The complete V domain amino acid sequences of two myeloma inulin-binding proteins

The myeloma proteins binding inulin afford a unique opportunity to study the V region patterns of variation because of the similarity in the VL as well as the VH regions. The diversity patterns in both the VL and VH regions suggest these proteins are encoded by multiple, very similar V gene segments or that somatic mutation may repeatedly generate identical variants. Because of the close similarity in the V domains of these proteins and the extensive idiotypic analyses that have been carried out previously, several interesting conclusions can be drawn about the nature of idiotypic determinants. First, a single amino acid residue may be involved in determining multiple idiotypic determinants. Second, hapten-inhibitable idiotypes may depend on residues within and outside the hypervariable regions. Third, idiotypic similarity does not always predict a corresponding sequence similarity.

The complete V domain amino acid sequences of two myeloma inulin-binding proteins

The myeloma proteins binding inulin afford a unique opportunity to study the V region patterns of variation because of the similarity in the VL as well as the VH regions. The diversity patterns in both the VL and VH regions suggest these proteins are encoded by multiple, very similar V gene segments or that somatic mutation may repeatedly generate identical variants. Because of the close similarity in the V domains of these proteins and the extensive idiotypic analyses that have been carried out previously, several interesting conclusions can be drawn about the nature of idiotypic determinants. First, a single amino acid residue may be involved in determining multiple idiotypic determinants. Second, hapten-inhibitable idiotypes may depend on residues within and outside the hypervariable regions. Third, idiotypic similarity does not always predict a corresponding sequence similarity.

Generation of visual representations

The visual confusability of uppercase letters was manipulated in a successive same-different task to study the conditions under which visual generation from auditory inputs would occur and to investigate the figural specificity of the generated representations. Prior experiments have shown that visual confusions do occur when the initial stimulus is auditory and the second one is visual, which indicates that auditory stimuli can be encoded into visual forms. There has been some suggestion, however, that the generated visual code may have been too abstract to differentiate between the two cases in which letters can appear. In the present experiment, although the confusion effect was not eliminated when the subjects had no advance knowledge regarding the case in which the visual stimulus would appear, the marked confusion effect obtained when the visual stimulus was an uppercase letter was substantially attenuated when the letter appeared in lowercase. This was taken to indicate that the visual characteristics of a generated visual representation may be relatively specific. The results also suggested that subjects may wait until after the second stimulus is presented before they generate the visual representation of the initial auditory stimulus.

Generation of visual representations

The visual confusability of uppercase letters was manipulated in a successive same-different task to study the conditions under which visual generation from auditory inputs would occur and to investigate the figural specificity of the generated representations. Prior experiments have shown that visual confusions do occur when the initial stimulus is auditory and the second one is visual, which indicates that auditory stimuli can be encoded into visual forms. There has been some suggestion, however, that the generated visual code may have been too abstract to differentiate between the two cases in which letters can appear. In the present experiment, although the confusion effect was not eliminated when the subjects had no advance knowledge regarding the case in which the visual stimulus would appear, the marked confusion effect obtained when the visual stimulus was an uppercase letter was substantially attenuated when the letter appeared in lowercase. This was taken to indicate that the visual characteristics of a generated visual representation may be relatively specific. The results also suggested that subjects may wait until after the second stimulus is presented before they generate the visual representation of the initial auditory stimulus.

Femoropopliteal vein grafts for intermittent claudication

Femoropopliteal vein grafts were performed for intermittent claudication in 160 patients (182 legs) over a 12-year period. The accumulative patency rate was 67 per cent at 5 years. However, patency rates improved significantly in the latter 6 years of the study, to 75 per cent at 5 years. Early postoperative occlusion and morbidity rates also markedly declined in this latter period. Patency rates were significantly better in males than in females, in patients who were able to stop smoking after operation and in legs with a three-vessel run-off compared with those with a two- or one-vessel run-off. The patients' age did not influence graft patency rates.

Computed tomography in pulmonary sarcoidosis

A group of 34 proven cases of pulmonary sarcoidosis was investigated by computed tomography (CT) to determine whether CT provided any information beyond that obtained from conventional chest films. Computed tomography disclosed a surprisingly high prevalence of minor pleural changes in sarcoidosis, including two patients with small pleural effusions. Unsuspected bullae and isolated "granulomatous" nodules were additionally demonstrated. Increases in lung density and alterations in gravity dependent vascular perfusion were assessed; these may reflect alterations in the vascular bed, and the increased density is possibly due to diffuse invasion of the lung not recognizable by conventional chest X-ray films. Tracheal compression was noted in one case and vertebral densities in three. Prominence of "small air spaces" was recorded in four patients; the nature of the pathology responsible for this finding is at present speculative. While not replacing conventional chest radiography, CT does make a definite contribution to the assessment of pulmonary sarcoidosis.

Rates of release of subcutaneously injected antigens in the rat. Comparison of an aqueous preparation with two alum-precipated preparations

Release of antigen E-125 I from the site of subcutaneous injection in male rats was delayed significantly when either of two alum-precipitated preparations containing 1.0-1.2 mg of Al/ml was administered rather than an aqueous preparation. The rates of 125I excretion were similarly influenced being statistically slower through the first week after single doses of the alum-precipitated preparations. The results of these studies strongly support the view that alum-precipitated vaccines offer more protection from system reactions than aqueous vaccines.

Clonal growth of metastatic carcinoma of bronchus in bone marrow culture

Bone marrow cells from a 35-yr-old male with small cell anaplastic carcinoma of the bronchus and bone marrow metastases were cultured in semisolid agar. Numerous small clones grew in the cultures, with a similar gross appearance to clones produced by cell from a proportion of patients with acute myeloid leukemia. Examination of the cells from these clones by electron microscopy revealed marked differences between these cells and cells grown in cultures from normal and acute myeloid leukemia marrow. This suggests that metastatic cells of the anaplastic carcinoma of the bronchus grew in clones in the agar culture system.

Group psychotherapy for substance abuse patients: development of a technique

A voluntary open psychotherapy group in a Veterans Drug Dependence Treatment Center was conducted along psychodynamic-integrative lines. Interpretations were first made as with psychiatric patients. These patients regressed to drug use or dropped out. The style was changed to emphasize pertinent general questions. The derivatives of personality problems emerged in the discussions. "Samplers" (patients attending less than five times) and "regulars" (patients attending more than five times) of 104 sessions are compared with one another and the total Center population. Reviewing the literature confirmed our impression that this group treatment was worthwhile.

Carotid endarterectomy: a follow-up study of the contralateral non-operated carotid artery

In a study of 103 patients surviving carotid endarterectomy, follow-up information was obtained from all patients over a period of time extending to four years. This was done so that better decisions could be made regarding recommendations for contralateral carotid surgery. In this follow-up study, only three patients had contralateral surgery. Three additional patients had events clearly in the territory supplied by the contralateral carotid artery, and no patient suffered a contralateral stroke. There were an additional four patients who suffered stroke in territory not supplied by the contralateral carotid artery. In addition, four patients experienced classical transient ischemic episodes referrable to the operated carotid artery and ten patients experienced nonclassical cerebral ischemia. Seven of the 103 patients died at times remote from the carotid surgery of nonstroke cause.

Surgical treatment of the severely ischaemic leg: II. Salvage rates

The salvage rates in 437 severely ischaemic legs (384 patients) treated by arterial reconstuction or by lumbar sympathectomy were studied by the life table method. The results were analysed in the surviving patients.

Following arterial reconstruction, the salvage rate was 70 per cent at 2 years and 60 per cent at 5 years. The results were similar for aortofemoral reconstruction and for femoropopliteal bypass grafting. Following aortofemoral reconstruction the outcome was better for endarterectomy procedures than for Dacron grafts. The salvage rate for femoropopliteal bypass grafts with patent tibial vessels was higher than for grafts to an isolated popliteal segment or for femorotibial grafts. Late occlusion of a reconstruction frequently did not necessitate major amputation, whereas several amputations were required in spite of a functioning reconstruction.

Following sympathectomy the salvage rate was 60 per cent from 1 year onwards. The results were better for tibial artery disease than for femoropopliteal or aortoiliac disease. Failed sympathectomy frequently led to major amputation of the leg or death of the patient.

The salvage rates after either reconstruction or sympathectomy were not influenced by age, sex or a prior history of clinical myocardial ischaemia, but the rates were worse in diabetics. The outcome of either operation was best when the procedure was performed for rest pain or ischaemic ulceration, satisfactory for limited gangrene but very poor for extensive gangrene.

Fate of 14C-3-methylamino-1,2,3,4-tetrahydrocarbazole hydrochloride in rats and dogs

The fate of 14C-3-methylamino-1,2,3,4-tetrahydrocarbazole hydrochloride, a potential psychotherapeutic agent, was studied in rats and dogs. Rats were given a single oral or intraperitoneal dose while dogs received the drug either orally or intravenously. Radioactivity in plasma samples and excreta was determined by liquid scintillation counting. In addition, 14C-levels in various rat tissues were estimated. The drug appeared to be well absorbed in both species. 14C-levels were highest in liver and lung and lowest in plasma. Excretion was primarily urinary and was more complete within the first 96 hr in the rat than in the dog, which suggested a longer 14C-half-life in the dog. No evidence was seen that the drug was demethylated.

Diaphragm pacing in central von Recklinghausen's disease: a case report

A patient with central von Recklinghausen's disease with multiple lower cranial nerve tumors developed nocturnal central hypoventilation that was successfully treated with diaphragm pacing. An unusual postimplant complication requiring an increased amplitude of stimulation occurred and was later found to be due to a neurofibroma that had partially displaced the electrode cuff off the phrenic nerve.

Surgical treatment of the severely ischaemic leg: I. Survival rates

Over a 10-year period, 411 patients with atherosclerotic major artery disease causing severe ischaemia of the legs were treated by surgery. Their survival rate, assessed by the life table method, was 80 per cent at 1 year and 50 per cent at 5 years. Early and late survival rates were significantly worse in elderly patients, and in patients with extensive gangrene. Late survival rates were significantly worse in diabetics, and in patients with clinical myocardial ischaemia. Patients treated by arterial reconstruction showed a better survival rate than those treated by sympathectomy or amputation, though the latter groups contained more poor risk patients. Survival rates were not influenced by the technique of reconstruction.

The effect of smoking on the late patency of arterial reconstructions in the legs

In a retrospective study of 217 patients, smoking habits were related to the late patency rates of arterial reconstructions performed for ischaemia of the legs. Patients who had stopped smoking or who smoked no more than 5 cigarettes per day after the operation had late patency rates of approximately 90 per cent for aortofemoral reconstructions and 80 per cent for femoropopliteal vein grafts. Patients who continued to smoke more than 5 cigarettes per day were approximately three times more likely to block an aortofemoral reconstruction and four times more likely to block a femoropopliteal vein graft. The results were similar for males and females, for various age groups, for claudicants and patients with severe ischaemia and for aortofemoral endarterectomy and Dacron grafts. The late patency rate was approximately inversely proportional to the number of cigarettes smoked per day after the operation. There was no such correlation with the number smoked per day before the operation.

Improved colorimetric determination of aspirin and salicylic acid concentrations in human plasma

An improvement in a previously described method for the determination of plasma salicylic acid and aspirin levels in humans is described. The procedure was simplified by employing only one plasma sample for both salicylates. More accurate estimation of salicylates, particularly aspirin, was achieved by using two different calibration curves. Salicylic acid was estimated by reaction with an aqueous solution of the Folin-Ciocalteu phenol reagent. Absorbance of the blue-colored complex, which formed on addition of sodium hydroxide, was measured at 670 nm. The influence of alkalinity in the formation of the colored complex is discussed. The average recovery of aspirin added to plasma was 94.61%; it was 214.72% by the previous method.

Aneurysm formation in an expanded microporous polytetrafluorethylene graft

Microporous expanded polytetrafluoroethylene (PTFE) has recently been proposed as an arterial graft. Although excellent graft patency rates have been achieved both experimentally and clinically, aneurysm formation of the graft has occurred in a small number of cases. This report describes a further case of aneurysm formation in a PTFE graft five months after insertion. We discuss the possible causes of graft aneurysm formation and a newly developed reinforced form of PTFE graft.

Mixed bacterial meningitis: a complication of ventriculo- and lumboperitoneal shunts

Infectious complications of ventriculo- and lumboperitoneal shunts in two patients are presented. Cerebrospinal fluid infection due to aerobic and anaerobic enteric flora was characteristic of each case. Both infections occurred several months after shunt surgery and were associated with colonic perforation by the distal limb of the peritoneal catheter. These cases emphasize this unusual hazard of peritoneal shunts and demonstrate methods for diagnosis and effective therapy.

Carotid cavernous fistula in pregnancy

A carotid-cavernous fistula in pregnancy is not rare. Increasing pain and worsening of the proptosis made prompt operative intervention necessary. The fact that other known cerebrovascular lesions lend themselves to surgical attack without undue risk during this time8--11 prompted us to proceed with surgery. There was no adverse effect on the pregnancy, other than premature delivery. Both the mother and child are doing well 4 years after surgery.

Changes in role perceptions by first-year dental students

Dental education combines the learning of technical skills with the professional role of health care provider. The investigation compared first-year dental students perception of themselves, dental practitioners, dental school upper-class students, and patients. The study indicated that first-year students are more likely to identify with upper-class students than with dental practitioners. They also tended to see themselves as clearly different from dental patients. It is suggested that dental educators should recognize this fact in order to avoid the depersonalization of dental care delivery.

Pleuroscopy and cautery control of intrathoracic hemorrhage with a flexible fiberoptic bronchoscope

Intrathoracic hemorrhage from adhesions torn by a spontaneous pneumothorax is relatively uncommon. Continued hemorrhage from such adhesions after the evacuation of 1,500 ml of blood would usually require thoracotomy for control. Through a flexible fiberoptic bronchoscope, we confirmed the source of hemorrhage and cauterized the bleeding point. This case illustrates another application for pleuroscopic examination, further broadening the use of the flexible fiberoptic bronchoscope.

Descending thoracic aortofemoral bypass for distal aortic reconstruction after removal of an infected dacron prosthesis

A simplified technique of descending thoracic aortofemoral bypass is presented. This technique was employed successfully in a patient in whom an infected aortofemoral Dacron bypass was removed and an axillofemoral reconstruction had failed.

Changes in intra-vascular complement and anti-treponemal antibody titres preceding the Jarisch-Herxheimer reaction in secondary syphilis

Six patients with secondary syphilis and one control subject were observed over a period of up to 8 hr following the administration of either penicillin or erythromycin. Serial clinical observations were made and blood samples obtained for complement and serological analysis. The patients showed Jarisch-Herxheimer reactions (JHR) of varying intensity which were found to be preceded by and to parallel in degree certain changes in complement and syphilitic antibody titres. Falls in total haemolytic complement, in C4, C3, C6 and C7 and a marked drop in C1INH were observed. There was no change in total GBG/GGG or evidence of conversion of GBG to GGG. Associated falls occurred in the titres of the QFTA and the QTPHA antibodies but not of the QVDRL or QTPI antibodies. C3 conversion was found in the two patients that suffered severe reactions. Immune complexes were not detected and it is suggested that complement activation occurred in the extra-vascular body compartment. The significance of these changes in relation to other plasma enzyme systems and to the development of the full clinical picture of the JHR is discussed.

Ruptured iliac aneurysms

Iliac aneurysms are uncommon as compared with aneurysms of the abdominal aorta. Rupture is the most serious complication of aneurysms of both vessels. Considerable attention has been focused on the management of ruptured abdomonal aortic aneurysms, but ruptured iliac aneurysms have received little notice. The problems in the management of ten ruptured iliac aneurysms, seen over the last five years, together with the rarity of other reports of this condition, have stimulated this review.

The management of popliteal aneurysms

Twenty-three patients with 34 popliteal aneurysms were treated between 1963 and 1974. Nearly half of the aneurysms were the site of thrombosis when they first presented, and of these nearly half required a major amputation. Surgical treatment of aneurysms in which the popliteal artery was patent was satisfactory; the only failure occurred when a Dacron graft became occluded after eight years. A small group of patients was observed for an average of one year, during which time the thrombus in one aneurysm embolized and one aneurysm became occluded, necessitating an amputation. The results of this series suggest that the prognosis for a limb with popliteal aneurysm depends on the patency of the popliteal artery at the time of the initial presentation, and lends support to the belief that popliteal arteries with aneurysms are best reconstructed before the onset of a serious complication.

Response decrement as a function of effort

Albino rats were given acquisition training on a 6 ft. enclosed straight alley runway which could be adjusted for inclinations of 0°, 20°, and 40°. After receiving equal training on each of the three effort conditions, three groups of subjects were given massed extinction trials for 30 min. on only one effort condition. Results indicated fewer responses during extinction under the greater effort conditions. These results support a relation between effort and response decrement in extinction, consistent with the predictions of Hull's theory of reactive inhibition.