Effects of long-term administration of chlorpromazine on the pineal gland of rats.

Long-term (6 months) administration of 25 mg/kg body weight/day chlorpromazine (CPZ) to rats resulted in remarkable inhibition of normal increase with age of osmiophilic lipid droplets (OLD) in the pineal gland, and atrophy of pinealocytes. The breeding conditions such as illumination, humidity, and room temperature were strictly controlled. Hence, these changes were ascribed solely to the effects of the drug. OLD are considered as an indicator of physiological activity of the gland. In view of the possible functional relations of this organ to endocrine or autonomic nervous activity, our finding may give a clue to the clarification of the possible cause of some side-effects of the drug.


Loss of pigment-laden stellate cells: a severe alteration of the isocortex in juvenile neuronal ceroid-lipofuscinosis.

Juvenile neuronal ceroid-lipofuscinosis is associated with a moderate numerical decrease of isocortical neurons. From Nissl preparations, it is not apparent, whether this neuronal rarefication occurs at random or affects specific types of cortical neurons. Lipopigment preparations facilitate the distinction between pyramidal and stellate cells. In juvenile neuronal ceroid-lipofuscinosis, they reveal an almost complete to total loss of small pigment-laden stellate cells. This type of local circuit neurons, scattered throughout the corpuscular and pyramidal layer in varying numbers and patterns of distribution, is common to all isocortical regions. Its pronounced and selective vulnerability in this lysosomal disease may be causally related to the marked functional impairment of the brain.


Tuberous sclerosis and dysplasia of the corpus callosum. Case report of their combined occurrence in a newborn.

A neuropathological study is presented of a case showing the association of tuberous sclerosis of the brain and dysplasia of the corpus callosum as well as omphalocele and malrotated colon. No signs of tuberous sclerosis were found in the internal organs. From a review of the literature this appears to be the fourth case report of tuberous sclerosis and dysplasia of the corpus callosum. The association with omphalocele, to our knowledge, has not yet been reported.


Dural involvement in rheumatoid arthritis.

Involvement of the cranial dura in rheumatoid arthritis is rare; a new case of this complication is added to the four recorded instances. Dural involvement in rheumatoid arthritis may occur in the absence of other rheumatoid lesions of the CNS; it appears to take a clinically uneventful course and does not seem to represent a factor predisposing to the development of chronic subdural hematoma.


Primary familial amyloidosis with vitreous opacities. Report of an autopsy case.

A 41-year-old Japanese male with a new type of primary familial amyloidosis was reported. The patient developed vitreous opacities, and later, disturbances in the gastrointestinal and nervous systems. At autopsy, amyloid was observed in the vitreous and the retinal vessels. There were extensive cerebral infarcts and heavy meningo-vascular amyloid deposition. Although the postmortem study revealed slight peripheral nerve degeneration in the lower extremities secondary to amyloid deposition, there was no clinical evidence of polyneuropathy.


Suppression of remyelination in the CNS by X-irradiation.

Rat and cat spinal cords were exposed to 2000, 3000 or 4000 rads of x-irradiation prior to producing an area of primary demyelination in the dorsal columns by the injection of lysolecithin. In animals irradiated with 4000 rads no remyelination by either Schwann cells or oligodendrocytes occurred. With 2000 rads both types of remyelination occurred, but when compared to unirradiated controls, central remyelination was less extensive, while Schwann cells remyelinated a greater percentage of axons. With 3000 rads the results were variable, some animals responded similarly to those in the 4000 rad group, whereas others responded as the 2000 rad animals. Oligodendrocytes were found among the persistently demyelinated axons in the 4000 rad animals and their processes were associated with, but only rarely formed a myelin sheath round, the demyelinated axons. It was concluded that irradiation damage to local cells was responsible for the inhibition of remyelination but it could not be determined if this was due to its effect on the oligodendrocytes alone. The origin of the oligodendrocytes found among the demyelinated axons is discussed in this context.


Lewy bodies in cerebral cortex, report of three cases.

The histochemical and structural properties and the topographical distribution pattern of Lewy bodies in the cerebral cortex as well as in the brain stem and diencephalon were studied in three cases. The Lewy bodies in the cerebral cortex were found in the small or medium-sized neurons of the fifth and sixth layers, particularly in the anterior frontal, temporal, insular, and cingulate cortex, and showed minor differences in their histochemical and structural properties from typical Lewy bodies in the brain stem and diencephalon. By light microscopy they were more irregular in shape, less eosinophilic, less sharply demarcated, and did not have clear halos and central cores. From the ultrastructural aspect, the filaments in them did not radiate, but were arranged at random, and circular profiles were not associated in the central zone. This type of Lewy body was also distributed in the basal ganglia. A close relationship between Lewy bodies and monoamines in the cerebral cortex of our cases was not recognized. These three cases showed also concomitant senile changes, i.e., senile plaques and neurofibrillary tangles.


Dendro-dendritic pentalaminar junctions in the Weaver mouse cerebellum.

The cerebellum of weaver mouse is characterized by an extensive reorganization of cell interaction secondary to the absence of mature granule cells. One yet undescribed modality of reorganization found in the hemispheres of 1-month-old animals consisted in the presence of dendro-dendritic pentalaminar junctions. The possible formation of these junctions by fusion of facing post-synaptic densities is discussed.


Granulovacuolar degeneration in pyramidal cells of the hippocampus.

We have shown that as the number of granulovacuolar bodies in affected pyramidal cells of the hippocampus increases so cytoplasmic RNA contant is reduced. Prior to its degeration, the nucleolus is increased in volume while that of the nucleus remains unchanged in size throughout. The effects of these degenerative changes are to bring about a progressive decline in the capacity for nerve cell function, leading eventually to the death of the cell.


Hemosiderin deposition in muscle. Report of three cases.

This report presents the morphological character of iron deposits in muscle biopsies of three patients who have been suffering from secondary hemochromatosis. The granules observed by light microscopy and located either in the cytoplasm of macrophages or inside muscle fibres are illustrated in electron micrographs. In this study, Thiery's technic, which is a specific and very sensitive reaction, has been very useful to confirm by electron microscopy that these granules contain iron. Such a study in muscle appears to be unique. In our experience, accumulation of hemosiderin pigment in muscle does not seem to be specific of any disease but suggests that a hepatic biopsy must be done.


Topographic distribution of neurofibrillary tangles and granulovacuolar degeneration in hippocampal cortex of aging and demented patients. A quantitative study.

Topographic analysis was performed of the distribution of Alzheimer's neurofibrillary tangles and the granulovacuolar degeneration of Simchowicz in the hippocampal cortex of patients with Alzheimer's dementia and mentally normal aged controls. A semiautomated scanning stage microscope was linked potentiometrically to an XY pen recorder in order to plot cytoarchitectonic "scattergrams" from the sequentially screened hippocampal formations. The density of both lesions per cubic mm of pyramidal cortex was quantified by measuring the area of each of six "zones", using a digitizer and programmable calculator. In elderly normal brains as well as those of Alzheimer's disease, the statistically most representative ranking order of predilection for neurofibrillary tangles (in decreasing severity) was: entorhinal cortex greater than subiculum greater than H1 greater than end-plate greater than presubiculum greater than H2. For granulovacuolar degeneration the best rank order was: subiculum greater than H1 greater than H2 greater than end-plate greater than entorhinal cortex greater than presubiculum. The notable similarities of both such orders of predilection to the well-recognized "selective vulnerability" of certain hippocampal neurones in clinical conditions of hypoxia, ischemia and epilepsy suggest some common, focally accentuated cytotoxic mechanism may underlie all these regional predispositions.


Ultrastructure of the Bunina bodies in anterior horn cells of amyotrophic lateral sclerosis.

Light and electron microscopic studies were made on the anterior horn cells in a case o amyotrophic lateral sclerosis. Eosinophilic inclusions of Bunina type were observed almost selectively in the motor neurons of spinal cord, as well as of brain stem, at the light microscopic level. Fine structural study revealed the presence of two types of cytoplasmic inclusions. The first, mainly corresponding to the light microscopic inclusions, were homogeneous, electron-dense, round- or oval-shaped bodies with vesicular or tubular rims and ribosome particles, about 2-5 mu in diameter, which contained filaments or other cytoplasmic componenets in the clear areas within them. The second were lamellar structures (laminated cytoplasmic bodies, Morales) which appeared to be originating from endoplasmic reticulum. There was no distinct transition in these two types of inclusions and the relationship to each other is not clear. The significance of Bunina body is unknown, but some manifestation of a primary disorder, e.g., protein metabolism, rather than a secondary degenerative change in the motor neurons in amyotorophic lateral sclerosis.


Pathological involvement of primary sensory neurons in Werdnig-Hoffmann disease.

Seven patients with the typical clinical picture and muscle biopsy findings of classical Werdnig-Hoffmann disease showed Wallerian degeneration in their biopsied sural nerves. In dorsal root ganglia of one patient there were residual nodules and several chromatolytic neurons. By electron microscopy the changes of chromatolysis were confirmed and found to be consistent with an axonal reaction. Involvement of the primary sensory neuron is probably a regular pathologic feature of Werdnig-Hoffmann disease. The type of abnormality suggests in initial failure of the axon distal to the nerve roots.


Stress fractures caused by physical exercise.

A series of 142 stress fractures caused by sporting activities and physical exercise is presented. 121 fractures occurred in athletes and 21 in non-competitive sportsmen. Distance runners presented with 68 fractures, skiers 12, sprinters 10, orienteering runners 9, vaulters 3, and football-players 3 fractures. Athletes engaged in other events had fewer stress fractures. 76 fractures occurred in the tibia, 26 in the metatarsal bones, 20 in the fibula, 5 in the femoral neck, 4 in the femoral shaft, and 2 in the metacapal bones, lower pubic arch and sesamoid bones of the first MTP-joint. There was one fracture of each of the following: the humeral shaft, the ulna, the vertebral arch of L 5, the tarsal navicular and the proximal phalanx of the fifth toe. The treatment was generally a pause in training for 4-6 weeks, on the average. Running caused most of the stress fractures; the rest followed jumping exercises. The athletes mostly developed stress fractures during a period of alteration from one training session to another or during the preparation period close to the competition season. Joggers usually developped stress fractures 2-4 months after the beginning of regular training.


Fractures of the olecranon. Analysis of 37 consecutive cases.

This study is based on 37 consecutive cases of fracture of the olecranon, treated during the period 1973-1975. The average follow-up time was 2 years. The treatment was operative in all but two of the cases. Superficial post-operative infection occurred in three cases and in three cases the internal fixation failed due to porotic bone. The transverse fractures healed more satisfactorily than the comminuted ones. A short post-operative immobilization of 3 weeks or less gave the best results (P less than 0.05). In the comparison of methods cerclage combined with two Kirschner wires gave better results than cerclage alone.


Fracture of the radial neck in children. A long-term follow-up study of 43 cases.

A series of 43 radial neck or head fractures in children was analysed with respect to the type of fracture and whether conservative or surgical treatment had been employed. Thirty-seven patients were examined after a follow-up period of 1-18 years (average 8 years). Tilting of the radial head, the length of the radius and the size of the radial head were  measured roentgenologically to evaluate any growth disturbances. The results were good in 24, fair in 10 and poor in 3 cases. In the 14 patients treated surgically results were good in five, fair in six and poor in three cases. All but two of these patients had an angulation of the radial head of 30 degrees or more. The result was good in 20 of the 23 patients who were treated conservatively because the angulation was less than 30 degrees after reduction. In fair and poor cases the function was impaired by the limitation of motion. Disturbances in growth were generally slight, but an enlargement of the radial head was observed in 16 cases at the follow-up.


Reduction of displaced supracondylar fracture of the humerus in children by manipulation in flexion.

Sixty-one children with posteriourly displaced supracondylar fractures of the humerus were treated by minipulation with the elbow flexed 40 degrees-60 degrees. This method proved to be safe, easy to apply and was followed by a high rate of success. The elbow was immobilized using a collar-and-cuff or a broad sling and binding of the arm to the forearm with zinc oxide adhesive plaster. In difficult children, the limb was put under the child's clothing to avoid its being used. Redisplacement occurred in only 8.2 per cent of the patients and in none of these was it severe enough to justify remanipulation.


A photoelastic study of a model of the proximal femur. A biomechanical study of unstable trochanteric fractures I.

In attempt to standardize an experimental model for biomechanical studies of unstable trochanteric fractures, acrylic models of the proximal femur were investigated by the photoelastic technique. By matching the stress distribution in the acrylic models to those calculated by Pauwels, it was found that the optimal femoral shaft and resultant hip joint force angles were 5 degrees and 6 degrees to the vertical, respectively. The abductor muscle pull was determined to be 55 per cent of the resultant hip joint force at 15 degrees medial inclination to the vertical.


A photoelastic study of the hip nail-plate in unstable trochanteric fractures. A biomechanical study of unstable trochanteric fractures II.

The photoelastic technique was applied to acrylic models of unstable trochanteric fractures. Model osteosynthesis was performed on nail-plates with different angles. An increase of the angle between the nail and plate was shown to reduce the shear force between those two components considerably. From mecnanical considerations it is recommended that a steep placement of the nail-plate is advantageous in osteosynthesis of unstable trochanteric fractures without medial support.


A roentgen stereophotogrammetric investigation of innominate osteotomy (Salter).

The effect of the innominate osteotomy according to Salter was investigated by a roentgen stereophotogrammetric method in a 17-year-old girl with hip dysplasia as a part of the tricho-rhino-phalangeal (Giedion) syndrome. The osteotomy resulted in a total rotation of 32 degrees about an axis passing cranially to the pubic symphysis and the osteotomy. The acetabulum rotated 22 degrees forwards about a transverse axis, 9 degrees laterally about a longitudinal axis and 24 degrees laterally about a sagittal axis. The acetabulum was translated 2 mm laterally along a transverse axis, 21 mm caudally along a longitudinal axis and 19 mm dorsally along a sagittal axis. The position of the screw axis indicates that some motion also took place in one or both of the sacroiliac joints. The correction as measured with the CE-angle was 25 degrees which was almost the same as the correction about the sagittal axis. It is, however, noted that the CE-angle was also dependent upon the rotations about the transverse and longitudinal axes.


Quadriceps function following indirect nailing of femoral shaft fractures.

A series of 24 adult patients with isolated, unilateral fractures of the femoral shaft treated by indirect Street-Hansen nailing is submitted. Follow-up included clinical and radiological assessment as well as measurement of quadriceps power. Isometric strength as well as dynamic endurance were significantly decreased at the 5 per cent level as compared with the unaffected leg. There was a poor correlation between thigh circumference and strength. The decrease in strength and  endurance after indirect nailing was less than that found in previous investigations of femoral fractures treated by direct nailing.


High tibial osteotomy for rheumatoid arthritis of the knee. A one to six year follow-up study.

Although high tibial osteotomy for osteoarthrosis of the knee joint is well recognized, its place in the management of rheumatoid arthritis of the knee is much less well established. Thirty-six rheumatoid knees were reviewed 1 to 6 years following tibial osteotomy. The results were 42 per cent good, 19 per cent satisfactory and 39 per cent poor. No patient remained free of pain for more than 3 years, and recurrence of pain was not always associated with recurrence of deformity. Varus knees did considerably better than valgus knees despite some technical errors. Maintenance of a normal femoro-tibial angle range of 164 degrees to 177 degrees at follow-up was important but not as vital as in osteoarthrosis of the knee. The beneficial effect of tibial osteotomy in rheumatoid arthritis of the knee seldom lasted more than 3 years after which time an increasing number of bad results were seen. It was concluded that high tibial osteotomy was a satisfactory procedure for rheumatoid arthritis of the knee but its efficacy was not comparable to that seen in osteoarthrosis nor was its effect long-lasting.


A physical examination of orthopaedic implants and asjacent tissue.

This paper reports a metallurgical study of five metal-on-metal total hip replacements removed from patients because of varying degrees of loss of bone substance and/or proven sensitivity to Ni and Cr. Evidence of corrosion of the Co-Cr-Mo-C alloy used to fabricate the prostheses was found. It is suggested that the products of this corrosion may alter the balance of bone formation/resorption to produce a loss of bone substance. An unusual tissue response which included rod-like particles (1-2 micron long x 0.2 micron in cross section), of possible immunological origin, was seen on examination of the articulating surface of one of the prostheses by scanning electron microscopy.


The SAAB jig: an aid in high tibial osteotomy.

To increase the precision of high tibial osteotomy a surgical tool has been developed. The instrument is described. The precision obtainable using the instrument is found to be significantly ( P less than 0.001) higher than that obtained when operating without the instrument.


Osteochondritis dissecans of the talus.

Nineteen patients showing radiological subchondral changes in the trochlea tali are submitted. In 16 cases the changes were osteochondritis dissecans, either with sequestra or with multilocular cysts, and in three cases so-called synovial cysts. The site was in 13 cases the upper medial and in five cases the upper lateral angle of the talus, and in one patient both. In five of the six lateral cases symptoms had started following trauma, while this applied to only five of the 13 medial cases. The three solitary cysts showed marked similarity to the other cases with respect to symptoms, signs, operative findings, as well as possible traumatic aetiology.


A case of septic arthritis in multiple joints due to Bacteroides fragilis in a patient with rheumatoid arthritis.

A case of arthritis in multiple joints due to B. fragilis ssp. fragilis is described. The patient was a 55-year-old man badly disabled by rheumatoid arthritis. The patient's immune response to the isolated strain was studied and a significant titre reduction during the course of the disease was observed. The serum antibodies of the patient cross-reacted with heterologous strains of B. fragilis ssp. fragilis. It is suggested that indirect immunofluorescence tests against a certain number of B. fragilis strains could be performed with serum from a patient in whom an infection with B. fragilis is suspected.


Antibody-coated bacteria in the urine of infants and children with their first two urinary tract infections.

The presence of antibody-coated bacteria in urine has been shown to be an indicator for renal bacteriuria in adults with chronic UTI. To evaluate this method (ABCU test) in pediatric patients, 128 infants and children with their first UTI were investigated. Twenty-nine patients of the 78 who had a first clinically defined upper UTI had antibody-coated bacteria in urine. The test was seldom (2/20) positive in the infants under six months. In the older patients (27/58 ABCU-positive) the frequency of positive tests increased with the duration of symptoms. When the symptoms had lasted for over one weeks, 11 out of the 13 children with their first upper UTI showed antibody-coated bacteria in urine. Four of the 36 first lower UTIs and 5 out of the 14 asymptomatic cases were ABCU-positive. The patients were followed-up for an average of 9 months. Those who were classified as having first upper UTI had in most cases a positive ABCU test in recurrences, independently of the clinical picture. The recurrences after the first lower UTIs showed antibody-coated bacteria in urine only when the recurrence was classified as upper UTI on the grounds of the clinical criteria used.


Long-term effect of previous swimtraining in girls. A 10-year follow-up of the "girl swimmers".

Thirty girls, studied in 1961 after 2.5 years of intensive swimtraining, were the subject of a follow-up for ten years. When last examined, seven and ten years after the original study, all the girls had given up swimtraining. The increased values for vital capacity observed in 1961 remained unchanged, but residual volume, functional residual capacity and total lung capacity showed small increases even after corrections for body growth. Such increases are, however, normal in these years. Heart volume which was high originally, was found to be lower ten years later, although mean values were still higher than normal. The decreases seen from 1961 to 1971 could mainly be ascirbed to a decrease in the subjects with the larges hearts originally. Both total hemoglobin and blood volume decreased to normal values in relation to body size. Maximal oxygen uptake, though, fell from 2.80 l/min (51. 4 ml/kg X min) to 2.18 l/min (36.4 ml/kg X min) ten years later. It is suggested that the functional capacity of the cardiovascular system declined more markedly than its dimensions.


Effect of intravenous L-alanine administration on plasma glucose, insulin and glucagon, blood pyruvate, lactate and beta-hydroxybutyrate concentrations in newborn infants. Study in term and preterm newborn infants.

Ten term and eleven preterm newborn infants with appropriate weights for their gestational age were infused for one minute with L-alanine (150 mg/kg) at the age of 29 to 76 hours (mean 48 hours) and circulating levels of glucose, lactate, pyruvate, D-betahydroxybutyrate (D-BOHB), insulin and glucagon were monitored. Plasma glucose concentrations increased from 2.7 +/- 0.16 (mean +/- S.E.M.) to 3.7 +/- 0.2 mmol/l after 50 min (p less than 0.01) in term infants. In preterm infants, after an initial decrease of the glucose level from 3.1 +/- 0.16 to 2.6 +/- 0.16 mmol/l (p less than 0.05), it returned to the baseline level at 50 min: 3.0 +/- 0.2 mmol/l. The blood concentration of D-BOHB decreased in term infants from 192 +/- 37 to 112 + 6 micrometer/l (p less than 0.01) after 40 min. In preterms, its decrease was not significant (p greater than 0.05). Plasma glucagon level rose from 53 +/- 5 to 70 +/- 8 pmol/l after ten minutes (p less than 0.01) in terms infants and from 61 +/- 6 to 75 +/- 9 after 20 min (p less than 0.01) in preterm infants. There were no significant changes in plasma insulin concentrations in either group. Forty minutes after L-alanine infusion, I/G ratios were lower in preterm infants (1.26 +/- 0.14) than in term infants (1.71 +/- 0.25) (p less than 0.01). There was no relationship between the glycemic responses to L-alanine and the basal levels of D-BOHB. The data suggest that the glycemic effect of L-alanine infusion and circulating glucagon depends upon a specific stage in maturation. The antiketogenic effect of L-alanine infusion is observed in term infants as in adults.


Copper deficiency and hypocalcemic rickets in a small-for-date infant.

A case of copper deficiency associated with hypocalcemia, radiological features of rickets and hyperparathyroidism is described in a small-for-date infant (gestational age 39 weeks, B.W 1 240 g). Neonatal serum copper (Cu) levels were found between 223 and 138 mumol/l. She was given daily 2 400 U of vitamin D2 and a load dose of 80 000 IU at the age of 55 days. At the age of 79 days, X-rays of the legs and wrist showed spread, cupped and frayed metaphyses. Serum Ca was 1.35 mmol/l, P = 0.99 mmol/l with high alkaline phosphatases (A.P.) 590 IU/ml. But plasma level of 25 hydroxycholecalciferol (25-OH-CC) was normal = 10.8 ng/ml. Serum Cu  was low = 3.14 mumol/l and serum immunoreactive parathormone (iPTH) level was elevated: 520 mulEq/ml (N less than or equal to 100). Administration of vitamin D2 (15 mg) induced an immediate normalization of serum Ca, normal serum iPTH (68 mulEq/ml) in one month, normal X-rays in two months and normal A.P. in four months. Serum Cu and ceruloplasmin levels increased slowly without any supplementation to subnormal levels at the age of eight months (14.9 and 1.65 mumol/l. Serum Cu concentrations were found to be normal (16.0--33.7 mumol/l) in five children with hypocalcemic rickets. These results suggest a role of Cu deficiency in the occurrence of this transient vitamin D-resistant rickets.


Diagnostic value of hand X-rays in Turner's syndrome.

Previously described radiological signs of Turner's syndrome were evaluated in X-rays of the left hand from 17 patients with Turner's syndrome (age 10.4--15.3 years) and 17 age-matched girls with constitutional short stature. While none of the signs clearly distinguished between the two groups, ballooning of the tips of the terminal phalanges with a high ratio between the tip and mid-shaft diameters seemed to be the most useful of Turner's syndrome. Disproportionately long phalanges in the 4th finger and the presence of a coarse reticular pattern in the carpal bones appeared to be the next most useful signs. The presence of a short 4th metacarpal or a narrow carpal angle, and assessment for Madelung's deformity were of little value in distinguishing between the two groups.


Renal function in idiopathic respiratory distress syndrome.

Renal function was studied in 11 pre-term infants with idiopathic respiratory distress syndrome (IRDS) grade 1 according to Prod'hom's criteria. As a reference 16 healthy pre-term infants were studied. The groups did not differ with regard to mean gestational age (GA) and mean postnatal age (PNA). The studies were prefomred twice, first at a PNA of 33--37 hours and then at 132--148 hours. GFR and CPAH were determined with the single injection technique and the ability to excrete Na+ was determined following an oral Na+ load. GFR was higher in IRDS infants at the first investigation and slightly lower in IRDS infants at the second investigation. The GFR correlated to the lowest recorded PaO2 (r=0.45) in IRDS infants. CPAH was similar in IRDS and controls at the first, and lower in IRDS infants at the second investigation. The urinary Na+ excretion was significantly higher in IRDS infants. Treatment with digitalis was in part responsible for the high urinary Na+ excretion. The IRDS infants had a higher Na+ and glucose intake than the control infants. It is suggested that this higher intake is in part responsible for the relatively high GFR and urinary Na+ excretion in IRDS infants.


Acute hemolytic anemia related to diphtheria-pertussis-tetanus vaccination.

Three infants developed severe hemolytic anemia following the second or third diphtheria-pertussistetanus vaccination. Direct antiglobulin tests were positive, and the infant most severely affected also had reduced serum complement levels, indicating an immunological mechanism for the hemolysis. The presence of IgM on the erythrocytes from 2 of the infants could be demonstrated by antiglobulin tests or immunization experiments. Heat eluates of the erythrocytes from one of the infants contained antibodies to tetanus and diphtheria toxoids, as well as to Bordetella pertussis, suggesting that these antibodies were antigenically bound to the erythrocytes. Virus antibodies or isoagglutinins, present in the serum, were not found in the eluate. No antibodies against the vaccine components could be demonstrated in eluates of erythrocytes from control subjects. In vivo experiments showed that tetanus and diphtheria toxoids were easily bound to human erythrocytes. This finding could help explain the pathogenesis of the autohemolysis.


Renography in the foetal and newborn lamb.

Hippuran renography indicates kidney function as reflected in a substance handled mainly by the tubules. The working conditions of the kidneys undergo a fundamental change at birth with the cessation of placenta circulation, and these organs become responsible for waste elimination. 131I-hippuran renography was performed on foetal and newborn lambs using a gamma camera and a computer. The intervals of the maximum- and half-time renal activity were determined. These decreased by a half from mean foetal value of Tm=7 mi and T12=19 min in 1 to 1.5 days and reached the full-grown level in 2 to 5 weeks. No sudden change occurred as a result of the first breath.


The diagnosis of iron deficiency by erythrocyte protoporphyrin and serum ferritin analyses.

Free erythrocyte protoporphyrin (FEP) and serum ferritin have been determined in 57 healthy children and in 25 children with varying degrees of iron deficiency. FEP was found to be inversely correlated to the concentration of hemoglobin (r = -0.80) as well as to serum ferritin (r=-0.64). Elevated FEP was found in children with hemoglobin less than 12.5 g/dl, or serum ferritin less than 8 microgram/l. In a group of apparently hematologically normal children between the age of 10--14 years (hemoglobin greater than 12.5 g/dl), a 2-month-trial of iron medication resulted in an increase in hemoglobin and ferritin, and a decrease in  FEP, indicating suboptimal supply of iron for hemoglobin synthesis before iron medication. In a patient with iron deficiency (FEP 15.3 mumole/l, hemoglobin 5.2 g/dl), iron therapy was followed by a rapid fall in FEP before any changes in hemoglobin, serum iron transferrin saturation and ferritin could be detected. The rapid fall in FEP during start of treatment in iron deficiency makes FEP a sensitive biochemical parameter on iron homeostasis in iron deficiency anemia.


Effects of thiamine in a patient with a variant form of branched-chian ketoaciduria.

A boy with the intermediate variant of branched-chain ketoaciduria was studied. Treatment with an amino acid mixture was discontinued at the age of 7.5 years. Reintroduction of normal protein-containing foods precipitated the biochemical abnormalities, characteristic of MSUD, which were relieved by 10 mg thiamine/day. Adaptation to this regiment developed and thiamine intake was increased to 100 mg/day, later to 1 000 mg/day. The patient developed well and had no attacks of ketoacidosis. 1-14C-leucine degradation in intact fibroblasts was 15% of controls and did not increase upon addition of thiamine to the incubation medium.


Visual disorders in 7-year-old children with and without previous vision screening.

An analysis of visual defects among 310 children referred from a vision screening of 2 178 7-year-old children revealed a 50% frequency of significant eye defects among the referrals (7% of screened children). Of the screened children, one group (1 530 children) had previous visual screening three years earlier. The other group (648 children) had no previous vision screening until the age of seven. A comparison between the two groups showed that the risk of finding a new significant eye disorder in a school entrant was more than 6 times greater for a child who was not examined in his preschool years, and the risk of finding an amblyopic child was more than 10 times greater. The results do indicate the need for continuation of the present vision screening program of pre-school children.


Abnormal neutrophil chemotaxis in a syndrome of unusual facies, proportionate small stature and sensorineural deafness-mutism.

Two of 5 children in one family presented with unique facies, proportionate small stature and sensorineural deafness-mutism. One of the children who had a history of recurrent infections, was shown to have a defect of leukocyte chemotaxis. Although impairment of chemotaxis could not be demonstrated in the other affected sibling, it is unlikely that the association of a previously undescribed syndrome and a rare disorder of chemotaxis is a chance occurrence.


Polyamines and nucleic acids in the mouse kidney induced to growth by testosterone propionate.

Daily injections of testosterone propionate to castrated mice resulted in a striking increase in kidney weight. Renal putrescine rose sharply and the amounts of spermidine were also increased. The activity or ornithine decarboxylase was enhanced to values of more than 1 000 times the control level within a few days of testosterone substitution. A moderate and temporary increase in the activity of the putrescine-activated S-adenosyl-L-methionine decarboxylase was observed. Testosterone injections produced a large increase of renal RNA but only a minor change in DNA. It is apparent that in mice distinct alterations in polyamine metabolism occur during the development of renal hypertrophy induced by testosterone administration.


The effect of endogenous and exogenous GABA on the level and turnover of noradrenaline and dopamine in the rat brain. Acta Physiol. Pol., 1978, 29 (2): 117--121. GABA administered to the lateral ventricle of the rat brain (i.v.c.) in doses of 200 and 600 microgram decreased the level of noradrenaline and had no effect on dopamine level. A similar effect was obtained after raising the level of endogenous GABA in the brain by means of intraperitoneal hydroxylamine (Hx) in doses of 50 and 75 mg/kg. It was also observed that GABA given i.v.c. in a dose of 600 mg/kg reduces the turnover of dopamine in the brain.


Time course of light induced changes in pilocarpine sensitivity of rat iris.

Pigmented rats were kept under different light regimens for 1--20 days. Supramaximal light was used. The response of the iris sphincter in enucleated eyes with their cornea intact was tested in vitro. Pilocarpine at 6 X 10(-5) M was used as a standard stimulus. In agreement with previous authors there was a marked difference between constant light treated (subsensitive) eyes and dark treated (supersensitive) ones. Animals pretreated to reach maximal sub- and supersensitivity and then shifted to the opposite regimen, showed that reversal was a gradual process starting within a few hours. Full reversal had not been reached at 72 h. The two curves of sensitivity vs time intersected around 24 h. The time constants of the two curves were approximately equal. Light regimens using intermittent light shifting every 1, 3, 6 or 12 h gave intermediate results.


The effect of hemorrhage on blood arginine vasotocin level in the domestic fowl. Acta Physiol. Pol., 1978, 29 (2): 107--110. The blood arginine vasotocin (AVT) level of domestic fowl after hemorrage was determined on the isolated bladder of the frog. It was found that hemorrhage equivalent to 10--20% of the blood volume caused a 2--3 times greater increase in blood AVT level compared to that found before stimulation.


Relationships between muscular strength and the level of energy sources in the muscle. Acta Physiol. Pol., 1978, 29 (2): 139--151. An attempt was made to establish a relationship between the post-excercise changes in the level of anaerobic energy sources and changes in the muscular strength. The gastrocnemius muscle of Wistar rats was examined. The muscle strength was measured by the resistance tensometry. In muscle specimens ATP, CP and glycogen contents were determined. It was demonstrated that changes in the post-excersise muscle response to electric stimulus have a phasic character resembling the overcompensation curve. The percent changes in the content of anaerobic energy sources in the muscle after contractions varying in duration suggests also overcompensation the muscle content of these substances. The parallelity between the time of appearance of peak overcompensation phase in the muscle strength and in the post-exercise level of musclar ATP, CP and glycogen contents suggest a casual relationship between these changes.


Competitive inhibition and exchange transport between arginine and lysine in the process of absorption from the caecum in pigs. Acta Physiol. Pol., 1978, 29 (2): 161--165. Arginine competes with lysine in the process of transport across the mucosal epithelium of the pig caecum, and the ability of arginine absorption is much greater than that of lysine. Absorption of large amounts of arginine causes secretion of large amounts of lysine into the intestinal lumen in the process of primary active exchange transport. Lysine is better absorbed from solution containing no other amino acids than from solutions containing mixtures of amino acids. Basic amino acids (Arg, Lys, His) stimulate the absorption of serine and threonine from the caecum of pigs.


Inhibition of vasopressin-release during developing hypernatremia and plasma hyperosmolality: an effect of intracerebroventricular glycerol.

In non-hydrated goats prolonged (3 h, 0.02 ml/min) intracerebroventricular (IVT) infusion of 0.35 M glycerol depressed the plasma vasopressin level during the entire infusion period which resulted in a conspicuous water diuresis outlasting the infusion by about 20 min. Since no compensatory drinking occurred during this sustained water diuresis it gradually induced pronounced dehydration (loss of greater than 1 liter of total body water causing 5% increase in plasma [Na+] and osmolality). The same degree of dehydration was in other experiments induced by water deprivation. It then caused a 5-fold increase in plasma vasopressin level. Corresponding IVT infusions of 0.35 M d-glucose depressed plasma vasopressin level only during the first half of the 3 h infusion period. Consequently, the resulting water diuresis was transient and subsided before the glucose infusion was finished. Plasma renin activity increased during the IVT glycerol infusion and during water deprivation, but was largely unaffected by IVT glucose. Both IVT glycerol and glucose decreased renal sodium excretion. The possibility is discussed that the pronounced ability of IVT glycerol to depress the vasopressin release and thirst is not only due to dilution induced reduction of CSF [Na+], but also to an influence of glycerol on choroidal and/or transependymal Na+-transporting mechanisms.


The effect of secretin on bile production, splanchnohepatic hemodynamics and liver function in cats.

The effect of secretin on bile flow, biliary clearance of 14C-erythritol and bile composition was studied in fasting, chloralose anesthetized cats. Secretin (2 U.kg-1 . h-1) increased from values below the values above the erythritol clearance, which did not change significantly. It is therefore concluded that secretin altered ductular transfer of fluid from a net reabsorption to a net secretion of a bicarbonate rich fluid. Secretin did not affect the sphlanchno-hepatic hemodynamics or the overall function of the liver and Indomethacin did not significantly alter the response to secretin.


Interrelationships between amino acids absorbed from the isolated pig caecum in situ. Acta Physiol. Pol., 1978, 29 (2): 167--176. Amino acids are absorbed selectively from the caecum of pigs depending on their qualitative and quantitative composition in the intestinal contents. Signigicant interrelationships were found between the absorption of different amino acids. Tyrosine exerted a significant stimulating effect on the absorption of most amino acids absorbed from the caecum, e.g. Asp-NH2, Ser, Thr, Arg, Asp, Glu. An increased absorption of Ser and Thr caused a rise in tyrosine absorption. The absorption of serine and threonine stimulated the absorption of arginine. Serine and threonine competed in the process of absorption, and the activity of serine in this process was much higher, in comparison with that of threonine. Secretion of amino acids back into the intestinal lumen was demonstrated.


Effect of the nonionic detergent triton X-100 on sodium permeability of the myelinated nerve fibre of Xenopus laevis.

The effect of the nonionic detergent Triton X-100 (TX-100) on the Na permeability (PNa) properties of the nodal membrane in myelinated nerve fibres of Xenopus laevis was analysed with potential clamp technique. Application of TX-100 caused a rapid initial decrease in PNa that was reversible at wash out as well as a slow irreversible block. Both effects dependend on [TX-100] and duration of exposure. The reversible reduction of PNa at the steady state was 50% at 40--60 micrometer TX-100. The slope of the Hill plot for the reaction was 1.75 indicating a deviation from a first order reaction. The equilibrium dissociation constant (KD) for n = 1.75 was 0.9 X 10(-7) (M1.75). KD calculated from the rate constants for onset and offset of the reversible reaction (KD = k2/k1) was 1.5 X 10(-7) (M1.75). The possibility that the action of TX-100 involves membrane proteins is discussed.


Dose-dependent inhibition of sensory nerve activity in the feline dental pulp by anti-inflammatory drugs.

The aim of the present study was to investigate whether substances known to antagonize algogenic agents can block an experimentally induced increased sensory nerve activity in the dental pulp of the cat. Increased neural activity following repeated brief head stimulation has been shown to be characteristic of the individual cat and can be utilized for intraindividual comparative studies on such increased activity. When indomethacin, diclofenac sodium or naproxen were given intravenously as a pretreatment prior to stimulation, a consistent blocking effect on expected impulse activity as compared to the impulse activity in the control teeth was produced. Indomethacin produced a dose-dependent inhibition (ID50 0.04--0.2 mg/kg). Diclofenac sodium (5 mg/kg) inhibited nerve activity by 51--91% and naproxen (15 mg/kg) by 92--95%. Methylsergide (0.02--0.08 mg/kg) did not show such blocking effect. When the drugs were administered during a state of established increased neural activity no effect on the current impulse activity was obtained. The present results suggest that prostaglandins may be involved in certain stages of heat induced pulp inflammation and act as mediators of increased intradental sensory nerve excitability.


Release of oxytocin from the rat posterior pituitary lobe incubated in situ and from the hypothalamic end of the cut pituitary stalk. Acta Physiol. Pol., 1978, 29 (2):97--105. Using the method of incubation in situ of the posterior pituitary lobe and washing the hypothalamic end of the divided pituitary stalk the activity of neurosecretory neurons was investigated directly. The oxytocic activity of the fluid incubating in situ the posterior pituitary lobe or washing the hypothalamic end of the cut pituitary stalk was determined on the rat myometrium. The oxytocic activity disappeared from this fluid after inactivation with sodium thioglycolate. The samples of the fluid incubating the posterior pituitary lobe obtained at 30 min intervals showed alternatingly increased or decreased oxytocic activity. In the fluid washing the cut pituitary stalk the activity was highest from 31 to 60 minutes after division of the stalk.


Sympathetic control of metabolic and hormonal responses to exercise in rats.

The importance of the sympatho-adrenal system for the pancreatic hormonal response to exercise and, furthermore, the role of glucagon and catecholamines for the hepatic glycogen depletion during exercise were studied. Rats were either surgically adrenomedullectomized and chemically sympathectomized with 6-hydroxydopamine or shamtreated. Two weeks later the rats had either rabbit-antiglucagon serum or normal rabbit serum injected. Subsequently the rats either rested or swam with a tail weight for 75 min. Immediately afterwards cardiac blood was drawn and liver and muscle tissue collected. In control rats in spite of an increase in blood glucose concentrati4ns during exercise plasma insulin concentrations were unchanged, while glucagon concentrations increased. In sympathectomized rats, compared to control rats, glucagon concentrations increased less, and insulin concentrations were higher, although glucose concentrations were lower during exercise. Sympathectomy completely abolished the exercise-induced decrease in liver and muscle glycogen concentrations, whereas neither glycogen depletion nor plasma catecholamine concentrations were influenced by the administration of glucagon antibodies. These findings indicate that the sympatho-adrenal system enhances glucagon secretion as well as muscular and hepatic glycogen depletion but inhibits insulin secretion in exercising rats. The increase in glucagon concentrations, however, does not enhance hepatic glycogen depletion at the work load used.


The in vivo transport of 14C-alpha aminoisobuturic acid into mouse blastocysts during activation for implantation.

The in vivo transport of 14C-AIB (14C-alpha-aminoisobuturic acid) into mouse blastocysts was studied during activation for implantation. Mice, kept in experimentally delayed implantation, were given estrogen to induce implantation and then injections of 14C-AIB i.v. at 0, 4 and 8 h after the estrogen. After in vivo incubation times for 1/3 or 4 h with the labeled amino acid the blastocysts were flushed out of the uterus and collected. A distinct uptake of 14C-AIB occurred in the blastocysts 8 h (the highest uptake) and 12 h after the induction, provided that the in vivo incubation time was 4 h. At these times the blastocysts are lying free in the uterine lumen and consequently there is a transport of 14C-AIB from the epithelium via the uterine secretion into the blastocysts. This uptake indicates that amino acids transported by the system A are important nutrients during early activation. The uptake and retention of 14C-AIB in the uterus was tested at 4 and 8 h after the induction of implantation. The highest uptake was observed when the labeled amino acid was given at 8 h while the longest retention time occurred when 14C-AIB was given at 4 h. Since the transport ratio between the blastocysts and the uterine tissue is not maintained constant it is concluded that the metabolic rates for 14C-AIB transport are different for the uterus and the blastocysts. The AIB transport into uterine tissue preceeds that into the blastocysts. The AIB transport into the blastocysts is maintained as long as they have a negative surface charge.


Influence of indomethacin and of prostaglandin E1 on total and regional blood flow in man.

The central and regional circulatory effects in man of the prostaglandin synthetase inhibitor indomethacin and of prostaglandin E1 (PGE1) were studied. Systemic blood pressure, cardiac output, and renal and splanchnic blood flow were measured at rest, following infusion of indomethacin (50 mg i.v.), and during infusion of PGE1 (4--8 mg x min-1 i.v.) after the administration of indomethacin. An increase in the total systemic resistance (+ 20%), as well as in the renal (+ 30%) and splanchnic (+ 16%) vascular resistances developed rapidly following the administration of indomethacin. Infusion of PGE1 completely restored the resistance in the renal and splanchnic regions, and in addition markedly increased the blood flow in non-visceral tissues. We suggest that the circulatory effects by indomethacin are elicited via the drug's inhibitory effect on prostaglandin synthetase in the vessel walls, and that vasodilating products of PG synthetase affect the regional blood flow distribution in man.


Ectopic ureterocele in the male infant.

An account is given of a series of ectopic ureterocele present in 14 male infants. The malformation is found to be more complex than in the female. The ipsilateral renal function is severely impaired or abolished and obstruction to the bladder outflow common. Associated dilatation and elongation of the posterior urethra during micturition may result in a valvelike appearance. Eversion of the male ureterocele is common and possible mechanisms to account for this event are discussed.


Kidney size in infants and children assessed by area measurement.

A method for assessment of the kidney size in infants and children is described based on measurement of the renal parenchymal area determined planimetrically, using for reference the height of the column of the upper three lumbar vertebrae or the body weight. The kidney size is expressed in standard deviation in the appropriate nomograms.


Relation of length of submucous segment of the ureter to lesions of the renal parenchyma in children.

The possible relationship between the length of the submucous ureteral segment and frequency and degree of renal parenchymal injury was analysed in children with urinary tract infection and vesico-ureteral reflux. If the grade of reflux was disregarded, no relation was found to exist between these parameters.


Relationship between area and function of the kidney in well defined childhood nephropathies.

Length, parenchymal area planimetrically determined and volume of the kidney were estimated at urography and related to glomerular filtration rate in patients with different nephropathies. The results demonstrate that the size of the kidney is an excellent index of renal function in patients with pyelonephritic scarring secondary to urinary tract infection and vesicoureteral reflux. It is also a good index in patients with obstructive hydronephrosis but a poor index in patients with glomerulonephritis.


Birth injuries to the epiphyseal cartilage.

A birth injury in the vicinity of a joint might lead to a fracture through the epiphyseal cartilage. The criteria for diagnosing such a fracture at radiography are considered and the continued remodelling of the bone demonstrated. The history of 2 cases with late diagnosis and serious long-term sequelae are described, in order to emphasize the necessity of early radiography.


Traumatic bowing of forearm and lower leg in children.

Traumatic bowing of the forearm or lower leg is reported in 31 children. It is a relatively rare condition. Bowing occurs most frequently in combination with fracture of the other bone in the same extremity. In a minority of cases a bowing deformity is a single lesion. Age distribution, degree of deformity, mechanism of origin and therapy are presented and discussed.


Recurrent intussusception. Analysis of a series treated with hydrostatic reduction.

The appearances at conventional radiography and barium enema were compared in a series of 35 patients with recurrent intussusception and in the same number of cases with an uncomplicated course. Only minor disparities between the groups could be established. The significance of a sparse amount of intestinal gas pointing to intussusception and the implication of a complete evacuation of the bowel following barium enema are stressed. The latter phenomenon, occasionally combined with persistent mild small bowel meteorism, occurred in approximately one-third of all early relapses. Patients with one manifest relapse run a significantly increased risk of further recurrences although in the majority of cases no significant etiologic factors are encountered.


Scanty intestinal gas in infants and children. Clinical significance and radiologic diagnosis.

A material of 23 boys and 18 girls attending as abdominal emergencies and covering the age interval of neonates to 15 years of age had only scanty amounts of intestinal gas on films of the abdomen. A wide variety of underlying abnormalities were revealed, some of them calling for immediate operation. Supplementary contrast examinations were frequently needed in order to establish the diagnosis.


Displacement of left ventricle in atrial septal defect.

Catheterization and biplane cineangiography were performed in 28 patients with atrial septal defect. The left and right ventricular volume in end-systole and end-diastole were estimated with a computed method. The relation between the left and right stroke volume ratio and the posterior displacement of the left ventricle was analysed. A statistically highly significant positive correlation between the angle of the long axis of the left ventricle and the shunt was established.


Stimulus intensity effects of acute extinction of the CER in rats.

Two groups of 9 rats were trained in the conditioned emotional response (CER) consisting of suppression of food-motivated behavior as a consequence of the pairing of white noise with unavoidable shock. One group was trained and then extinguished with an 80 dB white noise value and the other with the 50 dB white noise intensity as the conditioned stimulus (CS). The CER acquisition was faster with the more intense CS, however, on the last training day, conditioned suppression reached the same asymptotic level in both groups. Then an acute extinction procedure was introduced, wherein the CS was presented only once a day and lasted continuously until the end of the session with no US presentation during this period. This procedure was repeated over several consecutive days. During the first prolonged CS action, CER extinction was more rapid in the 50- than in 80-dB group. However, on the next extinction day the amount of suppression was less with the more intense CS. The results were discussed in terms of CS intensity effects on learning and performance of the conditioned response.


Deficit in postoperative learning and retention of complex tasks by septal rats.

Pre- and postoperative acquisition and retention of locomotor tasks of different complexity were investigated in septal rats. Experiment I involved acquisition and retention of a task using a four-unit-quadruple-choice apparatus. Severe impairment in both postoperative acquisition and postoperative retention was observed from all parameters of learning: trials, errors, repetitive errors and vicarious responses. However, there were significant savings in postoperative retention, scores compared to postoperative acquisition by septal rats. Experiment II examined acquisition and retention of a less complex task by using a two-unit-quadruple-choice apparatus. Impairment of postoperative acquisition in septal rats was reflected only in the number of trials to learning criterion and vicarious responses, while the number of errors and repetitive errors were not distinguished between normal and septal animals. Retention deficits in the septal rats were reflected in all learning parameters, although there were savings in postoperative retention compared to postoperative acquisition scores attained by septal rats. It is suggested that lesions of the septal area in rats may change the integration of intero- and exteroceptive cues, providing a source of interference if the task can be solved by the use of more than one strategy.


Proactive and retroactive effects of hippocampal stimulation on active avoidance learning, hippocampal EEG and brain acetylcholinesterase activity in cats.

The subject of this investigation were the effects of electrical stimulation of the hippocampus on the acquisition of active avoidance response (AAR) in a shuttle-box. The stimulation (200 microamperes, 50/s, negative rectangular pulses of 1.0 ms duration) was applied once for 10 s before or after each training session. It was found that the application of hippocampal stimulation before each session facilitated the acquisition of AAR; discontinuation of the stimulation after training did not cause a decrease of AAR performance. Application of the stimulation after each session inhibited learning in four out of six cats. However, the level of AAR performance increased rapidly in these cats after inversion of the trials-stimulation sequence. It was also found that the intensity of the somatic and vegetative symptoms evoked by stimulation (stupor, salivation, twitching of facial muscles, pupil dilatation, crying) increased gradually in successive experimental sessions, suggesting the development of the 'kindling effect in cats stimulated before each session. In cats stimulated after each session the intensity of these symptoms was greatly diminished as compared to sessions where the stimulation was not preceded by the avoidance training, or they did appear at all. However, normal sensitivity to stimulation returned after several applications of hippocampal stimulation before each experimental session. Electroencephalographic studies showed that hippocampal stimulation with the use of the same parameters as those used during training evoked hippocampal afterdischarges lasting 5-60 s. No changes of aceltycholinesterase activity in different brain regions were found in consequence of such stimulation.


Persistent embryonic veins in arteriovenous malformations of the brain.

The  course and direction of persistent foetal venous channels are easily defined in the relatively simple segmental portions of the nervous system, such as the spinal cord, the myelencephalon, the metencephalon, and the mesencephalon. In sites were embryonic development is more complicated, like the diencephalon and the telencephalon, rapid growth and folding of the cortex complicate the patterns of the foetal blood vessels. Arteriovenous malformations in such sites are correspondingly more complex.


[Traumatic arteriovenous fistula following epidural haematoma due to middle meningeal haemorrhage (author's transl)].

A case of traumatic arteriovenous fistula following rupture of the middle meningeal artery and epidural haematoma formation is reported. The underlying mechanisms responsible for this and the surgical consequences are discussed.


Spontaneous carotid-cavernous fistula with fibromuscular dysplasia.

A young woman presented with a spontaneous carotid-cavernous fistula. She also had fibromuscular dysplasia of the extracranial cerebral arteries. The possible relationship of the two diseases brought up important questions concerning how to manage the patient. Treatment by obliteration of the carotid circulation on one side would be expected to increase blood flow on the other side. If the cavernous carotid artery on the second side was weakened by fibromuscular dysplasia, the increased flow might predispose to the formation of a second carotid-cavernous fistula. We first attempted to avoid surgery. When progressive symptoms occurred, the cavernous sinus was obliterated with bronze wire, thus preventing venous shunting.


Treatment of tumours of the posterior part of the third ventricle and the pineal region: a long term follow-up.

This paper represents a further investigation into the origninal series, with additional cases from N.I.N.U. This follow-up has been immeasureably enhanced by the availability of the EMI Scanner. It seems clear that there continues to be adequate evidence that the use of shunting procedures, followed by radiotherapy, is a rational approach to tumours of the pineal and posterior third ventricular region. Short of more extensive evidence to the contrary, we feel that it remains the method of choice in the initial treatment of these difficult lesions.


Unruptured intracranial aneurysms--an unusual source of epilepsy.

Six patients with epilepsy were found to have intracranial aneurysms, mainly in the middle cerebral territory. The mechanism of production of these presenting symptoms is considered to be a minor haemorrhage with localized destruction of brain, or calcification in the aneurysmal wall behaving as a hamartoma. In the differential diagnosis of factors causing epileptic attacks, an intracranial aneurysm should be considered, and its presence should be excluded by angiography before any blind surgical procedure for epilepsy is undertaken.


Classification of aneurysms of the internal carotid system.

Microsurgery has improved the treatment of cerebral aneurysms techically and by more detailed knowledge of the topographic relations, the variations, and the anomalies of the involved arteries. A personal study of 450 aneurysms formed the basis of a modified and more detailed classification of aneurysms of the carotid system. It was confirmed that aneurysms originate at the junctions of arteries, and generally project according to the course of the vessel involved. The origins and projections aneurysms and their different sites were analyzed with the aid of angiography, angiotomography, magnification angiography, operative drawings, photographs, and films, which permitted the establishment of a special classification for every particular form. Preoperative knowledge of the types of aneurysms facilitates the surgical procedures and results in lowered morbidity.


[Postoperative vasospasm after clipping of intracranial aneurysms (author's transl)].

After clipping of intracranial aneurysms, postoperative vasospasm may occur remote from the distribution area of the artery and may cause death. The authors report two cases and give the clinical, neuroradiological, and neuroanatomical findings.


Cavernous angiomas of the brain. Account of fourteen personal cases and review of the literature.

Fourteen cases of cerebral cavernous angiomas are reported and the literature pertaining to the subject is reviewed. Some of these rare malformations remain asymptomatic throughout life, some give rise to symptoms (epileptic seizures with or without haemorrhage or slowly evolving focal nervous deficits) which usually appear in adult life. Precise pre-operative diagnosis is difficult, as at angiography they most often appear as avascular space-occupying lesions. Surgical removal is easy in most cases, and the operative outcome is good.


Surgical treatment of arteriovenous angiomas localised in the corpus callosum, basal ganglia and near the brain stem.

Seven cases of deep angiomas, in regions near the midline, were operated on in the National Institute of Neurosurgery, Budapest. In four cases the malformation was not so circumscribed that it could be localized in one structure alone. On two occasions it involved the corpus callosum and the neighbouring hemispheral substance; in one instance it involved the head of the caudate nucleus and the lateral ventricle also. Two intraventricular angiomas, supplied by the choroidal arteries, involved the corpus striatum and the thalamus. Three cases of juxtapeduncular angiomas are described in this series. They were situated in the deep medial part of the temporal lobe, closely adhering to the peduncle, and supplied by branches of the posterior cerebral and the lateral choroidal arteries. In one case the malformation, which involved the thalamus, could be only partly removed. In six cases total extirpation was carried out. All patients ar alive and six are working. No symptoms which were not present before operation have appeared. The importance of adequate radiological studies prior to surgery is emphasized. Attention is drawn to the possibility of eventual obstruction in the CSF circulation in the postoperative period following intraventricular manipulation.


Properties of platelet phospholipase A2.

Thrombin, within seconds after its addition, stimulated the release of 1-14C-20:4n-6 from the platelet phospholipids, phosphatidylcholine and phosphatidylinositol. Although inhibitors of prostaglandin cyclooxygenase did not inhibit this PLA2 activity, the anti-malarial drug, quinacrine, did. The location of the PLA2 that furnishes 20:4n-6 for the cyclooxygenase is not clear, but if it were in or near membranes containing the cyclooxygenase, phospholipids in the vicinity might serve as the source of 20:4n-6. How substrate specificity relates to the asymmetric distribution of the various phospholipid classes in membranes is yet to be determined.


A comparison of the electrophoretic haemoglobin patterns of the vertebrates.

A comparative study of the haemoglobins of 648 animals distributed over 300 species of vertebrates and belonging to different classes has been made by horizontal starch gel electrophoresis is tris EDTA-borate pH 8.6. Multiple haemoglobins were found within the different classes. The percentage of multiple haemoglobins varies from class to class. The frequency-distribution of the mobility values of haemoglobins is rather specific for the different classes and in certain instances for the different orders.


Study on the helminthiasis of Rutilus frisii katum from the South Caspian Sea.

Four different species of helminths: Anisakis spp. Diplozoon paradoxum, Aspidogaster limacoides and Asymphylodera kubanicum were found in 1.4%, 28%, 15% and 5% of 140 Rutilus frisii katum from the south Caspian Sea respectively. Generally, the number of worms collected was low and cannot be considered pathogenic to examined fish.


Localization of larvae of Metastrongylus apri (Gmelin, 1790) Vostokov, 1905, the lungworm of pigs, in the annelid Eisenia foetida Savigny, 1826.

The first stage larvae of Metastrongylus apri could be recovered from the crop of Eisenia foetida after 24 hours of their infection. These were found invading the calciferous glands of the annelid as early as 48 hours post-infection. The larvae were subsequently found localized in the calciferous glands. hearts, dorsal vessel, anterior part of crop and part of the oesophagus anterior to the calciferous glands of the annelid. In general, the larvae had a preference for the circulatory vessels of the annelid so that great majority of them inhabit in the vascular system and the blood sinuses of the above mentioned organs.


Renal papillary necrosis in the tiger.

Two examples of renal papillary necrosis in the tiger are described. The necrosis was characterised by large zones of liquefaction with minimal inflammation and was associated with pronouced scarring in the cortex. Both animals had been vomiting terminally and were severely dehydrated. It is suggested that papillary necrosis was precipitated by the reduced renal perfusion associated with dehydration in kidneys in which the medullary blood supply was already compromised by chronic cortical scarring. Comparisons are made between the lesions described in these tigers and those reported in the domestic cat, man and other domestic animals.


The total protein content in the blood serum of vertebrates.

The total protein content in the blood serum of 416 species and subspecies of vertebrates is determined by the microbiuret method. Generally speaking the total protein content of the serum shows an increase with a higher evolutionary level. The difference between the mammals and the other groups is particularly large. This increase is probably attributable to a number of factors, for instance adaptation to living on land, development of the circulatory system, the development of adaptive immunity and the forming of specific transport proteins. A connection between albumin content and level of development can also be noticed.


Establishing and administrating a private practice in a hospital setting.

This paper presents specific guidelines for establishing a private practice in an institution. Guidelines are discussed for structuring the practice, establishing the fee schedule, the billing procedures, proposals and contracts, general organization and administration, together with the expansion and termination of the practice for a client/institution.


Occupational therapist: OTR/manager.

Occupational therapists become more involved in management/administrative skills as they progress profesionally; however, varying degrees of these same skills are used by the therapist at every work level and in every work environment. Operational management skills may include applying and implementing policy on the part of the supervising therapist, or may include organization of time as well as management of supplies and persons by a therapist for effective and efficient productivity. Administrative management skills, forming and interpreting policy, are also needed on every work level. The effectiveness of all management/administrative skills is dependent on the institutional or organizational structure within which the therapist works. Occupational therapists must acquire an understanding of organization and administration, how structure affects function, and how to apply management skills in the everyday work situation in order to produce their best professional effort.


Doing and becoming: purposeful action and self-actualization.

While the critical nature of action to human existence and adaptation has been pursued by philosophers for many years, the characteristics of action transformed into purposeful doing and the meaning of human productivity have remained relatively unexplored in the behavioral sciences. This paper discusses several theoretical constructs in social and individual psychology that provide perspectives for understanding human action; defines doing as purposeful action that enables the nascent human to become humanized; and suggests, on the basis of these constructs, a prescription for doing for the development of performance skills and as a means for investigating the causes of psychopathology or dysfunction.


Work sampling: a tool in management.

"Work sampling" was used to determine the productivity of the employees of a small occupational therapy department and the nature and extent of the activities in which they were involved. Twelve general categories of activities were identified--peak loads occurred on Wednesday each week between 9:10 to 11:30 a.m., and daily between 1:40 to 3:20 p.m. It was found that the therapists spent more of their working hours productively compared to an aide's productive time. "Work sampling" is a convenient and inexpensive technique that may be used by small or large departments to justify staff size, hours of work, and assignments on the basis of activities and productivity.


Behavioral and nystagmus response of a hyperkinetic child to vestibular stimulation.

A five-year-old boy, referred for hyperkinetic behavior, was tested for vestibular function before and after a four-week regime of controlled semicircular canal stimulation. Hyperkinetic behavior was assessed both during and after the four-week treatment period. Initial testing showed that semicircular canal function was normal, but that two measurable central nervous system mechanisms representing integration of the sensory signal were not at a normal level. Behavioral instruments demonstrated an improvement in symptoms of hyperkinetic behavior. It is postulated that the behavioral improvement resulted from an increase in task-relevant arousal in the reticular formation, accompanied by increased cortical inhibition.


The soap opera: a dynamic group approach for psychiatric patients.

This article describes the use of television soap operas as a catalyst for group discussion in a psychiatric facility. Group objectives, membership criteria and format, as well as leadership styles and techniques are discussed. After analysis of the TV program and discussion themes, the authors determined that this group approach facilitates problem solving and patient interaction, while increasing self-awareness. In addition, this format eases the entry process of a new member into the group gy creating a nonthreatening atmosphere where patients are not pressured to relate to others immediately.


Neuropathic arthropathy in the diabetic foot.

Neuropathic arthropathy (Charcot's joint) is a relatively painless, progressive and degenerative condition due to underlying neurologic deficits. Although a variety of neurologic disorders may produce this arthropathy, diabetes mellitus has become the most common cause. In diabetes, the foot and ankle are the sites most often involved, particularly the tarsometatarsal and tarsal joints. In addition to neuropathy, trauma is an essential factor in producing the arthropathy.


Scoliosis and school screening for spinal deformity.

The onset of "idiopathic" scoliosis is gradual. It goes unnoticed by parent and child alike. The problem is often not detected until the curvature has progressed. Severe scoliosis has serious long-term systemic, cosmetic and psychologic effects. School-based screening programs are very effective in reducing the number of operations required. These programs can be carried out by school nurses, physical education teachers and volunteers who are trained by a knowledgeable physician. Brace treatment is successful when scoliosis is detected only.


The hives dilemma.

Reucrrent or persistent hives may sometime be due to an apparently insoluble emotional dilemma. Five case studies demonstrate this association. They show that resolution of the dilemma can be curative. When the dilemma is unalterable, explaining this insoluble conflict-hives phenomenon to the patient will ameliorate symptoms. Such an emotional history should be sought in patients with hives and, when found, should be pursued along with other possible causes discovered during the initial evaluation.


Rehabilitation of swallowing disorders.

Optimal rehabilitation of dysphagia requires an understanding of normal and diseased physiology, a systematic functional evaluation of the patient's disability and a wide repertoire of rehabilitative techniques. Nonsurgical techniques should be used first, especially when the possibility of spontaneous improvement exists. Cricopharyngeal myotomy is effective in a patient with obstruction at the cricopharyngeal level and good airway protection. When oral feeding is not possible, esophagostomy is usually the preferred bypass procedure.


Helping the hypochondriac.

Hypochondriasis can be reliably identified and requires a particular therapeutic approach by the family physician. These difficult patients are usually women over 40 with a chronic history of medical work-ups without significant findings, pride in suffering and self-sacrifice and a conviction of being ill which is essential for their self-esteem. To dismiss or confront this conviction results in a drain on medical services, while a supportive approach benefits both physician and patient.


Why does a child with a normal heart undergo cardiac catheterization?

Children who have no heart disease at cardiac catheterization have usually been referred because of signs or symptoms on the background of a basal flow murmur. The ECG and chest x-ray are sometimes spurious and may lead to catheterization. Advances in noninvasive testing are helping to screen this population. Only in rare instances should the risks involved with catheterization be taken in a child with a basal flow murmur and no other evidence of heart disease.


Intraocular pressure tonometry.

The family physician should include measurement of the intraocular pressure in his examination. Chronic open-angle glaucoma can be discovered early. Tactile tension is not adequate. Many methods are available, but the Schiøtz tonometer is the best for general use. Careful attention to technique is required. When the tonometer reveals an intraocular pressure exceeding 21 mm. Hg, further studies are necessary for a diagnosis of glaucoma.


Skull x-ray in the evaluation of endocrine diseases.

The skull x-ray remains invaluable as a first step in the diagnosis of many endocrine disorders. Pituitary tumors commonly cause enlargement or distortion of the sella turcica, which can be seen on skull x-ray. Pinealomas and craniopharyngiomas may also be detected. Hyperparathyroidism can cause granular decalcification in the skull. Hypoparathyroidism produces calcification of the basal ganglia and cerebellum. Lesions due due to metastatic malignancies or eosinophilic granulomas may be noted in cases of diabetes insipidus. Sellar enlargement may be due to the "empty sella" syndrome. Twenty-five percent of all cases of enlarged sella may be accounted for by this syndrome.


Essentials in the management of myasthenia gravis.

Myasthenia gravis is a disorder that most commonly affects young adults but occasionally appears in the elderly. Muscle weakness and easy fatigability, particularly of the ocular muscles, are characteristic. Diagnosis is confirmed by electromyography and the edrophonium (Tensilon) test. The pathology results from inability of acetylcholine to gain access to receptor sites at the neuromuscular junction, possibly because of a blocking antibody produced by the thymus. Initial treatment (in the absence of a thymoma) consists of administration of an anticholinesterase drug. If that is ineffective, thymectomy and/or corticosteroids may be useful.


Myocardial infarction in  the black population of South Africa: coronary arteriographic findings.

Thirteen Black patients who had classic electrocardiographic evidence of myocardial infarction supported by changes in serum enzymes were investigated by coronary arteriography. Ten of these had occlusive atherosclerosis and in none of these did the associated risk factors such as hypertension or diabetes appear to be operative, and most were manual laborers. Their mean serum cholesterol measurement was found to be 222 mg. per cent, a value which is found in 25 per cent of the urban Black population. In the remaining three patients, the coronary arteries were found to be angiographically normal and two of these were associated with the billowing mitral leaflet syndrome; it is postulated that their myocardial infarction was a result of coronary spasm, or a consequence of fibrin emboli emanating from the redundant mitral leaflets. Based on statistics from our major referring hospital, it is estimated that the prevalence rate from myocardial infarction among general admissions to a medical ward is less than 0.05 per cent, a figure lower than previously reported by clinico-electrocardiographic studies. It would appear that the prevalence of this disease has not increased over the last two decades and the immunity of the Black population is unexplained.


Four year follow-up of black schoolchildren with non-ejection systolic clicks and mitral systolic murmurs.

In 1972 we conducted a survey of 12,050 urban Black schoolchildren and detected 168 (prevalence rate of 14 per 1,000) with a non-ejection systolic click (NESC), a late systolic murmur, or both. The etiology of the mitral valve abnormality was unknown but we considered that a significant proportion might have early rheumatic heart disease. The auscultatory features four years later of 139 of the original 168 subjects as well as those of 139 age- and sex-matched controls are presented in this study. No cardiac abnormality was detected in as many as 55 of the subjects. Five children now had pansystolic murmurs but the mitral regurgitation was assessed as mild in four. Twenty-five (17.9 per cent) of the controls, 23 of whom had NESCs, had auscultatory features compatible with mitral valve prolapse. These findings do not support our earlier suggestion that a large number of the 1972 subjects have mild rheumatic heart disease. The results are in accord with other studies which have indicated that auscultatory features compatible with mitral valve prolapse are common in "normals" and also that the prognosis of the specific "billowing mitral leaflet syndrome" is generally benign.


Evaluation of the heart rate response to the Valsalva maneuver.

A study has been made of the heart rate (HR) response to the Valsalva maneuver in five different groups of normal white males and two groups of male coronary heart disease (CHD) patients using non-invasive methods. By means of the analysis of variance the effects of age, posture, Valsalva phase and CHD on the HR response were assessed. Both age and CHD were factors that reduce the HR response. Further analysis indicated that the HR change from Phase 3 to Phase 4 in the Valsalva was the preferred discriminator between normals and cardiac patients. We have derived a "Valsalva score" that can be used  to identify HR changes that deviate from the expected average normal response for a given age, control HR and Phase 3 HR. HR assessment of the Valsalva maneuver is a simple safe non-invasive test. An abnormal response suggests altered functioning of hemodynamic or autonomic cardiovascular mechanisms governing HR control.


Differences in metal content of the heart muscle in death from ischemic heart disease.

In a group of patients dying suddenly from ischemic heart disease, the uninfarcted heart muscle contained significantly lower concentrations of magnesium, iron, and potassium and a significantly higher concentration of calcium than the heart muscle from a group of normal controls and a group of patients dying more than three months after a coronary thrombosis. The late death group had significantly lower concentrations of manganese and copper than the normal group, and a slight decrease in magnesium concentration which was probably significant. There was no significant difference in the sodium concentration between the three groups. The results are discussed in relation to the increased death rate from ischemic heart disease in areas with soft drinking water, and possible dietary deficiencies in mineral salts.


The effect of chronic cardiac denervation on infarct size following acute coronary occlusion.

The effect of acute coronary ligation on infarct size was studied in (1) ten acute control dogs, which were non-denervated, (2) in six acutely denervated dogs in which the heart was denervated immediately prior to coronary ligation and in which intra-cardiac reflexes were pharmacologically blocked, (3) in seven chronically denervated dogs in which intrapericardial nerves were cut 2 weeks prior to ligation, and (4) in four dogs which were sham-operated 2 weeks prior to ligation. Infarct size was determined using a nitro blue tetrazolium stain for dehydrogenase activity. Infarct sizes in acute controls, acutely denervated, chronically denervated, and sham-operated hearts were 20.1, 15.0, 3.8, and 21.0 per cent of left ventricular weight, respectively. Infarct sizes in acutely and chronically denervated hearts were significantly less than in acute controls (P less than 0.05). In further studies the fluorescent stain thioflavin S was used to demonstrate that perfusion of myocardium distal to the ligation was substantially greater in chronically denervated hearts than in acute controls.


The significance of hypotension developing during treadmill exercise testing.

The significance of hypotension developing during treadmill exercise testing was evaluated and correlated with the findings at cardiac catheterization in two groups of patients. Twenty-five patients (Group I) had a fall in systolic pressure during exercise and were compared to 50 consecutive unselected patients (Group II) with a normal blood pressure response. Clinical characteristics were similar in both groups. Females comprised 48 per cent of the patients in Group I and only 30 per cent in Group II. The incidence of significant coronary artery disease was not different when the two groups were compared as a whole, 56 per cent in Group I and 36 per cent in Group II (P = NS). When males and females were considered separately, it was noted that the incidence of coronary artery disease was higher in hypotensive males (77 per cent) when compared to control males (40 per cent) (p less than 0.01). Females in both groups had a lower but comparable incidence of coronary artery disease (25 per cent and 27 per cent, respectively). Resting hemodynamics and angiographic characteristics, such as contraction abnormalities, and the number and distribution of diseased coronary vessels, were similar in both groups of patients. These findings suggest that hypotension in females does not necessarily connote coronary artery disease. Males with hypotension have a higher incidence of coronary artery disease, but the extent and distribution of their disease is no different from that of patients with a normal blood pressure response to exercise.


Carbon monoxide and ventricular fibrillation threshold in dogs with acute myocardial injury.

In a blind, randomized study, the effect of breathing 100 p.p.m. of CO versus compressed, purified air for 2 hours on ventricular fibrillation threshold (VFT) was investigated in 21 dogs with acute myocardial injury. The mean arterial carboxyhemoglobin was 1.16 per cent in the air control period, 1.07 per cent after air, 1.08 per cent in the CO control period, and 6.34 per cent after CO. In comparison to air, CO increased the mean arterial carboxyhemoglobin (P less than 0.001). One dog developed spontaneous ventricular fibrillation 100 minutes after CO. Mean VFTs in the other 20 dogs were 12.8 +/- 6.8 milliamperes after CO, 11.2 +/- 6.0 milliamperes in the air control period, and 15.0 +/- 5.1 milliamperes after air. In comparison to air, CO decreased the VFT (P less than 0.001). These data show that breathing 100 p.p.m. of CO for 2 hours reduces the VFT in dogs with acute myocardial injury.


Simulated tricuspid valve echoes in tricuspid atresia.

A case of tricuspid atresia with unusual echocardiographic findings is presented. The echocardiogram was successful in defining great artery interrelationships, ventricular looping, and cavity sizes. An echo pattern resembling the motion of a small tricuspid valve was observed; this was proven to be spurious at catheterization and necropsy. Caution should be exercised in diagnosing the presence of a tricuspid valve on the basis of atypical echoes from the tricuspid valve area.


Intravascular hemolysis in the late course of aortic valve.

The degree of intravascular hemolysis was evaluated in 315 patients in the late course of aortic valve replacement. Starr-Edwards aortic ball valves of series 2300 caused significantly more hemolysis than did those of series 1200, as estimated from the serum lactate dehydrogenase levels. Smaller valves of series 2300 caused a higher degree of hemolysis than did the larger ones. Aortic disc valves induced a more moderate red cell destruction than did the ball valves, the Lillehei-Kaster significantly more than the Bjørk-Shiley prostheses. Crushing of red cells is thought to be a more important cause of hemolysis than shearing forces in turbulent blood. Hemolytic anemia represented a problem only in some patients with Starr-Edwards valve type 2300, although iron substitution was necessary also in some with other prostheses, since the hemoglobin-binding capacity of haptoglobin was exceeded in several patients. Valvular or paravalvular leakage was associated with stronger hemolysis in some patients, and should be suspected whenever the rate of red cell destruction increases. Longstanding intravascular hemolysis did not seriously affect renal function.


Arterial thrombosis in essential thrombocythemia.

The course of essential thrombocythemia has been observed in ten patients, ages 46 to 83, of whom nine were followed for a period of 4 months to 9 years. In contrast to the experience with essential thrombocythemia recorded in the literature, manifestations of arterial thrombosis were far more common than hemorrhage. In six of the ten patients, the presenting complaints were ascribable to incipient gangrene of the toes and several of these patients additionally developed occlusion of tibial and larger arteries while under our observation. All patients with incipient gangrene showed marked clinical improvement accompanying busulfan-induced reduction and normalization of the platelet count. Relapses in five patients after 2 to 87 months responded well to retreatment with busulfan. No patient has shown evolution to another myeloproliferative disorder. Essential thrombocythemia should be considered in the differential diagnosis of occlusive arterial disease.


The error in indirect blood pressure measurement with the incorrect size of cuff.

This paper shows the error to be expected when blood pressure is measured indirectly with a cuff that is too wide or too narrow for the member to which it is applied. A cuff that is too narrow overestimates and a cuff that is too wide underestimated blood pressure.


Comparison of heart rate and blood pressure response to amyl nitrite, isoproterenol, and standing before and during acute beta-adrenergic blockade with intravenous propranolol.

Heart rate responses to three different procedures (amyl nitrite inhalation, standing up, and isoproterenol infusion), were studied before and during acute adrenergic beta blockade with intravenous propranolol in three normal and six hypertensive subjects. Propranolol decreased, but did not completely abolish, the heart rate increase produced by amyl nitrite and standing, probably because of vagal participation (withdrawal) in heart rate increase produced by baroreceptor hypotension (amyl nitrite) and on assuming the upright posture. Heart rate responses to amyl nitrite varied greatly from patient to patient (from 27 to 97%), but the drug proved to be the most potent stimulus for heart rate increase as a result of its marked hypotensive effect. However, this vasodilator-induced acute hypotension was well tolerated, and without deleterious hemodynamic consequences, despite the presence of beta blockade. Different degrees of correlation in heart rate increase were observed with the three procedures, reflecting probably the varying sympathetic-parasympathetic participation in reflex heart rate control. It is concluded that from the clinical stand point, neither amyl nitrite administration nor standing up can be used as a test to assess acurately the degree of beta blockade, because both procedures activate vagal withdrawal which increases heart rate regardless of the degree of beta blockade.


Variations in the critical cycle length inducing rate dependent bundle branch block.

In five patients with tachycardic RDBBB (rate dependent bundle branch block), variations in the critical CL (cycle length) inducing RDBBB were investigated. In one patient, independent of changes in the preceding CL, the critical CL inducing RDBBB was invariable, extending over two years. In the other patients, the critical CL inducing RDBBB varied within a comparatively short period. However, when RDBBB was maintained for only a few cycles, the critical CL allowing reversion to normal conduction was always longer than the critical CL inducing RDBBB here, in all patients except one. In one patient such a distinct difference in CL could not be disclosed because the critical CL inducing RDBBB varied from cycle to cycle. These observations suggest that independent of variations in the refractory period of the blocked bundle branch, the critical CL allowing reversion to normal conduction was considerably longer than this refractory period in all patients. The possible mechanisms by which RDBBB could be maintained are discussed. The most probable mechanism appears to be "true" unidirectional block in the affected bundle branch, in which the refractory period for the retrogradely conducted impulse is shorter than that for the anterogradely conducted impulse.


Myocardial infarction in young vs old male rats: pathophysiologic changes.

Young (90 days) and old (15 months) male, Sprague-Dawley rats were subjected to an acute and massive myocardial infarct by giving them two injections of a large dose of isoproterenol. The animals were autopsied at sequential time intervals to ascertain the similarities or dissimilarities in the pathophysiologic events which attend acute myocardial infarction and repair in young vs old rats. Although the signs and severity of hypotensive shock appeared to be equal, mortality was higher in the old rats, especially during the acute necrosis phase. The older rats also manifested more severe and persistent congestive heart failure, i.e., hydrothorax. Serum enzymes (CPK, SGOT, SGPT, and LDH), lipids (triglycerides, free fatty acids, and cholesterol), glucose, and BUN levels manifested a dynamic rise and fall concomitant with the induced myocardial necrosis and repair phases with distinct differences in these metabolic changes between young and old rats. Despite initially higher circulating levels of corticosterone in the old vs young rats, the older animals manifested little or no increase in circulating corticosterone levels during the acute stress of myocardial infarction. This apparent lack of adrenocortical responsiveness was accentuated by the concomitant finding of greatly hypertrophied, hemorrhagic, and lipid-depleted adrenal glands in the old rats vs a dynamic increase in circulating corticosterone levels and alterations in the weight of adrenal and thymus glands of the young rats. During the myocardial repair phase, the young rats manifested extensive endocardial fibrosis whereas the old rats displayed little or no endocardial fibrosis but copous and persistent myocardial edema and ground substance in keeping with their higher concentration of cardiac hexosamine. The pathophysiologic course of events which attends myocardial necrosis and repair is quite different in young vs old rats and may be related to the degree of responsiveness of the pituitary-adrenal axis which changes with age.


Effects of verapamil on ventricular rhythm during acute coronary occlusion.

The effects of verapamil on electrophysiologic parameters of the ventricle were studied during acute coronary occlusion in anesthetized open-chest dogs. Those parameters measured in the study were idioventricular automaticity, ventricular conduction, and fibrillation threshold. The incidence of rapidly repetitive beats and fibrillation induced by two successive premature beats was also studied. Verapamil significantly decreased idioventricular automaticity (in five dogs), improved conduction through the ischemic area (in six dogs), and increased fibrillation threshold of the ischemic ventricular (in eight dogs). The drug was effective in abolishing rapidly repetitive beats and fibrillation induced by closely coupled premature beats during acute coronary occlusion. Rapidly repetitive beats occurred in nine out of 15 dogs and these repetitive beats were degenerated into fibrillation in seven dogs before verapamil. Following pretreatment with the drug, rapidly repetitive beats and fibrillation occurred in none of the 15 dogs. The results indicate that verapamil can be very effective against ventricular arrhythmias occurring in association with myocardial infarction.


Acute idiopathic pericarditis and calcific aortic stenosis: unusual fatal disease combination.

Acute idiopathic pericarditis with massive pericardial effusion complicated left ventricular enlargement due to calcific aortic stenosis and led to intractable congestive heart failure and death during aortic valve replacement in a 42-year-old white male. This unusual combination of acute and chronic diseases is lethal due to their combined deleterious effect upon myocardial function.


Isolated dissecting aneurysm of the renal artery.

We report two cases of an unusual cause of the acute onset of hypertension, a spontaneous dissecting aneurysm localized to the renal artery. Also reviewed are 16 reported cases from the literature. The mean age of the 18 patients was 52 years. The majority of these patients were males (78%). Hypertension was a presenting sign in 14 (78%), but was not usually a pre-existing feature. Loin pain, often severe, occurred in eleven patients (61%), whereas gross hematuria was recorded only in two (11%). The right renal artery was involved in ten cases (55%), the left in three (17%), and both in five cases (28%). Atherosclerosis of the renal arteries and the aorta was absent in 69%, and mild in 23%. There has been no report of renal artery rupture; however, vascular occlusion occurs frequently. Medical and surgical approaches to the management of this phenomenon have been reported and are reviewed.


Microliths in sputum specimens and their relationship to pulmonary alveolar microlithiasis.

The sputa of 26 of 100 patients with chronic obstructive pulmonary disease contained microliths. The numbers of microliths per smear of sputum per patient ranged from one to 20. In seven of the sputum specimens containing microliths, deposition of calcium was present on the loops of Curshmann's spirals to different extents, from a single layer to the laminated appearance seen in a free microlith. Partial and complete separation of the calcified laminated masses from the spirals were also demonstrated. Based on these observations, the morphogenesis of microliths and the pathogenesis of pulmonary alveolar microlithiasis are discussed.