Postischemic cerebral blood flow and oxygen utilization rate in rats anesthetized with nitrous oxide or phenobarbital.

The present experiments were undertaken to measure postischemic regional cerebral blood flow (rCBF) and oxygen utilization rate (CMRo2) in rats anesthetized with either 70% N2O or phenobarbital (150 mg x kg-1). In previous studies we have found that extensive restitution of cerbral energy metabolites occurs after 30 min of complete cerebral ischemia irrespective of the type of anesthesia used. Following 30 min of pronounced, incomplete ischemia, however,  a comparable restitution of cerebral energy state was obtained in deeply anesthetized (phenobarbital 150 mg x kg-1) but not in superfically anesthetized (70% N2O) rats. The objectives of the present investigation were (1) to study whether postischemic cerebral blood flow was higher in barbiturate-anesthetized animals during the initial recirculation period, and (2) to investigate if the protective effects of phenobarbital previously observed could be attributed to a decrease in CMRo2. In both groups of animals a considerable variability in postischemic rCBF was observed between different animals. However, no signs of gross inhomogeneity in blood flow were found and no consistent differences in flow values between the two groups of animals were observed. Since the measured postischemic CMRo2 were identical in both groups of animals and since cerebral venous oxygen contents were above normal the results leave little support to the assumption that, in the present model of transient, incomplete cerebral ischemia, failure of recovery of cerebral metabolism (N2O group) is primarily due to impaired recirculation, nor do they indicate that the protective effects of barbiturates is due to their ability to reduce rate of cerebral energy utilization.


Cardiac receptors activated during the hypothalamic defence reaction.

The increases of arterial blood pressure, cardiac inotropy and venous return seen during the hypothalamic defence reaction are likely to lead to concomitant excitation of left ventricular receptors with nonmedullated afferents. The integrated efferent pattern of response resulting from the central interaction between the defence reaction and influences from the mentioned cardiac receptors was recently analyzed. These two, essentially opposing influences on the circulation were then seen to interact in such a way as to produce an optimal cardiovascular response with respect to increases in cardiac output and blood supply to the skeletal muscles. However, direct electrophysiological recordings from nonmedullated cardiac efferents during defence area stimulation have hitherto been lacking. The present experiments, performed on chloralose-anesthetized cats and utilizing electrophysiological recordings, clearly demonstrate that the left ventricular receptors are activated by the cardiovascular readjustments induced by the defence reaction. Defence area stimulation increased the activity of these receptors, which work within a very narrow, low frequency range, from 1.1 +/- 0.3 imp/s to 2.7 +/- 0.7  imp/s associated with rises in systolic blood pressure (afterload) and heart rate. Normally such a receptor activation would induce considerable bradycardia and sympathetic inhibition, but particularly the reflex bradycardia is centrally supressed by a concomitant defence area activation. The marked bradycardia  often seen immediately upon interruption of the defence area stimulation is, however, probably to a great extent initiated from the excited ventricular receptors.


Effects of low tissue temperature on peripheral vascular control mechanisms.

Influence of low temperatures on vascular effects produced adrenaline, noradrenaline and vasoconstrictor nerve stimulation was studied in the feet of ducks. Observations were made on isolated preparations as well  as on intact ducks with one or both feet immersed in ice-water. Isolated  preparations were perfused with physiological solution and information on changes in vascular resistance obtained by direct measurement of flow changes during perfusion at constant pressure or by measuring changes in perfusion pressure during perfusion at constant flow. In intact ducks changes in blood flow were recorded as changes in digital subcutaneous tissue temperature. The study revealed that in the duck  foot a relatively large fraction of the resistance to blood flow is found in the arteries of the proximal part of the foot. During cooling of the foot the influence of vasoconstrictor nerve stimulation and low doses of adrenaline and noradrenaline on vascular resistance is gradually lost, and it is negligible at temperatures below 8 degrees C. At these low temperatures the blood vessels stay dilated and blood flow through the web seems to be determined by the digital arterial blood pressure.


[Color agnosia: a brief review].

An introductory historical reminder situates the problem of color agnosia in the global frame of neuropsychological research and emphasizes the relevance of old questions. One examines later the description of agnosia, which indicates the polymorphic character of this trouble, its limits concerning linguistic and perceptual troubles, and the principal associated symptoms. The most important explanatory hypothesis are also studied, mainly according to the Italian school of Milan (conceptual and associative deficit) and the group of "La Salpétrière" in Paris (regression of past-acquisitions). The methodology then describes the most frequent means used in neuropsychology to analyze color agnosia. Finally, questions of anatomy and lesional localisation (left associative visual cortex) are also described.


Agranulocytosis in patients treated with clozapine. A study of the Finnish epidemic.

The occurrence of a sudden outbreak of agranulocytosis in Finland among patients being treated with clozapine led to intensive investigations in an attempt to find a local precipitating factor. Granulocytopenia after clozapine was found to have the same characteristics as that reported after phenothiazines. No local factor, either genetic or environmental, was found which could have been responsible for the increased frequency of occurrence in Finland. The need to be aware of the risk and to take appropriate precautionary measures (e.g. weekly leucocyte counts in the first months) is emphasized.


Twenty psychotic males with Klinefelter's syndrome.

Twenty males with Klinefelter's syndrome discharged from psychiatric hospitals with diagnoses classified as psychosis are presented. It is concluded that the higher frequency of psychoses in males with the Klinefelter syndrome most probably is due to reactive psychosis. Personality traits commonly found in these males may explain this. The importance of early diagnosis of the Klinefelter syndrome is stressed, as it is believed that treatment and advice in due time may prevent most of the reactive psychoses.


[Anxiety self-rating and myocardial infarction (author's transl)].

This study addresses to critical issues related to the role of anxiety in myocardial infarct. Is the predictive value of the Anxiety Scale Questionnaire (ASQ) to be found in content of items and its self-rating by the subject or in response style to the questionnaire? Would anxiety play in certain circumstances a positive role in that it drives the individual to seek early medical treatment? Differences in anxiety scores, response style indices and factorial structures of the ASQ items reveal :  1. myocardial infarction subjects have higher, but not significantly higher, anxiety scores relative to healthy volunteers to an atherosclerosis screening test and healthy control individuals matched for age, sex and socio-economic status, 2. healthy volunteers are characterized by extreme response style that could reveal their involvement in the testing situation; 3. control individuals show a tendency to intermediate response; 4. the lack of invariance of factorial structure across the three groups suggests that each of them has a specific organization of anxiety. Scale-checking style, though strongly associated with the content of items, could have a predictive value since, anxiety levels being equal, subjects may be differently involved in their answers. The assumption is supported by the specific organization of anxiety evidenced in each group considered. A relation between such organization and preventive behaviour is not infirmed by the present data and ought to be further analyzed.


Left coronary artery transit time in latent coronary heart disease.

In a group of 104 cases with possible silent coronary heart disease, 36 had normal angiographic findings and 68 significant coronary artery disease. The transit time of the contrast medium in the left coronary artery was significantly shorter in cases with abnormalities of the artery than in non-afflicted cases. The extent of arterial disease seemed to influence the transit time inversely, whereas the location of the abnormalities did not influence the transit time.


[Organisation of defence mechanisms in patients suffering from myocardial infarction (author's transl)].

This study was performed to determine the nature and organisation of specific defense mechanism in myocardial infarct patterns as compared to controls. It is also aimed at describing the organisation of these defenses and their relation to anxiety, depression and aggressivity. The samples consist in two populations of 112 male subjects with and without infarct and matched for age and socio-economic status. The EMO questionnaire of G.O. Baehr and M.E. Baehr and the COPE form from the FIRO scales of Schutz were used for psychological evaluation. The results show that the myocardial patients use more turning-against-self and that the other defence mechanisms do not discriminate between the subgroups. Furthermore, the scores for anxiety, depression, inferiority, hostility are similar in both groups. The patients state less sexual problems and use less fantasies than do normal controles. However, they use more somatic concern, but not significantly as compared to controls. This analysis was also concerned with the correlations between these defenses and affects. Furthermore, both subgroups were subdivided in three subsamples according to the score for turning-against self (high, median, low). Turning-against-self is associated with hostility in the patients while this mechanism is associated with a higher susceptibility to dayly events in normal subjects.


[Notes concerning two psychodrama treatments in a psychiatric institution (author's transl)].

After describing the introduction and evolution of two psychodrama treatment sessions in a psychiatric service, the author proposes an analysis of the processes underscoring the observed effects. On the one hand, the effects of the psychodrama game are indicated : elaboration of fantasies, projections and repetitions, emergence of identifications, analysis of transfert and effect of the comment. On the other hand, an indirect psychotherapeutic effect is demonstrated : modifications in institutional relationships seem to have been an important factor in the patients' course.


Blood flow in pulmonary and bronchial arteries in acute experimental pneumonia and pulmonary embolism.

Acute lobar pneumonia and pulmonary embolism were induced in rabbits and the blood flow in the pulmonary artery and bronchial arteries was determined using isotopic microspheres. In acute pneumonia the pulmonary artery flow to the involved lung was reduced 8.5 times and the bronchial artery flow was reduced 5.0 times compared to flow in the normal lung. In acute pulmonary embolism, both the pulmonary artery flow (2.3 times) and the bronchial artery flow (2.5 times) were also reduced. For all animals, the reduction in pulmonary artery flow paralleled the reduction in bronchial artery flow (r=0.65).


Comparison of cognition and performance in patients with organic brain damage and psychiatric patients.

A series of cognitive, memory and performance tests were administered to populations of control subjects, brain damaged patients and psychiatric cases. While the overall level of recognition, identification and memory was more impaired in brain damaged than in psychiatric patients, response latencies were found to be of higher significance in the differential diagnosis.


Vectorcardiographic changes at selective coronary angiography. Comparison of two contrast media.

Vectorcardiography revealed typical changes following routine selective coronary angiography using Urografin 60% and Isopaque Coronar; the response was dose-dependent. The two contrast media compare well with one another, no statistical difference being recorded, indicating that there is no difference in myocardial toxicity.


Body image boundary definiteness and psychopathology.

In an attempt to clarify the relation between body image boundary definiteness and psychopathology, the hypothesis that at each level of psychic adaptation groups with stronger and groups with weaker body image boundaries should be found, is examined. The hypothesis that hysterics as well as nonparanoid schizophrenics would have weaker, whereas obsessive compulsives and paranoid schizophrenics would have stronger body image boundaries receives only indirect empirical support. A short theoretical discussion is presented.


Comparison of the left ventricular volume using the Ahlkerg and Dodge methods.

Single plane cine left ventriculography was performed in 24 patients, 12 with normal and 12 with abnormal ventricular shapes. End diastolic and systolic volume and ejection fractions were calculated by two methods (Ahlberg and Dodge). The volumes and ejection fraction from either method were not significantly different. If calculated manually, the Ahlberg method took ten times longer than the Dodge method. At present some steps are difficult but a computer can perform the measurements and calculations, and print the results for ventricular areas.


Intra-arterial bolus of 125I labeled meglumine diatrizoate. Early extravascular distribution.

A mixture of 125I labeled meglumine diatrizoate and 131I labeled human serum albumin was injected into the lower abdominal aorta of 30 anesthetized, laparotomized male rats. Measurements of the activities in cardiac blood and in different tissues of the hindlimbs and tests were perfomed at six time intervals ranging from 5 seconds to 2 minutes after injection, the determine early uptake and distribution volumes of diatrizoate. Concentrations and distribution volumes were initially much greater than values obtained after intravenous injection, but these differences had considerably decreased or disappeared by 2 minutes.


Circulatory disturbances following transient soft tissue compression trauma.

Circulatory changes following standardized compression trauma to the hind leg in dogs were evaluated using an electromagnetic flow meter and repeated angiography. A transient increase of flow to the injured limb and within the traumatized region was observed. Good agreement was found between the electromagnetic flow recordings and estimates of relative changes in flow by the angiographic method.


Radiology and laryngoscopy for the diagnosis of laryngeal carcinoma.

A comparison is made of the radiologic and clinical findings in 51 patients with laryngeal carcinoma. The radiologic methods comprised conventional films, tomography and laryngography; the clinical examination technique included microlaryngoscopy and the use of a 90 degrees optical instrument. Laryngography was found to be superior to the other two radiologic methods, for the delineation of the tumors. Radiology should be performed before laryngoscopy and biopsy.


Precipitation of a cholegraphic contrast medium in a dog.

Following intravenous injection of medium for cholegraphy, calcium salt was precipitated in the tubules of rats and a 'gallstone' containing contrast medium developed in a dog. A review is given of biotransformation of contrast media in the biliary and urinary tracts.


Abnormal duodenal loop and pyloric regurgitation.

In a series of 48 patients with dyspepsia but without gastric ulcer it is shown that pyloric regurgitation occurred significantly more often in patients with distal and combined anomalies of the duodenum or a short loop than in patients with a normal duodenal loop. No difference existed between patients with proximal duodenal anomalies and the normal group. When pyloric regurgitation occurred in the erect position it could be prevented in the supine position and also to some extent by intravenous by intravenous administration of 20 mg metochlopramide.


Radiographic evaluation of rheumatoid arthritis and related conditions by standard reference films.

A review of radiographic evaluation of rheumatoid arthritis is given. Standard reference films are introduced for evaluation of rheumatoid arthritis and related conditions in the extremity joints. In this system, numerical evaluation of arthritis is given for individual joints in a patient.


Cortical index of the femoral neck.

The thickness of the medial cortex of the femoral neck does not decrease with age in the same way as other common parameters of bone mass. However, in women with fracture of the upper end of the femur, it is below normal. The variable, expressed as the cortical index of the femoral neck may have some use in predicting the risk of femoral neck fracture from routine films of the hip.


Studies on replacement and suppressive dosages of 1-thyroxine.

Serum thyrotropin (TSH) levels were studied in 55 hypothyroid patients in order to determine adequate replacement and suppression dosages of 1-thyroxine (T4). In accordance with previous reports it was found that most patients had normal TSH levels and were clinically euthyroid at daily doses of 0.10-0.15 mg T4. None of the patients required a dose exceeding 0.20 mg. When the TSH levels normalized, serum thyroxine and serum triiodothyronine also fell to levels within their normal ranges. The effectiveness of various doses of T4 in suppressing the temporary rise in serum TSH concentration normally induced by thyrotropin-releasing hormone was examined in 57 patients treated with T4 for atoxic goitre or after subtotal surgical removal of such a goitre. The rise in TSH was not usually inhibited by a T4 dose of less than 0.20 mg, a finding which at least theoretically has implications for the adequate suppressive dose of T4.


Idiopathic Hypoparathyroidism and Hyperthyroidism.

A case of idiopathic hypoparathyroidism is reported. The patient had presented symptoms for 16 years and various treatments and diagnoses had been tried before the correct conclusion was reached. Adequate treatment resulted in normalization of most of the symptoms. The patient also had hyperthyroidism, an exceptional combination. A possible relationship between the two diseases is discussed.


Total and subtotal colonoscopy with short instrument and without fluoroscopy.

The technique and results of 111 consecutive colonoscopies with a short colonoscope without the use of X-ray screening are reviewed. The caecum could be reached in 44 percent of the cases. No complications occurred. The great clinical value of the procedure is shown by the following findings:X-ray-negative lesions--including 2 cases of carcinoma--were found in 35 percent of the cases, radiologically demonstrated lesions could be defined more precisely in 18 percent, and the presence of colonic lesions could be ruled out in 11 percent in spite of equivocal X-ray findings. It is concluded that many more centres ought to take up the procedure, which offers the prospect of significantly reducing suffering and death from colonic disease.


Acute hepatitis: a prognostic study with observation time up to 37 years. A follow-up of the Iversen/Roholm liver biopsy material.

Re-evaluation of 890 consecutive liver biopsies from 1939-59 gave the diagnosis of acute hepatitis in 147 patients. A follow-up study of these patients was performed 15-37 years after the diagnostic biopsy, based on repeated liver biopsies, biochemical liver tests, autopsy reports and death certificates. Two patients died from acute liver failure, and development of cirrhosis was documented or strongly suspected in 22 patients (15 percent). A comparison between these 24 patients with a malignant course of hepatitis and 86 patients with a well documented uncomplicated disease, revealed a significantly larger number of women, a higher age, and more cases with piece-meal necrosis, confluent necrosis and marked portal inflammation in the intitial liver biopsy in the group with the poor prognosis.


Presymptomatic primary biliary cirrhosis.

Clinical, laboratory and follow-up results in 13 patients with primary biliary cirrhosis (PBC) collected during the last 10 years in a well defined population of 250,000 inhabitants are presented. The mean observation time was 5.5 years. 77 percent of these patients have been asymptomatic for many years. Characteristic laboratory features in asymptomatic patients are high alkaline phosphatases and glutamyl transpeptidases and very high levels of polyclonal IgM. ESR is often increased. Signs of active cell destruction are slight and functioning cell mass is well preserved. High titers of mitochondrial antibodies are consistently present. Needle biopsy is seldom sufficient for diagnosis but permits staging of the disease. There is no correlation between clinical features and histological evolution stage. Compared with a preceding 10-year period, the incidence of PBC has risen threefold. This increase can be fully explained by the extended use of laboratory facilities, resulting in the detection of asymptomatic patients.


Serum bile acids in man during vitamin C supplementation and restriction.

A daily dosage of 5 g ascorbate was given to 14 persons during one month. Various routine biochemical parameters were studied and the concentrations of individual bile acids in serum were determined. A significant increase in chenodeoxycholic acid concentration was found on interruption of vitamin C supplementation, whereas no other changes in bile acid concentrations were significant. One person, used to a large ascorbate intake (1 g/day), was deprived of ascorbate. On resuming the high ascorbate intake, serum bile acid concentrations showed an increasing trend. Urinary oxalate excretion and concentrations were impressively increased during vitamin C supplementation but no effects on kidney function were observed.


The liver in sarcoidosis.

Neddle biopsies of the liver were performed in 121 cases of sarcoidosis. Granulomas compatible with sarcoidosis were seen in 24 percent of the cases. Liver function tests (serum alkaline phosphatase, serum aspartate aminotransferase, serum alanine aminotransferase, and bromsulphthalein clearance test) were performed on 325 patients with sarcoidosis and on 132 with non-sarcoid erythema nodosum (EN). Pathological findings were seen especially in patients with extensive EN, without any correlation with the disease responsible for the eruption. Hepatic granulomas were found more often in patients with sarcoid changes in lung parenchyma than in those with bilateral hilar adenitis only. There were no other definite correlations between hepatic granulomas and other clinical and laboratory findings. The incidence of pathological results in this study was clearly lower than, e.g., in the USA, thus reflecting the good prognosis of sarcoidosis in the Scandinavian countries.


Cerebrospinal fluid sorbitol and myoinositol in diabetic polyneuropathy.

Changes in cerebrospinal fluid (CSF) concentrations of sorbitol and myoinositol in 21 patients with diabetic polyneuropathy were studied with gas-liquid chromatography. The sorbitol concentration was significantly increased in diabetic patients with elevated plasma glucose. Myoinositol concentration was significantly decreased in patients with polyneuropathy compared with the controls. Both alterations in polyol concentrations of the CSF were present already two months from onset of symptoms of diabetes. Patients with peripheral polyneuropathy receiving oral hypoglycemic drugs did not have elevated plasma glucose and CSF sorbitol levels, but showed significantly decreased CSF myoinositol concentrations compared with the controls. These observations suggest that myoinositol concentration may be decreased in the central nervous system in adult onset mild diabetes with normal plasma glucose and that the decrease in the myoinositol in CSF possibly is connected with the development of neuropathy.


Carnitine concentration in skeletal muscle tissue from patients with diabetes mellitus.

L-Carnitine concentration was determined in vastus lateralis and abdominal rectus muscle tissue from 15 patients with diabetes mellitus and 66 controls. Nine of the diabetics were treated with diet and hypoglycemic drugs only and six with insulin. The carnitine concentration was determined enzymatically with labeled [I-14C] acetyl-coenzyme-A as a substrate and given per weight of non-collagen protein. The concentration in muscle tissue did not differ significantly between patients and controls. Patients with insulin-treated diabetes had the same concentration of carnitine in muscle tissue as those treated with hypoglycemic drugs. The drastic decreases in carnitine muscle concentration and in carnitine body pool seen in alloxan-diabetic rats are not observed in skeletal muscle of diabetic humans.


Lactoferrin and lysozyme in arthritic exudates.

Lactoferrin (LF) has been assayed by radioimmunoassay in plasma and arthritic exudates and compared with lysozyme (LZ) levels and leukocyte counts. The mean LF concentration in 38 rheumatoid arthritis (RA) exudates was 9.1 mg/l (range 0.02-39.2). In 30 non-RA exudates LF was 3.3 mg/l (range 0.01-14.6). The corresponding LZ levels were 7.4 mg/l (range 2.5-18.5) in RA and 4.7 (range 1.0-12.5) in non-RA fluids. Exudate/plasma ratios were much higher for LF than for LZ and higher in RA than in non-RA exudates, whereas leukocyte counts did not differ. The LF/leukocyte count ratio was significantly higher in RA than in the non-RA group. The data suggest a more prominent release of neutrophilic granulocyte components in RA than in non-RA arthritis.


The value of thermography and the determination of fibrin-fibrinogen degradation products in the diagnosis of deep venous thrombosis.

Fifty-one patients with leg symptoms indicating deep venous thrombosis (DVT) were investigated concomitantly with thermography and phlebography. Altogether 26 legs with phlebographically proven DVT exhibited a thermographic picture typical of DVT. So, however, did 3 out of 25 legs with no DVT. A 94 percent agreement was found between phlebography and thermography when applied to legs with suspect DVT. The serum levels of fibrin-fibrinogen degradation products (FDP) were assayed in 58 patients attending hospital for suspect DVT. These patients were free from other diseases known to be followed by raised FDP levels. With borderline significance, the DVT group had higher FDP values. The usefulness of this laboratory test in the diagnosis of DVT is, however, questioned.


Electro-rentinal abnormalities in heterozygotes of renal-retinal dysplasia.

The relatives of two patients with medullary cystic disease associated with retinitis pigmentosa were studied. A new case was found in one of these families, and consanguinity of the parents was established in another. Conventional fundoscopic examination of relatives without renal disease did not show retinal abnormalities, but electro-ophthalmologic investigation demonstrated retinal dysfunction in three relatives, including two of the four parents who may be considered obligatory heterozygotes under the assumption of autosomal recessive inheritance of this syndrome. Less severe electro-ophthalmological abnormalities were observed in the other two parents. It is considered highly probable that all three patients are homozygous for a mutant gene causing both the renal and the retinal abnormalities. The results of this study support the view that medullary cystic disease associated with retinitis pigmentosa is transmitted as an autosomal recessive trait, in contrast to the dominant form, which is reported not to be associated with eye abnormalities. With respect to genetic couseling and donation of kidneys by relatives, it is important to establish the mode of inheritance of cystic medullary disease in a given family. Electro-ophthalmologic examination should therefore be included in the examination of families in which medullary cystic disease occurs.


Fluid turnover in renal cysts.

Cystic puncture was performed percutaneously in 18 patients with solitary renal cysts and in 22 with multiple, congenital renal cysts. With the aid of tritiated water it was possible to estimate the fluid turnover in the cysts and compare it with their volume, pressure and potassium and creatinine levels. Fluid turnover was rapid in all the renal cysts. Two to five hours after i.v. injection of tritium, the tritium concentration in cystic fluid averaged 88% of the concentration in plasma fluid in patients with polycystic kidneys and 73 percent in patients with solitary cysts. Fluid turnover was more rapid in small than in large cysts, but there was no such difference between cysts with high and low pressure. It is possible that the fluid turnover was slightly faster in cysts with high potassium and creatinine levels than in those with low levels. The results show that the fluid turnover in a renal cyst of 10 ml is considerable--probably more than 100 ml/24 hours. This indicates that fluid inflow to the cyst comes mainly from cells in the cyst wall and not from a single glomerule. Fluid probably leaves the cyst actively via cells in the cyst wall, since the fluid turnover does not increase with high cyst pressure. The fluid turnover is probably secondary to the active solute transportation, which is performed by the cyst cells. This means that these cells have a tubular cell-like function and should respond to pharmacotherapy.


Deleterious effects of cardiac pacing in a patient with mitral insufficiency.

A 70-year-old, artificially paced women with dizziness and extremely low physical capacity exhibited a systolic BP varying from one moment to another; in standing position it was not measurable. With the aid of a strain gauge technique, the amplitude of the pulse wave of her left thumb was recorded and shown to vary widely. The variations were correlated to synchrony or asynchrony between atrial and ventricular activity. Pronounced decreases in stroke volume and peripheral pulse volume were recorded with pacemaker-induced beats compared with idioventricular beats. With artifical stimulation at a rate of 45/min, thus avoiding competition but still protecting her from syncopes, she was free from symptoms.


Angina pectoris and myocardial infarction.

Angina pectoris was studied in a representative series of male patients (n = 504) with a first myocardial infarction (MI) surviving the hospital stay. The prevalence of questionnaire angina before MI was 28% and of effort-induced chest pain alone 40%. Of the patients with effort-induced chest pain, 72% retained symptoms also after MI. No correlation with age was found. Three months after and one year after infarction the prevalence of effort-induced chest pain was 55% and 45%, respectively. The patients with effort-induced chest pain before MI had a somewhat more severe clinical course and a significantly higher death rate (15% versus 6%) than those without chest pain.


Angina pectoris in young patients: clinical appraisal and evaluation by exercise, atrial pacing, and myocardial lactate metabolism.

Young patients with a symptom complex of angina pectoris constitute a problematic group in medicine. Many of them require a detailed investigation. By combining electrophysiologic and metabolic measurements with dynamic clinical experiments, one can distinguish with great probability between normal and pathological findings. Exercise ECG, atrial pacing and simultaneous sampling of blood from artery and coronary sinus were undertaken in 57 patients aged 40 or less. Although the patients were selected according to a history of effort angina, results were normal in four and in seven other only one test was pathological. The sensitivity was highest in atrial pacing (78%) and somewhat lower in exercise ECG (75%) and lactate extraction (67%). The specificity of the tests in series was about 53%. Concordant results made a diagnosis of ischemic heart disease highly probable. Discrepancies and probably false negative results in individual cases are evident. The need for angiographic evaluation of coronary arteries and left ventricular function is clear. The stepwise advance from the usual physical examination to more demanding investigations provides a possibility of classifying the patients according to the needs of an accurate medical appraisal.


Intravenous glucose tolerance test in middle-aged men with and without latent coronary heart disease.

During a cardiovascular survey, aimed at detecting cases of latent coronary heart disease (CHD), glucose elimination was studied after i.v. loading in 1970 presumably healthy men aged 40-59 years. The aim was to throw light on the importance of deranged glucose tolerance for the development of CHD. Of the 1970 individuals, 1798 were defined as "normals", 33 had chronic, non-anginal chest pain, 34 had slight albeit typical angina pectoris. The remaining 105 had various symptoms/signs strongly suggestive of CHD, and underwent diagnostic coronary angiography (69 angiopositive, 36 angionegative). Plasma insulin was determined in relation to the test in 249 of the subjects. The following conclusions were reached: 1) Mean k-values were similar in all subgroups (p less than 0.10). 2) Low and borderline k-values were significantly more frequent in angiographed individuals compared with the group of normals (p less than 0.025). However, an almost identical frequency was seen in angiopositive and angionegative cases. 3) K-values did not change with age between 40 and 59 years. 4) K-values were unrelated to the severity of angiographic findings in individuals with proven CHD. 5) Significantly lower k-values were found in individuals with a positive diabetic heredity, and 6) in individuals with a high insulin response. 7) The i.v. glucose loading did not influence an exercise ECG recorded in relation to a near-maximal bicycle exercise test.


Preliminary observations on interventricular septum vibrations: an echocardiographic sign in aortic valvular stenosis.

In previous experimental and clinical studies on aortic valvular stenosis it has been suggested that in addition to the degree of stenosis, other factors, such as the pathoanatomy of the valve and turbulence-induced vibrations, might be of importance. Using echocardiography, vibrations of the interventricular septum were demonstrated in six consecutive patients with congenital aortic stenosis. In comparable normal subjects no such vibrations could be seen. The clinical significance of ventricular wall vibrations has not yet been established.


The effects of four months' treatment with spironolactone on systemic blood pressure, cardiac output and plasma renin activity in hypertensive patients.

The effect of spironolactone on BP, cardiac output, plasma renin activity and urinary excretion of electrolytes has been studied in 12 hypertensive patients. After 1 month of spironolactone therapy there was a significant decrease in arterial BP. Urinary sodium excretion was significantly decreased and plasma renin activity increased. After four months of spironolactone therapy there was no further decrease in arterial BP. Cardiac output, heart rate and stroke volume were unchanged in the supine position, but the calculated total peripheral vascular resistance (TPVR) was reduced, indicating that the lower BP was mainly a result of dilatation of the resistance vessels. During exercise there was still a significant decrease in arterial BP but this was related to a decrease in both cardiac output and TPVR.


Effect of saluretic therapy on muscle content of water and electrolytes in relation to hemodynamic variables.

Muscle content of water and electrolytes (needle biopsy), intraarterial BP and cardiac output (dye dilution technique) were measured in 12 patients with essential hypertension before and after 4 months of mefruside therapy (25 mg/day). Before therapy there were no significant differences in muscle tissue electrolyte and water content compared with normotensive subjects. No correlation was found between central hemodynamic variables and the electrolyte and water content of muscle tissue either before or after therapy. After 4 months of mefruside therapy, muscle tissue water showed a mean decrease which was not significant. Serum potassium and muscle potassium content decreased significantly but there was no significant change in intracellular potassium concentration. Intracellular sodium concentration increased significantly, while muscle sodium content showed a mean increase which was not statistically significant. The change in intracellular sodium concentration showed a significant negative correlation with the decrease in mean arterial BP. The change in total cellular water content showed a significant negative correlation to the changes in total peripheral vascular resistance. Saluretic therapy seems to induce counterregulatory mechanisms that interfere with the hypotensive effect.


A human albumin of placental origin (albumin Rhodia) tested for tolerance.

Fifty infusions, each containing 125 ml 20% human albumin extracted from placental tissue, were tested in clinical practice. No effects such as changes in the patient's BP, pulse rate and rectal temperature were noted during the observation period, and no side-effects such as pain, dyspnoea, nasal symptoms, exanthema or thrombophlebitis, nor any other symptoms to suggest that the solution was not well tolerated.


Paroxysmal ventricular fibrillation in children. Long-term follow-up of three cases treated with beta-blocking agents.

A long-term follow-up report is given on three children with stress-induced bursts of ventricular activity, occasionally proceeding to ventricular fibrillation causing syncope. All patients were treated with a beta-blocking agent as prophylaxis for 12, 10 and 6 years, respectively. Case 1 has no signs of organic heart disease. She has been followed from the age of 8 years and had her last syncope in 1974. She was last seen in Nov. 1976, doing well at the age of 20. Case 2 started having syncopes after an attack of measles at the age of 8 years, at which time she probably acquired some damage to her myocardium. She had persistent bradycardia but no other signs of heart disease. She had an uneventful pregnancy and delivery in 1973 and gave birth to a normal child. She died suddenly in 1974, at the age of 22, four years after her last syncopal attack. Case 3 had cardiomyopathy with increasing heart size and exertional dyspnoea and marked ischaemic ECG changes during exercise. He was followed from the age of 7 years. He died suddenly in 1974 at the age of 16, four years after his last syncope.


Cardiomyopathy after chloroquine treatment.

A case of cardiomyopathy combined with vacuolar myopathy in the extremity muscles and irreversible retinopathy produced by chloroquine is described.


Details of the orbital connective tissue system in the adult.

The study of serial thick (60 mu) histological sections reveals a highly complicated but orderly constructed connective tissue system within the orbit. Between this system adipose tissue compartments are present built up in a comparable orderly fashion. In this intraorbital continuum, to which Tenon's capsule, the so-called check ligaments, the fascial sheaths of the muscles and the periorbital membrane belong, other different areas of characteristic connective tissue septa originating from the fascial sheaths of the eye muscles are recognizable. These different areas are linked to the presence of the different eye muscles and can be regarded as belonging to these eye muscles. That is why, in our opinion, this total of orbital connective tissue, together with the adipose tissue compartments lying in between, must be regarded as an additional mechanism playing an important role when eye movements are performed. The highly regular pattern and intra- and interindividual uniformity within this system will be clarified in the following paper, using models which specially highlight spatial architecture.


The effects of experimental unilateral anotia on skull development in the chick embryo. IV. Development of the bony skull in embryos of 9-20 days of incubation.

The study of the development of the bony skull in chick embryos with unilateral (right-sided) anotia revealed the following characteristics: 1. The perichondral bones initially follow exactly the cartilaginous structures to which they are related. Later, they may expand desmally to fill up the gaps and diminish the degree of pre-existing asymmetry. 2. The desmal bones which develop in close contact with cartilage, develop parallel to its margins and, hence, appear to be greatly dependent on the chondrocranium. 3. Among the desmal bones which arise independently from cartilage, only the bones of the cranial vault proved to be influenced by the unilaterally anotic condition.


The mutual relations of structures in the growing bill of chick (Gallus domesticus L.) and duck (Anas platyrhynchos L.) Embryos. IV. The size, shape, and position of the upper and lower bills in unilaterally microphthalmic duck embryos.

Unilaterally microphthalmic duck (DUM) embryos studied in stage 39 were obtained by damaging the right eye in stage 17. The development between stages 19 and 39 was observed in samples. After prolonged incubation, one duck hatched and reached adulthood. In DUM embryos partial crossbeak develops. Both the upper and lower bills deviate lateralwards, the upper bill more than the lower. In stage 39 a small orbit is present on the treated side. In stained and cleared heads most of the elements of the skull (the bones surrounding the orbit, the brain-case, and the upper and lower bill elements) are translated in the direction of the rudimentary orbit on the treated side. The bills are twisted around each other at the tip. Measurements of external dimensions as well as those made in stained and cleared stage-39 DUM heads show elongation of the left part of the lower bill. Except for the crossed bills, the changes found in the embryos persisted in the adult. The findings support a hypothesis concerning the mutual influence of bills during morphogenesis. The coherence of the functional cranial components in the embryo is discussed.


The study of recovery and modification of the evoked potentials and motor answers in the motor system.

After an electrical stimulus within the motor system there will follow a compulsion, a reflexlike process in functional dependency, naturally in illness (function disturbance) dependency as well. We can detect this process with the evoked potentials at the non-stimulated sites of the motor system and with the motor answers at the periphery. Because the motor system acts as a whole, it is certain that every process at a site has its correlates at the other sites, but the different part of the same process will be in a different grade pronounced (many times in opposite direction) at the different sites. If we want to know something from the basic process and to find the real correlates, we have to compare different evoked potentials within the motor system and motor responses at the periphery, or we have to enhance or depress the whole process or its parts. For the latter the double stimulation technique is suitable, but we have to take into consideration that during this investigation two alternating processes affect each other and therefore the result will not be direct.


Auditory evoked potentials recorded from chronic implanted gyrus of Heschl in man.

By means of implanted multileads electrodes, responses to clicks and prolonged sound stimulations were recorded from the Heschl gyrus of 2 human brains. These responses were strictly localized to this structure. Cortical averaged auditory evoked potentials (c.AEP) to clicks are consistent with scalp averaged auditory evoked potentials (s.AEP). So, Na Pa, Nb, P1, N1, waves have similar latencies and none of them in the s.AEP may be correlated with myogenic potentials (in opposition with the suggestions of Bickford et al. 1964 and Celesia et al. 1968). Increasing the duration of sound stimulation resulted in changes of the response. For a duration longer than 20ms, an "on-response" and an "off-response" were noted. No satisfying physiological explanation of these events is retained despite data obtained with monaural homo and heterolateral stimulations and with variation of tone of sound stimulation.


Intracranial pulse pressure dynamics in patients with intracranial hypertension.

The pulsative inflow of blood to the brain causes fluctuations in the cerebral blood volume, and this is considered to be the main cause of the pulsations of the intracranial pressure (ICP). This statement allows discrimination between two different factors that influence the pulse amplitude of the ICP: 1. The pulsatile pattern of the cerebral arterial blood flow. 2. The slope of the intracranial pressure-volume curve. In order to clarify the relative contributions of the two factors we have developed a simulation model of the intracranial pressure-volume curve and the cerebral blood flow. Measurements from clinical practice and data from other authors can be interpreted with reference to this model. The increase in the pulse amplitude due to a moderate increase in the ICP is mainly explained by the decrease of the intracranial compliance. However, it is recognized that, when the ICP approaches the arterial blood pressure, the ICP amplitude increases disproportionally with increasing ICP. In this situation the transmural pressure of the cerebral arteries approaches zero, and the compliance relevant to the arterial flow system is no longer that of the vessel wall but the compliance of the craniospinal compartment.


[Reticular activity and intracranial pressure. Acute and chronic intracranial hypertension (author's transl)].

Modifications of mesencephalic and bulbar reticular formation activity were studied with microelectrodes during acute and chronic intracranial hypertension. In both cases, the mesencephalic reticular activity increased progressively until a pressure level of 70 to 90 cm of CSF was reached and then fell irreversibly to less than the base value. The bulbar reticular activity followed the same pattern but more slowly. Different hypotheses are advanced to explain these modifications and their meanings.


The prognostic and therapeutic importance of changes in the CSF during the acute stage of brain injury.

This research deals with the gaseous and biochemical changes in the cerebrospinal fluid and their effects on the cerebral blood flow and metabolic rates in the acute stage of brain injury. The results have shown that the lactacidosis in the CSF is of importance for prognosis and therapy, because of its central position in the course of pathophysiological mechanisms after a traumatic brain injury. Thus the lactate concentration in the CSF does give early information about the further clinical course. CSF acidosis itself can be influenced in a favourable way by intrathecal therapy with sodium bicarbonate.


[Intracranial volume fluctuations. The importance of exact CSF-measurements in CSF-drainages (author's transl)].

The significance of simultaneous I.C.P. measurements together with exact C.S.F. volume measurements through the same ventricular catheter is emphasized. A new method using an electronic device is introduced. Volume fluctuations are shown as correlations of plateau waves. The fluctuating amount of C.S.F. (the probable equivalent of a plateau wave) ranges between 16 and 32 ml. Only with disturbed autoregulation is there a close correlation between the S.A.P. and the I.C.V. (intracranial volume) change. Simultaneous I.C.P. measurements up to a maximum pressure, determined by the level of the drainage system and corresponding to the primary brain dysfunction, together with electronic measurement of the drained C.S.F., seem to be ideal for the patient and for scientific purposes.


Extradural transducer for monitoring intracranial pressure.

In this paper we describe an epidural pressure-transducer which has been tested in over 200 patients. No complications were observed. The transducer has a very low drift and has virtually no temperature sensitivity.


Immediate visual deterioration after attempts at radical excision of pituitary adenomas.

Thirty cases of pituitary tumour have been operated on in the last five years by a transfrontal approach, using microsurgical technique. Three cases of postoperative blindness are described, with an analysis of possible contributory factors and causative mechanisms, prognosis, and measures to lessen the risk of this complication. The possibility of an impairment in the chiasma blood supply is discussed. Although the use of the microscope makes the removal of the so-called capsule an easier surgical task, it is recommended that this structure should be left undisturbed.


Giant cell tumours of the sellar region.

Six personal cases of giant cell tumours of the sellar region, as well as 19 cases collected from the literature are reported. Clinical findings are described, and the factors affecting the post-operative course are discussed. Radical excision of the growth and recurrence-free course were exceptional. As a general rule, biopsy and partial excision were performed. Progression of signs and symptoms was frequent in the follow-up.


Possible aetiopathogenetic correlation between primary empty sella and arachnoid cyst.

Three cases of surgically treated non-neoplastic diseases of the sella (two arachnoid cysts and one empty sella) are reported. All three patients had visual deficits but no gross endocrine disturbances. The study of these three clinical cases and an analysis of the relevant literature suggest a possible unitary hypothesis regarding the pathogenesis of sellar arachnoid cysts and empty sella.


An unusual case of chromophobe adenoma with conspicuous calcifications.

Abnormal calcification on skull films in the region of the sella turcica is not commonly found with chromophobe adenoma. A patient with such calcification in a verified chromophobe adenoma is presented. From the literature the incidence of calcification in these tumours is reviewed. The importance of considering a chromophobe adenoma in the differential diagnosis of parasellar calcification from the surgical point of view is mentioned.


[Intrasellar epidermoid cyst (author's transl)].

The authors present a case of epidermoid cyst in an unusual (intrasellar) situation and with untypical symptomatology (endocrine disorder without ophthalmological manifestations). The treatment was essentially surgical, and the patient's progress has been satisfactory.


Ectopic pinealoma. Report of a case and remarks on the treatment.

A case of ectopic pinealoma is reported. It presented with the clinical triad of visual disturbances of the chiasmatic type, diabetes insipidus, hypothalamic-hypophyseal impairment, and with enlargement of the sella turcica on roentgenographic examination. The patient is alive and well eight years after incomplete removal followed by radiation treatment. It is felt that this is the correct treatment for such lesions, rather than radiation treatment alone as apparently favoured in other reports. The diagnostic and therapeutic points supporting such an opinion are discussed.


Infra-optic course of anterior cerebral artery and low bifurcation of the internal carotid artery.

A description is given of a patient with bilateral visual field disturbances in whom chiasma exploration revealed an infra-optic anterior cerebral artery on the right. A short survey of analogous anomalies in the literature is presented.


Use of esterified retinol to trace the degradation of chylomicrons in cholesterol-fed rabbits.

Moderately hypercholesterolemic rabbits hydrolyzed chylomicron TG at the same rate as normal animals, but were found to accumulate partially degraded intestinal lipoproteins of Sf 100-400 and Sf 20-100. These results support the hypothesis that the hypercholesterolemia induced by cholesterol feeding results at least in part from an inability to clear chylomicron remnants in proportion to the rate of their formation.


The surgical repair of acute ventricular septal defect as a complication of myocardial infarction.

We advocate a classification of high and low ventricular septal defects following myocardial infarction. The natural history of the disease and the reasonable surgical results support an aggressive surgical approach in both types of septal perforation.


Mechanical assist in the treatment of impending or established myocardial infarction and cardiogenic shock.

In summary IABP is now a simple, well established technique which effectively supports patients undergoing acute myocardial ischaemia, to prepare them for coronary angiography and possible, subsequent surgery. Post-operative mechanical assist is also very satisfactory with IABP., but the membrane lung with its many advantages may prove to be much effective.


Studies of regression/progression of atherosclerosis in man.

1. Visual inspection and computer measurement of angiograms are highly correlated with direct examination of atherosclerosis in a specified vessel segment. 2. Computer assessment of an angiogram is highly correlated with cholesterol content of atherosclerosis in a specified vessel segment. 3. Serial change in human atherosclerosis can be measured by angiography. 4. Approximately 50% of men with premature atherosclerosis manifest by myocardial infarction between ages 40 and 49 will show progression in femoral atherosclerosis in one year. An equal number will have lesions which are apparently stable or show regression. 5. Small scale clinical trials employing atheroma regression/progression assessment by angiography are feasible.


The mode of calcification in atherosclerotic lesions.

In serveral arterial provinces, atherosclerosis and atherosclerotic calcifications are preceded by primary calcifications which develop in a seemingly unchanged arterial wall and often show regular gross patterns. In contrast, secondary calcifications which appear in the atherosclerotic lesions are irregularly distributed along the thickened atherosclerotic intima. At the predilection sites of atherosclerotic lesions, pronounced primary calcifications often precede the fatty streaking representing an independent pathological process. The deformation of the arterial wall resulting from calcific plaques may favor the activation of intimal mesenchyme and contribute to increased accumulation of lipid above and around calcific deposits. The exact nature of structural and biochemical changes which precede and result in primary and secondary arterial calcification still remains obscure.


National views: Australia.

The Austrialian scene in this area would seem to show the same features, and haze, as are found in many other countries. There is general recognition of atherosclerotic problems, of the common risk factors and of the need for prevention. Learned and informed bodies such as The Australian Academy of Science and The National Heart Foundation of Australia have made recommendations along  familiar lines, involving especially dietary changes, as preventive measures. The basis for these recommendations has been a general review of the subject and doses not include anything uniquely Australian. The admission of uncertainty about causes and prevention, awareness of controversy, confusion, ignorance and a natural reluctance to change habits no doubt contribute to popular disregard for the recommendations at the present time.


Specificity of delta 6 desaturase--effect of chain length and number of double bonds.

Rat liver microsomes contain a delta 6 desaturase that is active not only with the unsaturated acids of 18 carbons: oleic, linoleic and alpha-linolenic but also with similar acids of 20 carbons with the double bonds in delta 9, 12 and delta 12, 15. The rate of the reaction increases with the number of double bonds of the substrate but the acids of 20 carbons are less desaturated than the corresponding homologs of 18 carbons proving that the enzyme recognizes the number and position of double bonds as well as the chain length. The investigation of the inhibitory effect of different poly-unsaturated acids suggests that the acids would not only bind to the enzyme by means of the -CoA but also by other parts of the molecule different of the active center. The geometry of the molecule would be a substantial factor.


Regulation of acetaldehyde metabolism during ethanol oxidation in perfused rat liver.

Acetaldehyde (AcH) metabolism during ethanol oxidation has been studied in once-through perfused rat livers. The interest was focused upon the interrelations between the hepatic AcH concentration, AcH oxidation rate, ethanol metabolism, cytosolic and mitochondrial redox state, and aldehyde dehydrogenase (ALDH) activity. Correlational analyses between the possible regulative factors and regulated parameters were made and the following main conclusions drawn. The AcH concentration leaving the liver during the ethanol metabolism was regulated by both the ethanol and AcH oxidation rates, which in turn were regulated by the cytosolic redox state and the ALDH activity, respectively.


Alcohol metabolism at high alcohol concentrations.

The incorporation rate of tritium from (R,S)ethanol-1-3H, (R)ethanol-1-3H and (S)ethanol-1-3H in lactate and beta-hydroxybutyrate is investigated by means of a GLC method. Preliminary results show no decrease in incorporation of 3H from (R)ethanol during the period of labelling (15 min). These results indicate that either a shift in the isotope effect occurs at high concentrations of ethanol, or the results may indicate that ethanol does not exhibit a substrate inhibitory effect on alcohol dehydrogenase in the liver cells. Furthermore, the fraction of acetaldehyde metabolized in the cytosol is determined.


Ethanol metabolism, oxygen availability and alcohol induced liver damage.

The rates of ethanol oxidation in various species are linked to the rates of general metabolism, and more specifically that of O2 utilization by the liver. After chronic ethanol administration, increased oxidation of ethanol is accompanied by increased total hepatic O2 utilization, as studied in the whole animal, the perfused liver, and isolated liver slices. The correlation is particularly striking in the spontaneously hypertensive rat. This linkage makes the liver of the chronically ethanol-consuming rat abnormally vulnerable to hypoxic damage. Exposure to 5% oxygen atmosphere for 6 hours produced major elevations of SGOT and SOCT activities and marked centrilobular necrosis, in alcohol-treated animals but not in controls. The same differential susceptibility was found to acute anemia produced by bleeding. The possible relation of these findings to alcoholic liver damage in humans is discussed.


Alcohol: its effect on the kidney.

The effect of ethanol feeding on renal function, gross and microscopic morphology and constituent analysis was determined and compared to similar studies in isocalorically fed animals ingesting the same diet except that dextrimaltose was isocalorically substituted for ethanol. Alcohol-fed animals have significantly reduced renal function (p less than 0.01) and interstitial edema compared to their isocaloric controls. When renal mass and renal constituent analysis were normalized for body weight, alcohol-fed animals were found to have renal hypertrophy characterized by significantly increased absolute amounts of protein (p less than 0.01), fat (p less than 0.01) and water (p less than 0.01). All of these constituents increased in proportion to their percentage of total renal mass in control animals. In contrast, DNA content per kidney was similar for alcohol and isocalorically fed animals.


The effects of ethanol on dopamine metabolism in rat liver and brain.

Levels of dopamine metabolites are drastically altered in the presence of ethanol in liver slices, however no change in brain metabolism of dopamine is observed in a conscious animal which has been administered ethanol. Though THP can be formed in the cell during the metabolism of dopamine, increasing DOPAL levels does not cause an increase in THP formation. Thus if this compound is important in the overall alcohol problem more subtle ways of looking at its formation in individual synaptic regions will have to be developed in order to determine if ethanol will alter its level.


Slow wave sleep changes: alcohol tolerance and treatment implications.

Slow wave sleep abnormalities characterize the sleep of alcoholics. In this report, two questions are addressed: (1) Does the slow wave sleep loss in alcohol withdrawal relate to withdrawal treatment? (2) Do the slow wave sleep changes on and off alcohol relate to the clinical course of alcoholism? The first question was addressed by comparing recovery in sleep EEG and clinical measures following two types of alcohol withdrawal treatment. Eighteen subjects were randomly assigned to either a low dose ethanol or chlordiazepoxide treatment for alcohol withdrawal. The results indicate that chlordiazepoxide produces a marked synergism with alcohol withdrawal suppression of slow wave sleep. The second question was addressed by an experimental alcoholization study involving 9 subjects who drank for 5 consecutive days, with 18 ounces of 95 proof ethanol consumed daily. Changes in slow wave sleep from baseline (abstinent) values to those on alcohol showed faster rate of tolerance development for the low slow wave sleep subjects. The rate of tolerance development was significantly related to treatment outcome, with faster tolerance development associated with poorer treatment outcome. In this regard it is noted that the use of chlordiazepoxide in alcohol withdrawl needs to be reviewed for potentially prolonging tolerance ""carryover" and thereby being counterproductive for treatment outcome.


Synthesis and application of new bifunctional reagents.

Two new bifunctional reagents suited for the step-wise cross-linking of cysteine and lysine residues in proteins are described. Application to lactate dehydrogenase yields a cross-link between cysteine-165 and lysine-179, which suggests an alternative mechanism by which the "essential" cysteine reacts. For the mapping of the environment of a known and well defined amino acid the use of semireversible bifunctional reagents is suggested.


On the introduction of disulfide crosslinks into fibrous proteins and bovine serum albumin.

Hydroxyl groups in serine side chains of collagen, silk fibroin, and bovine serum albumin (BSA) were converted to SH by tosylation. In collagen film, 50% of the serine OH groups could be thiolated at most. In fibroin, only 13% because of its compact beta-pleated sheet structure and low susceptibility to swelling. The SH groups introduced are near enough together to form -S-S- bonds by oxidation. The residual SH content after oxidation was 0.1% in collagen and 0.03 to 0.25% in fibroin. Disulfide crosslinking increased the shrinkage temperature of collagen and fibroin and decreased the amount of shrinkage. BSA was crosslinked to dimers (MBSA) according to gel permeation chromatography and sedimentation analysis by the analytical centrifuge. Because these crosslinked proteins can be metabolized by the usual processes, in contrast to those crosslinked by artificial, nonphysiological bridges, they may be used for biological or medical purposes.


Thiolation and disulphide cross-linking of insulin to form macromolecules of potential therapeutic value.

Macromolecules have been prepared containing native insulin carried by a modified insulin skeleton made by partially thiolating the insulin hexamer and forming intermolecular cross-links through disulphide bridges. Oxidation of partially thiolated insulin (0.5-0.7 SH group/mole), formed by reacting insulin with AHTL, with, (a) potassium ferricyanide, (b) Cu++-oxygen gave water soluble macromolecules containing 20-26 and 410-708 monomer units respectively which had rod-random coil shape (light scattering). The larger molecules formed by (b) contained 8g-atom CU++/hexamer unit and insulin. The insulin was firmly bound within the marcomolecules and was probably bound within an insulin-modified insulin hexamer through coordination to copper.


The enzymic derivation of citrulline residues from arginine residues in situ during the biosynthesis of hair proteins that are cross-linked by isopeptide bonds.

An enzymic activity present in hair follicles is described that can convert arginine residues to citrulline residues in proteins in situ. The Ca2+ dependent enzyme activity has been detected in hair follicle extracts but not in similar extracts of serum, liver or brain. The enzyme appears to act on proteins other than hair proteins and the citrulline produced can be quantitated in acid hydrolysates by a colorimetric procedure. The formation of citrulline has been confirmed by amino acid analysis and does not  appear to be related to the formation of isopeptide linkages which is catalysed by the transamidase present in hair follicles.


Thermodynamics of cross links.

Comparison of the melting temperatures of native lysozyme and a cross-linked ester derivative of lysozyme (Imoto and Rupley, 1973) yielded a value of 5.5 kcal/mole for the free energy of stabilization developed through forming the cross link and a value of zero for the corresponding enthalpy. There is close agreement between experiment and calculation from the statistical theory of polymers.


Physical and chemical consequences of keratin crosslinking, with application to the determination of crosslink density.

The high levels of covalent disulfide crosslinking in keratins strongly affect (1) structural stability, (2) viscoelasticity, and (3) chemical reactivity. This paper briefly reviews recent work on these subjects, with critical emphasis on methods by which chemical and physical properties can be related to inter-and intra-molecular crosslink density in heterogeneous systems like keratins. Detailed attention is drawn to effects of crosslinking on the hydrolysis of keratin by acids or enzymes. Within the limits of reasonable assumptions, it is possible to account quantitatively for crosslink dependent variations in the hydrolysis rate of different keratins, and also to derive a formula for calculating the absolute intermolecular crosslink density from the amount of keratin dissolved after partial hydrolysis and the number of chain ends appearing in the soluble fraction.


Disulfide crosslinks and the specificity of protein turnover in plants.

Studies of the protein metabolism of detached tomato leaves, hormonally induced to accumulate proteinase inhibitors, have indicated that the state of oxidation of protein-bound half-cystine residues may be a principal parameter affecting in vivo and in vitro stability of leaf proteins. Induced leaves exhibited a general specificity of intracellular protein degradation directed towards the preferential hydrolysis of proteins having free-sulfhydryl residues. Proteins having disulfide cross-linkages, including the proteinase inhibitors, were markedly stable to in vivo degradation, and as a result, accumulated. These results provide a precedence for a cellular protein selection process, resulting from a directed specificity of intracellular protein degradation, which is focused on a particular protein structural parameter.


An x-ray diffraction study of thermally-induced structural changes in alpha-keratin.

A series of events takes place as wool is heated under vacuum from room temperature to 250 degrees C: Loosely and strongly bound water molecules are removed at temperature at and below 150 degrees C; a glass transition of the amorphous keratin occurs at 160-175 degrees C; helices melt at 215 and 235 degrees C. The structural changes take place between the glass transition and the helix melting temperature  are observed as reflected in the low-angle X-ray diffraction patterns: The 39 A meridional reflection is intensified; a 4-point diagram at azimuthal angle of 45 degree with spacing around 46 A appears; the intensity of the 33 A meridional reflection decreases, and the 66 A meridional reflection is the most heat-resistant.


Cross linking in the radiolysis of some enzymes and related proteins.

In non-covalently bound complexes of serveral serine proteases and of ribounclease with DNA the enzymes were protected against the effects of ionizing radiation. No scavenging by the nucleic acids was observed. Similarly, complexing trypsin with silica protected the enzyme from radiolytic destruction. Irradiation of solutions of serine proteases required about twice the D37 dose to produce about 10% polymerization: significantly lower relative doses were effective in causing polymerization in both lima bean protease inhibitor and in the octapeptidal hormone oxytocin. Several sulfhydryl enzymes which have been examined were very efficiently inactivated by ionizing radiation. There was, at the same time, apparent formation of novel intra-molecular -S-S- bonds.


Crosslinking of nucleic acids and proteins by bisulfite.

Sodium bisulfite is a food and beverage additive. It is also a salt of the urban air pollutant, sulfur dioxide. Bisulfite catalyzes, at neutral pH and physiological temperatures, the transamination reactions of cytosine derivatives with amines. The products of the reactions are N4-substituted cytosines. Both the alpha and epsilon-amino groups of L-lysine react with cytosine, and its nucleosides, in the presence of bisulfite. Bisulfite catalyzes the binding of cytosine to polylysine, lysine to polycytidylic acid, and polysine to polycytidylic acid. Polylysine crosslinks with heat-denatured, but not native, calf thymus DNA, in the presence of bisulfite. Other workers have demonstrated crosslinking of viral RNA with maturation and coat protein, after treatment of bacteriophage MS2 with bisulfite. Nucleic acid-protein crosslinking reactions may contribute to the adverse effects of sulfur dioxide and bisulfite upon health.


Mass spectra of cysteine derivates.

The mass spectra of a series of cysteine derivatives of structure X-CH2CH2SCH2CH(NH2)COOH were examined to assess the influence of the electron-withdrawing functional group X on the mass spectral fragmentation patterns. Measurable molecular ions were present in most of the spectra although in some cases such peaks had relative abundances below a few per cent. More useful information on the nature of the substituent could be obtained from the M - 74 peak corresponding to cleavage C2H4O2N at the sulfur atom. The results show that mass spectroscopy is valuable for identifying the S-alkyl side chain in S-alkyl cysteine derivatives, a process frequently required in studies on chemical modification of sulfhydryl groups andin determining disulfide bonds in proteins. The observed fragmentation patterns are discussed in terms of localization of positive charges of ionic species on either sulful, nitrogen, or heterocyclic rings and in terms of substituent effects on available decomposition pathways.


A nuclear magnetic double resonance study of N-beta-bis-(beta'-chloroethyl) phosphonylethyl-DL-phenylalanine.

Studies were carried out on the effect of decoupling, deuterium labeling, concentration, temperature, and solvent media on the NMR parameters of the vinyl phosphonate adduct of phenylalanine, C6H5CH2CH(COO-)NH2+CH2CH2PO(OCH2CH2C1)2. The results permit assignments of chemical shifts and coupling constants to the various protons of this molecule which contains unique structural features. The NH2+-CH2-protons are deshielded by more than 1 ppm than the CH2-PO-protons. The -OCH2-protons are nonequivalent exhibiting a fine split. Possible sources of the fine split include NH...O=P hydrogen bonding. The deuterium-labeling method should be applicable for synthesizing deuterium-and tritium-labeled crosslinked amino acids such as lysinoalanine and lanthionine and demonstrating analgous dehydroalanine-alpha-amino group-crosslinking.


Role of tumor antigen in vaccine protection in Marek's disease.

Chickens vaccinated with HVT developed lymphoproliferative lesions and a cell-mediated immune response to MATSA. These observations are considered in view of the overall mechanism of vaccine protection in MD. A mechanism of vaccine action is proposed that suggests that MATSA immunity in vaccinated chickens may play an important role in protection.


[Morphometric Investigations of Regularly Descended Testicles of Children (author's transl)].

On 89 regularly descended, autoptically obtained testicles, the following morphometric investigations were performed: Calculations  of the volums, the mean diameter of the tubuli seminiferi, the total lenght of the tubuli, the mean content of spermatogonia per cross section of one tubulus seminiferus, and the total number of spermatogonia. The testicles evaluated have been obtained from children at the age of one day to fourteen years. The calculation of normal values of quantitatively assessed testicle structures are of fundamental importance for the estimation of the morphological significance of congenitally dystopic testicles.


[Results of mass-longitudinal screening in Görlitz. 1. Morbidity of important infectious diseases].

The Authors inform about the degree of infection in children, which are born in Görlitz in 1957 to 1959. This study aimed at finding out, which infections still called "Classical children's diseases" should be particularly considered in childhood at present. The possibilitiy of vaccination against mumps and rubeolae in the GDR is discussed.


[On psycho-diagnostic of practical technical ability in juveniles (author's transl)].

230 juveniles were examined by means of the  box of constructional blocks-in conformity with Huth -, and the results were analysed statistically in regard of sex, age, school year, and school certificates. Concerning  working speed and the marks for technical conception, there is a significant  difference between girls and boys. On an average, boys achieved better results than girls. These results of the performance variables have mainly been influenced by the school year that the juvenile attended at the date of these tests. Irrespectively of their sex, applicants for vocational training who had attended 10 forms achieved significantly better results than pupils of the 9th form. The test is useful for examinations concerning the aptitude-diagnostic.


[The jimpy mouse].

Ultrastructural study of the Jimpy mice shows lack of myelin in the central nervous system: low density of glial cells, defect of maturation of oligodendrocytes and deficiency in axonal growth. The lack of myelin is more proeminent in late myelinating structures: corpus callosum and corticospinal fasciculus. Failure in myelin is rather the consequence of an early interruption of myelination as that of demyelination (a destruction of the sheats).


Peripheral nerve blocks.

Infiltration of local anesthetic agents to achieve analgesia for the repair of lacerations or the excision of large lesions requires multiple injections, uses large volumes of local anesthetic solution and frequently produces inadequate pain relief. Peripheral nerve blocks utilize a small number of precisely placed injections to anesthetize relatively large areas of the body. Many of these blocks are safe and easy to perform in an outpatient setting.


An update on reactive hypoglycemia.

Reactive hypoglycemia usually occurs in response to a carbohydrate load, rather than presenting as fasting hypoglycemia. The clinical picture may be that of excess circulating epinephrine or decreased cerebral cortical function. The principal causes are alimentary, "functional" (a debatable diagnosis) or early diabetes mellitus. The diagnosis is confirmed by simultaneous serum insulin and blood glucose levels and a five-hour oral glucose tolerance test. Simple management regimens are tailored to each type of hypoglycemia.


The mental status examination.

The mental status examination evaluates appearance and behavior, attitude, perception, orientation, judgment, cognition, abstraction and insight. It can be administered quickly and repetitively. This examination provides information to distinguish organic from "functional" illnesses and also provides objective data regarding the patient's improving or deteriorating sensorium. It helps substantiate clinical decisions on competance, potential for danger and hospitalization.


Thermoregulation of the newborn.

The classic modes of heat loss affecting the newborn are conduction, convection, radiation and evaporation. The disproportionate ratio of surface area to body weight (SA/BW) of the premature infant is the basis of inefficient heat conservation, combined with a blunted metabolic response. Hypothermia leads to hypoxemia, acidosis, hypoglycemia, kernicterus and other lethal complications. Mistakes are common. Attention to minute details is required for stabilization of body temperature at the "neutral temperature zone" in delivery room, nursery and in transport.


Outpatient management of minor burns.

The overwhelming majority of burns are minor and can be treated on an ambulatory basis if hospitalization is not indicated. Recommended are topical antimicrobial agents in the acute phase and pressure garments after wound healing. Sound principles of burn wound management determine the ultimate outcome of treatment, the degree of function and the cosmetic appearance of the healed wound.


Intrauterine contraception.

Newer medicated IUDs, such as the copper or progesterone-releasing devices, are more effective, better tolerated and have fewer side effects than nonmedicated IUDs. Major complications are rare if adequate precautions are taken. The IUD is an ideal contraceptive for patients with contraindications to oral contraception and for those who have difficulty remembering to utilize other methods.


Propranolol in mitral stenosis during sinus rhythm.

Patients with early symptomatic mitral stenosis usually suffer from pulmonary congestion on the basis of left atrial and pulmonary venous hypertension. They are often in sinus rhythm, and cardiac output is usually well maintained. Symptoms occur most often when heart rate, cardiac output, or both are increased. In this study, intravenous propranolol administered to patients with pure mitral stenosis in sinus rhythm resulted in significant reductions in mitral diastolic gradient (-7.1 mm. Hg +/- 1.6 SED), mean pulmonary wedge pressure (--6.9 mm. Hg +/- 1.2) and mean pulmonary artery pressures (--9.0 mm. Hg +/- 1.2). This was due to simultaneous reduction of heart rate (--13.0 beats/minute +/- 2.6 and cardiac output (--0.5 L./minute +/- 0.2). A small associated reduction of left ventricular systolic pressure (--5.1 mm. Hg +/- 2.6) was not accompanied by adverse clinical effects. A potential role for propranolol in medical management of pure mitral stenosis in the presence of sinus rhythm is suggested.


Conal anatomy in aortic atresia, ventricular septal defect, and normally developed left ventricle.

Although aortic valve atresia is usually associated with severe underdevelopment of the mitral apparatus and left ventricle in rare cases of aortic atresia, the left ventricle may be of normal size, or even enlarged. This occurrence seems related to the presence of a significant ventricular septal defect. We have presented the morphologic findings in seven patients with aortic atresia and normally developed left ventricle, (six necropsied patients, and one studied angiocardiographically). Four autopsied patients had conal type ventricular septal defects, characterized in three by conoventricular malalignment. Subaortic atresia in these patients resulted from leftward deviation of the conal septum. One patient with aortic atresia and well-developed left ventricle had a membranous defect, and one patient had a complete A-V canal. The ventricular septal defect in the patients with conoventricular malalignment are very similar to the conal VSD observed in patients with aortic arch interruptions. Although ultimate survival with these uncommon groupings of anomalies necessitates patency of the ductus arteriosus, clinical recognition rests on (1) awareness of its existence, (2) ultrasonography, and (3) selective biventricular and aortic angiography. It is possible that some of these patients might be candidates for ventriculo-aortic reconstitiution.


The length of the left main coronary artery: pathological features.

The mean length of the LCA found by pathological (or angiographic) methods is fairly constant. This exclusively anatomical study shows no significant relationship between the length of the LCA and stenotic atherosclerosis in the LCA or the heart weight or a dominant left circumflex coronary artery or a complete His left bundle-branch block.


Effect of lidocaine on the atrial fibrillation threshold.

The effect of lidocaine on the atrial fibrillation threshold (AFT) and the ventricular fibrillation threshold (VFT) was studied in anesthetized dogs. In ten animals, injection of lidocaine 2 mg./Kg. intravenously resulted in a markded increase of the ventricular fibrillation threshold (from 11.0 +/- 1.5 to 33.3 +/- 6.2 mA., P less than 0.001). In another group of ten animals, lidocaine did not have consistent effect on the atrial fibrillation threshold. However, a dose of lidocaine of 3 mg./Kg intravenously produced a significant increase in AFT (from 14.0 +/- 0.56 to 41.1 +/- 0.32 mA., P less than 0.001). No changes in AFT or VFT were noted in control experiments. The data suggest that lidocaine possesses an antiarrhythmic effect on the atria but higher than usual doses are required.


Management of the patient with renovascular hypertension.

Renal artery stenosis, either fibromuscular or atheromatous, is probably the most common cause of secondary hypertension in man. Both of these diseases are active, ongoing processes that may be ameliorated but not cured by medical or surgical treatment. The clinical history and examination of the patient with hypertension may help differentiate renovascular hypertension from essential hypertension. The presence of a systolic-diastolic or continuous bruit is often an indicator of severe renal artery stenosis. Systemic hypertension is the physiologic consequence of significant renal artery stenosis. Knowledge of the basic concepts of the renin-angiotensin-aldosterone system, as has evolved from experimental models of renovascular hypertension, forms the basis for understanding the process of evaluation and treatment of such patients. The treatment of choice for the patient with severe hypertension and a functionally significant renovascular lesion is surgical--both in terms of successful treatment of hypertension and improved long-term prognosis. Diligent periodic reevaluation of these patients as well as those with less severe hypertension who are receiving medical treatment enables the physician to select the proper management that offers optimal control of patient blood pressure and avoids target-organ damage to the kidneys, central nervous system, or cardiovascular system.


Survey of need for industrial hygienists.

Grass roots surveys of the need for industrial hygienists, areas of specialization, and related subjects can fill a real void in currently available information. AIHA local sections and other professional groups may wish to conduct regional studies similar to the one described here. A pooling of results by reporting to their national organizations would be beneficial to all in the profession.


Experience with a high output sulfuric acid aerosol generator.

Experience with a high output sulfuric acid aerosol generator suitable for large chamber exposure studies is described. Sulfuric acid aerosol is produced by combining sulfur trioxide (SO3)(g) vapor with water vapor in the exposure chamber air supply. The mass output of the generator is stable over long periods, and the mass median aerodynamic diameter of the aerosol produced is in the submicron size range (0.3-0.6 micrometer).


Respirator cartridge service lives for exposure to vinyl chloride.

Respirator cartridge service lives (1 ppm breakthrough) were determined for low level (approximately 10 ppm) exposures to vinyl chloride using simple apparatus and an infrared spectrophotometer. Two classes of organic vapor cartridges were tested; six brands which received approval from MESA-NIOSH before July 15, 1975 ahd two brands which were not approved but were available through local safety supply outlets on that date. Cartidges were tested both as they came from the supplier and after being preconditioned for 6 hours. Effects of insult concentration, preconditioning, and absorbent weight were investigated. No cartridge service life exceeded 1 hour; many did not provide protection for even 30 minutes. As a result, the use of cartridge containing half mask respirators for vinyl chloride exposure should be questioned.


Comparison of recommended respirable mass dust sampling devices.

The draft, "Revised Guide for Respirable Mass Sampling," prepared by the AIHA-ACGIH Aerosol Hazards Committee, recommends five respirable mass sampling devices that sample in accordance with the "Los Alamos" respirable dust criterion. The spectrum of recommended sampling rates for these devices ranges from 1.8 to 430. liters per minute. A study was conducted to determine if simultaneous measurements with these devices yielded comparable respirable mass concentrations. The penetration characteristics of the first stage separators were also evaluated and compared.


Odor detection and respirator cartridge replacement.

If the odor threshold of a compound is greater than its TLV, overexposure of a respirator user is possible since breakthrough may not be detected. Odor threshold data are assembled for a number of different materials and compared to their TLV's. Use practices are recommended for chemical cartidge respirators for various grouping of compounds, based on their odor threshold to TLV ratio.


Collaborative testing of a gas chromatographic charcoal tube method for seven organic solvents.

The National Institute for Occupational Safety and Health has undertaken a program to provide reliable sampling and analytical methods for a number of industrial hygiene uses. Recommendation of methods to the Department of Labor for compliance testing and inclusion of methods in critera for Recommended Standards for Occupational Exposures are two prime areas of utilization. This paper presents the results of our initial efforts in collaborative testing. The method is a charcal tube sampling procedure and a gas chromatographic analytical technique. Samples of seven single component solvents which included benzene, carbon tetrachloride, chloroform, dioxane, ethylene dichloride, trichloroethylene, and xylene along with two solvent mixtures which consisted of a benzene-xylene combination and an ethylene dichloride-trichloroethylene conbination were tested in two phases by 15 participating laboratories. The data analysis indicates the overalll error associated with the method and identifies sources of error within each segment of the method.


Trace metal contamination of evacuated blood collection tubes.

A study was undertaken to investigate the magnitude of potential trace metal contamination contributed by various commercial evacuated blood tubes to blood samples under experimental conditions. None of the tubes tested contributed significant Cu contamination whereas the 1% nitric acid and human blood leaching data clearly indicate that Zn, Pb and Cd contamination of blood samples can be a significant problem with certain blood collection tubes under normal handling, shipping and storage conditions. The implications of these experimental findings are discussed. It is recommended that several of the evacuated blood tubes be leach tested prior to use with blood or plasma and the eluate analyzed for potential trace metal contamination problems.


Electrophysiologic effects of anterior septal arterial occlusion.

The effect of reduction in anterior septal arterial flow on the conduction system was studied in seven anesthetized dogs. After 2 hours of occlusion P-Q, A-H, and H-V intervals as well as atrioventricular nodal effective and functional refractory periods were significantly prolonged, sinoatrial conduction time was prolonged and the heart rate was decreased. The duration of the His bundle electrogram was significantly prolonged and the configuration altered. However, QRS duration did not prolong significantly. Fifteen minutes after reperfusion, A-H interval, duration of the His bundle electrogram, effective refractory period and functional refractory period returned toward control values. However, the H-V and QRS intervals as well as sinoatrial conduction time were unchanged after reperfusion. Thus, reduction of anterior septal arterial flow influences not only the distal but also the proximal portion of the conduction system; the most vulnerable part is probably the His bundle. The distal portion of the conduction system is directly influenced by ischemia itself, whereas the proximal portion is influenced through other mechanisms induced by reduction of anterior septal arterial flow.


End-systolic pressure/volume ratio: a new index of ventricular contractility.

A thesis recently developed from a series of experiments on the isolated canine left ventricle is described. It is claimed that the ventricular presure/volume ratio at end-systole is relatively insensitive to cardiac loading and varies greatly in response to changes in ventricular contractility. The clinical viability of this basic finding rests on the substitution of diameter for volume in this formulation. Diameter can be measured using a noninvasive ultrasonic technique in the clinic. Accordingly, end-systolic pressure/diameter ratio was studied in the isolated preparation and found to be similarly insensitive to loading conditions and sensitive to inotropic interventions. A further analysis of the pressure/diameter ratio in the ventricle of the conscious dog is in progress. In parallel with these studies, use of the pressure/diameter ratio to evaluate contractility in cardiac patients is being tested. The preliminary findings from conscious dogs and clinic patients are briefly discussed.


Echocardiographic assessment of the relation between left ventricular wall and cavity dimensions and peak systolic pressure in children with aortic stenosis.

Echocardiographic measurements of the left ventricular end diastolic minor axis and posterior and septal wall thickness were obtained in 19 children with congenital aortic stenosis with left ventricular peak systolic pressures ranging from 110 to 225 mm Hg at cardiac catheterization. From these measurements were derived (1) the left ventricular peak circumferential wall stress, (2)the end-diastolic h/r ratio (that is, mean of septal and posterior wall thickness (h) to minor semiaxis (r) ratio), and (3) the LVM/LVV ratio (that is, left ventricular mass (LVM) to left ventricular end-diastolic volume (LVV) ratio). The peak stress was found to be within the normal range and independent of the left ventricular peak systolic pressure. The end-diastolic h/r and LVM/LVV ratios had highly significant linear relations to the left ventricular peak systolic pressure. It is concluded that these easily determined echocardiographic measurements provide a useful noninvasive means of assessing left ventricular peak systolic pressure in patients with aortic stenosis without myocardial decompensation.


Development of the pulmonary circulation in ventricular septal defect: a quantitative structural study.

The application of quantitative morphometric techniques to evaluation of the lungs of nine children who died with a ventricular septal defect between the ages of 3 months and 4 years showed that the presence of pulmonary hypertension interferes with the growth and development of the pulmonary circulation. In all cases the preacinar arteries were of normal size and not dilated, and arterial size and number within the acinus were reduced and similar to those seen in the normal child at birth. Arterial and venous muscularity was increased as judged by an increase in wall thickness and by the presence of muscle in smaller and more peripheral arteries than is normal. Elevation of resistance was associated with failure of the intraacinar pulmonary circulation to develop normally rather than to obliterative pulmonary vascular disease. In view of the rapidity with which impairment of growth and elevation of resistance can develop, closure of a large defect is recommended before age 2 years.


Echocardiographic findings in severe paradoxical pulse due to pulmonary embolization.

A 47 year old man with acute pulmonary embolism had severe pulsus paradoxicus in the absence of pericardial disease. Echocardiography demonstrated inspiratory failure of the aortic valve to open, a decreases in left ventricular cavity size and a decrease in mitral valve diastolic excursion.


Pacemaker-induced endocardial friction rub.

Two patients had a typical sounding cardiac friction rub after placement of a temporary transvenous pacemaker. Absence of myocardial perforation was documented in one patient during thoracotomy for placement of an epicardial electrode and in the other with an electrogram recorded from the pacemaker as it was being withdrawn. The rubs disappeared during pacemaker removal. These cases are believed to represent endocardial friction rubs resulting from contact of the pacing wire with the endocardium.


Traumatic right coronary artery-right ventricular fistula with retained intramyocardial bullet.

A case of traumatic right coronary artery-right ventricular fistula secondary to a gunshot wound is presented. In addition, the bullet was retained within the interventricular septum. The diagnostic approach, surgical findings and operative procedure of this and other reported cases are discussed. Several key points are emphasized. First, extended follow-up is necessary after trauma to the heart since fistulas may develop years after the initial injury. Second, surgery is generally indicated for fistulas although some data are presented suggesting that small to moderate fistulas may be treated medically. Third, if surgery is undertaken, very careful operative technique must be utilized to locate and close the fistula. Surgical treatment of choice may be coronary arterial ligation with a distal bypass graft if necessary. Postoperative evaluation is mandatory because fistulas may recur. Indications for removal of a foreign body within the myocardium are also discussed.


Pheochromocytoma of the urinary bladder: a broad clinical spectrum.

A case of pheochromocytoma of the urinary bladder is reported, and 35 perviously reported cases are analyzed. This interesting entity can present with symptoms of catecholamine excess and severe hypertensive spells (often micturition-induced) or as asymptomatic hematuria without hypertension. The present case represents the severest end of the clinical spectrum, with advancing acute retinopathy and visual loss, very high blood pressure and greatly increased catecholamine excretion. Several special precautions were utilized during diagnostic studies and surgery. On the whole, prognosis is excellent in nonmalignant cases properly handled, and the location of the tumor provides opportunity for early case finding and complete cure.


Rupture of the papillary muscle of the tricuspid valve. A complication of cardiopulmonary resuscitation and a rare cause of tricuspid insufficiency.

Rupture of a papillary muscle is a rare occurrence. Two patients are described in whom rupture of a papillary muscle of the tricuspid valve developed after external cardiac massage during cardiopulmonary resuscitation. One of these patients survived briefly with clinical evidence of triscupid regurgitation immediately after resuscitation. Although tricuspid valve papillary muscle rupture has been described as a complication of bacterial endocarditis, chest trauma and myocardial infarction, it is a generally unrecognized complication of external cardia massage. Findings in the two patients reported here suggest that patients with a dilated right ventricle may be more susceptible to this rare complication of cardiopulmonary resuscitation.


A study of light and scanning electron microscopy of the lining epithelium of the guinea pig bladder following artificial ulceration.

Following artificial ulceration of the guinea pig bladder epithelium, study by light microscopy showed that mitotic activity occurs within 24 hours in the basal layer of the remaining epithelium; which leads to thickening, disorganization and cell shedding. At the ulcer margin, the epithelium forms a rolled edge, from the extremity of which a two-layered sheet of flat cells grows over the edematous ulcer bed, and the ulcer site is protected during dilation of the bladder by localized muscle spasm. Healing is effected within about one week, as the mitotic activity declines. Organization of the new epithelium commences at the periphery and the cells acquire glycogen and alkaline phosphatase. Study by SEM, which included normal bladders, confirmed that new epithelium spreads from a rolled epithelial edge, and also showed that cells undergoing rejection have globular profiles with surface microvilli. The immature epithelial cells are markedly distorted from mutual pressure during migration and their surfaces show only short microvilli. Ulcers heal after four to seven days, depending on size, and the new cells rapidly assume the pentagonal and hexagonal outlines and the reticular pattern of surface ridges, characteristic of mature surface cells. The ridges apparently develop by fusion of rows of microvilli. By the tenth day it is difficult to identify the original ulcer site.