Isolation of influenza C virus recombinants.

Recombinants between two different influenza C viruses were isolated. In MDCK (canine kidney) cells, one strain, C/JJ/50, caused lytic plaques, whereas C/JHG/66 virus did not produce clear plaques. From a mixed infection of MDCK cells with C/JHG/66 virus and UV-inactivated C/JJ/50 virus, clones were isolated which possessed the clear-plaque phenotype. Fingerprint analyses indicated that the RNAs of parent viruses had different oligonucleotide patterns and that one of the clones derived from the mixed infection was formed by reassortment of parental genes. This recombinant clone most likely inherited RNAs 1, 2, 3, 6, and 7 from C/JGH/66 virus and RNAs 4 and 5 from C/JJ/50 virus.


Inhibition of influenza C virus replication by actinomycin D, alpha-amanitin, and UV irradiation.

Actinomycin D and alpha-amanitin caused similar reductions in the yields of influenza A/WSN and influenza C/JBH/1/66 viruses in a chicken kidney cell culture system. Irradiation of host cells with UV light before virus infection also produced a similar reduction in yields of the two viruses. The results indicate a close similarity between the replication processes of influenza C and other orthomyxoviruses.


Purification of the JS-3 isolate of Herpesvirus ovis (Bovid herpesvirus 4) and some properties of its DNA.

A procedure incorporating the use of heparin was developed to purify Herpesvirus ovis. The viral DNA has a buoyant density of 1.706 +/- 0.001 g/cm3, and the sedimentation constant was estimated to be 47.5 +/- 1.5S; from the latter, the molecular weight was calculated as 67.3 +/- 5.4 X 10(6). Estimates of the guanine-plus-cytosine content made from the buoyant density and melting point (72 degrees C) gave levels of 47 and 46%, respectively.


Composition and molecular organization of lipids and proteins in the envelope of mycoplasmavirus MVL2.

MVL2 virus was purified from culture supernatants of infected Acholeplasma laidlawii cells by differential centrifugation, followed by velocity centrifugation in sucrose gradients. The purified virus contained 0.08 to 0.1 mumol of lipid phosphorous per ml of viral protein. Thin-layer chromatography of viral lipids revealed the presence of phospho-, glyco-, and phosphoglycolipids identical with those found in the host cell membrane, but the relative amount of phosphatidylglycerol was much lower than that in the virus. The fatty acid composition of lipids incorporated into the virus included lipids synthesized before and after infection. The freedom of motion of spin-labeled fatty acids in MVL2 depended markedly on temperature and on the position of the nitroxide group on the hydrocarbon chain of the probe, suggesting that the local environment of the probe has the properties of a lipid bilayer. Nevertheless, the lipid hydrocarbon chains in MVL2 appear to be less mobile than those in membranes of the host cells. Polyacrylamide gel electrophoresis of purified MVL2 revealed four major and about five minor polypeptide bands. None of the polypeptide bands gave a positive periodic acid-Schiff reaction. Lactoperoxidase-mediated iodination, followed by proteolytic digestion of intact MVL2 particles, revealed that at least two major polypeptides are localized on the external surface of the viral envelope.


Regulation of the primary expression of the early adenovirus transcription units.

The time course of appearance of transcriptional activity from five early adenovirus type 2 transcription units has been determined. RNA complementary to region 1A (1-4.4 map units), the first region to be transcribed, was detectable at 45 min after infection; a maximal rate of RNA synthesis was reached at 3 h after infection and was maintained thereafter for at least 6 h. RNA from region 2 (75-56 map units), which encodes the mRNA for the 72,000-dalton DNA-binding protein, was the last to be synthesized; transcription commenced at about 2 h postinfection, reached a maximum at 7 h, and then declined. Transcription of regions 3 (76-86 map units) and 4 (99-91 map units) reached a maximal value at 3 h postinfection. The rates of RNA synthesis from these regions then declined over the next 6 h. The decline of transcription from regions 2 and 4 appeared to be a specific repression of these transcription units. The repression did not occur in the absence of protein synthesis, suggesting that a viral protein might be involved. Transcription of all early regions was initiated and continued for at least 2 to 3 h in cells that were treated with cycloheximide or emetine before and during infection, suggesting that at least the initiation of RNA synthesis from the five early adenovirus type 2 transcription units does not depend on the formation of a viral protein. Moreover, mRNA was formed in the absence of protein synthesis that hybridized to DNA fragments representing each of the five early transcription units. The increase in mRNA accumulation in the presence of cycloheximide (or emetine) does not appear to be due to increased RNA synthesis; thus, either increased mRNA stability or increased efficiency of nuclear RNA processing must occur.


Stabilization of "A" particles of coxsackievirus B3 by a HeLa cell plasma membrane extract.

Previous studies in our laboratory showed that HeLa cell plasma membranes were recovered from sucrose gradients in two major bands and that the heavier band possessed a putative inhibitor of uncoating of coxsackievirus B3. It has now been found that the mechanism of inhibition is the stabilization of "A" particles against inactivation at 37 degrees C. [3H]uridine-labeled virions converted to A particles by band 4, the heavier band, were four times more stable at 37 degrees C than those produced by band 3. Partially purified A particles from both bands were equally unstable. It was found that the stabilizing factor was extractable by saline from band 4 and remained soluble after centrifugation (109,000 X g for 2 h). Addition to A particles of this soluble factor isolated from either band 4 or band 3 stabilized the A particles. The stabilizing factor could not be replaced by an extract from band 3 or by bovine serum albumin. Thus, the finding that the membrane factor inhibits virus uncoating by stabilizing A particles against spontaneous disruption at 37 degrees C focuses attention on an inherent problem associated with defining receptor-mediated virus uncoating.


5'-terminal nucleotide sequences of the Rauscher leukemia virus and gibbon ape leukemia virus genomes exhibit a high degree of correspondence.

The 5'-terminal regions of gibbon ape leukemia virus-Hall's Island and Rauscher murine leukemia virus have been completely sequenced. The chain length for the 5'-terminal region of Rauscher murine leukemia virus is 140 nucleotides, and that for gibbon ape leukemia virus-Hall's Island is 144 nucleotides. An alignment of the sequences maximizing the number of ocrrespondences with the minimum introduction of gaps shows 81% nucleotide matches. From the complementary RNA, secondary structures of this region have been proposed. These data demonstrate the conservation of the 5'-terminal genetic sequences of these viruses and strongly reinforce the concept that viruses of murine origin and viruses of the gibbon ape leukemia virus-Simian sarcoma-associated virus group are closely related.


Cap and internal nucleotides of reovirus mRNA primers are incorporated into influenza viral complementary RNA during transcription in vitro.

Reovirus mRNA's containing a 5'-terminal methylated cap structure (m(7)GpppG(m)) were shown to be effective primers for influenza viral RNA transcription in vitro catalyzed by the influenza virion transcriptase. Priming activity required the presence of methyl groups in the cap since reovirus mRNA's with 5'-terminal GpppG were inactive as primers. Both the cap and internal nucleotides were physically transferred from radiolabeled reovirus mRNA to influenza viral complementary RNA (cRNA) during transcription in vitro. By using reovirus mRNA's with methyl-(3)H-labeled caps as primers, we showed that the influenza viral cRNA synthesized in the presence of unlabeled nucleoside triphosphates contained [methyl-(3)H]m(7)GpppG(m), identical to that found in the reovirus mRNA primer. To demonstrate transfer of internal residues, reovirus mRNA's synthesized in the presence of all four alpha-(32)P-labeled ribonucleoside triphosphates were used as primers. The resulting influenza viral cRNA was (32)P-labeled. Diethyl-aminoethyl-Sephadex chromatography of the RNase T2 digest of this cRNA demonstrated (32)P radiolabel in both internal residues (charge -2) and the cap (charge -4.6). Approximately 25 internal nucleotides along with the cap of reovirus mRNA were transferred to each chain of influenza viral cRNA. Gel electrophoretic analysis indicated that the segments of influenza viral cRNA primed by reovirus mRNA were approximately the same size as those primed by a different mRNA, globin mRNA, strongly suggesting that the influenza virion transcriptase complex transfers approximately the same number of nucleotides plus the cap from different mRNA primers to the 5' end of influenza viral RNA transcripts.


regA protein of bacteriophage T4D: identification, schedule of synthesis, and autogenous regulation.

Proteins labeled with 14C-amino acids after infection of Escherichia coli B by T4 phage were examined by electrophoresis in the presence of sodium dodecyl sulfate. Four regA mutants (regA1, regA8, regA11, and regA15) failed to make a protein having a molecular weight of about 12,000, whereas mutant regA9 did make such a protein; regA15 produced a new, apparently smaller protein that was presumably a nonsense fragment, whereas regA11 produced a new, apparently larger protein. We conclude that the 12,000-dalton protein was the product of the regA gene. The molecular weight assignment rested primarily on our finding that the regA protein had the same mobility as the T4 gene 33 protein, which we identified by electrophoresis of whole-cell extracts of E. coli B infected with a gene 33 mutant, amE1120. Synthesis of wild-type regA protein occurred from about 3 to 11 min after infection at 37 degrees C in the DNA+ state and extended to about 20 min in the DNA- state. However, synthesis of the altered regA proteins of regA9, regA11, and regA15 occurred at a higher rate and for a much longer period in both the DNA+ and DNA- states; thus, the regA gene is autogenously regulated. At 30 degrees C, both regA9 and regA11 exhibited partial regA function by eventually shutting off the synthesis of many T4 early proteins; the specificity of this shutoff differed between these two mutants. We also obtained evidence that the regA protein is not Stevens's "polypeptide 3." As a technical point, we found that, when quantitating acid-precipitable radioactivity in protein samples containing sodium dodecyl sulfate, it was necessary to use 15 to 20% trichloroacetic acid; use of 5% acid, e.g., resulted in loss of over half of the labeled protein.


Transformation of primary rat kidney cells by DNA fragments of weakly oncogenic adenoviruses.

Primary cultures of baby rat kidney (BRK) cells were transformed by intact DNA and DNA fragments of weakly oncogenic human adenovirus types 3 and 7. The smallest fragment found to contain transforming activity was the left-terminal 4% endo R.HindIII fragment (for both adenovirus type 3 and 7 DNAs). The efficiency of transformation of this fragment was low, and no permanent cell line could be established. Left-terminal fragments ranging from 84 to 4,5% of the viral genome could all transform BRK cells with the same efficiency as intact viral DNA. A number of adenovirus type 7 DNA fragment-transformed lines were established and were found to contain persistent viral DNA sequences and adenovirus subgroup B-specific T antigen. Consequently, the transforming functions of adenovirus types 3 and 7 are located at the extreme left-hand end of the genome, and the minimum size for a DNA fragment with transforming activity is 1.0 X 10(6) daltons. These results do not rule out the possibility that viral genes located outside the transforming region may also influence transformation.


Genome organization of retroviruses. VI. Heteroduplex analysis of ecotropic and xenotropic sequences of moloney mink cell focus-inducing viral RNA obtained from either a cloned isolate or a thymoma cell line.

The genome of a recombinant murine leukemia virus capable of inducing focal areas of morphological alteration in mink lung fibroblasts was studied by heteroduplex analysis. The dual-tropic recombinant virus was isolated from a thymoma cell line (Th16.3) and is referred to as BALB/Moloney mink cell focus-inducing virus (BALB/Mo-MCF virus). The nucleic acid sequences of RNA from virions obtained from either a thymoma cell line (Th16.3) or a clonal isolate (BALB/Mo-MCF81) were compared with the genomes of ecotropic and xenotropic viruses. The following inferences were drawn (i) A single nonhomologous region (substitution loop alpha) of about 0.7 kilobase was observed in a heteroduplex formed between Moloney murine leukemia virus complementary DNA (cDNA) and BALB/MoMCF81 RNA. This nonhomology region was mapped between 1.71 and 2.40 kilobases from the 3' end of the genome. (ii) The predominant class of heteroduplexes formed between virion RNA obtained from the thymoma cell line (Th16.3) and Moloney murine leukemia virus cDNA showed a substitution loop similar to that observed with the RNA obtained from a cloned isolate, BALB/Mo-MCF81. However, there were other molecules with additional regions of nonhomology. (iii) Heteroduplexes formed between NZB xenotropic RNA and ecotropic Moloney murine leukemia virus cDNA exhibited four major nonhomology regions extending 0.75 to 1.46, 2.0 to 2.8, 3.6 to 4.3, and 7.4 to 7.9 kilobases from the 3' end of the genome. (iv) The MCF-specific substitution loop alpha (1.71 to 2.40 kilobases) appeared as a duplex region when NZB xenotropic RNA was hybridized to cDNA transcripts synthesized by virions obtained from thymoma cell line Th16.3. The position of the other substitution loops observed in a heteroduplex formed between NZB xenotropic RNA and Moloney murine leukemia virus cDNA was not affected. (v) Heteroduplexes formed between xenotropic BALB virus 2 cDNA and NZB xenotropic RNA demonstrated a large degree of nucleic acid sequence homology. Of the 29 heteroduplexes examined, 24 appeared to be homoduplexes, and in the remaining 5 heteroduplexes only one region of nonhomology located between 3.2 and 3.8 kilobases from the 3' end of the genome could be identified. Hybridization of BALB virus 2 xenotropic RNA to NZB xenotropic cDNA followed by digestion with single-strand-specific nuclease S1 showed an 80% sequence homology.


In vitro association of empty adenovirus capsids with double-stranded DNA.

Several lines of evidence suggest that empty adenovirus capsids are preassembled intermediates in the pathway of virion assembly. We have observed that purified empty capsids of subgroup B adenoviruses have a remarkable affinity for DNA in vitro. The products of capsid-DNA association are sufficiently stable, once formed in low-salt solution, to permit purification and characterization in CsCl density gradients. Neither virions nor the DNA-containing incomplete particles of subgroup B adenoviruses can give rise to such in vitro reaction products. The average molecular weight of the empty adenovirus capsids is about 123 X 10(6), consistent with the absence of viral core peptides and a small deficiency of exterior shell polypeptides. Electron microscopy of negatively stained capsids and the capsids bound to DNA reveals a typical adenovirus size and architecture. The particles appear with a surface discontinuity that is presumed to expose the DNA binding site(s). The DNA molecules associated with the empty capsids are susceptible to the actions of DNase and restriction endonucleases. The dependence of rate of capsid-DNA association on DNA length suggests randomly distributed binding sites on the DNA molecules. Although the DNA molecules can successively acquire additional empty capsids, the empty particles themselves are restricted to interactionwith only one DNA molecule. Electron microscopy of the capsid-DNA complexes spread in cytochrome c films shows that the particles are bo-nd along the contour of extended duplex DNA. The amount of DNA within each bound particle appears to be less than 300 base pairs, as estimated by the length of the DNA molecules visible outside of the bound particle. The empty capsid-DNA association product described in this report provides an interesting substrate for further investigation of the DNA packaging process in a defined in vitro system, with extracts or purified components from infected cells.


Cystoscopy in children: indications for its use in common urologic problems.

The use of cystoscopy in children as part of the routine urologic evaluation in 4 diagnostic categories is evaluated for its ability to provide significant data and influence the course of management and cost effectiveness. Records of patients with hematuria, voiding dysfunction, urinary tract infection and vesicoureteral reflux were reviewed. Our analysis of these data suggests that this procedure has certain well defined indications. Its omission when these indications are not fulfilled presents the potential for considerable monetary savings without reduction in the quality of medical care.


Lack of agreement between subjective ratings of instructors and objective testing of knowledge acquisition in a urological continuing medical education course.

Objective scores from multiple-choice questions before and after a postgraduate course were compared to subjective ratings of the instructors at a 3-day seminar. The objective mean scores after the course were significantly higher than the scores before the course (p less than 0.0001). There was no correlation between test results and subjective ratings of instructors.


Accuracy of ultrasound in predicting the nature of renal masses.

Renal ultrasonography is an established, reliable means of evaluating the consistency of renal masses. In a retrospective evaluation of 136 proved cases renal ultrasonography was 95 per cent accurate in distinguishing normal from pathological renal masses, 85 per cent accurate in diagnosing uncomplicated cysts and 100 per cent accurate in identifying complicated cysts, polycystic disease, extrarenal lesions and solid or partially solid neoplasms. Ultrasonography was useful in directing the diagnostic examination and in determining which patients should undergo further, more invasive diagnostic procedures.


Renal pedicle injury in the multiple injured patient.

Renal pedicle injuries were associated with multiple system trauma and a mortality rate of 42 per cent in 31 patients seen from 1959 to 1978. These injuries were to the renal artery in 14 patients, branches of the renal artery in 5, renal vein in 8, and renal artery and vein in 4. Priority of treatment for life-threatening associated injuries resulted in delayed diagnosis of the renal pedicle injury, which was not optimal for preservation of functioning renal tissues. Since 1968 an immediate excretory urogram has been performed for hematuria or a perirenal hematoma found during laparotomy for associated injuries. This study has resulted in the early diagnosis of renal pedicle injuries and immediate vascular repair has been attempted in 6 patients. Three of these patients survived with no hypertension on followup. A repaired renal vein in 1 patinet resulted in normal renal function and renal arteries were repaired in the other 2 patients with reduced renal function.


The management of urinary fistulas and strictures with percutaneous ureteral stent catheters.

A method is described for percutaneous anterograde introduction of a ureteral stent catheter. The experience and treatment of 5 patients are reported: 2 ureterovaginal fistulas, 2 ureterocutaneous fistulas and 1 ureteral stricture. The capability of the technique to place a stent catheter in the presence of an almost complete separation of the ureter or through ureteral segments deformed by extensive cicatricial changes is emphasized. The method is advocated as a most effective alternative to supravesical drainage in patients with ureteral fistulas and impaired healing potential of ureters devitalized by surgical stripping and/or radiation therapy.


Leukocyte migration inhibition assay in patients with bladder cancer.

The leukocyte migration inhibition assay has demonstrated successfully tumor-associated antigenic activity in protein extracts of cell culture lines of a number of neoplasms. Our data have shown a high degree of leukocyte migration inhibition reactivity with protein extracts from the well characterized T-24 transitional carcinoma cell line. Thus, the leukocyte migration inhibition assay may prove a valuable method of in vitro assessment of the cell-mediated immunity of bladder cancer patients and as a method to monitor attempts at further purification of tumor-associated antigens.


Phallography: technique and results of nocturnal tumescence monitoring.

Phallography, or nocturnal tumescence monitoring, is a relatively new technique to measure and record nocturnal erections. The technique is most useful in differentiating between organic male erectile disability and psychogenic impotence. It is a relatively simple procedure and the equipment is available commercially. Of 40 recordings done on 17 patients 35 were adequate for interpretation. Six patients had total erectile failure, 9 had various erectile disabilities and 2 were normal. The 2 patients with normal erections represented psychogenic erectile disability. The technique is reliable and can be recommended for general use to separate organic from psychogenic impotence and to define different types of erectile disability.


The use of fluorescein in radical inguinal lymphadenectomy.

Necrosis with slough of skin flaps is a common and distressing complication after radical inguinal node dissection. Conventional methods to predict viability of dermal flaps are notoriously unreliable. Intravenous fluorescein has been shown to be a reliable indicator of the adequacy of blood supply to dermal flaps in experimental models and in radical mastectomies. Fluorescein has been used in 6 separate node dissections for carcinoma of the penis. In all cases fluorescein reliably delineated viable skin flaps and its use can help decrease the morbidity rate in inguinal node dissection.


Testicular abnormalities of the subfertile male.

Evaluation of 48 cases of male infertility included testicular biopsy. The histologic classification included normal spermatogenesis (normal or abnormal supporting tissue, maturation arrest (spermatocyte or spermatid stage), hypospermatogenesis, Klinefelter's syndrome and Sertoli-cell-only syndrome. No diagnostic advantage was found in bilateral over unilateral testicular biopsies. Clinical presentation of the patient was correlated with histologic classification: 1) 4 of 13 azoospermic cases had normal spermatogenesis, suggesting post-testicular obstruction, 2) severe oligospermic cases (1 X 10(6) sperm per ml.) had spermatogenic abnormalities and 3) only 1 of 8 mild oligospermic cases (10 to 20 X 10(6) per ml.) had abnormalities of spermatogenesis. The histologic pattern in patients with varicocele seemed consistent with hypospermatogenesis in 9 of 13 cases studied. Testicular biopsy may be useful in the diagnosis of reversible post-testicular obstruction in some azoospermic patients. In addition, some patients with severe oligospermia may find an advantage of increased accuracy of diagnostic counseling based on histologic information. Testicular biopsy in cases of moderate oligospermia may be useful as investigational information in determining histologic patterns that may be responsive to certain modes of therapy. Histologic information obtained in cases of mild oligospermia was not sufficient to provide indication for testicular biopsy in mild oligospermic patients.


The value of sonography and lymphography in the detection of retroperitoneal metastases in testicular tumors.

Lymphography has led to falsely negative or falsely positive diagnoses in 10 to 45 per cent of the cases of testicular tumor metastases reported in the literature. In our comparative study of lymphography and sonography in the preoperative staging of 29 malignant testicular tumors lymphography was accurate in 58.5 per cent of the cases, while sonography had an accuracy rate of 82.5 per cent. Sonography was superior to lymphography in the evaluation of hilar lymph node metastases and their extent, as well as for routine checkups after lymphadenectomy or irradiation.


Immediate radiological evaluation and early surgical management of genitourinary injuries from external trauma.

An immediate diagnostic evaluation of genitourinary trauma is mandatory for an early operation. A method of immediate radiological evaluation is presented and the accuracy rate in the diagnosis of the type and site of injury is detailed. The advantages of early surgical management are compared to the results with expectant management.


Further observations on the cystometric and uroflowmetric effects of bethanechol chloride on the human bladder.

We evaluated the cystometric and uroflowmetric effects of bethanechol chloride on non-neurogenic, non-decompensated human bladders. Statistically significant changes were measured using cystometric and uroflowmetric parameters. We discuss the indications and methods for therapy with bethanechol chloride.


Urodynamics in spinal shock patients.

We investigated 17 spinal shock patients with traumatic complete cord lesions with cystometry, urethral pressure profile, anal and rectal pressure recordings, and electromyography of the pelvic floor sphincters. Bladder filling was accompanied by an elevation of resistance in the bladder neck area, with a concomitant increase of pressure in the external sphincter zone but without a simultaneous increase of the electromyographic activity. These results indicate an increased sympathetic activity in the smooth muscle component of the entire urethra. In the majority of patients the continuous withdrawal pressure profile had higher values in the membranous urethra than the interrupted withdrawal pressure profile had higher values in the membranous urethra than the interrupted withdrawal pressure profile, revealing the importance of sensory afferents from the urethral mucosal receptors in producing artifactual reflex activity in the pelvic floor muscles. In the majority of interrupted withdrawal urethral pressure profiles higher pressures were recorded in the juxtabulbous region than in the mid part of the membranous urethra. A somewhat decreased electromyographic activity was found in the anal and urethral sphincters at rest. It did not often relate to the amount of resistance recorded in either sphincter. High urethral sphincter pressures and somatic activity of the conus medullaris reflexes show that external urethral and anal sphincters escape spinal shock, the primary characteristic of which is areflexia.


A simple inexpensive urodynamic catheter.

Described herein is an easily constructed and inexpensive triple lumen urodynamic catheter. The catheter permits accurate and reproducible simultaneous measurements of urethral and bladder pressure.


Ureteral structure and ultrastructure. Part V. The dysplastic ureter.

The ureters in neonates and infants can be anatomically and functionally so severely compromised to warrant the term "dysplasia". The clinicopathologic criteria for this diagnosis are: 1) a variable degree of dilatation on the excretory urogram and/or cystogram. 2) poor or absent ureteral motility as observed on cine-fluoroscopy or at operation, 3) poor muscularization and decreased muscle/connective tissue ratio under light microscopy and 4) small and deformed muscle cells with nexuses that are markedly decreased or absent and intracellular organelles that are poorly defined under electron microscopy. Excessive collagen and ground substance are present throughout the ureter. Although these qualitative and quantitative structural abnormalities are non-specific and can occur as a result of prenatal obstruction and postnatal infection, their severity in early postnatal life and their frequent association with dysplastic kidneys suggest congenital dysplasia as their etiology.


The uroradiographic evaluation of the enuretic child.

The proper evaluation of the enuretic child is controversial. A standardized evaluation was devised to decrease the number of examinations done based on the extant literature. During a 5-year period 138 children were examined uroradiographically. Of these patients 21 were found to have a significant anatomic abnormality. These abnormalities were found in children with either a history of a urinary tract infection, infected urine at the time of examination or obstructive signs or symptoms. Based on these findings a simple flow sheet for the evaluation of enuretic children is presented.


Adrenal hemorrhage in the newborn with evidence of bleeding while in utero.

A case is reported of bilateral hemorrhagic adrenal cysts in a newborn. Evaluation of the patient included x-rays of the abdomen, excretory urography, retrograde pyelography and sonography. The presence of a faint calcification in the region of the right adrenal at birth and further progression of calcification in the same area suggest that some initial bleeding occurred in utero.


Bivalve nephrolithotomy in kidneys with ileal ureter.

We describe the surgical management of 2 patients with staghorn stones in kidneys previously operated upon and an ileal ureter. Bivalve nephrolithotomy was accomplished in situ using local hypothermia and anatrophic nephrotomy. This approach seemed to be the most suitable in these cases because other procedures could have been difficult and risky for the pelvioileo-anastomosis.


Hyperchloremic acidosis and imperforate anus.

The predominant electrolyte imbalance associated with enterourinary fistulas is hyperchloremic acidosis. The mechanism is the absorption of urinary electrolytes across the colonic mucosa. One of the genitourinary associated anomalies of a high imperforate anus is a rectourinary fistula. There have been 5 cases of hyperchloremic acidosis as a complication of an imperforate anus with a rectourinary fistula reported in the literature to date. An additional case is presented with a clinical analysis of the previously reported cases. The important factors in the development of hyperchloremic acidosis in patients with an imperforate anus are 1) the presence of a rectourinary fistula, 2) an initial diverting colostomy permitting a long segment of colonic mucosa for the absorption of urinary electrolytes, 3) distal urinary tract obstruction allowing significant volumes of urine to flow into the colonic segment and 4) the presence of urinary tract infection contributing to the urinary obstruction. Management should consist of vigorous electrolyte therapy, decreasing the retrograde flow of urine into the colon by temporary catheterization and early repair of the fistulous tract.


Association of crossed fused renal ectopia and multicystic kidney.

A male newborn presented with mild azotemia, an abdominal mass and non-visualized right kidney on excretory urography. Evaluation, including ultrasound and surgical exploration, revealed the simultaneous occurence of crossed fused renal ectopia and multicystic kidney.


Renal insufficiency in a solitary kidney secondary to hydronephrosis of pregnancy.

A case is reported of renal insufficiency in a solitary kidney secondary to hydronephrosis of pregnancy. Evidence supporting obstruction on a mechanical basis is presented. This entity should be considered when pursuing a correctable cause for functional renal deterioration in pregnant women. The clinical importance of this entity in the management of renal insufficiency in the pregnant woman is discussed.


Treatment of arteriovenous angiomas of the kidney: surgical intervention and intra-arterial embolization.

Angiomas of the kidney are benign vascular dysplasias, which usually can be identified angiographically. If there are no clinical symptoms treatment is not necessary. In cases of hematuria and/or hypertension either intra-arterial superselective embolization seems to cause less functional loss of the renal parenchyma, whereas excision often leads to heminephrectomy or even total nephrectomy. Even if the angioma is initially not completely embolized followup study to 2 years has shown complete occlusion of the angioma, either owing to inflammatory reactions or redistribution of blood flow and diminished blood pressure. Two cases of renal angiomas are presented. Treatment consisted of intra-arterial superselective embolization in 1 case and surgical clipping of the supplying arterial branch in the other.


Intraoperative management of renal cell carcinoma with supradiaphragmatic caval extension.

A new technique for inferior vena caval tumor thrombectomy is described. Vascular isolation of the cava from the right atrium to the pelvis is achieved by temporary circulatory arrest of the lower torso. Removal of the neoplastic thrombus under direct vision with minimal blood loss was accomplished in a patient with renal carcinoma, whose tumor extended into the intrapericardial vena cava.


Eosinophilic pyeloureteritis: report of a case.

A case is reported of ureteral obstruction that was owing to eosinophilic pyeloureteritis, a previously unrecorded entity. The microscopic findings of extensive fibrosis and a relatively mild eosinophilic infiltrate were similar to those found in a series of eosinophilic cystitis, which was reported recently from this laboratory. Also, local injury appears to initiate some examples of eosinophilic cystitis and in the present case there was a striking history of injury 1 month before the symptoms of ureteral obstruction.


Flaccid neurogenic bladder as a presenting symptom of spinal cord ependymoma.

Spinal cord tumors commonly present with back pain, sciatica, weakness in the legs and bladder symptoms. A case is reported in which an isolated flaccid neurogenic bladder was the only presenting symptom of a spinal cord ependymoma.


Ultrasonic localization of a non-palpable testis tumor.

A young man was found to have a retroperitoneal seminoma and normal testicles by palpation. Initial diagnosis was an extratesticular primary germ cell tumor until ultrasound examination detected a lesion in the left testicle. A left radical orchiectomy was done and a seminoma of the testicle was found. We recommend ultrasound examination of the testicles to demonstrate occult testicular tumors when faced with the possibility of an extratesticular primary germ cell tumor.


Children in motor vehicles. Never too young to die.

In a series of 89 children less than 15 years old who were killed as motor vehicle occupants, children under 1 year of age were greatly overrepresented. Only three children were using child restraint systems or seat belts. Eight were traveling on their parents' laps. Head injuries predominated and were most common in the youngest children. Children under age 1 were the most likely to have reached the hospital alive. The high death rate for very young children was not explained by the circumstances of the crashes or by the age distribution of children involved in all crashes.


Efficacy of radionuclide scanning in patients with lung cancer.

Ninety-two patients with histologically proved carcinoma of the lung were studied retrospectively to determine the usefulness of liver, brain, and bone imaging in their examination and treatment. Occult metastatic liver disease was observed in two (5.3%) of 38 asymptomatic patients, while four (6.6%) of 58 neurologically intact patients had abnormal brain scans. Eight (13.6%) of 59 asymptomatic patients had metastatic bone disease. Seven (18.4%) of 38 patients with no clinical evidence of metastatic disease to liver, brain, or bone had at least one type of abnormal radionuclide study. More than half (52.5%) of the patients studied had at least one abnormal scan exclusive of symptoms. Radionuclide imaging is a useful procedure in the initial evaluation and subsequent management of lung cancer.


Predictability of the response to the ergonovine test. Value in the diagnosis of coronary spasm.

Thirty-five patients with atypical chest pain were given ergonovine maleate as a provocative test for coronary spasm. None of the patients had significant coronary atherosclerosis. The patients were divided into two groups based on clinical information available before ergonovine testing. Group 1 patients (n=13) had objective evidence of cardiac disease manifested by episodes of syncope, ventricular tachyarrhythmias, myocardial infarction, or transient ST segment shifts with chest pain. Group 2 patients had chest pain but no objective evidence of cardiac disease. The ergonovine test was positive in 11 of 13 patients in group 1. None of the 22 group 2 patients had a positive response to ergonovine. These data suggest that ergonovine testing does not allow for any more precise recognition of patients with atypical chest pain who have coronary artery spasm than do clinical data alone.


Carpal tunnel syndrome in patients undergoing maintenance hemodialysis.

Five of 62 maintenance hemodialysis patients were found to have carpal tunnel syndrome, and another five had prolonged distal motor latencies. Contrary to previous reports, there was no relation between carpal tunnel syndrome and the site of vascular access. Synovial biopsy specimens from flexor tendons demonstrated edema without inflammation, suggesting that extracellular fluid volume excess in the presence of flexion and immobility during dialysis may be pathogenetically important.


Methemoglobinemia resulting from absorption of nitrates.

Three cases of toxic methemoglobinemia resulted from absorption of nitrate salts through burned skin areas. In addition to the unusual route of intoxication, this report emphasizes the occupational hazard of methemoglobinemia in workers exposed to nitrogen salts and the importance of rapid diagnosis and treatment. The diagnosis of methemoglobinemia should be suspected in any case of cyanosis refractory to oxygen therapy. Appropriate treatment should include oxygen, methylene blue, and exchange transfusion in clinically severe cases.


Evaluation of a new uricosuric diuretic--ticrynafen.

Ticrynafen is an orally administered diuretic that is similar to the thiazides in its therapeutic actions, but unlike the thiazides, it increases urate excretion and lowers serum uric acid levels. Ticrynafen is useful in the treatment of hypertension and in selected cases of chronic congestive heart failure. At present, it appears to be indicated primarily in patients with these disorders who have a history of gout. Patients who are currently receiving a thiazide should not have their therapy arbitrarily changed to ticrynafen because of asymptomatic hyperuricemia.


Rehabilitation after myocardial infarction.

The concept that many patients with asymptomatic coronary atherosclerotic heart disease, including myocardial infarction, can and should return toward normal living is the basis of the rehabilitation effort. The primary care physician is increasingly employing this approach in the care of patients with myocardial infarction. Much of the capacity to effect rehabilitation should be available in the community hospital, in the office of the primary physician, or through community, governmental, public, and voluntary health care agencies and facilities. Although some patients with complex diagnostic problems and more severe impairment require consultative services or referral to specialized cardiac centers, all patients must eventually be returned to the care system and services of their local communities.


Electron microscopic studies on the alveolar-capillary barrier in the patients of chronic pulmonary edema.

Electron microscopic studies on the alveolar-capillary barrier were carried out in 13 patients of chronic pulmonary edema and/or congestion resulting from heart disease of various etiologies. The characteristic findings are tremendous proliferation of type II granular pneumocyte and irregular thickening of alveolar epithelial and capillary basement membrane. These ultrastructural changes correlated to the duration of heart failure and mean pulmonary arterial wedge pressure despite of disease groups and the age of the patients. In particular, lamination of capillary basement membrane with fragmentation was more specific finding which was observed only in patients with mean pulmonary arterial wedge pressure above 35 mmHg and duration of heart failure over 6 hears. There was no apparent relationship existed between the ultrastructural changes and pulmonary arterial pressure. In addition to these characteristic changes the remaining ultrastructural changes of the alveolar-capillary barrier were difficult to make a correlation to clinical course and cardio-pulmonary hemodynamics.


Influence of surgery for ischemic heart disease on early postoperative left ventricular function.

The pre- and postoperative systolic time intervals, hemodynamics and serum catecholamines were studied in 30 patients with successful myocardial revascularization surgery or left ventricular aneurysmectomy and the influence of the surgery on the left ventricular function was evaluated. 1. Significant depression of left ventricular performance was recognized in the group of patients with left ventricular aneurysm as compared to the patients with angina pectoris with or without previous myocardial infarction before the operation. 2. At 2 hours after the operation, signigicant decrease of ET/PEP, cardiac index and stroke work index and marked elevation of systemic vascular resistance were seen in the group of patients with aortocoronary bypass surgery who had previous myocardial infarction and with left ventricular aneurysmectomy as compared to the group of patients without previous myocardial infarction. 3. At 2 hours after the operation, ET/PEP seemed to reflect the left ventricular stroke work and the depression of the left ventricular function was mainly affected by the elevation of systemic vascular resistance due to the hypersecrection of serum catecholamines. 4. Reduction of systemic vascular resistance by vasodilator brought an improvement of EG/PEP, cardiac index and stroke work index.


Chemical analysis of vascular collagen in stroke-prone spontaneously hypertensive rats.

Chemical characteristics of vascular collagen were studied in stroke-prone spontaneously hypertensive rats (SHRSP) which developed cerebrovascular lesions spontaneously in over 90% of the population. Aminoacid analysis of arterial collagen among SHRSP showed no remarkable difference from stroke-resistant SHR (SHRSR) and normotensive Wistar-Kyoto rats (WK). The uronic acid content of the aorta, which elevated with aging, was increased in SHRSR and especially in SHRSP. The hexose content of collagen was also increased in SHRSP characteristically with a concomitant increase in the ratio of the disaccharide unit (glucosyl-galactosyl-hydroxylysine) to the monosaccharide (galactosyl-hydroxylysine). The relative increase in beta and gamma components was also noted in SHRSP. These structural changes of vascular collagen especially noted in SHRSP may be related to the fragility of arterial wall or to the stroke-proneness.


[A clinical study of intravenous doxycycline in the pediatrics field (author's transl)].

An intravenous preparation of doxycycline (DOTC, Vibramycin 'Pfizer'), a long-lasting tetracycline, was administered mainly by drip infusion for a series of study in the pediatrics field, and the results were as follows: 1) DOTC (100 mg) was dissolved in a 100 ml of glucose solution and 2--3 mg/kg was administered intravenously. When the total infusion time was adjusted between one to two hours, the peak serum level of DOTC was seen at the end of infusion in each case. The serum level in a two-hour infusion time, however, the serum level was delectable for a long period of time: the serum level after 10 hours was 0.82--1.23 micrograms/ml. Above results suggest that DOTC intravenous should be given in a two-hour infusion twice a day for applicable infections in the pediatrics field. 2) Urine excretion of DOTC was about a half (50%) of the administered dosage. 3) DOTC was given mostly at about 3--5 mg/kg per day (twice a day) infusion to 25 children with five infections, viz. acute angina lacunaris, acute bronchitis, bronchopneumonia, Mycoplasma pneumonia and acute urinary tract infections. A clinical improvement seemed attributable to DOTC was clearly observed in 23 out of 25 patients (92%). 4). DOTC infusion was also effective for Mycoplasma meningoencephalitis, severe Mycoplasma pneumonia associated with pleuritis, bronchitis and bronchopneumonia with a lot of Staphylococcus aureus identified in the sputum medium, acute urinary tract infections caused by E. coli. 5) Before and ten days after DOTC infusion, laboratory tests for liver and renal functions and blood were performed. No noticeable abnormalities were found except one case with transient GOT and GPT elevations. Above summary was presented at the 26th annual meeting of Japan Society of Chemotherapy in June 1978.


[Clinical studies of cefamandole in children (author's transl)].

Clinical studies on cefamandole were carried out with the following results. (1) Cefamandole was administered 100 mg/kg/day (q.i.d.) by intravenous route to 29 cases of children. In 10 out of 29 cases bacteriological effect was observed. Bacteriological response was effective in 8 cases (80.0%). Clinical responses were effective in 27 cases (93.1%). (2) As to adverse reactions, granulocytopenia and elevation of S-GOT, S-GPT developed in each two cases.


[Laboratory and clinical study of cefamandole by intravenous injection in the pediatric field (author's transl)].

Cefamandole sodium (CMD) was intravenously administered and following laboratoric and clinical results were obtained. (1) The peak blood concentration was 32 approximately 44 micrograms/ml when the drip infusion was finished. At 1 hour after the end of the drip infusion the blood concentration was 7.6 approximately 8.1 micrograms/ml. Half life was approximately 0.64 hours. (2) Urinary recovery rate was 84.5 approximately 95% in active state within 6 hours. (3) Penetration of cerebrospinal fluid was found in 2 cases. (4) In most of 170 strains of Streptococcus haemolyticus MICs of cefamandole were 0.05 microgram/ml. They were less susceptible to cefazoline, cefmetazole and ceftezole. (5) CMD was administered to 35 pediatric patients (upper or lower RTI, lymphadenitis, enteritis or UTI) at 100 mg/kg/day for 3 approximately 9 days, the efficacy rate was 97.1%. (6) Side effect: Rash occurred in one case, and eosinophilia was observed in 4 cases. No abnormal finding of renal and liver function was observed.


[Laboratory and clinical studies on cefamandole in pediatric field (author's transl)].

Laboratory and clinical studies were performed on a new semisynthetic cephalosporin, cefamandole (CMD), and following results were obtained. (1) Serum concentrations and urinary recovery rates of CMD were determined after an intravenous administration of CMD 30 mg/kg in 13 children with normal renal function.  In 5 of 13 children, mean serum levels after a one shot intravenous injection were 112.5 micrograms/ml at 15 minutes, 52.2 micrograms/ml at 30 minutes, 23.3 micrograms/ml at 1 hour, 4.9 micrograms/ml at 2 hours and trace at 4 hours. In other 5 children, mean serum levels after drip infusion for 1 hour were 78 micrograms/ml at 30 minutes, 59 micrograms/ml at 1 hour, 9.8 micrograms/ml at 2 hours and trace at 4 hours, after the onset of drip infusion. In the remaining 3 children who received CMD by drip infusion for 2 hours, mean serum levels were 24.3 micrograms/ml at 30 minutes, 35.3 micrograms/ml at 1 hour, 30.2 micrograms/ml at 2 hours, 5.3 micrograms/ml at 3 hours and 1.5 micrograms/ml at 4 hours after the onset of drip infusion. Urinary recovery rates in 5 children were 154.7%, 98.3%, 93.2%, 111.8% and 66.9%, respectively, during 8 hours. (2) CMD was administered to 40 patients with various infections (acute U.T.I. 8, acute angina lacunaris; 2, acute bronchitis; 5, cervical purulent lymphadenitis; 2, post-measles bronchopneumonia; 3, acute bronchopneumonia; 18, pyothorax; 2, S.S.S. syndrome; 1) by one-shot intravenous injection at a dose of 40-120 mg/kg per day. The clinical efficacy rate was 92.5% and bacteriological efficacy rate was 79.2%. (3) As the side effect of CMD, eosinophilia was observed in 1 case, rash and elevation of GOT and GPT in 1 case, and proteinuria in 1 case.


[Experimental study of the biliary excretion of antibiotic (cefotiam) in the presence of biliary tract obstruction (author's transl)].

Excretion of a new semisynthetic analogue of cephalosporin, cefotiam (CTM), and cefazolin (CEZ) in bile was investigated in dogs with experimental obstruction of biliary tract. In the control group, peak concentrations of antibiotics in bile after 50 mg/kg intravenous administration were as follows: In CTM administrated groups, 5,302 micrograms/ml at one hour after administration; and in CEZ administrated group, 1,249 micrograms/ml after one hour. The total biliary excretory rates summed to 6 hours after administration of antibiotics were 7.8% in the CTM group, and 2.1% in the CEZ group. On the other hand, in the biliary tract obstruction group, the peak concentration in bile in CTM group was 65.7 micrograms/ml after 1 hours, and in CEZ group, 62.4 micrograms/ml after 2 hours. The total biliary excretory rate in the CTM group was 0.202%, while in the CEZ group 0.12%. The peak concentration and the excretory rate of CTM in bile was four times higher than that of CEZ in the control group. No significant difference was revealed in the peak concentration and the excretory rate in bile between CTM and CEZ in the biliary tract obstruction group.


[Pharmacokinetics and clinical results of cefuroxime (CXM) (author's transl)].

I. Pharmacokinetics (1) CXM 24.4 and 31.9 mg/kg were administered by intravenous drip infusion for 4 hours. The plateau levels were obtained at 1 approximately 2 hours, the blood levels at which time were 25.6 and 33.8 micrograms/ml respectively with dose response observed. (2) The respective  half-lives were as short as 49.4 and 36.2 minutes. (3) The total clearances were 74.6 and 127.2 ml/min respectively; when calculated on plateau level and infusion rate, these were 81.6 and 111.0 ml/min. These differently determined values were near each other. (4) The respective renal clearances were 157.8 and 101.9 ml/min. II. Clinical results CXM for intravenous use was administered to 21 pediatric patients, and the clinical results were good and excellent in 19 (90.5%). Excluding 2 cases with elevation of cold hemagglutination values, the efficacy rate of 94.7% (18/19 cases) was achieved. The doses administered ranged 44 approximately 100 mg/kg body weight, and this dosage level was considered enough to achieve clinical effect. With the current clinical trial we considered that although the effectiveness of this drug was proved in 3 approximately 7 day intravenous drip infusion and intravenous injection, the continued treatment with other oral antibiotic following CXM treatment would be necessary from the patients' general conditions and laboratory examination findings. No noteworthy side effects were observed in any of the patients. No abnormality was seen in biochemistry and electrolyte findings, either.


[Clinical experience with cefuroxime in pediatric field (author's transl)].

Cefuroxime (CXM) was administered to 11 patients with pediatric bacterial infections, and clinical effective results were obtained in all these cases. Causative organisms detected in 5 cases with respiratory tract infection, and with urinary tract infections were all eliminated, and the bacterial count decreased in patients with colitis. As for side effect, 1 case developed eosinophilia, and another case with impaired liver function as underlying disease showed transitory exacerbated examination values. Time-course determinations of blood levels and urinary excretions were performed in 1 case. Fecal levels were determined in 2 cases but could not be detected; inactivation action of CXM was observed from the same fecal filtrate.


[Clinical study in cefuroxime in pediatric field (author's transl)].

Cefuroxime (CXM), a new cephalosporin antibiotic, was used in pediatric field, and the following results were obtained. 1. Absorption and excretion CXM was administered by intravenous drip infusion to 3 patients aged 14 years, 1 year and 1 month, and 5 years and 3 months, respectively, at doses of 15.4 mg/kg, 14.1 mg/kg, and 13.2 mg/kg. The following blood levels were obtained; 71 micrograms/ml at the completion of infusion, 26.8 micrograms/ml at 30 minutes, 13.2 micrograms/ml at 1 hours, 5.05 micrograms/ml at 2 hours, 2.07 micrograms/ml at 4 hours, and less than 0.45 micrograms/ml at 6 hours after the infusion. Urinary excretion of the drug administered was measured in one of these cases. The urinary excretion rate at 1 approximately 6 hours after intravenous drip infusion was 50.4%. 2. Clinical result CXM 17 approximately 55 mg/kg were administered for 2 approximately 4 days to 6 patients with acute respiratory tract infection, 1 with acute cervical lymphadenitis, and 1 with acute enteritis. The clinical results was poor in the case with acute enteritis and good in the other 7 cases. No side effect was observed in 9 cases (the above 8 cases plus 1 unassessable case), and the laboratory examination results showed no abnormality, either.


[Fundamental and clinical studies of cefuroxime, a new cephalosporin antibiotic, in pediatric field (author's transl)].

A series of studies on cefuroxime (CXM) were carried out and the following results were obtained. 1) Most of MICs to recent clinical isolates of Group A hemolytic Streptococcus were less than 0.0125 micrograms/ml. 2) A single intravenous bolus dose of 36.5 mg/kg of CXM was given to two children, and the peak blood levels of 30 and 40 micrograms/ml were obtained at 30 minutres after injection; mean half-life in blood was 1.02 hours. The doses of 25 approximately 50 mg/kg were given over 1 hour by intravenous instillation to six children. The peak blood level appeared at the end of instillation, and half-life in blood was distributed between 0.56 and 0.81 hour. With both of these administrations, measurable blood levels were maintained up to 6 hours, and urinary excretion rate in active form up to 6 hours was distributed between 40.5 and 96%. 3) Serious upper respiratory tract inflammations, low respiratory tract inflammations (acute bronchitis and bronchopneumonia), staphylococcal exanthema and acute urinary tract infections mostly responded well to CXM intravenous administration (one shot injection, or instillation at dose of 50 approximately mg/kg/day in 2 approximately 3 daily divided doses. 4) Staphylococcal pyothorax was completely cured by 17 day-long CXM intravenous instillation at dose of about 150 mg/kg/day. 5) No difference in CXM therapy result was seen between the two administration forms used, i.e., one shot injection and instillation. 6) Clinical efficacy rate in 48 patients was 100% (excluding 1 unassessable case). As for side effect, transitory elevation of GPT and Al-P were seen in only 1 case each. The summary of this paper was reported on June 9, 1979 at 27th General Meeting of Japan Society of Chemotherapy (Fukuoka).


[Experience with cefuroxime in pediatric field (author's transl)].

Having resistance to beta-lactamase-producing strains and showing resistance to not only cephalosporin resistant strains of E. coli and Klebsiella but also to Citrobacter, Proteus and Enterobacter, Cefuroxime (CXM) was used in pediatric field for both fundamental and clinical studies. CXM was found to be a useful antibiotic in views of high clinical efficacy rate obtained and no side effect noted. As for the dose, the single dose of 25 mg/kg achieved sufficient blood levels. Also in view of good clinical effect, the dose of 25 mg/kg three or four times daily seems appropriate for treatment of children.


[Study of cefuroxime in pediatric field (author's transl)].

1. Cefuroxime (CXM) was studied for absorption and excretion in 4 pediatric patients given one shot intravenous injection of 20 approximately 25 mg/kg. The following serum levels were determined: 24.5 approximately 38.0 micrograms/ml at 30 minutes (mean 33.3 +/- 6.1 micrograms/ml), 10.0 approximately 17.0 micrograms/ml at 1 hours (mean 13.9 +/- 3.3 micrograms/ml), 3.4 approximately 7.6 micrograms/ml at 2 hours (mean 5.2 +/- 1.9 micrograms/ml, 0.7 approximately 2.1 micrograms/ml at 4 hours (mean 1.3 +/- 0.6 micrograms/ml, 0.1 approximately 0.3 microgram/ml at 6 hours (mean 0.2 +/- 0.1 microgram microgram/ml). Half-life (T 1/2) was 0.65 approximately 0.88 hour (mean 0.75 +/- 0.10 hour). Urinary levels were 1,280 approximately 7,100 micrograms/ml at 0 approximately 2 hours, 96 approximately 3,400 micrograms/ml at 2 approximately 4 hours, 68 approximately 250 micrograms/ml at 4 approximately 6 hours. Urinary recovery rate at 0 approximately 6 hours was 54.1 approximately 74.4% (mean 61.8 +/- 9.4%). 2. From the study on spinal fluid concentration in pediatric patients with Haemophilus influenzae-induced meningitis, the dose of CXM 52.2 mg/kg was given to 1 pediatric case with this disease by one shot intravenous injection. Spinal fluid levels were presumed as 9.0 micrograms/ml at 30 minutes, 6.8 micrograms/ml at 1 hour, 3.8 micrograms/ml at 2 hours and 1.2 micrograms/ml at 4 hours. 3. CXM was studied in 19 pediatric patients with bacterial infection for clinical efficacy, bacteriological effect and side effect. Clinical result was found good in 1 with purulent meningitis; excellent in 9 out of 15 with acute lobar pneumonia or acute bronchopneumonia, and good in remaining 6 cases; good in 2 with acute bronchitis; excellent in 1 with acute pyelonephritis. This represents efficacy ("excellent" plus "good") rate of 100%. Of 5 strains of H. influenzae presumed as causative organisms, 4 were disappeared and 1 was reduced. Two strains of Streptococcus pneumoniae and 1 strain of Escherichia coli were disappeared. No side effect was noted in terms of clinical symptom. Laboratory examination showed elevation of GOT and GPT in 1 case, but these elevated values returned to normal after the end of the CXM treatment.


[Treatment of Diphyllobothrium latum and Taenia saginata infections with aminosidine (author's transl)].

Recently, it has been known that the aminosidine has marked anthelmintic efficacy against tapeworm. In this investigation, aminosidine was used for treating 14 cases with Ciphyllobothrium latum infection and 5 cases with Taenia saginata infection. Aminosidine was administered orally in a single dose of 50 mg/kg, followed by a purge after the treatment. Fourteen patients with D. latum infection and 5 patients with T. saginata infection expelled long strobila in all cases. Although only 7 scolices of 18 worms of D. latum were found in the stool and no scolex of T. saginata was found, follow-up examination for a long period showed no evidence of remaining infection with one exception of D. latum. Mild nausea, vomiting and abdominal pain were observed in only one of 19 cases given aminosidine. But in the other 18 cases, no side effects were encountered. It was concluded that aminosidine is safe, effective therapeutic agent for the treatment of cestodiasis in man.


[Studies on small dosage regimen of minocycline in the treatment of urinary tract infections (author's transl)].

In the course of treating twenty patients with acute urinary tract infections, the toxicity and efficacy of a small dosage regimen (50 mg p.o., t.i.d.) of minocycline were evaluated. No vestibular symptoms attributable to minocycline treatment were observed in any of the cases entered in this study. Adverse reactions included mild nausea in 1 case and urticaria in another case. Minocycline with this dosage regimen sterilized the urine of 90% of patients with acute urinary tract infections.


Endotracheal epinephrine in a canine anaphylactic shock model.

This study was undertaken to determine if epinephrine administered endotracheally is as effective in treating anaphylactic shock as is intravenously administered epinephrine. An animal model of anaphylactic shock was produced in anesthetized dogs by the intravenous administration of histamine phosphate. Both the endotracheal and intravenous routes of epinephrine administration resulted in efficient and effective reversal of histamine-induced hypotension. At the doses employed, the intravenous administration of epinephrine resulted in the production of significantly (p less than 0.05) greater numbers of ventricular cardiac arrhythmias than did the endotracheal route of administration.


Trauma to the cervical spine.

Ninety-one patients with cervical injuries treated at the Geisinger Medical Center Emergency Department were reviewed. Most injuries were bony injuries with no evidence of cord injury. Of the 43 cases with cord injury, 56% had partial cord injuries and 44% had complete cord injuries. Clinical presentations of these patients were reviewed. A basic outline of management is discussed.


The observation-holding area; a prospective study.

Although emergency department observation-holding units have been shown to be effective in limiting hospitalizations and improving the accuracy of disposition, the possibility of adverse outcome following discharge from such units has not been addressed. To establish the safety of the unit, a five-month prospective study of all patients admitted to this area was carried out and included long-term follow-up. There were 442 patients admitted. Of these, 78% were discharged improved. Complications in the unit were minimal and there were no deaths. Long-term follow-up revealed four deaths (1%) and four patients (1%) who had complicated hospitalizations. Diagnosis, age, patient condition, and time of admission to the unit were predictive of the need for inpatient hospitalization. We conclude that the observation-holding unit, with appropriate supervision, represents a safe alternative disposition for selected emergency patients.


Emergency medical technician (EMT-A) instruction of medical students.

In 1977 the Department of Anesthesiology of the Medical College of Virginia coordinated a compulsory 72-hour course for first-year medical students fulfilling all requirements of the Department of Transportation and leading to eligibility for certification of the medical student as an Emergency Medical Technician (EMT-A). We describe the methodology and content of this course, as well as problems encountered and lessons learned. This sound foundation in emergency care concepts will enable the medical student to develop greater competence in critical skills during the clinical years.


Endotracheal epinephrine in cardiorespiratory collapse.

The endotracheal route for the administration of epinephrine has been studied extensively in dogs. There has been little in the medical literature to document the successful use of this technique in humans. The successful use of endotracheally administered epinephrine in two patients with cardiorespiratory collapse is reported. Specific points concerning endotracheal drugs are discussed and a set of guidelines for clinical use is offered.


Strychnine intoxication.

Strychnine intoxication is manifested by agitation, muscle spasms, and convulsions. We report a case in which intractable convulsions led to severe lactic acidosis which secondarily resulted in visceral (lung, heart, kidney, liver, and brain) collapse and death. Aggressive therapy instituted in the emergency department and aimed at control of seizure activity and lactic acidosis may be lifesaving.


Hypothermia: quantitative aspects of therapy.

Quantitative aspects of various methods of warming are presented comparing the peripheral method of warm bath immersion to the central method of ventilation with heated water-saturated air, infusion of warmed intravenous solutions, peritoneal lavage with warmed solutions, and hemodialysis or cardiopulmonary bypass. The need to convert arterial blood gas results for body temperature is emphasized. Two cases demonstrate combined use of peripheral warming using warming mattress and blankets and central warming with ventilation and infusion.


External rotation method of shoulder dislocation reduction.

We used the external rotation method for reducing anterior shoulder dislocations on 85 consecutive patients seen in our emergency department during a one-year period. In relatively inexperienced hands, the external rotation method was successful on first attempt in 80% of cases. There were no complications attributable to the technique itself. We feel that it is a successful, easy, and atraumatic method of achieving reduction in both first occurrence and recurrent anterior shoulder dislocations.


Suspected esophageal foreign body -- choosing appropriate management.

Twenty-two cases of probable esophageal or pharyngeal foreign body seen at an emergency service were studied retrospectively, using 15 predetermined factors chosen to detect or anticipate the acute consequences of foreign body ingestion. Three findings were particularly predictive: 1) foreign body visualized directly or on plain x-ray films; 2) hypersalivation; 3) obstruction or foreign body image in the esophagus on barium swallow. No patient with none of these three abnormal findings, even in the presence of localized pain increased by swallowing, received further treatment, and no complications developed. All patients with any one of these three findings underwent direct foreign body removal (four cases) or esophagoscopy (11 cases). Five esophageal foreign bodies passed spontaneously into the stomach before esophagoscopy; four foreign bodies were removed, and two esophagi were abnormal (stricture, myasthenia gravis). In two cases no foreign body was found. Hypersalivation was the only finding always associated with an abnormal esophagoscopy. Particular attention must be paid to the interpretation of plain x-ray films, with regard to probable foreign body location at the cricopharyngeal constriction and to indirect signs such as fluid levels, soft tissue swelling, free air, if small foreign bodies are not to be missed.


Comparative evaluation of the effect of a high yield criteria list upon skull radiography.

Based on results of studies using high yield criteria to determine the need for skull radiography, the Utilization Review Committee of the University Hospital (UH), University of Washington, Seattle implemented a policy encouraging use of the criteria in ordering skull radiology. The Bureau of Radiologic Health of the FDA supported a project comparing skull radiology use patterns at UH, with the high yield criteria policy, and Harborview Medical Center (HMC), without a policy. Results showed an increase of around 60% at HMC since the 1972--73 academic year. At UH, there was a decrease of 40% since the 1972--73 academic year. At HMC a medical record review showed only 51 positive reports that significantly contributed to patient care, about the same rate observed in 1967. At the UH, only nine positive reports significantly contributed to patient care, with 62% compliance with the high yield criteria. A current demonstration project under the auspices of the Washington State Professional Standards Review Organization and Bureau of Radiologic Health involves implementing the high yield criteria list at both HMC and UH. After three months, out of 6,003 patient visits, skull radiography was deemed necessary in 518 cases. Of this total 181 had high yield criteria checked. There were 37 positive reports out of these and 23 examinations that made a documented significant contribution to patient care. In the group without high yield criteria, 434 cases, there were 22 positive reports but no significant contribution to patient care documented after four weeks.


Teaching emergency department administration: the in-basket exercise.

Borrowing from formats that have been successfully used in teaching administrators, we developed a limited, time-dependent simulation model, the In-Basket Exercise for teaching emergency department administration. The exercise is designed as an introduction to nonclinical decisions, management communication, and managerial control. Using selected material, and under time constraints, participants are asked to describe the options for several types of administrative items. These options and decisions are then discussed within a group. The In-Basket Exercise has been well received as a simple new tool for teaching emergency department administration where existing methods are generally deficient.


Self-administered nitrous oxide: an adjunct analgesic.

In a pilot study of 26 patients, a mixture of 50% nitrous oxide and 50% oxygen (N2O-O2) appeared to be an effective and safe analgesic for the incision and drainage of closed-space infections. The analgesic effect of N2O-O2, as measured by a Mean Analgesic Index, is augmented by both amnesic and dissociative effects, ie, patients remembered experiencing significantly less pain than they complained of during the procedure (p less than .01) and reported significantly more pain than they appeared to be having, as recorded by an observer (p less than .01). The patient's recollected pain, however, correlated well (r = .68) with the observer's assessment. Forty-two percent of patients had undergone a similar or identical procedure in the past without the benefit of N2O-O2 and made uniformly favorable comparative statement concerning the analgesic effect of the gas.


Acute poisoning from over-the-counter sleep preparations.

All cases received by the Rocky Mountain Poison Center involving over-the-counter (OTC) sleep preparations were studied during an 18-month period to elucidate 1) the range of toxicity; 2) characteristic symptoms, and 3) the time of onset of symptoms. In 155 cases reviewed retrospectively, the three most commonly ingested agents were Sominex, Nytol and Sleepeze. Multiple ingestions were also involved. Symptomatology was equally divided among no symptoms, mild symptoms and possible life-threatening symptoms. The least amount taken to produce possible life-threatening symptoms was 16 Sominex, 18 Nytol and 15 Sleepeze, although the average amount producing the same symptoms was approximately twice that. These symptoms were seen within six hours in all but three of the 39 cases presenting with these symptoms. There were no deaths.


Mucus-stimulating substances in human body fluids assayed in an invertebrate mucous cell system.

An in vitro cell system has been shown to respond differentially to body fluids from normal subjects and from those with disorders of mucus secretion. The urn cell complex of the marine invertebrate Sipunculus nudus responds to mucus-stimulating substances (MSS) in normal human lacrimal fluids and stool filtrates by producing mucus. The process of mucus secretion can be directly observed, and the amount produced can be measured, in a calibrated light microscope. MSS are decreased in lacrimal fluids of patients with dry-eye conditions, while they are periodically increased in filtered stools of patients with acute Shigella dysentery and acute cholera. MSS are remarkably increased isotonic dilutions of sera of rabbits with acute mucoid enteritis, but are absent from sera of normal rabbits. MSS are present in isotonic dilutions of normal human sera which are heated to 85 degrees C for 4 minutes, but are absent from similarly processed sera of immunosuppressed patients. Mean MSS values of heated sera of children with cystic fibrosis are higher than those of controls. The active factor in tears and serum is a large molecule and is heat-stable.


Alkaptonuria.

Alkaptonuria is found relatively frequently in Slovakia, Eastern Czechoslovakia (1 in 25,000 inhabitants). Reported herein are the clinical, radiographic, and biochemical aspects and genetics of 126 patients with alkaptonuria. Forty-seven were diagnosed in childhood; the sequential appearance of each manifestation is documented by decade. A simple screening method for this disorder is described. Pedigree analyses confirm recessive inheritance. Possible genetic and sociologic factors responsible for this high frequency of alkaptonuria are discussed.


Digoxin -- quinidine interaction.

A patient with chronic paroxysmal atrial fibrillation, receiving maintenance doses of digoxin, was admitted for addition of quinidine therapy. With stable serum digoxin levels, the institution of oral quinidine sulfate resulted in a rise in the serum digoxin level in less than 24 hours. The serum digoxin concentration increased more than threefold before digoxin was discontinued. The rise and fall of the digoxin serum concentration appeared to correlate directly with an increase and decrease in the PR interval. With the reinstitution of digoxin at lower doses, apparently stable therapeutic levels of both digoxin and quinidine were achieved. However, discontinuation of quinidine alone was followed by a prompt fall in the serum digoxin level. This study demonstrates that quinidine produces a significant increase in the serum digoxin level. The increased digoxin concentration appears to correlate with enhanced electrophysiologic effects of digoxin and emphasizes the caution required when these two drugs are used simultaneously.


An alternative method for proximal placement of the heparin-coated tridodecylmethylammonium chloride (TDMAC) shunt.

An alternative method for proximal placement of the heparin-coated tridodecylmethylammonium chloride (TDMAC) shunt is described. A side arm is sewn on the grafts and the proximal shunt is inserted. The distal cannulation is done in the usual fashion. This provides an additional site of proximal cannulation and increases its versatility.


[Current problems in the surgical treatment of acquired mitral heart defect].

The experience of 22 years in the surgical management of patients with mitral valvular disease is discussed. A total of 7,122 operations was carried out, among which 6,810 were performed by the closed method and 244 under conditions of extracorporeal circulation. The principal ways for improving the immediate and late postoperative results are discussed.


[Late results of mitral commissurotomies].

The late results of 1,205 operations for mitral commissurotomy were studied. The investigation embraced 88.3% of patients discharged from the clinic after surgery. The follow-up period was 8 years and 9 months on average. The late postoperative result was good in 47%, satisfactory in 26.4%, and poor in 16.4% of patients. Late mortality was 10.2%; 75% of patients were alive 15 years after the operation. The effect of the stage of the disease, the volume of the reverse blood flow on the mitral valve and the presence and extent of its calcification on the late results of the operation was studied. Longterm follow-up testifies to the high efficacy of closed mitral commissurotomy.


[Problems of rehabilitating patients who have undergone a mitral commissurotomy].

The article analyses the course of the rheumatic process in 241 patients who underwent mitral commissurotomy. Study was conducted at the same time of the volume of antirecurrence antirheumatic treatment applied before and after operation and its importance in the prevention of exacerbations of rheumatism in late postoperative periods. Analysis was made of the working capacity of 241 patients in follow-up periods of one to 20 years after operation and the individual tolerance to physical exertion was determined in 52 patients. It was found that the maximum number of individuals in occupation (62.3%) is encountered in the period from 5 to 11--12 years.


[Congenital heart defects in persons over 16].

The authors had under their observation 389 patients over 16 years of age with congenital heart diseases, 157 of whom were operated on. The specific features of the diagnosis, course, and operative treatment of the most commonly encountered congenital heart disease among adults were studied. Peculiarities were revealed in the clinical symptomatology in adults with congenital heart diseases complicated by pulmonary hypertension. The authors discuss the problems of rehabilitation of adults who had been operated on, in the light of the study of the late postoperative results.


[Physical activity and work capacity of patients in the late periods after the surgical correction of pulmonary stenosis].

From analysis of the data on the physical activity and working capacity of 162 patients with valvular stenosis of the pulmonary artery and tetraology of Fallot before and after correction of the anomaly, it was found that only 26.5% of patients have good physical resources before operation. In the late periods after effective correction of the defect in all grades of stenosis and even in secondary stenosis of the right conus arteriosus, reverse dynamics of functional disorders occurs and high physical activity is restored in more than 90% of patients.


[Hyperbaric oxygenation in the overall therapy of chronic ischemic heart disease].

Seventy-seven patients with chronic ischemic heart disease were treated in single-seater oxygen hyperbaric chambers; 52 patients had angina pectoris of effort or angina of effort and at rest while 25 patients with macrofocal postinfarction cardiosclerosis had insufficiency of pulmonary or systemic circulation. Treatment consisted of 12--15 procedures. The use of hyperbaric oxygenation in a complex with drug therapy makes it possible to alleviate or arrest the attack of angina pectoris and relieve considerably the symptoms of cardiac decompensation. The initial condition of central hemodynamics affects greatly the results of barotherapy. Normal parameters of hemodynamics hardly change after treatment. At the same time, in patients with markedly reduced myocardial contractility hyperbaric oxygenation causes evident positive changes in hemodynamics. The combination of hyperbaric oxygenation with drug therapy improves the effect of treatment significantly.


[Blood serum lipoprotein spectrum in myocardial infarct].

The lipoprotein spectrum was studied in polyacrylamide gel and by thin-layer chromatography on silica gel in 236 patients with myocardial infarction in different periods of the disease, in 45 patients with unstable angina pectoris, in 75 healthy persons and in 8 dogs with experimental myocardial infarction. Besides an increase in the concentration of cholesterol and triglycerides and a decrease in the level of diglycerides in blood serum, there is a disturbance in the ratio of phospholipid fractions, mainly in myocardial infarction. The level of pre-beta-lipoproteins was increased in the acute period of myocardial infarction, the level of beta-lipoproteins in the subacute period. Complications and concomitant inflammatory diseases were attended by a higher level of beta-lipoproteins. A connection was noted between the lipoprotein spectrum, predominantly of the pre-beta-fraction, and the ABO phenotype and the season.


[Metabolic manifestations of myocardial ischemia in the cardialgia syndrome of varying origin (study data on lactate from the coronary sinus, the precardiac stimulation test and coronary angiography)].

Twenty-one patients with various myocardial lesions (myocardial infarction, ischemic heart disease, noncoronarogenous cardialgias) were examined. The atrial stimulation test with collection of blood specimen from the coronary sinus and determination of arteriovenous difference by lactate was conducted. It was established that the beginning of lactate production is the most early and significant sign of myocardial ischemia and is of considerable differential-diagnostic and prognostic value.


[Express evaluation of the contractile state of the myocardium after heart operations].

By means of the method of long-term catheterization of the cardiac chambers, the authors studied the dynamics of changes in the shape of the intraventricular pressure curves after correction of congenital and acquired heart diseases. Analysis revealed three main types of pressure curves. With the development of myocardial insufficiency under conditions of normal pressure, pressure curves characteristic of hypertension of pulmonary circulation were recorded in the right ventricle. The absence of abnormalities in pulmonary circulation made it possible to demonstrate a direct dependence of the shape of the curves on the contractile condition of the myocardium, which is valuable in the rapid diagnosis of myocardial insufficiency.


[Changes in the contractile function of the myocardium in various methods of excluding the heart from the circulation during the surgical correction of acquired heart defects].

Changes in myocardial contractile function were studied during 46 operations with extracorporeal circulation on patients with acquired heart diseases; the operations were performed with the use of cold cardioplegia and electrical fibrillation of the heart. The dependence of the decrease in myocardial contractilicy on the method of cardioplegia, the duration of the heart arrest, and the parameters of extracorporeal circulation is analysed. The results obtained are evidence that it is necessary to improve the method for protecting the myocardium during operations with extracorpeal circulation.


[Trauma to the blood during assisted circulation].

Trauma inflicted to blood in different method of assisted circulation was studied in experiments and in the clinic. Morphological disturbances of red blood cells and changes in their aggregation properties were revealed. Left ventricular shunt and aorto-aortic counter-pulsation are attended with increased aggregation properties of blood platelets. Aorta-aortic counter-pulsation causes a greater damaging effect than shunting of the left ventricle. Counter-pulsation by means of a balloon pump is attended with least hemolysis.


[Basic courses of approach to the surgical treatment of postinfarct defects of the interventricular septum].

The authors studied 20 patients with postinfarction ventricular septal defects; among them 9 had been operated on and 2 of these patients died. Eleven patients did not undergo operation, 10 of them died. All patients subjected to operation had severe circulatory insufficiency; in 3 the septal defect was of nor more than one month's duration. Patients whose condition was particularly severe were subjected to intubation, catheterization of the heart, left ventriculo- and coronarography, and after the operation has been planned they were operated on on the same day. Some patients who could move about but who also suffered from circulatory insufficiency were operated on according to the planned schedule. In 10 patients who had died without being operated on the anatomy of the defect and the condition of coronary circulation were examined. The authors contend that before undertaking an operation it is necessary to assess the patient's condition and the possibility of operating on him and determine the role of the ventricular septal defect and the hemodynamic disturbances consequent upon the infarction; all cardiac lesions should be corrected during the operation. Besides closure of the defect and resection of an aneurysm 2 patients also underwent operation for aorticocoronary shunt.


[Sympathetic-adrenal and enterochromaffin systems and homeostatic indices in open-heart surgical operations under morphine anesthesia].

Catecholamine, serotonin and histamine metabolism and the level of acid metabolites and the activity of the enzymes lactate dehydrogenase and catalse in blood were studied in patients with congenital heart disease who were operated on under conditions of extracorporeal circulation and morphine anesthesia. The results obtained were compared with the values of acid-base balance, haemodynamics and volume of diuresis. It wwas found that the period of morphine induction was marked by a significant increase in the blood plasma noradrenalin content in the absence of essential changes in the other biochemical and hemodynamic indices studied. No significant changes were noted in the systems of neurohumoral and tissue regulation, indices of the redox processes and renal excretion in the most traumatic periods of the operation. The data obtained allow morphine to be accepted as an anesthetic which provides adequate protection of the organism from operative trauma.


[Use of correlation analysis of clinical biochemical indices for a study of the pathogenesis of acute arterial obstruction].

The role of serotonin, histamine, and the kallikrein-kinin system in acute arterial occlusion during ischemia was studied from the standpoint of multivariate correlation analysis. The mechanisms of their participation in the genesis of pathophysiological disorders in the organism in acute arterial occlusion are discussed. The important role of serotonin and the kallikrein inhibitor in this pathological condition is shown.


[Effect of auxilliary orthograde perfusion on lesser circulation hemodynamics].

The causes of disorders of the venous return of blood to the heart in development of acute experimental cardiovascular insufficiency were studied. It was established that grave hemodynamic disturbances in pulmonary circulation are the consequence but not the cause of the sharp decrease of venous blood return to the heart with the development of acute cardiovascular insufficiency.


[Behavioral factors in the problem of treating arterial hypertension].

The paper deals with the role of the psychological factors in the control of arterial hypertension in the population. The attitude of the population towards their own health and possible medical intervention--these are the factors. It is proved that the negative attitude can low down the efficiency of the public health effort in the revealment and systematic management of hypertensives. Special attention is paid to the discussion of the role of the psychological factors in the pathogenesis of the essential hypertension. Personality traits of the patients with different forms and course of arterial hypertension (symptomatic included) are considered. Strategy and psychological intervention methods in essential hypertension control in order to increase the treatment efficiency are also discussed. The importance of the multidisciplinary approach which envisages routine hypertensive drugs, beta-blocker, psychotropic agents and relaxatiion technique, causal-pathogenetic psychotherapy methods, psychosocial intervention is stressed.


[Nature of the reaction of blood plasma steroid hormones in hypertension to various types of stimulation].

Fifteen healthy persons and 31 patients with essential hypertension whose ages ranged from 18 to 45 were examined. The basal level of three steroid hormones (progesterone, aldosterone, and cortisol) in blood plasma and their level after loading (walking, furosemid and rest, furosemid and walking) were studied by the radioimmune method. It is shown that in comparison with healthy individuals, patients with essential hypertension are marked by a change in the ratio of the pressor (aldosterone, cortisol) to the depressor (progesterone) hormones in blood plasma during loading. In different types of loading, no direct correlation was found, on the whole, between the degree of the reactions of aldosterone and renin in healthy individuals and in patients with essential hypertension.


[Clinical aspects of hypertensive crises].

Hypertensive crises were studied in 80 patients. In severe cases the ECG provided evidence of systolic overloading of the left ventricle with intensification of coronary circulation and development of acute myocardial ischemia. Phase analysis showed prolongation of the mechanical systole with increase of the myocardial index. In more complicated cases there was a more evident hypodynamic syndrome with marked myocardial insufficiency. Hemodynamic disturbance were marked by a sharply increased peripheral resistance with a heterogenous reaction of the cardiac output. Blood supply to the cerebral tissue reduced sharply with an increase in the resistance of cerebral vessels. Renin activity was directly related to the severity of the crisis. A sharp onset of cerebral and cardiac ischemia was marked by changes in the antigen albumin. Timely diagnosis and differentiated treatment made it possible to avoid vascular complications in hypertensive crisis.


[Fluorescein angiographic studies of the fundus oculi in the malignant arterial hypertension syndrome].

Fluorescein-angiographic examination of fundus oculi in 33 patients with the syndrome of malignant hypertension made it possible to recognize for the first time changes in the choriocapillary layer, which in 29 patients were displayed by choroidal retention; ischemic zones were seen in 20 patients. It is suggested that the discovery of ischemic zones in the choriocapillary layer may be an early diagnostic criterion of malignant hypertension.


[State of the vascular wall in experimental hypertension induced by the administration of indomethacin in combination with a saline drink].

It is shown that various types of vessels (elastic, musculo-elastic, and muscular) possess initially different capacity for synthesizing and destroying prostaglandins. Under the effect of indomethacin and salt load considerable changes occur in the synthesis and metabolism of prostaglandins and the closely related system of cyclic nucleotides in the vessels of experimental animals. The character of these changes suggests the predominance of constrictive vascular reactions, which was confirmed by the results of functional tests on segments of the aorta and femoral arteries. It was shown also that the walls of small arteries of different organs, the kidneys in particular, undergo marked structural changes resulting in their thickening and narrowing of the lumen. These functional and structural changes may underlie the increase in peripheral vascular resistance and be the principal pathogenic mechanism of hypertension.


[Blood plasma lipoextraction as a method of lipid removal from atherosclerotic lesions of the aorta in rabbits].

The effect of repeated lipoextraction of their own blood plasma on regression of the atherosclerotic process was studied in rabbits with experimental hypercholesterolemia 2 months after they had been fed cholesterol. The blood plasma cholesterol level at the end of the experiment was lower in the experimental animals than in the controls, whereas the results of morphological examination of the aortic areas involved in atherosclerosis showed that repeated removal of lipids from the blood plasma promotes rapid regression of experimental atherosclerosis in the experimental animals.


[Effect of the characteristics of the preinfarct period on the state of patients in the 1st year after a myocardial infarct].

From a follow-up of 496 patients (males aged from 20 to 65 years) the authors analyse their condition during the first year after recovery from myocardial infarction. It is shown that preceding arterial hypertension, a history of myocardial infarction and angina pectoris as well as the patient's elderly age have an unfavourable effect with regard to the possible development of circulatory insufficiency during the first year after myocardial infarction which must, without doubt, be taken into account in planning regimens of motor activity for these patients. An unfavourable prognostication factor with regard to the hazard of a new myocardial infarction developing during the first year is a recurrent affection of the cardiac muscle, and in patients of the 60--65 year group, the existence of hypertension prior to myocardial infarction.


[Functional state of the left ventricle in patients who have had a myocardial infarct according to ultrasonic scanning data].

In most patients who had suffered from myocardial infarction 3 1/2 to 12 months (7.6 months on the average) previously and had no clinical symptoms of circulatory insufficiency, ultrasonic scanning of the heart showed normal stroke volume and stroke index, and normal minute volume and cardiac index against the background of low indices of left ventricular contractility function (ejection fraction, % delta S, VcF) and large end-diastolic and end-systolic left ventricular volumes. Normal stroke ejection was achieved due to an increase of the end-diastolic volume, the decrease in the contractility of the left ventricular was thus compensated for with the participation of the Frank-Starling mechanism.


[Blood hormones in chronic ischemic heart disease and acute myocardial infarct].

The activity of some blood hormones was determined by radioimmune analysis in 58 patients with chronic ischemic heart disease (CIHD), 60 patients with myocardial infarction (MI) and in 24 practically healthy individuals. Increased activity of pituitary hormones (ACTH and TTH) with simultaneous increase in the blood STH content in the absence of essential changes in the FSH and LH content was established. These shifts in the production of pituitary hormones are evidently due both to disorders in the hypothalamo-hypophyseal area and to changes in the activity of systems coordinated to the pituitary gland in patients with CIHD. In patients with MI the activity of these hormones in blood does not differ from that in the control group. In patients with CIHD, the activity of the thyroid is diminished due to a decrease in its thyroxin-producing ability against the background of high activity of the pituitary thyreotropic function. The discussed shifts in the activity of some hormones in CIND and MI are conducive to the advancement of atherosclerosis and changes in myocardial metabolism.


Study of factors which modify the development of norepinephrine-induced acute renal failure in the dog.

Previous studies have demonstrated that the fall in inulin clearance which occurs 3 hours after the intrarenal administration of norepinephrine can be markedly attenuated by the prior administration of intrarenal prostaglandin E2 (PGE). Since in the previous studies PGE led to a marked increase in both renal blood flow and solute excretion, we designed the present series of experiments to investigate whether an increase in renal blood flow, solute excretion, or other factors were responsible for the protective effect in the norepinephrine model. Two renal vasodilators, bradykinin and secretin, were evaluated initially. Bradykinin administration prior to norepinephrine administration had a protective effect similar to that previously found with PGE, whereas secretin did not. Both of these vasocilators increased renal blood flow to the same degree, but only bradykinin increased urine flow and solute excretion. The fall in inulin clearance 3 hours after the administration of norepinephrine was also attenuated by two diuretics (mannitol and furosemide) which tended to increase renal blood flow. In contrast, two natriuretic agents, which are also renal vasoconstrictors (chlorothiazide and benzolamide), had no protective effect. Further, chlorothiazide and benzolamide obviated the protective effect of bradykinin. These studies demonstrate that there are several types of pharmacologic agents which can modify the magnitude of renal functional impairment resulting from extreme renal ischemia. Although the mechanism of the protective effects remain unclear, the findings are compatible with the view that the protective effect noted with PGE, bradykinin, mannitol, and furosemide may be related to an increase in osmolar excretion which occurred with administration of each of these agents. This potentially salutory effect (increased osmolar excretion), however, could be overcome by an agent (e.g., chlorothiazide or benzolamide) which also increased renal resistance prior to the administration of norepinephrine.


Effects of fluorocitrate on renal ammoniagenesis and glutamine metabolism in the intact dog kidney.

Renal glutamine metabolism was studied in vivo following infusions of fluorocitrate into chronically acidotic and alkalotic dogs. Coincident with a dramatic rise in renal cortical citrate concentrations, there was a significant fall in tissue glutamate in both acid-base states. This was accompanied by a significant increase in total renal ammonia production. Glutamine metabolism and ammoningenesis in alkalotic dogs receiving fluorocitrate simulated that achieved in acidotic dogs. The simultaneous administration of alpha-ketoglutarate and fluorocitrate significantly diminished the fall in tissue glutamate and the rise in ammoniagenesis induced by fluorocitrate alone. These results are compatible with the hypothesis that ammonia production from glutamine is enhanced secondary to increased glutamate deamination. We postulate that this chain of events may be the consequence of impaired alpha-ketoglutarate production from citrate.