Serum gastrin response to food stimulation and gastric acid secretion in male patients with duodenal ulcer. A test meal was given to 9 male controls and 9 male patients with duodenal ulcer. The serum gastrin concentrations were determined by radioimmunoassay, and gastric secretion of acid was determined before and after stimulation with 6 mug pentagastrin per kg body weight given subcutaneously. The pattern of gastrin response was found to be biphasic, with an early maximum of the first peak in the patients versus a monophasic response with a maximum in the second hour in the controls. Fasting serum gastrin levels were positively correlated to the basal acid outputs (BAO) in the patients but not in the controls. The mean quotient BAO/Fasting serum gastrin concentration was highest in the patient group, but the quotient of "maximal" acid output (MAO)-BAO/"integrated gastrin response" was equal in the two groups.


Gastroscopy with directed biopsy and routine x-ray examination in the diagnosis of malignancies of the stomach. A retrospective study. The examinations were performed in 418 patients with malignancy or an ulcer of the stomach. In all cases the Cancer Registry of Norway was asked for the final diagnosis and date of death. The diagnosis of malignancy was based on histology on operated or autopsy specimens, and the surviving cases were re-examined by answering a questionnaire. At the time of the primary examination a total of 103 cases of malignancies were found, of whom 41 were women. 84 patients had not been operated on previously. Among these 7 cases of early carcinoma were found. In 19 patients a partial gastrectomy had been performed. A false diagnosis of benign lesion was given on biopsy in 2 per cent, by gastroscopy in 8, and by X-ray examination in 31 per cent. A definite diagnosis of malignancy was made correctly by the same procedures in 95, 53 and 16 per cent, respectively. After 30 months of observation 16 cases of malignant lesions were reported among the patients (315) who had an ulcer of the stomach with benign histology on directed biopsy at the primary examination. A false benign diagnosis had been made in 33 per cent of 119 with malignancy by X-ray examination, in 10 per cent by gastroscopy, and in 15 per cent by histology on biopsy. The corresponding percentages in the total material of cases with benign and malignant lesions were 10.2, 2.9, and 4.3, respectively. In cases with previous partial gastrectomy, and in those with early cancers much higher rates of false negative diagnosis of malignancy has so far been suggested in 12 per cent of cases with benign ulcers, a gastroscopical diagnosis has been suggested in 22 per cent, and a bioptical in none. A combination of diagnostic procedures provided a correct diagnosis of malignancy in 118 out of 119 patients.


The combined effect of pentagastrin and magnesium on gastric acid secretion in man. The mechanism by which magnesium acts on gastric acid secretion is obscure. It has been demonstrated that magnesium inhibits basal as well as hypercalcemic-induced acid secretion. It has furthermore been shown that magnesium does not interfere with gastrin release. It is not, however, known if magnesium acts as an antagonist to gastrin. To elucidate this the combined effect of pentagastrin (0.5 mug/kg-hr) and magnesium sulphate (0.4 meq Mg++/kg-hr) was studied in 10 healthy subjects. The secretory plateau obtained during pentagastrin infusion was unchanged during the combined infusion of pentagastrin and magnesium. This applies to volume secretion, acidity as well as acid output.


A modified fecal excretion test for assaying intestinal absorption of 3H-folic acid. A method for determination of the intestinal absorption of folic acid is described. It is based on the principle of double tracer technique in assay of fecal samples using gas proportional counting for 3H determinations. As the procedure is simple, reliable, and inexpensive, it is considered to be of value for laboratories without advanced equipment for radiochemical assay.


The small intestinal disaccharidase activity in ulcerative colitis. In 12 patients suffering from ulcerative colitis the small-intestinal disaccharidase activity has been determined during an acute exacerbation of the disease as well as after remission. The lactase activity was significantly lower during the acute stage. No case of transitoric lactose malabsorption was found.


Survival of patients with untreated liver metastases from colorectal cancer. In 105 patients with colorectal cancer, liver metastases were found at extirpation of the primary tumor. The spontaneous survival was a median of 10 months. The intraoperative clinical diagnosis of liver metastases was subsequently confirmed by autopsy in 77 patients, was uncertain in 26, and was proved wrong in two at subsequent celiotomy. The accumulative experience shows that the median survivals range from 6 to 12 months, which is considerably better than in unselected series of liver metastases.


[Single-needle hemodialysis].

[Single-needle hemodialysis]. In 10 patients on chronic dialysis a new hemodialysis technique, in which the extracorporeal and patient circulations are connected by controlled bloodflow reversal using a single cannula, has been compared with the conventional two-needle method. For two control periods (two-needle dialysis) and an intermediate test period (one-needle dialysis) involving 12 hemodialyses in each case, clinical, biochemical and hematolgic values and extracorporeal hemodynamic findings were studied. During the one-needle dialysis period the incidence of dialyzer membrane ruptures or muscular cramps, body weight, blood pressure, neurologic status, serum electrolytes and uric acid, and hemolysis rates, remained unchanged. There was however a diminution of dialysis effectiveness due to a significant bloodflow reduction of 26 percent (p less than 0.001) and extracorporeal blood recirculation of 6-54 percent. Correspondingly, there was a slight rise in the pre- and post-dialysis values for serum creatinine and urea nitrogen (p less than 0.0125). The observed reduction in effectiveness with one-needle dialysis can presumably be compensated by the use of systems with low recirculation and a correspondingly longer dialysis time. If these conditions are fulfilled, one-needle dialysis is a technically acceptable procedure which is comparatively easy to carry out and involves markedly less discomfort for the patient than the conventional two-needle method.


[Factors of arterial and renal complications in diabetes]. In a population of 744 diabetics composed mainly of elderly female patients, 172 developed hypertension after the onset of diabetes. Compared to normotensive diabetics, they had an increased prevalence of diabetic retinopathy (p less than 0.001), cerebral accidents, ischemic disorders of the lower limbs and a decreased glomerular filtration rate (p less than 0.05); they are frequently insulin-dependent and difficult to manage. In 173 other indivuals the diabetes emerged several years after the hypertension. This group was characterized by relatively easily controlled blood sugar and increased prevalence of angina and myocardial infarction (p less than 0.001). The association of hypercholesteremia with hypertension increases the risk of coronary disease (p less than 0.02) and, to a lesser degree, of glomerular insufficiency. The prevalence of coronary symptoms increases with obesity (p less than 0.05) while retinopathy increases with insulin dependence (p less than 0.001). From this information it may be concluded that the importance of various risk factors in the diabetic chiefly varies according to the vascular territory involved: cerebral vascular accidents occur mainly in hypertensives, while the presence of retinopathies, proteinuria and peripheral ischemia is directly related to the diabetes and particularly to insulin dependence. The risk of coronary lesions increases considerably when hypertension is added to the diabetes, with an even greater risk in the case of a diabetic, hypertensive, hypercholesterolemic nexus.


[Detection of thyreogenic osteopathy with the aid of the modern photon absorption technic]. 163 male and female patients with confirmed metabolic status of the thyroid have been investigated with the aid of the 125-J photon absorption technique ("Bone Analyzer"). In the normothyroid group pathologically low values were found in 14.6 percent of cases. Findings which fell below a standard deviation of the normal range were regarded as pathologic. In 42 male and female patients with confirmed thyroid hyperfunction and decompensated autonomous adenomas, mineral content measurements in the radius revealed pathological values in 28.5 percent.


[Abnormal absence of displacement of the cerebral median line]. The angiographic cerebral midline is described. It is pointed out that the midline may be abnormally undisplaced despite the presence of a unilateral or bilateral expansive lesion. The causes of such abnormal non-displacement of the midline are reviewed in the light of examples, and the importance is stressed of bilateral carotid angiograms, sometimes with oblique series, in the case of head injuries and certain tumors.


[Pulmonary echinococcus cysticus].

[Pulmonary echinococcus cysticus]. A 23-year-old Spanish male presenting with hemoptysis, fever and radiologic signs of lung tumor was found to have hydatid disease of the lung with rupture into the bronchial system. Diagnosis was possible only by demonstration of scoleces in the sputum. The cyst was totally enucleated by surgery. The epidemiology, diagnosis and treatment of this quite rare disease are briefly reviewed with special reference to immunology, radiology and cytology.


[The radiofibrinogen test in differential diagnosis of fresh deep venous thrombosis]. The radio-fibrinogen test is a simple and sensitive method for diagnosing deep vein thrombosis. Intravenously administered radioactive labelled fibrinogen is incorporated as radioactive fibrin in freshly developing thrombi, and such labelled thrombi may be detected on the body surface with nuclear medical equipment. Homologous iodine 125 labelled fibrinogen is chiefly used since it is known not to transmit viral hepatitis. The weak gamma emittor 125-I allows the use of a portable scintillation detector rate meter with an easily moved measuring device. This bedside method does not involve discomfort for the patient. The correlation between ascending phlebography and the radioactive fibrinogen test is more than 90 percent. The radiofibrinogen test may be used to study thromboembolic diseases, to evaluate drugs for prevention of thromboembolic complications and to confirm clinically suspected fresh deep vein thrombi. Details of the method as used in several thousand measurements are given.


[Renal venous thrombosis in the adult].

[Renal venous thrombosis in the adult]. Eleven cases of renal vein thrombosis (RVT) are reported, 9 of which presented with nephrotic syndrome (NS) and 2 with acute renal failure (ARF). Hematuria, enlarged kidneys, assymetric peripheral edema and collateral vein dilatations were the classic symptoms. Phlebography was employed in 101 suspected cases and permitted definitive diagnosis in 11 percent. Phlebography was performed in 13 percent of the NS cases and 11 percent of the ARF cases, but in none of the other cases. Fifteen kidney biopsies (KB) were performed in 8 patients, 6 with NS and 2 with ARF. In the 6 cases of NS, 4 presented a pattern of membranous glomerulonephritis and 2 had mild thickening of the basement membrane. This was confirmed by electromicroscopy in 5. In the 2 with ARF capillary dilatations, polynuclear infiltrates and interstitial edema was found. Repetitive KB, performed in 3 cases, revealed the same histological pattern in 2, while in the other case granular membranous deposits were found on the second biopsy that were not apparent in the first. This last patient was free from clinical manifestations at the time of this last biopsy. Immunofluorescent studies (iF) were performed on 7 KB of 5 patients, 4 with NS and 1 with ARF. Three of the 4 with NS presented a pattern of membranous deposits. On i.F one patient was found to have IgG and C3 deposits, one IgG and fibrinogen and one no detectable IgG, IgA, IgM, IgE, C3 or fibrinogen. The fourth with minimal histological changes was also negative for i.F, as was the case of ARF. Sequential treatment by heparin and antivitamin K was administered in 8 patients. Recovery occurred in 3 and stabilization in 4, while in 1 case this treatment was without effect.


[Renal insufficiency in tuberous sclerosis (Bourneville disease)]. A case of tuberous sclerosis in a 29-year-old female is reported. Over a period of 7 years renal failure had developed, with recurrent renal bleeding. The patient had therefore to be nephrectomized and is awaiting kidney transplant. The involvement of other organs and the longterm course of the disease are discussed in the light of the literature. The question whether kidney transplantation should be performed is considered.


[Conjugation of chenodeoxycholic acid and cholic acid during passage through liver]. Both chenodeoxycholic acid, in the dosage administered for dissolution of gallstones, and cholic acid are completely conjugated during one passage through the liver. The glycine:taurine ratio increases with the cumulative amount of exogenous bile acids secreted, which suggests consumption of available taurine. Since conjugation with glycine compensates for deficiency of the taurine conjugating system, it can be assumed that in the normal liver and with doses not exceeding 2.5 mmoles, chenodeoxycholic acid is efficiently and completely transformed into its "physiologic" conjugated form.


[Physiological proteinuria. Data of acrylamide-SDS gel electrophoresis and other methods of qualitative and quantitative analysis]. Since detection of the first stage of nephropathies requires an exact definition of physiological proteinuria, this has been sought in 97 healthy individuals. Measured by a modification of the biuret reaction, physiological proteinuria did not exceed 100 mug/min in the recumbent position (average of 24.5 mug/min) and 150 mg/24 h (average of 51 mg/24 h). No significant differences were seen with respect to age or sex. Qualitative analysis of urinary proteins was done by cellulose acetate electrophoresis, immunoelectrophoresis and polyacrylamide-SDS electrophoresis. This latter method has the great advantage of classifying the proteins according to their molecular weight, wtihout electrostatic interference. Its graphic representation delineates a normal zone allowing an objective distinction between physiological and pathological proteinurias. In the majority of cases, the proportion of albumin is between 25 and 55%. The orthostatic position increases proteinuria (average of 41 mug/min) with a tendency to a distribution which erroneously suggests a glomerulopathy. Accordingly, investigation for small changes in proteinuria should always be carried out on urine formed in the recumbent position.


[The Hollander test: an unsuitable method aimed at judging success following selective proximal vagotomy]. In a prospective, randomized study, proximal selective vagotomy with or without pyloroplasty was used as the exclusive procedure for elective treatment of duodenal ulcer without pyloric stenosis in man. Three months postoperatively 32 out of the first 35 patients exhibited incomplete vagotomy assessed by the 2-deoxy-D-glucose test. This incomplete vagal denervation of the parietal cell mass is due mainly to the principle of proximal selective vagotomy. In order to maintain the motility of the gastric antrum the denervation should be halted at a distance of 7 cm from the pylorus.


[Study of endemic nephropathies].

[Study of endemic nephropathies]. Clinical and microscopic investigations in the kidneys of patients with endemic nephropathy have revealed alterations in the epithelial cells of glomeruli and in the epthelium of nephron segments, and thickening of the basal membranes. These changes have been studied from the viewpoint of distrubances in filtration and reabsorption, and indicate that the primary alterations occur in the glomeruli, i.e. the nephrons, of the patients observed.


[Psychodiagnostic factors of indication for abortion]. The psychodiagnostic indication for abortion was investigated by means of the MMPI in 251 women with unwanted pregnancy. The results showed: 1. that, independently of the MMPI, positive indications exhibited more obvious psychopathological distrubance than the negative indications; 2. that women with negative indications where in some ways psychologically different from women with wanted pregnancy; 3. that after abortion women with positive indication no longer differed from a group of women with wanted pregnancy, so that the former could be identified as psychologically well adjusted; and 4. comparison between women with unwanted pregnancy and a group of neurotic women showed that both groups are phenomenologically very similar although women with unwanted pregnancy should be diagnosed as "reactive". The results are presented without comment as a basis for the medical and political debate now in progress.


[Mode of action and indication for appetite depressants in the treatment of obesity]. After a brief introductory discussion of methods generally used in the treatment of overweight (dieting; fasting; behavioral therapy; physical activity), the pharmacology of anorexigenic drugs and the considerations governing their clinical use and indications are discussed. All currently available anorexigens exert their action through nor-adrenergic stimulation at receptor sites located in the hypothalamus (amphetamine and ephedrine derivatives) or in the limbic system (Mazindol). In view of the CNS-stimulatory effect of these agents, drug addiction must be considered a potential hazard of their prolonged use. Since any drug treatment of obesity interferes with the patient's motivation to subject himself to the prolonged and possibly life-long changes in his eating habits and exertional behavior which are mandatory for the achievement of long-term therapeutic success, the use of drugs is rarely indicated in the treatment of obesity and should remain the exception. In view of their additional potential to induce drug addiction, this is particularly true of appetite suppressants.


[Osteoporosis and osteomalacia].

[Osteoporosis and osteomalacia]. The pathogenesis, clinical course and treatment of senile-postmenopausal osteoporosis are reviewed. It is likely that several factors, including genetic and racial determinants as well as nutritional calcium and/or vitamin D deficiency in the elderly play a pathogenic role. Available data are consistent with the possibility that the primary alteration of bone metabolism in senile-postmenopausal osteoporosis may be a decrease in de-novo bone formation below the level necessary to compensate for age-related bone loss. The second part of the study deals with the osteomalacia syndrome. The most common known causes of osteomalacia are vitamin D deficiency, especially secondary to malabsorption, and a defective vitamin D metabolism associated with chronic renal insufficiency or prolonged anticonvulsant therapy. The hypophosphatemic forms of osteomalacia may be induced by renal tubular dysfunction or by phosphate deficiency of other origin; in these disorders a pathogenic role of altered vitamin D metabolism has not yet been established.


[The diagnosis of hyperparathyroidism and hypoparathyroidism]. Some recent pathophysiologic, diagnostic and therapeutic aspects of hyper- and hypoparathyroidism are reviewed. Three clinical forms of hyperparathyroidism can be distinguished: one with symptoms essentially affecting the skeleton, a second with renal symptoms and a third with scant and sometimes atypical symptoms. The most reliable laboratory criteria for diagnosis of hyperparathyroidism are serum levels of calcium and immunoreactive parathormone. Some authors believe that with a combination of these two parameters a diagnosis is possible in almost all cases. Other determinations such as serum phosphorus and 24-h urinary calcium, and most special tests, are less reliable. A new method for preoperative localization of adenoma, involving catheterization of the thyroid veins, should make future operative procedures easier. With regard to pseudohypoparathyroidism, recent work has contributed to a greater understanding of the pathophysiologic mechanism. On the basis of normal or elevated parathormone in these cases and in other investigations, Albright's hypothesis, which assumes resistance of the renal tubules to parathormone is considered to be proven. Hypoparathyroidism is usually fairly easy to treat with vitamin D or AT 10 and calcium supplements, provided that frequent and careful checks on serum calcium levels are made.


[Indications for and effectiveness of retrograde cholangiopancreatography]. The practical value of endoscopic retrograde cholangiopancreatography (ERCP) has been evaluated on the basis of experience in 159 own examinations. The cannulation rate as an important index of the success rate rose with experience, and was 85 percent in the last 110 cases. Diagnostic information was however obtained only in 65 percent, as it was not always possible to cannulate the appropriate ductule system and differentiation between chronic inflammatory and neoplastic pancreatic disease was often difficult. The greatest reliability was found in bilary duct disease, though the difference as compared with pancreatic disease was not significant. With strict limitation of the indication and a few important precautions (avoiding parenchymography of the pancreas and prompt surgical drainage of an obstructed biliary duct or pancreatic pseudocysts) no severe complications were observed throughout this series. The morbidity was thus limited to 4 cases of pancreatitis of moderate severity. In spite of the limitations of ERCP in differentiating malignant from chronic inflammatory pancreatic disease, the method was valuable for establishing the indication for, and planning, surgery. Furthermore, the diagnostic reliability was improved by combining ERCP with selective pancreatic angiography.


[Incidence of thalassemia in Switzerland]. A total of 2672 cases with thalassemia syndromes observed in the period from 1 January 1968 to 30 April 1974 are classified according to type of thalassemia and the patient's country of origin. During the past 15 years some 10 patients annually with classical heterozygous beta-thalassaemia have been found to be of purely Swiss origin. Due to increased immigration from Mediterranean countries the Swiss patients represent only 2.6 percent of all cases at the present time, a marked decrease from the earlier 30 percent. Since 1968 2260 cases of thalassemia syndrome have been found in Italian patients. Smaller groups of patients originate from Greece, Spain and Turkey. Homozygous beta-thalassemia was observed in 56 cases. Ranking third among thalassemia syndromes is the Hb Lepore trait found in 16 cases. The increase in thalassemia syndromes due to population migration over the past 10 years has resulted in the finding of rare types in Switzerland: 8 patients with HbS-beta-thalassemia, 2 with HbC-beta-thalassemia, 3 cases of HbH-alpha-thalassemia and 2 cases of Hb Bart's-alpha-thalassemia are reported. The difficulty of diagnosing deltabeta-thalassemia and alpha-thalassemia is emphasized.


[Contraction disorders of the left ventricle in ischemic heart disease. Studies using atrial stimulation]. Sixty-one patients with suspected ischemic heart disease (IHD) have been investigated by atrial stimulation (AST). Group A patients had normal coronarograms and served as controls. Group B patients had pathological conronarograms (at least 50% stenosis in one of the 3 vessels) and normal ventriculograms. Group C patients had pathological coronarograms and ventricular aneurysms. During AST, group C patients exhibited lower dp/dt max and dp/dt min as well as higher left ventricular end-diastolic pressure (LVEDP) and/or mean pulmonary artery pressure (MPAP) than groups A and B. Group B differed from group A only by increased MPAP during AST. When compared to controls, contractility in group C was reduced even at rest. AST offers an excellent means of diagnosing IHD if heart rates of 140/min and above are used. An abnormal increase in MPAP serves as the simplest parameter for IHD. Elevated MPAP at rest prompts suspicion of ventricular aneurysm. It is possible to deduce a quanitative estimate of contracitility by correlating dp/dt max to LVEDP. A hyperbolic relation results.


[Abnormal movements induced by L-dopa. New therapeutic possibilities]. One of the major difficulties in the treatment of Parkinson's disease with L-Dopa alone or associated with a decarboxylase inhibitor lies in the frequent occurrence of involuntary movements. In some cases these movements can be prevented (eliminated) by increasing the plasma DCI concentration or by associating 3-oxy-methyl-dopa. In resistant cases the authors have conducted a trial with EP 19-088, which belongs to a new class of tricyclic derivatives of indenopyridine. The trial population comprised 42 patients. In 12 of these there was complete cessation of symptoms. In 9 patients a marked improvement was noted, while in 10 others the improvement was slight but definite. The treatment was discontinued in 2 cases due to episodes of increased confusion. In the other 9 patients the experimental treatment had no effect. No side effects were observed in 24 of the 42 patients tested. In addition to symptoms such as nausea or transient heartburn, the remaining patients reported either a slight worsening of their parkinsonian symptoms or an increase in diurnal fatigability.


[The problem of masked depression].

[The problem of masked depression]. The term "masked depression" appears to be increasingly used as a diagnostic label, but underlying the label are a multitude of problems. Questions of definition, diagnosis, nosologic classification and differential diagnosis are discussed in detail.


[Incidence of extra-arachnoid discharge following lumbar puncture]. Dimer-X is considered a good contrast medium for lumbar myelography. Its physical properties guarantee a homogeneous mixture with cerebrospinal fluid, with the result that postpunctural fluid leakage is easy to detect. One hundred Dimer-X lumbar myelographies were performed with two different spinal needles, a short beveled needle of 1.2 mm outer diameter and a special beveled "Quincke" needle of 0.7 mm outer diameter. Postpunctural fluid leakage is observed in 32% of the cases with the former and in only 12% with the latter. False-route injections occurred in 5% of the cases. Epidural leakage is the most frequent and can be detected by its "Christmas tree" appearance on antero-posterior X-ray. Subdural leakage is represented by a "railroad track" appearance on a lateral view. The leakage is observed more frequently in patients with normal myelogram (28%) than in patients with a herniated lumbar disc (18%).


[New aspects of tuberculosis therapy].

[New aspects of tuberculosis therapy]. The introduction of ethambutol and rifampicin has modified the therapy of tuberculosis. Therapy in hospitals or sanatoria can be shortened, and intermittent regimens (once or twice weekly under supervision) are possible. Better knowledge of the side effects of particular drugs, particularly rifampicin, (such as allergic reactions in intermittent administration and reduced effect of oral contraceptives) has been gained. Instead of mere supervision, preventive chemotherapy is given in many cases such as in recently discovered fibrotic lesions and in high risk cases (silicosis, treatment with corticosteroids and immunosuppressive agents)minadequate treatment may lead to functional impairment such as fibrosis and cor pulmonale. These aspects are discussed and the resultant guidelines for the treatment of tuberculosis are presented.


[Antiinfectious chemotherapy in pregnancy]. Antibiotic therapy during pregnancy is generally given to treat infectious diseases of the mother rather than of the fetus. Despite her altered physiology the pregnant woman poses few specific pharmacokinetic problems. The main concern is possible damage to the fetus, depending on its developmental stage at the time of administering the drug. Largely on an empirical basis, antibiotics which can be administered without hazard throughout pregnancy are distinguished from those which should be completely avoided during pregnancy and from others which must be omitted during certain phases of pregnancy. Similar considerations apply in the case of drugs used for the treatment of tuberculosis and mycoses.


[Chemotherapy treatment of infectious diseases in infancy and early childhood]. Some specific pediatric aspects of therapy with antibiotics and other chemotherapeutic agents (dosage based on age, body weight and body surface area) are discussed. In early infancy problems such as the "immaturity" of enzyme systems and excretion mechanisms must be considered. Tetracycline staining is discussed as an example of age-dependent vulnerability of organs. A selection of antibiotics suitable for use in ambulatory pediatrics is proposed.


[Antiinfectious chemotherapy in renal insufficiency]. In patients with renal failure the administration of antiinfectious chemotherapeutic agents (antibiotics) raises two main problems. Antibiotics which are effective only by virtue of their high urinary concentration may lose their effect with reduced renal function (plasma creatinine above 1.5-1.7 mg%). This is true of nitrofurantoin, nalidixic acid, colistin and, to a lesser extent, sulfonamides. Decreased renal elimination of antibiotics may ultimately lead to accumulation and toxic side effects, and the dose of a given antibiotic should therefore be adapted to renal function. Simple dose-adaptation rules are proposed on the basis of plasma creatinine concentration as an index of renal function, a table listing the elimination constants of several antibiotics, and a nomogram which serves to determine graphically the appropriate global elimination constant for the individual patient and a given antibiotic.


[Selection of drugs in chemotherapy].

[Selection of drugs in chemotherapy]. An attempt has been made to classify the wide range of available antimicrobial chemotherapeutic agents from the practical viewpoint. A group of drugs with selective indications and a series of alternative chemotherapeutic agents are distinguished from chemotherapeutic agents for everyday medical routine (penicillin G and analogs, ampicillin, tetracyclines, sulfonamides). The indications for the main drugs and some practical guidelines for chemotherapy are summarized. The excessive commercial supply of ampicillin derivatives and cephalosporins comes in for special comment. It is emphasized that some valuable antibiotics (cephalosporins, carbenicillin, gentamycin, kanamycin) should be kept in reserve.


[Antibiotic combination therapy and chemotherapeutic prophylaxis]. Despite the large number of available chemotherapeutic agents and antibiotics, monotherapy is not always possible. The practical indications for antibiotic combinations are discussed and the controversial topic of chemotherapeutic prophylaxis in different clinical situations is raised.


Septicaemia.

Septicaemia. Septicaemia still presents a major diagnostic and therapeutic challenge to the clinician. Most cases are hospital-acquiredand the reasons for their increasing prevalence are discussed, with reference to predisposing factors and opportunistic infections. The pathology and bacteriology of proven cases (positive blood cultures) in 1974 in a modern children's and maternity hospital complex are presented. Gram-positive and Gram-negative varieties are compared and the molecular biology and mechansims of endo- and exotoxaemia described. Successful therapy demands correct choice of antibiotic and the development of shock requires skilled supportive measures. For the former a rational scheme is outlined and a plea is made for collection of data for this purpose. Polypharmacy is deprecated and either an aminoglycoside or a cephalosporin forms the mainstay of therapy. The emergence of Bacteroids sp. in cases of abdominal and puerperal sepsis necessitates addition of a lincomycin or metronidazole. Superinfection with systemic candidiasis requires 5-fluorocytosine.


Uniflagellate spermatozoa in Nemertoderma (Turbellaria) and their phylogenetic significance. An ultrastructural study of Nemertoderma (Turbellaria, Nemertodermatida) has revealed that its spermatozoa have only a single falgellum. This is the first uniflagellate spermatozoon known in the Turbellaria; it is indicative of the primitiveness of Nemertoderma and is evidence in support of the view that the Turbellaria as a whole are among the most primitive living Bilateria.


Polyzonimine: A novel terpenoid insect repellent produced by a milliped. A nitrogen-containing terpene 6,6-dimethyl-2-azaspiro[4.4]non-1-ene (polyzonimine) was isolated from the defensive secretion of the milliped Polyzonium rosalbum. Polyzonimine, which is repellent to such natural enemies of the milliped as ants, acts as a topical irritant to insects (10-4 M induces scratching in cockroaches). Its structure was confirmed by a five-step synthesis starting from 2,2-dimethyl-7-oxabicyclo[4.1.0]heptane.


Lung cancer induced in hamsters by low doses of alpha radiation from polonium-210. Lung cancers have been induced in 9 to 53 percent of hamsters given multiple intratracheal instillations of polonium-210 in amounts yielding lifetime exposures of 15 to 300 rads to the lungs.  Cigarette smokers have previously been estimated to receive 20 rads to areas of the bronchial epithelium from deposited polonium-210.  This finding thus supports the hypothesis that alpha radiation resulting from the polonium-210 or lead-210 present in cigarette smoke may be a significant causative factor in human lung cancer.


Mechanism of insulin-induced paralysis of muscles from potassium-depleted rats. Zinc-free insulin elicited a reduction in the potassium conductance of muscle fibers from potassium-depleted muscle, which led to depolarization, blockage of action-poteintial mechanism, and paralysis.  These changes are proposed as the mechanism of insulin-induced paralysis in patients with hypokalemic periodic paralysis.  A similar effect by concanavalin a suggests that the effect may be mediated through the insulin receptors.


Gouty arthritis in the black race.

Gouty arthritis in the black race. This review of 65 black-black patients with gout, in contrast to tan or tinted, is presented to emphasize the universal nature of the disease, irrespective of race or geographic region. One case of a female who delivered a living child 4 yr after her initial attack of gout is reported. No case of gout secondary to chronic renal disease, or to a blood dyscrasia, including sickle cell disease, was discovered. Except for the race, aberrant sex distribution and low incidence of urate stones, this series is not unlike a series of white gout patients.


Orthopedic infections: A prospective study of 378 clean procedures. Six hundred twenty orthopedic surgery patients were evaluated in a prospective study of postoperative infection. The wound infection rate among the 378 elective clean procedures was 5.8 per cent (3.2 per cent major plus 2.6 per cent minor infections). Staphylococcus aureus was the single most common pathogen recovered in both major and minor infections. Gram-negative rods predominated in major infections, but were rarely found in minor infections. In the clean procedure group, infection rates increased with age and duration of operation. Preoperative consideration should be given to all A "profile sheet" or checklist of several such factors is presented for this purpose.


Single image pericardial effusion evaluation with technetium compounds. Three cases of suspected pericardial effusion were evaluated with rapid, noninvasive procedure, combined use of macroaggregated albumin technetium 99m and human serum albumin technetium 99m to produce a single radiography showing the heart, liver, and lung perfusion simultaneously. This technic confirmed the diagnosis of pericardial effusion in two cases and ruled out this possibility in the third case.


An educational strategy for teaching psychosocial pediatrics. The functions and operation of two outpatient clinics, the Pediatric Family Clinic and the Child Psychiatric Consultative Service, are described to illustrate an approach to teaching residents and medical students how to diagnose and deal with the psychosocial problems frequently encountered in children. Learning experiences in this busy ambulatory setting are pediatric and family practice.


Cardiorespiratory changes associated with intracranial pressure waves: Evaluation of these changes in 27 patients with head injuries. Alteration in heart rate and respiratory rate and depth occurred in association with intracranial pressure (ICP) waves in 27 patients with head injuries. Usually the ICP wave was preceded by a transient increase in end-alveolar CO2 levels. Thereafter, the ICP gradually increased and was accompanied by simultaneous decreases in heart rate and respiratory rate and depth. Immediately before the termination of the ICP wave, there was an abrupt increase in heart rate and respiratory rate and depth. After the ICP fell to base line level, heart rate and respiratory returned to control values. It is suggested that the transient alterations in the CO2 level at the beginning and during the ICP wave probably initiate these abnormal waves. While the heart rate changes are striking, their role in the formation and termination of ICP pressure waves is uncertain.


Sexual function after abdominoperineal resection. A survey of the sexual changes in patients having abdominoperineal resection for ulcerative colitis was made at the Medical College of Georgia. The incidence of impotence in our series is zero. Only one of our female patients had a successful pregnancy. The other women seemed to be hampered by anatomic derangements relating to strictures, adhesions, or dislocation of the uterus, although the precise causes of infertility have not been elucidated. We suggest that in young men, fear of infertility have not been elucidated. We suggest that in young men, fear of injuring sexuality should not impede selection of appropriate surgical modality. However, we also suggest that the woman's risk of post-operative impairment of sexual function is greater than the man's.


Prestenotic enteritis and enterocolitis in children: Description of a syndrome and review of five cases. A clinical syndrome of prestenotic enteritis and enterocolitis consisting of abdominal distention and pain, intermittent diarrhea and constipation, failure to thrive, fever and in some patients, extreme prostration and death is described. The pathogenesis of this enteritis and enterocolitis apparently is related to partial mechanical obstruction of the bowel with proximal dilatation, stagnation, and capillary stasis. Acute relief from the enteritis and enterocolitis may be obtained by stomal dilatation and colonic irrigation; however, all patients in our series required surgical intervention. because mortality in this disease is significant and the results with early surgical intervention are favorable, surgical intervention is encouraged at the first sign of prestenotic enteritis or enterocolitis in children. Surgical correction of the distal stenosis produced a growth spurt in the two successfully treated patients without other growth-limiting disease.


Aggression in adolescents: Use of the Buss-Durkee Inventory. The Buss-Durkee Inventory (BDI) is a 75-item true-false design to measure hostility and aggression. Norms have been established for adult populations, and data are available for adult psychiatric populations. Adolescent norms have not been established, nor are data available for adolescent psychiatric populations. This study provides BDI data on 438 high school students, giving breakdown by age, sex, and race. In addition, BDI scores for 100 patients admitted consecutively to an adolescent inpatient unit are presented. Scores on the BDI were higher in the younger high school age groups. Female patients had higher scores than girls in the high school control group; male patients scored lower than their male controls. Female patients surprisingly scored higher than male patients.


Upper extremity arteriovenous fistulas for hemodialysis and administration of chemotherapeutic agents. The arteriovenous fistula (AVF) is the choice made of access to the circulation in patients having chronic hemodialysis. AVFs are also used in patients having repeated courses of intravenous chemotherapy. This relatively simple operation can result in considerable morbidity if improperly done. The technics used in our center, which result in a high patency rate, are described. Maneuvers designed to reduce the resistance to flow and increase the minute flow through the fistulas are stressed.


Gender identification and the female impersonator. This case study supports the plea by a number of psychiatrists for thorough psychiatric and psychologic screening of all persons seeking sexual reassignment surgery. The patient, a female impersonator taking estrogen, was seriously considering such an operation in order to cope with identity problems and an inability to achieve gratification in life. His psychiatric and psychologic evaluations indicated that his profession and desire for anatomic change were more a reflection of a borderline personality than true feminine gender identity.


Rupture fo the intestine in patients with hernia. Two cases of perforation of the small intestine associated with minor abdominal trauma and right inguinal hernia are presented along with a review of 104 cases in the literature, The condition is treacherous because this minimal injury can produce catastrophic intraabdominal perforation. The most reliable signs and symptoms are abdominal pain associated with guarding and rigidity. Laboratory data may only show leukocytosis and signs of dehydration. Early operation, using a formal laparotomy, is imperative. Systemic antibiotics are recommended.


Depression in elderly patients.

Depression in elderly patients. Depression is a common reaction to the vicissitudes of life among elderly people. Aged persons are physiologically and psychologically less able to adapt, yet they are required to change their life styles because of retirement, lowered financial resources, death of family and friends, and illness. Although many mental health professionals are reluctant to treat geropsychiatric patients, the prognosis for depressed patients can be good. Drug therapy is usually the most effective, although psychotherapy and other behavioral therapies may be used adjunctively. Electroconvulsive therapy (ECT) may be indicated for severely depressed patients. The beginning dosage of medication should be lower than for younger patients, and elderly patients must be monitored carefully for side effects. Adverse reactions due to multiple drug interactions are also possible. When aged persons become severely depressed, they are at high risk of suicide; almost all suicide attempts by elderly people are successfl. Depression in later life is treatable, and the pessimism that often surrounds the prognosis for geropsychiatric patients is unwarranted.


In-hospital mortality after acute myocardial infarction. In order to determine if the risk factors contributing to mortality from acute myocardial infarction (MI) during the period of coronary care unit (CCU) observation are different from those in patients dying in the hospital after CCU discharge, the hospital records of 172 acute MI patients seen over an 18-month period were reviewed. Of the 32 deaths from acute MI, 25 per cent occurred suddenly outside the CCU. The risk factors identified in the 32 deaths were (1) anterior MI (2) Previous MI, (3) cardiac failure, (4) significant ventricular arrhythmia, (5) intraventricular conduction defects, and (6) murmur suggestive of papillary muscle dysfunction. These same risk factors were found to be far more frequent in the patients dying suddenly outside the CCU.


Monilial esophagitis.

Monilial esophagitis. A case of monilial esophagitis, developing in a diabetic patient treated with gentamicin for Escherichia coli septicemia, is described. The esophagogram was normal and the diagnosis was confirmed by fiberoptic esophagoscopy and biopsy examination. The patient responded to oral nystatin. The literature on esophageal moniliasis is reviewed.


Immunotherapy for human malignant melanoma. The status of immunotherapy up to 1972 for malignant melanoma in man is reviewed. The immunotherapeutic approaches used are based on the demonstration that man reacts to malignant melanoma antigens with both humoral and cell-mediated immunologic responses. Immunotherapy for human melanoma includes both specific and nonspecific approaches. In the former, tumor antigen, committed antimelanoma lymphocytes, or cytotoxic antimelanoma antibody are used. In nonspecific immunotherapy, an unrelated antigen (eg, BCG or smallpox vaccine) is used to provoke an immunologic response that results in tumor destruction. Although several promising approaches and mounting testimonials suggest that immunotherapy for human melanoma is feasible, the results to date are far from being uniformly successful. Nonetheless, the results are encouraging enough to warrant mounting a immunotherapeutic approach to this dreaded form of cancer.


Renal failure associated with acetazolamide therapy for glaucoma. Presented is a case of acute renal failure induced by acetazolamide therapy for glaucoma. The 69-year-old patients recovered rapidly after oral administration of fluids and sodium bicarbonate. This sulfonamide like nephropathy should be differentiated from acetazolamide-related calcium phosphate nephrolithiasis.


A mathematical model of phytochrome - the receptor of photomorphogenetic processes in plants. A mathematical model of the phytochrome pigment system is considered, the parameters of which are determined by solving the problem of identification on the basis of the dynamic characteristics of the photoreceptor obtained experimentally. The model is based on two photochemical and four dark reactions occurring in the phytochrome system. A study of the model permitted establishing the dynamics of processes in the photoreceptor and determining the relation between the behavior of the active form of phytochrome and the intensity and spectral distribution of light. The results of the investigation allows explaining of the high-energy reaction of photomorphogenesis as a consequence of the dynamics of phytochrome processes.


The effect of analogs of juvenile hormone on the morphogenesis of the flight apparatus of the house cricket. The morphogenetic action of juvenile hormone (JH) on the development of the flight apparatus was studied on the house cricket (Acheta domestica L.). Simulation of an excess of JH, created by treatment of nymphs of the last instar with analogs of JH, led to the formation of adultoids with various degrees of expression of the imaginal characteristics in the structure of the elytrons and wings. An analysis of the state of the wings, wing base, and wing muscles in the adultoids shows that the flight apparatus develops as an integral functioning system, and not as a result of independent imagination of its individual constituents. The great importance of inversion of the wings was demonstrated: imaginal characteristics absent before inversion were expressed to one degree or another in all parts of the flight apparatus after inversions. The imaginization of the wing musculature is associated primarily with the degree of formation of the wing base, determining the degree of mobility of the wings. It was proposed that the morphogenetic action of JH and its analogs be evaluated on the basis not so much of the length of the wings as the degree of formation of the flight apparatus, which is most simply judged according to the mobility of the wings. It was proposed that the morphogenetic action of JH and its analogs be evaluated on the basis not so much of the length of the wings as the degree of formation of the flight apparatus, which is most simply judged according to the mobility of the wings and their position at rest.


Effect of retinal factors on the chick-embryo lens in vivo. The effect of water-soluble retinal factors on lens differentiation in 11-day chick embryos was studies in vivo. Retinal extract accelerated cell transfer from zone to zone, promoted lens-fiber formation, and reduced total protein in the lens. Acrylamide-gel electrophoresis detected four basic protein fractions in the lens. Retinal factors caused a fraction identified as gamma-crystallin to disappear and lowered the peak of delta-crystallin. The data obtained are evidence that retinal factors participate in the regulation of cell differentiation and protein turnover in the lens.


Methods of regeneration.

Methods of regeneration. This paper is concerned with methods of regeneration: morphallaxis, epimorphosis, and regeneration by induction. The last method was demonstrated by investigations to study the restoration of lost regenerative power of the cranial bones in adult dogs and in some other cases. During regeneration by induction an inducing agent, reactive or competent material, and the right conditions for induction must be present. It is emphasized that the method and mechanism of regeneration are one and the same thing. The methods of regeneration specified above differ not only in their formal and secondary features, but also in the essence of their fundamental processes: true reorganization, growth, and induction. Each method of regeneration can be found not only in the pure form, but also in combinations of varying degree and type. Besides regeneration, hypertrophy is also very important for the restoration of parenchymatous internal organs in mammals, but it is not identical with regenerations.


Radioautographic and cytometric analysis of myocyte growth and myocardial regeneration in rats. During postnatal histogenesis of the rat myocardium DNA synthesis and myocyte proliferation are essentially completed by the 20th-25th day of development, while growth of the muscle cells continues after the 30th day. On the first days following injury of the myocardium of newborn and four-day-old rats the index of labelled nuclei and the mitotic index decrease considerably. Later in myocardial regions adjacent to and remote from the focus of the injury the changes in both indices were identical. No such phenomena were observed in 14-day-old, 30-day-old, and adult rats. After injury in all stages of development a scar formed in the myocardium. It is concluded that regeneration (secondary morphogenesis) does not occur in the myocardium, as assumed earlier, but the process of natural development which had been disturbed by the trauma continues. In the myocardial region remote from the site of the trauma this process, especially in four-day-old rats, is of a compensatory nature. The trauma briefly stimulates myocyte proliferation of the stumps of 14-day-old rats. In the center of the focus of the injury even after the repeated injection of H3-thymidine labelled nuclei were not found in the muscle fibers. This raises doubt as to the possibility of proliferative morphogenesis of muscle fibers located in this region.


Ultrastructure of neurosecretory cells at different stages of differentiation in the preoptic nucleus of immature sterlet. Ultrastructure of neurosecretory cells of the preoptic nucleus in immature sterlet (Acipenser ruthenus L.) was studies for the first time. The dorsal zone of the preoptic nucleus houses light, dark, and pycnomorphic neurosecretory cells, which contain varying numbers of elementary secretory granules measuring 1995 plus or minus 32 A in diameter. Light cells containing numerous secretory granules with a diameter of 1707 plus or minus 27 A are predominant in the middle zone. Pycnomorphic cells are absent in this zone. The ventral zone contains only poorly differentiated cells with solitary elementary granules measuring 1100-1300 A in diameter. The neurosecretory cells also differ with respect to the number and structural characteristics of their organoids. Thus, neurosecretory cells in the preoptic nucleus are found in different morphofunctional states, a circumstance that reflects the sequence of their development in ontogenesis and different phases of the secretory cycle.


Investigation of the ultrastructure of DNA-synthesizing cells of a focus of aseptic inflammation. The ultrastructure of cells of a focus of aseptic inflammation, synthesizing DNA (incorporating H3-thymidine) was studied with the aid of a combination of methods of light autoradiography and plane-parallel embedding. It was shown that these cells have the ultrastructure specific for collagen-synthesizing cells (fibroblasts): a well-developed granular endoplasmic reticulum with a large number of polyribosomes, an extensive Golgi complex, a characteristic structure of the mitochondria, and a large number of cytoplasmic microfibers. Collagen fibers are detected on the surface of the cells.


The role of mitosis in the formation of binuclear cells with a pigmented epithelium of the retina and in the rat liver. The formation of binuclear tetraploid cells in the pigmented epithelium of the retina and the rat liver was investigated by the method of autoradiography using H3-thymidine. It was shown that binuclear cells are formed in these tissues as a result of incomplete mitosis. Only mononuclear diploid cells participate in the formation of these cells in the livers of 24-day-old animals, while in the pigmented epithelium of the retina of four-day-old animals, in addition binuclear tetraploid cells also participate. The duration of the phases of the mitotic cycle of cells of the pigmented epithelium of the rat retina and liver was determined.


Study of the specificity of the action of adhesive factors isolated from the liver and lungs of adult mice and rats. Adhesive factors (AF), enhancing the cohesion of cells in liver and lung tissues, were isolated from the liquid obtained in the incubation of pieces of liver and lung of adult mice and rats in calcium-free salt solution. The action of AF was evaluated according to their influence on the strength of cohesion of the cells in the lung and liver, measured with a micromanipulator, and according to the number of cells isolated from the liver by dispersion. The presence of tissue specificity and the absence of species specificity of the action of AF on the tissues of adult animals was demonstrated.


Some peculiarities of the expression of exterases in larvae and adult individuals of Drosophila virilis. It was discovered that certain isoenzymes of esterases in Drosophila virilis are represented by fast and slow subfractions. In various inbred lines, pecularities are observed in the distribution of activity between these subfractions, so that in adult individuals of some lines, the fast subfraction is the most active, and in others the slow subfraction. During the process of ontogenesis, a redistribution of activity between the two subfractions is observed.


Redistribution of newly synthesized RNA between nucleus and cytoplasm in sea urchin embryos. The kinetics of the release of newly synthesized RNA from the nucleus into the cytoplasm in embryos of the sea urchin Strongylocentrotus nudus was investigated. Preliminary data indicate that some of the newly synthesized RNA may return from the cytoplasm to the nucleus.


Expression of aldolase-controlling genes in hybrid fish embryos. Use of thermostability as a genetic marker. A new method based on differences in protein thermostability has been proposed for studying genetic control of protein synthesis during development. The effectiveness of this method was checked for aldolase, whose thermostability was established from the temperature required for 50% inactivation after heating for 30 min (T50%). Eggs from a relatively cryophilic species, the loach, were fertilized with sperm from warm-water aquarium fish: the danio, barb, rasbora, and goldfish. The T50% for aldolase from the hybrid embryos and fry was 1-4 degrees higher than for aldolase from the loach. The increase in T50% in the loach times danio and loach times rasbora hybrids was shown to be caused by functioning of the paternal aldolase-controlling genes, which began at the somite-formation stage and coincided with the increase in enzyme activity in the embryo. The value of T50% was increased to a greater extent and reached its maximum more rapidly in the somite tissues than in the cephalic tissues. A decrease in aldolase thermostability occurred in reciprocal danio times loach hybrids during the same developmental stages.


Variation patterns in the respiration of avian embryos. Our own data and those in the literature show that the increase in body weight and respiration rate in avian embryos is divided into three periods. Equations are given that describe the increase in weight and oxygen-consumption rate during individual periods and throughout embryogenesis. The meaning of the coefficients in the equation relating body weight to respiration rate is clarified. It is hypothesized that the analytic expression representing respiration rate as a function of embryo weight can aid in finding relationships between respiration and other parameters of the developing organism.


Use of plastome and nuclear mutants of higher plants to study the genetic control of plastid formation and function. We conducted comparative biochemical and electron-microscopic studies of several types of plastome and nuclear mutants of Antirrhinum majus and Pelargonium zonale. It was shown that specific blocking of the photosynthetic reaction occurs in plastome mutants of A. majus; Photosystem II was found to be damaged in the en:alba-1 mutant and photo-system I was affected in the en:viridis-1 mutant. The plastid mutations in these mutants caused loss of certain soluble lamellar proteins and pigment--protein complexes or a reduction in their content, which led to disappearance of photosynthetic activity. When the content of high-molecular ribosomal RNA in the leaves of normal and mutant P. zonale plants was compared, the normal plants were found to have four types of RNA: two types of cytoplasmic-ribosome RNA and two types of plastid-ribosome RNA. No plastid-ribosome RNA was detected in the mutant. These results were confirmed by electron-microscopic examination: no ribosomes were detected in the mutant plastids. Thus, use of plastome mutants made it possible to establish that the genetic information concentrated in the plastid DNA controls formation of ribosomes and lamellae in the chloroplasts and thus affects chloroplast photosynthetic function.


A modified Robertson's equation of animal growth. A growth equation is presented, differing from Robertson's equation only in its constnats. It is shown that this equation satisfactorily describes the growth of birds and mammals.


Cell cycles in the early development of axolotl. In axolotl embryos, during the course of development, the generation time increases, chiefly on account of a lengthening of the phase of DNA synthesis, the longest in the cell cycle. At the stages of the middle blastula and early gastrula, the G1 phase is shorter than in the G2 phase, while at the neurula stage, the G1 phase is far longer than the G2 phase. Cells of the chordamesoderm pass through the cycle nonuniformly during gastrulation: a period with a very low index of labeled nuclei and slow entry of cells into the S phase gives way to a period of their intensive entry into the S-phase.


Transplantation of nuclei from growing oocytes into fully grown enucleated sturgeon oocytes. Experiments involving enucleation of oocytes and transplantation of germinal vesicles showed that, at the start of the period of greatest growth, the oocyte caryoplasm already contains the substances necessary to make the cytoplasm capable of cytotomy.


Biosynthesis of mitochondrial proteins in oocytes of the loach Misgurnus fossilis L. The incorporation of C14-valine into the mitochondrial proteins of loach oocytes in vivo is seven times greater during the period of slow growth and the early phase of the period of greatest growth than the incorporation of this amino acid into mitochondrial proteins at the end of the period of greatest growth. Incorporation of the tagged amino acid into the mitochondrial proteins is inhibited by chloramphenicol. Cycloheximide inhibits tagged-precursor incorporation into the proteins of the nucleus and 14, 000-g supernatant and into the mitochondrial proteins.


Change in the maternal effect in Drosophila hybrids at low temperatures. Interspecies Drosophila hybrids of the virilis group were used to study the maternal effect (expression of the recessive glossy mutation when females of D. virilis strains carrying this mutation are crossed with D. littoralis males of the wild type) at low temperatures. The maternal effect was found to be intensified by a factor of four at 17 degrees and there was also an increase in the incidence of haplo-6 individuals (95%, as against 26% at 25 degrees), apparently as a result of the increased frequency of elimination of the 6th D. littoralis chromosome during cleavage division I.


Changes in the pool of deoxyuridine monophosphate in the normal embryogenesis of rats and under the influence of the folic acid antagonist chloridin. Using the methods of ion exchange and paper chromatography, the content of d-UMP, AMP, GMP, and UMP was measured in 13-15 day rat embryos, and the changes in the pools of these nucleotides under the action of chloridin, one of the inhibitors of dihydrofolate reductase, were also determined. Only the concentration of d-UMP changed appreciably: it increased in the case of normal development from the 13th to the 14th day, apralleling a decrease in the specific activity of TMS, and especially sharply under the action of chloridin, which, inhibiting dihydrofolate reductase, evidently created a deficiency of FA-H4 and thereby blocked the TMS reaction.


The temporal and spatial separation of specific syntheses in the process of chondrogenesis (electron microscopic investigation). The ultrastructural of the chondroblasts was investigated in vitro by the methods of light and electron microscopy, determining the degree of differentiation of the individual cells. It was found that in the process of differentiation, the surface area of the membranes of the rough endoplasmic reticulum undergoes a five-fold increase, while the concentration of free ribosomes in the cytoplasm decreases. The total concentration of free ribosomes and those attached to the membranes per unit volume is unchanged and is approximately 5500 ribosomes per mu3. The use of H3-proline showed that collagen is synthesized on free polyribosomes in the cytoplasm, and not on the rough endoplasmic reticulum. A hypothesis was advanced on the temporal and spatial separation of specific syntheses in the cartilage, playing an important role in the differentiation of the chondroblasts.


Metabolic acidosis in the acute abdomen. Acid-base balance in 13 patients with acute abdominal conditions has been studied. Superior mesenteric arterial occlusion in 3 patients  produced a base excess of less then-12. Other acute abdominal emergencies did not produce as profound a metabolic acidosis. The limitations of using severe metabolic acidosis as a diagnostic criterion in superior mesentric arterial occlusion are discussed.


Education for appropriate psychiatry.

Education for appropriate psychiatry. Appropriate psychiatry depends on the careful delineation of educational objectives in terms of the knowledge, skills and attitudes that doctors can be expected to use, the development of suitable learning experiences and methods of evaluation to test whether the objective have been attained.  A method for the analysis of objectives is described, as well as techniques to facilitate learning. Clinical skills are not enough in planning postgraduate training in the south african context. Managerial and educational skills should also be fostered,  as well as the personal growth and development of the trainee. Special attention should be given to preparing the psychiatrist to meet the needs of different cultural groups. A case is put forward for the development and acceptance of a single basic qualification of clinical competence for psychiatrists in South Africa and it is proposed that the F.F. Psych. should fill this gap.


Isotopic method using xenon-133 for assessing placental blood flow and for detecting light-for-dates babies. A method for measuring uteroplacental blood flow is described and applied to mothers with light-for-dates and normally-grown fetuses. The two groups of fetuses showed a significant difference in their clearance rates, the inportance of which is discussed in terms of diagnosis and management.


A case of recurrent subacute disseminated intravascular coagulation associated with malarial prophylaxis. An adult male who twice presented with a sudden haemolytic anaemia and disseminated intravascular coagulation of uncertain aetiology is described. A possible causative agent common to both episodes is the breakdown product of pyrimethamine (Daraprim) and chlorguanide (Paludring). A very similar case has been attributed to penicillin sensitivety. The usefulness of high dosage heparin in the treatment of the subacute form of disseminated intravascualr coagulation is illustrated in the first admission.


An evaluation of tilidine hydrochloride in the treatment of pain requiring immediate analgesia. Problems relating to analgesia in various situations are briefly discussed. A simple working classification for analgesic administration is given. The results of a trial, in which 50 mg of a new analgesic, tilidine, was given sublingually, are presented. The drug was evaluated in cases where immediate analgesia was indicated. The majority of patients had injuries to the hand or head. It was found that tilidine provided a marked analgesic effect in 27 of the 30 patients. The onset of action was rapid, 25 of the 30 patients obtaining complete relief within 6 minutes. It is concluded that tilidine is a powerful analgesic, with a rapid onset of action when it is give in the sublingual drop form. Moreover, it is a drug of choice, in this form, for acute, moderately severe situations (those which require immediate analgesia, but where opinates are not thought to be necessary).


Cavitation of pulmonary metastases.

Cavitation of pulmonary metastases. Although cavitation of pulmonary metastases is not as frequent as that of primary involvement, it should always be considered in the differential diagnosis of multiple cavitary lesions. The most frequent cause is squamous cell carcinoma, but it is by no means confined to this type of pathology.


The quality of perinatal care received by patients in the Greater Harare area during 1973. The perinatal deaths which occurred during 1973 in the Harare perinatal service were analysed in relation to their obstetric associations. Seventy-one per cent of all the deaths were associated with just five obstetric complications, namely asphyxia in laubour, preterm delivery, minor antepartum haemorrhage, unexplained intra-uterine death and disproportion. It is suggested that asphyxial deaths occurring labour will only be eliminated when continous cardiotocographic monitoring becomes standard practice for all patients. Until then, selected cardiotocography will remain as the main diagnostic aid. Its value will be improved by reviewing the principles of selection. The potential exists to eliminate preterm delivery by the use of beta-adrenergic stimulant drugs. It is suggested that the rational application of this potential would reduce perinatal mortality from preterm delivery. The unexplained intra-uterine deaths and those associated with a minor antepartum haemorrhage presented major problems of understanding and therefore management. These are discussed. Deaths associated with disproportion occurred in 0,10% of booked patients and 3,22% of unbooked patients. The management of the booked patient is satisfactory, and improvement in perinatal mortality will only be achieved by decreasing the number of unbooked patients.


Carcinoma of the urinary bladder in the Western Cape. The histology of the initial biopsy specimens of 473 patients with tumours of the urinary bladder has been reviewed and the tumours categorised. The patients selected were normally resident in the Western Cape. The findings show that there is a low percentage of squamous carcinomas in the series when compared with similar published series from other parts of the African continent. These findings suggest that whatever aetiological or modifying agents are operative in the remainder of Africa, these are not present in the Western Cape.


Haemangiopericytoma of the thigh.

Haemangiopericytoma of the thigh. Haemangiopericytoma is a very vascular tumour which is slow growing and often painless. It is important to realise the malignant potential of these tumours and to treat them by wide surgical excision. Angiography was helpful in this case because it gave warning of probable malignancy.


Canine ringworm caused by Trichophyton rubrum; probable transmission from man to animal. A case of ringworm in a 2-year-old male Dachshund caused by Trichophyton rubrum is described. The owner of this dog had tinea pedis probably caused by the same fungus. The authors believe that this is the first authenticated case of T. rubrum infection in a dog recorded in Japan, the infection probably having been acquired from man.


Emmonsia parva as causal agent of adiaspiromycosis in a fox. The authors report on adiaspiromycosis of a fox (Vulpes vulpes) caused by Emmonsia parva. Species diagnosis was made on the basis of dimensions of the fungus found in the lungs of the animal, the histopathological picture of tissue changes and the properties of the isolated culture. The identification of the fungus was also confirmed by experimental infection. The differential diagnosis of the agent of adiaspiromycosis is discussed by experimental infection. The differential diagnosed of the agent of adiaspiromycosis is discussed and attention is called to confusion of the species. E. crescens and E. parva in the past. The finding represents the first case of adiaspiromycosis due to E. parva in Europe.


[Balck piedra in chimpanzees from Zaire]. Black piedra was present in 21 of 72 museum pelts of chimpanzees (Pan paniscus and Pan satyrus) from Zaïre. In the absence of culture, the mycological characteristics observed in vivo, although insufficient to allow a definite identification of the Piedraia species involved, are almost identical with those of Piedraia quintanilhae Van Uden, De Barros-Machado & Castelo-Branco, 1963.


Classification of some Gymnoascaceae by pyrolysis-gas-liquid chromatography using added marker compounds. Methyl esters of fatty acids were added to samples before pyrolysis to superimpose peaks of known retention time on the pyrochromatograms. These peaks were useful in calibrating the retention time scales so that peaks on different chromatograms could be appropriately homologized. The study included 3 species of Nannizzia, 3 strains of Trichophyton rubrum and 1 strain each of Gymnoascus uncinatus, G. reesii, Arachniotus hyalinosporus, Chrysosporium pannorum and Gliocladium viride. Pyrograms of the 3 T. rubrum strains were not as similar to each other as the pyrograms of some of the supposedly distantly related species. Unless our identification of 1 or more of the T. rubrum strains is incorrect, these results cast doubt on the usefulness of pyrochromatograms as indicators of genetic similarity.


Antigenic analysis of yeast cell-walls.

Antigenic analysis of yeast cell-walls. Agglutination and complement fixation tests with yeast cell-walls revealed an extensive and complex pattern of cross-reactions amongst 26 species of 20 genera of yeasts. Common antigens were found in all yeast cell-walls. Ascosporogenous yeasts possessed antigens not found in the asporogenous yeasts and vice versa. Nuberical analyses of serological properties confirmed this distinction and also that little differentiation could be achieved at generic level with respect to Saccharomyces and Candida spp.


The cause of post-traumatic pulmonary insufficiency in man. Respiratory failure in man most frequently follows sepsis. A sign of occult sepsis may be pulmonary failure. Shock and its necessary fluid therapy may predispose to a brief requirement for ventilatory assistance. Shock and multiple injury predispase to sepsis. Mechanical ventilation with intubation has adverse effects upon the lung as well as beneficial effects of the patient. The most important adverse effect is pneumonia.


Factors influencing mortality in the treatment of pyogenic hepatic abscess. This analysis of 80 patients with pyogenic hepatic abscess seen at this hospital demonstrated that there was no significant change in the incidence, age, sex, race, location or number of abscesses, symptoms, physical findings, labrotory data, routine roentgenograms, or complications over a 21 year period. However, there were relatively more women, the patients were older, and the incidence of appendicitis as an etiologic factor was much lower in this series than in the preantibiotic era. Ascending cholangitis was the most common etiologic factor throught this series, although malignant extrahepatic obstruction has become more prevalent in recent years. Escherichia coli remains the most commonly isolated organism, and gram-negative organisms are found in 72 per cent of the cultures. More than one organism was isolated in 65 per cent of the patients and there has been a significant increase in the number of anaerobic organisms isolated in recent years. Furthermore, a majority of anaerobic abscesses were solitary, and therefore, they had a better prognosis. The factors associated with a poor prognosis were age greater than 70 years, multiple abscesses, a biliary cause, an associated malignant condition, jaundice, an elevated serum glutamic-oxalacetic transaminase level, hypoalbuminemia, polymorphonucleocytosis, bactermia especially with multiple organisms, aerobic infection, and pulmonary, peritoneal, or other significant complication.


Comparison of sterilization by tubal ligation and hysterectomy. A comparison was made between sterilization by hysterectomy and by tubal ligation at the time of cesarean section and as an interval procedure. All operations were done at one institution and, essentially, by the same physician population, allowing for promotion within the residency program. The major deterrent to hysterectomy was the associated high incidence of necessary blood transfusion. However, a hysterectomy does offer the benefits of a permanent and completely effective procedure and the removal of an organ which ultimately may be the source of other problems. If another pathologic condition exists, making ultimate hysterectomy likely, it is the procedure of choice for sterilization, avoiding risks, costs, and the inconvenience of another operation. Methods of elective sterilization must be individualized. If the patient is appraised of the increased risk of hysterectomy and desires this more definitive procedure on the basis of informed consent, the incidence of complications is not prohibitive. These should not deter the well trained surgeon but should mandate use of all available skills, intensive evaluation of the patient, and concerned recognition of the potential adverse consequences.


The diagnostic value of protein bound serum fucose in cancer of the breast. Protein bound serum fucose levels were measured in women with cancer of the breast and in normal women serving as controls. Thirteen healthy women gave a mean value of 13.9 plus or minus 2.4 milligrams per cent, which was not significantly different from the figure of 15.0 plus or minus 3.1 milligrams per cent obtained from 11 patients with operable cancer of the breast, Stage I and II. Only the serums from nine patients with disseminated cancer of the breast showed a significantly elevated fucose concentration of 18.8 plus or minus 3.6 milligrams per cent. It is concluded that serum fucose determination is of no diagnostic value in the early stages of cancer of the breast.


The effect of an intraduodenal elemental diet on pancreatic secretion. The effect of an elemental diet on canine exocrine pancreatic secretion was evaluated by infusing an elemental diet into the duodenum of dogs and monitoring the output of the pancreas. The stimulatory properties of the elemental diet were compared with a nearly equimolar dose of an L-form neutral amino acid, 0.16 normal hydrochloric acid, and 2 units per kilogram per hour of exogenous cholecystokinin. Intraduodenal infusion of elemental diet produced significant increases in pancreatic volume and protein output. These changes were similar to those produced by the amino acid solution and suggest that the stimulatory properties of the elemental diet are primarily due to the amino acid content. The results of the this study suggest that elemental diets stimulate the duodental mucosa to secrete cholecystokinin which stimulates the exocrine pancreas. Elemental diets administered in such a manner that the substance passes through the duodenum would not theoretically be a satisfactory method of providing calories to patients with acute pancreatitis.


Pulmonary embolism after amputation of the lower extremity. Patients requiring amputation of the lower extremity for arteriosclerosis are at high risk for the development of venous thrombosis and pulmonary embolism. Inapparent venous thrombosis was discovered in the amputated leg at operation in eight patients. Pulmonary embolism was documented by angiogram or at autopsy in ten patients. The majority of emboli discovered in this study was not suspected by the physician responsible for the care of the patient. The perfusion lung scan in this elderly group of patients had a false-positive rate of 60 per cent, while a normal lung scan was strong evidence against pulmonary embolsim. Although imperfectly randomized, the prophylactic use of low molecular weight dextran in this study did not decrease the incidence of pulmonary embolism. The pulmonary arteriogram proved a safe procedure in the elderly and should be used before therapy is initiated for suspected pulmonary embolism.


Systolic slope and other pressure measurements in patients with peripheral vascular disease. Measurements of systolic blood pressure at the ankle are of proved value for quantitating the severity of peripheral arterial disease. Preliminary results indicate that the measurements of the rate of rise of arterial pressure at the ankle divided by the pulse pressure in the arm is a much more sensitive measurement and is capable of detecting minor degrees of arterial stenosis.


The results of cholecystostomy for the treatment of acute cholecystitis. Six of 22 patients with acute cholecystitis who had a cholecystosomy died. All six deaths were attributed to cholangitis, none of the patients had undergone common bile duct decompression at the time of cholecystosomy. Cholecystostomy must be accompanied by choledochotomy in the treatment of acute suppurative cholangitis. Cholecystostomy is a safe procedure, can be performed rapidly, and is recommended in a select group of patients with acute cholangitis without jaundice or for clinical signs of cholangitis.


Highly selective vagotomy with intraoperative acid secretive test of completeness of vagal section. This technique of highly selective vagotomy with an intraoperative acid secretion test to determine completeness of vagal section is designed to demonstrate, on one hand, the vagal fibers which escaped section and, on the other hand, the exact lower limit of the acid-secreting parietal cell mass.


A simple aid in greater saphenous phlebography. During the last 32 months, we have used isometric contraction of the muscles of the lower extremities during saphenous phlebography for the purpose of improving the degree of opacification of the greater saphenous vein. Using this technique, acceptable visualization of the greater saphenous system may be obtained with minimal risk in over 90 per cent of the patients.


Alterations in nerve cells and myelinated fibers in spinal cord injury. The morphological alterations occurring in the primate spinal cord following acute nondisruptive trauma resulting in paraplegia were studied by light microscopy at intervals up to three months. Specimens were stained specifically for nerve cells, axon cylinders, myelin sheaths, and free fat. Hypoxic degenerative changes were observed in nerve cells. Initially these consisted of cytoplasmic vacuolation and dispersion of the Nissl substance followed by a progressive decrease in the size and the number of nerve cells seen. Simultaneously in the white matter traumatic degenerative changes were noted. At four and eight hours after injury, structures indicating the severance of axon cylinders and of myelin sheaths were observed. Although shearing of myelinated fibers by the mechanical impact of the injury is suggested, it is not possible in this study clearly to separate the development of alterations in the white matter from the changes occurring in the gray matter.


Sinus pericranii with aneurysmal malformation of the internal cerebral vein. A case of sinus pericranii is reported because of a previously unobserved clinical feature. There were associated anomalous dilated deep crebral veins and an aneurysmal venous malformation. Six years after the surgical occlusion of the sinus pericranii the aneurysmal malformation became thrombosed.


The familial occurrence of glioma.

The familial occurrence of glioma. In a family with four children, an intracranial neoplasm developed in three of the siblings at or before the age of 12 years. Two of the tumors were hitologically verified gliomas and the third was diagnosed on ventriculography but did not have microscopic confirmation. One of the three siblings also had a presacral lipoma, and the fourth sibling developed a mediastinal cystic hydroma. There was no known history of brain tumors in any other family members, nor was there any evidence suggestive of neurofibromatosis. A careful examination of this family and an extensive review of other published cases of similar familial constellations of brain tumors reveal no definite pattern which would suggest a specific mode of inheritance. Careful documentation of familial aggregation of brain tumors is important in order to explore the genetic, environmental, demographic, and clinical features (such as associated extracranial tumors) that could serve to identify groups at high risk for the familial occurrence of brain tumors.


Brain stem abscess treated surgically. Wtih special note upon the employment of thorium dioxide. A 10-year-old girl, with congenital heart disease, harboring a brain stem abscess, was recently treated at the UCLA Hospital. Needle aspirations of the abscess was performed through a posterior occipital craniectomy, and thorium dioxide (Thorotrast) was placed within the abscess cavity as a marker. Postoperatively, the patient improved temporarily but died 18 days later. Autopsy examination included radioactive analysis of brain and liver tissue. Radioautographs were superimposed on H&E preparations of the abscess wall to localize the extent of activity of the thorium dioxide. The unusual occurrence of this abscess in a young patient, clinically diagnosed and treated by operation, provided a rare opportunity to assess the problem of the surgical accessibility of brain stem abscess as well as to reevaluate a role for thorium dioxide as a marker for intracranial purulent collections.


Effect of histamine on immunoreactive gastrin in gastric juice and in serum. Due to recent reports claiming that gastrin is present in the gastric juice, the method for gastrin determination has been evaluated. Separate experiments showed that gastrin added to gastric juice disappears rapidly if the juice is not boiled or neutralized. A total of 82 patients with various abdominal disorders were examined. No or only a trace amount of gastrin was found in untreated, boiled, or boiled and neutralized gastric juice in every patient, including three patients with achlorhydria. Histamine injection (0.04 mg. per kilogram, subcutaneously) did not influence this and was without effect upon serum gastrin concentrations of nine duodenal ulcer patients. Because gastrin apparently is degraded rapidly by gastric juice, this study does not necessarily disprove that gastrin is secreted into the stomach. However, the virtual absence of gastrin in all specimens examined, including some collected directly upon boiling water bath during continuous gastric aspiration lends no support to this speculation. Because gastrin does not survive even a short exposure to gastric juice without degradation, we suggest that earlier reports on the presence of gastrin within the stomach are questionable.


Observations by a James IV traveler on British surgical centers. In Great Britain and Ireland there were many well-trained, technically excellent, clinical surgeons practicing the art of surgery in a system that guarantees an equitable and even distribution of quality care. University departments tended to be small but were very effective and stimulating units without the administrative and clinical burdens of a large teaching hospital. Surgical training programs were superb, but long, and continued to be molded by service requirements. Clinical research protocols were everywhere in evidence and were patient oriented, well controlled, and of the highest quality. Although there are several new impressive clinical plants, hospitals tended to be old and facilities somewhat dated. There are fewer intensive- and critical-care units than we have become accustomed to. As hosts, the British and Irish are unsurpassed as the most gracious, interesting, and educated people I know.


Time utilization of a population of general surgeons in community practice. A time-motion study was performed on a population of general surgeons in suburban community practice whose median weekly operative work load had been previously determined to be 3.1 hernia equivalents (HE). The mean observed 6 day working week of this population of general surgeons was found to be 34.5 hours, of which 28.7 hours were devoted to professional activities for the total work week of 44.3 hours. Thirty-five percent of the mean observed working week was spent in office activities and 50 percent spent in hospital activities. During the mean observed week, 18.5 hours (54 percent) were devoted to patient care, of which 16.5 hours were judged to be devoted to surgical care. Surgeons with above-median operative work loads in the previous study devoted 67 percent more time to professional activities and twice as much time to surgical activities as surgeons with below-median work loads. The findings support the hypothesis that there appears to be an underutilization of costly and highly specialized medical skills in the particular community and suggest that the HE methodology is a valid measure not only of the operative work of surgeons in community practice but of total time devoted to surgical care.


Bile lakes in congenital biliary atresia. During an 18 year period intrahepatic bile "lakes" were identified at postmortem examination in the hepatic parenchyma of six infants with intrahepatic biliary atresia and four infants with type C extrahepatic atresia. The bile lakes were located in the central portion of the liver and were not identified in any patients under 6 months of age. The lakes did not communicate with identifiable intrahepatic ducts in any of the six patients with intrahepatic atresia. Each of the four patients with type C extrahepatic atresia had a few ductal communications with the peripheral hepatic parenchyma. Bile lakes most likely represent dilated ductal remnants that contain inspissated secretions and cellular debris. They do not characterize potentially curable patients if the condition is associated with intrahepatic atresia. Bile lakes occur late in the course of the disease, beyond the age of 3 months, when irreversible hepatic damage occurs. Nonetheless all infants with biliary atresia should have a hepatic portoenterostomy or biliary-enteric anastomosis regarding the long-term prognosis after such operations.


A simplified system for surgical operations: The economics of treating hernia. This paper presents a cost analysis for herniorrhaphies as they are currently performed, as compared with a new plan. The current system utilizes hospital postoperative care. The new plan involves a different utilization of hospital facilities, personnel, drugs, supplies, and postoperative home care. Costs are considerably reduced under this new proposal. Projections reveal that implementation of the new plan with the same level of present expenditures could eliminate 75 percent of the present backlog of hernias over a 10 year time period. Although the cost and disease estimates derive from an experimental study conducted at the Universidad del Valle, Cali, Colombia, this model can help meet population health care needs in any country or geographic region by basing the system of services and facilities on epidemiologically derived disease prevalence and incidence rates.


Na+ minus K+ transport and adenosine nucleotides in the lung in hemorrhagic shock. This study was undertaken to determine the effects of hemorrhagic shock on cellular energy production and utilization in the lung. Energy-dependent Na+ minus K+ transport was measured by quantitating tissue cation changes during a cold (0.5 degrees C.) and a subsequent warm (37 degrees C.) incubation of lung slices from rats in late hemorrhagic shock and from unbled control rats. Active Na+ extrusion and K+ reaccumulation by the tissue were observed upon rewarming of lung slices from shock animals. Whereas K+ reaccumulation was not altered with shock, the rate of Na+ extrusion was approximately 40 percent higher. The measurement of the intracellular water content with cold and warm incubations showed no alterations with shock. Extracellular water increased with chilling in shock tissue but not in normal tissue. Lung tissue contents of adenosine triphosphate, adenosine disphosphate, or adenosine monophosphate were likewise unaltered. Thus cellular energy utilization or production in the lung was not damaged by hemorrhagic shock but a tendency toward increased interstitial water seemed to be present.


Hepatic regeneration in the absence of portal viscera. In an effort to investigate the influence of portal factors on hepatic regeneration in the rat and to clarify glucagon's apparent regulatory role, a rat preparation was developed which was totally devoid of portal viscera and thus deficient in all possible hepatotrophic substances of portal origin. It was found that, following partial hepatectomy, such an eviscerate rat was able to undergo hepatic deoxyribonucleic acid (DNA) synthesis, but the peak DNA synthetic response was significantly delayed by such portal deprivation. As demonstrated by a group of rats with intact portal viscera, but with a portacaval shunt, reduction of blood supply to the hepatic remnant by diversion of portal flow accounted for only a portion of the delay. The remainder of the delay encountered in the eviscerate group was attributed to the deprivation of specific portal substances. Since glucagon supplementation administered to the deficient eviscerate animal restored peak DNA synthesis to the time of its appropriate shunted control, this hepatotrophic substance is a major portal factor modifying the response to partial hepatectomy. Evidence is cited which suggests that glucagon's influence on DNA synthesis is mediated through the formation of cyclic adenosine monophosphate (AMP) and subsequent histone phosphorylation.


Depression of human myocardial contractility with "respiratory" and "metabolic" acidosis. The effect of a similar degree of "respiratory" and "metabolic" acidosis was studied in seven isolated in vitro human pectinate muscles and eight ventricular muscle bundles. Either "respiratory" or "metabolic" acidosis (from 7.36 plus or minus 0.03 to 7.01 plus or minus 0.02 and 6.98 plus or minus 0.03, respectively) depressed in vitro contractility in human atrial or ventricular muscle to a similar extent. Previous contradictory responses of myocardial tissue to alterations in pH appear to be the result of species differences.


In vitro demonstration of cryosurgical augmentation of tumor immunity. C57B1 mice bearing methylcholanthrene-induced fibrosarcomas (MCA-10) and receiving a single cryosurgical treatment to those tumors showed significantly greater humoral and lymphocyte-mediated cytotoxicity to MCA-10 target cells than did untreated tumor-bearing animals or mice which had undergone tumor amputation. Sera and lymphocytes from normal animals receiving crycosurgery demonstrated no immunity to the MCA-10 target cells. Specific immunity to the MCA-10 line following tumor cryosurgery was demonstrated since lymphocytes and sera from cryosurgically treated tumor-bearing mice were not cytotoxic to a different methylcholanthrene-induced sarcoma (MCAP) in C57 mice or a malignant melanoma (S91) being transferred in Balb/C mice. It can be concluded that cryosurgical treatment of the MCA-10 sarcoma does not produce heightened immunity to H-2 transplantation antigens, nor does it nonspecifically stimulate the immune system. Instead, the result of tumor cryosurgery appears to be a boosting of the immune response to the tumor-specific antigens of the sarcoma.


Hemodynamics within a canine femoral arteriovenous fistula. Blood flow and pressures around a canine femoral arteriovenous fistula, constructed from an autogenous carotid artery, were measured to determine the pressure-flow relationships within the fistula, as well as to determine the presence or absence of retrograde flow in the distal artery  and vein. The findings indicate that retrograde arterial flow occurs only when the proximal femoral artery is occluded and, even then, the contribution to fistula flow is small and well below control femoral arterial flow. Retrograde distal venous flow is negligible. Pressure within the fistula is high at the arterial end but is rapidly dissipated across the loop fistula to equal systemic venous pressure on the venous side. Modest distal venous hypertension accompanies this type of fistula. For these reasons, a loop-type, arteriovenous fistula is preferable to other types of fistulas for most clinical surgical indications.


Parathyroid cysts: Functional and mediastinal. A report of a functioning mediastinal parathyroid cyst is presented with a review of the world literature. This represents the tenth functional, eleventh mediastinal, and third functioning mediastinal parathyroid cyst reported. The predilection of functional cysts for aberrant locations would suggest on hypothesis of their occurrence by degeneration of pre-existing adenomas based on an inadequacy of their blood supply. The criteria for ascribing functional activity to a parathyroid cyst are presented and discussed.


Complete occlusion of the infrarenal abdominal aorta: management and results in 64 patients. Sixty-four patients with complete occlusion of the infrarenal abdominal aorta were reviewed. The clinical findings, diagnostic procedures, and surgical management are described. Sixty-one patients underwent thromboendarterectomy and bypass grafts from the infrarenal abdominal aorta to the iliac or common femoral arteries. Because purulent material was found in the retroperitoneum of two patients, the proximal anastomosis was performed to the descending thoracic aorta in one patient and to the upper abdominal aorta in the other. One patient underwent thromboendarterectomy and patch graft angioplasty. The hospital mortality rate was 4.6 percent. Sixty-one patients discharged from the hospital were followed (average length of follow-up was 37 months). There were three late deaths (4.9 percent). Two patients have had occlusion of one limb of their bypass grafts and, along with four others, have developed recurrent symptoms of vascular insufficiency of the lower extremities. These symptoms were due to progressive atherosclerotic occlusive disease of the distal arterial tree for which additional distal procedures were required.


Lack of effect of an experimental prepaid group practice on utilization of surgical care. The utilization of surgical care in an experimental period group practice for a 3 year period is reported. In contrast to what was expected, prepaid enrollees used the same or more surgical care than did control enrollees. The same proportion of emergency, urgent, and nonurgent admissions, occurred in both groups. Likewise there was no difference in the proportion of various procedures often thought to be overutilized in the traditional medical care system. High quality of surgical care in the area where the study was conducted was considered the most likely explanation for failure to show differences in the prepaid growth practice. Few, if any, unnecessary operations were performed in either group studied. Thus, under the conditions of this study, no significant measurable effect on surgical utilization by a change in the method of medical care organization and payment could be demonstrated.


The dispensable right ventricle.

The dispensable right ventricle. The historical development of the concept that an anatomic ventricle is not needed for the pulmonary circulation is reviewed. The application of this idea to surgical treatment of congenital heart disease has culminated in atriopulmonary bypass for tricuspid atresia, an operation that relieves cyanosis and creates a functionally normal circulation, but which may have late risk due to arrhythmias or valve failure.