Regional cerebral blood flow measurement using a scintillation camera.

A scintillation camera connected to auxillary equipment with off-line data processing or connected to an on-line dedicated computer system permits measurement of hemispheric and regional cerebral blood flow. Reliable flow values are obtained from regions limited in size by spatial resolution and the count rates achieved. Flow measurements obtained with the camera are able to resolve inhomogeneities of cerebral circulation in normal subjects. In a variety of clinical conditions, the localization, severity and extent of flow alterations are shown. Results of flow measurements in individual cases elucidate the pathogenesis of neurologic deficits, quantify the damage to the brain, indicate therapeutic measures of potential value and permit an estimation of the further clinical course. With restricted spatial resolution, flow measurements after intravenous 133Xe injection are also feasible.


Extrahepatic portal hypertension due to congenital obstruction of the portal vein and associated gross hepatic lobulation.

A 10-233k old girl presented with splenomegaly and recurrent hematemesis from esophageal varices. Splenoportography revealed a dilated extrahepatic portion of the portal vein with nonvisualization of its intrahepatic tributaries. The child died following an episode of hematemesis and was found to have a dilated portal vein which ended blindly. In addition, there was abnormal lobulation of the inferior surface of the liver which was not cirrhotic. The portal vascular anomaly, which presumably was responsible for the portal hypertension, was probably due to failure of communication between the embryonic vitelline veins or to atresia of the portal vein secondary to pressure from the abnormal hepatic lobulation in utero. It would appear that congenital factors may be significant in the etiology and pathogenesis of some cases of extrahepatic portal hypertension in early life and recognition of such developmental anomalies is of importantance in management.


Iron poisoning: assessment of radiography in diagnosis and management.

Severe acute iron poisoning developed in a 1 1/2-year-old child who had eaten an iron preparation that resembles a popular chocolate candy. Tablets containing iron, with and without vitamins, and the sugar-coated candy of similar appearance, were radiographed with human gastric juice in vitro. Times of dissolution of the radiopaque tablets were noted, to assess the value of abdominal radiographs in the diagnosis and management of acute iron poisoning.


Neonatal appendicitis.

Another example of neonatal appendicitis is presented, and the clinical details of 33 cases previously documented in the literature are reviewed. This rare condition is characterized by an inordinate delay in diagnosis, a high incidence of perforation of the appendix and a high mortality.


Collaborative research between a Department of Pediatrics and its clinical faculty.

Collaborative research involving members of the full-time and clinical faculties of a Department of Pediatrics increases our knowledge of problems encountered in primary care practice by bringing the practitioner's perspective on the nature of such problems and the population of patients he serves to the investigative arena. For the practitioner, active involvement in collaborative research is rewarding because he or she formulates the questions to be addressed and takes part in planning and implementing the research and reporting results. Through such collaboration, the academician gains immeasurably by being able to study common clinical problems in primary care settings, where they are encountered most often. To be successful, collaborative research must be a joint effort with ongoing communication and sharing of responsibilities between academicians and practitioners.


Cholestyramine treatment of chronic diarrhea associated with immune deficiency syndrome.

A 5-year-old boy with known severe combined immunodeficiency disease presented with chronic diarrhea, malabsorption and retarded growth. Candida albicans was found in distal duodenal fluid, and invading the intestinal mucosa. Chronic diarrhea persisted after antimycotic therapy, but responded to treatment with cholestyramine. Repeated courses of cholestyramine resin over a 6-month period were required for complete resolution of the gastrointestinal symptomatology.


Kinetics of mucosal influx of glycylsarcosine, glycine and leucine into hamster jejunum and ileum in vitro.

1. This paper describes an investigation of the kinetics of influx of the dipeptide glycylsarcosine and the amino acids glycine and L-leucine into rings of everted hamster small intestine in vitro, in proximal and distal small intestine (jejunum and ileum). Results were expressed per unit wet weight of intestine. 2. At all concentrations studied (0.1--100 mmol/l), influx of glycylsarcosine was more rapid in the jejunum than in the ileum. In contrast, at all concentrations studied, influx of glycine and leucine was more rapid in the ileum than the jejunum. 3. Estimates of the simple diffusion component in total influx were made. This component became increasingly large as the substrate concentration was raised. After correction for simple diffusion, transport of all three substrates conformed to Michaelis-Menten kinetics in both jejunum and ileum. Values for simple diffusion, apparent Kt and Vmax, are reported. 4. Possibly physiological implications of the results are discussed, and it is pointed out that under experimental conditions similar to our own, simple diffusion is too large a component in total influx to be ignored.


Arterial wall renin and renal venous renin in the hypertensive rat.

1. Infusion of sufficient renin to raise the blood pressure of normal rats to hypertensive levels resulted in increased renin in the arterial wall. 2. Arterial wall renin and renal venous renin were normal in younger spontaneously hypertensive rats, but in older spontaneously hypertensive rats arterial wall renin was significantly increased and renal venous renin was significantly decreased. 3. Arterial wall renin in rats with either acute or chronic two-kidney Goldblatt renal hypertension was significantly increased, whereas circulatory renin was elevated in the former, but depressed in the latter. 4. Arterial wall renin may play a role in the maintenance of acute and chronic renal hypertension and also perhaps of spontaneous hypertension of long duration in older rats.


Fluorescent lipid-peroxidation products in synovial fluid.

1. Samples and extracts from synovial effusions were examined for the presence of fluorescent degradation products of free-radical oxidation (peroxidation). 2. Two classes of fluorescent compounds were identified and their fluorescence and physical properties are described. The fluorescence in the aqueous methanol phase of the extracts had the characteristics of conjugated Schiff bases. 3. Changes in synovial fluid and synovial fluid extracts in vitro induced by u.v. irradiation, prolonged incubation and the enzymic generation of oxidizing free radicals, with or without admixed peroxidizing arachidonic acid, and in the absence and presence of antioxidants, suggest that the fluorescent material is derived from peroxidized polyunsaturated lipids in damaged synovial tissue.


Time-dependent changes in prostaglandin excretion in response to frusemide in man.

1. To evaluate in man by a non-invasive technique the possible role of prostaglandin (PG) compounds in initial renal haemodynamic effects after frusemide we studied the urinary excretion of PGE2 and of PGF2 alpha before and at 15 min and 120 min after intravenous injection of this drug. 2. An increase of PGE2 and of PGF2 alpha excretion was found in all 19 volunteer subjects within 15 min after frusemide, and PG excretion had returned towards control values at 120 min. The stimulation of PGF2 alpha excretion by frusemide was markedly lower in men than in women, but this difference was statistically not significant. 3. No clear-cut relation was found between urinary PG compounds, on the one hand, and urinary volume, urinary sodium and urinary potassium, on the other hand, during the study. 4. The results support the assumption that the rapid increase of urinary PG compounds after frusemide, which parallels the changes in renal haemodynamics, may be an indicator of an activation of the PG system, in part or predominantly, in the vascular compartment.


Binding of human serum ferritin to concanavalin A.

1. A high proportion of the ferritin in normal serum binds to concanavalin A. Binding is prevented by the addition of alpha-D-methylglucoside to the reaction mixture. 2. Ferritin in extracts of normal heart, liver and spleen or serum ferritin from patients with massive hepatic necrosis does not bind to concanavalin A. 3. Isoelectric focusing of preparations of serum ferritin from patients with primary haemochromatosis shows that the ferritin fraction binding to concanavalin A consists, predominantly, of the more acidic isoferritins. 4. These findings suggest that carbohydrate residues may be added to ferritin during its secretion into the plasma. Glycosylation may account for the heterogeneity of serum ferritin on isoelectric focusing. 5. Direct release of intracellular ferritin from damaged tissue may be indicated by an increase in the proportion of circulating ferritin which does not bind to concanavalin A. Such an increase has been found in sera from patients with iron overload.


Niacin depletion in Parkinsonian patients treated with L-dopa, benserazide and carbidopa.

1. Benserazide and carbidopa, decarboxylase inhibitors used in the treatment of Parkinson's disease, have been shown to inhibit the enzyme kynurenine hydrolase in rat and mouse liver. This results in reduced synthesis of nicotinamide coenzymes from tryptophan, and hence an increased reliance on dietary niacin. 2. Pellagra might be expected as a result of this inhibition of endogenous synthesis of nicotinamide nucleotides, but has not been reported in patients treated with either drug. 3. The urinary excretion of N1-methyl-nicotinamide, a product of nicotinamide nucleotide metabolism, is considerably reduced in patients treated with dopa alone or in combination with an inhibitor of peripheral dopa decarboxylase, to as low as 40% of the control value. This means that many of these patients could be classified as 'at risk' of niacin deficiency, even if not frankly deficient. 4. Patients treated with dopa plus a decarboxylase inhibitor, but not those treated with dopa alone, also show a reduced excretion of xanthurenic acid, and an increased excretion of kynurenine, as would be expected after inhibition of the kynurenine pathway, and possibly indicative of marginal vitamin B6 deficiency.


The influence of ammonia and octanoic acid on liver regeneration in the rat.

1. We have investigated the effect of intermittent doses of ammonia and octanoic acid on liver regeneration in the rat after partial hepatectomy. Regeneration was assessed by uptake of tritiated thymidine into liver deoxyribonucleic acid. 2. We have found a reduction in hepatic regenerative response in animals treated with ammonium acetate as a source of ammonia. 3. No inhibiting effect of octanoic acid on liver regeneration was found, at the dose used. 4. The implications of the results for management of fulminant hepatic failure are discussed.


Presence of apolipoprotein-CII in commercially available albumin fractions.

1. Commercially available bovine serum albumin as Cohn fraction V was demonstrated to contain small amounts of apolipoprotein-CII. 2. This apolipoprotein activated lipoprotein lipase in the same way as apolipoprotein-CII purified from human very-low-density lipoproteins.


Inactive renin in rabbit plasma: effect of haemorrhage.

1. Renin activity in rabbit plasma increases after acidification (pH 3.3), probably due to activation of an inactive form of renin. 2. Both active and inactive renin in plasma increase after haemorrhage. This stimulus does not change the relative proportions of the two forms. 3. After ligation of the renal blood vessels neither form of renin increases in response to haemorrhage. 4. One day after bilateral nephrectomy no inactive renin could be demonstrated in plasma. 5. In the rabbit, therefore, the kidney is a major source of the inactive renin in plasma.


Hypertension with mineralocorticoid administration to the Long-Evans rat.

1. The Carworth Long-Evans rat has been reported to develop adrenal-regeneration hypertension but not deoxycorticosterone acetate (DOCA) hypertension. Deficiency of a hypothalamic receptor for deoxycorticosterone which mediates saline polydipsia has been postulated to underlie this resistance. Since a mineralocorticoid etiology for adrenal-regeneration hypertension has been postulated and all mineralocorticoids are thought to act on common receptors, these previous reports are difficult to reconcile. 2. To determine if an absolute or relative resistance to mineralocorticoids is present, Charles River Long-Evans and Sprague-Dawley rats were given 40 mg (107 micromol) of DOCA pellets/rat or 250 microgrms (0.65 micromol) of 2 alpha-methyl-9-alpha-fluorocortisol/day subcutaneously. 3. Saline polydipsia occurred with both steroids with both rat strains, though significantly less with the Long-Evans rats. Both types of rats became hypertensive and developed cardiac and renal enlargement with both steroids. Hypertension developed more rapidly with 2 alpha-methyl-9 alpha-fluorocortisol. 4. Thus mineralocorticoid hypertension can be produced in the Charles River Long-Evans rat, and the development of adrenal-regeneration hypertension in this rat strain is not incompatible with a mineralocorticoid etiology for adrenal-regeneration hypertension.


Evidence for activation of circulating inactive renin by the human kidney.

1. In eight patients with essential hypertension (EHT) and six patients with renovascular hypertension (RVHT) peripheral venous enzymatically active and inactive renin values were followed after acute stimulation of renin release by the vasodilating agent diazoxide (300 mg intravenously). Active renin rose during the first hour after diazoxide and remained high during the following 15 h, but inactive renin fell during the first hour and rose thereafter. Peripheral venous active and inactive renin were not different from arterial values both before and after diazoxide. 2. Sixteen patients with EHT received propranolol, 80 mg, four times a day. Six of them had a first injection of diazoxide the day before propranolol was started and a second one after 10--14 days of propranolol treatment. Peripheral vein active renin was lowered by propranolol, but inactive renin was raised. Both the diazoxide-induced rapid rise of active renin and the fall of inactive renin observed in untreated patients were absent during treatment with propranolol. 3. In four patients with EHT and seven patients with RVHT renal vein sampling was performed before and 30 min after diazoxide. Increased release of active renin from kidneys that were not markedly contracted was associated with a fall of the renal vein to peripheral vein ratio of inactive renin to a value less than one. 4. It is concluded that under certain circumstances stimulated release of active renin is associated with removal of inactive renin from the circulation by the kidney. This may in fact be due to intrarenal transformation of circulating inactive renin into its active counterpart. The findings suggest that a beta-adrenoreceptor might be involved in this activation process.


Structural and functional alterations in the mucosa of self-filling intestinal blind loops in rats.

1. Self-filling blind loops of jejunum were constructed in three groups of rats; in the first, blind loops were created without further manipulation; in the second the bile was diverted permanently into the lower ileum below the blind loop, whereas in a third neomycin was added to the drinking water throughout the experiment. Two weeks after the creation of the blind loops, they were used for structural and functional studies. 2. Morphometric and microdissection techniques demonstrated that the surface area of the individual villi of the mucosa of 'ordinary' blind loops had increased fourfold in comparison with corresponding control jejunum, whereas the increase was only twofold in rats with bile diversion or in the series treated with neomycin. There were proportional increases in crypt length and mitotoic activity of the crypts in all three series, which suggest that the alterations in the mucosa were due to hyperplasia in both villus and crypt compartments. 3. Sucrase, succinate dehydrogenase, alkaline phosphatase and non-specific esterase activities, determined biochemically or histochemically, were reduced in the mucosae of all blind loops, though the changes were most pronounced in the 'ordinary' blind loops. The accumulation of L-phenylalanine by mucosal slices in vitro was depressed, although the decrease was less marked in the series treated with neomycin. 4. These results suggest that both bacteria and deconjugated bile acids play a role in the development of the hyperplastic changes of the blind-loop mucosa, but that another factor might also be involved: as a possible candidate, stasis of the intestinal contents was considered. 5. To test this hypothesis, loops of rat colon were transposed into the jejunum. Above the transposed loop, the jejunal mucosa developed hyperplasia of both villus and crypt compartments, with a reduction in its ability to accumulate L-phenylalanine. It is argued that these changes, probably caused by stasis of the intestinal contents, are triggered off by the dilatation of the gut, which may also be implicated in the mucosal alterations in blind loops.


The role of the baroreceptor reflex in the cardiovascular effects of propranolol in the conscious spontaneously hypertensive rat.

1. The role of baroreceptors in the cardiovascular mechanism of action of DL-propranolol has been studied by comparing the acute effects of subcutaneous injection of 1 and 5 mg/kg (3.3 x 10(-6) and 16.5 x 10(-6) mol/kg) of this drug in conscious baroreceptor-denervated spontaneously hypertensive (SH) rats with those in sham-operated control SH rats. 2. At 5 mg/kg (16.5 x 10(-6) mol/kg) propranolol caused a small, but significant, increase in blood pressure in sham-operated SH rats, whereas both after 1 and 5 mg/kg (3.3 x 10(-6) and 16.5 x 10(-6) mol/kg) immediate hypotension was observed in baroreceptor-denervated animals. 3. Heart rate dropped rapidly after injection of 1 or 5 mg/kg (3.3 x 10(-6) and 16.5 x 10(-6) mol/kg) propranolol both in the baroreceptor-denervated and sham-operated SH rats. Bradycardia was significantly larger in the baroreceptor-denervated animals after an injection of 5 mg/kg (16.5 x 10(-6) mol/kg). 4. It is concluded that the lack of an early hypotensive effect of propranolol in intact animals is caused by an increased baroreceptor reflex activity as a consequence of the fall in cardiac output.


Renal sodium retention in cirrhosis: relation to aldosterone and nephron site.

1. In a group of patients with cirrhosis who showed a wide range of values for the rate of renal sodium excretion, the latter was found to be inversely related to both the plasma concentration and rate of renal excretion of aldosterone. However, for a given sodium excretion the values for aldosterone were significantly lower in the patients than for a group of healthy control subjects. These findings suggest either an increased renal tubular sensitivity to aldosterone or the participation of other factors in the pathogenesis of the sodium retention. 2. Based on measurements of the rate of urine flow and the clearances of free water and inulin during a maximal water diuresis, the fractional reabsorption of sodium by the 'proximal', 'diluting segment' and 'distal' segments of the nephron was estimated. For patients retaining sodium the enhanced reabsorption occurred at both proximal and distal sites, the latter being quantitatively more important. There was no significantly enhanced sodium reabsorption in the diluting segment.


Myopathy in bone loss of ageing: improvement by treatment with 1 alpha-hydroxycholecalciferol and calcium.

1. Eleven patients with the bone loss of ageing were treated with the vitamin D analogue 1 alpha-hydroxycholecalciferol and calcium for 3--6 months. 2. Muscle biopsies were taken from the vastus lateralis before and after the treatment and the activity of several enzymes was measured. Succinate dehydrogenase and total phosphorylase activities, which are a measure of the oxidative capacity, were low and increased significantly with the treatment. The lactate dehydrogenase activity, which can be taken as a measure of the anaerobic metabolism, was normal and did not change with treatment. The phosphagen stores, ATP and creatine phosphate were low and increased to normal with treatment. 3. Histochemical classification of the fibre composition revealed that the treatment induced an increase in the relative number of fast-twitch a (FTa or type II A) fibres accompanied by a reduction of the fast-twitch b (FTb or type II B) fibres. The cross-sectional area of the FTa fibres also increased with the treatment. 4. The present findings indicate that treatment with the active vitamin D analogue, 1 alpha-hydroxycholecalciferol, and calcium improves the myopathy associated with the bone loss of ageing.


Pregnancy-associated disease of the renal microcirculation.

1. Platelet factor 3, platelet survival, renal platelet localization and fibrinolytic activity have been studied in normotensive subjects with a previous history of pregnancy-associated hypertension. Studies were carried out up to 6 years after the complicated pregnancy. 2. Renal platelet localization was found to be significantly increased despite normal platelet survival and platelet factor 3 availability. Significant impairment of both resting and post-venous-occlusion fibrinolytic activity was also demonstrable. 3. The significance of these findings in relation to mediation of progressive intrarenal vascular disease is discussed.


Carbohydrate-containing materials in urine from normal and diabetic subjects.

1. Abnormalities in glycoprotein metabolism are believed to play a role in diabetic microangiopathy. We have therefore measured the urinary excretion of carbohydrate-containing materials in normal and diabetic subjects. 2. Diabetic subjects were found to excrete excessive quantities of such material, which may parallel the increases observed in plasma and structural glycoproteins found in previous studies. 3. Systemic administration of a synthetic derivative of vasicine, which is known to affect mucus glycoprotein, was shown to restore these elevated urinary concentrations seen in diabetic subjects to values close to normal, but his drug had no significant effect on urinary concentrations of such materials in normal subjects.


The pattern of breathing in patients with chronic airflow obstruction.

1. The pattern of breathing in 12 patients with severe irreversible airflow obstruction has been studied during ventilatory stimulation by rebreathing CO2. Mean maximum tidal volume response was only 1.23 +/- 0.30 litres (mean +/- SD); this represented 65% of mean measured vital capacity and 82% of mean measured inspiratory capacity. During the course of rebreathing mean total breath duration was reduced from 3.48 +/- 0.93 to 2.44 +/- 0.48 s. 2.  End-expiratory thoracic gas volume (FRC) was elevated at rest in all subjects and increased significantly by a further 0.50 +/- 1.90 litres during ventilatory stimulation in 10 of the 12 subjects. The maximum increase in FRC was proportional to the degree of airflow obstruction afforded by the airways in each subject. 3. It is suggested that the increase in FRC during ventilatory stimulation is responsible for the diminished tidal volume response and is an important determinant of breathing pattern and symptomatology in patients with airflow obstruction.


Diuretics, hepatic and thoracic duct lymph flows in the dog.

1. Simultaneous thoracic duct and hepatic lymph flows were measured in 29 mongrel dogs before and after the intravenous administration of mannitol, ethacrynic acid, frusemide and chlorothiazide in separate experiments. 2. Thoracic duct lymph flow increased significantly after each diuretic agent was administered. 3. Hepatic lymph flow increased only after ethacrynic acid and mannitol administration. Frusemide and chlorothiazide did not alter hepatic lymph flow. 4. These data show that increases in thoracic duct lymph flow after ethacrynic acid and mannitol arise partly from the liver, as well as from other organs.


Erythropoiesis, iron stores and tissue iron exchange in man.

1. The exchange of iron between plasma and erythroid and non-erythroid tissues was measured in 14 normal subjects, 17 iron-deficient patients, nine patients with primary idiopathic haemochromatosis and in 13 patients with haemolytic disorders. 2. The two main factors determining tissue iron turnover were shown to be the level of iron stores and the erythropoietic activity of the bone marrow.


Plasma renin activity in diabetes mellitus.

1. The plasma renin activity (PRA) was measured in 76 diabetic patients who were attending an outpatients clinic. Of these patients 16 had untreated hypertension and 28 had diabetic complications, which ranged from microaneurysms to renal failure and blindness. 2. Compared with age- and sex-matched normotensive control subjects, both normotensive and hypertensive diabetic patients had significantly higher PRA (P less than 0.001). 3. Hypertensive diabetic patients also showed a higher PRA than matched hypertensive control subjects (P less than 0.005). There were no significant differences between diabetic patients with hypertension or complications compared with those without these features. 4. Although this elevation of PRA could be due to a change in another component of the renin-angiotensin system, hypersecretion of renin is the most likely explanation.


Plasma and urine dopamine in man given sodium chloride in the diet.

1. Plasma and urine free dopamine were measured daily for 5 days in six normal subjects maintained on a low sodium diet. The subjects were then given dietary supplements of sodium chloride for 5 days and the measurements repeated. 2. Throughout the experiment the 24 h free dopamine excretion rates for all the subjects were higher than could be accounted for by renal clearance. Dopamine excretion increased significantly in response to the added sodium chloride whereas plasma dopamine remained unchanged. The rise in dopamine excretion preceded that of sodium excretion. 3. It is concluded that free dopamine is formed within the kidney in response to increased dietary sodium and may have a role in the control of sodium excretion.


Sites of clearance of leucocyte pyrogen in the rabbit.

1. The dose-response curve for sustained infusions of leucocyte pyrogen has been demonstrated, and an optimum dose indicated for leucocyte pyrogen clearance experiments. 2. The lungs, liver and small bowel are not significantly involved in removal of leucocyte pyrogen from the circulation in conscious rabbits. 3. A single circulation through one kidney removes up to half of the infused dose of leucocyte pyrogen.


Correlation of ethanol concentrations in blood and saliva.

1. The concentrations of ethanol in blood, mixed saliva obtained before and after rinsing and drying the mouth and parotid saliva have been monitored in 12 healthy subjects after the ingestion of alcohol. 2. A highly significant linear correlation was found between blood and the three types of saliva examined from 20 min after completion of drinking. 3. Blood and mixed saliva samples were obtained from 20 patients attending the Casualty Department with evidence of ethanol intoxication. A similar correlation was obtained. 4. These results show that salivary ethanol may be used as an index of blood ethanol concentrations, provided that the salivary sample is not obtained within 20 min of the ingestion of alcohol.


Plasma level and renal clearance of oxalate in normal subjects and in patients with primary hyperoxaluria or chronic renal failure or both.

1. Plasma oxalate has been measured by a radioisotopic method applicable to all concentrations of plasma oxalate and renal function, and also by an enzymatic method which was only applicable to raised concentrations of plasma oxalate. 2. Where the two methods could be applied simultaneously, the agreement between them was good. 3. Plasma oxalate was 86% ultrafiltrable at concentrations of up to 44 micromol/l. 4. Oxalate clearance and the exchangeable oxalate pool were also measured. The ratio of oxalate clearance to creatinine clearance was greater than unity in most normal subjects and patients. 5. These methods were used in normal subjects and in patients with primary hyperoxaluria and/or chronic renal failure. A raised plasma oxalate concentration was found in both conditions. Chronic renal failure is probably the most common cause of a raised plasma oxalate.


Effect of the exercise of seven consecutive days hill-walking on fluid homeostasis.

1. The effect of 7 consecutive days of strenuous exercise, hill-walking, on water balance and distribution was studied in five subjects. The exercise was preceded and followed by 3 control days. The diet was fixed throughout but water was allowed ad libitum. 2. Packed cell volume was measured daily. Serum electrolytes and arginine vasopressin were measured twice daily. Daily water, sodium and potassium balances were calculated. 3. During exercise there was a fall in packed cell volume, reaching a maximum of 11% by day 5 and a retention of sodium reaching a cumulative maximum of 358 mmol by day 6. During and immediately after exercise there was a retention of potassium, reaching a total of 120 mmol by day 3 after stopping exercise. 4. There was a loss of 650 ml of water on day 1 of exercise, followed by a modest retention reaching a cumulative maximum of 650 ml on day 5 of exercise. 5. Neither arginine vasopressin nor serum electrolyte concentrations were affected by exercise. 6. From the packed cell volume, sodium and water balances it was calculated that by day 5 of exercise there was an increase in plasma volume of .068 litre (22%), an increase in interstitial fluid volume of 2.0 litres (17%) and a decrease in intracellular fluid volume of 1.8 litres (8%). 7. These changes, together with the clinical observation of facial and ankle oedema during the experiemnt, suggest that continuous exercise may cause oedema and thus may be a factor in the aetiology of high-altitude oedema.


Central and peripheral circulation in relation to muscle-fibre composition in normo- and hyper-tensive man.

1. Fibre composition in the vastus lateralis muscle, and blood pressure, were determined in age-matched normotensive (n = 22) subjects and previously untreated patients (n = 19) with essential hypertension. 2. In all subjects the muscle fibres were classified, as fast-twitch (FT) and slow-twitch (ST), and blood pressure was recorded. Eleven patients and seven of the normotensive subjects participated in an extended haemodynamic study with intra-arterial pressure measurements and determinations of leg blood flow. 3. In both normo- and hyper-tensive subjects, ambulant and intra-arterial blood pressure and leg vascular resistance were negatively correlated to the percentage of ST fibres; no significant correlation was found to total leg blood flow. 4. The findings show that muscles with a high proportion of FT fibres have a higher resistance than muscles rich in ST fibres and suggest that the type of fibre in skeletal muscle might be of importance for the development of the hypertensive disease.


Age-dependent changes in the rate of myofibrillar protein degradation in humans as assessed by 3-methylhistidine and creatinine excretion.

1. Urinary excretion of 3-methylhistidine and creatinine have been measured in normal male and female humans ranging in age from pre-term neonates to 68 years to assess changes in the rate of muscle protein degradation and in muscle mass. 2. The 3-methylhistidine excretion by six adult men was measured before and after subjects were transferred to meat-free diets. It was established that a meat-free diet should be eaten for a minimum of 3 days before urine collection to eliminate exogenous sources of 3-methylhistidine. 3. The 3-methylhistidine/creatinine excretion ratio declined about twofold between normal full-term birth and maturity. The ratio in pre-term neonates was higher than for full-term neonates. 4. The variability of 3-methylhistidine/creatinine ratios between individual untime urine samples within a subject is similar to the variability between different subjects with total daily collections. 5. The 3-methylhistidine content of human muscle averaged 3.63 +/- 0.06 micromol/g for subjects aged between 4 and 65 years with protein accounting for 20.4 +/- 0.8% of muscle weight. These values are used to relate 3-methylhistidine excretion to muscle protein degradation. 6. It is concluded that control groups must be matched by age and sex to the group being examined. Where creatinine excretion is not perturbed it can be used as a reference base for comparisons of 3-methylhistidine excretion to indicate the average fractional degradation rates of muscle protein.


Increased turnover of muscle contractile proteins in Duchenne muscular dystrophy as assessed by 3-methylhistidine and creatinine excretion.

1. Myofibrillar protein degradation has been measured in patients with Duchenne muscular dystrophy, normal boys, adult males and Duchenne carriers by the rate of 3-methylhistidine excretion after transfer of subjects to a meat-free diet. 2. Although absolute rates of protein breakdown are lower in Duchenne patients, expression of the data to allow for differences in muscle mass gives fractional degradation rates 2--3 times higher than in age-matched controls. 3. Fractional rates of muscle protein synthesis are increased in the Duchenne patients to almost the same extent as protein breakdown. 4. Rates of muscle protein breakdown in obligate and presumed carriers of the Duchenne gene are not different from controls.


Acyl-coenzyme A--cholesterol acyltransferase activity in human liver.

1. In the presence of CoA and ATP, human liver microsomes catalyse the incorporation of [14C]oleate or [14C]cholesterol into cholesteryl oleate, thus demonstrating the presence of acyl-coenzyme A-cholesterol acyltransferase (cholesterol acyltransferase) in human liver. 2. The enzyme has properties similar to those of rat liver enzyme and with both the concentration of endogenous cholesterol in the microsomal fraction is adequate to support a constant initial rate of esterification. However, unlike the rat liver enzyme, the human cholesterol acyltransferase does not efficiently utilize added cholesterol as substrate. 3. The activity of cholesterol acyltransferase in human liver was 25% of that measured in rat liver under similar conditions of assay.


Changes in cholesterol metabolism with dietary cholesterol in children with familial hypercholesterolaemia.

1. Possible defects in cholesterol metabolism were sought in children with familial hypercholesterolaemia. 2. In nine affected children (eight heterozygotes and one homozygote) and in five healthy children, cholesterol synthesis and bile acid synthesis were determined from the excretion of steroids in the faeces during a low cholesterol diet. Cholesterol synthesis of 10.1 +/- 4.4 mg day-1 kg-1 in the hypercholesterolaemic children was similar to that in these and other normal children. Mean bile acid synthesis of 4.0 +/- 2.1 mg day-1 kg-1 also resembled normal values though three severely affected heterozygotes excreted substantially less. 3. The response to 4 weeks' additional 450 mg of dietary cholesterol/day led to variable changes in the plasma cholesterol and in the sterol balance. On average the affected children showed a rise in plasma cholesterol which resembled that in healthy subjects. The sterol balance fell in most, suggesting a reduction in cholesterol synthesis, which is the normal response to dietary cholesterol. 4. The response to dietary cholesterol was therefore at least qualitatively similar in the hypercholesterolaemic children to that reported in healthy subjects.


Prolactin in primary aldosteronism.

1. This study was done to examine the possibility that escape from the sodium retention produced by aldosterone may be associated with an inhibition of prolactin secretion. Plasma prolactin concentrations were determined in seven patients with adrenal adenoma and aldosteronism, before and after unilateral adrenalectomy, at a time when they were in balance on a sodium intake of 109 mmol/day. 2. After operation, plasma aldosterone was normal [before operation, 52.7 +/- 12.1 (supine), 64.6 +/- 9.1 ng/dl (upright); after operation, 6.8 +/- 1.5 (supine), 11.1 +/- 3.0 ng/dl (upright)], while plasma prolactin remained unchanged [before operation, 19.6 +/- 2.8 (supine), 15.5 +/- 3.3 ng/ml (upright); after operation, 23.8 +/- 2.3 (supine), 11.1 +/- 3.0 ng/ml (upright)]. 3. Our results do not support a role for prolactin in the renal response to aldosterone in man.


Absorption of inorganic phosphate in the human small intestine.

1. Intestinal phosphate absorption in human subjects was studied by the technique of triple lumen intestinal perfusion in vivo. 2. Ileal phosphate absorption increased as the intraluminal phosphate concentration was increased. 3. Ileal rates of phosphate absorption were lower at any given intraluminal phosphate concentration than previously described jejunal rates. Acidification of the ileal lumen did not increase phosphate absorption. 4. Phosphate absorption was shown in the jejunum to be dependent on the intraluminal sodium concentration. 5. Phosphate absorption in the human small intestine consists of at least two components, one directly proportional to water movement and the second apparently independent of water movement.


Studies on mineralocorticoid 'escape' in cirrhosis.

1. The mineralocorticoid 9 alpha-fluorohydrocortisone was given to 12 patients with cirrhosis without ascites. In seven an 'escape' from its sodium-retaining effects was observed, the other five continuing to retain sodium. 2. Changes in plasma renin activity (PRA) and inulin clearance (Cinulin) were used in the assessment of possible changes in the 'effective' extracellular fluid volume. PRA fell and Cinulin increased to a similar extent in each of the two groups of patients. The findings do not support the concept that the failure to show the mineralocorticoid escape in some patients with cirrhosis is due to a failure of expansion of the effective extracellular fluid volume. 3. Sodium reabsorption in the different segments of the nephron as estimated by clearance techniques under conditions of maximal water diuresis showed that the greatest changes to account for both mineralocorticoid escape and sodium retention were in the part of the nephron beyond the diluting segment.


Arterial distensibility in normal and hypertensive man.

1. The pulse-wave velocity along the brachial radial artery was measured in 38 subjects and volume distensibility values were calculated. 2. Measurements made at each subject's resting blood pressure showed that those with high blood pressure had higher pulse-wave velocity values and hence less distensible arteries. 3. An acute rise in arterial distending pressure was accompanied by a rise in pulse-wave velocity. 4. When pulse-wave velocity was remeasured in all subjects at identical arterial distengin pressures, no difference was found between hypertensive and normal subjects. 5. It appears that poor distensibility of large arteries in hypertensive subjects is a consequence of the elevated distending pressures and not due to irreversible structural changes in the arterial wall.


A defect in zinc uptake by jejunal biopsies in acrodermatitis enteropathica.

1. In a system in vitro, 65Zn accumulation by jejunal mucosal biopsies from patients with acrodermatitis enteropathica was found to be markedly reduced compared with controls. 2. We suggest that defective uptake of zinc by enterocytes is the primary abnormality responsible for the zinc deficiency underlying this disorder.


Faecal methylamine in normal and uraemic subjects.

1. A ninhydrin-reacting substance seen during ion-exchange chromatography of faecal dialysate obtained in vivo from normal and uraemic subjects has been isolated and identified as methylamine. 2. Faecal dialysate concentrations of methylamine were higher in uraemic subjects and were related to the degree of renal impairment (P less than 0.05). 3. Methylamine concentrations in faecal dialysate and centrifugate were not significantly different.


Analysis of 47Ca kinetics in normal subjects by means of a compartmental model with a non-exchangeable plasma calcium fraction.

1. 47Ca kinetic studies were performed in eight normal young adult males. Plasma, urinary and faecal stable and radioactive calcium and whole-body radioactivity were measured for up to 40 days after intravenous administration of the tracer. 2. The plasma radioactivity data could be fitted to the sum of four exponentials corresponding to a four-compartment model, but this model did not account for the consistently greater 47Ca specific radioactivities in plasma relative to those in urine at the same time in five of the subjects. 3. A non-exchangeable fraction of plasma calcium estimated as 5% of the mass in the plasma compartment was postulated to account for this finding. 4. An estimate of the insensible losses of calcium was obtained from the whole-body radioactivity counting data.


Accidental hypothermia and rewarming in dogs.

1. Twenty lightly anaesthetized dogs were cooled to 29 degrees C by cold-water immersion. Ventilation was spontaneous and the animals were allowed to shiver freely. Metabolic heat production and respiratory heat exchange were measured during rewarming. 2. The animals were divided into four groups each of five dogs and each group was rewarmed by a different technique. The control group was allowed to rewarm spontaneously; a second group was given warm (45-50 degrees C) fully humidified air to breathe in addition; a third group was rewarmed in a hot-water bath (42-44 degrees C) and the remaining group was given in muscle relaxant to abolish shivering and rewarmed by warm inspired air only. 3. The group rewarmed in hot water achieved normal core temperature most rapidly but there was no difference in the rewarming rates of the group rewarmed spontaneously and of the group given warm air to breathe in addition. 4. The group given a muscle relaxant and rewarmed with warm inspired air required 12 h to achieve the same core temperature as the shivering groups achieved in 2 h. Compared with the heat produced by shivering the amount of heat which it was possible to transfer across the respiratory tract was so small that it did not materially influence the rate of rewarming.


Vitamin D and magnesium absorption in man.

1. The effects of vitamin D and its hydroxylated derivatives on calcium and magnesium absorption have been examined in 47 balance studies on patients with various disorders of calcium or bone metabolism. 2. Vitamin D significantly increased the mean net absorption of calcium and also the calcium balance. The mean net absorption of magnesium was also significantly increased although the rise was much less than that of calcium and the mean magnesium balance was unaffected. 3. It is suggested that the slight effect of vitamin D on magnesium absorption may be incidental to its stimulation of active calcium transport, since the latter system has weak affinities for other alkaline earth ions including strontium, barium and magnesium.


Neurogenic activity--angiotensin II interaction during the development and maintenance of renal hypertension in the rat.

1. Pentolinium tartrate (a ganglionic blocker) was injected in conscious rats during the early and late phases of two-kidney renal hypertension produced by aortic ligation. 2. In the early phase ( 5 days after aortic ligation), ganglionic blockade resulted in a decrease in blood pressure equal to that obtained in normotensive rats. Later, at days 12 and 40, for equally severe hypertension, ganglion blockade resulted in a greater decrease in blood pressure. 3. A 30 min infusion of [Sar1, Ala8]angiotensin II during the pentolinium-induced nadir in blood pressure resulted in a further decrease in blood pressure at day 5. Later, at days 12 and 40, this effect was smaller. 4. A 300 min infusion of [Sar1, Ala8]angiotensin II normalized the blood pressure in hypertensive rats at day 40. This delay response may be secondary to a central effect of the antagonist, reducing neurogenic tone or peripheral antagonism of locally generated angiotensin II in the blood vessel walls. 5. At day 40, removal of the small left kidney resulted in a greater decrease in blood pressure. This suggests the presence of a renal factor other than renin in the chronic phase of this hypertension.


A comparison of chromium sesquioxide and [51Cr]chromic chloride as inert markers in calcium balance studies.

1. Chromium sesquioxide (Cr2O3; 1.5 g/day) and [51Cr]chromic chloride [51CrCl3 (0.3 muCi/day)] were compared as continuously administered non-absorbed markers for the correction of faecal recoveries in 14 calcium balance studies each lasting at least 18 days. 2. The mean recoveries of each, 98.4% for Cr2O3 and 101.9% for 51CrCl3, were not significantly different from 100%. 3. The two markers reduced the uncertainity in a typical 3 x 6 day calcium balance study to a similar extent (SD = 1.4 mmol/day for Cr2O3 and SD = 1.5 mmol/day for 51CrCl3. 4. 51CrCl3 is a convenient and satisfactorily alternative to Cr2O3 when the laboratory hazards associated with estimating the latter cannot easily be eliminated.


Measurement of water distribution and transcapillary solute flux in dog lung by external radioactivity counting.

1. A method for measuring the pulmonary water compartments in vivo in anaesthetized dogs is described. 2. The technique depends upon the sequential intravenous injection of markers labelled with gamma-ray-emitting isotopes. Each is allowed to become evenly distributed throughout the compartment to which it is confined. A calibrated gamma-counter placed at the surface of the inflated lung then records a count rate delated to the total quantity of isotope in unit volume of tissue. The size of each water compartment can be calculated from the external count rate and the isotopic concentration of the marker in plasma. 3. The markers used were 125I-labelled serum albumin for plasma, [125I]iodide for extracellular water and [125I]iodoantipyrine for total water. 4. The method was extended to calculate trans-capillary flux rates of serum albumin and showed that rapid exchange of serum albumin takes place between the plasma and interstitial space. 5. Results obtained non-invasively by the isotopic method were compared with direct measurements. Agreement was good.


Fractured neck of femur in the elderly: an attempt to identify patients at risk.

1. During a 15-month period, 110 elderly patients admitted with fractured neck of femur were studied in comparison with 72 elderly control patients undergoing elective surgery admitted over the same period to the same orthopaedic wards. 2. A striking finding was the marked similarity of all variables measured in the fracture and control groups. The principal differences between the two populations were that the fracture patients had a lower mean forearm bone mineral content, and that their serum concentrations of albumin, globulin and phosphate were reduced. 3. Neither measurements of radioisotopic calcium absorption, nor those of the serum concentrations of calcium, 25-hydroxy-vitamin D3 nor alkaline phosphatase provided satisfactory discrimination between the groups. 4. Several indices were devised, based on linear combinations of the test results obtained, in an attempt to predict the liability to future fractures of patients being considered for prophylactic therapy with oestrogens or other drugs. However, further work is required to define an index of improved predictive power and to evaluate it prospectively.


Evidence for the local occurrence of angiotensin II in rat kidney and its modulation by dietary sodium intake and converting enzyme blockade.

1. Angiotensin II (ANG II) was measured in acid-ethanol homogenates of rapidly frozen rat kidneys by a method involving ion-exchange and immunoadsorbent purification of peptides before radioimmunoassay. 2. Concentrations of ANG II found in kidney were 10--20 times that in plasma. 3. Perfusion of the kidneys via the renal artery with isotonic sodium chloride solution or with disodium EDTA solution did not alter the concentrations of intrarenal ANG II. 4. Animals fed on a sodium-deficient diet for 8 days had markedly higher concentrations of intrarenal ANG II, plasma renin activity and kidney renin concentration than sodium-replete animals. 5. After oral sodium loading for 3 weeks, rats had suppressed plasma renin activity and kidney renin concentration but unchanged intrarenal ANG II when compared with animals on a normal sodium intake. 6. One hour after the administration of a converting enzyme inhibitor (SQ 20881) plasma renin activity was elevated, kidney renin concentration unchanged and intrarenal ANG II was depressed. 7. These results demonstrate the presence of ANG II in the extravascular compartment of the kidney. They further suggest that its quantity is influenced by sodium intake and that angiotensin I converting enzyme is essential for its formation.


Cysteine-homocysteine mixed disulphide: differing plasma concentrations in normal men and women.

1. The mixed disulphide of cysteine and homocysteine is known always to be present in the plasma of patients with homocystinuria, an abnormality of methionine metabolism. Recently we have shown that it is also detectable in low concentration in the plasma of normal fasting man. In the present study we measured mixed disulphide concentrations after an overnight fast in 24 normal men and compared the findings with those obtained in 24 normal premenopausal women of similar age. 2. The mean value for men (+/- SD) of 3.3 +/- 0.8 micromol/l was significantly higher than that for women (2.4 +/- 0.7 micromol/l; P less than 0.001). Of the other neutral and acidic amino acids measured mean values for leucine, isoleucine and valine (P less than 0.001) and cystine (P less than 0.01) were also higher in the men but methionine concentrations were not significantly different. 3. The higher branched-chain amino acid concentrations in men could be related to larger muscle bulk and protein intake, but the higher cysteine-homocysteine mixed disulphide concentrations are consistent with differences in methionine metabolism between men and women under the age of 50 years.


Protein synthesis in isolated human skeletal muscle tissue: evaluation of an experimental model.

Amino acids were incorporated into soluble proteins, myosin and myoglobin at constant rates for at least 4 h on incubation of isolated human skeletal muscle fibres. The time course of incorporation of leucine into proteins not attached to ribosomes was approximately constant, suggesting a continuous termination of proteins. A comparison between estimated pool size of ribosomes and incorporation rate of leucine into proteins indicated that initiation of peptides occurred even in the absence of insulin.


Sodium excretion in man, and adaptation to a low-sodium diet: effect of intravenous sodium chloride.

1. The aim of this study was to test whether a postulated gastrointestinal or portal monitor of sodium intake plays any part in adjusting renal sodium excretion when dietary sodium is reduced. 2. Normal male subjects were given 50 mmol of sodium chloride intravenously three times daily for 3 days to replace or to supplement a constant oral intake of sodium chloride. 3. When oral sodium chloride was replaced with intravenous sodium chloride, renal sodium excretion remained constant. 4. When oral sodium chloride was kept constant, sodium administered as intravenous sodium chloride was promptly excreted in three out of four subjects. There was a delay in the increase in sodium excretion in the fourth subject. 5. Infusions containing 50 mmol of sodium chloride in 50 ml given intravenously over 22 min produced a rise in plasma sodium concentration and a fall in concentration of total plasma solids. 6. These results provide no evidence for a gastrointestinal or portal monitor of sodium intake, but do not disprove the existence of such a monitor.


Changes in blood glucose and plasma insulin after intravenous galactose in human injury.

1. The increase in blood glucose after intravenous galactose was measured at 6--8 h and 14 days after hip replacement (14 patients) and accidental injury (14 patients). 2. After hip replacement there was a greater rise of glucose after galactose on the day of the operation than on recovery, despite basal hyperglycaemia. This earlier period was also associated with inappropriately low insulin concentrations for the prevailing glucose concentration, and hyperketonaemia (13 out 14 patients). 3. After accidental injury patients with initial hyperketonaemia (nine out of 14) also had a greater rise of blood glucose after galactose than on recovery and had relative insulin deficiency; in contrast those who were initially normoketonaemic (five out of 14) showed a rise in glucose comparable with that after recovery and basal insulin concentrations more appropriate to the existing glucose concentration. 4. It is concluded that in most subjects after injury hepatic glucose release after galactose administration is not suppressed despite hyperglycaemia.


Effect of age on hypertensive stimuli and the development of hypertension in Brattleboro rats.

1. In rats with inherited diabetes insipidus, unilateral nephrectomy plus drinking of 0.6% NaCl solution (saline) did not influence blood pressure in adult rats. However, when these factors applied before puberty, they produced hypertension. 2. We therefore analysed whether saline administration before puberty or unilateral nephrectomy before puberty was more important for this hypertensive response. 3. Saline drinking was found to be necessary for the response because hypertension was elicited by unilateral nephrectomy in adult rats only if saline consumption began before puberty.


Peptiduria in experimental Fanconi syndrome in rats.

1. The plasma concentrations and urinary output of proline and hydroxyproline contained in peptides were measured in normal rats and in rats with Fanconi syndrome produced by injection of sodium maleate. All animals received a prior injection of 10 mg of the dipeptide L-prolyl-L-hydroxy-proline to increase plasma and urinary peptide content. There was a significant increase of urinary output of the two imino acids contained in peptides and a fall in their plasma concentrations. 2. It is concluded that increased output of peptides derived from collagen degradation in the experimental Fanconi syndrome in rats is at least in part due to diminished tubular reabsorption of these compounds from the glomerular filtrate. The results are claimed to be relevant to the increased output of urinary peptides in the Fanconi syndrome in man.


Bedside maneuvers in the diagnosis of heart disease.

Numerous other pathologic conditions are encountered. The relatively few maneuvers and drugs presented here were chosen as the ones most commonly used in daily practice. Cardiac auscultation is just one aspect of the cardiovascular examination; equal attention should be paid to determination of jugular venous pressure, jugular venous wave form, carotid upstroke characteristics, and to observation and palpation of the precordium. Finally, if the examiner keeps in mind the hemodynamic changes induced by the various maneuvers and pharmacologic agents while auscultating the heart, and if he understands the pathophysiology of the commonly encountered cardiac lesions, he should be able to diagnose heart disease and to evaluate more intelligently various murmurs and heart sounds without necessitating the use of expensive invasive or noninvasive procedures.


Religious beliefs and psychiatric disorder in Sri Lanka.

After a brief description of the popular beliefs on the causation of illness held in Sir Lanka, eight illustrative case histories are presented. Although the incidence of religious-supernatural contents of mental disorders has been decreasing in the West it is by no means rare. It does, however, occur mostly in psychotic illness, whereas in Sri Lanka it occurs with great frequency in both psychotic and neurotic conditions. The indigenous exorcistic methods of treatment will be more effective in some cases than in others and a careful diagnosis will provide indications as to the choice of treatment.


Further data on the diagnostic value of spontaneous drawing.

In discussing 2 patients, the authors point out that a study of spontaneous drawings by psychotics can be of considerable diagnostic importance in clinical practice. The clear structure of the drawings threw doubt on the diagnosis of schizophrenia in the case of the first patient who could be classified in the schizophenia spectrum on the basis of the formal symptoms. In the case of the second patient, where th clinical picture suggested different diagnosis, the drawings represent the 'ossified' essence of the experience and behavior symptoms and thus provided an objective basis for nosological classification. In addition, a characteristic feature of the difference between the creativity of the schizophrenic and the creative artist could be seen from a comparison with medieval Gothic art.


[Word play and schizophrenic language disorder - what constitutes the difference?].

The listener often perceives a similarity between humorous comments by schizophrenic patients and linguistic word plays, especially puns. A structural analysis of specific examples illustrates the basic difference. In 'good' as well as 'bad' word plays the humorous effect stems from the surprising similarity of word pairs (homonyms and homophones), while the seemingly humorous comments of the schizophrenic patient are rooted in an alteration of the semantic field of the word(s) employed. In spite of certain similarities in superficial structure there is a basic and specific difference in the semantic structure of these two forms of word play.


Relationship between one individual and another - relationship between the individual and society: limitations in the formation of psychotic disturbances.

The relations of the individual to others and family are understood through 'intersubjective' and/or 'interfamiliar' concepts. This 'inter' is always the origin of the relations between subjects; it is a reality which is of an atmospheric pneumatic nature. Its creative power and the uniqueness of the word are clarified by a selection of examples from oriental and occidental cultures. In contrast to it, the relations of the individual are also determined by norms, in which the 'objektive Geist' (Hegel) of a particular time is manifested. The individual is, in this relation, first of all a carrier of roles. A conditional analysis of psychotic disturbances must be based on the concept that the individual's psyche, in both spheres, is not a 'tabula rasa' (Locke), but always conveys a selection of that which has been offered in the situation (Leibniz). Out of this come constellations of a conditional nature conductive to the development of endogenous psychoses which exhibit themselves in the inter-sphere and role-sphere. These can only develop where a coherence of specific personality-structures with specific situations occurs. What makes various situations pathogenic for a particular, predisposed type, is a specific inference of meaning from peristatic precipitations.


Blood levels of medroxyprogesterone acetate after multiple injections of depoprovera or cycloprovera.

Mean levels of MPA in blood taken 90 days after injection were not significantly different between women who had received a single injection of DepoPrevera and those who had received eight injections at 90-day intervals. There was a wide variation in plasma MPA concentration in the two groups of women. In women who had received 31 to 45 injections of CycloProvera, plasma levels of MPA 28 days after injection were significantly higher than those of women who had received a single injection. The levels were also higher than those found in women 90 days after injection of DepoProvera. The results suggest that the dose of MPA in CycloProvera could be reduced.


Bleeding and ovulation control with use of a small contraceptive vaginal ring releasing levonorgestrel and estradiol.

Levonorgestrel and estradiol releasing contraceptive vaginal rings (CVR) with an outer diameter of 50 mm were used by twenty women. The treatment was given in three-week cycles followed by one treatment-free week. The treatment was planned to cover six cycles. All subjects kept records of bleeding and were controlled clinically in the course of treatment. Three subjects were followed by blood sampling. Plasma levonorgestrel, estradiol, progesterone and gonadotropins were determined. The subjects experienced no difficulties in using the CVR and 90 per cent continued the treatment through the whole experimental period of six months. One subject discontinued after three cycles because of irregular bleedings and one subject after five cycles because of urinary discomfort. Regular bleedings were observed only in three subjects and in nine cases the bleeding started with the CVR in situ during the last days of the three-week treatment period. Breakthrough bleeding occurred in the remaining eight subjects. The subjective side-effects were as follows: weight gain in four subjects, oedema in one subject and urinary discomfort in one subject. Pituitary function was not generally suppressed as judged by plasma gonadotropins. Out of the three subjects studied, two experienced ovulatory plasma progesterone concentrations.


Effect of prior pregnancy and combined oral contraceptives on baseline menstrual blood loss and bleeding response to intrauterine devices.

No effect of pregnancy was found on baseline menstrual blood loss (MBL) in women within one year of parturition or abortion. The increased bleeding response of women to intrauterine devices (IUDs) was found to be independent of pregnancy status during the year preceding IUD sertion. Women pregnant within a year of insertion had no different MBL than those pregnant more than a year prior to insertion. MBL quantified in subjects within three months of discontinuing combined oral contraceptives (OCs) was significantly lower than in prior non-OC users. Furthermore, MBL was significantly reduced in the former group during the first three menses following IUD insertion. At the sixth and twelfth menses post-insertion, MBL was still lower in prior OC users, but the difference between users and non-users was less and no longer statistically significant.


[Nonverbal communication and its implication for psychiatry].

Psychiatry unlike philosophy (with its problem of solipsism) recognizes the existence of other minds from the nonverbal communication between doctor and patient. This nonverbal, or having deeper roots in evolution, preverbal communication, is the connection within a herd or horde. As psychiatry gains many of its diagnostic criteria like mood, excitation or fear by nonverbal communication, it brings the patient in a biological-ethological frame where aim, biological sense and evolutional origin are justified questions of normal and abnormal behavior and of psychological events.


A randomized double blind study of two oral contraceptives.

To study the question of whether one brand of oral contraceptives may be as acceptable as another for use of publicly-assisted family planning programs, a double blind study of two well-known brands, Ovral and Norinyl, was undertaken in Costa Rica and Trinidad. The pills were randomly assigned to 1,200 women. Common side effects - nausea, dizziness, vomiting, headaches - were associated with both Norinyl and Ovral. Differences in event rates for these conditions were much more marked by country than by the pill used. Ovral was associated with increases in skin problems, notably chloasma, in Cost Rica. A higher percentage of women using Norinyl reported intermenstrual bleeding and spotting in both countries. In Costa Rica continuation rates for Norinyl were adversely affected by this. With these exceptions there appear to be no important differences between the brands that would affect their use in family planning programs.


Antifertility efficacy of the plant Aristolochia indica linn on mouse.

Two compounds isolated from the alcoholic extract of the roots of Aristolochia indica Linn were tested on day 6 pregnant mice. One of the compounds, p-coumaric acid showed 100% interceptive activity at the single oral dose of 50 mg/kg of body weight. The antifertility efficacy of these two compounds is discussed.


Microsurgical tubal anastomosis in the rabbit following three types of sterilisation procedure.

The reversibility of Falope ring, Pomeroy and unipolar cautery methods of sterilisation was examined in 30 rabbits. Using microsurgical techniques, an overall pregnancy rate of 56.6% was attained. Reversibility was more readily achieved and resulted in a higher pregnancy rate after Falope ring than Pomeroy or cautery sterilisation. The pregnancy rate after each method of sterilisation seems to correlate with the results obtained for reversal of sterilisation in the human.


Veterinary medicine in New York State: overview of distribution patterns.

An understanding of the distributional patterns of Veterinary practitioners in New York State can assist in optimizing veterinary services and opportunities. Veterinarians have been arrayed by type of practice and location within counties and major land form regions. Relationships between the number of practitioners and human and animal populations have been examined in these areas and show the inadequacy of basing veterinary needs on human population data. In contrast, large animal numbers show a much closer correspondence to veterinary practitioners, with ranges of 3341 to 6561 animals being serviced per veterinarian in the large and mixed service fields (98% of these totals are food animals). Data on age composition and degree institution (in-state versus out-of-state) provide indications of the length of service, turnover rate and retention rate for practitioners trained in New York State. At present 60 percent of New York State practitioners received their education at Cornell and more than three quarters of the active total completed their education since 1950.


Pharmacokinetics of norethindrone in Indian Women.

Pharmacokinetics of norethindrone (NET) was evaluated in eleven women belonging to a low socio-economic group and in five womem belonging to the high socio-economic group after the administration of an oral dose of 0.35 mg NET minipill on an empty stomach. Blood samples were collected at different intervals of time over a period of 24 hours. Plasma NET was estimated by radioimmunoassay. In all women, peak levels of NET occurred within 1-2 hours and a semi-log plot of plasma NET levels showed a biexponential decline. The half-life of plasma NET clearance was relatively shorter in women of low socio-economic group with poor nutritional status as indicated by anthropometric indices, as compared to that in well nourished women of high socio-economic group. There was a significant positive correlation between weight/(height) 2x 100 index on the one hand and t1/2 (beta) on the other in all the women studied, thereby suggesting a role for nutritional status in the metabolic handling of NET.


Acquired hyposegmentation of granulocytes (pseudo-Pelger-Huët anomaly) in a dog.

Hyposegmentation of granulocyte nuclei was diagnosed in an adult dog after unsuccessful attempt at finding an occult chronic infection. Intermittent signs of prostatitis were temporarily observed, but the immature nature of circulating granulocytes persisted nine months. Electron microscopic examination and neutrophil function studies revealed no abnormalities. Since previous blood smear evaluation had been normal, it is proposed that the granulocyte anomaly was acquired and may have resulted from an idiosyncratic reaction to one of several chemotherapeutic agents administered.


Nodular skin disease associated with Dirofilaria immitis infection in the dog.

Three dogs with dirofilariasis had a dermatologic syndrome, characterized by pruritus and multifocal nodules which tended to ulcerate. The cutaneous nodules revealed angiocentric pyogranulomatous inflammation with variable numbers of eosinophils. Microfilariae were often present in the blood vessels surrounded by the pyogranulomatous process. Therapy for dirofilariasis resulted in complete resolution of the dermatitis.


Demodex cati Hirst 1919: a redescription.

All life stages of Demodex cati are described and compared with D. canis. Presence of D. cati is reported for the first time from the external auditory meatus. In the two cases examined mites occurred in large numbers with little pathogenic effect.


Ethylene glycol toxicosis in cattle.

A 1-month-old Jersey calf died of oxalate nephropathy. The calf had access to antifreeze (ethylene glycol) 3 days prior to death. Since ethylene glycol toxicosis had not been reported in cattle, the effects or oral administration of ethylene glycol were studied in 7 calves and 3 cows. The toxic dose ranged from 2 to 10 ml of ethylene glycol per kg of body weight. Clinical signs were increased respiration, staggering gait, paraparesis, depression and later, recumbency and death. Hemoglobinuria and epistaxis were seen at doses of 10mg/kg of body weight. Azotemia, hypocalcemia and neutrophilia were constant findings whereas acidosis, plasma hyperosmolality and hemolytic anemia were seen in the animals receiving the higher doses. A diagnosis of ethylene glycol toxicosis must be based upon a history of ingestion and the presence of calcium oxalate crystals in body tissues (especially the kidney and brain).


Surgical procedure for exposure of the chorda tympani in dogs: a ventral approach.

An experimental neuroanatomic investigation of the innervation of the dog's tongue by the method of retrograde axonal transport of horseradish peroxidase required that chorda tympani neurectomy be performed in neonatal pups. Surgical exposure and transection of the chorda tympani proximal to its union with the lingual branch of the mandibular nerve in the past has been accomplished by radical lateral approach which is suited only for acute experimentation. This report describes a ventral surgical exposure of the extracranial portion of the chorda tympani in the dog. This surgical procedure permits long-term survival and is considered especially useful for the chronic neuroanatomic and neurophysiologic investigations on the role of the chorda tympany in taste, salivation and lingual vasodilation in the dog.


An immunohematological study of chronic copper toxicity in sheep.

Direct and indirect Coombs tests were performed on six experimentally chronic copper poisoned sheep and on two control sheep. Initially, all sheep were direct Coombs test negative and five of six experimental and one of two control sheep were indirect Coombs test positive. During intoxication, five of six experimental sheep became direct Coombs test positive while controls remained negative. Eluates, prepared from the red cells of three experimental sheep, sensitized normal sheep red cells, as measured by the indirect Coombs test. Similarly prepared eluates from control sheep were negative.


Relationship between clinical presentation of atrioventricular block and its localization defined by His bundle electrogram.

The frequency of clinical and electrocardiographic symptoms in dependence on the localization of the atrioventricular (AV) block, defined with the aid of His bundle electrogram, was investigated in 49 patients with 2nd-or 3rd-degree AV block. The Adams-Stokes syndrome, broad ventricular complex, and Mobitz II-type AV block were most frequently encountered in patients with infrahisian block, whereas Mobitz I type block was most frequently found in patients with suprahisian block. A chronic course of AV block was most frequent in patients with intrahisian block. The mean ventricular frequency of complete blockade was highest in suprahisian block, and lowest in infrahisian block. The localization of the block is a decisive factor for estimation of the prognosis and for indication of pacemaker implantation.


Evaluation of the left ventricular ejection function by means of single beam echocardiography.

Echocardiographic examination of the left ventricle was performed in a group of 50 patients with various heart diseases. Five methods proposed for left ventricular pump function calculation were used, based on measurements of ventricular end-diastolic diameters. The results have shown that all tested methods of determining the ejection fraction or its functional equivalent (fractional shortening) correlate significantly with the ejection fraction obtained from the considered angiocardiographic technique. The closest correlation (r=0.771) was found when the ejection fraction was calculated from volume values determined by the cubed formula. Among other methods, that of fractional shortening and ejection fraction derived from those values seemed to be well interpretable. Other methods of ejection fraction calculation have a rationale in some cases, but have also their specific limitations.


Accumulated creatine phosphokinase release as a prognostic index in the course of acute myocardial infarction.

Accumulated creatine phosphokinase (ACPK) in 25 patients with acute transmural myocardial infarction (MI) was evaluated as a prognostic criterion of clinical severity of the disease. It has been shown that ACPK values above 2.5U/ml are observed in 91.7% in MI complicated by pump failure. This does not apply to repeated MI. The possibility of mathematical estimation of the course of CPK release was also verified. The contribution of this method for the clinician is discussed.


Acute myocardial infarction--prehospital and posthospital phases.

The prognosis of acute myocardial infarction depends to a large extent on quick access to medical facilities, preferably in a hospital. Total delay in hospitalization (THD) consists of patient's delay (PD--time from the onset of the attack to the call for a doctor), doctor's delay (DD--time from the call for a doctor to his arrival), and hospitalization delay (HD--time from the doctor's arrival to the admission in a hospital). In a group of 507 cases of acute myocardial infarction the median THD was 215 min., PD--95 min., DD--20 min., HD--35 min. Better interpretation of symptoms both by the patient and the doctor seems to be one of the most effective means of shortening the total hospitalization delay. The final outcome of infarction in terms of the patient's return to normal life depends on proper rehabilitation and treatment in the posthospital phase.


Capillary diffusion capacity for I-131 and capillary filtration rate in female patients with idiopathic oedema.

In female patients with idiopathic oedema the capillary filtration rate and capillary diffusion capacity for I-131 were studied in lower-limb muscles and subcutaneous tissue. The capillary filtration rate averaged 0.276 ml/100 ml per minute, and the capillary diffusion capacity for I-131 averaged 9.8 mol/(mol/ml) per 100 g per minute in the gastroonemius muscle and 8.7 mol/(mol/ml) per 100 g per minute in the lower-limb subcutaneous tissue. All of these figures are statistically significantly higher than the corresponding control findings. The results are compatible with the concept of disturbed capillary permeability, and etiopathogenetic factor of idiopathic oedema.


Effects of centrally applied thiamenidine on pressure response to central nervous system stimulation.

Rise in blood pressure and heart rhythm disorders were provoked in rabbits submitted to electrical stimulation of the central nervous system. When injected into the cisterna magna, the hypotensive agent thiamenidine at a single dose of 100 microgram caused a fall in blood pressure and heart rate; this was not the case when the same dose was applied intravenously. Thiamenidine did not hinder the pressor response following stimulation of subthalamic zones, yet a reduction of rhythm disorders was obtained when the drug was administered by either route. The results suggest a central nervous action of thiamenidine.


Estimation of size of infarcted focus by spatial quantitative vectorcardiography in patients with acute anterior myocardial infarction.

The study included 113 patients with acute myocardial infarction of the left ventricular anterior wall. The patients were repeatedly followed up from the first hours of the affection onward in the course of the individual stages of treatment (stage of intensive monitoring and therapy; intermediate stage; initial rehabilitation with application of active therapy; early mobilization, activation and rehabilitation). A new approach to the estimation of the size of the infarcted focus is described, namely, the method using spatial quantitative vectorcardiography. It was found that the spatial localization of the 40-ms vector, especially its azimuth, is a specific indicator, with the aid of which the localization, extent and depth of the lesion in the left ventricular anterior wall can be assessed with a high probability in most instances. The compensatory adaptive and reparative capacity of the affected myocardium, estimated on the basis of spatial quantitative VCG, is closely correlated with the size of the infarcted focus.


Lateral asymmetry in testing long-term memory for faces.

Accuracy of recognition memory for faces initially seen in the central visual field was found to be greater 48 hours when previously seen and new faces were presented to the left visual field than when presentation was to for right visual field. It is argued that this result reflects relative specialization for the right hemisphere in storing visual patterns.


Incidental learning of image-mediated or pronounced words after right temporal lobectomy.

The use of visual images in word recall by patients with right temporal lobectomy was studied by testing the incidental learning of 40 (20 abstract, 20 concrete) words that had been either carefully pronounced or the referent visualized. When tested immediately after presentation of the list, the right temporal-lobe group (N = 30) did not differ from a matched normal control group, but in delayed recall 2 hours later the patient group showed impaired recall of concrete words that had been visualized. Recall of visualized abstract words was also poor but not significantly so, while pronounced words, whether abstract or concrete, were recalled normally. Further analysis revealed an impaired recall for visualized concrete words in both immediate and delayed testing in patients having a large right hippocampal removal, indicating an important role of the mesial temporal structures in image recall.


Naming to picture versus description in three aphasic subgroups.

Twenty-three male aphasics, classified as Broca's, Wernicke's and anomic, were tested on their ability to name objects to either visual confrontation or oral associative description. For the Broca's and Wernicke's aphasics, naming to visual confrontation was significantly better than to oral description. Broca's aphasics tended to produce more correct names than both other groups in both conditions, although significance was reached only in oral description. Differences were not significantly affected by the comprehension deficit or severity of aphasia. With picture naming, all groups tended to name immediately or not al all. For oral description, there was a greater proportion of long latency responses for the posterior patients. When given phonemic or visual cues to assist naming, Broca's aphasics benefited the most, the anomics performing most poorly. All these results suggest qualitative differences in naming ability in aphasic subgroups.


Cognitive impairment of aphasics in a colour-to-picture matching task.

Broca's and Wernicke's aphasics, non-aphasic brain-damaged patients and chronic schizophrenics were tested in a colour-to-picture matching task. For each of 42 black-and-white drawings of objects the most "typical" colour was to be selected from a set of 24 colour strips. Separate scores for the appropriateness of the choices as to hue, brightness, and saturation were obtained by comparison with the data from 50 normal Ss. The choices of both aphasic groups were more deviant than those of brain-damaged controls for chromatically coloured objects with respect to all three colour dimensions, and for achromatically coloured objects with respect to saturation and brightness. Wherever the aphasics' performance was worse than that of the controls, the deviancy-scores correlated significantly with the Token Test. Results are interpreted as an impairment of aphasics in the ability to isolate analytically specific features of objects or concepts which might be conceived of as a prerequisite of propositional language.


Problems in the acquisition of imagery mnemonics: three brain-damaged cases.

The literature provides little direction on how to overcome difficulties which some brain-damaged patients have in acquiring imagery mnemonics as a memory aid during the period of anterograde amnesia. For those interested in the therepeutic usefulness of imagery mediation, we provide a detailed account of the acquisition of some mnemonic skill in three brain-damaged patients who initially failed in using visual imagery mediators to recall words lists.


Semantic judgment ability in adult aphasia.

Recent psycholinguistic literature suggests that language usage often involves the ability to make judgments or appraisals about various aspects of language. It was therefore the purpose of the present study to examine the semantic judgment or evaluation abilities of thirty persons with aphasia in comparison to these same behaviors in a group of thirty normal individuals. That is, this study examined subject ability to use knowledge to make comparisons or judgments in reference to specific criteria. Results support the existence of a judgment capacity and indicate that persons with aphasia are impaired in their ability to evaluate semantic material. Therefore, speech pathologists may wish to include semantic judgment tasks in their evaluation procedures and plan therapy directed toward the retrieval of judgment responses.


Individual differences and asymmetry effects in memory for unfamiliar faces.

Visual field effects for recognition of unfamiliar faces was investigated using memory intervals of 0, 10, and 20 sec. and 8 stimuli in a same-different comparison paradigm. In Experiment I, 24 male and 24 female familial righthanders, half of whom had high and the other half, low Block Design (BD) scaled scores participated. Faces were recognized significantly more often in the LVF. A visual field x memory interval interaction resulted from reliable LVF superiorities with the 0 and 10 sec. memory intervals and a non-significant RVF superiority with the 20 sec. memory interval. Performance decreased significantly as the duration of the memory interval increased. No sex differences were found. Subjects with high and low BD scores performed similarly. In Experiment II, 16 stimuli were employed and the task repeated. Twenty-four male and 24 female familial righthanderds were given the BD and Vocabulary subtests of the WAIS as well as a brightness discrimination task. Field effects were non-significant. Performance decreased with longer memory intervals. For males, field effects for the 0 sec. memory interval were positively related to brightness discrimination scores.


Impaired recognition memory after head injury.

A continuous recognition memory task employing 120 line drawings of familiar stimuli was administered to patients recovering from closed head injury of varying severity and control patients. Mildly injured patients obtained significantly more correct responses, and higher memory sensitivity (d') values than moderately and severely injured patients who performed similarly. The measure of response criterion, c, was significantly lower in patients with injury of moderate severity when compared to mildly injured cases and control patients. Controls and mildly injured patients did not differ in their performance. In general, the total correct responses most impressively differentiated head injured patients with measurable coma duration as more than two-thirds had scores below the control group. Group differences in hits, false alarms and misses were examined also. Age and education, skull fracture, and hematoma were generally unrelated to any of the measures, whereas coma duration was significantly related to most measures of mnemonic efficiency.


Differential effects of age and cerebral atrophy upon span of immediate recall and paired-associate learning in older patients suspected of dementia.

Seventy-eight patients suspected of dementia, 50 years of age or older and without evidence of focal cerebral lesion or systemic illness, were administered the Digit-Span Forward and Paired-Associate Learning subtests of the Wechsler Memory Scale. Computerized axial tomography, allowing a visualization and measurement of the lateral ventricles and cortical sulci, was employed to measure cerebral atrophy. Four groups were defined as follows: (1) age 50-69, without atrophy (N = 27), (2) age 50-69, with atrophy (N = 17), (3) age 70-89, without atrophy (N = 18), (4) age 70-89, with atrophy (N = 16). Results of analyses of variance indicate that Digit-Span is affected by cerebral atrophy but not by age, while Paired-Associate Learning is affected by both age and cerebral atrophy. No interaction effect between age and cerebral atrophy was found for either task. These results are discussed within the context of previous research, and implications for both models of memory and theories of the effects of cerebral atrophy in different ag groups are suggested.


Recovery from alexia without agraphia: report of an autopsy.

The patient is a 58-year-old Japanese teacher of German literature who suffered twice from cerebrovascular accidents, showing alexia without agraphia. Pathological examination showed an old infarct in the posterior two-thirds of the fusiform and almost the whole lingual gyrus, involving the posterior border of the parahippocampal gyrus in the left hemisphere. The left cuneus and the calcarine cortex were preserved. There was degeneration of the lower third of the splenium of the corpus callosum, extending to its occipital radiation and tapetum on both sides. Comparing clinico-pathological findings of the 31 known autopsy cases, it was proposed that the lesion of the left spleno-lingual system produces alexia without agraphia but it may ameliorate. In addition, when spleno-cuneate system is also involved alexia becomes persistent and it may accompany object agnosia or optic aphasia.


Ipsilateral and contralateral reactions to monaural lateralized stimuli.

Twelve subjects, six right-handers and six left-handers, participated in an experiment in which they were tested on an ipsilateral and contralateral auditory-manual reaction-time task. No difference in reaction-time was found between left and right ear presentation in the ipsilateral task, whereas for nearly all subjects, right-handers as well as left-handers, a difference between the left and right ear presentation was recorded in the contralateral task. The right-handers showed a tendency to a right ear preference, the left-handers to a left ear preference. The results are discussed in terms of a combination of S-R compatibility and the cerebral organization in man.


Handedness and sleep duration.

The differences in habitual sleep duration and absolute deviations in habitual sleep duration from the normative mean between 60 left-, 36 mixed- and 125 right-handed college students were tested. It was found that mixed-handers tend to sleep less and as a group show significantly greater deviations in habitual sleep durations than either left- or right-handers. The heuristic value of this relationship for future research was discussed briefly.


Alpha hemispheric asymmetry of males and females on verbal and non-verbal tasks: some preliminary results.

The present study gathered preliminary data from males and females for verbal and non-verbal tasks to explore differences in alpha hemispheric asymmetry. Results indicated a significant task by hemispheric interaction effect which revealed significantly less alpha for the left hemisphere, as compared to the right hemisphere, for the verbal task. Significantly less alpha was found for the right hemisphere during the non-verbal task as compared to the right hemisphere on the verbal task. While significant differences between males and females were not revealed, task, subject, and stimuli differences are discussed as variables which may contribute to results obtained from hemispheric processing research.


Early childhood amnesia: a quantitative study with implications for the study of retrograde amnesia after brain injury.

Measurement of retrieval of episodic memories ascribed to the various years of early childhood was made over a three-month period of search by 17 normal young adults. The distribution of episodes ascribed to various ages is described, and it is shown that the recovery of memory from early childhood tends to show features of shrinking retrograde amnesia. Methods which were used to recover very early episodes are described, and implications for the study of shrinking retrograde amnesia in brain-damaged patients are discussed.


Evaluation of delayed auditory feedback (DAF) effect: comparison between subjective judgments and objective measures.

The effect of Delayed Auditory Feedback (DAF) on speech duration was evaluated subjectively and measured objectively in 30 subjects (10 normals, 10 nonfluent aphasics and 10 fluent aphasia). The average correlation coefficient between the subjective and objective data was .52 for 180 msec. delay and .46 for 360 msec. delay. Analysis of variance of data derived from the two methods showed the same highly significant differences among groups, delay and tasks. We conclude from these results that both objective and subjective procedures are equally useful in evaluating DAF effect on speech duration, and that both may also be valuable in assessing other types of behavior.


Significance and application of blood gas determinations from the left atrial catheter.

Left atrial catheters are used to measure left heart filling pressure in patients after open-heart surgery. It was observed that in some patients blood gases obtained from the left atrial catheters had a markedly higher PO2 as compared to PaO2 in the presence of severe hypoxemia. Twenty-five patients were studied consecutively; pulmonary venous admixture calculated from arterial blood was higher in 19 patients and lower in 5 as compared with that calculated from blood withdrawn from the left atrial catheter. These differences in venous admixture are due to regional changes in the lungs. This observation can be utilized in concentrating respiratory therapy to the regions of the lungs involved with significant therapeutic benefit to the patient.


Effects of closed-chest cardiac massage on intracranial pressure.

Closed-chest cardiac massage results in a marked increase in intrathoracic pressure and unusual patterns of blood flow. Among the physiological consequences of these changes appears to be a marked increase in intracranial pressure associated with chest compression as documented by the following patient case studies. While temporary, the marked nature of this rise in intracranial pressure suggests that the technique of closed-chest massage may, in itself, be responsible for clinically significant alterations in cerebral hemodynamics.


Oxygen consumption and recovery from surgical shock in rats: a comparison of the efficacy of different plasma substitutes.

Shock was induced in 537 rats by exteriorization of the intestines and occlusion of the superior mesenteric circulation for 1 hour. After 1 hour of this intestinal ischemia shock, oxygen consumption (VO2) decreased to half of the preexperimental values. When no infusion was given, the survival rate at 24 hours was 22%; this was correlated with the degree of restoration of VO2 at 1 hour after shock. VO2 and survival rate improved with infusion of albumin, dextran 40, and dextran 40, and dextran 70. With increasing doses of colloids, both VO2 and survival rate increased; the optimal effect was at the dose of 2 g/kg body weight. When no other therapy was given, colloids at concentrations of 3.5 or 6% solutions had a better effect on survival than the 10% solution. Colloids were more effective than Ringer's acetate when the latter was given in the same volume and up to three times the volume of the colloids.


Cryosurgery of verrucous carcinoma of the penis (Buschke-Lowenstein tumor).

Verrucous carcinoma of the penis (Buschke-Lowenstein tumor, giant condyloma accuminatum) is a common clearly defined variant of epidermoid carcinoma which features relentless local growth and little tendency to metastasize. Two cases successfully treated by liquid nitrogen cryosurgery are presented herein.


Oculoauriculovertebral dysplasia (Goldenhar's syndrome).

Oculoauriculovertebral dysplasia is a developmental disorder characterized by a triad of anomalies; epibulbar dermoids with or without lipodermoids, preauricular appendages or blind preauricular fistulae, and vertebral anomalies. Multiple associated anomalies have been reported. A case of this syndrome and a review of the literature are presented herein.


Acquired digital fibrokeratoma.

In 1965, Steele reported three cases of garlic-clove fibromas that histologically resembled the acquired digital fibrokeratoma described by Bart in 1968. We present a case that clinically resembles garlic-clove fibroma and fits the histologic criteria of acquired digital fibrokeratoma. We believe they are the same entity.


Arteriovenous hemangioma.

A case of the recently described vascular tumor, the arteriovenous hemangioma, is presented herein. Clinical and histologic differentiation from other benign, acquired vascular lesions is stressed.


Propranolol and alopecia.

A case is presented herein of alopecia developing in a patient receiving propranolol. The literature is reviewed and this case compared to the first one reported. The two cases have similarities, and most importantly, both showed an effluvium of the telogen type. This may be important as a diagnostic aid, if substantiated in further cases. In a survey of several major textbooks this side effect of propranolol is not noted and it is hoped that this article will make practitioners aware of the possible complication.


Sarcoid granulomas in venipuncture sites.

Scar changes may be an important clue in the diagnosis of sarcoidosis. Any patient complaining of changes in scars, areas of trauma, or venipuncture sites, should be evaluated for sarcoidosis. In patients already suspected of having the disease, these areas should not be overlooked as an easy source of tissue specimens for histopathologic confirmation of the diagnosis.


Annular atrophic plaques of the face and upper body. An unusual variant of lichen sclerosus et atrophicus or lichen planus.

A particular scarring atrophic disorder occurring in tropical countries and usually affecting dark-skinned persons is presented herein.


Localized tick bite reaction.

A woman presented with a localized tick bite reaction. The tick (Amblyomma americanum, the "lone star" tick) was still attached to the erythematous, indurated skin of the upper back. After several unsuccessful attempts at removal, a punch biopsy was performed, and the resultant histologic sections incorporated both tick and involved skin. The various systemic and localized tick bite reactions are discussed, as are the diagnostic dilemmas which may arise when the organism is no longer present. Punch biopsy is suggested as an effective means of removing the organism.


Innovative adjuncts in hair transplantation.

After development of the technical, organizational, and esthetic phases, hair transplantation has progressed to a fourth stage. This is a comprehensive approach determined by the patient's degree of baldness and may require a combination of procedures to best correct the patient's defect. The punch autograft technique remains fundamental for most patients at this time, while scalp reduction, flaps, and various types of grafts may be selective adjuncts. "Individualization" is being achieved through these various ancillary modalities.


The treatment of geographic tongue with topical Retin-A solution.

A new treatment for geographic tongue with topically applied tretinoin is suggested and its effective use on three patients is described.


An unusual organoid nevus.

The sites of predilection, stages of development, and suggested therapy for organoid nevi are discussed herein, and the case of an unusual nevus is presented.


Molluscum contagiosum: the volcano phenomenon.

Molluscum contagiosum, a common cutaneous viral infection, responds to a variety of therapeutic modalities, but patient cooperation often limits the practitioner's choice. In an effort to provide minimally traumatic treatment for a four year old boy with this dermatosis, an interesting phenomenon was chanced upon, which greatly facilitated therapy.


Atrophie blanche. An unusual ulcerative state of the lower limb.

A case of atrophie blanche, an unusual ulcerative state of the lower limb, is presented herein.


Giant condyloma acuminatum.

The subtle histologic differences between condyloma acuminatum and giant condyloma acuminatum are presented in the following report.


Acanthoma fissuratum. Histopathology and review of the literature.

A review of the literature and report of a case describing perhaps the youngest and first black patient recorded in whom bilateral lesions of acanthoma fissuratum developed and were successfully treated with intralesional corticosteroids is presented herein. Awareness of the clinical characteristics of this benign process can prevent potentially costly and needless diagnostic and therapeutic procedures.