[The influence of cyclophosphane and phenthyrine and their combination with zymosan and serotonin on the functional features distingusihing peritoneal macrophages in mice].

Radiometric analysis into phagocytic activity of macrophages in intact and tumourous mice following introduction to them of phenthyrine and cyclophosphane showed the former to suppress to a greater extent the absorption function and the latter--that of digestion. A combined application of phenthyrine and cyclophosphane together with serotonin helps re-establish the microphages function in tumourous animals and to heighten the antineplastic activity of these compounds. Zymosan and its combination with phenthyrine and cyclophosphane do not produce any positive effect on the peritoneal cells.


[Effect of furosemide on the amino acid content of serum and elimination by the kidneys].

The effect of intraventously administered furosemide (20 mg) on the concentration of 21 amino acids in the blood serum and urine of 6 healthy volunteers was investigated. A substantially increased concentration of glutaminic acid and citrulline and a statistically significantly greater excretion of arginine with urine were ascretained.


[The effect produced by pyrazidol on the gastrointestinal tract].

In experiments with animals pyrasidol, a new Soviet-made tetracyclic antidepressant, lowers the tone and peristalsis of the intestines, reduces cholic acid secretion in the liver and basal gastric secretion to a lesser degree than this does imipramine.


[Antisilicotic properties of polyethylene-piperazine N-oxide--a new polymeric compound].

A high antisilicotic activity of a new polymeric compound--polyethylene-piperazine N-oxide (molecular mass 5000--8000, degree of exidation--80 per cent), synthetized on the basis of aliphatic amine, was shown as against polyvinylpyridine-N-oxide in experiments conducted on albino rats with silicosis.


[The activity of microsomal hepatic cytochromes as affected by x-ray contrast media].

Tests on rats evidenced that X-ray contrast media can bring down the cytochrome P-450 content in the endoplasmatic reticulum of hepatic cells. The observed effect is most characteristic of cholecystrographic substances and is not linked with intesified processes of lipids peroxidation in themicrosomal membranes.


[The action of 9 alpha-fluorohydrocortisone on some aspects of water-electrolyte metabolism in animals].

This mineralocorticoid effect of different doses of the synthetic hormone 9-alpha-fluorhydrocortisone was studied. The introduction of the drug to intact animals per os was found not to produce any sodium-retention effect. A single adminstration of 9-alpha-fluorhydrocortisone causes an intensified excretion of water, sodium potassium with the urine. A course-wise application of the hormone brings about the development of hypokaliemia.


[Changes in RNA biosynthesis and ultrastructure of hepatic cells as affected by sodium ribonucleate].

Sodium ribonucleate (per os application) increased the biosynthesis of mitochondrial, nuclear and cytoplasmic RNA in the rat liver and transportation of nuclear RNA into the cytoplasm. Administration of ribonucleate changed the ultrastructure of hepatocytes, increased nuclear and nucleolar diameter, the number of rough endoplasmic elements, reticulum and glycogen particles and decreased the size of the mitochondria. This suggests that sodium ribonucleate can stimulate the biosynthesis of RNA and change the ultrastructure of hepatocytes also with application per os.


[Kinetics of accumulation and elimination of 14C-dipine, an antineoplastic drug].

An investigation on evaluating the distribution of 14C-dipine in rats with sarcoma 45 was carried out. With intragastric administration of the drug its resorption occurs largely in the small intestine. The maximally absorbed portion of the tag is detected in 1 hour and by this time it reaches 36.4 per cent of the introduced radioactivity. The share of the tumour is 2,32 per cent (coefficent of radioactivity absorption CA-0.42). Tests involving washing of the vascular system enabled it to ascertain a rather weak bonding of the drug with the tissues. The results of the CA comparison in the blood and tissues indirectly suggests that the accumulation of radioactivity takes place not only at the expense of its presence in the blood but also because of its penetration into the structural formations of the cells. A mathematical modelling that features the presence of 14C-dipine in terms of time (CA/hour) showed that with intragastric as against intravenous administration of the drug the fibure under consideration was higher for a number of organs and tissues. A feature common to 14C-dipine is to become accumulated in the organism with its daily administration for 3 days. With its intragastric administration 14C-dipine is eleminated, argely via the kidneys, in the course of 13 hours, which is its half-decay time.


[The lack of damaging effect from sigetin on the development of the reproductive system in rats].

Sygethin, an estrogen-like drug, was introduced to rats of the Wistar line during critical periods marking differentiation of hypothalamic sex centers, initial development and differentiation of the mammary glands as well as the time when administration of estrogens caused irreversible changes in the testes. No deviations in the development of test animals similar to those produced by estrogens were disclosed.


[Radioprotective and toxicological properties on some 4-oxyhexa- and 1,2,3,6-tetrahydroprimidine-2-thione derivatives].

Test on mice demonstrated the radio-protective activity of 12 derivatives of 4-oxyhexahydropyrimidinethione-2 and 1,2,3,6-tetrahydropyrimidinethione-2 well-marked with intraperitoneal administration 10--20 minutes prior to irradiation (1000 r, exposure dose rate--10 r/min). As a whole the tetrahydroderivates are more toxic.


[The effect of syrepar and oxaphenamide on liver function in experimental hypokinesia].

Experiments set up on albino rats evidenced that 30-day hypokinesia changes the reaction of the liver to cholagogues. In particular, the degree of the choleretic action of oxaphenamide as well as of its inhibitory affect on the synthesis of bile acids diminshes, while the influence on the bilirubin secretion -- increases. In hypokinesia syreper, inhibits biliation, but stimulates the secretion of bilirubin. Owing to a reduced secretion of cholesterol the cholesterol-stablizing properties of the bile improve.


[The effect of phenobarbital on the acetylation of sulfapyridazine and formation of sulfadimethoxine glucronide in man].

In the urine of 20 normal male students-volunteers aged 20 to 30 the percentage of acetylated sulphapyridazine and sulphadimetoxin was measudred 12 hours of taking by them 1.0 g of sulphanilamide. Takinpreliminarily phenobarbital (0.1 g before going to bed for 2 days) did not have any effect on the percentage of acetylated sulphapyridazine in the urine of the examined, nor did it affect the level of the free compound. Phenorbarbital was found to significantly raise the level of sulphadimetoxin from 84.3 up to 88.1 per cent in the urine, the amount of free sulphadimetoxine then declining. In experiments on isolated lenghts of the small intestine of the rat turned inside out it was shown that a coursewise introduction of phenobarbital (25 mg/kg for 5 days) did have any effect on the acetylation of sulphapyridazine.


[The mechanism of circulatory hypoxia in acute with sodium fluoride poisoning].

Intraperitoneal injection of a 1-sodium fluoride solution (35--40 mg/kg) to male rats was seen to cause a 8--9 fold rise of the blood histamine content and to significantly lower the oxygen tension in the musculus femorins. Preliminary administration of diprazine (5 mg/kg) prevented the death of the animals and lowered the degree of oxygen deficiency in the tissues. An interference is drawn on the important pathophysiological role played by an increase of the histamine content in the blood of the animals in the mechanism underlying the development of circulatory hypoxia in acute poisoning with sodium fluoride.


[The structure and antihypoxic action of alpha-dicarbonyl compounds and their derivatives].

The protective action in hypoxic hypoxia of 29 synthetized alpha-dicarbonyl compounds were studied. In this series of substances the natihypoxic activity was found to be most marked in drugs whose redox potential amounted to 0.15--0.3 V and which displayed a high dehydrating activity. Such compounds include isatin, its 3-anyl, 3-thiosemicarbation of ethyl either, isatin-1 of acetic acid and acenaphthequinone. Substitution is position 1 and 3 of isatin can lead to the formation of active substances, whereas substitution in position 2 usually reduces the antihypoxic activity.


Observations on 320 infertile patients treated with human gonadotropins (human menopausal gonadotropin/human chorionic gonadotropin).

From 1964 to 1975, 320 patients with failure of ovulation were treated with human gonadotropins (human menopausal gonadotropin [HMG]/human chorionic gonadotropin [HCG]). Estimation of the pituitary and ovarian function of each patient rather than classification into clinical groups contributed positively to the selection of patients. The dosage schedules used for the patients should be considered conservative, insofar as the amount of HMG and HCG administered per treatment cycle is concerned. The response to human gonadotropins was evaluated mainly according to excretion levels of estrogen and pregnanediol. Of the 320 patients, 256 ovulated at least once during treatment with gonadotropins (80%). Ovarian hyperstimulation syndrome was encountered in 22 patients (6.8%). Pregnancy occurred in 163 patients (50.9%) and in some of them twice, so that the total number of pregnancies was 206. Fifteen pregnancies were multiple (all of them twins). Of 197 pregnancies followed, 43 ended in abortion and 36 in premature labor. Cesarian section was performed in 21 cases.


Induction of ovulation with clomiphene and estradiol benzoate in anovulatory women refractory to clomiphene alone.

Twenty-two infertile and clomiphene-nonresponding patients received a course of clomiphene, 100 mg/day for 5 days, followed 7 days later by an intramuscular injection of 1 mg of estradiol benzoate. The diagnosis of idiopathic chronic anovulation had been established. None of these patients had galactorrhea, hirsutism, or ovarian enlargement. Thirteen of the twenty-two women had surges of both luteinizing hormone and follicle-stimulating hormone after the estradiol injection; the peak gonadotropin levels occurred within 72 hours of the injection. These 13 patients ovulated and pregnancy ensued in 10 of them. The estradiol benzoate injection also elicited a significant increase in serum prolactin levels- This enhanced prolactin release had no apparent effect on the gonadotropin surge. These results suggest that the association of clomiphene and estradiol benzoate potentiates the action of clomiphene and may prove useful in clomiphene nonresponders.


Endometrial prostaglandin F content in women wearing nonmedicated or progestin-releasing intrauterine devices.

Prostaglandin F (PGF) was measured in endometrial samples from eight women wearing Lippes Loops and 14 women wearing Progestaserts after 6 months' use of the intrauterine devices (IUDs). In addition, in 37 women wearing dydrogesterone-T IUDs, endometrial PGF was measured after 1 month, 3 to 7 months, and 8 to 12 months of use. Endometrial samples were also obtained from 51 women without IUDs. The following means and standard errors of endometrial PGF, expressed in picograms per microgram of endometrial protein, were obtained in women without IUDs: early proliferative phase, 3.11 +/- 1.0; midproliferative phase, 4.1 +/- 0.7; late proliferative phase, 4.4 +/- 1.0; midluteal phase, 7.13 +/- 1.0; and late secretory phase, 6.08 +/- 1.0. The midproliferative phase mean was significantly different from the midsecretory phase mean (P is greater than 0.05). Except for one group, no differences were noted during the midproliferative and midsecretory phases among the groups of women wearing medicated and nonmedicated IUDs, when compared with values for women without IUDs. The only difference noted was during the midsecretory phase in the dydrogesterone group at 8 to 12 months. In these women, the mean endometrial PGF content was 2.8 +/- 0.8, significantly different (P is greater than 0.05) from that of women without IUDs (6.1 +/- 1.0).


Studies of carbohydrate and lipid metabolism in women using the progesterone-T intrauterine device for six months: blood glucose, insulin, cholesterol, and triglyceride levels.

A prospective, detailed study of both lipid and carbohydrate metabolism was carried out in 35 women who used a progesterone-T type intrauterine device (IUD). A 3-hour oral glucose tolerance test was performed in each woman before the IUD  was inserted and again after 6 months of use. There was no change in the patients' weight or in the fasting glucose, cholesterol, or triglyceride levels. There were significant increases in the 3-hour glucose and the fasting, 0.5-, and 3-hour plasma insulin values in the 6-month tests. These values were less than those found after 6 months of systemic progestogen use, but do suggest some systemic effect of the released progesterone.


Failed tubal sterilization as an etiologic factor in ectopic tubal pregnancy.

An indirect statistical method was used to demonstrate that failed tubal sterilization must be considered as a significant etiologic factor in tubal ectopic pregnancy. Since the exact incidence of poststerilization pregnancies was unknown in our population, a "theoretical" incidence of a 0.71% failure rate was used as the most realistic estimate on the basis of published reports of failed tubal sterilizations. From this figure the "expected" number of poststerilization conceptions, both total and tubal, was computed. The observed incidence of poststerilization ectopic tubal pregnancy was found to be 20 times the "expected" incidence in our population.


A randomized study of 12-mm and 15.9 mm cannulas in midtrimester abortion by laminaria and vacuum curettage.

We evaluated the adequacy of a new large-bore vacuum cannula system for midtrimester abortion by randomly allocating patients to be treated with a standard 12-mm vacuum system or the new 15.9-mm system. Cervical dilataion was accomplished by overnight placement of laminaria tents. Blood loss was similar for the two treatment groups and was significantly greater at gestational ages 17 to 18 weeks than for abortions at 16 weeks or less. Operating time was slightly less in the large-cannula group. When the 12-mm cannula was used beyond 13 weeks' gestation, forceps were usually needed to empty the uterus completely. The large-cannula system was able to empty the uterus through 16 weeks, but at 17 and 18 weeks it offered no advantage over the smaller system and forceps were always needed. Complications were minimal. We caution against forcible cervical dilatation to 16 mm and urge the use of laminaria instead. Our findings, together with published reports of the safety of late dilatations and evacuation, would appear to justify wider clinical trials by experienced investigators.


Recovery of midcycle human follicular oocytes: correlation of their morphology with endomethrial and follicular histology.

The ovarian follicles of 23 of 33 women undergoing elective pelvic laparotomy during menstrual cycle days 11 to 17 were aspirated by a low-vacuum device. The study compared the ovulatory status of women in midcycle with the health of the oocytes obtained, and determined the frequency of recovery of mature oocytes without the preadministration of exogenous hormones. Maturing or mature oocytes were obtained from 22% and nonmature oocytes from 48% of the 23 women. Sixty per cent of the women in each of the maturing or mature and nonmature groups were postovulatory as judged by evaluation of the endometrial and ovarian tissue recovered. Furthermore, 20% of the maturing or mature oocytes and 65% of the nonmature oocytes showed a moderately heavy amount of cytoplasmic degeneration, which was independent of ovulatory status. Therefore, it is concluded that, because of the relatively low rate of return of oocytes, the frequent postovulatory status of patients in midcycle, and uncertainty about the viability of the oocytes so obtained, women not stimulated by exogenous hormones are ill-suited for recovery of maturing or mature follicular oocytes for in vitro fertilization studies.


A longitudinal analysis of artificial insemination with donor semen.

A longitudinal analysis of artificial insemination with donor semen (AID) in 114 consecutive couples revealed a 37% over-all pregnancy rate. The 45 pregnancies occurred in 39 patients, and approximately 90% of these pregnancies occurred within six cycles of AID. Pregnancy rates were higher in the age group 25 to 30, in those who received only fresh semen, and in those with a history of a previous pregnancy. Lower pregnancy rates were observed in patients age 31 or older, in those with pelvic disease, and in those randomly receiving freshly thawed semen or fresh semen. The use of a vaginal device for retaining semen, the use of patient positioning, or the duration of infertility did not appear to affect the success rate. When surgically correctable pelvic disease was treated, a pregnancy rate of 22% was obtained.


Insemination of husband's semen with and without the addition of caffeine.

Four hundred cervicovaginal artificial inseminations using husband's semen were carried out for a variety of clinical indications. Before insemination, to one-half of the samples caffeine was added to a final concentration of 6 mM. Although the motility of the spermatozoa was enhanced in each case, no pregnancies were achieved. Of the four pregnancies in the series, only one could be attributed to artificial insemination.


Intrauterine insemination of isolated motile sperm.

Semen from infertile males was filtered through liquid albumin, and sperm retrieved from the most distal fraction were used for intrauterine insemination. Compared with the ejaculate, the isolated specimens contained fewer sperm but an increased percentage of motile sperm. The fractions were also free of the debris (white cells, agglutinated sperm, immature forms, and particulate matter) commonly seen in the ejaculates. Despite the improvement in motility none of the 19 women who were treated for a total of 67 cycles became pregnant. It is possible that even the best sperm from a poor specimen may have intrinsic defects that interfere with their ability to fertilize.


In vitro fertilizing ability of testicular, epididymal, and ejaculated rabbit spermatozoa.

The fertilizing ability of testicular, epididymal, and ejaculated rabbit spermatozoa was evaluated in vitro following in vitro capacitation by high ionic strength treatment. Fewer than 11% of inseminated ova were apparently fertilized (i.e., in pronuclear, two-, and four-cell stages as determined by light microscopy) when testicular sperm treated with caffeine, caput epididymal, or corpus epididymal sperm samples were tested. A greater fertilizing ability, reflected by the percentage of ova fertilized and more normal progression of embryonic development, was exhibited by cauda epididymal sperm. Of 93 ova, 68 (73.1%) were fertilized by cauda sperm, whereas ejaculated sperm from the same 10 bucks fertilized 34 (36.6%) of 93 ova (P is less than 0.005). Ultrastructural examination of selected ova apparently fertilized by sperm from levels of the male reproductive tract proximal to the cauda epididymidis revealed abnormal activation. Authentic fertilization occurred when ova were inseminated with cauda epididymal and ejaculated sperm. An unusual and infrequent form of activation involving failure of cortical granule breakdown in ova penetrated by cauda epididymal and ejaculated sperm was seen. A comparison of fertilizing ability of sperm from first, second, and third ejaculates revealed a significant decrease with the third ejaculate (P is less than 0.01).


Persistence of immunological tolerance to HSA in chickens after cell transfer to immunosuppressed hosts.

The nature of immunological tolerance to HSA in chickens was analyzed by means of spleen cell transfers to 3-day-old, cyclophosphamide-treated, syngeneic recipients. The cell donors were 2-week-old tolerant or control chickens. The primary challenge with HSA was done 26 days after cell transfer. Spleen cells from both control and tolerant donors restored the immunoglobulin levels and the ability to produce antibodies to SRBC to normal. While cells from normal donors also reconstituted the ability to form antibodies to HSA, the recipients of cells from tolerant donors either did not form detectable amounts or formed only low titres of these antibodies. The ability of cells from normal donors to respond by anti-HSA antibody formation, when transferred together with cells from tolerant donors, was neither suppressed nor decreased. Thus, tolerance to HSA in chickens was not reversible and the existence of an active immune process, causing its duration, could not be demonstrated.


Termination of tolerance to HSA in chickens.

A major part of chickens made tolerant to HSA at hatching formed anti-HSA antibodies when immunized with cross-reacting antigen, the BSA, at 4 weeks of age, although tolerant birds immunized with HSA produced no detectable antibody levels. Immunization with HSA + BSA did not prevent anti-HSA antibody formation in tolerant chickens, but it seems that the escape from tolerance is more rapid in birds immunized with BSA only than in those immunized with HSA + BSA and/or HSA only.


Changes in the recovery ability of colony-forming units after continuous irradiation.

The recovery ability of colony-forming units from mice continuously irradiated for 30 and 100 days at an exposure rate of 25 and 50R/day was investigated. The rate of recovery depended not only on the daily exposure but also on the total dose accumulated. The course of the recovery process was assumed as follows: B(t) = Bs + (Bo--Bs). (formula:see text) was characterized by calculating the estimate(s) of the recovery coefficient tau.


6-Phosphogluconate dehydrogenase polymorphism in some inbred lines of laboratory rats.

We examined 6-PGD isozyme patterns in laboratory rats (Rattus norvegicus) and found the phenotype S in the lines CAP/Cub, WAG/RijCub, BDV/Cub, BDVII/Cub, BDX/Cub, and the phenotype F in the lines LEP/Cub, DA/Cub, AVNj/Cub.


[Plasma renin activity response to isometric handgrip exercise in normotensive and hypertensive patients (author's transl)].

1) Plasma renin activity (PRA) response to isometric exercise was studied before and after the intravenous administration of 0.2 mg/kg of propranolol in 8 normotensive and 10 normal renin hypertensive patients. 2) Handgrip exercise at the 30% level of maximal voluntary contraction (MVC) for four minutes induced a significant increase in PRA in either normotensive or normal renin hypertensive patients, while the increase in PRA in normal renin hypertensive patients was significantly higher than that in normotensive patients. 3) Pretreatment with the administration of propranolol inhibited an increase in PRA after handgrip exercise in either normotensive or normal renin hypertensive patients. 4) The results suggest that isometric handgrip exercise can induce an augmentation in renin release mainly by stimulation of the sympathetic nervous system in either normotensive or normal renin hypertensive patients. The possible mechanism of the exaggerated response in PRA to handgrip exercise in normal renin hypertensive patients has been discussed.


[Diffuse cutaneous mastocytosis in childhood].

We report the case of a 15-month-old child suffering from diffuse cutaneous mastocytosis characterized by blisters and widespread skin involvement but without systemic manifestations. Skin biopsies were examined by electron microscopy. We observed various alterations in the morphology of mast cells and mast cell granules.


Bacteriology of psoriatic plaques.

Qualitative and quantitative studies of cutaneous bacterial flora were carried out in psoriatic patients and normal healthy controls. In psoriatics, the flora isolated from the affected skin was compared with the flora of adjacent normal skin. No significant qualitative difference was observed. The total number of bacteria isolated from the psoriatic plaque was significantly higher than on the adjacent normal skin. Flora of normal skin of psoriatics when compared with the skin of healthy controls did not reveal any qualitative difference, but a statistically significant difference was observed in the total bacterial counts. The nasal carriage rate of Staphylococcus aureus in psoriatics was higher than the control groups.


Woolly hair--study of a family.

A white English family is described with autosomal dominant woolly wiry hair. The propositus had woolly curly scalp hair, congenital perceptive deafness and dominant ichthyosis vulgaris. Her brother was epileptic and also deaf, but his skin and hair were normal and a male first cousin had dominant ichthyosis vulgaris but normal hair and hearing. Consanguinity was an interesting additional feature in this family.


Squamous cell carcinoma of the nail bed.

A case is presented of squamous cell carcinoma developed from carcinoma in situ of the nail bed of the first finger in a 79-year-old patient. Stress is laid upon the importance of the differential diagnosis. Surgery is considered the treatment of choice for this uncommon condition.


Two types of contact urticaria and immediate reactions to patch-test allergens.

3 patients with contact urticaria as the only pathological symptom are described, 2 with contact urticaria and other manifestations of hypersensitivity and 3 with immediate reaction to patch-test allergens.


Neurodermatitis and intralesional steroids.

The present work describes the results of treatment of 30 cases of neurodermatitis circumscripta by intralesional injections which were given by Dermo-Jet. 15 cases were treated with triamcinolone acetonide (0.25 mg/cm2 of the skin) and the rest with aqua distillata every week for 8 weeks and were followed for another 4 weeks. The results of treatment were excellent in 66% of triamcinolone treated cases and 46% of aqua distillata treated cases. The difference in the response was statistically insignificant. So we conclude that aqua distillata might have worked as suggestion therapy in emotionally labile individuals.


The effect of photochemotherapy on epidermal-glycogen and on capillaries in psoriatic skin.

This study was undertaken to assess the amount of glycogen present in psoriasis vulgaris (PV), psoriasis erythrodermica (PE) and psoriasis pustulosa generalisata (PPG) lesions before and after photochemotherapy (PUVA). There were more deposits of glycogen in PPG than in PE and PV. With PUVA treatment, glycogen almost completely disappeared in PV and PE, but traces were still observed in PPG. After treatment, the epidermal layers returned to their normal structure but there was no significant improvement in the dilated and tortuous capillaries in the upper corium.


Serum uric acid levels in untreated and PUVA-treated patients with psoriasis.

Hyperuricemia occurs frequently in patients with psoriasis. An increased purin breakdown due to the enhanced epidermal turnover was stressed as a reasonable explanation. To prove this theory serum uric acid, cholesterol, triglyceride levels and the average body overweight were determined in 318 untreated psoriatic patients and the parameters were correlated with the extent of psoriatic skin involvement. In more than 100 psoriatic patients treated by oral photochemotherapy (PUVA), uric acid serum levels were examined additionally after the PUVA clearing phase and during PUVA maintenance treatment. The present study demonstrates: (1) There is no relationship between the frequency of hyperuricemia and the extent of psoriatic skin involvement, indicating that the increased epidermal turn over may not play a role in psoriatic hyperuricemia. (2) The most reasonable explanation for elevated uric acid in psoriasis seems to be a combination of genetic predisposition and hyperalimentation. (3) No significant change was found in the incidence of hyperuricemia under the influence of photochemotherapy.


Hyperlactatemia in diabetics with retinopathy during combined sulphonylurea and phenformin therapy.

Blood lactate concentration has been measured at intervals over a twelve hour period in four maturity-onset diabetics with retinopathy treated by sulphonylurea and phenformin therapy. Despite moderately good control of blood glucose, all four patients had markedly elevated concentrations of blood lactate (12h means of 2.1-2;4 mmol/1) with concentrations greater than 3 mmol/1 at some time during the day. Hepatic function was normal in all patients and in all four patients plasma creatinine was 80-85 mumol/1, (normal range 60-125 mumol/1) so that the usual indications for not using biguanides were absent. It is concluded that diabetics with retinopathy constitute a group of patients with an increased risk of phenformin-associated lactic acidosis, and that plasma creatinine estimation may be unreliable in assessing whether patients are suitable for phenformin therapy.


Plasma glucose and insulin in the hibernating hedgehog.

Plasma glucose and insulin have been studied during lethargy and spontaneous arousal of hibernating hedgehogs. During lethargy, plasma glucose and insulin were low and showed no variation. Glucose and insulin injections given during lethargy showed no effects on plasma insulin and glucose respectively but confirmed a very low plasma clearance of glucose and insulin. During spontaneous arousal, the increase in plasma insulin occured before the increase in blood glucose and at about the time that utilization of blood glucose was restored.


[Metabolism of capillary endothelium tissue and its abnormalities in diabetes mellitus (author's transl)].

Glucose is the major energetic substrate of blood capillary endothelium; aerobic glycolysis is quantitatively the most important pathway. Insulin has no direct effect on glucose utilization. The glucokinase activity of the capillary endothelium is undetectable and the plasma cell membrane is freely permeable to glucose. All pathways of glucose utilization are stimulated by a high ambient glucose concentration: intracellular sorbitol accumulation and glucose-carbon incorporation into basement membrane collagen are most sensitive to the glucose effect. During chronic hyperglycemia, the amino acid composition of the basement membrane is modified and its capacity to incorporate glucose is enhanced. The glucose induced alterations of the blood capillary metabolism may contribute to the development of the diabetic microangiopathy.


Karyotype analysis of a frog pronephric tumor cell line.

Pronephric tumor cell lines, established from explants of a herpes virus induced frog renal adenocarcinoma, were shown to have a aneuploid modal chromosome number of 39. A karyotypic analysis of one line demonstrated the presence of abnormal chromosomes and chromosomal aberrations not previously reported for Lucké tumor cells. The cell line was characterized by two marker chromosomes of high incidence, but there was no evidence of a stemline population of tumor cells.


Cell migration during the reassembly of dissociated embryonic cells of sea urchins.

Disaggregated single cells from the embryos of Strongylocentrotus purpuratus were allowed to reaggregate and reform quasi-normal embryos in culture. In this investigation, emphasis was placed on cell migration and its role during cell segregation. Epithelial cell migration appears to be initiated through the sequential formation of (a) cytoplasmic blebs, (b) microvilli, (c) filopodia and (d) hyaloplasmic lamellae. After functioning as a locomotive structure during cell migration, the lamella enlarges and forms a hyaloplasmic sheet, which makes up part of the blastocoel wall. The blastocoel wall is the first recognizable structure reformed in the reassembling embryo.


S-100 protein: regional CNS concentrations in rats raised in different environments.

The S-100 protein was measured in 7 discrete brain areas from rats raised in an enriched, social, or isolated environment for 21, 42, or 84 days after weaning. S-100 was measured at significantly higher concentrations under enriched than under social environmental conditions in cerebellum and brainstem at 21 days but not thereafter. The protein in corresponding areas of brain in isolates was significantly less concentrated than in social controls. The results suggest changes, in turnover of the protein as a result of stimulation and activation of functionally specific brain regions, of the animals' responses to and interaction with environmental stimuli and adaptation to those stimuli.


Lateralization in normal 6-year-olds as related to later reading disability.

The differentiation of lateral preference in hand, eye, ear, and foot was measured in 110 normal Grade 1 children and reading achievement was tested 3 and 5 years later. No support was found for the widely held belief that delays in early lateralization underlie subsequent reading impairment. Paradoxically, boys with serious reading disability showed a strong degree of early lateral concordance. Male, impaired readers displayed a tendency when they were in Grade 1 to be either uniformly right- or left-preferring across all 4 sensory-motor modalities. The results contradict the popular notion that lateral usage emerges from an undifferentiated state in the direction of greater degrees of specialization. Lateralization may be an expression of reflex constraints bound initially to the infant's tonic-neck posture, with later development less reflex-patterned during the acquisition of more sophisticated information-processing strategies. Such an interpretation implies a progressive discontinuity between lateral usage and neuro-maturational processes. Alternatively, the results can be accounted for by (1) a new maturational delay model in which maturation-dependent lateralization proceeds in graduated stages from a highly specialized beginning toward greater levels of neuromotor integration; or (2) a model that maintains the notion of emergent lateralization but in which delays in the lateralization process are actually beneficial to later performance.


The ontogeny of exploration in the rat: habituation and effects of handling.

Exploration, measured by head-dipping in a holeboard, was tested in male rats at 16, 21, 28, 56, and 84 days of age. Head-dipping increased with increasing age from Day 16 to Day 84, and so did the number of rears made. At all ages handled rats showed more head-dipping and made more rears than did their unhandled litter-mates. The age differences in exploration cannot be explained by different patterns of habituation: rats showed significant within-session habituation of head-dipping at all ages tested (Days 16, 21, and 28). Day 16 rats also showed significant between-session habituation.


Maternal behavior of wild and domestic Rattus norvegicus recorded continuously in dual-chambered cages.

Continuous measurements of maternal behavior--the amount of time the mother was in contact with the litter and quality of nest--indicated no differences between these 2 stocks of rats. A decrease in both measures was found for both stocks over the 22 days of postnatal observation. The data indicated that the mother was with the litter more during the light portion of the 24-hr light-dark cycle and that wild rat mothers were in contact with their litters more than domestic mothers in the period around light offset.


The effects of litter size during gestation and lactation on rat development prior to weaning.

Physiological and behavioral development of rats was affected by prenatal nutrition and postnatal litter size. Prenatal nutrition was manipulated by combining differences in maternal nutrition with variation of prenatal litter size produced by pre-mating isolation of 1 uterine horn. The pups were reared in postnatal litters of either 4 or 12. During the 1st postnatal week, development and free behavior were affected only by the prenatal treatments. During the 2nd postnatal week, both prenatal and postnatal effects were observed. Development and behavior during the 3rd postnatal week reflected only postnatal litter size. Brain weight at weaning was influenced by both the prenatal and postnatal treatment.


Behavioral effects of neonatal thyroid hormones and differential postweaning rearing in rats.

Male and female rats (T rats) given an injection of 75 microgram tri-iodothyronine (T3) and 25 microgram thyroxine (T4) on Day 3 after birth were raised under enriched (E) and impoverished (I) postweaning conditions. Observations of their open-field behavior and Days 63 and 112 revealed a higher rate of activity in T groups as compared to controls (C) as well as faster running times and more entries/min in Hebb-Williams maze testing on Days 74-86, indicating behavioral hyperactivity in T rats. Active-avoidance testing at age 91 days revealed a higher number of intertrial crossings and significantly faster unconditioned response and conditioned response latencies in T as compared to C groups. Enriched postweaning rearing altered the behavioral effects in T rats comparatively little, least in the open-field and more so for escape- and avoidance-latencies and for the number of errors in the Hebb-Williams maze.


Hyperkinetic disorder in psychiatric clinic attenders.

Sixty-eight boys (age-range five to 11 years), referred to a child psychiatric clinic, were studied in order to determine the validity of a broadly-based concept of hyperkinetic syndrome, as generally employed in the USA. Hyperactivity was measured on the Conners' Teacher Questionnaire, the Conners' Parent Questionnaire and by systematic time-sampled observations of each child's behaviour during psychological testing. There were low and statistically insignificant correlations between these different measures of hyperkinesis. On the other hand, overactivity correlated highly with conduct disturbance. Psychiatrically abnormal children with and without hyperkinesis were compared on cognitive functioning, perinatal history, neurological examination, congenital anomalies and psycho-social circumstances. Few differences were found, and it was concluded that there was no evidence for the validity of a broad concept of hyperkinetic syndrome. Nevertheless, a small number of children were found who were overactive in all situations studied. These children had a variety of clinical diagnoses but differed significantly from their peers--matched for age, IQ and diagnosis--with respect to neurological anomalies, erratic responses on the Matching Familiar Figures Test, and early onset of hyperkinesis. It is suggested that this less common clinical picture of hyperkinesis may have some validity, but it remains uncertain whether it constitutes a distinct syndrome or rather a constitutional risk factor.


Infants of very low birthweight. I: Perinatal factors affecting survival.

The neonatal mortality of 692 liveborn infants with birthweights of 2000g or less born in south-east London was studied. They represented 98 per cent of all the liveborn infants of this birthweight born and admitted to hospitals in the study area. The over-all neonatal mortality rate was 303.5 per 1000 live births. The following factors were shown to have significant and independent associations with mortality: birthweight; a history of early bleeding in the mother; hour of birth; condition of the infant assessed after birth; temperature of the infant on admission to the special care unit; and the presence of respiratory disease. Implications for the organisation of neonatal care are discussed.


Infants of very low birthweight. II: Perinatal factors in and conditions associated with respiratory distress syndrome.

The incidence and case fatality of certain neonatal conditions reported in 692 liveborn infants of birthweights 2000g or less born in South East London in 1970, 1971 and 1973 are presented. 210 (30.3 per cent) died in the neonatal period: respiratory disease and cerebral haemorrhage were the leading causes of death. 482 (69.7 per cent) survived. In these infants, jaundice, respiratory disease and biochemical disorders were the most frequently reported conditions. Because of the numerical importance of the respiratory distress syndrome, both as a single and as an associated diagnosis, a special study was made of predisposing factors. Gestational age, sex, condition of the infant assessed after birth, temperature of the infant on admission for care, and caesarean section were all shown to be independently associated with the incidence of respiratory distress. This confirms the views that the incidence could be reduced if particular attention were paid to the maintenance of body temperature, especially in those infants at risk by reason of the other factors identified.


The effect of age upon the entry of some amino acids into the brain, and their incorporation into cerebral protein.

The way in which the influx of amino acids into the brain changes as the age of rats increases from one to 25 weeks is reported. Most of the amino acids have a very high rate of influx during the first weeks of life, which falls progressively until an adult is reached by about 8 to 10 weeks of age. The high influx in early life is due to carrier-mediated transport systems which act more rapidly in the young than in the adult. These systems can be saturated by raised levels of amino acid in the blood, both in young and adult animals. The high influx in early life is necessary to provide abundant supplies of amino acids for cerebralprotein formation during the period of rapid brain growth. In adult life, influx declines to a level that is adequate to support the synthesis of cerebral protein, which is still being continuously broken down and renewed at a remarkably high rate.


A child psychiatry consultation service to paediatricians.

A review of referrals to the University department of child psychiatry in Newcastle upon Tyne demonstrated active consultation and collaboration between the department and paediatric departments. Important differences in sex, distribution of psychiatric disorders and presence of associated physical and social handicap were found between patients referred from different sources. The presence of some psychological disturbance in those children referred from hospital wards was evident to most paediatricians, and constituted the most frequent reason for referral. Recommendation for psychiatric treatment was made for the majority of patients, but subsequent parental co-operation was often poor. In the authors' view the greatest value of this research is that it highlights atrange of disorders of common concern to paediatricians and children's psychiatrists, using not only the terminology traditional in child psychiatry but also employing a descriptive terminology. They believe it is essential that trainees of both disciplines should have adequate experience in this wide range of disorders.


Behavior therapy for a child with Lesch-Nyhan syndrome.

The behavioural symptoms in a 10-year-old boy with Lesch-Nyhan syndrome were effectively ameliorated by the behavior therapy techniques of systematic desensitization and extinction. Therapy was undertaken in a highly controlled environment. The hypothesis that the self-destructive behaviours in this syndrome were voluntary and maintained through continuous reinforcement was confirmed. Characteristic biting and other maladaptive behaviours were extinguished. Over a period of time it was possible to remove all the physical restraints previously used to prevent the boy injuring himself. During treatment his anxiety, associated with phobic reaction to being unrestrained, was reduced by nitrous oxide. At 1 1/2 years follow-up the boy continues to be symptom-free. He attends a special class at school and is learning to walk with crutches. It is emphasied that a trained and experienced therapist and a controlled environment are essential for the success of this form of behaviour therapy, and the dangers inherent in this method of treatment are discussed.


Mechanisms of the inhibitory action of prostaglandins on meal-induced gastric secretion.

In dogs with gastric fistula and Heidenhain pouch (HP), 15(S)-15-methyl prostaglandin E2 methyl ester (PG-S) infused intravenously in graded doses (0.5--2.0 microgram/kg/h) inhibited dose-dependently, meal-induced acid secretion both from the vagally innervated main stomach and from the HP. This inhibition was associated with a marked reduction in mucosal blood flow but without significant change in the ratio of aminopyrine concentration in the gastric juice and blood plasma, indicating that the reduction in gastric microcirculation was probably secondary to the inhibition of gastric secretion. In dogs with special cannulae that allowed complete separation of the stomach and the intestine, PG-S caused stronger inhibition of gastric acid and serum gastrin responses to gastric and intestinal meals after application directly to the gastric mucosa, than following duodenal administration. PG-S applied topically to the HP mucosa also suppressed direct chemical stimulation of the HP by L-histidine meal. We conclude that PG-S exerts its inhibitory action on gastric secretion both by local contact with the mucosa via suppression on gastrin release from the antral G-cells and by direct inhibition of the secretory activity of the oxyntic glands.


Stimulation of non-parietal cell secretion in canine Heidenhain pouches by 16,16-dimethyl prostaglandin E2.

The permeability effects of topical and intravenous prostaglandin E2 (PGE2) and 16,16-dimethyl prostaglandin E2 (16DM) were studied in canine Heidenhain pouches using an acid-free perfusate, and changes in volume and HCO-3 content of the perfusate were measured. Topical and intravenous 16DM increased the apparent flux of Na+ and Cl-, and stimulated the secretion of fluid containing HCO-3. 16DM stimulates non-parietal cell secretion and therefore the movement of Na+ cannot be interpreted as passive flux in response to changes in permeability.


Effect of early weaning of the neonatal rat on pancreatic acinar cell responsiveness to urecholine.

Pancreatic response to urecholine was studied in rats weaned prematurely on the morning of their 13th, 15th, 17th and 19th day and killed 2 1/2 days later. In pups kept with their mother and weaned at 21 days, amylase chymotrypsin and lipase concentrations increased gradually. Weaning after 12, 14 and 16 complete days is associated with significant increases in pancreatic amylase and chymotrypsin concentrations; if it occurs after 16 and 18 days, a significant delay in lipase development is observed. Premature weaning is associated with modifications in the basal release of the three enzymes and their secretion in response to urecholine. Amylase and chymotrypsin secretions are increased if weaning occurred before day 18. Lipase secretion, however, is decreased in rats weaned after 16 days. If, however, secretion is expressed in percentages, as the amount of enzyme released over the total tissue content, premature weaning does not seem to modify the capacity of the tissue to secrete enzymes under basal and urecholine stimulation. It thus seems that solid food intake as early as 12 days is not an important factor in the maturation of the pancreatic response to urecholine.


Gastric secretion of acid in patients with pancreatic disease.

In view of the destruction of pancreatic extract, used in the treatment of pancreatic insufficiency, by gastric juice, we measured the gastric secretory response to pentagastrin in patients with pancreatic disease. The patients with chronic pancreatitis and steatorrhoea secreted as much acid as patients with duodenal ulcer, emphasising the need for therapeutic gastric secretory inhibition to supplement treatment of pancreatic insufficiency with pancreatic extract.


Direct inhibition of gastrointestinal carbonic anhydrase by ethanol.

Carbonic anhydrase (CA) was found to be equally susceptible to direct inhibition by ethanol, whether the enzyme originated from homogenates of rabbit gastric, duodenal, or ileal mucosa. When gastric mucosa was separated into a soluble (cytoplasmic) and a membrane fraction, the membrane CA was more susceptible to ethanol inhibition, but less susceptible to acetazolamide inhibition, than the soluble enzyme. Male rat liver CA is relatively insensitive to acetazolamide inhibition, while female rat liver CA shows a sensitivity similar to that of other tissues. We found ethanol inhibited male and female rat liver CA equally, indicating a different site, or mode, of inhibition for ethanol and acetazolamide.


Effects of motilin and octapeptide of cholecystokinin on antral and duodenal myoelectric activity in the interdigestive state and during inhibition by secretin and gastric inhibitory polypeptide.

In conscious dogs prepared with gastric cannulae and antral and duodenal electrodes, intravenous administration of synthetic porcine motilin and CCK-OP in varying doses resulted in significant increases in the mean percent frequency of spike potentials on slow waves. Motilin was a more potent stimulant than CCK-OP. Motilin-stimulated spike potentials in both antrum and duodenum were significantly suppressed by either natural porcine secretin or synthetic porcine GIP. Secretin suppressed the spike potentials of the antrum stimulated by CCK-OP but not those of the duodenum. The spike potentials stimulated by CCK-OP could not be suppressed by GIP in the dosages employed.


HBeAg in viral hepatitis type B.

58 patients with acute hepatitis type B, including 13 with fulminant hepatitis, were tested on presentation for HBeAg. Positive results were obtained in 24%. The frequency was highest in those with fulminant hepatitis (46% positive), and this was probably related to the earlier presentation of patients with this condition. Patients with acute hepatitis who were HBeAg-positive had had a significantly shorter duration of symptoms than those who were HBeAg-negative at presentation. HBeAg was still detectable more than 3 weeks after the onset of symptoms in only 2 patients, both of whom progressed to chronic active hepatitis. The early detection of HBeAg in patients with acute hepatitis is of no prognostic significance, but its persistence may provide the earliest evidence of potential chronicity.


The effect of acetylsalicylic acid on insulin response to glucose and arginine in normal man.

In 14 normal subjects, treatment with acetylsalicylic acid (ASA, 3.2 g daily for 3 days) a well known inhibitor of prostaglandin synthesis, caused a slight but significant decrease (p is less than 0.05) in basal plasma glucose levels; by contrast, basal insulin rose from 5 +/- 1 to 8 +/- 1 muU/ml (p is less than 0.01) after ASA. Pretreatment with ASA augmented the early insulin response to a standard IV glucose tolerance test (25 g) in  7 normal subjects (p is less than 0.05 at 2 min; p is less than 0.02 at 5 min; p is less than 0.01 at 10 min). No significant changes were detected in the rate of glucose utilization. 7 additional subjects received a standard arginine test without and with ASA pretreatment. Arginine stimulated insulin levels were increased after ASA (p is less than 0.01 at 15 min; p is less than 0.05 at 30 min; p is less than 0.05 at 45 min), whereas glucose values were lower than under basal conditions at all times, with significant differences at 105 (p is less than 0.02) and 120 (p is less than 0.05) min. A possible role of prostaglandins upon the insulin responses to glucose and arginine is discussed.


Prognosis of diabetics with diabetes onset before the age of thirty-one. II. Factors influencing the prognosis.

In 307 patients with diabetes mellitus, developed prior to 1933 and before age 31 it was demonstrated that: (1) frequent contact with a specialized diabetes clinic from an early stage of the disease; (2) a good quality of "metabolic control"; (3) a low insulin dose; (4) a body weight of 10% less than ideal; and (5) a mean blood pressure below 100 mm Hg, all had significantly beneficial effects upon the survival. It was also found that patients domiciled in Copenhagen had a significantly better prognosis than patients domiciled outside Copenhagen. Frequent contact with a diabetes centre was accompanied by an appreciable decrease in disabling late diabetic complications.


Pancreatic polypeptide, glucagon and insulin secretion from the isolated perfused canine pancreas.

The release of pancreatic polypeptide (PP) by gut hormones, acetyl choline and adrenaline was investigated in an isolated perfused pancreas preparation. PP was potently released by 1 nmol/1 caerulein (186 +/- 12%, p is less than 0.001) and gastric inhibitory peptide (GIP) (211 +/- 31%, p is less than 0.005) as well as by 1 mumol/1 acetyl choline (1097 +/- 59%, p is less than 0.001). A significant two-fold release of PP was also evoked by 1 nmol/1 vasoactive intestinal peptide (VIP) (129 +/- 38%, p is less than 0.02 and gastrin (108 +/- 25% p is less than 0.01). Insulin release, induced by high glucose concentration was enhanced by both GIP (210 +/- 38%, p is less than (0.01) and VIP (48 +/- 5%, p is less than 0.001). In addition GIP enhanced the release of glucagon by 179 +/- 18% (p is less 0.001) at 1.4 mmol/1 glucose and by 127 +/- 24% (p is less than 0.005) at 8.3 mmol/1 glucose. Thus no simple inter-relationship appears to exist between the control of the three circulating islet hormones.


[Reproducibility of the clinical, electrocardiographic and coronarographic aspects of spontaneous coronary spasm with the use of ergonovine maleate].

Five patients affected by angina pectoris showed a spontaneous attack of myocardial ischemia in the course of coronary arteriography examination. During the ischemic episode it was shown a severe coronary arterial spasm promptly relieved by nitroglycerin. In these patients the administration of ergonovine maleate induced the same clinical, electrocardiographic and coronariographic patterns of spontaneous ischemic episodes. These data support the hypotesis that the ergonovine maleate administration is a suitable test for detection of the vasospastic pathogenesis in acute myocardial ischemia.


[Oxprenol and platelet aggregation (author's transl)].

The effect on the platelet aggregation of the administration of 6 mg of oxprenolol has been studied in patients suffering from coronary artery disease. Four samples were collected: a control one, at the end, 1 and 5 hours after the end of the infusion. The aggregation has been induced both by ADP and adrenaline. The results are exposed and some pathogenetic hypotesis are suggested.


[Analysis of the Luciani-Wenckebach phenomenon in the A-V node. II. Relationship between conduction and recovery times].

We have studied 20 cases Wenckebach A-V block by atrial pacing. The relationships between conduction time and recovery time of N. AV Wenckebach point, basal A-H time and A-H time of first cycle beat were analysed. No correlation was found between W point, basal A-H and A-H of the first beat by analysing the A-H = f (H-A) we found different curves which occur when the first A-H is longer or shorter than 110. These data were discussed on the basis of modern hypotheses of electrophysiological mechanism of Wenckebach periodism.


[The Doppler-echocardiography in the study of transvalvular pulmonary flow (author's transl)].

The AA. studied 96 subjects: 74 normals, 15 patients with pulmonary stenosis, 6 with pulmonary regurgitation and 1 with combined stenosis and pulmonary regurgitation, by using pulsed Doppler echocardiography. This technique, which supplements M-mode echocardiography with Doppler flow detection, allowed determination of direction and quality--laminar or turbolent--of flow through pulmonary valve. In our experience, pulsed Doppler echocardiography is a sensitive and specific method for detection of pulmonary stenosis and regurgitation and extends ultrasound diagnosis beyond the capabilities of M-mode echocardiography.


[The intraaortic balloon counterpulsation (author's transl)].

Indication for and clinical experience with intra aortic balloon counterpulsation at Harefield Hospital are reported. From Sept. 1973 to Sept. 1977, 87 patients had counterpulsation. Indications were: postinfarction cardiogenic shock in 28 cases; acute ischaemic episode in 19 and postoperative cardiogenic shock in 40. Of the 28 patients in postinfarction cardiogenic shock 15 underwent open heart surgery with an hospital mortality of 40%. All the patients with acute ischaemic episodes had surgery with an hospital mortality of 10%. In the group of 40 patients with postoperative cardiogenic shock overall mortality was 47%: it was of 18% in the 22 patients who had coronary artery bypass surgery while it was of 83% in the 18 patients who had valve surgery. Early recognition and treatment of conditions requiring counterpulsation is essential for achieving the best results.


[Renal failure and aortic coartaction. Report of two cases of newborns successfully treated (author's transl)].

Congestive heart failure may frequently occur in patients with isolated coarctation of the aorta within the first six months of life. Renal failure is on the contrary a very rare pathologic sequela. This is caused by a low renal blood flow related either to a poorly developed collateral circulation or in those instances of preductal coartation to an early closure of ductus arteriosus. Peritoneal dyalisis is very effective in these critically ill infants both in correcting biochemical abnormalitics and in supporting cardiac performance. Surgical treatment is however the only way to restore normal renal blood flow and good cardiac output. This report describes two patients with isolated coarctation of the aorta in whom renal failure developed within the first two months of life. Both patients were successfully treated by peritoneal dyalisis and subsequent surgical intervention.


[The total anomalous pulmonary venous connection: pathophysiological, clinical and surgical aspects. Observations on 10 cases (author's transl)].

Ten cases of total abnormal pulmonary venous connection are described: 5 cases with supracardiac drainage, 4 with sub-diaphragmatic drainage and one with intracardiac drainage, 3 cases with supradiaphragmatic drainage, and 4 with subdiaphragmatic drainage have undergone surgical treatment. Some developmental, embryological and pathophysiological signs of this malformation are reported. The more significant clinical and instrumental data arising from our personal cases and from review data are discussed. In the clinical description a distinction is made between cases with venous obstruction and those without venous obstruction. The importance of hemodinamic tests, which allow us to identify the type of connection present, and whether or not there are associated malformations, are underlined. The natural history is conditioned by the presence of venous obstruction, by the value of the pulmonary hyper-flow and by the possibility of communication between the two circulatory districts. The prognosis of the cases with marked obstruction, and of those with irreversible cardiac failure is one of rapid deterioration: surgical correction in the first months of life is the only therapeutic possibility, even if the death risk is high. The cases without venous obstruction, and with fairly normal weight and circulation, are corrected surgically at a later age with much more favourable results.


[Mitral and aortic regurgitation: a rare association in ankylosing spondylitis (author's transl)].

The occurrence of mitral regurgitation in ankylitis is very unusual. The case reported herein is a remarkable one because the subaortic bump at the base of the anterior mitral leaflet, the mose characteristic aspect of the heart involvement in this disease, was visualized for the first time by echocardiography. Moreover, the prolapse of the mitral leaflets was documented; it allows for a new understanding as far as the mechanism of the regurgitation is concerned.


[Use of ajmaline in the diagnosis of sick sinus syndrome with a-v associated conduction defects].

The electrophysiological effects of ajmaline (1 mg/Kg i.v.) on sinus node were evaluated in 63 control subjects and in 12 pts with sick sinus syndrome (S.S.S.). In the control group the mean spontaneous cycle length (S.C.L.) was found significatively (less less than 0.001) reduced (8,?%), and corrected sinus node recovery time (C.S.N.R.T.) significatively (p less than 0.01) prolonged (30,2%) by the drug. In the patients with S.S.S. the S.C.L. was prolonged by 16% but not significatively and the C.S.N.R.T. by 60,7% (p less than 0.05). In 8/12 pts, with S.S.S. spontaneous sinoatrial blocks appeared or were more frequently observed following ajmaline injection. The use of ajmaline as a unic pharmacologic test for the differential diagnosis of symptomatic bradycardia in patients with atrioventricular associated conduction defects is discussed.


[Recording of the right atrial monophasic action potential in humans. I. Subjects not affected by arrhythmia].

Using a bipolar suction electrode technique, right atrial monophasic action potential (RA MAP) was recorded in 18 patients surely free from any kind of arrhythmia. Two morphologically different kinds of RA AMP were obtained: the former exhibiting an evident transition between phase 1-2 (plateau) and phase 3 of repolarization (FP), the latter without any appreciable palteau (FL). Electrophysiological properties of human myocardial atrial tissue have been investigated by microelectrode technique. The two types of MAP recorded by us resemble the former the action potential obtained from conducting specialized fiber, the latter the action potential of contractile fibers. A statistically significant difference in RA MAP duration measured at 90% level of repolarization (D 90%) was found between the two kinds of MAP: therefore we suggest to perform quantitative evaluations and pharmaco-ogical investigations only including MAPs of similar morphology. The intraindividual variation coefficient of D 90% may be considered an expression of the range of variability of repolarization duration in man; we suggest that only MAPs of similar configuration should be accepted for its calculation in order to avoid errors of evaluation.


[Etiopathogenetic differences and therapeutic possibillities of the carotid sinus syndrome. Report of two rare cases (author's transl)].

Two cases of carotid sinus syndrome with peculiar clinical and nosological characteristics are presented. The clinical symptoms were characterized by syncope with bradicardia and hypotension, which occurred contemporarily or independently of each other. The most valuable medical therapy to prevent or got over the syncopal attacks has proved to be one associating  the sympathicomimetic drugs (high dosage dopamine, particularly on demande pacemaker. Complete decrease of symptoms following was obtained only after surgical treatment: denervation of carotid sinus in one case, intracranical section of the glosspharyngeal nerve and of the two vagal termination nearer to IX in the other case. This last result makes it possible to consider the case in question from an original nosological point of view exploiting the pathogenetic importance of stimulating the afferent nerve-fibres of the glossofaryngeal-nerve.


[Motion of the interventricular septum in patients with right intraventricular electric stimulators. Echocardiographic and vectorcardiographic study].

An echo- and vectorcardiographic study had been performed in order to analyze the motion of the interventricular septum (IVS) in thirty-six patients with chronic pacing at the apex of the right ventricle. As this pattern has been reported as just like that of LBBB, five patients with LBBB have been studied as well, with transient pacing. As far as the first group, in 25 P. IVS moves, both during spontaneous activity and pacing, like in normal subjects; in 8 P. the records were questionable; in 3 P. IVS moves liek in LBBB. The group of 5 P. with LBBB shows paradoxical motion of IVS both before and during pacing. In vectorcardiograms, the initial ventricular vectors (from 0 to 30 msec) are upward, backward and rightward oriented, in 33 of the first group's 36 P. The second group of 5 LBBB failed to show a costant pattern. The possible electrophysiologic hypotheses, about genesis of these patterns, are discussed.


[Clinical and angiographic observations in aneurysm of the membranous septum. Pathologenetic implications].

Aneurysm-like kialations of the membranous septum are described with increasing frequency in association to a ventricular septal defect (VSD). Their etiology may be congenital, though with different pathogenesis and acquired. An anatomical distinction between true aneurysm of the membranous septum and pseudoaneurysm is proposed. The acquired forms may be joined to a decrease of left to right shunt and are regarded as the mechanism of closure of a VSD. Nine cases of aneurysm-like dilation of the membranous septum are presented: an interpretation of their etiology and pathogenesis is discussed, on the basis of the history and clinical and instrumental data.


[An unusual case of elevated and persistent levels of LDH in the blood of a patient after acute myocardial infarct].

The Authors illustrate a peculiar case of elevated and persistent levels of LDH activity in serum of a patient after acute myocardial infarction. The patient was also affected by a testicular tumor. Surgical ablation of neoplasm normalized LDH activity serum.


[Diet and the heart: end of an era? or beginning of a hope?].

A critical review is made of a recent article by G. Mann (New Engl. J. Med., 297, 644, 1977) where an attack is moved to the theory according which the diet is a basic factor in the epidemic of coronary heart disease. Most of the Mann' arguments are contradicted and an attempt is made to explain why his article has received such a large attention also outisde the strictly scientific mass-media.


Anticancer activity of isomers of 6-phenyl-2,3,5,6-tetrahydroimidazo[2,1-b]thiazole.

Three phenylimidazothiazole isomers, L-(-)-form (levamisole), D-(+)-form (dexamisole), and DL-(+/-)-form (tetramisole), modulate mouse and rat immune responsiveness. They depress the relapse of urinary bladder cancer, BC-47, when they are used with 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU) for treatment of rats bearing BC-47. Levamisole was the most effective isomer. Effectiveness of the isomers is expressed by their ability to enhance the number of plaque-forming cells to sheep red blood cells. They also stimulate the DNA synthesis of murine lymphocytes in vitro.


Effect of ovariectomy on x-ray carcinogenesis in rats.

Tumor induction by fractionated whole-body X-irradiation (400 rad) was studied in spayed Sprague-Dawley rats. Ovariectomy was chosen as an intensifying factor for radiation leukemogenesis. Ovariectomized rats gained more body weight and responded more quickly (but transiently) in the recovery of WBC levels after the last (3rd or 4th) X-irradiation. A total of 26 tumors developed in 21 out of 47 ovariectomized rats, 11 tumors in 6 out of 13 ovariectomized and ovary-grafted rats, and 44 tumors in 25 out of 29 sham-ovariectomized rats during the observation period up to 64 weeks after starting X-irradiation. Eighty per cent of tumors were of mammary gland origin in the latter two groups with intact or grafted ovaries. By contrast, 61.1% of tumors in the spayed rats were derived from the subcutaneous mesenchymal tissue and the hematopoietic tissue. This may imply that some forms of mesenchymal tumors including leukemia are under the suppressive influence of female sex hormones.


Induction of preneoplastic hyperplasia and carcinoma by N-methyl-N'-nitro-N-nitrosoguanidine from regenerated mucosa of ulcers induced by iodoacetamide in fundus of rat stomach.

Differences in susceptibility to N-methyl-N'-nitro-N-nitrosoguanidine (MNNG) of fundic mucosa in various states of regeneration after induction of ulcer with iodoacetamide were examined histologically in male Wistar rats. Iodoacetamide was given to rats in their drinking water, before (Group 1), with (Group 2), or after (Group 3) MNNG. Atypical hyperplasia in the renewed mucosa and pyloric gland metaplasia were observed on the ulcers in Group 1 in higher incidence than in Groups 2 and 3. In addition, adenocarcinoma developed in the ulcer of 2 of 17 effective animals in Group 1. These observations suggest that the mucosa showing pyloric gland metaplasia is more susceptible to MNNG than the young rapidly regenerating mucosa at the margin of ulcers.


Carcinogenicity of boiling water extract of bracken, Pteridium aquilinum.

Carcinogenicity of an aqueous extract of bracken was studied in inbred strain ACI rats. In Experiment 1, Group 1 rats received a diet containing unprocessed dry bracken powder for 3 months, Group 2 received the boiling water extract of dry bracken as drinking water for 16 months, Group 3 received the cold water extract of dry bracken as drinking water for 16 months, and Group 4 received a diet containing the concentrated boiling water extract of dry bracken during the whole experimental period. Rats in Experiment 2 also received a diet containing the boiling water extract of dry bracken. A control group was fed a normal diet. Majority of the animals in Group 1 developed multiple ileal tumors, such as adenomas and adenocarcinomas. In Group 2, 6 of 11 rats which survived beyond 7 months developed tumors in either the ileum or urinary bladder, or in both. Rats in Group 3 had no tumor. In Group 4 and in Experiment 2, all the animals except 1 rat in Experiment 2 had urinary bladder tumor. Furthermore, almost all the rats in these groups had simultaneously ileal tumors. Based on these results, it may be assumed that the carcinogen in bracken is extractable in boiling water and is most probably also water-soluble.


Nutritional depletion of the established stationary phase during growth of mouse mammary carcinoma cells in suspension culture.

The stationary phase of cell growth in suspension culture was analyzed with regard to nutritional depletion using FM3A cells originally derived from a spontaneous mammary carcinoma in a C3H mouse. When cells reached the stationary phase at the cell density of 5 X 10(5) cells/ml, cells began to lose the ability to form colonies and viability as determined by the dye exclusion test. When the amount of amino acids and vitamins in the medium decreased, cells reached the stationary phase at a low terminal density. Cells in the spent medium supplemented with amino acids, vitamins, glucose, and serum grew with the same growth rate as in the fresh medium. It is concluded that depletion of nutrients, especially amino acids and glucose, is the reason for the establishment of the stationary phase.


Effect of phenacetin and caffeine on the urinary bladder of rats treated with N-butyl-N-(4-hydroxybutyl)nitrosamine.

The effect of phenacetin and caffeine on urinary bladder carcinogenesis in rats treated with N-butyl-N-(4-hydroxybutyl)nitrosamine (BBN) was examined. Animals were given a high or low dose of BBN for 4 weeks and then phenacetin or caffeine was administered for 30 or 32 weeks, respectively. All the animals were examined histologically after 36 experimental weeks. The incidence of papillary or nodular hyperplasia, papilloma, and cancer of the urinary bladder was significantly higher in the groups treated with BBN and then with phenacetin than in those treated with BBN alone, especially with a high dose of BBN. Simple hyperplasia and papillary or nodular hyperplasia developed in the urinary bladder of rats treated with phenacetin alone. Papillary proliferative growth of the renal pelvis was seen in one rat treated with a low dose of BBN and phenacetin. Treatment with caffeine after BBN had no enhancing effect and caffeine alone caused no remarkable changes.


Cancer chemotherapy model using autochthonous large bowel cancer in rats.

Chemotherapy of methylnitrosourea-induced autochthonous large bowel cancer in rats, which is similar to that in man, was studied to evaluate the intrarectal administration or topical application of chemotherapeutic agents. Rats with large bowel tumors confirmed by endoscopic examination received an intrarectal instillation of 1 mg of 1-(4-amino-2-methyl-5-pyrimidinyl)methyl-3-(2-chloroethyl)-3-nitrosourea hydrochloride (ACNU), 1 mg of 1-(2-chloroethyl)-3-(4-methylcyclohexyl)-1-nitrosourea (Me-CCNU), or 5 mg of 5-fluorouracil (ir groups), or intraperitoneal injection of 2.5 mg of 5-fluorouracil (ip group) daily for 8 weeks. All the rats, including non-treated control rats, were necropsied after the treatment. The number of large bowel tumors per rat detected by endoscopy before the treatment was mostly the same among groups, whereas that observed at necropsy after the treatment was significantly smaller in ir groups, compared to non-treated group and ip group. The tumors increased significantly in rats of non-treated group and ip group between the time of endoscopy and necropsy, but not in rats of ir groups. These results showed that the maximum tolerated dosage of the agents administered intrarectally suppressed the development of new tumors after start of the treatment and also the growth of tumors which were detected by endoscopy before the treatment.


Separation and identification of 3-methylcholanthrene-related compounds by gas chromatography-mass spectrometry.

Separation and identification of 3-methylcholanthrene and its synthesized derivatives were examined by gas chromatography-mass spectrometry (GC-MS) system. Hydroxyl derivatives were silylated and all chemicals were applied to columns of OV-1 and Dexsil-300 at a constant temperature of 260 degrees and 290 degrees, respectively. Mass spectra of all derivatives were simple at ionization voltage of 20 eV and their molecular ions gave base peaks in most cases. Mass fragmentography plotted against molecular ions satisfactorily separated all standard derivatives so far examined.


Trauma to the esophagus.

We have classified esophageal trauma into three major categories: (1) Iatrogenic trauma including endoscopic perforation, trauma due to dilatation, surgical trauma, tube trauma, radiation trauma, and drug trauma; (2) Self-induced trauma including foreign bodies, corrosive or drug ingestion, and postemetic trauma; (3) Direct trauma including penetrating trauma and blunt trauma. Discussion and illustrative cases are presented.


Esophageal stricture secondary to candidiasis.

Esophageal candidiasis may rarely progress to stricture formation. All patients reported to date with stricture due to candidiasis have had an underlying immunologic deficiency or were undergoing chemotherapy for malignancies. Early diagnosis and adequate anti-fungal therapy are recommended to prevent this disabling complication.


Gastroduodenal fistulae and double pyloric canal.

Four cases of endoscopically proven gastroduodenal fistulae (double pyloric canal) are presented, and ten case reports in the literature are reviewed. The fistula develops from a penetrating gastric ulcer. Presumably, the ulcer becomes adherent to adjacent duodenum and penetrates further to establish a fistulous connection, which ultimately becomes lined with mucosa, creating a second pyloric canal. Fistulae between the lesser curve of the antrum and superior fornix of the duodenal bulb were the commonest (9 out of 14). Fistulae also form between the lesser curve of the body of the stomach and the duodenal bulb or fourth part of the duodenum. Gastro-gastric fistula and a fistula into the inferior fornix of the duodenal bulb from a pyloric ulcer have been described. In two of the four cases in this series fistulae had formed from the greater curve of the antrum to the inferior fornix of the duodenal bulb, an entity not previously described. Radiologic appearances may be confused with an antral carcinoma, an ulcerating carcinoma, Crohn's disease, or lymphoma. The presence of previous ulceration and evidence of scarring should aid in avoiding confusion with malignancy. The term gastroduodenal fistula is suggested to describe double pyloric canal.


Giant duodenal ulcers.

Twenty-six giant duodenal ulcers, all correctly diagnosed prior to endoscopy, are presented. The concept of the ulcer/bulb ratio (ratio of longest diameter of the ulcer to that of the total bulb including the ulcer) is introduced. In all cases this ratio was 0.8 or greater; in 18 cases (69%) the ulcer completely replaced the duodenal bulb. An 'ulcer within an ulcer' appearance, representing a small area of deeper ulceration within the giant ulcer, was noted in 8 (31%). Half of the patients have remained symptom-free on medical therapy alone. Only two patients in our series (8%) died of complications of giant duodenal ulcer.


Adenocarcinoma of the duodenum arising in a villous adenoma.

Duodenal villous adenomas are premalignant lesions. Prior to malignant transformation, their appearance on upper gastrointestinal examination is often characteristic. Following malignant change, the final diagnosis frequently requires tissue.


Experience with percutaneous transhepatic cholangiography using the Japanese needle.

Percutaneous transhepatic cholangiography using a very thin needle has been performed in 885 patients with a variety of underlying hepatic, biliary, and pancreatic disorders. The procedure was successful in 99% of the patients with dilated intrahepatic bile ducts and in 85% of those with non-dilated ducts. Complications which required surgical intervention occurred only in two cases (0.2%). In patients with obstructive jaundice, external bile drainage was performed immediately after visualization of the bile duct. Percutaneous transhepatic cholangiography is an extremely useful and safe method for investigating disorders of the biliary tract, for localizing the cause of obstructive jaundice, and for reducing the degree of jaundice and improving the general status of patients with obstructive jaundice.


Angiography in the diagnosis of ileocecal tuberculosis.

Ileocecal tuberculosis is still found sporadically in industrialised countries and occurs commonly in the underdeveloped world. Differentiation from Crohn's disease is a major diagnostic problem on which rational treatment depends. An angiographic appearance demonstrated in two patients is believed to be a useful diagnostic indicator of tuberculous etiology.


Unusual fistulae due to colonic diverticulitis.

Examples of diverticulitis of the colon associated with fistulae to the left hip, inferior mesenteric vein, and portal vein resulting in the demonstration of intrahepatic abscesses, the vermiform appendix, and the skin are presented with a review of the literature. A case of a fistula to the epidural space is included.


Metastasis to the colon from bronchogenic carcinoma.

Two cases of primary carcinoma of the lung with clinically demonstrated colon metastases are presented. Such metastases may present with intermittent or continuous colonic obstruction, lower gastrointestinal tract bleeding, or anemia. The metastases may be synchronous or metachronous with respect to diagnosis of the lung lesion. Potential problems in management are discussed and the literature, relating to colonic metastasis from bronchogenic carcinoma, is reviewed.


Angiography of colonic Crohn's disease: the zoning sign revisited.

The zoning sign can be demonstrated in 50% of angiographies in colonic Crohn's disease and provides a reliable differential diagnostic aid against ulcerative colitis. The composition of the sign has been enlarged by the recognition of a zone C. The application of angiography in the radiologic diagnosis of inflammatory disease of the colon is discussed.


Radiologic demonstration of multiple foci of malignancy in the esophagus.

Three patients, each with two synchronous esophageal carcinomas demonstrated radiologically, are presented. The importance of complete esophageal evaluation in patients with one obvious tumor of the esophagus is emphasized. Assessment of the full extent of disease in such cases directly affects treatment planning.


Stratification in the gallbladder during intravenous cholangiography.

The stratification (layering) phenomenon in the gallbladder is a source of errors in interpretation of intravenous cholangiography. It may mimic stones that do not exist or conceal stones that do. To avoid false-positive or false-negative interpretations, it is suggested that delayed films be taken at 4 hours in cases which demonstrate a layering phenomenon. By this time, a normal gallbladder will be homogeneously opacified and a diseased one will reveal its stones. Horizontal beam roentgenograms are mandatory for complete evaluation.


Unusual pelvic complications of a pancreatic pseudocyst.

Pancreatic pseudocysts are notorious for their extension beyond the normal confines of the pancreatic bed. Their inferior extension has been known to involve kidney and ureter. However, involvement of the bladder and rectum is unique although understandable on anatomic grounds. We report an enormous pseudocyst with extension deep into the pelvis to displace both rectum and bladder.


Carcinoid tumors of the alimentary tract. I. Radiographic diagnosis.

This paper is based on a retrospective analysis of the radiographic findings in 18 new proven cases of carcinoids of the gastrointestinal tract. Examples of lesions involving different segments together with a detailed review of the pertinent literature are provided. Background information regarding the malignant potential of all carcinoids with particular reference to invasiveness, size, site, and symptomatology is discussed. Depending on the time of the examination during their development, carcinoids present either as smoothly defined, mostly small intramural nodules, or as large infiltrating and ulcerating malignant looking tumors. When mesenteric infiltration is present, a more specific combination of findings composed of submucosal nodules, separation of loops, and localized kinking may be seen. The demonstration of an isolated, sharply contoured defect does not exclude malignancy. The less common radiographic manifestations of tumoral calcifications and bony metastases are reviewed and illustrated.


Carcinoid tumors of the alimentary tract. II. Angiographic diagnosis of small intestinal and colonic lesions.

The angiographic findings of five small intestinal and two colonic carcinoids are described and illustrated, together with a review of the pertinent literature. It is pointed out that the demonstration of a complex of angiographic findings related to the primary site, mesentery, and liver is highly specific. It helps in the preoperative diagnosis as well as in the localization and stage of development of the gastrointestinal carcinoid. The triad of findings is composed of: (a) faint to moderate staining at the primary site; (b) narrowing, obstruction of the distal mesenteric arcade, cluster of irregular kinked vessels, and encasement in the more central areas of mesentery; and (c) hypervascular liver metastasis. The colonic lesions examined are unique in the literature, and exhibited angiographic findings similar to the small bowel carcinoids.


Borderlands in the diagnosis of regional enteritis: trends in overdiagnosis and value of therapeutic trial.

Our regional experience in the state of Connecticut indicates that Crohn's disease is being overdiagnosed. Six patients with disorders mimicking regional enteritis are presented, one of whom had an atypical clinical course and the remainder had atypical therapeutic responses. The radiologist should be aware of clinical responses and make reassessments if necessary, in order not to overlook surgically treatable conditions.


Circumferential web of the upper esophagus.

Two patients with circumferential webs of the upper esophagus are presented. Both patients had a long history of intermittent dysphagia, particularly with solid food. The clinical, endoscopic, and radiologic features of these webs are discussed.


Large mucosal bridges: an unusual roentgenographic manifestation of ulcerative colitis.

An unusual case of colonic mucosal bridges in a patient with ulcerative colitis was demonstrated by double-contrast barium enema and confirmed at colonoscopy. We believe this to be the first report of this entity in the radiologic literature. The probable etiology of this uncommon manifestation of chronic inflammatory bowel disease is discussed.


Focal granulomatous (Crohn's) colitis: radiologic-pathologic correlation.

In patients with Crohn's disease, early or localized lesions of the colon, termed 'focal granulomatous colitis', may give rise to small and often relatively inconspicuous nodular or tumor-like contour defects in conventional barium enema studies. This radiologic sign, first illustrated by Ettinger [7], has received scant attention in the literature. The present communication is intended to re-emphasize the radiologic appearances of focal granulomatous (Crohn's) colitis in conventional barium enema examinations, provide pathologic correlation, and illustrate by selected case reports the clinical significance of recognizing this particular radiologic abnormality.


Abnormalities in the sequence of filling and emptying of mesenteric arteries and veins: a guide to ischemic disease of the bowel.

Functional abnormalities in the sequence of filling and emptying of mesenteric arteries and veins may indicate significant disease of the bowel which is not associated with identifiable structural alterations in the blood vessels. In three patients, focal ischemic damage to the bowel was associated with significantly delayed arterial emptying, delayed or absent filling and emptying of mesenteric veins or a combination of both. Evaluation for sequential filling and emptying of vessels proved most helpful since an abnormal pattern may represent the only angiographic abnormality indicative of intestinal infarction.


Idiopathic intestinal pseudo-obstruction in a family.

A patient with severe manifestations of idiopathic intestinal pseudo-obstruction is presented. Three members of his family suffer from similar symptoms but in a much milder form. The disease has a wide range of clinical and radiologic presentations and its diagnosis is dependent upon the exclusion of all known causes of intestinal pseudo-obstruction. A high incidence of associated megacystis in this family as well as in some reported cases in the literature lead us to conclude that idiopathic intestinal pseudo-obstruction is not a primary disease of the gastrointestinal tract. Its etiology remains obscure.


Corrugated mucosal pattern in the esophagus associated with progressive systemic sclerosis.

Three cases of unusual corrugated mucosal pattern in the esophagus accompanying the typical motility disturbance of progressive systemic sclerosis (PSS) are reported. The changes were rarely seen in a group of patients with esophageal involvement by PSS.


Synchronous and metachronous squamous cell carcinomas of the head, neck and esophagus.

Thirty-four (1%) of 3,287 patients with squamous carcinoma of the head-neck developed carcinoma of the esophagus. The clinical and radiological importance of this relationship is emphasized. Since there is an increased incidence of esophageal carcinoma in this group, perhaps all such patients should have an annual esophagogram.


Infrequent patterns of upper gastrointestinal tract malignancy.

The skin and the upper gastrointestinal tract are frequent sites of malignant tumors. However, cutaneous metastasis from primary gastrointestinal tract lesions remains a relative rarity. Similarly rare is spread of primary skin cancer (nonmelanomatous) to upper gastrointestinal tract. This paper presents an unusual example of primary esophageal carcinoma with synchronous skin and bone metastases and a case of squamous cell carcinoma of the stomach, possibly due to spread from a remote squamous cell carcinoma of the skin.


Double-contrast artifacts.

With the increasing use of double-contrast technique in radiological evaluation of the gastrointestinal tract, certain artifacts peculiar to this mode of examination need to be identified. These artifacts arise because of: (a) the characteristics of the barium suspensions used for double-contrast studies; (b) the see-through effect obtained on double-contrast studies whereby opacities lying in front of or behind the organ being examined may simulate pathologic lesions; (c) infolding of the mucosa which may simulate pathology; (d) extraneous or foreign material which is frequently detected and must be differentiated from intrinsic disease; (e) certain anatomical structures such as the cardia, pylorus, and retrogastric structures which are seen with unusual clarity and detail and which, in some cases, may simulate pathology. In general, these artifacts may simulate diffuse superficial ulceration, discrete ulceration, or polypoid lesions. Familiarity with the double-contrast technique and an understanding of these artifacts will help to avoid diagnostic errors.


Antral and esophageal rimple: a normal variation.

The occurrence of fine antral and esophageal rimpling appears to be the result of contractions of the muscularis mucosa. The lack of persistence during distention is compatible with this conclusion. The folds have no pathologic significance.


The radiologic manifestations of diabetic gastric neuropathy and its differential diagnosis.

The radiologic signs of diabetic gastric neuropathy consist of ineffectual peristalsis, solid gastric residue, elongated sausage-shaped stomach, gastric barium retention, and duodenal bulb atony. This entity is seen in patients with long-term diabetes mellitus under relatively inadequate control with the likelihood of other complications of this disease. The radiologic differential diagnoses include surgical and autovagotomy as well as drug-induced gastric motility disorders. Theories advanced to explain the pathophysiology of this entity are discussed.


Value of the compressive technique associated with pharmacological hypotonia in the diagnosis of erosive gastritis.

The double-contrast method and the compressive technique associated with pharmacological hypotonia of the stomach were compared in 13 cases and found to be equally valuable in the diagnosis of erosive gastritis.


Hypotonic duodenography--too often performed but of too little value? A comparison with conventional spot films.

Hypotonic duodenography was compared with conventional barium examination in 68 patients (70 examinations) with clinically suggested or verified disease of the pancreas or duodenum. In 13 cases (18.5%) conventional examination demonstrated the duodenal anatomy better than hypotonic duodenography. In nine cases (13%) hypotonic duodenography was superior and in 48 cases (68.5%) both techniques were diagnostically equal. It is concluded that, in only a few cases, does hypotonic duodenography add any diagnostic information to that which can be obtained with properly performed conventional examination of the duodenum.


Calcifications within the duct of Wirsung in calcific pancreatitis.

A review of abdominal radiographs of 50 patients with the clinical diagnosis of chronic pancreatitis showed calcific pancreatitis in 27 patients. Ten patients had severe pain associated with weight loss. Five had obstruction of the duct of Wirsung:  one by a pseudocyst and four by large stones near the ampulla of Vater. The radiologic workup presented emphasizes the need to study the duct of Wirsung in patients with chronic pancreatitis to guide the surgical approach for relief of intractavle pain. Theories regarding the pathophysiology of calcium deposition and stone formation and migration are reviewed.


Detection of hepatic amebic abscesses by infusion tomography.

The liver represents a major challenge for radiologic imaging. A simple method of diagnosing acute inflammatory lesions of the liver by infusion tomography is presented. Results of this technique in 48 consecutive patients with amebic abscesses of the liver are described, and their typical appearance is presented. The test also appears to aid in defining the acuteness of the lesion.


Use of the C-terminal octapeptide of cholecystokinin in clinical radiology. I. The gallbladder.

Two 30-min. infusion doses of the octapeptide of chloecystokinin (C8-CCK) (1 and 4 ng/kg/min) produced equal and consistent gallbladder contractions (75 +/- 8% mean and SEM decrease in size) in 24 human volunteers. The long 30-min infusion method of C8-CCK administration appears better than bolus injection (30 to 180 s) for cholecystokinetic cholecystography.


Use of the C-terminal octapeptide of cholecystokinin in clinical radiology: II. The small bowel.

The octapeptide of cholecystokinin (C8-CCK) administered by bolus (20 ng/kg) and by infusion (4 ng/kg/min for 30 minutes) doses produced significant shortening of small bowel transit time. Significantly, fewer side effects occurred with the infusion method. The problems encountered in studies of small bowel motility are discussed.


A modified technique for the double-contrast small bowel enema.

A small bowel enema technique is described which makes it possible to achieve double-contrast images comparable to those routinely obtained in the stomach or colon. It is a biphasic procedure, requiring the transtubal injection of barium sulfate, followed by 0.5% methylcellulose. Adjustment of relative injection quantities and injection speeds can adapt each examination to a patient's individual diagnostic problem. Indications for the examination are discussed.


Radiological detection of colonic dysplasia (precarcinoma) in chronic ulcerative colitis.

Epithelial dysplasia occurring in long-standing ulcerative colitis is a precancerous lesion. Macroscopically it has a nodular or villous appearance or may be indistinguishable from the surrounding mucosa. An investigation into the radiological diagnosis of dysplasia, using in vivo and in vitro double-contrast examinations with magnification radiographic studies, correlated with the histological analysis, has been made in four patients. Characteristic radiological abnormalities have been identified in the areas of the mucosa associated with histologically proven dysplasia. These appearances include nodularity and irregular areas with sharply angulated edges which may represent enlarged areae colonicae. The demonstration of these changes is an indication for endoscopic examination and biopsy of the suspicious area.


Dermoid perforation of the colon.

A case report of an ovarian dermoid tumor perforation the sigmoid colon in a pregnant woman is presentd. Various complications of dermoid perforation are discussed.


Radiologic findings in anorectal gonorrhea.

Gonorrhea is the most prevalent communicable disease in the United States and the incidence of anorectal involvement is high. Anorectal gonorrhea may be clinically elusive making the radiologic findings crucial in suggesting the diagnosis. Edematous rectal mucosa with limited distensibility and small ulcerations are the prominent radiologic findings.


Plasmacytoma of the large bowel: a review of the literature and a case report of multiple myeloma involving the rectosigmoid.

Large bowel involvement is a rare manifestation of plasma cell tumors, especially in association with multiple myeloma. A review of the world literature reveals only 21 reported cases, the majority of which are classified as the solitary form of the disease. A case of multiple myeloma with rectosigmoid involvement is herein presented, and the radiological findings of reported cases are summarized.


Gas-filled appendix with meniscus: outline of the appendicolith.

A meniscus was produced in a gas-filled appendix by the outline of the obstructing appendicolith. This meniscus appearance should be specific for appendicitis since it represents the obstructing stone. This sign can be elicited by oblique or other projections, perhaps with fluoroscopic control.


A new approach to absorptive function of gallbladder.

To investigate the mechanism of concentration of bile, the normal canine gallbladders were cannulated through the cystic duct into the gallbladder neck with polyethylene tube, and hypotonic, isotonic and hypertonic salines as well as hepatic and gallbladder biles were placed in the gallbladder. Low molecular electrolytes such as Na+ and Cl- were transported across the epithelial membrane against water flux. The hepatic bile was decreased markedly in volume and each level of electrolytes including bile acids approached that in the gallbladder bile. The different results were obtained by concentration of the hepatic bile in the gallbladder with chemically induced cholecystitis.


Therapeutic effect of histidine decarboxylase inhibitor on chronic active hepatitis.

The effect of orally administered histidine decarboxylase inhibitor on liver function tests and histological appearance as well as on plasma histamine level were evaluated in biopsy proven 13 patients with chronic active hepatitis, whose liver function tests were refractory to other measures. Tritoqualine was used as histidine decarboxylase inhibitor and was administered in dose levels of 600 to 1,600 mg per day. Before treatment the average value of SGOT, SGPT and plasma histamine showed 252 +/- 24U, 318 +/- 152U and 15.2 +/- 5.5 microgram/L, respectively. Results obtained at six weeks' treatment, however, gave significantly improved values, indicating SGOP 57 +/- 24 (p less than 0.001), SGOP 40 +/- 28 (p less  than 0.001) and plasma histamine 8.6 +/- 0.4 (p less than 0.001). Serum gammaglobulin also tended to fall (p less than 0.1). Marked improvement was noted in reexamined biopsied specimen, representing disappearance of fibrogenesis as well as round cell infiltration in and around the portal tract, together with pericellular fibrosis. Four cases have been proven to be healed. Despite long-term administration, no obvious side effect was observed. Investigation for HBsAg revealed to be positive in 4, however, no conspicuous difference was seen from that of negative cases in the improvement.