTc-labeled phosphate uptake, usually in a smaller area than that shown by marrow scanning. Follow-up bone imaging shows increased activity, particularly along the circumference of the bone where periosteal reaction can be demonstrated radiographically. Magnification by use of the pinhole collimator provides better definition of the uptake defect and the distribution of the increased reactive uptake. Timing of examination is important. If marrow imaging is performed in an asymptomatic period, the repeat examination during a painful crisis permits differentiation of old and acute marrow infarction. If 99mTc-phosphate imaging is performed after about 2 days of symptoms, acute infarction can be differentiated from osteomyelitis, which it may mimic clinically. Although osteomyelitis may cause no increased activity in the first 48 hr after onset of symptoms, it is characterized by intense focal activity thereafter (see article by Handmaker in this issue). To assist in differentiating bone infection in a site of marrow infarction demonstrated by marrow imaging, serial bone imaging with magnification may be useful. The uptake defect, followed in several days to 2 weeks, by circumferential increased activity, is a different pattern than the homogeneously intense activity of osteomyelitis, but the peripheral distribution may not be apparent on routine imaging. It is hoped that the utilization of these techniques can decrease the emotional and economic costs of prolonged hospitalization for suspected infection and can also expand our knowledge of the complex pathophysiologic changes of sickle cell bone disease.


The benign lymphoepithelial lesion--a harbinger of neoplasia. The patient presented had well-documented benign lymphoepithelial lesion, many years before the appearance of neoplastic disease. The relationship between this type of lesion and the later development of neoplasia is unclear, but evidence points to its existence, and further study is needed to clarify its frequency and significance. It appears that in some patients the benign lymphoepithelial lesion is a forerunner of the neoplastic process, and thus may serve as another clinical clue to the early diagnosis of neoplasia, especially that on the lymphoreticuloendothelial cell type.


Synthesis of certain puromycin analogues and their use in studying the peptidyl synthetase enzyme of e. coli and rat liver ribosomes. The beta-alanyl and L-histidyl analogues of puromycin were synthesized chemically and tested for their ability to release [3H] N-acetylphenylalanine from its tRNA carrier in the rat liver and E. Coli ribosomal systems. Both analogues were found to be inactive in releasing [3H] N-acetylphenylalanine. Reasons for the inactivity of these compounds are discussed in relation to the structure of the puromycin molecule and the requirements for puromycin-like activity.


Carbenicillin in acute renal failure.

Carbenicillin in acute renal failure. Three septicaemic patients with acute renal failure required carbenicillin. Septicaemia was caused by Pseudomonas in 2 patients and by Serratia marcescens in the third. Therapy in the first 2 patients was complicated by massive gastro-intestinal and uterine bleeding. Septicaemia in the third patient was initially uncontrolled owing to inadequate serum levels of carbenicillin, despite increased dosage as renal function improved. The problems and indications for the use of carbenicillin in renal failure are discussed and the possible relationship to bleeding diathesis is considered.


History of mental health services in South Africa. Part XI. Services for alcoholics. The earliest services for alcoholics in South Africa were begun by private organisations. The first legal steps were taken in 1911. The number of alcoholics in South Africa is discussed and a report on the 'tot system' is given. The facilities for the treatment of alcoholics are described, with special reference to the role of the Department of Social Welfare and the South African National Council on Alcoholism and Drug Dependence.


History of mental health in South Africa. Part XII. Services for criminals, delinquents and psychopaths. The development in the United States of psychiatric services for delinquents and criminals, which had a considerable influence on mental health services in South Africa, is described. It was followed by the appointment of court psychiatrists in thsi country, mainly to assist the Children's Courts. The findings of the Rumpff Commission on the responsibility of the mentally deranged persons are described, and psychiatric services for children are discussed.


Factors influencing morbidity and mortality of renal transplantation in a high risk population. A group of 37 patients with 39 renal transplants were studied from January 1971 to June 1974, in which 32 were considered at high risk by well defined cardiovascular, gastrointestinal, cerebral vascular, or pulmonary disease or age categories. Three of the 37 patients have died, and two patients in the high risk group, 92 per cent. Eighty-eight per cent of the entire group have functioning kidneys at present, and 93 per cent of those in the high risk group have functioning kidneys. Evaluation of pretransplant mixed lymphocyte cultures, HL-A antigen, and immune responder status; close follow-up observation of lymphocyte culture and humoral responses by in vitro testing; and the use of antilymphoblast globulin are considered to be the reasons for the improved results.


Effect of suture materials on healing skin wounds. A systematic comparison has been made of six suture materials used as subcuticular closure of abdominal incisions in dogs. The effect on wound healing was measured by mechanical, biochemical, and histologic methods. No difference was demonstrated in wound breading strength among wounds closed with different suture materials up to 28 days postoperatively. At 70 days, wounds sutured with nonabsorbable sutures were weaker than those closed with absorbable sutures, but this difference probably was due to a much higher incidence of infection in wounds closed with nonabsorbable sutures. It was our observation that monofilament sutures were superior to multifilament sutures with regard to the incidence of wound infection. By five days, the rate of collagen synthesis in wounds was increased over that of normal skin and remained elevated throughout the 120 day observation period. Suture material had no effect on collagen synthesis. The rate of noncollagenous protein synthesis in the wound was not altered throughout the entire observation period and did not differ from that measured in normal skin. Catgut, both plain and chromic, produced only a mild cellular reaction in dogs after 21 days as contrasted with the intense inflammatory reaction reported by others in rats and rabbits. We observed neither plain nor chromic catgut was absorbed rapidly in dogs; intact sutures were frequently observed at 120 days. Polyglactin, a synthetic absorbable suture, produced a moderate tissue reaction and uniformly disappeared between the twenty-eighth and seventieth days. Silk and Mersilene showed the highest rate of wound infection and the most intense and prolonged tissue reaction. Prolene, a monofilament suture, produced only a mild to moderate tissue reaction. These results taken in conjunction with those of other investigators suggest a marked species difference in the reaction to suture materials, particularly catgut, and suggest caution in transferring these observations to human beings.


Colonoscopy associated bacteremia.

Colonoscopy associated bacteremia. Fifty-two patients undergoing uneventful diagnostic colonoscopy with or without polypectomy and biopsy were evaluated for evidence of bacteremia during and after the procedure. In only two instances was bacteremia noted. Positive findings were noted in patients with carcinomatosis and severe liver involvement. These data suggest that routine prophylactic antibiotic coverage is unnecessary in uncompromised patients. Further studies are warranted when patients have either severe liver involvement or impairment of normal host defense mechanisms.


Computer processed 99mTc-DTPA studies of renal allotransplants. In order to refine the diagnostic possibilities of the radionuclide renal study in transplanted patients and to compensate for the nonspecificity of the 131I-hippuran study in some situation, 99mTc-DTPA WAS USED SIMULTANEOUSLY FOR IMAGING AND TIME-ACTIVITY CURVES. For these curves to be significant, appropriate background subtraction had to be made with a simple computer-processing method. The results obtained have shown that it is possible to distinguish marked acute tubular necrosis from milder degrees, thus affording a prognostic index in the immediate postoperative period, when the hippuran data are often nonspecific. Further, the diagnosis and follow-up of acute rejection episodes can be improved by the DTPA processed curves. Although these curves when examined individually do not show a specific pattern for rejection, they may reveal striking evolutionary changes when compared to the previous studies, even when the hippuran curves are unchanged. The physiologic basis for the differences between the two time-activity curves may be related to the differential handling of the two radiopharmaceuticals by the kidney.


Hyperglycemic pseudorejection in the diabetic transplant patient. Serum creatinine elevation in a stable transplant recipient most often suggests rejection of the transplant and requires further evaluation and management. In our series of juvenile diabetic patients who have received kidney transplants, we frequently have observed creatinine elevations in association with hyperglycemia. Correction of the hyperglycemia resulted in return of serum creatinine to normal levels and no rejection therapy was required. To better define this syndrome, 2,734 paired measurements of blood glucose and serum creatinine were obtained in 52 stable post-transplant diabetic patients. A mean increase in blood glucose of 100 mg. per 100 ml. was found to increase serum creatinine by 0.5 mg. per 100 ml. in these patients (r=0.93; p less than or equal to 0.001). Evidence strongly suggests that the pathogenesis of this phenomenon is not a result of a laboratory artifact due to the technique used to determine serum creatinine. The pathogenesis may be due to the increased serum osmolarity and resulting intracellular dehydration associated with hyperglycemia. Recognition of this syndrome is important to all centers participating in the care and management of the diabetic transplant recipient.


Serum lactic dehydrogenase and irreversible renal allograft rejection. The relationship between serum lactic dehydrogenase (SLDH) values and renal allograft rejection was examined in the dog and in man. Nine dogs with renal allografts and four with autografts had similar maximal elevations of SLDH during the first five postoperative days (mean, 420 +/- 213 and 433 +/- 80 I.U. per liter, respectively). During rejection of the allografts between days 7 and 14 the maximum SLDH was 810 +/- 285 I.U. per liter, and in autografts the peak SLDH was 233 +/- 22 I.U. per liter (p less than 0.01). The isoenzyme pattern of maximum SLDH during rejection was prominent in LDH5 and corresponded with renal tissue LDH isoenzyme composition. In 93 episodes of initial acute human renal allograft rejection reactions, the SLDH peaked above 500 I.U. per liter in 23 cases and remained below 500 I.U. per liter in 70 cases. SLDH levels above 500 I.U. per liter were associated with complete rejection of the kidney in 91 percent of patients and SLDH levels persistently below 500 I.U. per liter corresponded with reversal of rejection reaction in 99 percent of patients (p less than 0.01). Marked SLDH elevation is associated with severe, usually complete renal allograft rejection and may be useful in identifying patients with irreversible rejection reactions.


Ophthalmic complications of giant cell arteritis. Temporal arteritis, or giant cell arteritis, is a common cause of blindness among older age groups. Classical and occult forms are described with particular reference to ocular symptomatology. Although the disease is self-limiting and usually subsides spontaneously within a year, prompt diagnosis and treatment are required if second eye involvement and blindness are to be prevented. Erythrocyte sedimentation rate is of major significance to diagnosis, but biopsy is necessary to prove or disprove the existence of temporal arteritis. Pathology, etiology, association with other disorders and laboratory studies are discussed. A regime of corticosteroid therapy is recommended and described in detail.


Improved patient survival in renal transplantation. Patient and graft survival in 655 consecutive renal transplants performed at the University of California, San Francisco, was analyzed in two separate groups to assess the results of the low-dose immunosuppressive regimen established in September, 1972. These results show that graft survival is not jeopardized by adopting a policy of low-dose immunosuppressive therapy, but, in fact, that patient survival is improved significantly. This study also shows that cadaver renal transplantation can be performed with a mortality rate comparable to or better than that in patients on chronic hemodialysis.


Oculogenital disease.

Oculogenital disease. This review comprises brief discussions of the epidemiology, clinical manifestations, laboratory features, and treatment of the oculogenital diseases as they appear typically in the newborn infant, the child, and the adult. Inclusion conjunctivitis is the most frequently occurring oculogenital infection in all three categories of patient. Oculogenital diseases are becoming increasingly important in both frequency and severity. They can be extremely serious and may thus require the immediate attention of the physician.


The incidence of adverse reactions from steroid/antiinfective combinations. Steroid/antiinfective combinations have a number of advantages over the separate ingredients, but the possibility of complications has been a subject of concern. Based on data obtained from the files of eight pharmaceutical companies and the health registry records of the United Kingdom, Australia and New Zealand for the period 1964-1973, it is concluded that the statistical incidence of adverse reactions was no greater with the steroid/antiinfective combinations than with their separate ingredients. In addition, there was no increase in incidence of the reactions during the same period with combinations. These conclusions were borne out by adverse reaction data reported in the literature and in certain unpublished prospective clinical studies. It was not feasible to obtain data from ophthalmologists who may have observed adverse reactions, but not reported them. A critical evaluation by Dr. Philip Ellis follows the review.


Immunotherapy with neuraminidase-treated cells and bacillus Calmette-Guerin. Experiments were designed to determine the effectiveness of active immunotherapy, both specific (neuraminidase-treated cells) and nonspecific [bacillus Calmette-Guerin (BCG) organisms] in the L1210-BDF1 tumor-host system. Tumor burden was minimized with chemotherapy (1,3-bis-(20chloroethyl)-1-nitrosourea) prior to immunotherapy. The effectiveness of immunotherapy was dependent on the amount of drug used to minimize tumor burden. An interval 36 hours between chemotherapy and immunotherapy produced the maximum number of survivors. A single immunization with 10(4) neuraminidase-treated cells was superior to other single or multiple immunizations. BCG was most effective when mice were given 393 X 10(5) organisms. Beneficial effects of immunotherapy were observed only when immunizations were given by an intraperitoneal route. All mice cured of tumor developed tumor-specific immunity. The highest levels of immunity were observed in mice given both neuraminidase-treated cells and BCG organisms after chemotherapy.


Studies on infiltrating host cells harvested from acutely rejecting rat cardiac allografts. Although the cellular events of rejection of organ allografts have been fully described histologically, little information exists regarding actual mechanisms of graft destruction. Available concepts are based primarily upon assays performed in vitro. This study describes a model designed to correlate such in vitro information with events occurring in vivo within acutely rejecting organ allografts. Infiltrating host cells had been harvested by two techniques from heterotopic cardiac allografts in rats. The various cell classes have been noted and their differential rates of accumulation compared to serial histological observations. Subpopulations of cells have been identified by surface markers, and specific cytotoxicity against donor alloantigen has been determined as a T lymphocyte function. These techniques may be of aid in unraveling the complexities of graft rejection.


Isolated metachronous renal artery emboli. We have reported on a patient with isolated metachronous renal artery emboli. The second embolus was treated successfully surgically 12 hours after the onset of symptoms. A review of the literature shows that emboli to the renal arteries occur more frequently than realized and that late embolectomy often is successful. A clinical triad of flank pain, atrial fibrillation, and nonfunctioning of the involved kidney has been discussed.


In situ kidney preservation for transplantation with use of profound hypothermia (5 to 20 degrees C.) with an intact circulation. Twenty-seven anesthetized dogs were surface cooled at 4 to 6 degrees C. or 15 to 20 degrees C. Circulation was provided by the mechanical ventricular assist in 23 dogs. After 24 or 48 hours of in situ preservation, the kidneys were transplanted into the necks or iliac fossas of anephric recipients. Renal function was preserved in the cadaver for up to 48 hours at 15 to 20 degrees C. by maintaining a pulsatile circulation. Further cooling to 4 to 6 degrees C. caused progressive deterioration in renal function. The nonperfused kidneys kept in situ at 4 to 6 degrees C. did not produce any urine after transplantation. If the practical problems of total body cooling are solved, in situ preservation of multiple organs in the cadaver would increase the number of available organs for transplantation.


Vascular complications in human renal transplantation. There were 13 arterial complications in 202 transplants done in 162 patients, an incidence of 6.5 percent. Renal arterial stenosis was demonstrated by angiogram in six kidneys; four were reconstructed successfully. Four renal arterial occlusions were found in delayed rejected kidneys. Of three arterial dehiscences secondary to infection, all led to graftectomy. One of these patients died 56 days later due to infectious hepatitis, and one underwent a successful retransplant. One patient had an occluded iliac artery which was repaired successfully. A single venous complication occurred in one patient.


Response of serum LH, FSH and prolactin to injection of synthetic LH-RH into rat anterior pituitary. Changes in serum LH, FSH and prolactin were measured by radioimmunoassay following injection of synthetic LH-RH into the anterior pituitary and median eminence of rats. The time course of serum levels of LH and FSH after injection of synthetic LH-RH into the pituitary showed a peak at 15 min. The synthetic LH-RH had a more marked releasing effect on LH than on FSH. After injection of 20 ng into the pituitary, the serum LH rose to about 10.7 times the control level but the serum FSH only to about 1.8 times. A significant rise of serum LH over the control level was noted after injection of more than 0.2 ng of synthetic LH-RH, while that of serum FSH was after injection of more than 2 ng. An injection of 2 ng of synthetic LH-RH into the pituitary following 0.1 mug of estradiol benzoate resulted in a fall of serum LH and FSH levels, and a rise of serum prolactin level. An injection of 2 ng of synthetic LH-RH into the median eminence resulted in a tendency towards slight decrease in serum LH and FSH. No significant response of serum prolactin to synthetic LH-RH was noted.


Fixation of dormant Tilletia teliospores for thin sectioning. Dormant Tilletia caries teliospores in fixative solution or distilled water were frozen onto specimen chucks of an FTS Sorvall-Christensen frozen thin sectioner and cut or fractured at various temperatures (-20 C to -75 C) and thickness settings (10, 15, 20 and 25 mum). Cytoplasm of dormant spores was well preserved and organelles were found to differ from those of germinated spores in morphology. This procedure makes it possible to fix adequately dormant spores and thus compare the ultrastructure and histochemistry of dormant spores with those of germinated spores.


[Review on the afterloading technics in gynecological radiotherapy]. A review of clinically used afterloading techniques - remote controlled and manually operated ones - is given by tables. The advantages of afterloading techniques are discussed with regard to radiation protection as well as to the therapy of gynecologic carcinomas.


[The bilateral breast neoplasm].

[The bilateral breast neoplasm]. Of 282 patients, who had been treated for breast cancer between 1968 and 1973, bilateral carcinoma was diagnosed in 23 women. In these, a simultaneous second carcinoma was found seven times; in 16 cases, the second carcinoma developed during the further course of the disease, wherein the free intervals amounted to maximally 20 years. Attention is drawn to the relatively high risk of up to eight or ten per cent for the development of a carcinoma in the contralateral breast following the previous unilateral carcinoma. This reason calls for a half-yearly, clinical and radiological check-up examination of women having been treated for carcinoma of the breast. Finally, the problem of differentiation of a primary, autonomous second carcinoma from metastases of the first carcinoma on the contralateral side is considered and discussed with regard to the corresponding references in literature.


Modification of the rat alloimmune response by enhancing antibodies and the role of blocking factors in the survival of renal grafts. Correlation of morphological and immunological events ocurring in control and passively enhanced rat renal allograft recipients has revealed an important role for vasculitis in rejection, whereas the tempo and severity of graft lymphocyte infiltration and tubular damage was comparable in both groups during the first 5 days. Thereafter, the degree of cellular infiltration in enhanced allografts progressed and actually exceeded that in control grafts. 2-Mercaptoethanol-sensitive lymphocytotoxic antibodies were present in both groups with comparable titers and appearance times; however, the presence of a severe IgG-containing necrotizing arteritis and glomerulitis in control, but not enhanced, grafts suggests that passive enhancement protects by interfereing with the cooperative T cell-dependent inductive response. Further support for this possibility comes from the fact that the development of cytotoxic lymphocytes against donor target cells was delayed for 48 hr in the enhanced group. While controls died at days 9-11, enhanced animals entered a period of prolonged survival with stable renal function. This state of "autoenhancement" was characterized by a low degree of cell-mediated cytotoxicity and the appearance of serum factors that blocked the in vitro cellular assay. Blocking factors have a low affinity for the attacking cell population, suggesting that they are immune complexes or anti-idiotypic antibodies, and not free alloantibody of high affinity.


The immunogenicity of tooth allografts in rats. Orthotopic and heterotopic tooth allografts stimulated the production of alloantibodies in rats incompatible at the major histocompatibility locus. The immunogenicity of whole tooth grafts was slightly diminished but not eliminated by sealing the pulp cavity prior to grafting. Suspensions of dentine in saline elicited alloantibody formation on i.p. injection into allogeneic hosts. Orthotopic tooth allografts, but not heterotopic grafts, were as effective as skin allografts at stimulating second set rejection of challenging skin grafts. Orthotopic tooth allografts were indistinguishable from syngeneic grafts on histological examination over the period 1-6 weeks after grafting. The occurrence of alloantibody formation after tooth grafting was capricious, and this, combined with the histological difficulty of distinguishing syngeneic from allogeneic grafts, and also the differing capacity of orthotopic and heterotopic tooth allografts to provoke accelerated skin grafts rejection, probably accounts for some of the differences of opinion expressed previously on the immunogenicity of grafted teeth.


Cytotoxic and enhancing properties of early gammaM alloantibodies elicited by first set renal allografts. In vitro and in vivo studies with rat and guinea pig complement on somatic target cells with varying antigen density. First set rat renal allografts transplanted over the strong Ag-B histocompatibility locus elicit antibodies of the gammaM class demonstrable at the time of graft rejection. These early gammaM alloantibodies with guinea pig complement are cytotoxic in vitro to high antigen density target cells like lymph node cells and splenocytes but not to low antigen density target cells like thymocytes and bone marrow cells. With rat complement, gammaM alloantibodies are required in far greater amounts to kill some high density target cells. This in vitro discrepancy between rat and guinea pig complement is not caused by the presence of natural antibody in guinea pig serum nor by a deficiency of complement components in rat serum, but is dependent on the antigen antibody interaction studied. In vivo studies show early gammaM alloantibodies to be cytotoxic to donor lymphoid cells but to enhance renal allografts. These cytotoxic and enhancing qualities reside in the same preparation of immunoglobulin and are influenced by antigen density. These studies suggest that the failure to damage donor kidneys by early, probably low avidity, antibody is caused by a low concentration of antigen on the endothelial cells within the renal graft, and or an inability of this antibody antigen interaction to activate syngeneic complement.


Adverse effects of meglumine diatrizoate on renal function in the early post-transplant period. Thirty-four renal transplant recipients received drip infusion urograms from 2-24 days post-transplantation. Twenty-two patients exhibited changes in renal function within 1-4 days of the urogram that were indistinguishable from allograft rejection: a tender, swollen kidney, elevation of serum creatinine, oliguria, decreased urine sodium concentration, weight gain, and hypertension. Two patients developed acute tubular necrosis and required hemodialysis, but renal function in the remaining 20 patients improved after therapy for "graft rejection" with i.v. methyprednisolone sodium succinnate. Kidneys from older-age donors that were functioning suboptimally and kidneys which exhibited subsequent clinical allograft rejection were more at risk for contrast media toxicity. This suggests that occult vascular lesions may have been present in the allograft which were exacerbated when exposed to the irritant vascular effects of contrast media, producing a mild, reversible toxic nephritis. However, several kidneys with normal function and several kidneys which never exhibited rejection activity were also adversely affected by exposure to contrast media. It appears these agents should be used cautiously, if at all, in the early post-transplant period.


An immunological study of renal allograft rejection using the direct macrophage inhibition test. The direct macrophage inhibition test was used to evaluate the relationship between cellular immune response and graft rejection in related renal allograft recipients. Forty recipients were evaluated before and at regular intervals after transplantation while on maintenance immunosuppressive therapy. Allograft recipients were classified into four categories: 1) Non-HL-A-identical with a rejection episode (14 patients); 2) non-HL-A-identical without a rejection episode (13 patients); 3) 3) HL-A-identical with a rejection episode (3 patients); 4) HL-A-identical without a rejection episode (10 patients). Ten HL-A-identical sibling pairs in good health were utilized as controls. Cellular immunity against donor antigen (macrophage inhibition greater than 20%) uniformly occurred in 16 of the 17 patients who experienced episodes of rejection in both the HL-A-identical and nonidentical graft recipient groups. Transplant recipients who did no experience any rejection episodes up to 2 years post-transplant, and members of the HL-A-identical control group had negative inhibition tests. In 5 cases changes in cellular immune response preceded rejection by several days. The two recipients with positive macrophage inhibition to their prospective donors before transplantation experienced irreversible accelerated rejection. Thus, the direct macrophage inhibition test can be used to screen prospective related donors and to monitor cellular immunity in recipients after transplantation. Preexistent cellular immunity to the donor detected before transplantation correlates with a very high incidence of rejection episodes. Graft recipients who experienced no rejection episodes failed to develop cellular immunity to their donors.


The fate of cadaver renal allografts contaminated before transplantation. Through the routine use of cultures from saline slush transport solution and the initial and final organ perfusates, 14 of 81 cadaver allografts (17.3%) were found to have been contaminated before transplantation. Gram negative organisms, cultured from 5 of the 14 contaminated allografts, resulted in the recipient's death on the first encounter with this problem and the loss of two other allografts. Early antibiotic therapy begun even without evidence of overt infection appeared to prevent any further deaths or graft loss in those whose allografts were contaminated and yielded an overall survival comparable to that of uncontaminated allografts. Without such an approach to the study of perfused cadaver allografts and the management of them when found to be contaminated, this type of infection may go undetected and contribute to allograft and patient loss.


Prevention of blood transfusion-induced immunization against transplantation antigens by treatment of the blood with antibody. The experiments reported show that alloantisera directed against the transplantation antigens of allogeneic blood will completely suppress (1) the lymphocytotoxic antibody response to the blood and (2) its ability to sensitize against renal allografts. AS (Ag-B1) rats injected i.v. with 1 ml of August (Ag-B5) blood gave a strong primary (mainly IgM) and secondary (IgG) lymphocytotoxin response. If the August blood was mixed with AS anti-August serum in vitro before injection, the lymphocytotoxin response was completely suppressed. However, rats given the blood-antiserum mixture gave a primary IgM response upon rechallenge with blood. Rats previously primed with blood had substantial but only partial suppression of the secondary response if the secondary stimulus was given as a blood-antiserum mixture. An AS anti-Wistar (Ag-B2) serum, which showed only weak serological cross-reaction with August lymphocytes, could suppress the lymphocytotoxin response to August blood. A protocol of widely spaced injections of August blood was found to sensitize AS rats to (AS X August)F1 renal allografts. If the blood injections were given as a blood-antiserum mixture, sensitization was prevented. In addition, the blood-antiserum mixtures were found to induce a slight degree of immunosuppression. The clinical application of this approach to preventing blood transfusion-induced sensitization is discussed.


Effect of polyunsaturated fatty acids on skin allograft survival and primary and secondary cytotoxic response in mice. Primary and secondary cell-mediated immune responses are inhibited in vitro and in vivo by polyunsaturated fatty acids, which may have an immune regulatory function in the organism.


Allogeneic bone marrow chimerism in germ-free mice. IV. Therapy of "Hodgkin's-like" reticulum cell sarcoma in SJL mice. "Hodgkin's-like reticulum cell sarcoma develops spontaneously in most SJL mice. Germ-free and conventional SJL mice bearing advanced reticulum cell sarcoma were treated with X-irradiation and transplantation of bone marrow from SJL or C3H/He donors. The 120-day survival rate of germ-free mice receiving allogeneic bone marrow (70%) exceeded that of all control groups; more importantly, germ-free mice that survived more than 4 months after treatment with allogeneic cells had no evidence of neoplastic lesions when killed. The germ-free environment effectively prevented graft-versus-host disease that was lethal to conventional mice. The results of these experiments offer additional evidence that bone marrow transplantation can be used as a therapeutic tool for spontaneous murine neoplasms.


Immunological reactivity of B mice reconstituted with various numbers of syngeneic bone marrow cells. Adult thymectomized mice were sublethally irradiated and reconstituted with various doses of syngeneic bone marrow. Immunological reactivity was assessed by allogeneic skin grafting at various intervals after reconstitution. It was found that reconstitution with high doses (1 X 10(7), 2 X 10(7)) of bone marrow was associated with an ability to reject allogeneic skin grafts and that this reactivity increased with time. Following rejection of a first skin graft, second grafts were rejected in an accelerated manner. These mice had measurable levels of Thy 1.2 positive cells in the spleen. In contrast, low-dose bone marrow reconstitution (1 X 10(6), 2 X10(6)) produced mice which did not reject either first or second allogeneic skin grafts, and such mice had at most only very low levels of Thy 1.2 positive cells in their spleens.


B cell ontogeny in rabbits. Immunofluoresecent localization of B cells in fetal and neonatal rabbits. The mammalian equivalent of the Bursa of Fabricius, the organ responsible for B cell maturation in avian species, has not been identified despite anatomic and ablative studies which suggest that the gut-associated lymphoid tissues (GALT) subserve this function. By analogy to the Bursa, the mammalian organ directing B cell ontogeny should be the site where IgM-bearing cells (B cells) are first identifiable. In this study, fluorescein-tagged heavy chain specific antirabbit IgM is used to localize initial sites of B cell appearance in rabbit fetal and neonatal lymphoid tissues. IgM-bearing cells are found 2 days before birth in the thymus and 1 day before birth in GALT. Immunoglobulin-bearing cells in spleen, lymph node, and bone marrow are undetectable until after birth. B cells bearing the IgM marked precede the appearance of IgG-bearing cells by 1 to 4 days in all instances. Intraperitoneal implantation of Millipore chambers containing immature fetal thymic tissue into neonatal hosts reveals that in situ development of IgM cells takes place independent of host cell traffic. The results suggest that B cell ontogeny in mammals is more complex than in avian species and demonstrates probable involvement of the thymus in the maturational process.


Enhancement of skin allograft survival by soluble alloantigen is serum-mediated. H-2d mice treated before skin grafting with either soluble alloantigen prepared from H-2b cells or with serum obtained from similarly sensitized mice showed a significantly prolonged survival of H-2b skin allografts. This in vivo enhancement was paralleled by a depression of cell-mediated cytotoxicity to [51Cr]H-2b target cells in vitro. Such in vitro and in vivo effects were abrogated when mice were repeatedly injected with soluble alloantigen before and after skin grafting, demonstrating that enhancing antibody present could be neutralized by this mode of antigen administration. The data suggest that serum factors present in mice pretreated with soluble alloantigen lead to specific blocking at the induction phase of the cell-mediated immune response and result in skin graft enhancement.


[New data on the structure of fibrinogen]. The results of physical and chemical investigations show the closeness of fibrinogen to globular proteins, but some differences from globular proteins in certain characteristic features are found resulted from high asymmetry or high hydration of the molecule. The results of electron microscopy cannot be interpreted in a simple way, but nevertheless they show the presence of conformational mobility and existence of configurational isomers. The amino acid sequence of the most important parts of a fibrinogen molecule is known now: "the N-terminal disulphide knot" including peptides A and B being splitted by thrombin, and the part of the gamma-chain participating in covalent binding of fibrin. The study of plasmin and CNBr split products is a fruitful approach to the study of fibrinogen structure and the chemical models of fibrinogen are based on them. In the latest models the N-terminal parts of all 6 polypeptide chains of fibrinogen are located in the centre of a molecule, so the earlier concepts on monomeric fibrin polymerization in the end-to-end way must be reconsidered. None of the existing models produces a definite description of the functional properties of fibrinogen; the appearance of such a model is expected in the nearest future.


[Synthesis of RNA and proteins with exogenous template in the DNA-directed cell-free system from Escherichia coli B. after UV-irradiation]. The RNA and protein synthesis was studied in the DNA-directed cell-free system with extracts and ribosomes of intact and ultraviolet (UV) irradiated E. coli B. The UV-doses used did not kill the cells, but produced noticeable morphological changes. DNA of bacteriophage T2 was used as a template for the RNA synthesis. All the UV-doses used cause an approximately equal decrease in the incorporation of uracil-14C into the acid-insoluble sediment in assays incubated with the extracts of the irradiated cells. The presence of ribosomes from the irradiated cells does not affect the uracil-14C incorporation. With the lower UV-doses incorporation of 14C-labelled amino acids into the acid-insoluble seciment by the irradiated cells extract decreases to the same degree as the uracil-14C incorporation. This may be the result of proportional decrease in the intensity of total RNA and m-RNA synthesis. The intensity of 14C-labelled amino-acid 14C incorporation with the ribosomes from the cells irradiated with lower UV-doses is decreased too. This testifies to a direct effect of uv on the ribosomes. With an increase in the UV-doses these effects disappear. It is supposed that the applied doses of UV-irradiation change differently the properties of the components of RNA- and protein-synthesing systens. This discrepancy becomes more noticeable with an increase in UV-dose.


[Etiology, diagnosis and treatment of spontaneous ruptures of the kidney (author's transl)]. Spontaneous ruptures of the kidney occur seldom. As a rule they are observed in impaired organs. According to the various underlying diseases the symptomatology can differ widely. Etiology and pathogenesis often become clear only after surgical exposure of the kidney. Our own observation of such a case lead us to review the causes as well as the diagnosis and treatment of spontaneous ruptures of the kidney. For clinical purposes we propose a classification into spontaneous ruptures of the kidney with perirenal hematoma and spontaneous ruptures of the pelviocalyceal system.


[Excoriation injuries of the penis and scrotum (author's transl)]. In total excoriation of the penis and scrotum caused by injury the immediate manifestations of new skin cover are seen within 8-12 hrs. In the sense of a "postponed emergency" the usual wound toilet should be performed, a bladder catheter introduced, and penis lowered into a subcutaneous tunnel beneath the abdomen. However, in every case, the ultimate goal is formation of a new skin covering via a split skin flap. The testicles should be lowered into a pouch on the thigh where they will not suffer thermal damage.


[Varicocele as a cause of disorder in fertility (author's transl)]. In this study the pathophysiological connections in varicocele genesis are discussed, as well as its effect upon spermiogenesis and the causal factors. In 73 patients the high retroperitoneal ligature of the testicular vein was performed. Indication was given either on the basis of subjective complaints or on the proof of subfertility. In 79% of the cases a good anatomic result was obtained after operation. Of the spermiograms established prior to operation 56% showed postoperatively a distinct improvement in quality. In 52% of the sterile marriages conception occurred following operative intervention. In our clinic the operative method according to Bernardi is preferred, since it meets best the criteria of an ideal varicocelectomy. Operative intervention should take place early for possible preventing of spermiogenetic lesion.


[How to prevent the TUR-syndrome (author's transl)]. The TUR-syndrome is due to the absorption of irrigating fluid free of electrolytes, producing hypervolemia, and dilutional hyponatremia, as well as hyperkalemia. Strict adherence to the above ten rules is necessary in preventing the TUR-syndrome. After using them for 30 years, we were able to avoid this complication without using non-hemolytic solutions nor limiting the operative time.


[Pancreatic islets, plasma glucagon and renal calcification in rats fed various diets. Results of a pilot study (author's transl)]. Rats fed abnormally composed isocaloric diets during 21 days (low magnesium, atherogenous, high in proteins or carbohydrates) develop a mean increase in total number of pancreatic A cells, a significant increase of A/B ratio (atherogenous), and hyperglucagonemia in most of the groups under study. Histologic examination reveals calcification most marked in animals under low magnesium and atherogenous diets. They are only scarce following high protein diet; a normal or carbohydrate rich diet nullifies this phenomenon. Independent of the morphologic and functional state of the islets, supplementation by argining and histidine of normal chow is followed by a certain degree of renal calcification. Lowered urinary magnesium and calcium and elevated urinary sodium and phosphate together with a tendency toward hypercalcemia point to stimulation of parathyroids during malnutrition. Absolute or relative hyperglucagonemia must be considered the main causstive factor.


Renal fascia of Gerota.

Renal fascia of Gerota. There are controversial views regarding the configuration of the renal fascia of Gerota. Various arrangements described in the literature are presented. A consensus is derived and its clinical importance stressed.


Simplified experimental ureteroneocystostomy. Improvement in renal transplantation has been the result of increased clinical experience and laboratory investigation. One of the causes of transplant failure is urinary leakage and slough at the ureteroneocystostomy site. A simplified extravesical ureteral implantation technique is described. This method has been used in more than 200 canine renal transplants producing consistently good results.


Disseminated nocardiosis presenting as testicular abscess. A case of a localized testicular abscess due to Nocardia asteroides in a patient on immunosuppressive therapy for a myeloproliferative disorder is reported. Subsequent fatal dissemination of the infection to the prostate, lungs, and liver occurred. This represents the second reported case of nocardiosis of the testis. Extrapulmonary forms of nocardiosis must be recognized so that appropriate treatment can be instituted prior to dissemination.


Analgesic abuse nephropathy.

Analgesic abuse nephropathy. Analgesic abuse nephropathy is seldom considered as a cause in patients presenting with chronic renal disease. In a three-year period 450 patients were seen with chronic renal failure. Of these 103 had interstitial renal disease as the cause of their failure. Twenty of these 103 were due to chronic analgesic abuse, which indicates that need for a greater awareness of this problem. The spectrum of clinical and roentgenographic aspects of analgesic abuse nephropathy are discussed. What constitutes analgesic abuse, helpful clinical findings, frequency of other medical illnesses, and the low incidence of documented renal infection prior to onset of renal failure are discussed. Intravenous pyelographic findings related to visualization, renal size, corticomedullary margins and pelvicalyceal changes are also discussed and demonstrated.


Compression neuropathy subsequent to renal transplantation. Compression neuropathy occurred in 7 patients who underwent renal transplantation. The neuropathy occurred on the same side as the surgery and was associated with the use of selfretaining retractors. Other contributing factors were presence and degree of uremia and diabetes. We suggest that self-retaining retractors be used carefully and length of application reduced to a minimum. Efficient dialysis prior to transplantation may decrease the incidence and severity of neurologic deficit by reducing the extent of uremia.


Twenty-eight-day courses of antibiotics for urinary tract infection. A prospective double-blind study was performed in which 30 adult patients with recurrent urinary tract infections due to Escherichia coli, and Proteus mirabilis organisms were treated by twenty-eight-day courses of either ampicillin, 500 mg. four times a day, or trimethoprim-sulphamethoxazole, 2 tablets twice a day. In terms of freedom from infection fifty-six days after the cessation of treatment in both complicated and uncomplicated infections, trimethoprim-sulphamethoxazole yielded results superior to those of ampicillin. In comparing the results of this study with those of a similar study in which the same agents were given for ten-day courses it appears that only in the complicated infection is there an advantage in giving a prolonged course of trimethoprim-sulphamethoxazole. This study did not generate any evidence to support the extension of ampicillin therapy for urinary tract infection beyond ten days.


Comparison of absorbable sutures in urinary bladder. Experimental cystotomy wounds in dogs were closed with sutures of polyglactin-910, polyglycolic acid, and chromic catgut. Animals were sacrificed at intervals of five to thirty days, and wounds were examined grossly and microscopically. This study reconfirms the benignity of early tissue reaction to catgut and points out the similarity of tissue reaction to polyglycolic acid and polyglactin-910 suture in the urinary bladder, the reaction characterized by early separation and invasion of suture fibers by cellular infiltration.


Immunostaging in carcinoma of prostate.

Immunostaging in carcinoma of prostate. Immunostaging is a new method of assessing patients immunologically before and after immunotherapy. Twenty-eight patients with adenocarcinoma of the prostate were immunostaged independently by two investigators. There was a positive correlation between both immunostagings. There was also a positive correlation between the patient's immunostage and the clinical stage of his cancer.


Ultrasound in diagnosis and evaluation of lymphoceles after renal transplantation. Three cases of lymphoceles after renal transplantation are described. The value of ultrasound is stressed in making the diagnosis, totally delineating the size, following the progression, evaluating the transplanted kidney for secondary hydronephrosis, and localizing the lymphocele for aspiration. Ultrasound is, therefore, believed to be a valuable diagnostic study in the evaluation of patients with a transplanted kidney with an unexplained reduction in renal function, leg edema, or a suspicion of a pelvic mass.


Congenital choanal atresia -- a technique for surgical correction. A technique for transnasal correction of unilateral and bilateral congenital atresia in both infants and older children has been used repeadedly with no difficulty encountered in creating an adequate passage in patients with either unilateral or bilateral atresia. In no instances was there any deviation from the intended path of the boring tool causing injury to the palatine vessels, roof of the nasopharynx, or posterior pharyngeal wall.


The influence of subconjunctival depot corticosteroid on choroidal detachment following retinal detachment surgery. This study indicates that primary retinal detachment surgery on patients aged 55 or over is complicated by uveitis and choroidal detachment at approximate rates of 24% and 44%, respectively. These complications did not influence the anatomic cure rate or recovery of visual acuity. Although only 89 patients were recruited, the technique of random selection equally distributed the parameters studied and provided results of high reliability. The internal controls of the protocol prevented the examiners from being aware of whether the drug or placebo had been administered. We were concerned that the corticosteroid injection might have been producing the apparent increase in infection rate of 7.7% and the study was temporarily discontinued. Because statistical analysis showed there was no significant difference in infection rate between the treatment and control groups, the project could have been continued again.


Palatoplasty: a comparative study.

Palatoplasty: a comparative study. A comparative analysis of 275 patients who underwent palatoplasty between 1961 and 9171 is presented. Of these, 149 patients had a Langenbeck palatoplasty and 188 a V-Y pushback palatoplasty. Speech results in these patients were carefully assessed by experience speech pathologists using conversational and structured (word articulation tests) speech, manometric ratios, and radiographic evidence of palatal movement. Over all, 73% of the V-Y pushback patients attained acceptable speech compared to 56% in the Langenbeck category. Patients with clefts of the soft palate only had the highest incidence of acceptable speech (91% in Langenbeck, 81% in V-Y). In both categories the results were poorer in the more extensive clefts.


Two remarkable events in the field of intraocular foreign body: (1) The reversal of siderosis bulbi. (2) The spontaneous extrusion of an intraocular copper foreign body. Two unusual events concerning intraocular foreign bodies are presented. The first patient had an occult or unsuspected intraocular foreign body. He showed iridoplegia with mydriasis, siderosis iridis, and an intraocular piece of iron lying posteriorly near the retina. The foreign body was removed and the patient regained normal iris color and pupillary activity. His vision remains 20/15 six years postoperatively dispite ensuing retinal detachment one year after removal of the foreign body. The second patient was a young boy injured by a blasting cap explosion. He lost one eye from the injury and had a piece of intraocular brass in his left eye. In spite of the development of chalcosis and a mature cataract the lens gradually shrank in the pupillary space permitting a clear aphakic area and 20/25 vision. The brass fragment migrated forward and inferiorly and was finally extruded under the conjunctiva five years later, where it was removed and chemically analyzed by x-ray diffraction.


[Comparative characteristics of the methods of surgical treatment of extrasphincteric rectal fistulas]. The number of recurrences ranged from 2.1% to 14.3% depending on the degree of fistula complexity. Fistulectomy with suturing of its stump by dosage sphincterotomy is indicated in case of extrasphincteric fistulas without cicatricial and inflammatory changes in the intestinal wall and pararectal cellular spaces. Fistulectomy with suturing of the sphincter should be accomplished only in patients with non-branching extrasphincteric fistulas without inflammatory changes in pararectal cellular spaces. The technic of ligation may be employed in most complex forms of rectal extrasphincteric fistulas. A variant of surgery when ligature is put during the operative procedure and the wound is partially closed makes it possible to obtain adequate functional results.


[Use of a hollow drill in osteoplastic arthrodesis of the hip joint]. The technic of osteoplastic arthrodesis of the coxa, using a hollow drill, is described. The operation was performed in 54 patients. 48 patients were examined within the terms from 1 year to 5 years postoperatively. Ankylosis occurred in 46 cases. The cause of a failure in 2 cases was an early cessation of immobilization.


[Injuries of the large veins of the limbs]. 161 observations of the extremity vein injuries, including 141 cases with associated arterial injuries and 11 cases with isolated traumas, as well as 9 cases of replantation of the extremity in complete tears are analysed. Venous reconstruction was performed in 37 patients, in the remainder veins were ligated. Indications to reconstructive procedures and ligation of injured veins are discussed.


[Open diaphyseal fractures of the long tubular bones and their treatment]. Based on the study of the immediate results of therapy in 172 patients and late results in 123 patients with open diaphyseal fractures of long tubular bones, the number of poor immediate and late results were found to be directly related with the degree of damaging soft tissues at the fracture site. An analysis of the results also indicated their reliable dependence on the choice of the therapeutic method employed. A predominant immobilization of the fracture in a plaster dressing after primary surgical treatment of the wound and open or closed reposition of the fracture is largely recommended. In some kinds of fractures when securing of fragments in a plaster dressing was unfeasible, then the use of delayed metallic osteosynthesis is indicated. Primary osteosynthesis in open fractures may be used only if specially indicated.


Bacteriological and pathological studies of the "collapse syndrome" in suckled calves. During the winter of 1971-72 faecal samples from 91 diarrhoeic calves, 25 of which were considered to be suffering from the "collapse syndrome" were examined bacteriologically. E coli of serotypes reported as having the ability to produce enterotoxins were isolated from most of the calves with the "collapse syndrome", but from only a few of the other diarrhoeic calves, as well as a few unaffected in-contact animals. On post mortem examination, abomasal dilatation was a characteristic finding in calves dying of the "collapse syndrome" but not of other diarrhoeic deaths. The significance of these findings is discussed.


[Influence of tissue emulsions on the phagocytic activity of the RES]. Radiometric, microbiologic, biochemical and morphologic investigations were carried out with a total of 95 guinea pigs and 20 rabbits in order to study the effect of the biogenic stimulants after Filatov on the phagocytic activity of the reticulo-endothelial system. Use was made of a tissue emulsion of swine embryos with biologic activity up to 160 per cent and a microbial stain - Escherichia coli 078. The labeling of the microorganisms was effected by means of 32P as obtained from Na2 H32PO4. It was found that the parenteral treatment of the animals with tissue emulsion after Filatov leads to the enhancement of the phagocytic activity and the lysing of the phagocytised bacteria by the elements of the reticulo-endothelial system by 7 to 10 per cent more than was observed with the use of control animals. The biogenic stimulants after Filatov activate the plasmocytic reaction of the body and the development of ribonucleoproteids in the parenchymal organs, and raise the level of properdin and gamma-globulins in the blood of the treated animals.


[Influence of the storage of slaughtered birds at low temperature on the viability of some microorganisms]. Studied was the effect of the period of storing slaughtered broiler birds at low temperatures on the activity of pathogenic staphylococci, enteropathogenic Escherichia coli organisms and pathogenic species of the Proteus genus. It was found that freezing at minus 34 degrees C and storage of the slaughtered birds at minus 18 degrees C contribute to the considerable decrease in the bacterial count of the investigated test organisms, this being observed to a highest extent during the first fifteen days of storage.


[Diagnostic scheme of the causes of embryonal morbidity in poultry]. A diagnostic scheme has been worked out to reveal the factors causing higher embryonic morbidity and mortality rates in birds. It is based on the morphologic analysis and the bacteriologic and mycologic studies, and can be programmed and put into effect in three stages in the course of 48 hours. On the one hand, the post-mortem analysis is useful in establishing the factors of noninfectious character (overheating, insufficient heating, humidity of low or high values, poor air exchange, improper egg position, insufficient air velocity, improper and continuous storage of eggs, deficiency and hereditary diseases). In such cases the scheme provides a special table displaying the correspondence between the morphologic changes and some possible reasons of embryonic mortality, coded from "A" to "K". On the other hand, the bacteriologic and mycologic investigations are helpful in establishing the factors of infectious character (Staphylococcus aureus, Escherichia coli, Salmonella gallinarum-pullorum and other Salmonellae, Pseudomonas aeruginosa, Aspergillus fumigatus, etc.).


[Methods of treatment of puerperal endometritis in cows]. Tested were two drug combinations for the treatment of a total of 111 cows affected postpartum with acute endometritis. The cows showed equal values in terms of age, annual milk yield, tending and feeding. The animals were treated via the uterus, three times at the interval of 48 hours. Used were antibiotics in combination with other therapeutic means. The first combination used included: furaccillin 1g, furazolidon 0,5 g, kanamicyn 1 g, penicillin 1 g, citric acid 5 g, and trivitaminol 80 cu. cm. Its use contributed to a 76.3 per cent conception rate within the limits of an 80-day service period, and a 56.2 per cent conception rate at first insemination. The second combination consisted of tetracycline 0.5 g, norsulfasol 5 g, pepsin 3 g, citric acid 5 g, and trivitaminol 80 cu. cm. In this case the conception rate obtained was 47.4 per cent and 28.9 per cent, respectively. The cows treated with the first combination had a shorter service period (15.9 days shorter), and the insemination index was 0.3 lower as compared with the cows treated with the second combination.


[Study of Salmonella cultures. IV. Immunogenicity of Salmonella resistant to antibiotics]. Three avirulent and 5 slightly virulent for birds mutants of Salmonella enteritidis and Salmonella braenderup, resistant to streptomycin (S), chlorteracyclin (CT), and chloramphenicol (Ch) were used in the production of live vaccines. The latter were tested for immunogenicity on albino mice and birds. On the eighth and 15th day following vaccination the protein fractions in the blood serum of the birds were followed up through electrophoresis on agar gel, while the agglutinin titer was determined by means of test tube agglutination. The experimental results were mathematically processed with the use of statistical methods. All slightly virulent and resistant to antibiotics mutants showed strong immunogenic properties and gave protection (preventing death) to 76.2-81.82 per cent of the mice. Of the avirulent mutants one showed moderate virulence giving protection to 71.43 per cent of the animals. Tested on 110-day-old chickens the avirulent mutants gave protection to 80 per cent of them. The average titers of the blood serum antibodies of birds vaccinated with immunogenic mutants, and the average percent values of the gamma-globulin fractions were higher on the eighth than on the 15th day. The protein fractions showed changes in the albumin and the gamma-globulin. The rate of correlation between these indices, as shown by the coefficient of correlation, is high (rxy = - 0.843). In this case the negative value of rxy in the equation points to the negative link between the characters.


[Telegammatherapy in the treatment of malignant neoplasms of the nasopharynx]. The authors present an analysis of clinical and pathomorphological findings in 48 cases of malignant neoplasms of the epipharynx. The immediate and late results obtained in radiation, associated radiation and combined therapy are discussed. As a result of the conducted investigation, it was concluded that, while planning a distant radiotherapy, it is essential to take into account the histomorphology, and extent of local and regional spread of malignant epipharyngeal tumor. It is felt that 6000 rads is an optimum absorbed dose in the primary focus and regional metastases. A specific method of an associated radiotherapy for epipharyngeal neoplasms, including distant gammatherapy of the primary focus and lymph outflow routes, and irradiation with fast electrons (15 Mev) to zones of regional metastases is described.


[The effect of hormones regulating calcium metabolism on the growth and metastasis of experimental tumors]. Injection of parathormone and thyrocalcitonin into rats with DMBA induced sarcomas resulted in a considerable stimulation of the metastasization process. It was found that the level of total Ca++ in tumor tissue was reduced under the influence of PTH. Under conditions of chronic exogenous hyperparathyroidism autoimmunereactions were suppressed. A prolonged administration of TCT did not alter considerable the total Ca++ content in tumor and markedly activated the autoantibody production in immunocompetent cells.


[An analysis of meat products as possible factors responsible for transmission of dysenterial toxic infections]. The paper carries experimental data derived from a bacteriological analysis of infected minced meat products for the presence of Shigella sonnei and for ascertaining technological stages non-compliance with whose proper course presents the greatest epidemiological hazards. The procedures employed in analyzing infected meat products are shown to be sufficiently sensitive, for they enable one to count Shigella dysenteriae in numbers of 102-106/g, depending upon the degree of total bacterial contamination of these products. The infringement upon the established process most dangerous epidemiologically is incomplete thermal treatment of the meat products.


[Comparative characteristics of some products of decomposition of lactic protein and fat in cheeses produced with addition of boar pepsin]. The influence of a mixture of pig pepsin with renin (in a ratio of 1:1), used instead of renin in making natural cheeses according to the method proposed by the authors, on the content of some products secondary to decomposition of lactic protein and fat because of a dissimilar nutritional value of the latter, was studied. It has been found that cheeses prepared by using the above mixture do not differ from the control ones in the content of soluble forms of nitrogen, essential amino acids, volatile fatty acids, the sum-total of higher fatty acids and differ but slightly (except for butanone-2) in the proportion of various carbonyl compounds. Hence, an inference is drawn on the suitability of using the renin and pig pepsin mixture in making cheeses according to the method proposed by the authors, since the composition and the quantitative content of products secondary to decompesition of lactic protein and fat in test specimens of the cheese did not differ from the control ones which, in turn, points to the identity of the nutritional value of the finished products in either of these cases.


[Study of the specificity of various classes of immunoglobulins (IgM and IgG) v techenie ornitoznoĭ infektsii]. Studies of the specificity of immunoglobulins of different classes in the course of both experimental and natural orinthosis infection showed IgG antibody to possess a wide spectrum of activity: group-, species- and strain-specific, but specificity to group antigenic components was predominant. IgM antibodies were species-specific, however, population of gammaM-immunoglobulins of animal sera in approximately 7 and 14 days after infection antibody suggested a method for the study of the antigenic structure of the agents of the genus Chlamydia.


[Physicochemical characteristics and macromolecular organization of bacteriophage FI-5 (author's transl)]. Physico-chemical parameters and features of macromolecular orgnization of FI-5 phage were studied. This virus was shown to contain a molecule of double-strander DNA with the standard set of nitrous bases (37.8 mol% GC). The molecule of this DNA in situ is characterized by partial disorder of the second structure. Phage virions contain about 47% of DNA and 53% of protein. The genome of the phage is represented by a DNA molecule with molecular weight 65X10(6) daltons and is capable of coding for a least 15 different proteins.


[Optimization of a method for setting up the neuraminidase activity inhibition reaction (author's transl)]. Different conditions for neuraminidase activity inhibition test using ovomucine as the substrate were compared. The optimal results could be obtained after 1-hour contact of virus with antibody at 37 degrees C and after 18-hour contact of virus-antibody mixture with the substrate also at 37 degrees C. Antineuraminidase antibody titer may be calculated by the results of the test integration in comparison with virus control without correction for normal rabbit serum.


[Surgical technique for institution and plastic closure of the tracheostoma. Ist communication]. Within the frame of intensive care we do no longer use the conventional tracheostomy but the so called "sewed-up tracheostomy". Between January 1971 until November 1973 31 children of all age-groups were treated by that method. Special care for patients with sewed-up tracheostoma is obviously facilitated. The replacement of cannulas has become easy. Plastic closure after decannulation offers good functional and cosmetic results. Surgical techniques, indications and criteria for institution and closure of the tracheostomas are described and 31 cases are evaluated. Complications occuring during the period of tracheostoma and subsequent to the plastic closure as well as the general fate of the children are reported.


[Identification of antibodies by means of immunofluorescence in autoimmune diseases]. A short survey of the methods of the immunofluorescence microscopy for the demonstration of various humoral antibodies is given. It is referred to the necessity of a far-reaching standardisation, whereby especially exact data in publications are necessary. Apart from the fluorochromium/protein ratio as conjuncate criteria among others have proved the ratio of antibody protein to the total protein content and the suitability test at the antigenic material concerned. The following antibodies are dealt with in particulars; antinuclear factors, antibodies of thrombocytes, antibodies of the skeletal muscles, antibodies against smooth musculature, antibodies against mitochondria, antibodies of parietal cells, antibodies against microsomas and antibodies against structures of connective tissue.


[The larval development of the warble-fly Oestromyia leporina Pall. (Deptera, Hyodermah'dae) (author's transl)]. The present paper deals with the larval development of the warble-fly Oestromyia leporina and especially with the development of the first instar larvae (L 1). The hatching from the egg and the modus of infection is described. The migration of the L 1 within the host is reported for the first time as well as the perforation of the skin after the migration period. Exact dates on the duration of the different larval stages are given. Experimental infection reveals a partial immunization of the host against new infections. Some remaining problems of larval biology are discussed. By comparison several facts suggest our present knowledge of the perforation of larval (L 1) Hypoderma bovis probably to be wrong.


[Light microscopical, electron microscopical and clinical findings in orthotopic allogenic porcine liver homografts (author's transl)]. Orthotopic allogenic liver transplantations were carried out on 39 pigs. The length of survival time ranged from a few hours until 179 days. The clinical and biochemical laboratory findings as well as the macroscopical, light microscopical and electron microscopical findings established by biopsy and autopsy in the period after the transplantation are described and discussed with regard to their diagnostic significance and pathogenesis. The causes of death are generalized haemorrhages (15 cases), post-operatively bleeding gastric ulcers (12 cases), infections (7 cases), and early or late complications connected with the surgical interventions (5 cases). Observations of liver homografts over a long period after healing-in without complications and during sufficient function of the transplant show (without immunosuppressive treatment) the development of alterations in accordance with the features of chronic aggressive hepatitis and subsequent liver cirrhosis. Complications resulting from this account for some of the established causes of death. According to the results of experiments in animals surviving for a longer time after transplantation there are a general adaptive activation of metabolism and focal alterations in the outer cell membrane of the parenchymal cells in the transplanted liver. This alteration in the cell membrane of the liver epithelial cells causes an abnormal permeability and may lead to partial peripheral lysis and to total lytic necrosis (colliquation necrosis) of these cells. The main cause of these changes is ischaemia or hypoxia brought about by a variety of factors and the cytolytic effect of specifically sensitized lymphocytes ("killer", lymphocytes, immunocytes, effector cells) of the host organism which is the basis of the actual immunologic rejection process. The observed increase of glutamic oxalacetic transaminase (GOT) and lactate dehydrogenase (LDH) as well as potassium in the blood serum may be regarded as a sign of a progressive (developing) rejection or a chronic insufficience of blood circulation of the transplant. Long-term observations show the tendency for a slow continuous reduction in number of the erythrocytes and leucocytes in the host animals. The behaviour of the macrophages (Kupffer cells) in the liver transplant in relation to erythrocytes, thrombocytes and also lymphocytes of the host organism requires particular attention.


[Results of preventive mycological examination in pregnant women]. From accidential patients fifteen per cent of 2328 pregnant women showed in a cultural method (malt-extract-agar) a vaginal mycosis in the seventh month of pregnancy. In most of the cases it was Candida albicans, but there were also other cases of Candida and Toruplopsis glabrata. The therapy of vaginal mycosis during pregnancy should be done generally, to prevent infections of infants and infections is gynecological and neonatological departments.