Characterization of the DNA from bacteriophage P2-186 hybrids and physical mapping of the 186 chromosome. The DNA from two P2-186 hybrid phages and three 186 Insertion mutants have been characterized by heteroduplex analysis and denaturation mapping. The results allow the orientation of the physical and genetic maps of bacteriophage 186 DNA and put physical limits on the chromosomal locations of the phage attachment sites, immunity genes and tail genees.


Appearance of transducing particles and the fate of host DNA after infection of Salmonella typhimurium with P22-mutants with increased transducing ability (HT-mutants). The kinetics of production of transducing particles for different bacterial markers were followed by premature lysis of Salmonella typhimurium cells infected with P22 phages. The were compared for cells infected with wild type phage or with HT-mutants which show increased transduction frequencies. Measuring the sedimentation velocity of bacterial DNA of cells infected with wild type or HT-phages, it was shown that: a) there is no cutting of DNA at random; b) original fragments necessary for packaging host DNA into transducing particles cannot be smaller than 10 phage-genome lengths; c) cutting of transducing fragments leads immediately to the right length; d) there is no loss of precipitable DNA due to phage infection.


Isolation of phage P2-186 intervarietal hybrids and 186 insertion mutants. Intervarietal hybrids formed between coliphages P2 and 186 have been isolated and their preliminary genetic characterization described. Three insertion mutants of 186 have also been isolated.


Studies of partially repressed mutants at the tamA and areA loci in Aspergillus nidulans. Mutants, designated tamAr, have been isolated on the basis of simultaneous resistance to toxic analogues thiourea, aspartate hydroxamate and chlorate with L-alanine as the sole nitrogen source. tamAr mutants are also resistant to methylammonium. This resistance of tamAr mutants is correlated with partially repressed activity of a number of enzyme and transport systems regulated by ammonium. Furthermore, tam-Ar mutants have low NADP-glutamate dehydrogenase (NADP-GDH) activity and also efflux ammonium under certain growth conditions. Mutants at the areA locus (areAr) have also been isolated on the basis of resistance to these analogues, with nitrate or L-aspartate as the nitrogen source. These, similar to tamAr lesions, result in resistance to methylammonium and are partially repressed for ammonium  repressible system, but in contrast to tamAr, areAr alleles have wild-type NADP-GDH activity and normal ammonium efflux. tamAr and areAr mutants grow as wild type on all nitrogen or carbon sources tested, are recessive, and appear to be epistatic to all other mutations (gdhA1, meaA8 and meaB6) which result in derepressed levels of ammonium regulated system. Whereas tamAr and areAr phenotypes are additive, tamAr is epistatic to areAd phenotype.


Studies on a temperature sensitive nuclear petite mutant of Saccharomyces cerevisiae: phenotypic reversibility of the mitochondrial functions. 1. We have studied the pleiotropic effect of a single-gene mutation of the pts mutant strain 1511 grown at 23 degrees C and 36 degrees C. 2. Growth of the mutant at the non-permissive temperature results in a decrease of respiration rate to about 50% after one generation and to less than 5% after five generations. The cytochrome spectra analysis revealed that only cytochrome c was present after growth at 36 degrees C. 3. Mitochondrial protein synthesis experiments in vivo demonstrated that the protein synthesizing system was not as rapidly inactivated by high temperature as the respiratory system. 4. The recovery of the respiratory capacity of the cells at 23 degrees C is complete but dependent on the de novo synthesis of a temperature sensitive protein.


panD, a new chromosomal locus of Salmonella typhimurium for the biosynthesis of beta-alanine. Three mutants of Salmonella typhimurium LT2, which required either pantothenate or beta-alanine for growth, were obtained after treatment with N-methyl-N'-nitro-N-nitrosoguanidine. Their phenotype was: SM30 Pan-, SM31 Pan- Met-, SM32 Pan- Thi- (requirement for the thiazole-moiety of thiamine). Neither aspartate, dihydrouracil, nor beta-ureidopropionate replaced beta-alanine as growth factor. By conjugation it was found that the three genetic lesions (Pan-, Met-, Thi-) were located at about minute 128 of the bacterial chromosome. By transduction 63% linkage was found between the Pan and Met loci, and 84% between the Thi and Pan loci. Probably the thiazole auxotrophy was due to a lesion in the thiG locus. The new genetic locus responsible for the synthesis of beta-alanine was named panD.


Plasmid-determined alterations of Salmonella typhimurium lipopolysaccharides. Salmonella typhimurium Rc902 infected with derepressed ColIb mutants gave rise to changes in the composition of bacterial lipopolysaccharides (LPS). Bacteria carrying ColIbdrd7, derepressed in transfer, exhibited a marked decrease in the content of all 0-side-chain sugars of LPS. Similar effect were found upon the introduction of R64-11, also derepressed in transfer. In LPS of S. typhimurium containing ColIbdrd2, derepressed in colicin synthesis, a decrease of abequose content associated with an increase of glucose level was observed. Bacteria carrying the wild-type ColIb, the revertant of a drd mutant to the wild type, or the non colicinogenic strain resulting from the elimination of ColIbdrd2, showed no changes in the sugar composition of LPS.


Effect of different mutations in ribosomal protein S5 of Escherichia coli on translational fidelity. The effect of three different types of mutations in ribosomal protein S5 of Escherichia coli on translational fidelity has been studied. Two of them, namely that conferring resistance to spectinomycin and that selected for partial suppression of a temperature-sensitive analyl-tRNA synthetase mutation, do not exhibit ribosomal ambiguity in the in vivo and in vitro test system employed. In contrast, mutations in ribosomal protein S5 selected for suppression of streptomycin dependence mutations are able to derestrict the restriction of translational ambiguity imposed by str A mutations, though to different degrees depending on the type of mutation. Mutants in which streptomycin dependence is suppressed by an alteration in protein S5 are more restrictive than mutants resistant to streptomycin. Again, the extent of restriction depends on the type of the str Ad allele. mutations in ribosomal protein S5 can act as ram mutations like mutations in protein S4. The part of the S5 polypeptide involved in control of translational fidelity is different from regions altered in spectinomycin resistant strains and in the alanyl-tRNA synthetase suppressor mutant.


The relationship of 2-acetamidofluorene mutagenicity in plate tests with its in vivo liver cell component distribution and its carcinogenic potential. Using a plating technique, the mutagenic potentials of 2-acetamidofluorene (AAF) and N-hydroxy-AAF were examined after metabolic activation by liver preparations from different animals. Animals used were: male and female rats; male rats treated with 3-methylcholanthrene (MC); male rats treated with AAF; hamsters; guinea pigs; cotton rats and baboons. Irrespective of the animal susceptibility to AAF carcinogenesis, mutation frequency was always increased in the Salmonella typhimurium TA 1538 tester strain. Indeed, the greater response was found in the presence of liver from cotton rats, a species which is resistant to AAF-induced carcinogenesis. Carcinogen binding, with labelled molecules, was also studied in liver cell constituents of rats, guinea pigs and cotton rats. A much better correlation was found between carcinogenicity and carcinogen binding, at least in those species studied, than between carcogenicity and plate test mutagenicity. The difficulty which this new information poses for the interpretation of plate tests is discussed.


The effect of caffeine on survival of UV-irradiated diploid yeast strains of different sensitivities. The action of caffeine post-treatment after UV exposure in three strains of diploid yeast has been studied. The addition of the drug to the plating medium reduced survival in all cases. Higher colony-forming abilities were found in all strains when the UV dose had been split into two fractions with an interval of about 6 h. Caffeine added to the incubation medium between dose fractions did not interfere with this process in the wild type but suppressed split-dose sparing completely in two sensitive strains.


Induction of DNA double-strand breaks by X-rays in a radiosensitive strain of the yeast Saccharomyces cerevisiae. Sedimentation profiles for chromosomal DNA from unirradiated and X-irradiated yeast cells of wild type and rad 52 strains are presented. These profiles indicate that, whereas wild type strains rejoin DNA double-strand breaks, rad 52 strains apparently do not. These data suggest that the rad 52 mutant lacks a repair system for X-ray induced damage and are consistence with the proposal that an unrepaired chromosome break leads to reproductive cell death.


Induction of rho- mutants in Saccharomyces cerevisiae by guanidine hydrochloride. II. Conditions that prevent rho- induction. The induction of rho- "petite" mutants by guanidine hydrochloride (GuHCl) is inhibited in several conditions. Anaerobiosis inhibited the induction either with or without cell multiplication. Both nalidixic acid (NA) and cycloheximide (CH) inhibited the induction of mutants. On the other hand, chloramphenicol (CAP) produced a dual effect: at low concentration it stimulated, at high concentration it inhibited, the induction. The effect of these different inhibitors on the transformation of rho+ mother cells into rho- by GuHCl is discussed.


1-Phenylalanine mustard (L-PAM) in the management of primary breast cancer. A report of early findings. Prolonged 1-phenylalanine mustard (L-PAM) administration as an adjuvant to mastectomy in the management of patients with primary breast cancer and pathologically positive axillary nodes was evaluated by a prospective, randomized, clinical trial. Treatment failures occurred in 22 per cent of 108 patients receiving placebo and 9.7 per cent of 103 women given L-PAM (p = 0.01). A statistically significant difference (p = 0.02) existed in favor of L-PAM relative to disease-free interval. In premenopausal women, the difference with respect to disease-free interval of treated and control groups was highly significant (p = 0.008). A treatment failure occurred in 30 per cent of premenopausal patients receiving placebo and 3 per cent of those treated with L-PAM (p = 0.008). Whereas a similar trend was observed in postmenopausal patients, the difference is not statistically significant. Thus, L-PAM has been demonstrated to be effective in the treatment of women with primary breast cancer, particularly those who are premenopausal. Results were achieved with minimal undesirable side effects.


HL-A antigens and antibody response after influenza A vaccination. Decreased response associated with HL-A type W16. We investigated possible associations of HL-A types and antibody-response patterns during clinical trials with a live, attenuated intranasal influenza A vaccine. After vaccination, subjects with HL-A type W16 had, as a group, a mean convalescent-phase hemagglutination-inhibiting antibody titer of 14, which was significantly lower (P less than 0.001) than the mean titer of 36 in subjects without Type W16. Of 25 subjects with a poor antibody response, 32 per cent had HL-A type W16, whereas only 5 per cent with a good response had Type W16. The mean titers in nasal secretions of five W16 subjects at 13 and 30 days were less than 3; in contrast, similar titers of 22 subjects without W16 were 8 and 9 respectively. The results suggest that the lower antibody response in W16 subjects is due to increased cellular resistance to infection rather than to a suppressed immune response because other subjects with W16 had normal antibody responses after vaccination with killed influenza vaccine.


A comparison of early-onset group B steptococcal neonatal infection and the respiratory-distress syndrome of the newborn. In attempting to differentiate early-onset Group B streptococcal infection from hyaline-membrane disease we found features of severe Group B infection to be rupture of the membranes for more than 12 hours before delivery (four or eight versus one of nine), gram-positive cocci in the gastric aspirate (four or four versus none of one), apnea and shock in the first 24 hours of life (seven of eight versus none of nine), and the generation of lower peak inspiratory pressures on avolume-cycled respirator (mean of 36.5 +/- 2.8 versus 63.9 +/- 6.2 cm of water; P = 0.005). In eight fatal cases of Group B infection, four patients had radiographic features indistinguishable from hyaline-membrane disease whereas the other cases were consistent with neonatal pneumonia. Seven of the eight infected infants had no histologic evidence of coexisting hyaline-membrane disease. Microscopical features of Group B infection included cocci in unevenly distributed hyaline membranes and minimal atelectasis. Group B streptococcal infection differs clinically and pathologically from hyaline-membrane disease. Differentiating clinical features include early apnea and shock and lower inspiratory pressures on mechanical ventilation.


Arthritis associated with intestinal-bypass procedure for morbid obesity. Complement activation and characterization of circulating cryoproteins. Five patients were studied after intestinal-bypass operations for morbid obesity to determine if the arthritis observed in three of these patients was associated with circulating cryoproteins. Only serum from the three patients with acute arthritis contained cryoprotein complexes. The complexes comprised IgG, IgM, IgA, complement components C3, C4, C5 and IgG antibody against Escherichia coli and Bacillus fragilis. The C3-activator fragment of the properdin complex was identified in fresh serum samples obtained from two of the three patients with circulating cryoprotein complexes and arthritis. These observations suggest that systemically absorbed intestinal bacterial antigens may lead to (or contribute to) the formation of circulating cryoprotein complexes. Circulating cryoprotein complexes activated both the classical and alternate complement pathways and may be important in the pathogenesis of the arthritis associated with the intestinal-bypass procedure for morbid obesity.


Significance of autogenously regulated and constitutive synthesis of regulatory proteins in repressible biosynthetic systems. The functional implications of the different modes of regulation have been examined systematically. The results lead to certain predictions. The regulatory protein in repressor-controlled systems is constitutively synthesised. In activator-controlled systems synthesis of the regulatory protein is autogenously regulated. There is favourable agreement between these predictions and published experimental evidence.


The place of the australopithecines in human evolution: grounds for doubt? Although most studies emphasise the similarity of the australopithecines to modern man, and suggest, therefore, that these creatures were bipedal tool-makers at least one form of which (Australopithecus africanus--"Homo habilis", "Homo africanus") was almost directly ancestral to man, a series of multivariate statistical studies of various postcranial fragments suggests other conclusions. Their locomotion may not have been like that of modern man, and may, though including a form or forms of bipedality, have been different enough to allow marked abilities for climbing. Bipedality may have arisen more than once, the Australopithecinae displaying one or more experiments in bipedality that failed. The genus Homo may, in fact, be so ancient as to parallel entirely the genus Australopithecus thus denying the latter a direct place in the human lineage.


Possibilities of using insectistatics and pheromones in pest control. Agents that can decimate insect populations by suppressing growth and reproduction rather than by causing rapid mortality are called insectistatics. Their activity includes interruption of cuticle formation, induction of hormonal imbalance by extrinsic juvenoids or ecdysoids, developmental disturbances due to nutrient antagonists, symbioticides, or accelerators of metabolism. Disruption of mating may be accomplished by pheromone trapping and disorientation or by prevention of sex attraction. The possible contribution of such biotechnical procedures to the control of storage pests is discussed.


[Modern research on the cell cycle and mitosis in the myxomycete Physarum polycephalum]. The plasmodial stage of Physarum polycephalum contains up to 10(9) nuclei which undergo a naturally synchronous mitosis every 8 h. Nuclear processes such as DNA and RNA  synthesis as well as many cytoplasmic processes such as histone synthesis are also synchronous. Physarum polycephalum is therefore widely used in studies of cell-cycle events. This article describes experiments that may help to explain two fundamental biological processes: (1) the mechanism that triggers mitosis, (2) the structural basis of mitotic movement.


[Structure and function of the endoplasmic reticulum]. After a general review of enzyme topology and the molecular architecture of endoplasmic reticulum the latest research results are discussed. Microsomal enzymes do not occur in specialized regions of the endoplasmic reticulum but are uniformly distributed over the entire membrane system. Functionally associated enzymes are also located in the direct vicinity of the membrane. It has been shown that the catalytic activity of integral enzyme proteins depends on phospholipid and membrane structure. These membrane-bound lipoproteid complexes exert specific effects as vectorial enzyme catalysts. The endoplasmic reticulum is active is active in the intracellular transport of metabolites.


[Osteosyntheses].

[Osteosyntheses]. "Osteosynthesis" or internal fixation is the term used for operative reduction of bone fragments. The aim of the procedure is to effect such stable fixation that the affected extremity may be moved freely. The paper gives a survey of the technical basis of and indications for modern methods of internal fixation.


Function of the UVR marker in dark repair of DNA molecules. It had been found earlier that the excision repair mechanism in E. coli B/R Hcr+ could be depressed by preirradiation, amino acid and thymine starvation; such an interference proved to have no appreciable influence on survival after ultraviolet irradiation. A comparison between Hcr+ and Hcr- cells had revealed that the former were capable of tolerating a greater amount of unexcised dimers than the latter. In this paper it is demonstrated that the above-mentioned pretreatment will depress excision activity also in cultures of E. coli K12 and E. coli 15T- both strains of the uvr+ rec+ genotype. A comparison of two E. coli K12 strains of the uvr+ and uvr- genotype shows that uvr+ cells also have a greater capacity to tolerate unexcised dimers. To throw light on the nature of that increased capacity to tolerate unexicsed dimers we have compared restoration of DNA daughter chains in cells of the uvr+ and uvr- genotype and found that integrity of uvr loci is a conditio sine qua non for an effective restoration of daughter chains, but that depression of excision activity by the mentioned pretreatment does not influence restoration of DNA daughter chains. This suggest that uvr loci are involved not only in excision but also in postreplication mechanism of DNA repair.


A new method for producing a chronic E. coli pyelonephritis in rabbits. Chronic pyelonephritis, especially that caused by the most common invader E. coli, corresponding satisfactorily to the pathophysiology of the human disease is difficult to reproduce. We have developed a pattern of infection with which we succeeded reliably in producing a chronic E. coli pyelonephritis. This was achieved by inserting a plastic catheter into the renal pelvis. A suspension of E. coli was injected via the catheter into the renal pelvis of 32 rabbits. This pattern of infection takes a chronic progressive course and, in all cases, results in typical macroscopic and histological changes in the kidney. The bacterial excretion in the urine remains unchanged over a period of months. With the experimental procedure described, the pathogenesis and pathophysiology of chronic E. coli pyelonephritis can be clearly studied. Drugs currently used on patients can be tested for their effectiveness in long-term application.


Blood viscosity factors and occlusive arterial disease in renal transplant recipients. 29 cadaveric renal transplant recipients were assessed clinically for evidence of occlusive arterial disease prior to undergoing blood viscosity studies. Nineteen patients had manifest arterial disease (myocardial infarction, cerebral thrombosis, angina, intermittent claudication, absent peripheral pulses), while ten were free from vascular complications. Patients with arterial disease showed significant elevations of plasma viscosity (p less than 0.005), aggregation of red cells measured both at 37 and 20 degrees C (p less than 0.05), fibrinogen (p less than 0.005), serum triglyceride (p less than 0.01), serum cholesterol (p less than 0.01), erythrocyte sedimentation rate (p less than 0.02), and a significant reduction in the albumin/fibrinogen ratio (p less than 0.005) when compared with those free of disease. Two patients with no apparent vascular disease when investigated were found to have distinctly abnormal blood viscosity factors, and one subsequently developed retinal arterial thrombosis while the other suffered serious damage of the graft within 3 months of viscosity study. When all patients were considered together, significant correlations were found between viscosity of artificial thrombi or aggregation of red cells and fibrinogen level (both p less than 0.05), and serum triglyceride level (both p less than 0.05); and between rigidity of red cells and the parathyroid hormone level (p less than 0.01).


Acute renal failure after rifampicin: a case report and survey of the literature. A new case of acute renal failure after rifampicin is presented, together with a review of the 36 similar cases published up to date in the literature. Evidence is provided that irregularities in drug intake, either as true intermittent treatment or as discontinuation of continuous therapy, play an important role in the pathogenesis of such reactions. Renal failure appeared after a rather long uneventful interval from the beginning of rifampicin therapy, ranging from 1 month to more than 1 year. Its clinical course was favourable in all but one case; the histological picture was mainly of tubulo-interstitial type. The controversial immunological data reported in the literature are reviewed; an increase of histamine release by rat mast cells has been found in presence of rifampicin plus the serum of our patient: the implications of this finding are discussed, suggesting a possible immunological factor in the pathogenesis of acute renal failure after rifampicin.


Actinomyces peritonitis associated with dialysis. A case of actinomyces peritonitis occurring in a young girl undergoing regular dialytic treatment is reported. The peritoneal localization was the only one detectable and occurred in a patient who at the beginning of the dialytic treatment had received peritoneal dialysis on two occasions. During 4 months of treatment the patient underwent surgical drainage of the peritoneal fluid and medical treatment with various antibiotics. Super-infection with Escherichia coli and Candida, and an acute episode of bronchopneumonia, complicated the course of the treatment which was finally successful


"Phantom" sensations following intraspinal injury. The sensations associated at times with neural lesions in the spinal canal may have the following features and phases: 1) early anosognosia, i.e. lack of awareness of disability; 2) initial stimulation; 3) illusion of amputation; 4) disappearance of that illusion and 5) grotesque sensations. Detailed features of the phantoms such as changes in their size, position, and vividness as well as tactics evoking changes in the sensations are recorded. The special situations are described in which paraplegia is accompanied by actual amputation, or there is a phantom of an upper limb after avulsion of the brachial plexus or after extensive posterior rhizotomy. Finally phantoms associated with incomplete lesions of the cord are analyzed and the basis presented for concluding that a lesion of an ipsilateral posterior column is responsible for the phantom experience in cord lesion.


Simple determination of the foramen in trigeminus coagulation. The object is to achieve a high degree of precision in the determination of the foramen ovale in managing trigeminus neuralgia stereotactically as well as by free-hand penetrations. We carried out exact measurements on lateral skull x-rays of 55 corpses and 25 patients. With the aid of a design and several plain x-ray films we drew connecting-lines between fixed, easily determined points of the skull. The middle of the foramen ovale coincides with the dissecting point of these 3 co-ordinates, the maximal deviation of 2 mm is clinically negligible compared with the total width of the foramen. The average distance of the foramen from the midline as measured on the basic projection is 2.8 cm +/- 2 mm. The puncture technique and the thermocontrolled coagulation of the trigeminus branches are discussed.


Light and electron microscopic examination of isolated neurons, astrocytes and oligodendrocytes. Astrocytes and neuronal and oligodendroglial perikarya isolated by the method of Norton and Poduslo (1970) were examined by transmission and scanning electron microscopy and inverted phase contrast microscopy. The viability of the cells, as determined by the eosin exclusion method, was also determined. The three cell fractions showed only slight cross-contamination, but the astrocyte fraction contained significant amount of small debris. The ultrastructural appearance of the cells indicated that much of the in situ properties were retained, with bundles of fibrils preserved in astrocytes with well-defined plasma membranes. Oligodendroglial perikarya were found to be the best preserved of the cell types. The viability studies indicated that about 90% of the cells excluded eosin. Scanning electron microscopy revealed the neuronal cell surface to be rough and studded with knob-like bodies. Oligodendrocytes tended to aggregate and demonstrated a much smoother surface than the neurons.


[Two cases of primary intracerebral malignant lymphoma (author's transl)]. Two cases of primary intracerebral malignant lymphoma were reported. Case 1 was a 42-year-old man who had been suffering from headache and mental disturbances for about 3 months prior to admission. These complaints progressed insidiously. He was admitted to our hospital on March 31, 1973. On neurological examinations he was in somnolence state and had neck rigidity, positive of Kernig's sign, disorientation and dyscalculia. Lumbar puncture gave a C.S.F. pressure of 240 mmH2O and the fluid contained 180 mg/dl of protein. A left vertebral angiogram via brachial artery demonstrated thalamic and cerebellar mass lesions. For the development of symptoms of increased intracranial pressure, a ventriculoperitoneal shunt operation was performed on April 7. A right carotid angiogram after ventriculoperitoneal shunt operation disclosed a frontal mass lesion. On May 2, a right frontal craniotomy was carried out and the frontal lobe was removed together with the tumors. After the operation his consciousness remained stupor. Thereafter consciousness and clinical pictures gradually worsened, and he died on May 30. Autopsy was performed, and gross examinations revealed tumors in the bilateral frontal and temporal lobes, right parietal lobe, and left cerebellar hemisphere. On coronal sections, there were neoplastic proliferation extending from the right thalamus to the putamen and a tumor in the right midbrain. No evidence of neoplastic proliferation was found outside the central nervous system. Microscopic examinations showed a diffuse proliferation of tumor cells with mitosis and polymorphism. The tumor was consisted of small lymphoid cells. Reticulin fibers were not found in the tumor with Watanabe's silver method. It was also unable to impregnate the tumor cells with silver carbonate. This case may be classified the primary interacerebral lymphosarcoma. Case 2 was a 48-year-old man, who was admitted to the hospital complaining of occipitalgia, speech disturbances and diffculty in walking. On neurological examinations, he had a right spastic hemiparesis and dyscalculia. A right carotid angiogram showed the frontal mass lesion. On April 18, a left frontal craniotomy was performed and frontal lobe was removed with the tumor. He made a good recovery from the operation and remained well for about 1 month. However, it culminated in a gradual diminution in the level of consciousness. Unfortunately, he died on June 20. No autopsy was performed. Histologically, the tumor cells had round or ovoid nuclei, mitosis and polymorphism. The perivascular arrangement of the tumor tissue showed tendency to confluence. There were reticulin fibers in the tumor tissue, particularly around the blood vessels. Microglial cells were not impregated with silver carbonate. It is supposed that this case belongs to the primary intracerebral "reticulum cells sarcoma-microglioma" described by Rubinstein or reticulum cell sarcoma. Both the case 1 and the case 2 should be filed to be malignant lymphoma in the wide category.


[Artificial hyperventilation in head injury. I. Spontaneous hyperventilation and assisted ventilation (author's transl)]. The present study was desined to clarify the roles of artificial hyperventilation in management of the patients with cerebral injury. Here reported is the first part of the serial studies and concerned with general informations about hyperventilation. The measurements of PaCO2, minute ventilation volume (VE), dead space (VD), tidal volume (VT), cardiac output (by dye dilution method), oxygen consumption (by Fick' principle) and oxygen equilibrium were performed in the patients suffering from acute, severe head injury. And the effect of assisted ventilation on them were investigated (using pressure-limited respirator). 1. There was a common finding that marked and sustained increase in VE, VA (alveolar ventilation), and decrease in PaCO2 existed during the first week of injury. 97% of both VE and VA were above normal and mean value of PaCO2 was 29-33 mmHg. The syndrome of spontaneous hyperventilation was evidently more prominent in the nonsurvived group of patients. It was noteworthy that increased VE (or VA) was dependent neither on VD or pulmonary dysfunction nor on metabolic acidosis of arterial blood. The relation of VA to base excess in head injury was well contrasted to that of acute CO poisoning. 2. Assisted ventilation resulted in increased VT and decreased respiratory rate, and little change in VE. Consequently, PaCO2 changed only from 33.0 to 29.4 mmHg as a mean of entire series of patients. But when the influence affected by hypoxemic drive was subsided, a significant reduction of PaCO2 was disclosed following assisted ventilation. The assisted ventilation with pure oxygen was also associated with reduced cardiac output (from 6.0l/min to 5.3l/min), though the oxygen consumption changed variedly among the patients. 3. The fact was confirmed that both hypocapnea and alkalosis produced the left-sised shift of oxygen dissociation curve, decrease in P50 (P02 at 50% saturation of oxygen), and in addition, narrowed arterio-mixed venous oxygen difference. The changes of artero-mixed venous oxygen saturation difference which were calculated at 100 mmHg of PaO2 and 40mmHg of mixed venous PO2 were in a linear fashion with those of P50. Apart from the problems on injured brain, the beneficial and non-beneficial effects of hyperventilation were further discussed. The availability and inidcation of artificial hyperventilation should be precisely evaluated later, in a comprehensive manner with the subsequent studies (Part 2 and 3) on cerebral metabolism and intracranial pressure.


[Prolactin-secreting pituitary gland adenoma. Present-day possibilities of diagnosis and treatment]. Among the 230 pituitary adenomas that we treated, 23 patients aging from 20 to 39 had a prolactin-secretary pituitary adenoma and were all demonstrating an amenorrhea-galactorrhea syndrom. It is not always very fast to establish the more and more frequently observed etiology of this clinical state, especially when the existence, or not, of a pituitary adenoma is concerned. A total endocrinological study (determination of serum prolactin and inhibition and stimulation tests) of all hypothalamic-hypophyseal-peripheric axis must be done, as well as precise radiological studies, able of showing small distortions of the sella turcica. On our patients, the diagnosis of a pituitary tumor and the surgical intervention have never been decided on the base of only one element of the diagnosis. We now think that only the presence, at the same time, of clinical, radiological and biological signs, however small they are, allows the decision for a surgical intervention when prolactin-secreting pituitary adenoma is suspected.


[Two cases of spina bifida cystica with congenital dermal sinus]. Spina bifida cystica and congenital dermal sinus are congenital anomalies which are called dysraphic states. Numerous reports of congenital dermal sinus can be seen in Europe and America, but in this country we have been able to find no more than six reported cases. Also in this country, to the best of our knowledge, only two cases of combined spina bifida cystica and congenital dermal sinus have been seen. The small incidence of reported cases may be due to the fact that congenital dermal sinus tends to go unnoticed except when infection develops. Consequently when dermal sinus is asymptomatic, even in both combined cases, it probably is thought to be only spina bifida. We have seen the combination with congenital dermal sinus in two among twenty cases of spina bifida cystica which we have observed during the past seven years. We report on this and discuss it in relation to the other literature.


Duchenne dystrophy: electron microscopic findings pointing to a basic or early abnormality in the plasma membrane of the muscle fiber. In seven patients with Duchenne dystrophy, high-resolution phase microscopy demonstrated a population on non-necrotic fibers with one or more focal lesions. The typical lesion was wedge-shaped, with the base resting on the fiber surface. In the electron microscope, the plasma membrane overlying the lesion was either absent or disrupted, while the basement  membrane was always preserved. Within the lesion, there were cytoplasmic abnormalities, and in the neighboring fiber region, the myofibrils were usually highly contracted. The structural defect in the plasma membrane suggested that this site was an ineffective cellular barrier. This was confirmed by the frequent ingress of peroxidase-containing extracellular fluid into the lesions. In two control subjects, peroxidase penetration into fibers was seen only rarely and only with other evidence of mechanical injury to the specimen. The findings point to an early and possibly basic abnormality in the plasma membrane of the muscle fiber in Duchenne's dystrophy.


[Anti-inflammatory and analgesic action of S-adenosyl-L-methionine (SAMe) in experimental tests on laboratory animals]. S-adenosyl-L-methionine (SAMe) always plays an important role in the metabolism of catecholamines. Since the importance of the latter in the inflammatory process has been reported by several Authors, we examined the effect of SAMe in various tests of acute inflammation (carrageenin and white egg oedema) and chronic inflammation (cotton pellet induced granuloma, adjuvant induced arthritis). Considering the positive results we have obtained and being aware that many drugs with antiinflammatory activity also have an antalgic activity, we examined the effects of a treatment with SAMe on animals subjected to analgesic tests: hot plate and streching by acetic acid in mice.


[Pharmacological and clinical aspects of S-adenosylmethionine (SAMe) in primary degenerative arthropathy (osteoarthrosis)]. After some preliminary remarks of a biochemical and pharmacological nature, the authors have started a clinical study to test the antiinflammatory activity of the S-adenosyl-methionine (SAMe). An open trial, carried out on 90 patients with severe degenerative arthropathies has shown that 30 mg SAMe intravenously twice a day for 14 days have a marked anti-inflammatory effect a rather term and no side-effects. In a "double-crossover" investigation, SAMe was next compared to indomethacin by i.m. administrations to 15 arthropathic patients. The therapeutic responses of the two drugs proved exactly alike, whereas the side-effects following indomethacin administration were not present after SAMe. In 9 patients affected with rheumatoid arthritis administrations of SAMe have proved less effective, although some clinical parameters showed improvements.


[Antistaphylococcal activity of gentamicin]. A review of the literature suggests the following conclusions: 1) since its first practical use in 1965, namely over the past 10 years, there has been no drop in activity of Gentamicin on Staphylococcus aureus and on numerous other Staphylococcus and/or Micrococcus species. 2) In comparison with the other aminoglycosidic antibiotics employed up to the present, i.e. Streptomycin, Neomycin, Kanamycin, Amminosidine, and Framycetin, Gentamicin has demonstrated a much superior antistaphylococcic activity, and this has also been documented on numerous strains of staphylococci recalcitrant to Kanamycin, Streptomycin, Framycetin and Neomycin. This goes to prove the absence of any cross resistance between Kanamycin, Streptomycin, Framycetin and Neomycin on the one hand and Gentamycin on the other. 3) Along with Rifampicin, certain Cephalosporins (Cephalotine, Cephaloridine) and Pristinamycin-Virgimycin, Gentamicin must undoubtedly be considered a "greater" antibiotic as far as antistaphylococcic activity is concerned. It also has the advantage over other antistaphylococcic-acting antibiotics that only in exceptional cases does it give rise to resistant strains.


[Current dietetic and pharmacological treatment of hyperlipoproteinemia]. Secondary hyperlipoproteinaemia necessitates direct management of the main disease (hypothyroidism, nephrosis, etc.), whereas primary forms are essentially handled by dietary regimens adapted to subject types, as classified by Fredrickson-Levy-Lees and adopted by the WHO. These regimens are described and discussed schematically. Drugs may be employed if diet proves ineffectual. Anionic exchange resins, d-thyroxine, clofibrate and nicotinic acid have been shown effective for this purpose. Their mechanisms, doses and side-effects are described. The criteria governing their selection are explained in the light of the recent literature and with reference to the six phenotypes proposed by Fredrickson-Levy-Lees.


[A case of granuloma caused by a plant foreign body retained in the perineal subcutaneous tissue]. A case of granuloma caused by a foreign vegetal body (part of a thorn of Triticum vissosum) lodged in the subcutis of the perineum, observed at the Department of Surgical Symptomatology of Palermo is reported. The clinical case was of interest for the rarity of the way in which the foreign body reached the perineal tissues, the abnormal resulting clinical episode, and the histological finding. The intention is also to demonstrate how at times symptomatology and clinical objectivity are not always enough to guide the physician to correct diagnosis; where historical data are lacking, clinical objectivity, often suggest neoformation of heteroplastic type or aspecific chronic inflammation rather than granulomatous reactions due to foreign bodies.


Clonidine in menopausal flushing: a double-blind trial. Twelve hypertensive women were treated with low doses of the antihypertensive drug clonidine for their menopausal flushing in a double-blind trial. There was a high degree of placebo effect but clonidine at a daily dose of 150mug was more effective than placebo.


Abdominal wound disruption.

Abdominal wound disruption. Abdominal wound disruption occurred in 6 cases in a series of 2500 consecutive abdominal laparotomies. A prospective study of 900 laparotomies utilizing polyglycolic acid suture material and the Smead-Jones closure technic was carried out over a period of 1 year with a reduction in the incidence of wound disruption from 0.4 to 0.1%. Etiologic factors placing patients in a high-risk category for disruption are identified, and specific prophylactic measures are discussed. Prevention of catastrophic disruption is advocated because of its high mortality rate, averaging 20%.


Pituitary and ovarian response patterns to stimulation in the postpartum and in galactorrhea-amenorrhea. The role of prolactin. In order to assess the action of prolactin on the puerperal pituitary-ovarian resistance to physiologic stimulation, a study was conducted in 27 women divided into three groups. Group I: 9 postpartum women who did not wish to breastfeed their infants and received 2.5 mg bromocriptin (CB 154) twice daily for 14 days starting immediately after delivery; Group II: 9 normally lactating mothers; and Group III: 9 women with hyperprolactinemia associated with amenorrhea. The three groups underwent stimulation with LHRH and Pergonal 500. Results indicate lack of prolactin dependence in the pituitary-ovarian resistance of the puerperium. The possible mechanisms involved in the anovulatory period of lactation are discussed.


Obstetric problems in association with anencephaly. A survey of 60 cases. Obstetric problems associated with 60 anencephalic births are analyzed according to cause and severity. Treatment is selected problems is discussed. Early diagnosis and the real problem-prevention-is stressed.


Topical anesthesia of the uterine cervix or corpus. A potent topical anesthetic drug, 1% tetracaine, and a placebo were evaluated in a "double-blind" study to determine whether or not topical anesthesia could be achieved on the exocervix, endocervix, and endometrial cavity. No anesthetic effect of tetracaine was demonstrated.


Primary reticulum cell sarcoma of the uterus. The authors present a case of primary uterine reticulum cell sarcoma who developed disseminated disease 6 years after undergoing a total abdominal hysterectomy. Review of the literature reveals 27 other patients with uterine lymphomas. Abnormal vaginal bleeding was the presenting complaint in 66% (14/21) of patients. Reticulum cell sarcoma was the most frequent histologic type, 68% (19/28). 28% of patients were alive and well 6-24 years after therapy.


The occurrence and pathology of chlamydiosis in domestic and laboratory animals: a review. The literature on the various disease syndromes caused by chlamydia in domestic and laboratory animals is summarized. A review of the pathological lesions which characterize these diseases is presented and the pathogenesis of chlamydiosis is briefly discussed. Some aspects of unpublished findings on the occurrence of intestinal, kidney and genital lesions in natural and experimental cases of chlamydiosis in cattle and sheep, abortions and conjunctivitis in horses in South Africa are recorded.


Gamma camera images of the salivary gland using 99mTc. Report of four cases. Following the intravenous injection of 99mTc pertechnetate, the gamma camera enabled us to define the dynamic characteristics of salivary gland function as well as morphologic characteristics in a normal patient and in three patients with diseased parotid glands. We will continue this study in an attempt to define further the functional and morphologic characteristics of abnormal salivary glands.


Lung growth and alveolar multiplication. As the lung grows in volume from infancy to adult life, considerable amounts of tissue are added to the lung, mostly as a result of alveolar multiplication. Species differences may exist: at birth alveoli are absent in mice and rats but alveoli are generally thought to be present in humans at birth. Alveolar multiplication is brought about by the subdivision of the primitive terminal units, primary pulmonary saccules, by secondary alveolar crests, and by alveolarization of nonalveolated and partly alveolated airways. The exact method of alveolar development and the relative importance of the above modes of alveolar growth are not known. In the first few days of life in rats and mice, there is a phase of dilatation of the lung, followed by a phase of rapid cellular and tissue proliferation. Subsequently, remodeling of the lung occurs, during which stage lung tissue increases little and dilatation is more prominent; this leads to stretching of the alveolar walls. Alveolar multiplication may occur throughout life in the rat. In human subjects, alveolar multiplication is most rapid in the first few years of life. After this, it appears to slow and perhaps stop by age 8 years, although there is some suggestion that alveolar multiplication may continue until somatic growth stops. Pneumonectomy produces enlargement and increase in tissue of the contralateral lung by virtue of cellular hyperplasia. Alveolar multiplication likely does not occur. Diminution of intrathoracic volumes produces small lungs which, in the human, may also have too few alveoli if the chest wall deformity has its onset in infancy or in intrauterine life. High altitude produces large, heavy lungs which may have more alveoli than normal.


Mechanisms of tissue injury in systemic lupus erythematosus. SLE is a syndrome with protean clinical manifestation, a diversity of immunologic abnormalities, and a host of potential etiologic agents. In recent years, considerable information has been accumulated concerning the immunopathogenesis of SLE, and significant advances have been made in the treatment of the disease by utilizing immunosuppressive therapy. Further investigation will be needed to clarify the mechanisms of tissue injury, especially as they relate to the CNS, and to identify the factors responsible for initiating the SLE syndrome.


[Study of the direct immunofluorescence method for the differentiation of trichomonad serotypes]. It is possible to differentiate the serotypes of Trichomonas vaginalis by the direct immunofluorescent method using the tupe-specific antisera labelled with fluorescein-isot-hiocyanate. The most decisive factor in expressing the degree of induced fluorescence is the serotype of the protozoa. Evans blue, which has an intensive red fluorescence, totally eliminates the green autofluorescence of T. vaginalis and does not influence the induced specific fluorescence.


[Study in man of the blood and urinary effects of intense muscular exercise on certain elements of protein metabolism]. The effect of heavy physical exercise of long and short duration was studied on a group of 33 sportsmen and non-sportsmen after a run on a treadmill. Blood samples were taken just before the exercise, just after, one hour later and the next day. Urine was collected during the 24 hours preceeding the exercise, just after, one hour after, and then until the following day. Urea, uric acid, creatinine were analysed in each sample and amount of excretion calculated. The results, show an obvious rise in protein catabolism. The increase in urea and uric acid is the consequence of increased adrenal functioning and the increase in creatinine can be explained as the consequence of an increase in its metabolism from phosphagen and creatine. A temporary impairment in renal function, resulting from hemodynamic and humoral conditions was also observed. The relative importance of these two mechanisms varies with the different subjects.


[Renal functions and extracorporeal circulation]. During 76 extracorporeal circulations (CEC) carried out for open heart operations using an identical protocol, the authors carried out renal function tests from the time of administration of the anesthetic to the post-operative period. Various periods may be distinguished: pre-operative, anesthesia induction (CEC 1, CEC 2) post induction (CEC 1, post CEC 2) finally, the post-operative period (post-operative 1 to 4). As far as renal hemodynamics are concerned, the authors made the following observations: constant reduction in thiosulphate clearance and endogenous creatinine clearance, which reflect glomerular filtration. Reduction in PAH clearance, which reflects renal perfusion. Taking into consideration changes in the hematocrit, one may consider that there is a reduction in renal blood flow at all stages of anesthesia. Taking into consideration concomitant variations in blood pressure, one may calculate that intrarenal resistances are increased. The diuresis/minute increases in very great proportions during induction of anesthesia. Plasma osmolality also increases, urinary osmolality becomes reduced and osmolar clearance rises. The ratio between osmolar clearance and creatinine clearance rises. The clearance of free water rises from negative values. The serum sodium becomes slightly reduced, and sodium diuresis increases. Serum potassium becomes slightly reduced and urinary potassium rises. The interpretation of these phenomena is difficult and should take into consideration the experimental conditions. Comparison with published results shows that there are definite differences depending on whether pure or diluted blood is used. It is however, possible to seek the role of the anesthetic, the thoracotomy or the extracorporeal circulation itself and its load, quite independent of prior changes due to decompensation or not of the congenital heart disease, whether or not it has been treated. The study of these changes in renal function permits one to understand better the precariousness of renal perfusion during extracorporeal circulation, imperfectly corrected by osmotic diuresis and responsible for transient and reversible renal hypofunction, liable to lead however, in cases of complications and prolonged low blood flow, to organic renal failure.


[Ultrastructure of the blood platelets in Wiskott-Aldrich syndrome]. The platelets of 3 undoubted cases of Wiskott-Aldrich syndrome and of 1 suspected case have been investigated from the ultrastructural point of view. The platelet defects were striking by their small size, variable and distorted shape with numerous microvillosities, degranulated cytoplasm (scarce granules or lysosomes, rare mitochondria) and the distension of the canalicular system. The specificity of the ultrastructural platelet defects was discussed in comparison with other hereditary platelet diseases. An attempt was made to find out the meaning of the platelet alterations in this immunologic deficiency.


[Reference values in biology. Use and special value in preventive medicine]. The idea of reference values should replace in biology, the idea of normal or abnormal values. In fact, progress in physiopathology and laboratory techniques has demonstrated the difficulty of fine interpretation of laboratory examinations. It is first necessary to understand factors of variation due to sampling, then the techniques of analysis themselves. Then, the importance of variations within and between individuals for each laboratory examination. Among the most important factors, we may quote age, sex, drugs, exercise, etc. These various possibilities of interference may be classified in order to remember only those which may falsify reference values, i.e. the values used for clinical interpretation. Thus, these factors are of greater importance in preventive medicine where finer and earlier variations may be observed. The best reference is that of the individual himself, if laboratory examinations are to be used profitably both in preventive and curative medicine. It would be necessary to draw up, for each subject, reference values during a period of good health between the ages of 18 and 25.


[Determination of hemoglobin in gastric juice]. Among the complications of surgical operations gastric haemorrhages are often unpredictable. Detecting them during the infraclinical stage is possible by measuring hemoglobin in the gastric juice. We have adopted a method allowing the measurement of very low concentrations of hemoglobin.


[Tetrazolim nitroblue reduction test. Influence of the latex on the reliability of the results]. The finding of sudden variations in the results of the N.B.T. reduction test, using Baehner and Nathan's technique, depending on the latex used, led the authors to doubt the quality of this latex. A comparative study was carried out on adult controls with two different types of latex. With the new type of latex, the results were more reproducible and the sensitivity of the technique was increased. A study in rheumatoid arthritis confirmed these two findings and showed that the new latex was more reliable using the N.B.T. reduction test.


Effectiveness of carbenicillin - aminoglycoside and of cephalothin-aminoglycoside combinations against enterococci in vitro. Combination of carbenicillin and cephalothin with various aminoglycosides (gentamicin, sisomicin, tobramycin, kanamycin and amikacin) were studied in vitro using 20 strains of enterococci isolated from clinical material. The addition of the aminoglycosides to carbenicillin increased the rate of bactericidal action of carbenicillin on most strains. Little benefit was obtained by adding the aminoglycosides to cephalothin and antagonistic action has been observed on some strains.


[Trial of use of computer technology for the assistance of neurologic diagnosis]. This article describes our experience of computer-assisted diagnosis. The original aspects of this work are both the subject chosen and the method used. Our study of clinical and semiological data included the whole of neurological signs above the spinal cord. The interest of the method, based on Bayes theory was in the use of auto-learning and the sample of patients studied as our experience increased. The preliminary results are encouraging, with 85 % correct results, if one considers the first three replies.


Method for diphenylhydantoin and phenobarbital assay by gas chromatography. A rapid and easy method for determination of diphenylhydantoin and phenobarbital in plasma by gas liquid chromatography which provides monitoring of epileptic patients therapy is described. These drugs are extracted from plasma by partitioning between cholroform and buffered aqueous phase. The final extract is evaporated to dryness and the residue dissolved in an internal standard (methaqualone) solution. An amount of the final extract is injected tnto OV1 3% column at 230degreeC without previous derivative formation. The results are compared to those obtained by thin layer chromatography followed by colorimetry.


[Current data on growth hormone].

[Current data on growth hormone]. The present concept of growth hormone is not that of an isolated hormone. Growth hormone is closely related to all other parts of system. Chemically, it belongs of to a family of 3 hormones, with prolactin and human placental lactogen. This chemical relationship produces some similar effects. Physiologically, it belongs to  a series of hormonal secretions of which the elements are gradually recognized. Above, it is under the control of a releasing factor, still not identified : somatostatin which is an inhibiting factor, tetradecapeptide recently isolated ; below, the majority of the totality of its actions are developped through another hormone, or group of hormones : somatomedine. Present work on this endocrine system suggests new therapeutic prospects.


[Current evaluation of epidemiologic research on the Australia antigen in Senegal]. Prevalence of the antigen Australia has been measured in Senegal in different urban groups an rural communities. Three facts seem to characterize the epidemiology of hepatitis B in the sahel area of Senegal. The high level of the prevalence is for all ages, for both sexes and in all the groups. The rapid appearance of the antigen HB in very young children. The decrease of this prevalence from the age of 8 years. This high level of the prevalence seems much more in connection with the intensity of interpersonal contacts than the activity of the anopheline mosquito. For immunologic reasons, in connection with the age at which the children were infected, with the interference of other multiple seem more able to develop chronic infection.


[Kintetics of lymph node reaction during humoral immunization. Ultrastructural autoradiographic study]. An ultrastructural autoradiographic analysis was done in order to study the kinetics of the lymph node cellular reactions during primary immunization of the mouse with heterologous red blood cells. A single injection of 3H-thymidine is given 24 hours or 48 hours after the antigen administration ; the animals are sacrified 2 to 48 hours later. The localisation of the labelled immunoblasts varies : they are first concentrated in the germinal centers to be dispersed later in the paracortical area and to infiltrate finally the medullar cords, where they change into plasma cells. These results suggest strongly the existence of an immunoblast migration from the cortex to the medulla.


[Stereologic analysis of differentiation of immunocompetent cells during reactions of humoral type]. Previous investigations have shown that, during a primary reaction against a single injection of heterologous red blood cells in the Mouse, immunoblasts migrate from the lymph node germinal centers to the medullary cords through the paracortical area. In that study, we combined ultrastructural examination with stereological methods in order to analyze the differentiation of the immunocompetent cells during this migration. The data permit one to characterize two important events in this differentiation. Between the 12th and 24th hour after the antigen injection, when the germinal centers are being dispersed, the cytoplasmic volume of the cells increases 2.5 fold. The estimated number of ribosomes per cell increases from 350,000 to 1 X 10(6) and the volumetric and surface densities of endoplasmic reticulum increase by a factor of 10. Four days later, 120 hours after the antigen administration, the immunoblasts, now located in the medullary cords, show a spectacular increase in the volume and surface density of endoplasmic reticulum, and in the surface density of Golgi membranes. This change results in the transformation of immunoblasts into young plasma cells. Between these two developments, there is a three day period during which the immunoblasts undergo little change.


[Survival in gazeous phase and reconstitution "in vitro" of the natural microenvironment of alveolar macrophages]. Alveolar macrophages of guinea pigs laid on a porous membrane applied to the surface of a reservior filled with nutrient fluid, may be maintained in survival in gaseous phase. The addition of biological material obtained by centrifugation of the broncho-alveolar nutrient fluid, creates in vitro a micro-environment comparable to the physiological alveolar or bronchial environment. Examination of these macrophages under the light and electron microscopes, and study of their phagocytic and bactericidal activity, demonstrate the value of this experimental model, which opens new possibilities for research on the means of phagocytic defence of the respiratory apparatus and their disturbances by gases which pollute the atmosphere.


[Quantitative evaluation and homeostasis of alveolar macrophage populations]. The rat's alveolar macrophage population is a biological constant which significantly varies according to the season, the strain and the bacteriological state,in healthy animals. The percent rate of excreted macrophages remains constant in spite of the physiological changes of the total population variation. This rate is close to 3,5 %. So, the variations of the population are due to the changes in cell arrival. The possible different sources of alveolar macrophages are analysed and evaluated. The direct monocyte source is not sufficient to insure the stability of this population. Division of intra alveolar macrophage enables homeostasis. In pathological conditions, variations of cell populations result from two effects : reduction of excretion, positive or negative changes in cellular influx.


Immunofluorescent demonstration of lymphocyte surface Markers. 1. A microscopy system giving good fluorescence at 400 times magnification or greater is essential, and in effect this means a vertical illumination incident light system of the Ploem type, with optical quality lenses and objectives. 2. Enumeration of positive cells must allow for the probability of contamination of separated mononuclear cell preparations by monocytic cells. 3. The specificity of the immunofluorescent reagents used must be rigorously checked, and the presence of aggregated labelled IgG excluded. 4. The concurrent use of an independent method of identifying T-cells provides an important check, especially when there is a possibility of anti-lymphocytic antibodies being present. 5. In chronic lymphocytic leukemia, tests for surface markers for T and for B cells may permit detection of the less common T-cell leukaemia, which may have a graver prognosis. 6. Immunofluorescence tests a morphological lymphocytic marker. In the more subtle forms of lymphocytic disturbance, there is a need for tests of lymphocyte function.


[Application of the immunoperoxidase method to the study of the membrane of human lymphocytes]. Immunoelectron microscopy was applied to human lymphocytes exposed to purified peroxidase-conjugated anti-immunoglobulin. Indeed, detectable surface immunoglobulins are a salient feature of so-called " B " lymphocytes. On living cells, a rapid and massive internatization of the labelled membrane is observed. Prior glutaraldehyde cell fixation avoids such a phenomenon. Thus, exposure of fixed cells to conjugated anti-immunoglobulin allows the visualization of a dense and continuous specific membrane labelling. Immunoglobulin-bearing lymphocytes have a characteristic membrane surrounded with numerous microvilli. On the other hand, non-labelled lymphocytes have a smooth membrane. Intermediate forms are also noted among these extreme morphological features.


[ Products of fibrin degradation in the urine during experimental and human glomerulonephritis]. Intravascular coagulation localized in glomeruli is of pathologic importance in human and experimental GN. The measure of fibrinogen related antigen (FRA) in serum and urine after concentration (Merskey's technique) was used to detect and estimate this phenomenon. In Rabbit Masugi GN, FRA were detected in urine  5 to 20 mg/24 h, in close correlation with the amount of proteinuria, the intesity of histological changes and the presence of fibrin deposits in glomeruli. In human GN, urine FRA were detected in many cases (0,5-10 mg/24 h) in correlation with the histological type of lesions (FRA + in primary or secondary proliferative GN) and with the evolutivity of disease (FRA + in cases with rapidly progressive kidney function deficiency). Urine FRA are also in correlation with intraglomerular fibrin deposits : this suggests that urine FRA originate from lysis of fibrin deposited within glomeruli. So urine FRA appears to be an indicator of type and severity of GN and probably of therapeutic measures, indicating anticoagulant and/or antithrombic therapy : the variations of urine FRA during treatment is of value to assess the effects of these drugs and to establish the prognosis of the disease.


[Determination of glomerular and tubular clearance in children without urine collection]. The determination of glomerular and tubular clearance in a child was carried out by using a method excluding urine collection, with a continuous intravenous infusion of polyfructosan and para-amino-hippuric acid. A loading injection followed by a continuous perfusion provides a constant plasmatic level 150 minutes after the beginning of the study.


Hepatomegaly. An approach to differential diagnosis. Hepatomegaly is not an uncommon occurrence in infancy and childhood. When the pediatrician encounters a patient with an enlarged liver, he must carefully evaluate that patient in order to determine the necessary approach to establishing a diagnosis. Specific emphasis must be made as to those conditions which necessitate hospital admission and complete evaluation and those self-limited conditions which may resolve with time.


Pyritinol hydrochloride and cognitive functions: influence on children in slow learner classes. Pyritinol-HCl was tested for its impact on the cognitive functions of children with learning disabilities. This study is a contribution to scientific discussion on the complicated methodologic problems in evaluating the clinical efficacy of psychopharmacologic agents. Sixty-seven pupils of slow learner classes between the ages of 11 and 16 years were treated for 6 months with 300 mg pyritinol-HCl/24 hr or placebo under strict double-blind conditions. Drug intake was stimulated and controlled by means of intense psychosocial interaction with the mothers of the subjects. The dependence variables used to test medication effects were 22 parameters of cognitive performance measured in psychologic tests for perceptual and intellectual functions which were administered immediately before and after the medication phase. First the gainscores before and after treatment with pyritinol or placebo within the 22 cognitive parameters were statistically compared. In addition, an analysis of covariance on the corrected results of the second test (treating the results of first testing as covariates) and a two group discriminant analysis for overall differences were performed. None of the 22 parameters showed statistically significant treatment effects with respect to average performance (t (pyritinol - placebo) = 1.96 to 1.31), neither could the two groups be separated by discriminant analysis (Hotelling's T2 = 35.4, df - 22 and 43, P = 0.465). With respect to a variability of gainscores, however, in four parameters there was a significantly higher variance in the pyritinol group (F = 1.85-2.33, P less than 0.05, less than 0.02, respectively). This fact may signify that pyritinol-HCl had different effects on different subjects. By means of prognostic stratification we therefore attempted to define objective criteria for a selection of subjects with probable positive treatment effects. None of the 15 tested criteria, such as body weight, age, perceptual handicaps, or reduced short term memory, IQ range, proved, however, to be critical for a prognosis of pyritinol effects within the present test population.


Plasma growth hormone, insulin, and glucagon responses to arginine infusion in children and adolescents with idiopathic short stature, isolated growth hormone deficiency, panhypopituitarism, and anorexia nervosa. The effects of intravenous infusion of arginine (20 g/m2) after an overnight fast on plasma immunoreactive growth hormone (GH), insulin (IRI), and glucagon (IRG), and blood glucose were examined in five groups of children and adolescents: 10 normal individuals, 18 with idiopathic short stature, 6 with isolated growth hormone deficiency, 8 with panhypopituitarism, and 6 with anorexia nervosa. The mean fasting plasma GH concentration was significantly elevated in the group with anorexia nervosa (P less than 0.05), and similar to the value for the normal group in all other groups. After arginine infusion, four- to sixfold increases of plasma GH were observed in the normal children, and similar increases were seen in those with idiopathic short stature as well as in those with anorexia nervosa; whereas, in the children with isolated growth hormone deficiency or panhypopituitarism, there was no significant increase in plasma GH. Fasting blood glucose concentrations were significantly lower than normal in subjects with isolated growth hormone deficiency (P less than 0.05), panhypopituitarism (P less than 0.001), and anorexia nervosa (P less than 0.001), whereas fasting plasma IRI and IRG concentrations were similar to the values in the normal group. Plasma IRI increased eightfold at the end of the 30-min arginine infusion in the normal subjects; the increase was slightly but not significantly less in those with idiopathic short stature, and significantly less in those with isolated growth hormone deficiency (P less than 0.05), panhypopituitarism (P less than 0.001), and anorexia nervosa (P less than 0.05). Arginine infusion resulted in two- to threefold increases of plasma IRG in the normal group, and similar increases were observed in all of the other groups tested. These results suggest that whereas pancreatic beta cell responsiveness may be deficient in children and adolescents with isolated growth hormone deficiency, panhypopituitarism, or anorexia nervosa, pancreatic alpha cell responsiveness, to arginine at least, appears to be intact under these conditions.


Kanamycin and gentamicin treatment of neonatal sepsis and meningitis. Mortality from neonatal meningitis due to gram-negative microorganisms remains 50% despite use of aminoglycoside antibiotics. Blood was obtained on 238 occasions from 77 neonates with putative or documented sepsis; paired blood and cerebrospinal fluid (CSF) samples were obtained on 14 occasions from ten neonates with meningitis. Kanamycin and gentamicin were measured by a radioisotopic assay procedure. Kanamycin was administered at 15 mg/kg/day in three divided doses intravenously; serum concentrations peaked at one hour (mean, 7.77mug/ml). Gentamicin was administered at 7.5 mg/kg/day in three divided doses intravenously; serum concentrations peaked at two hours (mean, 5.34mug/ml). Both aminoglycosides generally were nondetectable within the CSF; survival of neonates with gram-negative meningitis correlated specifically with the sensitivity of their isolates to ampicillin which was administered concurrently. This study suggests that alternative approaches to the treatment of neonatal sepsis should be explored; administration of an antibiotic which crosses the blood-cerebrospinal fluid barrier more readily should be considered.


Acute hemorrhagic leukoencephalitis: report of three cases and review of the literature. Attention is directed to the diagnosis of acute hemorrhagic leukoencephalitis and the possibility of its clinical recognition is discussed. Three case histories, two diagnosed at autopsy and one clinically, are presented. The latter was treated with very generous doses of steroids and recovered spectacularly. On omission of steroids, a mild, temporary clinical recurrence occurred. Clinical, clinico-pathologic, and pathologic aspects of the disease are discussed, and etiologic factors mentioned. Some thoughts on the relationship of this disease to experimental allergic encephalomyelitis are mentioned. Differential diagnosis is considered and the use of biopsy for confirmation of diagnosis especially from herpes encephalitis considered. A plea is made for the trial of treatment with large doses of steroids.


The surgical management of pediatric breast masses. Information regarding the surgical management of breast masses in the pediatric age group is sparse and is primarily directed at unusual neoplasms. We have reviewed the surgical treatment of 50 patients with inflammatory and neoplastic breast masses occurring in a 15-year period (1957 to 1973) at the Children's Hospital of Los Angeles. There were 42 girls and 8 boys, ranging in age from 12 days to 18 years. All patients had either surgical excision or incision and drainage of the masses with a subsequent histologic diagnosis. A variety of pathologic entities were encountered, but there were no primary malignancies. There were 33 patients with fibroadenomas, including four patients with multiple masses. Thirteen patients, six of whom were male, had cellulitis with an underlying breast abscess. The offending organism was gram-negative in one third of these abscesses. While none of the masses in this series were malignant, surgery was indicated to (1) establish diagnosis, (2) allay fears of patient, family, and referring physician, and (3) correct an obvious cosmetic deformity. Surgical drainage encouraged resolution of the inflammatory process, aided in the recovery of the organism, and assured appropriate drug therapy.


Mortality from tuberculous meningitis reduced by steroid therapy. In this study of 99 tuberculous meningitis patients from Cali, Colombia, treatment with steroids (in conjunction with antituberculous drugs) was shown to be more effective in reducing mortality than treatment with antibacterial drugs alone. Results further suggest that low dosages of steroids (1 mg/kg of prednisone daily for r 30 days) are equally effective in treating the disease as high dosages (10 mg/kg of prednisone at the start of treatment, gradually reduced over a 30-day period). These results are band 4(-43 and -kk mg/100 ml) demonstrated cerebral release. Arterial blood hyperammonemia can be detoxified safely in the brain as long as the levels do not exceed approximately 300 mug/100 ml. Beyond that level lactic acidosis is observed, particularly in cerebral venous drainage. Arterial blood hyperammonemia was also related to the extent of alveolar hyperventilation. These findings are very similar to those seen in experimental hyperammonemia and support the concept that neurotoxicity in children with Reye's syndrome is at least partly due to impaired oxidative metabolism secondary to hyperammonemia.


Determination of extracellular fluid volume in the dog with ferrocyanide. The suitability of ferocyanide as an indicator for the measurement of extracellular fluid volume was tested. Added ferrocyanide could be recovered completely from urine, plasma and blood. In in vitro experiments ferrocyanide did not penetrate into erythrocytes, nor did it adhere to the red cell membrane. In gel filtration and electrophoresis experiments binding of ferrocyanide to plasma proteins could not be demonstrated. In in vivo experiments on dogs, the urinary recovery of intravenously administered ferrocyanide was 98.9 +/- 2.1% (n = 14). The partition ratio of ferrocyanide between lymph water and plasma water was 0.99 +/- 0.02 (n = 20). Ferrocyanide could not be detected in cerebrospinal fluid or red cells of dogs after administration by intravenous infusion. No untoward effects of the infused ferrocyanide were observed during or after the experiments. In nephrectomized dogs ferrocyanide reached its ultimate distribution volume 2 hrs after intravenous administration of a single dose and remained constant for up to 10 hrs. The average distribution volume was 224 +/- 17 ml-kg-1 body mass (n = 6). In intact dogs continuously infused with indicator, ferrocyanide also reached its ultimate distribution volume in 2 hrs and remained constant thereafter for up to 7 hrs after the start of the infusion. The average distribution volume was 237 +/- 27 ml-kg-1 body mass (n = 14). It is concluded that ferrocyanide fulfils the requirements to be met by an indicator for the measurement of the extracellular volume, and is well suited for repeated determinations of the extracellular fluid volume in one and the same experiment.


Outflow from the left and the right coronary artery into the coronary sinus in the dog heart in situ. The fractions of the left and the right coronary arterial flow determining coronary sinus flow (facs, facd) were measured in the open-chest dog. Both coronary arteries were isolated and perfused at the same pressure, while the sinus outflow was isolated and drained against the prevailing mean pressure in the right atrium. The fractions were determined by injecting 51Cr labeled erythrocytes into each coronary artery selectively and measuring the total resulting radioactivity in the sinus blood. In addition, they were estimated from flow measurements. The values of facs and facd were found to approximate 0.70 and 0.02 respectively. The variability between the different dog hearts was considerable and it was demonstrated that they were not intercomparable with respect to their coronary flow distribution.


Preweaning mortality in pigs. 7. Polyarthritis. The incidence and causes of polyarthritis in sucking pigs were studied in herds with 2,936 litters during a 2-year period. Among pigs more than 3 days old, the average morbidity rate was 3.3 per cent and the mortality rate amounted to 1.5 per cent (Table I). Among herds the morbidity ranged from 0.9 to 7.0 per cent and the mortality due to polyarthritis from 0.5 to 2.8 per cent. The incidences of polyarthritis were higher in the progeny of gilts than in the progeny of sows of other age groups (Table II). No consistens correlation between litter size at birth and the mortality rate due to polyarthritis was found (Table III). Cases of polyarthritis were observed in 17.8 per cent of the examined litters. Death due to polyarthritis occurred in 10.8 per cent of the litters (Table I); 67.3 per cent of the fatal cases occurred sporadically with only one pig lost per litter (Table IV). The mortality due to polyarthritis appeared to be higher in male pigs (Table V). An analysis of some possible contributory factors showed that the frequency of polyarthritis was adversely affected by new introduction of female breeding stock, clipping of the canine teeth and tail docking in the new-born, and by occurrence of skin diseases in individual piglets (Table VI, IX & XII). No obvious relation was found with such factors as: season of the year, sow's health condition, herd size (Table I), or hygiene level in the individual herds (Table VIII). Death due to polyarthritis occurred most frequently in pigs 2--4 weeks of age (Table X). The pathological lesions, which varied according to the duration of the inflammation and to the aetiology, are described. Arthritis was most frequently observed in the larger limb joints, although every joint may be affected (Table XI). In the majority of the cases a meningoencephalitis was present. A survey of other concomitant, complicating or possible predisposing lesions are presented (Table XII). The bacteriological examination of joints and other organs Table XIII) showed that haemolytic streptococci by far dominated as causative organism. Staphylococci species and E. coli were isolated from affected joints in 6.4 per cent and 4.3 per cent of the pigs, respectively. C. pyogenes and E. rhusiopathiae were rarely encountered in these sucking pigs with polyarthritis. Aspects of the epidemiology and pathogenesis are discussed in regard of minimizing the losses due to polyarthritis/meningitis in sucking pigs.


The influence of oral administered iron compounds on the intestinal absorption of immunoglobulin-G in newborn piglets. The intestinal absorption of IgG from colostrum in newborn piglets was not disturbed by oral administration of iron preparations used for prophylactic treatment of anaemia in piglets. Iron dextran, ferrous fumarate or a combination of these compounds were administered simultaneously with the colostrum supply, soon after birth and the concentrations of IgG in serum were determined.


[Dexon, applicability in the horse (author's transl)]. Dexon is a new, synthetic, absorbable suture material. Its applicability for suturing distally in the extremities of horses was tested in 65 cases. The indications included burried sutures as well as skin closure. It was concluded that the material can be used with advantage in cases traditionally sutured with catgut, vetafil or mersilene. It is technically a pleasant material and has further the advantage that it shall not be removed.


A study of skin diseases in dogs and cats. I. Histology of the hairy skin of dogs and cats. The structure and function of normal hairy skin of dogs anc cats are surveyed. The appearence of sections processed and stained by routine methods is emphasized. A bibliography is provided.


The incidence of Salmonella bacteria in Danish wildlife and in imported animals. Based upon examination during the three-year-period 1972-74 of 2519 Danish game animals and of 415 warmblooded and 214 cold-blooded animals of foreign origin an attempt has been made to make out the incidence of Salmonella infection among Danish game as compared to Danish domestic animals, to estimate the risk of cross contamination in the kitchen from such animals, to find out if Danish game are infected from polluted areas, and to uncover the possible risk of introducing new Salmonella species with imported animals. The results (Table I) show a Salmonella incidence of 0.9% among Danish game, 1.3% among warm-blooded animals of foreign, and 13.6% among reptiles of foreign origin. Details about the distribution of types are given in Table II for animals of Danish origin, and in Table III for imported animals. The conclusion is: (I) In Denmark Salmonella infections are less common among game than among domestic animals. (II) Of game animals regularly used for human consumption only two mallards and no mammals yielded Salmonella, which implies that the risk of cross contamination is very small. (III) Except for sea-gulls Danish game do not seem to pick up infection from polluted areas. (IV) The greatest health hazard seems to be associated with imported reptiles, because these animals are potential excretors of Salmonella and because they are often sold as pets which means that especially children are exposed. Besides what is shown in the tables an outbreak of salmonellosis in small birds during the winter 1973-74 is described. This outbreak, however, does not influence the general estimate of the risk involved in the consumption of game, since small birds are not used for human food in Denmark.


[Dental health and treatment pattern of Norwegian recruits in 1959]. The present study describes the treatment pattern of a group of 381 recruits aged 20 in 1959. All men had taken part in the school dental service to the age of 14; 41% continued with regular care, 33% reported occasional treatments (2--4 times), and 12% no care from the of 14 (Table 1). The mean number of decayed (primary and secondary lesions), filled, and extracted teeth was found to be close to 21 in the various treatment groups (Table 2). The findings indicate a mean DMFT between 16 and 20 in the regular treatment group. When the recruits were grouped according to treatment pattern and the number of decayed teeth, the mean number of filled teeth was close to 15 in the sub-grojps with regular treatment (Fig 2). The mean number of filled teeth in the regular treatment groupd may be used as parameter in future evaluations.


[Surgical treatment of metastases in the cervical spine. Principal orientations]. Alongside classical methods used against metastatic malignant disease, two methods are suggested aimed at stabilising secondary bony lesions of the cervical spine. For the upper cervical spine an occipito-vertebral plate is used together with a bony arthrodesis using an iliac crest graft. For the lower cervical spine a mixed approach makes possible adequate medullary decompression when used in association with screw fixation of the posterior articulations using Roy Camille plates and a replacement cervical prosthesis after corporectomy.


[Serologic diagnosis of syphilis by the passive hemagglutination test]. The passive haemagglutination test in the diagnosis of syphilis was used with: 139 sera posing serological problems, 965 sera from subjects with syphilis at all stages of the disease and non-syphilitics. The percentages of agreement seen both in comparison of THPA with the TPI (94,5 p.cent) and the FTA abs test (97 p.cent) demonstrate its high degree of specificity and sensitivity. The reaction may be performed rapidly on a routine basis and requires little in the way of specialised material. These qualities should lead, in the near future, to the adoption of the T.P.H.A. as a routine examination in all laboratories, reserving the use of the F.T.A. abs test and the T.P.I. for difficult cases.


[Effects of iodine contrast medias on the function of transplanted kidneys]. The effects of renal arteriography (n = 94) and intraveinous urography (n = 137) on renal function were studied in 80 renal transplant recipients. No damage to renal function was noted when these investigations were performed in patients with normal renal function. In transplanted patients with previous renal insufficiency, arteriographies, even selective, did not seem to be more dangerous than highdose urographies. The degree of seriousness of nephrotoxic accidents seems to be increased when the iodine dose is more than 1 g/kg b.w. and when the investigations are repeated within short intervals.


[Sequential chemotherapy based on the hypothesis of a circadian rhythm of tumor proliferation]. The authors treated 41 cases of advanced solid tumors by a combination chemotherapy with methotrexate, vinblastine and cyclophosphamide administered in a sequential manner according to the hypothesis of a circadiam rhythm of proliferation of human neoplasia. A tumoral regression was observed in 66. 6 p. cent of adenocarcinomas and 86.2 p.cent of non glandular carcinomas.


[Therapeutic action of coagulation factor XIII in scleroderma. 20 cases]. Clotting factor XIII was used in 13 patients suffering from scleroderma, 17 with generalised scleroderma and 3 with localised scleroderma. The duration of treatment varied between 15 days and 6 months. The effect was marked in 7 cases and more moderate in 5 others. It took the form of increased suppleness of the skin, improved joint mobility and, to a lesser degree, an improvement in vasomotor disturbances of the extremities. Oesophageal abnormalities on X-ray were never altered. The return to normal of alveolar-capillary diffusion seen in two cases requires futher confirmation. The action of factor XIII in scleroderma may be explicable by the formation of transamidation bonds between the alpha chains of the collagen molecule, similar to those obtained on fibrin.


Heroines of '98: female Army nurses in the Spanish-American war. Experiences of female Army nurses-their devotion to duty, contributions, and successes as well as their trials, tribulations, and sufferings--during the Spanish-American War and afterwards are described. How service by the heroines of '98 led to a change of attitude by the Army Medical Department is sketched. At the beginning of the War with Spain, the Medical Department had been reluctant to use female nurses; by the end of the war, the nurses had so demonstrated their value that Congress established permanent Army Reserve Nurse Corps.


Candida albicans in women.

Candida albicans in women. Ninety-two pregnant and nonpregnant patients were randomly selected from two obstetric-gynecologic clinics for the purpose of investigating factors that affect the incidence and severity of vaginal candidiasis. Six factors were found to be significantly associated with the incidence of Candida albicans: drug addiction, obesity, birth control pills, pregnancy, antibiotic therapy, and diabetes mellitus.


Experience with prazosin in a clinical setting. In a three-phase study that began in 1969, prazosin was shown to be especially suitable for use in treatment of hypertensive patients with gout, renal disease, or borderline diabetes, owing to the sparing of organ systems often harmed by other antihypertensive drugs.


Clinical evaluation of prazosin in 20 private practice patients. The safety and efficacy of prazosin alone and in combination with polythiazide are being assessed in an ongoing study of private patients. All patients entering the study have diastolic pressures consistently greater than 100 mm Hg while taking placebo. Thus far, 20 patients have been given therapy for periods ranging from three to 10 months. In patients with mild hypertension, prazosin in a dosage of 5 mg three or four times a day was consistently effective in lowering blood pressure to less than 100 mm Hg and often reduced it to less than 95 mm Hg. The patients with moderate to severe hypertension responded particularly well when polythiazide was added to prazosin, while those continuing to receive prazosin alone for a comparable period showed no further improvement. Few if any side effects were observed which can be attributed to prazosin.


The clinical evaluation of prazosin, a new antihypertensive agent. The hemodynamic and therapeutic profiles of prazosin have been delineated in a comprehensive clinical program involving more than 1,000 patients. Efficacy was established in double-blind placebo-controlled studies and open, noncomparative long-term studies and comparisons with standard antihypertensive agents. The efficacy and safety of prazosin make it particularly suitable for initiation and maintenance of long-term outpatient therapy for hypertension.


A three-phase clinical evaluation of prazosin. A preliminary study of cardiac hemodynamics with measurement in both supine and tilt positions showed that the antihypertensive effect of prazosin given intravenously is associated with a fall in total peripheral resistance, with minor effects on cardiac output and heart rate, and with no consistent orthostatic hypotension. The postural reflexes appear to remain intact. The results are entirely similar to those reported by Lund-Johansen. In a second, short-term study of ambulatory patients, prazosin alone exerted an antihypertensive effect somewhat less than that of methyldopa, but the difference in blood pressure reduction between supine and standing positions was less with prazosin than with methyldopa. Both drugs were well tolerated. In a third, long-term study, prazosin alone gave satisfactory antihypertensive results, and prazosin used in combination with polythiazide produced a satisfactory response in 80% of the patients.


Long-term efficacy and safety of prazosin in essential hypertension. The long-term efficacy and safety of prazosin plus a thiazide diuretic in severe hypertension has been evaluated in an open trial that is now in its fifth year. The combination is consistently effective in reducing diastolic blood pressure to 90 mm Hg or less. No side effects or adverse reactions have been observed except a "first-dose" fall in blood pressure, and there is no evidence of development of tolerance to the agent.


Experience with prazosin in the treatment of hypertension. These data are from a study of 24 hypertensive patients receiving either prazosin alone or prazosin plus one or more other antihypertensive drugs. It appears from the results that prazosin lowers both supine and erect pressures when used alone or in combination with other agents. Side effects do not appear to be a problem.


Treatment of hypertension with a combination of prazosin and polythiazide. Preliminary results of a study of 20 patients show a combination of prazosin and polythiazide to be effective in controlling hypertension not responsive to the diuretic alone. The maximum useful dosage of prazosin was not defined, but increasing the dosage above 15 mg a day did not improve control of blood pressure.


Double-blind studies of the clinical effectiveness of prazosin. In separate double-blind trials, prazosin was compared with placebo and with methyldopa and placebo. In both, prazosin was well tolerated and succeeded in lowering blood pressure in patients with mild to moderate hypertension. The mean reductions with methyldopa were greater, but the difference was not statistically significant and a higher percentage of the patients in the prazosin group became normotensive.


Clinical experience with prazosin in hypertension. Twenty of 24 hypertensive patients, six of whom had severe disease, had a reduction in standing blood pressure to less than 140/90 mm Hg after six weeks of treatment with prazosin alone or prazosin plus other antihypertensive drugs. The absence of significant side effects was impressive.


A long-term clinical trial of prazosin.

A long-term clinical trial of prazosin. The efficacy of prazosin given either alone or in combination with polythiazide was assessed in a study of 50 outpatients with essential hypertension. Among the 29 who completed 42 months of therapy, blood pressure fell significantly in 76%. Of the 21 who dropped out of the study after 1 to 41 1/2 months, 43% showed improvement, 38% showed no change, and 19% showed worsening of hypertension. The most common side effects were lack of energy and weakness. Diabetics and alcoholics tolerated prazosin well. Of the 50 patients who started treatment with prazosin alone, only 23 required addition of polythiazide.


Viral and mycoplasmal pneumonias: reviewing current concepts. The pathogenesis of viral and mycoplasmal infections is probably similar, but pathologic findings vary, depending on the etiologic agent. In the absence of inclusion bodies in epithelial cells, definitive diagnosis of viral pneumonia depends on isolation of the virus. Viral pneumonias are more insidious in onset than bacterial types. In the early stages, physical findings may be minimal. Complications include those associated with viremia or bacterial superinfection. Culture of a throat swab is suitable for isolation of almost all respiratory viruses except respiratory syncytial virus, which requires special techniques. Antibody studies are also of great value. The major effort in controlling viral illness has been prevention of infection by vaccination. Treatment at present is symptomatic.


Effects of cytotoxic and immunosuppressive agents on the immune system. Most chemotherapeutic agents are myelosuppressive and immunosuppressive. Consequently their use greatly increases a patient's susceptibility to infection. Neutropenia creates greater risk than lymphopenia and is a particular problem in patients with acute leukemia who are treated with combination chemotherapy. Chemotherapy is less immunosuppressive if given in short intensive courses rather than continuously. Continuous therapy causes severe depression of antibody production and inhibition of delayed hypersensitivity reaction.


Cardiogenic shock: can the prognosis be improved? The prognosis in cardiogenic shock remains poor despite improvements in treating other complications of acute myocardial infarction. In some situations, left ventricular function can be improved by increasing the vascular volume, but the benefits of increasing the cardiac uutput must be balanced agains the risk of pulmonary edema. Monitoring of volume therapy is best done via the pulmonary route. The goal of drug therapy is to raise arterial blood pressure and make the heart pump more effectively. An aggressive approach will not cure great numbers of extensive myocardial damage remains, but it will identify those who are hypovolemic or who have other correctable contributory factors. Most important, this approach may help to identify therapies currently in use that may actually increase rather than lessen myocardial damage.


The treatment of cerebral vascular disease. The routine investigations in patients with cerebral ischaemia are considered. Surgical treatment of the extracranial carotid and subclavian arteries is still advocated in the management of selected patients with transient cerebral ischaemia. Little fundamental advance has been made in the treatment of acute cerebral infarction. The role of hypertension in cerebrovascular disease is considered and the value of treating associated hypertension is stressed.


Anxiety/depression in elderly patients. A double-blind comparative study of fluphenazine/nortriptyline and promazine. A double-blind study involving sixty-two patients, aged 65 years or over, treated for twenty-eight days, showed that fluphenazine 0-5 mg/nortriptyline 10 mg three times daily was superior to promazine 50 mg three times daily in relieving symptoms of anxiety and was associated with a lower incidence of side-effects. The results are discussed in the light of the nature of anxiety/depression syndromes in the elderly and it is suggested that since symptoms of anxiety in these disorders are often manifestations of an underlying depressive illness, the antidepressant effect of the nortriptyline may have enhanced the 'anxiolytic' advantage of fluphenazine/nortriptyline.


Survival and 'true' rehabilitation after dialysis and transplantation: a 7-year follow-up. Serial follow-ups of processed and recorded semi-quantitative data (bone biopsies, nerve conduction velocity, glucose A-V, etc.) have been carried out in 152 chronic uraemic patients of which 39 underwent kidney transplantation. The comparative studies have been performed in order to evaluate the magnitude of survival/rehabilitation ratio due to dialysis and transplantation. After a minimum of five years, the overall survival rate is better on dialysis. The most important determining factors seem to be: type of donor in transplantation and the nature of renal lesions and residual Ccr in dialysis. 'True' or 'effective' rehabilitation has been documented only after transplantation. Dialysis does not reverse systemic uraemic changes and the rehabilitation in survivors may be 'apparent'. Dialysis may prevent systemic uraemia, provided that starting time of treatment is gauged earlier (residual Ccr greater than 10).


Urinary excretion of NAG and FDP in acute renal graft rejection. Determination of the urinary excretion of N-acetyl-D-glucosaminidase (NAG) and fibrin degradation products (FDP) made it possible to make a diagnosis of 25 out of 26 acute rejection episodes at least 24 hr before deterioration in renal function occurred. Of the two tests, the estimation of daily urinary NAG is the most practical for routine clinical use. This test alone permitted early diagnosis in 21 out of 26 episodes. In 9 out of 11 episodes in which both estimations showed an increase, the rise in FDP occurred before the rise in NAG. This is consistent with the view that in some forms of rejection, at least, intravascular fibrin deposition occurs first and causes ischaemic damage to renal tubular cells and consequent deterioration in function.