Radiolabeling of antigens: procedures and assessment of properties. The role of labeled tracers in  radioimmunoassay procedures (RIA) and the advantages of the iodine-labeled antigens over 14C or tritium-labeled antigens are discussed. Different methods of labeling with iodine isotopes are presented. The ease with which microgram amounts of hormonal proteins are tagged, achieving high specific activity with the chloramine-T procedure of Hunter and Greenwood, is indicated in a detailed presentation of a typical procedure. More sophisticated methods that present none of the drawbacks of the chemical oxidation methods for iodination would seem to have greater versatility, resulting in labeled antigens with better immunologic properties. These are likely to come into vogue for many inhouse preparations of labeled antigens in the next few years. The iodination procedures developed for haptenic substances have extended the usefulness of the RIA method to many steroidal hormones and have helped to achieve a limit of detectability at picogram levels. Greater specificity has also resulted. The assessment of the properties of the labeled antigens is equally important, and methods to evaluate the parameters of purity, immunoreactivity, specific activity as well as storage, are discussed. This review is intended to serve as an introduction to the radiolabeling of antigens or haptens. A thorough appreciation of the problems and pitfalls in these procedures is essential for the development of a new RIA or adaptation of a well-studied method for routine use.


Evaluation of commercial radioimmunoassay kits. By means of kits, RIA and competitive binding assays are beginning to fulfill their great clinical potential. The reliability of these kits is still difficult to assess. The great variety of assayable substances and differing methods prevent any standard approach to kit analysis. Nevertheless there are means of evaluating many features of RIA kits. More important even than the necessary reproducibility of assays are the means of testing for (1) tracer-specific activity, maximal bindability, damage, and free iodine; (2) assay sensitivity; (3) antisera stability, cross-reactivity, ability to measure plasma zero values, ability to accurately measure serial plasma dilutions; (4) comparability of standard curve slopes from assay to assay. Separation techniques need proper standardization. Correction for incubation damage is recommended. It is necessary to insist on reasonable precise manufacturer's specifications as to antibody specificity and sensitivity. Knowledge of RIA in general and each assay in particular adds to the usefulness of the results obtained in the laboratory.


Positive scans in angiographically proved cases of recanalized cerebral infarction. In 20 patients with acute major cerebral arterial occlusion, follow-up angiograms were obtained to inspect the occluded artery. These angiograms were compared with brain scans in the fourth week after the stroke. The angiograms revealed that frequent recanalization of the occluded arteries occurred within a week after the onset. On the other hand, brain scans showed the increased uptake of radioisotopes even in the patients with angiographically demonstrated arterial recanalization. The present study clarified that positive scans could be obtained in the patients with and without recanalization, and emphasized the diagnostic value of brain scans in the subacute or chronic stage of cerebral infarction, especially in patients with no arterial occlusion appearing on the angiograms.


Brain scanning in cerebral vascular disease: a reappraisal. The frequency of abnormal brain scans in patients with cerebral vascular disease admitted to a stroke intensive care unit has been evaluated in relation to diagnosis, time after onset of symptoms, effect of delayed imaging and the degree of clinical neurological recovery. In patients with completed thromboembolic infarction, 33% had abnormal scans including 39% of those with hemispheric lesions and 14% with posterior fossa lesions. Completed hemorrhagic infarction occurred in seven patients, and three (43%) had abnormal brain scans. Of 14 patients with either transient ischemic attacks or reversible ischemic neurological deficit, two (14%) had abnormal scans. Twenty-seven percent of brain scans in patients with completed thromboembolic infarction were abnormal in the first two days after infarction, a higher frequency than previously reported. Delayed images confirmed the initial interpretation that the scan was either normal or abnormal in 71% of the cases while in 10% of the cases only the delayed views were abnormal. The frequency of abnormal scans was significantly greater in patients who died or had a large neurological deficit at discharge than in patients with lesser residual deficit.


Estimating total cerebral blood flow from the initial slope of hydrogen washout curves. An initial slope index of total cerebral blood flow, measured by the hydrogen clearance technique, shows a high correlation with flows calculated by bicompartmental analysis. In 247 flow measurements done on 41 rhesus monkeys, a linear regression analysis between these two methods of calculating flow shows a correlation coefficient of 0.928 with a standard error about y values of plus or minus 7.63. The initial slope index is not only faster but does not require that a steady state be maintained for ten minutes.


Regional cerebral blood flow by 133xenon inhalation. Repeated measurements of regional cerebral blood flow (rCBF) were made by the short (ten minutes) 133Xenon inhalation technique and bicompartmental analysis in 11 patients with cerebrovascular disorders, mainly acute cerebral infarction. rCBF was measured 3 to 11 times during one to two weeks. The blood flow of the fast compartment (f1) was calculated as well as the relative weight of this compartment (w1, assumed to correspond to gray matter). In addition a new flow index, the Initial Slope Index (ISI) modified for the inhalation technique, was used. This index of predominantly gray matter flow was calculated from a one-minute epoch of the early part of the clearance curve corrected for recirculation. In three of the patients the f1 and ISI varied in parallel and the w1 showed generally only minor variations from one measurement to the other. However, in the other eight patients fluctuation of the w1 and f1 values were seen which often showed no meaningful relation to the clinical course. The observed w1 changes indicated that some tissues (slowly perfused gray matter and/or rapidly perfused white extracerebral tissues) fluctuate between the fast and the slow compartment. In such cases the f1 values obtained cannot be used for comparison between measurements, since they represent flow rates of varying tissues and do not always represent a true gray matter blood flow. In these patients the ISI, which is independent of such weight changes, showed moderate and clinically likely variations.


The effect of cerebral infarction on the regional cerebral blood flow of the contralateral hemisphere. Regional cerebral blood flow (rCBF) measurements were performed over the contralateral hemisphere by the 133Xe intracarotid injection method in 20 patients with acute cerebral infarction in the territory of the internal carotid artery. The rCBF was found to be reduced, sometimes remarkably, in all of the patients. The mean reduction was 30 percent to 36 percent from the lowest normal value for the mean age of these patients. In the younger age group (40 to 59) the reduction was greater, 40 percent to 47 percent from the lowest normal value for this age. tthe rCBF depression was not related to cerebral dominance, previous hypertension or arterial PCO2 levels. The occurred in both patients who were fully alert and those with disturbances or consciousness, although it tended to be more diminished in the latter. tit can be assumed that the flow reduction in the nonaffected hemisphere is part of a general phenomenon affecting the entire brain and caused by globally reduced cerebral metabolism.


Hindbrain stroke in children caused by extracranial vertebral artery trauma. Hindbrain transient ischemic attacks (TIAs) culminating in posterior circulation stroke are described in five children. Atlanto-axial subluxation and angiographical documentation of C1 to C2 level arterial pathology are documented in one patient. Four additional patients with nearly identical clinical presentations, posterior fossa TIAs, stroke and basilar angiographical pathology are reviewed. A mechanical traumatic etiology is suggested. Unexplained transient repeated brain stem and/or cerebellar sympotomatology may be due to extracranial vetebral artery stenosis or occlusion by atlanto-axial instability. After appropriate documentation, stabilization may prevent further TIAs or strokes.


Spontaneous thrombosis of deep cerebral veins: a complication of arteriovenous malformation. An uncommon type of stroke in children is presented. An intracranial arteriovenous malformation in a 13-year-old boy spontaneously occluded about 22 months after surgical intervention. Precipitating factors, such as bacterial infections, could not be demonstrated in this patient, who had been attending school since the time of the craniotomy. The histological features of venous encephalomalacia in the galenic territory are contrasted with hemorrhagic encephalomalacia as seen after arterial occlusions: in the former, hemorrhages are more widespread and edema is more pronounced.


Data base for stroke rehabilitation using computerized English text discharge summaries. A data processing system programmed in a terminal-oriented language called APL is described. This user-oriented system features the print-out of English text discharges summaries for patients treated in a stroke rehabilitation unit. The variables contained in the summaries are stored in the computer for statistical analysis, allowing continous monitoring of the unit's activities. Seventy-eight percent of patients with moderate to severe hemiparesis were able to return home after an average length of stay of 44 days. The value of the described system is suggested for muliticenter, cooperative studies on stroke.


Cerebral blood flow in cats after an acute hypertensive insult with damage to the blood-brain barrier. Cerebral blood flow was measured with the 133Xenon clearance method in anesthetized cats under controlled ventilation. An acute pressure increase in the carotid system increases the cerebrovascular permeability to Evans blue, indicating damage to the blood-brain barrier. In these conditions the reactivity or cerebral blood vessels toward changes in the acid-base balance is altered: the CO2 reactivity is less pronounced, while the effect of increasing the plasma (HCO-3) is more pronounced than in normal cats. Autoregulatory capacity toward moderate alterations in arterial blood pressure or in intracranial pressure is well maintained in these conditions.


Characterization of malignant gliomas and cerebrovascular disease by cerebral dynamic studies. A technique for analysis of dynamic radionuclide studies of the cerebral circulation is described. This technique permits objective classification of observed radionuclide distribution patterns. Variation in the time-to-peak activity, and in the maximum attained activity as determined by region-of-interest analysis of cerebral hemispheric activity, was defined for a normal population. Application of these normal values permits classification of observed hemispheric radionuclide distribution patterns in anaplastic gliomas and in occlusive cerebrovascular disease. Radionuclide activity in gliomas may be normal, decreased, or increased in the region of the tumor. In cerebrovascular occlusion, decreased activity, associated with a delay in time-to-peak activity, is frequently demonstrated in the affected hemisphere.


Assay of alpha-N-acetylgalactosaminyltransferases in human sera. Further evidence for several types of Am individuals. The study of the alpha-N-acetylgalactosaminyltransferase in the sera of 19 individuals belonging to the rare Am blood group makes it possible to confirm the heterogeneity of this phenotype established on genetical and immunological criteria. Two groups of subjects, Am and Ay, can be distinguished. For the individuals of the first group, named Am, 15 samples (7 families) have been studied, the phenotype is inherited as an allele at the ABO locus. 14 of these subjects, have an alpha-N-acetylgalactosaminyltransferase whose kinetic properties were similar to those of A1 subjects. In one family, however, the A transferase detected is of the A1 type. On a quantitative level, the enzyme activities of these sera only reached 30-50 percent of the average value observed for A1 or A2 subjects, respectively. These facts suggest the existence of a genetic inhibitor, possibly linked to the ABO locus, preventing either an A1 or A2 gene from acting at the level of some cellular lines and leading therefore to the recognition of phenotypes named A-m-A1 and A-m-A2. On the contrary, under the experimental conditions used, no alpha-N-acetylgalactosaminyl-transferase activity was detected among the four individuals of the second group, named A-y by Weiner et al. (37), and whose appeareance in siblings results from the action of a recessive modifying y-A gene.


A correction to the autoanalyzer data for quantitative agglutination measurements. The AutoAnalyzer was used for quantitative measurements of antibody agglutinating activity by a Polybrene agglutination technique. Since the continuous flow system introduces an experimental error to the determination of true agglutination percentage, it is necessary to apply a correction factor. The experimental method of correction is described.


Bisalbuminaemia Birmingham - a new variant in an Indian Family. Characterisation and comparative studies with albumin Kashmir. Bisalbuminaemia has rarely been reported in races of the Indian subcontinet. The variant described in a native of the Punjab is shown to have a similar electrophoretic mobility to albumin Kashmir but different dye binding properties. The dye binding properties are also different from other albumin variants where such studies have been reported.


Influence of free amino and carboxyl groups on the specificity of plant anti-N. It is shown that M-active glycoproteins react de novo with anti-N lectins from Vicia graminea and Bauhinia purpurea after blocking of free amino and carboxyl groups. The significance of this phenomenon is briefly discussed.


[Properties of influenza virus strains causing the influenza epidemic in Moscow in 1972-3]. The antigenic and some biological properties of influenza virus strains isolated during 1972-1973 epidemic were studied. Altogether 114 strains were isolated from sick infants of the first months of life beginning from neonatality. The strains under study were found to have high adaptation and elution activity, to be highly sensitive to inhibitors and to produce polymorphous allantoic population in the adaptation period. The hemagglutinating and neuraminidase components were shown to be fairly closely related to those of the membrane of the reference A2/Hong Kong/1/68 strain (H3N2). At the same time, a low neutralizing activity of the antisera for this strain against Moscow strains of 1972-1973 in biological neutralization tests in chick embryos was observed, explaining very high susceptibility of the population to influenza type A infection in the winter of 1972-1973. The strains under study were antigenically homogenous and most closely related to the reference A2/England/42/72 (H3N2) strain.


[Serological study of the neuraminidase activity of cholera filtrate and influenza virus]. The capacity of homologous (influenza virus) and heterologous (V. cholerae) anti-neuraminidase antibody to neutralize the neuraminidase activity of influenza virus was studied. The lack of antigenic relationship between the enzyme of V. cholerae and that of influenza virus was established and differences in the antigenic structure of neuraminidase of influenza virus of both different types (A0, A1, A2) and within one type were demonstrated.


[Effect of antibiotics on experimental influenza immunity]. The influence of antibodies (tetracycline, penicillin, streptomycin) on formation of immunity to influenza was studied experimentally in white mice which were immunized with live influenza A/PR8 virus and were given antibiotics in average therapeutic doses for 10 days. These antibiotics were found to inhibit formation of antiviral immunity.


[Immunochemical characteristics of human blood proteins, exhibiting anti-influenza gamma-inhibitor activity]. The molecular composition of gamma-inhibitors in human serum was found to be heterogenous. In gel filtration of serum gamma-inhibitors were detected in macroglobulin 19S and low molecular 4S fractions. Heating at 100 degrees C for 10 min resulted in a considerable (32--128-fold) increase of the activity of 19S and 4S gamma-inhibitors. A mixture of specific antibody and gamma-inhibitors could be isolated from human serum by means of immunosorbent. The eluate from the immunosorbent was separated into two fractions in gel filtration through Sephadex G-200 column. According to the results of HI tests, both fractions showed the activities of both antibody and gamma-inhibitors. Proteins of the eluate and its fractions were identified by means of disc electrophoresis in polyacrylamide gel and immunodiffusion analysis. The function of gamma-inhibitors in human sera was found to be performed by alpha2-macroglobulins and transferrin. Antibody for influenza A2/Singapore/1/57 virus belong to IgG and IgA classes.


[Evaluation of the preventive efficacy of bonaphthone in influenza]. Bonaphthone was tested as a prophylactic drug in 4927 adults during 1973 influenza epidemic caused by influenza A/England/42/72 (H3N2) virus, and shown to exert a protective effect: the index of effectiveness was 1.8-2.9, the protection rate 44.7-66.4%. When given per os in a daily dose of 50 mg for 24 days bonaphthone produced no manifest side effects.


[Isolation of Bhanja arbovirus from Boophilus decoloratus ticks in Cameroon]. A strain of virus designated YaK-10 was isolated from Boophilus decoloratus ticks (10 specimens) collected in March 1971 from cattle pastured in savanna near Garoy (United Cameroun Republic) by the intracerebral inoculation of suckling mice at the Pasteur Institute in Cameroun. The results of investigations of the biological properties of the strain showed it to be pathogenic for 1-3-day-old suckling mice by the intracerebral and intraperitoneal routes, for 3-week-old mice by the intracerebral route and to be nonpathogenic for adult mice. The incubation period was 5-7 days. The virus multiplies in chick embryos producing death of the majority of eggs and in chick embryo fibroblast cultures with a weak cytopathic effect, and it is sensitive to ether and sodium deoxycholate, passes Millipore filters with pore diameter of 220 nm and has no hemagglutinating properties. Studies of the antigenic properties of the virus by CF and neutralization tests showed it to be identical with Dakar D-9540 VIRUS (Bhanja).


[Clone cells obtained from continuous cultures and differing in their sensitivity to tick-borne encephalitis viruses]. Studies on cloning of continuous HEp-2 and SPEV cell lines were carried out. The sensitivity of the resulting clones to tick-borne encephalitis virus was determined and the clone lines were shown to be heterologous in their sensitivity to TBE virus by means of the immunofluorescence and virological methods. Among 47 clones of HEp-2 line virus reproduction was observed in 30 clones, no reproduction was demonstrated in 17 clones. The maximum number of cells simultaneously synthesizing virus antigen did not exceed 35% of the population which was conformity with the results obtained in the study of the original HEp-2 cell line. Twenty-nine clones derived from the continuous SPEV cell line were examined. Reproduction of the virus was observed in all of them. However, according to the maximum number of cells involved in the process of antigen synthesis, all the clones could be divided into two groups which differed also by the dynamics of cell involvement in antigen synthesis. The results of the study of clones derived from chronically TBE-infected Hep-2-Soph cell line are presented. In 13 out of 15 clones, the infectious virus and antigen synthesis were demonstrated which suggested that the majority of cells of the parental HEp-2-Soph line had been infected with TBE virus.


[Conditions affecting renal excretion of silver by humans. Studies on metabolism of trace elements. VIII]. The renal excretion of silver was investigated in adult experimental persons of both sexes with normal or variously decreased kidney functions. Silver was measured by emission spectrum analysis. With an indifferent urinary flow of 4.71 plus or minus 2.5 (mean value with standard deviation) ml/min, the mean Ag-excretion was 0.653 plus or minus 0.432 ng/min for a standard 1.73 m2 body surface area. An apparent small increase in the Ag-excretion with increased rate of urine flow could not be statistically confirmed. The widely different Ag-excretion between individuals showed no dependence on the state of diuresis, or on kidney haemodynamic factors down to a decreased inulin clearance of less than 40 ml/min, and a decrease of the PAH clearance to values less than 200 ml/min.


[Determination of iron with CentrifiChem System]. The determination of iron was adapted to the CentrifiChem System. The iron bound to transferrin is freed with a detergent, reduced to Fe++ with sodium dithionite, and determined with bathophenanthroline disulphonate. The operation consists of one run for the blank value and one analytical run. Although the actual reaction time is extremely short, a reaction time of 8--10 min is recommended for both the blank value and the analysis. This ensures adequate clearing during centrifugation under the influence of Teepol. 2 times 100 mul serum are required, and 80 determinations per hour are possible.


Induced hypercapnia in experimental hemorrhagic shock. The inhalation effect of a 90% oxygen and 10% carbon dioxide mixture was compared with pure oxygen inhalation in the treatment of rabbits, bled to a mean arterial pressure of 25 mmHg. A pronounced respiratory acidosis developed in the O-2-CO-2-treated rabbits. Both groups showed similar changes in the blood concentration of lactate and the base deficit values. In the rabbits inhaling O-2-CO-2, the PvO-2 was significantly higher than in those treated with oxygen. All the relationships were recorded independent of the time of onset of the inhalation treatment regardless of whether it was commenced before or after the bleeding. Our conclusion is that, in spite of the apparent increase in the shunting of oxygenated blood to the venous circulation, the perfusion through the capillaries is unaffected by the carbon dioxide inhaled in hemorrhagic shock.


Effects of hyperbaric oxygenation and prolonged hypoxia on the healing of open wounds. In a study on rats, long-tern intermittent hyperbaric oxygenation at 2 ATA had no effect on the healing rate of open wounds in which the circulation was left intact. When the wound edges were devascularized, however, hyperbaric oxygen enhanced the wound closure rate in the final stages of healing, thus counteracting the delay caused by disturbed blood supply. During the hyperbaric exposure, tissue pO-2 increased considerably in both normal and devascularized skin, whereas tissue pCO-2 increased only slightly. Combined systemic and local hypoxia--12% oxygen at 1 atm--retarded the closure rate of full-thickness skin wounds. This was noted both in acclimatized and in unacclimatized rats. Thirteen-day adaptation to hypoxia increased the healing rate and subcutaneous tissue pO-2 to normal levels, but when hypoxia was continued, tissue pO-2 and the wound closure rate decreased markedly. This was probably due to a decreased blood flow induced by secondary erythrocytosis and an elevated blood viscosity.


Primary hyperplasia of the parathyroids. Eight cases of primary hyperplasia of the parathyroid are reported among 322 cases of primary hyperparathyroidism. Preoperatively, all had high serum calcium. Six cases were water-clear, one chief cell, and one mixed hyperplasia. The case of chief cell hyperplasia was misdiagnosed primarily as adenoma. Its exact nature was recognised retrospectively. Identification and biopsy with frozen section of all the parathyroid glands is stressed. This is essential to rule out the presence of multiple adenoma or adenomatous formation in hyperplasia. When hyperplasia was proved, total parathyroidectomy and autotransplantation of parathyroid tissue equivalent to 1/2 or one normal-sized parathyroid gland was done in 7 cases. Although one patient had hyperplastic tissue in situ, the results of this management are considered to be satisfactory. On to six years postoperatively, all surviving patients are without symptoms of hyperparathyroidism and have normal serum calcium. Two patients required a small dose of Vit D-2 to sustain a normal calcium level. Total parathyroidectomy and autotransplantation of parathyroid tissue (PTA) is preferred to subtotal parathyroidectomy in cases of primary hyperplasia. There is a good primary result and reoperation can be easily done if there is recurrence of hyperparathyroidism.


Surgical or conservative treatment of total dislocation of the acromioclavicular joint. A follow-up investigation on 41 patients with complete dislocation of the acromioclavicular joint was performed. Nineteen patients had been treated surgically, 22 conservatively. The surgery performed had consisted of repair of the coracoclavicular ligament and fixation of the acromioclavicular joint by means of a Kirschner wire. In the conservatively treated patients, a strapping was applied to maintain reduction of the acromioclavicular joint. A good functional end-result is correlated with a good anatomical result. A good anatomical result was more frequent in the surgically treated group. Better functional results were achieved by operation than by conservative treatment. In general, post-traumatic arthrosis of the acromioclavicular joint was slight and was not correlated with the functional results.


Instramedullary supramid pin and plate-screw fixation for fracture of the humerus. A method of fixing the humerus is presented. A supramid pin is introduced into the medullary cavity and a plate with screws is attached to the bone surface. The screws are driven through the fracture fragments into the supramid pin. The resulting fixation is firm and suitable for certain complicated cases in which the usual fixation methods have their limitations.


Diagnostic laparocentesis and peritoneal lavage in patients with multiple blunt injuries. A series of 53 patients with multiple injuries and suspected abdominal trauma were analysed to determine the accuracy of diagnostic laparocentesis and peritoneal lavage. Thirty-one positive findings resulted in immediate laparotomies. Fifteen patients with an otherwise strong suspicion of intra-abdominal injury were treated conservatively with an uneventful clinical course. All three false-negative findings were in patients who has previously been subjected to laparotomy. These 3 patients were laparotomized on the basis of other diagnostic evidence. Four positive and two false-positive findings resulted in unnecessary operations. Trocar laparocentesis combined with peritoneal lavage is a quick and safe aid in the diagnosis of blunt abdominal trauma. Trauma to the urinary tract, however, should be diagnosed without laparocentesis. The test does not replace other diagnostic methods, but it may shorten the preoperative delay in complicated situations.


Lissencephaly and Pachygyria: an architectonic and topographical analysis. The architectonic features of abnormal cerebral cortex in a brain with lissencephaly and pachygyria suggest that neuronal migration was interrupted by cortical and subcortical laminar necrosis in the fourth fetal month. The severest cortical abnormality lies in the distal perfusion fields of the major cerebral arteries, while the normal areas are located in the proximal perfusion fields. These architectonic and topographic features suggest that intra-uterine hypoxia or perfusion failure may be a pathogenetic mechanism leading to lissencephaly and pachygyria.


Infantile neuroaxonal dystrophy. An electron microscopic study of a case clinically resembling neuronal ceroid-lipofuscinosis. An unusual case of infantile neuroaxonal dystrophy (INAD) in which seizures were the presenting and predominant clinical feature is described. Although the clinical manifestations were indistinguishable from neuronal ceroid-lipofuscinosis, the diagnosis was readily established by electron microscopic examination of the brain biopsy specimen. Even after the ultrastructural features were known, the dystrophic axons were not evident by light microscopy. This case broadens the clinical picture of INAD to include seizures as the presenting complaint and suggests that some patients with childhood epilepsy who "deteriorate" may have this genetically determined disease.


Ultrastructure of the syndrome of continuous muscle fibre activity. The ultrastructure of muscle and the myoneural junction of a man of 60 suffering from the syndrome of continuous muscle fibre activity was studied. This syndrome is manifested by disturbances of walking, muscle weakness, permanent muscle contractions and involuntary movements. The myoneural junction was hypertrophied and showed ramifications of the secondary clefts. The presynaptic nerve ending contained no synaptic vesicles. The relationship of these findings to the disease is discussed.


Dermatophytes: conidium-ontogeny and classification. The ontogeny of the conidia of representative Dermatophyte species has been examined by time-lapse microphotography. The results are summarized in five main conclusions. (i) the genera Microsporum, Trichophyton and Epidermophyton have holoblastic conidium-ontogeny; (ii) the investigated species exhibit polymeristematic development; (iii) delivery of the conidia occurs by means of a special detaching mechanism: consisting in autolysis of a detaching-cell or cells; (iv) the macroconidia have a primary septum; (v)chlamydospores including "gemmae" and "persistent-organs", strikingly similar to the macro- and microconidia as investigated in aqueous preparations, are also formed. The author classifies the dermatophytes into section III of the system of HUGHES and into the group III/C of TURBAKI's system.


Studies on the sensitivity of anticancer agents of normal human cells in culture. Two biopsies of human periosteal tissue have been tested for sensitivity to several antitumoral agents. The tests were performed during the lifespan of the cultured cells in order to reveal possible variations in sensitivity. The results indicate that the age of the donor affects drug sensitivity; cells obtained from the young donor show a higher growth potential, together with a variable sensitivity and morphology during their life in vitro, while cells from the adult donor have a lower growth potential, a constant sensitivity to chemotherapy and a constant morphology.


The effect of hydrocortisone on DNA synthesis and cell division during aging in vitro. Hydrocortisone (14 muM) added to cultures of human diploid fibroblast-like cells extends the lifespan of the population. This effect is expressed during a single growth cycle by an increased rate of proliferation and a higher rate of incorporation of 3HdT into DNA. The hormone appears to exert its effect by increasing the fraction of cells in the proliferating pool, and this increase is expressed at all levels of serial subcultivation (population ages). The effect requires a minimum of between 12 and 18 hr exposure of the cells to hydrocortisone. Studies with varying amounts of serum suggest that the hormone affects the cells by amplifying the serum signal which is the primary signal for cell division.


Pathophysiology of second degree atrioventricular block: a unified hypothesis. An in vivo and in vitro correlative study of second degree atrioventricular (A-V) block in the canine proximal His-Purkinje system after ligation of the anterior septal artery is reported. Evidence is presented to suggest that Mobitz type II and the Wenckebach ypte of conduction represent different degrees of the same disorder rather than two distinct electrophysiologic processes. The in vivo study showed that an increment of conduction delay almost always preceded the blocked impulse in second degree A-V block. The increment, as 1 or 2 msec at the early stage of block, often increased gradually up to 180 msec. The in vitro study consistently showed an increment of conduction delay preceding the blocked impulse. The same experiments revealed a greater increment in conduction delay early after excision that, on recovery during superfusion, gradually decreased to a few milliseconds (the reverse order of the in vivo observation). Characteristic changes in duration and configuration of action potentials in the ischemic proximal His-Purkinje system were observed depending on the state of transmission and the temporal relation of the impaled cell to areas of slow propagation and block. The study revealed a remarkable similarity between characteristics of conduction in the ischemic His-Purkinje system and conduction in both the normal A-V doe and Purkinje fibers subjected to various pathophysiologic interventions. It is suggested that in the pathologic situation--exemplified in this study by acute myocardial ischemia--the normal His-Purkinje system may gradually lose the characteristics of the fast response and start showing properties of the slow response. At an early stage of departure from normal, the proximal His-Purkinje system may show second degree A-V block with no perceptible to a few milliseconds' increment of conduction delay (the equivalent of Mobitz type II block). On further departure from normal, the His-Purkinje system resembles the A-V node in showing a significant increment of conduction delay prior to the blocked impulse (the equivalent of Wenckebach periodicity). Both the in vivo and in vitro observations demonstrated a clear propensity of the ischemic proximal His-Purkinje system to develop paroxysmal A-V block during the stage of second degree A-V block when there is no perceptible to a few milliseconds' increment of conduction delay. A new classification of second degree A-V block is presented based on the suggested electrophysiologic mechanism.


A degeneration study of some habenular efferents to the midbrain in a wallaby. In this study, specimens of both sexes of a Western Australian wallaby (Steonix brachyurus) had surgical or electrolytic lesions made in the habenular complex unilaterally. Thirty-five-micron sections, cut coronally and parasagittally, were stained by the Nauta-Gygax ('54) or the Fink-Heimer ('67) technique to demonstrate degenerating fibers. Degeneration was seen in the habenular commissure and bilaterally in the habenula and fasciculus retroflexus, but was most extensive ipsilaterally. Habenular fibers destined for the tegmentum and central gray passed caudally into the midbrain in a continuous fan-like array which extended from the central gray dorsally to the interpeduncular nucleus ventrally. In their posterior course some fibers crossed the midline with the decussating cerebellar fibers. The majority of fibers, with those in the fasciculus retroflexus which passed ventral to the decussation of the superior cerebellar peduncle, turned dorsally. They passed mostly just lateral to the midline nuclei and into the central gray where degeneration was seen throughout the entire extent. Terminal degeneration was seen in the interpeduncular nucleus primarily in the dorsal and posterior parts, in the ventral tegmental nucleus and throughout the central gray, but was more densely clustered in the region of the dorsal tegmental nucleus.


Ethionine induced degeneration and regeneration in the rat parotid gland: an electron microscope study. The object of the present study was to establish a model for the study of parotid gland regeneration. Adult female Spague-Dalley rats were placed for 11 days on a protein-free diet with daily intraperitoneal doses of aqueous DL-ethionine equivalent to 0.5 hg/gm body weight, and returned to a normal diet on day 12. At varying intervals, both during and after intoxication, animals were sacrificed and the parotid glands prepared for study with the transmission electron microscope. Ultrastructural observations indicated that damage was essentially limited to the acinar cells, in which the protein synthetic apparatus was the focus of injury. The rough endoplasmic reticulum displayed atypical configurations, loss of attached ribosomes and membrane fragmentation. In the Golgi region, an atypical structure, a "crystalloid" arose during intoxication. Because of the morphology and apparent formation of the "crystalloid," it was assumed to be an abnormal secretion product. Resumption of a normal diet resulted in the rapid restitution of the normal cytoarchitecture. During the first week of recovery, there was prominent mitotic activity in mature acinar cells. It was concluded that the primary effect of ethionine upon the parotid gland is interference with the function of the protein-synthetic apparatus, leading to morphologic alteration of the acinar cells. The mitotic activity observed during recovery indicated that in the adult rat, acinar cells retain the potential for proliferation.


Development of the endometrium during the estrous cycle in the bitch. The endometrium of 40 cycling bitches was studied using cytological, cytochemical, and morphometric techniques. Two principal phases of growth and differentiation can be discerned. Phase one begins at the end of anestrus as serum estrogen levels begin to rise and is completed just prior to estrus. It is characterized by growth of the crypts and differentiation of the glandular epithelial cells into well-developed, mucus-secreting cells. Growth, initially rapid, gradually slows. The second growth phase does not begin until the middle of estrus as serum progestin levels rise and lasts nearly a week. Both hypertrophy and hyperplasia of the glandular epithelium and growth of the basal glands characterize this stage. The gland cells develop many well-defined characteristics of absorptive and secretory cells. Another phase of growth occurs in pregnant animals at the onset of implantation. During the third week of metestrus in non-pregnant bitches, the uterus begins to involute. Acid phosphatase and the number of lysosomes increase dramatically in the epithelial cells particularly in the basal glands. Cells lining the lumen and crypts accumulate numerous large lipid droplets. The data are discussed in relation to the clear separation of two distinct uterine functions: (1) sperm transport and maintenance and (2) production and secretion of nutritive uterine milk. Extended periods of follicular development, breeding, and preimplantation in the bitch probably impose this separation.


Ultrastructural study of mouse olfactory epithelium following destruction by ZnSO4 and its subsequent regeneration. Regeneration of olfactory epithelium was studied at the ultrastructural level in two different strains of mice (C57B1/6J and SWR/J) following destructive changes induced by nasal irrigation with 1% aqueous solution of zinc sulfate (ZnSO4). Three epithelial conditions were seen during the first four to 14 days following treatment: a "surface alteration" state characterized by changes at the apical ends of olfactory and columnar supporting cells, a "squamous-metaplastic" state, and a simple-squamous" state. In the latter two conditions, thought to represent regenerative states, cells contained inclusions similar to secretion granules in Bowman's glands. This observation supports earlier suggestions that new epithelial cells originate from these glands. Later regenerative changes consist of differentiation of new sensory cells and columnar supporting cells in an initially disorganized epithelium. This epithelium then changes to a normal, pseudostratified organization. Regeneration of the epithelium begins earlier and proceeds more rapidly in the SWR/J strain than C57B1/6J mice. Possibly, a genetic difference exists between strains. After 72 days the epithelium in both strains had regenerated.


Rubella and measles serosurvey among a nonurban pediatric population. A serologic survey for rubella and measles immunity was conducted to determine the immunity levels among a nonurban, relatively isolated pediatric population. Among 1,273 students in grades kindergarten through 9, the overall susceptibility rate was 24.3% for rubella and 16.3% for measles. There was significant variation in susceptibility rates among the various grades and schools involved. The susceptibility rates were similar to those found for urban populations. The results indicated that vaccination efforts for the population have been partially successful, but additional effort was needed.


Gonadal function in children with nephrosis treated with cyclophosphamide. Conadal function was evaluated in 23 boys and 11 girls treated with cyclophosphamide, 2 to 5 mg/kg/day for periods of 1.5 to 6 months. Serum follicle stimulating hormone (FSH), luteinizing hormone (LH), and testosterone levels were determined by radioimmunoassay. All 16 boys treated when prepubertal or during early puberty had normal, FSH, LH, and testosterone levels. Testicular biopsy was performed in five of the 16, and was abnormal in four and normal in one. Sperm count was normal in two other patients. The remaining seven boys were treated when pubertal; all have decreased spermatogenesis, and five of them have increased FSH levELS. The LH and testosterone levels were normal. No evidence of gonadal dysfunction was detected in any of the girls. Of four patients treated when postpubertal, three have become pregnant.


Coxsackievirus B5 infection and aseptic meningitis in neonates and children. In metropolitan Washington, DC, an outbreak of aseptic meningitis in children was recognized in the summer and fall of 1972. Age-specific attack rates were highest in children less than 1 year of age. The incidence of cases showed two peaks: one in July and another in October. Coxsackievirus B5 was associated with cases occurring in July, August, and September, but was not implicated in the October cases. Seventy-six percent of the confirmed coxsackievirus B5 infections in aseptic meningitis patients occurred in infants less than 2 months old. Specific meningeal symptoms were less frequently observed in these young infants, although viral isolations were more common (13 of 15) compared to patients over 2 months of age (four of 19). Analysis of reported coxsackievirus B5 infections in Washington, DC, and the United States as a whole suggests a five- or six-year periodicity.


Intussusception in children: hydrostatic reduction. The records of 104 patients with the diagnosis of intussusception who were admitted to the Saisei-kai Suita Hospital during the past five years were reviewed. There were no deaths. All patients were treated primarily by barium enema with a successful reduction rate of 82%. Successful reduction requires the use of general anesthesia, repetition of the procedure after a three- or five-minute waiting period, use of a balloon catheter, and manipulation. The most important points are early detection of this disease by the pediatrician and enthusiasm on the part of the surgeon.


4p- phenotype in an infant with t(4p-;19p or q+)mat translocation. Four family members had an apparently balanced t(4p-;19p or q+) translocation indentified by Giemsa banding. One of these individuals, a male infant, has a 4p- phenotype with seizures, large bilateral cleft palate, abnormal anterior fontanel, abnormally shaped ears, hypertelorism, small penis with third-degree hypospadias, and bilateral simian creases. It is theorized that 4p material containing loci essential for normal development was lost in this infant by a simple deletion or "aneusomy by recombination."


Translocation 4p-- syndrome: a general review. The casee presented here may be the first fully identified and verified cas of translocation 4p-- syndrome, a B4/G22 translocation, ie, 45,XX,-4,-22,+t(4q 22q). Thirty-nine other cases of the 4p--syndrome, including one other possible translocation case, have been found in the medical literature. Conventional chromosome studies cannot distinguish between 4p-- (Wolf) syndrome and 5p-- (cri-du-chat) syndrome, and the clinical features, as in our case, may not be sufficiently characteristic to permit differentiation. The newer chromosome banding techniques have made specific identification possible.


On "an experimental evaluation of sensorimotor patterning": a critique. A critique was presented of a study by Neman, Roos, McCann, Menolascino, and Heal (1975) in which a sensorimotor training method of treatment for retarded children was evaluated. They presented evidence which they interpreted as support for the effectiveness of this treatment method in benefiting their sample of retarded individuals. Many shortcomings of the Neman et al. study were pointed out in the areas of evaluating the theoretical rationale underlying the treatment, subject selection, procedure, statistical analyses, and interpretation of the findings. In addition, the problems raised by the premature release of the findings to the press were discussed. Special note was made of the potential harmful effects of this publicity on retarded children and their families. The important role and responsibility of the National Association for Retarded Citizens in endorsing and recommending treatment methods for retarded individuals was also discussed.


A reply to Zigler and Seitz.

A reply to Zigler and Seitz. The Zigler and Seitz (1975) critique was carefully examined with respect to the conclusions of the Neman et al. (1975) study. Particular attention was given to the following questions: (a) did experimenter bias or commitment account for the results, (b) were unreliable and invalid psychometric instruments used, (c) were the statistical analyses insufficient or incorrect, (d) did the results reflect no more than the operation of chance, and (e) were the results biased by artifactually inflated profile scores. Experimenter bias and commitment were shown to be insufficient to account for the results; a further review of Buros (1972) showed that there was no need for apprehension about the testing instruments; the statistical analyses were shown to exceed prevailing standards for research reporting; the results were shown to reflect valid findings at the .05 probability level; and the Neman et al. (1975) results for the profile measure were equally significant using either "raw" neurological scores or "scales" neurological age scores. Zigler, Seitz, and I agreed on the needs for (a) using multivariate analyses, where applicable, in studies having more than one dependent variable; (b) defining the population for which sensorimotor training procedures may be appropriately prescribed; and (c) validating the profile measure as a tool to assess neurological disorganization.


Imitation of retarded children by their nonretarded peers. The purpose of this study was to determine whether nonretarded children would imitate the behavior of retarded children who were more competent in an experimental task and to determine whether this imitation would generalize to the selection of the retarded children as task partners in another situation. Each nonretarded observer was allowed to imitate the task behavior of an EMR model when the model was either (a) more competent than the observer, (b) equeally competent, or (c) less competent than the observer in the experimental task. Results indicated that (a) nonretarded observers imitated the behavior of the high competent EMR model significantly more often than the moderately competent model, with the latter in turn being imitated more than the noncompetent model and (b) that girls imitated both low and high competent models more than boys, who were most apt to imitate the behavior of moderately competent models. The data further revealed that competent EMR models were more likely to be chosen as partners on a future game task.


Long-term effectiveness of imagery instructions with retarded persons. The effects of imagery instructions on paired-associate learning efficiency and on the retention of 16 picture pairs were investigated using two groups of EMR individuals with approximate mental ages of 8 and 11 years, respectively. While facilitated list mastery was obtained under imagery instructions, no facilitation was found for 1-week retention performance. However, in learning a new list immediately following the retention task, those individuals who had received imagery instructions during original learning continued to exhibit facilitated learning. These results extend previous work.


Retarded adult's discrete work performance in a sheltered workshop as a function of overall productivity and motivation. Production times of high and low retarded adults in a sheltered workshop were analyzed in terms of actual time working as opposed to actual time not working and under conditions of standard and high motivation. Under standard conditions, low productivity was primarily the result of more time spent not working. High motivation attenuated this effect. The results were discussed in terms of cognitive vs. motivational interpretations of individual differences in work performance.


Measurement of social learning and its relationship to cognitive, behavioral, demographic, and diagnostic variables. A curriculum-based paper and pencil group-administered test was developed to assess the objectives of the Self Level of the Social Learning Curriculum. The major objective of the study was to determine the extent to which performance on this measure was related to cognitive skills and adaptive behavior. A total of 242 primary level EMR subjects were tested. The results indicated that a reliable assessment procedure which taps cognitive skills and behavioral dimentions is feasible. Both of these factors related to the major assumptions underlying the Social learning curriculum.


Jeopardy in community placement.

Jeopardy in community placement. As part of a broader research effort, a survey of the adaptive behavior of 424 community-placed retarded persons was conducted through small group, tape-recorded interviews with their 109 caretakers. From 1252 incidents of problem behavior cited, 203 were judged to contain jeopardy. Seventy-seven percent of these incidents involved jeopardy to health and/or safety, 4 percent to general welfare, and 18 percent contained legal jeopardy. In 79 percent of incidents, the client jeopardized himself, in 12 percent he jeopardized a fellow client, and in 9 percent he jeopardized a member of the community at large. The evidence exposes need for full examination of this problem and ways to minimize it.


Relationship between linguistic performance and memory deficits in retarded children. Performance of retarded children was measured on four tests of linguistic ability and two memory tests. Subjects were 50 retarded children: 10 each at mental ages 3, 4, 5, 6, and 7. The relationship between linguistic performance and memory was assessed by correlational analysis. Multiple and partial correlations were computed using a measure of language comprehension and a measure of memory span as predictor variables and three measures of language production as criterion variables. Different patterns of correlation were found with the three production as criterion variables. Different patterns of correlation were found with the three production measures, suggesting that the relative importance of memory span in language production depends on the specific production task.


Relationship of reaction time to deceleration and variability of heart rate in nonretarded and retarded persons. Heart rate was monitored for nonretarded and retarded subjects during a simple reaction time (RT) TASK. Both groups were further divided into those receiving either a 4-second or 12-second preparatory interval (PI). For retarded subjects responding under 4-second PI conditions, it was found that (a) RT performance was poor, (b) heart-rate deceleration did not accompany the response, and (c) reduction in heart variability did not occur during the PI. The remaining groups responded more rapidly, showed heart-rate deceleration and variability reduction. These data were interpreted as supporting the view that retarded subjects cannot reliably make the biological adjustments necessary for rapid RT responding when operating under the constraints of a short PI.


Galvanic skin response orienting response as a measure of tactile discrimination in retarded children. The GSR orienting reflex has been successfully applied to the measurements of normal and disordered tactile sensation and perception in nursery-school children, college students, and brain-injured adults. Because the technique eliminates practically all of the cognitive requirements of conventional measurement procedures, it provides a potential approach for measuring somato-perceptual abilities in the younger, language deficient, and more severely retarded child. In the present study the feasibility of the technique was evaluated by applying it to the discrimination of touches to the soles of the feet. In this simple discrimination, the retarded children performed as well as a control group of nonretarded children.


Investigating the phenomenon of helplessness in mentally retarded adults. Helplessness, or the inability to take effective action in a problem situation, appears to involve both behavioral-motivational and competence factors. As a personality characteristic, it may cause difficulties in community adjustment for mentally retarded persons. Helplessness in a group of mentally retarded adults was investigated through a set of behavioral and questionnaire measures specifically adapted for this population. Similar measures were applied to a CA control group. Both institutionalized and noninstitutionalized retarded subjects exhibited significantly more signs of helplessness than did the nonretarded control subjects. The results support the hypothesis that helplessness is a meaningful personality dimension among retarded persons and can be objectively measured.


Effects of treatment programs on the acquisition of basic skills. The relative effectiveness of alternative programs in producing changes in ambulation and toilet training among retarded individuals admitted to an institution was evaluated. Little change in ambulation over a 3-year-period was found unless special programming such as sensory-motor training was provided. The impact of such institutional programs was also evident for toilet training. However, about 40 percent of the retarded individuals placed in foster care also improved. In all instances, those individuals in standard care showed the least change. It was concluded that simple answers regarding the "best" placement or program are not available.


Differences between EMR and nonretarded children in fluency and quality of verbal associations. An association task, in which a subject was asked to give up to 25 associations to each of 10 verbal stimuli, was administered to 32 EMR and 32 nonretarded subjects, along with the Peabody Picture Vocabulary Test. The associations were scored for quantity and speed of response; they were also categorized by a modification of Flavell's system for response quality. As expected, the two groups differed in vocabularly size. When vocabularly size was controlled, relatively few differences between EMR and nonretarded subjects remained: EMR subjects were slower than nonretarded subjects in their first and continuing responses to the association stimuli, used fewer logical associations, and used fewer responses with vocational connotations. In light of the fact that after adjustment for vocabulary differences, the two groups differed on only 6 of the 24 measures examined, the associative networks of the two groups were surprisingly comparable. The remaining differences demonstrated a specific deficit in logical connections and in speed of access to the associative net.


Application of Premack's generalization of reinforcement to modify occupational behavior in two severely retarded individuals. Premack's generalization that a more probable response will reinforce a less probable one was applied to modify occupational behavior of two severly retarded individuals. When opportunity to work on a more preferred activity was made contingent upon spending some time on a less preferred activity, an increase in the amount of time spent on less preferred work occurred. As the reinforcement schedule was gradually reduced in terms of time allowed on more preferred work, time spent on the less preferred activity tended to increase. Behavior did not return to baseline levels on extinction, however. Possible reasons for these findings are outlined, together with the practical advantages of utilizing Premack's generalization as a reinforcement technique for motivating retarded individuals in rehabilitation settings.


Clinical features of idiopathic preretinal macular fibrosis. Schoenberg Lecture. Of 150 consecutive cases of preretinal macular fibrosis that occurred predominantly in older subjects, 118 cases involved only one eye while 32 occurred binocularly. The ratio of women to men was 3:2. Visual acuity was usually 20/50 or better, and only four of 178 eyes had acuity below 20/200. The vast majority of lesions involved the macula and few extended outside the macular zone. The characteristic clinical finding on ophthalmoscopy was a glinting reflex probably due to a layer of connective tissue cells lying on the internal limiting membrane. Small white exudates, venous abnormalities, and occasional hemorrhages may also be part of prepretinal macular fibrosis. Amsler grid testing usually demonstrated irregularity and distortion of some part of the grid. Fluorescein angiography revealed a characteristic tortuosity of the small macular vessels. Most eyes had previous posterior vitreous detachments but, except for one possible case, there were no cases where the posterior vitreous body was adherent to either the retinal membrane or the macular region. There was no significant systemic disease related to preretinal macular fibrosis. In most instances, preretinal macular fibrosis either was stationary or slowly progressive. The etiology and treatment of the condition remains obscure.


Relationship of idiopathic preretinal macular fibrosis to posterior vitreous detachment. Of 100 consecutive cases of spontaneous posterior vitreous detachment, 20 patients had bilateral posterior vitreous detachments, and 50 patients experienced light flashes just before, or at the moment, that they noticed a floating opacity. Most patients had no loss of vision at the time. A prominent provoking factor rarely caused the detachment. In five cases there were hemorrhages at the disk where the posterior attachment of the vitreous body was torn from the disk margin. Six peripheral retinal holes were found in patients with posterior vitreous detachments and in four, the holes were fresh and three were associated with fresh blood in the peripheral vitreous body. There was no attachment between the posterior face of the receding vitreous body and the macular region. There were no macular pathologic findings in this study and there was no secondary pathology anywhere near the macula at the posterior pole. Spontaneous preretinal macular fibrosis did develop in two cases after posterior vitreous detachment, but only after more than two years and in the absence of any vitreoretinal adhesion.


Congenital preretinal macular fibrosis.

Congenital preretinal macular fibrosis. A 35-year-old woman and a 36-year-old man had asymptomatic, preretinal macular fibrosis involving their left eyes. Both patients were asymptomatic and the lesions were found on routine ocular examination. An opaque gray fibrotic membrane extended toward a lamellar hole in the macular region. Vision, fluorescein angiograms, and Amsler grid testing were normal in both cases. The defect in these two cases possibly arose during early embryonic development and might have been due to a defect produced by adherence of the primary vitreous body to the retina, thus differentiating them from idiopathic preretinal fibrosis,


Ultrastructure and clinicopathologic correlation of idiopathic preretinal macular fibrosis. Detailed light and electron microscopic examination of early idiopathic preretinal fibrosis lesions showed that the fibrosis consisted of a layer of glial cells on the retinal surface. Two cases supported the clinical observation that a glinting retinal reflex preceded the development of retinal folds and traction lines. In both cases there was a break in the inner limiting lamina through which glial cells migrated and, presumably, proliferated on the retinal surface. There was no evidence for vitreoretinal adhesions. The ultrastructural similarity of the lesion to preretinal glial membranes seen in other disease entities suggested the possibility of a common biochemical stimulus for glial cell migration and proliferation on the retinal surface.


Central retinal artery occlusion.

Central retinal artery occlusion. Data regarding the etiology and subsequent course of 54 patients with an occlusion of the central retinal artery included the following: of 44 patients over 40 years of age at the time of the central retinal artery occlusion, eight (18%) had cerebrovascular accidents, but only two patients (5%) had a stroke clearly related to the vessels involving the affected central retinal artery. Five patients (11%) had occlusive disease of the ipsilateral internal carotid artery; two of these had cerebral involvement later or simultaneously. Ten of the older patients had cardiac valvular disease and presumed embolic occlusion of the central retinal artery. Associated medical disorders were common. Of the ten patients under 40 years of age, six occlusions were secondary to atrial myxoma, mitral insufficiency with Marfan's syndrome, polycythemia, hypercoagluopathy, hypertension, and orbital compression. Four had no apparent etiology at onset and were in good health many years later.


Retinal vascular lesions in two patients with prolapsed mitral valve leaflets. Two patients with retinal vascular lesions had mid-late systolic clicks on cardiac auscultation, suggesting the diagnosis of prolapsed mitral valve. The first patient demonstrated an inferonasal arteriolar branch occlusion secondary to embolization; the second patient had a central vein occlusion with multiple hemorrhages, glial proliferative tissue, and retinal neovascularization. This report describes the association between the prolapsed mitral valve syndrome and retinal vascular lesions.


Lacquer crack lesions in pathologic myopia. In evaluating the anatomic and functional status of 22 eyes of 14 patients demonstrating lacquer cracks, these lesions occurred in the eyes of young adults with posterior staphylomas and markedly increased axial lengths. Decreased visual acuity and altered visual fields were the rule; choroidal hemorrhage and focal chorioretinal atrophy were less frequently associated. Fluorescein angiography revealed early and late pseudofluorescence and late staining of the lesions. These clinical data suggest that lacquer cracks represent healed, mechanical breaks in the pigment epithelium-Bruch's membrane-choriocapillaris complex. The presence of these lesions implies a guarded prognosis for the retention of central vision.


Kaposi's sarcoma of the conjunctiva.

Kaposi's sarcoma of the conjunctiva. A 75-year-old man with known Kaposi's sarcoma of three-years' duration developed chronic hemorrhagic thickening of the conjunctiva. Biopsy demonstrated histopathologically that the conjunctiva thickening represented sarcoma involvement. Although surgically untenable, the conjunctival lesion responds satisfactorily to radiotherapy.


Anterior segment complications of retinal photocoagulation. Seven patients had anterior segment complications following xenon arc retinal photocoagulation. Irreversible keratopathy was induced in two cases; all patients showed evidence of iris injury. The absorption of radiation by the iris was considered the main factor in producing overheating of the anterior segment.


Corneal perforation in nontuberculous (staphylococcal) phlyctenular keratoconjunctivitis. An 18-year-old white man with severe staphylococcal blepharokeratoconjunctivitis of several years' duration developed phylctenules intermittently. At age 22 an active corneal phlyctenule caused perforation of the cornea. Seven days after this occurrence, the perforation closed spontaneously but perforated again ten days later. This occurrence may have been caused by an increase in the patient's hypersensitivity to the Staphylococcus as a result of concurrent viral infection, or it may have been due to the patient's failure to return for treatment at the scheduled time. The area of perforation appeared to be healed 10 and one half months later.


Ocular fireworks injuries.

Ocular fireworks injuries. A survey in Arkansas of 14 cases of ocular injuries caused by the explosion of Class C fireworks showed significant, and possibly permanent, visual loss in five men. The most common injuries, corneal abrasion and hyphema, occurred in nine male patients with no residual ocular damage.


Ocular changes in epidermolysis bullosa letalis. Ocular changes in a rare case of epidermolysis bullosa letalis included edema of the trabecular meshwork, ciliary body, lens, optic nerve, and formation of edema cysts in the iris. The retinal was completely detached and focally necrotic. Foci of necrosis and detachment of the retinal pigment epithelium were also observed with occasional breach in the Bruch's membrane. The choroid showed focal edema and congestion.


Effects of renal lymphatic occlusion and venous constriction on renal function. The effects of renal lymphatic occlusion or increased lymph flow due to renal vein constriction on renal function were investigated in rats. In each experiment, the renal lymphatics or vein of the left kidney were occluded or constricted and the right kidney served as a control. Occlusion of renal lymphatics caused renal enlargement, no change in glomerular filtration rate, a marked increase in urine flow and solute excretion without any change in urine osmolality, and enhanced urinary loss of urea, potassium, sodium and ammonium. Urea concentrations in medullary and papillary tissues were significantly elevated. Renal vein constriction caused renal enlargement and a marked drop in glomerular filtration rate, urine volume, urine osmolality and solute excretion. tissue concentrations of urea and potassium were decreased in the medulla and papilla and total tissue solute was significantly decreased in the papilla. The data indicate that in the rat, renal lymphatic occlusion traps urea in the medulla and induces a urea diuresis resulting in a large flow of normally concentrated urine. On the other hand, increased lymph flow secondary to renal vein constriction decreases medullary urea and potassium concentrations and papillary osmolality. These changes and the reduced glomerular filtration rate result in a small flow if dilute urine. Thus both renal lymphatic occlusion and enhanced lymph flow have a significant effect on renal function.


Experimental hypertension. The effects of chemical ablation of the renal papilla on the blood pressure of rats with and without silver-clip hypertension. Because of the ease with which ablation of the renal papilla of the rat can be effected by chemical means, a study was carried out to determine the effects of this ablation on the blood pressure. Significant elevation was found, lennding support to the idea of the antihypertensive role of the renal medulla. Constriction of one renal artery of rats with their papillae removed resulted in a more rapid and greater elevation of pressure than the same procedure in rats ith their papillae intact. The rise in pressure approximated the sum of the rises caused by removal of the papilla alone and by renal artery constriction alone, consistent with the idea of two mechanisms being at work in this model.


Cardiopulmonary baroreflexes: effects of staircase, ramp, and square-wave stimulation. Anesthetized dogs were pump perfused in a system that held systemic arterial pressure constant. Pulmonary arterial beds were pressurized, and the induced transient falls of systemic vascular resistance (SVR) were measured. An approximately linear relationship between percent fall of SVR and pulmonary artery pressure was obtained. Left atria and pulmonary venous beds were pressurized using square-pulse, staircase, and ramp wave forms, and changes in SVR were measured. The effect of varying the interval between stimuli was appraised. An approximately linear relationship was obtained for responses to square-wave left atrial forcing pressure (Pla). With staircase forcing, the change of SVR per unit change of Pla depended upon prestimulus Pla. With ramp forcing, responses increased approximately linearly with respect to the logarithm of the rate of pressure rise. Responses to square-wave stimulation varied directly with respect to the interstimulus interval. This study shows that left atrial-pulmonary vein baroreflexes are capable of producing substantial short-term falls of SVR, and that the response depends upon stimulus pressure, rate of pressure change, base-line pressure, and pressure history.


Oxidative energy metabolism in germ-free and conventional rat liver mitochondria. The ADP:O ratios and State 3 (ADP-stimulated) and State 4 (controlled) rates of succinate, beta-hydroxybutyrate, isocitrate, glutamate, pyruvate + malate, alpha-ketoglutarate, and ascorbate + N,N,N',N'-tetramethylphenylenediamine (TMPD) oxidation were examined in liver mitochondria from germ-free and conventional rats of both Lobund Wistar (100-day-old) and Fisher (120-day-old) strains. The State 3 respiration rates of isolated mitochondria from germ-free and conventional rats were comparable except for the rate of succinate oxidation in the Wistar rats, which was significantly lower (approx. 10%). The State 4 respiration rates were generally lower in mitochondria isolated from germ-free Fisher rats (approx. 8%) and significantly lower (approx. 18%) in germ-free Wistar rats. The ADP:O ratios were similar in germ-free and conventional rats. Serum thyroxine concentrations indicated delayed maturation of thyroid function in young germ-free rats, but adult animals had concentrations similar to those found in conventional rats. The results indicate that, although absence of a microflora results in a 20-30% reduction in metabolic rate, the germ-free state has little influence on the functional respiration or oxidative phosphorylation of mitochondria isolated from the liver of the adult rat.


[Experimental erysipelas in different species as a model for systemic connective tissue disease. II. The chronic phase with special reference to polyarthritis (author's transl)]. In part I of this paper (Schulz et al., 1975) it was shown that in the initial phase of experimental erysipelas a transition from the vascular processes to a systemic connective tissue reaction can be demonstrated in different species. It is the purpose of this paper to describe the chronic phase of the disease with special emphasis on polyarthritis. 12 spontaneously diseased and 22 experimentally infected pigs were used in experiments to study the pathogenesis of the disease. In addition, 74 Wistar rats and 148 Sprague-Dawley rats were used in the experiments. All experimental animals were specific-pathogen-free and were parenterally infected with the standardized E. insidiosa serotype B strain T 28. The observation period for the pigs was up to 2 years, for the rats up to 11 months. The methods used for pathohistological and electron microscopical studies are described in part I. Immunihistological studies were carried out on synovial tissue with peroxidase-conjugates of goat-anti-pig-IgG, goat-anti-pig-IgM, pig-collagen, E. insidiosa-homogenate and heat-aggregated-pig-IgG. Furthermore, goat-anti-pig-IgG and rabbit-anti-pig-C3 conjugated with FITC were used. Passive hemagglutination tests and Latex agglutination test (Singer and Plotz) were performed to demonstrate rheumatoid factors and collagen antibodies. Polyarthritis occurred in pigs between the 4th and 10th day p.i. and between the 4th and 8th day p.i. in nearly 100% of the infected rats. Fibrinous exudation, proliferation and destruction with pannus formation are marked in most of the joints examined during the first three months. Fibrosis begins 30 days p.i. in the rats' joints and is most severe in both species between the 5th and 8th month. 3 types of lining cells may be differentiated electron microscopically: A (M) cells, B (F) cells and an intermediate form which is found in both species most frequently. Swelling of the endothelial cells together with constriction of the lumen and thickening of the basal membrane occurs in the capillaries. A comparison of chronic erysipelas polyarthritis in pigs and rats with rheumatoid arthritis of men reveals many morphological and immunological similarities between the two diseases. Systemic connective tissue activation manifests itself in organs predilected for rheumatic changes, such as heart valves, endocardium and joints. The possible prepetuation of the processes by specific or nonspecific immunomechanisms or by deposits of fibrin is discussed. In addition, experimental erysipelas is reproducible in nearly 100% of the animals given one single subcutaneous application of one defined bacteria strain. Therefore too, erysipelas is suited as an animal model for human rheumatic diseases.


Quantitative ultrastructural study of the adrenal cortex: effects of a mammotropic pituitary tumor producing growth hormone and prolactin (MtT-W10), and of injected growth hormone in the rat. The ultrastructure of the adrenal cortex has been examined in animals bearing a growth hormone and prolactin secreting mammotropic tumor (MtT-W 10). The large quantities of hormone secreted by the tumor caused a stimulation of zona fasciculata cells. The adrenal weight increased approximately 2-fold in tumor bearing animals. There were increases in the cellular volume of zona fasciculata cells and in the volume of mithchondria and smooth endoplasmic reticulum per cell as determined by quantitative morphometric techniques. The surface area of smooth endoplasmic reticulum and total mitochondrial membranes showed a significant increase in zona fasciculata cells as well. Injections of purified bovine growth hormone caused small but not significant increases in mitochondrial and smooth endoplasmic reticulum volumes. Growth hormone however did induce a significant increase in the surface area of mitochondrial membrane.


Methyoxuflurane and serum fluoride concentrations during anaesthesia and postoperative renal function. In twenty gynaecological patients scheduled for hysterectomy, arterial blood concentrations of methoxyflurane and fluoride ions were measured during operation. Renal function was assessed by pre and postoperative measurements of BUN, creatinine, osmolality and serum electrolytes. Fluid balances were calculated by the daily intake and output values. During the first five postoperative days, from the 12 hour urine specimens the fluoride concentrations were measured, and from the 24 hour specimens urine electrolytes and creatinine levels were calculated. No clinical or laboratory evidence of renal dysfunction was observed. Fluoride levels were lower than those previously associated with renal toxicity. Methoxyflurane concentrations in arterial blood showed concentrations lower as previously reported.


Gas chromatographic determination of methoxyflurane in maternal and foetal blood during anaesthesia for Caesarean sections. In 50 cases of Caesarean section for various indication, methoxyflurane was administered to two groups of patients in two different dosages by a Pentec-vaporizer. Blood was sampled simultaneously in the radial artery of the mother and in the umbilical vein. The methoxyflurane concentrations of both samples of blood were measured by gas chromatography. With an inspiratory concentration of 0.2 vol.-% methoxyflurane, the mean concentration was 166 mumol/1(2.75 mg/100 ml) in the maternal blood and 69 mumol/1 (1.14 mg/100 ml) in the umbilical vein. With 0.5 vol.-%, the corresponding values were 345 mumol/1 (5.72 mg/100 ml) and 137 mumol/1 (2.25 mg/100 ml) respectively. The condition of the new-born did not appear to be affected by the given doses of methoxyflurane.


Role of thiopentone, nitrous oxide and relaxant anaesthesia in causing the syndrome of post-operative paralysis in man. Forty-seven patients undergoing elective/emergency surgery were investigated for the recovery pattern by numerically scoring the state of consciousness, skeletomuscular tone, respiration and blood pressure after the neuromuscular transmission at the level of thenar muscles returned to normalcy. Anaesthesia in them consisted of thiopentone induction and passive ventilation with nitrous oxide and oxygen mixtures (4 1/2:2 1/2 1) with consequent changes in PaCO-2 (22.0 to 90 mm Hg) after using 0.43 to 0.68 mg/kg d-tubocurarine or 2.3 to 3.8 mg/kg gallamine. In this series twelve patients were selected at random and biological assay of cerebrospinal fluid in them for curare/gallamine after 15 min anaesthesia and in the recovery phase was carried out on frog rectus muscle. All the patients recovered satisfactorily and did not present clinical signs of depression of central nervous system, even though all of them showed the presence of curare (ranging from 0.05 to 0.33 mug/ml) and gallamine (from 0.1 to 0.75 mug/ml) in the cerebrospinal fluid. This study therefore indicates that thiopentone, nitrous oxide and relaxant type of anaesthesia does not cause clinical syndrome of post-operative paralysis even when mild to moderate degree of hypocapnia is present and even when such a technique of anaesthesia is administered in poor-risk patients with associated changes in acid-base balance, electrolytes etc. Significant quantities of skeleto-muscular relaxant drug (used during the technique) when found in cerebrospinal fluid after the technique of anaesthesia need not induce post-operative paralysis in man.


[Integration of palmitat-1-14-C in lecithine and phospholipid content in normal and micro-embolized rabbit lungs (author's transl)]. Glass microspheres were used for a diffuse pulmonary microembolisation, as a modell for shock lung. Microembolisation is regarded as an important factor in pathogenesis of shock lung. The capacity of lung for lecithin synthesis was measured with palmitat-1-14-C incorporation. The phospholipid content and the composition of the fatty acids of lecithin were investigated. From the results it was possible, that the surfactant system may alterated by the vascular blocking. The dates supporting the importance of microembolisation in pathogenesis of shock lung.


[Intense therapy in two cases of "near-drowning" (author's transl)]. A short review of the pathophysiological mechanisms in case of 'drowning' or 'near drowning' with or without aspiration of hypo- or hypertonic water is given. In our clinical experience on 22 cases, 17 did not need intensive care and improved without further problems. 3 came dead into the clinic, there being more than 30 min latency between cardiac arrest and the beginning of resuscitation, resuscitation, therefore, being without success. The last 2 cases of 'near-drowning' with fresh water aspiration developed, 100 min and 50 min respectively after the drowning accident, fulminant pulmonary oedema, which could be cured after application of PEEP in Engstroöm-IPPB in one case. In our opinion PEEP should be applied in all cases of intraalveolar pulmonary oedema in the same way as was advised for interstitial pulmonary oedema, if the individual case requires mechanical ventilation at all. The possibility of pulmonary oedema developing, even hours after the accident and primary resuscitation, should be born in mind in all cases of 'near-drowning'.


Structure of rat ultimobranchial bodies after birth. The evolution of ultimobranchial bodies in Holtzman rats during the first 64 weeks after birth was studied by reconstructing three-dimensional models from serial sections stained by the periodic acid-Schiff technique.Radio-autography with 125I was made to see if ultimobranchial cells and/or follicular cells lining the lumen of mixed follicles were able to iodinate proteins. The term ultimobranchial body designates herein an embryonic vesicular structure (derived from the third pharyngeal pouch) whose wall is made of stratified squamous epithelium. During the first week after birth, the vesicular ultimobranchial body elongates rapidly and becomes a canal or a duct. During the second week, cell desquamation brings about local dilatations in the lumen of these ducts; with further enlargement ultimobranchial follicles will appear. In one-day-old rats, mixed follicles are present. Only the follicular component of mixed follicles iodinates proteins as is shown by radioautography. The reconstructed models enlarge rapidly up to the 56th day after birth at which time their weight has increased nineteenfold. These same models show that the three morphological components of ultimobranchial parenchyma, namely ducts, follicles and mixed follicles, are in continuity within the thyroid parenchyma. The formation of new thyroid follicles after birth and the possiblility that the ultimobranchial parenchyma may function as an endocrine gland of holocrine type are discussed.


Pathways of clearance in mouse lungs exposed to iron oxide aerosols. The history of particle clearance was studied in lungs of mice serially sacrificed at intervals up to 14 months following single exposures to an aerosol of submicronic, particulate, iron oxide used as a similitude for atmospheric dust. Clearance was followed by light microscopy in unstained and Prussian blue stained frozen and plastic embedded sections, as well as by electron microscopy, where iron oxide can be recognized by its form. Related problems were investigated through histochemical demonstration of acid phosphatase activity in pulmonary lysosomes and Prussian blue staining of various tissues after administration of iron compounds by gastrointestinal and vascular routes. The iron particles settle extensively but not uniformly on pulmonary alveolar surfaces. Clearance is centripetal and involves two mechanisms, an extracellular mechanism fed by fluid currents sweeping across the surfcace, and cellular mechanism principally involving alveolar macrophages. In the early post exposure period both actively remove deposited particles predominantly through the pulmonary airways. By 24 hours uncleared residues have become ingested and clearance thereafter results mainly from cellular action. Macrophages enter bronchial passages where they sometimes continue to pursue normal activities. A chronic phase of clearance begins when deposited particles become sequestered in macrophages of pulmonary connective tissues. These cells are reached by several routes, not least by crossing the bronchial epithelium. Particle clearance from these macrophages is very slow, and residue-containg cells eventually congregate in lymphoid tissues surrounding major bronchi. These findings are discussed as they help to develop an overall picture of clearance from the lungs and as they bear on related topics, such as functional roles of alveolar and pulmonary connective tissue macrophages and the pathogenesis of chronic bronchial disease.


The wall structure of the arteries in the corpora cavernosa penis of rabbits; light and electron microscopy. Wall structures of the arteries in the corpora cavernosa penis were observed in rabbits. The deep (central) arteries in the proximal part of the penis have five or more independent ridges of the wall which are formed by the internal layer of the media consisting of almost longitudinal muscle cell layers. Electron microscopy of these regions revealed that the endothelial cells are connected to each other by many maculae and zonulae adherentes, and that smooth muscle cells of the media are separated from one another by a wide intercellular space embedding abundant collagenous fibers. The epithelioid cells constituting the media of the helicine branches of the deep artery vary in their fine structure from close resemblance to muscle cells, to cells with easily identified special features. Frankly epithelioid cells have few scattered cytoplasmic filaments of a single type, 60-90A in diameter, abundant ribosomes, active Golgi, and other features different from the typical smooth muscle cells. There is no suggestion that these epithelioid cells are either degenerative or undifferentiated forms of smooth muscle cells, as postulated by light microscopists. Transitions from muscle to epithelioid cells are consistent with, but not proved by, our data.


The postanatal development of high-endothelial venules in lymph nodes of mice. The postnatal development of high-endothelial venules (HE-venules) in popliteal lymph nodes of normal and athymic mice was studied by light and electron microscopy. In the normal mice, undifferentiated postcapillary HEvenules are already present at birth. During the first four days after birth, ribosomes and mitochondria in the endothelial cells of the venules become more numerous, and the endoplasmic reticulum and in particular the Golgi complexes enlarge. At day four lymphocyte diapedesis through the venules becomes apparent. From the tenth day the HEvenules are structurally mature. However, diapedesis activity still increases till about a month postnatally. In mice with congenital aplasia of the thymus (nude mice) and in neonatally thymectomized mice the development of the HEvenules is similar to that in normal mice. In the athymic mice both lymphocytes and granulocytes migrate through the walls of the HEvenules. However, the blood level of lymphocytes in these mice is far below the value in normal mice. It is concluded that the development of the HEvenules during the first month of life is independent of the blood level of lymphocytes.


Spatial distribution of rat fungiform papillae. The objective of this study was to determine the spatial distribution of fungiform papillae on the rat's tongue. Since each fungiform papilla in the rat has a single taste bud, the  spatial distribution of fungiform papillae is equivalent to the location of taste buds on the anterior tongue. A mean total number of 187 fungiform papillae per tongue were found which were about equally divided between the two lateral halves of the tongue. Over 50% of the total number of fungiform papillae were located on the tongue tip for an average density of 3.4 papillae/mm2,while the dorsal surface of the tongue had an average density of 1.3 papillae/mm2 of tongue surface. Papillae were absent on the dorsal midline, but a paracentral line of papillae running from anterior to posterior was a consistent finding. Though not identical, the distribution of papillae was essentially the same on different tongues. The functional significance of the papilla distribution is not understood, but electrophysiological experiments show evidence of neural interaction of papillae which are clustered together. The distribution of papillae and the distribution of nerve fibers which innervate them must be evaluated together in order to appreciate the significance of the distribution of fungiform papillae and their associated taste buds.


Prognostic and therapeutic considerations in pure hypertension vs hypertension and superimposed arteriosclerosis. In summary, a prognostic and therapeutic evaluation of 227 patients first seen from 1967 to the end of 1969 with a follow-up of 4-7 years was made. The results are indeed depressing. In spite of close follow-up and systematic treatment with modern antihypertensive agents, the mortality of patients having hypertension with superimposed arteriosclerosis was 27% (15 to 56) for males as contrasted to 3% (2 of 75) for females. Since the last casual blood pressure in both living and deceased patients of the mixed group were similar, the level of blood pressure following treatment could not be incriminated for the deceased patients. An exaggerated systolic and pulse pressure cold pressor response emerged as an important indicator of presence of arteriosclerosis alone. When hypertension and arteriosclerosis coexisted there was also exaggeration in diastolic cold pressor response. A further exaggeration in systolic and diastolic cold pressor response was seen in the decreased as compared to living male patients, a finding which appears to have grave prognostic significance for coronary heart disease and stroke. Thus a marked exaggeration in both systolic and diastolic cold pressor response in males might prove to be the single most important predictor of premature death from atherosclerotic vascular disease. A further analysis of the deceased male patients having hypertension and superimposed arteriosclerosis, indicates that treatment of hypertension may prevent oeath from stroke but not form coronary heart disease. Two-thirds of the deaths occur suddenly and only one-third of the deceased patients reached the hospital befor dying. In view of these distressing findings a plea for early detection and treatment of hypertension, prior to the development of superimposed arteriosclerotic changes, particularly in males, is made.


Possible hazard with use of fiberglass air filters. The proper use of air filtration is of established importance in the environmental treatment of nasal and pulmonary allergies. Unfortunately the use of fiberglass material in central heating and cooling systems has created a possible insult to tissues already sensitized. The alternate use of washable all metal mesh filters is highly recommended.


Atopic skin test re-evaluated. III. The wheal: flare ratio, the log-dose response curve and the bio-assay of allergen extracts. It is demonstrated that the sum of the length and width of the flare is linearly correlated with the logarithm of the sum of the length and width of the wheal; on this basis a valuable "skin-reaction index" is proposed. Furthermore, the log-dose response curve of the skin reaction, at least in the medium-sized reactions, proved to be a straight line. These methods permit a bio-assay of allergens extracts giving a maximal dispersion of 100% above and below the exact value. Coefficient of variation: 62%.


Passive immunity in transmissible gastroenteritis of swine: intramuscular injection of pregnant swine with a modified live-virus vaccine. Nine pregnant swine were intramuscularly injected with a modified live-virus transmissible gastroenteritis (TGE) vaccine at approximately 6 and 2 weeks before parturition. The TGE antibody levels in milk whey rapidly decreased within a few days after parturition, and the antibodies were mainly, if not solely, of the immunoglobulin G (IgG) class. Nursing newborn pigs were challenge exposed with virulent TGE virus when 2 to 4 days old. All pigs in 8 of the 9 litters became affected with typical signs of TGE. Of the pigs nursing vaccinated sows, 55% died, and of the 9 vaccinated sows, 8 became affected after challenge exposure of their litters. Subsequently, the antibody titers in serum and milk markedly increased in all 9 sows, with the antibody in milk being predominantly of the immunoglobulin A (IgA) class. Serum samples of prenursing newborn pigs from vaccinated sows did not contain detectable TGE antibodies. The capability of the vaccinated sows to provide only limited passive immunity to their suckling pigs was considered to be due mainly to the low titer and class (IgG) of TGE antibody existing in the milk of the sows at the time the newborn pigs were challenge exposed.


Use of the gallbladder neck in the reconstruction of the bifurcation of the main hepatic ducts. A case of successful resection of an adenocarcinoma of the junction of the right, left and common hepatic ducts is reported. The right hepatic duct was anastomosed to the gallbladder neck and the left hepatic to the common hepatic duct in order to restore the continuity of the biliary tract. This unusual technique offered effective decompression. It may prove, in selected patients with a normal gallbladder and a wide cystic duct, to be a useful alternative to other commonly performed internal drainage procedures.


Bile duct adenomatosis of the liver: a misleading finding on surgical exploration of the abdomen. A patient found to have the unusual condition of bile duct adenomatosis of the liver is discussed. The liver was "peppered" with small subcapsular nodules, which microscopically appeared as multilocular cysts, lined with cuboidal cells similar to those of normal bile ducts. This benign condition most likely is developmental in etiology, and may present early in life as polycystic liver disease, or later when discovered as an incidental finding at laparotomy or autopsy. Its differentiation from metastatic disease by the surgeon on gross examination of liver alone may not be possible.


Agenesis of the gallbladder: report of two cases. Two cases of agenesis of the gallbladder are presented. In one patient there was a remnant of cystic duct, the other had no cystic duct. A brief review of the literature is included.


Acute hemorrhagic pancreatitis in the dog. 3. The effect of antidiuretic hormone on pancreatic tissue and body fluids. Antidiuretic hormone had a marked effect on the microscopic anatomy of the pancreas and the duodenum subjected to a closed duodenal loop obstruction. In contrast to the acute hemorrhagic pancreatitis usually seen, the pancreas showed only a slight extravasation of red and white blood cells into the connective tissue spaces, some blood vessel engorgement and a slight edema. No tissue disruption of the pancreas was observed. The appearance of the closed loops were also modified by the antidiuretic hormone. These closed loops contained small amounts of fluid with little odor and the duodenal villi showed little or no necrosis. Antidiuretic hormone also reduced the amylase concentration and the fluid volume in the peritoneal cavity and in the closed duodenal loop.


A difference between the inheritance of classical juvenile-onset and maturity-onset type diabetes of young people. A difference in the inheritance of diabetes has been shown between the families of twenty-six patients with maturity-onset type diabetes of young people (MODY) and families of thirty-five patients with classical juvenile-onset diabetes (JOD). In the families of MODY: 1) twenty-two of twenty-six (85 per cent) propositi had a diabetic parent; 2) 46 per cent of families showed direct vertical transmission of diabetes through three generations; 3) of forty-seven tested siblings twenty-five (53 per cent) had latent diabetes; 4) the diabetic phenotype in the families was consistent, most affected individuals having a noninsulin requiring type of disease. These findings are compatible with autosomal dominant inheritance of MODY, although they do not exclude multifactorial inheritance. In contrast, in the families of JOD: 1) only four (11 per cent) of propositi had a diabetic parent; 2) three generation inheritance was found in only two (6 per cent) of JOD families, and 3) of seventy-four tested siblings eight (11 per cent) were diabetic. This difference provides further evidence of genetic heterogeneity in diabetes mellitus and indicates that there is a need for careful definition of the phenotype of diabetes in populations in which the genetics of diabetes is to be analyzed. Diabetes 24:44-53, January, 1975.


Immediate assessment of vascular operations using segmental plethysmography. Segmental plethysmography was used as a monitoring device during 156 direct vessel operations on the abdominal aorta and lower extremity vessels. Patency of distal vessels was assessed continuously and noninvasively before and during wound closure. A pulsatile response at wound closure was indicative of immediate and lasting patency in 94 per cent of extremities monitored. Plethysmographic detection of acute intraoperative occlusive phenomena allowed correction of such problems during the same procedure. The "chronic nonpulsatile" plethysmographic response, although not indicative of accidental occlusions in the majority of cases, portended a poor result, primarily on the basis of insufficient collateralization around pre-existing distal occlusive disease. Patients with such responses should be considered for additional efforts at revascularization. Segmental plethysmography is a reliable and objective method of immediate assessment of vascular patency and for prediction of long-term results.


Penetrating neck wounds: a review of 218 cases. A series of 218 patients with penetrating wounds of the neck is presented. The overall mortality rate was 8 per cent. One hundred seventy-five patients were explored promptly after admission; 60 per cent had structural damage present within the neck. Six of the patients without signs or symptoms to suggest injury beneath the platysma had injury demonstrated at exploration. Of 38 patients who were observed, only one developed a significant late complication. Thirty-four per cent of the patients had associated extracervical injuries; 38 per cent developed one of more complications during their hospitalization. Negative neck explorations were not associated with an increase in morbidity or prolonged hospital stay. In our hospital, early exploration of all wounds that penetrate the platysma appears to be the best approach for management of penetrating neck wounds.