Development of Purkinje cell somatic spines in the weaver mouse.

The cerebellar cortices of weaver mice and their normal littermates ranging in age from six to thirteen days after birth were examined with the electron microscope. The initial development of spines, both somatic and dendritic, are the same in both the weaver and its normal littermates despite the extreme paucity of parallel fibers in the former.


Ultrastructural changes of the dog myocardium in extracorporeal circulation.

The effects of the cardiopulmonary bypass circulation on the cardiac muscle cells were studied electron microscopically. Subendocardial hemorrhage was commonly recognized in both ventricles. However, it appeared earlier and more severely in the right ventricle than in the left ventricle. Clear flocculent areas containing numerous filamentous structures were originated from degradation of myofibrils. Degradation of myofibrils occurred within 1 hour after bypass circulation. Degenerative changes of myocardial cells such as zonal lesions, contraction bands and swelling or condensation of mitochondria appeared in both ventricles. Damages of myocardial cells in right ventricular wall were more severer as compared with those in the left throughout the period of observation.


Proliferative fasciitis. A variant of nodular fasciitis.

The clinical and pathologic features of eight cases of proliferative fasciitis, a variant of nodular fasciitis, were described. The lesion affected adults older than 51 years of age. It involved various parts of the body and grew rapidly in most cases. Follow-up information, however, revealed that the patients took a benign clinical course after a local excision. Microscopically a diffuse proliferation of fibroblastic cells intermingled with a number of large basophilic cells resembling ganglion cells was characteristic, and was accompanied by slight lymphocytic infiltration and by slight fibrinous exudation and hemorrhage. The large basophilic cells seemed to be metamorphosed from cells of fibroblastic series.


Angiographic, histometric and histopathological studies on the intramural coronary arteries in the infarcted heart.

Arterial changes of the intramural branches of the coronary arteries were studied angiographically, histometrically and histopathologically in the heart obtained at autopsy from 50 cases with myocardial infarction and 21 control subjects. Stenosis was observed in 14.4% of the intramural coronary arteries in the infarction group, 3.0% in the aged and 0% in the young control group. Hypertrophy of the media was observed in 18.9% of the intramural coronary arteries in the infarction group and 10.7% in the control group. Proliferation of the internal elastic lamina was observed in 6.9% of the intramural coronary arteries in the infarction group and 0.9% in the control group. Stenosis of the intramural branches was the most frequent in those less than 300 mu in diameter and was caused by muscular hypertrophy of the media. Histological changes in the vascular wall of the intramural coronary artery was less frequent in the distal to the epicardial branches with marked stenosis than distal to the epicardial branches without stenosis.


Malignant change in a solitary hamartoma of the lung. A case report.

A case report of a malignant hamartoma of the lung observed in a 36-year-old housewife was presented. The hamartoma was non-chondromatous (fibromyomatous), located beneath the pleura of the left upper lobe. The malignant lesion corresponded to anaplastic carcinoma of the lung. A review of the literatures on the malignant hamartoma of the lung revealed rare incidences of the tumor, but hamartoma and hamartomatous lesions of the lung should be regarded as one of the histopathological backgrounds where pulmonary carcinoma may arise.


Immunoelectron microscopy of surface immunoglobulins in pseudolymphoma of the lung. Report of a case.

A case of pseudolymphoma of the lung was studied by light, electron, and immunoelectron microscopy. The tumor consisted predominantly of small lymphoid cells with a few germinal centers. Both light and dark cells were found by electron microscopy. While the dark cells contained abundant free ribosomes, lysosome-like electron dense bodies were more prominent in the light cells. The proportion of surface staining positive pseudolymphoma cells for IgC, IgM, and IgA was high (each about 80%) compared with control spleen cell suspensions by immunoelectron microscopy. But the serum levels of IgG, IgM, and IgA were normal. It is discussed that the polyclonal presence of surface immunoglobulins does not necessarily support the benign nature of the disease.


Vacuolated meningioma. A light and electron microscopic study.

Two unusual cases of meningioma with extensive vacuolization have been studied by light and electron microscopy. There were two kinds of vacuoles in the tumor cells which had the characteristic ultrastructure of meningioma as well. The smaller intracytoplasmic vacuoles were lipid droplets, while the larger, more prominent vacuoles were found to be extracellular spaces probably containing plasmatic fluid. The tumor cells were very much stellate with extremely thin and long cytoplasmic processes having desmosome junctions and forming cavernous intercellular spaces, some of which contained collagen fibers and fibrils. Although the xanthomatous change has been well known, the latter features provide a resonable interpretation for the histology of the present tumors and fat-negative vacuoles in the ordinary meningiomas. The picture may be recapitulation of the subarachnoid structure. Furthermore, recognition of this type of meningioma is practically important especially in frozen section diagnosis not to misinterpret the tumor as liposarcoma, chordoma or metastatic adenocarcinoma.


Extrarenal renin-secreting tumor associated with hypertension.

Described herein is an autopsy case of a 16-year-old female with severe hypertension, hyperreninemia and secondary aldosteronism. She had had a progressively growing tumor of her right orbita from the age of 4. The tumor was partially excised 13 months before death. A high content of a renin-like material was detected in the excised tumor, which was histologically a hemangiopericytoma. Bowie stain revealed some granules in small number of tumor cells and electron microscopic study showed some cytoplasmic granules. Following the operation, hypertension was somewhat improved, but the levels of plasma renin activity and plasma aldosterone concentration remained elevated, because the tumor was partially resected. At autopsy, the tumor invaded into the cranial base and right frontal lobe, and metastasized to the lungs. In the present case, renal renin-secreting tumor, malignant hypertension and renovascular hypertension were ruled out by the clinical and pathological studies.


Complement studies in adipose patients treated with intestinal bypass.

Seventeen consecutive patients subjected to jejunoileostomy for obesity have been investigated for complement abnormalities and cryoglobulinaemia. The study took place 1-9 1/2 years after the operation. A concomitant clinical examination revealed recurrent arthritis in 6 (30%) of the patients. In 6 of the patients complement abnormalities were found, as activation of the classical pathway in 3 and activation of the alternative pathway in another 3 could be suspected from immunochemical data. One patient showed activation of both the classical and the alternative pathway. Two of the patients with arthritic symptoms belonged to the group showing activation of the alternative pathway. It is suggested that deficient inactivation of bacterial products from intestinal bacteria (lipopolysaccharides) have a role in the complement abnormalities found. No patient exhibited the cryoprotein complexes found earlier in this type of patients.


The study of women in Gothenburg 1968-1969. Intake of energy and nutrients in five age groups.

Women from five age groups (38, 46, 50, 54, and 60 years), participating in the population study "Women in Gothenburg 1968-1969", were subjected to a 24-hour recall dietary interview (n = 1361). In a randomized subsample (n = 418), a dietary history was obtained and individuals in another randomized subsample (n = 755) submitted a 24-hour urine specimen for nitrogen analyses. There were significant differences between the 24-hour recall and dietary history figures in all five age groups with respect to energy and all nutrients. The mean protein intake calculated indirectly from the urinary nitrogen excretion came close to the figures calculated from the dietary histories in four out of five age groups. The energy intake and, consequently, the intake of most nutrients calculated from the dietary histories were higher than generally ascribed to Swedish women, as most previous data have been obtained by 24-hour dietary recall interviews. Most women (71-89% in the different age groups) consumed too much fat and most women of fertile age (80-92%) consumed too little iron. A significant decrease in the mean energy intake was apparent only in the age group 60, i.e. 1870 kcal versus 1965--2 105 in the other groups.


Renal venous output of kinins in patients with hypertension and unilateral renal artery stenosis.

In four patients with hypertension and angiographically pronounced unilateral renal artery stenosis, kallikrein activity was estimated in each kidney separately by the determination of kinin output in the renal veins. All patients showed suppression of renin release from the kidney with a non-stenotic artery. Accordingly, plasma flow from the kidney with artery stenosis could be estimated. The ratio of venous output of kinins between the kidney with a non-stenotic artery and the one with artery stenosis was 2.6-6.5. This indicates that renal artery stenosis leads to diminished intrarenal kinin generation. Reduced kinin formation may explain the low diuresis and natriuresis found in the kidney with artery stenosis.


The concentration of cadmium in renal tissue from smokers and non-smokers.

The concentration of cadmium is determined by atomic absorption spectrophotometry of renal tissue excised at autopsy. Tissue from 19 non-smokers and 42 smokers of either sex in the age group 45-65 years has been analysed. The concentration of cadmium in kidneys from 16 subjects who had been smoking pipes, cigars or cheroots did not differ significantly from the concentration in non-smokers and cigarette smokers. On the other hand, in both normotensive and hypertensive individuals, the concentration of cadmium in kidneys from cigarette smokers was twice as high as in kidneys from non-smokers.


Respiratory distress syndrome and thrombotic, non-bacterial endocarditis after amitriptyline overdose.

Three patients with documented or suspected amitriptyline poisoning developed a uniform clinical picture with progressive respiratory insufficiency, thrombocytopenia and evidence of embolization. Post-mortem examination revealed equally uniform changes: thrombotic, non-bacterial endocarditis (TNBE) with multiple embolization and marked pulmonary stiffness with extensive invasion of alveoli with connective tissue. The lung pathology and clinical picture of progressive respiratory insufficiency are in agreement with the respiratory distress syndrome (RDS) in the adult. The simultaneous occurrence of RDS and TNBE suggests a similar pathogenesis. Prophylactic measures are described.


The hepatic conversion of vitamin D in alcoholics with varying degrees of liver affection.

The seasonal variations in circulating 25-hydroxycholecalciferol (25-HCC) were studied in 102 alcoholics with fatty liver disease without histologic signs of cirrhosis and in 35 patients with alcoholic cirrhosis. The mean levels were compared with those of normal persons. Alcoholics had generally lower 25-HCC values than the controls, particularly in the summer. This was primarily explained by insufficient diet and reduced exposure to sunshine. The ability of the liver to hydroxylate in the 25-position was studied in three groups of alcoholics with 1) fatty liver disease without cirrhosis, 2) compensated cirrhosis, 3) severely incompensated liver cirrhosis. All three groups exhibited a significant increase in serum 25-HCC following the peroral administration of cholecalciferol at a dose of 1 200 U daily for 7 days. Similar rises were seen 7 days after a single injection of 10 000 U cholecalciferol. This indicates a normal intestinal absorption of vitamin D, even in advanced alcoholic liver disease, and is inconsistent with a severely damaged 25-hydroxylation capacity in these patients. Osteomalacia due to impaired liver hydroxylation of vitamin D can hardly explain the increased fracture rate and the decreased bone mass, which have been described in alcoholics.


Clinically undiagnosed active tuberculosis. Experience from an autopsy material.

The incidence of clinically undiagnosed active tuberculosis (CUDAT) was 0.1% in an autopsy material comprising about 75% of all autopsies carried out in Denmark during the period 1.1.1969-1.1.1974. This incidence, corresponding to one case in every 895 autopsies, is a minimum value. From the present study it is apparent that the miliary form is predominant. CUDAT is most often found in elderly patients from medical units. The most common cause of death is the active tuberculosis, especially the miliary form. Fever often occurs during the stay in the hospital and is an almost invariable sign in miliary tuberculosis. Many of the patients had been treated with corticosteroids and/or cytostatics for associated diseases, especially malignancies.


Pheochromocytoma and renovascular hypertension. A case report on a review of the literature.

A case of hypertension with simultaneous occurrence of a para-aortal pheochromocytoma and a functionally significant membranous renal artery stenosis is reported. The pheochromocytoma was excised surgically and a vein patch angioplasty was performed. Postoperatively the BP returned to normal. Three years after surgery the patient is normotensive and urinary catecholamines are normal. On the basis of this case and 27 previously reported cases of pheochromocytoma and renal artery stenosis, the possible relationship between the two conditions is discussed.


Anticoagulant treatment in sarcoidosis.

The treatment of sarcoidosis has so far been disappointing. This paper presents a patient in whom persistent disappearance of the pulmonary infiltrations was observed during anticoagulant treatment for venous thrombosis. A possible mechanism for a beneficial effect of anticoagulant treatment in sarcoidosis is discussed.


Changes in the subarachnoid space after experimental subarachnoid haemorrhage in the dog: scanning electron microscopic observation.

The possible changes in the subarachnoid space after subarachnoid haemorrhage were studied in animals by using a scanning electron microscope (SEM). About 1 ml/kg of autogenous blood was injected intracisternally in 36 adult mongrel dogs to investigate changes in the subarachnoid space, over periods ranging from immediately after the injection to as long as 6 months. We have come to the conclusion that the injected blood disappears in about one to two weeks; the fibrosis or thickening of the arachnoid membrane appears in one to three weeks, and then returns to normal in a month in instances of rapid recovery, but there are some cases in which fibrosis persists for a long period and becomes chronic. The fact that an increase of fibrous tissue was found in the parietal region, where the injected blood had hardly reached, appears to indicate that the fibrosis is not always limited to the site of the haemorrhage but can occur in remote regions. We also discuss the usefulness of the SEM in the observation of the subarachnoid space, and the finding that vascular specimen preparations can be made by perfusing the brain with 2-10% phosphate-buffered formaldehyde solution.


Aneurysmal bone cyst of the spine.

Long term follow up of three patients with aneurysmal bone cysts has allowed us to draw attention to features which facilitate diagnosis and determine adequate treatment. The lesion occurs usually under the age of twenty with a slight female predominance. Treatment consists in complete local excision. Failing this, curettage should be carried out, and this gives good results. The effectiveness of radiotherapy cannot be assessed from our series, but in our opinion it may not be necessary in every case and should be applied judiciously, as postradiation sarcomas have been reported. Special attention must be paid to the tendency for spontaneous regression and cure after incomplete removal, particularly in recurrent cases, with a view to avoiding more aggressive treatment than is necessary. Multilocation (vertebra and distant bone), endothelial proliferation, and obliteration of the lumen of the small blood vessels support the view that this is a vascular lesion.


Intrasacral meningocoele.

A case of an intrasacral meningocoele is described with typical radiological findings and obvious improvement after surgical treatment, but a somewhat unusual neurological picture.


Spinal teratoma.

A very rare case of intramedullary spinal teratoma without spina bifida is described in a man with congenital kyphoscoliosis. A connection is suggested between the spinal tumour and the dorsal deformity.


Recurrent intraspinal arachnoid cyst treated with a shunt procedure.

A case of a recurrent arachnoid cyst in the thoracic region in a 13-year-old boy is reported. At the first operation, complete removal of the cyst proved impossible. At a second operation four years later, it was still impossible to remove the cyst so we performed a shunt procedure with drainage through a Hakim valve to the right atrium. This procedure was successful, resulting in complete disappearance of symptoms. In the presence of recurrent intraspinal cysts the authors recommend this treatment, as it is an easy operation which does not cause undue discomfort to the patient.


[Proteolytic enzyme activity in the cerebrospinal fluid after head injury--a preliminary report (author's transl)].

Report on seven cases of severe head injury, where proteolytic enzyme activity in the ventricular fluid was measured within a period of eight days. The result was positive in four cases. This finding is discussed in relation to clinical features and morphology. Earlier reports and these results are considered.


Serotonin in contused spinal cord.

An intensive experimental spinal cord impact trauma in rabbits led, after 90 minutes, to a significant increase of serotonin content in the segments of spinal cord at the injury epicentres. Adjacent segments showed normal values. It is suggested that the existing contradictory published data concerning the serotonin concentration in a traumatized spinal cord are accounted for by differences between animal species, the method of analysis used, and the technique employed in causing the injury. Potential involvement of serotonin in the autodestructive process is discussed.


[Chondrosarcoma with intraspinal, intra- and extrathoracal extension (author's transl)].

A case of intraspinal, intrathoracic, and extrathoracic chondrosarcoma is described, and the literature is critically examined. Despite apparently total extirpation by the neurosurgeons and thoracic sugeons of a tumour that was identified histologically as a chondroma, there was an early recurrence noted to be obviously malignant at the second operation. Diagnosis and therapy are discussed briefly.


[Malignant degeneration in a parapontine epidermoid (author's transl)].

A case of malignant degeneration in a right parapontine epidermoid cyst giving rise to leptomeningeal carcinomatosis in a 57 year old woman is presented. The malignant tissue had infiltrated the right cerebellar hemisphere and produced a symptomatic trigeminal neuralgia, a change in the psychological state of the patient, and an acute conus and cauda syndrome following metastasis implantation. Only eight unequivocal previous reports of malignant transformation of intracranial epidermoid cyst have been reported in the literature with metastases in four.


Decompressive laminectomies with clinical improvement but persistent myelographic blocks.

Surgical decompression for spinal cord compression secondary to metastatic epidural neoplasms is a common procedure. Preoperative myelography is nearly always done, and clinical improvement postoperatively is assumed to be correlated with relief of the radiologically demonstrated subarachnoid block. Three cases with postoperative clinical improvement but persistent subarachnoid blocks are reported. The recognition of this is important to avoid unnecessary secondary surgery.


Sickle cell lung disease.

When a patient with sickle cell disease has fever and a lung infiltrate, usually it will be due to infection, even though cultures may be negative. However, pulmonary infarction can be virtually indistinguishable from pneumonia. Pneumonia is likely to be present in those younger than five years, with purulent sputum and upper lobe infiltrates. Coexisting crisis, a normal or low leukocyte alkaline phosphatase score and microangiopathic changes on peripheral blood smear favor thromboembolic disease. The fat embolism syndrome, caused by bone marrow necrosis and infarction, occurs in sickle cell disease.


Aeromedical evacuation.

Physicians who use aircraft to transport patients should be familiar with the general principles of altitude physiology, the basic characteristics of aircraft and the specific medical problems which are encountered in an aviation environment. Hypoxia, gas expansion and acceleration forces are common effects of air travel which must be anticipated and avoided in acutely ill patients. Provision of supplemental oxygen, use of decompressive tubes and proper positioning of the patient may obviate or minimize these problems.


Common injuries of the fingernail and nail bed.

The most common injury to the dorsal distal finger is a subungual hematoma. Relief of pain is promptly achieved by draining the  hematoma. If a heated paper clip is used, however, the underlying fluid may be seared and the hole plugged. Local anesthetic block followed by puncture with an 18-guage needle is advocated. When nail avulsion occurs, the free-floating proximal portion should be removed so that it will not serve as an irritant or hide any underlying pathology.


Nonthyropathic exophthalmos.

Although most cases of bilateral exophthalmos and many cases of unilateral exophthalmos are related to hyperthyroidism, there are numerous other diagnostic possibilities. These include tumors, hemorrhage, vascular anomalies and infections. Exophthalmometric measurements are useful in diagnosis and follow-up. The determination of a nonthyroidal etiology for exophthalmos may require sophisticated radiologic and other techniques, as well as a team approach.


Diagnosis of right ventricular infarction: experimental study through the use of body surface isopotential maps.

This investigation was designed to diagnose right ventricular infarction, which is difficult to diagnose by the standard twelve-lead ECG, through the use of body surface isopotential maps which have significant diagnostic information. Right ventricular infarction was experimentally caused by ligation of the canine right coronary artery. Each dog had a series of maps recorded before and a week after experimentally-induced myocardial infarction. The common features of maps in right ventricular infarction are: 1. In the early stage of the ventricular depolarization the negative area occupies a comparatively large part of the right anterior chest surface, and in the middle stage, the larger part of the right anterior surface is also occupied by the negative area. 2. A minimum appears on the right anterior chest surface in the early stage. The delayed excitation resulting from intraventricular conduction disturbance caused by infarction, as verified by the epicardial isochronic map, is also well represented by the body surface isopotential map. In conclusion, through the use of body surface isopotential maps, it is much easier to diagnose right ventricular infarction and intraventricular conduction disturbance caused by infarction even in cases in which the standard twelve-lead ECG does not show the abnormalities clearly.


The pathophysiologic basis of acute coronary insufficiency. Observations favoring the hypothesis of intermittent reversible coronary obstruction.

Clinical, coronary angiographic, and myocardial metabolic data were analyzed to test alternative hypotheses for the pathophysiologic basis of acute coronary insufficiency. The initial incidence of coronary collaterals was not low in relation to coexisting coronary obstructive disease; the early subsequent coronary occlusion rate was high; and in asymptomatic intervals during the acute illness, myocardial hypoxia was infrequent and coronary reserve substantial. These observations support the hypothesis that the acute coronary insufficiency syndrome is caused by reversible coronary ischemic episodes rather than by a new permanent atherosclerotic lesion.


Clofibrate effects: mitochondria vs exercise tolerance in aging hamsters.

Mitochondria in skeletal and cardiac muscle have been found to be less stable in aging hamsters, in contrast to preparations from young animals. We have found previously that clofibrate (Atromid-S) will reverse this degeneration in the older hamsters. This study examined the exercise tolerance of aged hamsters, to see if clofibrate had a parallel effect on exercise tolerance as had been shown for muscle mitochondria stability. Maximal duration of exercise for hamsters on a treadmill was measured in a control and treatment group before and after treatment with clofibrate. There was no improvement in exercise tolerance with clofibrate. We conclude that inferences of functional effects in intact animals from changes found in isolated tissue preparations should be drawn with caution.


The small coronary arteries in alcoholic cardiomyopathy.

The small coronary arteries of two patients with alcoholic cardiomyopathy were studied by means of fine particle barium injection and soft x-ray technic. The spatial architecture of these small arteries which penetrated into the depth of the right and left ventricular myocardium were normal. Their lumina were somewhat dilated and their luminal surfaces were smooth. The "tree circulatory units" were described from this study and were found to be normal. The left ventricular myocardium was richly supplied with small arteries, whereas the myocardium of the right ventricle was not so richly supplied. The myocardium of the papillary muscles and the trabeculae carneae of the left ventricle also had a good supply of small arteries, as did the remote endocardial myocardial appendages. Numerous fine hair-like arteries extended to the epicardial myocardium of the right ventricle to form a brush-like appearance.


Lenegre's disease in youth.

The case of a 22-year-old white male without known heart disease who presented with activity related lightheadedness at age 19 and dizziness and fatigue at age 21 is described. Standard electrocardiograms (ECG's) revealed intermittent complete trifascicular block. Rapid progression of symptoms over the succeeding eight months resulted in increasing incapacity. Holter monitoring demonstrated that symptoms were related to development of second and higher degrees of A-V block. Normal A-H interval and markedly prolonged H-Q interval on His bundle electrograms indicated that block was infranodal and localized to bundle branch system. Conduction problems aside, clinical and laboratory evaluation, including echocardiograms and cardiac catheterization, were unremarkable. Progression of bilateral bundle branch disease in a young patient without other demonstrable heart lesions and a negative family background conforms with criteria for Lenegre's disease. To our knowledge, this represents the youngest reported patient with this entity. Possible electrophysiologic basis of block and of exercise induced improvement in A-V conduction also are considered.


Myocardial infarction association with the Riley-Day syndrome.

The "sudden death" of a 23-year-old Ashkenazy Jew, suffering from "familial dysautonomia" was probably caused by an arrhythmia accompanying a myocardial infarction. Such a report is unique. Diffuse coronary atherosclerosis and direct myocardial "catecholamine cardiomyopathy" seem responsible for the myocardial damage. However, diversion of the endocardial blood flow toward dpicardium and a "coronary steal" phenomenon, both the result of a sudden catecholamine discharge, could aggravate the ischemic injury.


The effect of respiration on normal and abnormal Q waves. An electrocardiographic and vectorcardiographic analysis.

The diagnostic significance of Q waves in Leads II, III, and aVF when analyzed retrospectively remains controversial. Persistence of the Q wave on inspiration is said to reflect inferior infarction. Studies in the past, which have evaluated respiratory variation as a means to separate normal from abnormal Q waves, were performed utilizing the ECG only, were often retrospective, and frequently there was inadequate documentation of myocardial infarction. The present study was performed prospectively and utilized both electrocardiographic and vectorcardiographic analysis of the first 30 msec. vector before and after inspiration in 33 patients with documented acute myocardial infarction and in 22 normal volunteers. Inferior myocardial infarction was documented prospectively by ECG, VCG, by conventional enzymes, and by MB CPK. The VCG demonstrated increased sensitivity over that of the ECG, but the effect of inspiration noted on ECG and VCG was variable and extremely unreliable as a means of separating normal from abnormal Q waves.


Echocardiographic features of mitral annulus calcification.

Ten patients with roentgenographically demonstrable mitral annulus calcification (MAC) were found to have distinctive echocardiographic patterns. MAC was confirmed at the time of cardiac catheterization in six of these patients. Standard M-mode echocardiograms revealed a dense band of echoes in the region of the mitral annulus in contrast to the thin and delicate echoes generally recorded from the normal mitral annulus. Intraoperative and pathologic confirmation of thickening and calcification limited to the mitral annulus was made in two patients who underwent mitral valve replacement for severe mitral regurgitation due to myxamatous "floppy" valve. Patients with marked MAC may have coexisting aortic valve or papillary muscle calcification which can be recognized by echocardiography. Over-attenuation of left ventricular wall echoes in patients with marked MAC, and reduction in E-F slope of the anterior mitral valve leaflet in others can simulate pericardial effusion and mitral stenosis, respectively. Thus, recognition of MAC can avoid confusion with similar echocardiographic patterns due to other common cardiac abnormalities.


Effect of magnesium chloride on electrical stability of the heart.

The effect of magnesium chloride on the ventricular fibrillation threshold (VFT) and the threshold for the ventricular premature contraction (VPCT) was studied in 20 dogs. Seven of the dogs were pre-treated with digitalis and four were in the form of heart-lung preparations. In the anesthetized, intact dogs, the VPCT was 0.19 +/- 0.01 mV. After treatment with magnesium chloride (100 mg. per kilogram intravenously), the VPCT increased by 53% (P less than 0.01). In the same group of animals, the VFT averaged 0.50 +/- 0.06 mV., which more than doubled after administration of magnesium. The threshold of VPC in the digitalis-treated dogs measured 0.18 +/- 0.01 mV; this value doubled after magnesium. The VFT in the digitalized dogs also increased after magnesium; however, resistance to electrical defibrillation was encountered in this group. In the heart-lung preparations, VPCT improved by 72% and a gain of 131% in the VFT followed magnesium administration. The results suggest that magnesium increases the ventricular threshold of arrhythmias in normal, denervated (heart-lung preparations) and also digitalis-treated hearts and, thus, indicate its usefulness in the treatment of ventricular arrhythmias.


Provocation of coronary spasm with ergonovine maleate. New test with results in 57 patients undergoing coronary arteriography.

Ergonovine maleate (Ergotrate) was given to 57 patients undergoing coronary arteriography for investigation of angina occurring at rest or without provocation when routine study showed normal arteries or insufficient occlusive disease to explain their symptoms. This provocative test induced coronary arterial spasm in 13 patients, 10 of whom had definite Prinzmetal's angina. The spasm was easily reversed with sublingually administered nitroglycerin. The spasm was occlusive or nearly occlusive in nine patients, and there was associated reproduction of the chest pain and S-T elevation similar to the spontaneous episodes. One patient with Prinzmetal's angina had S-T depression rather than elevation in association with the chest pain. The other three patients without Prinzmetal's angina had focal narrowing without coronary occlusion, reproduction of the chest pain or electrocardiographic changes. Of the 44 patients who did not demonstrate coronary spasm in response to ergonovine, 29 had normal coronary arteries and 15 had various degrees of atherosclerotic occlusive disease. We conclude that cautious administration of ergonovine maleate during coronary arteriography can be safely used to elicit coronary spasm in some patients who have insufficient fixed occlusive disease to explain their symptoms.


Significance of exercise-induced junctional S-T depression in evaluation of coronary artery disease.

Isolated junctional S-T depression induced during treadmill exercise testing was correlated with coronary arteriographic findings in 230 patients. Of 75 patients with junctional depression of less than 1.5 mm, 10 had 50% or greater stenosis of at least one major coronary artery and 2 patients (3%) had multivessel disease. Of 42 with junctional depression of 1.5 mm or more and a rapid upsloping S-T segment, 23 had 50% or greater coronary stenosis and 12 of these had multivessel disease. Of 35 with an upsloping pattern (junctional depression of more than 2 mm, upsloping S-T segment depressed 2 mm or more, 0.08 second after the J point), 33 (94%) had 50% or greater coronary stenosis compared with 46 (96%) and 30 (97%) with 2 mm or more junctional depression ahd a horizontal or downsloping S-T segment. In conclusion, multivessel disease is rare with isolated exercise-induced junctional depression of less than 1.5 mm but common when the J point is depressed 1.5 mm or more. Junctional depression of more than 2 mm is associated with the same incidence of coronary disease when the S-T segment is slowly ascending (upsloping pattern) as when it is horizontal.


Symptomatic myocardial infarction without chest pain: prevalence and clinical course.

Symptomatic myocardial infarction without chest pain was identified in 26 of 102 patients (25.5%) admitted to the hospital with acute myocardial infarction. As a group, these patients had a significantly lesser prevalence of a history of angina (P less than 0.05) and cigarette smoking (P less than 0.01). Their mean age was 69.1 years compared with 58.7 years for patients with chest pain (P less than 0.001). The group had a significantly greater median delay between the onset of symptoms and (1) arrival at the hospital (P less than 0.05), (2) examination by a physician in the emergency room (P less than 0.05), (3) diagnosis of possible myocardial infarction (P less than 0.001), and (4) transfer from the emergency room to the intensive care unit (P less than 0.001). They had significantly higher admission values for mean heart rate, respiratory rate, temperature and white blood cell count and more frequent in-hospital complications of pneumonia (P less than 0.001) and cardiogenic shock (P less than 0.05). Mortality in the group was 50% compared with 18% in the group with chest pain (P less than 0.05). Discriminant function analysis identified an at-risk population with 80% reliability.


Atrial fibrillation in the preexcitation syndrome.

One hundred patients with proved accessory pathways of the Kent bundle type were studied with multiple intracardiac catheters. During the procedure 16 had atrial fibrillation. Two patterns of induction of atrial fibrillation were noted. In most patients an earlier than expected atrial deflection appeared in one of the atrial recordings and was followed by atrial flutter (cycle length less than 220 msec) or atrial fibrillation either immediately or after a brief period of acceleration of atrial rate. In a few patients, intraatrial conduction delay, manifested as 2:1 block or Wenckebach block from the right to the left atrium or vice versa, occurred before the onset of atrial fibrillation. The incidence of atrial fibrillation was not statistically related to any associated cardiac abnormalities. A significantly large incidence of ventricular fibrillation was recorded in patients who had documented atrial fibrillation either before admission or during the catheter study.


Supraventricular tachycardia in Lown-Ganong-Levine syndrome: atrionodal versus intranodal reentry.

The mechanism of the abbreviated atrioventricular (A-V) nodal conduction time and paroxysmal supraventricular tachycardia in the Lown-Ganong-Levine syndrome was evaluated in six patients. In each the A-H interval increased in response to rapid atrial pacing and atrial extrastimuli; typical dual A-V nodal pathways were demonstrated. In five patients studied at two cycle lengths prolongation of conduction and refractoriness of the "fast" pathway was noted at the shorter basic cycle length. Propranolol prolonged conduction and refractoriness of the "fast" pathway in three patients and in one produced Wenckebach conduction during atrial pacing which did not occur prior to its administration. In three patients the atrium did not appear necessary to sustain supraventricular tachycardia. These findings suggest that preferential rapidly conducting A-V nodal fibers and intranodal reentry are the responsible mechanisms in those patients with Lown-Ganong-Levine syndrome and reciprocating tachycardia.


Echocardiographic study of cardiac dimensions and function in the endurance-trained athlete.

Adaptive cardiac responses to isotonic training were studied with echocardiographic measurement of cardiac dimensions and function in 20 endurance runners whose maximal aerobic capacity on the treadmill was 4.88 +/- 0.13 (mean standard error of mean) liters of oxygen/min. They were compared with 26 young sedentary control subjects whose capacity was 3.34 +/- 0.11 liters of oxygen/min (P less than 0.001). A modest degree of right and left ventricular chamber enlargement and left ventricular hypertrophy was observed in endurance runners (left ventricular mass index 140 +/- 6 g/m2 compared with 107 +/- 4 g/m2 in sedentary control subjects, (P less than 0.001). Resting heart rate was slower in endurance runners (51 +/- 2 versus 62 +/- 2 beats/min, P less than 0.001) and resting left ventricular function as evaluated with ejection fraction and maximal posterior wall shortening velocity and mean circumferential shortening velocity (VCF) was comparable or slightly depressed in endurance runners (0.98 +/- 0.03 versus 1.02 +/- 0.05 circumferences/sec [difference not significant]). This study suggests that isotonic training results in adaptive changes in ventricular volume and mass, slower heart rates that may be associated with more efficient pumping function (that is, increasing stroke volume) and insignificant alterations in resting ejection phase indexes of left ventricular function.


Effect of procainamide, propranolol and verapamil on mechanism of tachycardia in patients with chronic recurrent ventricular tachycardia.

The effect of short-term intravenous administration of procainamide (12 patients), propranolol (4 patients) and verapamil (4 patients) was studied in 12 patients with chronic recurrent sustained ventricular tachycardia. In all patients tachycardia could reproducibly be initiated and terminated with programmed electrical stimulation of the heart. Procainamide (1) lengthened the effective refractory period of the right ventricle, (2) affected the tachycardia zone, (3) reduced ventricular rate during tachycardia, and (4) lengthened the interval between the tachycardia-initiating premature ventricular beat and the first QRS complex of tachycardia. No effect on the refractory period of the right ventricle or the mechanism of tachycardia was seen after administration of propranolol or verapamil. Apart from their therapeutic implications these data suggest that it may be possible to use drugs to study mechanisms of ventricular tachycardia in the human heart.


Differences in cardiac function with prolonged physical training for cardiac rehabilitation.

Ten men aged 40 to 68 years with clinical manifestations of cardiovascular disease and who had participated for 2 to 59 months in a physical training program for cardiac rehabilitation were studied. All 10 underwent measurements of maximal oxygen uptake and invasive studies of cardiac output, using the direct Fick method, at rest and at graded levels of exercise in the upright posture. Of four men who left the training program, three continued activities individually. Physiologic measurements were repeated after a lapse of 13 to 38 months (average 23 months). The rate of change in maximal oxygen uptake relative to normal changes with aging was decelerated in four men over an average of 21.8 months and was accelerated in six men over an average of 23.2 months. At comparable oxygen requirements of exercise, stroke volume and cardiac output were unchanged in the former group but significantly decreased in the latter. Arterial oxygen content and arteriovenous oxygen difference increased in both groups. These results show that prolonged physical training results in physiologic adaptations of cardiac rehabilitation even though deterioration of cardiac function with advancing disease is probable in some patients.


Left heart myxomas.

Separate left ventricular and left atrial myxomas were detected with echocardiography in an asymptomatic young adult with a systolic murmur. Successful surgical removal of both tumors was performed without complications. The value of echocardiography in evaluating heart murmurs of uncertain origin is demonstrated by this unique case.


Echocardiographic features of cor triatriatum.

A patient is presented who had cor triatriatum documented with angiography and surgery. On echocardiographic study, an abnormal, dense linear echo on "sector scan" was consistently seen to traverse the left atrial cavity obliquely; the ends of the echo were attached to the posterior aortic and lateral walls of the left atrium. In addition, high frequency oscillatory movements were evident in the echo of the posterior mitral cusp. Both echocardiographic features disappeared promptly after successful resection of the intraatrial fibrinous membrane. This experience indicates that in the presence of strong evidence of mitral stenosis, an unexpectedly normal mitral valve echogram should initiate a thorough echographic search for cor triatriatum, a treatable cardiac malformation whose diagnosis can easily be missed on "routine" echocardiographic studies.


Provocative testing for coronary arterial spasm: rationale, risk and clinical illustrations.

Two cases of Prinzmetal's variant angina are presented in which coronary spasm was documented by electrocardiographic evidence obtained in the coronary care unit during provocative testing with ergonovine maleate after the arteriographic demonstration of anatomically normal coronary arteries. The rationale and risks of provocative testing for spasm in patients with chest pain and anatomically normal coronary arteries are reviewed. The advantages of performing provocative testing in the coronary care unit after arteriography rather than in the catheterization laboratory during coronary arteriography are discussed.


Verbal conditioning of angina pectoris during exercise testing.

A 40 year old man with far advanced coronary heart disease consistently experienced pain and exhibited marked S-T segment depression after 44 crossings during a Master two-step test. When the number of times traversed was miscounted so that he exercised less, the pain occurred at the precise count of 44 and he showed the same marked degree of S-T depression. However, when the count was accurate, he had neither pain nor S-T segment deviation at the reduced exercise level. The possible basis for verbal conditioning provoking angina pectoris is explored.


Intermittent tachycardia-dependent combined right bundle branch and left anterior conduction block.

A patient is described who had intermittent tachycardia-dependent combined right bundle branch and left anterior conduction block (left axis deviation) with simultaneous onset and disappearance during observations extending over 15 months. Although the site of conduction block could not be definitely determined the pathologic and electrophysiologic data suggest that there was a lesion in the distal part of the His bundle, presumably in fibers already arranged and predestined to supply the right bundle branch and left anterior areas. A single lesion at the so-called pseudobifurcation or two separate lesions with similar electrophysiologic consequences could also account for the observations.


The transketolase assay of thiamine in some diseases.

Erythrocyte transketolase activity (ETKA) and the effect of adding thiamine pyrophosphate have been measured in a group of 27 healthy individuals and in 37 patients diagnosed as having diabetes mellitus, anemia, polyneuritis, or malnourishment secondary to vascular disease of the brain. The observed values for the malnourished group did not differ significantly from those for the control group. The low ETKA values in diabetes mellitus seem to be due to a reduced apoenzyme level resulting from the disease itself rather than thiamine deficiency. Polyneuritis patients had low values of ETKA. In the anemic group as a whole the values showed a difference of only marginal significance from those found in the control group, but the patients with pernicious anemia all had a highly significant elevation of the ETKA values. Although the absolute thiamine pyrophosphate effect differ, there are no significant differences in percentage of thiamine pyrophosphate effect between the groups. It appears that differences in the patient groups studied here reflect variations in apoenzyme levels rather than thiamine status.


Calcium balance and calcium requirements in middle-aged women.

Calcium balance performance was evaluated in 130 normal perimenopausal women ages 35 to 50, studied on their usual, self-selected dietary calcium intakes. Two distinct balance methods were used, one based on customary intake and output measurements, and the other based on absorption and clearance of two simultaneously administered calcium isotopes. Both methods yielded essentially identical results. Under study conditions as closely approximating normal living as possible, these women averaged -24 and -31 mg Ca/day by the two balance methods (exclusive of unmeasured dermal losses). More significantly, there was a positive correlation between intake and balance, with women on higher self-selected intakes exhibiting more positive balance than women selecting lower intakes. The calcium intake predicted from our data which would be required to produce an average balance of zero was 1.241 g/day. This is significantly in excess of the current recommended dietary allowance for calcium. The implications and significance of this discrepancy are explored in detail.


Nutritional supplementation--whom does it benefit most?

Two hundred eleven preschool children who had received a food supplement and a group of 82 children who had not received any supplement were classified into various nutritional groups. Data on their increments in height and weight were analyzed to determine whether different groups behaved differently. The results indicated that those who were most severely malnourished benefited the most from the nutritional supplementation program and also that following on such programs nutritional dwarfs would have a chance to move toward normalcy.


Are Eskimos more or less obese than other Canadians? A comparison of skinfold thickness and ponderal index of Canadian Eskimos.

Skinfold thickness, height, and weight measurements were recorded from 1964 through 1970 for more than 1,000 adult Eskimos who resided in the Central and Eastern Canadian Arctic. Among the men and women of all age groups, 70 to 83% had a low ponderal index (PI less than 12.5). Nutrition Canada reported similar rates in 200 adult Eskimos and therefore considered Eskimos, especially Eskimo men, as more obese than other Canadians. Thin skinfolds were found in most Eskimo men, including those with a low PI. The usefulness of the PI or other height/weight indices for appraisal of body fatness and prevalence of obesity in different population groups is questioned. Marked sex differences were found in the ratio of the skinfold thickness over the triceps to the mean thickness of two sites on the trunk (subscapular and suprailiac). Thus, use of the arm plus trunk sites provides important information about subcutaneous fat distribution, and comparisons of prevalence of obesity in different sex and age groups based only on arm skinfold measurements may be inappropriate.


Effect of covert nutritive dilution on the spontaneous food intake of obese individuals: a pilot study.

The present study investigated the feasibility of a new experimental approach for studying the effect of covert nutritive dilution on the spontaneous food intake of obese individuals. Eight obese subjects were studied as inpatients on a metabolic unit for 15 days during which time they were unaware that their food intake was being monitored. A platter method of food presentation encouraged ad libitum ingestion. Caloric dilution was achieved by replacing sucrose-containing products with aspartame-sweetened analogues in an otherwise normal diet. During the base-line period the subjects spontaneously ate sufficient conventional food to maintain or even slightly increase body weight. Covert substitution of aspartame-sweetened products for their sucrose counterparts resulted in an immediate reduction in spontaneous energy intake of approximately 25%. The aspartame analogues were as well accepted as their conventional counterparts, as indicated by the equal quantity of each consumed. These preliminary results demonstrate that, in a metabolic ward setting, it is possible to maintain the spontaneous food intake of obese individuals at levels sufficient to preserve body weight and arbitrarily to decrease those levels of intake by 25% or more through covert changes in the caloric density of the diet.


Hematological and immunological effects of excess dietary leucine in the young rat.

Young rats were subjected to a dietary leucine overload for several weeks. Although no significant changes in growth, food consumption, and hematological and immune responsiveness occurred when the basic diet was balanced (18% casein), rats which were both overloaded with leucine and subjected to a protein-poor diet (4% casein) displayed a strong impairment of immunological reactions to sheep red cells (rosette and plaque-forming cells in the spleen, serum hemagglutinins, and hemolysins). The effect was significantly more pronounced than in rats on a protein-poor nonsupplemented diet or in pair-fed controls on a balanced diet. The immunodepression was as profound as after complete protein deprivation. It is suggested that a secondary defect in valine and isoleucine utilization may play a role in the harmful effects of excess leucine, because isoleucine and especially valine have been shown to be highly deleterious to lymphopoiesis.


A comparison of three defined formula diets in normal volunteers.

Defined formula diets, shown to be clinically effective in separate trials, have never been compared in the same subjects under identical controls. The intent of this study was to determine which one  of three diets, (Vivonex, Flexical, or Precision LR) was most effectively absorbed and utilized. Stool weight and frequency, nitrogen balance and fecal fat, ash and moisture were measured. In addition, subjective comments were recorded regarding overall acceptability and ease of preparation. Statistically significant differences were found only in total stool weight. The data imply that the underlying disease state of the patient, the individual's response to the diet, the composition, cost, availability, and storage requirements of the diet must be taken into consideration when selecting a low residue formulation.


Vitamin B6 deficiency in cancer patients.

The plasma pyridoxal phosphate concentration was determined in 30 cases of early breast cancer, 21 patients with locally recurrent disease, and 43 patients with systemic metastases. The two groups of advanced breast cancer had significantly lower plasma pyridoxal phosphate levels than 36 healthy women of similar age. Urinary 4-pyridoxic acid excretion was normal in breast cancer. Plasma pyridoxal phosphate concentrations were also reduced in 34 women with widespread cancer derived from primary sites other than breast, but were normal in 39 with early disease.


Chemical interactions between thiamin and tannic acid. I. Kinetics, oxygen dependence and inhibition by ascorbic acid.

Consumption of food high in tannins can cause thiamin deficiency. The interactions between tannic acid and thiamin were studied by allowing them to react at pH 7.5, 60 C, and determining free remaining thiamin by the thiochrome method and by recording changes in ultraviolet absorption profiles at intervals. The reaction was biphasic, having a rapid initial phase which was oxygen-independent, followed by a slower phase which was oxygen concentration-dependent. Ascorbic acid completely inhibited the reaction if present at the beginning of the reaction and could partially reverse the reaction if added during the first 30 min.


Effect of repeated food restriction-refeeding on growth rate and weight.

The effect of repeated food restriction-refeeding was investigated in male Wistar rats. After the first food restriction, rats grew faster than did ad libitum-fed animals. The extent of compensatory growth was less with each subsequent restriction-release episode. Food intake determinations gave similar results: the extent of overeating decreased with each successive restriction. Studies on the effects of the first restriction-refeeding at various sizes (ages) indicate that a considerable portion of the decrease in compensatory growth with increasing number of food restriction-refeeding is due to increasing size (age). However, some of the decreased response can be directly attributed to the repetition of food restriction.


Factors responsible for weight loss in tropical sprue.

The respective roles of reduced dietary intake and malabsorption in the pathogenesis of weight loss in persons with chronic tropical sprue have been evaluated . Dietary intake was found to be significantly (P less than 0.001) less in a group of 45 patients with tropical sprue, all of whom had anorexia due to deficiency of folate and/or vitamin B12, than in a group of 51 healthy Puerto Ricans. Weight loss was equally prominent in those patients with tropical sprue who had normal absorption of fat and protein as in those who had excessive fecal loss and reduced absorption of these nutrients. Treatment of five sprue patients with folic acid or vitamin B12 for 2 weeks resulted in improved appetite and increased in dietary intake with weight gain in the absence of significant improvement in intestinal absorption. Treatment with oral tetracycline for a similar period of time in five other patients was not associated with vitamin repletion, return of appetite or weight gain. These observations indicate that reduced dietary intake resulting from anorexia caused by vitamin deficiency is a significant, and sometimes the most important, factor in the pathogenesis of weight loss in persons with chronic tropical sprue.


Plasma free amino acid levels in human subjects after meals containing lactalbumin, heated lactalbumin, or no protein.

Plasma free amino acids were measured in six adult human subjects at four consecutive 1/2 hr intervals following meals containing either 50 g lactalbumin, 50 g heated lactalbumin, or no protein. After the lactalbumin meal, all essential and several nonessential amino acids increased in the plasma. After the heated lactalbumin meal, these increases were either much less or did not appear. Following the no protein meal all measured plasma amino acids fell. The absence of a response to the heated lactalbumin meal was considered to be related to a drop in digestibility of heated lactalbumin as measured in rats.


The public health significance of fat-modified ruminant foods.

The apparent consumption of dietary fat in Australia is 115 g/person/day, of which two-thirds is contributed by ruminant-derived foods. Consequently, the polyunsaturated fatty acid/saturated fatty acid ratio of the Australian diet is low, approximately 0.2. Recently a process has been developed which allows modification of the fatty acid composition of ruminant body fat, and a range of foodstuffs (fat-modified foods) which have a substantially higher polyunsaturated fatty acid/saturated fatty acid ratio than their conventional counterparts has been produced and marketed. In the clinical trials in which there was complete substitution of fat-modified ruminant foods for conventional ruminant products the fall in serum cholesterol was approximately 10%. In the trial in which there was only partial substitution the fall in serum cholesterol was insignificant. Using the equation developed by Keys, the predicted fall in serum cholesterol resulting from varying degrees of substitution of fat-modified ruminant meats for their conventional counterparts in the Australian diet is shown to be negligible. The fat-modified products were marketed at approximately twice the price of their conventional counterparts and  it is claimed that this will limit the degree of substitution. It is concluded that the public health significance of fat-modified foods is limited.


Energy expenditure, productivity, and physical work capacity of sugarcane loaders.

VO2, E and heart rates (fH) were measured in 28 Colombian sugarcane loaders while loading cane and in the laboratory during a VO2max test. Productivity (metric tons-day-1) of the workers was also obtained. During work, VO2 was 1.251-min-1, VE 38.81 min-1, and fH 120 beats-min-1. The subjects worked at 42% of VO2max (6.3 +/- 1.0 kcal-min-1) during the field measurement periods. Energy expenditure was estimated to average 3,281 kcal-24 hr-1. Productivity was higher in men with lower fat content, resting fH and fH at VO2 = 1.25 1-min-1, indicating a positive relationship between productivity and physical fitness. Productivity was not related to age but, since VO2max decreased with age, the relative effort required to maintain productivity increased in the older workers. Efficiency (kg cane loaded-1 VO2-1) and estimated sustained effort (percent VO2max) were not significantly correlated with productivity in this type of discontinuous, moderate work.


The association of population density, reduced space, and uncomfortable temperatures with misconduct in a prison community.

This study investigated the relation of population size, amount of personal space, and population density to the incidence of disruptive behavior over a 3-year period in a correctional institution for male youthful offenders. Population size was significantly correlated with the number but not the rate of disciplinary violations. The total amount of personal space and the index of population density were significantly correlated with both the number and the rate of violations. A post hoc analysis showed that the incidence of uncomfortably hot days had no relation to disruptive behavior. These results are contrasted with laboratory data on human crowding reporting no relation between population density and behavior pathology. It is suggested that the chronic high density explored in the present field study differs from temporarily crowded conditions produced in laboratory research on human crowding.


Treatment environment and staff ideology in two British mental hospitals.

Hypotheses were derived from assumptions inherent in two contrasting conceptions of a treatment environment, attitudinal and ecological. Research was conducted in two different British mental hospitals, using scales from the OMI and the CTE. As predicted, the OMI scales were related only to staff attributes and did not discriminate among environments of institutions or units that differed in program, philosophy, organization, or type of patients. CTE scales distinguished between hospital treatment environments and wards. There was slight evidence that observed attributes influenced ecological measures of the objective treatment environment, or that staff ideology had any substantial impact upon treatment environments.


The use of paraprofessionals in university mental health settings; a national survey.

A national survey of 218 counseling centers was conducted to determine the extent and nature of paraprofessional use. Responses from 119 centers indicated that only 38% employ paraprofessionals. Those programs that do exist tended to be at larger, public institutions. Paraprofessionals were generally salaried, and they functioned in multiple roles. The selection  procedure most frequently employed was professional staff interviews with an emphasis on "interpersonal characteristics" as the selection criterion. Training and evaluation procedures were usually conducted on an ongoing rather than on a "one-shot" basis. Reasons for not employing paraprofessionals varied considerably from center to center.


A stress inoculation approach to anger management in the training of law enforcement officers.

Consultation with law enforcement personnel in the area of conflict-management has typically been concerned with interpersonal rather than intrapersonal conflict. An approach to anger management that is based on cognitive self-control techniques is described as it has been used in the training of police officers. The approach follows a procedure called "stress inoculation" that has been applied to anxiety and pain (Meichenbaum, 1975). Data are presented on the anger experiences of policemen, and suggestions are offered for the selection of police candidates regarding their proneness for provocation.


Sex differences in behavior ratings: male and female teachers rate male and female pupils.

Male and female primary school teachers rated their male and female pupils using a 16-item classroom behavior rating scale (Modified AML). Male pupils were generally rated more poorly than femal pupils by both male and female teachers. Male teachers rated both male and female pupils more conservatively than did female teachers on the separate factors of the AML scale. There was no difference in ratings by male and femal teachers of the overall adjustment of pupils, where the extreme scale point called for a professional decision as to whether the child should be referred to child guidance services. The findings have methodological implications for epidemiological studies, and for longitudinal studies. The findings fail to support the view that male pupils have more difficulty in school because they are taught by female teachers.


Which patients respond to a mental health consumer survey.

Characteristics of patients at the Los Angeles County - University of Southern California Medical Center, Adult Psychiatric Outpatient Clinic who responded to a Los Angeles County voluntary "Client Satisfaction Survey" were compared with those who did not. Three significant differences consistently emerged. If an individual was a member of a minority group (black of Spanish surname), had less than a high school education, and was taking antispsychotic medication, his chance of returning a questionnaire to a waiting-room collection box was 79% as compared to the 30% chance of returning if he had none of these three characteristics. Younger patients had "Anglos" more often used the U.S. mail than the collection box to return the questionnaires. It is important that both methods be used to minimize bias. Most of the many patient-characteristics studied did not influence return rate. These findings are discussed in relation to the return method, ethnicity, medication, chronic mental illness, diminished freedom, and consumer voice in voluntary questionnaires.


Postnatal somatic growth in infants with atypical fetal growth patterns.

We differentiate patterns of postnatal physical growth in 61 fullterm newborns with either normal or atypical somatic fetal growth. At birth, 14 normal babies had average ponderal indices, 14 were overweight for length (high ponderal index), 18 were underweight for length (low ponderal index), and 15 had short crown-heel lengths for dates and normal ponderal indices. Appropriate statistical analyses determined attained and velocity growth of the four groups during the first postnatal year. Statistically significant and marked differences in postnatal growth were noted between short babies and babies with low ponderal indices. The slow postnatal growth of the short infants appeared to be a continuum of their fetal growth pattern. On the other hand, infants born with low ponderal indices accelerated their weight gains and reversed the malnourished state in which they were born. These findings suggest that there are two distinct types of fetal growth retardation.


Perceptual-motor functioning in children with phenylketonuria.

Children with treated phenylketonuria (PKU) have been described as being at high risk for perceptual-motor dysfunction. In this study, the Wechsler Intelligence Scale for Children (WISC) and the Bender Gestalt test were administered to 19 school age children with treated PKU and of average intelligence who have been off diet from five months to six years four months. Perceptual-motor performance was evaluated, and school functioning was rated by classroom teachers. Substantial impairment of perceptual-motor functioning as measured by the Bender Gestalt test and lower WISC performance IQs than verbal IQs were observed in children of average intelligence. Quality of dietary control was found to be associated with performance on the Bender Gestalt test. These findings suggest the possibility of a specific deficit that could seriously interfere with academic progress, but which is not signalled by obvious impairment of overall intellectual functioning.


Clindamycin in the treatment of osteomyelitis in children: a report of 29 cases.

Clindamycin phosphate was used in the treatment of 29 children with osteomyelitis of whom 25 had an acute and four a chronic type of infection. The usual dose was 50 mg/kg/day intravenously for approximately three weeks followed by oral clindamycin palmitate at home in a dose of 30 mg/kg/day for an additional six weeks. Staphylococcus aureus was isolated in 22 of 29 cases: 96% of strains were penicillin resistant. The clinical and bacteriologic results in the present series were good to excellent. There was prompt clinical and bacteriologic response shortly after initiation of clindamycin therapy. Good bone penetration of the drug was observed. Long-term evaluation revealed satisfactory clinical and roentgenographic progress in all patients. No diarrhea or manifestations of enterocolitis appeared in any patient in spite of high doses of the drug for intervals up to nine weeks.


Respiratory failure in childhood status asthmaticus.

Thirteen of 356 children consecutively admitted for treatment of status asthmaticus in a 37-month period experienced 19 episodes of respiratory failure, an incidence of 5.3%. In this retrospective study, all children received similar pharmacologic therapy after admission, and all were treated with nasotracheal intubation and controlled ventilation with a volume-cycled ventilator. Mean duration of mechanical ventilation was 54 hours and mean duration of hospital stay was 7.5 days. Complications occurred in nine of 19 episodes and there was one death not directly related to acute asthma. It is possible that 12 of the 19 episodes of respiratory failure might have been prevented by more prompt or more appropriate treatment of the child with acute asthma.


Perforation of the peritoneum and intra-abdominal hemorrhage: a complication of umbilical vein catheterizations.

We report a major hemorrhage into the peritoneal cavity caused by perforation of the umbilical vein by a venous catheter in a critically ill neonate. A lateral roentgenogram was necessary to confirm the position of the umbilical vein catheter and the peritoneal perforation. Conservative management, including replacement of lost volume and correction of coagulation abnormalities, controlled the hemorrhage, and surgical intervention was not necessary.


Congenital adrenal hypoplasia and hypogonadotropic hypogonadism.

A 19-year-old male patient with congenital adrenal hypoplasia and elevated plasma adrenocorticotropic hormone level was found to have gonadotropin deficiency. Other hypothalamic-pituitary functions were normal. A possible relationship between hypothalamic-pituitary dysfunction and development of the cytomegalic form of congenital hypoplasia of the adrenals is suggested.


Wheat-based diets: effect of short-term consumption on serum cholesterol and triglyceride levels in infants.

The effect of consumption of wheat-based diets on serum cholesterol and triglyceride levels was studied in eight previously malnourished children. While consuming a control diet of casein, soy-cottonseed oil blend, and a mixture of sucrose and starch, the serum cholesterol level was 169 +/- 42 mg/dl (mean +/- SD). This decreased significantly (P less than .001) to 108 +/- 30 mg/dl after nine days' consumption of an isoenergetic-isonitrogenous diet in which whole wheat or white flour provided all the protein and +/- 50% of carbohydrate, and remained at this level for the 27-day dietary period. On changing again to the casein-based diet, the serum cholesterol level rose within nine days to 154 +/- 42 mg/dl. There was no similar diet-related change in serum triglyceride values. None of the known mechanisms whereby diet affects serum cholesterol adequately explains these findings.


Mania in childhood. II. Therapeutic trial of lithium carbonate and further description of manic-depressive illness in children.

Six children with childhood mania were identified using established diagnostic criteria. Poor response to tranquilizers led to a therapeutic trial of lithium carbonate. Outpatient administration of lithium carbonate in dosages of 30 to 40 mg/kg/day produced therapeutic blood lithium levels, and improved manic symptoms in all six children. Two of the children had a prolonged remission of symptoms with the lithium treatment. Lithium was discontinued in three patients whose depressive symptoms were uncontrollably worsened. Electroencephalographic epileptiform activity developed in one child receiving lithium carbonate. Using the strict diagnostic criteria for childhood mania, further therapeutic trails including double-blind studies are indicated to establish the proper role of lithium carbonate in the treatment of this disorder.


Allergic bronchopulmonary aspergillosis in infants.

Allergic bronchopulmonary aspergillosis (ABPA), a serious complication of asthma, is thought to rarely afflict infants. We report three children less than 2 years of age in whom this disorder developed. The major criteria for the diagnosis include: (1) asthma, (2) recurrent pulmonary infiltrations with peripheral eosinophilia, (3) positive aspergillus skin tests at 15 minutes and at 4 to 6 hours, (4) serum precipitating antibodies to aspergillus, and (5) elevated serum IgE levels. Early diagnosis and treatment of ABPA in infants may prevent the ravages of the disease and help to sharpen our concepts of the course and immunopathogenesis.


Lupus-associated chorea in childhood.

Chorea associated with systemic lupus erythematosus (SLE) has been reported in only 28 patients. The clinical and laboratory features of these cases are reviewed here, along with those of a 7-year-old boy who, we believe, represents the youngest child reported to date. In approximately half of these 29 individuals, most of whom were children, chorea preceded other manifestations of SLE. The age range and clinical characteristics of lupus-associated chorea were not appreciably different from those of Sydenham's chorea and most of the patients in whom chorea developed before other manifestations of SLE were initially assumed to have Sydenham's chorea. Systemic lupus erythematosus should especially be considered if chorea begins in the older child or is associated with a persistently elevated erythrocyte sedimentation rate.


The contribution of hyperglycemic hormones to the pathogenesis of diabetes mellitus.

Changes in cortisol, growth hormone, and glucagon levels observed in diabetes mellitus appear to be secondary to insulin deficiency, and can be related to the severity of insulinopenia with its attendant metabolic sequelae. Similarly, disturbances in plasma concentrations of catecholamines in diabetes also appear to be secondary to insulin deficiency, although a primary disturbance in adrenergic function or receptors at the cellular level cannot be excluded. As "inappropriate" compensatory responses, these hormones may aggravate the diabetic syndrome, but their dysfunction is not the cause of diabetes and cannot be used to identify prediabetes. To date, the primary hormonal disturbance in insulin-dependent diabetes remains defective insulin secretion.


The pancreas and immunoglobulins. II. Immunoglobulin levels in the pancreatic secretions of patients with chronic pancreatitis.

A comparison of the pancreatic excretory immunoglobulin levels of G, A, M in the normal and chronic pancreatitis patient reveals no satistically significant differences. Further study is indicated to determine whether or not there is a difference between the group as a whole and those patients with chronic pancreatitis whose symptoms continue after cessation of ethanolism.


Malabsorption following radiation therapy.

Gastrointestinal injury is known to occur following radiation therapy of tumors in the abdominopelvic compartment. Chronic radiation changes may be associated with diarrhea and malabsorption. A patient with transitional cell carcinoma of the bladder developed diarrhea following radiotherapy and was treated symptomatically for nine years with the assumption that the diarrhea was secondary to radiation enteritis. Further evaluation including endoscopic cholangiopancreatography, revealed pancreatic insufficiency with steatorrhea as the probable cause of the patient's diarrhea. Although temporally related to radiation therapy, the etiology of his pancreatic insufficiency remains speculative. All patients developing diarrhea and/or malabsorption following radiotherapy should be evaluated thoroughly for treatable causes.


Papillary cystadenocarcinoma of the pancreas.

Papillary cystadenocarcinoma is a rare lesion of the pancreas. A case is reported in a 38-year old female where radical resection of an extensive lesion resulted in a four-year survival without evidence of recurrence.


Malabsorption in infectious mononucleosis.

A case of infectious mononucleosis, complicated by malabsorption, is presented. Malabsorption was documented by abnormal d-xylose, small bowel series, 72-hour stool fat and jejunal biopsy. Small bowel abnormalities and other gastrointestinal manifestations of infectious mononucleosis are discussed.


The radiology corner. Is an air-fluid level within a gastric ulcer a reliable roentgen sign of benignancy?

A review of 108 cases of benign gastric ulcers and 33 ulcerated malignant gastric neoplasms showed that air-fluid levels were present within 25 benign ulcers and in only one malignant ulcer. These differences are statistically significant. Since, however, in unusual circumstances, a malignant ulcer may contain an air-fluid level, use of this roentgen sign alone to determine benignancy is not recommended. If used in conjunction with other accepted roentgen criteria, the presence of an air-fluid level within a gastric ulcer substantiates the diagnosis of benignancy in the majority of cases.


Needle aspiration biopsy of the pancreas at laparotomy.

Thin needle aspiration biopsies obtained from the pancreas during laparotomy have been taken on 56 patients over the past six years. An 18- to 22-gauge spinal needle attached to a disposable syringe was employed. The specimens were fixed immediately and stained according to the method of Papanicolaou. Of the 36 carcinomas, the accuracy was 94%; there were no false positives in the 20 benign lesions. The safety, ease of interpretation and high accuracy of this method make this an extremely useful procedure.


Biliary bacteriology based on intraoperative bile cultures.

This paper presents a study of bile cultures taken during 174 operations on the extrahepatic biliary tract. Twenty-six per cent of the cultures were positive. Septic complications developed in 33.3% in this group. Since septic complications must be the result of intraoperative contamination from the infected bile, an argument is presented for prophylactic preoperative antibiotic administration as well as for routine culture of the bile at time of surgery.


Studies on serum gastrin of the patients with gastric cancer.

In patients with gastric cancer who were to undergo gastrectomy, the fasting serum gastrin concentration in the peripheral vein was estimated by radioimmunoassay. The blood samples were also collected from the gastric veins and artery during the time of operations. These gastrin values were compared with morphological findings in the resected stomach. No significant differences in serum gastrin concentration was found between the patients of gastric cancer and normal subjects. In the patients with mucosal atrophy in the oxyntic gland area but with no atrophy in the pyloric gland area, however, significant increase in serum gastrin concentration was observed. In cases where fundal atrophy was accompanied by atrophy in the pyloric gland area, the increase was not observed. The amount of gastrin content in cancer tissue was negligible. These results indicate that the increase in serum gastrin concentration in some patients with gastric cancer might be due to the accompanied atrophy of oxyntic glands in the stomach.


The diagnostic value of serum lysozyme activity in inflammatory bowel disease.

Serum lysozyme (muramidase) activity was determined by the Lyso-Plate diffusion technic in 419 subjects consisting of normal persons and patients with Crohn's disease, ulcerative colitis, nonspecific diarrhea and various other disorders. Lysozyme activity in the normal subjects did not exceed 37.8 microgram/ml. The values in the several groups of patients overlapped markedly with each other and with the normal range. Approximately two-thirds (62.1%) of the 37 patients with Crohn's disease had values that were within the normal range. In about half (51.8%) of the patients with this disease in whom the process was clinically active, serum lysozyme activity was increased. Of 10 patients with Crohn's disease who had undergone resection, heightened serum lysozyme activity was found only in the three patients in whom there was clinical evidence of recurrence of the disease. It is concluded that serum lysozyme activity is not a dependable means of distinguishing Crohn's disease from ulcerative colitis or nonspecific diarrheas. The determination would appear to be of value, however, in helping to identify activity, recurrence, or extension of the disease in patients with Crohn's disease.


A case of afferent loop obstruction secondary to recurrent carcinoma of the stomach with ultrasound and C.T. scan findings.

A case of afferent loop obstruction secondary to recurrent carcinoma of the stomach is reported. The patient presented in the early recurrence period with the clinical picture similar to that of pancreatic pseudocyst. This was the first reported case of afferent loop obstruction demonstrated by abdominal ultrasound and C.T. scan. The radiological distinguishing features and similarities of pancreatic pseudocyst and afferent loop obstruction are discussed. This case also shows a rarely reported manifestation of recurrent carcinoma of the stomach.


Enterobiliary fistula and ERCP.

A case of ascending cholangitis with a patent enterobiliary fistula is presented. The feasibility of ERCP via the fistula and the safety of the procedure by virtue of the incomplete obstruction is discussed.


Pleural effusion with pancreaticopleural fistula: a case report.

A case of pancreaticopleural fistula with recurrent hemorrhagic pleural effusion has been described and the pathogenesis of pleural effusion associated with pancreatitis was discussed. Importance of thinking about pancreatic disease as a cause and estimation of amylase in pleural fluid is stressed. The diagnostic limitation of endoscopic retrograde cannulation of the pancreatic duct for defining a fistulous tract has also been noted.


Carcinoma of the pancreas presenting as relapsing pancreatitis.

A case is reported of a 32-year old man, in which relapsing pancreatitis was the presenting symptom of an underlying carcinoma of the body of the pancreas. The rare association of clinically manifest pancreatitis and pancreatic carcinoma is reviewed and a possible pathogenetic mechanism is proposed in this case. It is suggested that pancreatic carcinoma should be suspected in patients with relapsing so-called idiopathic pancreatitis.


Angiographic diagnosis of leiomyomas of the small intestine.

Leiomyomas of the small intestine were demonstrated by visceral angiography in a 54-year old man with recurrent episodes of severe gastrointestinal bleeding over a five-year period. Angiographic features were irregular vessels within the tumor and early opacification of prominent feeding and draining vessels.


A nationwide survey of heavy metal absorption in children living near primary copper, lead, and zinc smelters.

Arsenic, lead, and cadmium absorption levels were determined in 1774 children 1-5 years old living in 19 USA towns with primary nonferrous metal smelters. Results were compared with data on 258 children of the same age in three communities without smelters. Increased systemic absorption of arsenic, as reflected by urine arsenic content, was noted in children near 10 of 11 copper smelters. Blood lead levels were also modestly elevated near two copper smelters. Near lead and zinc smelters, elevated levels of lead and cadmium in hair provided evidence of external exposure to these elements. Levels of lead in blood were not, however, elevated near any of three lead smelters and were elevated near only two of five zinc smelters. Blood cadmium levels were high near one lead and two zinc smelters. The apparent sources of exposure (except in one community with elevated levels of arsenic in drinking water) were air, soil, and dust contaminated by smelting operations. While the full biologic significance of these findings is not known exposure of children to toxic heavy metals emitted by smelters should be reduced to a minimum.


Lung function, respiratory disease, and smoking in families.

Respiratory symptoms, disease and lung function were studied in 376 families with 816 children who participated in a survey in three USA towns. Parental smoking had no effect on children's symptoms and lung function. Also, there was no evidence that passive smoking affected either lung function or symptoms of adults. There was no association between prevalence of self-reported cough and/or phlegm in parents and their children. There was a highly significant association between the prevalence of wheeze in parents and their younger children, for whom parents reported this symptom. Wheeze in children was also significantly associated with a parental history of asthma, and lung function was lower in children with a family history of asthma. Even after accounting for height, weight, age, sex and race, children's lung function correlated significantly with parents' lung function. However, the contribution of familial factors (i.e., parents' lung function, smoking, and history of asthma) to children's lung function is small compared to the effects of height, weight and age.


"Pap" testing and hysterectomy prevalence: a survey of communities with high and low cervical cancer rates.

There is an inverse relation between cervical cancer rates and income in Los Angeles County communities, and there is a positive association between level of Papanicolaou (Pap) testing and income. Ethnic differences in cervical cancer rates and Pap testing are dependent on income. The relatively high rate of cervical cancer and low level of systematic screening in low income communities suggest that a community trial to assess the value of cytologic screening in reducing cervical cancer rates is feasible. Information on hysterectomy prevalence by type of procedure supports the idea that the long-observed decline in cervical cancer rates is in part attributable to a concomitant decrease in the ratio of subtotal to total hysterectomy.


Age-specific correlation analysis of longitudinal blood pressure data.

To evaluate the predictive value of blood pressures for future levels, longitudinal measurements were analyzed among Welsh subjects from age 5 to 74 at entry. The measurements were taken on 863 individuals from the Vale of Glamorgan in 1956, 1960, 1964, and 1971 and on 734 individuals from the Rhondda Fach in 1954, 1958, 1964, and 1971. The tracking correlation, defined as the correlation between blood pressure readings on the same person taken at two different times, is used as a descriptive measure of the magnitude of the association. The tracking correlations range from 0.25 to 0.6-0.7 with most of the increases occurring before age 20. The tracking correlation depends on initial age, sex, and time interval between measurements. The age-specific tracking correlations decrease as time interval between measurements increases. For a given time interval, the age-specific correlations are slightly higher for females than for males. These findings are very similar for each of the two regions studied.


An epidemiologic study of homicides in Allegheny County, Pennsylvania.

Extensive demographic data concerning homicide victims and perpetrators in Allegheny County, 1966-1974, were obtained retrospectively from the records of the County Coroner's Office and Police Department. Analysis revealed that the demographic characteristics describing perpetrators and victims were essentially identical. Rates of homicide peaked in the young adult years of life. The race ratio (B/W) among victims was 18.7 for males and 6.7 for females, while sex ratio (M/F) was 5.4 for blacks and 1.9 for whites. An inverse relationship between the rate of homicide and socioeconomic status was present among both black and white races. The majority of victims were killed by a spouse, relative, or friend (66%), usually in familiar locations, i.e., residence or place of work (60%), and usually during an alteration (68%). Shooting was the method used to perpetrate 61% of the killings, most of which were by means of a handgun. An increasing trend of homicide was noted, particularly for the type perpetrated by shooting.


The overuse of single patient isolation in hospitals.

Single patient isolation of adults to prevent spread of infection was studied in five high occupancy community hospitals. The acceptable standard was a guideline for isolation in hospitals, published by the Center for Disease Control (CDC). Overusage of single patient isolation was found to vary between 4% and 96% of physician's isolation orders. Diagnoses of viral hepatitis, surgical wound infections, skin infections and respiratory infections accounted for the majority of overisolated patients. When infection control personnel rather than attending physicians determined the type and duration of isolation, a decrease in overisolation and a saving of patient (or third party payer) charges could be demonstrated. Reduction in overisolation does not bring about savings for hospitals unless bed occupancy is high and few single rooms are available. No evidence of cross-infection was observed in one hospital as a result of implementation of the CDC guidelines.


Intracranial tumors simulating the presentation of cerebrovascular syndromes. Early detection with cerebral computed tomography (CCT).

One hundred thirty consecutive patients in whom the initial diagnosis of cerebrovascular disease was made on clinical basis were evaluated by cerebral computed tomographic (CCT) scan. Three of 20 patients with transient ischemic attacks were found to have an abnormality on CCT scan. Of 30 patients with an initial diagnosis of stroke-in-evolution, 13 were found to have a clinically unsuspected lesion by CCT scan. Of 60 patients with completed stroke, CCT scan made possible differentiation of intracerebral hematoma, hemorrhagic and nonhemorrhagic infarction, and excluded intracranial tumors. Of 20 patients believed to have symptoms of cerebral arteriosclerosis, six had nonvascular lesions and eight had a cerebral atrophic process. This study demonstrates the efficacy of this safe and noninvasive procedure in evaluating patients with cerebrovascular disease.


A controlled study of the efficacy of granulocyte transfusions in patients with neutropenia.

A randomized clinical trial to determine the efficacy of granulocyte transfusions in neutropenic patients with infection was conducted. Criteria for patient selection included a proved infection, a granulocyte count of less than 300/mm3, availability of a suitable donor and failure to respond to at least 72 horus of appropriate antibiotic therapy. Thirty patients were assigned at random to receive either granulocyte transfusions or to serve as a control group. Antibiotic therapy was continued in both groups. Responses were judged by the degree of diminution of infectious episodes and survival. The results showed that 11 of 13 control patients failed to respond during the period of observation, whereas 10 of 17 patients given transfusions responded. The results were statistically significantly different (p less than 0.05). The median survival was 22.5 days in the group given transfusions (group 2) and 7.7 in the control group (group 1) (p less than 0.01). The granulocyte transfusions were most effective in patients with hypocellular marrows who failed to recover during the period of observation. These results indicate that granulocyte transfusions are effective in the short-term control of infections in neutropenic patients.


Afterload reduction with phentolamine in patients with acute pulmonary edema.

Phentolamine in amounts of 10 to 40 microgram/kg/min was infused intravenously for the emergency treatment of acute pulmonary edema due to left ventricular failure. Fourteen patients with arteriosclerotic heart disease, ranging in age from 52 to 87 years, had clinical and roentgenographic signs of pulmonary edema. The pulmonary artery wedge pressure was increased to an average of 24 mm Hg and the cardiac index was decreased to 1.9 liters/min/m2 or less prior to the administration of phentolamine. A reduction in the pulmonary artery wedge pressure to 14 mm Hg and an increase in the cardiac index to 2.5 liters/min/m2 was observed in response to this alpha adrenergic blocking agent. Reduction in peripheral resistance with phentolamine was associated with reversal of pulmonary edema.


Medial calcinosis of Mönckeberg. A review of the problem and a description of a patient with involvement of peripheral, visceral and coronary arteries.

Massive medial calcific deposits (Mönckeberg's calcinosis) are described in the peripheral and visceral arteries, and similar but small-sized deposits in the coronary arteries of a 41 year old woman with diabetes mellitus. Although observed by roentgenogram fairly commonly during life in the muscular arteries of the legs in middle-aged men, medial calcinosis infrequently involves the visceral arteries and has never, to our knowledge, been documented in the coronary arteries. Although it may be associated with intimal atherosclerosis, medial calcinosis, per se, does not obstruct the lumens of the arteries and, therefore, does not lead to symptoms or signs of limb or organ ischemia. The cause of medial calcinosis remains a mystery, but it appears to affect people with diabetes more frequently than those without.


Severe aortic regurgitation secondary to idiopathic aortitis.

Clinical and morphologic features are described in two relatively young adults with aortic regurgitation secondary to chronic aortitis. The regurgitation in each was severe enough to require aortic valve replacement. Both patients had normochromic, normocytic anemia, considerable weight loss despite congestive cardiac failure, and negative serologic tests for syphilis. These systemic manifestations in association with the aortitis suggest that both had Takayasu's arteritis. In addition, one patient had total occlusion at the origin of one subclavian artery (classic pulseless disease). Takayasu's arteritis must be added to the list of causes of severe aortic regurgitation.


Fibrosing mediastinitis causing pulmonary arterial hypertension without pulmonary venous hypertension. Clinical and necropsy observations.

Clinical and morphologic observations are described in two patients with severe pulmonary arterial hypertension without pulmonary venous hypertension from fibrosing mediastinitis. In one patient, both main pulmonary arteries and one major pulmonary vein were severely narrowed by dense fibrous tissue; in the second patient, only the right main pulmonary artery was severely narrowed. Both patients had normal intrapulmonary arteries and normal pulmonary parenchyma. Of nine previously described necropsy patients with pulmonary hypertension due to fibrosing mediastinitis, seven had severe narrowing of multiple large pulmonary veins and in six of them the pulmonary hypertension was entirely due to pulmonary venous obstruction. In one other patient, the pulmonary hypertension was due to obstruction of one main pulmonary artery and several large pulmonary veins. Each of these seven previously described patients had severe changes in the small intrapulmonary arteries. Of the other two previously described patients with pulmonary hypertension from fibrosing mediastinitis, one had severe narrowing of only the main right pulmonary artery, and the other, of both main pulmonary arteries. Thus, although pulmonary arterial hypertension in patients with fibrosing mediastinitis is usually due to obstruction of multiple large pulmonary veins and to severe secondary changes in small intrapulmonary arteries, fibrosing mediastinitis can cause severe pulmonary hypertension by obstructing the right or both main pulmonary arteries.


Blood volume in pre-eclampsia: fantasy and reality.

A great deal has been stated recently about the importance of hypovolemia in pre-eclampsia and eclampsia from the point of view of pathogenesis and management. Some authors even believe that the so-called hypovolemia represents an etiologic factor and should be "corrected." In this paper, the hemodynamic factors that maintain the circulation in the normal nonpregnant and pregnant states are discussed. These factors are then used as a background for explaining the pathophysiologic abnormalities of the acute hypertensive disease of pregnancy. It is concluded that the slight decrease in blood volume observed in pre-eclampsia has no hemodynamic relevance; the blood volume is merely "fitting" a contracted vascular bed. The major abnormality resides in the constricted arteriolar system and not in the blood volume.


Vaginal adenosis and polycystic ovaries during infancy and childhood.

A histologic study of 40 postmoretem specimens of vagina, uterus, and ovaries obtained from fetuses, infants, and children revealed vaginal or ectocervical adenosis in eight cases (20.0%) and polycystic ovaries in 13 cases (32.5%). All cases of adenosis were associated with polycystic ovaries and moderate to marked theca luteinization. Five patients who had adenosis died of diseases of the central nervous system (CNS) such as cerebral injury and hydrocephalus. A total of seven of 13 cases or 53.8% with polycystic ovaries had CNS diseases. The possible roles of neurogenic and hormonal factors in the pathogenesis of these conditions are discussed.


Comparison of uterotrophic and vascular effects of estradiol-17beta and estriol in the mature organism.

Estradiol-17beta (E2) has been considered the most potent of the natural estrogens in terms of uterine growth and vasodilatation. As a result of studies of uterine growth in rodents, estriol (E3) has been considered an "impeded" estrogen. In this study, direct comparisons of the actions of E2 and E3 on the sheep uterus were made in nonpregnant, oophorectomized ewes by using bilateral uterine artery catheters and electromagnetic flow transducers. Intra-arterial injections of E2 or E3 had equal growth-promoting and vascular effects. There were slight but statistically significant differences in the time course of vasodilatation. Estriol induced a more prolonged dilatation than did estradiol.


Neurilemoma-like uterine myomas: an ultrastructural reaffirmation of their non-Schwannian nature.

Some uterine leiomyomas demonstrate a curious rhythmic pattern of cellular arrangement, suggesting the appearance of nerve sheath tumors. Leiomyomas of similar appearance are more frequently found in the gastrointestinal tract. Ultrastructural examination of two such tumors from the uterus, one simulating the Antoni type A pattern and the other predominantly of the Antoni type B pattern, showed features of smooth muscle cells to be present in both. There also was a close fine structural resemblance to light microscopically similar tumors of the gastrointestinal tract. This study should dispel the implications that these tumors are of Schwannian origin.