A study of 3H-L-flucose-containing glycoproteins of the crude synaptosomal fraction obtained from rat brain regions at various ages.

The frontal cortex showed a marked elevation of incorporation of 3H-L-fucose into glycoproteins of the crude synaptosomal fraction at 9 days of age. The effect was observed at both 8 and 24 hr after intraperitoneal administration of radioactive fucose. The elevation was absent in the 1, 5, 16, and 25-day-old frontal cortices. It was also absent in the hippocampus and cerebellum at all ages studied. Fucose-labeled glycoproteins of high molecular weight in the crude synaptosomal fraction, as separated by polyacrylamide gels,were preferentially labeled in the hippocampus, frontal cortex, and cerebellum at all ages studied. In general, these glycoproteins became less prominent in the oldest animals studied (25 days). However, the relative amount of these glycoproteins varied with age of the animal, time between administration of isotope and sacrifice, and with the brain areas studied.


Analysis of the response to therapeutic measures to reduce intracranial pressure in head injured patients.

Five methods of therapy for increased ICP were used in the treatment of 32 head-injured patients. The effects of steroids could not be evaluated. Withdrawal of CSF was always effective because intracranial volume was reduced and pressure must follow, but because of brain swelling and collapse of the ventricular system in this group of patients, it was not an effective permanent form of therapy. Hypertonic Mannitol reduced ICP in nearly every case irrespective of the degree of brain damage or the height of ICP. Hyperventilation was least effective in the most severely ill patients, presumably due to the non-responsiveness of the cerebral vessels to changes in PaCO2. The poorest response of ICP seemed to be with hypothermia.


A civilian air emergency service: a report of its development, technical aspects, and experience.

1) The development of Air Emergency Service sponsored by a private community hospital is described. 2) Helicopter evacuation of the seriously injured and critically ill in civilian life proved feasible if the community is willing to pay for the services rendered. 3) Two thousand six hundred fifty patients have been transported by helicopter (85%) or fixed-wing plane in 27 months. A minimum of 2,000 flights seems a certainty for 1975. 4) The types of patient, causes of death, and other medical aspects are discussed. 5) The helicopter must be considered as only one component in the E.M.S. System. It will be successful only with development of a complete program which includes: communications; cooperation of law enforcement agencies, fire districts, and rescue squads; integration with ground transportation; the inclusion of highly trained allied medical personnel, physicians, emergency departments and hospitals; and community education and acceptance.


Pulmonary capillary permeability - a transfusion lesion.

Massive transfusion of bank blood has been implicated as a major etiologic factor in the evolution of pulmonary insufficiency after injury. In spite of the demonstration of significant debris, including aggregates, in stored blood, a precise and reproducible pulmonary effect of transfusion has not previously been demonstrated. Since clinical pulmonary insufficiency is frequently accompanied by increased lung water, these experiments were designed to measure pulmonary capillary permeability and its response to transfusion of blood and blood components in rats. These experiments demonstrate that: 1) the rat lung is a target organ with regard to blood transfusion; 2) the lung lesion with transfusion is attributable, at least in part, to a selective and acute increase in pulmonary capillary permeability; 3) pulmonary capillary permeability is highly responsive to viable platelets; 4) prolonged storage of blood in polyvinyl chloride containers may enhance its ability to induce pulmonary capillary permeability; 5) increased capillary permeability with transfusion is largely eliminated when platelets and buffy coat are eliminated.


Post-traumatic trapped dislocations of the proximal interphalangeal joint.

This paper deals with the uncommon and frequently unrecognized problem of trapped dislocations of the proximal interphalangeal joint. These may be dorsal or volar. Soft tissue forming a noose, or interposed in the joint, is implicated. There is injury to one or more of the following structures: 1) extensor mechanism, 2) collateral ligament, 3) volar plate, 4) flexor tendon sheath, and 5) skin (compound dislocations). Open reduction and appropriate soft tissue repair are mandatory the essential features of diagnosis and management are discussed and four illustrative cases are presented.


The influence of route of administration on wound fluid concentration of prophylactic antibiotics.

The effectiveness of prophylactic antibiotics is dependent upon both the antimicrobial potency of the drug and the time at which it is first administered. Effectiveness is progressively lost when therapy is delayed, and it is generally recognized that drugs administered only 3-4 hours after contamination of a wound are largely without benefit. Another factor potentially influencing effectiveness in the traumatized patient is the considerable variation in the rate in which various antibiotics penetrate into the interstitial fluid compartment of surgical or traumatic wounds. The present study investigated the effect of route and method of administration of ampicillin, gentamicin, clindamycin, tetracycline, and cephalothin on subsequent wound fluid concentrations. Equivalent doses of each antibiotic were administered by either intermittent intravenous bolus (IV Push), continuous IV infusion (IV Cont) or intermittent intramuscular injection (IM). Peripheral blood and wound tissue fluid from previously implanted stainless steel cylinders were sampled sequentially during an 18 to 24 hour period and assayed for concentration of the antibiotic. Each antibiotic had a different pattern of distribution between serum and wound tissue compartments, but in general, the IV Push method showed comparable levels in wound fluid 4-12 times faster than the IV Cont method. After 12 hours, the highest sustained antibiotic concentrations in wound fluid was usually achieved with the IM route. These data suggest that the earliest and most sustained levels of antibiotic in wound tissue fluid can be achieved by a simultaneous IV Push and IM injection of the drug followed by intermittent IM injections in the normotensive patient or by an IV Push followed by IV Cont administration for patients in shock. These techniques are recommended when it is not possible to administer prophylactic antibiotics before bacterial contamination has occurred, such as regularly occurs in the traumatized patient, especially when treatment is delayed.


Changing concepts in the management of pathological and impending pathological fractures.

The benefits in the management of pathological fractures by internal fixation are well recognized. However, failures in bone or metal can occur where there is a large amount of bone destruction. Seven of 69 pathological fractures in our series were treated by internal fixation with adjunctive use of methylmethacrylate without failure. This allowed for secure fixation in fractures with large amounts of bone destruction, thus decreasing the patient's pain and allowing earlier mobilization. Neither the effects of radiotherapy on bone involved with neoplasm nor methylmethacrylate are altered when radiotherapy is used after internal fixation and adjunctive use of methylmethacrylate. We believe that an aggressive program of stabilization of these fractures or fixation before actual fracture provides significant patient benefits including reduction of pain, decreased length of hospital stay, reduction of financial expense, and return to as near normal function as possible.


Peritoneal tuberculosis presenting as pyrexia of unknown origin in immigrants.

Three immigrant patients with peritoneal tuberculosis seen over a three year period are discussed. All three patients presented with fever and minimal abdominal signs. One patient developed ascites while under investigation. In all cases, the fever was prolonged, liver enzymes were elevated and the ESR was raised. Two patients required laparotomy to make the diagnosis, and in the third tubercle bacilli were grown from the ascitic fluid. The difficulties in diagnosis are discussed.


Cutaneous leishmaniasis in Bisha Town, Saudi Arabia.

Of 620 out-patients of Bisha hospital, 110 showed cutaneous leishmaniasis. Leishmania bodies were demonstrated in smears of 73 patients. Both sexes were similarly affected. The highest incidence was among children in the age group one to 10 years. A single lesion was the predominant feature. The face was the commonest site of infection.


The problem of medical officer recruitment in agricultural industry.

All developing countries have difficulty in persuading doctors to opt for service in rural areas. This problem is shared by the agricultural industries. Two factors play a major role in this: isolation and the lack of a career structure. Isolation is an unavoidable accompaniment to rural practice. It can be considered as isolation from amenities, social isolation and professional isolation. The doctor in the rural area is often deprived of all urban amenities e.g. suitable shopping facilities, entertainment, cultural amenities and suitable leisure pursuits. Most of all, perhaps, he has major difficulties in educating his children. The maintenance of friendships and family connections is made difficult. There is a lack of suitable social intercourse for himself and his wife, a lack which very often leads to his wife's unhappiness and his own resignation. Professional isolation is serious and reflects adversely after a time on his professional ability. It may be that he only sees a colleague at long intervals and there is no stimulus towards keeping up to date professionally, and no opportunity to talk out professional and ethical problems. In many agricultural industries there is no career structure and therefore no scope for the good, ambitious doctor. This is particularly true of small, single-ownership plantations. It is clear that there is nothing to attract a good doctor to a place where he may remain at the same status for the rest of his professional career. It is suggested that only by the creation of a service structure within agricultural industries, which will create opportunities and within which means can be found to alleviate the effects of isolation, can a solution be found to the recruitment problem.


Use of amphotericin B in mucocutaneous leishmaniasis.

Twelve patients with South American mococutaneous leishmaniasis who attended the Hospital Amazonico in Peru between February and September 1974 were treated with amphotericin B. The lesions responded rapidly to treatment. A relatively low total dose of amphotericin B induced healing of active lesions. No serious adverse effects of treatment were encountered.


Serum proteins in hepatic amoebiasis.

Serum proteins were estimated in two patient groups, namely (i) 20 cases with proven ameobic liver abscess and (ii) 12 cases with hepatic amoebiasis without demonstrable pus, commonly referred to by the misnomer 'ameobic hepatitis'. In amoebic liver abscess a fall in albumin and an increase in alpha 2 and gamma globulin results in a serum protein pattern somewhat different from that in hepatic amoebiasis without demonstrable pus, where an elevation in gamma globulin was infrequent. Post-therapy serum protein estimations revealed that, irrespective of the presence or absence of pus, a rising gamma globulin level in hepatic amoebiasis may be of prognostic significance and post-treatment surveillance would be necessary in patients showing this type of response.


Middle ear disease in native Indian children in British Columbia--incidence of disease and an evaluation of screening methods.

A total of 1,109 Indian children in five British Columbia communities were surveyed for middle ear disease. Evaluation included a history, pure screening, impedance audiometry, and otolaryngological examination. Of these, 12.7 per cent had middle ear disease requiring treatment, namely serous otitis media, perforated tympanic membrane, or cholesteatoma. Serous otitis media was the commonest disease and it was most prevalent in the 0-4 years age group. Pure tone audiometry and impedance audiometry were both unsatisfactory screening methods in this study. The tests could not be performed in the majority of patients four years of age or younger, and they both showed a high incidence of false positive results as well as a significant incidence of false negative results. On the basis of this preliminary report a proposal is made for a screening and continuing evaluation program involving local health care personnel, audiologists, and otolaryngologists.


Ear disease in Western Canadian natives with a note on treatment by tympanoplasty.

A review is given of otitis media in northern native populations, including incidence, natural history, the effects on the individuals affected, and what is known of causative factors. A brief account of tympanoplasty is presented, followed by a description of the method used at the Charles Camsell Hospital, and the results obtained. Suggestions are made for improved follow-up and a plea is made for improved home conditions for the native population.


Chronic ear disease along the coasts of Labrador and Northern Newfoundland.

The high incidence of chronic ear disease among the three ethnic groups, Eskimo, Algonkian Indians, and Caucasians living under the same environmental conditions is studied. The role of socio-economic factors in the incidence and sequelae of ear disease in this population was similar to other studies among the native peoples of Alaska, Canada, and Greenland. The variation in the disease pattern in the different ethnic groups was shown to be related to the aeration of the middle ear cleft. The air cell system of the mastoid is determined by x-rays and/or surgical exploration, but the patency of the Eustachian tube and its size is determined by impedance audiometry and use of ureteric catheters. The clinical and surgical findings of the behavior of chronic ear disease in the different ethnic groups is correlated to tissue culture experiments. The role of lowered oxygen tension in the formation and behavior of cholesteatoma is illustrated well among the Caucasians with poor aeration of the middle ear cleft who show a high incidence of cholesteatoma, unlike the Eskimos with good aeration who show a complete absnece of cholesteatoma.


Surgical treatment of laryngeal stenosis.

In this study of the surgical treatment of acquired definite stenoses and atresia of the larynx, the author made the following classification: (i) stenoses due to bilateral paralysis of the recurrent nerve; (ii) stenoses caused by cicatrization of endolaryngeal structures, complete atresia of the larynx with obliteration of the lumen (a) the cartilaginous skeleton of the larynx is still preserved, (b) cases in whom for various reasons the cartilaginous skeleton had been destroyed and the lumen of the larynx assumed the shape of a narrow fissure covered with mucosa; and (iii) cases without cartilaginous skeleton or mucosa where only a cicatricial tissue has remained. As a basis for this research 120 cases were used. Two surgical techniques in bilateral paralysis of the recurrent nerve are described in detail. A combined extra- and intralaryngeal method of submucosal exenteration of the larynx and arytenoidectomy on one half, and cordopexy and disarticulation of the arytenoid was carried out on 30 patients. The second technique, which is still in a clinically experimental phase, is called arytenoidectomy and cordopexy via intercricothyroidolaryngotomy. It was used on only two patients, while greater experience has been gained through experiments carried out on animals (horses and dogs). In 22 patients treated for cicatricial stenoses and atresia various kinds of plastic reconstructive procedures were used. In all 22 patients treated for cicatricial stenoses and atresia various kinds of plastic reconstructive procedures were used. In all 120 cases the respiratory function of the larynx was satisfactorily restored. The voice of all these patients was altered and the phonatory function in 65 per cent of cases remained significantly impaired.


Tracheal stenosis.

Tracheal stenosis following assisted ventilation is becoming recognized as a major complication of tracheostomy, and the use of cuffed tracheostomy tubes. The possible causes and surgical management of this condition are discussed together with recommendations to minimize the possibility of post-tracheostomy tracheal stenosis.


Electronystagmographic findings in cerebellar dysfunction.

Ocular dysmetria is seldom mentioned in the neurootologic literature as an electronystagmographic (ENG) abnormality. For the last two years, we found ocular dysmetria on 38 cases out of 1,879 ENG recordings. Cerebellar dysfunction was the most apparent cause in 13 out of 21 cases examined by us. The group of unilateral hypermetria showed some other ENG abnormalities like positional nystagmus, post-caloric directional preponderance, failure of fixation suppression of post-caloric nystagmus (FFS), more scattered distribution of quick phase amplitudes of post-caloric and optokinetic nystagmus on the side of hypermetria. We wonder whether this symptomatology, or at least part of it, is due to dysfunction of the flocculo-nodular lobe of the cerrebellum.


A clinical-functional evaluation of facial paralysis.

A clinical-functional evaluation of facial paralysis is presented in order to suggest a uniform and standard classification. The outcome of this disease treated with various modalities may be similarly appraised by all medical disciplines. A score of 50 per cent is allotted to each of the main divisions of the facial nerve, namely, eye and oral commissure; 15 per cent is given to the symmetry in repose of the eye and oral commissure respectively; and 35 per cent to the sphincteric function of the orbicularis oculus and oris respectively.


Cryosurgery in chronic nasal obstruction.

This is a paper presented to show the results that have been achieved by the utilization of cryosurgery in chronic rhinitis. In my hands, it has worked out very successfully and I offer this as an encouraging modality of treatment for a troublesome group of cases.


[Malignant bilateral external otitis in a 10-year-old girl].

Malignant external otitis in which the prognosis is very severe has been recently described, as related to diabetes in old age. We present a case with malignant external otitis which occurred in a 10 year old girl, with a very peculiar development. Indeed, the external otitis which appeared at first on the left side was accompanied on this side by a facial paralysis, and six months later in the right, a malignant external otitis was also found without facial palsy. Furthermore, this young girl has been affected by an insipid diabetes, for which no hypophysial or renal pathology has been found. After reviewing the literature on that subject, the authors discuss the clinical aspect of that case and its treatment.


Familial bleeding tendency and tonsillectomy.

A retrospective study of 2,292 tonsillectomies revealed 12 cases of hereditary capillary fragility. These cases showed an increased morbidity from bleeding complications and accounted for 4.8 per cent of those with a secondary hemorrhage. When diagnosed, skin bleeding time should be carried out at the time of premedication, and, if prolonged, the procedure postponed.


Wound healing.

This paper briefly summarizes some aspects of wound healing with particular reference to: the healing of a simple skin incision as compared to that of a wound with separated edges; granulation tissue formation and the nature of myofibroblasts; wound contraction; and, finally, the structure and biosynthesis of collagen.


Facial asymmetry and the oral surgeon.

Facial asymmetry is often caused by deformities of the mandible or maxilla. Mandibular deformities are often pronounced, and various surgical procedures have been developed to treat such conditions. Deformities of the maxilla are similarly deviated from the normal. Although they are not always so noticeable as those of the mandible, they adversely affect function, esthetics and mental wellbeing. There are instances where both jaws are at fault and require treatment. More recently, osteotomies in the anterior of the maxilla or mandible have been performed with success. If the blood supply to the segment of bone and teeth is respected, a variety of procedures is possible in mandibular-maxillary surgery.


Current developments in bronchoscopy. The role of the flexible fiberscope.

The development and increasing use of flexible fiberoptic bronchoscopy has added immeasurably to the potential of diagnostic and therapeutic bronchoscopy. However, neither the flexible nor rigid (open tube) bronchoscope should be regarded as the "primary instrument", but the use of one or the other in the individual case should depend on relative indications. Ideally, bronchologists should be proficient with both rigid and flexible instruments; it is preferable that those experienced only in flexible bronchoscopy work in collaboration with those who are familiar with open tube bronchoscopy as well. In any case, the need for facility in management of airway obstruction, indirect and direct laryngoscopy, and proper administration of topical anesthetics to the larynx and tracheobronchial tree should be recognized. Indications, instrumentarium and technique, special applications, contraindications and complications of flexible bronchoscopy are reviewed.


Anesthesia for endolaryngeal surgery.

A method of anesthesia for endolaryngeal surgery that dispenses with the use of an indwelling endotracheal tube with consequent improvement in the surgical conditions is described. This method further permits the manipulation of the surgeon's laryngoscope and the use of endolaryngeal surgery to improve the compromised or potentially compromised laryngeal airway without serious risk and with avoidance in some circumstances of preliminary tracheostomy.


Observations on the simultaneous occurrence of laryngocele and cancer.

The simultaneous occurrence of laryngocele and laryngeal cancer is uncommon. To date, 64 detailed descriptions of this association have appeared in the world's literature. In large restrospective series of laryngeal cancers, the incidence varies between zero and 9.7 per cent. Four additional cases are discussed. The pathogenesis of laryngoceles associated with tumor appears to be related to factors altering the mechanics of the laryngeal ventricle to a chronically elevated intralaryngeal pressure. Circumstances producing a ball valve effect appear to be a factor for saccular distention in some cases. In other instances, the association between laryngocele and cancer is probably coincidental.


A radiological and clinical correlative study of laryngeal abnormalities seen in Northern Alberta.

Contrast laryngograms performed on 50 patients referred to the radiology department of University Hospital between 1967 and 1973 were correlated with the direct laryngoscopic and pathological findings. Not a single malignancy in this series was missed radiologically, but in three out of 32 cases, the radiological extent of these lesions was considered more advanced than the pathology results. All patients with proven chronic inflammations, had symptoms of carcinomas of the larynx. No false positive carcinomas were diagnosed laryngographically in this group. In a patient with the nasopharyngeal carcinoma and in a case of myasthenia laryngis the radiological diagnosis would probably not have been misinterpreted if clinical histories were obtained prior to laryngography.


Petrous meningioma en plaque presenting as a right middle ear tumor.

A case of meningioma en plaque presenting as a tumor in the right middle ear is described. A review of the relevant literature indicates only three previous reports of an en plaque meningioma occurring in the posterior cranial fossa. The unusual features of this tumor are described and the clinical manifestations and diagnosis discussed in detail.


Effect of marihuana on hearing.

Marihuana has been said to improve hearing. Two earlier studies have supported this contention. In this investigation, marihuana or placebo cigarettes were randomly smoked by 30 subjects, 15 in each group. Before and after smoking, batteries of standard audiological tests were carried out; pure tone threshold (air and bone conduction), speech reception threshold, speech discrimination at most comfortable level, and relative acoustic impedance measurements including middle ear pressure, stapedial reflexes, compliance, tympanic mobility, and Eustachian tube function. A comparison of pre and post smoking auditory test scores did not demonstrate any significant change in auditory function in the marihuana or placebo group. However, as all subjects had normal hearing and maximum speech discrimination scores pre-smoking, it can only be concluded that smoking marihuana did not worsen the hearing--the experiments were not designed to see whether it would improve hearing.


Clival chordoma.

Chordomas are uncommon tumors arising from embryonic remnats of the fetal notochord. The spheno-occipital and sacrococcygeal regions account for over 90 per cent of cases, the remaining 10 per cent occurring anywhere along the vertebral axis. A case of chordoma arising from the clivus is presented with a view to discussing management. The ability to obtain reasonable survival times associated with a useful and meaningful quality of life is emphasized. This may be accomplished by repeated, judicious surgical intervention with surprising ease and little morbidity to the patient in spite of its intracranial location.


Complication and correction of the pierced ear.

This paper emphasizes three major complications that are corrected by techniques of soft tissue surgery. These are: (1) keloid formation; (2) bifid earlobe; (3) recurrent itching and weeping. Other complications are also mentioned.


[Surgery of the narrow liminal valve extranasal let out: technic and biomechanical explanation].

Using cadaver material and drawings, the surgical procedure called "let out" of the nasal pyramid was described. It utilizes the principles of conservation of the skeletal integrity of the nasal dorsum of the "push down". This procedure is indicated in patients with a narrow valve and high thin nose, without vasomotor rhinopathy or allergy. A patient illustrates the good functional results of the surgery as shown by the base view and the secondary benefits from an appearance standpoint as shown by the profile view. We thought that we could explain the improved nasal ventilation by an augmentation of the cross section area of the nose at the valve. Measurements on the cadaver showed that the area was smaller after surgery. We hypothesized finally that the improved rigidity of the valve secondary to its shortening and the augmentation of the angle of the liminal valve created a conduit that allowed normal inspiratory flow through the nose.


Crossed fusion of renal pelves and Klippel-Feil syndrome.

Congenital fusion of the renal pelves occurs rarely and is usually associated with fusion of the kidneys. The first case of surgically proved separate kidneys with crossed fusion of the renal pelves is reported.


Renal medullary fibroma presenting as a calcified mass with neovascularity.

Radiologic evaluation of a 70-year-old woman revealed a large calcified mass in the left kidney. Arteriography demonstrated neovascularity and left nephrectomy was performed. Pathologic evaluation revealed the lesion to be a large renal medullary fibroma.


The stone-forming kidney: a study of functional differences between individual kidneys in idiopathic renal lithiasis.

The 24-hour urinary excretion of various electrolytes, as well as the glomerular filtration rate, renal plasma flow and maximal rate of tubular excretion of para-aminohippuric acid was measured in each kidney of 10 patients with idiopathic renal lithiasis. Results in hypercalciuric patients indicate that, in contrast to earlier views, actively stone-forming, normally functioning kidneys are normocalciuric but hypophosphaturic in comparison to their mates with inactive or no stone disease, which are hypercalciuric but normophosphaturic. Therefore, hypophosphaturia rather than hypercalciuria may be an important calculogenic factor in some patients.


Spontaneous rupture of an iliac artery aneurysm into a ureter: a case report and review of the literature.

A case of massive hematuria from spontaneous rupture of an iliac artery aneurysm into a ureter is reported. The vascular causes for gross hematuria are reviewed and the various arterial aneurysms are discussed. The need to consider vascular abnormalities when dealing with massive hematuria is emphasized.


An unusual complication  of pelvic exenteration.

A case of recurrent carcinoma at the site of a urinary conduit stoma after total pelvic exenteration for carcinoma of the cervix is reported. Treatment by radical excision of the abdominal wall encircling the conduit and postoperative radiotherapy was successful. The patient is free of disease 6 years later.


Septic arthritis secondary to vesico-acetabular fistula: a case report.

The second case of septic arthritis resulting from a vesico-acetabular fistula secondary to a penetrating injury is reported. Despite reported good results in blunt trauma with hip and urinary tract drainage combined with appropriate antibiotics, improvement occurred in our patient only after surgical excision of the fistulous tract. It appears that in some cases early fistulectomy can shorten hospital stay and reduce the incident of complete ankylosis.


Leiomyoma of the female urethra: a case report.

A case of leiomyoma of the female urethra arising from the anterior lip of the external urinary meatus is presented. The tumor was missed originally and, subsequently, increased in size. Although the neoplasm was suspected clinically, it was confirmed only by histopathology. The tumor was responsible for recurrent urinary tract infection, which ceased after the neoplasm was excised.


Urethral carcinoma after radiation therapy for mixed prostatic carcinoma.

The first case of transitional cell carcinoma of the bulbous urethra occurring 8 months after radiation therapy for mixed ductal and adenocarcinoma of the prostate is presented. The significance of the sequential appearance of these tumors is discussed. Periodic endoscopic evaluation appears warranted following the diagnosis of transitional cell carcinoma of the prostate to ensure early recognition of secondary  urethral lesions or bladder extension of the tumor.


Priapism: an unusual presentation.

A patient with an unusual form of priapism is described. Only the corpora cavernosa proximal to the suspensory ligament were erect. A well defined membrane was found in each corpus cavernosum at the penoscrotal junction, separating turgid and flaccid erectile tissue. When these membranes were removed the erect proximal corpora drained into the flaccid distal corpora and the entire penis remained flaccid 6 weeks later.


Reaction to indigo carmine.

The commonly encountered cardiovascular effects of intravenous indigo carmine administration is transient alpha-receptor stimulation, namely increased total peripheral resistance, diastolic and systolic blood pressure, and central venous pressure with decreased cardiac output, stroke volume and heart rate. These usually cause no problems and frequently go undetected unless the patient is monitored closely during that brief interval. However, significant problems occur occasionally and its use is not totally without risks.


Treatment of hemorrhage from renal trauma by angiographic injection of clot.

Experimental results in rats and modest clinical experience now indicate that persistent or massive hemorrhage from renal trauma can be treated by injection of clot(under angiographic control) into the bleeding vessels. There is minimal loss of renal tissue and an operation is avoided.


Diagnosis and treatment of a urinary leak after ureteroileal conduit for diversion.

Of 1,120 cases of ileal loop urinary diversion reviewed from our hospital 21 postoperative loop leaks were noted (1.87 per cent). Definite indications for diagnostic studies of urinary extravasation include persistent postoperative azotemia, sepsis and/or urinary leakage via the drains. In this series 2 types of loop leaks were noted--an early postoperative leak within the first 24 hours and a leakage 6 to 12 days postoperatively. More aggressive management of postoperatively urinary extravasation is urged, especially in patients who had been irradiated and suffered leakage later on in the postoperative course.


A unified concept of renal trauma.

Of 115 cases of renal trauma 75 injuries were blunt and 40 were penetrating. Primary exploration was done in20 per cent of the patients with blunt injuries and in 100 per cent of those with penetrating injuries. A reparative procedure was done in 60 per cent of the patients operated on for  blunt trauma and in 73 per cent of those operated upon for penetrating trauma. Only 3 per cent of the patients with blunt injury and 28 per cent of those with penetrating injury required a nephrectomy. We have concluded that renal injuries should be classified by type and extent rather than by etiology, that the extent of injury should be determined and not surmised, and that the management of renal trauma is a function of the extent of injury and the over-all status of the patient. In addition, the non-operative management of an inadequately defined renal injury cannot be considered conservative management.


Bilateral simultaneously-occurring adenocarcinoma of the kidney.

Our 3 patients with simultaneously-occurring hypernephromas treated with simultaneously-directed surgical therapy on both kidneys are described. One patient died with residual neoplasm 2 1/2 years postoperatively, while the other 2 patients are alive and presumably free of tumor 60 and 22 months postoperatively.


Vesicorectostomy revisited.

Between 1948 and 1959 vesicorectostomy, a permanent anastomosis between the bladder and rectum, was constructed in 7 male patients. Scattered reports of this procedure exist but none since 1959 and long-term followup has never been reported. we present long-term followup, including renal function, excretory urography and voiding cystorectography, and review the quality of life in the 7 patients. The most frequent complication was stenosis of the anastomosis. None of the patients in this series with normal preoperative upper tracts showed radiographic or chemical deterioration postoperatively. Since this procedure maintains urinary continence, does not disturb the normal physiology of the ureterovesical junction and minimizes urinary reabsorption its use should be considered in certain patients as an alternative method of urinary diversion.


Further experience with intravesical dimethyl sulfoxide in the treatment of interstitial cystitis.

Intravesical dimethyl sylfoxide has given satisfactory symptomatic relief in 75 per cent of patients with interstitial cystitis so treated. The treatment is simple and inexpensive, and can be safely administered as an office procedure. Objective improvement in the endoscopic appearance of the disease, with improvement in bladder capacity, was noted in 80 per cent of the patients in our series. Further work with dimethyl sulfoxide is indicated in the treatment of interstitial cystitis, as well as a variety of other genitourinary disorders.


A second look at injection of vesical neck contractures with triamcinolone.

Adjuvant therapy for vesical neck contractures with triamcinolone injection has given good results with long-term followup but similar results have been obtained with transurethral resection alone in our current re-evaluation. Herein we review 220 consecutive vesical neck contractures treated by the aforementioned modalities.


Cytology in the diagnosis and followup of transitional cell carcinoma of the urothelium: a review with a case series.

Acceptance of the value of urinary cytology in transitional cell carcinoma has been mixed. Over-all accuracy is only fair to good and the results in mass screening are poor. However, cytology can be valuable in the serial evaluation of selected patients by the collection of multiple specimens. It is an important adjunct in upper tract lesions, in carcinoma in situ and in the evaluation of the patient with unexplained hematuria. Herein we analyze patients with transitional cell carcinoma of the urothelium with special reference to the use of cytology irrigation specimens from the bladder and the renal pelvis as  an initial diagnostic tool and as an adjunctive technique for the evaluation of recurrence.


Experience with implantation of the Small-Carrion penile implant for organic impotence.

The 13 patients described herein have had successful placement of a Small-Carrion penile prosthesis through a penile incision. Because of surgical control and possible decreased chance of infection this approach is advocated over the perineal incision except in cases of post-priapism impotence or simultaneous placement of a Kaufman anti-incontinence device.


Association of priapism in phenothiazine therapy.

We present 4 patients seen in the last 5 years who had taken thioridazine (Mellaril) prior to development of priapism. One of the 4 patients suffered penile trauma while taking the phenothiazine drug and this is another possible etiologic factor in that case. No underlying urologic or hematologic disorders were present. All patients were treated by corporeal aspiration and corpus cavernosum-corpus spongiosum shunts. The mechanism of phenothiazine=induced priapism is hypothesized as being related to its peripheral adrenergic blockade, perhaps directly blocking the sympathetic impulse for detumescence, although a central nervous system effect must be considered as well. Lastly there exists the possibility of coincidence since phenothiazine treatment is becoming more common and was unrelated to the condition in an additional 6 patients with priapism seen during the same period.


Treating the subfertile male patient: improvement semen characteristics after low dose androgen therapy.

Preliminary results suggest that the semen of selected patients can be improved after administration of low doses of fluoxymesterone and that the therapeutic regimen may be most beneficial for individuals with reduced sperm motility, abnormal semen morphology and/or low semen volume.


Endocrine studies in Sertoli-cell-only syndrome.

Pituitary-gonadal endocrine functions were studied in 15 patients with Sertoli-cell-only syndrome and a comparison was made with other testicular diseases, such as Klinefelter's syndrome. Elevated levels of serum luteinizing hormone as well as follicle stimulating hormone and lowered levels of serum testosterone suggested the existence of Leydig cell failure in addition to germ cell failure. However, the degree of these endocrinological abnormalities in patients with Sertoli-cell-only syndrome was mild compared to that in patients with Klinefelter's syndrome. Reserve capacity of Leydig cells in patients with Sertoli-cell-only syndrome was considered to be preserved as suggested by the human chorionic gonadotropin stimulation test.


Prognosis for pathologic stage I non-seminomatous germ cell tumors of the testis managed by retroperitoneal lymphadenectomy.

The over-all 3,5 and 10-year survival rate for 87 patients with non-seminomatous germ cell tumors of the testis undergoing retroperitoneal lymphadenectomy was 90.5 per cent. Of the 72 patients receiving no form of therapy other than retroperitoneal lymphadenectomy after operative removal of the testicular tumor the 5-year survival rate was 90.8 per cent. The 5-year survival rates for these 72 patients, calculated according to the histologic characteristics of the primary tumor, were 74.4 per cent for 18 patients with embryonal carcinoma, 93.0 per cent for 36 patients with teratocarcinoma and 100 per cent for 18 patients with teratoma. Although no advantage could be demonstrated for bilateral lymphadenectomy as opposed to unilateral dissection, it is concluded that a modified bilateral dissection should be reserved only for tumors on the left side.


Studies of introital colonization in women with recurrent urinary infection. VI. Analysis of segmented leukocytes on the vaginal vestibule in relation to enterobacterial colonization.

Segmented leukocytes on the vaginal vestibule were quantitated in 93 specimens from 27 women with recurrent bacteriuria (1.03 times 10(5) plus or minus 4.9 times 10(5) cells per ml.) and compared to 251 specimens from 26 control women who had never had bacteriuria (8.0 times 10(4) plus or minus 1.7 times 10(5)). There was no significant difference (p more than 0.6). Leukocyte counts accompanying colonization with more than 100 Enterobacteriaceae per ml. (6.4 times 10(4) plus or minus 1.0 times 10(5) cells per ml). were no different from those unaccompanied by Enterobacteriaceae (8.7 times 10(4) plus or minus 3.3 times 10(5) cells per ml., p more than 0.9). No distinctive pattern was observed in excretion of vaginal leukocytes during the menstrual cycles of 21 premenopausal, control volunteers.


Coagulum pyelolithotomy using autogenous plasma a and bovine thrombin.

Herein we describe a technique in which the patient's own plasma was used to form an intrapelvic clot, thus aiding in the removal of calculi lying loose in the renal pelvis or infundibula.


Investigating wide ureters with ureteral pressure flow studies.

A perfusion study is described and its usefulness in the diagnosis of ureterovesical obstruction is discussed. The study includes 31 children with either primary or secondary non-refluxing wide ureters or ureters that had been reimplanted previously.


Concentrating ability after antireflux operation.

Children undergoing surgical correction of reflux require short-term and long-term assessment of the functional, bacteriological and radiologic results. In short-term assessment concentrating ability may be a more sensitive indicator of benefit or harm than creatinine clearance. There were no cases of persistent reflux and a 7 per cent obstruction rate in 59 ureteral reimplantations in 36 children.


Silver nitrate irrigation to control bladder hemorrhage in children receiving cancer therapy.

Silver nitrate irrigations after cystoscopic evacuation of clots stopped intractable hemorrhage from the bladder in 8 of 9 children who had received cyclophosphamide and/or pelvic irradiation for various malignant diseases. This method of management produces fewer adverse side effects yet appears to be as effective as the more drastic measures of control, such as cystectomy or colocystoplasty.


Urinary ascites secondary to posterior urethral valves.

Neonatal urinary ascites demands prompt diagnostic and therapeutic medical attention. Obstructing posterior urethral valves are a major cause (70 per cent) of this entity. Survival in these children can be directly related to age, selection of therapeutic modality and the presence or absence of associated pulmonary and electrolyte abnormalities. Oligohydramnios is implicated in the production of pulmonary hypoplasia leading to respiratory distress in these patients. Other manifestations of prolonged, increased fetal compression, that is the non-renal features of Potter's syndrome, include altered facies, aberrant hand and foot development and late fetal growth deficiency. Aberrant pulmonary development seems to be related to increased intrauterine pressure (oligohydramnios alone) as well as increased fetal intra-abdominal pressure (oligohydramnios plus urinary ascites). The best therapeutic results were achieved in those children treated by early, high urinary diversion. The mortality rate for newborns less than 72 hours old was significantly higher (66 per cent) than for those more than 72 hours old (15 per cent).


Pneumomediastinum following a surgical renal biopsy.

A case of pneumomediastinum, which appeared after a biopsy of the right kidney by minimal lumbotomy, is reported.  The anatomicopathological condition of the renal fragment obtained was judged to be focal and segmental hyalinosis. We wish to emphasize the rarity of such a complication, the type of electrocardiographic changes observed, and the rapid and spontaneous recuperation of the patient without further repercussions.


Wedged catheter management of a bleeding renal pseudoaneurysm.

A patient with significant gross hematuria following renal biopsy is managed successfully with subselective wedged arterial occlusion.


Percutaneous transfemoral embolization of arterio-infundibular-venous fistula.

An arterio-infundibular-venous fistula complicating partial nephrectomy was embolized successfully via transfemoral catheterization of the right renal artery using autologous muscle. The use of autologous material occluded this vascular malformation with preservation of renal function in the remaining portion of the kidney. The technique was lifesaving since this patient was in critical condition and could not tolerate an operation.


Environmentally acquired lead in the laughing gull, Larus atricilla.

Lead concentrations were measured in eggs, prefledgings and adult laughing gulls collected near Galveston, Texas. No lead was found in eggs. Prefledgling and adult birds had lead ranging from zero to 16 mug/g wet tissue. Liver had the greatest lead concentrations followed by brain, heart and skeletal muscle. There were no significant differences in lead concentrations between fledglings and adults or between males and females.


Visual defects in white-tailed deer from Michigan six case reports.

Six cases of unrelated visual defects in free-ranging white-tailed deer (Odocoileus virginianus) from Michigan are described. Two were congenital, two were of infectious etiology, one from central nervous neoplasia, and one from degenerative changes in lenses of both eyes.


Dirofilariasis in Iowa coyotes.

(Dirofilaria immitis) were found in eight of 220 (3.6%) coyotes (Canis latrans) collected from fur buyers in Adams, Carroll, Cass, and Warren counties in southwestern Iowa. Infections ranged from one to 23 worms per coyote.


A case report of an epidermal papilloma in Mustelus canis.

A white, raised mass present on the caudal fin of a smooth dogfish shark (Mustelus canis) was identified as an epidermal papilloma with areas suggestive of carcinoma in situ. When examined by electron microscopy no structures or particles of viral origin were apparent.


Prevalence of cuterebrid parasitism among woodmice in Virginia.

Botfly infestation was analyzed in 1319 small mammals from varied habitats and elevations in upland Virginia, 1972-1974. Adult Cuterebra fontinella were reared from bots infesting the woodmouse (Peromyscus leucopus). Of 651 woodmice, 199 (30.6%) were infested at least once. The season of bot infestation extended from May through November of all years, with peak prevalence (mean 42.2%) in August. Infestation in woodmice was general over a 2000 km2 study area during peak months. Significantly greater prevalence (P less than 0.001) was seen in forested and brushy habitat (39.9%) compared with old fields (2.6%). Higher prevalence (P less than 0.01) was found in males than in females, and in postjuveniles compared to adults. Greatest overall prevalence (39.1%) was in postjuvenile males. Most warble sites (98%) were inguinal, and observations suggested that many infested adults were non-reproductive. Mean burden (1.27) was independent of host age, sex, habitat, and month of capture. Multi-infestations occurred in 23% of the affected mice; maximum burden was six bots. Botflies were absent or negligible in sympatric deermice (P. maniculatus) and twelve other species of rodents and shrews.


A hematologic survey of captive waterfowl.

Hematologic parameters were studied in giant Canada geese (Branta canadensis maxima), mallard ducks (Anas platyrhynchos platyrhynchos) and various species of diving ducks at seasinal intervals throughout the year. Highest values for packed cell volume, hemoglobin content and erythrocyte counts were found in the winter and pre-nesting periods. Mean corpuscular volume and mean corpuscular hemoglobin varied inversely with these values.


Moose milk and hair element levels and relationships.

Milk was collected from 21 Alaskan moose (Alces alces gigas) at the Kenai Moose Research Center (MRC), Soldotna, Alaska nad analyzed by atomic absorption spectroscopy for Al, As, Ca, Cd, Co, Cr, Cu, Fe, Hg, K, Mg, Mn, Mo, Na, Ni, Pb, Se and Zn. Hair samples were collected from 100 moose at the MRC to correspond with the lactation period and serve as a metabolic indicator of mineral elements stored in tissue. Published analyses of bovine milk were compared to moose milk; Al, Fe, Se and Zn were higher in moose milk by factors of 1.6 to 290. Elements potentially influenced by nutrition and those determined genetically were also  considered. Elements in moose milk and hair values were compared, since mineral element levels in hair potentially reflect the availability and intake of these elements. Calcium and Mg were the only values in hair lower than the values in milk (factors of 4.2 and 1.5 respectively). Moose, as well as domestic cattle, apparently are subjected  to lactation stress by the genetically determined levels of Ca and Mg in milk.


Growth dynamics and seasonal prevalence of Crepidostomum isostomum and Phyllodistomum pearsei in Aphredoderus sayanus.

A trematode survey of pirate perch, Aphredoderus sayanus, in Louisiana demonstrated a seasonal periodicity of Crepidostomum isostomum with regard to prevalence, worm burden, and maturation. The prevalence of Phyllodistomum pearsei showed no discernable periodicity and only the worn development followed a seasonal pattern.


Experimental chlamydiosis in wild and domestic lagomorphs.

Chlamydia psittaci (strain M56, the agent of epizootic chlamydiosis of muskrats and hares) was highly lethal for the snowshoe hare (Lepus americans) following intravenous inoculation, whereas the agent was much less virulent for cottontail (Sylvilagus floridanus) and albino domestic rabbits (Oryctolagus cuniculus). Tissue titres of strain M56 were generally higher after 96 hr in the snowshoe hare than in tissues of the other lagomorphs. Spleen, liver and bone marrow were apparently the chief sites of primary multiplication of strain M56 in the hare. Virulence appeared to be very host specific in that only strain M56 among the six chlamydiae tested was highly lethal for the snowshoe hare.


Clinical observations on the use of ketamine hydrochloride in wild carnivores.

Ketamine hydrochloride was administered intramuscularly to 171 individual animals of five carnivore species. The drug was used in doses which resulted in a range of effects from simple immobilization to a surgical plane of anesthesia during which minor operations were conducted. The drug was found to have a wide margin of safety, was easily administered by syringe, and took effect rapidly. Undesirable side effects of excessive salivation and maintenance of muscle tone were readily controlled by combining ketamine hydrochloride with other drugs.


Prevalence of antibodies to Toxoplasma gondii in wild and domestic animals of New Mexico, Arizona and Colorado.

Using the Sabin-Feldman dye test, sera from wild and domestic animals in New Mexico, Arizona and Colorado were tested for the prevalence of antibodies to Toxoplasma gondii. The prevalence of positive titers (greater than or equal to 1:8) in animals from these areas was: New Mexico (178 of 569, 31%), Arizona (11 of 56, 20%), and Colorado (2 of 7, 29%). The overall prevalence of antibodies to Toxoplasma was 30% (191 of 632). Nine of 17 fecal samples from wild zoo felines contained Toxoplasma-like oocysts which were inoculated per os and intraperitoneally into mice. Mice from six of these nine inoculations later showed positive dye test titers and tissues from five of these six groups had tissue cysts when examined histologically.


Further studies on trypanosomers in game animals in Wyoming.

Blood samples were collected from captive and free-ranging elk (Cervus canadensis), mule deer (Odocoileus hemionus), white-tailed deer, (Odocoileus virginianus), black-tailed deer (Odocoileus hemionus columbianus), pronghorn (Antilocapra americana), moose (Alces alces), and bighorn sheep (Ovis canadensis) for cultural evidence of Trypanosoma sp. infection. Eleven of 188 (12%) hunter-killed elk, 22 of 37 (59%) free-ranging elk, and 79 of 119 (66%) captive elk were culture positive in 1973-74. Parasitemia in adult captive elk showed seasonal variation. Other captive or live-trapped animals found positive included 16 mule deer, two white-tailed deer, and one black-tailed deer. No pronghorn, moose, or bighorn sheep were positive. A 0.25 ml inoculum of elk blood was sufficient to give positive culture results. Small sample size may have contributed to negative results from elk trapped in March 1973.


Subcutaneous exposure of the Richardson's ground squirrel (Spermophilus richardsonii Sabine) to western equine encephalomyelitis virus.

Both adult and suckling Richardson's ground squirrels (Spermophilus richardsonii) were susceptible to subcutaneous exposure with western equine encephalomyelitis (WEE) virus, but the virus was more virulent for sucklings than adults. In sucklings, the incubation period was from 4 to 5 days, followed by apparent signs of central nervous system (CNS) involvement. Death occurred 10 to 13 days postexposure. In adults, infections were inapparent or acute with typical signs of CNS involvement similar to those observed in sucklings. In both age groups, brain and lymph nodes were the most frequently involved tissues. The highest titres of virus were recovered from brain, sections of which also showed the most marked histological changes. Lesions in the brain included multifocal vasculitis, perivascular edema, perivascular cuffing, focal or diffuse gliosis, parenchymal hemorrhage, meningitis with infiltration of mononuclear cells, neuronal degeneration, and occasional demyelination. For both age groups, viremias were detected for 3 to 5 days with a maximum virus titre of 4 to 6 logs, a sufficient time and magnitude to infect numerous mosquitoes, further supporting the hypothesis that S. richardsonii may serve as an amplifying host of WEE virus in the prairie provinces.


Necrosis and bacterial infection in channel catfish (Ictalurus punctatus) following hypoxia.

Apparently sterile lesions developed in the skin and musculature of channel catfish (Ictalurus punctatus) six days after fish were severely stressed by an oxygen depletion associated with a phytoplankton die-off in an 8.9 ha pond. Lesions were characterized by hemorrhage and necrosis. Aeromonas hydrophila was isolated from either the lesions ot internal organs of all moribund fish necropsied the day after lesions were first found. As the water quality improved the health of the fish improved. Water quality data collected before and after the oxygen depletion, and associated fish mortality, are presented.


Erysipelothrix rhusiopathiae infection in chukar partridge (Alectoris graeca).

Erysipelas was diagnosed in chukar partridges (Alectoris graeca) kept as hunting stock. Mortality was 265 of 500 (53%) over a period of one week.


An investigation of North Atlantic whales for trichinosis.

In 1971, 81 finback (Balaenoptera physalus), 119 sei (B. borealis), two piked (B. acutorostrata), 15 humpback (Megaptera novaeangliae) and one sperm whale (Physeter catodon) taken in the North Atlantic off the Newfoundland and Nova Scotia coasts were examined for the presence of Trichinella spiralis. All 218 whales were negative for trichinosis.


The effect of sublethal concentrations of zinc on growth and plasma glucose levels in rainbow trout, Salmo gairdneri (Richardson).

The long term effects of three sublethal concentrations of zinc (0.214, 0.52 and 1.12 ppm) on growth and plasma glucose concentration in yearling rainbow trout Salmo gairdneri (Richardson) were investigated. Analysis of covariance of percent weight increase revealed that a significant inhibition of growth (P less than 0.05) in the 1.12 ppm zinc-exposed fish had occurred. Plasma glucose showed a significant hyperglycemia (P less than 0.05) in all three zinc-exposed groups of fish after 7 days exposure and in the 1.12 ppm zinc-exposed group after 63 days. The hyperglycemia observed has been explained as possibly resulting from activation of the pituitary-interrenal axis by the stress of zinc causing mobilization of tissue glycogen.


Cerebral abscess associated with stranding in a dolphin.

A captive Atlantic bottlenosed dolphin (Tursiops truncatus) was examined after being found beached in the shallows of its lagoon enclosure. An abscess was found in the right cerebral hemisphere, and Staphylococcus aureus was isolated from the lesion. Histopathologic examination of the brain revealed a pyogenic meningoencephalitis.


Studies of hypoxemia and pulmonary hemodynamics in acute myocardial infarction.

On 55 patients with acute myocardial infarction blood gas changes and A-aDO2 while breathing room air were observed for a period of 5 weeks. PaO2 during the 35% O2 inhalation was measured on admission and 5 weeks later for comparisons with the PaO2 while breathing room air. Pulmonary circulatory hemodynamics was measured in 29 cases on admission using Swan-Ganz's right heart flow directed catheter 7F, and the catheter was kept in the pulmonary artery in 13 cases for a maximum of 9 days. The mean PaO2 while breathing room air on admission was 66.7 mmHg in the 55 cases. It was 52.3 mmHg in the heart failure group and 74.9 mmHg in the non-heart failure group, showing prominent hypoxemia in the heart failure group. The mean PaO2 recovered to normal (84.1 mmHg and 87.0 mmHg) 5 weeks later. Inhalation of 35% O2 was performed for 20 minutes on admission and 5 weeks later. The elevation of PaO2 during the oxygen inhalation on admission was smaller than that 5 weeks later, significantly smaller in the heart failure group (P less than 0.001). The mean A-aDO2 on admission was higher in the heart failure group (58.1 mmHg) than in the non-heart failure group (34.8 mmHg). PaO2 showed significant correlations with cardiac index and SvO2. Although it was significantly correlated with PA diast. and TPR, no correlation with CVP was observed. Hypoxemia in acute myocardial infarction is caused by the following process: the onset of myocardial infarction causes low output, leading to left ventricular failure. As the result of elevated left atrial pressure and pulmonary venous pressure, intestinal pulmonary edema develops provoking ventilation-perfusion inequality, intra-pulmonary shunting, and diffusing defect.


Intermittent claudication of the foot in view of foot muscle blood flow measured by 133Xe clearance technique and arteriographic findings.

In 20 limbs of 10 healthy subjects and 55 limbs of 41 patients with occlusive areterial diseases of the legs, muscle blood flow was measured in the flexor hallucis brevis muscle by 133Xe clearance technique. The clearance curves after the ischemic exercise differenciated limbs with intermittent claudication of the foot from normals and limbs without claudication. An attempt was also made with arteriographic findings in 102 limbs of 84 patients with occlusions of the leg and/or foot arteries only. From results obtained, it is concluded that 133Xe clearance technique applied in the flexor hallucis brevis muscle can be used for diagnosis of foot  pain during walking of uncertain origin and intermittent claudication of the foot is caused by severe circulatory insufficiencies of the plantar muscles during walking in the patients with involvements of the posterior tibial and/or plantar arteries.


Effect of prolonged administration of clonidine to spontaneously hypertensive rats on blood pressure, cerebral norpinephrine content and angiographic finding in the kidney.

1. The effects of clonidine on blood pressure, cerebral norepinephrine content and vascular structures of the kidneys were investigated in 21 SHR. Although the body weight was not affected by long term clonidine treatment up to 36 weeks, the syatolic blood pressure was significantly reduced. The reduction of the blood pressure was already obvious after 1 week administration of clonidine but the effect was  more prominent after long term treatment of 30 weeks or longer. 2. The cerebral norepinephrine content was significantly lower in SHR, regardless of with or without clonidine treatment, than in the control Wistar rats. Although the cerebral norepinephrine content was slightly increased following clonidine treatment SHR, the increase was not statistically significant. 3. Angiographic study of the kidneys revealed a poor opacification of the blood vessels and glomeruli in SHR compared with the control Wistar rats. There was no difference in the sizes of the arcuate and interlobular arteries in SHR and the control Wistar rats, although the medial muscular hypertrophy of the arteries was slightly more prominent in the SHR histologically. The more prominent in the SHR histologically. The angiographic and histologic findings of the renal arteries were not altered following long term clonidine treatment. A possibility was considered that the renal arterioles are mainly functionally affected in SHR.


Effect of verapamil on electrical activities of SA node, ventricular muscle and Purkinje fibers in isolated rabbit hearts.

In the isolated rabbit heart, verapamil reduced the rate of rise and the slopes of diastolic slow depolarization, the maximum diastolic potential (Ed) and the membrane potential at the peak of depolarization (Ea) of the SA node without preventing regenerative responses in ventricular and Purkinje fibers. This effect of verapamil on SA node was counteracted by raising the extracellular calcium ion concentration. On the other hand, tetrodotoxin (TTX) had almost no effect on these parameters of the SA node, but it reduced the maximum rate of rise of the ventricular and Purkinje fibers markedly and eventually rendered these tissues non-excitable. The difference in the actions of verapamil and TTX on the SA node suggests that the SA nodal action potential comes from a different ionic channel (slow channel) from that of the Purkinje fibers or the working myocardium, and the effect of calcium ion suggests that this ion plays an important role in the generation of the SA nodal action potential. The difference in the effect of verapamil on the  repolarization phase between ventricular and Purkinje fibers was pointed out and the possible participation of calcium ion in the repolarization phase of these two tissues was discussed.


Maximal cardiac output in angina patients before abd after coronary artery surgery.

Ten patients with angina pectoris underwent multistage maximal treadmill exercise with hemodynamic measurements before, and again 6 months following coronary artery surgery. Subjectively, 9 patients experienced a total and one patient partial relief from angina, and all patients noted improved exercise tolerance following surgery. Objectively, significant improvement was found in duration of exercise, maximal oxygen intake in maximal cardiac output, maximal heart rate, and maximal pressure-rate product. Surgery did not significantly affect systemic or pulmonary arterial pressures during exercise. Despite these improvements, maximal cardiac output did not return to normal levels following surgery, due to an unexpected but significant reduction in stroke volume.


A clinical study on familial heart diseases.

Clinical pictures of 107 cases of familial heart diseases belonging to 30 families were studied. 1. Initial manifestations frequently observed were palpitation, chest pain, becoming aware of irregular heart beats, dyspnea and a syncopal attack. The initial manifestation was most frequently observed in the second or the third decade. In familial idiopathic cardiomyopathy a systolic murmur was the most common auscultatory findingd followed by the third and fourth heart sounds. 2. The cardiothoracic ratio was not necessarily increased. 3. In the ECG of familial idiopathic cardiomyopathy, arrythmia was frequently observed. A-V block was rare but a premature ventricular contraction was frequent. During a syncopal attack, the ECG showed ventricular trachycardia. An abnormal Q-wave, ST segment depression and a negative T-wave were also observed but their incidence did not differ from one lead to the other. Some cases of familial heart diseases showed QTc-prolongation but QTc was not over 0.47 seconds and was not as markedly prolonged as in familial QT-prolongation syndrome. 4. A similarity of clinical findings was observed among cases belonging to the same family. There was a striking similarity among the patients belonging to the same family  in initial symptoms, characters of a systolic murmur, morphology of the cardiac silhouette, morphology of an abnormal Q-wave or ST segment depression and in the leads which showed these abnormalities. 5. The most frequent mode of death was sudden death. A cardiothoracic ratio of 0.6 or more, an abnormal R-wave in V1 suggesting high dorsal wall damage, left axis deviation, and the low voltage of Sv1 + Rv5 of 1.5 mV or less suggested a poor prognosis.


[Evaluation of left ventricular function in acute and old myocardial infaraction by non-invasive method with special reference to systolic time intervals].

Systolic time intervals were studied in acute and old myocardial infarction, and the following conclusions were drawn: 1. Acute myocardial infarction. a) LVET was the shortest on the 3rd and 4th day of the illness, normalizing on the 14th day in cases without heart failure; but generally lower values were encountered in cases with heart failure, with a delay in recovery. b) PEP tended to be prolonged in the initial stage in cases with heart faii showed scarcely any change. d) PEP/LVET was the greatest prolongation near the 4th day of the illness, normalizing on the 14th day in cases without heart failure; but no recovery was seen after 10th week in cases with heart failure. e) Correlation was found between LVET or PEP/LVET and SI, but no concentration was seen between Q-II or PEP and SI. f) A tendency of correlation was noted between Peel's prognostic index and LVET or PEP/LVET. g) A marked deviation of either one of STI, especially that of PEP/LVET, suggests a poor prognosis. Persistence of the LVET value less than 240 msec up to the 7th day of the illness suggests the complication of heart failure. 2. Old myocardial infarction. While LVET was almost normal, PEP was considerably high regardless of the presence or absence of heart failure, with a tendency of aggravation in the course of years. The tendency of PEP/LVET was similar to that of PEP.


[Clinical use of amoxicillin in the otorhinolaryngological field (authors's transl)].

Forty-eight cases of otorhinolaryngological infections were treated with amoxicillin (AMPC) at a daily dose of 750mg. The clinical and microbiological effects were studied, and the results were summarized as follows. 1. The subjects comprised 20 cases of otitis media, 10 of tonsillitis, 4 of sinusitis, 4 of chroditis, 2 bronchitis, 5 of furuncle of the ear and 3 of furuncle of the nose. The clinical effective rate of AMPC was 82.9%, and the microbiological effective rate was 80.6%. 2. The effect of AMPC against strains isolated from the above diseases was also studied. The effective rate against Streptococcus was 91.6% and against Staphylococcus 83.3%. 3. Side effects were observed in 4 cases (one of diarrhea, two of abdominal discomfort and one of lingual pain), but none of them was so severe as the use of AMPC should have been discontinued.


[Studies on erythromycin stearate capsules (OE-7) (author's transl)].

The blood concentration and urinary excretion of OE-7 (erythromycin stearate capsules) and control drug were investigated in 6 volunteers having gastroptosis. OE-7, newly arranged capsules containing erythromycin stearate, was investigated and obtained the results of high blood concentration by oral administration. To confirm the above, we measured blood concentration and urinary excretion of OE-7 comparing with ordinary erythromycin stearate capsules in 6 volunteers having gastroptosis. The peaks of blood concentration were noted at 3 hours after administration in 6 volunteers uniformly. The mean maximum blood concentration of OE-7 was 1.17 mcg/ml which was significantly higher than ordinary erythromycin stearate capsules. In time course of mean blood concentration, the blood concentration levels of OE-7 were higher than those of control erythromycin stearate capsules at any measurement. Effective blood levels were continuously high in OE-7. Urinary excretion of OE-7 reached to the maximum from 4 to 6 hours after administration which was also higher than control erythromycin stearate. Clinical efficacy of OE-7 was investigated in 28 cases in acute respiratory infection. The results noted were excellent in 5 cases (17.9%), good in 16 cases (57.1%), no change in 6 cases (21.4%), and undetermined in 1 case (3.6%). There were 5 cases of slight gastro-intestinal discomfort as the side effects. As the conclusion, OE-7 revealed good bioavailability and seemed to be useful antibiotic for acute respiratory infections.


Quantitative and qualitative determinations of the combined effect of tetracycline and oleandomycin. II. In vivo effect.

The combination effect of tetracycline (TC) and oleandomycin (OM) on acute infection of mice with four strains of Staphylococcus aureus including TC or OM resistant ones was examined by the quantitative determination of protective potencies of single and combined drugs. The grade of synergism was expressed by the synergistic ratio (SR), a ratio of experimentally determined potency of the combined drug over a hypothetical potency in which additive effect of the both drugs is assumed. With 3 out of the 4 strains of S. aureus synergism between TC and OM or triacetyloleandomycin (TAO) was demonstrated by the determination of the 50% effective dose and by statistical examination of the SR. The grade of synergistic protection by these drugs varied with the strains infected and it did not depend upon the sensitivity to antibiotics or grade of synergism in vitro. There was no synergistic enhancement of acute toxic action in the combined administration of TC and OM to mice.


[Bacteriological studies on doxycycline (Bonnamycin 'Cipan') (author's transl)].

Bonnamycin which is a new tetracycline group antibiotic isolated from a variant strain of Streptomyces rimosus and is identified chemically as doxycycline was investigated, comparing with tetracycline. The results are as follows: (1) In in vitro studies of anti-bacterial spectrum, doxycycline is widely effective against standard strains kept in our department. (2) The distribution of susceptibility of 75 Staphylococci, 62 Salmonella and 64 Shigella strains isolated from clinical materials was similar to that of tetracycline. (3) As to the therapeutic experiment in acute infection of Klebsiella pneumoniae in mice, the drugs were equally effective and the ED50 was both 70.8 mcg. (4) Doxycycline administrated orally or subcutaneously in rats was distributed in kidneys, livers, lungs and spleens at relatively high concentration among organs.


A case of acute anterolateral infarction complicated with "left posterior hemiblock".

A case of transient left posterior hemiblock and various intraventricular conduction disturbances associated with acute anterolateral infarction is reported. The earliest manifestation was an appearance of ventricular premature systoles originated in the area of the left posterior fascicle. On following recordings left posterior hemiblock with periods of high grade A-V block developed. A few minutes later regular alternation of left posterior hemiblock and left anterior hemiblock was recorded in the presence of 2:1 A-V block. The mechanism for such rare manifestation is analysed. After representing complete left bundle branch block, spontaneous recovery of normal conduction was obtained without any change in heart rate.


Prinzmetal's angina pectoris with normal coronary arteriograms.

Four cases of variant angina pectoris with normal findings on coronary arteriogram were experienced. The facts may show that the existence of serious arteriosclerotic lesions in a major branch of coronary artery as pointed out by Prinzmetal is at least not essential for the occurrence of anginal attack in the present disease. But the finding that age and sex distribution of variant angina was nearly the same as that of effort angina seems to still indicate the possibility that arteriosclerotic lesion somehow participates in the mechanism of occurrence of the present disease.


Antiarrhythmic effect of hypertonic sodium bicarbonate and sodium chloride in ouabain-induced arrhythmias.

Ouabain-induced tachyarrhythmias in cats can be abolished by bolus injection of NaHCO3 solution. This effect is consistent, rapid and of short duration. The antiarrhythmic effect appears to be due to high sodium concentration of this solution, as hypertonic NaCl solution with equal concentration of sodium exerts the same effect. Alkalinity and hyper-osmolality cannot account for the antiarrhythmic effect of NaHCO3 as respiratory alkalosis and mannitol solution with equal osmolality did not relieve the arrhythmias. Overdrive suppression is not responsible for this effect as the heart rate slows down during normalization of the cardiac rhythm. It is postulated that high Na+ concentration abolished ouabain-induced arrhythmias by competition with calcium ion in the myocardial cell sarcotubular system thus replacing it. This hypothesis is supported by the known effect of other agents such as sodium-EDTA and magnesium chloride, in digitalis-induced arrhythmias, which exert their antiarrhythmic properties by removal or displacement of calcium in the myocardial cells.


Differences in chronotropic and inotropic responses of canine atrial muscle and SA node pacemaker activity to adenosine and ACh.

The right atrium isolated from the dog heart was perfused through the cannulated sinus node artery with heparinized arterial blood led from a support dog anesthesized with 30 mg/Kg of sodium pentobarbital. When adenosine was administered into the sinus node artery, negative chronotropic and inotropic effects were dose-relatedly induced. The threshold dose for inducing the negative ones was 0.3 mug. Even a large dose level of 100 mug of adenosine did not cause sinus arrest although a profound sinus deceleration was induced. Adenosine action was suppressed by treatment with caffeine both in chronotropism and in inotropism. On the other hand, ACh induced only negative inotropic effect at a dose range of 0.01-0.03 mug. At 0.1 mug, ACh produced a significantly negative chronotropic effect. A large amount of 3-10 mug of ACh usually caused sinus arrest. Atropine treatment inhibited a negative chronotropic effect much more readily than a negative inotropic one. Although ACh action was enhanced by physostigmine, the difference of threshold doses remained unchanged even after physostigmine treatment. From these results, either adenosine or ACh depresses both SA nodal pacemaker activity and atrial contractile force and there may be the difference of receptor density for ACh between the SA node and atrial tissue.


Effects of allopurinol on tissue oxygen tension of the ischemic myocardium.

The effects of allopurinol on the myocardial oxygen metabolism were studied in dogs with acute coronary artery occlusion. Upon occlusion of the contributory branch of the coronary artery, myocardial pO2, as measured with an improved polarographic technique, decreased to various lower values depending on the site of the electrode inserted. In the slightly ischemic myocardium, where myocardial pO2 decreased less than 50% of the control by the coronary occlusion, administration of allopurinol brought about a further diminution in myocardial pO2. In the severly ischemic myocardium, where myocardial pO2 decreased more than 50% of the control upon the coronary occlusion, no significant change was observed following allopurinol infusion. Theoretical beneficial effects of allopurinol on the ischemic myocardium by preserving functional purine bases might be offset by the aggravation of the negative oxygen balance in the ischemic but still viable myocardium following administration of allopurinol.


Effects of pyridinolcarbamate on the cardiovascular system of the anesthetized dog after bilateral cervical vagotomy.

Pyridinolcarbamate (PDC) was injected at a dose of 10 mg/Kg of body weight into the femoral vein of anesthetized dogs with a bilateral cervical vagosympathotomy. At this dose, it produced a transitory decrease in systolic, diastolic, and mean arterial pressure and an increase in heart rate. In addition, it produced a more prolonged increase in stroke volume, peak aortic flow, cardiac output, and left ventricular minute work. It also lowered peripheral resistance and apparently decreased the vaso-constrictor action of injected norepinephrine (1 mug of active base/Kg of body weight). These data are consistent with the view that PDC has a direct action on the heart that is similar to that of norepinephrine and that PDC blocks the alpha adrenergic receptors of the systemic resistance vessels.


A 4-year survival rate after cardiac pacing in A-V block in the heart institute of Japan.

The long-term prognosis after cardiac pacing in A-V block was assessed by a follow-up study of 59 patients in whom pacing had been introduced 4 years or more before analysis. The 1 year survival rate was 85% and the 4 year survival rate was 71%. These figures are substantially better than the survival rate reported in patients not paced. The mortality has been higher in patients older than 70 years old. Even though patients were reviewed monthly or every 3 months in a pacemaker clinic, there were 3 sudden deaths in 4 years.


The significance of T-loop change in Frank's lead exercise electrocardiography.

Thirty-one patients with angina pectoris and 15 patients with myocardial infarction who performed exercise test by Master's double two-step test have been longitudinally followed up for 4-10 years. Exercise electrocardiogram was taken by Frank's lead and T loop was constructed in frontal and horizontal planes from 3 scalar tracings recorded at a paper speed of 100 mm/sec. ST vector was determined at 100 msec from the beginning of Q wave and the line connecting 2 ST vectors before exercise and at the point of the maximal ST change after exercise was determined as ST exercise vector. To indicate width of the T loop, the length to width ratio (L/W) was used and the change of width of the T loop induced by exercise was expressed by a ratio of L/W between before exercise and at the maximal change in frontal and horizontal planes. In cases having ST exercise vector of 0.1 mV or more the magnitude or the direction of the ST exercise vector alone has little prognostic value and widening of the T loop in addition to the ST exercise vector of 0.1 mV or more occurring after exercise was a predictive sign of poor prognosis and no widening of the T loop was a predictive sign of good prognosis.


Genesis of the third heart sound. Phonoechocardiographic studies.

To clarify the genesis of the third heart sound (IIIS), phonoechocardiographic analysis was made in 31 cases with apparent IIIS. The mitral valve, either anterior or posterior, showed no definite movement coincided with the IIIS. At the time of IIIS, mitral valve is in the closing process, but it is still widely open, and there was no evidence of the stretch or tension of the valve apparatus. On the other hand, the endocardial echoes, either of interventricular septum or of posterior wall of the left ventricle, almost always showed definite check point (point of inflexion) during (or exactly at the end of) rapid ventricular filling as manifested by the sudden change in the diastolic dimension of the left ventricle near the apex. The IIIS seems likely to originate from the abruptly arrested momentum of the moving mass of blood at this check point and then the vibration of the relaxed cardiohemic system.


Echocardiography and angiocardiography for detection of left atrial thrombosis.

Diagnostic capabilities for detection of the left atrial clot in patients with mitral stenosis were compared between echocardiography and angiocardiography. Large clots in the left atrial body were correctly diagnosed either by echocardiography or by angiocardiography. Clots in the left atrial appendage were not disclosed by echocardiography. Left atrial visualization with pulmonary arteriography offers only possible diagnosis of the clot in the appendage. Definite diagnosis of the clot in this location requires transseptal left atriography.


P waves in acute myocardial infarction.

Relationships between P wave abnormalities in lead II and V1 and clinical as well as hemodynamic findings and the prognosis of 27 attacks of AMI were evaluated. 1) Patients with clinical left ventricular failure showed large negative deflections in lead V1 compared to patients without. 2) There was a significant correlation between the magnitude of PTF-V1 and PCW (r=-0.75, p less than 0.01). 3) In 20 of the 27 attacks (74%), PTF-V1 correctly identified whether or not PCW was normal on admission. 4) Patients with frequent premature beats and any of the bundle branch blocks had a large negative deflection in V1 compared to patients without. 5) There was a significant correlation between the magnitude of PTF-V1 and Peel's prognostic index (r=-0.74, p less than 0.01). Moreover, 70% of the patients with abnormal PTF-V1 (less than -0.03 mm-sec) and elevated Peel's prognostic index (more than 12) died during hospitalization. 6) The patients who died during hospitalization had a large negative deflection in lead V1 compared to those patients who survived. 7) Patients with past history of old myocardial infarction had a larger negative deflection in lead V1 compared to the patients without past history of old myocardial infarction. 8) There is no correlation between the duration and amplitude of P wave in lead II and PCW. 9) Thus, it is concluded that in patients with AMI, the magnitude of PTF-V1 reflects the level of PCW and is useful as a parameter for therapy and prognosis evaluation.


The construction method of the QRS loop in myocardial infarction.

In order to investigate the relation between the infarcted area in myocardial infarction and the change of the QRS loop, the following method was tried. The normal QRS loops in 3 planes were constructed with the digital computer. Then the vector of an optional segment corresponding to infarction was diminished and the QRS loops were constructed. The comparison of the QRS loops in clinical cases and in the construction method was made and the vectorcardiographic findings to estimate the infarcted area were discussed.


Influence of heart rate and age on Q-Korotkoff sound intervals.

The Korotkoff sound appearance time (QK intervals) was measured in 224 normal subjects of both sexes between the age of 6 and 79 years. The sex difference was not obvious except for the diastolic values of the intervals (QKd) in the sixth decade. Although the QK intervals remained almost unchanged between the third and the fifth decade, both the systolic (QKs) and the diastolic values were significantly smaller in the young subjects under the age of 20. On the other hand, QKs was significantly decreased and QKd and the difference between the systolic and diastolic values (QKs-d) were significantly increased in the elderly subjects. The short QK interval in the young subjects was considered to be mainly attributable to the short preejection period, while the increased pulse wave velocity was postulated to be the main responsible factor for the shortening of QKd in the elderly subjects. A statistically significant negative correlation was demonstrated between QKd and the heart rate in both sexes, while QKs and QKs-d were not significantly correlated with the heart rate.


Correlative changes in total vascular capacity and resistance in carotid sinus reflex.

To attain a quantitative understanding of carotid sinus reflex control of circulation, we studied the correlation between changes in total vascular capacity (V) and total peripheral resistance (R). We used a newly devised, accurate and simple method to measure changes in V while both mean central venous and arterial pressures being kept constant. In 7 open chest dogs (7-11 Kg, mean 8.9 Kg), bilateral carotid occlusion after vagotomy reduced V by as much as 58 +/- 9 (SE) ml or approximately 8% of total blood volume while R increased by 36 +/- 5% from 0.08 +/- 0.01 mmHg-min/ml. Similar responses were obtained either in the reflex before vagotomy or with infusion of norepinephrine. Mathematical analysis with Poiseuille's law suggested that internal radius of an average resistance vessel decreased approximately 1.5 to 3 times as much as that of an average capacitance vessel. The wall to lumen ratio of the average resistance vessel estimated from the correlation was 0.3 to 0.6, being within physiological range. Therefore, the difference in vascular sensitivity may be partly owing to the wall to lumen ratio of resistance vessels. Moreover, the correlative changes in the capacitance and resistance vessels were elucidated to be significantly responsible for the characteristic hemodynamic changes in carotid sinus reflex.


Sympathetic influence on ventricular compliance.

Intracisternal injections of veratrine in the anesthetized dog were used to study the effects of extreme sympathetic stimulation on left ventricular diastolic compliance. The results obtained were compared with those seen during volume expansion with whole blood, and after removal of both stellate ganglia. The injection of veratrine into the cisterna magna caused an increase in left ventricular end-diastolic pressure (LVEDP) which was considerably larger than that which occurred in left ventricular end-diastolic circumferential (LVEDC) segment length suggesting a reduction in diastolic compliance. There were also increases in left ventricular systolic pressure (LVSP) as well as its first derivative (LV dp/dt). Bilateral stellectomy during the veratrine response abruptly reduced LVEDP with a lesser decrease in LVEDC. Thus, the left ventricular compliance change was reversed. Both LVSP and LV dp/dt were decreased by stellectomy but remained above control levels. During transfusion, the pressure-length curve of the ventricle was located downward and to the right in comparison with the curve observed with intracisternal veratrine.


Pathological studies of the animals replaced totally with the artificial heart. Part I. Concerning lungs, natural heart, and brain.

Pathological studies using routine pathological technics, microangiography and electron microscopy were performed on the 28 goats with an artificial heart (including 2 goats which survived for 30 and 37 days). In this paper, the brain, natural heart, and lungs of the goats were discussed. No special findings were seen in the brain except for rare infarcted areas. The natural heart almost always showed infarction-like lesions in the sub-endocardium and myocardium at the cut surface. The longer the animal survive, these findings became the more serious. The light microscopic findings on the lungs were classified into 6 groups. The most important findings of them are massive, diffuse exsudation with hemorrhage and its changes to chronic status. The main pathophysiological status, causing the pulmonary lesions, seemed to be peripheral circulatory insufficiency with increased permeability of peripheral vessels, especially of venulae. Thrombi were detected more frequently in the kidneys and lungs than in any other organs. The vascular walls where the thrombi were attached to, where often seen to be damaged, so that almost all thrombi were thought to be formed in the local vessels in situ, but not in the artificial heart. The main clinical causes to the pulmonary insufficiency were thought to be surgical operation including anesthesia, functional incompleteness of the artificial heart, etc.


Spontaneous electrical activity induced by depolarizing currents in canine ventricular myocardium. A preliminary note.

Spontaneous action potential (AP) discharge could be induced by an application of long (5-10 sec) depolarizing currents in 68% of canine ventricular myocardium tested in the voltage range between about -65 and -10 mV. The constant currents of various intensities were applied across a sucrose gap, and intracellular potentials were recorded with a microelectrode. The firing rate of the AP's was voltage-dependent and ranged between 0.7 and 2.5 Hz. The AP was dependent on both [Ca++]0 and [Na+]0. Increase of [Na+]0. Increase of [Na+]0 from 37 to 149 mM increased the firing rate, maximum rate of rise, and overshoot of the AP's while increase of [Ca++]0 from 0.45 mM to 1.8 and 7.2 mM increased the firing rate and maximum rate of rise, but did not change the amplitude of overshoot. AP discharges were not blocked by tetrodotoxin (10(-5) Gm/ml), but were effectively blocked by verapamil (6 X 10(-6) Gm/ml). Adrenaline (5 X 10(-6) Gm/ml) initiated AP's in otherwise quiescent preparations. The results suggest that spontaneous AP's may be produced by inflowing of slow Na+ and Ca++ currents modified by underlying change of K+-permeability. Possible clinical significance of this phenomenon is discussed in relation to ventricular arrhythmia.


A case of aortic atresia associated with right aortic arch.

A case of aortic atresia associated with right aortic arch is described. This is the second case in the literature. The diagnosis of aortic atresia was made prior to death by right heart catheterization with angiocardiography and this was confirmed at autopsy. The necessity of an early and accurate diagnosis of this disease is discussed for providing more opportunity of surgical treatment.


A case of tumor embolism of the coronary artery, resulting in myocardial infarction and cardiac rupture.

A case of tumor embolism of the coronary artery in a 78-year-old woman was presented. The tumor embolus originating from cancer of the breast resulted in massive large myocardial infarction in the lateral wall of the left ventricle, and she died of cardiac rupture. Metastatic lesions were found in the bilateral lungs, the endocardial and subendocardial layers of the left ventricle, with a growth of tumor thrombus into the left atrium, and also other extracardiac organs.


Potentiation by lithium and protection by rubidium of digitalis intoxication.

Investigating the effects of Li and Rb on the toxicity of digoxin and ouabain revealed Li to be a potentiator while Rb to be a protector. The effects of Rb in this respect are, more or less, qualitatively comparable to those of K; the intensity of Rb effects is more than that of K. In case of digoxin the effect produced from the combined use of both Rb and K is more than each individual effect. With ouabain, however, whereas Rb offered protection K failed to do so. Electrolyte changes in cardiac tissue showed that Li increased the tissue content of Ca while Rb produced the opposite effect. In comparing Rb with K, both increased the K level in the cardiac muscle. However, in the case of ouabain the infusion of K failed to decrease the Ca level and this might explain its failure to protect against ouabain toxicity. This points to the importance of Ca, rather than K, in controlling the excitability of the cardiac muscle and in effecting the toxicity of cardiac glycosides. Evidences presented indicate the superiority of Rb over K and propose its trial in clinical practice.


Migration of Oncomelania quadrasi observed by the mark and release method in a wet bank of a stream in Leyte, Philippines.

The migration and population size of Oncomelania quandrasi were studied at two sites in a submerged bank of a stream in Leyte Philippines. The snails collected by filter paper in an experimental area were marked with manicure and released in the same area. Collection was repeated every 4 days in the same area for 5 more times and snails without mark were marked with manicure of different colors at each time. The immigration and emigration rates and population were calculated from the collection data. One experimental site with an area of 5.86 m2 was established at the edge of the water pathway, 3 sides of which were surrounded by wooden planks except that side facing the water pathway to determine the migration between the bank and water pathway. The other experimental site was 7.54 m2 in area, located in a submerged place close to high land and was left open in all sides. The ranges of the population, immigration and emigration rates during a 4 day period were 3845 to 7638, 0 to 0.4448 and 0.2263 to 0.8911, respectively in the former site. The results in the latter area were 1336 to 2468, 0.1261 to 0.6725 and 0.1349 to 1.2340, respectively. It was observed that the replacement of individual snails in a habitat was largely due to migration which in turn was influenced much by the change of water level in the bank. The emigration increased with the elevation of water level. On the other hand, the immigration increased with the lowering of water.


Studies on hemagglutination test on filariasis. I. The fractionation and purification of antigens by column chromatography and disc electrophoresis.

The fractionation of antigens for hemagglutination test from adult worms of Dirofilaria (D.) immitis was carried out by defatting with diethylether, sonication, centrifugation, gel-filtration on sephadex G-100 column, DEAE cellulose column chromatography, saturation with ammonium sulfate and disc electrophoresis. An antigen FPSD4 thus obtained, showed potent HA activity against sera from patients infected with Wuchereria (W.) bancrofti. But it was also reactive with normal sera. After elimination of the cross-reacting substance from antigen FPSD4 by the saturation of ammonium sulfate, a specific antigen FPSD4-2 was obtained. By the tests using FSCD4-2 in a protein concentration of 20 mug/ml, sera of 27 patients with microfilariae of W. bancrofti in their blood were examined and 18 positive cases (66.7% positive) were obtained. With 21 normal human sera, no cross reaction was found. As antigen FPSD4-2 showed about 20 protein bands, the further purification of the antigen by disc electrophoresis was carried out. Among three subfractions thus obtained, FPSDA which contained 5 protein bands was most reactive and specific.


Furylfuramide-induced hepatic necrosis in mice and its modification by phenobarbital.

Oral administration of furylfuramide (2-(2-furyl)-3-(5-nitro-2-furyl) acrylamide), used as an antimicrobial food preservative until recently, caused centrolobular coagulation necrosis of the liver of the mouse (ddYS, male) in the degree corresponding to the doses. The recovery process after a single oral administration was characteristic: the necrotic cells were laden with calcium and replaced by foreign body granuloma accompanied by multinucleate giant cells. Complete healing ensued in about a month. Phenobarbital pretreatment reduced injurious effect of furylfuramide on the liver with preservation of the centrolobular region. In this case necrosis occurred in the intermediate zone in a ring-like shape. This indicates enhanced detoxication of furylfuramide by microsomal drug metabolizing enzyme(s) of the liver cells induced by phenobarbital.


Differential response of cultured mammalian cells to cytochalasin B in multinucleation.

Cytochalasin B (CB) was applied to 13 kinds of non-tumorigenic or tumorigenic cells in vitro to investigate whether the drug would be applicable as an indicator to identify the transformation of cells. Normal cell strains suffered from more deteriorative changes in morphology than cell lines, showing arborization of their cytoplasm at 5 mug/ml. CB at 2.5 mug/ml consistently prevented cytoplasmic cleavage without interfering with nuclear division. Multinucleation of the cells exposed to CB was not related to their generation time. The correlation between multinucleation and tumorigenicity of the cells was found with some exceptions. It appears, however, that multinucleation induced by CB would not be a reliable parameter for identifying malignant transformation of cells in vitro.


Pseudoasthma: a new clinical entity?

A functional syndrome resembling either asthma or airway obstruction, or both, is described. It is probably caused by voluntary glottic closure. Therapy with sedation and reassurance has proven successful. Patients with this syndrome must be carefully examined and observed to exclude the possibility of organic upper airway obstruction.


Bedside emergency transvenous cardiac pacing: experience in two community hospitals.

Emergency bedside transvenous subclavian cardiac pacing in 51 patients over a three-year period in two community hospitals is described. Fifty-three procedures were performed at the bedside with semifloating bipolar pacemaker catheters under continuous electrocardiographic monitoring to assist in the placement of the catheter tip. Of the 53 procedures, initial success in pacing was observed in 41 patients (77%). The largest number of failures to either initiate or maintain pacing was observed in the group with cardiac arrest associated with extensive myocardial infarction and complete heart block. Complications of this procedure were minimal. Only one 10% pneumothorax was noted. This modified technique is easily mastered and may prove lifesaving in an emergency.