The renal perfusion/excretion determination renogram: a new method of individual renal function determination in obstructive renal disease.

The divided renal function of 10 patients with unilateral renal obstruction was measured with the renal perfusion/excretion determination renogram, a computerized radioisotope function study, and with endogenous creatinine clearances. Functional impairment of the obstructed kidney when estimated by the effective renal plasma flow determination of the renal perfusion/excretion determination renogram correlated closely with that measured by creatinine clearance. The clinical applications of the renal perfusion/excretion determination renogram in unilateral renal obstruction include the preoperative evaluation of individual renal function and serial estimates of individual renal function in chronic obstructive processes.


Anterior transperitoneal approach for treatment of urolithiasis.

An anterior transperitoneal incision was used to remove stones from 20 kidneys in 18 patients (2 bilateral). Our experience with 35 kidneys operated upon by this method (15 previously reported) has been favorable. Use of percutaneous nephropyelostomy tubes to drain obstructed kidneys in septic patients has permitted all procedures to be done under non-emergency conditions. Careful alignment of x-ray equipment and adjustment of exposure technique in the operating room before induction of anesthesia result in consistently good quality preoperative and intraoperative roentgenograms. The transperitoneal approach has afforded good access to the anterior portion of the renal pelvis even in those patients who have had previous operations on the kidney by the flank approach. Additional intra-abdominal procedures done at the same operation have included urinary diversion by ileal loop, revision of previous ileal loop, ureterolithotomy, pyeloureteroplasty, partial nephrectomy, cholecystectomy and appendectomy. The procedures done with the patients in the supine position have been well tolerated even in patients with serious coincident medical diseases.


Anatrophic nephrolithotomy in the solitary kidney.

A retrospective analysis was conducted on 30 patients who had undergone anatrophic nephrolithotomy for staghorn calculus disease in a solitary kidney. No statistically significant difference (p greater than 0.1) was found between the average preoperative and postoperative renal function values. Of 27 patients who were infected preoperatively 19 were rendered free of further urinary tract infection and 24 of 30 patients (80 per cent) had no further recurrence of renal calculi. Because of the predictable morbidity and mortality associated with the non-operative management of staghorn calculus disease these patients are managed best by the complete surgical removal of all calculi and intensive antimicrobial therapy.


Simultaneous balloon occlusion of the renal artery and hypothermic perfusion in in situ surgery of the kidney.

Renal ischemia and cooling may be achieved by intraluminal balloon occlusion and intermittent hypothermic perfusion using a double lumen, balloon-tipped catheter introduced into the renal artery percutaneously. This technique was used successfully in 26 of 31 extensive nephrolithotomies, eliminating the need for dissection and clamping of the renal artery and intricate surface cooling. Intrarenal operations could be performed as effectively as with clamp occlusion. Despite a mean ischemia time of 54 minutes the individual 131I-hippuran clearance of the operated kidneys was only reduced to a mean 78.4 per cent of the preoperative value 2 to 3 weeks postoperatively and increased to 92.2 per cent after 3 to 6 months, with a tendency toward further improvement.


Non-metastatic hepatic dysfunction associated with renal carcinoma.

A retrospective computer analysis of 102 patients treated for renal tubular carcinoma revealed 7 patients who presented with non-metastatic hepatic dysfunction. Of these 7 patients 5 also had the triad of fever, weight loss and fatigue. Only 1 patient survived more than 10 years after nephrectomy. A review of the literature on non-metastatic hepatic dysfunction revealed a significant interval between onset of symptoms and detection of the underlying renal malignancy, as well as a poor over-all survival rate if the syndrome persisted after nephrectomy.


Ipsilateral ureteroureterostomy for single ureteral disease in patients with ureteral duplication: a review of 8 years of experience with 16 patients.

Ipsilateral ureteroureterostomy near the bladder (end-to-side anastomosis) for treatment of single ureteral disease in patients with complete ureteral duplication has been performed in 16 patients during the last 8 years. The operative technique, indications, results, followup and complications are presented. Reflux in the lower segment ureter was treated in 13 patients and upper segment ectopia or ureterocele was managed in 3 patients with this operative procedure. This operative technique is simpler and safer than reimplantation of both ureters into the bladder. Because no dissection of the bladder wall is needed there is less risk of injury to the pelvic viscera and vasculature. The chance of success in correcting reflux appears better than with reimplantation of both ureters into the bladder. Long-term followup has shown few complications and no repeat operations were needed in this series. The small stump of the diseased ureter left behind near the bladder caused no serious problems.


Use of the omental pedicle graft in exenterative surgery.

The pedicled omentum can be used effectively to cover the ureterointestinal anastomosis and to fill the irradiated, denuded pelvis after a radical cancer operation.


Pregnancy in women with bladder exstrophy.

Little is known about pregnancies in women with bladder exstrophy. Of 28 women with bladder exstrophy who were evaluated 7 became pregnant and 5 delivered successfully. Problems seen during pregnancy, the long-term effects and the need for early, informed counseling by the urologist are discussed.


Phenoxybenzamine in neurogenic bladder dysfunction after spinal cord injury. I. Voiding dysfunction.

Phenoxybenzamine is a welcomed adjunct in the pharmacologic management of patients with neurogenic bladder dysfunction resulting from spinal cord trauma. Side effects are infrequent. Bladder balance was predictably and effectively achieved and maintained in patients with 1) lower motor neuron lesions, 2) upper motor neuron lesions and coexisting autonomic dysreflexia and 3) intact sympathetic innervation and upper motor neuron bladders. The response was unpredictable in patients with upper motor neuron lesions without coexisting dysreflexia.


Phenoxybenzamine in neurogenic bladder dysfunction after spinal cord injury. II. Autonomic dysreflexia.

Phenoxybenzamine blockade of the alpha receptor site can abolish the vascular and internal sphincter responses in patients with chronic recurrent autonomic dysreflexia associated with bladder filling or contraction. The life-threatening hypertensive response is suppressed by this medication. Therefore, the drug is a beneficial adjunct in the pharmacologic management of autonomic dysreflexia. When the drug is used patients can be maintained free of a catheter. The drug had no serious side effects at the dose regimen used. One particularly significant advantage is its long duration of action--patients occasionally can skip doses of medication and not suffer acute symptoms.


Experience in the urologic management in 120 early spinal cord injury patients.

More than 120 patients with recent spinal cord injuries have been admitted to our hospital during the last 3 years. Intermittent catheterization has been the preliminary step in the urologic management of these patients. The transcutaneous suprapubic cystocath with intermittent aspiration of urine also has been used in 7 cases. A bladder outlet operation after 3 months was indicated 3 times more often in patients with complete than in those with incomplete neurologic lesions. Results and indications are discussed.


The natural history of papillary transitional cell carcinoma of the bladder and its treatment in an unselected population on the basis of histologic grading.

Between 1950 and 1965, 365 patients were treated for transitional cancer of the bladder at our hospitals. A retrospective study was done, using clinical records and a histopathologic review to determine the long-term natural history of this population when treated conservatively. The natural history of 3 separate patient populations was discovered, based solely on the grading of the transurethrally resected fragments. Based on the grade on initial presentation these patients were divided into grades I, II and III. Of the patients 5 per cent in grade I, 16 per cent in grade II, 28 to 35 per cent in grade III not involving muscle and 83 per cent in grade III involving muscle died of bladder cancer. Ninety-seven patients (26 per cent) died of bladder cancer, 110 (31 per cent) died of other causes and 158 (43 per cent) have been alive more than 5 years (104 more than 10 years). Grade I tumors that progressed to a higher grade did so within 2 years of the initial diagnosis. Of the bladder cancer deaths 83 per cent occurred within 2 years of the initial diagnosis. Of 64 patients dying more than 5 years after presentation only 7 died of bladder cancer.


Treatment of advanced bladder cancer with cis-diamminedichloroplatinum (II NSC 119875): a pilot study.

A pilot study was done using 19 patients with bladder cancer to test the efficacy of cis-diamminedichloroplatinum as a single agent to treat transitional cell carcinoma. Fourteen patients had stage D lesions, 3 patients had stage C and 2 patients had stage B tumors. The patients received 1 mg./kg. cis-diamminedichloroplatinum mixed with 2,000 cc dextrose 5 per cent in one-third normal saline solution, 37.5 gm. mannitol and 40 mEq. potassium chloride. The mixture was given in a slow infusion lasting 6 to 8 hours every week for the first 6 weeks and every 3 weeks thereafter. In the patients with stage D disease 1 complete clinical remission, 7 partial clinical remissions, 1 minimal objective response and 1 subjective response were observed. Four patients did not respond to the treatment. In the 3 stage C patients no response to the drug was observed. In the stage B patients 1 partial remission and 1 minimal objective response were seen. A total objective response (complete remission and partial remission) was seen in 9 of the 19 patients (47 per cent). The duration of the responses varied from 2 to 10 months, with an average of 4.8 months. These promising results seem to indicate the high degree of effectiveness of cis-diamminedichloroplatinum against transitional cell carcinoma of the bladder.


Transurethral urethrotomy under vision.

Transurethral urethrotomy under vision with the Sachse urethrotome is a new surgical procedure for the treatment of urethral strictures. The chief advantage of the urethrotome is the fact that the surgeon can cut strictures selectively and accurately under clear vision. The procedure is less painful than blind internal urethrotomy and less extensive cases can be done in the office with the patient under local anesthesia. We report on 36 cases with at least 6 months of followup. In 20 cases the strictures were distal to the prostate and the results were considered good in 16, improved in 3 and a failure in 1. The other 16 cases involved vesical neck contractures and all patients had good results. The technique for urethral strictures distal to the prostate and for vesical neck contractures is described and postoperative treatment is emphasized and discussed.


Erections and sexual function in post-sphincterotomy bladder neck patients.

A study of 131 patients who underwent sphincterotomy and bladder neck incision was done to determine changes in postoperative erectile and sexual function. A complete, permanent loss of erectile function was noted in 8.2 per cent of the patients and diminished erectile function was noted in 16.8 per cent. Unchanged or improved erections were noted in 74.8 per cent of the patients, while a complete loss of ability to engage in vaginal sexual intercourse, which had been present preoperatively, was sustained by 3.9 per cent of patients with diminished erections suffered no impairment of their preoperative sexual ability. Unaltered, improved or induced sexual function was present in 96.1 per cent of the patients postoperatively.


Clinical aspects of sperm bank.

The ability to preserve human sperm by cryogenic methods has been developed and successfully applied to reproductive biology. Some of the advantages include 1) availability of sperm for heterologous (donor) insemination, 2) accumulation of multiple oligospermic specimens for homologous (husband) insemination, 3) preservation of sperm prior to vasectomy, 4) collection and preservation of sperm from men who face permanent injury to spermatogenesis through an operation, chemotherapy or radiation, 5) to obviate the potential genetic danger of man's exposure to environmental pollutants such as radiation and 6) availability of husband's sperm at ovulation time.


Radical retropubic prostatectomy: 59 cases.

Our results with radical retropubic prostatectomy in 59 patients are described. This is the largest retropubic series outside a university setting that we could find. We discuss the reasons that we believe our technique is beneficial. Our blood loss has been less than the loss in most series, with 48 per cent of our patients receiving no units of blood and, over-all, 64.5 per cent receiving 0 or 1 unit. None of our patients had total urinary incontinence or required a collecting device. Of the 59 patients 5 (9 per cent) are potent. A discussion of the method, complications and 5 and 10-year results is presented. Our statistics compare favorably to those of other series and we believe that this operation is beneficial for the patient.


Treatment of advanced carcinoma of the prostate (stage D) with infusion of cis-diamminedichloroplatinum (II NSC 119875): a pilot study.

A study was done on 21 patients who had advanced carcinoma of the prostate (stage D) treated with 1 mg./kg. cis-diamminedichloroplatinum per week for 6 weeks. The infusions were then spaced every 3 weeks thereafter. One patient had never been treated previously and 20 patients were failures of previous therapy with estrogens and/or radiotherapy and/or chemotherapy. A partial objective clinical remission was seen in 9 of the 21 patients (43 per cent). This response lasted from 3 to 14 months, with an average of 5.8 months. The responses were evidenced by a 50 per cent or more decrease of lesions in the liver (2 patients), recalcification of a bone lytic lesion (1 patient), disappearance of positive lymph nodes in the neck (2 patients), disappearance of pleural effusion (1 patient), disappearance of lymphatic block of lower extremities (2 patients) and disappearance of lung metastases and ureteral obstruction (1 patient). Six patients (28.5 per cent) had a complete disappearance of the bone pain and became ambulatory and asymptomatic, 2 patients (9.5 per cent) with bony metastases remained asymptomatic and apparently stable and 4 patients did not respond to treatment and showed progression. Cis-diamminedichloroplatinum seems to be the most effective drug available to date for the treatment of advanced carcinoma of the prostate.


Dysgenetic male pseudohermaphroditism.

Dysgenetic male pseudohermaphroditism is a disorder of sexual differentiation in which patients present with bilateral dysgenetic testes, persistent müllerian structures, cryptorchidism and inadequate virilization. There were 10 patients with this syndrome seen at our hospital between 1956 and 1976. In this series, there was a 30 per cent incidence of testicular tumors. Because patients with dysgenetic male pseudohermaphroditism have a high incidence of testicular tumors this disorder, which is actually a variant of mixed gonadal dysgenesis, must be distinguished from the other forms of male pseudohermaphroditism.


Factor XI deficiency: detection and management during urological surgery.

Hereditary factor XI deficiency may remain undiagnosed until severe bleeding is observed after an operation or trauma. Two such cases were encountered and, therefore, a regular screening test for coagulation disorders among urological patients was initiated. During 2 years (1975 and 1976) 10 additional cases of factor XI deficiency were detected: 5 severe and 5 partial. All patients were Ashkenazic Jews of Eastern European origin. The 5 patients with severe factor XI deficiency underwent an operation without any complications. They were transfused with 5 to 20 ml./kg./day of fresh frozen plasma from the day before the operation until 10 to 14 days postoperatively. Of the 5 patients with partial XI deficiency 4 underwent an operation. In 1 of 3 patients who did not receive transfusions postoperative bleeding was observed. A minimal level of 0.3 U./ml. (30 per cent) factor XI was found necessary to ensure good hemostasis during and after an operation. In view of a recent finding of relatively high gene frequency of factor XI deficiency in Ashkenazic Jews it seems warranted to do a partial thromboplastin time in such patients who need an operation.


Genetics of cystinuria in an inbred population.

After the identification of 2 cystinurics in a large eastern Virginia isolate a population study was undertaken to identify carriers of the gene and others who could be affected by it. Of 102 individuals 3 additional homozygous cystinurics and 27 possible carriers were found. The cystinuria gene shows a highly variable expression, although all those affected and carriers could be traced to 1 couple who married about 1890. These studies demonstrate that there is considerable variation in urinary concentrations of cystine even in an affected population. No form of therapy should be based on random or isolated samples.


Anti-arcing loop and resectoscope.

A new modified cutting loop assembly and a modification of the resectoscope to prevent arcing between the bare wire loop and the distal end of the telescope are described.


Gas cystometry in cases of continent bladder exstrophy.

Cystometry in 21 cases of closed continent bladder exstrophy revealed that 14 patients had a normal reflexic bladder. A simultaneous anal plug electromyogram showed an appropriate response in all patients when correlated with a cystometrogram.


Continence in cases of bladder exstrophy.

The relationship of the onset of continence, staged surgical procedures and continence length was investigated in 21 patients with closed continent exstrophy. Continence occurred within a year of operation in 13 patients and 10 of these 13 patients had a Young-Dees urethroplasty and Marshall-Marchetti-Krantz suspension. In 11 of these 13 patients the continence length was greater than 1 cm. In the remaining 8 patients continence was delayed beyong a year. Only 1 of these 8 patients had undergone both bladder neck procedures and in 5 patients the continence length was greater than 1 cm.


Comparison of techniques to determine continence zone.

The urethral pressure profiles for 36 patients were analyzed specifically for continence zone by 3 techniques: 1) triangle, 2) planimeter and 3) weight. Graphically, the best agreement was between the weight and planimetry methods but, statistically, there was a significant difference among techniques except for the subgroup that had the smallest continence area.


Orthotopic ureteroceles in children.

Experience with 20 simple ureteroceles in 18 children is reviewed. In most cases hydroureteronephrosis of various grades of severity was present. In 5 cases the related kidney was non-functioning. The ureterocele generally is seen on excretory urography, either as a positive cobra-head dilatation or as a negative filling defect in the cystogram when renal function is impaired. Cystoscopy is diagnostic but confusion may occur when a lax ureterocele is compressed and emptied or even everted by a high intravesical pressure. Expectant management is warranted in the absence of upper tract dilatation but operative intervention is needed in most cases. Nephroureterectomy may be unavoidable if the kidney is afunctional. Simple unroofing or incision of the ureterocele is followed by vesicoureteral reflux and ascending infection. The preferred technique is total excision of the ureterocele and reimplantation of the ureter into the bladder by an antireflux technique.


Ureteral reimplantation by the transverse advancement technique.

When the transverse advancement technique of ureteral reimplantation is used the submucosal tunnel is made transversely across the base of the bladder. This method was used for reimplantation of 131 ureters in 92 children. The results indicate that the transverse advancement technique is adaptable to virtually any situation requiring ureteral reimplantation and is a simple, safe and reliable procedure for prevention of reflux.


The role of adjunctive drug therapy for intermittent catheterization and self-catheterization in children with vesical dysfunction.

Thirty-nine children with vesical dysfunction were managed with clean intermittent catheterization. Most children achieved effective urinary continence, the majority with the help of adjunctive drug therapy to relax the detrusor, contract the bladder neck or both. Intermittent catheterization had a generally favourable effect on infection, reflux and hydronephrosis. Intermittent catheterization in childhood is a perferred alternative to urinary diversion in cases of neurogenic bladder dysfunction.


Splenic cysts in the differential diagnosis of suprarenal masses.

Splenic cysts are uncommon and their preoperative diagnosis is suspected rarely from the clinical presentation. The urologist should be aware that on an excretory urogram these cysts appear as suprarenal masses, suggesting adrenal enlargement. Two recent cases are presented, with a discussion of their classification, incidence, diagnostic evaluation and therapy.


Renin angiotensin involvement in transient hypertension after renal injury.

Transient hypertension occurred in 3 patients shortly after blunt injury to the abdomen. Renal trauma was suspected in all 3 patients and radiological evidence for renal injury was present in 2. Plasma renin activity definitely was elevated in 1 patient and probably was elevated in another. There was a decrease in blood pressure in all 3 patients during infusion of the angiotensin II analogue--saralasin--showing that the hypertension in these patients was angiotensin-mediated. Renal function as reflected by the blood urea nitrogen, creatinine and electrolytes was not impaired significantly. Thus, acute hypertension after blunt abdominal trauma may be angiotensinogenic and is not necessarily sustained.


The significance of delayed post-traumatic renal hemorrhage.

An impression is presented pertaining to the significance of delayed recurrent post-traumatic renal hematuria, documented by 3 case reports and an appraisal of relevant data selected from prior reports. Adjunctive features may include prolonged initial hematuria despite acceptable radiographic features, a preponderant relationship to penetrating (knife and low velocity missile) wounds and a tendency to respond temporarily to conservative management.


Hypovascular renal tumors: an aggressive diagnostic approach required.

The value of a fine needle aspiration biopsy for confirmation of malignancy is demonstrated in 3 cases of angiographically hypovascular renal tumors. In 2 cases ultrasound examination suggested solid lesions but in 1 case it was predominantly sonolucent. Reliable documentation in the literature indicates that the risk of spreading tumor cells and, hence, of decreasing the survival rate is negligible.


Carcinosarcoma of the renal pelvis.

An unusual heterologous carcinosarcoma of the renal pelvis is reported. The differential diagnosis, problems related to nomenclature and histogenetic implications of this rare neoplasm are discussed.


Impotence: a diagnostic approach.

A diagnostic approach to erectile impotence using a sexual function questionnaire, nocturnal penile plethysmography, penile blood pressure measurement, cavernosograms, cystometrograms and plasma testosterone levels is presented. Case examples demonstrate the clinical value of these diagnostic tools. Psychogenic impotence should be diagnosed only after nocturnal penile plethysmography has demonstrated the presence of complete erections.


Survey for toxoplasmosis in wild and domestic animals from Norway and Sweden.

Fifty-nine of 1250 (4.7%) wild and domestic animals from Norway and Sweden had positive dye-test titers (greater than or equal to 1:8) for antibody against Toxoplasma gondii. A dye-test titer of 1:8 (30-40 i.u.) or higher was detected in 3 of 732 small rodents (0.4%), 21 of 87 domestic cats (24%), 9 of 29 red foxes (Vulpes vulpes) (31%), 2 of 2 domesticated arctic foxes (Alopex lagopus), 12 of 99 red deer (Cervus elaphus) (12%), 5 of 8 roe deer (Capreolus capreolus) (63%) and in 7 of 34 wild rabbits (Oryctolagus cuniculus) (21%). Antibodies were not found in 29 shrews (Sorex spp.), 127 gulls (Larus spp.), 4 terns (Sterna sp.), 10 skuas (Stercorarius sp.) 68 domestic reindeer (Rangifer tarandus) and 21 wild reindeer. Histologic examination of brain tissue from another 51 wild rabbits on which serological data were not available, did not reveal cysts. Sero-conversion was not observed in laboratory mice inoculated with the same material. Infection with T. gondii was confirmed in two of the three sero-positive small rodents using a FA-technique. Cysts were not detected in the brains of another 55 rodents, of which 26 were sero-negative and 29 were not tested serologically.


Cryptocotyle lingua infection in a bald eagle (Haliaeetus leucocephalus).

Approximately 11,000 heterophyid trematodes, Crytocotyle lingua, were recovered from the small intestine of a bald eagle, Haliaeetus leucocephalus, in Nova Scotia. Severe emaciation of the eagle was attributed to the heavy burden of trematodes. The wide distribution of this trematode in the Maritime area and the fact that fish are a primary source of food for eagles in Nova Scotia might be predisposing factors in this case.


Oral papillomatosis in coyotes (Canis latrans) and wolves (Canis lupus) of Alberta.

Twelve cases of oral papillomatosis were detected in wild carnivores of Alberta, ten in coyotes (Canis latrans) and two in wolves (Canis lupus). Lesions ranged from mild with a few small papillomas to severe with much of the surface of the lips, tongue and buccal cavity covered with papillomas. Three of five coyotes with severe papillomatosis were in obvious poor health. The gross and histologic lesions are described and the significance of this disease in wild carnivores is discussed.


Occurrence and attempted transmission of Toxoplasma gondii in European starlings (Sturnus vulgaris).

Serums of 563 fledgling starlings (Sturnus vulgaris) trapped during a 14 month period near Lodi, California were examined for antibodies to Toxoplasma gondii using the microtiter indirect hemagglutination method. Titers ranging from 1:64 to 1:512 were found in 4.8% of the birds. Starlings collected during May through October had a higher prevalence of antibody than those collected during November through April. Rats inoculated with individual heart and brain suspensions from 10 seropositive starlings remained seronegative for T. gondii antibodies when tested at 22 and 82 days post-inoculation. Peritoneal smears made from these rats at post-inoculation day 82 were negative for T. gondii.


Clinical blood values of the northern fur seal, Callorhinus ursinus. III. Comparison of eye fluid and serum values.

The levels of 13 components in the serum and eye fluids of the northern fur seal, Callorhinus ursinus, are compared. The wide variations observed would appear to limit the usefulness of eye fluid values as a substitute for serum values.


Lead poisoning of raccoons in Connecticut.

A wild raccoon (Procyon lotor) had clinical signs, histopathologic and ultrastructural lesions indicative of lead intoxication. The diagnosis was confirmed by chemical analyses of liver and kidney tissues which revealed 35 ppm of lead in wet tissues. A survey of hepatic lead concentration in 13 additional raccoons was conducted.


Evaluation of the hemagglutination test for epidemiologic studies of leptospiral antibodies in wild mammals.

Sera from 153 wild animals of 18 species were tested for antibodies against 12 serovars of Leptospira by the microscopic agglutination (MA) test. Seventy-five percent of the animals tested were seropositive against one or more of the 12 serovars used. The most commonly found serovars were pomona, autumnalis, pyrogenes, icterohaemorrhagiae, australis, and canicola. Of 62 carnivores representing 7 species, 55 (89%) were seropositive, as were 46 (60%) of 77 rodents from 9 species. Leptospira of the serovar copenhageni serogroup icterohaemorrhagiae were recovered from kidney tissues of a Norway rat (Rattus norvegicus). Of 443 wildlife sera tested by the indirect hemagglutination (IHA) test using cells sensitized with L. illini antigen, 47 (11%), mainly carnivores and deer, gave a heterophile reaction. Of the remaining 396 sera, 164 (41%) were seropositive for leptospirosis by the IHA test. To compare the IHA test with the MA test, 143 serum samples were tested by both methods. There was 84% concordance between the two tests.


Frequency and duration of paratyphoid organism shedding by experimentally infected bobwhite quail (Colinus virginianus).

Four-week old bobwhite quail (Colinus virginianus) were experimentally infected with Salmonella urbana, S. infantis, S. newport, S. gaminara, S. braenderup, and S. litchfield. Rates of mortality varied from 0 to 50%. The rate of shedding of paratyphoid organisms varied from 14 to 100% for 18 or more days after infection. The maximum duration of shedding was 53 days by 12% of the quail infected with S. braenderup and the minimum duration was 18 days by 14% of the quail infected with S. litchfield.


Cholelithiasis in the cottonrat, Sigmodon hispidus, from the high plains of Texas.

A high prevalence (71%) of gallstones was noted in free-ranging cottonrats, Sigmodon hispidus, collected from one site in Lubbock County, Texas. The gallbladder of affected animals was distended and filled with white, soft, friable, cholesterol gallstones of variable sizes. Focal hyperplasia of the epithelium and connective tissue layer of the gallbladder was evident in affected cottonrats. As the forage available to affected animals was different from that available to gallstone-free animals collected from other areas, this may be the cause of the higher prevalence of cholelithiasis in this population. The significance of this disease and possible use of the cottonrat as an experimental model are discussed.


Granulosa cell tumor in a garter snake (Thamnophis sirtalis).

A granulosa cell tumor was identified in a captive six year old Garter Snake (Thamnophis sirtalis). Metastasis to both kidneys was manifested as miliary white foci and structure distortion.


Lesions of tuberculosis in mountain whitefish (Prosopium williamsoni).

Lesions of tuberculosis in mountain whitefish (Prosopium williamsoni) were present in all visceral organs. The tubercles were composed of large rounded macrophages which contained numerous intracytoplasmic acid-fast bacilli. The lesions were not encapsulated and mineralization was not observed.


The 1975-76 avian cholera outbreaks in Humboldt County, California.

The 1975-76 avian cholera outbreaks were observed from 25 November 1975 to 17 February 1976 at three sites in Humboldt County, California. This is the first known occurrence of avian cholera on one of the sites (City of Arcata Oxidation Ponds).


Mortality of young-of-the-year rainbow smelt (Osmerus mordax) in Lake Erie associated with the occurrence of Glugea hertwigi.

An extensive mortality of young-of-the-year rainbow smelt (Osmerus mordax) occurred in Lake Erie during the fall of 1969. Dead and dying smelt were observed along the north shore from west of Long Point in the central basin to Port Maitland in the eastern basin. No other fish species was involved. Glugea hertwigi, a microsporidan parasite, was observed in 90% of the distressed smelt examined, and is believed to have been a major contributing factor to the mortality.


Naturally occurring hepatozoonosis in a coyote.

Schizonts of Hepatozoon sp. were found in the myocardium of an adult cyote (Canis latrans) collected from the Aransas National Wildlife Refuge, Austwell, Texas. This constitutes the first time hepatozoonosis has been recorded in Canidae in the Western Hemisphere.


Spontaneous renal disease in beaver in Louisiana.

Interstitial nephritis was present in 13 of 25 adult beavers (Castor canadensis). Results of serum chemistry, serotyping, and culture for leptospires were compared with the extent of renal lesions. Although the pathogenesis of the nephritis was not determined, the survey provided baseline information on spontaneous renal disease in beavers.


Avian cholera in eider ducks in Maine.

Outbreaks of avian cholera (Pasteurella multocida) occur frequently in common eiders (Somateria mollissima dresseri) in Maine during early summer. Studies over a seven year period show that over 90% of the loss occurred in incubating females and might be associated with their weakened condition because females do not feed during the incubation period. High nesting densities also may contribute to the losses. The exact source of P. multocida is unknown although carrier birds were found.


The histopathology and prevalence of Henneguya sebasta and Kudoa clupeidae in the rockfish, Sebastes paucispinis of southern California.

The pathogenesis of two histozoic myxosporidans, Henneguya sebasta and Kudoa clupeidae, was studied from the Pacific rockfish, Sebastes paucispinis. Infection of the bulbus and truncus arteriosus with H. sebasta was observed in 30 of 100 fish. The parasite metastasized throughout the tissue causing necrosis, hyperplasia and hypertrophy of the connective tissue and smooth muscle. K. clupeidae, found in 37 of 100 fish, caused necrosis and atrophy of host skeletal muscle. The unattractive appearance of Kudoa cysts in rockfish filets detracted from their commercial value.


The development of clinical signs and the population significance of neurologic disease in a captive wapiti herd.

Clinical signs attributable to meningeal worm (Parelaphostrongylus tenuis) were recorded in three male and three female wapiti (Cervus elaphus canadensis) ranging in age from 5 - 29 months. The study was conducted from September, 1976 to May, 1977 in a 2104-ha preserve. Some differences were noted in occurrence, time schedule and sequence of signs but the basic pattern was similar. The mean time between initial sign observed and death was 100 days. The effect of neurologic disease on population socialization, harvest and recruitment is discussed. A comparison of projected potential population numbers with sighting data in 1959-1977 revealed a trend of lower than expected numbers since 1968 related to suspected neo-natal mortality as well as known natural mortality in the younger age classes due to meningeal worm infection.


Girls' sports injuries in high school athletics.

Because of appreciable increases in the number of participants, injuries resulting from girls' interscholastic athletic activities have become a concern for school administrators and medical care providers. Four girls' high school athletic programs were prospectively studied for two years. Specially trained athletic trainers placed at each school examined each injured athlete and collected epidemiologic data. The 870 participant-seasons in nine sports resulted in 192 injuries. Three times more injuries occurred in practices than in competitive events. Although more than one third required a physician's services, the majority (59%) had returned to full athletic activity within a week of injury. Strains and sprains accounted for nearly two thirds of the injuries. Generally, the type and frequency of injuries were comparable with those seen in noncontact boys' interscholastic sports.


Hypertension-hypotension in pregnancy. Correlation with fetal outcome.

Data from 38,636 pregnant women were studied to determine the best criteria for diagnosing pregnancy hypertension based on the constellation of clinical factors yielding poorest perinatal and long-term results to the offspring. It was found that the combination of maximum diastolic blood pressure and maximum proteinuria, as observed during the interval 28 weeks to term, provided the closest correlation with outcome. This information offered an objective means for establishing a classification of hypertension-hypotension in late pregnancy.


Performance of male and female medical students in a medicine clerkship.

Little has been published about objective evaluation and comparison of performance of female and male medical students in clinical clerkships. Data were collected on objective grading and examination results of a three-month medicine clerkship involving 269 medical students, 222 men and 47 women, during 1975 and 1976. There were no significant differences in final course grades between the two sexes. Performance in wards and clinics and on written and oral examinations was also without significant differences when the two sexes' scores were compared. Thus, gender would appear to have no relationship to medical student performance in this clinical clerkship.


Extensive metastases in Peutz-Jeghers syndrome.

A 27-year-old woman with Peutz-Jeghers syndrome since age 11 years was hospitalized with a sudden onset of weakness of the right extremity, an expressive aphasia, and a three-month history of back pain. Liver and whole-body scintigrams demonstrated multiple metastatic disease; the brain scintigraphic study was compatible with infarction of the left hemisphere. Postmoretem examination two weeks after these studies showed extensive metastases in bone, liver, brain, lung, and left ovary. The source of the metastases was a malignant change from Peutz-Jeghers polyps.


Corpus luteum hemorrhage. Cause of acute abdominal pain in patients receiving anticoagulant therapy.

Intra-abdominal bleeding from the corpus luteum developed in three women receiving anticoagulant treatment. In one of these patients, no other hemorrhagic manifestations were present. Bleeding from corpus luteum should be considered in differential diagnosis of low abdominal pain in women of reproductive age receiving anticoagulant therapy. The ovary has not been widely recognized as a site of hemorrhage complicating anticoagulant therapy, although abdominal bleeding in this location may be more common than previously thought. Thorough clinical studies are needed to establish the precipitating factors and true incidence of this complication.


False-positive complement-fixation serology in histoplasmosis. A retrospective study.

A review of the records of 79 consecutive patients who had a positive immunodiffusion or complement-fixation test for histoplasmosis showed 28 (35%) with false-positive serologic results in relation to their clinical significance. Twelve patients (15%) had complement-fixation titers of 1:32 or greater, without cultural or histological evidence of active infection. No common clinical or laboratory finding could be correlated with the presence of false-positive tests. The latter finding correlates well with the incidence of false-positive complement-fixation titers (12%) in the normal random patient population.


Understanding rheumatoid arthritis. Evaluation of a patient education program.

We evaluated a patient education program on understanding rheumatoid arthritis; 94% of those responding to our questionnaire considered the program helpful in increasing their understanding of their condition, and 93% said it enhanced their communication with their family. A total of 85% reported one or more behavioral changes, such as not abusing joints (63%), getting more rest (56%), and using medications more meticulously (48%) after participating in the program. We recommend patient education as an effective means of helping patients understand and hence comply with physicians' instructions as well as helping patients to assume greater responsibility for their own health care.


A new technique for external heart compression.

The traditional arm-hand method for external heart compression has proved effective but still can lack force and result in complications when performed by weak or fatigued rescuers. Consequently, a leg-heel method was tested as an alternative. Using a cardiopulmonary resuscitation manikin as the victim, our pilot study showed that external heart compression can be administered effectively by a rescuer standing next to a victim in a supine position. The leg-heel method deserves to be tested to establish its place in cardiopulmonary resuscitation.


Secondary malignant neoplasms in patients with Hodgkin's disease.

Retrospective analysis of 232 cases of Hodgkin's disease (HD) treated at the University of Manitoba from Jan. 1, 1965, to Dec 31, 1973, and followed up to 44.3 months disclosed five cases of secondary malignant neoplasms. Two cases of acute leukemia were discovered compared with an expected value of 0.05 in our community. All neoplasms developed in the mixed cellularity group, representing only 28% of the HD cases. Combinations of radiotherapy and chemotherapy may have increased the incidence of leukemia, but its frequency does not appear high enough to abandon combined modality treatment.


Increased prevalence of seizure disorders among prisoners.

In an effort to determine the prevalence of seizure disorders among persons confined to jails and prison, the prescription rates for anticonvulsant medications in ten Illinois correctional institutions were surveyed. The institutions housed 12,030 persons at the time of the survey. Analysis of the results of the survey suggests a point prevalence of seizure disorders of 1.9% among the Illinois prison and jail population. This estimated prevalence of seizure disorders is approximately three times higher than among middle-class nonprisoner populations on which previous epidemiologic studies of epilepsy have been based. Special programs and resources for the detection, treatment, and prevention of seizure disorders among prisoners appear necessary. Provisions to ensure continuity of care after release from incarceration are also needed.


Intermediate-range sweat chloride concentration and Pseudomonas bronchitis. A cystic fibrosis variant with preservation of exocrine pancreatic function.

We studied the clinical and laboratory characteristics of seven patients with sweat chloride concentration consistently between 40 and 60 mEq/liter. Each has chronic Pseudomonas bronchitis, and all lack digestive symptoms. Laboratory findings indicate the preservation of exocrine pancreatic function. The patients include two of five children in one family and two of four in another. In a third family, one of five siblings has an intermediate sweat chloride concentration, but another has a typical fibrosis value (105 mEq/liter). One patient died of respiratory failure; results of an autopsy showed bronchiolectasis typical of cystic fibrosis, but minimal pancreatic changes. The data suggest a genetic basis for this variant of cystic fibrosis. These patients may be homozygous for a portion of a closely linked multigene cystic fibrosis locus or may have modifier genes that ameliorate the pancreatic and sweat lesions.


Genetic diversity in hemoglobins. Disease and nondisease.

Recent mass screening programs for sickle cell trait have been the first large-scale efforts to detect potentially deleterious genes and to provide genetic counseling to healthy carriers. In these programs, the expected prevalence of sickle hemoglobin and hemoglobin C has been found, and other mutant hemoglobin genes have also been uncovered. Many of these are not associated with disease, but simply reflect normal genetic diversity. A paradox of this finding is illustrated when, in counseling, many persons demonstrate difficulty in understanding that though they have an abnormal hemoglobin gene, they themselves are not ill or abnormal. The problem's solution lies in educating both health professionals and the public so that the normal existence of considerable genetic diversity is recognized. Since every person may carry mutant genes, whether potentially deleterious or innocuous, our definition of normal must be revised.


Elevation of creatine phosphokinase in young men after recreational exercise.

Twenty healthy male volunteers were divided into four groups for a period of recreational physical exercise. Standard blood chemistry determinations were made before exercise and on the two subsequent days. Creatine phosphokinase (CPK), SGOT, and lactic dehydrogenase levels were transiently elevated, but the change was considered significant only in the CPK level after certain types of exercise. Persons having these determinations performed should be questioned about recent physical exertion in the event of abnormal laboratory results.


Recurrent intermittent small bowel obstruction due to carcinoid tumor.

We encountered an unusual case of carcinoid tumor of the terminal ileum with intermittent recurrent small bowel obstruction of seven years' duration rather than the usual presentation of chronic progressive obstruction.


Self-induced vomiting. Psychiatric considerations.

Self-induced vomiting has been associated with the psychiatric diagnosis of anorexia nervosa and a newly proposed disorder named bulimia. Two patients with a self-induced vomiting compulsion did not fulfill criteria for either of these diagnoses. One patient had an affective disorder, and the other had no psychiatric illness, but the habit had developed as a weight control measure. Systematic studies of these symptoms are not available. Clinical diagnostic decisions should not be base on one outstanding sign or symptom, eg, self-induced vomiting, unless research clearly relates the sign or symptom to only one disorder.


[Chemotherapy of peritonitis with particular reference to concentrations of sulbenicillin in human ascites (author's transl)].

Twenty-seven patients with peritonitis to whom a drain was applied were given sulbenicillin (SBPC), a broad-spectrum antibiotic, which has so little hepatic and renal toxicity that massive doses may be feasible, and examination was made as to its therapeutic effects and concentrations of the antibiotic in the ascites. Daily dosage of SBPC was 10g in two divided doses in most cases given by the intravenous infusion. Medication was continued for 3 approximately 15 days. The highest daily dosage was 20g and the largest total dosage reached 190g, but there was no adverse reaction except for one case of a slight anemia. Peritonitis complicated appendicitis, adnexitis, duodenal ulcer perforation, intestinal obstruction or trauma as its primary disease. No difference in the therapeutic effect existed among the primary diseases. The response to SBPC treatment was excellent in 8 of the 27 patients and good in 17. Two patients failed to respond to the therapy. When SBPC was given just before operation, the SBPC concentration in ascites obtained at operation was 112 microgram/ml in 2 cases. The SBPC concentrations in ascites were examined following intravenous infusion of 5g over an hour, and a peak concentration of 94.7 microgram/ml was obtained at the completion of infusion (an hour after the start of infusion), which gradually decreased thereafter. In the ascites excreted from the drain after operation, a high concentration of 12.7 approximately 90.2 microgram/ml (mean: 51.7 +/- 7.7 microgram/ml) was obtained on the day after the operation day, but the concentration was lower thereafter. The SBPC concentrations in ascites were compared as regards the sites of drainage (Winslow's foramen, ileocecum and Douglas' fold), but no particular difference was observed. The SBPC concentrations in ascites after operation were in inverse proportion to the alleviation of peritonitis. They were higher when the inflammation was severer.


[Lung abscess due to Fusobacterium nucleatum (author's transl)].

A patient with epilepsy, 45 years of age, developed a lung abscess due to Fusobacterium nucleatum which was successfully treated with intravenous lincomycin. Quantitative anaerobic cultures of washed sputum proved to be useful in detecting the causative organism.


[Radioimmunoassay of 125I-sagamicin (author's transl)].

A radioimmunoassay for an aminoglycoside antibiotic, sagamicin, was developed using antisera from rabbits injected with a sagamicin-bovine serum albumin conjugate. Sagamicin was iodinated by a modified Bolton & Hunter method. The standard curve was linear on a logit-log plot yielding an sensitivity of 0.5ng/tube. A correlation coefficient of 0.95 was obtained between the radioimmunoassay and a microbioassay for sagamicin in human sera. Cross-reaction occurred with gentamicin components and some of sagamicin subunits, but there was no cross-reactivity to neomycin, kanamycin and amikacin. Antibody was purified by affinity chromatography on sagamicin bound agarose.


Pathology of chronic rheumatic mitral valvulitis in Iran and its surgical implications.

Sixty-two consecutive surgically removed chronic rheumatic mitral valves were classified and tabulated according to their pathological features in relation to age and sex of the patients. The pathological features of the valves are quite different from the cases seen in Western hemisphere. Three types of gross pathological features are described. First is fibrous stenotic type which has very thick cusps and extremely short chordae tendineae. It is the most frequent rheumatic vavle seen in children, and majority of the valves show pure stenosis, for which probably open commissurotomy is the procedure of choice. Those which have a combination of stenosis and insufficiency usually require valve replacement. The second is the elastic insufficient type, which has a unique gross pathological feature, consisting of a remarkable elasticity and moderately thickened cusps. A valve replacement or valve repair when feasible is the treatment of choice for this type. The third is the calcific stenotic type. In this type the cusps are moderately thickened with short chordae tendineae with various degrees of calcification. This type is seen usually in the 4th decades of life and is more frequent in males. This type of valve must be treated either by open commissurotomy in order to eliminate the risk of embolization of calcific material or with valve replacement.


Comparison of myocardial and adipose tissue lipase activity in the rat.

Effects of catecholamines and iodoacetamide on lipase activity (pH 6.8) and triglyceride mobilization were investigated in adipose tissue, myocardial slice and isolated perfused heart preparation of the rat. Epinephrine and isoproterenol did not enhance myocardial lipase activity in vitro and in perfused hearts. No detectable amount of fatty acid was released from myocardial slice by epinephrine in vitro. Epinephrine, however, induced an increase in lipase activity and in the amount of fatty acid released from the adipose tissue. The results suggest a difference in properties of lipase present in the myocardium and in the adipose tissue. Iodoacetamide decreased lipase activity in vitro both in the myocardium and in the adipose tissue. Triglyceride content in the perfused heart receiving iodoacetamide at 30 min of perfusion was higher than that of the control. However, there was no correlation between triglyceride mobilization and lipase activity in these 2 tissues.


Interpretation of the body surface isopotential maps of patients with right bundle branch block. Determination of the region of the delayed activation within the right ventricle.

Body surface isopotential maps were produced by computer processing of the 85 electrocardiograms obtained from the entire thorax of 28 patients with complete or incomplete right bundle branch block (RBBB). We divided the map patterns into the following 3 groups. Type I map pattern (10 cases): at the early stage of QRS, the maximum was located in the left chest. It shifted to the left from the normal position; at the instant of 44 msec, on the average, after the onset of QRS breakthrough minimum appeared over the left chest. Its appearance was delayed and its site shifted to the left as compared with the normal; at the late stage, the positive zone covered extensively the right chest and the right back; terminally, the maximum was positioned along the right parasternum. Type II map pattern (13 cases): at the early stage of QRS, the maximum was in the left chest as in Type I; breakthrough minimum appeared at 38 msec on the average, later than in the normal, but the site of breakthrough minimum varied from the left chest as in Type I to the midsternal region as in the normal; at the late stage, the positive zone covered the upper part of the right chest and the right back, less extensively than in Type I; the terminal maximum was in the upper sternal region. Type III map pattern (5 cases): the map pattern passed normally until the late stage, but thereafter a small positive zone survived over the upper sternal region. In Type I the delayed activation was presumed to occur all over the right ventricle, in Type II mainly over the smaller area of the right anterior free wall, and in Type III over the localized area of the outflow tract. Patients with complete RBBB showed Type I pattern. Patients with incomplete RBBB showed Type II or Type III pattern, although electrocardiograms failed to differentiate Type II patients from Type III patients. These findings suggest that the electrocardiographic pattern of incomplete RBBB probably arises from the various mechanisms.


Comparative regional and subcellular distributions of histamine and norepinephrine in the hearts of rats, mice, guinea pigs, rabbits, and dogs.

The patterns of distribution of histamine and norepinephrine among the 4 chambers of the heart of rats, guinea pigs, and rabbits and among 15 portions of the dog heart were quite similar, except for the coronary ring of the dog, which was disproportionately high in histamine. In whole mouse hearts the separate chambers were not assayed; in the whole heart, the contents of the 2 amines did not correlate. The subcellular distribution of histamine in the rat and guinea pig heart was different from that of norepinephrine. Histamine was mostly associated with mast cell-like granules. Toluidine blue-staining granules of 2 widely different densities were found.


Electrophysiologic effects of propranolol on the human heart.

Effects of propranolol (10(-9) to 10(-4) Gm/ml) on various electrophysiologic properties of human papillary muscles obtained from patients undergoing corrective open heart surgery were studied to have an insight into the mechanism of its antiarrhythmic activity in man. Propranolol (10(-8) to 10(-6) Gm/ml) produced significant decreases in the action potential duration, effective refractory period and dv/dt of depolarization phase of action potential without significantly affecting the resting potential and amplitude of action potential. These effects were concentration dependent. High concentration (10(-4) Gm/ml) of propranolol not only produced greater decreases in the above parameters but also reduced the resting potential and amplitude of action potential. Although propranolol decreased both the action potential duration and effective refractory period, the shortening of the action potential duration was greater than the shortening of the effective refractory period. It shifted the membrane responsiveness curve to the right and down. It produced frequency dependent decreases in the dv/dt of phase 0 of action potential and the rate of repolarization. Propranolol also increased the threshold of stimulation. Propranolol produced electrophysiologic changes in the human myocardium qualitatively similar to those in canine myocardium. The probable mechanism of its antiarrhythmic activity in man has been discussed.


An accelerated hypertension with neither malignant nephrosclerosis nor elevation of plasma renin activity.

A case of accelerated hypertension, which was unique in a resistance to an angiotensin antagonist, and a lack of the elevation of plasma renin activity (PRA) is reported. Non-elevated PRA was coincided with non-malignant nephrosclerosis in renal histology. The acceleration was attributed to the neurological cause i.e., cerebral hemorrhage in the right hypothalamus which extended to the ventricle and subarachnoid space. The case therefore clinically seemed malignant-like, but it was not malignant hypertension in the sense of Volhard's classical definition. This does not conflict with the usefulness of the determination of PRA in the diagnosis of malignant hypertension with nephrosclerosis.


False inhibition of a demand pacemaker by inactive myocardial electrodes.

A 14-year-old girl has been implanted a cardiac pacemaker with a myocardial electrode since 8 years old. As the first myocardial electrode fractured near its tip, the second one was added. Thus, patient had two pairs of myocardial electrode systems with one demand pacemaker implanted. When she was readmitted to hospital because of light-headedness, ECG monitor revealed the frequent suppression of pacemaker emission on transcutaneous waving of pacemaker unit. Application of the magnet over the generator resulted in no inhibition even on moving the unit. The pacemaker pocket was reopened. Waving the active myocardial electrode or pacemaker unit did not inhibit the demand pacemaker, but manipulation of the inactive lead induced suppression of pacemaker emission. Such manipulation produced high interference waves, which were created probably by motion of the cut end of inactive leads against patient's abdominal muscle. The exchange of the demand pulse generator to a fixed mode was followed by complete disappearance of light-headedness in this case.


Quantitative angiocardiographic recognition of atypical form of tetralogy of Fallot with absent pulmonic valve.

A 9-year-old boy is reported who had tetralogy of Fallot, rudimentary pulmonic valve, and supravalvar pulmonic stenosis. The patient lacked almost all of the clinical findings commonly encountered in this syndrome. Thus he never had signs of a large left-to-right shunt, or congestive heart failure. He had no murmur of pulmonic regurgitation and his pulmonary artery was not large on chest roentgenogram. Angiocardiography revealed moderate main pulmonary arterial dilation. The lack of the usual manifestations of tetralogy of Fallot with absent pulmonic valve was due to supravalvar pulmonic stenosis, acting as a natural pulmonary artery band. A quantitative angiocardiographic study was undertaken in order to find a clue for the diagnosis of these atypical cases. The ratio of the transverse diameters of the main pulmonary artery and the aortic root as measured on lateral angiocardiograms in 31 children with uncomplicated tetralogy of Fallot was 0.70 +/- 0.22, whereas this ratio was 1.70 in this particular patient (p less than 0.001). It is concluded that a quantitative evaluation of the ratio of the transverse diameter of the main pulmonary artery to the aortic root on lateral angiocardiogram allows differentiation of tetralogy of Fallot with absent pulmonic valve associated with supravalvular pulmonic stenosis from uncomplicated forms of tetralogy of Fallot.


Body surface isopotential maps. Clinical application to the diagnosis of myocardial infarction.

This paper is a review of recent work relating body surface isopotential maps to the detection of the site and extent of myocardial infarction in cases which are either indetectable or difficult to diagnose through the use of standard 12 lead ECGs. According to the difference of the site and extent of myocardial infarction, the characteristic maps are obtained. Through the use of body surface isopotential maps, the significant clinical information may be obtained in a number of cases, and we can do better with mapping than without it in the evaluation of patients with myocardial infarction.


Ultrasonic features of anomalous origin of the left coronary artery from the pulmonary artery.

Two cases of anomalous origin of the left coronary artery from the pulmonary artery with and without marked dilatation of the right coronary artery were studied by M-mode echocardiography and cross-sectional echocardiography. The M-mode echocardiogram obtained from the case with the dilated right coronary artery demonstrated an abnormal structure anterior to the aortic root. The cross-sectional echocardiogram of the same case visualized the origin of the dilated right coronary artery. In addition, echocardiographic abnormalities suggesting the ischemia of the left ventricle were observed in both cases. Although many of the ultrasonic features are nonspecific, the combination of ultrasonic technique provides useful clues to the diagnosis of anomalous origin of the left coronary artery from the pulmonary artery.


Echocardiographic features of congenital pulmonary regurgitation.

Eight patients with congenital pulmonary regurgitation documented by cardiac catheterization and angiography were studied by echocardiography. Echocardiographic features of the pulmonary valve observed in this condition included a) diastolic fluttering (5 cases), b) diastolic separation (2 cases), and c) increase of posterior motion during atrial systole (a wave). Maximum a wave depth exceeded the upper limit of the normal value in 2 cases and averaged 6.1 +/- 0.7 (standard error of the mean) mm. In addition, d) diastolic fluttering of the anterior tricuspid valve was seen in 5 cases and e) abnormal interventricular septal motion in 2 cases (one, paradoxical and the other, flat). Of these findings, the diastolic fluttering of the pulmonary valve, which results from the turbulent stream of blood in the outflow of the right ventricle striking the pulmonary valve, is pathognomonic for pulmonary regurgitation. Although the other findings are nonspecific, all patients had at least 1 of these 5 findings. Echocardiography, therefore, provides useful clues to the diagnosis of pulmonary regurgitation. Furthermore, echocardiography should be of use in differentiating congenital from functional pulmonary regurgitation and from aortic regurgitation.


Role of autonomic and non-autonomic circulatory components in borderline hypertension in young men.

The role of autonomic nervous system and non-autonomic components in hemodynamic abnormalities of young patients with borderline hypertension was examined by comparing the effects of sequential pharmacological autonomic blockade on hemodynamics between 8 patients with borderline hypertension (mean age 20.0 +/- 0.2) and 10 normotensive subjects (mean age 19.3 +/- 0.2). Propranolol (0.2 mg/Kg), atropine (0.04 mg/Kg), and phenotolamine (10 or 15 mg) were given intravenously in that order to produce "total" autonomic blockade. Increased cardiac index, heart rate, and mean arterial blood pressure with normal peripheral vascular resistance were noted at rest in patients with borderline hypertension. Cardiac index and heart rate in patients with borderline hypertension were normalized by propranolol, but after "total" autonomic blockade mean arterial blood pressure and peripheral vascular resistance were higher in patients with borderline hypertension as compared to those in normotensive subjects. These results suggest that, although autonomic nervous system control of circulation is abnormal, non-autonomic components play an important role in maintaining increased peripheral vascular resistance in borderline hypertension in young men.


Clinical evaluation of left ventricular myocardial stiffness.

Left ventricular myocardial stiffness was calculated in clinical cases. Thirty patients who underwent diagnostic cardiac catheterization were studied. Left ventricular cineangiograms and simultaneously recorded left ventricular pressure tracings were analyzed. The left ventricular stiffness constant k, was computed by substituting the left ventricular myocardial stress (sigma) and strain (epsilon) throughout the period between the end of rapid ventricular filling and the beginning of atrial contraction, in the equation sigma = b.ek.epsilon. Left ventricular myocardial stiffness was measured as follows: Group I (normal): 9.6 +/- 4.3, Group II (mitral stenosis): 10.7 +/- 4.0, Group III (left ventricular volume overload): 12.1 +/- 4.2, Group IV (coronary artery disease without myocardial infarction): 8.6 +/- 2.5, and Group V (myocardial infarction): 23.6 +/- 7.4. All of the normal cases showed stiffness constants of less than 15 and maxVcf of more than 2.0 circ/sec, and all the patients with histories of heart failure in Groups III to V showed stiffness constants of more than 15 and maxVcf of less than 1.0 circ/sec. For the rest of the patients, measurements of the stiffness constant were valuable for the assessment of patients' clinical status, especially when combined with contractility.


Sodium excretion in volume-expanded dogs. I. Comparison of the effects of physiological saline and 5% glucose solution.

Dogs were subjected to volume expansion with physiological saline and 5% glucose solution. During the infusion Na excretion was significantly increased only when saline was given. Maintenance of the volume expansion with 5% glucose solution immediately following saline infusion was ineffective in preventing the decline of Na excretion rate after the cessation of saline loading. Although the indices of hemodilution such as plasma total protein concentration and peripheral venous hematocrit were reduced along with natriuresis, these values also correlated with the total amount of Na retained during saline infusion. And this amount of retained Na has also a good correlation with the natriuresis. It is concluded that hemodilution is not the essential cause of natriuresis in the present volume expansion experiments, and that the amount of Na retained during saline loading determines the Na excretion rate in some unknown manner. The implication of regression coefficient between Na retention and Na excretion is discussed as a characteristic value in the Na homeostatic mechanism of the organism.


Ultrasono-cardiographic diagnosis of the prolapsed mitral valve.

The characteristic ultrasono-cardiographic (UCG) findings of prolapsed mitral valve were studied in 9 cases by means of ultrasonocardiotomography (UCT). The changes in degree and shape of the prolapsed valve were examined and the leaflet involved was identified. Of the 9 cases, 5 had prolapse of anterior, 3 had that of posterior leaflet and 1 had both. In all cases with midsystolic click and late systolic murmur or pansystolic murmur with late systolic accentuation, the prolapse of anterior leaflet was observed on UCT, and though UCG disclosed midsystolic buckling it was difficult to determine the exact timing of the prolapse by UCG alone. In the cases with rheumatic mitral regurgitation, the prolapse of posterior leaflet and the ballooning of anterior leaflet could easily be found on UCT, but the detection of the above-mentioned 2 findings was difficult by UCG alone. Three of the 9 cases were found to have prolapse of posterior leaflet by left ventriculography, whereas these 3 had prolapse of anterior leaflet on UCT. Hence, the diagnosis of prolapsed mitral valve based on the cineangiography may require re-evaluation.


Isometric contraction and  relaxation times of right and left ventricles in normal subjects and in patients with right ventricular overloading measured with bidirectional echocardiography.

With the use of bidirectional echocardiography, the isometric contraction (ICT) and relaxation times (IRT) of both ventricles were measured in 14 normal subjects (N), 6 cases with right ventricular (RV) diastolic overloading (DO), and 5 cases with RV systolic overloading (SO). The RVDO group consisted of patients with atrial septal defect of ostium secundum type who had large left-to-right shunting, and the RVSO group those with pulmonary hypertension of various origins. The mean ICT and IRT in N were 28.5 +/- 4.8 and 43.8 +/- 1.7 msec for RV, and 43.3 +/- 5.6 and 60.9 +/- 9.0 msec for left ventricle (LV), respectively. The RVDO group showed no significant change in the mean ICT and IRT of RV (29.7 +/- 4.6 and 54.3 +/- 11.8 msec, respectively), but significantly greater means of ICT and IRT of LV (58.5 +/- 9.5 and 83.6 +/- 14.1 msec, respectively. In the RVSO group, the mean ICT and IRT were 51.0 +/- 4.1 and 86.8 +/- 8.2 msec for RV, and 72.4 +/- 12.2 and 116.0 +/- 20.4 msec for LV, respectively. These values were all significantly greater than the means for both N and RVDO groups, except that the mean ICT of LV was insignificantly different between the RVDO and RVSO groups. It was noted that the intervals of LV tended to increase with the increasing intervals of RV, suggesting the changes in LV function secondarily due to RV overloading. It was concluded that the measurement of ICT and IRT of both ventricles is of clinical value for evaluation of overall cardiac function in the patients with RV overloading.


Quantitative relationship between serum Ca and inorganic phosphate concentrations in uremic patients.

Sixty four blood samples from 28 uremic patients were analyzed for total calcium (Ca), inorganic phosphate (P), total protein (TP), and albumin in the serum. In these patients Ca had no significant correlation with either TP or albumin as was generally postulated, but showed significant correlation only with P. The regression analysis revealed that the residuals were of the same order of magnitude in both linear and non-linear formation. It was also found that the product, CaxP, increased along with BUN in uremic patients.


The effects of infusion of calcium and magnesium ions on the cardiovascular system in man.

The effects of Ca++ and Mg++ infusion on the cardiovascular system were studied in 96 normotensive subjects and 85 hypertensive patients. The results obtained were as follows: (1) The effects of Ca++ infusion on the systolic time intervals were characterized by the shortening of QS2I, PEPI, and ICT, and increase in ET/PEP. The responses of the systemic hemodynamics were elevation of mean blood pressure and increase in cardiac index and stroke index. The heart rate was not altered. (2) These results support that Ca++ has a positive inotropic action and increases the left ventricular performance. (3) The effects of Mg++ infusion on the systolic time intervals were characterized by the prolongation of QS2I, PEPI, and ECT. The responses of systemic hemodynamics were elevation of mean blood pressure and increase in heart rate. The ET/PEP and cardiac index tended to decrease, but these changes were not significant. (4) From these results it is suggested that Mg++ depress myocardial contractility and has a positive chronotropic action. (5) There were no significant differences in the systolic time intervals and hemodynamic responses to the infusion of Ca++ and Mg++ between normotensives and hypertensives.


Effects of cardioactive substances on the post-stimulation potentiation of contractility in the isolated dog atrium.

Effects of cardioactive substances on the post-stimulation potentiation of atrial contractility were studied in 17 isolated, blood-perfused preparations of dogs. Maximum degree of the post-stimulation potentiation was obtained over approximately 3.5 Hz within 5-60 sec of stimulation. Each drug was administered directly into the cannulated sinus node artery of isolated atrium. An adequate dose of verapramil, manganese chloride, or pentobarbital which caused marked depression of contractility did not significantly suppress the post-stimulation potentiation in percent changes. The post-stimulation potentiation was not inhibited by continuous infusion of adenosine, which caused a negative inotropic effect. Tetrodotoxin, propranolol, or caffeine also never suppressed the post-stimulation potentiation but ouabain abolished it in the majority of cases.


Hydraulic and hemodynamic studies on the blood flow through the cardiovascular system.

To investigate the hemodynamic aspects across a stenosis in the cardiovascular system, in vitro, in vivo, and clinical studies were performed. The results are summarized as follows: 1) Remarkable changes in the pressure profile were recognized downstream. The relationship between pressure gradient and flow across the stenotic orifice revealed an inverse linear relationship in in vitro studies, but showed a slight convex curve in in vivo studies. 2) The critical stenosis in vitro and in vivo studies 10% and 25%, respectively. 3) In the group of mitral valve area larger than 0.5 cm2, flow coefficient C was smaller than 1.0 and blood flow could be "vena contracta". 4) Gorlin's formula is considered to be appropriate in the cases with valve area larger than 0.5 cm2. But Gorlin's formula may over-estimate in the group with valve area smaller than 0.5 cm2.


Prostaglandin E2 and epinephrine participate in cyclical reduction of coronary blood pressure and flow.

The effects of the agents that inhibited synthesis of prostaglandins (PGs) and thromboxanes (TXs) on cyclical reduction of blood flow in partially constricted coronary artery of anesthetized dog were examined. The cyclical reduction of coronary blood flow was eliminated by intravenous injections of aspirin that inhibited synthesis of endoperoxides, of benzydamine that inhibited synthesis of endoperoxides and TX A2, and of phenylbutazone that inhibited synthesis of PG E2, but was not of reduced glutathione that inhibited synthesis of TX A2 and accelerated synthesis of PG E2. In the preparations in which cyclical reduction of blood flow did not occur spontaneously, intracoronary injection of PG  E2, but not of PG F2a, induced the cyclical reduction. The cyclical reduction was also induced by intravenous injections of epinephrine and reduced glutathione that accelerated synthesis of PG E2. The results indicate participation of PG E2 in the cyclical reduction of coronary blood flow.


Intra-aortic oxygen distribution during veno-arterial bypass (VAB) without oxygenation in circulatory assist.

Right atrium-femoral artery VAB without oxygenation was performed in 7 dogs at 3 different bypass ratios, 15% 30%, and 45%. Respiration and cardiac output were controlled. Precise intra-aortic distributions of PO2 and O2 saturation were determined by means of a PO2 catheter probe and an oxygen analyzer. The following was concluded: 1) The blood pumped from dog heart produced a narrow "mixing zone" in the mid-aorta with the blood pumped from VAB. The area of the "mixing zone" was in the distal half between renal artery and bifurcation at 15% bypass ratio, in the proximal half between renal artery and bifurcation at 30% bypass ratio, and from celiac artery to below renal artery at 45% bypass ratio. It shifted proximally as the bypass ratio increased. 2) In order to supply necessary oxygen to abdominal viscera, it is recommended that the bypass flow should not exceed 30% of the baseline cardiac output.


Renovascular hypertension due to Buerger's disease.

In a 42-year-old man with severe hypertension, stenosis of the left renal artery at its origin and occlusion of the abdominal aorta below the level of the renal arteries were observed. His past history and clinical and laboratory findings suggested that the renal artery stenosis was due to Buerger's disease which was reported to be a rare cause of renovascular hypertension.


Effects of catecholamines and adrenergic blockade on fluid reabsorption in isolated rat cauda epidiymidis.

The rate of fluid reabsorption in the cauda epididymidis of rat has been measured in vitro. Both adrenaline and isoprenaline produced a prompt, reversible and dose dependent increase in the reabsorption rate. These effects were completely blocked by propranolol. The response to noradrenaline consisted of two components. In the presence of an alpha blocker, noradrenaline caused an increase, while in the presence of a beta blocker, it produced an inhibition in the rate of fluid reabsorption. The effects of these adrenergic agents were only observed when sodium ions were present in the intraluminal fluid, suggesting that they only affect the Na+-dependent component of fluid reabsorption. The possibility that they may affect the active transport of sodium in terms of the presence of alpha and beta receptors in the epithelium of the rat cauda epididymidis.


Fundamental studies on physiological and pharmacological actions of L-ascorbate 2-sulfate. VI. Effects of L-ascorbate 2-sulfate on lipid metabolism in guinea pigs.

Effects of L-ascorbate 2-sulfate (AAS) on lipid metabolism were studied in guinea pigs maintained on diet I with sufficient L-ascorbic acid (AA) supplement or on diet II without AA supplement. AAS(300 mg/kg) inhibited an increase in serum and liver levels of lipids to a greater degree than AA (175 mg/kg), a reference compond, in hyperlipidemic guinea pigs induced by cholesterol feeding with diets I or II. AAS also induced a decrease in serum and liver levels of lipids in guinea pigs which had been previously maintained for 6 weeks on diet II containing 1.0% cholesterol. AA administration significantly increased AA level in various organs of animals maintained on both the diets containing cholesterol. It also rectified the AA level lowered by previous maintenance on diet II containing cholesterol. AAS showed a slight AA replacing effect on the AA level. Both AA and AAS exerted preventive and curative effects on several symptoms due to chronic AA deficiency.


Effects of intracerebroventricular prostaglandins E2 and F2alpha on the urine outflow, and a possible role of pgE2 as a modulator.

Effects of intracerebroventricularly (i.c.v.) injected PGE2 and PGF2alpha on the urine outflow were studied in ethanol-anesthetized rats. PGE2 and PGF2alpha, when injected i.c.v., caused diuresis which was followed by antidiuresis. Phentolamine, when perfused i.c.v., was an antidiuretic and inhibited the diuretic and antidiuretic effects of PGE2. Diphloretin phosphate inhibited both effects of PGE2. Polyphloretin phosphate (PPP) and propranolol blocked completely the PGE2-induced diuresis and consequently remarkable antidiuresis was observed after the combined treatments with PGE2 and PPP or propranolol. When PGE2 was perfused i.c.v., a sustained diuresis was obtained and antidiuretic effects of noradrenaline, gamma-aminobutyric acid and L-glutamate were potentiated, inhibited and unaffected by the perfusion with PGE2, respectively. It was indicated that the antidiuretic effect of PGE2 could be dissociated from the diuretic effect and that both effects were mediated through adrenergic mechanisms. The present result also suggested that central PGE2 might act as a modulator of some neurotransmitters involved in water metabolism.


Metabolites of piperidine in rat urine.

Piperidine is one of pharmacologically active biogenic amines. While two pathways for piperidine production have been reported, little is known about metabolism of the compound. In the present study, piperidine and its hydroxylated, conjugated and unknown metabolites were detected in rat urine by radiochromatographic analysis. Using GC-MS technique, it was confirmed that 3-hydroxypiperidine and 4-hydroxypiperidine are major metabolites of piperidine of either exogenous or endogenous origin. The findings substantiate the existence of a mechanism which inactivates piperidine in the living body, since both metabolites lack the potent pharmacological activities as those induced by piperidine.


Effects of centrally affecting drugs on the diuretic and antidiuretic actions of intracerebroventricular prostaglandin E2.

Effects of centrally affecting drugs on the diuretic and antidiuretic actions of intracerebroventricularly (i.c.v.) injected prostaglandin (PG) E2 in ethanol-anaesthetized rats were studied. PGE2, when injected i.c.v. at a dose of 1 nmole, produced diuresis followed by antidiuresis. When morphine (0.1 mM) was perfused i.c.v., urine outflow decreased and neither diuretic nor antidiuretic effects of i.c.v. PGE2 was apparent. The perfusions with picrotoxin, gamma-aminobutyric acid and L-glutamate inhibited either the diuretic or the antidiuretic effect of PGE2. On the other hand, when pentobarbital, diazepam, isoniazid and strychnine were perfused i.c.v., the diuretic action of PGE2 was diminished and antidiuresis in response to PGE2 remained unchanged. These results suggested that the diuretic and antidiuretic effects of PGE2 could be separated. The developed of the diuretic effect of PGE2 was completely blocked by amitriptyline and antidiuresis was increased. In rats pretreated i.c.v. with reserpine, the diuretic effect of PGE2 was prolonged and antidiuresis in response to PGE2 was not observed. An antidiuretic action of i.c.v. norepinephrine was not varied by reserpine. Mechanisms for both effects of PGE2 are discussed.


Fundamental studies on physiological and pharmacological actions of L-ascorbate 2-sulfate. V. On the hypolipidemic and antiatherosclerotic effects of L-ascorbate 2-sulfate in rabbits.

Effects of L-ascorbate 2-sulfate (AAS) on lipid metabolism and on pathological changes of aorta and visceral organs were investigated in cholesterol fed rabbits, with ascorbic acid (AA) and clofibrate (CPIB) as reference compounds. Administration of AAS (300 and 150 mg/kg) inhibited an increase in the levels of serum total cholesterol, free cholesterol, triglycerides and phospholipids caused by cholesterol feeding. A high dose of AAS prevented an increase of liver weight. An increase in the level of liver cholesterol was inhibited by a high dose of AAS. Both doses of AAS effectively prevented an accumulation of cholesterol in the aorta. The area rate of atheromatous plaque in aorta was less in specimens from both groups of AAS than in those from control I. Pathological changes in intima and media of aorta were milder in specimens from both groups of AAS. Developed of patholoigcal changes in arteries of various organs were prevented with both doses of AAS.


Binding of H3-imipramine, H3-dimetacrine and S35-chlorpromazine to synaptosomes.

Binding of H3-imipramine, H3-dimetacrine and S35-chlorpromazine to synaptosomes of rat cerebral cortex was studied using a centrifugation method, and kinetic analysis of the experimental data. Three psychotropic drugs were shown to be rapidly bound to synaptosomes at 2 degrees C, representing a typical binding mode with two classes of binding components, i.e., saturable and non-saturable binding. A double reciprocal plot of the saturable binding component of these drugs revealed that H3-dimetacrine and S35-chlorpromazine represented a single binding mode, whereas H3-imipramine showed a multiple one. When the synaptosomes were treated by freezing and thawing 15 times, a high affinity binding component of H3-imipramine was not observed, while the other two drugs showed a single binding mode as well as those of the undisrupted synaptosomes.  To investigate the specificity of this multiple binding mode, comparative binding studies of H3-imipramine were carried out using myelin fragments of rat cerebral cortex. In the myelin fragments preparation, two typical classes of binding mode as shown in the synaptosomes were also recognized. However, a double reciprocal plot of the saturable binding component showed only a straight line, i.e., single binding mode. These findings suggest that imipramine has multiple binding sites to synaptosomes and a high affinity binding component is affected by freezing and thawing procedure.


Anti-convulsant effect of phthalazino-[2,3b]-phthalazine-5(14H), 12(7H)-dione (L-5418). II. Electroencephalographic study.

L-5418 has an anti-convulsant effect which is similar to that of diphenylhydantoin. The effects of L-5418 on EEG activity in rabbits with acute and chronic implantation of electrodes were studied in comparison with those of currently available anti-convulsants. Intravenous administration of L-5418 increased a slow-wave sleep pattern in the spontaneous EEG, which was also induced by diphenylhydantoin. With respect to the focal seizure in the cerebral cortex induced by local application of penicillin, L-5418 showed suppressive effects on the frequency and duration of seizure discharge, and on the spread of seizure discharge to other parts of the brain. The efficacy was about twice that of diphenylhydantoin. L-5418 and dephenylhydantoin did not increase the threshold of seizures induced by bemegride while trimethadione raised the threshold. L-5418 also showed suppressive effects twice as active as diphenylhydantoin on after-discharge induced by electrical stimulation of the hippocampus and amygdala. This suppressive effect on after-discharge of the limbic system may be parallel with the suppressive effect on psychomotor seizure. From these results of L-5418 on an experimental model of epilepsy, it is suggested that L-5418 has suppressive effects similar to that of diphenylhydantoin on convulsion and the efficacy proved to be twice that of diphenylhydantoin in the EEG study.


Evaluation of chemotherapeutic effects on gastric cancer in relation to the histological pattern.

A combination of MFC (Mitomycin-C, 5-FU and Cytosine arabinoside) was administered to 32 gastric cancer patients and study was made of the therapeutic efficacy in relation to the histological pattern. In evaluation based on the degree of cancer cell infiltration (INF), chemotherapy was more effective in cases with INF alpha and beta than those with INF gamma. As for the grade of follicular hyperplasia in regional lymph nodes of gastric cancer, the higher was the grade, the more effective was the chemotherapy. However, a significant relationship could not be observed between histological pattern of stromal reaction of the gastric cancer and clinical effects of chemotherapy. The grade of lymphocyte infiltration or connective tissue reaction in the stroma was not related with the therapeutic effects. No relationship was also obtained between the grade of sinus histiocytosis of lymphoid reaction in the lymph nodes and therapeutic effects.


Gastric response to meat extract stimulation in patients with gastroduodenal ulcer and patients after vagotomy or antrectomy.

Gastric acid secretion basally and in response to intragastric meat extract instillation or to tetragastrin, and circulating gastrin concentration basally and after meat extract stimulation were studied in 67 patients with gastroduodenal ulcer, 30 patients after highly selective vagotomy or selective vagotomy for duodenal ulcer, 12 patients after antrectomy for or gastric ulcer and 10 control subjects. Circulating gastrin concentration increased significantly after meat extract stimulation in control subjects, patients with ulceration and patients after highly selective vagotomy, and acid secretion in each group was increased significantly above basal level. In patients after selective vagotomy, significant increase of circulating gastrin concentration was observed, but it was not associated with significant increase of acid secretion. After antrectomy, neither gastrin nor acid secretion increased significantly after meat extract stimulation. In conclusion, present study suggested that (1) gastric acid secretion in response to intragastric meat extract is chiefly affected by the responsiveness of oxyntic cells and release of antral gastrin and that (2) the presence of the antrum is almost essential for acid secretion after a test meal, and release of duodenal gastrin after antrectomy would not be so potent biologically as to result in an acid secretion.


Thyroid cancer in childhood.

Thyroid cancer in childhood is a relatively rare condition. Often it shows biological characteristics different from those seen in adults. Based upon 10 cases in our clinic and 57 cases collected from the Japanese literatures, clinical features, pathology, treatment and prognosis of thyroid cancer in childhood are discussed. Pathogenesis is most likely to be related to hormonal changes during adolescence and previous radiation of the neck region. Cervical lymph nodes swelling was the chief complaint in 84.6 per cent of the cases. On the other hand, pulmonary metastases were recognized in the early stages in 33.5 per cent of the cases. Radical excision of the tumor with modified radical neck dissection is the treatment most frequently employed even in the presence of lung metastases. However, hypoparathyroidism and recurrent nerve injuries should be avoided at all cost in view of long life expectancy and the difficulty in treating them satisfactorily. Prognosis could be as good for children as it is for adults except in cases with early lung metastases.


Operative treatment of alveolar echinococcosis of the liver.

This study is based on the experience with 51 cases of hepatic alveolar echinococcosis underwent operative treatment up to the end of 1976. Hepatic resection was carried out in 28 cases with overall operative mortality of 25 per cent, but no death occurred in the last 10 years period during which 12 cases were subjected to the procedure. This apparent improvement of the result is ascribed to the establishment of the strict criteria for operative intervention, i.e., when less than three segments are involved, the hepatic hilum is not highly involved, and the inferior vena cava is not invaded. Marsupialization is employed when hepatic resection is not indicated and the lesion shows liquefaction. Ten cases underwent the procedure with one operative death. Biliary tract reconstruction was carried out in two cases with hilar involvement, but the prognosis was poor. Eleven cases were only with celiotomy. The follow-up studies indicated that the hepatic resection offers the best hope for cure followed by marsupialization. Unlike unilocular echinococcosis in which a cyst grows expansively, the alveolar echinococcosis should be considered clinically malignant, in that it grows invasively and often shows metastatic lesions. Surgical intervention at its early developmental stage is the only definitive way of the treatment. Only recent advances in diagnostic procedures and development of type specific serological studies made it possible to bring the disease under control.


Autogenous internal iliac artery bypass in the surgical treatment of renovascular hypertension: a case report.

A 24 year old female with severe renovascular hypertension resulting from bilateral fibromuscular dysplasia was successfully treated surgically. The internal iliac artery was used for a left aortorenal grafts. The right renal artery was dilated through the amputated left renal stump. Although saphenous vein graft is most commonly used, the autogenous internal iliac artery is considered a satisfactory graft in aortorenal reconstruction, especially for a young patient.


Basic experiments on oral administration of 5-fluorouracil emulsion as adjuvant chemotherapy to surgical treatment for gastric cancer.

Oral administration of 5-fluorouracil (5-FU) emulsion was compared experimentally with that of 5-FU aqueous solution as to the degree of absorption and tissue distribution. After oral administration of both the 5-FU emulsion and the 5-FU solution, 5-FU was detected at the highest level in both the stomach and the duodenum. This seems to suggest that 5-FU is strongly affinitive to the tissues of the gastrointestinal tract. As to the relative concentration of these two forms of the drug, the oral administration of the 5-FU emulsion resulted in a maximum value 1.5 times higher than that of the 5-FU solution. An appreciable concentration of 5-FU was maintained for a considerably long time with the administration of 5-FU emulsion. In the lymph, the maximum level of the 5-FU emulsion was three times higher than that of the 5-FU solution. The drug concentration of the 5-FU emulsion remained higher than that of the 5-FU solution through the entire duration of the experiment. Regarding the drug concentration in the regional lymph nodes, the pattern demonstrated was almost the same as in the lymph itself. It is expected that the oral administration of 5-FU emulsion may be useful as an adjuvant to the surgical treatment of gastric cancer, because of the high drug concentration resulting both in the gastrointestinal tract and in the regional lymph nodes.


A case report of surgical repair of traumatic rupture of the pericardium and diaphragm.

A 55 year-old male with traumatic rupture of the pericardium, diaphragm and spleen, and with crush of the pancreas was successfully operated upon. The diagnosis of rupture of the diaphragm was done on the chest X ray on admission, and the rupture of the pericardium was diagnosed at the time of laparotomy and thoracotomy. The ruptured spleen and the crushed pancreas tail were removed, and the ruptured pericardium and diaphragm were closed successively.


Surgical treatment of infantile lobar emphysema in cardiovascular disease with left-to-right shunts.

Serious symptoms associated with the lobar emphysema in congenital heart diseases with left-to-right shunt disappeared after radical operation for cardiac lesion. The study of seven autopsied cases revealed that the lobar emphysema resulted from check valve mechanism created by compression of the bronchi by distended pulmonary artery. Eight cases of our experience of lobar emphysema disappeared shortly after the operation for congenital heart disease with left-to-right shunt seems to indicate infantile lobar emphysema in congenital heart diseases with left-to-right shunt should not be treated by resection but rather by radical operation for cardiac lesion as soon as possible even in infancy.


Milk of calcium renal stone: a case report.

A case of milk of calcium renal stone was reported. It is an unusual condition in which there is suspension of calcium salt within a pyelogenic cyst. The diagnosis is difficult because of its rarity. Reviewing literature, plain abdominal X-ray in different positions were emphasized. We found that fluoroscopy with spot films in different positions is worthwhile. It has to be differentiated from gallstone and also from usual renal stone. Conservative treatment is advised if there is no suggestive malignancy.


Postirradiation fibrosarcoma following radical mastectomy.

A case of fibrosarcoma arising in the scar of the radical mastectomy with postoperative irradiation of breast carcinoma is reported. The tumors arose five times in spite of the extirpations including surrounding tissue since 11 years after radical mastectomy and postoperative irradiation. All of arisen tumors were diagnosed fibrosarcoma histologically and with every recurrence the aggravation of malignancy of tumors was shown. In this case, the primary tumor of the breast was infiltrating carcinoma and no sign of fibrosarcoma was noted histologically. The mastectomy scar was indicated the irradiation therapy postoperatively and fibrosarcoma developed 11 years after postoperative irradiation. Namely, this case agreed to the strict criteria of the postirradiation sarcoma proposed by Cahan et al. In this paper, a case of postirradiation fibrosarcoma arising in the scar of radical mastectomy for carcinoma is presented.


Doppler ultrasound monitoring of systemic blood flow during CPR.

During cardiopulmonary resuscitation in 12 patients, Doppler ultrasound monitoring of radial arterial flow provided an audible, instantaneous flow sound to which the resuscitation team referred, along with the monitor electrocardiogram (EKG), in determining hemodynamic status. Incidental to the resuscitation effort, a separate analog flow signal and the monitor EKG were simultaneously recorded in eight patients. Doppler blood flow monitoring allowed evaluation of effectiveness of cardiac massage; immediate recognition of electromechanical dissociation; rapid determinations of blood pressure, often during profound hypotension, and estimates of changes in cardiac output. When the hemodynamic consequences were immediately obvious, both ineffective chest compression and pauses longer than five seconds during effective chest compression were not tolerated by those in attendance, for whom the Doppler flow signal often became the primary reference in determining the patient's cardiac status.


Severity, satisfaction and symptom resolution in patients of emergency medicine residents.

Emergency department patients treated by first and second year emergency medicine residents were compared with those treated by surgical interns and residents and medical interns and residents to see if emergency medicine residents are exposed to patients with problems that aid in teaching and whether there is a suitable correspondence between patient severity and clinical training level. The Emergency Department Surveillance System at The Johns Hopkins Health Services Research and Development Center was used to gather data. Results indicated emergency medicine residents were exposed to fewer severe medical causes than medical housestaff but saw a significantly greater number of severe surgical cases than surgical interns and residents. Patients reported greater satisfaction with nonemergency medicine residents. Regarding outcome, there was no significant difference among the clinician groups. For all the patients, pain and anxiety levels improved significantly. Although the findings may be specific to The Johns Hopkins Adult Emergency Department, they demonstrate the methods and motivation for examining the training experience offered emergency medicine residents.