Severe thrombocytopenia probably due to acute folic acid deficiency.

Thirteen patients with significant hemorrhage, severe thrombocytopenia, and megaloblastic bone marrows are described. Unusual features of this problem included its acute onset, frequent absence of the typical peripheral blood changes of megaloblastic anemia, normal serum B12 levels, and serum folates which were often not clearly abnormal. Most patients were critically ill and common clinical features included reduced dietary intake, renal failure, renal dialysis, the postoperative state, and sepsis. These clinical features, the laboratory findings, and a platelet increase in most patients after folate therapy lead to the conclusion that this problem is probably due to acute folic acid deficiency. Possible explanations for the atypical laboratory findings include the acuteness of onset, recent blood transfusion therapy, and impaired folate utilization. This problem may be relatively common. Because of its potential clinical importance, rapid onset, and attendent diagnostic difficulties, prophylactic folic acid is recommended in the clinical setting described.


Method for sampling airway gas.

We have devised an improved technique for sampling gas from endotracheal airways for mass spectrometer analysis. It is reliable and unobtrusive and is particularly resistant to occlusion of the sampling line by secrections. It has performed well during continuous monitoring of patients in a respiratory ICU.


Early retransfer: a method of optimal bed utilization of NICU beds.

To facilitate increased utility of Neonatal Intensive Care Unit (NICU) beds, we adopted a policy of early discharge (ED) of infants less than 2000 g to the hospital of their birth after recovery from acute illness and when the infant was breathing room air and taking adequate oral feedings. An inservice teaching program at the primary hospitals preceded such policy. In a 24-month period, 446 infants were referred to the NICU. 111 of 446 died; 335 infants survived. 114 of 335 infants were less than 2000 g at birth; 42% (48 of 114) of them were discharged early to the hospital of their birth (ED); 58% were discharged late (LD) to their homes. 59.7% of the ED and 46.3% of the LD required assisted ventilation. Gestational age, birth weight, and final weight at discharge from hospitals were the same in both groups. None of the ED infants developed complications at the hospital of birth after retransfer. The length of NICU stay for LD was significantly higher 40 +/- 6 (p less than 0.001) than the ED; 20 +/- 2.2 days. In addition, a 15% increase in bed utilization was also noted because of ED. We conclude that ED of infants from the NICU 1) increases utilization of beds; 2) decreases the cost of health care; and 3) increases the participation of primary physicians.


Swan-Ganz catheterization in the critically ill newborn.

The authors placed Swan-Ganz catheters in 11 preterm and 2 term infants with severe cardiopulmonary distress. The infants ranged in weight from 1100-4000 g. The procedure was performed in the neonatal ICU by jugular venous cutdown. Intracardiac pressures and oxygen saturations were measured in each chamber entered. The authors also evaluated the presence of right to left shunting through the patent ductus arteriosus and assessed the degree of pulmonary arterial hypertension. In 5 hypoxemic infants, the authors found a patent ductus arteriosus with pulmonary hypertension. Intermittent measurement of PAP served as a guide to further therapy. In 2 infants, the unexpected diagnosis of cyanotic congenital heart disease was made. The placement of flow directed pulmonary arterial catheters in critically ill infants can be performed safely at the bedside and can provide useful diagnostic and therapeutic information.


The significance of facial burns in acute smoke inhalation.

The medical records of 21 patients with smoke inhalation admitted to a medical ICU (MICU) were reviewed. Of 21 patients, 6 (29%) died. Of 21 patients, 13 (62%) had facial burns and 11 of the 13 (85%) later developed pneumonia. Only 1 of 8 patients (12%) without facial burns developed pneumonia (p less than 0.005). Of the 12 patients with pneumonia, 7 required ventilatory assistance and 6 of the 7 died in the MICU. The authors conclude that the presence of facial burns is associated with the later development of pneumonia in a high percentage of cases. Pneumonia contributes significantly to the high mortality rate. The need for ventilatory assistance in smoke inhalation patients is associated with a poor prognosis.


Fiberbronchoscopic retrieval of iatrogenically introduced endobronchial foreign body.

Although the traditional management of aspiration of foreign bodies has been extraction with the open tube bronchoscope, an expanding array of these have now been removed with the flexible bronchofiberscope. Accidental introduction of a foreign body into the tracheobronchial tree is a poorly recognized, but potentially common hazard of topical anesthetic preparation before endotracheal intubation. We demonstrate that this can be safely and rapidly managed by bedside fiberbronchoscopy. Circumstances favoring the use of the fiberbronchoscope for foreign body extraction are suggested.


Disopyramide in pregnancy: a case report.

Disopyramide (200 mg 8-hourly) was given to a pregnant patient from the 26th week onwards for the treatment of bigeminy and paroxysmal ventricular tachycardia. Labour was spontaneous and normal. Although disopyramide was demonstrated in the foetal blood there was no evidence of congenital abnormality or growth retardation. The drug treated the mother satisfactorily with no apparent ill effects to the child.


Primary postoperative wound infection due to Staphylococcus pyogenes.

Using S. pyogenes as a tracer organism, an examination of the importance of air-borne infection of clean wounds in the modern, plenum-ventilated operating room has been made. It appears that, for most surgical procedures, additional ultra-clean air installations are not necessary. It has been shown that even if the air is sterile, the skin remains a possible source of infection. This is especially so as far as the patient's skin is concerned. It will remain so, since the skin cannot be sterilized. Indeed, until the ecology of the skin is better understood, rigorous efforts directed toward its disinfection may compromise its inherent defense mechanisms and its protective bacterial flora. It will be argued by some that operating rooms with ultraclean air should be afforded for certain specialized procedures in sugery; for example, those in which prosthetic materials are being implanted or in which the patient's immune mechanisms are depressed. Although not disagreeing with this, I wish to note that the only controlled trial on this aspect of surgery that exists to date shows no advantage for patients randomly apportioned to have hip arthroplasty, either in an isolator or in the same modern operating room but without the isolator. From this experience, I believe that any further trial of this nature, if it is to be controlled to a similar high level, will require very large numbers of patients to show even a marginal advantage for ultraclean air or isolator installations over the modern, plenum-ventilated and meticulously managed operating suite. The verdict on the need to install ultraclean air plant for operating rooms must, therefore, be couched in the third alternative that exists under Scots Law-- "not proved." I suggest the money could be better spent on devising methods to keep skin pathogens out of surgical wounds. Perhaps more urgently, there is a need to discover how to increase the defense mechanisms of the wound milieu to implanted harmful bacteria. There is also a pressing need to improve the ward environment with the aim of diminishing secondary infections of surgical wounds.


Verrucous ulcerative skin lesions in sarcoidosis. An unusual clinical presentation.

A twenty-seven year old man with a two year history of sarcoidosis and systemic manifestations of this disease along with verrucous ulcerative skin lesions is presented. Biopsy specimens of the cutaneous lesions showed typical noncaseating granulomas as well as necrotizing granulomatous inflammation. After other possible etiologies were excluded, prednisone therapy was instituted with prompt resolution of the skin lesions, leaving atrophic scars.


Lymphatic complications of manual herpes simplex infection.

In seven patients with typical recurrent herpes simplex of the hand, lymphatic complications, developed in the arm during periods of herpetic activity. Six of the patients presented with lymphangitis and lymphadenitis. In one patient, persistent lymphedema developed in the involved hand and forearm.


Nail bed carcinoma.

Chronic conditions of the nail bed are frequently seen. Rarely a carcinoma will be present, which can only be diagnosed by a high degree of awareness of its possibility and then by performing a biopsy.


Traumatic nodule in surgical scar.

Presented herein is a report on a patient in whom a hyperkeratotic nodule developed in an abdominal surgical scar, ten months after exploratory laparotomy.


Tetracycline staining of wisdom teeth.

Tetracycline hydrochloride given by mouth for acne vulgaris was found to be deposited in the amelogenetic region of developing wisdom teeth.


Subungual malignant melanoma.

A sixty year old white woman with a history of Peutz-Jeghers syndrome with nail involvement, presented with a marked hyperpigmentation of the terminal phalanx and nail of the right index finger. Two preceding biopsy specimens from the fingertip were interpreted as junction nevus. After amputation of the fingertip and terminal phalanx, the final diagnosis was subungual malignant melanoma. Further amputation of the entire finger and portion of the corresponding metacarpal bone was done as a successful follow-up procedure.


Methotrexate treatment of pityriasis lichenoides and lymphomatoid papulosis.

Pityriasis lichenoides is a notoriously difficult disease to treat. Three patients with this condition and a fourth with lymphomatoid papulosis have been successfully treated with doses of methotrexate once a week. Toxicity noted during the treatment periods has been minimal.


Tinea of the ear mimicking chondritis.

A case of tinea of the pinna, mistaken for chondritis, is presented. Chondritis should be added to the list of diseases that tinea infection may mimic.


Infection with hair transplant surgery.

The problem of infection during hair transplant surgery in one dermatologist's office is described herein. Careful epidemiologic investigation identified the causative organism and its source, and the infection was effectively controlled by the use of "semi-sterile" technique. Infection may be more common than generally suspected and it should be considered as a possible cause of otherwise unexplained disappointing results as reflected by decreased numbers of viable hairs per graft.


Onycholysis secondary to tetracycline hydrochloride.

A case of onycholysis secondary to the ingestion of tetracycline hydrochloride is reported. The patient was not photosensitive, and the nails returned to normal after withdrawal of the causative drug.


Malpractice--in dermatology.

Among twenty-three types of physicians, dermatologists rate sixth lowest in malpractice risk. With dermatology, the risk of a suit is general; no one doctor or type of dermatologic practice has been shown to bear unusual risk--everyone is susceptible. However, dermatologist who give x-ray therapy or limit their work to cosmetic procedures rate higher. Patients sue because of facial burns or scars, negligent diagnosis, drug reaction, falls in the office, wart removal, and treatment that exceeds the patient's desire at the moment. Care must be exercised in the use of problem drugs such as antineoplastic agents, corticosteroids, oral contraceptives, sulfones, vitamin A acid, liquid nitrogen, cantharidin, podophyllin, and fluorescent dyes. Dermatologists are urged to obtain consultation for the benefit of patient and doctor, to maintain good relations with fellow physicians, and to avoid inappropriate criticism of other physicians. Lengthy lists of "do's" and "don'ts" in patient care are included, and some possible changes in the malpractice situation are listed.


Myocardial infarction in dermatomyositis.

A case of dermatomyositis manifesting electrocardiographic and vectorcardiographic changes compatible with an inferior and anterolateral wall myocardial infarction is presented herein. The nonocclusive nature of the heart muscle damage is evidenced by perfectly normal coronary artery angiography. We believe that this is the first reported case of a myocardial infarction pattern apparently due to dermatomyositis.


Fatal pulmonary hemorrhage in Henoch-Schönlein purpura.

An unusual case of an eight year old boy with Henoch-Schönlein purpura in whom fatal pulmonary hemorrhage developed resulting from leukoclastic vasculitis of the lungs is presented herein.


A tdic(5;15)(p31;p11) chromosome showing variation for constriction in the centromeric regions in a patient with the cri du chat syndrome.

Some dicentric chromosomes show only one primary constriction at metaphase and behave in cell division as if they are monocentric. The few previous reports of tdic (translocation dicentric) chromosomes showing one morphologic indicate that among the cells of an individual the same centromere consistently shows the primary constriction. The present case deals with a tdic(5;15)(p13;p11) chromosome that is an exception to this pattern. Scoring 98 GTG-, C-, and QFQ-banded metaphases specifically for primary constrictions revealed 15 (15%) containing a tdic chromosome with a single primary constriction. Among these chromosomes, 8 (8%) were at the chromosome 15 centromere and 7 (7%) were at the chromosome 5 centromere. The remaining 83 (85%) tdic chromosomes showed two primary constrictions. We analyzed a total of 172 metaphases from peripheral blood, and all except 3 (1.7%) contained the tdic chromosome. Among these three cells, the tdic chromosome was broken in two and absent in one, which indicates that there was some unstable separation of this dicentric in cell division. In two metaphases, there was a chromatid gap at the site of one centromere. Possibly, the absence of certain primary constrictions was associated with deletion of centromeres. This mechanism may be a continual source for additional centromere inactivation during the life of this patient. This case demonstrates that for some dicentrics either centromere may become nonfunctional and inactivation can occur more than once within an individual. The karyotype of this patient was 45,XX,tdic(5;15)(p31;p11). Thus, she was monosomic for about 3/4 of the chromosome 5 short arm. Clinically, this infant had a shrill catlike cry and facies of the cri du chat syndrome.


Confirmation of the assignment of the gene for galactose-1-phosphate uridylyltransferase (E.C. 2.7.7.12) to human chromosome 9.

The gene for galactose-1-phosphate uridylyltransferase (GALT) has previously been assigned to human chromosomes 2, 3, and 9. We have studied a further series of human-mouse hybrids and are able to confirm that the human gene for GALT is located on human chromosome 9.


Aging and sister chromatid exchange. IV. Reduced frequencies of mutagen-induced sister chromatid exchanges in vivo in mouse bone marrow cells with aging.

Induction of sister chromatid exchanges (SCE's) was examined in bone marrow cells of young and old C57BL/6J mice exposed to three different DNA-damaging agents (cyclophosphamide, mitomycin C, and doxorubicin). At low concentrations of all three mutagens, the levels of induced SCE's were similar in young and old cell populations. However, at higher mutagen concentrations, SCE induction was significantly reduced in old cell populations. Studies of mice aged 5 to 32 months revealed that induced SCE frequencies remain stable during early adulthood (5 to 12 months) and then begin to decline as a function of age. These results indicate that with aging there exists a gradual alteration of cellular response to DNA damage.


Preoperative pulmonary preparation of patients with chronic obstructive pulmonary disease: a prospective study.

A group of 157 patients with chronic obstructive pulmonary disease who were treated before surgery using a standardized pulmonary preparation underwent physiologic assessment both before and after the prophylactic program. The postoperative course of each patient also was evaluated to assess the incidence of respiratory morbidity and mortality. Although many physiologic values were statistically improved after the pulmonary preparation, most of the changes are of doubtful functional significance. It is difficult to determine which patients will develop pulmonary complications not requiring mechanical ventilation, but the group requiring this type of support appears to be predictable on the basis of the severity of their pulmonary functional impairment and their lack of response to the standard pulmonary preparation used. The single most reliable test for this purpose was the mean forced expiratory flow during the middle half of the forced vital capacity. The frequency of postoperative respiratory complications was related to the type of operation, with the highest incidence occurring in the group that had extensive upper-abdominal surgery. While the occurrence of these complications was significantly reduced in patients undergoing a standard preoperative pulmonary preparation, the explanation for the beneficial effect of this procedure is not apparent.


Preoperative pulmonary function and complications after cardiovascular surgery.

Results of preoperative pulmonary function tests were evaluated in 106 patients who had major thoracic or upper abdominal cardiovascular surgery. These results were related to the occurrence of postoperative complications by comparison of pulmonary function data in patients with an ICU stay of less than 5 days versus patients with an ICU stay of greater than 5 days. However, quantitative analysis of several specific parameters of pulmonary function tests failed to reveal any difference in the incidence of postoperative complications between patients with modest versus severe preoperative dysfunction. The occurrence of atelectasis was related to type of cardiovascular surgical procedure, but not to preoperative pulmonary function tests. Abnormalities on pulmonary function tests were not the major determinants of use of preoperative respiratory therapy, and its use was unrelated to the length of stay postoperatively in the ICU. We conclude that prior to cardiovascular surgery, routine quantitation of clinically apparent pulmonary dysfunction may be of little value in predicting postoperative morbidity and much less important than careful clinical evaluation. When pulmonary function tests are performed in such patients, simple spirometric tests and arterial blood gas levels are adequate.


Numbers of asbestos bodies in urban patients with lung cancer and gastrointestinal cancer and in matched controls.

We compared the numbers of asbestos bodies extracted from the lungs of 103 patients with lung cancer and 50 patients with gastrointestinal malignant neoplasms to the numbers of bodies extracted from lungs of control patients matched for age, sex, smoking habits, and, in some cases, occupation. All patients were urban dwellers over the age of 40 years, and none was a primary asbestos worker. No differences in the counts of asbestos bodies were observed between the tested and control populations. The numbers of asbestos bodies did correlate well with occupation; the highest counts were found in male manual laborers. We conclude that in the urban population studied herein, the numbers of asbestos bodies alone do not correlate with the presence of pulmonary or gastrointestinal carcinoma; however, uncoated asbestos fibers are also known to be present in the lung, and the possibility that such tumors may be related to the numbers of these fibers in lungs remains to be explored.


Early treadmill testing after myocardial infarction: Angiographic and hemodynamic correlations.

Twenty-eight patients who were two weeks post acute myocardial infarction walked on a motorized treadmill at 1 MPH 0 percent grade for five minutes (group 1) or to an end-point of symptoms, ST-T wave changes or arrhythmias (group 2). At subsequent cardiac catheterization, 73 percent in group 1 had single vessel coronary artery disease whereas 82 percent group 2 had three or four vessel coronary artery disease. Ejection fraction was better in group 1 as was the slope of a modified left ventricular function curve. We conclude that limited exercise treadmill testing soon after acute myocardial infarction may be useful in predicting the extent of coronary artery disease and the amount of left ventricular dysfunction.


Pulmonary alveolar proteinosis: abnormal in vitro function of alveolar macrophages.

Pulmonary alveolar proteinosis is characterized by the accumulation of granular proteinaceous material within the alveoli of the lung. It is well established that patients with pulmonary alveolar proteinosis have a high incidence of complicating pulmonary infections, which suggests that the function of the alveolar macrophages is abnormal. To investigate the function of these cells, they were obtained from two patients by pulmonary lavage with physiologic saline solution and were incubated with Staphylococcus aureus in vitro. The decline in viable organisms from the culture was measured and compared with results obtained with normal alveolar macrophages. On the basis of decreased phagocytosis, results indicate that pulmonary alveolar macrophages from these patients had defective antibacterial function.


Vectorcardiographic detection of early hemodynamic abnormalities in chronic obstructive pulmonary disease.

The ability of the vectorcardiogram to detect mild circulatory abnormalities in patients with chronic obstructive pulmonary disease (COPD) is unclear. Therefore, vectorcardiographic changes were correlated with hemodynamic measurements made at rest and during supine exercise in 32 patients with COPD and no clinical or electrocardiographic evidence of right ventricular hypertrophy. Twelve patients had normal hemodynamic data (group 1), nine had abnormal hemodynamic data only during exercise (group 2), and 11 had abnormal hemodynamic data at rest and during exercise (group 3). The extent of rightward terminal QRS forces noted on the vectorcardiogram was significantly less in group 1 (5.5 +/- 8.7 percent) than in either group 2 (19.0 +/- 10.7 percent) or group 3 (17.8 +/- 14.8 percent). Sixty-five percent (13) of the 20 patients with hemodynamic abnormalities had rightward terminal QRS forces of 15 percent or more, whereas only 8 percent (one) of the 12 patients with normal hemodynamic data had such forces of 15 percent or more. The mean of the rightward terminal QRS forces in 27 age-matched normal subjects was 5.0 +/- 5.4 percent, and only one subject had forces of 15 percent or more. We conclude that hemodynamic abnormalities are frequent in patients with COPD and no clinical evidence of right ventricular hypertrophy and that the vectorcardiogram provides an indirect method of detecting these abnormalities.


Measuring exhaled volume with continuous positive airway pressure and intermittent mandatory ventilation. Techniques and rationale.

When patients breathe spontaneously through a ventilator circuit, a fall in airway pressure during the inspiratory cycle may increase inspiratory effort. A system of delivery which incorporates a distensible reservoir bag and delivers a constant flow of gas that is two or three times the patient's minute volume will prevent a significant drop in inspiratory airway pressure. Unfortunately, the constant flow of gas mixes with the patient's exhaled gas and makes continuous monitoring of exhaled volumes difficult. Two modifications of circuits are described which allow accurate continuous measurement of volume. One of these circuits allows analysis of the concentrations of expired gases. When spontaneous ventilation occurs, tidal volume and minute ventilation demonstrate an intact connection between the ventilator and the patient, continuously indicate the patient's ability to sustain independent ventilation, and give early warning of a change in respiratory status.


Pulmonary amyloidoma and hilar adenopathy. Rare manifestations of primary amyloidosis.

Three cases of primary intrathoracic amyloidosis are reported. Two of these three patients initially had localized parenchymal pulmonary amyloid tumors (or pulmonary amyloidomas). The third patient developed bilateral enlargement of the hilar lymph nodes as a manifestation of primary amyloidosis. These rare manifestations of primary amyloidosis are illustrated, and their clinical signifiance is discussed. Amyloidoma should be considered in patients with unexplained pulmonary nodules or enlargement of hilar lymph nodes.


Diagnostic accuracy in peripheral lung lesions. Factors predicting success with flexible fiberoptic bronchoscopy.

Ninety-seven consecutive peripheral lung lesions were evaluated by biplane fluoroscopically guided flexible fiberoptic bronchoscopy and analyzed to define features that predict diagnostic yield. The overall diagnostic accuracy was 56 percent (63 percent for malignant and 38 percent for benign lesions). The most important characteristic associated with a positive cyto- or histopathologic diagnosis was size of the lesion; the yield was 28 percent when the diameter was less than 2.0 cm compared to 64 percent if the diameter was greater than or equal to 2.0 cm (P = 0.0035). The diagnostic yield was similar for lesions located in the outer and middle third of the lung if the diameter was greater than 2.0 cm; inner one-third lesions were correctly diagnosed more frequently, related in part to the larger size of these lesions. There was no significant difference in diagnostic yield for the following: segmental location, greatest distance from carcina on either the posteroanterior or lateral radiograph, or radiographic characteristics of the lesion. We conclude that biplane fluoroscopically guided flexible fiberoptic bronchoscopy is a reasonable diagnostic procedure for peripheral lesions greater than or equal to 2.0 cm in diameter, but that alternative procedures should be used for lesions under 2.0 cm in diameter.


Evaluation of the progress and prognosis of adult respiratory distress syndrome. Simple respiratory physiologic measurement.

In our study of 14 patients with adult respiratory distress syndrome (ARDS), we measured A-aDO2, VD/VT, arterial-to-end tidal PCO2 ), effective dynamic compliance, and pulmonary vascular resistance on a daily basis. At the onset of ARDS, all patients showed bilateral interstitial edema on the chest X-ray films, P(A-a)O2 of more than 500 mm Hg, marked decrease in effective dynamic compliance, a moderate increase in VD/VT, and a normal value of a-etPCO2. Pulmonary vascular resistance was low. After seven days, all of those who subsequently died and developed persistent elevation of P(A-a)O2, significant increase in VD/VT, a-etPCO2 and pulmonary vascular resistance, and significant decrease in effective dynamic compliance compared to the values at the onset of ARDS. Those abnormalities diverged significantly from the findings in those who survived. By evaluating sequential changes of those parameters, we might be able to predict an accurate prognosis of ARDS.


Multiple cardiac output measurements in man. Evaluation of a new closed-system thermodilution method.

Cardiac output estimates by a new closed-system automatic injection thermodilution method (COI-TD) were compared serially with the direct Fick technique (COFICK) and the standard open-system manual injection thermodilution method (COTD). Comparison with cardiac outputs determined simultaneously by the direct Fick technique in 100 measurements involving ten patients showed close agreement with the new closed system method using both 25 degrees C and 3 degrees C injectates. The cardiac output range was between 1.9 to 11.6 L/min. The open-system manual injection thermodilution method under identical conditions produced a wide scatter of measurements when compared to the direct Fick technique. Reproducibility of simultaneous COI-TD and COTD measurements was examined in quadruplicate. The reproducibility of measurements was within 1.9 percent with COI-TD and 5.9 percent with the COTD method using both 25 degrees C and 3 degrees C injectates. The COI-TD method eliminates the technical problems of recirculation, unstable indicator baseline changes, thermal continuity, and reproducibility encountered with the current COTD method. Analysis of cardiac output by the closed-system automatic injection thermodilution method provides a simple, rapid, reproducible, and highly accurate method for multiple cardiac output measurements suitable for use at the bedside.


Primary alveolar hypoventilation managed by negative-pressure ventilators.

A girl who had a history of repeated apnea was found to have absent chemical drive to ventilation and, on sleep monitoring, both central and obstructive types of apnea. She is currently undergoing successful mechanical ventilation at night with negative-pressure ventilators.


Development of aortic valvular vegetations during appropriate antibiotic therapy. Demonstration through serial echocardiograms.

The development of echocardiographically demonstrable vegetations on cardiac valves while the patient is receiving appropriate antibiotic therapy has not been previously reported. We report a case of alpha-hemolytic streptococcal endocarditis involving the aortic valve. Echocardiographically visualized vegetations were noted to occur on the 11th day of hospitalization. We discuss the role of serial echocardiograms in the management of patients with bacteremias and suspected endocarditis but absence of vegetations on the initial echocardiogram.


Epicardial pacemaker complicated by cardiac tamponade and constrictive pericarditis.

Following insertion of an epicardial pacemaker, our patient developed cardiac tamponade complicated by subacute constrictive pericarditis. Echocardiographic findings and intracardiac pressures were typical of constrictive pericarditis, which was confirmed at surgery. Although rare, these unusual complications should be considered in patients who develop evidence of reduced cardiac output following either transvenous or epicardial electrode placement.


Actinomycotic cervical abscess: A complication of transtracheal aspiration.

Transtracheal aspiration is frequently employed to obtain sputum for microbiologic analysis. Infectious complications of this procedure have been reported rarely. We report an actinomycotic anterior cervical abscess traversing the needle track of a transtracheal aspiration in a patient with actinomycotic pneumonia. Organisms most frequently encountered in anterior cervical abscesses complicating transtracheal aspiration have the recognized potential for local invasion of soft tissue from the primary pulmonary lesion.


Spontaneous regression of diffuse tracheobronchial amyloidosis.

Diffuse tracheobronchial amyloidosis which underwent an extensive spontaneous regression is described in a 39-year-old man. This regression was documented by serial roentgenograms of the chest, studies of pulmonary function, and bronchoscopic procedures with mucosal biopsies. The clinical implications of this spontaneous change are discussed.


Evaluation of the biliary excretion of pencillin G.

Biliary excretion of penicillin G was studied experimentally by perfusion of isolated rabbit liver. Under these conditions, bile recovery accounted for 5% of the amount of penicillin G added to the perfusing blood (10 mg). In man, after intravenous administration of a 599-mg dose of penicillin G (1,000,000 U) to patients provided with T-tube drainage (n = 10), the maximum biliary level averaged 18.0 +/- 8.0 microgram/ml at 2 h; biliary recovery of penicillin G accounted for 0.12% of the administered dose. The excretion of penicillin G in the juice collected through duodenal tubing in normal subjects averaged 0.07% of the administered dose. Peroperative assays showed that the concentrations determined 1 h after intravenous administration 599 mg of the drug attained 45.7 +/- 16.7 microgram/ml in the gallbladder bile and 93.5 +/- 16.3 microgram/ml in the common-duct bile.


Incidence and mechanisms of resistance to trimethoprim in clinically isolated gram-negative bacteria.

Over an 18-month period (October 1973 to April 1975), 133 strains of gram-negative bacteria with acquired resistance to trimethoprim (TM) were isolated from infected urines cultured at the Royal Free Hospital. The overall frequency of resistance was 3.2%. A disproportionately high number of resistant strains (63.1%) were Kebsiella aerogenes. Resistance to TM mediated by R plasmids occurs infrequently (9% of all resistant strains); the majority of TMR plasmids isolated belonged to one incompatability group (W). Chromosomally mediated resistance to TM in most Escherichia coli and K. aerogenes strains appears to be due mainly to production of a dihydrofolate reductase with a reduced susceptibility to TM. In some strains, increased activity of the DHFR was also a contributing factor. Increase in enzyme level alone was only great enough to account for the level of resistance to TM in a small number of cases.


Sensitivity of gentamicin-resistant Enterobacteriaceae to cefamandole and cefoxitin.

A collection of gentamicin-resistant Enterobacteriaceae strains was significantly more resistant to cefamandole than a species-matched collection of gentamicin-sensitive organisms. Cefamandole and gentamicin resistance could be simultaneously transferred by conjugation from four different species, Citrobacter freundii, Escherichia coli, Klebsiella pneumoniae and Serratia marcescens, to a recipient E. coli strain. Plasmids specifying linked resistance to cefamandole and gentamicin are thus commonly present in the environment of our medical center despite the fact that cefamandole has never been used here. Gentamicin-resistant organisms were not more resistant to cefoxitin than gentamicin-sensitive isolates. Conjugal transfer of cefoxitin resistance could not be demonstrated. Relative resistance to cefoxitin was nevertheless common among Enterobacter and Serratia isolates.


Pharmacokinetics of cefadroxil in normal subjects and in patients with renal insufficiency.

Pharmacokinetics of cefadroxil, a new orally semisynthetic cephalosporin, was studied in 5 subjects with normal renal function and in 20 patients with varying degrees of renal insufficiency. All subjects received 1,000 mg per os in a single dose and the elimination phase was studied. In healthy subjects, elimination half-life (T1/2) was 1.39 +/- 0.06 h. Apparent volume of distribution was 0.305 liters/kg and area under the serum concentration versus time curve AUC was 82.94 +/- 19.98 microgram . h/ml. Peak level averaged 25.72 +/- 4.68 microgram . ml-1 and occurred at 1.20 +/- 0.45 h postingestion. 93.0 +/- 3.6% of the dose was recovered in urine during the first 24 h. Renal and serum clearance averaged 166.7 and 172.4 ml . min-1/1.73 m2, respectively. In patients with renal insufficiency, T1/2 increased to 25.49 h in severe chronic renal failure. Renal impairment did not significantly modify volume of distribution. During a 6- to 8-hour hemodialysis session, antibiotic serum concentrations decreased by 75.4 +/- 5.6%. Dosage schedules could be suggested on the basis of these pharmacokinetic results.


Reaction of the vaginal flora to ornidazol in patients with cervicitis.

The cervical and high vaginal flora of 76 patients with cervicitis were studied before and after therapy with Ornidazol by quantitative culture methods. Lactobacilli were the predominant organisms, but Peptostreptococci, Bacteroides and Trichomonas were encountered in 17, respectively 32 and 81% of all specimens. During and after therapy Trichomonas disappeared completely, the bacterial flora normalized and became comparable to that of healthy women with incidences for Bacteroides of 8-13% and Peptostreptococci of 4-5%. The in vitro susceptibility (MIC and MBC) of 50 strains of Bacteroides to Ornidazol was determined by a broth dilution method and an agar plate technique. The MIC varied from 0.07 to 10 microgram/ml. All strains were susceptible to 10 microgram/ml. There was a slight variation in resistance between the various species tested. B. fragilis was less susceptible to Ornidazol than other Bacteroides species. Within the species B. fragilis the subspecies thetaiotaomicron and 'other' were most susceptible, spp. fragilis and spp. distasonis least.


Evaluation in residential treatment: the conceptual dilemmas.

Determining effectiveness of residential treatment must be preceded by basic decisions on precisely what the goals are, and in what time-frame and dimensions--symptoms or adaptability--will achievement be measured.


Outcomes of residential treatment: designing accountability protocols.

This paper is a preliminary report on a year-old pilot project attempting to formulate protocols for measuring goal achievement in residential treatment.


The threat of abuse: problems in aggression and individuality.

Children whose early developmental years are marked by constant threat of parental abuse often manifest as adults an inability to tolerate aggression or to develop close relationships.


A joint treatment "package" of the Army and a child welfare agency.

A project at Fort Riley, Kansas, combining military, community and private resources, stresses parent education and problems of isolation and self-concept.


Parental perceptions of behaviors in preschool children.

A comparison of parental descriptions revealed that mothers of developmentally delayed children listed fewer deviant behaviors than did mothers of behaviorally disturbed children, but significantly more than mothers of non-clinic children. The Washington Symptom Checklist, used in this research, proved a useful clinical tool.


Child welfare management: a model curriculum.

A social work school curriculum designed especially to train persons to manage child welfare program is in its second year of operation. It may provide a model for training personnel in this area.


Today's unmarried mothers: the choices have changed.

A mid-1970s study of the characteristics of pregnant unmarried mothers who keep their children and those who surrender them for adoption discloses some differences from the characteristics of such mothers in the late 1960s and early 1970s. The swing away from adoption may reflect changes in social values.


Racial and cultural issues in adoption.

A review of the philosophical and practical issues in transracial adoption yields theoretical conclusions and some suggestions to agencies.


Reciprocal nature of parent-infant interaction: implications for child maltreatment.

Exploration of the infant's role in creating a potentially abusive situation suggests a different orientation for child maltreatment programs.


Sex education for children in a residential center.

Sex education programs for emotionally disturbed children present special problems. This article emphasizes training of child care workers and their role as teachers.


Homemakers for Israeli families of retarded children.

Homemakers especially trained to assist in the care of retarded children remaining at home have proved effective in a year of experimentation.


The results of operating upon cerebral aneurysms and angiomas in children and adolescents. I. Cerebral aneurysms.

This paper summarizes the clinical presentation, location, surgical management, and results in 32 patients with cerebral aneurysms. Surgical mortality has been 21.9% for aneurysms (all grades). For good risk aneurysms (Botterell 1 and 2), the surgical death rate was 8.0% (2/25). Clinical presentations and techniques of treatment are summarized.


The results of operating upon cerebral aneurysms and angiomas in children and adolescents. II. Cerebral angiomas.

Symptomatic angiomas of the brain, brain stem or cerebellum are uncommon in all age groups. They usually present by subarachnoid and intraparenchymatous hemorrhage, but they may act as expanding mass lesions, as causes of ingavescent neurological deficit (?'steal phenomenon'), as epilepticogenic foci, or as a source of relentless headache. We have operated upon 20 patients, 18 years of age of less, with symptomatic angiomas. There has been no surgical mortality, and no patient has been made worse by operation.


Pathophysiology, treatment and outcome following severe head injury in children.

The pathophysiology and outcome following severe head injury in 85 children are presented. The commonest initial CT diagnosis was of acute brain swelling. This swelling was associated with an increased white matter density on the CT scan which decreased to normal concomitant with recovery and increased ventricular size. CBF measurements in 6 of these patients revealed an increased blood flow despite a decreased CMRO2 and clinical coma. This CT pattern of diffuse swelling is believed to be due to acute cerebrovascular congestion and hyperemia and not to edema. Because of this, all children were treated with endotracheal intubation and controlled hyperventilation as part of the initial management. Mass lesions were uncommon, 20%. ICP was monitored in 40 children. The ICP rose above 20 Torr despite therapy in 80% of children with decerebrate or flaccid coma and in only 20% of children with spontaneous motor function. The ICP was at its highest between the second and fifth day. Aggressive therapy to control the ICP, with barbiturates if necessary, was successful in 80% of the patients. The overall results were useful recovery in 87.5% of the children, 3.5% were left vegetative or severely disabled and 9% died.


Prophylactic craniofacial surgery.

One-stage radical reconstructive surgery for the common craniofacial deformities has become standard procedure in a few medical centers. With increasing experience and expertise, young children and adolescents, as well as a few adults have been greatly benefited. It has long been recognized that both the cranial and facial deformities of Couzon's disease and Apert's syndrome are progressive, having their inception either before birth or in the neonatal period, and evolving to the full blown syndrome during the first years of life. The authors believe that the progressive nature of these anomalies is secondary to a combination of permaturely fused sutures of the calvarium and cranial base (coronal, sphenozygomatic, frontoethmoidal and frontosphenoidal). In an effort to arrest and correct both the cranial and facial deformities as well as obviate the need for future radical surgery the authors have treated several children with Crouzon's disease and Apert's syndrome with suture craniectomy along the base of the skull. Following this procedure, deformity has regressed and ultimate cosmetic improvement has been dramatic. It is unlikely that radical craniofacial surgery will be necessary in this group of patients at any future time. On the basis of this experience, it is believed that the pendulum is now swinging and that in the future, stripping of the appropriate sutures along the base of the skull will limit deformity and make additional surgery unnecessary.


Physiopathology and a new treatment of chronic subdural hematoma in children.

Chronic collections of fluid in the subdural spaces may result from trauma or may complicate meningitis. The etiological factor, or factors, which contribute to chronicity of subdural fluid in children remains obscure. We postulate that one possible mechanism is the progressive stretching and narrowing of the cortical veins, bridging the subarachnoid and subdural spaces to enter the superior sagittal sinus. This process ultimately leads to thrombosis of these 'hanging veins'. Narrowing and angulation of these veins could result in elevated back pressure favoring the formation of a transudate. 16 children who had progressive and persistent collections of xanthochromic fluid in the subdural spaces secondary to trauma or infection who were treated previously either with subdural tap, burr holes, subdural peritoneal shunt, craniotomy, stripping of membranes and/or a combination of these, were treated by lowering and advancing the superior sagittal sinus with its overlying sagittal suture and performing a duraplasty. This new surgical technique is directed to improve venous drainage from the superior anastomotic vein into the superior sagittal sinus. Angiographic follow-up showed that only 2 patients still have evidence of fluid collection: the rest of the patients showed normal arterial phases, the medullary system was minimally filled and all of these showed remarkable improvement of the venous drainage throughout the superficial cortical veins with no evidence of hanging veins. Intellectual development of these children following lowering of the superior sagittal sinus showed that 8 patients (50%) were normal or above normal; 5 patients (31.2%) were retarded and 3 patients (18.7%) were borderline.


Hemispherectomy for Sturge-Weber syndrome.

Patients with Sturge-Weber disease who have the onset of seizures in infancy invariably face a progressively downhill course which leaves them severely hemiplegic, demented and usually institutionalized because of uncontrolled seizures. During the past 12 years, we have carried out 6 hemispherectomies in infants under 1 year of age who presented with seizures and Sturge-Weber disease. The results have been gratifying. Seizures have stopped, hemipareses have been minimal and intellectual development has been good.


Analysis of therapeutic modalities for head-injured children.

The various stages and therapeutic modalities in the management of children with moderate and severe head injuries is reviewed. Emphasis on aggressive management upon arrival to the emergency room, and continuing until brain swelling has definitely resolved, is stressed. Management includes prompt endotracheal intubation and hyperventilation, arterial and venous lines and bladder catheter insertion. Computed tomography to assess underlying pathology, intracranial pressure monitoring for appropriate therapy should follow. In this way mannitol, other diuretics, hypothermia and barbiturate coma can be decided on, and the response assessed. The role of high dose steroids is discussed.


Neuropsychological outcome of closed head injury in children and adolescents.

45 children and adolescents recovering from closed head injury underwent neuropsychological testing. Multiple indices were used to classify the severity of injury but most important in this study were the persistence of coma indexed by grades I--III and the Glasgow Coma Scale. Although the presence of early neuropsychological sequelae and long-term intellectual deficit was generally related to the severity of injury, residual impairment was also found in patients with relatively mild injuries. Analysis of memory and learning demonstrated disruption of both storage and retrieval processes.


Management of ventricular shunt infections.

The authors report the incidence (2.7%) of shunt infection in a series of 778 consecutive shunt procedures. The management of these infections and an additional group of infected patients operated elsewhere is discussed. A protocol is given for the treatment of external infections, gram-positive internal infections and gram-negative internal infections.


Medulloblastoma in childhood: comparative results of partial and total resection.

51 medulloblastomas under 12 years of age were treated from 1966 through 1977. 50 patients underwent craniotomy and 39 of them completed postoperative radiation therapy. Surgical mortality rate of primary posterior fossa craniotomy was 8%. One year survival rate was 71.4%, 3 years 45.6% and 5 years 34.5%. Extent of surgical resection was found to affect the survival, and a group of radical or visibly total resection showed higher postoperative survival. Female patients enjoyed longer survival. The patients under 12 months of age showed poor prognosis. Reexploration of the posterior fossa failed to prolong the survival by more than 3 months.


Biopsy of pediatric brain stem tumors.

26 patients, average age of 7.3 years, has biopsies of a brain stem tumor. 62% of the patients presented with hydrocephalus, and ventriculoperitoneal shunts were placed 7-10 days prior to biopsy. The midbrain was biopsied 13 times, the pons 3 and the medulla 12 times. Tissue for histopathologic examination was obtained at each operation and demonstrated astrocytoma in 13 patients, glioblastoma in 6, 'no tumor seen' in 5 and ependymoma in 2. Astrocytomas were usually located in the upper brain stem, and all of the glioblastomas were located in the medulla. The operative mortality was zero, and the morbidity was largely related to increased cranial nerve deficit. All the astrocytoma patients were treated with radiation only; whereas, 4 patients with glioblastoma were treated with vincristine, CCNU and methylprednisone in addition to radiation as described by the Children's Cancer Study Group (CCG-944). 3 patients with 'no tumor' were not treated and are alive and well 15-41 months following operation. 2 patients with no tumor were treated, one as a glioblastoma multiforme, subsequently verified at postmortem examination, and one as a midbrain astrocytoma. 1 patient with astrocytoma died 3 months following operation, all the remainder are living and well 4-51 months following operation. Irrespective of the treatment, all 7 patients with glioblastoma expired within 9 months of diagnosis. The prognosis for survival for patients with brain stem astrocytoma is superior to those with glioblastoma multiforme. Specific histopathologic correlation with clinical management may lead to improved and prolonged survival for patients with brain stem glioma.


Arteriovenous malformations of the spinal cord in children.

Spinal arterivenous malformations occur in the pediatric age range more commonly than previously acknowledged. An analysis of 64 cases with onset under 18 years of age demonstrates pain to be the most common first symptom. A long delay to diagnosis permits development of significant paresis or plegia in the majority. Correctly performed myelography (with supine views) provided the diagnosis in 60%. A radical microsurgical excision appears to offer the best long-term results.


B waves--a reflection of cardiorespiratory or cerebral nervous systems rhythm?

A review of 92 consecutive shunt revisions is presented in an attempt to assess the contribution of computerized axial tomography to the long-term management of the child with shunted hydrocephalus. 20-22 percent of all cases of acute shunt malfunction presented with small ventricles, indicating that absence of ventricular enlargement should not be interpreted as demonstrating adequate shunt function. The single most useful application of computerized axial tomography in our hands is the detection of indolent shunt malfunction associated with ventriculomegaly and decline of cognitive function in the older child.


Klippel-Feil syndrome, iniencephalus, anencephalus, hindbrain hernia and mirror movements: overdistention of the neural tube.

Bony anomalies encountered in the 'no neck' form of Klippel-Feil syndrome (KFS) are a wide, short, fused, bifid, retroflexed spinal canal; craniolacunia, cranium bifidum, and acrania. The only symptom may be mirror movement (MM). The CNS anomalies are hindbrain hernia, hydrocephalus, hydromyelia, syringomyelia, meningocele, myelocele, encephalocele, and anencephalus. In severe KFS, i.e. iniencephalus (IN) and in anencephalus (AN), the inion is in contact with the back. In both there is hindbrain hernia and the left thorax may contain the stomach tethered to an anterior spina bifida. KFS results from distortion of somites by an overdistended neural tube. A neural tube that fails to close cannot overdistend.


The physiopathogenetic basis for the angiographic diagnosis of bacterial infections of the brain and its coverings in children. II. Cerebritis and brain abscess.

Most of the small (50--60 micrometers) vessels nourish exclusively the cerebral cortex, whereas larger caliber (80--150 micrometers) arteries penetrate the entirety of the cortical layer to enter the underlying white matter. A single layer of nonfenestrated endothelial cells, surrounded by a continuous layer of basement membrane (which in places splits to envelope a pericyte), and perivascular glial cells attached to the outer surface of this basement membrane, with no pericapillary space, represent the anatomical structure of the blood-brain barrier (BBB). Concentrated electrolyte solutions and increases in mean arterial pressure may reopen the BBB. Water-soluble contrast media used in cerebral angiography are hypertonic solutions of iodinated salts. In cerebritis, one observes a very typical angiographic picture: 'laminar' staining of the gyri. The intervening sulci appear as negative images. In brain abscess, one may note angiographic evidence of a space-occupying lesion, a capsular stain in the granulation tissue surrounding the abscess, 'halo' formation and 'pooling' of contrast media in the sulci, and 'laminar' staining of the gyri.


Seeding of intracranial ependymomas in children.

19 cases of intracranial ependymomas were reviewed to determine the incidence of seeding. 4 patients demonstrated conclusive evidence of seeding in sites remote from the operative and irradiated field, 3 of whom had high-grade ependymomas. Clinical-pathological correlation disclosed a greater tendency to seeding and a worse prognosis among patients with high-grade ependymomas. A more aggressive therapeutic approach is indicated when high-grade ependymomas are involved.


Hydrocephalus in myelomeningocele.

156 children born with myelomeningocele were studied over a 3- to 10-year follow-up period. The appearance, type and rate of development of hydrocephalus were noted and correlated with the findings on neonatal and follow-up physical examination. 80% of the children developed overt hydrocephalus; 73.4% of these cases were secondary to aqueductal stenosis. Only 15.3% of the cases showed physical evidence of hydrocephalus at birth. Another 64.8% of the children developed clinical signs of hydrocephalus during the follow-up period, most during the first few weeks but some as late as the third year of life. The neonatal examination is unable to predict the subsequent appearance of hydrocephalus or its rate of development, and even serial determinations of head circumference are often of limited value. The authors conclude that the early diagnosis of hydrocephalus in children with myelomeningocele cannot reliably be made on physical examination alone and that other means of assessing ventricular size should be employed.


Peculiar congenital parieto-occipital head tumor: report of 3 cases.

3 infantile cases of congenital parieto-occipital midline soft tumor, the clinical and pathological findings of which did not correspond precisely to a known congenital head tumor, are reported. One of them probably belongs to McLaurin's type of encephalocele with heterotopic glial rest, and the remaining two to McLaurin's type of meningocele without central connection. The types of anomaly shown by the present cases should generally be called 'atretic cephalocele' or 'rudimentary cephalocele'.


[Preoperative detection of antrum mucosa in patients with peptic ulcer following gastric secretion -- indication for reintervention?].

In 6 of 23 patients with marginal ulcer after gastric resection (B II and Roux-Y anastomosis) a retained ("excluded") gastric antrum attached to the duodenal stump was detected by 99mTC pertechnetate scintiphotography; serum gastrin levels were normal in two of those cases. Resection has been abandoned as a treatment method, and transthoracic vagotomy is recommended for this disease.


[Comparative endoscopic, light microscopy and scanning electron microscopy studies of the gastric mucosa in patients with chronic uremia].

Ten patients suffering from chronic uremia were selected for comparison studies of gastric mucosa. With endoscopy erosive gastritis was seen in the corpus and antrum of five patients and in the fundus of two patients. Conventional microscopy (nine patients) revealed chronic gastritis I three times in the fundus and five times in the corpus. Gastritis II was localized once in the corpus and twice in the antrum. Gastritis III was present in the antrum of four patients. Under the scanning electron microscope lesions of gastric mucosa were present in all ten cases. Single cell necrosis (A), mucosal defects involving basal membrane (B), destruction of tunica propria (C), and muscularis mucosae with bleeding (D) were seen. Mucosal lesions A and B are early stages of gastric erosions. The most severe lesions were seen in the antrum mucosa with all three methods.


[Vein substitution using PTFE prosthesis--results of animal experiments and initial clinical experiences].

The expanded PTFE prosthesis (Gore Tex), which has been used for 4 years as an artery substitute, was examined in the "low-pressure system" in dogs. In 23 dogs an infrarenal segment of the vena cava was resected and substituted by a Gore Tex prosthesis. In nine dogs an arteriovenous shunt between the right iliac artery and the corresponding vein was also performed. Phlebographic examinations were made 8 days after the operation and at monthly intervals thereafter. After a mean period of 233 days the dogs were killed and histopathologic and electron microscopic analyses performed. Patency was found in 89% of transplants with, and 86% of transplants without, the arteriovenous shunt. Aafter these experiments the Gore Tex prosthesis was implanted successfully in patients suffering from postthrombotic syndrome to serve as a substitute for the superior vena cava and iliac vein. It also acted as a substitute for the jugular vein after neck dissection.


[The effect of somatostatin on the ileocecal sphincter (ICS) before and after extensive small bowel resection].

The ileocoecal sphincter pressure of rabbits was studied under somatostatin infusion before and after subtotal small bowel resection. Before resection, somatostatin increased the pressure necessary to pass fluid through this zone according to the applied doses. Seven days after resection, a decrease in the ileocoecal sphincter pressure was found, which could not be affected by somatostatin infusion. One year after resection, the reflux pressure was again normal, and the somatostatin effect was similar as to that before resection.


[Animal experiments in stagnant loop syndrome].

Using the perfusion technique, the absorption of water, sodium, and glucose was studied in a partial occlusion of the intestine. In this study we investigated the mucosal enzyme, the metabolic changes of the small bowel wall, and the morphology of the mucosa. The reason for the decreased absorption of glucose, sodium, and water in the prestenotic phase may be the increased proliferation of the mucosa. The decreased absorption of the glucose, sodium and water in the poststenotic phase may be caused by an atrophy of the mucosa.


[Free jejunum graft as substitute of the cervical esophagus done with microsurgical technic--morphological and functional results in long-term studies].

It is possible to undertake a free transplantation of the jejunum with a low rate of thrombosis by a microsurgical technique of vascular anastomosis. The animals could be nourished sufficiently via the interponate with pasty food. Peristalsis within the interponate was retained. Stenoses caused by a periluminar cicatrix are possible. After 1 year a transformation of connective tissue of the interponate was not observed.


[Functional and morphological studies on diverticulosis of the large bowel].

In comparison to the normal colon, longitudinal and circular musculature in diverticular disease (DD) was investigated--regarding motility and morphology--and a comparative measurement between musculature and mucosa was also performed with following results: 1. Only the tenia in DD revealed a spastically contracted muscle. 2. There was a ribbon formation due to contraction only in tenias of DD, although there was hypertrophy in both muscle groups. 3. The longitudinal muscle in DD was found to be shortened.


[A method for differentiation between the participation of the smooth and the cross-striated anal sphincter muscles in resting tonus].

By means of simultaneous recordings of the external anal sphincter EMG activity and the anal resting pressure with at least ten voluntary sphincter contractions, it is possible to estimate by correlation calculation the resting pressure exerted by the internal anal sphincter. The value of the method had been proved by comparing investigations in conscious and curarized patients under general anesthesia. In patients with hemorrhoids and chronic constipation, the amount of internal pressure found in the resting tonus (91% in hemorrhoids, 55% in chronic constipation) was significantly different when compared with a health group. The comparison of only the resting pressure did not show a significant difference.


[Surgical technic to alleviate anal incontinence using a magnetic anal closure].

Available operative procedures to reduce incontinence are gracilis transplant, levator plastic, free muscle transplantation and pacemakers. Further procedures being tested in clinical trials are electronic cuffs, modified Scott's sphincters, and implantation of cuffs of unstriated muscle. The magnetic anal ring, which has been developed in Erlangen, consists of two halves. Using a sacral approach both parts can be placed around the rectum without opening the bowels. An anal tampon consisting of a magnetic tampon and a tampon covering is responsible for occlusion. The tampon covering consists of polyvinylformalfoam, which guarantees an excellent plugging. Application is similar to tampons for menstruation; tampons can be changed three times a day and the bowel can be emptied normally when a change is made. In order to work successfully the tampon is pressure adapted to the pressure profile of the large bowel. Histologic investigations of the mucosa did not show any alterations. Megacolon or megarectum proximal to the anal ring did not occur.


[A mathematical model for the determination of loss of venous capacitance using impedance plethysmography].

The results of impedance plethysmographic examination were evaluated by a mathematical curve analysis. The magnitude of the exponential coefficient of the saturation and discharge function provides a highly accurate measure of the loss of functionality. The percentage change in the flow rate may be obtained by substitution of the exponential coefficients in a model formula.


[Xenotransplantation of human breast cancer in athymic nude mice].

Of 150 human breast cancers, 90 (60%) were successfully transplanted onto thymusaplastic nude mice without the use of adjunctive immunosuppressive therapy. Four months after transplantation, 12 rapidly growing tumors had diameters of 2.5-3.5 cm. Investigations revealed a high correlation between the histology of original tumors and xenografts. We conclude that the nude mouse may be used as an animal model for studies such as this, or in determining the sensitivity of transplanted tumors to cytostatic drugs, steroid hormones, and radiation.


[Topical differences in estrogen receptor content of primary breast cancer].

In 50 primary cancers of the mammary gland, tissue samples from three different parts of each tumor were analyzed for estrogen content by agar gel electrophoresis. In 12 tumors receptor-rich and receptor-poor zones were detected within the tumor for the 4-s fraction, and in 11 tumors for the 8-s fraction. Confidence limits (99%) indicate that these findings might range from 10.4% to 42.5% for the 4-s fraction, and 10.2%-44.1% for the 8-s fraction.


[Effect of estradiol on RNA biosynthesis of human breast carcinoma cells in vitro].

The possibility of differentiating estrogen-sensitive human breast cancer using incorporation studies with labeled uridine as a precursor of RNA metabolism is described. The purpose of this study was to explore inadequate function of the estrogen receptor as an alternative or supplementary aid in selecting patients for hormonal manipulation. The disadvantage of the test is that only hormone dependence of a proliferating tumor cell population can be evaluated. Highly differentiated breast cancer cells exhibit the greatest estrogen sensitivity. The hormone-dependent tumors of premenopausal women show an increase in RNA synthesis, whereas uridine incorporation appeared to be inhibited in postmenopausal women.


[Model for the study of influences on fracture healing. Animal experiments].

Primary and secondary bone healing were studied for 30 and 60 days, respectively, by means of X rays, scintigraphy, determination of callus thickness, scintillation counter, and determination of bone mineral content. Primary bone healing was terminated after 30 days, secondary healing after 60 days. Scintillation counting proved to be a quantitative method, the other methods serving as controls. The different influences on bone healing can be quantitatively studied by means of this model.


[Intramedullary pressure development and its sequelae in intramedullary nailing].

High pressure exceeding 1000 mm Hg are measured during reaming of the narrow cavity with ASIF instruments after osteotomy of the sheep's tibia. Histologic evaluation 8 weeks after intramedullary nailing shows obliteration of the canalis a. nutritiae and smaller cortical vessels with fat and bone particles. The internal circumference of the cortex remains nonvital. Revascularization and bone remodeling is proceeding in a mainly centripetal direction.


[Femoral head blood flow in dogs subjected to intra-articular pressure increase and to pressure release].

In six beagles femoral head blood flow is measured with radioactive microspheres. When intra-articular pressure of the hip joint is increased by 50 mm Hg, blood flow is diminished to 48%. Reducing intra-articular pressure to the initial level increases femoral head blood flow to 78%. The results support the demand for immediate pressure relief of hemarthrosis.


[Experimental studies on the biomechanics of the lateral ligaments of the knee joint].

Measurements of absolute strain and stress on collateral ligaments of human knees were made with two new measuring cells. The medial collateral ligament was found to have three functional different parts, the most important of which was the ventral. During motion of the knee, tensile forces amounted to about 20 N when the lateral ligament was in extension and the medial ligament in full flexion. Moments of abduction and adduction increased strain and stress manyfold.


[Studies on the intra-osseous fastening of alloplastic ligament substitutes in sheep using carbon fibers].

The alloplastic replacement of the medial collateral ligament of the knee of sheep by carbon fibers gave a strength comparable with the natural ligament. Coating of the fibers, e.g., with epoxy resin, leads to a reduced integration of the implant into the tissues. Physical and histologic results together with the intraosseus anchorage show that pure carbon fibers are a suitable material for alloplastic ligament replacement.


[A new treatment method of hydrofluoric acid burns of the extremities].

A new method to arrest the unremitting progression of hydrofluoric acid burns, which occurs in the absence of appropriate therapy, is described. The treatment consists of repeated perfusions of calcium gluconate into one of the arteries supplying the affected areas. To date 11 patients have been treated in the described manner, and the therapy brought about recovery in all cases, with little loss of tissue or function.


[Postoperative disturbance in insulin secretion: studies on the altered secretion mode].

1. Depending on the operative trauma, insulin secretion is decreased until the 10th day after abdominal surgery. 2. The decreased insulin release is caused by a diminished discharge from the pancreatic beta cell during the second phase of insulin secretion (partially newly synthesized insulin). Insulin release during the early phase of insulin secretion (prestored insulin) is unchanged or even accelerated. 3. The glucose tolerance level is pathologically diminished until the 10th postoperative day.


[Mode of action and tolerance of a single weekly dose of 1 mg of L-thyroxine for the prevention of recurrence of goiter].

After resection of euthyroid goiter, different doses of thyroxine administration for prophylaxis against recurrence were tested and compared. Group 1 (n = 30) received 1 mg L-thyroxine weekly; group 2 (n = 31), 0.1 mg L-thyroxine daily. The intermittent, high-dose thyroxine turned out to be equally effective as the conventional daily intake and showed no negative side effects.


[Changes in ionized calcium and citrate levels in dogs during mechanical autotransfusion with heparin, ACD and CPD].

The control of ionized calcium (Ca++), total calcium, and citrate levels in serum were determined in dogs during autotransfusion (AT) of blood stabilized with heparin, ACD (formula B) and CPD. Blood samples were taken according to the changes of aortic pressure (AOP), which was continuously monitored. Taking the values during the stable phase of AOP preceding the AT as baseline, Ca++ dropped by 27% with ACD and by 34% with CPD at the maximum decrease of AOP immediately after the AT. The corresponding increase of citrate was 174% with ACD and 521% with CPD, while total calcium remained stable. Thus cardiac depression after AT of citrated blood seems to be mainly caused by the drop of Ca++, which is significantly more pronounced with CPD, corresponding to the higher content of citrate.


[Viscosimetric studies on the effectiveness of a postoperative bronchial secretolytic agent].

During postoperative care we examined the effect of bromhexine HCl and prostaglandin E1 on the viscosity of bronchial secretion. Both drugs reduced the viscosity and produced a liquefaction of the secretion. In the control group, which was treated with 0.9% NaCl solution, no significant effect was seen.


[Role of histamine in acute pancreatitis].

Elevated histamine concentrations of pathophysiological significance could be determined in plasma of dogs suffering from acute pancreatitis according to Pfeffer. This result was also obtained in dogs treated with aminoguanidine, a very effective diamine oxidase blocker, in addition to the duodenal blind loop preparation. Elevated histamine concentrations were found in nine out of ten dogs.


[Histamine level and histamine metabolism of the human liver in biliary tract diseases].

In a control group (n = 12) the histamine content of the liver was 1.42 microgram/g tissue and the activity of the histamine-degradating enzyme, HMT, 421.5 pmol/(min . mg protein). In patients with affections of the biliary tract (n = 12) the histamine content was significantly raised to 3.09 microgram/g tissue and the HMT activity slightly diminished [349 pmol/(min . mg protein)]. The lowest values of HMT activity were found in the livers of those patients with histologically proven damage of liver cells.


[Reaction of the liver cells to surgical intervention in obstructive jaundice. Electron microscopic-morphometric studies of the rat liver].

In Wistar rats, bile was drained by biliocutaneous fistulas 7 days after ligation of the common bile duct. Morphometric analysis using a computer program registered about 60 parameters of a hepatocyte. Most cell organelles are again normal 7 days after intervention. The ultrastructural changes are not fully compatible with histologic and biochemical findings.


[Of what kind of material should bile duct T-tubing be made?].

T-drainage tubings consisting of siliconized latex, silicone rubber, siliconized latex with additional silicone treatment of the surface of the short legs, or silicone rubber with PVC covering of the long branch were tested in experiments with dogs. Fibrous encapsulation, incrustation, and behaviour of the material were checked after 1, 2, 4, and 12 weeks. Siliconized latex proved to be the most suitable material.


[Animal experiments on the hemodynamics of prehepatic portal hypertension before and following various methods of portacaval anastomosis].

In 24 dogs (29 +/- 5,7 kg) general and intestinal hemodynamics were measured during acute prehepatic portal hypertension before and after mesentericocaval, splenorenal, and splenocaval (SCA) shunt. From the hemodynamic point of view the SCA is superior because of its complete venous decompression of the region of the spleen and cardia and a greater blood flow to the liver. Furthermore shunt flow, and consequently volume load imposed on the general circulation, is significantly smaller in SCA.


[Myocardial metabolic status in various methods of inducing a reversible heart arrest].

In experiments with dogs, three different methods of inducing a reversible cardiac arrest were compared: (A) the ischemic arrest for 45 min, (B) the cardiac arrest for 90 min due to injection of Cardioplegin according to KIRSCH, and (C) the cardiac arrest for 90 min due to infusion of solution LK 352 according to BRETSCHNEIDER. The body temperature was reduced to 30 degrees C during the period of cardiac arrest. From the alterations in the adenylic acid system of the left ventricular myocardium at the end of the period of myocardial standstill and after 60 min of recovery, it can be deduced that the best myocardial protection is given by method C. Method A has the least effect.


[Function of the residual pancreas following partial duodeno-pancreatectomy].

After Whipple operations, follow-up examinations were conducted under hospital conditions in order to investigate the function of the remainder of the pancreas and the extent to which general health was adversely affected. General parameters such as vocational rehabilitation, history of pain, and weight were analyzed, as well as chemistry related to the severity of pancreatic malassimilation, e.g., stool weight, stool fat contents, fat utilization, chymotrypsin in stool, and PABA test. An exocrine pancreatic insufficiency was found in 80% of patients, but this was easily manageable using medications, sometimes in combination with a MCT fat diet. Subclinical diabetes mellitus was shown in 80% of patients using glucose tolerance tests. However, clinical manifestations of diabetes did not occur.


[Significance of the complement system in acute pancreatitis in rats].

The influence of complement system in acute pancreatitis in the rat was examined. Two different experimental procedures were used to induce pancreatitis: distal choledochal ligature and the Pfeffer model as modified by NEVALAINEN. In both procedures an acute pancreatitis developed and complement depression was noted. These results showed that consumption of complement will occur even in pancreatitis induced by other than immunologic models. In a second series the same experimental procedures were used in rats that had been decomplemented by application of cobra venom factor. It was possible to produce an acute pancreatitis of moderate severity.


[Cryosurgery in the treatment of Echinococcus alveolaris. Animal experiments].

The influence of cryosurgery on echinococcus alveolaris is studied in 100 mice. In a second series cryosurgical effects on structures of the hepatic portal (hepatic artery, portal vein, hepatic duct) were examined. The experiments showed that echinococcus alveolaris can be devitalized by cryosurgical measures at temperatures between -100 degrees C and -190 degrees C. No damage of the hepatic artery, portal vein, and hepatic duct occurred. Clinical application of cryosurgery for the treatment of inoperable echinococcus alveolaris of the hepatic portal appears to be justified.


[Regional myocardial blood flow and ventricle function following hypothermic ischemia and cardioplegia].

Regional myocardial blood flow (MBF) and left ventricular (LV) function were measured in 18 dogs after 60 min hypothermic (14-16 degrees C) arrest with (group I) and without cardioplegia (group II). Regardless whether postischemic LV function was severely (group II) or only moderately (group I) impaired, the amount of MBF and its transmural distribution was not significantly altered after 30 min reperfusion. In contrast to topical hypothermia, additional cardioplegia maintained metabolic regulation of coronary flow.


[Immunosuppressive properties of Anturan].

The influence of Anturan on rosette-forming cells and hemolytic antibodies in male Wistar rats immunized with 5 . 10(8) sheep red blood cells was investigated. An unknown influence of Anturan on the cellular and humoral immune response was detected. Anturan was most effective when given 2 days after immunization.


[Comparative studies on pulsatile and continuous flow during extracorporeal circulation. Effects on liver function and endocrine pancreas secretion].

The effects of pulsatile and nonpulsatile flow pattern on pancreas and liver blood flow were studied in nine dogs on cardiopulmonary bypass (CPB). Furthermore, plasma levels of glucose, insulin, glucagon, growth hormone, and cholinesterase were compared in 20 patients subjected to open heart surgery with either pulsatile or nonpulsatile perfusion. Impairment of liver and pancreas function was significantly greater at the end of CPB and 48 h afterwards with nonpulsatile flow as compared with the pulsatile flow pattern. A decrease of intestinal blood flow that was demonstrated in dogs subjected to nonpulsatile perfusion could at least in part be responsible for the difference in postoperative organ function observed in patients after CPB.


[Hyperdynamic septic shock in man: concentration course of selected coagulation factors and plasma proteins].

Coagulation factors and plasma proteins are significantly decreased in patients with hyperdynamic septic shock. Besides the activation of the coagulation system, the endotoxin-induced release of granulocyte proteases is responsible for a septic disseminated intravascular coagulation. In this situation special emphasis should be placed on the levels of antithrombin III regarding application of heparin.


[Effects of bacterial peritonitis on the low-pressure system in man].

The effective compliance (C) of the "low-pressure system" has been measured in ten patients with bacterial peritonitis by means of plotting pressure and volume on the first postoperative day (deltaV = 500 ml/10 min). The value of C is decreased in one group of patients, while it increases to as much as five times that of "normal patients" in the other. The cause might be a summation effect of hypovolemia, blood volume shift from intra- to extrathoracic space, and endotoxin reaction on the tone of vascular smooth muscle. The augmentation of the intravascular volume results in an increase of portal venous pressure, which is less than central venous pressure. Splanchnic pooling through increased vascular resistance does not appear.


[Extravascular albumin and water content of the lungs in traumatic-hemorrhagic shock].

Fifteen mongrel dogs are subjected to a standardized traumatic hemorrhagic shock. Plasma albumin, measured by J-125-albumin distribution, decreases to 58% of its original level after trauma and hemorrhage. Lung albumin content increases to 53% of the blood level. Lung water content is studied in vivo using the double indicator technique, post mortem by gravimetric methods. None of these methods shows an augmentation of lung water. The massive albumin loss occurs, particularly in the lungs, due to capillary leakage. The constant pulmonary water content can possibly be explained by early artificial respiration and by the fact that in contrast to clinical situations no infusion therapy was performed.


[Pharmacological modification of regional blood flow in rat stomach mucosa].

The effect of three agents with antisecretory function on regional gastric mucosal blood flow was measured using the microspheres technique. Salbutamol caused a significant decrease in blood flow, while DMPGE2 caused a significant increase. After calcitonin no change was observed. This is contrary to the belief that inhibition of acid secretion is always associated with a decrease in gastric mucosal blood flow.


[Superselective vagotomy in rats. Functional criteria in rest and during stress].

A microsurgical technique allows the isolated severence of proximal vagal fibers at the minor curvature of the rat stomach (superselective vagotomy). In contrast to the conventional highly selective vagotomy, which favors formation of stress ulcers, this new procedure appears able to prevent gastric mucosa from developing stress ulcers.


[Effect of hypophysectomy on gastrin release and antral gastrin concentration].

Hypophysectomy resulted in a lower amount of basal serum gastrin. In hypophysectomized rats, there was a release of serum gastrin after food intake; however, the serum gastrin level was lower 30 min postprandially. The most important effect of hypophysectomy is absence of repletion of antral gastrin after an initial postcibarial depletion. We conclude that the immediate synthesis of antral gastrin after food intake is inhibited by hypophysectomy.


Effects of celiacectomy and stellatectomy on gastric mucosal innervation and acid secretion in the dog.

The effect of surgical excision of the celiac and superior mesenteric ganglia and the stellate ganglia, respectively, on gastric acid secretion and adrenergic innervation of gastric mucosa was studied in five dogs. After removal of the abdominal ganglia, there was a significant increase in acid secretion while there was a marked decrease in the number of adrenergic nerve terminals in the mucosa. When, addition, the stellate ganglia were excised, acid secretion increased slightly in two dogs, while little change in mucosal innervation was noted. These data suggest that the adrenergic innervation of the stomach has an inhibitory role in the control of acid secretion in the dog. Vagal adrenergic nerve fibers seem to be of limited importance in gastric acid production.


[Cancer of Vater's ampulla].

From 1964 to 1977 a total of 50 patients were operated on for carcinoma of the ampulla of Vater, the second most frequent tumor of the periampullar region. The cardinal symptom was jaundice. The diagnostic procedures of high value were roentgenographic examination of the upper gastrointestinal tract with the use of barium, also hypotonic duodenography, sonography, and percutaneous transhepatic cholangiography (ERCP, angiography). Curative treatment was possible by duodenopancreatectomy, with a resection rate of 74%. The 5-year survival rate was 27% with a postoperative death rate of 13.5%.


[Surgical correction of venous insufficiency following arteriovenous fistula for hemodialysis].

The percentage of venous insufficiency in the original Cimino-Brescia shunt is very low. In cases of venous insufficiency, early diagnosis is important; operative correction is then easily performed. Ligature of the distal venous limb next to the anastomosis is the treatment of choice, providing the proximal limb is still open. If the proximal limb is obstructed, the distal venous part is dissected and anastomosed to a more proximal vein. The result is an immediately functioning shunt for dialysis.


[Surgical management of traumatic thoracic aortic aneurysms using the TDMAC-heparin shunt].

Rupture of the aorta frequently occurs in major blunt trauma to the thorax, but few patients survive long enough to develop a chronic aneurysm. A TDMAC-heparin-coated shunt was used for operative procedures on the thoracic descending aorta in 5 patients aged 18--40 years. The lesions constituted in 4 recent ruptures and 1 chronic aneurysm. In 3 cases the aneurysm was resected and replaced with a prosthetic graft. End-to-end aorta sutures were performed in the other two cases. One patient died of renal and pulmonary insufficiency. There have been no complications attributable the shunt. The advantage of this shunt include elimination of the need for systemic heparin, avoidance of hypertension during crosslamping, and adequate perfusion of the distal circulation without an interposed pump. Because of the ease of handling and low risk we consider the use of this shunt the preferred method for operative procedures on the thoracic descending aorta.


[Spontaneous erosion hemorrhage in pancreatic cysts].

Spontaneous hemorrhage without earlier exploration in pseudocysts is a serious complication of chronic relapsing pancreatitis. In the past six years we have seen 6 patients with that disease in 91 cases of pancreatic cyst; 4 patients had distal pancreatectomy and partial excision of the cyst without postoperative complication; 2 patients died without having operative intervention.


[Morphological findings on free intestinal muscle transplants as sphincter replacement].

Using autotransplants of an autonomous intestinal muscle segment a sphincter substitute and consequently a continent colostomy can be produced in humans and dogs. The histological study of the intestinal muscle section resected 1--28 weeks after implantation shows, in dogs, a good healing process and vascularization of the transplant muscle, which explains the clinical success. Even after many weeks only slight atrophy and fibrosis can be observed. Only a few of the intramural nerve plexuses perish. Some of the small intestine sphincters remain incontinent. The specimens show a more or less extensive hemorrhagic necrosis of the transplant with high inflammation. The reason for these complications is thought to be the mucosa glands, which were not completely removed from the vulnerable small intestine of the dog before the transplantation.


Higher order structure of chromosomes.

Isolated Chinese hamster metaphase chromosomes were resuspended in 4 M ammonium acetate and spread on a surface of distilled water or 0.15 to 0.5 M ammonium acetate. The DNA was released in the form of a regular series of rosettes connected by interrossette DNA. The mean length of the rosette DNA was 14 micron, similar to the mean length of 10 micron for chromomere DNA of Drosophila polytene chromosomes. The mean interrosette DNA was 4.2 micron. SDS gel electrophoresis of the chromosomal nonhistone proteins showed them to be very similar to nuclear nonhistone proteins except for the presence of more actin and tubulin. Nuclear matrix proteins were present in the chromosomes and may play a role in forming the rosettes. Evidence that the rosette pattern is artifactual versus the possibility that it represents a real organizational substructure of the chromosomes is reviewed.


Effects of griseofulvin on mitosis in PtK1 cells.

The concentration dependent effects of griseofulvin (GF) on mitosis in PtK1 cells were studied using a combination of time lapse cinematography and polarization and electron microscopy. Low concentrations of GF (4 X 10(-5) M) allowed a substantial number of cells to enter and complete an apparently normal mitosis. At higher concentrations of GF (1 X 10(-4) M and 2.5 X 10(-4) M) all cells entering mitosis were arrested. Typical c-mitotic chromosome arrays were observed at 1 X 10(-4) M GF with microtubules present but no spindle formed. At 2.5 X 10(-4) M GF chromosomes did not orient toward a common center to form a c-mitotic figure, but instead remained in a loosely clustered grouping at the center of the cell. Electron microscopy showed microtubles to be absent but revealed in irregularly shaped electron dense cloud around the centrioles. Quantitative polarization microscopy of metaphase cells perfused with GF showed rapid loss of spindle birefringence after exposure to the drug. Coinciding with loss of birefringence the spindle shrank rapidly with a pronounced shortening of pole to pole distance.


Underreplication of a polytene chromosome arm in the chironomid Prodiamesa olivacea.

The genome of Prodiamesa olivacea (Diptera, Chironomidae) has a 2 CDNA content of 0.25 pg. Mitotic metaphases reveal 3 pairs of chromosomes: 2 metacentric ones and one submetacentric. The latter comprises 20.8% of total Feulgen DNA. During larval polytenization the complemental portion of the 3rd falls to 6.5%. Concomitantly the polytene 3rd chromosome is much shorter than expected. It has no constriction and is shaped like a ball sector. -- Underreplication is understood as suppression of DNA syntheses mainly in the long arm of the 3rd chromosome at the first to third endoreplicative cycle. Most of the dense heterochromatin seen in the apex of the 3rd polytene element is not itself underreplicated; it conceals the underreplicated long arm of this chromosome. -- In ovarian nurse cells which are closely connected with the germ line the longer heterochromatic arm of the 3rd polyneme chromosome is fully replicated. -- Underreplication is discussed in the context of "dna silencing".


Ecdysone-induced changes in Glycoprotein synthesis and puff activities in Drosophila virilis salivary glands.

During five hours after the injection of alpha-ecdysone into the hemolymph of D. virilis late third instar larvae the formation of larval glycoproteins in the salivary glands is terminated and the synthesis of a different set of glycoproteins which is characteristic for the prepupal gland is initiated. The data presented suggest that products from early puffs inhibit the formation of larval glycoproteins while the induction of late puffs may be responsible for the appearance of prepupal glycoproteins.


Molecular cytogenetics of the Equidae. I. Purification and cytological localization of a (G + C)-rich satellite DNA from Equus przewalskii.

A (G + C)-rich density satellite DNA (rho = 1.713 gm/cc) has been purified from splenic DNA of Przewalski's horse, Equus przewalskii, by successive equilibrium density gradient centrifugations. The purified satellite, which may comprise as much as 29% of the total DNA, renatures rapidly; however, analyses of native, single-stranded, and reassociated molecules by analytical ultracentrifugation and melting properties suggest that some sequence heterogeniety exists in the 1.713 gm/cc satellite. Complementary RNA (cRNA) transcribed from satellite DNA has been utilized for in situ hybridization studies with E. przewalskii metaphase chromosomes previously identified by quinacrine-banding. These studies establish that sequences complementary to the 1.713 g/cc satellite are greatly enriched in the centromeres of some, but not all, chromosomes. The differential distribution of satellite DNA sequences over heterochromatic regions allows discrimination of three classes of heterochromatin and serves to define three types of pericentromeric regions in the karyotype of this endangered equine species. Additionally, apparent polymorphism in concentrations of satellite DNA sequences between homologs in the same karyotype is noted.


Lysosomal enzymes in pure pancreatic juice from normal healthy volunteers and chronic alcoholics.

Investigation of pure human pancreatic juice obtained by direct cannulation of the main pancreatic duct of 11 healthy volunteer subjects and 10 chronic alcoholics without detectable pancreatic disease revealed the presence of numerous acid hydrolases in this secretion. The pH optimal and substrate specificities of these enzymes suggest that they are of lysosomal origin. Stimulation of the pancreas by injection of cholecystokinin-pancreozymin (CCK-PZ) (1 Ivy dog unit/kg) resulted in a striking increase in activity of some of these hydrolases (N-acetyl-beta-D-glucosaminidase, arylsulfatase, etc.) similar to that observed for trypsin, amylase, and other pancreatic digestive enzymes. In a second group of hydrolases (beta-D-glucuronidase, leucine naphthylamidase, etc.) the effect of this hormone was greatly reduced or absent, particularly in normal individuals. In chronic alcoholics enzyme activity in response to CCK-PZ injection was greater than in normal subjects. Although this increase achieved statistical significance (P less than 0.05) in the case of beta-D-glucuronidase only, it was observed for all lysosomal hydrolases tested and suggests either increased synthesis or a more facile release of these enzymes from the pancreas of chronic alcoholics than of normal individuals.


An appraisal of tests for severe atrophic gastritis in relatives of patients with pernicious anemia.

The sensitivities, specificities, and predictive values of parietal cell antibody, serum gastrin, and serum pepsinogen I (PG I) for severe atrophic gastritis of the oxyntic gland mucosa have been determined in 171 first-degree relatives of 62 patients with pernicious anemia. Parietal cell antibody had the lowest sensitivity (65%), specificity (87%), and predictive value (44%). A low serum PG I and a high serum gastrin had identical specificities (97%), and similar predictive values (84 vs 83%), but the sensitivity of a low serum PG I was greater than that of a high serum gastrin (91 vs 83%). Parietal cell antibody was found in 19 of 148 relatives without severe atrophic gastritis and occurred as an isolated finding in 17. In contrast, 14 of the 15 relatives with severe atrophic gastritis who had parietal cell antibody also had a high serum gastrin and a low serum PG I. A high serum gastrin together with a low serum PG I had a specificity of 100%. The results recommend serum PG I and serum gastrin, but not parietal cell antibody, as tests for severe atrophic gastritis in relatives of patients with pernicious anemia.


Liver function in physically trained subjects: galactose elimination capacity, plasma disappearance of indocyanine green, and aminopyrine metabolism in long-distance runners.

Physical exercise and physical training are known to affect several aspects of hepatic metabolism. To assess whether adaptation to long-lasting exercise modifies microsomal drug metabolism, 8 long-distance runners were compared with a group of medical students having significantly lower maximal rates of oxygen consumption. At rest the hepatic galactose elimination capacity and the indocyanine green plasma disappearance rate used as reference methods were the same in both groups. The plasma clearance of ([14C]dimethylamine) aminopyrine and the kinetics of 14CO2 in breath did not differ either. It is concluded that adaptation to long-lasting exercise can occur without evidence for changes in hepatic galactokinase activity, liver blood flow, or microsomal metabolism of aminopyrine.


Platelet function in chronic liver disease: relationship to disease severity.

Abnormalities of platelet aggregation in response to adenosine diphosphate in 56 patients with chronic liver disease correlated with impairment of hepatocellular function but not with the etiology of the liver disease. Platelet-poor plasma from some patients appeared to contain an inhibitor since, in cross-over studies, it reduced the degree of aggregation of control subjects. However, platelet-poor plasma from some other patients enhanced aggregation in controls, and this was thought to be due to the presence of fibrin monomer. In the majority of patients with severe liver disease, platelet function still appeared defective, even after exclusion of the effects of plasma, and was independent of the platelet count in peripheral venous blood. Since patient platelet volumes were smaller than those of controls, these findings might be explained by deficiency of the larger hemostatically active type of platelet as a consequence of either bone marrow failure or splenic sequestration.


Colonic involvement in salmonellosis.

Two cases of Salmonella colitis are described. Clinical and radiological differentiation from ulcerative colitis is difficult and necessitates repeated stool cultures. The management of Salmonella colitis is reviewed.


Biliary and pancreatic duct pressures measured by ERCP manometry in patients with suspected papillary stenosis.

Papillary stenosis is an imprecisely defined clinical syndrome which eludes definitive diagnosis. In this study we evaluated 26 patients with suspected papillary stenosis by manometric examination of the sphincter of Oddi done during ERCP examination. Basal pressure in the sphincter of Oddi was elevated in 14 of the patients. Of these 14 patients, 10 underwent sphincterotomy and all experienced improvement in clinical symptoms after their surgery. We suggest that ERCP manometry is a useful procedure for identifying patients with papillary stenosis who may benefit from sphincterotomy.


Nonsteroidal antiinflammatory drugs: effect on pyloric sphincter and duodenogastric reflux.

We have investigated the effect of nonsteroidal antiinflammatory drugs on canine pyloric sphincter pressure, mucosal potential difference (PD), and duodenogastric reflux in 5 dogs. Only intragastric aspirin at doses of 30 and 100 mg/kg caused a significant (P less than 0.05) decrease in pyloric sphincter pressure, an increase of duodenogastric reflux, and changed the mucosal PD. Neither intravenous aspirin, intragastric phenylbutazone, or intrarectal indomethacin produced these changes. The mechanism for the aspirin effect may be mediated by local pathways related to changes in mucosal PD. We postulate that increased duodenogastric reflux may be an aggravating factor for the gastric mucosal damage caused by intragastric aspirin.


A prospective study of the course of Crohn's disease.

To better define the course of Crohn's disease, certain clinical, laboratory, and radiological features were studied prospectively in a representative group of 25 patients at intervals of up to 77 months. Eleven variables of potential use in assessing the course were analyzed for clinician preference, and the statistical relationship of one variable, the Crohn's disease activity index, to the other 10 was determined. Modest improvement was documented in three clinical variables, as well as in anemia, serum albumin, intestinal protein loss, and radiological extent of disease. Variables most frequently ranked high as reflections of the course of Crohn's disease were hematocrit and extent of disease, followed by body weight, stools per day, B12 absorption, serum albumin, and intestinal protein loss. The highest intervariable correlation was between improvement in protein loss and decrease in radiological extent (r = 0.75).