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Gastro-oedophageal reflux may be responsible for symptoms and sometimes for the development of oesophageal damage. These effects are inconstant when reflux is demonstrated by radiography or by conuentional pH studies. This unpredictability may be accounted for by the observation that during the day refluxed material is rapidly cleared from the oesophagus by swallowing, while during sleep little swallowing occurs. To explore the hypothesis that reflux during deep is the important factor, prolongedintra-oesophageal pH studies have been done and a method has been developed for quantifying nocturnal gastro-oesophageal reflux.The investigation has Ahown that persistence of acid within the oesophagus is associated with prolonged periods during sleep when no swallowing occurs. Measurements of nocturnal intra-oesophageal pH were made in 41 patients with symptomatic sliding hiatus hernia. In 12 patients with mild symptoms reflux measured by this index did not exceed 15 minutes, with one exception, and no patient showed oesophagitis. In 10 patients with moderate symptoms reflux did not exceed 1 hour, with one exception, and mild to moderate oesophagitis was present in 4 cases. Nineteen patients had severe symptoms; in all hut one the period of reflux was in excess of 1 hour, and oesophagitis was found in 13.

Aqueous ethanol extract of a tunicate which was previously found to exert antitumor and immunosuppressive activities in vivowas tested for its effect on normal human lymphocytes in vitro.The extract suppressed the uptake of tritiated thymidine by lymphocytes stimulated with mitogen. This suppressive effect did not require continuous presence of the extract. Treatment of lymphocytes prior to mitogenic stimulation resulted in suppressive effect. The fact that suppression by the extract could also be achieved 24 hr after exposure to mitogen, an interval which was found to suffice for the attainment of maximal commitment for blastogenic transformation indicates that Ete can act at a stage subsequent to the binding of the lectin and elicitation of a mitogenic signal(s).

The free energies of mixing for molten indium-antimony, cadmium-antimony, indium-bismuth, lead-bismuth and tin-bismuth were calculated from the variation of electrical resistivity with composition employing the model of Takeuchi and Endo. Resistivities measured in this laboratory with an electrodeless technique for In-Sb alloys, together with published values for Cd-Sb, In-Bi, Pb-Bi and Sn-Bi alloys were used in the calculations.Evaluation of the resistivity data gave the composition dependence of the derivatives of the chemical potentials of the constituents and the integral molar free energies of mixing. No assumptions regarding ideal entropy were made to obtain these free energy values although a statistically random mixture of ions is presumed in the scattering model.Conclusions drawn from a comparison between the calculated free energy values and published thermodynamic data for these systems are discussed in terms of departures from regularity and the variations in the effective free electron concentration.

Through studies of the distribution of HL-A antigens in a family and related donor selection on the basis of genotyping, excellent results have been achieved in cases of donor-recipient HL-A identity. Similar good results may be achieved in cases of donor-recipient monoallelic compatibility where the donor's nonshared allele is not associated with a major detectable HL-A antigen. In instances of monoallelic incompatibility where donor's nonshared allele is associated with a single detected HL-A antigen, the individual "strengths" of these antigens can be estimated on the basis of the clinical course of the recipient and studies of renal function and histology.

Demethylchlortetracycline (DMCT),* a new antibiotic, is produced by a mutant strain of Streptomyces aureofaciens.1 Three laboratories have demonstrated that significant antibacterial activity is found in the serum as a result of oral administration of this drug.2-4 Each of these groups of investigators has shown that this antibiotic is more effective than its analogue, tetracycline, when equal amounts of the two antibiotics are tested against the common laboratory assay organisms Bacillus cereus #5, Streptococcus 98, or Staphylococcus 209P. In addition, many strains of Staphylococcus aureus organisms isolated from infected patients share this increased sensitivity.4 DMCT is somewhat less effective in vitro than chlortetracycline. Comparable antibacterial activity in the serum is achieved with a lower dosage regimen of DMCT than of tetracycline or chlortetracycline because DMCT has a slower rate of renal clearance than the other two compounds.2 The effects of three dosage regimens on the resulting serum levels of antibacterial activity

Experience with 40 patients and 150 pacemakers is reviewed. In 13 patients the initial pacing was by epicardial electrodes and in 27 by transvenous catheter electrodes. When epicardial systems were used, two electrodes were always fixed to the heart, the additional electrode being provided for temporary pacing and as a spare in case of future need. The battery unit was usually buried behind the rectus abdominis muscle. Vacuum drainage of the pacemaker pocket was used and was considered helpful in avoiding some complications.The right cephalic vein was preferred for transvenous pacing but existing venous abnormalities sometimes required use of the external jugular vein. Five patients had epicardial systems changed to transvenous ones, and in 5 the reverse procedure was needed. Pacemaker battery problems included inadequate soft tissue protection for the unit, epoxy resin fracture, titanium case leak and problems relating to design change and the special needs for overseas travel. While the danger from diathermy and radiofrequency is now recognized, similar dangers exist for those paced by ‘demand’ units in large electromagnetic fields.

Natural disasters, which in recent years have seemed to occur more frequently, have brought about an awareness by hospitals of the need to develop plans to handle large numbers of casualties. The necessity for this type of planning has been further emphasized by a growing reliance by the public that the hospital is a part of the normal security services available in the community, along with the police, fire, and health departments and the American Red Cross. The public expects hospitals to function efficiently in emergency situations. This function has been recognized by the American Hospital Association and the American Medical Association, which have urged that hospitals appoint disaster committees to develop adequate and workable disaster plans. The importance of this function has been further pointed up by the Joint Commission on Accreditation stipulating that accredited institutions must have a written disaster plan which must be tested periodically.In this

The human γ-globulins, γ-A and γ-B, identified by monkey antisera, and γ-C, identified by both monkey and horse antisera, have antibody activity. In 3 sera from patients with chronic thyroiditis, the γ-A, γ-B and γ-C were shown to have anti-thyroglobulin activity by radioautography with I125labeled thyroglobulin after immuno-electrophoresis.Addendum: After submission of this paper, an abstract has appeared which confirms the observations made here (Fed. Proc. 23:454, 1964—W. D. Terry and J. L. Fahey).Dr. Sheldon Dray provided monkey and horse anti-sera and Dr. Howard C. Goodman supplied thyroglobulin extract and thyroiditis sera.

THE study of viral hepatitis has been held up by the failure to isolate or serologically identify the active viral agent. Hirschman et al.1have shown that the Australia antigen2is present in serum of 74 per cent of patients with serum hepatitis, and they have identified a virus-like particle from electron micrographs of the precipitate of the Australia antigen by antiserum from multi-transfused patients, which they tentatively consider to be the infectious agent. With antiserum in chimpanzees transfused with chimpanzee blood, the Australia antigen in human serum could also be detected with apparent antigenic identity.

TO THE EDITOR:— Dr. Holt may be criticized for his statements on the uselessness of cervical discography. However, when his results are considered statistically, this opinion is almost an understatement. Note that only 10 out of 148 disk spaces were considered normal. If two or three interspaces are injected in each individual, the chances of finding a completely normal neck become quite remote.Considering extravasations that are asymmetric in the lateral directions only—64 interspaces—there is a statistical probability of abnormality of more than 50% if three interspaces are injected. Any procedure which has so many false positives (even with the results as restricted as this) can hardly be considered a valuable diagnostic procedure.