Degradation of prostaglandin E2 and F2alpha by the canine liver.

Degradation of prostaglandin E2 (PGE2) and F2 alpha (PGF2 alpha) by the liver was determined in 16 dogs. PGE2 (8 dogs) or PGF2 alpha (8 dogs) was infused into the left ventricle at rates of 3.75, 7.5, 15, 37.5, and 75 mug/min. Blood samples obtained simultaneously from the portal vein (PV), hepatic vein (HV), and abdominal inferior vena cava (IVC) at each infusion rate were tested for PGE or PGF concentration by radioimmunoassy. During PGE2 infusion the mean PGE concentrations in the PV were 0.60, 1.05, 1.40, 2.29, 4.80, and 7.29 ng/ml at each infusion rate, Corresponding concentrations in the HV were 0.51, 0.62, 0.71, 0.96, 1.94, and 2.62 ng/ml, and in the IVC 0.51, 0.95, 1.31, 1.96, 4.31, AND 5;18 NG/ML. During PGF2 alpha infusion, the mean PGF concentrations in the PV were 0.32, 0.59, 0.73, 1.73, 4.11, and 7.11 ng/ml at the respective infusion rates; Corresponding concentrations in the HV were 0.26, 0.24, 0.33, 0.48, 0.49, and 0.96 ng/ml, and in the IVC 0.32, 0.50, 0.61, 1.10, 2.40, and 4.17 ng/ml. Thus, these data indicate that the canine liver has substantial, but not unlimited, capacity for degradation of PGE2 and PGF2 alpha in the portal circulation. Whether or not PGE or PGF levels in the PV may exceed this capacity during periods of stress or whether this enzymatic mechanism may be suppressed by either physiological or pharmacological factors is not known.


Responses of abdominal vascular capacitance to stimulation of splachnic nerves.

In chloralose-anesthetized dogs the abdominal circulation was vascularly isolated without opening the abdominal cavity. The region was perfused at constant flow through the aorta and drained at constant pressure from the inferior vena cava. Changes in resistance were calculated from changes in perfusion pressure and changes in capacitance were calculated by integrating changes in venous outflow. Stimulation of both splanchnic nerves at 20 Hz increased resistance by 135% and reduced capacitance by 7.20 ml kg-1. The capacitance responses at 1 and 2 Hz (3.42 and 5.43 ml kg-1) were 48 and 67% of the responses at 20 Hz, However, the resistance responses at 1 and 2 Hz (14 and 31% increase) were only 12 and 26% of the responses at 20 Hz. After occlusion of the splenic pedicle, capacitance responses were reduced by about 40%. Although changes in inferior vena caval pressure changed the volume of blood in the abdomen by 0.92 ml kg-1 cmH2O-1, the responses to stimulation were relatively constant in any one animal at constant venous pressures between 5 and 15 cmH2O.


Effects of food deprivation on protein synthesis and degradation in rat skeletal muscles.

The effects of food deprivation on protein turnover in rat soleus and extensor digitorum longus (EDL) were investigated. Muscles were removed from fed or fasted growing rats, and protein synthesis and breakdown were measured during incubation in vitro. Rates of synthesis and degradation were higher in the dark soleus than in the pale EDL. One day after food removal protein synthesis and RNA content in the EDL decreased. On the 2nd day of fasting, rates of protein catabolism in this muscle increased. Little or no change in synthesis and degradation occurred in the soleus. Consequently, during fasting the soleus lost much less weight than the EDL and other rat muscles. In unsupplemented buffer or in medium containing amino acids, glucose, and insulin, the muscles of fasted rats showed a lower rate of protein synthesis expressed per milligram of tissue but not per microgram of RNA. Thus the decrease in muscle RNA on fasting was responsible for the reduced synthesis observed under controlled in vitro conditions. In vivo the reduction in muscle protein synthesis on fasting results both from a lower RNA content and lower rate of synthesis per microgram of RNA. Reduced supply of glucose, insulin, and amino acids may account for the lower rate of synthesis per microgram of RNA demonstrable in vivo.


Short-range stiffness of slow fibers and twitch fibers in reptilian muscle.

The semitendinous muscle of the lizard Tilique contains both slow and twitch fibers; by subdivision of its motor nerve, fibers of each type may be stimulated separately. When, during repetitive stimulation of nerve filaments, the muscle was lengthened or shortened, the tension changes included an initial short-range stiffness, followed by a later compliance. With increasing velocities of movement, the short-range stiffness increased toward a limiting value. For slow fibers this limiting value was reached with lower velocities of movement than for the twitch fibers. Provided that the same velocity of movement was used and the movements began from similar initial isometric tensions, the slow fibers resisted the movements with a greater stiffness than the twitch fibers. It is suggested that not all of the observed differences between the two fiber types can be interpreted simply in terms of differences in rates of formation and breakdown of cross-links.


Integration of the cardiovagal mechanism in the medulla oblongata of the cat.

The central cardiovagal mechanism of the medulla oblongata was explored by stimulation and ablation techniques in the anesthetized cat. Insertion of an electrode into the nucleus solitarius (NS) occassionally evoked slight and transient bradycardia, but similar mechanical irritation to the nucleus ambiguus (NA) usually evoked prolonged and intense bradycardia. Electrical stimulation of the dorsal motor nucleus of the vagus (DNV) produced no or little bradycardia. Stimulation of NS and NA consistently produced cardiac slowing with a latency of less than 2 s and the effect was more prominent in the NA. Contralateral vagotomy did not significantly affect the bradycardia on the NS and NA stimulation but ipsilateral vagotomy caused a complete abolition. Lesions of the NA or DNV largely or completely abolished the bradycardia consequent to NS stimulation. Extensive destruction of the NS and/or DNV did not affect the bradycardia resulting from NA stimulation. Destruction of the ventral midline area partially reduced th bradycardia on NS STIMULATION BY 36-54%. The results suggest that the sequence of the three vagal nuclei for cardiac inhibition runs in the following order: NS, DNV, and NA. Synaptic connections are probably scanty in the DNV. Part of the vagal pathway passes through the ventral midline area before it reaches the NA. A scheme of the neural pathway for reflex bradycardia of vagal origin has been proposed.


Gastrointestinal metabolism of cadmium in experimental iron deficiency;.

The average gastrointestinal uptake 4 h after an intragastric dose of 400 nmol of cadmium chloride labeled with 109CdCl2 in iron-deficient mice, 25%, was significantly greater than the result, 16%, in iron-normal animals, and more cadmium entered the body of the former, 3.8%, than the latter, 2% (P less than 0.05). Between 4 and 72 h, gastrointestinal radioactivity declined without further increase in body activity; however, more radiocadmium remained in the duodenum of iron-deficient than iron-normal animals (P less than 0.05). The radiocadmium sequestered in the duodenum was bound to a protein with a molecular weight of about 12,000. After subcutaneous injection of radiocadmium, the rate of excretion of radioactivity from the body was similar in iron-normal and iron-deficient mice; however, a greater proportion of the injected dose accumulated in the duodenum of the iron-deficient animals (P less than 0.05). Thus, the intestinal adapative response to iron deficiency may enhance cadmium toxicity, whereas sequestration and subsequent excretion of cadmium by the intestinal mucosa serves to protect the body against toxic effects. The duodenum, particularly in iron-deficient mice, is especially vulnerable to the toxic effects of cadmium.


Micropuncture studies of glucose transport in the dog: mechanism of renal glycosuria.

Clearance and micropuncture studies were performed in 23 dogs without glucose loading to examine the tubule mechanism of renal glycosuria. Studies were carried out in three groups of animals before and after 10% extracellular volume expansion, and administration of maleic acid in low dose at 150 mumol/kg and in high dose at 300 mumol/kg. Specific hexokinase methods were used for the determination of glucose in tubule fluid and urine. Under control conditios, glucose reabsorption occurred predominantly in the proximal tubule. In all three groups, proximal tubule reabsorption of both sodium and glucose was inhibited in the second phase, showing a good correlation between the two. In contrast, fractional urinary glucose excretion remained unchanged after volume expansion and low-dose maleic acid, indicating reabsorption of virtually all the increased glucose load at a further "distal" site. On the other hand, significant glycosuria developed after high-dose maleic acid that was a result of reduced glucose reabsorption in the distal nephron, in addition to the proximal effect. It was concluded that distal glucose transport plays a significant role in regulating urinary glucose excretion and maintains renal thershold for glucose,


Protein metabolism in burned rats.

Incorporation of [2-14C]glycine was used to estimate serum protein synthesis in four groups of rats. These were the control (group C); 20% body surface burn (group B); 20% burn, seeded with Pseudomonas aeruginosa (group BI); and burned-infected treated topically with mafenide (alpha-amino-p-toluenesulfonamide) acetate (group BIS), a treatment which controls P, aeruginosa burn-wound infection in humans. On the 6th day postburn the relative specific activities of all fractions were increased in the order BI greater than BIS greater than B greater than C, as were the concentrations of the globulins; Serum albumin concentration fell, being lowest in BI. Tissue albumin contents, measured by radioimmunoassay, of eviscerated blood-free bodies of rats were (mg/100 g rat wt): C, 207; B, 294; BI, 256. Analyses of individual tissues showed that the difference was due to increased albumin content in the burn-wound area. The tissue albumin was of normal molecular size and was immunologically reactive. We conclude that the prolonged hypoalbuminemia following burn injury is not a consequence of impaired albumin synthesis, but a result of altered compartmentation.


Cerebral circulation and norepinephrine: relevance of the blood-brain barrier.

The systemic administration of norepinephrine has minimal effects on the cerebral circulation, perhaps due to blood-brain barrier mechanisms. To test hypothesis, the cerebrovascular effects of norepinephrine beyond the blood-brain barrier were studied in anesthetized baboons, Intraventricular norepinephrine (40 mug/kg) resulted in significant increases in cerebral blood flow (40%), cerebral oxygen consumption (21%), and cerebral glucose uptake (153%). Intracarotid hypertonic urea opens the blood-brain barrier by osmotic disruption; Consequent to hypertonic urea, the intracarotid infusion of norepinephrine, 50 ng/kg-min, significantly increase cerebral blood flow (49%), cerebral oxygen consumption (21%), and cerebral glucose uptake (76%), It appears probable that the cerebrovascular responses to norepinephrine are dependent on the integrity of the blood-brain barrier; It is likely that the increase in cerebral blood flow, associated with norepinephrine when it bypasses the barrier, is secondary to an increase in cerebral metabolism.


Influence of endogenous norepinephrine on cerebral blood flow and metabolism.

The influence of brain norepinephrine on cerebral metabolism and blood flow was examined because exogenous norepinephrine, administered in a way that the blood-brain barrier is bypassed, has been shown to effect pronounced changes in the cerebral circulation. Reserpine (40 mug/kg, by intracarotid infusion) was administered in order to release brain norepinephrine in five anesthetized baboons. Reserpine significantly increased cerebral oxygen consumption (23%) and cerebral blood flow (50%). This response lasted for approximately 60 min. In a further  five animals, effects of central beta-adrenoreceptor blockade were studied. Pro pranolol (12 mug/kg-min) produced an immediate, significant reduction in both cerebral oxygen consumption (40%) and cerebral glucose uptake (39%). Cerebral blood flow was reduced minimally. However, the responsiveness of the cerebral circulation to induced hypercapnia was severely attenuated from a gradient of 3.22 before, to 1,11 after, administration. These experiments suggest that central norepinephrine can influence the cerebral circulation primarily through noradrenergic effects on brain metabolism.


Frank-Starling relationship as an important determinant of fetal cardiac output.

The importance of the Frank-Starling mechanism was evaluated in seven chronically instrumented fetal lambs (128-141 days gestation). Continuous determinations of left ventricular (LV) internal dimensions and pressures were obtained while LV end-diastolic diameter (LVEDD) was reduced by superior vena cava occlusion and increased by infusion of fetal blood into left atrium. A highly significant relationship was found to exist between stroke volume and LV extent of shortening (delta D) (r = + 0.99, P less than 0.001). Altering LVEDD from 10,5 to 13mm or LV end-diastolic pressure from 2.5 to 8 mmHg resulted in a 68% augmentation, in delta D. Spontaneous respiratory efforts resulted in frequent beat-to-beat variations in LVEDD and delta D, which maintained cardiac output constant over a wide range of respiratory rates. Moreover, LV output determined by indicator-dilution techniques remained unchanged over a wide range of spontaneous heart rates (114-180 beats/min) as a result of changes in delta D appropriate to alterations in LVEDD. Thus, changes in resting myocardial fiber length are of fundamental importance in fetal cardiovascular homeostasis and, within physiologic limits, it is quite clear that the Frank-Starling mechanism is operative and effective in the fetal lamb;


Ion transport and structure of urinary bladder epithelium of Amphiuma.

The urinary bladder of Amphiuma exhibits stable transport properties and an electrical potential difference in vitro. The lumen is significantly negative to the serosa and under short-circuited conditions flux rations for Na and Cl of 5.92 +/- 0.42 and 1.81 +/- 0.20, respectively, were observed. The close agreement between the short-circuit current and net Na flux suggests that most, if not all, of the current is carried by Na. Both ouabain and amiloride decreased the short-circuit current and the mucosal-to-serosal (M leads to S) flux of Na. Furosemide caused a transient increase in the M leads to S flux of Na and Cl but ADH was without effect. In bladders that had high transmural resistance, a net movement of K in the M leads to S direction under short-circuited conditions with flux ratios of up to 2 could be observed. The epithelium of the Amphiuma bladder consists of three cell types: granular cells, basal cells, and mitochondria-rich cells. No goblet cells are present. The mitochondria-rich cells comprise less than 5% of the population of the surface epithelium in Amphiuma in contrast to other amphibian bladders, where it accounts for up to 25% of the population.


Urate reabsorption in proximal convoluted tubule of the rat kidney.

Urate reabsorption was examined in the rat utilizing clearance and in vivo microperfusion techniques. In control rats, the fractional excretion of urate averaged 12.5 +/- 1.3% of the filtered load, with 60-70% of perfused urate reabsorbed at 2 mm of perfused tubule length (urate efflux). Increasing the perfusion concentration of urate to 6, 12, and 25 mg/100 ml did not alter the fractional rate of reabsorption. The acute administration of chlorothiazide resulted in a fall in GFR and Curate such that the fractional excretion was unchanged from controls and averaged 13.3 +/- 2.0%, without an associated change in urate reabsorption from proximal perfusates despite the presence of significant inhibition of sodium and water reabsorption. By contrast, the chronic administration of chlorothiazide accompanied by a low-sodium diet resulted in a significantly lower fractions excretion rate of urate of 7.95 +/- 0.5% and a significant increase in reabsorption of sodium and water as well as urate from microperfusates, In control rats receiving an infusion of 5% mannitol in isotonic saline, urate secretion was demonstrated by the urinary precession of [2-14C]urate from [methoxy-3H]inulin following placement of these isotopes on the surface of the kidney. The additional infusion of chlorothiazide did not alter this pattern of isotope recovery in the urine.


Influence of sympathetic nerves on oxygen uptake or resting mammalian skeletal muscle,.

Gracilis muscles of anesthetized dogs were isolated and perfused with blood at constant flow. Oxygen uptake (Vo2) was measured by spectrophotometry of paired arterial and venous samples and monitored by continuous recording of HbO2 saturation. The sympathetic chain, connected to the isolated muscles, was stimulated electrically with supramaximal pulses. High frequencies (8-16/s) increased vascular resistance (R, ratio to control 1.86 +/- 0.6 SEM) and decreased Vo2 (0.61 +/- 0.02). Both effects could be maintained 10 min or longer. After stimulation there was an increase in Vo2, which could be less than equal to, or greater than the O2 deficit, depending on the stimulation frequency, the period of stimulation, and the blood flow. Low frequencies (0.5-4/s) increased R (1.39 +/- 0.04) and increased Vo2 during (1,18 +/- 0.03) and after stimulation. In several experiments there was an initial decrease in Vo2 which changed to an increase during the stimulation period while R remained elevated. These observations indicate that the decrease in Vo2 is due to closure of precapillary sphincters, whereas the increase is a direct effect on cell metabolism.


Noncompensation of adipose mass in partially lipectomized mice and rats.

The effects of surgical ablation of adipose tissue were studied in normal mice and rats. It was found that: 1) restortation of adipose tissue does not occur locally in epididymal fat pads of young rats. 2) Bilateral epididymal fat pad removal in mice disrupts the testes and causes the other fat depots to accumulate excess lipid, but these effects are not sustained; After a sufficient recovery period, testes appear normal and no excess lipid is found in the remaining depots; 3) Temporary enlargement of remaining depots is probably due specifically to epididymal pad removal. It does not occur in response to inguinal depot removal, nor in response to disruption of the testes alone; 4)The quantity of lipid stored by a rapidly growing mouse depends on the number of intact depots in the mouse. These results suggest that surgical removal of fat does not lead to compensatory growth of fat. Autoregulation of adipose tissue mass, if it occurs, most likely operates through detection of adipocyte size rather than adipocyte number or total fat mass.


Afterload-induced homeometric autoregulation in isolated cardiac muscle.

Pressure-induced homeometric autoregulation (HAR) has been demonstrated by many investigators in the mammalian ventricle; In isolated cardiac muscle, however, several investigators have reported the opposite effect (anti-HAR); namely, that the first beat after a transition from isotonic to isometric contraction is the most forceful, with a decline over several beats to a steady state. In the present study we find that trabeculae from the canine right ventricle demonstrate either HAR or anti-HAR, depending on the rate of stimulation, the calcium level, and the temperature. Higher calcium, higher temperature, and lower rate of stimulation produce either less HAR or more anti-HAR. When only temperature and rate of stimulation are varied, in each muscle there is a unique rate for each temperature above which HAR occurs and below which anti-HAR occurs.


Polyamine synthesis in liver and kidney of flounder in response to methylmercury.

The effect of methylmercury administration on polyamine synthesis was studied in the liver and kidney of the winter flounder (Pseudopleuronectes americanus). A single injection of methylmercury resulted in five- and sevenfold elevations of ornithine decarboxylase activity in the liver and kidney within 15 and 45 h, respectively. There were elevations of both putrescine- and spermidine-stimulated S-adenosylmethionine decarboxylase activities (approximately 1.5-fold) in both tissues. Evaluation of the polyamine accumulation patterns in these tissues indicated that in the liver all three polyamines increased in concentration until 48 h and then decline. In the kidney, the concentration of putrescine increased steadily until it was 200% of control at 72 h and then declined. Spermidine concentration decreased throughout the time studied and was 17% of control at 1 wk. There was no significant change in the concentration of spermine throughout the period studied. The changes in the polyamine pools and in the activities of the polyamine biosynthetic enzymes after methylmercury administration are consistent with an involvement of the polyamines in the recovery phase to a toxic dose of methylmercury.


Effects of peptide hormone structure on H+ secretion by Necturus gastric mucosa.

The actions of human synthetic gastrin I(G), the C-terminal tetrapeptide of gastrin (T), and the C-terminal octapeptide of cholecystokinin (OP) on acid secretion and transepithelial potential difference (PD) of the isolated Necturus gastric mucosa were determined. All three peptides induced H+ secretion, but the maximum H+ output was less with OP than with G or T. G and OP produced their maximum H+ output at lower molar concentrations than T. G- and OP-stimulated secretion was long sustained, but T-stimulated secretion rapidly returned to basal levels. T- and G-stimulated secretion was partially inhibited by the addition of OP. Evidence is presented that T rapidly disappears from solutions exposed to gastric mucosa, whereas G does not. Washing sensitized the mucosa to subsequent addition of T. The results suggest that the action of the common C-terminal tetrapeptide of G, T, and OP is modified by the preceding amino acid sequences, and that T, the smallest of the three peptides, is rapidly degraded by gastric tissue in vitro. The implications of the work for the study of gastrointestinal hormone structure-function relationships in isolated tissue preparations are discussed.


Effects of potassium depletion on control of breathing in awake rats.

Possible mechanisms for the variable ventilatory response to metabolic acid-base disturbances have been examined in normal and K-depleted rats. Ventilatory measurements are correlated with CSF acid-base data. The ratios VE/VO2 and 1/PaCO2 are utilized as indices of alveolar ventilation. The log of these indices correlates closely with CSF [H+] independent of [K+] except at very low CSF [H+] where the change in log 1/PaCO2 and log VE/VO2 per change in CSF [H+] is much diminished in low-K rats. This finding suggests the presence of an additional stimulus to breathing in the low-K rat opposing the inhibitory effect of low CSF [H+]. Otherwise the chemical control of ventilation appears to be normal. However, low-K rats always breath with a low-flight-Vt pattern and occasionally with abnormal rhythms. The similarity of the low K breathing pattern to that reported in awake animals with vagotomy and pneumotaxic center (PC) lesions suggests that the altered breathing pattern in depletion involves vagal and/or PC pathways. The similarity of the low-K breathing pattern to that observed with reserpine administration together with the known relationships of K and catecholamine metabolism lead to the speculation that K depletion alters breathing via an effect on central catecholamine metabolism. However, other mechanisms involving changes in membrane excitability and intracellular pH in K depletion might also be involved.


Renal responses of Australian lungfish to vasotocin, angiotensin II, and NaCl infusion.

The Australian lungfish (Neoceratodus forsteri) responds to intravenous injections of 0.63 ng/kg or more of arginine vasotocin with increased dorsal aortic blood pressure, inulin clearance, urine flow, and tubular rejection of Na+. Single injections of 1 ng/kg or more of angiotensin II or norepinephrine also increase dorsal aortic pressure but do not cause consistent diuresis and natriuresis, Continuous infusions of angiotensin II or repeated injections of norepinephrine produce sustained hypertension and more modest diuresis and natriuresis than are seen after injections of arginine vasotocin that cause less hypertension. Infusions of isosmolar or hyposmolar NaCl solutions increase blood pressure, inulin clearance, urine flow, and tubular Na+ rejection in a manner resembling the response to argininge vasotocoin injections. These data are consistent with the hypothesis that arginine vasotocin is released in response to volume expansion in lungfishes and that it may act on the kidney as a diuretic and natriuretic hormone. They do not rule out a more direct action of expansion on renal functions.


Renal sugar transport in the winter flounder. I. Renal clearance studies.

The renal handling of several sugars was examined using clearance techniques in the winter flounder Pseudopleuronectes americanus. The nonmetabolizable sugar alpha-methyl-D-glucoside was extensively reabsorbed, with consequent accumulation in renal tissue to nearly twice plasma concentration. Both glucose and phlorizin abolished reabsorption and reduced tissue-to-plasma ratios (T/P). D-Galactose was reabsorbed. However, the T/P for free galactose was only 0.6 (total sugar was 1.7). Glucose and phlorizin produced only a transient decrease in reabsorption and no change in T/P. 2-Deoxy-D-glucose showed neither net reabsorption nore secretion. Nevertheless, kidney T/P were inexcess of 6 for total sugar and 1.2 for free sugar, indicating entry through the peritubular face of the tubule. Neither glucose nor phlorizin altered 2-deoxy-D-glucose clearance, but both reduced T/P for total sugar (2.4) and free sugar (0.7). Thus, several systems govern the handling of these sugars at the luminal membrane of the renal tubule, just as has been previously demonstrated at the peritubular membrane in this species.


Renal sugar transport in the winter flounder. II. Galactose transport system.

The structural specificity of the transport of 0.5 mM D-galactose and 2-deoxy-D-galactose by teased renal tubules of the winter flounder Pseudopleuronectes americanus was investigated. The sugar uptake reflects preponderantly transport at the antiluminal membrane of tubular cells. Both sugars compete for the transport sites, indicating the sharing of a common carrier. 1) The structural requirements for the hexose-carrier interaction were defined by an inhibiton analysis using 12 structurally analogous sugars (5 mM): a (pyranose) ring structure; a free hydroxyl on C1; free hydroxyls (equatorial configuration) on C3 and C4; an oxygen on C6. Close packing in the vicinity of C2 is indicated. 2) Consonant with the requirement of a free C1-OH, beta-methyl-D-galactoside is not transported 3) Increasing concentrations (0.05-0.5 mM) of phlorizin and phloretin inhibit sugar uptake by lowering cellular levels of phosphorylated hexoses, whereas the levels of free sugars are not depressed. The possibility of an interaction of the sugar at C1-0H with a phosphorylated group at the carrier as the first step in the translocation process of both hexoses across the basal membrane is raised.


Alanine metabolism and gluconeogenesis in the rat.

The metabolism of alanine and several other gluconegoneic substrates was studied in anesthtized fed and fasted rats, i.e., rats with low and high rates of gluconeogenesis. Glutamine was released by the hindquarter (muscle) in both groups, whereas lactate, pyruvate, and alanine were taken up in fed rats and were released during starvation. Despite this, blood levels of alanine, lactate, and pyruvate were diminished in fasting rats, suggesting increased extraction by liver. Treatment of fasted rats for 24 h with phloridzin caused glycosuria and secondarily led to hypoglycemia and an intensification of the chargesobserved with fasting, i.e., hyperketonemia, hyperglucagonemia, and increased gluconeogenesis (assessed by urea N excretion). Blood alanine was decreased, even though the release of alanine from muscle was increased. Pretreatment with triamcinolone and administration of exogenous alanine both attenuated the hypoglycemia and ketosis, It is concluded that 1) in states of heightened gluconeogenesis, alanine release from muscle may not keep pace with extraction by liver and blood alanine decreases; 2) the release of alanine, lactate, and pyruvate from muscle parallel each other suggesting common control factors; and 3) in the red state muscle is an important site of lactate disposition.


Organic solutes in fluid absorption by renal proximal convoluted tubules.

Proximal convoluted tubules were dissected from rabbit kidneys and perfused with artificial solutions in vitro. The effect of various organic solutes on rate of fluid absorption and transepithelial voltage was tested by removing solutes from or adding them to perfusate and/or bath. Omission of albumin from the bath caused rate of fluid absorption to descrease 33% without any change in voltage. Omission of glucose, lactate, alanine, and citrate from the bath had no effect. In contrast, when they were removed from perfusate, rate of fluid absorption fell by 45-75% (depending on whether they were replaced by NaCl or mannitol and NaCl), and voltage (normally negative in lymen) decreased to near zero. Adding glucose or alanine individually to perfusate caused a small increase in rate of fluid absorption and a relatively large increase in voltage. alpha-Methyl-D-glucoside and cycloleucine (which are transported but not metabolized) had effects similar to glucose and alanine, except that voltage changes were not as great. Phlorizin (10(-5) M in perfusate) had the same effect as removing glucose from perfusate. When glucose and alanine were added to perfusate, epithelial cell swelled significantly. Lactate and citrate also caused rate of fluid absorption to increase when they were added to perfusate, but they did not affect transepithelial voltage nor did they cause cells to swell significantly. Possible mechanisms of these effects and the role of organic solutes in fluid absorption by proximal convoluted tubules are discussed.


Osmotic interaction of plasma proteins with interstitial macromolecules.

The osmotic interaction of plasma proteins with collagen and hyaluronate has been evaluated by measuring the oncotic pressure of mixed solutions of varying composition. Collagen, despite its insolubility, exhibits a pronounced volume exclusion effect on plasma proteins, and the oncotic pressure of mixed solutions is considerably higher than that of the plasma protein stock solution. The volume exclusion of collagen on small molecules such as sucrose is negligible. A solution composed of 1.6% plasma proteins, 20% collagen, and .4% hyaluronate in Ringer solution, approximating the composition of the interstitium, was found to yield higher oncotic pressures than those previously reported from the interstitium. The probable role of impurities and degradation in the isolation process is discussed. Results reported earlier from in vitro and in vivo studies indicated that tissue oncotic pressures are considerably higher than generally recognized and that tissue fluid is in probable osmotic equilibrium with lymph in skin and muscle.


Renal tubular reabsorptive response to hypernatremia.

Renal tubular reabsorptive response to rapid infusions of isotonic saline and 5% NaCl solutions were measured during brisk ethacrynic acid diuresis in anesthetized dogs. When adjustments were made for effects of variations in volume expansion, as indexed by plasma protein concentration ([Pprot]), tubular reabsorption of sodium per unit filtrate volume (TNa/GFR) was found to be significantly and positively correlated with plasma sodium concentration ([PNa]) despite hypernatremia and total body surfeit of sodium. The proportions of sodium and water reabsorbed were also homeostatically inappropriate, since the sodium concentration in the reabsorbate was somewhat in excess of that in contemporary plasma ultrafiltrate. These findings signify that glomerulotubular balance holds when the filtered load of sodium is increased by an increment in [pNa] as well as GFR. It is proposed that the moiety of tubular reabsorption (some 75% of GFR) studied here is more closely related to regulation of volume than of osmolality of sodium concentration, and the primary regulation exerted is on tubular volume reabsorption (bulk fluid reabsorption) rather than on the amount of sodium reabsorbed.


Subcellular membrane fatty acids of rat heart after cold acclimation or thyroxine.

Relative percent changes in fatty acid (FA) composition of heart mitochondria and microsomes from 30-day-warm-acclimated and cold-acclimated rats were determined by gas chromatography. Rats in both environmental groups received thyroxine (T4) (1 mg/kg per day) or propylthiouracil (PTU) (5 mg/rat per day) for 10 days prior to sacrifice. Mitochondrial total unsaturated fatty acids (TUFA) decreased in cold-acclimated rats relative to warm-acclimated controls but not in cold-acclimated animals receiving PTU. In mitochondria of the T4-treated warm-acclimated group, the relative content of linoleate decreased and that of stearate increased. Heart microsomes from warm-acclimated rats receiving T4 showed large increases in the percentage content of palmitate and stearate accompanied by reductions in linoleate and arachidonate. In cold-acclimated control rats, the relative content of stearate was elevated in both membrane fractions. The results suggested that thyroid hormones may decrease the TUFA composition of heart subcellular membranes by a relative increase in percent stearic acid and decrease in percent linoleic acid. Similar FA changes in these membranes in cold-acclimated rats may be related to the action of thyroid hormones.


The identification and treatment of adult brain dysfunction.

The authors hypothesize that adults who have had minimal brain dysfunction as children constitute a distinct diagnostic entity, adult brain dysfunction (ABD), which may exist alone or with a variety of other psychiatric syndromes. Patients with ABD share a basic impairment in ability to focus attention effectively; they may have different personality structures, symptom complexes, and behavioral patterns. However, with medication that corrects this impairment, remarkable improvement in the presenting symptoms and in the ability to work in therapy may occur, leading to changes in personality structure and behavior.


Reversal of tricyclic-overdosage-induced central anticholinergic syndrome by physostigmine.

Although there is evidence that the delirium, stupor, coma, and seizure-like activity seen in overdosage with tricyclic antidepressants and antiparkinson drugs are due to the central anticholinergic activity of these agents, patients with overdosage of these drugs are still frequently misdiagnosed. The authors present a case of reversal of anticholinergic-drug-induced prolonged coma, myoclonus, and choreoathetosis by physostigmine. This report supports the anticholinergic basis of the clinical manifestations of such overdosages, provides information on the role of acetylcholine and dopamine in psychiatric and movement disorders, and illustrates dramatically the need for accurate diagnosis and treatment.


Marijuana and hostility in a small-group setting.

The authors used several indices to assess the relationship between marijuana and hostility as both inner affect and verbal behavior in a small-group setting. Marijuana subjects reported a small but statistically significant decrease in hostile feelings after the introduction of a frustration stimulus. They also showed significantly less verbal hostility than placebo subjects both before and after introduction of a frustration stimulus. The authors note that research findings on marijuana and hostility are not consistent and suggest a multidetermined relationship based on dose, environment, nature of the frustration stimulus, and intraindividual factors.


The treatment of anorexia nervosa.

The authors report on their treatment of 32 young patients with severe anorexia nervosa who had lost an average of 37% of their original body weight. The therapeutic approach, conceived to meet both the physiological and the psychological needs of the patients, was carried out in a psychiatric unit for adolescents in a general hospital and involved separation of the patient from his or her family, treatment of the malnutrition, individually planned psychotherapy, and concurrent work with the family. The importance of accepting the patient's uniqueness, maintaining long-term contact, and encouraging the patient's striving toward constructive growth and autonomy is emphasized.


Neuropsychological and EEG disturbances in polydrug users.

EEG and neuropsychological evaluation of 66 polydrug users revealed that 43% had EEG abnormalities and 45% had neuropsychological impairment 3 weeks after admission to a polydrug study unit. At 5-month follow-up, 27% of 30 retested subjects were still impaired neuropsychologically. Impairment may be related to extensive involvement with sedatives, alcohol, or heavy polydrug use. The authors suggest that cerebral dysfunction in polydrug users might be the result of organicity of intermediate duration and that deficits may be experienced by some beyond 5 months of reduced use or abstinence. Organicity may dictate structured, reality-based intervention techniques, especially early in treatment.


A description and evaluation of an outpatient intensive psychotherapy center.

The intensive psychotherapy center described and evaluated in this paper is unique because of its intensity and the fact that available treatment modalities are integrated into the program. Pateints are literally immersed in therapy on a full-time basis for an average of 3 weeks. Assessment of the program through the use of questionnaires completed by 335 patients at the time of discharge showed significant improvement in their presenting symptoms, interpersonal relationships, ability to work, and general level of comfort. An 8-month follow-up study of 171 patients revealed that this improvement was retained.


Quality-of-care standards and professional norms.

Incursions upon professional prerogatives are increasing with the advent of new requirements for accoutability; this has stemmed in part from the government's enlarged role in paying for mental health services. The author discusses the effect of professional norms on the assessment of quality of care, including the concepts of risk and autonomy, observability and privacy, the perspective of time, and the appropriateness of the penalty. He offers some suggestions for the design and implementation of quality-of-care standards that he believes will benefit both professionals and administrators, as well as protect the patient.


Mental health services in the public and private sectors.

Analysis of data on mental health service providers indicates that in 1971 the private sector accounted for 34% of inpatient days, 86% of outpatient visits, 44% of expenditures by source of funds, and 51% of expenditures by receipt of funds. The author believes that mental health professionals must familiarize themselves with the economic interests influencing national health insurance proposals and with public policy making processes if they are to help preserve appropriate roles for the public and private sectors in mental health service delivery.


Utilization of prepaid services by patients with psychiatric diagnoses.

The authors document and discuss the utilization of psychiatric services in a rural group practice before and after the institution of a prepaid health plan. They found that the utilization of psychiatric services increased dramatically during the first year of the plan's operation. The increase in outpatient utilization continued throughout the 3 years studied, but inpatient utilization decreased after the first year and later reached a level lower than that seen before the plan was instituted. One possible reason for the decline in inpatient utilization is that increased outpatient care prevents hospitalization.


Milieu therapy: toward a definition for reimbursement.

The authors identify certain essential elements and processes within the milieu therapy approach that could provide the basis for reimbursement of this treatment modality under insurance. They also examine a philosophical framework, various guidelines, and a mechanism for accountability in the use of this form of treatment.


Psychotherapy fees and residency training.

Many residents in psychiatry tend to ignore their patients' attitudes and behavior concerning payment of fees for psychotherapy. The authors report on a new fee policy program designed to earn additional revenue for a low-fee outpatient psychotherapy clinic; they stress the therapeutic importance of resident and patient attention to fee-related issues.


Albinism and schizophreniform psychosis: a pedigree study.

The author presents a pedigree study of albinism associated with schizophreniform psychosis and concludes that the evidence of an association between the two traits is strong; the evidence for genetic linkage is suggestive. The pineal hormone melatonin and the melanocyte-stimulating hormone inhibitory factor may be etiologic determinants of psychosis associated with albinism.


Anticholinergic exacerbation of phenothiazine-induced extrapyramidal syndrome.

The authors used tremography to record the bilateral digital tremor of a patient showing extrapyramidal system effects in response to withdrawal from phenothiazines. They found that changes in the amplitude of tremor correlated with clinical ratings of extrapyramidal disturbance. Changes in the amplitude and in the spectrum of tremor were similar to the bipolar paradoxical changes seen during intoxication with an anticholinergic psychotogen.


Rapid treatment of acute psychosis.

Twenty-four patients with acute functional psychoses were treated with intramuscular haloperidol in a three-hour period. There was almost complete remission of cardinal symptoms (thought disorder, hallucinations, and delusional activity) in this period for 11 patients. Acute dystonia, easily reversed, was the only significant side effect. The authors therefore suggest that outpatient management may be feasible and preferable in the treatment of some acute psychotic episodes.


Attitude of psychiatric residents toward patient requests.

The authors assessed residents' comfort in dealing with 14 previously identified types of patient requests in inpatient, outpatient, and acute service settings. First-year residents expressed significantly more discomfort than more experienced residents on 11 categories. They were also significantly less comfortable in the acute service than the inpatient setting. All residents expressed more comfort dealing with dynamic, psychological, and "nonsevere" requests. These findings suggest a need to teach residents specific therapeutic responses to various categories of requests and to evaluate the desirability of starting the residency experience on an acute service.


Treatement of excessive weight gain in patients taking lithium.

Six female primary affective disorder patients who had gained an average of 9.5 kg while taking lithium lost an average of 2.9 kg on a 10-day 900 calorie a day hospital diet containing 100 mEq of sodium per day. No evidence of lithium toxicity was observed on this regimen. There was no evidence that fluid retention played a major role in the weight gain.


Difficult issues in health planning, development, and review.

To give an overview of the kinds of issues expected to be encountered by the new Health Systems Agencies being established in conformity with Public Law 93-641, the authors draw from the experiences of the Comprehensive Health Planning agency and Regional Medical Program of an Upstate New York area. Problems faced together in the years 1972 to 1975 in health planning, development, review, and public policy are described. The unusual geographic and working relationship of these agencies makes them, together, a useful prototype of the HSA to examine.


A Bayesian approach to health project estimation.

This paper illustrates how a Bayesian statistical approach was used to estimate the outcomes of the National Tuberculosis Program in India. Such an estimate, it is argued, is necessary for a proper judgement about a project's social usefulness. The process of medical care delivery is reduced to a set of conditioned probabilities. The numbers are estimated using as source material medical records, the results of medical research, and the opinion of experts. Bayesian methods of estimation are used and their value is discussed. The final discussion contains a brief treatment of the role of project analysis in public decision making. The place of Bayesian methods in project analysis is briefly illustrated, demonstrating their operational value in the field of public health decision making.


Nursing assessment in industry.

In order to be able to offer nursing service to industry, a community health agency must have some knowledge of the industry and the daily problesm faced by both management and worker. The nursing process can serve as a framework for the gathering of necessary information and planning of sound care. The five-step nursing process, which includes assessment, diagnosis, planning, implementation and evaluation, is discussed and annotated model Assessment Guide for Nursing in Industry is given (Appendix A). The six areas from which information should be gathered when assessing an industry are the following: I. The community in which the industry is located: II. The industry, its historical development, policies, and projections; III. The plant or physical structure; IV. The working population; V. The industrial process of the plant; VII. The existing health program. Once the assessment is completed and a diagnosis formulated, services can be offered based on specific, defined needs.


Efficacy information in contraceptive counseling: those little white lies.

Various procedures for estimating the effectiveness of a method of contraception have been devised. These measures, in turn, have been used in populations which differ widely in their propensity to use contraceptives properly. Therefore, a wide array of failure rates is available in the family planning literature. Unfortunately, because of differences in measurement and in choice of population, a random selection of these reported failure rates will not produce a consistent ordinal or cardinal ranking of methods by their effectiveness. Moreover, such a wide variety or reported rates permits the family planning practitioner to choose selectively in order to maximize the attractiveness of his favorite method(s). By surveying family planning personnel in two major cities, we found that they do indeen appear to place the methods they actively dispense in an extremely favorable position. Specifically, they are biased against the traditional contraceptives, foam and the condom. In this paper, we discuss the theoretical underpinnings of the measurement of effectiveness, report the apparent bias in the levels of contraceptive effectiveness reported to the patient, and finally, recommend a procedure for eliminating the jumble of rates in the literature and the consequent confusion among family planning personnel.


Applications of a job classification system in occupational epidemiology.

An occupational preventive medicine program attempts to control exposure so workers experience no detrimental effect on health. In a chemically complex industry, the definition of exposure is difficult because of the many different chemicals used and produced, the many different jobs and processes with qualitatively different exposures, and the movement of workers from job to job. Jobs have therefore been grouped on the basis of process or product into functionally homogeneous categories called occupational titles (OT's). Work experience can now be quantified independent of exposure (or by the dominant toxicants in each OT) and compared to health outcomes. Examples are discussed of the application of OT's to studies of the mortality and morbidity experience in the rubber industry, and the development of dose-response relations.


Radiation therapy among A-bomb survivors.

Survey of hospitals and clinics where atomic bomb survivors and their comparisons reported having received radiation therapy confirmed that 137 were so treated. The malignancies of five subjects were possibly related to their earlier radiation therapy rather than their atomic bomb radiation exposure, stressing the importance of recording all medical X-ray exposures as a potential variable in epidemiological studies of cancer etiology.


The use of utilization review records as a source of data on nursing home care.

Data form the Utah nursing home Utilization Review Program, 1970-73, provide a description of the population of nursing home patients in Utah and changes over time in patient medication and measures of activity. These data are analyzed according to type of care in home: personal, intermediate, or comprehensive. The collection of data in utilization review programs can help to evaluate the quality of care as well as appropriateness of placement, provided the information collected is designed with these ends in mind.


Communication, compliance, and concordance between physicians and patients with prescribed medications.

Forty-six practicing physicians and 357 patients with diabetes mellitus or congestive heart failure were the subjects for this study, which focuses on the impact of medication regimen and doctor-patient communication in affecting patient medication-taking behavior and physician awareness of these behaviors. Four types of medication errors were defined: omissions, commissions, scheduling misconceptions and scheduling non-compliance. The average error rates were 19 per cent, 19 per cent, 17 per cent and 3 per cent, respectively. The combined average error was 58 per cent; scheduline non-compliance on the part of the patient was a minor component. Specific aspects of the medication regimen were associated with increased errors: (1) the more drugs involved between the doctor-patient pair, the greater the errors of omission and commission; and (2) the greater the complexity of the scheduling, the greater the errors of commission and scheduling misconceptions. If the patient did not know the function of all his drugs, errors of commission and scheduling misconception increased. Neither characteristics of patients nor the severity of disease were influential in determining the extent of medication errors. For patients with congestive heart failure, good communication of instructions and information from physician to patient was associated with low levels of all types of errors.


Racial difference in incidence of ABO hemolytic disease.

In this review of 7,464 consecutive infants born at North Carolina Memorial Hospital, hemolytic disease from ABO incompatibility was found to be two to three times as common in black infants as in white infants. The statistical significance of the difference remained high as more restrictive criteria for ABO hemolytic disease were applied. ABO disease, serious enough to cause an indirect serum bilirubin of 15 mg/100ml or higher, had an incidence in black newborns as great as the incidence of Rh hemolytic disease in whites. In contrast, the general prevalence and severity of hyperbilirubinemia was not found to be higher in black newborns than in white infants. The difference cannot be attributed to differences in the prevalence of ABO blood groups between the two races. Policies of early discharge of newborns could be affected by the finding that ABO erythroblastosis is two to three times as common in black infants as in white infants.


Estimates of motor vehicle seat belt effectiveness and use: implications for occupant crash protection.

Estimates of the effectiveness of seat belts, when used, in reducing motor vehicle occupant deaths vary widely. A recently publicized claim by one analyst that seat belts reduce vehicle occupant deaths 70-80 per cent is based on studies found to contain fundamental systematic error. Deaths occur only 50 per cent less often to belted compared to nonbelted vehicle occupants in crashes, according to previously unanalyzed data from three U.S. states during recent years. New belt systems would be about 60 per cent effective with 100 per cent use. But surveys of observed belt use in 1975 U.S. cars indicate that two-thirds of drivers were not using belts. Prospects for widespread adoption and enforcement of belt use laws in the U.S. are not encouraging. Substantial reductions in fatal and other injuries would result from the adoption of requirements mandating automatic (passive) protection for front seat occupants in crashes with forward decelerations.


Dental visits by income and race in ten urban and two rural areas.

Household surveys in 12 low income areas found large differences in dental visit rates after control for income and race. The dental visit rate for Red Hook (NYC) exceeded the national rate whereas in seven of the areas the rate was below national averages by 40 per cent or more. The ranges in dental visit rate for low income Blacks was from two-thirds the national rate (in two areas of the South) to two to three times greater than the comparable national rate (in three areas of the Northeast). Lesser but nevertheless large variations among area dental visit rates existed for other race and income groups.


Trends in intravenous drug abuse as reflected in national hepatitis reporting.

A procedure for obtaining an indicator of trends in illicit intravenous (I.V.) drug use-a form of drug use which is very harmful and difficult to measure-has been developed using national hepatitis surveillance data. Hepatitis reports are separated into two groups: one containing mostly cases related to transmission via I.V. drug use and the other containing cases related to transmission via personal contact and blood transfusion. The analysis of ten years of national hepatitis reporting (1966 to 1975) shows an almost ten-fold rise in drug-related hepatitis cases from 1966 to 1972. In the last three years the number of cases has declined but remains substantially greater than the pre-epidemic levels. The rise in I.V. drug-related cases began in the 1960's among minority groups living in the center cities of the East and West Coasts and spread during the 1970's into the suburbs of these cities and into metropolitan areas throughout the United States. Limitations of this indicator of I.V. drug use relate to the characteristics of the surveillance system and to the underlying relationship of hepatitis to I.V. drug use.


Brucella canis infectivity rates in stray and pet dog populations.

A serological survey of 200 healthy, mature dogs was made to determine Brucella canis infectivity rates. The 9 per cent rate reported in the stray dogs was significantly higher (0.05 less than P greater than 0.025) than the 1 per cent rate found in pet dogs. These rates coupled with a predictably growing stray dog population have patent zoonotic implications.


Suprascapular neuropathy in the differential diagnosis of rotator cuff injuries.

Four cases of suprascapular neuropathy treated by nonoperative means have been presented. Complete recovery occurred in all four. The anatomy of the suprascapular nerve and probable mechanisms of injury secondary to traction have been discussed. The importance of electromyography in diagnosis has been stressed. Longer periods of nonoperative treatment are recommended here than by previous authors. Since the lesion is felt not to be an entrapment phenomenon but, rather, a traction injury, operative treatment should consist of release of the nerve at the notch to reduce the possibility of further traction injury, and a neurolysis should be done as well.


Achilles tendonitis in runners: a report of five cases.

Achilles tendonitis is a significant disability in the runner and may often cause runners to lose an entire season of competition. The exact pathophysiology of the problem is uncertain. However, it is the belief of the authors that Achilles tendonitis in the runner often represents a microscopic tear in the tendon which, if not adequately treated, may lead to a macroscopic tear. We recommend surgical treatment in those patients with chronic symptoms who have not responded to conservative measures.


An evaluation of the Elmslie-Trillat procedure for management of patellar dislocations and subluxations: a preliminary report.

The Elmslie-Trillat procedure involves lateral retinacular release, medial capsular reefing, and medial transposition of the anterior tibial tubercle hinged on a distal periosteal attachment. It is an easily performed procedure and is an excellent method for realignment of the extensor mechanism in cases of dislocation and subluxation of the patella. In our series of 52 cases with 6-24 months postsurgical evaluation, 46 cases, or 88 percent were rated as good or excellent. It must be emphasized that this technique is used only if the epiphyseal plates are closed.


A dynamic method of repair for acute and chronic acromioclavicular disruption.

The authors have presented a surgical procedure for disruption of the acromioclavicular joint with or without fracture of the lateral end of the clavicle. The results of the dynamic repairs have been excellent with restoration of stability and normal strength in all cases. The majority of this group were vigorous young high school college and professional athletes prior to their injury and all were returned to their previous activities.


Therapeutic evaluation of oxantel pamoate (1, 4, 5, 6-tetrahydro-1-methyl-2-[trans-3-hydroxystyryl] pyrimidine pamoate) in severe Trichuris trichiura infection.

The efficacy of oxantel pamoate (1, 4, 5, 6-tetrahydro-2-[trans-3-hydroxystyryl]-1-methyl pyrimidine pamoate) was evaluated in 25 children with severe Trichuris infection. The presence of chronic dysentery and sigmoidoscopic demonstration of whipworms in the intestinal mucosa were the criteria for inclusion in the trial. Most of these patients had severe anemia, rectal prolapse, digital clubbing, hypoproteinemia, and growth retardation. There were a high incidence of concomitant parasitism with other intestinal helminths and with Entamoeba histolytica and Giardia lamblia. Sigmoidoscopic grading of Trichuris load and egg count in the feces were carried out prior to treatment and 2 days after each course of oxantel therapy. Oxantel was administered at a dose of 10 mg/kg body weight twice daily for a 3-day course. Satisfactory response, as judged by relief of dysentery and absence of whipworms from the mucosa at sigmoidoscopy, was achieved in 17 patients after the first course and in the remaining 8 patients after a second course of oxantel. The drug was well tolerated and no side effects were noted during or after treatment. It is concluded that oxantel is a safe and effective anthelmintic for severe clinical trichuriasis.


Mebendazole in treatment of severe Trichuris trichiura infection in Malaysian children.

Children with severe Trichuris trichiura infection pose significant social, clinical, and therapeutic problems in Malaysia. Thirty such children were investigated, and mebendazole was found to be safe and effective in the treatment of severe trichuriasis but it had to be given for a longer period than currently recommended. A poor correlation was found between egg load and worm burden in these children. Direct visualization of the rectal and colonic mucosa was the most reliable method of assessing severity in untreated cases, and response to treatment. The eggs of Trichuris that had been exposed to mebendazole were morphologically altered and not viable when incubated. This may be of considerable epidemiological importance.


Effect of inoculum size and length of infection on the distribution of Toxocara canis larvae in the mouse.

The effect of inoculum size and time on the distribution of Toxocara canis larvae in the mouse was investigated by recovering larvae from various body regions 7, 14, 28, and 56 days after administration of either 200, 600 or 1,000 infective eggs to groups of ten male mice. An analysis of variance of larval recoveries from the carcass, liver, brain and cardiopulmonary system suggests that inoculum size was a significant factor determining the proportional recovery for each of these sites. Length of infection was significant in relation to numbers of larvae in the anterior carcass, genitourinary system, brain and heart plus lungs, while length of infection and inoculum size acting in concert influenced the numbers of larvae recovered from the carcass, liver, brain, heart and lungs. Crowding effects, manifested as altered dispersion rates, were seen in the heavier infections.


Immunoglobulin E: raised levels in sera and pleural exudates of patients with paragonimiasis.

Serum IgE concentrations of patients with paragonimiasis were determined by a radioimmunosorbent test. The mean concentration was 3,462.3 IU/ml in a group of 13 cases of paragonimiasis miyazakii in which patients showed clinical symptoms and/or positive immunological diagnostic tests, and 1,026.6 IU/ml in a control group of 13 individuals who had eaten uncooked freshwater crabs, Potamon dehaani, but had been found to be free from the infection. Moreover, the IgE level of the pleural exudates obtained from four patients with paragonimiasis miyazakii on the day of bleeding or within several days after was significantly higher than that of their sera, ranging between 4,200 IU/ml and 10,000 IU/ml. This was true also in a case of paragonimiasis westermani. Sera and pleural exudates of patients with both forms of paragonimiasis were applied to immunosorbent columns of Sepharose 4B beads coupled with saline extracts of Paragonimus miyazakii, P. weetermani, or P. ohirai. IgE eluted from the corresponding column was considered to be specific, being around 5% to 10% of the total IgE.


Schistosomiasis in the Gorgol Valley of Mauritania.

Schistosomiasis may be increasing in West Africa due to the development of water-resource projects which were given a strong impetus by the disastrous Sahelian drought. This report concerns the existing epidemiology of schistosomiasis in West Africa for the Fourth Region of Mauritania, along the Gorgol River. In this area two reservoirs are proposed, to supply a new rice irrigation system. During May and November 1974, field surveys were made to determine the prevalence and intensity of schistosomiasis, and the relevant species of snails. The surveys were made as a basis for designing the irrigation systems to minimize transmission. The only snails found in the area were two species of Bulinus; therefore, the human population was tested for Schistosoma haematobium. A high prevalence of schistosomiasis was found in M'Bout, the town nearest the proposed reservoir at Foum Gleita. Prevalence rates were lowest in Kaedi near the confluence of the Gorgol and Senegal rivers. During the period between the first and second survey the incidence rate among children in M'Bout became very high (68%), probably because of increased water contact related to the rains that broke the long drought in August 1974.


Tissue degradation of calcific Schistosoma haematobium eggs.

Calcific eggs of Schistosoma haematobium were separated from an inactive sandy patch in a cystectomy specimen from an Egyptian farmer; the purified egg suspension was injected into tail veins of inbred mice, some of which were killed immediately and some at intervals of 1, 2, 11, 14, 30, 90, 120, 180, and 365 days. Lungs were examined by tissue digestion and histologic analysis. Calific egg burdens decayed in an exponential manner (eggs/g of lung tissue = 284.9e-0.001x where e = natural log and x = time in days), with a loss of 5,610 eggs/g of lung tissue, i.e., 98% reduction over the year of the experiment. Histologic examination revealed that calcific S. haematobium eggs incited a typical granulomatous reaction as they decalcified.  Compared with viable egg granulomata, the response to calcific eggs was accelerated in onset, of lesser magnitude but persisted longer. Small numbers of calcific eggs persisted for at least 1 year after injection of either viable or calcific eggs. It is concluded that despite the apparent lack of tissue reaction to calcific eggs in chronic bladder lesions, these eggs are not antigenically exhausted foreign bodies. Moreover, it is shown that calcific eggs are degraded in significant numbers by mammalian tissue.


Hycanthone dose-response in treatment of schistosomiasis mansoni in St. Lucia.

Clinical trials of hycanthone (single intramuscular dose) were undertaken in schistosomiasis mansoni patients in St. Lucia at five dose levels: 3.0, 2.5, 2.0, 1.5, and 1.0 mg/kg body weight. The most common side effect, vomiting, decreased in frequency from 51% at the highest dose to 3% at the lowest; minor side effects showed a similar trend. Three fecal specimens were examined before and at 6 months after treatment by qualitative, quantitative, and hatching techniques. All dose levels caused reductions in egg excretion of 89 to 98%. Rates of cure (absence of eggs by all three methods) according to dose (descending), pretreatment egg output (0-19, 20-49, 50-399, 400+ eggs/ml feces), and age (0-7, 8-14, 15-29, 30+ years) were analyzed to estimate the effect of each variable if the others had been constant. For dose, the standardized percentage success rates were 53.9%, 62.0%, 51.2% 54.0%, and 27.4%; for egg output, 67.0%, 51.8%, 43.2%, and 21.7%; and for age, 25.2%, 34.5%, 59.3% and 57.4%. Logit regression analysis shows a significant difference in cure rate (a) between the lowest dose and all others, among which latter there was no difference, (b) between patients excreting 0 to 49 eggs/ml before treatment and those excreting 50+ eggs/ml, and (c) between the age groups 0 to 14 and 15+ years. All dose levels caused some regression in enlargement of liver or spleen. A dose of 1.5 to 2.0 mg/kg body weight is considered to be as effective as one of 3.0 mg/kg and more acceptable for a control program because of the marked reduction in side effects.


Relation of intensity of infection to disease in hamsters with acute schistosomiasis mansoni.

Groups of young hamsters were exposed to 3, 20, 40, 80, or 160 cercariae. A highly significant correlation was observed between the number of cercariae, worm burdens, and liver and fecal egg counts. The most heavily infected animals were the first to lose weight and die. Hamsters exposed to 20 or more cercariae and harboring a mean of 4.2 or more worm pairs developed significant hepatosplenic disease by 10 weeks after infection as assessed by hepatomegaly, splenomegaly and the development of portal hypertension. Lightly infected animals with single worm pairs did not develop significant disease.


Anti-liver antibody in rabbits infected with Schistosoma japonicum.

Anti-liver antibody has been demonstrated in the sera of Schistosoma japonicum-infected rabbits. By the 8th week after exposure to cercariae, perceptible levels of autoantibody were present and appeared to be direct predominantly determinants located in the cell membrane of the hepatocyte.


Evaluation of immunodiagnostic techniques for the detection of human hydatid cyst carriers in field studies.

In a study of 662 sera from a hydatidosis endemic area, the indirect hemagglutination test based on a minimal nonspecificity criterion of positivity and the latex agglutination (LA) test were found to be suitable screening techniques for the detection of sera positive to the arc 5, diagnostic of hydatid infection. The lower nonspecificity of the LA test, its greater simplicity and its excellent correlation with the immunoelectrophoresis test suggest that it is the choice screening technique for use in field surveys or seroepidemiologic studies of hydatid disease. The advantages and limitations of this serologic approach for the detection of human hydatid cyst carriers in field studies are discussed.


Bubonic plague from direct exposure to a naturally infected wild coyote.

An 11-year-old boy developed axillary bubonic plague and plague meningitis 3 days after skinning a dead coyote near Albuquerque, New Mexico. The coyoto carcass was recovered 10 days later, and Yersinia pestis was isolated from spleen and marrow of the animal. This is the first report of human plague from exposure to a coyote. A review of experimental and epidemiologic studies suggests that severe plague infection in members of the family Canidae is unusual, and that the risk of acquiring plague from direct contact with coyote tissues is minimal. Nevertheless, certain precautions are outlined for persons working with wild coyotes.


Experimental alimentary infection of anole lizards (Anolis carolinensis) with Mycobacterium ulcerans.

Pathogenic Mycobacterium ulcerans were recovered from the stool of anole lizards up to 11 days after inoculation by stomach tube. M. ulcerans was isolated from the liver of 3 of 20 lizards and acid fast bacteria were seen in the mucosa of intrahepatic bile ducts in 2 of these 10 weeks post-inoculation. These results provide equivocal support for our hypothesis that herpetofauna are a reservoir of infection with M. ulcerans.


Sickle cell trait, hemoglobin C trait, and Burkitt's lymphoma.

In a controlled study in Ghana, the hemoglobin electrophoretic pattern in 112 patients with Burkitt's lymphoma was compared to that of their nearest neighbor controls of the same age, sex, and tribe, as well as their sibling controls. Analysis of the data obtained did not show any statistically significant protective advantage for sickle cell trait against Burkitt's lymphoma. Hemoglobin C trait appeared to offer a slight protective advantage (p less than 0.1), but this did not reach statistical significance. These results do not disprove the malaria co-factor hypothesis in the etiology of 0urkitt's lymphoma, but deprive it of an additional indirect evidence in its favor.


Relation of mosquito density to bird: mammal feeding ratios of Culex tarsalis in stable traps.

Stable traps, each baited with a jackrabbit and either a chicken or a pheasant, collected more than 21,000 mosquitoes in the Sacramento Valley, California, in 1972 and 1973. The focus of interest was the feeding behavior of Culex tarsalis, a primary vector of encephalitis viruses. Generally, feeding success was less and feeding rates on the jackrabbit were greater when larger numbers of mosquitoes were collected, or when a bird was exposed that was less receptive to mosquito feeding. Greater feeding rates on the jackrabbit apparently resulted from decreased feeding on the avian host and from diversion of mosquitoes to the jackrabbit. Figures are given that show how changes in feeding rates on birds affect the probabilities that a mosquito that feeds twice would feel both times on a bird, or on a bird and then on a mammal. Relatively small collections of nine mosquito species other than C. tarsalis revealed distinct species differences in feeding behavior. Aedes malanimon showed a preference for jackrabbit, which is relevant to its role as a vector of western equine encephalitis and California encephalitis viruses.


Autopsy analysis of disease frequency in Kinshasa, Republic of Zaire.

Between July 1973 and December 1974, 304 autopsies were done at Hopital Mama Yemo, Kinshasa, Republic of Zaire. The causes of death and sudden death were tabulated and analyzed. The frequency of various diseases and groups of diseases among all the individuals and a large subset of individuals who died traumatically are tabulated and discussed. The present report is the most quantitative, albeit only, current estimate of mortality and prevalence of diseases in Zaire.


Brugia malayi in a cervical smear.

A microfilaria, identified as that of Brugia malayi, was found in a routine cervical smear from a healthy, 38-year-old female Malaysian aborigine.


Evaluation of the slide-latex agglutination and intradermal (Casoni) tests for echinococcosis.

Fifty-one patients with surgically proven hydatid disease were examined with the intradermal (ID) (Casoni) and latex-agglutination (LA) tests. Before surgery, results of the former test were 80.4% positive and of the latter were 82.3%. For 105 persons who were diagnosed free of hydatid cysts by surgical, clinical and serological observations, 6.7% were positive with the ID test and 4.8% with the LA test. The close agreement between results obtained with the LA and ID tests in this selected group of patients suggests that the LA test merits further evaluation as a diagnostic tool.


Effects of Ascaris infection of nutritional status in children.

The nutritional status of 30 children infected with Ascaris lumbricoides was compared with that of 30 uninfected controls matched for age, race, sex, and family income. Statistically significant evidence of an adverse effect of ascariasis on serum albumin levels and plasma vitamin C levels was found, but no child had inadequate levels of these nutrients. Suggestive evidence of an adverse effect of the infection on weight for height and on riboflavin nutriture was also found. There were no significant differences between infected and control children with respect to seven other laboratory measurements.


Anisakid larva from the throat of an Alaskan Eskimo.

An anisakid nematode, identified as Phocanema sp. fourth-stage larva, was "pulled" from the throat of a 46-year-old Alaskan Eskimo. The nematode is described and illustrated.


Strongyloides fulleborni-like infections in man in Papua New Guinea.

During the course of a survey of intestinal parasites among the inhabitants of villages along the Fly River in the Kiunga region of Papua New Guinea, eggs of a Strongyloides species were found in the feces of several persons. In subsequent studies, 93 (17.8%) of 520 persons examined from five villages were found to be infected with this parasite. The examination of parasitic and free-living stages of the worm revealed that it is very similar to S. fulleborni, a parasite of monkeys, baboons and apes in Africa and Asia, although a definitive identification could not be made with the material available. Since non-human primates have apparently never inhabited New Guinea, the origin of these S. fulleborni-like infections is unknown.


Serum glycoproteins in schistosomiasis.

Serum glycoprotein electrophoretic fractions as well as protein bound hexose and seromucoid levels were measured in 21 male Egyptian patients before and after treatment for schistosomiasis, and in 8 normal controls. Results indicate that alpha1 and gamma-glycoprotein were significantly higher while beta-glycoprotein was lower in bilharzial patients than in controls. Protein-bound hexose and seromucoid levels were also significantly elevated in the patients. After treatment, the levels of these fractions approached those of the controls.


Chemotherapy of  hydatid disease (Echinococcus granulosus) in mice with mebendazole and bithionol.

We treated female Swiss Webster mice with heavy, long standing infections of Echinococcus granulosus with mebendazole, 50 mg/kg body weight daily for 10 days and bithionol, 70 mg/kg every other day for four doses. Necropsy performed 6 weeks after completion of therapy showed no gross or histologic differences between untreated controls and bithionol-treated mice or their cysts. Mebendazole-treated mice had a significant decrease in the total number of cysts (15 vs. 100), with many of those present being ruptured. Electron microscopy of intact, mebendazole-treated cysts revealed a marked increase in vacuolization and disarray of the distal cytoplasm, dilated and degenerating microtubules, increase in the size and number of lysosomes, a decrease in the number of normal appearing golgi, and increased density of mitochondria. Several mice died shortly after the termination of mebendazole therapy, all with ruptured cysts. Due to the large volume of the cysts, the presumed cause of death was acute volume overload, but toxic or anaphylactic reactions could not be excluded. We suggest that any proposed chemotherapy of humans with hydatid disease be done cautiously, with careful monitoring.


Epidemic influenza in a hill tribe of northwest Thailand.

An investigation of an epidemic of respiratory disease in a remote region of northwest Thailand revealed Influenza A/H3N2 as the etiologic agent. This epidemic would not have been recognized were it not for an unusual increase in respiratory disease following a meeting attended by residents of many villages. The influenza strains isolated most closely resembled A/Port Chalmers/1/73 when tested by hemagglutination inhibition but showed consistent antigenic differences when tested by quantitative neutralization. It is suggested that the differences noted between this strain and influenza viruses isolated elsewhere may have been due to the sequential transmission of influenza through partially immune people.


Endemic rabies in Ghana. Epidemiology and control measures.

Rabies is well established in Accra and there has been no decline in canine or human cases during the past 5 years. In the first 6 months of 1975, canine cases almost doubled over the period average. So far dogs are the only confirmed carnivorous vector in Ghana. A clear seasonal peak exists, so that intervention efforts can be times to achieve a maximum impact. Persons at greatest risk of contracting rabies are males and school-aged children, who need improved educational and post-dog bite services. The fundamental issue for health policy is to achieve a proper balance between environmental, preventive and treatment aspects of rabies. The report describes problems with logistics, canine vaccine shortage and failures, lack of owner cooperation, and control of a large stray dog population. Several proposals to improve coordination and organization of control programs are suggested.


Epidemiology of an outbreak of head lice in Georgia.

An outbreak of head lice infestation (pediculosis) occurred in elementary school children in Barrow County, Georgia, in January 1974. An investigation was initiated to define the magnitude of the outbreak, determine factors that contribute to transmission, and disseminate information on control. All elementary school children in the county were examined for head lice and answered a questionnaire. Fifty-three (3%) of 1,783 white pupils were infested, but none of the 500 black pupils was infested. Distribution of infestation in the white pupils was influenced by grade, bed-sharing, socioeconomic status, infestation of other family members, crowding in the home, and family size; distribution was not influenced by hair length or the sex of the pupil. Recommendations for control based on the results of the investigation included procedures for identifying and processing cases, distributing free pediculicides, continuing surveillance, educating school personnel and parents on how to control the parasite.


Species identification of blood meals from Culex tarsalis that had fed on passeriform birds.

Blood-engorged Culex tarsalis (4,209) collected during 1960 to 1965 in Kern County, California and previously shown to have fed on passeriform birds by the precipitin test were further tested by the more sensitive passive hemagglutination inhibition test (PHI). It was shown that these mosquitoes fed principally on House Finches and House Sparrows, the most common passeriform birds found in the collection areas. These data demonstrate the usefulness of the PHI test for the identification of arthropod blood meals from closely related species.


Field evaluation of arthropod repellent netting as a ground cloth against ticks.

Tick repellent, wide-mesh net ground cloths were tested against Amblyomma americanum (Linnaeus) by the CO2 bait technique. Two repellents, N,N-diethyl-metatoluamide (deet) and 3 acetyl-2-(dimethyl-5-heptenyl)-oxazoladine, and two netting fabrics were compared. All combinations tested provided over 90% protection. The effectiveness of repellent ground cloths against chiggers is discussed.


Comparison of morbidity interviews with a health examination survey in rural Africa.

This paper describes a study of the Danfa Comprehensive Rural Health and Family Planning Project, Ghana. The report compares information obtained from morbidity interviews with information obtained during subsequent health examinations. One to 4 days prior to examination by a team of physicians, 3,653 rural Ghanaians were interviewed by a team of auxiliary workers. Information obtained from the interview survey was noticeably different from examination diagnoses. Significant health problems such as malaria, intestinal parasites and diarrhea, as well as minor and chronic conditions were seriously under-reported. Interview findings were more accurate for children, women in the reproductive age group, and in cases in which the disease caused considerable discomfort or diability. Although individual examination was eight times as costly as an interview, small scale rural health examination surveys of a representative sample of the population are recommended to provide accurate morbidity information for health planners.


Isolation of Leishmania from a black rat in the Baghdad area, Iraq.

Leishmania was recovered from a black rat in the Baghdad area, Iraq. Leptomonads from samples of blood and tissues of this animal cultivated on NNN medium produced visceral leishmaniasis when injected into white mice. This is the first record of natural visceral leishmaniasis in a non-human host in Iraq.


Oral transmission of Brugia pahangi to dogs.

Oral transmission of Brugia pahangi, already demonstrated in jirds, has now been accomplished in dogs. Beagle puppies, four anesthetized and two unanesthetized, were exposed to B. pahangi by instilling third-stage larvae (L-3s) into the mouth. Infections matured in all the dogs, and adult worms were recovered mainly from the mandibular, retropharyngeal, and axillary lymphatics. Worms were relatively numerous and peripheral microfilaremia developed in the dogs exposed under anesthetic, while worms were infrequent and microfilariae were found only intracardially in the dogs exposed without anesthetic. It appears that in orally exposed dogs, as in jirds studied earlier, the successful L-3s probably penetrated mucosa in or near the mouth.


Half-body radiotherapy of advanced cancer.

Half-body radiotherapy to deliver doses up to 1000 rads in a single exposure evolved to meet a need in treating patients with advanced cancer. Large fields are required and a high radiation output. Treatments are well tolerated, although radiation sickness occurs in 80% of upper half and 33% of lower half-body treatments. Marrow depression is not a problem and the second half body can be treated when the peripheral blood count has returned to normal. Subjective improvement occurs in most patients and this group had a median survival of six months.


Localization of gallium-67 citrate in salivary glands following radiation therapy.

Gallium-67 citrate was found to localize in the salivary glands of eight patients after therapeutic doses of radiation to a treatment field including the glands. In two patients, autopsy evidence to the effect that no primary disease was present to explain such uptake was obtained. In another two patients the abnormal uptake was not observed on follow-up. The recognition that radiation sialadenitis is a potential cause of false-positive gallium scintiscans is important in their interpretation.


Disease of the gallbladder in patients with normal cholecystograms.

In contrast with what has widely been assumed, disease of the gallbladder sometimes remains undertected by even repeated cholecystography or cholegraphy. Chronic cholecystitis, gallstones, and acalculous cholesterolosis can escape detection by roentgenography of the gallbladder. Of 4,000 patients subjected to cholecystectomy between 1962 and 1973, the cholecystogram had been normal in only two. The range of indications for the operation has since been widened. Patients with typical symptons of gallbladder disease or recurrent pancreatitis of unknown origin have been operated on despite a normal cholecystogram. Within as short a period as eight months, an additional six patients with a normal cholecstogram have been operated on at our hospitals. Treatment consisted of cholecystectomy also in the four patients in whom no stones could be palpated in the gallbladder. Gross and microscopic examination of the gallbladder in these patients revealed cholesterolosis. When last seen, seven of the eight patients were still symptom-free an average fifteen months after the operation.


Diagnostic considerations in acute alcoholic and gallstone pancreatitis.

Comparison of a group of patients with acute alcoholic pancreatitis with a group with gallstone pancreatitis has established the serum amylase level on admission as one of the most useful laboratory tests in aiding to differentiate the two entities. A serum amylase level greater than 1,500 IU was most often due to gallstone pancreatitis, as was elevation of the serum bilirubin and alkaline phosphatase levels.


Surgical management of impotence: progress report.

Our experience utilizing a new design Lash-Maser silicone implant in the surgical management of impotence has been detailed. The present series includes twenty-five patients, twenty-three of whom achieved satisfactory intercourse without problems or complications. The implant's simplicity of design, function, and surgical implantation is appealing.


Surgical considerations in hyperparathyroidism: reappraisal of the need for multigland biopsy.

Sixty-seven cases of neck exploration for suspected hyperparathyroidism were reviewed. Thirty-nine patients underwent removal of an adenoma with biopsy of one or more other parathyroid glands. In another group, nine patients underwent removal of the adenoma only. Both groups have had no recurrences of hyperparathyroidism in follow-up periods of two months to twelve years. The data presented indicate that removal of a parathyroid adenoma alone, without biopsy of other tissue, represents satisfactory treatment. Experience with hyperplastic glands is also reviewed. Subtotal parathyroidectomy was effective treatment in all patients, but a 30 per cent incidence of hypocalcemia was noted after this operation.


Bone scans of the facial bones: normal anatomy.

Some features of facial anatomy have been identified on 99mTc polyphosphate bone scans by a comparison of scans, radiographs, and photographs. 99mTc polyphosphate bone scans are used clinically to show bone injury and increased osteoblastic activity; the primary use is to identify malignancy and other diseases involving bone. A knowledge of normal anatomy is of the utmost importance in the accurate interpretation of bone scans of the face.


Pulmonary function studies after smoke inhalation.

Pulmonary function studies were performed within 72 hours of injury in seven patients with smoke inhalation injury diagnosed by positive 133Xe scintiphotographs and in eight patients with burns of similar size but with negative 133Xenon scans. The former patients showed decreased peak flow, decreased flow at 25, 50, and 75 per cent of vital capacity, and an elevated pulmonary resistance. In addition, single breath nitrogen tests revealed evidence of maldistribution of ventilation/perfusion abnormalities. Total lung capacity, functional residual capacity, and compliance (both dynamic and static) were similar in the two groups. Pulmonary function studies can be of assistance in evaluating smoke inhalation, estimating the severity, and following the course of patients with this disorder.


The centrineurogenic etiology of the respiratory distress syndrome: induction by isolated cerebral hypoxemia and prevention by unilateral pulmonary denervation.

Twenty-eight anemic control dogs were subjected to isolated cerebral hypoxemic (PO2,35+/-5 mm Hg) perfusion for 2 hours. All were found to have functional pulmonary impairment. Two hours later, twenty were sacrificed and found to have the bilateral anatomic complex of the respiratory distress syndrome (RDS). All those not sacrificed expired within 20 hours with progressive respiratory distress and at autopsy had the bilateral anatomic complex. Twenty-three beagles with chronic denervation (autotransplantation) of the left lung also were subjected to the 2 hour isolated cerebral arterial hypoxemic perfusion. Minimal pulmonary functional impairment was measurable in all. Ten of sixteen were long-term survivors. The six that succumbed did not appear to suffer respiratory deaths. These six, as well as seven sacrificed 2 hours after perfusion, had the anatomic complex of RDS in the normally innervated right lungs. However, the denervated left lungs were anatomically normal. These findings are offered as additional evidence that RDS has a centrineurogenic etiology. We postulate the following sequence: "shock" causes cerebral (probably hypothalamic) cellular oxygen deprivation and dysfunction; there is autonomically mediated, increased resistance of the pulmonary venules ("postcapillary sphincters"); this leads to capillary hypertension, congestion, hemorrhage, edema, surfactant inactivation, and atelectasis. Pulmonary denervation blocks this sequence and protects the lung.


Nonanastomotic aneurysms in venous homologous grafts and bovine heterografts in femoropopliteal bypasses.

In the absence of a suitable autologous vein for a long distal femoropopliteal bypass, the homologous vein appears to be a good substitute. However, the patency rate after one year is less than 50 per cent and nonanastomotic aneurysms occurred in one third of our patients followed for more than one year. These two complications may be related to an immune response which may be lessened by preservation of the graft in the frozen state. Bovine heterografts function well when placed subfascially for femoropopliteal bypasses ending above the knee. Failure rate is high when the distal end of the graft extends across the knee joint. In our experience nonanastomotic aneurysms have developed in 50 per cent of patent grafts followed for more than one year, although other surgeons have reported an incidence of only 3 to 20 per cent. In the follow-up of twenty-three venous homografts and twenty bovine heterografts placed as femoropopliteal bypasses, eight nonanastomotic aneurysms appeared and required replacement. This occurrence was noted in more than 33 per cent of grafts patent beyond one year. When an adequate autologous vein is not available, the composite Dacron-vein graft is the best substitute.


Swelling of the hand after arteriovenous fistula for hemodialysis.

Despite a high patency rate and low incidence of infections, several complications have been described with the Brescia subcutaneous arteriovenous fistula. We recently observed five patients with swelling of the hand and wrist secondary to increased distal vein flow. Ligation of the distal vein, with or without proximal reconstruction resulted in cure. Proximal vein patency must be assessed.


Idiopathic perforation of the colon in a newborn.

Although infrequent, idiopathic perforation of the colon in the newborn is a surgical emergency. Etiology remains obscure. Diagnosis of a pneumoperitoneum, prompt operative intervention, and the use of antibiotic therapy are essential to the survival of these infants.


Spontaneous return of function after surgical excision of the seventh cranial nerve in parotid tumor surgery.

Spontaneous return of function after surgical excision of the seventh cranial nerve in surgery of parotid tumors is not impossible. This seems to occur through the several existing neural pathways between the fifth and seventh cranial nerves. It is probable that voluntary motor impulses by reeducation find their way from the cortex through the fifth cranial nerve to the respective muscles.


The renal compression syndrome.

A clinical example of perirenal compression producing documented renin-mediated hypertension is presented. The pathophysiology of this disorder is discussed as it relates to renin release mechanisms. In the future, recognition of the renal compression syndrome may obviate needless nephrectomies since simple removal of the source of compression should result in the cure of hypertension.


Pancreatic trauma: a new diagnostic approach.

The difficulties encountered in the diagnosis of solitary pancreatic injury when there is no other indication for surgical exploration of the abdomen are discussed. We suggest that endoscopic transduodenal pancreatography is a reliable diagnostic tool of great help in evaluating such injuries with little morbidity.


Unusual presentation of hydatid disease.

Hydatid disease is endemic in most areas in Iran where sheep are raised, and diagnosis is fairly easy in a majority of cases. However, this fairly common disease may become very difficult and even impossible to diagnose. The most important factor in diagnosing hydatid disease is the awareness of its possibility. The striking clinical resemblance between hydatid disease and malignant diseases of some organs makes the correct diagnosis essential. In countries where this disease is endemic, any growing mass or tumor should arouse suspicion of hydatid disease.


Acute venous hemodialysis using the unipuncture apparatus.

Hemodialysis is a well recognized treatment modality for the support of patients with acute renal failure. In such patients, rapid access to the circulation for hemodialysis is important. For those patients with self-limited acute renal failure in whom recovery is expected, a rapid means of gaining temporary access to the circulation would be particularly desirable. The Seldinger technic for femoral vein catheterization and the use of the unipuncture dialysis apparatus have been combined to meet this requirement. The efficiency of unipuncture dialysis through a single femoral catheter compares favorably with the efficiency of dialysis by the standard two catheter technic.


Functional longevity of intraperioneal drains: an experimental evaluation.

Various types of drains were inserted into the peritoneal cavity of twenty-eight dogs. After one to seven days, all drains failed to show the presence of 200 cc of colored fluid injected intraperitoneally. On autopsy, all tubes were surrounded and occluded by omentum.


[On the mechanism of action of acupuncture analgesia (author's transl)].

The correlation between the effects of acupuncture (A) and hypnosuggestion (H) on subjective pain perception was studied in normal volunteers using somatosensory evoked potentials technique. Both methods influenced identically the subjective pain perception and affected the evoked cortical responses similarly. In those subjects in whom analgesia was achieved, location of the A needles proved unimportant and the suppression of the cortical response elicited by A or H was identical. This could be explained by cortically induced inhibitory activity in descending control systems for both methods. A. analgesia thus appears to be a suggestive modality which depends on individual susceptibility. A specific cultural background also seems to be of importance.


[Clinical and experimental results with acupuncture-analgesia (author's transl)].

Operations under acupuncture analgesia have been performed in Vienna since March 1972. A total of 102 procedures has been performed with "classical" Chinese acupuncture analgesia. Additionally given analgesics, psychodynamic factors and neurophysiological components are of joint importance. Our success rate in these cases was 64 p.c. Since October 1972 we call "two-phase-acupuncture-analgesia". Up to June 1975 72 operations were performed under some modifications of this method. In a neurophysiological study 17 volunteers and in 2 patients undergoing stereothalamotomies depression or even disappearance of evoked potentials was be observed during acupuncture with alectrical stimulation. Thus an interaction between pain stimuli and acupuncture stimuli in the thalamus could for the first time be demonstrated in man.


[Combined acupuncture-analgesia as a method in general anesthesia (author's transl)].

The clinical results of 162 operations performed with combined-acupuncture-analgesia are reported. The experiences so collected are satisfying. This method seems suitable for anaesthetic practice. Total absence of toxity good analgesia and the negligible circulatory reactions give this method advantages in the anesthetic treatment of old and poor risk patients. A heavy disadvantage is that the method in time consuming is expensive in personnel.


[Changes of bloodchemical parameters of healthy volunteers under influence of acupuncture (author's transl)].

The influence of acupuncture on some biochemical parameters in blood was investigated in healthy volunteers. These results were compared with two control series. The significant increase especially of free fatty acids concentration must be considered as an effect of acupuncture.


[On the application of electric stimulation currents in operations. Concept of a clinically applicable device (author's transl)].

With the use of high voltage electric currents in patients who initally have been anaesthetised, the anaesthesiologist faces new aspects. For this reason basic principles of physical medicine and medical engineering with respect to special problems are described. The majority of impulses current generators used so far do not even comply with the first principal requirement of any therapy namely knowledge of the dose of the agent applied. A system for electric currents crossing the body is outlined, which is characterized by constant current and isovoltage-free outlets in connection with a special ECG-amplifier and a control pattern. This apparatus for the first time guarantees maximal safety in clinical use. First animal experiments demonstrate the possibility of the risk if this method is applied in a inexperienced manner: in all animals ventricular fibrillation could be achieved when the electrodes were used in a position near the heart and there appeared to occur nonspecific reactions when current was directed through the brain (ear acupuncture)