Sodium cyanide antagonism of the vasodilator action of sodium nitroprusside in theisolated rabbit aortic strip.

Resistance to sodium nitroprusside (SNP) is uncommon, but its occurrence has led to massive overdoses of SNP and sometimes death. To examine the mechanism responsible for resistance, aortic smooth muscle strips were prepared and dose-response curves for norepinephrine (NE) obtained. SNP alone caused a shift of the dose-response curve for NE to the right. However, this shift was less when the strips were exposed to both SNP and sodium cyanide (CN-). When CN- alone was added to the aortic strips, the response to NE was unchanged. In a further group of aortic muscle strips first contracted with NE and then relaxed with SNP, the addition of CN- caused the muscles to contract again. It is concluded that CN- antagonizes the action of SNP in vitro, and that this antagonism is specific for SNP.


Naloxone does not antagonize general anesthesia in the rat.

The administration of naloxone 2, 10, 50, or 250 mg/kg intravenously did not alter halothane requirement (MAC) in Sprague-Dawley rats (12 per group). Two rats convulsed when given 50 mg/kg while anesthetized with halothane. In a separate group of awake rats, seven of nine animals convulsed when given naloxone, 100 mg/kg. It is concluded that any effect of naloxone on anesthetic requirement must be small (not significant in our study), and that if an effect exists it is the result of a nonspecific analeptic action of naloxone rather than a specific action at opiate receptors.


Naloxone has no effect on nitrous oxide anesthesia.

It has been reported that naloxone antagonizes general anesthesia in rats when the tail clamp is used as a painful stimulus to assess anesthesia. The authors' hypothesis is that this antagonism is to the analgesic component of anesthesia only, and that anesthesia assessed by a non-painful stimulus would not be antagonized by naloxone. Therefore, the anesthetic potency of nitrous oxide in mice was measured using loss of the righting reflex as a non-painful stimulus. Naloxone, 2 and 16 mg/kg, intraperitoneally, failed to antagonize nitrous oxide anesthesia measured 14--39 min after injection. Thus, 19 min after injection of naloxone, 2 mg/kg, the nitrous oxide ED50 was 1.25 +/- 0.0600 atm (n = 35), compared with 1.19 +/- 0.059 atm (n = 35) after injection of saline solution (control). Following naloxone, 16 mg/kg, the nitrous oxide ED50 was 1.18 +/- 0.059 atm (n =35), compared with 1.22 +/- 0.059 atm (n = 35) for saline solution. At neither dose of naloxone was the ED50 different from the control ED50, a finding that supports the author's hypothesis.


Naloxone fails to antagonize the righting response in rats anesthetized with halothane.

The righting responses of 75 Wistar rats during exposure to halothane, 0.5 per cent, 10 min after subcutaneous injection of naloxone, 10 or 20 mg/kg, or saline solution were examined. There was no difference in recoveries of the righting responses among the three groups. It is concluded that naloxone does not antagonize the loss of righting response produced by halothane anesthesia in the rat.


Plasma levels of testosterone and male sexual behaviour in strains of the house mouse (Mus musculus).

This paper investigates whether differences in measures of sexual behaviour between strains of the house mouse (Mus musculus) are related to differences in the levels of plasma testosterone. There was found to be a significant negative correlation between measures of sexual behaviour and plasma testosterone. This correlation was not behaviourally mediated, and could be demonstrated for some of the behavioural measures in an F2 generation.


Spectral sensitivity and colour vision in the ground-dwelling sciurids: results from golden mantled ground squirrels and comparisons for five species.

Behavioural measurements of several indices of visual sensitivity and colour vision for the golden-mantled ground squirrel (Spermophilus lateralis) are reported. The spectral sensitivity functions for this animal show a change from having a single peak at about 520 nm to having a strongly bipartite appearance with peaks at about 540 and 460 nm as the level of light adaptation is increased from low to higher levels. Discrimination tests reveal that these squirrels have dichromatic colour vision with spectral neutral points centered at 507.5 nm. Comparisons are made of the visual capacities of five species of ground-dwelling sciurids, all of which have been tested in the same situations. These comparisons indicate that: (1) the retinas of all of these species contain a small number of functional rods in addition to a much more obvious cone population; (2) the spectral sensitivity functions of these species do not show systematic variations; (3) the cone pigments found in the retinas of these animals have sensitivity peaks at about 440 and 525 nm; (4) all of these species have dichromatic colour vision; (5) there is no evidence for systematic differences in visual sensitivity or colour vision among these five species.


The influence of corticotherapy on mitogen induced lymphocytotoxicity in bronchial asthma.

In a previous study the hyperreactive lymphocytes in bronchial asthma (BA) have been documented by mitogen induced cell-mediated cytotoxicity (MICC). Since MICC was considerably low in patients receiving substantial doses of steroids, further investigation was conducted. BA patients were divided into three groups: the first was given daily steroids, the second was given steroids on alternate days and the third consisted of a longitudinal follow-up study on the same individual being on different doses of steroids. Mixture of blood lymphocytes, phytohemagglutinin and Cr51 labeled target cells (P815/DBA2) were incubated in ratio 10:1 for 12 hours. Subsequently the cytotoxic potential of effector lymphocytes was detected by measuring the Cr51 in the supernatant of reacting cells. It was observed that cytotoxic correction index (CCI = Patient/Control Cytotoxic Index) was significantly lower among those in the first group and when the dose of Prednisone or its equivalent exceeded 40 mg/day. Comparison of the CCI between patients from the first and second groups supports alternate day corticotherapy in BA. Considerable fluctuation of CCI was apparent in the third group. Selected high doses of steroids suppressed MICC. This effect is reversible and offers a new practical in vitro guidance for monitoring an adequate dose of steroids in vivo.


On respirable organic antigens, mattresses and some idiopathic lung diseases.

In surveying the environment of workers in a mattress factory thermophilic actinomycetes as well as phycomycetes and aspergillus species were isolated readily from work room dust, finished bat, sissal and the interior of baled linters. Those persons working with cotton products were shown to have a heavy, daily exposure to organisms known to be implicated in the pathogenesis of hypersensitivity pneumonitis. The authors suggest that further study of the inhaled antigens to which cotton workers are exposed is indicated before discarding immunologic mechanisms to explain the development of byssinosis and other pulmonary disorders to which such workers are subject.


Use of a chemically defined diet in the diagnosis of food sensitivities and the determination of offending foods.

A chemically defined diet of low allergenicity was used to provide complete nutritional support for a week in a referred group of 27 patients. Food-sensitive patients remitted 70% of their allergy symptoms, supporting a diagnosis of dominant food etiology. For those the diet was continued while selected foods were orally challenged. Safe diets were thus established in about three weeks of largely patient-executed effort. Patients without remission were given concentrated attention toward establishing other etiologies. Remission was thus achieved in 85% of the cases.


Correlation of RAST and provocation tests for diagnosing allergic asthma and rhinitis.

252 bronchial (BPT) and 346 nasal (NPT) provocation tests were done. A positive RAST coincided with a positive BPT in 81% and a positive NPT in 82% of the cases. When RAST was negative the BPT's were positive in 33% and NPT's in 54% of trials. Contrary to the NPT's the RAST and the BPT's agreed well in different allergen groups, excepting mold provocation.


Late and delayed responses of the nasal mucosa to allergen challenge.

In 600 patients suffering from allergic rhinitis the possible existence of another type of allergic reaction of the nasal mucosa other than Type I (immediate) was investigated by means of nasal provocation tests with allergens. Late response of the nasal mucosa to allergen challenge indicated that Type III hypersensitivity might be involved. Delayed reactions also made Type IV suspect.


Natural and synthetic fibers as causes of asthma and rhinitis.

One hundred and thirty-six textile workers were tested with natural fibers; 97 were tested with synthetic fibers. By inhalation testing 20% were positive to both types of fibers; by nasal provocative testing 30% were positive. There was a close correlation between the size of the wheals in the prick tests and the percentage of fiber challenge tests. Fiber provocation tests and metacholine tests did not display any conformity with each other. The authors feel that synthetic fibers may act as haptens and cause Type I or IgE-mediated allergy and both natural and synthetic fibers should be considered important causes of occupational asthma among textile workers.


[Malignant hemangiopericytoma. Apropos of the ultrastructural and histoenzymological analysis of a case].

The histoenzymological and ultrastructural study of a haemangipericytoma with the clinical and histological characteristics of malignancy led to the identification within the tumour, in addition to pericytes and more differentiated cells, fibroblastic or muscular, of younger cells. The latter, arranged in cords undergo multiple appearances of transformation to result in a double maturation, at one and the same time pericytic and angio-endothelial, rarely seen up to the present in haemangipericytomas.


[Stages of carcinogenesis of experimental colonic tumors induced with 1-2 dimethylhydrazine].

The authors poisoned 500 female Wistar rats with a dialy dose of 15 mg/kg, The total dose ranged from 15 mg/kg to 420 mg/kg, according to the group. The animals were either killed when the dose defined for each group and been reached, or allowed to live. In a first series of 6 groups (120 animals), the following facts were noted: tumours deeveloped in all animals left alive, after 28 weeks (total dose of 1/2 D.M.H. = 420 MG/KG). Changes in the mucosa were seen from the 40th day on with, in the descending colon, a punctate abnormality involving two or three glandular tubes, in general at the summit of the folds. This abnormality consisted of basophilia of the upper part of the tubes, with a loss of mucus secretion. All transitional stages were seen between this lesion, hyperplasia of the apex of the tubes, the formation of "polyp seeds" and the appearance of polyps. Carcinomas most frequently developed in polyps but sometimes in flat mucosa. In the ascending colon, changes in mucosecretion were seen after a similar time delay at the base of the glandular crypts.


[Angiomyolipoma of the kidney. 2 new cases of symptomatic tumors].

The authors present two observations of angiomyolipoma of the kidney one of which bilateral and multicentric. They analyse the clinical manifestations and the morphologic features of these tumors in a review of the litterature and insist on the frequency and the seriousness of hemorragic complications that may result in medical emergencies. The histogenesis of these hamartomas is considered and the underlying genetic disorders are discussed. The surgical treatment is discussed in considering the possible bilateral localizations and the common age incidence with Grawitz's tumor. The authors admit the benign nature of angiomyolipomas and give little credit to frozen-section diagnosis because of the frequent occurence of cellular atypias in these tumors.


[Ultrastructural study of a case of monostotic fibrous dysplasia].

Ultrastructural study of a case of fibrous dysplasia taken together with the rare data in the literature confirmed that the morphological characteristics of this lesion consist of a typical appearance of "woven bone", irregularly mineralised, containing osteocytes and bordered by osteoblasts, clearly distinct from fibroblasts. The cell elements are invariably endowed with a large microbrillary cytoplasmic brush, apparently made up of scleroproteins and showing the usual ultrastructural characteristics associated with low metabolic activity. The presence of myofibroblasts is unlikely. The numerous mastocytes seen by light microscopy show a large number of "rosette" granulation at electrom microscopy, which distinguishes them from the mastocytes seen in osseous modelling. These morphological data provide no decisive argument in favour of the truly dysplasic nature of this lesion.


Albendazole therapy for experimentally induced Paragonimus kellicotti infection in cats.

The effect of albendazole therapy was studied in 6 cats with pulmonary paragonimiasis induced by experimental inoculation of metacercariae (25/cat) of Paragonimus kellicotti. At 76 to 101 days after they were inoculated, 5 cats were administered an oral aqueous suspension of albendazole in 2 divided doses totaling 20 mg (2 cats), 50 mg (1 cat), or 100 mg (2 cats)/kg of body weight each day for 14 to 21 days. The 6th cat (control) was not administered albendazole. Nine days after cats were given the 50- and 100-mg/kg dosages, Paragonimus ova were not seen in the feces of 3 cats. There was marked reduction in ova production in the feces of the 2 cats administered 20 mg/kg of albendazole. Live flukes were not recovered from the lungs of 3 cats necropsied 4 or 5 weeks after dosing with 50 or 100 mg/kg, but the lungs of the 2 cats administered 20 mg of albendazole/kg yielded 9 and 7 apparently viable flukes. Seventeen live flukes were recovered from the control cat not treated with albendazole. In 4 noninoculated normal cats administered 20 mg (1 cat), 100 mg (1 cat), and 200 mg (2 cats) of albendazole/kg of body weight each day for 14 days, there were no gross or microscopic lesions attributable to the drug.


Tetrachlorvinphos as an ineffective feed additive in control of gastrointestinal nematodes of beef cattle.

Tetrachlorvinphos was evaluated for anthelmintic efficacy as a feed additive against gastrointestinal nematodes of cattle. Tetrachlorvinphos was added to the mineral mixture of medicated cattle (n = 13) at the rate of 1.6 mg/day/kg of body weight for a 29-week period beginning May 2, 1975. Data suggest that the level of parasitism, as estimated by the number of nematode eggs per gram of feces, was not reduced by the addition of tetrachlorvinphos to the mineral mixture of medicated cattle. Results obtained from identification and quantification of nematodes recovered at necropsy from 6 medicated and 6 nonmedicated control heifers indicated that tetrachlorvinphos was ineffective as an anthelmintic against gastrointestinal nematodes of cattle.


Evaluation of fenbendazole as an anthelmintic for gastrointestinal nematodes of cattle.

Calves naturally infected with Ostertagia, Haemonchus, Trichostrongylus, and Cooperia were used in a controlled experiment to determine the anthelmintic efficacy of fenbendazole, methyl-5-(phenylthio)-2-benzimidazolecarbamate, and to compare this with the efficacy of levamisole. The calves were placed in dry lots for approximately 3 weeks, ensuring that immature Ostertagia larvae were in arrested development before the calves were treated. In calves given doses of 8 mg of levamisole/kg of body weight and 5 and 7.5 mg of fenbendazole/kg, reductions of adult Ostertagia were 95%, 99%, and 99% respectively. Reductions of developing Ostertagia L4 were 29%, 99%, and 100%; of arrested Ostertagia L4--5%, 24%, and 72%; of adult Haemonchus--97%, 100%, and 100%; of adult Trichostrongylus--97%, 99%, and 100%, and of adult Cooperia--100%, 100%, and 100%--as compared with data in untreated controls.


In vitro stimulation of bovine peripheral blood lymphocytes: analysis of variation of lymphocyte blastogenic response in normal dairy cattle.

Lymphocyte immunostimulation tests were performed on 12 lactating dairy cows once every 2 weeks for 1 year. The results indicated that the greatest response of peripheral blood lymphocytes to mitogens occurred in 4- to 6-year-old cows in the month of August and in cows at 2 months before the end of the gestation and again at 1 month after parturition. The least lymphocyte mitogenic response was shown in 7- to 9-year-old cows in the month of February or at parturition and 2 to 4 months after parturition. The magnitude of variations in lymphocyte blastogenic response is reported.


Correlation between antler and long bone relative bone mass and circulating androgens in white-tailed deer (Odocoileus virginianus).

The relationship between serum androgen concentrations and relative density changes in the antlers and long bones of male deer was determined. Four male white-tailed deer were sampled 2 times a week during the antler-growing period. Serum androgen values were determined by radioimmunoassay, and relative bone mass (RBM) coefficients were determined by radiograph densitometry. As circulating androgen concentrations increased over the antler-growing period, the RBM coefficients of the antler increased from a mean of 18.5 (+/- 1.96 SD) to a mean of 57.7 (+/- 2.74) at 2 weeks after "rubout." Concurrently, the RBM coefficients of the metacarpus decreased from a mean of 52.0 (+/- 1.92) to a mean of 46.4 (+/- 1.86). There were positive correlation between increasing androgen concentrations and increasing antler RBM and negative correlation between androgens and decreasing metacarpus RBM. Antler RBM coefficients continued to increase after rubout, but metacarpus RBM did not change after rubout. Two castrated deer were injected subcutaneously with 1 g of testosterone and sampled every other day. Similar but smaller changes occurred in RBM values of the metacarpus and developing antler.


Survey of parasites in dairy goats.

The survey was performed to study prevalence and intensity of parasitic infection in goats. Fecal samples were examined from 336 goats in southeastern Pennsylvania and northern Maryland. On the basis of fecal egg, oocyst, and larval counts, the following results were obtained. Eimerian oocysts were found in 100% of the fecal samples and the greatest fecal oocyst counts were found in goats under 6 months of age. Strongyle eggs and Strongyloides eggs were present in 76% and 20%, respectively, of the samples. Moniezia eggs were found in 9%, Trichuris eggs in 4%, and Nematodirus eggs in 1% of the samples. Twenty of 24 flocks examined for Muellerius capillaris were infected with this parasite. In these 20 flocks, 83% of the goats examined were infected with the parasite. Skrjabinema caprae infections were found.


Comparison of ketamine and pentobarbital anesthesia in the Mongolian gerbil.

The clinical course of pentobarbital and ketamine anesthesia are compared following a single injection of each and as anesthesia for carotid ligation in the Mongolian gerbil. Induction time to pinprick insensitivity was found to be the same for each agent; however, ketamine allowed earlier emergence and, moreover, observation of peripheral motor activity during the operative procedure.


Characteristics of a local virulent strain of Newcastle disease virus.

A local virulent strain, VLT, of Newcastle disease virus formed 3- to 4-mm plaques on monolayers of primary chicken embryo cultures on the 4th day after inoculation. It agglutinated chicken and human 0 erythrocytes. Its hemagglutinin was stable at 56 C when compared with those of Komarov (K) and F vaccinal strains of the same virus. The viral titer of infected allantoic fluid dropped from 10(8.1) plaque-forming units to 10(1.0) plaque-forming units/ml within 2 hours when incubated at 56 C. The strain was ether-sensitive; it adsorbed readily on monolayers of chicken embryo cells and did not diffuse through agar. Its intracerebral pathogenicity index, chicken dose LD50, and embryo mean death time (hours) were 1.8, 9.0, and 48, respectively. Two virulent strains isolated in 1974 and 1975 were found to be identical to the VLT strain in terms of certain physical and biological properties. On the basis of plaque morphologic characteristics, hemagglutination spectrum, and hemagglutinin inactivation at 56 C, it was possible to identify readily the field isolate when it was compared with vaccinal strains (K and F) commonly used in Lebanon.


Scanning electron microscopy of nerve sheath neoplasms.

Neurofibromas and schwannomas were clearly differentiable by scanning electron microscopy of thin microscopic sections. Neurofibromas exhibited ordered laminations of collagen with scattered fibroblast-like cells interspersed. Schwannomas contained proliferations of smooth tube-forming cells. These neoplastic characteristics were compared with cellular characteristics of normal nerve sheaths to determine the cell of origin in each neoplasm.


Transmission of swine dysentery by carrier pigs.

Swine dysentery (SD) was transmitted to healthy pigs by contact with experimentally-induced carrier pigs. Carrier pigs were produced by exposure of specific pathogen-free (SPF) swine to swine acutely affected with SD. When carrier pigs became acutely affected with SD, they were allowed to recover naturally or were treated with dimetridazole or ronidazole. Recovery was based on disappearance of clinical signs of SD. At a given time after recovery, normal SPF swine were housed with the carriers in a disinfected isolation unit to determine the ability of carriers to transmit SD. In each of 3 experiments, carriers that had recovered and remained asymptomatic for 11 to 25 days transmitted SD to contacts in 14 to 51 days. In 2 experiments, pathogenic Treponema hyodysenteriae was isolated from carriers 12 days before clinical SD was observed in contacts. Carriers which had recovered and remained asymptomatic for 70 and 90 days transmitted SD to contacts in 1 of 3 experiments. Treponema hyodysenteriae was isolated only from contacts with clinical signs of SD. In 4 experiments, carriers that had been treated with nitroimidazole compounds and subsequently recovered for 19 to 44 days failed to transmit SD. Culture of fecal samples on trypticase soy agar with 5% bovine blood and 400 microgram of spectinomycin/ml was helpful in predicting the carrier state, but phase contact contact microscopy of wet fecal smears was not.


Immune responses of cows to a chemically modified anaplasma antigen.

Cows were vaccinated at 0 and 28 days with either a standard or a chemically modified anaplasma antigen. The humoral antibody response was measured by the anaplasma complement-fixation and card agglutination tests. The antibody response to bovine erythrocyte antigens was also evaluated. Peripheral blood leukocytes were collected for an in vitro lymphocyte-transformation test. Both groups of vaccinated cows developed a significant cell-mediated response as measured by lymphocyte-transformation test. However, only the cows given the standard anaplasma antigen developed anaplasma antibody and significant titer of bovine erythrocyte antibodies. Vaccinated and control cows were challenge exposed 1 month after the 2nd antigen injection. The vaccinated cows developed lower levels of parasitemia than did the control nonvaccinated cows.


Stability of plasma metabolites and hormones in lactating dairy cows.

Plasma concentration stability of glucose, free fatty acids, ketone bodies, growth hormone, insulin were determined in lactating dairy cows. Concentrations of these metabolites and hormones were measured during a 36- to 48-hour period in 3 normal, mature dairy cows in the 2nd month of lactation. Samples were taken at 30-minute intervals; also, intensive sampling (every 10 minutes) was done at varying times in relation to feeding and milking. Of the 5 components measured, glucose concentration was the most stable, easiest to assay, and most reliable for use as a diagnostic aid in assessing metabolic carbohydrate disturbances in dairy cattle.


Stability of plasma metabolites and hormones in parturient dairy cows.

Metabolic changes that accompany the transition from parturition to lactation in dairy cows were studied. To measure these changes, plasma samples were obtained from 20 mature Holstein-Friesian dairy cows 10 days before through 10 days after parturition. They were analyzed for glucose, free fatty acids (FFA), lactic acid, ketone bodies, glucocorticoids, insulin, and growth hormone concentration. Lactic acid and glucocorticoids remained constant during the experiment, except for the day of parturition itself. In the prepartum period, changes were not detected in concentrations of hormones (glucocorticoids, insulin, and growth hormone), whereas, plasma metabolites began changing prior to parturition. Most evident were prepartum increased in FFA, ketones, and glucose. Postpartum plasma glucose concentration rapidly returned to prepartum concentrations. Plasma concentration of FFA and ketone bodies remained elevated for longer periods.


Effect of fasting on plasma metabolites and hormones in lactating dairy cows.

Metabolic and pathophysiologic changes of secondary ketosis were studied. Plasma samples were obtained from a group of 8 mature, lactating dairy cows before, during, and after a 48-hour fast. These samples were analyzed for glucose, free fatty acids (FFA), lactic acid, ketone bodies, glucocorticoids, insulin, and growth hormone concentrations. In the prefasting period, metabolites and hormones remained constant. Lactic acid and glucocorticoids also remained stable during the entire experiment, except on the 1st day after termination of the fast, when glucocorticoids increased significantly (P less than 0.05). Glucose values decreased significantly (P less than 0.01) with the onset of fasting, began to rise halfway through the fast, and were elevated following termination of the fast. Plasma glucose concentration returned to normal by the end of the experiment. Plasma FFA concentrations increased during the early portions of the fast and decreased thereafter. Plasma ketone body concentration responded similarly, but the change occurred approximately 12 hours after the plasma FFA changes. A value determined as ketotic was reached during the fast (14.6 +/- 1.3 mg/dl). Insulin concentrations remained low during the fast and increased after fasting. Plasma growth hormone concentration increased to a new plateau in response to fasting and then decreased somewhate after fasting was ended.


Chronic lead poisoning in horses.

Lead acetate was fed to 4 groups of 2 horses each to study chronic lead intoxication. A 5th group of 3 horses was maintained as controls. The leas was fed in capsules, with the minimum dosage of 6.25 mg/kg/day of lead as lead acetate (group I). The dose was increased from group I through group IV in an approximate geometric series, with each group being given about 125% of the dose given the previous group. These doses were given for 105 days, a period designated as phase 1. Since clinical signs were not observed after 105 days, the doses were increased and fed for an additional 190 days (days 106 to 295). This period was designated phase 2. The smallest daily dose in phase 2 was set at about 125% of the largest daily dose in phase 1. The doses in each group was increased by about 125% of that of the previous group, as was done in phase 1. Seven horses died or were euthanatized after 18 to 190 days of phase 2 (123 to 295 days after the 1st dose). One horse in group I did not develop any clinical signs of intoxication. Dose-related responses were unnoticed with doses larger than 15.3 mg/kg/day. All horses given lead had increased blood lead and serum iron concentrations. During phase 2, the hematocrit (erythrocyte volume) and hemoglobin contents were depressed. The lead concentration in kidney, liver, spleen, pancreas, brain, bone, and heart was increased in the treated horses. The dose level required to produce lead intoxication was greater than that reported for cattle and that estimated in epizootiologic studies of horses.


Serum values of amylase and pancreatic lipase in healthy mature dogs and dogs with experimental pancreatitis.

Serum values of amylase and pancreatic lipase were determined by the iodometric and the turbidimetric methods, respectively, in 44 mature healthy dogs and in 8 dogs with experimentally induced pancreatitis (plus 1 sham-operated control). Serum value of amylase in mature healthy dogs varied from 250 to 1,500 Caraway units/dl and that of pancreatic lipase varied from 0 to 50 IU/L. Maximal serum values of amylase and pancreatic lipase in the dogs with experimentally induced pancreatitis varied from 4,540 to 14,000 Caraway units/dl and 325 to 810 IU/L, respectively. Following pancreatic damage, serum values of amylase and pancreatic lipase increased rapidly in the 8 dogs and ran parallel to each other in 6 of the 8 dogs studied. However, the serum value of amylase returned to within normal range earlier than the serum value of pancreatic lipase in 2 dogs; the reverse was true in 2 other dogs.


Chemical cardioversion of electrically induced ventricular fibrillation in dogs.

An acetylcholine-potassium cocktail was used to defibrillate chemically the electrically induced ventricular fibrillating myocardium of thoracotomized dogs. This drug combination was highly effective (75%) in comparison with potassium alone (20%) and acetylcholine alone (zero %). Atropine prevented chemical defibrillation. On dogs which failed to defibrillate after the administration of the cocktail, high energies were required to defibrillate the ventricles electrically and not all could be electrically defibrillated. After the administration of the ionic-choline cocktail, increased ventilatory resistance, generalized skeletal muscle contraction, urination, and defecation were observed.


Effects of ionic salts or acetylcholine, or both, on electrically induced ventricular fibrillation in dogs.

A dose-response curve was delineated for an acetylcholine-potassium chloride cocktail previously found to be highly effective in chemically defibrillating electrical induced ventricular fibrillation of thoracotomized dogs. The cocktail dosage responsible for the greatest percentage of chemical defibrillations was transthoracically given to nonthoracotomized dogs subjected to ventricular fibrillation; this resulted in 33% chemical defibrillation. Two clinical canine patients were transthoracically administered the acetylcholine-potassium chloride cocktail because they failed to respond to external electrical defibrillation; both were chemically defibrillated. Potassium citrate when substituted for potassium chloride, in the cocktail, or alone appeared to be more efficacious for chemical defibrillation. Magnesium chloride with acetylcholine failed to chemically defibrillate any dog administered this cocktail.


Effect of shock strength on survival and acute cardiac damage induced by open-thorax defibrillation of dogs.

The safety of open thorax defibrillation with single damped sine-wave shocks and 6-cm-diameter electrodes was evaluated in healthy anesthetized dogs. Twenty-one dogs were allotted to 6 groups: Group A were nonshocked controls and groups B through F were given single shocks of 4-, 7-, 12-, 19-, or 32-fold, respectively, greater than a defibrillation threshold dose (30 mA/g of heart). Immediate postshock death resulted in group F dogs; group A through E dogs survived and were killed after 2 days. The incidence and severity of cardiac morphologic damage increased with shock strength (mild damage occurred in 1 of 3 dogs in group C and in 3 of 4 dogs in group D and severe damage occurred in 2 of 3 dogs in group E). The cardiac lesions were characterized grossly and microscopically. In dogs that died immediately after shocking, damage was apparent as pale circular zones of edema and myofibrillar degeneration in the ventricular free walls beneath the electrode placement sites on the cardiac surface. In the dogs that survived 2 days, the defibrillator-induced areas of myocardial necrosis and calcification were concentrated in arc or ringlike patterns beneath the periphery of the electrode placement sites. All dogs that were studied 2 days after shocking had mild fibrinous pericarditis. Postshock electrocardiographic changes were not good indicators of cardiac damage because the mild epicardial inflammatory reaction associated with the surgical procedure produced large ST and T wave changes which masked any changes associated with myocardial necrosis induced by the electric shocks. It was concluded that a substantial safety margin exists between the required defibrillation threshold shock dose and the large shocks required to produce marked cardiac damage or death in healthy dogs.


Nitrogen inhalation as a method of euthanasia in dogs.

Thirty-four dogs were euthanatized in a chamber flushed with pure nitrogen. Electroencephalograms and arterial blood pressure, recorded during euthanasia, showed the dogs to be unconscious in an average time of 40 s and to be dead in 204 s. The dogs displayed no detectable signs of pain before unconsciousness occurred. Hypoxia produced by nitrogen inhalation was found to be effective, humane, safe, and economically feasible as a method of euthanasia.


Effect of selenium-vitamin E on adriamycin-induced cardiomyopathy in rabbits.

Administration of selenium-vitamin E (Se-E) to weanling rabbits chronically treated with adriamycin (ADR) resulted in decreased incidence and severity of cardiomyopathy and decreased cumulative mortality during a 10-week experiment. However, Se-E did not protect against extracardiac lesions or against a number of clinicopathologic alterations induced by chronic ADR toxicosis. Histopathologic alterations of ADR-induced cardiomyopathy were concentrated periarterially in the free and septal walls of the left ventricle. Initial vacuolar degeneration of injured cardiac muscle cells was followed by myofibrillar lysis and eventual cell death with subsequent interstitial fibrosis. Ultrastructurally, degenerated cardiac muscle cells had 3 prominent alterations: (1) sarcoplasmic vacuolization caused by distention of elements of sarcoplasmic reticulum and T-tubules, (2) degeneration of mitochondria forming large myelin figures from disrupted membranes, and (3) lysis of myofibrils producing granular sarcoplasmic masses. Severely injured fibers were necrotic and macrophages invaded to remove cellular debris. The interstitium was distended by edema and increased amounts of collagen. Extracardiac lesions in rabbits with chronic ADR toxicosis included the usually recognized alterations involving cell-renewal systems in kidney, testis, bone marrow, skin, and alimentary tract, as well as vacuolar degeneration of skeletal muscle and focal loss of pancreatic tissue, with ensuing pancreatic fibrosis and fat necrosis. Deaths in ADR-treated rabbits usually were precipitated by terminal septic embolism. The partial protection afforded by Se-E against ADR-induced cardiomyopathy may be associated with stabilization of the membranes of injured muscle cells or with prevention of ADR-induced inhibition of coenzyme Q10-dependent mitochondrial enzymes.


Pneumonia in a Navajo community: a two-year experience.

This report describes surveillance of pneumonia in an entire community during a 2-year interval. The study, which was performed on the Navajo reservation, included those who sought care for defined clinical manifestations and who showed pulmonary infiltrate(s) on roentogenographic examination. Approximately 10 bouts of pneumonia per 1,000 persons required hospitalization, and an equal number were treated at home each year. Rates were highest at the extremes of age and were higher among males. Multiple attacks were observed in 14.5 per cent of infants and children and in 7.6 per cent of adults. Most illnesses were associated with pneumococci. The proportions of these illnesses, however, were smaller among hospitalized children than among adults. Pneumococcal bacteremia was uncommon in infants and children. Most pneumococcal serotypes isolated are included in currently proposed antipneumococcal vaccines. The 2-year case fatality rate was 2.2 per cent. None of those who dided had been previously well. Factors associated with multiple occurrences need further study. Efforts at prevention should be directed to life's extremes, especially to those already infirm.


Reversible respiratory disease in beryllium workers.

A medical and environmental survey was carried out in a beryllium extraction and processing plant in 1971, and a follow-up study was done in 1974. Peak air concentrations of beryllium of as much as 50 times the accepted peak limit value were found in the plant in 1971. Radiographic changes of interstitial disease were found in 31 workers, hypoxemia was found in 20, and in 11 workers a combination of hypoxemia and radiographic changes of interstitial disease was seen. Follow-up in 1974 showed that air concentrations had all decreased significantly, mainly because of improvements in engineering and ventilation in the plant. Improvement in hypoxemia and decreased alveolar-arterial O2 tension difference at rest ([A-a]DO2) were noted in 13 of the 20 men who had hypoxemia in 1971 and were available for follow-up. In addition, radiographic abnormalities of interstitial disease were reversed in some workers. Our results suggest that improvement in gas exchange and radiographic findings of interstitial disease occurs when peak air concentrations of beryllium are decreased. Our approach in combining environmental and medical screening in workers exposed to beryllium enabled us to identify persons with early changes, to detect reversible abnormalities, and to correlate air concentrations with the medical status of workers.


Bronchoconstrictive suggestion in asthma: a role for airways hyperreactivity and emotions.

Using whole-body plethysmographic measurements, asthmatic patients inhaled aerosolized saline presented either as a neutral substance (day 1) or in the guise of a bronchoconstrictor (day 2). Bronchoconstrictive suggestion resulted in increased airway resistance and decreased specific airway conductance, whereas thoracic gas volume was unchanged. The variation in the response was analyzed in relation to airways hyperreactivity, as indexed by methacholine and histamine inhalation challenges, and physiologic measures of the emotional reaction to bronchoconstrictive suggestion, as indexed by changes in blood pressure, heart rate, finger pulse amplitude, and forehead electromyographic activity. It was found that the bronchoconstrictive response was significantly related to the degree of airways hyperreactivity and to the emotional response. These results suggest that asthmatic patients apt to respond to bronchoconstrictive suggestion with airways obstructions are characterized by highly hyperreactive airways. Responders also appear to be emotionally labile, although it is not yet clear whether the emotional response per se evokes airway obstruction or is merely a by-product of the occurrence of airway obstruction.


Effect of body position on carbon monoxide diffusing capacity in asymptomatic smokers and nonsmokers.

We measured carbon monoxide diffusion capacity (DLCO) in the sitting and supine position in 73 apparently normal subjects (41 nonsmokers and 32 smokers). The coefficient of DLCO standardized for alveolar volume (KCO) was less in the smokers than in the nonsmokers (P less than 0.05) in the sitting position, but the separation was wider in the supine posture (P less than 0.01). The per cent changes between supine and sitting KCO (deltaKCO) were shown to be age dependent in both nonsmokers and smokers, but this age dependence was more accentuated in the latter group. Only 3 smokers were below the 95 per cent confidence limit of nonsmokers for KCO in the sitting position, but there were 7 smokers below that limit for deltaKCO. An attempt was made, using intravenous injection of xenon-133, to study the mechanism of this impairment. Persons who failed to increase KCO in the supine posture showed an ability to increase apical blood flow in that position. The mechanisms of impairment in deltaKCO remain to be explained and may be due either to a predominant apical defect or to a widespread abnormality of the pulmonary capillary bed.


Diagnosis of airflow obstruction at high altitude.

Using predicted sea level values for spirometry done at high altitude, underestimation of airway obstruction may result. We therefore established spirometric normal values for an altitude of 3,100 m for white men.


PUlmonary alveolar proteinosis: shunt fraction and lactic acid dehydrogenase concentration as aids to diagnosis.

The shunt fraction breathing 100 per cent O2 and serum lactic acid dehydrogenase concentration were evaluated as 2 easily obtainable, rapid laboratory procedures that might aid in the early diagnosis of pulmonary alveolar proteinosis. The mean +/- SE shunt fraction was 20 +/- 1.2 per cent in patients with alveolar proteinosis compared to 8.9 +/- 0.5 per cent in other groups of patients with diffuse lung disease (P less than 0.001). The lactic acid dehydrogenase concentration was increased in all patients with alveolar proteinosis and helped to separate further the 2 groups. Thus, when a patient presents with the findings of chronic diffuse lung disease, the lactic acid dehydrogenase concentration and the shunt fraction can be of value in suggesting the diagnosis of pulmonary alveolar proteinosis.


The effects of endogenous and exogenous histamine on pulmonary alveolar membrane permeability.

The effects of exogenously administered histamine phosphate (0.1 microgram per kg of body weight per min, or 90 microgram per hour) and endogenous histamine released by intravenous injection of 0.5 mg of Compound 48/80 on alveolar membrane permeability to substances of differing molecular weight (60 to 20,000 daltons) were studied using the in vivo saline-filled dog lung model. The half-time, i.e., the time required for 50 per cent equilibration between tracer substances in the blood compared to the saline-filled lung, was measured at baseline for urea, sucrose, and dextrans of varying molecular weight. The half-time decreased significantly for substances as large as 10,000 daltons after histamine infusion, and 20,000 daltons after injection of Compound 48/80. We conclude that histamine can increase alveolar epithelial permeability for substances of low molecular weight.


The relationship of age to pulmonary membrane conductance and capillary blood volume.

The lung transfer components of 70 normal, adult nonsmokers 18 to 78 years of age were measured by the single-breath diffusing capacity of the lung for CO. The membrane conductance and the pulmonary capillary blood volume were estimated by several measurements of the diffusing capacity at increasing alveolar PO2. Diffusing capacity, membrane conductance, and pulmonary capillary blood volume are functions of biometric references (height or alveolar volume) and of age. The observed decrease with age was more evident after 40 years of age for diffusing capacity and membrane conductance. Pulmonary capillary blood volume decreases at a later age. The changes in membrane conductance and pulmonary capillary blood volume with age may be due either to morphologic changes in the alveolar capillary surface or increasing inhomogeneities of distribution or both.


Isoniazid-related hepatitis: a U.S. Public Health Service cooperative surveillance study.

After an outbreak of hepatitis in Washington, D.C. in 1970 among a group of persons taking isoniazid to prevent tuberculosis, an isoniazid surveillance study was conducted among 13,838 persons in 21 participating health departments. Age appeared to be the predominant factor influencing the risk of developing isoniazid-related hepatitis, i.e., increasing age was associated with an increasing risk. Drinking alcohol, especially on a daily basis, also seemed to enhance the risk of hepatitis among persons concurrently taking isoniazid. In general, case rates among males and females of the same race, and rates among different races, were not markedly different; however, there were striking differences in the case rates among males of different races. The incidence of hepatitis varied greatly among the 21 cities, but was not unique to any geographic region, nor was it related to a specific manufacturer of isoniazid. The onset, in most cases, occurred within the first few months of treatment. Eight fatalities were reported by the 21 participating health departments, 7 occurring in one city. Black females accounted for 5 of the 8 deaths. This information provides a basis for weighing the benefits of isoniazid in preventing tuberculosis against the risk of its causing hepatitis. Close monitoring for overt signs or symptoms of hepatitis among persons receiving isoniazid preventive therapy is indicated, especially for persons greater than or equal to 35 years of age and those who drink alcoholic beverages on a daily basis.


Noninvasive techniques for evaluating peripheral vascular and extracranial cerebrovascular diseases.

Five hundred and fifty-eight patients have been evaluated at the peripheral vascularocular pulse blood flow laboratory over a year. The accurate correlations with angiography in the peripheral arterial investigation has been 100%, the cerebrovascular investigation has been 75% and the venous correlation has been 86 2/3%. Even though the results from ocular testing are slightly lower than reported by Kartchner and McRae, we believe that the results emphasize the delicacy of instrumentation and the degree of refinement necessary in reading of the tests. We do think, however, that a 75% accuracy does indicate this method to be of significant benefit as a noninvasive stroke screening procedure.


Pyogenic liver abscess.

A review of 20 cases of pyogenic liver abscesses seen from 1971 through 1976 is presented. In this five-year interval, no amebic liver abscesses were found. The primary inflammatory processes were evenly divided among those patients with biliary, urinary, and intraperitoneal disease. Intensive antibiotic therapy was less efficient in sterilizing the abscess than the blood stream. The nebulous histories, clinical findings, and routine laboratory studies emphasize the difficulty in establishing an early diagnosis of liver abscess. Radioisotopic scanning of the liver proved to be the most reliable tool not only for the diagnosis but also for monitoring the postoperative course of the drained cavities. The overall mortality of pyogenic liver abscesses was 45% and the greatest mortality occurred in those patients over 40. Closed needle aspiration of pyogenic liver abscess in the elderly poor-risk patient in conjunction with the appropriate antibiotics may offer an acceptable alternative.


Ileocecal masses discovered unexpectedly at surgery for appendicitis.

During the past five years we have encountered 15 patients who were found to have an ileocecal mass of undetermined etiology when explored through a right lower quadrant incision for presumed appendicitis. Diverticulitis of the ileocecal region accounted for almost one-half of these lesions. There are many possible etiologies for mass lesions in this location, but beacuse malignancy cannot be excluded at operation, a right hemicolectomy is advised. We found that this procedure could be done with relative safety in unprepared bowel under emergency conditions.


Upper gastrointestinal fiberoptic endoscopy reveals the silk suture-line ulcer.

Suture-line ulceration can be prevented by the use of absorbable suture material in upper gastrointestinal operation. Suture-line ulceration can be diagnosed by the more careful and more frequent use of upper gastrointestinal fiberoptic endoscopy in a symptomatic postoperative patient with or without a positive upper gastrointestinal barium x-ray study. Suture-line ulceration can be treated by the gastroscope or by operation once the suture has been confirmed as the etiology of the ulceration.


An analysis of 15 cases of gallbladder carcinoma.

Fifteen cases of cancer of the gallbladder are presented. Unfortunately, this lesion is not diagnosed until well advanced and survival rates are consequently poor. Cholelithiasis is usually present. Gallbladder carcinoma is a disease of older people. Because of the much higher morbidity and mortality of cholelithiasis in this age group, prophylactic cholecystectomy in good risk surgical patients is recommended.


Tracheostomy in children without heart disease.

A series of 27 patients less than 15 years of age who had tracheostomies from 1968--1975 showed that only two of these patients had cardiac disease as the primary lesion. Only three pneumothoraces could be definitely attributed to the tracheostomy, while sepsis in two patients and pneumonia in one patient might possibly have been related to the tracheostomy itself. One death was due to the performance of the tracheostomy. In patients who have tracheostomy for noncardiac conditions, performance of the tracheostomy in the operating room with an endotracheal tube in place, the use of plastic or silastic body contour conforming tubes, and proper intensive care nursing immediately after tracheostomy have reduced complications to a minimum and made the performance of tracheostomy in this age group a safe and effective procedure when oro- or nasotracheal intubation is inadequate.


[Infantile brucellosis (author's transl)].

Some aspects concerning brucellosis are revised. This is a disease with a high incidental rate among the children's population in Salamanca and bordering provinces. The local prevailing epidemiologic conditions are reviewed, as well as the most outstanding clinical features, which are in children, according to the author's personal experience, less protean than in adult's illness.


[Infantile cushing's disease with paradoxical response to dexamethasona due to a probable periodic hormogenesis (author's transl)].

A case of Cushing's disease in a ten year old girl with bilateral diffuse hyperplasia of the adrenal cortex and postoperative enlargment of the sella turcica is presented. The administration of dexamethasone elicited a paradoxical response with a clear elevation of the already high excretion of 17-hydroxycorticoids. The possible mechanisms for this previously described, but infrequent, response to dexamethasone are discussed. It is concluded that: 1) Interpretation of the classical dexamethasone suppression test can occasionally be misleading; and 2) Periodic hormonogenesis may account for this type of paradoxical response.


[Primary osteomyelitis of sternum (author's transl)].

A case of a one month-old girl with primary osteomyelitis of sternum is described. The presence of a positive blood culture to staphylococcus and the antecedent of respiratory physiotherapy are considered to be important etiologic factors. The proccess had a favorable evolution treated with antibiotics and drainage of subperiostal abscess.


[Maternal incompetence syndrome. Report of three cases (author's transl)].

This paper presents three cases of children suffering from repeated diseases and failure to thrive as a consequence of maternal inability in providing health care. Mother's oligophrenia, poverty, and familial unbalance were underlying causes. Authors define maternal incompetence syndrome as the association of mother's incapacity to provide proper health care with direct injury to the child and decreased growth rate. The relationship between this syndrome and the pediatric social illness is discussed. Strategies for treatment should include creation of multidisciplinary teams of social pediatricians, social workers and psychologists, and development of health education programs.


[Subacute necrotizing encephalomielopathy. Leigh syndrome (author's transl)].

A 6-month-old girl with familiar history of two dead sisters few months old, was admitted to the Hospital with a neurological process. After her admission progressively worsened until her death. The patient had clinical manifestation of proximal tubular acidosis. Levels of lactic and piruvic acid were normal. Necropsic study was compatible with the diagnoses of subacute necrotizing encephalomielopathy of Leigh syndrome.


[Ring chromosome 13 with. 13p. preserved. A case report and review of literature (author's transl].

A case with ring chromosome 13 is presented. The G and Q band analysis indicates that breakes are on long arms at region 3, band 4, and other on the short arms region 1, band 3. Short arms are nearly complete. The behaviour of the ring and of different cell lines obtained are interpreted. Authors also discuss the possible paternal origin of the abnormal chromosome.


The determinants of plasma-renin activity in essential hypertension.

Plasma-renin activity was studied, under different conditions of sitmulation, in normal subjects and patients with essential hypertension. In normal subjects, three components of renin release, "basal," "neural," and "sodium-sensitive," could be delineated. Among the hypertensive patients, abnormal patterns of renin release were noted. The categorization of patients according to "plasma-renin status," however, differed with the conditions of testing, being dependent both on the pathophysiology of the essential hypertension and the character of the renin-releasing stimulus, specifically whether this stimulus elevated plasma-renin activity through a predominantly neural (upright posture) or non-neural mechanism (dietary sodium deprivation). Abnormal plasma-renin activity in essential hypertension resulted in part from disordered sympathetic nervous system function. Patients with mild hypertension and elevated plasma-renin activity exhibited increased neural stimulation of renin release, whereas in patients with low plasma-renin values, all three components of renin release, including the neural element, were diminished.


Bone-marrow mast cells in lymphoproliferative disorders.

Increased bone-marrow mast-cell content and lymphoproliferative disorders have been previously linked. Using a semiquantitative method we examined bone-marrow mast-cell content in 120 marrow specimens from patients with multiple myeloma, chronic lymphocytic leukemia, non-Hodgkin's lymphoma, and reactive lymphocytosis. Results indicated a statistically significant increase of marrow mast-cell content in patients with chronic lymphocytic leukemia, non-Hodgkin's lymphoma, and reactive lymphocytosis when compared with iron-deficient control subjects (p less than or equal to 0.0005). Patients with multiple myeloma had decreased marrow mast-cell content, clearly separating them from patients with lymphoproliferative disorders and reactive lymphocytosis. Linear regression plot of marrow mast-cell content against percentage of marrow lymphocytes showed a direct relation, indicating that marrow mast-cell density may be related more to the degree of lymphoid proliferation than to the specific lymphoproliferative process. Marrow mast-cell content may therefore be reproducibly determined and used to support the morphologic diagnosis of lymphoproliferative disorders and differentiate them from atypical myelomas.


Skin involvement in generalized amyloidosis. A study of clinically involved and uninvolved skin in 50 patients with primary and secondary amyloidosis.

A punch or excisional biopsy of the skin was done in 50 patients with generalized amyloidosis: In 46, clinically normal skin, usually the forearm, was biopsied and in four, only cutaneous lesions. Amyloid was seen in the skin of 21 of 38 patients with primary and multiple myeloma-associated amyloidosis. Sixteen of 34 biopsies from clinically uninvolved skin were positive. Five of 12 patients with secondary amyloidosis had amyloid deposits in clinically normal skin. Overall, amyloidosis was definitively diagnosed on skin biopsy examination in 26 patients. A punch biopsy of clinically involved or uninvolved skin is an innocuous, simple procedure with a high diagnostic yield and can be done in an office setting.


Influenza vaccination of patients with systemic lupus erythematosus.

Twenty-nine patients with systemic lupus erythematosus and 29 control subjects matched for age and prevaccination antibody titer received 200 chick-cell agglutinin units of A/New Jersey/76 HswINI influenza virus vaccine. Serum hemagglutination-inhibiting antibodies were measured before and 4 weeks after immunization. Clinical and laboratory evaluations were done before and 4 and 8 weeks after vaccination. Except for one patient with active lupus erythematosus who developed renal disease, there was no evidence of an increase in lupus erythematosus activity after immunization. Fourteen patients and 18 control subjects had a fourfold or greater increase in antibodies to influenza A/New Jersey/76. Mean postvaccination antibody titer of patients tended to be lower than that of controls (Student's t-test, t = 1.52, 0.05 less than p less than 0.10). Since patients with lupus erythematosus may have increased morbidity and mortality with influenza infections, they should receive influenza immunization even though the magnitude of their antibody response may be less than that of normal persons.


Inherited deficiency of second component of complement and HLA haplotype A10,B18 associated with inflammatory bowel disease.

A patient with inflammatory bowel disease and sacroiliitis had haplotypes A10,B18 and Aw32,b18 at the major histocompatibility locus. Serum total complement and C2 hemolytic complement activities were undetectable; levels of the remaining C1-C9 components were normal. The parents, both siblings, and a child each had half-normal levels of C2 and either the A10,B18 or the Aw32,b18 hla haplotype. In a second unrelated family, an only child and both parents developed inflammatory bowel disease. The father and child had HLA haplotype A10,B18, but, along with the mother, each had normal serum levels of hemolytic C and C2. Homozygous C2 deficiency, often in association with the A10,B18 haplotype, has previously been linked with various autoimmune diseases and with propensity to infection. Our findings suggest that C2 deficiency or this haplotype also may predispose to inflammatory diseases of the intestine.


Giardiasis: association with homosexuality.

Giardiasis is a common gastrointestinal illness among travelers. Recently an increased prevalence of giardiasis in men who had not traveled outside New York City was seen at The New York Hospital and was found to be due to transmission of this disease among homosexuals. Cases of giardiasis for a 5-year period were then reviewed, and it was discovered that 19 male patients who had not traveled or had an immunodeficiency disease were homosexuals. This accounted for 22% of the adult men with giardiasis during that period. Adult women with giardiasis usually were either travelers or had an immunodeficiency disease (96%). It is important to obtain a sexual history in these patients and treat sexual contacts to prevent recurrent infection. Our findings are consistent with venereal transmission of giardiasis.


Limitations of continuous ambulatory electrocardiogram monitoring for detecting coronary artery disease.

To assess the value of continuous ambulatory electrocardiogram (ECG) monitoring for detecting coronary artery disease in symptomatic patients, we evaluated 70 patients with chest pain and normal resting ECGs prospectively by calibrated ambulatory monitoring, graded treadmill exercise, and selective coronary cineangiography. Ischemic-type ST-wave changes were detected by monitoring in 24 of the 39 patients with coronary artery disease (62% sensitivity). Twenty-six of the 39 patients had a positive treadmill (67% sensitivity). Of the 31 patients without coronary disease on angiography, 19 had negative monitoring studies (61% specificity). The treadmill was negative in 23 of these 31 patients (75% specificity). When the results of both tests were combined, 85% of the cases of coronary artery disease were detected, but only 52% of the patients without disease had negative studies. We conclude that continuous ambulatory monitoring is of limited value for detecting or excluding coronary artery disease in symptomatic patients with normal resting ECGs.


Growth rate patterns of solid tumors and their relation to responsiveness to therapy: an analytical review.

The clinical doubling times of human solid tumors are reviewed. Methods are also described for estimating subclinical tumor doubling times, and these methods are applied to Wilms' tumor, choriocarcinoma, Burkitt's tumor, and breast cancer. Rapidly growing tumors are often responsive to therapy, and such complete responses are often quite durable. Slowly growing tumors respond less favorably to therapy, and responses are generally not durable. Rapidly growing tumors in advanced stages are similar in their response behavior to the slowly growing tumors. A strategy based on cell kinetics principles and tumor doubling time data is proposed for improving therapeutic results in responsive tumors. Data on clinical and subclinical tumor doubling times are used to distinguish early recurrences from late recurrences in a given tumor type. Early recurrences call for intensification of induction therapy, whereas late recurrences call for prolongation of consolidative therapy. This strategy may also apply in adjuvant therapy of slowly growing tumors.


The relation of blood pressure to stroke prognosis.

The relation between blood pressure before stroke and survival after the event, was examined in the Manitoba study cohort of 3983 men. The last recorded blood pressure before the first stroke and the change in blood pressure from a measurement 5 years earlier were used. Increasing magnitude of systolic blood pressure and its 5-year changes were associated with worsening prognosis. The same association was less apparent for diastolic blood pressure and was not found for 5-year change in diastolic pressure. After adjusting for the effect of age at stroke and previous evidence of ischemic heart disease in multivariate analysis, systolic blood pressure and its 5-year change were each significant predictors of short-term (30 days) mortality. Considering all these factors as well as diastolic blood pressure, systolic blood pressure was the best predictor of short-term mortality. Thus, high blood pressure and large positive 5-year change in systolic blood pressure before stroke occurrence are significant predictors of a poor prognosis.


Septic bursitis in the prepatellar and olecranon bursae: an analysis of 25 cases.

Five cases of septic prepatellar and 20 cases of septic olecranon bursitis are reported. All were men, with a mean age of 47 years. Seventeen had a history of recent trauma to the affected limb or sustained pressure on knees or elbows, or both, required by certain occupations. Septic bursitis was not associated with septic arthritis and could be easily distinguished from it by the characteristic bursal swelling and joint examination. Septic bursitis was misdiagnosed as nonseptic bursitis in eight cases despite characterstic bursal fluid leukocytosis (greater than 1000 cells/mm3) and recovery of bacteria on culture. Staphylococcus aureus was identified in 22 cases; 76% were resistant to penicillin. Intravenous antibiotics and bursal fluid drainage were uniformly succesful. Oral antibiotic ttherapy was also successful unless the infection was extensive or there was underlying bursal disease. Early recognition, prompt therapy, and preventive measures are necessary to reduce the morbidity of septic bursitis.


Circulating immune complexes in disseminated gonorrheal infection.

Circulating immune complexes were detected by the Raji-cell radioassay or the C1q solid-phase assay in 13 of 17 patients with disseminated gonococcal infection. In contrast, only three of 20 patients with local gonococcal infection and four of 40 normal persons were positive. The immune complexes were found to be 19S or larger in size, and complement abnormalities suggestive of complement activation showed some correlation with the levels of immune complexes in disseminated gonorrheal infection. These results indicate that in addition to bacterial dissemination, circulating immune complexes may be involved in the pathogenesis of disseminated gonococcal syndrome.


Nephrotoxicity from cancer immunotherapy.

Because systemic intravenous immunotherapy with Corynebacterium parvum is an effective immunopotentiating and immunotherapeutic agent in animals, clinical studies of this agent have been undertaken. Toxicities in man have been noted, but most are treated symptomatically. Three patients with metastatic melanoma developed oliguria, edema, diffuse bilateral pulmonary infiltrates, azotemia, hypoalbuminemia and hypocomplementemia, while receiving intravenous C. parvum therapy. All had renal biopsies that showed a proliferative glomerulonephritis with subendothelial basement membrane deposits. Immunofluorescence showed glomerular IgG, IgA, IgM, and the C3 component of complement. A fourth patient was found in retrospective chart review of 87 patients registered on two C. parvum-containing protcols. The frequency of the complication in this group was 3/87. Renal failure resolved in all four patients spontaneously after the cessation of C. parvum immunotherapy. Serial evaluation of renal function should be carried out in all patients on systemic adjuvant immunotherapy.


Urinary diagnostic indices in acute renal failure: a prospective study.

A prospective analysis of the value of urinary diagnostic indices in ascertaining the cause of acute renal failure was undertaken. Our results show that in the setting of acute oliguria a diagnosis of potentially reversible prerenal azotemia is likely with urine osmolality greater than 500 mosm/kg H2O, urine sodium concentration less than 20 meq/litre, urine/plasma urea nitrogen ratio greater than 8, and urine/plasma creatinine ratio greater than 40. Conversely, a urine osmolality less than 350 mosm/kg, urine sodium concentration greater than 40 meq/liter, urine/plasma urea nitrogen ratio less than 3, and urine/plasma creatinine ratio less than 20 suggest acute tubular necrosis. A significant number of oliguric patients will not have urinary indices that fall within these guidelines. In this setting, urine sodium concentration divided by the urine-to-plasma creatinine ratio (the renal failure index) and the fractional excretion of filtered sodium provide a reliable means of differentiating reversible prerenal azotemia from acute tubular necrosis.


Renal injury associated with intravenous pyelography in nondiabetic and diabetic patients.

We studied 23 patients with renal functional deterioration after intravenous pyelography; 16 were nondiabetic. Nondiabetic patients at risk are often elderly and have preexisting renal disease. The course of acute renal failure is fairly characteristic; most patient recover, but some do not. Estimates suggest that the syndrome is not uncommon in susceptible nondiabetic subjects. Pyelography cannot be considered absolutely safe for this group, and alternative diagnostic procedures or caution with contrast dosage and patient preparation may be wise.


A characteristic precordial repolarization abnormality with intermittent left bundle-branch block.

We reviewed electrocardiograms of 23 patients with intermittent left bundle-branch block. A characteristic electrocardiographic pattern consisting of right and mid-precordial deep symmetrical T-wave inversions was detected during normal conduction in 19 of the 23. Of the seven patients who had cardiac catheterization, only two had findings suggestive or organic heart disease and only one had significant obstructive coronary disease. Thus we conclude that patients with intermittent left bundle-branch block frequently have T-wave inversions in right and mid-precordial leads during normal conduction that do not necessarily reflect coronary disease. These T-wave changes are similar to those after termination of chronic right ventricular pacing (left bundle-branch pattern), suggesting that both patterns of abnormal ventricular activation can produce abnormal repolarization when activation returns to normal.


Oral contraceptives and nonfatal stroke in healthy young women.

The Boston Collaborative Drug Surveillance Program obtained medical histories on 29 premenopausal women with a discharge diagnosis of stroke. Of these women, 14 were otherwise healthy with no known predisposing illnesses. Eleven of the 14 patients were taking oral contraceptives just before admission compared with seven of 56 otherwise healthy control women (13%). The relative risk estimate for stroke among oral contraceptive users compared with nonusers is 26 (lower 90% one-sided confidence bound = 7.0). Cigarette smoking was only weakly associated with stroke in this group of women.


Mitral-valve prolapse syndrome and recurrent ventricular tachyarrhythmias: a malignant variant refractory to conventional drug therapy.

Of 60 patients referred for management of drug-refractory ventricular tachyarrhythmias, 10 (17%) had mitral-valve prolapse. These 10 patients ranged in age from 19 to 70 years (mean, 47 years); seven were women. All 10 had recurrent ventricular tachycardia, while four had a history of ventricular fibrillation. Nine patients were refractory to propranolol in combination with one or more of the standard antiarrhythmic agents. All showed improvement with aprindine therapy. The results show that refractory malignant ventricular prolapse syndrome; patients with mitral-valve prolapse account for a rather high percentage of those patients referred with recurrent drug-refractory ventricular tachyarrhythmias; in patients with unexplained ventricular arrhythmias, mitral-valve prolapse should be considered; and aprindine may be effective for ventricular tachyarrhythmias associated with mitral-valve prolapse.


Ultrasonography in the diagnosis of obstructive jaundice.

Forty-seven patients with cholestatic jaundice were evaluated for extrahepatic biliary obstruction by ultrasonic cholangiography and the results verified by contrast cholangiography, celiotomy, or autopsy. Sonograms were evaluated both with ("official" reading) and without ("blind" reading) clinical information. By showing dilated bile ducts, sonography correctly diagnosed extrahepatic obstruction in 26 of 30 patients on "official" reading and 23 of 30 on "blind" reading. In all 17 patients without extrahepatic obstruction, sonography revealed the absence of dilated bile ducts. Among patients with extrahepatic obstruction, those with larger bile ducts had higher bilirubin concentrations, longer duration of jaundice, and were more reliably detected by sonography. In these patients, 94% with total bilirubin concentration greater than 10 mg/dl were detected by sonography, while 47% with total bilirubin concentration less than 10 mg/dl were detected. Although we recognize the limited sensitivity of sonography in early extrahepatic obstruction, we find it to be a valuable screening test in cholestatic jaundice.


Comparison of chemical composition of peritoneal fluid and serum: a method for monitoring dialysis patients and a tool for assessing binding to serum proteins in vivo.

It is hypothesized that peritoneal fluid might be used as an alternative vehicle for monitoring the clinical chemistry of patients on peritoneal dialyses and save these patients the venesection and resultant blood loss. Peritoneal fluid was obtained before 47.2% of 106 dialysis treatments and compared with simultaneous serum samples. Very close correlation was noted for phosphorus, uric acid, blood urea nitrogen, creatinine, potassium, bicarbonate, and sodium (r greater than 0.82, p less than 10(-6)), and we conclude that peritoneal fluid may be useful for monitoring these chemistries. The peritoneal fluid concentrations of calcium and albumin were consistently 20% and 43% lower than the corresponding serum values. Because the peritoneal fluid is in equilibrium with the serum, it could also be used to measure protein binding of low molecular-weight substances in vivo that cross the peritoneal membrane. The results presented here fail to support the suggestion that urate is bound to serum proteins in vivo.


Treatment of Depression with drugs.

The multiple manifestations of depression may mimic those associated with many physical illnesses, leading to delay in diagnosis. The consequences of depression are disability, suffering, and sometimes death by suicide. Antidepressant drugs have greatly improved the prognosis for the depressed patient. Tricyclics are the drugs of first choice, with monoamine oxidase inhibitors playing a secondary role except in special instances. Drugs can be used along with electroconvulsive therapy when treatment is urgent. Differences in the pharmacologic effects of tricyclics may affect their choice for individual patients. Monitoring of plasma concentrations of tricyclics may uncover some sources of drug failure, such as altered drug kinetics in an individual patient or noncompliance with treatment. Side-effects of antidepressant drugs are numerous; most represent extensions of known pharmacologic actions. Overdoses produce severe intoxications that require expert and assiduous management.


Radiation dose in the selection of 131I or surgical treatment for toxic thyroid adenoma.

Clinicians, by their patterns of referral to colleagues in nuclear medicine or surgery, may strongly influence the selection of 131I versus surgical treatment for patients with toxic thyroid adenoma. The information presented here is intended to aid them in making an informed choice. As nodule size of an adenoma increases from 2 cm to 6 cm, the amount of radioiodine administered to the patient to deliver the same dose (30 000 rads to the nodule center, assuming a 30% uptake) increases from 5.6 mCi to 135 mCi. Concurrently, the suppressed thyroid tissue receives a radiation dose as high as 2300 rads. Despite these potentially carcinogenic doses, few patients with radioiodine-induced thyroid tumors have been reported; we discuss possible reasons for this. For young patients with large nodules, surgery is preferred.


[Synchronous growth in liquid medium of species related to "Mycobacterium rhodochrous": "Nocardia restricta" and "Jensenia canicruria" (author's transl)].

The synchronous development of nocardioform and coryneform populations had not yet been studied. We have observed that it is possible to obtain a synchronous growth of Nocardia restricta and Jensenia canicruria (species related to Mycobacterium rhodochrous) in a liquid synthetic medium by inoculating the medium with spherical cells taken during the advanced stationary phase, at the end of the cell division cycle. Good synchrony produces a series of breaks in the slope of culture absorbance and of cell protein content. DNA replication checked either by cell DNA content measurements or by pulse-incorporations of tritiated thymidine, is discontinous; peaks of incorporation of thymidine follow one another with a periodicity equal to the generation time. A study of the cell division cycle, hitherto unknown, is now possible.


Gas-liquid-chromatography of trimethylsilyl derivatives from whole cell methanolysates of Leptospira : preliminary evaluation of its applicability to the taxonomy of the genus.

Gas-liquid-chromatography of trimethylsilyl derivatives from whole cell methanolysates was investigated as a supplmentary means for taxonomical classification within the genus Leptospira. Reproducibility of this technique was assessed through the peak height variations occurring in chromatograms of strain Patoc 1, serotype patoc, when samples either from the same or different batches of culture were used. From each chromatogram seven peaks were selected. Their heights were measured and calculated as percent values of the seven peaks total height. The values of relative standard deviation reported show that the reproducibility of this technique lies within the usual limits of biological methods. Four out of seven different serotypes analyzed gave elution patterns dissimilar enough to allow a clear distinction among them by the simple visual examination. Differentiation of the other three had to be done comparing the relative heights of the seven selected peaks. One not yet classified new strain was submitted to this technique; results seemed to confirm available serological information about it. Data reported encourage further research in order to evaluate the potential of GLC as an useful aid in the taxonomy of genus Leptospira.


[Diphtheria toxin titration using "Staphylococcus aureus" protein A (author's transl)].

The antigen-antibody reaction between diphtheria toxin and its corresponding IgG antibody may be visualized if IgG are adsorbed on the surface of S. aureus cells carrying protein A (SpA). If enough antigen is mixed with SpA--IgG, a visible agglutination occurs. On a glass slide, a rapid test can detect 0.3 Lf/ml toxin. If the mixtures are incubated overnight at 37 degrees C, the highest dilution of toxin producing agglutination is 0.01 to 0.02 Lf/ml for a given batch of toxin. The sensitivities of this or of the biological titration using the lethal effect on guinea-pigs are the same. The high sensitivity of the skin reaction was however not approached.


[New "chlamydia" isolation methods applied to the current medical practice and epidemiology (author's transl)].

From 935 men attending a consultation for veneral diseases and 117 women suffering from vaginal discharge, 1 052 genito urinary tract specimens were inoculated on monolayers of McCoy cells which were irradiated or treated with either cytochalasin B or 5-iodo-2-deoxyuridine. The value of these technics was estimated in routine diagnostic procedures according to the number of positive cultures, regardless of the number of inclusions per culture and also by comparison of the number of inclusions seen in cells inoculated with reference strains of lymphogranuloma venereum, trachoma and human urethral Chlamydia. The best method seems to consist of the use of McCoy cells treated with cytochalasin B for routine isolation and of acridine orange for the staining of inclusions.


Mycobacterium phlei PN-bb colonies: a morphological characterisation by scanning and transmission electron microscopy.

Colonies of a non-acid-fast mutant of Mycobacterium phlei--termed "PN--bb"--were examined by scanning electron microscopy of gold-sputted whole colonies and by transmission electron microscopy of thin sections. Inspection of the colonies before and after preparation showed that the fixed colonies had retained their original appearance. Colonies are about 2-5 mm in height and width. They are made up of converging ridges forming a cone. These ridges consists of rounded bodies which are made up of clustered cells. The top of the cone consists of small, rugged, irregular structures. Thin sections show that the cells are arranged close together, without interconnections but with some electron-dense material between them. The colony is covered with a layer of unknown composition.


[Spirochetes: coiling direction].

On electron micrographs of spirochetes, the axial fibers are alternatively visible and hidden, i.e. above then under the cytoplasmic cylinder. From this observation the sense of coiling can be inferred. Leptospires are right-handed structures. So are other spirochetes, but it is less conspicuous. The opposite, however, appears on most published photographs and on schematic drawings. The explanation would be that the preparation introduced into the electron microscope was not facing the photographic plate, but turned to the electron beam. Also the picture must not be turned over, neither in the photographic laboratory nor when used as a slide.


[The prognostic value of the time of progression of symptoms and signs in carcinomas of the pharyngo-larynx (author's transl)].

The authors study the Time of Progression of Symptoms and Signs (TPSS) before diagnosis and treatment in 733 carcinomas of the pharyngo-larynx and 233 carcinomas of the piriform fossa. They show that for a given tumour stage (lymph node: clinical and histological), the longer the TPSS, the better the vital prognosis, the better the local and lymph node prognosis (results statistically significant). By contrast, the TPSS has no influence in the development of metastases nor in the occurrence of second tumour sites. In the opinion of the authors, TPSS, based upon routine questioning is the clinical reflection of cell division and of tumours growth. The treatment of these carcinomas whould be modified in the light of the TPSS. The value of chemotherapy used before surgery and radiotherapy is discussed in carcinomas with a short TPSS, less than 3 months, these being tumours with a rapid course with a particularly unfavourable vital, local and lymphatic prognosis.


[Hyperfractionated irradiation with cobalt 60 in ORL cancers].

So-called "hyperfractionated" radiotherapy is aimed at obtaining synchronisation of tumour cells and to kill the cells synchronised in this way. The technique has been used now for approximately a year and a half in the treatment of 45 advanced or inoperable squamous carcinomas of the upper respiratory and digestive tract. The initial results are encouraging. Oncological sterilisation of the lesions is obtained at the price of actinic reactions which rapidly disappear, but also tumour necrosis, which indicates the need for review of the protocol.


[Vasomotor rhinitis and vasomotor tests (author's transl)].

The classification of types of vasomotor rhinitis remains controversial. Too frequently, the presence of salvoes of sneezing leads to a diagnosis of allergy. The authors point out the only relatively accuracy of skin tests and show that marked local histamine liberation may occur in the absence of allergy. They have perfected a battery of vasomotor tests using nicotinic acid, histamine, 48/80 and acetylcholine. On this basis, they propose a pragmatic clinical classification of types of vasomotor rhinitis. Underlying tendency to tetany is the most common aetiology, going hand in hand with increased histamine sensitivity.


[A graphical method for the assessment of the sensitivity of the vestibular system (author's transl)].

The authors present a graphical method for the assessment of the sensitivity of the vestibular system. With the aid of this method it is possible, with a high degree of probability, to exclude the existence of disturbances (80%) or confirm the presence of disease.


[Vertebral-basilar artery insufficiency nystagmus (author's transl)].

The vertebral-basilar artery insufficiency nystagmus is the nystagmus induced by torsion and extension of the neck, continued for more than three minutes, after nystagmus of other origin has been excluded. It stands particularly in opposition with the nystagmus of cervical origin, which is proprioceptive. On the contrary, vertebral-basilar artery insufficiency nystagmus is of vascular origin. It enables the detection of an infra-clinical vertebral-basilar insufficiency. It deserves to be elicited before subjecting patients to any operation requiring prolonged cervical rotation.


Use of the stomach for bladder replacement and urinary diversion.

The current methods of urinary diversion and bladder replacement have many drawbacks. The pyloric antrum of the stomach was chosen for this purpose because of its good blood supply, relatively poorly absorbing mucosa, acidification of urine, and good contractility. This was first tried out in dogs with extremely encouraging results in the form of both bladder replacement and conduits. Since 1969 these techniques have been applied to human clinical use. Extensive postoperative studies have shown that the pyloric antrum functions well in the urinary tract and that its use for bladder replacement and urinary diversion is probably superior to other recognised methods for these purposes.


Thyroid function in patients with breast cancer.

Thyroid function has been assessed in 40 patients with breast cancer and compared with an age-matched control female population. The free thyroxine index was lower and the level of thyroid-stimulating hormone in the serum higher in the cancer group and these changes became more marked at 6 months. It is concluded that patients with breast cancer show more evidence of hypothyroidism as time progresses.


Aneurysm formation on the small pancreatic arteries in assoication with coeliac axis compression.

The coeliac axis compression syndrome has been recognized for 12 years. More recently an association between this syndrome and the occurrence of aneurysms on the collateral circulation has been described. A review of the coeliac axis compression syndrome is presented and the management of associated aneurysms discussed.


Anatomical pitfall of subclavian venepuncture.

Dissection of 30 human cadavers demonstrated a 45% incidence of accessory phrenic nerves crossing in front of the subclavian vein. There was a small incidence of other anomalies, including instances of the phrenic nerve crossing anterior to the subclavian vein and of the accessory phrenic nerve passing through the subclavian vein and dividing in into two separate channels. These may be hazards in the procedure of subclavian venepuncture.


Portal phlebothrombosis: the role of thrombectomy.

The causes, pathology, and clinical features of thrombosis within the portal venous system are discussed. When thrombosis starts in the periphery of the mesentery the extent of infarction in the bowel may be limited and treatment by resection of the thrombosed mesentery and adjacent gut may be successful. When the thrombosis is proximal thrombectomy is essential. A case is described in which proximal mesenteric venous thrombosis occurred in assoication with volvulus of a common embryonic midgut mesentery. Laparotomy was performed and a thrombus 25 cm long extending into the portal vein successfully removed by catheter thrombectomy.


The transmaxillary K-wire.

The transmaxillary K-wire is a simple, fast, safe, and effective technique for the fixation of unstable tractured malar bones. Combined with other techniques such as interdental fixation it simplifies and provides the fixation of the Le Fort II fracture or osteotomy and certain osteotomies used for facial advancement. The technique of insertion is described and illustrated.


Visual dysfunctions in optic tract lesions.

Characteristic visual symptoms and signs in 12 patients with neoplasms or aneurysms involving the optic tract are summarized. Blurred vision was the most common initial manifestation. Optic atrophy became apparent in 7 of the 12 patients. Most patients had uniocular central scotomas with reduced visual acuity, and 2 had homonymous scotomas. Field defects were frequently incomplete and incongruous, combining central scotomas with elements of homonymous and bitemporal amblyopias. Seven patients had endocrine disturbances and memory deficits in addition to their visual symptoms.


Metabolic response to hypertonic glucose administration in Reye syndrome.

Blood substrate and hormone concentration were determined in 16 children with Reye syndrome prior to and following administration of hypertonic glucose. Baseline concentrations of lactate, pyruvate, alanine, glutamine, glutamate, proline, hydroxyproline, lysine, and aspartate were elevated (p less than 0.01), whereas citrulline and arginine were low. All substrate concentrations were below or within the normal range following 36 hours of therapy except those of lactate, pyruvate, and aspartate. Urea nitrogen excretion was reduced (p less than 0.05) on the second day of therapy. Plasma concentrations of insulin and growth hormone increased and glucagon decreased during the first day. Cortisol remained elevated throughout the study period. We conclude that the high circulating concentrations of substrates are the result of both increased mobilization and decreased clearance and that hypertonic glucose infusion suppresses substrate mobilization. A primary abnormality of the mitochondria could explain the metabolic perturbations that occurred. A possible relationship between the encephalopathy in this disorder and an insult to both brain and brain capillary mitochondria is discussed.


Ventricular volume in man computed from CAT scans.

A new interactive computers has been developed to measure ventricular volume from CAT scans. Testing this system on phantoms demonstrated an accuracy to within 16%. Then a series of scans of patients with obstructive hydrocephalus was analyzed using both tradional linear measures and the computer method. None of the traditional measures were directly proportional to the calculated volume. The area measure of ventricular volume correlated well with the computer-generated values. Clinical studies which attempt to quantitate ventricular volume should use a computerized or planigraphic measure.


Anomalies of motor development in hyperactive boys.

Forty-eight boys who scored high on rating scales for the "hyperactive syndrome" but who went without traditional neurological signs of learning disabilities were compared with 50 control boys on coordination tests. Discriminant function scores for speed, rhythm, and overflow correctly classified 89% of the boys as those with "hyperactive" versus "normal" behavioral histories. Thus, neurological examination of "hyperactive" boys does reveal developmentally immature coordination.


Gaze-evoked blepharoclonus.

Painful bilateral orbicularis clonus on eccentric gaze developed in 2 patients with demyelinating disease. This unusual phenomenon was of variable intensity but persisted for years and did not respond to phenytoin or carbamazepine therapy.


Predictors of mortality in presenile and senile dementia.

Forty-seven hospitalized patients with a diagnosis of presenile or senile dementia and without focal neurological disease of major systemic illness were given complete neurological, neuroradiological, and neuropsychological examinations. Mortality at one year after hospitalization was determined, 12 patients being lost to follow-up. Of the remaining 35 patients, 19 were alive and 1l had died. These groups did not differ in age, education, length of dementia history, sex, race, or degree of cerebral atrophy (by computerized tomography). Significant differences were found in degree of electroencephalographic abnormality and in 8 of 14 cognitive measures, the the largest single difference being on a test of expressive language. Discriminant function analysis made with the cognitive measures as dependent variables yielded a correct prediction (classification analysis) of mortality in all but 1 case (97% accuracy). These results suggest that (1) degree of functional brain impairment rather than degree of cerebral atrophy may be the more important influence on mortality in dementia patients without focal lesions, (2) short-term survival may be accurately predicted in such patients by tests of cognitive functioning, and (3) expressive language deficit in such patients may indicate a particularly poor prognosis for survival.


Familial degeneration of the basal ganglia with acanthocytosis: a clinical, neuropathological, and neurochemical study.

Three siblings, offspring of normal consanguineous parents, had a progressive neurological disorder characterized primarily by chorea and leading to death in the fourth or fifth decade. The most carefully studied patient had neither malabsorption nor absent serum beta-lipoprotein but did have erythrocyte acanthocytosis. Postmortem examination showed marked neuronal loss and gliosis of the caudate nucleus and putamen. Activities of glutamic acid decarboxylase and choline acetyltransferase were normal in cortex, caudate, and putamen. Autosomal recessive inheritance, acanthocytosis, and probable peripheral neuropathy help differentiate this disorder from Huntington's disease.


Changing patterns of childhood aphasia.

Acquired aphasia in children has been generally characterized as nonfluent, transient, and frequently due to right hemisphere lesions. We studied 65 children with unilateral hemispheric brain lesions occurring after speech acquisition any time from the second through the fourteenth year. Of 34 patients with a left hemisphere lesion, 25 had an initial aphasic speech disturbance, while of 31 patients with a right hemisphere lesion, only 4 (including 2 left-handers) showed any initial aphasia. All those who became aphasic before the age of 8 years eventually regained speech, but recovery time required ranged from less than a month to more than two years. One 5-year-old boy who recovered had initial jargon aphasia. Our review of the literature indicated that the conflict between our results and the traditional claim of frequent aphasia with right hemisphere lesions only apparent; the great majority of crossed aphasias are concentrated in reports written before antibiotics were used, and many cases were assoicated with systemic bacterial infections.


Speech disorders in cerebellar disease.

The areas of cerebellar damage most commonly associated with dysarthria were sought by reviewing the clinical, radiographic, surgical, and autopsy findings in patients with nondegenerative cerebellar disease. Case histories on 162 patients with focal cerebellar lesions were reviewed. All but 15 of the patients underwent surgery, and 28 had autopsies. Thirty-one of the 122 patients with adequate descriptions of speech had dysarthria. Twenty-two of these 31 dysarthric patients had exclusively or predominantly left cerebellar hemisphere disease; 7 had right hemisphere disease; and 2 had vermal disease. Only 19 of 41 patients with exclusively or predominantly left hemisphere disease had had normal speech before surgery. Dysarthria developed in isolated cases following cerebellar resections extending into the paravermal segments of the left hemisphere. There was no correlation between the extent of vermal damage and development of abnormal speech. Cerebellar speech function was most commonly affected with  damage to the superior portion of the left cerebellar hemisphere.


The EEG manifestations of chronic ethanol abuse: relation to cerebral cortical atrophy.

Eleven chronic alcoholic patients without other nonneurological or traumatic disease were evaluated by a simultaneous electroencephalogram and computerized axial tomogram. The findings suggested that chronic abusers of approximately 60 years of age or less may have a normal EEG despite the presence of cerebral cortical atrophy or dementia. In alcoholics over 60 years of age, the greater the severity of cerebral cortical atrophy, the greater the slowing in background frequency of the EEG. Voltage diminution and slow-wave transients also occurred more frequently in the older patients. The incidence of EEG abnormalities was greater than the incidence of CAT scan evidence for cerebral cortical atrophy in alcoholics over 60 years of age with dementia.


Free amino acid levels in amyotrophic lateral sclerosis.

To evaluate reports of abnormal levels of free amino acids (AA) in patients with amyotrophic lateral sclerosis (ALS), we studied serum, cerebrospinal fluid, and urine AA in 12 patients with ALS and 12 controls matched for age, sex, and severity of disability. ALS patients had statistically significant elevations in serum levels of tyrosine, total aromatic AA, and total basic AA. ALS patients also had statistically significant elevations in cerebrospinal fluid of total basic AA, lysine, essential AA, and leucine. The severity of ALS correlated inversely with acidic AA (glutamate and aspartate) and O-phosphoserine in cerebrospinal fluid. Activity of ALS correlated directly with serum aspartate and cerebrospinal fluid alanine. We conclude that subtle abnormalities of AA levels are present in ALS and that these are not due to age, sex, or disability. The pattern of distribution of AA levels differs from that in hepatic or renal disease and suggests defective membrane transport or poor cellular utilization of basic and essential AA in the central nervous system.


Experimental analysis of EMG feedback in treating dystonia.

Recent clinical reports have suggested that electromyographic feedback offers promise as a palliative therapy for neuromuscular disorders. This study utilized a single-subject experimental analysis to evaluate the effects of EMG feedback training on a 20-year-old man with adult-onset idiopathic dystonia to achieve control of orofacial dysfunctions. Feedback training produced reductions in levels and variability of tension in facial and forearm muscles, as measured by EMG. Reliable blind observations of facial control indicated that feedback training enabled the patient to produce normal facial relaxation in extraclinical environments.


The syndrome of facial nevi, anomalous cerebral venous return, and hydrocephalus.

A 25-year-old man with facial and nuchal pigmentation and contrast radiographic changes identical to those in the syndrome described by Shapiro and Shulman is reported. Without surgical intervention in infancy, the patient attained normal maturation and development.


Comparison between lergotrile and bromocriptine in parkinsonism.

The therapeutic and adverse effects of two ergot derivatives, bromocriptine and lergotrile, were compared in idiopathic parkinsonism. At both low (50 mg daily) and high (150 mg daily) dosage there was a similar but not identical profile of response. Initially, lergotrile tended to induce more severe but always transient hypotension. At higher doses, bromocriptine caused more dyskinesia. Neurological deficits improved with increasing doses up to an average daily level of 80 to 150 mg of ergot derivatives combined with levodopa, 450 to 1,150 mg, and carbidopa, 45 to 115 mg. However, efficacy often declined at the highest doses of antiparkinsonian agents. Adverse effects caused by ergot derivatives are more common with dosages greater than 100 mg per day. In general, the best overall therapeutic results with bromocriptine and lergotrile were obtained in the dose range of 50 to 100 mg daily for each. It is concluded that bromocriptine and lergotrile are similar in their therapeutic properties and that both are comparable in efficacy to levodopa plus carbidopa (though optimal results are commonly obtained by combining submaximal doses of levodopa with ergot derivatives). The role for each drug in the treatment of parkinsonism is likely to be determined by factors such as cost (bromocriptine) and hepatotoxicity (lergotrile).