Uptake and esterification of circulating carnitine by aorta and heart in rabbits in vivo.

Disappearance of intravenously injected DL-[methyl-14C]carnitine from the bloodstream and its uptake and esterification by heart and aorta were studied in rabbits fed atherogenic or non-atherogenic control diets. The disappearance rate of [14C]carnitine from the bloodstream was approximately 2-fold greater in animals fed the control diet than in those fed the atherogenic diets. No evidence was found for carnitine esterification in the blood. Circulating [14C]carnitine was taken up and esterified in both the heart and aorta of all animals regardless of diet; however, on comparing dpm/mg lipid-free dry weight, uptake of [14C]carnitine and accumulation of [14C]carnitine esters by the heart was greater (6-fold and 12-fold, respectively) than by the aorta. Analysis of defined arterial segments indicated that aortas in animals fed the atherogenic diet contained greater [14C]carnitine activity (4- to 8-fold) and greater acetyl-[14C]carnitine activity (4-fold) when compared to aortas of control animals; uptake of plasma [14C]carnitine and accumulation of acyl-[14C]carnitine compounds by the heart was independent of diet. Butyryl-[14C]carnitine, although not detected in aortas from animals fed the non-atherogenic or atherogenic diet for only 7 weeks, was detected in aortas from animals fed the atherogenic diet 17 weeks. Butyryl-[14C]carnitine was detected in heart tissue regardless of the animals' dietary regime. The increased uptake of circulating [14C]carnitine and its accumulation as both free and esterfied carnitine in atherosclerotic aortas occurred before the development of extensive macroscopic atherosclerotic lesions; this response of the aorta to atherogenic stimuli was not a general tissue response in that the heart did not respond similarly. Since blood carnitine is found predominantly in the plasma fraction, it is likely that these results refect the uptake and metabolism of plasma carnitine in vivo.


Influence of opium availability on addiction rates in Laos.

Crude rates of opium addiction were determined in 1972-1974 in ten communities of Laos, representing eight different ethnic groups and three provinces. In six rural communities, data were obtained by a house-to-house survey, and in four urban communities by opium den registration. Communities raising opium poppy as a cash crop had highest crude rates of addiction (7.0-9.8 addicts per 100 people). Thos involved in opium commerce had intermediate rates (4.1-5.5). Where neither opium production nor commerce was present, the communities had the lowest rates of addiction (1.8-2.3).


The primary structure of the alpha subunit of protocatechuate 3,4-dioxygenase. II. Isolation and sequence of overlap peptides and complete sequence.

The complete primary structure of the alpha subunit of protocatechuate 3,4-dioxygenase has been determined by automated Edman degradation and carboxypeptidase digestionof the intact alpha chain and of peptides derived from trypsin (N.A. Kohlmiller and J.B. Howard (1979) J. Biol. Chem. 254, 7302-7308) and Staphylococcus aureus protease digestion, and from hydroxylamine and dilute acid cleavage. The alpha chain was found to consist of 200 residues in the following sequence from the NH2-terminal end: (formula: see text).


Hepatic siderosis in alcoholics.

In a population of 157 (120 males, 37 females) predominantly British alcoholics with liver disease, the incidence of some degree of hepatic siderosis, as estimated by stainable parenchymal iron, was 57.3%. The incidence of significant siderosis (grades III and IV) was 7%, and was similar for both sexes. In the female alcoholics there was a significant correlation between age and the degree of siderosis (P less than 0.05)--four of the five females with significant siderosis being premenopausal. In the male alcoholics there was a significant inverse relationship between the grams of ethanol consumed per day and the degree of siderosis (P less than 0.05) and a significant correlation between the percentage saturation of iron-binding protein and the degree of siderosis (P less than 0.05). The mean daily iron intake from alcoholic beverages was 1.5 mg; there was no relationship between the amount of iron ingested in the alcohol and the degree of siderosis. In this population of alcoholics the incidence of significant siderosis in both sexes was low.


[Computed tomography of the heart: anatomical findings in normal subjects (author's transl)].

Clear images of the chambers of the heart and the vessels can be obtained by rapid scanning with computed tomography, associated with rapid perfusion of a contrast medium. A study in 30 normal subjects demonstrated that it was possible to identify and localize the heart chambers and the large vessels in different planes, and to obtain precise measurements of the various diameters. These results could form the basis for etiological studies of the cardiopathies.


[Retrograde carotid approach to aortography in neonates and babies: technique and results in 21 cases (author's transl)].

A new radiological technique is described for opacification of the thoracic aorta in neonates and babies weighing less than 10 kg. The exploration method is described: injection of a contrast medium after retrograde carotid puncture, and increased endothoracic pressure. The results obtained in 21 babies aged from 3 to 157 weeks, and weighing 3.3 to 10 kg are discussed. Radiographic results were excellent in 17 cases, satisfactory in 3 cases, and only moderate in 1 case. The procedure was perfectly well tolerated, and enabled visualization of an arterial canal in 4 cases, stenosis of a Blalock-Taussig anastomosis in 1 case, aortic stenosis in 7 cases (2 tubular hypoptasias, 1 coarctation, 3 segmentary interruptions, 1 recoarctation), coronary-cardiac fistula in 1 case, and a normal aorta in 9 cases. The authors review the advantages, inconveniences, and risks of the other methods of opacification of the thoracic aorta in neonates and babies. They conclude that when right cardiac catheterization cannot give, in babies under 10 kg of weight, a satisfactory radiological assessment of the thoracic aorta in the following clinical conditions: coarctation syndrome, badly tolerated left-right shunt, or possible abnormality of the aortic arch or coronaries, the technique of opacification of the thoracic aorta by retrograde puncture of the common carotid is the best radiological method for establishing a definite diagnosis.


[Vascular risk in angiography examinations (author's transl)].

About an experience of 7,757 investigations and after study of the published series in the literature, it appears the frequency of the accidents following vascular roentgenology has not really changed since ten years. -- 0,5% complications; 0,07% death in aortographies; -- 0,4% complications; 0,09% death in femoral artery catheterization; -- 3% complications; no death in axillary artery catheterization. The authors use the term "complications" when a surgical operation is necessary or after effects are present in the evolution. The study of the recent literature proves no significant amelioration in comparison with the last ten years. The accidents are analysed in aortography, in arterial catheterization using femoral or axillary arteries: the latter is the most dangerous. The considerable increment of the number of investigations suppressed the progresses provided by the material improvements. An explanation: in hospitals, it is necessary to train the students for roentgenology.


[Radiological aspects of infections due to mycoplasma pneumoniae in children (author's transl)].

The authors review 69 cases of infections due to mycoplasma pneumoniae in children, including the clinical, biological, and radiological aspects, and compare their results with those in the published literature. Clinical and radiological signs and non-specific, and diagnosis is made exclusively by serological tests.


[Ultrasonography of the pancreas. Diagnostic problems and findings in cases of solid pancreatic masses (author's transl)].

By using rigourous examination techniques and interpretive criteria, ultrasonography of the pancreas can, in many cases, confirm the etiological diagnosis of solid pancreatic masses. Factors influencing diagnosis are the volume and shape of the pancreas, the ultrasound structure, the attenuation of ultrasounds, the outline of the pancreas, and the effect on neighbouring structures. The association of signs is often characteristic and can differentiate benign from malignant masses.


[False tumor of the posterior mediastinum in a case of portal hypertension (author's transl)].

A man of 37 years of age developed portal hypertension which was observed on radiological examination as a mediastinal opacity having the appearance of a tumor. No oesophageal varices were seen on barium meal examination or by endoscopy. A smooth liver was seen during laparoscopy. Pre-operative hemodynamic studies showed that there was no sinus block. Thoracotomy revealed an aneurysm of the azygos veins. Exploratory laparotomy after coelio-mesenteric arteriography confirmed the diagnosis of diffuse nodular hyperplasia of the liver, cirrhosis, and portal hypertension. The findings in 16 cases of mediastinal opacity from portal hypertension reported in the published literature are discussed.


[Vaginal membrane with hydrocolpos and pyocolpos in children (author's transl)].

A child aged 4 1/2 years was found to have secondarily infected retained secretions in the vagina from a vaginal membrane. The authors underline the value of intravenous urography coupled with rectal insufflation, which is essential in order to confirm the diagnosis of colpos and to eliminate any associated urinary malformation.


[Role of the barrier system of the cerebral membranes in subarachnoid hemorrhage].

On the basis of literary and his own data the author distinguishes 3 stages of subarachnoidal hemorrhage, each having its own specific pathophysiological and pathomorphological features. The extracerebral barrier system can be divided into 3 structural and functional groups, such as: a) barriers between the cerebrospinal liquor and the blood; b) barriers between the liquor and the border tissues, and c) histohematic barriers. In the conditions of subarachnoidal hemorrhage accompanied with development of arterial spasm one observes disturbances of the liquor microcirculation because of blood clotting in the liquor and sticking of the blood clots in various parts of the subarachnoidal space, as well as changes in the ultrastructure of the morphological substrate of the extracerebral barrier system. All this, in the author's opinion, leads to damaging the innervation apparatus elements and smooth muscle cells of the cerebral arteries and arterioles; promotes the development of cerebral edema, etc. The data obtained make it possible to evaluate the role of the extracerebral barrier system of the meninges in cases of subarachnoidal hemorrhage with accompanying arterial spasm.


[Ultrastructural characteristics of the intracerebral components of the blood-brain barrier].

Electron microscopic studies of interactions between the cerebral tissue, the basal membrane of intracerebral vessels, and the limiting superficial membrane have been carried out. It has been demonstrated that highly specialized contacts of the compact and gap type are maintained constantly between the membranes of the neighboring astrocyte spicules around the vessels and under the limiting membrane. Such contacts are also encountered in the intercellular space in the whole mass of the brain. It is suggested that this specialized system and the basal membrane are of importance for regulating the functioning of the hematoencephalic barrier. It is noted that there exists a united structured system at the border between the cerebral tissue, cerebrospinal fluid, and blood, the participates in the pathogenetic and homeostatic mechanisms.


[Microglia-type cells in normal and pathologic human embryonic brains].

The brains of 7--12 week embryos, developing in normal and mentally ill females (normal--14, schizophrenia--12, other mental disorders--10) were studied by means of electron microscopy. It was established that the cells of the microglia type may be encountered in the brain of embryos beginning from 7 weeks. In the brain of embryos from normal females these cells had mainly a round or oval form (globose microglia). Axons were encountered relatively rarely. Some of the cells had protrusions of the pseudopodia-like type. In the brain of embryos from mentally ill females the cells of the microglia type have diverse, sometimes sticklike forms; they form multiple thin axons, actively fagocyte. The ultrastructure in such conditions was not destructed. These changes are considered to be the result of an increased activity of microglial cells under the influence of factors of the pathological process.


[Morphologic changes in the brain after sustaining asphyxia during labor (pathogenesis of mental retardation)].

An analysis was accomplished of pathomorphological changes in the brains of 10 newborns, who died of intranatal asphyxia and of 1 adult brain with mental retardation, due to asphyxia during delivery. The dynamics of hypoxic changes of an irreversible character in the brain of the newborn and the existence of chronic hypoxic encephalopathy with pronounced cellular devastation in the late period of asphyxia indicate common genesis of the pathological process in the brain, conditioning its progression. The role of intranatal asphyxia in the pathogenesis of changes in postnatal development of neuropsychic activity is discussed.


[Effect of tissue hypoxia on the structure of cerebral cortex neurons (light--electron microscopic study)].

An examination of the cerebral cortex of rats exposed to sublethal doses of potassium cyanide has revealed changes in the neurons characteristic of the developing histotoxic hypoxia. The neurons of the large hemisphere cortex showed a pronounced hydropic reaction in their cytoplasm with prevalent involvement of the mitochondria. This form of the pathology was observed irrespectively of the duration of the animals live after the poisoning. In rats which survived for a longer time there appeared hyperchromic neurons the number of which gradually increased. This fact was interpreted as addition of the hypoxic state of the neurons to the cyanide intoxication: this was confirmed by development of signs characteristic of hypoxic hypoxia at this stage. The degree of the changes in the mitochondria was found to correlate with the depth of the impairment of vitally important neuron structures. The data obtained show that the primary morphological changes in the neurons develop in their cytomembranes. The degree of the impairment of the mitochondrial membranes can serve as a criterion of reversibility or irreversibility of the pathological process in the nerve cells.


[Changes in the state of the blood-brain barrier in rats following experimental neurosensitization].

The accumulation and distribution of phosphorus radioisotope was studied in different brain areas of rats. These rats were desensitized by antigens of a whole homologous brain and its separate structures. A certain general tendency towards an accumulation of the brain phosphorus was detected after neurosensitization. Besides, in sensitization by separate structures (brain cortex, cerebellum) the most pronounced changes were in the hematoencephalic barrier (HEB) of the corresponding brain areas are less pronounced in other structures. The paper contains data concerning the function of HEB in animals immunized by the medulla oblongata. The found changes in the barrier mechanisms of the HEB in neurosensitization may be one of the pathogenetical mechanisms of certain diseases accompanied by neuroautoimmune processes.


[Heterogeneity of neurocytes of different brain regions to repeated superhigh-frequency irradiation].

The study was based on the analysis of morphological changes in the brain of 45 rats exposed for 10 days to ultrahigh frequency field of moderate gravity. Detailed studies of the state of the basophilic substance and the volume of the nuclei in the course of the neurocyte swelling were undertaken. The response of the neurocytes of various brain divisions was found to be heterogenous. The most pronounced were dystrophic changes in the sincipital area of the cortex. A lack of correlation between the character of the nuclear swelling and the degree of chromatolysis in the thalamic neurocytes was noted.


[Structure of the viscerocutaneous sensitive syndrome (pathogenesis of Zakhar'in--Head zones)].

On the basis of literature analysis, clinical observations, and examinations of the spinal cord ganglia of man (autopsy material) and experimental animals (dogs) performed with the use of a set of naurohistological and cytochemical methods an original explanation of the pathogenesis of the Head zones is suggested. The principal link in the formation of the viscero-cutaneous and viscero-sclerotomic sensation syndrome are transitory presynaptic terminals formed by the axons of the vegetative sensor neurons (cells of Dogel type 2) on the surface of the somatic receptor neurons innervating the skin and the sclerotomic tissues, and responding to temperature and pain. Within the zone of the innervation by the dendrites of these somatic receptor neurons (cutaneous and sclerotomic) a reflected viscero-sensory syndrome is formed. The formation of these viscero-cutaneous and viscero-sclerotomic syndromes proceeds in 4 steps.


[Thermopulsation rhythms and their importance to the physiology of thermoregulation and clinical practice].

Application of thermopulsation as a method of action on the human temperature analyzer for investigative, diagnostic and therapeutic purposes is substantiated on the basis of previous works of the author and his coworkers. New thermopulsation techniques are described and the results of their use are compared. Ideas of some specific mechanisms of thermoregulation and its clinical application are formulated in view of the fact that thermopulsation has proved highly efficacious for respiratory rhythms.


[Syndrome of aspontaneity in frontal lobe tumors].

The syndrome of aspontaneousity in tumors of the frontal lobes is expressed in a sharp decrease of initiative, spontaneous volitions, crude changes in the emotional sphere and peculiar disorders of thinking. In a "clear" form, i. e. without changed consciousness, the syndrome proceeds with signs of increased distractability and a combination of distrubances of wakefulness with rapid fatigueability. The first variant is more characteristic of bilateral intracerebral tumors, located on the level of the callosum sorpus. The second--for large unilateral tumors, exerting influence on the opposite frontal lobe and frequently on the diencephalic area.


[Muscle spasms in patients with amyotrophic lateral sclerosis (clinico-electromyographnic analysis)].

The diagnostic importance and electromyographic characteristics of the muscular spasms were studied in patients with lateral amyotrophic sclerosis at various stages of the disease. It has been shown that the muscular spasms are a typical symptom of this disease, and may be an early manifestation of the latter. The clinical and electromyographic characteristics of the spasms depend on the depth of the pathological process. Of importance in the origin of the muscular spasms in the lateral amyotrophic sclerosis is involvement of many levels of the cortico-muscular path, however, distrubances of the intraspinal mechanisms are, probably, the leading cause.


[Neurologic manifestations of periodic disease].

Results of comprehensive neurological examinations of 4 patients suffering from periodic disease have shown that the latter may be not only a disease entity, but also a syndrome characterizing some organic affections of the brain. The abdominal and other crises of the periodic disease included cerebrovascular disturbances which manifested hemipareses, syncopes, and migraine-like cephalgia. EEG and REG examinations have revealed dysfunction of the mesodiencephalic structures which, probably, underlies the pathogenesis of the periodic disease. The knowledge of the formerly almost unexplored neurological manifestations of the periodic disease will contribute to improvement of the therapy of this rare ailment.


[Experience with X-ray study of the skull structure of schizophrenic patients and their relatives].

Anthropological signs of the skull were studied in 431 schizophrenic patients, 99 parents (64 mothers and 35 fathers), and in 1371 individuals in the control group. By means of a comparitive polyvectoral statistical analysis a significant accumulation of abnormal and rare variants of the skull structure was established among the schizophrenic patients and their parents which significantly exceeds the frequency in a mentally healthy population (P less than 0,01--P less than 0,001).


[Pathomorphology of the brains of schizophrenic patients treated with psychotropic drugs (concerning drug pathomorphosis)].

Histological methods demonstrated that the use of psychopharmacological drugs in schizophrenic patients does not remove the characteristic neuron pathology (shrinkage, atrophy, lipofuscin dystrophy, cytolysis), but increases the metabolic processes in the intact nervous cells (an increase in the volume and basophilia in the cytoplasma, an enlargement of nuclei and nucleoli) and the glia activity (an increase in the amount of perineuronal satellites, general glia and the glioneuronal index). It is believed that the treatment does not remove the organic brain defect, but stimulates the metabolic processes in the CNS.


[Pathohistologic and biochemical changes in the brain in atherosclerotic dementia].

The data obtained from studies of 48 postmortem cases of atherosclerotic dementia with the use of histological and biochemical methods demonstrated a prevalence of ischemic changes in the nervous cells, cells-shadows, demyelinization, fragmentation of nervous filaments, hyperplasia, hypertrophy of astrocytes, a swelling of oligodendroglia compared to other changes. A drop in the amount of lecithin in the brain is the highest, while that in kefaline fractions is the lowest. A drop in the amount of sphyngomyelin occupies a middle place.


[Several diagnostic errors in cerebral atherosclerosis (clinico-anatomic study)].

A clinicoanatomical study was conducted in 218 cases of atherosclerotic dementia. 12 cases (5,5% of the total amount) showed diagnostic errors. Atherosclerotic dementia with Alzhemier-like symptomatology during life was considered to be Alzheimers disease, while Alzheimers disease, complicated by cerebral atherosclerosis as atherosclerotic dementia. Some objective and subjective factors of diagnostic errors were established. Late detection of such patients is considered as one of the risk factors of diagnostic errors during life.


[Radiological and manometric study of gastroesophageal reflux in normal infants].

The incidence of the gastroesophageal reflux was studied in 39 healthy infants with ages between 2 and 24 months. X-ray studies of gastroesophageal passage and esophageal manometry were practiced in all cases. Only 3 infants showed radiological reflux. The pressure in the gastroesophageal sphincter was normal in all babies and the highest pressures were reached less--than 6 months--old infants. Older infants showed lesser pressures. The same was true for the length of the gastroesophageal sphincter. The factors involved in the genesis of the gastroesophageal reflux are discussed.


[Electrophysiologic studies in Guillain-Barré syndrome].

A preliminary investigation into electrodiagnostic methods in healthy children and in children with the Guillain-Barré syndrome (polyradiculoneuritis) was carried out in order to assess the validity of these procedures in the management of the disease. Studies of the strength-duration curves, the rheobase, the chronaxyie, the accommodation index curves, motor nerve conduction and electromyography were made in 30 healthy children and in 15 children suffering from polyradiculoneuritis. The strength-duration curves plotted on the rectus femoris muscles of the 15 sick children showed a steeply rising hyperbola and no response was elicited at the shorter pulse durations (less than 0.3 ms). The chronaxyie was long in very clinically involved muscle. The accommodation index curve showed a notably decreased slope in the left gastrocnemius muscles of the 15 patients. Conduction velocity of the anterior tibial nerve was either absent or low in all the patients during the first month of the disease. Electromyographic records showed disappearance of the interference pattern on maximal contraction of the diseased muscles; only a few isolated motor units could be recorded in the first month of the disease. The duration and amplitude of these units was markedly reduced, there was an increase in infrequency of polyphasic potentials and the presence of fibrillation potentials was noted in some cases. Serial electrophysiological studies should therefore be of interest and of value in the management of polyradiculoneuritis.


[Balance technic in the syndrome of infantile diarrhea].

Ninety-six infants were studied with water balance technique at the Infant Unit of Hospital Roberto del Río, Santiago de Chile. Sixty-eight with acute diarrhoea and twenty-eight with protracted diarrhoea associated to carbohydrate intolerance. Total water losses in most of them were in the range of 150 to 225 ml/kg day. Stool loses were in the range of 25 to 75 gm/kg/day, with humidity percentage varing from 97.4 to 92.5%. In patients with acute diarrhoea, stool losses and humidity percentage showed slight decreasing tendency in the following balances. By contrast, those with protracted diarrhoea showed a definite decreasing tendency in both parameters. Most infants showed a urinary output in the range of 20 to 80 ml/kg/day. Ten percent showed oliguria. Polyuria was observed occasionally. Insensible water losses were in the range of 50 to 80 ml/kg/day. Most patients showed weight gain of 0.1 to 5.0% in the first balance. Stool acidity and presence of reductant substances (tested by positivity of Fehling reaction) were found in 24% of infants with acute diarrhoea in the first balance. Sodium concentration in stools varied from 40 to 70 mEq/l; and potassium varied between 20 and 40 mEq/l. Bacterial pathogens were isolated in 64% of patients with acute diarrhoea; most of them E. coli enteropathogenic.


[Renal function in normal and malnourished children given different doses of vasopressin in continuous infusion].

The effects of vasopressin administered by continuous infusion (0.75 and 0.5 mU/m2/minutes) was studied in two groups of three normal and two groups of 5 and 8 malnourished children given 0.5 and 0.3 mU/m2/minute. The following parameters were analyzed: urine volume, osmolality, water reabsorption, PAH, urea and inulin clearances, Na and K urinary excretion. Malnourished children had a urine volume 3 to 5 times higher than the normal groups. Vasopressin increased urine volume initially, but a mild antidiuretic effect followed in the normal groups. In malnourished children with a high CH2O, antidiuresis showed quite important figures with vasopressin. A transient fall in PAH and inulin clearances was observed with vasopressin in both malnourished groups with a mild drop in the normal group. Natriuresis with a higher % of the filtered sodium excretion was observed in the malnourished groups and in normal children with 0.5 mU of vasopressin. These results show that vasopressin had similar effects, but at a different level in the normal and malnourished children that we studied.


[Hepatitis A antibodies in children].

With the finding of HBV and HAV, it is possible at the present time to recognize according to its etiology three types of viral hepatitis: type A, Type B and type non-A-non-B. In this paper we have proved that a low socioeconomic status plays a very important role in the spreading of this disease. In a community with a low socioeconomic status, of forty children attending the fourth grade of a primary school, 97 percent were found to have anti-HA: while in a similar group of children with a higher socioeconomic background, we found only 40 per cent of positive cases. A positive sero convertion to anti-HA was found in 90 per cent of the 73 children with acute hepatitis; the remaining 10 per cent were non-A-non-B. A group of 61 children admitted to the L. Calvo Mackenna Children's Hospital with acute or chronic non hepatic disease were studied for anti-HA. We found 77% positive cases in the group of infants under 4 months old; in older infants, a low incidence of anti-HA was observed, but a notorious increase of positive cases was seen after the age of two years, reaching 100 percent of positive cases in children above four years of age. In ten patients studied with prolonged hepatitis, five of them could be possibly classified as having a non-A-non-B hepatitis.


[Maternal lactation. I. Resistance of maternal milk to bacterial contamination].

Bacteriologic studies in hands, nipples and milk in 10 wet-nurses were done in order to establish regulation for the recollection of breast milk to be used in low -birth-weight infants. The same studies were done in the hands of 10 nurse-aids, that help in the recollection of breast milk. The results depicts that the breast milk has bacteriostatic and bactericidal properties enough to protect against contamination by germs of the mother's bacterial flora. It does not have the same property against germs that are not of their own flora: those of the nurse-aids's hands. The protection is such that is possible to maintain the breast milk at environmental temperature of 4 degrees C, for 72 hours, without having the developing of germs not isolated previously, and even with the disappearance of some strains present in the initial cultures.


[Evolutionary study of 81 children with celiac disease].

A review of 81 children with celiac disease over a period of 5 years is presented. These cases were seen at the Gastroenterological Unit of the Hospital de Nińos Roberto del Río, during years 1970 through 1972. 62% of the patients (50) were placed under control of their disease, the rest were studied and diagnosed only for other centers. The short term evolution was good in 48 children (96%), while the medium and long term evolution, 2 to 5 years, was good only in 56% of the patients. This evolution was in direct relationship to the fulfillment of the dietary indications. The therapeutic test was positive among the studied group. A delay was observed in 80% of the cases that lasted from 1 to 6 months. The clinical and laboratory features of the group are analyzed, and the working method is described.


[Maternal lactation. II. Intestinal colonization in breast fed newborn infants].

Twenty-three low birth weight infants were studied to establish the role that breast milk plays in the intestinal colonization of the preterm infant, and in the control of epidemic diarrhea due to enteropathogenic E. coli, in nurseries. Twelve of these case were fed breast milk in bottles, and eleven with "humanized" powder cow's milk (NAN M.R.). Bacteriologic studies of feces were performed daily during the first 18 days of life. In 5 cases given breast milk, and in 8 receiving cow's milk, Staphylococcus aureus was isolated. Enteropathogenic E. coli was found in 3 cases with breast milk and in 6 with cow's milk. The finding of other non-pathogenic strains, was similar for both groups, except in the case of Proteus, that was found in 10 cases with breast milk, and in only 3 cases with cow's milk. Breast milk was unable to avoid the colonization by E. coli and in one case, was unable to eradicate this germ. None of the cases fed breast milk had diarrhea, including the three cases with E. coli. In another group, 4 cases developed severe acute diarrhea, due to enteropathogenic E. coli followed by 2 deaths. The results seem to point out that although colonization by enteropathogenic strains of E. coli is not completely avoided, these strains do not cause disease when these infants are fed breast milk.


[Bronchial asthma in children under 2 years of age].

Bronchial asthma is defined and some basic physiopathological phenomena are quoted. The most important facts leading to the investigation and the possibility of establishing the diagnosis of bronchial asthma in infants are mentioned. 61 children under 2 years of age who had been taken for consultation to the Bronchial Pulmonary Disease Department of the Exequiel González Cortés Hospital and the Child Medical Institute were analyzed in connection with the contribution of the anamnesis, physical check-up and the laboratory test to the diagnosis of the bronchial asthma. The following items are emphasized: value of the clinical history, the clinical test of total reversability of bronchial obstruction to (towards) adrenaline and the esoinophil count in bronchial secretion, and the skin test in children over 12 months of age. The conclusion is that it is possible to diagnose bronchial asthma in the child under two years old through simple, specific methods in any medical center with minimal equipment.


[Vascular rings].

22 cases of several types of vascular rings are presented. Most of them were double aortic arch (15): 12 were operated on without mortality before the first years of age because of the great severity of the symptoms. The precocity of the symptomatology and the predominance of the respiratory distress is emphasized. Our data point out to the importance of the differential diagnosis of vascular rings in newborns and infants in the presence of laryngeal stridor or respiratory distress, essentially because the surgical correction is very effective and the risk of the intervention is minimal.


[Rheumatic fever prevention unit].

The author describes the steps that have been taken recently on the prevention and the magnitude of rheumatic fever in Chile. Likewise, he describes the measures proposed by the Advising Committee on Rheumatic Fever, the evolution this disease has followed and the goals that they expect to reach before the next Pan American Conference on Rheumatic Fever.


[Cholestyramine in the treatment of acute bacterial diarrhea in infants].

32 infants admitted to Hospital "Roberto del Río" with infectious diarrhea and dehydration were assigned random to two groups, one of them receiving the usual therapeutic regimen of rehydration, refeeding and furazolidone and the other group the same treatment plus cholestyramine. The patients were studied with balance technique on days 1st, 3rd., and 5th. after admission, analyzing clinical progress, features of the stools, total digestive transit time, pH of the feces and the presence of reducing substances, volume of the stools, water excretion and sodium, potassium and chloride elimination in the feces. The patients receiving cholestyramine showed an earlier improvement in the appearance of the stools, less excretion of feces and water and diminished sodium and potassium elimination. Chloride excretion was similar in both groups. Cholestyramine tolerance was excellent. No side effects or complications were observed.


[Environment, nutrition and intellectual development].

The differential effects of malnutrition and psychosocial cultural deprivation (PSAC) upon intellectual performance and psychomotor development were studied in 52 preschool children attending nursery schools in urban Santiago (Chile). Nutritional status was evaluated according to Gómez, intellectual performance according to Weschler's scale (WISP and WISC tests), psychomotor development according to the Denver Developmental Screening Test and PSAC according to a numerical scale constructed from maternal I.Q.; socioeconomic status (Graffar) and a psychological questionnaire the correlational analysis, undernutrition was assigned a single value calculated from the severity and duration of the disease. An inverse correlation of - 0.36 existed between malnutrition and intellectual performance, and of - 0.39 between malnutrition and psychomotor development. Also, there was an inverse and significant correlation of - 0.73 between PSAC and psychomotor development; there was no correlation between PSAC and intellectual performance. Verbal I.Q. was more affected (r = - 0.52) than manual I.Q. (r = - 0.18) and children malnourished during the first 6 months of life attained lower scores of I.Q. than normals. The duration of malnutrition (mild in all cases) had no influence upon subsequent I.Q. This study was the basis for a rehabilitation program (educational-nutritional) to be applied in preschool children from nonprivileged areas.


[Urinary infection and pyelonephritis].

Actual concepts on urinary tract infection (UTI) and pyelonephritis have changed constantly through the years. A brief historical review has been considered in this paper, with the hope that nowadays concepts may help the clinician towards a better diagnostic and management approach of these still so common clinical disorders. Bacteriological studies were performed in 245 urine samples obtained by three different procedures, in order to evaluate the reability of each technique, which were: different procedures, in order to evaluate the reability of each technique, which were: a) suprapubic puncture; b) single culture obtained by midstream voiding technique, and c) serial cultures in three different samples, also obtained by the latter technique. E. coli was isolated in 91% of the initial diagnosed episode of UTI, and in 87% of the recurrences. Same bacteria, as well as other organisms and mixed flora were isolated from patients with predisposing factors present within the urinary tract (intra UT predisposing factor). Results show that suprapubic tap is the most reliable technique, since bacterial contamination of the sample is avoided. Fifty percent incidence of false positive results was found when a single culture by midstream voiding technique was used. A better correlation between suprapubic puncture and serial cultures obtained by midstream voiding technique was found. Both procedures are recommended. Predisposing factors, mainly within the urinary tract, were found in 68% of the cases with demonstrated UTI. Vesicoureteral reflux was found in 27% from the total number of patients studied, and in 52% of the patients with intra-UT predisposing factors. Suggestions are made in relationship with diagnostic approach and management of patients with UTI, in order to reveal the presence of predisposing factors, since they are the main feature to take into account regarding UTI, location of the site of infection, recurrences, chronic evolution, treatment and prognosis.


[Study of the immune system in relatives of children with dermatomyositis].

In view of the fact that relatives of patient with other connective tissue diseases may show immunologic abnormalities, we investigated cellular (PPD, SK-SD, candidine and diphteria-tetanous toxoid cutaneous tests) and humoral (IgG, IgM, IgA. CH50, C3, rheumatoid factor and ANA) immune responses in first degrees relatives (parents and siblings) of children with dermatomyositis. Of the 53 subjects tested, 19 had high values of one or two immunoglobulines; however, the mean Ig value was not different from that of the general population (p greater than 0.1), CH50, C3, rheumatoid factor and ANA were normal or negative. Cutaneous tests made on 46 subjects did not reveal abnormalities. Therefore our conclusion is that first degree relatives of children with dermatomyositis have not significant immunologic abnormalities.


[Intraventricular therapy in the management of ventricular ependymitis].

Through Scott's tubes, intraventricular administration of amynoglucoside antibiotics was given to two groups of patients: a) ten children with purulent meningitis and ventricular ependymitis due to gram - negative germs without malformation of the central nervous system (CNS) and b) sixteen children with ventricular ependymitis and malformation of the CNS. The duration of treatment was three weeks and no deaths issued in the first group. In the second group, there were four therapeutic failures related with the existence of encephalodysplasia or intraventricular wailing. The results described are very encouraging and allow to foresee a marked drop in the lethality of ventricular ependymitis.


[Acute pulmonary edema at high altitude in Mexico City].

For the first time in Mexico, two cases of acute pulmonary edema of high altitude are reported in a 6 year -old child and in a 16 year- old adolescent; both children lived in the city of Mexico. In identical circumstances, both developed progressive acute respiratory insufficiency on their return to Mexico City after several days at sea level. The final diagnosis was acute pulmonary edema of high altitude. In this paper, the producing mechanisms of this complication are discussed, together with the importance of making it known, in order to put on the lookout the medical personel, who work in the plateau, so that they may be conscious that this disturbance may occur at altitudes like that of Mexico City, (2480 meters above sea level) which is much lower than the altitude considered dangerous. (3000 meters). The most important facts of the clinical picture, together with the treatment recommended are pointed out.


[Placental pathology and perinatal infection].

The purpose of this review is to call attention on the participation of the placenta in intrauterine infections. The importance of a prompt recognition of the latter and the value of the placental examination to the understanding of such problems affecting the fetus and the newborn are emphasized.


[Short stature and nephrogenic diabetes insipidus. Report of a clinical case].

A male child who was initially studied as a short stature syndrome, was found to have a severe picture of polyuria-polydipsia. The routine tests for dehydration and vasopressin administration were carried out and the results obtained were fully demonstrative of a lack of renal response to the administration of vasopressin.


[Epidermolysis bullosa of the newborn].

Nine cases of epidermolysis bullosa of the newborn are reported. Three cases corresponded to the simple type; 4 were dystrophic and two belonged to the letal phase. Those of the letal variety died from septicemia, while simple and dystrophic varieties are under hospital control at the out-patient department.


[Engelmann-Camurati's disease. Report of a clinical case and its evolution during 4 years].

Engelmann-Camurati's diseases is a progressive alteration of the diaphysis of the long bones, where the etiology is unknown. It appears clinically around the age of two years, showing weakness of the lower limbs and frequent falls; there is also weight loss and in older patients, the appearance of secondary sexual characteristics is retarded. The diagnosis is made clinically and corroborated with x-ray studies that show increased density and width of the diaphysis. We report a case in a female where the diagnosis was established at twelve years of age; she received steroid therapy for four years without improvement. The mechanism of action of the steroids is unknown, but it seems that they stimulate the formation of healthy bone with adequate remodelling. Physiotherapy is necessary in these patients and if there should be a compression of the cranial nerves, surgical management may be useful to relieve compression.


[Acute toxoplasmic myelitis in the newborns].

The present paper describes 3 patients with congenital toxoplasmosis. The spinal cord was extremely affected. Differential diagnoses were established with poliomyelitis and neonatal hypoxia. Histopathological studies revealed toxoplasmosis.


[Perinatal morbimortality].

Between 1972 and 1975 (4 years), the Hospital de Ginecoobstetricia "Dr. Ignacio Morones Prieto" of the I.M.S.S. at Monterrey, N.L., reported a birth rate of 106, 771 with 98.35% (105,004) live borns. The morbidity rate was 262.06/1000 live borns and the perinatal mortality was 31.24/1000, divided into antenatal 16.54/1000 and posnatal 14.70/1000. Within morbidity, prematurity and/or low weight occupies the first place, followed by respiratory pathology and afterwards, jaundice, infections, obstetric trauma and finally, congenital malformations. The neonatal mortality reached 14.70/1000 live borns and if we consider gestational age, 22.9% corresponds to immature products, 50.2% prematures and 26.0% to full-term products. In relation to hours of life, we find that 62.50% of the total number of deaths were reported in products less than 24 hrs. of life and 37.50%, in products over 24 hrs. of life.


[Histopathological study on experimental cerebral infarction in rat (author's transl)].

An experimental model of cerebral infarction in rat brain was successfully established by means of the unilateral internal carotid injection of carbon microspheres. A histopathological investigation of the infarcted brain was performed. The results were as follow: 1. No cerebral infarction was made by the unilateral internal carotid ligation alone. 2. Focal cerebral edema was most marked at the white matter of the embolized hemisphere. 3. The edema was also conspicuous in the deep cerebral gray matter, especially in hippocampus. Degeneration and pyknosis of the neurons were observed at the same area. 4. Transudative hemorrhage in the focal cerebral edema was usually observed in the thalamus. 5. Edematous change in the cortical gray matter was not so marked as compared with the hippocampus and thalamus. 6. Carbon microsphere was not found in the capillaries of ipsilateral choroid plexus. The present experimental model of cerebral infarction will be useful in elucidating the pathological mechanisms of the cerebral infarction.


[Surgical closure of the patent ductus arteriosus in preterm newborns].

Two cases of patent ductus arteriosus in preterm newborns who were operated on are reported. Several physiopathologic and clinical aspects of importance for the diagnosis and treatment of this entity are pointed out.


[Renal failure and rickets].

Acute renal failure secondary to interstitial nephritis caused by therapeutic ingestion of sodium diphenylhydantoins has been reported recently. The interference of sodium diphenylhydantoins on Vitamin D metabolism causing or aggravating ricketts has also been reported. This communication deals with an infant girl who was admitted to the hospital due to seizures. Four months before, she had convulsions and she was treated with diphenylhydantoins until admission. She was found to have renal failure and ricketts. Histological diagnosis of interstitial nephritis was established by means of percutaneous renal biopsy. Clinical and radiological improvement of ricketts was observed after dehydrotachysterol treatment. Clinical and biochemical alterations of renal failure slowly subsided. She had a clear-cut history of vitamin D defficiency ricketts. Seizures were due to hypocalcemia tetany but was erroneusly treated as "grand mal" epilepsy, with diphenylhydantoins. Interstitial nephritis complicated with acute renal failure was probably caused by diphenylhydantoins administration.


[Capillaria hepatica. Report of the 2nd cased found in the Mexican Republic].

The 2nd. case of Capillaria hepatica seen in the Mexican Republic is reported together with clinical and laboratory findings of the visceral larva migrans syndrome, diagnosis which was made at the Hospital of Specialties of the Mexican Social Security Institute at Puebla, Pue. Mex. Same considerations are made regarding the biological cycle, its morphological characteristics and a review of the present state of the pathology, evolution and prognosis of the illness is made, focusing the attention to an immunological trend, as a close origin of the illness. Thus, it is concluded that an early recognition and diagnosis leads to an a adequate treatment that will be benifical to this kind of patients.


[The battered child syndrome. Preliminary review in a Bolivian pediatric hospital].

Taking into account the prevalence of child abuse in countries with different socioeconomic levels, the authors review this entity through the casuistics in a Bolivian pediatric hospital. Besides confirming unquestionable clinical findings, it was observed that among twenty-seven cases there was a predominance in preschool and school age children, in contrast with previous papers. The finding of three children with burns of various degrees and two cases who died as consequence of child abuse must be emplasized. The authors comment the varying forms of this syndrome according with foregoing Occidental publications, accepting that non-physical forms should require prospective researches in order to define a creditable prevalence and incidence of child abuse in an exposed population.


[Cellulitis in pediatrics. Diagnostic and therapeutic considerations].

The clinical histories of 180 cases of cellulitis or phlegmona diffusa were studied at the Hospital de Pediatría del Centro Medico Nacional. The disease prevailed in infants and preschool children. Staphylococcus aureus was the etiological agent most frequently found, but with the presence of enterobacteriaceae in 39% of patients under 2 years of age. One third of the children with cellulitis showed one or several complications. Lethality reached 5% (9 cases), but always related to septicemia from S. aureus. In 14.4%, osteoarthritis was present; frequently there was: fever for over 5 days in spite of adequate treatment, a history of late initiation of the antimicrobial drug (over 1 week) and phlogosis or functional limitation. The radiological picture that shows the bony lesion was evident only after two weeks. One half these cases remained with sequelae. Considerations are made on the adequate plans for antibiotic treatment and the early diagnosis of the osteoarticular complication.


[Cerebral infarction due to vasospasm following intracranial aneurysm rupture (author's transl)].

We have made an investigation of the 827 cases of ruptured saccular cerebral aneurysms operated on and 151 of them presented infarction attacks thought to be due to vasospasm brought about by aneurysm rupture. Based upon symptoms, angiography and surgical findings, an analysis was made of their age, sex and aneurysm location so related to incidence of infarction, period from the initial or last rupturing until time of infarction, indication of vasospasms from angiographical findings, and symptoms of infarction. Infarction occurs only between the fourth and fifteenth days following the last bleeding and in this period there was a high incidence of rebleeding, so that the current conception of reattack following cerebral aneurysm rupture must be updated in light of the fact that the therapy for rerupture and the therapy for infarction due to vasospasm are completely different.


[On the phenomena of multiple extravasations of contrast medium in cerebral angiogram of the cases of hypertensive intracerebral hematoma (author's transl)].

It is interesting to note the pathological findings that the rupture of multiple microaneurysms in the basal ganglia appears to be the cause of the hypertensive intracerebral hematoma. But there is few report that the carotid angiogram demonstrated multiple leakages of contrast medium of intracerebral hematoma in vivo than in Westberg's postmortem angiogram. The authors experienced 15 cases of hypertensive intracerebral hematoma whose cerebral angiogram showed extravasation of contrast material. It was fifty-seven per cent of which angiogram within 6 hours after the stroke showed leakage of contrast medium. However, there was remarkably decreased appearance of the extravasation after 9 hours after the stroke. Moreover, emphasis showed be placed upon the facts that eleven cases of 15 cases showed more than two adjacent spotty extravasations of contrast medium and that six cases demonstrated the simultaneous multiple leakages of contrast material from more than two lentriculostriate arteries. These angiographic findings has led us to the conclusion that there is intimate correlation between the large hematoma and multiple ruptures of the microaneurysms of lentriculostriate arteries.


Abnormal left ventricular wall movement in patients with chest pain and normal coronary arteriograms. Relation to inferior T wave changes and mitral prolapse.

Left ventriculograms of 45 patients with angina and normal coronary arteriograms were digitised frame by frame in order to detect regional abnormalities of wall movement. Though left ventricular pressures, end-diastolic volume, and ejection fraction were normal in all, regional outward movement during early systole was present in 10 patients, and abnormal inward wall movement during isovolumic relaxation also in 10, involving the apex or inferior surface. Both were present together in 8 patients, and affected segments showed normal amplitude and peak velocity of movement during ejection. These disturbances of wall movement were associated with inferior T wave changes on the electrocardiogram, and mitral prolapse, particularly when the latter resulted from delayed movement of the valve during ejection. It is suggested that the onset of contraction is delayed in affected areas, but that it proceeds normally thereafter. The resulting persistence of tension into the period of relaxation of the remainder of the ventricle may interfere locally with coronary flow, particularly during tachycardia, thus causing manifestations of regional ischaemia.


Echocardiographic pattern of posterior mitral valve leaflet movement after mitral valve repair.

The pattern of movement of the posterior leaflet at the time of opening of the stenosed mitral valve has been described as either anterior or posterior in direction. In 32 patients who underwent mitral annuloplasty, the anatomical features of the mitral apparatus were correlated with the postoperative echocardiographic pattern of movements of the posterior leaflet. Anterior movement of the posterior leaflet was associated with extensive disease of this leaflet, and posterior movement with minimal disease. No relation was found between valve orifice or anterior leaflet mobility and the pattern of movement of the posterior leaflet.


Mitral stenosis with high left ventricular diastolic pressure.

Three patients with mitral stenosis are described, in whom the haemodynamic findings at cardiac catheterisation were more suggestive of left ventricular myocardial disease, in that the left ventricular diastolic pressure was high and the mitral valve gradient small. However, their echocardiograms showed abnormal wall movement during diastole characteristic of severe inflow obstruction, with slow and protracted filling, and at operation mitral stenosis was confirmed. Left ventricular wall stress was estimated throughout the cardiac cycle in one patient, and the diastolic stress-strain relation shown to be abnormal. The effects of mitral stenosis on left ventricular function are complex, and are not explicable simply by reduction in size of the mitral orifice.


Measuring the effect of a mobile coronary care unit upon the community.

A mobile coronary care unit working within a geographically defined area retrieved 20% of the estimated number of cases with myocardial infarction. These cases were similar to the population at risk in terms of age, sex, and previous history of ischaemic heart disease. Patients retrieved by the mobile unit had a lower overall case fatality ratio. This discrepancy was greater than could be explained by resuscitation or preventive treatment by the mobile unit teams. Reasons for this difference in mortality were explored. The benefits of the mobile coronary care unit were obvious in terms of the existing service but small in terms of the community. Any judgment on the effectiveness of a mobile unit must use both approaches to get a balanced view.


Patterns of haemodynamic alteration during left ventricular ischaemia in man. Relation to angiographic extent of coronary artery disease.

Haemodynamic changes produced by rapid atrial pacing (60 patients, 52 of whom developed angina) or in association with spontaneous angina (32 patients) were measured in 92 patients with angiographic coronary artery disease. The extent of coronary artery disease was scored by the jeopardy score system (range 0 to 12). The haemodynamic changes induced by ischaemia occurred in 3 patterns: pattern I, no change in filling pressure or in mean systemic arterial pressure; pattern II, a rise in filling pressure and a rise in mean systemic arterial pressure; pattern III, a rise in filling pressure, but no significant change or a fall in mean systemic arterial pressure. In patients who had a pattern II or a pattern III response to ischaemia, the change in mean systemic arterial pressure was linearly related to the corresponding change in cardiac output. The likelihood of a patient showing a given pattern of ischaemia-induced haemodynamic change was related to the extent of coronary artery disease; of 22 patients with jeopardy scores of 2 or 4, 91% exhibited pattern I, 9% pattern II, and none pattern III; of 39 patients with jeopardy scores of 6 or 8, 40% exhibited pattern I, 22% pattern II, and 38% pattern III; of 31 patients with jeopardy scores of 10 or 12, 12% exhibited pattern I, 10% pattern II, and 78% pattern III (P less than 0.01). Among the 54 patients in whom serial cardiac output determinations were available, a decline of the left ventricular function curve during ischaemia was demonstrable in 8% of those with a pattern I response, in 54% of those with a pattern II response, and in 90% of those with a pattern III response (P less than 0.01). The pattern of response was unrelated to resting angiographic left ventricular ejection fraction, whether ST segments became elevated or depressed, or whether ischaemia was pacing-induced or spontaneous. These results suggest that the haemodynamic response to ischaemia is determined by the fraction of the left ventricle that becomes dysfunctional during ischaemia.


Pulmonary hypertension and sudden death in aortic stenosis.

Sudden death is now an infrequent occurrence in severe aortic stenosis. However, an impressive increase in pulmonary arteriolar resistance has been found in some patients with end-stage aortic stenosis dying suddenly or deteriorating suddenly after catheterisation. Pulmonary hypertension does not seem to cause sudden death, but, in conjunction with decreased cardiac output, a critical reduction in aortic orifice area, and left ventricular failure, pulmonary hypertension identifies a population at significant risk. The rare finding of severe pulmonary hypertension in aortic stenosis should be considered an important marker for sudden death and in association with left ventricular failure may indicate an urgent need for valve replacement, regardless of the apparent clinical condition of the patient. In a small number of subjects catheterised postoperatively, increased pulmonary arteriolar resistance lessened rapidly.


Doerr's theory of morphogenesis of arterial transposition in light of recent research.

Doerr's theory of the morphogenesis of transposition is discussed with special reference to recent studies by Goor and co-workers and Anderson and associates. The views advanced by all these authors coincide in three points: (a) the description of the reorganisation process occurring at the arterial end of the embryonic heart (a process called by Doerr vectorial bulbus rotation); (b) the pathogenetic interpretation of transposition as the result of an arrest of vectorial bulbus rotation; (c) the recognition of a teratological series or spectrum of anomalies pathogenetically related to transposition. Vectorial bulbus rotation is explained mainly as the result of three largely simultaneous events; bulbar shift, bulbus torsion, and truncus torsion. The spectrum of anomalies related to transposition appears as a close-knit series. Bulbar retraction does not seem to be a necessary condition for the connection of the aorta to the left ventricle.


Gross distortion of atrioventricular and ventriculo-arterial relations associated with left juxtaposition of atrial appendages. Bizarre form of atrioventricular criss-cross.

Two pathological specimens are described in which a bizarre distortion of atrioventricular and ventriculoarterial relations existed. In both cases anterior and leftward displacement of the tricuspid valve coexisted with rightward displacement of the infundibular regions and semilunar valves. Abnormal expansion of the AV canal, possibly secondary to malrotation of the cardiac tube, is considered as a possible cause of the anomaly. One of the hearts showed severe subpulmonary stenosis produced by a valve-like structure which was well differentiated, with a complete annulus and chordae tendineae that inserted in a parachute-like fashion on the infundibular septum. The morphology of this structure was clearly different from that fo the fibrous tags described in other anomalies. Its origin is uncertain. These anomalies have important implications in relation to the nomenclature and classification of congenital heart malformations, and illustrate the value of recent modifications of the segmental approach.


Elective aortic and mitral valve surgery in patients over 70 years of age.

The results of elective cardiac surgery carried out between 1970 and 1975 on 29 patients over 70 years of age are reported. Operative mortality was 10%, late cardiac mortality 14%, with 72% survival at a mean follow-up of 38.6 months. Before operation 96% were in functional classes 3 and 4. After operation 90.5% of late survivors were in functional classes 1 and 2 at a mean follow-up of 43.5 months. These results compare favourably with those in younger patients. Complication rate and length of hospital stay were unremarkable. The risks of neurological damage and of long-term anticoagulation are not increased. Emergency surgery carries a very high risk in this age group. The importance of biological youth and good left ventricular function is emphasised. For aortic stenosis at least prognosis is improved by surgery.


Sinus node dysfunction associated with absence of right superior vena cava.

A 41-year-old man presented with dizziness associated with sinus bradycardia and sinus arrest. An attempt to implant a transvenous pacing lead was frustrated by absence of the right superior vena cava. The left superior vena cava persisted and drained via the coronary sinus into the right atrium. Absence of the right superior vena cava may present with symptomatic sinus node dysfunction and may require an epicardial demand pacing system.


A case of isolated primary chylopericardium.

Primary chylopericardium presented as radiographic cardiomegaly in an asymptomatic 19-year-old man. Normal findings at cardiac catheterisation and angiographic demonstration of cardiac displacement from the diaphragm suggested a collection of fluid below the heart which was confirmed by M and B mode ultrasound scanning. Thoracic blood pool isotope scanning indicated that the lumen was a pericardial effusion rather than a cyst. Lymphangiography did not indicate any direct lymphatic communication though a small pool of contrast appeared in the pericardium and the diagnosis of chylopericardium was confirmed by pericardiocentesis. Surgical treatment was undertaken after rapid reaccumulation of chyle and the patient remains well 6 months later.


Rotational excursion of heart in massive pericardial effusion studied by phased-array echocardiography.

We have observed rotational excursion, comprising anteroposterior and right to left movement of the heart, and cardiac twist around the long axis in 2 patients with massive pericardial effusion, using a phased-array echocardiograph recently developed in this country. Sagittal real-time cross-sections showed only the anteroposterior swing motion, but horizontal cross-sections revealed a counterclockwise rotational excursion and cardiac twist during this rotational excursion. The rotational excursion consisted of a rapid and almost straight movement right and posteriorly in systole, and a slow arcing excursion left and anteriorly in diastole. The speed of this movement was not uniform. The heart disclosed dominant counterclockwise twisting motions in mid to late systole and in late diastole, synchronous with atrial contraction. These movements were described relative to an external system of co-ordinates. Controls, consisting of a normal healthy subject, and cases with mitral stenosis, mitral regurgitation, and hypertrophic cardiomyopathy, did not show any rotational excursion. In the latter 2 diseases, cardiac twists were observed, but they were less dominant than in cases with massive pericardial effusion.


Evaluation of posterior aortic wall echogram in diagnosis of mitral valve disease.

The clinical usefulness of detecting abnormal movement of the posterior wall of the aortic root by M-mode echocardiography was studied in 93 patients with common cardiac diseases (mitral and aortic valve disease, atrial septal defect, hypertrophic and congestive cardiomyopathy) and in 17 normal subjects. Though abnormally slow (less than 3 cm/s) or prolonged (greater than 240 ms) diastolic movement was confirmed to be common in mitral stenosis, since it occurred in 35 of 36 patients it was non-specific. Similar abnormalities frequently occurred in other patients with, for example, mitral regurgitation, aortic valve disease, after aortic valve replacement, and in both hypertrophic and congestive cardiomyopathy. The severity of mitral stenosis, assessed at operation, could not be accurately predicted from abnormalities of aortic root movement. Information derived from aortic movement was not diagnostic and did not predict severity in isolated mitral regurgitation though both the peak rate of systolic aortic motion and total aortic excursion were significantly greater than normal. We conclude that abnormalities of posterior aortic wall movement are frequent and their specificity and clinical usefulness are limited.


Determination of pressure gradient in mitral stenosis with Doppler echocardiography.

The accuracy of a non-invasive ultrasound Doppler technique for the determination of the pressure gradient in mitral stenosis was evaluated in a study of 8 adult patients. Transseptal left atrial catheterisation and retrograde left ventricular catheterisation were performed. The same diastoles were used to compare the gradient constructed from the ultrasound data (delta PU) with that constructed from the manometric data (delta PM). In the 8 patients the difference betweent he mean diastolic values of delta PU and delta PM was - 0.54 +/- 1.0 (SD) mmHg. The corresponding figure for mid-diastole was 0.01 +/- 0.9 (SD) mmHg. The results indicate that the ultrasound technique is sufficiently accurate for diagnostic purposes.


Nomenclature and classification of congenital heart disease.

At present there is no universally accepted nomenclature for congenital cardiac malformations. Much of the controversy results from failure to distinguish the structural connections of the heart from the morphology and spatial relations of its components. The confusion is compounded by an abundance of individual definitions, many of them speculative. The present article proposes a totally descriptive nomenclature. It describes in turn the connections of the cardiac segments, their morphology, their relations, and additional anomalies in any segment. Each step in the segmental approach is discrete. The overall effect is to force a succinct and comprehensive description of any cardiac malformation, no matter how complex.


Prevalence of congenital heart disease in black schoolchildren of Soweto, Johannesburg.

A survey conducted by cardiologists in Soweto, Johannesburg, provided an opportunity of assessing the frequency of congenital heart disease in black schoolchildren. Among 12,050 schoolchildren aged 2 to 18 years, 48 had a congenital heart defect, yielding a prevalence of 3.9 per 1000. Only in 2- to 6-year-old children did the prevalence exceed that of rheumatic heart disease. The distribution of the types of defects was largely similar to that reported in other surveys with a predominance (52%) of ventricular septal defects. Two unusual findings were the unexplained absence of persistent ductus arteriosus in these children, and the detection of 5 children with situs inversus (1 in 2410). In all but one child, the congenital heart defect was first discovered during the survey. Despite the limitations of a prevalence study, it can be concluded that congenital heart disease is at least as common in this South African black community as in Caucasians.


Haemodynamic studies in veno-occlusive disease of the liver.

Haemodynamic studies in 8 tribal patients from central India with veno-occlusive disease of the liver are reported. The disease was caused by eating cereals contaminated with seeds of a crotalaria species rich in toxic pyrrolizidine alkaloids similar to monocrotaline and fulvine. All patients showed raised hepatic venous wedge pressures and pressure gradients between hepatic venous wedge and free hepatic vein. Significant pressure gradients were also observed in the inferior vena cava. Right and left heart pressures were normal. Cardiac and stroke indices and ventricular work were significantly increased while systemic and pulmonary resistances were reduced. Hepatic blood flow was also reduced. Hepatic venograms were abnormal and the changes correlated well with the pressure gradients between hepatic venous wedge and free hepatic vein and with the histological changes in the liver.


Electrophysiological and haemodynamic basis for application of new pacemaker technology in sick sinus syndrome and atrioventricular block.

A fundamental description of pacemaker systems which are commercially available or in clinical validation is given as a background for their application in a series of 62 consecutive patients presenting over a period of 1 year for permanent cardiac pacing. The patients (23 (37%) sick sinus syndrome, 38 (61%) atrioventricular block, and 1 ventricular tachycardia) were studied electrophysiologically and haemodynamically to allow the appropriate application of a pacemaker system. In sick sinus syndrome, 8 patients had permanent atrial pacing, 14 ventricular pacing, and 1 atrioventricular sequential pacing; in atrioventricular block, 8 patients had atrial synchronous ventricular inhibited pacing and the remaining 30 had ventricular pacing. A high incidence of atrial fibrillation, 9 patients, and abnormal sinus node function, 15 patients, precluded wider use of atrial synchrony. The results show benefit in acute haemodynamic studies of using systems including atrial sensing and/or pacing, and with greater availability of atrioventricular sequential and still more advanced pacemakers with dual sensing as well as dual pacing the majority of patients may be offered this benefit.


Cardiomyopathic syndrome caused by coronary artery disease. III: Prospective clinicopathological study of its prevalence among patients with clinically unexplained chronic heart failure.

Each day, for one year, the medical records of adult patients who died in hospital were reviewed before seeing the necropsy findings. For those patients who had had chronic left or left and right heart failure, a presumptive cause was assigned on the basis of antemortem clinical data. Of 740 consecutive patients who were studied at necropsy, 90 had had chronic heart failure. In 15 patients the cause of heart failure was not apparent by clinical criteria; of these, 7 were found at necropsy to have cardiomyopathic syndrome caused by coronary artery disease. In retrospect, the presence of overt diabetes mellitus was a clue that cardiomyopathy caused by coronary artery disease was the cause of clinically unexplained heart failure; 5 of 7 patients with unexplained heart failure who were found to have this at necropsy were diabetic, whereas only 1 of the other 8 patients with clinically unexplained heart failure was diabetic (P less than 0.05). Patients in whom clinically unexplained heart failure was found to be the result of cardiomyopathy caused by coronary artery disease had multiple myocardial infarctions on pathological examination, which, with one exception, were nontransmural. By contrast, myocardial infarctions were transmural on pathological examination in each of 7 matched 'controls' with heart failure, in whom the diagnosis of coronary artery disease had been clinically apparent (P less than 0.01).


Marfanoid hypermobility syndrome associated with coarctation of the aorta.

There are intimate interrelations between various elements of connective tissue, viz. collagen, elastin, and glycoproteins. It is not unexpected that Marfan and Ehlers-Danlos syndromes share common features. The condition is labelled as Marfanoid hypermobility syndrome. In the patient described here, the Marfanoid hypermobility syndrome was associated with coarctation of the aorta which was corrected surgically.


Polymyositis and complete heart block.

The development of complete heart block is described in a patient with polymyositis. The implantation of a permanent pacemaker has controlled the heart block, but the progression of the underlying disease despite treatment with relatively high dosage of corticosteroids makes the outlook uncertain.


Prognosis of patients paced for chronic atrioventricular block.

Between the years 1960 and 1974, 839 patients were paced for chronic complete atrioventricular block. Analysis of survival compared with the general population showed that 170 deaths were expected according to standard mortality tables and 288 actually occurred, giving a ratio of actual to expected deaths of 1.7:1. Patients with a definite history of myocardial infarction showed a higher than average mortality when paced. Mortality was not influenced whether heart was constant or intermittent, whether the ventricular rate was below or above 40/minutes, or whether QRS duration was greater or less than 0.1 second. Analysis of the age groups paced disclosed the most important correlations. Between the ages of 80 and 89 years paced patients could expect to survive as long as other of the same age without heart block. There was, however, a very high ratio of 4.5:1 for 90 patients in the age group 50 to 59 years. The reason for the high mortality ratio was uncertain but it may have been the result of a greater incidence of underlying coronary artery disease.


Complete right bundle-branch block: echophonocardiographic study of first heart sound and right ventricular contraction times.

High speed enchocardiograms of the mitral, tricuspid, and pulmonary valves were recorded with a simultaneous electrocardiogram and phonocardiogram in 20 patients with complete right bundle-branch block and in 67 normal subjects. Late opening of the pulmonary valve indicating late right ventricular ejection was found in all patients. In 8 patients with wide splitting of the first heart sound the late ejection was related mainly to delay in tricuspid valve closure, suggesting a late onset of the right ventricular pressure pulse. In 10 patients with a single first heart sound the delayed ejection was associated with a long interval between tricuspid valve closure and pulmonary valve opening, suggesting a slow rising right ventricular pressure pulse; 3 of these patients also had late tricuspid valve closure but the tricuspid component of the first sound was absent. Late onset of pressure rise is thought to result from block in the main right bundle-branch, and a slow rising pulse from block in the distal Purkinje network. These findings explain the conflicting results in previous studies of the first heart sound and right ventricular pressure pulse in patients with right bundle-branch block, and may have prognostic significance.


Patients treated in a coronary care unit without acute myocardial infarction: identification of high risk subgroup for subsequent myocardial infarction and/or cardiovascular death.

Consecutive patients admitted to a coronary care unit (CCU) during one year were studied. The diagnosis of acute myocardial infarction was not substantiated by our criteria in 206 of the patients discharged from the CCU. Of these, 193 were retrospectively followed up during one year. Seventeen of the patients (9%) died from cardiovascular causes during the 1-year period. Another 14 patients (7%) had a subsequent non-fatal acute myocardial infarction during the same period. The majority of the patients had coronary artery disease. Only 32 (17%) could be classified as non-coronary cases, and these had an excellent prognosis without any subsequent acute myocardial infarctions or deaths. The occurrence of transient ST-T shifts in serial electrocardiograms obtained during the first 3 days in hospital selected a subgroup of patients who had a high risk for subsequent non-fatal acute myocardial infarction and/or cardiovascular death. This high risk subgroup provides a basis for more aggressive diagnostic and therapeutic intervention.


Reduction of early ventricular arrhythmia by acebutolol in patients with acute myocardial infarction.

To assess the effects of intravenously administered acebutolol (1-20 mg every 4 hours for 24 hours) on cardiac rhythm and performance, we studied 72 patients with evolving myocardial infarction. Twenty-five patients were treated with acebutolol beginning 6 hours after the first increase in the level of plasma creatine kinase. Enzymatically estimated infarct size was compared with that of 25 controls matched for predicted infarct size. Observed infarct sizes were not significantly different in the 2 groups (37 +/- 5 and 30 +/- 5 CK-gram equivalents, respectively). Mean heart rate, diastolic blood pressure, and cardiac output declined from control values during treatment with acebutolol, but remained within the normal range. Mean pulmonary artery pressure and pulmonary artery occlusive pressure were unchanged. In a group of 22 treated patients matched with 22 control subjects for frequency of ventricular extrasystoles, acebutolol effected a prompt reduction in frequencies of ventricular extrasystoles and repetitive arrhythmias, whereas values were not significantly changed in controls during the corresponding intervals. Accordingly, acebutolol may be a useful antiarrhythmic agent in selected patients with acute myocardial infarction with adversely altering haemodynamic stability or enzymatically estimated infarct size.


Estimation of myocardial infarct size in man using 99m Tc polyphosphate.

We have critically evaluated the use of 99m Tc polyphosphate to estimate myocardial infarct size. Optimum conditions were first defined with respect to infarct edge definition, and relative activity over infarct and bone and in blood pool. The scintigrams of 53 patients with acute transmural myocardial infarction were recorded under these defined constant conditions and analysed in various ways. Visual grading of infarct area or intensity correlated poorly with other indices of infarct severity. Computer-assisted measurements of above-background infarct uptake area or of total farct activity correlated well with clinical, electrocardiographic, and enzymatic measurements of infarct severity.


Uhl's anomaly.

Uhl's anomaly of the heart is a rare condition. Another well-documented case is presented with a review of the published reports outlining the main clinical features and the bad overall prognosis. Right atriotomy should be avoided if closure of the atrial septal defect is attempted.


Maximal supine exercise haemodynamics after open heart surgery for Fallot's tetralogy.

Maximal supine exercise studies at the time of heart catheterisation were performed one to five years after open heart surgery for Fallot's tetralogy on 29 subjects 6 to 16 years of age. During exercise right ventricular systolic pressure exceeded 50 mmHg in all but 2 subjects, and end-diastolic pressure increased to over 15 mmHg in 10 subjects. Pulmonary artery peak systolic pressure was abnormal in 5 patients. Maximal exercise cardiac index was below the normal range in only 2 subjects, but below the mean for normals in 80 per cent of the patients. Only 3 patients had clinical exercise performances below the 3rd centile of normal subjects using a maximal upright bicycle exercise test, and only 1 subject was below the normal range for endurance time on the Bruce treadmill test. The patients in this series performed better than those in other series, possibly because of their younger age at operation, the use of a large control series of normal subjects taken from a clinic population, the willingness of the patients to work to near exhaustion, and previous encouragement of the patients to become normally active children.


Long-term follow-up in primary pulmonary hypertension.

Two patients with severe primary pulmonary hypertension, who are alive 38 and 27 years after the onset of the disease, were closely followed by the authors for 24 years. No previous report of such a long course has been found. Despite pulmonary artery pressures at systemic level, effort syncope disappeared and there were long intervals without symptoms during which the 2 patients were able to take part in physical activity with minimal discomfort. Severe primary pulmonary hypertension should not always be considered a malignant disease.


Clinical electrophysiological effects of propranolol on normal sinus node function.

In 35 patients aged 18 to 69 years (mean 48) with clinical, electrocardiographic, or electrophysiological evidence of normal sinus node function, the effect of intravenous propranolol (0.1 mg/kg) was assessed on 3 indices of sinus node function. The drug significantly prolonged sinus node cycle length (12%), slightly prolonged the corrected sinus node recovery time (15%), and slightly but insignificantly lengthened sinuatrial conduction time. Propranolol may be administered safely in patients with normal sinus node function without the fear of producing severe sinus bradycardia, sinuatrial block, sinuatrial pauses, or prolonged sinus asystole, after spontaneous or stimulation-induced conversion of a tachycardia.


Comparability and reproducibility of apex cardiogram recorded with six different transducer systems.

A comparison was made in 7 dogs of the results obtained by 6 different apex cardiographic transducers applied before, during, and after controlled infusion of angiotensin and isoprenaline. The electrocardiogram, internal phonocardiogram, aortic and left ventricular pressure using a Telco micromanometer, and apex cardiogram were recorded simultaneously on magnetic tape and paper. Digital computer techniques were used to derive various measurements. The comparison of the 6 transducer systems was made expecially with respect to measurements derived from the normalised derivative, calculated using total as well as developed pressure or displacement. Measurements derived from left ventricular pressure were very reproducible. Differences in results of 'contractility' indices varied between 0.5 and 1.9 per cent. Indices from the apex cardiogram using 6 different transducer systems showed variations up to 20 per cent, with mean values varying between 3.2 and 8.1 per cent. There was a systematic deviation for one transducer system, which was responsible for a significant part of the observed variability. It may be concluded that in order to assure maximal reproducibility, technical characteristics of the apex cardiograph transducer should be taken into account and an optimal recording technique should be used.


A severe complication of pulmonary vein angiography.

A pulmonary vein angiogram was performed using a pressure injection with the tip of an end and side hole catheter in a near-wedge position; extravasation of contrast material into a bronchus occurred, causing severe bronchoconstriction. It may be possible to avoid this complication by the use of an end hole balloon catheter in the wedge position, slow flow rates of contrast material, and low pressure injections.


Mitral valve replacement for mitral stenosis caused by Libman-Sacks endocarditis.

A women who developed mitral stenosis from Libman-Sacks endocarditis is described. The mitral valve was replaced by a Starr-Edwards prosthesis. One year later, despite her being maintained on steroids and azathioprine, the verrucous endocarditis progressed to cause sudden, severe dysfunction of the prosthetic valve.


Alternating atrial and ventricular tachycardia.

A patient with alternating atrial and ventricular tachycardia is described. He had an acute myocardial infarction and was taking digitalis. The atrial tachycardia, which was occasionally associated with aberrant ventricular conduction, was able to interrupt the ventricular tachycardia though the reverse was not true, suggesting a retrograde conduction block. This patient shows that atrial and ventricular arrhythmias can alternate and, since tachycardia with aberrant ventricular conduction can closely resemble ventricular tachycardia, intra-atrial electrocardiography may be necessary to establish an accurate diagnosis.


Cytotoxic effects of procaine, lignocaine and bupivacaine.

Cytotoxic effects of procaine, lignocaine and bupivacaine were investigated on cultures of Chinese hamster lung fibroblasts. Cell growth was inhibited over 24 h exposures with an ED50 of 0.17% for procaine, 0.07% for lignocaine and 0.02% for bupivacaine. Cell survival (measured as colony-forming ability) was reduced over 24 h exposure with an ED50 of 0.21% for procaine, 0.09% for lignocaine and 0.06% for bupivacaine. Morphological changes included vacuolation, cell rounding and retraction from the surface on which the cells were growing. Motility was reduced to about 50% of control by lignocaine 0.1%. On removal of the local anaesthetics, cell growth was resumed after about 15 h without evidence of chromosome damage. Corresponding changes induced by inhalation anaesthetics are only seen at two to three times the minimal alveolar concentration required for anaesthesia.


Effect of the chronic administration of nitrous oxide 0.5% to gravid rats.

Twenty-four gravid Wistar rats (12 experimental and 12 control) were studied. From day 1 to day 19 of gestation the experimental group was exposed day and night to nitrous oxide 0.5%, while the control group was exposed to air. On day 19 the rats were killed and a detailed examination of the uterus, ovaries and fetuses was undertaken. The fetuses were fixed, cleared and stained with alizarin red, examined for skeletal anomalies and their crown-rump lengths measured. There was a significant decrease in litter size of the dams exposed to nitrous oxide as compared with control (P less than 0.001). Fetal resorption occurred in 10 of the 12 exposed dams. Skeletal anomalies were observed in 9% of the fetuses in the experimental group and there was an overall reduction in their size. None of the above changes were observed in the control.


Effect of hypercarbia on hepatic blood flow and oxygen consumption in the greyhound.

The stability of a technique for measuring hepatic blood flow and oxygen consumption was established in six greyhounds anaesthetized with pentobarbitone (group A). Subsequently, the effects of increased PaCO2 were studied in another six animals (group B). With one exception (splenic blood flow) no significant changes were observed in any of the indices measured in group A. In group B, although hepatic arterial blood flow (HABF) decreased when PaCO2 increased, both portal venous blood flow (PVBF) and total liver blood flow (HABF+PVBF) increased. However, these changes were much less marked after 20 min. Hepatic oxygen consumption and splenic venous blood flow were unchanged with an increase in PaCO2.


Effect of hypotension induced with sodium nitroprusside on canine coronary arterial flow.

In seven dogs anaesthetized with pentobarbitone, coronary and pulmonary artery blood flows were measured using electromagnetic flow meters. The infusion of a 0.01% solution of sodium nitroprusside caused an initial small increase in mean coronary artery flow which returned to control as the arterial pressure decreased. No changes were noted in cardiac output nor were further changes observed in coronary flow. Heart rate was increased consistently during the hypotension and left ventricular dp/dt max was reduced as were coronary and total peripheral resistances. There were no significant changes in myocardial or total body oxygen extraction or consumption.


Depression of hypoxic pulmonary vasoconstriction in the dog by dopamine and isoprenaline.

The effects of dopamine and isoprenaline on the pulmonary vasoconstrictor response to alveolar hypoxia were assessed by measuring the redistribution of blood flow between the lungs in response to unilateral hypoxia. Dose rates of dopamine 25 micrograms kg-1 min-1 and isoprenaline 0.25 micrograms kg-1 min-1 (which produced equal increments in thecontractile force of the heart in dogs) produced a similar degree of depression of they hypoxic vasoconstrictor response, whereas dopamine 2.5 micrograms kg-1 min-1 had little effect on the response PaO2 during unilateral hypoxia was inversely related to the blood flow through the hypoxic lung.


Effect of etomidate on intracranial pressure and cerebral perfusion pressure.

Ten patients with intracranial lesions, anaesthetized with thiopentone and nitrous oxide (70%) in oxygen (30%) received etomidate 0.2 mg kg-1 i.v. Ventilation was controlled in each patient. Intracranial pressure (i.c.p.) and mean arterial pressure (m.a.p.) were recorded. I.c.p. decreased significantly in all patients (0.01 greater than P greater than 0.001). Although PaCO2 decreased during the period of measurement, the extent and time-course of this change suggested that it was not mainly responsible for changes in i.c.p. M.a.p. decreased in most patients, but the decrease was statistically significant only at 3 and 4 min after the administration of etomidate (0.05 greater than P greater than 0.02). The changes in cerebral perfusion pressure (c.p.p.) and heart rate were not clinically or statistically significant. We conclude that etomidate can be used for the induction of anaesthesia in patients with intracranial space-occupying lesions without increasing i.c.p. or seriously reducing c.p.p.


Presynaptic effect of I.V. anaesthetic agents at the neuromuscular junction.

The effect of Althesin, diazepam, ketamine, propanidid and thiopentone on the release of acetylcholine was tested at the mouse neuromuscular junction. Althesin, diazepam and thiopentone increased the quantal content of the end-plate potential. Ketamine at low concentration (3.6 micromol litre-1) had a similar effect, but at high concentration (116.7 micromol litre-1) quantal content decreased sharply. Propanidid and cremophor EL did not affect quantal content. The increase in quantal content antagonized the effect of postsynaptic depression on the amplitude of the end-plate potential. The lack of enhancement of acetylcholine release appears to explain the in vitro interaction of propanidid with tubocurarine. The diversity of presynaptic actions of these drugs makes it unlikely that this is an important mechanism in producing anaesthesia.


Labetalol in controlled hypotension: administration of labetalol when adequate hypotension is difficult to achieve.

A study of controlled hypotension was undertaken in 50 major surgical patients using labetalol, a drug with both alpha- and beta-adrenoceptor blocking activity. The patients were such that difficulty in achieving controlled hypotension could be anticipated: the young, the anxious and those for whom halothane was contraindicated. The administration of labetalol quickly induced hypotension which was controlled easily and was rapidly antagonized.


Extradural analgesia for caesarean section: a comparison with general anaesthesia.

Thirty-two patients received lumbar extradural anaesthesia for elective Caesarean section. The results obtained from this series were compared with those from a similar (control) group of parturients who received general anaesthesia. The extradural group (mothers and infants) were metabolically acidaemic relative to control. However, maternal to fetal blood-gas differences were comparable in the two series. Infants sustained respiration more rapidly after regional blockade, otherwise the clinical condition of the infants was similar with extradural and general anaesthesia. No advantage of conduction over general anaesthesia was evident from this study, with respect to the biochemical status of the infant at birth.


Small endotracheal tubes: ventilator and intratracheal pressures during controlled ventilation.

The use of small endotracheal tubes reduces the trauma of intubation. Ventilator and tracheal pressures were measured during controlled ventilation with various tube dimensions and ventilation volumes. Ventilation with large volumes using small tracheal tubes results in high ventilator pressures. However, tracheal pressures are only marginally greater than those obtained with larger tubes. Small endotracheal tubes and high ventilation volumes result in a positive tracheal pressure at the end of expiration. The measured end-expiratory pressures are within the limits which might be used therapeutically (in PEEP). The force required to reshape endotracheal tubes of varvious dimensions to an "anatomical" shape was related to the tube dimensions; the beneficial effects of performed, "anatomically shaped" endotracheal tubes can be achieved by using small tubes of standard design.


Airway closure and fluid filtration in the lung.

We have investigated the effect of airway closure on fluid balance in the isolated, perfused rabbit lung in which the alveolar, pleural and vascular pressures could be regulated independently. The rate of filtration into the interstitial space was monitored by continuous weighing. A reduction in pleural pressure of 0.5 kPa with open airways increased fluid filtration by 0.11 g min-1. Reduction in pleural pressure of 0.5 kPa with the main airways closed reduced the alveolar pressure by 0.4 kPa and increased fluid filtration by 0.86 g minp1. We concluded that the pleural pressure is transmitted poorly to the alveolar interstitial space in the normal lung with open airways. However, airway closure allows the pleural pressure to be transmitted almost completely to this interstitium, with interstitial oedema as a possible consequence.


Effect of i.v. administration of lignocaine and tetrodotoxin on sensory units in the tooth of the cat.

A study in cats was designed to investigate the blocking of sensory nerve terminals by i.v. injection of lipid-soluble local anaesthetics such as lignocaine. I.v. injection of lignocaine 15--30 mg kg-1 did not completely block sensory nerve endings in the tooth of the cat, whilst tetrodotoxin (TTX) in large non-toxic doses did so. Based on the i.v. doses of TTX and the relationship between the local anaesthetic potency of the two substances when injected intra-arterially, it was calculated that lethal doses of i.v. administered lignocaine are necessary to block sensory nerve endings. It seems unlikely that peripheral pain pathways can be blocked by systemic i.v. injections of local anaesthetics.


Pattern of respiration and responses to carbon dioxide during trichloroethylene anaesthesia in the cat.

Tidal volume (VT), minute ventilation (VE), the duration of inspiratats anaesthetized with 0.7%, 1% and 1.5% (inspired) trichloroethylene (TCE). The tracheal cannula was occluded at intervals at the start of inspiration and the tracheal pressure was measured to assess the force of contraction of the respiratory muscles. Anaesthesia with TCE 0.7% was associated with an increase in VE, a reduction in VT, and a marked increase in respiratory frequency and mean inspiratory flow rate, but PaCO2 values did not differ significantly from those in conscious animals. Ventilation was also greater than in conscious animals during anaesthesia with TCE 1%. TCE 1.5% caused a significantly greater PaCO2 than in conscious animals. All concentrations of TCE caused a reduction in the ventilatory response to carbon dioxide, measured by the steady-state method. Cervical vagal section did not abolish the tachypnoea caused by TCE.


Haemodynamic consequences of citrate infusion in the anaesthetized dog: comparison between two citrate solutions and the influence of beta blockade.

We have compared the effects of a solution of acid--citrate--dextrose (ACD) with those of a solution of citrate--phosphate--dextrose (CPD), infused at equal rates, on blood calcium ion concentration and different indices of haemodynamic performance in 17 dogs. The influence of beta adrenergic blockade on these changes was examined. The effects of ACD and CPD were studied in five dogs and were similar. Peripheral vascular changes were the principal cause of arterial hypotension. In six dogs, propranolol 0.5 mg kg-1 intensified the hypocalcaemia-induced left ventricular dysfunction.


Experience with spinal analgesia in a British obstetric unit.

A series of 443 spinal anaesthetics is described. The procedures included operative vaginal delivery, removal of retained placenta and a miscellaneous group common to most obstetric units. Failure to provide effective relief of pain occurred in 5.2% of patients. There was one potentially serious complication, but with this exception hypotension was not a feature. Headache following spinal analgesia was experienced by 16.3% of patients, the frequency being greater among those who received spinal analgesia at or shortly after delivery, but was unrelated to the size of the needle (23-gauge of 25-gauge) used. Extradural blood patch promptly and permanently cured the headache. The duration of sensory and motor loss after operation varied considerably with the local anesthetic agent used. The re-introduction of spinal analgesia into British obstetric anaesthetic practice is advocated.


Diazepam and droperidol as i.v. premedicants.

The effects of i.v. diazepam and droperidol both alone and in combination administered as premedication were studied in 240 patients. Relief of anxiety, sedation, lack of recall, acceptance by both patient and physician and side-effects were evaluated. Overall, the combination of droperidol 2.5 mg with diazepam 5 mg produced better ratings of these variables than could be achieved with either droperidol 10 mg or diazepam 10 mg alone. Larger doses of droperidol with diazepam produce an increased frequency of anxiety; larger doses of diazepam with droperidol may cause over-sedation.