[Discharges in the white rami communicantes evoked by stimulation of various sections of the hypothalamus].

Electrical responses in L2--L3 white rami on stimulation of anterior and posterior hypothalamus were studied in anesthetized and immobilized cats. The stimulation evoked a complex response consisting of waves I, II, and III with mean latency 19.7 +/- 4.5 msec, 34.0 +/- 5.9 msec, 61.8 +/- 8.7 msec, and 20.5 +/- 6.8 msec, 30.;7 +/- msec, 66.0 +/- 14.9 msec for anterior and posterior hypothalamus respectively. In experiments with simultaneous recording of arterial pressure and hypothalamo-sympathetic discharges, after 10-sec period of tetanic (100/sec) stimulation of the hypothalamus, the early I and early II components were facilitated, while the late component of the hypothalamo-sympathetic discharge was depressed. The duration of this inhibition corresponded to the period of pressure reaction and, therefore, is of baroreceptor origin. Possible mechanisms of hypothalamic regulation of the activity of sympathetic preganglionic neurons are discussed.


[Effect of low-concentration potassium ion solution on the frog neuromuscular synapse].

The effect of solution with low potassium concentration ([K+]o = 0.2 mM) on neuromuscular synapse was studied in m. cutaneus pectoris of the frog. The MPs of muscle fibers and the amplitudes of m.e.p.p. practically did not change after Ringer's solution had been replaced by low potassium one. The frequency of m.e.p.p. increased up to 100/sec. The latency of e.p.p. increased the rise time of e.p.p. decreased slightly. The amplitude and quantum content of e.p.p. decreased also. After 5 min of action of the low potassium solution the blockade of synaptic transmission occurred. The data suggest the depolarization of motor nerve terminals in the presence of low--potassium solution to be a result of the depressed activity of the ionic pump.


[Automatic activity of the pacemaker cells of the atrioventricular valves under the action of parasympathetic and sympathetic mediators].

Effects of neorpinephrine, epinephrine, and acetylcholine 4.5.10(-7) M--2.9.10(-6)M on the automatic activity of the pace-maker cells of the rabbit atrioventricular valves were studied. The sympathetic mediators accelerated spontaneous beating by increasing the rate of slow diastolic depolarization or by the inducing additional subthreshold potentials converted in action potentials. Acetylcholine (1.1.10(-6)M) reduced the rate of the spontaneous beating and in concentrations 2.7.10(-6)M eliminated automatic activity either by suppression of AP when subthreshold potentials gradually disappeared or by gradual decrement of AP rate and amplitude. Simultaneous application of equal doses of acetylcholine and sympathetic mediators revealed a predominant effect of acetylcholine as well as intensification of the acetylcholine effect under the influence of sympathetic mediators. Sympathetic-parasympathetic interactions can be explained by their influence on permeability of membrane of the pace-maker cells through the slow Na-Ca channel.


[Ion excretion by the rat kidney in depressed reabsorption in proximal tubule and ascending protion of the loop of Henle].

Simultaneous suppression of reabsorption in the proximal tubule with the aid of polyethylenglucole 400 (PEG) and in ascending part of Henle's loop with furosemide increased diuresis by 121 times and natri-uresis by 242 times on the average. The increase was based on changes in the tubule reabsorption and secretion. The changes of sodium and calcium excretion as well as excretion of potassium and magnesium were parallel. Excretion of sodium and calcium was lesser than the diuresis while that of magnesium and potassium exceeded it. Furosemide reduced the reabsorption of osmotically free water.


[Neural regulation of substance transport in the kidney].

The denervation diuresis and natri uresiswere manifest in anesthetized dog and rats after acute or chronic renal sympathectomy with no changes in RBF, GFR or in their intrarenal distribution. Micropuncture showed the principal site of action of renal denervation on to be within the proximal tubule. The unchanged relationship between reabsorbed sodium and consumed oxygen suggested that active transport of Na decreased on denervation. No causal relationship between denervation natri uresis and decreased release of renin was revealed. As tubular transport of d-glucose, inorganic phosphate, para--aminohippurate and of uric acid was suppressed by the sympathectomy, the renal sympathetic activity seem to be able to regulate the proximal tubular transport functions.


[Kidney function and mitochondrial metabolism in excluded renal blood flow against a background of diuretic action].

Single administration of furosemid, etacrine acid and mannitol prior to switching off circulation in the only kidney for 2.5 hrs preserves the renal tissue from ischemic lesion, aids to normalizing the excretory processes on the 2nd--4th days of postischemic period, reduces duration of the oligo--anuric phase in acute renal insufficiency, and raises survival rate in the rats. The above substances are ineffective if administered after cessation of the ischemic period. Etacrin acid and novurit suppress functional activity of isolated mitochondria incubated in hypoxia at 37 degrees. Furosemid and mannitol in these conditions exert no effect. Preliminary administration of furosemid aids to preservation of lumen in proximal tubules of superficial nephrones both during cessation of the renal circulation and in the postischemic period.


[Electrophysiological characteristics, nature and localization of the hepatic osmoreceptors].

Functional characteristics of 45 osmosensitive units of the liver were analysed under conditions of intraportal administration of different osmotic stimuli. The most effective stimulus was the distilled water, the other substances, according to intensity of the response, were arranged in the following order: NaCl greater than glucose greater than or equal to mannitol. The latency of response varied from 1.5 to 10 sec, and the rate and duration of impulsation were dependent on tonicities of solutions. True osmoreceptors are supposed to exist in the liver tissue.


[Sodium-depositing function of the skin in white rats].

The sodium deposing function of the skin in Wistar albino rats under conditions of different salt loads were studied. 6 mEq NaCl per os was followed by an increase in sodium content of the skin on account of the exchangeable fraction. The diet with high content of sodium (15 mEq a day during 30 days) led to saturation of the skin storage structures, the blood sodium concentration after a single salt load increasing sharply. The storage of sodium in the skin is, evidently, carried out with the aid of the cation by glycosamino--glycans. The increase in exchangeable sodium of the skin under the condition of highsodium regimen is, evidently, due to an increase in sulphated GAG.


[Neural regulation of glucose, sodium and potassium transport in the kidneys].

When the speed of filtration and plasma circulation are constant, the absolute sodium reabsorption is increased in kidney on the side of stimulation of nervous fibers. The stimulating effect of adrenergic nerves on the tubular transport of sodium and potassium is inhibited with guanethidin. The maximum transport of glucose is increased by the activity of cholinergic fibers of vagus nerves.


[Acid-excreting activity of the kidneys in dogs administered ammonium chloride into the carotid artery].

Injection of 0.5 mM of ammonium chloride into the dog carotid artery caused no changes in the blood acid-base balance, but distinctly increased the urinary excretion of both titratable acids and active hydrogen ions. The rate of glomerular filtration was slightly increased. The amount of sodium reabsorbed in the tubules was also risen. The role of humoral factors stimulating the renal acid-excreting activity, is discussed.


[Effect of sodium transport inhibitors on maximal glucose reabsorption and cardiotrast excretion by the kidneys].

Effects of intrarenal infusion of potassium cyanide and strophanthinum were studied in acute experiments on dogs. The decrease fractional of reabsorption of sodium to 80--82 per cent did not affect renal reabsorption of glucose and tubular excretion of cardiotrast. Combined infusion of strophanthinum and cyanide decreased the fractional sodium reabsorption to 65.6 per cent. During this period maximal reabsorption of glucose reduced but not so the tubular excretion of cardiotrast.


[New data on the mechanism of organic substance secretion by the kidney].

The substrate stimulation of renal secretory transport of cardiotrast and penicillin have been studied in conscious rats. This phenomenon takes place not only after repeated injections of substrates three times daily during three days but also after administration of the compounds for two or one days or twice daily with interval of two hours. The tubular secretion of organic substances seems to be the substrate inducing process.


[Osmoregulating function of the kidneys in immersion].

Tests for tolerance of water and isotonic NaCl solution (20 ml/kg) were used to study the osmotic and volume regulation during a 3-day immersion of the normal human kidneys and in recovery period, as well as to evaluate adequacy of hydro-ionic homeostasis of the body under these conditions. Mechanisms of shifts in renal functional state and in systems for regulation of water-salt exchange under altered cardiac inflow during and after immersion are discussed.


[Effect of thyroidectomy on the water-eliminating function of the kidneys in puppies].

Removal of the thyroid gland in puppies in the early postnatal period (10--20 days) suppressed the hemodynamics and the glomerular filtration, increased concentration of urine in the tubules of the kidney and reduced spontaneous diuresis. Two months after the operation, a progressive disturbance of the osmotic concentration of urine occurred, and the diuresis increased. Thyroidectomized puppies at different age are unable to react to water deprivation, to develop osmotic diuresis; the elimination of water load is lesioned. In the first 6 months the introduced water is retained in the organism. The thyroid hormones are essential for the water elimination and concentrating functions of the kidney, for its adequate hemodynamics.


[Characteristics of the functional organization of the kidney medullary substance in desert birds].

The contents of sodium, potassium, magnesium and urea equally increases from the renal cortex to medulla in desert birds. This process is due, mainly, to the countercurrent multiplior of the medulla and, under natural conditions, depends on the length of medullar cone and the number of Henle's loops.


[Effects of changes of body temperature on serum cortisol fractions (author's transl)].

Most of the cortisol in circulating blood is bound to proteins (transcortin and albumin), and the rest is protein-unbound. It has generally been accepted that transcortin-bound cortisol (Tr-F) and albumin-bound cortisol (Al-F) are physiologically inactive, and that protein-unbound cortisol (U-F) is active. It is also known that the binding capacity of transcortin to cortisol is lower at 37 degrees C than at 4 degrees C. However, no investigations concerning the influence of temperature changes the physiological range have been reported, probably because of the lack of proper methods. In this report, the influence of temperature changes the physiological range on serum protein-cortisol binding is assessed and its physiological roles are discussed. Cortisol binding of transcortin and albumin was determined by a newly developed isocolloidosmolar equilibrium dialysis method. The total cortisol concentration was determined by the CPB assay method described by Murphy. In the beginning, experiments were performed using pooled human serum. This serum was dialyzed at 35, 37, 39 and 41 degrees C. U-F and Al-F concentrations increased in accordance with the increment of incubation temperature, whereas Tr-F concentration decreased. The association constant of transcortin to cortisol decreased with the rise of incubation temperature. It was 3.43, 2.92, 2,32 and 1.66 X 10(7)M-1 at 35, 37, 39 and 41 degrees C, respectively. However, the association constant of albumin to cortisol was 3.04 X 10(3)M-1 and stayed unchanged under these conditions. These results suggest that the transcortin-cortisol complex dissociates with temperature rises and that a part of freed cortisol is bound to albumin while the other part remains protein-unbound cortisol. When various amounts of cortisol were added to the pooled human serum, which was dialyzed at 35, 37, 39 and 41 degrees C; U-F, Al-F and Tr-F concentrations increased corresponding to the amount of added cortisol. The increase of U-F, Al-F concentrations and decrease of Tr-F concentration induced by the rise of temperature was still significant at each total coritsol concentration. Cortisol fractions in the serum of healthy subjects were compared with those of 39 febrile patients consisting of A group (body temperature 37 approximately 38 degrees C), B group (38 approximately 39 degrees C), and C group (39 approximately 40 degrees C). Total cortisol concentrations increased with the rise of body temperature. They were 7.62 (normal), 10.64 (A), 14.84 (B) and 21.37 (C) microgram/100ml, respectively. U-F% and Al-F% increased parallel with the total cortisol concentration. Tr-F%, binding capacity of transcortin. These results reveal that the rise of body temperature elevates the total cortisol concentration, and the greater part of increased cortisol becomes U-F and Al-F, while a relatively small part of it is bound to transcortin. The percent change of the total cortisol concentration in comparison with healthy subjects was 150 (A), 209 (B) and 593 (C),  respectively...


[Degradation of the parathyroid hormone in the kidney and liver (author's transl)].

The cleavage of the parathyroid hormone has been reported to take place in various peripheral tissues, especially in the kidney and liver. In order to claify the mechanism of such a degradation, bovine PTH (bPTH 1--84) and its synthetic N-terminal peptide (bPTH 1--34) labelled with 125I by the chroramine-T method (125I-bPTH 1--84) and (125I-bPTH 1--34) or labelled with horseradish peroxidase Pox-125I-bPTH 1--84 and Pox 125I-bPTH 1 34) were used to study the disappearance from the blood stream and degradation and retension in the kidney and liver after intravenous injections in male Wiastar rats, weighing approximately 200g. Degradation of PTH was also studied in vitro, using isolated cells and a homogenate of the kidney and liver. PTH labeled with 125I and Pox was more readily degraded by the kidney than PTH labelled with 125I alone, but the opposite was found in the degradation by the liver. Isolated intact kidney cells degraded PTH less efficiently than the homogenate, but the isolated intact liver cells degraded PTH more efficiently than the homogenate, indicating the prominence of an intracellular mechanism of degradation in the kidney and an extracellular mechanism in the liver.


[Postnatal development of adrenocortical circadian rhythm in neonatally cortisol- and estriol-treated rats (author's transl)].

The effect of a single neonatal administration of cortisol and estriol on the development of the adrenocortical circadian rhythm was investigated in immature rats. In normal control rats of both sexes, the plasma corticosterone rhythm was discernible on day 21. In male rats the adult pattern was observed on day 28, but in females as the plasma corticosterone level elevated progressively during puberty, the rhythm increased in amplitude and the adult pattern was established at 8 weeks of age. In neonatally cortisol-treated rats, the plasma corticosterone rhythm appeared at 4 weeks of age, but the plasma level was significantly lower than that of the controls until 6 weeks and attained a level similar to the controls at 8 weeks. Neonatally estriol-treated rats exhibited the rhythm as early as 2 weeks of age, but this was temporary. It disappeared at 3 weeks and reappeared a 4 weeks. Although 5-week-old males showed normal rhythm as seen in the controls, in females the plasma corticosterone level remained low for weeks and approached the control level at 8 weeks of age. The development of circadian periodicity of adrenal corticosterone content almost paralleled that of plasma corticosterone not only in the controls but also in steroid-treated groups, but the rhythm was occasionally equivocal. In neonatally estriol-treated rats, stress response of plasma and adrenal corticosterone to ether was similar to that of the controls, but the response to exposure to a strange environment was significantly small.


Protoplasts from Acetabularia: isolation and fusion.

Protoplasts were isolated from cells of Acetabularia cliftonii, which are presumed to be haploid. The release of the protoplasts occurred after treatment of the cells with papain or proteinase K. They are genuine protoplasts since they contain a nucleus. Fusion was initiated by mechanically pushing together two protoplasts. Under these conditions, the efficiency of fusion was more than 90% within 30 minutes at room temperature. Haploid cells from one cyst, i.e., cells which eventually would have formed gametes of the same mating type, exhibit a greater propensity for fusion as compared to haploid cells from different cysts.


Microtubules and organelle movements in the rust fungus Uromyces phaseoli var. vignae.

Direct visual observation and time lapse films of in vitro differentiating infection structures of the cowpea rust fungus Uromyces phaseoli var. vignae revealed three categories of movement: a) general movement of cytoplasm, plus organelles, into the developing portions of the fungus during which the nuclei, in particular, maintained their characteristic position with remarkable constancy, b) relatively slow movements of various organelles such that they became displaced relative to one another and to the growing fungal tip, and c) erratic, rapid, saltations of small organelles over short distances. Serial section ultrastructural analysis showed that microtubules were typically orientated parallel to the direction of cytoplasm migration. Simple statistical analyses showed that the microtubules were non-randomly associated with mitochondria but only rarely associated with lipid droplets or microbodies. All microtubules were typically short (less than 2 micrometer) and, in various parts of the cell, were often intimately associated with 3 to 6 nm diameter filaments of unidentified material. Interphase nuclei characteristically lacked microtubules emanating from their variously laterally or posteriorly located NAOs (nucleus associated organelle) but were associated with groups of laterally placed microtubules. The correlations between the observed types of movement and the ultrastructure of the cells discussed in terms of various models for organelle motility.


[Ultrastructural and chemical study of the chromatin during spermiogenesis of the fish Scyliorhinus caniculus (L.) (author's transl)].

Electron microscopic, cytochemical and biochemical techniques were applied to study structural aspects and changes in nuclear components during the spermiogenesis of Scyliorhinus caniculus. Five major stages of nuclear differentiation were recognized and characterized by variations in the organization and chemical properties of chromatin. Stage I is analogous to a somatic nucleus with heterogeneous chromatin. At the second stage, the nuclear content is dispersed but the chromatin fibers are of the same diameter as those of the stage I. The nuclear elongation begins at stage III, the DNP fibers running preferentially parallel to the long axis of the nucleus. During these early modifications of chromatin structure appear two new basic nuclear proteins (S 1 and S 2) which migrate faster than histones but typical histones remain assosciated with these nuclei. In later elongation stage (stage IV), the chromatin fibers organize in a helical form and fuse side by side giving lamellar systems which have a reticular structure. At the end of this stage, the nuclear material has become uniformly compact. These late variations in chromatin organization are parallel to the association of chromatin with new basic nuclear proteins (S 3, S 4, Z 1, Z 2 and Z 3). The cytochemical and electrophoretical properties of one of these proteins (S 4) which appears at the end of spermiogenesis are similar to those of a protamine. In stage V, the chromatin is homogeneous and the nucleus assumes a helical configuration beginning at the posterior end. The deoxyribonucleoproteins of the mature sperm show some novel chemical characters, including the appearance of a stable nuclear acidophilia with the ALFERT and GESCHWIND method and extraction with 0.25 N HCl of one of the basic protein fractions newly appeared in late spermiogenesis (Z 3), two other fractions (Z 1 and Z 2) being extracted with a more drastic procedure. The other fractions described before are no more detectable.


Fine structure of the homologous tergo-coxal muscles of flying and flightless beetles.

The flight-related tergo-coxal muscles of flying and flightless beetles are compared. In the flying beetle, Pachynoda sinuata, the myofibrils and cylindrical and the myofilaments packed in double hexagonal arrays. The sarcomeres are short (2.8 micrometer) and wide with many large, closely packed adjacent mitochondria but the sarcoplasmic reticulum is poorly developed in this fibrillar (asynchronous) muscle. Sarcoplasmic glycogen in rosette form is abundant. In the flightless beetle, Anthia thoracica, the myofibrils are lamellar-like with sarcomeres of 5.3 micrometer. The myosin filaments form a single hexagonal array each thick filament having an orbital of 11 to 12 thin filaments. The width of the  Z-line (120 nm) of A. thoracia muscle was twice that of the Z-line of P. sinuata muscle. The sarcoplasmic reticulum and T-system are well-developed in this afibrillar (synchronous) muscle. Few glycogen granules are present. Triangular projections of the sarcolemma occur regularly opposite the Z-lines in A. thoracica and they appear to extend into the Z-lines. Membranous connections joint adjacent Z-lines in A. thoracica and occasionally in P. sinuata.


Plasma potassium in hypertensive Africans on frusemide.

The effects of potassium chloride (as Slow-K 600 mg three times daily) and spironolactone (as Aldactone A 25 mg four times daily) were compared in hypertensive African patients on frusemide. Mean plasma-potassium levels in patients on frusemide plus Slow-K and frusemide plus Aldactone-A rose from 3.6 to 3.8 mOsm/L whilst on frusemide alone mean plasma-potassium fell from 3.7 to 3.6 mOsm/L. The mean blood pressure, both systolic and diastolic, was significantly reduced in the frusemide plus Aldactone-A group when compared with patients on frusemide alone or on frusemide plus Slow-K.


Concomitant administration of timolol and hydrochlorothiazide/amiloride in hypertensive patients. Results of a titration study.

In an open dose titration study we evaluated the antihypertensive effect of the concomitant administration of timolol and hydrochlorothiazide/amiloride, administered on a b.i.d. basis. Twenty-eight out of 39 patients completed the study. Supine and standing systolic and diastolic blood pressures and pulse rate were significantly lower at the end of the titration period than at the end of the diuretic period.


Netilmicin treatment of serious infections in patients with renal insufficiency.

Out of 24 patients with suspected moderate to severe infections and treated with the semisynthetic aminoglycoside netilmicin, 11 patients had decreased renal function. Non-bacterial aetiology was present in five cases. There was good netilmicin effect in 10 cases, indeterminate effect in 6 cases (due to simultaneously given other antibiotics) and failure in 3 cases. Pharmacokinetic parameters were studied. Curves are given for serum concentration patterns relative to creatinine clearance, and serum half-lives are calculated in renal dysfunction. In this series of very ill patients including impaired renal function, metilmicin proved to be an efficient antibiotic with low toxicity. Only one transient minor vestibular abnormality in an 80-year-old man with concomitant diuretic medication was registered.


Nonuniform distribution and grouping of insulin receptors on the surface of human placental syncytial trophoblast.

These studies were designed to investigate the cytologic localization and topographic distribution of insulin receptors in human placental villi. Biochemical studies showed placental villi to specifically bind 125I-insulin. Radioautographic studies showed the specific binding to be localized to the surface of the syncytial trophoblast. Topographic distribution of insulin binding was determined with ferritin-insulin. Initial studies using ferritin-insulin containing some oligomers of ferritin revealed the insulin receptors to be specifically associated with the glycocalyx region of the surface membranes of microvilli. No insulin receptors were detectable in association with the intermicrovillous plasma membrane even though its glycocalyx is in direct continuity with the glycocalyx of microvilli. Monomeric ferritin-insulin showed the same nonuniform distribution of the insulin receptor, which suggests that there is not complete freedom of lateral mobility of the insulin receptors in the surface membrane of this tissue. The insulin receptors were found to occur as singletons or in groups of two or more. Incubations with monomeric ferritin-insulin at 4 degrees or with tissue prefixed with formaldehyde showed that the groups of insulin receptors were naturally occurring, i.e., they are present prior to and independent of insulin binding and thus not secondary to ligand-induced aggregation. The physiologic meaning of the nonuniform distribution and the groups of insulin receptors is unclear at present.


Ketoacids and the insulin receptor.

The binding of insulin to a specific receptor on IM-9-cultured human lymphocytes was studied in vitro under conditions simulating diabetic ketoacidosis. Compared with control incubations at pH 7.4, binding was reduced by 19 per cent at pH 7.1 and by 48 per cent at pH 6.8. Addition of beta-hydroxybutyrate, at concentrations similar to those seen clinically, "restored" insulin binding toward normal. We suggest that, by counteracting the effects of acidosis, ketoacids themselves maintain normal insulin-receptor binding in diabetic ketoacidosis. These data also illustrate that small molecules, present in vivo, can significantly alter the interactions between a hormone and its receptor in vitro.


Age-related glucose intolerance in hyperthyroid patients.

In an attempt to study age-related metabolic abnormalities, glucose intolerance and serum insulin were examined in normal subjects and hyperthyroid patients. For comparison, serum concentrations of thyroxine (T4), triiodothyronine (T3), and total cholesterol were also measured in normal subjects and hyperthyroid patients. Although serum T4 concentration remained unchanged, serum T3 concentration decreased significantly in an elderly group of normal subjects. Similarly, serum T4 did not change with age and serum T3 decreased slightly but progressively with age in hyperthyroid patients. In addition, serum total cholesterol concentration increased progressively with age in normal subjects. Oral glucose tolerance decreased with age in normal subjects despite the same timing, peak level attained, and total magnitude of insulin response for old and young subjects. Although the severity of hyperthyroidism decreases with age, age-related glucose intolerance was much more apparent in hyperthyroid patients because of the age-related decrease of basal concentration, the peak level attained, and the total magnitude of insulin response. It is suggested that age-related glucose intolerance is magnified by the hyperthyroid state.


The site of insulin resistance in acute uremia.

In order to define the mechanism of glucose intolerance in acutely uremic rats, various studies were carried out 24 hours after bilateral nephrectomy. Glucose removal following intravenous glucose was significantly (p is less than 0.001) decreased in uremic rats compared with sham-operated rats (k = 2.1 +/- 0.03 per cent vs. 5.1 +/- 0.2 per cent). This deterioration in glucose tolerance was associated with higher insulin levels in uremic rats from one to 40 minutes after glucose administration, suggesting that insulin resistance accounted for the decrease in glucose removal by uremic rats. To identify the site of the insulin resistance, we compared the ability of insulin to enhance net glucose uptake by isolated perfused liver and muscle (hindlimb) preparations obtained from uremic and sham-operated rats. Insulin suppressed glucose outflow from perfused livers of uremic rats at least as well as it did from livers of sham-operated rats, and suppression occurred at both maximal ( greater than 600 micromicron./ml.) and threshold (75 micromicron./ml.) perfusate insulin levels. In contrast, there was a significant decrease in the ability of insulin (mean perfusate level = 225 micromicron./ml.) to enhance glucose uptake of perfused hindlimbs of uremic as compared with sham-operated rats. These results suggest that the insulin resistance of acute uremia may be due primarily to decreased insulin-mediated uptake of glucose by skeletal muscle without any decrease in sensitivity of the liver to insulin.


Neurotensin hyperglycemia:evidence for histamine mediation and the assessment of a possible physiologic role.

The hyperglycemic and hyperglucagonemic effects of systemically administered neurotensin in rats were investigated to explore the possibility that they are mediated by histamine and to determine whether neurotensin might have a role in the mediation of the responses to central nervous system glucopenia. The hyperglycemic response to neurotensin was partially blocked by the histamine H-1 receptor blockers, diphenhydramine and promethazine, and by the H-2 receptor blocker, cimetidine. The hyperglucagonemic response was completely blocked by diphenhydramine and promethazine and only partially blocked by cimetidine. The effects of histamine on glucose, glucagon, and insulin secretion were similar to those of neurotensin, and the inhibitory effects of both H-1 and H-2 blockers were comparable. The stimulatory effect of histamine on insulin secretion observed after adrenal autotransplantation was also similar to that previously reported for neurotensin. Neither antineurotensin serum nor diphenhydramine, however, was effective in blocking the hyperglycemic and hyperglucagonemic responses to the central administration of 2-deoxyglucose. The results are consistent with a histamine mediation of the effects of exogenously administered neurotensin but do not support a proposed role for neurotensin or histamine in the mediation of the hyperglycemic and hyperglucagonemic responses to central glucopenia.


Effects of glucose and sorbitol on proliferation of cultured human skin fibroblasts and arterial smooth-muscle cells.

To determine effects of metabolic abnormalities associated with diabetes mellitus on proliferation of diploid human cells, cultured human skin fibroblasts and arterial smooth-muscle cells were grown in media containing added glucose in the range often seen in diabetic subjects (10 to 30 mM, 180 to 550 mg./dl.). "High" glucose media enhanced proliferation of fibroblasts, with an "optimal" response at about 18 mM (325 mg./dl.). Equimolar sorbitol gave similar results, with the greatest increase in proliferation occurring at about the same concentration as for glucose (1 mM). Since neither equimolar mannitol nor sucrose produced such effects consistently, these results cannot be explained solely on the basis of hyperosmolarity. In contrast, arterial smooth-muscle cells failed to show a consistent growth response in the presence of either added glucose or sorbitol. These results suggest that studies with cultured human cells may be useful in assessment of responses to components of the disordered metabolic milieu of diabetes. Such studies of arterial smooth-muscle cells should also be useful for investigation of the mechanism of atherosclerosis in diabetes.


Multiple daily insulin injections in the treatment of diabetic retinopathy. The Job study revisited.

Data based on the prospective study of Job et al. are reanalyzed while initial number of microaneurysms and duration of patient follow-up are controlled. The reported statistical difference in the rate of microaneurysm increase between the single- and the multiple-daily-injection groups may be due to a difference in a subgroup who had a larger number of microaneurysms initially and who were studied for a shorter period of time. No uniform difference was observed in the results of their treatment between the groups given a single injection and those given multiple injections. While this does not invalidate the conclusions of the study, it does point out the need for greater control in conducting future studies.


Synthetic fragment of human growth hormone with hyperglycemic properties: residues 44-77.

Peptides homologous to Cys53 44-77 and Cys53 52-77 of the human growth hormone molecule were prepared by solid-phase synthesis and tested by our acute glucose tolerance test in ob/ob mice. Peptide 44-77, as either the Acm-Cys53 or Cam-Cys53 derivative, adversely affects glucose tolerance at doses of 100 to 150 nmol. Peptide 52-77 is nonhyperglycemic. Other diabetogenic properties are being tested.


Increased glomerular permeability to albumin induced by exercise in diabetic subjects.

The urinary excretion of albumin was measured in insulin-dependent diabetics under ordinary conditions of life and in response to exercise. Possible mechanisms of exercise induced albuminuria in diabetics were also investigated. Under ordinary conditions of life the insulin-treated diabetics, as a group, had a higher mean urinary albumin excretion than normal controls; however, half of the diabetics had albumin excretion rates within the control range. A given exercise load (600 kpm/min for 20 min) produced an exaggerated albumin excretion in diabetics, particularly evident in the post-exercise period. The elevated urinary albumin excretion was due to an increased transglomerular passage of albumin, not to reduced tubular reabsorption. The increase was not associated with differences in blood pressure or urine flow between controls and diabetics. This exercise test has proved to be a suitable provocation test to unmask abnormalities in the glomerular handling of albumin that might not be recognisable at rest.


Anti-insulin receptor antibodies inhibit insulin binding and stimulate glucose metabolism in skeletal muscle.

Autoantibodies against the insulin receptor are found in the serum of some patients with severe insulin resistance. The effects of one of these sera on insulin binding and on glucose transport and metabolism were investigated in the isolated mouse soleus muscle. Preincubation of muscles with the patient's serum resulted in an inhibition of subsequent 125I-insulin binding (half-maximal effect at 1:500 dilution) and in a two to three-fold stimulation of glucose transport and metabolism (half-maximal effect at 1:2000 dilution). The insulin-like effects were blocked by anti-human IgG, but not by anti-insulin antibodies. The magnitude of the serum effects on 2-deoxyglucose uptake and glycolysis was similar to that of insulin, but the effect on glycogen synthesis was smaller than that of insulin. It is suggested that the patient's serum and insulin promote glucose transport and glycolysis through a common pathway, but act differently on glycogen synthesis.


Studies on the mechanism of insulin resistance after injury in the mouse.

Acute insulin resistance developed after scald injury in the mouse. After 2h plasma glucose and insulin concentrations were each raised about two-fold. Glucose metabolism was studied in vitro in soleus muscles isolated at this time. Glycolysis and glycogen synthesis, and their stimulation by insulin, were unchanged in muscles from scalded mice, and insulin-stimulated transport of 2-deoxyglucose slightly increased, showing that the insulin resistance seen in vivo is not maintained in isolated tissues. Binding of insulin to liver cell membranes prepared from scalded mice was unaltered, whilst that of glucagon was slightly but significantly reduced, showing that changes in polypeptide-hormone receptors can occur within this short time. It was concluded that the acute loss of sensitivity to insulin after injury does not result from a change in insulin receptor sites and presumably reflects an impairment of glucose metabolism in vivo mediated by circulating hormones.


[An epidemiological study of congenital heart disease. I. Incidence of cardiovascular malformations in 11,584 live-born babies in the District of Florence (Italy) (author's transl)].

11,584 consecutive live-born babies in the Ostetric Clinic of Florence in the years 1975 and 1976 were examined for the presence of congenital heart disease. Diagnosis was made by necropsy, cardiac catheterization and operation in 20% of cases and by clinical observations in 80%. The 74% of babies who were diagnosed as affected by congenital heart disease at birth were eventually controlled. The incidence of congenital heart disease was 7.1% in 10,789 live-born of weight over 2500 g while it was 37% in 795 under such weight. Global incidence was 9.2%. The first essentials in epidemiological study of congenital heart malformations is to define the method which is used for diagnosis since this is the primary factor responsible for wide variations in incidence. It is suggested that the institution of a Regional Register of malformations would allow more accurate estimate of overall incidence of congenital cardiopathies.


[Phenocardiographic and auscultatory patterns in patients with normally functioning Björk-Shiley aortic prosthesis (author's transl)].

Phonocardiographic examination was carried out in 40 patients who had undergone to aortic valve replacement with the Björk-Shiley prothesis. The regular function of the prothesis was evaluated on the basis of the physical, radiological and electrocardiographic data. In the majority of the cases the first sound was slight. The prosthetic closing sound was made of two components (a2, A2) and the opening sound by one or more components (C1, C2, C3). A sistolic aortic murmur was always present, and a diastolic murmur has been found in 20% of the cases.


[Anomalous muscle band of the right ventricle. Part II: Report of six cases associated to other cardiac congenital malformations (author's transl)].

Six cases of anomalous muscle band of the right ventricle associated to other cardiac congenital malformations are described. In five of them ventricular septum defect was present; in one aortic valvular stenosis with supravalvular diaphragm, plus right pulmonary artery stenosis. Modification in pathophysiology of ventricular septum defect due to the obstacle represents by the anomalous muscle band in the right ventricle are discussed in detail. In every case corrected diagnosis was suggested by right ventricle angiography.


[Observations on the sequence of endocardial activation in the left ventricle of the normal subject].

To obtain information on normal left ventricular activation, endocardial recordings with an electrode catheter were made a seven left ventricular sites in ten patients undergoing diagnostic heart catheterization. All the patients had: 1) sinus rhythm; 2) normal duration and shape of the QRS complex of left chest leads; 3) normal left ventriculography, i.e. normal volume and contractility of the left ventricle. The earliest left ventricular endocardial activation was recorded at septal and/or posterior level, i.e. at the septum (6 to 16 msec, average 9.7 msec, after the onset of intracardiac QRS complex) in seven patients; at the posterior wall (0 to 4 msec, average 2.6 msec, after the onset of intracardiac QRS complex) in three patients (in one of these, the earliest activation occurred at the posterior wall and apex simulaneously). If the earliest activation occurred at the left interventricular septum, the next excited point was found on the posterior wall or at the apex, and vice versa. The latest part to be activated was on the lateral free wall in seven patients; on the posterior wall in two patients; at the apex in the last one.


[Pacemakers: concerning check-ups (author's transl)].

The Authors have re-examined their case histories of 1503 patients who have had 2459 pacemakers implanted and who have undergone check-ups as outpatients. All the complications which have arisen from 1967 to the present have been taken into consideration. The total number of complications has been found in 355 patients with 14% of the total number of pacemakers and they have been subdivided into 3 groups: 1st group: complications arising during the stay in hospital (110); 2nd group: complications arising after discharge from hospital and discovered by the patient (239); 3rd group: complications found casually during outpatients' check-ups (6). Of the complications found after discharge, 97% belong to the second group and only 3% to the third group. 657 substituted pacemakers have also been taken into consideration with the purpose of finding out the parameters which showed up as the battery was running down. Out of 145 pacemakers substituted because of flat batteries, 130 (90%) have shown brusque variations in the frequency of stimulation, while only 15 (10%) have shown variations in other parameters (width, length of impulse, etc). The Authors therefore retain that a periodic outpatients' check-up of the pacemakers is of little use as regards the patients' safety and the complete utilization of the device, while they advise that the patient be educated so as to be able to carry out his own daily control of the pacemaker.


[The antegrade GAPs (author's transl)].

GAP in a-v conduction is defined as a zone within the cardiac cycle where premature atrial impulses fail to evoke ventricular responses whereas atrial beats of greater and lesser prematurity do. This phenomenon occurs when the effective refractory period (ERP) of a distal site is greater than the functional refractory period (FRP) of a proximal site of the conduction system. To date, Damato and Co. classify antegrade gaps into six types on the basis of blocks location and proximal delay that permits conduction recovery: type I: HPS and AVN; type II: HPS (distal) and HPS (proximal); type III: HPS and His-bundle; type IV: AVN (distal) and AVN (proximal); type V: AVN or HPS and atrium; type pseudo-V: AVN or HPS and antrial miocardium proximal to stimulation site; type VI: HPS and supernormality (no proximal delay). The Authors propose, on the basis of 37 cases of GAP phenomenon observed in 185 electrophysiological studies, a new classification of antegrade gaps, which complete and partially modifies Damato's one. Tyes I-II-II-IV and V are divided into A and B forms according to the type and the site of the distal block. GAP type VI is replaced by Damato's pseudo-V. Two new types are proposed: in the first (type VII) the distal block is in the atrium and the proximal delay is in atrial miocardium proximal to stimulation site; in the second (type VIII), in subjects with pre-excitation, the block is in the accessory pathway and the proximal delay is in atrium.


[Analysis of Luciani-Wenckebach periodism in A-V node. I. Typical features (author's transl)].

Electrocardiograms of 20 patients developing Wenckebach A-V block duting atrial pacing and 20 with spontaneous Wenckebach block were reviewed to determine the frequency of typical features of classical Wenckebach periodicity. Few cases only met all six typical criteria. Cases with long cycles with conduction ratios of 5/4, with Wenchkebach point less than 130 min, and with first greater than A-H 110 msec were the most likely to show typical features. The implications of these observations are discussed on the basis of modern hypothesis of electrophysiological mechanisms of Wenckebach periodism.


[The conservative mitral valve surgery (author's transl)].

From 1969 to 1976 at Harefield Hospital 260 patients underwent conservative mitral valve surgery. The different techniques used are described. Of the 223 patients followed up (1 to 8 years, mean follow up 48 months) 73% are asymptomatic, 20%  are improved and 7% are the same or worse. A conservative operation is possible in approximately 85% of the cases and according to our results this should be the operation of choice in mitral valve surgery.


[The incomplete atrio-ventricular canal. Operative and long term results in 100 cases (author's transl)].

100 patients with endocardial cushion defect of the partial type underwent surgical correction between the years 1957-1975. The age of patients ranged from 3 to 57 years with a mean of 18 years. In 89 patients there was a mitral insufficiency. The repair of the mitral valve was performed in 78 patients; in 21 was repaired also the tricuspidal valve. The hospital mortality was of 8 patients. The mortality was correlated with the age of the patients, the pulmonary pressure and with the presence of malformations of the tricuspid valve. A major complication was represented by a complete atrioventricular block that occurred in 8 patients, in 5 of these the block disappeared before the dimission from the hospital. 86 patients have been followed for a period variable from 2 to 228 months and an average of 61 months. The late mortality was of 4 patients. Two patients have been reoperated of mitral valve replacement because of residual important mitral insufficiency. The phonocardiographic study, done in 50 patients, showed a presence of a holosystolic murmur in 20. The standard X-ray chest and electrocardiogram iid not show important changes between the pre and post operative examination.


[Anatomy and embriology of double outlet right ventricle (author's transl)].

After formulating the definition of double outlet right ventricle (DORV) as the persistence origin of the trunco-conal structures from the right ventricle, 64 autopsy cases meeting this definition were reviewed. A wide spectrum of anatomic variations of DORV were found. A classification is proposed based upon the type of relationship between the great vessels and upon the presence and type of ventricular septal defect. Twenty-five cases had normally crossed great arteries (13 of which had pulmonic stenosis), nine cases had transposed vessels and 23 cases had a double muscular conus and a side-by-side arrangement of the great vessels in the frontal view, a relationship called "partial distortion" or atypical transposition. Seven cases had absent trunco-conal septum (common truncus). Only one case had intact ventricular septum. Anterior ventricular septal defect was found only in cases with partial distortion or common truncus. Angiographic and surgical correlations are presented. Because of their great heterogeneity, the need for detailed description of the anatomy of the individual case of DORV is emphasized.


[Diagnosis of pulmonary hypertension by means of noninvasive techniques (author's transl)].

On 33 patients with mitralic heart disease (III and IV class N.Y.H.A.) we have carried out polimechanical investigations (ecg, fcg, x-ray examination, external heart impulse record) and the following parameters was determined: 1) interval Q-I sound; 2) interval II sound-OS; 3) Wells's index; 4) Q-I sound/II sound-OS ratio; 5) duration of electromechanical systole of right ventricle; 6) duration of external heart impulse; 7) relative amplitude of E and E1 as percentage of amplitude from E point to nadir point; 8) relaxation isovolumetric time of right ventricle; 9) medium value of pulmonary capillary pressure, total pulmonary resistances, and area of mitral valve. The results demonstrate that there is a correlation between these parameters and the pulmonary blood pressure, whose value is possible to determine as well as haemodynamic investigation. The data indicate validity of non invasive techniques in detecting pulmonary hypertension in mitralic valve diseases.


[Effect of potassium chloride on myocardial stimulation threshold and correlated electrophysiologic parameters (author's transl)].

The influence of KCl on different electrophysiologic parameters and myocardial stimulation threshold (MST) are considered in 9 patients with cardiac pacemaker. Reduction of MST during the diastolic period and the supernormal phase of excitability (SNP), depression of automaticity and slight bradycardia have been observed. The Authors, on the basis of kaliemia values and electrophysiologic parameters, emphasize the improvement of myocardial responsiveness when kaliemia does not exceed 6.5 mEq/l. The electrophysiologic effects of KCl are compared with those obtained in vitro on the transmembrane potential. Therapeutic effects for the treatment of arrhythmias and exit block in patients with cardiac pacemakers are considered.


[Swallowing-induced supraventricular tachycardias in an asymptomatic young man (author's transl)].

Three patterns of swallowing-induced supraventricular tachycardia in an asymptomatic young man are described. The patient had no esophageal disease. The electrophysiologic mechanism of arrhythmias remains speculative. Vagal stimulation produced by swallowing appears to cause tachcardias because atropine (1,5 mg iv) prevents their occurrrence.


Secretin secretion in patients with duodenal ulcer, chronic pancreatitis and diabetes mellitus.

Secretin releasing response to intraduodenal acid infusion was investigated in 15 cases of diseased control, 7 cases of duodenal ulcer, 5 cases of chronic pancreatitis, and 6 cases of diabetes mellitus. Plasma secretin levels in response to duodenal acidification were less in duodenal ulcer and the appearance of the maximal peak was delayed compared with that found in control. It is suggested that the secretin release was impaired in duodenal ulcer in spite of hypersecretion of gastric acids. In chronic pancreatitis, secretin releasing response to acidification was markedly impaired, in addition, inhibition of secretin release by bicarbonate was diminished due to a lack of bicarbonate flow from the pancreas. On the other hand, although the response of secretin release in diabetes mellitus was also lower compared with that in control group, the capacity of secretin response showed values in-between control subjects and chronic pancreatitis. This research was supported in part by grant from the Ministry of Education, Science and Culture in Japan.


The diagnostic value of pneumoperitoneogram for splenomegaly in chronic liver diseases.

The splenic enlargement is an important symptoms of portal hypertension, and various attempts have been made to objectively describe it. But, endoscopic diagnosis for splenomegaly in chronic liver diseases may be sometimes difficult for these uncharacteristic appearances. The pneumoperitoneography was performed in 141 chronic liver diseases just before laparoscopic procedure, size and form of the spleen on X-ray film were measured and analysed. We have compared these results with the laparoscopic findings (the gross appearance of liver and spleen, the degree of portal hypertension, etc), the patterns on scintigram and the histological findings of the liver. There were fairely good correlation between the splenic findings on radiogram and above factors, especially the size of the spleen was gradually increased according to the degree of portal hypertension and the fibrous change of the liver specimens. In conclusion, the findings of spleen on pneumoperitoneogram were valuable for diagnosis of splenomegaly in chronic liver diseases.


The effect of motilin on the gastrointestinal propulsion in rats.

We studied the gastrointestinal propulsion in unanaesthetized rats by 51Cr method that permits the simultaneous determination of two functions of the gastric emptying and the intestinal propulsion. The results obtained are as follows: 1) The semi-logarithmic presentation of the gastric emptying showed a linear relationship with the time. 2) When synthetic motilin was subcutaneously injected at the dose of 1 microgram/kg, the gastric emptying was promoted to a statistically significant extent.


Specific cancer immunotherapy adjunctive to surgery for advanced gastric cancer: a report of six long term survivors.

In order to improve the results with non-curatively resected advanced gastric cancer, we have tried specific cancer immunotherapy adjunctive to surgery. In this article, six long term survivors (median 6.2 years) are reported.


Studies on the CEA-like substance in gastric juice.

Concentration and heterogeneity of CEA-like substance in gastric juice were studied using radioimmunoassay. Statistically significant increase of CEA-like substance in gastric juice was found in advanced atrophic gastritis (P less than 0.01), early gastric cancer (P less than 0.05) and advanced gastric cancer (P less than 0.01) as compared with normal subjects. In cases with atrophic gastritis with a high degree of intestinal metaplasia, the concentrations above 300 microgram/dl were noticed. The results indicate that increased concentrations of CEA-like substance in gastric secretions may strongly suggest the presence of a marked intestinal metaplasia and/or cancerous changes of gastric mucosae, including the early cancer. The distribution of CEA activity in gel filtration fractions of gastric juice was compared using kits of two different radioimmunoassay systems. The patterns of CEA activities were different between the two different kits used, but the main peaks were located in the fractions with the molecular weight of 20x10(4) daltons corresponding to that of serum CEA. It is considered, however, that the CEA-like substance in gastric juice specimens may be more or less heterogenous when any of the methods is used.


Recurrent pyogenic cholangitis: a study by endoscopic retrograde cholangiography.

Endoscopic retrograde cholangiograms were studied in 52 patients with recurrent pyogenic cholangitis, a condition which is prevalent in Asia and in which there is a primary bacterial cholangitis. The earlier changes of recurrent pyogenic cholangitis were identified and found to be confined to the intrahepatic biliary tree. The left hepatic duct was more severely affected than the right hepatic duct and had a higher infestation by clonorchis. The severity of radiological changes correlated well with the duration of illness and the need for surgery. Gallstones were present in 34.2% of the patients and pancreatic ductal abnormality in 7.7%. The decision for surgery could be made early and accurately, and the type of surgery and the assignment of surgeons could be planned in advance--situations which conventional intravenous cholangiograms could not achieve. Cholangitis complicated endoscopic retrograde cholangiograms in 23.1% of the initial 26 patients without antibiotic cover but none of the subsequent 26 in whom this was used.


Frequency of intrahepatic arteriovenous fistula as a sequela to percutaneous needle puncture of the liver.

Incidence of intrahepatic arteriovenous fistula after needle biopsy of the liver, percutaneous transhepatic cholangiography, and transhepatic catheterization of an intrahepatic bile duct or portal vein, was determined by studying the hepatic arteriograms obtained within 1 month of the transhepatic procedure. An arteriovenous fistula, mostly arterioportal, occurred in 5 (5.4%) of the 93 patients after biopsy, in 3 (3.8%) of 79 after percutaneous transhepatic cholangiography, and in 7 (26.2%) of 26 after catheterization. None of the fistulae was so large and close to the porta hepatis as to cause portal hypertension. In 1 patient with an intrahepatic bile duct carcinoma, the long track of a 0.7-mm caliber needle became a fistula draining arterial blood into the parenchyma. In another, an aneurysm was found after biopsy and percutaneous transhepatic cholangiography. The possibility of spontaneous closure of small fistulae is discussed.


Bile acid conjugation in organ culture of human fetal liver.

An organ culture system for prolonged maintenance of human fetal liver has been developed and used to investigate the formation of bile acid conjugates. Multiple liver specimens were obtained from human abortuses and stillbirths ranging from 10 to 29 weeks of gestation. Within 3 hr of hysterotomy, small fragments of liver were established in organ culture. The morphological integrity of the explants was demonstrated by light and electron microscopy. Functional viability was determined by adding radiolabeled primary bile acid to the medium and assaying the taurine and glycine conjugates formed. Primary bile acid was taken up by the tissues, conjugated with taurine and glycine, and secreted into the medium at a constant rate during 10 days in vitro and in constant increments during a selected 24-hr period. The results establish that human fetal liver survives intact for periods up to 10 days in vitro. Taurine conjugates of the primary bile acids predominate throughout gestation and conjugates of cholic acid are synthesized in preference to those of chenodeoxycholic acid. Supplementation of the medium with taurine results in enhanced taurocholate formation with competitive inhibition of glycocholate synthesis, suggesting one acyl transferase system for both taurine and glycine. Finally, in medium supplemented with hydrocortisone there is a reversal of the glycine-taurine ratio seen in fetal liver.


Hyperglucagonemia in cirrhosis: altered secretion and sensitivity to glucagon.

Plasma glucagon concentration was elevated 2- to 6-fold in cirrhotic patients with spontaneous portal systemic shunting or surgically induced portacaval anastomosis but was comparable to controls in cirrhotics without portal-systemic shunting. The metabolic clearance rate of glucagon (mol wt 3500) was normal in all of the cirrhotic groups, but the estimated basal systemic delivery rate of glucagon was increased 2- to 6-fold in the hyperglucagonemic patients. The blood glucose response to infusion of glucagon (3 ng per kg per min) was reduced in the cirrhotics with portal-systemic shunting or portacaval anastomosis, and correlated inversely with the delivery rate of endogenous glucagon. Administration of ammonium chloride (3 g) failed to elevate plasma glucagon concentration. It is concluded that hyperglucagonemia in cirrhosis is a consequence of hypersecretion rather than decreased hormonal catabolism. A negative feedback signal may exist between hepatic sensitivity to glucagon and the secretion of this hormone.


Cimetidine and prostaglandin: evidence for different modes of action on the rat gastric mucosa.

We have previously shown that the prostaglandin analogue 15(R)15 methyl-prostaglandin E2 methyl ester (Me-PGE2) when administered at a dose of 50 microgram per kg significantly inhibits aspirin-induced gastric mucosal erosions in the rat. In this study we have investigated the effect of cimetidine under similar circumstances. Cimetidine in a dose of 50 mg per kg significantly inhibited gastric mucosal erosions induced by aspirin (192 mg per kg) in the rat, reducing the incidence from 70% of 20 rats to 9.5% of 21 rats, the mean lesion score was reduced from 9.3 +/- 2.1 (mean +/- SEM) to 0.4 +/- 0.3. We then compared the effect of the above doses of Me-PGE2 and cimetidine on gastric erosions induced by aspirin (192 mg per kg) with the hourly addition of 160 mM HCl. The incidence of erosions in the aspirin + HCl group was 100% of 20 rats (mean lesion score 27.4 +/- 2.4). This was not significantly reduced by cimetidine, the incidence being 90% of 20 rats (mean lesion score 19.7 +/- 3.4). The incidence of erosions in the presence of Me-PGE2 was significantly less than that in both the other groups, 13% of 23 rats, (mean lesion score 3.1 +/- 0.8) P less than 0.01 in both instances. These results suggest that, whereas cimetidine protects the gastric mucosa through acid inhibition, Me-PGE2 appears to have a protective effect independent of acid inhibition.


Altered lower esophageal sphincter function during early pregnancy.

To determine whether lower esophageal sphincter (LES) function was normal during early pregnancy, studies were performed in 8 pregnant women before and after abortion. Resting LES pressures were 22.1 +/- 2.4 and 22.6 +/- 2.3 mm Hg before and after abortion, respectively. During early pregnancy the LES pressure responses to pentagastrin were inhibited significantly. The LES responses to edrophonium and methacholine were decreased also. Finally, LES pressure responses to a protein meal were diminished in an additional 5 pregnant women. Serum concentrations of estrogen and progesterone were elevated during pregnancy, but the serum concentration of gastrin was unchanged. It can be concluded that in early pregnancy the basal LES pressure was within normal limits, but the LES pressure responses to hormonal, pharmacological and physiological stimulation were reduced (during demonstrated elevations of serum concentrations of estrogen and progesterone). These studies suggest that during early pregnancy, when no clinical symptoms of reflux are present, altered LES function may be demonstrated.


Relation between volume swallowed and velocity of the bolus ejected from the pharynx into the esophagus.

The velocity of the front face of a liquid saline bolus ejected from the pharynx into the esophagus was measured by recording changes of luminal electrical impedance with three sets of electrodes in 9 subjects. At a site 26 cm from the incisors, the mean velocity of the front face of the bolus increased from 10 to 70 cm sec-1 as the volume swallowed was raised from 5 to 30 ml. The velocity of the front face of the bolus was greater 26 cm from the incisors than it was 32 cm from the incisors.


Mechanisms of transport of Na, Cl, and K in the human colon.

Ionic transport across isolated, stripped, human colonic mucosa was studied in vitro using a modified short circuit current technique. Electrical potential difference and short circuit current were dependent on the presence of sodium ions in the mucosal bathing solution and were unaffected by addition of 10 mM glucose to the solution. Ouabain (10(-3) M) added to the serosal reservoir abolished both potential difference and short circuit current. Isotopic flux measurements across short-circuited colonic mucosa showed a net active sodium absorption which accounted for the observed short circuit current and was unaffected by 10 mM glucose. Chloride was also actively absorbed and this was unaffected by removal of sodium from the bathing solutions. Ouabain abolished net sodium absorption but had no effect on chloride absorption. There was a net active secretion of potassium which was abolished in sodium-free buffer. We conclude that sodium is actively absorbed via a rheogenic process which is not stimulated by glucose; chloride is actively absorbed via a nonelectrogenic process, not linked to sodium transport, and probably involving a Cl-HCO3- exchange; and postassium is actively secreted possibly via a Na+K+ exchange.


Explant culture of human colon.

Human colonic epithelium has been cultured as explants in a chemically defined medium for periods of 1 to 20 days. The viability of the explants was shown by the preservation of the ultrastructural features of the colonic epithelial cells and by active incorporation of radioactive precursors into cellular DNA and protein. A progressive decrease in the number of goblet cells, decrease in the depth of the crypts, and a change from a columnar to a cuboidal epithelium were observed. After 20 days in culture the colonic mucosa consisted of a single layer of cuboidal epithelial cells and a few glands. The ability to maintain colonic mucosa in culture was subject to both intra- and interindividual variation. Cultured human colonic mucosa also activated a chemical procarcinogen, benzo[a]pyrene, into metabolites which bound to cellular DNA. A 100-fold interindividual variation in this binding was observed.


Gastric emptying rates of solid food in relation to body size.

The relationship of body size to rates of gastric emptying of solid food was investigated in order to obtain data that may allow this variable to be considered when populations of varying size are studied. Rates of gastric emptying were measured using a beef stew meal to which were added pieces of chicken liver tagged with [99mTc]sulfur colloid, and following the passage of the isotope through the gastrointestinal tract with intermittent gamma-imaging. Results showed an inverse linear relationship between gastric emptying rates and body surface area, and between gastric emptying rates and body weight. The variable of body size must be taken into account when measurements of gastric emptying of solid food are measured.


Selective release of gastric inhibitory polypeptide by intraduodenal amino acid perfusion in man.

Intraduodenal amino acids are known to stimulate the release of gastric inhibitory polypeptide and cholecystokinin. In order to separate and quantitate gastric inhibitory polypeptide secretion selectively, 12 normal subjects received an intraduodenal perfusion of a mixed amino acid solution (158 mM) containing either methionine, phenylalanine, tryptophan, and valine (perfusate 1), or an amino acid solution containing arginine, histidine, isoleucine, leucine, lysine, and threonine (perfusate 2). Serum concentrations of gastric inhibitory polypeptide and insulin were significantly greater in the group receiving perfusate 2 (P less than 0.001). In contrast, after administration of amino acid perfusate 1, there was only a slight increase in serum gastric inhibitory polypeptide concentration and insulin secretion increased only slightly. Mean trypsin and bilirubin outputs in the group receiving perfusate 1 were nearly 3 times greater than the outputs of the group receiving the other amino acid mixture. This study expands the importance of intraduodenal amino acid mixtures in stimulating secretion of gastric inhibitory polypeptide and insulin and quantitatively separates gastric inhibitory polypeptide release from release of hormones that stimulate pancreatic enzyme secretion, such as cholecystokinin.


Protein digestion and absorption in rats with pancreatic duct occlusion.

The effects of pancreatic duct ligation on the digestion and absorption of a randomly 14C-labeled protein meal has been investigated in the rat. Although there was a significant reduction in luminal digestion and absorption of the protein meal in the pancreatic duct-ligated animals compared with controls, 37% of administered protein was absorbed despite absence of luminal pancreatic proteolytic enzyme activity. To characterize further the digestive and absorptive processes that occur in the absence of luminal pancreatic proteolytic enzyme activity, whole protein meal (untreated) and protein preincubated with (1) pepsin and HCl, and (2) HCl alone (treated), was instilled into isolated loops of rat intestine containing no demonstrable pancreatic proteolytic enzyme activity. Thirty per cent absorption of the untreated protein meal occurred in 4 hr; significantly greater amounts of both treated forms of meal were absorbed. It is concluded that the small bowel has the capacity to hydrolyze and absorb nutritionally significant amounts of dietary large molecular weight protein in the absence of luminal pancreatic enzyme activity. Furthermore, this process may be enhanced by prior denaturation and proteolysis in the stomach.


Villous adenomas of the duodenum.

A patient with multiple villous adenomas of the duodenum is described. Endoscopy plays an essential role in the management of these neoplasms. If no evidence of invasive malignancy is found on multiple endoscopic biopsies, wide local excision is the initial procedure of choice. Invasive malignancy found in either the endoscopic biopsy or the surgical specimen is indication for pancreaticoduodenectomy.


Eosinophilic esophagitis in a patient with vigorous achalasia.

A patient with vigorous achalasia is presented who had marked smooth muscle hypertrophy and eosinophilic infiltration of the esophagus identical to that seen in patients with eosinophilic gastroenteritis. Eosinophilic infiltration of the esophagus probably represents a variant of the eosinophilic gastroenteritis syndrome and may predispose to an esophageal motor disorder.


Paneth cells in Barrett's esophagus.

Paneth cells were identified in esophageal biopsies from 4 patients with Barrett's epithelium of the specialized columnar type. These cells were identical to human intestinal Paneth cells by light microscopy, electron microscopy, and histochemical staining reactions. Retrospective review of biopsies from 8 additional cases with esophageal specialized columnar epithelium yielded 2 further cases with Paneth cells. The presence of Paneth cells, along with goblet cells, suggests that specialized columnar type epithelium in the esophagus may be a form of highly differentiated intestinalization.


[The problem of information of the patient about medical malpractice (author's transl)].

The treatment contract of the physician does not include the duty of legal counselling of the patient. The physician should avoid amateur attempts at legal advice. The civil contract between physician and patient includes the duty to inform the patient of blatant negligence by others or himself in the observation of the generally recognized rules of medical science. An unsubstantiated suspicion of malpractice without obvious adverse effects should not be revealed to the patient. Critique of the treatment by a colleague is not unprofessional when a higher legal obligation than the professional obligation to a peer is at steak. The physician is not obliged to inform the police of malpractice by a colleague. Only imminent crimes such as manslaughter, murder or genocide must be reported.


[The significance of prenatal diagnosis of twins (author's transl)].

By means of ultrasound and fetal electrocardiography the diagnosis of twin pregnancies can be made prenatally without any reservation; the diagnosis is even possible in the first half of pregnancy. Comparative analysis of two approximately equal collectives of in all 602 twin pregnancies--1,45% of all births in the years 1955-1975 at the University Clinic for Gynecology and Obstetrics of the University of Cologne--revealed a better prognosis concerning the course of pregnancy and the new-born by prenatal diagnosis. The earliest possible diagnosis of twins, resulting in more intense clinical observation--and occasional clinical treatment--facilitated a significantly longer duration of pregnancy, leading to a higher percentage of mature twins. Whereas the total number of obstetric operations was reduced because of prenatal diagnosis, selection of highrisk cases led to a distinct increase in Caesarian sections. The prolongation of pregnancy, the higher birth weights and better maturity attained, were accompanied by decrease in perinatal mortality and in improvement in the Apgar-index of the newborn in that collective, in which prenatal diagnosis was achieved.


[Perinatal mortality in twin pregnancies (author's transl)].

Report on the perinatal mortality of 258 twin pregnancies at the department of obstetrics and gynecology of the University of Zürich, Switzerland from 1966 to 1976. The perinatal mortality of the twin deliveries was 11.6% compared to a general perinatal mortality of 2.9%. The perinatal mortality of second twins was 14.0% compared to 9.3% for the first twin. The high incidence of abnormal presentations and operative deliveries of the second twin is discussed. The incidence of prematurity under 37 weeks gestation was 48.4%. About 70% of the perinatal mortality in twins was due to prematurity with pulmonary causes leading in 44.5% of the deaths. The difficulties in the recognition of intra-uterine growth retardation in twin pregnancies is discussed.


[Twin deliveries (author's transl)].

The statistics on twin deliveries for Bavaria from 1920-1925 were compared to those for 1972-1976. The number of twin deliveries showed a reduction from 15 per thousand in 1920-1925 to 9 per thousand in 1972-1976. The largest number of twin mothers were young primigravidas or older multi-gravidas. The percentage of twins of the same sex increased by 4.7% for boys and 5.7% for girls. The percentage of twin deliveries of different sex decreased by about 7%. Of all twin deliveries in Bavaria from 1920-1976 66% were of the same sex and 34% had different sex.


[Invasive squamous cell carcinoma of the uterine cervix three years after cryosurgical treatment of a benign ectopy (author's transl)].

Report on a 33 years old para 4, who developed invasive squamous cell carcinoma of the cervix three years after cryosurgery for a large ectopy of the ectocervix. The carcinoma developed under an intact layer of normal superficial epithelium. The pap smears were negative at yearly intervals until a positive smear was obtained from a small iodinenegative area. Cases following cryosurgery appear to require careful follow-ups.


[On the clinical significance of sequential scintigraphic examinations of the uteroplacental perfusion (author's transl)].

The utero-placental perfusion was examined by means of the method of Hünermann (1972) in a group of 74 patients with toxemia of pregnancy, diabetes mellitus, or intrauterine growth retardation. The perfusion measurements were categorized and evaluated according to the clinical findings. The correlation between single values deriving from the time-activity curves and their clinical predictive value was ascertained. A strong correlation between the parameters and the clinical findings resulted when several criteria were considered simultaneously. Among the single values resulting from the perfusion curves, the Tmax (placenta) and Tmax (uterus) (time of activity maximum) as well as the quotient of both revealed the highest significance. Pathological time-activity-curves were found in 16 of 19 patients with moderate and severe intrauterine growth retardation, and in all patients with moderate and severe toxemia, or diabetes mellitus. The limited clinical value of the used method is discussed.


[Puerperal psychoses (author's transl)].

Studies show that a hundred cases of puerperal psychoses can be divided into two major groups according to their symptomatology and their option to build recidives: those physically motivated with exogenous and endogenous symptoms and those caused by endogenous psychoses.


[The diagnosis of urinary incontinence in gynaecology. Indications for urodynamic diagnosis and description of urodynamic diagnostic apparatus (author's transl)].

Our experience with comparative measurements using various methods of diagnosis of urinary incontinence resulted in the development of a urodynamic measurement station within the department. This station is equiped for urethrocystotonometry with microtransducers for urethrocystograms and for lateral urethrocystograms. The technological details of the apparatus are described. The greatest diagnostic value give measurements in the standing patient. The methods of measurement, the interpretation of the results and the pre-operative records of urethral pressure profiles are described. The urethrocystotonometry is especially valuable for functional diagnosis. For the morphologic evaluation and especially in view of the choice of the operative procedure a modified method of the lateral urethrocystogram is used.


[Motivation for the presence of the husband at delivery (author's transl)].

The motivation for the presence of the husband at the delivery of his wife was investigated in 52 couples with the husband present and in a control group of 50 couples without the presence of the husband. A standardized interview constructed for this purpose was used for testing. Standardized scales for personality factors such as neurotic tendencies, fear, prejudice, ego strength, and shyness were also tested regarding their importance for the presence or absence of the husband at delivery. The results were statistically evaluated and the differences checked for significance. The husband present at delivery usually has a higher ego-strength than his wife and the wife enlists his help for the resolution of the crisis situation of delivery. The wife of the non-present husband has the same personality traits but does not expect help from her husband in the crisis situation and therefore does not request his presence.


[Diagnostic assessment of normal and risk pregnancies. 1. Comparison of two radioimmunological methods for the determination of human placental lactogen (author's transl)].

The HPL-concentrations of 103 plasma samples from normal and 58 samples from risk pregnancies were analyzed with two radioimmunological assay kits from Pharmacia/Freiburg (I) and Ames/Frankfurt (II). Intra- and inter-assay-variation of both methods are similar. The absolute values of HPL-concentrations analyzed by the two methods correspond to a value of about 3.5 microgram/ml (about week 24 of pregnancy). Above this value higher concentrations are analyzed with method II. These differences probably result from use of different standards and different methods of separation of free and bound hormone. Analysis of variance shows a high degree of correlation (r = 0.93, P less than 0.001, n = 147) of the results obtained by both methods.


[Comparison of two methods for the determination of LH: HI-GONAVIS and LH-radioimmuno-assay in women with normal and irregular menstrual cycles (author's transl)].

A new direct hemagglutination test (HI-GONAVIS) for urinary LH was compared with the serum radioimmuno-assay of LH. The pairs of values showed a good correlation of r-0.87. In conjunction with clinical parameters and further hormone determinations the test was of value in the diagnosis of: the follicle phase of the cycle, the per-ovulatory phase, the luteal phase, the menopause, hypogonadotropic hypogonadism and hypergonadotropic hypogonadism.


[Behçet's syndrome (author's transl)].

Descriptions of Behçet's syndrome have been appearing more and more frequently in dermatological, ophthalmological, neurological, and pathological literature as well as in the literature in the field of internal medicine. Only two reports (1, 8) have appeared in gynecological journals during the last 15 years, even though the second most frequent symptom of the disease is vulval and/or vaginal aphthae and/or ulcers (80%-90% of the patients). For this reason, the diagnostic problems, therapeutic possibilities and prognosis were explained with the help of this casuistic contribution.


[The differential diagnosis of female urinary incontinence (author's transl)].

The different types of urinary incontinence in the female are defined and described. A meticulous differential diagnosis is a prerequisite for adequate treatment. The pre-treatment examination includes a detailed history, a residual urine, a gynaecological examination, a neurological examination, an intraveinous pyelogram, the incontinence test, the Bonney and the Bethoux tests, and a urethro-cystoscopy. In difficult cases urodynamic tests and X-rays of the bladder and the pelvic organs are added to the workup. Among 54 patients with urinary incontinence, 31 had stress incontinence and 23 had incontinence of another cause such as detrusor instability or a urethral syndrome.


[Morphological placental findings in intrauterine death (author's transl)].

Morphological placental findings of 46 stillborn infants are discussed and, heeding the present literature, the significance of such examinations in the scope of practical perinatology from a pathological point of view in routine diagnosis is evaluated.


Guidelines for maintaining adequate nutrition in old age.

Nutrient requirements do not change markedly with advancing age, but life style, socioeconomic status, psychologic changes, and the presence of chronic disease alter nutrient intake in the elderly. It is important to recognize and deal with these factors in attempting to correct malnutrition and in prescribing dietary treatment. Malnutrition includes a variety of disorders: undernutrition, nutrient deficiencies and imbalances, and obesity. Frequent small feedings, with nutritional supplements for patients with profound weight loss, are the initial treatment for undernutrition. Iron supplements and a diet of foods rich in iron and in promoting iron absorption are required in treating iron deficiency anemia. Management of macrocytic anemia should include specific nutrient therapy plus improvement of diet to include leafy vegetables and animal foodstuffs. Diet is an important adjunct in treating chronic diseases. Maturity-onset diabetes mellitus often can be managed by diet alone, with attention to correct proportions of fat, carbohydrate, and protein and to the decreased caloric requirements of elderly patients. The importance of continuing dietary modifications in hyperlipidemia and hypertension is well known. Although dietary manipulation in osteoporosis is not curative, a diet high in calcium and containing adequate floride and vitamin D affords maximum dietary protection against progress of the disease.


How aging affects the structure and function of the respiratory system.

Age-associated changes in the lung resemble emphysema. Progressive loss of the aging lung's static recoil forces produces airway closure at lung volumes in the tidal volume range,which leads to decreased arterial Po2. Under conditions that decrease oxygen content of arterial blood, the increase in both ventilation and cardiac output is smaller in elderly persons than in younger subjects. Therefore, less oxygen may be delivered to the tissues. Muscular strength of the respiratory apparatus consistently declines and the chest wall stiffens with advancing age. Thus, the elderly have weaker muscles to act on a chest wall that becomes progressively harder to move. Both maximal inspiratory and expiratory pressures are significantly decreased. Loss of the functional reserve of the respiratory system with age increases the risk of respiratory failure and leaves elderly subjects with decreased compensatory mechanisms for dealing with even moderate stress. The physician must be aware of these problems and provide early and vigorous respiratory care for elderly patients.


Relieving suffering--and pain--with hypnosis.

It is helpful to perceive pain and suffering as separate entities when planning therapy. The physical, anatomic, and electrochemical expression of pain is treated by physical therapy, medicines, nerve block, electric stimulators, and surgery. The suffering component involves the patient's (1) nonacceptance, (2) fear of the unknown, (3) pessimistic evaluation of the meaning of pain, (4) feeling of no time limit to suffering, and (5) often self-destructive feelings of guilt and resentment. These emotions and imaginings are quite amenable to good hypnotherapy. When suffering is removed, pain tends to become tolerable or may even disappear.


Significance of anergy to dinitrochlorobenzene (DNCB) in inflammatory bowel disease: family and postoperative studies.

To evaluate the pathogenetic significance of impaired cellular immunity in inflammatory bowel disease (IBD), we have measured the cutaneous responsiveness to dinitrochlorobenzene (DNCB) among 58 patients with IBD, 33 with Crohn's disease and 25 with ulcerative colitis, 63 of their clinically normal relatives, 24 additional ileitis and colitis patients who had undergone resection of all visibly diseased bowel, and 23 control subjects. Cutaneous anergy to DNCB was demonstrated among 70% of the patients with CD and 48% of those with UC, as against only 9% of the controls (p less than 0.001). There was no increased incidence of anergy among either 44 first-degree relatives (7%) or 19 spouses (3%), nor was there any special proclivity toward anergy among six pairs of patients with familial inflammatory bowel disease. In Crohn's disease, anergy was still present after bowel resection in six of 10 patients (60%), while in ulcerative colitis anergy was found after colectomy in only two of 14 patients (14%). Our data suggest that the immune defect in patients with inflammatory bowel disease may be a secondary phenomenon. In ulcerative colitis, the defect appears to reverse after colectomy, but in Crohn's disease it persists despite resection. This finding is consistent with the observed tendency of Crohn's disease, but not ulcerative colitis, to inexorable postoperative recurrence.


Further evidence of a primary mucosal defect in coeliac disease.

Subfractions of fraction 9, obtained from a peptic-tryptic-pancreatinic digest of wheat gliadin, were subjected to in vitro mucosal digestion and the filtrates examined for residual peptides. Small-intestinal mucosa from four groups of individuals were studied-eight patients with coeliac disease in remission; eight healthy controls; nine first degree relatives of patients with coeliac disease, and six children with recurrent diarrhoea investigated for possible coeliac disease, but in whom the diagnosis was excluded. The highest amounts of residual peptides (measured by scanning densitometer) were detected after digestion with mucosa from patients with coeliac disease and the lowest amounts with the control groups. The results obtained with the group of relatives fell between those of the coeliac disease and control groups, while the recurrent diarrhoea group overlapped the relatives and controls. The residual peptides were derived chiefly from the B-type subfractions of subfractions 1 and 2, obtained by ion-exchange chromatography of fraction 9. These subfractions are rich in glutamine/glutamic acid and proline and have a molecular weight (apparent) of not greater than 1500 Daltons. The results lend further support to the hypothesis of an enzyme deficiency in coeliac disease. A partial enzyme deficiency may exist in some first-degree relatives and in some children with recurrent diarrhoea but with histology of the small intestine within normal limits. HLA-B8 antigen is not correlated with this deficiency, but, when the two factors are associated, they could be related to the manifestation and severity of coeliac disease.


Absence of K cells in human gut mucosa.

Lymphocytes have been isolated from human rectal biopsies in numbers sufficient for microassay procedures. No antibody-dependent cell-mediated cytotoxic (ADCC) activity could be detected in normal or inflamed human gut mucosa, using two assay systems which detect predominantly K cell activity. The tissue localisation and circulation characteristics of K cells require definition before establishing their role as an efferent immunological mechanism.


Effect of ioglycamide (Biligram) on bile flow and biliary lipid secretion in man.

Twenty-one anicteric patients with a t-tube in situ were studied between the ninth and 11th postoperative days. Eleven patients were given an intravenous infusion of the biliary contrast agent ioglycamide (Biligram), while the other 10 acted as controls. Bile flow was recorded and the biliary concentrations of ioglycamide, bile salt, phospholipid, and cholesterol estimated in the two groups. The biliary excretion of ioglycamide was associated with a significant choleresis which was probably due to the obligatory coupling of the osmotically active contrast agent molecules with water. Biliary ioglycamide excretion did not significantly alter bile salt secretion rates. In contrast, the biliary secretion of both phospholipid and cholesterol was significantly lowered (P less than 0.001). Unlike chenodeoxycholic acid, ioglycamide significantly reduced bile acid independent cholesterol secretion (P less than 0.01), although secretion rate in terms of mumol of bile acid was essentially unchanged.


Lymphocyte cytotoxicity in chronic active hepatitis: effect of therapy and correlations with clinical and histological changes.

A study of lymphocyte cytotoxicity for rabbit hepatocyte cultures in 15 patients with untreated chronic active hepatitis showed positive results in all cases, both HBsAg positive and negative. After immunosuppressive therapy cytotoxicity became negative and remained negative, in four of nine patients followed serially. In 51 patients established on therapy for periods from three months to 12 years, cytotoxicity was negative in 19 and all patients are currently alive. However, in the remaining 32 patients in whom cytotoxicity was positive there has been a 34% mortality. Cytotoxicity remained persistently positive in 12 of 15 patients followed serially, and persistently negative in seven of nine. Cytotoxicity showed a significant association with histological disease activity, especially the extent of piecemeal necrosis, but not with biochemical tests of liver function, immunoglobulins, or autoantibodies. The basis of this cytotoxicity test is an antibody dependent cell-mediated autoimmune reaction directed against a liver specific protein, and the results suggest that in some cases immunosuppressive therapy is followed by control of this reaction. It may be possible to stop therapy in these patients, but in those in whom the reaction continues, as shown by continuing cytotoxicity, the prognosis is not as good and the use of other drug schedules would seem worthy of trial.


Secretion of intrinsic factor and hydrochloric acid after 12 weeks' treatment with cimetidine.

A sample of 16 patients had pentagastrin stimulation studies performed before starting a 12 week course of cimetidine, and again 12 hours after completing the course. Basal and pentagastrin stimulated intrinsic factor secretion was assayed in 13 patients. There was no significant difference in the pattern of secretion after 12 weeks' treatment with cimetidine. The basal and peak acid outputs of all 16 patients were measured. No significant difference was found in the pattern of acid secretion after treatment. It appears that parietal cell secretory function is restored to normal within 12 hours of discontinuing a prolonged course of cimetidine.


Serum carbenoxolone in patients with gastric and duodenal ulcer: Absorption, efficacy and side-effects.

The absorption of carbenoxolone sodium has been studied in 15 patients with gastric ulcer and eight patients with duodenal ulcer treated for four weeks. Blood levels of carbenoxolone showed a log distribution, varied markedly between patients, and were significantly higher after Biogastrone tablets (300 mg/day) than after Duogastrone capsules (200 mg/day). Serum carbenoxolone levels were similar in patients taking Biogastrone tablets before or after meals, and in patients taking Biogastrone tablets or Duogastrone capsules with or without antacids following chronic administration. Serum carbenoxolone levels were similar in patients whose gastric ulcers had or had not healed after four weeks' treatment. Serum carbenoxolone was significantly higher in patients who developed oedema, and was significantly correlated with age and with fall in plasma potassium. Carbenoxolone may exert its metabolic effects systemically, but its ulcer-healing effects topically; additional studies are needed to test this hypothesis.


The effectiveness of homemaker--home health aides.

The results of this study indicate that H/HHAs possess a wide array of objectives when working with clients. They are also perceived to be very effective in improving the quantity and quality of home care for their clients. This improved home care means clients are left alone less of ten and also receive meals with greater regularity. The clients perceive the H/HHAs as having many roles simultaneously, and they are viewed more as professional people than servants (the professional roles correlate highly with adequacy of client service). Based on the perceptions of the clients samples, social workers can utilize confidently the services of H/HHAs in an interdisciplinary approach to practice. It is hoped that this study will encourage social workers to utilize the services of the H/HHAs more appropriately, efficiently, effectively, and confidently when working with clients who may need these services. The authors suggest that future research should focus on the H/HHAs themselves, in areas such as their job descriptions and their job satisfactions and dissatisfactions, as well as how they and other professionals perceive their effectiveness.


Adolescent unwed motherhood: implications for a national family policy.

Out-of-wedlock pregnancies among adolescents from impoverished families and the decision of these girls to have their babies rather than to seek an abortion represent on adaptation to the circumstances of poverty. The authors content that a national family policy might help some of these girls avoid out-of-wedlock pregnancy and childbearing.


Counseling women for tubal sterilization.

In view of the current concern about sterilization abuse, the federal government has issued guidelines to prevent women from being sterilized without their knowledge or consent. The authors describe a counseling program in a large inner-city hospital that followed these specifications.


Social work consultation to nursing homes: a study.

This is a study of 39 social work consultants to nursing homes in the Southeast who continued their consultation activities after the federal government removed the requirement for nursing homes to employ social work consultants to qualify for reimbursement of cost through federal programs. It examines their knowledge and attitudes about aging and their consultative skills in relation to case, process, and program consultation and three types of group work.


Assertiveness training for nurses in a general hospital.

This article describes the first stage of an assertiveness training program for staff and managerial nurses in a general hospital. Special problems were raied in the group and their origins discussed. The group focused on the role of the professional nurse and the relationships between doctors, nurses, and patients.


Variability of Aspergillus niger after treatment with N-emthyl-N'-nitro-N-nitrosoguanidine.

N-Methyl-N'-nitro-N-nitrosoguanidine influences strongly the variability of Aspergillus niger MU 90, particularly on long-term treatment. The number of spores capable of growth decreases with the duration of treatment and the number of morphological and biochemical mutants considerably increases. The highest number of mutants with increased organic acid production was obtained after a mutagenic treatment when the number of surviving spores decreased below 1%.


Viability of spores after repeated freezing and thawing shocks.

Survival of spores of the fungus Rhizopus nigricans after repeated freezing and thawing was investigated. The cooling rate was 10(4) degrees C/min. Dry spores were fully inactive after 32 repeated shocks. About one-half of spores were killed after 8 repetitions. The water content did not change the resistance, swollen spores reacted to shocks much like dry ones. The sensitivity of spores to freezing-thawing shocks increased considerably when the spores changed from the dormant to the active state. Already after a 30 min cultivation of spores in the nutrient medium two freezing and thawings were sufficient for inactivation of 60% spores. After a 90 min cultivation one freezing and one thawing were sufficient to inactivate practically all spores.


Degradation by Eco R1 endonuclease of DNA isolated from phages infecting Bacillus licheniformis and Bacillus thuringiensis.

DNA was isolated from lytic phages of two strains, Bacillus licheniformis, a producer of bacitracin, and Bacillus thuringiensis forming protein paracrystals with pronounced insecticidal effects. Its sensitivity to Eco R1 restriction endonuclease was determined. It was the aim of the work to find out whether these phages could serve as vectors in the transfer and possible amplification of genes of the two important industrial species of bacilli. Approximate values of the molecular weight of DNA of the two phages were determined after degradation of the phage DNA by Eco R1, followed by comparison of electrophoretic mobility of individual fragments with that of the Eco R1-degraded DNA of phage lambdab2.


The annual reproductive cycle of captive Macaca sylvana.

The annual reproductive cycle of a captive colony of Barbary apes, Macaca sylvana, was examined for the 26-year period from 1950 to 1976 and then compared with the annual reproductive cycle of semifree ranging M.sylvania in Gibraltar. Mating and birthing seasons for the two populations were similar although birth synchrony was more pronounced in the Gibraltar colony. The environmental factors influencing the maintenance of the annual cycles in both localities are examined.


[Intestinal angina].

Based on the experience with 243 patients with chronic occlusive disease of the visceral arteries, the different symptoms of intestinal angina are described. Problems concerning diagnostic procedures, especially angiography, and indication for reconstructive arterial surgery are discussed.


[Surgical treatment of ulcer].

The standard of today in surgical treatment of the duodenal and gastric ulcer in Germany is shown. Positive and negative aspects of the different methods are discussed. Special technics are recommended for the different types of gastroduodenal ulcera.


[Treatment of burns. Experimental and clinical studies].

Burn disease is a severe complication of all extensive deep burns. Therefore, the destroyed skin must be removed and the open wounds closed as soon as possible. Until now only the early surgical necrectomy and grafting can meet these essentials. Our studies on "chemical débridement" by various enzyme preparations showed that collagenase hastened the removal of dead tissue without any complications. The subsequent application of soluble collagen to the would area caused significant acceleration of wound closure in rats as well as in pigs without immunological reactions. Finally, evidence of anti-collagen antibodies may be important for the treatment of burn disease if a direct effect can be proved.