The influence of the degree of maturation of donor tissue on the reconstruction of elastic cartilage by isolated chondrocytes.

Chondrocytes isolated from auricular cartilage of 1-, 14-, 28- and 56-day-old rabbits were injected intrasmuscularly as auto- or allogeneic transplants, and the development of the reconstructed cartilage was compared to that of intact tissue. Chondrocytes in cartilage of 1- and 14-day-old rabbits (younger group) were relatively uniform in size. During further development in situ (28 and 56 days) central cells increased considerably and many of them became binucleated. Cartilage reconstructed by chondrocytes from the younger group of animals displayed regular arrangement of cells, i.e. smaller cells at the periphery and larger in the centre. Transplantation of chondrocytes from 28 or 56-day-old rabbits (older group) led to the reconstruction of cartilage with irregular distribution of cells, i.e. some large cells were located at its periphery, while in the centre smaller and larger cells were intermingled in a haphazard manner. Elastic fibres were scanty and thin in cartilage of 1-day-old animals, but their number and size increased with time and they displayed a characteristic pattern. Formation and maturation of these fibres proceeded in cartilage reconstructed by chondrocytes from the younger gorup of animals similarly as in the intact tissue. Chondrocytes from the older group of rabbits reconstructed cartilage in which the number of elastic fibres was reduced and their arrangement appeared irregular.


Ocular myopathy (progressive external ophthalmoplegia) with neuropathic complications.

The condition known as Ocular Myopathy or Progressive External Ophthalmoplegia is reviewed. Three hundred and thirty-five published case reports have been analyzed and 13 personal cases are described. Histological and electron microscopical studies on one of our cases are reported. It is clear from these cases that, although in its simplest form the condition may consist merely of myopathic changes confined to the upper eyelids and external ocular muscles, myopathic changes may also occur in the muscles of the face, neck and proximal parts of the limbs. In addition, however, a variety of neurological disorders may also develop and degenerative lesions have been found in the peripheral nerves, spinal cord, brain stem, and basal ganglia. Other associated conditions such as perceptive deafness, pigmentary retinal degeneration, cardiomyopathy and red cell abnormalities may also occur. There is thus a wide spectrum of syndromes, all based on a condition which is possibly a general metabolic disorder. Recent work has directed attention to mitochondrial abnormalities in the affected muscle fibers and other cells. A positive family history may be present and an autosomal dominant mode of inheritance seems likely.


Brain proteins in hepatic encephalopathy.

Brain proteins were analyzed in supra- and infratentorial structures of 6 patients dying from liver failure. An equal number of patients, lacking any evidence of liver disease or neurological disorder, served as controls. The results were related to regional light microscopic findings. Hepatic coma was associated with a marked reduction of soluble brain proteins, particularly in areas of grey matter. The protein loss is probably neuronal and may be secondary to abnormalities in glial function. Implications for the pathogenesis of hepatic encephalopathy are discussed.


Studies on epidemiological, clinical, and etiological aspects of ALS disease in Sardinia, Southern Italy.

This investigation was conducted to clarify the epidemiology of ALS disease in Sardinia. During the years 1965-1974, the average annual incidence was found to be 0.64/100,000 inhabitants. On prevalence day, October 24th, 1974, the prevalence rate was 1.56/100,000 inhabitants. A significant male predominance was found, the average annual incidence rates for men and women being 0.88 and 0.40, respectively. The peak in both sexes was reached between 60 and 69 years. ALS distribution in the study area was uniform but its occurrence was significantly higher among agricultural workers (5.28/100,000). ALS started on average at 56.58 years and its duration was 2.5 years, being significantly longer in patients under 40-years-old. The distribution of the various clinical forms was: 66 per cent conventional forms, 20 percent bulbar and 14 per cent pseudo-polyneuritic. In the bulbar type, a female predominance was found. About 96 percent of cases were sporadic and 4 per cent familial. Familial cases presented no difference from sporadic cases. Trauma was present in 10.5 percent of the cases and gastrointestinal disfunction in 13 per cent. This probably reflects some relationship between trauma and ALS, and between malnutrition and ALS. No combination of ALS, dementia and parkinsonism was observed. Dementia was associated with ALS in four cases and Parkinson's disease in one case, separately. The combination of other disease states with ALS in the present study may be simple coincidence.


Neuronal loss, neurofibrillary tangles and granulovacuolar degeneration in the hippocampus with ageing and dementia. A quantitative study.

The number of pyramidal neurones in the hippocampal cortex was determined in serially sectioned mesial temporal lobe from brains of 18 mentally normal people, as well as those of 8 demented patients with pathologically confirmed Alzheimer's disease. Normal ageing was accompanied by a gradual loss of neurones, whereas dements' brains showed a much more severe decrease, exceeding that of controls at any age. A high degree of negative exponential correlation was found between the density of neurones/mm3 of cortex and both the number of neurones with neurofibrillary degeneration and the number with granulovacular degeneration. The functional significance of the latter changes is thus probably greater than previously assumed, given the diminished population of surviving neurones in which these alterations appear. Both tangles and granulovacuoles demonstrated a stronger propensity for occurring in the posterior half of the hippocampus in demented patients' brains. This would not have been predicted from the relative distribution of neuronal loss in the two halves. The posterior portion of the hippocampus may be considerably more susceptible to the degenerative nerve cell changes prominent in dementia of the Alzheimer type.


[Morphological findings on the brain of rats after local freezing (author's transl)].

In continuation of our investigations of the wound healing process after cryonecrosis in the liver, kidney, spleen and stomach, the wound healing in the brain was studied under the same condition. Through a trepanation of about 3 mm diameter, the cortex of the parietal region of the cerebrum was frozen by a cryoprobe applied directly through the intact dura mater (-196degreesC/30s). The animals were killed at definite time intervals between 12 h and 21 days after freezing. Twelve hours after freezing, the necrosis of the brain cortex is complete. It extends wedgeshaped into the subcortical white matter. The central parts of the necrosis become colliquative and are demarcted by leucocytes. Two days after freezing, the necrotic area is almost totally invaded by leucocytes. Three days p.op. the brain wound is infiltrated by microglial cells, later on the mesenchymal cell proliferation extends to the meninges. There is new capillary formation and partially a wall like proliferation of the perivascular connective tissue cells. Ten days and later, an uni- or multiloculated pseudocyst develops, which can be considered as the final stage of the reparative wound healing of the cryonecrosis. Similar as in the other investigated organs (liver, kidneys, spleen) these investigations underline the rapid wound healing of the cryonecrosis in the brain. The advantages of cryosurgical manipulations with the well known good wound healing process of other organs, justifies therefore the short term tissue freezing on the cerebrum.


Increased vesicular transfer of horseradish peroxidase across cerebral endothelium, evoked by acute hypertension.

Acute hypertension in rats was produced by intravenous infusion of metaraminol bitartrate (Aramine). The permeability to intravenously injected horseradish peroxidase (HRP) was increased across the cerebral arterioles, capillaries and venules. From the basement membranes of the vessel walls the protein tracer moved into the extracellular spaces of the adjacent neuropil. No endothelial cell damage was observed. The tight junctions between endothelial cells were intact and prevented intercellular movement of peroxidase. Many HRP-labeled vesicles within the endothelial cells or connected with the luminal or abluminal surface, occurred in segments of the microvasculature. Otherwise the endothelium was unchanged. Diffuse uptake of HRP into the cytoplasm of neurons and glial cells was not observed. The alphablocker phentolamine (Regitin) was given to a group of rats simultaneously to Aramine. The increase in blood pressure was thus prevented; furthermore, the permeability remained as under normal conditions. The Aramine, Regitin and HRP did not significantly influence the pH, PO2 and pCO2 of the arterial blood. It is concluded that acute hypertension increases the vesicular transport of HRP across the endothelium of cerebral arterioles, venules and capillaries that normally occurs to a small extent only after intravenous injection of the tracer.


Regeneration of the node of Ranvier: a light and electron microscope study.

Regeneration of the node of Ranvier was investigated in the rat peroneal nerve 10-60 days after nerve crush, by light and electron microscopy. At 10 and 20 days after crush nodes of Ranvier were clearly identifiable by electron microscopy but had a relatively simple structure. At 40 days after crush however nodes were highly differentiated showing specialised features such as paranodal bulbs, nodal constriction of the axon, paranodal Schwann cell mitochondria, nodal Schwann cell microvilli, and nodal gap substance. By light microscopy some nodes were identifiable as early as 20 days after crush. At both 30 and 60 days after crush regenerated internodes were uniformly short (means of 275 micronm and 339 micronm respectively).


Neurologic complications of Hodgkin's disease. Choroid plexus involvement.

Involvement of the choroid plexus by lymphoma (Hodgkin) is a hitherto undescribed complication. We report herein the case of a 49-year-old man who developed, shortly before death, neurologic symptoms seemingly related to extensive involvement of choroid plexus and surrounding ventricular structures by lymphoma (Hodgkin's). There was also multifocal involvement of cranial nerves and spinal canal contents.


Ultrastructure of neurofibrillary tangles in progressive supranuclear palsy.

Ultrastructure of neurofibrillary tangles was investigated on the subcortical neurons of an autopsy case of progressive supranuclear palsy. The patient was a 64-year-old female and suffered from her illness for 9 years. Two kinds of ultrastructure were observed in the subcortical neurofibrillary tangles, i.e. that 150 A straight tubules and the 220 A twisted tubules. They appeared separately in each neuron and a transition between these two structures could not be remarked. Besides, a few particles with a paracrystalline hexagonal structure were observed in some subcortical neurons.


Ultrastructural and biochemical studies on ouabain-induced oedematous brain.

Ouabain, a specific inhibitor of active cation transport across cell membrane, was applied topically to brain surface of cats. The cerebral cortex to which 10(3) M ouabain was applied showed a spongy state, which was ultrastructurally revealed to be swelling of the neuronal cell processes, especially of dendrites. Astrocytes did not show swelling even in the most severely affected lesions. There was a marked increase in sodium with a slight increase of water in the cortex treated with 10(3) M ouabain. No evidence of increased vascular permeability was noted in the cortex, morphologically or biochemically. Electron microscopic cytochemistry to detect the sodium ion revealed that the increased sodium in the cortex accumulated in the swollen neuronal cell processes. It is speculated that neuronal rather than astocytic elements might be highly dependent upon active cation transport, and that intracellular oedema in the brain tissue responsible for impairment of active cation transport might be related primarily to neuronal elements.


Focal nodular hyperplasia of the liver. Possible influence of female reproductive steroids on the histological picture.

In a series of 18 patients with focal nodular hyperplasia of the liver characteristic histological changes were found in the lesion of 5 patients receiving female reproductive steroids, e.g, four women taking oral contraceptives for several years, and one man treated with synthetic estrogenic compound for carcinoma of the prostate. These lesions contained young, connective tissue septa with abundant proliferation of bile ducts, piecemeal necroses and lymphocytic infiltration. Much less or no activity, was found in the lesion of 11 women and 2 men without hormone treatment. Possible mechanisms for this activity are discussed, and it is proposed that focal nodular hyperplasia represents a congenital malformation, possibly a hamartoma, the liver cells of which may suffer from enzymatic defects, which may render them especially vulnerable to female sex hormones.


Morphometric and dynamic studies of bone changes in hyperthyroidism.

Bone biopsies were performed after tetracycline double-labelling by transfixing the right iliac crest in forty hyperthyroid patients. The bone changes in cortical and trabecular bone were determined by simple measurement and point counting on decalcified and undecalcified stained sections. A slight decrease in the amount of cancellous bone was found. The mean cortical width was normal. The amount of osteoid and the length of the osteoid seams were increased, whereas the mean width of osteoid seams was decreased. The cortical osteoclastic activity and porosity were markedly increased. The trabecular osteoclasic activity was moderately increased and the mean size of periosteocytic lacunae was slightly increased. The calcification rate in cancellous bone was increased as were the active calcification surfaces (tetracycline-labelled). The osteoclastic activity in cortical bone was positively correlated to the free thyroxine index and to the urinary calcium and phosphorus excretion. The findings indicate that the bone changes in hyperthyroidism are specific and that thyroid hormone(s) stimulates both bone formation and resorption followed by increased porosity in cortical bone and by mobilization of bone mineral.


Immunohistochemical demonstration of lysozyme in the lymph nodes and Kveim reaction papules in sarcoidosis.

Lysozyme (LZM) was demonstrated by an immunoperoxidase method in some but not all epitheloid-cell granulomas, free macrophages and giant cells in the lymph nodes and Kveim reaction papules of patients with sarcoidosis. In inactive disease, LZM staining was weak or absent in fibrotic lymph nodes. The pattern of LZM staining in Kveim reaction papules was similar to that seen in the "active" sarcoid lymph nodes. The presence of LZM in sarcoid tissue explains the high concentration of serum LZM in patients with active sarcoidosis and the extent of LZM distribution in tissues is probably an index of disease activity.


The fine structure of three-dimensional colonies of human glioma cells in agarose culture.

The fine structure of human glioma cells cultivated as three-dimensional colonies in agarose was investigated during exponential growth. The colonies did not show central degeneration, although they reached diameters of up to 600 mum. Large extra-cellular spaces extended throughout the colonies. The mean volumetric fraction of the spaces increased from about 20 per cent at the periphery up to nearly 40 per cent in the central regions. The quotient between nuclei and cytoplasm showed a slight decrease with depth. A proliferative gradient existed in the colonies, i.e. the mitotic index decreased almost exponentially with the distance from the surface. The distance at which the mitotic index changes by a factor of 2 was about 90 mum, corresponding to nearly five cell diameters. Cytoplasmic extensions, with a ruffling-like appearance, occurred both at the periphery and in the centre of the colonies but were larger and more frequent at the periphery. The fractions of mitochondria and vacuoles in the cytoplasm showed rather large local variations. However, the mean number of mitochondria decreased somewhat towards the centre and the number of vacuoles containing highly electron-absorbing substance increased in the most central regions.


The incidence of the so-called acute selective necrosis of the granular layer of cerebellum in 1000 autopsied patients.

Acute selective necrosis of the granular layer of the cerebellum (NGL) was demonstrated in 264 patients out of a total of 1000 autopsies. The relatively high incidence of NGL was distributed evenly over the main groups of causes of death, and over all age groups, with the exception of children under the age of 10 years, in whom the incidence was lower. The lack of correlation between NGL and any particular disease makes it difficult to put forward a plausible explanation of the necrosis. In view of recent studies it is concluded that NGL develops after death.


Transthoracic fine-needle aspiration biopsy. A histologically verified material.

A material consisting of 227 histological verified transthoracic fine-needle aspiration biopsies is presented. The result of the first biopsy attempt gave a diagnostic sensitivity with regards to malignancy of 77 per cent and a diagnostic specificity of 98 per cent. The method is recommended in cases where conventional preoperative diagnostic procedures fail to reveal the nature of the lung lesion.


Aspiration biopsies from diagnostically difficult pulmonary lesions. A consecutive case material.

A consecutive material of 244 cases of transthoracic aspiration biopsies collected in a two year period is presented. The biopsy method concerning malignant tumour cells and suspected malignant tumour cells was 8.28 per cent, the specificity was 94.9 per cent. It is suggested that the biopsy method might be applied earlier in the sequence of preoperative diagnostic procedures.


The diagnostic significance of intestinal metaplasia in endoscopic gastric biopsies.

The incidences of intestinal metaplasia in two groups of benign endoscopic biopsies taken from stomachs with malignant and benign lesions respectively were compared. 315 single biopsies were taken from stomachs with proven carcinoma, but outside the carcinomatous area. They were compared to 786 single biopsies taken from stomachs with proven benign lesions. Each single biopsy was placed in one of three groups: intestinal metaplasia absent, or making up less or more than 50 per cent of the epithelium in the biopsy. The results showed that single biopsies with intestinal metaplasia regardless of the extension of the metaplasia in the biopsy were found more often in stomachs with carcinoma than in stomachs with benign lesions but without any significant difference. If more than half of the benign biopsies taken during an examination demonstrated extensive grades of intestinal metaplasia a sligtly significant difference in favour of carcinomas was found.


Occurrence of amyloidosis secondary to the induction of experimental hypertension in mice.

Following the induction of three different forms of experimental hypertension, deposits of amyloid were found in the spleens of 5-20 per cent of the mice late in the course of the hypertension, Amyloidosis was found in nude (with genetical aplasia of the thymus) as well as in haired (normal) mice. The highest frequency of amyloidosis was observed in mice with hypertension due to partial infarction of one kidney and contralateral nephrectomy. The hypertensive vascular disease, involving lesion of the vessels and of the organs supplied by the affected vessels, is believed, to represent a stimulus for the reticulo endothelial system (RES) with development of amyloidosis as a secondary event.


Effect of human leucocyte interferon on DNA synthesis in human psoriatic skin cultured in diffusion chambers.

Pieces of human psoriatic skin were cultured for five days in diffusion chambers implanted intraperitoneally in mice. Partially purified human leucocyte interferon was injected into the experimental animals daily during the culture period. Phosphate buffered saline and, in one experiment, also mock interferon were used as control materials. On the fifth day, incorporation of 3H-thymidine into the epidermal cells was studied autoradiographically. The results showed that human leucocyte interferon does not depress DNA synthesis in human psoriatic epidermal cells cultured by this method. In fact, DNA synthesis seemed to be stimulated in two of the three experiments but the effect was not statistically significant.


The effect of oxygen on peripheral airways.

In ten normal young subjects four alveolar O2-concentration levels ranging from about 7% to 95% were obtained by breathing different concentrations of oxygen in nitrogen at a constant alveolar CO2-concentration of about 5%. Maximum expiratory flows at 60% TLC were measured at each level and corrected for the influence of the expired gas density on flow. The corrected maximum flows were not significantly different, which is taken as evidence of no effect of oxygen on tone of peripheral bronchi.


Renal hemodynamics in the perinatal period. A study in lambs.

The perinatal changes in renal hemodynamics have been studied in lambs. Eleven of the lambs were exteriorized, but maintained on placental circulation (fetal lambs). Eight of the lambs were delivered with cesarean section and studied immediately after clamping of the cord (newborn lambs). Nine lambs were delivered spontaneously and studied during the first 9 days of life. Renal blood flow (RBF) was determined by the microsphere method using a sample drawn from the iliac artery as the reference flow. The filtering capacity of the nephrons was evaluated after ferrocyanide injection and dissection of the nephrons. Total RBF did not seem to change much at birth but increased in relation to kidney weight during the first postnatal week. Clamping of the cord did, however, result in a change in intrarenal blood flow distribution, so that in the newborn lambs relatively more of the blood flow was perfusing the outer cortical region. During the first postnatal week there was a slight, but insignificant further relative increase in outer cortical blood flow. The relative increase in outer cortical blood flow at birth was accompanied by an increased frequency of filtering superficial nephrons from 22 to 77%. Practically all juxtamedullary nephrons were filtering before birth. Three days postnatally 98% of the superficial and 100% of the juxtamedullary nephrons were filtering.


Vasodilator fibres to the tongue in the chorda tympani proper nerve.

Electrical stimulation of the chorda tympani proper nerve (CT) causes vasodilatation in the constant-flow perfused tongue. It has been suggested, as an explanation for this, that the vasodilatation is the result of antidromic impulses in sensory fibres of the CT. However, after degeneration of the efferent fibres in CT in the rat it was found that electrical stimulation of the CT caused no vasodilatation. Since, by all criteria available, the sensory fibres remained, the result indicates that antidromic impulses could not be the cause of the vasodiltation observed in tongues with intact nerve supply. Further, since there are no glands in the part of the tongue innervated by the CT and the circulation of the large salivary glands is separate from the tongue in the rat, it is concluded that the vasodilatation was not a secondary effect of glandular activity, but was caused by vasodilator fibres in the CT.


Blood pressure and heart rate regulating capacity of the carotid sinus during changes in blood volume distribution in man.

The influence of changes in blood volume distribution on the carotid baroreflex was studied in 18 subjects. Blood volume distribution was changed by varying the pressure around the lower body above and below ambient, thereby varying the amount of blood pooled in this region and exerting a secondary influence on the central blood volume. The carotid arterial stretch receptors were stimulated by varying the pressure in air-tight box enclosing the neck. To obtain a standardized carotid sinus stimulus (SCS) the pressure in the box was varied sinusoidally between - 10 and - 40 mmHg with a fixed freqency of 0.03 Hz. The effects on heart rate and blood pressure were assessed by harmonic analysis performed off-line on a digital computer. During lower body negative pressure of -40 mmHg (LBNP -40), i.e. during a procedure known to reduce the central blood volume, SCS induced an augmented effect on the blood pressure regulating capacity but not on the heart rate response. Expressing the blood pressure regulating capacity as peak-to-peak changes in systolic arterial pressure, the response during LBNP -40 mmHg was almost twice the control value. The opposite stimulus-lower body postive pressure-influenced the SCS-induced effects only slightly but on the average a minor reduction in both blood pressure and heart rate regulating capacity was found compared with the control condition, though the difference did not reach significant levels. The results support the hypothesis that changes in blood volume distribution modify the function of the carotid baroreflex, possibly via intrathoracic receptors sensitive to changes in central blood volume and/or central venous pressure.


Effect of sodium pentobarbital on the apparent turnover of acetylcholine in different brain regions.

The turnover rate of acetylcholine(ACh)was measured in six different brain regions in the mouse following pulse injection of radioactive choline (Ch) and killing of the animals by microwave irradiation of the head (0.25 s, 5 kW). The time course of the change in 3H-ACh/3H-Ch ratio was linear 0-06 s in all brain regions after administration of 3H-Ch. Plots of the specific radioactivities (SA) of ACh and Ch versus time indicate a precursor-product relationship in all brain regions except the cerebellum both in control and sodium pentobarbital anesthesized animals. The turnover was highest in the striatum (55 nmol-g-1-min-1), while in the cortex and hippocampus this value was approximately half (27 and 21 nmol-g-1-min-1). In the midbrain and medulla oblongata the turnover rates were only 11 and 10 nmol-g-1-min-1. Sodium pentobarbital anesthesia reduced specifically the turnover in the cortex and hippocampus to about 60 to 70 percent.


Adrenergic and Cholinergic Nerves of the Human Urethra and Urinary Bladder. A histochemical study.

The occurrence and distribution of adrenergic and acetylcholine esterase (AChE) positive nerves in the human urethra and urinary bladder were studied histochemically with the fluorescence method of Falck and Hillarp, and the copper thiocholine method of Koelle and Friedenwald. Both types of nerves were mainly confined to the layers of smooth muscle cells in the walls of the organs. In all parts of the urethra, there was a scanty supply of adrenergic nerves. Few adrenergic nerves were also found in the urinary bladder, except in the trigone area, where they were abundant. AChE-positive nerves were uniformly and richly distributed in the urinary bladder. Throughout the urethra the distribution of AChE-positive nerve fibres was uniform, but the number was clearly less than in the urinary bladder. No intrmurally located adrenergic or AChE-Positive ganglion cells could be demonstrated.


Slow action of Ca on myelinated nerve fibres of Xenopus laevis.

Single myelinated nerve fibres were isolated and the nodal currents were recorded with potential clamp technique. Rapid solution changes were performed by use of a recording chamber so shaped that it had a minimal dead space. A volume ten times larger than the dead space flowed past the node within about 20 ms. The half-time of the change in Na current (INa)amplitude associated with changes between solutions of different [Na]:s was 100-150 ms, whereas the half-time of the change in INa associated with changes between solutions of different [Ca]:s was 200-300 ms. The external [Ca] affects INa through its action on the Na permeability properties of the nodal membrane. The difference in rate of effect between changes in [Na] and [Ca] was also noticeable when simultaneous changes were performed. These findings are discussed with regard to the properties of the nodal gap.


Quantitative evaluation of the blood-brain barrier capacity to form dopamine from circulating L-DOPA.

The ability of the blood-brain barrier to form dopamine from increasing doses of systemically administered L-DOPA has been studied in rats by a combination of chemical determination of dopamine, and histochemical and cytofluorometric measurements of L-DOPA and dopamine. The break-through of L-DOPA from the circulation into the brain parenchyma via the enzymatic blood-brain barrier was estimated by comparing the amount of newly formed dopamine in the caudate nucleus-putamen and in the cerebellum. The capillaries were found to efficiently trap L-DOPA in their walls, and an upper limit was reached (at an administered i.p. dose of 100 mg/kg of L-DOPA). It could be estimated that approximately 3% of the total dose of L-DOPA given was decarboxylated by the blood-brain barrier. The possible influence by the regional differences in perfusion of the two regions seen after administration of L-DOPA was ruled out in measurements of local cerebral blood flow using the 14C-ethanol technique.


Is the existence of a forensic psychiatry justified? On forensic psychiatry in the Scandinavian countries.

In Scandinavia during the past decade forensic psychiatry has been the subject of discussions, which have occasionally reached the height of vehement attacks. Changes in penal laws have expressed a declining interest in the cooperation of psychiatrists in the evaluation and treatment of offenders. Scandinavian forensic psychiatrists, lawyers and criminologists have analyzed and discussed the present situation and have found that there is still a need and justification for forensic psychiatry. Higher priority, however, should be given to psychiatric contributions at the stage after disposition, at the post-trial level. The diagnostic activities at the pre-trial level should be limited to what is necessary for further dispositions. The development of forensic (penal) psychiatry and the trends with the individual Scandinavian countries differ considerably.


Present functions of forensic psychiatry in Scandinavia.

An attempt is made to give a description of the functions of forensic psychiatry in the Scandinavian countries, including some statistical information on activities and persons involved. Definitions are given. Organizational differences in preparing psychiatric reports to the court in the five countries are outlined, as are the ways in which psychiatrists participate at the post-trial level. Some problems and divergent trends are mentioned. It is concluded that a demand for psychiatric evaluation and treatment of offenders who are psychotic or moderately and more severely mentally retarded will continue to exist, whereas it seems unclear how psychiatrists should deal with the psychiatric problems of offenders with other mental abnormalities. Forensic psychiatric research should include analysis of the functions of this discipline (frequency studies, studies of content, organization and effect).


Present status of forensic psychiatry in Denmark.

In Denmark the desire for psychiatric cooperation within the juridical system has on the whole been on the decline during the past decades. This applies both to the writing of psychiatric reports to the court, and to the sanction system. Within civil forensic psychiatry, practice is almost unchanged and unchallenged, while the demand for one form of social forensic psychiatry has been drastically reduced with the literalization of abortion and sterilization laws. The present practice of penal forensic psychiatry is described. Remarks on the future organization and research are made.


Present status of forensic psychiatry in Finland.

During the last 3 years the number of prisoners in Finland, has risen, being for the moment 105 per 100,000 inhabitants, one of the highest rates in Europe. This is dependent not only on the increase in criminality, but on the traditionally very severe scale of punishments applied. The penal institutions now have a 50% overloading. The actual situation of forensic and penal psychiatric work is characterized by overloaded services, long waiting lists and a generally irritated atmosphere.


Present status of forensic psychiatry in Iceland.

This paper gives a brief survey of forensic psychiatry in Iceland at the present time. Because of few inhabitants and limited financial resources there are no special forensic psychiatric institutions in the country, nor any forensic psychiatrists; this kind of work is mainly carried our by general psychiatrists, but also to a certain extent by general practitioners, Formalities around compulsory admission and detention of mental patients, uncooperative and lacking insight, are briefly described. The psychiatric examination of probably mentally ill offenders is also accounted for. Such investigations are without doubt the main task of forensic psychiatry in Iceland to-day. Finally the main faults of forensic psychiatric services in Iceland and very limited educational facilities in this domain are referred to. Some future plans are also mentioned.


Present status of forensic psychiatry in Sweden.

A description is given of the use and functions of mental reports preceding the sentence. The problems-- mainly the long waiting times for observations, the concentration on diagnosis, and the forensic psychiatrist's isolation from treatment work - associated with the present system are pointed out. The article also contains a brief account of psychiatric treatment within the penal system, inside and outside prisons, and a description of the Uppsala Clinic for Forensic Psychiatry, where the patients during observation for mental reports are treated in accordance with the ideas of "therapeutic community". A report, with recommendations for reforms, can be expected at the beginning of 1977.


A case of familial heterosexual transvestism.

A brief review of the literature concerning familial transvestism is given. The case history of father-son heterosexual transvestism is presented. The son appears to have been ignorant of his father's transvestism. Early childhood experiences as an aetiological factor seem inadequate to explain the similarities of the two subjects' transvestite behaviour. It is suggested that constitutional factors play a part in the aetiology of heterosexual transvestism.


Evidence for polygenic inheritance in schizophrenia?

The frequency of psychotics among sibs of index cases with a functional psychosis was found by Odegaard (1972) to be positively associated with the number of psychotics in the parents' generation. Odegaard considered this correlation to be indicative of polygenic inheritance. However, an attempt at replicating this fascinating finding in a sample of schizophrenic families was not successful. Although this discrepancy in results might have been due to chance, the importance of the problem of the mode of inheritance induced a search for biases that might have obscured the comparison of the two samples. Unfortunately, the discrepancy remained unexplained, but certain structural and diagnostic differences were brought up and discussed. The very existence of such incongruities, together with the contrasting main results, seems to caution against definite genetic conclusions until further evidence is available.


Lithium side effects in relation to dose and to levels and gradients of lithium in plasma.

The relation between lithium dose, lithium concentrations, and lithium gradients in plasma and the side effects tremor, nausea, abdominal pains, and loose bowels was studied in 19 subjects. Rapidly dissolving lithium carbonate tablets were used. Tremor was related to higher doses, to higher concentrations, and to higher gradients of lithium in plasma. Nausea was related to higher gradients. Abdominal pain and loose bowels showed no relation to doses, levels or gradients. Concentrations of lithium were dose-dependent, while gradients were relatively independent of dose.


Dopaminergic function in two patients with catalepsy.

Apomorphine HC1 (2 mg subcutaneously), a dopamine receptor agonist, was administered to two schizophrenic patients with catalepsy. In one of these patients the clinical response to apomorphine was compared with that of sodium amytal and the growth hormone response apomorphine (0.75 mg subcutaneously) was compared with that of 25 control subjects. Apomorphine had no effect whereas sodium amytal caused rapid disappearance of catatonic symptoms including catalepsy. The peak growth hormone response to apomorphine was similar to that of controls. These data suggest that unlike experimental catalepsy in animals, catalepsy associated with schizophrenia may not be dependent on impaired dopaminergic function. Further case studies as well as the use of other dopamine receptor agonists are required before definite conclusions can be drawn.


WAIS performances in antisocial personality (disorder).

In the present study, the WAIS performances of subjects with antisocial personality disorder were compared with the performances of controls, who had other personality disorders and had usually only occasional criminality. It appeared that in all subtests the age-scaled scores of the controls were higher than those of the subjects. Statistically significant differences emerged in subtests Information, Comprehension and Arithmetic of the Verbal Scale, and in the picture Completion subtest of the Performance Scale, as well as in the Verbal, Performance and Total IQ. In the light of these results, one fundamental feature in antisocial personality could be the lack of general interest and intellectual curiosity, which is probably associated with a poor ability to "feel" (inadequacy of feelings of pleasure) in those predisposed to antisocial personality.


Season of birth of schizophrenics in Tokyo, Japan.

The monthly distribution of births of 7,960 schizophrenic patients in Tokyo born during the period of 1841-1950 was studied in comparison with that of a control population in Tokyo. A spring excess of schizophrenic births were found after 1901 as in previous studies in Western countries. Before 1900, however, there was no significant spring excess. The maximum excess of schizophrenic births occurred in May before 1900 and in April after 1901. The possibility of a shift in the seasonality of schizophrenic births was discussed.


Reactive paranoid psychosis in a 47, XYY male.

A case of a reactive paranoid psychosis in a 47, XYY male is presented. It is suggested that reactive psychoses in double Y males would tend to be of paranoid type. Detailed case reports in future studies are desirable in order to evaluate the type of reactive psychosis in 47, XYY males.


Prolonged induction of germfree bile acid pattern in conventional rats by antibiotics.

Male conventional rats have been treated for five days with benzylpenicillin, neomycin, kanamycin, erythromycin, bacitracintneomycin, succihylsulfathiazole or metronidazole. Total fecal bile acids were analyzed in samples collected during periods of three days during the pretreatment period and during the eight weeks following drug treatment. Metronidazole or succinylsulfathiazole had no or minor effects on the conventional bile acid pattern and the  "bile acid index" (ratio beta-muricholic acid/deoxycholic acid) remained low. Benzylpenicillin, neomycin or kanamycin induced a germfree bile acid pattern, i.e. increased the relative amounts of alpha-and beta-muricholic acid in feces and eliminated deoxycholic acid and hyodeoxycholic acid from feces. The high bile acid index was normalized within three weeks after termination of drug treatment but the excretion of alpha- and beta-muricholic acid was not normalized until a normal flora had been established by giving an enema with intestinal contents from intact, oncentional rats. Treatment with eythromycin or bacitracintineomycin also produced a germfree bile acid pattern. In these cases, the bile acid index was not back to normal until after five to eight weeks and the excretion of the muricholic acids was not normalized until an enema with intestinal bacteria had been given. It is suggested that these long-lasting effects of antibiotics on the metabolism of bile acids in the intestinal tract should be considered after short-term antibiotic therapy in humans.


Studies on plasma lipid and phospholipid composition in pernicious anemia before and after specific treatment.

Patients with pernicious anemia (PA) have been compared with a reference group concerning the concentration of lipids in plasma before (34 cases) and after (15 cases) treatment with vitamin B12. The lipid parameters in plasma and in postheparin plasma have been measured before and after 6 hours' incubation at 37degree C before and after specific treatment. In a limited number of cases the lecithin: cholesterol acyl transfer (LCAT) rate has been determined. In relapse, the PA cases showed increased free fatty acid (FFA) and triglyceride (TG) concentrations but decreased concentrations of total cholesterol (TC), unesterified cholesterol (UC) and all examined phospholipid fractions. After treatment, FFA remained unchanged and TG decreased, while TC and possibly also UC and the phospholipid frations were in line with reference levels. After incubations, UC and phosphatidylcholine (PC) decreased and lysolecithin (LL) increased. FFA increased and TG  decreased. Incubation of postheparin plasma resulted in an augmented decrease in TG and PC and increase in FFA and LL, In relapse, the changes on incubation were less pronounced than after treatment. The LCAT was low but within the normal range before treatment in the six cases examined. After treatment, LCAT rates increased but were still normal in relation to the plasma lipid concentrations. The study showed a decreased net esterification of cholesterol and LL formation on incubation of plasma in PA cases in relapse. This finding might be explained by the low concentration of plasma substrates for the LCAT reaction and phospholipases. After treatment the concentration of lipid substrates was restored to normal, with subsequent normal LL formation and cholesterol esterification. The observations could also explain the frequent lack of stabilization of erythrocytes suspended in plasma of PA after incubation, resulting in virtually the same ESR after as before this procedure. Due to low LL formation following the insufficient substrate availability for LCAT and phospholipase, the previously reported critical level of the LL concentration is not reached and cannot achieve its normal reduction of the ESR.


An eleven-year follow-up on 64 subjects with M-components.

In a medical health survey in 1964 of 6995 subjects, 64 persons with M-components were detected by serum electrophoresis. One had clearcut signs of myelomatosis and one had lymphatic leukemia. Eleven years later 27 persons had died. In the case with lymphatic leukemia the disease had changed after 6 years into a myelomatosis. One person died after 9 years from a malignant lymphoma. Among the 37 persons still alive there seemed to be no clustering of diseases. The whole series represents an observation time of 487 years. No more myelomas or lymphomas were detected. One M-component had disappeared.


Different composition of the eosinophilic bone marrow pool in reactive eosinophilia and eosinophilic leukaemia.

The composition of the eosinophilic cell series in the bone marrow has been analysed in 10 patients with a pronounced reactive eosinophilia (RE) and in 2 with eosinophilic leukaemia (EL). An imparied differentiation of the eosinophils was found in the EL patients compared with the RE group. Thus the ratio of eosinophilic promyelocytestmyelocytes: segmented eosinophils was 9.2 and 9.1, respectively, in the patients with EL and 0.1--3.1 (average 1.3) in the RE patients. It is suggested that EL is characterized by an impaired differentiation of the eosinophilic bone marrow cells and that the recognition of this abnormality is of value in the diffential diagnosis between EL and RE.


Studies on the Pelger anomaly in Iceland.

An Icelandic family, containing 15 members with Pelger anomally, is reported. Affected individuals in two branches of the family, living in the south-east and east of Iceland, have been traced to common ancestors born 200 years age. The results of scanning of blood films from approximately 20% of the population of Iceland suggest that the Pelger family described contains the only mutation of this kind in Icelanders.


Studies on herediatary spherocytosis in Iceland.

Thirty members with typical hereditary spherocytosis (HS) and over 90 apparently unaffected members belonging to 12 families have been studied. Splenectomy has been performed on 22 HS patients. Of nine HS individuals, who had not undergone surgical treatment in 1957, four suffered from temporary severe anaemia, presumably due to aplastic crisis associated with influenza. One of them died, a male 18 years of age. Pedigree studies on one of the families indicate that the HS gene or genes have been transmitted through six generations over the past 200 years. Marked deficiency in the number of affected compared with the apparently unaffected members in the HS families is present. The most striking example of uneven genetic ratio is a sibship of 15 members investigated haematologically, with one suffering from typical HS. Much reduced penetration of the HS gene or the presence of the socalled "mild form" is upheld as the main explanation for the unevenness in the genetic ratio. However, families are also present in which abortions and death at an early age indicated that selection against the affected could also disturb the genetic ratio in HS families.


Leucocyte migration inhibitory activity of concanavalin-A-stimulated lymphocytes. In vivo and in vitro modifications with dipyridamole and acetylsalicylic acid.

Lymphocytes from 14 patients treated with a combination of acetylsalicylic acid (ASA) and dipyridamole (DIPY) showed a decreased ability to produce leucocyte migration inhibitory activity (LMIA) when stimulated with concanavalin-A (ConA). The combined treatment also produced a decrease of leucocyte response to a standard LMIA-containing culture supernatant. Treatment with only one of the two drugs did not cause detectable alteration of the lymphocyte response to Con-A or the leucocyte response to LMIA. In vitro, both DIPY and ASA were independently effective in decreasing the LMIA production of Con-A-stimulated lymphocytes and the leucocyte response to a standard LMIA-containing culture supernatant.


Treatment of progressive systemic sclerosis (scleroderma, PSS) with a new drug influencing connective tissue.

Cyclofenil is a new diphenyl ethylene derivative related to stilboestrol without oestrogenicity but with marked effects on connective tissue metabolism. The drug has been tested, in a daily dose of 200mg X3, in six patients with progressive systemic sclerosis (PSS) to analyze the expected beneficial effects on the PSS symptoms. The typical skin hardness, joint and muscle rigidity, and reduced breathing capacity were improved to varying dgrees. The only side-effect was a slight transient liver enzyme elevation in 1 out of 6 patients. A slight increase was found in urinary calcium and hydroxyproline excretion. In several cases serum calcium, cholesterol, triglyceride and in some cases the serum uric acid levels were decreased. The ANF titres diminished to varying degrees in 4 out of 6 patients. These results indicate that further detailed clinical and laboratory studies on the therapeutic potential of cyclofenil in PSS and other diseases affecting connective tissue seen to be justified.


Giant-cell arteritis, temporal arteritis and polymyalgia rheumatica. A retrospective study of 63 patients.

The initial clinical symptoms, the course of the disease, and the effect of corticosteroid treatment have been analyzed in a retrospective study of 63 patients with temporal arteritis or polymyalgia rheumatica. The relationship between the physical examination of the temporal regions, the ophthalmological examination, and biopsy from the temporal artery with respect to the diagnostic value were examined. Histological examination of biopsy specimens from the temporal artery in 58 patients revealed arteritis in 46. Half of the patients had only local symptoms from the temporal regions; one fourth presented such symptoms as well as myalgias, and one fourth had myalgias only. Patients presenting local symptoms of temporal arteritis as well as of myalgias had always had myalgias as the initial symptom and developed local symptoms of temporal arteritis 1-24 months later. Permanent reduction of vision occurred in 20% of the patients. Symptoms of generalized arteritis were observed in several patients. The overlapping of the clinical symptoms, the positive biopsy findings in patients with polymyalgia rheumatica as the only local symptom and the identical reaction to corticosteroid treatment support the conception of temporal arteritis and polymyalgia rheumatica as two manifestations of the same disease. The physical and the ophthalmological examinations were of limited diagnostic value. Positive biopsy findings were seen in 25 patients with noraml palpatory findings, and in 46 patients without eye symptoms the ophthalmoscopic examination revealed no signs of arteritis. If the first biopsy from the temporal artery is negative, biopsy from the contralateral temporal artery should be performed. Correctly timed corticosteroid treatment in adequate doses can prevent reduction of vision in giant-cell arteritis. The treatment is a long-term therapy, its average duration in the present study being more than two years.


Evaluation of the sulphapyridine acetylator phenotyping test in healthy subjects and in patients with cardiac and renal diseases.

The acetylator phenotype of 35 healthy, drug-free volunteers and 21 patients with cardiac and/or renal disease has been assessed using oral sulphapyridine. Comparative evaluation of a simplified and a more selective method of sulphapyridine analysis was performed. Thirteen of the patients were also phenotyped by determination of plasma isoniazid half-life. 81% of the patients were slow acetylators, compared with only 51% of the volunteers. When phenotyping healthy, drug-free subjects the analytical procedure, involving a direct estimation of sulphapyridine in urine with the Bratton-Marshall procedure, was satisfactory. On the other hand, in patients receiving concomitant drug therapy the more selective analytical procedure was necessary in order to diminish the risk of methodological interference.


Spontaneous systemic lupus erythematosus and acelylator phenotype.

Fifteen patients with spontaneous systemic lupus erythematosus (SLE) have been phenotyped by determination of plasma isoniazid (INH) half-life. Seven patients had signs of renal insufficiency. Of the 15 patients, 13 were slow and only 2 rapid acetylators. No correlation was found between the plasma INH half-lives and the renal function. Thus, there is the same marked predominance of slow acetylators in patients with spontaneous SLE as in patients with the drug-induced SLE-like syndrome.


Cardaic arrhythmias in chloral hydrate poisoning.

In  three patients admitted to hospital after ingestion of an overdose of chloral hydrate, the ECG showed supreventricular and ventricular tachyarrhythmias. The possible mechanism for the arrhythmias may be an enhanced automaticity of supraventricular and ventricular pacemaker cells caused by metabolites of chloral hydrate. The ventricular arrhythmia responded to i.v. treatment with lignocaine in one patient, and to phenytoin in another in whom lignocaine failed to restore a normal sinus rhythm.


ECG recording in emergency home visits.

During the first half of 1974, 756 emergency home calls have been made by 6 doctors in the City of Oslo. A portable ECG instrument was available at all visits. The visits were unselected as regards complaints. ECG was recorded in 7% of all patients and in 19% of all patients over 60 years of age. The main indication for recording an ECG was chest pain (nearly 2/3 of all recordings). In only a small number of cases did the recording give a definite result as regards diagnosis of management of the case. However, a slight additional benefit was obtained with a majority of the ECG recordings, including what we defined as a phychotherapeutic benefit. The results of this study indicate that the value of a portable electrocardiograph is very limited for emergency home calls in a city.


Pattern of acute drug poisoning in Oslo.

All 1742 admissions occasioned by acute drug poisoning to a medical ward in Oslo during the periods 1958--60, 1963--65, 1966--69 and 1970--73 have been reviewed. The number of admissions per annum in these periods was 99, 119, 128 and 144, respectively. Because the hospital situation and number of inhabitants in the city remained fairly constant from 1958 to 1973, the increasing figures were assumed to reflect a corresponding increase in the incidence of acute drug poisoning in Oslo. The incidence was estimated to be within the range of 1--2 per 1000 inhabitants per annum. No female predominance was noted except for the age group under 30 years. The occurrence of barbiturate poisonings decreased markedly during the peroids studied, whereas those due to non-barbiturate hypnotics, tranquillizers and tricyclic antidepressants showed a proportionate increase. Slightly less than one fourth of the females and half of the males had taken alcohol. More males (43%) than females (13%) also were alcoholics. A suicidal intention was, however, found more frequently among females (70%) than males (43%). The hospital mortality was approximately 1 %. No death was associated with tricyclic antidepressants, which in the last study period had been ingested by approximately 10% of all patients.


Myelofibrosis and rapid thrombocytolysis. A case report.

A 69-year-old woman was referred to our department because of moderate anemia and thrombocytopenia. On admission the spleen was slightly enlarged. On the basis of histological examination of biopsy specimens from spinal processes the diagnosis of myelofibrosis was made. The subsequent clinical course was progressively downhill. Although splenomegaly was of only moderate degree, severe anemia and thrombocytopenia supervened. Platelet mean life span was dramatically shortened (1.8 hours) and platelet production rate considerably increased (about 18xnormal). Neither corticosteroid therapy nor splenectomy alleviated the thrombocytopenia. Extremely large platelets, with diameters of up to 10 mum, were seen in the peripheral blood. The mean platelet diameter and percentage of megathrombocytes reached peak values about 2 weeks after splenectomy. It is suggested that the immunologic background of the rapid thrombocytolysis is similar to that which governs platelet destruction in idiopathic thrombocytopenic purpura.


Disturbances in the blood-brain barrier and cerebral blood flow after rapid brain decompression in the cat.

The effect of sudden decompression of the brain on the blood-brain barrier and cerebral blood flow was studied in cats. The decompression experiments were performed on 9 cats which had been subjected to two hours of compression with an epidural balloon and on 10 cats subjected to four hours of balloon compression. In both experimental groups one could observe haemorrhages and disturbances in the blood-brain barrier in the cortex of the previously compressed hemisphere and in the basal nuclei. The extent of these changes depended on the duration of the epidural compression. At the same time, a decrease in cerebral blood flow, mainly in the brain cortex, was observed in both experimental groups.


Treatment of intracranial hypertension. Analysis of 105 consecutive, continuous recordings of intracranial pressure.

One hundred and five consecutive recordings of intracranial pressure (ICP) in 95 patients over a three-year period, using a Scott cannula inserted through a burr hole or a twist drill hole into the anterior horn of the lateral ventricle, represent the patient material for this report. The clinical diagnoses were head injury 32, intracranial tumour 31, aneurysm and arteriovenous malformation 18, brain swelling secondary to systemic disease 8, and brain swelling of unknown etiology 6. ICP exceeded 20 mm/Hg in 86 of the recordings (maximum 110 mm/Hg). Hypertonic mannitol was administered 73 times in 48 patients. ICP was reduced 10% or more (mean 52%) in all but three administrations. The effect of hyperventilation was tested in 50 trials in 34 patients. ICP was reduced 10% or more (mean 47%) in 34 trials. The mean time to maximum reduction of ICP was eight minutes, and ICP returned to control almost immediately after cessation of hyperventilation. Hypothermia was studied in 40 trials in 40 patients. ICP was reduced 10% or more (mean 51%) in half the patients. The infection rate was 6.3% in this four-hospital setting, but four of the six infections were in one hospital. If this hospital is excluded, the infection rate is 3.1%.


[A simple method for continuous measurement of CSF pressure (author's transl)].

We describe for the continuous recording of CSF pressure a method in which a polyethylene catheter is introduced into the subarachnoid space. The pressure is shown on a polygraph by means of a recording apparatus. The technique can be applied to patients with subarachnoid haemorrhage, ischaemic infarcts, supratentorial space occupying lesions, or communicating hydrocephalus. The accuracy and limitations of the technique are discussed.


Angiographic contribution to the problem of enlargement of cerebral arteriovenous malformations.

From a series of 325 cases of cerebral arteriovenous malformations, seven patients are reported presenting a change in size of the malformation in the course of several years. The enlargement of the malformation is documented by four vessel cerebral angiography, and haemodynamic and histopathological characteristics are discussed. Serial four vessel cerebral angiography is strongly indicated for accurate diagnosis, and radical excision of these malformations with the microtechnical method is advocated.


[Contribution to the question of enlargement of cerebral arteriovenous angiomas (author's transl)].

The growth of a small arteriovenous angioma over a period of almost 18 years in a 20 year old patient has been proved by arteriography. This case is added to 29 cases previously published in the literature. The authors do not readily accept the theory of autochthonous growth, but prefer secondary or "pseudo-growth". In favour of this there are the following factors: 1. Not all arteriovenous angiomas observed over long periods show growth. 2. There are undoubted haemodynamic circulatory disturbances with turbulence, "wind-pocket effects", and abnormal shunts. 3. After complete removal of an angioma the cerebral circulation becomes normal and there is regression of the dilatation of the feeding and draining vessels.


[Spontaneous intracerebellar haematoma in childhood (author's transl)].

Spontaneous cerebellar haemorrhage accounts for 10% of all intracranial spontaneous haematomas. It is a disease which principally affects patients over middle age, and it is rare in childhood. To twelve cases previously reported we now add a further three. Attention is drawn to the diagnostic difficulties and the values of echoencephalography, angiography, and computerized axial tomography in diagnosis and localisation of the condition. Prognosis can be good even in cases in poor condition of diagnosis and treatment are prompt.


[Biomechanics of the jaw apparatus in the horn-shark (Heterodontus portusjacksoni = Heterodontus philippi)].

The constructional morphology of the jaw apparatus in the horn-shark Heterodontus has been investigated. The origines and insertions of the jaw muscles have been delimited and the lines of action were determined. The individual muscles have been weighed, in order to get on the basis of their masses an estimate of the forces which are exerted by the components of the jaw musculature. The mandibular joints, the occlusion of the jaws, morphological details of the upper and lower jaws as well as the "subodontium" have been subject to macroscopic and microscopic study. The joint between palatoquadrate and mandibular consists of a medial and a lateral compartment. Only hinge movements are possible. If the jaws are closed, the contacts between upper and lower jaws are confined to the large crushing teeth of only one or two tooth families. The teeth are fixed to the jaw cartilage by ligamentous structures. Three layers can be discerned histologically: The uppermost layer, beneath the bases of the teeth, is composed of the fibrae interdentales and of the fibrae subbasales. By these, the individual teeth are firmly connected to form a continuous pavement. - The middle layer is characterised by the great number of cell nuclei. - The fibre system which constitutes the lowermost layer is arranged according to its function. The subdental layer of fibrous tissue grows faster than the one adjacent to the jaws. Thus a particular growth structure is formed. - Two constructive principles are realised: 1. The biting forces or "loads", applied to one or two teeth, are split and distributed on all teeth of the same family which are lingual of the loaded one. 2. As in the thecodont mammals, the compressive biting (= occlusal) force is transformed into a tensile force by the tooth-fixing apparatus and by the shapes of the jaws and this is sustained by fibrous structures. Magnitude and directions of the stresses which appear in the upper and lower jaw during biting are compared with stress patterns evoked in consoles and in beams of technical constructions. The moments of resistence have been calculated for 9 or 8 cross sections, respectively, through the upper and the lower jaw. The forms of both jaws are comparable to a beam of equal strength on two supports, namely, bitten object and joints; while the load is represented by the muscular force. Where the bending moments are at a maximum, opposite to the muscle insertions, a strong ligamentous reinforcement of the perichondrium extends parallel to the tooth rows and fades out towards the joint and towards the symphysis. The strength properties of cartilage and of collagenous fibres in the species under consideration have been measured. The lines of action of the jaw muscles intersect in the area where the moments of resistence reach their maximum. The largest crushing teeth are located in this same section, so that the muscles exert most force on the teeth, while the joint is exposed to only moderate compression.


Temporary mechanical support of left ventricular failure following open heart surgery.

Patients coming to open heart surgery with advanced cardiac dysfunction may require mechanical cardiac support to avoid life-threatening low cardiac output in the postoperative period. 15 patients who could not be withdrawn from cardiopulmonary bypass because of low cardiac output were supported with a left heart bypass system (left atrium to ascending aorta). Ten were ultimately separated from the device, 6 were dismissed from the hospital and 4 remain well (the longest 2.6 years postoperative). A major asset of the device is that thoracic reentry is not required when support is discontinued.


Angina with "normal coronary arteries". A misnomer.

Angina with "normal coronary arteries" might best be thought of as "angina with coronary dysfunction". It seems likely that this syndrome is due to inadequate regional myocardial perfusion with manifestations similar to those seen when ischemia results from occlusive coronary artery disease. The prognosis of the disorder is favorable, but occasional catastrophic events occur. It appears likely that maldistribution of perfusion results from dynamic changes affecting proximal, and perhaps distal coronary vessels, potentially mediated by vasoactive substances released from platelets precipitating or exacerbating coronary arterial spasm. Clarification of the pathogenesis of the syndrome should permit implementation of more effective therapy and prevention of the rare malignant sequelae of this disorder.


Automated data processing. An essential decision-making aid in the treatment of acute myocardial infarction.

Automated data processing is playing an increasing role in evaluations of left ventricular function, infarct size, and ventricular dysrhythmia in patients with acute myocardial infarction. For example, radionuclide angiocardiography permits accurate, serial non-invasive assessments of ejection fraction and detection of ventricular wall motion abnormalities; estimation of infarct size from observed and projected plasma CPK changes facilitates evaluation of interventions designed to reduce ischemic injury; positron emission transaxial tomography (PETT) appears to offer prompt, objective, non-invasive determination of the extent of jeopardized myocardium; and automated analysis of rhythm characterizes relationships between infarction and ventricular dysrhythmia. These and related techniques are useful not only in patient management, but also as research tools. Thus, factors potentially responsible for early and late ventricular dysrhythmias may be delineated by objective characterization of large numbers of ectopic depolarizations; the mechanisms underlying early (malignant) and late ventricular dysrhythmias may be differentiated and clarified. These and other applications of automated data processing techniques should facilitate objective evaluation and development of more effective therapy and prove increasingly useful in the management of patients with acute myocardial infarction.


Rat model for hereditary retinal degeneration.

The disorder in Wag/Rij rats is a spontaneous, bilateral retinal deneration. It is characterized by an early onset, slowly progressive degeneration of the photoreceptor cells leading to destruction of the retina. Degeneration affects both rod cells and cone cells, and to a lesser degree the cells in the inner nuclear layer. The remarkable alterations in the retinal pigment epithelium during the course of the disease suggest a profound change in metabolism and function of the pigment epithelium and implicate a possibility of interaction between the pigment epithelium and the photoreceptors. Since degenerated cells have also been observed in the inner nuclear layers, there is a possibility that Muller's cells are involved in the retinal degeneration. Controlled experiments have demonstrated that the disease is not induced by light damaging effects of the retina, and initial breeding experiments suggest that the disease is inheritable, probably as an autosomal dominant trait. The retinal degeneration in Wag/Rij rats is a new, unique system and it is a potentially very useful animal model of retinitis pigmentosa.


A therapeutic trial of vitamin A in patients with pigmentary retinal degenerations: a negative study.

A prospective therapeutic trial was designed to test the hypothesis that measurable improvement of retinal functions might occur in some patients with pigmentary retinal degeneration when placed on high doses of solubilized vitamin A (Aquasol A, 50,000 I.U. per day by mouth for 28 days). After a standard ophthalmic history and examination pre-trial examinations consisting of visual acuity, visual fields, color vision tests, dark adaptations and cone thresholds were obtained on two separate occasions. Electroretinography was usually performed only once. Forty-seven patients were entered into the study of which 27 had typical retinitis pigmentosa. The patients showed no significant change in visual function from pre-trial results when tested after taking the vitamin A for 28 days. Post-trial electroretinography performed on 10 patients with recordable pre-trial electroretinograms showed no change. The 10 patients retested at six and 12 months after the trial showed no significant change in visual function.


Protection against photic damage in retinitis pigmentosa.

Experiments on photic damage to the retinas of rats with hereditary retinal dystrophy and some tentative clinical evidence on human patients suggest that, in human retinitis pigmentosa, one could try to protect the retina and especially the rods from bright light in an attempt to delay the retinal degeneration and to prolong the period of useful vision. Several theoretical criteria have been proposed for protection of RP patients from possible photic retinal damage. Observing these criteria, Adrian developed a brownish ophthalmic filter which absorbs the short wavelengths preferentially, thus protecting the rods primarily. Whether or not use of these filters will be efficacious has yet to be determined and will require careful experimentation and the accumulation of clinical experience. Several brown ophthalmic filters also have been tested against the criteria for a protective device. The NoIR Amber 7% plastic glasses satisfy these criteria quite well and thus can be considered as a substitute for the Adrian lens. The characteristics of the two types of filters are compared. Experience with different methods of protection may show whether it is better to attempt to delay degeneration of both retinas simultaneously by decreasing their illuminations with filters or to exclude light completely from one eye in an attempt to preserve it while the other eye degenerates in the usual course of the disease. In any event, given the present state of knowledge, it seems to be appropriate, especially in the early stages of the disease, to suggest that RP patients protect their retinas from excessive light.


Trace metals in a family with sex-linked retinitis pigmentosa.

Lead, cadmium, copper, and zinc levels were examined in RP patients, carriers, and controls in a family with sex-linked RP. The mean plasma copper concentration was significantly higher in the RP patients and carriers than in the controls. The mean plasma zinc concentration was significantly higher in the carriers than in the RP victims or controls. The mean plasma zinc/copper ratio was significantly lower in the RP victims than in the controls or carriers. These findings may help explain the onset of RP in some sex-linked carriers and may be of diagnostic value.


Application of the zinc protoporphyrin (ZP) test as a monitor of occupational exposure to lead.

Zinc protoporphyrin, the predominant abnormal metabolite that appears in whole blood as a result of chronic lead absorption, can be assayed fluorometrically in diluted whole blood with great sensitivity. An extremely simple and rapid test for the effects of lead absorption is described that is based on this assay. Results of a field trial show a characteristic dose-response relationship between zinc protoporphyrin and lead, and indicate that this test should be seriously considered as a monitor for the effects of chronic lead adsorption.


A study of benzene exposure versus urinary phenol levels.

On the job benzene vapor exposures of less than 5 ppm were measured concurrent with the 24 hour collection of urine from 52 employees. Urinary phenol levels of the collective study group, measured as either concentration or weight, showed a positive statistically significant correlation with benzene exposure. However, due to variances in individual baseline phenaol levels, determination of benzene exposure at these low concentrations is relatively weak. Since baseline phenol concentrations exist over a range of values, adjustment for a single value of each individual's baseline did not improve correlation for the collective study group.


Identification of stainless steel welding fume particulates in human lung and environmental samples using electron probe microanalysis.

Open lung biopsy specimens from two welders and air samples from their workplace environments were examined with the electron probe microanalyzer. X-ray analysis showed that the majority of particles found in the lung tissue from both workers and in the air samples to be composed of varying amounts of iron, chromium, manganese and nickel, the major components of some types of stainless steel. Based upon these analyses, it was concluded that the majority of the particles in both biopsy specimens were a result of the workplace environment.


Performance characteristics of the 10 mm cyclone respirable mass sampler: part I--monodisperse studies.

The 10 mm cyclone respirable mass sampler was evaluated to determine the flow rate which best matched the BMRC and the LASL-ACGIH criteria and to determine effects of pulsating flow, particle charge, mass loading and sampler orientation. Part 1, this paper, describes the work with monodisperse aerosol. The best match for BMRC was 1.4 lpm; for LASL, 1.7 lpm. The two separate criteria should be merged. The 10 mm cyclone is two separate criteria should be merged. The 10 mm cyclone is better for sampling logistics than the BMRC horizontal elutriator.


Cardiac prostaglandin release during myocardial ischemia induced by atrial pacing in patients with coronary artery disease.

The relation between myocardial release of prostaglandin and myocardial ischemia was studied in 12 selected patients with multivessel coronary artery disease. These 12 were chosen for analysis because they experienced angina pectoris, ischemic electrocardiographic changes and decreased myocardial lactate uptake during atrial pacing. Simultaneous aortic and coronary sinus blood samples were obtained at rest, during angina and after recovery and were assayed for prostaglandins F, E and A with radioimmunoassay. Cardiac release of prostaglandin F was observed during angina in 11 of 12 patients. Aortic prostaglandin levels remained constant throught each study. During angina, the mean aortovenous difference (+/- standard error) was -0.30 +/- 0.04 ng/ml (P less than 0.001) for prostaglandin F and -0.10 +/- 0.03 ng/ml (Pless than 0.001) for prostaglandin E. There was no significant release of prostaglandin A. Blood samples were also drawn at subanginal heart rates in two patients. Prostaglandin F was released only during angina. In three control patients with a chest pain syndrome and normal coronary arteries, comparable atrial pacing produced no release of prostaglandin F, E or A. These results, together with the known vascular and metabolic actions of prostaglandins, suggest that these pharmacologically active compounds may also play a physiologic role in the cardiac response to ischemia in man.


Comparative study of cardiovascular function and ventricular premature complexes in smokers and nonsmokers during maximal treadmill exercise.

Maximal treadmill exercise tests were performed by 586 male members of the Indiana State Polic Force who were free of clinical evidence of cardiovascular disease. The study population was categorized into groups according to cigarette smoking experience and subgroups according to age and number of pack-years of exposure. There were 176 nonsmokers (30 percent), 268 current smokers (46 percent) and 142 former smokers who had abstained for at least 1 year (24 percent). No statistically significant differences were found in the prevalence of exercise-induced ventricular premature complexes when current smokers were compared with nonsmokers or former smokers either as a group or as subgroups classified by age. The duration of maximal exercise and the peak heart rate and systolic blood pressure during maximal exercise were compared for each group. The duration of maximal exercise was significantly shorter in smokers (P less than 0.001) and former smokers (P less than 0.005) than in nonsmokers. Maximal systolic blood pressure during exercise was greater in smokers than in nonsmokers (P less than 0.01) but did not differ significantly between nonsmokers and former smokers. Maximal heart rate during exercise was significantly lower in smokers (P less than 0.01) and former smokers (P less than 0.01) than in nonsmokers. In conclusion, there was a statistically significant difference in the duration of exercise and the maximal heart rate and systolic blood pressure attained during exercise between men who smoked and nonsmokers, but the prevalence of the exercise-induced ventricular premature complexes did not appear to be influenced by smoking habits.


Aortic stenosis: echocardiographic cusp separation and surgical description of aortic valve in 22 patients.

Diminished echocardiographic aortic cusp separation is used as one indicator of the severity of aortic stenosis. To test the validity of this index, 22 patients--12 (55 percent) with isolated aortic valve disease and 10 (45 percent) with aortic stenosis associated with mitral or coronary artery disease--underwent M mode echocardiographic examination before aortic valve replacement. Tracings of diagnostic quality were obtained without difficulty from all 22 patients. Cardiac catheterization was performed in 21 patients. Echocardiographic cusp separation was measured from the apparent mid-systolic orifice and from the outer periphery of the anterior cusp to the outer periphery of the posterior cusp (maximal peripheral cusp separation). Mid-systolic cusp separation varied in nearly every patient, depending on the angle of leaflet presentation to the ultrasonic beam. Maximal peripheral cusp separation measured 16 mm in 18 of 22 patients (82 percent); it indicated neither the severity of the aortic stenosis as documented with cardiac catheterization nor the mobility of the cusps seen at operation. The surgical and echocardiographic descriptions of leaflet and aortic root calcification were similar. In situ examination of aortic cusp separation indicated that diseased aortic valves are not comparable with normal valves or valves with uncomplicated congenital obstruction. The aortic leaflets were curled, fused, calcified and deformed from their natural state of coaptation. Abnormal thickening and limited or eccentric mobility of the aortic leaflets were useful indicators of the cause of valve disease, but cusp deformity secondary to aortic stenosis invalidated mid-systolic cusp separation and maximal peripheral cusp separation as indicators of the severity of aortic stenosis.


Frequency and significance of coronary arterial dominance in isolated aortic stenosis.

Myocardial infarction during aortic valve replacement has previously been reported to result from obstruction of a branch of the left main coronary artery by the perfusion cannula. Patients with a dominant left coronary arterial system may be at greater risk. To assess the frequency and significance of a dominant left coronary arterial system the coronary angiograms of 75 consecutive patients more than 34 years of age with isolated aortic stenosis were studied and compared with those of a control group of 150 patients. Among the patients with aortic stenosis, 19 (25 percent) had left dominance, 9 (12 percent) a balanced circulation and 47 (63 percent) a dominant right coronary arterial system. Among control patients, 14 (9 percent) had left dominance 18 (12 percent) a balanced system and 118 (79 percent) right dominance. The increased prevalence of left dominance in patients with aortic stenosis was significant (P less than 0.005). Among patients with aortic stenosis, the left main coronary artery was shorter (P less than 0.01) in those with left dominance (6.2 +/- 1.3 mm [mean +/- standard error]) than in those with right dominance (9.9 +/- 0.7). Sixty-nine patients with aortic stenosis underwent aortic valve replacement. Perioperative myocardial infarction occurred in 4 of 15 (26.7 percent) of those with left dominance and in 4 of 54 (7.4 percent) of those with right dominance or a balanced circulation (P less than 0.05). Perioperative myocardial infarction occurred in all three patients with left dominance and obstructive coronary artery disease. The increased prevalence of a dominant left coronary arterial system in aortic stenosis suggests that this may be part of a developmental complex. Patients with left dominance have a shorter left main coronary artery than patients with right dominance. They also have an increased risk of perioperative myocardial infarction if there is associated obstructive coronary artery disease. Preoperative information about the coronary arterial anatomy and extent of coronary artery disease may be helpful in planning the use of coronary perfusion and other myocardial preservation techniques during surgery in order to reduce the incidence of myocardial infarction.


Diagnosis of old inferior myocardial infarction by body surface isopotential mapping.

Body surface isopotential maps obtained from 28 patients with old inferior wall myocardial infarction were compared with maps from 120 normal subjects. The 12 lead electrocardiogram of 8 of the 28 patients (29 percent) with inferior wall infarction was normal or showed only nondiagnostic ST-T wave abnormalities at the time the isopotential maps were obtained. In all patients with inferior wall infarction the isopotential map showed a minimum (area of negative potentials) on the inferior or right thoracic surface during the early portions of the QRS complex. This finding was observed in patients with normal or nonspecific abnormalities in the 12 lead electrocardiogram as well as those with QRS abnormalities. By contrast, the minimum during the early QRS complex in normal subjects was located on the right upper back and shoulder region...


Acute blood pressure elevation and ventricular fibrillation threshold during coronary occlusion and reperfusion in the dog.

The effect of acute elevation of arterial blood pressure on the ventricular fibrillation threshold was examined in 19 closed chest dogs anesthetized with chloralose during 10 minutes of occlusion followed by abrupt reperfusion of the left anterior descending coronary artery. Ventricular fibrillation threshold was determined using two methods of electrical testing: sequential R/T pulsing and the train of stimuli method. Blood pressure was increased with an intravenous injection of the alpha adrenergic stimulator phenylephrine. Acute hypertension significantly diminished the enhanced vulnerability associated with coronary occlusion. After denervation of the carotid sinus and aortic arch baroreceptors, elevation of blood pressure failed to affect vulnerability during occlusion. In both intact and denervated animals, the predisposition to ventricular fibrillation after reperfusion was unchanged by the increase in blood pressure. It is suggested that withdrawal of sympathetic tone mediated by the baroreceptor reflex is the basis for the protection against ventricular fibrillation resulting from elevation of blood pressure. The failure of acute hypertension to alter vulnerability during reperfusion suggests that the predisposition to ventricular fibrillation during reperfusion is due to mechanisms other than those operating during coronary occlusion.


Functional significance of coronary arterial stenoses assessed by regional changes in intramyocardial S-T segment voltage and myocardial gas tensions with atrial pacing.

Myocardial carbon dioxide tension and intramyocardial S-T segment voltage have previously been shown to provide useful quantitative indexes of the severity of regional myocardial ischemia. This study was designed to determine if (1) changes in intramyocardial S-T segment voltage and myocardial gas tensions, with the addition of atrial pacing, could be used to assess the functional significance of a coronary stenosis, and (2) if changes in S-T voltage recorded in intramyocardial electrodes proved a more sensitive indicator of ischemia than changes recorded in epicardial electrodes. In 12 open chest dogs, a variable constrictor and an electromagnetic flow probe were placed on the proximal left circumflex coronary artery. Myocardial carbon dioxide and oxygen tensions were recorded with mass spectrometry and unipolar intramyocardial S-T segment voltage with multicontact plunge electrodes. Intramyocardial S-T voltage and myocardial carbon dioxide tension showed parallel increases with atrial pacing in the presence of subcritical, critical and supercritical coronary stenoses. In the presence of a critical stenosis, S-T segment changes recorded in deepr myocardial layers were of greater magnitude than those recorded near the epicardial surface. These findings suggest that the severity of myocardial ischemia can be assessed by measuring intramyocardial S-T voltage or myocardial gas tensions at resting and paced heart rates. They also suggest that intramyocardial S-T voltage is a more sensitive indicator of the severity of pacing-induced myocardial ischemia than epicardial S-T changes. Application of this technique to patients undergoing coronary revascularization could allow intraoperative determination of the functional significance of questionable angiographic lesions and a more rational approach to the assignment of priorities to individual arteries when multiple bypasses are being considered.


Early changes in regional and global left ventricular function induced by graded reductions in regional coronary perfusion.

To determine the sequence of changes in segmental myocardial function, regional lactate metabolism and global left ventricular function induced by mild regional ischemia, blood flow in the left anterior descending coronary artery of 10 dogs was reduced by 10 percent decrements with use of a screw clamp. At each level of flow, segmental mechanical function and regional metabolism were assessed, the former with use of a mercury-in-Silastic length gauge and the latter with transmyocardial lactate balance measurements obtained with sampling from the anterior interventricular vein. Coronary arterial flow at the onset of regional lactate production was 48 +/- 4 percent (mean +/- standard error of the mean) of the control value. The onset of segmental mechanical dysfunction coincided with the onset of lactate production. Epicardial S-T segment abnormalities over the ischemic zone usually could not be detected until coronary flow was further reduced. After the onset of regional ischemia there was a linear correlation between coronary arterial flow and regional lactate production. At the onset of mild regional ischemia, defined as the onset of regional lactate production, no significant or directionally consistent changes were noted in standard measurements of global left ventricular performance, including heart rate, mean aortic pressure, left ventricular end-diastolic pressure, cardiac output, stroke volume, stroke work and peak positive dP/dt (maximal rate of rise of pressure). However, peak negative dP/dt (maximal rate of pressure decrease) decreased from 99 +/- 2 to 89 +/- 3 percent of the control value (P less than 0.0005) coincident with the onset of ischemia. It is hypothesized that dyssynchronous wall motion in the ischemic zone during isometric relaxation accounts for this decrease in peak negative dP/dt.


Effect of drugs on conduction delay and incidence of ventricular arrhythmias induced by acute coronary occlusion in dogs.

The effects of various drugs on delayed activation of the ischemic myocardium and the incidence of ventricular arrhythmias were studied in 34 open-chest anesthetized dogs. The left anterior descending coronary artery was occluded for 6 minutes before and 42 minutes after administration of aprindine (2.85 mg/kg body weight), quinidine (8 mg/kg) and verapamil (0.2 mg/kg) and during infusion of isoproterenol (0.2 microng/min). The time intervals from the onset of the QRS complex to the major deflection of the bipolar electrograms recorded within the normal and ischemic zones were measured at cycle lengths of 500, 400 and 300 msec and were correlated with the development of ventricular arrhythmias. At a cycle length of 500 msec, aprindine increased by 19.5 msec the delay in activation time produced by coronary ligation alone (P less than 0.05), whereas verapamil reduced by 10 msec the extent of ischemia-induced conduction delay (P less than 0.05). The delay in activation time in the ischemic zone was not significantly altered by quinidine or isoproterenol. The incidence of ventricular arrhythmias was increased by aprindine (from 1 in 11 to 8 in 11 dogs), decresed by verapamil (from 3 in 7 to 0 in 7 dogs) and was not changes by quinidine or isoproterenol. Thus, delayed activation of the ischemic myocardium appears to play an important role in the genesis of early arrhythmias due to myocardial ischemia, and drugs that significantly depress conduction in the ischemic myocardium may predispose to the development of ventricular arrhythmia whereas those that improve conduction may be protective. Contrary to their effects on slow channel-dependent conduction, verapamil improved and isoproterenol worsened conduction during ischaemia.


Cardiac pacing in children and adolescents.

Nineteen patients aged 1 month to 18 years underwent implantation of a cardiac pacemaker and were followed up for up to 9 years (average duration of pacing 54 months). Complete heart block was present in 16 patients and sinus nodal dysfunction in 3. Heart block was presumably of congenital orgin in eight, secendary to cardiac surgery in seven and subsequent to cardiac catheterization in one. Sinus nodal dysfunction was of presumed congenital origin in one and occurred after cardiac surgery in two. Pacing was required because of syncopal attacks in eight patients, three of whom had congestive heart failure or low cardiac output on physiologic studies. It was required in four because of congestive heart failure, in two because of low cardiac output (one with a wide QRS complex), and in five for postoperative rhythm control. With return of sinus rhythm after 2 and 3 months, respectively, pacing was discontinued in two patients. One child was partially corrected disease died within 3 months, one died of wound breakdown and sepsis after 10 months of pacing and one died suddenly 4 years after implantation. All others have returned to normal activity; only one requires cardiac medication. The degree of emotional stability has been striking. Asynchronous and atrial synchronous pacing are of equal therapeutic value. The very small radiofrequency implanted receiver has been useful in younger children. The major problems have been caused by the large size and short longevity of the generators and the child's growth stressing the lead system. Transvenously implanted pacemakers have presented no greater management problems than those placed during thoracotomy.


Postoperative complete heart block in 64 children treated with and without cardiac pacing.

Between 1957 and 1973, a total of 64 children had complete heart block during intracardiac surgery were treated by one of three methods: (1) No pacemaker: Six of the 13 patients in this group had reversion to sinus rhythm. Seven patients continued to have complete heart block, and five of these died of Stokes-Adams episodes. Two patients continue to have complete heart block without pacemaker insertion. (2) Temporary pacemaker: Seventeen of 25 patients had reversion to sinus rhythm and the temporary pacemaker was removed; the other 8 continued to have complete heart block. Five of the eight died--three of Stokes-Adams episodes and two at the time of cardiac reoperation. Three remain asymptomatic without placement of a permanent pacemaker. Six died of postoperative complications unrelated to heart block or pacemaker implantation. None of the other 20 experienced Stokes-Adams attacks. There was one late death in this group. Although there are problems in using permanent pacemakers and electrode systems, in these patients with operatively induced complete heart block their use was associated with a low mortality rate.


Interruption of the aortic arch: preoperative and postoperative clinical, hemodynamic and angiographic features.

Interruption of the aortic arch, studied in 10 patients, was associated with a variety of other cardiac anomalies in 8 patients and was an isolated anomaly in 2. Clinical and angiographic evaluation in the former group revealed congestive heart failure and generalized cyanosis in early infancy, pulmonary and systemic arterial hypertension and a variety of intracardiac and aortic shunt. The two patients with an isolated anomaly had clinical and hemodyanmic features not dissimilar from those of severe coarctation but interruption of the aortic arch was demonstrated on aortography. Surgical treatment was successful in four of the eight infants with associated anomalies and in both children with the isolated defect. Postoperative angiography revealed several related complications and the status of the aortic reconstruction. Clinical angiographic recognition of this lesion is important because operative intervention has been successful in an increasing number of patients.


Ventricular septal defect in interruption of aortic arch.

A necroscopy study of 34 patients with interruption of the aortic arch was carried out to characterize more fully the ventricular septal defect and the anatomic basis of subaortic obstruction. In 21 patients (61.8 percent) the site of interruption was between the left common carotid artery and the left subclavian artery; in 13 (38.2 percent) it was distal to the left subclavian artery; no case of interruption just distal to the innominate artery was found. A ventricular septal defect was present in all but two patients, both with large aortopulmonary fenestrations. All patients had visceroatrial situs solitus and D-ventricular loop. The great arteries were normally related in 33 patients and D-transposition was found in one patient. Twenty-one patients had a ventricular septal defect involving the conal septum. Conoventricular malalignment resulted in a typical subpulmonary ventricular defect. The malignant was characteristically in a leftward direction allowing for potential muscular narrowing of the left ventricular outflow tract. In some patients, the conal ventricular septal defect was characterized by a deficiency of a the conal septum without malalignment. In 4 of 21 patients with a ventricular septal defect involving the conal septum, the defect was immediately adjacent to the pulmonary.value. Typical infracristal membranous ventricular defects five patients), cushion defects (3 patients) and muscular defects (3 patients), were also found. The potential for subaortic narrowing was present in some of these patients as well. No relation between position of ventricular septal defect and type of arch interruption could be discerned. The presence or absence of subaortic obstruction was not predictive of a specific type of interruption. Similarly, although deformity of the aortic valve was not uncommon in this series, it was not associated with any specific type of interruption.


Evaluation of a computerized arrhythmia alarm system.

A prospective study of a computerized arrhythmia alarm system was carried out in the coronary care unit during 200 patient hours of monitoring. The computer system was designed to activate an alarm on the development of rhythm and conduction disorders including asystole, ventricular tachycardia, atrial tachycardia, sinus tachtcardia, bradycardia, frequent premature ventricular beats, atrial fibrillation and bundle branch block. Study patients were simultaneously monitored by the computer system and a conventional analog heart rate alarm system. All alarms generated by the two systems were evaluated. Of 79 computer alarms, 42 (53 percent) were true positive alarms; during the same period there were 167 analog alarms of which only 13 (8 percent) were true positive alarms. In both systems, false positive alarms were primarily due to patient movement, but they occurred only 25 percent as often with the computer system as with the analog system. These results indicate that computerized arrhythmia monitoring systems offer significant advantages over conventional monitoring techniques.


Effects of dobutamine in patients with acute myocardial infarction.

This study was designed to evaluate the effects of dobutamine, a new cardioselective beta adrenergic agonist, on cardiac performance and myocardial injury in patients with evolving myocardial infarction. Results in 16 patients given dobutamine (1 to 40 microng/kg per min for 24 hours) were compared with those in two groups of control patients: one of 16 patients matched for predicted infarct size, and the other of 16 patients matched for early ventricular dysrhythmia, analyzed by computer. Infarct size was predicted from plasma creatine kinase (CK) values during the first 7 hours after the initial elevation, before infusion of dobutamine. Overall observed infarct size was estimated from hourly CK values for 48 hours (including those before and after administration of dobutamine). In all patients technetium-99m (stannous) pyrophosphate scans were positive for myocardial infarction. Dobutamine increased cardiac output (assessed by thermodilution) from 4.9 +/- 0.37 (mean +/- standard error) to 6.0 +/- 0.38 liters/min (P less than 0.05) and decreased pulmonary arterial occlusive pressure from 21.5 +/- 2.7 to 16.7 +/- 1.6 mmHg (P less than 0.01) without significantly altering heart rate or systemic arterial blood pressure. The ratio of observed to predicted infarct size, the frequency of independently detected reinfarction or extension of infarction and the frequency of premature ventricular complexes were similar in control and treated patients. Thus administration of dobutamine in doses sufficient to improve ventricular performance after myocardial infarction does not exacerbate myocardial injury or ventricular dysrhythmia.