Effect of variation in dietary NaCl intake on total and fractional renal blood flow in the normal and mercury-intoxicated rat.

We studied the effect of different chronic (3-4 weeks) dietary salt intakes on intrarenal hemodynamics of normal and mercury-intoxicated rats. Cardiac output (CO), total renal blood flow (RBF), and the zonal perfusion rate in the outer cortex (OC) and inner cortex (IC) were measured by the radioactive microsphere method. The distribution of cortical blood flow was calculated as the distribution index (DI), which reflects the ratio OC/IC. Rats were placed on a high salt diet (group I), intermediate salt diet (group II), or low salt diet (group III). For each group control rats (subgroup A) and mercury-intoxicated rats (subgroup B) were studied. No effect of the different salt intakes on the DI could be detected. The DI in group IA was 2.35 +/- 0.14; in IIA, 2.40 +/- 0.16; and in IIIA, 2.38 +/- 0.09 (P greater than 0.05). After mercury injection RBF changed from 5.32 +/- 0.36 ml/g.min(-1) (IIA) to 3.31 +/- 0.20 ml/g.min(-1), IIB and from 4.32 +/- 0.11ml/g.min(-1) (IIIA) to 1.98 +/- 0.10 ml/g.min(-1) (IIIB) P less than 0.01). The DI was lowered to 1.53 +/- 0.06 (IIB) (P less than 0.05) and to 1.16 +/- 0.10 (IIIB) (P less than 0.01). In both IIB and IIIB a marked elevation of the blood urea was noted (IIB = 97 +/- 9 MG/100 ML AND IIIB = 182 +/- 25 mg/100 ml). In group IB no effect on RBF, OC, IC, or DI could be observed (for all values, P greater than 0.05) despite similar histological renal lesions. Group IB rats also had normal blood urea levels (31 +/- 6 mg/100 ml;P greater than 0.05). We conclude (1) that variations in dietary salt intake appear to have no detectable effect on the intracortical blood flow distribution; and furthermore (2) that the mercury-induced acute renal failure (ARF) is characterized hemodynamically by a total renal and preferential outer cortical ischemia and that chronic salt loading prevents the ARF while preserving normal renal perfusion.


Effects of sodium pentobarbital anesthesia on left ventricular function and distribution of cardiac output in dogs, with particular reference to the mechanism for tachycardia.

Sodium pentobarbital (PB), 30 mg/kg, iv, was administered to 30 conscious dogs instrumented for measurement of cardiac output and regional blood flow distribution, left ventricular (LV) diameter, LV pressure, dP/dt, and dD/dt, i.e., velocity of myocardial fiber shortening. Ventilation was controlled during anesthesia to maintain arterial blood gases at control values for conscious dogs. The anesthetic produced an initial transient, peripheral vasodilation but the steady state effects 15-30 minutes later were characterized by slight reductions in mesenteric flow and cardiac output and increases in mesenteric and systemic resistances, whereas iliac and renal resistances were not significantly different from control. When heart rate rose, PB increased end-systolic diameter and decreased coronary resistance, LV end-diastolic diameter, dP/dt/P (42%), and shortening velocity (36%). When heart rate was controlled, PB still increased end-systolic diameter and decreased shortening velocity and dP/dt/P, as occurred during spontaneous rhythm, but end-diastolic diameter rose instead of falling and coronary resistance did not change. After recovery from bilateral cervical section of both carotid sinus and aortic nerves, PB failed to elicit tachycardia. Thus, PB affects systemic and regional hemodynamics only slightly, but depresses the myocardium markedly. The tachycardia associated with PB anesthesia in intact, trained dogs appears not to be only vagolytic, as previously thought, but is predominantly mediated through the arterial baroreceptor reflex.


Speech problems in a national survey: assessments and prevalences.

In this paper we present data on the prevalence of speech problems in a nationally representative group of children according to three modes of assessment. There was a large measure of disagreement between the assessments. Sex, social class, birth order and family size differences were examined. There was indirect evidence to suggest that the social class differences in the teacher's assessments of poor speech could be explained in terms of differences in children's dialect and language rather than a reflection of speech deficits. Finally we examined the relationship between parental assessment and the three modes of assessment. Overall, the degree of concurrence was low.


Bioassay in vivo for circulating vasoactive agents after renal artery constriction in dogs.

We used the gracilis muscle vascular bed to bioassay blood from the two renal veins, vena cava, and aorta continuously for the presence of vasoactive agents before and for 45 minutes after partial occlusion of the left renal artery in dogs. Compared to comparable blood samples from control dogs, left renal venous, vena caval, and aortic blood, but not right renal venous blood, from dogs with renal artery constriction developed vasoconstrictor activity. This was associated with increased renin concentration in plasma from the left renal vein and the vena cava and an increase in systemic arterial pressure. In dogs pretreated with indomethacin, blood from the right renal vein also showed vasoconstrictor activity. Pretreatment with antirenin serum abolished all of the differences between control and experimental dogs. These findings suggest that during acute unilateral renal artery constriction the constricted kidney releases renin and the contralateral kidney releases prostaglandins in sufficient quantity to produce systemic vascular effects.


beta-adrenergic blockade in essential hypertension: reduced renin release despite renal vasoconstriction.

The acute effects of small doses of intravenous propranolol on renin release and on circulatory dynamics were studied at the time of renal arteriography in 12 persons with essential hypertension. All of the subjects had a normal peripheral renin response to chronic sodium depletion and all had normal renal function. Seven subjects received a 10-mEq sodium diet. At the time of arteriography, arterial blood pressure, pulse rate, cardiac output, renal blood flow, and arterial and renal venous renin activity were measured before and 6-20 minutes after the intravenous administration of propranolol (9-18 mjg/kg). Average renin secretion rate in the salt-depleted subjects fell from 367 +/- 80 (SEM) U/ml per 100 g/min to 122 +/- 51 U/ml per 100 g (P=0.03) and renal plasma flow fell from 189 to 155 ml/min per 100 g (P = 0.018). We also found that in the salt-loaded subjects, renal plasma flow fell from 213 to 184 ml/min per 100 g (P = 0.025), whereas renin secretion did not change significantly in either group. We conclude that propranolol rapidly blocks renin release despite circulatory changes which ordinarily constitute a stimulus for renin secretion, i.e., renal vasoconstriction and reduced renal blood flow.


Gestational changes in pulmonary vascular responses in fetal lambs in utero.

Pulmonary arterial (PA) blood flow patterns, changes in pulmonary blood flow, and pulmonary vascular responses to graded hypoxemia and intravenous acetylcholine (ACh) were studied in 15 fetal lambs in utero 3-12 days after surgical implantation of an electromagnetic flow transducer and PA catheter. Phasic PA flow in the fetus was forward only during the first third of systole, almost zero during midsystole, and backward during late systole and early diastole. In contrast, neonatal lambs showed forward PA flow throughout systole. The constriction of the fetal pulmonary vasculature in response to progressive hypoxemia varied with gestational age. At 103 days there was no significant drop in PA flow and only a small increase in pulmonary vascular resistance (Rp) with hypoxemia. The greatest increase in Rp was seen in fetuses after 121 days of gestation. This response was unaffected by alpha- and beta-sympathetic and parasympathetic blockade. Similarly, the pulmonary vascular response to ACh injected into the fetal jugular vein depended on gestational age. Little or no increase in pulmonary flow was noted in the youngest fetus, whereas ACh produced a marked increase in pulmonary flow in festuses over 120 days of gestation. These data suggest that the mechanisms by which hypoxemia constricts and ACh relaxes the pulmonary vascular smooth muscle are not fully developed in fetal lambs at 100 days of gestation and furthermore, that these mechanisms progressively develop during the last third of gestation.


Lower limit of cerebral blood flow autoregulation in experimental renovascular hypertension in the baboon.

The effect of chronic renovascular hypertension on the autoregulation of cerebral blood flow was studied in anesthetized baboons. Cerebral blood flow was measured by the intracarotid 133Xe clearance method. Six baboons with renal hypertension of 8-12 weeks' duration were compared with six normotensive controls. The lower limit of autoregulation was determined following controlled hemorrhage. In the initially normotensive baboons, cerebral blood flow remained constant until mean arterial pressure had decreased to the range of 45-59 mm Hg. Thereafter, cerebral blood flow decreased with each further decrease in mean arterial pressure. In the chronically hypertensive baboons cerebral blood flow autoregulated until the mean arterial pressure had decreased to the range of 75-89 mm Hg. Therefore, the lower limit of autoregulation of cerebral blood flow was shifted to higher absolute levels of mean arterial pressure in baboons with chronic renovascular hypertension presumably due to adaptive changes in the cerebral circulation.


The response of canine coronary vascular resistance to local alterations in coronary arterial P CO2.

The effect of hypercapnia on coronary vascular resistance (CVR) was studied in seven open-chest dogs. Coronary blood flow was supplied to the cannulated left main coronary artery from the femoral artery by a precision pump. Coronary arterial PCO2 was locally controlled with a small membrane oxygenator in the coronary perfusion circuit. Each PCO2 change was made at a constant coronary flow, and CVR was calculated from the ratio of perfusion pressure to flow. Coronary sinus (CS) PCO2 and PO2 were recorded continuously from blood withdrawn through a CS catheter. Normocapnia (PCO2 = 42.3 +/- 2.8 mm Hg) was obtained with a membrane oxygenator gas composition of 95% O2-5% CO2, and hypocapnia was produced with 100% O2-0% CO2. In addition to physiology normal coronary flow (determined by a CS PO2 of 20-30 mm Hg) relatively high and low flow states were studied. At a normal control CS PO2, a decrease in coronary arterial PCO2 from 42.3 +/- 2.8 to 23.8 +/- 1.3 mm Hg caused CVR to increase by 84.2%, from 1.27 +/- 0.06 to 2.30 +/- 0.04 units. Since pH was inversely related to PCO2, the effect on CVR may have been mediated through a pH change. CS PCO2 decreased from 65.2 +/- 1.9 to 39.4 +/- 1.3 mm Hg. myocardial oxygen consumption was unchanged. Increases in CVR of 74.5, 119.5, and 69.3% occurred during hypocapnia in three additional experiments in which control arterial PO2 was maintained at 52-90 mm Hg. When CS PO2 was greater than 30 mm Hg, the normocapnic CVR was high, and was only minimally increased by hypocapnia. When coronary flow was reduced to an ischemic level there was little response in CVR to hypocapnia. Thus the level of arterial PCO2 can have an important effect on CVR independent of changes in O2 consumption. Myocardial PCO2, derived from metabolically produced CO2 and contributed to by arterial CO2, may be a major factor in normal control of coronary flow.


The effect of prostaglandin A1 on renin and aldosterone in man.

Blood pressure, pulse rate, plasma aldosterone (PA), renin, and cortisol were monitored during graded intravenous infusions of prostaglandin At (PGA)1), 0.075-0.6 mug/kg min-1, alone and superimposed on angiotensin II (A II) administration in five normal men. The infusions of PGA1 did not affect blood pressure, but did progressively increase the pulse rate up to 15.2 +/- 2.0 (SEM- beats/min at the highest prostaglandin dose (0.6 mug/kg min-1). Both PA and plasma renin activity (PRA) increased in a dose-related fashion in response to the prostaglandin infusions. Aldosterone increased from a control of 4.8 +/- 0.4 to 20.7 +/- 1.2 ng and PRA increased from 0.9 +/- 0.1 to 5.4 +/- 0.4 ng/ml hr-1 at the dose of 0.6 mug/kg min-1. The correlation between the aldosterone and renin values was r = 0.85 P less than 0.001. In separate experiments, acute volume expansion with 2 liters of saline did not affect the increase in renin activity induced by exogenous prostaglandin. A II (5 ng/kg min-1) increased aldosterone and blood pressure and decreased the pulse rate. The hemodynamic effects were progressively reversed by the superimposed prostaglandin infusions, but the observed changes in renin and aldosterone concentrations were not further altered. The PA response to A II infusions was not influenced by indomethacin pretreatment. Prostaglandin A (infusion) appears to have a direct effect on renin release in man.


Morphology and relationship to extensibility curves of human mitral valve chordae tendineae.

Human mitral valve chordae tendineae in which elastic response curves are nonlinear have also been found to exhibit extensibility that increases with chordal size and decreases with chordal age. We used selective enzymatic digestion and scanning transmission electron microscopy to explain these observations. Removal of the outer elastin sheath by enzymatic digestion did not significantly affect the elastic response of this tissue. Scanning electron microscopy revealed that the collagen fibers in the central core of young chordae exhibited a very wavy pattern but the pattern in adult specimens was relatively straight. The increased waviness accounted for the greater extensibility of the young specimens. The collagen fibers from young and old chordae consisted of a network of collagen fibrils that became more collapsed when the tissue was fixed under tension. This network arrangement of the fibrils explains the nonlinearity in the elastic response of the tissue. Transmission electron micrographs showed that the density of collagen fibrils decreased as chordal size increased. The number of fibrils per 10(-8) cm2 of the central core decreased from 182.4 (SE = 1.3) to 131.3 (SE = 1.6) as average chordal cross-sectional area increased from 0.0016 cm2 to 0.0268 cm2. This difference in fibril density provides an explanation for the greater extensibility shown by the thicker chordae. The collagen fibril diameters ranged from 516 A to 552 A.


Echocardiographic detection of intracardiac right-to-left shunts following peripheral vein injections.

A contrast echocardiographic technique using peripheral vein injections for the detection and localization of intracardiac right-to-left shunting is described. Fifty children underwent cardiac catheterization and peripheral contrast echocardiographic studies. The site, degree, and direction of shunting were established at catheterization by oximetry, indicator dilution analysis and/or angiography. Peripheral vein injections were performed from the right antecubital vein or the right saphenous vein. Right-to-left shunts were documented at catheterization in 27/50 patients; contrast echocardiographic studies indicated the presence and level of shunting in all 27 patients. The contrast echocardiographic technique using peripheral vein injections detects and localizes right-to-left intracardiac shunting. It is a safe and sensitive method to evaluate systemic desaturation in ambulatory and postoperative patients.


Echocardiographic features of congenital left ventricular inflow obstruction.

The echocardiographic features of congenital left ventricular inflow obstruction are described in six patients. The echocardiograms in two patients with cor triatriatum were distinguished by normal mitral valve motion and an abnormal echo within the left atrium. In two patients with supravalvar mitral ring, in addition to abnormal mitral valve motion, an abnormal echo, presumably originating from the obstructive membrane, was located between the anterior and posterior mitral leaflets. In two cases of parachute mitral valve, mitral valve motion was abnormal. In one of these cases there were multiple mitral valve echoes similar to those found in supravalvar mitral ring. The echocardiographic identification of an obstructive membrane within the left atrium is difficult because of the occurrence of artifacts. However, membranes may be identified if careful scanning techniques are employed in patients in whom left ventricular inflow obstruction is suspected. The echocardiogram is useful in detecting mitral valve abnormalities in these patients and is valuable in cases where mitral valve replacement is contemplated.


Multiple accessory pathways in patients with the pre-excitation syndrome.

We have studied 135 patients with the pre-excitation syndrome and have demonstrated evidence of multiple accessory pathways in 20 patients. Five patients had two distinct accessory atrioventricular (A-V) connections, associated with enhanced A-V node conduction in one patient. Twelve patients had a single accessory A-V connection associated with enhanced A-V conduction. In one of these there was an additional fasciculo-ventricular connection. One patient had an accessory A-V connection associated with a nodoventricular bundle. Two patients had fasciculo-ventricular connections combined with enhanced A-V conduction. The latter two patients had electrocardiograms suggestive of a complete accessory A-V connection. Patients with enhanced A-V conduction had shorter cycle lengths during reciprocating tachycardia, primarily because of a short A-H during the dysrhythmia, than those without such conduction. In addition, patients with enhanced A-V conduction demonstrated more rapid conduction from atrium to His bundle during induced atrial fibrillation and two developed life-threatening ventricular responses during atrial fibrillation. A nodo-ventricular pathway was documented to participate in reciprocating tachycardia in one patient. Surgery was undertaken in 13 patients. In 11, the intraoperative mapping studies confirmed the preoperative predictions. In two patients, the presence of a second accessory A-V connection was documented after ablation of one.


Use of changes in the epicardial QRS complex to assess interventions which modify the extent of myocardial necrosis following coronary artery occlusion.

The goal of this study was to determine if changes in the epicardial QRS complex after coronary artery occlusion (CAO) can be used to evaluate the efficacy of interventions designed to limit infarct size. Forty-one open-chest dogs with CAO were studied: 15 were controls, 18 received hyaluronidase and eight received propranolol starting 20 minutes after CAO. Epicardial ECGs were recorded at specific time intervals to analyze ST-segment elevation and changes in Q and R waves. Transmural specimens were obtained 24 hours after CAO from the same sites at which ECGs were recorded. Q wave development (deltaQ), R wave fall (deltaR), and their combination (deltaR + deltaQ) at 24 hours correlated with the extent of necrosis, as determined by myocardial creatine phosphokinase activity depression and histologic appearance. In the control group ST-segment elevation 15 minutes after CAO (ST15M) predicted changes in Q and R waves 24 hours later; in the treated groups, the same ST15M prior to drug administration resulted in significantly less QRS changes. Thus, 1) Q wave development and R wave fall 24 hours after CAO accurately reflect myocardial necrosis. 2) ST15M predicts subsequent changes in Q and R waves. 3) The efficacy of hyaluronidase and propranolol, agents previously shown to reduce myocardial necrosis, can be detected by less Q wave development and a smaller fall in R wave voltage.


The protective effect of hyperosmotic mannitol in myocardial ischemia and necrosis.

Morphologic and hemodynamic changes that occur following coronary occlusion are examined. The effectiveness of hyperosmotic mannitol in lessening the extent of myocardial damage is assessed and mechanisms for its action discussed. Forty and 60 min of coronary vascular occlusion followed by 15 and 45 min of reflow were associated with a persistence of ischemia following reflow of blood, as established by infusions of silastic into the aortic root. Electron microscopic studies demonstrated myocardial and endothelial cell swelling at the end of the reflow period. The process of cell swelling appeared to be initiated during the period of arterial occlusion. This cell swelling was reduced by elevation of serum osmolality by 30-40 mOsm above control with the administration of mannitol during and following occlusion. There was an associated 40-50% reduction of vascular resistance following occlusion if mannitol was administered. In addition, the extent of necrosis, which was widespread in untreated hearts 12 hours after occlusion, was strikingly less in the hearts of dogs which received mannitol. Thus, in ischemic myocardium, elevation of osmolality by mannitol reduces myocardial necrosis, probably through its restoration of normal cell volume.


Regional contractility. Selective depression of ischemic myocardium by verapamil.

The effects of verapamil (0.02-0.2 mg/kg) on contractility in normal and partially ischemic myocardium were compared with the changes following propranolol (0.01-1.0 mg/kg). Regional contractile function was studied in open-chest dogs with ultrasonic crystals and ischemia was controlled by graded occlusion of a carotid-to-coronary artery shunt. Reduction in shunt perfusion pressure (40-55 mm Hg) resulted in hypokinesia. Verapamil depressed contractility in ischemic myocardium in 5/5 dogs, but did not alter the maximum velocity of shortening (max V) or end-diastolic segment length in normal myocardium. Propranolol in doses sufficient to depress ischemic myocardium also depressed contractile function in normal myocardium. In two dogs without coronary occlusion, verapamil (up to 1.0 mg/kg) increased end-diastolic segment length but did not reduce max V. We conclude that verapamil selectively depresses ischemic myocardium, a finding that may have clinical implication since ischemic injury can be decreased by reducing contractility (and thereby MVO2).


Stress testing with ST-segment depression at rest. An angiographic correlation.

Near maximal graded exercise tests and coronary angiograms were compared in 37 patients with a history of chest pain and with ST segment depression at rest, who were free of obvious nonischemic causes of ST depression. Additional ST depression of 0.1 mV or more occurred with exercise in 26 patients and 23 of these had obstruction of one or more coronary arteries (sensitivity = 0.92). Eleven patients showed no additional ST-segment depression with exercise, and nine of these had normal coronary angiograms (specificity = 0.75). Patients with no increase in ST depression on exercise developed the highest heart rates; those with asymptomatic additional ST depression achieved intermediate rates; and those with anginal attacks during testing demonstrated the least heart rate acceleration. Those with less coronary obstruction exercised longer on the treadmill than those with more obstruction. Those showing added ST depression were predominantly men (18 of 26) and were older (mean 54 years) than those who did not (mean 44 years). No test complications were encountered. This study suggests that safe and effective stress testing may be accomplished not only in persons with normal resting ECGs but also in selected patients who have abnormal ST segments at rest.


Limitations of thallium-201 myocardial perfusion scintigrams.

The reliability of myocardial perfusion scintigrams with thallium-201 (201Tl) for detecting areas of hypoperfusion was assessed in 16 closed-chest dogs. Variable areas of ischemia were produced either by occluding or stenosing the left anterior descending coronary artery. Cardiac scintigrams taken in four projections were compared with regional myocardial perfusion maps. Segmental concentrations and segmental perfusions were quantitated by counting the emissions from 201Tl and the microspheres in each of 96 segments of the left ventricle. In addition, studies with a phantom were performed. The results indicate: 1) The emissions from 201Tl and from microspheres correlated well in ischemic segments (r = 0.93 +/- SE 0.02). 2) Seven of twelve ischemic hearts had definitely abnormal scintigrams and in each of these the hypoperfused zone was greater than 4.9 grams and perfusion was decreased by more than 45%. 3) In the phantom, abnormal scintigrams could be detected in the presence of lesser deficits than in the dogs. The limitation of the thallium perfusion scintigrams will be the inconsistent detection of small perfusion deficits.


Effect of coronary thrombus age on fibrinogen uptake.

A study was carried out to define the time limits during which an experimental coronary thrombus remains capable of incorporating fibrinogen. 131I-fibrinogen was given to intact anesthetized dogs at different time intervals, up to 67 hours, following the formation of a coronary thrombus by catheter-electrode. Radioactivity of the recovered thrombi as a whole and segmentally divided, was determined following variable time intervals of exposure to circulating fibrinogen and was expressed as thrombus/blood ratio. The results indicate that coronary thrombi formed in a normal coronary vessel remain capable of incorporating fibrinogen for at least eighteen hours, with no significant differences in the segmental distribution of radioactivity. These findings do not support the view that the recovery of isotopic fibrinogen, which was given after the onset of coronary symptoms, in thrombi from patients with myocardial infarction establishes that the thrombus was initiated after the ischemic process.


Continuous murmur following Mustard operation for transposition of the great arteries. A sign of pulmonary venous obstruction.

Three patients developed severe pulmonary venous obstruction following Mustard operation for transposition of the great arteries. Each patient had a soft continuous murmur with distinct diastolic accentuation at the low left sternal border or xiphoid area. Simultaneous recording of intracardiac sound and pressure in one patient showed that the murmur originated at the site of obstruction in the surgically-constructed pulmonary venous atrium. Selective cineangiograms demonstrated the baffle to be the cause of the obstruction. A continuous murmur in a patient following Mustard operation may suggest significant pulmonary venous obstruction.


De subitaneis mortibus. XX. Cardiac electrical instability in the presence of a left superior vena cava.

Abnormalities of cardiac rhythm have been reported by others in patients with a persistent left superior vena cava. We present the histological findings from postmortem examination of the cardiac conduction system of two such patients. The first patient was a schoolboy who died suddenly and unexpectedly. His sinus node was abnormally small, his A-V node contained numerous venous lacunae and was stretched out beneath the enlarged coronary sinus, both A-V node and His bundle were dispersed in the central fibrous body in a fetal pattern, and isolated fragments of A-V nodal tissue were connected to the myocardium at the crest of the interventricular septum. The second patient complained of palpitations many months prior to surgical correction of an interventricular septal defect; his postoperative course included multiple arrhythmias and he died suddenly on the 16th postoperative day. Although his sinus node was histologically normal, the nutrient artery contained a polypoid fibromuscular  mass virtually occluding its lumen; his A-V node and His bundle were also dispersed in the central fibrous body in the fetal pattern, and the A-V node contained numerous venous lacunae as well as being histologically disorganized in its cytological pattern. These anatomical findings may indicate a basis for various forms of cardiac electrical instability, and deserve consideration in the future evaluation of any patient found to have a persistent left superior vene cava, but particularly if there is clinical evidence suggesting an arrhythmia or conduction disturbance.


Predisposing factors and the development of reaginic allergy in infancy.

In a prospective study of fifty-eight newborn infants of parents with reaginic allergy, twenty-seven developed eczema and twenty-eight positive prick tests to one or more of six antigens during the first year of life. These reaginic manifestations were related to presymptomatic transient IgA deficiency. The development of positive skin tests was also related to HLA A1 B8, and to season of birth. The order of frequency of positivity was Dermatophagoides, grass pollens, cat fur, feathers and cow's milk. The skin tests were often positive in infants in whom serum IgE was not detected. The eczema disappeared and the skin tests became negative in some infants at the end of the first year. This work suggests that sensitization in the new-born period is important in the subsequent development of disease.


Immunological development in infants of allergic parents.

Serum immunoglobulins were determined every 4 months from cord blood to age 2 years in ninety-two infants of allergic parents. By 7 months of age, the concentration of IgA was significantly greater in infants who developed atopic dermatitis than those who did not. The IgA was also significantly greater than in matched non-allergic controls. The difference continued to the end of the 2-year study. No significant difference was found in the three groups for levels of IgG and IgM. These findings differ from the results of a previous report and possible explanations are presented.


Asthma and wheezy bronchitis in children. Skin test reactivity in cases, their parents and siblings. A controlled population study of sex differences.

Twice as many boys as girls are prone to wheeze (15-3% compared with 7%). This study examines the possible immunological basis for this phenomenon. There were 1064 children in this survey. The family of each wheezy child was indexed, and a control sample of families was selected. At least 85% of the study population were skin tested for Type 1 allergic reactions. An interval survey of values for FEV1, FVC and PEFR against height was completed. Of 118 wheezy subjects there were 83/542 boys and 35/522 girls. Single and multiple sensitivity, the capacity to react to two or more major allergens, is examined. Of the child asthmatics, significant differences from controls emerge for pollens, foods and the house dust mite. These differences are borne out with multiple sensitivity. (P greater than 0-001.) Of the brothers and sisters of asthmatics, only the sisters show differences from controls. This is true for grass pollen, cow's milk and the house dust mite, and also to a highly significant degree for multiple sensitivity (P greater than 0-001). When the incidence of multiple sensitivity is expressed for all children in the asthma group, that is, cases and their siblings, the sex difference is not demonstrable. The mothers (P greater than 0-05) and fathers (P greater than 0-01), of asthmatics also differ from control parents in respect of skin sensitivity. If multiple sensitivity is equated with atopy, it may not be the main determination of the capacity to wheeze, and thus of the sex difference. The mean curve for interval PEFR for asthmatic children was significantly lower than that of control children and of the brothers and sisters of asthmatics.


Demonstration of reaginic antibodies on human basophils by immune adherence to allergen-coated Sepharose beads.

Human basophils purified by gradient density centrifugation and differential glass bead adherence were interacted with grass pollen allergen in particulate form prepared by covalent coupling of Dactylis glomerata protein concentrate to Sepharose beads. Basophils from allergic subjects were found to interact specifically with the allergen-coated bead surface in a manner so highly characteristic that false negatives with basophils from non-allergic subjects or subjects with unrelated allergies were not encountered. Microscopic examination indicated that the specifically stained malleable basophils had adapted in a multi-point attachment to the rigid bead surface by becoming one-sidedly flattened against it. When using basophils from highly pollen sensitive subjects all the beads carried basophils and sometimes as many as thirty per bead. The percentage of beads with basophils and the number of basophils per bead roughly correlated with clinical history and skin tests. Immunocytoadherence of the basophils to the allergen-coated beads was specifically inhibited by anti-IgE and anti-allergen antibodies, including reagins.


Intranasal steroid aerosol in perennial rhinitis: comparison with an antihistamine compound.

Intranasal betamethasone valerate aerosol, given for 28 days, was compared with an oral antihistamine compound in a couble-blind, double-dummy, cross-over trial involving thirty patients with perennial rhinitis. The steroid aerosol was more effective in reducing symptoms and was preferred by the patients (P less than 0-01). Nasal blockage index, calculated from oral and nasal peak expiratory flow measurements, did not provide useful or additional information. There were no side effects from the steroid and Candida albicans was not cultured from nasal swabs. It is concluded that beta-methasone valerate aerosol is a suitable short-term alternative for patients whose perennial rhinitis fails to respond to conventional therapy.


The relationship between bronchial histamine reactivity and atopic status.

It has been proposed that increased production of IgE, a feature of atopy, is a cause of the non-specific bronchial hyper-reactivity that is characterisitc of asthma. This hypothesis was examined by selecting groups of subjects with asthma or rhinitis and a group of healthy control subjects and studying the relationship between their bronchial histamine reactivity and their atopic status. In none of the groups tested was there a significant association between the degree of bronchial histamine reactivity and either the serum level of total IgE or the number of extracts of aeroallergens giving positive prick test reactions.


Qualitative and quantitative comparison of pollen calendars for plain and mountain areas.

A comparison of the quantity and the quality of pollen content in the atmosphere of two regions, one of the plains bordering the Mediterranean sea (altitude 40 m), the other of the mountains of the Pyrenees (altitude 1550 m), was made during the climatological year 1974-1975. The method which was used intercepts the pollen flux of the atmosphere with a vertical filtering unit, which is exposed facing the direction of wind on the filtering door of the weather-vane and collects much larger quantities of pollen than the other techniques of collection. The atmospheric currents displace from one region to another numerous spores and pollens, the trajectories of which are directly influenced by the general circulation of the atmosphere. The density of these fluxes can be very large, reaching 2500 grains/m3 of air at M.T.P.R. in the last week of January; the taxons collected are very numerous (more than 700). The atmospheric transfer of pollen modifies largely the pollen content of the atmosphere of different flowering domains. These interferences manifest themselves in the simplest cases by the presence of two peaks of concentration, the principal corresponding to the local efflorescence, the second to the pollen transferred from other regions. The pollen concentrations in the mountains are one-third of those in the plains. Pollination in the mountains is several weeks late in comparison to the plain during the first semester, whereas during the second semester, it is the plains that show a certain delay. These findings show why some allergic patients who go to the mountains during summer are affected twice by pollination.


Identification of allergen-specific IgE antibodies in the sera of African asthmatics.

Of eighty African asthmatics, sixty-three had significant levels of specific IgE against the house dust mite dermatophagoides pteronyssinus. By contrast, grass-specific IgE was found in six patients and mould-specific IgE in none. Sixty-three patients also had symptoms predominantly during the rainy season. Positive skin tests against D. pteronyssinus correlated well with the presence of mite-specific IgE, as did the size of these skin test weals with the amount of specific IgE. For grass pollen and moulds there was no such relationship. There was no correlation between a history of sensitivity to house dust and either skin tests or specific IgE against D. pteronyssinus. The results support previous findings that it is allergy to house dust mite and not to grass pollens or moulds which is important in producing the seasonal symptoms in our patients.


Preanesthetic care. Intoxication and trauma.

On the basis of the above discussion, a number of useful guidelines appear for the anesthetic management of alcohol and drug abusers. 1. Because of the decreased ability of intoxicated patients to withstand hemorrhage, blood replacement therapy should probably be instituted earlier than in the nonintoxicated patient. 2. Because the chronic alcoholic may actually be iso-osmotically overhydrated, fluid therapy must be planned with care. 3. Because of the tendency to hypoglycemia, glucose should be added to the fluid management regimen. 4. Because of the enzyme induction effect of chronic ETOH ingestion, anesthetic agents that are in part metabolized (methoxyflurane, halothane, fluroxene) are perhaps best avoided. Increased ability to metabolize anesthetic agents appears to be associated with toxicity. 5. Because ETOH is a CNS depressant and has been shown to have amnesia-inducing properties, supplementation of nitrous oxide-relaxant technique with narcotics or other depressant drugs should be reduced, if not eliminated. 6. Because acutely intoxicated individuals are more prone to hypothermia, their core temperature should be monitored intraoperatively. All intravenous fluids should be warmed and a warming blanket should be employed, if necessary, to maintain body temperature. 7. Because of the sympathomimetic effect of many of the drugs, pulse and blood pressure can be misleading in the assessment of blood loss.


Transportation and emergency care. Emergency assessment and management.

An organized approach for the management of the multiply injured patient has been presented. Adequate equipment and ancillary facilities support patient care. The principles of airway management, treatment of shock, and specific organ injuries have been described. More than one surgical discipline may work on a patient simultaneously; however, one physician, preferably the trauma surgeon or general surgeon, is in charge and coordinates the consultative care.


Postanesthetic care. Respiratory care.

Careful management of all severely patients, traumatized particularly those undergoing general anesthesia and surgery, is essential to prevent the development of serious pulmonary problems in the postoperative period. In addition to insuring adequate oxygenation, humidification, and analgesia, particular attention should be paid to careful monitoring of volume therapy, efficient filtration of banked blood, and the prevention of aspiration.


The interactions between iophenoxic acid, iopanoic acid, bilirubin and human serum albumin as studied by fluorescence and Sephadex gel filtration.

Iophenoxic acid increases the fluorescence of bilirubin bound to human serum albumin at drug/albumin molar ratios lower than 1, while iopanoic acid decreases it. The fluorescence enhancement results probably from a change in the fluorescence efficiency due to an iophenoxic acid-induced conformational change in the albumin, which in turn causes displacement of bilirubin from the protein. Iophenoxic acid does not affect the high-affinity bilirubin binding site of albumin. Therefore any enhancement in bilirubin fluorescence caused by the drug indicates that bilirubin is bound to the low-affinity binding sites of albumin. The use of iophenoxic acid in the determination of the extent of saturation of the high-affinity bilirubin binding site of albumin may be of value in the clinical management of infants with neonatal jaundice.


Mammalian acetoacetate decarboxylase activity. Its distribution in subfractions of human albumin and occurrence in various tissues of the rat.

In this article further information is presented about the characteristics of the mammalian enzyme acetoacetate decarboxylase (acetoacetate carboxylase, EC 4.1.1.4). The Michaelis-Menten plot shows a sigmoidal relationship between the enzyme activity (v) and the substrate concentration (s) indicating an allosteric hindrance. Because of this, the KM value can only be predicted to be equal to or less than 1 X 10(-1) M. Cysteine and glutathione, although activating the spontaneous decarboxylation, have no effect upon the enzyme activity. From experiments with human albumin by means of gel filtration with Sephadex G-200, it can be concluded that the acetoacetate decarboxylase activity does not depend upon the degree of polymerisation of albumin. From experiments performed by means of ion exchange chromatography the enzyme activity may be localized in the non-mercaptalbumin fraction. Investigation of enzyme activity in homogenates of various rat tissues, as well as in their respective subfractions, reveals that: (1) the specific activity of brain tissue exceeds those of liver and kidney and (2) most of the activity in liver tissue is localized in the 20 000 X g supernatant, containing the endoplasmatic reticulum, the ribosomes and the soluble part of the cytoplasm, while in brain tissue a high activity is found in the nuclei fraction.


Determination of serum triglycerides by mass fragmentography.

A mass fragmentographic reference method for determination of serum triglycerides is described. A fixed amount of a mixture of [1,1,2,3,3-2H5]glycerol tripalmitate and [1,1,2,3,3-2H5]glycerol trioleate (500 nmol) is added to a fixed amount of serum (250 mul) and extracted with chloroform/methanol (2 : 1, v/v). The triglycerides are isolated by means of thin-layer chromatography. The glycerol obtained after acid hydrolysis is converted into the tri-trimethylsilyl derivative and the amount of unlabeled glycerol is determined from the ratio between the recordings at m/e 218 m/e 222, obtained after analysis with a gas chromatograph-mass spectrometer equipped with an MID (multiple ion detector). The two ions correspond to the peak at M--90 and M--91 in the mass spectrum of the tri-trimethylsilyl derivative of unlabeled and (1,1,2,3,3-2H5)-labeled glycerol. The relative standard deviation of the method in the range 0.4--5.8 mmol/l was 2.4%. A fully enzymatic routine method for determination triglycerides was compared with the mass fragmentographic reference method. There was a good correlation between the two methods (r = 0.995) and the regression coefficient was 1.19.


The relationship between serum carnitine levels and the nutritional status of patients with schistosomiasis.

Serum carnitine levels were investigated in a group of normal adults and two groups of patients with active schistosomiasis who also showed signs of malnutrition and vitamin deficiency. The first group consisted of 16 patients with Schistosoma mansoni and/or Schistosoma haematobium infection. They received an adequate diet supplemented with vitamin and iron therapy and received no treatment for their parasitic infection till their hemoglobin levels were restored to normal. The second group consisted of 12 patients with schistosomiasis as well as intestinal polyposis. They received the same diet as the first group but because of their poor condition were immediately treated for parasitic infection. Results showed that both groups of patients had subnormal levels of serum carnitine with the polyps patients (Group II) having a significantly lower level than patients with simple schistosomiasis (Group I). After nutritional repletion a significant increase was observed in the carnitine levels of most patients in group I indicating a relationship between the nutritional status of the patients and their serum carnitine levels. The patients with polyps also showed considerably increased carnitine levels after treatment and dietary repletion. The usefulness of serum carnitine measurement as an index of protein malnutrition in man is discussed.


Lysosomal enzymes in cerebral atrophy.

In seven patients with cerebral atrophy due to pre-senile dementia and/or cerebrovascular disease, the activity of acid phosphatase in lumbar cerebrospinal fluid (CSF) was higher (p less than 0.05) than in six controls. The activity of arylsulphatase and beta-galactosidase in CSF was the same in the two groups. In the serum, the activities of acid phosphatase and arylsulphatase were the same in the two groups but the activity of beta-galactosidase was lower (p less than 0.02) in patients with cerebral atrophy.


A method for the statistical evaluation of results in external quality control surveys.

A method for the evaluation of results in external quality control surveys is developed on purely statistical grounds. This system allows to establish accuracy and precision of assay methods by comparing statistical data from subsequent surveys. However, for a particular survey the overall accuracy, precision and quality of each laboratory are defined in statistical terms and visually displayed. Results for each laboratory are summarized on a two-page computer printout. Per component assayed and combining all components determined in the particular survey, the laboratory is assigned one of the four possible qualifications i.e. "very good", "moderate" or "bad". A few general conclusions drawn from experimental data of previous surveys are reported.


Automated determination of the antitrypsin activity of serum.

An automated determination of the serum antitrypsin activity is described in which all reaction parameters have been optimized. The determination is carried out by measuring the difference between the activity of a standard amount of trypsin with and without addition of serum. Trypsin activity is measured using N-alpha-benzoyl-L-arginine-p-nitroanilide as a substrate. The assay is performed by means of an automatic enzyme reaction rate analyser the Vitatron AKES. The antitrypsin activity is expressed in Inhibitor Units making standardization of the trypsin preparation superfluous. Normal values of the antitrypsin activity for some of the most frequently occurring genetic variants of alpha1-antitrypsin are given.


An active site peptide from human placental alkaline phosphatase.

A preparation of human placental alkaline phosphatase was labelled covalently at the active site with [32P]orthophosphate. Treatment with trypsin gave essentially one radioactive peptide, the active site peptide, of approximately 2300 molecular weight. Dansylation of the peptide showed that the amino-terminal residue was glycine. After acid hydrolysis the only radioactively-labelled amino acid present was serine phosphate. The amino acid composition was similar to those compositions reported for active site peptides from other alkaline phosphatases.


The determination of progesterone receptors in breast cancer and their relationship to estrogen receptors.

A simple method for the assay of specific progesterone receptors in breast cancer tissue is described. Progesterone receptors were detected in 63 of 74 breast cancer specimens (85%). Estrogen receptor positive tumors had a wide range of progesterone receptor concentrations, but in 77% of cases the level was above 3 fmol/mg protein. The progesterone receptor level was generally low in tumors lacking estrogen receptors, 75% of the samples having concentrations between 0 and 3 fmol/mg protein. Unlike estrogen receptors, age had no influence on the number of progesterone receptors in breast cancer tissue.


Oxalic acid determination in plasma.

A method is described for the estimation of oxalic acid in plasma. After removing interfering substances with an ion-exchange resin, oxalic acid is reduced to glycolic acid, which forms a coloured compound with chromotropic acid. No special equipment is required. A good recovery and precision are found.


Effect of riboflavin treatment on human red cell pyruvate kinase deficiency.

The effect of riboflavin on six patients with hemolytic anemia due to hereditary pyruvate kinase deficiency was studied. Treatment over a period of four to six months produced no significant hematologic or enzymologic changes in the variants investigated.


Excretion of neuraminic acid-containing trisaccharides in the urine during pregnancy.

The excretion of neuraminic acid-containing trisaccharides in the urine during the course of normal pregnancy was studied. Neuraminyl-lactose and neuraminyl-galactosyl-(l led to 4)-N-acetylglucosamine were identified, and their excretion patterns were analyzed by thin-layer and gas chromatography. A progressive increase in the outputs of these acidic oligosaccharides was observed during the course of pregnancy in all cases studied. Neuraminyl-lactose excretion increased threefold, from 13.7 +/- 1.75 to 37.1 +/- 2.56 mg/24 h, and neuraminyl-galactosyl-N-acetylglucosamine twofold, from 8.4 +/- 1.27 to 15.3 +/- 2.21 mg/24 h (Mean +/- S.E.).


3-Hydroxy-3-methylglutaric aciduria: deficiency of 3-hydroxy-3-methylglutaryl coenzyme A lyase.

A marked deficiency of 3-hydroxy-3-methylglutaryl coenzyme A lyase activity is present in cultured skin fibroblasts from a baby with 3-hydroxy-3-methylglutaric aciduria.


A screening test for patients suspected of having Turner syndrome.

An index has been devised using dermatoglyphics and selected physical traits to screen  for patients suspected of having Turner syndrome. About 60% of females with and without Turner syndrome can be diagnosed as having or not having the syndrome with a 98% or greater probability. The patient's score on the index, expressed in probability, can be used to decide whether chromosome studies should be done. Using the approach demonstrated in this pilot study, the discriminative power can be increased by adding more features and by enlarging the sample to permit division of features into more discriminating classes.


Origin of the extra chromosome in trisomy 16.

Chromosome analysis was carried out on 22 spontaneous abortuses with trisomy 16 and their parents by means of sequential Q- and C-banding techniques. In seven cases, the extra chromosome No. 16 originated from a non-disjunctional error in the first meiotic division in the mother, and in two cases from an error in the first meiotic division in the father. In two cases, non-disjunction had occurred during the second meiotic division (one in the mother and one in the father). It seems that trisomy 16, although independent of maternal age, most frequently results from a first meiotic non-disjunction in the mother.


Genetic risks in Perthes' disease.

A population study of Perthes' disease in South Wales over a 25-year period has shown a low risk of the disorder in relatives. The risk of Perthes' disease in sibs is under 1% (2 in 323), while the risk to children of an children of an affected parent is about 3% (1 in 35) when adjusted for age of onset. No increased risk was found in relatives of patients with bilateral as compared with unilateral Perthes' disease. A mating between two affected individuals resulted in monozygotic twins concordant for Perthes' disease, but no familial concentration to suggest the action of a single major gene was found. The importance of excluding generalised disorders which may mimic Perthes' disease and may show Mendelian inheritance is emphasised, but it is concluded that true Perthes' disease has a relatively minor genetic component.


Cultured fucosidosis fibroblasts: a simple technique demonstrating storage of tritiated-fucose labeled material.

Incorporation of tritiated fucose into the acid-soluble and acid-insoluble fractions of cultured fucosidosis and control fibroblast monolayers was determined over a 10-day period. Fucosidosis cells incorporated significantly more label into the acid-soluble, but not the acid-insoluble fraction, than control cells. The ratio of acid-insoluble radioactivity increased lineraly from 1 to 10 days for the fucosidosis cells, indicating the storage of low molecular weight partial degradation products.


Surface receptors on human haematopoietic cell lines.

The expression of complement receptors, of Fc receptors, of SRBC receptors and of S-Ig was investigated on human haematopoietic cell lines of proved malignant derivation. According to their origin and to a panel of phenotypic markers these lines have been classified into lymphoma lines, myeloma lines and leukemia lines. Results were compared with those obtained on non-malignant EBV carrying lymphoblastoid cell lines (LCL). Among the lymphoid cell lines the LCL showed a pattern of B-lymphocyte surface markers, i.e. surface immunoglobulins, C3 receptors but low density of Fc receptors. The non-Burkitt lymphoma lines bore in varying degree these B-lymphocyte markers. The lines U-698 M and DG-75 were exceptional in having only surface immunoglobulin. The Burkitt lymphoma lines had all B-lymphocyte markers. The myeloma lines differed from the lymphoid lines in lacking C3 and Fc receptors and showed only trace amounts of surface immunoglobulins. In contrast to lymphoid and myeloma lines, the leukaemia lines were completely lacking surface immunoglobulins, but showed C3 and Fc receptors in variable densities. On line, the ALL derived line MOLT-3 showed the capacity to spontaneous rosette formation with SRBC. The findings that LCL presented a homogeneous pattern of B-lymphocyte surface markers may be of value in order to discriminate between these lines and lines derived from haematopoietic malignancies other than Burkitt lymphomas.


Differences between plasma and serum complement in patients with chronic liver disease.

Of sixty patients with chronic liver disease, eight with cirrhosis or chronic hepatitis had very low serum CH50 but normal plasma CH50. The complement component profiles of these sera revealed markedly decreased C4 and C2 activities and normal C3T (C3-C9) activities. From these results, it is suggested that the early acting complement components had been non-specifically activated during blood coagulation in these patients. No difference between plasma and serum CH50 was found in patients with hepatitis B(s) antigen.


A new haemolytic assay for the second component of complement (C2) in human serum.

A new, specific haemolytic assay for C2 is described using EAC43 (Antrypol) cells and serum deficient in C4 and C2 from a patient with hereditary angio-oedema. The method is simple and the results in pathological and normal sera correlate well with those obtained using the EA and C2-deficient serum method.


Hapten-specific lymphocyte transformation in humans sensitized with NDMA or DNCB.

The primary immune response to a contact sensitizing dose of para-N-dimethylnitrosaniline (NDMA) and dinitrochlorobenzene (DNCB) was obtained in humans and measured in vitro by increased thymidine incorporation into sensitized lymphocytes. No cross-reaction was found between these two haptens, and it is thus possible on two separate occasions to quantify and follow the primary cellular immune response in man.


Regionalization of perinatal care for the United States.

A scheme of regionalization is proposed in which a regional perinatal system within a defined geographic area permits access of the high risk mother-fetus and infant to the appropriate level of technology for improved perinatal outcome.


The perinatal research program of the National Institute of Child Health and Human Development.

The Institute's research emphasis is on the interrelationships of specific health and developmental problems in the antenatal, perinatal, and infant periods, and the effects that these events may have upon maternal health, maternal-infant relationships, and subsequent development and well being of the child.


Newborn Country USA.

"Newborn Country USA" describes a concept for a regionwide, integrated perinatal care system that serves a population of more than four million. How the four sectors of the Denver Regional Perinatal Center - The Children's Hospital, Denver, Denver General Hospital, Fitzsimons Army Medical Center, and the University of Colorado Army Medical Center - interact as a regional resource, relate to 223 hospitals in portions of 10 states, and assist in serving a portion of 70,000 live births in 1976 are reported.


Neonatal intensive care in community hospitals and remote areas. The problems and a possible solution.

This has been a brief summary of the problems emerging as more community hospitals develop neonatal intensive care, analyzing their possible origins and significance. A description of one solution to the problem has been given, exemplified by an outreach program from the University of California, San Diego, and University Hospital, San Diego, with the community of Las Vegas, Nevada. We feel strongly that the responsibilities of medical schools toward community hospitals and toward regionalization in isolated communities should be unique and are not covered by usual regulations or traditional concepts of regionalization.


The large private hospital and neonatal intensive care.

The experiences of the Methodist Hospital of Indiana in integrating family physicians into neonatal intensive care are related, and some useful organizational innovations in neonatal nursing are suggested.


Regionalization and service medicine.

A comprehensive plan for perinatal regionalization in the medical facilities of the military services is advocated. Factors peculiar to military medicine which must be recognized in planning are discussed.


Principles of organization of an obstetrical unit from scratch.

The previous discussion has attempted to outline some basic principles in developing a high-risk obstetrical unit from scratch. Needless to say, emphasis in specific areas will be dictated by community needs, financial resources, numbers and training of personnel, and space limitations. The basic functions of patient care, education, and self-evaluation can be accomplished in any high-risk obstetrical unit.


Principles of organization of a neonatal intensive care unit from scratch.

This discussion has dealt with major principles to be considered when planning and organizing an infant special care unit. However, there remains one very important principle in the organization of any such unit: the job is never complete. As concepts and practices relative to care of the high-risk neonate change, so must organization of any unit delivering this care be modified and reorganized.


Preventing obsolescence in the design of a perinatal unit.

Basic principles are offered to support the suggestion that use of special care space must be made with a mind toward prevention of obsolescence. Certain conventional design features should be examined critically and decisions made as to their applicability to the needs of a particular program.


Obstetrics: basic equipment needs.

The enunciation of equipment requirements has been attempted as needs appear today. Detailed and technical specifications for some of this equipment must be understood prior to major acquisitions. An awareness of current trends in clinical research can often be obtained from appropriate consultants which should forestall obsolescence. Finally, it must be reemphasized that the proper and intelligent use of equipment or diagnostic methods is essential. Likewise, the need to employ many of these techniques may become apparent only by paying close attention to the patient's clinical historical comments or as a result of skilled clinical observations.


Equipment maintenance.

Basic to the success of the perinatal intensive care unit is a cooperative liasion between the medical and nursing staff and the clinical engineering staff. To this end the functions of the clinical engineering staff are preventive maintenance, inventory documentation, pre-purchase evaluation, emergency repair, personnel education, and management integration.


Laboratory and blood bank needs of a perinatal center.

Prenatal and neonatal laboratory diagnostic tests are discussed in terms of purpose, technique, and evaluation of results. The need for quick access to fresh blood products must be appreciated by the blood bank, and the perinatologist must have a thorough understanding of blood products and the need for established procedures to guarantee safe transfusion.


Diagnostic radiography and ultrasound in the perinatal intensive care unit.

A range of possible solutions to common problems associated with radiographic examination of the newborn is presented. The various modes in which ultrasound is currently used as a diagnostic modality are reviewed together with recent innovations that have greatly increased the clinical utility of the technique.


Climate and environmental concepts.

What constitutes an optimal environment is still under question, but active research involves determining which external stimuli are beneficial and which are detrimental to infants. Temperature control and visual, auditory, proprioceptive, and tactile stimulation are discussed.


Family centered maternity care: its relationship to perinatal regionalization and neonatal intensive care.

For several months prior to birth a major portion of a family's attention, conversation, thought, and often worry, is directed toward the idea of a new child. This prolonged attention and anticipation contribute to making childbirth an emotionally charged experience. In psychological terms, it is therefore a critical period of peak motivation for learning, and a time to peak susceptibility to reinforcement. Theory, reason, and scientific evidence indicate thng with childbirth and early postpartum experiences, can significantly affect subsequent parental behaviors, the child's central environment influence. Evidence strongly suggests that these parental attitudes and behaviors so crucial to the child's ultimate well-being are learned rather than derived instinctually, and therefore they are malleable and can be taught, directed, and corrected. Through education and reinforcement it is possible to encourage parental behaviors and child interactions which are products of feelings of control, competence, accomplishment, understanding, and caring. Similarly we can recognize and work toward replacing attitudes, feelings, and behaviors that express fear, worry, and insecurity about the child. Over the past 50 years major changes have occurred in the practice of obstetrics and newborn pediatrics. Other major changes will necessarily occur as we move toward perinatal regionalization. Changes instigated solely on physiologic data can have unrecognized collateral effects on the psychological component of the childbirth experience. All concerned health care personnel, especially obstetricians and pediatricians, can insist that the importance of desirable mother-father-child interactions be recognized and that practices fostering them be afforded a high priority. I would like to endorse a comment from a recent article by Richmond concerning the advent of behavioral pediatrics by adding that behavioral obstetrics is also "an idea whose time has arrived".


Family crisis care.

By examining aspects of the family crisis care program in the Newborn Special Care Unit at Yale-New Haven Hospital, an illustration is made of one approach to utilizing the theory of crisis intervention in the development of a family oriented program of preventive intervention. The elements reviewed are adaptable as a framework for initiating such a program or as a reference for assessing programs now under development in other perinatal centers.


Training of personnel-pediatrics.

The educational programs that have been developed in newborn special care facilities have two purposes: first, they teach personnel the manual skills that are necessary to manage the sick newborn infant; second, they provide personnel with a better understanding of neonatal pathophysiology so that they can begin to recognize the subtle responses of the sick neonate. With these skills and knowledge, the nursery staff assumes a more active role in the team's effort to preserve a child's life.


The infant transport service.

The ultimate goal of an infant transport service is the reduction of neonatal morbidity and mortality in a given area. In order to attain this goal, the program must provide for the controlled transfer of a stabilized infant. Sub-objectives will include but not be limited to the integration of a readily available and knowledgeable ambulance service, the selection of appropriate transport teams, the establishment and maintenance of ongoing communications between all parties, the teaching of neonatal medicine to stimulate thereferring hospital to begin infant stabilization, and the constant evaluation of the overall performance of the infant transport system to detect defects in the system.


Intraoral cancer of the minor salivary glands.

Intraoral minor salivary gland carcinomas are relatively uncommon. The glands are concentrated in the mucosa of the mouth but occur over a wide area in the head and neck region. Little is known about the etiologic factors responsible for these tumors. Histologically, most salivary gland tumors are similar to those occurring in the parotid gland, but are more likely to be malignant. The most common presentations is an asymptomatic submucosal mass on the palate in a patient in the fifth or sixth decade, although it can occur in any age group. Neck node metastases occur in about one fourth of these patients. Surgical resection is the treatment of choice; irradiation may be a useful adjunctive method of palliation. Multiple recurrences over a long period of time are the rule, with 5 year survival for all malignant lesions being 44.5 per cent. The survival decreases another 10 per cent for each succeeding 5-year period of follow-up.


Function and appearance following surgery for intraoral cancer.

Operations for intraoral carcinoma do produce deformities and loss of function. Historically, surgeons have constantly tried to correct or improve these deficiencies. The tendency on the part of the surgeon is to replace each bit of tissue removed, hoping that if the site appears normal the patient will be normal. The appearance of the patient has as a rule been given more attention than the functional result. Dysfunction is related to the alteration of certain anatomic and physiologic conditions identified as: (1) inability to obliterate the anterior oral cavity, (2) defects in the palate, (3) inability to close off the oropharyngeal space, and (4) disturbance of normal channels to bypass the larynx. Lateral mandibulectomy and radical neck dissection performed for cancer of the retromolar area, lower gum, lateral tongue, or floor of the mouth will in most instances result in very acceptable cosmetic and functional results. These patients look well, speak well, eat and swallow well, and can assume their usual role in society. Further surgical attempts to improve any deficiencies are discouraged. Patients sometimes ask about bone grafting or devices to replace the resected mandible and our recommendations are very emphatic on the negative side.


Intraoral reconstruction in head and neck cancer surgery.

Numerous techniques are available to resurface the oral cavity. These range from the very simple and straightforward to the very difficult and complex. Certainly for small lesions, local excision and direct approximation of mucosa is all that is necessary. For larger defects, particularly those which will require some other form of reconstruction, additional tissue must be brought into the operative defect. For superficial excisions, skin or mucosal grafts are adequate to resurface the mouth. For areas of extensive resection, flaps of some type are required. The use of local random flaps, regional arterialized flaps, and myocutaneous flaps have been described. The decision for their use must be as individual as each patient. Free flap transfer has specific theoretical benefits. The advantages and disadvantages of each technique have been presented and, it is hoped, will allow the reconstructive surgeon greater latitude in selecting a technique of reconstruction.


Haemodynamics and body fluid volumes in response to fluid loading in conscious dogs: non-excretory renal influences.

1. Twelve conscious, chronically instrumented dogs were subjected to rapid loading with sodium chloride solution (150 mmol/1; saline) before and 1 day after bilateral nephrectomy (six dogs) or ureterocaval anastomosis (six dogs). Measurements were performed up to 3 h after the fluid load and included cardiac output with an electromagnetic flowmeter, mean arterial pressure and right atrial pressure with chronically implanted catheters, interstitial fluid pressure with a plastic capsule, heart rate, extracellular fluid volume, erythrocyte volume, plasma volume, plasma protein concentration and other variables. 2. The increase in cardiac output in response to saline load was significantly prolonged in the anephric dogs compared with those with uretero-caval anastomosis; mean arterial pressure, right atrial pressure and heart-rate changes were similar in both groups. 3. Plasma volume appeared to increase more in the anephric dogs than in those with uretero-caval anastomosis during the first hour after the infusion, although conflicting results were obtained with different estimates of plasma volume changes. Interstitial fluid pressure increased significantly less in the anephric dogs in the early stages of the fluid load. 4. Effective vascular compliance (the ratio of the change in blood volume to the change in right atrial pressure) appeared increased in the anephric dogs. On the other hand, the change in cardiac output for a given change in right atrial pressure was found to increase after bilateral nephrectomy. 5. It is suggested that the prolonged increase in cardiac output observed in anephric dogs was not the consequence of preferential plasma volume expansion nor of decreased venous compliance, but may reflect an alteration in the cardiac function curve.


The esterification of exogenous fatty acids by adipose tissue of hypertriglyceridaemic subjects with or without diabetes mellitus.

1. The esterification of exogenous palmitate to diglyceride and triglyceride in adipocytes was studied in obese and diabetic patients with and without hypertriglyceridaemia. The rate of esterification correlated significantly with the triglyceride content of adipocytes. 2. In diabetic patients with hypertriglyceridaemia, the rate of esterification to triglyceride was significantly greater than in diabetic patients with normotriglyceridaemia. This difference could not be attributed to differences in glucose tolerance or to the degree of obesity. 3. Fasting plasma insulin levels were greater in the hypertriglyceridaemic group than in the normotriglyceridaemic group. The difference in esterification rates could have been due to differences in adipocyte size. 4. The esterification of fatty acid in adipose tissue of diabetic patients was lower than in non-diabetic subjects and this difference could not be accounted for by differences in adipocyte size or differences in the intracellular pools of fatty acid in adipose tissue. 5. The role of esterification of exogenous fatty acids in adipose tissue as a possible determinant of the uptake of glyceride fatty acids from plasma is discussed.


The response of arginine vasopressin and plasma renin to postural change in normal man, with observations on syncope.

1. Fourteen mildly hydropenic normal volunteers were slowly tilted at a constant rate from the horizontal to the 85 degrees head-up position in order to study the interrelationship between plasma arginine vasopressin concentration, plasma renin activity and the change of plasma volume. 2. Nine subjects did not develop vaso-vagal symptoms and were studied for 45-60 min. Arginine vasopressin rose biphasically in all subjects: a small initial rise, which was seen at 3 min and persisted for 30 min, was followed by a striking rise between 30 and 45 min, when the fall of plasma volume had reached its maximum (17%). 3. Plasma renin activity reached a maximum at 30 min but fell by 45 min, as plasma concentration of arginine vasopressin rose. 4. Five subjects developed vaso-vagal symptoms 4-24 min after reaching 85 degrees when the study was terminated. A striking increase of arginine vasopressin concentration was seen within 4 min of syncope, but there was no change of plasma osmolality, cortisol concentration or renin activity.


Influence of sodium restriction upon two models of renal hypertension.

1. Restriction of dietary salt intake does not affect the development or maintenance of hypertension in rats with unilateral renal ischaemia whether the contralateral kidney is present (Goldblatt 2 model) or not (Goldblatt 1 model). 2. Acute dietary salt depletion induces a similar loss of sodium and fall in body weight with little change in blood pressure in both normal and hypertensive rats. 3. Excision of the ischaemic kidney in rats with short-term (less than 50 days) Goldblatt 2 hypertension restores the mean blood pressure to normal, whereas Goldblatt 1 hypertensive rats show only a partial response. Previous salt depletion of this model enhances the blood pressure response to nephrectomy. 4. Sodium retention plays no part in the development or maintenance of Goldblatt 2 kidney hypertension. However, although sodium retention is normally involved in the Goldblatt 1 model, hypertension can develop in the absence of dietary sodium.


Potassium transport across the distal colon in man.

1. The mechanism of potassium transport across human distal colon was investigated in twenty-two individuals without evidence of bowel disease, by using a dialysis method in conjunction with measurements of the transepithelial potential difference (p.d.). 2. Whether potassium was absorbed or secreted depended on its initial concentration in the lumen. The potassium net flux was approximately zero when the luminal potassium concentration was between 30 and 50 mmol/l. 3. Potassium secretion rate was little affected by sodium absorption rate, or by the luminal sodium concentration or by the osmolality of the luminal solution. 4. Potassium secretion rate was increased by partial substitution of other cations for sodium, in the descending order Li greater than NH4 greater than Rb greater than Na. Potassium concentration increased on average to over 80 mmol/l when lithium was in the lumen. 5. The observed transepithelial p.d. was inadequate to account for the intraluminal potassium concentrations attained, the discrepancy being most marked when ammonium or lithium was in the lumen.  It is suggested that some potassium is secreted by the epithelial cells and this component of the total potassium flux into the lumen is increased when rubidium, ammonium or lithium is substituted for sodium.


Blood flow through the calf during recovery from fractures of the lower limb.

1. Venous occlusion plethysmography has been used to measure the blood flow in the calves of nineteen patients with fractures of the lower limb and in six normal control subjects. 2. The resting blood flows were significantly higher in the injured legs than in uninjured legs, irrespective of the site of injury. Flows in the uninjured limbs were similar to those of the control subjects. 3. During reactive hyperaemia after 10 min arterial occlusion, the increase of flows in both legs of the patients was significantly lower than in the control subjects. Because of the increased resting flow, the maximal flow in the injured leg was similar to that in the control subjects, whereas the maximal flow in the uninjured leg was significantly lower than in the control group. 4. The changes in resting flow cannot be accounted for by a change in the proportions of tissues in the limb but they may be explained by an increase of the flow through muscle secondary to a relative increase in the mass of slow to fast muscle fibres.


Effects of immersion in water and changes in intrathoracic blood volume on lung function in man.

1. In healthy, normal subjects simultaneous peripheral venous occlusion of all four limbs caused a small but significant increase in vital capacity (VC) and single-breath carbon monoxide transfer factor (DLCO) without significantly changing total lung capacity (TLC), residual volume (RV), pulmonary gas flow or pulmonary compliance. 2. Immersion in water to the neck resulted in a small but significant fall in VC, FEV 1.0/FVC and TLC, and a rise in DLCO, but flow/volume curves and 'closing volume' were unchanged. Peripheral venous occlusion during immersion only significantly increased VC and DLCO; pulmonary compliance and flow/volume curves did not alter significantly. 3. It is concluded that peripheral venous occlusion produces these effects by altering intrathoracic blood volume. Water immersion reduces TLC, mainly from the hydrostatic pressure, and VC is reduced from both the hydrostatic pressure and the increase in intrathoracic blood volume consequent on immersion. The increase in DLCO is due, almost entirely, to the increase in intrathoracic blood volume.


Common bacterial urinary tract infections in women.

Unfortunately, there is no general consensus as to how long patients with bacteriuria or urinary tract infections should be monitored and certainly there is no agreement on how long recurrent episodes should be treated beyond ten days to two weeks. The most important points to remember are: 1. Culture the urine both at the time of therapy and during follow-up. The patient should be examined periodically for the presence of bacteruria. If bacteria cannot be eradicated, at least the physician is aware of the organism most likely causing the patient's symptoms. 2. Do not subject the patient with frequent recurrent (chronic) and complicated infections to continual antibacterial therapy, but rather, manage the acute episodes. 3. Use prophylaxis, particularly single bed-time doses for dysuria and frequency symptoms. 4. Screen for bacteriuria during pregnancy. 5. Avoid the use of catheters except where absolutely necessary. 6. Avoid systemic prophylaxis of infection in patients with catheters; rather, use closed-system drainage with antibacteri-irrigation. It is to be hoped within the next few years, studies now underway will allow specific recommendations regarding the management of asymptomatic bacteruria, the duration of therapy for recurrent infections, the prevention and treatment of L-form bacterial infections, and indications for urologic procedures.


Effects of prostaglandin E2 and F2alpha therapy.

Prostaglandins are widely  distributed in the nervous system and have important effects on nerve cells. Prostaglandins of the E series tend to cause sedation, whereas this action is much less obvious with F prostaglandins. Prostaglandin therapy for termination of pregnancy is usually administered by the intrauterine route, which means that only very low concentrations of prostaglandin E2 or prostaglandin F2alpha reach the cerebral circulation after passage through the highly effecient metabolizing system in the lungs. The blood-brain barrier may also reduce the amount of prostaglandin reaching the nerve cells.However, prostaglandin F2alpha appears to have been responsible for major convulsions in a small proportion of patients, and the appearance of epileptiform spike activity has been clearly demonstrated in some patients with normal pretreatment EEGs. Prostaglandin E2 has not been reported to cause convulsions or epileptiform spike activity in normal women, although deterioration of an already abnormal EEG has been seen in one patient. Although the risk of convulsions with prostaglandin F2alpha is low, it seems preferable to use prostalgandins E2 where possible, particularly on patients with a history of epilepsy.


Emergency treatment of wounds of the colon.

Colonic wounds vary greatly in their severity and the number of concomitantly injured organs. Relatively few colonic wounds are single; these can usually be treated by primary repair. The approach to colonic wounds generally must be selective and take into account the degree of associated shock,contamination, and surrounding tissue damage. Judicious application of the wide variety of technical approaches available today has increased the incidence of primary repair to over 50% and has reduced mortality to 10% to 15%.


[Psychiatry and humanitarianism].

Opposing positions on mental disorder in current psychiatry, their origins and therapy are presented through a few extreme viewpoints. Considering the foundations of the 'medical model' of psychiatric disorder (Griesinger), it is evident that this model is not a closed system, but rather an open approach which still has validity today. The humanitarian roots of psychiatry prevented Griesinger from treating various positions in an absolute or ideological manner. Finally, the concept of 'illness' is discussed in relation to psychophysiological activation research. Pathology changes in each different situation and is therefore not a static phenomenon. Mental disturbance is not determined by absolute measures, but rather by a reduction in variability of reactions to the particular situation. This concept of illness can determine somato-, psycho-, and sociotherapeutic measures. Psychiatry can only remain based on humanitarian concepts as long as the sciences upon which it is founded are kept in appropriate relation to one another.


Obesity: some psychological and physiological considerations.

The case report of an obese patient deals with his background, history of life and its correlation to obesity. The causes, circumstances and habits of eating are almost a perfect expression of the traditional theories of obesity. This case report emphasizes the correlation between the psychiatric theory that divides the obese people into adult and juvenile types and the histological findings that obesity can be divided into hyperplastic and hypertrophic types according to the quality and quantity of the fat cells. In fact these two theories may be manifestations of the basic, yet unknown cause of obesity. A doubt to the classical theories is cast by the operation of jejunoileostomy which changes many personality characteristics which were considered primary in obesity.


The dream of a twenty-four-year-old graduate student. Existential and Jungian considerations.

There are dreams that portray with unusual clarity critical junctures in a person's life. Inasmuch as the realm from which the images of a dream emerge is of the same nature as the source of genuine fairy tales, it is intuitively perceptive of the latter's deeper meanings. Thus suitable fairy tale themes can enhance the experiential insight into dreams. The young student's dream that we discussed indicates a sharp awareness of several existential disharmonies. He confuses the messages originating in his innermost self with external demands against which he still rebels blindly; he is incapable of metamorphosing creatively the numerous disorganized urges within himself; and he thus cannot achieve a positive relationship with his deeper potentials which are set aside. The comparison of the dream with an analogous, charming Romansh tale portraying a harmonious solution of the young man's impasse proved to be of crucial help.


Evaluation of the cytological examination in mass survey of gastric cancer.

The significance of the cytological examination in the diagnosis of gastric cancer, especially in the detection of the early cancer of the stomach, was examined in 1200 cases subjected to the cytological examination in the mass survey, including 181 cases with early cancer of the stomach, 148 cases with advanced cancer of the stomach. Comparison of the detection rates of cancer in cases of surgically confirmed stomach cancer revealed that cytological examination is more reliable than endoscopic and X-ray examinations of the stomach. In only a few instances, the false negative and false positive diagnoses were made, and therefore it is important for correct diagnoses to correlate the cytological finding with the other findings. The importance of cytological examination was clearly indicated by examination of the annual detection rate of early cancer, which showed a sudden increase after the period of the introduction of the cytological method in mass survey.


A new fiberintestinoscope type FIS-T1 patterned after intestinal biopsy tube.

A new type of fiberintestinoscope (FIS-T1) patterned after an intestinal biopsy tube was developed for observing the small intestine beyond the ligament of Treitz. The flexible part of the new FIS has been made as pliable as the Cantor tube or the Miller-Abbott tube so that the tip of the new FIS is carried on into the small intestine by peristaltic activity along its natural configuration. A balloon attached near the tip of the new FIS acted as a bolus, enabling peristaltic activity to carry the fiberscope to the distal portion. In order to facilitate the passage of the fiberscope, it was also advisable to keep changing the posture and position of the body with a minimum of fluoroscopic exposure. Inflation of the balloon as well as air feeding through the air channel of the fiberscope made possible satisfactory observation. In a patient suffering from protein-losing gastroenteropathy, multiple white spots on the diffuse rough surface of the mucosa were visualized by using the new FIS. Histological finding of the biopsy specimen taken from near the ligament of Treitz by using the fiberduodenoscope showed dilated lymph vessels in the villi.


Further studies on lipid-chemical differences between cancerous and adenomatous polypous tissues in the human large intestine.

17 cases of cancer and 18 cases of adenomatous polyp in the large intestine were subjected to lipid-chemical studies of their tissues in order to clarify the biochemical differences between malignant neoplastic growth and benign growth. Cancerous and adenomatous polypous tissues were collected by biopsy or surgical operation together with the respective control tissues. One part of the total lipid extracted from each tissue was separated into triglyceride and phospholipid fraction by a thin-layer chromatography (TLC). The fatty acid composition and content of each lipid fraction were measured by a gas-liquid chromatography (GLC). When the fatty acid composition of a phospholipid was expressed in terms of the deviation rate, that of C14:0 was remarkably increased and that of C20:4 was remarkably decreased in the cancerous cases as compared with the respective values of the cases of adenomatous polyp. More definite differences were recognized between the cancerous cases and the cases of adenomatous polyp, when the ratio of the deviation rate of C14:0 to that of C20:4 was calculated in each case. Namely, the ratios distributed between 2.064 and 4.125 in 10 cancerous cases, and between 0.393 and 1.856 in 16 cases of adenomatous polyp, indicating the biochemical differences between cancerous tissues and adenomatous polypous tissues.


Ischemic colitis.

Although several hundred cases of ischemic colitis have been reported from western countries, no case has been reported in our country. Ischemic colitis is a well established entity. Clinicopathological manifestations, disgnosis, treatment and prognosis of the disease are well known. A majority of reported cases were not particularly unusual. Two cases, of which one showed an unusually long lasting acute episode but good prognosis, and the other presented a diagnostic problem and was found to have a fibrous stricture due to ischemic colitis in the sigmoid colon at surgery, were described and discussed in relation to their symptoms, diagnosis and prognosis.


Chronic hepatitis: a follow-up study.

51 cases of chronic hepatitis were followed up by serial liver biopsies. 6 cases, all of which were of the active type, showed transition to liver cirrhosis within 5 to 10 months after the initial biopsy which had indicated chronic hepatitis. In 109 cases of liver cirrhosis, the antecedent acute hepatitis had been found within a relatively short period, usually 2 to 3 years before the establishment of the diagnosis of liver cirrhosis. Whether these cases which showed rapid transition to liver cirrhosis after acute hepatitis should be included in the group of chronic hepatitis or in another group remains to be settled.


Clinical evaluation of iron metabolism in pancreatic disease.

In order to estimate the possible influence of pancreatic disease upon iron absorption, fecal analysis was carried out after administration of 5 mg iron labeled with 59Fe. Twelve cases of pancreatic calcification, 7 cases of chronic pancreatitis, 3 cases each of pancreatectomy and miscellaneous diseases, and 52 cases for control were studied. Significant elevation of iron absorption was observed in 4 or 21 patients with pancreatic diseases. Two of the 4 cases were also found to have low transferrin saturation and the other two have had a long history of heavy alcoholic intake. There was no definite correlation between the iron absorption rate and the total bicarbonate secretion, and duration of the diseases. Three cases treated with pancreatectomy failed to show increased iron absorption. The alternative administration of 59Fe and 55Fe for consecutive 4 days either alone or together with pancreatin or secretin was done to see the effect of these preparations on iron absorption. No significant inhibitory effect of these preparations on the iron absorption was noticed. These observations suggest that exocrine pancreatic function seldom appears to influence directly iron absorption, and that iron deficiency and ingestion of alcoholic beverages can be important factors affecting the iron absorption in pancreatic diseases.


Continuous secretin infusion with pancreozymin pretreatment as a pancreatic function test.

This paper deals with a pancreatic function test with the submaximal dose of secretin given by continuous infusion after injection of cholecystokinin-pancreozymin (CCK-PZ) in the submaximal dose. The active elimination of bladder bile by CCK-PZ pretreatment decreased the influence of biliary contamination, and the volume output and the bicarbonate concentration were stabilized by the continuous infusion of secretin. As a result, the coefficients of variation in the volume output and the bicarbonate concentration were calculated to be about 15 and about 5%, respectively. These variations were considerably smaller than those obtained in the standard secretin test. Therefore, the present study is expected to improve the diagnostic means for pancreatic excretory dysfunction.


A diagnostic re-evaluation of electric skin resistance, skin temperature and deeper tenderness in patients with abdominal pain.

Diagnostic re-evaluation of measurement of electric skin resistance (ESR), skin temperature (ST) and deeper tenderness (DT) was performed in patients with abdominal pain due to pancreatitis, cholecystopathy and duodenal ulcer. These determinations were conducted when the pain was complained of and after the pain ceased by paravertebral anesthesia. ESR was decreased on the opposite tender points of the abdominal walls as compared with those values of the healthy abdominal walls. On the contrary, ESR was increased on the suffered body areas in patients with active myelitis. ESR was decreased on the abdominal walls where visceral pain was induced by inflation of a balloon attached to the apex of a Miller-Abbott double lumen tube. DT tended to show decrease, while ST a slight increase, when the pain was evoked. However, in these pain induced experiments, ST changes were not so remarkable as those of ESR. A viscero-cutaneous reflex machanism and the predominance of sympathetic nerve control might be possible causes to produce these changes. Several important factors influencing the determination of the ESR were also discussed.


Minute gastric cancer.

Nineteen cases of minute early gastric cancer were diagnosed under endoscopical examinations. Diagnosis was established by endoscopic biopsy in 18 cases, and exceptional one case of type IIb was incidentally found. Some of the endoscopic characteristic features of superficial depressed minute cancer were mentioned. By these findings, the diagnosis of superficial depressed minute cancer is possibly made in certain extent only by endoscopic observation. Prognosis of minute gastric cancer is excellent. Especially in the minute early cancer, the actual 7-year-survival rate was 100%. Prognosis of minute advanced cancer is also quite good. Minute gastric cancers can be found clinically and are almost completely curable.


Clinical significance of Congo red test.

Clinical significance of Congo red test was studied, especially on its relation to the liver function and amyloidosis. No significant relationship was observed between Congo red test and Indocyanin green test in cases of various liver diseases except liver cirrhosis. Histological studies also revealed that there were no pathologic features specifically affecting Congo red index (CRI), even though CRI in cases of various liver diseases tended to be increased as compared with other diseases. As a cause of increased CRI which was seen most remarkably in cases of liver cirrhosis, obstructive change of the liver blood flow followed by the hepatic tissue damage is suspected. The concept that Congo red test is a kind of the hepatic excretory function test does not have, from our data, enough evidence. The present study confirmed our previous data on the fate of Congo red injected intravenously, which indicated that this test is one of the best tests available for RES function and this test is related mainly to Kupffer's cell rather than to the so-called hepatic excretory function. There were no cases which showed notable decrease of CRI in experimental amyloidosis and in clinical amyloidosis, and it can be said that Congo red test is not the best test for the diagnosis of amyloidosis.


Erythrocyte rosette forming activity of macrophage.

Erythrocyte rosette forming activities of the rat lung macrophage, peritoneal macrophage, Kupffer cells and expressed splenic cells were studied. The erythrocytes employed were fresh human red blood cell (RBC), fresh sheep RBC (SRBC), and tanned SRBC coated with bovine albumin or with bovine gamma-globulin. The macrophages were mixed with RBC at a ratio of 1 to 100 or 200 in gelatin veronal buffer or phosphate buffered saline. The experiments were carried out at 4 degrees C. No autologous serum nor anti-RBC serum was added to the experimental system. 10 to 20 per cent of the lung macrophages formed rosette and their entire surfaces were covered with RBC. The peritoneal macrophage and Kupffer cells were also capable of forming rosette with fresh SRBC as well as with SRBC coated with bovine albumin or with bovine gamma-globulin. Examinations for cell surface immunoglobulin of alveolar macrophage, peritoneal macrophage, Kupffer cells and splenic cells revealed that alveolar and peritoneal macrophages apparently possessed surface gamma-globulin and that almost all of these macrophages possessed surface immuno-globulin. In order to examine the effect of different natures of SRBC on in vivo phagocytosis, rats were immunized with SRBC by injecting various SRBC into the femoral or the portal vein and the hemagglutinin titer was studied. The maximum hemagglutinin titer was observed in the rat injected with fresh SRBC into the femoral vein and the minimum hemagglutinin titer was observed in the splenectomized rat injected with fresh SRBC and in the rat injected with SRBC coated with albumin or gamma-globulin into the femoral or portal vein. Immunological role of Kupffer cells was discussed.


Long-term corticosteroid therapy of idiopathic aplastic anemia.

The results of a long-term corticosteroid therapy performed in 55 patients with idiopathic aplastic anemia are reported. Of these patients, cure was attained in 20 patients, remission in 5, and improvement in 10. The duration of the treatment of cured cases ranged from 138 to 1109 days with a median of 522 days. The results were much better than those with other treatments conventionally performed. However, necessity of paying attention to side-effects was pointed out.


Hemorrhagic diathesis in Weber-Christian disease.

A case of a 21-year-old woman with Weber-Christian disease, associated with consumption coagulopathy and adequately controlled over the past year or more by corticosteroid and heparin therapy, has been described. Through the study on this case, it was concluded that a hemorrhagic diathesis complicating Weber-Christian disease, at least in advanced cases, was characterized by consumption coagulopathy associated with enhanced blood coagulability which arises from hyperlipemia due to abnormal lipid metabolism and further, that the consumption coagulopathy was modified by diminished synthesis of clotting factors and activation of the fibrinolytic system due to the secondary hepatic impairment. It might also be likely that systemic vascular changes contribute to the activation of the clotting system as a trigger of clotting factor consumption. The complex pathophysiology of a hemorrhagic diathesis in this disease seemed to be brought about by a complex combination of such a variety of factors. In addition, decreased erythrocyte sedimentation rate observed characteristically during hemorrhage might probably have a direct correlation with hypofibrinogenemia due to consumption coagulopathy in advanced cases.