[Effect of long-term space flight on protein biosynthesis in different rat tissues and organs].

Protein synthesis in the heart, lungs, liver, pancreas, thymus, kidneys, skeletal muscles and testes of the 22-day Cosmos-605 flight and synchronous rats was studied with the aif of 14C-amino acid incorporation. On the 2nd postflight day both flight and synchronous rats showed an increased synthesis of heart sarcoplasmatic proteins. On the 26th postflight day the rate of incorporation was normal. On the 2nd and 26th days the synthesis of myofibrillar proteins in the m. quadriceps femoris was inhibited in flight animals postflight day the rate of incorporation was normal. On the 2nd and 26th days the syn-only. On the 2nd and 26th days the liver of the flight and synchronous rats showed qualitatively similar changes in protein metabolism of subcellular structures. No changes in the protein synthesis of other organs tested were detected.


[Clinico-biochemical aspects of human adaptation in central Antarctica as applied to the problems of space biology and medicine].

The paper presents the results of clinical, physiological and biochemical examination of 27 polar explorer--members of the 17th Soviet Antartic Expedition at the Vostok station. It gives data on the morbidity rate and describes the development of the asthenic-neurotic syndrome. On the basis of studies of catecholamines and serotonin, the role of the sympatho-adrenal system in the human adaptation to the harsh environments of the Central Antarctica has been shown.


[Effect of a constant magnetic field of ultra-high intensity on the morphologic composition of peripheral blood].

An exposure of mice to a constant magnetic field (CMF) of 9.9, 25.4 and 39.4 kersted produced changes in the leucocyte and reticulocyte counts and caused no changes in the red blood cell count and hemoglobin. The changes noted during and after the exposure were of a cyclic pattern. During a 24-hour exposure of animals to a CMF of 39.4 kersted a short-term increase in the reticulocyte and leucocyte counts and a concomitant decrease of the neutrophil and lymphocyte counts were noted. Afterwards the reticulocyte count decreased and increased again by the end of the exposure. Following a 3-hour exposure to CMFs of the above intensities the changes persisted for 20-35 days. Normally the parameters increased during the 1-2 days of the exposure and decreased thereafter. The level of changes was not correlated with the CMF intensity. The increase in the reticulocyte count during and exposure to a CMF of 39.4 kersted was identical to that during an exposure to a CMF of I kersted.


[Cytochemical study of proteins and RNA in individual spinal cord motor neurons and intervertebral ganglion neurons of rats following space flight].

By the methods of quantitative cytochemistry the content of RNA cytoplasmatic protein was measured in motoneurons of anterior horns of the spinal cord and neurons of spinal ganglia of rats after their 22-day space flight. The exposure did not alter the content of RNA in motoneurons of the anterior horns of the spinal cord and reduced the value in large neurons of spinal ganglia. The flight diminished significantly the protein content in the cytoplasm of motoneurons and neurons of spinal ganglia as compared with the preflight level. On the 27th postflight day the RNA content in motoneurons of the anterior horns of the spinal cord increased and that in neurons of spinal ganglia did not differ from the preflight level. On the 27th postflight day the protein content in the cytoplasm of motoneurons returned to the preflight level and remained decreased in the cytoplasms of large neurons of spinal ganglia.


[Cataractogenic effect of protons with energies of 25 and 50 MeV].

The frequency of cataract formation in mice was studied during their exposure to protons of 25 and meV and X-rays of 200 kV at doses of 100-600 rad. The frequency of cataract formation was a function of the irradiation dose and postirradiation time. The frequency of occurrence and intensity of development of radiation-induced cataracts was related to the dose rate. No qualitative differences in the clinical picture of the formation and development of cataracts indlced by protons or by X-rays were noted. The RBE coefficients of 25 and 50 meV protons approximated a unit.


[Personality characteristics of pilots and navigators].

One of the pathways of improving the psychological selection of the flying personnel is to study properties of the personality responsible for flying tasks. It is important to form an ideal of personality properties of the pilot and navigator. With this purpose a special set of psychological methods allowing a comprehensive study of the personality was used. The results helped to identify personality properties typical of pilots and navigators and to suggest that high achievements in the professional activity of pilots and navigators are associated with their personality characteristics and correct selection of the flying specialty.


Measurement of guinea pig body surface area.

The body surface area (BSA) of 50 adult 2/N guinea pigs of both sexes and varying age was measured by the skinning and paper weight technique, or calculated from two equations in which the animals' weight (W) alone or the weight and length (L) were known. The equations BSA = W2/3 x 8.054 and BSA = W0.425 x L0.725 X 3.545 were developed by the method of least squares. The differences between the values obtained by measurement and those obtained by either of the calculation methods were not statistically significant. Differences because of sex and age were also not significant.


Long term bile collection in the rat.

Bile was collected from the rat continuously, over an extended period, using an externalized cannula brought through an intrascapular incision. The cannula was protected by a 30-cm, 16-gauge stainless steel tube attached to the skin through the incision. The rat was housed in a 10.2 x 10.2 x 12.7 cm cage at a lever higher than the collection vial to aid in drainage of bile. A hole in the vial cap permitted the cannula to turn freely as the rat moved about the cage. This method allowed bile to be collected conveniently over long periods of time with minimal restraint of the animal.


[Dynamics of cyclic and acyclic locomotion by the crew of "Soyuz-18" after a 63-day space flight].

After the 63-day flight Soyuz-18 crewmembers P. I. Klimuk and V. I. Sevastyanov performed different types of walking, long and high jumps. During the exercises the coordination structure, bioelectric activity of anterior and posterior groups of calf and femoral muscles, distribution of loads along three coordinate axes in the center of body gravity and support reactions of feet were investigated. The study demonstrated certain stages in the recovery processes, duration of the readaptation period, dependence of the level of locomotion disorders upon the inflight exercises. The investigation showed a better condition of the locomotion functions of Soyuz-18 crewmembers as compared with those of Soyuz-9 and Soyuz-17 cosmonauts. The study also helped to determine how to arrange the readaptation period.


Effect of syntactic order on serial-recall performance of hearing-impaired and normal-hearing subjects.

Previous research on the effect of syntactic order on the memory performance of hearing-impaired subjects has indicated that in contrast to normal-hearing subjects the deaf do not make use of the syntactic order of a word string to facilitate retention and recall. The present study used an immediate serial recall paradigm rather than a paired associate paradigm requiring longer term retention. Using this paradigm, 10 normal-hearing, 10 hearing-impaired subjects trained with manual communication, and 10 hearing-impaired trained with oral communication were presented with word strings of four, six, and eight words in length. One set of word strings was syntactically well formed while another was randomly ordered. The subjects were presented the stimuli over nine trials. An analysis of the number of errors for each list length and order condition revealed facilitation due to syntactic order at the eight-word length for all subjects and at the six-word length for the hearing-impaired populations. An error analysis further supported the use of syntactic order by the hearing impaired to facilitate their retention of the word strings. Two ways of resolving the conflict between these results and prior results showing no facilitation are presented. The first recognizes the possible use of an order of mention strategy and its effect upon performance in these two studies. The second notes the differences in the involvement of semantic versus syntactic information in the tasks used in these studies.


Auditory/vibratory perception of syllabic structure in words by profoundly hearing-impaired children.

Sixty monosyllabic, disyllabic, and trisyllabic words were recorded and presented at different times through earphones and vibrators to 20 normal-hearing adults and to 20 profoundly hearing-impaired children to evaluate their perception of number of syllables. Vibratory perception by the profoundly hearing-impaired and normal-hearing subjects and auditory perception by the profoundly hearing-impaired subjects all were similar. Their responses could be predicted by counting the number of prominent energy bursts displayed on the screen of a storage oscilloscope. The subjects' responses obtained under these conditions differed considerably from normal auditory perception, which could be predicted by "dictionary criteria" for syllabification. These findings suggest the need for a special perceptual viewpoint in teaching stress or prosody to profoundly hearing-impaired children.


Tympanometric asymmetry.

Tympanometric asymmetry was investigated in 17 normal adult subjects. Experimental variables included transmission quantity, probe frequency, direction of pressure change, and type of probe tip. Tympanograms were characterized by systematic asymmetries that appeared to be related predominantly to middle-ear effects, although ear canal effects probably contributed to the asymmetries as well. Implications for the standardization of measurement procedures are discussed.


Interactions among tympanometric variables.

To gain a better understanding of tympanometric results that have been difficult to interpret, such as asymmetrical and W-shaped tympanograms, acoustic susceptance and conductance tympanograms were measured from subjects with normal hearing and from subjects with well-defined middle ear pathology. Acoustic reactance, resistance, and impedance were computed and predicted from the measured data. Asymmetrical tympanograms derive in large part from the marked asymmetry in acoustic resistance as a function of ear canal pressure. W-shaped tympanograms result from interactions between reactance and resistance that occur when the two quantities assume similar absolute values or when reactance is mass controlled. A criterion for distinguishing between W-shaped tympanograms that are normal from those that are abnormal is discussed.


Development of the California Consonant Test.

A 100-item, multiple-choice test for consonant identification labeled the California Consonant Test (CCT) has been developed expressly for use with hearing-impaired patients. A computer-assisted analysis was obtained for the test responses of 550 patients with sensorineural hearing loss. The test seems highly sensitive to configurations of high-tone loss, but the correlation with degree of loss, especially in the instance of flat configurations, is somewhat low (-0.40). Test-retest correlation is 0.96. A correlation of 0.35 with a W-22 list indicates that the two tests are measuring different aspects of speech reception. In addition to its usefulness in identifying consonant confusions for rehabilitation purposes, the CCT may prove helpful in ranking hearing aids. For the latter purpose, two 50-item subforms, designed for equivalence, have been under observation for possible use when time is a critical factor. Repetitions of the 100-item list offer greater stability, however.


Influence of reading level difficulty on the disfluencies of normal children.

This study assessed the effect of increasing the difficulty of reading material on the frequency and type of disfluency in the oral reading of normally fluent elementary school children. Eighty children participated in the study. Ten boys and 10 girls each, from Grades 3, 4, 5, and 6, read five 200-word passages, corresponding to one grade below their school placement, the grade of their school placement, and one, two, and three grades above their school placement. Results indicated a significant increase in total moments of disfluency and four specific types of disfluency as the difficulty of reading material increased. The data revealed a tendency for "stuttering" disfluencies to increase more in frequency than "normal" nonfluencies. Results are discussed with respect to theoretical and experimental implications.


An acoustic-perceptual method for the quantitative evaluation of hypernasality.

A computer implementation is proposed as a method for assessing the quality of an individual's speech from a perceptual and communicative point of view. The input to this procedure is a standardized set of speech samples (vowels and selected consonants) designed to permit an evaluation of the speaker's phonology. The output is a numerical specification of the functional adequacy of the target values of the phonetic segments under analysis. The computer program consists of three parts: a simulated auditory analyzer, the output of which is a spectral representation of each test item; an algorithm that computes a psychoacoustically based measure of distinctiveness or perceptual distance for each pair of test spectra, and a routine for comparing, in terms of this measure, the test items with the corresponding reference items drawn from a population of normal speakers or a recording made before patient intervention.


Short-term memory scan in normal individuals and individuals with aphasia.

Ten matched pairs of normal adults and adults with aphasia participated in a short-term memory, visual recognition paradigm wherein each determined whether or not a probe digit appeared in a subset of digits previously presented. Reaction times, measured in milliseconds from onset of probe digits until completion of visual-motor responses, were analyzed as a function of increasing subset size (two, four, and six digits) and the positive versus the negative response condition. Reaction times were significantly slower for the subjects with aphasia. Both groups of subjects demonstrated linear increases in reaction time across levels of subset size. For both groups, increases in reaction time were similar in the positive vs the negative-response conditions. Resulting parallel slopes suggested that both groups of subjects used a serial exhaustive scan of short-time memory. Results from this study did not support results obtained by others in previous studies which may have been confounded by group differences in visual retention spans.


Reliability of performance for dichotic listening using two response modes.

Stop consonant-vowel syllables were presented dichotically to eight normal-hearing adult females over eight weekly sessions under two response conditions: a two-choice forced mode and a one-choice preferred mode. Total number of correct responses and right-ear advantage did not vary significantly across sessions for either response mode. Ear laterality, measured using percent of error, did not vary between response modes. Substantial differences were found between subjects in accuracy and ear laterality, but individuals tended to perform consistently across sessions.


Nonindependence of feature processing in initial consonants.

Mutual dependence in the processing of manner and place of articulation was investigated in two experiments. The first study assessed the location of the voiced-voiceless boundary as a function of place of articulation, and the second investigated the location of the labial-alveolar boundary as a function of manner class. In both experiments, the location of the phonetic boundary systematically varied as a function of the nontarget feature value. These results indicate that the processing of phonetic feature information occurs in parallel, with decisions about one feature influencing the particular value assigned to another feature.


Mastery of verb tense markers by normal and learning-disabled children.

Sixty learning-disabled children with a mean age of 7-11 and 60 children in regular classes with a mean age of 7-10 were given a tense marker test to elicit future, present, and past tense markers for 50 verbs organized into 10 categories based on the operation required to form the past tense. Results indicated that both normal and learning-disabled children had achieved control of future, present, and /-d/ and /-t/ past tense markers. Neither group has mastered the /-ed/ nor seven categories of irregular past tense markers. Children in regular classes showed significantly higher correct responses across 10 categories of past tense items. Analysis of error patterns indicated that learning disabled children used a different pattern of responses and a different set of rules to mark past tense. This study shows the need for data on the linguistic status of normally developing children above the age of seven, if we are to make any inferences about the performance of children whose development is deviate.


Order effect of acoustic segments of VC and CV syllables on stop and vowel identification.

The purpose of this study was to determine the importance of the vocalic transition relative to other acoustic cues in the perception of both CV and VC syllables. Subjects identified stops, /p, t, k, b, d, g/ and vowels, /i, u, 3/ from the aperiodic, aperiodic + vocalic transition, vocalic transition, and vocalic transition + vowel segments edited from VC and CV syllables. The major findings were as follows: (1) no significant difference was found in consonant identification scores between aperiodic, aperiodic + vocalic transition, and vocalic transition segments in CV syllables compared to those in VC syllables; (2) consonant identifications from vocalic transition + vowel segments in VC syllables were significantly greater than those from vocalic transition + vowel segments in CV syllables; (3) no significant difference was found in vowel identification scores between aperiodic + vocalic transition, vocalic transition + vowel, and vocalic transition segments in CV syllables compared to those in VC syllables; and (4) vowel identifications from aperiodic segments were significantly greater in CV syllables than in VC syllables. The results revealed a significant right-to-left perceptual advantage for both vowels and consonants. The findings for consonant identification emphasize the importance of the temporal order relationship between the vocalic transition and steady-state vowels in the perceptual process.


Respiratory tracking of dichotically presented tonal amplitudes.

This study investigated the possible existence of a lateralized auditory sensorimotor integration system between amplitude modulations of a tone and respiratory movements controlling them. A dichotic pursuit auditory tracking paradigm was utilized that has previously implicated a lateralized sensorimotor system for lingual and mandibular control of frequency modulated acoustic stimuli. Thirty-two normal right-handed subjects tracked a continuously varying pure tone, the target, randomly fluctuating from 65 to 95 dB SPL, and presented to one ear, with another tone, the cursor, controlled by inhalation/exhalation movements (lung volume changes) and presented to the other ear. Target and cursor tones were counterbalanced for right and left ear presentation across 40 one-minute trials. Results failed to show a statistically significant laterality effect. Significant interactions revealed an advantage for cursor/RE, target/LE laterality presentation during the second half of each 20-trial block, and a predominant within trial REA. Tracking efficiency was far below that observed for upper articulator control of the cursor. A tentative conclusion is that the particular subpart of the speech musculature used in the tracking paradigm is more relevant to a lateralized sensorimotor integration system than the compliance between the sensory result of the movement, re: speech production and the movement pattern itself.


The acoustic reflex and temporary threshold shift: temporal characteristics.

One ear of each of seven normal-hearing subjects was exposed to a continuous 1000-Hz tone at 110 dB SPL for three minutes. During exposure, a broad-band noise at 100 dB SPL was presented to the contralateral ear. The noise was either continuous or pulsed. Four pulsed conditions employed repetition periods of 360, 180, 90, or 9 msec with a 50% duty cycle. A control condition in which no noise was presented was also included. Temporary threshold shift was measured at selected postexposure times at the frequency one-half octave above the exposure frequency. TTS2 was greatest for the control condition and least for the 360- and 180-msec conditions. Results are discussed in relation to the dynamics of the acoustic reflex, particularly reflex relaxation, reflex adaptation, and reflex temporal summation.


Analytic study of the Tadoma method: background and preliminary results.

Certain deaf-blind persons have been taught, through the Tadoma method of speechreading, to use vibrotactile cues from the face and neck to understand speech. This paper reports the results of preliminary tests of the speechreading ability of one adult Tadoma user. The tests were of four major types: (1) discrimination of speech stimuli; (2) recognition of words in isolation and in sentences; (3) interpretation of prosodic and syntactic features in sentences; and (4) comprehension of written (Braille) and oral speech. Words in highly contextual environments were much better perceived than were words in low-context environments. Many of the word errors involved phonemic substitutions which shared articulatory features with the target phonemes, with a higher error rate for vowels than consonants. Relative to performance on word-recognition tests, performance on some of the discrimination tests was worse than expected. Perception of sentences appeared to be mildly sensitive to rate of talking and to speaker differences. Results of the tests on perception of prosodic and syntactic features, while inconclusive, indicate that many of the features tested were not used in interpreting sentences. On an English comprehension test, a higher score was obtained for items administered in Braille than through oral presentation.


Criteria for stuttering.

Judges are able to differentiate stuttered from nonstuttered speech samples using written transcriptions. These decisions clearly are associated with the presence of certain types of disfluency which have been identified previously as the essential features of stuttering.


Radiation-induced carcinoma of the lung--the St. Lawrence tragedy.

This paper reviews the problem of radiation-induced carcinoma of the lung in the fluorspar mines of Newfoundland. Seventy-eight workers have died from this disease since commercial operation commenced in 1933. In 1959 the source of the radiation was identified as radon, and its daughter nucleotides present as contaminants in water seeping into the mines. Heavy smoking is probably a synergistic cocarcinogen. The histology in this group of patients with radiation-induced lung cancers is unusual, since squamous cell carcinoma accounts for 90 percent of all cases. There have been four patients with second primary lung cancers. Radical radiotherapy has been the primary mode of treatment based on the reluctance of the miners to undergo operation. Surprisingly good results have been obtained, with an average survival time of 34 months after treatment. Institution of improved ventilation has reduced radiation to safe levels, but an estimated 120 miners from the pre-1960 era are still at risk.


Results of surgical treatment in Stage I lung cancer.

One hundred fifteen patients underwent resection for Stage I non-oat cell carcinoma of the lung. Each of these patients was evaluated carefully for extent of disease and classified as having a Stage I cancer only after the resected specimen was reviewed histologically and all regional nodes in the mediastinum were assessed. There were no deaths following operation. At 1 year of follow-up 75 of 81 patients (93 percent) were alive, and at 3 years, 77 percent were alive and free of disease. No patient had local recurrence and none was lost to follow-up. Patient with correctly staged early lung cancers have an excellent survival rate at 2 and 3 years with surgery alone. Merits of various adjuvant programs in this group of patients can be assessed correctly only if follow-up periods are prolonged and the numbers of patients evaluated are large.


Early pleural decortication for thoracic empyema in immunosuppressed patients.

Patients with empyema and impaired immune response often remain in a toxic condition after tube thoracostomy because the infection is not localized and walled off satisfactorily. Consequently, the reported mortality rate is extremely high. Despite the expectation of a high mortality rate from thoracotomy and débridement in this category of critically ill patients, we were forced to perform pleural decortication in eight patients after lesser procedures had failed. They were immunodeficient because of (1) high-dose steroids (HDS) for sagittal sinus thrombosis, (2) HDS for systemic lupus erythematosus, (3) HDS for chronic myelogenous leukemia and myelofibrosis, (4) HDS for multiple myeloma, (5) hemolytic anemia with pulmonary infiltrates, (6) chemotherapy for Hodgkin's disease, (7) diabetes mellitus with Kimmelstiel-Wilson disease, and (8) diabetes mellitus with chronic glomerulonephritis. Six of the eight patients survived and were discharged with completely healed incisions 3 to 6 weeks after operation. This compares well with the survival rates reported by others. Although risky, the over-all survival rate may be better with thoracotomy and decortication than with prolonged tube drainage and open drainage in immunodeficient patients with empyema, and the period of morbidity is shortened considerably.


The surgical treatment of pulmonary aspergillomas.

During a 4 year period 11 patients underwent 12 operations for pulmonary aspergillomas. The usual reason for operation was hemoptysis--massive or moderate. There was one death after operation and two complications. One patient since has an aspergilloma on the opposite side and has recurrent hemoptysis. There may be an increasing incidence of aspergillomas secondary to a larger number of open negative tuberculosis patients in the population. The mortality rate from operation is under 10 percent, and the complications in the saprophytic infestation are few. Surgery is the preferred treatment for the good-risk patient.


Unusual manifestation of Coccidioides immitis infection.

Cavitary pulmonary disease secondary to coccidioidomycosis occurs in endemic areas of the southwestern United States. Significant hemoptysis requiring pulmonary resection may develop in patients with cavitary lesions. In rare instances hemoptysis may be due to the development of a fungus ball within the cavity, and such mycetomas may contain spherule and mycelial forms of Coccidioides immitis. A patient with a documented coccidioidal cavity who had hemoptysis is described in this report. Chest radiograph revealed a fungus ball within a left lower lobe cavity. The patient underwent left lower lobectomy and recovered without complications. Examination of the resected left lower lobe disclosed a cavity containing a fungus ball comprised of mycelial and spherule forms of Coccidioides immitis. A review of the literature found three reports of biphasic growth of this condition within a coccidioidomycosis cavity and two additional cases of radiographically diagnosed coccidioidal mycetoma. Discussion of the potentially contagious nature, the medical and surgical management, and the prognosis of coccidioidal mycetoma form the basis of this report.


Primary plasmacytoma of the atrium. Report of a case with successful surgical management.

A 44-year-old woman with a superior caval syndrome was found to have an isolated plasmacytoma of the right atrium causing partial obstruction of the superior and inferior vena cavae. The tumor was excised locally, and after operation, irradiation was given. There has been no local recurrence or systemic disease demonstrated after 30 months. This is the first reported surgical excision of an intracardiac plasmacytoma.


Effects of methoxamine on the coronary circulation during cardiopulmonary bypass.

Effects of perfusion pressure augmentation with methoxamine on transmural distribution and adequacy of coronary blood flow during cardiopulmonary bypass were investigated. Flow in normal, nonworking canine hearts was measured with tracer microspheres and electromagnetic flow probes while heart rate, myocardial oxygen consumption, left ventricular contractility and epicardial ST-segment stability were monitored. Measurements during normotensive cardiopulmonary bypass were compared with values during intraoperative hypotension and subsequent normotension achieved following methoxamine infusion. Total and regional coronary blood flow returned to levels not different from normotensive controls after methoxamine infusion with a redistribution of flow to the subendocardium. We conclude that elevating perfusion pressure during cardiopulmonary bypass with methoxamine infusion increases total coronary and subendocardial blood flow by means of peripheral and selective subepicardial alpha adrenergic vasoconstriction.


Surgical correction of a case of common atrium with anomalous systemic and pulmonary venous drainage.

A case of common atrium with anomalous systemic and pulmonary venous connections and pulmonary stenosis is described. Surgical correction was performed by pulmonary valvotomy and the insertion of an intra-atrial pericardial baffle. To our knowledge this is the first reported case of surgical correction of total anomalous connections of both systemic and pulmonary veins. The embryologic development of this condition is discussed.


Management of bilateral ductus arteriosus in complex cyanotic heart disease.

Bilateral ductus arteriosus (BDA) usually is associated with complex cyanotic heart disease. Since pulmonary valve atresia often is part of the complex, hypoxia may necessitate emergency cardiac catheterization and surgery for these critically ill newborn infants. Optimum management depends on accurate delineation of the intracardiac and great vessel anatomy. Since the ductus arteriosus has a tendency to close spontaneously, the true anatomy of the fourth to sixth aortic arch connections should be determined on the first catheterization. An over-all plan for future care by the medical-surgical team should have been made at the time of the initial surgical procedure. The case histories of four newborn infants with BDA associated with cyanotic heart diseases are reported. The anatomy and basic embryology of the fourth to sixth arch system is reviewed and recommendations for long-term management are given.


Modified Shumacker operation for correction of transposition of the great arteries.

Correction of the transposition of the great arteries can be accomplished with a modified Shumacker operation. This procedure has been demonstrated in cadavers to have many advantages over the techniques used by Mustard and by Angelini and Sandiford. At present these two operations provide the best clinical results in correction of transposition of the great arteries. The details of the modified Shumacker technique are described and the different advantages of this technique are discussed.


Correction of type B interrupted aortic arch with ventricllar septal defect in infancy.

The successful correction of a Type B interrupted aortic arch (IAA) with simultaneous closure of a ventricular septal defect (VSD) in a 6-month-old infant is described. With the use of profound hypothermia and limited cardiopulmonary bypass, a flap of pulmonary artery, together with the persistent ductus arteriosus (PDA), was dissected free and sutured so as to form a tube which then was anastomosed to the ascending aorta. The ventricular septal defect and the pulmonary arteriotomy then were closed. Cardiac catheterization 5 months later demonstrated a satisfactory reconstruction with no gradient between the ascending and descending aorta.


Hypoplastic left heart syndrome. Experience with an operation to establish functionally normal circulation.

A new operation to establish functionally normal circulation was performed in five neonates with hypoplastic left heart syndrome. With a limited period of cardiopulmonary bypass, deep hypothermia, and circulatory arrest, the patent ductus arteriosus was ligated. The atrial septum was excised and the atrium was repartitioned with a pericardial baffle so that pulmonary veins were in continuity with the tricuspid valve and right ventricle. The pulmonary artery was divided above the sinuses of Valsalva, and the proximal end was connected to the aortic arch with a tubular Dacron prosthesis. The distal end of the pulmonary artery was brought in continuity with the right atrium by way of a second Dacron conduit. The right ventricle thereby became the systemic ventricle and blood passed through the lungs vis a tergo. Circulation was supported temporarily, but all of the patients died from inadequate right ventricular performance or compromised coronary blood flow. This experience is presented to stimulate thought and some hope for babies with a uniformly fatal cardiac anomaly.


Anatomic correction of transposition of the great arteries without significant ventricular septal defect or patent ductus arteriosus.

A case of transposition of the great arteries without a significant ventricular septal defect or patent ductus arteriosus was treated when the patient was 5 months of age by retransposition of the great arteries and coronary arterial supply to the appropriate ventricle. The patient has done well for 13 months, despite the late occurrence of aortic regurgitation.


In situ placement of a valved conduit at the pulmonary annulus.

The technique of repair of pulmonary atresia with intact ventricular septum is described. The porcine valved conduit (Hancock) was placed so that the valve was in the "anatomic" position, avoiding compression by the sternum. There was a mild gradient (15 mm. Hg) at a cardiac index of 4 L. per minute per square meter across the porcine valve itself, measured at the postoperative catheterization. The valve orifice diameter was only 15 mm., which is considerably less than the 22 mm. valve annulus. The possible merits of this procedure over the conventionally placed valved conduit and over an outflow tract patch are discussed.


Effects of heavy metals (cadmium, copper, chromium and lead) on a freshwater snail: Biomphalaria glabrata Say (Gastropoda, Prosobranchia).

This study concerns the effects of heavy metals (cadmium, copper and chromium) on the mortality and fecundity of the adults of Biomphalaria glabrata and the viability of their embryos. Embryos were also tested for lead. The concentrations used ranged from 0 ppm to 4.0 ppm for Cd2+ and Cu2+ and from 0 to 1.4 ppm for Cr6+. Cadmium and copper were far more toxic than chromium. Fertility was abolished by 0.1 ppm of cadmium and copper and fecundity was severely affected by chromium. Some evident sublethal effects were observed. Survival of the hatchlings treated with chromium was of the same order of magnitude as that of the controls and sexual maturity did not show any delay. Forty-one percent of the embryos kept at concentrations of 0.1 ppm Pb2+ completed their development in 51 days, that is, with a delay of 37 days. The hatchlings at 0.1 ppm died after 15 days. The advantages of using freshwater pulmonates as a toxicity test are discussed.


Susceptibility of Planorbarius metidjensis from Portugal and Spain to Schistosoma bovis from Salamanca, Spain.

The susceptibility of Planorbarius metidjensis from Portugal and Salamanca (Spain) to Schistosoma bovis from Salamanca was studied. The degree of susceptibility as measured by positivity rate, number of cercariae, pre-patent period and survival rate, showed that P. metidjensis from Portugal and Spain are very susceptible to S. bovis from Salamanca. The role of P. metidjensis as a host of S. haematobium is questioned and further studies are shown to be necessary. To determine if the disease exists in Portugal, the bovine and snail populations on the border with Salmanaca and Algarve are beginning to be screened.


Synaptic activation of Helix ganglion cells by barium ions.

Experiments were carried out on Helix suboesophageal ganglion cells by use of microelectrodes in order to study the effects of barium ions applied in 1-8 mM concentration. The overall effect of barium ions consisted in a marked depolarization, the thresholds of the ganglion cells, however, were quite different. In case of the most sensitive cells, bursting transformation and paroxysmal depolarization shifts occurred. A minor part of the neurons responded to barium ions with interruption of the spike generation which, in most cases, was accompanied by hyperpolarization. For a considerable part of the cells, the application of barium ions resulted in appearance of repetitive EPSP's and, infrequently, IPSP's. This was ascribed to excitatory effects exerted on the presynaptic terminals. It is concluded that barium ions have at least 2 points of attack in the ganglion: 1, on the soma membrane of the neurones, and 2, on the presynaptic terminals controlling them.


Management of malignancy of the temporal bone.

An analysis was made of 31 patients with malignancy of the temporal bone treated at Massachusetts Eye and Ear Infirmary between 1959 and 1975. Treatment modalities included: partial temporal bone resection, subtotal temporal bone resection, total temporal bone resection, radical mastoidectomy followed by radiation therapy, radiation therapy alone, and chemotherapy. When tumor was limited to the external ear canal, partial temporal bone resection was effective in 10 out of 11 patients. When tumor involved the middle ear, subtotal temporal bone resection cured 3 out of 5 patients, and radical mastoidectomy followed by radiation therapy cured 5 out of 12 patients. Total temporal bone resection and chemotherapy failed to cure a patient each, but radiation therapy alone was successful in controlling tumor in one patient.


Problems of diagnosis in the evaluation of mediastinal sarcoidosis.

The diagnosis of sarcoidosis can be established when the case meets the criteria of clinical course, radiologic findings, and supportive histology. When there is variation from the established criteria and the clinical course of age, systemic evidence of disease or the radiologic findings of unilateral or solitary adenopathy are encountered, then ongoing evaluation is necessary to identify a possible second disease existence. Cases have been presented which indicate some problem requiring further investigative studies before acceptance of the diagnosis of sarcoidosis.


Thymic cysts in the neck.

The etiologic considerations in head and neck lesions rarely include the diagnosis of thymic cysts. A correlative summary of three new cases was analyzed with respect to the already existing body of data. A classification of thymic cysts, their embryogenesis, clinical signs, and appropriate pre-operative studies were stressed. The gross and microscopic histopathology was reviewed with the conclusion that in many instances normal thymus was included in the surgical specimen. Given our increasing knowledge regarding thymic function, it was stressed that heightened awareness of this clinical entity should enable preservation of the normal thymus gland.


Allergy in Ménière's disease related fluctuating hearing loss preliminary findings in a double-blind crossover clinical study.

Several clinical reports suggest allergy as a causative or associated factor in the etiology of Ménière's Disease or endolymphatic hydrops. The A.A.O.O. subcommittee reported in 1972 its criteria for a therapeutic improvement in Ménière's Disease. This important report allows for clinical studies to proceed in a scientific manner using the subcommittee's criteria to evaluate the results. In an ongoing study utilizing a double-blind crossover technique, fourteen Ménière's patients have been evaluated for allergies utilizing the Rinkle and Lee techniques for inhalent and food allergies. Several cases directly relate symptoms to specific food ingestion and were given challenge food tests.


Surgical management of Ménière's disease with the endolymphatic subarachnoid shunt: A five-year study.

The majority of individuals with Ménière's Disease can be successfully managed by medical means; however, there are some patients who become refractory to this form of therapy. It is this group of patients who are candidates for some type of surgical procedure. This paper reviews 109 patients who underwent 112 endolymphatic subarachnoid shunt procedures for the control of their Ménière's Disease. Medical therapy, indications for surgery, surgical technique, results, and complications are covered in detail.


Endolymphatic sac surgery.

There is a disturbing variation in the reported success rate in Endolymphatic Sac Surgery in the literature. Relatively long-term (24 months to 10 years) follow-ups are given in a series of 66 patients in this paper. Results reveal only a 55% long-term relief of vertigo in these patients. Only 30% of this series of cases had any improvement in cochlear function. There was a definite trend towards recurrence of vertigo in the longer follow-up cases. It is concluded that Endolymphatic Sac Surgery still is important in the treatment of idiopathic endolymphatic hydrops, but is of questionable value early in the course of the disease. Total removal of the endolymphatic system remains the best single surgical approach in a large number of patients with Ménièr's disease.


The deviated nose-its correction.

The deviated nose remains a challenge to any rhinoplastic surgeon. The authors approach this problem via a one-stage septorhinoplasty based on the fundamental anatomic deformity present. The technique involves taking the nose apart, realigning the building blocks, and carefully splinting of the nose for proper realigning.


Carcinoma in thyroglossal duct remnants.

Two cases of carcinoma arising in thyroglossal duct remnants are reported to add to the previously documented 78 cases in the literature. This rare lesion, which occurs is less than 1% of thyroglossal duct abnormalities, pathologically and clinically is similar to primary tumors arising in the thyroid gland. Papillary adenocarcinomas constitute 75-85% of all cases reported and most are confined to the duct remnant itself with metastasis being infrequently recorded. Therapy consists of wide excision of the tumor-bearing tissue (Sistrunk procedure) in those cases localized to the duct remnant itself. In instances where metastasis or additional lesions are detected in the thyroid gland, thyroid ablation and neck dissections are indicated. Additional modalities such as suppressive thyroid therapy, radioactive iodine, and external radiation have been employed. Distant metastasis is rare and the long-term prognosis is very favorable.


Anatomical variations of the stylohyoid complex and their clinical significance.

Anatomical variations of the styloid process and its ligaments may be responsible in some patients for vague symptoms referrable to the throat and neck. On occasions, they result in some diagnostic and therapeutic quandaries. The anatomy is reviewed and five case reports used to illustrate typical and unusual problems.


Mucocutaneous lymph node syndrome: a new clinical entity.

A six-year-old black male presented to the Otolaryngology service with fever, sore throat and an inflammatory mass in the left neck. Forty-eight hours later he developed the full blown clinical picture of mucocutaneous lymph node syndrome (MLNS). This is a relatively new clinical entity, well known in Japan, but only recently described in the English literature. The following case report and discussion will serve to alert the otolaryngologist to this disease.


Presbycusis: what is it?

The history and current misusage of the term presbycusis is discussed and current knowledge of pathology associated with presbycusis and aging are reviewed. A study involving retrospective analysis of audiometric data and clinical information on three groups was performed. Results suggest that a group of individuals previously identified as "presbycusic" probably represent undiagnosed cases of familial or genetic related hearing loss. We urge as thorough an identification of correct diagnosis as possible, thus reserving the term "presbycusis" for those rare, soley age-related cases of sensorineural loss.


Morphologic analysis of tympanic membrane grafts.

Many materials are presently used for repair of tympanic membrane defects. Since the microscopic organization of these tissues may play a role with respect to the suitability of replacement of one with the other, a comparative electron microscopic study of temporalis fascia, fresh and preserved amniotic membrane was undertaken. An effort was made to determine the similarities and differences of these tissues and our clinical experience with their use is presented.


Oncocytic lesions of the larynx.

True laryngeal adenomas are considered extremely rare and some doubt their existence. Laryngeal lesions having oncocytes as the predominant cell type have been described in the literature under a variety of different names: oncocytoma, oncocytic papillary cystadenoma, papillary cystadenoma, oxyphilic granular cells adenoma, etc. The oncocytes originate from changes in normal acinic and ductal cells. The significance of these changes is controversial. Whether the oncocytic laryngeal lesions represent true neoplasms or are degenerative in nature remains to be determined. We present clinical and histopathological details of four cases of oncocytic lesions of the larynx and compare their histology with microscopic findings in 30 cases filed as laryngeal cysts at the Minneapolis V.A. and University of Minnesota Hospitals. While the controversy regarding the neoplastic versus degenerative etiology of these lesions could not be resolved from a histopathological standpoint, their clinical behavior is that of a benign neoplasm. We review the literature on the subject and suggest a course of treatment for these lesions.


The homograft myringoplasty and the lamina propria of the tympanic membrane.

The lamina propria of the tympanic membrane is composed of a unique system of radial and nonradial fibers which contribute importantly to its function. Over 1000 patients have undergone operations for the transplantation of the homograft tympanic membrane. Animal experiments have been presented to determine whether or not the fiber system of the lamina propria of the tympanic membrane is preserved in the homograft tympanic membrane. In conjunction with this, a small series of experiments was conducted to determine the appearance of the fiber system in perforations that heal spontaneously. Current knowledge concerning the function of the fiber network is discussed. The results of the present study indicate that the lamina propria fiber network is at least partially preserved in the homograft tympanic membrane and that the fiber network of the lamina propria is not reconstituted in spontaneously healed tympanic membranes.


Unrelated sensorineural hearing loss in patients with otosclerosis. A report of three cases.

Although it is generally accepted that 20% or more of patients with clinically manifest otosclerosis have a concomitant sensorineural hearing loss, it is still debated whether otosclerosis is the cause of the neural loss. Three cases are presented of other causes of sensorineural loss in otosclerotic patients who underwent stapes surgery. One of these cases, the Mondini malformation, is discussed in detail.


Temporal bone histopathology of Paget's disease with sensorineural hearing loss and narrowing of the internal auditory canal.

A temporal bone report is presented of a patient with progressive sensorineural hearing loss and advanced Paget's disease involving the skull. The histopathology reveals Pagetic bone invading the internal auditory canal and compressing the cochlear division of the VIIIth cranial nerve resulting in severe neural degeneration. There are no other histopathologic abnormalities present in the cochlea to explain the hearing loss. A low-frequency conductive hearing loss was also present, but no histopathologic correlate could be identified.


Neurilemmoma of the auricle: a case report.

A report of a case of a solitary benign neurilemmoma of the auricle is presented. It is believed to be the first such documented case. Its nature, histology, and differential diagnosis is reviewed. It is suggested that "neurogenic tumors" be added on to the current classification of auricular masses.


Luetic hearing loss.

Luetic hearing loss has been noted with increasing frequency in recent years. Four cases of luetic hearing loss seen at Walter Reed General Hospital from 1974 to 1975 are presented and discussed. Symptoms and pathology of luetic involvement of the inner ear are also presented. Serum FTA-ABS and TPI, in addition to VDRL, must be routinely obtained during the workup of hearing loss. CSF FTA-ABS should be obtained if serum FTA-ABS and TPI are positive.  Reversibility may be dependent on early detection of luetic hearing loss and treatment with high doses of antibiotics and steroids.


Supernumerary nasal tooth.

A tooth presenting in the nasal cavity is an unusual phenomenon. Supernumerary teeth usually occur in the upper incisor area. Other locations may be the maxillary third molar and the mandibular bicuspid areas. Nasal teeth are a rare form of supernumerary teeth. They may be asymptomatic or may present with nasal obstruction and infection. They may be removed through a nasal approach.


"Practical suggestions on facial plastic surgery--how I do it". Modifications of the Fomon technique in the approach to the lower lobule.

The advantages of the Fomon technique modifications in rhinoplasty are outlined. The importance of these adaptations is emphasized.


[A study of cardiac dynamics during multistage exercise tests performed on a bycicle ergometer (author's transl)].

The authors analysed the behaviour of the mechanical systole (electromechanical systole; tension time, left ventricular ejection time), as well as of the diastole (both cardiac and hemodynamic diastole) during exercise tests performed on a bycicle ergometer, with 40, 80, 120 watt workloads. The mechanical systole--as well as its components--duration is influenced, during exercise test, by both heart rate and stroke volume--pulse pressure being assumed as an indirect index of the latter. The study of the correlation between the two above mentioned parameters has a great importance in evaluating the cardiac pump efficiency both in health and disease. The study of the behaviour of diastole is likewise very important, as it provides useful information concerning: a) the length of the cardiac muscle post-exercise recovery phase; b) the coronary available perfusion time; c) the Windkessel (arterial bellows) emptying time. Moreover, the blood pressure fall rate in diastole is an useful indirect measure of the peripheral resistance changes during muscular work. A statistical analysis is made and the correlation coefficients and the regression equations between the various parameters are defined.


[Chronic bronchitis in a fire-proof material plant].

The prevalence of chronic bronchitis has been evaluated in a group of refractory material workers. Diagnosis was made on the basis of symptoms, signs and functional and radiologic evidence of the typical changes of the disease. The relationship with age, length of working activity and cigarette smoking habit were also investigated. It can be concluded that, in the examined people, chronic bronchitis was better attributable to the working exposure to dust, than to the age or smoking habit.


[Epidemiological study of chronic bronchitis in a population of workers in a fertilizer factory].

The authors investigated the influence of working conditions--with particular reference to dust and fluorite pollution--on the epidemiology of chronic bronchitis in 197 subjects working in a fertilizer producing plant in Krakow (Poland). The investigation included history, respiratory function tests (VC, TVC), height and weight measurement, rhinolaryngologic examination, nasal mucosa cytology and physical examination. The environmental survey included measurements of the dust respirable fraction and fluorite concentration in the  air. The prevalence of chronic bronchitis was found to increase with the length of working activity and to be much higher in smokers than in non-smokers. Furthermore, in subjects working at the sites with the worst environmental situations it proved to be twice as high as in the remainders. Likewise higher proved to be the prevalence of laryngitis and sinusitis. The prevalence of chronic bronchitis was found to be much higher in workmen with more marked spirometric changes. In subjects affected with chronic bronchitis alterations of the nasal mucosa epithelium were also found.


The need for medical statistics in the training of health personnel.

Medical statistics is essential in the training of all categories of health workers and early involvement with the subject is advocated during the training of these health personnel. Four important areas of the application of statistical methods have been defined, namely, (1) the study of specific rates, (2) evaluation of clinical trial of drugs, (3) the assessment of factors affecting health or disease, and (4) the establishment of new avenues of medical research. Using examples from the training of the undergraduate medical student, the midwife and the family planning field health worker, different aspects of medical statistics should be emphasized at different levels of learning depending on the professional or academic needs of the trainee health worker.


Specialist training and medical research in developing countries of tropical Africa: a case for the establishment of postgraduate medical schools.

Developing countries like developed ones need highly skilled medical personnel, referred to as 'specialists'. In the case of developing countries, the training of these specialists abroad is expensive to the sponsoring governments, imposes a lot of hardship on the doctors and, above all, the course-content of such training takes little or no cognizance of the environment in which these doctors would later practise. The developing countries also cannot afford the loss of years in valuable services which the training abroad entails. Attempts are now being made to train specialists wholly or partly at home, in some developing countries. The approach is still not much divorced from what obtains in Britain and North America, that is, one of being trained on the job, with the onus for self-education being placed on the prospective students. Such students in most developing countries of tropical Africa have little or no facilities for further education outside their places of work. It is proposed that purpose-designed postgraduate medical schools may provide a temporary solution to specialist training in developing countries of tropical Africa. Such schools would in addition provide highly skilled medical service as well as obviate the need and the expense for the setting up of government sponsored medical research and training institutes.


Is EPA's radium-226 drinking water standard justified?

The U.S. Environmental Protection Agency's (EPA) proposed drinking water standard for radium-226 (226Ra) of 5 pCi/l is evaluated according to its health basis and carcinogenic implications. Proposed health risks of 226Ra in drinking water by other leading theoreticians (Evans, Gofman-Tamplin and Peterson) are also considered in light of the EPA proposal. It is concluded that the EPA proposal to raise the standard for 226Ra in drinking water is not justified on the basis of present knowledge of 226Ra carcinogenic effects.


Atheroma as a neoplastic disease.

An hypothesis is proposed that atheroma may be classified as a leiomyosarcoma derived from the tunica media of an artery. The notion that atheroma is a neoplastic disease provides a simple explanation for a highly complex phenomenon; the pathogenesis of artherosclerosis. According to this hypothesis some smooth-muscle cells in the media undergo malignant transformation, which is manifested by excessive production of hyaluronidase and other glycosaminoglycan hydrolases. This enzymic system frees cells from their bonds and allows them to proliferate. The enzymes also evoke a fibroblast hyperplasia which is followed by a protective collagenization producing a local area of increased resistance to the hydrolases. This accounts for the sclerosing aspect of the disease. Several other features of atherosclerosis are a result of the neoplastic nature of the disease.


General types of relationships between the development of the organism and the development of the subsystems of the organism.

There are elementary and complex types (combined elementary types): of temporospatial relations between the pattern of development of the organism and the patterns of development of individual subsystems; of influences exercised by the development of the organism upon the development of the subsystems of the organism; of influences exercised by the development of individual subsystems upon individual development; of temporospatial relations between the stability of the line of individual development and the stability of the line of development of individual subsystems; of mutual influence between the stability and variation of the line of individual development, on the one hand, and the stability and variation of the line of development of the individual subsystems, on the other.


Schizophrenia and tardive dyskinesia: is schizophrenia also a "denervation hypersensitivity"?

In human beings, amphetamine can induce both schizophreniform psychosis and oral-facial dyskinesia resembling tardive dyskinesia, while neuroleptic agents reduce the manifestations of both conditions. This suggests that such psychosis and movement disorder may occur by the same or very similar mechanisms. It is thought that tardive dyskinesia may result from neuroleptic-induced denervation hypersensitivity to dopamine. The author cites evidence suggesting that amphetamine may act on dopaminergic pathways in the CNS to produce a denervation hypersensitivity like that caused by neuroleptic agents. Clinical evidence compatible with a denervation hypersensitivity hypothesis of schizophrenia is then discussed.


The selective induction of cellular damage within neoplasia in situ; a putative role for sympathomimetic agents.

Cancerous cells can be selectively injured within a host by various means. The effects generally appear to be manifested indirectly, and are consistent with the concept that uptake from the plasma of non-esterified fatty acids (NEFAs) by malignant tissue leads to an increase in uncoupling of oxidative phosphorylation. Certain lipolytic agents are already known to cause selective damage to cancerous growths in situ. The employment of appropriate sympathomimetic agents to accentuate the nocturnal rise in plasma NEFA concentrations may permit the management and control of a variety of human neoplasia.


Three instructive cases of tiger snake (Notechis scutatus) envenomation--and how a radioimmunoassay proved the diagnosis.

Three unusual cases are described, in which, in separate incidents, young snake bite victims were found comatose. Tiger snake vemon was detected by radioimmunoassay in the urine and serum, and in one case on the clothing of these children. Gross myoglobinuria was present in all cases. The three cases demonstrate clearly the myolytic potential of tiger snake venom if specific treatment (administration of antivenom) is delayed. Extreme elevation of serum enzyme levels was found in the two victims who survived. Evidence was obtained that the major neurotoxin of tiger snake venom is absorbed at least partly via the lymphatics and that some is excreted in the urine.


Improved quality of packed cells.

Improved viability, quality, oxygen delivery capacity and metabolic activity of packed cells was obtained when blood was collected into (CP2D) citrate-phosphate anticoagulant with extra dextrose and, after separation of plasma, stored in an adenine-enhanced electrolyte solution. The system has been incorporated into clinical transfusion practice.


Chronic illness and country living.

A household health survey of an entire rural shire in the Central Western Region of New South Wales was conducted by the Health Commission of New South Wales, Regional Health Office in Bathurst along with the Central Western Regional Advisory Council during April-May, 1976, to determine the prevalence of chronic illness. Approximately 1,056 dwellings were located in the Oberon Shire by the interviewers; household interviews were obtained from 789 of them. Slightly more than 42% of the survey population reportedly had one or more chronic illnesses. Types of chronic illness associated with diseases of the respiratory and circulatory systems were most prevalent which leads one to speculate about clean, fresh, country air and the simple, easy-going, lifestyle of farming communities.


An unusual snake bite story.

The case is reported of a seven-year-old girl who was bitten by a tiger snake and sustained severe liver, skeletal muscle and myocardial muscle damage as a result of envenomation. She recovered after treatment with polyvalent snake bite antivenom preceded by promethazine.


[Alteration of potassium metabolism by cardiac glycosides in suicidal intoxications (author's transl)].

The potassium concentrations in erythrocytes, serum and urine were continously determined in 3 patients who had taken acetyldigoxin (45 to 100 tablets Novodigal à 0,2 mg) in order to commit suicide. In the first 3 to 8 hours after ingestion of digitalis the potassium concentration in serum increased while the potassium concentration of erythrocytes declined a little. The elimination of potassium with the urine remained still normal. After this period of time the potassium concentration in serum and in erythrocytes considerably fell, simultaneously large amounts of potassium were excreted with the urine. It was not until after 14 days that the potassium metabolism normalized.


[Creatine kinase isoenzyme MB and CK/GOT-ratio in the differential diagnosis of acute myocardial infarction (author's transl)].

In 56 patients with certain transmural myocardial infarction the reliability of myocard specific creatine kinase isoenzyme MB is compared with the usual estimation of creatine kinase activity in serum and the use of CK/GOT activity quotient. In measurements at different times CK-MB proves to be more reliable than other laboratory parameters: during the first 24 hours after hospital admission CK-MB indicates the infarct and correlates with ECG alterations in practically all cases. In 11 patients with CK-activity increase over 100 U/l of extracardial origin, myocardial involvement can be excluded by measuring CK-MB-activity. Formation of CK/GOT quotient shows erroneously an infarction in about half the cases.


[Concomitant infarction of the right ventricle in patients with acute transmural myocardial infarction (author's transl)].

In 56 patients with acute transmural myocardial infarction hemodynamic parameters were studied. 21 patients proved to suffer from anterior infarction and 35 patients an inferior infarction. By clinical as well as by hemodynamic findings 10 patients out of the group of the 35 patients with inferior infarction were suspect of having a concomitant infarction of the right ventricle. As it is known from literature and documented by the present results this is not a rarity. Failure of the right ventricle is the main cause of death in these patients.


[Familial sinuatrial and atrioventricular arrhythmia causing an emergency case (author's transl)].

An acute life endangering bradycardy-tachycardy-syndrome in a 37 years old female could be referred to a rare familiar sinuatrial and atrioventricular arrhythmia with an inherited autosomal dominant trait. The patient's mother, three brothers, one sister and four children showed arrhythmias ranging from sinusbradycardia to second degree heart block. There was an obvious coincidence between intellectual retardation and the extent of the cardiac arrhythmia. Familial arrhythmias should be considered in instances of sudden death or rhythm disorders in young individuals.


[Artrial septal defect in the adult (author's transl)].

The clinical and hemodynamic findings of 96 adult patients with ostium secundum defect are presented. There are no interrelationships between the extent of symptoms and clinical state on one side and heart size, shuntvolume and other hemodynamic parameters on the other hand. Our observations do not allow firm conclusions as the the natural course of the affection. It can be stated however, that this congenital cardiac malformation can be associated with a normal life exspectancy and without severe symptoms for decades. Hence we see problems as to the indication of the surgical closure of the defect, since not much is known about the longstanding usefulness of surgery in respect to a possible prolongation of life exspectancy and diminuition of morbidity. We therefore are of the opinion that - until such data are available - the indication for surgery should not be guided by prospective nonproved assumption but by the clinical state of the patient and the severity of his symptoms.


[Renal vein thrombosis: a complication of the nephrotic syndrome? (author's transl)].

The nephrotic syndrome is complicated by an increased thromboembolic risk. This is related to changes in one or more factors of the Virchow triad (vessel wall, blood flow, coagulation). The hypercoagulability may be enhanced by iatrogenic manipulations as for instance vessel punctures, application of steroids and diuretics. The preferential location of thrombus formation are the veins of the leg, pelvis, kidney, and the cerebral sinuses. In contrast the "primary" renal vein thrombosis has long been considered not as a complication of the nephrotic syndrome but as its cause. In the meantime there have been accumulated histological, experimental and clinical facts showing the nephrotic syndrome causative for the renal vein thrombosis. This is revealed too by our own cases.


[Efficiency of patients with chronic renal failure (author's transl)].

In 77 patients with chronic renal failure - all were conservative treated - exercise-tests were performed with the bicycle and in 67 cases spiro-ergometric tests. We found a correlation between the decrease of hemoglobin and the decrease of efficiency and a linear function between the decrease of hemoglobin and the increase of creatinin in serum. There was no direct correlation between the increase of creatinin and the decrease of efficiency. The efficiency, measured in Watt, and the oxygen pulse correlated. More patients with hypertonia exceeded the level of 70 of the quotient heart volume/oxygen pulse but those with normal pressure. The efficiency was reduced in general: only 13,4% obtained 100 Watt, 28,4% 75 Watt and the rest of 58,2% were of bad efficiency and performed only 50 Watt or less.


[Filtration and irradiation of the dialysis fluid to prevent bacteriemia during hemodialysis (author's transl)].

For prevention of bacteriemia caused by contaminated dialysis fluid it is necessary to protect the dialysator by decontamination of the fluid immediately before entering the dialysator. Using filters with a pore size of 0.2 micrometer or 0.45 micrometer sterile samples of dialysis fluid could be obtained, but flow rate and pressure of the fluid could not be kept constant, when the resistance of the filter increased during use. With UV-lamps no problems concerning flow rate or pressure were encountered, but really satisfying results emerged only in laboratory experiments. This was due to causes which can be influenced by technical improvements of the irradiation unit, while the use of filters implies additional measures at the monitor unit to control flow rate and pressure. The success of the applied antimicrobial techniques should be monitored for not inducing a false conviction of safety.


[Behavior modification and obesity (author's transl)].

Good results were obtained treating 49 obese patients with an elaborated selfcontrol behavior modification program. This program was an addition to the normal program of the obesity clinic of the 2. Medizinische Klinik der Universität Düsseldorf. The normal program contains some principles of behavior modification but less accentuated. After the initial 12 weeks of controlled training patients tried to reduce weight further decreasing external control. Only few patients were able to loose additional pounds during this period of 8 weeks. At the end of the initial 12 weeks patients had asked for another control before the vacational season, but only 10 out of 49 appeared at the control sessions 9 months after the program's start. If an additional behavior modification program is considered for incorporation into an already existing weight reduction clinic, additional costs and expected results have to be checked. Durative success of behavior modification techniques in weight loss programs has still to be submitted to proof.


[Secondary failures in modern therapy of diabetes mellitus with blood glucose lowering sulfonamides (author's transl)].

The analysis of the case histories of 914 diabetics exclusively treated with blood glucose lowering sulfonamides in a university clinic outpatient station yielded an annual secondary failure rate of 5-10 p.c. Cumulative incidence calculations showed a continuous increase of secondary failure depending on the duration of treatment. Thus less than 20 p.c. of the diabetics have a chance of a satisfactory long-term therapy after 10 years of treatment. Any dependency of secondary failure from age at onset of diabetes could not be proved. Both "old" and "new" sulfonamide derivatives were equally subject to secondary failure. Changing the treatment from a therapy using grammscale derivatives to any of the modern milligramm-scale substances has been more or less equally "successfull" but lastly unsatisfactory. Diabetics with secondary failure show more overweight than patients with positive long-term treatment


[Treatment of primary hyperlipoproteinemia type IIb and IV. Comparison of the lipid lowering effect of phenformin, clofibrate, and a combination of both (author's transl)].

22 outpatients with primary hyperlipoproteinemia type IIb and IV were treated in periods of eight weeks as follows: placebo; 0,15 g phenformin/day; 0,15 g phenformin + 1,5 g clofibrate/day; 1,5 g clofibrate/day; placebo. Compared to the first placeboperiode the serumtriglycerides were significantly lowered by phenformin (about 26%), by the combined treatment with phenformin + clofibrate (60%) and by clofibrate (51%) after eight weeks of treatment. The serumcholesterol was significantly lowered by phenformin (10%) and by the combined treatment with phenformin and clofibrate (14%), but not significantly by clofibrate (8%). After eight weeks of treatment with phenformin alone or in combination with clofibrate the body weight decreased significantly (1,9% or 1,4%). These changes in body weight were not related to changes in blood lipids. In conclusion, the combined treatment with 0,15 g clofibrate/day was more effective in lowering increased serum lipids than the treatment with phenformin or clofibrate alone.


Backscatter factors in the mammographic energy range.

Backscatter factors for kVps and half-value layers typical of mammographic beams have been determined as a function of beam diameter and half-value layer. The method utilized thin TLD-100 chips with the scattering medium alternately present and absent. Results indicate that the field-size dependence of the backscatter factor for lower half-value layers is less than that shown in the British Journal of Radiology Supplement 11.


Corrections to absorbed dose calculations for tissue inhomogeneities.

Traditional methods for correcting for the presence of tissue inhomogeneities may produce errors as great as 10% at points within or closese to the inhomogeneities. Measurements were made in phantoms containing aluminum or cork inhomogeneities. Agreement between measured and predicted results was usually within 2%-3%.


Use of electron filters to improve the buildup characteristics of large fields from cobalt-60 beams.

It has been shown that for Cobalt-60 units capable of producing large fields (up to 40 X 40 cm2)at 80 cm, the dose distribution in the buildup region is quite different from that observed with small fields. First, the maximum dose occurs at 1-2 mm instead of 5 mm; and second, the maximum does in some extreme cases is 15%-20% higher than the dose at 5 mm. Thus, the dose is decreased by more than 15%-20% by 3 mm of tissue, suggesting severe electron contamination. In this report, it is shown that this contamination can be best removed by a filter of thickness 0.4 g/cm2 of medium atomic number, placed some 25 cm from the source inside the collimator. For existing units, positioning the filter inside the collimator is not practical. Acceptable results, however, can be obtained by placing the filter just below the collimator.


Energy dependence of correction factors for the Victoreen Model 666 Portable Radiographic Health Survey System.

The energy dependence for each of three models of Victoreen 666 ionization chambers is characterized through an examination of the correction factors determined over the diagnostic x-ray range (0.4-4.9 mm A1 HVL) for many samples of each model. The results of an analysis of variance performed for each chamber model on the correction factors are reported as mean correction factors for the x-ray beams evaluated, with a relative standard error of less than 0.6% in all cases. Energy-dependence curves for the three chamber models are given, and their use is described.


Validity of computer simulation of blood vessel imaging in angiography.

The computer-simulation technique for imaging of vessels in angiography is being recognized as a useful tool for the study of the effect of physical parameters on the vessel image. We have examined the validity of this technique by comparing the computed image distribution directly with experimental results. The imput x-ray pattern of a blood vessel phantom, the LSF of the focal spot, and the LSF of a screen-film  system were measured. From the data obtained, the final image distributions of the phantom were computed and compared with the experimentally determined distributions. A high-precision device for the alignment and positioning of the vessel phantom was employed in the experiments. Results indicate that computer simulation can correctly predict the image distribution of the blood vessel phantom.


Electrical constancy check for remote-reading op-amp radiation dosimeters.

A constancy check is described for dosimeters using fast op-amp electrometers with remote ionization chambers. The check's usefulness is reported, as are capacitance values for some commercial ion chambers.


Dosimetric considerations of symmetric and asymmetric 60Co teletherapy split fields.

Split fields are commonly used for a variety of treatments for which local shielding is desired; a single field is split into two fields by means of lead blocks placed in the beam. The condition for assuming independence of the two fields is investigated by using the area over perimeter calculational method and comparing this to experimental depth-dose data measured in a water phantom using a Shonka ionization chamber. Two principal variations affecting dose distributions are examined: block width and position of the block expressed as the fractional perpendicular distance between the central ray of the overall field and the center of the block. An intercomparison between calculation and experimental data shows that the right and left sides of the split field behave as independent fields giving TAR values in agreement with experimental data to within +/-1%. If the fields are asymmetric and if the larger field is less than 70% of the total area including the blocked part, then the dosimetry should be based on average TARs, off-center ratios, and backscatter factors for the two fields. If the larger area is greater than 70% of the total area, then the treatment time can be calculated from the larger field only.


Energy dependence of correction factors for some Victoreen Model 570 Condensor R-Meter medium-energy chambers.

The energy dependence of each of six models of medium-energy Victoreen 570 Condenser R-Meter chambers was determined by measurement of the exposure correction factors over the diagnostic x-ray beam-quality range (0.4-4.1 mm A1 HVL) for several samples of each model. The results of an analysis of variance performed by model on the correction factors are reported as mean correction factors for the x-ray beams evaluated, with a relative standard error less than 0.8% in all cases. Energy-dependence curves for the six chamber models are given; their use is described.


A new type of grid.

A new type of grid is discussed. It is anticipated that it will have the same primary transmission as and will eliminate scatter more efficiently than a conventional linear grid of equal thickness and lead content. The construction of the new type of grid is similar to a conventional one except that the lead strips are arranged in zigzag rather than linear pattern. Geometrically ideal "zigzag" and linear grids were constructed and their performance tested. The scatter transmitted by the ideal zigzag grid was one-half that of the comparable ideal linear grid. The implications regarding the improved scatter-eliminating capabilities of a practical zigzag grid are discussed.


Ribosomal proteins of mouse kidney: normal status and during compensatory renal hypertrophy.

Ribosomes were isolated from normal and growing kidney and the protein complement was examined by a two-dimensional gel electrophoretic procedure. Proteins were resolved in the first dimension on the basis of charge and, in the second dimension, on the basis of molecular weight. 60S and 40S ribosomal subunits from normal kidney contained respectively 42 and 31 proteins. 80S ribosomes contained 23 proteins not found with either sub-unit. Nineteen of these proteins were removed from the ribosomes when isolated ribosomes were washed in a high salt buffer. Six proteins of the 80S ribosome corresponded to proteins associated with both sub-units. 80S ribosomal proteins were also studied during compensatory renal hypertrophy after 4-96 h of induced growth. The protein complement displayed by electrophoresis was identical to the pattern seen from normal renal cells.


Characterization of cytoplasmic arginine-rich basic protein of Guerin epithelioma.

Arginine-rich basic protein from cytoplasma of Guerin epitheliomas has been isolated and characterized. It contains five amino acids: arginine, lysine, glycine, alanine and glutamic acid which make together 74% of all amino acid residues. The protein has a cationic character with an isoelectric point of 8.2. No carbohydrate component was found in this protein. The significance of arginine-rich basic protein in the cytoplasma of Guerin epithelioma is discussed briefly.


The ostrich (Struthio camelus) egg-white lysozyme.

The purification of Ostrich (Struthio camelus) egg-white lysozyme is reported. The quantitative amino acid composition, the molecular weight, the N-terminal sequence (34 amino acids) as well as kinetic studies allow to range this enzyme among the goose type lysozymes.


Essential arginine residues in beef kidney D-aspartate oxidase (a preliminary report).

Partially purified D-aspartate oxidase from beef kidney has been tested in the presence of butanedione or phenylglyoxal, which specifically modify the arginine molecule. The results obtained clearly indicate that arginine residues are involved in the binding of the substrate to the active site of the enzyme.


Studies of interaction of immune RNA with normal spleen cells.

Normal mouse spleen cells incorporate in vitro radioactively labeled immune RNA. At saturation, 10(6) cells incorporate about 6 X 10(16) daltons of this RNA. Immune RNA is incorporated in two times greater amounts than control RNA. Maximum incorporation is observed in the first few minutes of incubation. Immune RNA incorporated by spleen cells is present both in cytoplasm and nuclei. Protamine sulphate has stimulatory effect on immune RNA incorporation. Actinomycin D does not affect incorporation of immune RNA.


[Dietary management of familial Hypercholesterolemia in Children and adolescents -- a feasibility study (author's transl)].

The efficacy of a fat-modified, low-cholesterol diet was studied in 38 children and adolescents with familial hypercholesterolemia on an out-patient basis, and the results compared with those achieved with dietary treatment in hospital. On an out-patient basis, a 10% reduction of plasma cholesterol levels was achieved and maintained. However, no patient showed normalization of plasma cholesterol levels. During hospitalisation, the mean plasma cholesterol levels fell by 24%, beta-cholesterol levels by 27%. This resulted in normal plasma lipids in almost half of the patients. Our results demonstrate the efficacy of intensive dietary management in children and adolescents with familial hypercholesterolemia. Long-term results on an out-patient basis could probably be improved by early nutrition education and an improved supply of suitable dietary foods.


[Screening of newborns for argininosuccinase deficiency. First experiences in Austria (author's transl)].

In 1973, the screening for argininosuccinase deficiency was taken up by the Austrian Metabolic Disorder Screening Program using Murphey's enzyme auxotroph test. Amongst 293802 tested newborn infants, two cases of this disorder could be identified, which under protein restricted diet had a normal development until now. Inhibition zones due to antibiotic or desinfectant contamination do not disturb test evaluation in contrast to the bacterial inhibition assay (Guthrie test). The frequency of "false positive" results is small (0.05%) as well as additional work for this test procedure. So screening for argininosuccinase deficiency seems to be a useful completion of a neonatal blood screening program.


[Evaluation of diagnostic parameters in chronic recurrent urinary tract infections in children. IV. The isotopic renogram (author's transl)].

The results of isotopic renograms (ING) (n = 73) and renal concentration capacity tests (n = 65) performed at the same time before and during therapy of recurrences have been compared. In 43 children with chronic urinary tract infections. ING done prior to chemotherapy showed pathologic findings in 65% of children with bacteriuria. A significant correlation between normal and pathologic findings of ING and renal concentration capacity tests has been found. Impaired (normal) renal concentration capacity lead to pathologic (normal) ING in 74% of cases. 94% of children with a pathologic ING either had bacteriuria children with pyelonephritis (n = 19) the ING was pathologic, whereas in all children with cystitis (n = 8) it was normal. During therapy the ING became normal before the impaired renal concentration capacity returned to normal.


[Somatomedin and growth hormone in patients with retarded growth and atrophy due to congenital heart disease or malabsorption (author's transl)].

Serum somatomedin activity was found to be very low in cases of growth retardation and malnutrition due to congenital heart disease and to malabsorption, respectively. Growth hormone levels in these cases were slightly elevated. The possible role of low somatomedin activity in the origin of growth retardation due to organic diseases is discussed.


[Renal failure in an infant due to bilateral ureter obstruction by Candida albicans pyelonephritis (author's transl)].

In the course of Candida albicans pyelonephritis an infant devleoped acute renal failure as a result of bezoar production with bilateral obstruction of the ureters. As on the one hand "obstructive" Candida pyelonephritis is not a well-recognised cause of renal failure, and on the other a noticeable increase in the number of cases of serious Candida infection with pyelonephritis can be observed during antibiotic and immmunosuppressive therapy, it seems worthwhile to report this case.


[Mixed tuberculous and pneumococcal meningitis after splenectomy (author's transl)].

A 16 year old boy, splenectomized at the age of 11 years, after an accident, died of a recurring pyogen meningitis. The bacteriologic diagnosis of the CSF culture revealed a mixed pneumococcal-tuberculous infection. Splenectomy is discussed with regard to a disturbed immediated and delayed immunresponse.


[Localizationstudies in female patients with recurrent urinary tract infection. I. Patients without ureterovesical reflux (author's transl)].

In 16 girls and 12 women with recurrent urinary tract infection without  ureterovesical reflux we performed 75 bladder washout-tests. 52 (72%) tests indicated a vesical, 19 (27%) of supravesical bacteriuria. The 16 girls had less often (18%) supravesical bacteriurias than the 12 women (58%). If follows that in the absence of reflux, ascension of bacteria from the bladder to the upper tract is a relatively frequent phenomenon, the pathogenic importance of which is not yet clear. Clinical manifestations and urographic aspect correlated rather poorly with the results of the bladder-washout-test.


[Localizationstudies in female patients with recurrent urinary tract infection. II. Patients with ureterovesical reflux (author's transl)].

In 17 girls and 5 women with urinary tract infection and low-pressure reflux we performed 23 bladder-washout-tests. 12 were interpreted as supravesical, 11 as vesical bacteriurias. All patients with vesical bacteriurias had a normal IVP. The majority of patients with supravesical bacteriurias had clubbing and scarring. The possibility of interpreting the supravesical bacteriurias as a sign for pyelitis rather than pyelonephritis is discussed.


[Localizationstudies in female patients with recurrent urinary tract infection. III. Patients after successfull antireflux-operation (author's transl)].

In 14 girls and 5 women with recurrent urinary tract infections after successfull antireflux-operation we performed 72 bladder-wash-out-tests. Whereas preoperatively 50% of the patients had a supravesical bacteriuria, only 25% had it postoperatively. Most of the postoperativ vesical and supravesical bacteriurias were interpreted as reinfections. The demonstrated postoperativ ascension of bacteria in the upper urinary tract in spite of successfull surgical treatment cannot be taken as an argument against operation. The postoperative supravesical bacteriurias are less frequent and have less morbidity than the prepoerative supravesical infections.


[Behaviour therapy of autoagression with the Lesch-Nyhan-syndrome ( author's transl)].

Successful behaviour therapeutic treatment of autoagression in a child with Lesch-Nyhan-Syndrome was combined with the establishment of alternative behaviour at the same time. Treatment applying negative stimuli could be avoided.


[Cell mediated and humoral immunity against glomerular basement membranes in children with glomerular diseases (author's transl)].

43 patients with glomerular disease and 15 healthy children from 2-15 years of age were examined for the presence of cell mediated immunity against enzymatically solubilized glomerular basement membranes. Peripheral lymphocytes of 3 patients with acute hemorrhagic glomerulonephritis, 10 children with chronic glomerulonephritis and 2 children with congenital nephrotic syndrome showed positive reactivity in form of rosette formation. The application of the test for differential diagnosis between different glomerular diseases is discussed.


[Items on physical examination and general anamnesis in pediatrics (author's transl)].

Proposed items on physical examination and general anamnesis in pediatrics to be included in the first part of the medical examination are discussed. Students should learn principles of examination and geneneral anamnesis relevant to the supervision of growth and development during childhood.


Microdosimetry and chromosome aberrations: effects of 230 keV neutrons on Vicia faba chromosomes.

Physical energy deposition events have been related to sub-nuclear cytological events (chromosomal changes) in metaphases sequentially accumulated from the latter part of the cell cycle of Vicia faba. 230 keV neutrons produce about 0.4 recoil protons per late interphase nucleus per rad with the majority of protons traveling 1 to 2 microns from their origin, depositing energy at around 90 keV per micron. The frequency of induced abberrations is basically linear with dose, though varying through consecutive cell sampling periods because of differential induced mitotic delay. Distributions of chromosomal aberrations and total cytological events are overdispersed in relation to the Poisson distribution indicating that some proton recoils produce multiple events. When gaps and aberrations within chromosomes and multiple aberrations between chromosomes, are considered as discrete events, distributions follow Poisson expectations. About 40% of proton recoils result in observable cytological change. The highly energetic proton recoils (approximately 90 keV per micron) which can induce multiple events are the ones most likely to produce effects which result in cell death. The sphere of influence of the proton recoils is probably adequately estimated from their range (approximately 1 to 2 micron) since it seems compatible with the spatial proximity of the initial components of the resultant chromosome aberrations.


Mutagenesis at the ouabain-resistance locus in human diploid fibroblasts.

The variables affecting the frequency of ouabain-resistant mutant clones have been studied in a strain of foetal lung fibroblasts. Optimum mutant recovery was obtained when cells were selected in 10(-6) M ouabain at a cell density of 2 X 10(4) cells/cm 2 (10(6) cell per 100-mm dish). The spontaneous mutation rate was estimated to be 4 X 10(-8) per cell generation. Treatment with the mutagens ethyl methanesulfonate (EMS), N-methyl-N' -nitro-N-nitrosoguanidine, and UV light increased the frequency of mutant colonies by an order of magnitude. The maximum number of mutants after mutagenesis with EMS occurred after two population doublings of growth in non-selective medium prior to selection and depended on the dose of EMS. Ouabain-resistance is a useful marker for studies of quantitative mutagenesis in human cells.


Analyses of differential sensitivities of synchronized HeLa S3 cells to radiations and chemical carcinogens during the cell cycle. Part IV. X-rays.

Radiation-induction and rejoining of single-strand breaks (SSBs) in the DNA of synchronized HeLa S3 cells were investigated by alkaline sucrose density gradients. We could not find any significant differences in the extent of SSBs induced in cellular DNA and in the extent of their rejoining throughout the cell cycle, including mitosis. The cyclic variation curve of the content of non-protein sylfhydryls (NPSH) during the cell cycle is similar to that of X-ray survivals except in mitosis, although there was no close correlation between the content of apparent total sulfhydryls (APSH) and X-ray survivals. Radiation-induced mutants resistant to 8-azaguanine (8AG) occurred in higher frequency in the radio-sensitive G1-S boundary phase than in the radio-resistant G1, S and early G2 phases. Further, the pre-irradiation treatment with 50 mM cysteamine prevented reproductive death and induction of 8AG-resistant mutants by X-rays throughout the cell cycle. These findings seem to indicate that there is a close correlation between the extent of lethal radiation damage to the cells and their mutability, and that sulfhydryls may play an important role as a factor governing cellular radio-sensitivity.


Comparative sensitivities of meiotic prophase stages in male mice to chromosome damage by acute X-and chronic gamma-irradiation.

Radiation-induced multivalents, fragments and bivalent separation were studied at metaphase I in mouse spermatocytes. These cells had been irradiated with 200 rad X-rays as spermatogonia or in different stages of prophase. Radiation sensitivity increased towards the latter end of prophase with respect to multivalents and fragments. These results were compared with protracted gamma-irradiation throughout prophase.


Photoreactivation of thymine dimers in UV-irradiated human cells: unique dependence on culture conditions.

UV-irradiated human fibroblasts in tissue culture were exposed to photoreactivating light in an attempt to demonstrate a light-dependent loss of thymine dimers from the acid-insoluble fraction of the DNA. The only experimental conditions in which this phenomenon was observed was if the cells were grown for at least 10 days in Dulbecco's modified Eagle's minimum essential medium. Such cells lost a maximum of between 10-30% of the thymine dimers from their DNA during illumination for 1 h. When cells were grown in a variety of other media the phenomenon was not observed. The present experiments do not discriminate between true enzymatic photoreactivation and a medium dependent photosensitization phenomenon that is not enzymatic in nature.


Multifactorial index of cardiac risk in noncardiac surgical procedures.

To determine which preoperative factors might affect the development of cardiac complications after major noncardiac operations, we prospectively studied 1001 patients over 40 years of age. By multivariate discriminant analysis, we identified nine independent significant correlates of life-threatening and fatal cardiac complications: preoperative third heart sound or jugular venous distention; myocardial infarction in the preceding six months; more than five premature ventricular contractions per minute documented at any time before operation; rhythm other than sinus or presence of premature atrial contractions on preoperative electrocardiogram; age over 70 years; intraperitoneal, intrathoracic or aortic operation; emergency operation; important valvular aortic stenosis; and poor general medical condition. Patients could be separated into four classes of significantly different risk. Ten of the 19 postoperative cardiac fatalities occurred in the 18 patients at highest risk. If validated by prospective application, the multifactorial index may allow preoperative estimation of cardiac risk independent of direct surgical risk.


In vitro cell-mediated immunity of cerebrospinal-fluid lymphocytes to myelin basic protein in primary demyelinating diseases.

In an attempt to characterize the immunologic reactivity of cerebrospinal-fluid lymphocytes in demyelinating diseases, we compared the myelin-basic-protein-induced in vitro responses of these cells to peripheral blood lymphocytes from the same subjects with a variety of neurologic diseases. Peripheral blood lymphocytes from patients with acute disseminated encephalomyelitis and progressive multiple sclerosis had increased reactivity as compared to those of normal volunteers (P less than 0.01 and P less than 0.05, respectively). Cerebrospinal-fluid lymphocytes from patients with acute disseminated encephalomyelitis and acute and progressive (but not stable) multiple sclerosis were more reactive than cells from subjects with other neurologic diseases (P less than 0.005, P less than 0.02 and P less than 0.05, respectively). Cerebrospinal-fluid lymphocytes manifested a greater reactivity than peripheral blood lymphocytes in acute and progressive multiple sclerosis but not in acute disseminated encephalomyelitis. These findings demonstrate that lymphocytic cells reactive to myelin basic protein are present in the spinal fluid during active demyelinating disease; and that these cells may be more reactive than peripheral blood lymphocytes.


Effect of hypophosphatemia on myocardial performance in man.

Severe hypophosphatemia is associated in man with low intracellular stores of ATP and a set of specific cellular dysfunctions. To investigate whether hypophosphatemia affects myocardial performance, we measured cardiac output by thermodilution and calculated stroke work in seven patients with severe hypophosphatemia before, during and after repletion with an intravenous potassium phosphate solution. Mean left ventricular stroke work for these patients increased from 49.57 to 71.71 g-m per beat (P less than 0.01) at the same or higher afterload whereas pulmonary-artery wedge pressure fell from a mean value of 10.1 to 6.7 torr (P less than 0.02). Return of serum phosphate to normal, therefore, improved myocardial stroke work independently of the Starling effect. The mechanism of this improvement in contractile force is unknown but may be related to intracellular availability of ATP.


Structure of a dinucleoside phosphate--drug complex as model for nucleic acid--drug interaction.

The crystal structure of a 3:2 complex of the frameshift mutagen proflavine with the dinucleoside phosphate cytidylyl-3'5'-guanosine has been determined. The complex has one drug molecule intercalated between Watson--Crick base pairs of the nucleotide duplex. The other two proflavine molecules are bound to the exterior of the miniature double helix. The orientation of the base pairs in this miniature double helix has aspects similar to that found in RNA 11.


Orientation of cell-surface antigens in the lipid bilayer of lymphocyte plasma membrane.

Human HLA-A, B, C and Ia antigens were labelled by lactoperoxidase-catalysed iodination of the inner surface of lymphocyte plasma membrane and thus are transmembrane proteins. In contrast, membrane-bound human IgM and mouse IgM, IgD and Thy-1 antigen were not labelled on the inner membrane surface.