A new procedure for the statistical evaluation of intrauterine contraception.

An improved statistical method for assessing the efficacy of intrauterine contraception is presented. This method, called the log-rank method, is based on a daily life table, which yields the best estimates of the cumulative net termination probabilities. It provides a sensitive chi-square test statistic to detect differences among these probabilities for two or more contraceptive devices. When three or more devices are compared, the chi-square statistic may be partitioned into additive components representing comparisons among groups of devices. The log-rank method also permits adjusting for differences among subgroups by controlling for factors such as parity or age. Although calculations may be performed on a desk calculator, a FORTRAN-IV computer program is made available to interested researchers.


Pure red cell aplasia: three cases responding to immunosuppression.

Successful treatment of three patients with red cell aplasia is presented. No thymoma or other underlying etiology was discovered. An autoimmune disease with intramedullary destruction of red cell precursors was suspected. All patients responded to prednisone and/or immunosuppressive therapy and have maintained normal hemoglobin levels for 3, 7, and 2.5 years without recurrence. The pathogenesis and therapy of red cell aplasia is discussed.


Incidence, significance, and follow-up of para-aortic lymph node metastases in late invasive carcinoma of the cervix.

One hundred and four patients with Stages II and III of cervical carcinoma underwent para-aortic node biopsies. Of these, 12.5 per cent of patients with Stage IIA, 14.9 per cent of patients with Stage IIB, and 38.4 per cent of patients with Stage III carcinoma of the cervix had positive para-aortic nodes. They subsequently recieve 6,000 rads to the para-aortic area. The radiotherapy complication rate was high. Within four years, 50 per cent of the patients with positive para-aortic nodes had other distant metastases. The two- and four-year follow-up is presented. Only one of 13 patients with positive para-aortic nodes was alive at the end of four years.


Mediterranean lymphoma -- an unusual course.

A case of Mediterranean lymphoma with an unusual short and stormy course complicated by spontaneous perforation of the small bowel in a 32-year-old Jewish Moroccan-born male is presented. Such a course has not been described previously. Literature pertinent to the subject is reviewed.


The effect of peripherally fenestrated contact lenses on corneal edema.

To determine the effect of peripherally fenestrated contact lenses on central corneal edema, 6 subjects (12 eyes) wore steeply fitted lenses of identical dimensions but with various numbers of 0.1-mm diameter peripheral fenestrations for 3-hr periods. At the end of the wearing periods, thickening, steepening, and central clouding of the cornea were generally reduced as the number of fenestrations was increased. However, 20 fenestrations were required before the edema was reduced to a clinically acceptable level.


Selective atrophy in the lateral geniculate nucleus associated with iris coloboma in cat.

A kitten with a unilateral, congenital coloboma of the iris was raised in a normal environment and sacrificed at 6 monthlicted eye was seen in Nissl-stained sections taken through the lateral geniculate. The result suggests that image degradation is more important than luminance reduction in causing selective changes in the visual pathway.


Team management of Parkinson's disease.

This report describes a multidisciplinary approach to the treatment of Parkinson's disease. By using published sources, the disease process, clinical findings, and medical management of Parkinson's disease are reviewed. The continual change in the clinical picture as well as the therapeutic needs require that clinicians have a full understanding of the disease and drugs used. This is followed by a description of a group program, including the evaluation process, treatment goals, and individual and group activities employed. Rehabilitation services are needed as medical management alone is not sufficient to maintain patient's daily living skills. The occupational therapist is skilled in assessment and training of activities for  daily living. As a result, occupational therapy can be an integral part of the treatment program.


Incidence and prevalence of eye cancer.

Cancer of the eye is the only ocular disease which directly threatens life. The average annual incidence rate (new cases) in the U.S. is about 1/100,000 population and the estimated prevalence rate (total cases) is about 12/100,000 population. With few exceptions, eye cancer occurs more frequently in whites than in blacks and more often in older than in younger people. The survival rate for persons with localized ocular tumors receiving early treatment is almost 80%. This statistic indicates the importance of optometric detection of this uncommon disease.


A clinically useful eye movement recording system.

A simple, stable, and relatively calibration-free eye movement recording system for clinical application is described. This limbal sensing device makes use of a standard trial-lens clip that can be attached to the patient's spectacles, allowing easy and quick addition of lens or prism power. Horizontal eye movements or positions can be recorded with an accuracy of better than 1 degree over a 50-degree range; the linear range of the device is approximately 30 degrees.


Effect of sensory integrative therapy on the coordination of children with choreoathetoid movements.

Learning-disabled children with deficits in sensory integration as well as choreoathetosis and who received sensory integrative therapy gained more on an eye-hand coordination test than did control children. Using a one-tailed test, levels of significance difference between the mean gain scores of the experimental and control groups were .058 for the more accurate hand and .061 for the less accurate hand. It is not possible to determine whether the therapeutic effect was on the motor or on the sensory integrative aspect of coordination or on both.


Analysis of developmental processes possibly related to human dental sexual dimorphism in permanent and deciduous canines.

Analysis of published odontometric data on human dental sexual dimorphism indicates that this characteristic is most clearly expressed by the canine teeth. Review of the several processes involved in coronal odontogenesis suggests that such dimorphism is related to an absolutely longer period of amelogenesis for both deciduous and permanent dentitions.


Relationship between tooth and long bone size.

Canonical correlations between tooth and long bone dimensions showed a greater correlation for Anglo-Saxons and apes than for Nineteenth Century Londoners, i.e., coefficients of 0.75 for gorilla, 0.72 for chimpanzee, 0.69 for orang-utans, 0.74 for Anglo-Saxons, but 0.53 for Nineteenth Century Londoners. Although based upon limited sample sizes and limited metrical profiles of teeth and long bones, the data support the thesis that modern Europeans are under reduced selection pressure to maintain tooth size compared with apes or ancient man.


Racial differences in anthropometric traits in school children of Bahia, Brazil.

Two thousand four hundred and forty-four Brazilian school children were classified as Light, Medium and Dark according to a subjective jedgment of the proportion of Negro admixture, and studied for weight, height, span and upper-segment/lower-segment (US/LS) ratio. The mean US/LS ratio decreases significantly as the proportion of Negro admixture increases giving an intermediate value for those children belonging to the Medium group for race.


A multivariate, osteological approach to Towa culture history.

Eleven cranial measurements on 14 archeological populations from the American Southwest support the archeologically derived reconstruction of Towa population movements. The supposed (linguistic) relationship between Pecos and the Towa speaking villages is questioned.


Effect of glucagon on thermogenesis in the pigeon.

The effects of glucagon injection on temperature regulation and some metabolic parameters were studied in the pigeon. Glucagon (100 microng/kg) always inhibited shivering and caused a fall in the oxygen consumption and body temperature of the unanesthetized pigeon at + 6 degrees C. At + 34 degrees C, the same dose of glucagon had no effect on these parameters. At 22 degrees C, glucagon produced an elevation in plasma free fatty acid (FFA) and blood glucose levels. The rise in FFA at 22 degrees C coincided with the suppression of shivering at 6 degrees C. The glucagon-mediated rise in plasma FFA, but not glucose level, was potentiated by cold ambient temperature. Adrenergic blocking agents given prior to glucagon did not abolish its effects. Phentolamine even prolonged the absence and accelerated the suppression of shivering. A dissociation in the mechanisms by which catecholamines and glucagon suppress shivering is suggested. Although mobilizing energy reserves, glucagon does not seem to be calorigenic in the pigeon at this dose. The interpretation of the changes in plasma FFA levels is discussed in relation to fuel consumption during shivering.


Effects of cholecystokinin, gastrin, and related peptides on coho salmon gallbladder contraction in vitro.

Isometric contractions of coho salmon (Oncorhynchus kisutch) gallbladder longitudinal muscle strips were recorded in response to porcine cholecystokinin (CCK), octapeptide of CCK (OP-CCK), desulfated octapeptide of CCK (ds-OP-CCK), porcine heptadecapeptide gastrins I and II, and pentagastrin. Peak tonic contraction amplitude and peak rhythmic contraction frequency were used to construct concentration-response curves for each peptide. Observed maximal responses to each peptide were not significantly different; therefore, all peptides tested were equal in efficacy. CCK, OP-CCK, and gastrin II were equipotent, and ds-OP-CCK and gastrin I were equipotent. 1) porcine CCK can stimulate contraction of the coho salmon gallbladder; 2) tonic and rhythmic contractile responses are elicited in coho salmon gallbladder by agonists; 3) coho salmon gallbladder muscle cannot distinguish between agonists that differ in the location of a sulfated tyrosyl residue at position 6 versus position 7 from the C-terminus; and 4) the results of this study are consistent with the hypothesis that coho salmon gallbladder muscle contains a relatively primitive CCK receptor.


Food intake controls in the suckling pig: glucoprivation and gastrointestinal factors.

The energy balance of suckling Yorkshire pigs 1 day to 2 wk old was challenged by: food deprivation, glucoprivation, and caloric and noncaloric gastric loads delivered by intubation. tafter 2--4 h fasts, food intake greatly increased over nonfasted control intake during a 3-h refeeding period. This response occurred both when body weight gain was used as a measure of intake for pigs nursing on the sow and when intake was measured directly in bottle-fed pigs. Glucoprivation produced by 0.5--2 U/kg insulin did not stimulate food intake although plasma glucose fell to a mean of 49 mg/100 ml (43% of control) after 1 U/kg insulin. Gastric loads of water or 3% NACl depressed intake after 3-h fast, but 0.9% NaCl did not. All the caloric gastric loads depressed intake; in order of increasing effectiveness, they were: heavy cream, protein hydrolysate, corn oil, milk, 5% glucose, and 5% lactose. The carbohydrate loads were most effective, a result which indicates that the response was not to calories alone but to some specific nutrient, possibly glucose.


Electron probe microanalysis: its present, its future.

Electron probe microanalysis (EPM) is a method of elemental ultramicroanalysis based on the spectrometry of the characteristic X rays which are emitted when a target sample is excited by an electron beam. In the same sample many more elements (from carbon and up in the periodic table) in much smaller volumes (less than 1 micronm3 or 10(-15) liter) can be analyzed with EPM than with any other ultramicroanalytical method. Quantitation down to 10(-15) g is relatively easy. Any application of EPM in biology depends on the development of suitable methods for biological sample preparation. Liquid droplets of 10(-11)-liter volumes are routinely analyzed. Elemental content in isolated cells can be quantitated. The analysis of cellular, extracellular, and intercellular content in the same preparation is in sight: a general method for the analysis of diffusible elements in different compartments in tissue relies on the manipulation of frozen hydrated tissue near liquid nitrogen temperature. Localization in the same preparation of several organic compounds at high resolution will be possible by use of appropriate tags. All fields of microphysiology are likely to benefit from this new discipline.


Renal response to vasopressin after inhibition of prostaglandin synthesis.

The renal effects of vasopressin (VP) in water-loaded and hydropenic conscious dogs were examined with and without the previous administration of prostaglandin (PG) synthesis inhibitors (indomethacin and meclophenamate). The parameters studied were: urinary output, sodium and potassium excretion, plasma and urinary osmotic concentration, total renal blood flow, mean arterial pressure, heart rate, and the clearance and extraction ratio of p-aminohippuric acid and inulin. The infusion of VP caused antidiuresis and marked saluresis during water diuresis, whereas it was found to be diuretic and saluretic in hydropenic animals. Inhibition of PG synthesis greatly enhanced the antidiuretic activity of VP and abolished its saluretic and diuretic actions. Changes in renal water and solute excretion and changes in the hemodynamic parameters are uncorrelated. It is concluded that intrarenal PGs may play an important role in modulating the renal action of VP.


Relations of renal transport rate, transport maximum, and competitor potency for tetraethylammonium and choline.

By use of the Sperber technique in chickens, the renal tubule transport maximum (Tm) for the organic cation tetraethylammonium (TEA) was determined in vivo. The tubular transport rate, the Tm, and the competitor potency are assumed to have causal relationships. It was demonstrated that the two cations TEA and choline compete for the tubular transport of [14C]TEA. The saturating load of one cation was reduced by the simultaneous presence of the other. The Tm for these two cations was different by a factor of 2.4 and their respective competitor potency was inversely related to their Tm.


Tracer Na fluxes in Necturus proximal tubule.

Steady-state bidirectional sodium fluxes were measured across Necturus proximal tubules. New methods for capillary perfusion and collection of venous effluent enabled flux determination to be made from the appearance of luminal tracer in the capillaries. Fluxes and permeability were measured in the absence of net fluid reabsorption. The sodium permeability measured in the plasma-to-lumen direction was 3 X 10(-6) cm/s. The flux ratio (lumen-to-plasma/plasma-to-lumen) was about twice the passive value calculated from the measured concentrations and potentials. Estimates for the permeability and flux across the shunt pathway were obtained from nonsteady-state flux determinations. The shunt pathway appeared to be the most significant route for passive sodium movement from plasma-to-lumen. Nonsteady-state tracer measurements also enabled an estimate to be made of the lumenal cell membrane permeability and unidirectional sodium flux. Two-thirds of the lumen-to-plasma flux was calculated to traverse the cellular path and the remainder through the shunt. Approximately one-third of the intracellular sodium was found to exchange rapidly with tracer.


Fibrinogen synthesis in rabbits: effects of altered levels of circulating fibrinogen.

The effects of altered fibrinogen concentrations on fibrinogen synthesis in rabbits were evaluated by determining the rate of appearance of [75Se]selenomethionine (75SeM) in circulating fibrinogen. Fibrinogen levels were maintained at twice normal by infusion of homologous fibrinogen for either 1 or 6 days before the intravenous injection of 20 micronCi of 75SeM, and the rate of appearance of labeled fibrinogen was measured during the subsequent 24 h. In both groups, synthesis was unchanged. Five hours after induction of partial defibrinogenation by the infusion of bovine thrombin, fibrinogen synthesis was increased threefold. Stimulation was not attributable to decreased fibrinogen concentrations; synthesis was increased equally when levels were maintained above normal by infusion of fibrinogen before administration of thrombin. Heat-inactivated thrombin and diisopropylfluorophosphate-inactivated thrombin did not stimulate fibrinogen synthesis. Thrombin produced elevated titers of fibrinogen-fibrin degradation products (FDP-fdp). However, fibrinogen synthesis was not increased in rabbits that had received FDP-fdp from thrombin-treated donors. These data suggest that neither the fibrinogen concentration nor FDP-fdp influenced fibrinogen synthesis.


Cardiorespiratory control by carotid chemoreceptors during experimental dives in the seal.

The diving responses of apnea and bradycardia, produced experimentally by immersing the face in water, were successfully elicited in the harbor seal Phoca vitulina anesthetized with urethan. The role of the carotid body chemoreceptors in the production of the diving bradycardia was studied in isolated carotid sinus-body preparations autoperfused with blood from the arterial circulation. When asphyxia was well developed during a dive the chemoreceptor drive was withdrawn by temporarily perfusing the chemoreceptors with blood of high PO2 (greater than 400 mmHg) and normal PCO2 from a disk oxygenator. The heart rate immediately rose to its predive value. Reestablishing hypoxic hypercapnic blood perfusion of the chemoreceptors from the animal's own circulation caused bradycardia with persistence of the apnea. Breathing restarted only on emersion. Substitution of normal arterialized blood from the oxygenator before or at the onset of a dive had no effect on the existing heart rate. It is concluded that the carotid bodies play an important part in maintaining the diving bradycardia during developing asphyxia without affecting respiration.


Determinants of hypoxic and posthypoxic myocardial contracture.

The relationship between contracture (a rise in resting tension at constant length) and contractile activity was studied in isometric rat trabeculae carneae and cat right ventricular papillary muscles. Muscles at Lmax were paced at 12/min in solutions equilibrated at 29 degrees C with 95% O2-5% CO2. In rat myocardium, exposure to 60 min hypoxia (95% N2-5% CO2) at alkalotic pH produced contracture. In cat myocardium contracture was produced by the combination of exposure to digitalis and the recovery from hypoxia. Delayed relaxation was not responsible for the rise in resting tension in either preparation. In muscles not paced during hypoxia, contracture appeared despite total absence of contractile activity. Exposure to low calcium or acidosis reversed or prevented the rise in resting tension. Thus, contracture can be: 1) dynamic, reversible, and modified by factors which affect intracellular calcium availability; 2) independent of contractile activity and apparent activity of the relaxing system; and 3) distinct from delayed or incomplete relaxation. The extent of contracture during the recovery from hypoxia is not simply the function of the level of contractile activity during hypoxia but appears related to calcium availability at a critical time.


Impact of centrally applied biogenic amines upon the energy balance of fowl.

The impact of intraventricular injections of 100 microng of the biogenic amines, norepinephrine or dopamine, upon the energy balance of white leghorn hens Gallus domesticus was examined. Both drugs reduce metabolic heat production (about 35% at 9 and 20 degrees C, and about 15% at 35 degrees C) by inhibiting shivering or by reducing activity or both. Also the drugs inhibit the opposing thermal response, evaporative heat loss (about 3% at 9 and 20 degrees C, and about 20% at 35 degrees C) by reducing respiration rate. The relative balance of inhibiting these opposing responses by the drugs results in hypothermia at 9 and 20 degrees C, and hyperthermia or no change in body temperature at 35 degrees C. Both drugs usually caused an initial vasodilation of the feet and comb at all temperatures tested but did not persist long enough to have much of an impact on body temperature. It was concluded that differing ambient temperatures do not alter the action of the biogenic amines upon the modes of physical thermoregulation in chickens even though the direction of body temperature change is reversed at different ambient temperatures.


Brainstem control of shivering in the cat. II. Facilitation.

Regions containing areas and pathways mediating heat gain responses in the mesencephalon and upper pons and in the medulla were studied using topical microinjection of a local anesthetic. These facilitatory areas and pathways were compared in the decerebrated and intact cats. In lower pontine preparations shivering was abolished by bilateral injections of procaine into the lateral medullary reticular formation. Injections into the same areas in the intact anesthetized cat resulted in the cessation of shivering. These effects on facilitatory areas are reversible and can be repeated in the same preparation several times. Permanent effects were obtained by electrolytic lesions or by the local microinjections of 1% osmic acid. In summary it shown, by means of microinjection of local anesthetic, that the pathways mediating shivering in the intact and lower pontine cats are located in the same area in lateral reticular formation of pons and medulla.


Sensory information and subjective contour.

The possibility that subjective contours are an artifact of brightness contrast was explored. In one experiment, inducing luminance was found to have different effects on the clarity of subjective contours and the magnitude of brightness contrast. The results of a second experiment indicated that differences of luminance in a stimulus display are necessary for subjective contours to be sustained, whereas chromatic differences are not. It is concluded that subjective contour and brightness contrast are distinct perceptual phenomena but share a dependency on the processing of edge information transmitted through the achromatic channels of the visual system.


Auditory perception of spatiotemporal patterns.

To test the tendency of subjects to perceptually organize discrete temporal patterns with regard to runs of identical stimulus events, spatiotemporal patterns of white noise were presented for reproduction. The subjects in Experiment I began their reproductions with the true starting points of the patterns, but the subjects in Experiment II, who could not perceive the true starting points, began their reproductions with either long or short runs. It is suggested that changes in runs of auditory patterns are perceptually analogous to changes in contours of visual patterns.


Surgical management of complications of radiation-injured gut.

Radiation-injured bowel has been diagnosed in 5.1 per cent of 1,824 patients receiving pelvic or abdominal radiotherapy over the past ten years. Surgical intervention to manage these complications was required in 35 per cent. The type of procedure employed for large and small bowel complications has been evaluated to define guidelines for future therapy.


Cuffed endotracheal tubes: mucosal pressures and tracheal wall blood flow.

Eighteen brands of cuffed endotracheal tubes, including those with the new low pressure cuffs, were evaluated and compared. Experiments were performed in vitro on excised dog tracheae to measure the mucosal pressure exerted by the inflated cuffs. Pressure was measured directly with a mechanical sensor. Latex cuffs exerted the highest mucosal pressures, whereas silicone cuffs exerted the lowest mucosal pressures. Polyvinyl chloride cuffs exerted intermediate levels of mucosal pressure. With each material, predistended cuffs exerted lower mucosal pressures than nonpredistended cuffs. A second set of experiments was performed in vivo to determine the effect of mucosal pressure on tracheal wall blood flow. These studies employed a thermistor technic. The data showed that, when inflated sufficiently to seal within the trachea, stiff cuffs reduced blood flow more than compliant cuffs. With all cuffs, blood flow was reduced more at the mucosa than at deeper regions of the tracheal wall.It was concluded that for clinical use, compliant cuffs are preferable to stiff cuffs because they should cause less ischemia.


Thrombocytopenia and its management in the surgical patient needing multiple reconstructive procedures.

Thrombocytopenic patients with surgically correctable lesions such as radial clubhands are too often repeatedly transfused with randomly pooled platelets. This is followed by a clinical rejection of the foreign protein and rapid destruction of the platelets. There may be excessive bleeding episodes. Tissue typing technics now available can provide antigenically compatible platelet concentrates which elicit few of these reactions. Therefore, multiple reconstructive procedures can be achieved with a greater safety margin than previously possible.


Staging laparotomy for Hodgkin's disease in children.

Experience with staging laparotomy in twenty-one children has produced minimal immediate postoperative morbidity. Sepsis in two patients after discharge has prompted the long-term use of penicillin. Confirmation or revision of clinical staging by laparotomy has proved to be an accurate means of determining therapy and prognosis in children.


Duplication of the duodenum extending into liver.

A large intrahepatic duodenal duplication connected to the duodenum by two openings is described. No similar cases of intrahepatic cysts have been found in the literature. The patient, a forty-four year old woman, had recurrent and numerous bouts of right upper quadrant pain over many years before the intrahepatic portion of the cyst was drained by a Roux-en-Y anastomosis after the connections with the duodenum had been excised.


Aneurysm of the gastroduodenal artery as a cause of hemobilia.

One case of iatrogenic aneurysm of the gastroduodenal artery with hemobilia is reported. Surgical treatment consisted of ligature and resection after arteriographic diagnosis. The literature is reviewed.


The respiratory injury in burns. An account of the management.

The management of three patients suffering from respiratory complications of burns is described. The pathogenesis and treatment of pulmonary inhalational injury is reviewed and methods of monitoring respiratory function are discussed.


Pancuronium and the placental barrier.

Maternal and cord levels of pancuronium were estimated using a fluorimetric method in a series of ten patients. Low concentrations of pancuronium (0-04--0-1 microng/ml) were found in all the cord samples analysed, indicating placental transfer of pancuronium.


Effects of droperidol and fentanyl on human bone marrow cultures.

The effects of droperidol and fentanyl on three samples of human bone marrow with regard to their colony forming in culture was studied in more than 256 multiple experiments. There was no evidence of any toxic effect of droperidol and fentanyl on the bone marrow cells.


An unusual complication of an inadvertent dural tap.

The report describes a case of a large arteriovenous malformation of the brain becoming manifest following an inadvertent dural tap which was achieved while performing a lumbar epidural for the relief of labour pains.


A simple home-made haematocrit centrifuge.

A simple, easily made haematocrit centrifuge is described.


A modification of Bier's intravenous analgesia. Use of the pneumatic splint.

Prior to the administration of a "Bier's block", painless exsanguination of the limb, even in the presence of a displaced Colles' fracture, can be achieved with the use of an orthopaedic pneumatic splint.


Anaesthetic technique for microsurgery of the larynx.

The problems of anaesthesia for microsurgery of the larynx are reviewed and the disadvantages of some current techniques are discussed. A modified headrest, laryngoscope, dental protector, laryngostat, and a technique of ventilation based on insufflation, which prevents tracheal soiling and allows visibility and room for instrumentation, are described.


Anaesthesia for laryngoscopy: a new method of ventilation.

A technique for anaesthesia for laryngoscopy using a Foley catheter is described.


Oral premedication: diazepam, metoclopramide and a drink.

A technique of premiedication using oral diazepam and metoclopramide with a drink is described and shown to provide better sedation and less vomiting than pethidine and atropine given intramuscularly without a drink to a group of similar patients.


A new operating position for posterior spinal surgery.

A new operating position is described for the posterior approach in patients with lumbar or thoracic spinal lesions. This position has the advantages of unimpeded venous drainage and improved presentation in height and aspect of the relevant part to the surgeon. It is derived from and is compared with the "Mohammedan praying position".


[Effects of ethrane and halothane on compliance and resistance (author's transl)].

In young patients with healthy lungs, the effects of ethrane and halothane on compliance and resistance have been investigated. With the use of ethrane we found a dose-dependent decrease in compliance, but this decrease was statistically assured only at relatively high inhalation concentrations. The resistance of the respiratory passages remained virtually unchanged. Similar changes in compliance and resistance have also been observed with the use of halothane. The decrease in compliance induced by both anesthetic agents may be due either to interference with the surface tension of the alveolar wall, or to transitory changes in the fluid content of the pulmonary parenchyma. For the practical use of ethrane and halothane no significant differences appear to exist on the basis of their effects on compliance and resistance.


[The use of ketamine in patients with liver damage (author's transl)].

Continuous ketamine drip anaesthesia was used in 151 patients with liver disease. The anaesthetic management is described and changes in serum enzymes and bilirubin are reported. Our results indicate that ketamine does not impair hepatacellular function.


[The serum potassium level during and after cardio-pulmonary bypass in children: a comparative study of the effects of the preoperative administration of digitalis and diuretics (author's transl)].

The serum potassium levels were determined in 2 groups. The first group (40 children) was treated preoperatively with digitalis and diuretics. The second group (20 children) received none of these drugs and served as a control group. During the period of bypass, all patients received potassium-chloride, 1 m Eq/per Kg/h, which was infused into the heartlung machine. The serum potassium levels were determined before, during and after extracorporeal circulation. The first group showed a significant decrease in the serum potassium level during and after the bypass. The lower serum potassium levels (less than 4 m Eq/L) had to be corrected by injection of potassium aspartate. In the second group, an increased serum potassium level was observed. It is advisable to reduce the amount of potassium administered by half in patients not pretreated with digitalis and diuretics. In those who have been pretreated with these drugs, hypokalaemia should be avoided by frequent serum potassium estimation and potassium administration if needed.


[Complete loss of brainstem-functions following epidural anaesthesia (author's transl)].

A 77 year old male patient developed complete loss of brainstem-functions following epidural anaesthesia for prostate electroresection. On the basis of anatomical and pathophysiological considerations an attempt is made to explain the development of this event. The most important factor seems to be that the local anaesthetic agent can diffuse into the subarachnoid space via the arachnoid villi, which can protrude into the epidural space. Once in the subarachnoid space the anaesthetic can ascend. By this mechanism a complete loss of brainstem functions may evolve. Survival without residual deficit is possible if immediate intensive care with control of the vital functions is instituted.


[A simple apparatus for comparisons of low-pressure coff function in vitro (author's transl)].

A simple apparatus comprising basically a glass tube closed on one side, two low-pressure manometers with a range of 150 millibars, a pump with a small reservoir of compressed air as well as the necessary connections and valves allows in vitro comparisons of pressures in low-pressure cuffs whereby the introcuff-pressure can be adjusted to any value between zero and 150 milibars. One can also monitor continually the interdependence between the intracuff-pressure and the airway pressure whereby the latter can also be varied continuously.


Cerebrospinal fluid levels of d-tubocurarine in man.

Using radioimmunoassay, d-tubocurarine (dTc) was found in the cerebrospinal fluid (CSF) of man after intravenous injection. When dTc was administered in a single dose (0.3 mg/kg) to nine patients, small quantities, 3.5 +/- .26 ng/ml (mean +/- SE), appeared in the lumbar CSF within 5 minutes. The concentration of dTc (0.3 mg/kg) were given at 90 minute intervals. Concentration of dTc in the CSF remained constant for the next 25 minutes, but then began to increase with time to to 9.3 +/- 4.4 ng/ml 30 minutes after injection, 14.5 +/- 4.4 ng/ml at one hour, and 24.9 +/- 6.5 ng/ml at six hours. In another group of six patients, three doses of dTc (0.3 mg/kg) were given at 90-minute intervals. Concentration of dTc in the CSF increased after each injection. The quantities of dTc found in the CSF are unlikely to produce any pharmacologic or adverse effect (e.g., convulsion) in man.


Dose-dependent depression of cardiac function and metabolism by halothane in swine (Sus scrofa).

Halothane depresses myocardial blood flow and metabolism in the dog, but no studies in man have been published. However, the coronary circulation of the pig is remarkably similar to that of man. The authors investigated the effects of halothane-nitrous oxide anesthesia on cardiac function and metabolism in piglets. Thermodilution cardiac output, catheter-tip-manometer measurement of left ventricular function, electro-magnetic flowmeter measurement of coronary blood flow, and blood and tissue measurements of gases and metabolites were made during 0.04 (control), 0.46 (low concentration), and 1.04 (high concentration) per cent halothane vaporized in nitrous oxide, 60 per cent: oxygen, 40 per cent. Compared with control, the low concentration decreased cardiac output (CO) by 10 per cent, left ventricular systolic pressure (LVSP) by 30 per cent, peak contractile element velocity (Vmax by 34 percent, coronary blood flow (CBF) by 36 per cent, and cardiac oxygen uptake (V02) by 55 per cent. Compared with control, the high concentration decreased CO by 32 per cent, LVSP and Vmax by 53 per cent, CBF by 63 per cent and V02 by 62 per cent. This indicates that the dose-related depression in left ventricular function produced by halothane was accompanied by equivalent decreases in coronary blood flow and oxygen comsumption. There was minimal evidence of anaerobic metabolism in these depressed ventricles. Tissue levels of the high-energy phosplates, adenosinetriphosphate and creatine phosphate, and glycogen were unchanged. It is concluded that changes in cardiac oxygenation and metabolism in the pig during halothane anesthesia result from the changes in ventricular function.


Chylothorax: therapeutic alternatives.

Persistent loss of chyle, rich in metabolites, water and electrolytes, can be quickly devastating, particularly in debilitated patients and children. Chylothorax of traumatic origin, especially when loss of chyle is rapid, is most effectively arrested with direct closure of the fistula or ligation of the thoracic duct. Thoracic duct ligation is indicated when a controlled fat diet or parenteral hyperalimentation without oral intake and closed chest drainage are not effective in arresting chylous pleural effusions.


Traumatically injured aortic arch repaired under profound hypothermia and circulatory arrest.

A case report has been presented to illustrate that profound hypothermia with complete circulatory arrest may be used as an effective method to control massive hemorrhage and to repair lacerations resulting from trauma to the aortic arch. This method should be considered for control of bleeding in intrathoracic life-threatening situations.


Abdominal pain of spinal origin. Value of intercostal block.

A prospective study was made of 73 patients presenting in one year with abdominal pain provisionally diagnosed as of spinal origin. The criteria for audit of diagnosis and treatment are defined. The diagnosis was confirmed in 53 patients, 49 of whom had been treated with a lignocaine intercostal block in the relevant segment. Thirty-three of these (67.3%) had both complete and prolonged relief. It is suggested that the block causes interruption of a vicious circle of pain and muscle spasm in a 'spinal reflex pain syndrome'.


Supracostal incision for access to the upper abdomen.

A supracostal staggered incision in the form of an inverted U gives excellent exposure to the upper abdominal organs. It has been used in 915 operations and has been followed by partial wound dehiscence in only 3 patients. Postoperative discomfort is reduced in comparison with vertical incisions.


[Metabolism of steroids in the central nervous system and pituitary of various mammals].

The central nervous system and pituitary of various mammals were examined by radioautography after injection of different tritiated steroid hormones. After injection of 3H estradiol into ovariectomized mice, radioautograms revealed a significant labelling in cells of the amygdala, the bed nucleus of the stria terminalis, the nucleus preopticus medialis, the nuclei arcuatus and ventro-medialis. The radioactive material was associated with the cell nuclei. Certain anterior lobe cells retained the hormone. After injection of 3H testosterone into castrated rats, the central nervous system and the anterior pituitary contained labelled cells. In the hypothalamus, the distribution pattern of androgen-neurons appears to be similar from the estrogen-neuron areas, although some differences in the number of cells and the intensity of labelling seen to exist. After injection of 3H progesterone into castrated estrogen-primed guinea-pigs, labelled neurons have been observed in the regions of nucleus arcuatus and nucleus preopticus suprachiasmaticus. However, the presence of progesterone receptors in the hypothalamus has not been still clearly demonstrated. After injection of 3H corticosterone into adrenalectomized male rats, radioactivity was found to be selectively concentrated in neurons of septum, hippocampal complex (precommissural hippocampus, cornu Ammonis, gyrus dentatus, subiculum) indusium griseum, amygdala and in certain areas of the cortex. Most of the silver grains were localized in the nuclei of labelled cells. On the other hand, after injection of 3H dexamethasone radioactivity concentration was high in the medial basal hypothalamus, in the anterior pituitary and in the pineal gland. Differences appear to exist in the topographic distribution of dexamethasone and corticosterone-concentrating cells.


[Radioimmunoassay for human plasma 8-arginine-vasopressin (author's transl)].

The authors have developed a radioimmunoassay for human plasma vasopressin (AVP) which permits the estimation of antidiuretic hormon (ADH) levels as low as 0,8 pg/ml. The average plasma level of AVP after overnight water restriction was found to be 14,3 pg/ml (sd = 4,4 pg/ml) in normal subjects. They provoked a hypersecretion of ADH by the intravenous injection of 1-2 mg of nicotine. In 11 volunteer normal subjects this stimulation by nicotine provoked ADH hypersecretion which reached a maximum between 2nd and 15th minutes after injection. In 3 cases of diabetes insipidus, nicotine injection did not induce ADH hypersecretion; in 1 case of potomania this response was weak; in 2 cases of syndrome of inappropriate ADH secretion, AVP plasma levels were elevated and the response after nicotine stimulation was exaggerated.


[Characteristics of the antibiotic sensitivity of the pathogenic enterobacteria isolated from sick children].

The authors studied 2287 strains of pathogenic enteric bacteria, i.e. Shigella, enteropathogenic Escherichia and Salmonella freshly isolated from children with respect to their sensitivity to the most widely used antibiotics, i.e. levomycetin, tetracycline, streptomycin, monomycin, neomycin, kanamycin and erythromycin. Low sensitivity of these strains to the above antibiotics and their combinations was observed. In the treatment of children of this group it is necessary to take into account multiple antibiotic sensitivity of the isolates of the enteropathogenic bacteria.


Rachitic respiratory distress in small preterm infants.

A syndrome of subacute respiratory distress, severe metabolic bone disease affecting the thoracic cage, and mild cholestasis occurred in 4 small preterm infants during the first three months of life and was associated with considerable morbidity. The early radiological features in the chest resembled thos of the Mikity-Wilson syndrome, with which the disorder may be confused. After spontaneous improvement in hepatic function 3 of the infants fully recovered. The fourth died of paralytic ileus. Various nutritional and absorptive abnormalities probably contribute to the pathogenesis of the bone disorder in this syndrome. The best prophylaxis might be to supplement the diet with 25-hydroxyvitamin D rather than native vitamin D.


Standards for skinfold thickness in British newborn infants.

Standards of triceps and subscapular skinfold thicknesses for 1293 Caucasian newborn infants of gestational ages 37-42 weeks, and of 0-25 kg birthweight intervals between 2-25 and 4-5 kg are presented. Female infants had a greater skinfold thickness than males, and the subscapular skinfold was greater than the triceps. The skinfold thickness in both males and females declined after 40 weeks of gestation.


Endocrine and metabolic response in the human newborn to first feed of breast milk.

The hormonal and metabolic response to the first feed of breast milk was studied in 12 infants at 4-6 hours of age. After the feed there was an increase in blood glucose concentration but no changes in the concentrations of lactate, pyruvate, alanine, or ketone bodies. The feed was followed by an increase in the concentrations of plasma insulin, growth hormone, gastrin, and enteroglucagon, but no change in levels of plasma glucagon or gastric inhibitory peptide. Several hormone systems are functionally active at birth and are stimulated by the first feed of milk.


Comparative study of group A and group C meningococcal infection.

114 patients with meningococcal infection were studied; 72 had group C infection and 42 group A infection. 14 patients had acute meningococcaemia, all of whom had group C infection and 9 of whom died. Clinical and laboratory findings were similar in patients with meningitis due to a group A and C organisms, but arthritis and cutaneous vasculitis were more common in patients with group C infection. The overall mortality was 22% in patients with group C infection, and 12% in patients with group A infection, but was the same in both groups when cases of acute meningococcaemia are excluded.


Symptomatic sinus arrest in a young girl.

Sinus node dysfunction, previously unreported in girls, occurred in a 13-year-old girl who required permanent pacemaker implantation because of recurrent syncopal attacks. In addition to periodic sinus arrest, the presence of significant atrioventricular conduction disturbance was also documented. Although she had had a persistent ductus arteriosus divided at an earlier age, the disturbance of rhythm and conduction cannot be ascribed to a congenitial or haemodynamic abnormality. An acquired origin can only be postulated.


Carotid endarterectomy: neurologic complications as related to surgical techniques.

Three hundred seventeen carotid endarterectomies performed on 240 consecutive patients in four Charleston hospitals were reviewed. The overall incidence of stroke was 10.7% and the mortality 3.2%. From these 317 operations a standardized series of 253 operations performed on neurologically stable patients was analyzed for neurologic complications as related to the use of an intra-operative shunt. Additional factors studied were length of time of carotid occlusion and degree of contralateral carotid stenosis. From the standardized series the incidence of stroke in 137 shunted cases was 9.5%, and in 116 non-shunted cases was 0.9%, a significant difference (p less than 0.01). Carotid artery occlusion times from 30 seconds to 12 minutes in the shunted group, and three minutes to 24 minutes in the non-shunted group had no relationship to the incidence of stroke. Significant contralateral carotid artery stenosis, present in 28/137 shunted cases and 30/116 non-shunted cases, had no predictive value in the development of a stroke. The use of an intra-operative shunt did not protect against stroke in these patients.


Concomitant aortic valve replacement and myocardial revascularization.

Twenty-six consecutive patients underwent combined aortic valve replacement and myocardial revascularization at the Emory University Affiliated Hospitals between May, 1973 and March, 1976. Acute myocardial infarction resulted in two operative deaths (8%). There have been four late deaths, all Class IV preoperative. The age range was 37 to 79 years with an average age of 60. Preoperatively all patients were Class IV or late Class III. Twenty-three patients had symptoms of angina pectoris; congestive heart failure was evident in 56%. Postoperatively, 70% are now Class 1 or II. Single coronary bypass was performed in 16 patients, double in 6, and triple in three. Double bypass plus mitral valve replacement was required in two with aneurysmectomy in one. The rate of intraoperative infarction was 27% for the series but only 7% in the last year. The methods of intraoperative myocardial preservation and the technical approach for the operative procedures were variable. Results with each method are correlated, and currently preferred techniques are presented and discussed. Best results were obtained in patients who presented early in their symptomatic course with isolated proximal coronary lesions and good renoff vessels. Excellent results could be achieved despite advanced age of patients, requirement for multiple bypass grafts, and correction of other associated cardiac lesions. Poorest results were obtained when long-standing ventricular failure was combined with poor vessels distal to coronary stenoses.


Blue light-dependent regulation of cytoplasmic ribosomal RNA synthesis in Chlorella.

Effect of blue and red light on ribosomal RNA synthesis in autotrophic synchronous cultures of Chlorella pyrenoidosa (strain 211-8b) is studied by pulse labeling experiments with tritiated guanosine. Nucleic acids were separated by electrophoresis on polyacrylamide gels. Compared with darkness and red light (679 nm), blue light (457 nm) of equal quantum flux (0.5-5x10(-10) Einstein cm-2 s-1) stimulates incorporation into ribosomal RNA. This blue light effect is observed in the cytoplasmic ribosomal RNA after 5 min of illumination, whereas the stimulation of chloroplast ribosomal RNA synthesis by blue light appears later. Maturation of chloroplast ribosomal RNA is slower than that of cytoplasmic ribosomal RNA. The blue light effect on the cytoplasmic ribosomal RNA formation does not require chloroplast RNA or protein synthesis as shown by inhibitor studies with rifampicin or lincomycin. The blocking of cytoplasmic protein synthesis by cycloheximide inhibits the blue light effect on ribosomal RNA formation. It is concluded that the cytoplasmic ribosomal RNA transcription is controlled by a blue light sensitive system.


Cell wall carbohydrates in Phycomyces blakeslesanus Burgeff.

The carbohydrate composition of the cell walls from spores, mycelium and sporangiophores of Phycomyces blakesleeanus was analyzed. Spore wall polysaccharides contained over 50% glucose, about 20% uronic acids, 10% mannose and 10% amino-sugars. During the growth of the hyphae amino-sugars became the main carbohydrate (45%); uronic acids contributed some 25%, glucose and fructose 10% and galactose nearly 6%. Sporangiophores contained almost 90% aminosurgars and some 6% uronic acids. Traces of rhamnose were found in all wall preparations. A similar picture emerged from studies on the incorporation of [U-14C]-glucose into wall materials. Furthermore we looked for a GDP-fucose synthesizing system and found an increasing activity during early germination. This rise in activity was inhibited by cycloheximide but only by 5-fluorouracil.


Synaptonemal complexes in antheridia of Achlya ambisexualis E87.

This is the first report of longitudinal sections of synaptonemal complexes in oömycetous fungi. These indicators of meiosis were observed in antheridial nuclei of Achlya ambisexualis E87. They were attached to a platelike structure at the inner membrane of the nuclear envelope. The lateral elements were separated from each other by an average distance of 160nm. These results provide new ultrastructural evidence for gametangial meiosis in Oömycetes.


Hyperserotonemia and amine metabolites in autistic and retarded children.

Mean whole blood serotonin (5-HT) levels were elevated in groups of autistic and severely retarded children. Eight of 27 (30%) individual autistic children, 13 of 25 (52%) severely retarded children, two of 23 (9%) mildly retarded children, and none of the control children had statistically significant blood 5-HT levels elevations (hyperserotonemia). Hyperserotonemic autistic children excreted more urinary 5-HT, 5-hydroxyindoleacetic acid (5-HIAA), tryptamine, and vanillylmandelic acid than did mildly retarded children with normal blood 5-HT levels. Rates of depletion and repletion of blood 5-HT levels in these two groups following reserpine therapy were identical. Oral tryptophan administration doubled urinary 5-HIAA excretion in both groups and raised urinary 5-HT levels in hyperserotonemic autistic children, but lowered urinary 5-HT in mildly retarded, normal blood 5-HT children. No clear mechanism for hyperserotonemia was found; the rationale for further investigations is discussed.


Dopamine and serotonin metabolism in neuropsychiatrically disturbed children. CSF homovanillic acid and 5-hydroxyindoleacetic acid.

Lumbar cerebrospinal fluid homovanillic acid (HVA), 5-hydroxyindoleacetic acid (5-HIAA), and probenecid were measured in four subgroups of neuropsychiatrically disturbed children and a contrast group of pediatric patients. With the exception of a serotonin metabolite difference between autistic and nonautistic psychotic children, there were no significant differences in metabolite concentrations among autistic, nonautistic psychotic, aphasic, and cognitively and attentionally impaired groups, or between the developmentally disabled and contrast groups of children. Younger children had higher concentrations of HVA than older children. Girls had significantly lower HVA/probenecid ratios than boys, which did not appear to be related to underlying neuropsychiatric disorder. Significant probenecid-metabolite correlations indicate the importance of measuring probenecid in the cerebrospinal fluid in clinical studies.


Sustained attention in children at risk for schizophrenia. Report on a continuous performance test.

A test of sustained attention (the Continuous Performance Test) was administered to a group of children at risk for the eventual manifestation of schizophrenia and to a group of "normal control" children. Differences in performance between the two groups were attributable to poorer discriminability on the part of the high-risk subjects.


Eye tracking in relation to age, sex, and illness.

Impaired eye-tracking performance in psychotic patients has been previously demonstrated. Nine groups of ten patients each were used to determine if, when equated for age and sex, some of the eye-tracking dysfunction observed by others could be alternately explained in terms of aging, sex, or the presence of Parkinson-like symptoms. Horizontal eye tracking was recorded while patients visually tracked a target moving at 5degrees/sec and 20degrees/sec. Both sinusoidal and triangular target movements were used. Results indicated that Parkinson patients were the poorest eye trackers and that young normal men were the best. Additionally, men were better eye trackers than women and normal controls were better eye trackers than were schizophrenic patients or their parents.


A comparison study of amitriptyline and nortriptyline with plasma levels.

Forty-one depressed outpatients were treated for six weeks after random assignment to amitriptyline hydrochloride (N = 22) or nortriptyline hydrochloride (N = 19). On a mean daily dose of 119 mg, amitriptyline-treated patients had a mean tricyclic level (amitriptyline plus nortriptyline) of 120 ng/ml. Nortriptyline-treated patients on a mean dose of 117 mg/day had a mean nortriptyline level of 141 ng/ml. The two drugs were equally effective in the treatment of depression. The correlation between the Hamilton Score and the mean tricyclic level was negative in the amitriptyline-treated patients (r = -0.54, P less than .025) and positive in the nortriptyline-treated patients (r = -0.49, P less than .05). Patients treated with amitriptyline or nortriptyline with plasma levels within the therapeutic range, defined in other laboratories, had a better response, as measured by the Hamilton Score (P less than .001), Zung Score (P less than .01), and percent recovered (P less than .001), than those above or below the therapeutic range.


Language therapy effects in long term aphasia.

This report describes the results of language therapy initiated 1 to 6 years after the onset of aphasia in 14 patients. During the course of treatment, each of the 14 patients improved strongly in their communicative abilities (PICA), according to clinical observation and reports from family, hospital ward personnel, or both.


Social discomfort in the patient with spinal cord injury.

A 20-item inventory of social situations which might create anxiety and/or lead to aviodance in patients with spinal cord injury was administered to 40 male inpatients. The respondents rated each item on the basis of the amount of social discomfort they would feel in the situation. The results were analyzed by dividing the subjects into eight groups based on age, type of injury and length of time since injury. On the total score of the items rated as producing the most discomfort, older patients, regardless of type or duration of injury, perceived themselves as having more social discomfort in these situations than younger patients. Implications for social skills training programs and further assessment procedures are discussed.


Cylinder splints: their use in the treatment of arthritis of the knee.

Cylinder knee splints afforded significant relief of pain and were not associated with loss of range of motion or muscle strength in 13 of 15 patients. Splints help patients who demonstrate persistent synovitis of the knee, who do not respond to intraarticular injection of steroids, and for whom surgery is not immediately appropriate. The fiberglass polymer used in this study has several advantages over plaster for splints.


Foot mass effect on gait in the prosthetic limb.

A series of patients with amputations were investigated to determine the effect on gait of increasing the mass of the prosthetic foot. Weights of 113.4 and 226.8 gm (4 and 8 oz) were added and gait parameters observed. No changes were noted as the result of the extra foot mass.


Primary small bowel volvulus: cause and management.

Most reports of patients with primary small bowel volvulus have indicated that the ingestion of a high-bulk vegetable diet in some way contributes to the development of this condition. During a recent 13-month period at Nangarhar University Hospital at Jalalabad, Afghanistan, the frequency of occurrence among 26 patients was found to be related to abrupt changes in dietary intake. The first and last months of the study were Ramadan, the annual period in which Mohammedans abstain from all oral intake during daylight hours and take a single large meal after dark. During these two isolated months, there was a ten fold and nine fold increase, respectively, in the incidence of the condition. Early diagnosis and surgical intervention offer the only possibility for minimizing an otherwise excessive mortality.


Tumor cells in venous blood draining mammary carcinomas.

Tumor cells were identified in mammary vein blood in ten of 38 (26.6%) patients during total mastectomy with axillary dissection performed as the primary therapy for breast carcinoma (pathological stages I and II). This finding was analyzed with respect to 35 histological characteristics of the primary tumors. The presence of blood-borne tumor cells was inversely related to perineural space invasion, whereas there was no apparent relationship with the remaining 34 characteristics. The significance of blood-borne tumor cells remains unknown.


[Circadian variations of bilirubin in the blood].

A group of 12 presumably healthy subjects was standardized for 7 days with rest time extending from 22.00 to 05.00. Meals were scheduled at 08.00-08.30, 12.00-12.30, 17.30-18.00 and the amounts consumed were standardized and measured. Each subject was sampled at 4-hour intervals throughout one 24-hour period; this involved the measurement of body temperature, radial pulse, blood pressure. In addition a sample of blood was collected at each time point and subsequently total, direct and indirect bilirubin measurement was made on each sample of serum. All data were analized by macroscopic approach (chronograms) and by mean cosinor. A circadian rhythm is detected in total, direct and indirect serum bilirubin.


Reversal of vertebral artery blood flow demonstrated by Doppler ultrasound.

Vertebral artery blood flow was studied by a Doppler ultrasound technique in two patients with the subclavian steal syndrome. The Doppler probe was positioned in the region of the Chassaignac tubercle. The direction of vertebral artery flow corresponded with the angiographic flow direction preoperatively. Postoperatively, the technique was used to confirm the patency of a carotid-subclavian graft, and also to study the hemodynamic effects of axillary-axillary grafting. Reversal of vertebral flow direction was easily demonstrated by this technique, which is simpler to perform than previously described methods.


[Changes in insulin (IRI) and NEFA levels in diabetic subjects after acute intravenous glipizide and tolbutamide administration].

Glypizide and i.v. tolbutamide were administered to a series of diabetics. On different days, 10 subjects (controls for themselves) received 1 mg glypizide anal 100 mg tolbutamide; a further 10 received 2 mg glypizide and 200 mg tolbutamide. Blood sugar and insulin and NEFA values were determined every 10' for one hour after the injection. It was found that the hypoglycaemising activity of glypizide was about 140 times that of tolbutamide. It also caused a greater incretion of insuline and a more marked reduction of NEFA.


[Water and electrolyte composition of the body in the newborn infant].

The hydro-electrolytic composition of a newborn organism is different from that of an adult and this must be attributed only to a deficiency in the function of kidney which is already anatomically and morfologically complete from birth. The kidney hypofunction, which is more evident in the premature baby, can negatively affect the whole hydro-electrolytic equilibrium of the newborn child. It is therefore necessary to know such problems in order to correct any alteration of the hydro-electrolytic equilibrium in such a delicate phase for the human organism as is the neonatal.


Postichemic renal failure: accelerated recovery with adenosine triphosphate-magnesium chloride infusion.

Since previous studies have shown a protective effect of the administration of adenosine triphosphate-magnesium chloride (ATP-MgCl2) in shock, the present study was undertaken to determine the effect of the infusion of ATP-MgCl2 after 30 minutes of renal artery occlusion. In animals who received no infusion or only MgCl2, the combination of reduced glomerular filtration rate (GFR), marked diuresis, and reperfusion of the outer cortex suggested that these animals were in the early recovery phase of acute renal failure. In the animals who received ATP-MgCl2, there was improved GRF, no diuresis, and a normal pattern of cortical blood flow distribution. These findings would suggest that the infusion of ATP-MgCl2 appears to have either ameliorated the effect of renal ischemia, or to have accelerated the recovery process. While the precise mechanism of action of ATP-MgCl2 remains unknown, these observations may have important implications for future use in organ preservation and the management of acute renal failure.


[Ampicillin in high doses in bronchopneumopathies in aged patients].

Ampicillin at 2-4 g/day per os and 2 g/12 hr slow venous drip gave good results in 88% of 25 and 90% of 20 cases of bronchopneumopathy respectively. Tolerance was excellent in all but 4 cases. In spite of the introduction of new semi-synthetic penicillins, it is felt that ampicillin must still be rated as one of the most effective and best tolerated antibiotics. At the doses at present recommended, it is of particular significance in the treatment of aged subjects.


Radiologic diagnosis of appendicitis.

Many articles published in the medical literature have stated that a normal-appearing appendix as seen via contrast enema is inconsistent with the diagnosis of acute appendicitis. This assumes that appendicitis is always associated with complete luminal obstruction of the appendix, and that the length of the normal appendix is known to the interpreter of the x-ray examination. Retrospective analysis of the barium contrast studies of three patients found to have acute appendicitis demonstrated the limitations of this hypothesis. These patients were diagnosed as having acute appendicitis at operation in spite of radiologic evidence of normal-appearing appendices. We review radiologic findings that can be helpful in recognizing this condition and discuss the severe limitations of barium contrast studies in making an accurate diagnosis.


Psychological aspects of pain patient treatment.

Acute and chronic pain complaints are in part determined by psychological factors unrelated to disease or trauma. Suffering associated with acute pain is greatly influenced by the anxiety of the patient, and it can be managed by helping him form useful defensive attitudes toward the pain he will experience. Chronic pain, in contrast, tends to be linked to personality problems and payoffs in the home and job situation for adopting a sick role. Both pain states may be usefully construed as problems of perceptual distortion. A model for the perception of pain is presented and suggestions for applying psychological considerations in the diagnosis and management of pain states are offered.


Basic principles in managing chronic pain.

Experience over the past 30 years suggests that treatment of patients with chronic pain is best achieved through a multidisciplinary team approach. The pain clinic at the University of Washington, started in 1961, has developed into a group of 20 health professionals representing 13 disciplines. Successful operation of such a heterogenous group depends on careful organization and a clear definition of responsibility. A patient is referred to a specific member, who becomes his manager, or to the clinic without specifying the physician, in which case a manager is assigned. The manager examines the patient, coordinates the evaluation by consultants, interprets the evaluation, and, if the diagnosis and therapy are clear-cut, refers the patient either back to his physician or to be cared for by the pain clinic group. Where the diagnosis or therapy or both are still doubtful, the patient's case is reviewed at the pain clinic weekly conference.


[Effect of the addition of antibiotics on the fattening capacity of broilers fed optimum rations. 4. Lambdamycin].

A total of 3426 broilers were used in 3 fattening trials. The birds received supplements of the antibiotic lamdbamycine in amounts of 30 or 40 mg per kg of feed added to adequately balanced fattening rations. OTC supplements (40 mg per kg) which were an obligatory food component at the time of the trial were used as controls. The results obtained may be summarized as follows: Supplements of neither lambdamycine nor oxytetracycline exerted any significant influence on food consumption. Lambdamycine improved the rate of liveweight gains by 2% (trial 1, alpha greater than 0.05) and 5% (trial 2 and 3; trial 2: alpha less than 0.05, trial 3: alpha greater than 0.05). The growth-promoting effect of OTC was less pronounced than usual (2-3%; alpha less than 0.05) or was completely absent (trial 2). Lambdamycine decreased the rate of food consumption per unit of weight gain in 2 trials (trial 2: alpha less than 0.01) OTC did not influence the rate of food consumption.


[The use of decanted solids from swine manure in the nutrition of fattening calves].

3 feeding trials were carried out in which dried and decanted solids from pig faeces were used in varying proportions. A total of 55 fattening bulls were slaughtered at the end of the trial period. Additionally, a number of characteristic data on ruminal physiology were determined in these trials. The molar proportions of acetate and propionate found with the feeding of rations containing faecal solids were intermediate between those observed in concentrate feeding and those established with the feeding of commercial food pellets containing 40% or 50% straw. Slight increases in the molar proportion of butyrate were noticed when rations were fed containing faecal solids. Nonfasted animals fed rations containing a higher proportion of coarse fodder had a significantly lower slauglitered bady mass (0; 50% straw; 25% straw + 25% faecal solids; 50% faecal solids: 55.7%; 51.9%; 51.1%; or 52.2% of the final fattening weight). They developed a lower proportion of flesh and contained a higher proportion of digesta in the stomach and intestines (11.4%; 18.4%; 17.0%; or 16.3% of the final fattening weight). The proportion of fat contained in the stomach & bowels decreased with the feeding of straw or faecal solids. Other organs and tissues were not affected by the different types of feeding used. An analysis of the results of slaughtering showed that the feeding of faecal solids did not produce any specific effect.


[Pathomorphology of chromomycosis].

The article presents the results of pathomorphological studies of chromomycosis of the skin in 10 patients. The material from the center of the lesion focus, from its periphery and from bordering areas of the apparantly healthy skin were investigated pathomorphologically. Two variants of inflammation are described. The former was characterized by proliferation of the epiderma, the presence of polymorphocellular infiltrate and microabscesses, numerous elements of Hormodendrum. In two patients with an elevated content of sugar in the blood a tendency to the expansion of the process was noted. The second variant was of a tuberculoid character.


[Ultrastructural signs of differentiation of stomach cancer cells].

Studies of the ultrastructure of stomach cancer were carried out: adenomacarcinoma (4 observations), signet ring cell carcinoma (1 observation), nondifferentiated cancer (1 observation). In 5 out of 6 observations cells of each tumour were homogeneous in principle. Signs of differentiation were revealed in them in a various degree of manifestation in any one direction: according to the type of additional or surface cells in 3 adenocarcinomas; according to that of goblet cells in signet ring cell carcinoma. In the case of nondifferentiated cancer signs of differentiation were absent. In one observation the cells of adenocarcinoma had ultrastructural features of various cells: mucoid, chief, parietal, endocrine, enterocytic, goblet cells. In a part of cancer cells there were noted combined ultrastructural signs of various cells of the gastric mucosa.


[Histogenesis and mechanism of regression of congenital cutaneous angiomas in children (electron-microscopic study)].

The ultrastructure of hemangiomas of the skin was investigated in 4 children at the age of 3 to 6 months. Histologically, the hemangiomas were represented by hypertrophic and capillar forms. Tumour cells, both those forming walls of capillaries and distributed between capillaries, were similar with respect to their ultrastructure and analogous to the endothelial cells they originated from. Capillaries and cells were "immured" with fibrillary substance which was produced by the tumour cells themselves. In intercellular and intercapillary areas there were also observed fibroblasts and collagenous fibres. Many cells of the tumour underwent necrosis. The cause of destruction of tumour cells resulting in regression of angiomas was fibrosis, the development of which was associated with the activity of the tumour cells themselves and fibroblasts.


[Ultrastructural features of fibrosarcoma].

An electron-microscopy investigation of two fibrosarcomas was carried out. Blastomatous elements were represented by fibroblasto-like cells. In their cytoplasm there were observed phaged fragment of collagenic fibrils, and in small canals of the granular endoplasmic reticulum--crystalloid formations. Diagnostic significance of these findings is discussed.


The third alexia.

A variety of alexia has been demonstrated that can be distinguished from the two classically recognized types of alexia. This reading disorder is seen in patients with a dominant frontal lobe pathologic condition that has produced a motor language disturbance (Broca aphasia) and is sufficiently disabling to deserve consideration as a variety of alexia. Functionally, the frontal reading disturbance differs from the other two types in that the patient comprehends meaningful content words better than relational or syntactic structures. Four factors that may underly frontal alexia have been noted: (1) gaze paresis, (2) inability to maintain verbal sequences; (3) inability to comprehend syntactic structure, and (4) literal alexia.


Left-right asymmetries of the temporal speech areas of the human fetus.

Left-right asymmetries of the transverse temporal (Heschl) gyri and the temporal plane become recognizable by 31 weeks' gestation. The transverse temporal gyri are larger in number and extent on the right side in 54% of 207 serially sectioned fetal brains ranging in gestational age from 10 to 44 weeks, and the temporal plane is larger on the left side in those brains. There are two transverse temporal gyri on the left and a single right transverse temporal gyrus on the right in 18% of the brains. No asymmetry of number of transverse temporal gyri or extent of the temporal plane is apparent in 28%. These findings, which confirm those in adult brains, suggest that anatomical asymmetries for left hemispheral speech and language dominance may be established during the last trimester of fetal life.


Selective stimulus-sensitive myoclonus in acute cerebral anoxia. A case report.

We report a 69-year-old patient, a chronic diabetic, who had a cardiac arrest after myocardial infarction. In the state of acute anoxic coma, massive myoclonic jerks occurred, and it was found that myoclonus could be elicited by light touch of the right trigeminal area (but of no other body region). The myoclonus was associated with complex EEG discharges against an almost flat background of activity. Findings of the autopsy showed cerebral edema with bilateral uncal herniation and prominence of the right cerebellar tonsil. Stimulus-sensitive myoclonus based on proprioceptive stimuli has been reported in chronic postanoxic states. This type of somatosensory elicitation seems to be extremely rare. We discuss the neurophysiological substratum; it is presumed that the cortex was still reached by the somatosensory stimuli.


Interactive effects of age and brain disease on reaction time.

Simple visual and auditory reaction time (RT) was studied in younger (16 to 44 years old) and older (46 to 63 years old) control and brain-diseased patients. Differences in RT related to age were larger for brain-diseased than control patients. Differences in RT related to diagnostic category were larger for older than younger patients. Analysis indicated an interactive effect of age and brain disease on RT supporting the suggestion that acquired brain disease leads to a more pronounced retardation in RT in older patients.


Syndrome of inappropriate secretion of antidiuretic hormone in patients treated with psychotherapeutic drugs.

We report two patients in whom the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) developed during the administration of psychotherapeutic drugs. In one, the syndrome occurred after administration of a phenothiazine drug and in the other, a butyrophenone. Both the patients were diagnostically studied for evidence of other disorders, either neurologic or systemic, which could cause this syndrome with negative results. They responded to fluid and free water restriction with remarkable recovery and no sequelae. It is stressed that psychotherapeutic drug administration must be considered as one of the iatrogenic causes of SIADH.


Significance of seizures in infants weighing less than 2,500 grams.

We review the records of 153 infants weighing 2,500 gm or less admitted consecutivtly to the University of Utah Medical Center Newborn Intensive Care Unit. Thirty-one (20.2%) infants had seizures and 28 (90%) of these died. In comparison, only 17% (21 of 122) of patients without seizures died. The diagnosis of intraventricular hemorrhage (IVH) was made in 27 (87%) of the seizure patients. These findings differ significantly from those studies in which no distinction was made between the birth weight of neonates with seizures. Anticonvulsant medication had little effect on clinical seizure activity and did not significantly alter the outcome.


Three-dimensional computerized tomographic scans of brain. A new approach to intracranial diagnosis.

A new method for displaying computerized tomographic cross sections of brain in the coronal and sagittal planes is described. These images are reconstructed from the original horizontal 3-mm thin slices. This method uses an Artronix scanner and has the advantage of completely eliminating the need to rescan the patient. These pictures are of excellent quality and have proved to be of significant value in demonstrating the special relationships between lesions and anatomical landmarks. This has proved to be of particular importance in the localization of surgical lesions preoperatively.


Epinephrine-induced cystoid macular edema in aphakic eyes.

A population of glaucomatous aphakic eyes being treated with topical epinephrine compounds was studied in order to determine the incidence of cystoid macular edema that had been induced by this medication. Eyes were considered responders only if fluorescein angiography demonstrated that macular edema was eliminated with discontinuation of epinephrine and recurred with reapplication of epinephrine. Reversible maculopathy occurred in six of 47 eyes. Topical epinephrine caused macular edema in an appreciable percentage of aphakic eyes, and we recommend that other medications be used to control glaucoma in aphakic patients when possible. If epinephrine compounds are required, periodic angiography is advisable.


Macular lesions associated with retinitis pigmentosa.

Of 31 patients with retinitis pigmentosa, 18 (58%) had lesions of the retinal pigmentary epithelium within the maculae of both eyes. Six of the 31 patients (19%) showed macular cysts or holes (five bilateral, one unilateral) without angiographic evidence of leakage from perifoveal capillaries, while seven patients (23%) had macular cysts in both eyes associated with cystoid macular edema evident by fluorescein angiography. We believe that the macular cysts or holes were caused by changes at the vitreoretinal interface, eg, vitreous traction and preretinal membranes. Other pathologic sequences may also be responsible, such as an intrinsic increase in the permeability of retinal capillaries.


Vertical saccadic velocity determination in superior oblique palsy.

Vertical saccadic velocities were measured in various horizontal gaze positions in patients with known superior oblique weakness and compared to similar measurements in a normal control group. Marked slowing of the down saccade in the adducted position occurred in the patients with superior oblique weakness and not in the controls. This suggests that it is possible to differentiate oblique and rectus function by saccadic velocity analysis.


Intraocular wooden foreign body clinically resembling a pearl cyst.

Five years after injuring his right eye with a wooden arrow, an 11-year-old boy had an iris lesion resembling a pearl cyst. Surgery demonstrated an intraocular wooden foreign body. Wooden foreign bodies are uncommon but may be surprisingly well tolerated if uncontaminated. A differential diagnosis of iris mass lesions in the posttraumatic eye is provided.


Intraocular extension of squamous cell carcinoma of the conjunctiva.

The present case report illustrates the clinical and pathologic features of intraocular invasion by squamous cell carcinoma of the conjunctiva. Cytologic study of aqueous humor aspirate is a useful technique for confirming the diagnosis of this unusual route of tumor extension.


Monochromatic ophthalmoscopy and fundus photography. The normal fundus.

Anatomical details in the ocular fundus can be seen with increased contrast when appropriate monochromatic illumination is used. This technique permits more accurate visualization and documentation than can be achieved with white light. This article reports the optimal spectral ranges for visualization of the different fundus structures. It describes and illustrates the appearance of individual structures and areas of the fundus under different spectral illuminations. There is a detailed discussion of the optical properties of the fundus layers that provides a background for interpreting the data and a baseline for examination of pathologic conditions.


[Angiography in coxarthrosis (author's transl)].

1. This is a report of 58 pat. with osteoarthritis of the hip who underwent angiography. Two patients with pegmented villonodular synovitis were among this group (Maurer, Hald and Odegaard). 2. There was a female over male predominance of 3.5 to 1. 3. Beyond the age of 53 all patients showed signs of arteriosclerotic changes, frequently with an occlusion of the R. profundus a. circumflexa femoris med. which supplies the femoral head. 4. The significance of angiography with regard to prognosis and eventual treatment is being discussed. 5. Possible causes are being debated.


[The traumatology of the articular disc of the wrist (author's transl)].

Roentgenological signs, which seems typically for a posttraumatic lesion of the articular disc of the wrist in case they appeared together with a corresponding clinical manifestation, were found in arthrographies of wrist by 89 patients with posttraumatic troubles. Four different types of roentgenolo-ic alterations and the difficulties by examinating them were described. In our opinion arthrography of the wrist is a successfull method to apprehend a lesion of the triangular disc.


At 89 Patients with painfull wrist and clinical symptoms like a lesion of the triangular disc, arthrography of the radiocarpal joint was performed. In 18 cases with corresponding arthrographical findings removal of the disc results in clear recovery respectively painlessness. That simple operation seems to be an alternative to the resection of the ulna and a replaceable method if symptomatology and arthrography are accordingly. The described proceeding becomes important because no recovery was seen by conservative treatment.


[Corrective osteotomies at posttraumatic deformities of the femur (author's transl)].

The importance of the posttraumatic deformities is apart from the aesthetic point of view also due to the "praearthrotic deformity" according to Hackenbroch. Certain cases require operative correction, the indication of which being corresponding to the diagnosis possibilities. On account of examples the technique of osteotomies at the femur has been pointed out which should always be done in combination with a Compressionosteosynthesis.


[Osteomyelitis of the os calcis (author's transl)].

The treatment of osteomyelitis in the os calcis causes problems in most cases. The os calcis as a cancellous bone offers ideal conditions for the spreading of infection. Specially in posttraumatic osteomyelitis the infection is supported by disturbed blood circulation. Hind foot deformity, trophical disturbance, excessive scars and ulceration cause therapeutical problems. According to literature and to our own experiences none of the different operative procedures received extraordinary importance. The procedure has to be evaluated according to the special circumstances.


[The importance of occupational therapy in fitting upper extremity amputees with myoelectrical prostheses (author's transl)].

As in other parts of the rehabilitation of disabled, e.g. paraplegics the teamwork of all staff-members together with the integrated patient is indispensable. The occupational therapists combine the experience of a many year's training with their creative phantasy. The amputee learns by the assistance of occupational therapists to become independent. The physician has a coordinative and leading function in the team of nurses, occupational therapists, physiotherapists and the orthopaedical technical workshop.


[Clinic and pathogenesis of Morton's disease (author's transl)].

From experience with 58 own cases the authors found that Morton's metatarsalgia due to a sclerosing neuroma of the plantar digital nerve is very often not recognised for many years. As this painfull affection easily can be cured, the clinical symptoms and histological findings, the diagnostic steps and treatment are described and the etiology discussed. For the excision of the plantar digital neuroma, situated generally between 3rd and 4th metatarsal head, the dorsal web-splitting approach is preferred because of better scars and immediate weigt-bearing. The operation is performed on outdoor patients. There were no complications. The results of 35 operations two or more years back show immediate and complete relief of pain in 31 cases and significant but incomplete relief in 4 cases.


[Osseous rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb (author's transl)].

Osseous ruptues of the ulnar collateral ligament in the metacarpophalangeal joint of the thumb are to be found more frequently in experimental ruptures at an isolated preparation than they are described in clinical examinations. It must positively be achieved to re-affix also a small avulsion fragment to do not remove the entire compound attachment of the ligament. The own surgery technique is described.


[Pathology of paratenonitis achilleae in Athletes (author's transl)].

This is a report about the histopathological findings after excision of the inflammably overhead paratenon at top sportsmen, which were operated of cause of a paratenonitis. The good clinical results are written and the histological findings are described and discussed. The development of the paratenonitis is decleared. Pathological alterations of the paratenon at the tendon itself are difficulty to merk off. At the sportsmen the etiology of the disease is often a mechanical overloading of the tissue.


[Forefoot reconstruction. The frequency and importance of the toe and metatarsal formula (author's transl)].

The forefoot reconstruction as a routine treatment, is increasing in significance, not only in treating polyarthritic patients, but also after numerous surgical failures in treating halux valgus or hammer toes. Far from being a simple operation, the reconstruction requires an exact knowledge of the physiopathology of the foot. Special attention should be given to the digital and metatarsal formula. Based on an analysis of 200 forefoot reconstructions, the advantages and the disadvantages of the various methods are discussed. For the first time in the German speaking countries, the frequency of occurrences of the different digitial and metatarsal formulas has been compiled in tables from an examination of 500 forefeet.


[The tolerance of the hip prosthesis evaluted through scintigraphic studies (author's transl)].

The authors assert the usefulness of the scintigraphy in the early diagnosis and/or for the confirmation of the main complications connected with the artroprosthesis of the hip. Such investigation is effective only if it is carried out at a distance of at least six months from the operation and must be completed by clinical, bio-humoral and radiographic tests. This study is based on the observation of 40 cases, of which 20 represent the control group. The isotope used is the Tc99m-pyrophosphate.


Nutrition and family practice.

Where necessary, women should be counselled so as to understand that a slim, elegant figure is not the prerogative of all. An inherited large frame requires a corresponding body contour, and dieting to change this situation will be in vain. All weight reducing diets must provide an adequate amount of vitamins and minerals. Women on the contraceptive pill often have diminished serum levels of folic acid and vitamin B6, and there have been suggestions that vitamin supplementation may help overcome depression and diminished libido in some women. This has been partially successful. A well-balanced diet should be recommended prior to trial of supplements. During pregnancy and lactation there is an increased need for protein, calcium, iron, iodide and fluoride. Vitamin and iron supplementation may be required where deficiencies exist due to dietary neglect. Excessive alcohol and smoking should be discouraged--especially during pregnancy. The elderly are particularly vulnerable to diseases of nutritional deficiency for various reasons. The importance of foods providing protein, calcium and vitamins should be stressed, as these are the main nutrients lacking. The consumption of meat, milk, cheese, eggs, fish, fresh fruit and vegetables should be encouraged.


Combined effect of space flight and radiation on skeletal muscles of rats.

Skeletal muscles of rats flown for 20.5 d aboard the biosatellite Cosmos-690 and irradiated with a dose of 800 rads on the 10th flight day were studied. The radiation exposure aggravated the severity of atrophic and dystrophic processes in m. soleus and atrophic process in m. gastrocnemius that developed under the conditions of weightlessness and hypokinesia. At the same time, an exposure to penetrating radiation did not affect the muscles where no flight-induced pathologies occurred. The radiation affected the pattern of reparation in those regions of the soleus muscle that developed pathology inflight, slowed down resorption of the connective tissue formed during the pathological process, and inhibited the course of the reparative process.


Induction of illusory self-rotation and nystagmus by a rotating sound-field.

Subjects seated in darkness often experience illusory self-rotation when exposed to a rotating sound field. Compelling illusions of self-rotation are generally accompanied by nystagmoid movements of the eyes with the slow phase in the direction opposite that of the experienced self-rotation. These phenomena are related to the functioning of a spatial constancy mechanism by which a stable distinction is normally maintained between movements of self and movements of the environment. The appearance of nystagmus during illusory self-rotation indicates that apparent body orientation can influence oculomotor control.


Heart rate and core temperature as indicators of heat stress during deep underwater activity.

In hyperbaric environments, comfortable ambient temperatures are necessarily higher than normal room temperature, and high levels of humidity are also common. These conditions are stressful and even hazardous for an exercising diver. We monitored the heart rates and core temperatures of divers participating in deep experimental dives to pressures up to 300 msw. Accelerated heart rates (100 to 180 beats/min) and elevated core temperatures (+0.4 to 0.9 degrees C) were registered. The increase in heart rate can be explained by the rise in core temperature. Formulas are presented for the relationships between heart rate and duration of activity, between core temperature and duration of activity, and between heart rate and core temperature. These formulas allow the estimation of core temperature from the diver's pulse, and serve to prevent excessive heat stress which could lead to an accident.


Maximal aerobic power in women cadets at the U.S. Air Force Academy.

A sample of 17 women cadets of the U.S. Air Force Academy's Class of 1980 was assessed to determine their maximal oxygen consumption and percent body fat. The sample was selected using the ponderal index to insure a stratified sample of body types. The Short Balke protocol was used to determine Vo2 max, and the Siri and the Keys and Brozek equations were used to find percent body fat. The Katch and McArdle equation was employed to determine body density. The average Vo2 max for the women cadets was 46.1 ml/kg/min (S.D. = 4.0). Correcting for altitude, this value compares quite favorably with other reported values. The 24.8% mean body fat places these subjects well within the normal range for college age females. The female cadets of the Class of 1980 appear to be above their contemporaries in civilian life in circulo-respiratory fitness.


Coronary risk factors in flying personnel: a progress report.

Since October 1974, the Flight Surgeon's Office at the USAF Hospital Dover has implemented a program of early detection and treatment of coronary risk factors in aircrew personnel. The program is integrated with USAF periodic physical examinations with interval follow-up of members found to have possible risk factors. A report of initial (baseline) findings was presented at the Aerospace Medical Association meeting in May 1975. During the past year, the base did experience one death due to myocardial infarction in an aircrew member, while two others were grounded due to serial ECG changes, consistent with silent myocardial infarction, confirmed by review at the USAF-SAM ECG Library.


Visual field contraction during G stress at 13 degrees, 45 degrees, and 65 degrees seatback angles.

In support of the High Acceleration Cockpit program, two groups of six experienced subjects, operating a high-resolution visual field limit tracker, were exposed to gradual-onset (0.067 G/s) G stress to a 7-G maximum on the USAFSAM human centrifuge. Data obtained from one group described the G-induced vertical visual field contraction, and that from the other described horizontal visual field contraction--as they occurred in relaxed subjects in seats with 13 degrees, 45 degrees, and 65 degrees seatback angles. Curves of peripheral vision remaining vs. G level indicated a statistically significant difference in tolerance provided by the 65 degrees seat over that provided by the 13 degrees and 45 degrees seats in the 5- to 7-G range, and a significant difference in tolerance provided by the 45 degrees and 65 degrees seats over that provided by the 13 degrees seat in the 4- to 5-G range. Two-dimensional reconstructions of the superior half of mean binocular vision remaining at the various levels of G stress showed complete visual loss near 5 G in the 13 degrees seat, complete loss near 6 G in the 45 degrees seat, and substantial peripheral vision remaining at 7 G in the 65 degrees seat.


Thermal problems in plethysmography and pressure/volume recording.

Where volume changes are recorded as the concomitant changes in pressure, modern, fast-responding pressure transducers might record not only the pressure changes due to volume changes in the measured object but also the heat of compression, showing itself as an overshoot or hysteresis phenomenon in the calibration curves. Introduction of an effective heat sink (e.g. copper mesh) within the air space in the plethysmograph might absorb this heat and thereby diminish the overshoot phenomena. The effect is not of practical importance in classical venous occlusion plethysmography where rapid changes only contribute to a smaller part of the total volume change during venous occlusion. When rapid changes, as in volume pulse recordings, are to be evaluated, the effect must be taken into consideration and should be reduced.


Effects of high O2 and N2-O2 pressures on the physical performance of deer mice: preliminary studies.

Exposure of deer mouse colonies to oxygen tensions of 0.8, 1.0 and 1.5 ATA are accompanied by reductions in wheel-running activity. The magnitude of the reductions was correlated with the partial pressure of oxygen and duration of exposure. Efforts to minimize the toxic effects of high-pressure oxygen by simultaneous exposure to a high nitrogen tension were not effective. Earlier studies (8) showed that exposure to 13.8 atm nitrogen under normoxic conditions reduced running activity by 10%. When this same nitrogen tension was provided in each of the elevated oxygen environments, wheel-running activity deteriorated in a manner comparable to that observed in the absence of added nitrogen. Visual observations of social behavior and respiratory distress suggest that a nitrogen tension of 13.8 atm does not provide protection against oxygen toxicity.


Femur-bending properties as influenced by gravity: I. Ultimate load and moment for 3-G rats.

Fresh experimental bones can withstand greater bending forces and moments after 1.0 to 2.5 weeks of 3-G exposure. This appears more attributable to a 50% greater strength of bone material than to effects upon size or shape, and is most measurable for animals of 5 to 8 weeks of age. Experimental bone material seems to grow to its mature level at a younger age rather than there being so marked an effect upon the mature level itself. We simulated 3.1 G by chronic centrifugation of 66 albino rats and compared them to 63 1-G controls. Extrapolation of the simplest mathematical description of the present results to weaker, zero-G bones could be tested by a total of 60 space-based control and experimental animals. A flight of only 15 animals would be necessary for comparison to ground-based control animals. This is consistent with reports of bone demineralization during space-flight. In light of the differences in bone histology, however, extrapolation of these results to humans would be premature and, if at all applicable, are most likely to be so for children rather than adults.


Pseudoephedrine producing postural hypotension in a pilot.

A pilot taking pseudoephedrine (Sudafed) experienced postural hypotension documented as being caused by the drug. This care reemphasizes the potential hazard of self-medication for upper respiratory tract symptoms by flight crew members.


Bursa-independent plasma cells in the Harderian gland of the chicken (Gallus domesticus). Histomorphometrical investigations.

Morphometric investigations of the Harderian gland in normal and bursectomized chickens at the 16th, 30th, and 60th day after hatching, show a significcant suppressive effect of bursectomy on the volume of the plasma cell compartment in this organ. However, the suppression of the plasma cell population in the Harderian gland is not complete. The plasma cells remaining in the Harderian gland after bursectomy are probably components of a bursa-independent B cell population.


[The issue of professional discretion for pathologists (author's transl)].

According to German law the physician shall not disclose secrets that were confided or made known to him. The definition reads: physician is who practises the healing art (including medicine and surgery). When considering this definition part of the jurisprudence is of the opinion, therefore, that subject of such healing is exclusively the living human being and the pathologist acting as post-mortem examiner makes solely statements concerning the dead body and thus is not to be considered as physician. This opinion does not do justice to the real tasks of the pathologist. The basic idea of the tasks of the pathologist is the consultation and assistance of the physician practising the healing art. Hence the post- mortem examinations serve indirectly as healing treatment. Consequently the pathologist acts as physician and is bound to professional discretion. The result corresponds with the law enforce according to which secrets are subject to protection beyond death.


Molecular aspects of muscle contraction and regulation.

Current views regarding some aspects of the contraction of muscle and its regulation are reviewed. Recent work bearing on the segmental flexibility of myosin is related to cross-bridge movements and ATP metabolism in living muscle. Interaction of troponin with calcium, the process that initiates activation of actin-myosin interaction, is discussed in terms of Ca-induced conformational changes and protein-protein interactions.