Population studies on Gilbert's syndrome.

Total serum bilirubin concentration was measured by an Autoanalyzer technique in 197 normal males and 102 normal females. The mean bilirubin concentration was significantly lower in the females than in the males. Total bilirubin concentration in the males showed a bimodal distribution with an antimode at 24 mumol/1 (1.4 mg/100ml). Individuals with bilirubin concentration above this value had unconjugated hyperbilirubinaemia and probable Gilbert's syndrome. Total bilirubin concentration in the females again showed a bimodal distribution with an antimode at 12 mumol/1 (0.7 mg/100ml). It is conceivable that females with bilirubin levels above this also have Gilbert's syndrome. This suggests that the population incidence of Gilbert's syndrome could be as high as 6% and that the sex incidence is approximately equal.


Carbohydrate metabolism in dystrophia myotonica.

Serum insulin, blood sugar, and growth hormone levels were measured in response to a 50g oral glucose tolerance test in 10 patients with proven dystrophia myotonica. Three patients belonged to one family; seven patients had no known family history of the disease. One patient, a chronic invalid aged 56 years, produced a mild diabetic glucose tolerance curve and a delayed prolonged rise in serum insulin. Six of the group, including the three affected members from one family, exhibited normal glucose tolerance and fasting serum insulin values, but a markedly exaggerated rise in peripheral insulin levels maximal at 30 and 60 min. This abnormality showed no correlation with age of onset of the disease nor with severity of the muscle weakness. Growth hormone levels were normal in all of the patients studied. It is concluded that an excessive rise in circulating immunoreactive insulin in response to glucose is a common abnormality in dystrophia myotonica and reflects genetic heterogeneity in this condition. Futhermore, if the index patient in a family demostrates this abnormality, it is suggested that the 30- or 60-min blood insulin level during a glucose tolerance test is a useful methold of intra-family screen-ing for asymptomatic heterozygotes at an early stage before the development of physical defects.


Homozygous beta thalassaemia in Liberia.

The clinical and haematological findings in 19 Liberians probably homozygous for beta thalassaemia are described. The haemoglobin patterns were similar with Hb F levels in the 30-50% range and a raised level of Hb A2 and, although the clinical severity varied widely, over half the cases were symptomless and even the more severely affected ones showed a milder picture than that found in Mediterranean races. Haemoglobin-synthesis studies carried out on three homozygotes and two heterozygotes indicated a variable degree of globin-chain imbalance. The reasons for the mild course of the disease in Liberians and other African races are discussed; it is likely that the beta-thalassaemia genes in these populations are different from those in other racial groups. It is noted that all persons in this study belong to tribes which have a low incidence of the sickle-cell gene.


Dermatoglyphic findings in 54 triple-X females and a review of some general principles applying to the soles in sex chromosome aneuploidy.

The dermatoglyphic findings from 54 females with XXX sex chromosomes are reported. Sole prints were available for study in 33 cases. Compared with female controls, an excess of radial loops and arches and a reduced mean for total finger ridge-count were the main peculiarities on the fingers. On the palms, the absence of pattern in areas I and II, and wider ridges in the a-b interval were characteristics observed. Prevous findings by other authors with respect to: (1) zygodactylous tendency in the palms, (2) tendency for the ridge width to increase with the number of sex chromosomes, and (3) greater effect of an extra X chromosome in pattern size reduction but lesser influence on ridge width than an additional Y chromosome, were confirmed. On the soles, pattern intensity was above the control average. There was a significant deficit of proximal loops in area III but excess of proximal V together with triradius H. Triradius  p" and zygodactylous z' were also significantly reduced in frequency. General findings with respect to the soles of patients with X,XXX,XXY, and XYY sex chromosomal abnormalities are also reviewed. Discrepancies are apparent and further studies are needed. Finally, a dictionary (Appendices 1 and 2) is provided which gives the frequencies of the complete pattern configurations on the palms and soles of XXX females.


Familial trisomy 7 mosaicism.

A trisomy 7 mosaicism (46, XX/47, XX+7) was identified by quinacrine mustard fluorescence studies in a psychiatric patient and in her daughter who also had mental illness. The aetiology of the trisomy 7 mosaicism in two generations of this family is postulated to involve an autosomal dominant gene as initially described by Zellweger and Abbo in 1965.


A mentally retarded child with a translocation involving chromosomes 12 and 19.

This report concerns a de novo reciprocal translocation between the long arms of the chromosomes 12 and 19 in a mentally retarded child with bilateral radioulnar synostosis, agenesis of the corpus callosum, and several minor congenital malformations.


The future of medical eduction: forecast of the Council of Deans.

This paper reports the results of a Delphi probe of the perceptions of medical school deans regarding the most significant changes in medical education and in the health care system which they expect to influence medical education over the next 20 years. The study, conducted in the first quarter of 1974, included an analysis of 54 potential changes distilled from over 440 suggestions. A composite view of the probability of occurring, impact on the system and percentage of deans favoring the change are presented. In general, the future is believed to hold more positive changes than negative ones, and those most likely to occur will come about in the near term. The results disclose few surprising conclusions but provide a structural description of areas of consensus and disagreement among deans.


Typological analysis of U.S. medical schools.

Using multivariate statistical techniques, a large number of variables describing medical school characteristics was reduced to five general dimensions of variation. Patterns of factor scores on these five dimensions served as the basis of a typology of 107 U.S. medical schools. The types of schools so identified were found to be related to the proportions of graduates entering different areas of medicine.


Factors related to medical students' research activities.

The study reported here was designed to assess different aspects related to the research activities undertaken by students in medical school. An extensive questionnaire was administered to 580 graduating seniors which covered degree of participation in research, length of time, circumstances, importance of pay, and level of resulting benefit. Other information included career choice and primary interest. A profile of the research-oriented student emerged from the findings.


A generalized modeling approach to determining environmental costs of education.

It is generally agreed that the cost of an educational program includes elements other than instruction. Using medical education as a case study, the author begins this article by outlining the historical reasons for determining the costs of the educational program leading to the M.D. degree. Attention is then focused on the modeling approach taken by the Association of American Medical College for the determination of environmental costs of education. Finally, a generalized model is proposed which would make this methodology applicable to other educational environments.


Voluntary election of basic science courses by medical students.

The medical curriculum at the University of Washington places considerable responsibility on the student in planning his education. This is provided for by assigning to elective courses 50 percent of the credits required for graduation. While the student has considerable freedom to choose among electives, as many credits are elected in the basic sciences as in the clinical disciplines. Four consecutive entering classes elected a disproportionately high number of credits in anatomy and pharmacology. A need for basic science courses in apparently perceived by the medical student, and their voluntary election is bound to facilitate learning. In new curricula the responsibility rests on the faculty to provide opportunities for detailed coverage of the various disciplines in order to cater to those students who are motivated to pursue them in greater depth.


A residency elective in medical education.

A three-month elective in medical education was undertaken by a first-year resident to obtain a background to prepare for a potential career in academic medicine and medical student teaching. This experience, jointly sponsored by the Department of Obstetrics and Gynecology and the Office of Medical Studies of the University of North Carolina School of Medicine, permitted the resident to investigate components of the clinical teaching-learning encounter, suggest means of improving clinical instruction, and develop a series of self-instructional materials. Stemming from this experience, a workshop on clinical teaching skills for faculty and house staff has been designed, and four self-instructional units on family planning have been added to the teaching program on the Department of Obstetrics and Gynecology. Benefits to the resident of the elective are outlined, and guidelines for similar experiences are suggested.


The nature and incidence of lysogeny in Mycobacterium fortuitum.

Ten of 28 strain of Mycobacterium fortuitum (ranae) were found to be associated with bacteriophage; three were pseudolysogenic, one liberated a phage that lysed a sensitive indicator strain, two liberated morphologically complete phages that did not lyse any of the strains used in this study and four liberated morphologically defective phages. The lysogenic and defectively lysogenic strains showed anomalies in cultural, biochemical and antigenic properties and in susceptibility to superinfecting phages. In view of the high frequency of lysogeny found in M. fortuitum, the role of bacteriophage in the variation of properties, including pathogenicity, of mycobacteria of greater clinical importance merits further consideration.


A study of virulence factors with induced mutants of Staphylococcus aureus.

The contribution of a number of extracellular products of Staphylococcus aureus to the virulence of the organism for mice was studied by comparing a wild-type strain with various mutants derived from it in three virulence tests: (1) subcutaneous and (2) intravenous challenge in normal mice, and (3) subcutaneous challenge in mice after total body X-irradiation. Mutants with lower production or non-production of coagulase, staphylokinase and leucocidin were just as virulent for mice as the wild type in all three tests. Unlike the wild type, mutants with low production or nonproduction of alpha-lysin never gave necrosis after subcutaneous injection in normal mice. One mutant with loss of delta-lysin and unaltered alpha-lysin production gave necrosis only when injected in high doses. Dermonecrosis seems to be caused by a combination of alpha- and delta-lysin. Intravenous injection of each of the two types of mutant in normal mice gave a lower mortality rate than that obtained with the wild type. Mutants with deficient alpha-lysin production, but not delta-lysin-deficient mutants, multiplied more slowly in the kidneys than the wild type under these conditions. alpha-Lysin appears to have a growth-enhancing effect for the organism in vivo, but delta-lysin does not. Differences in virulence between the wild type and mutants could not be demonstrated in irradiated mice.


Susceptibility to mitomycin C and lecithinase activities of Clostridium oedematiens (C. novyi) type B and D.

In tests with broth-culture products of Clostridium oedematiens, none of 15 type-B strains showed beta-toxin lecithinase activities exceeding 20 egg-units per ml, whereas 12 of 13 type-D strains consistently produced much greater amounts of the lecithinase. The types also differed in their susceptibility to lysis by mitomycin C (MC). Of 13 type-D strains tested, 12 were sensitive to MC at a concentration of 1 or 2 mug per ml, whilst 14 of 15 type-B strains were insensitive. Phage-like particles were observed in the MC-lysates of some type-D strains. No type-specific differences in the production of indole or the fermentation of maltose were demonstrated.


Reinvestigation of the taxonomy of Clostridium bifermentans and Clostridium sordellii.

The taxonomic relationships between Clostridium bifermentans and C. sordellii were reinvestigated by numerical taxonomy, studies of DNA-DNA homology and DNA duplex thermal stability, and by analysis of cell-wall sugar components. Although the results indicate that both species may be grouped into one geno-species, C. sordellii strains could be differentiated from C. bifermentans strains on the basis of a few phenetic criteria that include the inability to ferment mannose and sorbitol, the absence of mannose in the cell wall, the production of urease, the absence of arginine deaminase activity, and susceptibility to inhibition of growth by mannose.


Tracer flow, permeability, and partial conductance.

It is often not possible to evaluate a permeability coefficient for net flow P from the small flows produced by physiological gradients of concentration or electrical potential. The common use of a tracer permeability coefficient P-x for this purpose, under the assumption that P-x = P, requires that the species be transported passively, and that there be no significant coupling between its flow and that of other chemical species, and between the flows of its tracer and abundant isotopes (isotope interaction). These conditions are often not satisfied. However, for passive transport in the absence of coupling of flows of different chemical species the measurement of tracer flow at two values of electrical potential difference evaluates (P-x/P) and thus P. In the presence of coupling of flows of different chemical species, although these measurements no longer evaluate P, they evaluate the partial conductance G. A graphical method of evaluating (p-x/P), P, and G is presented.


Passage of inulin and p-aminohippuric acid through artificial membranes: implications for measurement of renal function.

Diffusion of inulin and p-aminohippuric acid (PAH) in combined aqueous solution through artificial membranes was measured at room temperature and atmospheric pressure. The membranes had pore diameters of 26, 50, 100, 200, 250, 350, 510 or 990 A. The diffusion of PAH was only restricted with a pore size of 26 A, but inulin diffusion was restricted at 100 A. When diffusion of both solutes was unrestricted (pore diameter greater than or equal to 200 A), PAH diffused four times faster than inulin, and in restricted situations this ratio was even greater. The results of these diffusion studies allow the major and minor molecular dimensions of the solutes to be estimated. Filtration of the two solutes was studied in slowly flowing situations and also with increased temperature and pressure. Pore sizes required for unrestricted filtration were the same as for unrestricted diffusion but the passage ratio was reduced from 4 to 2. These results suggest strongly that two conditions are necessary if the glomerular filtration rate (GFR) of inulin is to equal the true GFR: membrane pore size must be at least 200 A and passage through the membranes must be by bulk transport.


Interaction of a purified hydrophobic protein from myelin with phospholipid membranes: studies on ultrastructure, phase transitions and permeability.

A purified protein fraction from the proteolipids of human brain myelin was recombined with different lipids either in aqueous buffer or in a chloroform-methanol-water (10:5:1, v/v/v) mixture. It was found that under both conditions it binds strongly to phospholipids irrespective of surface charge, the presence of cholesterol or double bonds on the fatty acyl chains. The buoyant density of the resulting lipoprotein membranes is intermediate to that of pure lipids, and proteins. The lipoproteins formed by either of these methods were observed by either freeze-fracture or negative stain electron-microscopy. The overall morphology was similar to that of pure phospholipids, showing large closed multilamellar vesicles. The presence of the protein was detected by the appearance of intramembrane particles in freeze-fracture. The addition of the N-2 protein generally increases the permeability vesicles to 22-Na-+ by 2-3 orders of magnitude depending on the concentration. The presence of calcium in the aqueous medium further increases the Na-+ efflux through negatively charged vesicles. Changes in lipid composition, surface charge, cholesterol, etc., have no appreciable influence on the effect of the protein. Differential scanning calorimetry indicates that the presence of small amounts of N-2 have no effect on the lipid phase transition from solid to liquid crystalline. As the amount of protein bound to the phospholipid increases, the enthalpy of the transition decreases, the main endothermic peak broadens, but there is no change on the midpoint temperature. Membranes containing 50% by weight of protein still show a transition with an enthalpy approximately one half that of the original lipid.


Physico-chemical studies of taste reception. IV. Response of individual phospholipid membrane to a variety of chemical stimuli.

Variations in the membrane potential across model membranes made of Millipore filter paper and various single phospholipids were measured in response to salt, acid and distilled water. The phospholipids used were phosphatidylcholine (c), spingomyelin (SM), phosphatidylethanolamine (PE), and phosphatidylserine (PS). Results were compared with those obtained with the model membrane made of the total lipids extracted from bovine tongue epithelium, which simulated well the receptor potential observed with intact tast organs. The membrane potential of PE- and PS-membranes increased monotonously with increase of the concentration of 1:1 type salt, while that of PC- and SM-membranes exhibited no appreciable change in 1:1 salt solutions. Application of CaC12 to the membranes brought about a varity of response depending on the species of lipids used. PE- and PS-membranes showed a larger change in the membrane potential than PC- and SM-membranes when pH of the solution was varied. Fe-3+ was strongly absorbed on the surface of PC and SM-membranes, while Fe-3+ bound to PE- and PS-membranes was easily removed by an application of salt solution. A transient increase in the membrane potential was observed when distilled water was applied to the membrane adapted to an appropriate salt solution, which was similar to the water response observed in taste cells. PC- and SM-membranes responded to water when the membrane adapted to either NaC1 or CaC12, but PS-membrane responded only when the membrane was adapted to a solution containing CaC12. PE-membrane did not respond to water in any cases examined. The membrane prepared with a mixture of two species of phospholipids responded neither to salt nor to water, while the membranes prepared with the total lipids or a mixture of three species of lipids in appropriate ratio responded to both. The water response of the total lipids membrane vanished in a high temperature medium, while the water response of PC-membrane retained in all temperature ranges examined, i.e. between 20 degrees and 62 degrees C. The results obtained suggest that a mosaic structure, where each domain has different functions against various chemical stimuli, is formed on the surface of the model membrane made of the total lipids.


Auditory systems of Heteromyidae: functional morphology and evolution of the middle ear.

Middle ears (515) from 26 species of the rodent family Heteromyidae - genera Dipodomys, Microdipodops, Perognathus, and Liomys - were studied both grossly and histologically, for qualitative and quantitative comparisons. Middle ear modifications characteristic of each genus are qualitatively described. Quantitative comparisons are made among the 26 species in the study. Some correlations between middle ear size and other measurements are discussed. The middle ear is an acoustical transformer that for best efficiency must match the impedance of the cochlea to the impedance of the air in the external auditory meatus. It accomplishes this by a pressure increase and a velocity decrease through the combined effects of the lever and areal ratios; however, because the important consideration is a matching of two impedances rather than an absolute pressure increase, the pressure transformer ratio is a less informative measure of the middle ear's efficiency than is the impedance transform ratio. The impedance transformer mechanism is explained (from a morphological point of view), and equations are presented. Dipodomys, Microdipodops, and Perognathus have a theoretical transmission (at the resonant frequency) of 94-100% of the incident acoustical energy; Liomys, 78-80%. The areal ratio of stapes footplate to 2/3 tympanic membrane is remarkably constant among the species, varying only from 0.04 to 0.07: in Dipodomys and Microdipodops this small ratio is due to the very large tympanic membrane; in Perognathus and Liomys it is due to the extremely small stapes footplate. The lever ratio of incus to malleus varies from 0.28 to 0.33 in Dipodpmys and Microdipodops, from 0.37 to 0.46 in Perognathus, and from 0.55 to 0.60 in Liomys. In addition, the middle ear volumes and the morphology of tympanic membrane, ossicles, ligaments, and muscles, all combine to minimize both mass and stiffness. All these data suggest middle ear mechanisms which are very efficient over a broad frequency range. The middle ear modifications found in heteromyids are adaptive in predator avoidance, especially in areas of little natural cover; nevertheless, contrary to expectations, there is no firm relationship between habitat and the extent of these modifications in the 26 species. However, environment did apparently plan an important role in the evolution of the family, and this is discussed.


Auditory systems of Heteromyidae: postnatal development of the ear of Dipodomys merriami.

Serial histological sections of kangaroo rats of postnatal ages 0-, 3-, 7-, 10-, and 14-days were prepared and studied. At birth the middle ear is mostly filled with mesenchyme and small in size, having only a small hypotympanum and a very small epitympanic recess. During the first postnatal two weeks, much of the hypertrophy found in the adult middle ear develops. Because an entotympanic element is nev er formed, the previously called entotympanic chamber is here renamed the hypotympanum. The epitympanic recess greatly expands to form what has been called the dorsal (or anterior) mastoid sinus. Since this chamber has no relation to the mastoid, it is here renamed the epitympanum. Posteriorly, the previously called posterior mastoid sinus develops from the growth of the hypotympanum into and beyond the region of the posterior and horizontal semicircular canals. In development and adult position it is comparable to the primate antrum and so is here renamed the antrum. At birth the organ of Corti is very immature but its major cell types can be identified. During the first two weeks of development the following events occur: (1) the vas spirale disappears, (2) the inner spiral sulcus cells atrophy, (3) the hair cells and supporting cells mature, (4) the cells of Hensen differentiate with their apical processes elevating the reticular lamina, (5) the innermost cell of Claudius migrates under and supports the Hensen's cells, and (6) the hyaline mass of the zona pectinata of the basilar membrane loses its connective tissue cells and expands in size. The developmental events support the previous description and identification of Hensen's and Claudius' cells.


Cytological differentiation in the uropygial gland.

Ultrastructural changes were studied in the cells undergoing secretory differentiation in zone I of the tubules of the uropygial gland of White Plymouth Rock chickens. A layer of basal cells and four secretory stages are recognized as the cells migrate from the periphery to the lumen of tubules and progressively elaborate a secretion product. Basal cells, containing rough endoplasmic reticulum and free ribosomes, rest on the basement membrane and are the source from which secretory cells arise. Dilated perinuclear cisternae and the proliferation of smooth endoplasmic reticulum in the form of vesicles, invaginated sacs and cusp-shaped cisternae indicate the onset of lipgenesis in stage I cells. The perinuclear cisternae are more dilated and the endoplasmic reticulum is composed on saccules and cisternae in stage II cells. Stage III cells are characterized by concentric lamellae of endoplasmic reticulum surrounding secretory droplets. Dilated cisternae of endoplasmic reticulum and secretory droplets both contain a reticular substance. The perinuclear cisternae of stage III cells have returned to normal dimensions. Large mature lucent secretory droplets, lined with electron-dense material, fill the cytoplasm ostage IV cells which degenerate and release their secretory product into the tubule lumen. Spherical membrane-bound compartments containing a mottled substance of moderate electron density occur in basal cells and all subsequent secretory stages. These mottled bodies are surrounded by saccules of endoplasmic reticulum in stage II cells and are intimately associated with secretory droplets in stage III cells, but there is no evidence that they give rise to secretory droplets and their role in secretory differentiation is unknown.


A survey into the the clinical presentation of Hodgkin's disease at Harare Hospital, Salisbury, Rhodesia.

A series of 20 cases of Hodgkins disease in Africans is presented. Mode of clinical presentation, haematological abnormalities and type of histological picture closely paralleled studies performed elsewhere in the world. The great majority of cases were in either Stage III or Stage IV, all patients in this series with the lymphocyte-depletion being aged under 20 years of age.


Bronchial carcinoma in Nigerians. A report of six cases.

Six cases of bronchial carcinoma in Nigerians are reported. The clinical presentations were not different from those described in temperare countries. The view is expressed that bronchial carcinoma is rare in Nigerians. Two factors are suggested as being responsible for this: decreased longevity and decreased contact with external carcinogens, of which the most likely are cigarette smoke and atmospheric pollution.


Clinical staging of malignant lymphoma in patients suspected to have hepato-splenic schistosomiasis.

Exploratory laparotomy, splenectomy and liver biopsy were carried out as a pre-treatment staging procedure in 32 cases of pathologically proved malignant lymphoma with clinically palpable spleen. The spleen was found to be negative for lymphoma in 17 cases, of which liver pathology showed bilharzial hepatic fibrosis in eight cases, nutritional cirrhosis in two cases and non-caseating granuloma in three cases. The liver was clinically positive in 13 cases. After laparotomy, three cases showed bilharzial pathology only. Bilharziasis has accounted for about one half of the false positive hepato-splenic involvement. These findings exemplify the usefulness of laparotomy as a staging procedure in regions endemic for hepato-splenomegaly.


Polypeptide composition of spleen necrosis virus, a reticuloendotheliosis virus.

The polypeptide composition of virions of spleen necrosis virus, a reticuloendotheliosis virus, was determined using electrophoresis on sodium dodecyl sulfate-containing, 10 percent polyacrylamide gels. Ten polypeptides were resolved. Four of these were present in minor and somewhat variable amounts. Two proteins, gp71 and gp22, contained D-glucosamine and were located on the outer surface of the lipid envelope, as demonstrated by lactoperoxidase-catalyzed iodination and by bromelain digestion. The results suggest that two of the minor proteins, p36 and p26, were also located on the outer surface, although they lacked D-glucosamine. Treatment of the virus with 0.25 percent Nonidet P-40 and 1 percent dithiothreitol produced a subparticle with a buoyant density of approximately 1.31 g/cm-3. This particle was relatively enriched with polypeptides p77, p62, and p50 and contained small amounts of three other polypeptides.


Heat-stable variant of human adenovirus type 5: characterization and use in three-factor crosses.

A variant of human adenovirus type 5 which is heat stable (hs) in vitro has been isolated following three rounds of heat inactivation at 52 C. The variant is genetically stable, both through vegetative viral passage and through recombination into other genetic backgrounds, which suggests that it arises from a single mutation. Three-factor crosses, using this mutant in conjunction with previously described temperature-sensitive mutants, suggest the hs mutation lies near the left-hand end of the genetic map. The mutant has been used to demonstrate the production of reciprocal recombinants in two-factor crosses. The mutational lesion is unknown, but phenotypic mixing occurs in hs times hs-+ infections, which suggests that it lies in a gene specifying a viri on structural protein. Other biological parameters examined have shown no differences from the wild-type hs-+.


Analysis of early adenovirus 2 RNA using Eco R-R1 viral DNA fragments.

Adenovirus 2 RNA synthesized early in productive infection was analyzed by RNA-DNA hybridization. Hybridization experiments were performed with adenovirus 2 DNA and wit, the six adenovirus 2 DNA fragments generated 0y digestion with the restriction endonuclease Eco R.R1. Duplex formation between RNA and -32P-labeled viral DNA was assayed by S(1) nuclease digestion. RNA from the cytoplasm annealed 12 percent of the total viral DNA and the following percentage of each of the R.R1 fragments: 6 percent of R1-A, 24 percent of R1-B, 0 percent of R1-F, 40 percent of R1-D, 13 percent of R1-E, and 22 percent of R1-C. The early cytoplasmic RNA is composed of two sequence classes: class I, present in greatly reduced quantities at late times in infection (18 h), and class II, which remains at high concentrations at 18 h. In hybridization-inhibition experiments, hybridization of class II RNA is inhibited by late cytoplasmic RNA, whereas hybridization of class I RNA is not blocked by late cytoplasmic RNA (J. J. Lucas and H. S. Ginsberg, 1971; E.A. Craig and H. J. Raskas, 1971). To determine the location of class I and II sequences on the genome, membrane bound DNA fragments were used in hybridization-inhibition experiments. These studies demonstrated that the early cytoplasmic transcripts of R1-D belong to class II, whereas R1-C transcripts are class I sequences. The cytoplasmic RNAs transcribed from fragments A and B contain both class I and class II sequences. Analysis of cytoplasmic RNA fractionated by size demonstrated that the class I sequences include a 19 S RNA transcribed from R1-B and class II sequences include a 20S RNA derived from R1-D. Nuclear RNA purified from cultures early in infection was annealed with -32P-labeled R1 fragments. With all six fragments the nuclear RNA annealed as much or more of the DNA than did cytoplasmic RNA. Eco R1-F annealed at least 25 percent with early nuclear RNA, whereas no sequences homologous to R1-F were detected in early cytoplasmic RNA. When cultures were labeled from 2 to 6 h after infection, at least 5 percent of the -3H-labeled early nuclear viral RNA annealed to Eco R1-F. Some of these nuclear transcripts from R1-F appear to be covalently linked to sequences transcribed from a contiguous region of the genome (Eco R1-B). 8.4 percent of the RNA selected by hybridization of R1-F reannealed to R1-B, whereas no more than 1.5 percent reannealed to R1 fragments A, D, E, or C.


Isolation and characterization of a bacteriophage infectious to an extreme thermophile, Thermus thermophilus HB8.

A bacteriophage (phiYS40) infectious to an extreme thermophile, Thermus thermophilus HB8, was isolated and characterized. phiYS40 grows over the temperature range of 56 to 78 C, and the optimum growth temperature is about 65 C. The phage had a latent period of 80 min and a burst size of about 80 at 65 C. The phage has a hexagonal head 0.125 mum in diameter, a tail 0.178 mum long and 0.027 mum wide, a base plate and tail fibers. The phage is thermostable in broth but rather unstable in a buffer containing 10 mM Tris, 10 mM MgCl2, pH 7.5. The addition of Casamino Acids (1 percent), polypeptone (0.8 percent), yeast extract (0.4 percent), NaCl (0.1 M) or spermidine (1 mM) to the buffer restores the thermostability of phiYS40 to the same degree as in broth. The phage is also thermostable in water of the hot spring from which this phage was isolated. The nucleic acid of PhiYS40 is a double-stranded DNA and has a molecular weight of 1.36 X 10-8. The guanine plus cytosine content of the DNA was determined to be about 35 percent from chemical determinations, buoyant density (1.693 g/cm-3 in CsCl), and melting temperature (83.5 C in 0.15 M NaCl plus 0.015 M sodium citrate).


Isolation of DNA polymerase gamma from an adenovirus 2 DNA replication complex.

The major DNA polymerase in a nuclear membrane complex that is capable of synthesizing viral DNA sequences in vitro has been purified about 900-fold from adenovirus 2-infected KB cells. The enzyme was characterized as belonging to the class of mammalian DNA polymerases (DNA polymerase gamma) that can utilize poly(A) with oligo(dT) as template primer.


Spontaneous remission of peripelvic renal cysts.

Three cases are presented of spontaneous regression of peripelvic renal cysts. The lesions were manifested by lateral extrinsic pressure defects in the renal pelvis and major calices (all 3 cases), and selective renal angiography showing stretching of vessels plus sharply defined defects in the nephrographic phase (2 patients). In 1 case the mass disappeared following trauma to the flank, while in the remaining 2 cases it disappeared spontaneously.


Cholesterol emboli in transurethral curettings: report of 4 cases.

Cholesterol emboli were observed in tissue obtained by transurethral resection from 4 patients who were followed for 4 years. Two patients died of cardiovascular disease and 1 of failure of union of an ileal-ureterostomy in which cholesterol emboli were found in small submucosal arteries of the ileum.


Experiences with acetylcysteine in cystinuric patients.

Acetylcysteine seems to be beneficial in treating cystinuric stone-forming patients. It probably is effective in reducing cysteine to cystine disulfide, which is more soluble. Six brief case reports demonstrate its use and its lack of toxicity. The results merit a larger clinical trial.


Merlin modification of ureteral catheters.

A modification for ureteral catheters to increase their effectiveness in retrograde pyelography is described.


Problems and solutions in surgical treatment of 100 consecutive ureteral duplications in children.

Surgical management of 100 children with abnormalities related to ureteral duplication is reviewed. In general, separation of the distal portions of the double ureters is avoided, at least during the initial procedure, because this maneuver represents a significant risk to the blood supply and hence to the integrity of the remaining ipsilateral ureter. Complete ureteral duplication with vesicoureteral reflux is best managed initially by reimplantation of the duplex unit. On the other hand, upper segment heminephrectomy with subtotal ureterectomy is the initial treatment of choice for ureters ending ectopically with or without ureterocele.


Exstrophy of the bladder. I. Long-term results in a series of 37 cases treated by ureterosigmoidostomy.

Of the 37 patients with exstrophy of the bladder in whom ureterosigmoidostomy was selected as the mainstay of treatment 4 died of causes related to the procedure. Faulty judgment and poor followup accounted for these deaths, which might well be preventable today. In 18 survivors, or approximately half of the entire series, the operation has held up well for many years, with no further surgical procedure being required for complications. In 12 patients, or approximately a third of the group, remedial operations for complications attributable to the ureterosigmoidostomy have been required but it was elected to retain this form of diversion. The long-term end result in these patients also remains acceptable. Combining these 2 groups 30 of 37 patients with ureterosigmoidostomy may be considered to have been eventually successful. However, in 7 of 37 patients the method was a frank failure, in that 4 patients died and 3 required substitution of another form of diversion. While all forms of treatment of exstrophy of the bladder leave much to be desired, results obtainable in today's setting lead us to recommend ureterosigmoidostomy as first choice in the management of this disorder. This recommendation is accompanied by the admonition that systematic followup is imperative so that if things do go badly from the clinical, laboratory or urographic viewpoint corrective measures can be done before renal deterioration occurs. The measures required may range from simple correction of electrolytes to conversion to an ileal loop.


Long-term results of ureterosigmoidostomy in children with bladder exstrophy.

The records of 87 children with bladder exstrophy seen between 1912 and 1935 are reviewed. We believe that ureterosigmoidostomy with cystectomy can provide a satisfactory solution to the problem of bladder exstrophy. Furthermore, ureterosigmoidostomy appears suitable from the standpoint of preservation of upper tracts and provides a socially acceptable solution of the question of disposal of the diverted urine.


Acute adult onset bacterial nephritis: long-term urographic and angiographic followup.

Most adults with acute bacterial renal infection demonstrate no roentgen abnormality in the acute stage and recuperate without significant functional or morphological renal abnormality. We report the initial and long-term findings in a virulent form of acute bacterial nephritis caused by gram-negative organisms and predominantly in patients with diabetes and associated septicemia. The findings of a small, poorly functioning symmetrically scarred kidney with significant caliceal distortion and the associated angiographic abnormalities are presented for the first time in the long-term followup of this disease.


A case of secondary aldosteronism induced by pheochromocytoma.

A case of secondary aldosteronism caused by a pheochromocytoma containing a large amount of norepinephrine is described. The increased level of angiotensin induced by norepinephrine seems to play an important role in the development of secondary aldosteronism.


Aberrant renal papilla: a diagnostic dilemma.

Filling defects of the renal pelvis not uncommonly present a difficult diagnostic challenge to the urologist and the radiologist. The precise etiology of the radiographic picture is not always evident, even after a battery of clinical tests. A pathologically proved case of an aberrant renal papilla is reported herein, and the significant differential diagnostic possibilities are considered and reviewed.


Primary carcinoid tumor of the urethra.

The first reported case of a carcinoid tumor of the urinary tract is presented. Because of rapid local recurrence and distant spread early radical surgery is recommended. Several methods of palliation of the carcinoid syndrome-surgical, pharmacologic and chemotherapeutic-are discussed.


Is nephrectomy justified in patients with metastatic renal carcinoma?

The survival data of 93 patients with metastatic renal carcinoma are discussed with respect to the site of metastasis and whether nephrectomy was performed as part of the initial treatment. Analysis of the cumulative survival rates revealed that nephrectomy significantly increased survival only for those patients pesenting exclusively with osseous metastases. Nephrectomy did not alter survival for patients with pulmonary and/or soft tissue metastases.


Rapid sequence excretory urography in the diagnosis of pheochromocytoma.

Rapid sequence excretory urograms are useful as a screening method when searching for pheochromocytomas. Two patients with pheochromocytomas are reported in whom the correct diagnosis was made preoperatively.


Secondary carcinomas of the kidney.

We reviewed 81 cases of secondary carcinoma of the kidney, the clinical detection of which still remains a challenge. All lymphomas were excluded from this study. There was no direct relationship of the cell type of the primary tumor to the degree of renal invasion. Generally, functional renal impairment was not a significant entity unless renal destruction was extreme. Ureteral obstruction was infrequent in this group. Angiography was helpful in determining the metastatic spread as well as the degree of renal involvement. The varied aspects of the primary tumor's pathophysiology have been a continuing challenge to early detection and successful therapy in any patient. Furthermore, the anatomic location and the peculiar biologic behavior of some primary tumors may make the clinical course and response to treatment unpredictable. Lungs, stomach, breast and contralateral kidney remain the common primary sources of malignancy likely to metastasize to the kidney, with an apparent period of occult growth and further metastases before symptoms appear, The possible delay in seeking medical attention, that is chemotherapy and radiation, as well as the aggressiveness of the primary tumor itself may contribute to the poor survival noted in this study despite the use of various therapeutic modalities.


Sex-linked familial reflux.

A family is described in which all 3 brothers and the maternal grandfather had vesicoureteral reflux, whereas the father, mother and 3 daughters were urologically normal. This pedigree strongly suggests and X-linked mode of genetic transmission. Nevertheless, available evidence indicates that familial reflux is usually transmitted by multifactorial polygenic inheritance. Hundreds of additional pedigrees will have to be studied before the methods of inheritance are firmly established.


Ileal conduit parastomal hernias.

Of 400 patients who underwent ileal conduit diversion between 1963 and 1972, 18 (4.5 per cent) had parastomal hernias. A poorly fitting appliance was the most common presenting symptom. The hernia was found most often in the superolateral quadrant of the stoma at the site of mesenteric attachment of the conduit. In situ and translocation repairs of the stoma are discussed.


Acute renal insufficiency following hydrostatic pressure treatment: comments on technical procedure.

A man with a solitary bladder carcinoma suffered acute tubular necrosis following hydrostatic pressure therapy. The nephrotoxicity caused by antibiotics and/or the septicemic shock seems to be responsible. The animal experiment suggested changes in the technique: 1) the bladder should be overdistended via a Foley catheter with a rubber ballon at the tip to prevent a possible postoperative complication and 2) one should try to decrease rather than maintain the high intravesical pressure during overdistension to avoid bladder wall rupture. The overstretching of a blood vessel alone is quite sufficient to bring the anoxia upon the bladder tumor, which is verfied by the biophysical principle.


Post-diversion pre-cystectomy irradiation for carcinoma of the bladder.

In 47 patients treated sequentially with urinary diversion and laparotomy staging, irradiation therapy and total cystectomy for invasive carcinoma of the bladder, the mortality rate was 2 per cent and the complication rate was 20 per cent. The survival rate was most favorable in patients in whom the pathologic specimen revealed no tumor after irradiation. The lower mortality and morbidity rates are attributed to staging of surgical procedures and the challenge remains to increase the number of patients in whom carcinoma of the bladder is converted by irradiation therapy to a lower stage or no tumor.


Post-obstructive diuresis.

Massive diuresis after relief of urinary tract obstruction has been divided into 3 categories: 1) salt, 2) urea and 3) water. Measurements of the urinary electrolytes and urine osmolality establish the character of the diuresis and facilitate in the fluid management of these patients. A clinical example of the 2 most common varieties, salt and urea, is presented in conjuction with the method of fluid replacement.


Management of non-penetrating distal urethral trauma.

Two cases of non-penetrating distal urethral trauma are reported to illustrate the potential routes of urinary extravasation. The nature and management of such injuries are discussed to emphasize that the typically incomplete rupture of the distal urethra responds satisfactorily to catheter diversion of the urinary stream, antibiotic coverage, drainage of extravasated urine and delayed debridement of necrotic tissue. Primary surgical repair of the urethra is rarely indicated in this injury.


The transpubic approach for strictures of the membranous urethra.

Strictures of the membranous urethra following pelvic fractures pose a challenge in management because of their relatively inaccessible position above the urogenital diaphragm and behind the pubic symphysis. The corrective procedures the pass up from the perineum through the urogenital diaphragm to reach the stricture have the real or theoretical disadvantage of defunctionalizing the external urethral sphincter and leaving continence dependent solely upon the competency of the bladder neck. On the other hand, transpubic surgery allows a direct attack upon the stricture without violating the sphincter. Our experience with 4 such cases has convinced us of the superiority of this approach.


Peyronie's disease: a study of its natural history and treatment with orthovoltage radiotherapy.

Followup data on 90 of 177 patients with Peyronie's disease seen from Janurary 1, 1950 to April 1, 1970 revealed that the ultimate outcome of the disease when not treated was no different from that following orthovoltage radiotherapy. The real benefit derived from orthovoltage radiotherapy appears to be that it hastens symptomatic improvement by 3 to 7 months. In 21 per cent of the patients there was an associated inflammatory joint or tendon disease, an association not previously reported.


Experiences with priapism.

During a 10-year period 11 cases of priapism were treated with a saphenocavernous bypass. Uniformly good functional results were obtained if the procedure was done within 36 hours of the commencement of priapism. Prior aspiration and irrigation appear to lengthen this interval. The formation of temporary cavernovenous communication with the superficial venous system of the penis by aspiration and irrigation with large needles is demonstrated and is postulated as a mechanism by which this method of treatment alone is occasionally successful. Persisting graft patency has been associated with impotence. If erection does not occur within 3 months of the saphenous bypass the shunt should be ligated.


Anaplastic seminoma.

The clinical and morphological features of 7 cases of anaplastic seminoma are reviewed. Although this tumor appears to behave more aggressively than classical seminoma, presenting with earlier metastases, it has the same prognosis when staging is taken into consideration. Radiotherapy remains the treatment of choice.


Delayed cutaneous hypersensitivity in patients with prostatic adenocarcinoma.

Cell-mediated immunocompetence of patients seen for followup of adenocarcinoma of the prostate is evaluated using dinitrochlorobenzene as a contact sensitizing agent. The immune status is correlated with the presence or absence of metastatic disease. A highly significant correlation is found between the lack of immune response and the presence of metastatic carcinoma, suggesting that immunotherapy will be useful in the treatment of carcinoma of the prostate.


Urinary polyamine levels in the diagnosis of carcinoma of the prostate.

Urinary excretion of the basic polyamine, spermidine, was significantly elevated in patients with prostatic carcinoma as compared to a control group of patients, Of 44 urine specimens from patients with prostatic malignancy 31 had spermidine levels more than 2 mg. per 24 hours, while only 3 of 13 urine specimens from the control groups had levels in excess of this value. The increase in spermidine appeared to be correlated with the histologic grading of the tumor, that is 30 of 34 specimens from patients with grade II, III or IV carcinoma had excessive spermidine excretion and only 1 of 10 urine specimens from patients with grade I tumors had similiar spermidine elevations. High spermidine levles were found in tumors localized to the prostate and in 7 of 8 patients with negative pelvic and para-aortic lymph node biopsies. This study raises the possibility that urinary spermidine determinations may aid in the development of a biochemical screening test for prostatic neoplasms.


Inhibition of platelet aggregation caused by estrogen treatment in patients with carcinoma of the prostate.

Platelet aggregation is increased in patients with carcinoma of the prostate treated with estrogens. Hence, these patients have a high incidence of cardiovascular and thromboembolic diseases. Platelet aggregation has been tested with the platelet aggregation test. It was inhibited by administration of 500 mg. acetylsalicylic acid twice daily. An aggregation inhibiting effect has been found in all 38 patients. To reduce the excess hazards of cardiovascular complications of estrogens in treating carcinoma of the prostate acetylsalicylic acid is recommended as an adjunct therapy.


In vitro studies on the human renal calices.

Smooth muscle preparations taken from the minor calices of human kidneys were investigated by an isolated tissue technique. The existence of alpha-adrenoceptor and muscarinic receptor sites were demonstrated and it was shown that stimulation with the appropriate agonist resulted in an excitatory response. No evidence could be found to support the presence of beta-adrenoceptors in such tissues. The results of transmural electrical stimulation of similar preparations were highly suggestive of an effective innervation of the alpha-adrenoceptors.


Percutaneous renal cyst puncture: unusual results in 2 cases.

Percutaneous puncture and aspiration were used successfully in 2 cases: 1) a calcified benign renal cyst and 2) a grossly infected benign renal cyst. Percutaneous aspiration might be a useful procedure in either calcified or infected renal cyst. If percutaneous puncture is contemplated in a calcified ring lesion, preliminary angiography is strongly recommended to exclude possible renal artery aneurysm or arteriovenous malformation.


Continuous infusion urography in unilateral hydronephrosis.

In cases of unilateral hydronephrosis the urine concentration of contrast medium, for example diatrizoate, depends on the remaining renal function, the rate of turnover in the obstructed renal pelvis and the function of the contralateral kidney. Contrast medium for a single injection or a short infusion time is rapidly excreted by the normal contraleteral kidney, without allowing high enough plasma levels long enough for sufficient urine concentrations in the hydronephrotic kidney. This excretion rate can be compensated for by continuous infusion urography for several hours with large doses of contrast medium (up to 1,250 ml. 30 per cent diatrizoate). This method was theoretically computerized, tested in animals experiments and clinically used in 11 patients. It can improve the diagnostic possibilites of excretory urography, especially in cases of unilateral obstruction, and can minimize the need for retrograde pyelography with its known complications.


Percutaneous catheter-aided infarction of renal tumors: a preliminary report.

Three patients with moderate-sized cell carcinomas underwent percutaneous catheter-aided gelfoam embolization several days prior to an operation. Reduction of the vascular bed of the tumors shortened operative time and simplified the procedure. In the future these patients, along with others, will be followed to determine if reduction of tumor size by necrosis will alter the immune mechanism of the metastases. Even our small series and short followup illustrate that embolization is a simple and logical extension of diagnostic catheterization.


Elective transcatheter renal artery occlusion prior to nephrectomy.

An hour before nephrectomy 10 patients with hypernephroma and 2 with pyonephrosis underwent occlusion of the renal arteries with gelfoam via selective catheterization, using the Seldinger percutaneous technique. This technique facilitated the operation by collapsing the renal and perirenal veins, decreased blood loss and prevented the dissemination of tumor cells or septic emboli from organ manipulation.


Ballon occlusion of the renal artery in tumor nephrectomy.

A method of preoperative intraluminal occlusion of the renal artery in cases of kidney tumors using a 5F Swan-Ganz ballon catheter is presented. The procedure was used in 26 tumor nephrectomies without complications and resulted in marked facilitation of the operation in 70 per cent of the cases.


The place of bone scan in the diagnosis of renal cell carcinoma.

We herein review 12 cases of renal cell carcinoma evaluated by bone scan and skeletal survey. Comparison of these techniques revealed a high incidence of falsely negative results (42 per cent) when using skeletal survey alone. It is now our policy to include the bone scan in our initial evaluation of patients with renal cell carcinoma.


Extended angiography in diagnosis and treatment of renal carcinoma.

New and highly sophisticated advances in uro-angiography need to be systematically analyzed and presented for evaluation. Our experience with these techniques applied to renal carcinoma is reviewed. This series demonstrates the important features of angiography in the diagnosis and treatment of renal carcinoma although the number of patients was not large enough to permit statistical treatment of the data. We anticipate that close cooperation between radiologist and urologist will continue to produce advances such as annotated in this report.


Renal cell carcinoma: natural history and chemotherapeutic experience.

Eght-four patients with renal cell carcinoma were analyzed retrospectively in order to 1) determine the effectiveness of systemic chemotherapy-hormonal and non-hormmonal, 2) identify the clinical features of renal cell carcinoma that may be important in prognosis and 3) characterize the paraneoplastic features of renal cell carcinoma. Metastatic disease was present at diagnosis in 57 per cent of the cases and developed within 1 year in an additional 19 per cent of the cases were paradoxically associated with a longer survival (20 months median) compared to single-organ metastasis (5 to 11 months median). Paraneoplastic syndromes occurred in up to 40 per cent of patients with variable survival. Metastatic disease was unresponsive objectively to either primary nephrectomy or to a variety of chemotherapy trials.


Studies on the immune status of patients with renal adenocarcinoma.

Thirty-one patients with renal carcinoma were divided into 3 groups according to the stage of the disease and evaluated with skin tests to determine cell-mediated immunity and an in vitro chemostaxis assay to measure monocyte function. The patients demonstrated a significant defect in monocyte function, that is the ability to undergo chemotaxis when compared to healthy controls and patients with non-neoplastic disease (p less than 0.001). The defect tended to be more severe in patients with advanced disease. Improvements in monocyte function occurred following nephrectomy in patients with localized disease. The patients were skin tested with recall antigens and dinitrochlorobenzene to determine the presence of a delayed cutaneous hypersensitivity response. Croton oil was used to evaluate the non-specific inflammatory response. These studies indicate that a defect exists in cellular immunity as well as the inflammatory response. Patients with advanced disease tend to be unresponsive to these skin tests while those with localized disease are more likely to react to dinitrochlorobenzene and croton oil.


Elastic characteristics of the ureter.

An explanation was sought as to why the ureter becomes tortuous with increased intraluminal pressure. Changes in ureteral diameter and length, secondary to increased intraluminal pressure, were measured in different pathologic conditions and these changes were compared to similar ones in a non-biologic material (latex rubber tubing). It was demonstrated that these changes were anisotropic and remarkably similar under quite different pathologic conditions. Ureteral tortusity occurring secondary to increased intraluminal pressure may be related to anisotropic expansion of a tube with both ends in a fixed position.


Post-hysterectomy vesicovaginal fistula: treatment by partial colpocleisis.

Urologists have been reticent to approach vesicovaginal fistulas via the vaginal route. The Latzko partial colpocleisis seems to be an easier, faster and less traumatic procedure than advocated in the literature. The success rate is high and the procedure is highly recommended.


Partial cystectomy in the treatment of bladder cancer.

A retrospective study was made on 57 partial cystectomies for bladder cancer performed during a 25-year period. Operative mortality was zero and morbidity was low. The 5-year survival rate was 59.5 per cent. The procedure is believed to be a good choice in certain cases. These criteria are discussed.


Transurethral sphincterotomy: relationship of site of incision to postoperative potency and delayed hemorrhage.

A series of 33 cases of transurethral sphincterotomy is reviewed, comparing the incidence of postoperative complications between incisions at the 3 and 9 o'clock and those at the 1 and 11 o'clock positions. Postoperative impotence and delayed hemorrhage were more frequently encountered following incisions at the 3 and 9 o'clock positions. It is recommended that patients be warned of the possibility of loss of erections following sphincterotomy and that the 1 and 11 o'clock positions be adopted routinely for this procedure.


Imipramine toxicity.

Clinical experience has firmly established the usefulness of imipramine in the management of enuresis. Our report describes the serious dose-related cardiac and central nervous system toxic effects of imipramine. Comparison of the human and animal toxicity data is presented and recommendations are given for safe human dose ranges.


Manipulation of torsion of the testicle.

Testicular torsion, although not an uncommon clinical entity, is likely to be unrecognized, particularly if the patient is not within the expected age range. Manual derotation can readily be achieved and will significantly improve results of ultimate treatment. All painful scrotal masses should be considered possible torsed testes, unless obvious predisposing factors exclude its diagnosis.


Operative management of chronic hidradenitis suppurativa of the scrotum and perineum.

Hidradenitis suppurativa of the perineum and scrotum is a progressive disease and, if left untreated, may require a radical operation for its control, including orchiectomy and skin grafting. Five patients with this disease who had failed to respond to antibiotics, and incision and drainage were treated with excision of the involved scrotal and perineal tissue. Healing was promtp and contractures were minimal. Early operative management of this chronic disease is encouraged.


Bone marrow acid phosphatase in staging prostatic carcinoma.

We evaluated bone marrow acid phosphatase in 30 patients as another parameter in staging prostatic carcinoma. This method is reliable and useful as part of the staging precedures. No falsely positive results were found and the procedure provided the only indication of metastatic diseases in 4 cases.


Hydroxyurea in stage D carcinoma of the prostate: a pilot study.

There was 13 patinets with histologically metastatic prostatic adenocarcinoma treated with a single oral dose of 80 mg. per kg. hydroxyurea every third day (based on ideal or actual weight, whichever is less) and 12.5 mg. chlorotrianisene per day. Toxicity was mild. The most common manifestations were nausea, occasional vomiting leukopenia. A definite attempt was made to depress the white blood count to approximately 2,000 cells per cu. mm. Hydroxyurea was not discontinued unless the white blood count decreased to less that 2,000 cells per cu. mm., after which a single dose was usually omitted. Omission of a single dose would allow the white blood count to return promptly to more than 2,000 cells per cu. mm. Objective tumor regression was demonstrated in 6 of the 13 patients and all patients had a definite improvement in the quality of life.


Urologic manifestations of paroxysmal nocturnal hemoglobinuria.

A long-term study of 17 patients with paroxysmal nocturnal hemoglobinuria revealed an unexpectedly high incidence of functional and anatomic renal abormalities. All patients demonstrated varying degrees of hematuria and proteinuria distinct from hemoglobinuria. All patients also had granular casts in multiple urinalyses. Evaluation of renal function revealed hyposthenuria, abnormal tubular function and declining creatinine clearance. Radiologically, one or more of these demonstrated enlarged kidneys, renal cortical infarcts and thinning, papillary necrosis, acute renal atrophy, retroperitoneal hematoma and ureteral infarction, which were confirmed by autopsy studies. Hypertension developed in 7 patients. Urinary tract infection was uncommon and no patient had a clinical history compatible with chronic or acute pyelonephritis. Contrary to usual opinion our compatible clearly showed evidence of frequent and widespread renal pathology in paroxysmal nocturnal hemoglobinuria most likely due to repeated microvascular thromboses similar to the venous trombosis involving other organs in this disorder. Since most of these patients present initially to urologists knowledge of this entity is mandatory.


Ileal conduit urinary diversion in children.

In the evaluation of the morbidity associated with ileal conduit urinary diversion in children, a retrospective analysis of the complications in 125 such children was done. When retroperitoneal Penrose drainage was used or when additional surgical procedures were performed, a significantly increased number of early postoperative complications were found. Conversely, when peristomal skin preconditioning was accomplished or when a single layer ureteroileal anastomosis was constructed, postoperative morbidity was markedly reduced. Ileal conduit urinary diversion remains the most satisfactory method of permanent urinary diversion in children.


Non-obstructive megacystis and refuluxing megaureter in pre-teen enuretic boys with minimal symptoms.

We herein describe 4 older boys with non-obstructive, non-neurogenic refluxing megacystis-megaureter syndrome. These patients require immediate investigation and aggressive surgical intervention, the goal being total reconstruction of the bladder and upper tracts in continuity. This goal was achieved in 3 patients with followup in excess of 4 years. Failure to recognize the syndrome, as with our fourth patient, may result in improper classification and treatment. A plea is made for urological investigation of pernicious nocturnal enuresis in older boys and in all children with a history of urinary tract infection.


Evaluation of children with meatal stenosis.

Not all patients with meatal stenosis require a complete urologic study. In those asymptomatic patients presenting with a small meatus found on routine examination, a urologic study is required only for clear historical or laboratory evidence of infection. Complete evaluation is still required for those patients with hematuria or a suggestive history on physical examination. We do not suggest abandoning the evaluation of meatal stenosis but hopefully provide guide lines for the evaluation of patients with a small meatus and no other symptoms or history. The management of these patients in the office or in day-care surgical facilities may be a suitable alternative to formal hospitalization. This should minimally include a careful history and physical examination, urinalysis, urine culture and consultation with the referring physician when necessary.


Small atrophic kidney secondary to renal vein thrombosis: report of a case diagnosed arteriographically.

Although rena vein thrombosis usually presents with a large or normal-sized kidney radiographically, a small atrophic kidney may be the end stage result of complete renal vein thrombosis with subsequent hemorrhagic infarction. A small atrophic kidney secondary to renal vein thrombosis (probably of neonatal origin) was diagnosed by selective renal arteriography in a 31-year-old woman being studied for hypertension of unknown etiology.


The treatment of bilateral synchronous renal pelvic tumors with Bench surgery.

Bilateral nephrectomy, renal perfusion and bench surgery have been used in the management of synchronous bilateral renal pelvic tumors in a 35-year-old man. The possibility of bilateral nephrectomy followed by hemodialysis and eventual transplantation was considered but was not done because we believe for the present time that the nature of the immune response and its importance in the pathogenesis of cancer are complicated and poorly defined. It is likely that immunosuppression may tip the balance toward the tumor. Bench surgery allowed us to perform radical resection of these urothelial tumors yet preserve enough renal tissue to sustain life. This patient is now enjoying an active life and has a blood urea nitrogen of 30 mg. per cent and a serum creatinine of 1.2 mg. per cent from the functioning third of the former right kidney.


Parasites of black bears of the Lake Superior region.

Parasites collected from free-ranging black bears, Ursus americanus Pallas, 1780, from northeastern Minnesota or northern Michigan include the dog tick, Dermacentor variabilis (Say, 1821), the winter tick, D. ALBIPICTUS (Packard, 1869), a louse, Trichodectes pinguis euarctidoes Hopkins, 1954, an ascarid worm, Baylisascaris transfuga (rudolphi, 1819), a filarial worm, Dirofilaria ursi Yamaguti, 1941, taeniid tapeworms, and unidentified fleas. The broad fish tapeworm, Diphyllobothrium latum (linnaeus, 1785), was reported to be common in man and black bears in northeastern Minnesota earlier in this century, but now it apparently is uncommon in black bears in norther Wisconsin. Cannibalism of carcasses is common in the black bear and may play a major role in the transmission of Trichinella.


Wyominia tetoni (Cestoda: Thysanosomatinae) from bighorn sheep in Washington.

In washington, eitht California bighorn sheep, Ovis canadensis californiana, were necropsied to ascertain age and general physical condition. Four were found to harbor Wyominia tetoni.


Oral fibroma in a captive python.

A massive growth in the lower jaw of an Indian python (Python molurus) was diagnosed from biopsy samples as a fibroma. Moderately satisfactory treatment was achieved by surgical excision.


Presence of rabies neutralizing antibodies in wild carnivores following an outbreak of bovine rabies.

In an outbreak of bovine rabies in Argentina, a study was made of vampire bats (Desmodus rotundus) and wild carnivores. Rabies antibody rates of high prevalence were found in the bats, foxes (Dusicyon gymnocercus) and skunks (Conepatus chinga). The outbreak was part of an extensive continuing epizootic of vampire transmitted bovine rabies which may have also involved other vectors in the area of this study. Consumption of dead and dying bats by the carnivores is the suggested means of passage of rabies virus from vampire bats to foxes and skunks. Given optimum conditions it is conceivable that some outbreaks in carnivores may begin in this way.


Experimentally induced Fasciola hepatica infections in black-tailed deer.

The susceptibility of black-tailed deer (Odocoileus hemionus columbianus) to the common liver fluke (F. hepatica) was studied. Two deer and one sheep comprised each of three experimental groups. Animals in each group were inoculated individually with 250, 500, or 1000 F. hepatica metacercariae. One deer and one sheep given 1000 metacercariae died with lesions consistent with black disease 7 weeks after inoculation. At necropsy 6 or 15 weeks postinoculation, the mean percentage recovery of the inoculum was 38.9% from the deer and 51.9% from the sheep. Fluke eggs recovered from the deer were viable and metacercariae cultured from the eggs were fully infective for sheep. Pathologic changes associated with F. hepatica infection were more severe in the infected deer; consequently, the deer were less resistant to the lethal effects of the parasite than sheep. Considering the experimental results and the fact that naturally acquired common liver fluke infection has been reported infrequently from black-tailed deer, it was concluded that black-tailed deer do not constitute a significant reservoir for F. hepatica in domestic livestock.


Fibrous osteodystrophy in an opossum.

A free living opossum (Didelphis marsupialis) was found to have severe fibrous osteodystrophy of the maxilla and mandibles. No significant lesions were found in the kidneys, ruling out an etiology of renal secondary hyperparathyroidism. An etiology of primary phperthyroidism or nutritional secondary hyperparathyroidism is suggested.


Babesia moshkovskii (Schurenkova, 1938) Laird and Lari, 1957; from the prairie falcon, Falco mexicanus, in Wyoming; with comments on other parasites found in this host.

Babesia moshkovskiiwas found in the blood of 6 of 30 downy (D) Prairie Falcons and in none of 5 adults (A) from Wyoming. Intestinal parasites included Neodiplostomum (C) spathula (A,3), Cladotaenia globifera, (A,1), Physaloptera sp., (A,1), and Serratospiculum amaculatum, (a,4). ornithodorus concanensis, (D,3), Thrassis francisi, (D,1), Opisocrostis sp., (D.1), Degeeriella rufa, (D,2), Simulium (E.) canonicola (D,2), and an unidentified hippoboscid fly, (D,2) were external parasites. It is considered that the soft tick, O. concanensis, is the most likely vector of the hematozoon. The morphological forms of B.moshkovskii are described and discussed. This is the first report of an avian babesoid on this continent.


A survey of Erysipelothrix insidiosa agglutinating antibody titers in vaccinated porpoises (Tursiops truncatus).

Antibody activity against Erysipelothrix insidiosa was measured in 15 porpoises which had undergone a series of vaccinations, at 6 month intervals, with erysipelas bacterin. Relatively high levels of aggluntinating antibodies were found to persist in the serum for a least 6 months following booster inoculations of the vaccine.


Morphology of typanosomes from white-tailed deer and wapiti in Michigan.

Trypanosomes were isolated from a wapiti (Cervus canadensis) and 72 white-tailed deer (Odocoileus virginianus) from several locations in Michigan. Although significantly fewer fawns were infected, there were no significant differences in rate of infection between sexes or among geographic areas. From appearance of the trypomastigote, the trypanosome from white-tailed deer belongs in the genus Trypanosoma and the subgenus Megatrypanum. It was morphometrically similar to the common trypanosome of cattle, Trypanosoma theileri.


The histopathology of fin rot disease in winter flounder from the New York Bight.

The histopathology of fin rot disease in winter flounder, Pseudopleuronectes americanus, from the New York Bight is described. Fin rot in winter flounder was characterized by progressive loss of portions of the anal and dorsal fins. Microscopic findings included epidermal hyperplasia accompanied by dermal fibrosis, hyperemia, and hemorrhage. Bacteria were not observed in situ and a pronounced leukocytic inflammatory response was not noted.


Parasites of the black-tailed jackrabbit in north central Colorado.

Forty-four black-tailed jackrabbits, Lepus californicus melanotis Mearns, 1890, were collected near Denver from August, 1972, through July, 1973, and amined for parasites. Recovered parasites and their infection rates were: Eimeria sp. 100%, Cittotaenia sp.27%, coenuri of Multiceps sp. 57%, Cediopsylla inaequalis 14%, Hoplopsyllus affinis 9%, Haemodipsus setoni 2%, Dermacentor andersoni 14%, and Haemaphysalis leporis-palustris 25%.


Toxoplasma antibodies among bobcats and other carnivores of norther California.

The prevalence of antibodies to Toxoplasma gondii was investigated among five species of wild carnivores in Norther Ccalifornia. The highest prevalence was among bobcats (Lynx rufus), with 15 of 21 tested being serologically positive. Other results included serological evidence of toxoplasmosis in two of seven raccoons (Procyon lotor), one of three badgers (taxidea taxus) and two of three coyotes (Canis latrans). Two gray foxes (Urocyon cinereoargenteus) were serologically negative. Oone badger with an indirect hemagglutination antibody titer of 1:8192 was found to harbor T. gondii in its brain tissues.


Effects of low-sodium salines upon the atrio-ventricular propagation of the turtle heart.

The perfused heart in situ and strip preparations were used. In the in situ preparation, low-Na hypoosmotic saline had a positive inotropic effect, shortened the A-V interval and abolished arrhythmia or A-V blocking. The return to normal saline caused a transient off-response: further acceletation of the heartbeat and further shortening of the A-V interval. Low Na isoosmotic saline (sodium replaced by sucrose) increased pacemaker activity but the effect on the length of the A-V interval was variable. In the strip preparation, Low-Na hypoosmotic saline increased the rate of rise of the action potentials of atrioventricular ring (R-potentials) and shortened its latency of activation. The effects of the isoosmotic saline varied with the substitute used, either sucrose or lithium. Sucrose saline gave unpredictable results, though the rate of rise of R-potentials increased in 14 out of 24 experiments. Lithium saline decreased the rate of rise of R-potentials and blocked atrioventricular propagation in all experiments. Tetrodotoxin (10- minus 5 g/ml) did not abolish R-potentials. An increase of calcium concentration to 3 and 5 times the normal decreased the rate of rise of R-potentials and blocked atrio-ventricular propagation. While the Low-Na saline blocked pacemaker activity at the sinus venosus, it stimulated the generation of R-potentials, so that throughtout low-Na treatment, the site of pacemaker activity shifted to the A-V ring. The situation was reversed  when normal saline was restored. The data are discussed according to the current ideas of action potential generation.


The role of cardiac sympathetic discharges during the pulmonary depressor reflex.

The role played by the cardiac sympathetic fibers in the pulmonary depressor reflex was analyzed in twenty dogs. The selective perfusion with homologous blood of the inferior lobar vessels of the left lung with pressures of 40 to 60 mmHg decreased the spontaneous background discharges recorded from the left superior or inferior cardiac sympathetic nerves. This decrease was maximal at perfusion pressure of 80-100 mmHg. Following the decrease in the sympathetic discharges, the systolic and diastolic systemic arterial blood pressure decrease about 10 per cent. The changes were reversible when the perfusion pressure was returned to the control. The intravenous injection of atropine sulphate did not change either the systemic hypotension or the responses of the sympathetic efferent discharges induced by elevation of the pressure in the vascular bed of the lung lobe. Thus, it is believed that the systemic arterial blood pressure during this reflex may have fallen due to a diminution of the vascular tone caused by a decrease in the sympathetic efferent discharges. After transection of the vagus nerve ipsilateral to the tested lobe, the reduction of the sympathetic discharges as well as the decrease of the systemic arterial blood pressure were no longer observed. Our results further substantiate the concept that the vagus nerve is the afferent pathway for the pulmonary depressor reflex, and it may be concluded that during this reflex the sympathetic efferent activities are inhibited.


Effects of antipyretics on normothermic rabbits.

The effects of antipyretics on the ear skin and rectal temperature (Te and Tre) were investigated in non-febrile rabbits placed in a cold environment or when they were cooled locally in the hypothalamus. Intravenous injections of sulpyrin (25-500 mg/kg) or sodium salicylate (25-100 mg/kg) produced the dose-related increase in Te and slight fall in Tre. Decrease in Te induced by hypothalamic cooling was also reversed by the intravenous injection of antipyretics. Intraventricular injections of sulpyrin and salicylate (0.5-5.0 mg/kg) also caused the vasodilatation of the pinna skin and the fall in Tre. Bilateral microinjections of sulpyrin were made into various areas of the brain stem in order to locate the site of action. The injection sites where the vasodilatatory effect was elicited were the anterior hypothalamus, ventromedial nucleus of hypothalamus and the midbrain reticular formation. The responses elicited from the ventromedial nucleus were usually accompanied by restless and violent struggling. Injection of antipyretics into the mammillary body had no effect on Te. Intrahypothalamic injection of procaine depressed the sulpyrin-induced vasodilatation. These findings suggest that action of antipyretics on the normal body temperature is mediated through anterior hypothalamus and midbrain reticular formation.


Mechanical responses to linearly rising currents in the red and white muscles of the silver carp.

The mechanical response of the red and white muscles of the silver carp was investigated using linearly stimulating currents. In the presence of tetrodotoxin, the peak tension increased when the rate of rise was reduced to about 0.3 mA/sec in the red muscle, and to about 3 mA/sec in the white muscle, provided that the maximum current applied always reached 3 mA. Further reduction of the rate of rise decreased the tension, particularly in the white muscle. Low concentrations of caffeine (0.5 mM) potentiated mainly the early phase of contraction. However, the tension produced by a stimulating current with a rate lower than this value was suppressed by caffeine. When the external K ion was cumulatively increased to more than 13.5 mM in the red muscle and to more than 10.8 mM in the white muscle, the tension elicited by a linearly rising current was reduced. La and Mn ions suppressed mainly the late phase of contraction. It is postulated that two different mechanisms are involved in increasing the intracellular-free Ca concentration. The early phase of contraction may be a result of Ca release from the surface of terminal cisternae of the sarcoplasmic reticulum triggered by depolarization. The late phase produced by a prolonged depolarization may be a consequence of Ca movement across the plasma membrane or the membrane of sarcoplasmic reticulum. There seems to be an inactivation process for both the early phase and late phase. The difference in mechanical properties between the red and white muscles may be due to the presence of strong inactivation in the excitation-contraction coupling in the white muscle.


Excitatory potentials induced by stimulation of the inhibitory axon at the crustacean neuromuscular junction.

Synaptic events in a chloride-deficient condition were studied to elucidate functional aspects of presynaptic inhibitory synapses. The extracellular junctional potentials and nerve terminal potentials were concurrently recorded from a synaptic region. Inhibitory stimulation produced repetitive spikes on the inhibitory nerve terminal and then the excitatory nerve terminal, which resulted in the extracellular excitatory junctional potentials. Excitatory stimulation did not produce repetitive spikes on the inhibitory nerve terminal, indicating one-way signal transmission in this axo-axonal synapse from inhibitory to excitatory axon. The interval required for an inhibitory stimulation to produce the first response in the postsynaptic muscle membrane ranged widely from 10 to 800 msec. When gamma-aminobutyric acid (GABA, 1 times 10-minus 4 M) was added in these experimental conditions, the muscle membrane was transiently depolarized by about 10 mV. The action of GABA mimics that of the neurotransmitter at presynaptic inhibitory synapses. The experimental observations may be well explained by the concept of synapses on synapses, i.e., presynaptic inhibition, where the neurotransmitter may be GABA and chloride ions may be playing essential roles as in the case of postsynaptic inhibition.


Association of leucogenenol with specific proteins in serum.

Determination of the concentration of leucogenenol in the IgM, IgG, albumin, and low molecular weight protein fractions of serum demonstrated that leucogenenol is found only in protein fractions of molecular weights in the range of IgM and IgG. Determination of the distribution of leucogenenol in chromatographically separated serum proteins showed that leucogenenol has a maximum concentration in the proteins intermediate between those with the molecular weights of IgM and IgG. Comparison of the ratio of effluent to void volumes with the ratios of known proteins suggest that the associated or carrier protein of leucogenenol has a molecular weight of approximately 3 x 10-5. When additional leucogenenol is added to serum it is found in the same protein fractions as the leucogenenol normally present, indicating that there is excess carrier protein for leucogenenol in the serum.


The arthropathy of Behçet's disease.

Behçet's disease, originally described as a triad of ocular inflammation and oral and genital ulcerations, is better understood as a mulitsystem disease involving skin, joints, central nervous system, large bowel, and peripheral veins. This report of a 49-year-old female patient with uveitis and recurrent orogenital lesions, polyarthritis, and skin lesions, serves as introduction to a review of articular involvement in Behçet's disease. Included is complete synovial fluid analysis with measurement of intraarticular complement. Arthropathy, occurring in at least one-half of reported patients, is usually polyarticular and asymmetrical. It affects knees and ankles most frequently and rarely produces loss of function or deformity. During exacerbations synovial fluid appears inflammatory with polymorphonuclear leukocytosis greater than 25,000 cells/mul; synovial fluid complement is consistently elevated. Histologically the synovium shows increased vascularity with perivascular lymphocyte infiltration. Etiology and treatment of Behçet's disease are briefly discussed.


Medicine and the behavioral sciences: the Johns Hopkins M. D. - Ph. D. program.

The behavioral sciences have much to offer medical research and practice, and they are likely to play an increasingly important role in medical education. The need for researchers and teachers trained in both medicine and behavioral sciences has been addressed at Johns Hopkins by the establishment of a joint degree program. Concurrent, as opposed to consecutive, training in both fields shortens the duration of study and fosters interdisciplinary research early in the trainee's career.


[Remote results of multivalvular prostheses in patients with acquired heart defects].

The authors examined remote results in 57 patients who had had multivalvular prostheses placed: 35-with mitral and tricuspid valve prostheses, 10-with mitral and aortic valves and 3-with replacement of all 3 valves. Observation period lasted from 3 months to 5 years. Positive results were seen in 42 patients (73.6%). Mortality rate was 21.5%. The main cause of lethal outcomes was myocardial insufficiency in the majority of patients with mitral and aortic prostheses.


[Change in catecholamine and acetylcholine concentration in myocardial tissue in assisted circulation].

The authors stress the importance of reactions associated with the concentration of biologically active substances in the body tissues, in particular their influence on the contractility and escitability of the heart muscle. They cite the results consequent upon a study on the catecholamines and acetylcholine content in the myocardial tissue of the left ventricle and left auricle of the heart before and after institution of an auxilliary circulation effected with the aid of a valveless pump connected to the subclavicular artery in 22 dogs. An analysis of the results demonstrated that by producing counter-pulsation with the pump the concentration of catecholamines and acetylcholine in the tissues of the left head diminishes, but the fall of the catecholamines concentration does not reach the level typical of cardiac insufficiency. The authors believe that investigations of this kind may help elaborate optimal conditions and a permissible duration of the auxilliary circulation.


[Use of the platinum-hydrogen test for diagnosis of left-right ejections in congenital heart defects].

In 120 patients with "functional" murmurs and congental cardiac defects with sinistodextral shunts at the aorto-pulmonary level and at that of the cardiac cavities the platinum-hydrogen test was employed in diagnostic probing. In all cases of the shunts this test revealed a distinct ejection of the body from the left to the right, whereas the oxygenonetry of the blood samples failed to indicate any increased oxygenation at a corresponding level, or else it proved questionable in 26 per cent of the interatrial septum defects, in 32 per cent of the interventrical septum defects and in 19 per cent of aorto-pulmonary communications. An analysis of the material showed the method to display a high degree of sensitivity. Its simplicity, reliability and safety for the patient justify recommending the platinum-hydrogen test for a wider application in the clinical practice.


[Systolic shift of the right ventricle base in patients with defects of the tricuspid valve].

A study of cinocardioangiograms taken in 29 patients (11-with "pure" tricuspidal insufficiency, 11-with a combined tricuspidal defect and 7-without any disturbances of the intracardiac hemodynamics, all of whom being examined for affections of the lungs and mediastinum) brought evidence that during the systole there occurred an intensive shifting of the right ventricle base (0.5-3 cm, the normal figure being 0.3-0.5 cm). This shift is caused by an increased stroke volume of the right ventricle due to regurgitation and high pulmonary arterial hypertension.


[Importance of electro- and phonocardiography in diagnosis of pulmonary hypertension in pregnant women with mitral valve stenosis].

The possibilities of electro- and phonocardiography in detecting the extent of pulmonary hypertension are elucidated. Taking as a basis pertinent changes in the electro- and phonocardiograms made it possible to objectively estimate the degree of risk that involves labour at early terms of pregnancy. This is of importance in solving the problem of its preservation and also in deciding on the management of gestation and labour.


[Results of the aortic valve prosthesis with a follow-up period of over 3 years].

The results of the aortic valve prosthetics in 71 patients discharged from the A.N. Bakulev institute of Cardio-Vascular Surgery of the AMS of the USSR as far back as three and more years ago are analyzed. All these patients had been given implanted a Soviet-made ball-type prosthesis, model AK4-02. In 5 patients some additional operative interventions were performed. No indirect action anticoagulants were used. Nine patients (12.7 per cent) died late after the operation. Good, persistent results were achieved in 48 cases (67.6 per cent) with follow-up period ranging from 3 to 9 years. Major causes responsible for a reduced effect of surgery were thromboembolic complications, paravalvular fistulas and also uncorrected or inadequately corrected concomitant failures of other valves. Ways of increasing the effective prosthetics of the aortic valve with the ball-type prosthesis are discussed.


[Surgical tactics in pregnant women with mitral valve stenosis].

The rationale of undertaing operative interventions in pregnant women with mitral stenosis of the III and IV stages is analyzed. On the basis of his investigations the author thinks that in women with severe mitral stenosis of the II and IV stages and with the gestation term of up to 30 weeks mitral commissurotomy is indicated. In patients at these stages of the disease and with full-term pregnancy laparotomy may be performed when there is no pulmonary edema and no risk of its development. Simultaneous mitral commissurotomy and cesarian section are indicated in women with mitral stenosis of the III and IV stages and full-term pregnancy in cases of already existing pulmonary edema or when there is a danger  of its development.


[Clinical course of mitral insufficiency after commissurotomy].

In 172 patients in whom transventricular mitral commissurotomy had been complicated by the development of post-operative regurgitation the immediate and remote results of the surgery were studied. Among patients with mitral incompetence a complicated post-operative period with regurgitation of the I degree was registered in 51 per cent of the cases, with the II degree-in 73 and with the III-in 100 per cent of the patients. The principal complications included cardiac insufficiency and various derangements of the cardiac rhythm. The nature of cardiac insufficiency depended upon the degree of emerging regurgitation. A study of such patients over periods from 1 to 10 years after surgery proved good and satisfactory results to be recorded more seldom than in the case of an adequate commissurotomy and that they are dependent upon the degree of regurgitation. In the event of mitral incompetence of the II degree an urgent surgical correction of the defect is indicated. In need for operative treatment are also patients with mitral incompetence of the II degree with a possible progressive decompensation of the circulation.


[Association of aortic coarctation with patent ductus arteriosus (analysis of clinical and surgical data].

A retrospective analysis of clinical and operative data was made covering 56 cases with combined coarctation of the aorta and patent ductus arteriosus. Prior to surgery both anomalies were recognized in 27 patients. Clinical data failed to furnish an reliable criteria as to the difference in anatomic variants of combined aortic coarctation and patent ductus arteriosus. The clinical picture and diagnosis of this congenital pathology are largely contingent upon the conspicuousness of each abnormality and consequently, on a definite orientation of the clinical diagnosis. There is a direct relation between the frequency of detection of the patent ductus arteriosus and its size.


[Catamnesis of patients with a history of mitral commissurotomy in childhood and adolescence].

In 129 children catamnesis was traced over a period from 6 months to 12 years after commissurotomy. Late after surgery the course of rheumatism proved more favourable than before the operation. On expiration of 6 months good results were recorded in 93.2, in 1-3 years-in 83.5 and after 7-12 years-in 50 per cent of the patients. With lengthened periods of observation the number of good results was diminishing due to restenosis and formation of new defects. Most patients with unfavourable results had earlier undergone a fully effective commissurotomy and during the first follow-up years the results were good. Relapses, new defects and progressive deterioration of the initial ones were registered in 36.4 per cent of the cases and 1/3 of the patients are in need of repeated surgery.


[Intracardiac phonocardiography in young persons with congenital heart defects].

Thirty nine persons 17 to 22 years old with mild forms of an interatrial defect, stenosis and congential dilation of the pulmonary artery were examined. During catheterization of the right heart intracardiac phonocardiography and characteristic systolic murmurs in the pulmonary artery and in the right ventricle were recorded, all this being of help in precisely diagnosing these minor and, therefore, atypical clinical forms of the malady.


[Age-specific aspects of hemodynamic and morphological changes of the pulmonary vessels in tetralogy of Fallot].

The results of investigations of 50 patients with tetralogy of Fallot aged from 5 months to 15 years, made prior to surgery, and of 14 others, examined after palliative operations, furnished grounds for assessing hemodynamic and morphological changes in the pulmonary vessels as viewed in an age-specific aspect. The patients underwent catheterization of the heart, angiocardiography and histological investigation of the pulmonary tissue. In each age group the characteristics of the cardiac cycle in the right ventricle, minute volume and cardiac index, hemodynamic indices of the lesser circulation, pulmonary and greater circulation vessels resistance were analyzed. In the age category of up to 6 years the development of compensatory-adaptive reactions of the organism were recorded. The pressure in the pulmonary artery remained normal. Morphological alterations in the pulmonary arterial trunks were seen to occur already in the early childhood.


[Spontaneous closure of the interventricular septal defects in children].

A total of 214 patients with a defect of the interventricular septum have been examined starting from the first days of their life and to the age of 7 years. In 50 of them the defect closed spontaneously (23.4 per cent). Twenty of these patients had a complicated course of the defect (circulatory insufficiency, colds and pneumonia). The spontaneous closure of the interventricular septum defect occurred most frequently at the age of from 1 to 4 years (86 per cent).


[Certain mechanisms of prophylactic effect of physical training in hypertensive disease].

Physical training produces definite changes in the state of the blood and renal kininine system. In skilled sportsmen the renal kinine system has a higher resistance to the effect of an intensive muscular work than that in physically untrained individuals. At rest the level of the kinine system enzymes in the blood of sportsmen is lower than in untrained persons. On effort sportsmen demonstrate a moderate, but protractedly rising kininogenesis. The functional potentialities of the renal kinine system in sportsmen  th hypertensive disease of the I degree continue to be higher than they are in untrained patients. The development of an adequate reaction of the renal and blood kininine system under different conditions appears as one of the mechanisms of the prophylactic effect produced by physical training in hypertensive disease.


[Effect of propranolol on hemodynamic shifts and respiration during physical exertion in patients with hypertensive disease].

An examination of 25 patients with hypertensive disease of the I-II stage proved that following propranolol treatment the systolic and mean arterial pressure, the rate of cardiac contractions and the minute blood volume accrue on physical effort to a lesser extent, and the circulation time, diastolic pressure and peripheral resistance ot the blood flow-to the same degree as before the medication. Changes in the phasic structure of the left ventricle of the heart in physical exertion are less marked than they were prior to the treatment. Propranolol does not materially change the level of the oxygen consumption on effort; the lactic acid level and the ratio lactate/pyruvate in the blood rise against the background of the medication with this drug to a some-what lesser degree than before the treatment.


[Characteristics of reaction of the coronary vessels and metabolism of the myocardium in changing over from high to low frequency electric stimulation of the heart].

In 22 tests on an isolated dog's heart perfused from a donor the oxygen intake, coronary blood flow, oxyhemoglobin content in the coronary venous blood and arterio-venous difference were compared with a jumpwise and gradual depression of the electrostimulation of the heart rhythm from 4.5 down to 2.0-2.5 Hd. With an abrupt reduction of the contraction rhythm in the myocardium these persisted hypermetabolism outwardly resembling an acquintance of the oxygen debt, although the preceding work of the heart proceeded without any signs of hypoxia. There could be noted an elevated consumption of oxygen, an increased coronary circulation, a diminished utilization of lactic acid and even its ejection. Worthy of note is the fact that an elevated oxygen intake was ensured at the expense of the larger coronary circulation with a reduced extraction of oxygen, so that the saturation of the coronary venous blood with oxygen exceeded the initial values. With a gradual slowing down of the rhythm there were no manifestation of hypermetabolism: the consumption of oxygen returned back to its initial level, the coronary circulation decreased, while extraction of oxygen was rising. The data obtained are considered in the light of the metabolic hypothesis on the regulation of the vascular tone.