[Clinical study of CS-1170 in children (author's transl)].

CS-1170 was administered to 9 cases of the pediatric field. The clinical effect was good in 6 cases, fair in 2, and poor in one. The doses ranged from 80 mg/kg to 100 mg/kg, and an intravenous injection of 300 mg/kg was given in only one case. In the poor case, continuous instillation of 100 mg/kg was given. In the 2 fair cases, the patients with septicemia received 80 mg/kg and 300 mg/kg, respectively. There was no improvement in clinical findings, but the bacteria alone disappeared. As side effects, vasalgia due to intravenous injection was observed in 2 cases, but it disappared by the intravenous injection of 500 mg dissolved in 10 ml. No case showed eruption, diarrhea, or acidophilia. GOT or GPT increased in no case either.


[Clinical evaluation of CS-1170 in pediatric field (author's transl)].

CS-1170 was used for treatment of 26 children who were diagnosed as bacterial infections, and a response rate of 88% was obtained as the drug was effective in 15 of 17 determinable cases. In our evaluation, daily dosage of 75 approximately 270 mg/kg (100 approximately 200 mg/kg in the majority of the cases) was divided into 4 doses, and administered intravenously by one-shot injection over a 10-minute period. The period of drug administration ranged from 1.5 to 25.5 days, but in most cases it was 3 to 6 days. Elevation of GOT and GPT as a side effect of the drug was seen in one case (3.8%), which was reverted to normal level upon cessation of the drug administration.


[Clinical effects of CS-1170 on respiratory tract infections. II: Mainly on the use of 2 g piggy bag alone (author's transl)].

The following results have been obtained in our trial of CS-1170, in 2 g piggy bag, on the respiratory tract infections: 1) CS-1170 was found to be effective in all the cases treated, including 6 cases in which CS-1170 was used alone. The cases treated with CS-1170 included those cases in which no other antibiotics had been used, as well as 5 cases in which other penicillins and cephalosporins were found to be ineffective or not adequately effective. The results indicate the usefulness of CS-1170 in the treatment of the respiratory tract infections. 2) Slight elevation of GOT and GPT was observed in one case as the side effect of CS-1170. No abnormality was found in other laboratory tests. The incidence of side effects of CS-1170 is believed to be not higher than those of other cephalosporins.


[Laboratory and clinical studies CS-1170 (author's transl)].

CS-1170 is a new antibiotic, a derivative of cephamycin C. In vitro, 50 strains of E. coli and Klebsiella consisting of gentamicin-sensitive isolated from the blood and gentamicin-resistant strains isolated from the urine were inhibited at concentrations from 0.4 to 12.5 mcg/ml of CS-1170, whereas only 2 strain of Klebsiella isolated from the blood had MIC more than 50 mcg/ml of the antibiotic. Moreover, CS-1170 was significantly more effective than cefazolin and cephalothin against these strains. Ten strains of gentamicin-sensitive Serratia isolated from the blood and the 2 gentamicin-resistant strains were inhibited at concentrations from 3.2 to 50 mcg/ml of CS-1170 and only one strain was resistant to this agent. All tested Serratia were resistant to cefazolin and cephalothin. CS-1170 was not effective against Enterobacter. Three cases of biliary tract infections consisting of 2 cases of cholelithiasis and a case of carcinoma of bile duct were treated with 4 g/day dosage of CS-1170. The remarkable effects were obtained in the two cases with cholelithiasis, whereas a case with the carcinoma was treated not so effectively by administration of CS-1170.


[Clinical studies of cefmetazole (author's transl)].

1. Cefmetazole was administered to 10 patients; 5 acute cholecystitis, 4 acute peritonitis and 1 periproctitis. 2. Cefmetazole was given by drip infusion at a daily dose of 2 to 4 g. 3. Clinical response was excellent in 3 patients, and good in other 7 patients. 4. No clinical adverse effect was recognized except the increase of GOT and GPT in 1 patient.


[Experience with CS-1170 in gynecological infections (author's transl)].

CS-1170 was used in gynecological cases of infection, and the following satisfactory results were obtained. 1. The drug was markedly effective in 3 of 12 cases, effective in 7, and ineffective in 2, being the efficacy rate 83.3%. 2. It was highly effective even in the cases in which cefazolin (CEZ) and sulbenicillin (SBPC) were ineffective. 3. The results of the bacteriological examinations turned to negative in 7 cases, but continued to be positive in 2, being the bacteriological efficacy rate 77.7%. It is noteworthy that E. coli completely disappeared by the administration of CS-1170 in 2 cases in which CEZ was ineffective. 4. No side effect attributable to CS-1170 administration was observed.


[The clinical studies about side effects of sodium cefapirin in the stomatic infective diseases (author's transl)].

The clinical effects and side effects of administrating sodium cefapirin to the stomatic infective diseases were examined in twelve cases. The following are the main results: (1) The clinical results of the treatment were noted effective in one case, effective in nine cases and slightly effective in two cases. (2) The results of renal function tests were as follows: After the administration, it was observed that the values of Ccr test decreased in two cases, the values of PSP test decreased in one case, but the BUN values remained within the normal range in all cases. However, in all cases, no significant deviations were observed in the values of each test measured before and after the test. (3) The results of hepatic function tests were as follows. The values of GOT and GPT showed slight decrease in majority cases. However, the difference between pro and post values was within the normal range and no significant deviations were observed. (4) No side effects including drug allergy were observed in every cases.


[Clinical studies on apalcillin treatment for bile duct infections (author's transl)].

The clinical effects of apalcillin (APPC) treatment for 7 patients with bile duct infections were investigated and the following results were obtained. 1) Clinical effectiveness: Of 7 patients treated with APPC, the results were good in 5 cases, fair in 1 case and poor in 1 case. 2) Absorption and excretion of APPC: One g of APPC was administered with one shot intravenously to 4 patients of which 2 were malignant tumor cases and the remaining 2 non tumor cases. A peak of APPC level in serum and bile was 79 microgram/ml and 140 microgram/ml respectively in malignant tumor cases and 96 microgram/ml and 180 microgram/ml respectively in non tumor cases. 3) Side effects of APPC: No significant side effects were observed in 7 patients treated with APPC, except abnormal elevation of S-GOT and S-GPT levels occurred transiently in 2 of 7 cases.


Role of thymectomy in the surgical treatment of myasthenia gravis.

Of the 26 patients with myasthenia gravis undergone thymectomy, 11 cases had either benign or malignant thymoma as judged not only by hitological examination but also by their clinical and operative findings. Age of initial onset ranged from 13 to 64 years old. Fifteen out of 26 (58 per cent) benefited from thymectomy. Duration of the symptom from the onset to the operation and the presence or absence of the thymoma are not related to their outcome. Benign or malignant nature of thymoma should not be determined by histological examination alone but by combined evaluation of clinical and operative findings. Serial studies of serum immunoglobulin levels before and after thymectomy suggested that this disorder could be associated with humoral antibody (IgG). HLA typing of the patients with myasthenia gravis did not indicate the presence of any specific antigens.


Clinicopathological studies on thyroglossal duct remnant.

The clinicopathological findings in 48 cases underwent complete surgical excision of epithelial tissue of the thyoglossal duct remnants were reviewed. Simple incision of the cyst does not seem to have any therapeutic value and would be followed frequently by recurrence. The widely used Sistrunk procedure 2,6 surgical excision of the central portion of the hyoid bone together with fibrous tract extending to the base of tongue, seems to be warranted in some cases so long as complete eradication of the epithelial tissue can be made.


Submucosal esophagography: a new method for demonstrating the depth of invasion of esophageal cancer.

We developed a new method to determine the depth of esophageal cancer invasion prior to surgery. According to this method, a fiberoptic esophagoscope is used to insert a double cannula into the biopsy canal and the submucosal layer is punctured and fixed by the needle at the tip of the inner cannula through which iodized oil fluid is injected into the submucosal layer. After this procedure, plain films of the posterior mediastinum and an esophagogram are taken in at least four different directions at 24 hour, three and seven day intervals. Seventy one esophageal cancer patients were examined with this method in order to determine the depth of invasion, and whether the adventitia was involved. In three cases the method failed due to technical difficulties and in 14 surgical treatment was not indicated. In 50 of the 54 remaining patients who underwent surgery, preoperative results obtained by using this method coincided well with operative findings. Our findings strongly indicate that this method is diagnostically highly accurate in determining the surgical procedure to be used. Furthermore, this method was proven very useful in obtaining a differential diagnosis of the malignancy of submucosal esophageal tumors,


Wraparound end-to-end hepaticojejunostomy (Roux-en-Y) for intrahepatic pigment calculi.

Intrahepatic pigment calculi are frequently found in East Asia and are associated with a considerable morbidity and mortality. The various methods of surgical treatment are unsatisfactory. A wraparound end-to-end hepaticojejunostomy presented may provide an effective and alternative method of treatment.


A radiopharmaceutical in the diagnosis of congenital biliary atresia.

Diethyl-HIDA, a new hepatobiliary radiopharmaceutical labeled with 99mTc, was used in the preoperative diagnosis of biliary atresia and in the postoperative evaluation of hepatic-porto-enterostomy function. The good results obtained in the four first cases suggest extensive use of the method, with the aim of a more precocious and more attendable diagnosis.


Measurement of local blood flow of the intestine by hydrogen clearance method; experimental study.

Local blood flow of the bowel wall was measured by hydrogen clearance method both in the muscular and submucosal layers in the mongrel dog, separately and concurrently. A platinum wire electrode with a bare tip of 0.5 mm in length and 0.2 mm in diameter was inserted into the each layer. About 10 per cent hydrogen gas was inhalated directly through the side hole attached to the endotracheal tube for 1-2 minutes and the obtained clearance curves were plotted on the semi-logarithmic scale, which was almost monoexponential. The results obtained were as follows: 1) Mean basal perfusion rate of the muscular layer of the intestine was 0.81-0.92 ml/min/gm, whereas that of the submucosal layer was 1.29-1.31 ml/min/gm, respectively. There was little difference of perfusion rates between the small and the large intestine. The results showed good correlationship with those reported by other authors. 2) The effect of vasoactive substances such as vasoconstrictor and vasodilator on the local blood flow in the bowel wall was confirmed. 3) This method is repeatedly applicable for measurement and also renders the information on the distribution of blood flow in the splanchnic area.


Results of stripping operation for varicose veins.

Approximately 150 stripping operations for primary varicose veins of the lower extremities were performed. Long-term evaluation (postoperative follow-up of more than five years) was made on 102 extremities and 83 per cent of these showed good or excellent results. Six patients were reoperated due to recurrence of varices. Accurate diagnosis and complete operation are most important in stripping operations.


Idiopathic granulomatous orchitis.

A case of idiopathic granulomatous orchitis in a 37-year-old Nigerian male is discussed. He presented with a history of pain and swelling of left testis of three weeks duration. A clinical impression of tumor of the testis was made followed by orchidectomy. A systemic review failed to show evidence of any infective proccess. Histology showed non-caseating tuberculoid granulomas replacing the seminiferous tubules.


Effects of aldosterone and dexamethasone on blood chemical mediators in endotoxin shock.

Although the pathogenesis of endotoxins shock is still a matter of speculation, we attach importance to chemical mediators in endotoxin shock. We measured chemical mediators such as histamine, serotonin, bradykinin and catecholamines and investigated the anti-toxic effects of aldosterone and dexamethasone on rabbits in endotoxin shock. Histamine, serotonin and catecholamines were measured by fluorometric assay. Bradykinin was measured by bioassay using rat uteri. The blood concentration of chemical mediators after endotoxin administration was elevated. Aldosterone and dexamethasone inhibited the release of chemical mediators, thereby preventing endotoxin shock.


Blood levels following intravenous and endotracheal epinephrine administration.

The blood levels of epinephrine and its metabolites which were obtained when the drug was given by both the intravenous (IV) and endotracheal (ET) routes were compared. Anesthetized dogs were subjected to radioactive epinephrine in doses of 0.005, 0.03, 0.06, and 0.09 mg/kg administered both intravenously and endotracheally. Blood levels were obtained at 0.25, 0.75, 1.5, 3, 5, 10 and 30 minutes following injection and analyzed by thin layer chromatography. The maximum measured concentration following IV injection was observed at 15 seconds. Epinephrine was rapidly metabolized with 20% of the original concentration detected at 5 minutes following IV injection. When the drug was given by the ET route, the maximum measured concentration was similarly observed at 15 seconds. Following ET installation, initial blood concentrations are sustained over a much longer period of time and 80% of the initial concentration was detected at 5 minutes. Maximum concentrations are approximately one-tenth of those achieved with an equal IV dosage. It is concluded that endotracheally and intravenously administered epinephrine rapidly reach maximum blood levels although there are differences in kinetics between the two routes.


Ketamine dissociative anesthesia--emergency department use in children.

An on-going study to determine the efficacy and safety of ketamine dissociative anesthesia in the emergency department for children less than 10 years of age is presented. Preliminary results of the first 30 cases indicate that this technique may be safe and convenient if used within the appropriate protocol.


Acute chlorine gas exposure.

The heavy use of chlorine gas in industry and water purification poses the constant threat of mass gas exposure. In a recent experience with a chlorine gas disaster involving over 100 patients, 64, including six subsequently requiring admission, were treated in the main emergency unit facility. The remainder were triaged to a safe area away from the emergency unit with instructions for symptomatic treatment. Injuries were limited to four organ systems: pulmonary, gastrointestinal, ophthalmic, and cutaneous. Current treatment methods are compared with those in the literature and a protocol for management provided.


An injury severity scale for comprehensive management of central nervous system trauma.

The Glasgow Coma Scale (GCS) is used in central Virginia by emergency medical technicians (EMT's), emergency department personnel and neurosurgical staff to evaluate patients with central nervous system (CNS) trauma. In a series of 406 patients admitted to the neurosurgical services at the University of Virgina Hospital between October 1977 and February 1978, a GCS score was recorded by the neurosurgeon, nurse, and EMT. All 250 data points, including clinical diagnosis and incidence of associated injuries were entered into our information system analysis. The scale can be easily mastered by all members of the emergency medical team giving reproducible results. It  also appears to be a valid predictor of the ultimate outcomes of head injury. The GCS has substantial clinical value in the management of the nuerotrauma patient. It is presently being employed in all phases of the emergency medical system to monitor the progression of the neurologic injury. Ultimately, this injury severity scoring system will be used to standardize patient populations in well controlled clinical studies in which different treatment parameters will be assessed.


Emergency management of acute phencyclidine intoxication.

Phencyclidine (PCP) is a potent sympathomimetic and hallucinogenic dissociative anesthetic agent. As an abused street drug, it is most often smoked, thus allowing the user to titrate the dose. The clinical signs of PCP intoxication can be viewed in three dose-related stages, but waxing and waning of signs through the three stages is not uncommon. Treatment protocols for each stage address drug therapy and both clinical and psychological supportive measures.


Orientation program for emergency medicine residents.

An orientation curriculum was developed for incoming residents in emergency medicine at the University of Cincinnati (UC) in  July, 1976. The major objectives of the orientation were 1) to identify and delineate the subject matter of emergency medicine, and 2) to review the basic elements of emergency medicine. Results of a pre- and posttest using the residency program at the Medical College of Pennsylvania (MCP) as a control group are presented. The pretest scores of the study groups showed no significant difference at a .05 level. The posttest, however, resulted in a significant improvement of the UC scores (p less than 0.05), while little change occurred in the MCP scores. An inter-group evaluation shows the UC group to have out-performed the MCP group significantly (p less than 0.05). Results of a one-year posttest showed the UC residents scoring an overall average of six points higher on the test. However, the general difference between the two groups of residents was not significant at the 0.05 level.


Clinical assessment of patients undergoing CPR in the emergency department.

A problem frequently encountered in the emergency department is assessing the effectiveness of cardiopulmonary resuscitation (CPR), particularly when it is continued over a period of time. To evaluate the effectiveness of CPR in our emergency department we use a mechanical cardiopulmonary resuscitator (Michigan Instruments, Thumper) together with early invasive monitoring of pulse and blood pressure. This also allows for frequent monitoring of blood gases. Three patients are presented who underwent longterm CPR (ie, longer than one hour), and invasive monitoring. Results indicate that better management of the clinical status of patients undergoing prolonged resuscitation can be obtained by using continuous blood pressure and pulse monitoring, and frequent blood gas analysis. In addition, when frequent arrhythmias are taking place, this system allows for better determination of appropriate procedures and medications.


Laparotomy in the emergency department.

Reports of advancements in emergency department operative resuscitative skills have included craniotomy, thoracotomy, cardiorrhaphy and even cardiopulmonary bypass. The efficacy and advisability of laparotomy in the emergency department remain in question. Between July, 1972, and July, 1977, adhering to an established protocol, resuscitative laparotomy was performed on 51 patients in the emergency department. All 51 patients underwent emergency thoracotomy also. Twenty-four patients were victims of gunshot wounds, 24 had sustained blunt trauma, and three had abdominal stab wounds. Injuries to the liver, major vessels, and spleen were most common. Control of hemorrhage by clamps, packs or pressure was the primary objective of laparotomy. Control of exsanguinating hemorrhage with precise application of vascular clamps was possible in all but 15 patients. Because of extensive multiple injuries and inability to achieve cardiovascular stability, only 11 patients reached the operating room, and none survived to leave the hospital. Although technically possible, laparotomy in the emergency center did not alter the fatal outcome of moribund patients in this series.


Incidence, etiology, and outcome of pulseless idioventricular rhythm treated with dexamethasone during advanced CPR.

The cardiac resuscitation records of 458 patients who received advanced cardiac life support at Detroit General Hospital during the last two years were reviewed to identify patients who had pulseless idioventricular rhythm (PIVR) recognized and treated with dexamethasone. Twenty-five cases were identified. The initial successful resuscitation rate of 52% in these patients contrasts sharply with other published data indicating 100% failure with the use of conventional chronotropic drugs. The most common etiology of cardiac arrest in our patients who display PIVR during resuscitation is hypoperfusion shock. Dexamethasone may counteract the lethal arrhythmia by causing the release of aditional adenosine triphosphate into the cytoplasm from the mitochondria.


Caustic esophageal and gastric erosion without evidence of oral burns following detergent ingestion.

The effects of accidental ingestion of a caustic detergent are studied in the report of 14 patients seen in the Hennepin County Medical Center. Since the history of amount ingested was unclear, all patients underwent endoscopy. Four patients had esophageal injury serious enough to warrant hospitalization. None of the patients had evidence of oropharyngeal burns, thus challenging the validity of the widely held notion that oral lesions nearly always accompany esophageal injury following caustic ingestion. The importance of analyzing the ingested substance is emphasized, as is the need for emergency departments to have wide range pH paper available to help determine the necessity for endoscopy.


Observations on the rate and mechanism of hemolysis in individuals with Hb Zürich [His E7(63)beta leads to Arg]: II. Thermal denaturation of hemoglobin as a cause of anemia during fever.

Individuals with unstable hemoglobins may become more anemic during episodes of intercurrent viral or bacterial infections. Pathophysiologic mechanisms that are responsible for this phenomenon have not been elucidated. Recently we observed a patient with Hb Zürich [His E7(63)beta leads to Arg] whose anemia worsened during a febrile episode characterized by temperatures ranging between 40 degrees and 41 degrees C, splenomegaly, and the appearance of Heinz bodies in the circulating erythrocytes. There was no history of self-medication and no drugs were administered during hospitalization. To determine the effect of a 3 degrees to 4 degrees temperature elevation above the physiologic range on the rate and degree of Heinz body formation, normal (Hb A) and Hb Zürich bloods were incubated in vitro at 4 degrees C, 37 degrees C, and 41 degrees C for 3, 6, 12, and 24 hours and stained for two minutes at the end of each incubation period with rhodanile blue. No Heinz bodies appeared at 4 degrees C. The rate of Heinz body formation was significantly greater in Hb Zürich than normal blood, both at 37 degrees C and 41 degrees C. These observations suggest that in vivo exposure of red cells to temperatures in the biologic range of fever may contribute to the worsening of anemia that occurs during infections in individuals with unstable hemoglobins. Incubating whole blood at 41 degrees C for three hours and staining with rhodanile blue for two minutes appears to be a simple and effective screening test for Hb Zürich and possibly the other unstable hemoglobins. Also the technique is semi-quantitative and may be useful as a research tool for defining factors altering the in vivo stability of the unstable hemoglobins.


[Effect of hyaluronidase on morphological changes in the myocardium in experimental myocardial infarct].

ECG, histological, and histochemical examinations on a model of experimental myocardial infarction showed that hyaluronidase administration leads to a decrease in the sum of elevation of the ST segment and the number of points (NST) at which this elevation is recorded, acceleration of healing processes in the affected zone, and to activation of respiratory enzymes and the pentosophosphate shunt in some of the fibres of the peri-infarction zone.


[Hemodynamic variants of acute myocardial infarct].

In 165 patients with myocardial infarction admitted to the clinic within the first 24 hours of the disease the size of the zone of the lesion and its dynamics were appraised in the immediate 4-5 days. Cartographic ECG analysis and study of the vectorcardiogram in dynamics and analysis of the creatine phosphokinase activity curves make it possible to appraise the dynamics of the necrotic zone in the first days of myocardial infarction. It was found that in most patients with macrofocal myocardial infarction the zone of the necrosis increases both in length and in depth in the first days of the disease.


[State of general and renal hemodynamics in acute myocardial infarct].

The results of studying central and renal hemodynamics in 49 patients with a different course of myocardial infarction in the acute period (1st, 3rd, and 10th day) are analysed. It was established that on the 1st day the cardiac output decreases considerably in circulatory insufficiency and hardly changes in an uncomplicated course of the disease. The stroke output of the heart reduces significantly in all forms of the course of myocardial infarction. At an increase of total peripheral resistance is observed in myocardial infarction, particularly in circulatory insufficiency. A significant increase in the central hemodynamics indices is noted at the end of the acute period. On analysing the dependence of central and renal hemodynamics, the authors conclude that local mechanisms are involved in the changes in renal hemodynamics in addition to its dependence on the disorders of central hemodynamics.


[Spasm of the coronary arteries in acute myocardial infarct].

Emergency coronarography was performed in 36 patients with myocardial infarction. Spasms of the coronary artery supplying the area of the infarction were observed in some cases. The fact that the vessel was demonstrated along its entire length after 0.5 mg of nitroglycerine was placed under the tongue confirmed the existence of the spasm. In most patients with acute myocardial infarction the vessel supplying the area of the affected muscle has the appearance of a stump, i.e. its peripheral segments are not demonstrated. At the same time, in some patients, who died some time after the examination, anatomical study of the heart showed that these segments of the vessel were not occluded. Such an angiographic picture may also be explained by the spasm of the coronary arteries. The angiographic pattern of the coronary channel in patients with acute myocardial infarction suggests that coronarolytics and spasmolytics injected both intravenously and into the coronary vessel in coronarography may be used still more extensively.


[Use of the method of counterpulsation by means of an intra-aortic balloon in the treatment of myocardial infarct].

The results of applying counterpulsation with an intraaortic balloon in the treatment of 17 patients suffering from myocardial infarction are discussed. Counterpulsation was indicated in 15 patients because of cardiogenic shock and in 2 (with concomitant arterial hypertension) because of expansion of the zone of myocarial infarction against the background of unstable arterial pressure. Nine patients died, counterpulsation in these cases was begun 5 hours after the appearance of the shock symptoms or later. A comparative analysis of hemodynamic changes associated with counterpulsation in patients who survived and in those who died is made.


[Clinico-morphological characteristics of recurrent myocardial infarct with lethal outcome].

The work is based on the results of follow-up of 656 patients with myocardial infarction who survived the first 72 hours after the attack. The disease followed a recurrent course in 105 persons (16.1%), 32 (30.4%) of whom died. Nine (1.6%) out of 551 patients who had no recurrence of the disease died. Recurrent necrosis was the principal cause of hospital mortality in myocardial infarction, with death occurring 3 days after the onset of the disease. The clinical picture of recurrent myocardial infarction with a lethal outcome is characterized by a high incidence of the predominance of the asthmatic and arrhythmic variants. The morphologic picture of recurrent myocardial infarction is characterized by the predominance of colliquative necrosis, large foci of myocardial "injury" in the perinecrotic zone, and poorly demonstrated proliferative processes.


[Diagnostic value of the system of Frank's orthogonal leads in inveterate myocardial infarct].

Comparison of data obtained in recording corrected orthogonal leads of the Frank system and 12 classical ECG leads in 118 patients with ischemic heart disease, among whom there were 76 patients with an old myocardial infarction, showed that corrected orthogonal leads may be used in mass population survey with the use of automatic diagnostic machines. It was established that the following ECG indices may be used in recording Frank's corrected orthogonal leads in the diagnosis of cicatricial myocardial changes: amplitude and duration of Q wave, the Q/R and R/S coefficients, the appearance of wave S in lead "Z". In an old myocardial infarction of posterior localization changes are recorded in lead "Y", in infarction of antero-septal localization changes are recorded in lead "Z" and to a lesser degree in lead "X"; in infarction of antero-lateral localization changes are recorded in lead "X" and to a lesser degree in lead "Z".


[Comparison of the blood plasma depressor prostaglandin content and the indicators of hemodynamics in dogs with experimental myocardial infarct and cardiogenic shock].

The quantitative composition of depressor prostaglandins PGE1 and PGA1 in the plasma of arterial and venous blood and blood from the great cardiac vein was studied in comparison with the values of hemodynamics in dogs with experimental myocardial infarction and cardiogenic shock. The content of prostaglandins in blood plasma was determined by the radioimmune method. The development of acute coronary insufficiency was attended with changes in the quantitative composition of the depressor PGE1 and PGA1 in the plasma of arterial and venous blood and blood from the great cardiac vein. In myocardial infarction and particularly in cardiogenic shock, intensification of PGE1 and PGA1 synthesis and an increase in the consumption of these PG by the myocardium occurred beginning with the first hours following occlusion of the coronary arteries, which suggests that PGE1 and PGA1 may probably take part in the normalization of the activity of the affected heart.


[Various characteristics of lipid metabolism in experimental myocardial infarct and their effect on myocardial contraction].

It was established in rabbit experiments that in acute focal myocardial ischemia induced by ligation of the descending branch of the left coronary artery, diminution of the force of cardiac contractions and an increase in the content of free fatty acids in blood plasma are observed. Progressing intramyocardial lipolysis is noted for 6 days. Lipolysis blockade with large doses of nicotinic acid leads to an extremely sharp drop in the contractile force of the heart in experimental animals with acute focal myocardial ischemia and to drastic damage of the myocardial ultrastructures as well as to disorders of the metabolism of intracellular lipids.


[Adenosine metabolism in the myocardium in experimental myocardial infarct].

It was shown in dog experiments that the formation and content of the adenosine precursor in the zone of the infarction and the surrounding parts of the myocardium undergo no essential changes. At the same time, further conversion of adenosine monophosphate in an infarction heart is deeply disturbed due to shifts in the enzymatic systems of the adenosine cycle. In the area of the necrosis adenosine monophosphate is metabolized mainly without the production of adenosine because high activity of AMP aminohydrolase here occurs in conjunction with deep inhibition of 5-nucleotidase. Diametrically opposite relationships are created in the myocardium outside of the focus of infarction and adenosine production does not suffer evidently. In both areas of the involved heart adenosine decomposition is delayed due to the inhibition of adenosine deaminase, but in the infarction zone this shift is restricted to 48 hours whereas in the periinfarction zone it is not corrected even 10 days after reproduction of the pathological condition.


[Significance of the atrial stimulation test in the diagnosis of ischemic heart disease. A comparison with measured physical loading on the bicycle ergometer and with coronary angiographic data].

The results of the atrial stimulation test were compared with the data of the test on a bicycle ergometer and coronary arteriography. The atrial stimulation test made it possible to diagnose coronary insufficiency in 91.6% of patients with ischemic heart disease. It was established that atrial stimulation helps in determining exactly the causes of a vague cardialgic syndrome in some cases in which the test on a bicycle ergometer cannot be carried out or when it is difficult to appraise its results. As compared to the test with dosed physical load on a bicycle ergometer, the atrial stimulation test proved more sensitive and less specific.


[Comparison of electrocardiographic tests with measured physical loading in ischemic heart disease].

The results of tests with physical load on a bicycle ergometer and treadmill in 50 patients with ischemic heart disease were compared. The control group was formed of 20 patients with neurocirculatory dystonia. Agreement between the results of both tests was encountered in 90% of patients with ischemic heart disease. The authors conclude that the tests do not differ essentially in the main indices (rate of cardiac contractions, index of cardiac activity at the peak of the load, time of uninterrupted work until the criteria of load cessation). It is suggested that tests on the treadmill and those on the bicycle ergometer in patients with ischemic heart disease are equivalent.


[Measured physical load test and the atrial stimulation test in the differential diagnosis of ischemic heart disease in patients with unchanged coronary angiograms].

Assessment of the clinical findings and the results of the bicycle ergometry test conducted in 17 patients and the atrial stimulation test performed in 13 patients allowed the diagnosis of ischemic heart disease to be made in 8 of 20 patients with normal coronary arteriogram. It is noted that the combined performance of the test with dosed physical load on a bicycle ergometer and the atrial stimulation test raises their values in differential diagnosis. The authors content that to improve the differential diagnosis of ischemic heart disease and functional cardiopathy in patients with normal coronary arteriogram it is advisable to study coronary microcirculation and myocardial metabolism during performance of the atrial stimulation test.


[Importance of the atrial vectorcardiogram in evaluating the myocardial functional state in ischemic heart disease].

The results of examination of 61 patients suffering from ischemic heart disease are analysed. All were subjected to catheterization of the right and left parts of the heart, left ventriculography, and selective coronarography. Some parameters of intracardiac hemodynamics, including the end diastolic pressure in the left ventricle, were determined. Atrial vectorcardiogram was recorded after I. T. Akulinichev's system (with mV = 100 mm). Comparison of the parameters of the atrial P loop of the vectorcardiogram with the findings of heart catheterization showed a direct dependence between the atrial changes recorded on the vectorcardiogram and the value of the left ventricular end diastolic pressure. Signs of overexertion of the left atrium grow with an increase in the end diastolic pressure. Quantitative dependence between these parameters is demonstrated. When the end diastolic pressure grows higher, overexertion of the left atrium is naturally joined by overexertion of the right atrium. Atrial vectorcardiography may be an important invasive method for appraising the functional condition of the left ventricular myocardium in patients with ischemic heart disease.


[Myocardial contractile function in ischemic heart disease patients who have had a myocardial infarct].

The results of the examination (electrocardiography, selective coronary arteriography, and left ventriculography) of 100 patients with ischemic heart disease and a history of myocardial infarction are discussed. All patients with postinfarction cicatricial changes in the myocardium of the anterior wall had severe affection (occlusion or stenosis by more than 75%) of the anterior interventricular branch of the left coronary artery, while 93% of patients with cicatricial changes in the myocardium of the inferior wall had affection of the right coronary artery. The parameters of myocardial contractility (ejection fraction, left ventricular and diastolic pressure, and Vmax) in patients with microfocal postinfarction cardiosclerosis both of the anterior and the inferior walls and in patients with macrofocal cardiosclerosis of the inferior wall remain within the lowest normal level. The contractility of the myocardium is sharply impaired in patients with macrofocal cardiosclerosis of the anterior wall and in those with combined cardiosclerosis of the anterior and inferior walls.


[Fate of ischemic heart disease patients depending on the nature of the coronary artery lesion].

The natural course of ischemic heart disease was followed up in 240 patients in periods of 1 to 7 years (average follow-up period 3 years). In all patients the character of affection of the coronary arteries was verified by angiography. The coronary arteries were normal or had mild changes in 27 patients. Obstruction of arteries (50 to 100%) was found in 189 patients. The study made it possible to establish the prognostic significance of angiographic and clinical data. Survival was highest when the coronary arteries were normal or only mildly changed as well as in isolated affection of a single artery. The disease followed a severe course with high mortality in involvement of three coronary arteries with grade III--IV stenosis.


[Lipid level in the blood, based on multiple study data, and the characteristics of the course of ischemic heart disease].

The blood lipid content and lipoprotein spectrum were repeatedly tested in 216 males with ischemic heart disease for follow-up periods of 4 to 5 years. Irrespective of the type of hyperlipoproteinemia, the blood triglyceride level was marked by the greatest individual fluctuations and the level of total cholesterol by the least fluctuations. Comparison of the clinical course of ischemic heart disease with the peculiarities of the changes in the blood lipid content revealed a higher incidence of recurrent myocardial infarction and sudden death among individuals with type IIa hyperlipoproteinemia. Recurrent vascular catastrophes were observed not only in patients with stable hypercholesterolemia but also in individuals with its labile form. It is concluded that repeated tests for the blood lipid content provide for more reliable diagnosis of hyperlipidemia and the type of hyperlipoproteinemia, which is of unquestionable practical importance.


[Thrombocyte phospholipids in ischemic heart disease with a varying degree of coronary arteriosclerosis severity].

A significant increase of the relative phosphatidyl serine level, a decrease in the percentage of lipoleic and arachidonic acids, and an increase in the oleic acid level were revealed in blood platelet phospholipids of patients with ischemic heart disease and severe coronary atherosclerosis. In the entire group of patients with ischemic heart disease (with coronary atherosclerosis of various degree), these changes are less marked and only the decrease in the linoleic acid level as compared to that in healthy individuals is significant. It was established that besides these changes in the phospholipid structures, blood platelet aggregation increases when the severity of the atherosclerotic process in the coronary arteries becomes more pronounced.


[Cardiodynamic characteristics of chronic coronary insufficiency patients at medical rehabilitation stages using therapeutic physical exercise measures].

The functional condition of the cardiovascular system was studied in patients with chronic coronary insufficiency in various stages of rehabilitation employing measures of remedial gymnastics with the elaboration of criteria for substaintiating the broadening of the movement regimen. Sixty patients suffering from ischemic heart disease marked by the clinical picture of chronic coronary insufficiency and 25 persons forming a control group were examined Polycardiography, aortic and arterial rheocardiography, and tele-electrocardiography were used. A follow-up of the functional condition of the cardiovascular system makes it possible to detect signs of the development of its reserve possibilities under the effect of long-term remedial gymnastics. Favourable shifts in the functional ability of the cardiovascular system may be only produced after long-term (12 months) remedial gymnastics performed regularly and with sufficient physical exertion, including walking and running.


[State of hemostasis and blood rheology in congestive circulatory insufficiency].

One hundred and ninety-eight patients with congestive circulatory insufficiency were examined; 54 had stage IIA, 88 stage IIB, and 56 stage III of the disease. Blood viscosity, blood platelet and erythrocyte aggregation, fibrinogen disintegration products, and soluble fibrin were determined and the protamine sulfate test was performed. Statistically significant reduction of hematocrit, increase of erythrocyte aggregation, dysfunction of blood platelets, and increase in the content of products of fibrinogen and fibrin disintegration were revealed with progression of congestive circulatory insufficiency. These changes are evidence of disseminated intravascular coagulation in such patients and are important in prognostication.


[Presystolic change in the length of the ischemic, border and distant myocardial areas in experimental coronary insufficiency and the action of inderal and metacin].

Changes in the presystolic length in the phase of late diastole and in the size of active shortening in the phase of ejection were determined in the ischemic area and in areas of the myocardium bordering upon and in those remote from the focus of ischemia in acute experiments on the 20th and 60th seconds of reversible clamping of the coronary artery. Marked increase in the presystolic length and size of active shortening of the remote areas was noted by the 20th second. In the ischemic zone these values decreased. Due to the effect of a therapeutic dose of inderal, the intensifying reaction of the remote areas diminished markedly and the unfavourable effect of ischemia on the stretching and shortening functions of the ischemic zone became somewhat weaker. Metacin caused no such effect.


[Topography of orbital lymphomas (author's transl)].

In 15 cases of orbital lymphoma topographic characteristics are demonstrated by contact B-scan ultrasonography as follows: The tumour is only infiltrating some single structures of the orbit as muscles. Tenon's membrane, lacrimal gland and the peripheral orbital space. Such enables the examiner, to take an excision exact in this point, where the tumour is located. The problems in differentiating lymphomas from other pseudotumours and from sarcomas by echography are discussed.


[Aetiology and therapy of Mooren's ulcer (author's transl)].

A report is given of 34 cases of Ulcus rodens of the eye (Mooren), which were examined and treaded during a period of five years in Togo, West Africa. The cases were divided into two groups according to the development of the disease. In fourteen cases the progress of the disease was arrested by local treatment (described individually for each eye), and by simultaneous treatment of the Helminthosis (Ascaris lumbricoides and Ankylostoma duodenale), from which the patients were also suffering. It seems likely that Ulcus rodens is caused by an antigen-antibody reaction to Helminth toxins.


[The artificial epithelium in chronic corneal diseases and to avoid emergency keratoplasty (author's transl)].

Report on the treatment of 41 patients in the last 10 years. In chronic corneal diseases epikeratoprosthesis is possible when every other therapy failed. With growing experience functional results are better and complications seldom. Since several years we use glued-on contact lenses in acute ulcers too in order to avoid emergency keratoplasty. When suitable donor material is missing or if plastic surgery of the eye lids is necessary the artificial epithelium prevents ulcer perforation as a mechanical collagenase inhibitor. The anterior chamber can be reinstalled in perforated ulcers by sealing with cyanoacrylate glue and covering with artificial epithelium. A corticosteroid therapy of the iritis becomes possible to avoid the frequent complication of anterior synechia in later keratoplasty. By reducing the steroid dosis vascularisation of the ulcer is reached and  a corneal grafting can be evaded sometimes if the prognosis of keratoplasty is poor or the central cornea is clear such as in ulcers near the limbus.


[Keratoconjunctivitis sicca caused by denervation of lacrimal gland (author's transl)].

An irreversible, unilateral keratoconjunctivitis sicca developed in a healthy 16-year-old female patient due to traumatic denervation of the lacrimal gland after oto-basal skull fracture with reversible complete peripheral facial paralysis, the corneal sensitivity remaining normal. This observation and other reports on keratoconjunctivitis sicca caused by isolated lacrimal gland insufficiency indicate the physiological importance of the main lacrimal gland as indispensable part of the secretory tear system.


[Correcture of keratoconus with contact lenses made from HEMA and gas permeable materials (author's transl)].

After discussing the oxygen demand of the cornea the relevance is shown on basis of 100 patients who wear normal HEMA-lenses in contrast to 100 patients with ultra-thin-lenses, and after doing so it is stated that as well cornea curvations as well as refractions are hardly changed by the wear of ultra-thin contact lenses. These ultra-thin soft lenses have proved extremely successful in case of visual defects ranging from - 16,0 to + 16,0 dioptrics. The use of ultra-thin soft lenses has not proved successful in case of heavy astigmatism and keratoconus. In these cases lenses made from Polycon and BPflex were used, which proved very compatible and have corrigated the visual defect in the best way possible. Also here a comparativing research of 100 patients with PMMA-lenses and 100 patients with Polycon and BPflex-lenses has proved a successful fit and possiblity of correcture of these beforesaid visual defects.


[Improvement of fixation by early Fadenoperation (clinical and experimental observations) (author's transl)].

17 children aged 6 months to 2 1/2 years with strabismus convergence, amblyopia and overconvergence were treated with Fadenoperation on the medial rectus of the deviating eye, after therapy with occlusion had not been tolerated. In all cases tolerance of the occlusion had been achieved, central fixation in 15, unrestricted abduction in 9 children. The period of observation ranged from 18 to 24 months. Repeated controls after Fadenoperation on infantile rabbit's eyes and echografic measurements on 6 patients have stated that there is no danger of a restriction in the bulbus growth. As late retinal complication following Fadenoperation cannot be excluded, a serious indication is recommended.


[First results with hydrophile tear duct prosthesis (author's transl)].

The author reports on a new tear duct prosthesis from hydrophile silicone. The advantage of this material is its hydrophilia absorbing the tears to the medial angle, and its softness preventing pressure necrosis and allowing an exact fixation in the medial angle of the lid. The implantation of the prosthesis in combination with conjunctivo-dacryocystotomy seems to be the best technique but also other techniques are demonstrated and discussed.


[The pharmacocinetics of azlocillin (author's transl)].

Azlocillin concentrations in the rabbit eye were studied after intravenous and subconjunctival injections. The following results were found: therapeutic levels of Azlocillin were achieved in the aqueous humor, using either way of administration. Concentrations of the antibiotic were much higher after s. c. injection than after i. v. administration. The pharmacocinetics of Azlocillin proved to be comparable to those of other penicillins. No antibiotic could be detected in the vitreous body, irrespectively of the administration. With regard to the better antibacterial activity of Azlocillin in comparison with other known penicillins it should be preferred in eye infections caused by gramnegative rods, especially by Pseudomonas aeruginosa.


[Is a general operative prophylaxis of the fellow eye in cases of acute glaucoma necessary? (author's transl)].

The fellow eyes of 136 patients suffering from acute glaucoma were checked during their hospitalization by means of provocation-tests and gonioscopy. Ten cases had a simultaneous attack of both eyes, and 27 were submitted to a peripheral iridectomy prophylactically after a positive provocation-test. Of the remaining 99 patients observed up to 12 years after the operation only 22 developed an attack in the fellow eye; 11 of them were below the age of 60 years, and only 4 over 70.


[Concerning the Toti operative procedure (author's transl)].

It has been shown by a series of 127 dacryocystorhinostomies using the Toti technique, that this operation, which is independent of age or aethiology, can be performed using a simple procedure and a short hospitalization time. The success rate of over 90% indicates that this operation should be used as a standard procedure in preference to the intubation with polyethylene tubes.


[The incidence of squinting in school beginners in Hamburg (author's transl)].

In 830 children medically examined at the time of beginning school 20% showed conditions which needed treatment or correction. From these children half had never been in ophthalmological treatment. We found a squint in 52 children (6.3%), and from these, 9 (17.3% of the squinters) showed microstrabismus. One squinter in five had never started ophthalmological treatment. Out of the non-squinting children, however, 15 out of 778 (1.9%) had amblyopia (6/12 or worse visual acuity). In 4 cases an organic condition was the cause of the reduced visual acuity. Among the squinters amblyopia was commoner--23 out of 52 cases (44.2%). From these 4 showed bilateral amblyopia.


[On the etiology and therapy of essential blepharospasm (author's transl)].

The etiology of essential blepharospasm is extraordinarily manifold and still not clarified in many instances. The therapeutic possibilities are as manifold and not always satisfactory. One of these surgical interventions consists in the dissection of the auriculo-temporal nerve shortly after its separation from the stem of the facial nerve. In 3 cases with particularly severe blepharospasm, a permanent therapeutic result which was satisfactory in every respect could be achieved in cooperation with an otorhinolaryngologist. For the ophthalmologist, a knowledge of the various therapeutic possibilities is of significance in order to adjust the treatment accordingly.


[Visual field in the Cushing syndrome (author's transl)].

According to traditional opinion the basophile adenoma, in contrast to the eosinophile or chromophobe tumours of the hypophyse, practically never causes lesion of the chiasm. However, the case of a 16-year-old girl suffering from adiposis, hypertonia, striae distensae and a "full moon face" is used to demonstrate that through the precis examination of the visual field on the Goldmann perimeter even with normal disque of the optic nerve, normal sella turcica established by X-ray, and uncharacteristic hormon condition, a slight chiasmal lesion caused by pressure from below can be established.


[Retinitis septica Roth (author's transl)].

The authors report on a case of retinitis septica Roth in a 27-year-old pregnant woman with septic pyelonephritis caused by enterobacter aerugines.


[Influence of anticholinergic drugs on the intraocular tension of medicinally treated glaucoma simplex (author's transl)].

In 10 patients the influence of pizotifen on the intraocular tension of their medicinally treated open-angle glaucoma was examined. The clinical results and their statistical evaluation showed that anticholinergic drugs behaving pharmacologically like pizotifen do not impair conservative antiglaucomatous local treatment. Therefore, they may be used in cases of open-angle glaucoma.


[Bupranolol eye-drops (Ophtorenin) in long-term therapy of glaucoma (author's transl)].

A clinical study with Bupranolol (Ophtorenin), a beta adrenergic blocking agent, is presented. 85 eyes with kinds species of glaucoma were treated during 22 months. A satisfying hypotensive effect was attained in a high percentage. Suitable combinations with Clonidine and Acetazolamide were tested. Based on its atoxic properties and lack of adverse reactions Bupranolol represents a valuable enlargement of glaucoma therapy.


[Experiences with continuous wear of silicone lenses (author's transl)].

Experiences with continuous wear of silicone lenses in 66 aphakic eyes are reported. By a careful fitting a long-term wearing has been obtained, the lenses were well tolerated in all cases. There was no vascularisation of the cornea. Three cases of temporary infiltration of the cornea have occured.


[Contact lenses and parachute jumping (author's transl)].

The wearing of corneal contact lenses during parachute jumping has not caused any impairment of vision or other problems in 18 jumps executed by the author. Thus corneal contact lenses can be tolerated for parachute jumping.


[Cinematography of ocular fundus with a jointed optical system and tv or cine-camera (author's transl)].

A method of Cinematography of the ocular fundus is introduced which--by connecting a camera with an indirect ophthalmoscop--allows to record the monocular picture of the fundus as produced by the ophthalmic lens.


Renal and vascular activity of prolactin preparations. Contamination of prolactin preparations with ADH and implications on renal and vascular prolactin research.

Prolactin, as a "broad spectrum hormone", has been described to exert also vascular and renal actions in laboratory animals and in humans. However, prolactin preparations of various species are contaminated with neurohypophysial hormones (ADH, oxytocin) which possess vascular and renal activities. Antisera against ADH, oxytocin and prolactin are rather specific inactivators of the biologic activity of the respective hormone; the oxytocinasevasopressinase system of pregnancy plasma destroys ADH and oxytocin. Incubation-identification procedures with antisera against ADH, oxytocin and prolactin and with pregnancy plasma revealed that changes in blood pressure, urine flow and urinary osmolarity cannot be ascribed to prolactin per se but to the ADH impurity of prolactin preparations. Furthermore, recent metabolic studies in normally hydrated, overhydrate and dehydrated animals and humans have shown that prolactin does not affect renal water and electrolyte excretion. Thus, earlier reports on vascular and renal activity of prolactin in laboratory animals and humans should be viewed with great caution. Elimination of neurohypophysial hormone impurities of prolactin preparations by incubation with either ADH and oxytocin antisera or with pregnancy plasma provides techniques for better assessment of the real biologic effects of the prolactin molecule.


[Improved method for the diagnosis of diabetes mellitus (author's transl)].

Based on a sample of 953 subjects without known metabolic abnormalities and a sample of 186 diabetics a classification rule was developed by a quadratic discriminant analysis. The measurements of blood glucose 1 and 2 h after the oral administration of 100 g oligosaccharids are used to classify the patients into the categories of "healthy", "suspect" and "diabetic". The rates of false positive and false negative classification were estimated from a second sample of 128 non-diabetic and 73 diabetics. By administration of 100 g oligosaccharids these rates were found to be 3.1% and 0%, respectively. An analogous study for the administration of 100 g glucose was based on a different sample of N = 472, 99 diabetics included. Misclassification rates were found to be 1.6% and 2.7%, respectively. For practical application of the rules two-dimensional netplanes are given.


Alcohol metabolism in man: effect of intravenous fructose infusion on blood ethanol elimination rate following stimulation by phenobarbital treatment or chronic alcohol consumption.

The effect of phenobarbital (PB) pretreatment and of chronic alcoholism on blood ethanol elimination rate (BEER) was investigated in man. In order to gain additional information concerning the mechanism of possible changes BEER was determined before and during intravenous infusion of fructose, a compound known to increase the NADH-oxidizing capacity of the liver and thereby stimulating alcohol oxidation rate. Following PB-treatment (300 mg/day for 5-6 days, n = 8) a marked increase in unstimulated (U-) BEER was obtained. But the fructose stimulated (FS-) BEER was not significantly changed by PB-treatment. In chronic alcoholics (n = 15) U-BEER values above the upper limit (chi + 2 S D) obtained in healthy controls, were observed only when the time of sobriety was less than one week (n = 6). Values of FS-BEER in chronic alcoholics with increased basal alcohol oxidation rates were in the same range as those of healthy controls. In 5 out of the 6 alcoholics in whom the values were elevated on admission, BEER decreased significantly after withdrawal of alcohol for 2-4 weeks. Since FS-BEER was nearly identical in all conditions tested, the distinct changes in U-BEER are probably independent of changes in the activity of enzymes involved in alcohol oxidation. It is assumed that alcohol metabolism in man is mainly controlled by the rate of NADH reoxidation in the liver.


Influence of somatostatin on carbohydrate absorption in human small intestine.

Oral carbohydrate tolerance tests with xylose, galactose and lactose were performed. After an interval of at least 24 h the same tests were repeated following an i.v. bolus and during infusion of somatostatin. Somatostatin does not influence xylose absorption. However, absorption of galactose and lactose is significantly reduced (p less than 0.01/0.008) during somatostatin infusion. On the other hand, serum levels of galactose remain unchanged despite administration of somatostatin, when galactose is given parenterally. The results support the assumption that the absorption process in small intestine is affected by somatostatin. Possible effects of somatostatin on hormones regulating the intestinal absorption and on energy-depending carrier mechanisms are discussed.


[Histopathology of the kidney in pseudo-Bartter's Syndrome induced by chronic abuse of diuretics (author's transl)].

A 38-year-old female patient developed a Pseudo-Bartter's-Syndrome with hypokalemic alkalosis, hyponatremia and hyperrenism as the result of the abuse of diuretics (furosemide, spironolactone, thiabutacide) for a period of more than 10 years. The needle biopsy specimen from the kidney showed a hyperplasia of the juxtaglomerular apparatus and of the mesangium cells as the morphologic basis of hyperrenism, a focal vacuolisation of the proximal tubular epithelium and a focal atrophy of the distal tubules. The pathogenesis of the tubular alterations and their possible relation to hypokalemia, hypoxemia or drug-toxicity is discussed, a satisfactory interpretation, however, cannot be given. The encroachment of proximal tubular epithelium on the parietal layer of Bowman's capsule is another striking pathoanatomical finding, and considered a compensatory mechanism under the continuous loss of water.


Indomethacin induced hypotension in sodium and volume depleted rats.

After a single oral dose of 4 mg/kg indomethacin (IDM) to sodium and volume depleted rats plasma renin activity (PRA) and systolic blood pressure fell significantly within four hours. In sodium repleted animals indomethacin did not change systolic blood pressure (BP) although plasma renin activity was decreased. Thus, indomethacin by inhibition of prostaglandin synthesis may diminish the blood pressure maintaining effect of the stimulated renin-angiotensin system in sodium and volume depletion.


[Plasma renin activity, plasma volume extracellular fluid volume and cardiac output in essential hypertension (author's transl)].

The plasma renin activity (PRA), the plasma volume (PV), the extracellular fluid volume (ECV), the cardiac output and the peripheral vascular resistance (TPR) were determined in 51 patients (14 women, 37 men) with essential hypertension of varying severity. The following findings were achieved: 1. In 9 of the 51 patients with essential hypertension (approximately 18%) a low and non-sensitive PRA was detected. 2. PV, ECV, cardiac output and the calculated peripheral vascular resistance of the essential hypertensive patients with low and non-sensitive PRA did not differ significantly from those of the essential hypertensive patients with normal or elevated PRA. 3. The hypertensive patients with low and nonsensitive PRA had the highest average arterial pressure. From these findings it can be concluded that the essential hypertensive patients with low PRA are not an homogeneous group. It is assumed that in a subgroup the elevated blood pressure may be the cause of the renin suppression.


[Increase of force of concentration under hypoxic conditions by glucose-insulin. Experiments in isolated papillary muscles of the guinea pig (author's transl)].

The minimally remaining force of contraction under the influence of hypoxia was measured in isolated right-ventricular papillary muscles of the guinea-pig, incubated in hypoxic (pO2 90 mm Hg) and oxygenated (pO2 630 mm Hg) buffer solution. With insulin (0.05 IE/ml) and elevated glucose (300 mg% compared to 100 mg%) the force of contraction fell to only 70 +/- 9% minimally instead of 38 +/- 11% (control, p less than 0,001). Elevated glucose or insulin alone had less pronounced effects which were not statistically significant for insulin. The results show an increase of tolerance against hypoxia of isolated papillary muscles under the influence of glucose and insulin.


Deposition of amyloid in the liver of hamsters: an enzyme-histochemical and electron-microscopical study.

In induced amyloidosis the amyloid was first deposited in the portal areas, then in the centre of the lobule and disseminated through it in the spaces of Disse. No intracellular amyloid was found in the predeposit phase. In the hepatic lobule both mononuclear phagocytes and hepatocytes showed a topographic relationship to the first deposits of amyloid. Some macrophages showed invaginations or vacuoles containing amyloid fibrils. Between the microvilli of hepatocytes, parallel amyloid fibrils occurred. Between the amyloid fibrils were 30-50 nm membrane-bounded spherical particles which may have been lipoprotein aggregates. There was no large-scale phagocytosis of amyloid during the induction period or after survival without casein treatment up to 18 weeks. Lysosomal enzyme activity was seen in the deposits of extracellular amyloid.


Haemoglobin variants in mice.

Haemoglobin variants were studied in wild and laboratory house mice (Mus musculus), including standard and new inbred strains, using starch-gel electrophoretic technique. Single (Hbbs) or diffuse (Hbbd) types of haemoglobin were found in all of them. The embryonic haemoglobin pattern was different from although similar to that of the adult in all the strains. The haemoglobins revealed monomorphism in the inbred strains, while polymorphism was observed in non-inbred laboratory and wild mice.


Urolithiasis in the Sprague--Dawley rat.

A 7 year collection of calculi from short- and long-term studies with Sprague-Dawley rats showed that although the incidence of rats with urolithiasis was small (0.5%), the variety of sizes and composition of the calculi could be of general interest.


Peak littering and the stud male in relation to virgin and remated female P(SD) mice.

Peak littering occurred on the 22nd day after pairing. The percentage of pregnancies from virgin females increased as the stud males became more experienced; their success with remated females showed a more varied and lower response.


Conjunctivitis in the nude rat (rnu/rnu).

Nude rats are susceptible to similar eye problems to those suffered by nude mice, notably conjunctivitis leading to periorbital abscesses. Pasteurella pneumotropica has been isolated from the conjunctiva. The condition can be alleviated by washing the eyes of mildly affected rats with warm water. More severe cases respond to treatment with ampicillin. Conjunctivitis has not appeared in a germ-free colony of nude rats.


A radio-controlled live trap.

A live trap, designed to drop a net by radio control, was constructed to capture small wild mammals and birds. Advantages of the radio-controlled trap included capabilities to select and trap only the species desired, collect animals immediately after capture, eliminate injuries during capture and operate from a protected area a distance from the trap.


Blood sampling and intravenous injections in Japanese quail (Coturnix coturnix japonica).

The suitability of five different sites (brachial, jugular, caudal tibial vein, external dorsal thoracic vein and the heart) were examined for blood sampling and intravenous injections in Japanese quail. In terms of safety, ease of collection, repeated collections or injections, the jugular vein was found to be the most suitable.


Dissection hood to control irritating fumes and vapors in biological research.

A small exhaust hood was designed and constructed of clear acrylic plastic for use within a biological research environment. The hood's primary function was to draw irritating vapors away from the user's breathing zone and into an exhaust system. The hood was of simple construction.


General anesthesia in pigs.

Conventional swine weighing 20-45 kg were anesthetized for surgical procedures. After fasting for 24 hours, ketamine hydrochloride and xylazine were administered intramuscularly. Following tracheal intubation, sodium thiopental was administered via the aural or femoral vein.


Partial oculocutaneous albinism in Mystromys albicaudatus: nonhomology with the Chediak-Higashi syndrome.

Partially albinic Mystromys albicaudatus were examined to determine if the condition in these animals was homologous with the Chediak-Higashi syndrome. Tissues and cells from partially albinic and normal Mystromys albicaudatus were studied by light and electron microscopy. No evidence of cytoplasmic granule enlargement, which is characteristic of the Chediak-Higashi syndrome, was detected in the cells of the partially albinic rats when compared to controls. It was concluded that the inherited condition of partial albinism of Mystromys albicaudatus was not homologous with the inherited partially albinic disease known as the Chediak-Higashi syndrome.


Organ weights and organ:body weight ratios of the African white-tailed rat (Mystromys albicaudatus).

Fifty-three adult female and 51 adult male white-tailed rats (Mystromys albicaudatus) were killed with ether and weighed; the spleen, kidneys, liver, heart, lung, pancreas, brain and gonads were dissected free of adhering tissue and weighted. The mean absolute organ weight and organ:body weight ratios by sex and organ were calculated and compared. The male rats were significantly (p less than or equal to 0.05) heavier. The mean weight of the males was 110.0 +/- 23.8 g versus 82.9 +/- 16.1 g for the females. The absolute weights of the heart, liver and kidneys were significantly (p less than or equal to 0.05) greater for the males. The organ:body weight ratios, except for heart and brain (excluding ovary and testicle), were unaffected by sex. The heart to body weight ratio and the brain to body weight ratio were significantly (p less than or equal to 0.05) larger in female rats.


Total lung capacity of baboons and humans determined by planimetry of radiographs.

Total lung capacity and radiographic lung area of 25 young and 7 aged baboons (Papio cynocephalus) and seven nonsmoking young adult men were measured. For all subjects, total lung capacity and radiographic lung area raised to the 3/2 power were shown to be highly correlated (r = 0.995). The regression equation for this relationship was total lung capacity (ml) = 78 + 0.234 x radiographic lung area (1.5) (cm2). A more useful regression equation for predicting values of total lung capacity was found to be log total lung capacity = -0.3819 + 1.4153 x log radiographic lung area (r = 0.993), because the standard error of estimate remains a constant percentage of Y values (+/- 12%). Total lung capacity and radiographic lung area were also highly correlated with height, weight and arm span of young baboons and men (r greater than 0.92), but the lungs of aged baboons were disproportionately larger.


A visual display board used for efficient breeding and utilization of an athymic (nude) mouse colony.

A visual display board was designed to aid in the management of a barrier sustained athymic (nude) mouse colony. The board displayed pertinent information for breeding and weaning, including phenotype and age for each animal in the colony. In addition, the board showed the availability and current status of experimental groups. This system provided an efficient means of organizing production and planning utilization of animals in the colony.


A simple technique for rapid implantation of a permanent cannula into the rat brain ventricular system.

A simple, rapid method of implantation of a permanent cannula into the ventricular system of the rat brain was developed using polyethylene tubing. Intraventricular injections were performed on nonrestrained, conscious animals. This cannula was used repeatedly during several weeks.


Chronic intravenous infusion in the rat: a nonsurgical approach.

A rapid, simplified technique of intravenous catheterization of the unanesthetized rat was developed for continuous infusion. A 19-gauge thin-walled needle was inserted percutaneously into the dilated tail vein, and polyethylene tubing was advanced through the needle into the vein. The catheter was protected by wire mesh electrical sheathing taped securely to the tail. This approach eliminated the need for anesthesia and surgery which were traumatic to the animal and time consuming for the investigator. This method was used successfully in 32 rats given continous infusion for up to 5 days.


Bronchoscopy in the European hamster (Cricetus cricetus).

A pediatric bronchoscope was modified for use in the European hamster (Cricetus cricetus) and has been used successfully to obtain biopsy specimens from these animals. Biopsy specimens were obtained by means of small forceps with visual control given by the modified bronchoscope.


Noninvasive measurement of bone mineral mass in the unanesthetized rabbit.

Direct photon absorptiometry was used for the in vivo measurement of bone mineral mass in the rabbit tibia. Bone mineral mass in 124 male and female rabbits was correlated (p less than 0.001) with age to 26 weeks and weight to 5.5 kg. Examining reproducibility and repositioning error, three rabbits were measured 12 times each. Bone mineral mass in the three rabbits was: 0.432 +/- 0.020 g/cm2, 0.414 +/- 0.010 g/cm2 and 0.487 +/- 0.037 g/cm2. The greatest coefficients of variance observed for measurements without repositioning and measurements with repositioning were 4.8% and 7.6%, respectively. The technique provided sensitive, reproducible and noninvasive measurement of bone mineral mass without anesthesia or undue restraint.


Structural distortion of glomerular capillary loops in the chronic phase of rat Masugi nephritis.

Structural distortion of glomerular capillaries in chronic rat Masugi nephritis was studied by light, transmission electron, and scanning electron microscopy. A few months after rats were given injections of heterologous nephrotoxic antibodies, focal and local mesangial as well as basement membrane thickenings were observed. Using scanning electron microscopy, glomerular corrosion castings disclosed that definite loop constriction with occasional gaps occurred in such local foci. The local changes were gradually extended to adjacent areas in rats with severe proteinuria, later resulting in a broad disappearance of the loops. Also observed were glomeruli undergoing a collapse with structural simplification resulting from multiple loss of communicating branches. At the terminal stage, almost all glomeruli were involved in varying degrees in either of these changes. In contrast, no progression of the disease process was observed in rats with minimal proteinuria. By scanning electron microscopy, a large number of castings from various angles revealed that morphologically normal glomeruli were involved in local and ultimately global obsolescence under the condition of persistent proteinuria.


Silicate pneumoconiosis of farm workers.

Abnormal numbers of birefringent particles have been found in the lungs of seven patients (five vineyard workers, one farmer, and one rural resident) in association with a spectrum of early to late interstitial inflammation and fibrosis. Nodular granulomas of the type seen in silicosis were absent. Scanning electron microscopy and energy dispersive x-ray analysis of 177 individual particles (less than 5 micrometer.) in situ in the lungs of four of the patients showed mostly silicates (notably aluminum, silicon, and potassium), with 5 to 10 per cent silicon dioxide. An analysis of particles less than 5 micrometer. from both vineyard and non-vineyard soil showed lung and soil particles to have a similar composition. The presence of large amounts of silicates in the lung tissues, in association with chronic inflammation and fibrosis, implicates the silicates in the causation of the fibrosis. The silicate deposits may, in large part, be a marker, reflecting a mixture of toxic soil additives or pesticides found in commercial clay silicate products or in dusts from the soil itself. The findings do not exclude lung pathology of a similar nature in regions outside of the farm.


A correlated thin section and freeze-fracture study of mouse tracheal epithelium before and after ether anesthesia.

Tracheal epithelium of mice anesthetized with ethyl ether was studied in the electron microscope with the techniques of thin sectioning and freeze fracture. After ether anesthesia, alterations in the tight junction between epithelial cells were observed. In the control animals, the junctional strands were either parallel or had a polygonal arrangement of continuous solid strands. After anesthesia, the junctional strands became fragmented. Other specializations of the membrane of epithelial cells such as gap junctions and rectilinear entities were not altered by ether.


Analysis of the cores of ferruginous (asbestos) bodies from the general population. III. Patients with environmental exposure.

Typical asbestos bodies visible by light microscopy were isolated from the lungs of 29 persons with fewer than 100 such bodies per gram of lung, a level that is considered indicative of environmental rather than occupational asbestos exposure. Of 144 bodies examined by electron diffraction, 143 contained an amphibole asbestos core and one contained a chrysotile asbestos core. Thirty-five bodies from 21 patients were also analyzed by electron microprobe. Of these, 21 were chemically consistent with amosite or crocidolite asbestos, 13 with anthophyllite asbestos, and one with tremolite asbestos. Certain differences in chemical fiber types between men and women became apparent. Although cores of amosite and crocidolite predominated in men (12 of 14, 86 per cent), anthophyllite and tremolite comprised 57 per cent (12 of 21) of the cores found in women, a statistically significant difference. These differences suggest that the major commerical varieties of amphibole asbestos (amosite and crocidolite) are the source of the fibers in men, whereas in women a major source may be cosmetic talc, which is often contaminated with anthophyllite and tremolite. On the basis of this study and our previous studies, we conclude that almost all typical asbestos bodies from the lungs of the general population contain an amphibole asbestos core.


Proteolytic cleavage and structural transformation: their relationship in bacteriophage T4 capsid maturation.

Giant T4 phage capsoids formed in canavanine-treated cultures infected by phage mutants in genes 21 and 17, respectively, differ with regard to cleavage of the major capsid protein, gp23, and in the fine structure of their hexagonal surface lattices. Quantitative computer processing of electron micrographs shows that the significant differences in capsomer morphology amount to six symmetrically placed features present in the uncleaved hexamer but absent after cleavage. These features may be related with the N-terminal portions of gp23 monomers excised by phage-specific proteolysis. Cleaved 17- giants can be induced to undergo a further structural transformation (expansion). Structural characteristics of partially transformed giant particles give clues about the dynamics of the cleavage and expansion transformations. Both processes appear to be polar, initiating in one cap and propagating along the particle. The transition zone of partial cleavage is diffuse, whereas the transition between unexpanded and expanded areas is confined to a narrow band of some 20 nm width.


Tight junction development between cultured hepatoma cells: possible stages in assembly and enhancement with dexamethasone.

Freeze-fracture and thin-section methods were used to study tight junction formation between confluent H4-II-E hepatoma cells that were plated in monolayer culture in media with and without dexamethasone, a synthetic glucocorticoid. Three presumptive stages in the genesis of tight junctions were suggested by these studies: 1) "formation zones" (smooth P-fracture face ridges deficient in intramembranous particles), apparently matched across a partially reduced extracellular space, develop between adjacent cells; 2) linear strands and aggregates of 9--11 nm particles collect along the ridges of the formation zones. The extracellular space was always reduced when these structures were found matched with pits in gentle E-face depressions; 3) the linear arrays of particles on the ridges associate within the membranes to form the fibrils characteristic of mature tight junctions. The formation zones resemble tight junctions in terms of size, complexity and the patterns of membrane ridges. Although some of the beaded particle specializations may actually be gap junctions, it is unlikely that all can be interpreted in this way. No other membrane structures were detected that could represent developmental stages of tight junctions. Dexamethasone (at 2 x 10(-6)M) apparently stimulated formation of tight junctions. Treated cultures had a greater number of formation zones and mature tight junctions, although no differences in qualitative features of the junctions were noted.


Differences in the redistribution of concanavalin A and wheat germ agglutinin binding sites on mouse neuroblastoma cells.

Concanavalin A (Con A), wheat germ agglutinin (WGA), and Ricinus communis agglutinin (RCA) bound with either 125I, fluorescent dyes, or fluorescent polymeric microspheres were used to quantitate and visualize the distribution of lectin binding sites on mouse neuroblastoma cells. As viewed by fluorescent light and scanning electron microscopy, over 10(7) binding sites for Con A, WGA, and RCA appeared to be distributed randomly over the surface of differentiated and undifferentiated cells. An energy-dependent redistribution of labeled sites into a central spot occurred when the cells were labeled with a saturating dose of fluorescent lectin and maintained at 37 degrees C for 60 min. Reversible labeling using appropriate saccharide inhibitors indicated that the labeled sites had undergone endocytosis by the cell. A difference in the mode of redistribution of WGA or RCA and Con A binding sites was observed in double labeling experiments. When less than 10% of the WGA or RCA lectin binding sites were labeled, only these labeled sites appeared to be removed from the cell surface. In contrast, when less than 10% of the Con A sites were labeled, both labeled and unlabeled Con A binding sites were removed from the cell surface. Cytochalasin B uncoupled the coordinate redistribution of labeled and unlabeled Con A sites, suggesting the involvement of microfilaments. Finally, double labeling experiments employing fluorescein-tagged Con A and rhodamine-tagged WGA indicate that most Con A and WGA binding sites reside on different membrane components and redistribute independenty of each other.


Cross-linkings between spectrin and band 3 in human erythroycte membranes.

A specific structural association between spectrin component 1 and band 3 in human erythrocyte membrane has been demonstrated by covalent cross-linkings, specific labeling, and the technique of two-dimensional gel electrophoresis. A complex of 330,000 daltons, representing 1 + 3, was produced in mildly oxidized membranes at physiologic pH and isotonic conditions but not at hypotonic conditions ( less than 10 mM KCl or NaCl). The yield of this complex decreased dramatically as the monovalent cation concentration decreased from 90 mM to 30 mM. The presence of Mg++ or Ca++ (2 mM) at low ionic strength promoted 1 + 3 cross-linking in an amount similar to that produced at isotonic conditions. The specific segment of band 3 involved in the cross-linking was also investigated by means of chymotrypsin digestion of band 3 in the intact red cells. The results showed the cross-links between spectrin component 1 and the 55,000-dalton fragment of band 3 at physiologic pH and isotonic conditions. This is consistent with the idea that band 3 is anchored on or contacted with the submembrane meshwork at the cytoplasmic membrane surface.


Certain aspects of analysis of complement dependent antibody in breast cancer patients.

Specific anti-breast cancer complement dependent antibody (CDA) was sequentially determined in the sera of patients before and after mastectomy or during progressive recurrent breast cancer. Several observations were made. (1) There appears to be a different pattern of antigenic cross-reactivity detected by cancer patients' anti-tumor CDA than by their anti-tumor cell-mediated immunity; the former being broader than the latter. (2) Patients can be classified into three categories: those with persistent anti-tumor CDA pre- and post-mastectomy; those with detectable CDA post-mastectomy but not pre-mastectomy; and those with only occasionally detectable CDA. (3) Some sera obtained from patients with clinically evident tumor inhibited anti-tumor CDA found in the sera of other cancer patients. The significance of these results are discussed.


Serum immunoglobulins in breast cancer.

Eighty-one women admitted for breast tumor biopsy have been followed sequentially for 12 months. Thirty-one women had clinical stage I and II breast cancer and 50 had benign breast disease. All these women had serum immunoglobulin IgA, IgG, IgM and IgE levels measured by immunodiffusion and radioimmunoassay preoperatively, two weeks postoperatively, then three months, six months, nine months and twelve months postoperatively. Significant differences were found in IgA and IgG levels preoperatively in the cancer group while no differences were found in IgM or IgE levels at any time. There was positive correlation between the extent of metastatic breast cancer and IgA level. There was negative correlation between the extent of metastatic breast cancer and IgM levels. These findings raise the value of measuring the levels of immunoglobulins in patients with breast cancer as a guide to subclinical spread of the disease. The results may also support the hypothesis of the role of early immune defect in immunoglobulin metabolism in the pathogenesis of breast cancer.


Autoantigens in breast cancer tissue.

Two antigens in specimens of human breast cancer have been identified as autoantigens. One antigen appears to be an IgG Fc fragment; the other, an IgG Fab fragment. Antibodies in sera of cancer patients directed against these antigens have also been identified. These autoantibodies occur in patients with breast cancer as well as other cancers, and rarely in patients with non-cancerous disease or in people screened in a detection center for breast diseases. The breast cancer patient found to have antibody directed against the IgG Fab antigen falls into a group that has improved two-year survival statistics over groups of patients who lack this antibody.


Tumoricidal effects of Mycobacterium ulcerans toxin on murine adenocarcinoma (C3HBA).

Fresh homogenized mammary gland adenocarcinoma (C3HBA) material was subcutaneously inoculated in the anterior right thigh of transplant host mice (C3H/HeJ). When tumors were palpable, the mice were separated into three groups. The test group received biweekly intratumoral injections of Mycobacterium ulcerans filtrate containing 40 mg of protein per ml. One control group received intratumoral injections of normal physiological saline, and the remaining group received no treatment at all. The survival rate of toxin-treated animals was 13.5% at 15 weeks when compared with the control groups. Additionally, tumor metastasis was apparently abrogated in test animals when compared to the control animals. Marked necrosis of the tumors in the test animals was noted by histological examination. Controls showed slight to moderate degrees of tumor necrosis. In this model Mycobacterium ulcerans toxin appears to have therapeutic value as an antitumor agent.


Assessment of myelotoxic effects of chemotherapy from early leukopenic response: application of a mathematical model for granulopoiesis.

A recently developed model of the human granulpoietic system had been used to analyze the toxic effects of 5-fluorouracil administered to cancer patients. From this analysis there appeared to be a relationship between the level of the early leukopenic depression and the rate at which the drug kills cells in the marrow. In particular, it may be possible to estimate this kill rate from the extent of the maximal depression in the white blood count during the second or third week after treatment begins. This estimate may be useful when planning modifications in treatment in order to prevent the onset of hematologic crises.


Explorations of antimitotic agents in the treatment of a congenital disease, ichthyosis linearis circumflexa.

Successful therapy of a genetic disorder, Ichthyosis Linearis Circumflexa, was achieved using a low dose systemic cyclophosphamide. Prior to such therapy, 80 to 90% of the body surface was affected; the use of antimitotic agents reduced the extent of the lesions to less than 15% of the body surface. As a result, the clinical status was changed from severely disabling to being compatible with a normal way of life. It is believed that this phenomenon is related to selective effects of cyclophosphamide, such as those on lymphocyte subpopulations. To our knowledge, successful chemotherapy for diseases of genetic or congenital origin has not been previously reported.


The spouse as facilitator for esophageal speech: a research perspective.

The role of the spouse in relation to the quality of esophageal speech of laryngectomized patients was investigated using psychodiagnostic instruments and speech ratings and through an assessment of the verbal interactions between the patient and spouse. Analysis of the results indicates that those speakers who were objectively judged to have higher quality speech and learned esophageal speech rapidly had spouses who were more likely to disagree verbally with them, addressed them in a way that encouraged long answers, and evidenced reciprocal compatibility for meeting affectional needs.


Cardiac surgery under age two years. A review.

To assess the current status and risks of both open and closed cardiac procedures for congenital heart disease in patients under the age of 2 years, we reviewed all cardiac catheterizations and cardiac operations done from January, 1974, through December, 1977, at The Children's Orthopedic Hospital and Medical Center in Seattle, Washington. In this interval 370 patients under 2 years of age were catheterized. Eighty open procedures were performed in patients under 2 years of age, with seven hospital deaths. One hundred twenty-four closed heart procedures were performed on children under the age of 2 years, with eight deaths, for a hospital mortality rate of 6.5 percent. This review of consecutive cases over a 4 year period suggests that the judicious application of palliation or open repair using current techniques can lead to an overall mortality rate of between 6 and 7 percent for both open and closed heart procedures in children under 2 years of age. Since all deaths except one in the open-heart group occurred in patients with the most complex multiple defects, it seems reasonable to suggest that improved intraoperative and postoperative techniques have lowered the time for repair of straightforward congenital heart defects to under 2 years of age.


Repair of tetralogy of Fallot after Waterston anastomosis.

Sixty-three corrective operations have been performed in patients with Tetralogy of Fallot and a previously constructed Waterston shunt. The patients were from 1.4 to 8 years of age (median 4.3 years), and the mean interval between the Waterston shunt and the repair was 39.3 +/- 16.05 months. Three patients developed pulmonary atresia and six required a second anastomosis prior to intracardiac repair. Kinking and stenosis of the right pulmonary artery at the site of the Waterston anastomosis occurred in 12 (19 percent; 70 percent confidence limits 14 to 26 percent) patients who required patch enlargement of the right pulmonary artery at repair. Seven (11 percent; 70 percent confidence limits 7 to 17 percent) patients died in the hospital and three (5 percent; 70 percent confidence limits 2 to 11 percent) during the period of late follow-up. None of the early or late deaths was specifically related to the presence of the previously performed Waterston anastomosis.


Taussig-Bing anomaly with straddling mitral valve.

Five patients with the left-sided or intermediate type (Lev) of the Taussig-Bing anomaly were found to have an associated straddling of the mitral valve. In four patients the anomaly of the mitral valve was not recognized preoperatively, and all four died postoperatively. The persistent subpulmonic obstruction caused by the abnormal attachment of the anterior mitral leaflet is considered a significant factor in the poor operative outcome. Retrospective study of angiograms in these four patients revealed diagnostic clues of straddling mitral valve which enabled us to diagnose a fifth patient angiographically and confirm the diagnosis by cross-sectional echocardiography. A surgical approach to correct this association of abnormalities is proposed which avoids operating upon the mitral valve. Its function is thereby preserved, yet the hemodynamic problem caused by the straddling is bypassed. The fifth patient in this series was successfully treated by the proposed operative method.


Further evaluation of the sutureless, screw-in electrode for cardiac pacing. Experience with first 300 implantations.

This report details our experience with 300 sutureless epicardial electrode implantations performed in the past 6 years. Indications for pacing, surgical approaches, implantation sites and complications are presented. The subxiphoid approach was valuable in obtaining safe, reliable, and long-term impulse generation. Complications have been few and of short duration. In general, pacing thresholds have been lower and sensitivity thresholds higher with left ventricular implantation than with right ventricular implantation. Endocarcial pacing is reserved for the very aged and debilitated patients, patients requiring implantation within 4 to 6 weeks of acute myocardial infarction, and for atrial or atrioventricular sequential pacing.


The mechanism of opening of the aortic valve.

The mechanism of opening of the aortic valve was investigated in dogs by attaching radiopaque markers to the commissures and the leaflets. Analysis of abnormal cardiac cycles demonstrated that, when the ventricular pressure first equalled the aortic pressure, the intercomissural distances increased 9 percent, and the valve opened with a stellate orifice without forward flow and without a rise in aortic pressure. Further opening of the aortic valve was dependent on forward flow over a narrow range. A new mechanism of aortic valve opening is proposed. This mechanism results in minimal flexion stresses on the leaflets and is important for the longevity of the normal aortic valve. It can occur only if the leaflets arise from an expansile aortic root.


Acute renal failure following cardiac surgery.

In a prospective 6 month study of 204 patients requiring cardiac operations, five (2.5 percent) developed acute renal failure (ARF) and five (2.5 percent) had documented renal dysfunction (RD). Preoperative left ventricular dysfunction and prolonged cardiopulmonary bypass (CPB) were important predictors of subsequent RD/ARF; CPB pressure per se was not. Physiological and clinical studies in 51 selected patients studied over an 18 month period documented the effectiveness of low flow, low pressure CPB in preserving postoperative renal function. Twenty-two patients with nonazotemic postoperative courses demonstrated moderate depression of cardiac function while the glomerular filtration rate (GFR) was normal (98 +/- 30 ml./min/1.73 M.2) within 24 hours of operation. Seventeen high risk patients developed AFF (65 percent mortality rate) and 12 experienced severe RD without ARF (17 percent mortality). ARF (65 percent mortality rate) and 12 experienced severe RD without ARF (17 percent mortality). Eleven patients with ARF and 11 with RD were studied in the early postoperative period; at this time, all 22 patients demonstrated RD with equivalent severe depression of cardiac and renal function. Superposition of further hemodynamic or toxic insults upon ischemic kidneys was usually necessary for ARF to occur.


Effects of systemic hypothermia on myocardial metabolism and coronary blood flow in the fibrillating heart.

Ventricular fibrillation during normothermic cardiopulmonary bypass is deleterious to the myocardium. This study was undertaken to determine if moderate systemic hypothermia would protect the myocardium during ventricular fibrillation. Fourteen mongrel dogs were subjected to 1 hour, 15 minutes of total cardiopulmonary bypass. Ventricular fibrillation was induced by a continuous electrical alternating current applied at the beginning of bypass and lasting for 1 hour. Six animals were maintained at normothermia (Group I), and eight were cooled to 30 degrees C. for 1 hour (Group II). The hypothermic group (Group II) demonstrated lower myocardial oxygen consumption and metabolism, decreased coronary blood flow, and less myocardial lactate production during ventricular fibrillation than did Group I. It is concluded that hypothermia does offer some protection, although not complete, against the deleterious effects of ventricular fibrillation described previously.


Comparative study of prophylactic antibiotics in cardiac surgery. Clindamycin versus cephalothin.

A randomized, prospective study of the relative effectiveness of clindamycin versus cephalothin was performed in 263 adult patients having cardiac surgery from September, 1977, to August, 1978. There were no statistically significant differences in frequency of postoperative infections in these two antibiotic groups. Wound infection developed in 6.5 percent of the cephalothin group and 3.2 percent of the clindamycin group. Urinary tract infection developed in 5.6 percent of the clindamycin group and 2.1 percent of the cephalothin group. Four bacteremic episodes occurred in the clindamycin-treated patients, and one episode of bacteremia occurred in a cephalothin-treated patient. No cases of endocarditis occurred during the study. Clindamycin deserved consideration as an alternative prophylactic agent to cephalothin for cardiac surgery.


Compensatory synapse growth in aged animals after neuronal death.

The capacity of neurons to grow new synapses following partial denervation has been studied in the brain of aged rats and compared to that of younger animals. Lesion induced synapse formation is reduced in aged rats in the hippocampus and septum, two brain areas which show particularly robust growth responses in younger animals. The rate of growth as well as the final magnitude of the response is diminished in aged animals. A possible mechanism for the decreased growth response in aged animals is discussed in light of current models of reactive synaptogenesis. The loss of a compensatory growth response in the aged animal may be one of the factors which contribute to decreased brain plasticity and the slower and poorer recovery from brain damage following injury.