Spontaneous return of normocalcemia. Association with long-term hypoparathyroidism.

A 58-year-old man was admitted to the hospital with the superior vena cava (SVC) syndrome. The patient had a 13-year history of hypocalcemia resulting from surgically induced hypoparathyroidism, which he controlled with calcium lactate. Nine months before admission, he discontinued his daily therapy and still remained in a normocalcemic state. After he had the SVC syndrome, a small-cell tumor of the lung was found. His serum calcium level decreased after radiation of the tumor mass, suggesting that the tumor may have been secreting a substance producing the normocalcemia. A substance was extracted from the tumor that reacted immunologically like parathyroid hormone.


Sellar enlargement with hyperprolactinemia and a Rathke's pouch cyst.

A woman with secondary amenorrhea was found to have hyperprolactinemia without clinical galactorrhea. Radiological findings of an enlarged sella turcica with displacement of the pituitary stalk were considered consistent with a prolactin macroadenoma. Treatment with bromocriptine corrected the amenorrhea and hyperprolactinemia, and the patient inadvertently became pregnant. However, no complications to the mother or fetus occurred during pregnancy or postpartum. On transsphenoidal surgery three months postpartum, the unexpected presence of a large Rathke's pouch cyst with a microadenomatous or nodular hyperplasia type of prolactin-secreting tumor was observed to account for the preoperative clinical and radiological findings.


[Clinical and bacteriological studies on infections due to Acinetobacter calco aceticus (author's transl)].

The present studies concern with clinical backgrounds of the patients from whom Ac. calcoaceticus was isolated at the Juntendo University Hospital from Oct. 1976 until May 1977, and in-vitro observations on the susceptibility to antibiotics and chemotherapeutic agents of the organisms isolated from various clinical specimens from Sept. 1976 to May 1977. One hundred and eight strains of Ac. calcoaceticus were isolated from various clinical specimens of 78 patients. Approximately 70% of them was isolated from respiratory tract, and 6 approximately 8% from urinary tract, wound or bile. Ninety six of 108 strains were isolated in combination with other organisms. In retrospective view of 35 patients, all of them had one or more underlying diseases or predisposing factors, e.g., chronic disease, malignancy, infection due to other organism, surgery. Antibiotics had been administrated to 26 patients before onset of their infection with Ac. calcoaceticus. According to in-vitro susceptibility testing, the most active antimicrobial agents were minocyline and doxycycline. Gentamicin, tetracycline, kanamycin, amikacin, dibekacin, colistin, erythromycin, naladixic acid were given in this order. Most strains were resistant to ampicillin, sulbenicillin, cephaloridine, cefazokin, chloramphenicol, lincomycin, clindamycin, pipemidic acid and piperamic acid.


[Isolation of enterococci from clinical materials and their susceptibility to antibiotics (author's transl)].

Three hundred and fifty-one strains of enterococci were isolated from 2,337 clinical materials including urine, blood, pus and other during 6 months of spring and summer in 1977. Urine was the most frequent source of the organism among them. As for species, S. liquefaciens was isolated most frequently (45.5%), being followed by S. zymogenes (26.5%) and S. faecalis (21.5%) in order. The susceptibility of the isolates was tested with 10 antibiotics. In general, the majority of the strains were resistant to several antibiotics, but almost all the strains were susceptible to ampicillin and benzylpenicillin. The susceptibility of S. liquefaciens, S. zymogenes and S. faecalis to 10 antibiotics was similar with each other in pattern, while that of S. faecium and S. durans was considerably lower.


[Clinical evaluation of intravenous administration of ampicillin-oxacillin (Broadcillin 'Banyu') in bacterial infections in children (author's transl)].

Broadcillin 'Banyu', which contains an equal amount of ampicillin and oxacillin was given intravenously to children with acute bacterial infections and the following results were obtained. 1. Patients were 55 children with the following bacterial infections; respiratory tract infections (8 cases), pneumonia (34), sepsis (1), meningitis (1), cutaneous and subcutaneous suppurative inflammation (5), osteomyelitis (1), urinary tract infection (2), enteritis (1), and chemoprophylaxis (2). They ranged in age from newborns to 8 year old, but most of them were infants. In the majority of the patients, broadcillin 'Banyu' was administered 50 approximately 150 mg/day in three to four equally divided doses by one shot-injection or by a continuous drip infusion for a period of 2 approximately 10 days. The overall efficacy rate was 88.7% in 53 cases after two cases of chemoprophylaxis were excluded, i.e., excellent in 28, good in 19 and failure in 6: excellent in 4 and good in 4 in 8 cases of respiratory tract infections; excellent in 20, good in 11 and failure in 3 in 34 cases of pneumonia (an efficacy rate 91.2%); failure in sepsis and meningitis: excellent in 2 and good in 3 in 5 cases of cutaneous and subcutaneous suppurative inflammation; excellent in osteomyelitis; excellent in 1 and good in 1 of 2 cases of urinary tract infection; failure in enteritis. 2. Adverse reactions were noted on 10 occasions in 9 cases (16.4%), including 1 case of skin eruption, 1 case of eosinophilia, 5 cases of slight elevation of GOT, 1 case of slight elevation of GPT and 2 cases of slight elevation of BUN. 3. Based on the above results, it was concluded that clinical effect of broadcillin 'Banyu' by an intravenous administration is comparable to its intramuscular route and that safety of intravenous usage seems to be verified as long as the above described dosage is followed.


[Experience in use of amoxicillin tablets for treatment of cases mostly of acute tympanitis (author's transl)].

Amoxicillin tablets (50 mg (potency)/tablet) were administered to 14 cases of acute tympanitis and one case of acute tonsillitis, and the following results were obtained. (1) Of 15 cases in total, 3 cases were remarkably improved, 11 improved, and one not improved; that is, the effective rate was 93%. (2) Acute simple tympanitis: 6 cases, effective rate 100%. Acute suppurative tympanitis: 8 cases, effective rate 88%. Acute tonsillitis: 1 case, improved. (3) There was one case of diarrhea which appeared to be a side effect of this drug.


Studies on the enhancement of interferon production in human diploid (FS-4) cells by ultraviolet.

Interferon production stimulated with Polyinosinate-Polycytidylate [Poly (I). Poly (C)] in cultures of human FS-4 cells was enhanced ('superinduced') by the irradiation of cells with UV at the time of induction. UV showed no additional enhancing action on interferon production in cultures already superinduced by the sequential treatment with cycloheximide and actinomycin D; UV doses above 1,000 erg/mm2 inhibited interferon synthesis. In UV-irradiated cells interferon production remained sensitive to inhibition by high concentrations of actinomycin D for at least 3 hr after exposure to Poly (I). Poly (C). Irradiation of induced cells at 4, 5 or 6 hr after stimulation with Poly (I). Poly (C) prevented the rapid decline (shutoff) of interferon synthesis seen in control cultures. All these results support the conclusion that the action of UV protects the interferon mRNA from inactivation. This effect, and the fact that interferon mRNA synthesis can occur after the irradiation of cells with superinducing doses of UV, form the basis of the enhancement of interferon production by UV.


Comparative studies on effects of incomplete oil adjuvants with different physical properties.

The author investigated the effects of Freund's incomplete adjuvant (FIA) with different physical properties on precipitin formation and skin hyperreactivity in rabbits and mice following intramuscular injection of ovalbumin (OA) with the adjuvant. Histopathological changes in the injection site and in some visceral organs were also examined. The observation periods after the injection for mice and rabbits were 20 and 28 weeks, respectively. In contrast to the most reports, FIA of both imperfectly emulsified-water-in-oil (W/O II) and oil-in-water (O/W) types were sometimes equivalent or superior to perfectly emulsified water-in-oil (W/O 1) type FIA in the enhancing effects in precipitin formation both in rabbits and mice. The skin displayed the immediate type hypersensitivity reaction to OA throughout the observation period irrespective of the type of adjuvant. The O/W type often caused significantly stronger skin hyperreactivity than the other types. Histopathological findings in the injection site indicated that the abscess formation in rabbits was severer than that in mice, and that the O/W type induced the severest abscess. No relation was found between free fatty/acid contents of adjuvant emulsion and abscess formation in either animal species. Granuloma formation in mice was always severer than that in rabbits. The O/W type caused extremely weak granuloma in mice, and none in rabbits. Histopathological changes in main visceral organs, being dependent on the emulsion type, were also discussed.


Optimal conditions for plaque assay of echoviruses in human embryonic lung fibroblast cells.

The present paper gives optimal conditions for plaque assays tn human embryonic lung fibroblast cells with 45 echoviruses including 11 fresh isolates, covering 31 serotypes. All the viruses tested except echovirus type 23 produced plaques at a high titer in the same cells by the methods described in this communication. Plaque formations by a number of strains were markedly enhanced in size or number or both by the addition of polycation.


The role of membrane electrical activities and extracellular calcium in high-K-induced contracture of guinea pig ureter.

Electrical and mechanical activities in high-K-induced contracture of guinea pig ureter and taenia coli were studied using the sucrose-gap method. Ureter immersed in high-K solution showed a contracture consisting of three components as well as twitch contractions evoked by a few spikes which were observed during the depolarizing phase. Reapplication of high-K solution after a short washing procedure with normal solution induced a contracture composed of only the first and the third components. No action potential was observed during the course of membrane depolarization by this procedure. High-K-induced contracture was highly sensitive to extracellular Ca: no tension development of the ureter despite the membrane depolarization was observed in Ca-free high-K solution. The addition of Ca to Ca-free high-K solution caused a contracture similar to that by high-K solution in the presence of Ca. Verapamil (10(-5) M) blocked all three components, leaving only slightly depressed twitch contractions initiated by action potentials. The possibility that all of these components of high-K-induced contracture were initiated by influxed Ca from extracellular space was also strengthened.


Effects of heart rate and isoproterenol on the functional refractory period of the AV node.

The effects of heart rate and l-isoproterenol on the functional refractory period (FRP) of the atrioventricular (AV) node were analyzed in anesthetized dog. A rectangular hyperbola was adopted to express the relationship between the AV conduction time of the premature beats and the atrial coupling intervals. FRP was shown to be expressed as FRP = E + 2 square root of C - C/(T - E). Thus, it is a function of the effective refractory period (E), basic cycle length (T), and C, a constant. A decrease in the basic cycle length caused a decrease in the effective refractory period as well as FRP; the minimum conduction time remained unchanged. As expected from the above equation, relationship of FRP to the basic cycle length was curvilinear. The above equation also indicates that changes in FRP produced by a change in the basic cycle length were to be ascribed to the change in the AV conduction time of the basic beats. Therefore, FRP under this condition cannot be equated with the refractory period in its true sense. In the paced hearts, l-isoproterenol hydrochloride caused a decrease in the effective refractory period, FRP, C and the minimum conduction time, and the changes in FRP were shown to be correlated with the changes in the effective refractory period, indicating that the change in FRP attained in a given fixed cycle length may be due to a change in the effective refractory period.


The rate of action of calcium on the electrical and mechanical responses of the crayfish muscle fibers.

The effects of sudden changes in external Ca concentration on the time courses of the changes in size of the action potential and of the associated contraction in a single crayfish muscle fiber were investigated. Procaine-HCl was added to the bathing solution to make the muscle fiber excitable. The concentration of the divalent cations (Ca and Mg) was high enough to keep the threshold potential constant. In Ca-free solution, neither action potential nor contraction was observed. When the external Ca concentration was suddenly increased from 0 to 14 mM, the full sized action potentials were generated within several seconds, but the tensions recovered slowly in an exponential time course with the time constants of 15-40 sec depending on the muscle fiber radius. The tension recovery was further delayed by addition of Dextran to the bathing solution, and it was also slowed at temperatures as low as 4-5 degrees C. When the Ca concentration was changed from 14 mM to 0 mM, the decreased in action potential was slow rather than instantaneous. The delay in tension recovery was attributed to the diffusion time of Ca ions into the TTS, and it was suggested that the Ca entry through the TTS membranes was the first step in the excitation-contraction coupling of the crayfish muscle fibers. The diffusion coefficient of Ca ions inside the TTS was calculated from the recovery time of tension development. It was one order smaller than that in free solution.


Further studies of periodic miniature response in squid giant axons.

Electric responses of extremely small amplitudes (1-30 muV peak-to-peak) repeating with more-or-less definite periodicity could be induced by a variety of chemical stimulants applied to squid giant axons either extracellularly or intracellularly. The chemical stimulants studied include allethrin, aminopyridines, N-bromosuccinimide, dimethylamino-pyridine, glutaraldehyde, osmium tetroxide, parachloromercuribenzoate, rose bengal, scorpion venoms and veratridine. With several mild stimulants, it was possible to evoke periodic miniature responses unaccompanied by a fall in the resting membrane potential. The frequency of miniature responses could be lowered by intracellular injection of TEA (tetraethylammonium). These miniature responses could readily be suppressed by external application of TTX (tetrodotoxin). The miniature responses evoked by 4-aminopyrine were characterized by a large variation in the frequency of responses. Cross-linking of the membrane proteins with a dilute solution of glutaraldehyde produced miniature responses repeating at progressively falling frequencies. Analyses of the processes of production of miniature responses with these and other stimulants have clarified several aspects of the physicochemical properties of the excitable sites of the axon membrane.


Modification of the American Burn Association injury severity grading system.

This study evaluated the regional burn health care system of the Commonwealth of Virginia using the criteria for optimal care of the burn patient designated by the American Burn Association. The data base for this evaluation was hospital records of seven hospitals in Virginia. The major shortcoming of the designated criteria was the grading system for the severity of burn injury. Using the criteria designated by the American Burn Association, a large number of minor burn injuries were judged erroneously to be major burn injuries. A modification of the American Burn Association's injury severity grading system is proposed which more precisely identifies the minor burn injury.


External ear injuries.

The unique shape of the external ear depends on the underlying cartilaginous framework. Injuries of the external ear are common. In dealing with lacerations, subperichondrial hematomas, perichondritis, burns and frostbite, particular care should be taken to maintain the cartilaginous framework and to prevent infection. In this way cosmetic deformities of the external ear can be prevented.


Autocategorization: a new technique for statistical comparisons of medical diagnoses.

Autocategorization is a new technique appropriate for studies involving relative frequencies of illness diagnoses using the International Classification of Diseases. It is ideally suited for emergency department illness patterns. The technique uses the standard chi-square statistical test, but is novel in objectively determining the aggregation of diseases into categories for analysis. The numbers of observed occurrences of the various diseases are used. without applying any a priori judgements, to decide whether a disease should be analyzed alone, or aggregated with others. This technique, because it is based on the ICDA code, will permit comparisons between various studies while retaining the statistical validity of the individual studies.


High-pressure injection injury with river water.

A case of high pressure injection and laceration of the calf with river water is reported, the first such case appearing in the literature. As with high pressure injection of grease, paint, paint thinner, mineral spirits, diesel oil, gasoline, and turpentine, this injury is a surgical emergency. All patients must be admitted for surgical debridement, irrigation, parenteral antibiotics, and observation. River water, contaminated by sewage and industrial wastes, has great irritative and infective potential.


Fatal drug-induced heat stroke.

In the case reported, fatal hyperpyrexia resulted from massive doses of chlorpromazine combined with benztropine mesylate given to a paranoid schizophrenic admitted for increased psychotic symptoms. Phenothiazines disturb the thermoregulatory mechanism and also exert anticholinergic effects peripherally, including sweating. The goal of treatment of drug-induced hyperpyrexia is to reduce oxygen demand and core temperature. Ice water soaked towels, fanning, thermal blanket, or immersion in an ice bath can be used. Oxygenation will help combat further tissue anoxia. Severe acidosis may be present and must be corrected with sodium bicarbonate after arterial pH determination. Vasoconstrictors should be avoided if shock is present.


Epicardial nodules: a possible sign of coronary endarteritis with hypoplastic right heart syndrome.

Hypoplastic heart syndromes in infancy have been associated with an unusual obliterative coronary endarteritis. Only one case was revealed amont the 16 autopsies performed over the past ten years at The Johns Hopkins Hospital on infants with the hypoplastic right heart syndrome. Grossly visible epicardial nodules at the time of autopsy prompted further investigation in this case and should be considered markers of this unusual entity.


[The relatinship between prognosis and "Kiel" classification of malignant non-Hodgkin lymphoma. A study of 201 patients (author's transl)].

The clinical course of 201 patients with malignant non-Hodgkin-lymphomas was analysed according to the Kiel classification. The five-year survival rate of 133 patients with lymphomas of low grade malignancy was 63% in comparison to 23% out of 68 patients with lymphomas of high grade malignancy. Radio- and chemotherapy were used in a different way. Patients with centrocytic-centroblastic lymphomas had the best porgnosis, which was not influenced by the stage of the disease. The poorest prognosis was observered in patients with lymphoblastic lymphomas. These results support the importance of a classification of malignant non-Hodgkin-lymphomas which is not only based on morphological criteria.


[Rational use of bone marrow biopsy. longitudinal hemisection of samples, for simultaneous adaption of various histological preparations without loss of material (author's transl)].

Unfortunately, the combination of the superior histologic embedding technique for semi-thin sectioning of undecalcified bone in methacrylate with special methods in enzyme or immune histochemistry did not prove to be very successful up to now. These shortcomings are attributed to the influence of the embedding medium itself. They can be overcome by processing one part of a biopsy specimen after embedding in methacrylate, the other one after freezing. Optimal and comparable results have been obtained by a simple instrument for longitudinal hemi-sectioning of a cylindrical biopsy specimen of cancellous bone of adequate size, and by developing a suitable technique for the cutting of frozen sections of undecalcified bone. These methods are presented. Examples are given of the benefits of the simultaneous evaluation of one and the same biopsy-specimen with light-microscopic, ultramicroscopic, enzyme- and immun-histochemic technique.


[Isoenzymes of creatine kinase: distribution in the skeletal muscle and in sera of patients with muscular diseases or damages (author's transl)].

In skeletal muscle isoenzymes of CK were determined by immunprecipitation and chromatography. The activity of CK-MB was between 17 and 47 U/g muscle, corresponding to a quota between 2,1 and 4,2% of the total activity. In sera of patients with muscular dystrophy, polymyositis, hypothyroidism, after arterial embolism, epilepsy, hyperventilation, operations and polytrauma with and without injury to the thorax isoenzymes were measure by immune precipitation- and immune inhibition-test. The percentage of CK-MB in all sera was less than 6% of the total CK-activity (range: 0 to 6%). Only patients in the first day after neurosurgical operations showed a quota till to 6.5% CK-MB. In serum of patients after polytrauma without injury to the thorax the percentage of CK-MB ranged from 0-5.7% while after polytrauma with injury to the thorax and a reasonable suspicion of a damage to the myocardium this quota was between 5.1 and 23.6% of the total activity. CK-BB activity was not detectable in any cases. Therefore a disease or damage of the skeletal muscle is more probable, if the percentage of CK-MB in less than 6%, because in sera of patients with myocardial infarction in the first 48 h after beginning of the symptoms this quota of CK-MB in the most cases in more than 6%.


[Antibody coated bacteria in the urine: a specific test for pyelonephritis (author's transl)].

Three groups of subjects have been studied: the first group with sterile urine, the second with significant bacteriuria without antibody-coated bacteria and the third with significant bacteriuria with antibody-coated. IgG, IgA, IgM and transferrin were determined by immunological methods (partigen plates). The antibody coating was determined by immunofluorescence. Subcultures were prepared from the urine samples containing bacteria. The bacteria obtained from the subcultures were then incubated with the original urine which had been sterilised by passing through a filter. These were then treated with AH-IgG containing fluorescein. Serum was taken from several patients and incubated with the bacteria from the subcultures. These were also treated with AH-IgG fluorescein. In no case could specific antibodies against the infecting organisms be found, although IgG in the urine were elevated and specific antibodies were present in the serum. This leads to the conclusion that specific antibodies are formed by direct tissue contact of the bacteria and that coating is not established in the urine itself.


[Change in the total potassium content, hemoglobin volume and bromine space in Soiuz-14 crewmembers].

The specific factors of the 15-day space flight caused the predominance of catabolic over anabolic processes. This was equally true of tissue proteins and hemoglobin. Red blood cell and hemoglobin losses developed in parallel. They were more pronounced in the flight engineer than in the commander. No significant signs of body dehydration were noted.


[Dynamics of the blood circulatory indices in the crew of the Saliut space station in a functional test under physical load].

On the 4th, 9th, 16th and 21st days of the "Salyut" mission the crewmembers performed exercises with a load of about 1100 kgm. The results were compared with those obtained on the Earth. Immediately after the tests the crewmembers showed an increased heart rate and greater changes in the diastolic and pulse pressure, cardiac output and left ventricular ejection time. The above parameters returned to the normal at a slower rate. A comparison of the values recorded on different flight days did not demonstrate a distinct correlation between the changes and time of the weightlessness exposure.


[Principles for making up pharmaceutical kits to supply cosmonauts with drug packs].

Pharmacological, pharmaceutical, clinical, physiological and other aspects of drug supply of cosmonauts are discussed. The procedure of choosing a drug to be included into the medical kit is illustrated by way of a new tranquilizer--a derivative of gamma-aminobutyric acid. The data are presented to describe the contents of the medical kit and their use in the flight of Soyuz-19/Salyut-4.


[Substantiation of a set of preventive measures applicable to the flight missions of the Saliut orbital station].

The paper describes the effect of exercises, LBNP, controlled water and salt consumption, and drugs used as countermeasures against cardiovascular deconditioning during prolonged (2--7 weeks) head-down bed rest. Each of the above countermeasures applied separately had a limited effect. The use of a combination of exercises, LBNP and water-salt supplements at the final stage of the bed rest experiment made it possible to prevent entirely deterioration of work capacity and decrease of orthostatic tolerance of the test subject. The paper presents the scheme and regimens of the above countermeasures employed to meet the requirements of the flights of the orbital station "Salyut".


[Psychology of the formation of special action skills in nonstandard flight situations].

The reliability of pilot actions depends essentially on the development of the specific skill to know how to process incomplete information and to recognize indistinct situations under stress conditions. The skill includes as its components operational thinking and anticipation. The paper presents characteristics of this skill, discusses conditions and methods of its development, and gives the results of training experiments.


[Combined action of vibration and ionizing radiation on the body].

The effect of vibration on the development and outcome of radiation injury was studied and the efficacy of pharmacochemical and local protection was measured. The biological effect of the combined exposure was estimated by radiobiological and hematological methods. The animals were exposed to vibration with a frequency of 70, 700, 1500 Hz (during single and repeated exposures) and irradiation with X-rays, gamma-rays and protons at different doses. Vibration may exert a significant effect on the development and outcome of radiation injury of animals. The effect was that this factor was capable either of increasing or decreasing responses of the animal body to ionizing radiation. The direction and level of changes depended on the pattern and force of stimulation, time and sequence of action of factors, etc. The lymph tissue showed high sensitivity to vibration. The findings indicate that vibration may both enhance and diminish the efficacy of antiradiation pharmacochemical drugs.


[Kidney function study of healthy persons by the 131I-hippuran renography method under prolonged hypokinesia].

The paper describes renography studies (using I131-hippurane) of the renal function of 28 test subjects who participated in 30- and 120-day bed rest experiments. Typical changes in the vascular, secretory and evacuatory segments of renograms were noted. The delay in the isotope absorption and excretion from the blood and kidneys was mostly expressed by the end of bed rest. A relationship between renographic changes and renal blood flow as well as between renal excretion of water and sodium at different experimental stages was established. The above changes in the renal function were functional and associated with changes in the systems controlling the fluidelectrolyte metabolism.


[Autogenic training in psychophysiological preparation for parachute jumps].

The efficiency of specific psychophysiological preparation--autogenic training--to parachute jumps was measured in two groups of cadets (test subjects and controls). Hetero- and autogenic training was carried out according to a scheme specially developed for this type of activity. The study of questionnaires and physiological data demonstrated that the specific psychophysiological preparation by means of autogenic training for a certain type of activity helped to develop active self-control over one's own state and emotions, alleviated tension, arrested adverse neurotic manifestations (sleep disturbances, depression, anxiety), contributed to the feeling of confidence in the successful completion of the jump and promoted positive tuning towards subsequent jumps.


[Importance of the step test for the evaluation of the functional state of the cardiovascular system].

Cardiovascular reactions of 100 healthy cadets (1st group) and 45 persons with clinical signs of autonomic-vascular dystonia of the cardiac type (2nd group) to submaximal exercises (Harvard step-test of 1800--21000 kgm/min for 5 min with a total workload of 9000--10500 kgm) were investigated. The cardiovascular function was estimated with respect to electrocardiography, polycardiography, carotid artery sphygmography and left ventricular cardiography. After the step-test the 2nd group test subjects showed distinct changes--hypoxia, arrhythmias, disorders in the phase structure of the systole and diastole--which pointed to a decrease of reserve capabilities and resistance of the cardiovascular system.


[Effectiveness of using oxygen at different periods of increased atmospheric pressure action (experimental studies)].

The allowable value of nitrogen supersaturation was determined in 4 dogs during 219 experiments in a hyperbaric atmosphere (2 and 3 ata) which simulated diving. In the course of a 1-and 4-hour exposure of dogs to increased pressures of oxygen and an inert gas the allowable value may either decrease or increase. In order to increase the value, it is most effective and reliable to allow a 20-minute prebreathing of oxygen at 2--3 ata.


[Glucocorticoids and the blood anticoagulation system under the effect of SHF-range electromagnetic waves].

With an increase in the strength of the ultrahigh frequency field the sensitivity of the hypophyseal-adrenal system increases and activity of the anticoagulatory blood system decreases. Functional changes in these systems repeatedly exposed to ultrahigh frequency effects can be considered as adaptive reactions with a delayed resistance at a flux density of 50--80 Mwt/cm2.


The effects of l-norepinephrine on myocardial zonal lesions in dogs in hemorrhagic shock.

Intravenous l-norepinephrine was given to dogs in hemorrhagic shock to determine the effect on myocardial zonal lesions which are characteristically seen in hypovolemic shock. Zonal lesions produced by hemorrhagic shock in drug-treated and nondrug-treated groups were quantitatively compared both at the light microscopic and ultrastructural levels. A significantly greater percentage of myocardium was found to be involved with zonal lesions in animals treated with l-norepinephrine following shock as compared to that found in nondrug-treated animals. The effect was greater for the right ventricle than for the left ventricle. The average size of zonal lesions was slightly smaller in the drug-treated group, indicating that there must have been a greater total number of zonal lesions produced in the treated group. Zonal lesions were not present in "sham shock" animals nor in animals given l-norepinephrine alone. The results indicate that the treatment of hemorrhagic shock with l-norepinephrine can be anatomically deleterious to the heart.


Compensatory hyperplasia with increasing loss of renal mass.

When a rat with two kidneys is cross-circulated with an anephric rat, compensatory renal hypertrophy occurs as indicated by an increased ratio of RNA to DNA within 6 hours and an increased ratio of kidney weight to body weight within 12 hours. Removal of three kidneys between the rats further increases residual renal mass and RNA/DNA after 24 and 48 hours of cross-circulation as compared with results of removing two kidneys. Trinephrectomy triples the mitotic index and doubles the proliferative index. Increasing the magnitude of renal loss causes appreciable hyperplasia as well as increasing the magnitude of compensatory renal hypertrophy.


Explant culture of human peripheral lung. I. Metabolism of benzo[alpha]pyrene.

Human lung explants have been maintained in vitro for a period of 25 days. Autoradiographic studies indicated that the broncholar epithelial cells, type 2 alveolar epithelial cells, and stromal fibroblasts incorporated 3H-thymidine during the culture. After 7 to 10 days, type 2 cells were the predominant alveolar epithelial cell type. Lamellar inclusion bodies were released from the type 2 cells and accumulated in the alveolar spaces. The metabolism of benzo[alpha]pyrene (BP) in human lung explants cultured for up to 7 days was investigated. Human lung explants had measurable aryl hydrocarbon hydroxylase activity and could metabolize BP into forms that were bound to cellular DNA and protein. Peripheral lung had significantly lower aryl hydrocarbon hydroxylase activity than cultured bronchus but both tissues had similar binding levels of BP to DNA. Radioautographic studies indicated that all cell types in the peripheral lung can metabolize BP. The major ethylacetate extractable metabolites of BP formed by peripheral lung were tetrols and trans-7,8-diol. The primary water-soluble metabolite released with arylsulfatase and beta-glucuronidase was 3-hydroxybenzo[alpha]pyrene.


Combining auditory and visual stimuli in the adaptive testing of speech discrimination.

This investigation determined the feasibility of using both auditory and visual stimuli in the adaptive testing of speech discrimination. Thirty-six adults with normal hearing and vision were subjects. Using the adaptive methodology known as the Doublet technique, speech-discrimination testing using monosyllabic word lists from the Northwestern University Auditory Test No. 6 (NU-6) (Tillman and Carhart, 1966) was performed at the target levels of 29.3 and 70.7% for both auditory-only and auditory-visual conditions. The results indicated that a specific discrimination score could be obtained under more adverse listening conditions with the addition of visual cues. The contribution of visual cues was constant for the two target scores. The adaptive technique at the 29.3 and 70.7% targets was reliable for both the auditory-only and auditory-visual conditions. Constant level testing showed good agreement with the adaptive technique for the auditory-visual condition. In conclusion, the use of standard error calculations is useful in determining measurement errors and the effects of an aural rehabilitation program.


Clinician-child discourse: some preliminary questions.

Various pragmatic procedures were used to analyze clinician-child discourse in a language remediation setting. Communicative acts, responses to prior requests, and discourse topics were described in the interaction between clinician and child. Three major trends were derived from the data. First, consistent patterns were found among clinicians and children for the relative frequency of communicative acts as well as the general and specific types of communicative acts. Second, patterns were not found for the responses to prior requests for either clinicians or children. Last, consistent patterns were found across data on groups of clinicians and children for the introduction, continuation, and reintroduction of discourse topics. Preliminary questions are raised regarding the variables associated with clinician-child discourse to begin to understand the nature of this interaction.


Effect of lisping on audience evaluation of male speakers.

The social consequences of adult listeners' first impression of lisping were evaluated in two studies. Five adult speakers were rated by adult listeners with regard to speaking ability, intelligence, education, masculinity, and friendship. Results from both studies indicate that listeners rate adult speakers who demonstrate frontal lisping lower than nonlispers in all five categories investigated. Efforts to correct frontal lisping are justifiable on the basis of the poor impression lisping speakers make on the listener.


Evaluation of a clinical method for measuring comfortable loudness for speech.

The reliability of a clinical method for measuring most comfortable loudness for speech was evaluated on 100 subjects with sensorineural hearing loss. The method uses spondaic words as the test stimuli. The test-retest reliability was determined for an ascending and descending approach mode for all 100 subjects as well as for subgroups categorized on the basis of severity of hearing loss and pure-tone configuration. Results indicated that reliability was not affected by approach mode, hearing loss severity, or pure-tone configuration. Test-retest differences were not significant and test-retest correlations were high (r = 0.73 to 0.93) across all subgroup categories. Clinical reliability was demonstrated by the high percentages (85 to 92%) of subjects who had test-retest differences no greater +/-5 dB. The procedure is rapid, uses no special equipment, is easily performed, and is reliable. Thus, it is recommended as the preferred clinical procedure.


Aerodynamic studies of cleft-palate speech.

The aerodynamic oral-nasal factors related to the speech of two groups of cleft-palate children were evaluated. One group presented hypernasality and the other group presented normal nasal resonance. The aerodynamic parameters evaluated were oral pressure, nasal flow, and flow-pressure ratio (nasal flow/oral pressure). Oral temperature readings were also obtained. These parameters were evaluated under three conditions (1) blowing, (2) vocalizing the vowel /i/, and (3) reading eight sentences representing two different rhythm patterns, two types of consonant loadings, and two conditions of syllable stress. The findings revealed significant differences between the hypernasal and normal resonance groups in flow-pressure ratio, oral pressure, and nasal flow while subjects were reading sentences. However, only a small proportion of the variability in these aerodynamic measurements could be accounted for based on the classification of hypernasality or normal nasal resonance. Oral-nasal aerodynamic studies done during speaking activity are more useful clinically than blowing activity or saying vowel sounds. No aerodynamic differences were noted between the two groups for the different rhythm and stress patterns and phonemic loadings within the sentences used.


Signal monitor for audiometry.

Conventional volume unit (VU) and auditory monitors of signals generated by or fed through an audiometer do not allow monitoring of the signal after the attenuator or output selector. An amplifier-compressor circuit has been designed and constructed which allows auditory monitoring of the electrical signal at the transducer. The circuit and its use are described.


Velopharyngeal relationships of /i/ and /s/ as seen cephalometrically for persons with suspected incompetence.

Measurements of velopharyngeal gaps were obtained for 110 subjects with suspected velopharyngeal incompetence. Cephalometric x rays during a high vowel, /i/, and a sustained voiceless sibilant, /s/, were compared. Velopharyngeal gaps for the two phonemes differed in group means and for most individual subjects, with greater gaps being found for /i/ than for /s/. Persons with smaller gaps generally were found to have /i/ gaps in the absence of /s/ gaps, and greater /i-s/ discrepancy. Relationships between velum and pharyngeal wall perceived cephalometrically during /i/ and /s/ were not found to be equivalent. Generally, the /i/ radiograph agreed better with presumed velopharyngeal incompetence.


Effects of instructional set on the comfortable loudness range.

Ten normal-hearing young adult subjects measured their Comfortable Loudness Ranges (CLRs) using two instructional sets. The first instructional set (range tracking) was similar to the Bekesy Comfortable Loudness tracking method described by Jerger and Jerger (1974). The second instructional set (limit tracking) required the subjects to perform separate trackings of each limit (upper and lower) of their CLRs. Results demonstrated a 34.4 dB difference between CLRs for the two instructional sets. The range tracking method yielded the narrowest CLR. Both instructional sets yielded similar upper limits of the CLR. The results of the present investigation demonstrate the importance of instructions employed in research and clinical measurements of the CLR.


Absolute thresholds for frequency-modulated signals: effects of rate, pattern, and percentage of modulation.

Absolute monaural thresholds for continuous unmodulated and frequency-modulated signals were determined for five normal-hearing subjects using the method of adjustment. Three carrier signals (250, 1000, and 4000 HZ) were modulated at rates of 2 and 20 times per sec using frequency deviations of +/- 5, 10, and 20%, and both ramp and sinusoidal modulation. Thresholds measured at the slower modulation rate were 5 to 10 dB lower than those measured for unmodulated signals at the two higher test frequencies. Suggestions are presented as to how the clinician may minimize the possible discrepancy between modulated and unmodulated signals using currently available warble-tone equipment.


Learning visual correlates of fricative production by normal-hearing subjects: a preliminary evaluation of the video articulator.

This investigation provides a preliminary evaluation of the use of the video articulator, a phonemic recognition device for the hearing impaired. The subjects were five young adults with normal hearing and vision (corrected) who were matched with respect to age, sex, dialect, education, and phonological sophistication. Each subject received 150 min of programmed training to learn the video configurations of the eight English fricatives both in isolation and consonant-vowel contexts. Following the training period, the subjects were given a test to determine adequacy of learning and retention of the video configurations for the training stimuli, in the absence of auditory cues. The subjects' responses were analyzed using a common covariance measure. The results demonstrated generally low transmission values for consonants in isolation. Moreover, identification of consonants in context was less accurate. The subjects, as a group, had greater difficulty in recognizing the productions of other subjects when compared with recognition of their own utterances. The clinical implications of these findings are discussed.


I don't understand what you mean by comprehension.

Current clinical approaches to the assessment of language comprehension in children are characterized by the measurement of "receptive" knowledge of lexical items and syntactic structure. A more comprehensive approach would go beyond measuring the child's ability to comprehend the literal meaning of sentences to include two other aspects of obtaining information from spoken utterances: presupposition and inference and illocutionary acts. A selected review of clinical instruments measuring language comprehension that are in current use is presented, revealing that these tests of vocabulary, basic concepts, and comprehension of syntactic structure are limited to the literal-meaning aspect of spoken messages. Tests of intelligence and reading skills for children and tests for adult aphasia include more complex comprehension items that require linguistic integration and inference. There are no tests that measure the listener's ability to determine the speaker's illocutionary intent. An integrated approach to the measurement of language comprehension is not available in the form of clinical tests.


Physical and physiological constraints on the use of bone-conduction speech audiometry.

Several authors have recommended the use of bone-conduction speech audiometry, and the literature supports the clinical value of this procedure. It has been claimed that bone-conduction output for speech can be increased to 110-dB HL with the Radioear B-70-A vibrator through supplementary amplification, but this claim is unsubstantiated by objective measurements. Available technical data indicate that the maximum output level attainable with this virbator without incurring serious distortion is 65- to 70-dB HL at midfrequencies and substantially less at lower frequencies. Both behavioral and electromechanical data are presented which show, not only that 70-dB HL is the absolute maximum hearing level for speech attainable through the B-70-A vibrator without serious deterioration of speech-discrimination scores in normal listeners, but also that this appears to be very close to the maximum vibratory level that human observers can comfortably tolerate.


A follow-up study of children with articulation and language disorders.

Thirty-six subjects, 18 language-impaired and 18 articulation-impaired children, were followed up with respect to communication skills and educational performance 13 to 20 years after their initial contact with the Speech and Hearing Clinic. According to their parents, nine language-impaired subjects continued to exhibit communication problems as adults, compared to only one of the articulation-impaired subjects. Standardized educational testing conducted while the subjects were in elementary and secondary schools indicated that the language-impaired group consistently achieved at a lower level than the articulation-impaired group, particularly in reading. Differences between the groups were also exhibited in the types of postsecondary education attempted by the subjects. Clinical, educational, and research implications of these results are discussed.


Assessment of parent-administered listening training for preschool children with articulation deficits.

Two studies concerning preschool misarticulating children are reported. The first study was concerned with direct effects of two varieties of parent-administered listening training. The second study focused on the influence of that same training on children's responses to sound-production training. Subjects were assigned to one of three conditions: listening, reading-talking, and control. Children in the first group were provided training by their parents that was intended to focus the child's attention on consonants in syllables or words and to teach discrimination between correctly and incorrectly articulated consonants. Parents of children in the second group read to and talked with them about the material. Neither treatment group surpassed the control group in gains made on any auditory processing or articulatory measure employed, and some parents found the listening training frustrating. In the second study, a subset of the children in each of the three groups was given sound-production training. The data obtained did not show any effect from earlier listening experiences on sound-production performance.


Measurement of speech thresholds of Spanish-speaking children by non-Spanish speaking clinicians.

This study investigated the feasibility of a prerecorded speech threshold procedure that was used in a picture-pointing format, and was administered to Spanish-speaking children by non-Spanish-speaking clinicians. The derived Spanish word list was compared for equivalency to English spondees on a group of bilingual adults. The test, administered to 16 children ages three to six years, resulted in good agreement between SRT and pure-tone average. The test was found to be feasible, rapid, and reliable.


Development and testing of an intraoral electrolarynx for laryngectomy patients.

A wireless intraoral electrolarynx for laryngectomy patients has been developed. The instrument consists of an earphone receiver and a pickup coil housed in the patient's denture. A separate transmitter with hand switch, worn under the patient's clothing, activates the receiver. Intelligibility testing revealed that this device was comparable to the Verbalizer Electrolarynx, a transoral instrument similar to the Cooper-Rand Electrolarynx. If the long-term endurance study now in progress proves that the device can meet the communicative needs of the laryngectomee, and if the favorable results obtained in this study can be duplicated with subsequent instruments, this electrolarynx may be a viable alternative to others now available.


Surgical treatment of lung cancer in patients over the age of 70 years.

Eighty patients of 70 years of age with lung cancer have been treated since 1964. Forty-eight received no therapy or chemotherapy and/or irradiation. Mean survival was 3.5 to 10 months, and only three (6%) survived for 2 years. Twenty-two of 32 patients selected for thoracotomy underwent resection for cure (70%). The operative mortality rate was 18% for resection, and 64% of the patients survived for at least 2 years. The incidence of exploratory thoracotomy decreased in the last 5 years of the study with the introduction of more rigorous preoperative evaluation. The poor survival rate without resection and the favorable survival rate following recovery from resection support the continued use of surgical resection for lung cancer in elderly patients, despite an increased operative risk.


Corrected transposition. Another approach for repair of associated intracardiac malformations.

A variety of surgical approaches have been used for repair of cardiac lesions associated with corrected transposition of the great vessels. These techniques have met with variable success and generally high surgical mortality rates. In an effort to simplify the surgical approach to repair of ventricular septal defect and replacement of left atrioventricular valve in a 4-year-old youngster, we chose to correct the defects through a left posterolateral thoracotomy and through the left atrium utilizing profound hypothermia and circulatory arrest. Ease of intracardiac assessment and repair and postoperative results to date have been most gratifying.


Primary pleural melanoma. A first reported case and literature reivew.

Although metastatic pulmonary and pleural melanoma has previously been noted, primary pleural melanoma has not been reported. In addition, an extracutaneous response to Adriamycin chemotherapy for melanoma is documented. The patient demonstrated a continued objective response and remained in remission for 10 months. His death was not related to the tumor, and at autopsy there was no gross or microscopic evidence of other organ involvement or origin. Previously reported unusual primary sites associated with this tumor are reviewed, and the established criteria for determination of a primary site in the lung are reiterated. Possibilities of prior unrecognized presence of a primary site are discussed. After having reviewed pertinent literature regarding this intriguing case, we believe that all necessary criteria for proof of a first report have been met.


Massive impalement wound of the chest. A case report.

A 29-year-old man sustained an impalement wound of the right side of the chest with a 6 foot long, 4 by 4 inch wooden post during a high-speed automobile accident. The post entered the right side of the chest anteriorly and exited posteriorly. The great vessels of the chest were spared, but the right lung was lacerated and contused. Removal of the post, treatment of pulmonary parenchymal damage, and reconstruction of the two large chest wall defects presented problems in management. Rapid transport of the patient to the hospital, effective emergency treatment, surgical repair of the chest injury, and appropriate supportive measures contributed to his survival.


Pulmonary gas exchange during venoarterial bypass with a membrane lung for acute respiratory failure.

In patients with fulminating pulmonary edema not responsive to conventional therapy, venoarterial membrane lung bypass can provide assistance if decreased systemic blood pressure prevents use of high-level positive end-expiratory pressure ventilation. In 10 patients with acute respiratory failure, partial venoarterial bypass provided a rapid and marked improvement of systemic oxygenation. Measurement of pulmonary blood flow (PBF) and intrapulmonary shunting (QS/QP) during bypass via prolonged left heart catheterization showed that left ventricular PaO2 was increased through a rapid and profound reduction of QS/QP. During the first days of bypass, derecruitment of pulmonary vessels is probably the mechanism of improved pulmonary oxygenation. When low pulmonary arterial pressures (PAP) are sustained, resorption of pulmonary edema is favored. Despite the beneficial effects of bypass, death occurred in every case due to diffuse interstitial fibrosis and/or parenchymal damage. The absence of healing, due to prolonged circulatory exclusion, may be detrimental despite immediate improvement. Because of this possibility, venovenous or mixed perfusion should be more extensively explored.


Surgical treatment of tachyarrhythmias in patients with both an Ebstein anomaly and a Kent bundle.

The report relates experience with six patients with Kent bundles, five of whom had the Wolff-Parkinson-White syndrome, operated upon for tachyarrhythmias caused by the presence of the pathway. It was successfully divided in four patients, its antegrade conduction capacity interrupted in one, and a failure occurred in the sixth patient. In the three patients who had a Kent bundle with a short effective refractory period for antegrade conduction, the life-endangering potential of the Kent pathway was corrected. To emphasize the complexities of the tachyarrhythmias in Ebstein's anomaly, two patients have mild but controllable postoperative supraventricular tachyarrhythmias (SVT) due to a Mahaim pathway. The surgical problems encountered in these patients are reviewed.


Myocardial protection during ischemic cardiac arrest. The importance of magnesium in cardioplegic infusates.

The increasing use of coronary infusates for the protection of the human heart drug ischemic cardiac arrest has placed great emphasis on the need for a rational and safe formulation of any infusion solution. Using a rat heart model of cardiopulmonary bypass and ischemic cardiac arrest, we have found magnesium to be a highly effective component of protective infusates which can be additive to hypothermia and other protective agents. However, the concentration of magnesium bears a complex relationship to the degree of protection, a fact which stresses the need for the establishment of the correct concentration for optimal protection.


Effects of procaine-induced cardioplegia on myocardial ischemia, myocardial edema, and postarrest ventricular function. A comparison with potassium-induced cardioplegia and hypothermia.

The extent of myocardial protection afforded by a procaine cardioplegic solution during cardiac ischemia has been evaluated and compared with the protection seen using a potassium cardioplegic solution. An isolated cat heart model was employed, and ventricular function parameters, intramyocardial gas tensions, and postischemic myocardial edema were measured and compared following 60 minutes of induced ischemia at 37 degrees C. and 27 degrees C. There was no significant improvement in recovery of postarrest ventricular function when procaine cardioplegia was used during normothermic ischemia. When used at 27 degrees C., however, both cardioplegic solutions were associated with significantly better recovery of postarrest ventricular function, although there was less myocardial edema formation in the potassium-treated hearts. Results of this study indicate that procaine-induced cardioplegia provides myocardial protection during anoxic cardiac arrest which is additive to that afforded by hypothermia alone. In addition, procaine cardioplegia results in postarrest functional recovery which is similar to that seen with potassium cardioplegia.


Permanent cardiac pacemakers implanted in the pleural space.

Intrapleural implantation is recommended for children, active adolescents and adults, psychiatric patients, and infection-prone patients because of the protection afforded by the pleural space. The implantation technique is briefly described. Complications include diaphragmatic muscle stimulation (with a unipolar unit) and continuous migration of the pulse generator. The advantages of this implantation site include the following (1) reduced risk of lead fracture, (2) protection from physical trauma, (3) reduced risk of infection and erosion. (4) improved cosmetic appearance, and (5) minimized child/generator size disproportion. In one groups of patients undergoing both standard and intrapleural implantation, the number of pacing months per surgical procedure was increased from 5.1 months (standard implant) to 26.2 months (intrapleural implant). Intrapleural implantation may be considered the generator position of choice for the small percentage of patients who require special pacing system protection.


Ascending aorta-right pulmonary artery anastomosis. Long-term results in 137 patients with cyanotic congenital heart disease.

Long-term  follow-up of 137 patients who had an ascending aorta-right pulmonary artery anastomosis at the Children's Hospital of Philadelphia between 1966 and 1975 is presented. One hundred four patients survived the first hospitalization. Of the 81 patients currently alive, 30 have had a succesful corrective. operation. Nine patients died at the time of correction. Fifty patients have adequate  pallation. Of the 56 deaths, only nine were shunt related. Late complications in the 104 first admission survivors included congestive heart failure (23%), pulmonary artery hypertension (7%), pulmonary vascular obstructive disease (1%), and shunt failure (9%). Special catheterization techniques to evaluate the shunt and its effect on the pulmonary arteries prior to surgical correction are described. The ascending aorta-right pulmonary artery anastomosis can provide effective palliation without interfering with subsequent corrective operations.


The cause of kinking of the right pulmonary artery in the Waterston anastomosis. A growth phenomenon.

The case is presented of an infant, referred at the age of 8 hours, who underwent a Waterston anastomosis for pulmonary atresia with intact ventricular septum and a hypoplastic right ventricle. Angiographic studies performed 3 days and 12 months after the Waterston anastomosis clearly demonstrated that kinking was not present soon after the operation but developed later. Kinking of the right pulmonary artery is a widely recognized complication of the Waterston anastomosis. Data from other workers show that severe kinking occurs more frequently in infants operated during the first year of life than in those treated after 1 year of age. These data and the case herein presented support the hypothesis that the kinking occurring after the Waterston anastomosis develops because of growth and realignment of the great arteries. Because of this and other problems encountered after the Waterston anastomosis, it is recommended that either primary correction or, in case of an uncorrectable cardiac defect, a Blalock-Taussig shunt should be performed.


Vulnerability of coronary arteries in surgery for transposition of the great arteries.

A detailed anatomic study of 82 hearts from patients operated upon for complete or congenitally corrected transposition of the great arteries revealed 12 instances of intraoperative injury to a major coronary artery. Because the coronary arterial anatomy is so variable in transposition of the great arteries, there is a significant risk of injury to them during operation. This is especially so if epicardial adhesions and scarring from previous operations obscure the surface anatomy of the heart. The most common site of injury was adjacent to incisions in the anterior surface of the right-sided ventricle, particularly in congenitally corrected transposition. Without a meticulous examination, these complications of cardiac surgery may be easily overlooked even when the hearts are examined at autopsy.


Myocardial protection during ischemic cardiac arrest. Possible deleterious effects of glucose and mannitol in coronary infusates.

Cardioplegic protective infusates are designed to induce rapid diastolic arrest and also to reduce or delay the onset of ischemic damage. As this study shows, the use of such infusates can greatly improve postischemic recovery of cardiac function. A number of investigators include glucose, insulin, or mannitol in their infusates in an attempt to increase the amount of protection afforded to the ischemic myocardium. Using an isolated, working rat heart model of cardiopulmonary bypass and ischemic cardiac arrest, we have shown that under certain conditions these additives can be deterimental to tissue protection. The deleterious effects of glucose and mannitol are dose dependent and can be modified by the inclusion of insulin in the infusate. The damaging effects of glucose appear to be both osmotic and metabolic in origin and those of mannitol, purely osmotic. The effects of insulin are complex and may affect a number of cellular processes.


Protection of the ischemic myocardium. Ultrastructural, enzymatic, and functional assessment of the efficacy of various cardioplegic infusates.

The increasing use of cardioplegic protective infusates for reducing ischemic tissue injury requires that all infusates be carefully assessed for any protective or damaging properties. This study describes ultrastructural, enzymatic, and functional assessments of the efficacy of three infusates (Bretschneider, Kirsch, and St. Thomas' Hospital) in a rat heart model of cardiopulmonary bypass and ischemic cardiac arrest. The study reveals a close concordance of results as assessed by the three totally different indices of tissue damage. The results also indicate that, in the rat heart model, the St. Thomas' Hospital solution is an effective protective agent under all conditions studied but the Bretschneider solution is effective only under hypothermic conditions and the Kirsch solution is ineffective under all conditions studied and may exacerbate tissue injury. The studies further suggest that the potentially damaging effects of calcium-free myocardial infusates may be due to their induction of a "calcium paradox."


Fiberoptic bronchoscopy. Comparison of procedures used in the diagnosis of lung cancer.

We have compared the relative value of various techniques used in association with fiberoptic bronchoscopy for the diagnosis of lung cancer. We analyzed the results in 114 patients who underwent diagnostic fiberoptic bronchoscopy and in whom a definite histologic diagnosis of lung cancer was made. A comparison of the diagnostic yield from cytologic examination of prebronchoscopy and postbronchoscopy sputum and of fiberoptic bronchial biopsy, brushing, and washing was made. Over-all, bronchial washings gave the highest diagnostic yield (75.4%) and forceps biopsy the next higher (65.8%). The combination of bronchial washings and forceps biopsy gave the highest diagnostic yield (95.8%). In six patients, postbronchoscopy sputum was the only source of positive diagnostis; in 20 patients only one procedure was positive. Our results suggest that although fiberoptic bronchoscopy washings and forceps biopsy have the highest diagnostic yield, brushings and postbronchoscopic sputum examination are also important diagnostic maneuvers and should be routinely performed.


Left ventricular-coronary sinus fistula following repeated mitral valve replacements.

After mitral valve replacement, symptomatic deterioration and new murmurs characterstistic of atrioventricular valvular regurgitation are usually the result of periprosthetic leaks or prosthetic dysfunction with or without endocarditis. In the case which we are reporting, an iatrogenic fistula between the left ventricle and coronary sinus was responsible for the murmur and symptoms. This type of shunt has not been previously reported. Thorough debridement of the anulus is necessary during mitral valve replacement; additionally, previously implanted prostheses are occasionally embedded in the endocardial wall and must be excised. Hematoma in the atrioventricular groove and perforations of the posterior left ventricular wall are widely recognized complications of mitral valve replacement. Similar mechanisms of injury can cause other problems such as left ventricular-right atrial communications and the unique anatomic shunt described in this report.


Comparative analysis of isolated aortic valve replacement with fascia lata and homograft valves.

Thirty-eight consecutive patients who underwent isolated replacement of the aortic valve with fascia lata in 1970 were compared with a similar series of patients undergoing homograft replacement of the aortic valve. These series were well matched in number, age sex of patients, symptomatology, valvular disease, electrocardiographic and roentegenographic changes, and preoperative cardiac catheterization data. The mean follow-up time was 73 months in the fascia lata series and 69.1 months in the homograft series, and all the post-operative survivors were reviewed. The early and long-term results were similar of the two series, and there was no statistical difference in the operative and late mortality, the incidence of early and late diastolic murmurs, valve failure necessitating valve replacement, infective endocarditis, thromboembolism, over-all survival, and survival with an intact valve. It is concluded that the long-term results of valve replacement using these two tissues, in the aortic position, are similar and there is little to choose between the two types of valves. If fascia lata, as we believe, is no longer acceptable as a satisafactory valve substitute, then homograft valves are not acceptable either.


Repeat open intracardiac operation. Analysis of fifty operations.

Between December, 1972, and February, 1976, 50 open-heart operations were performed on 44 patients who had previously had open cardiotomies. Reasons for reoperation were failure of biological tissue valves (15 cases), failure of mechanical valves (12 cases), paraprosthetic reguritation (nine cases), recurrent or incompletely corrected congenital malformations (eight cases), prosthetic endocarditis (two cases), misdiagnoses (two cases), and miscellaneous causes (two cases). Operations performed included 20 aortic valve replacements, 10 mitral valve replacements, seven double valve replacements, five repairs of paraprosthetic leaks, one tricuspid valve replacement, and seven procedures for congenital defects. There were two deaths within 30 days of operation (operative mortality rate of 4 percent) and six deaths between 7 weeks and 3 years after operation. Postoperative complications were slightly more frequent than in patients undergoing similar operations for the first time. The late functional result was good in the majority (73%) of survivors.


Subclavian artery approach for insertion of intra-aortic balloon.

Subperiosteal clavicular resection for access to the subclavian artery is described. In those patients requiring intra-aortic balloon placement in the nonsurgical setting, such an approach provides a reasonably benign alternative when aortoiliac atherosclerosis prevents the usual retrograde femoral placement. Little morbidity or functional compromise is associated with clavicular wedge resections, and the anatomic availability of a large artery without the need for major surgical maneuvers in these gravely ill patients is a distinct advantage.


Continuous epicardial echocardiographic assessment of postoperative left ventricular function.

An ultrasound transducer which is sutured to the heart at operation and removal percutaneously has been developed and tested in 20 animals. The potential of this device to monitor cardiac function was measured by simultaneously recording 67 left ventricular angiograms and echograms over a wide range of hemodynamic function. In addition, the reproducibility of the data obtained from the transducer and the safety of application and withdrawal were examined. We found highly significant (p less than 0.005) linear correlation between echocardiographic and angiographic measurements of left ventricular end-diastolic volume, end-systolic volume, and ejection fraction. This transducer may provide the means to assess left ventricular size and ejection fraction continuously after cardiac operations in man.


Alterations in regional contractility following cardiopulmonary bypass with intraoperative ischemia.

Coronary occlusion during cardiopulmonary bypass has been used in place of aortic occlusion to perform coronary artery anastomoses, but this procedure on distal myocardial function has not been evaluated. Regional myocardial function was examined with the use of ultrasonic crystals in 20 dogs subjected to this technique to compare normothermic and hypothermic (30 degrees C) bypass in both beating and fibrillating hearts. We found a significant decline in the velocity of contraction of the distal segment in fibrillating compared to bearing hearts (p less than 0.01). Hypothermia prevented this decline in the beating, but not the fibrillating, hearts. With respect to contractile function in the distal myocardial segment, local occlusion techniques cause an injury similar to that reported for aortic cross-clamping.


Anatomic, clinical, and therapeutic features of acute cardiac rupture. Successful surgical management fourteen hours after myocardial infarction.

A 62-year-old man sustained an acute myocardial infarction complicated on the thirteen hour by left ventricular rupture and acute periocardial tamponade. Echocardiography confirmed the suspicion of intrapericardial fluid, and immediate pericardiocentesis improved the hemodynamic state for a period sufficient to permit preparation for operation. Resection of ruptured and necrotic anteroapical left ventricular myocardium with primary reconstruction was successfully accomplished with the aid of temporary extracorporeal circulation. The patient has remained well for 1 year after the operation. Anatomic, clinical, and therapeutic features of acute cardiac rupture are discussed.


Wounds traversing two or more cardiac chambers. Case presentation of two survivors and review of the literature.

A review of the literature on patients who have survived wounds traversing two or more cardiac chambers is presented and two further cases are documented. The inital management of the patient should be directed toward control of hemorrhage or treatment of cardica tamponade or both. Cardiopulmonary bypass is helpful in repair of many intracardiac defects but is not absolutely essential for survival. Surface myocardial wounds should be sutured during the initial procedure to allow for immediate survival. A subsequent procedure may be indicated to correct intracardiac defects. Repair of injuries to the mitral and aortic valves should be directed at an attempt to reconstruct the damaged valve. If this is impossible, a prosthetic valve should be inserted. Injuries to the tricuspid and pulmonic valves probably warrant a conservative approach. Septal defects can be treated easily with Dacron patches or primary suture closure. Postoperative complications include all of those commonly seen with thoracic procedures, but infection is less prominent than one would anticipate, even when prostheses have been implanted. With early, aggressive management it is anticipated that more survivors of these serious wounds will be recorded.


Technique for insertion of apicoaortic conduit.

A technique for insertion of an apicoaortic prosthesis is described. It provides a hemostatic aortic and ventricular anastomosis and can be performed with a minimum of bypass time and without interruption of coronary circulation. The technique requires no special instruments.


Monitoring of electroencephalogram during open-heart surgery. A prospective analysis of 118 cases.

The electroencephalogram (EEG) was prospectively analyzed in 118 consecutive open-heart procedures. In 96 patients (81%) the records were normal whereas in 22 patients (19%) the EEG showed slow wave activity and decreased electrical voltage. In 16 of these patients the EEG abnormality was transient or only of mild degree. In 10 of this group of patients the abnormality occurred with the institution of total cardiopulmonary bypass (CPB) and returned to normal within 2 minutes. In four other patients the abnormalities were mild, persisted to the end of the CPB, and then returned to normal; in two patients the EEG abnormalities developed in the last half of CPB and then returned to normal. In the remaining six patients the EEG was grossly abnormal. In one of these patients the abnormality was secondary to a previous stroke. In five patients, however, the EEG alerted the surgeon to an otherwise unsuspected poor cerebral blood flow. A serious neurologic insult was probably prevented by identifying and correcting the mechanical cause.


Recently developed elastomers for facial prostheses.

Ever since ancient times, man has been searching for the proper artificial substitute for living tissue. This has been a most frustrating and challenging task for the scientific community involved. Prosthetic restoration is the only alternative to reconstructive surgery for the facially deformed. This paper reviews the progress that has been made in recent years in developing a suitable material for the prosthetic restoration of facial defects. There is encouraging evidence that the development of an ideal material for facial prostheses is an attainable goal.


Incidence, trend, and outcome of bronchogenic carcinoma in Olmsted County, Minnesota, 1935--1974.

The 40-year incidence trends of bronchogenic carcinoma in Olmsted County, Minnesota, are presented and analyzed. The incidence in men has risen rapidly with each decade. During the last decade this increase was due to an increase of the rate among men over 65, rates in men under 65 appearing to have plateaued. The incidence in women increased for the first time in the decade 1965 to 1974. During the period 1935 through 1974, rates for all cell types increased in men, with that for squamous cell carcinoma increasing most. In women the recent overall increase was due mainly to an increase of adenocarcinoma, which has been the predominant cell type in women throughout. Among all cases together the 5-year survivorship was 11%, which comprised 24% for squamous cell carcinoma, 11% for large cell carcinoma, 12% for adenocarcinoma, and 0 for small cell carcinoma.


Intraventricular hemorrhages in full-term and premature infants.

Intraventricular hemorrhages were the most common neuropathologic findings in both full-term and premature infants in a retrospective study of neonatal deaths. In general, the intraventricular hemorrhages of full-term infants were less frequent, originated from veins of the choroid plexus, were small, and rarely caused death. Intraventricular hemorrhages of premature infants usually originated in the germinal matrix and were large enough to be fatal. Intraventricular hemorrhages were most frequently found when death occurred between 24 and 72 hours of age.


Roentgenographic simulation of colonic cancer by benign masses in Crohn's colitis.

Crohn's colitis has recently been shown to predispose the patient to cancer of the colon. Unfortunately, many of the manifestations of colonic malignancy, such as polypoid intraluminal masses and strictures, can be simulated roentgenographically by Crohn's colitis. We present five patients in whom this diagnostic difficulty arose. As established by total or subtotal colectomy, none proved to have malignancy; instead, pronounced transmural inflammation and, in two cases, multiple large pseudopolyps were found to account for the roentgenographically indeterminate lesions. These findings exemplify the difficulty in roentgenographic diagnosis of colonic mass lesions in patients with Chrohn's colitis.


Series on clinical testing. 1. The diagnostic usefulness of specific IgE antibody measurements.

In vitro measurements of specific IgE antibodies are useful in the evaluation of patients with diseases characterized by clinical signs of immediate hypersensitivity. In general, measurable levels of specific IgE antibodies indicate immediate hypersensitivity to the allergen tested regardless of the clinical expression of allergy. With the exception of low-level specific IgE antibodies to milk and egg antigens in children and to other foods in unselected adults, false-positive results are rare. However, despite the high probability that positive test results represent allergic disease, some patients with clinically apparent respiratory allergy have borderline or negative test results to certain allergens, and uncommon hypersensitivities such as those elicited by drug and insect-venom allergens may be missed if antibody testing is not performed at the appropriate time following antigen exposure. For these reasons, in vitro IgE antibody measurements are not recommended as screening tests for respiratory allergic diseases or drug or insect-venom hypersensitivities. Useful information is obtained by in vitro testing in these diagnostic situations only when tests are performed on carefully chosen patients.


Medical, psychologic, and legal aspects of child custody disputes.

An increasing number of children seen in pediatric practice are children of divorce. The child is often involved in the conflict between his parents in regard to custody and visitation. The physician will want to be familiar with the historical background of child custody decisions and the present guidelines the courts are using in determining custody and visitation, together with the newer and controversial proposals concerning the elusive concept of "best interests of the child." It is important that the pediatrician recognize the usual phenomenology of the young child's response to family disruption, lest he ascribe it to some fault on the part of the current caretaker. Some children respond to disruption in the family with symptoms that warrant intervention directed toward helping the child. All cases warrant intervention designed to enhance the parenting ability of the custodial parent and to enlist the cooperation of the noncustodial parent to minimize adverse influences on the child's developmental agenda. The physician should be well prepared if he participates in court procedures regarding custody and visitation controversy.


Unusual echocardiographic findings in a patient with left atrial myxoma.

A 53-year-old patient is presented who had left atrial myxoma with unusual echocardiographic findings. The patient had been regarded for 10 years as having mitral stenosis. This error in diagnosis was due in part to misinterpretation of his echocardiograms. This report is presented to emphasize not only the unusual echocardiographic findings but also the subtle findings on the phonocardiogram and apexcardiogram which should have led to the correct diagnosis.


Associative memory and pattern recognition.

This tutorial review presents a model of neural associative memory along with a set of computer demonstrations showing the relevance of this memory mechanism in visual information processing. The model is based upon the hypothesis that adaptive changes in neural networks are intermediated by changes in synaptic efficacies. The signal patterns are stored by gradual changes of the network and they may be recalled later using a part of the original signal pattern as a key. The ability of this type of memory mechanism to process sensory information is emphasized.


Excitation and adaptation in the vertebrate rod photoreceptor.

The excitatory processes and the reactions of the rhodopsin photoproducts in vertebrate rods are summarized, and an adaptation model of the rod is outlined. The transmitter factor Q describes the ability of the discs to release a transmitter carrying the signal from the site of light adaptation to the plasma membrane of the receptor. If Q decreases appropriately when the background light intensity increases, the response range of the rod is preserved and the rod obeys Weber's law. This kind of receptor adaptation is experimentally observed in several species. A photoisomerization in a disc apparently affects the release of a transmitter also in neighbouring discs. The background light also affects the neuronal network of the retina, preserving the response range of the ganglion cell. After an exposure bleaching an appreciable fraction of rhodopsin the sensitivity of the rod returns in two phases: a fast intermediate adaptation and a slow opsin adaptation. After a rather small bleach the photoresponse is fairly well preserved (mainly Q-adaptation), but large bleaches cause a strong reduction in the response range. Different experimental methods utilized when correlating rhodopsin photoproducts and intermediate adaptation are discussed.


Processing of visual information in the insect retina.

The fly is presented as an example for visual information processing. It is shown that "simple" compound eyes of insects possess functions which are comparable with those of the complex lens eyes in higher vertebrates. The problems of coding of contrast, colour and polarized light are discussed. Temporal resolution of the visual system is characterized in terms of a transfer function and this reveals differences to vertebrates, but only in respect to the higher fusion frequency. Spatial coding of light informations is not very well understood but there is evidence for lateral inhibitory interactions, especially in the lamina. Thus we can conclude that the retina presents all premises at least for a simple shape and motion analysis in the fly's tiny brain.


Retinal mechanisms of visual adaptation and afterimages.

Recent results obtained from recordings of isolated photoreceptor activity and from correlations of this activity with time-dependent changes in the responses of other retinal cells in several vertebrates have made a thorough revision of former theories of visual adaptation necessary. The present paper reviews the current state of research and relates the new discoveries with psychophysical findings in an attempt to explain human light and dark adaptation from the novel starting point. The former conceptions of adaptation have to be replaced with a three-level process consisting of photochemical receptor neural and network adaptation. Several adaptive mechanisms can be discerned at each level. Depending on adaptation conditions, any level of the three can play a dominating role and can also produce afterimages that display the behaviour of the mechanisms working at each level. The total achievement of visual adaptation is an optimized end product of the actions of all the various mechanisms.


Receptive field density of retinal ganglion cells and cortical magnification factor in man.

A mathematical relationship is derived between the density or retinal ganglion cell receptive fields and cortical magnification factor. The derivation is based on an assumed constant density of visual fibres entering the striate cortex and on a continuous retinotopic mapping of the visual field thereto. After considering the effect of cortical ocular-dominance columns the human cortical magnification factor along the principal meridians of the visual field is calculated from the empirical estimates of receptive field density of ganglion cells in human retina. The computed estimates of cortical magnification factor agree with experimental data obtained from studies of cortically induced phosphenes, visual migraine hallucinations, and contrast sensitivity functions.


Tension headache.

Headache is an extremely common symptom, and many headaches undoubtedly have a relationship to stressful situations. The clear definition, however, of a "tension headache" complex and its differentiation from migraine in some patients is difficult. The problems are in the identification of a specific headache pattern induced by stress or "tension" and the relationship of the symptom to involuntary contraction of neck and scalp muscles. Treatment consists of analgesics and occasionally mild tranquilizers. Psychotherapy consists of reassurance and often other supportive measures, including modification of life styles. Various feedback techniques have been reported of value, but their superiority to suggestion and hypnosis is still problematic.


Radiological techniques in the examination of patients with headaches.

It can be said that in the majority of headache patients who have a long typical history, a negative neurologic examination, and a noncontributory general physical examination, radiologic studies will probably not give further pertinent information. Nevertheless, in a sufficient number of these patients, the noninvasive and essentially atraumatic procedures of plain skull radiography, computed tomography, and (as indicated) echoencephalography and radionuclide brain scanning will provide a considerable amount of information pertinent to the clinical problem. Hospitalization for angiography and, on occasion, pneumoencephalography or other special procedures, will then become indicated for those patients in whom an abnormality is found in these screening procedures.


[Surgical rehabilitation of speech after total laryngectomy: the Staffieri techniques (author's transl)].

Surgical speech rehabilitation after total laryngectomy by the three procedures of Prof. Staffieri is based on the principle of establishing a short fistula lined by pharyngeal mucosa between trachea and hypopharynx. It permits voluntary air pressure control for voice production while preventing aspiration during deglutition. In a single-stage procedure the "neoglottis phonatoria" is established on the occasion of the laryngectomy at the top of the trachea. In cases of prevoius laryngectomy a shunt is established between the trachea dorsal wall and the oesophagus, either cranially (direct internal shunt) or more caudally (retrograde internal shunt). The three methods are described, and the one-way function of the different fistulas are demonstrated. The percentage of successful voice restorations that remain free from swallowing difficulties in 700 patients, subjected to these techniques in Europe and Overseas is between 60 and 90%. The main advantage of this operation, which is easy to perform and without risk for the patient, is the wide oncologic spectrum of indications.


[Valve-neoglottis after laryngectomy by cartilage implantation into the trachea (author's transl)].

After  laryngectomy the opening of the upper trachea is closed up to 3/4--4/5 by implantation of a cartilage plate (if possible from the epiglottis). The anterior part is left open. During exspiration the oesophago-pharyngeal flap is pressed upwards, whereas the position of the cartilage plate does not change much. The air can be expired by a 90 degrees turned 6--8 mm fistula (Staffieri) in the flap opposite of the cartilage plate (valve opened). As well as by its own weight as by flow of saliva, eating, drinking and vomiting the fistula is pressed on the cartilage plate (valve closed). By aid of this valve mechanism the patient can drink 1 week postoperatively without suffering from flow of saliva into the trachea. The patient's ability to speak developes well 10--14 days postoperatively.


[On the recurrence risk with partial larynx resections (author's transl)].

28 cases of recurrences after 127 vertical and horizontal partial larynx resections (22 per cent) were analysed. Unfavourable preconditions for partial resections are the affliction of the ary cartilage and arrest of vocal chord movility. The hemiresections according to Hautant have the heighest recidivation percentage (40 per cent) judging from the observations available. Radical operations after failured partial resections are uncertain as to their prognoses.


[Analysis of 1700 compensated cases of noise induced hearing loss in the metal industry (author's transl)].

The files of an occupational insurance association (Berufsgenossenschaft), in that case the Süddeutsche Eisen- und Stahl-Berufsgenossenschaft with 1.4 million insurants, gave the chance to analyse statistically the development of the noise induced hearing loss during about 10 years. As a result of this documentation inter alia it was possible to allocate the compensated cases to the different branches, to investigate the influence of the noise exposition on the hearing loss as well as other audiological data of interest which enable e.g. to compare the different test methods or to estimate on the basis of the pure tone audiogram the probability that a noise induced hearing loss will be compensated.


[Hair cell noise damage after improved hypoxia tolerance (author's transl)].

Guinea pigs were gradually adapted to a simulated altitude of 10,000 m. The round window microphone potential (RMP) frequency response was measured 24 hours after pure tone exposition (2.7 kHz, 130 dB, 1 hr). The electrophysiologically demonstrable sound induced damage of the organ of Corti of the adapted guinea pigs was significantly smaller than those of the nonadapted (normal) group. Altitude adapted animals: m = 18, Hb: 18.5 +/- 1.8 g%, Hc: 57.3 +/- 4.4+ RMP mean loss: 1.7 +/- 0.8 dB. n = 18, Hb: 12.7 +/- 1.8 g%, Hc: 40.5 +/- 1.6%. RMP mean loss: 5.8 +/- 2.4 dB. All differences significant p less than 0.001. The evident possibility to reduce noise induced hair cell damage by means of previous adaptation to high altitude might be explained by the greater hypoxia tolerance and perhaps additional better oxygen supply to the receptor cells.


[Vestibulometry by infrared emission (author's transl)].

The paper describes a method for caloric stimulation of the labyrinths by means of infrared emission. The introduction of a probe the tip of which carries an efficient gallium arsenide diode effects short wave infrared radiation and induces a caloric nystagmus toward the same side. This method can be employed also in cases of tympanic membrane perforations without any adverse effects. Its significance can be considered equal to that of the traditional methods.


[Fibrous dysplasia of the facial bones (author's transl)].

On the occasion of three cases of fibrous dysplasia (two of frontal sinus and the ethmoids and one of the upper jaw) the problem of fibrous dysplasia of the jaws is analysed. The clinical picture is characterized by a slow and gradual emergence of facial assymetric or exophathalmos. Histologically there is a variety of form. The treatment is largely a remodeling osteotomy. The writers effectively applied on all three cases a radial removal of the lesion.


[The subclavian-steal-syndrome on the view of the ENT-expert (author's transl)].

Case report. Six months after a fracture of the left clavicle beginning of bilateral deafness and tinnitus as the only symptom of an angiographically proved subclavian steal syndrome (SSS). In spite of the well functioning Teflonprothesis the ear symptoms persisted. Remarkable points of the cases were 1. the rare traumatic origin of a SSS, 2. the monosymptoms of the acoustic organ, 3. the necessity of judgement of the ear symptoms by six ENT-specialists with regard of the result of a traumatic origin. Four affirmed the traumatic cause.


[A rupture of the dorsal pharyngeal wall following a blunt neck trauma: 4th case in the world literature? (author's transl)].

A report is given of a 22-year-old woman who suffered from an external non-penetrating injury to the ventral side of the neck resulting in a rupture of the dorsal pharyngeal wall. She was successfully treated with conservative therapy, i.e. intravenous fluids and conservative therapy, i.e. intravenous fluids and antibiotics. It is concluded that not all cases of pharyngeal rupture due to a blunt external trauma of the neck need surgical treatment.


[A case of late pneumatocephalon and late meningitis after a conservatively treated fronto-basal fracture (author's transl)].

An unusal case of fronto-basal fractures in reported and the question of the management of such fractures is discussed.


Initial cholesterol uptake by everted sacs of rat small intestine: kinetic and thermodynamic aspects.

The kinetics of initial cholesterol uptake by everted rat proximal and distal small intestinal sacs were evaluated in vitro. The mucosal incubation solution consisted of 0.05 mM cholesterol solubilized in 4.8 mM sodium taurocholate micellar solution at pH 7.4 Experiments were performed at temperatures from 26 to 38 C. The rate of cholesterol uptake followed a linear relationship when plotted against time indicating an apparent zero-order kinetics mechanism for initial uptake. An Arrhenius plot of the results of uptake versus temperature remained linear over the entire range of temperatures studied. The large free energy of activation (20 kcal/mole) suggests that an energy barrier for cholesterol uptake exists at the enterocyte luminal cell membrane and may be an important limiting step in cholesterol uptake. It is proposed that a transient association between cholesterol and a component of the enterocyte luminal cell membrane is formed during initial uptake of cholesterol. The transient association may be an activated complex formed with proteins present at or within the luminal enterocyte cell membrane.


Studies on the hydrogen belts of membranes: III. Glycerol permeability of dihydrosphingomyelin-cholesterol membranes.

The permeability of an N-oleoyldihydrosphingomyelin bilayer against glycerol was similar to that of a bilayer of phosphatidylcholine with identical effective hydrophobic chain length. Cholesterol at 1:1 molar ratio reduced the permeability, and also reduced the energy of activation of glycerol penetration, an effect not found for diesterphosphatidylcholine with cholesterol. The higher level of the ground state of the entropy of activation for permeability can be interpreted in terms of a hydrogen belt model which postulates lipid-lipid hydrogen bonding in membranes and explains the effect found as a disturbance of the hydrogen belt structure. Dihydrosphingomyelin can be considered to function as an "extender" in the hydrogen belt network.


Cyclopropene fatty acids of selected seed oils from bombacaceae, malvaceae, and sterculiaceae.

Fatty acid compositions of seed oils from three species of Bombacaceae, eleven from Malvaceae, and six from Sterculiaceae were determined. Each of the seed oils contains varying amounts of both malvalic and sterculic acids accompanied by one or both of the corresponding cyclopropane fatty acids. In addition, the seed oil of Pachira aquatic Aubl. (Bombacaceae) contains 12.8% alpha-hydroxysterculic acid.


Mass fragmentographic determination of docosenoic acid in rapeseed oils.

A highly sensitive and accurate reference method for determination of docosenoic acid (mainly erucic acid, 22:1n-9) in different rapeseed oils is described. A fixed amount of [1-14C] erucic acid methyl ester (about 1 microgram) is added to a fixed amount of oil. After treatment with sodium methoxide/methanol reagent and extraction with hexane, the amount of unlabeled erucic acid is determined from the ratio between the recordings at m/e 320 and m/e 322 obtained after analysis with a combined gas chromatograph-mass spectrometer equipped with an MID (multiple ion detector). The two ions used correspond to the M-32 peak in the mass spectrum of unlabeled and [1-14C] labeled erucic acid methyl ester. The relative standard deviation of the method is about 1.8%. The method was compared with a gas chromatographic method for determination of erucic acid.


Occurrence of dolichol in human tissues.

The concentration of dolichol has been determined in various human tissues obtained at autopsy. The highest levels ( 3000 microgram/g wet weight) were found in testes. Liver and several other endocrine tissues contained about 1000 microgram/g. Lower levels were present in other tissues examines. Only a small proportion of the total dolichol in human tissues was esterified to fatty acids.


Effects of storage conditions on rat brain ethanolamine glycerophospholipids, cerebrosides, and cholesterol.

The effects of storage on rat brain lipid composition were studied in terms of ethanolamine glycerophospholipid, cerebrosides, and cholesterol. Rat brains were stored at several combinations of temperature and time. Storage conditions were: 2 hr at room temperature, 12 hr of refrigeration, and a sequence of both of these conditions. Two-dimensional thin layer chromatography followed by colorimetric analyses of eluted lipids were used to determine molar ratios of phosphatidylethanolamine, ethanolamine plasmalogen, lysophosphatidylethanolamine, and cerebrosides. Cholesterol was also determined. These studies revealed small but significant increases in lysophosphatidylethanolamine in all three cases. A slight increase was also noted in the apparent molar proportion of cholesterol.


Steric requirements for the stimulation of glycosyltransferase activity by lysophosphatidylcholine.

1-Palmitoyl-sn-glycerol-3-phosphocholine and 3-palmitoyl-sn-glycerol-1-phosphocholine have been found to be equipotent in the stimulation of membrane-bound glycosyltransferases in microsomes of rat intestinal villus cells. This indicates that the stimulatory effect of lysophosphatidylcholine is not stereospecific, but that it may be related to a specific detergent property dependent upon the peculiar balance of hydrophilic and hydrophobic components in the molecule.