External counterpressure to control postoperative intra-abdominal hemorrhage. The effectiveness of the G-suit controlling massive postoperative intra-abdominal hemorrhage was studied in twenty-eight patients whose diffuse bleeding could not be controlled during operation. Most patients had developed deficiencies of platelets and clotting factors due to dilution, and in addition three had documented disseminated intravascular coagulation. After application of the G-suit, hemorrhage stopped in nineteen patients, allowing the replacement of platelets and clotting factors in patients with deficiencies and the administration of heparin to three patients with disseminated intravascular coagulation. After an average of twenty-one hours the G-suit was removed without rebleeding in seventeen patients. The major cause of G-suit failure was an arterial source of intra-abdominal bleeding. Application of the G-suit had no adverse effect on renal function in at least half the patients; urinary output declined in on third. Mos patients experienced respiratory impairment and some had ischemic skin lesions. The G-suit is frequently effective in halting postoperative intra-abdominal hemorrhage, allowing correction of acquired coagulopathies with acceptably few complications. Its use does not replace the need for proper surgical hemostasis.


Problem-oriented surgical audit in the community hospital. A concept in evolution. A system of surgical audit based on identification and solution of surgical problems is described. The system relies initially on universal review of patient records on a monthly basis by surgeons in the involved institution. Evolution of the system to one which the records of certain patients can be excluded from review by physicians is seen as practical, if careful definition of such records is maintained. Emphasis on the goal of meaningful quality of care assessment is critial. Utilizing this system, surgeons in Stamford, Connecticut, have found significant deficiencies in diagnostic, therapeutic, or both of these aspects of patient care in 5 per cent of records reviewed. Ninety-five per cent of patients were judged to have had no important inadequacies in their surgical care, based on evidence in their medical records. Attempts to evaluate surgeons' behavioral changes, when deficiencies in their patients' care have been demonstrated, are being pursued actively.


Localization of hyperfunctioning parathyroid tissue. Radioimmunoassay of parathyroid hormone on samples from the large veins of the neck and thorax and selectively catheterized thyroid veins. Radioimmunoassay of parathyroid hormone on samples obtained from the large veins of the neck and thorax was utilized for localization in twenty-one patients with hyperparathyroidism. In seventeen of these patients, as many of the thyroid and mediastinal veins as possible were also sampled. This study reveals that sampling of the large veins of the neck and thorax is an insensitive means of adenoma from hyperplasia. Anatomic variations in the drainage of the inferior thyroid veins and dilution of the parathyroid venous effluent by the large veins of the neck and thorax seem to explain this insensitivity and the occasionally misleading results of large vein sampling. Sampling of the small thyroid veins, however, is a sensitive and specific means of localization and permitted preoperative differentiation of adenoma from hyperplasia in fourteen of our seventeen patients. Communications between the inferior thyroid and thymic veins and the fact that mediastinal adenomas frequently bring their blood supply down from the cerevical area suggest that sampling of the small thyroid veins may be of only limited value in identifying a mediastinal adenoma.


Bypass vein grafts in patients with distal popliteal artery occlusion. The results obtained by placing reversed autogenous saphenous vein bypass grafts in either isolated popliteal artery segments or tibial vessels distal to the popliteal artery segments or tibial vessels distal to the popliteal artery are compared. Fifty-five patients with arteriosclerotic peripheral vascular disease who were threatened with limb loss were followed up from six months to nine years prior to this report. The success rate at one year was 94 per cent for the isolated popliteal segment grafts and 73 per cent for the tibial vessel grafts. The success rate after four years was 70 per cent for the isolated popliteal segment grafts and 63 per cent for the tibial vessel grafts. The clinical factors associated with the success of isolated popliteal segment bypass grafts and the factors apparently associated with failure of vein grafts in both of these groups with very poor distal arterial outflow are discussed. Our results suggest that either an isolated popliteal artery segment graft or a tibial vessel graft is a satisfactory means of treating these patients; however, a graft to an isolated popliteal segment is probably preferable to a graft to a tibial artery.


Vascular access for dialysis. Technics and results with newer methods. Over a five year period, 114 patients had one or more secondary operations for access to the circulation for hemodialysis, these being a Thomas femoral shunt, saphenous vein graft, or Sparks mandril graft. The patient group was different from the general dialysis population, containing more females, more patients with diabetes, and more patients with collagen-vascular disease. Comparing duration of utility by the life table method for each technic, the femoral shunt lasted longest but with a high incidence of septic complications, the mandril graft was intermediate, and the saphenous vein graft least durable in use. The mandril is considered a tentative first choice for secondary access when the required maturation time is available.


Extent of leg vein thrombosis determined by impedance and 125-I fibrinogen. Modification of impedance plethysmography to include a thigh cuff improves sensitivity. Twenty-seven of thirty-two subjects (85 per cent) were correctly classified by comparison with phlebograms. Combined surveillance of patients at risk with cuff impedance plethysmography and 125I fibrinogen, carried out fifty subjects after total hip replacement demonstrated that silent venous thrombosis can be detected. Moreover, an estimate of thrombus size can be made, at least to the extent that clinically significant thrombi can be distinguished from minute thrombi.


Decreasing morbidity after liver trauma. Fifty-one patients with significant recognized hepatic trauma were treated at Hartford Hospital during a four year period ending May 1973. Seventy-five per cent of the injuries were the result of blunt trauma. Many patients had severe associated injuries and three died in the emergency room before operation could be undertaken. Forty-eight patients underwent laparotomy and various types of repair including sixteen resections of significant volumes of nonviable liver. Three patients died in the operating room, but no patient who left the operating room alive after resection diet. Hematologic, pulmonary, renal, and gastrointestinal complications are analyzed in detail. There were no postoperative intrahepatic or subphrenic abscesses in patients undergoing resection and we believe that this is attributable to changes in technic. This review stresses the technical details of the operations as they may relate to the apparent improvement in morbidity and mortality.


The role of IgA in the pathogenesis of atopy. The role of IgA in the pathogenesis of infantile atopic disease was examined to determine whether the presence or absence of IgA in umbilical cord serum at birth could be correlated with the subsequent development of asthma and atopic eczema. Asthma occurred in four of the 50 infants without detectable IgA and in four of the 21 infants with detectable IgA. Atopic eczema occurred in three of the 50 infants without detectable IgA and in none of the 21 infants with detectable IgA. The difference in the incidence of atopic disease in the two groups was not statistically significant. The results of this study suggest that IgA deficiency in early infancy does not play a causal role in the development of atopy.


Intrinsic asthma associated with diabetes mellitus; abnormal vascular response and glucose tolerance tests. Patients manifesting intrinsic idiopathic rhinitis and/or asthma in association with diabetes or aspirin intolerance were studied. Various metabolites (sugars and L-histidine) and chemical (aspirin, insulin and glucagon) challenges were studied using the parameter of the induced sequential vascular response. A standard oral glucose tolerance test was also correlated. The results indicated similar as well as divergent ab- nc. nalities of responses to the various carbohydrates, insulin, glucagon, L-histidine and aspirin challenges. This permitted a separation of some patients with idiopathic rhinitis and/or asthma into those associated with diabetes and those with tolerance to aspirin.


Isoproterenol aerosols.

Isoproterenol aerosols. Notable acute improvement in pulmonary function in the majority of 32 patients with known bronchial asthma followed two inhalations of Isoproterenol. No deleterious clinical or cardiovascular effects of EKG changes (after one-half hour) were observed. A slight drop in blood pressure was noted in previously hypertensive patients. Isoproterenol's short duration of effects is ideal and one or two inhalations spaced four hours apart may be safely recommended for the relief of the acute asthma paroxysm.


Effect of exercise on lung function tests in hay fever. The patients in this study were divided into three groups on the basis of V50. Group I included completely normal subjects with normal V50 before and after exercise. Group II showed a normal initial V50 which decreased following exercise. This indicates small airways dysfunction which is exaggerated by exercise. Group II showed abnormal V50 initially which remained unchanged after exercise, suggesting more permanent impairment of the small airways function. Thus significant physiologic abnormalities were identified in patients belonging to Group II and Group III.


Enzyme potentiated hyposensitization: IV. effect of protamine on the immunological behavior of beta glucuronidase in mice and patients with hay fever. The ability of beta glucuronidase and a small dose of antigen to modify the anaphylactic reaction of previously sensitized mice has been further investigated. Protamine has an important effect on the immunological behavior of the enzyme. A trial on hay fever patients shows that the results in mice are relevant and that the method can produce significant clinical hyposensitization.


A study of western red cedar-induced asthma. Seventeen asthmatic patients who were workers dealing with Western Red Cedar in a Japanese wooden frame factory were studied. One fraction from the aqueous extract of the lumber induced a positive skin test, Prausnitz-Kustner test and the inhalation test. This confirms the existence of antigen in Western Red Cedar and its ability to produce allergic asthma in sensitive workers.


Correlation between date of birth and pollen sensitivity. Attempts by previous investigators have failed to show significant correlation between seasonal pollens and the birth dates of individuals as evidence for the development of tolerance in immunologically immature neonates. Using a large clinic population with adequate controls, significant correlation between ragweed, grass or tree pollen sensitivity and the dates of birth was not obtained.


Induced bleeding changes with aspirin in various tolerant and intolerant patient groups. The advantages of aspirin as a first stage anti-hemostatic agent, combined with its relatively low cost, ease of administration and simplicity of control, have led to its use in prophylaxis for atherosclerotic and thromboembolic disease processes, in addition to its long established employment as an analgesic and antipyretic agent. However, adverse reactions in aspirin-hypersensitive patients have led to reappraisal of the risks involved in its casual administration. A method to reduce such risks is proposed.


Newcastle disease virus antigens and strain variations. Study of antigenic differences among strains of Newcastle disease virus is complicated by the presence in most field isolates and strains of several genetically distinct plaque populations, and by differences in avidity (reactions to antibody) among Newcastle disease viruses. Kinetic neutralization tests were used to demonstrate antigenic differences among 3 plaque clones of velogenic viscerotropic Newcastle disease viruses recently isolated from 3 avian species. The 3 viruses could be distinguished on the basis of plaque structure and hemagglutinin and neuraminidase activity. Antigenic differences among these viruses distinguished them from older, well characterized Newcastle disease viruses.


Purification and concentration of viruses associated with transmissible (coronaviral) enteritis of turkeys (bluecomb). Purification and concentration of viruses contained in pathogenic material was accomplished by sucrose density gradient centrifugation. Electron microscopy was also performed. Viruses recovered from intestinal preparations of both affected and unaffected turkey poults had a density of 1.16 to 1.17. The viruses resembled myxoviruses, paramyxoviruses, or oncornaviruses morphologically. In addition, preparations from bluecomb-affected poults were found to contain viruses indistinguishable from known coronaviruses. No such virus particles were seen in the control preparations. Data are presented to indicate an etiologic relationship between the coronavirus and transmissible enteritis of turkeys.


Immune response to fowl cholera antigens. Experimentally prepared and commercially manufactured bacterins were evaluated by a 2-stage bird protection bioassay. Ninety percent of the commercial bacterins gave acceptable protection levels to Pasteurella multocida type 1. Sixty-seven percent of the commercial bacterins produced acceptable protection to P. multocida type 3. Survival of 75 percent was considered acceptable protection.


Protective quality of an aluminum hydroxide-absorbed broth bacterin against infectious coryza. Various aspects of immunity induced by a merthiolate-inactivated, aluminum hydroxide-absorbed chicken meat infusion (CMI) broth bacterin prepared from Haemophilus gallinarium were studied. A bacterin dose of 10-8 colony-forming units (CFU)/ml was the minimal dose which protected a significant number of chickens against intrasinus challenge with live organisms. This finding simplifies production procedures because yields of 10-8 CFU/ml of CMI broth are routinely obtained. A significant number of chickens vaccinated with the bacterin were immune to intrasinus challenge through 9 months postvaccination. On a comparative basis, an egg-yolk bacterin prepared from the same strain protected for only 3 months. Birds vaccinated with broth bacterins prepared from 2 strains of H gallinarum (17756 and M) which shared common surface antigens were immune to intrasinus inoculation with the homologous but not to the heterologous organisms. Preliminary data indicated that the broth bacterin prevented a sharp decrease in egg production when the immunity of vaccinated birds was challenged (instrasinus) at the height of egg production.


Clearance of cryoprecipitated factor VIII in canine hemophilia A. Canine factor VIII was isolated by a cryoprecipitation method and injected into dogs with hemophilia A. Assays of factor VIII in the cryoprecipitate resulted in a range of 92 to 660% of the factor VIII level of normal dog plasma, with a mean of 266%. Half times of the cryoprecipitate in the hemophiliac dogs, as measured by the partial thromboplastin time (PTT) test, ranged from 7.7 to 32.3 hours, with a mean of 13.2 hours.


Effects of phenobarbital on digitoxin and digoxin elimination in the dog. When normal dogs were orally pretreated with a known microsomal enzyme inducer, phenobarbital, the serum biological half-life of digitoxin was not significantly affected, whereas the serum biological half-life of digoxin was significantly shortened by nearly 30%. These results are variant with that previously reported for human beings, wherein microsomal enzyme induction resulted in shortening of plasma biological half-life of digitoxin by more than 40% and insignificant effects on plasma biological half-life of digoxin. Because of the effect on plasma biological half-life, concomitant digoxin and phenobarbital administration to the canine cardiac patient may necessitate careful evaluation of the digitalization.


Efficacy and safety of selenium-vitamin E injections in newborn pigs to prevent subclinical deficiency in growing swine. Seventy-eight newborn pigs were allotted to 4 treatment groups: 22 pigs in group A were given no selenium-vitamin E (Se-E), 22 pigs in group B were given small doses of Se-E, 22 pigs in group C were given medium doses of Se-E, and 12 pigs in group D were given large doses of Se-E. Pigs were intramuscularly injected before 7 days of age and at weaning (40 days of age), respectively, as follows: group A--1 ml of physiologic saline solution/pig each time, group B--0.25 mg of Se/pig and later 0.06 mg of Se/kg of body weight, group C--1.0 mg of Se/pig and later 0.24 mg of Se/kg, and group D--1.5 mg of Se/pig and later 0.72 mg of Se/kg. Selenium was supplied as sodium selenite in commercially available Se-E injectable compounds. From 2 weeks of age to weaning, the pigs were fed a corn-torula yeast creep feed containing Se at the concentration of 0.03 ppm, and from weaning to slaughter, a corn-soybean meal ration was fed containing Se at the concentration of 0.07 ppm and alpha-tocopherol at the concentration of 15.7 mg/kg. Subclinical Se-E deficiency developed in control pigs of group A and was characterized by subtle muscular stiffness, significant increases in plasma activities of glutamic oxalacetic transaminase (GOT) and creatine phosphokinase (CPK), and typical residual lesions in heart and skeletal muscle, but not in liver, at slaughter at 165 days of age. Pigs injected with Se-E did not develop these evidences of subclinical deficiency. Pigs in group D were stunted for several weeks after the 2nd Se-E injection, and plasma GOT and CPK activities were significantly increased at 3 weeks after injection. Growth rates were otherwise similar between groups. Significant difference in Se content of liver, muscle, serum, and hair was not seen between pigs in the 4 groups at 120 and 165 days of age. A test period of physical exertion and heat stress resulted in significant increase of plasma GOT and CPK activities in 4 of 8 pigs at 110 days of age.


Changes in plasma glucose and lactate concentrations and enzyme activities in the neonatal calf with diarrhea. Plasma glucose and lactate concentrations and glutamate-pyruvate transaminase (SGPT), glutamate-oxalacetic transaminase (SGOT), alkaline phosphatase (AP), aldolase (ALD), creatine phosphokinase (CPK), and hydroxybutyrate dehydrogenase (HBD) activities were determined before, throughout the incubation period, and during the course of a viral-induced diarrhea in the neonatal calf. Hypoglycemia with a glucose concentration less than 40 mg/dl of plasma was observed in 3 of 10 calves. Plasma lactate concentration increased to 1.84 plus or minus 0.1 times normal in 7 and 6 to 7 times normal in 2 of the animals. The major change in both glucose and lactate concentrations during diarrhea occurred during the 24 hours preceding death. Changes in SGPT, SGOT, or AP activities were not observed, indicating the absence of marked hepatic damage. The ALD, CPK, and HBD activities were increased in 2 calves and the CPK alone was increased in 2 others, indicating cardiac and possibly skeletal muscle damage.


Intravascular granulocyte kinetics in developing calves. Intravascular granulocyte kinetic values of normal developing calves were determined, using the chromium radioisotope 51Cr as the cell label. A total of 15 kinetic trials were conducted in the calves at 8 to 365 days of age. The clearance of labeled granylocytes from the circulation was an exponential function. The kinetic data from the oldest group of calves (7 experiments on 5 calves, 180 days of age and older) were remarkably similar to those reported for persons. Mean total blood granulocyte pool was 6.34 times 10-8 granulocytes/kg of body weight, of which 45.6% was in the circulating granulocyte pool. Mean clearance half-life (T1/2) was 8.9 hours, and mean granulocyte turnover rate was 12.44 times 10-8 granulocytes/kg of body weight/day. In the oldest calf group, there was significant correlation between the blood granulocyte count and the total blood granulocyte pool size. There was also significant correlation between the total blood granulocyte pool size and the clearance half-life. The youngest group of calves (4 experiments on 4 calves, 8 to 16 days of age) had significantly larger total blood granulocyte pool and shorter intravascular half-life than did the oldest group. These factors combined to yield a markedly greater granulocyte turnover rate of 39.91 times 10-8 granulocytes/kg of body weight/day in the youngest group of calves. Calves of an intermediate age group (70 to 127 days) had kinetic which were intermediate between those of the youngest and oldest groups of calves.


Surgical and anatomic study of calving paralysis. Dissections of the bovine pelvic inlet region were made to determine which nerves were vulnerable to fetal-induced traumatic damage. Surgical sections of the obturator nerves and the lumbar roots of the sciatic (ischiatic) nerves were done to determine a possible cause of calving paralysis. Only 1 of 11 cattle in which bilateral obturator nerve section was done was unable to stand after the operation, and in this individual, secondary stifle injuries were found on necropsy. Subsequent surgical operations were performed on some of these cattle in order to section the lumbar root of the sciatic nerve. Of 6 cattle prepared, 2 were unable to rise after surgery and another 2 became "downer" cattle after 30 to 45 minutes of forces exercise. Also, some of these cattle were very ataxic and had intermittent fetlock flexion.


Corpus spongiosum penis pressure and penile muscle activity in the stallion during coitus. A needle-tipped catheter or subminiature pressure transducer was implanted in the corpus spongiosum penis (CSP) of Shetland Pony stallions to determine pressure during coitus. Electrodes for monitoring the electromyographic (EMG) activity were implanted in the ischiocavernosus (IC) and bulbospongiosus (BS) muscles. The mean peak CSP pressure recorded with the catheter was 762 mm of Hg, and with the subminiature pressure transducer, it was 994 mm of Hg. The simultaneous occurrence of the CSP pressure peaks and bursts of BS muscle activity indicated that these muscles were the likely source of energy for the increased pressures, which were far greater than the systemic blood pressure. This conclusion was further supported by the finding that anesthesia of the BS muscles greatly reduced the CSP pressures of the stallion during attempted coitus.


Equine laminitis of alimentary origin: an experimental model. Acute alimentary form of laminitis was uniformly induced in 11 of 12 horses by administration of a starch and wood flour gruel and could be graded by previously established (Obel) and presently defined criteria. The experimentally induced laminitis was similar to naturally occurring laminitis, as determined on the basis of lameness severity and vital signs. Packed cell volume, leukocyte count, and total protein were significantly increased (P smaller than 0.05) at 24 and 40 hours after administration of gruel. Arterial systolic and diastolic pressures increased, central venous pressure decreased, heart rate increased, and rectal temperature increased consistently within the 56-hour experimental period. Of the 11 affected horses, 7 horses had Obel grade 3 lameness (horse moved most reluctantly and vigorously resisted attempts to lift a forefoot) at 40 hours after gruel was placed in the alimentary tract, 2 horses had Obel grade 3 lameness at 32 hours, and 2 horses had Obel grade 3 lameness at 48 hours.


Carboxyhemoglobin concentrations in normal cattle. Percentage carboxyhemoglobin (HbCO) values were determined in 29 cows and 24 bulls in Minnesota during the summer of 1973. Results indicated that, in normal cattle, the HbCO value was 0.3%. Individual and daily variations in these values were recorded in 2 calves.


Vertical transmission of progressive pneumonia of sheep. Forty-two lambs were derived by hysterectomy from 27 ewes. Eight ewes had lesions of chronic progressive pneumonia (CPP) and 19 did not. Eleven lambs were derived from ewes with lesions of CPP. These 11 lambs were maintained in isolators under germfree conditions until killed at 2 to 4 months of age. Lungs from each lamb were examined for gross and microscopic lesions of CPP and examined by microbiological cultural technique (blood, eosin methylene blue, and PPLO agar). The lungs of one 4-month-old lamb from a ewe infected with CPP had foci of gray consolidation in the apical and cardiac lobes. The microscopic changes were comparable to those in the dam. The lungs of a 2.5-month-old lamb from a ewe infected with CPP had lymphocytic accumulations in the alveolar walls and around blood vessels and bronchioles. The 9 other lambs were free of lesions. Neither bacteria nor mycoplasmas were isolated from any of the 11 lambs. Lesions of CPP were not found in 31 lambs from the 19 noninfected ewes.


Technique for study of lymph changes induced by feeding ticks (Acarina and Ixodidae) on the dog. A surgical technique is described for cannulating the right cervical lymphatic duct. Methods for securing the cannula, restraining the dog during collection of lymph, and exposing the dogs to ticks are also discussed.


Pulmonary function evaluation of the lung resection candidate: a prospective study. In the past, preoperative pulmonary function abnormalities have identified a group of patients in danger of postoperative cardiorespiratory morbidity and mortality. We selected a group of 56 patients, each of whom had a lung mass and had demonstrated significant abnormalities in screening pulmonary function. By using temporary unilateral pulmonary artery occlusion and quantitative macroaggregate lung scanning, we then studied these patients for split pulmonary function. Those patients whose noncancerous lung had a calculated forced expiratory volume in 1 sec greater than 800 ml and a circulation that could accommodate all of the cardiac output without producing hypertension or arterial hypoxemia were offered thoracotomy. Of the 56 patients, we judged 6 to be physiologically inoperable and did not offer surgery. Another 4 patients were not offered surgery, and 4 refused surgery. Forty-two patients underwent surgical exploration-of these, 17 then had a pneumonectomy and 13, a lobectomy. Of the 30 patients resected, 6 died in surgery (4 from respiratory insufficiency). These cardiorespiratory mortality rates (neumonectomy, 17.6 per cent; lobectomy, 7.7 per cent) are lower than those reported previously when patients had equivalent pulmonary function abnormality. A follow-up of 49 of 56 patients revealed that 59 per cent of the patients undergoing either pneumonectomy or lobectomy were still living 1 to 3 years after the resection. Our results suggested that the preoperative testing of split pulmonary function permitted an attempt at surgery in patients who might otherwise be considered inoperable by history, physical examination, screening pulmonary function tests alone.


Changes in small airway function after live attenuated influenza vaccination. Live, attenuated influenza vaccine was given by intranasal inoculation to 15 young, adult volunteers. Modest symptoms occurred within 3 days of challenge, but the agent was otherwise well tolerated. Hemagglutinin-inhibition antibodies increased in 9 of the 12 subjects whose initial volumes, but closing volume did not change. These changes in airflow reverted to previous levels after 1 week. On a second challenge 2 weeks after the first, symptoms were far less frequent, and no changes in airflow were detected. We conclude that this agent is biologically active and that the airflow changes observed may reflex involvement of small airways.


Comparison of maximal mid-expiratory flow, flow volume curves, and nitrogen closing volumes in patients with mild airway obstruction. Maximal mid-expiratory flow (MMEF), maximal expiratory flow volume (MEFV) curves obtained with a wedge spirometer, and nitrogen closing volumes were determined in 38 patients with mild airway obstruction. Seventeen patients had asthma in remission and 21 had bronchitis. In all of them the forced expiratory volume in one second was within the normal range. Results were compared with predicted data in the literature and with a group of normal control subjects. In the patients with asthma, compared to predicted flow rates, MMEF was abnormal in 5, MEFV curves were abnormal in at least 8; closing volume was abnormally increased in only one patient, and an abnormal slope of the alveolar plateau was present in 4 additional patients. In the patients with bronchitis, compared to predicted flow rates, -MEF was reduced in 5, MEFV curves were abnormal in at least 7; increased closing volumes were present in 6, and the slope of the alveolar plateau was abnormal in 3 other patients. When flow rates were compared with those of normal control subjects, MMEF was about as frequently abnormal as MEFV curves, suggesting that the discrepancy between abnormal MMEF AND MEFV curves was due to variability of the predicted data. The results indicated that flow rates can be abnormal in subjects with normal closing volumes and a normal slope of the alveolar plateau, and that MEFV curves can be more sensitive than closing volume in detecting abnormalities in patients with mild airway obstruction. The results suggested that the use of both MEFV curves and the closing volume test for screening would defect functional abnormalities more frequently than either test alone.


Suppression of lymphocyte function by products derived from cigarette smoke. The effect of various concentrations of nicotine and water soluble fraction from whole cigarette smoke on the transformation of rabbit peripheral lymphocytes by concanavalin A and goat anti-rabbit Fab was determined. The results demonstrated that incorporation of H3-thymidine into DNA by lymphocytes stimulated with optimal concentrations of these mitogens was inhibited in a dose-dependent manner by nicotine and water soluble fraction, and that this suppression was not a results of cytotoxicity. The response of lymphocytes to goat and rabbit Fab was slightly more sensitive to suppression by nicotine and water soluble fraction than was the response induced by concanavalin A. Moreover, water soluble fraction was more suppressive than nicotine. These results indicate that nicotine and water soluble fraction are not mitogenic.


The course of untreated Mycobacterium kansasii disease. Four patients with Mycobacterium kansaii pulmonary infection were followed without treatment for 10 to 14 years after diagnosis. Although spontaneous resolution of active disease occurred 5 years after diagnosis in one patient, slowly progressive disease in the absence of significant symptoms was documented in 3 patients during a 12-to-14-year follow-up period. Administration of antituberculous drugs resulted in rapid resolution of signs of active disease in these patients. These observations added to our limited knowledge of the natural history of M. kansasii disease.


Tension pleural effusion. A delayed complication of pneumothorax therapy in tuberculosis. Three cases of delayed development of pleural effusion under tension, 20 to 30 years after therapeutic pneumothorax, are described. A sudden increase in dyspnea and the radiographic findings of increasing opacity, a change from hypovolemia to hypervolemia of the hemithorax, and mediastinal shift should alert one to this delayed complication. Careful thoracentesis to decompress intrapleural tension effusion can relieve the dyspnea and improve hypoxemia. The potential risks of creating excessive negative intrapleural pressure are presented.


Bacteremia related to fiberoptic bronchoscopy. A case report. This is the first reported case of fiberoptic bronchoscopy associated with bacteremia originating in the respiratory tract. The patient had a gram-negative bacterial bronchitis before fiberoptic bronchoscopy and later died of complications of the bacteremia.


An alternate method for fiberoptic bronchoscopic examination of the intubated patient. Fiberoptic bronchoscopy can be performed easily on patients requiring mechanical ventilation through endotracheal or tracheostomy tubes greater than 8 mm inside diameter. In patients with smaller tubes the procedure can still be performed by passing the bronchoscope transnasally and then through the glottis alongside the endotracheal tube.


Respiratory function during prostaglandin-induced labor. In a group of patients receiving intraamniotic injection of prostaglandin F2alpha or intramuscular injection of a methyl analogue of prostaglandin E2 for the termination of pregnancy, significant ariway constriction was demonstrated. The greatest responses were seen in 2 patients who had personal or family histories of asthma. If such patients receive prostaglandins, they should be carefully monitored to detect clinically important airway obstruction.


The antigens participating in the macrophage micration inhibition to Mycoplasma pneumoniae. Recently the association of cellular immunity with pulmonary infiltrates in Mycoplasma pneumoniae infection has been suggested. Guinea pigs infected experimentally with M. pneumoniae developed a cellular hypersensitivity that could be demonstrated in vitro by the macrohage migration inhibition test. Peritoneal exudate cells obtained from guinea pigs sensitized with the organism were inhibited from migrating out of capillary tubes by the whole cell antigen. When the whole cells were extracted with aqueous acetone, the activity was found in the acetone insoluble (lipid-depleted) fraction, but not in lipid fraction. The activity was heat resistant, but diminished by treatment of 0.8 N HC1 at 100 degrees C for 30 min. The antigens responsible for the cellular immunity of M. pneumoniae were separated from the lipid, which had been considered the specific hapten associated with humoral immunity to this organism.


Traumatic duodenal injuries: an analysis of 32 cases. Thirty-two patients were treated for duodenal and associated injuries during the past five years. Fifty-nine per cent resulted from penetrating trauma, while 41 per cent were secondary to blunt injury. The incidence of blunt trauma represents a fourfold increase from previously published series. The morbidity rate still remains high at 47 per cent, with fistulas and infections being the most common complications. The mortality rate was 9.3 per cent, with death resulting from major intra-abdominal vascular injuries. Awareness of the potential injury to the duodenum, aggressive resuscitative measures, early operative management and improved postoperative care can lead to further reduction of these figures.


Disruption of the diaphragm by blunt trauma: new dimensions of diagnosis. Early diagnosis of diaphragmatic defects after blunt trauma is difficult. Multiple co-existing injuries complicate the accurate detection of lacerations of the diaphragm. Roentgenographic evaluation and a "high index of suspicion" have proven to be inefficient and inaccurate, since the average reported time for diagnosis is three and one-half years. Modified peritoneal lavage with intercostal water seal tubes in the pleural spaces is an added dimension of diagnosis. Earlier detection of diaphragmatic defects should become possible by this method.


Penetrating abdominal injuries in children and adolescents. A total of 107 children and adolescents underwent laparotomies for penetrating trauma. There were 64 patients with stab wounds and 43 with gunshot wounds. Only 8 per cent of the patients were under 12 years of age. Three patients died--two from gunshot wounds of major vessels and one from a gunshot wound of the colon. Most of the injuries were related to crimes of violence or were self-inflicted. Multiple organ injuries and postoperative complications were significantly more common among patients with gunshot wounds than in those with stab wounds. Associated extra-abdominal injuries appeared to be more common among patients with gunshot wounds but the difference was not statistically significant. Unnecessary laparotomies were twice as frequent in victims of stab wounds.


Hepatic resection and gastric secretion. These experiments serve to deny the theory that abnormal liver function in the remaining liver tissue after 60-70 per cent hepatic resection might result in gastric acid hypersecretion as a result of a "physiologic shunting" of histamine or other gastric secretagogues.


Mesenteric cysts: a cause of small bowel obstruction in children. Intestinal obstruction secondary to a mesenteric cyst in childhood, although rare, should be considered in the child between ages 2-10 years with chronic or acute obstruction. A case of mesenteric cyst associated with obstruction is presented, along with a review of the literature.


Hernia through the foramen of Winslow.

Hernia through the foramen of Winslow. The authors present a patient who has ascarid-containing jejunum herniated through the foramen of Winslow and incarcerated. Some remarkable anatomic abnormalities were noticed upon operation. These consisted of a short ascending colon, an unusually large foramen of Winslow, and smallness of the greater omentum. Before reduction, resection of the herniated and incarcerated segment of jejunum were performed. Barium enema and swallow are valuable diagnostic acids, as well as the plain film of the abdomen, but we prefer gastrographin study. With it the dangers of perforation and peritonitis are avoided.


Cervical metastasis from an unknown primary. Summary--Forty-nine patients with cervical metastases from unknown primaries were treated during an 11-year period. Thirty-one (63%) of these patients were treated for cure rather than palliation. The three-year survival rate of these patients treated for cure was 39%. Although the treatment of these patients varied, a systematic mode of therapy has evolved: patients with histopathologic diagnosis of epidermoid carcinoma, or undifferentiated malignant tumor, metastatic to the neck from an unknown primary, are treated with full course radiation therapy (6000-7000 rads at 1000 rads per week). This is delivered to the nasopharynx, pyriform fossae, base of tongue, and the neck, and is followed by radical neck dissection in those patients in whom the neck nodes remain palpable. Six of the last 11 consecutive patients treated in this manner are long-term survivors. This paper describes the evaluation of patients with cervical metastases from unknown primaries as well as their therapy.


Viral labyrinthitis -- an experimental study. Summary--An attempt was made to produce viral labyrinthitis in the rhesus monkey. Rhesus monkeys are susceptible to the mumps virus. Nine animals were used. After removal of the stapes, the left oval windows were plugged with Gelfoam soaked in a culture of live mumps virus; right oval windows were plugged with Gelfoam soaked in killed cultures. Animals were sacrificed at different time intervals, postinfection. In eight of the nine animals there was seroconversion from negative to positive; however, none of the animals developed the histologic changes of viral labyrinthitis.


Follicular carcinoma of Hürthle cell type as cause of hemoptysis. Summary--A patient with follicular carcinoma, Hürthle cell type, who developed subglottic extension and uncontrollable hemoptysis is presented . In consideration of the patient's age a conservative therapeutic program was instituted with a definite response to I-131 therapy despite poor radioactive iodine (RAI) uptake by the tumor. Laryngectomy and thyroidectomy were eventually required to control hemoptysis; the patient remains socially functional and asymptomatic after a  30-month period. The two-year period of weekly office visits and temporizing treatment as occurred in this patient cannot be recommended. It seems appropriate to advocate surgical treatment including laryngectomy for follicular carcinoma, Hürthle cell type, localized to the laryngotracheal area without regard for the age of the patient.


Auditory-nerve potentials from ear canals of patients with otologic problems. Summary--The feasibility of making rountine measurements of human auditory-nerve potentials in an office environment is demonstrated. Using a portable device for stimulus generating and response recording, auditory-nerve potentials are recorded from subjects with normal and abnormal hearing by means of an electrode placed on the skin of the ear canal. The results can be compared with those of others obtained under laboratory conditions. Preliminary results indicate that in many instances, the nature of the hearing deficit is related to the latency and size of the click-evoked auditory-nerve potentials. The precise relationships between nerve responses and specific disease conditions are still difficult to formulate.


Scanning evaluation of parotid gland after tympanic neurectomy. Summary--Nine patients suffering from chronic parotitis, gustato sweating syndrome, and gustato lacrymation syndrome underwent tympanic neurectomy. Follow-up showed discrepancies between the good clinical results and the unchanged parotid scans in eight out of nine patients. Parasympathetic bypasses to the parotid gland are discussed.


Acrocephalosyndactly (Apert's syndrome): Temporal bone findings. The middle ear and ossicular chain were not complete in the specimen, but the remnants present appeared normally developed except for the stapediovestibular joint region. The annular ligament was incompletely developed in two areas where fixation by undedifferentiated cartilage occurred. The subarcuate fossa, normally filled with fibrous tissue and usually narrowed by a rim of newly deposited periosteal bone at birth, was unusually large. Included in this fibrous tissue were remnants of the primary cartilaginous capusule undergoing absorption, as well as islands of partially removed endochondral bone. The abnormalities in both instances indicated a disturbance in maturation or resorption of the embryonal cartilaginous capsule.


Laryngeal phonatory reflex. The effect of anesthetization of the internal branch of the superior laryngeal nerve: Acoustic aspects. Summary--The laryngeal phonatory reflex through the internal branch of the superior laryngeal nerve (SLN) was investigated by means of anesthetization of the nerve, after which acoustic signals were subjected to computer analysis to determine how anesthesia affected basic vocal parameters. Results showed that the anesthetization did not affect the abrupt cycle-to-cycle frequency changes and also did not influence the gross control of the fundamental frequency. But slower fluctuation of the fundamental frequency increased following anesthesia. From these results, it is suggested that the anesthetization of the internal branch of the SLN may derange the fine control mechanism of the larynx without affecting overall or gross performance of the phonatory apparatus.


Effect of intracochlear aminooxyacetic acid on cochlear potentials and endolymph composition. Summary--Aminooxyacetic acid (AOAA; 1 MM) when perfused through the scala tympani of guinea pigs produced a biphasic reduction in the endocochlear potential, together with a shift in the input-output functions of the cochlear microphonics and the compound action potential of the cochlear nerve. Since the ionic (Na+, K+) content of the scala media was not alerted, it appears that such changes did not underlie the reduction recorded in the endocochlear potential. The negative direct current potential recorded in the organ of Corti did not appear to be affected by the drug. Attempts to antagonize the effects of AOAA with pyridoxine failed.


Thorotrast (thorium dioxide) granuloma of the neck: Surgical considerations. Summary--Thorotrast (thorium dioxide) is a contrast material which was first used for angiography about 40 years ago. Its use was discontinued because of the reported incidences of malignancy following injection. Its long-term effects are related to its long half-life and slow excretion rate. Following extravasation into the soft tissues of the neck, the prolonged radiation effect results in tissue breakdown with formation of granulomas. There can also be cranial nerve palsies, occlusion of the major blood channels, laryngeal edema, pharyngeal and esophageal ulceration, and fistula formation. To avoid these late consequences, it is suggested that Thorotrast granuloma in the neck be excised radically. Partial or limited resections are inadequate.


Surgical anatomy of the guinea pig ear.

Surgical anatomy of the guinea pig ear. Summary--The basic anatomy of the guinea pig ear is outlined as background for a description of two surgical approaches to the guinea pig temporal bone. These approaches provide acess to the external, middle and inner ear without significant blood loss or mortality. The superior approach, made by incision at the superior anterior attachment of the auricle and removing the lateral wall of the epitympanic space, exposes the round window, epitympanum, lateral canal, and external auditory canal, leaving the tympanic membrane intact. The inferior approach through the neck exposes the cochlea, Eustachian canal, horizontal and posterior semicircular canals, tympanic membrane, and ossicles.


Reassessment of the coagulase and thermostable nuclease tests as means of identifying Staphylococcus aureus. A total of 91 enterotoxigenic strains of Staphylococcus auerus isolated from foods and tested for production of coagulase and thermostable nuclease and the ability to ferment glucose and mannitol showed, with the exception of four strains, a complete correlation among these properties. A similar correlation was observed with 103 cultures of S. aureus isolated from clinical material. In all instances, the coagulase reactions were sufficiently strong to be scored at either the 3+ or 4+ levels. Presumptive staphylococcal cultures isolated during routine examination of foods and yielding 2+ coagulase reactions or lower were invariably negative for thermostable nuclease production. It is suggested that the thermostable nuclease test be performed on cultures with doubtful coagulase reactions before classifying them as S. aureus.


Large tracheal papillomas: A difficult anesthetic problem and an apparent cure. A case report. Summary--A six-year-old female with papillomatosis of the trachea causing respiratory embarrassment was operated upon under general anesthesia. Utilizing a specially designed anesthetic technique to fit the problem and utilizing a cryoprobe followed by electrodessication, the lesions were removed. Furthermore, simple operative procedures and the use of bovine wart vaccine has, over the course of seven months, resulted in an apparent cure.


Fungal air spora at Ibadan, Nigeria.

Fungal air spora at Ibadan, Nigeria. The fungal air spora at Ibadan, Nigeria, was investigated by using Casella Slit Samplers. Three sites, incorporating three locations at each site, were selected for the exposure of replicate plates during sampling. To provide data on a wide range of saprophytic and pathogenic fungal spores, isolations were made on Sabouraud dextrose agar and malt agar plates incubated at 26 and 37 C. Altogether over 60,000 fungal colonies were isolated and counted during the 12-month sampling period. The prevalent fungal genera recorded were: Cladosporium, Curvularia, Fusarium, Aspergillus, Penicillium, Pithomyces, Aureobasidium, Geotrichum, Phoma, Nigrospora, Epicoccum, and Neurospora. The wet and dry seasons (indicated by the temperature, relative humidity, and rainfall data) caused seasonal periodicity in colony numbers. The influence of culture media on the isolated colonies was not significant when the total number of isolated colonies were considered on a monthly basis, but in reviewing a few of the fungal genera there were marked differences between the two media, especially with Pithomyces. Attempts were made to identify some of the isolated colonies by species, e.g., Aspergillus carneus, Aspergillus flavus, Aspergillus fumigatus, Curvularia geniculata, Fusarium oxysporum, Penicillium herquei, Pithomyces chartaum, Rhizopus arrhizus, and Syncephalastrum racemosum. Such identifications proved a basis for further studies on the role of these fungal species in the frontier problem of contamination and biodegradation of drugs and pharmaceuticals, allergies and other problems in the local environment.


Effects of time and growth media on short-chain fatty acid production by Bacteroides fragilis. Gas-liquid chromatography was used to monitor the evolution of short chain fatty acids by Bacteroides fragilis in five media. Acetic and succinic acids, the prominent end products encountered, were readily detected within 24 h. Propionic, isobutyric, isovaleric, and lactic acids were usually recorded in more limited quantities. Maximum rates of bacterial multiplication, glucose catabolism, and end-production coincided with the first 24 h in carbohydrate-supplemented media. Extended incubation (672 h) favored substantial succinate increases in three of five media. These observations suggest that incubation time and composition of the medium are important determinants in short chain fatty acid production by B. fragilis.


Biohazards assessment in large-scale zonal centrifugation. A study was conducted to determine the biohazards associated with use of the large-scale zonal centrifuge for purification of moderate risk oncogenic viruses. To safely and conveniently assess the hazard, coliphage T3 was substituted for the virus in a typical processing procedure performed in a National Cancer Institute contract laboratory. Risk of personnel exposure was found to be minimal during optimal operation but definite potential for virus release from a number of centrifuge components during mechanical malfunction was shown by assay of surface, liquid, and air samples collected during the processing. High concentration of phage was detected in the turbine air exhaust and the seal coolant system when faulty seals were employed. The simulant virus was also found on both the centrifuge chamber interior and rotor surfaces.


Skeletal and tissue lesions resulting from exposure to radium and fission products. The chief effects of absorbed radionuclides and external radiation are radiation osteitis, disturbed bone growth, myelofibrosis and bone tumors. The lesions are dependent in part on localization and character of the radiation and in part on dose. Data on radium have been derived from dial painters, radium chemists and those treated some years ago by oral or parenteral administration.


Effect of water potential on growth and iron oxidation by Thiobacillus ferrooxidans. The effect of water potential on the growth of two strains of Thiobacillus ferrooxidans was determined by adding defined amounts of sodium chloride or glycerol to the culture medium. The two strains differed slightly, and the most tolerant strain had a minimum water potential for growth of minus 15 to minus 32 bars when chloride was used and minus 6 bars when glycerol was used. In another approach, the limiting water potential was determined by equilibrating small amounts of culture medium with atmospheres of relative humidities equivalent to specific water potentials, and the ability of the organism to grow and oxidize ferrous iron was determined. Under these conditions, which are analogous to those which might control water potential in a coal refuse pile or copper leaching dump, the lower limit at which iron oxidation occurred was minus 23 bars. The water potential of some coal refuse materials in which T. ferooxidans was present were determined, and it was found that the water potentials at which the organism was active in these habitats were similar to those at which it was able to grow in culture. However, marked variation in water potential of coal refuse materials was found, presumably due to differences in clays and organic materials, and some coal refuse materials would probably never have water potentials at which the organism could grow. Some literature on the water potentials in copper leach dumps is reviewed, and it is concluded that control of water potential is essential to maximize the success of leaching operations. Because adequate drainage is necessary in a leach dump to ensure sufficient aeration, in many cases water availability in leach dumps may restrict the development of the bacterium necessary for the process.


Toxicity and occurrence of Balansia on grasses from toxic fescue pastures. Balansia epichloe (Weese) and B. henningsiana (Moell.) were isolated from grasses in toxic fescue pastures. B. epichole, cultured in a synthetic medium, was toxic to chicken embryos. Thin-layer chromatography and ultraviolet absorption data indicated that in submerged culture the fungus produced compounds with the indole or ergoline nucleus.


Isolation of Vibrio parahaemolyticus and Vibrio alginolyticus from estuarine areas of Southeastern Alaska. The first reported isolations of halophilic vibrios, including Vibrio parahaemolyticus, from three seafood processing areas in Southeastern Alaska are described.


Limitations of xylose tolerance test as a screening procedure in childhood coeliac disease. The usefulness of the xylose tolerance test as a screening procedure for coeliac disease has been reassessed in 54 children with suspected coeliac disease. 5- and 24-hour urinary excretion rates of xylose were of no value in discriminating between patients with and without coeliac disease; similarly, the 3-hour blood xylose concentration was nondiscriminatory. Three (15-8%) patients with subtotal villous atrophy and 8 (61-5%) with partial villous atrophy due to coeliac disease had one-hour blood xylose values which fell within the normal range. The effect of withdrawal or reintroduction of dietary gluten on sequential one-hour blood xylose levels was variable and generally unhelpful in predicting those patients who developed gluten-induced mucosal changes. The results of the present study emphasize the serious limitations of the xylose tolerance test as a screening procedure in childhood coeliac disease. It is recommended that the use of the urinary xylose test should be abandoned in the paediatric population. A normal one-hour blood xylose value does not exclude a diagnosis of coeliac disease even in young children who have never received a gluten-free diet. A clinical suspicion of coeliac disease remains the most important single factor in deciding whether to preform a jejunal biopsy.


Birth trauma to muscles in babies born by breech delivery and its possible fatal consequences. Dissection and histological examination was made of the muscles of 86 babies who died after breech delivery, and of 38 babies who died after vertex presentation. A control group of 50 surviving breech-delivered babies was examined clinically and the results compared. It was concluded that the most common type of birth trauma to a baby born by breech delivery is injury to muscles and soft tissues of the back and lower extremities, which is often extensive. In some severly injured babies histological examination of organs revels signs of crush syndrome and disseminated intravascular coagulation. It is suggested that the extensive muscle trauma forms the background of these fatal conditions.


Follicular ovarian cysts in stillbirths and neonates. A review of the histology of 332 ovaries from stillbirths and neonatal deaths within the first 28 days of life showed that follicular cysts, lined by granulosa epithelium and having a diameter greater than 1 mm on a microscopical section, were present in 113 infants. In 48 cases multiple cysts were present, while in 65 only a single cyst satisfying the criteria was found. There was an excess number of infants of low birthweight score among those with multiple cysts and the results were highly significant. Cysts, whether single or multiple in distribution, were commoner with increasing gestation, and possibly occurred more commonly in the infants of diabetic mothers and in infants where pregnancy had been complicated by rhesus isoimmunization. The nature of the changes seen in the granulosa lining and theca internal layer surrounding the cysts suggested that these cysts were not some degenerative phenomenon but occured in response to stimulation. It is suggested that homologous changes may occur in the testis of the dysmature male. The possible significance of these findings with regard to hormonal imbalance in the growth-retarded infant is considered, and the need for closer attention to endocrine function in these infants stressed.


Familial hyperargininaemia.

Familial hyperargininaemia. A third case of hyperargininaemia occurring in one family was studied from birth. In cord blood serum arginine concentration was only slightly raised, but arginase activity in red blood cell haemolysates was very low. In the urine on day 2 a typical cystinuria pattern was present. Arginine concentration in serum increased to 158 mumol/100 ml on the 41st day of life. Later determinations of the arginase activity in peripheral blood showed values below the sensitivity of the method. Blood ammonia was consistently high, and cystinuria was present. The enzymatic defect was further displayed by intravenous loading tests with arginine. Serum urea values were predominantly normal or near the lower limit of normal, suggesting the presence of other metabolic pathways of urea synthesis. In urine there was no excretion of guanidinosuccinic acid, while the excretion of other monosubstituted guanidine derivatives was increased, pointing to a connexion with hyperargininaemia. Owing to parental attitude, a low protein diet (1-5 g/kg) was introduced only late. The infant developed severe mental retardation, athetosis, and spasticity.


Rickets in Tehran. Study of 200 cases.

Rickets in Tehran. Study of 200 cases. Radiologically diagnosed rickets was found to be common in children of the poorer classes in Tehran. It was frequently associated with gastroenteritis or bronchopneumonia and a large proportion of the children were severely underweight for their age. In children below the age of 1 year malnutrition tended to mask the signs of rickets. Convulsions were much less frequent in the malnourished children; the concentration of calcium in the serum was higher and that of alkaline phosphatase was lower than in those who were well nourished. Biochemistry is of little value in the diagnosis of rickets in the presence of malnutrition.


Early life of the 'battered child'.

Early life of the 'battered child'. The obstetric histories and early lives of 28 subsequently abused children are reviewed. The youngest child, more often male, was shown to be most 'at risk' especially of the mother was pregnant. Reduced antenatal care, separation of mother and child during the neonatal peroid, illness, poor features. It is felt that these and other difficulties may be regarded as 'environmental pressures' leading to child abuse by susceptible indivisuals, early recognition of such situations could lead to preventive and supportive measures.


Complication of suprapubic bladder aspiration. Suprapubic abscess formation was seen in 2 babies after attempted suprapubic bladder puncture. In both cases the baby was grossly dehydrated and gut contents were aspirated. Though this complication is rare, it should be remembered, as with all investigations, that a definite indication should be present before suprapubic aspiration is undertaken.


Anterior fontanelle size in the neonate. A simple method is described for measuring the area of the anterior fontanelle at birth. Normal values in preterm and term infants suggest enlargement of the fontanelle with gestational age. Small-for-dates infants have significantly larger anterior fontanelles than either preterm or term infants. Knowledge of the normal variation in anterior fontanelle size may be of help in the early diagnosis of congenital hypothyroidism or provide a clue to other disorders of skeletal development.


Rheumatoid synovitis and joint disease. Relationship between arthroscopic and histological changes. Arthroscopic and histological synovial features have been studied in forty-two patients with classical or definite rheumatoid arthritis. A total index of disease activity as judged arthroscopically correlates significantly with a total index of histological activity. In those patients who have dense, waxy looking villi, the intensity of the villus-proliferation is associated with lymphocytic infiltration of the synovium. No relationship between synovial lining cell proliferation and cartilage disease nor between sparsity of lymphocyte infiltration and cartilage disease could be established.


Development of periarticular osteophytes in experimentally induced osteoarthritis in the dog. A study using microradiographic, microangiographic, and fluorescent bone-labelling techniques. (1) The development of periarticular osteophytes in experimental osteoarthritis in the dog degins as early as 3 days after induction of the disease process. (2) Development of the osteophytes is still proceeding 48 weeks after induction. (3) The common site for development of the osteophyte is at the marginal zone where synovial membrane merges with fibrocartilage. (4) At this site the osteophyte begins as a deposition of outside the existing femoral bone cortex. (5) Further deposition of new bone and resorption lead to a remodelling which ultimately produces a mature osteophyte having a trabecular bone structure and free communication with the bone marrow spaces of the femur. (6) In some dogs there is also hyperplasia of bone with remodelling which takes place beneath the cartilage of the nonarticulating face of the trochlear ridge. This develops a mature trabecular structure later in the disease process and may become confluent with the osteophyte at the marginal zone. (7) The bone changes are not confined to development of the osteophyte. The whole distal end of the femur appears to have a marked increase in bone turnover, and there is also evidence of increased bone metabolism in the contralateral limb. (8) Dye injection techniques have shown that an increase in vascularity is associated with this development of new bone, and it is suggested that the results indicate the possible importance of a vascular component in the pathogenesis of osteoarthritis.


Development with age of human articular cartilage surface structure. A survey by interference microscopy of the lateral femoral condyle. The weight-bearing surfaces of the lateral femoral condyles taken from twenty normal human cadavers aged 0-47 years have been examined by reflected light interference microscopy (RLIM) and by scanning electron microscope (SEM). The surfaces appeared normal by naked eye examination. The presence of both 200-400 mum diameter secondary undulations and small ovoid 20-45 mum diameter tertiary hollows was confirmed in all specimens using both techniques. Measurements by RLIM showed that the tertiary hollows increase significantly in depth and diameter with increasing age. A further order of quaternary surface irregularities was shown. Small irregular ridges, 130-275 nm deep and 1-4 mum diameter, were found with increasing frequency on specimens obtained from persons aged 21 years. These quaternary irregularities are thought to be due to exposure of superficial fibre bundles after the loss, with age, of surface ground substance.


Virus antibodies in serum and synovial fluid of patients with rheumatoid arthritis and other connective tissue diseases. Rubella and influenza A (H3N2) haemagglutination inhibition (HI) antibody titres and measles complement-fixing (CF), haemagglutination inhibition (HI), haemolysis inhibition (HLI), and ribonucleoprotein gel precipitation (RNP-GP) antibody titres were studied in the serum and synovial fluid of twenty patients with rheumatoid arthritis (RA), two patients with ankylosing spondylitis, and two patients with Reiter's syndrome. Antibody titres were also studied in the serum and CSF of four patients with systemic lupus erythematosus (SLE), one patient with dermatomyositis, and in the synovial fluid only of five patients with osteoarthritic knee effusions. Antibodies were found with each serological technique used in the synovial fluid of RA patients and the antibody titres were usually at about the same level as in the serum. The mean measles (HI, HLI, and RNP-GP) antibody titres were 4 to 6 times higher in the synovial fluid of RA patients than in synovial fluid of patients with osteoarthritic knee effusions, but a corresponding difference was not found in rubella and influenza A antibody titres. The mean measles antibody titres (CF, HI, HKI, and RNP-GP) were consistently higher in the synovial fluid of RA patients without rheumatoid factor than in the synovial fluid of RA patients with rheumatoid factor. In serum this difference was observed only with measles CF titres. The mean measles, antibody titres were consistently lower in the serum and synovial fluid of the RA patients without the synovial fluid haemolytic complement than in the RA patients with this haemolytic complement. No similar differences were found in the rubella and influenza antibody titres. No significant measles antibody titres were found in the CSF of patients with SLE or dermatomyositis.


Acute knee joint rupture after yttrium 90 injection. Two cases of acute rupture of the knee joint are reported after the intra-articular injection of radioactive yttrium 90. It is suggested that this may be a complication of intra-articular radioactive injections.


Histological study of effects of colloidal 90 yttrium on knee joint tissues of rabbits. The administration of 0-2-0-4 mCi 90 yttrium (90Y) into a normal rabbit knee joint fails to induce medical synovectomy and results in the proliferation of the synovialis. The synovial mesothelium shows early radiation damage but subsequently follows a restitution of the whole. Later (within 4 to 16 weeks) an extensive fibrosis of the stratum synovialis develops, as well as an occlusion and sclerosis of smaller synovial vessels and capillaries. These changes explain the beneficial therapeutic effect of 90Y in a chronic inflammatory joint effusion. After irradiation that joint cartilage shows an increased cellular proliferation of the superficial tangential cells and in the vicinity of the cruciate ligaments small foci of degenerated cartilage are present. The overall pattern of a joint treated with intra-articular 90Y corresponds to the histological pattern encountered regularly in joints of older people. Changes of the cartilage after the 90Y radiation could represent a factor predisposing the treated joint to a subsequent development of osteoarthrosis.


Lack of correlation of synovial histology with joint damage in rheumatoid arthritis. Twenty-two patients with rheumatoid arthritis (RA) involving the knee were studied. The systemic features of the disease were graded and the extent of knee involvement was quantified in terms of the clinical, radiological, and arthroscopic appearances. Adequate synovial biopsies were obtained from 21 patients. In these patients no correlation could be found between the severity of any of the features on histological examination nor between any of these features and the extent of local joint damage, inflammation, or the severity of the systemic disease.


Terminal phalageal osteosclerosis.

Terminal phalageal osteosclerosis. Osteosclerosis of the terminal finger phalanges was assessed by means of a grading score in two age-matched groups of 96 females, each suffering from rheumatoid arthritis (RA) and osteoarthrosis (OA), respectively, and in a sample of 894 males and females, above the age of 44 years, from Dutch small town populations. Cortical thickness of the therminal phalanges decreases markedly with age. Whereas in the age group 45-54 years, terminal phalangeal osteosclerosis is more pronounced in females, at higher ages the difference between the sexes disappears. The diameter of the terminal cortex increases gradually from the second to the fifth finger. No differences were found between the RA and the OA groups, nor were these groups different from the population survey except for a lower incidence of terminal phalangeal osteosclerosis in female osteoarthrotics between 45 and 55 years of age, compared to females of the same age group from the population sample.


Temporo-mandibular joint disease in ankylosing spondylitis. The occurrence of temporo-mandibular joint (TMJ) disease in ankylosing spondylitis is not widely recognized and its incidence is disputed. Seventy-nine patients attending two routine rheumatology clinics were therefore examined by dental surgeon and nine (11-5 per cent) were considered to have specific TMJ involvement. These patients were older than the remainder, and had more extensive spinal and peripheral joint disease. Symptoms were mild and the predominant clinical feature was restricted mouth opening, which could present considerable difficulties during emergency anaesthesia. Bilateral condylectomy was undertaken in one patient with some benefit.


Pre-ankylosing spondylitis. Histopathological report. A novel explanation for the natural history of joint destruction in the early phase of ankylosing spondylitis is proposed on the basis of the clinical history, x-ray appearance, operative findings, and histopathology of a young patient believed to be suffering from the peripheral form of this disease.


Rheumatoid plantar synovial cysts.

Rheumatoid plantar synovial cysts. A patient is described with rheumatoid arthritis and a painful synovial cyst, which originated from a metatarsophalangeal joint and presented as a swelling on the plantar surface of the foot. The cyst was successfully excised.


Detection of the predators of Simulium damnosum by the precipitin test. Saline cell free extracts of larvae of the Simulium damnosum complex were used to immunize rabbits for the production of damnosum-antisera. Injections into the lymph nodes produced a more specific antiserum than was obtained by intramuscular injection followed by absorption. This antiserum was used to identify by the precipitin test natural predators of S. damnosum collected from the bandama River in the Ivory Coast. Various trichopteran larvae and odonatan nymphs and adults were found to be the most important predators.


Paederus (Coleoptera: Staphylinidae) in Uganda. I: Outbreaks, clinical effects, extraction and bioassay of the vesicating toxin. A brief review is made of the extensive, scattered and sometimes conflicting literature concerning outbreaks and effects of the vesicating Staphylinid beetles of the genus Paederus and their toxin. Observations are reported on outbreaks of Paederus sabaeus and Pachypaederus puncticollis which occurred in Uganda in 1961-62 and subsequently. Clinical effects seen in Kampala are described and a case of ocular involvement is reported in detail. It was found that the cuticle of P. sabaeus must be broken and haemolymph released for any reaction to follow, that the mucosa of the mouth is relatively little affected by the toxin, and that Pachypaederus puncticollis possesses similar vesicating properties to the Paederus species. Methods of extraction of toxin from the beetles using various solvents and a bioassay technique based on mean daily scores of reaction on mouse ears are described. Problems of treatment are discussed.


Some aspects of the ecology and lifecycle of Amblyomma cajennense (Fabricius 1787) in Trinidad and their influence on tick control measures. The distribution in Trinidad of the tick Amblyomma cajennense is defined, and the methods used to determine the boundaries of the infested areas are outlined. The relationships between climate, vegetation and husbandry methods and the distribution of the tick are described. Monthly tick collections from specific animals to determine exact seasonal variations were not possible but a study was made of the normal life cycle under laboratory conditions, the results being used to assist in interpreting the field picture and formulating methods of control. Possible systems of control are outlined and mention is made of the feasibility of eradication of the species in Trinidad.


Studies on isolation and drug sensitivity of Trypanosoma vivax in northern Nigeria. In a study to investigate the occurrence in cattle of Trypanosoma vivax strains resistant to the normal therapeutic dose of homidium, 47 isolates of T. vivax were collected from 10 different trypanosomiasis treatment centres in the North Central State of Nigeria. Of these 47 isolates, 23 produced infection in the experimental animals that were used for subsequent drug sensitivity trials. While all but one of the experimental cattle inoculated with T. vivax became infected, less than 50% of the experimental sheep and none of the experimental goats were able to reproduce infection. This difference in infectivity is discussed and related to the stage of the T. vivax infection in the donor cattle. None of the 23 isolates of T. vivax was resistant to homidium. The value of sheep and goats in T. vivax experiments is discussed.


Anti-leishmania activity of normal animal sera. The growth inhibition activity of normal human, dog, rabbit, guinea pig, rat, sheep, cat, mouse and chicken sera was quantified against Leishmania enriettii and Leishmania tropica. The pattern of anti-L. enriettii activity of various animal sera was somewhat different from that observed in L. tropica. Against L. enriettii, mouse serum was inactive, and against L. tropica rat and mouse sera were inactive. All the other animal sera tested had growth inhibition activity on both leishmanias. This growth-inhibiting factor was found to be heat-labile, complement dependent, adsorbable by the specific organism and non-dialyzable. Only the first few subcultures of leishmania were affected by the active sera.


Surveys for amoebiasis; interpretation of data and their implications. In survey work, stool microscopy for cysts and serology are the only really practicable measures of amoebic infection. The diagnostic sensitivity of stool microscopy should be estimated. Using a simple deterministic mathematical model, the rates of gain and loss of infection and seropositivity may be estimated from survey data. The low value of the constants creates difficulties but they can be estimated from: (1) cumulative data from frequently sampled cohorts; (2) analysis of the curves of age prevalence; (3) analysis of curves of long-term follow-up studies. The second method is the simplest and normally gives valid results. Appropriate epidemiological studies can give useful information about protective immunity, incubation period, superinfection, and interactions between amoebic infection and various host factors, including other disease states. Knowledge of the rate constants of infection allows predictions to be made about the likely effect of control measures.


Arthropod-borne viral infections of man in Nigeria, 1964-1970. During the years 1964 to 1970, 171 arboviruses of 15 different types were isolated from humans in Nigeria. Isolation rates were highest in 1969, and lowest in 1965 and 1967. Monthly arbovirus activity was highest in the rainy season months of June, July and August and lowest in the dry months of January and February. Viruses were isolated from all age groups, with the majority from children one to four years old. The viruses isolated in largest numbers were chikungunya and yellow fever, which caused epidemics in 1969, and dengue types 1 and 2 and Tataguine, which are endemic in Ibadan. Bwamba virus was isolated in 1964 and 1969, and Bunyamwera group viruses were encountered for the first time in 1969. Other viruses recovered less frequently were Zika, Igbo-Ora (an agent related to o'nyong-nyong), two viruses related to the Uganda mosquito virus Ug MP 359, Dugbe, Thogoto, Lebombo and Shuni. Several of these are new agents and have not previously been isolated from man. Clinical details are presented where available.


A survey of species A and B of the Anopheles gambiae Giles complex in the Kisumu area of Kenya prior to insecticidal spraying with OMS-43 (fenitrothion). Throughout 1972 surveys were made in Kenya on the Anopheles gambiae Giles complex in an area near Kisumu, part of which was to have all houses sprayed with OMS-43 (fenitrothion) the following year. Pre-spray data was collected on monthly hut densities, man-biting rates, parity and the human blood indices and sporozoite rates of A. gambiae caught in both an area designated for spraying (evaluation zone) and a comparison zone which was to remain unsprayed. The sporozoite rates, host preferences, and population size of the A. gambiae comples in relation to the human population were similar in the two zones. Few adults were collected from artificial pit-shelters in either zone. Cytotaxonomic identifications showed that although species A of the A. gambiae comples predominated throughout the year, the population of species B decreased relatively less in the drier months than that of species A. No marked differences were found between the host preferences or sporozoite rates of the two species.


The customer approach to patienthood. Attending to patient requests in a walk-in clinic. This report conceptualizes the initial psychiatric interview as a process of negotiation between the clinician and patient. Patients are conceived of as appearing with one or more requests, many of which represent legitimate needs. It is the clinician's task to elicit the request, collect the relevant clinical data, and enter into a "negotiation" that should foster a relationship of mutual influence between patient and clinician. We have attempted to show that this approach to patienthood not only improves patient care and patient satisfaction but also leads to improved staff morale. The "customer approach" has special relevance to those clinical settings (walk-in clinics and community mental health centers) in which clinicians see a broad range of patients with a broad definition of psychiatric problems and requests.


Personality factors influencing vocational rehabilitation. Fifty male patients with chronic renal conditions and receiving hemodialysis underwent psychiatric examination and repeated followups in a predictive study aimed at elucidating personality factors that influence vocational rehabilitation. Previous level of functioning, satisfaction with work, sick role, and patients' dependency needs were found to influence substantially the level of vocational rehabilitation. All the data collected in the present study indicate that "rehabilitation" should start at a much earlier stage and aim at preventing regression.


Attitudes and fantasy themes of patients on a psychiatric research unit. A systematic investigation of patients' attitudes and fantasies on a psychiatric research unit showed that initial attitudes were most indicative of whether or not the patient was willing to cooperate with the regimen. Surprisingly, being subjected to no research was associated with negative attitudes at mid-hospitalization. Negative attitudes were also associated with poor clinical competence rating of the primary physician. At the end of their hospitalization, most of the patients had positive attitudes toward the unit and the fantasy theme that was most prevalent at that time was "research is therapy."


The written summary as a group psychotherapy technique. During the past 18 months, we have been preparing detailed written summaries of the events of group therapy meetings, which have then been mailed to the group members. This technique was introduced initially as a device to provide structure in a very anxious group. We soon realized that the summary had a great potential for enhancing therapist effectiveness and it came to assume a number of other functions. In this report, we describe our experience with this technique, emphasizing its importance as a tool to improve the cognitive integration of the group therapy experience for both patient and therapist.


Causalgia.

Causalgia. Causalgia is a distressing syndrome which should be diagnosed and treated promptly. A presumptive diagnosis can be made on the basis of the existence of burning pain, autonomic dysfunction and atrophic changes. Confirmation of diagnosis can be obtained by assessing the results of a sympathetic block. Some patients with causalgia may be mistaken for "hysterics" or "malingerers." Treatment may require physical and occupational therapy, analgesics, tranquilizers, sympathetic block or sympathectomy. The merits of adrenergic blocking agents, percutaneous electrical stimulation, dorsal column stimulation and acupuncture are still to be evaluated.


Initial work tolerance of extremely obese patients. Initial work tolerance (walking) of 16 extremely obese (133 to 238 kg) patients entering a multidisciplinary rehabilitation program was low, as previously reported, but also highly variable. Some were capable of walking one mile nonstop while others required as much as eight weeks of progressive exercise training to reach this goal. Treadmill test - indirect calorimetry results indicate that patients required approximately 20 minutes to walk one mile at their fastest pace (3 mph), displayed near steady state aerobic metabolism and expended approximately 150 to 200 net kcal/mile. Patients were screened for abnormal cardiac responses to work using graded exercise test procedures with electrocardiography and there were no apparent hazardous episodes during rehabilitative training.


Energy expenditure of ambulation in patients with above-knee amputations. Oxygen consumption during ambulation was measured in nine middle-aged or elderly subjects having above-knee amputations, in an effort to determine the mode of ambulation and prosthetic prescription requiring the least energy expenditure. Studies revealed that crutch walking and prosthetic ambulation require the same energy expenditure; that there is no significant difference between the energy requirements of ambulating with knee locked or unlocked; and that 65 percent more energy is required at approximately one-half the normal speed of ambulation for above-knee amputees as compared to normal persons.


Conditioning of postcoronary patients: comparison of continuous and interval training. Interval training is theoretically attractive as a means of training the postcoronary patient, since by appropriate choice of exercise and recovery intervals substantial cardiac training can be achieved without the accumulation of anaerobic metabolities and associated increases of blood pressure and cardiac work load. Six patients with frequent exercise-induced anginal attacks coped well with a program based upon running or jogging (1/2 to 1 minute) followed by 1 to 1-1/2 minutes of slow walking. Despite a poor previous response to several months of continuous training, they showed a substantial gain of aerobic power with one year on the interval regimen. The ST segmental response to a fixed increment of pulse rate remained unimproved, but probably because of the enhanced cardiorespiratory fitness, the ST depression at a fixed work load was lessended. Twenty other patients who had also followed a continuous exercise regimen for up to one year were switched to interval-type work. Over the next year they failed to progress as fast as a group of 15 patientswho persisted with continuous effort training. While interval work is helpful to the severely disabled anginal patient, it apparently leads to slower progress in the average postcoronary patient.


Renal function in patients with spinal cord injury: the eighth year of a ten-year continuing study. In the eighth year of a continuing study of renal function in patients with spinal cord injury, 78 percent had good function, 13 percent mild deterioration, 4 percent moderate deterioration and 5 percent severe deterioration of kidney function. No single factor was shown to be a dominant cause of decreased function. The factors most frequently associated with renal deterioration were vesicoureteral reflux, renal calculi, recurrent pyelonephritis as demonstrated by calyceal blunting, and recurrent decubitus ulcers, the latter usually in combination with other factors. Most of these factors could be prevented by good medical supervision and meticulous self-care.


Electromyography in paraspinal muscles following surgery for root compression. The paraspinal muscles were examined by electromyography (EMG) in 20 patients who had undergone laminectomy for root compression in the lumbosacral region. Cases were carefully selected to include only those in which there was no evidence of recurrent radiculopathy. The precise anatomic sites having electromyographic (EMG) abnormalities (fibrillation potentials and positive sharp waves) were determined. These data were obtained to determine if EMG of paraspinal muscles following laminectomy is useful in patients with a suspected recurrence. EMG was done 1 cm and 3 cm lateral from the midline at each vertebral level from L3 through S2. The interval between surgery and EMG ranged from 3-1/2 to 41 months. Seventeen of the 20 cases showed EMG abnormalities; and of these, 15 were abnormal at three or more vertebral levels and 13 at both 1 cm and 3 cm from the midline. It was shown that patients who have undergone laminectomy for root compression may demonstrate EMG changes in the paraspinal muscles for periods of up to 41 months postoperatively even without recurrent radiculopathy. The abnormalities are usually present at both 1 and 3 cm lateral from the midline and at multiple vertebral levels.


Recurrent superior mesenteric artery syndrome in a quadriplegic patient. Recurrent superior mesenteric artery syndrome occurs less frequently than other complications in patients having high spinal cord injury. However, as illustrated by the case reported here, it is important that the clinician be aware of the possibility of this syndrome in such patients.


Nervous system degeneration produced by the industrial solvent methyl n-butyl ketone. Because of a number of cases of peripheral neuropathy that occurred in factory workers employed in a fabric-printing plant in 1973, chronic inhalation experiments have been conducted using the printing-ink solvents methyl n-butyl ketone (MBK) and methyl iso-butyl ketone (MIBK). After four months of intermittent respiratory exposure to 1,300 parts per million (ppm) MBK, all six rats tested developed severe symmetric weakness in the hindlimbs. Morphological studies showed massive focal axonal enlargements containing abnormally large numbers of neurofilaments and dying-back axonal degeneration in peripheral and central nerve fibers. Six rats similarly exposed for five months to 1,500 ppm of MIBK showed minimal distal axonal change, but remained neurologically intact. The principal conclusion of this study is that MBK is a neurotoxin in rats.


Familial cerebrotendinous xanthomatosis. Report of a new family and review of the literature. Cerebrotendinous xanthomatosis occurred in a new family. This is a rare familial disorder characterized by juvenile cataracts, enlargement of tendons, low intelligence, and a variable neurological syndrome with cerebellar ataxia as the most prominent feature. The mode of inheritance is autosomal recessive. The basic defect remains obscure, but recent investigations have shown an excess of cholestanol in the tissues and serum of affected persons, which forms the basis of diagnosis.


Complications of phenol neuroloysis.

Complications of phenol neuroloysis. Phenolic stellate ganglion blockade caused triparesis in one patient, and phenolic neurolysis of cervical posterior roots caused respiratory arrest in another. These complications illustrate the dangers of the spread of phenol beyond the intended site of neurolysis with resultant local anesthesia, direct neural damage, vascular damage, and infarcts.


Human masseter muscle: H- and tendon reflexes. Their paradoxical potentiation by muscle vibration. We developed a method for direct electrical stimulation of the masseter nerve in man. Both direct M-reponses and genuine H-reflexes were recorded from the ipsilateral masseter muscle. Muscle vibration that inhibits the Achilles tendon reflex and the soleus H-reflex was found to potentiate the masseter tendon reflex and also the masseter H-reflex. This unexpected contrast may be related to peculiar brain stem circuitry of the masseter reflex mechanism.


Cerebral hemispheric asymmetry in humans. Cortical speech zones in 100 adults and 100 infant brains. Morphological asymmetry of the frontal operculum and temporal planum becomes measurable at the 29th week of gestation. There is evidence of subsequent differential development of the planum in favor of the left, with the left planum larger than the right. While both the frontal operculum and left planum were always present, the right planum ranged in size from absent (10%)to larger than the left (about 10%). Females predominated (P less than .05) in the latter group. The findings suggest that (1) a higher percentage of persons may have right-sided cerebral representation for speech than has been assumed previously; (2) a predetermined morphological asymmetry contributes to establishing the ultimate pattern of cerebral speech representation following an early insult to a predisposed hemisphere; and (3) it is necessary to scrutinize clinical material for the differential organization of hemispheric development between sexes.


Multiple cerebral aneurysms and cardiac myxoma. Neurological signs are a frequent manifestation of left atrial myxoma, but the association of cardiac myxoma with multiple cerebral aneurysms is rare. A case of left atrial myxoma was detected in the course of a long-lasting psychiatric and neurological illness. Four-vessel study showed the presence of multiple saccular and fusiform aneurysms, regularly and almost symmetrically distributed. The intracardiac mass was removed, and the patient improved.


The resultant force on the femoral head in rheumatoid arthritis. The resultant force on the femoral head was measured by suing a roentgenographic method in 100 rheumatoid patients (152 hips) who had Charnley arthroplasties.  Postoperative avulsion of the greater trochanter has been frequently observed in the rheumatoid hip. After operation the resultant force and the abductor pull were increased in 18 of 31 with the detached trochanter, whereas decreased in the non-detached group in 81 of 121. In the hips with acetabular protrusion, preoperative values of the force were less than in that the trochanter united and postoperative increase in the abductor force was noted. This seems to be related to the great tendency for trochanteric avulsion in this group.


[Effects of various solvents on skin surface lipid composition]. 1. Samples of cutaneous sebum were taken from different skin regions, according to the method of Herrmann and Prose. 2. Some samples were removed from the skin using diethyl ether, while others were removed under similar conditions, with cyclohexane. 3. As a rule, thin-layer chromatography revealed darker, clearer and more numerous bands after the use of diethyl ether, than after the use of cyclohexane. However, some exceptions were seen. 4. The chromatograms showed individual differences while the differences between the samples taken from different skin regions of one and the same person were less considerable. 5. Despite the individual differences, the samples taken from persons without skin diseases showed some characteristic features.


Skin irritancy and sensitivity to laundry detergents containing proteolytic enzymes. Part I. In the present study the contact irritative--eczematogenic--effect of alkaline protease enzymes (PE) contained in syndet laundry detergents has been investigated. The method employed was the occlusive epicutaneous test (ET) involving the use of increasing serial dilutions of PE and various times of exposure. The tests were made on sympton-free skin, on skin showing premorbid or slight irritative changes, on skin previously acid- or base-treated, in the presence of increased skin permeability and following the skin stripping method. The results obtained in the 912 test series indicate that the PEs tested ("Tenzym prilled" Grindstedvoerkek, and "Maxatase" Gist-Brocases) caused no irritation or other damage to the intact or slightly lesioned skin even in response to close contact lasting several days. When as a result of increased irritation, or for other reasons, the PEs may be assumed to penetrate into the subcorneal layers, they may exert a proteolytic effect, as manifested in the increasing number of positive ETs. In such cases the PE concentrations exceeded by far those employed in the commercial detergents. It is most likely that the skin changes noted in connection with the use of bioactive laundry detergents are due not to the PE content of these detergents, but to other factors.


Studies on hypersensitivity to "para group". The author reports the results of patch tests using various aromatic compounds in subjects sensitized to PPD. It was found that aromatic nitro and hydroxyl compounds as well as secondary and tertiary amines do not cause cross-reactions. Positive reactions were obtained only with primary aromatic amines, independently of the position of the amino group in the ring-para, ortho or meta.


Nonvirionic inhibitor of DNA synthesis in human embryo fibroblast cell cultures infected with rubella virus. Human embryo fibroblast cell cultures (RU-I) infected with virulent and attentuated strains of rubella virus of treated with a cell extract form infected and from control cultures have been studies in respect of their mitotic activity by evaluating the (3-H) thymidine uptake by autoradiography. The results show the presence in infected cell cultures of a nonvirionic inhibitor of DNA synthesis, which is detectable in control cell cultures too, though to a lesser degree. The relation of this inhibitor to the chalone system is so far unclear. No effect of the extracts on human chromosome pattern was observed. Attempts of biochemical characterization by fractionation of 14-C-labeled extracts on polyacrylamide gel followed by autoradiography were unsuccessful.


[1:7 ratio in the distribution of adw and ayw subtypes in a population of HBs Ag-positive hepatitis patients in northern Italy]. The subtypes of HBsAg have been determined in 41 cases of acute type B hepatitis by counterelectrophoresis (CEP) using mono-specific D (anti-d), Y (anti-y), W (anti-w) and R (anti-r) antisera following Dr. Holland's technique.  In 36 cases (87.8 percent) the subtype was ayw and in 5 (12.3 per cent) adw.  Neither r subtypes nor simultaneous presence in the same patient of both d and y subtypes were detected.  The subtype distribution in Itayl is closely related to the observed distribution of d/y subtypes in the Mediterranean countries, except for Spain, showing a pattern similar to that of Central and Northern Europe countries.


[The antigenic structure of Toxoplasma gondii.  III. Behavior of human sera as compared with purified antigens]. 263 human serum samples obtained from 9 controls and 42 patients with clinical diagnosis suggestive for toxoplasmosis were examined by means of Sabin and Feldman's dye test (DT) in comparison with complement fixation test (CF) with a whole toxoplasma antigen.  6 out of 9 controls and 21 out of 42 patients showed analogous behaviour in both methods while the remaining ones behaved differently.  24 out of the 42 patients as well as the 9 controls were chosen between these two groups (showing concordant or discordant DT/CF behaviour) to determine the presence or absence of anti-"polysaccharide" and anti-"protein" antibodies against purified antigens by means of CF test.  Presence of anti-polysaccharide antibodies was shown in 15 subjects (4 out of 17 "DT/CF discordant" groups) and antiprotien antibodies in 8 patients (2 and 6 respectively in the two groups).  Antibodies against these two purified antigens were never shown in the 9 normal people.  Critical as well as hypothetical implications concerning the results so far obtained are discussed.


Purification and concentration of influenza inactivated viruses by continuous-flow zonal centrifugation. A mathod is described for the purification, on an industrial scale, of influenza viruses grown in allantoic cavity of embryonated eggs.  The mehtod consists of combining continuous-flow centrifugation with zonal centrifugation in a sucrose (36.6 per cent-52.5 per cent w/v) density gradient.  The sample flow rate is approximately 3.7 litres/h and the volumes treated vary between 3 and 33 litres of allantoic fluid.  Both the recovery of the virus and the degree of concentration and purification result satisfactory.


Complete heart block as a consequence of atriondal discontinuity. We have recently studied a case of complete heart block in which there was considerable difficulty in deciding whether it was of congenital or acquired origin. This was because the heart block was first discovered at the age of 2 years in the course of acute diphtheria. Though diphtheritic infections are known to affect the cardiac conduction system, authenticated cases of post-diphtheritic block persisting after the infection are rare, and, furthermore, histopathological study in this case revealed discontinuity between the atrial tissues and the more peripheral parts of the atrioventricular conduction tissues. This has been more commonly observed in congenital cases of complete heart block and it has been postulated on theoretical grounds that this could be thebasis for congenital heart block; on the other hand, it has been noted in a single casethought to be of acquired origin. Review of the evidence available failed to allow accurate classification of the case into either congenital or acquired categories. Thenormal, segmental development of the atrioventricular node, each segment being of different embryological origin, is discussed and the case presented is understandable in thelight of this.