[Importance of determination of the content of lactate dehydrogenase and its isoenzymes in patients with myocardial infarct complicated by rupture of the heart].

In 18 patients with myocardial infarction. who had died due to the rupture of the heart muscle the activity of lactate-dehydrogenase (LDG) and of its isoenzymes in the blood serum and cardiac tissue was studied. Comparisons were made with the results of investigations in donors, in persons dead as a result of accidents, in patients with uncomplicated transmural myocardial infarction, with aneurysm of the heart, severe cardiogenic shock and with other lethal complications of myocardial infarction. The highest levels of the blood LDG activity were registered in cases involving rupture of the heart. The determination of the LDG and its isoenzymes activity mat be used in assessing the degree of the resorption-necrotic syndrome intensity and of factors indicating the risk of a developing aneurysm and rupture of the heart in patients with myocardial infarction.


[Importance of determination of the activity of lactate dehydrogenase and its isoenzymes in blood serum for differential diagnosis of myocardial infarct, thromboembolism of the pulmonary artery and acute pancreatitis].

In 12 patients with macrofocal myocardial infarction and in 14 others with rheumatic mitral cardiac defects and congestion in the greater circulation complicated by thromboembolism of the pulmonary artery the activity of total lactate-dehydrogenase (LDG) and of its isoenzymes was determined in the blood serum. As shown by investigations the intercurrence of the lastly named complication was accompanied in these patients by an augmented activity of the total LDG and by readjustment of its isoenzymatic spectrum. The latter involved a progressive percentage growth of the activity displayed by LDG3 and LDG4 fractions. In patients with myocardial infarction without thromboembolism of the pulmonary artery the nature of the isoenzymatic spectrum changes is dissimilar, this enabling the method to be used in the differential diagnosis of the affections. The blood serum of patients with acute pancreatitis shows an increased activity of the total LDG, this being conditioned by a growing activity of the LDG3 and LDG4 fractions. The determination of the blood serum LDG isoenzymes activity as a test supplementing other methods of investigation may, with due account of the clinico-electrocardiographic picture, be used in the differential diagnosis of myocardial infarction and acute pancreatitis.


[Characteristics of the course of myocardial infarct in patients with diabetes mellitus].

Two groups of patients with myocardial infarction in conjunction with diabetes mellitus and with myocardial infarction without diabetes mellitus, similar as regards their sex and age and not suffering from hypertensive disease (a total of 165 persons) were subjected to a clinico-statistical analysis. A number of factors characterizing the clinical course of myocardial infarction and diabetes mellitus in these two groups were compared. It was found that the nature and localization of pain showed not significant differences in the patients of the study groups. However, the duration of the algetic history was much longer in patients suffering from myocardial infarction combined with diabetes mellitus. In such patients complications develop more often and run a more severe course. In most of them the onset of myocardial infarction was attended by an exacerbation of diabetes mellitus and in some cases diabetes becomes apparent for the first time at the time of myocardial infarction.


[Lipids and the lipoprotein spectrum of blood in men engaged in intensive mental activity].

A group of 242 males, aged 35 to 45 years, employed as engineers in several research institutions, was examined. The examination was conducted in accordance with WHO recommendations. Among the biochemical indices the blood level of lipids (cholesterol, triglycerides) and the lipoprotein spectrum of the blood serum were determined by means of polyacrylamide gel electrophoresis. Distinct hypercholesterinemia was noted in 8.7% of the examined males, hypertriglyceridemia--in 23.8%. The revealed peculiarities of the lipid metabolism combined with the characteristics of the lipoprotein serum spectrum permitted to demonstrate the prevalence of Type IV hyperlipoproteinemia in 27% of those with diagnosed ischaemic heart disease, in 19.4% of those with the above pathology suspected, and in 18% of practically healthy individuals. Other types of hyperlipoproteinemia, type II in particular, were less common (4.7%, 6.1% and 2.6%, respectively).


[Study of total magnesium concentration in the blood of patients after surgery with extracorporeal circulation].

In 30 patients with acquired and 14 with congenital heart diseases operated on under extracorporeal circulation a significant decrease in the blood Mg level was noted, its amount never returning to the preoperative one within the first week. Therapy with Mg salts helped to prevent these disorders and to maintain the plasma and erythrocytes Mg levels within the normal limits throughout the whole period of therapy.


[Disorders of electrolyte balance in patients with coronary atherosclerosis].

In 30 patients with stage I and III coronary atherosclerosis the interrelationship between K and Na content in blood and erythrocytes, daily urine excretion of aldosterone and blood level of cholesterol was studied. It was established that in patients with chronic ischaemic heart disease the electrolyte balance disorders manifested themselves on the early stages of the disease in increased plasma Na concentrations. The hypernatremia in such cases was traced against the background of an elevated mineral-corticoid activity of the adrenal glands during exacerbations of coronary insufficiency. A positive correlation was revealed between the blood levels of Na and cholesterol.


[Determination of the size of the left ventricle and of the contractile capacity of the myocardium in patients with ischemic heart disease and early signs of circulatory insufficiency].

Echocardiography was employed in examining 120 patients with ischemic heart disease and early indications of circulatory insufficiency along with 40 practically healthy subjects. In patients with an atherosclerotic lesion of the heart of the I--III degree without signs of circulatory insufficiency the systolic and diastolic volumes of the left ventricle of the heart were found to be enlarged. In patients with circulatory incompetence of the IIb degree these volumes were extended to the maximum, comprising 278 and 136 per cent, respectively, of the figures in controls. The excursion rates of the myocardium during the periods of systole and diastole were declining proportionally to the severity of the cardiac affection and in patients with circulatory insufficiency of the IIB degree they amounted to 60 and 52 per cent of the initial level. The ejection fraction--% delta S and VCF in this group of patients decreased down to 30 and 24 per cent of the results in controls. The most sensitive indicator proved VCF, which was depressed even in patients presenting no manifest clinical signs pointing to the circulatory insufficiency. Echocardiography is a novel valuable non-traumatic procedure that enables one to assess the extent to which the contractility of the myocardium suffers parallel with the development of early signs of decompensation.


[Certain methodological problems of the use of temporary electric stimulation of the heart in disorders of atrio-ventricular conductivity in patients with acute myocardial infarct].

Some methodical problems are discussed that are of practical importance for the performance of transvenous endocardial pacing of the heart in patients with acute myocardial infarction in whom the clinical course is complicated by an atrio-ventricular block. Some results of the employment of this method in 66 cases of acute myocardial infarction are presented. A set of criteria is suggested for controlling the proper position of the probe in the cardiac cavity, the most important approaches for the introduction of the probe are described, as well as the main reasons of ineffective cardiac pacing and its most common complications.


[Theoretical basis of the search of individual limits of fluctuations and the maximum long-term maintainance of arterial pressure within the maximum permissible limits in hypotensive therapy].

The methods of determining the maximum permissible and functionally justifiable (upper and lower) limits of arterial pressure fluctuations limiting the zones of individual "comfort" "caution" and "alarm" for every patient are described. The mathematical method of the least squares was used for long-term control of the maintenance of arterial pressure within the limits individually pre-set for those treated on an out-patient basis. The above methods permit to decrease the duration of therapy with a minimal drug expenditure and to ensure a mass control of the efficacy of hypotensive therapy.


[Certain problems of intensive therapy of patients with acute myocardial infarct].

The communication is based on the observation of 573 patients with acute and sub-acute myocardial infarction. The arrangement of intensive care units and wards permitted to render timely and qualified aid to the patients with myocardial infarction, to reduce the percentage of complications, and in cases of the development of the signs of clinical death to undertake immediate resuscitation measures. Of the 123 patients in whom clinical death was recorded, 34 were successfully resuscitated (27.6%). The problems of the management, prognosis and prevention of clinical death are discussed. The great importance of a proper arrangement of the intensive care units, of the qualification of the staff on duty and of continuous monitoring is emphasized. Electroimpulse therapy of acute rhythm disorders is highly praised as well as the employment of anti-arrhythic agents (lidocaine, hilurithamal, novocainamide, panangin) in such situations. The tactics in cases of atrioventricular block developing in such patients is described.


[Postoperative period and principles of intensive therapy after surgery of ischemic heart disease].

The early postoperative course (within 10 days after surgery) is analysed in 218 patients operated upon for the ischaemic heart disease. Resection and plastic repair of the postinfarction aneurysm was undertaken in 132 of them, aortocoronary bypass procedures--in 86. The peculiarities of an uneventful postoperative course are presented, the diagnosis and therapy of the complications are discussed, and the mortality is analysed.


[Certain problems of intensive therapy of acute myocardial infarct].

Using the whole set of modern methods of examinations of the external respiration function, acid-base balance, as well as of the determination of various biologically active substances--catecholamines, glucocorticoids, aldosterone, kinines, the authors were guided in conducting intensive therapy for myocardial infarction by the measurable functional and metabolic disturbances. This permitted to optimatize the employment of therapeutic neuroleptanalgesia in the acute period, to assess the efficacy of some new drugs, glukagon including to give recommendations as to the perfection of the organizational principles of intensive therapy.


[Principles of intensive therapy in heart surgery of early childhood].

The paper deals with the problems of intensive therapy in cardiac surgery of early childhood. Proceeding from their experience in the treatment of 1036 children aged under 3 years the authors give recommendations as to the measures of intensive therapy both prior to surgery, and in the early postoperative period. The principal differences of pre- and postoperative intensive therapy are determined.


[Treatment of cardiogenic shock complicating myocardial infarct by the methods of counterpulsation].

The results of treatment of myocardial infarction complicated by cardiogenic shock by-means of arterial counterpulsation and that with an intra-arterial ballon are presented. In order to determine the indications for counterpulsation the authors introduce a classification of cardiogenic shock that takes into account the reactivity of the patient and the speed of decompensation of the systemic circulation. Both methods of counterpulsation permitted to reverse the cardiogenic shock in 81.8% of the cases. In 18.2% the shock appeared to be areactive in nature, 15.9% of the patients died due to a recurrence of the cardiogenic shock after it had been reversed by means of assisted circulation. Other complications of myocardial infarction caused the death of 43.3% of the rest. Hospital mortality comprised 77.4%. The main factors that determine the stable positive countershock effect of counterpulsation in myocardial infarction cases complicated by cardiogenic shock include early introduction of counterpulsation into the set of therapeutic and resuscitation measures, high capacity of assisted circulation devices (up to 31/min.), long duration of continuous counterpulsation (not less than 12 hours).


[Certain humoral factors in acute myocardial infarct complicated by cardiogenic shock].

The activity of the sympathoadrenal and renin-angiotensin-aldosterone systems was studied in patients with myocardial infarction complicated by cardiogenic shock. During the initial 12 hours after the onset of myocardial infarction an increased plasma level of adrenalin and noradrenal is observed, which then returns to the normal level on the 3rd day. In cases of cardiogenic shock a lower content of catecholamines in blood is noted. The determinations of renin activity in the plasma of peripheral venous blood demonstrated that it was increased since the 1st day of the disease in the myocardial infarction patients, but that its maximum elevation fell within the 7th--10th days. In patients with cardiogenic shock the plasma renin activity was much higher than in those with uncomplicated myocardial infarction. Urine aldosterone excretion was higher in patients with cardiogenick shock since the 1st day of the disease than in those with an uncomplicated course of myocardial infarction. The study of the electrolyte balance in patients with myocardial infarction complicated by cardiogenic shock demonstrated that on the 1st day of the disease the potassium level in plasma and erythrocytes was decreased, while the sodium concentration was somewhat increased.


[Use of glucagon for the treatment of acute cardiac insufficiency during open-heart surgery].

The results of the employment of glukagon in 40 patients operated upon under extracorporeal circulation for acquired and congenital heart diseases are presented. Instrumental studies of the haemodynamics in 11 cases demonstrated that glukagon in a dose of 3 mg produced in most cases an increase of the cardiac output and stroke volume, and of the systolic index by over 20%, with the heart rate increasing insignificantly. Clinical observations conducted in 29 patients demonstrated a high efficacy of glukagon in the management of acute cardiac failure and low cardiac output syndrome in the early post-perfusion period.


[Principles of early postoperative management of patients after open-heart surgery].

Proceeding from their personal 5-years experience comprising over 1500 operations with extracorporeal circulation the authors formulate their tactics of the early postoperative therapy. The attention is mainly paid to the maintenance of the optimum pulmonary gas exchange, adequate haemodynamics and stable homeostasis. An important role belongs to prolonged artificial pulmonary ventilation that was used for therapeutic purposed in 324 cases of cardiac and respiratory insufficiency and for preventive purposes--in 908 patients. The therapeutic tactics for various forms of respiratory and cardiac insufficiency and multiform cardiac rhythm disorders is presented in detail. On the example of 149 patients shows that a moderately incomplete blood replacement in the postoperative period does not result in clearsut anaemia. The authors recommend donor blood transfusions when the hemoglobin level is below 10 Gm%.


[Survival and state of patients during the 1st year after myocardial infarct (according to data of epidemiological study - myocardial infarct register)].

The results of observations conducted in accordance with the programme of myocardial infarction register are presented for 143 patients aged under 65 years, surviving beyond 28 days after the onset of the lesion. In 13.2% of those surviving an acute myocardial infarction a recurrence was found to develop within the first postinfarction year, among them in 11.5% of the cases with a fatal result. Over half (51-54%) of those surviving the infarction retain angina of effort, 16.3-23% have cardiac insufficiency. An examination conducted 3 months following the infarction revealed lipid (57.1%) and carbohydrate (54.3%) metabolism disorders in many patients, as well as disturbances in the blood coagulation and anticoagulation systems. Patients surviving myocardial infarction require differentiated and lasting secondary preventive measures.


[Tactical characteristics of physical rehabilitation of patients after myocardial infarct].

A study of the dynamics of the electrocardiographic, hemodynamic and cardiodynamic indices in patients who survived myocardial infarction showed that a specially compiled programme of physical rehabilitation for such patients corresponded in terms of the tempo of load increase to the normalization of these parameters. The leading tactical principle of this programme, that consists in an early activization of the patient in bed and a relatively unhastened transit to active movements in an upright position, may be recommended for a wide practical implementation as the most physiologically grounded.


[Rehabilitation of visually handicapped persons (author's transl)].

Appropriate measures of rehabilitation are needed not only persons having lost their sight but also by those who have become severely visually handicapped through illness or injury and thereby have difficulties in carrying out their occupation and in everyday life. The way of proceeding depends on the general factors of the country in question and on the special situation of the individual. Besides Medical care retraining is most important in a general and special way. In order to attain these objectives the supply also of technical aids of various character necessary. The person afflicted should be rehabilitated in a complete way, which means he should be re-introduced into employment as well as into the society and his personal sphere of life. The body responsible for carrying the cost, which is not low, of all measures of rehabilitation is determined by the cause of sight loss or of the handicap.


[Pre-conditions of proliferative diabetic retinopathy (author's transl)].

From two groups of diabetics, i.e. an "invesitgation-group" of 40 cases and a "comparison-group" of 55 cases, the following characteristics of a state preliminary to proliferative diabetic retinopathy are resulting: early commencing of angiopathy by means of proteinuria (nephropathy), progression of retinopathy (pre-stage), pronounced progressiveness of the accompanying nephropathy and arterial hypertension, and finally uncommon diabetic heredo-familiarity. They all permit permature conclusion on proliferative retinopathy (and glomerulosclerosis).


[Giantcell arteriitis and ophthalmodynamogram (author's transl)].

Report on seven patients with giantcell arteritis. An ophthalmodynamographic finding typical for these aspects of case was recorded in all cases. In one-sided and permanently one-sided functional disturbances, too, a pathologically reduced pulsation volume on both sides could always be derived.


[Pigmentary degeneration of the retina: neurological and biochemical findings (author's transl)].

A report on the neurological results of an investigation carried out on 38 patients with pigmentary degeneration of the retina. The ophthalmological investigation did not indicate a systemic disease. The neurological findings, however, revealed a systemic disorder in many cases.-The constitutions of 20 patients (52.5%) were marked by pathological stigmata. The EEG was abnormal in more than 50% of the cases. The EMG showed a prolonged nerve conduction time for 2 of a total of 4 deaf patients. The EMG also revealed a patient with both pigmentary degeneration of the retina and a mold form of myasthenia gravis. The biochemical results indicated hyperlipoproteinemia in 6 cases (15.8%), diabetes mellitus in 2 cases and a pathological increase of uric acid in the serum in 8 cases. These results suggest that pigmentary degeneration of the retina is not a homogenous disease. It must be seen as a "phenomenologically identical, polygenetic type of reaction" (Janzen). A comprehensive analysis of the individual case can therefore lead to implications which are of direct therapeutic significance.


[Acoustic investigations in orbital tumor diagnosis (author's transl)].

360 patients with unilateral exophthalmos were examined with echoophthalmograph to study the diagnostical possibilities of a method of echography in orbital tumors. The findings of para- and transbulbal methodics were checked in 140 patients. The tonometry of tumors and soft orbital tissues was performed. The methodics of acoustic orbitonometry based on the measurement of retrobulbal neoplasms at the moment of their step-by-step compression was worked out. The echographic symptoms of different orbital neoplasms is described as well as those of pseudotumor and tireotropic exophthalmos. The possibility of acoustic measurement of orbital neoplasms is shown. The dependence between the extent and progress of deformation in the exophthalmed eye on one hand-nature of exophthalmos, character and localization of the tumor on the other was revealed. The quantitative data about the compression of different orbital tumors were obtained. It was shown that the surveying echography, biometry and acoustic orbitonometry facilitate the task of differential diagnosis, allow the localization and size of the tumor to be detected and help to control the results of the treatment.


[Metastatic orbital tumors:a case of orbital metastasis in malignant melanoma of the skin (author's transl)].

The authors feel that orbital tumor metastases are more common than generally presumed. The occurence of orbital metastases of malignant melanomas of the skin is discussed in this paper. Until now 20 cases have been published. Therapy of metastases is an unsolved problem, immunologic factors might be of some importance. The authoress describes a case of histologically verified orbital metastasis of a primary malignant melanoma of the skin, which was surgical removed three years ago. In contrast to similar cases other haematogen tumor manifestations were absent first, and the orbital metastasis seemed to be totally removed by orbital exenteration. One year later however, probably as a second metastasis, rapidly progressive tumor tissue appeared. General melanomatosis having appeared at the same time finally lead to death.


[The electrical activity of retinal ganglion cells according to central blood pressure (author's transl)].

Recording of single fiber activity of the N. opticus represents an objective electrophysiological method for investigation of the function of the retina. The relationship between retinal function and blood pressure was explored in cats and it was discovered that the autoregulation of the eye secures normal retinal functioning even in the presence of considerable variations in central blood pressure. With cats this ranges between 60 and 140 mm Hg average pressure in the A. carotis communis.


[Sedation and decreasing of tension in glaucomatous patients before the operation for cataract (author's transl)].

The increased operative risk of glaucomatous eyes in extraction of cataract is reduced by preoperative treatment of the patients with sedatives and diamox. The author reports on the results of 310 eyes and emphasizes the advantages of a peroral diamox therapy through several days in contrast to the solitary intravenous application of this drug.


[Metastases of the choroid of the bronchial carcinoma (author's transl)].

Clinical and histopathological findings are described in 6 cases of chronchial carcinoma metastatic to the choroid of the eye. These findings show that especially in bronchial carcinoma, metastases of the choroid often are the first symptoms of the disease even before the primary site of the tumor is recognized. As these metastases often grow in a manner quite different from that of other uveal metastases, they are likely to be mistaken for uveal melanomas. Yet the right diagnosis is decisive for the right therapy. While in case of melanoma the eye has to be enucleated, x-ray therapy should be employed in metastatic carcinoma. Thus the patient can be prevented from becoming blind and from enucleation. The effect of x-ray treatment on the carcinoma cells in the choroid is demonstrated histologically in one of the cases.


[Retinoblastoma as a diagnostic problem in a 16-years-old boy (author's transl)].

A secondary glaucoma due to an intraocular tumour with retinal detachment in a 16-years-old patient whose brother had died of suspected leucaemia illustrates the difficulties in the clinical diagnosis at this age. Although the ophthalmoscopical appearance was that of Coats's lesion a malignant melanoma of the choroid could not be ruled out. The histopathological examination revealed a retinoblastoma.


[Alterations of the fundus in the sense of a "flecked retina" in onchocerciasis (author's transl)].

Onchocerciasis is one of the main reasons of blindness in aequatorial Africa. In 50 patients suffering from onchocerciasis fluoangiograms of the eye fundus have been studied. After the treatment of onchocerciasis we often found changes similar to those of a "flecked retina". The angiographic observations demonstrated that the alterations are to be localised into the pigmented epithelium of the retina. Furthermore these alterations which are similar to a "retinitis punctata albescens" are interpreted as the result of a antigen-antibody reaction of the uveal tract. This reaction is due to deliberated endotoxins of dead microfilaria.


[Secotrial diabetic retinopathy in a case of partial atrophy of the optic nerve (author's transl)].

In a 35-year-old man diabetic patient with atrophy of the upper half of the right optic nerve and loss of the lower half of the visual field, no signs of diabetic retinopathy developed in the upper half of the eyeground. The diabetic retinopathy affecting the inferior half of the fundus was strictly confined to the inferior half of the eyeground; in addition the retinopathy took a more benign cours compared with the left eye showing a normal disc. After photocoagulation in the left fundus, the retinopathy improved to a grade comparable to the influence of the partial optic atrophy upon the course of the diabetic retinopathy in the right eye.


[Early diagnosis of microangiopathy in infantile diabetes (author's transl)].

The authors have carried out fluorescein angiography in infantile diabetics--negative by ophthalmoscopy,--looking for the earliest symptoms of microangiopathy. The study concerned 161 diabetics in the age between 3-18, and 50 non-diabetic children in the same age. There is no significant difference between diabetics and control-group in the frequency of symptoms, described in literature as early signs of microangiopathy, as multiple capillary-, and peripapillary-filling and early venous dilatation. Increased capillary filling was found at anxious children with strained cervical muscles during the examination. In 54% of the 161 diabetic patients-negative by ophthalmoscopy,-solitary or multiple microaneurysms were found fluorescence angiographically. The increase of number of the microaneurysms is correlated to the duration of the diabetics and advance in age. In the authors opinion the presence of microaneurysms is in some cases due to genetic factors and is independent from the metabolic changes of diabetes.


[Histoplasmin skin test and focal hemorrhagic chorioiditis (author's transl)].

A histoplasmin skin test was performed on 56 patients with focal hemorrhagic choroiditis. The test was negative in 53 choroiditis patients and positive in three patients. The three patients with posi-ive skin test had been living for a long time in the eastern part of the U.S.A. where histoplasma capsulatum occurs endemically. The results of this study suggest that the infection with histoplasmin capsulatum is not the cause of focal hemorrhagic choroiditis in our area.


[Contribution to Ehlers-Danlos syndrome (author's transl)].

A case of Ehler-Danlos syndrome with the rare complication of ablatio retinae without myopia is described. The alterations of the eye be Ehlers-Danlos syndrome, which are available in literature are demonstrated.


[Suggestion of an improved technique of general anaesthesia for ophthalmological experiments on rabbits (author's transl)].

The potentiated general anaesthesia with ethyl urethane and propionylpromazine for long-time ophthalmological experiments on rabbits is not adequate. It is suggested to apply additional ketamin (i.v. and i.m.). With this procedure a satisfactory position of rest is obtained for more than two hours.


[Pancreatic secretion of patients with chronic renal insufficiency (author's transl)].

Pancreatic function tests were performed in 15 patients with advanced renal insufficiency. Pancreatic secretion was stimulated with CCK/PZ and secretin and 60 minutes later with bile given intraduodenally and CCK/PZ and secretin intravenously. The Wilcoxon-test showed that there were significantly higher lipase levels in serum and lower amylase amounts in duodenal juice compared to normal volunteers. No differences could be demonstratd for volume, maximal bicarbonate concentration, lipase and trypsin outputs. It could be shown by nonlinear discriminant analysis that pancreatic secretion might specifically be changed in patients with chronic renal failure. These patients can be definitely differentiated according to the secretion pattern from normal controls and patients with chronic pancreatitis, pancreatic carcinoma, chronic and acute duodenal ulcer.


[Biological activity of bacterial peptidoglycan (mucopeptide) (author's transl)].

A brief survey on the ultrastructure, the chemical composition and the immunological properties of bacterial cell wall peptidoglycan (mucopeptide) is presented. This paper deals with the various recently discovered biological activities of peptidoglycan. These could be divided into three different groups, namely: 1. Endotoxin-like properties: pyrogenicity, induction of the local Shwartzman reaction, increase in non-specific resistance to bacterial infection, release of 5-hydroxytryptamine from rabbit platelets, complement activation,gelation of amebocyte lysate. 2. Inflammatory reactions of skin and internal organs, aggressin activity (virulence factor), inhibition of phagocytosis of bacteria by granulocytes and macrophages, inhibition of growth of cell cultures, cytotoxity to granulocytes and macrophages. 3. Potentiation of humoral and cellular immune responses (adjuvant), enhancement of tumor defense in experimental animals. The potential mechanisms of action of peptidoglycan are discussed and attention is focused on the implications of the various peptidoglycan activities for medicine.


Histometrical glomerular studies in minimal proliferative intercapillary glomerulonephritis (minimal changes without nephrotic syndrome) with different clinical symptomatology.

Histometrical glomerular studies were carried out in minimal proliferative intercapillary glomerulonephritis (minimal changes without nephrotic syndrome) with different clinical symptomatology. Results of morphometric examinations of renal corpuscles of 58 cases of minimal proliferative ntercapillary glomerulonephritis (MPI-GN) without nephrotic syndrome were compared with those of normal and mesangiosproliferative glomerulonephritis cases and showed that MPI-GN without nephrotic syndrome is accompanied by proliferation of the glomerular cells. The cell density in the glomeruli is increased by 47% compared with the norm. Different clinical symptoms (proteinuria, haematuria, haematuria and proteinuria) have no different morphometrical correlate. A differentiation of this disease from mesangio-proliferative glomerulonephritis seems justified.


[Thyroidal autoregulation in nontoxic goiter patients: normalization of the T3/T4 ratio in serum by treatment with potassium iodide (author's transl)].

In iodine deficiency areas, an increased T3/T4 ratio in serum was reported earlier. In this study the influence of potassium iodide on the T3/T4 ratio was investigated. Treatment with 200 mug KI per day for only 4 weeks normalized the initially elevated T3/T4 ratio in 16 nontoxic goiter patients (24.6 plus or minus 9.9 times 10-3, mean plus or minus S.D., before, respectively 18.9 plus or minus 5.5 times 10-3 after KI treatment, p smaller than 0.0025). The mean basal TSH levels (1.42 plus or minus 0.68 before, respectively 1.29 plus or minus 0.52 mugU/ml after KI), and the TSH increase 30 min after 200 mug TRH i.v. (5.54 plus or minus 4.22 and 6.50 plus or minus 5.09 mugU/ml, respectively) did not change significantly. Since the normalization of the T3/T4 ratio in nontoxic goiter patients was independent from changes in the TSH levels, this effect of KI obviously represents an example of thyroidal autoregulation.


[Influence of beta 1-methyl-digoxin to red cell electrolyte contents in healthy normals (author's transl)].

6 healthy controls received daily doses of 0.6 mg beta-methyl-digoxin for 3 days and further 0.3 mg for the following 5 days each. After the first 3 days sodium content in the red cells increased from 4.8 to 6.6 meg/kg significantly in parallel to the glycoside level of 1.5 ng/ml (1.2 times 10-9 M). At the same time magnesium in the cells fell significantly from 4.1 to 3.7 meg/kg. There was no change in the concentration of potassium, calcium or chloride at this time. While the glycoside level dropped during the following 5 days under 0.3 mg of methyl-digoxin to 1.2 ng/ml (1 times 10-9 M), sodium content in the cells increased further up to 8.3 meq/kg and was paralleled by a decrease in potassium content from 84.6 to 82.0 meq/kg. There were no changes in plasma electrolyte concentrations during the experiments. Our results confirm the concept of Hoffman that there are two transport pathways in human red cells which differ basically in their dependencies of the sodium and potassium composition of the external medium and the concentration of glycoside needed to inhibit the transport. Our data evidence that red cell electrolyte contents reflect levels of digoxin. They might be useful to follow up the therapeutical effect of cardiac glycosides.


[Variations of human serum alpha-fetoprotein concentration after partial hepatectomy (author's transl)].

Alpha-fetoprotein serum concentrations were determined by radioimmunoassay in 5 patients with echinococcus involvement of the liver. In 4 cases a partial hepatectomy was possible, whereas in 1 case laparotomy had to be confined to an exposure of the liver hilus because of too many dispersed echinococcus cysts. All patients showed normal AFP levels below 20ng/ml before operation. Within the first to third postoperative day maximal AFP increases of AFP level between 2760 and 5600 ng/ml developed, which returned to normal during the following days and weeks. One patient who was submitted to strumectomy and to the same anaesthetic liver charge had no change in her normal AFP concentration. The postoperative changes of AFP level observed are interpreted as an expression of a quick and intense liver cell regeneration following the surgical treatment.


Endogenous and postheparin monoglyceride hydrolase in plasma of patients with acute virus hepatitis.

Endogenous and postheparin monoglyceride hydrolase (MGH) was studied in 9 patients with acute virus hepatitis and in 25 normal subjects with the use of a new spectrophotometric method. During the 4 weeks of observation the patients had significantly higher endogenous and reduced postheparin MGH levels if compared with the controls (p smaller than 0.001). In the initial phase of hepatitis the alterations were more pronounced and the serum glyceride concentration was raised. The results show that MGM activities in plasma may be greatly influenced by the liver.


[Kidney in heart failure (author's transl)].

The adaptability of the kidney in heart-failure is restricted. This is due to a sympathetically mediated renal vasoconstriction, forming part of a sympathetically induced general rearrangement of haemodynamics. This is reflected in a rise of the total peripheral vascular resistance and of the right auricular pressure and can be normalized to a large extent by sympathetic gamma-blockade. The renal vasoconstriction reduces the glomerular filtration rate and, thus, the tubular sodium load. Simultaneously, possibly by the same sympathetic stimulus, more renin is liberated from the juxtaglomerular apparatus. This increases the production of angiotensin and in turn, raises the production of aldosterone. By the combined effect of the reduced glomerular sodium load and aldosterone-mediated increase in tubular reabsorption of sodium, sodium and water will be retained in the body. During the night-rest the load on the circulatory system diminishes. In the early stages of heart-failure this emergency circulatory reaction, therefore, subsides and the rise of the renal fraction of the cardiac output leads to the excretion of the retained fluid and is the basis of nocturia.


Thymectomy in the neonatal rat.

A method for removal of the thymus in the newborn rat employing measures aimed at reducing the mortality incurred by the surgical procedure, cannibalism and infection is described in detail. Tranquilisation of the dam, sterile technique, magnification of the operative site for thymus aspiration, warming to 37 degrees C during the recovery phase, and application of pheromones to the offspring prior to their reunion with the dam, all proved important in increasing the survival rate.


Topical application of a chlordane-containing ectoparasiticide: effect on the plasma half-life of warfarin in dogs.

Brief exposure of dogs to topical chlordane solutions resulted in a significant and long-lasting decrease in the biological half-life of orally administered warfarin. The effect is presumed to be an expression of chlordane's well-documented inductive effect on hepatic microsomal drug metabolizing enzymes and its long-term storage in fat depots. The facility with which chlordane is absorbed through the intact skin of dogs may render casually-treated animals unsuitable for subsequent pharmacologic study for long periods of time.


The origins of some hitherto undescribed inbred mouse strains.

The origins of 7 inbred mouse strains (OUBW, OUCW, OUGW, OUYW, OUBCr, OUF and OUW) are reported. 6 of these strains have been in existence for a number of years, and 4 of them have not been mentioned in the literature. 2 of the strains have been referred to in published work, but because of incorrect designation may have caused some confusion. The remaining strain (OUBCr), which has considerable research potential, has been developed from a mutation in an NZB subline.


Housing mice in a caging system with automatic flushing.

Male Har:(ICR)BR mice were housed 8 wk in wire bottom cages over paper, in wire bottom cages over an automatic cascade flushing system, or in solid-bottom plastic cages with bedding material. There were no substantial differences in general health or weight gain. Pentobarbital LD50 values were lower for the mice housed in wire bottom cages than for the mice in solid bottom cages with bedding. This difference was probably related to gastrointestinal content. It appears that the automatic cascade flushing system is suitable for housing mice for periods up to 8 wk.


Some factors determining yields of peritoneal exudate macrophages from guinea pigs.

Several features which affect the yields of guinea pig peritoneal exudate macrophages were investigated. Optimum yields were obtained from ex-breeding female guinea pigs, aged ca 18 mo, 10 da after injection with Marcol 80.


An epizootic of necrotic dermatitis in laboratory mice caused by Lancefield group G streptococci.

During a 7-mo period, mice from a group of 383 being used in a toxicology experiment developed severe progressive necrotic dermatitis, and some animals developed paralysis. The overall mortality rate for the group was 134/383 (35%). Seventeen mice were necropsied for bacteriologic and histopathologic examination. A streptococcus identified as Lancefield group G was isolated from the skin lesions of 15 of the mice, from 8 of 9 throats cultured, from 4 of 8 spleens, and occasionally from other sites. It was thought that the infections were initiated and perpetuated by bites from mice carrying the streptococcus in their mouth and throats. Microscopic examination of affected skin revealed necrotic dermatitis characterized by epithelial ulceration with suppuration. The skin lesions were reproduced in 6 of 15 mice inoculated with the isolated streptococcus.


Sialocele (ranula) simulating oral papillomatosis in a domestic (Oryctolagus) rabbit.

A sialocele originating in the duct of the sublingual salivary gland near its opening, close to the lingual frenulum, was observed as a naturally-occurring lesion in a laboratory rabbit. The lesion was assumed during necropsy dissection to be an oral papilloma. Microscopic examination of histologic sections revealed the lesion to have the characteristics of a sialocele (ranula).


Retinal dystrophy in Sprague-Dawley rats.

A spontaneous retinal dystrophy was found in 4 percent of Sprague-Dawley-derived rats examined. The lesion occurred both unilaterally and bilaterally in equal frequency, but the incidence in the females was 2 times greater than in males. Retinal change consisted of focal or diffuse absence of the outer layers of the retina, but frank degenerative changes or progression of the lesion was not observed. The cause of the dystrophy was not determined, but its increased occurrence with increasing age of the rats suggests an age-related lesion.


Normal functions of the thyroid gland of the pygmy goat.

Normal values were obtained for blood serum PBI, T3 index. T4, and cholesterol in a colony of pygmy goats (n equal to 55) of mixed sex and age. Serum PBI values averaged 8.1 plus or minus 1.2 mug/dl with no significant sex differences. The mean T3 index and T4 value were 1.1 plus or minus 0.1 and 7.2 plus or minus 1.1 mug/dl, respectively, with no sex differences. The mean serum cholesterol value was 90.0 mg/dl, with sex differences apparent. Serum cholesterol averaged 84.9 mg/dl (n equal to 44) for females and was significantly higher in intact males (97.4 mg/dl; n=8) and significantly lower in castrate males 69.2; n=6. There was a consistent and significant increase in cholesterol values with age in females, an unexplained phenomenon also observed in humans. There was no evidence of thyroid malfunction in the animals studied.


An anesthetic system for small laboratory animals.

A non-rebreathing anesthetic system for administering volatile anesthetic mixtures to small laboratory animals was designed. The device is easily constructed and simple to operate, yet permits the anesthetic management of small animals by technics similar to those used for man and larger species.


Prolapse of invaginated colon through the anus in golden hamsters (Mesocricetus auratus).

Six cases of invagination of the colon with prolapse through the rectum were reported in the Golden Syrian hamster. The anatomy of the colon and its enveloping mesentery in the hamster are thought to be predisposing factors in the process of invagination. The mesenteric fold incorporates the spleen in this animal and acts as a ligament stopping further invagination. The gross pathology associated with the process of invagination was described. Observations with respect to the pathogenesis were included, emphasizing the point that peristalsis and not the initiating intestinal irritant is the major causal factor.


A method for intratracheal instillation in the rat.

A method was developed to provide safe, rapid, and accurate intratracheal instillation of radionuclides into the rat lung. Rats were anesthetized with halothane and suspended vertically on an animal support stand with rubber bands attached to the incisor teeth, holding the mouth open. A speculum was inserted into the trachea and the radionuclide was injected from a syringe through tubing inserted through the tracheal speculum into the trachea. The amount of radionuclide retained in the lung varied by less than a factor of 2 within groups of rats observed 4 hr-20 da after employing this method of instillation. When a volume of 2 ml was instilled, the radionuclide distribution between the left and right lung was similar to that observed following incorporation by inhalation. Instillations of less than 2 ml showed unequal distribution of radionuclide between the right and left lung.


Selected blood values for Macaca nemestrina fed semipurified fiber-free liquid diets.

Selected plasma chemistry and hematologic data were obtained from 8 pig-tailed monkeys fed semipurified fiber-free liquid diets for a prolonged period of time. No significant differences were noted from reported values of pig-tailed monkeys fed solid foods except for a slightly higher level of total plasma protein and globulins.


Design of a metabolic cage for infant rats.

A glass metabolic cage was designed for studies involving newborn rats and small animals up to about 15 g. The metabolic chamber is a jacketed tube, open on both ends and closed with 0-ring clamps. Water is circulated around the cage to maintain a constant and physiologic chamber temperature. Information about the metabolic pathway of nutrients and drugs can thus be studied, and the effects of drugs on metabolism of substrates to CO2 can also be assessed in the newborn animal.


Cutaneous and pulmonary aspergillosis in rabbits.

Cutaneous and pulmonary aspergillosis was diagnosed in rabbits. Dichotomous branching, septate hyphae typical of Aspergillus spp were observed in cystic hair follicles. Atypical, short, knobby mycelia with radiating projections were seen in nodular lesions in the lung.


A cage for the collection of excreta from individual mice in radioactive tracer studies.

A simple and inexpensive unit for the collection of excreta from individual mice was designed. The results of experiments in which counts of collected radioactive excreta were made closely approximated those previously obtained using a whole-body gamma counter.


A simple technic for repeated collection of blood samples from mice.

A device for repeated collection of small blood samples from mice was constructed from a plastic syringe. Blood was collected into a 3.33 lambda capillary tube. Bleeding was stopped by a hemostat made from a rubber stopper. This technic allows easy collection of approximately 20 serial samples within an 8-hr period.


Naturally occurring hypertrophic pyloric stenosis in the domestic rabbit.

Hypertrophic pyloric stenosis was observed to occur naturally in laboratory rabbits. Three cases in juvenile and adult rabbits and their antemortem histories were examined. The gross and microscopic pathology were studied. It was shown that not only the pylorus, but the stomach as a whole was increased in size both relatively and absolutely. The thickness of the pylorus was doubled, but its circumference was not increased, in hypertrophic stenosis. The chief histologic finding was hypertrophy of circular and longitudinal smooth muscles and their enveloping fascia. The myenteric plexi were essentially normal in appearance. The literature on a similar condition in man, dog, and cat was reviewed.


Lipolysosomes in human hepatocytes. Ultrastructural and cytochemical studies of patients with Wilson's disease.

Lipid droplets surrounded by a peripheral membrane closely apposed to an electron-dense layer and containing acid phosphatase activity, similar to the lipolysosomes in hamsters described by Nehemiah and Novikoff (J. Cell Biol. 59: 246a, 1973; Exp. Mol. Pathol. 21:398, 1974), were found in the hepatocytes of patients with Wilson's disease. These organelles account for 1 to 2 per cent of the observed lipid droplets at the stage of the disease when excess fat is present. The occurrence of lipolysosomes in a condition not known to be associated with an acid lipase deficiency suggests that lipolysosomes may represent a nonspecific, alternate route for the mobilization of excess lipid from hepatocytes.


Influence of cotton dust inhalation on free lung cells in rats and guinea pigs.

The influence of cotton dust inhalation on pulmonary leukocyte recruitment has been examined in rats and guinea pigs in an attempt to develop an animal model which can be used to assess the relative pulmonary toxicity of dusts from various varieties of cotton. Statistically significant increases in leukocyte populations in the lungs occur as the result of dust inhalation. Although the response is not influenced by the sex or age of the test animal, species differences do occur; guinea pigs are more sensitive to the effects of exposure than rats. Also, the exposure regimen tends to influence the degree of the response, with intermittent exposure producing fewer cells than continuous exposure for the same period of time. Future investigations will use the information gathered here to employ the most appropriate animal species as a tool to screen varieties of cotton, and thereby to rank them according to their potential to aggravate or to initiate certain pulmonary pathologies.


Relationship of hyperplasia to cancer in 3-methylcholanthrene-induced mammary tumorogenesis.

Light microscopic study of the evolution of 3-methylcholanthrene-induced mammary tumors in Wistar-Furth rats revealed a seriation of changes proceeding from early hyperplasia (8 days) to advanced hyperplasia (57 days) and cancer (78 days). Ultrastructurally, cellular changes in advanced hyperplasia and cancer were indistinguishable, being characterized by nuclear chromatin clumping, prominent nucleoli, cytoplasmic polyribosomal aggregates and pseudopodal extensions, and prominent Golgi structures. These features, as well as the lack of limiting lamina basalia, allowed for their distinction from the cells of early hyperplasia. Further, only nodules of both advantanced hyperplasia and cancer were transplantable in syngeneic recipients. Chromosomal aberrations were qualitatively similar in cells obtained from all lesions but were progressively more frequent. Although these findings do not allow for the discrimination of advanced hyperplasia and cancer, they indicate their close pathogenetic relationship as well as the very early occurrence of chromosomal alterations in the development of mammary cancer in this model system.


Lipid profile in the evolution of experimental atherosclerotic plaques from thrombus.

Nonocclusive white mural thrombosis was induced in the abdominal aortae of normolipidemic rabbits by insertion of a polyethylene catheter into the abdominal aortae. The thrombus subsequently organized into intimal thickenings which resembled fibrofatty type atherosclerosis seen in man, showing large numbers of foam cells containing stainable lipid, fatty necrotic centers, cholesterol clefts, calcification, and fibrous caps. The lipid composition of the thrombus and lesions was followed at serial time intervals from 4 hours to 60 weeks. Lipid analysis showed significant concentrations of lipid in the early lesions and with time these lipid concentrations increased and later decreased. These studies demonstrate that the fibrofatty lesions derived from a white thrombus have significant amounts of the same lipids that characterize the atherosclerotic lesions of man, however, there is a lower proportion of cholesterol to the other constituents and a higher proportion of phospholipids. The free cholesterol and cholesteryl ester of the 4-day lesions were much greater than that of platelets alone indicating that significant amounts of plasma are trapped in a thrombus when it forms.


Changes in the microvasculature of ischemic and infarcted myocardium.

The fine structure of the small vessels in experimental myocardial infarcts of 10- to 360-minute duration was studied in 32 dogs and compared with the appearance of the small vessels in the corresponding normal myocardium. Following 10 to 60 minutes of coronary artery occlusion, increasing numbers of endothelial cells showed a marked swelling which was consistent with the presence of an intracellular edema and frequently resulted in various degrees of obstruction of the vessel lumen. After 120 minutes of ischemia, not all endothelial cells were obviously swollen, but all showed signs of degeneration, including changes in organelles similar to those in surrounding muscle cells. A progressive intensification of degenerative changes, particularly with respect to the continuity of the endothelial lining and the integrity of the membrane systems of individual endothelial cells, was observed at 3, 4, 5, and 6 hours after coronary artery ligation, and cell debris could be seen in the lumina of most small vessels.


Uptake of histamine by rabbit hypothalamic slices.

The accumulation of [-14C] histamine into slices of rabbit hypothalamus was studied. All areas of hypothalamus took up histamine against a concentration gradient. The highest accumulation was into the infundibular area and the lowest into the mamillary body. The uptake did not correlate with the level of endogenous histamine. The uptake continued for at least two hours and a maximum tissue/medium ratio of about 5.6 was reached. The major part of radioactivity was chromatographically shown to be histamine. The uptake was temperature dependent and required sodium. It was not significantly inhibited by compound 48/80, but it could be inhibited with desipramine and 5-hydroxytryptamine. Therefore, the uptake of histamine shares many characteristics of the uptake of monoamines by brain slices, even if the rate of uptake appeared to be slower.


Economic and noneconomic barriers to the use of needed medical services.

This paper introduces an index of access to medical care that describes the use of services relative to the actual need for care. Findings on this particular measure suggest that, contrary to the implications of much of the existing literature, the poor continue to use fewer services-relative to the disability they experience-than do the nonpoor. Further, despite the advent of publicly financed economic solutions to these access differentials-Medicaid and Medicare, in particular-organizational barriers to entry, such as the long queues to obtain service and long travel times to care in some areas, still exist. The implications of these findings for the evaluation of existing and proposed national health policy efforts are discussed.


Verbal communications of community pharmacists.

Community pharmacists, by virtue of their location, are thought to be among the most accessible health care workers in the delivery system. To estimate the importance of this assertion it is necessary to understand the communication habits of pharmacists, especially their interactions with patients. Since verbal communication is the most frequent form of patient interaction, this study attempts to specify the type and amount of all pharmacist communication with emphasis on the pharmacist-patient process. Using a modified work sampling technique, communication data were collected on community pharmacists practicing in chain pharmacies. Data are presented in the context of a causal model. The strongest pathway in the model is found to be the inverse relationship of prescription department staffing to the percentage of time pharmacists devote to communication with patients. Prescription volume is seen to have a moderately positive effect on the level of communication. However, further analysis reveals staffing to be the limiting factor. The findings suggest that changes in the environment of the community pharmacists studied would do much to increase pharmacist-patient contact. An educational effort also is indicated to assure that patients receive quality communication.


Lysosomal enzymes and aging in vitro: subcellular enzyme distribution and effect of hydrocortisone on cell life-span.

The acid phosphatase and beta glucuronidase activities of four subcellular fractions (nuclear, mitochondrial-lysosomal, microsomal, supernatant) of WI-38 cells were compared during in vitro aging. All of the fractions showed an age-associated increase in activity. The increase in the lysosomal fraction was sufficient to account for the increase in the whole homogenate. The supernatant fraction showed a consistent and pronounced increase suggesting a decrease in latency. Hydrocortisone stabilized the lysosomes to some extent. However the presence of hydrocortisone (5 mug/ml) in the growth medium consistently extended the life-span of the culture 20-30%. The magnitude of the extension seemed to be directly proportional to the amount of time the cultures were exposed to the added hormone.


A study of consumer attitudes about health care: the delivery of ambulatory services.

This paper examines the patient's decision to select a source of care, offers a theoretical construct of this choice process, and reports on the results of a survey that tested the model among the population of Rochester, New York. Respondent reasons for selecting a source of ambulatory care are collapsed into categories that relate to individual perceptions of the utility of cost, time, convenience, sociopsychological factors, and the technical quality of care. The relative importance of these criteria and other findings relating to sociodemographic characteristics and individual patterns of utilization are reported. The data are derived from a survey (N = 521) of households representative of the area of Rochester, New York.


Changing health care opinions in Regionville, 1946-1973.

This study is a partial replication study of a community with the fictious name of Regionville which was first studied by E. L. Koos in the period 1946-50. In the present paper, we are concerned principally with that part having to do with the changing health care beliefs in this community. The indications are that: 1) there has been considerably liberalization of opinion, particularly among upper class respondents, in terms of issues relating to national health insurance and the role of ancillary medical personnel such as social workers; and 2) social classes are much more similar in their perceptions of many medical care issues now than they were a generation ago. Finally, we suggest that the changing pattern of response of the questions asked in the late 1940s and again in the 1973 is reflective of profound changes in American life.


Age-related refractoriness of PHA-induced lymphocyte transformation. I. Comparable sensitivity of spleen cells from young and old mice to culture conditions.

The decline in phytohemagglutinin (PHA) responsiveness of spleen cells from aged mice was studied in an effort to determine the nature of the depressed PHA reactivity. The reduced response of DNA synthesis (thymidine incorporation) to PHA stimulation could not be attributed to a decreased viability of spleen lymphocytes from old mice in in vitro culture conditions, to different PHA dose requirements, or to longer periods of culture time for old mouse spleen cells to reach maximal activity. Culture of cells for 24-48 h prior to addition of PHA gave patterns of thymidine incorporation similar to those of freshly prepared spleen cells. The elimination of red blood cells by a brief hypotonic shock significantly increased thymidine incorporation in spleen lymphocytes from both yound and old mice.


Effect of environmental conditions upon age changes in the human liver.

Age changes in the liver of the Hawaii-Japanese have been compared with those of native Japanese and Caucasians in the United States. Among the Japanese in Hawaii, all cases over 70 years of age were migrant Japanese to Hawaii, i.e. Issei, those under 60 years of age were their Hawaii born descendents, i.e. Nisei, and cases in the 7th decade were composed of Nisei and Issei. Aging changes of the liver seem to begin earlier in the Nisei and Caucasians than in the native Japanese. The earlier onset of aging can be explained on the basis of earlier maturation due to better nutritional conditions. The marked decrease in the number of hepatic cells in the Issei may well be a reflection of their nutritional state during their early years. They, in this sense, resemble the native Japanese.


Comprehensive pediatric care: the patient viewpoint.

Two meanings of the term comprehensive care are delineated. The first refers to a wide scope of health services, the second to a humanistic approach to the patient. Findings from a sample of patients from one pediatric practice suggest that the two meanings constitute two independent variables with respect to patient expeciations. Patient responses to questions regarding their expectations of the pediatrician revealed a tendency to hold a traditional disease orientation. Comprehensive care as a broad scope of health services that include mother guidance in child rearing is not a common goal for mothers utilizing the pediatric practice under study. On the other hand, a comprehensive approach by the pediatrician is a standard shared by most respondents in the sample: high priority is accorded the pattern of the personal physician with whom a patient forms a continuous doctor-patient relationship which instills in the patient trust that the physician's recommendations are based on thorough knowledge of the patient as an individual.


Emergency hospitalization of young children: some neglected psychological considerations.

In spite of the fact that emergency admission is the most common form of hospitalization for young children, as well as containing the greatest potential for trauma, almost no reference has been made to it in the psychological literature on pediatric hospitalization. To explore the theoretical and practical feasibility of research in this area, a pilot study was designed to investigate the reactions of a sample of children, parents, and staff to the first six hours of emergency hospitalization, compared with those of a similar sample to elective admission. Sixteen children (eight in each group) aged 11 to 48 months were selected on a time-sample basis from the patient population of a large, metropolitan, pediatric hospital and were followed by trained observors using a specially designed observation schedule. The results indicated that, as expected, emergency does constitute an even greater stress for children, parents, and staff that the already stressful situation of elective admission. In both conditions however, the results were more complex and more disturbing than anticipated. The implications of these findings, as well as suggestions for further research, are discussed.


Missing links in the human services nonsystem.

Four separate human services programs and their West Philadelphia service consumers were studied by the 1971 Health Network Project: a hospital receiving ward, a community mental health satellite center, a public assistance district office, and a public child welfare agency. The basic hypotheses were that 1) the four consumer groups present common health, economic, and social problems, and 2) each agency confines its services to its own specialized range of problems and provides minimal linkages to other service facilities, including those available within its own subdivisions. Data were obtained by interview and record review from over 600 patients and clients. Each agency was found to respond to presenting problems with specific interventions. However, failure to detect, treat, or refer concurrent problems was pronounced. Despite the great prevalence of physical and mental illness, compounded by economic marginality, each agency made minimal use of internal support services and external referrals. The human services nonsystem is discussed conceptually in light of specialization and fragmentation. Proposals for shifting the nonsystem toward a responsive service network include the introduction of comprehensive screening devices and of service generalists for case management.


Studies on ageing in Turbatrix aceti.

Morphologic and physiologic changes which occur during senescence in the free-living nematode Turbatrix aceti are described. With age areas of the interchordal hypodermis containing nerve elements thickened, electron-dense aggregates formed within the pseudocoelom and age pigment granules accumulated within the intestinal epithelium. Specific gravity did not change with age. Old nematodes which had reproduced showed increased osmotic fragility, but this change was not observed in virgin females. The parameters characterizing senescence in T. aceti are compared with those of Caenorhabditis briggsae, another nematode being used as a model to study biological ageing.


The value of Gallium67 scanning in the evaluation of head and neck malignancy.

Gallium (67Ga) citrate is a scanning agent that has been shown to have a differential uptake in a variety of malignancies. Investigation of the usefulness of 67Ga scanning patients with proven squamous cell carcinoma of the head and neck region is now in progress. These patients have a 67Ga total body scan as part of the pre-treatment evaluation. The accuracy of the procedure is then judged by correlation with clinical and surgical findings. The results in 25 patients show that a clearly positive uptake occurs in 60 percent in the region of the primary. Uptake in metastatic disease in lymph nodes is much less, occurring in 6 of 18 sides of the neck. In one case, where clinical examination was considered to be negative, the gallium scan was positive and subsequently proven to be correct by histological examination of the surgical specimen. The various difficulties encountered in interpreting gallium scans in the head and neck region are described. It is felt that by improved patient selection and special techniques the yield of positive cases can be improved and unsuspected extension of malignancy demonstrated.


Laryngeal transplantation: current status 1974.

There are four major areas of concern that must be examined before human laryngeal transplantation can be considered feasible in clinical practice. These are: 1. surgical mechanics of revascularization; 2. reinnervation; 3. prevention of host rejection; and 4. justification. Of these criteria, the first two habe been met sucessfully at present. Safe suppression of rejection without increased risk of cancer recurrence remains to be achieved. Until this third criterion is satisfied, one is probably not justified to make further attempts at laryngeal transplantation in humans.


Laryngeal structure following microcauterization.

This paper supports and reaffirms the objectives of contemporary laryngology in the treatment of cancer of this organmthese objectives are, first and foremost, the eradication of the tumor, and second, the preservation of function. A relatively recent contribution to the "state of the art" has been the development of the field of microlaryngology. The introduction of the surgical microscope has provided the laryngologist with better means to judge the type, localization and extent of neoplastic lesions. Reports indicate that superficial limited carcinomas of they larynx with good vocal cord mobility can be successfully treated by vocal cord stripping and/or radiotherapy. This paper presents the serious challenge posed by these limited tumors when they recur after radiotherapy. In a selected number of these patients radical surgery has been prevented by treating these recurrent tumors with the microcautery. Some of these patients, so treated, habe been free of disease for more than three years after their recurrent tumors were destroyed with the microcautery. During this time these patients have enjoyed adequate voices.


Management of chylous fistulas;.

Chylous fistula following radical neck dissection is a disturbing and potentially serious complication. Meticulous surgical technique in the areas of the thoracic duct on the left and the lymphatic ducts on the right will usually prevent the occurrence of a chylous leak. If one should develop, however, a pressure dressing alone is usually not sufficient to tamponade the leaking vessel. The patient should be returned to the operating room where the leak is identified and ligated. Loss of chyle from the body will rapidly deplete the body stores of fluid, proteins, and electrolytes. Careful monitoring of serum electrolytes and proteins and accurate replacement of these substances is essential. The anatomy, physiology, surgical technique, and treatment of the lymphatics and chylous fistulas at the base of the neck are considered herein.


Arytenoid vocal shunt in laryngectomized patients.

A method is presented for forming short, mucosa-lined vocal shunt in cases of supracricoid laryngectomy with preservation of one or two arytenoids, or the interarytenoid fold alone. On the basis of radiologic and particularly radiocinematographic examinationion of the anterior pharyngeal wall is of paramount importance. In cases of complete absence of leakage, said wall lies in the plane of the arytenoids or somewhat posteriorly. After simple supracricoid laryngectomy it is possible to prevent aspiration also by translocation of the anterior pharyngeal wall into the plane of the cricoid cartilage plate. The clinical experience with this supracricoid shunt is still scanty. Of 25 cases with the arytenoid vocal shunt, phonation was possible in 22 cases under the expiratory pressure of 20-45 cm H2O; in one under the more elevated pressure, and in the last two the result is still not known. Loudness of speech was 70-100 db and its comprehensibility 73-90 percent.  Complete absence of leakage was observed in 17 cases, "practical" prevention of aspiration (some drops of thin fluids, no saliva) in seven cases, profuse leakage in one case (ceased after correction), In the last 10 consecutive cases the problem of aspiration was completely eliminated. Advantages and disadvantages of our own method in comparison with Asai's method have been presented.


Open tube, proximal illumination mirror and direct laryngeal photography.

Equipment is described for mirror and open tube direct laryngoscopic photography. It consists of specially constructed reflex camera systems that provide adequate exposure and depth of the desired field, sharpness of focus, correct color and effective composition for meaningful illustrations. The separate cameras for still and motion pictures consist of units that contain the light source, lenses, optic reflex systems and film chambers. The mirrors for indirect laryngoscopy and the open tube direct laryngoscopes are attached by rigid, easily released clamps for quick interchange. It is stressed that the laryngologist himself must be the photographer. The pictures are adjuncts to case recording, are supportive evidence of investigative work and may be used as chronologic sequences in study of physiology and pathology and in pre- and postoperative evaluation.


Rhinorrhea with airway obstruction.

Life endangering airway obstructions have many facets and causes. Rhinorrhea is a symptom whose etiology may be overlooked if an immediate crisis of airway obstruction is present. Unless the cause for the obstruction or rhinorrhea is investigated it may go undetected and continue to present further problems for the patient. This is especially true of infants under six months of age who are obligate nasal breathers. The following are three cases representing this problem.


D'emblee type of mycosis fungoides of head and neck.

Mycosis fungoides as a disorder of reticulo-endothelial system occurs in the eczematous or psoriatic stage, progresses to infiltrated plaque stage and finally to tumorous form with or without systemic spread. The head and neck is rarely involved. A case is presented in which the disease process started as a tumor (d'emblee type) and remained localized in the head and neck region without a generalized spread. The tumorous lesion rapidly increased in size and involved deeper tissues of the neck to cause infranuclear facial palsy and medial bulging of the tonsil' it also extended in the superior mediastinum casuing pressure on the trachea and the esophagus. The patient died of respiratory failure.


Centennial conference on laryngeal cancer papers. Primary laryngoplasty.

A new procedure is described for the surgical reconstruction of the larynx following total laryngectomy.  Postoperatively, the voice was as good as that resulting from Asai's laryngoplasty.  Aspiration of fluid into the trachea was minimal.  The procedure may be briefly summarized as follows: 1. The lateral portion of both thyroid cartilages are left in situ.  2. The posterior laryngeal wall is formed with the superior horns of the same cartilages.  3.  The inner surface of the reconstructed larynx is lined by mucosal flaps from the hypopharynx.  4. The reconstructed larynx is firmly sutured to the base of the tongue.  This procedure was employed in 19 cases with an extensive laryngeal carcinoma.  In five of them healing was retarded by the formation of postoperative pharyngeal fistulas.  All patients regained their voices and their ability to swallow.


Replacement of the arytenoid following vertical hemilaryngectomy.

A considerable body of literature advocates and defines treatment of vocal cord cancer with posterior extension by hemilaryngectomy.  The present study was carried out to determine the feasibility of using a newly devised pedicle flap, composed of thyroid cartilage and inferior constrictor muscle, to replace the ablated arytenoid cartilage.  Animal investigation revealed satisfactory viability of the pedicle flap in canines, and in humans, five patients with T2 glottic carcinoma demonstrated excellent postoperative deglutition and return of voice.  The results of the study indicate that this surgical technique merits consideration for its use in minimizing protracted glottic incompetence following hemilaryngectomy.  The thyroid cartilage-inferior constrictor muscle pedicle flap may also prove useful as partial cricoid replacement in selected cases of subglottic extension and in cricoid reconstruction following trauma.


Glottic reconstruction after hemilaryngectomy: bipedicle muscle flap laryngoplasty.

This paper presents the techniques for glottic reconstruction after partial laryngectomy using a bipedicle muscle/perichondrial flap. The use of this technique extends the scope of lesions amenable to conservation surgery and maximizes the postoperative laryngeal function in terms of satisfactory phonation, respiration, and deglutition.


Reasons for irradiation failure in squamous cell carcinoma of the larynx.

The reasons for irradiation failure in squamous cell carcinoma of the larynx can be: 1. Geographical miss because of undiagnosed extensions is the exception. Almost all of the recurrences were well within the treatment portals. 2. Specific extensions with an unfavorable tumor bed. Extension of disease into poorly vascularized structures and/or deep infiltration with fixation are causes of failure. 3. Low dose for the volume cancer. Higher doses delivered in longer treatment time are necessary for 90 percent control of bulky exophytic supraglottic lesions. 4. Techniques which do not assure daily coverage of the tumor. With carefully drawn and checked anatomical portals, geographical misses should be nonexistent. 5. Sigmoid response curve. There is an 85 percent control of the T1 glottic tumors. The control rate is 90 percent of the T1 and T2 supraglottic tumors, and the 10 percent failures have no obvious explanation except that the plateau of the sigmoid response curve has been reached. A negligible yield would be obtained by increasing doses which would not be justified because of concomitant increase in frequency and severity of complications and lessening of the quality of voice. 6. New cancer. Probably 25 percent of the so-called recurrences on the vocal cords are actually new primary lesions. The ultimate failure rates respectively are 2 percent for T1 lesions and 10 percent for T2 lesions after a rescue surgical procedure. All patients with T1 vocal cord lesions who did not experience a failure or a complication, have a normal voice. In the patients with T2 lesions in whom the cancer had completely replaced the cord(s), some hoarseness is present; but most of these lesions would have been suitable only for a total laryngectomy. In the 15 failures in T1 and T2 supraglottic lesions, surgery was not attempted in only three patients, one of whom was salvaged by re-irradiation. Following 12 laryngectomies there is only one definite failure and two patients died within two years NED locally. Except in the patients who had severe edema and/or necrosis, the voice has been normal or near normal. In patients with lesions of the suprahyoid epiglottis which had amputated the suprahyoid epiglottis swallowing difficulty has not developed.


Metabolites of aspergilli. II. Asparvenone and O-methylasparvenone, naphthalenones from Aspergillus parvulus.

When grown on a malt extract-glucose medium, Aspergillus parvulus Smith (ATCC "169911) produced at least four metabolites detectable on thin-layer plates with ferric chloride spray. Two of these metabolities, asparvenone (7-ethyl-3,4-dihydro-4,6,8-trihydroxy-1(2H)-naphthalenone) and O-methylasparvenone (7-ethyl-3,4-dihydro-4,8-dihydroxy-6-methoxy-1(2H)-naphthalenone), were isolated and their structures determined. The structure of O-methylasparvenone was determined by chemical and spectral means and X-ray crystallographic studies of its monoacetate. The structure of asparvenone was deduced by spectral and chemical means and by methylation with diazomethane to O-methylasparvenone.


Essential fatty acid deficiency: metabolism of 20:3(n-9) and 22:3(n-9) of major phosphoglycerides in subcellular fractions of developing and mature mouse brain.

Essential fatty acid deficiency was initiated in young and mature mice.  The metabolism of 20:3(n-9) and 22:3(n-9) in brain subcellular fractions was followed after the mice were switched from the deficient diet to a corn oil supplemented diet.  After switching to the supplemented diet, the proportions of (n-9) polyunsaturated fatty acids in brain in both groups of mice decreased with time.  The rate of disappearance of (n-9) polyunsaturated fatty acids was faster in the young groups than in the mature group.  In the developing mice, the half-linves of the (n-9) polyunsaturated fatty acids in the total ethanolamine phosphoglycerides of brain microsomal, synaptosomal, and myelin fractions were 3, 10, and 15 days respectively.  In the mature group, the half-lives for 20:3(n-9) in diacyl-glycerophosphorylethanolamine of microsome, synaptosome, and myelin fractions were 8-10, 10, and 22 days, respectively; and the half-lives for 22:3(n-9) in alkenylacyl-glycerophosphorylethanolamine of the same subcellular fractions were 8-12, 28, and rate of disappearance of 20:3(n-9) in brain was faster in the diacyl-glycerophosphorylethanolamine than in the alkenylacyl-glycerophosphorylethanolamine.  These results demonstrate that the metabolism of (n-9) polyunsaturated fatty acid in brain phosphoglycerides during recovery from essential fatty acid deficiency not only varies with age, but also depends upon individual phosphoglycerides present in each subcellular fraction.


Constituents of West African medicinal plants. VII: Alkaloids of Tiliacora dinklagei.

Tiliacore dinklagei (Menispermaceae), a woody climber of the rain forests of West Africa, has been used as a native medicinal and an article of commerce. Chromatography of an ethanolic extract of the powdered roots afforded the three alkaloids tiliacorinine, funiferine and nortiliacorinine A; the new alkaloid, tiliageine and the incompletely characterized alkaloid, TD-2.


Isolation of chrysophanic acid-9-anthrone, the major antifungal principle of Cassia tora.

An antifungal principle of defatted seed power of Cassia tora Linn. was isolated by extraction of an aqueous paste of the powder with benzene, followed by column chromatography over activated silica gel C using chloroform as the developing solvent. Besides chrysophanic acid and other hydroxyanthraquinone derivatives, the major antifungal compound was identified as chrysophanic acid-9-anthrone, the structure of which was assigned on the basis of its chemical properties and uv, ir, nmr and mass spectral analysis. The compound was active against Trichophyton rubrum, T. mentagrophytes, Microsporum canis, M. gypseum and Geotrichum candidum in broth in the presence of 100 mug/ml L-ascorbic acid as antioxidant.


Studies on chemical nature of lipofusion (age pigment) isolated from normal human brain.

Human brain lipofusion isolate was studied for its purity and physical and chemical properties.  Purification of the inpure material was achieved by gel permeation chromatography using Sephadex LH-20 and BioBeads S-X1 gels.  The purified lipofusion polymer represented ca. 12% of the starting material with the rest of the material being various mixed lipids.  The mol wt of the purified lipofuscin was determined to be between 6000-7000 daltons.  IR, UV-visible, NMR, and fluorometric spectra were obtained, all indicating the fundamentally lipid nature of lipofuscin.  The NMR spectrum strongly resembled that of a typical long chain fatty acid.  Numbers of fatty acids and several amino acids were present as a portion of the lipofuscin structure.  The results obtained suggested that the brain lipofuscin employed in the present study consisted mainly of polymeric lipid and phospholipid structures along with amino acids either bound to the lipids or as included proteins.


Stimulatory effect of glucose upon triglyceride synthesis from acetate, decanoate, and palmitate by mammary gland slices from lactating mice.

Slices prepared from the mammary glands of lactating mice incorporate only small amounts of (1--14C) acetate, (1--14C) decanoate, or (1--14C) palmitate into lipids.  However, when glucose is added to the incubation medium, fatty acid incorporation is stimulated-13-fold from acetate, 17-fold from decanoate, and 2-fold from palmitate.  Over 90% of the -14C activity in the lipid fraction is in triglycerides.  Analysis of fatty acids in the triglycerides showed that almost all of the decanoate and the palmate were incorporated as intact molecules, while acetate yielded acids of varying chain lengths.  The glucose stimulation of triglyceride synthesis is not solely due to its effect upon chain elongation but also could involve glyceride-glycerol availability, as well as other unknown factors.  However, from measurements of the amounts of glycerol 3-phosphate in the tissue incubated in the presence of palmitate, it would appear that glyceride-glycerol availability is not rate limiting in triglyceride synthesis.


The incorporation of orally fed radioactive gamma-linolenic acid and linoleic acid into the liver and brain lipids of suckling rats.

The incorporation of radioactivity from orally administered gamma-linolenic acid-1--14C and linoleic acid--3H into the liver, plasma, and brain lipids of suckling rats was studied.  Significantly more radioactivity from the former compound was incorporated into the liver and brain lipids 22 hr after dosing.  The distribution of the radioactivity in the fatty acids of the liver and brain lipids was different for each isotope.  Most of the -3H was still associated with linoeic acid, whereas most of the -14C was in the 20:3 and 20:4omega6 fractions.  These results suggest that the desaturation of linoleic to gamma-linolenic acid in vivo is a rate-limiting step in the conversion of linoleic to arachidonic acid.


Alkaloid screening. VI.

One thousand and five plant extracts were screened for the presence of alkaloids. The number of positive tests obtained was 267, or 34.01%. New to the literature are 137 species. In the five previous communications (1-5) in this series we have reported on the screening of 4,990 plant extracts for alkaloids. These 4,990 extracts represented 4,103 species of plants, of which 1,069 gave positive tests.


Androgens and exercise.

In this presentation several of the reasons why androgenic hormones might be responsible for some of the effects of physical training and for some of the differences among individuals in athletic ability have been outlined. It seems apparent that minimal amounts of androgen are necessary to produce the normal differences between males and females in aggression, red blood cell production and bone growth, but it seems unlikely that any additional natural androgen, perhaps produced as a result of physical training, can be shown to enhance these characteristics after puberty. It seems more likely that changes in androgen levels or changes in sensitivity to androgens may be shown to be involved in the increases in muscle glycogen, protein synthesis, and lean body mass associated with chronic exercise. However, the data suggesting changes in androgen levels or androgen uptake with exercise are so meager and contradictory that no complete answer to any of these problems can yet be offered. Perhaps the best evidence that androgens are involved in athletic performance is that boys become more athletically proficient than girls at puberty, the time of the greatest changes in blood testosterone. The changes in muscle strength, body weight and lean body mass caused by anabolic steroid treatment are probably greater than many would hope and somwhat less than many think. There is apparently a wide range of individual responses to these drugs.


The role of insulin and glucagon in regulating glucose turnover in dogs during exercise.

During exercise the flux of glucose is regulated so that the increased demand of glucose by the muscle is met by a corresponding increased release of glucose by the liver; plasma glucose concentration does not change markedly, while glucose turnover increases. These precise regulatory mechanisms can be studied by quantitative isotope dilution methods; measurements of plasma glucose concentrations do not necessarily reflect any changes in glucose fluxes. Insulin is considered to be an important regulatory hormone during exercise. Its concentration decreases during exercise in part because of a decrease in insulin secretion by the pancreas and in part because the removal of insulin is increased. This conclusion was reached because insulin concentration in plasma decreased both in normal and in depancreatized insulin-infused dogs. A sudden decrease of portal insulin concentration facilitates glycogenolysis and gluconeogenesis in the liver. At the same time blood flow decreases in those areas which are inactive during exercise such as the splanchnic beds, while increased blood flow and opening of the capillary beds increases the total amount of insulin perfusing the muscle. Therefore, even in presence of low insulin concentration in plasma the insulin supply to the working muscle can presumably be maintained at an adequate level. We considered that exercise changes the distribution of insulin in relation to the liver and the muscle; such a distribution pattern may represent an important physiological regulatory mechanism. The question whether glucagon is essential in regulating glucose production during exercise could not be resolved because depancreatized insulin-infused dogs had essentially normal plasma concentrations of immunoreactive glucagon. Glucagon concentration increases during strenuous but not during moderate exercise of normal dogs. This increase is apparently not indispensable because during strenuous exercise depancreatized insulin-infused dogs did not increase IRG


Growth hormone and catecholamine response to exercise in relation to physical training.

Exercise of moderate intensity results in an increase in growth hormone concentrations. During prolonged moderate work, growth hormone levels fall toward resting values, but training causes these levels to be maintained. Circulating norepinephrine increases with work, and the increment is less following physical training. The adjustments to endurance training may be mediated through the sympathetic nervous system.


Cardiorespiratory response to exercise on a rowing and bicycle ergometer.

Eight experienced oarsmen and five inexperienced subjects performed a multi-stage exercise test on a rowing and bicycle ergometer. Oxygen uptake, heart rate and minute ventilation were observed on both exercise modes from light to maximal exercise. Although the VO2 max values were slightly higher on the bicycle ergometer (6.0% and 4.0% for the oarsmen and inexperienced subjects) differences were not significant (P greater than 0.01), nor consistent in all subjects. Max heart rates and lactate levels were similar on both exercise modes. The VE/VO2 ratio, however, was consistently higher on the bicycle than on the rowing ergometer at maximal exercise for all subjects (7.2% and 8.2% for the oarsmen and inexperienced subjects, (P smaller than 0.01). Apparently, the development of VO2 max on the bicycle ergometer was characterized by a larger VE/VO2 when compared with the rowing ergometer. The cramped position of the body while rowing appears to constrict the abdominal muscles, which may limit their ability to aid in the expiratory phase of the breathing cycle. The forcing up of the abdominal viscera in this position may also constrict the action of the diaphragm during inspiration.


Effects of hyperoxic gas mixtures on exercise tolerance in man.

This study was undertaken to determine the effects of O2-enriched gases on performance. Nine trained subjects ran to exhaustion on the treadmill on five different occasions breathing one of a range of hyperoxic gas mixtures--20%, 40%, 60%, 80%, or 100% O2. Each subject worked at a workload determined to be 110% of that necessary to elicit his maximum O2 uptake. The exercise bouts were scheduled one week apart to minimize the effects of training and fatigue. The subjects were given no cues as to the mixtures being breathed or to their running times. The parameters measured included running time, minute ventilation, and heart rate. The results indicate that the maximum performance time increases significantly as the O2 fraction of the gas is increased. Contrary to other published literature, 100% O2 increases performance significantly over 60% O2. Ventilation at any point in time is decreased when breathing hyperoxic mixtures. This decrease appears to be more a function of breathing frequency than of tidal volume. Terminal heart rates are not significantly different regardless of the O2 fraction of the inspired gas.


Swim performance decrement over middle life.

Swim records data from the U.S. Masters swim program afforded a chance to estimate the decline in swim performance over middle life. Men's records data indicated a falloff in swim performance of slightly less than one percent per year over the ages of 27.5 to 57.5 years. Men's decline in freestyle performance was seen to be essentially the same, regardless of varying oxygen requirements secondary to the distance swum. Men's decline in swim performance for the breaststroke and backstroke events was nearly that of the freestyle. Falloff in men's performance in the butterfly stroke rose to 1.47 percent per year. Women's times showed a decline between 20 to 50 percent greater than that seen for the men. Previous findings of athletes' decrease in pulmonary function over middle age closely parallel the observed decrease in Masters swimmers' records--approximately one percent per year.


The role of glucocorticoids in exercise.

From the literature we can make the following statements concerning the role of glucocorticoids in exercise and training. These conclusions are summarized graphically in Figure 3. 1. The principle physiological functions of glucocorticoids are stimulation of gluconeogenesis and mobilization of amino acids and fatty acids from body stores. 2. Injected glucocorticoids produce significant increases in the work produced by isolated muscle and by intact animals. 3. Light to moderate exercise work loads may produce an increase, decrease or no change in plasma glucocorticoid (GC) levels; depending on the degree of psychological and/or physiological stress involved in the exercise. 4. In moderate to exhaustive exercise the plasma GC levels progressively increase. In some subjects (especially animals) exhaustion produces a decrease in plasma GC which may represent a defense mechanism to prevent depletion of body resources. 5. Chronic exercise training produces adrenal cortex hypertrophy and usually a smaller rise in plasma GC during an acute exercise bout than that obtained with nontrained subjects. The resting GC levels frequently increase initially during training but return to normal as the trained state is reached. 6. The changes in GC response during training appear to be produced by decreased responsiveness of the adrenal cortex itself to ACTH stimulation and possibly by adaptation of the hypothalamus-hypophysis axis which reduces the ACTH released in response to stress. 7. The many combinations of psychological and physiological stress present in different exercise regimens probably account for the variety of GC responses to exercise reported in the literature.


Benign intracranial hypertension.

Ninety percent of these 120 patients with BIH were women and were obese. Headache was present in almost all patients and visual symptoms occurred in 35%. There was no neurologic abnormality other than visual loss in these patients followed up to 10 years. Twenty-five percent spontaneously remitted after the initial LP and the others required repeated LP, steroids, or surgical procedures. Thirteen of 15 patients who did not remit spontaneously or respond to repeated LP improved dramatically in 3 to 4 days on prednisone or dexamethasone. Complications of BIH include recurrence of the syndrome, visual impairment and development of the empty sells syndrome. Recurrence rate was 10% and relapses always occurred in the first 12 months. Visual acuity impairment or inferior nasal quadrant field defect occurred in 2% of patients. In only two patients was there a sudden decrease in visual acuity which did not improve with any therapy. There was no way to predict subsequent visual impairment.


Acute renal failure in multiple myeloma.

1. The clinical manifestations, laboratory data and renal histologic features of acute renal failure occurring in 14 patients with multiple myeloma are reviewed and contrasted with the data from 29 previously reported cases. 2. Whereas other reports have stressed the role of intravenous pyelography and dehydration in the development of acute renal failure in multiple myeloma, the most common etiologic factor in our experience was hypercalcemia (7 patients). Other factors included potentially nephrotoxic antibiotics (3 patients) and volume depletion (2 patients). Intravenous pyelography could be clearly implicated in ony one patient. 3. The unusually high incidence of Bence Jones proteinuria in these patients is consistent with the possibility that Bence Jones protein excretion is associated with an increased susceptibility to renal injury. This could be due to an adverse effect of Bence Jones proteins on the renal tubules or their tendency to precipitate in tubular lumina during periods of reduced tubular flow. 4. The prognosis of patients with multiple myeloma who develop acute renal failure is poor; only 5 of our 14 patients survived the early period of acutely impaired renal function, and 4 of these subsequently died within 2 months. Preventive measures particularly the prompt correction of hypercalcemia and volume depletion, are the most important aspects of patient management.


Radiation-related pericardial effusions in patients with Hodgkin's disease.

Pericardial effusions following radiotherapy for Hodgkins Disease have previously been described as infrequent and related to the total dose of radiation received. Analysis of all chest x-rays on 81 patients who received upper-mantle radiotherapy for Hodgkins Disease at the Baltimore Cancer Research Center between 1968 and 1972 disclosed an incidence of pericardial effusions of 30.9% (25 of 81), with 13.6% (11 of 81) requiring limitation of activity (5) or pericardiectomy (6). Clinical presentation of radiation-related percardial effusions was subtle, with signs and symptoms a late finding if they occurred. Radiotherapy data was reviewed and no difference in total dose (rads) or time-dose relationships (rets) was found between the groups who did or did not develop effusions. Analysis of multiple pre-treatment clinical and pathological characteristics disclosed four parameters that were felt to be related to the development of pericardial effusions; elevated ESR, normal absolute lymphocyte count, initial presence of extensive mediastinal adenopathy and the addition of adjuvant chemotherapy. The presence of increasing combinations of these pretreatment 'risk factors' led to an increasing likelihood of developing a radiation-related pericardial effusion such that six of seven patients with all four 'risk factors' developed a pericardial effusion. Nine of 13 clinically significant effusions were associated with the addition of adjuvant chemotherapy. Possible pathogenetic mechanisms that include factors other than radiation dosage and the clinical management of radiation-related pericardial effusions are discussed.