Sport-specific performance factor profiling: fencing as a prototype.

A musculoskeletal profiling study was done on 24 members of the U. S. Pan American and Olympic fencing squads. This was presented as a methodological prototype for future, more comprehensive sport profiling studies. It is proposed that sport-specific profiling data have practical application in the following areas: 1. The identification of physical deficiencies in an athlete, using his or her sport profile as a comparative standard. This would apply to general pre- and postseason screening as well as to medical complaint-related examinations. 2. Providing objective, sport-specific criteria for determining when an injured athlete has recovered to the extent that he or she is adequately prepared to return to play. Rehabilitation goals for full recovery can also be defined. 3. Increasing the efficacy and efficiency of training techniques. 4. The prospective identification of superior performance potential in athletes at early competitive levels. If sport profiles were developed for the major participant sports at several competitive levels, the profiling system as described here could have significant application to a large number of athletes in a variety of playing situations.


Sports stress syndromes of the hand and wrist.

Many injuries to the hand and wrist may be seen in the practice of sports medicine. Most of these injuries are well known and the details of their diagnosis and treatment are well documented. However, even among this group, certain injuries frequently escape detection or are not monitored carefully enough to detect their frequent residual complications. These injuries are particular sources of problems. Some little known diagnoses are seldom considered, but any diagnosis, even a presumptive one, is better than applying vague, descriptive, but nondefinitive terms to an athlete's injury. Although the ideal treatment is not yet available for any of these injuries, a lack of diagnosis will often mean that treatment is haphazard or nonexistent.


Trampoline injuries.

We feel that there are dangers on the trampoline if it is poorly supervised. This is especially true in regards to the possibility of spinal cord injury and quadriplegia. We have presented documented cases of quadriplegia and safety suggestions have been given for the use of the teampoline. We hope that by presenting this problem, physicians, who are associated with the prevention and care of athletic injuries, will be made aware of the possibility of the dreaded quadriplegia associated with trampoline injuries and that this injury will be greatly decreased.


Acute exertional superficial posterior compartment syndrome.

This case report of an acute exertional compartment syndrome involving predominantly the superficial posterior compartment emphasizes several important facts: (1) The subacute recurring syndromes, if left untreated, may develop into an acute syndrome. (2) The diagnostic findings separating the acute syndrome from the chronic forms are marked pain with passive stretch of the involved muscles, paresis, and sensory deficit.8,12,15, (3) In the acute form, immediate fasciotomy is mandatory and often results in full recovery. (4) All four major compartments of the leg are susceptible to chronic or acute compartment syndromes initiated by exertion. These compartments can be decompressed as necessary through a limited skin incision as recently reported.11 (5) The need for an easily obtainable and reproducible method for measuring intracompartment pressures (e.g., the wick catheter technique) is indicated.


Gastric ulcer: the importance of follow-up care.

One hundred forty-four gastric ulcer patients in an inner city hospital were studied retrospectively over a five year period. Emphasis was placed on patient follow-up after discharge. The length of hospitalization and the mortality were higher for the surgical group; however, the recurrence rate was higher in the medically treated group. Almost half the patients were followed for less than six months. Reasons are given for this poor follow-up. The high recurrence rates necessitate close follow-up for a prolonged period.


Laboratory evaluation of various cold therapy modalities.

An attempt to evaluate the potential of four modalities to cool soft tissue mass has been done under laboratory conditions using canines. The cooling of deep soft tissues within the thigh after application of various cooling devices was recorded over a 60-min exposure period. Under these circumstances, ice performed best, a frozen gel pack performed in a parallel but slightly less efficient manner. Two other modalities, an inflatable bladder filled with refrigerant gas and an endothermic chemical reaction, were least efficient in cooling.


Role of ultrasonography in the primary diagnosis of cholelithiasis: an analysis of fifty cases.

The use of ultrasonography to diagnose cholelithiasis has recently been recommended to supplement standard reinforced oral cholecystography or as an alternative to reinforced oral studies when a single dose fails to visualize the gallbladder. As yet the use of ultrasonography in the primary diagnosis of cholelithiasis is not generally accepted. To assess the specificity and sensitivity of this mode of diagnosis, fifty patients were reviewed retrospectively. The findings of ultrasonography are compared with standard oral cholecystography and with the pathologic findings. The results of this analysis suggest that diagnosis of cholelithiasis by ultrasonography has a high level of accuracy. Use of this mode of evaluating the gallbladder is suggested as a primary diagnostic test for jaundiced or pregnant patients.


Colonoscopy and polypectomy.

An overview of colonoscopy and polypectomy is presented. The merits of this procedure are pointed out, highlighting the newer technics and those technics that have survived. The complications of colonoscopy and polypectomy are reviewed in detail.


Clinical and pathologic evaluation of patients with recurrence of gastric cancer more than five years postoperatively.

From the clinical and pathologic findings, the characteristics of recurrence of gastric cancer more than five years postoperatively were evaluated as compared with recurrence of less than five years postoperatively. The late (more than 5 years postoperative) recurrence rate was 2.0 per cent, or 17 of 864 patients who had undergone the so-called radical operation. The duration of disease prior to the first operation was comparatively long in  the patients with late recurrence. Late recurrence is characteristic of localized cancer, such as Borrmann's type II, and differentiated adenocarcinoma with nonserosal invasion (pathologic findings of the resected stomach at the first operation) and by a recurrence pattern of hematogenous metastasis, especially liver metastasis.


Serum immunoglobulin changes after accidental splenectomy in adults.

Serum immunoglobulin levels were examined in a group of twelve healthy adults who underwent accidental splenectomy. Depressed mean IgM levels and elevated mean IgA levels were found in these patients as compared with the control group consisting of forty-five healthy, untraumatized volunteers. Immunoglobulin changes may have some relevance for the increased tendency to severe infections which has been noted after splenectomy.


Estrogen receptor levels in multiple biopsies from patients with breast cancer.

The results of estrogen receptor assays of more than one sample of breast carcinoma in sixty-two patients are reviewed. There was an overall disagreement of 28 per cent between two simultaneous samples, and in the asynchronous group there was a statistically significant difference (p is less than 0.05) in the interval between those who remained positive and those who became negative. As a practical policy, decisions regarding endocrine ablation should be made on contemporary estrogen receptor status rather than on the status of the primary lesion.


Aspiration cytology of head and neck masses.

Fine needle aspiration biopsy and cytologic examination of the aspirate were performed on 203 masses involving glandular and nodal structures of the head and neck: thyroid gland (85); salivary glands (31); and lymph nodes (87). Overall cytologic-histologic correlation was 91 per cent, with a 10 per cent false-negative rate. The ease of the procedure coupled with the rapidity of obtaining a pathologic diagnosis allows a more intelligent therapeutic approach.


Surgery for thyroglossal duct and branchial cleft anomalies.

A retrospective review was carried out of 338 patients with thyroglossal duct remnants and 274 patients with branchial cleft anomalies who had undergone surgery at the Mayo Clinic from 1954 to 1975. Attention was directed to the preoperative history of these lesions, their clinical presentation, the nature of surgery performed, the complications of surgery, and the incidence of recurrence. The recurrence rate after the Sistrunk procedure for thyroglossal duct remnants was 2.6 per cent, whereas the recurrence rate after surgery for branchial cleft anomalies was 5.8 per cent. The findings suggested that these lesions are a significant source of morbidity and that surgery should be performed before infection occurs and should be radical in the first instance if the recurrence rate is to be minimized.


Laryngeal fracture in the multiple trauma patient.

The Cincinnati General Hospital experience with early diagnosis and repair of laryngeal fractures in the multiple trauma patient is presented. The results demonstrate the feasibility and value of early laryngeal diagnosis and repair in these severely traumatized patients.


Femoral artery profundaplasty.

In advanced ischemia of the lower extremity, the deep femoral artery is rarely completely occluded, but may have a hemodynamically significant occluding plaque at its origin. Detection of this lesion requires biplanar arteriographic views. As indicated in this report, the related simple procedure of femoral artery profundaplasty may salvage limbs and lower amputation sites, and it is suitable for poor risk patients.


The use of extended profundaplasty in limb salvage.

Obstructive lesions of the profunda femoris artery extending beyond the lateral circumflex branch were repaired in sixty-two limbs with superficial femoral occlusion and profound ischemia. The operation relieved rest pain in all thirty-four limbs with this symptom. Of twenty-eight limbs with tissue loss, twenty-two were salvaged without further reconstructive surgery. This experience illustrates that in diffuse profunda disease, extended profundaplasty is a useful alternative to femoropopliteal by pass, particularly for the relief of rest pain, and does not preclude more distal arterial reconstruction.


Management of aortic bypass graft thrombosis: utility of thrombectomy.

The condition of many patients with early or late thrombosis after an aortic bypass operation can be improved by appropriate secondary operations. Late thromboses generally occur in patients with impaired arterial outflow. Restoration or establishment of good outflow is the most critical part of most secondary operations. Thrombectomy is an expedient procedure and, if properly monitored by arteriography, can in many instances permit retention of the graft limb as a satisfactory conduit, particularly in emergency limb salvage attempts.


The use of a laminar airflow isolation system for the treatment of major burns.

A laminar airflow isolation burn ward was designed which would maintain a sterile environment and also allow unrestricted burn care and rehabilitation to be performed. A very low rate of sepsis and sepsis-related complications have been found in the 115 patients treated in the unit. Patient cross contamination has been completely controlled under laminar airflow conditions. The incidence of burn colonization and infection by virulent gram-negative organisms, namely pseudomonas, serratia, klebsiella, and proteus, in these patients has been extremely low, particularly in comparison with burn patients managed in a non-laminar flow intensive care environment.


Mechanisms by which proteolytic enzymes prolong the golden period of antibiotic action.

These experimental studies provide an explanation for the therapeutic value of proteolytic enzymes as adjuncts to antibiotic treatment of contaminated wounds. After wounding, a fibrinous coagulum develops on the wound surface. This coagulum surrounds the bacteria and protects them from contact with sustemically or topically administered antibiotics. Treatment of the wound surface with proteolytic enzymes disrupts the coagulum and exposes the bacteria to the action of the antibiotic. The topical use of enzymes is also associated with significant increases in the concentration of antibiotic at the wound and thus a decrease in the rate of infection.


Jaundice associated with polycystic liver disease.

Jaundice is rarely encountered in polycystic disease of the liver. In the present case, pressure from tense cysts at the hilus of the liver caused a marked narrowing of the common hepatic duct and slowing of bile flow with the formation of stasis stones. Decompression of the cysts and removal of debris in the intrahepatic ducts resulted in a rapid decrease of the serum bilirubin level.


Side-to-side portacaval shunt versus nonsurgical treatment of Budd-Chiari syndrome.

Although a side-to-side portacaval shunt will relieve some patients with Budd-Chiari syndrome, distinction between relief as a result of operation and spontaneous recovery may be inexact. A nonshunting operation relieved one of two patients as much as a side-to-side portacaval shunt did. In these two patients and one additional patient, streptokinase therapy may have been beneficial.


Demonstration of a pancreatic fistula by endoscopic pancreatography in a patient with chronic pleural effusion.

A patient with massive pancreatic pleural effusion in whom the use of endoscopic retrograde cholangiopancreatography (ERCP) revealed the site of a pancreatic fistula to the pleural cavity is presented. It is suggested that with this form of pleural effusion, ERCP may aid in the selection of those patients whose lesions may be surgically correctable.


Direct intralumen balloon tamponade: a technic for the control of massive retroperitoneal hemorrhage.

Control of massive retroperitoneal hemorrhage by the direct insertion of a Fogarty, catheter into the lumen of the vessel and inflation of the balloon is described. The applicability of this new technic for the control of hemorrhage from inaccessible vessels is discussed.


Gel foam embolization of a functioning pheochromocytoma.

For the first time, to our knowledge, a patient with a functioning pheochromocytoma was subjected to gel foam embolization for physiologic destruction of the tumor. The operation, 24 hours later, provided an uneventful anatomic removal of the infarcted tumor. Observation was considered as a possible alternative to surgical excision. Experience gained may allow testing of the validity of a nonoperative approach in selected cases.


Celestin tube intubation for advanced esophageal carcinoma.

Nine patients with advanced esophageal carcinoma underwent intubation with Celestin tubes between July 1973 and May 1975. Our indications for intubation were inability to swallow liquids or handle secretions and tracheoesophageal fistula resulting from advanced carcinoma involving the esophagus. Eight patients received adequate palliation; one died of continuing aspiration from a tracheoesophageal fistula. Major complications were noted in two survivors. The operative technic is discussed in detail.


A technic for reconstructing the digestive tract after pancreatoduodenectomy.

A technic for the reconstruction of the alimentary tract after pancreatoduodenectomy is presented with the aim of separating the biliary and pancreatic fistulas when it occurs. The advantages and possible hazards of this kind of reconstruction are discussed.


Congenital arteriovenous malformation of the head and neck.

A discussion of congenital arteriovenous malformation of the head and neck based on five patients followed from three to twenty years is presented. Definition of the lesion and its progression as followed by angiography is described. The poor response to surgery is ascribed to the ischemic nature of the area of involvement. The concept of supplying normal tissue with normal vascularity to the involved area is advocated.


Cervical presentation of thymic cysts.

Sixteen cases of cervical thymic cyst are added to the previously reported fifty-six cases. Seventy-five per cent of the patients were less than twenty years old. Eighty per cent complained of a painless mass preoperatively. The histologic diagnosis of cervical thymic cyst was made if thymic epithelial elements could be found adjacent to the cyst cavity; Hassall's corpuscles were usually present. Cholesterol granulomata could usually be identified. The theories of origin of cervical thymic cyst are discussed.


Malignant pseudothyroiditis: a new clinical entity.

Six patients with thyroid cancer presented with clinical and, in most cases, biochemical features of subacute or chronic thyroiditis. Pathologic study revealed all types of cancer, including metastatic and neighborhood parathyroid malignancy. Confusion in diagnosis lead to a delay of diagnosis of one month to ten years. When thyroiditis is diagnosed, the patient should be followed carefully, including the use of needle aspiration biopsy. Where doubt exists as to diagnosis or response to treatment, open biopsy or operation may be indicated.


The diagnosis of thyroid carcinoma during the postoperative period after less than total thyroidectomy.

In clinical practice, small or localized thyroid cancer is often missed at the time of surgery and is diagnosed only later after the pathologist has been able to study multiple sections. Our data suggest that patients with early or localized thyroid cancer can be controlled with less than total thyroidectomy. If the nodule is completely excised without fracture (preferably lobectomy) or not cut into, if there is no evidence of metastatic disease either by palpation or frozen section, and if gross examination of the surgical specimen and frozen sections is negative for carcinoma, it is our policy to place these individuals on a regimen of observation only. Additional surgery is performed only if clinical evidence of recurrent cancer develops. Long-term follow-up of forty-four patients supports this treatment policy. Of these, seven had clinical recurrences: three benign; four (9 per cent) malignant. (The 2 patients with metastatic periglandular lymph nodes in the surgical specimen would not meet our present criteria.) We have in our files several additional patients who seem to support the same conclusions but will be reported on only after longer follow-up.


The role of external radiation in the management of papillary and follicular thyroid cancer.

Review of 137 patients with differentiated thryroid carcinoma (82 papillary and 55 follicular) demonstrates that external radiation in moderate dosage eradicates microscopic disease. Its use could lead to a decrease in surgical complications by avoiding unnecessarily radical attempts at removing all potential microscopic disease. Gross tumor also responds favorably to external radiation, but its very slow regression rate has led to the misconception that external radiation is ineffective in the treatment of these cancers. Both radioiodine and thyroid hormone play an important role in the management of differentiated thyroid cancers, but their effectiveness should not be overestimated.


Mucoepidermoid carcinoma of salivary gland origin. A clinicopathologic study of 367 cases.

A thirty year experience with 367 patients who had mucoepidermoid carcinoma of salivary origin is reviewed. The tumor arose in the parotid gland in 254 patients. The presentation and clinical course depended significantly on whether the tumor was low, intermediate, or high grade in histologic appearance. Metastasis and tumor-related death were occasionally noted in patients with low grade lesions, suggesting that even the most innocuous-appearing mucoepidermoid tumor has malignant potential. Significant correlation was demonstrated between the clinical stage of a tumor and its histologic appearance. Stage I tumors were usually of low histologic grade and were effectively controlled by conservative surgical procedures. Radical operations were often ineffective in patients with stage III tumors, most of which proved to be of high histologic grade. Considering the poor prognosis in the latter patients, adjunctive therapy in the form of postoperative external radiation seems indicated. In our experience, "cure" rates in patients who had intermediate or high grade lesions varied widely, depending upon the stage of the tumor. This strongly suggests that therapeutic decisions should not be based on histologic appearance alone.


TNM classification and disease description in head and neck cancer.

The TNM concept is beset by frequent revisions, ambiguities, and incomplete coverage of tumor sites. A study comparing clinicians' classifications with computer-derived TNM classifications yielded discrepancies ranging from 44 per cent in T designations to 25 per cent in N designations, of which 35 per cent and 20 per cent, respectively, are ascribable to clinician error. To remedy these problems, it is proposed that clinicians record basic clinical data on standard forms covering the most relevant information. These forms can substitute for existing office and hospital records, thus avoiding added paperwork. TNM classification and staging may be subsequently generated from the recorded data. This two stage process affords the flexibility of applying common TNM systems for comparison of diverse clinical series while preserving the original basic data for alternative uses. Proposed data forms cover tumor characteristics, involved sites, palpable nodes, vocal cord mobility, nerve dysfunction, distant metastasis, and pretreatment diagnosis.


Partial laryngectomy: analysis of associated swallowing disorders.

Evaluation of postoperative swallowing ability in thirty-eight patients having had partial laryngectomy indicates that there are marked differences in the degree of dysphagia among individuals with similar surgical defects. This variation in swallowing disability, however, appears to have definable limits. Rehabilitation is possible for many patients disabled by postoperative dysphagia. A transoral surgical technic for reconstruction of the obliterated pyriform sinus is described.


Laryngeal carcinoma: transoral treatment utilizing the CO2 laser.

The CO2 laser has been found to be a useful adjunct in our efforts to treat laryngeal carcinoma. Utilized endoscopically, it has been of help in establishing the proper staging, in diagnosing recurrence after radiation therapy, in reestablishing airways blocked with tumor, in debulking tumor mass prior to radiation and/or chemotherapy, and as a primary mode of excisional therapy, all accomplished with minimal morbidity. Most patients may return home the first postoperative day, eating, with serviceable voice, and requiring no tracheotomy or analgesics, all of which provide a significant cost benefit.


Surgical treatment of advanced carcinomas of the base of the tongue.

During the decade of 1964 through 1973, thirty-four patients with advanced squamous carcinoma of the base of the tongue (20 with T3 lesions and 14 with T4 lesions) were treated by surgical resection. These patients underwent an operative procedure as the only and definitive form of treatment. Twenty-eight (82.3 per cent) presented with clinically positive cervical nodal metastases (4 staged N1, 13 staged N2, and 11 staged N3). The number of primary lesions controlled, cervical metastasis, and the failures of treatment were analyzed. The patients were followed for a minimum of two years or until death or recurrence. The determinate control at two years was 27 per cent and the final determinate survival 20 per cent. Fifteen patients (44.2 per cent) required laryngectomy as part of the primary surgical treatment. The surgical procedures used and other therapeutic options available are discussed.


Results in suprahyoid, modified radical, and standard radical neck dissections for metastatic squamous cell carcinoma: recurrence and survival.

Two hundred sixty-one patients who underwent three types of neck dissection for cervical lymphadenopathy in association with squamous cell cancer of the head and neck are analyzed retrospectively. Patients were grouped into those with histologically negative nodes and those with histologically positive nodes. Statistical analyses for neck recurrence and survival rates were made using the sampled permutation method. The results show that suprahyoid neck dissection is associated with an unusually high recurrence rate in the neck in patients with histologically negative nodes. Modified radical neck dissection and standard radical neck dissection are equivalent with regard to recurrences in the neck and five year survival rates when the disease is above the juguloomohyoid lymph node group. The study suggests that simple upper neck dissection is contraindicated in patients with negative or positive nodes and that modified radical neck dissection can be used in selected patients instead of the formal radical neck operation.


Radical or modified neck dissection: a therapeutic dilemma.

Three hundred ten evaluable patients received a classic, functional, or spinal accessory-nerve-sparing neck dissection during 1970 to 1975. The functional procedure was at least equal to the classic procedure in the patients in whom it was employed. The spinal accessory-nerve-sparing operation is offered as an alternative to the classic procedure in all patients in whom the nerve is not directly invaded by cancer. If these guidelines are followed, the patient will rarely experience the pain and shoulder dysfunction that result from the loss of the trapezius muscle, while the chances of control of cancer in the neck remain optimal.


Significance of site and nodal metastases in squamous cell carcinoma of the epiglottis.

One hundred twelve patients treated by surgery alone for squamous cell carcinoma of the epiglottis were retrospectively reviewed. The results showed: (1) 27 per cent of patients with N0 disease had microscopic nodal metastases; (2) 35 to 47 per cent of patients with N0 and N1 disease and histologically positive nodes (micrometastases) in the initial neck dissection developed contralateral nodal metastases; (3) 36.9 per cent of the patients who had nodal micrometastases (histologically positive) survived five years, as contrasted with 94.5 per cent of those who did not have node involvement; (4) 53.2 per cent of the patients who had nodal metastases in one neck and 16 per cent of those who had metastases in both necks survived five years; (5) when the primary tumor in the epiglottis was located in the midline or there was bilateral supraglottic involvement, 18 to 50 per cent of patients developed contralateral ("second") neck nodal metastases; (6) performing early elective contralateral ("second") neck dissection shortly after recovery from the initial surgery may improve survival of patients in whom either the "first" neck dissection showed microscopic nodal metastases and/or the primary tumor was located either in midline or there was bilateral supraglottic involvement.


The prognostic and therapeutic value of frozen section determinations in the surgical treatment of squamous carcinoma of the head and neck.

The records of 216 patients with squamous cell carcinoma of the oral cavity, oropharynx, and hypopharynx treated by surgery alone were reviewed. Frozen section control at the time of the surgical procedure was used to evaluate the margins of the excision. Findings at frozen section were correlated with local control and survival. The inability of the surgeon to obtain clear margins by frozen section for whatever reason resulted in a very high incidence of local recurrence and death. The fact that the patient's tumor could be removed with free margins at the time of surgery did not guarantee long-term success, although the frozen section technic did prove to be reliable and an effective tool for evaluating the patient's prognosis and the efficacy of the surgical procedure.


Chemotherapy for advanced and recurrent squamous cell carcinoma of the head and neck with high and low dose cis-diamminedichloroplatinum.

Cis-diamminedichloroplatinum (cis-DDP) in both a high dose regimen of 120 mg/M2 every three weeks with pretherapy hydration and mannitol diuresis and a low dose regimen of 20 mg/M2 daily for five days and cycled every three weeks have effective antitumor activity in approximately one third of patients. Its toxicity in both regimens appears to limit the number of cycles of administration and the duration of response. Further trials with dose schedules intermediate between the present high and low dose schedules are needed to provide a suitable and effective one day regimen every three to four weeks that can be given on an outpatient basis and on a long-term basis.


Endoscopic measurement of pancreatic juice secretory flow rates and pancreatic secretory pressures after secretin administration in human controls and in patients with acute relapsing pancreatitis, chronic pancreatitis, and pancreatic cancer.

Secretory flow rates were measured inside the main pancreatic duct during endoscopic retrograde cholangiopancreatography (ERCP) in patients with acute relapsing pancreatitis, chronic pancreatitis, and pancreatic cancer and in controls after intravenous administration of secretin. Peak secretory flow rates in these groups were 5.04 +/- 1.74, 0.71 +/-1.28, 0.60 +/- 1.37, and 4.13 +/- 0.88 ml/min, respectively. Peak secretory pressures were also measured intraductally in patients with acute relapsing pancreatitis and pancreatic cancer and in controls and were 402 +/- 69, 75 +/- 161, and 403 +/- 99 mm pancreatic juice, respectively. Peak secretory flow rates and pressures measured in controls during constant administration of secretin were similar to those measured when secretin was administered as a bolus.


Prospective evaluation of gray scale ultrasonography in the diagnosis of pancreas cancer.

One hundred thirty-four patients suspected of having pancreas cancer successfully underwent gray scale ultrasound examination of the pancreas. The prospective ultrasound findings were correlated with the final diagnoses, laparotomy findings, and pathology findings. Fifty-four patients had pancreas cancer, confirmed by resection or biopsy in all cases. On ultrasonography, the pancreas was correctly reported to have abnormalities in sixty-one of seventy-eight patients (78 per cent) and correctly reported to have no abnornalities in thirty-eight of  fifty-six patients (68 per cent). A correct ultrasound diagnosis of pancreas cancer was made for forty-four of fifty-six patients (81 per cent), and there were thirteen false-positive reports. Ninety-four percent of cancers confined to the head of the pancreas and 70 per cent of cancers at other locations within the gland were detected by ultrasound examination. The correct ultrasound diagnosis was given for fifteen of seventeen patients with resectable pancreas cancer, the degree of associated pancreatitis ranging from minimal to severe. Analysis of the predictive values of positive and negative ultrasound examinations suggests that this test could be used to screen a population of patients with symptoms mildly suggestive of pancreas cancer. The importance of preselecting the level of confidence of a positive test result, a,ove which further investigation is indicated, is emphasized.


Factors influencing the late results of operation for carcinoma of the pancreas.

In 151 patients with carcinoma of the pancreas presenting at the surgical clinic of Tohoku University Hospital, predominant factors affecting postoperative prognosis were studied with relation to the stages of the disease. The presence of lymph node metastasis and of cancer invasion to the pancreatic capsule, particularly the latter, was apparently a significant factor most crucially affecting the survival of the patients who underwent pancreatoduodenectomy. The mean survival periods of resected patients were 16.4 months for those with carcinoma of the head of the pancreas and 11.0 months for those with carcinoma of the body and tail of the pancreas, distinctly longer than after palliative operations. However, in patients with stage III disease, pancreatoduodenectomy tended to lead to a shorter period of survival, suggesting that surgery at that stage is generally unpromising for cure.


An assessment of carotid phonoangiography and oculoplethysmography in the detection of carotid artery stenosis.

Carotid phonoangiography (CPA) and oculophlethysmography (OPG) examinations for the detection of extracranial carotid occlusive disease were performed in 308 patients, 103 of whom underwent arch angiography. When correlated with angiographic findings, the overall accuracy of CPA/OPG was 86 per cent. There were 4 per cent false-positive 9.6 per cent false-negative results, and these were further analyzed. Significant carotid bruits demonstrated by CPA strongly suggested the presence of appreciable carotid stenosis. Noninvasive CPA/OPG is an excellent diagnostic tool in patients with non-hemispheric symptoms, in those with asymptomatic bruits, as a screening procedure in potential stroke victims, and for follow-up after cartotid endarterectomy. Caution is advised in relying on this and other noninvasive technics as the sole method for recommending angiography and operative treatment in symptomatic patients.


Femorofemoral grafts: the role of concomitant extended profundaplasty.

Twenty-one femorofemoral grafts were placed in high risk patients with symptomatic, unilateral, iliofemoral, arterial occlusive disease. There was 100 per cent immediate postoperative relief of ischemia or improvement in claudication. Three late below-knee amputations have been performed. All other living patients had healed extremities and were ambulatory at last follow-up. Cumulative graft patency determined by the life table method was 95 per cent at twenty-four months. The physiologic "steal" created by a femorofemoral bypass with donor limb and/or outflow stenosis must be considered to prevent clinical donor limb functional impairment. A gradient of 10 mm Hg or less between the radial artery mean pressure and the donor femoral artery ensured adequate donor artery flow without regard to angiographic a-pearance of the donor artery. The crucial technical problem in patients operated on for ischemia was reconstruction of adequate outflow. All but one patient required at least minimal profunda endarterectomy, and nine of seventeen (53 per cent) required concomitant extended profundaplasty procedures.


The aberrant cervical thymus. Embryology, Pathology, and clinical implications.

Cervical thymic anomalies are not as rare as previously suggested. Six cases were encountered over a relatively short period of time, prompting us to report them and emphasize the importance of this entity. Five of the six patients were children, two of them infants less than one year old. The occurrence of thymic remnants in the neck of young children is not surprising, considering the nature and behavior of the thymus at different stages of life. After a brief embryologic survey, the various types of cervical thymus (solitary ectopic, cystic, or partially arrested descent) and their pathogenesis are discussed. The rare occurrence of thyroid and parathyroid tissue within the mass of a large cervical thymic cyst is reported and evaluated. Cervical thymic lesions can either be symptomless or cause severe dyspnea and dysphagia, especially in the young infant. Accurate diagnosis and an intelligent surgical approach in the child with a cervical mass can avoid the obvious parental apprehension and lead to the correct treatment. Symptoms due to pressure on neighoring structures are promptly eliminated after excision, and prognosis is excellent.


Quantitation of passive cutaneous anaphylaxis (PCA) by using radiolabelled antigen.

The major problem of detecting reaginic antibody by passive cutaneous anaphylaxis (PCA) is the quantitation of the dye reaction. Radiolabelled antigen was used in an attempt to quantitate the PCA reaction (Radio-PCA). Antisera containing reaginic antibody against human serum albumin (HSA) were produced in rabbits. These antisera were injected into normal rabbit skin in different dilutions. Twenty-four hours later HSA was injected intravenously either with Evans Blue or as 125-I-HSA. Radioactivity found in antibody-containing skin was significantly higher than in control specimens containing saline or normal rabbit serum, as low as antiserum dilutions of 1:1,000. Compared with the Evans Blue technique Radio-PCA was able to distinguish quantitatively between different antiserum dilutions at a higher level of statistical significance.


Hypersensitivity to apple and carrot can be reliably detected with fresh material.

Hypersensitivity to birch pollen was linked with allergy to apple and carrot, apple seeds and carrot seeds and also with their fractions. Skin reactions among other atopics were rare, and non-atopic patients showed no reactions to fresh fruits and vegetables. Apple and carrot as well as apple seeds and carrot seeds were fractionated using column chromatography. Two major fractions were obtained, one with sugar and proteins, and one with proteins, the latter giving skin reactions more often than the former. The correlation between clinical symptoms and skin test results with the fractionated material was somewhat lower than that obtained with the non-fractionated fresh material. The allergens of fruits and vegetables might be proteins (enzymes).


Comparison of the effect of the beta1-blocking drugs atenolol and metoprolol on bronchial asthma.

Twenty patients with severe or medium severe asthma were given atenolol (Atenol ICI-Pharma) and/or metoprolol (Seloken Hässle) for tachycardia, hyperkinetic tremor, arterial hypertension or symptoms of angina pectoris. These cardioselective beta-blocking drugs caused only a very slight decrease in PF values. There was no difference between atenolol and metoprolol as regards the PF values. A 24 hourly dose of 100 mg atenolol caused a distinct fall in diastolic fall in diastolic pressure as compared with the same amount of metoprolol. Both these two beta1-blockers moderated the tachycardia which occurs in asthma; atenolol in this dose had a slightly stronger action. The subjective condition of five patients with severe or medium severe asthma was considerably relieved by atenolol and/or metoprolol. The relief manifested as a lessening of dyspnoea and improvement of the general status. No essential change was observed in the PF values despite the subjective effects. The most noteworthy change was the amelioration of tachycardia which had continued longer than expected in these patients. The heart rate dropped from 140-120/min to 90-70/min and dyspnoea was relieved at the same time.


The content of eosinophil cationic protein in eosinophil leucocytes. Study on normal controls and patients with bronchial asthma.

Eosinophil cationic protein constitutes a major part of eosinophil leucocyte granule protein. Low serum concentrations have previously been found in patients with bronchial asthma. As this might reflect a low intracellular content, eosinophils were isolated from normal controls and patients with bronchial asthma. Eosinophil cationic protein was estimated after extraction of the cells and a similar content was found in cells from both groups.


Aluminium phosphate but not calcium phosphate stimulates the specific IgE response in guinea pigs to tetanus toxoid.

The ability of aluminium phosphate and calcium phosphate to stimulate the synthesis of tetanus toxoid-specific anaphilactic and antitoxic antibodies is compared. The observed differences in the kinetics of IgG1a, IgG1b and antitoxines are quantitative--titres after application of aluminium phosphate are higher. Booster immunization with aluminium but not calcium phosphate-adsorbed toxoid leads to a prolonged synthesis of specific IgE. It is hypothesized that the regular application of aluminium compound-containing vaccines on the entire population could be one of the factors leading to the observed increase of allergic diseases.


Developmental organization of raphe serotonin neuron groups in the rat.

The pre- and early postnatal development of serotonin neurons in the rat brainstem was studied using the fluorescence histochemical method. The technique utilized does not require drug pretreatment to visualize an intense serotonin fluorophore localized in neuronal perikarya, dendrites, and axons. All the serotonin neuron groups develop as bilateral nuclei which extend from the midbrain through the medulla. Six of the nine groups undergo a midline fusion from embryonic day 18 (E 18) through postnatal day 6 (P 6) in a rostrocaudal gradient. Cells of the nucleus raphe dorsalis fuse first (by P 1), whereas the serotonin neurons located in nucleus raphe pallidus do not fuse until P 6. This gradient is comparable to the one described for the first observable fluorescence in the serotonin neurons groups. After final cell division, the serotonin neurons undergo a primary migration from the ventricular zone along the midline, where they are situated during embryogenesis, and a secondary migration extending into postnatal life which concludes with fusion in the midline. The bilateral origins of the serotonin cell groups are maintained in the adult. This is expressed by the apparent ipsilateral projections of some of the raphe neurons determined recently in our laboratory utilizing autoradiographic and horseradish peroxidase techniques.


Pre- and postnatal development of catecholamine-containing and cholinesterase-positive nerves of the rat cornea and iris.

Glyoxylic acid-induced fluorescence technique and a copper thiocholine method were used to investigate the ontogenesis of the catecholamine-containing and cholinesterase-positive nerves of the rat iris and cornea. First fluorescent nerve fibres appeared in the iris on the 18th gestation day and in the cornea on the 19th day. A rapid increase in the density of the adrenergic nerve fibres of the iris continued to the age of three weeks, while the number of such fibres were small in the cornea. Acetylcholinesterase-positive fibres appeared both in the cornea and in the iris on the 19th gestation day. Their density increased more rapidly in the iris, especially in the sphincter muscle, than in the cornea. Non-specific cholinesterase activity was localized in the Schwann cells and the reaction was more intense during development than in the nerves of the cornea of adult rats.


Autoradiographic study of early neurogenesis in rat neocortex.

The early neurogenesis of rat neocortex was analysed by means of light and electron microscopic autoradiography. It was found that the very first preneurons originate probably as early as ED 11. They are the horizontal cells of Cajal-Retzius. The peak of their formation is on ED 13 (surface index estimated on ED 17 after injection of 3H-thymidine on ED 13:21, after injection on ED 12:4, after injection on ED 15:5), WHereas no Cajal-Retzius cells could be found to have originated after ED 15. Theses cells are the developmentally most advanced of the neocortex. The cells second in date of origin and maturation are preneurons which presumably correspond to the presumptive neurons of Layer VII (VI b), and begin to originate on ED 12. The end of their formation could not be defined owing to a lack of ultrastructural differences to other, younger preneurons in later gestational stages. These two cell types are the first cellular components of the primordial plexiform layer (Marin-Padilla, 1978) or pallial anlage (Rickmann, 1977), demonstrating an outside-in gradient within this layer, and are separated by the formation of the cortical plate. This could be proven by their simultaneous labelling above and below the cortical plate after administration of 3H-thymidine before ED 15. These results confirm the hypothesis of a dual origin of the mammalian neocortex (Marin-Padilla, 1978).


Postnatal quantitative changes in the cerebellar uvula of albino rats.

The postnatal quantitative changes in cell diameter, cell density and total number of granule cells in the sublobule IXa of female rats from 6 to 760 days old were examined. There occurs and initial rapid increase in cell density from 1232.00 +/- 91.92 granule cells per 10(-3) mm 3 to 2995.50 +/- 322.07 granule cells per 10(-3) mm 3 and from 3 135 316 +/- 233 937 to more than 24 millions of granule cells between the 6th and 25th postnatal day. After the middle of the 3rd postnatal week, cell density and total number of granule cells decrease. The diameter of the granule cells reaches a maximum at the 6th day post partum and decreases continuously with progressing age. The possible mechanisms of these quantitative changes are discussed.


The mammalian tubuli recti: ultrastructural study.

The ultrastructure of the tubuli recti was studied in the testes of sexually mature bulls, boars, rams, goats, rabbits and rats fixed by vascular perfusion. The tubuli recti are lined with a simple epithelium that varies in height, from squamous to tall columnar according to the species and the region. The cells are characterized by extensive lateral and tortuous basal plasma membranes and a luminal border with microvilli. Tight junctions and desmosomes are found in the upper half of the lateral borders. The Golgi apparatus is sizable and associated with it are coated vesicles and many smooth vesicles concentrated towards the luminal border. A distal segment of the tubuli recti is found in bulls only and is characterized by a high epithelium which is thrown into folds giving the lumen a festooned appearance. It is suggested that the epithelial cells of the tubuli recti are involved in fluid exchange and in the removal of unwanted spermatozoa.


Changes in length of sarcomeres following tenotomy of the rat soleus muscle.

Tenotomy of the proximal and distal tendons of the soleus muscle of female Wistar rats was performed and sarcomeric length and muscle fascicle length measured. On the first postoperative day muscle bellies were found shortened and their sarcomeric length considerably reduced. Four weeks following tenotomy, although the muscle bellies remained shortened, sarcomeric length was comparable with that of control muscles. Measurement of muscle fascicle lengths at this time showed that those of experimental muscles were nearly 50% less than those of control muscles. It was concluded from these experiments that a reduction of the number of sarcomeres in series had occurred, thus compensating for the reduced length of the muscle belly.


Morphological observations on the normal human cardiac glands.

The majority of human cardiac glands that lie immediately distal to the termination of esophageal epithelium are compound or branched tubular glands. They empty into overlying gastric pits. The glands of this region are often organized into lobule-like complexes by the surrounding connective tissue of the lamina propria. The secretory tubules contain mucous cells, parietal cells and endocrine cells. The mucous cell is the most common cell type observed and appears to comprise two populations. The majority are pyramidal in shape and show numerous spherical, electron-dense secretory granules. Profiles of rough endoplasmic reticulum are observed scattered throughout the cytoplasm and Golgi complexes occupy a supranuclear position in relation to forming secretory granules. Morphologically this cell type appears similar to the mucous neck cell of the fundus. Secretory granules of a second mucous cell type are mottled in appearance and show an area of increased electron density near the limiting membrane. Parietal cells are observed and appear identical to those in the fundus. The large number of endocrine cells present raises questions concerning the traditional concept of the function of these particular glands.


Progressive occlusive thrombarteriopathy: a case report.

A case of occlusive arterial disease of obscure nature  and etiology is reported. The most puzzling aspect of this case was an apparent lack of correlation between the acute, progressive clinical course of the disease, especially in its final stages and the absence of any corresponding acute changes on microscopic examination of the affected vessels. Furthermore the combination of clinical features and pathologic findings--particularly the thrombotic involvement of the heart and the thoracic aorta by a process starting in the small and medium size vessels of the lower extremities--is not consistent with any of the recognized syndromes leading to a thrombotic occlusion of the arterial system. We conclude that the case represents an obscure syndrome of progressive occlusive thrombarteriopathy, perhaps related to a cumulative effect of heavy smoking, alcoholism, and drug addiction. It is possible that increased coagulability of the blood contributed to the thrombotic process but was not recognized by means of the hematologic studies performed.


Gastroesophageal reflux and asthma: a possible reflex mechanism.

Fifteen asthmatic patients with gastroesophageal reflux underwent an intraesophageal acid provocation test. Pulmonary function measurements demonstrated increased flow resistance when reflux symptoms occurred. After relief of symptoms, these changes tended to rapidly reverse. The technique employed and the prompt reversal of pulmonary functions suggest reflex mechanisms may be producing the observed bronchoconstriction.


The relationship between croup and asthma.

In 241 outpatients with asthma a higher prevalence of croup (33.2%) was found than in 131 controls (20.6%). The difference for recurrent croup was even more significant. Among inpatients with croup, compared with controls without, a greater tendency towards asthma, but not towards other atopic diseases, was found.


The airborne pollens of Walla Walla, Washington.

A Pollen Survey: During the pollen seasons of 1975 and 1976 a total of 821 pollen samples were collected with a Rotorod sampler in and near Walla Walla, Washington. A total of 51 genera in 22 families were identified; most were also determined to species. A pollen chart was constructed to show the duration of pollen production of each taxon.


Use of laser nephelometry in the measurement of specific antibody to lamb's quarters antigen.

Laser nephelometry was used to measure specific antibody to lamb's quarters antigen. It was demonstrated that the same specific antibody detected by indirect hemagglutination could readily be measured by this sensitive technique. Current investigations are being conducted to determine if this system might be validated for the measurement of blocking antibody in human serum.


[Rapid column chromatography of blood amino-acids from a paper sample (author's transl)].

Authors propose a method permitting rapide quantitative analysis of blood amino-acids from a blood sample on paper. The amino-acid analyser was equiped with two columns of different lenght and diameter, one (0.5 x 30 cm) permitting rapid detection (complete chromatography in 110 minutes), the other (0.63 x 35 cm) permitting a quantitative study of amino-acidopathies (complete chromatography in 240 minutes). The apparatus and the program of elution proposed have the advantage of being adaptable without any other modification than the time of passage of the reagents to very rapid analysis of amino-acid groups and classical analysis of samples of serum and urine.


Predisposing factors in hepatitis induced by isoniazid-rifampin treatment of tuberculosis.

Seventy-five patients who developed mild hepatic reactions (serum transaminase concentrations of 45 to 149 units per liter) and 50 patients who showed more serious liver damage (serum transaminase values greater than 150 units per liter) were compared with 261 consecutive patients who had no liver reactions during treatment with rifampin and isoniazid. Generally, liver toxicity occurred in 18 per cent of patients receiving combined anti-tuberculous drug therapy. Small increases in transaminase occurred in 14 per cent of the patients; large increases occurred in 4 per cent. Elderly women comprised a risk group. Among patients exhibiting a more serious hepatic lesion (transaminase values greater than 150 units per liter), alcoholics, mostly men, formed another risk group, together with other patients with a history of previous liver or biliary disease. Of 261 patients who did not develop a liver reaction, 57 per cent were slow INH acetylators. In this study, the groups with small and large increases in transaminase were clearly separated; in the former group there was no preponderance of phenotype, whereas in the latter group, slow acetylators clearly dominated among early (first 4 weeks of treatment) hepatic reactions (P less than 0.01). Studies of single-drug regimens of isoniazid have shown that neither slow nor rapid acetylation has any causal influence on isoniazid-induced hepatitis. Because the metabolism of rifampin is independent of the acetylation process, rifampin and isoniazid in combination seem to cause a toxic hepatitis that differs from the hepatitis induced by either drug separately.


Inhibition of Mycobacterium intracellulare by some vitamin K and coenzyme Q analogues.

Because vitamin K is present in several species of mycobacteria, and because coenzyme Q has been found to stimulate the growth of Mycobacterium tuberculosis and atypical mycobacteria, 8 quinones that can be considered to be dual analogues of vitamin K and coenzyme Q were tested for their activity against Mycobacterium intracellulare. One compound, 6-cyclo-octylamino-5,8-quinolinequinone (CQQ) exhibited considerable activity in vitro against several strains of Mycobacterium intracellulare at a concentration of 8 micrograms per ml. It has also shown evidence of bactericidal activity against growing cultures of Mycobacterium intracellulare. Time exposure studies indicated that a minimal contact period of 24 hours with a concentration of 8 micrograms of CQQ per ml is necessary for permanent inhibitory action against Mycobacterium intracellulare. At a concentration of 1 microgram per ml, CQQ inhibited Mycobacterium tuberculosis, including the rifampin-resistant strains. The drug has no activity against rapidly growing mycobacteria or organisms that are not acid-fast.


A prospective study of plasma DNA in the diagnosis of pulmonary embolism.

To assess the usefulness of plasma deoxyribonucleic acid (DNA) detection in the diagnosis of pulmonary embolism (PE), we prospectively studied the frequency and duration of the occurrence of free plasma DNA in 23 patients with PE and in 49 patients with pneumonia, myocardial infarction, thrombophlebitis, or normal lung scans. Plasma DNA was detected in 19 of the 23 patients (83 per cent) with PE and in none of the 49 patients with other diagnoses. Eighteen of the 19 PE patients with free DNA had persistence of DNA on all subsequent sampling for up to 5 days. In this series, plasma DNA had a sensitivity of 83 per cent in the diagnosis of PE and was extremely specific for PE. Thus, detection of free plasma DNA may be useful as a rapid, noninvasive test to aid in the diagnois of PE.


Compliances of human rib cage and diaphragm-abdomen pathways in relaxed versus paralyzed states.

The respiratory magnetometer method of Konno and Mead was used to measure separately the rib cage and the diaphragm-abdomen components of the total respiratory system compliance in 11 subjects with normal respiratory systems. Measurements made in the awake, relaxed state by the method of Heaf and Prime were compared with similar measurements made in the anesthetized, paralyzed state by the supersyringe method. The rib cage component was greater in the paralyzed than the relaxed state in 9 of 11 subjects, but the diaphragm-abdomen component was greater in the relaxed than the paralyzed state in 8 of 11 subjects. We believe that these differences can be explained by respiratory muscle activity in the presumed relaxed state. The fraction of the tidal volume attributable to rib cage displacement compared to abdominal displacement was greater during mechanical ventilation in the paralyzed state than during awake, spontaneous breathing. This can be explained by the different distribution of inflating forces produced by diaphragmatic contraction compared to positive airway and alveolar pressure, in particular by the very different patterns of diaphragmatic displacement in the 2 states.


Effects of sulfuric acid aerosol on cardiopulmonary function of dogs, sheep, and humans.

Submicronic aerosol of sulfuric acid (H2SO4) originates from the burning of fossil fuels and discharge of vapor from the automobile engine equipped with the catalytic converter. This study was conducted to determine whether brief exposure to this aerosol in high concentrations adversely affects the cardiopulmonary system. In all studies, submicronic aerosol of sodium chloride was used as a control. Anesthetized dogs that breathed H2SO4 aerosol in concentrations up to 8 mg per m3 showed no effects on respiratory resistance, static lung compliance, and functional residual capacity. A 4-hour exposure to H2SO4 aerosol (4 mg per m3) produced no significant changes in mechanics of breathing, functional residual capacity, pulmonary and systemic arterial blood pressures, cardiac output, heart rate, and arterial blood gas tensions. Conscious sheep that breathed H2SO4 aerosol in concentrations up to 14 mg per m3 for 20 min had no alteration of tracheal mucous velocity in an immediate 3-hour follow-up period or 5 to 10 days later. Conscious sheep that breathed H2SO4 aerosol (4 mg per m3) for 4 hours had no significant alteration of tracheal mucous velocity immediately and 2 hours thereafter. Both normal and asthmatic adults breathing H2SO4 aerosol in concentrations up to 1 mg per m3 for 10 min showed no significant alteration of lung volumes, distribution of ventilation, ear oximetry, dynamic mechanics of breathing, oscillation mechanics of the chest-lung system, pulmonary capillary blood flow, diffusing capacity, O2 consumption, and pulmonary tissue volume. No delayed effects in pulmonary function nor exacerbation of bronchial asthma were observe during a follow-up period of a few weeks. The present study indicates that single exposure to submicronic H2SO4 aerosol does not produce an immediate or a delayed adverse effect on cardiopulmonary function in anesthetized dogs, conscious sheep, and normal and asthmatic adults.


Ventilation-perfusion inequality in asymptomatic asthma.

Ventilation-perfusion (Va/Q) inequality was measured by a multiple inert gas elimination method in 6 asymptomatic patients with asthma and in a seventh patient during a severe asthmatic episode. Measurements were made before and at 5-min intervals after administration of aerosolized isoproterenol. All patients had some residual airway obstruction as measured during forced expirations. All except one patient had clearly bimodal distributions of Va/Q ratios during all phases of the study, as confirmed by an extensive exploration of distributions compatible with each set of inert gas data. One mode lay within the normal range of Va/Q, but the other, containing 19.8 per cent of the cardiac output on the average, was centered on a Va/Q ratio of only 0.07. There was essentially no shunt. Five min after the administration of isoproterenol, the blood flow to the low Va/Q mode approximately doubled, accounting for the observed decrease in arterial PO2. Breathing 100 per cent O2 had little effect on the distribution. The presence of a bimodal distribution of Va/Q ratios without shunt suggests that collateral ventilation may be an important mechanism determining the distribution of Va/Q ratios and preventing the development of shunts. This study also showed that in some asymptomatic asthmatic patients, as many as one half of the lung units may lie behind completely closed airways and have very low but finite Va/Q ratios as a result of collateral ventilation.


Gas exchange during acute experimental canine asthma.

The inert gas infusion technique was used to recover distributions of ventilation-perfusion ratios in anesthetized dogs during 17 episodes of acute asthma produced experimentally by broncho-provocation with aerosolized Ascaris suum extract, methacholine, or histamine. Regardless of the  agent used, 2 general patterns of ventilation/perfusion maldistribution were observed. During mild attacks of bronchospasm, a broadening of the normal unimodal distribution of ventilation-perfusion ratios occurred. During more severe attacks, the ventilation/perfusion distributions were clearly bimodal (with true right-to-left shunt of more than 4 per cent present on only one occasion), suggesting that there are, in general, 2 populations of gas-exchanging units in the lung under these conditions. One population has approximately normal ratios of ventilation to blood flow. The second is a population centered on a low ventilation-perfusion ratio (average, 0.14) that can be explained by ventilation of lung units with completely obstructed bronchi via collateral pathways. The postmortem appearances of the lungs and the time course of the gas-exchange abnormalities suggest that the chief cause of the bronchial occlusion responsible for the low ventilation-perfusion units was excessive mucus in the lumen. The presence of collateral pathways of ventilation in the canine lung appeared to protect the animals from developing areas of true shunt under these conditions. The ventilation/perfusion distributions were similar to those seen in human patients with bronchial asthma.


Localized amyloidosis of the lower respiratory tract.

Amyloidosis limited to the lower respiratory tract is a relatively rare condition. Three new patients are reported, and the pertinent literature is reviewed. The available information is discussed with regard to clinical forms, diagnostic methods, therapy, and clinical course. Tracheobronchial deposition is the most frequent form of localized amyloidosis; it affects relatively younger persons and often gives rise to symptoms of airway obstruction. Bronchoscopy, although carrying a risk of bleeding, is the procedure of choice diagnostically and therapeutically. Single or multiple pulmonary nodules are usually discovered as an incidental roentgenographic finding, and surgical resection (for suspected malignancy) has resulted in cure in all cases. On rare occasions, amyloid may be deposited diffusely in the pulmonary parenchyma, leading to death from respiratory insufficiency.


Pulmonary arterial wedge pressure in hemorrhagic shock.

To test the hypothesis that the position of a pulmonary arterial wedge catheter might affect its ability to measure left atrial pressure, we inserted 2 wedge catheters, one superiorly, and one dependently, in supine dogs. The position of the catheter tips and the zero level of the transducers were located on a lateral chest radiograph so that by referencing the transducers to the posterior surface of the lung and measuring the height of the catheter tip above that reference point, the zones in which the catheter tips were located were determined. When both catheters were in Zone III (pulmonary arterial pressure greater than left atrial pressure greater than alveolar pressure), the wedge pressures accurately reflected left atrial pressure. However, during hemorrhage, left atrial pressure decreased, and when the pulmonary arterial wedge catheter placed superiorly came under Zone II conditions (pulmonary arterial pressure greater than alveolar pressure greater than left atrial pressure), it recorded a constant pressure somewhat greater than left atrial pressure; the pulmonary arterial wedge catheter placed dependently, which remained in Zone III, continued to reflect left atrial pressure. We conclude that a pulmonary arterial wedge catheter measures left atrial pressure only when it is located in Zone III.


Effect of O2 exposure on pulmonary metabolism of prostaglandin E2.

The effect of exposure to oxygen on lung metabolism of prostaglandin E2 to 15-keto-prostaglandin E2 and 13-14-dihydro-15-keto-prostaglandin E2 was studied in the isolated, perfused rat lung. During a 30-sec period, lungs were infused with varying concentrations of prostaglandin E2 labeled with hydrogen-3 and the fraction metabolized during one passage was determined. At a prostaglandin E2 concentration of 5 nM, which approximates that in normal mixed venous blood, an average of 93 per cent of infused prostaglandin was metabolized by normal lungs. At prostaglandin E2 concentrations of 2 to 70 micrometer, the fraction metabolized decreased. The computed concentration of prostaglandin E2 for half-maximal rate of metabolism was 4.2 micrometer. Metabolism of prostaglandin E2 by isolated lungs was unaffected by exposure of rats to greater than 97 per cent oxygen at 1 atmosphere absolute for 24 hours, but was markedly depressed after both 36 and 48 hours of hyperoxia. These results indicate that exposure of the rat to oxygen for 36 and 48 hours is associated with decreased ability of the lung to metabolize prostaglandin E2 to its keto derivatives and may result in increased concentration of prostaglandin E2 in the systemic arterial blood.


Excessive polycythemia of high altitude: role of ventilatory drive and lung disease.

Persons residing at high altitude who develop excessive polycythemia are more hypoxemic than normal high-altitude residents. We investigated the causes of hypoxemia in 20 patients with excessive polycythemia residing at an altitude of 3,100 m. Lung disease evidenced by abnormal spirometric features and results of a respiratory questionnaire was present in 10 of 20 patients and resulted in increased alveolar-arterial difference for PO2 [(A-a)PO2]. The excessive hypoxemia in the patients with normal lungs was not due to increased (A-a)PO2. We measured ventilatory responses to hypoxia and to hypercapnia to determine whether blunting of these responses was a cause of this excessive hypoxemia. We found, however, that chemical drives to breathe, although blunted, were the same in patients with polycythemia as in high-altitude control subjects. However, an abnormal breathing pattern was observed; the polycythemic patients had a smaller tidal volume and a greater ratio of dead space to tidal volume than did the normal subjects. In addition, the polycythemic patients had increased minute ventilation on breathing 100 percent O2, whereas the normal subjects did not. Thus, hypoxic depression of ventilation may have been present. Our findings suggested that blunted chemical drives are not causative in this disease, and that some other cause of hypoxemia must be present.


Pulmonary function in young smokers: male-female differences.

To delineate the pattern of pulmonary function abnormalities and associated pathophysiologic mechanisms in young smokers, 205 volunteers between the ages of 18 and 25 were studied with a variety of pulmonary function tests. Differences between male and female smokers were observed. Pulmonary function abnormalities consistent with small airway dysfunction were noted in male smokers, but not in female smokers. Decreased forced expiratory flows at high lung volumes suggesting large airway dysfunction were noted in both male and female smokers. Decreases in diffusing capacity for CO consistent with abnormalities of the pulmonary vascular system were seen in smokers of both sexes, but were more prominent in females. Because men develop chronic obstruction pulmonary disease more frequently than do women even when adjustments for smoking are made, and because women develop primary pulmonary hypertension more frequently than do men, these chronic diseases may reflect distinct pathophysiologic response of the 2 sexes to agents such as cigarettes.


Problems in the plethysmographic assessment of changes in total lung capacity in asthma.

We studied the effect of abdominal gas compression on plethysmographically determined total lung capacity (TLC) in asthmatic patients before, during, and after treatment of induced bronchospasm. TLC was derived from panting maneuvers near residual volume, at functional residual capacity, and near TLC. Significant differences among these "derived TLC" values increased significantly during bronchospasm. Whether or not TLC appeared to increase, and by how much, depended on the level of the vital capacity from which it was derived. Individual increases in TLC during bronchospasm could not be explained by increases in abdominal gas volume or in the extent to which it was compressed and decompressed during panting. We postulate that during the Boyle's Law panting maneuver, pleural, and therefore alveolar, pressure swings may be nonhomogeneous and greater over lung regions subtended by closed airways than over regions in communication with the mouth. This would result in an underestimation of alveolar pressure swings as measured at the mouth and an overestimation of thoracic gas volume, and would account in large part for the observed increase in discrepancies between the "derived TLC" values in asthma as well as the dependence of apparent TLC changes on the level of the VC at which the panting maneuver is performed.


Aryl hydrocarbon hydroxylase in asbestos workers.

Aryl hydrocarbon hydroxylase (AHH) activity and inducibility were studied in the lymphoblasts of 47 asbestos workers and 31 control subjects. Mean inducibility (3-methylcholanthrene [MC]-or dibenz(a,h,)anthracene [DBA]-induced divided by basal enzyme activity) was greater in the occupationally exposed subjects than in the control subjects. The estimated estimated change in mean value (+/- SE) of MC inducibility was 0.88 +/- 0.21 (P less than 0.001), and that of DBA inducibility was 1.59 +/- 0.56 (P less than 0.01). Differences in inducibility values were particularly apparent in 12 pairs of spouses, in all of whom the inducibility values of the occupationally exposed subjects exceeded those of their spouses. The differences in inducibility of AHH resulted from increases in induced activity, not from any appreciable change in basal activities. They were independent of subject age, sex, smoking status, year of first exposure to asbestos, yield of lymphoblasts, or the rate of blastogenesis as measured by the incorporation of tritiated thymidine into nucleic acid. Increased AHH inducibility may bear some relation to the greatly increased risk of bronchogenic carcinoma in asbestos workers who smoke cigarettes.


Oral therapy for experimental coccidioidomycosis with R41 400 (ketoconazole), a new imidazole.

Oral treatment of mice with R41 400, ketoconazole, after intranasal challange with arthrospores of Coccidioides immitis prevented death at doses of 40 mg per kg of body weight per day. Doses of 160 mg per kg of body weight per day during 50 to 100 days eradicated the fungus from the lungs, liver, spleen and kidneys of approximately one half of the infected animals. Resistance to the drug was not induced during prolonged treatment. Hydropic changes in the liver occurred in animals receiving doses of 160 mg per kg of body weight per day by the fiftieth day of treatment, but did not occur at lower doses.


Volume-pressure and morphometric observations after acute alveolar injury in the dog from N-nitroso-N-methylurethane.

Volume-pressure diagrams during inflation with air and saline were made with the lungs of 6 control dogs and 24 dogs with acute alveolar injury induced by subcutaneous injection of 6 mg of N-nitroso-N-methylurethane per kg of body weight 3 to 14 days before study. The extent of alveolar closure was estimated by measuring the mean linear intercept of the remaining open air spaces after inflation of the lung with liquid formalin at a pressure of 40 cm H2O. This alveolar closure was defined as irreversible. The volume-pressure diagrams and compliance data derived from them during the 3 to 4, 5 to 7,  and 9 to 14 day periods after injection were analyzed and compared with the morphometric data. The diagrams with air inflation showed a progressive downward shift beginning with the 3 to 4 day period. This shift was at least partly independent of volume loss. The diagrams with saline inflation were unchanged during the 3 to 4 day period, but showed a downward shift, largely due to volume loss thereafter. Irreversible alveolar closure, reflected by an increased mean linear intercept, was present in the 3 to 4 day period, and its extent increased with time, correlating inversely with total lung capacity and saline compliance. The data indicate that decreased lung compliance and volume during the first 7 days of injury induced by injection of N-nitroso-N-methylurethane were due largely to increased surface tension and that tissue forces became a significant factor later. They suggest that the altered tissue forces were due principally to irreversible alveolar closure.


A clinical trial of mebendazole in the treatment of alveolar hydatid disease.

In July 1974, mebendazole was reported to be effective against the larval stage of Echinococcus granulosus in experimentally infected mice. A clinical trial of mebendazole was initiated in December 1974 in 4 patients with far advanced, nonresectable lesions caused by Echinococcus multilocularis. A daily dose of 40 mg of the drug per kg of body weight was administered to the 4 patients for more than 3 years. No evidence of toxicity or adverse reactions has been observed. Detectable plasma mebendazole concentrations were achieved with high-dose mebendazole therapy. Serum concentrations of IgE increased and decreased early in therapy. There was no evidence that the larval cestode was killed. The metastatic lesions appeared to be stabilized or diminished, and over-all clinical results were encouraging. Progressively enlarging thoracic metastases in 2 patients regressed during therapy, and symptomatic improvement was observed in all 4 patients. Mebendazole, a highly effective antihelmintic in enteric infections, is poorly absorbed by the gastrointestinal tract. Resulting low serum concentrations limit treatment of the massive, scirrhous lesions characteristic of E. multilocularis infections. Nevertheless, encouraging clinical responses observed with mebendazole therapy suggest that a more soluble form of this or a related drug might prove highly effective in the medical management of hydatid disease in humans.


Pathogenesis of neurogenic pulmonary edema.

A patient presenting with apparent pulmonary edema in whom transient, large increases in systemic arterial, pulmonary arterial, and pulmonary capillary wedge pressures occurred and spontaneously resolved within a few minutes is presented. This appears to lend support to the pressure and volume overload theory of the pathogenesis of neurogenic pulmonary edema that previously has not been demonstrated in humans.


Quantitation of damage to the alveolar epithelium by means of type 2 cell proliferation.

The purpose of this study was to determine whether the amount of alveolar epithelial tissue damaged during exposure of NO2 could be quantified by measuring the proliferative response to Type 2 cells. To accomplishe this, we used tissues from previously published experiments in which rats had been exposed to NO2 and the proliferative response to Type 2 cells had been measured during a 5-day period. The proportion of alveolar epithelium damaged was determined by stereologic examination with electron microscopy of tissue sections from those rats exposed to NO2 for 24 hours. These values were then compared with the total proliferative response to Type 2 cells for the 5 days of exposure. The study demonstrated that increasing tissue damage is assocaited with a greater proliferative response to Type 2 cells. The high degree of correlation (r = 0.93) indicates that the proliferative response of Type 2 cells can be used as an indirect means to quantify acute damage to the alveolar epithelium.


Lower extremity amputation for ischemia.

Three hundred-twenty-four amputations of the lower extremity for ischemia at the University of Oregon Health Sciences Center over the past ten years are presented. Striking differences between the first and second five-year periods are noted in level of amputation. The primary healing rate of all patients in the two periods was similar. Diabetics tended to have more distal amputations but primary healing was lower than that of nondiabetics.


Experience with gastric bypass for massive obesity.

Gastric bypass was performed for the control of massive, exogenous obesity on 50 patients. There was a preoperative average weight of 134 kg. The average weight of these patients at one year was 85 kg, at 2 years was 87 kg and at 3 years was 93 kg. There were five patients who failed to lose 25% of their preoperative weight. An early major complication rate of 10% occurred with one death. Cholelithiasis occurred at some time in 38% of these patients.


Complications of jejunoileal bypass.

Jejunoileal bypass for morbid obesity is accompanied by excessive morbidity and significant mortality. Weight loss is achieved at the expense of major nutritional changes which in and of themselves produce complications. The operation should be considered investigational and be limited to those centers with special interest in the problem and where longterm follow-up and management can be carried out.


Splenectomy for hypersplenism.

The five-year experience with 75 consecutive splenectomies has been reviewed. Special detail was given to eight critically ill hypersplenic patients. Their diagnoses included Hodgkin's disease, lymphoma, leukemia, myelofibrosis and Felty's syndrome. Three presented with sepsis, two with anemia not responsive to transfusion, three had pathologic bleeding and two could not receive additional needed therapy of underlying disease because of low counts. All cases responded to splenectomy favorably. Hypersplenism is primarily a loss of balance between the splenic destruction-sequestration and bone marrow production. The demonstrated rapid consumption of transfused cells and some degree of functional reserve of the bone marrow is the prerequisite and clue for splenectomy response in critically ill patients.


An evaluation of the changing approach to the diagnosis of breast masses.

For what we believe are varied and compelling reasons, the majority of physicians in our hospital have abandoned the traditional inpatient approach to the evaluation and treatment of a woman with a breast mass. We attempt to tailor the diagnostic procedure to fit the most probable pathology. In general, we believe a patient with carcinoma should have the diagnosis established by needle biopsy. This allows complete staging, the development of an appropriate treatment plan and gives us the opportunity for frank and open discussion with our patients. Those patients with probable benign disease should have the diagnosis established by an outpatient biopsy performed using a local anesthetic.


Surgical treatment of choledochal cyst.

A case of multiloculated choledochal cyst occurring in an 18-year-old girl is presented. The choledochus which contained multiple pigment stones was excised as the primary treatment and the patient remains well on two year follow-up. Ten additional cases of choledochal cyst treated in the past 20 years have been reviewed. It is concluded that excision of the choledochus is a safe and acceptable treatment of choledochal cyst in young low risk patients and that the alternative treatment of Roux-en-Y choledochocyst-jejunostomy gives satisfactory results.


Radioiodine treated hyperthyroidism and thyroid carcinoma.

External irradiation of the head and neck has been shown to increase the incidence of thyroid carcinoma. Fourteen cases have also been reported of thyroid cancer developing in individuals treated with radioiodine for hyperthyroidism. Another patient's case is reported here to emphasize the possible role of I131 on the genesis of thyroid malignancy and the importance of surgery in the treatment of hyperthyroidism.


[New procedure for protein spinning: the hydrodynamic process].

In this text, we describe a new protein spinning process called hydrodynamic process. Parameters which are related to production of fibers and which can influence diameter and texture are explained extensively. In this process, a spinning dope is extruded through a spinnerette in a moving coagulation bath in which the fibers are coagulated, stretched and carried.


[New extraction process for milk whey proteins].

The main objective of this report is to present a new process of the extraction of milk proteins based on the use of selective absorbants (registered trade mark : Spherosil, ions exchanger), recently developed in our laboratory.


A chemical approach to the nutritional availability of methionine in food proteins.

The background to earlier experiments that were designed to evaluate the nutritional availability of peptide-bound methionine sulphoxide is described. After mild acid hydrogen peroxide treatment of casein, NPU had fallen from 71 to 58. A gas-chromatographic analysis for intact methionine residues that has been developed since then has shown that in the oxidised casein all methionine residues had been oxidised to the sulphoxide, whereas in several foods only moderate levels of sulphoxide were found. The methionine potency of sulphoxide residues is considered to be less a function of digestion and absorption than of the body's capacity to reduce it to methionine. Evidence is given that hydrogen peroxide also modified cystine residues in casein to be rendered nutritionally unavailable. On a molar basis, half the sulphur amino acids in most foods is furnished by cystine which therefore plays a more important role in protein nutrition than is generally recognised.


[Use of small peptides to study the loss of available methionine, lysine and tryptophan during technological processing].

Peptides such as glycyl-L-methionyl-glycine, glycyl-L-lysine, L-lysyl-glycine and glycine-L-tryptophyl-glycine are used to study side-chain reactivity of three essential amino acids during food processing. The treatment of glycyl-L-methionyl-glycine with sodium hypochlorite resulted in the two following types of reaction: 1. Methionyl residues are oxidised to the corresponding sulfoxide at sodium hypochlorite concentrations up to 0,1 p. 100 w/v; 2. Oxidation of methionine residues to methionine sulfone and deamination reactions also occur for sodium hypochlorite concentrations over 0,2 p. 100 w/v. Sodium hypochlorite treatment of glycyl-L-lysine and L-lysine-glycine causes, probably by deamination of the epsilon-NH2 groups, a loss of lysine of 20 and 30 p. 100, for sodium hypochlorite concentrations of 0,1 and 0,2 p. 100 w/v, respectively. Treatment of glycyl-L-tryptophyl-glycine with hydrogen peroxide (0,05 M) modifies tryptophan residues in such a way that it cannot be retrieved after hydrolysis of the tripeptide with methane sulfonic acid and subsequent chromatographic analysis; six new unidentified components appear on the chromatogram. Glycyl-L-methionyl-glycine was incubated with food constituents or additives such as reducing oses, acrolein, p-benzoquinone, methyl iodide, or dichloro I, I ethylene. Thin layer chromatography and RMN show that carbonyl compounds or quinones do not react with the thioether group. Alkylating agents sometimes used in food processing only gave traces of sulfonium compounds. Thus, it appears that the only reaction liable to render methionine residues unavailable in foods would be its oxidation to methionine sulfone.


[Biologic availability and metabolic transit of amino acids modified by technological processing].

The biological availability of amino acids modified by industrial processes has been measured in trials on rats, and their metabolic transit (urinary and faecal excretions, transformation into CO2 and retention in organs) has been studied using molecules labelled with 14C. Maillard reaction products. epsilon-fructose-lysine is not utilized as lysine source. However, less than 10 p. 100 of this substance, bound to proteins, is excreted unmodified in the urine. Intestinal flora destroys most of the fraction which is not absorbed. Premelanoidins are partially absorbed and "burnt" in the organism, whereas high molecularightwe melanoïdins are totally excreted in the faeces. epsilon-(gamma-glutamyl)-lysine and epsilon-(beta-aspartyl)-lysine isopeptides. 80 to 100 p. 100 of free epsilon-(gamma-glutamyl)-lysine are utilized by the Rat. It seems to be absorbed by the intestine, and subsequently hydrolyzed by the kidney, thus releasing lysine. Utilization of this isopeptide bound to proteins has not been shown till now. Free epsilon-(beta-aspartyl)-lysine is not utilized as lysine source. Methionine sulfoxyde and methionine sulfone. Methionine sulfone is not utilized as methionine source whereas most of the free and bound methionine sulfoxide is, in part, it is "reduced" by the liver (perfused liver). Lysino-alanine. Formation of lysino-alanine reduces the availability of lysine and cystine. It is partially excreted in urines, mainly as free lysino-alanine, but also as acetylated derivatives and unknown catabolites.


[Effects of technological processing on digestive and metabolic utilization of amino acids from various protein foods].

The use of vegetable proteins such as legumes or oilseeds proteins is often restricted by antinutritional or toxic factors. Therefore, it is usefull, in order to extend their consumption, to isolate proteins from most of the other components of the seeds. Unfortunately, the technological processes may have some deleterious effects on the nutritive value of the proteins. Moreover, the proteins isolates and concentrates need further processing to be texturated in order to look like conventional foods for humans. We used growing rats to study the effect of some of these technological processes on the nutritive value of some field bean and sunflower protein feedstuffs. We estimated the digestive utilization of dry matter, nitrogen and amino acids, and the amino acid composition of feces was used in trying to explain some decreases in nitrogen digestibility. We also studied the ability of their amino acids to be used for growth, and tried to estimate their availability from blood and muscle free amino acids determinations. It may be inferred from the results that the technologists were successfull in improving their processes, and that textured field beans and sunflower proteins of good nutritional quality may be processed now.


[Effect of the extrusion process on the availability of proteins].

The extrusion process has grown rapidly as in the preparation of meat-extenders from vegetal proteins as in the fabrication of cocktail-snacks and food for breakfast. The nutritional modifications induced by the thermic shock during the extrusion affect: -the diminution of the content of nutrient: loss in vitamins, destruction and unavailability of amino-acids; -the structural modification of a few compounds: starch gelatinization; -destruction of antinutritional factors: essentially antitrypsic factor. We studied the effect of extrusion with a model-mixture on the availability of amino-acids and particularly lysin. We effected the systematic study of different factors which can interfer in the intensity of the Maillard reaction in relation to the composition of the mixture (presence and nature of sugar, etc.) and to the technological parameters (screw-section, moisture of the mixture, etc.) The model mixture composed of cereal flours shows a global loss of 32 p. 100 in lysin (destruction 18 p. 100, biological unavailability 16 p. 100) after extrusion. When this mixture is added up with 7,2 p. 100 of saccharose the total loss in lysin reaches 40 p. 100. If saccharose is substituted by a more reducing sugar (fructose) the lysin loss approaches 80 p. 100. The addition of 4 p. 100 water at the mixture containing saccharose (total moisture 14 p. 100) limits the lysin loss to 10 p. 100. The modification of other technological parameters does not improve significatively the level of available lysin. The moisture of the mixture before extrusion appears to be a preponderatting factor in the intensity of the Maillard reaction during extrusion.


[Physiologic effect of a dietary regimen rich in soy proteins in man].

The increasing availability of palatable soya bean protein materials for use in human foods raises the question of possible effects on the health and well-being of the consumer. On the basis of available evidence, no unfavourable effects are to be expected, but apart from nitrogen balance investigations, systematic human experiments with these novel foods are scarce. Therefore, we carried out a large-scale experiment covering many physiological and health aspects. Two diets were compared in 4 + 4 weeks cross-over design with 92 healthy volunteers. One diet contained a wide variety of soya protein foods (test diet), about 25% of the protein intake being from soya, the other (control) diet contained similar products made from conventional protein sources. The diets were given in two identical menu cycles. Blood, urine and feces were sampled at the end of each period. Health status and subjective reactions were monitored throughout. About 90 out of the more than 100 parameters investigated did not show any difference. Statistically significant reactions to the diet composition were found in the following areas: of the blood serum enzymes, alkaline phosphatase was higher after consumption of the test diet, while serum inorganic phosphate showed a decrease. The higher magnesium content of the soya protein materials was reflected by an increase in fecal excretion, and in serum levels in the fed state. Fasting serum levels, however, were lower on the soya diet. Measurement of the intestinal noise indicated that more intestinal gas was produced on the test diet; this was confirmed by reports from the volunteers. Immunological tests showed that the females had increased IgA and soya specific IgE levels on the test diet, but no indications for allergenicity were found. All the mentioned effects were well within normal physiological ranges and do not indicate unfavourable trends. We conclude, that these results confirm the prevailing view that soya bean protein materials are acceptable ingredients for our daily food.


[Vitamin evolution during preparation and conservation of baby food].

The Baby-Foods process is explained and a rapid sum up of vitamins degradations factors. This paper studies vitamins degradations during processing and storage (Shelf live). Six vitamins were controlled in 26 recipies. The general results are listed. The vitamin C appears to be the most labile during storage and vitamins A and C during process.


[Influence of microorganisms on the formation of nitrosamines].

The N-nitroso compounds synthesis from amine and nitrite contained in food is influenced by many factors: -the pH; -the temperature; -the amine basicity; -the presence of organic groups which catalyse or inhibit the reaction. The chemical nitrosation of the amino group takes place at pH between 2 and 4,5. At the near neutrality pH of most of food, this synthetis, cannot be realised. Under these conditions the nitrosamine occurence can be explained by the effect of microorganisms. We have studied the influence of moulds used in cheese making on the nitrosation reaction in a middle where nitrate and amino groups are found together. The middles are realised on caseine or curdled milk, and contained 150 mg/l of nitrate and 100 mg/l of piperidine. The nitrosopiperidine has been identified in all the middles studied. The results are discussed concerning the risk of nitrosamine formation of this type of food during the technological process.


[Influence of various thermal processes and microwaves on the amino acid composition of food products: implications on their nutritional value].

The cinetic study of free amino nitrogen and total soluble nitrogen of hard wheat semolina, when comparatively treated by thermal processings (convection and microwaves) shows a decrease conditioned by time and strength of heating. Aminograms show the same decrease, which is however different for each amino acid. After thermal treatment, appear ninhydrin-reactive substances, to be identified. In short, micro-wave heating seems to have the same effect as conventional heating, on free amino acids of these cereal products.


Influence of heating and keeping warm on the quality of meals.

Meals produced on a large scale for public feeding establishments (sterilized, quick frozen, cooled) have to be heated before they are served. Meals prepared in central kitchens are kept warm for several hours. The influence of heating and holding is explained with quick frozen meals being kept warm as examples. If quick frozen meals in multi-portion trays are heated (hot-air oven) under unfavourable conditions and up to high central temperatures, the content of the various vitamins is notably reduced. Vegetable meals also show an inferior sensorical quality. The meals should be kept warm in a way that, on the one hand, microbiological risks are avoided and that, on the other, quality changes are minimized. The higher the holding temperature, the more thermolabile ingredients are destructed. During a holding time up to 5 hours at temperatures ranging from 60 degrees C to 80 degrees C, losses to varying degrees of vitamins C, B1, B2, niacin, retinol and beta-carotin occurred in nearly all meals. A holding time of max. 3 hours seems possible if a certain detraction from the nutrition-physiological and sensorical quality is tolerated.


The nutritional value of hot meal components prepared in different ways.

When the experiment "Convenience foods in hospitals" was planned it had to be established that it is nutritionally justified to replace conventionally cooked hot meals by deep-frozen ones. Therefore a study was devoted to the assesment of the nutritive value, immediately prior to consumption, of hot meal components prepared in different ways, namely: under ideal domestic conditions, in the central kitchens of institutions and industrially deep-frozen. The following meal components were chosen for the study: 6 different types of meat with their gravies, 6 different types of vegetables and potatoes prepared in 2 different ways. In these products the following nutrients were determined: proteins, fat, carbohydrates, iron, vitamin C and 7 vitamins of the B-complex. The study revealed that the nutrient-content of hot meal components immediately prior to consumption is not influenced by the way of preparation. An exception was vitamin C. The deep-frozen meals had a significantly lower vitamin C-content than the meals prepared under ideal domestic conditions.


[Physiopathological effects of feeding heated oils to rats].

1. Reproduction tests were carried out in rats receiving diets containing 10 p. 100 fresh or heated linseed oil (L) or 20 p. 100 fresh or heated rapeseed (Cz) or canbra (Cb) oils. These oils were heated either at 275 degrees C (12 hours, under nitrogen), or at 200 degrees C (100 hours or 60 X 30 minutes, exposed to the air). With L-275, we observed in the young rats a very important perinatal mortality and an hepatic hypertrophy with steatosis. With L-200, the mortality was lower, but the body growth of surviving young rats was slower and their liver were enlarged. With Cz-275 and Cb-275, the results were qualitatively identical, but less important that with L-275. With Cz-200 and Cb-200, a slowing down of the body growth and an enlargement of the liver were observed. With all the heated oils, cyclic monomers were detected in liver lipids of young rats before weaning. 2. The detoxification mechanisms of components formed during heating of the oils were studied in the weaned rat. We noted that a diet containing 10 p. 100 heated linseed oil markedly increased the urinary excretion of hippuric acid and mainly of glucuronic acid as compared to the results obtained with a 10 p. 100 fresh oil diet. Kinetics of excretion of conjugated glucuronic acid shows that there are two phases: a phase of fast increase of excretion (appearance of the detoxification system), then a phase where this increase was much lower. The authors draw some practical conclusions from their whole work.


[Incidence of UV rays on nutritional elements of baby foods according to the nature of the wrapping: white and dark glass].

Drawing the inference from their experiment the authors have both pointed out the baneful influence of light on evolution of some vitamins and proved that the filter power of tinted packing is an important factor in this test mechanism: --vitamin C has a light development in an atmosphere without oxygen and is more sensitive about temperature than about light; --vitamin A is sensitive about both light and temperature. U.V. radiation applied to a product whose temperature is higher than 20 degrees C causes more damage to this product when packing is made of transparent glass; --the protector power of stained glass is still more obvious in vitamin B2.


[Very low temperature (quick freezing) and pseudo-stabilization of the chemical composition of food of plant origin].

The consequences of freezing at -18, -30 degrees C are presented: slowing down or acceleration of enzymatic or non enzymatic reactions, concentration effect, consequences of the death of cells, (time--temperature relation). The most characteristic examples of nutritive value adulterations are presented: ascorbic and dehydroascorbic acids, other vitamins, derivatives of the insaturated fatty acids oxidation, changes in proteins. Other damages more related to sensorial quality are summarized: "chlorophyll, phenolic substances, aroma, pectins. These chemical changes occurring at low temperatures are generally less important than the losses in nutritional value of frozen plant products related to the necessary treatments preceding or following cold storage. Particularly, the losses during blanching and thawing (drip) are discussed. Finally, quick freezing as it is used now industrially does not exactly stabilize the nutritive quality of plant products but protects this quality satisfactorily. Progress is however possible, concerning the cold treatments (storage temperature lowering) and especially the losses before and after freezing and storage (blanching, transport, distribution, thawing).