Unidirectional complete heart block.

Forty-two patients with complete heart block were subjected to electrophysiological studies wherein apart from localization of the site of the conduction defect, ventricular pacing was done to assess ventriculo-atrial (VA) conduction and concealed ventriculo-nodal (VN) conduction. There was evidence of retrograde conduction in the presence of orthograde CHB in 22 patients (52.4 per cent). Fifteen patients (35.7 per cent) had VA conduction and seven (16.6 per cent) had concealed VN conduction. In patients with supra-Hisian CHB, three of the nine patients had VA conduction while of the 11 patients with intra-Hisian CHB, six had retrograde conduction (four with VA and two with concealed VN conduction). In the infra-Hisian CHB group, of the 22 patients, eight had VA conduction and five had concealed conduction. Incremental ventricular pacing induced VA Wenckebach periods at VPR from 110 to 133/minute with a VA interval of 110 to 130 msec. In view of the induction of Wenckebach VA periods, the recording of retrograde H potentials in some cases, and relatively long VA conduction time, it is surmised that retrograde conduction in the presence of orthograde CHB takes place through the AV conduction system.


Postpartum cardiac failure--heart failure due to volume overload?

Ventricular function has been studied in 43 patients with the peripartum cardiac failure (PPCF) syndrome which occurs around Zaria. All patients had an echocardiogram on admission and 10 patients had right heart catheterization. Despite the gross edema, left ventricular function assessed by echocardiography and systolic time intervals was relatively good and the estimated cardiac output were high. At catheterization, although the pressures were high, the cardiac outputs were greater than normal in four out of six patients. No patient had a low cardiac output. These findings are not compatible with a severe heart muscle disorder, or cardiomyopathy. We suggest that the primary event in PPCF of Zaria is fluid retention which leads to a form of high output cardiac failure. The postpartum practices in this area (taking high sodium diets and lying on heated beds) almost certainly cause the fluid to accumulate initially, but the heart may be unable to meet the demands either because of preexisting heart muscle disease or, more likely, because of a rise of the peripheral resistance due to the volume expansion, overburdens such dilated hearts and leads to myocardial damage. Since there are similarities between this condition and PPCF in temperate climates, it is possible that there is a common mechanism which the traditional practices of this area have unveiled.


Thrombosis of epicardial coronary veins in acute myocardial infarction.

Thrombosis of epicardial coronary veins was demonstrated in 16 of 50 cases of left ventricular acute myocardial infarction and/or recent coronary arterial thrombosis. All patients with valvular heart disease had venous thrombosis. In cases without valvular heart disease, venous thrombosis was seen in infarctions involving more than 30% of the left ventricular myocardial mass with a post-attack survival time of at least 24 hours. The veins thrombosed were in all cases those draining the infarcted myocardium. Coronary vein thrombosis seems not to be prevented by anticoagulant medication.


Sarcoidosis of the cardiac conducting system.

In a consecutive series of 2.950 routine autopsies two of 13 cases with sarcoidosis had cardiac involvement, one of which showed extensive granulomatous lesions in the sinus node. It is suggested that sudden death in this 52-year-old woman was caused by cardiac sarcoid involvement, possibly by leading to sinus arrest with cardiac standstill. However, because of the lack of electrocardiographic evidence, sudden death from ventricular fibrillation can not be excluded. As sudden death is a well-known complication in sarcoidosis, all such patients should be regularly screened for cardiac involvement in order to prevent fatal arrhythmias.


Hereditary bundle branch system defect. A new genetic entity?

A familial survey demonstrated mendelian inheritance in three large kindreds with conduction abnormalities and heart block. The trait was autosomal dominant, with varying expressivity and penetrance, apparent male preponderance, and congenital onset. Manifestations included right bundle branch block, left axis deviation, and right bundle branch block associated with left axis deviation. Complete heart block proved almost always to be a late event, and developed in all documented cases from bilateral bundle branch block. An r' pattern, most likely representing a right ventricular conduction delay, is discussed.


Limitations of the cardiokymograph for assessing left ventricular wall motion.

In order to evaluate the reliability and reproducibility of the CKG we studied four groups of patients. In 27 patients with a prior myocardial infarction the CKG recordings were compared to simultaneous wall motion videotracking. Identical wall motion was recorded in 75% of left ventricular sites and most of the discordant sites were false abnormal posterior wall motion recorded by the CKG. The second group consisted of 21 normal subjects studied by CKG only and 35% displayed anterior dyskinesis during expiration. The third group consisted of nine stable patients who were studied on two separate days by CKG and identical wall motion was recorded in only 55% of the sites on the two recordings. The final group consisted of seven patients with mitral regurgitation and all had late systolic outward movement posteriorly. Systolic wall motion was normal postoperatively in the three patients who underwent valve replacement. We conclude that: (1) the usefulness of the CKG is limited by the frequent recording of false wall motion abnormalities in normal subjects, (2) false anterior wall motion abnormalities can be reduced by recording during inspiration, (3) false posterior wall motion abnormalities may be due to systolic left atrial expansion, and (4) cardioxymography recordings are often not reproducible.


Prognostic value of echocardiographic evaluation of septal function in acute anteroseptal myocardial infarction.

To determine the clinical usefulness of echocardiography in patients with anteroseptal myocardial infarction, echocardiograms were performed within 24 hours of admission on 40 patients with acute transmural anteroseptal myocardial infarction. Twenty-one patients had normal septal motion and septal systolic thickening, and 19 patients had abnormalities of one or both of these measurements. Of the 21 patients who had normal septal motion and thickening, only five developed congestive heart failure, none developed bundle branch block, and none died. Of the 19 patients with abnormal septal motion and/or thickening, 17 developed congestive heart failure (p less than .001), seven developed bundle branch block (p less than .001), and six died (p less than .001). Therefore, (1) electrocardiographic evidence of septal infarction does not correlate with abnormalities of the portion of septum seen on echocardiogram, and (2) patients with anteroseptal myocardial infarction and abnormalities of the septum on echocardiogram have more complications and a higher in-hospital mortality rate. These patients may have more extensive myocardial infarction predisposing to pump failure and possibly involving the conduction system.


The single precordial lead for ST segment monitoring: comparison with the multiple lead map.

ST segment elevation, used as an index of the relative extent of myocardial ischemic injury, was measured using a single precordial lead located at the point of maximum ST elevation. ST changes were followed for two hours after acute coronary occlusion in pigs, and were compared to the sum of ST elevation recorded with an 18 lead precordial map. Some animals were subjected to Reperfusion (n = 12), others to infarct extension (n = 10), while a control group (n = 9) was followed without an ST-modifying intervention. Correlation between sigmaST and ST in the single lead was good, with a correlation coefficient of 0.844 at 360 points of comparison. Time to peak ST elevation using the single lead technique was comparable to that using the 18 lead map. Changes in the ST elevation using both techniques were similarly reduced following reperfusion, increased following extension, and followed a similar downslope pattern in the unmodified infarct group. This single lead technique offers the advantage of simplicity of use without sacrifice of accuracy. Its use can facilitate clinical studies of myocardial ischemic injury and its modification.


Pathophysiologic observations on premature opening of the aortic valve utilizing a technique for multiplane echocardiographic analysis.

The use of a simple technique for multiplane echocardiographic analysis and study of the effect of arrhythmia enabled us to investigate the mechanism of premature opening of the aortic valve in two patients with subacute aortic insufficiency. In one patient, premature opening evolved with the development of left ventricular dilatation and failure. In this case the prematurity of opening in each beat was related to diastolic filling time and was accompanied by septal recoil and by premature closure of the mitral valve. We classified this as the diastolic duration-dependent subgroup. In the second patient, who had a hypertrophied, non-dilated left ventricle, premature opening depended on atrial contraction and was independent of diastolic filling time. This case defined an atrial contraction-dependent subgroup. In the light of these findings we analyzed previously reported cases in patients with acute severe aortic insufficiency. These patients appear to fall into the diastolic duration-dependent subgroup.


Effects of digitalis on normal and abnormal left ventricular segmental dynamics.

To study the effects of digoxin on regional left ventricular performance, continuous ventricular dynamics were assessed in nine patients with stable coronary disease. Computer-assisted analysis of the fluoroscopic motion of surgically implanted mid wall myocardial markers was used. The markers define six minor ventricular radii and outline the left ventricle. One and one-half hours after administration of 1 mg of intravenous digoxin, mean velocity of circumferential fiber shortening for all segments increased 19 percent, from 0.67 +/- 0.06 to 0.78 +/- 0.06 circumference/sec (P less than 0.01) and ejection fraction increased 4.5 percent, from 0.50 +/- 0.03 to 0.53 +/- 0.03 (P less than 0.05). Segmental velocity of circumferential fiber shortening, total segmental shortening and early segmental systolic shrtening increased in 83 percent to 91 percent of normal segments, depending on which index was used. Only 45 to 55 percent of initially abnormal segments benefited from digoxin. In general, segmental dyssynergy increased even when net ventricular function was enhanced. These results suggest that in pateints with chronic left ventricular contraction abnormalities due to coronary disease, deterioration of performance in abnormal regions after administration of digoxin may result from increased stress imposed by increased afterload and by improved segmental dynamics in more normal areas.


Effect of isosorbide dinitrate on response to submaximal and maximal exercise in patients with congestive heart failure.

Isosorbide dinitrate is an effective vasodilator that improves resting left ventricular performance in patients with congestive heart failure, but little is known of the effect of the drug on the response to exercise. Bicycle exercise to symptomatic maximum was performed by 18 patients with class II to IV congestive heart failure before and 90 minutes after administration of isosorbide dinitrate, 40 mg orally. Although resting pulmonary wedge pressure and systemic vascular resistance were significantly reduced after isosorbide dinitrate, exercise duration was not altered and maximal oxygen consumption was not significantly changed (13.6 +/- 1.3 [SEM] standard error of the mean versus 13.8 +/- 1.2 ml/kg per min). At peak exercise pulmonary wedge pressure of 37.1 +/- 1.7 mm Hg, cardiac index of 4.19 +/- 0.35 liters/min per m2, and systemic vascular resistance of 14.7 +/- 1.3 units were not significantly different after nitrate administration. However, at submaximal loads, pulmonary wedge pressure was reduced from 33.6 +/- 1.7 to 27.9 +/- 1.8 mm Hg (P less than 0.01), and systemic resistance from 16.5 +/- 1.5 to 13.7 +/- 1.0 units (P less than 0.01) after administration of isosorbide dinitrate. Thus, short-term administration of nitrates does not improve maximal exercise capacity or left ventricular performance at maximal exercise in patients with congestive heart failure, but it does appear to improve pump function at submaximal work loads and may therefore enable patients to perform limited exercise more comfortably.


Paroxysmal nonreentrant tachycardias due to simultaneous conduction in dual atrioventricular nodal pathways.

Electrophysiologic studies were performed in a 41 year old man for analysis of paroxysmal tachycardias appearing in various electrocardiographic patterns of supraventricular and ventricular bigeminy, junctional and ventricular tachycardia and atrial fibrillation, among others. All these arrhythmias were due to dual atrioventricular (A-V) nodal pathways with simultaneous dual fast and slow conduction of single atrial beats at a normal basic sinus rate. Moderate changes in sinus rate and in fast or slow pathway conduction times, or both, changed the position of the slowly conducted beats between the neighboring two fast conducted beats and resulted in various electrocardiographic manifestations of the conduction disturbance. Different blocks, such as second degree type 1, 2:1, 3:1 and possibly also type II, in one of the two pathways and occasionally aberrant conduction induced even more unusual tracings. After intravenous injection of 25 mg of ajmaline, unexpected lengthening and shortening of the A-H interval occurred, suggesting variable shifts between fast and slow pathway conduction. The incidence of dual A-V nodal pathways is discussed; it was documented in 17 (4.2 percent) of 405 patients studied. A theoretical model of A-V nodal conduction is proposed to explain its normal properties and abnormal patterns.


Systolic click from a Swan-Ganz catheter: phonoechocardiographic depiction of the underlying mechanism.

Although echocardiographic manifestations of Swan-Ganz catheters have received increasing attention, auscultatory sequelae have not previously been described. In the patient described in this report, insertion of a Swan-Ganz catheter resulted in a loud mid systolic click; removal of the catheter eliminated the click. Simultaneous phonoechocardiograms suggest that the click resulted from crisp contact of the catheter against the ventricular septum. Catheter momentum was enhanced by wide excursion and systemic pressures in the right ventricle; paradoxical motion of the septum during systole may have accentuated the force of its contact with the catheter.


Mid systolic notching of the pulmonary valve in the absence of pulmonary hypertension.

In a patient with idiopathic dilatation of the pulmonary artery the pulmonary valve echogram showed a prominent mid systolic closing motion or notching indistinguishable from that seen in pulmonary hypertension. Normal right ventricular and pulmonary arterial pressures were recorded simultaneously with echocardiograms of the pulmonary valve.


Disopyramide-induced ventricular fibrillation.

Three cases are described with documented ventricular fibrillation shortly after the patients received disopyramide in moderate dosage. Electrocardiograms showed markedly prolonged Q-T intervals in two patients and a prominent U wave with a prolonged Q-U interval in one patient, but no change in QRS width. Disopyramide-induced ventricular fibrillation appears to be similar to that caused by quinidine and is an indication to discontinue the drug.


Right ventricular apical activation times in patients with conduction disturbances occurring during acute transmural myocardial infarction.

His bundle and right ventricular apical electrograms were recorded in 18 patients with acute transmural myocardial infarction in whom catheter insertion was considered necessary for clinical reasons. The V-RVA and H-V intervals were of normal duration (5 to 30 and 35 to 55 msec, respectively) in five patients (Group 1) with persistently narrow (less than 100 msec) QRS complexes. In contrast, 13 patients (Group 2) who manifested a "complete" right bundle branch block pattern within 96 hours after admission had prolonged V-RVA intervals (range 50 to 80 msec, mean 59.2 msec) and H-V intervals that were at the upper limits of normal or prolonged (range 55 to 90 msec, mean 63 msec). In 6 of these 13 patients, the duration of the V-RVA interval became normal when the "complete" right bundle branch block pattern disappeared and was replaced by a "complete" left bundle branch block pattern in three patients and by narrow QRS complexes in the three other patients. This study showed that transmural myocardial infarction in itself did not increase the duration of the V-RVA interval even when "complete" left bundle branch block was present. Moreover, a prolonged V-RVA interval coexsting with a "complete" right bundle branch block pattern was not due to distal right bundle branch block but resulted from a conduction disturbance located in the proximal portions of the right bundle, or perhaps, even within the His bundle itself.


Use of apexcardiography to evaluate left ventricular diastolic compliance in human beings.

The relation between various relative amplitude measurements of the left apexcardiogram and internally derived indexes of diastolic compliance of the left ventricle was studied in 29 patients. Simultaneous high fidelity recordings of the left apex tracing and left ventricular pressure were obtained in 11 patients without left ventricular disease (group I) and 18 patients with congestive cardiomyopathy (group II). In 204 normal subjects the ratio of the A wave amplitude to the total diastolic deflection (A/D ratio) of the left apexcardiogram was 31.4 +/- 11.4 (mean +/- standard deviation) percent, the ratio of the A wave amplitude to the total height (A/H ratio) 8.9 +/- 4.3 percent and the D/H ratio 30.4 +/- 14.7 percent. The A/D and A/H ratios were significantly (P less than 0.001 and P less than 0.005) increased in group II (69.2 +/- 12.2 percent and 16.8 +/- 8.2 percent, respectively); they were within normal limits in group I. In contrast, the D/H ratio was within normal limits in both groups of patients. The A/D ratio correlated significantly better with specific compliance (deltaV/deltaP.V) (r = -0.87) than did the A/H ratio (r = -0.53), whereas similar correlations were obtained with end-diastolic volume compliance (dV/dPV) (r = -0.61 and r = - 0.64, respectively). In contrast, the D/H ratio correlated significantly only with end-diastolic distensibility index (dV/dP) (r = -0.52). It is concluded that A wave amplitude/total diastolic deflection (A/D) ratio and, to a lesser degree, the A wave amplitude/total height (A/H) ratio of the left apexcardiogram correspond best to diastolic compliance and are useful noninvasive measurements of this property of the left ventricle.


Lack of correlation between echocardiographic pulmonary valve morphology and simultaneous pulmonary arterial pressure.

Pulmonary valve echograms recorded simultaneously with right heart pressures were correlated with mean and end-diastolic pulmonary arterial pressures and the peak magnitude of the right atrial a wave in an attempt to predict noninvasively levels and changes in pulmonary arterial pressure. Satisfactory pulmonary valve echograms were obtained in 16 of 23 patients studied. No significant correlation was found between hemodynamic measurements and the echographic pulmonary valve a wave amplitude, diastolic E-F slope or the systolic opening B-C slope. Changes in hemodynamic measurements observed in serial observations were not associated with predictable changes in configuration of the pulmonary valve echogram. The combination of mid systolic pulmonary valve notching and an absent a wave was observed in more advanced degrees of pulmonary hypertension and was specific, but not sensitive, for that condition.


Unusual vascular anomalies causing persistent pulmonary hypertension in a newborn.

A unique case of pulmonary vascular anomalies causing persistent pulmonary hypertension in a newborn is described. The child died 3 days after birth. Necropsy revealed marked hypoplasia of the right and left pulmonary arteries with a normal main pulmonary artery, patent ductus arteriosus, bilateral systemic arteries to the lungs from the abdominal aorta, and partial anomalous pulmonary venous connection. Quantitative morphometric techniques demonstrated slight abnormalities of alveolar development and severe arterial medial hypertrophy with abnormal extension of muscle into small peripheral arteries. Bronchopulmonary development appeared relatively normal in spite of the vascular abnormalities.


Monitoring ventricular function at rest and during exercise with a nonimaging nuclear detector.

A portable nonimaging device, the nuclear stethoscope, for measuring beat to beat ventricular time-activity curves in normal people and patients with heart disease, both at rest and during exercise, is being developed and evaluated. The latest device has several operating modes that facilitate left ventricular and background localization, measurement of transit times and automatic calculation and display of left ventricular ejection fraction. The correlation coefficient of left ventricular ejection fraction obtained with the device and with a camera-computer system was 0.92 in 35 subjects. During bicycle exercise the ejection fraction in 15 normal persons increased from 44 to 64 percent (P less than 0.001), whereas among 12 patients with heart disease it was unchanged in 5 and decreased in 7.


Method for the rapid and atraumatic insertion of permanent endocardial pacemaker electrodes through the subclavian vein.

One hundred sixty-four permanent pacemaker implantations through the subclavian vein were accomplished by 17 different physicians at four institutions utilizing a specially constructed peel-away introducer. Fourteen attempts (8.3 percent) to cannulate the subclavian vein were unsuccessful. There were four cases of pneumothorax (2.4 percent) and two cases of hematoma formation (1.2 percent). The procedure has the advantage of a rapid and atraumatic insertion of a variety of transvenous pacemaker electrodes, and the avoidance of surgical dissection for a venous entrance site.


Effects of digoxin on sinus nodal function before and after vagal blockade in patients with sinus nodal dysfunction: a clue to the mechanisms of the action of digitalis on the sinus node.

To increase the limited knowledge of the effects of digitalis on sinus nodal function in patients with sinus nodal dysfunction and to initiate an investigation into the mechanisms underlying its effects, 34 patients with sinus nodal dysfunction were studied. Twenty patients underwent determination of sinus cycle length, estimated sinoatrial conduction time and maximal corrected sinus recovery time before and after the administration of 0.75 mg of intravenous digoxin. For the group, sinus cycle length did not change, sinoatrial conduction time increased insignificantly and maximal corrected sinus recovery time shortened; however, individual variation occurred. The effects of acute digitalization appeared to predict the effects of chronic digitalis administration on sinus nodal function in the eight patients who subsequently continued to take digoxin. Fourteen patients received digoxin after vagal blockade with atropine. After vagal blockade, digoxin lengthened sinus cycle length, sinoatrial conduction time and maximal corrected sinus recovery time. The effects of digoxin administered after atropine could be antiadrenergic, direct, or both, and are opposite to those induced by atropine alone. Because these effects are similar to those of vagotonia yet are not apparent when the vagi are unblocked, digoxin may have direct excitatory, adrenergic or previously unrecognized vagolytic effects on sinus nodal function in man and their manifestation may be dependent on heart rate or autonomic tone.


Lack of ouabain effect on pacing-induced myocardial ischemia in patients with coronary artery disease.

Sixteen patients with significant two and three vessel coronary artery disease but without clinical congestive heart failure were studied during rapid atrial pacing before and after infusion of 0.015 mg/kg of ouabain. Seven patients with a decreased (less than 50 percent) ejection fraction and nine patients with a normal ejection fraction had a significant (P less than 0.05) increase in resting arterial systolic pressure after the administration of ouabain. However, resting values for coronary sinus flow, coronary vascular resistance, myocardial oxygen consumption and myocardial lactate extraction did not change significantly in either group. During pacing, patients with a decreased ejection fraction demonstrated more ischemia than patients with a normal ejection fraction; however, the administration of ouabain did not significantly alter pacing-related changes in coronary sinus flow, myocardial oxygen consumption, myocardial lactate extraction, ischemic electrocardiographic changes or onset of chest pain in either group. The administration of ouabain has a negligible effect on coronary hemodynamics, myocardial metabolism or clinical signs of ischemia in patients with coronary artery disease with normal or abnormal left ventricular function.


Anatomy of the renal pelvis in the hamster.

The hamster renal pelvis has been studied by means of low-power light microscopy, scanning electron microscopy and morphometric analyses. The results of this study are highly suggestive that the contact of pelvic urine with the other medulla as well as with the inner medulla may be an important aspect of final urine formation. The outer medulla constituted nearly 50% of the total pelvic surface area, with the inner stripe of the outer medulla more than twice the pelvic surface area of the outer stripe of the outer medulla. The large outer medullary pelvic surface area was accounted for by the elaboration of the upper pelvic walls into peripelvic columns, opercula ("secondary pyramids"), fornices and secondary pouches. A thin simple-squamous to low cuboidal pelvic epithelium separated pelvic urine from outer medullary parenchyma. The inner medulla which constituted about one quarter of the total pelvic surface area was covered by a cuboidal to columnar pelvic epithelium which appeared morphologically similar to the papillary collecting duct epithelium. Tubules and capillaries of the inner medulla did not appear as closely juxtaposed to the pelvic epithelium as did those of the outer medulla. Cortical tissue comprised only 11.7% of the total pelvic surface area and was covered by transitional epithelium similar to that of ureter and bladder. The previously reported impermeability of this epithelium suggests that pelvic urine contact with the cortex is unimportant in final urine formation. The rich layer of smooth muscle under the transitional epithelium probably functions to move urine into and out of the pelvis during pelvic peristalsis, which has been observed in vivo.


Retinal development in the lamprey (Petromyzon marinus L.): premetamorphic ammocoete eye.

Development of the retina of the ammocoete begins early in embryogenesis, with the formation of the optic vesicle, but development of the rudimentary eye is suspended and remains arrested during larval life. Prior to the onset of metamorphosis, the retina of the ammocoete is completely undifferentiated, with the exception of a small area (Zone II) surrounding the optic nerve head, where all of the adult retinal layers are found. The photoreceptors in this area have developed to include synaptic contacts as well as inner and outer segments. The pigment epithelium in this area, too, has differentiated to include well-formed melanin granules, myeloid bodies and endoplasmic reticulum and is closely associated with the receptor cell outer segments. With the approach of metamorphosis, differentiation of the remainder of the retina (Zone I) begins, taking place in a radial fashion from the optic nerve head. Differentiating pigment epithelial cells adjacent to the differentiated retinal zone begin to accumulate melanin granules. In the neural retina, junctional complexes are established in the form of an external limiting membrane, and connecting cilia project into the optic ventricle. Photoreceptor differentiation begins with the formation of a mitochondria-filled ellipsoid within the inner segment. Development and differentiation of the ammocoete retina is unique to vertebrates in that only a small area of differentiated retina is present during the larval stage. The remainder of the retina differentiates and becomes functional during metamorphosis.


The corpus luteum of the guinea pig. IV. Fine structure of macrophages during pregnancy and postpartum luteolysis, and the phagocytosis of luteal cells.

Little information is available on the ultrastructure of macrophages in the corpus luteum or their importance in the regression of luteal tissue. In the present study, the fine structure of activated luteal macrophages during pregnancy and the postpartum period was examined by electron microscopy of guinea pig ovaries fixed by vascular perfusion. In these corpora lutea, macrophages can readily be distinguished from luteal cells. Activated macrophages typically display three prominent inclusions in their cytoplasm: (1) heterophagic vacuoles, (2) distinctive large dense inclusions, and (3) large and small electron-lucent vacuoles. In addition, they contain numerous smaller lysosome-like dense bodies. Activated macrophages in corpora lutea also characteristically show many surface protrusions, such as processes, folds or pseudopodia, which often occur in close contact with nearby luteal cells. Generally, nuclei of macrophages are irregular in shape and display a dense border of heterochromatin, thus differing from those of luteal cells. Macrophages seem to be most abundant in regressing corpora lutea, where they commonly display heterophagic vacuoles containing recognizable luteal cell fragments, evidence that these phagocytes ingest senescent luteal cells. The digestion of luteal cell components in heterophagic vacuoles presumably gives rise to the distinctive large dense inclusions typically seen in macrophages. The findings of this study indicate that macrophages play a central role in luteolysis by phagocytizing luteal cells or their remnants. They therefore appear to bring about the reduction in volume of the corpus luteum that occurs as this tissue regresses. These results taken together with those previously published (Paavola, '78) further indicate that breakdown of the corpus luteum during postpartum luteolysis in guinea pigs involves both autophagy and heterophagy.


The atrioventricular node and bundle in the ferret heart: a light and quantitative electron microscopic study.

The cells of the atrioventricular (AV) junction in the ferret heart were examined using light microscopy, a wax-model reconstruction and quantitative electron microscopy to determine their organization and characteristics. A series of subdivisions of the specialized tissues of the AV junction was apparent at both the light and electron microscopic levels. A transitional zone was observed interposed between the atrial muscle cells and the AV node. The AV node consisted of a coronary sinus portion, a superficial portion and a deep portion. The AV bundle had a segment above the anulus fibrosus, a segment which penetrated the right fibrous trigone, a non-branching segment below the anulus fibrosus and a branched segment. At the ultrastructural level the AV junctional conduction tissues had fewer irregularly oriented myofibrils than did working atrial myocardial cells. T-tubules, present in atrial muscle cells, were not observed in the modified muscle cells of the AV node and bundle. Conventional intercalated discs also were not observed between the cells of the AV node or the AV bundle. Atrial myocardial cells had the highest percentage of the plasma membrane occupied by desmosomes, fasciae adherentes and gap junctions. The AV bundle cells had the highest percentage of appositional surface membrane and a relatively large fraction of plasma membrane occupied by gap junctions. Cells of the superficial portion of the AV node had the smallest percentage of the plasma membrane composed of gap junctions, desmosomes or fasciae adherentes, as well as the smallest fraction of the cell membrane apposed to adjacent cells. The stereological data indicate that the most useful distinguishing characteristic between atrial muscle cells and conduction cells was that a smaller percentage of the conduction cell sarcoplasm was occupied by mitochondria and myofibrils. The most useful characteristics that could be used to differentiate between the regions of the AV junctional conduction tissues were the amounts and types of surface membrane specializations in the respective cell types.


The cochlear nuclei in man.

The human cochlear nuclei are composed of a ventral and a dorsal nucleus which are similar, though not identical, in their cytoarchitecture to those of other mammals. The ventral cochlear nucleus (VCN) consists of a rostral area of spherical cells, a central area of multipolar and globular cells, a posterior area of octopus cells, and laterodorsal cap of small neurons. The interareal boundaries are less distinct in man than in the cat. The central region of multipolar cells and the cap area of small cells constitute the bulk of the human VCN. The spherical, globular, and octopus cells appear relatively less numerous in man than in other mammals. The dorsal cochlear nucleus (DCN) in man is relatively large, but lacks the typical stratification seen in other mammals, with only vestiges of the granular and molecular layers remaining. Virtually the entire DCN consists of an area of cochlear fiber neuropil containing pyramidal cells, small neurons, and occasional giant cells. The pyramidal cells have lost their typical radial orientation and lie scattered within the cochlear neuropil. Thus the entire human DCN may be equivalent to layers 2 and 3 of this nucleus in other mammals. In spite of the relatively large DCN, the acoustic striae appear small. This is in contrast to the large trapezoid body leaving the VCN. Intrinsic and descending fiber pathways to the cochlear nuclei are not clearly defined and may be less prominent in man than in the cat.


A scanning electron microscope study of aberrations in the prism pattern of rat incisor inner enamel.

The prism pattern in the inner enamel of adult rat incisors was studied with the SEM in unfixed tissues that had been sectioned, ground, polished, and etched. Six different types of aberrations in the prism pattern were encountered: 1. Prism lamellae may be shorter than the mesio-lateral width of enamel. 2. Prism lamellae may deviate from a transverse orientation. 3. Prism lamellae may "fuse" or "bifurcate." 4. Prisms of two adjacent lamellae may pursue a common course. 5. Prisms may change direction. 6. Variations exist in the outline of transversely cut prism profiles. Aberrations were observed at any distance from the dentino-enamel junction. These observations were used as a basis for an analysis of the movement of ameloblasts during rat incisor amelogenesis. It was concluded that it is physically possible for the ameloblasts to create the observed aberrations as they move along the path of the prisms. However, the aberrations seem to make it more difficult to understand the factors controlling ameloblast movement. Occasionally crystallite bridges connecting adjacent prisms were observed. A configuration resembling a bifurcating prism is pesented.


A comparative radioautographic study of chondrocytic proliferation in nasal septal cartilage of the 5-day-old rat, rabbit, guinea pig and beagle.

Growth sites within the cartilaginous nasal septa of four different species of animals (5-day-old rats, rabbits, guinea pigs and beagles) were identified by monitoring cellular proliferation radioautographically. A statistical analysis (MANOVA) was employed. It showed that, of the six combinations compared (rat-beagle, rat-guinea pig, rat-rabbit, beagle-guinea pig, beagle-rabbit, and guinea pig-rabbit), in only one (beagle-guinea pig) was there any similarity in growth pattern. The other five combinations all were significantly different. Since no particular areas emerged, with any consistency, as common growth sites within any of the four kinds of septa, it was concluded that the nasal septum might well play a passive role in midfacial growth, rather than an active role as previously thought.


Influence of iron upon the development of tetracycline-treated mouse tooth germs in vitro (1).

The inhibitory action of tetracycline on the development of embryonic mouse incisors cultured in vitro was examined. Explants exposed to tetracycline were severely inhibited in development. In contrast, tooth germs cultured in the presence of both tetracycline and iron escaped inhibition and attained a stage of development which compared favorably with the controls.


Lack of association between avian cartilages of different embryological origins when maintained in vitro.

The possibility that cartilages of differing embryological origins behave as separate types with respect to cell-to-cell associations was tested by placing the cut ends of transversely sectioned embryonic chick tibial cartilages (of mesodermal origin) in apposition to transversely sectioned Meckel's cartilages (neural crest (ectodermal) cartilage) on the surface of a semi-solid organ culture medium and maintaining the combinations in vitro for five to ten days. Tibia-tibia and Meckel's cartilage-Meckel's cartilage (homotypic) combinations, which served as controls, became united by a common extracellular matrix and by the proliferation of chondroblasts. Analysis of combinations where one partner had been prelabelled with 3H-thymidine indicated that chondroblasts intermingled at the contact zone. In contrast, tibia-Meckel's cartilage (heterotypic) combinations became separated by a layer of fibrous tissue. The chondroblasts at the contact zone failed to intermingle. We conclude that avian embryonic chondrocytes are not all equivalent and that part of their nonequivalence could be related to their embryological origin either from the mesoderm or from the ectodermal neural crest.


Evidence that sclerotomal cells do not migrate medially during normal embryonic development of the rat.

During embryonic development the medial part of the somite disorganizes or breaks up into sclerotomal cells which, according to many published reports, migrate medially to surround the notochord. The purpose of the study was to determine whether these cells actually migrate medially toward the notochord. Distances were measured between the notochord and the adjacent neural tube and the somite or its remnant during the period of somite disorganization. Serially sectioned, normal 10.5- to 13.5-day (d) rat embryos were used. Only transverse sections through the middle of the fourth cervical (C-4) body segment were measured, corresponding to the level of somite No. 8 (10.5 d) or its dermatomyotome remnant (10.5-11.5d) or spinal nerve C-4 (12.5-13.5d). Measurements were taken at six stages from photographic montages, all of which were made at precisely the same magnification. The notochord was the central axial structure from which the measurements were determined. The changes in distance show that during the period of somite breakup the neural tube grows dorsally, away from the notochord which lies adjacent to its ventral surface. Simultaneously the somite remnant moves laterally and dorsally, all the while maintaining its position relative to the overlying ectoderm and leaving behind a trail of sclerotomal cells. Also at each stage cell counts were made on the medial sclerotomal region of the C-4 segment. The average counts reveal that not only does the total number of cells increase substantially over the three-day period (42-7,546), but also the total number of mitoses (3.5-200), while the mitotic index decreases (9.0-2.7). High proliferative activity is apparent in the medial sclerotomal cells throughout the 3-day period. The evidence supports the conclusion that local proliferation of the trailing cells, which were left by the somite remnant as it moved dorsolaterally, causes the subsequent increase in density of the perichordal tissue, rather than an influx of migrating cells. Instead of sclerotomal cells migrating medially toward the notochord, the present study suggests that these cells retain their position relative to the notochord or central axis and that the medial sclerotomal region forms as a result of the growth movements of the surrounding structures.


Fine structural studies of rat seminal vesicle in castrated and intact animals following estrogen treatment.

The effect of estradiol and/or testosterone upon secretion by seminal vesicle in castrated and intact rats was assessed in young adult Sprague-Dawley rats, using light microscopy (LM), transmission (TEM) and scanning (SEM)electron microscopy. Hormones were injected daily for ten days beginning ten days after castrations were performed. The normal rat seminal vesicle, as revealed by SEM, was characterized by a large saccular lumen with highly folded walls. Cell surfaces were covered with microvilli, or occasionally displayed a protruding, ruffled surface, sparsely covered with short microvilli. Cytology was normal in testosterone-treated animals. Estradiol treatment of castrated animals stimulated secretion by seminal vesicle epithelial cells as evidenced by the presence of normal secretory bodies, the presence of RER, and moderately hypertrophied Golgi complexes. These glands were not heavier than were glands from castrated, untreated animals, although the epithelial cells were significantly taller. Secretion was maintained in intact animals treated with estradiol, although glands were smaller and epithelial height was reduced. Estradiol and testosterone treatment in combination did not appear to have an additive effect on secretion, weight of the gland, or epithelial height. The following results support the hypothesis that estrogen-induced prolactin synthesis and release may be involved in the mechanism by which estradiol effected stimulation of seminal vesicle epithelium. Prolactin-treated, castrated animals exhibited focal areas of stimulated epithelium. In hypophysectomized animals (untreated controls), the seminal vesicle epithelium retained some secretory bodies and secretory fluid in the glandular lumen; epithelial height was taller than that in castrated controls. Estrogen treatment reduced the epithelial height to that of castrated controls; there was no evidence of secretion. This suggests that in the absence of anterior pituitary hormones, including prolactin, the stimulatory effect of estradiol on seminal vesicle epithelium was nullified. In adrenalectomized/castrated animals, estradiol treatment stimulated secretion in seminal vesicle epithelium just as in non-adrenalectomized/castrated animals. This indicates that the adrenal gland plays a non-essential role in the action of estrogen on seminal vesicle epithelium.


Morphogenesis of the truncus arteriosus of the chick embryo heart: the formation and migration of mesenchymal tissue.

The appearance and migration of mesenchymal cushion tissue within the truncus arteriosus of the normal 2.5 to 6-day chick embryo heart was surveyed systemically with the light microscope. Series of cross-sections taken from replicate hearts at successive developmental stages allowed comparison of the following qualitative and quantitative aspects of early truncal morphogenesis. Mesenchyme within the truncus was derived from two distinct sources. The first mesenchyme appeared to migrate caudally into the cardiac jelly of the distal truncus from the nearby aortic arch region, coincident with slowing of the anterior elongation of the heart tube (Hamburger-Hamilton Stage 17-18). A second, separate mesenchymal population, derived from endocardium, began to fill the conus and proximal truncus in a radial direction, coicident with expansion of the bulbs cordis (Stage 12-19). The measured kinetics of relative cell numbers, distributions, and mitotic indices suggest substantial contributions from both sources. By Stage 26, the conotruncal region was filled with mesenchyme, which then condensed to form the anlagen of three future structures: the semilunar valves, the aorticopulmonary septum, and the tunica media of the great arteries.


The rostral level of origin of sympathetic neurons in the chick embryo, studied in tissue culture.

Groups of three consecutive somites from the first to the eleventh somite from chick embryos of stages 17-18 were grown in tissue culture for seven days. Sympathetic neurons, identified both by phase contrast microscopy and FIF histochemistry, occurred only in cultures which included the sixth, or more caudal, somites. If it is assumed that sympathetic precursor cells (neural crest cells) have not undergone a caudal shift prior to stages 17-18, and taking into account the loss of one or two rostral somites, then the anterior sympathetic ganglia are derived from neural crest caudal to the sixth or seventh somite. Thus, the vagal zone (level with somites 1-7) contributes little to the sympathetic nervous system.


Functional heterogeneity in a multipinnate muscle.

Many mammalian muscles have a complex internal architecture. This type of structure could allow a single muscle to produce a variety of force vectors through selective regional contractions. This hypothesis was tested electromyographically in the multipinnate pig masseter by recording simultaneously from several intramuscular sites. It was found that the activity in different portions of the masseter varied systematically during the various phases of mastication. anatomical correlates of the differential activity included fasciculus orientation and length, sarcomere length in specific jaw positions, and histochemical fiber type. The usual assumptions made about muscles for biomechanical analysis, such as uniform contraction and constant line of action, are inappropriate for complex muscles such as the pig masseter.


Protein-induced hypercalciuria: a longer term study.

Urine calcium excretion is known to be directly correlated with the level of dietary protein intake. In this experiment we examined the persistence of the hypercalciuria induced by the consumption of high protein diets, and the mechanism of the calciuric response. In a 95-day metabolic study, each of six adult male subjects received formula diets supplying 12 g nitrogen or 36 g nitrogen, and approximately 1400 mg calcium per day. Urine calcium increased rapidly and significantly from an average of 191 mg/day on the 12 g nitrogen diet to 277 mg/day on the 36 g nitrogen diet. There was no significant difference in the apparent absorption of calcium, so that overall calcium balance was -37 mg/day on the 12 g nitrogen diet, and significantly lower at -137 mg/day in subjects consuming the high protein diet. Levels of urinary hydroxyproline, serum insulin, and parathyroid hormone were not significantly increased by high intakes of protein. A decrease in the fractional reabsorption of calcium by the kidney seems to be the most likely cause of the protein-induced hypercalciuria. The consumption of high calcium diets is unlikely to prevent the negative calcium balance and probable bone loss induced by the consumption of high protein diets.


Total free amino acids, ammonia, and protein in the sweat of children.

The concentrations of total free amino acids, ammonia and protein in sweat of 44 children, 20 males, and 24 females, 6 to 8 years old, were determined. The children were divided into three groups according to their height, weight, and body weight/height ratio; group I children had heights and weights below the 10th percentile for their age, group II had heights and weights between the 10th and 90th percentile, and group III had heights and weights above the 90th percentile. Sweating was induced by allowing the child to be moderatley active. The temperature at the time of the experiment was 31 to 33 C and the relative humidity 48%. The mean concentrations of total free amino acids (mg/100 ml) in sweat from groups I, II, and III children were 318.9 +/- 52.5, 293.9 +/- 82.9  and 265.1 +/- 57.0, respectively. Alanine, glycine, phenylalanine, threonine, and serine were the principal amino acids in sweat. The concentrations of ammonia in the sweat of group I, II, and III children were 6.90 +/- 2.97, 2.35 +/- 0.81, and 1.17 +/- 0.48 mg/100 ml, respectively. Protein concentrations were 44.15 +/- 14.07, 40.70 +/- 16.60, and 35.75 +/- 5.46 mg/100 ml, respectively.


Long-term effects of kwashiorkor on the electroencephalogram.

The long-term effects of kwashiorkor on the electroencephalogram were assessed by means of computer analysis techniques. The experimental group, consisting of 30 black children, 6 to 12 years old, hospitalized for the treatment of kwashiorkor during the first 27 months of life, was age-matched with three control groups. These were a group of siblings and of yardmates, neither of whom had been exposed to acute infantile malnutrition, and a very high socioeconomic group of white children. The results revealed significantly less alpha activity and more slow-wave activity in the electroencephalogram of the kwashiokor group than in those of the control groups. These findings confirmed previous results based on visual analysis procedures.


Functional assessment of nutritional status: heart rate response to submaximal work.

The heart rate response to submaximal treadmill work been calculated using the heart rates and oxygen intakes obtained from normally nourished and undernourished adult male subjects during a maximal oxygen consumption test. Increased severity of malnutrition was associated with an increased heart rate response to the same submaximal work loads. The response was observed to decrease during a period of high protein dietary repletion of the most severely malnourished subjects. The data suggest the possibility of developing a submaximal work test for use in the field to provide physiological data to supplement anthropometric and biochemical information used to assess the nutritional status of populations.


Insulin and glucose responses in rats fed sucrose or starch.

Rats fed 54% sucrose for 11 to 13 weeks ad libitum or 5 weeks ad libitum followed by 6 to 8 weeks of meal feeding had significantly higher serum insulin, glucose, and triglyceride levels than rats fed comparable amounts of starch after 12 to 14 hr without food. The serum insulin response measured before, 1/2, and 4 hr after a meal showed insulin levels of sucrose-fed rats to be higher than comparable levels of rats fed starch at all three times. An intraperitoneal glucose tolerance test measuring serum glucose before, 1/2, 2, and 2 hr after a glucose injection revealed glucose levels of rats fed sucrose to be higher than levels of rats fed starch. When insulin was added to the injection medium, serum glucose of rats fed sucrose remained higher than comparable levels of rats fed starch indicating insulin insensitivity. Meal feeding generally resulted in higher insulin and triglyceride levels than in rats fed ad libitum but had little effect on glucose levels. These results are clear evidence that sucrose feeding has undesirable effects on glucose tolerance.


Zinc retention and losses of zinc in sweat by preadolescent girls.

Preadolescent girls, ages 7 to 9 years, were fed levels of zinc ranging from 5.61 to 14.61 mg/day during an 18-day metabolic study. All other nutrients were provided at or above Recommended Dietary Allowance levels. The sweat loss of zinc was measured using an arm-bag method and whole body zinc loss was calculated from whole body nitrogen and arm loss of nitrogen and zinc. Fecal zinc reflected dietary zinc, but urinary zinc remained relatively stable. The mean daily loss of zinc through sweat was calculated to be 1.43 mg. Zinc retentions were not significantly different (P greater than 0.05) though the retention increased generally with intake of zinc. A comparison of these data with previously reported studies indicated that the absorption of zinc was usually in the range of 20 to 30%. Based on sweat losses reported by others and found in this study and on usual absorption of zinc, it appears that diets should provide a minimum of 7 mg of zinc daily for growing children.


Food iron absorption in human subjects. V. Effects of the major dietary constituents of semisynthetic meal.

Studies were performed in adult volunteer subjects to determine the effect on nonheme iron absorption of protein, carbohydrate, and fat. These constituents were administered as egg albumin, dextrimaltose, and corn oil, respectively, in a semisynthetic meal containing 700 kcal and 4.1 mg iron. Because any one of these ingredients are unpalatable when administered alone, their effect was determined by serially deleting or doubling their content in the basal semisynthetic meal. With both approaches, carbohydrate and fat had little influence whereas egg albumin had a significant inhibitory effect on the absorption of nonheme iron.


Wine versus ethanol in human nutrition. II. Fluid, sodium, and potassium balance.

Six healthy males were studied under metabolic unit conditions to determine the effects of wine vs ethanol on the absorption of various elements. Fluid, sodium, and potassium data are reported here. The following test beverages in the amount of 1 liter/day were administered in random order to each of the subjects during four 18-day experimental periods: Zinfandel wine (9.3% w/v alcohol); dealcoholized Zinfandel wine; pure ethanol (9.3% w/v aqueous alcohol solution); and deionized water. A strictly controlled isocaloric formula diet was given with the test beverage in four equal feedings over a 12-hr period. No diuretic effect of alcohol was detected in any of the subjects. Urinary sodium was significantly less during the dealcoholized wine period than during the ethanol and water periods. Urinary potassium was significantly greater during ethanol administration as compared with the other test beverages. Fecal and serum sodium and potassium were essentially unchanged throughout the study.


Wine versus ethanol in human nutrition. III. Calcium, phosphorous, and magnesium balance.

A metabolic balance study was performed to determine the effects of wine vs ethanol on absorption of various elements. Calcium, phosphorus, and magnesium data are reported here. The study was divided into four 18-day experimental periods during which six healthy males were given, in random order, 1 liter/day of one of the following test beverages: Zinfandel wine (9.3% w/v alcohol); delacholized Zinfandel wine; pure ethanol (9.3% w/v aqueous solution); or deionized water. The test beverages were administered along with a controlled isocaloric diet in four equal feedings over a 12-hr period. Each man served as his own control. Urinary calcium and magnesium did not change appreciably during the course of the study. Urinary phosphorous, however, was significantly greater during wine and ethanol administration, suggesting that alcohol may affect the metabolism or renal tubular reabsorption of this element. Despite considerable individual variation, the data showed that wine and dealcoholized wine enhanced absorption of calcium, phosphorus, and magnesium. This apparently was due to an effect of one or more of the many congeners present in wine and absent in a calorically equivalent amount of pure ethanol. The natural acidity of wine also may have played a role in creating a more favorable intraluminal environment for absorption. There was no significant difference between experimental periods in serum calcium, phosphorus, and magnesium.


Determination of urinary 4-pyridoxic acid using high performance liquid chromatography.

A high performance liquid chromatographic method is presented for the determination of the vitamin B6 metabolite, 4-pyridoxic acid, in urine. Urine samples are treated with trichloroacetic acid to precipitate protein. An aliquot of the supernatant is chromatographed using 0.033 M  phosphate buffer containing 5% (v/v) methanol (pH 2.2), a fluorometric detector and a commercial reverse phase octadecylsilica column. The high precision of the method and the absence of interfering compounds have been demonstrated. This method provides a rapid, sensitive, and quantitative technique for the measurement of urinary 4-pyridoxic acid for use in metabolic and nutritional studies.


The food and nutrient intakes of the Tarahumara Indians of Mexico.

A nutritional survey of 372 semiacculturated Tarahumara Indians in the Sierra Madre Occidental Mountains of Mexico was carried out to determine the composition of their diet and its nutritional adequacy. Dietary histories from 174 adults and 198 children were obtained by interviews and field observations during 1973 and 1974. The histories for the children were calculated in part from the menus of six boarding church schools. Nutrient calculations of daily intake were based upon food composition tables and some actual analyses of Tarahumara foods. The protein intake was ample, at 87 g, and generously met the FAO/WHO recommendations for daily intake of essential amino acids. Fat contributed only 12% of total calories, its composition being 2% saturated and 5% polyunsaturated with a P/S ratio of 2. The mean dietary cholesterol intake was very low, less than 100 mg/day, and the plant sterol intake was high, over 400 mg/day. Carbohydrate comprised 75 to 80% of total calories, mostly from starch. Only 6% of total calories were derived from simple sugars. The crude fiber intake was high, 18 to 21 g/day. Salt consumption was moderately low, 5 to 8 g/day. The daily intakes of calcium, iron, vitamin A, ascorbic acid, thiamin niacin, riboflavin, and vitamin B6 exceeded or approximated the FAO/WHO recommendations. Thus, the simple diet of the Tarahumara Indians, composed primarily of beans and corn, provided a high intake of complex carbohydrate and was low in fat and cholesterol. Their diet was found to be generally of high nutritional quality and would, by all criteria, be considered antiatherogenic.


The vitamin B6 requirement in oral contraceptive users. I. Assessment by pyridoxal level and transferase activity in erythrocytes.

Eight college-age women using estrogen-containing oral contraceptives (OC) were fed a low vitamin B6 diet (0.36 mg/day) for 42 days. During the first 10 days (adjustment period) the diet was supplemented with 1.7 mg pyridoxine hydrochloride bringing the total intake to 2.06 mg/day. Following depletion, repletion was done in three consecutive steps: intakes of 0.96, 1.56, and 5.06 mg were consumed for 8, 9, and 7 days, respectively. Continuous 24-hr urine collections were made throughout the study and fasting blood samples were drawn periodically. Vitamin B6 nutriture was assessed by erythrocyte pyridoxal level, erythrocyte alanine aminotransferase and erythrocyte aspartic aminotransferase activity; and stimulation of these enzyme systems with pyridoxal phosphate. Results were compared with data obtained from non-OC users who consumed a similar diet. The data obtained suggest that 0.96 mg vitamin B6 was not adequate to meet the needs of OC users. Predepletion levels had been reached in almost all subjects at an intake of 1.5 mg/day. Assessed by the parameters studied, an intake between 1.5 and 5.0 mg/day of vitamin B6 was adequate to meet the needs of OC users; this compares with 1.5 mg/day previously suggested for the nonuser.


Effect of dietary fructose on triglyceride transport and glucoregulatory hormones in hypertriglyceridemic men.

Effects of dietary fructose on triglyceride metabolism and on basal levels and meal responses of glucose, insulin, and glucagon were studied in six hypertriglyceridemic men, two of whom were also diabetic. Constant composition, weight-maintaining formula diets were used with substitution of fructose for 20% of the carbohydrate calories in both fat-containing (45% carbohydrate) and fat-free (85% carbohydrate) periods; each of the four dietary periods was at least 2 weeks long in every subject. No effect of fructose on fasting levels of triglycerides could be seen in any of the diets. No alterations of triglyceride transport occurred with fructose substitution in the fat-containing diets, but significant reductions of triglyceride transport rates were seen with fructose substitution in the 85% carbohydrate diets using both the heparin infusion lipolytic rate method and the 3H-glycerol methods of assessment of tryglyceride turnover (- 16 and - 21%, respectively). Dietary fructose induced no significant changes in either basal levels or responses during a "formula tolerance test" of glucose, insulin, or glucagon. Thus, dietary fructose given for several weeks does not appear to cause further elevations of plasma triglyceride levels in hypertriglyceridemic men.


Effect of dietary egg on human serum cholesterol and triglycerides.

One hundred sixteen male volunteers between the ages of 32 and 62 years (mean age 46) consumed two whole fresh eggs daily in their customary diets for 3 months and also eliminated eggs for 3 months before or after eating eggs. The men had had normal-range serum cholesterol and triglycerides for the past 7 years. Four-day food records kept by them in each experimental period were assessed for nutrient intake. A Latin square design allowed analyses for season and sequential effects on serum lipids. The serum cholesterol and triglyceride levels at the end of 6 months were compared with their initial levels on customary free choice diets as well as their levels after the first 3 months of study. No significant increase in mean serum cholesterol was found nor was there a significant association of dietary cholesterol intake with either serum cholesterol or triglyceride.


Lactation and pregnancy in Iran. III. Hormonal factors.

Lactation failure is common in urban areas of industrially developing countries, but little is known about its epidemiology and causality. The study reported here was undertaken to investigate the serum levels of some hormones other than prolactin that have been shown in animal studies to play a role in lactation, and to examine their relationship to adequacy of lactation and to nutritional and socioeconomic status in urban Iranian women. Serum levels of placental lactogen, growth hormone, cortisol, and thyroid hormones were measured under standard conditions in two groups of pregnant women from low and low middle socioeconomic areas of Teheran, 1 or 2 weeks before parturition and the latter three hormones again in the 3rd month postpartum. Significant differences were found in the biochemical parameters between socioeconomic groups. Hemoglobin and serum albumin values were lower and all the globulin fractions (except alpha 2 globulin during pregnancy), growth hormone and cortisol were higher in the low than the middle socioeconomic subjects, both during pregnancy and postpartum. The discrepancies between the socioeconomic groups were greater postpartum. Growth hormone level was significantly lower in subjects with adequate lactation than inadequate or ceased, and cortisol values show the same trend. No correlations were found between the measured parameters of nutritional status nor free thyroxine values and lactation adequacy. In view of the role of growth hormone and cortisol in stress and malnutrition and some evidence of a reciprocal relationship between growth hormone and prolactin, these hormones may be a link in the chain between the urban environment, malnutrition and lactation failure.


Myocardial tissue concentrations of magnesium and potassium in men dying suddenly from ischemic heart disease.

Optimum tissue levels of magnesium and potassium ions are essential to the structure and function of the myocardium. We hypothesized that an inapparent deficiency of one or both of these elements might contribute to sudden cardiac death in a susceptible person, and in this study investigated levels of these elements in the myocardium of men experiencing sudden death to determine if there was such an association. Subjects dying suddenly with ischemic heart disease had significantly lower levels of myocardial tissue magnesium and potassium than the controls (men dying of acute trauma). The four lowest potassium values were obtained for the only men in the group with a history of angina (P less than 0.0005). Three of the men with angina also had the lowest tissue magnesium levels (P less than 0.005). The intriguing finding gives support to the hypothesis.


Kinetics of intravenously administered 15N-L-alanine in the evaluation of protein turnover.

After a pulse injection of 15N-L-alanine to a healthy male subject, the distribution of 15N in the various components of blood and urine were determined as function of time. The rapid appearance of the isotope both in the urinary urea and ammonia and in the plasma amide and urea suggests that transamination (and not deamination) may be the key step in the interaction. After 30 to 60 min postinjection, the tracer dynamics represents the overall metabolic pool characteristics and does not reflect the metabolism of alanine only. The nitrogen of alanine is used effectively in the synthesis of body protein.


Body composition during nutritional repletion of severely undernourished men.

Body composition was studied in severely undernourished adult male inhabitants of a rural area of Colombia to evaluate the extent and the time course of the changes occurring upon nutritional repletion. During a 45-day basal period on a low (26g/day) protein diet containing adequate calories, body fat depots increased significantly (mean +/- SD = +3.02 +/- 2.9 kg), and there was a significant decrease in cell hydration from 81.8 to 76.4% (-5.4 +/- 9.1%). Upon protein repletion (100 g/day), cell hydration decreased significantly to 71.4%, while body cell mass increased markedly (9.0 +/- 1.1 kg). During protein repletion, muscle cell mass increased significantly (+5.5 +/- 0.6 kg) and rapidly, while the increase in nonmuscle cells (+3.5 +/- 3.8 kg) and specifically in red cell mass lagged behind. With repletion, the changes in the absolute values for plasma volume (+0.4 +/- 0.13 liters) were significant, but those in extracellular fluid volume (-0.7 +/- 1.9 liters) were not. Thus, the major compositional changes observed occurred in the body fat and the body cell mass components; these occurred independently of each other.


Electrolyte output, blood pressure, and family history of hypertension.

Adult, normotensive subjects were divided into two groups on the basis of whether their first degree relatives were diagnosed as being hypertensive. Urine samples were collected over a 24-hr period for 3 days and analyzed for electrolyte excretion; the rate of electrolyte excretion was also measured separately during the overnight period. Significant correlations were shown between blood pressure and sodium and chloride excretion, both the 24-hr total and the overnight rate; Na/K ratio; weight; and body mass index for those subjects with a positive family history of hypertension. In subjects with no family history of hypertension there were no significant correlations between those parameters and blood pressure. The rate of urinary excretion of sodium overnight may provide a means for further studies on populations to determine the interrelationship between sodium excretion, other parameters, blood pressure, and family history of hypertension.


Intravascular endothelial proliferations in children.

Six children who had benign cutaneous vascular lesions characterized by papillary or solid proliferation of the endothelial cells were seen in a 16-year period. In five of them, the lesions had the histologic features of the entity originally described by Masson and recently reported by Clearkin and Enzinger as intravascular papillary endothelial hyperplasia. In one of the five, the lesion appeared in the pure form within large vascular spaces, whereas in the remaining four it appeared as a very limited focal change in a hematoma. The authors agree with others that this lesion represents a peculiar variant of an organizing thrombus. The histologic features of the lesion in the sixth patient were compatible with the so-called "intravenous atypical vascular proliferation," another pseudomalignant vascular disorder recently described by Rosai and Akerman.


Histologic study of ovaries from young women with endometrial adenocarcinoma.

A histologic study of 15 ovaries from patients in whom endometrial adenocarcinoma developed before the age of 40 years was performed. These ovaries were randomized with control groups of 21 age-matched normal ovaries and 25 ovaries from patients who had Stein-Leventhal syndrome. The study was done in an attempt to determine whether the ovaries from these young patients showed any histologic feature that would indicate  abnormal ovarian function resulting in unopposed estrogenic stimulation of the endometrium. Histologic features assessed included type and size of cysts, presence and number of primary follicles, corpora lutea, corpora albicantia, and presence of stromal luteinization and sclerosis. Analysis of the results indicated that from a histologic point of view ovaries of patients less than 40 years old who have endometrial adenocarcinoma are more similar to normal ovaries than to polycystic ovaries. Only 11.1% of ovaries of the study group had features suggestive of polycystic ovarian disease.


A computerized word-processing and data system for histology in a private medical laboratory.

This report describes the use of a word-processing micro-computer, the Lanier Text Editor, for preparation of surgical tissue reports. Gross and microscopic description formats are stored on floppy disks, which may easily be completed and edited on a cathode-ray tube (CRT) for rapid computerized printing. Also described is the use of a PDP 8/E mini-computer for entry, storage, and manipulation of historic, demographic and diagnostic data, printing of numeric and alphabetic listings, cross-indexing of cases by diagnosis, and the accumulation of data for direct patient or physician billing.


Effects of time, platelet concentration, and sex on the human platelet aggregation response.

The platelet aggregation responses induced by adenosine diphosphate (ADP) and collagen were characterized by parameters defining rate and extent of reaction. Values were compared on the basis of platelet concentration, time elapsed between sample collection and test performance, and sex of donors. Rate and extent of aggregation varied as a function of platelet concentration. Maximal responses were obtained for platelet concentrations greater than 100,000/microliter. Results from samples processed after 90 min of incubation at room temperature were consistently and significantly lower than those obtained from samples processed immediately. ADP-induced aggregation responses elicited by samples from male and female normal donors differed significantly. This indicates that comparisons between normal and patient results should be made with sex-matched individuals to avoid erroneous interpretations.


Functional studies of hairy cell leukemia (leukemic reticuloendotheliosis).

Reports proposing that the cell or origin of "hairy cell" leukemia (leukemic reticuloendotheliosis) is a B lymphocyte have been based primarily on the presence of surface immunoglobulin markers, frequently in "cap" form. Most of the immunoglobulin markers in this series of patients with hairy cell leukemia were multiclass, but were present in cap form under conditions not usually inducing cap formation in normal or leukemic human lymphocytes. In five cases the authors were able to remove these surface immunoglobulins by trypsinization or overnight incubation in serum-free tissue-culture medium. There was no evidence of synthesis of surface immunoglobulins in these cases following incubation in serum-free tissue-culture medium; however, surface immunoglobulins could again be detected after subsequent reintroduction of these hairy cells into the patients' own sera. The peculiar cap formation could not be prevented with sodium azide, a standard inhibitor of cap formation. Phagocytized latex particles and neutral red dye produced similar caplike structures. These findings suggest that hairy cells readily adsorb and pinocytose circulating immunoglobulins, but do not synthesize them.


Gm and Km allotypes in disputed parentage.

Immunoglobulin allotyping in 925 cases of disputed paternity provided evidence of exclusion for 70 alleged fathers. Combining results from erythrocytic antigen, enzyme, and serum protein tests, 230 men were proven to be falsely accused; in 15 cases the immunoglobulin allotype provided the only evidence for exclusion, in 67 no exclusion would have been identified if testing had been limited to ABO, Rh, and MNSs. Various cases in this study illustrate the importance of using an extensive battery of immunoglobulin reagents in order maximally to exclude falsely accused men, and to identify infrequent haplotypes, which might erroneously be interpreted as indirect exclusions or may indicate a high likelihood of paternity. The problems of Gm typing of very young children are described. When child is less than 6 months of age, direct exclusions may be missed by the Gm allotypes; indirect exclusions are valid only when the phenotype differs from that of the mother. Km allotypes are not age-dependent.


Quality assurance in the blood bank. Studies of technologist performance.

A series of experiments was conducted to assess the performance of technologists in the blood bank, with particular reference to precision and accuracy in the technical and mechanical aspects of routine work, including preparation of erythrocyte suspensions, pipetting, interpretation of hemagglutination, detection of mixed-field agglutination, detection of weak alloantibodies, and antibody titration and scoring. The authors conclude that use of semiquantitative technics contributes significantly to imprecision in blood bank work. A plea is made for expediture of increased effort in quality assurance programs directed toward the technical staff.


A radioimmunoassay for the measurement of human cardiac myosin light chains.

A double-antibody radioimmunoassay that specifically measures serum or urinary concentrations of human cardiac myosin light chains has been developed. The assay is both sensitive and specific for myosin light chain I. The antiserum used in the assay is capable of detecting 1--2 ng/ml of cardiac myosin light chain I and shows no cross-reaction to cardiac myosin, the heavy chains of myosin, actin, tropomyosin, or light chain II. Of 114 patients admitted to the Coronary Care Unit, 227 measurements obtained from 84 patients without myocardial infarction revealed that the serum light chain level of 2.0 +/- 0.18 ng/ml was not significantly different from that of a control group (2.1 +/- 0.17 ng/ml, n = 12). In contrast, 89 measurements from 30 patients with myocardial infarction evidence clinically, electrocardiographically, and by creatine phosphokinase determinations were found to have an average serum light chain I concentration of 10.9 +/- 1.39 ng/ml (P less than 0.001). Thus, the radioimmunoassay for human cardiac myosin light chain I provides a sensitive and specific marker for myocardial damage.


Effects of bacterial contamination of reagent water on selected laboratory tests.

The effects of three widely spaced levels of bacterial contamination of reagent water on several chemistry, radioimmunoassay, and coagulation procedures were studied. These included determinations of lactate dehydrogenase, creatine kinase, aspartate transaminase, alkaline phosphatase, blood urea nitrogen, total protein, thyroid-stimulating hormone, digoxin, thrombin time, activated partial thromboplastin time, and prothrombin time. Statistical analyses included calculations of means and coefficients of variation, and analysis of variance, as well as correlation coefficients for test results versus logarithm of bacterial contamination. Statistically and clinically significant differences occurred together only for an elevated level of creatine kinase.


The platelet function profile. A new format for recording platelet function tests.

A platelet function profile that provides a concise record of platelet function tests has been developed. This format can be easily modified to meet local requirements or to include hematologic tests unique to each laboratory.


Hyperplastic polyps of the gastric mucosa adjacent to gastroenterostomy stomas.

In two patients with functionally active, nonatrophic oxyntic gastric mucosa, hyperplastic polyps developed on the gastric side of Billroth II and Billroth I anastomoses. The polyp associated with the Billroth II procedure was almost circumferential, sparing only the lesser curvature. That associated with the Billroth I operation was on the anterior wall from lesser to greater curvature. The operations had been performed 11 years and ten years earlier for peptic ulcers of the gastroduodenal junction. The sites of polyp formation resembled those of experimental cancers in rats with Billroth I and Billroth II anastomoses, and of human cancer occurring 20 or more years after gastrojejunostomy for benign disease. This suggests that stomal carcinomas and hyperplastic polyps each result from the reflux of enteric contents into the stomach remnant.


Chondrosarcoma of the breast. Report of two cases.

The clinical and pathologic findings in two cases of pure chondrosarcoma of the breast are presented. As with other sarcomas, both tumors were large (5.5 and 25 cm in greatest diameter), did not invade the skin or axillary lymph nodes, and occurred in women more than 40 years old. Infiltrating margins, cellular atypism, and high mitotic rates adversely affected the prognosis.


Ochronosis in the breast.

A patient who had masses in the breasts clinically suggestive of neoplasia had fibrous mastopathy and striking deposition of ochronotic pigment within the soft tissue of the breast. The gross appearance and light microscopic features are illustrated. The histochemical features of ochronotic pigment and the difficulty in differentiating it from melanin are discussed.


Germ cells and ova in dysgenetic gonads of a 46-XY female dizygotic twin.

The frequency of germ cell neoplasms in girls with 46-XY gonadal dysgenesis suggests that germ cells may persist in the dysgenetic gonads for many years. A phenotypic female infant with a karyotype of 46-XY in blood, skin, and gonads had a few ova in primordial follicles and numerous germ cells in her dysgenetic gonads at the age of 3 months. At 3 years and 10 months of age her gonads contained no primordial follicle and the only remaining germ cells were in a gonadoblastoma. We propose that germ cells are lost from dysgenetic gonads much more rapidly than from normal gonads, but that the rate of loss in patients with a karyotype of 46-XY may be less than the rate of loss in patients with a karyotype of 45-XO.


Errors in drug computations during newborn intensive care.

Medical personnel in a pediatric center were tested for their ability to correctly compute drug doses for sick newborns. One of every 12 doses computed by 95 registered nurses contained an error that would result in the administration of an amount that was ten times higher or lower than the dose ordered. The error rate was no different for experienced or inexperienced nurses. The test also included an evaluation of the nurse's ability to judge the appropriateness of the drug dose ordered for a specified infant. Experienced nurses tended to be more certain, although wrong, in their judgment when compared to inexperienced nurses. Eleven pediatricians, when given the same test, scored higher than the nurses but still made errors at the rate of one of every 26 computations attempted. Five registered pharmacists who were tested demonstrated far better computational skills than either the nursing or physician group.


Wormian bones. A marker of CNS abnormality?

The present investigation was undertaken to determine the incidence and significance of Wormian bones (WBs) in a random group of infants and children seen at the Jewish Hospital Medical Center of Brooklyn. Ninety-one (17%) of 515 infants and children were found to have WBs; 82 of these children (90%) had a gross disorder of the CNS and five (6%) had the so-called minimal brain dysfunction syndrome. In the remaining four patients, the data and follow-up are incomplete. Three of these did have developmental anomalies of other organ systems. Thus, the presence of WBs is almost invariably associated with abnormal development of the CNS and may serve as a useful marker for the early identification and treatment of the affected infant or child.


4q- syndrome.

To our knowledge, there have been three prior reports of patients found, with trypsin-Giemsa banding, to be monosomic for the terminal q segment of chromosome 4. Described herein is a fourth patient with this chromosome abnormality. Comparison of these four patients suggests a characteristic phenotype in the 4q- syndrome: cleft palate, satyr deformity of the pinnae, snub nose, retrognathia and micrognathia, hypertelorism, oropharyngeal hypothonia or upper airway obstruction, cardiac defect, clinodactyly of the fifth fingers with absence of a flexion crease, simian lines, displaced or clinodactylous toes, and mental retardation. In the three prior reports, the 4q- syndrome resulted from a de novo deletion. In the present case, the 4q monosomy was inherited from the father, who had a 4;20 translocation.


Childhood dermatomyositis and polymyositis. Treatment with methotrexate and prednisone.

The conditions of three children with dermatomyositis and one child with polymyositis were treated for nine to 31 months with combined prednisone and intravenous methotrexate (1 mg/kg/wk) when prednisone alone was ineffective in controlling the disease or when there were substantial steroid-related toxic effects. All children showed a major clinical improvement within three months despite concomitant reduction of the prednisone dose. Three children completely recovered; one patient relapsed and died. The toxic effects of methotrexate included elevated liver transaminases (3/4), nausea (2/4), abdominal pain (2/4), bone pain (2/4), mild neutropenia (1/4), and mild pruritus (1/4). Intravenous methotrexate is an effective adjunct to steroid therapy in the treatment of steroid-resistant or life-threatening dermatomyositis-polyositis or dermatomyositis-polymyositis complicated by severe steroid-related effects.


Familial arthrogrypotic-like hand abnormality and sensorineural deafness.

We describe a family with arthrogrypotic-like hand abnormalities. There were ten affected members in two generations. Three of ten affected persons showed an associated sensorineural hearing loss. The degree of the hand deformities and hearing loss varied in affected individuals. The  pattern of inheritance seems to be autosomal dominant with variable expressivity. The findings in this syndrome resemble those reported previously.


Endogamic incest and the victim-perpetrator model.

Traditionally incest has been seen as the aggressive act of a deranged adult perpetrator against a child victim. While this conceptualization is true for some cases of incest, it ignores the family dynamics and the underlying affectional neglect and deprivation that the child has experienced in the home environment. It can lead to interventions such as immediate incarceration of the perpetrator in all cases, which may cause more harm than good; furthermore, it may permit the state to provide no therapeutic services to the child. By using a more realistic conceptualization of prolonged endogamic incest, useful interventions and therapeutic plans can be designed.


The hyperactive child. Should we be paying more attention?

Current literature on hyperactivity stresses the central role of short attention, distractibility, and impulsivity in contributing to the child's behavioral and learning difficulties. Less emphasis is presently placed on minor neurological abnormalities ("soft signs") and unproved theories of brain injury. There has also been a trend toward a more comprehensive, multidisciplinary approach to the problem in an attempt to meaningfully integrate medical and psychoeducational input. Professional awareness of the family's need for supportive counseling and the importance of appropriate educational placement for the hyperactive child has enhanced the effectiveness of intervention programs. Although stimulant medication has been clearly shown to favorably influence behavior ratings and measures of attention in hyperactive children, pharmacologic manipulation of deviant social behavior remains a very controversial subject.


Recurrent abdominal pain.

A long-term follow-up study (minimum of five years) of 161 children with recurrent abdominal pain disclosed that three had organic disease and that was missed--inflammatory bowel disease. Anorexia nervosa developed in one patient. Three fourths of the patients recovered from the initial symptom; most recovered within a few weeks; but some patients continued to have complaints for a number of years. Approximately 20% of patients underwent additional surgical or medical treatments of doubtful necessity. In 18% of patients, other psychosomatic symptoms developed.


Chronic nonspecific diarrhea. A complication of dietary fat restriction.

Chronic nonspecific diarrhea is a frequent cause of prolonged diarrhea in childhood. Typical diagnostic features include onset by 30 months of age, normal growth and development, and diarrhea lasting longer than two weeks. It usually follows a gastroenteritis or an acute infection and has been associated with a low intake of dietary fat. Five patients experienced this condition following dietary manipulation to prevent the occurrence of atheromatous coronary artery disease. This indicates that diminished dietary fat not only can prolong postinfectious diarrhea but can also induce a state of chronic diarrhea without evidence of malabsorption.


Group D streptococcal septicemia in the neonate.

The clinical course of 11 patients with neonatal group D streptococcal septicemia is reviewed. Two of the infants died and hydrocephalus developed in one. Group D Streptococcus, both enterococci and nonenterococci, should be considered pathogenic in the neonate until proved otherwise. The antibiotics of choice for treating such infections in the newborn are ampicillin sodium and either kanamycin sulfate or gentamicin sulfate.


Endocrine abnormalities in thalassemia major.

Endocrine function evaluations in 16 patients with beta-thalassemia indicate that hypogonadotropic hypogonadism, hypoparathyroidism, and reduced adrenocorticotropic hormone reserve occur frequently, whereas reduced growth hormone and thyroid reserve are less common manifestations. Hemosiderosis-induced damage of the endocrine glands seems to be the main cause for endocrine dysfunction in the patients studied.


Infantile obstructive cholangiopathy.

The relationship between neonatal hepatitis and biliary atresia has been extensively discussed. Clinical and laboratory evaluations are often unsuccessful in distinguishing between the two diseases. Laparotomy, cholangiogram, and liver biopsy are often required. Several authors have proposed that the two diseases may represent variable expressions of one entity. A case that illustrates infantile obstructive cholangiopathy is presented and the clinical implications are discussed.


RBC surface pits in the sickle hemoglobinopathies.

Functional asplenia develops in children with sickle cell anemia. This asplenia is related to the increased incidence of bacterial sepsis that has been documented in these patients. With the use of direct-interference contrast microscopy to quantitate splenic function, we studied children with the sickle hemoglobinopathies. A gradual increase in splenic dysfunction with increasing age was documented in children with homozygous sickle cell disease. Children with the sickle variants also seem to manifest degrees of splenic dysfunction. Direct-interference contrast microscopy is a simple quantitative technique for the evaluation of splenic function in children with the sickle hemoglobinopathies.


Body image and the process of reconstructive surgery.

Newer craniofacial operative techniques produce rapid changes in objective appearance and permit the study of body-image change. In 21 patients with either Crouzon's disease or Alpert's syndrome, a four-factor model of body-image development was applied that emphasizes cognitive growth, perception of body stimuli, stimuli from the environment in the form of comparison, and the response from others. Before a child is of school age, he has substantially defined his body image, therefore corrective surgery must be considered earlier. Although surgical intervention may produce significant objective physical change, there is not a correspondingly rapid change in body image. Four phases in the modification of body image are (1) the decision to undergo surgery, (2) the operative experience, (3) the immediate postoperative period, and (4) the reintegration stage. Recognition of this phasic process will help integrate care of these patients.


Duodenal involvement with Crohn's disease: a spectrum of radiographic abnormality.

The clinical and radiographic features of 22 cases of duodenal Crohn's disease were analyzed. The presenting clinical findings in the majority suggested peptic disease rather than regional enteritis. There was no cases of isolated duodenal Crohn's disease but a spectrum of radiographic abnormalities was produced by duodenal involvement with Crohn's disease which simulated a variety of clinical entities. A radiographic examination of the small bowel or colon was useful to confirm a diagnosis of Crohn's disease when duodenal abnormalities were suggestive.


Esophageal achalasia secondary to gastric carcinoma. Report of a case and a review of the literature.

A case of invasive gastric carcinoma mimicking idiopathic achalasia radiologically, endoscopically and manometrically is described. This is only the second case of tumor-associated achalasia with a positive mecholyl test where there was no demonstrable histological tumor involvement of the myenteric plexus in the body of the esophagus. The interpretation of the manometric findings including the positive mecholyl test are discussed in the light of these histological findings. The short duration of symptoms, the presence of anemia and guaiac positive stools, along with subtle radiologic abnormalities of the gastric fundus were aspects of this case which should increase the index of suspicion and lead to the correct diagnosis. In the evaluation of patients with the achalasic syndrome, a tumor-associated functional and organic disorder mimicking idiopathic achalasia in all respects has to be considered.


Percutaneous transhepatic cholangiography with the Chiba needle.

Ninety patients with suspected pathology of the biliary tract were submitted to percutaneous transhepatic cholangiography. Forty-two of 43 dilated biliary tracts and 32 of 47 without dilatation were successfully entered. Except for fever following the procedure in two patients, there was no major complication. This technic was of prime importance in the management of patients with suspected pathology of the biliary tract.


Transverse taeniamyotomy in localized acute diverticulitis.

Transverse taeniamyotomy has been in use for over four years in the surgical correction of the muscle abnormality of diverticular disease. Essentially, the technic is to carefully transversely incise the two antimesenteric taeniae coli at 2 cm. intervals, in a stepwise manner, from the rectosigmoid junction proximally up to normal colon. This causes the cut ends of the taeniae coli to pull apart into separate 2 cm. blocks of longitudinal muscle. Thus elongation and widening of the colon occurs, resulting in dilatation of the necks and free drainage of the diverticula obstructed by inflammation. Four patients are presented with localized diverticulitis who had simple transverse taeniamyotomy from which they quickly recovered. This operation justifies continuing study as it may increase the surgeon's range of response over one end of the spectrum of acute diverticulitis.


Mediastinal pancreatic pseudocyst. An ultrasonic diagnosis.

Mediastinal extension of pancreatic pseudocysts is uncommon. Frequent presenting complaints include chest pain and shortness of breath. Dysphagia is rare. A patient with mediastinal pseudocyst causing dysphagia is presented. The role of gray-scale ultrasound as a reliable means of diagnosis is discussed.


Regeneration of jejunal mucosa during recovery from malnutrition and pancreatic insufficiency.

A patient with a history of alcohol abuse, who presented with severe malnutrition, was subjected to serial jejunal biopsies during his hospitalization. The improvement in villous size and absorptive cell ultrastructure paralleled his clinical recovery. It is concluded that the caloric and trophic benefits of food, the pancreatic and vitamin replacement therapy and withdrawal of alcohol, all played an integral part in the regeneration of the jujunal mucosa.


Determination of the lower esophageal sphincter pressure in patients having a Nissen or Belsey fundoplication.

Thirty patients were studied prospectively in evaluating the Nissen (28) and Belsey (2) fundoplication manometrically using the Kronsberg probe and Honeywell recorder. Twenty-eight patients in the Nissen fundoplication group had abnormally low LESP preoperatively and normal postoperative for one year with an average increase of 9 mm. Hg. They became asymptomatic and their esophageal mucosa became normal and remained normal endoscopically for three years. The only failures were two patients treated with the Belsey fundoplication. The gas bloat syndrome occurred in two patients and was relieved by esophageal dilatation. The Nissen fundoplication should be highly recommended as the surgical procedure of choice in the treatment of reflux esophagitis not responding to medical program.


Hepatitis B antigen and antibody in heroin users.

Hepatitis B surface antigen (HBsAg) and antibody (anti-HBsAg) were determined on 442 asymptomatic heroin users and 246 controls. Of the drug-taking group, 124 used heroin intravenously and 318 nonintravenously (smoking, sniffing). Twenty-three (5.2%) heroin users were HBsAg positive and 118 (26.7%) anti-HBsAg positive, compared to three (1.2%) HBsAg positive and 28 (11.4%) anti-HBsAg positive controls, both statistically significant. HBsAg was positive in eight (6.5%) intravenous heroin users and statistically identical to 15 (4.7%) HBsAg positive nonintravenous users. Positive anti-HBsAg in 55 (44.4%) intravenous heroin users compared to 63 (19.8%) nonintravenous users, however, is statistically significicant.


Ultrasound in the diagnosis of cholestatic jaundice.

A total of 70 cases of cholestatic jaundice have been studied by gray scale ultrasonography in order to evaluate how this technic may be used to differentiate between intra- and extrahepatic cholestasis. In 37 out of 42 patients (88.1%) with jaundice of extrahepatic origin, dilatation of the biliary tree was demonstrated, whereas in all the 28 patients with intrahepatic cholestasis biliary dilatation was clearly excluded. In addition, gallstones in the biliary ducts were detected in 12 out of 20 cases and enlargement of the head of the pancreas (due to carcinoma or chronic pancreatitis) was often correctly diagnosed (nine out of 13 cases). These results suggest that ultrasonography should represent the first step in the diagnostic approach to cholestasis. Information gained from this noninvasive technic should make it possible to correctly plan the more complex investigations (endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangiography).


Idiopathic calcific pancreatitis, CRST syndrome and progressive systemic sclerosis.

A 43-year old man with CRST syndrome (calcinosis, Raynaud's phenomenon, sclerodactyly and telangiectasia) and progressive systemic sclerosis presented with a four-year history of relapsing abdominal pain, the result of chronic pancreatitis, not associated with alcoholism, biliary disease, or any of the known causes of pancreatitis. He had a good response to retrograde pancreatic duct drainage but exhibited management problems and complications that may be peculiar to the systemic sclerosis patient with pancreatitis. A cause and effect relationship between progressive systemic sclerosis and pancreatic disease is not proven but we believe there is evidence to suggest such a relationship.


Pancreatic polypeptide (PP) responses to oral and intravenous glucose in man.

Serum human pancreatic polypeptide (hPP) responses to 50 gm. of oral glucose and a 25 gm. intravenous bolus of glucose were measured in 10 healthy human volunteers. Oral glucose caused a 50% rise, whereas I.V. glucose caused a 35% fall in hPP concentration. There was no relationship between the absolute glucose concentration or the change in glucose level and the PP concentration. It is suggested that oral and I.V. glucose affect PP by indirect mechanisms and that PP may be involved in carbohydrate metabolism in man.