Use of dermal flaps about the breasts during major reconstruction

During major breast surgery, we have achieved superior results by securing a dermal flap to the chest wall. This technique has been used successfully for the past three years with improvement in breast contour, prevention of ptosis, and less pronounced scarring than is produced by techniques of the past.

Rhytidectomies in office operating rooms

We report our experiences in 100 consecutive face lifts done in a well-equipped office operating room, and we believe the results answer the question about the safety of face lifts being done in this manner in a carefully screened population. With the application of our preoperative criteria for patient selection, the complication rate in these outpatients compares favorably with the reported rates in inpatient series of face lifts. Patient satisfaction has been higher, we feel.

Anti-lymphocyte antibody levels in chronic lymphocytic leukaemia

A radioimmunoassay for measuring levels of lymphocyte autoantibody in chronic lymphocytic leukaemia (CLL) has been developed. Antibody in the form of crude IgG was extracted from patients' sera and iodinated. The assay utilizes its cross-reactivity with other CLL cells. Levels were measured in 23 patients. The results show that an inverse relationship exists between the quantity of circulating CLL autoantibodies and the number of mouse red blood cell rosetting lymphocytes (M cells). The preliminary findings do not correlate with disease activity although it is our impression that patients who are maintaining higher levels of autoantibody and fewer M-rosetting cells have nonprogressive disease.

Results with commercial radioassay kits compared with microbiological assay of folate in serum and whole-blood

We compared results with three commercial folate radioassay kits [Bio-Rad, New England Nuclear (NEN), and RIA Products] with those by microbiological assay for more than 200 samples of human serum and whole blood. All but one kit (NEN) compared favorably with the microbiological assay for serum samples, although there were notable diagnostic discrepancies. Two kits (NEN and Bio-Rad) were tested on whole-blood samples; both yielded values significantly higher than those by microbiological assay. The frequency distributions of erythrocyte folate data differed strikingly between the two kits; the NEN method yielded a much narrower range of normal values than did either the Bio-Rad or the microbiological assay. Radioassay kits appear to be suitable diagnostic agents for serum folate, if the behavior of a particular kit is investigated thoroughly before its routine use. However, the diagnostic value of radioassays of erythrocyte folate needs to be validated.

Results with commercial radioassay kits compared with microbiological assay of folate in serum and whole-blood

We compared results with three commercial folate radioassay kits [Bio-Rad, New England Nuclear (NEN), and RIA Products] with those by microbiological assay for more than 200 samples of human serum and whole blood. All but one kit (NEN) compared favorably with the microbiological assay for serum samples, although there were notable diagnostic discrepancies. Two kits (NEN and Bio-Rad) were tested on whole-blood samples; both yielded values significantly higher than those by microbiological assay. The frequency distributions of erythrocyte folate data differed strikingly between the two kits; the NEN method yielded a much narrower range of normal values than did either the Bio-Rad or the microbiological assay. Radioassay kits appear to be suitable diagnostic agents for serum folate, if the behavior of a particular kit is investigated thoroughly before its routine use. However, the diagnostic value of radioassays of erythrocyte folate needs to be validated.

Immune complexes in myelofibrosis: a possible guide to management

Using a fluorescent technique intracellular immune complexes were found in the peripheral leucocytes in all of 12 patients with myelofibrosis studied. Fluorescent cells varied from 12% to 81%; with no relation to the total white count or any obvious clinical finding. Three of the patients with severe refractory anaemia benefited from immunosuppressive therapy.

Fluorescein test for prediction of flap viability during breast reconstructions

The fluorescein test is a useful ancillary procedure for predicting the viability of breast flaps in reconstructive procedures after subcutaneous mastectomy or radial mastectomy.

Autoimmune antibodies in chronic lymphatic leukaemia

In chronic lymphocytic leukaemia a factor in patients' serum enhances the in vitro viability of the abnormal cells and this has been identified as an antibody. The activity of this factor can be removed by interaction with anti-immunoglobulin and by ammonium sulphate precipitation with a degree of saturation in excess of 46%. Cohn fractionation and chromatography with A-50 Sephadex show that the factor is not a complex but an immunoglobulin. No activity is removed after reaction of sera with 2-mercapto-ethanol and di-thiothreitol. The evidence therefore suggests that a gamma-G immunoglobulin is involved. Concentrated washings from the leukaemic cells behave in exactly the same way as patients' sera and activity is retained in the same fraction during precipitation and purification procedure. The extensive cross-reactivity of the sera suggests a common chronic lymphatic leukaemic antibody and it is considered that an active autoimmune response may be an integral part of the disease.

Immune complexes in myeloproliferative disorders

A fluorescein-labelled anti-human immunoglobulin was used to demonstrate that peripheral blood from patients with myelofibrosis had a high proportion of phagocytic cells containing fluorescent immune complexes. Cells from patients with other myeloproliferative diseases (either chronic myeloid leukaemia or polycythaemia rubra vera) did not show similar intracellular immune complexes. Serum from patients with myelofibrosis incubated with polymorphs from healthy subjects caused the appearance of inclusions similar to those found when the patients' own cells were used, the healthy phagocytes apparently engulfing complexes from the patients' sera. The presence of platelets or complement did not alter the incidence of intracellular fluorescence. These tests may help in the diagnosis of myelofibrosis and may also be valuable in recognising the onset of this condition in patients with polycythaemia rubra vera.

Lymphocyte surface membrane changes in dividing cells and following regidification with mitogens

Iodination of surface membrane protein has allowed the dynamics of lymphocyte surface membrane protein to be examined. A comparison has been made between the rate of membrane turnover in fresh peripheral blood lymphocytes and lymphocytes in other states. When receptor redistribution is inhibited with high concentrations of mitogens, 'rigidification' of the membrane occurs and protein turnover is very much reduced. Loss of surface membrane protein is also much slower in lymphocytes which have been stimulated with mitogens and are undergoing active DNA synthesis. It is thought that these observations may relate to immunological inactivity and may have implications for pathological unresponsiveness.

Restoration of "normal" membrane function in CLL cells by patients' serum

Direct labelling of cell surface protein with 125I has enabled measurements to be made of lymphocyte membrane turnover. In CLL cells this is evidently much retarded in comparison with normal lymphocytes and it was thought that slow replacement of cell surface proteins might be responsible both for lack of membrane mobility and poor immunological responses. Serum from CLL patients has been found to enhance viability of the leukaemic cells in culture and the interaction of these serum factors with the CLL cell membrane gives rise to rapid replacement of surface proteins. Thus the rate of membrane turnover in vivo would be comparable with that of normal lymphocytes. Lack of cell-surface mobility and poor membrane biosynthesis can not be held responsible for poor immunological activity in vivo and it is suggested that autoimmune antibodies binding to the surface of CLL cells may spatially inhibit activation by ligands.

Skin reaction and antibody responses in guinea-pigs sensitized to human leukaemia cells or their nuclei in combination with Bacillus Calmette-Guérin

Guinea-pigs sensitized by subcutaneous injection of chronic lymphatic leukaemia (CLL) cells combined with Bacillus Calmette-Guérin (BCG) displayed good skin reacitons 24 and 48 h after challenge with CLL cells. Equally good responses were also demonstrated using nuclei from the leukaemic cells in combination with BCG. These reactions were significantly greater than those produced in the same manner but without BCG. Sera form the animals were examined for the presence of antibodies against CLL cells by cytotoxicity and immunofluorescence techniques. Only samples from guinea-pigs innoculated with CLL cells were found to contain significant antibodies. Histological examination showed that whereas leukaemic cells persisted at the sensitizing injection site leukaemic cell nuclei could not be visualized. It is suggested that because leukaemic cell nuclei in combination with BCG are able to induce good skin reactivity without provoking a vigorous humoral antibody response they may have possible advantages over leukaemic cells when used for immunotherapy.

Lymphocyte stimulation by soluble subcellular fractions

Nuclear material can produce inhibition or stimulation of healty leucocytes under different experimental conditions, Reactivity could not be produced in cultures using intact nuclei and allogeneic lymphocytes. The effect of nuclear and cytoplasm fractions was compared with that of whole cells on intact healthy lymphocytes. The HLA activity in the individual fractions was assessed. Stimulation was produced by certain nuclear and cytoplasmic fractions and these were closely related to the peaks of HLA activity. The response to these fractions showed less activity than that achieved in conventional one way MLC tests.

[Ventricular aneurysmectomy and infarctectomy]

During a 22-month period, April 1972 to February 1974, 4 patients underwent ventricular aneurysmectomy at the Karl Bremer and Tygerberg Hospitals for congestive cardiac failure. In addition, 1 patient with an aneurysm and 3 patients with acute myocardial infarcts, ranging from 16 to 28 days postinfarction, underwent emergency surgery for recurrent malignant arrhythmias. The preoperative treatment, cardiac catheterisation data and surgical findings are outlined. The over-all survival rate is 75% for a mean follow-up period of 12,5 months (range 8-22 months). It is concluded that aneurysmectomy, for congestive cardiac failure, and infarctectomy, for life-threatening ventricular arrhythmias, are gratifying and worthwhile procedures.

The role of nuclear material in the transfer of immunological information. II. The mode of action of nuclear mitogen

Nuclei from lymphocytes which have been stimulated with phyto-haemagglutinin (PHA) or concanavalin A (Con A) are capable of stimulating both T and B lymphocytes. The basis of the mitogenic properties of these nuclei has been investigated in more detail. Mitogen has been labelled with ¹²⁵I and the various constituents of the nuclei (RNA, DNA and protein) have also been labelled in an attempt to determine their cellular localization during stimulation. The effects of competing sugars and inhibitory antisera have also been examined. The results of the experiments suggest that the mitogenic effects of nuclei may result from concentration or complexing of PHA or Con A either in the nucleus or on the nuclear membrane.

Changes in antigenic nature of lymphocytes caused by common viruses

Healthy human lymphocytes were incubated in the presence of influenza A2/Singapore/57, herpes simplex type 1, or adenovirus type 2. After two days the cultures were inactivated by irradiation. Fresh lymphocytes taken from the same donor were then found to react to the virus-treated cells in short-term cultures. We suggest that this reactivity is due to a change in the surface characteristics of the lymphocytes brought about by the presence of the virus. This may account for anomalous reactions in mixed lymphocyte cultures, and a similar effect in vivo might cause accelerated graft rejection.

The immunogenic and co-operative effects of lymphocyte nuclear material from antigen-primed mice

When nuclei from the lymphocytes of mice immunized with rabbit erythrocytes are injected into unprimed animals the number of cells forming antibody to rabbit erythrocytes increases to a level approaching that of the immunized donor animals. The specificity of the response induced by nuclei is equally as good as that induced by native antigen. When `T' and `B' mice are immunized with rabbit erythrocytes a poor response is observed but when the nuclei from primed `T' animals are used to immunize `B' mice the number of antibody-producing cells is very much increased. In view of current theories about cellular co-operation it is pointed out that this co-operative effect of `T' lymphocyte nuclei is independent of both cell membrane and additional antigen.

The role of nuclear material in the transfer of immunological information. I. Nuclei from rat lymphocytes stimulated with mitogens

It has been shown that nuclei from lymphocytes stimulated with either PHA (Pegrum, Perera and Thompson, 1972), Con A or pokeweed have marked mitogenic properties. The ability of various lymphoid tissues to respond to such nuclear material differs from the response they show to the mitogens themselves. Nuclei from rat lymphocytes stimulated with PHA or Con A will activate the lymphocytes from either spleen, bone-marrow or thymus whilst nuclei from pokeweed-stimulated cells appear capable of stimulating only the bone-marrow-derived lymphocytes. It is suggested that the ability of the nuclear material from PHA or Con A-stimulated lymphocytes to induce mitogenesis in bone-marrow-derived cells may relate to cellular co-operation; `T' cell processing being a prerequisite for `B' lymphocyte triggering.

Error theory and ageing in human diploid fibroblasts

Immunological and enzymatic assessments of lactate dehydrogenase in human lung fibroblasts strongly suggest that altered proteins accumulate in ageing cells. This supports but does not prove the error catastrophe theory of all death.

The baboon (Papio ursinus) heart (coronary blood supply, muscle function and metabolism)

The sub-human primate baboon (Papio ursinus) was subjected to cardiac catheterisation studies and pathologic injection techniques with a view to establishing baseline values pertaining to coronary artery morphology, coronary blood flow and myocardial energetics and metabolism. The similarities to the human situation (and minor differences) are considered in the light of possible extrapolation to clinical conditions in contemplated future experimental studies of myocardial physiology.