[25-hydroxy vitamin D deficiency with reduction of intestinal calcium absorption and bone density in chronic alcoholism].

Plasma levels of 25-hydroxycalciferol (25-OH-D), 47-calcium intestinal absorption, bone mineral content and the biologic parameters of phospho-calcium metabolism were studied in 30 chronic alcoholics, 15 with Laennec's cirrhosis (group A) and 15 without (group B). These patients were compared with 27 normal subjects. In group A, the mean 25-OH-D plasma level was 23.7 +/- SD 18.5 microgram/l and in group B 35.2 +/- SD 21.8 microgram/l. These mean levels were lower than those of the control group, which were 57.2 +/- SD 22.5 microgram/l (p less than 0.001). The mean value of the 47Ca intestinal absorption, measured as the percentage of the ingested dose per litre of plasma and multiplied by the body weight, was also significantly lower in group A, which was 140 +/- SD 47 (p less than 0.01), and in group B, which was 145 +/- SD 69 (p less than 0.05), compared with the normal subjects whose average was 182 +/- SD 45.6. Similarly, the total plasma calcium was low: 1.99 +/- SD 0.24 mmol/l in all the alcoholics, while that of the control group was 2.22 +/- SD 0.18 mmol/l (p less than 0.001). For the 30 chronic alcoholics there was a positive correlation between 25-OH-D and 47Ca intestinal absorption, (r = 0.484; p less than 0.004). This suggests that in chronic alcoholism the deficiency of 25-OH-D induces a diminution of the intestinal absorption of calcium which, in the long term, can result in bone demineralization evidenced in the patients studied by a bone mineral content lower than normal (p less than 0.001).


[Determination of carcinoembryonic antigen in medical practice].

108 determinations of CEA plasma concentrations were ordered for diagnostic purposes by the medical staff of our clinic between January 1974 and April 1976. Its usefulness was retrospectively analyzed by comparing the initially suspected diagnosis serving as the rationale for CEA determination with the CEA plasma levels and the final diagnoses of the patients when leaving the hospital. Of 32 patients with proven malignancies of various types the CEA concentrations were normal in 10, slightly elevated (2.5-20.0 ng) in 15, and highly elevated in 7, all having metastatic tumors. However, in 35 of the remaining 67 tested individuals without detectable malignancies the CEA concentrations were also slightly elevated (2.5-20.0 ng); these patients either had acute infections (10 individuals), autoimmune disease disorders (1 individual), various other nonmalignant diseases (10 individuals), or were heavy smokers. In 98 of 108 patients CEA testing had been ordered either to confirm or to rule out a suspected malignancy. The results were most often of little help. Malignancies were found in 15 of 50 patients with elevated CEA, but also in 9 of 48 patients with normal values. In only 6 patients did the CEA results influence further diagnostic and/or therapeutic measures, which consequently did not always prove to be beneficial for the patient.


[The CEA test and other immunological tests as disease course controls in gastrointestinal adenocarcinoma].

161 patients with adenocarcinoma of the gastrointestinal tract were studied to determine the value of the CEA test and a battery of non-specific immunological tests during the course of the disease. The ability of these tests to detect a tumor recurrence in radically operated patients was evaluated. A false negative preoperative CEA value was found in 40% of the patients with gastric carcinoma and 32% with colorectal carcinoma. Patients with a negative preoperative CEA value, and those with only slightly elevated values, had a distinctly better prognosis regarding initial operability and tendency to postoperative recurrence than patients with primarily markedly elevated values. With few exceptions, the development of distant metastases was detected earlier and more easily with the CEA test than by the usual routine follow-up methods. However, in the event of isolated local recurrence the CEA test was positive in only 1 of 5 patients. This reflects the direct correlation between tumor size and CEA elevation. The CEA test is a valuable supplement in the follow-up of patients with gastrointestinal carcinoma.


[Serum digoxin concentration: dependence on body weight and age].

In patients of a cardiological practice, 121 digoxin serum concentrations were determined by radioimmunoassay (RIA). Some drugs were suspected of interfering with the RIA or with the pharmacokinetics of digoxin. Patients having such additional drugs or patients with elevated serum creatinine were not included. The daily maintenance dose of digoxin was roughly adjusted to body weight. Patients with 0.5 mg digoxin daily showed unexpectedly low serum digoxin levels not fully explained by the relatively high body weight. This dose group was not included in the following correlations. At a maintenance dose of 0.25 and 0.375 mg digoxin and in the age groups 40-69 years (n = 66) there was an approximately inverse proportionality between serum digoxin concentration (per 0.25 mg digoxin daily) and body weight. When all age classes from 20 to 89 years were included (n = 96), a week positive correlation between serum digoxin concentration (per 0.25 mg digoxin daily and per 69.28 kg body weight) and age was found. A similar positive correlation resulted between serum digoxin concentration (per 0.25 mg digoxin daily) and the reciprocal of the nomographically determined creatinine clearance, always within the normal serum creatinine range. Based on these correlations, two simplified formulas are presented to predict the serum concentration and therapeutic maintenance dose of digoxin. The formulas are valid for the normal serum creatinine range and for digoxin tablets of optimal bioavailability.


[African sleeping sickness in Switzerland (trypanosomiasis rhodesiensis)].

The fatal course of a case of African trypanosomiasis in Switzerland is reported. The feeling of sickness after an African trip is a diagnostic pointer. An infected fly bite and enlargement of lymphatic nodes or even symptoms of involvement of the central nervous system increase the suspicion. The diagnosis may be established simply by microscopic examination of a blood film. Because of the possibility of severe complications due to the sickness itself or due to toxicity of specific drugs, patients should be treated in hospital. Immediate contact with an Institute for tropical diseases seems to be advisable in every case.


[Specific and non-specific defense mechanisms against infection].

Defense mechanisms against bacterial, viral or parasitic infections require the cooperation of effector cells (mainly polymorphonuclear and mononuclear phagocytes) and mediators such as antibodies, complement and lymphokines. Antibodies and some complement components promote the endocytosis of microorganisms whereas lymphokines activate phagocytic cells. Once endocytosed, microorganisms are killed either by oxidative reactions consequent to the respiratory burst, or by the particular conditions and factors that they encounter in phagolysosomes. Intact microorganisms or their degradation products handled by mononuclear phagocytes represent immunogenic moieties which can trigger immunocompetent lymphocytes and induce specific immune responses. Phagocytic cells may have characteristic intrinsic deficiencies that are responsible for prolonged or recurrent infections.


[Transfer factor therapy in a patient with anergic pulmonary tuberculosis].

Report on a patient suffering from severe, relapsing pulmonary tuberculosis showing progressive clinical deterioration accompanied by the appearance of cutaneous anergy to tuberculin. In addition, the sputum cultures showed growth of Mycobacterium intracellulare. During therapy with transferfactorZurich there was a slow but impressive clinical improvement, the skin reactivity to tuberculin was reconstitued and the sputum cultures became negative. The radiological findings remained unchanged.


[Significance of serological studies in the diagnosis and therapy of insect-sting allergy].

IgE-antibodies against venoms and wholebody extracts of bees and wasps and hemagglutinins against phospholipase A were determined in patients with allergy to insect stings before and during hyposensitization therapy. The results show that venoms are superior to wholebody extracts for diagnosis and therapy of insect sting allergy.


[Combined form of chronic aggressive hepatitis primary biliary cirrhosis].

15 patients with primary biliary cirrhosis (PBC) and 109 patients with chronic aggressive hepatitis (CAH) have been followed. Features of PBC, namely the generalized pruritus, massive rise in alkaline phosphatase, antimitochondrial antibodies and high levels of IgM-globulins, were present in 7 patients with CAH. This group was treated with immunosuppressive drugs for 1-2 years. Clinical, biochemical, immunological and histological parameters were used to assess the therapeutic effect. The pruritus improved and there was a statistically significant reduction in the IgG-hyperglobulinemia. Some resolution of the piecemeal necroses was seen. However, in judging these changes the sampling error must be taken into account. The unknown agent attacks both the hepatocytes and the epithelial cells of the bile ducts. The immunosuppressive treatment protects the liver cells from further damage while the progressive destruction of the bile ducts remains uninfluenced. The results suggest that the smallest possible dose sufficient to suppress the activity of CAH must be selected.


[Benign symmetric lipomatosis--symptom of alcoholic liver disease].

Benign symmetric lipomatosis (BSL) leads to characteristic multiple lipomas of the neck and submandibullar region. Seven men with BSL, aged 36--65 years, were investigated with regard to alcohol consumption, clinical findings and liver histology. They admitted a long standing ethanol intake (x = 107 ml/day) prior to the development of BSL. The growth of the lipomas was irregular and occurred over a period of months. There was no correlation with overweight or hyperlipidemia. However, liver biopsy revealed features consistent with alcoholic liver disease in all subjects. It is concluded that BSL represents a symptom of alcoholic liver disease affecting middle aged men.


[Aldosterone and renin in liver cirrhosis with ascites].

Supine plasma aldosterone and plasma renin activity were determined in patients with cirrhosis of the liver and ascites (n = 10). Most of the patients initially showed an increase in plasma aldosterone and plasma renin activity. However, values within the normal range were observed (plasma aldosterone, n = 3; plasma renin activity, n = 4). In the ascitic fluid renin activity could not be detected, whereas aldosterone concentrations correlated significantly with the respective plasma levels (r = 0.8, p less than 0.01). During therapy with spironolactone alone (n =2) or in combination with furosemide (n = 4), diuresis and natriuresis showed no correlation with changes in plasma aldosterone and/or plasma renin activity. Our results suggest that other factors than renin and aldosterone secretion may be important in the formation of ascites in patients with cirrhosis of the liver. In addition, the inverse correlation between mean arterial blood pressure and plasma renin activity (r = -0.65, p less than 0.05) found in our patients supports the assumption that the increase in renin secretion is probably induced by changes in (renal) hemodynamics.


[Immunological aspects of acute viral hepatitis treated with corticosteroids].

Acute viral B-hepatitis is the consequence of an effective specific immune response against the hepatitis B-virus with elimination of the virus. Corticosteroids decrease this immune reaction and thereby inhibit virus elimination. In principle, therefore, corticosteroid therapy promotes a transition to chronicity. This theoretical concept is documented practically by 8 patients treated with steroids in the early phase of acute viral hepatitis. Transition to some form of chronic liver disease is documented by serial liver biopsies in all 8 patients. The immunohistological findings showed the presence of HBsAg and HBcAg, as theoretically expected. These 8 selected cases, although uncontrolled, together with the theoretical concept of B-virus elimination, provide evidence against the use of corticosteroids in acute B-hepatitis.


[Evaluation of the role of circulating antigen-antibody complexes in the pathogenesis of glomerular nephropathies].

Immunofluorescence studies of the glomeruli in patients suffering from glomerulonephritis (GN) suggest the deposit of immune complexes from the circulating blood. Immune complexes were quantitated using a sensitive radioimmunoassay from sera of 41 patients with GN drawn at the time when renal biopsy was performed. Simultaneously, degradation products of C3 (C3d) were measured. Eleven of 12 patients with GN secondary to a systemic disease (usually LED) presented increased C1q-binding activity of their sera (C1q-BA). C3 was further demonstrated in 9 of these patients, suggesting the presence of circulating immune complexes. By contrast only 2 of 12 patients with idiopathic GN characterized by deposits of complement and IgG in the glomeruli exhibited increased C1q-BA. One of 17 patients with idiopathic GN without deposit of immunoglobulins and C3 in the glomeruli also had increased C1q-BA. The results observed in the group of patients with idiopathic GN with glomerular deposits could be accounted for either by a transitory or minimal presence of immune complexes or by local formation of complexes in the glomerular structures.


[Studies on the differential determination of renin activity in renal venous blood in renal artery stenosis].

Plasma renin activity (PRA) was determined in both renal veins of 37 patients with angiographically proven renal artery stenosis. Renal venous PRA was determined in 17 patients without furosemide stimulation and in 20 patients before and 15 and 30 min after intravenous injection of 40 mg furosemide. 21 of 37 patients showed abnormally high peripheral PRA. In the 17 patients in whom renal venous PRA was measured without stimulation, 11 showed a PRA ratio (PRA stenotic side/PRA unaffected side) greater than or equal to 1.5. The 20 patients in whom stimulation with furosemide was performed were divided into 2 groups each containing 10 patients: The first group was characterized by an increase in PRA ratio after furosemide stimulation, while in the second group this PRA ratio decreased. In the first group mean duration of hypertension was 4.5 years compared to 7.5 years in the second group. In 17 of 37 patients renal artery stenosis was corrected by surgery. After operation 12 patients became normotensive and in 2 patients hypertension improved. There was no effect of renovascular surgery on blood pressure in only 3 patients. None of these patients showed an increasing ratio in response to furosemide. Our results suggest that the validity of renal venous PRA measurements is enhanced when the procedure is performed before and after administration of furosemide.


[Treatment of uremic sympathicopathy with levodopa].

Two patients with chronic uremia suffering from postural hypotension and hypotensive episodes during hemodialysis have been successfully treated with L-DOPA. In one patient the autonomic insufficiency and the beneficial effect of L-DOPA has been demonstrated by tests of the autonomic nervous system. The action of L-DOPA remains unclear. It is possible that the administration of L-DOPA results in increased synthesis of norepinephrine.


[Metabolic effects of acute experimental hypoxia and hypercapnia].

Hypoxia and the hypercapnia were produced in anesthetized dogs by artificial respiration with appropriate gas mixtures, and a study was conducted of the effects of these conditions on various metabolic parameters, viz. catecholamines, renin activity, lactate, pyruvate, cortisol, non-esterified free fatty acids (FFA), and ammonia, in the plasma of the arterial blood. Hypercapnia caused a distinct increase in catecholamine concentrations, renin activity and ammonia, and a decrease in lactate and pyruvate; cortisol and FFA levels were only slightly altered. Hypoxia increased lactate, pyruvate and--though only to a slight extent--FFA, cortisol and NH3. The changes induced by hypercapnia were chiefly attributable to activation of the sympathico-adrenal system; those induced by hypoxia were not.


[Clinical experiences with the serum digitalis concentration. 1006 radioimmunological determinations].

Serum digitalis concentration was measured radioimmunologically on 1006 patients in the period from 1974-1976. The serum levels were correlated with the clinical signs of digitalis toxicity and the indications for determination of the serum digoxin concentration were established. Clinical signs of toxicity appear at a serum level of digoxin above 2.5 ng/ml. Therapeutic limits (range) are most influenced by individual factors. Serum digoxin determination is especially necessary in patients with renal failure and in undisciplined patients with erratic digitalis intake. It is a useful aid in controlling the course of digitalis intoxication, in "low dosage" digitalization and in the case of possible drug interactions.


[Course and prognosis of primary pulmonary hypertension].

Between 1967 and 1970 primary pulmonary arterial hypertension was diagnosed in 52 patients. Menocil had been taken by 36 patients. Overall survival rate after 9 years was 0.58. Mortality was particularly high within 2 years after the diagnosis was established (22%). Survival rate was low in the group with pulmonary vascular resistance exceeding 1000 dynes-sec-cm-5 (0.42 after 9 years). Initially slight pulmonary hypertension generally had a good prognosis but even severe pulmonary hypertension can regress or even disappear. With respect to survival rate, there were no significant differences between patients with and without Menocil intake.


[The diagnosis of the sinus node syndrome].

The "specific" investigations for sinus node syndrome (SNS) in 22 patients are analyzed. SNS was defined as sinusbradycardia below 40/min and sinus-standstill over 2 sec. Atropin (1 mg i.v.), exercise test and carotid pressure were of little help in establishing the diagnosis, while Holter monitoring and sinus-node recovery time were significantly abnormal in all patients investigated.


[A useful method for the diagnosis of Raynaud's phenomenon: cold suppression of reactive  post-ischemic hyperemia in the fingers].

A method is described which is of assistance in diagnosing Raynaud's phenomenon by making it possible to estimate the degree of cold sensitivity. 5-minute ischemia provoked by tourniquet round the wrist results in reactive finger hyperemia when the tourniquet is released. In 25 of 28 patients with Raynaud's phenomenon, postischemia reactive hyperemia was suppressed by cooling the hand to between 10 and 20 degrees, but remained unchanged in normal subjects. The critical temperature at which Raynaud's phenomenon occurs can be determined in a given patient, and the natural history of the disease and the effect of treatment can be observed. Cold induced reactive hyperemia suppression is probably caused by Burton's critical closing  phenomenon.


[Personality traits (type A) in patients with intermittent claudication. 1. Results of the Bortner test].

It has never been considered whether type A (coronary prone) behavior can also be found in patients with peripheral atherosclerotic disease (intermittent claudication). This question has been studied by means of the 14-item (Bortner) questionnaire. The questionnaire was filled out by 10 patients (self-assessment) with coronary artery disease and intermittend claudication, 13 with intermittent claudication alone and 10 with comparably severe, but not arteriovascular disease and independently by their wives (relative's assessment). In the self-assessment the test discriminated significantly between the three groups (Kruskal-Wallis p less than 0.05). The correlation coefficient (Spearman) between expression of type A behavior and extent of atherosclerosis was 0.3720 (p less than 0.02). In the relative's assessment the groups were also differentiated significantly (Kruskal-Wallis p less than 0.05). The correlation coefficient (Spearman) was 0.4080 (p less than 0.009). The results indicate that patients with intermittent claudication demonstrate a predilection for type A behavior, which is more pronounced in those with additional coronary artery disease. The multiple stepwise regression indicated that type A behavior is related to atherosclerosis independently of other factors.


[Cushing's syndrome and adrenal suppression by means of intranasal use of dexamethasone preparations].

In two 15-year-old boys with bronchial asthma and allergic rhinitis, bronchospasm disappeared with prolonged use of intranasal dexamethasone ointment and drops respectively. Both showed cushingoid features and total or partial suppression of adrenocortical function. The first patient died during a sudden and unexpected asthma crisis one week after withdrawal of the 0.25% dexamethasone ointment he had been taking at the rate of 1.8 mg/day for one year. The second boy recovered near-normal adrenocortical function 3 months after gradual withdrawal of the 0.01% dexamethasone nose drops he had been on at an average daily dose of 0.5 mg, for the past 6 years. An acute trial in 10 normal volunteers showed marked short-term suppression of endogenous cortisol production after a single intranasal ointment application containing 0.9 mg dexamethasone. Long-term use of dexamethasone preparations on the nasal mucosa may be dangerous by inhibiting hypophyseal-adrenocortical function. Abrupt withdrawal may lead to sudden relapse of a potentially life-threatening accompanying disease such as bronchial asthma.


[Standardization of a new thyroid gland suppression test by means of 3000 microgram L-thyroxine].

The suppressibility of the TSH-thyroid axis one week after a single dose of 3000 microgram L-thyroxine was studied in 21 euthyroid subjects. In all cases the normal thyroid function was proven by euthyroid values for thyroxine (T4), free thyroxine index (FT4-I), triiodothyronine (T3), radioiodine uptake, PBI-131, a normal scintiscan and by a physiologic TSH response to thyrotropin-releasing hormone (TRH). Compared to the baseline values the mean suppression of radioiodine uptake at 2,24 and 48 h was 61.8% (+/- 32.9), 62.0% (+/- 15.3) and 62.1% (+/- 13.4) respectively. Because of the large variation at 2 h this value can be disregarded. If the 24 h value shows a clear suppression over 50%, no further measurement is necessary. Mean serum levels of thyroxine and free T4-index rose from 8.2 +/- 1.0 to 13.0 +/- 2.1 microgram/100 ml and from 7.7 +/- 1.9 to 15.1 +/- 3.4 respectively on the third day, to the upper limits for normal controls. Triiodothyronine increased from 1.69 +/- 0.42 to 2.08 +/- 0.38 ng/ml and remained definitely below the level of 2.60 ng/ml observed in overt thyrotoxicosis. In single subjects T4, FT4-I or T3 achieved slightly hyperthyroid levels. In view of the effectiveness of a single dose of 3000 microgram T4 with good suppression of radioiodine uptake and TSH production after stimulation with TRH without noticeable side effects, the classical T3 suppression test should be abandoned and replaced by this test, which latter can be used for the same diagnostic and therapeutic purposes.


[Study of glucagon secretion in patients with hemochromatosis].

Diabetes in idiopathic hemochromatosis has been considered to be secondary to islet cell damage resulting from the iron deposits. Plasma glucagon was measured by immunoassay using the pancreas specific 30-K antiserum, and was found to be normal or slightly elevated during arginine-infusion tests in patients exhibiting both hemochromatosis and pathological glucose tolerance. This suggests that diabetes in hemochromatosis is not due to a lesion resulting from the iron deposits. The two affections appear to be merely associated and are possibly genetically linked.


[Hypersomnia with periodic apnea in a patient with acquired micrognathism].

A case presenting association of sleep apnea with daytime hypersomnolence and retrognathia is described. Sleep laboratory evaluation showed severe discontinuous hypoxemia and a mean of 250 upper airway obstructions. The patient was treated successfully by surgical correction of the retrognathia.


[Frequent cases of agranulocytosis due to clozapin (leponex) in eastern Switzerland].

Two personally observed cases of severe agranulocytosis within 3 months, one of them fatal, could be attributed to the new dibenzodiazepine derivative Clozapine (Leponex). Clozapine, a very effective neuroleptic for the treatment of acute and chronic schizophrenia, has been found before to induce agranulocytosis of the metabolic type, as  phenothiazines are known to do. An inquiry in al Swiss medical departments and mental hospitals revealed a total of 20 cases of Clozapine induced agranulocytosis in some 50% of institutions responding. 9 of these were observed in Eastern Switzerland. This time-space clustering recalls the "finnish epidemic" of 1975 in Southern Finland. Possible explanations for this phenomenon are discussed. Calculations of the incidence suggest a higher rate of agranulocytosis induced by Clozapine than has been assumed for the phenothiazines. Clozapine should therefore be restricted to schizophrenic patients and initially (6 weeks) be given only on a stationary basis under regular blood controls.


[Protection against acute renal insufficiency by means of forced diuresis in an ischemic rat model].

Renal ischemia of 90 min duration provokes initial oliguria and hyperazotemia; however, in rats with high diuresis, with or without renal renin depletion, protection against acute renal failure is observed in this model. The protection is directly proportional to the diuresis.


[Increased renal prostaglandin E2 secretion in Bartter's syndrome].

In a 52-year-old patient with Bartter's syndrome, peripheral venous prostaglandin E2 (PGE2) and plasma renin activity (PRA) levels were markedly elevated and plasma aldosterone concentration (pa) was at the upper limit of normal, though inappropriately high relative to the decreased plasma and whole body potassium levels. Blood pressure, plasma volume, exchangeable body sodium, plasma cortisol and urinary catecholamines were normal. Renal venous PGE2 was two to three times higher than peripheral PGE2. Indomethacin (300 mg/day) decreased peripheral PGE2 by 50%, PRA by 84% and PA by 72%, induced a positive potassium balance (greater than 350 mEq) with normal plasma potassium levels, and returned the previously marked resistance to the pressor effect of angiotensin II to normal. During the entire study, highly significant correlations (p less than 0.001) between peripheral PGE2 and PRA (r = 0.86) or PA (r = 0.90) were found. In this patient the hyperreninemia was not related to volume depletion. These data indicate that in Bartter's syndrome renal PGE2 secretion may be increased, systemic blood levels of PGE2 may be elevated and closely related to PRA, and indomethacin ameliorates these abnormalities and improves potassium balance. These results are consistent with the ascription of an important role to excessive renal PGE2 secretion in the pathogenesis of Bartter's syndrome.


Some medical aspects of North Sea oil industry.

Most illness and injury cases seen in the Sick Bays of North Sea Oil Installations are similar to those in industry generally. Some are due to the sea depth and the hostile environment. The course of treatment may be affected by the isolated situation. The basic plan to meet a disaster situation may in the event be unworkable because of installation air traffic disturbance. Transportation of casualties to pre-arranged destinations may be affected by weather or the availability of suitable helicopters or ships. Practice to meet different medical contingencies is essential. For efficient rescue there must be a reliable, uninterrupted communication system between installation and base.


Endometrioma of the perineum associated with episiotomy scars.

Two cases of endometrioma occurring in the perineum, associated with episiotomy scars and involving the external anal sphincter are described. Previous similar cases in the literature are reviewed and discussed. Misdiagnosis of this uncommon lesion is the rule when it is seen outside gynaecological practice. If, however, its existence is appreciated then correct diagnosis is simple and treatment is straight forward.


Intergeneric transfer of genes involved in the Rhizobium-legume symbiosis.

Genes that seem to be involved in the initial steps of infection of a legume by Rhizobium have been transferred, by transformation, to mutant strains of Azotobacter vinelandii that are unable to fix nitrogen. These genes code for a surface antigen that binds specifically to a protein from the host plant.


Mapping the locus of the H-Y gene on the human Y chromosome.

The H-Y locus is on the short arm of the human Y chromosome in most individuals but on the long arm in at least one of 17 individuals with structural abnormalities of the Y.


A phantom-motion aftereffect.

Motion aftereffects, typically found to result only from localized retinal stimulation, were obtained within regions of the visual field that had not been stimulated by moving contours. "Phantom" stripes are seen moving through a physically homogeneous (empty) region of the visual field when vertical stripes move above and below that region. Immediately afterward, stationary stripes in the previously empty region appear to move in the opposite direction. This phantom-motion aftereffect provides a novel instance of the way global structure affects processes that have been assumed to be influenced only by simpler local spatial and temporal variables.


Gap junctions: their presence and necessity in myometrium during parturition.

Thin sections of longitudinal and circular muscle of myometrium obtained from rats during pregnancy, at term, during delivery, and postpartum were quantitatively examined in the electron microscope. Gap junctions (low resistance pathways) were only present during or immediately prior to delivery and immediately postpartum. The absence of gap junctions during gestation may be necessary for maintenance of pregnancy, while their occurrence during parturition may lead to effective termination of pregnancy.


Minimum size of mammalian homeotherms: role of the thermal environment.

The minimum size of a mammalian homeotherm appears to be related to the animal's maximum rate of endogenous heat production, the ambient thermal environment, and the animal's ability to be a facultative homeotherm.


Construction of chimeric phages and plasmids containing the origin of replication of bacteriophage lambda.

Segments of the replication control region of bacteriophage lambda (lambda) and lambda mutants defective in replication were attached in vitro to the phi80 phage vector Charon 3 and to the plasmid vector mini Col El (pVH51). The chimeric phages and plasmids have been used to localize the origin of lambda DNA replication and to facilitate a structural analysis of the lambda replicator.


Genetic structure of the replication origin of bacteriophage lambda.

A fragment of bacteriophage lambda DNA produced by the restriction endonuclease Eco RI and extending from the immunity region to a point inside gene O is found to have a fully functional origin of replication. Seven ori- mutations of lambda cluster in a small region just to the left of the Eco RI cleavage site which defines the right end of this fragment. These mutations lie within gene O.


Physical structure of the replication origin of bacteriophage lambda.

The nucleotide sequence of part of the replication region of wild-type bacteriophage lambda and of four mutants defective in the origin of DNA replication (ori-) has been determined. Three of the ori- mutations are small deletions, and one is a transversion. The sequence of the origin region, defined by these mutations, contains a number of unusual features.


Hunger in humans induced by 2-deoxy-D-glucose: glucoprivic control of taste preference and food intake.

Intracellular glucopenia induced by 2-deoxy-D-glucose (2DG) administration in man produces increased hunger ratings and magnitude estimates of pleasantness for sucrose solutions. Augmented food intake substantiates these changes in affective behavior and relieves experimentally induced hunger. Intracellular glucopenia activates counterregulatory mechanisms to raise plasma glucose concentrations. Inducing hunger experimentally with 2DG provides a useful method for studying appetitive behavior in humans. The neurohumoral control of pituitary hormone release and other hypothalamic functions may be examined after 2DG infusion.


Breast-feeding and population growth.

Abandonment of breast-feeding in parts of the world where contraception is not in common use may mean both higher birthrates and, especially among the poor, higher infant death rates. In this article estimates of the magnitude of these effects are made.


Evolution of primate chromosomes.

Human and higher primate chromosomes have been compared by general and regional banding methods, including hybridization in situ. The general banding patterns of the chromosomes of gorilla, chimpanzee, and orangutan, but not gibbon, are similar to those of the human. Preliminary results show that chromosomes with similar banding patterns in different species often carry the same genes. Repetitious DNA's have undergone changes in structure and distribution which are reflected in changes in the regional banding patterns. These studies confirm that the evolutionary distance between the gibbon and the orangutan is relatively great compared to the distance between the orangutan and the other great apes, and suggest that man is more closely related to the gorilla than to the chimpanzee.


Fascioliasis: role of proline in bile duct hyperplasia.

In animals fascioliasis, extensive hyperplasia of the main bile duct occurs that often results in enlargement of the duct to more than 20 times the normal. We report that proline infused into the abdominal cavity of rats caused hyperplasia of the bile duct resembling that produced in the early stages of the disease. We suggest that Fasciola hepatica, which synthesizes and releases large amounts of proline, induces enlargement of the bile duct by a similar mechanism.


Measurement of the human magnetic heart vector.

A unipositional lead system has been developed to record the human magnetic heart vector and to permit comparison with the electric heart vector recorded with a conventional Frank lead system. Recordings made in five normal subjects showed a remarkably consistent relation between the electric and magnetic heart vectors. However, the angle between electric heart vector R and T waves was markedly different from the magnetic heart vector R-T angle. In addition, recordings made in two patients with bundle branch block showed a different relation between the electric and magnetic heart vectors compared to normal subjects. These data support the hypothesis that magnetic measurements have a different sensitivity to some components of cardiac activation compared with body surface potential measurements.


Polymorphonuclear leukocytes: possible mechanism of accumulation in psoriasis.

Extracts of involved and uninvolved skin from nine patients with untreated psoriasis were studied for chemotactic activity. Psoriatic plaque contains increased amounts of a complement-dependent chemotactic factor that is inhibited by diisopropyl fluorophosphate. This factor may be human skin serine proteinase.


Fibrous apatite grown on modified collagen.

Fibrous apatite has been grown by the enzymatic hydrolysis of calcium beta-glycerophosphate on reconstituted calfskin collagen tapes which had been modified by the addition of a phosphoprotein, phosvitin, in the presence of a cross-linking agent, dimethylsuberimidate. The deposits were identified as a carbonate-bearing hydroxyapatite by x-ray diffraction, and scanning electron micrographs confirmed their fibrous character.


Fenfluramine and fluoxetine spare protein consumption while suppressing caloric intake by rats.

The effects of fenfluramine and other sanorectic drugs on the consumption of both protein and total calories by rats given simultaneous access to two isocaloric diets containing 5 or 45 percent casein were examined. Anorectic doses of fenfluramine failed to decrease protein intake but increased the proportion of total dietary calories represented by protein. In contrast, anorectic doses of d-amphetamine decreased protein and calorie consumption proportionately. Subanorectic doses of fenfluramine also increased the proportion of caloric intake represented by protein among animals given prior treatment with the serotonin precursor tryptophan. Fluoxetine, a drug that blocks reuptake of serotonin, similarly spared protein consumption while reducing caloric intake. These observations indicate that two distinct brain mechanisms, sensitive to different drugs, underlie the elective consumption of protein and calories.


Polychlorobornane components of toxaphene: structure-toxicity relations and metabolic reductive dechlorination.

2,2,5-endo,6-exo,8,9,10-Heptachlorobornane and four derivatives of this heptachlorobornane, with an additional chlorine atom at position 3-exo,8,9, or 10, account for a major portion of the acute toxicity of toxaphene and for up to 23 percent of toxaphene composition as analyzed by open tubular column gas-liquid chromatography with an electron capture detector. Both in several organisms and model environmental systems and on photolysis, this heptachlorobornane undergoes facile reductive dechlorination at the geminal-dichloro group and sometimes dehydrochlorination.


Spiroplasmavirus citri 3: propagation, purification, proteins, and nucleic acid.

SVC3 is a short-tailed polyhedral virus particle morphologically detectable in many spiroplasmas. It was isolated from two different spiroplasmas (Spiroplasma citri and the suckling mouse cataract agent) by infecting lawns and broth culture of another strain of Spiroplasmavirus citri. Virions from either donor strain had a buoyant density of 1.26 grams per cubic centimeter (metrizamide) or 1.45 grams per cubic centimeter (cesium chloride), and contained five proteins and linear double-stranded DNA with a molecular weight of 14 X 10(6). Other spiroplasmaviruses have not been propagated, and the molecular weights of double-stranded DNA from other mycoplasma (Acholeplasma) viruses are unknown.


Noninvasive, infrared monitoring of cerebral and myocardial oxygen sufficiency and circulatory parameters.

The relatively good transparency of biological materials in the near infrared region of the spectrum permits sufficient photon transmission through organs in situ for the monitoring of cellular events. Observations by infrared transillumination in the exposed heart and in the brain in cephalo without surgical intervention show that oxygen sufficiency for cytochrome a,a3, function, changes in tissue blood volume, and the average hemoglobin-oxyhemoglobin equilibrium can be recorded effectively and in continuous fashion for research and clinical purposes. The copper atom associated with heme a3 did not respond to anoxia and may be reduced under normoxic conditions, whereas the heme-a copper was at least partially reducible.


Body weight: reduction by long-term glycerol treatment.

Elevation of body glycerol concentration by multiple daily injections of glycerol was shown to lead to hypophagia and body weight loss followed by normal food intake and normal rate of body weight increase in rats. Termination of injections was followed by hyperphagia and an accelerated rate of growth. These findings suggest that the blood glycerol concentration plays an important role in the control of body weight and may be one signal by which the central nervous system monitors body lipid content.


Masking of electrical by acoustic stimuli: behavioral evidence for tonotopic organization.

When pure-tone acoustic masking stimuli of various frequencies were presented simultaneously with electrical stimuli applied to cochlear nucleus, only those maskers within a limited frequency range interfered with the detection of the electrical stimuli. The form of the masking functions obtained suggest that the electrical stimulus directly activated only a small population of neurons which were functioning in a tonotopic fashion.


Receptive fields of auditory neurons in the owl.

The influence of sound location on the responses of auditory neurons in the forebrain of the owl (Tyto alba) was studied directly by using a remotely controlled, movable sound source under free-field, anechoic conditions. Some auditory neurons demonstrated well-defined receptive fields that were (i) restricted both in elevation and in azimuth and (ii) relatively independent of the intensity and the nature of the sound stimulus. The majority of the fields were located frontally and contralateral to the recording site.


The relationship between scholastic progress and nutritional status. Part I. A study of 488 school beginners.

The reading progress of 488 Chatsworth Indian school beginners, in relation to their nutritional status, was assessed. It was found that the majority of the children were grossly growth-retarded and some 90% of them could be classified as slow learners. The significance of these findings is discussed. It is recommended that dietary supplementation be introduced for preschool as well as for school-going children in communities where growth retardation is prevalent.


A suggested method of preparation of the large bowel for investigation and surgery.

A safe, effective method of large-bowel preparation is outlined, the emphasis being on a standardized technique for the average patient. The rationale for the use of the technique is briefly described, and there is a further section on the preparation of the bowel in a patient with a colostomy. The importance of a residue-free fluid diet and adequate saline purgation is stressed.


The relationship between scholastic progress and nutritional status. Part II. A one-year follow-up study.

A 1-year follow-up study was conducted on a group of Indian children who were initially identified as being grossly anthropometrically stunted, and who had severe problems in reading after having attended school for 1 year. It was found that after an additional year's schooling virtually no improvement, either in the ability to read or in anthropometric status, had occurred. It is suggested that as a matter of urgency educationists, sociologists and physiologists should confer to take cognizance of the recent, extremely important findings pertaining to permanent intellectual stunting resulting from chronic malnutrition of infants up to their 4th postnatal year.


Alcoholics and the emergency ward. Part II. A one-year follow-up study.

The results of treatment 1 year after initial contact for detoxification in a group of Black (Blacks, Cape Coloureds and Asiatics) and White male alcoholics who were referred to specialized alcoholic treatment units are described. It is concluded that unsuitable patients are sent to these units, and that more effective management should take place at the first point of contact.


The lack of communication between doctors and patients.

In their daily work the majority of doctors assume that communication with patients is easy and that it needs no special study. This is a false assumption which starts at undergraduate level, where there is no formalized training of the South African medical student in the art of communication. A mass of literature on communication in medicine has evolved very recently; some of it is reviewed, and a plea is made that urgent attention be devoted to this gap in South African medicine.


Employee-benefit plans, 1975.

Despite the national decline in the number of employed workers in 1975, the number of workers covered lnder most types of employee-benefit plans increased slightly. Contributions and benefit payments underwent the greatest change. Total contributions increased 17 percent and benefit payments rose 14 percent. In part this change can be attributed to inflation, but it also reflects real growth in contributions and payments for most types of plans, particularly those for retirement and health care benefits. Review of the private pension plans shows that an increasing number were terminated in 1975, but the reason has not been determined; contributions to these retirement plans showed one of the largest annual increases ever.


Gonorrhea in adolescents: complement-fixing antibodies in a selected population of young women.

Over a four-year period a group of 209 young women committed to a state institution for deliquent youths was screened for infection with Neisseria gonorrhoeae by multiple bacteriologic cultures and by gonococcal complement-fixation tests. In this selected population of sexually active young women with a relatively high prevalence of gonorrhea, the gonoccal complement fixation test proved too insensitive to justify primary reliance on it for the identification of cases of actual disease. Only 25 (38%) of infected women had reactive sera. The specificity of the test was somewhat better; in two cases unexpected sero-positivity led to the identification, and treatment of previously-missed asymptomatic disease.


Federal civil-service annuitants and social security, December 1975.

This article examines personal and work-related characteristics of a sample of the nearly 1 million Federal civil-service retirees who were receiving annuities based on their own wage records as of December 31, 1975. Employment patterns and subsequent annuities in civil-service careers have been related to corresponding experience in jobs covered under the old-age, survivors, disability, and health insurance (OASDIHI) program. With some exceptions, the review uncovered patterns generally similar to those found in a study of 1967 annuitants. About 2 out of 5 annuitants were entitled to OASDHI cash benefits in 1975. Most of these dual beneficiaries received benefits on the basis of their own OASDHI-covered earnings, but 11 percent were entitled as dependents or survivors of other workers. About two-thirds of the annuitants not currently receiving benefits had some OASDHI-covered employment during their work careers. In general, those with the shortest civil-service careers and lowest annuities were most likely to be entitled to OASDHI cash benefits.


The effects of highly selective vagotomy on secretion and emptying of the stomach.

The results of a prospective study of 60 patients with nonobstructive duodenal ulcer treated by highly selective vagotomy show that the gastric acid secretion postoperatively is effectively reduced. Judgment of completeness of highly selective vagotomy is only possible by means of an intragastric pH-metry during operation. The Hollander test answers it insufficiently. In a number of patients, highly selective vagotomy caused a fast initial phase of gastric emptying of porradge. The impression is that the contractional activity of the antrum has the same pattern before and after highly selective vagotomy.


Treatment of secondary syphilis: an evaluation of 204 patients.

Our recommended treatment schedule for secondary syphilis is intramuscular benzathine penicillin G, 2.4 million units weekly for two consecutive weeks. If the patient is allergic to penicillin, we recommend that 2 gm of oral tetracycline be given each day for 12 days. Two hundred and four patients with secondary syphilis were treated with these schedules; 165 were given benzathine penicillin G and 39 received tetracycline. All of the patients were cured clinically and all achieved seronegativity within 24 months. There was a direct correlation between the duration of the rash and the secondary lesions that the patients exhibited. Patients who presented early in the course of illness tended to have macular and maculopapular lesions, whereas those who appeared later were more likely to have papular of pustular lesions. The serologic response to treatment was correlated with the duration of the rash and the appearance of the secondary lesions. Patients whose rash was of short duration and those with macular and maculopapular lesions became seronegative sooner than those patients whose rash was of longer duration and who had papular or pustular lesions.


Appraisal of the treatment of carcinoma of the anus and anal canal.

Anal bleeding and pain were the symptoms in half of 53 patients with carcinoma within and around the area of the anus treated from 1950 to 1974. Twenty-seven carcinomas were exclusively located in the anal canal and six, in the perianal skin. Vaginal invasion was present in 13 of the women. There were 39 squamous cell carcinomas and nine basaloid cell carcinomas. More than 37 of the patients had an abdominoperineal resection as part of the treatment. The resection margins were positive for carcinomas in 11 patients. Radiation as the primary treatment was used only once. Palpably enlarged inguinal lymph nodes were treated by subsequent radical groin dissection. The crude over-all survival rate was 42 per cent; the adjusted five year survival rate was 38 per cent. Significant correlates of death were symptoms for longer than six months' duration bleeding, inguinal adenopathy and presence of hemorrhoids. In general, abdominoperineal resection is the operation of choice for carcinoma of the anal verge or anal canal. Inguinal lymphadenectomy at a later time should be reserved for patients with signs of metastases to the inguinal nodes.


Treatment of seropositive primary syphilis: an evaluation of 196 patients.

One hundred seventy-five patients with primary infection with Treponema pallidum were treated with benzathine penicillin G, 2.4 million units given intramuscularly weekly for two weeks for a total of 4.8 million units. Twenty-one patients with primary syphilis who were allergic to penicillin were treated with oral tetracycline, 500 mg four times daily for 12 days for a total of 24 gm. All 196 patients had resolution of their lesions, and all were seronegative within one year. White patients presented for treatment earlier than black patients. The duration of symptoms prior to presentation for treatment was positively correlated with the height of the serologic titer in the rapid plasma reagin card test. Patients who had high titers before treatment became seronegative less rapidly than patients who had low pretreatment titers.


The physiopathologic background and standard technique of selective proximal vagotomy and pyloroplasty.

The observations collected on selective proximal vagotomy plus functionally and structurally appropriate pyloroplasty during a period of 13 years have demonstrated that inadequate selective proximal vagotomy results in an excessive rate of relapses and that adequate selective proximal vagotomy without drainage leads to stasis, resulting in retention difficulites or secondary gastric ulcers. In both instances, reoperations are to be expected. If complete healing without resection is what one wishes to accomplish, and who doesn't, adequate selective proximal vagotomy combined with structurally and functionally appropriate pyloroplasty is indicated. This combination can now be considered a reliable standardized procedure of curative nonresection surgical therapy for gastroduodenal ulcers.


A cilia-bearing cell system in the intrahepatic bile ductules of the rat.

A scanning electron microscopic investigation of the luminal surface of the intrahepatic bile ducts of the rat has been performed using tissue prepared by critical point drying. Results of these studies have demonstrated that intrahepatic bile ducts of the rat are composed of cells, the luminal surface of which contains either microvilli or numerous long cilia. It was suggested that these cilia play an important role in tissue function, particularly in the propulsion of hepatic bile.


Noninvasive assessment of collateral blood flow of the cerebral hemisphere by Doppler ultrasound.

Directional flow in the frontal artery, a terminal branch of the ophthalmic artery, was assessed nonivasively by Doppler ultrasound druing brief digital compression of the ipsilateral common carotid artery in 62 patients. Directional frontal artery flow during carotid compression was compared with mean distal internal carotid back pressure measured at subsequent carotid endarterectomy. Mean carotid back pressure in 28 patients with normal frontal artery flow direction during carotid compression, 68 +/- 14 millimeters of mercury, was significantly higher than that observed in 24 patients in whom frontal artery flow was completely obliterated and ten in whom frontal artery flow was reversed. Distal internal carotid back pressure exceeded 48 millimeters of mercury in all patients with normal frontal artery flow direction during carotid compression. Conversely, carotid back pressure was below 41 millimeters of mercury in all but one patient in whom frontal artery flow was obliterated or bliterated or reversed during carotid compression. The results of this study indicate that Doppler ultrasound assessment of frontal artery flow direction during simultaneous carotid compression provides a rapid, sale noninvasive estimate of the adequacy of collateral hemispheric circulation.


Wound infection following cesarean section.

To investigate a high incidence of wound infections occurring in patients following cesarean section at a 650 bed charity hospital in Louisiana, a bacteriologic investigation was carried out. In this study, cultures were made at multiple sites prior to operation. An attempt was made to identify those bacteria that were predominately responsible for wound infection and their source, whether from the patient herself or from a nosocomial origin. The patients were divided into three groups depending on the degree of postoperative morbidity that followed. The bacterial flora in each group was relatively the same. Other factors were more significant in predicting those patients in whom postoperative morbidity occurred.


The expediency of peritoneal lavage for blunt trauma in children.

Two hundred and thirty children, ten years of age or younger, suspected of having blunt abdominal injuries underwent diagnostic peritoneal lavage. Peritoneal lavage was 99.1 per cent accurate in determining the presence or absence of abdominal injuries. One patient had a false-positive peritoneal lavage. Sixty-nine of the 70 patients with blunt abdominal injuries, who underwent peritoneal lavage, had a positive peritoneal lavage; one patient had a false-negative peritoneal levage. Ninety-one per cent of the positive peritoneal lavages were grossly positive for hemoperitoneum. All 11 children with extraperitoneal abdominal injuries had positive peritoneal lavages from associated intraperitoneal injeries. The mortality for children with blunt abdominal injuries was 19.4 per cent. Intra-abdominal injuries were solely responsible for 29 per cent of the deaths and were a major contributing factor in an additional 21 per cent of the deaths. The routine use of diagnostic peritoneal lavage during the initial evaluation of blunt abdominal trauma was, in large part, responsible for the rapid, definitive treatment which -he children with abdominal injuries received. Sixty-five per cent of the children underwent exploratory laparotomy within one hour of admission to the hospital.


On the origin of the regeneration factor.

The data presented indicate a complexity of the process through which the hepatocyte replication is controled after partial hepatectomy. It can be said that several factors may be working together, including hepatic inhibitor, splenic inhibitor, intestine associated stimulator and pancreatic factor.


Value of a follow-up study of recurrent carcinoma of the colon and rectum.

The results of our programmed follow-up study of patients with carcinoma of the colon and rectum have been disappointing. This is true also for those patients who have undergone resection with the intention of cure. This is mainly because of the discouraging results of our treatment of recurrent lesions. Chemotherapy or roentgen radiation has not regularly been used. The mean survival time has probably been prolonged in some single instances. Only three out of 36 are still alive. Oour negative results show that a follow-up study of this magnitude has been too extensive when the poor outcome is considered. We believe that a follow-up study of patients who have been operated upon for carcinoma of the colon and rectum is necessary but in a simpler form than we have done.


The reverse fistula for vascular access.

A new technique for vascualr access in the patient requiring chronic hemodialysis and who has had multiple failures of forearm fistulas involves the formation of a side-to-side anastomosis between the brachial artery and the basilic vein and creates reverse flow into the antecubital venous system. Attention to technical considerations will prevent edema of the arm and allow for future use of graft procedures, if necessary.


A new technique for the treatment of comminuted, transverse fractures of the patella.

In an attempt to re-establish continuity of the quadriceps mechanism following partial patellectomy more securely in patients with comminuted, transverse fractures of the patella, a technique whereby the patellar ligament is inserted into a transverse groove created in the proximal patellar fragment and this anastomosis is then protected by a tension band wiring, is described and depicted. Using this method, it is possible to provide a larger surface area fro more satisfactory tendon to bone healing and to initiate relatively early motion of the knee, without compromising the site of reconstitution of the extensor mechanism.


Autogenous venous grafts ten years later.

The status of 103 patients and their 113 autogenous venous femoropopliteal bypass grafts exactly 5 years after operation was presented previously. A 10 year follow-up now is possible. The mortality rate at 5 years was 48% (50 of 103) and at 10 years was 73% (75 of 103). Myocardial infarction was considered to be the cause of death of 36% of the 103 patients. The actual graft patency rate for survivors at 5 years was 59% (35 of 59) and at 10 years was 38% (11 of 29). Utilizing the same date, late graft patency rates of 45%, 58%, and 58% would have been calculated or predicted by other methods of reporting. Of 46 extremities operated on for claudication, 22 patients were alive and 45% of grafts (10 of 22) were patent 10 years later. Of patients with a total of 67 extremities operated on for rest pain or gangrene, only seven patients were alive and 14% (one of seven) of the grafts patent. Patency rates at 10 years of short grafts were 43% (nine of 21) and of long grafts 25% (two of eight). Extremities with good runoff had patency rates of 41% (nine of 22) at 10 years and those with poor runoff had patency rates of 29% (two of seven). Arteriograms demonstrated atherosclerotic changes in one of 18 grafts at 5 years and in two of eight grafts at 10 years. This study provides more facts for answering the questions of patients regarding long-term prognosis following their arterial reconstruction. It is important to analyze carefully any report in which a comparison of patency rates is suggested or invited.


Effects of experimental hypertension and hypercholesterolemia on the lipid composition of the aorta.

This study evaluates alterations in canine aortic lipid composition under conditions of hypertension, hypercholesterolemia, or a combination of these factors. Hypertension was produced in the proximal thoracic aorta by creation of an aortic coarctation, whereas hypercholesterolemia was brought about by a lard-cholesterol diet in combination with thyroidectomy. Hypertension alone produced only minor changes in the lipid content of the arterial wall, but hypercholesterolemia yielded modest increases. The combination of hypertension and hypercholesterolemia, however, produced a striking increase in the total lipid content in the arterial wall. This change was most marked in the cholesteryl ester fraction, and a shift in cholesteryl ester fatty acids from linoleate to oleate was found. These data indicate that the interaction of hypertension and hypercholesterolemia produces alterations in lipid composition in a relationship which appears to be more geometric than arithmetic in nature.


Refractory ventricular arrhythmia: the role of intraoperative electrophysiological study.

Thirty patients with drug refractory ventricular tachycardia (RVT) were studied between 1 week and 5 years after myocardial infarction with coronary agniography and left ventriculography. They were divided into four groups: (1) inoperable, five patients; (2, a) operated, with primary left ventricular failure, five patients; (2, b) operated with primary RVT, not mapped, 15 patients; (2, c) operated, with mapping, five patients. The mortality rate in group 1 was 100%, and in group 2, a it was 80%. In group 2, b, despite aggressive drug therapy and operation, including aneurysmectomy, coronary revascularization, and intra-aortic balloon pumping when appropriate, the mortality rate wad intraoperative mapping in group 2, c. Arrhythmogenic foci were identified and removed in four. There was one operative death (20%) and four patients are alive from 12 to 27 months after operation, three of whom are asymptomatic. Intraoperative epicardial mapping is an important adjunct to surgery for RVT.


In vivo assessment of anticoagulation.

All methods of assessing anticoagulation rely on in vitro techniques. Although these may reflect the clotting tendency in a specimen of blood accurately, they do not necessarily indicate the effectiveness of the anticoagulant in the body where stasis, acidosis, catecholamines, endotoxin, and exposed collagen may alter the coagulability of blood locally. We have utilized autologous 125I-labelled fibrinogen to assess fibrinogen half-life in normal subjects and in patients with clotting complications before and after the administration of anticoagulants. Fibrinogen half-life has varied from normal (104 hours) to markedly abbreviated (13 hours) in patients apparently fully anticoagulated, utilizing standard laboratory parameters. Although there are many potential causes of the shortening of fibrinogen half-life, including fibrinogenolysis and extravascular losses into the interstitial space and wounds, we have been able to establish whether the disappearance of the radioactive-labelled fibrinogen is due to these causes or to clotting by increasing the levels of anticoagulation. Plateauing of fibrinogen half-life values despite increased doses of heparin, or return of the half-life to normal, indicates full anticoagulation. This has permitted determination and administration of the theoretically optimal dose of heparin. In situations involving life-threatening clotting complications, such as massive pulmonary embolism, the use of 125I-labelled fibrinogen provides a means for controlling anticoagulant therapy in a rational fashion by this technique of assessing clotting.


Noninvasive evaluation and management of the "asymptomatic" carotid bruit.

Cervical bruits in patients who are asymptomatic or who have nonhemispheric neurological symptoms present a universal challenge. Of 4,000 patients evaluated noninvasively for carotid occlusive disease, 1,287 presented with "asymptomatic" bruits (697 had nonhemispheric neurological symptoms and 590 were clinically asymptomatic). Carotid phonoangiography (CPA), the visual analysis of carotid bruits, identifies bruits indicative of significant stenosis, documents progression, and differentiates bruits of carotid bifurcation and sub-bifurcation origin. Sub-bifurication bruits were diagnosed in 619, insignificant bifurcation bruits in 426, and significant carotid bruits in 242 patients by CPA. Oculoplethysmography (OPG) evaluates the hemodynamic significance of carotid bruits by comparative timing of simultaneously recorded ocular and ear lobe pulses. OPG detected 273 asymptomatic bruit patients with significant internal carotid flow reduction and indicated 5% of the bifurcation bruits were of external carotid origin. An accuracy of 89% in determining greater than 40% stenosis by OPG/CPA in 295 patients having arteriography increases to 97% when both OPG and CPA are positive. Six-month to 70-month clinical follow-up of the 1,287 patients documented 154 carotid endarterectomies and 38 strokes. Analysis of the strokes favors arteriography and operation only for those patients with appropriately positive or progressive OPG/CPA or with focal transient ischemic attacks (TIAs).


Initial results from an agressive roentgenological and surgical approach to acute mesenteric ischemia.

The 70% to 80% mortality rate of patients with acute mesenteric ischemia (AMI) has remained unchanged over the past 40 years. We report here the initial results using an aggressive approach to this problem. This included the earlier and more liberal use of angiography in patients at risk and the intra-arterial infusion of papaverine for the relief of superior mesenteric artery (SMA) vasoconstriction in both nonocclusive and occlusive forms of AMI. Of the first 50 patients managed by this approach, 35 (70%) had AMI demonstrated by SMA angiography, Nineteen (54%) of these 35 patients survived, including nine of 15 patients with nonocclusive mesenteric ischemia, seven of 16 with SMA embolus, two of three patients with SMA thrombosis, and the one patient with mesenteric venous thrombosis. Seventeen of the 19 survivors lost no bowel or had excision of less than 3 feet of small intestine.


Teratogenicity of cytochalasin D in the mouse.

Cytochalasin D, a mold metabolite identified in food, was injected intraperitoneally in doses of 0.4 to 0.9 mg per kilogram on gestational days 7 through 11 and produced evidence of teratogenicity in two out of three strains of mice. Exencephaly, hypognathia and axial skeletal defects were found in strains C57BL/6J and BALB/c while no increase in defects was observed in the Swiss Webster strain. In all three strains, a significantly increased resorption rate was found. Oral doses of approximately 7.0 mg per kg on days 7 through 11 in the BALB/c produced exencephaly in the offspring. Autoclaved cytochalasin D retained its teratogenic potential.


Environmental heat stress effects in the hamster.

Exposure of Syrian hamsters for two twenty-minute periods at 40 degrees C on a single day of pregnancy (ranging from day 6 to day 13) resulted in differing teratogenic effects. Maximum resorption (52.6%) was seen with treatment on day 7 whereas the highest rate of malformation (51.9%) was observed with treatment on day 9. Cranial defects predominated with treatment early in pregnancy (highest incidence of day 9) while limb defects were not observed with any treatment administered before day 9. Exencephaly occurred with treatments on day 6 and 8, with a single case after treatment on day 10. Cleft lip and cleft palate were observed with treatment on days 9 and 10. These studies illustrate the usefulness of the Syrian hamsters in teratological studies and characterize some of effects exerted after mild heat treatment at varying stages of pregnancy.


Translocation heterozygosity in a malformed piglet and its normal littermates.

A translocation with centric fusion between the Nos. 13 and 17 acrocentric chromosomes was described in a malformed female piglet and three phenotypically normal littermates by the G-banding staining technique. Since the translocation was heterozygous, the chromosome number was 37. The differences between the translocation of the present cases and those previously reported in the domestic swine species, as well as in some wild pigs, are mentioned.


Comparative teratogenicity of selected glucocorticoids applied ocularly in mice.

Three glucocorticoids (dexamethasone, hydrocortisone, and prednisolone), were ocularly applied to pregnant CD-1 mice on days 10-13 of gestation. The drug concentrations were various multiples of the common therapeutic dose levels and were applied to both eyes in 1 microliter drops five times a day. Eighteen-day fetuses were examined for malformations. A significant increase in the incidence of cleft palate was observed in fetuses treated with each of these glucocorticoids. There appeared to be a dose related effect on cleft palate width among fetuses from both dexamethasone and prednisolone treated dams. The incidence of sex organ anomalies, although lower than the incidence of cleft palate, also showed a positive dose relationship. Analysis of variance was used to compare the teratogenic effects of these glucocorticoids ocularly applied in equipotent anti-inflammatory concentrations. Our results indicate that dexamethasone produces a higher incidence of cleft palate, than either of the other two drugs when given in equipotent concentrations. It appears that the teratogenic potency of these ocularly applied glucocorticoids cannot be predicted on the basis of anti-inflammatory potency.


The effect of intrauterine position on the radiosensitivity of rat embryos.

Rats were exposed to gamma rays or helium ions on one of days 4-9 of gestation. Embryonic survival was recorded as a function of intrauterine position at autopsy on day 20 of gestation. Embryos located at the ovarian and cervical ends of the uterus experienced higher rates of mortality than did their littermates located at the middle of the uterine horn. This effect was observed in litters exposed to both radiation modalities on all days studied. The influence of intrauterine position on embryonic survival was directly proportional to radiation dose and to the number of fetuses occupying the uterus horn. Under the least advantageous conditions (i.e., a crowded uterine horn exposed to a moderately high radiation dose), the cervical embryo's probability of survival was less than half that of the litter as a whole. A disproportionately high rate of embryonic mortality at the cervical position was also observed in litters irradiated under hypoxic conditions, suggesting that the non-random distribution of radiation effect was not the result of variations in oxygen concentration within the uterus. In contrast, there was no indication that intrauterine position influenced the distribution of gross morphologic abnormalities in irradiated litters.


Effects of methyl mercury on murine fetal amino acid uptake, protein synthesis and palate closure.

Methylmercury (MeHg: 5 mg Hg/kg maternal body weight) in 0.13 M NaCl, 0.01 M NaH2PO4-Na2HPO4, pH 7.4 (PBS) administered to gravid CFW mice on day 12, hour 6 (12(6)) of gestation induced a high incidence of cleft palate in fetuses examined on days 15(6) (72%), 16(6) (62%) and 17(6) (40%). Palate closure (100%) in PBS control animals occurred by 14(10). One day post MeHg administration, total fetal protein was decreased 22% while DNA content was unaltered. Protein was maximally decreased (28%) on 14(6) and, thereafter, returned toward control levels. Alterations in DNA content followed a similar pattern; but the maximal decrease (32%) occurred on 15(6). The rate of fetal protein synthesis was depressed 5% at 12(9) and between 20% to 26% from this time to 13(6) (end of observation). The agreement between the calculated decrease in protein synthesis (19%) and the measured decrease in protein content (22%) suggests that a reduction in protein synthesis is responsible for the decreased fetal protein content. Placental blood flow and fetal water space, measured with 3H--H2O at 12(18), were not affected by MeHg treatment. However, fetal free amino acid concentrations at 12(18) were generally decreased (alanine, 23.0%; valine, 9.7%; methionine, 22.6%; isoleucine, 12.0%; leucine, 18.2%) while uptake of the non-metabolizable amino acid, 14C-cycloleucine, was decreased 23%. From this, it is concluded that the growth inhibitory effects of MeHg are related, at least in part, to impaired placental/fetal transfer of amino acids.


Digital anomalies in the embryonic mouse limb cultured in the presence of excess vitamin A.

Forelimb buds of days 10 to 12 ICR/JCL mouse embryos were cultured on a liquid medium consisting of 90% Eagle's MEM and 10% fetal calf serum. Experimental explants were exposed to retinol (10 iu/ml) for the first 24 hours of culturing. In the control explants, chondrified metacarpals and proximal phalanges increased in number as the age of the donor limb bud increased. All treated explants cultured on the experimental medium showed abnormal development compared with the controls. Lesions caused by vitamin A shifted from proximal to distal limb segments as the age of donor limb bud increased.


A note on the epidemiology of acardiac monsters.

The literature on acardiac monsters has been reviewed. The following conclusions were drawn: 1. The probability of their appearance seems considerably higher among monoamniotic than diamniotic monochorionic twin pairs. 2. They seem more likely to occur within monozygotic (MZ) pairs in higher multiple births than in MZ twins. 3. The data are consistent with the suggestion that there is a slight female excess among them.


Sternal metastases and associated pathological fractures.

A review of 839 necropsies revealed 415 cases of malignant neoplasm, 63 of which were found to have evidence of metastatic spread to the sternum. Nineteen of these metastases resulted in pathological sternal fractures. Fine detail radiography proved a quick and accurate technique for detecting these lesions post mortem. The characteristics of pathological sternal fractures were compared with traumatic sternal fractures with respect to deformity and healing. Pathological fractures of the sternum demonstrate a tendency to greater deformity and slower healing than traumatic sternal fractures.


Squamous-cell carcinoma of the pleura.

There are few reports of primary malignant tumours of the pleura other than mesothelioma. Reports of squamous-cell carcinoma of the pleura are especially rare. Epidermoid carcinoma of the pleura may occur in connection with persistent empyema drained by a pleurocutaneous fistula or long-standing extrapleural pneumothorax without fistula.


Postoperative lobar torsion and gangrene.

Following left upper lobectomy for a pulmonary nodule, complete 180-degree torsion of the left lower lobe with haemorrhagic infarction occurred. Despite re-exploration within 24 hours of the initial procedure the patient died. Postoperative torsion requires early diagnosis and resection of the gangrenous tissue.


Primary pulmonary sporotrichosis with unusual fungal morphology.

Primary pulmonary sporotrichosis is a rare disease. Comstock and Wolson (1975) were able to trace approximately 30 such cases. We report a further case; to our knowledge, the various stages in the development of sporotrichosis, from a cigar body to the mature asteroid body with radiations which were present in our case, have not been so well demonstrated in a single case.


Bronchial carcinoid with osteoblastic metastases.

Bony metastases in association with a lesion in the lung are usually regarded as secondary to bronchial carcinoma. This is generally true when the metastases are osteolytic. However, in the presence of a solitary lung lesion with osteoblastic metastases, the diagnosis of bronchial carcinoid should be considered. The following case illustrates this point.


[Assay of somatomedin C in bovine plasma (author's transl)].

Somatomedin C is an important hormone which in all probability directly controls growth. The assay of this hormone in bovine plasma is described and the experience gained in the research required to develop this method of determination is reported. Although bovine plasma is a difficult material in which to perform these assays, satisfactory conditions were created to make possible further studies of serial samples.


[Structure in rations of dairy cattle (author's transl)].

Efficient utilization of feed by ruminants is closely related to fermentation in the reticulum and rumen. A deficiency is long roughage ("structural material") may impair this fermentation and result in a low-milk fat syndrome. The deficiency in long roughage is particularly apparent in diets containing large amounts of readily available carbohydrates. Factors involved in the absence of structure were described. Readily available carbohydrates such as sugars and starch from grains will promote high concentrations of volatile fatty acids in the rumen. Chewing and ruminating stimulate the secretion of salive and so increase the buffering capacity of the rumen fluid. tlong roughage is required to maintain the structural layer in the rumen, inducing regular and rigorous contractions. The buffering capacity in conjunction with adequate rumen motility may partly reduce the effect of high concentrations of volatile fatty acids produced from high amounts of readily available carbohydrates. Coarseness and type of roughage also are important factors. At least one-third of the total uptake of dry matter should consist in long, coarse and fibrous roughage. Extremely high concentrations of volatile fatty acids in the rumen of high-yielding cows may be reduced to some extent by providing the mixture of concentrates in more meals a day at intervals of at least 3-4 hours.


[Pulmonary contusion after blunt chest trauma--an experimental model (author's transl)].

A model in the rat for pulmonary contusion after blunt chest trauma is described. It is possible to avoid trauma of the mediastinal organs, liver and spleen; therefore it is possible to produce pulmonary contusion with a good reproducebility. The parameter for the extent of contusion was the lungweight which rose statistically with a specific force of trauma. Simultaneous injection of high doses of prednisolone with the blunt chest trauma inhibits the increase of the lung weight.


[The effect of nitrates on the function of intact and ischemic myocardium (author's transl)].

The effects of Sodium Nitroprusside (NPN), of Isosorbidedinitrate (ISDN), and of a combined therapy with NPN and the intraaortic balloon pump (IABP) on left ventricular function and on local contraction patterns of normal and ischemic myocardial regions were studied. In acute experiments on 16 dogs the anterior descending branch of the left coronary artery was stenosed to produce a hypokinesia or dyskinesia of the anterior wall of the left ventricle. Regional myocardial function was assessed using the ultrasound transit time method. When the LV filling pressure was initially norman (LVedP 5.7 +/- 0.6mmHg) nitrate infusion (120 microgram/minn NPN: 800 microgram/min ISDN) resulted in an aggravation of the ischemic dysfunction. Conversely, with high initial filling pressure (LVedP 15.4 +/- 1.3MMHg) regional myocardial function in the ischemic area returned to normal under therapy. Additional application of the IABP further improved regional myocardial mechanics. It is concluded, that reduction of coronary perfusion pressure due to nitrate therapy becomes critical when coronary reserve is depleted. Compensation is however possible if ventricular wall stress can be reduced and thus the oxygen consumption and the extravascular component of coronary resistance are decreased. Only when the initial filling pressure is high these conditions are met.


[Prevention of edema during coronary perfusion with cardioplegic solution (author's transl)].

In arrested and with cardioplegic solutions perfused rabbit hearts the relation of perfusion-pressure and flow rate were examined, showing that edema of the myocardium can be avoided even using erythrocytes-free solutions by two measures. First the solution has to contain colloid active agents and secondly the perfusion pressure has to be significantly below the colloid-osmotic pressure. Furthermore the edema can be avoided by adding 300 mg 6-methyl prednisolone/1. If no attention is paid to these facts the coronary flow decreases constantly due to developing interstitial and interfibrillar edema and degenerative changes of endothelial cells of the capillaries, which even can undergo necrosis. These changes were not seen using steroids. On the contrary here we found by densitometry and increased number of lysosomes. These findings show the effectiveness of corticosteroids in stabilizing the cell membranes.


[Surgical treatment of chronic occlusions of the carotid bifurcation (author's transl)].

Optimal protection of the brain during carotid endarterectomy is of great importance and is guaranteed by general anaesthesia with maintenance of normal blood-pressure and a normal CO2-level, routine use of internal shunts and heparinization. Operation of "asymptomatic" patients has to be seriously considered. Patients with acute occlusions of the carotid artery should not have surgery as emergency procedures, unless the operation can be done immediately after the onset of symptoms. In chronic occlusion of the internal carotid artery endarterectomy may be considered if the shiphon is patent and in good condition.


[Pre- and postoperative Doppler-ultrasound measurements in carotid artery surgery (carotid artery Doppler) (author's transl)].

The evaluation of carotid artery perfusion with Doppler-ultrasound is based on semiquantitative measurements of blood flow in the terminal branches of the ophthalmic arteries (supratrochlear and supraorbital artery) and the common carotid arteries. Diagnosis is performed with a set of 8 parameters and informs about obstructions in the carotid artery as well as the collateral circulation. The method was applied on 1500 patients of whom 340 underwent angiography and has proved to be about 90% reliable. Its value in carotid artery surgery was evaluated with 62 extracranial reconstructive operations on 55 patients and 35 iatrogene anastomoses between the temporal superficial and a branch of the middle cerebral artery on 35 patients.


[Doppler ultrasound technique compared to angiography, intraoperative pressure gradients and blood flow measurements in carotid surgery (author's transl)].

Doppler ultrasound technique was used in 32 patients to differentiate between non-signigicant stenosis, significant stenosis and occlusion of the internal carotid artery. The results were then compared to angiographic findings and peroperative pressure gradients and blood flow measurements. The Doppler examinations showed good agreement with the angiograms. Pathologic Doppler results were positively correlated to a high pressure gradient but were not correlated to the internal carotid blood flow. Pre- and postoperatively the Doppler ultrasound examinations increased the diagnostic security, improved the assessment of the hemodynamic significance of a stenosis and made in some cases an angiogram unnecessary.


[The validity of degree and variety of carotid-artery-stenosis (author's transl)].

In cerebro-vascular deficiency the significance of carotoid artery-stenosis is determined by local and general risk factors. Indications for surgical treatment depend both on the degree and variety of stenosis. Clinical findings and measuring of blood pressure during operation have shown that cardiac efficiency, blood pressure, sympathetic affections of other brain-supplying arteries and above all function of arterious circle of Willis constitute further important risk factors.


[The value of measuring intraoperative pressure in carotid endarterectomy (author's transl)].

During the last 4 years 92 operations at the carotid bifurcation were performed. In almost all cases carotid stump pressure was measured. If the stump pressure was below one third of the systemic pressure endarterectomy was done with intraluminal shunt. Under these conditions neurologic symptome deteriorated 3 times, but improved after a few days. There was no hospital mortality.


[The frequency of the combination of arterial occlusive disease in supraaortic and leg range. An analysis in the patient population of a vascular surgical department (author's transl)].

Among 337 male patients who were hospitalized because of chronic ischemia of the leg, 103 (=30.6%) were shown to suffer from concomitant occlusive vascular disease of supraaortic branches. This was evaluated by simple examination like auscultation, bilateral blood pressure measurements, and palpation of pulses. In 52% the patients history revealed dizziness, hemiparesis and transient ischemic attacks (TIA). Arteriell hypertension promotes supraaortic vascular diseases as is shown by a relative frequency of 0.52 in contrast to 0.39. Combined occlusions of the iliac and femoropopliteal arteries are accompanied by supraaortic vascular disease in 40%, in femoropopliteal occlusion alone in only 20%. If the basic diagnostic approach is improved by directional ultra-sonic examinations of the carotid arteries, approximately 20% of all patients with advanced vascular disease of the iliac and femoropopliteal arteries have to be operated on for cerebrovascular disease.


[Subclavian steal syndrome: long-term course over 3 years spontaneously and postoperatively (author's transl)].

It was studied development of Subclavian Steal Syndrome in 27 patients postoperatively and spontaneously over a period of 3 years. It was seen a high quote of spontaneous recovery of cerebral symptoms, on the other side there was a lack of complete remissions of cerebral symptoms after vascular operation. Vascular operation is only indicated in syncopal and severe ischemic brachial symptoms.


[Pressure-and flow measurements during carotid-subclavian-bypass operations (author's transl)].

In 7 Carotid-Subclavian-Bypass operations pressure and blood-flow were studied. In 4 patients a reduced flow in the common carotid artery was noticed after opening the bypass. There were no neurological complications in the postoperative period in any patient. This decreased flow can be explained as a so-called "pseudosteal" due to changing in direction of flow in numerous and good functioning collaterals of this area.


[Surgery of the extracranial cerebral vessels. (Indication and results)].

Surgery of the extracranial cerebral vessels nowadays under right indication and operative technique is one of the most satisfying areas of vascular surgery. Our present status of indication is shown in table 1; it should be pointed out that the classical indication is a lesion of the internal carotid artery with a Transitoric Ischemic Attack, but also in cases of progressive stroke with acute carotid occlusion the operation will be successful relentless of any time limit as long as the patient is conscious. For the extrathoracal bypass procedure we now prefer the subclavio-subclavian bypass to the formerly performed carotio-subclavian bypass.


[Radiological diagnosis of mediastinal tumors (author's transl)].

In most cases mediastinal lesions can correctly be differentiated from tumor simulating conditions. Their effect on normal anatomical structures of the mediastinum can be revealed by different methods; but separating benign from malignant masses on the base of the radiological findings is not reliable enough.


[Mediastinal angiography. A helpful method to evaluate to operability of mediastinal and lung tumors (author's transl)].

Preoperative mediastinal angiography, as a simple method, shows alterations of pulmonary and venous mediastinal circulation. It enables the surgeon to evaluate the operability of malignant thoracic neoplasms without performance of other diagnostic procedure with a higher rate of complications, e.g. mediastinoscopy or explorative thoractomy.


[Diagnostic and therapeutic aspects of endothoracic goiter (author's transl)].

Among mediastinal tumors requiring operative treatment endothoracic goiters have to be considered as common cause (13.7%) in differential diagnostic aspects next to dysontogenetic and neurogenic tumors. Final diagnosis is best established by chest x-rays in two directions, perhaps with additional barium swallow and a scintigraphy (131I or technetium). Angiography is of no valuable further information concerning tumor identification or operability. The disadvantage refers to unwanted iodine load in case of thyroid malignancy. The operative approach for real mediastinal goiter necessitates partial or total sternotomy or occasionally lateral thoracotomy.


[Diagnostic and surgical treatment of thymic tumors (author's transl)].

X-rays in different planes, roentgenisation, tomograms and not so often the clinical symptoms today are still responsible for the diagnosis. Mediastinoscopy and lateral mediastinoscopy very often ensure the diagnosis and dignity of the tumor. From 1956 to 1976 948 patients at our clinic were operated because of a mediastinal tumor. In 67 or 7% it was a thymic tumor. With thymic hyperplasia, thymoms and cysts of the thymic gland the survival time after operation was hardly reduced. The prognosis of the malign tumors of the thymic gland was bad with or without ray-treatment. By thymectomia 43% of the patients with myasthenia showed a good recovery.


[Risks and complications on mediastinoscopy (author's transl)].

Own experiences on 2500 cases of mediastinoscopy. Risks concerning the indication for the mediastinoscopy. Summary of complications with regard to 19 other authors including 12 161 mediastinoscopies. Most appearing complications: Lesions of the nervus recurrens. Lesions of the bigger vessels avoidable by concerning the local anatomy. Recommendations for emergency cases.


[Psychiatric and neurological complications associated with cardiac surgery (author's transl)].

The following problems are discussed as the result of an own investigation done with 150 patients after cardiac surgery: 1. the differences in incidence of cerebral complications understood as 2. a probleme of qualitatively different psychopathological and neurological syndromes. 3. Causes and relationship between the clinical stages of heart-disease and neuropsychiatric complications with special regard to the question 4. congenital heart-disease versus aquired heart-disease. 5. The role of extracorporeal circulation. 6. Remarks on the role of microembolism associated with open cardiac surgery. 7. Hereditary factors as the cause for specific psychopathological reactions.


[Classification of psychopathological disorders after open-heart surgery (author's transl)].

A better discrimination of phenomenology and severeness of psychopathological disorders after open-heart surgery has been obtained: a) There is no equal distribution of degrees of severeness, a high correlation of severeness with duration of the disorders, a low correlation with age and no dependance of sex. b) Disorientation, clouding of consciousness and disorders of awareness arise earlier, delusions, hallucinations and paranoid ideas tentatively later after surgery. c) Three psychopathological syndromes have been identified. They appear in different frequency, intensity and can be combined.


[The regulation of the circulatory system in the early postoperative period after open-heart surgery during physical therapy and orthostatic exercise (author's transl)].

17 patients, who underwent open heart procedures, were examined during and after standardized exercises at the first, second and third postoperative day. At 10 defined time intervals the following parameters were measured: arterial blood pressure, right and left atrial pressure and in the pulmonary artery, arterial and venous blood gases and cardiac output by thermodilution. Oxygen consumption and cardiac index were calculated. The results show that the majority of patients after open heart surgery are well able to adjust to additional work load even early postoperatively.


[Surgical repair of Ebstein's disease (author's transl)].

In 1976 4 patients with Ebstein's disease underwent surgical repair. In one patient (22 yrs.) the tricuspid valve leaflets were suitable for reconstructive surgery using Hardys method in addition to De Vegas annuloplasty. In the other three cases (17, 29, 51 yrs. old) excision of the malformed tricuspid valve was necessary, and porcine heterografts of greatest possible diameter were implanted. Three patients improved considerably 9 months postoperatively. The fourth patient, a 51 years old woman, died 2 days postoperatively on cardiac failure. From our own results and based upon reports from the literature we conclude that reconstructive surgery of the tricuspid valve should be preferred to replacement. If valve replacement is necessary, bioprostheses ought to be used. At the age of 15 to 40 years, surgical repair seems to have the best prognosis in patients with Ebstein's malformation.


[Hemodynamics after reconstruction of the outflow tract in tetralogy of Fallot. Infundibulectomy, patchreconstruction or valve rearing conduit (author's transl)].

The peak systolic pressure ratio PRV/PLV of the right and left ventricle after correction of the outflow tract (OFT) in Tetralogy of Fallot (TF) yields reliable dates about the efficiency of the outflowtract correction and the probability of survival. In 110 patients (2 to 57 years) the ratio after correction PRV/PLV was measured and compared with different methods of reconstruction of the OFT. Infundibulectomy (54) pericard-patch insertion across the pulmonary valve ring (43) and a valve bearing Hancock-Conduit (13) were used. To calculate the statistical differences the U-test according to Wilcoxon, Whitney, Mann was applied on the 95% level. Moreover the pulmonary insufficiency (PI) was evaluated in 60 patients within 15 to 60 days, after correction with a videodensitometric method. There is no PI after use of a valve bearing Hancock-Conduit. In severe TF a valve bearing Hancock-Conduit is hemodynamically superior to a pericard-patchreconstruction of OFT to relief right ventricular hypertension, particularly if hypoplasia of pulmonary vessels and pulmonary vascular disease after shunt-operation is present.


[Surgical treatment of aortic arch anomalies (author's transl)].

Anomalies of the aortic arch can be deducted by embryology. Aortic ring anomalies (double aortic arch, Art. lusoria, right descending aorta with Lig. arteriosum) have to be opened if clinically indicated. Aortic arch stenosis has to be removed by resection of intraaortic membranes, end-to-end-anastomosis, patch enlargement, or prosthetic bypass graft. Aortic interruptions require a functionally sufficient bridging by end-to-end-anastomosis, prosthetic bypass graft, or interposition of an aortic arch vessel. In 1971 the left common carotid artery was used in a 14 years old boy which seems to be insufficient for bridging the aortic arch defect five years later.


[Intracardiac correction of congenital heart anomalies in 104 infants (author's transl)].

From 1974 to 1976 104 infants (under 1 year of age) underwent intracardiac correction for congenital heart diseases. Mean age and body weight were 6.6 +/- 3.6 months resp. 5.66 +/- 1.4 kgs. The diagnoses and mortality rates were: transposition of the great arteries (TGA) with intact ventricular septum 27 (0), TGA plus associated anomalies 9 (0), ventricular septal defect (VSD) 20 (1), VSD plus associated anomalies 6 (1), total anomalous pulmonary venous drainage 9 (5), pulmonary stenosis and pulmonary atresia with intact ventricular septum 9 (2), aortic stenosis 7 (3), ASD I or II 7 (0), and miscellaneous 10 (3). Intracardiac correction was performed either on cardiopulmonary bypass and moderate hypothermia or in deep hypothermia with or without total circulatory arrest. The early mortality in the first group was 7% (6 out of 90), in the second group 64% (9 out of 14). With increasing experience, cardiopulmonary bypass has proven to be a save method for intracardiac correction of congenital heart anomalies in infancy even in the youngest age group under three months of age and under emergency conditions.


[Traumatic rupture of the descending aorta. A report of 21 operated cases (author's transl)].

From 1965 to December 1976, 21 traumatic ruptures of the descending thoracic aorta have been operated; the last 13 cases have been managed in 1975 and 1976. The lesions consisted in 15 recent ruptures (R.R.) and 6 chronic aneurysma (C.A.). Associated injuries were the rule and 6 patients underwent exploratory laparotomy prior to thoracotomy. Surgical repair was consistently due by use of an extracorporeal by-pass (20 times), and resulted in 12 end-to-end aortic sutures (11 R.R., 1 C.A.) and in 9 reconstruction by means of a tubular dacron graft (5 C.A., and 4 R.R.). 4 patients died. 16 of the 17 survivals are healthy and active. Paraplegia developed in one patient.


[Pulmonary hypertension and histological findings before and years after surgical treatment of congenital heart disease (author's transl)].

The coincidence of pulmonary hypertension and pulmonary vascular disease was investigated in 186 infants and children with congenital heart disease and left to right shunts. The correlation between pulmonary hypertension and pulmonary vasculopathy was highly significant. Hemodynamic pulmonary hypertension is completely suppressed by early pulmonary artery banding or total correction. Even pulmonary vascular alterations can be reversed by these measures.


[Combined application of magnesium-aspartate-cardioplegia and general hypothermia in aortic valve replacement (author's transl)].

The surgical results of two similar groups of patients are compared in whom aortic valve replacement was performed utilizing magnesium-aspartate-cardioplegia combined with mild (group A = 71 patients) and profound (group B = 69 patients) hypothermia, respectively. Mortality was 5.6% in group A and 4.3% in group B. Two deaths in group A were due to a severe low cardiac output syndrome, three patients required continuous inotropic circulatory support during the early postoperative course. There was no low cardiac output in group B, no patient required inotropic support. Profound body cooling (esophageal temperature 25 degrees C) and hypothermic injection cardioplegia with magnesium-aspartate provide efficient myocardial protection up to 60 minutes of anoxia.