Hemodialysis in patients with carcinoma.

All patients who underwent hemodialysis as part of their treatment for cancer at Roswell Park Memorial Institute from 1965 to 1974 were retrospectively studied to determine the value of hemodialysis in cancer patients. Approximately 25% (8 cases) lived 5 weeks or longer in spite of advanced renal failure and carcinoma with no severe complications. The longest survivor is still alive after ten years.


Exploratory laparotomy and splenectomy in the diagnosis of Hodgkin's disease in children.

Thirty-three children with histologically proved Hodgkin's disease underwent exploratory laparotomy with splenectomy and biopsy of lumbar lymph nodes, liver, and bone marrow. In 13 patients (39%) the lesion of spleen and/or splenic hilar lymph nodes was diagnosed. The involvement of spleen was mostly found in patients with mixed cellularity type, in the presence of systemic symptoms ("B"), and in the biological stage "b." Involvement of the liver was found in 1 patient, of the hepatic hilar lymph nodes in 3 patients, and of the bone marrow in 4 patients. The lymphographic and histologic data as regards lumbar lymph nodes coincided in 65% of cases. After operation the stage of the disease was changed in 48% patients. The early and late complications were not numerous.


Neuraminidase immunotherapy: serum potentiation of lymphocyte cytotoxicity related to immunoglobulin levels.

Seven patients completed couses of immunotherapy using neuraminidase-altered autochthonous cells. Their response to therapy was monitored by a cytotoxicity assay using 3H-proline-tagged tumor cells from the patient's own cultured tumor in a strictly autologous system. Serum effects were measured by exposing the tumor target cells to serum to see whether this impeded (blocked) or augmented (potentiated) lymphocyte cytotoxicity. Three of the seven patients developed increasing degrees of serum blocking effect and all died within six months of completing therapy. Four of the seven showed rapidly decreasing blocking and three eventual potentiation. Three patients are living, improved, and free of evidence of tumor. There was an increase in average serum immunoglobulins in patients developing potentiation, and a decrease in those showing blocking. In any immunotherapy program attention must be given to in vitro monitoring studies, and such studies should include attention to the serum factors influencing host response.


Monograph on "Lithoglyphopsis" aperta, the snail host of Mekong River schistosomiasis.

We discuss the morphology, histology, ecology, distribution, systematics, and evolutionary relationships of "Lithoglyphopsis" aperta Temcharoen, the snail host of Mekong River Schistosoma sp., and part of a vast, complex, endemic hydrobid fauna consisting of 11 genera and over 80 species. "L" aperta is a member of the Hydrobiidae (as broadly outlined by Fretter & Graham, 1962), subfamily Triculinae (as defined by Davis, 1968b). "L" aperta cannot be assigned to Ltihoglyphopsis because its shell and radula differ from those of the type-species, L. modesta (Gredler) from China, and because L. modesta is apparently more closely allied to other Mekong River genera in these traits. The female reproductive system of "L." aperta is similar to that of Tricula burchi Davis, a species from NW Thailand outside the Mekong River drainage. It is not possible to assign aperta to a named genus until the morphologies of numerous other hydrobiid taxa in the Mekong River are unknown. "L." aperta is typically hydrobiid in grade of morphological organization, in the nervous digestive, ctenidial and male reproductive systems. Differences from other hydrobiid taxa are in the female reproductive system and micromorphological features of the digestive tract. "L." aperta and species of Tricula from Thailand have a female reproduction system where sperm enter at the posterior end of the mantle cavity and travel to the bursa copulatrix via a spermathecal duct. These and related traits are the basis for the subfamily Triculinae. Hydrobiid taxa from Europe (Hydrobiinae s.s.) belong in a different phyletic line, where sperm enter the female reproductive system at the anterior end of the mantle cavity and travel via a ciliated groove in the palial oviduct to the bursa copulatrix. "L." aperta, as well as taxa of the Pomatiopsinae (e.g. Oncomelania, Pomatiopsis), differ from most known mesogastropods in lacking a hypobranchial gland. "L." aperta, other triculines, pomatiopsines and hydrobiines, as well as taxa studied in the Bithyniidae, Truncatellidae and Assimineidae differ from other mesogastropods, e.g. Viviparidae, Pleuroceridae, Littorinidae, etc., in that the salivary glands are dorsal to the nerve ring i.e. do not pass through the nerve ring. "L." aperta lives on solid substrata, particularly wood, shells and leaves in the Mekong River from Khemarat, Thailand, to the Cambodian border, 200 river miles downstream. The range probably extends another 100 river miles downstream to Kratie, Cambodia. It is an "r"-selected species by having a high density-independent mortality and using much of its resources for reproduction. The species is a colonizer in a river with severe annual floods. Females live less than 12 months; they apparently lay eggs in late January or February and die. In early March neither adults nor young can be collected. By mid or late March young suddenly flourish. The new generation does not mature until late May or June, after the beginning of the rainy season...


A natural population of Helisoma duryi in Brazil.

A well established natural population of Helisoma duryi (Wetherby) was recently found in central Brazil, where it was introduced probably with aquatic plants conveyed by aquarists. A morphological description based on the observation of 10 specimens is presented, involving the shell, cephalopodal mass, mantle organs, reproductive system and buccal apparatus.


The karyotype of Biomphalaria glabrata, the snail vector of Schistosoma mansoni.

Karyotyping was done on the mitotic metaphase chromosomes obtained from the embryos of Biomphalaria glabrata. The 18 chromosome pairs were identified and classified into 6 groups. The diploid cell has 10 pairs of metacentric, 4 pairs of submetacentric, 2 pairs of acrocentric and 2 pairs of telocentric chromosomes. The pair number 8 with secondary constriction can be used as a marker in genetic experiments.


Alkaloids and coumarins of Thamnosma montana.

From the turpentine broom, Thamnosma montana, four alkaloids and three coumarins were isolated and characterized. Skimmianine (5), N-methyl-acridone (4) and 5-(3'-methyl-2',3'-dihydroxybutanyl)-8-methoxypsoralen (1) were obtained previously from T. montana. Robustine (2) is reported from a Thamnosma species for the first time and acridone (6), thamnosmonin (9), and thamontanin (14) are reported from a natural source for the first time. Evidence for the structures of the new isolates is presented.


Indicine-N-oxide: the antitumor principle of Heliotropium indicum.

Extracts of Heliotropium indicum Linn. (Boraginaceae) showed significant activity in several experimental tumor systems. The active principle is isolated and shown to be the N-oxide of the alkaloid, indicine, previously isolated from this plant. Supporting structural data and anti-tumor data are provided.


Antineoplastic agents. 41. The beetle Allomyrina dichotomus.

The Asian beetle Allomyrina dichotomus L. has been found to contain an antineoplastic agent. The substance responsible for this biological activity was located primarily in the beetle's legs and isolation guided by bioassay led to its characterization as a protein of at least 106 amino acid units. The protein was found to inhibit(64% at 3 mg/kg) growth of Walker intramuscular carcinosarcoma 256 in rats and was marginally active against P388 lymphocytic leukemia in mice.


Lipid composition of rat sciatic nerve.

In the course of our study on the lipids of the rat sciatic nerve, the analysis of the neutral lipids allowed us to detect and characterize cholesteryl esters present at a relatively high level (5%). Among the phospholipids, ethanolamine phosphoglyceride is the most abundant fraction and contains neraly all the plasmalogens (20% of total lipid phosphorus). The glycolipids consist of five different fractions; the cerebrosides with hydroxy fatty acids account for 38% of total glycolipids. Monogalactosyl diglyceride represents 7% of total glycolipids.


Utilization of L-serine in the in vivo biosynthesis of glycerophospholipids by rat liver.

The incorporation of L-serine-U-14C, L-serine-3-14C, and D,L-serine-1-14-C into the glycerophospholipids of rat liver in vivo was determined over a period of 3 min to 13 hr following intravenous injection. The radioactivity from these serines was transferred to variable extent into the glycerol, fatty acid, and nitrogenous base parts of all the glycerophospholipids and neutral lipids. The half-lives and turnover rates of phosphatidylserine calculated from the precursor-product specific activity curves obtained with L-serine-U-14C were 14 min and 0.28  mumol/min/liver, respectively. The half-lives and turnover rates of phosphatidylserine as measured from the decay data of lipid serine from all markers averaged, respectively, 8.2 hr and 0.0008 mumol/min/liver. The discrepancy between these turnover rates was attributed to an understimation of degradation of phosphatidylserine due to its continued biosynthesis and/or an extensive reutilization of L-serine. By monitoring the formation of radioactive lipid ethanolamine, it was found that phosphatidylserine was decarboxylated at one-half the rate of lipid serine biosynthesis. It is suggested that as much as one-half of total phosphatidylserine may be degraded by other mechanisms, such as base exchange with choline, ethanolamine, and serine, as already demonstrated in vitro by other workers. The time course and nature of labeling of phosphatidylcholine was consistent with an extensive conversion of radioactive L-serine to 1-carbon fragments and a rapid methylation of phosphatidylethanolamine to phosphatidylcholine.


Quantitation of phosphatidyl N-methyl-and N,N-dimethylaminoethanol in rat liver.

The contents of phosphatidyl N-methyl- and N,N-dimethylaminoethanol were determined in the liver of rats injected with (Me-C14) methionine. Total phospholipids were extracted from aliquots of the liver and fractionated by two-dimensional thin layer chromatography after addition of carrier phosphatidyl-N-methyl- and N,N-dimethylaminoethanol. The radioactivity present in the two phosphatide spots was determined and used to calculate total disintegrations per min/100 g  body wt. The remainder of the livers was pooled, and total phospholipids were isolated and subjected to acid hydrolysis. N-methyl- and N,N-dimethylaminoethanol were purified by thin layer chromatography, and their specific activity was determined after quantitation by gas liquid chromatography and radioactivity measurement. The liver contents of phosphatidyl N-methyl- and N,N-dimethylaminoethanol were determined by dividing disintegrations per min/100 g body wt by the specific activity of N-methyl- or N,N-dimethylaminoethanol.


Protective effects of 3-hydroxy-3-methylglutaric acid in alcohol-induced lipemia.

Oral administration of l g of 3-hydroxy-3-methylglutaric acid (HMG) before the ingestion of whiskey and a fatty meal markedly reduced the elevation of serum triglycerides, beta-lipoproteins, phospholipids, and cholesterol in man. In rats receiving an ethanol and corn oil mixture, HMG also inhibited the increase in postprandial serum and liver lipids. A comparative study of HMG and nicotinic acid in rats showed that, therapeutically, 50 mg MHG/kg body weitht is equivalent to 200 mg nicotinic acid/kg body weight in offering almost total protection against lipemic effects of ethanol.


Sensitive fluorometric method for tissue tocopherol analysis.

A sensitive, highly reproducible method for tissue tocopherol analysis that combines saponification in the presence of large nmount of ascorbic acid to remove interfering substances, extraction fo the nonsponifiable lipids with hexane, and fluorometric measurement of the tocopherol is presented. The nonsaponifiable lipids phase contained only one fluorochrome in the 290 am excitation and 330 nm emission range, and it was identified as tocopherol by thin layer and column chromatography. Column chromatography of the hexane extract of a saponified, 14C-tocopherolspiked microsomal fraction showed that no measurable oxidation to tocopherylquinone had occurred. The flurometric method for tocopherol analysis was applied to homogenates and subcellular fractions from rat liver, kidney, lung, and heart and red blood cells. The heavy mitochondrial and microsomal fractions had the highest subcellular concentrations of tocopherol.


Low and moderate concentrations of lysobisphosphatidic acid in brain and liver of patients affected by some storage diseases.

The relative amount of lysobisphosphatidic acid (LBPA), known also as bis(monoacylglycerly)phosphate, among the total phospholipids was analyzed in post mortem samples of brain and liver of patients affected by four storage diseases. In spite of the extensive accumulation of storage lysosomes, none of the samples revealed a highly evelated LBPA content comparable to that found in the liver in Niemann-Pick disease and in the liver in lipidosis induced by 4,4'-diethylaminoethoxyhexestrol. We conclude that, although LBPA is often present in high concentration in lysosomes of many types of cells, it is not always a major component of these organelles.


Cardiopathogenicity of rapeseed oils and oil blends differing in erucic, linoleic, and linolenic acid content.

Male Wistar rats were fed semipurifed diets containing 20% fat for 25 weeks. Ten different oils or oil blends were employed, including rapessed oils, simulated rapeseed-type oils, and modified rapeseed-type oils. Safflower, soybean, and hydrogenated coconut oils served as control oils. Histopathological examination of the cardiac tissue was conducted at the end of the study and an incidenceseverity rating assigned to the lesions induced by each fat. Oils containing high levels of erucic acid (26-30%) induced the most severe cardiac necrosis, irrespective of the source of erucic acid (rapeseed oil or nasturtium oil). Increasing the linoleic: :linolenic acid ratio of the high erucic oils to that of soybean oil failed to reduce necrosis, but the absence of linolenic acid from a high erucic acid oil blend resulted in a markedly reduced lesion incidenceseverity rating, comparable to those obtained for low erucic acid rapessed oil and soybean oil which were similar. Lowest lesion incidence was obtained with safflower oil and hydrogenated coconut oil. We have postulated that linolenic acid plays a role in the etiology of cardiac necrosis observed when rats are fed diets containing low erucic acid rapeseed oils.


Study of bound phospholipase activities of fungal mycelia using an organic solvent system.

It has been possible to demonstrate and characterize high phospholipase activities in mycelia of Rhizopus arrhizus and Mucor javanicus by use of a system in which substrates were dissolved in diisopropyl ether. Such activities were associated with bound enzymes and would have been difficult to detect using aqueous assay systems. In both cases, phosphatidylcholine hydrolysis was by phospholipase A1 (EC 3.1.1.32) activity followed by the action of lysophospholipase (EC 3.1.1.5). Phospholipase D (EC 3.1.4.4) activity was also detected. The methods used appear to be of general applicability for the detection and study of insoluble phospholipases.


Lipid metabolism of the yellow clam, Mesodesma mactroides: 2-polyunsaturated fatty acid metabolism.

The fate of labeled linoleic, alpha-linolenic, and higher homologs of alpha-linolenic acid administered to the yellow clam, Mesodesma mactroides, was investigated. It was found that the clam incorporated the acids dissolved in sea water and converted 18:2 (n-6) into 20:2 (n-6) and 18:3 (n-3) into 18:4 (n-3) and 20:3 (n-3). The addition of casein hydrolysate to the sea water increased the desaturation capacity of the calm and allowed the conversion of 18:2 (n-6) into 18:3 (n-6) to be demonstrated. An enhanced desaturation of 18:3 (n-3) into 18:4 (n-3) was also demonstrated. After 12 hr admininistration of the acid, no radioactivity was found in arachidonic, 20:5 (n-3), or 22:6 (n-3). Feeding the clams a culture of Phaeodactylun tricornutum previously incubated with 1-14C-alph-linolenic acid demonstrated that all the homologs of the alpha-linolenic series were found in the clam without any important changes. Six hour administration of labled linolenic acid resulted in the incorporation of the acid into diglycerides and phospholipids.


Effect of cholesterol and cholestyramine feeding and of fasting on sterol synthesis in the liver, lleum, and lung of the guinea pig.

The effects of feeding diest containing either cholesterol (0.24% w/w) or cholestyramine (2.5% w/w) and of fasting on sterol synthesis in the liver, ileum, and lung of both male and female guinea pigs have been studied by measuring the incorporation by tissue slices of 14C-labeled acetate into total digitoninpredipitable sterols. Cholesterol feeding significantly decreased (P less than 0.05) sterol synthesis in the liver, ileum, and lung of the males and in the ileum of females. Cholestyramine feeding stimulated the rate of hepatic sterol synthesis 13-fold but did not significantly affect sterologenesis in the ileum. Sterol synthesis in the lung was significantly increased (P less than 0.05) but to a much lesser extent than in the liver. Fatty acid synthesis in the liver, ileum, and lung was not significantly affected by either cholesterol or cholestyramine feeding. In guinea pigs fasted for 24 hr, sterol synthesis was inhibited in all three tissues, the most pronounced effect occurring in the liver. Only in the lung was fatty acid synthesis significantly decreased (P less than 0.001) by  fasting. Cholesterol feeding resulted in increased concentrations of cholesterol in the plasma and liver. Cholestyramine feeding reduced plasma cholesterol concentration by 81% in females and by 64% in males. However, it did not significantly change the tissue cholesterol concentrations. Fasting resulted in a significant increase (P less than 0.05) in plasma cholesterol concentration but did not effect the concentration of cholesterol in the tissues. It was concluded that in the normal guinea pig, the feedback inhibition produced by both cholesterol and also possibly by bile acids suppresses sterol synthesis in the liver to very low rates compared to those in the small intestine, where sterologenesis is not only less sensitive to the cholesterol negative feedback system than that in the liver, but also is not subject to regulation by the bile acid negative feedback system.


Oleic and vaccenic acid levels in lipid clases of tumors.

The isomeric octadecenoate composition of triglyceride, phosphatidyicholine, and phosphatidylethanolamine classes from a variety of rat and mouse tumors was examined. Phosphatidylethanolamine from the tumors contained a higher percentage of octadecenoate than reported for many normal tissues. The octadecenoate fractions of the three lipid classes from various tumors consisted of ca. 75% or greater oleate, with vaccenate making up the balance. These data indicate that the loss of lipid class specificity for isomeric octadecenoates reported in hepatomas (Lipids 10:746, 1975, and Lipids 9:987, 1974) also occurs in other tumors.


Aortoduodenal fistula.

A primary aortoduodenal fistula is usually associated with an atherosclerotic aortic aneurysm, and a secondary fistula with a leaking anastomotic aortic suture line. Two examples of each are reported. The typical features of a primary fistula are haematemesis or melaena, pain, and a pulsatile abdominal mass; the features of a secondary fistula are haematemesis and melaena with a past history of aortic resection. The initial haemorrhage is rarely fatal: a lag period allows urgent laparotomy. The fistula is diagnosed by dissection of the fourth part of the duodenum from the aorta. The treatment is closure of the duodenum, and resection of an aneurysm if present. Reconstruction is by a graft anastomosed to the aorta proximal to the fistula, if the area is clean, or by an extra anatomical bypass, if the area is heavily contaminated.


Rupture of the bowel due to road trauma: the emergence of the "seat belt syndrome".

Seat belts have proved to be life saving for drivers and passengers involved in motor-car collisions. The number of severe head, face and trunk injuries has been significantly reduced. However, the wearing of belts has been responsible for an increased incidence of bowel rupture, in itself a potentially lethal injury if not diagnosed and treated early. There is still much to be done in improving seat belt design.


The management of breast cysts by aspiration.

A review is given of 75 patients presenting with breast cysts treated by aspiration. The patients have been followed for an average of four years and in no case has a carcinoma been detected. The technique is considered to be safe provided the guidelines laid down by the writers are followed.


Leiomyoma of the common bile duct causing obstructive jaundice.

The second reported case of leiomyoma of the common bile duct is described. It was treated by pancreaticoduodenectomy. The patient was well 28 months later.


A need for more psychophysiological research in australia.

Western communities are becoming increasingly more interested in altered states of consciousness such as hypnosis, meditation and other states associated with certain "brain wave" patterns. In the United States of America especially, psychophysiological research is beginning to lead to an understanding of some of the basic mechanisms underlying certain mental phenomena and their therapeutic uses. In Australia, on the other hand, experimental investigations in this area are negligible. It is important to begin intensive psychophysiological research now.


Affinity chromatography of tetanus toxin, tetanus toxoid, and botulinum A toxin on synaptosomes, and differentiation of their acceptors.

125I-labelled tetanus toxin and 125I-labelled botulinum A neurotoxin are known to be specifically bound to brain synapotosomes. In order to discriminate between active toxin and inactive admixtures present in the starting material or arising during iodination, synaptosome columns were prepared using bromacetylcellulose and/or kieselgur (Celite) as carriers. Both types of columns absorb the toxins from low ionic strength medium and release them if the pH and ionic strength are raised. Botulinum toxin was eluted with lower ionic strength than tetanus toxin, and could be freed from nontoxic admixtures. Analysis by affinity chromatography disclosed partially toxoided tetanus toxin in both labelled and unlabelled toxin samples. High concentrations of formaldehyde (0.5%) destroyed both toxicity and affinity to the synaptosomes of tetanus toxin. Low concentrations of formaldehyde  (0.05%) yielded a derivative of low toxicity which was still however less firmly, bound to synaptosomes. Tetanus and botulinum toxin differ by their acceptors. Whereas unlabelled botulinum toxin is unable to compete with labelled tetanus toxin, unlabelled tetanus toxin slightly competes with botulinum toxin. Both labelled toxins display anomalous binding behavior in that they cannot be displaced completely even with a large excess of unlabelled toxin.


Interaction of hexafluorenium with human plasma cholinesterase in comparison with hexamethonium.

1. The influence of the 2 alkane-bis-onium compounds hexafluorenium (HF1) and hexamethonium (C6) on human plasma cholinesterase (ChE) was studied with respect to the type of inhibition. 2. HF1 and C6 are reversible inhibitors of ChE. The inhibitory potency of HF1 (pI50 = 6.96; Ki = 2.4 x 10(-9)) is about 40 000-fold higher than that of C6 (pI50 = 2.4; Ki = 6.7 x 10(-2)). 3. The kinetic analysis displayed a competitive (C6) and a non-competitive (hf1) mechanism of action. 4. The inhibition of ChE by C6 is induced by a binding of C6 to the anionic site of the active center thus impairing the primary formation of the enzyme-substrate complex. HF1, however, is most probably bound to anionic side receptors in the vicinity of the active center; by that a conformational change of the enzyme protein is induced impairing the acylation step of the esteratic site.


Lethality of tyrosine in mice: its potentiation by decarboxylase inhibitors and reversal byascorbic acid.

High doses of tyrosine were found to be lethal in mice. The lethality was potentiated by decarboxylase inhibitors which acted by elevating tissues tyrosine levels when given together with large amounts of tyrosine. The lethality of either tyrosine or tyrosine given in combination with decarboxylase inhibitors was found to be correlated with the elevation of tyrosine levels in liver. This toxicity does not appear to involve either tyramine or p-hydroxyphenylpyruvic acid formation. Ascorbic acid pretreatment afforded a marked protection against tyrosine toxicity. This compound was found to prevent the elevation of tissue tyrosine levels by stimulating p-hydroxyphenylpyruvic acid oxidase, increasing the urinary excretion and inhibiting the gastrointestinal absorption of tyrosine.


Electrophysiological effects of droperidol in different cardiac tissues.

The effect of droperidol in concentrations between 0.05 and 5 mg/I was evaluated on different electrophysiological variables in auricular preparations of the guinea-pig, papillary muscles of dog and cat, Purkinje fibres of the dog, cow and sheep. At low concentration (0.25 to 0.5mg/I) droperidol decreased pacemaker activity and prolonged the effective refractroy period. The inhibition of pacemaker activity was not accompanied by a reduction in the rate of early diastolic depolarization, but was related to an  inhibition of the depolarization process during late diastole. At high concentrations (5mg/I) resting potential, action potential amplitude, (dV/dt)max and conduction velocity were reduced. Reduction of dV/dt during the upstroke was more pronounced at lower membrane potentials, the inactivation curve was shifted to more negative membrane potentials. The action potential was lengthened or shortened, the effect being dependent on the frequency, dose, exposure time and animal species. Droperidol had no deleterious effect on Ca-mediated action potentials. The antiarrhythmic activity of droperidol in therapeutic concentrations (0.25 and 0.5mg/I) can be explained by the reduction of pacemaker activity and the lengthening of the effective refractory period. In terms of changes in ion conductance most effects can be explained by a reduction in Na conductance. No simple explanation can be offered for the complex changes in action potential duration.


Effects of calcium and phosphate on catecholamines, ATP and dopamine beta-hydroxylase of chromaffin medullary granules.

Isolated bovine chromaffin granules lost their catecholamines to a significantly higher degree when incubated in isotonic sucrose-buffer of pH 7.4 containing 10 and 25 mM sodium phosphate, respectively, than during incubatation in sucrose with 4 mM sodium phosphate. 2. In 4mM sodium phosphate-sucrose, CaCl(2) in  a final concentration of 1 and 2 mM, respectively, produced only traces of an amorphous precipitate of calcium phosphate which increased the efflux of catecholamines only to a small degree. The same concentrations of CaCl(2) in 10 and 25 mM sodium phosphate containing sucrose solutions caused larger amounts of calcium phosphate precipitate and simultaneously a very high efflux of catecholamines. Small amounts of exogenous ATP (1 mM) and MgCl(2) (0.3 mM) effectively antagonized the efflux of catecholamines from the granules evolked by calcium phosphate...


The effect of pretreatment with reserpine on the diastolic potential of guinea-pig atrial cells.

It has previously been suggested that the reserpine-induced nonspecific increase in sensitivity of the guinea-pig heart to the chronotropic effect od drugs occurs as a result of an alteration in the electrophysiological properties of the cell membrane. The results obtained in the present study provide support for this suggestion. The diastolic potential of atrial cells of perfused hearts obtained from guinea pigs treated with rerpine (0.1 mg/kg/day) for 7 days was significantly less than control. This treatment schedule of reserpine results in a significant increase in the sensitivity of perfoused hearts to the chronotropic effects of drugs...


Pneumocephalus following mastoid surgery: a report of two cases.

Two cases of spontaneous pneumocephalus following mastoid surgery are presented. In both cases a fistula from the mastoid ended blindly in an area of cerebritis without any definite abscess formation. Etiological factors are discussed with congenital dural defects suspected as the precipitating factor.


Proptosis secondary to pneumocele of the maxillary sinus.

The third known case of a pneumocele of the maxillary sinus is reported. Radiographic findings included hyperlucency of a maxillary sinus with generalized expansion of its borders. Bone dehiscence was also visible with tomography. The present case emphasizes a gradual onset of clinical signs and manifested primarily by proptosis. Possible mechanisms in the production of this deformity are discussed.


Traumatic arteriovenous fistulas of the vertebral artery.

Arteriovenous fistulas of the vertebral artery are uncommon. Trauma, arterial erosion by abscess and congenital weakness of the arterial wall are the most frequent cause of these fistulas. Few of them have been reported following percutaneous puncture of the vertebral artery. Two such cases, as well as an exceptionnel false traumatic aneurysm of the V4 segment of the vertebral artery in front of a fracture of the occipital bone, are described here. The latter patient also has a malformation of the craniovertebral joint.


A radioanatomical study of the choroid plexus of the fourth ventricle.

A radioanatomical study of the plexus of the 4th ventricle has shown it to be clearly visible in about 35% of the lateral vertebral angiograms. With tumors of the posterior fossa the plexus is often not recognizable, perhaps because it is compressed. If filled, better information about the localization of tumors can be obtained.


Angiography of incomplete lobulation of the cerebellar virmis with small fourth ventricle associated with callosal hypoplasia.

A case of imcomplete lobulation of the cerebellar vermis with a high insertion of tentorium, associated with a hypoplastic corpus callosum and a small fourth ventricle is presented. The pneumographic and angiographic findings of these malformations are correlated.


Management of pregnancy-induced hypertension in the nullipara.

Three hundred and forty-six nulliparous women with pregnancy-induced hypertension prior to term were monitored in a high-risk pregnancy unit while awaiting fetal maturity. Management included ambulation as desired, regular hospital diet without salf restriction, blood pressure measured 4 times daily, weight and urine protein determined 3 times each week, creatinine clearance determined weekly, and serial sonography to monitor fetal growth. Sedation and antihypertensive agents were not prescribed. Delivery was delayed until term unless hypertension persisted or recurred following an initial salutary response. Factors other than hypertension that contributed to the decision to effect delivery were 1) rapid weight gain, 2) decreasing creatinine clearance, 3) appearance of significant proteinuria, 4) suspected fetal growth retardation, and 5) the development of severe headache or scotomata. With this method of management the perinatal mortality rate was 9/1000. Only 5 infants developed the respiratory distress syndrome and all survived. There were 26 women who left the unit against medical advice. Severe hypertension subsequently developed in 7 of these women and 4 of their fetuses were stillborn. The perinatal mortality rate among this group of patients was 154/1000. It is concluded that the nulliparous patient with pregnancy-induced hypertension prior to term can be safely managed by hospitalization and close observation as a viable alternative to prompt delivery.


Improved glucose control in nonhospitalized pregnant diabetic patients.

Methods for management of diabetic pregnancy in the outpatient setting require strict glucose control. To assess the effect of diet and injection of short and intermediate acting insulin on glucose, diabetic patients tested their urine daily for glucose and had biweekly serum glucose tests. A brief metabolic ward study in 9 diabetic patients during the third trimester yielded hourly glucose determinations. These results defined the range of serum glucose over a 24-hour period. Glucose data on 6 normal third trimester women also came from hourly glucose values. Glucose results of normal and diabetic subjects were similar. A 16th subject with diabetic eye, renal, and foot complications is included as a case report to illustrate management technics. Infants of the diabetic women had no perinatal mortality, morbidity, or macrosomia and thus differ from an earlier study where glucose was not strictly controlled. The data suggest hospitalization can be short and low perinatal morbidity and mortality are possible with this outpatient method of management of the pregnant diabetic patient.


Placental changes in gestational diabetes. An ultrastructural study.

A light microscopic, an electron microscopic, and a ultrahistochemical study have been made of seven placentas from women with mild and excellently controlled chemical gestational diabetes. Only one placenta showed no significant abnormality; the remainder showed, to a varying degree, changes in the syncytiotrophoblast, cytotrophoblast, trophoblastic basement membrane, and fetal vessels. These abnormalities were identical to and in some cases as severe as those found in placentas from women with longstanding, moderately controlled, overt diabetes mellitus. These findings indicate that control of hyperglycemia only partially prevents the development of placental abnormalities which must be due to some other constituent factor of the diabetic state.


X-ray pelvimetry of the pregnant adolescent. Pelvic size and the frequency of contraction.

Pelvic dimensions by x-ray of 282 pregnant adolescents and 181 adult women were compared to ascertain if the pelvis of the adolescent was smaller and contracted with greater frequency. The majority of 10 pelvic dimensions for black and white adolescents were significantly smaller or contracted with significantly greater frequency. The pattern of signifcant differences suggests that the adolescent pelvis has yet to mature fully by age 16. As a consequence of physiologic events during puberty, described by several authors, the adolescent pelvis grows at an accelerated rate and typically changes from an anthropoid to a gynecoid configuration. Caution must be taken in applying these results since pelvic size is not synonymous with obstetric outcome.


A computerized fetal monitoring system.

A computerized fetal monitoring system has been developed at the Cedars-Sinai Medical Center in Los Angeles, California. It utilizes unmodified fetal monitors feeding fetal heart rate and uterine pressure data into a minicomputer. The overall accuracy on internal monitoring is 91%. The concept of on-line computer analysis of fetal monitoring records has met with clinical acceptance and is utilized for all patients in labor at the Cedars-Sinai Medical Center.


Electronic monitoring of the fetal heart rate and uterine contractions during cesarean section under balanced anesthesia.

The influence of balanced anesthesia (BA) on fetal heart rate (FHR) and uterine contraction (UC) patterns was evaluated in pregnant women undergoing emergency cesarean section. The results showed that during operative delivery under BA there was a significant decrease in the beat-to-beat variability of the FHR, most probably due to the anesthetic agent. There was a decrease in uterine contractility expressed by the significant decreases in the peak pressure as well as in the duration of the uterine contractions. Periodic changes in the FHR as decelerations and acclerations disappeared or improved mostly due to the decrease of uterine contractility.


hCS regulation during pregnancy.

In order to define the homeostatic mechanisms which affect the secretion of human chorionic somatomammotropin (hCS), we have determinated its plasma levels by a radioimmunoassay method in normal, prediabetic, and chemically diabetic pregnant women in basal conditions and after stimuli. Oral glucose failed to modify hCS plasma levels as also did continuous intravenous glucose infusion. Rapid acute intravenous glucose decreased them, suggesting that only sudden changes in maternal plasma glucose can exert a regulatory effect on hCS secretion. In travenous arginine increased hCS levels, new evidence of the great similarity of structure and function between growth hormone and hCS.


The association of maternal lymphocytotoxic antibodies with obstetric complications.

The immunologic relation between mother and fetus has become of interest to those concerned with reproductive physiology. One method to assay this type of relation is to determine the immunologic response to HLA antigens expressed by the fetus which are of paternal origin. Although 20 to 50% of multiparous women develop lymphocytotoxic antibodies during pregnancy, the effect of these antibodies on gestation or the fetus has not been established. In a prospective study, 23 patients at the time of spontaneous abortion had negative cytotoxic antibodies. Of 129 obstetric patients followed with antibody screening over a 6 to 7 month period until delivery, 28 developed positive lymphocytotoxic antibodies (22%). These 28 patients with cytotoxic antibodies delivered male infants by a ratio of 4 to 3, and 11 patients (39.3%) had complications during the gestation. The responsiveness to the paternal histocompatibility antigens is valuable information for furthering the understanding of the fetal-maternal relation.


Preoperative and intraoperative evaluation in ovarian malignancy.

The survival rate for patients with all stages of ovarian cancer has not improved over the past quarter of a century. A review of 100 consecutive patients treated for ovarian cancer was undertaken to evaluate preoperative and intraoperative measures. The study revealed that one-third of patients has only physical examination, other than routine preoperative tests, prior to laparotomy, and that 11% did not have a pelvic examination. Eighty-three percent of the incisions were inadequate for evaluation of the upper abdomen for sites of other primary malignancies that could metastasize to the ovary and mimic ovavian cancer, or for evaluating known sites of metastasis from ovarian cancer such as the diaphragm, liver, and upper aortic lymph nodes. Specifically, the aortic nodes were not described in 92% of reports, the diaphragm in 84%, the stomach in 76%, the pancreas in 76%, the colon in 70%, and the liver in 59%. The ovary was not resected or biopsied for histologic confirmation in one-third of the cases. It is proposed that the efficacious use of adjuvant therapy for women with ovarian cancer must be preceded by careful preoperative and intraoperative evaluation of all women with presumed ovarian malignancy.


Comparison of continuation rates of intrauterine devices.

The validation of reports of the performance of intrauterine contraceptive devices (IUDs) is fraught with confounding factors such as different protocols, populations, and clinic environments. Two-year life table continuation rates from a comparative study of the Lippes loop, TCu-200, and Dalkon shield are reported from a single clinic in which 1626 insertions were performed by two obstetrician/gynecologists. The difference between the highest and lowest parity-standardized continuation rates for the three devices was only 3.7 percentage points after 2 years of use. The TCu-200 and Dalkon shield yielded significantly lower expulson rates than the Lippes loop. The more recently developed IUDs do not appear to have higher continuation rates than the Lippes loop.


Actinomycosis of the female genital tract.

Four cases of actinomycosis involving the uterus and adnexal structures are reported. In 2 cases the infection was transmitted from a ruptured appendix. Ascending actinomycosis involving the endometrium and resulting in adnexal abscesses was associated with the use of an IUD in 2 patients. This infection should be suspected in any patient who develops a pelvic abscess with an IUD in place. Culture and histologic examination of tissue removed with the IUD may be a means of early diagnosis. The nature of these infections became apparent only after serious complications developed. Each patient required several surgical procedures. The diagnosis remained unsuspected until repeated laboratory examinations detected the fungus. The difficulty encountered identifying Actinomyces israeli indicates the infection is often undetected. Gallium scans were helpful in localizing occult abscesses in 2 patients.


Cyclic changes of cervical mucus enzymes related to the time of ovulation II. Amino peptidase and esterase.

The enzymes amino peptidase and esterase were identified in human cervical mucus. Their concentration was serially determined during a menstrual cycle in 5 normal ovulatory women and correlated with the time of ovulation as monitored by the basal body temperature and radioimmunoassay of serum luteinizing hormone (LH), progesterone, and estradiol (E2). The activity of both enzymes decreased at midcycle just before the LH surge and began to rise after ovulation. The preovulatory decline in enzyme activity was significant for esterase but not for amino peptidase. The site of production and functional significance of these enzymes are not at present identified.


Fracture healing in estrogen-treated and castrated rats.

The healing of a midfibular fracture was studied in mature rats. The strength of the healing fracture was determined by a constant speed-driven tensiometer which measured the force required to separate the healing callus. The breaking strength of the healing experimental fracture was ascertained in control, estrogen-treated, and oophorectomized animals. The fracture strength was not significantly different in any of these groups.


Pathophysiology of disseminated intravascular coagulation in saline-induced abortion.

Our previous studies suggested that disseminated intravascular coagulation (DIC) may be a sequel to saline-induced abortion. A hypothetical mechanism for the DIC is that hypertonic saline produces cellular disruption in the products of conception with the release of thromboplastic substances into the amniotic fluid. These substances, in turn, diffuse through the damaged membranes into the maternal circulation. To examine this hypothesis we obtained samples of amniotic fluid (AF) from 5 patients just prior to and at 1 hour, 6 hours, and 24 hours after intraamniotic instillation of hypertonic saline. The procoagulant and thromboplastic properties of the various AF specimens were quantitated using the prothrombin time (PT), partial thromboplastin time (PTT), and activated clotting time (ACT) as in vitro test systems. The results indicate that a change in the procoagulant and/or thromboplastic activity of AF following saline instillation is not afactor in the pathophysiology of DIC associated with saline abortion.


Pure gonadal dysgenesis with nonmosaic XY sex chromosomes.

A person with pure gonadal dysgenesis (XY) is described in whom peripheral leukocytes, skin, fascia, and both gonads were subjected to chromosomal analysis, confirming a lack of mosaicism. Previous case reports and the developmental and genetic basis for such an anomaly are reviewed.


Ultrasound diagnosis of nonobstetric disease during pregnancy.

The use of ultrasound in obstetrics is well established; however, its use in nonobstetric disease during pregnancy has not been emphasized. A diagnostic work-up during pregnancy is complicated by the fact that many of the usual tests require radiation to the fetus. This paper presents 3 cases in which ultrasonic scanning contributed to the diagnosis of nonobstetric disease during pregnancy. Postitive findings included enlarged edematous pancreas, gallstones, and splenomegaly. In 1 case, the finding of a normal gallbladder was helpful. When usual diagnostic procedures such as oral cholecystogram, retrograde endoscopic pancreatography, and nuclear medicine scans are perhaps contraindicated during pregnancy, the ultrasound scan is the diagnostic test of choice.


Occult pregnancy. A pilot study.

As used herin, the term "occult pregnancy" is defined as a pregnancy which aborts so early that no clincial suspicion of its existence arises except perhaps that there has been a few days' delay in the onset of an otherwise normal menstrual period. Sixteen Clomid-induced ovulatory cycles as evidenced by biphasic temperature charts with hyperthermic phases of 12 days or more were studied. Of these, 10 had serum luteinizing hormone values in the late luteal phase normal for that part of the cycle (6-16 mIU/ml) and six, or 37.5% showed values sufficiently elevated (more than three standard deviations) to indicate a cross reaction with human chorionic gonadotropin and hence the presence of an otherwise unsuspected pregnancy. All had clinically normal menstrual periods 12 hours to 6 days later. The clinical significance of this finding is discussed.


An unusual foreign body in the pelvic cavity after laparotomy.

An unusual case of a glass bottle remaining in the pelvic peritoneal cavity for 6 years after laparotomy is reported, and the prevention of such occurrences is emphasized.


Central pontine myelinolysis. Two cases with associated electrolyte disturbance.

Two patients with central pontine myelinolysis are described. Both were middle aged women presenting with a history of protracted vomiting and drowsiness. Hyponatraemia (serum sodium 96 to 100 mmol/L) was a feature in both patients. No underlying malignancy, alcoholism, malnutrition or other serious disease was identified. Correction of electrolyte abnormalities was accompanied by deterioration in level of consciousness and development of a neurological syndrome characterized by quadriparesis, dysphasia and mutism. Death followed and histopathological examination confirmed classical myelinolysis in the central pons and extensive similar, though not identical, lesions in the cerebral hemispheres in both cases. The pathophysiological basis of the lesions is likely to be a special metabolic susceptibility of oligodendroglial cells in areas where neurones, glial cells and myelin sheaths lie in close proximity to one another.


Hypophosphataemic osteomalacia and Fanconi syndrome of adult onset with dominant inheritance. Possible relationship with diabetes mellitus.

Adult-onset osteomalacia with multiple renal tubular defects and generalized aminoaciduria is uncommon, and where familial it is characteristically an autosomal recessive disorder. This paper describes a kindred in which the syndrome has appeared in four successive generations, apparently inherited in a dominant manner, and possibly associated with diabetes mellitus. The proposita had hypophosphataemia, renal glycosuria, proteinuria and generalized aminoaciduria, and at the age of 22 developed symptoms of osteomalacia which responded to treatment with oral phosphate. Her father had been similarly affected: renal glycosuria was first noted when he was 24, and 12 years later he developed diabetes mellitus from which he died. One sister, aged 31, has renal glycosuria, aminoaciduria and hypophosphataemia without bone disease. In the three preceding generations at least seven other individuals had crippling bone disease and profound muscle weakness of early adult onset; in four, preterminal polydipsia was recorded, and others had renal glycosuria or diabetes mellitus. Three of the five children in the latest generation have slight proteinuria but not other detectable abnormality. The possible association between these renal tubular defects and diabetes mellitus is discussed.


Renal abnormalities and vascular complications in primary hyperaldosteronism. Evidence on tertiary hyperaldosteronism.

The frequency of underlying renal or renal artery disease, and the incidence of vascular complications were reviewed in a series of 136 cases of primary hyperaldosteronism. This was in order to investigate the possible existence of 'tertiary' hyperaldosteronism, and to examine the commonly held view that primary hyperaldosteronism is a relatively benign form of hypertension. Ten cases (7-4 per cent) had evidence of renal artery stenosis and eleven (8-1 per cent) parenchymatous renal disease. In comparison with the reported frequency in large general series of hypertensives, these data show no evidence of an excess of underlying renal disease. It is unlikely, therefore, that autonomous aldosterone secreting adenomata occur commonly as a consequence of prolonged secondary hyperaldosteronism. Four cases (2-9 per cent) had evidence of the malignant-phase of hypertension, and over a mean observation time of 5-9 years, 31 cases (22-8 per cent) developed 39 vascular complications. It appears, therefore, that vascular complications are not rare in primary hyperaldosteronism, and early and effective treatment is thus necessary.


Hypophosphataemic osteomalacia in fibrous dysplasia.

We describe three patients with fibrous dysplasia of bone in whom there was evidence of hypophosphataemic osteomalacia or rickets. Two of the patients had polyostotic fibrous dysplasia and osteomalacia. The third was a child with fibrous dysplasia of the facial and cranial bones and rickets. In all cases the manifestations of osteomalacia or rickets were controlled with large doses of vitamin D. In the child the rickets and hypophosphataemia ceased when most of the bone affected by fibrous dysplasia was surgically resected. Previously reported cases of the association between fibrous dysplasia and hypophosphataemic osteomalacia are reviewed. We suggest that these cases are analogous to the syndrome of 'tumour rickets' where hypophosphataemia appears to be due to the presence of a mesenchymal tumour and regresses when the tumour is removed.


Serum ionized calcium in nephrotic syndrome.

Serum ionized calcium was measured in 12 patients with nephrotic syndrome and 14 nephrotic patients during clinical remission. All subjects had normal creatinine clearance and were not receiving treatment at the time of study. The mean serum ionized calcium values of the two groups of patients, 1-08 +/- 0-10 (SD) mmol/l ultrafiltrate and 1-21 +/- 0-10 (SD) mmol/l ultrafiltrate respectively, are significantly lower than the normal mean (1-28 +/- 0-06 (SD) mmol/l ultrafiltrate). The mean values of the patients in remission is, however, significantly higher (P less than 0-005) than that of the patients with manifest nephrotic syndrome. Elevated serum complexed calcium, and high serum protein-bound calcium in relation to serum albumin, were encountered, being more apparent in patients with overt nephrotic syndrome.


The clinical aspects of mesothelioma.

Three hundred and twenty-seven cases of mesothelioma accepted by a panel of pathologists have been used to construct a clinical picture of the disease. The cases analysed  died between 1 January 1960 and 31 December 1969 and consisted of 267 pleural, 37 peritoneal, and 23 cases which could have arisen in either site. Two hundred and sixty-eight were in men and 59 in women and the disease appeared to be the same in women as in men. The mean age at death was 59-37 (+/- SD 9-89) years but ranged from 29 to 88 years. The mode of onset was insidious in all but a few cases and the mean interval before reaching the hospital was 3-39 (+/- SD 4-64) months for pleural and 3-08 (+/- SD 3-22) for peritoneal cases. Patients usually noticed a dull non pleuritic pain first but suffered some breathlessness, lassitude and weight loss by the time they reached hospital. On examination there was little evidence of disease apart from the signs of pleural effusion or thickening or ascites. Clubbing and signs of asbestosis were rare except in the peritoneal cases who more frequently gave an occupational history of heavy exposure and showed the radiological consequences of this. At the time when these patients were investigated diagnostic procedures were unrewarding and many patients were only diagnosed in retrospect. The prognosis was somewhat better for patients shown to have mainly epithelial cell tumours, 17-89 (+/- SD 18-26) months, predominantly spindle cell lesions surviving on the average only 7-98 (+/- SD 8-55) months and mixed tumours 11-3 months. The criteria for the early clinical diagnosis are described with a view of facilitating the search for effective treatment.


Variables discriminating between cryptogenic glomerular lesions in adults with the nephrotic syndrome.

A univariate analysis of individual clinical and biochemical values of adult patients with cryptogenic nephrotic syndrome has shown that significant differences exist between patients with proliferative glomerulonephritis, 'minimal change' nephritis and membranous nephropathy. For any given adult patient with the condition, the most likely clinical diagnosis is proliferative disease and the next, minimal change. These two diagnoses together account for most cases. The best clinical discriminants between them are the systolic blood pressure and plasma cholesterol concentration. If the systolic pressure is greater than 145 mm Hg proliferative disease is more likely, but if the cholesterol is greater than 530 mgm/100ml, a minimal change lesion is more likely. A scattergram for combining these variables in clinical practice is given, showing a zone of uncertainty where renal biopsy would be indicated. Although single variables do not permit discrimination between membranous nephropathy and the other two groups, it is suggested that analytical techniques where combinations of variables are used may be helpful, and should be developed.


Potassium supplements in patients receiving long-term diuretics for oedema.

Plasma, blood cell, and total body potassium levels were measured serially in 21 patients receiving long-term diuretics for the treatment of cardiac oedema and the results compared with similar measurements in 10 control subjects. Initially, all diuretic recipients received potassium chloride supplements. However, in 17 of the 21 subjects these were discontinued and measurements of potassium status were repeated regularly thereafter. No significant fall in the measured indicators of potassium status were observed in the patients in whom potassium was withdrawn; however, in one subject with persistent cardiac failure who presented with hypokalaemia this was not corrected even after intensive potassium supplementation. It is concluded that for those taking a normal diet who are free of any major gastro-intestinal disorder, routine potassium supplementation is unnecessary, and might indeed occasionally prove harmful.


Recessive inheritance of diabetes: the syndrome of diabetes insipidus, diabetes mellitus, optic atrophy and deafness.

A few rare syndromes have been delineated in which diabetes mellitus is inherited in association with other conditions. This paper describes five patients, including four siblings in one family, who have diabetes insipidus, diabetes mellitus, optic atrophy and deafness (the DIDMOAD syndrome). The parents of both families are normal but are first cousins. All the patients have insulin-dependent diabetes mellitus with a typical juvenile-onset. The onset of diabetes insipidus was insidious and the symptoms could easily have been ascribed to poor control of diabetes mellitus. The importance of diagnosing diabetes insipidus is that all these patients had dilatation of the urinary tract varying from mild hydroureter to severe hydronephrosis and this improved with treatment of the diabetes insipidus. It is suggested that patients with diabetes mellitus and optic atrophy should have regular screening tests for diabetes insipidus since it is likely that they represent cases of the full syndrome with incomplete clinical expression. The occurrence of this rare syndrome in four siblings of unaffected parents indicates that the syndrome is due to a recessive gene, but the pathogenesis is unknown.


Radiology of carcinoid tumours of the small intestine.

Carcinoid tumors of the small intestine are particularly known in the literature for their hormonal activity and for the carcinoid syndrome caused by the serotonin they produce. The radiological symptoms are based, not only on changes caused by the tumour itself but also on changes induced by hormonal products in the intestinal wall and mesentery. The classical excentric intramural defect in the contrast column is therefore often accompanied by swollen mucosal folds, swelling of the intestinal wall and evidence of mesenteric retraction.


Diagnostic radiology in fundoplication according to Nissen.

Radiological examination of oesophagus and stomach after fundoplication with hiatoplasty for hiatal hernia reveals unmistakable evidence of this intervention, and this indicates a good result. After relapse of the hiatal hernia, with or without reflux, the fundoplication is no longer recognizable, apart from a distinct demarcation of the oesophageogastric junction in some cases. The criteria for evaluation in the case of relapse are the same as those for preoperative evaluation.


Lipogranulomatosis of the mesentery.

This paper describes a 21-year-old man with lipogranulomatosis of the mesentery. This condition is characterized by a non-specific inflammatory process of the adipose tissue in the radix mesenterii. So far as could be established, this is the first patient in whom vascular anomalies and displacement of lymphatic vessels and lymph nodes have been described. However, these changes are hardly specific so that definite conformation of the diagnosis must be obtained by a biopsy. The aetiology is unknown. There is no established therapy for this benign, self-limiting disease.


Enteroclysis in coeliac disease.

48 patients with biopsy-proven coeliac disease are examined by means of intestinal intubation (enteroclysis). The radiological findings are discussed and these signs seems to be more specific for coeliac disease than the results of a conventional barium study of the small intestine.


Radiological examination of the colon.

In view of the diagnostic limitations of Welin's double-contrast method, which provides no total filling images or mucosal images, a description is given of a so-called universal method of investigation by which a diversity of diseases can be demonstrated. An essential feature of this method is the use of a barium sulphate suspension with experimentally established specific gravity and viscosity. This particular contrast medium has the advantage of permitting of total-filling exposures for assessment of contours and mucosal exposures for the diagnosis of inflammatory diseases and double-contrast method. The specific gravity at a given tube voltage also makes it possible to diagnose polyps after total filling.


The immunologic system, immunologic deficiency disorders and lymphoid hyperplasia of the small intestine.

The purpose of this paper is to review our current concept of the systems that subserve immunological functions. It concerns specifically the immunodeficiency diseases probably due to a B cell immunodeficiency. An attempt is made to classify those diseases clinically as well as roentgenologically. At last using the enteroclysis technique some examples of immunodeficiency syndromes are shown with special emphasis on developing a malignant disease.


Transpleural vascularization of pulmonary arteries in fibrous mediastinitis. Report of a case.

Idiopathic granulomatous and fibrous mediastinitis is an uncommon disease, the manifestation of which depends upon the organs involved. In a case of a Moroccan the rather unique complication of pulmonary artery obstruction on one side resulted in the development of functional important anastomoses between the bronchial and pulmonary arteries and also between the intercostal and pulmonary arteries by way of transpleural vascularization as is clearly demonstrated by bronchial and intercostal arteriography.


Goodpasture's syndrome.

This paper describes the case of a patient who combined severe pulmonary haemorrhages with symptoms of nephritis. These severe progressive changes led to a fatal issue. Clinical and postmortem findings led to the diagnosis 'lung purpura with nephritis', which is known in the literature as Goodpasture's syndrome.


Xanthogranulomatous pyelonephritis. Angiographic observations made in one case at an interval of six years.

In a woman aged 67, comprehensive angiographic examination revealed an extensive renal process which had led to thrombosis of the inferior vena cava. At exploratory surgery the process seemed inoperable. The angiographic study was repeated after an asymptomatic period of 6 years and disclosed shrinking of the kidney involved. Revision of the microscopic findings altered the initial diagnosis of renal carcinoma in favour of xanthogranulomatous pyelonephritis. The observation is of interest by virtue of the characteristic angiographic findings, extension of the process to the venous system, and angiographic evidence that spontaneous regression is possible.


Angiography of pheochromocytomas.

In 24 patients with a pheochromocytoma, angiography revealed a multiple localization in 20%, extra-adrenal localization in 20%, and insufficient information supplied by aortography in 25%. On the basis of this experience, several proposals are advanced for optimal execution of the vascular study, including retrograde phlebography of apparently normal adrenal glands and application of the subtraction technique.


Roentgen diagnosis of traumatic rupture of the aorta.

Traumatic rupture of the aorta is a frequent (10-15%) cause of death in automobile accidents. 10-20% of patients with this rupture live some hours to days before dying, and yet can be saved if the diagnosis is made in time. As clinical signs may be slight or absent the diagnosis must be made by the radiologist, who has three main tasks, namely (1) to detect the signs of the rupture on the plain film; (2) to perform angiography to prove the suspicion or to make a differential diagnosis; (3) to make angiography easily accessible without loss of time.


The thanatophoric dwarf. A report on two cases.

Two cases of thanatophoric dwarfism are presented. At external physical examination this anomaly is not readily distinguishable from achondroplasia and other forms of congenital disproportionate dwarfism. Radiologically, however, characteristic skeletal changes are demonstrable. The diagnosis can be made in utero. The clinical course is invariably fatal. The hereditary aspects, of importance for genetic counseling of parents, are still unexplained. The patients discussed show the typical thanatophoric skeletal changes in combination with a form of synostosis, i.e. bilateral radioulnar synostosis in one case, and synostosis of the coronal sutures and the lambdoid suture in the other. Emphasis is placed on the importance of radiological examination in cases of unexplained hydramnion and perinatal death.


Radiological findings in a case of type II fucosidosis. A case report.

This paper describes radiological characteristics of the skeleton in a patient suffering from type II fucosidosis. The early symptom of anterior beaking of the vertebral bodies, in combination with mental retardation and angiokeratoma corporis diffusum, can suggest the possibility of type II fucosidosis.


Bone changes in presellar meningioma.

Earlier recognition of presellar meningiomas may be achieved by looking for intracranial hyperplasia of the sphenoid sinus with additional hyperostosis as well as for the better known signs.


Sinus pericranii.

A 3-year-old patient with a sinus pericranii is described. A sinus pericranii should be differentiated from, in particular, hydromeningoencephalocele. In the diagnosis of sinus pericranii a brain scintiscan is an important but little known aid.


Gallbladder localization fo 131I-19-iodocholesterol; a pitfall in adrenal imaging.

Gallbladder concentration of 131I-iodocholesterol was observed in a patient studied for localization of adrenal activity. Misinterpretation of gallbladder activity as right adrenal function is possible if a lateral view is not obtained. The exposure of gallbladder mucosa may occasionally be far higher than the remainder of the biliary tract.


Negligible and non-negligible risks in radiodiagnostic examination of patients.

Ionizing radiation is regarded as a health hazard, but one is prepared to neglect this factor on the basis of certain motives. In 1975, KNOX published an analysis of these motives, none of which proved tenable. He concluded that a situation which in daily usage is described as safe, is one which entails risks considered to be negligible so that no safety measures are taken. It can be empirically established that in various health-endangering situations a health hazard of less than 1 X 10(-5) is being neglected. This article studies the risk factors to the individual patient in radiodiagnostic examinations involving low, medium and high radiation exposures. The estimates show that radiohygenic measures on behalf of the patient are advisable.


Less radiation, better images.

It is explained in this paper that the use of fast film-screen combinations, despite their greater intrinsic unsharpness, can lead to much better image quality in the case of involuntary movements of the organs to be visualized. It is also demonstrated that in such cases the use of a large focus with high ratings can be preferable. Also discussed is the possible value of the modern intensifying screens, in which compounds of the group of the so-called 'rare earths' are contained in the luminescent layer.


A teaching file, using 10 X 10 cm format copies.

A teaching file is of paramount importance for a teaching department. It should be easily accessible and readily available. Considerations of costs and available space influence the choice of film size for the copies. We have chosen for 10 X 10 cm copies, because the majority can be viewed by individuals on normal lightboxes, while for larger audiences various ways of projection are feasible. The possibility, offered by the Delcomat copying apparatus, of making copies of interesting parts of the original film in varying degrees of reduction in size, enhances the practicability of the method.


Gastric erosions: radiological and endoscopic aspects.

Varioliform gastric erosion is a common lesion which can be reliably diagnosed radiologically. The diagnosis was established in 27 (1.7%) of 1,600 detailed radiological examinations made in 1975. There was a good correlation with gastroscopic findings.


The relative effects of selective intra-arterial and intravenous vasopressin infusion.

The relative effects of selective intra-arterial and intravenous infusions of vasopressin were evaluated in 16 normotesive dogs. One group was infused via the left gastric artery, one was infused via a peripheral vein, and a control group was not infused. Flow to the stomach and bowel was reduced by an average of 73% and 45%, respectively. There was no significant difference between selective intra-arterial and intravenous infusions with regard to their effects on visceral flow or their systemic parameters. Control animals demonstrated only minor variations from base-line flow.


Transcatheter occlusion of abdominal tumors.

Radiological and clinical experience with transcatheter intravascular occlusion of abdominal and pelvic tumors in 55 patients is presented. Major indications include control of hemorrhage, palliation of local tumor symptoms, and preoperative management of facilitate surgery. Methods of occlusion included embolization (clot, subcutaneous tissue, and Gelfoam), introduction of a stainless steel coil into larger vessels, and balloon catheters. Hemorrhage was controlled in 8 of 12 patients with bleeding gastrointestinal and pelvic tumors. Experience in 36 patients with hypernephroma is discussed. Initial observations are presented, including occlusion of the hepatic artery for dearterialization of primary and secondary neoplasms and of the splenic artery for hypersplenism.


Acute cardiac herniation following pneumonectomy.

Pneumonectomy with partial pericardiectomy may result in herniation of the heart through the pericardial defect, leading to cardiovascular collapse and death. Awareness of this grave potential complication and familarity with its clinical and roentgenographic features should permit prompt diagnosis and facilitate lifesaving repeat thoracotomy.


Balloon catheter with a calibrated leak. A new system for superselective angiography and occlusive catheter therapy.

Problems with the use of the diagnostic angiography catheter as a therapeutic tool relate to difficulty in placing the catheter precisely in the desired area and controlling the infusion of the occluding agent. The author describes a soft microcatheter which has been developed to overcome these problems. The catheter ends in a balloon tip and thus can be flow-directed. To overcome the traditional difficulties of flow-guided catheters and the need for a double lumen, a calibrated leak in the balloon allows distal fluid delivery while the balloon remains inflated.


Bulbous splenic vein as a cause of renal pseudotumor.

A number renal and suprarenal pseudotumors have been described during the past two decades, paralleling the development of selective visceral angiography. An apparent left upper pole renal mass in a 71-year-old hypertensive man was found to ba a bulbous portion of the splenic vein during angiography. The anatomical basis of this renal pseudotumor is discussed.


Comparison of ejection fraction calculated by nine different volume calculation methods.

Single plane right anterior oblinque ventriculography was performed on 25 patients with normal left ventricular contraction and on 25 with left ventricular akinesia or dyskinesia. The value of the left ventricular ejection fraction (EF) was calculated by 9 different methods, including a new one utilizing the mathematical model of a cone. All methods tested were appropriate for inter-group comparisons of EF. For inter-individual comparisons, however, only those methods described by Davila, Chapman, Dodge, Beranek, and our new method, are appropriate.


A new method for percutaneous nephrostomy.

A new method of percutaneous nephrostomy using techniques to place a No. 12 French balloon catheter in the renal collecting system is described. Case reports demonstrate tumor palliation and temporary drainage to improve the very ill prior to definitive surgery. A translumbar aortogram catheter is placed lateral to paraspinous muscles and Dotter vascular dilators are used to allow insertion of the large balloon catheter.


Unilateral iliac horn (central Posterior iliac process). Case report.

An anomaly of the pelvis consisting of a unilateral iliac horn is presented. It appeared as an isolated bony malformation which was not associated with signs, symptoms, or stigmata of hereditary onycho-osteodysplasia.


Serial long-term phlebography after documented lower leg thrombosis.

Representative phlebograms from a series of 38 patients (86 phlebograms) followed up from 2 weeks to 6 years after the initial thrombotic episode are presented. The veins cleared earliest and most completely in patients with thrombosis, limited to the calf. Totally occluded veins cleared more slowly and less completely than non- or partially occluded veins. Post-thrombotic restoration of normal venous and valvular structures was commonly seen. The authors describe a phlebographic pattern which corresponds to previously documented pathological material, illustrating intimal thickening as a sequel to organization of thrombi onto the walls of the veins.


Adductor avulsive injuries near the symphisis pubis.

Avulsion injuries occurring near the symphisis pubis are related to the sites of origin of the adductor longus, adductor brevis, and gracilis muscles. Young athletes complain of pain near the symphisis which is increased by active adduction of the limb against resistance. Radiographic findings, similar to those found in infection and neoplasms, are mixed bone destruction and sclerosis on one side of the symphisis, frequently extending inferior pubic ramus.


The appendix of the ventricle of the larynx.

A review of 100 consecutive laryngograms showed visualization of the appendix of the laryngeal ventricle in 40% of cases. This high incidence of visulization is related to thorough anesthesia, repeated performance of phonation and the reverse "E" maneuver as well as awareness of the anatomical structure. The appendix of the laryngeal ventricle courses superiorly between the laryngeal vestibule and the thyroid cartilage which differentiates this normal structure from ulcerations and fistulous tracts of laryngeal tumors.


A computerized exposure system.

An application of computer technology to radiographic technique formulation and selection was developed. By proper monitoring and organizing of the immense number of variables associated with technique formulation, through computer program control, the resultant program can readily calculate a complete technique exposure system for virtually all standard radiographic generators in any number of diagnostic radiology installations. This results in significant saving of film cost and time in the preparation and continued maintenance of an exposure system, less exposure to the patient as a result of fewer repeat radiographs, and uniform film quality.


Radiologic-pathologic correlation from the Armed Forces Institute of Pathology. Lymphangiomyomatosis.

The radiologic patterns caused by interstitial lung disease evoke a long list of differential diagnostic possibilities. Though the problem may at first seem insoluble, subdivision into conditions that spare the pulmonary architecture, as opposed to those that lead to an end-stage "honeycomb lung", and consideration of the clinical findings will frequently narrow down the list. Occasionally, key associated findings such as pleural effusion, pneumothorax, and systemic involvement of many organs will help rule out inappropriate diagnoses. Lymphangiomyomatosis is a rare cause of "honeycomb lung" that may result in a very specific combination of radiologic and clinical findings.


Growing intracranial aneurysms.

Cerebral angiography is the best means by which an intracranial aneurysm can be demonstrated and studied in vivo. In 16 cases clinical deterioration paralleled a variable degree of enlargement of the aneurysms. In all patients the aneurysms were irregular and/or bior multilocular. Possible factors causing aneurysmal enlargement are discussed.


Chronic hypertrophic polypoid rhinosinusitis.

Chronic hypertrophic polypoid rhinosinusitis is a condition in which the mucous membrane lining the nose and paranasal sinuses becomes markedly hypertrophied, and nasal polyps become evident. Superimposed infection is common. Bony erosion, sometimes marked, may also result. Because of the alterations in bone, the condition may be mistaken for other more serious lesions.


Pseudo-metastases in the liver: a presentation of the Budd-Chiari syndrome.

Angiographic and scintigraphic findings closely mimicked vascular liver metastases in a young woman whose Budd-Chiari syndrome is probably the result of oral contraceptive use. Histological proof should be obtained before the diagnosis of hepatic neoplasm is accepted in patients with this syndrome.


The role of 133Xe ventilation studies in the scintigraphic detection of pulmonary embolism.

The angiographic, scintigraphic, and clinical data of 40 patients were reviewed in order to define the role of 133Xe ventilation studies in the radionuclide detection of pulmonary embolism. Two independent observers interpreted the perfusion images, and several weeks later reinterpreted them in conjunction with 133Xe ventilation studies. Overall diagnostic accuracy was significantly improved (p less than 0.05) when the xenon studies were included. The combined studies were slightly more sensitive and significantly more specific (p less than 0.05) for pulmonary embolism than the perfusion images alone.


Heterogeneity in the campomelic syndromes. Long-and short-bone varieties.

Analysis of 9 cases of bilateral bent limbs (campomelia) and dwarfism, as well as a review of the literature, indicate that campomelic syndrome appears to be a well-defined distinct disorder which the authors call long-limbed campomelic syndrome. Other neonates with congenital bent-limbed dwarfism can be classified as having short-limbed campomelic syndrome, and among these at least two distinct forms have been delineated--the craniosynostotic and the normocephalic form. Congenital bent bones also occur in a variety of generalized disorders of ossification that must be distinguished from these well-defined types of campomelic dwarfism.


Gray-scale ultrasonic properties of the normal and inflamed pancreas.

Eighty-seven examinations of the pancreas in 52 patients with acute or chronic pancreatitis and 31 examinations in 31 normal subjects were reviewed. Demonstration of the portal and splenic veins served as a guidepost to the pancreas. The normal pancreas was indistinguishable from the surrounding tissues in a substantial minority of examinations, and the ultrasonic characteristics of the normal pancreas were quite variable. Acute pancreatitis was found to be characterized by swelling, loss of internal echoes, and loss of distinction between the pancreas and splenic vein. In 50% of patients with chronic inactive pancreatitis, the pancreas could not be identified. Ultrasound should precede endoscopic retrograde cholangiopancreatography whenever a pseudocyst might be present.


Estimation of fetal dose to patients undergoing diagnostic X-ray procedures.

The estimation of fetal dose incurred by patients undergoing various radiologic procedures can be very perplexing. The problem is especially critical for women who do not know that they are pregnant at the time of x-ray exposure. A desciption is offered of efforts to quantitate the fetal dose by after-the-fact calculations. Such conservatively employed calculations may be essential for a clinical decision regarding therapeutic abortion.


Application of tissue-air ratios for patient dosage in diagnostic radiology.

A method for calculating organ dose form radiographic procedures which utilizes the concept of tissue-air ratio (TAR) is described. TAR's were measured for 70-120 kVp x-rays filtered by a total of 2.5 and 3.5 mm Al under conditions which simulate those in radiography. The output of the x-ray tube tube, in terms of mR/mAs at 40 inches (101.6 cm) was also measured, and these are compared with previously published data. A step-by-step procedure for calculating organ dose is described and an example given to illustrate the magnitude of the dose delivered by a typical radiographic procedure.


Reduction of scatter in diagnostic radiology by means of a scanning multiple slit assembly.

Evidence is presented that an array of long, narrow beam-defining slits scanning a patient coupled with scatter-eliminating slots beneath the patient will substantially reduce scatter in diagnostic radiology. Scatter/primary ratios and the distribution of scatter in the plane of the image detector have been measured as a function of slit width and slot depth for a long, narrow beam-defining geometry. Using these data, calculations for the scatter/primary ratio incident on the image detector are made for a multiple slit assembly and compared with conventional grids. An improvement in contrast is obtained with little or no increase in patient exposure. Design considerations for the construction of such an array and data trends are discussed.


Repair of sublethal and potentially lethal radiation damage by rat embryos exposed to gamma rays or helium lons.

Embryonic survival was examined in rats exposed to a 24-hour split-dose regimen of gamma rays or extended-Bragg-peak (EBP) helium ions on the fifth and sixth days of gestation. The data indicate that EBP helium ions, which are known to have a single-dose relative biological effectiveness (RBE) of 1.0, exhibit a split-dose RBE of 1.5 with respect to embryo killing. Using an experimental rat embryo system, delayed implantation, it was also noted that the embryocidal damage induced by EBP helium ions contains a smaller potentially lethal component than that induced by gamma rays.


Investigations of moving-slit radiography.

The technique of moving-slit radiography for reduction of scattered radiation was investigated using a prototype moving-slit radiographic apparatus. Slit widths of 1-2 cm, when used in conjuction with an 8: 1 grid, were found to improve radiographic contrast by a factor of 2 in studies employing physical as well as anatomic phantoms. Use of the moving-slit technique at elevated kVp's was found to provide radiographic contrast as good as or better than that obtained in conventional low-kVp full-field techniques, but with a substantial reduction of patient exposure (factor of 2-4). Considerations in the design of an optimal multislit apparatus are discussed. Excessive tube loading is shown not to be a factor in such a system.


Single dose fast neutron RBE for pulmonary and esophageal damage in mice.

Mice whose thoraxes were exposed to cyclotron neutrons or x rays died from esophagus damage 10 to 70 days after exposure, and from pulmonary damage 70 days to 6 months after exposure. The single exposure RBE for esophagus lethality was 1.9 at at a neutron dose of 1,475 rads and 1.6 for pulmonary lethality at a neutron dose of 950 rads. The significance of these values for neutron radiotherapy of the thorax is discussed.


A method to absorb scattered radiation without attenuation of the primary beam.

A method is presented for improving image quality by decreasing the scattered radiation. Two pairs of lead plates, one above and one below the patient, move in arcs with a common pivot point, the focal spot of the x-ray tube. The lower plates are separated by a 1-cm slot. The upper plates are also separated by a slot, the edges of which lie on common radii from the focal spot. The image is formed by moving the slots so that the X-ray beam emerging from the object sweeps across the film with a uniform speed during the exposure.


One-view mammographic screening?

Repeated mammographic exposures of asymptomatic women in the screening situation has raised questions regarding possible risks. Obtaining only one view, regardless of imaging technique, would approximately halve the exposure. While retrospective analysis indicates further investigation is warranted, one-view mammographic screening is not yet recommended. The lateral view, including the chest wall, would reduce exposure by approximatley 44% but little savings in technologist time could be anticipated.


A new photon scattering method for bone mineral density measurements.

A new technique for the determination of bone mineral density, based on the detection of both coherently and Compton scattered photons in a narrow beam geometry, is described. Initial results show that this method delivers an accuracy of less than 2% when varying quantities of materials surround the measuring site.


Use of tissue culture to examine neurotoxicity of contrast media.

The effect of small concentrations of diatrizoate, ioglycamate, and iopanoate salts on cultured sympathetic ganglia was studied. Biliary contrast media in clinical blood concentrations caused severe degeneration of cultured neurons, but similar concentrations of diatrizoate caused no effect. This technique may be used to measure the direct neurotoxicity or general cytotoxicity of contrast media.


A head-holder for radionuclide dacryocystography.

Proper patient immobilization, essential for good-quality radionuclide studies of the lacrimal system, is achieved with a head-holder which is adjustable in both vertical and horizontal directions.


External localization of solitary bone lesion for biopsy.

Exact localization of osseous lesions demonstrated by bone scanning with 99mTc-phosphorus compounds can be difficult. A simpler localizing procedure using two 99mTc markers and an Anger camera is described.


The myelography needle: a new cannula for aspiration.

Painless recovery of radiopaque substances after positive contrast myelography is often difficult, especially if the initial spinal tap is not made precisely in the midline. The author has designed a cannula for aspiration which has performed favorably in clinical tests and which will soon be available commercially.


Workshop on late effects of irradiation to the head and neck in infancy and childhood.

A summary statement for the Workshop on Late Effects of Irradiation to the Head and Neck in Infancy and Childhood is presented. The Workshop, conducted by the National Cancer Institute with the cooperation of several other organizations, was convened to determine the present status of knowledge about thyroid disease related to irradiation of the head and neck and to develop guidelines with respect to detection, diagnosis, treatment, and followup. It was decided that surgical exploration should be considered for all palpable thyroid nodules, particularly those that are firm and clearly demarcated and appear as a "cold" area on the scan. Persons at risk because of prior irradiation to the head or neck should have regular reexaminations every one to two years.


Reading and continuing education in radiology.

The medical journal acts as a primary vehicle for continuing medical education. A question-and-answer format within the journal will allow for formal recognition of the attentive reader.


Things are as they are, not as they should be.

As more departments of oncology are established in the United States, some radiologists are voicing concern about the possible loss of identity and administrative freedom in these centers. A realistic assessment of this question must involve the advantages to the patient, the teaching potential to medical students, and the recruitment of bright students. Collaboration with other specialists need not result in the total loss of professional and administrative independence.


Human breast tumour-induced osteolysis and prostaglandins.

Osteolysis effected in vitro by breast carcinomas can be inhibited by aspirin. Some prostaglandins stimulate in vitro bone resorption. Our results indicate that whilst osteolytically active PGE and PGF are released by the carcinomas in most cases, some other osteolytic principle is released as well.


The effect of angiotensin II and indomethacin on immunoreactive prostaglandin "A" levels in man.

The effect of angiotensin II on peripheral levels of immunoreactive prostaglandin A2 (IR-PGA) was determined in 17 normal male volunteers. IR-PGA rose from 338 +/-65 (SE) pg/ml to 635+/-142 in response to pressor infusions of angiotensin II (p less than 0.05 on paired analysis). This increase was not observed when indomethacin, 75 mg p.o., was given to 8 patients two hours prior to a repeat infusion. Five patients of the original group were placed on a low sodium diet (10-20 mEg). The response to angiotensin was now exaggerated (278+/-52 pg/ml to 916+/-284). These five patients were kept on a low sodium intake and given indomethacin 50 mg p.o. g 6 hourly for 4 days. There was no significant rise with angiotensin infusion (106+/-31 pg/ml to 120+/-70). Pressor infusions of angiotensin II raise peripheral levels of IR-PGA, and this response is exaggerated by a low sodium diet and blocked by either acute or chronic indomethacin administration. This data supports the concept that vasodilatory prostaglandins may be released by endogenous angiotensin and thus provide a dynamic antagonism to the renin angiotensin system in man.


Assay of prostaglandin-like substances in faeces and their measurement in ulcerative colitis.

A method is described for extracting and measuring prostaglandin-like substances from faeces. Bioassay has shown virtual absence of activity in stools from normal people (8 subjects) but raised levels in stools from patients with active ulcerative colitis (16 observations on 6 patients). The relevance of these observations to the mode of action of sulphasalazine is discussed and suggestions for possible applications of this method to other problems made.


Pentobarbital anesthesia: lack of effect on venous prostaglandins in dogs.

Venous prostaglandins A, E, and F were determined by radioimmunoassay in 10 dogs before and one hour after administration of sodium pentobarbital (35 mg/Kg, iv). In the conscious state, PGA was 0.34 + 0.04 ng/ml (mean +/- SE), PGE 0.20 + 0.01 ng/ml, and PGF 0.25 + 0.03 ng/ml. During pentobarbital anesthesia, these levels were unchanged (p greater than 0.05). Thus, pentobarbital anesthesia had no effect on peripheral venous prostaglandin levels.


Ethacrynic acid induced release of prostaglandin E to increase renal blood flow.

Ethacrynic acid administered to anesthetized dogs was found to increase the level of prostaglandin E as determined by radioimmunoassay in renal venous blood at the time when renal blood flow was increased by this agent. No change was found in the renal venous level of prostaglandin F. When ethacrynic acid was administered after treatment with indomethacin, which blocks the increase in renal blood flow induced by the natriuretic agent, no increase in the renal venous level of prostaglandin E was seen. Thus, the dilation of the renal vasculature would appear to be caused by a stimulation of synthesis and release of prostaglandin E by ethacrynic acid.


Central mediated pressor effect by prostaglandins in the rat.

Extremely small concentrations (1 ng/kg/min) of prostaglandins E1, A1, and A2 elevated arterial blood pressure in the rat when infused into the carotid artery. Similar infusions into the femoral vein failed to demonstrate a pressor response. Higher concentrations of the same prostaglandins infused into the femoral vein resulted in a significant depression of blood pressure.


Increased blood LH and testosterone after administration of prostaglandin F2alpha in bulls.

Two types of experiments were conducted to determine the relationship of changes in blood luteinizing hormone (LH) and testosterone in bulls given prostaglandin F2alpha (PGF2alpha). Episodic surges of LH and testosterone occurred in tandem, apparently at random intervals, on the average once during the 8-hr period after bulls were given saline. In contrast, after sc injection of 20 mg PGF2alpha, blood serum testosterone increased synchronously to a peak within 90 minutes four-fold greater than pre-injection values, and the testosterone surges were prolonged about three-fold compared to those in controls. Each of the PGF2alpha-induced surges of testosterone was preceded by a surge of blood serum LH which persisted for about 45 minutes and peaked at about 3 ng/ml. In a second experiment, PGF2alpha was infused (iv, 0.2 mg/min) for 20 hr; blood plasma testosterone increased from 7.0+/-0.6 to 16.0+/-1.5 ng/ml within 2.5 hr and remained near this peak for 10 hr. Then testosterone gradually declined to about 9 ng/ml at the conclusion of the 20-hr infusion. These changes in testosterone were paralleled by similar changes in blood plasma LH, although LH declined 3 hr earlier than testosterone. Random episodic peaks of blood plasma LH and testosterone typical of untreated bulls resumed within 8 hr after conclusion of PGF2alpha infusion. In both experiments, the surge of testosterone after PGF2alpha was preceded by increased blood LH. We conclude that increased LH after administration of PGF2alpha probably caused the increased testosterone. However the mechanisms of these actions of PGF2alpha remain to be determined.


The synthesis of prostaglandin analogs containing the (hydroxycyclooctylidene)methyl ring system.

The synthesis of prostaglandin analogs incorporating the (2-hydroxycyclooctylidene)methyl moiety in place of the natural C13-C20 sidechain has been accomplished via copper-assisted conjugate addition of the (cyclooctylidene)methyllithium 5 to the cyclopentenone intermediates 7 and 10.


Structure-activity relationships in a series of 11-deoxy prostaglandins.

A series of 11-deoxy prostaglandin derivatives and some naturally occurring prostaglandins have been investigated in the anaesthetized artificially respired guinea-pig for their effect on blood pressure, bronchial resistance (overflow pressure at constant volume), tracheal segment pressure, and on intestinal and uterine smooth muscle. The compounds were administered intravenously. Prostaglandins E1, E2 and F2alpha produced responses that were qualitatively similar to those in the literature. Prostaglandin A2 (100 mug) was a bronchoconstrictor, although it decreased tracheal segment pressure and blood pressure. Prostaglandin B2 (100 mug) caused double elevations in blood pressure, tracheal segment pressure and bronchial resistance. The intensity of bronchoconstriction produced by PGB2 was of the same order as with PGF2alpha. A number of structure-activity relationships were found. 11-Deoxygenation lowered the biological activity of the natural prostaglandins PGE1 and PGF1alpha. The vasodepressor and bronchodilator responses of 11-deoxy PGE1 were converted to vasopressor and bronchoconstrictor by epimerisation at C-15. Introduction of a methyl group at C-15 of 11-deoxy PGF1alpha both increased and prolonged vasopressor and bronchoconstrictor activity. At C-9 both the keto and beta-hydroxy group imparted vasodepressor and bronchodilator activity, while the alpha-hydroxy led to vasopressor and bronchoconstrictor activity. Extension of the omega sidechain by two methylene groups radically reduced the activity of 11-deoxy PGF1alpha and its derivatives. These experiments indicate that steric differences in the prostaglandin structures studied can result in diametrically opposed profiles of biological activity. Further, small variations in the prostaglandin molecule can lead to differences in potency and/or profile of activity in the guinea-pig.


[Cultural conflicts in the management of hydrographic watersheds in the Central American isthmus].

Productivity of natural ecosystems in watersheds in the Central American Isthmus is being seriously endangered by the disproportionate increase in population, which hampers an adequate development of water and agricultural resources. The logical consequences of the lack of planning in the use of these resources are rapid degradation of the soil and high levels of environmental pollution. Among the human activities which destroy the natural ecological balance are slash burning, overgrazing and farming on lands not suited for this purpose. These activities form part of the socio-economic and cultural aspects of the region and are associated with systems of land occupancy and distribution, and with inefficient practices, such as tenant farming and share cropping. Recent apprehensions by nature-loving groups and the general public are pressing for more realistic conservation and legislative policies, and for the creation of more dynamic government agencies that would not only actively participate in the planning and utilization of natural resources, but also in the technical studies of watersheds that after the socio-cultural aspects of the central American region.


[Quality of the water and public health in the Central American isthmus].

As of December 1970 the population of the Central American Isthmus was 16,436,723; 6,225,447 (37.9%) urban and 10,210,946 (62.1%) rural. Of the urban population, 63.3%, or 3,964,611 had water in the home, while 2,283,836 (36.7% had no adequate water supply. The problem is even worse in the rural population where only 732,150 inhabitants (7.17%) had water in the home; the rest, 9,500,000 were using water from contaminated rivers, streams, wells, etc. These low percentages do not meet the standards proposed at Punta del Este, Uruguay in 1961 of providing drinking water to 70% of the urban population and to 50% of those of rural areas. Nor do the very low figures for sanitary disposal of wastes meet these standards (31.4% in urban areas and 19.5% in rural areas). As a logical consequence, water-bourne morbility in the Central American Isthmus is very high. The rates per 100,000 inhabitants are 0.4 to 18.8 for typhoid fever; 0.7 to 13.0 for paratyphoid fever; 0.5 to 786.2 for bacillary dysentery; and 17.9 to 555.6 for amebiasis. Although it would be hard to evaluate the benefits of sanitary water and waste disposal systems, the damage caused by water-bourne illnesses is well known, especially their effect on the individual human being since they sap his energy, lower his life expectancy and productivity, and thus indirectly affect the national economy. It is a well known fact that the cost of optimum water supply and waste disposal systems will more than amply be paid for by the savings in medication and lost time through illness.


[Effect of urbanization on the future of agricultural development in Costa Rica].

The future agricultural development of Central America must be based of studies of land capacity in order to assure a sustained yield of the environment. The industrial development of the region, as well as the construction of the highways and rural roads must be carefully planned as a means of environmental conservation. New towns, housing developments, recreational facilities and highways should be planned to the effect that they occupy non-productive lands and thus minimize the modern trend of covering the best agricultural soils with concrete jungles. In recent years the price of agricultural lands has shown a tremendous rise, due mainly to the demand of land for urbanization. This situation has induced many farmers to abandon their lands, therefore, a selective land taxation system is suggested to encourage the cultivation of these suburban areas.