The role of myocardial ischemia in pacing-induced elevation of arterial pressure.

One hundred sixteen patients with suspected or proven coronary arterial disease underwent rapid atrial pacing until the occurrence of pain in the chest or a heart rate of at least 160 beats per minute. Significant elevation of arterial systolic pressure of 25 percent or more above control was observed in 17 patients. Each of these patients had significant coronary arterial disease shown by coronary arteriographic studies. During rapid atrial pacing, each of these 17 patients had pain in the chest and ST-segment changes suggesting ischemia, and 15 had abnormal (less than 10 percent) extraction of myocardial lactate. In the 99 patients who did not have increased arterial systolic pressure during rapid atrial pacing, the frequencies of coronary arterial disease, ischemic ST-segment changes, and abnormal extraction of lactate during rapid atrial pacing were significantly (P less than 0.05) less. Increased arterial systolic pressure during rapid atrial pacing appears to be highly indicative of coronary arterial disease and myocardial ischemia. We suggest that myocardial ischemia may, under certain circumstances, be responsible for short-term increases in arterial pressure.


Thoracoscopy: technique and results in eighteen patients with pleural effusion.

Eighteen patients with pleural effusion were examined. Nine patients had malignant neoplasm and in one the pleura was diffusely involved. Nine patients had pleural effusion of inflammatory origin. One of these was due to tuberculosis, one to trichinosis and the other seven were nonspecific. Thoracotomy in three of these seven failed to add additional information. All patients tolerated pneumothorax well with equilibration of pleural space and atmospheric pressure.


Perplexing pleural effusion.

Twenty-seven patients with perplexing pleural effusion were studied to determine clinical outcome. The value of performing pleuroscopic examination or open pleural biopsy (or both) in search of a diagnosis was assessed. After a mean follow-up period of six months, a diagnosis was reached in 16 patients, while 11 patients had no diagnosis after a mean follow-up period of 24 months. The causes for the effusions were neoplasm (eight patients), tuberculosis (one patient), blastomycosis (one patient), systemic lupus erythematosus (one patient), pulmonary infarction (two patients), and fractures of the ribs (three patients). The diagnosis was made by pleuroscopic examination or open biopsy in five patients, by autopsy in four, and by long-term follow-up studies in seven patients. When neoplasm or granulomatous disease was not suspected before surgery, pleuroscopic examination or open biopsy or both were nondiagnostic. These data support a policy of selecting patients for these procedures when a presumptive diagnosis of neoplasm or granulomatous disease is made but cannot be confirmed by less invasive methods. When the clinical data are too nonspecific to formulate a meaningful clinical impression, a more conservative approach is recommended.


Detection of ventricular ectopy in patients with coronary heart disease and normal subjects by exercise testing and ambulatory electrocardiography.

Maximal exercise testing and 24-hour ambulatory electrocardiographic recording (Holter monitor) were utilized in the detection of ventricular ectopy in 90 patients with stable chronic coronary heart disease and in 30 normal subjects. Although the occurrence of any ventricular ectopic activity, as detected by either or both methods, was common, the incidence was significantly higher (P less than 0.001) in patients with coronary heart disease (86 percent; 77/90), as compared to that in normal subjects (40 percent; 12/30). Ventricular arrhythmia was more frequently detected by the 24-hour continuous electrocardiographic recording, being found in 70 of the 90 patients with coronary heart disease and in ten of the 30 normal subjects. In comparison, exercise testing disclosed ventricular ectopy in 56 of the 90 patients with coronary heart disease and in two of the 30 normal subjects. Multiform and repetitive patterns of ventricular ectopy were detected twice as commonly by continuous electrocardiographic recording than with exercise testing, and these patterns were present in one-half of the patients with coronary heart disease. Both methods of examination adjunctively disclosed more ventricular ectopy than either method alone.


Diastolic rumbles with porcine heterograft prosthesis in the atrioventricular position. Normal or abnormal prosthesis?

Three patients with porcine atrioventricular valves (two mitral, one tricuspid) with diastolic rumbles and presystolic murmurs are presented. Full hemodynamic and angiographic studies demonstrated moderate to severe prosthetic stenosis, even in the one patient who was minimally symptomatic. Diastolic murmurs across atrioventricular porcine heterografts indicate prosthetic stenosis until proved otherwise by full hemodynamic and angiographic studies. If the studies indicate normal function of the device and calculated prosthetic valve area that is small for the patient, then it must be recognized that the device is hemodynamically "stenotic" for that particular patient (valve prosthesis--patient mismatch).


Myocardial involvement in systemic lupus erythematosus. A noninvasive study of left ventricular function.

A relatively high incidence of heart failure is noted among patients with systemic lupus erythematosus (SLE) without clearly defined clinical causes. To evaluate left ventricular performance in patients with SLE without evidence of cardiovascular disease, noninvasive measurement of the systolic time intervals was carried out. Simultaneous recording of the electrocardiogram, phonocardiogram and carotid arterial pulsation were obtained in 25 patients with systemic lupus erythematosus and compared with 22 normal subjects. The patients with SLE had a shorter left ventricular ejection time (P less than 0.05), a longer pre-ejection period (P less than 0.02) and an increased ratio of pre-ejection period/left ventricular ejection time (P less than 0.005). These abnormalities on ventricular function were independent of age, duration of the disease, hypertension, renal involvement, anemia, immunologic activity and corticosteroid treatment. Several etiologic possibilities are discussed and the clinical usefulness of this method to detect and follow-up the cardiac dysfunction in systemic lupus erythematosus is emphasized.


An effect of paraquat on the lungs of rabbits. Its implications in smoking contaminated marihuana.

Thirty-six rabbits received the herbicide, paraquat (1,1'-dimethyl-4,4'-dipyridylium dichloride), by selective intrabronchial instillation in doses ranging from 0.1 gm to 1 pg. Sixteen additional rabbits were given paraquat dichloride (25 mg/kg of body weight) intraperitoneally, subcutaneously, intravenously, or orally. The lung of the rabbit proved to be highly sensitive to paraquat administered by intrabronchial deposition, moderately sensitive to intravenously administered paraquat, and resistant to the chemical when given intraperitoneally or subcutaneously. One picogram of paraquat dichloride delivered by bronchial catheter produced a 1.0-mm pulmonary lesion consisting of focal hemorrhage, congestion of capillaries, intra-alveolar macrophages, and moderate thickening of the alveolar septa. This finding suggests that pulmonary damage could potentially result from smoking marihuana that has been sprayed with paraquat.


Correlation of biochemical and morphologic manifestations of acute pulmonary fibrosis in rats administered paraquat.

Rats were administered 24 mg/kg of paraquat intraperitoneally. One, two, three, six and seven days after this injection, the rats were evaluated by several toxicologic, biochemical, and morphologic criteria. These included determinations of weight loss, visible lung hemorrhage, pulmonary edema, in vitro protein and collagen biosynthesis rates of lung tissue, and staining properties of lung sections. Morphologic evidence of mild edema was seen at day 1, while more severe edema was observed at days 2 through 7. Weight loss was apparent from day 1 throughout the experiment. In vitro protein biosynthesis rates by tissue were elevated above control values from day 3 onwards, while collagen biosynthesis rates were elevated from day 2 onwards. Increased staining with the Gomori reagent was observed from day 1, while increased staining with van Gieson's or Masson's trichrome appeared by day 2 or 3.


Dynamic tricuspid valve insufficiency produced by a right ventricular thrombus from a pacemaker.

Acquired tricuspid valve incompetence was caused by a mobile thrombus attached to a permanent right ventricular endocardial electrode wire. The rarity of this complication is noted and the importance of its consideration in the proper setting is stressed. Diagnosis was made by angiography and confirmed at surgery.


Chylous reflux syndrome involving the pericardium and lung.

A ten-year-old boy with symptom-free pulmonary interstitial edema and pericardial effusion was found to have a chylous reflux syndrome involving the pericardium and lung. Evidence suggests that unlike patients with isolated primary chylopericardium in whom pericardial window and/or ligation of the thoracic duct is curative, those with chylous reflux should be managed medically since the morbidity and mortality of surgical treatment is high in this syndrome.


Trifascicular and complete heart block with anterior myocardial infarction. Electrocardiographic patterns and long-term medical management.

A 45-year-old man exhibited various patterns of delay in trifascicular conduction, culminating in complete heart block during acute myocardial infarction. A temporary pacemaker was utilized for the short period of heart block. Delay in ventricular conduction subsided, and the patient refused implantation of a permanent pacemaker. Ventricular irritability, which was detected eight months later, was suppressed with administration of digitalis, guided by testing with acetylstrophanthidin. Neither heart block nor delay in ventricular conduction recurred during 43 months after the infarction. In certain patients with heart block complicating anterior myocardial infarction, long-term prognosis may be dictated by coronary and myocardial residual function, rather than by the hazard of recurrent heart block.


Papillomas of the tracheobronchial tree with malignant degeneration.

Papillomas are rare tumors of the respiratory tract, which are usually considered benign. We studied a male patient with adult onset of squamous papillomatosis involving both the trachea and the bronchi, with malignant degeneration. When we obtained specimens bronchoscopically, only the bronchial lesions showed carcinomatous changes. Thoracotomy demonstrated carcinoma in the tracheal lesion as well. We conclude that transbronchoscopic biopsy may be inadequate in the evaluation of papillomatosis.


Aortic valve replacement for ochronosis of the aortic valve.

A patient with generalized ochronosis developed severe cardiovascular symptoms related to ochronotic deposits on the aortic valve and in the coronary arteries. A transvalvular gradient of 100 mm Hg and obstruction of the left anterior descending coronary artery were found by catheterization. Aortic valvular replacement and aortocoronary bypass were performed successfully, and the patient has been well two years since operation. This represented the first reported case of aortic valve replacement for this rare metabolic condition. With increased mobility of these patients due to aggressive orthopedic joint treatment, more patients with this syndrome may require surgery for cardiovascular symptoms.


Electrocardiographic changes in concussion.

A patient is described in whom electrocardiographic changes simulating acute nontransmural myocardial infarction occurred in association with head trauma. Despite extensive noninvasive investigation, including computerized axial tomography and myocardial scanning, no acute structural central nervous system or cardiac abnormality could be detected. A review of the literature failed to reveal a similar case of these electrocardiographic changes occurring in the absence of organic brain or cardiac pathology.


Streptomycin pharmacokinetics in malnutrition.

Pharmacokinetic parameters of streptomycin such as plasma concentration, plasma half-life, urinary excretion, and in vitro and in vivo binding to plasma proteins were studied in undernourished and well-nourished individuals. None of the parameters studied were different in undernourished subjects as compared to those in well-nourished, in spite of significant differences in mean albumin values between the two groups. This may be attributed to unaltered protein binding of the drug in undernourished subjects in spite of low serum albumin levels, since streptomycin binds to globulins, in addition to albumin.


Combined antiviral effect of DNA inhibitors on adenovirus multiplication.

9 purine or pyrimidine analogues or other inhibitors of DNA synthesis were studied on their single and combined inhibitory effect on the multiplication of adenovirus 9--15 in HeLa cell cultures. The criterium of inhibition was the total suppression of the formation of infectious virus. Inhibiting concentrations were derived from isobolograms. 34 of 36 drug pairs acted in a synergistic manner, one pair showed additive and one no interaction.


In vitro antibiotic sensitivity of Moraxella species.

Minimal inhibitory concentrations of 17 antibacterial agents for 34 Moraxella strains were determined using a plate dilution method. A strain of Moraxella nonliquefaciens was found which produced beta-lactamase and was resistant to ampicillin and carbenicillin but not to cephalothin. Several strains were relatively resistant to erythromycin and sulfisoxazole. Disk sensitivity tests could be used to reliably predict penicillin and erythromycin resistance but not sulfisoxazole resistance.


In vitro comparison of the antifungal activities of R34,000, miconazole and amphotericin B.

In vitro susceptibilities of 78 isolates of pathogenic filamentous fungi to the imidazole compounds R34,000 and miconazole and to amphotericin B were determined using an agar dilution technique. Allescheria boydii, Sporothrix schenckii and the dematiaceous fungi (Cladosporium, Fonsecaea and Phialophora spp.) were most susceptible to miconazole with minimum inhibitory concentration (MIC) values ranging from less than or equal to 0.25 to 32 microgram/ml and with geometric mean MIC (G-MIC) values of 0.56-1.24 microgram/ml. Isolates of Aspergillus fumigatus were more susceptible to amphotericin B and miconazole than to R34,000 with G-MIC values of 1.20 and 3.48 microgram/ml, respectively. Coccidioides immitis, Histoplasma capsulatum and Blastomyces dermatitidis were highly susceptible to all three drugs (G-MICs greater than 1 microgram/ml); R34,000 was the most active of the three compounds against C. immitis (G-MIC = 0.44 microgram/ml).


Combined effect of procarbazine and ionizing radiation on mouse jejunal crypts.

The interaction between procarbazine and gamma-radiation on animal survival and on cell proliferation in the jejunum of the mouse was investigated. Procarbazine (501 mg/kg) injected intraperitoneally enhanced the effect of the gastrointestinal radiation syndrome in whole-body lethality studies by reducing the 7-day LD50 by 269 rads. Similar lethality responses were noted whether the drug was administered immediately before or after irradiation. In a series of temporal response studies, 501 mg/kg procarbazine injected intraperitoneally affected intestinal crypt cell proliferative activity in a manner similar to the effect of 1,000 rads of gamma-radiation, by an increase to above-normal proliferative activity. The indices of proliferative activity employed were tritiated thymidine activity per milligram intestine, tritiated thymidine activity per crypt, labeled nuclei per crypt, and mitotic figures per crypt. When procarbazine was injected 15 min prior to irradiation, the crypt cell proliferative activity decreased but never recovered, thus indicating an enhanced response with combined treatment.


Fate of patients 1--6 years after operation on account of coronary artery disease.

The authors analyzed the fate of 234 patients 1--6 years after operation of the coronary arteries. In the majority of patients they recorded alleviation of complaints and improved physical performance. Part of the patients resumed employment. Successful revascularization of the heart muscle improved the mechanical function of the left ventricle. Indirect comparisons suggest that the number of patients who survived late myocardial infarction and late mortality are lower in operated patients than in similar patients treated only conservatively. Final evaluation of all possible methods of surgical treatment of the coronary arteries will call for further work. The experience as regards indications, surgical tactics and techniques in postoperative care assembled during the past period improve fundamentally the immediate results of surgical treatment of coronary artery disease and this must be manifested also in the subsequent fate of these patients.


Aimed sympathetic denervation of the heart.

The authors describe various denervation operations, and based on their findings, propose their own method of aimed sympathetic denervation of the heart. The results assembled in acute and chronic experiments on dogs indicate that by this operation the sympathetic activation of the heart during adequate physical strain is suppressed; this does not occur, however, in complete ischaemia of the brain. Vagus innervation of the heart is also preserved and thus also the parasympathetic regulation of its rhythm. The authors discuss the importance of aimed sympathetic denervation of the heart for the surgical treatment of ischaemic heart disease.


Effect of blood flow on the fate of venous grafts in the arterial circulation.

The paper deals experimentally with the influence of the blood flow on the long-term fate of venous grafts in the arterial circulation. Based on the results of experiments, and applying the laws of haemodynamics, the paper provides evidence that the blood flow has a decisive influence on the behavior of the implanted vein. Veins with a mean flow of 364.5 ml/min, dilate by 70% while the external diameter of veins with a mean flow of 65.4 ml/min. remain without major changes. This difference in the behaviour is statistically significant at the 1% level. From the results ensues that the vein is suited for reconstructions where a blood flow of 50--200 ml/min. may be expected.


Amino acid metabolism in the heart muscle in subjects with ischaemic heart disease at rest and during pacing.

In nine patients with ischaemic heart disease at rest and during pacing differences of free plasma amino acids, lactate, ammonia and uric acid between arterial blood and blood in the coronary sinus (a-cs differences) were investigated. At rest one single significant difference was found, i.e. a positive a-cs difference in aspartate. During pacing significant positive differences were recorded in aspartate, glutamate, leucine and isoleucine and significant negative a-cs differences in cystine-cysteine, glutamine and aspartic acid and in alanine. Among the correlations between a-cs differences the negative relationship between lactate and alanine and the negative correlation between cystine-cysteine and leucine, isoleucine and glutamine is significant. There is a positive relationship between the a-cs difference of alanine and glutamine and between the differences of leucine, isoleucine and glutamate. The a-cs differences of ammonia and uric acid correlate negatively.


'Chemical' splenectomy and the number of haematopoietic stem cells.

In mice subjected to chemical splenectomy by means of ethyl palmitate the number of CFU-S and CFU-C in bone marrow and spleen was assessed. In the bone marrow of chemically splenectomized mice a rise of CFU-S as well as CFU-C was found. In the spleen of mice after chemical splenectomy the number of CFU-S was reduced, while the number of CFU-C was elevated.


Nucleoli in lymphocytes of the peripheral blood in Hodgkin's disease: I. Changes in the course of the disease.

The authors examined systematically for three years in 38 patients with Hodgkin lymphomas the diagnostic value of nucleoli in lymphocytes of peripheral blood. A total of 241 examinations were made of 23 variables of the lymphocytic nucleolar test and other haematological values. Twelve healthy persons were subjected to the same examinations five times in two-week intervals. In untreated patients the authors proved in particular the diagnostically significant increase in the number of active nucleoli and micronucleoli, the elevated red cell sedimentation rate, the decline of lymphocytes in peripheral blood, uninucleolar lymphocytes and ring-shaped forms of nucleoli. These changes were potentiated in relapse and stagnate in remission of the disease. The authors introduced a new indicator--the percentage increase of red cell sedimentation after the second hour which is one of the most sensitive of the investigated variables.


Developmental stages of human embryos.

The embryonic period of human development was divided into eight main stages described as 1--unicellular, 2--blastomere stage, 3--blastoderm stage, 4--bilaminar stage, 5--trilaminar stage, 6--early somite stage, 7--stage of limb development, 8--late embryonic stage. These main groups were divided into further sub-groups. For description the decimal classification was used. The recommended classification is suitable for comparative purposes and was compared with hitherto used classifications of human embryos, in particular with Streeter's horizons.


Peroperative fine-needle aspiration biopsy: an aid to differential diagnosis between diverticular disease and colonic cancer? A preliminary report.

Fine-needle aspiration biopsy was performed at laparotomy on 15 patients in whose cases differential diagnosis between colonic diverticulitis and colonic cancer on the basis of preoperative and peroperative examinations was impossible. Histologic examination confirmed the cytologic diagnosis to be correct in 14 cases, in four of them correctly positive for tumor cells. There was one false-negative result. Culture of swabs taken from 11 patients after puncture showed growth of intestinal bacteria in five cases, but no complication developed in association with or after the punctures. Peroperative fine-needle aspiration biopsy is a cheap, simple, rapid and safe method that seems to offer a reliable aid to differential diagnosis between diverticulitis and carcinoma. With the use of a rapid staining technique, the result can be available as early as that of frozen-section microscopic examination.


Alcohol ingestion-induced changes in the human rectal mucosa: light and electron microscopic studies.

Histologic and ultrastructural examination of specimens of rectal mucosa from 11 patients who had recently consumed excessive quantities of alcohol revealed marked pathologic changes. Goblet cells were decreased and a dense mononuclear cell infiltrate was seen on light microscopic study. Electron microscopy revealed swollen, distorted mitochondria and dilated and vesicular endoplasmic reticulum. These abnormalities disappeared after two weeks' abstinence. It is suggested that disordered organelle structure and function might contribute to the diarrhea frequently observed following excessive alcohol intake.


Multiple lymphoid polyposis and familial polyposis of the colon: a genetic relationship.

A case of multiple lymphoid polyposis of the colon and terminal ileum occurring in a family of familial polyposis is presented. Only one other such case has been reported. Other cases where an association between the conditions was mentioned are reviewed. There is a genetic factor in the etiology of the condition, and a definite link with familial polyposis of the colon is found to exist. Differentiation of the conditions on clinical grounds could be very difficult.


Subcutaneous emphysema of the lower extremity of gastrointestinal origin.

Two cases of subcutaneous emphysema of the left lower extremity secondary to perforations of the rectum ,nd sigmoid colon are presented. Although this is an extremely rare syndrome, the true incidence is probably higher, as some cases will be misdiagnosed as gas gangrene unless careful clinical and postmortem examinations are performed. Only rapid recognition of the probable origin of the gas, coupled with aggressive, definitive therapy, can prevent the usually fatal course of this condition. In the absence of trauma to the chest or infection in a previously normal leg, subcutaneous emphysema of a limb should alert the physician to the possibility of a gastrointestinal perforation as a source of the gas. Perforations of the gastrointestinal tract into the subcutaneous tissue can occur anywhere from the neck to the lower extremities.


Obstructive colonic cancer.

The clinical courses of 68 patients with obstructive colonic cancers were reviewed. For the majority of patients with an acutely obstructing cancer of the left colon a conventional staged procedure remains the most appropriate treatment. Primary resection is suitable for the more proximal colonic cancer with obstruction. The operative mortality rate was 13.6 per cent, but with the addition of two nonoperative deaths, the figure rises to 16.2 per cent. Only six patients are known to have survived five years.


Crohn's disease of the appendix: report of a case and review of the literature.

A case of Crohn's disease of the appendix that simulated a cecal tumor is presented and 27 additional cases are reviewed. Crohn's disease of the appendix most commonly occurs in the younger patient, with 90 per cent in the second and third decades of life. Before operation, appendicitis or an appendiceal abscess is commonly diagnosed. Appendectomy should be performed, if possible; otherwise a limited ileocolectomy should be done. These patients should have a long-term follow-up program because inflammation can develop later in any part of the bowel. Crohn's disease of the appendix should be included in the differential diagnosis of pain or a palpable mass in the right lower quadrant, especially in the young adult patient.


Progressive systemic sclerosis: report of a case with colonic involvement.

A case of progressive systemic sclerosis associated with colonic involvement is described. Barium-enema examination revealed segmental involvement. Colonoscopic examination of the whole range of the involved colon revealed wide-mouthed diverticula with interspersed rigid areas and numerous ulcerations. These colonoscopic findings appeared to be distinct from those associated with tuberculosis and Crohn's disease.


Condylomata acuminata in an infant and mother: Report of a case.

A case of a 16-month-old child who had had perianal condylomata acuminata since the age of 3 months, born to a 20-year-old mother who had had extensive anorectal and vulvovaginal condylomas during her pregnancy and delivery, is presented. The probable mode of transmission of the condyloma virus and its application to this case are discussed.


Giardiasis and intestinal malabsorption: Report of a case.

The possibility of giardiasis should be considered in any case in which the patient has watery diarrhea and malabsorption syndrome. Investigation should include examination of at least three separate fecal specimens for Giardia lamblis. In case of negative results, this examination should be followed by aspiration of duodenal contents to search for the trophozoites. Treatment with metronidazole in the case reported resulted in a good clinical response, with disappearance of the patient's chronic diarrhea and intestinal malabsorption.


Abdominal actinomycosis: A complication of colonic perforation.

Actinomycosis is a chronic, suppurative, mycotic infection, which tends to form abscesses and fistulas. The organism is a saprophyte of the human mouth. When a break in the normal contiguity of the gastrointestinal tract occurs, the organism may gain access to the surrounding tissues and become almost impossible to eradicate without surgical extirpation and administration of a long course of antibiotics. The diagnosis of actinomycosis should be considered for any patient in whom persistent or unusual enterocutaneous fistulas develop, when there is a recent history of perforated viscus or surgical intervention involving the gastrointestinal tract, such as appendectomy. The diagnosis is confirmed by the presence of "sulfur granules" in the fistulous tracts.


Primary carcinoma of the duodenum producing a malignant duodenocolic fistula.

A unique case of primary duodenal carcinoma with a malignant duodenocolic fistula is reported. En-bloc resection of the lesion with pancreatico-duodenectomy and right hemicolectomy resulted in a 15-month disease-free interval.


Impotence after proctectomy for inflammatory disease of the bowel.

During 1964 through 1973, 76 men underwent abdominoperineal resection as part of or subsequent to resection for inflammatory bowel disease. No instance of permanent impotence was found. Proctectomy should not be deferred because of the risk of impotence.


Toxic idiopathic megacolon: fatal outcome in a mentally retarded adolescent.

The case of an 18-year-old mentally retarded boy who had long standing idiopathic megacolon and pica is presented. Acute toxic dilatation of the colon complicating pseudomembranous colitis developed, with a rapidly fatal outcome. No similar case of relatively benign idiopathic megacolon complicated by pseudomembranous colitis and toxic megacolon has been reported. The pathophysiology of this rare combination is discussed.


The management of colonic and rectal injuries.

One hundred fifty cases of patients treated at the Henry Ford Hospital with traumatic injuries of the colon and rectum are reviewed. Five of 119 patients treated with exteriorization died, two of them from multiple visceral injuries, shortly after operation. The mortality rate for the primary-closure group of 24 patients was 8.3 per cent. In this group, 11 patients had postoperative complications. Thirty-nine of the 119 patients in Group II nad 62 complications. Infection was the predominant problem in both groups of patients. We still believe that exteriorization of the injured colon remains the safest method of managing these patients.


Fournier's gangrene complicating perinal abscess: report of two cases.

Two cases of Fournier's gangrene in which toxemia and gangrene of the scrotum developed due to perianal abscesses are described. Cultures of anaerobic gram-negative Bacteroides with a mixed flora of Pseudomonas, E. coli and Proteus were obtained. Early diagnosis, wide and deep incisions, debridement of the necrotic tissue, and adequate antibiotic therapy can prevent a fatal outcome of this disease. A high mortality rate is still prevalent.


Dissolution of Barium-impaction ileus by Gastrografin.

Ileus caused by impaction of hardened residual barium stagnated in the colon-a rare complication of barium-meal examination-constitutes a particularly serious problem when it occurs following abdominal operations, leading to postoperative ileus. The administration of Gastrografin in such cases has proven efficacy in the dissolution of inspissated barium, refractory to routine means of evacuation. Four case reports provide an illustration of this problem. The satisfactory results obtained, and the hitherto reported lack of side effects of this compound, justify recommendation of Gastrografin as a safe, simple method for use in the management of these cases.


Absorption of sodium from hypertonic sodium phosphate enema solutions.

Absorption of sodium from hypertonic sodium phosphate enema solutions has been studied in 11 patients by means of labeling the contained sodium with added 24Na and determining the radioactivity of body fluids after administration of the enemas. The sodium absorption thus estimated is a maximal figure and may represent an overestimate, since radioactivity can enter the body fluids by ion exchange without net transport of sodium. An average of 5.5 per cent of the instilled radioactivity was absorbed, corresponding to not more than 228 mg sodium. Absorption of such a quantity of sodium does not appear to represent a source of concern in the management of salt-restricted patients.


Leiomyosarcoma of the rectum: report of three cases.

Three cases of leiomyosarcoma of the rectum are reported. The first patient underwent palliative surgery and died 18 months after diagnosis; local radiotherapy was not effective and chemotherapy failed as well. The second patient underwent radical surgical treatment but monetheless the tumor recurred and the patient died 37 months after diagnosis. The third patient underwent radical surgery for a tumor that was in an early stage, has been followed for several months without evidence of disease. Review of the literature indicates that leiomyosarcoma of the rectum is the most malignant sarcoma of the gastrointestinal tract, and has a 20 per cent five-year survival rate. Even radical surgical treatment yields disappointing results. Following localized operations, recurrences appear in most cases, and this treatment is not recommended. Should an effective chemotherapeutic combination be found, chemotherapy as an adjuvant to surgery will probably be indicated.


[Trichinosis: epidemiology, clinical features and diagnosis (author's transl)].

After ingestion of wild boar meat 58 patients developed typical clinical signs and symptoms of trichinosis. All patients had marked blood eosinophilia. In 45% of the patients GOT and GPT and in 62% HBDH were moderately increased, while in 76% LDH and in 86% creatine-kinase showed abnormally high values. CK-MB was increased in three patients. 92% of muscle biopsies showed typical morphological changes in skeletal muscles. Latexagglutination, complement-fixation and agar-gel diffusion tests were not reliable. In most of the examined cases clinical symptoms and histological results correlated well with the indirect haemagglutination test, the microprecipitation test with living larvae of Trichinella spiralis and evidence of specific antibodies (IgG, IgM, IgE) by indirect immunofluorescence and the ELISA technique. 25 patients were treated with thiabendazole (Minzolum), 19 of them successfully.


[Serum antibody findings in trichinosis (author's transl)].

Serum samples of 66 persons who had eaten meat from a wild boar were tested two to three times within 11 months for antibodies against extracts from Trichinella larvae. Watery extract of Trichinella spiralis larvae served as antigen. Complement-fixation was of little use because of its lack of sensitivity. Indirect haemagglutination and the ELISA test (enzyme-linked immunosorbent assay) gave uncertain results only in individual cases. There was a relationship between the clinical picture and the mean antibody concentration, clearer in the ELISA test than the indirect haemagglutination one. A fall in antibody titre was observed within the period of observation in only one third of patients. Results with sera of control subjects were of only limited use in relation to the specificity of the demonstrated antibodies.


[Ultrasound in differential diagnosis of intrahepatic and extrahepatic cholestasis (author's transl)].

116 patients with clinically suspected obstructive jaundice were subjected to primary sonographic examination by means of the "real-time" method to differentiate between intrahepatic (internal) and extrahepatic (surgical) cholestasis. Diagnosis was finally confirmed by observing the clinical course, by further examinations, and in 63 cases by surgery or PM. Sonographic examination revealed the direct cause of the extrahepatic obstruction in 82 of 87 patients (94.3%) with extrahepatic cholestasis; in case of dilatation of the bile duct, the approximate site of the obstruction could be determined. In about 75% of the cases, the cause of biliary obstruction was correctly identified. Intrahepatic tumours or metastases were present in 10 of 27 patients with intrahepatic cholestasis; sonographic identification was effected in all cases and histologically or cytologically confirmed with aspiration material from fine-needle biopsies. The high accuracy and uncomplicated technique avoiding discomfort or harm to the patient, make sonography a useful method in differential diagnosis of cholestasis.


[Clinical comparison of hemoFEC with Hemoccult II (author's transl)].

Two technically improved methods of testing for occult blood in stool--hemoFEC and Hemoccult II--were compared by parallel tests in 1500 successive unselected out-patients. HemoFEC was positive in 1.9%, Hemoccult in 2.3%, the difference is not statistically significant. But there was a difference in the colour development of the two tests. Six cases of carcinoma, 14 of large polyps and six other sources of bleeding from the colon were revealed in the course of this study.


[Treatment of essential hypertension with a combination of propranolol, spironolactone-thiabutazide and dihydralazine (author's transl)].

In 61 out-patients with essential hypertension, grade I or II, propranolol was administered alone in increasing doses (3 x 40 mg/d or 3 x 80 mg/d) or, if there was insufficient response, with a double or triple combination consisting additionally of spironolactone (50 mg/d)-thiabutazide (5 mg/d) and dihydralazine (3 x 25 mg/d). This treatment schedule achieved normal pressures in 51 patients, in 22 on 40 mg, in 7 on 80 mg propranolol, in 16 after the addition of the diuretic, and in 6 with the triple combination. Four patients had to be excluded from the study because they developed either marked bradycardia or anxiety states or paraesthesias after propranolol (3 x 40 mg/d). On chronic beta-adrenergic blockade the serum potassium level increased slightly, but remained within normal limits. The initial value of plasma-renin activity was highest in the group of those who responded to the propranolol treatment.


[Syndrome of symphalangism and stapes fixation: an autosomal dominant hereditary disease (author's transl)].

The autosomal dominant hereditary syndrome of symphalangism and stapes fixation consists of multiple synostoses, most frequently symphalangism, in addition to synostoses of carpal and tarsal bones and radio-ulnar synostoses, various other malformations of the limbs (restricted joint movement or syndactylism) and variable degrees of conduction disorders due to stapes fixation, starting in childhood. A family tree of four successive generations with various forms of the syndrome is described.


[The hypertensive heart. VI. Ventricular function and coronary artery haemodynamics as influnced by digitalis glycosides (author's transl)].

The effect of intravenous digoxin (0.01 mg/kg) on ventricular function, coronary arterial haemodynamics and myocardial oxygen uptake was studied in 12 patients with essential hypertension but no heart failure, significant left ventricular hypertrophy and normal coronary arteriogram. There was a definite, velocity-related increase in the inotropic function of the left ventricle, by 19.4%, 50 min after digoxin injection, while ventricular pumping function decreased by between 6.5 and 11.2%. Coronary blood flow through the left ventricle decreased by 8.8%. On the other hand, coronary vascular resistance and coronary arteriovenous oxygen difference increased by 11 and 5.9%, respectively. Oxygen uptake remained essentially unchanged (-2.1%). These results indicate that the increase in inotropism caused by intravenous digoxin in essential hypertension without heart failure produces not only no therapeutically useful improvement in left ventricular pumping function: there is also a coronary constrictor and ischaemia-inducing effect on the coronary arterial system.


[Hepatitis risk of human plasma-fraction concentrates of pooled plasma (author's transl)].

In 1975/76 the risk of hepatitis from human clotting preparations (fibrinogen, prothrombin complex) prepared from pooled plasma was studied prospectively in patients who had undergone open-heart surgery with cardiopulmonary bypass. Of 247 patients 25 (10%) developed hepatitis postoperatively, while of 17 recipients of plasma-fraction concentrates 12 developed hepatitis (71%). Even taking into account other potential risk factors this rate of hepatitis is statistically significant. It demonstrates that even with the most modern screening methods it is not possible to produce clotting preparations from "large pool" human plasma which is free of hepatitis risk, unless additional virus-inactivating measures are taken.


[On the histology of malignant tumours in infants and children (author's transl)].

Autopsy and biopsy material obtained between 1967 and 1976 at the Institute of General Pathology and Pathological Anatomy of the Medical Academy Erfurt included 260 malignant tumours in infants and children. Male to female ratio was 54.6:45.4. There were slight peaks for the fourth and sixth year of life. The most frequent site was the CNS (44.2%), followed by the haematopoetic-lymphatic system (28.1%), skeletal system (7.7%), sympathetic nervous system including adrenal medulla (6.2%) and kidneys (4.6%). Among tumour types the neurogenic ones were most frequent at 50.8%, followed by leukaemias (18.1%) sarcomas (12.3%), malignant non-Hodgkin lymphomas (7.3%) and mixed tumours (6.5%). Comparing these results with those quoted in the literature and earlier personal studies indicates that the higher frequency of CNS tumours is probably due to regional factors. Linked to this is a percentage increase of neurogenic tumours and a relative decrease in leukaemias. Additional changes in distribution among the different forms of tumour are due to the introduction of the group of malignant non-Hodgkin lymphomas.


[Pan American seminar on education and health care].

This is the Final Report of the Seminar, which was held at Caracas last February under the sponsorship of the World Federation of Medical Education and the World Health Organization, and organized by the Pan American Federation of Medical Schools and the Pan American Health Organization. The Seminar was attended by delegates from universities, ministries of education and health, social security administrations, medical educators, officers of national and international agencies, and other special guests from the Region of the Americas. These participants made up a broad-spectrum interinstitutional and interprofessional working group that brought an interdisciplinary analytical approach to the subjects dealt with. The Seminar examined the context of the relationship between education and health care, and discussed the following specific topics: need for coordination between education and health services, present systems of interrelationships, mechanisms for productive interrelations and a plan of action. The topics were considered in general sessions and then analyzed in discussion group meetings. The Report contains summaries of the presentations and commentaries on each subject and the consolidated reports of the discussion groups.


[Experimental studies of the duration of hexobarbital sleep and of the level of cytochrom P-450 and B5 in the microsomal fraction of rat liver after propoxur treatment].

Male sex-mature rats of the Wistar Strain with weight of 180--20 gm were treated per os daily for a period of 60 days with 1/10 of LD50 of Propoxur (10 mg of body weight per day of 2-isopropoxiphenyl-N-methylcarbamate). There was induction of cytochromosomal P-450 and B5 in the end of the first week after the intoxication was induced and shortening of hexobarbital sleep during the same period as well as on the thirtieth day since the onset of the experiment.


[Infrared spectroscopy of erythrocyte membranes].

The authors examined the properties of erythrocyte membranes, obtained from young and old erythrocytes of 2-old rats by means of infrared spectroscopy. The films, prepared on CeF2 plates were recorded before and after 30 minutes treatment with methanol, ethyl and isopropil alcohol respectively. There were age differences. The young erythrocytes contained 25% beta, 27% alpha, 28% random (diforderly) and 20% beta-antiparallel conformed proteins. The old erythrocyte membranes contained 45% alpha and 55% proteins, structured disorderly. After treatment of the films for a period of 30 minutes with methanol, ethyl or isopropil alcohol there were changes, which manifested beta structures in young erythrocytes around 31% and in old erythrocytes around 30% of the intensity of the total absorption of the membrane proteins. Methanol caused maximal increase of the disorderly structure in the young membranes and maximal beta structure in the old erythrocytes in comparison with the remaining alcohols. Ethanol caused maximal increase of beta structure in young membranes and maximal increase of disorderly structure in the old membranes. Isopropanol caused changes close to those induced by methanol. The observed changes in accordance with the age of erythrocyte membranes before and after treatment with alcohol manifested peculiarities in the conformation of the membranes proteins. These data corresponded to the discovered quantitative changes in the content of the erythrocyte membrane in the process of erythrocyte aging.


[Effects of imidazole, papaverine and theophylline on the picrotoxin convulsion-seizure threshold. The correlation with gamma-aminobutyric acid (GABA) and diazepam].

The author carried out studies on male white rats and examined the effect of imidazol, papaverine and theophyline (drugs affecting the activity of phosphodiesterase), singly or in correlation with GAMA and diazepam on picrotoxic seizure threshold (PSAT). He found that imidazol had various effects on PSAT in accordance with the interval of application and antagonized the effects of GAMA. Papaverine in low doses was ineffective, but in higher doses lowered PSAT; it antagonized the effect of GAMA, elevating the threshold. Papaverine in combination with CAMF antagonized the effect of GAMA, elevating the threshold. Theophyline lowered PSAT; it did not influence the effects of the combined application of GAMA and DIA. He thinks that the obtained changes in PSAT could partly be connected with the mediating influence of imidazol, papaverine and phe theophyline on cerebral phosphodiesterase both after their single application and after examination of their correlations with GAMA or DIA, used singly or in comibination, and partly with their own pharmacologic action.


[Comparative cytogenetic studies of newborn infants and adults].

The authors examined comparatively the frequencies of genomic, counted and structural chromosomal aberrations and associations of acrocentric chromosomes (AAC) in lymphocytic cultures from 35 phenotipic healthy newborns and 15 clinically healthy persons over 60 years of age. Polyploidy was found in 0,16% of the cells in the newborns and in 0,47% of the cells of the adults (0,1 greater than P greater than 0,05). Aneuploidy was established in 0% of the cells of the newborns and in 5,7% of those of the adults (P less than 0,05). In the hyperploid karyotypes 1,3% of the cells of the adults the additional chromosomes were of group C and D. Structural aberrations were observed in 0,58% of the cells of the newborns and in 3,6% of those of the adults (P less than 0,05%. Chromosomal and chromatoid breaks with or without the presence of fragment predominated. Cells with AAC in the newborns were 61,7% against 81,4% in the adult persons (P less than 0,001). The number of the associating chromosomes increased with advancement of age--19,2% in the newborns and 31,9% in the adults (P less than 0,001). In the newborns 21,5% of the chromosomes from group G participated in associations and 17,7% of chromosomes from group D; in the adults both groups were equally engaged--31,3% of the chromosomes G and 32,4% of the chromosomes D.


[Vascularization of the human esophageal mucosa].

The authors carried out studies on the vascularization of the oesophagal mucosa in 14 individuals at various age after preliminary administration of Indian ink-gelatine in blood. On the basis of the performed studies they found that mucosal vascular bed of the oesophagus had two vascular plexuses: deep, located in the propria and superficial--under the epithelium of the mucosa. The deep vascular plexus is of spacial character but the superficial--plane. From the latter loop capillaries are separated on vide basis, which are directed vertically to the epithelium together with conic connective-tissue papillae. The authors interpret also some age peculiarities of the mucosal bed of the oesophagus.


[Characteristics of the aortic rheogram (an experimental study)].

The authors aim to describe aortic rheogram and examine its changes under the influence of some agents, to compare with the phases of the heart activity and to explain the origin of the curve. They use experimental animals (cats), to whom aortic rheogram is recorded by means of a probe-electrode, as well as atreiral blood pressure, phonocardiogram and electrocardiogram. The changes in the aortic rheogram are recorded after elevation or diminition of arterial blood pressure (medicamentous and mechanical), replacement of a part of the abdominal aorta with nonelastic prothesis and application of a model heart-aorta-vascular bed, in which the "systolic volume" is changeable as well as the "peripheral vascular resistance". The authors come to the conclusion that the aortic rheogram, recorded by a probe-electrode, is a reflection of the fluctuations in the volume velocity of the blood flow. Furthermore the general amplitude of the curve is in direct dependence of the systolic volume of the left ventricle. The peripheral vascular resistance and elasticity of the aortic wall do not affect substantially the form and amplitude of the rheogram. The value of the mean arterial blood pressure itself does not influence the form and the value of the curves.


[Significance of spontaneous and evoked temperature changes in the brain in applying the thermoclearance technic to the determination of cerebral blood flow].

The authors carried out studies on cats under urethane narcosis and found that the presence of spontaneous temperature changes in two neighbouring regions of the cerebral cortex, were discovered at a distance of 5 mm from each other in a parallel course. After administration of pharmacological agents such as papaverine, nivaline, etc. in the region of the cerebral cortex there were quick transitory temperature changes as in the two neighbouring regions of the cortex these changes had one-way course, but not a parallel one. This caused the occurrence of changes in the temperature difference between them, which was recorded by switching of the differential amplifier. These changes could be indicated as "zero reaction", having in mind the essence of the thermoclearance methods by means of which additional source of heat was introduced in one of the two regions. The real changes in the blood flow of the brain under the influence of the administered pharmacological agent represented the difference between the recorded and the so called zero reaction. The established facts oblige to take into consideration a possible presence of "zero reaction" during usage of thermoclearance method for determination of blood flow in other organs as well.


Gastrointestinal fiberoptic endoscopy in pediatric patients and juveniles.

Over a period of 8 years 351 upper gastrointestinal endoscopies and 72 coloscopies were performed in infants, children and juvenile patients. Development of special pediatric instruments provides increasing application even to the youngest patients. Fiberendoscopy is a safe and sensitive diagnostic tool also in the pediatric age group; furthermore the therapeutic possibilities of operative endoscopy can be used without disadvantage.


Intraoperative endoscopy in oesophageal atresia and anorectal anomalies.

In four children with oesophageal atresia and two children with high anorectal anomalies a magnetic bougienage respectively a magnetic pull-through procedure have been performed. In all cases the cylinders have been placed under endoscopic control. The endoscopic intraoperative procedure has proved to be very useful in these 6 cases. Having performed a successful bougienage the cylinder of the upper segment can pass distal to the thread in the stomach and can then be grasped with a flexible endoscope via gastrostomy. Endoscopy after magnetic pull-through procedure in anorectal anomalies is necessary in order to control the newly created pathway together with manometry and x-ray studies.


Endoscopy of the biliary tract and the pancreas in children.

ERCP is a useful method in adults for diagnosing bilio-pancreatic disorders. The application of this technique in children is limited until now according to the rare case reports in the literature. Our experience with this procedure, based on the examination of six children and 12 youths, shows that ERCP can be employed with great benefit, when taking into account the correct indication. ERCP is mainly applied to clarify obstructive jaundice, especially when anomalies of the bile duct system are suspected, and to discover a reason for relapsing pancreatitis where other procedures fail. Blunt abdominal traumata with upper GI bleeding may well be another reason. In general our first reported data are encouraging.


Endoscopic retrograde cholangio-pancreatography (ERCP) in children.

ERCP was successfully carried out 6 times in 4 children with suspected round worm infestation of the biliary tree. A general anaesthetic was given in all cases, and an adult duodenofibrescope was used. Early experience indicates that the procedure is feasible and of value even in small children weighing 12 kg. As in adults, ERCP should be considered whenever a precise outline of the pancreato-biliary system is required, and when infusion cholangiography fails to give the desired information.


Gastric neoplasm in the West of Ireland: an endoscopic survey.

The results of endoscopic examination, biopsy taken at endoscopy and cytology of brush smears and/or gastric lavage specimens in 100 patients with proven malignant gastric lesions are described. Overall, a correct pre-operative diagnosis was achieved in 98 cases. Endoscopic appearance was a more accurate criterion in cases of exophytic advanced carcinoma, malignant ulcer and lymphoma than in diffuse infiltrative carcinoma or in early carcinoma, where biopsy and cytology were more accurate. Nine per cent of neoplasms were malignant lymphomas, which is much higher than the usual reported incidence. Early carcinoma was found in 5% of cases. In spite of readily available facilities for endoscopic diagnosis, most cases of gastric neoplasm were already advanced at the time of examination.


Out-patient gastroscopy risks.

Complications in out-patient gastroscopy were evaluated retrospectively in 995 examinations performed in 625 patients. At the examination seven complications were registered in the gastroscopy record. Two complications: perforation of the stomach and cardiac arrhythmia, required hospitalisation. None of the complications was lethal. Inquiries to the referring general practitioners revealed 5 cases where the gastroscopy had led to consultations because of minor complaints after the examination. Considering all complaints as complications the frequency of complications in out-patient gastroscopy was 1.2%.


Endoscopic examination of Egyptian mummies.

Three Pharaonic mummies, preserved for thousand of years, had fiberoptic endoscopy carried out of the cranial, thoracic and abdominal cavities. The aim of the study was to gather medical data and ascertain the extent of damage of these mummies before undertaking restoration procedues. The endoscopic examinations revealed some valuable data concerning certain points of historical interest.


Peroral cholangioscopy in choledocho-duodenostomy--patients using the pediatric fiberscope.

In patients with wide-open bilio-digestive anastomoses peroral cholangioscopy using the pediatric endoscope GIF-P2 is easily performed. The common bile duct is visualised down to the papilla and up to the distributaries of the hepatic ducts. The instrumentation channel allows mobilisation of incarcerated concretions, extraction of food particles (cholangiophytiasis) and guided biopsy of pathological findings. The experience in 12 patients with this method is promising.


Descending sphincterotomy of the papilla of Vater through the T-drain under endoscopic view. Variants of endoscopic papillotomy (EPT).

An indwelling T-drain is a valuable access to the common bile duct if the conventional EPT fails in the case of choledocholithiasis. It is often easier to cannulate the duodenal papilla from the common bile duct than from the duodenum. A papillotome of the Erlangen type introduced through the T-drain into the papilla spontaneously has the correct cutting direction. The incision is controlled endoscopically. If a patient has undergone Billroth II operation, the particularly difficult cannulation and incision of the papilla is make much easier by the descending technique. Two variants of the endoscopically controlled descending electropapillotomy were successfully performed.


Endoscopic retrograde cholangiography (ERC) through artificial endoscopic choledocho-duodenal fistula.

A new endoscopic method for retrograde cholangiography in cases of unsuccessful cannulation of the papilla is described. In 1 patient with obstructive jaundice, severe diabetes and a previous history of biliary pain traditional ERC failed. An endoscopic artificial choledocho-duodenal fistula by means of a diathermic cutter (needle type) was performed at the lower end of the intramural portion of the common bile duct for retrograde cholangiography. X-ray showed an obstruction of the common bile duct due to a carcinoma of the head of the pancreas. Complications did not occur during the procedure and in the post-operative period. It is concluded that the described method may be helpful when traditional selective ERC fails, moreover it may permit an endoscopic choledocho-duodenostomy for choledocholithiasis in cases of unsuccessful endoscopic papillo-sphincterotomy.


Perforation of the oesophagus with an oblique--viewing endoscope in a patient with caustic stenosis.

A case of accidental oesophageal perforation during endoscopy in an elderly woman with acute alimentary obstruction of a caustic stenosis is presented. This demonstrates the risks in routine use of oblique-viewing endoscopes, especially in oesophageal exploration. The lesion was successfully treated by internal splinting with a Celestin tube. The indications for this kind of treatment arise in elderly patients with poor general condition in whom a preexisting stenosis guarantees the tight fitting of the tube.


Caroli's disease: diagnosed by ERCP and ultrasonography.

A patient with Caroli's syndrome is reported; diagnosis was made by ERCP and ultrasonography. Caroli's disease occurred in its "pure" form in this patient, i.e. dilatation was present only in the intrahepatic biliary system while the extrahepatic bile ducts were normal. Pathogenesis and differential diagnosis are surveyed on the basis of available data. Further, the possibilities of treatment and prognosis are dealt with.


Overfilling of a pancreatic segment in endoscopic retrograde pancreaticography.

A case of parenchymal opacification of a segment of the pancreatic head without severe clinical sequelae is described. The authors discuss the pitfalls of the technique of duct filling and wedging of the cannula in a segment of the pancreatic duct. They call attention to the risks of such complications in patients with intolerance to i.v. administration of contrast medium.


Endoscopic extraction of a perforating paperclip from the stomach.

Report on succesful endoscopic removal of a metal clip perforating the gastric wall for about 2 cm.


Serum creatine kinase isoenzymes in progressive muscular dystrophy.

Creatine kinase isoenzymes in sera and muscle biopsies obtained from 50 controls, 72 patients with progressive muscular dystrophy (PMD), 68 patients with other neuromuscular disorders, 17 carriers of Duchenne-type PMD and 15 patients with myocardial infarction were studied. MB isoenzyme was detected in the sera of 58 patients with PMD and 56 out of 61 muscle biopsies. The MB activity varied between 4 and 400 IU/1 or 3.4--22% of total activity. The MB activity was demonstrated in a considerably smaller number of cases with polymyositis, dystrophic myotonia and Kugelberg-Welander disease. The MB isoenzyme in sera of PMD persisted for many years. It is admitted that the MB isoenzyme in the serum of patients with PMD originates chiefly from skeletal muscle.


Developmental profile of enzyme activity in several tissues of the C57BL/6 mouse between birth and 35 days of age.

The activity of 19 liver enzymes as well as the level of activity of a lesser number of enzymes in brain, kidney and heart tissue was measured in C57BL/6 mice at various ages between birth and 35 days. Several enzymes were present at significant levels in the liver at earlier ages than reported for rat liver. The time course of the development, the magnitude of the charges and the direction of the changes are often significantly different from the profiles observed in rat tissues, thus the mouse may respond differently than other species to dietary alterations and/or hormonal stimulations during the developmental period.


Vitamin B6 metabolism in human red cells. I. Variations in normal subjects.

Physiologic and pharmacologic factors affecting intracellular red cell vitamin B6 metabolism in normal human subjects were studied using a new assay for pyridoxine kinase (PnK) together with saturated and total aspartate aminotransferase (AST) activities as indirect indices of intracellular pyridoxal 5-phosphate (PLP) availability. The presence of reduced PnK activity in Blacks was confirmed but this could not be explained on the basis of increased enzyme inactivation during red cell aging in vivo. Racial differences were also noted in the metabolism of AST and, in Caucasians, net dissociation of PLP from the apoprotein was demonstrated to occur in vivo. Despite the wide variation in Pn5 activity, AST levels were maintained within relatively narrow limits. However, when pharmacologic doses of pyridoxine were administered, PnK and AST activities increased proportionately. These findings suggest that when the supply of B6 vitamers is not limiting, PnK may play a role in regulating red cell PLP levels.


Actins from mammals, bird, fish and slime mold characterized by isoelectric focusing in polyacrylamide gels.

Actins isolated from a variety of tissues and cultured cells were compared by isoelectric focusing in polyacrylamide gels in the presence of 9 M urea and 2% Nonidet P40. Actins isolated from muscle tissue with a sarcomeric structure like skeletal muscle and heart muscle invariably display, as previously shown, one single band with a pI of approximately 5.4 (alpha-actin) in isoelectric focusing gels. Actins isolated from mammalian or avian non-muscle tissue and cultured mammalian cells display two polypeptide bands (beta and gamma-actins) focusing at a slightly higher pH than alpha-actin as a closely spaced doublet. A gamma-like actin is the predominant species in chicken gizzard actin. However, this gamma-like form is not isoelectrically identical with gamma-actin from brain. These results are discussed in relation with the currently available amino acid sequence data known for different actins. Actin isolated from the liver of the electric fish Torpedo marmorata appears to consist of a single isoelectric species with an apparent isoelectric point similar to the beta-actin component of mammalian brain. The actin from the slime mold Physarum polycephalum shows only one single major band in isofocusing gels with an isoelectric point lower than that of alpha-actin.


The mechanism of action of cytochrome P-450. Occurrence of the 'NIH shift' during hydroperoxide-dependent aromatic hydroxylations.

The mechanism of liver microsomal aromatic hydroxylation has been investigated by using cumene hydroperoxide as the hydroxylating agent and comparing this reaction with the NADPH-dependent reaction. The conversion of [4-(3)H]acetanilide to 4-hydroxyacetanilide by rat liver microsomes (or purified cytochrome P-450) in the presence of either cumene hydroperoxide or NADPH is attended by comparable 'NIH shifts'. This indicates that hydroxylation in the two systems proceeds via a common intermediate, presumably an arene oxide. The intermediacy of an arene oxide, phenanthrene-9,10-oxide, is established by incubating [3-(3)H]-phenanthrene with rat-liver microsomes and cumene hydroperoxide in the presence of either non-radioactive phenanthrene-9,10-oxide as a 'trap' or in the presence of cyclohexene oxide, an inhibitor of the enzyme epoxide hydrase. Incubation of phenanthrene with cumene hydroperoxide in an 18O-enriched medium has confirmed that the oxygen atom in phenanthrene-9,10-oxide is derived from the hydroperoxide and not from the medium.


Isolation and characterization of secretory actin . DNAase I complex from rat pancreatic juice.

DNAase I isolated from rat pancreatic juice was always found in association with a protein of molecular weight 43 000. This association leads to inhibition of the isolated rat pancreatic DNAase I activity by 66%. The molecular weight of the complex was found to be 74 000 by gel filtration indicating a 1 : 1 molar association of both proteins. Since the protein of molecular weight 43 000 has a number of properties similar to skeletal muscle actin such as filament formation, nucleotide binding, inhibition of the rat pancreatic DNAase I activity and comigration with skeletal muscle actin on polyacrylamide gels in the presence of dodecylsulfate, it is concluded that DNAase I is bound to actin in rat pancreatic juice in a 1 : 1 complex. It is demonstrated that a protein fraction from bile is able to activate the DNAase I enzymatic activity of the rat secretory actin . DNAase I complex.


Human erythrocyte membrane acetylcholinesterase. Incorporation into the lipid bilayer structure of liposomes.

Human erythrocyte acetylcholinesterase was incorporated into liposomes of different phospholipid composition by detergent depletion methods. Complete incorporation of activity into liposomes was achieved. Either by gel filtration or by dialysis 99.96% of the sodium deoxycholate originally present was removed. The preferred method of liposome formation involved the use of dialysis followed by gel filtration, as gel filtration alone resulted in liposomes heterogeneous in size. The liposomes had a diameter of about 30 nm (determined by electron microscopy and gel filtration). Studies involving the use of Triton X-100 and proteolytic enzymes revealed that at least 70% of the incorporated activity was located on the outer-side of the liposomes; this percentage was even higher in small liposomes.


Purification and characterisation of prostatic binding protein and its subunits.

The prostatic binding protein, previously described in rat ventral prostate, was isolated. The purified protein binds pregnenolone with an affinity of 1.2 X 10(6) M-1 and contains an average of 0.84 binding site per molecular. Its carbohydrate content is 3.2%. Its Mr, estimated by gel filtration, is 51 000 but in the presence of 6 M guanidine hydrochloride or 0.1% dodecylsulfate it dissociates into two subunits (S and F), which can be separated by polyacrylamide gel electrophoresis or by chromatography on hydroxyapatite. The Mr of these subunits is about 17 000, when estimated by gel filtration in 6 M guanidine hydrochloride, or 19 000 for subunit F and 20 000 for subunit S, when measured by dodecylsulfate/polyacrylamide gel electrophoresis. Their isoelectric points, estimated by isoelectric focusing in 8 M urea, are 4.6 for subunit F and 4.9 for subunit S. Prostatic binding protein and both subunits have a very similar amino acid composition. Upon reduction of disulfide bridges each subunit dissociates further into two components: one of these components is the same in both subunits.


Structure-activity relationships for the lipid-mobilising action of locust adipokinetic hormone. Synthesis and activity of a series of hormone analogues.

A series of compounds structurally related to adipokinetic hormone, the decapeptide neurohormone less than Glu-Leu-Asn-Phe-Thr-Pro-Asn-Trp-Gly-Thr-NH2, have been prepared by synthesis and by enzymic cleavages of synthetic hormone. Their relative agonist activities in mobilising lipids over a fixed time interval (1 h) in locusts were assessed. The similar time courses for lipid release shown by two of the peptide analogues and adipokinetic hormone suggest that the analogues and the hormone are transported to the receptors on the fat body cells, and are also degraded, at similar rates. Consequently, the analogue activities can be correlated with the structural requirements of the locust fat body hormone receptors. The requirements for activity demonstrated in this study are as follows. Residues 1--8 from the N-terminus are necessary to elicit some activity (20%). Residues 5 and 7 in the octapeptide can be changed without affecting activity but L-pyroglutamic acid as the N-terminal residue is necessary formaximum activity both in the octapeptide and the decapeptide. Full activity is achieved only by adding the dipeptide glycyl threonine amide to the active octapeptide 'core'. In the decapeptide, residues cannot be interchanged to the same extent as in the octapeptide without reducing activity. The peptide probably has to be uncharged. Inactive analogues of seven residues or less do not interfere in the hormone-receptor interaction.


Studies on the biosynthesis of bacterio-opsin. Demonstration of the existence of protein species structurally related to bacterio-opsin.

1. The kinetics of processing newly synthesized bacterio-opsin from the non-crystalline state within the brown membrane to the crystalline state within the purple membrane was followed by pulse-chase experiments. 2. Biosynthesis of bacterio-opsin was found to be highly resistant to RNA-synthesis inhibitors like rifampicin and ethidium bromide. In the presence of ethidium bromide, only five protein species continue to be synthesized in halobacteria, one of them being bacterio-opsin. 3. In spheroplasts, synthesis of bacterio-opsin is found to be selectively disturbed. The purple membrane isolated from spheroplasts contains new, additional protein species with apparent molecular weights of 19 000, 23 000 and 29 000. These proteins share common amino acid sequences with bacterio-opsin. 4. In the halobacterial cell membrane, two membrane proteins with apparent molecular weights of 30 000 and 36 000 were detected which are structurally related to bacterio-opsin. 5. Bacterio-opsin as well as the 30 000 Mr and 36 000-Mr proteins contain covalently bound sulphate.


Ethanol oxidation by isolated rat-liver cells. Stimulatory effects of fructose.

Isolated liver cells from starved or fed rats were used to examine the mechanisms by which fructose stimulates hepatic ethanol oxidation, particularly in relation to the role of intercompartmental hydrogen transfer. The presence of added fructose stimulated ethanol oxidation, the degree of stimulation being directly related to the initial fructose concentration up to a level of 10--20 mM. In the presence of fructose and ethanol, sorbitol, glycerol and glycerol 3-phosphate accumulated. The stimulation of ethanol oxidation by fructose could be attributed to its ability to promote the oxidation of cytoplasmic NADH by the provision both of cytoplasmic hydrogen sinks and components of the glycerol 3-phosphate shuttle. Shuttles mediated by malate dehydrogenase were unimportant for fructose-stimulated ethanol oxidation. Rates of respiration and gluconeogenesis were similar over a fructose range of 5--20 mM although ethanol oxidation was faster at higher fructose concentrations. Hence the stimulation of ethanol oxidation by fructose is not merely a direct function of the energy demands of gluconeogenesis.


Two structurally closely related polypeptides encoded by 14-S mRNA isolated from rat lens.

14-S mRNA from rat lens codes for two subunits of alpha-crystallin, A2 (Mr 20 000) and AIns (Mr 24 000, previously referred to as alphaX). Structural relationship between both translation products has been proved by immunoprecipitation with antisera directed against the different crystallin classes. Competition immunoprecipitation showed that the 14-S mRNA translation products are precipitated by common antibodies, specific for the A subunit of alpha-crystallin. Two-dimensional gel electrophoresis and peptide analysis provided further evidence that the 24 000-Mr polypeptide, synthesized in vitro under direction of 14-S mRNA, is identical with native alphaAIns. Although the structures of alphaA2 and alphaAIns are very similar, no precursor-product relationship exists between both 14-S-mRNA-encoded polypeptides.


Rat alpha-crystallin A chain with an insertion of 22 residues.

Rat lens alpha-crystallin contains, besides the usual alphaA and alphaB subunits, an additional minor chain. This subunit was purified by ion-exchange chromatography and its primary structure studied. It appeared to be an elongated alphaA-like chain, having an insertion of 22 residues between position 63 and 64 of an otherwise normal alphaA2 chain. Therefore this subunit was called alphaAIns, i.e. an alphaA chain with an inserted sequence. This inserted region, which contains three methionyl, five basic and no acidic residues, apparently results in an adequately functioning alphaAIns chain. The alphaAIns chain may be the product of a gene which has originated, after duplication of the alphaA gene, by insertion in one of the copies of a stretch of 66 nucleotides of unknown origin, or alternatively be the result of unusual transcription or processing of precursor mRNA (pre-mRNA), leaving an extra 66 nucleotides internally in the mRNA to be translated.


Spectral properties of chlorophyll a monolayers in the presence of an exogenous electron donor and acceptor.

Chlorophyll a monolayers are studied at a nitrogen-water interface in the presence of a reducing or oxidizing agent: sodium ascorbate and benzyl viologen, respectively. Absorption spectra of the films are measured directly on the aqueous surface. With the aid of a computer, fourth derivative and difference spectra are determined. In the presence of ascorbate, a bathochromic shift of the absorption maximum to 693 nm can be induced as compared to 683 nm for a chlorophyll monolayer without any additives. In the presence of ascorbate, chlorophyll species at 676, 712 and 750 nm (present in a pure chlorophyll monolayer) are decreased or diminished. Illumination causes no change in the position of these absorption maxima; however, there is an increase of the absorbance of the main red absorption band. In the presence of benzyl viologen there is a hypsochromic shift of the red absorption maximum to 679 nm. Chlorophyll species at 670, 694, 712 and 740 nm (present in pure chlorophyll monolayers) are decreased or diminished upon addition of benzyl viologen. Upon illumination, there is a decrease in absorbance at 686 nm. It appears that the redox reagents induce the formation of specific chlorophyll aggregates, in the interfacial system, which might be analogous to the various chlorophyll species observed in green plant photosynthesis.


Studies on lipid A from Yersinia pseudotuberculosis lipopolysaccharide. Isolation and general characterization.

Lipid A was isolated from lipopolysaccharide of Yersinia pseudotuberculosis S form (strain 341, subtype IB) using mild hydrolysis with acetic acid. The purified material (yield about 25%, molecular weight about 2900) contained D-glucosamine (11%), fatty acids (54%), protein concomitant (9.7%) and phosphorus (approximately 2%). Dodecanoic and 3-hydroxy-tetradecanoic acids in a molar ratio of 1 : 3.6 were detected as major fatty acid constituents. The hydroxyl groups of D-glucosamine were acylated with the residues of both fatty acids, while the amino groups were substituted with the residue of 3-hydroxy-tetradecanoic acid. Such a simple fatty acid composition is reminiscent of that found in lipid A in Y. pestis.


Changes of mitochondrial DNA polymerase-gamma activity in synchronized mouse cell cultures.

Following synchronization by a double hydroxyurea block, mouse cell cultures exhibited a period of accelerated precursor incorporation into mitochondrial DNA during the late nuclear S phase. Peak activity of mitochondrial DNA polymerase-gamma occurred concurrent to the interval of accelerated organelle DNA synthesis. Mixing experiments suggested that the variations in mitochondrial DNA polymerase activity during the cell cycle were not due to free inhibitors in the enzyme preparations examined.


The conformation of membrane-bound and detergent-solubilised bovine rhodopsin. A comparative hydrogen-isotope exchange study.

The conformations of the intrinsic membrane protein, rhodopsin, in its membrane-bound and detergent-solubilised states have been compared by hydrogen isotope exchange measurements. The infrared peptide exchange data show that the highly hydrophobic nature of rhodopsin is conserved in the presence of the two detergents used: Cemulsol LA 90 and Ammonyx LO. Only about 50% of the peptide hydrogens exchange under conditions where about 80% would exchange in most soluble proteins. The conformational stability of rhodopsin in these two detergents is also demonstrated by the similarity of the tritium exchange-out kinetics and the infrared amide I band frequencies for both membrane-bound and detergent-solubilised rhodopsin. Upon illumination of rhodopsin (bleaching) in the presence of detergents, the hydrogen exchange rates are greatly increased and shifts in the amide I band frequencies are observed, indicative of a large conformation change. No such change occurs upon bleaching membrane-bound rhodopsin. We conclude that the conformation of rhodopsin is not altered by solubilisation in non-ionic detergents. However, in agreement with previously published results, bleached rhodopsin is stabilised by the membrane but does not retain a native conformation in these detergents.


Selenium content of human milk, cow's mild and cow's milk infant formulas.

The selenium content of human milk, cow's milk and cow's milk infant formula were estimated by instrumental neutron activation analysis. The highest values were found in 3 samples of human colostrum (524--865 x 10(-9) g/g dry weight). There was a significant decrease with increasing time post partum. Mature human milk exhibited a selenium content of 230 +/- 79 x 10(-9) g/g dry weight. The selenium content of 45 samples of cow's milk from the north-western area of Germany was 200 +/- 39 x 10(-9) g/g dry weight. While there was no significant difference between the values of mature human milk and of cow's milk, cow's milk infant formula exhibited significantly (P less than 0.01) lower values than human milk. The average selenium content of 107 samples of 10 different commercially available fluid and powdered cow's milk infant formulas (range: 18--171 x 10(-9) g/g dry weight) amounted to about only one third of that in mature human milk.


Design of a multiple longitudinal study of growth and health in teenagers.

This paper describes the design of a study to follow the development of boys and girls in secondary schools from the age of 12 through 17 on an annual basis, in order to acquire more information concerning the growth and development of teenagers. In this study, both physical and psychological characteristics are measured. Normal daily diets, usual physical activity, and attitudes towards physical education are measured to assess their influence on physical and psychological characteristics. In view of the inadequacies of pure-longitudinal and of cross-sectional designs, a multiple longitudinal design has been chosen in which four repeated measurements are made in two overlapping cohorts by which age-, time of measurement-, and cohort-effects can be distinguished. Test effects are isolated by comparing the data from the test cohorts with data from an independent sample of identical cohorts from a second "control" school.


Maple syrup urine disease: treatment of the acutely ill newborn.

Three patients with maple syrup urine disease were treated during the acute neonatal stage. Multiple exchange transfusions proved to be a satisfactory means of achieving rapid clinical and biochemical improvement during this phase. On the other hand, evidence is provided suggesting that in addition to exchange transfusions, a high calorie intake above 150 Cal/kg body weight/day is necessary to lower the plasma concentration of the branched chain amino acids to near-normal levels. As long as this calorie intake was not provided, further exchange transfusions failed to lower the plasma leucine concentration to below 17 mg/100 ml in one patient. It is assumed that this high calorie intake is necessary to prevent the breakdown of endogenous protein. Treatment of acute episodes in maple syrup urine disease should therefore not only eliminate the elevated alpha-keto acids and branched chain amino acids quickly (i.e. by multiple exchange transfusions or peritoneal dialysis), but in addition should provide a high calorie intake.


Association of neonatal respiratory distress with birth asphyxia and deficiency of red cell mass in premature infants.

Red cell mass (RCM) was estimated using 125I-labelled human serum albumin in 128 premature infants born after 26 to 36 weeks gestation. Infants of three different gestational periods (26--29, 30--32, and 33--36 weeks) with respiratory distress (RD) averaged lower one-minute Apgar scores and lower RCM than infants without RD (P less than 0.05). The incidence of RD was significantly (P less than 0.05) higher in infants with Apgar scores below 6 and in infants with RCM of less than 35 ml/kg than in the infants with greater values. The highest incidence of RD and the highest mortality rate were found in the infants with low Apgar scores and low RCM values. Prematures with similar Apgar scores showed a higher incidence of RD when RCM was low, and infants with similar RCM showed a higher incidence of RD when Apgar scores were low. Our results suggest that both birth asphyxia and deficiency of red cell mass interfere with postnatal cardio-respiratory adaptation. In high-risk premature infants, erythrocytes should be transfused when the venous haematocrit is below 0.459


Achalasia sicca--juvenile Sjögren's syndrome with achalasia and gastric hyposecretion.

Sjögren's syndrome (SS) in its classical form, which includes keratoconjunctivitis sicca, xerostomia and recurrent enlargement of the salivary glands, is associated with a connective tissue disease in at least half the patients. According to the present study of three patients with SS, achalasia and gastric hyposecretion seem to be either further manifestations of SS, or separate phenomena associated with SS. The gastric hyposecretion involves both the hydrochloric acid and the total volume of the secretion, but the gastric mucosa has a normal appearance on microscopy. Because of the simultaneous presence of achalasia, gastric hyposecretion and reduced salivation, we have called the combination "achalasia sicca". The reduction in the secretions of the upper gastrointestinal tract might have a pathogenic association with achalasia.


Influence of the phenylalanine dose on the aromatic acid excretion in phenylketonuric heterozygotes and controls after oral loading.

Heterozygotes for phenylketonuria and controls were given oral loads of 100 mg and 200 mg L-phenylalanine per kilogram body weight. The concentrations of urinary aromatic acids were determined by gas-chromatography after isolation by ion-exchange chromatography and ethylacetate extraction. On an intake of 100 mg L-phenylalanine per kilogram, controls and carriers of classical phenylketonuria excreted nearly the same amounts of aromatic acids (P greater than 0.05). However on an intake of 200 mg per kilogram L-phenylalanine they could be distinguished from one another (P less than 0.001).


Premature closure of the foramen ovale with levoatriocardinal vein.

Two cases of the hypoplastic left heart syndrome with premature closure of the foramen ovale and levoatriocardinal veins are described and the literature is reviewed. One of the patients is the only case with both mitral and aortic valve atresia. The other is associated with the asplenia syndrome, double-outlet right ventricle without ventricular septal defect, and an anomalous connection of the left atrium to the right auricle.


The syndromes of familial atrioventricular block with sinus bradycardia: prognostic indices, electrophysiologic and histopathologic correlates.

A family with adult onset heart block (AOHB) and sinus bradycardia (SB) was investigated 5 yr after previous study. A 44-yr-old female previously 'normal' presented ECG evidence of 1st-degree and 2nd-degree atrioventricular block (AVB) with normal intraventricular conduction and episodic 3rd-degree AVB. His bundle electrocardiography (HBE) demonstrated A--H prolongation (245msec) with normal H--V time during sinus rhythm and 3rd-degree AV nodal block with a His bundle escape rhythm. Sinus node function served in first-order relatives. HBE and sinus node function were normal in a 38-yr-old sister with new SB. 37 families with familial 3rd-degree AVB were reviewed with attention to prognostic indices and electrophysiologic-pathologic correlates. The incidence of conduction abnormalities supported an autosomal dominant transmission with variable penetrance. Subsidiary pacemaker rate and QRS morphology showed no discriminative value with respect to prognosis. HBS identified A--H prolongation in 2 patients with AOHB and 2 with AOHB and SB, with coexistent H--V conduction delay in 2 cases of AOHB and SB with abnormal QRS morphology. Histopathology was variable, but the finding of multiple lesions in 2 of 5 patients with congenital heart block and each of 2 with AOHB and SB suggests that mixed conduction system disease is prevalent in familial heart block.


Patients with intractable angina: free thyroxine index, immunoreactive insulin and free fatty acids in blood, free adrenaline and noradrenaline in urine.

The activity of adrenergic system, thyroid gland and blood levels of insulin and FFA were studied in 120 patients with intractable angina. Noradrenaline excretion was normal but that of adrenaline was augmented in a vast majority of patients and even doubled in 27% of cases. Free thyroxine index values were abnormally high in 22% of cases and inversely correlated with ergometric performance. A diabetic-like insulin response after 50.0 g oral glucose intake was found in 10 out of 26 examined patients. Abnormally high values of FFA were observed in 66%. The mechanisms likely to account for these alterations and their suspected influence on clinical course of intractable angina are discussed.


Mean electromechanical delta P/ delta t and systolic time intervals in coronary artery disease.

Mean electromechanical deltaP/deltat and systolic time intervals were measured in 30 patients with coronary artery disease. Total electromechanical systole (QS2), left ventricular ejection time (LVET) and preejection period (PEP) were measured and PEP/LVET calculated. Systolic time intervals were obtained noninvasively. Mean electromechanical deltaP/deltat was calculated by means of systemic diastolic blood pressure, pulmonary wedge pressure and PEP. Left ventricular ejection fraction (EF), pulmonary wedge pressure and stroke index were determined by catheterization and left ventriculography. PEP (r = -0.69) and PEP/LVET (r = -0.68) were better correlated to EF than mean electromechanical delatP/deltat (r = 0.63). Patients with previous myocardial infarction were found to have significantly longer PEP (P less than 0.02) and higher PEP/LVET (P less than 0.01) than patients without infarction. Neither of the methods showed significant differences between the groups of patients with 1-, 2- and 3-vessel disease. Although systolic time intervals cannot be used in predicting invasive measurements such as EF, the findings indicate that PEP and PEP/LVET may be useful supplement to clinical examination in evaluating left ventricular function in coronary artery disease.


Effects of nifedipine on creatine kinase release during myocardial ischemia in dogs.

25 anesthetized mongrel dogs underwent a left thoracotomy. Creatine kinase (CK) activity was measured in serial blood samples drawn simultaneously from the aorta and a coronary vein. The distribution of myocardial perfusion was determined by a continuous infusion of krypton-81m (half-life 13 sec) into the aortic sinuses. Heart rate and arterial blood pressure were also measured throughout the procedure. In 20 dogs regional myocardial ischemia was produced by ligation of a major branch of the left anterior descending coronary artery. Five of these dogs received 1 microgram.kg-1 nifedipine i.v. and a further 5 received 13 microgram.kg-1. Thoracotomy alone produced a slight rise in plasma CK activity but the arteriovenous difference (AV) across the segment of the heart remained positive over 5 h. Myocardial ischemia in the untreated dogs caused a considerable increase in CK activity and the AV difference became negative at 90 min. Treatment with the lower dose of nifedipine considerably reduced the plasma CK activity and the AV difference did not become negative until 3 h. Regional myocardial perfusion showed a significant improvement. Conversely, the higher dose of nifedipine produced a marked increase in the area of ischemia and an acceleration of CK release from the heart. This was associated with a decrease in arterial pressure and an increase in heart rate. These results show that nifedipine can be beneficial in experimental myocardial infarction but care must be taken to avoid hypotension and increases in heart rate.


Intravenous and oral practolol in the acute stages of myocardial infarction.

The influence of routine administration of the beta adrenoceptor blocking drug practolol on the outcome of acute myocardial infarction has been studied in 94 patients. The study was restricted to patients under the age of 70 experiencing their first myocardial infarction and in whom there was no contraindication to beta blockade. In the treated group an initial dose intravenous practolol 15 mg was followed by five oral doses of practolol 200 mg at 12 h intervals. A significant reduction in heart rate and systolic blood pressure was apparent in the treated group within 2 h. No difference was detectable in the course of the acute stage of the illness between treated and control patients, apart from a significant reduction in the incidence of atrial fibrillation among those receiving practolol. Patients with inferior infarctions showed a tendency to develop potentially harmful bradycardia and hypotension on receiving practolol which lead to withdrawal of the drug in many cases. At regular review over 7 mth no detectable difference emerged between the treated and control groups in the incidence of cardiac failure, death or reinfarction.


Atypical echocardiographic pattern of the posterior leaflet motion in mitral stenosis.

In 10% of cases of mitral stenosis the echocardiogram shows a normal backward movement of the posterior mitral leaflet. On the basis of a personal observation the authors suggest that this atypical pattern is related to the type (commissural) and degree (slight) of the valvular involvement.


Ileum-like congenital elongation of the proximal descending aorta.

A case of extraordinary congenital elongation of the proximal descending aorta giving origin to multiple aortic loops, packed in the left-postero-superior mediastinum, is presented. Clinical findings, that is, mid-late systolic ejection murmur, a delayed peak of the femoral pulse, blood pressure in the legs slightly lower than in the arms, were considered noncontributory from the diagnostic point of view, since they may also be present in mild aortic coarctation and in aortic kinking. Chest roentgenogram and fluoroscopy showing 2 pulsating masses protruding to the left of the proximal descending aorta suggested the presence of a more complex aortic malformation. Only angiography provided a correct diagnosis and detected some associated abnormalities as well.


Congenital apical aneurysm of the left ventricle: surgical removal in two infants.

The case histories are described of 2 infants, representing either type of congenital apical left ventricular aneurysm. Case 1 had a finger-like, pulsatile, actively contracting aneurysm which was associated with a split distal end of the sternum and a ventral hernia. In contrast to most of the 55--60 cases hitherto described, no other cardiovascular anomalies were detected at heart catheterization with angiocardiography. The aneurysm was resected at the age of 23 days. Postoperative angiocardiography demonstrated a normal-sized left ventricle with good contractions and no residual aneurysm. He was last seen at the age of 15 mth, doing well. Case 2 had a noncontractile aneurysm and congenital pyloric stenosis, which hitherto has not been found in association with this type of aneurysm in the about 20 reported cases. The aneurysm was resected at the age of 9 mth; the estimated reduction of the left ventricular cavity was 20%. 1 yr after operation the patient was doing well, but the chest roentgenogram was unchanged and at angiocardiography the left ventricular appearance was largely unchanged compared to the preoperative findings. He was last seen at the age of 2 yr, doing well. The long-term prognosis in the latter type of aneurysm has still to be elucidated.


The effect of drugs on enzyme release from the hypoxic myocardium.

The leakage of enzymes from the myocardial cell can be used as an index of the onset and severity of tissue damage. A study has been carried out using the isolated perfused hypoxic rat heart in which the ability of various doses of isoprenaline, dobutamine, propranolol, glucose, insulin, mannitol, adenosine triphosphate and hydrocortisone to increase or decrease myocardial enzyme leakage has been evaluated.


Anomalous origin of the right coronary artery from the main pulmonary artery.

A case of anomalous origin of the right coronary artery from the main pulmonary artery, in a previously asymptomatic young woman, is presented. Direct transposition into the aortic root of the anomalous vessel was performed. To our knowledge this is the 4th case of this malformation to be successfully corrected.


Chronic ventricular ectopic activity and sudden death.

The majority of deaths from coronary heart disease (CHD) occur before the victims receive medical attention. Chronic ventricular ectopic activity (VEA) is a well-established predictor of coronary mortality as well as sudden death. Evidence that chronic VEA is independently and causally related to sudden death, however, remains equivocal. Only more advanced grades of chronic VEA appear to be significant. Arrhythmias are clearly more common in patients with advanced coronary obstruction, and therefore prone to new ischemic events and their associated electrical disturbances. Autopsy studies are limited in their ability to identify an acute myocardial infarction in patients who die suddenly, but experience with the mobile coronary care units has reemphasized the role of acute ischemia. The prospective, randomized trial, including reliable assessment of VEA, offers the only definitive means of identifying the contribution of chronic VEA to the incidence of sudden death from CHD.


Use and abuse of electrocardiographic classification systems in epidemiologic studies.

An analytical study is performed to examine the utility of the Minnesota Code ECG classification for estimation of the prevalence and incidence of coronary and hypertensive heart disease. A statistical model is introduced which permits comparative analysis of the contribution of human coding errors to the overall fraction of misclassified records. It is demonstrated that the poor sensitivity and visual coding variability can seriously limit the usefulness and obscure the meaning of ECG coding results if the disease prevalence or annual event incidence is low. Gross over- or underestimation of prevalence and incidence data takes place frequently. Occasionally, reasonably good estimates are made on the basis of false evidence, for instance when false classifications 'compensate' for a high miss rate. Visual classification errors may contribute a substantial fraction to the overall misclassifications. It is pointed out that the traditional method of estimating classification errors by repeated coding of a given set of records gives a false impression of coding reliability. It is concluded that a substantial reduction of coding variation and an overall improvement of diagnostic accuracy will be required in order to justify continued use of ECG classification in population studies.


Multiple ventricular premature beats in five adolescents.

Multiple, short runs of repetitive ventricular premature beats are present in 5 adolescents. These premature beats are continually present, uniform, long and variably  coupled and occasionally fuse with sinus beats. This pattern is constant over several years and is associated with generally healthy individuals and otherwise normal hearts. Four of the subjects are completely asymptomatic without syncope or palpitations. The 5th case was asymptomatic for 2 yr until she died suddenly during sleep. Autopsy revealed a pathology of the specialized conduction system in the region of the AV junction. The distinctive pattern and characteristics of this arrhythmia suggest a congenital etiology and a mechanism different from other forms of ventricular ectopia. The single incident of sudden death indicates that this disorder is not benign.