[Prolapse of the mitral valve].

Intending to find out which is the prevalence of mitral valvular prolapse in cases of ischemic cardiopathy with "normal" coronariography, a review was made of the coronary-ventriculographic studies at the I.N.C. archives, which showed as clinical diagnosis that of ischemic cardiopathy with "normal" coronaries. In the present studies we record 47 cases showing chest angina and/or electrocardiographic changes in rest or effort tests, compatible with myocardic ischemia and coronariography undoubtedly normal. We found 30 cases (63.8%) showing strong evidence of mitral prolapse in the left cineventriculography taken in right-front oblique position.


[Usefulness of technetium 99m diphosphate scintellography in the diagnosis of acute myocardial infarction. Electrocardiographic correlation].

We made myocardial gammagraphies on a group of 141 patients with acute thoracic pain, using 99 mtc diphosphonates. We obtained images with three projections (LOA, LL and PA); for reading the gammagraphy we used the diagnostic criteria of Berman and Cols. Studying 106 patients with acute myocardial infarction we found affirmative diagnosis in 89 cases (83.93%). In another group, 32 patients with chest angina, the results were negative in 20 cases (62.5%). We got a total of eight false positive images in patients showing post-infarction aneurism, post-defibrillation damage, and myocardial metastatic tumors. This method showed a specificity of 62.9%. Correlation with the electrocardiogram refering to the localization of the infarction, was of 85.39%. This method proved to be of high sensibility and specificity in confirming the diagnosis of acute myocardial infarction or establishing it with certainty in some patients when the electrocardiogram fails and, in some cases, to find out about the evolution and prognostic of the acute myocardial infarction.


[Pulmonary arterial hypertension of unknown etiology. Study of the cardiopulmonary function].

Thirty two cases of pulmonary arterial hypertension of unknown etiology (PAH-UE) were studied. The diagnosis was established by exclusion after the results of hemodinamics studies. Ninety percent of cases had severe PAH (100 mmHg). The end diastolic right ventricular pressure was elevated in 46% of cases. The total pulmonary vascular resistance was increased in the order of the 1700 dinas. seg. cm-5. The cardiac index was 3.3 1/m2 with a right ventricular work index of 3.96 K gm min. The total lung capacity (TLC) was normal, with a vital capacity (VC) of 78% of the predicted value. The residual volume was increased. The mean value of the maximal midexpiratory flow rate (MMFR) was 78%. The A-a gradient of O2 was 30 mmHg, with a venous mixture expressed as a percentage ratio of the cardiac output (Qva/Qt) of 26%. The mean paO2 mmHg and the anatomical pulmonary artery to vein shunt (Qs/Qt) was 9%, with a DLco normal. The clinical hemodinamic correlation was in good agreement. Our results suggested that PAH-UE "per se" has effect in pulmonary function changing slight lung mechanics, and in a moderate degree lung gas exchange. The hipoxemia results meanly from V/Q imbalance.


Ionic and metabolic requirements for decamethonium transport in mouse kidney cortex slices.

Decamethonium accumulates in mouse kidney cortex slices incubated in Krebs-Ringer bicarbonate buffer (37 degrees C, pH 7.4) aerated with O2-CO2 95:5 v/v%. Maximum tissue-medium accumulation ratio decreased with increasing external decamethonium concentration. Decamethonium was released from the tissue at a slow rate. The metabolic inhibitor cyanide inhibited accumulation of decamethonium but did not produce release of decamethonium already accumulated in the tissue. Substitution of external Na+ by other cations depressed decamethonium uptake. However, this cannot be ascribed to absence of Na+ since no inhibition occurred when Na+ was substituted by isoosmotic sucrose. Decamethonium uptake is inhibited when active Na+-transport is impaired (omission of K+ or addition of ouabain). The slow onset of this inhibition is compatible with the idea that it may be secondary to changes in the intracellular electrolyte concentrations. Furthermore, decamethonium uptake was depressed in absence of external Ca2+.


Influence of prostaglandins E1 and F1alpha on K-induced responses in vascular smooth muscle.

The effects of PGE1 and PGF1alpha (1.4-8.4 X 10(-8)M) were studied on contractures induced by 10--60 mM KCl in the isolated rabbit aorta. The greatest PG-induced increases in the K-contractures were observed at the lower concentrations of KCl. Greater tension increases were noted, particularly at the higher K concentrations with the simultaneous addition of KCl and the PGs rather than with their sequential addition in which the PGs were added after KCl. For example, when the PGs were added to tissues contracted with 60 mM KCl, no additional tension increases occurred, while significant increases were observed when the PGs were added simultaneously with 50--60 mM KCl. Isobolic plots of the data indicate that PGE1 at lower concentrations and PGF1alpha at all concentrations interacted with KCl as competitive antagonists. At median doses PGE1 exhibited an additive effect with KCl, while higher doses interacted in a synergistic manner.


Hepatic peroxisome proliferation: induction by BR-931, a hypolipidemic analog of WY-14,643.

Administration of BR-931, an ethanolamine derivative of Wy-14,643 [4-chloro-6-(2,3-xylidino)-2-pyrimidinythio]acetic acid, at a dietary concentration of 0.125% for 3 weeks to male F-344 rats, resulted in a significant enlargement of the liver. The hepatomegaly appeared to be due to liver cell hyperplasia and hypertrophy resulting, in part, from peroxisome and smooth endoplasmic reticulum proliferation. The hepatic catalase and carnitine acetyltransferase activities increased significantly in association with peroxisome proliferation. The hepatomegaly and peroxisome proliferation induced by BR-931 were comparable in degree to those resulting from feeding of an equivalent dose of Wy-14,643. All these hepatic effects were reversible when the drugs were withdrawn from the diet. Screening of new compounds for hepatic peroxisome proliferation and for increases in peroxisome-associated enzymes may prove to be an adjunct to evaluating their potency as hypolipidemic agents, in view of frequent association between hepatic peroxisome proliferation and hypolipidemia.


Cardiovascular reactivity in renal and spontaneously hypertensive rats.

Pressor reactivity to noradrenaline or vasopressin was studied in unanaesthetized, pithed and isolated perfused hindquarter, preparations from renal and spontaneously hypertensive rats. Unanaesthetized renal and spontaneously hypertensive rats showed hyperreactivity to noradrenaline and vasopressin. Vascular responses of noradrenaline in pithed and isolated perfused hindquarter preparations were to a lesser extent but significantly greater in the renal hypertensive rat, while responses of pithed and isolated perfused hindquarter preparations to noradrenaline were within normal limits in the spontaneously hypertensive rat.


Effects of ethanol on behavior under fixed-ratio, fixed-interval, and multiple fixed-ratio fixed-interval schedules in the pigeon.

Behavior of pigeons was controlled by fixed-ratio, fixed-interval and multiple fixed-ratio fixed-interval schedules of reinforcement. When each thirtieth peck on a response key produced food (fixed-ratio schedule) high rates of responding were maintained; low to intermediate doses of ethanol left unchanged or increased those rates. Under the fixed-interval schedule the first response after 5 min produced food and comparatively lower rates of responding were maintained that gradually increased up to food presentation. Low to intermediate doses of ethanol only decreased overall rates of responding under the fixed-interval schedule. When the fixed-ratio and fixed-interval schedules alternated regularly throughout a single experimental session (multiple fixed-ratio fixed-interval schedule), differential effects that depended upon the schedule of reinforcement were still obtained. Ethanol affected local rates of responding within the fixed intervals differently depending upon the rates prior to drug administration; low rates were increased while higher rates were decreased. As with other drugs, the effects of ethanol on schedule-controlled responding depended upon the particular rates and patterns of responding maintained by the schedule of reinforcement.


Motor effects of graded doses of pentagastrin on the gut of the anesthetized dog.

Gastrointestinal motor activity of the anesthetized dog was assessed by strain gage force transducers on longitudinal and transverse muscle of the gastric body and antrum, duodenum, jejunum, ileum, and colon. Dose-dependent effects of pentagastrin (1-8192 ng/kg, i.v.) were only seen on the stomach: increases in gastric body tone, antral contractile force and contractile frequency of the gastric phasic activity. Body tone and antral force were more sensitive to pentagastrin than was contractile frequency. Supra-maximal doses and repetition of the dose-response protocol gave smaller increments for body tone and antral force, while the increase in contractile frequency remained unaffected. The different responses to pentagastrin of force and frequency indicate that pentagastrin acts on 2 different receptor-effector systems.


Pharmacokinetics of ethosuximide in the dog.

The pharmacokinetics of ethosuximide were studied in dogs and compared with the data known for man. After intravenous injection of 40 mg/kg to 9 dogs, the concentration-time curve in serum could be described by the open one-compartment model. Serum half-lives were between 11 and 25 hr, the volume of distribution correspond to between 44 and 66% of body weight. After oral administration of the same dose, maximal serum concentrations were reached within 1-4 hr and the absorption amounted to 88-95%. By treatment with three daily doses, a plateau in serum concentrations could be reached and maintained. At serum concentrations above 100 microliter/ml, half-lives seemed prolonged when compared to the values determined previously with a dose of 40 mg/kg. Ethosuximide rapidly enters the cerebrospinal fluid, equilibrium was established after 20-30 min. Plasma protein binding of the drug was negligible. Comparison of the pharmacokinetic data for dog and man reveals, in spite of the somewhat shorter half-life in the dog, a rather good agreement. In female rats, ethosuximide had an average half-life of 10 hr, in mice of hardly 1 hr. Concentrations in serum and brain of mice equilibrated within 10 min.


Effects of some thioxanthenes on bile formation and organic anion clearance in the perfused rat liver.

Perfusion of the isolated rat liver with cis-thiothixene (THX), cis- or trans-flupenthixol (FPX), and cis- or trans-clopenthixol (CLX) has demonstrated that each of the compounds exerted adverse effects on hepatic excretory function and that their relative order of potency was THX greater than cis- = trans-FPX greater than cis- = trans-CLX. THX caused dose-dependent reductions in bile flow and sulfobromophthalein (BSP) clearance. The 14C-erythritol clearance and bile acid excretion data suggested that the primary effects of THX (10(-5)M) were on the bile acid-independent fraction of bile. The BSP kinetic data indicated that THX mainly affected the excretion of BSP and not its uptake. Since THX also decreased the excretion of indocyanine green, inhibition of hepatic conjugative enzymes did not appear to be responsible for the observed decreases in organic anion excretion. At 2.5 X 10(-5) M, both isomers of FPX reduced bile flow and BSP excretion. It took a higher concentration (7.5 X 10(-5) M) for either isomer of CLX to effect similar reductions.


Actions and interactions with alcohol of drugs on psychomotor skills: comparison of diazepam and gamma-hydroxybutyric acid.

Effects of gamma-hydroxybutyric acid (GOBA) on psychomotor skills related to driving were studied in healthy student volunteers. The effects of oral GOBA 1.0 and 2.0 g, alone or in combination with 0.5 g/kg of ethyl alcohol, were compared in double-blind cross-over trials against oral diazepam 10 mg (D), alcohol 0.5 g/kg, and lactose placebo. Reactive and co-ordinative skills, attention, flicker fusion, proprioception, nystagmus, Maddox wing, and subjective estimations were included. The first single-dose trial with 12 volunteers revealed that neither GOBA 1.0 g nor D modified attention. D impaired reactive skills whilst co-ordinative skills remained largely uninfluenced by D or GOBA. Both D and GOBA impaired leg proprioception. Only D was experienced as a sedative drug. In the second trial with 12 volunteers, GOBA 1.0 g slightly increased reaction mistakes whereas GOBA 2.0 g next day did not. Either dose of GOBA was ineffective on co-ordinative skills, critical flicker fusion frequency, and proprioception. Alcohol alone (0.41 +/- 0.047 mg/ml) improved rather than impaired skills. GOBA 1.0 g + alcohol (0.36 +/- 0.027 mg/ml) impaired reactive skills more than GOBA 2.0 g did but no potentiation was seen. D impaired reactive and co-ordinative skills and flicker fusion. When D was given on two consecutive days, some tachyphylaxis to the D response was seen on co-ordinative skills but not on reactive skills or flicker fusion. It is concluded that in the recommended anxiolytic doses used GOBA neither deteriorates driving skills nor importantly increases the effects of low doses of alcohol.


Mechanism of positive chronotropic response of the canine SA node to selective administration of ketamine.

Mechanism for induction of the positive chronotropic effect of ketamine was studied in vivo using a selective perfusion technique of the canine SA node artery. In the reserpinized dogs in which tyramine responsiveness could be restored with norepinephrine, an injection of ketamine induced no sinus acceleration, while its prior administration to norepinephrine suppressed the response to tyramine. In the tetrodotoxin treated preparation in which the effect of electrical stimulation of the vagus and the stellate ganglion was abolished, tyramine produced an increase of sinus rate as usual, but the induction of sinus tachycardia by cocaine and ketamine was completely blocked. The results indicated that the positive chronotropic response of the SA node to ketamine might be induced by an inhibition of the norepinephrine uptake at the adrenergic nerve endings in a cocaine-like manner.


The effect of verapamil, isoproterenol, and dexamethasone on enzyme release and viability of coronary obstructed guinea-pig hearts.

In isolated perfused guinea-pig hearts decrease of coronary flow, release of creatine kinase (CK), severe arrhythmias and early standstill were produced by intracoronary application of plastic microspheres. 1 X 10(-9) g verapamil/ml perfusion fluid significantly decreased the CK release from these "ischemic" hearts. With 1 X 10(-8) g/ml a significant increase of the survival times was obtained. Dexamethasone strongly depressed the enzyme release from the coronary obstructed hearts. The survival times, however, were not prolonged. Isoproterenol significantly shortened the survival times. Very low concentrations decreased the CK release, whereas higher concentrations themselves provoked an enzyme release.


Effects of intraventricular and intraspinal 6-hydroxydopamine on blood pressure of renal hypertensive rats.

6-Hydroxydopamine (6-OH-DA) was administered into the lateral brain ventricle of normal rats and of rats with renal hypertension produced by unilateral clipping of the renal artery, and was also administered into the spinal cord of normal rats. Intraventricular administration of 6-OH-DA prevented the development of renal hypertension in rats, but was ineffective in developed renal hypertension. The development of renal hypertension was not affected by pretreatment with intraspinal injection of 6-OH-DA, which produced a marked reduction only in spinal cord noradrenaline. These data suggest that brain adrenergic neurones may participate in the production of renal hypertension but the noradrenergic projections in the spinal cords are not essential for this process.


The potentiating effect of clorgyline and pyrogallol on the blood pressure responses to norepinephrine.

Intraventricular administration of norepinephrine (NE) into pentobarbital anesthetized rats elicits a pressor or a depressor effect depending on the dose injected: after a low dose, a depressor response is seen while after a high dose, a pressor response is observed. In the animal pretreated intraventricularly with clorgyline or pyrogallol, the hypotensive effect of a low dose of NE was reversed to a hypertensive effect, while the hypertensive effect of a high dose of NE was markedly potentiated. This result suggests that brain monoamine oxidase and catechol-o-methyltransferase can metabolize centrally released NE before it leaks into the peripheral circulation.


Effect of antihypertensives on calcium kinetics in the aorta of spontaneously hypertensive rats.

This study was undertaken to determine whether alterations in 45Ca kinetics, found previously in the aorta of spontaneously hypertensive rats (SHR), are the cause or the consequence of high blood pressure. SHR were treated for 3-6 weeks with hydralazine, propranolol or timolol before the uptake and efflux of 45Ca was measured in the aorta and compared with those in untreated animals. Hydralazine prevented the development of hypertension in the rats but did not alter the uptake or efflux of 45Ca. It is concluded that calcium handling in SHR is abnormal also in the absence of high arterial pressure.


Inhibition by metyrapone of the accumulation of nicotine-14C in bronchial epithelium of mice.

Further studies have been conducted in an attempt to define the mechanism of the intense accumulation of radioactivity in bronchial epithelium following the administration of nicotine-14C to mice. Male and female pigmented (C57B1/6J) and nonpigmented (A/HeJ) mice were studied by whole-body autoradiography following administration of either nicotine-14C (methyl- or 2'-labeled) or nicotine-1'-N-oxide-14C. When each of these compounds was administered at the same specific activity the radioactivity retained in the bronchial epithelium was much greater for the methyl-labeled nicotine-14C than for the ring-labeled. Following administration of the N-oxide very little radioactivity was retained at this site and this was seen only at a few time intervals. Pretreatment with NaHCO3, NH4Cl, SKF 525A, piperonyl butoxide, progesterone, cysteamine, phenobarbital or metyrapone prior to the administration of [methyl-14C]nicotine was studied. Metyrapone totally prevented the accumulation of radioactivity in the bronchial epithelium and progesterone reduced this accumulation; the other substances used for pretreatment had no effect on the uptake of radioactivity. These results are interpreted to indicate that the accumulation of nicotine in bronchial epithelium is not accounted for by transcellular pH gradients but is due to a high affinity of nicotine for a cytochrome P-450 in this tissue which demethylates the nicotine. The relationship and significance of metabolism of nicotine in this tissue to metabolism at other sites in the body are discussed.


Enhanced hepatotoxicity of carbon tetrachloride following sodium nitrite pretreatment.

The administration of sodium nitrite (60 mg/kg, s.c.) 30 min prior to carbon tetrachloride intoxication (2 ml/kg, p.o.) significantly enhanced the rise in serum glutamic oxaloacetic transaminase, glutamic pyruvic transaminase, and isocitrate dehydrogenase. Sodium nitrite pretreatment also enhanced the carbon tetrachloride-induced decrease in hepatic microsomal glucose-6-phosphatase activity. Microsomal diene conjugation absorption indicative of microsomal lipid peroxidation was observed following carbon tetrachloride intoxication, but was not altered by sodium nitrite pretreatment. The data indicate a potentially toxic interaction between sodium nitrite-induced methemoglobinemia and carbon tetrachloride-induced hepatic injury.


Coffee consumption and mortality. Total mortality, stroke mortality, and coronary heart disease mortality.

Total mortality showed no association with coffee usage in the four race-sex groups of Evans County, Georgia. Deaths of coronary heart disease (CHD) in white men and women and black men showed no statistically significant difference between high and low coffee consumers. In an area that has been designated as the "Stroke Belt," neither CHD nor cerebrovascular death rates seem related to coffee-drinking habits. However, to refute or confirm the allegations of a detrimental influence of high coffee intake, larger samples are needed. Nevertheless, our finding that mortality from all causes is not increased in the high coffee-consuming group means that a finding of increased CHD mortality with high coffee consumption would have to be compensated by a protective lower rate for other causes of death.


Myocardial function in hypothyroidism. Relation to disease severity and response to treatment.

Systolic time intervals (ST) were used to evaluate myocardial function prospectively in 29 hypothyroid patients. The patients were divided into three categories of disease severity: (1) severe hypothyroidism, (2) mild hypothyroidism, and (3) decreased thyroid reserve or "prehypothyroidism." Groups 1 and 2 showed decreased myocardial contractility with a prolonged preejection period (PEP), shortened left ventricular ejection time (LVET), and increase PEP/LVET, compared with normal controls. The STI were more abnormal (P less than .05) in group 1 than in group 2, suggesting that the severity of myocardial dysfunction correlates with the severity of the hypothyroidism. Group 3 had normal STI. Ten patients were restudied when euthyroid and showed complete normalization of their STI, supporting the thesis that hypothyroidism was the sole cause of the initial myocardial dysfunction.


Acid-base disturbances in the salicylate-intoxicated adult.

This study examined the acid-base disturbances in 67 adults with salicylate intoxication. On admission, 66 patients had an acid-base distrubance. In contract to previous suggestions, however, only 25% of the patients had simple respiratory alkalosis. Unlike salicylate intoxication in children, 33% of these adults with salicylate intoxication had ingested additional drugs. These additional drugs generally were CNS depressants and were important determinants of the variety of the acid-base disturbance. Those patients who ingested additional drugs had a significantly lower incidence of respiratory alkalosis (P less than .005) and a higher incidence of respiratory acidosis (P less than .005) and acidemia (P less than 0.25). The incidence of acidemia correlated with the presence of neurological symptoms.


Subcutaneous heparin-induced thrombocytopenia.

Two patients developed severe and symptomatic thrombocytopenia which was clearly related to the every-12-hour subcutaneous administration of heparin sodium. One patient died of hemorrhage while the other patient's platelet count normalized after withdrawal of the therapy. The literature reveals 27 cases of significant thrombocytopenia associated with intravenous heparin administration. In light of the increasing use of low-dose subcutaneous heparin therapy it is important to recognize that this side effect may occur. Periodic platelet counts are recommended for these patients.


Furosemide-induced forced diuresis in digoxin intoxication.

In three cases of attempted suicide by massive digoxin ingestion, a therapeutic attempt was undertaken to shorten the duration of toxicity of the drug by accelerating the removal of the glycoside from the body. Early administration of intravenous (IV) furosemide and fluids appeared to increase digoxin excretion in one case, which resulted in a substantially shortened digoxin half-time of eight hours. In two cases this therapy, initiated after a delay of 12 and eight hours was ineffective. The half-times were 51 and 43 hours, respectively. At an early preequilibrium stage, higher serum-tissue ratios of digoxin are present; thus, greater amounts of free digoxin are available for glomerular filtration and excretion. The prompt treatment by IV furosemide may be beneficial in the management of massive digitalis overdose.


Hyperparathyroidism and coexisting diabetes mellitus. Altered carbohydrate metabolism.

Hyperparathyroidism was diagnosed in a 67-year-old diabetic man treated for 20 years with isophane insulin suspension, 40 to 45 units/day. It was also diagnosed in a 64-year-old diabetic with severe retinopathy and vascular disease, who was not dependent on insulin. In the first case, removal of a parathyroid adenoma resulted in frequent hypoglycemic attacks, which led to a reduction of the administration of insulin isophane suspension to 20 units/day. In the second case, there was a notable improvement in the glucose tolerance testing that followed surgery, accompanied by a decrease in total plasma insulin response from 17,838 to 5,605 units, by planimetry. These observations suggest that hyperparathyroidism worsens coexisting diabetes mellitus and that one must be aware of increased insulin sensitivity and the possibility of severe hypoglycemia in cases that require insulin after surgical correction of the hypercalcemic state.


Apneusis.

Two cases of apneustic breathing that had several unusual features, as compared with experimental apneusis, are reported here. Both patients had intact vagal function. Respiratory rhythm showed mainly inspiratory apneusis, with a relatively smooth background rhythm. Frequency and duration of apneusis either decreased or were unaffected by breathing CO2, and increased, in one case, after hyperventilation. Both patients were alert and conscious. One had a long history of narcotic abuse, but had no other neurological or respiratory abnormality. Another had been deaf and mute since an episode of meningitis in childhood and had had apneusis for over 35 years, but suffered no other neurological abnormality. These unusual features suggest that the pathogenic mechanisms for apneusis are not the same in experimental models and patients.


A composite analysis of renin classification methods.

We investigated the possibility that variability in classification of patients with essential hypertension into low, normal, or high renin activity subgroups depends on the subject preparation that precedes the measurement of plasma renin activity (PRA). In 47 essential hypertensives, PRA was measured with patients supine and ambulatory who were receiving both an unrestricted dietray sodium intake and a low sodium diet. Additionally, PRA was determined following salt restriction, oral furosemide therapy, and ambulation. These results were compared, using several analytical techniques, to those of a group of age-, race-, and sex-matched normotensive controls. Extreme variability in classification was the rule, with only 28% of patients consistently classified as having normal PRA. No single approach provided maximal detection of both the low and high renin states. We conclude that renin classification of hypertensive patients requires a matched control population and that subtyping appears to be variable depending on diet, posture, and analytical approach.


Leukopenia in anorexia nervosa. Lack of increased risk of infection.

To determine whether patients with anorexia nervosa (AN) and leukopenia have an increased risk of infection, we reviewed the incidence of leukopenia and infection in 68 cases of AN and studied the mechanism of profound neutropenia in one. Compared with controls, patients with AN had substantially lower total leukocyte counts and absolute neutrophil, lymphocyte, and monocyte counts. Despite frequent and often severe panleukopenia, the patients with AN had no more infections than did the control subjects. The patient with severe neutropenia ahd a hypocellular bone marrow biopsy specimen showing relative myeloid hyperplasia, normal distribution of neutrophils between the marginal and circulating pools, and normal bone marrow neutrophil reserves as estimated by response to hydrocortisone sodium succinate. We conclude that patients uith AN and associated leukopenia do not have increased infection propensity.


Use of diuretics in treatment of hypertension secondary to renal disease.

Eleven patients with hypertension secondary to renal disease were treated with hydrochlorothiazide or furosemide plus other drugs to normalize blood pressure. Creatinine clearance fell during the initial treatment period, but then either remained constant or rose toward pretreatment levels in spite of continued therapy. Plasma renin activity was low-normal to subnormal in eight of the 11 patients prior to therapy and did not rise significantly with therapy. Aldosterone excretion was within the normal range prior to treatment and remained normal or increased moderately with treatment. This study demonstrates that diuretics effectively reduce blood pressure in patients with hypertension secondary to renal disease without producing severe volume depletion or clinically significant reduction in renal function. The low renin levels are consistent with other evidence that hypertension in these patients is related to salt and water retention.


ECG diagnosis of acute myocardial infarction in patients with pacemakers.

Ventricular pacing may mimic or obscure the Q waves of myocardial infarcton. Although ST-T changes may occur for other reasons, their presence should alert the physician to the possibility of acute infarction. QRS complexes may be evaluated for infarction if supraventricular beats without left bundle-branch block occur prematurely, as part of a supraventricular tachycardia or as escape beats after inhibition of the articifial pacemaker.


Rhabdomyolysis and acute myoglobinuric renal failure. Complications of inferior vena cava ligation.

A 50-year-old man underwent inferior vena cava ligation because of repeated pulmonary emboli despite adequate heparin therapy. His immediate postoperative course was complicated by the development of massive edema in the lower extremities, leading to a compromised arterial blood flow with the resulting ischemic myopathy and acute myoglobinuric renal failrue. Although massive pooling of body fluids in the lower extremities with fatal consequences has been reported as an immediate complication of the sudden mechanical obstruction of the venous return, to our knowledge this is the first case of myoglobinuric acute renal failure due to rhabdomyolysis reported in association with inferior vena cava ligation.


Primary hypothyroidism and pituitary enlargement. Radiological evidence of pituitary regression.

A patient with primary hypothyroidism and pituitary gland enlargement was studies extensively before and after replacement therapy with levothyroxine sodium. She had evidence of bulging of the diaphragma sellae and increased serum prolactin levels. Thyroid replacement therapy resulted in regression of the pituitary size, as shown on pneumoencephalogram, but mildly elevated serum prolactin levels persisted.


Aplastic anemia associated with type B viral hepatitis.

Aplastic anemia is a recognized complication of viral hepatitis, but, to our knowledge, no cases associated with type B hepatitis have been described. We report the case of a patient who developed severe aplastic anemia very early in the course of infection with hepatitis B virus.


Thrombophlebitis of the lower extremities and ABO blood type.

Of 86 medical patients with a hospital discharge diagnosis of thrombophlebitis of the lower extremity, 70 (81%) were of blood type A,B, or AB (non-O). Of the 344 reference patients matched for age, sex, and country, 187 (54%) were of non-O blood type. The estimate of risk ratio of non-O blood type patients to O blood type patients was 3.7 with 90% confidence limits 2.3 and 6.0. The association between non-O blood type and thrombophlebitis of the lower extremity was strongest among the younger patients and women.


The 12-lead electrocardiogram in exercise testing. A misleading baseline?

Mason and Likar reported a modified ECG lead system that largely eliminates intraexercise artifact without reportedly altering the configuration of the recorded leads. This system allows continuous monitoring of all 12 leads during and after exercise and has become the standard by which other systems are compared. We have found, however, that important changes may be seen between the baseline exercise ECG using the Mason-Likar modification and a simultaneous standard ECG. While these differences do not apparently affect the interpretation of the test, they may produce or obscure evidence of antecedent infarction on the baseline exercise ECG and thus preclude it from being considered interchangeable with a standard ECG.


Indirect hemagglutination with PPD in cerebrospinal fluid for the tuberculous meningoencephalitis.

Reliability of indirect hemagglutination test was evaluated with PPD in CSF for the diagnosis and prognosis of tuberculous meningoencephalitis. The test was positive 100 percent in 22 patients with this disease and negative in 53 patients from the control group (p = 0.001) with viral or pyogenic infection in the CNS. No correlation was observed between antibody titers and the prognosis of the disease. Modifications of the original technique are described.


Hepatic synthesis and albumin distribution in the primary nephrotic syndrome (PNS). as demonstrated by immunofluoresce.

To study some of the aspects of albumin homeostasis and proteinuria in PNS, the hepatic production of albumin is analyzed using semiquantitative immunofluorescent techniques, in biopsy specimens from nine subjects, free of hepatic or renal disease and nine patients with PNS, where renal biopsies were also made. Tissue sections 0.5 millimicron thick were cut. The hepatic synthesis of albumin, interpreted by the number of cells with specific fluorescence, was much higher in patients with PNS (p less than 0.001), and kept inverse relationship with serum albumin concentrations. Numberless droplets containing albumin were observed in the renal tissue indicating intense resorption and catabolism in the luminal and basal portions of the proximal convoluted tubules. Our findings indicate that, in PNS, albumin synthesis is substantially increased and hypoalbuminemia is caused by exaggerated renal excretion and catabolism.


Production and absorption of cerebrospinal fluid in the spinal subarachnoid space of the dog.

The formation and absorption capacity of CSF in the isolated spinal subarachnoid space was investigated in seven dogs by using a perfussion of a solution similar to the cerebrospinal fluid labeled with I 131. It was found that there was no CSF production in the spinal canal; however, there was an important absorption rate with an average of 0.2695 ml/min when the intraspinal pressure was of 10 centimeters of water. The clinical implications of this findings are discussed.


Affective disorders in a US urban community: the use of research diagnostic criteria in an epidemiological survey.

The current point and lifetime prevalence rates of affective disorders, based on the application of Research Diagnostic Criteria to a US urban community sample, are reported. The affective disorders studied included major and minor depression, mania, hypomania, bipolar I and II, primary and secondary depression, schizo-affective disorder, depressive and cyclothymic personality, and grief reactions. Epidemiologic surveys that include treated and untreated persons to obtain rates of specific psychiatric disorders are needed for scientific purposes and health care planning.


Age at onset of bipolar affective illness.

The age at onset of bipolar affective illness was determined for 100 males and 100 females who met the newly proposed DSM-III criteria for mania. Three different indices of onset were employed: first hospitalization, first treatment, and first apparent symptoms. A table was constructed indicating the cumulative percentage of those who became ill by the time they passed through each age quinquennium. One third were hospitalized before their 25th birthday, and at least 20% had already shown evidence of illness as adolescents. The early 20s was the peak period of onset. No manic episodes were confirmed prior to age 13, and onset after age 60 was rare. Sex, ethnicity, and socioeconomic status did not significantly affect age at onset. Affective illness should be given serious consideration in the differential diagnosis of mental disorders in young people.


Psychological functioning of bipolar manic-depressives in remission.

Several dimensions of psychological functioning of bipolar manic-depressives in remission were investigated. The following hypotheses were examined: (1) During remission, these individuals exhibit psychological maladjustment or a lack of positive mental health. (2) Bipolar manic-depressives are characterized by strong external orientations. The Personal Orientation Inventory, Marlowe-Crowne Social Desirability Scale, Levenson's Internal and Powerful Others Locus of Control Scales, and the Embedded Figures Test were administered to matched groups of 35 bipolar manic-depressives and 35 normal comparison subjects. Discriminant analysis disclosed no significant differences between the two groups on measures of positive mental health and on measures of external orientation. The relationship between these results and the etiology and treatment of manic-depressive disorder is briefly discussed, as well as the contradiction these findings pose to current views of this disorder pervasive among professional and lay populations.


Primary affective disorder, clinical state change, and MHPG excretion: a longitudinal study.

Urinary 3-methoxy-4-hydroxyphenethylene glycol (MHPG) excretion, which is thought to reflect CNS norepinephrine metabolism, has been shown to be significantly decreased in some depressed patients. Although there is consensus that urinary MHPG excretion varies directly with mood in rapidly cycling bipolar patients, there is little information on longer term state changes, such as those that accompany recovery from depression. Ten female patients with diagnoses of primary affective disorder were studied initially during an inpatient hospitalization and restudied at least ten months after discharge. Five healthy female comparison subjects were also studied over a similar interval of time. During the baseline period, the patient sample excreted less MHPG than did the comparison group. Improvement in clinical state from a seriously depressed baseline was associated with a significant increase in MHPG excretion, while the patients with recurrences of depression showed no change and continued to excrete less MHPG than the comparison subjects. These results suggest that urinary MHPG excretion may represent an index of psychobiological state in depressive patients.


[Autoradiographic findings in cerebrospinal fluid cells (author's transl)].

The report concerns the results of autoradiographic studies of cerebrospinal fluid cells. We investigated pleocytosis in cases of inflammatory diseases of the central nervous system, hemorrhage in the cerebrospinal fluid space, brain tumor and hemoblastosis, as well as in cases of undefined neurologic disease. Cerebrospinal fluid was incubated with tritiated thymidine. The results show that tumor cells have the highest labeling index and monocytes the lowest. Cells from primary brain tumors incorporate tritiated thymidine more rarely and less intensely than cells from cerebral metastases. Lymphocytes from inflammatory disease in infants may demonstrate a high labeling index.


[Cerebral and blood flow and cerebral blood volume in communicating hydrocephalus (author's transl)].

Regional cerebral blood flow (rCBF) and regional cerebral blood volume (rCBV) were estimated in patients with communicating hydrocephalus, arteriosclerotic and presenile dementia. In all groups ischemic patterns were detected which did not allow any differential diagnostic separation between the patients. In some patients with communicating hydrocephalus reduction of cerebrospinal fluid pressure by lumbar puncture or ventriculoperipheral shunt respectively resulted in increase of rCBF and rCBV. This was not achieved in the other patients with dementia. Predominantly areas with ischemic flow values gained profit from reduction of CSF pressure. This was interpreted as a sign of regional damage to the autoregulation.


Blink reflex in facial-hypoglossal anastomosis.

The blink reflex was investigated in two patients after a facial-hypoglossal anastomosis had been performed. In each case the first component of the blink reflex could be demonstrated with normal latency on the operated side after ipsilateral supraorbital stimulation. These findings give further evidence that the first component of the blink reflex is not monosynaptic in nature. The second component of the blink reflex was distinctly retarded in the first case and was not seen at all in the second case. The second component of the blink reflex is influenced strongly by alteration of the intrabulbar and efferent part of the reflex circuits; it shows some correlation with voluntary motor activity.


Kraepelin-oriented research-diagnosable schizophrenia, mania, and depression in Schneider-negative schizophrenics.

The rigorous neo-Kraepelinean research criteria of the St. Louis/Iowa and Taylor groups were applied to case record data of 116 first admissions of Schneider-negative schizophrenics--that is, those without first-rank symptoms (FRSs)--hospitalized in a strongly Schneider-oriented German University Psychiatric Clinic from 1962 to 1971. This sample had a total of 45.7% (53 cases) of psychiatric illness diagnosable by research methods. Indeed, only 31% (36 cases) of Schneider-negative schizophrenics turned out to have research-positive Kraepelin-oriented schizophrenia; and of these, 21 fulfilled both sets of research criteria for schizophrenia. It is important that 14.6% (17 cases) of Schneider-negative schizophrenia consisted of research-diagnosable affective disorder, with mania making up 5.2% and depression 9.4% of this figure. The findings suggest that a sample of Schneider-oriented schizophrenia without FRSs as routinely diagnosed in Germany does not seem to represent a clear-cut homogeneous and 'uncontaminated' group of schizophrenics.


[Focal migraine attacks without headaches (author's transl)].

The migraine without headaches is a special form of focal migraine, a migraine accompagnée without headaches. The diagnostic classification of the transient focal disturbances is made possible by careful analysis of the attacks. This type of attack starts in a localized manner (primarily in the ophthalmic area), develops corresponding to the cortical representation, and is not always restricted to one vascular area. Typical is the slow spread of symptoms over a period of ten minutes, on the average. This allows a differentiation from transient ischemic attacks or focal epilepsy. The diagnosis is supported by hereditary factors, early onset of manifestation and change of the side of focal symptoms (in 11 of 16 patients). Of 409 migraine patients, 16 were such cases, corresponding to an occurrence of 4%. There were no signs of symptomatic etiology for these transient focal disturbances.


[Readability of words as a function of their parts of speech in aphasics. A contribution to the definition of anomia (author's transl)].

Definitions of anomia as a symptom of aphasia have been classified into three categories. Some frequently cited experimental studies designed to establish a rank order of difficulty for parts of speech (nouns, adjectives, verbs) have been briefly evaluated. An experiment has been conducted with 18 mild adult aphasics who were required to read lists of words which were controlled with respect to length, frequency of occurrence and part of speech. The results show that the linguistic category of part of speech has a highly significant influence on readability. Nouns are easier to read than adjectives and these easier than verbs. This finding does not necessarily contradict many definitions of anomia, though it calls into question the validity of many widely accepted interpretations. The results were explained in terms of phrase structure and dependence grammars.


[Cytology, lactate dehydrogenase, and creatine kinase in CSF in mild head injuries (author's transl)].

Cytology, lactate dehydrogenase, and creatine kinase in cerebrospinal fluid were investigated 6-72h after mild head injuries in 59 patients aged 16-49 years. Significant differences were not found in creatine kinase. Lactate dehydrogenase, however, was significantly more elevated in mild cerebral contusions compared with concussions 24h after head injury. Monocytoid reaction in cerebrospinal fluid was significantly more distinct in mild contusions compared with concussions 24h after impact. Large phagocytes were rarely found in concussions and were not traceable 48h after impact. Large phagocytes, however, were found in 50-55% of the mild contusions 48-72h after head injury. Siderophages were found only in contusions (16.5-35%), 48-72h after impact). The optimal time for lumbar punction is 24h after head injury.


[Neuroradiological diagnosis and treatment of dural carotid-cavernous sinus fistulae (author's transl)].

The neuroradiological diagnostic and therapeutic procedure in seven patients with nine dural fistulae between distal branches of the external carotid artery and the cavernous sinus is described. All patients had proptosis, signs of increased orbital venous pressure, and different degrees of pareses of the ocular muscles. During the diagnostic investigations selective angiographies of the internal and external carotid arteries and of the vertebral arteries were performed on both sides in order to exclude or to demonstrate branches of these vessels supplying the shunts. Subsequently those branches of the external carotid arteries feeding the fistulae were angiographied superselectively and embolized by repeated Gelfoam-injections during this same examination. Finally, the embolization of the shunts was proved by control angiographies in all cases. Following embolization, a pulse-synchronous bruit preexisting in four patients had disappeared. In all patients there was a complete remission of proptosis, signs of increased orbital venous pressure and blepharoedema within 2 weeks, and of the pareses of the ocular muscles within 4 to 6 weeks. After periodical control examinations at intervals of 4 to 6 weeks and during a period of 6 to 15 months none of the patients showed neurological deficits or signs of recurrence of the embolized fistulae. Superselective angiography and simultaneous embolization of dural carotid-cavernous sinus fistulae is therefore proposed as the current therapeutic procedure of choice for the treatment of these vascular malformations.


Voluntary lid closing inability. Release of a compulsive reaction to the exploration of the environment.

Voluntary lid closing inability has been observed in two patients with right-sided frontal ischemic damage. The patients developed a transient inability to close their eyelids voluntarily at the same time as a transient forced grasping in the left hand and left hemiparesis not affecting the face. Automatic and reflex lid closures were retained as well as the ability to keep the eyes closed and to reopen them readily on command. In previous reports, inability to close eyelids voluntarily has been attributed to apraxia, paralysis, or motor impersistence. The localization of the lesion observed in our patients suggests other pathogenetic hypotheses similar to compulsive gaze [19]. It is conceivable that the voluntary lid closing inability produced by frontal lobe lesions is due to the release of a compulsion to maintain the lids elevated in the waking state, because of the overactive effect of the visual stimuli.


[Investigations of the plasma cortisol in psychiatric diagnostic groups (author's transl)].

In 23 endogenous depressives, 24 schizophrenics, 15 manics, 23 depressed neurotics, 23 nondepressed neurotics and 29 nonpsychiatric patients as controls, the plasma cortisol in the morning (7:30 a.m.) and the evening (7:30 p.m.) was measured with radioimmunoassay. Comparing the means of the groups, significant differences were found. In the morning the means of the nondepressed neurotics (-x = 16.6 microgram/100 ml), the endogenous depressives (-x = 14.8 microgram/100 ml), and the depressed neurotics (-x = 14.4 microgram/100 ml) are greater than that of the controls (-x = 10.0 microgram/100 ml). In the evening the means of the nondepressed neurotics (-x = 8.8 microgram/100 ml), the manics (-x = 6.4 microgram/100 ml), and the endogenous depressives (-x = 7.0 microgram/100 ml) are greater than that of the controls (-x = 3.6 microgram/100 ml); also, the mean of the nondepressed neurotics (-x = 8.8 microgram/100 ml) is greater than those of the depressped neurotics (-x = 4.9 microgram/100 ml) and the schizophrenics (-x = 4.4 microgram/100 ml). The results are compared with the literature. The interpretation of the findings is problematic: probably unspecific factors of stress and specific factors of illness--at least in depressive illness of the endogenomorphic type--are relevant.


Aneurysmal rupture during angiography.

A case of rupture, during angiography, of a right middle cerebral artery aneurysm with profuse hemorrhage into the subarachnoidal space is presented. Bleeding must have started between the two injections for the frontal and for the lateral carotidograms. The aneurysm that ruptured two days after a closed cerebral trauma was probably traumatic in origin.


The course of affective disorders. I. Change of diagnosis of monopolar, unipolar, and bipolar illness.

All patients suffering from affective psychoses (ICD 296) who were admitted to the Psychiatric University Clinic of Zurich between 1959 and 1963 were studied in a follow-up investigation until 1975. Of 254 affective psychoses, 95 were bipolar patients (37.4%) and 159 were monopolar (62.6%). The sample of bipolar patients was complemented with all patients who had been admitted in the period 1959--1963 because of manic or mixed manic-depressive syndromes. This paper describes the change of diagnosis in the two diagnostic groups. In 10% (N = 20) of monopolar depression cases there was a change of diagnosis to bipolar affective illness. An analysis shows that the diagnosis of patients with three or more depressive episodes (unipolar depressives) was especially prone to change. A mathematical correction of some diagnostic errors leads to the conclusion that the ratio of unipolar depression to bipolar illness may be about 1:1. A major source of diagnostic error lies in the change of affective to schizo-affective illness. Up to now, no clinical criterion exists that would exclude this error, which was found in 6% (n=12) of the monopolar but also in 7.5% (n = 3) of the bipolar index patients. It is recommended that studies of affective disorders should be based on truly representative samples of the illness, including patients with one or two episodes, and that the term 'unipolar depression' be used synonymously with the term 'monopolar depression,' originally created by Kleist (1947) and Leonhard (1957).


The course of affective disorders. II. Typology of bipolar manic-depressive illness.

A representative sample of 95 hospitalized bipolar manic-depressive patients was followed up from 1959 to 1975. The mean age of the group at the time of this study was 61 years. It was observed that female bipolar patients demonstrate depression much more frequently than mania, while male patients show a symmetric distribution of both manic and depressive syndromes. The longitudinal occurrence of syndromes remains more or less constant; for instance, individual patients do not tend to go into depression with increasing age. The study shows that even after three episodes 29% of all bipolar patients would still have been misdiagnosed as unipolar depression. An attempt is made to classify bipolar patients into three subtypes, 'preponderantly manic,' 'preponderantly depressed,' and a 'nuclear' type. Male patients belong mainly to the latter with an equal proportion of the first and third subtype. In contrast, female patients belong mainly to the depressed subtype. The findings are discussed assuming either a heterogeneity of bipolar disorders or a threshold model of affective disorders suggested by Gershon et al. (1976).


Marchiafava-Bignami disease. First case in germany.

The first case of Marchiafava-Bignami disease in a German is reported. The female patient was a heavy drinker and died after a fortnight of coma. Necropsy showed a typical degeneration of the corpus callosum and of the subcortical white matter of the right cerebral hemisphere. Furthermore, this case is the fourth of the cases of Marchiafava-Bignami disease in a woman described up to now.


Spatial distribution of colonic carcinoma.

During the past several decades, there has been a shift in the distribution of colorectal cancer toward the right side, with an increase in colon lesions on the right side and a marked decrease in rectal lesions. In 1,009 cases studied between 1966 and 1977, this change in distribution pattern is illustrated. A revision of widespread current concepts of colonic cancer detection is indicated.


Management of the appendiceal mass.

The records of forty-three patients with clinically diagnosed appendiceal abscess were reviewed to compare operative vs nonoperative therapy. Thirteen patients were operated on shortly after admission. Eleven of these had appendectomy or drainage of an abscess; two patients had right hemicolectomy. There were no serious complications, and median hospitalization was 7.2 days. Thirty patients were initially treated nonoperatively. Twenty-six of these did well and were discharged a median of 11 days after admission. Four patients required operations for failure to respond. One patient died of a pulmonary embolism. Four patients returned with recurrent appendicitis and underwent appendectomy. Three patients were later found to have other disease processes. Good results can be obtained with either form of therapy. Patients not operated on should be examined to exclude lesions masquerading as appendiceal abscesses.


Acute cholecystitis in the elderly: a surgical emergency.

A retrospective review of 88 male patients older than 60 years of age with billiary tract disease showed a mortality of 6.8%. More than 40% of the patients (39 of 88) had acute cholecystitis. Medical therapy failed for almost all of the patients (38 of 39) with acute inflammatory disease and they then required an operation during their initial hospitalization. In this acute disease group, 21% had empyema of the gallbladder, 18% had gangrenous cholecystitis or free perforation of the gallbladder, and 15% had subphrenic or liver abscesses. Escherichia coli and Klebsiella were obtained from 78% of the bile cultures, and obligate anaerobes were present in 25% of them. A delay in diagnosis and operation occurred in 33% of the patients with acute disease. Factors responsible for this delay included a deceptively benign clinical presentation and the requirement for prolonged resuscitation. Since response to conservative measures is unlikely in the elderly patient with acute cholecystitis, optimal management consists of resuscitation and prompt operation for control of infection.


Management of major arteriovenous fistulas by arteriographic techniques.

Five patients with major symptomatic arteriovenous fistulas were treated between July 1976 and December 1977. In two patients the fistulas were due to trauma; in two others, malignant neoplasms; and in one patient, congenital angiodysplasia. The anatomic location or extent of each arteriovenous fistula would have made direct surgical access to the fistula sites difficult; therefore, it was elected to use arteriographic embolization techniques to attempt definitve obliteration of the fistulas. Wool-tufted wire coli emboli were used in three patients and gelatin sponge-autologous blood clot was used in two patients. These were precisely embolized to the fistula site by superselective catheterization of the feeding artery. Complete obliteration of the fistulas was achieved in each case with no morbidity. Follow-up clinical and ateriographic examination confirmed persistence of fistula closure.


Salmonella arteritis: a precursor of aortic rupture and pseudoaneurysm formation.

Salmonella arteritis developed in three patients with subsequent arterial rupture and pseudoaneurysm formation. They had a one- to two-week history of chills and fever, and blood cultures were positive for salmonella. Pulsatile, tender abdominal masses developed in two patients with aortic infection while they were hospitalized. The third patient's femoral artery infection presented as a painful swelling behind the knee. Arteriography demonstrated large vessel rupture with pseudoaneurysm formation and allowed a planned operation in each case. The infected aortic aneurysms were totally excised, the aortic stump oversewn, and the retroperitoneum drained through the flank. Axillobifemoral grafts were constructed to bypass the infection area. Antibiotics effective against salmonella (ampicillin sodium, amoxicillin trihydrate, or chloramphenicol) were given for six weeks postoperatively. Allthree patients are alive without evidence of furhter infection. Recognition that microbial arteritis may be a complication of salmonella infections, particularly when Salmonella choleraesuis and Salmonella typhimurium are cultured, will lead to earlier detection of vascular lesions.


Poststress Doppler ankle pressures: a comparison of treadmill exercise with two other methods of induced hyperemia.

Postocclusion reactive hyperemia and isolated leg exercise were evaluated as techniques for functional evaluation of lower extremity arterial insufficiency by comparing them with treadmill exercise. Sixty patients with claudication and six normal subjects were evaluated. Changes in Doppler ankle pressures were measured after each form of stress. With substantial occlusive disease, there is a drop in pressure with gradual recovery. Postocclusion reactive hyperemia and isolated leg exercise are abnormal if the pressure does not return to resting levels within two minutes. There was good correlation between the three methods. Postocclusion reactive hyperemia avoids the problems of patient cooperation inherent in the other two methods. Postocclusion reactive hyperemia should probably replace treadmill exercise as the first method of stress testing lower extremities.


Patency of biologic and prosthetic inferior vena cava grafts with distal limb fistula.

A 5-cm segment of the infrarenal inferior vena cava (IVC) in 27 dogs was excised and replaced with a prosthesis of bovine heterograft, venous allograft, or polytetrafluoroethylene (ePTFE). On completion of the IVC graft, a side-to-side femoral arteriovenous fistula was constructed in the thigh. At six weeks an IVC venogram was obtained to assess patency and the femoral arteriovenous fistula closed. After three months, the dogs were reexplored, the grafts were removed, and patency was determined. Patency of the venous allograft and bovine heterografts were maintained with the arteriovenous fistula in only two dogs and further deteriorated after closure of the fistula so that only one dog in each group had a patent IVC graft at the end of three months. Eight of the 13 e-PTFE prostheses were patent at six weeks and remained patent for three months after fistula closure. Light and electron microscopy of the patent e-PTFE specimens excised at three months showed regenerative endothelium. Expanded e-PTFE was the most suitable prostheses for replacement of the IVC, resulting in 61% patency three months after closure of a distal arteriovenous femoral fistula.


Pseudo-obstruction of the colon.

Psuedo-obstruction of the colon is a potentially lethal condition. The diagnosis should be suspected in a patient with derangement of a major extra-abdominal organ system in whom abdominal distention develops. Diagnosis is established by plain abdominal roentgenograms, signoidoscopy, and barium enema examination. The salient features of these examinations are as follows: (1) massive gaseous distention of the cecum and variable distances of the distal colon to a "cut-off-point"; (2) lack of fluid-filled colon; (3) normal sigmoidoscopy; and (4) barium enema examination, which rules out mechanical obstruction, volvulus, and mesenteric vascular ischemia. If the diameter of the cecum is less than 12 cm, conservative therapy is indicated but persistence of the distention or cecal diameter greater than 12 cm is an absolute indication for cecostomy. Perforation must be treated by cecostomy or colectomy depending on the amount of colon necrosis.


Cardiac function and hypercarbia.

In 12 patients with heart disease, hypercarbia was induced for carotid endarterectomy. Anesthesia was maintained with nitrous oxide in oxygen and methoxyflurane. In addition to intra-arterial measurements of blood pressure, cardiac output, systolic time intervals (STI), and pressure time indices (PTI) were determined in order to assess cardiovascular responses in these patients. Internal carotid stump blood pressure was measured in five patients before and after induction of hypercarbia. Mild elevation of the Paco2 level affected systolic time intervals but not heart rate and blood pressure. When  Paco2 levels reached 56 to 65 torr, systolic but not diastolic blood pressure rose significantly, heart rate and cardiac output increased, while the shortening in the preejection period (PEP), left ventricular ejection time (LVET), and the decrease in the PEP/LVET ratio signified increased mechanical cardiac activity. Hypercarbia caused intense sympathetic stimulation as demonstrated by twofold to threefold increases in plasma catecholamine levels. Stump blood pressure was elevated. Cardiac oxygen demand was significantly increased, while coronary filling time was shortened, as indicated by the increase in the tension time index and shortening in the diastolic time. This signified a relative myocardial underperfusion. Thus, while hypercarbia to levels of 66 to 70 torr increased internal carotid artery stump pressure, it also caused increased cardiac mechanical activity and concomitant unfavorable balance between myocardial oxygen consumption and supply. The measurement of STI and the computation of PTI provided early detection of alterations in cardiac function.


Primary carcinoma of the cystic duct.

We described a case of primary carcinoma of the cystic duct that conforms to previously established criteria. To our knowledge, this is the 21st recorded case; it was accidentally discovered during cholecystectomy. The features of all 21 cases are reviewed. Since these tumors tend to be treated surgically at an early stage because of the relatively early developement of clinical symptoms, such as right upper abdominal pain and palpable mass, caused by the obstruction of the cystic duct, the prognosis is better than that of other extrahepatic bile duct carcinomas.


Closure of an acute perforated peptic ulcer with the falciform ligament.

When management of a perforated peptic ulcer necessitates simple closure, the omentum may not be of adequate quality to buttress such a closure. In  this unusual circunstance, we have found the falciform ligament to serve as an effective alternative to satisfactorily peptic perforations.


Late results of atrial septal defect repair in adults.

Repair of secundum atrial septal defects in 75 patients older than age 40 years was associated with a good long-term result, from five to 21 years postoperatively, in 89% of patients who were class I and II preoperatively and in 86% of those in normal sinus rhythm preoperatively. Functional class III or IV, atrial fibrillation, a higher pulmonary artery mean pressure and higher pulmonary vascular resistance affected the prognosis adversely. Repair of atrial septal defect in adults did not reverse existing atrial fibrillation and did not protect against the onset of new atrial fibrillation.


Congenital aortic stenosis: ten to 22 years after valvulotomy.

Between 1956 and 1967, 34 patients, aged 2 months to 40 years, underwent aortic valvulotomy under hypothermia for congenital aortic stenosis. There were two early and five late deaths. Twenty-seven patients were followed up for a mean of 15 years. Thirteen patients had no subsequent operation: 11 are asymptomatic, seven with mild aortic insufficiency. Ten patients have had aortic valve replacement (AVR), one revalvulotomy, three will require AVR. Three late deaths were sudden. The literature has been reviewed for data on mortality, endocarditis, aortic insufficiency, and reoperation. Operation improves longevity, but does not restore it to normal. Aortic valve replacement in children carries a poor prognosis, possibly reflecting severity of disease. The chances of reoperation after ten years are 20% to 40%. Valvulotomy must, therefore, be regarded as the first in a possibly lifelong series of operations.


Hemodynamic and angiographic guidelines in selection of patients for femorofemoral bypass.

Although crossover femorofemoral grafts have had good long-term patency, all patients have not been symptomatically improved. Seventy-one patients underwent 80 femorofemoral bypasses from 1968 to 1978. Hemodynamic assessment included preoperative and postoperative segmental Doppler pressures and femoral artery waveform recordings. Preoperative and selective postoperative arteriography was routinely performed. Twenty-nine failures occurred predominantely in two groups, those with greater than 50% stenosis of the donor iliac artery and those with severe recipient limb outflow occlusive disease. Ten patients with normal outflow beds bilaterally associated with 10% to 50% stenosis of the donor iliac artery underwent successful femorofemoral reconstruction. Progression of donor iliac artery disease was seen in only two patients. Cumulative five-year patency was 74%. Operative mortality totaled three (3.8%). This study supports the use of femorofemoral bypass as a primary procedure when proper guidelines are used.


Comparison of caval filters in the management of venous thromboembolism.

Over a seven-year period, 38 Mobin-Uddin MU and 33 Kim-Ray Greenfield KG vena cava filters were inserted in 71 patients with no substantial complications or deaths directly related to the surgical procedure. Thirteen of the 16 early deaths were due to progression of associated diseases. The remaining three deaths were caused by pulmonary emboli and occurred in each instance after insertion of a MU filter. None of the 14 late deaths were related to the caval filter or sequellae of venous thrombosis. Inferior vena cava patency was objectively assessed in 36 patients by cavagram (22) or autopsy (14). Caval patency of 95% (18 of 19) in those with KG filters was significantly greater than the 47% patency (eight of 17) seen with MU devices (P less than .01). Gray scale ultrasound, when successful in visualizing the vena cava, was found to be a reliable indicator of patency. Venous stasis phenomena were noted in 50% of those with a patent cava and in 70% of those with an occlusion. Thus, it is not surprising that edema was found in only 38% of the patients as compared with 75% of the patients with the MU filter. Both of these devices are safe to insert. However, on the basis of superior patency rate, lower incidence of stasis phenomena, and the absence of recurrent pulmonary emboli in our series, we prefer insertion of a KG filter when caval interruption is required.


Ex vivo renal artery reconstruction.

Twenty-four patients underwent ex vivo renal artery reconstruction of 26 extensive lesions using continuous hypothermic perfusion and replacement of the diseased renal artery with a hypogastric artery autograft. Postoperative acute tubular necrosis was avoided in these repaired kidneys. There was one postoperative graft occlusion accounting for the only failure in the series. Of the hypertensive patients, 95% were cured or improved during the follow-up period extending from six months to six years. Six of these patients have been followed more than three years and late postoperative arteriograms showed no alteration in their autografts. This method, therefore, extends the potential for renal artery reconstruction to most renal vascular lesions, reserving nephrectomy for the infarcted or severely atrophic kidney only.


Ultrastructure of medial smooth muscle and myofibroblasts in human arterial dysplasia.

Ultrastructural characteristics of 20 dysplastic human renal arteries were documented. Loss of smooth muscle with collection of fibrous connective tissue predominated in medical fibrodysplasia, whereas excessive accumulations of elastic fibrils typified perimedial dysplasia. Myofibroblasts were a unique feature of both forms of arterial dysplasia. These modified smooth muscle cells seemed to be the source of abnormal connective tissue synthesis. Transformation of medial smooth muscle cells to myofibroblasts represented a morphologic continuum. Intramedial vasa vasorum were often isolated from surrounding cellular elements by unusual amounts of mural ground substances. The results of this study lend further support to the hypothesis that ischemia and direct physical forces effect hormonally altered cells in the pathogenesis of arterial dysplasia.


Isolated aneurysms of the iliac artery.

Clinical and diagnostic material were gathered from eight cases of iliac aneurysms encountered over a ten-year period. From the literature, descriptions of 36 lesions were also reviewed to identify their outcome when treated conservatively. Six of the eight aneurysms treated as expected resulted in eventual rupture. Although 48% of all patients (those in the present series and those reported in the literature) had symptoms before rupture, the symptoms of intact iliac aneurysms often mimicked urological or neurological diseases. In contrast to persons with abdominal aortic aneurysms, only 36% of all patients had a palpable abdominal or rectal mass before rupture. In 65% of all cases, noninvasive roentgenography failed to show the lesions. An aneurysmal lesion was often (23%) present in the opposite iliac system as well. Ninety-three percent of all patients survived after an elective operation, but only 48% survived after an emergency iliac aneurysmectomy after rupture occurred.


Effect of arterial reconstruction on limb salvage: a ten-year appraisal.

Two hundred forty-four consecutive patients were reviewed who presented themselves over a ten-year period (1967 to 1977) with threatened limb loss secondary to arteriosclerosis involving the arteries supplying the lower extremities. Patients with claudication as the presenting complaint were not included. Primary amputation was performed in 14 patients (6%), with an operative mortality of 21%, whereas arterial reconstructive surgery was carried out in 230 patients (94%) with an operative mortality of 2.7% One hundred eleven femoral-popliteal vein grafts in 101 patients showed a cumulative five-year graft patency of 78% with a limb salvage rate of 73%. Twenty-eight femoral-femoral grafts and 21 axillary-bilateral femoral grafts yielded five-year graft patency rates of 91% and 77%, respectively: the limb salvage rates were 91% and 86%. Inclusive of the 14 patients undergoing primary amputation, the overall five-year cumulative limb salvage in the entire group was 76%.


Diagnosis of peripheral occlusive disease: comparison of clinical evaluation and noninvasive laboratory.

One hundred and two patients with peripheral vascular disease were evaluated by the attending surgeon, residents and students, and the vascular laboratory prior to arteriography to test their ability to make a correct anatomic diagnosis. The attending surgeons made a correct anatomic diagnosis in 98 patients and were at least partially correct in the other four. Surgical housestaff and students were 62% totally correct, 35% partially correct, and 3% totally wrong. The vascular laboratory results were almost identical with the attending surgeon, but two patients could not be evaluated because of calcified arteries. The operation that was eventually performed was suggested initially by the laboratory and the attending surgeon in 98% of the patients.


Improved treatment of popliteal arterial injuries using anticoagulation and extra-anatomic reconstruction.

Management of popliteal arterial injuries remains a challenging problem. Early recognition and treatment, arteriography, fasciotomy, and repair of concomitant popliteal venous injuries are modalities that have contributed to improved results. Systemic heparin sodium anticoagulation and selected extra-anatomic vein graft bypass of the popliteal area are two additional measures that have contributed to a 91% success rate in treatment of popliteal arterial injuries and five of six blunt injuries were treated successfully in this time period. A limb salvage rate of only 46% was attained in the previous five-year period. There were no operative deaths. No complications attributable to systemic anticoagulation or extra-anatomic bypass graft occurred. These adjuncts are recommended to all who manage vascular injuries.


Selected therapy for ascending aortic aneurysms.

Since 1971, ten patients, 26 to 62 years of age, have undergone repair of ascending aortic aneurysms with concomitant aortic insufficiency. Three patients had Marfan's syndrome, five patients had cystic medial necrosis, one had leutic aortitis, and one had atherosclerotic involvement of the aorta. There was one operative death. Follow-up exceeds seven years. Because of the tendency for progressive annular and sinus dilation in Marfan's syndrome, composite graft and valve conduits with reimplantation of the coronary arteries is the procedure of choice. In selected patients with annulaortic ectasia, good valve tissue and no sinus dilation, bicuspidization of the valve, and replacement of the ascending aorta is indicated. The operation is generally less formidable than composite graft replacement, maintains normal coronary anatomy, and alleviates the long-term risks of anticoagulation.


Significance of asymptomatic carotid bruits.

To assess the significance of the asymptomatic carotid bruit, the subsequent occurrence of symptomatic cerebrovascular insufficiency and stroke in 256 patients who had undergone operation for atherosclerosis arterial occlusive disease of the lower extremities was documented during a period of two to seven years postoperatively. At the time of operation, none had had a stroke or exhibited symptoms of cerebrovascular insufficiency, but 60 of the 256 patients had audible carotid bruits. A statistically significant difference was demonstrated: 21 (35%( of the 60 patients with carotid bruits exhibited manifestations of cerebrovascular insufficiency, in contrast to 30 (16%) of the 196 patients without bruits. It seems that detection of an asymptomatic carotid bruit is not an innocent finding, but rather predicts a higher incidence of cerebrovascular complications than that expected on the basis of generalized atherosclerosis alone.


Doppler cerebrovascular examination, oculoplethysmography, and ocular pneumoplethysmography use in detection of carotid disease: a prospective clinical study.

To determine the comparative acccuracy of three noninvasive cerebrovascular testing systems, 72 patients underwent complete evaluation by Doppler cerebrovascular examination (DCE), oculoplethysmography (OPG-Kartchner), ocular pneumoplethysmography (OPG-Gee), and angiography. Considering 60% diameter stenosis or more by angiography as a true positive finding, the noninvasive tests of the 72 patients showed the following results: DCE, two false-positive, 17 false-negative, and 53 correct with an overall accuracy of 74%; OPG-Kartchner, six false-positive, four false-negative, and 62 correct with an overall accuracy of 86%; and OPG-Gee, no false-positive, two false-negative, and 70 correct with an overall accuracy of 97%. Independent of noninvasive test results, 57 symptomatic and three asymptomatic patients were selected for carotid endarterectomy. Of these 60 patients, 55 (92%) had positive preoperative OPG-Gee tracings. Noninvasive testing is a valuable carotid endarterectomy. Although considerable carotid ulceration may be undetected by noninvasive study, it was uncommon in this series.


Natural history of nonstenotic, asymptomatic ulcerative lesions of the carotid artery.

To define the natural history of the asymptomatic, nonstenotic, ulcerative lesion involving the carotid artery bifurcation, the arteriograms and clinical course of 67 patients with 72 asymptomatic ulcerative lesions of the carotid artery were reviewed. The angiographic appearance of ulceration was classified into three groups: minimal (group A), large (group B), and compound (group C). Using life-table methods, the clinical course of these patients was compared between groups and was also compared to a nonrandomized surgically treated group of patients with nonstenotic ulcerative lesions in whom operation was performed for hemispheric or monocular symptoms. There were no significant (P greater than .1) differences in mortality, but the differences in stroke incidence was highly significant (P less than .001). The annual stroke rate, averaged over seven years, was 0.4% per year for group A, 1.47% per year for the surgically treated group, and 12.5% per year for groups B and C. The data indicate that group A ulcers have a benign prognosis, in noticeable contrast to group B and C ulcers which incur a high risk for subsequent stroke.


Results of carotid endarterectomy for vertebrobasilar insufficiency: an evaluation over ten years.

A review was performed of 114 patients with symptoms of vertebrobasilar insufficiency (VBI) alone, or in combination with carotid territory transient ischemic attacks or carotid territory completed stroke (cCS) with follow-up extending to ten years. The most frequent symptoms of VBI were visual changes (50%), dizziness (31%), and syncope (30%). Patients with symptoms of VBI and arteriographic evidence of intracranial disease, regardless of stump pressure, are at high risk for cerebral ischemia during endarterectomy. At late follow-up, ranging from one to ten years, 63% of the patients were alive; 88% were asymptomatic. Causes of death were mainly cardiac (44%) and stroke (36%), but patients with symptoms of VBI and cCS died earlier and from a second cerebrovascular accident. When a correct preoperative diagnosis was established, carotid endarterectomy produced relief of symptoms in 90% of the patients.


[Digestibility and utilization of rations containing differently treated straw. I. Digestibility by sheep of rations containing differently treated straw].

During 63 digestibility periods of adult sheep, the digestibility of wheat and oat straw sujected to different kinds of treatment was compared. The straw was fed in the following forms: chopped, chopped and treated with 6% sodium hydroxide, pelleted without and with NPN-addition (ammonium bicarbonate and/or urea) during pelleting. Notwithstanding pressing temperatures over 90 degrees C and light moistening of the straw during pellet production, the addition of the two NPN-components did not allow to increase digestibility and energetic feed value. Two replications averaged an increase in energetic feed value by 42% due to NaOH-treatment. Energy digestibility went up by 39 to 55%, and energy concentration increased from 322 to 457 energetic feed equivalents (cattle) per kg DM. In addition, a number of rumen-physiological indices were obtained.


[Digestibility and utilization of rations containing differently treated straw. 2. Energetic utilization by sheep of rations containing differently treated straw].

A total of 59 complete metabolic periods of adult sheep were used to compare energy balance and energy utilization of rations containing 45, 60 and 99% of straw previously subjected to different treatments. In addition, some indices of rumen physiology were determined. The straw was fed in the following forms: chopped, chopped and treated with 6% sodium hydroxide, pelleted with and without NPN-addition (ammonium bicarbonate and/or urea) during the pelleting process. Notwithstanding pressing temperatures above 90 degrees C during compaction, the addition of NPN-compounds did not result in increased digestibility. The NaOH-treatment of the straw increased the energy digestibility of the ration containing 45% straw by 5 to 6 digestibility units. All experiments revealed a higher energy balance and, consequently, a higher energy utilization than could be expected from calculations on the basis of equations derived from earlier experiments with adult sheep. The variations are discussed under the aspect of energetic feed evaluation and with regard to consequence for the efficient use of straw in rations for ruminants.


[Digestibility and utilization of rations containing differently treated straw. 3. Energetic utilization by fattening bulls of rations containing differently treated straw].

In 136 complete metabolic periods of fattening bulls (live weight range 250 to 440 kg) comparative studies were performed on rations containing 30 to 40% straw previously subjected to different treatments. In addition, several rumen-physiological and blood indices were determined. Chopped straw without and with NaOH (6%) treatment and straw pellets without and with NPN-addition (ammonium bicarbonate and/or urea) during the pelleting process were used. No significant differences were found between comparable rations as to energy digestibility. The rations containing 60% straw revealed a higher evergy balance and, consequently, a higher energy utilization than could be expected from calculations on the basis of equations derived from previous experiments with adult steers. The importance of straw as energy source for ruminant feeding is highlighted.


[Results of comparative studies on ammoniated straw pellets conducted in two research institutions of animal nutrition].

Ammoniated straw pellets were produced from pure wheat straw in a pelleting press reaching temperatures of more than 90 degrees C, 4% NH4HCO3 being added as degradation agent. Digestibility trials with sheep gave 389 energetic feed equivalents (cattle) per kg straw dry matter. This value exactly agrees with the formula Energetic feed equivalents (cattle)/kg DM = 650 -6x x = % crude fibre in dry matter which had been reported first in 1973 by Bergner and Marienburg (Arch. Tierernährung 23, 423 [193]) for chemically treated straw pellets. When testing the digestibility of the same straw pellets charge in the Animal Nutrition Division of the Dummerstorf-Rostock Research Centre for Livestock Production, considerably lower values were found which would allow to calculate energy concentration to amount to 310 energetic feed equivalents (cattle)/kg DM (see Arch. Tierernährung Vol. 28, page 393). The reason for this 20% lower feed value of the straws pellets lies possibly in the reversibility of the degradation effect when using ammoniacal media. The digestibility of the straw pellets had been tested in the Berlin research Institution one year earlier than at the Rostock Institute. The possible causes of the reversibility of the ammoniacal degradation effect are discussed.


[Improvement of the feed value of straw by pelleting and sodium hydroxide addition. 1. Changes in the digestibility of rye and wheat straw].

Four series of pelleting experiments were conducted using straw from winter rye and winter wheat crops. Pelleting was done with and without grain addition. In each of the experimental series, 7 NaOH dosage levels were tested Further, 2 to 5% urea were added to the mixture to be pelleted. The 28 different pellet batsches and untreated straw were fed to sheep to study digestibility. Evaluation by difference trial revealed that straw pelleting without NaOH addition reduces the digestibility of organic matter by 4.7 units, on the average, whilst NaOH addition was found to increase digestibility depending on the dose applied. The following relationship was found between digestibility of straw dry matter (y) and NaOH dose in g/kg straw dry matter (x): y = 43.4 + 0.358x -0.00116x2. The grain proportion proved largely inert as far as the NaOH action is concerned. In one experimental series in which wheat straw without grain addition had been compacted at high pressing temperatures, an additional disintegration effect was observed irrespective of the NaOH dose applied. It increased digestibility by 8.0 units and is very likely to originate from the specific action of urea.


Characterization of a Sinbis virus variant with altered host range.

A variant of Sindbis virus which is much more infectious for mouse cells than the standard virus has been examined for biochemical properties which might be responsible for this biological difference. The variant has a much enhanced ability to adsorb to mouse plasmacytoma (MOPC 315) cells, but when these cells were pretreated with heparin, they were able to adsorb the standard virus almost as well as the variant. This suggested that there was a surface charge difference between variant and standard virus. Differential elution of the viruses from hydroxyapatite and the results of isoelectric focusing of the virion glycoproteins substantiate this interpretation. Both viral glycoproteins E1 and E2 from the variant were more negatively charged than those of the standard virus but we were unable to find changes in tryptic peptides of the variant. Differences were found in stability of the two virus strains to heat and proteolytic enzymes.


Virulence alterations of tacaribe virus infection in adult mice: lethal model for encephalitis.

Selection of population of Tacaribe virus strain 11573 lethal for mice was carried out by serial intracerebral passage of the virus in adult mice. Viral populations have been characterized by determination of virulence for suckling, weanling, and adult mice, and by histopathologic changes observed in brains of adult mice after intracerebral inoculation. Some of the virus preparations produced 80 to 90 per cent mortality after two or three intracerebral passages in adult mice and maintained this virulence for 1 to 3 passages, after which the virulence rapidly declined with subsequent passages. Clinical signs of infection in adult mice were manifested by a rough hair-coat, ventriflexed posture, diminished activity, increased excitability, flaccid hind-limb extension with progressive paralysis and death. Histologic examination revealed meningoencephalitis.


Inhibitory effect of virazole (ribavirin) on the replication of tomato white necrosis virus (VNBT).

Tomato plants (Lycopersicon esculentum Mill.) inoculated with tomato white necrosis virus (VNBT) and treated with Virazole (1-beta-D-ribofuranosyl--1, 2, 4-triazole-3-carboxamide) at a concentration of 500 mg/l developed systemic virus symptoms in only 40 per cent of the plants in which a remarkable reduction in virus concentration was also observed. From inoculated and Virazole-treated plants which had produced no symptoms, no virus could be recovered. This result suggests that Virazole may inhibit replication of VNBT in tomato.


An electron microscopic study of the surface structures and hemadsorption on chick embryo cells infected with rabies virus.

Characteristic alterations at the surface of chick embryo cells infected with the HF-TC strain of rabies virus and the binding sites of hemadsorption were studied employing both scanning and transmission electron microscopes. The initial alteration of the cell surface structure revealed by scanning electron microscopy was an appearance of elongated and reticulated microvilli on the 2nd day after virus inoculation. On the 3rd day, numerous bullet-shaped virions could be seen budding as single, tetrapod-like structures and as radial projections both from the perikarya and microvilli. Thereafter, elongation of microvilli, formation of numerous blebs in various sizes, disappearance of filopodia, and rounding up of infected cells were observed as characteristic cytopathic effects by rabies virus infection. The attachments of goose erythrocytes to the infected cells occured in two forms. The one was adsorption of erythrocytes to the cell surface involving microvilli and filopodia in the absence of detectable virus, and the other was adsorptio n of erythrocytes to the virus particles budding from cell surface. The former could be seen from the early stage of infection through the end of observation period, while the latter was observed only on and after the 3rd day after virus inoculation. These findings were also confirmed with transmission electron microscopy.


[Morphology of the thymus as an index of immunodeficient states in children].

Thymus and other lymph organs were examined in 4799 dead infants and stillborns for the detection of immune deficiency conditions. Congenital immune deficiencies were found in 12 cases (11 deaths and 1 stillbirth) which made 2.5 cases per 1000. Changes in the thymus were found to be most important for the elucidation of the presence or absence of congenital defects of the immune system. Five main types of thymus changes were distinguished: agenesis, hypoplasia of the reticuloepithelium, hypoplasia of the lymphatic tissue, unscheduled fatty metamorphosis, hyperplasia of the lymphatic tissue with or without formation of follicles. A pattern of immune defect is suggested on the basis of changes in the thymus.


[Cytological recognition of the histological types of lymphogranulomatosis in children].

Examinations of punctates and impressions of lymph nodes from 68 children with primary untreated lymphogranulomatosis permitted to develop the criteria for differential cytological diagnosis of all types and variants of lymphogranulomatosis on the basis of histogenetic analysis and clinico-morphological comparisons, according to histological classification of the WHO. This proved to be possible only after it had been assumed that the original tumor cell must be a semi-stem cell of bone-marrow origin of histiocytic-reticular shoot which normally provides for physiological regeneration of reticular network of the lymph node. It appears that such a cell is a small lymphocyte-like cell with invaginated nucleus, the so-called small cleaved cell.


[Morphology and pathogenesis of "brain death" in stroke].

The results of morphological examinations of the central nervous system and hypophysis in 15 cases of insult and "brain death" developing in patients under conditions of application of artificial lung ventilation (ALV). Isolated death of the brain was observed to be due to discontinuation of intracerebral circulation owing to a sharp increase of intracranial pressure. Morphologically, cerebral edema, necrosis of all parts of the brain without reactive changes in neuroglia and vessels, necrosis of the 1st and 2nd cervical segments of the spinal cord, necroses in adenohypophysis, zones of demarkation in the hypophysis capsule and at the level of the 3rd and 4th cervical segments of the spinal cord, and arrest of the blood stream in the brain vessels were observed. The intensity of the morphological changes was found to depend on the duration of ALV.


[Morphological analysis of the Mallory-Weiss syndrome as the basic disease and as a syndrome complicating ischemic heart disease].

On the basis of the analysis of 8 autopsies of Mallory-Weiss syndrome macro- and microscopic changes of the gastric and oesophageal mucosa were found to be similar in Mallory-Weiss syndrome and in the same syndrome accompanying ischemic heart disease. Liver insufficiency and necrobiotic changes of the liver accompanying it are characteristic of Mallory-Weiss syndrome as a distinct disease.


[Proliferating myositis].

A clinico-morphological analysis of 6 cases of proliferating myositis is presented. The patients varied in ages from 31 to 59 years. All the patients reported an extremely rapid growth of swellings: the period from the moment of the "tumour" detection to the operation was within 1 month, and in 4 cases 2 weeks. The main features of the microscopic structure of proliferating myositis included marked proliferation of fibroblasts and random arrangement of large cells with basophilic cytoplasm resembling rhabdomyoblasts and ganglionic cells. A detailed clinico-morphological analysis of the disease permits to differentiate proliferating myositis from similar soft tissue neoplasms (embryonal rhabdomyosarcoma, ganglioneuroblastoma, fibrosarcoma, extraabdominal desmoid, nodular fascitis).


[Alveolar soft tissue sarcoma].

An autopsy observation of alveolar soft tissue sarcoma of the left hip muscles in a man of 66 is described. Predominantly lymphogenic metastasizing of the alveolar sarcoma was observed and two hypes of tumour cells, "dark" and "light" were distinguished. PAS-positive substances, lipids and mucus were found in the cytoplasm of the "light" cells. Histogenetically, the alveolar soft tissue sarcoma is assumed to be close to striated muscles.


[Sudden death syndrome in infants].

The literature data on the so-called sudden death syndrome (SDS) in children are presented. Theories interpreting this condition from epidemiological, morphological, microbiological, immunological, physiological and biochemical positions are discussed. SDS is thought to be an abstract notion including various definite pathological conditions which are thus far difficult to interpret from nosological positions. A possible role of unfavourable constitutional factors in the SDS genesis, particularly under conditions of virus infection conducive to their manifestation is suggested.


[Thrombocyte function in acute leukemia].

The literature data on the condition of the platelet part of the homeostasis in patients with acute leukemia are summarized. The importance of functional changes in blood plates in the development of hemorrhagic complications is demonstrated. In acute leukemia, the development of various platelet syndromes such as thrombasthenia, thrombocytopathy, including a deficiency of the pool of storage of athrombia is possible.


Intra-aortic balloon pumping: theory and practice. Experience with 325 patients.

Intra-aortic balloon pumping to support the failing circulation is now an accepted therapeutic modality. The device is simple. Insertion can be accomplished rapidly and efficiently in emergency rooms, coronary care units, cardiac catheterization suites and operating rooms, preoperatively, intraoperatively and postoperatively. The hemodynamic effects are immediate and predictable, and the accruing clinical results show increasing survival and hospital discharge rates. In these institutions, mechanical support of the circulation by this and more advanced methods has been formalized within the responsibility of a Circulatory Support Service. The purpose of this report is to summarize some observations and analyses which have been made during care of 325 consecutive postcardiotomy and/or postinfarction cardiogenic shock patients. Historical, theoretical, basic, and applied aspects and current results are included. Foremost are the straightforward concepts of considering the heart as a pump, the failing heart as a failing pump and intra-aortic balloon pumping as a temporary intravascular, auxiliary pump, capable of stabilizing or reversing that failure if utilized early in its evolution.


A simple left heart assist device for use after intracardiac surgery: development, deployment and clinical experience.

A simple left heart assist device (LHAD) has been developed and employed in nineteen patients with severe left ventricular dysfunction who could not be weaned from cardiopulmonary bypass following intracardiac surgery. It has been used when all other means of weaning, including maximum pharmacologic therapy and intra-aortic balloon counterpulsation (IABC), had failed. The device utilizes specially designed and constructed obturated cannulae in the left atrium and the ascending aorta, and an extracorporeal roller pump to partially bypass the left ventricle. With improved cardiac performance, the patient may be separated from the device without need for thoracic reentry. Of the nineteen patients having LHAD support (2-500 hours), thirteen were eventually weaned from the device and seven were discharged from the hospital. Five patients remain alive and well (18 to 50 months postoperatively).


Transapical left ventricular bypass: a method for partial or total circulatory support.

A simple cannula method of partial or total left ventricular bypass, utilizing a roller pump and outflow filter, has been developed and applied clinically. One of three patients with severe cardiac and multisystem failure was pumped with total left ventricular bypass for six days and decannulated with recovery of myocardial function after nine days. These results are encouraging and suggest that a number of patients could be salvaged from temporary cardiac failure with a simple cannula-roller-pump bypass system.


Clinical application of the ellipsoid left heart assist device.

The ellipsoid left heart assist device (E-LVAD) was implanted in eight patients suffering from intraoperative heart failure. It was not possible to remove these patients from extracorporeal circulation following an intracardiac procedure; therefore, implantation of the E-LVAD was performed during extracorporeal circulation. The inflow connector was pushed forward from a purse-string suture on the right superior pulmonary vein, across the mitral valve and into the left ventricle. The outflow connector was joined to the ascending aorta. In two patients, the artificial heart chamber was removed after complete recovery of the circulation; these patients, however, later died. In six other patients, untreatable right heart failure developed and these patients died with the pump in place. It is concluded, therefore, that the right heart must also be mechanically supported during postoperative heart failure.