Dizziness: surgical treatment.

The purpose of ths paper is to discuss the various surgical procedures which are available for the treatment of dizziness and vertigo. Special emphasis will be placed on the indications for these operations and the advantages of each. Dizziness is a common complaint of patients seen by general medical physicians and otolaryngologists. At the Otologic Medical Group in Los Angeles about one third of our new patients seek assistance because of dizziness. The etiologies of these various types of dizziness are multiple. It is not the intent of this paper to discuss the differential diagnosis or methods of evaluation. However, it is important to understand the various types of etiological factors as they are important in successful treatment.


The Health Science Institute: an experience in learning.

The Health Science Institute of Howard University was initiated during the summer of 1973 by students and faculty members in the Colleges of Liberal Arts and Pharmacy and Pharmacal Sciences to address one of the major problems related to the overall poor status of health-care delivery for residents of the nation's underserved areas-the critical health manpower shortage.


Splenic abscess in a tropical zone.

Abscess of the spleen is uncommon. The reported incidence varies widely and early observations of an association with tropical fevers are no longer evident. The pathogenesis is ill-understood and diagnosis is difficult and usually late. A careful clinical examination combined with the recent utilization of (99)Technitium scanning and splenic arteriography now permit early diagnosis. Splenectomy is the treatment of choice.


Service and teaching issues in an inner-city university-based psychiatry clinic.

The provision of quality out-patient psychiatric care to a predominately black inner-city population, in a University setting such as ours, is a complex and challenging task. This paper addresses service and teaching issues related to the provision of that care in the Adult Unit of the Howard University Hospital Mental Health Clinic. In this setting there is a mandate for clinical teaching and research as well, two vital components in the delivery of quality psychiatric service by knowledgeable and skilled health care providers.


Therapy for Asian Americans.

IN ORDER THAT ASIAN AMERICANS BE MORE ADEQUATELY PROVIDED WITH MENTAL HEALTH SERVICES, IT WILL BE NECESSARY TO: (1) have a thorough educational campaign over a long period of time to help Asians overcome their negative prejudices against mental illness, (2) devise culturally relevant diagnostic techniques, and (3) have treatment consonant with the cultural backgrounds of the patients and befitting the role expectations of the patients. It is likely that even with an excellent educational campaign, appropriate diagnoses, and culturally sensitive treatment methods, the first patients we will see will be those most seriously and chronically disturbed, probably when the family feels no longer able to cope with their psychotic behavior. We hope that subsequently, through the educational campaign and also through the outreach efforts of the Asian Mental Health Clinic, Asian Americans who are not psychotic but who want relief from psychosomatic symptoms, tension, depression, or help with family or marital problems will apply.


Diagnosis and management of early carcinoma of the endometrium.

Early (stage I) carcinoma of the endometrium is increasing in frequency. Outpatient diagnostic methods play a role in this increase. Prognostic factors such as histologic grade, uterine size, myometrial invasion, age, lymph node involvement, and cervical spread are important in determining five-year survival. Therapeutic options for early-stage disease are discussed.


Fibrous epulis: experience in clinical presentation and treatment of 39 cases.

The clinical features and treatment of 39 cases of fibrous epulis are described. Many of the epulides attained giant sizes before patients sought treatment. A few large or recurrent fibrous epulides were mistaken for malignant lesions, such as fibrosarcoma, Burkitt's lymphoma, or squamous cell carcinoma. Adequate excision and histological examination of all tissues excised were found to be the best management procedure for fibrous epulis.


Myocardial rupture in acute myocardial infarction: report of experience and review.

A review of eight cases of myocardial rupture following myocardial infarction confirmed the association of rupture with advanced age, a preponderance of females, hypertension, and physical exercise after infarction. In four patients, electrocardiograms recording the events of rupture showed further S-T elevation, supraventricular tachycardia, and conduction defects. One case of septal rupture showed increase in the amplitude of the P waves. The combination of these changes with sudden reappearance of chest pain, development or worsening of congestive cardiac failure with hypotension, and the appearance of a precordial systolic murmur should aid in the earlier diagnosis of this complication which may be amenable to surgery. Successful repair of rupture has been reported during the acute phase of infarction and after variable periods of delay.


Therapeutic group home care for adolescent girls: an interagency development.

In the District of Columbia, because of inappropriate placement resources, crisis units in mental health centers are keeping children long after treatment evaluation has taken place. It was thought that disturbed adolescents might be served in a small family-type setting with live-in house parents, direct clinical services, and back-up from the mental health center.This paper discusses an attempt to provide services to some disturbed adolescents in an interagency therapeutic group home. The study experience is limited, but the design of the program and the problems encountered may be of some value to health and child care agencies.


Nutritional programming for the elderly.

It is impossible to talk about nutrition and the elderly without reviewing related factors such as program funding levels, income and purchasing power, education, medical implications, and resulting social costs.Although we have witnessed a tremendous increase in federal appropriations for Title VII programs, many senior citizens have not and will not benefit from nutrition programs. As the ratio of elderly citizens to total population increases, we may expect: (1) an increase in program budgets with a concomitant decrease in the proportion of senior citizens served; and (2) a regressed government attitude toward income-related support programs, causing decreased purchasing power, ineffective nutrition programs, and little relative improvement in the health of our elderly population.


Hidradenitis suppurativa: a closer look.

The following is a review of the literature concerning hidradenitis suppurativa with emphasis on aspects of this disease which suggest that it may be a result of altered host-defense mechanisms.Deep fistula formation, anemia, and the development of carcinoma are complications seen only in disease affecting the perianal area. The term perianal is used loosely to describe the buttock, perineum, pubic, and genital areas.A variety of treatment regimens has been used with limited success. Surgery has evolved as the treatment of choice for advanced and chronic disease.


Neonatal meningitis due to Enterobacter cloacae.

Enterobacter species, in recent years, have been divided into E aerogenes, E hafniae, E liquefaciens, and E cloacae. Early reviews of neonatal meningitis include some cases due to Klebsiella-Aerobacter,(1) and recent reviews(2,3) include Enterobacter which did not divide them into species of Enterobacter. Reported here is a case of neonatal meningitis due to a gram-negative organism, Enterobacter cloacae.


Surgical treatment of keloids secondary to ear piercing.

Keloids are medically benign, but often psychologically and cosmetically malignant lesions. They are most commonly located on the posterior aspect of the ear lobes. The author's treatment of choice is the combined intralesional steroid and surgical approach. Surgically, the best results are obtained when some of the skin overlying the keloid is used as a split thickness graft after all of the keloidal tissue has been removed. Explicit postoperative wound care instructions are important in insuring complication-free surgery.


On the subject of caring for and caring about patients.

Recognition of the growing familiarity on the part of physicians in approaching patients is presented with discussion of alternative approaches to establishing rapport and, at the same time, respecting the rights and preserving the dignity of the patient.


Preliminary clinical experience with intraoperative radiotherapy.

Intraoperative radiotherapy is the term applied to the irradiation of unresectable tumors, partially resectable tumors, and regional lymph nodes with external beam radiation at the time of surgical exposure. Since only one treatment is given at the time of surgery, one should consider the intraoperative technique as "boost" therapy which may allow us to raise the conventional external beam dose to the tumor by 50 to 100 percent. At Howard University Hospital and Cancer Research Center, seven advanced-stage cancer patients have been treated since 1976 with single doses of electron beam irradiation in the range of 1,300 to 2,000 rad. The preliminary evaluation of these patients has shown no serious acute radiation reactions.


Benign esophageal stricture in a tropical African population.

In North America, the most common causes of benign esophageal stricture are hiatal hernia and reflux esophagitis. These are localized to the lower end of the esophagus.At the University College Hospital, Ibadan, Nigeria, the most common cause of benign esophageal stricture is ingestion of corrosives. The ingestion is accidental, suicidal, or for medicinal purposes. This stricture is long, narrow, and irregular. Most extend from the cervical esophagus to the cardioesophageal junction.A surgical procedure that has given good results is the use of left colon pedicled on the left colic artery for retrosternal isoperistaltic esophagocoloplasty.


Alternative pathway activation in sickle cell disease and beta-thalassemia major.

Total hemolytic complement activity (CH50), immuno-electrophoretic conversion of Factor B (C3PA), and of C3 were studied in 16 patients with sickle cell disease in a steady state, eight patients in crisis, and ten patients with β-thalassemia major anemia maintained on a constant transfusion regimen. Patients with sickle cell disease in a steady state have moderatley 56 (percent) depressed conversion of Factor B in addition to markedly decreased conversion of C3 in four of ten patients. One of the three sickle cell patients and two of the four thalassemia patients with low C3 conversion levels have died subsequent to the studies. The combination of chronically decreased Factor B conversion in the face of markedly decreased C3 conversion may make these patients occasionally vulnerable to overwhelming infection analagous to the situation seen in postsplenectomy cases.


Rotation technique for superficial total body electron beam irradiation.

Low megavoltage electrons, because of their limited penetration, have been found very useful in the treatment of generalized superficial malignancies. However, because of the complexity of the human body contour, it is extremely difficult to achieve uniform dose distribution over the entire body surface. To achieve this, various techniques ranging from two to six fields have been used. In this paper, we discuss the disadvantages of these techniques and describe a new technique, "the rotation technique," which is superior.


Measurement of diastolic events by apexcardiogram: correlation with hemodynamic state and prognosis after myocardial infarction.

Apexcardiograms and hemodynamic studies were performed in 32 postmyocardial infarction patients. Group 1 patients (5) had markedly elevated left ventricular end diastolic (LVED) pressures but normal LVED volumes; apexcardiograms included tall A waves (31 percent of the E to O points), prolonged A-wave durations of 134 msec or greater, short rapid filling wave durations (55 msec) and slow-filling waves replaced by plateaus in three patients. Group 2 patients (10) had markedly elevated LVED pressures and elevated LVED volumes, and had similar apexcardiographic findings: A-wave heights had a mean of 23.4 percent of E to O points, A-wave durations were 113 msec or more, rapid filling wave (RFW) durations were 93 msec and diastolic plateaus occurred in five patients. Group 3 patients (11) had intermediate hemodynamic findings and the apexcardiograms were varied; three patients with mild congestive heart failure (CHF) had apexcardiograms similar to Group 1 and five without CHF had apexcardiograms similar to those in Group 4. Group 4 patients (6) had normal hemodynamic findings; the mean A-wave height was 6 percent of the E to O point height, A-wave durations 90 msec or less RFW durations were 117.5 msec or more and the slow-filling wave duration (SFW) was normal in the configuration. Fourteen of 15 patients in Groups 1 and 2 developed CHF and six died on follow-up. Group 4 patients showed no evidence of CHF on follow-up and there were no deaths. Group differences were significantly different for A-wave height and duration, and for RFW duration at 0.05 or 0.01.Tall prolonged A waves and short RFWs were associated with poor left ventricular (LV) compliance and dysfunction, and diastolic plateau immediately following the RFW when present were confirmatory. Thus, the apexcardiogram is a reproducible useful noninvasive tool for clinical assessment, and predicting prognosis in postmyocardial infarction patients.


Becoming an independent Community Mental Health Center: perils of the process.

Over the past 12 years, since the inception of the Community Mental Health Center (CMHC) movement, there has been increasing concern that local communities have more input; in fact, that they actually have the opportunity to operate the mental health programs that they deem necessary for their communities.(1)Under the Amendments to the Community Mental Health Act (P.L.94-63) 1975, CMHCs were given such options as independence or governance. The whole process of governance presents numerous problems as well as opportunities. An overview of the vicissitudes of this process is presented in this paper.


Constipation.

Constipation pervades our society. It is associated with emotional stress, lack of dietary fiber, and ignorance. Laxative stimulants, bulk forming agents, stool softeners, and osmotic cathartics may all be needed to treat endstage constipation initially, but "weaning" should be possible in most cases. Endstage constipation, in rare cases, can be life threatening due to urinary tract or colonic obstruction or perforation.


Physical examinations in inner-city preschools.

This paper describes the physical examination program started in March 1974 and carried out by the Anacostia Headstart Program in Washington DC. Annual totals of 362, 274, and 458 preschool children were examined in 16 schools during the 1973-1974, 1974-1975, and 1975-1976 school years, respectively. For these years, 8, 9, and 12 percent, respectively, had heart murmurs. The rates for abdominal hernias were higher, 11, 17, and 16 percent, respectively. Eczema was also a common problem. Parents had easy access to counseling from health professionals who worked in the program.


The effectiveness of sickle cell education in New York City public elementary schools.

The present study attempts to ascertain the effectiveness of the health education component of the Queens Hospital Center Sickle Cell Education & Screening Program. The study is limited to children in grades four through six in the New York City public school system. Such elementary school students, representing a large segment of the population, are easily accessible and can be effectively educated about sickle cell disease. The findings indicate that professional sickle cell educators can successfully teach young children about the disease and can do so more effectively than the average schoolteacher.


Liver cirrhosis, tobacco, alcohol, and cancer among blacks.

Attributes of age, tobacco use, and alcohol consumption were studied in order to elucidate their roles in the increased risks of blacks for selected neoplasms. Black cancer patients with and without liver cirrhosis were compared by cancer sites, age, tobacco usage, and alcohol consumption. Subsequently, non-cirrhotic blacks and whites with cancer were characterized on the same variables.Black males with cancer and liver cirrhosis, when compared with similar males without liver cirrhosis, were significantly younger and had more than triple the frequencies of esophageal and hepatic cancers but less than one fourth the frequencies of gastric and prostatic cancers. Cirrhotic patients were rarely nondrinkers but drank whiskey excessively. Noncirrhotic blacks, when compared with noncirrhotic whites, had very high risks of liver, stomach, and prostate cancers and smoked less heavily but drank significantly more whiskey. Hence, factors associated with patterns of smoking cigarettes and drinking, especially whiskey, if not these habits themselves, are probably related to the increased risks of blacks for stomach and liver cancers when compared with non-cirrhotic whites and for esophageal and hepatic cancers when compared with non-cirrhotic blacks.


Gray areas in forensic psychiatry.

The field of forensic psychiatry is not always compatible with legalities in our court system, causing some cases to be in a "gray" area. A case is presented, demonstrating shortcomings of the M'Naghten rule, which is meant to protect the mentally ill person from being incarcerated when he is not aware of the nature or the seriousness of the crime of which he stands accused. However, this rule is not applicable when there is awareness, even if the patient is laboring under a delusional system. In the case to be considered, the individual suffers by being given a criminal record instead of being found not guilty by reason of insanity, although the end result is the same.The author feels there should be a much broader interpretation of the M'Naghten rule to encompass the full intent of protecting the mentally ill person but to exclude the sociopath and those with character disorders. The Durham rule is not workable because of this inclusion.


Synchronous cancer of the colon: a case for more definitive resection in colon cancer.

Carcinoma of the colon is reported to be the most common visceral cancer today in the United States, second only to cancer of the lung as a cause of cancer-related mortality. Three consecutive cases of multiple primary colon cancers-synchronous carcinoma, two of which were additionally associated with colonic polyps, prompted a review of the literature as it related to synchronous colon cancer. The incidence of this phenomenon seems to be in the range of three percent of colon cancers. These patients tend to have a higher than usual incidence of associated polyps and of metachronous colon cancer. Inasmuch as the colons of these patients have a clear proclivity to neoplastic transformation and recurrence, subtotal colectomy as the initial curative colon procedure is practiced. This diagnosis is more often made in retrospect. It would seem that subtotal colectomy should be the initial curative procedure for any cancer of the large bowel proximal to the rectum in otherwise healthy patients less than 60 years of age.


Health care professionals: a model for teaching the components of society-culture-personality in the delivery of care.

In recent years, the behavioral sciences have contributed tremendously tot he education of future physicians, dentists, nurses, and other health care professionals. With the inclusion of the behavioral sciences component in the National Board Examination (1972), many medical schools have revised their curricula to include sociology in the training of the future physician. However, the tremendous shortage of qualified social scientists made it difficult to meet the needs of medical schools and health programs in the country.In view of this problem, this paper will present a single conceptual model that can be used as an organizational device for teaching some basic social science concepts to health care students and to assist them in the comprehension of the impact of society-culture-personality (SCP) on the health care institution as a whole. Uses of this model have been presented elsewhere.(1,2)


Transplacental transfer of Bancroftian filariasis.

A pregnant patient with Bancroftian filariasis and documented evidence of transplacental transfer of the larvae is the basis of this report.


The stroke area: feasibility of adoption in community hospitals.

Pioneering efforts to establish what are known as stroke areas in community hospitals were made primarily by Dr Charles Bonner at Youville Hospital in Cambridge, Massachusetts, and Dr. Bertram Howard at St. Luke's Hospital in New Bedford, Massachusetts during the early 1960s. Analysis of comparative data collected in subsequent years from 15 or more hospitals that followed their lead suggests that the stroke unit concept has become recognized as a medically sound approach to the management of stroke victims toward enhancing, rather than simply trying to save lives.


Intra-arterial knotted catheter.

Although cerebral arteriography is commonly employed as a diagnostic radiologic procedure its use is not entirely innocuous. Beside the usual complications of an invasive technique the retention of a knotted distal flexible catheter tip may be encountered. This report presents a case in which this occurred with subsequent extraction by way of incision of the femoral artery.


Demonstration of pericardial effusion by real-time ultrasonography.

Pericardial effusion has a variety of causes. Among these, inflammatory processes are the most common. Traditionally x-rays, isotopic scanning, carbon dioxide injection, and M-mode echocardiography have been used for evaluation of pericardial effusion. The most recent advance in real time scanning enables the examiner to more completely and more accurately evaluate and serially investigate pericardial effusions through a noninvasive technique.


Pattern of thoracic surgical diseases in Nigeria: experience at the University College Hospital, Ibadan.

A prospective study of 595 patients treated by the Thoracic Surgical Unit (TSU) at the University College Hospital (UCH), Ibadan between July 1975 and December 1977 was carried out to determine the pattern of thoracic surgical diseases in Nigeria and to prove or disprove the rarity of certain cardiopulmonary diseases in tropical Africa. This review shows that pyogenic infections of the lung and pleura constitute the largest percentage (38.5) of the thoracic surgical diseases in Nigeria. Although pulmonary tuberculosis accounts for only 23.4 percent of our total inpatient load, it constitutes about 60 percent of our outpatient clinic practice. Cardiovascular diseases form 12.9 percent, notably congenital and acquired valvular heart diseases. An interesting finding was the occasional association of pyomyositis with pyogenic pericarditis and empyema thoracis. This triad is being investigated. Chest trauma was the most common thoracic surgical emergency accounting for 9.2 percent of the total thoracic surgical pathology. The most common causes of dysphagia are strictures from corrosive esophagitis, achalasia, and carcinoma of the esophagus. Present experience confirms the rarity of hiatus hernia, reflux esophagitis, atherosclerotic cardiovascular disease, and, perhaps, carcinoma of the lung among Nigerians.


Immunologic defect of the alternate pathway-of-complement activation postsplenectomy: a possible relation between splenectomy and infection.

Total hemolytic complement (CH50) and activation of the alternate mechanism were measured in eight patients before and after splenectomy and compared to similar measurements made in a control group of patients following other abdominal surgery. In the splenectomy group, alternate-pathway-mediated activation of C3 was significantly different from the controls. The mean five-day postsplenectomy value of 16 percent for the immunoelectrophoretic conversion of C3 to C3i was depressed (p<0.001) from the presplenectomy value of 85 percent and five-month postsplenectomy level of 71 percent (p<0.01). The difference between presplenectomy and five-month postsplenectomy values was not significant. Further, activation of C3 in patients five days postsplenectomy was significantly less (p<0.01) than in the five-day postoperative controls. In both the splenectomized patients and control group, five-day postoperative determinations indicated an increase in CH50 values and a decrease in degree of activation of Factor B. The spleen appears to manufacture certain substances required for activation of C3 via the alternate mechanism. That the manufacture is eventually assumed by other immune-competent organs is shown by the eventual increase of activation toward preoperative levels five months postsplenectomy. This defect in C3 activation may account for the tendency of splenectomized patients to have an increased incidence of bacterial infections and sepsis in the postoperative period.


Evaluation and treatment of patients with impotence.

Impotence is a common problem of adult males. Thorough history from both partners, physical examination, and laboratory work uncover a small minority who are suffering from an organic cause. The majority of such patients have a psychological basis for the condition. In the absence of demonstrated organic disease, psychiatric consultation is indicated. Surgery is helpful in erectile impotence.


Marijuana and the adolescent.

Growing marijuana use among young people, among teenagers in particular, poses serious problems that involve parents, society, law enforcement agencies, legislators, and health care professionals. This paper discusses the multifaceted problems surrounding marijuana use and suggests possible solutions.


Teenage pregnancy, a national disaster: a significant factor in black teenage unemployment.

Pregnancy is an unfortunate event in the life of preteen and teenagers. Yet, it is occurring with increasing frequency among children between the ages of 12 and 16. The magnitude of this growing problem is so great it demands the assistance of all segments of society to find a solution.While it is true that pregnancy is often a social, economic, and psychological burden to the young mother, the outlook for the baby may be even more bleak. Homes and schools are not meeting the needs for rearing and training these unplanned progeny to become productive citizens. Already, some of them are entering the labor market with few, if any, marketable skills.Preventive measures seem to offer the best prospects for dealing with this human dilemma. Since the majority of the unwed teens under discussion are black, the black physician must apply his talents and resources to finding a workable solution.


The relationship between sepsis and disseminated intravascular coagulation.

As the initial problems of trauma have been resolved, patients may survive the immediate period following critical injury only to succumb later to the effects of sepsis. We previously noted a correlation between multiple organ failure and intravascular clotting. The present study evaluated the incidence of infection complications following proven disseminated intravascular coagulation. Detailed analysis of multiple clotting factor changes following critical surgical illness (Factors I, II, V, VIII, IX, X, XI, and platelets, fibrin degradation products and plasminogen) were carried out prospectively in 48 patients. Twenty-one of the 48 were classified as having a severe degree of intravascular coagulation on the basis of hematologic evidence. Only one survived without evidence of infection; 16 showed changes consistent with a moderate degree of intravascular coagulation, and ten subsequently developed evidence of infection. Of the 11 patients with minimal evidence of intravascular coagulation, infection developed in only one.


A method for comparing survival of burn patients to a standard survival curve.

A method is presented which enables individual institutions to compare their patient survival rates to a standard survival curve. The method can be used for survival following any sort of trauma, here illustrated for survival of burned patients. The only requirements is that a standard survival curve be available which gives predicted probabilities of survival for each patient. The procedure is simple and can be easily computed with a small calculator. It requires fewer patients than does a corresponding Chi-square test, and can be used with as few as 30 patients. The power for a specified alternative can be calculated. Detailed examples are given applying the procedure to a randomly selected set of 50 patients from the National Burn Information Exchange registry, Ann Arbor, Michigan.


Myocardial contusion: effect of intra-aortic balloon counterpulsation on cardiac output.

Intra-aortic balloon counterpulsation (IABCP) improves impaired left ventricular (LV) performance associated with myocardial ischemia. We have evaluated the effect of IABCP on cardiac output (CO) after blunt trauma to the heart where LV performance is impaired by myocardial contusion but coronary blood flow is normal. Contusion of 20 to 40% of the LV in 13 dogs decreased CO by 41% +/- 6.4. A 30-minute period of IABCP was followed by 30 minutes without IABCP with three assist periods in each animal unless death occurred. Immediate IABCP after injury in six dogs increased CO 14% +/- 3.8 (p less than 0.01). Treatment was delayed for 30 minutes in seven dogs, and CO further decreased 0.7% +/- 3.2; initiation of IABCP then increased CO 9.2% +/- 6.5 (p less than 0.05). When CO was decreased less than 25% or greater than 50% after injury, IABCP had no effect on CO. In midrange when CO decreased 25 to 50%, IABCP increased CO 12.5% +/- 3.2 (p less than 0.001 initially, 9.3% +/- 1.3 (p less than 0.005) with second assist, and third assist 5.6% +/- 2(NS). It is concluded that IABCP improves LV performance following myocardial contusion, especially when applied early after injury.


An operative repair of acromioclavicular separation.

Sixteen patients underwent an open reduction for complete acromioclavicular separation with a loop of woven Dacron arterial graft. This technique of internal fixation permits an early range of shoulder motion and eliminates the need for a second procedure to remove wire or pins. Experience in vascular reconstruction suggests that fibroblastic ingrowth might occur to substitute for the disrupted ligament complex. All but two of the 16 patients showed excellent results: full restoration of shoulder function, satisfactory cosmesis, and complete relief of pain. One required reoperation for an improperly placed loop, and one had definite over-reduction of the clavicle on the acromion but remained asymptomatic. In several, X-rays showed evidence of pressure resorption and periosteal new-bone formation along the clavicle at the site of the loop, but no loss of fixation. This approach was used successfully in acute trauma and as late as one year following injury.


Doppler ultrasound and digital plethysmography to determine the need for sympathetic blockade after frostbite.

Thirty patients seen following frostbite injury during a 2-week period were treated with rapid rewarming in a saline bath. Vascular laboratory evaluations including digital plethysmograms and Doppler ultrasound mapping of digital vessels and distal palmar and pedal arches revealed three general degrees of vascular response to cold injury after rewarming. The most common, the hyperdynamic response, implying patent digital vessels, was often clinically apparent, with warm, red digits. Regional sympathectomy may be troublesome in these patients. Patients without a hyperdynamic response, including those whose Doppler and plethysmographic examinations were within normal limits for noncold exposed individuals, had evidence of vascular compromise at the digital level and benefited from regional sympathectomy with intra-arterial reserpine.


Urinary tract abnormalities presenting as a result of blunt abdominal trauma.

Fourteen patients with unsuspected urinary tract abnormalities had their disorders diagnosed at the time of their evaluation for blunt abdominal trauma. The trauma was generally inconsequential but all of the patients had gross or microscopic hematuria. The diagnosis could be made by intravenous pyelography or physical examination in all of these patients, although in some patients the abnormality was not evident until the patient had an arteriogram. These disorders are usually detected in children, but 12 of our 14 patients were 19 years of age or older. The importance of the urogram for all patients with hematuria and minor abdominal trauma is emphasized by this group of patients.


Hemorrhagic shock treatment with hot intravenous fluid in dogs.

In hot climates, only high temperature fluids (are greater than 100 F) may be available for treatment of blood loss shock in combat casualties. Can the hot fluid be used safely and effectively? We compared hot Ringer's lactate (51.7% C/125 F) resuscitation (n=10) to body-temperature (100 F) fluid resuscitation (n=10) in a hemorrhagic shock dog model. One liter of 125 F fluid, as part of the resuscitation, did not cause hyperthermia, red blood cell hemolysis, or any significantly different response in the cardiovascular system when compared to body-temperature fluid. All animals in both groups survived. These findings suggest that battlefield use of hot fluids in controlled amounts can be safe and effective for treatment of blood loss shock in human combat casualties.


A preliminary report on the spray application of topical silver sulfadiazine to burn wounds.

A simple, flexible system for spray application of topical antimicrobials has been developed in the Burn Unit at Hennepin County Medical Center. In contrast to previous attempts, this method allows spray application of silver sulfadiazine without dilution. Because of the viscosity of the micronized cream, aerosol spread is minimal. Inexpensive commercially available components are used without modification. This system can be readily adapted to most hospital situations and provides rapid topical antimicrobial application. Time required for dressing changes has been reduced in our Burn Unit by 75% and fewer nursing personnel are required. Spray application avoids direct physical contact with burn wounds, eliminating potential contamination and greatly reducing pain associated with dressing changes. Patient acceptance is high.


Methylmethacrylate as an adjunct in the internal fixation of intertrochanteric fractures of the femur.

Twenty-eight unstable four-part intertrochanteric fractures in 27 elderly patients with severely osteoporotic femurs were treated by means of internal fixation (commonly the 130 or 95 A.O. blade plate) in combination with methylmethacrylate. Of the 28, ten patients with eleven fractures were recalled and reexamined; 12 had died; five were lost to followup (1 1/2-8 1/2 years) at the time of this review but sufficient documentation existed for their inclusion. There were no deep wound infections. We did not encounter any hypotension during surgery or as a result of the methylmethacrylate. One patient developed a pulmonary embolus 5 days postoperation and responded well to anticoagulant therapy. There were three failures; one femoral shaft fracture at the plate end, one nonunion, both requiring total hip replacemens, and the third failure was due to malreduction of fracture and was later revised. Where bone fragments were in contact, union occurred rapidly and the presence of cement did not interfere with bone union in any way. The patients were pain free and began full weight bearing the day after surgery.


Injuries caused by seatbelts in stationary vehicles.

A new injury caused by seatbelts in the legs of automobile passengers in stationary cars not involved in accidents is described. The authors have treated 11 such injuries since 1974 in Hungary. Prevention of this injury by educating passengers to replace seatbelts before leaving their cars is recommended.


Microsurgical vascular anastomosis for traumatic middle cerebral artery occlusion.

A unique case is reported in which extracranial to intracranial arterial anastomosis was used to treat persisting traumatic middle cerebral artery occlusion. The rationale and indications for use of cerebral revascularization are discussed. Trauma surgeons are encouraged to consider extracranial to intracranial anastomosis in patients with cerebrovascular occlusion inappropriate for operations in the neck.


Claw hammer technique for extraction of knives.

A knife deeply imbedded in a patient's shoulder could not be pulled out easily before post-withdrawal angiographic study. The claw of a hammer was placed beneath the hilt of the knife for additional leverage, and the weapon was thereupon successfully removed. The advantage of a post-withdrawal angiogram to assess the degree of extravasation is stressed.


Traumatic intrapericardial rupture of the diaphragm.

A 60 year-old woman sustained an intrapericardial rupture of the diaphragm with herniation of a loop of transverse colon into the pericardium. There are ten previous reports of this condition. Reduction of the hernia and repair of the defect were readily accomplished through an upper midline abdominal incision.


Acute uraemic encephalopathy in tropical countries.

This is a prospective study on 24 patients with chronic renal failure. Thirteen of them had evidence of acute uraemic encephalopathy. Of those 9 patients were found to have dilutional hyponatraemia, two patients severe salt and water depletion and one patient septicaemia. Hyponatraemia was associated with pulmonary oedema in 3 patients. Correction of salt and water disturbances and treatment of heart failure improved cerebral functions in 10 (77%) patients. It is therefore concluded that dilutional hyponatraemia probably leading to cerebral oedema is a reversibe major factor in the development of acute uraemic encephalopathy. This, if left uncorrected, may prove fatal especially in tropical countries.


Hycanthone therapy in selected patients with S. mansoni and S. haematobium infections in the Sudan.

The results of a clinical trial of hycanthone in 601 selected Sudanese patients with S. mansoni and S. haematobium infections are reported. Hycanthone was given as a single intramuscular injection at a dose of 3.0 mg per kilogramme body weight. The commonest side effects were nausea and vomiting which occurred in 35 per cent and 32 per cent respectively. No incidence of acute hepatic damage and no deaths were encountered. About one third of patients reported for follow-up. Cure rate for S. mansoni was 90 per cent at 6 weeks of treatment and 97 per cent at three months and six months, while for S. haematobium infection it was 82 per cent at 6 weeks and 91 per cent at 3 months and 6 months. A significant reduction in egg excretion was achieved in those who were not cured.


Hypogammaglobulinaemic sprue in tropics: Report of an Indian patient.

Acquired hypogammaglobulinaemia is a rare disease and has not been reported from tropical regions before. A fourteen year old boy, who had symptoms of intestinal malabsorption since the age of seven years, was investigated and found to be suffering from severe hypogammaglobulinaemic sprue which ended fatally. The problems in diagnosis and management of this rare disorder have been highlighted.


Lassa fever--an autopsy report from the eastern part of Nigeria.

Autopsy findings of a case of Lassa fever from the Eastern part of Nigeria are presented. The authors suggest that in Lassa fever there is an involvement of the brain in the nature of encephalitis.


Diarrhoea, constipation and intestinal transit in a northern Nigerian population.

Healthy Nigerians from Zaria have a short intestinal transit time. It is usual for them to open their bowels daily and their concept of diarrhoea and constipation differs widely from the standard medical definition. To avoid confusion care must be taken to inquire exactly what patients mean when they present with these symptoms.


Serological evidence for the presence of antibodies to Salmonella typhi among slaughtered pigs, goats and sheep.

A serological search for healthy carriers of S. typhi was undertaken among regularly slaughtered pigs, goats and sheep. Serum samples from 49 pigs, 40 goats and 35 sheep were tested for the presence of antibodies to S. typhi by the tube agglutination (TAG) and indirect haemagglutination (IHA) methods. Of the 49 pig sera screened, a total number of 39 cases were positive, of which 27 were positive by both IHA and TAG methods, and 12 one test only. Twenty-two of the pig sera but none of the sheep and goat sera were positive at higher titre. These findings suggest that pigs may harbour S. typhi and may act as carriers in transmitting infection to man.


Typhoid fever manifesting with haematemesis, hepatitis and haemolysis.

A patient with documented typhoid fever had several uncommon manifestations. These included (1) haematemesis as the presenting feature, (2) hepatocellular jaundice with hepatic encephalopathy, (3) acute intravascular haemolysis and (4) probable disseminated intravascular coagulation. Haematemesis as the presenting feature in typhoid fever has not been reported previously.


Blood pressures of South African black schoolchildren aged 10--12 years.

In South Africa, in urban but not rural areas, hypertension in Black adults is commoner than in local White adults. To throw light on this situation, blood pressures have been determined in series of South African Blacks, initially on children aged 10--12 years, in rural and urban areas. Mean data are among the lowest recorded. They are lower (p less than 0.01) in the main than those of Black children in U.S.A. Neither levels of salt nor sugar intakes appeared influential. Evidently, noxious factors promotive of hypertension in urban Black adults are not yet in operation in children.


Seven complementation groups of respiratory syncytial virus temperature-sensitive mutants.

Fifteen temperature-sensitive mutants of the RSN-2 strain of respiratory syncytial virus have been classified into six complementation groups, two of which appeared to be homologous with two of the three complementation groups of the A2 strain described by Wright et al. (P. F. Wright, M. A. Gharpure, D. S. Hodes, and R. M. Chanock, Arch. Gesamte Virusforsch, 41:238--247). Thus seven complementation groups of respiratory syncytial virus, designated A, B, C, D, E, F, and G, have been defined. The frequency and type of mutant isolated varied according to strain; group C was unique to the A2 strain, and groups D, E, F, and G were unique to the RSN-2 strain. The highest complementation indexes were obtained by preincubation for 7 h at permissive temperature, followed by incubation at restrictive temperature for 40 to 50 h in the case of A2 strain mutants or 80 to 90 h for RSN-2 strain mutants. Genetic recombination was not detected.


Genetic characterization of Mu-like bacteriophage D108.

Infection of Escherichia coli by bacteriophage D108 was shown to result in the generation of apparently random chromosomal mutations. Approximately 1% of the cells lysogenized by D108, as with Mu, acquired new auxotrophic mutations. D108-induced mutations were nonreverting and were most probably the result of insertion of the D108 genome into regions of genetic function. D108 and Mu shared many similar properties but were heteroimmune and had different host ranges. Lytic infections of Mu lysogens with D108 and D108 lysogens with Mu resulted in 100-fold increases in release of phage with prophage markers over those due to spontaneous induction. Phenotypic mixing was common, with most phage carrying the prophage immunity being packaged in particles with the host range of the superinfecting phage. A fraction of the superinfecting phage genomes were, however, packaged in particles with the prophage-specified host range. Although 10% of the prophage progeny were D108-Mu genetic hybrids, superinfecting phage-induced release of the prophage with reciprocal phenotypic mixing occurred in recA hosts, in which the frequency of D108-Mu genetic hybrids was reduced 100-fold.


Structural studies on Rauscher murine leukemia virus: isolation and characterization of viral envelopes.

A preparative method for isolating pure viral envelopes from a type-C RNA tumor virus, Rauscher murine leukemia virus, is described. Fractionation of virions of Rauscher murine leukemia virus was studied after disruption of the virions with the detergents sodium dodecyl sulfate of Nonidet P-40 in combination with ether. Fractionation was performed through flotation in a discontinuous sucrose gradient and, as appeared from electron microscopic examination, a pure viral envelope fraction was obtained in this way. By use of sensitive competition radioimmunoassays or sodium dodecyl sulfate-polyacrylamide gel electrophoresis after immunoprecipitation with polyvalent and monospecific antisera directed against Rauscher murine leukemia virus proteins, the amount of the gag and env gene-encoded structural polypeptides in the virions and the isolated envelope fraction was compared. The predominant viral structural polypeptides in the purified envelope fraction were the env gene-encoded polypeptides gp70, p15(E), and p12(E), whereas, except for p15, there was only a relatively small amount of the gag gene-encoded structural polypeptides in this fraction.


Evolution of bacteriophage phi X174. IV. Restriction enzyme cleavage map of St-1.

The St-1 genome is about 6,050 base pairs in size, approximately 10% larger than phiX174 (5,375 base pairs). The DNA fragments obtained by HincII, HaeIII, and EcoRI digestion were ordered and aligned into a colinear map, and the single BglI cleavage site was located.


Evolution of bacteriophage phi C174. V. Alignment of the phi X174, G4, and St-1 restriction enzyme cleavage maps.

The restriciton enzyme cleavage maps of bacteriophage phiS174, G4, and St-1 were aligned by two-dimensional filter hybridization. These studies show that the basic genome structure of phiX174 is conserved in the other two bacteriophage. However, the data also suggest the existence of regions of nonhomology.


Gene expression and stability of mRNA affected by DNA-arrested synthesis in gene 59, 46, and 47 mutants of bacteriophage T4.

The effect of bacteriophage T4 gene 59 mutations (DNA-arrested synthesis) on kinetics of DNA synthesis, gene expression, and stability of mRNA has been studied. When Escherichia coli B was infected by a T4 gene 59 mutant, DNA synthesis proceeded to increase linearly after initiation, but started to decrease at 8 min and was completely arrested at 12 min at 37 degrees C. At various incubation temperatures (20 to 42 degrees C), the initial rates and times of arrest of DNA synthesis were different, but the total amount of DNA synthesized was constant. This result supports the hypothesis that function of gene 59 is required for the conversion of 63S DNA molecules to other replicative intermediates (39). The abnormality in protein synthesis caused by gene 59 mutation is manifested by (i) a delayed shutoff in the expression of early proteins (gene 43, 46, 39, 52, 63, 42-45, and some unidentified proteins), (ii) a reduced rate of late gene expression (gene 34, 37, 18, 20, 23, wac, 24, 22, 38, and 19), and (iii) an absence of cleavage of certain late proteins (23, 24, IPIII and 22 to 23(*), 24(*), IPIII(*), and small fragments). It appears that there was no effect on the expression of gene 33, 55, and 32 by a mutation in gene 59. Results obtained from an addition of rifampin at the prereplicative cycle after infection indicated that mRNA from genes 43, rIIA, 46, 39, 52, and 63 are more stable in T4amC5 (gene 59) than in wild-type-infected cells. mRNA remained functional longer in mutant-infected cells, and this may explain the prolonged synthesis of certain early proteins. The gene expression of other DNA arrested mutants-those in genes 46 and 47-showed a pattern of abnormal protein synthesis similar to that found in gene 59 mutant-infected cells, except more late proteins are synthesized. The gene expression in terms of phage DNA structure is discussed.


Sporulation-converting bacteriophages for Bacillus pumilus.

Thirty-three sporulation-converting bacteriophages for Bacillus pumilus NRS576 were assigned to two apparently unrelated groups on the basis of morphology and antiserum neutralization. Bacterial sporulation mutants responded similarly (conversion or nonconversion) to representatives of both phage groups. Evidence is presented indicating that PMB1 and related phages specify a restriction and/or modification system.


Absence of phospholipase activity in bacteriophage T4.

We assayed phospholipase activity in T4Dt+ and in t mutant phage grown under permissive and restrictive conditions. There was no correlation between the presence of the t+ gene product and phospholipase activity. Phospholipase activity in phage lysates could be attributed to the presence of bacterial debris or to the use of commercial DNase which contains phospholipase.


Purification and characterization of an early protein (E14K) from adenovirus type 2-infected cells.

One adenovirus type 2 (Ad2) early protein, with an apparent molecular weight of 14,000 in sodium dodecyl sulfate-polyacrylamide gels (E14K), was purified to homogeneity. Purification involved fractionation of cytoplasmic extracts, precipitation at low pH, and DEAE-cellulose, phosphocellulose, and hydroxylapatite chromatography. The yield was around 12 microgram of purified protein per 10(9) HeLa cells. The two Ad2 DNA binding proteins with molecular weights of 75,000 and 45,000 (E75K and E45K) were purified by the same procedure. Tryptic peptide analyses indicated that the E14K protein is unrelated to the DNA binding proteins. The purified E14K protein has a high content of basic amino acids and a sedimentation coefficient of 5.5S in the native state, corresponding to a molecular weight of around 95,000. Pulse-chase experiments suggest that the E14K polypeptide is a primary translation product. Immunoprecipitation with a monospecific antiserum against the E14K protein revealed that it is exclusively localized in the cytoplasm of infected cells. E14K started to be synthesized at 2 hpostinfection, with a maximal rate of synthesis at 4 to 6 h postinfection. Immunoprecipitation of cell extracts from four different Ad2-transformed hamster embryo cell lines revealed that only one (Ad2HE4) of them expresses this protein. The adenovirus-simian virus 40 hybrid virus (Ad2ND1) does not express this protein, suggesting that the gene for the E14K protein is located in the part of the Ad2 genome which is deleted in this hybrid virus.


Chemical cross-linking of proteins of Semliki Forest virus: virus particles and plasma membranes from BHK-21 cells treated with colchicine or dibucaine.

Chemical cross-linking of the proteins of Semliki Forest virus has been performed in virus particles and in baby hamster kidney-21 (BHK-21) cells infected with Semliki Forest virus. Most of the studies were done with the reversible cross-linkers dimethyl 3,3'-thiobis(propionimidate) and dithiobis(succinimidyl propionate). The identity of the cross-linked species was determined by two-dimensional electrophoresis. The results with virus particles showed extensive cross-linking of the nucleocapsid proteins and the formation of dimers of the two large envelope glycoproteins (E1 and E2). Similar patterns for the cross-linked virus proteins were observed in plasma membranes isolated from BHK-21 cells infected with Semliki Forest virus. No cross-linking of the third envelope glycoprotein (E3) was observed. Also, there was no evidence for significant cross-linking between host and virus proteins. The addition of colchicine, a drug that disrupts microtubules, to infected BHK-21 cells had no effect on the cross-linking of virus proteins in the plasma membrane. In contrast, dibucaine, a local anesthetic, greatly inhibited the formation of envelope dimers (E1-E2) in plasma membranes, but not in virus particles. The implication of these results for the involvement of the cytoskeletal system in the morphogenesis of Semliki Forest virus is discussed.


Initiation and maintenance of persistent infection by respiratory syncytial virus.

Propagation of cells infected with temperature-sensitive (ts) mutants of respiratory syncytial (RS) virus at nonpermissive temperature (39 degrees C) resulted in cytolytic, abortive, or persistent infection, depending on the mutant used to initiate infection. Five mutants from complementation group B produced cytolytic or abortive infections, whereas a single mutant (ts1) from group D and a noncomplbmenting mutant produced persistent infections. The persistently infected culture initiated by mutant ts1 (RS ts1/BS-C-1) has been maintained in serial culture for greater than 100 transfers, and infectious-center assays and immunofluorescent staining indicated that all cells harbored the RS virus genome. RS ts1/BS-C-1 cultures were resistant to superinfection by homologous and some heterologous viruses, and interferon-like activity against some heterologous viruses was present in the culture medium. Small amounts (0.002 to 0.2 PFU/cell) of infectious virus were present in the culture fluid, but autointerfering defective particles were not detected. This released virus formed small plaques and produced persistent infection of BS-C-1 cells at 37 degrees C. The RS ts1/BS-C-1 cells contained abundant RS virus antigen internally, but little at the surface, although the cells showed enhanced agglutinability by concanavalin A. Nucleocapsids and the 41,000-molecular-weight nucleoprotein were present in extracts of both nucleated and enucleated cells. No infectious RS virus was obtained by transfection of DNA from RS tsl/BS-C-1 cells to susceptible BS-C-1 or feline embryo cells under conditions allowing efficient transfection of a foamy virus proviral DNA. It was concluded that persistent infection was maintained in part by a non-ts variant of RS virus partially defective in maturation. The karyotype of the RS ts1/BS-C-1 culture differed from that of unifected cells.


Biochemical studies on bovine adenovirus type 3. IV. Transformation by viral DNA and DNA fragments.

By the calcium technique, intact DNA of bovine adenovirus type 3 (BAV3) was found to transform A31 cells, a clone of BALB/3T3. Transforming activity was resistant to RNase and Pronase but sensitive to DNase. The efficiency of transformation was approximately 5 to 10 foci per mug of DNA. Attempts were also made to test for transforming activity of BAV3 DNA fragments prepared with restriction endonucleases EcoRI and HindIII. The activity was found to associate exclusively with the EcoRI D fragment mapped in the region of 3.6 and 19.7 units (molecular weight, 3.9 x 10(6)). No transformation could be obtained with three HindIII fragments, J, E, and B, located at the left-hand end of the BAV3 genome. However, the enzymatic joining of J and E fragments (0 to 11.9 map units) with a ligase restored the transforming activity. These results suggest that all the genetic information of BAV3 required for transformation is located in the region between 3.6 and 11.9 units on the viral genome. Some properties of A31 cells transformed by BAV3 DNA EcoRI D fragment (TrD) and the ligated DNA of HindIII J and E fragments (TrJE), as well as those transformed by whole BAV3 DNA (Tr), were examined. As compared to untransformed A31 cells, all the transformed cell lines tested showed rapid growth, high saturation densities, and anchorage-independent growth. Moreover, they contained BAV3-specific T antigen and induced tumors in adult nude and BALB/c mice. These properties of Tr, TrD, and TrJE lines were similar to those of BAV3-transformed cells.


Transcription map for adenovirus type 12 DNA.

The regions of the adenovirus type 12 genome which encode l- and r-strand-specific cytoplasmic RNA were mapped by the following procedure. Radioactive, intact, separated complementary strands of the viral genome were hybridized to saturating amounts of unlabeled late cytoplasmic RNA. The segments of each DNA strand complementary to the RNA were then purified by S1 nuclease digestion of the hybrids. The arrangement of the coding regions of each strand was deduced from the pattern of hybridization of these probes to unlabeled viral DNA fragments produced by digestion with EcoRI, BamHI, and HindIII.. The resulting map is similar, if not identical, to that of adenovirus type 2. The subset of the late cytoplasmic RNA sequences which are expressed at early times were located on the map by hybridizing labeled, early cytoplasmic RNA to both unlabeled DNA fragments and unlabeled complementary strands of specific fragments. Early cytoplasmic RNA hybridized to the r-strand to EcoRI-C and BamHI-B and to the l-strand of BamHI-E. Hybridization to BamHI-C was also observed. The relative rates of accumulation of cytoplasmic RNA complementary to individual restriction fragments was measured at both early and late times. Early during infection, most of the viral RNA appearing in the cytoplasm was derived from the molecular ends of the genome. Later (24 to 26 h postinfection) the majority of the newly labeled cytoplasmic RNA was transcribed from DNA sequences mapping between 25 and 60 map units on the genome.


Properties of a persistent viral infection: possible lysogeny by an enveloped nonlytic mycoplasmavirus.

MVL2, an enveloped double-stranded DNA mycoplasmavirus, causes a nonlytic infection of Acholeplasma laidlawii leading to the establishment of a persistent infection. Persistently infected clones were found to be resistant to superinfection by homologous virus, but could be infected by heterologous virus. Cells in a persistently infected culture had the potential to produce virus and transmitted this potential as a stable heritable trait. Mitomycin C and UV light induced an increase in infectious centers in persistently infected cultures.


Anomalous behavior of bacteriophage lambda polypeptides in polyacrylamide gels: resolution, identification, and control of the lambda rex gene product.

The resolution of lambia proteins was compared on the two types of sodium dodecyl sulfate-polyacrylamide gels commonly in use. The two kinds of gel differ essentially in the ratio of the cross-linker, N'-N-bismethylene-acrylamide (bisacrylamide), to acrylamide monomer. Several lambda proteins migrate relatively more slowly in gels with high bisacrylamide/acrylamide ratios (HB gels) than in gels with low ratios, although the two types of gel are of roughly equivalent porosity. This effect is illustrated by a change in relative position of both the Rex and Int proteins, with apparent increases in molecular weight of about 8 and 15%, respectively, in the HB gels. This work confirms that like repressor and Int, the 28.5-kilodalton protein, identified as Rex on HB gels, is postively regulated by the lambdacII and cIII products and negatively controlled Cro. An intact y site is required for Rex and repressor expression after infection, whereas their synthesis in a lysogen is dependent upon a functional maintenance promoter, Prm.


Analysis of immunoprecipitated surface glycoproteins in measles virions and in membranes of infected cells.

Measles viral envelope proteins were immune precipitated from membranes of infected cells and from purified virus and analyzed by polyacrylamide gel electrophoresis. Under reducing conditions, specific precipitates contained two major polypeptide bands, designated virus glycopeptides 1 and 2 (VGP-1 and VGP-2). Both polypeptides appeared to be glycosylated, as indicated by their incorporation of [(14)C]glucosamine in infected cells. VGP-2 appeared as a single band in specific precipitates of infected cells and as a double band in precipitates of purified virus. Trypsin treatment of infected cells showed that reduced VGP-2 may be composed of two unrelated polypeptides. One may be F(1), which is unglycosylated, and the other may correspond to the proteolytic cleavage product of VGP-1, which is glycosylated. The relation of VGP-1 and VGP-2 to smaller surface antigens (X and Y) obtained by tryptic treatment of infected cells remains to be elucidated. In cells taken at various times postinfection and analyzed for viral membrane proteins, VGP-1 was detected at all times, indicating that the input virus VGP-1 was inserted into the cell and could not be differentiated from newly synthesized VGP-1. VGP-2 was not detectable before 24 h postinfection. In precipitates of cells 4 h postinfection and of infected cells incubated at pH 5.8, an additional polypeptide band migrated immediately ahead of VGP-1. We conclude that VGP-2 (molecular weight, 42,000) possibly consists of two components, one of which is the tryptic cleavage product of VGP-1 and the other of which is the unglycosylated polypeptide, F(1).


Transcription and translation of Newcastle disease virus mRNA's in vitro.

Transcription directed in vitro by Triton-activated Newcastle disease virus (NDV) was stimulated and prolonged by the presence of cytoplasmic extracts of animal cells. The RNA products closely resembled those of NDV transcription in vivo by several criteria: binding to oligodeoxythymidylic acid-cellulose, the mobility and relative abundance of each major band resolved by polyacrylamide gel electrophoresis, and the ability to direct the accurate cell-free synthesis of polypeptides corresponding to the NDV proteins HN, F0/F1, NP, and M. Synthesis of a novel polypeptide related to NP but of higher apparent molecular weight was also detected. These results indicated that cell-free transcription under these conditions was a close facsimile of NDV transcription in vivo. In addition, both in vitro and in vivo, NDV polypeptides were synthesized in nonequimolar amounts which reflected the order of the genes in the transcriptional map: NP, F0, M, (47K, HN), L. Strains AV and HP, virulent strains which have differences in biological activities, exhibited differences in the polypeptides synthesized in infected cells and in cell-free systems.


Homologous interference mediated by defective interfering influenza virus derived from a temperature-sensitive mutant of influenza virus.

A temperature-sensitive group II mutant of influenza virus, ts-52, with a presumed defect in viral RNA synthesis, readily produced von Magnus-type defective interfering virus (DI virus) when passed serially (four times) at high multiplicity in MDBK cells. The defective virus (ts-52 DI virus) had a high hemagglutinin and a low infectivity titer, and strongly interfered with the replication of standard infectious viruses (both ts-52 and wild-type ts+) in co-infected cells. Progeny virus particles produced by co-infection of DI virus and infectious virus were also defective and also had low infectivity, high hemagglutinating activity, and a strong interfering property. Infectious viruses ts+ and ts-52 were indistinguishable from ts-52 DI viruses by sucrose velocity or density gradient analysis. Additionally, these viruses all possessed similar morphology. However, when the RNA of DI viruses was analyzed by use of polyacrylamide gels containing 6 M urea, there was a reduction in the amount of large RNA species (V1 to V4), and a number of new smaller RNA species (D1 to D6) with molecular weights ranging from 2.9 X 10(5) to 1.05 X 10(5) appeared. Since these smaller RNA species (D1 to D6) were absent in some clones of infectious viruses, but were consistently associated with DI viruses and increased during undiluted passages and during co-infection of ts-52 with DI virus, they appeared to be a characteristic of DI viruses. Additionally, the UV target size of interfering activity and infectivity of DI virus indicated that interfering activity was 40 times more resistant to UV irradiation than was infectivity, further implicating small RNA molecules in interference. Our data suggest that the loss of infectivity observed among DI viruses may be due to nonspecific loss of a viral RNA segment(s), and the interfering property of DI viruses may be due to interfering RNA segments (DIRNA, D1 to D6). ts-52 DI virus interfered with the replication of standard virus (ts+) at both permissive (34 degrees C) and nonpermissive temperatures. The infectivity of the progeny virus was reduced to 0.2% for ts+ and 0.05% for ts-52 virus without a reduction in hemagglutinin titer. Interference was dependent on the concentration of DI virus. A particle ratio of 1 between DI virus (0.001 PFU/cell) and infectious virus (1.0 PFU/cell) produced a maximal amount of interference. Infectious virus yield was reduced 99.9% without any reduction of the yield of DI viruses Interference was also dependent on the time of addition of DI virus. Interference was most effective within the first 3 h of infection by infectious virus, indicating interference with an early function during viral replication.


Identification of lysis protein E of bacteriophage phiX174.

The product of gene E, the lysis gene of phiX174, has been identified as a distinct band in a sodium dodecyl sulfate-gel electropherogram. The position of the band is consistent with the molecular weight of 10,589 calculated from the nucleotide sequence of the gene. The band is eliminated by a nonsense mutation in gene E. It is estimated that roughly 100 to 300 molecules of E protein are made in an infected cell; this appears to be less than one-tenth the amount of protein made by gene D, in which gene E is wholly contained.


Small viral RNA segment of bunyaviruses codes for viral nucleocapsid protein.

Tryptic peptide analyses have been undertaken on the nucleocapsid (N) protein of snowshoe hare (SSH) and La Crosse (LAC) bunyaviruses. Similar analyses have been performed on the N proteins of two recombinant viruses which have the large/medium/small RNA genome configurations: SSH/LAC/LAC and SSH/LAC/SSH. The results provide conclusive evidence that the S RNA of bunyaviruses codes for the the viral N protein.


Absence of detectable capping and methylating enzymes in influenza virions.

In the presence of Mg(2+) and a specific dinucleotide primer (ApG or GpG), the influenza virion transcriptase synthesizes the eight discrete segments of complementary RNA (cRNA) containing polyadenylic acid (Plotch and Krug, J. Virol. 21:24-34, 1977). Virions were examined for their ability to cap and methylate cRNA containing di- or triphosphorylated 5' termini. By using the primers ppApG, pppApG, or ppGpG, viral cRNA was synthesized in vitro with [alpha-(32)P]-GTP and S-[methyl-(3)H]adenosylmethionine as labeled precursors. DEAE-Sephadex chromatography of the RNase T2 digest of the cRNA product demonstrated no (3)H incorporation at all and the absence of a (32)P-labeled cap structure. The 5' terminus of ppApG-primed cRNA could be capped and methylated by enzymes from vaccinia virus, indicating that the two 5'-terminal phosphates derived from the primer were preserved in the product cRNA. The cap structure formed by the vaccinia enzymes and released by RNase T2 digestion as m(7)GpppA(m)pGp was radioactively labeled at its 3'-terminal phosphate only when [alpha-(32)P]CTP was used as the labeled precursor during transcription. This indicates that the 5'-terminal sequence of the cRNA is ppApGpC and that, therefore, ppApG most probably initiates transcription exactly at the 3' GpCpU(OH) terminus of the virion RNA templates. Virions were also tested for their ability to cap and methylate ppApG in the absence of transcription. No such activities were detected, whereas under the same conditions the vaccinia virus enzymes successfully capped and methylated this compound. Consequently, these experiments, together with those reported earlier, have not detected in influenza virions any capping and methylating enzymes active on the 5'-initiated termini of viral cRNA chains synthesized in vitro, whether these termini possess one, two, or three phosphates. Some mechanism for capping and methylation of viral cRNA must, however, exist, because the viral mRNA (cRNA) synthesized in the infected cell contains 5'-terminal methylated cap structures (Krug et al., J. Virol. 20:45-53, 1976). Possible mechanisms are discussed.


Origin of the minor glycoproteins of murine leukemia viruses.

Polyacrylamide gel electrophoretic analysis and immunoprecipitation were used to study glycoproteins from purified Rauscher murine leukemia virus (R-MuLV) and from AKR thymic lymphoblastoid cell membranes. In addition to gp70, a minor glycoprotein of approximately 52,000 daltons (gp52) was demonstrated in purified R-MuLV preparations, which was antigenically related to gp70. Analysis of R-MuLV glycopeptides obtained after exhaustive Pronase digestion showed that gp70 has at least two different glycopeptide size classes with molecular weights of 5,100 and 2,900, respectively. gp52, however, contained only a single glycopeptide size class of approximately 5,100 daltons, indicating that the two glycoproteins contain distinct carbohydrate components. Trypsin treatment of R-MuLV converted gp70 into a product with a molecular mass of approximately 52,000 daltons as well as a 45,000-dalton minor product, with little effect on virus infectivity. Similarly, trypsin treatment of 125I-labeled glycoproteins derived from AKR mouse lymphoblastoid cell membranes generated fragments antigenically related to gp70 and similar in size to those obtained by trypsin treatment of R-MuLV. In both cases, the appearance of cleavage products was accompanied by a decrease in gp70 during trypsin treatment. The occurrence of glycosylated components antigenically related to gp70 in AKR membrane glycoprotein preparations and in purified R-MuLV preparations which were similar to those generated by trypsin treatment supports the concept that these minor components arise from proteolytic cleavage of gp70.


Effects of magnesium oxide on the crystallization of calcium salts in urine in patients with recurrent nephrolithiasis.

The effect of oral administration of magnesium oxide on the crystallization in urine of calcium oxalate and brushite was determined in 4 cases of recurrent calcium nephrolithiasis. Each patient was evaluated while on a constant metabolic diet before, during and after therapy with magnesium (1,000 mg. magnesium as magnesium oxide per day). During magnesium therapy urinary hydrogen ion concentration increased by approximately 0.5 unit in all 4 patients and urinary calcium increased about 50 mg. per day in 2. Urinary oxalate decreased significantly in 1 patient and urinary phosphorus was reduced in 2. The urinary activity product ratio of brushite (state of saturation) increased, owing largely to the rise in urinary hydrogen ion concentration but that of calcium oxalate was not changed significantly by magnesium treatment. Although urinary magnesium increased significantly there was no significant change in the urinary formation product ratio (limit of metastability) or the rate of crystal growth of brushite or calcium oxalate. Thus, no beneficial effect of magnesium therapy could be demonstrated in this short-term study.


Staged ureterocolocolostomy urinary diversion.

Disappointing long-term experience with the ureterosigmoidostomy and ileal loop diversion has prompted our use of a staged ureterocolocolostomy in 3 adults with a good prognosis. Creation of a non-refluxing colon conduit was followed by conduit take-down and end-to-side colocolostomy 4 to 8 months later, when satisfactory loop function was documented (that is absence of reflux, obstruction and infection). Followup has shown stable renal function and electrolyte balance, as well as urinary/fecal continence. The staged ureterocolocolostomy, as opposed to the primary ureterosigmoidostomy, allows the partially obstructed urinary tract to decompress isolated from the fecal stream, may be used with established pyelonephritis, permits confirmation of the non-refluxing nature of the ureterocolic anastomosis prior to colocolostomy and may have a lower incidence of electrolyte imbalance. The staged procedure is contraindicated in patients with a poor prognosis, previously irradiated rectosigmoid, fecal incontinence or poor anal sphincter tone, inflammatory large bowel disease, inadequate ureteral length and strong family history of colon cancer.


General resorption of intravesically instilled 5-fluorouracil.

To evaluate the resorption of intravesically instilled 5-fluorouracil a single dose of 250 or 1,000 mg. was injected into the empty bladder for 3 hours in 17 patients. The concentration of 5-fluorouracil in serum during instillation was recorded. A microbiologic agar plate method was used for the assay. No measurable 5-fluorouracil concentrations were recorded in the systemic blood of patients with undamaged bladder mucosa and low levels (less than 100 ng./ml. serum) of 5-fluorouracil were found in the systemic circulation of patients with mucosal lesions.


Corpus cavernosogram in the evaluation of carcinoma of the penis.

Treatment of carcinoma of the penis depends on the stage of the tumor, which is mainly clinical. A corpus cavernosogram was used preoperatively in 10 patients with carcinoma of the penis to assess the involvement of the corpus cavernosum, which is an important criterion in staging. In all 10 patients the involvement could be assessed correctly by this procedure, which was later confirmed by histology, and there were no complications. This is a safe, simple and valuable procedure to obtain additional information to stage correctly penile tumors preoperatively and plan the level of resection during penectomy.


Effect of amylase on sperm motility and viability.

The effect of increasing concentrations of amylase on the percentage of active spermatozoa, the quality of their motility and the percentage of viable cells was studied in semen samples in vitro. The amount of amylase needed to liquefy viscous semen samples in vitro also was determined. The percentage of active spermatozoa and viable cells, and the quality of sperm motility were altered in relationship to the amylase levels. Significant decreases in these parameters compared to control values were seen at the higher concentrations of amylase. The lowest level of amylase did not alter these parameters significantly and was sufficient to liquefy 80 per cent of the viscous semen samples. Amylase appears to be effective at low concentrations for use in liquefying viscous semen samples, thus making them easier to analyze during routine semen examination. The level of amylase used and the interval between addition and analysis must be controlled carefully.


Cell-mediated immune competence in patients with prostatic carcinoma.

The immune competence of 65 patients with prostatic cancer was evaluated by 2 in vivo and 2 in vitro tests to study the contribution of host factors to the progress of the disease. Patients with benign prostatic hypertrophy served as controls. Our results indicate that the delayed skin hypersensitivity response to common microbial recall antigens (streptokinase/streptodornase, purified protein derivative, dermatophytin 0 and dermatophytin) is unaltered in advanced stages of malignancy. The ability to be sensitized by dinitrochlorobenzene declines significantly in patients with metastatic disease. Blastogenic response of peripheral blood lymphocytes to phytohemagglutinin stimulation is not depressed in late stages of malignancy, although in the circulating T cells per cent and absolute values are somewhat lower in patients with metastases. Herein we show that immune competence (measured by the 4 tests) of patients with prostatic carcinoma does not decrease markedly even in the late stages of the disease. Primary sensitization to dinitrochlorobenzene is the only test showing a decline in responsiveness related to the tumor stage.


Hospital-associated candiduria: predisposing factors and review of the literature.

A series is presented of 98 patients with hospital-acquired candiduria identified by continual nosocomial infection surveillance. Analysis of the differences between case-matched controls and 20 patients indicated that there were significant increases in the duration of prior Foley catheterization (12 versus 6 days), length of time on multiple antibiotics (16 versus 7 days) and length of total hospitalization of the infected group. Review of the infected patients' charts showed that the indications for bladder catheterization and use of antibiotics were usually explicitly stated and considered valid. The English literature on primary Candida urinary tract infections is reviewed and future approaches to the problem are summarized.


Significance of pyuria in urinary sediment.

Microscopic examination of the urinary sediment to determine the degree of pyuria is an accepted method to screen for urinary tract infection. We investigated the significance of pyuria in relation to the method of specimen acquistion, number of white blood cells and isolation of pathogens on culture. Only 36 per cent of our patients with more than 10 white blood cells per high power field on examination of the first random specimen had more than 10 white blood cells per high power field when a repeat clean catch midstream specimen was examined, and only 20 per cent of the patients had more than 10(5) pathogens per ml. on culture. However, the finding of more than 10 white blood cells per high power field on a clean catch mid stream specimen indicated more than 10(5) pathogens per ml. in 40 per cent of the cases. The use of a higher threshold for significant pyuria (more than 20 white blood cells per high power field) on examination of a random specimen increased the incidence of more than 10(5) bacteriuria found in specimens with initial pyuria by 43 per cent and represents the additional detection of 8.7 per cent of the total poputation studied. These data indicate that when screening for pyuria and infection one should either obtain a clean catch midstream specimen for examination of urinary sediment or increase the threshold for significant pyuria on a random specimen.


Significance of hematuria after trauma.

There were 142 consecutive patients with post-traumatic hematuria evaluated prospectively during a 7-month period. Of these 142 cases 22 involved penetrating injuries and 120 were secondary to blunt trauma. There were 19 patients with 24 demonstrable genitourinary injuries at urologic injury. Only 8 of the 142 patients required an operation for the urologic injuries. The degree of hematuria did not correlate with the severity of injury. Liberal use of arteriography and renal scanning is proposed to delineate precisely the urologic injury.


Computed tomography of the pelvis.

The computed tomography scan has revealed the location and size of abnormal pelvic masses as an adjunct to other diagnostic studies. We have extended its usefulness by air distension of the bladder, which accommodates to adjacent structures and, therby, highlights abnormalities in its own wall and in other organs. The patients are prepared according to a simple routine. As we attempt further economy and efficiency the cost of each study becomes justified by the information gained.


Iglesias articulated endoscopy teaching attachment.

A new articulated teaching attachment with a single joint is described. The attachment allows a 360-degree rotation in 3 planes (sagittal, horizontal and frontal) by the 3 rotary unions at the single joint with only 2 tubes. Simultaneous observation by 2 persons and the operator is achieved by combining 2 of these optical units. The attachment may be sterilized by soaking. It can be dismantled for cleaning and for replacement of any damaged parts. Finally, it facilitates taking still photographs, movies and television endoscopy without interference to the operator.


Detrusor-sphincter dyssynergia and dyssynergic responses: recognition and rationale for early modified transurethral sphincterotomy in complete spinal cord injury lesions.

Some characteristics are described for detrusor-sphincter dyssynergia and the dyssynergic response in spinal injury patients with complete lesions. The urodynamic evaluation and clinical problems are analyzed in 53 patients to identify the importance of early recognition of sphincter dyssynergia. Cystomanometric and urethral profile pressures vary from 30 to 150 cm. water. Although high voiding pressure, particularly associated with autonomic dysreflexia, may be indicative of sphincter dyssynergia it is not diagnostic. Relevant characteristics of patients with detrusor-sphincter dyssynergia are 1) rhythmic detrusor contractions on cystomanometry with associated marked increase in electromyographic activity on attempted voiding. These characteristics enable early recognition of dyssynergia and afford expediency in its management. The modified approach to external sphincterotomy as practiced by the author provides optimal surgical approach for urological rehabilitation of dyssynergic patients. Thus, the rationale for characterization of dyssynergia and its management by modified sphincterotomy can help to terminate long-term intermittent catheterization, remove indwelling catheter, prevent renal damage and ameliorate autonomic dysreflexia.


Short stay surgery in pediatric urology.

Short stay surgery represents an innovation in the delivery and cost of medical care. The short stay surgical unit at the Children's Hospital of Michigan has provided urologic care for 311 children during the most recent 12 months of its operation. Eighteen patients (5.7 per cent) required postoperative hospitalization. No children have required rehospitalization after discharge from the short stay unit. Short stay surgery in pediatric urology has resulted in more economic and efficient use of hospital facilities and has decreased cost per procedure. Morbidity has not increased. Short stay surgery is well accepted by the child, parent and referring physician, and has not posed problems for the operating surgeons. Short stay urologic surgery is safe and applicable to many diagnostic and therapeutic urologic surgical procedures.


Renal pseudotumor on urography secondary to gallbladder empyema.

A case of gallbladder empyema is presented, which opacified initially on excretory urography and then on nephrotomography, mimicking a renal mass. Correct diagnosis was accomplished by angiography and ultrasound examination. With normal renal function gallbladder visualization on urography is indicative of a gallbladder abnormality.


Single vaginal ectopic ureter: a case report.

The seventh case of a female subject with a single, unilateral ectopic ureter draining to the vagina is reported. The renal unit was located in the renal fossa, wheras in 3 of the 7 cases reported it was within the pelvis. Although ectopia with ureteral duplication is not an uncommon anomaly the single ectopic ureter in the female subject is the rarest form of ureteral ectopia. Use of phenazopyridine hydrochloric acid as an excertory marker was most helpful in locating the vaginal orifice.


Management of the unsuspected ectopic ureterocele.

Five cases of ectopic ureteroceles associated with non-functioning upper pole segments are presented. Diagnosis was not made until the time of operation for correction of vesicoureteral reflux or decompression of the upper tracts through a flank approach. Options in the management of this problem are discussed.


The asphyxiated bladder as a cause of delayed micturition in the newborn.

Although delayed micturition in the immediate newborn period is ofter a normal physiologic variation it may be associated with pathological states leading to a decrease in urine formation or reduction of urine flow. Recently, 5 newborns subjected to severe perinatal stress were seen, who exhibited delayed micturition despite adequate urine formation and no evidence of gross anatomic abnormalities. These patients presented with distended bladders that could be maneuvered easily by Credé's method. We believe that these cases represent a heretofore undescribed asphyxiated bladder syndrome and suggest consideration of such a diagnosis when bladder distension occurs subsequent to an asphyxial event. In male newborns it is important to differentiate this syndrome from posterior urethral valves and if urine is not expressed easily one should consider early intervention with diagnostic studies and, perhaps, suprapubic drainage.


Anaerobic infection as a consequence of transrectal prostatic biopsy.

Reports on large series of prostatic needle biopsies have revealed many and varied complications but none has described anaerobic bacteremia as a complication. Herein are reported 2 such cases, with a discussion of the etiology various altered host factors and therapeutic modalities important to anaerobic infections. The consideration of anaerobic infection in the febrile patient after transrectal prostatic biopsy is emphasized.


Probable endometrial carcinoma of the prostate, crossed renal ectopia and dermatomyositis in a 32-year-old man.

An unusual type of prostatic carcinoma associated with crossed renal ectopia and dermatomyositis is reported in a young man. Infiltration by an epithelial tumor filled the enlarged prostate with soft papillary masses. Cystoprostatectomy and removal of a single large pelvic lymph node metastasis were done. Histologically, the tumor resembled endometrial carcinoma and may have arisen from paramesonephric tissue in the prostate. Large amounts of immunoglobulins were found in the tumor tissue. The patient has survived for more than 5 years, although a slow growing urethral recurrence has been noted.


Coronary angiogram interpretation. Interobserver variability.

Clinicopathological correlation of premortem coronary angiograms and postmortem data was performed to determine the degree of interobserver variability in the clinical interpretation of coronary angiograms using the pathological findings as the standard of accuracy. Comparison of the independent interpretations of the antemortem coronary angiograms by three cardiologists showed no substantial difference in overall diagnostic accuracy among the three observers. In the majority of instances where a substantial angiographic lesion was found on coronary angiography, it was verified pathologically. In false-positive or false-negative interpretations, a majority opinion was accurate when compared with a pathological lesion in 50% of the instances. Despite the fact that coronary angiography is an excellent diagnostic tool, there remain limitations of the accuracy of interpretation not solved by a majority opinion.


Lung tomography in cancer patients. Full-lung tomograms in screening for pulmonary metastases.

In a retrospective study of the cases of 415 patients with various malignant neoplasms, full-lung tomography and conventional chest roentgenography were compared for accuracy in the detection of pulmonary metastases. Sufficient information was available on 410 patients to permit confirmation as to whether pulmonary metastases were present at the time of screening chest roentgenographic and tomographic examinations. On screening by routine chest roentgenography, metastases were detected in 36 patients, 66.7% of the total with confirmed metastatic disease. Screening by full-lung tomography identified metastases in 51 (94.4%). Fifteen patients with normal chest roentgenograms had metastatic lesions on tomograms. Metastases were detected in 8.8% by chest roentgenograms and in 12.4% by tomograms in a population of cancer patients with a 13.2% incidence of pathologically confirmed metastatic lesions.


Disseminated intravascular coagulation. Complication of LeVeen peritoneovenous shunts.

Disseminated intravascular coagulation (DIC) occurred in three of five patients after insertion of a LeVeen shunt for intractable ascites. Four episodes of DIC in these patients ranged in severity from progressive and life-threatening to transient and asymptomatic. Interruption of the shunt in two patients stopped the DIC. Careful monitoring for DIC following shunt insertion allows rational decisions to protect the patient against life-threatening hemorrhage or thrombosis. Disseminated intravascular coagulation occurred in two patients during a trial intravenous infusion of ascites and occurred in one patient even when the surgical procedure was modified to minimize the volume and rate of the infused ascites.


Gentamicin tissue accumulation and nephrotoxic reactions.

In 64 adults treated with gentamicin sulfate, peak and trough serum concentrations rose gradually and declined in two phases after the final dose. Seventeen patients experienced renal damage. The 17 patients had greater amounts of gentamicin in tissues even after the first dose and before any renal effects were noted. This pharmacokinetics analysis provided evidence that patients who experience gentamicin-related nephrotoxic effects while receiving recommended doses of gentamicin could be distinguished from patients with no toxic effects because they experienced abnormal tissue accumulation before detectable changes in renal function occurred.


The quality of perinatal care in small rural hospitals.

Iowa birth and mortality statistics were reviewed to ascertain the outcome of perinatal care provided in hospitals with different-sized obstetric services. Although the data do not resolve the issue of the minimum number of deliveries necessary to ensure quality perinatal services, they do suggest that hospitals with small maternity services (fewer than 500 deliveries per year) can achieve acceptable perinatal outcomes when appropriate high-risk screening and prenatal referral occur.


Scintigraphic assessment of left ventricular aneurysms.

Thirty-five patients with coronary artery disease and possible left ventricular aneurysm underwent routine clinical examination, gated cardiac blood pool scintigraphy, and radionuclide cineangiography. Thirty-three of the 35 patients had coronary angiography and contrast left ventriculography. Sixteen patients had segmental left ventricular akinesia or dyskinesia, and 17 demonstrated left ventricular hypokinesis on contrast ventriculograms. Two patients had aneurysm confirmed at autopsy. Routine clinical evaluation was not sufficient to separate patients with aneurysm from those with hypokinesis. Radionuclide cineangiography correctly identified all cases of aneurysm or hypokinesis. The cinescintigraphic technique was preferable to the gated cardiac blood pool technique for qualitatively assessing and classifying abnormal ventricular wall motion. There was good correlation of the left ventricular ejection fraction by contrast ventriculograms and gated scintigrams in patients with either aneurysm or hypokinesis.


Impairment of hemostasis in patients with severe hemophilia. Failure of diphenhydramine, chlorpromazine, and guaifenesin.

Twenty-three patients with severe hemophilia were given single or multiple doses of diphenhydramine hydrochloride, chlorpromazine hydrochloride, or guaifenesin to test their effects on hemostasis. In contrast with earlier studies with aspirin, bleeding times were not prolonged after ingestion of these three drugs. No patient had hemorrhage because of the drugs, and none recalled excessive bleeding following drug ingestion. These results greatly extend the clinical implications of prior observations carried out in normal subjects demonstrating that many antiplatelet drugs have no effects on in vivo hemostasis. We conclude that these drugs are probably safe for patients with bleeding disorders like hemophilia.


The accuracy of the medical record as an index of outpatient drug therapy.

The records of 355 patients in outpatient clinics at Madison Veterans Administration Hospital were reviewed and compared with pharmacy files of the same patients. The records were evaluated for completeness and accuracy, with regard to the names, dosage, and directions for drugs ordered by the clinic physician. Twenty-one percent of the charts omitted the name of one or more drugs prescribed by the physicians, and 62% of the charts contained inaccuracies regarding dosage or directions. Documentation of potentially toxic drugs was not significantly different from that of less toxic drugs (p greater than .05).


The Russian flu. Its history and implications for this year's influenza season.

From November 1977 through mid-January 1978 the population younger than 25 years in the Union of Soviet Socialist Republics experienced a widespread epidemic of mild influenza (Russian flu) caused by an H1N1 virus similar to the virus that circulated worldwide during the early 1950s. Outbreaks of Russian flu occurred in school populations and military recruits in the United States starting in mid-January. Many other countries reported outbreaks of H1N1 virus in the winter of 1978. Predictions of influenza activity are always hazardous, but most experts believe that the Russian flu may occur again in the fall and winter of 1978. Other type A and B strains may also circulate; therefore, a trivalent vaccine containing A/USSR, A/Texas, and B/Hong Kong virus strains will be available. It is recommended that the chronically ill and those 65 years and older be the target populations for annual vaccination.


The tricyclic antidepressants.

Because only 9.4% of depressions are recognized at initial evaluation by primary physicians, the diagnosis of depression is important. Forty percent of a group of mixed depressions will resolve in a month without treatment, and 70% will resolve with the use of tricyclic antidepressants. Research on plasma levels of tricyclic antidepressants suggest new clinical strategies for adjusting dosages; neurochemical studies may provide an appropriate selection process for choosing a tricyclic antidepressant.


Normal findings in oral and cholecystokinin cholecystography.

Normal findings in oral cholecystography and normal response of the gallbladder to cholecystokinin are established in 200 normal controls. These include absence of right upper quadrant pain in 98.5%, absence of spasm of the body of the gallbladder and of severe spasm in the fundus, a common bile duct diameter of 6 mm or less in those 182 that were visualized, and gallbladder size of less than 11 cm in length in about 97% and less than 4 cm in width in about 97%. If normal contraction occurs after cholecystokinin (or sincalide), an unusually large gallbladder is of no importance. Little or no gallbladder contraction in the presence of normal concentration is probably of no importance.


Botulism and guanidine. Ten years later.

Guanidine hydrochloride was introduced as an adjunct in the treatment of botulism in 1968. It has been reported to be of benefit in 39 cases and of no benefit in 13 cases. No serious side effects have occurred with the short-term therapy required in botulism. Our two cases are similar to earlier cases in that the improvement seen with quanidine therapy is most notable in ocular muscles and least notable in respiratory muscles. Electrophysiological findings again showed an increase in the amplitude of evoked muscle-action potentials after guanidine administration.


Effect of atrial fibrillation on coronary circulation and blood flow distribution across the left ventricular wall in anesthetized open-chest dogs.

Effects of atrial fibrillation on coronary circulation and on blood flow distribution across the left ventricular wall were studied in anesthetized open-chest dogs. Atrial fibrillation was induced by pressing down mechanically the left atrial appendage or by stimulating electrically the left atrial appendage. Heated cross-thermocouples were used for measuring regional myocardial blood flow. The results showed a marked decrease in coronary blood flow with a significant increase in coronary vascular resistance; average values (SD) of flow and resistance during control simus rhythm were 71.6 +/- 7.36 ml/min . 100g heart muscle and 1.38 +/- 0.15 mmHg/ml/min . 100g heart muscle, respectively, and 54.0 +/- 13.60 ml/min . 100g and 1.54 +/- 0.18 mmHg/ml/min . 100gjust prior to cessation of atrial fibrillation. The termination of fibrillation caused a remarkable rise in coronary flow and a fall in coronary resistance. Pacing-induced tachycardia, similar to the average ventricular rate during atrial fibrillation, increased coronary blood flow and decreased coronary vascular resistance. These show that active coronary vasodilatation and an increase in extravascular support of coronary bed are produced by atrial fibrillation. Subendocardial myocardial blood flow during atrial fibrillation was reduced 22.0 +/- 14.8% from control levels followed by marked increase in flow after cessation of fibrillation, while subepicardial flow decreased only slightly. Thus, atrial fibrillation itself diminishes coronary flow reserve, especially in the subendocardial layer, partly due to the increase in myocardial component of coronary vascular resistance, and it is possible that irregular ventricular rhythm may play an important part in a rise in extravascular support.


Persistent left superior vena cava draining into the left atrium associated with the atrial septal defect and partial anomalous pulmonary venous drainage: surgical correction with sepcially designed prosthetic material.

Anomalous drainage of the persistent left superior vena cava into the left atrium with partial anomalous pulmonary venous return and the atrial septal defect is relatively rare condition, and there reported various kinds of surgical procedures in correction for this lesion. This report describes the original and simple surgical procedure in total correction of these lesions performed in our institute, using a large Dacron patch connected with a knitted Dacron vascular graft in its center. Surgical correction was accomplished by anastomosis of a Dacron draft with the orfice of the persistent left superior vena cava into the left atrium, widening of the atrial septal defect, and reconstruction of a new atrial septum with a Dacron patch. Postoperative cardiac evaluation revealed good condition of blood stream through a Dacron draft from the left superior vena cava to the right atrium, with corrected pulmonary venous drainage into the left atrium without pulmonary venous congestion and superior vena cava syndrome.