Membrane potential of mitochondria measured with an electrode sensitive to tetraphenyl phosphonium and relationship between proton electrochemical potential and phosphorylation potential in steady state.

The membrane potential of mitochondria was estimated from the accumulation of tetraphenyl phosphonium (TPP+), which was determined with the TPP+-selective electrode developed in the present study. The preparation and some operational parameters of the electrode were described. The kinetics for uptake by mitochondria of TPP+ and DDA+ (dibenzyldimethyl ammonium) were analyzed, and it was found that TPP+ permeated the mitochondrial membrane about 15 times faster than DDA+. The final amounts of accumulation of TPP+ and DDA+ by mitochondria were approximately equal. For the state-4 mitochondria, the membrane potential was about 180 mV (interior negative). Simultaneous measurements of TPP+-uptake and oxygen consumption showed that the transition between states 3 and 4 was detectable by use of the TPP+-electrode. After the TPP+-electrode showed that state-4 was reached, the extra-mitochondrial phosphorylation potential was measured. The difference in pH across the membrane was measured from the distribution of permeant anion, acetate, so as to calculate the proton electrochemical potential. The ratio of extra-mitochondrial phosphorylation potential to proton electro-chemical potential, n was close to 3. This value of n was also found to be 3 when ATP was hydrolyzed under the condition that the respiratory chain was arrested. The implication that n = 3 was discussed.


Self-injury in the de Lange syndrome.

Self-injury, a common problem among retarded children is thought to be a behavioural manifestation of an organic disease and the usual treatment has been through drugs or physical restraint. Psychological treatment techniques were used to control such behaviour in a de Lange syndrome patient. The treatment was effective in producing clinically significant control of self-injurious behaviour.


Sole dermatoglyphics of patients with Klinefelter's syndrome (47,XXY).

We have reported the dermatoglyphic findings on the soles of eighty Japanese Klinefelter's syndrome patients (47,XXY). As compared with normal Japanese males and females, three statistically different traits were observed: (1) Distal loops in the hallucal area are smaller, (2) pattern intensity is higher, and (3) the frequency of triradius p is elevated.


Prospects for extending the resolution limit of the electron microscope.

The factors that limit the performance of present-day high-resolution electron microscopes include the source brightness, the temporal coherence of the illumination, and phase contrast 'artefacts' due to spherical aberration and defocus. Further advancement of the instrumental performance might be accomplished in different ways, including the use of high coherence conditions combined with image restoration; the use of higher accelerating voltages; the use of aberration correctors; or the use of conditions for incoherent image formation. Current efforts in each of these directions are reviewed, from which it is evident that the combined use of higher voltages and improved coherence is the direction that is presently leading to the greatest degree of progress.


Intrinsic organization of snake dorsomedial cortex: an electron microscopic and golgi study.

The cellular populations present in dorsomedial cortex in the snakes Constrictor constrictor, Natrix sipendon and Thamnophis sirtalis are described at the light microscopic level using Nissl and Golgi preparations as well as at the ultrastructural level. This area plays a central role in cortical organization in snakes by participating in major commissural and association projections. Systematic analyses of Golgi preparations indicate that five populations of neurons are present in dorsomedial area and have a preferential laminar distribution. Layer 1 stellate cells have somata positioned in the center of the outermost cortical layer, layer 1. Their dendrites are confined to this layer. Double pyramidal cells have their somata loosely packed in layer 2. Their dendrites bear a moderate population of spines, ascending through layer 1 to the pial surface and descending partially through layer 3. Some double pyramidal cells have somata displaced downwards into the upper third of layer 3. These neurons closely resemble the layer 2 double pyramidal cells. Layer 3 stellate cells have somata positioned in the middle third of layer 3. Their dendrites extend in all directions throughout layer 3 and through layer 2 into layer 1. Finally, horizontal cells have their somata positioned deep in layer 3, near the ventricle, and dendrites aligned concentric with the ventricle. Comparison of the organization of the known afferents to dorsomedial area with the distribution of the five cell types suggests that the laminations of both afferent fibres and dorsomedial neurons places specific neuronal populations in synaptic contact with specific sets of afferents.


Nucleolar reorganization in liver cells of the aging rat.

The nucleoli of rat liver cells duplicate in great detail the life-long series of reorganizational changes encountered in kidney and intestinal epithelial cells. The ultrastructural components of the large, loosely organized polymorphous nucleoli, which are dominant in the rapidly multiplying stem cells of embryos, are readily accessible for chemical activities. Smaller, more compact amphinucleoli are dominant in more mature cells, which were characterized by Smetana ('70) as "idling" cells, showing slowly continuing ribosome formation and RNP synthesis. In older cells bipartite nucleoli become dominant and are reorganized in increasing numbers from the younger amphinucleoli. These, however, are not replaced in equal numbers from the shrinking pool of polymorphs of young cells which have greatly reduced mitotic potential. Paralleling the shifts in dominant nucleolar types, the high level of protein synthesis declines in older cells not only in the quantity of proteins synthesized but also in kinds of enzymes produced. These fail to meet the structural and functional requirements of aging cells leading ultimately to the onset of age-related degenerative changes. Again it is noted that separation of the karyosomal DNA from the plasmosomal RNA-protein complex of the nucleolus may lead to possible breakdown of the DNA-dependent RNA-protein transcription system ultimately bringing protein synthesis to a very low level in the senescent animal.


Marital sexuality and the psychological health of professional men.

A longitudinal study of married professional men explored the relation of adolescent and adult psychological health to marital sexual frequency, frustration, pleasure, and compatibility as well as the effects of sexual relations upon maturing. Psychological health was measured by seven adolescent and ten adult measures, including the MMPI, Rorschach, self- and judge-ratings, and questionnaires. Adolescent mental health did not predict any measure of adult sexual activity. Adult psychological health did not predict frequency of marital coital relations or degree of sexual frustration very consistently. It was associated more clearly with sexual pleasure and very consistently with marital sexual compatibility. Sexual relations did not contribute much to the men's maturing during adulthood; when they did, their principal effects were to further the integration and stabilization of the men's self-concepts.


The gestalt experiment in sex therapy.

The couple with a sex dysfunction is at an impasse. The natural process of sexual self-regulation is interrupted by the self. Growth requires experimenting with new solutions for unsolved problems. The gestalt experiment is a major modality of treatment applicable to sex therapy. To experiment is to invent and discover solutions and to find and make meanings. In posing an experiment, the therapist attempts to create a safe emergency in which risk and support are balanced, permitting the person to stay with the mounting excitement and coming solution. An atmosphere of playfulness and creativity invites experimentation. Thorough familiarity with modes and methods of experimenting permits the therapist's creativity to emerge. Applications of sexual metaphors and sex dysfunction as a nightmare are presented which use methods drawn from gestalt dream work. The use of gestalt experiments are illustrated in a client-therapist dialogue.


What personal photos reveal about marital sex conflicts.

A brief summation of the underlying rationale of the technique and a description of how photo reconnaisance is utilized are presented first. Then some specific adaptations of the technique to the therapist's understanding and treatment of sexual conflicts in marital pairs are delineated. Although some correlations between certain configurations appearing in pictures and specific sexual conflicts or dysfunctions are hypothesized, it is not possible to posit clear-cut one-to-one linkages. The photographs provide clues and highlight forerunners of current difficulties; they do not establish definitive causation.


Heterosexual marriage of homosexual males: some associated factors.

Three matched groups of predominantly homosexual men were compared using Weinberg and Williams' questionnaire. Two of the groups contained men who were currently heterosexually married and men who had been heterosexually married; the third group was unmarried controls. Reasons for marriage were reviewed and found to be a combination of situational factors and, to a greater extent, of the expectations of those men who married of a more negative societal reaction against homosexuality. Implications of these findings for therapy are briefly discussed.


The myth of symptomatic versus asymptomatic partners in the conjoint treatment of sexual dysfunction.

Although sex researchers and therapists alike talk about treating "couples," there persists an assumption that "symptomatic" partners vary significantly from "asymptomatic" partners with respect to early background and personality variables. Indeed, these differences have been sometimes viewed as primary causal factors for the couple's presenting state of sexual discord. Data from a short-term intensive treatment program was analyzed to compare factors such as parental-familial background, sexual attitudes and knowledge, and marital histories for individuals diagnosed as symptomatic and their partners who received no specific sexual diagnosis. Results indicated few significant differences between these identified groups. There were also few differences between groups based upon items from a follow-up evaluation, suggesting that the prognostic value of these classifications may likewise be placed in question. In general, the couple's ongoing relationship (rather than individual characteristics) appears responsible for establishing satisfactory levels of sexual intimacy. Suggestions were made toward developing couple-oriented diagnostic and outcome categories.


The penile prosthesis: a review.

This paper reviews the literature concerning the penile prosthesis. Included are discussions of the historical development of the penile prosthesis, characteristics of patients treated with prosthetic implantation, assessment techniques utilized in patient selection, and the relative outcome and complication rates for the two major types of prostheses. Recommendations regarding future research and practice are presented throughout.


Some systemic effects of superficial dermatomycosis.

A baffling case of systemic dermatomycosis is presented and the course of therapy instituted for 12 months described. There has been marked improvement in the patient, both subjectively and objectively, the first in his five-year history. Thirty-five additional and comparative patients were identified during the 12-month time period. These patients were placed on therapy and their responses to treatment were equally impressive.


Treating hypertension among inner-city dwellers: the problem of noncompliance.

Hypertension is perhaps the most common chronic disease in the United States, if not in the world. It is certainly the single most important chronic illness in which obtaining patient compliance to therapy is a challenging task. It is a lifelong, life-threatening condition, which may be completely asymptomatic in the afflicted individual. When this illness is detected early and given appropriate treatment, many of its complications, such as strokes, myocardial infarctions, renal disease, and retinal damage, can be prevented, or at least curtailed. The problem of noncompliance to therapy has been attacked in different ways by several investigators. The author believes that this problem can be approached using the following recommendations: thorough patient education, simplicity of therapy, elimination of drugs with serious side effects, and involvement of the patient and his family members in the therapeutic program. When these steps are taken, patient adherence to treatment usually improves, thus resulting in more effective management of hypertension and consequent reduction in its morbidity and mortality.


Thymoma metastatic to bone.

A patient with thymoma metastatic to bone is presented. The case differs radiographically and pathologically from one previously reported case in which the diagnosis was made during life. The diagnosis was obtained by percutaneous needle biopsy under fluoroscopic control.


Headache--a rare presenting symptom in multiple myeloma: a case report.

Headache is a rare symptom in multiple myeloma (MM). A 34-year-old black female presented with severe headache and investigation subsequently led to the diagnosis of non-secretory MM. Non-secretory MM is seen in less than one percent of MM cases. Further-more, less than two percent of MM cases are seen under the age of 40 years. An increasing number of cases of MM are being described in young adults. Attention is drawn to entertaining a diagnosis of MM even in those under age 40 years who may manifest unusual features of the disease.


Cervical deciduosis and intraepithelial neoplasia.

With the widespread use of routine cervical cytologic screening in pregnancy and the increasing use of colposcopy, the problem of coexistent decidual and neoplastic cervical changes becomes more frequent. This case report illustrates such a problem and discusses its management.


Nutritional care considerations of older Americans.

The US Census Bureau's 1977 projection of the nation's population aged 65 and older by the year 2000 was 31.8 million. This paper addresses the projection that in the future a higher proportion of the population in the United States will be older persons. It is obvious that older Americans are living longer with an increased incidence of diseases such as diabetes, hypertension, cardiac problems, and obesity, requiring medical and nutritional care. This paper discusses commitment to provide quality services in terms of prescribing appropriate and functional therapeutic diets to meet the needs of older Americans. Two mechanisms are discussed that are effective tools for calculating diabetic diet prescriptions and weight reduction diets based on energy level and energy needs. Also discussed are the provision of assistance to meet the social support needs of old people such as food stamps, Meals-on-Wheels, and homemaker's service.


Effects of prolonged cyanide and thiocyanate feeding in rats.

Male weaning rats were fed a semipurified diet containing 10% casein; this diet restricted in methionine, vitamin B12, and iodine; or the complete and restricted diets supplemented with either 1500 ppm potassium cyanide or 2240 ppm potassium thiocyanate for 11.5 mo. There were no deaths or clinical signs of toxicity. Cyanide, but not thiocyanate, caused a consistent reduction in weight gain in the complete and restricted groups. Both cyanide and thiocyanate caused decreased thyroid gland activity in young rats, particularly in the restricted groups. Plasma thyroxine concentrations were maintained in the mature cyanide-treated rats, even though secretion rates were decreased. However, the mature thiocyanate-treated animals showed decreased plasma thyroxine concentrations, despite thyroid gland enlargement. Modest primary myelin degeneration in the spinal cord white matter was found in the restricted group and in rats receiving this diet supplemented with either cyanide or thiocyanate. The lesions did not resemble those of a vitamin B12 deficiency in appearance or those of acute cyanide intoxication in distribution. Because of tissue autolysis, it could not be determined whether these changes resulted from histotoxic anoxia or an alteration of oligodendroglial myelin metabolism.


Nuclear interaction of Fusarium mycotoxins with estradiol binding sites in the mouse uterus.

By using cell-free preparations of uteri obtained from immature BALB/c mice, it was demonstrated that zearalenone and zearalanol, Fusarium mycotoxins, inhibited [3H]estradiol-17 beta binding to specific sites in cytosol. Significant inhibition was noted from zearalenone at 4 x 10(-6) M and from zearalanol at 4 x 10(-7) M. Unlabeled mycotoxins (5 x 10(-6) M) incubated with intact uteri caused translocation of specific estrogen binding sites into nuclei that were exchangeable with [3H]estradiol-17 beta. Zearalanol was more effective in this regard than zearalenone. Ability of the mycotoxins to compete with estradiol-17 beta for the cytosol receptor and to cause translocation of the receptor to the nucleus in general is correlated with their biological activity. These data suggest that the uterotrophic effects of Fusarium mycotoxins are mediated through their association with estrogen receptors in the uterus.


Evaluation of the transplacental toxicity of diethylstilbestrol with the scanning electron microscope.

Exposure in utero to the synthetic estrogen diethylstilbestrol (DES) is associated with reproductive tract lesions in male and female CD-1 mice. The scanning electron microscope was used to evaluate the luminal surface of the vagina, cervix, and uterus following prenatal exposure to DES. Abnormalities that have been observed include urethral openings in the cervicovaginal area, squamous metaplasia of the uterus, glandular elements in the vagina, and abnormal cell surface features in the vaginal epithelium.


Propachlor detoxication in the small intestine: cysteine conjugation.

14C-labeled 2-(S-cysteinyl)-N-isopropylacetanilide was recovered from the media of everted sacs of rat small intestine incubated in media that contained [14C] propachlor (2-chloro-N-isopropyl-[1(-14) C]acetanilide). The metabolite was identified on the basis of chromatographic characteristics and mass spectra of the butyl ester-trifluoro-acetamide derivative. This evidence shows that the cysteinyl conjugate was formed during incubations of the small intestine. Although the glutathione conjugate has not been isolated from the intestine, it is a likely precursor of the cysteinyl metabolite. Data from experiments conducted with 10(-5) and 10(-4) M propachlor in the media showed that the capacity to metabolize propachlor to polar metabolites was approximately the same throughout the length of the small intestine.


Mutagenicity and transformation by recycled water.

Increased use of contaminated water and long-range plans for the direct use of recycled water necessitate a careful assessment of the potential health effect on the population. Selected in vitro assays were used to evaluate the mutagenic and carcinogenic potential of a concentrated, recycled water sample. It was found that the concentrated water induced mutagenicity in hamster lung cells and cellular transformation in human embryonic lung fibroblasts. The use of in vitro analyses in conjunction with epidemiologic studies in determining the human risks of environmental carcinogens is discussed.


Neonatal lead toxicity and in vitro lipid peroxidation of rat brain.

Neonatal rats were given aqueous lead acetate intragastrically from d 2--20 of life at doses of 0, 25, 75, and 225 mg Pb/kg.d. Blood Pb concentrations on d 21 were (mean +/- SE) 27 +/- 4 (control), 150 +/- 26, 263 +/- 63, and 518 +/- 97 microgram/100 ml, respectively. Growth was significantly depressed only in animals given the highest dose of Pb (225 mg/kg.d). Hematocrits were significantly decreased by d21 at all doses of Pb. Malondialdehyde (MDA) formation in 750 x g (10 min) brain supernatants induced spontaneously by aerobic incubation at 37 degrees C was not altered by Pb on d 7 and 14, but a slight decrease was observed on d 21. The extent of MDA formation induced by enzymatically generated superoxide anion was not altered by Pb toxicity during the first 21 d of life. Addition of Pb to 750 x g (10 min) brain supernatants in vitro significantly decreased MDA formation at Pb concentrations of 10(-5) M and higher. These results show that the central nervous system toxicity of Pb in neonatal rats is not associated with accelerated in vitro lipid peroxidation of brain tissue.


Brain lipofuscin concentration and oxidant defense enzymes in lead-poisoned neonatal rats.

Neonatal rats were given aqueous lead acetate intragastrically from d 2-20 of life at doses of 0, 10, 50, and 225 mg Pb/kg.d. Blood Pb concentrations on d 21 were (mean +/- SE) 23 +/- 3 (control), 63 +/- 19, 246 +/- 55, and 994 +/- 223 microgram/100 ml, and brain Pb concentrations were 14 +/- 2, 60 +/- 5, 114 +/- 15, and 275 +/- 26 microgram/100 g, respectively. Growth was significantly depressed only in rats given the highest dose of Pb (225 mg/kg.d). Solvent-extractable lipofuscin pigment concentration of brain tissue progressively decreased over the 21-d duration of the experiment but was not significantly altered at any dose of Pb. Brain glutathione peroxidase, glucose-6-phosphate dehydrogenase, and 6-phosphogluconate dehydrogenase activities were stimulated on d 20 at the maximal dose of Pb, but the activities of brain superoxide dismutases and catalase were not altered by Pb exposure. Locomotor activity was significantly increased in the male animals on d 20, but only at the highest dose of Pb. These results indicate that Pb toxicity in neonatal rats is not associated with accelerated in vivo lipid peroxidation in the brain, but that certain oxidant defense mechanisms in the brain are stimulated by Pb.


Toxicity of selenium to developing Xenopus laevis embryos.

Se in the form of sodium selenite is toxic to Xenopus laevis embryos and tadpoles continuously exposed to concentrations above 1 ppm. Concentrations of 2 ppm and above result in severe developmental abnormalities and increased mortality. Uptake and loss of radioactive Se from water are rapid, but depuration is not complete indicating that some Se can remain bound by the organism. The facts that Se is toxic at low levels to Xenopus embryos and tadpoles, can cause developmental abnormalities, and accumulates in tissues suggest that increased release of Se compounds into the environment poses a potential threat to aquatic organisms.


Cadmium-induced alterations in RNA metabolism in cultures of Chinese hamster cells sensitive to and resistant to the cytotoxic effects of cadmium.

A variant population (CdR) of cultured Chinese hamster cells (line CHO) was derived that is more than 100 times as resistant to the cytotoxic effects of Cd2+ than is the parent population. The effects on RNA metabolism of exposure to sublethal concentrations of Cd2+ were studied in CHO and CdR. Exposure to 2 X 10(-7) M CdCl2 for 24 h resulted in increased polysome content (1.2 times) and increased uridine or adenosine incorporation into heterogeneous nuclear RNA (1.2-1.4 times) and messenger RNA ((1.5-1.7 times) in both populations. Measurement of ATP pool specific activity following exposure to radiolabeled adenosine showed that increased incorporation reflects increased synthesis. The equivalence of CHO and CdR in dose-response in terms of stimulated RNA synthesis and their disparity in dose-response in terms of cytotoxic effects indicate that the systems involved in conferring protection against the lethal effects of Cd2+ are not similarly involved in attenuating the effects on RNA metabolism.


Note on the metabolism of the mercury chelating agent sodium 2,3-dimercaptopropane-1-sulfonate.

Chromatographic analysis of the radioactive urine obtained after injection into rats of [1,3-(14)C] dimercaptopropane sodium sulfonate (DMPS, Dimaval) showed that part of the administered chelating agent is excreted unchanged. This was confirmed by the results of studies of sulfur excretion in the different fractions of the urine as well as by titration of the excreted thiol groups. The results show that, at least in rats, DMPS is not involved in important metabolic reactions.


Ocular injuries associated with periorbital fractures.

The incidence of serious ocular injuries found in association with periorbital fractures, 10%, was determined through a retrospective review of 230 patient records. Eye injury was most frequently in conjunction with supraorbital fractures. A brief survey of the diagnosis and treatment of the injuries identified, loss of visual acuity, global laceration or rupture, retinal contusion, intraocular hemorrhage, glaucoma, and optic nerve damage, is presented, with special emphasis on the importance of the acute physical examination of the eye and determination of the visual acuity. Use of the recently developed method of diagnosing glaucoma and determining visual acuity, the Arden Sine Wave Grating, is discussed.


Evaluation of management of the emergency right hemicolectomy.

To evaluate the morbidity and mortality attending emergency resection of the right colon, we studied retrospectively 119 consecutive patients from two major centers, particularly examining the role of delayed anastomosis (initial ileostomy with subsequent ileocolic anastomosis). Emergency right colectomy was defined as an operative procedure in which partial resection of the terminal ileum and total or partial resection of the cecum and/or ascending colon were necessary before the colon could be evacuated and prepared as might be the case in elective resection. Ninety patients underwent primary anastomosis; hospital mortality and morbidity were 26 and 11%, respectively. Among 29 patients who underwent ileostomy, hospital mortality was 38%; hospital morbidity was 10%. In general, the patients selected for ileostomy were somewhat more ill or had more severe injury. only 17% of all deaths and 8% of all serious complications could be attributed to the anastomosis, leaving little statistical opportunity for improvement by deleting it. The data indicate that a very high mortality (29%) attends emergency right hemicolectomy. Our study indicates that ileostomy in lieu of anastomosis does not reduce this high mortality.


The relationship of central venous and pulmonary artery catheter position to acute right-sided endocarditis in severe thermal injury.

Autopsies of 1,105 burned patients completed from January 1951 through March 1977 were reviewed at the United States Army Institute of Surgical Research to investigate the relationship between central venous and pulmonary artery cannula use and the incidence of endocarditis. The incidence of endocarditis increased from 3.4 to 9.4% after 1969 when cardiac injury attributed to central venous cannula use was first noticed at autopsy. Since 1969, right heart nonbacterial and bacterial endocarditis has dramatically increased and the right heart has become the prevalent site of the cardiac lesions. Review of premortem chest roentgenograms from 14 recent autopsy cases with right heart endocardial injury confirmed that central venous catheter tips were placed in the vicinity of the right atrium or right ventricle in 86% of the cases. Pathogenetically, the majority of the infected right heart lesions are probably the result of cannula-induced injury, with subsequent thrombosis and later bacterial colonization during episodes of bacteremia which are common in burned patients.


Ultrastructural evidence for the presence of "fibroclasts" and "myofibroclasts" in wound healing tissues.

We have observed, by light and electron microscopy, fibroblast-like cells which appear to be involved in collagen fiber and filament degradation. These cells are most prominent in the dermis of mature hypertrophic scars which were clinically observed to be in the remodeling phase of wound repair. Total incorporation of collagen filaments within cellular vacuoles, as seen by TEM, appears to precede the enzymatic degradation of the collagen. Cytoplasmic contractile bundles and/or collagen filament remnants found within residual lysosomes were also seen in many of these cells. Evidence of structural reorganization within the tissue was observed by means of SEM. These cells appear to be similar to osteoclasts in function: thus we propose to name them "fibroclasts" and "myofibroclasts."


Microvasculature in hypertrophic scars and the effects of pressure.

The fine structure of the microvasculature was compared among eight samples of normal skin, 79 granulation tissues, 48 hypertrophic scars, 11 hypertrophic scars treated with mechanical pressure, and 13 mature scars. Increased synthesis activity is suggested in endothelial cells from granulation tissues, is less in hypertrophic scars, and low in mature scars. In hypertrophic scars most of the microvessels appear partially or completely occluded. Endothelial cell nuclei are crenated, many villous projections from the endothelial cell membranes exist on the blood side, and endothelial cell junctions are often complex, although no large gaps are observed. In all the granulation tissues studied fibrin polymer is present, occurring intraluminally and interstitially, which may be related to endothelial cell proliferation. Therapeutic mechanical pressure over 1 to 3 months effects striking changes in endothelial and perivascular satellite cells. Rented areas appear in endothelial cell cytoplasm. A few such areas were found in cases of nontreated hypertrophic scars but in no other group. Pressure-treated scars also demonstrate degenerating perivascular satellite cells, which also are observed in a few cases of mature scars but in no other group. A previously published theory that hypoxia is related to generation of the hypertrophic scar, and that pressure probably increases hypoxia, resulting in long-term focal degeneration of selective cells, appears further supported by the present findings.


Aspergillus infection of the burn wound.

During a 15-year period, 18 patients with major burns developed a wound infection due to Aspergillus. Ages averaged 28 years, extents of burn were 54% (14-97%) BSA for total surface involvement and 42% (14-85%) BSA for full-thickness injury. Pseudomonas sepsis preceded Aspergillus infection in 16 cases. Thirteen of the episodes occurred in three epidemics, each apparently related to contaminated air-conditioner ducts and filters. Treatment was based upon wound excision in all 18 patients, with recurrence initially in each. Topical and parenteral antifungal agents were never individually successful in controlling the infection. Whenever fungal sepsis involved an extremity alone and thus amputation could rid the body of the entire infected site, survival could then be achieved. The overall mortality rate was 78%. Protection of the wound from Aspergillus colonization appeared to be the only reliable method of preventing this often lethal fungus infection.


Occult cervical spine injuries in fatal traffic accidents.

Post-mortem radiographs as well as careful inspection at autopsy of 100 consecutive traffic accident victims revealed an incidence of cervical spine injury of 24%. All but four of the 24 fractures and/or dislocations were localized to the level between the occiput and the axis. One half of the cases were not clinically suspected of having spine injuries before the detailed postmortem search. Seventeen of the 24 cervical spines were resected en bloc and the pathologic anatomy of the injuries was determined. The high incidence of cervical spine injuries and the anatomic findings at dissection have clinical implications for physicians who manage multiply traumatized patients. The need for immobilization and early radiographic evaluation of patients with cervical spine injuries is emphasized.


Intraosseous infusion: pressure-flow relationship and pharmacokinetics.

In order to quantitatively investigate the usefulness of intraosseous fluid and drug administration as a resuscitative modality, we studied the infusion flow rates of crystalloid solutions obtainable at varying infusion pressures into the bovine tibial medullary cavity and time to initial as well as 90% of maximal effect of intraosseously administered vasoactive drugs. Mean infusion rates +/- SEM (n = 6) at 300, 200, and 100 torr and atmosphere + 81 cm H2O were 41 +/- 2, 32 +/- 1, 27 +/-2, and 10 +/- 1 ml/min, respectively. The mean time (+/- SEM) to initial effect of intraosseous injections (n = 6) of either 0.5 mg epinephrine or 50 mg ephedrine was 17 +/- 3 seconds and mean time to 90% of maximal effect was 45 +/- 5 seconds. These results provide a quantitative basis for resuscitation by fluid and drug administration via the tibial malleolar intraosseous route and suggest that when performed in appropriate situations, the technique may have clinical utility.


Post-traumatic middle cerebral artery thrombosis.

Post-traumatic thrombosis of the middle cerebral artery (MCA) is uncommon: only 39 cases were found in the literature. In the present report, eight cases of post-traumatic MCA thrombosis are analyzed and compared with other reported cases. The symptoms can be easily confused with those of expanding intracranial hematoma. Although ancillary noninvasive diagnostic methods are helpful, cerebral angiography confirms the diagnosis. The morbidity and mortality rates are high, and treatment has been mainly supportive. The low mortality in the present study may be related to the absence of severe head or other trauma. Possible cerebral revascularization procedures are also discussed.


Field surgical intervention: an unusual case.

A case of crush injury to the lower extremities of an ironworker involved in the demolition of a bridge is presented. Extrication of the entrapped limbs was complicated by weakening of the bridge support due to acetylene torch cutting. After 3 hours the decision was made to complete the traumatic disarticulation of the right knee on site. Essential elements in the successful completion of such field intervention are presented and the unusual features of the case are emphasized.


Reversible heart block following nonpenetrating chest trauma.

Blunt chest trauma, if sustained selectively to the midchest or precordium, can result in a variety of cardiac injuries (3, 7). These lesions may involve separately or together all structures of the heart, including pericardium, myocardium, valves, and coronary arteries. Depending on the extent of trauma, such injuries can cause varying amounts of mechanical or electrical dysfunction. The incidence and nature of cardiac dysrhythmias following trauma are largely unknown clinically, but have been extensively documented in several animal studies (2, 4, 5). Disturbances in both impulse generation and transmission were noted, usually beginning immediately after impact with the development of complete heart block and progressing quickly through several other electrical patterns to either sinus rhythm or ventricular fibrillation. High-grade atrioventricular (A-V) block has rarely been recognized clinically in association with nonpenetrating heart trauma (1), perhaps because of its rapid replacement by other dysrhythmias. It was, therefore, of interest when a patient presented to this institution in third-degree heart block following a blunt chest injury. Specifics of her illness are discussed.


Cerebrospinal fluid rhinorrhea following nasogastric intubation.

This report describes a normal individual who sustained injury to the cribriform plate during nasogastric intubation. Cerebrospinal fluid rhinorrhea, a potentially fatal complication, resulted and persisted for 5 months until it was surgically corrected. The relevant anatomy is reviewed and the importance of proper technique of nasal cannulation, with minimal or no use of force, or other instruments, is emphasized. The leading end of the tube should not be directed cephalad.


The management of human bite injuries of the hand.

Three hundred twenty-seven bite injuries of the hand were reviewed for incidence of infectious complications. A policy to hospitalize all patients with human bite injuries was maintained, but noncompliance was high. Patients with uninfected or superficially infected bites (131) were hospitalized and treated with parenteral penicillin, cephalosporins, or clindamycin (mean duration, 45 hours). Among the 62 patients not lost to followup three minor septic complications occurred. Of similar patients not hospitalized (134), only two thirds received antibiotic therapy but no complications were observed. These data suggest that human bite hand infections can be averted and that established superficial infections can be successfully treated with outpatient antibiotic therapy. Of the 62 patients with moderately to severely infected human bites, 77% were injured by striking an opponent; 52% suffered injury over metacarpophalangeal joints. The mean delay in seeking medical attention was 2 1/2 days, compared to 1/2 day in the less severely infected group. Of the patients with more seriously infected bites, 94% received parenteral antibiotic therapy. Of 30 patients with known outcome in the latter group 27% suffered complications (stiffness; recurrent infection; other infectious complication), confirming the high morbidity of established deep hand infections secondary to human bites.


Management of stab wounds of the back and flank.

Abdominal stab wounds are managed on a selective basis with increasing frequency. Retroperitoneal injuries are more difficult to evaluate; hence wounds to the flank and back pose different considerations. A retrospective review of 108 patients with deep stab wounds of the flank and back was compared with a prospective study of 109 patients selectively managed with similar injuries. Physical examination was accurate in 86% of flank and 88% of back wounds. Local exploration was an effective procedure in differentiating superficial from deep wounds. Peritoneal lavage may be more accurate in flank wounds but is probably less reliable with retroperitoneal injuries. Adjunctive studies are helpful in selected patients. The incidence of negative celiotomies was reduced from 85.2% to 7.3% when the selective approach was adopted. There was no mortality or increased morbidity in the series. Although the risk of retroperitoneal injury is greater with flank and back wounds, frequent examination by the same observer combined with adjunctive studies in selected cases appears to be a safe, reliable method of managing patients with stab wounds of the back and flank.


Penetrating trauma of the lung.

Records of 373 patients with penetrating wounds of the lung seen at the Ben Taub General Hospital over a 1-year period were reviewed. Intercostal tube thoracostomy was the only therapy required in 282 patients. Thoracotomy was performed in 91 patients with repair of a pulmonary lesion in only 45 patients. Pneumonorrhaphy was performed in 33 patients, segmentectomy in six, and lobectomy in two. Four patients required repair of tracheal injuries. Fourteen patients initially treated with intercostal tube drainage required thoracotomy for complications of clotted hemothorax in eight and empyema in six. There were 29 deaths. Penetrating lung trauma in the majority of patients may be treated conservatively with a low incidence of infection or complication. Of the patients who require thoracotomy, associated injuries will frequently represent the major operative indication. Early thoracotomy for complication of clotted hemothorax or empyema is encouraged.


Low-velocity gunshot wounds to the maxillofacial complex.

A review of the past literature of gunshot wounds indicates that the clinical material deals mainly with high-velocity missile injuries from military experience. A series of 66 cases of low-velocity gunshot wounds to the maxillofacial complex at San Francisco General Hospital between 1971 and 1978 indicates a clinical difference between injuries caused by low-velocity as compared to previously reported high-velocity missiles. Damage to vital structures resulting from missile injury to the maxillofacial complex are classified in three anatomic areas: 1) supra-orbital (28 cases of which 20 involved neurological damage); 2) mid-face (24 cases of which 8 involved the orbits and/or globe); 3) lower face (14 cases, of which 3 involved laceration of the carotid and 2 involved airway obstruction necessitating tracheostomy). The management of gunshot wounds to the maxillofacial area is outlined, emphasizing: 1) Debridement and prompt closure of intraoral wounds with antibiotic coverage: 2) Early stabilization of mandible fractures: 3) Indications for tracheostomy; 4) Arteriographic studies. In our series there were only four infections, which were treated easily with incision and drainage and appropriate antibiotic selection.


Mechanical cornpicker hand injuries.

The mechanical cornpicker causes tearing anse injuries from 1962 to 1975 were studied with regard to mechanism and extent ohe time of injury in 36% of hands, and in 73% of the remainder following treatmophylaxis, and antibiotics, and 73% hands required some form of delayed surgical treatment. Antibiotics did not appear to be helpful. Eighty-nine ps the most common cause given for farmers for their injuries. Excluding four pr permanently disabled patients, the average length of disability was 135 days. Eighty-nine per cent of patients experienced some permanent impairment of hand function. The mechanical cornpicker is described, and the importance of its proper use and physician's emphasis on accident prevention as well as treatment are stressed.


Effects of hypoxia and hypotension on oxygen delivery in the brain.

Failure of microvascular re-perfusion, no reflow, of the brain after a period of ischemia has been proposed as the etiology of the cerebral dysfunction frequently seen in patients after resuscitation from hemorrhagic shock. For this investigation rats were stressed by subjecting them to a period of combined hypoxia and hypotension followed by resuscitation. Micro-oxygen electrodes measured brain oxygen tension, thus allowing an assessment of the distribution of cerebral blood flow, during stress and after resuscitation. After resuscitation, a hyperemic response was noted, followed by gradual return of some areas of the brain to normal perfusion, while other areas remained hyperemic for at least 2 hours post-resuscitation. On the basis of these results there appears to be no support for the no-reflow hypothesis. These data imply that therapeutic modalities aimed at increasing cerebral blood flow and oxygenation in the post-resuscitation period are insufficient in themselves for improved survival of patients sustaining a hypotensive, hypoxic episode.


Chondritis of the ear: a method of treatment.

Chrondritis may develop as a secondary complication of trauma to the ear. Its onset is often insidious and may be delayed until after apparent healing has occurred. Treatment is difficult, but if postponed, the result may be complete destruction of the external ear. A method of aggressive surgical therapy combined with antibiotics is presented which, when utilized early, results in good healing with minimal residual otic deformity.


Tissue pressure to evaluate compartmental syndrome.

This article presents a simplified, direct way of measuring tissue pressure and shows that in a series of 45 patients with serious extremity injuries, it is possible to predict the need for fasciotomy, eliminating much of the risk to the patient.


Splenorrhaphy for splenic trauma.

Thirty consecutive patients sustaining splenic injury from blunt abdominal trauma were evaluated as to the feasibility of performing splenorrhaphy rather than splenectomy. Twenty-four patients were over 14 years of age. The procedure to be performed was decided intraoperatively. Twelve patients required a splenectomy, and 18 patients had all or a portion of the injured spleen salvaged. The two groups were similar in age, mechanism of injury, and associated injuries. Nine of the 18 salvaged spleens required only debridement and the topical application of Avitene for hemostasis. The remaining nine patients required more extensive procedures including hemisplenectomy (three) and partial splenectomy (three); three patient patients required oversewing of bleeding splenic surfaces and the ligation of vessels without removal of splenic tissue. There were no differences in the number of blood transfusions required by the two groups. There were no postoperative complications resulting from the splenorrhaphy. Sixteen of the 18 who underwent splenorrhaphy were studied postoperatively by spleen scan. In all cases functioning splenic tissue was found consistent with the operative findings and procedure.


Failure of spleen repair.

A 25-year-old man underwent splenorrhaphy for a laceration of the inferior pole following blunt trauma. After 5 weeks of uneventful convalescence re-exploration was necessary for delayed formation of a perisplenic hematoma. We conclude that spleen repair is justified in the adult patient with simple injury to the poles of the organ. Careful selection and followup are essential for patients who undergo splenorrhaphy.


Traumatic renal arteriovenous fistula: case report and useful operative technique.

A patient with a traumatic extrarenal arteriovenous fistula underwent successful repair of the lesion. The reconstruction utilized a portion of renal vein to allow lateral repair of the renal artery. The patient's postoperative course was complicated by paradoxical hypertension and severe abdominal pain like that in the "post-coarctectomy syndrome." Satisfactory recovery has occurred and the patient remains normotensive.


Common carotid artery aneurysm after blunt trauma.

A case of false aneurysm of the common carotid artery after blunt trauma is described. We found seven other such cases in the literature. The literature is reviewed and it is concluded that this rare injury should be operated on as soon as the diagnosis has been made. Lateral excision and arteriorrhaphy, or aneurysm resection in larger lesions, are recommended.


Traumatic abdominal hernia.

Traumatic abdominal hernias are rare, but are easily missed in patients with multiple injuries in whom life-threatening injuries take precedence. A case is reported in which difficulty was experienced with closure of the abdominal wall; at re-exploration a diagnosis of abdominal hernia was made, and a tear in the retroperitoneum with herniation of 2 feet of small bowel on the right side of the abdomen found. The hernia was reduced and the patient's recovery was uneventful. In all cases of celiotomy for trauma, complete exploration of the abdomen should be performed before closure to assure normal anatomic relationships of all structures.


Correlation of hyperplasia, splenomegaly and hepatomegaly with parasite population in BIO.LP-a mice infected with Leishmania donovani.

Congenic strain of BIO.LP-a male mice were experimentally infected with Leishmania donovani 3S strain from the spleen of a hamster donor. The weight ratio of spleen body, liver body and spleen liver calculated from the weight of six mice taken at weekly intervals for a period of 49 days showed that there is no hepatomegaly or splenomegaly during the first 14 days of infection when the parasite population increases. Maximum enlargement of liver and spleen was observed at day 35 postinfection, when the parasite population had declined to 11 per cent. Slight recovery was noted at day 49 with parasites reducing to 1 per cent. It is suggested that in endemic areas of human visceral leishmaniasis a search for amastigotes should be made from the biopsy of the liver or sternal puncture during the first phase of the disease when the patients suffer from a high fever with rigors. With the enlargement of liver and spleen due to proliferative response and infiltration of plasma cells, the parasite population disappears.


[Prostatitis due to the circular form of trichomonas (author's transl)].

The authors underline the frequency with which trichomoniasis is located in the prostate. In these cases the parasite is rarely in its trophozoite form but has a circular shape which resembles the resistant pseudocystic type. They are found by phase contrast microscopy after staining with 1% cresyl blue which makes the difference with white blood cells. Out of a total of 178 men presenting with urethroprostatic signs (urethral discharge and burning), sterility with oligospermia, or a history of dyspareunia, the circular type of trichomoniasis was found in 40 (22%) of the cases, with urethritis in 26 cases, and prostatitis in the other 14 patients. Two courses of treatment, at one month's interval, with Tinidazole (2 tablets daily for 6 days) or Nimorazole (2 tablets daily for 8 days) produced healing in 4 cases with urethroprostatic effections, disappearance of dyspareunia in 2 out of the 3 cases treated, and return of fertility in 3 out of 7 patients. An up-to-date list of references is given.


[Cutaneous urine shunts in adults (author's transl)].

The authors review 123 cases of cutaneous urine shunts in adults. - 93 cutaneous ureterostomies in 63 patients (58 malignant and 5 tuberculous lesions). There were 5 postoperative deaths (8%) and in the 36 operated cases followed-up for varying periods there was 1 death only from progressive renal insufficiency (2.7%), 10 minor incidents (27.8%) and 2 cases with kidney stones (5.5%). Not one of these patients had to be operated on again - 3 cutaneous uretero-ureterostomies with 2 excellent results and necrosis of the foot of the Y in the other case. - 45 transintestinal cutaneous ureterostomies (38 ileal loops and 7 colon grafts) for fistula of the lower urinary tract (2 cases), malignant tumors (35 cases), tuberculosis (1 case), bladder extrophia (1 case), neurological bladder (6 cases). There were 4 early postoperative deaths (8.9%) and 5 severe complications (2 eviscerations, 2 occlusions, 1 digestive tract hemorrhage). Of the 37 operated cases followed-up for varying periods, 5 (13.5%) had diminished renal function, 23 (62%) had late complications requiring further operations in 17 cases (45.9%). These complications were 7 cases of stenosis of the ureter, 1 case of fistual of the ureter, 1 ileal fistula, 4 cases of stenosis of the graft opening, 3 prolapses of the graft, 1 skin lesion, 5 kidney stones and 1 case in which reflux was poorly tolerated. - 12 transprosthetic cutaneous ureterostomies with only 2 good results. No cutaneous shunt operation is exempt from complication. Transprosthetic cutaneous ureterostomies are probably the least affected. Direct cutaneous ureterostomies are statistically better tolerated than transintestinal cutaneous ureterostomies, which appear to have the major inconvenience of deteriorating at a later stage, requiring repeated further operations.


[Intravesical prolapse of the lower end of the ureter].

Report of a case of prolapse of the lower end of the ureter into the bladder. Observed in a 11 year-old boy with a history of recurrent urinary infection. The bladder deformity was seen as a non-opaque filling defect which possibly ressembles the shadow of a simple ureterocele. The child required resection of the prolapsed segment and ureteral reimplantation using the combined suprahiatal and infrahiatal routes.


[Retroperitoneal malignant xanthogranuloma. 1 case and a literature review].

A case is reported, the 33rd to be published in the literature, of malignant retroperitoneal xanthogranuloma. The tumor involved 2 cm of the right ureter at the junction between the middle and upper thirds. The middle third of the ureter was removed and ureteral continuity established by end to end ureteral anastomosis. The patient died fourteen months later probably from metastases, though the presence of these was not confirmed.


[Course of superficial malignant tumors of the bladder. Apropos of 135 cases].

After recalling the difficulty of comparing the various series published in the literature. in the absence of common histological criteria. the authors review the records of patients with a class III or IV carcinoma of the bladder. strictly confined to the musoca, whether or not the basal membrane was damaged (stage O or A), with the exclusion of all cases with histological invasion of the muscularis and any other clinical or radiological signs of deep infiltration: 135 records with a follow-up of at least 6 months. This study led to the following findings: - One third of the tumours progressed to deep infiltration and/or metastases. - This unfavourable course occurred. in almost 3/4 of cases. during the 2 years following the clinical presentation of the tumour. - Such a grave course may develop for tumours not affecting the basal membrane without it having always been possible to define the stage of infiltration of the chorion. - A metastasis may develop while the tumour remains superificial. - 5 out of these 135 patients developed 2 or more extra-urological carcinomas. - Two thirds of these superifical tumours did not invade the muscularis during the period of observation which in 41 cases exceeded 6 years. - The difficulty lies in detecting which superificial malignant tumours of the bladder will not recur. which will recur superficially (where preservation of the bladder is automatic) and which will recur with infiltration and/or metastases. where an aggressive therapeutic attitude should be adopted before any infiltration or diffusion of the tumour manifests itself. - Tumours which did not recur were unifocal. - All multifocal tumours treated conservatively recurred.


[Urothelial inverse papilloma. Review of the literature (appropos of 2 cases: 1 vesical, the other urethral)].

The authors report two cases of urothelial inverse papilloma and review the 94 observations in the published literature. Some fundamental features of the condition are outlined: 1) DEFINITION: paramalpighian papillary tumor which spreads towards the chorium but does not invade it, and lies under the intact urothelium which is folded towards the lumen of the urinary tract, 2) Site: usually cervicotrigonal but may be urethral; 3) Evolution: usually benign but sometimes recurrent; 4) Histogenesis: abnormal proliferation of Von Brunn's islets. 5) Association: possible with bladder carcinomas.


Complete responders to chemotherapy in metastatic breast cancer. Characterization and analysis.

Four hundred thirty-eight patients with metastatic breast cancer treated with nine prospective randomized trials were reviewed to analyze, characterize, and compare those with complete regression (CR) (N=49 [11%]) with those with noncomplete regression (non-CR) (N=389 [89%]). Site of dominant disease was identical in the CR and non-CR patients. However, CR was statistically more likely when the disease-free interval and the postmenopausal status was five years or less. Survival and time to progression occurred at sites of prior dominant disease, except that relapses occurred in the CNS in 14%. Six CR patients received prolonged chemotherapy and were believed to be "cured" when treatment was discontinued; however, all except one have had relapses.


Sensitivity of mammography and physical examination of the breast for detecting breast cancer.

Mammography and physical examination of the breast are evaluated as screening instruments for detecting breast cancer based on local biopsy data obtained from women enrolled in a national breast cancer screening program. One hundren thirteen cancers (15.5%) of women who underwent biopsy) were detected. The individual sensitivities of mammography and physical examination for detecting breast cancer are 62% and 24%, respectively. The sensitivity of the two methods combined is 75% (85 of 113). Thirty-seven cancers were in situ or minimally invasive (less than or equal to 1 cm in greatest dimension). Eighty-one percent (30 of 37) of these small cancers were detected by screening, and they comprised 35% (30 of 85) of all cancers detected by mammography, physical examination, or both. Improved survival is anticipated due to this high rate of discovery of small cancers.


Use of plasma products with whole blood and packed RBCs.

During the past five years, there has been a sharp increase in the use of packed RBCs (PRBCs) and plasma products, whereas whole blood (WB) transfusions have steadily decreased. In order to determine whether plasma and its derivatives were being used to "reconstitute" whole blood from PRBCs, we performed a retrospective evaluation of all transfusion episodes in ten representative regional hospitals during a five-month period. Our results indicate that PRBCs were transfused 2.5 times more frequently than WB. Plasma products were administered with PRBCs less often than with WB: 14% of all PRBCs vs 24% of all WB units tranfused. The likelihood of a patient receiving plasma was found to correlate with the total amount of blood transfused and the frequency of transfusion. This study provides evidence that, at most, only a small percentage of PRBCs are given in conjunction with plasma as "reconstituted" WB.


Complications with heparin-lock needles.

The incidence of phlebitis was determined for heparin-lock needles after use of three different methods of skin preparation and follow-up care. Phlebitis was significantly more frequent when iodophor solution and iodophor ointment, respectively, were used than when iodophor solution alone was used for heparin-lock needles in use longer than 48 hours, with more than ten manipulations of the systems, and when only one drug was infused through the systems. Iodophor solution skin preparation followed by daily application of iodophor solution is recommended to minimize the occurrence of associated phlebitis.


Digoxin overdose. Limitations of hemoperfusion-hemodialysis treatment.

We used charcoal hemoperfusion coupled with hemodialysis to treat a woman with massive digoxin ingestion complicated by hyperkalemia. Although dialysis controlled the serum potassium levels, hemoperfusion removed less than 1% of the total ingested dose. Hemoperfusion has a relatively minor impact on digoxin elimination and remains of unproved value in the therapy for digoxin overdose.


Conditioned adaptation-relaxation reflex in migraine therapy.

A new conditioned reflex, the adaptation-relaxation reflex, characterized by dilation of the peripheral blood vessels of the hand and arm, is associated with reduced blood flow in the area of the supraorbital and superficial temporal arteries. This reflex, learned through biofeedback training, is a central requirement for successful autonomic conditioning for migraine. In migraine patients whose conditions improve clinically, the finger-temperature feedback training is not associated with the conditioning of a single autonomic response, ie, digital vasodilation, but is associated with a general decrease of sympathetic tonic outflow.


Abrupt discontinuation of clonidine therapy.

Clonidine therapy was discontinued abruptly in seven patients. Blood pressure was recorded every hour or two hours throughout the study. Clonidine therapy was reinstituted 48 hours after its discontinuation in all except two patients, in whom it was reinstituted at 36 hours. During the withdrawal phase, blood pressure tended to return rapidly to nontreatment levels, but there was no "overshoot" in blood pressure. Apprehension, insomnia, palpitations, and sweating were experienced by two patients. These symptoms were relieved promptly by reinstituting clonidine therapy. In this prospective study, no blood pressure overshoot was noted with abrupt discontinuation of clonidine.


Extracorporeal membrane oxygenation in severe acute respiratory failure. A randomized prospective study.

Nine medical centers collaborated in a prospective randomized study to evaluate prolonged extracorporeal membrane oxygenation (ECMO) as a therapy for severe acute respiratory failure (ARF). Ninety adult patients were selected by common criteria of arterial hypoxemia and treated with either conventional mechanical ventilation (48 patients) or mechanical ventilation supplemented with partial venoarterial bypass (42 patients). Four patients in each group survived. The majority of patients suffered acute bacterial or viral pneumonia (57%). All nine patients with pulmonary embolism and six patients with posttraumatic acute respiratory failure died. The majority of patients died of progressive reduction of transpulmonary gas exchange and decreased compliance due to diffuse pulmonary inflammation, necrosis, and fibrosis. We conclude that ECMO can support respiratory gas exchange but did not increase the probability of long-term survival in patients with severe ARF.


Clinical features of diphtheria in the respiratory tract.

Clinical features of 44 culture-confirmed cases of diphtheria involving the respiratory tract treated at the University of Washington and affiliated hospitals in Seattle over a five-year period were studied. Of 42 patients treated primarily in Seattle, five (11.9%) died; nonfatal, toxin-induced complications occurred in seven (16.7%). Airway obstruction was the most common cause of death in this series. Diphtheritic membrane (especially in the larynx), dyspnea, and leukocytosis were dire prognostic signs. We urge indirect laryngoscopyin all cases showing membrane formation; tracheotomy should be considered when laryngeal membrane is present. Diphtheria should be suspected in any patient with pharyngitis who has been in contact with endemic areas, especially when pharyngeal membrane is present.


The impact of holistic medicine, medical groups, and health concepts.

Holistic medicine (Greek, holos, meaning entire or whole) focuses on the whole person--mind-body-spirit, well-being, and wellness. It is a new health care movement or medical approach that is gaining momentum. The basic concepts are simple and clear, avoiding a piecemeal approach to health with treatment of one disease. Two or three physicians may form holistic medical groups, sometimes inviting nonphysician health care professionals to join. Some of these nonphysicians are not licensed, and standards need to be devised. Governmental agencies are impressed by low-cost resuits, especially with chronically ill patients. There are also groups that have spiritual health care modalities and ministrations. Nevertheless, there are commercialistic tendencies and faddism in some centers, and the literature has been criticized as being for laymen by laymen; however, the movement deserves a sympathetic hearing.


Detection of intracolonic lesion by barium contrast enema. The importance of adequate colon preparation to diagnostic accuracy.

Frequently, the clinical significance of the barium contrast enema is minimal because of inadequate colon preparation prior to examination. The frequency of false-positive routine barium enemas was 17% in 230 consecutive patients who underwent colonoscopy for removal of specific radiographically identified polypoid colon lesions. Initial barium enema inaccuracies were documented with postendoscopic air-contrast radiography in colons that were endoscopically proved to be mechanically clean following a two-day colon preparation. These results suggest that more emphasis on a two-day colon preparation, before the initial barium contrast enema, would substantially reduce the frequency of false-positive interpretations.


Neuroblastoma, pheochromocytoma, and renal cell carcinoma. Occurrence in a single patient.

A 26-year-old woman had a neuroblastoma during infancy; an extra-adrenal pheochromocytoma at age 16 years, with hepatic recurrences during the next ten years; and multifocal renal cell carcinoma. Neuroblastoma and pheochromocytoma, despite their common embryologic origin, to our knowledge have not been previously reported as separate tumors in the same patient. Although many attributes of the patient's tumors suggest a hereditary disorder, thorough investigation disclosed no evidence of heritable conditions associated with any of these tumors in the patient or her family members. Long-term observation of persons surviving after treatment of neuroblastoma will be necessary to determine whether this case represents a previously unidentified tumor predisposition or a sporadic occurrence.


Reducing birth defect risk in advanced maternal age.

The incidence of birth defects increases with maternal age. Recent advances in fetal diagnosis, coupled with elective abortion, offer the older pregnant woman an opportunity to reduce this risk. To determine the magnitude of potential risk reduction, we reviewed the maternal age-specific incidence of infants born with one or more severe birth defects in metropolitan Atlanta from 1968 to 1975, removing from analysis certain anomalies that were preventable by currently available methods. For women aged 35 to 44 years, the risk of bearing an infant with a severe birth defect was reduced to a level comparable with that for younger women. Despite prenatal diagnosis and elective abortion, the risk for women aged 45 years or older, although reduced considerably, was two times greater than that for women aged 34 years or younger.


Anemia. Textbook vs practice.

Anemia, particularly if mild, is ignored frequently. We conducted a questionnaire survey of 252 physicians and medical students to verify this impression and to explore the reasons for it. A cumulative 40% to 57% depending on the hypothetical patients' circumstances) of respondents chose to investigate anemia only at hemoglobin levels too low for the accepted criteria in female patients; a striking 78% to 89% did so in male patients. Only 54% and 30% knew the correct textbook definition of anemia for women and men, respectively. More importantly, 35% to 60% demonstrated criteria for choosing to investigate anemia were lower than even their own perception of the textbook definition. Little difference existed among the various physician subgroups in their responses. The discrepancy between what physicians do and what they are taught appears to arise from several factors, of which lack of knowledge is only one.


Tetanus and diphtheria immunity in urban Minnesota adults.

Tetanus and diphtheria antitoxin levels were measured in 183 urban adults, using a hemagglutination technique. Protective levels (greater than 0.01 unit/mL) of tetanus antitoxin were present in more than 85% of sera from all subjects under 40 years of age and from men between 40 and 59 years old. A minority of women (36%) between 40 and 59 years of age, and of men (41%) and women (29%) over 60 years of age, were protected. Less than one quarter of the study group had protective levels (greater than 0.01 unit/mL) of diphtheria antitoxin. The results of the study suggest that a minority of middle-aged women and older adults have been appropriately immunized against diphtheria and tetanus.


Prediction of outcome of surgery and anesthesia in patients over 80.

We studied the outcome of surgery in 500 patients over 80 years of age. Hospital mortality within one month of surgery was 6.2%. The American Society of Anesthesiologists class 1 to 5 preoperative evaluation scale was useful in predicting death--less than 1% of class 2 patients died, 4% of class 3, and 25% of class 4. Six of seven perioperative deaths were caused by mesenteric infarction. Myocardial infarction was the leading cause of postoperative death. Twenty-four percent of 141 patients who underwent upper abdominal surgery required controlled endotracheal ventilation for more than 24 hours postoperatively; 57% after intrathoracic surgery; and only 2% after surgery that did not enter pleura or peritoneum. Forty-seven patients underwent gallbladder surgery, and 27 peripheral underwent vascular surgery without any hospital fatality. Enflurane appears to be a safe general anesthetic for sick, elderly patients.


New develpments in civil commitment of the mentally ill. Impact for patient, family, and psychiatrist.

In deciding Addington vs Texas the US Supreme Court established "clear and convincing evidence" as the standard of proof necessary for civil commitment of the mentally ill rather than the criminal standard, "beyond a reasonable doubt." This decision has major implications for the mentally ill person, the family, and the psychiatrist. The mentally ill person is returned to the role of patient. The family is given aid in their dilemma of coping with their psychotic member. The psychiatrist is seen as helper rather than jailer.


RBC exchange pheresis for priapism in sickle cell disease.

An intermittent-flow blood cell separator was used to perform a sub-total RBC exchange pheresis with prompt relief or priapism secondary to sickle cell disease. The blood cell separator offers an efficient, practical, safe method of performing exchange transfusion in the adult. Surgical procedures in the treatment of priapism have met with limited success and carry a 50% rate of subsequent impotence. We believe that RBC exchange pheresis offers a superior approach in the treatment of complications of sickle cell crisis, including priapism, and should be instituted in the symptomatic patient before more drastic procedures are undertaken.


Ascorbic acid and vitamin B12.

Using extraction procedures in which the extracted vitamin B12 was protected by cyanide or metabisulfite, several investigators found no change in vitamin B12 when meals were incubated in the presence of ascorbic acid for 30 minutes at 37 degrees C. A previous report suggested degradation of vitamin B12 under these conditions, but this was apparently caused by incomplete protection of the extracted vitamin B12 in the assay procedure. If incubation at 37 degrees C for 30 minutes is a laboratory mimic of the gastric environment, one must conclude that high doses of ascorbic acid do not affect the stability of vitamin B12 in vivo.


Examining the anterior right kidney. Frequent lack of appreciation in examination of the right upper quadrant.

An anteriorly positioned lower pole of the right kidney is often unappreciated on physical examination. Yet, on review of a large number of abdominal sonograms, more than 12% of the patients had a right kidney with a lower pole sufficiently anterior in position so as to lie at the same depth as the anterior surface of the liver. In a group of patients referred for ultrasound evaluation of hepatomegaly, 20% proved to have a normal liver and an anteriorly positioned lower pole of the right kidney.


Effectiveness of antihistamines in the symptomatic management of the common cold.

A multicentric trial compared the effect of chlorpheniramine maleate with a placebo on the signs and symptoms of the common cold. Two hundred seventy-one patients were domiciled for 48 hours and evaluated during this period and for four days afterwards. Evaluations by both patients and physicians showed that chlorpheniramine maleate was superior to placebo in lessening the degree of symptoms of the common cold. Statistically significant differences were found both on the first day and as late as the seventh day. Significant differences and trends were shown in such measures as total objective score, physicians' evaluation of symptoms. The overall incidence of side effects other than drowsiness did not differ between the treatment groups.


Self-administered analgesia with nitrous oxide. Adjunctive aid for emergency medical care systems.

Analgesia with a mixture containing 50% nitrous oxide and 50% oxygen (Nitronox) was evaluated in 47 patients with abdominal pain, chest pain, musculoskeletal trauma, and burns. Of these, 93.6% experienced either partial or complete relief of pain. There were no complications attributed to its application; the short duration of action makes its use suitable during emergency transportation.


An analysis of nonconfirmation rates. Experiences of a surgical second opinion program.

A review was conducted of the first 12 months' experience with a voluntary second opinion surgery consultation program. The program covers approximately 950,000 persons: employees of the city of New York, retirees, and their dependents. On a simple yes or no basis, the program's surgical nonconfirmation rate was 25%. More detailed analysis of consultants' narrative suggestions for patient care showed that a firm rejection of surgical intervention occurred in only 8% of the cases reviewed. Nonconfirmation rates were found to be unsatisfactory measures of program success in preventing potentially unnecessary surgery. Data from second surgical opinion programs should not be used to estimate the prevalence of unnecessary surgery in a community. The key benefit of such programs may be to facilitate and to encourage patient-physician communication.


Influenza-associated myoglobinuric renal failure.

Acute myoglobinuric renal failure developed in three patients during the course of influenza virus infection. Muscle enzyme levels were elevated in all patients. Myoglobin was detected in the urine or serum by immunodiffusion. Recent influenza infection was documented by elevated hemagglutination inhibition titers. One patient died, whereas the remaining two patients completely recovered renal function. These patients with influenza infection represented more than half of the cases of myoglobinuric renal failure seen on the medical services of the study institutions during ths same period. These observations suggest that the association between influenza infection and myoglobinuric renal failure may be more common than previously suspected.


Five-year findings of the hypertension detection and follow-up program. I. Reduction in mortality of persons with high blood pressure, including mild hypertension. Hypertension Detection and Follow-up Program Cooperative Group.

The Hypertension Detection and Follow-up Program (HDFP), in a community-based, randomized controlled trial involving 10,940 persons with high blood pressure (BP), compared the effects on five-year mortality of a systematic antihypertensive treatment program (Stepped Care [SC]) and referral to community medical therapy (Referred Care [RC]). Participants, recruited by population-based screening of 158,906 people aged 30 to 69 years in 14 communities througout the United States, were randomly assigned to SC or RC groups within each center and by entry diastolic blood pressure (DBP) (90 to 104, 105 to 114, and 115 + mm Hg). Over the five years of the study, more than two thirds of the SC participants continued to receive medication, and more than 50% achieved BP levels within the normotensive range, at or below the HDFP goal for DBP. Controls of BP was consistently better for the SC than for the RC group. Five-year mortality from all causes was 17% lower for the SC group compared to the RC group (6.4 vs 7.7 per 100, P less than .01) and 20% lower for the SC subgroup with entry DBP of 90 to 104 mm Hg compared to the corresponding RC subgroup (5.9 vs 7.4 per 100, P less than .01). These findings of the HDFP indicate that the systematic effective management of hypertension has a great potential for reducing mortality for the large numbers of people with high BP in the population, including those with "mild" hypertension.


Five-year findings of the hypertension detection and follow-up program. II. Mortality by race-sex and age. Hypertension Detection and Follow-up Program Cooperative Group.

Data are reported for four race-sex and three age subgroups of the Hypertension Detection and Follow-up Program (HDFP). Throughout the HDFP trial, for black men, black women, white men, and white women and for persons aged 30 to 49, 50 to 59, and 60 to 69 years at entry, control of blood pressure was consistently better for Stepped Care (SC) than Referred Care (RC) participants. This difference in degree of control was least for white women; it was less for whites than for blacks of the same sex. For white men, black men, and black women and for age subgroups 50 to 59 and 60 to 69 years, five-year all-cause death rates were substantially lower--by 15% to 28%--for the SC subgroups compared to the RC subgroups.


Cardiovascular deaths while running.

When a person dies of cardiovascular causes during recreational running, the public frequently assumes the exercise caused the death. For a statistical perspective, the number of cardiovascular deaths while running that occurs by chance alone is estimated. If white male runners resemble marathoners, being nonsmokers and at lowest lean weight, four deaths from cardiovascular disease would occur per year while running 20 minutes, three times per week and 30 deaths per year if the two hours after running are considered as a running-associated period. However, if runners resemble the white male population, then 15 deaths would occur from cardiovascular disease per year while running and 104 during the associated period. Thus, four to 104 cardiovascular deaths per year are predicted on a purely temporal basis in white men while running.


Acute renal failure and maneb (manganous ethylenebis[dithiocarbamate]) exposure.

A 62-year-old man spread maneb on about 200 sq m of garden and subsequently was taken to the emergency clinic with complaints of oliguria, diarrhea, and hoarseness. Based on the clinicobiochemical data, he was found to have acute renal failure; the serum levels of BUN, creatinine, and potassium were 144.3 mg/dL, 14 mg/dL, and 5.8 mEq/L, respectively. The ST segment depression in V4-6, reciprocal ST segment elevation in V1-3, and inverted T waves in V5 and V6 were recorded on ECGs. Both the renal failure and the ECG abnormalities disappeared after hemodialysis. The possibility exists that the maneb caused the acute renal failure.


[Fundamental studies of combination of antibiotics, especially on pharmacokinetics. III. Combination of ampicillin and dibekacin (author's transl)].

1. Pharmacokinetics was investigated when ampicillin (ABPC) (50 mg/kg) and dibekacin (DKB) (5 mg/kg), in combination with pre- or post-treatment, were intravenously injected to the rat or rabbit. 2. The antibiotics in the samples were separated by the paper-electrophoretic technique and then concentrations were determined by the cup thin-layer plate method using Bacillus subtilis ATCC 6633 as the test organism. 3. The biological half-life of DKB was prolonged in pretreatment with ABPC and that of ABPC was shortened in pretreatment with DKB. An initial level of ABPC was elevated. Similar tendency was observed in both of the rat and rabbit. 4. Urinary excretion rates of both antibiotics in the combining group tended to decrease compared with the single administration group. 5. Binding of ABPC to serum proteins was competitively inhibited by DKB. Binding of DKB to serum proteins increased.


[Clinical investigation on a new penicillin derivative, bacampicillin (author's transl)].

A clinical investigation was carried out on a new penicillin derivative, bacampicillin with the following results. (1) Clinical effect--Bacampicillin was administered orally to 18 patients with acute simple cystitis, acute simple pyelonephritis, chronic prostatitis and acute gonorrhoic urethritis. Daily doses ranged from 750 mg to 1,000 mg. The administration continued for 4 to 14 days. Clinical effect was excellent in 10 patients and good in 5 patients. (2) Side effect--Side effects were noticed in 4 patients, one was allergic eruption and other 3 were gastralgia. In a patient the drug was discontinued to administer.


Carcinogenesis in tissue culture 30: malignant transformation of normal rat liver cells treated with diethylnitrosamine in tissue culture with special reference to the differential effects of cytochalasin B on various cells with and without tumorigenicity.

Liver tissue of a suckling rat was cultured. After 3 weeks of cultivation, the cultures consisting of epithelial cells were treated with 50 micrograms/ml or 100 micrograms/ml DEN for 7 days. 5 months after the treatment, the mode of chromosome number was found decreased from 42 to 40 in the 100 micrograms/ml DEN-treated group and shifted to triploid range after 21 months. The mode in the 50 micrograms/ml DEN-treated group maintained the diploid number until the 5th month but was found reduced to 40 in 21 months. On subcutaneous backtransplantation into young rats at the 22nd month, the treated cells produced tumors at the site inoculated in all the rats. Metastatic foci were also detected in lungs. These tumors were histologically diagnosed as hepatomas. Untreated control cells did not produce tumors. The differential effects of cytochalasine B on the cells with and without tumorigenicity were examined by the use of these cells and other cells, and it revealed that the capacity of multinucleated cell-formation by cytochalasin B fairly corresponds with the backtransplantability of the cells. Binucleated cell formation, not more than 2 nuclei, in the culture of normal cells was found by time-lapse cinemicrography to be not due to the non-capacity of multinucleation but to the destruction of multinucleated cells.


[Epidemiological studies on the symptoms due to strawberry culture in the vinyl-house. 1. An analysis of subjective symptoms by working conditions and constitution of the farmers (author's transl)].

An epidemiological survey focused on farmers engaged in vinyl-house culture of strawberry was carried out among the inhabitants of a farming village. For avoiding residential and habitual factors, all residents (851 in number) over 12 years of age in the area were inquired about symptoms, personal and family histories. There were no marked difference in age and sex among three groups, i.e. farmers with and without vinyl-house culture and people with no relation to farming in this area. Incidence of one of the inquired symptoms were 54% and 45% in farmers with and without strawberry culture in vinyl-house respectively, and 34% in the non-farming people. This difference became more larger up to 83% in the strawberry farmers of allergic constitution. Symptoms found more in the farmers than the other were headache, dizziness, conjunctivitis, rhinorrea, sneeze, palpitation and neuralgia, and the last four symptoms were more marked among farmers in charge of strawberry culture. Incidence of the allergic symptom consisting of conjunctivitis, rhinorrea and sneeze was more marked among the persons of allergic constitution . In conclusion, health effects of strawberry culture in vinyl-house in farmers can be look upon from three aspects; overwork, a particular stance during the work and allergic responses to the dust in the vinyl-house.


[Epidemiological studies on the symptoms due to strawberry culture in the vinyl-house. 2. An analysis of clinical examinations with emphasis on allergic response (author's transl)].

Clinical mass surveys were carried out on the residents to whom questionnaires on symptoms with reference to strawberry culture in the vinyl-house had been delivered. Two hundred and eleven persons attended at the first survey in September, 1976 (off the season of strawberry culture) and the 58 attended at the second survey in March, 1977 (within the season). The participants of the first survey consisted of three groups, i.e. farmers with and without strawberry culture and people without farming. The participants of the second survey consisted only of farmers with strawberry culture. Results are summarized as follows. 1) There were no difference of incidence of various clinical findings detected by an ophthalmologist and otolaryngologists among the three groups. 2) There were also no difference of incidence of abnormal findings in urine tests, liver functions, respiratory test, blood examinations and blood pressure test among the three groups. However, the comparison of persons in charge of strawberry culture and attended at both tof the first and the second surveys, such changes were detected as increases in the value of GOT (within normal limits), of stab neutrophiles, lymphocytes and of monocytes within the season of strawberry culture. 3) Increases of positive rates in skintest by extracts of house dust and Candida sp. were observed in the farmers with and without strawberry culture. Positive rates of skintest by strawberry pollen and honey bee extracts among the farmers with strawberry culture were markedly higher than the allergic patients in Dokkyo Hospital having no relation to this culture. This positive rate was markedly elevated among the persons who complained the symptom of rhinorrea within the season.


[Accumulation of cadmium in organs of mice by a long-term injection of cadmium and interactions of cadmium with copper, manganese and zinc already present in the animals (author's transl)].

It is well known that the greater part of the administered cadmium is accumulated in liver and kidneys. But, in considering the toxicity of cadmium, it is important to make clear the time pattern of cadmium accumulation not only in liver and kidneys but in the other organs. Male mice were injected subcutaneously 1 mg/kg of cadmium daily for 25 weeks except one day in every week. Five mice at a time were killed in the suitable time during this experiment, and Cd, Cu, Mn, and Zn concentrations in several organs were determined by atomic absorption spectrophotometry. Cadmium content in liver and kidneys increased remarkably during the first 30 days, and it is scarcely increased after that period. Cadmium content in other organs, that is, heart, lungs, spleen, testes and femurs, increased slowly during the first 20 days, and this content increased hardly after that. The results show further that: Cd administered at the early stage accumulated mainly in liver an in kidneys. As Cd concentration in liver and kidneys arrives at saturation, Cd content in other orbans increased remarkably. And, after 30th day, Cd content in all the organs increased little in spite of the continuous injection of Cd. Concentrations of Cu, Mn, and Zn in the organs of mice injected with Cd were as follows: Cu concentration increased significantly in heart, liver, and kidneys, Zn concentration increased in heart, lungs, liver, and kidneys, whereas Mn concentration decreased remarkably in kidneys. Cadmium content in the organs of mice injected with Zn (0.5 mg/kg) or Mn (0.5 mg/kg) together with Cd (1 mg/kg) showed a tendency to increase remarkably compared with single injection of Cd.


Vascular resistance of intestine, muscle and skin during blood pressure oscillation.

After the blood supply to the head was surgically limited to one common carotid artery in rabbits, the artery was compressed by exertion of stepwise elevated side pressure on a segment of the artery. Systemic arterial pressure rose and began to oscillate when the side pressure was increased to 50 to 60 mmHg. The oscillations were regular and occurred at a rate of 3 to 4 per minute with a wave height of 15 to 45 mmHg. Concomitant with systemic pressure oscillations, and in near synchrony were undulations in the perfusion pressures recorded during constant flow from the vascularly isolated abdominal skin, skeletal muscle and small intestine. With the graded elevation of side pressure on the common carotid artery, mean systemic pressure and perfusion pressure showed a nearly exponential relation. The ratio between the two variables was slightly less than one below the systemic pressure of 120 mmHg and rapidly increased above this level. At ratios greater than one, the peripheral resistance undulations in the isolated areas gave a larger minimum and maximum, a sharper contour and, particularly in the skin, a phase lag in the period of the wave form when compared to the systemic pressure oscillations. These observations highlight the differences in response characteristics of peripheral resistance vessels and those of cardiac output and different consecutive parts of the systemic arteries during periods of intense sympathetic activation.


Lasting effect of infantile cold experience on cold tolerance in adult rats.

The effect of short and repetitive exposure to cold (5 degrees C, 4 hr/day for 2 weeks) from the birth up to the 14th day of newborn rats onthe thermal regulation in adulthood and on the tolerance to cold was investigated. After being exposed to cold, they were transferred to a room at 25 degrees C (N-CA). The control rats were raised at 25 degrees C (N-WA). An acute cold exposure test was performed by placing the animals in a room at 5 degrees C under urethane anesthesia. Electrical activity of neck muscles as an index of shivering was recorded. The colonic temperature fell at a significantly slower rate in N-CA rats with less shivering than in N-WA ones. Nonshivering thermogenesis tested by norepinephrine was significantly greater in N-CA rats than in N-WA ones. These results suggest that N-CA rats developed improved cold tolerance accompanied by greater nonshivering thermogenesis. Such a phenomenon in N-CA lasted for 18 weeks after the termination of cold exposure. Adult rats subjected to the same scheme of cold exposure (A-CA) (5 degrees C, 4 hr/day, 2 weeks) showed essentially the same results as seen in N-CA, but its improved cold tolerance and elevated nonshivering thermogenesis disappeared 4 weeks after the termination of cold exposure. Extirpation of interscapular brown adipose tissue immediately before the cold test did not appreciably affect the cold tolerance in N-CA and A-CA rats. The colonic temperature at the onset of shivering was significantly lower in N-CA as well as A-CA rats than in each of the corresponding control rats, indicating a shift of the shivering threshold to lower temperature values in the animals exposed intermittently to cold. These results indicate that an infantile experience with cold results in a greater and longer sustained ability to tolerate cold in adulthood, characterized by enhanced nonshivering thermogenesis.


Phasic and tonic contractions of rabbit intestinal muscle.

The effects of a single electrical stimulus upon the longitudinal and circular muscles of rabbit small intestine were investigated and the differentiation between phasic and tonic contractions was examined. A weak stimulus caused a phasic contraction and a stronger stimulus evoked both phasic and tonic contractions. The evoked phasic contraction was of an all-or-nothing nature, while the evoked tonic contraction was graded. Strength-duration curves of longitudinal and circular muscles were obts of rheobase and chronaxie. In the presence of verapamil or methoxyverapamil (D 600) the tonic contraction, but not the phasic contraction, could be evoked by a single strong stimulus, while in the presence of sodium nitroprusside the phasic contraction, but not the tonic contraction, could be provoked by a single strong stimulus. The phasic and tonic contractions differed in their strength-duration curves and drug responses.


Body temperature and oxygen consumption of newborn rats at various ambient temperatures.

The thermogenic response and rectal temperature (Tre) of newborn rats (0 to 32 days old) on exposure to various ambient temperatures (Ta) were investigated. The O2 consumption (VO2 in ml . min-1 per 100 cm2 surface area) was measured for one rat at a time by means of a closed circuit system. The results were that (1) within the thermal neutral ranges, Tre stood at 36--37 degrees C regardless of the age and the value of VO2 was lowest at the age of 6--7 days, after this period increasing and reaching a level of 1.4 ml . min-1 . cm-2 X 10(-2) after 18--21 days old (the weaning period); (2) the thermogenic response to cold (delta VO2/--delta Ta) was higher at ages prior to the weaning period than after the weaning period; (3) in spite of the higher thermogenic responses, Tre decreased markedly on exposure to cold prior to the weaning period, because of a poor development of thermal insulation; and (4) the achievement of homeothermy of the rat at subneutral temperatures was observed after the weaning period.


Whole body transvascular filtration coefficient and interstitial space capacitance.

Infusion experiments with Ringer's solution were performed on 5 splenectomized dogs with continuous monitoring of blood volume and hematocrit. The plasma volume was calculated from these data and followed during the infusion and also during the recovery period. Applying electrical equivalent simulation analysis to the result of the plasma volume, the capacitance of the interstitial fluid space and the transvascular filtration coefficient of water in the whole body were determined simultaneously. The mean values of the capacitance and the coefficient were 5.91 ml/kg-mmHg and 0.314 ml/min-kg-mmHg, respectively. From this simulation study, a transfer function which predicts the fluid shift between the vascular system and the interstitial fluid space was also derived. Using the transfer function, predictions of the changes in plasma volume are possible from any given rate of infusion.


Effects of stimulation of Auerbach's plexus on both longitudinal and circular muscles.

The effects of repetitive electrical stimulation of a node of Auerbach's plexus on both longitudinal and circular muscles were investigated by simultaneous recording of both muscle contractions. L-formed muscle strips, longitudinal and circular muscle strips, were made from a segment of rabbit small intestine. One strip was cut along, another strip was cut at 90 degrees to the oral-anal axis. The longitudinal muscle strip was peeled and Auerbach's plexus was exposed. Under a stereodissecting microscope the stimulating electrode, with tip diameter of 5--10 micron, was placed on a node of Auerbach's plexus situated at the junction of both muscle strips. Repetitive electrical stimulation of a node produced a mainly excitatory effect on spontaneous contractions of an orally-directed longitudinal muscle strip, excitatory and inhibitory effects on an anally-directed longitudinal muscle strip and a mostly excitatory effect on a circular muscle strip which always appeared with a delay after that on the longitudinal muscle. In a few instances the inhibitory effect of nodal stimulation was observed on the circular muscle. The evoked excitatory effect of longitudinal muscle was mainly due to a cholinergic mechanism, while that of circular muscle was partially due to cholinergic and partially noncholinergic activity. The evoked inhibition was nonadrenergic.


[Brightness power function and equal brightness contour for dark- and light-adapted eye in the peripheral visual field (author's transl)].

To test whether the equal brightness contour at supra-threshold runs parallel with the contour at threshold, magnitude estimation and the staircase procedure were employed for estimating brightness power function under dark- and light-adaptation. The luminance was changed from 43 to 83 dB re 10(-6) cd/m2 with the light adapting luminance at 53 dB. The retinal loci tested were 0 degrees to 70 degrees periphery in steps of 10 degrees. The exponent of the power function gradually increased from .37 to .73 as eccentricity and adapting luminance increased. The equal brightness contour decreased for dark-adaptation and increased for light-adaptation as eccentricity increased at supra-threshold but at threshold did not follow the parallel hypothesis for both adapting conditions.


[Overlearning of a pursuit tracking task and change in pulse rate and finger skin blood flow (author's transl)].

Eight subjects were given overlearning of a pursuit tracking task twice which they experienced once either half or one year previously. Distributed practice was employed in the present experiments. Finger skin blood flow (SBF) and pulse rate (PR) were measured throughout the experiments. SBF was smaller during trials and during intertrial rests than during rest with eyes closed, but the difference between during trials and during intertrial rests was not significant. It was supposed that the reason for this effect of overlearning was that the increase in motivation resulted in a high level of activation during intertrial rests. The changing pattern of SBF during trials became similar to that in adding task of the previous study (1977) because of learning or habituation. In the second half of the trials, however, SBF during trials gradually became smaller.


Spectral analysis of EEG during mental activity (author's transl).

With the use of power spectral analysis, the occipital and frontal EEGs in normal young subjects were examined during mental activity under closed-eye and open-eye conditions. Under the closed-eye condition, the peak of power spectral density in the alpha band was suppressed during mental activity, as compared with the finding obtained without mental loading. Moreover, the peak frequency of the alpha band shifted to higher frequencies under the mental loading condition in all of the subjects. Under the open-eye condition, alpha waves were prominently suppressed and no peak of power spectral density in the alpha band could be detected. However, during mental activity the peak of power spectral density could be detected in the delta wave band of both occipital and frontal EEGs.


[In-vitro motility studies on the strips of the canine gallbladder (author's transl)].

In-vitro motility of the gallbladder was studied in the longitudinally cut full-thickness strips obtained from 61 mongrel dogs. The strips, 5 mm in width and 15 mm in length, were prepared from the fundus, body and infundibulum of the gallbladder wall and the motility was examined by the changes of contractile dynamics which were transduced on a pen chart recorder. The results were summarized as follows: 1. The specimen from three parts of the gallbladder exhibited spontaneous motility which was comprised of tonic and rhythmic contractions and they seemed to be stable approximately during the period from three and half an hour to six hours in the Tyrode solution. 2. There was a characteristic pattern which was specific for each three parts in the waves of spontaneous rhythmic contraction. The specimen from infundibulum showed almost regular waves which were predominantly comprised of greater amplitude than those of other two parts. 3. The effects of gastrointestinal hormones and similar substance, caerulein, tetragastrin and secretin were investigated on the activity. Caerulein and tetragastrin were found to be potent stimulant of the dog gallbladder. The stimulated contraction waves were uniform and the pattern could be described with using a certain mathematical expression.