Deficits in binocular depth perception in cats after alternating monocular deprivation.

Allowing very young kittens to see with only one eye at a time greatly reduces the proportion of binocular cortical cells. Compared to normal cats these specially reared animals suffer deficits in binocular depth perception while retaining normal activity in the two eyes. Evidently, binocular cells play a crucial role in stereopsis.


Wrist arthrography: review and comparison of normals, rheumatoid arthritis and gout patients.

Bilateral wrist arthrograms performed on a randomly selected population of 100 adult males revealed an unexpected high prevalence of communications among the three wrist compartments. These findings warrant reassessment of wrist arthrographic criteris for synovial involvement of rheumatoid arthritis. Midcarpal joint extension correlated with increasing age and occupational trauma, suggesting a degenerative or "wear and tear" mechanism in the breakdown of the delicate interosseous intercarpal ligaments. Such extension was also found to a greater than expected frequency in gout. Radioulnar joint extension correlated with acute trauma secondary to wrist sprains or fractures, presumably through tears in the tough triangular fibrocartilage. Such extension was also found to a greater than expected frequency in RA. While midcarpal extension and inferior radioulnar extension correlate with gout and RA, respectively, their occurrence in a random adult male population is so frequent (as is three compartment communication) as to obviate their diagnostic value. However, synovial corrugation and lymphatic visualization were seen only in the wrists of patients with diagnosed inflammatory arthritic conditions and may have potential diagnostic significance. Selected anthropometric variables were analyzed by age in this randomly selected adult male population and compared with the gouty and RA patient groups. Significant continuously decreasing grip strength and hand mineralization occurred with age, which was opposite to the trend for osteoarthrosis. The hematocrit, erythrocyte sedimentation rate, and serum uric acid were impressively stable until the ninth or older decades, at which time a significant increase in sedimentation rate and decrease in hematocrit were found.


Gonococcal arthritis in pregnancy: a ten-year review.

Thirty-two cases of gonococcal arthritis in pregnant women admitted to Jackson Memorial Hospital between 1962 and 1971 are reviewed. Our specific aim is to reinforce awareness of this serious complication in pregnancy. The incidence of gonococcal arthritis is higher in women, but more significantly, it appears that the pregnant patient is at greater risk. The incidence of skin lesions seems to be higher in pregnancy. Penicillin was universally effective, since penicillin-resistant strains appear not to involve joints.


Childhood brain tumors: a 15-year survey.

Eighty-seven children with histologically confirmed brain tumors were reviewed. Fifty-nine of the tumors were in the posterior fossa, 19 were cerebral gliomas, and nine were miscellaneous supratentorial tumors, including five craniopharyngiomas and two papillomas of the choroid plexus. In the posterior fossa there were 22 astrocytomas, 11 medulloblastomas, and ten ependymomas, indicating that half of the cerebellar tumors are benign. Of the patients with cerebellar astrocytomas, 15 are alive and 10 are probably cured. The cerebellar ependymomas have a very poor prognosis with only one long-term survivor and an average survival time of 14 months. The medulloblastoma group has only four survivors, and some of these are less than two years postoperative. Of 11 patients having cerebral astrocytoma, only three are leading satisfactory lives, three are dead, and five are handicapped to a significant degree. Of the eight patients with supratentorial ependymoma, all are dead with the longest survival being six years. It is emphasized that a benign cerebellar astrocytoma is the single most likely tumor in childhood, and many of these patients can be cured and survive without significant neurologic deficit.


Tuberculosis of the wrist: a report of ten cases.

Ten patients with tuberculosis of the wrist are reported. In three, the disease was limited to the tenosynovium and these patients were treated by synovectomy. Seven patients had disease involving the carpal bones. In six of these an arthrodesis of the wrist was done, and solid fusion was attained in four. In all of the patients the wrist disease became inactive under treatment with isoniazid and para-aminosalicyclic acid.


Leiomyoblastoma of the stomach.

Two cases of leiomyoblastoma of the stomach are reported. Endoscopic features, ie, submucosal mass with umbilication and apical ulceration, presence of normal peristalsis, and absence of stenosis or irregularity, help differentiate this tumor from carcinoma of the stomach. Case histories are presented and pathologic features are described.


Male pattern baldness: classification and incidence.

The need for a widely accepted, accurate, and reproducible standard of classification for male pattern baldness has increased with the advent and increasing popularity of hair transplant surgery. This report establishes such a classification, and reports its use in determining the incidence of male pattern baldness at various ages in 1,000 white adult male subjects. The action of testosterone as an incitant in male pattern baldness is well known, but this study points out the continued effect of time, even in later years. Since most hair transplant surgery is peformed on subjects with male pattern baldness, and because the success of hair transplant surgery is largely dependent on proper patient selection, a complete understanding of male pattern baldness is essential for consistently good results with hair transplantation.


Trauma to the portal venous system.

During a 16-year period, 47 wounds of the portal and/or superior mesenteric veins were encountered. Overall mortality was 57%. Survival was greatest in patients with injury to the superior mesenteric vein, wounds repairable by lateral phleborrhaphy, absence of associated major vascular trauma, and only transient or minimal hypovolemic shock. The majority of deaths were due to uncontrollable bleeding or sequelae of profound hemorrhagic shock. Limited follow-up of survivors has demonstrated a low patency rate at the site of venous repair, suggesting that mere ligation may be all that is necessary when lateral repair is impossible.


Radiologic aids in the diagnosis of appendicitis in children.

Chest and abdominal radiograms are most helpful in evaluating acute abdominal pain in children. When basilar pneumonia is found the likelihood of associated appendicitis is slim. Evidence of appendicolithiasis on abdominal films secures the diagnosis of acute appendicitis and should prompt the surgeon to early operative intervention, since the threat of appendiceal perforation is great. Barium enema is safe and informative when obscure clinical presentation or associated illness exists. The likelihood of appendicitis is great when the appendix fails to fill at the time of barium enema. Complete filling of the appendix excludes the possibility of acute appendicitis.


Acute systemic toxicity from bupivacaine during epidural anesthesia in obstetric patients.

Convulsions occurred within 30 seconds after the injection of bupivacaine through the epidural catheter in four obstetric patients in labor, and mild excitation without convulsions occurred in three others. Since the time between injection and the reaction was so short and since the dose was so small, the response probably was due to intravenous injection resulting from lodgement of the catheter in a vein, rather than to absorption from the epidural space itself. It is not generally known that the epidural veins become thin-walled and engorged during labor; thus, inadvertent placement of a cathether in a vein can occur readily. Convulsions, therefore, may follow even injection of a test dose of a drug. Other colleagues have had similar though unreported experiences. Physicians performing epidural blocks should be aware that such an occurrence is possible and that the catheter may be within a vein without blood returning on aspiration.


Temporal bone radiography: a screening survey approach.

For preliminary evaluation of the temporal bone, a combination of conventional radiographs and hypocycloidal tomography in the frontal projection is advocated. If significant abnormalities are detected in this screening survey, a more in-depth study can then be pursued.


A rational approach to carcinoma of the ovary.

Carcinoma of the ovary is the leading cause of death from pelvic gynecologic malignancies in the United States. Factors which may reduce mortality from ovarian cancer include (1) emphasis on early diagnosis by awareness of neoplastic possibility and by an aggressive approach to persistent ovarian enlargement, (2) concentration upon the common epithelial tumors as the primary cause of ovarian cancer, (3) specific histologic classification and staging of the tumors as a guide to clinical management, (4) attention to certain principles of treatment, and (5) postoperative follow-up with radiation therapy and/or chemotherapy.


Innovar as a preoperative medication.

Innovar, administered intramuscularly 45 minutes preoperatively, provides excellent operative sedation, analgesia, and patient cooperation. Postoperative complications are minimized, and the quantity of postoperative analgesics and antiemetics is drastically reduced when Innovar is used as a preoperative medication.


Repair of vesicovaginal fistulas: simultaneous transvaginal-transvesical approach.

The records of 91 patients with vesicovaginal fistulas at the Ochsner Clinic between 1942 and 1974 were reviewed. The fistulas were managed in several ways: spontaneous closure, palliative operation, urinary diversion, transvesical repair, transvaginal repair, and a combined transvaginal-transvesical procedure. The latter had a 100% success rate in the eight patients in whom it was used. The technic of this procedure is described and the indications are expanded to include (1) large fistulas, (2) fistulas near the ureteral orifice, (3) if other abdominal or urologic surgery is being done, (4) if transvesical approach is being used, (5) previous failed attempts at correction, (6) difficulty of access by vaginal approach, and (7) fistulas resulting from transurethral resection of the bladder neck.


Glaucoma with elevated episcleral venous pressure.

A chronic elevation of the episcleral venous pressure may occur after venous obstructive disease or arteriovenous fistulas in the orbit, head, neck, or mediastinum. Idiopathic and familial occurrences of elevated episcleral venous pressure have been reported. Association with an increased episcleral venous pressure is a rise in intraocular pressure which, if of sufficient magnitude and duration, may cause cupping of the optic nerve and visual field loss. A case of glaucoma with visual field loss secondary to elevated episcleral venous pressure is presented. Recognition of the etiology of such cases is important, since the management of these patients differs from that of patients having primary open-angle glaucoma.


Reliability of the signs of fetal distress.

The outcome of 3 659 consecutive labours, during which no heed was paid to fetal monitoring, is reported. Perinatal morbidity and mortality were neither better nor worse than the rates which have been reported from units which practise intensive intrapartum fetal monitoring.


Rheumatic disorders in the South African Negro. Part II. Osteo-arthrosis.

The prevalence of osteo-arthrosis of the hip, the knee, the small joints of the hand and the metatarsophalangeal joint of the big toe, has been studied in a South African Negro population. The pattern of joint involvement differed considerably from that expected in a White population. Interphalangeal osteo-arthrosis was much less common in Black women than in White, and Heberden's nodes were seen in only 3 of 93 respondents who were over 65 years of age. Osteo-arthrosis of the metacarpophalangeal joints also, was less common in Black women than in White, but the Black men showed a much greater involvement than that seen in White men. As in White peoples, osteo-arthrosis of the metatarsophalangeal joint of the big toe was commoner in women than in men, but the over-all prevalence did not reach the high levels in Whites. Osteo-arthrosis of the knee was much commoner in the women than in the men; this was associated with a marked tendency to obesity in the older women. The hip joint which is a common site for osteo-arthrosis in Whites, was seldom affected in this Black population. It is clear from this study that the apparent rarity of certain forms of degenerative arthritis in the South African Negro is not owing to any inherent resistance to the disease, because osteo-arthrosis of certain joints, such as the knee in women and the metacarpophalangeal joints in men, is even more common in Blacks than in Whites. The differences encountered can, in many instances, be attributed to differences in occupation and life style in the two populations; but genetic factors, may also play a part in the sense that certain predisposing disorders, such as congenital subluxation of the hip, appear to be far less common in Blacks than in Whites.


Prazosin in the treatment of hypertension: a preliminary study.

This was an open, uncontrolled, comparative study of prazosin carried out in 32 patients, to test the efficacy and toleration of the hypotensive agent. In 8 patients prazosin was combined with a diuretic and in 2 patients prindolol (Visken), and in 1 patient, methyldopa (Aldomet), were added. A satisfactory drop in blood pressure occurred in 30 of the 32 patients. Other effects occurred in 18 patients (56%), but they usually disappeared with continued therapy. In 5 patients therapy was stopped because of these effects. There was no postural hypotension, nor did the males experience sexual problems. The mode of action appears to be an adrenoreceptor blockade without receptor occupancy. Prazosin alone or in a combination of drugs, may be a useful hypotensive agent.


Evaluation of aorto-iliac disease with Doppler ultrasound and isotope clearance techniques.

The clearance of 99mTc from the hamstring muscle compartment of patients with aorto-iliac or iliac disease was examined with the patients at rest and after exercise. The values were compared with those obtained in a group of controls and another group with superficial femoral, or femoropopliteal arterial occlusion. A statistically significant difference in the rate of 99mTc clearance was found in patients with proximal vascular disease.


Diagnostic peritoneal lavage in blunt and penetrating abdominal trauma.

Peritoneal lavage as a diagnostic aid is described in a small series which includes both blunt and penetrating abdominal trauma. Its value for blunt injuries has been confirmed, and it is recommended for penetrating injuries, when the diagnosis of visceral injury is in doubt.


Pre-operative preparation of the skin with a depilatory.

Although the removal of hair as a pre-operative preparation of the skin is desirable, it need only be removed over an area limited to a planned incision, and then only in hirsute patients. The use of a depilatory cream as an alternative to a razor would seem to have the advantages of increasing patient comfort; of avoiding injuries inflicted by even skilful shaving; and perhaps of diminishing the incidence of wound infection, without significant risk of reaction to the depilatory. Routine extensive pre-operative hair removal in all patients is unnecessary.


Visuomotor performance in Blacks.

The performance of Black hospital employees in the copying of designs, the drawing of human figures, and the assembling of blocks, is discussed. They performed the latter two tasks poorly. This may be attributable to their culture but it emphasises the unsuitability of these tests for Blacks, in that they are not standardised as a measure of ability for this ethnic group.


Enzymic micromethod for semiquantatative analysis of oxypurines in specimens of skeletal muscle.

A rapid and specific micromethod for semiquantitative determination of oxypurines in small specimens of skeletal muscle is described. Normal levels of xanthine plus hypoxanthine and uric acid in human skeletal muscle are in the ranges of 0,07-0,34 mg/100 g and 0,38-0,74 mg/100 g, respectively.


Forced expiratory volume and expiratory flow rate in Black miners and in a control group.

The peak expiratory flow rate and the forced expiratory volume and 1 second were measured in 772 Black miners who did not have pneumoconiosis, tuberculosis or chronic bronchitis. The same tests were done in 164 non-mining workers. It was found that exposure to dust associated with the miners' work had no effect on the results of these tests.


Effect of delta-aminolaevulinic acid on the resting membrane potential of frog sartorius muscle.

The porphyrin precursor delta-aminolaevulinic acid can significantly decrease the resting membrane potential in a single fibre from the sartorius muscle of the frog Rana angolensis. This effect is dose-dependent and reversible.


Analgesic renal papillary necrosis.

Analgesic nephropathy is well recognised. This is a retrospective review of 19 patients with the disease, who presented at Groote Schuur Hospital over a 4-year period. The diagnosis was made on historical and clinical grounds and on the radiological manifestations of papillary necrosis. The mean age was 49 years (26 - 74) with a sex ratio of 3,8 female : 1 male. The period of abuse varied between 3 and 20 years. Aspirin, phenacetin, codeine, and antipyrine were the compounds mainly ingested. If the abuse is stopped, renal deterioration can be halted. However, factors which lead to dehydration and infection tend to cause further decompensation. As a means of preventing this disease greater control over analgescis is needed.


Irreversible renal failure in acute post-streptococcal glomerulonephritis.

Irreversible renal failure in sporadic acute post-streptococcal glomerulonephritis rarely occurs. Most patients have extracapillary proliferation. Complete recovery from the epidemic form is the rule. It is possible that the two conditions are different clinicopathological entities.


Rheumatic disorders in the South African Negro. Part III. Idiopathic necrosis of the femoral head.

Idiopathic necrosis of the femoral head, with progressive articular destruction, is a well-recognised disorder in the South African Negro. Twenty-nine cases were studied in detail. In 17 there was evidence of associated iron overload, but it is unlikely that this contributed directly to the occurence of osteonecrosis. The syndrome of siderosis, scurvy and osteoporosis in Johannesburg Blacks is attributed to the ingestion of large quantities of iron in home-brewed beer. Often the beer is mixed with much more potent liquor and it is postulated that this, rather than the iron overload, is the cause of 'idiopathic' femoral head necrosis.


Potassium retention in acute diarrhoeal disease.

Most children suffering from severe acute diarrhoeal disease had a low total body potassium (TBK) or admission to hospital. TBK fell even lower during the first 5 - 9 days in hospital, and returned to normal levels during the next 8 - 12 days. There was good correlation between potassium retention and stool weight. An increase in the potassium intake had little effect on the rate of potassium repletion.


Split hands and feet.

We present 2 Iranian children, siblings, with the very rare but classical 'lobster-claw' deformities of hands and feet. We could not trace any hereditary influences.


Sulphonylureas and insulin resistance.

This is a case report of a diabetic who required 750-1000 units of insulin per day when gangrene of the leg developed, whereas previously he had needed no insulin. After amputation of the leg, the patient remained asymptomatic for 9 weeks without insulin. This was clearly related to an increased concentration of circulating antibody-bound insulin. Despite healing at the site of amputation, diabetic symptoms and insulin resistance reappeared. Chlorpropamide treatment reduced the insulin requirement to zero, which was unrelated to a change in insulin antibody concentration.


Pernicious anaemia with hypogamma-globulinaemia. A case report.

Auto-immune mechanisms are important in the evolution of pernicious anaemia, but cannot be demonstrated in all cases. Cell-mediated immunity is involved in the pathogenesis, and explains the occurrence of pernicious anaemia in patients with hypogammaglobulinaemia. The pernicious anaemia seen in these patients differs in some respects from the classical form of the disease. The case history of a patient with pernicious anaemia and hypogammaglobulinaemia is presented, and the possible pathological mechanisms are discussed.


Medical ethics and clinical therapeutic trials.

Old and modern codes of ethics exist, which can be used as guidelines in human experimentation. Medical researchers should be familiar with the contents of these codes. A four-point proposal, to be used in determining the ethical acceptability of clinical therapeutic trials, is presented.


Fetal tachycardia and maternal pyrexia during labour.

Fifty-two cases of fetal tachycardia during labour were investigated. Nine of these cases (17%) were possibly attributable to maternal pyrexia. In most, fetal tachycardia preceded the rise in maternal body temperature. Fetal tachycardia can be an early indication of intra-uterine infection.


Systemic lupus erythematosus and spontaneously arising anticoagulants.

Of 36 patients with systemic lupus erythematosus, 3 were demonstrated to have an abnormality in their haemostatic mechanism. In 2 this was believed to be on the basis of an auto-antibody to the phospholipid of platelets in the prothrombin activator complex. In the third an inhibitor was directed against factor VIII.


Congenital atresia of the external iliac artery.

A patient with congenital atresia of the external iliac artery is presented. Successful revascularisation was acheived by means of an ileofemoral reversed long saphenous vein graft. The embryology of this malformation is discussed.


Twenty-one years' experience with ruptured abdominal aortic aneurysms.

The surgical experience with 107 ruptured abdominal aortic aneurysms at this hospital during the years 1953 to 1975 has been reviewed. The operative mortality rate during the first ten years of this study was 86 per cent, but since 1966, it has fallen to 40 per cent. These improved mortality statistics are related primarily to improved techniques for controlling operative blood loss and minimizing the time of aortic cross clamping. The use of an intra-aortic balloon has been useful in this regard. Twenty-four additional patients died from ruptured aneurysms without undergoing operation, all before 1966. Only seven had a correct diagnosis prior to death, and these seven serve to emphasize the importance of being alert to the diagnosis of ruptured aneurysm which often masquerades as urologic or orthopedic problems because of the frequent symptoms of back, abdominal, flank or groin pain. Since the operative mortality rate for elective resection of the aneurysm has been less than 1 per cent at this institution during the last eight years, we believe we are justified in encouraging prompt resection of aneurysms on an elective basis to eliminate the high mortality rate that still accompanies rupture of the aneurysm.


Portal hepatotrophic factors, diabetes mellitus and acute liver atrophy, hypertrophy and regeneration.

The acute influence of portal blood hepatotrophyic factors upon the canine liver and upon hepatic regeneration was studied after surgical operations which provided qualitatively different portal venous perfusion to the right and left liver lobes. With one such procedure called splanchnic division, the nutrient rich venous return from the intestines was directed to the left lobes, whereas the hormone rich blood from the pancreas and other splanchnic organs of the upper part of the abdomen passed to the right lobes. Within three to five days, the rate of cell division on both liver sides was increased as judged by autoradiography, but the hormone influenced right lobes exhibited hypertrophy and hyperplasia relative to the nutrient enriched left lobes. In the latter, the hepatocytes underwent pronounced atrophy, deglycogenation, depletion or distortion of the rough endoplasmic reticulum, fatty vacuolization and other structural changes. When 30 or 60 per cent hepatic resection was carried out at the same time as splanchnic division, the regeneration of the hormone dominated hepatic tissue after three to five days was greater than that of the hepatic tissue receiving the intestinal venous effluent, as judged by multiple criteria, although both liver sides participated in the regeneration process. The advantage enjoyed by the right liver lobes in relation to the left liver lobes both in the resting or in the regeneration state after splanchnic division was reduced or eliminated by pre-existing alloxan-induced diabetes or after concomitant total pancreatectomy. Similar, but less complete, observations about the effect of pancreatectomy were made in dogs submitted to the procedure of partial portacaval transposition, in which all the splanchnic venous blood passed to the right lobes, whereas the left lobes were revascularized with systemic venous blood from the vena cava. These observations have added to the recent torrent of evidence that insulin is the most easily demonstrable and, therefore, probably the most important specific hepatotrophic factor in portal venous blood. At the same time, further subtle support has been added to our previously proposed hypothesis that mutliple other hormonal and possibly nonhormonal factors from the splanchnic viscera and other sources also contribute to the essence of the hepatotrophic effects. These effects were evident and quite advanced within a few days. A prominent hepatotrophic role of glucagon was not identifiable.


The use of bone and brain scans as screening procedures in patients with malignant lesions.

A retrospective study to determine the value of bone and brain scans was performed in preoperative patients with melanoma, sarcoma, cancer of the head and neck and carcinoma of the pelvis. No occult metastases were identified in 170 patients in whom brain scan was performed. On late follow-up data, eight patients had neurologic symptoms develop and had brain metastases identified on scan. Of 223 bone scans performed, only one distant metastatic lesion was identified. It is, therefore, suggested that, in these types of patients, bone and brain scans be reserved for those with symptoms referable to the neurologic or skeletal systems.


Behavior of the portal vein system in man after laparotomy.

At the end of an abdominal operation, a Teflon catheter was inserted into the portal vein, where it remained for nine days. Thus, blood samples could be withdrawn for analyses, and pressures could be recorded. The investigations were carried out in 41 patients who had a gastric or intestinal operation and had an uncomplicated postoperative course. The pressures in the portal vein and the arterioportal oxygen content difference were constant with 7 to 8 millimeters of mercury and by 2 volume per cent, respectively, during the period of all nine postoperative days. The pressure gradient between portal and central veins was about 6 millimeters of mercury. By infusing 350 to 500 milliliters of dextran 60 on day one or two postoperatively, the cardiac output was elevated about one-third, the central venous pressure increased from 0.9 to 4.9 millimeters of mercury and the portal venous pressure increased from 7.8 to 9.7 millimeters of mercury. This means that the pressure difference between the portal and central veins diminished. Simultaneously, the oxygen content difference between the systemic and pulmonary artery decreased from 4.7 to 3.3 volume per cent and between the systemic artery and portal vein, from 1.8 to 1.3 volume per cent. By assuming a constancy of the oxygen consumption in the region of the mesenteric circulation during infusion, it can be calculated from the behavior of the arterioportal oxygen content difference that the flow increase in the portal vein nearly equals that of cardiac output. The physical transhepatic resistance decreased about 50 per cent.


A urodynamic analysis of micturition symptoms in the female.

The presenting symptoms of 570 females with micturition disorders have been studied with particular reference to the urodynamic state of the detrusor in an attempt to define those symptoms and symptom complexes which are associated with the presence of absence of detrusor instability. The results show that patients who complain of recurrent urinary tract infection or stress incontinence in the absence of any other micturition symptoms usually have stable bladders and do not require cystometric confirmation of this fact. When the symptom of urge incontinence is associated with persistent frequency and nocturia, there is a high correlation with detrusor instability, although hypersensitive urethral states which may present with identical symptoms and are usually associated with stable bladders are difficult to differentiate clinically. Groups of patients in whom it was difficult to predict the detrusor state from the symptoms were studied, and the results of a prospective analysis, predicting the detrusor state from the micturition history of 230 incontinent females, have been presented.


The effects of nicotinic acid upon postburn plasma volume loss.

The effects of intravenously injected nicotinic acid upon postburn plasma volume loss have been studied in the anesthetized dog. Results of this study have shown that two hours after a third degree flame burn over 40 per cent of the surface area, approximately 12 milliliters per kilogram of plasma are lost to the extravascular spaces. If untreated, this loss will increase to 16 milliliters per kilogram at four hours postburn and 19 milliliters per kilogram at six hours postburn. Treatment of the dogs with nicotinic acid beginning two and one-half hours postburn will reduce the plasma extravasation to 13 milliliters per kilogram four hours postburn and to 11 milliliters per kilogram at six hours postburn. In general, the decrease in cardiac output observed after thermal trauma paralleled the loss of plasma volume. In the untreated dogs, this decrease continued with time postburn, but in the treated dogs, the decrease in cardiac output leveled off during the first two hours after beginning treatment and started what appeared to be a slow return toward control levels in the next two hour period.


The effect of antrectomy on gastric acid and gastrin secretion.

In three dogs with denervated fundic pouches, ingestion of beef liver test meal increased H+ output and serum gastrin levels during the first hour of the four hour experiment. H+ and serum gastrin output then slowly decreased but did not reach basal values. After antrectomy and gastroduodenal anastomosis, ingestion of the test meal did not lead to the early increase in H+ output and serum gastrin levels. Although serum gastrin levels did not significantly change throughout the four hour experiment, beginning at 80 minutes H+ output slowly increased. The rise in H+ output did not reach preantrectomy values. These results indicate that antrectomy abolishes the early rise in H+ and gastrin secretion in response to a protein test meal. Since gastrin levels did not significantly change throughout the whole experiment, the late increase in H+ output is due to a mechanism other than gastrin release.


The transcutaneous measurement of the elastic properties of the human saphenous vein femoropopliteal bypass graft.

The pressure-strain elastic modulus and compliance of 20 reversed saphenous femoropopliteal vein grafts have been measured by a noninvasive, ultrasonic method. The grafts had been in place for an average of 33.6 months, 11 days to 128 months. In this study no correlation was demonstrated between wall stiffness and duration of implantation. It is concluded that the elastic properties of vein grafts may remain stable for considerable periods of time.


The assets and liabilities of mammography.

Anyone using mammography should perform it seriously with one or two radiologists in any group as the primary physicians. It is only by being exposed to a high patient volume day after day and having a thorough knowledge of all the pathologic conditions that one can truly appreciate the subtle mammographic patterns present. In only this way is the diligent radiologist optimally helpful to the surgeon and pathologist, and this best serves patient welfare. Conversely, the part-time mammographer, although not necessarily besmirching his professional competence, will tend to give the examination a bad reputation by unnecessary hedges and reporting uncertainties characterized by long winded reports. Patients undergoing mammography should undergo a physical examination by the radiologist. Thus, accuracy rates for the detection of cancer can approach, 98 per cent. Liabilities consequent to mammography can be minimized by the professional competence of the radiologist, understanding the limitations of the examination and the expertise of the reporting style.


Angiographic spectrum in Crohn's disease of the small intestine and colon.

Barium and angiographic examinations of the small intestine and colon were performed in 34 patients with histopathologically verified Crohn's disease. The spectrum of angiographic findings varied from hypervascularity with no morphologic changes of the vasa recta to complete obstruction of the vasa recta resulting in hypovascularity of the diseased intestine. A distinctive angiographic pattern was present in the distal part of the small intestine in those patients with advanced narrowing of the intestinal lumen as demonstrated on barium examination.


Disconnection of the ampulla of Vater.

A patient with ampullary disconnection during gastrectomy is presented, emphasizing the chronicity and retractile scarring which exposes the bile and pancreatic ducts to simultaneous injury. As wider appreciation of this potentially lethal lesion is gained, greater use of predissection cholangiography or probe identification of the papilla should occur. Steps to detect the lesion and primary repair by duodenal advancement or, in unrecognized instances, the Hepp operation using a Roux-en-Y limb after a suitable waiting period are recommended.


Total proctocolectomy without the lithotomy position.

Total proctocolectomy for benign disease can be done entirely from within the abdominal incision, thus, avoiding the extra time and inconvenience of operating with the patient in the lithotomy position. This procedure is quick and simple, and the visibility is excellent even in a narrow adult male pelvis, and the lithotomy position is completely eliminated. Results in six patients have been gratifying.


Interposition of the azygous vein in the Blalock-Taussig procedure.

Interposition of the azygous vein between the subclavian and pulmonary artery is helpful in extending the subclavian artery, when additional length is required for a satisfactory anastomosis.


Reconstruction of the male external genitalia.

Congenital malformation, infection, lymphatic obstruction, trauma and carcinoma all have common denominator, the loss of tissue. This loss necessitates the surgeon's use of various techniques in reconstructing the male external genitalia. The stretching of remaining skin, split thickness grafts, flaps and pedicle tube grafts are used to cover the denuded area or reconstruct the penis and scrotum. These methods have been used recently in transsexual operations, combining the expertise of the plastic surgeon, urologist, endocrinologist and psychiatrist. Further improvement upon the preceding approaches is sought to maintain sensation, achieve acceptable cosmesis, create a sexual organ as well as a urinary conduit and prevent severe postoperative complications.


Embolization of angiomas of the spinal cord.

The treatment of arteriovenous malformations has been one of the most difficult of neurosurgical probelms. A high percentage of these cases can be satisfactorily treated by embolization. A series of such cases is reported here. In many instances this is more satisfactory than direct surgical intervention.


Schistosomiasis (bilharziasis) mansoni of the spinal cord stimulating an intramedullary tumor.

A case of involvement of the spinal cord by schistosoma masoni is described. There was a granuloma in the conus medullaris stimulating an intramedullary tumor. Biopsy led to the correct diagnosis. After decompression of the spinal cord and the oral administration of Niridazole (Ambilhar) the patient recovered satisfactorily.


Underwater deceleration curves in relation to injuries from diving.

Diving accidents result in more than 1,800 cases of paralysis from injury to the spinal cord each year. Studies have been made of underwater deceleration during diving. The mechanisms involved in spinal injury are discussed.


Simulated acute appendicitis secondary to ventriculoperitoneal shunt.

A case of simulated acute appendicitis caused by a ventriculoperitoneal shunt is described. This case presented as a perplexing clinical problem. When the diagnosis was established by laparotomy, it was apparent that another complication should be added to the list of abdominal complications which occurred secondary to insertion of a ventriculoperitoneal shunt.


Post-traumatic ophthalmic vein arterialization.

An unusual case of post-traumatic exophthalmos without pulsation, bruit or thrill, due to missile injury is presented. Arterialization of the ophthalmic vein represents one of the very few situations where an eye injury can lead to exsanguination and dealth unless the diagnosis is made early. Prompt carotid arteriography is advised to document the pathologic process and guide appropriate therapy.


Neurinomas of the trigeminal nerve.

Neurinomas of the trigeminal nerve are rare tumours. Six cases of a series of 8,894 intracranial tumours operated upon in the Neurosurgical Clinic of Bucharest are reported. The literature is reviewed. One hundred one other cases have been found. The signs and symptoms produced by these tumours, their slow development, the radiological and other diagnostic findings, the treatment and the prognosis are discussed.


Removal of an intracranial glioblastoma in a hemophiliac.

A case report of a Factor VIII deficient hemophiliac, who underwent surgery for a glioblastoma, is presented. Emphasis is placed on diagnosing the hemostatic deficiency by the use of four hematological tests: bleeding time, platelet count, partial thromboplastin time, and prothrombin time. With close cooperation of a hematologist during the intraoperative and postoperative period, there should be a low mortality associated with intracranial surgery in a hemophiliac patient.


Unilateral proptosis and intracranial schwannoma.

Two cases of unilateral proptosis associated with intracranial schwannomas in children are described. In both cases, tumour occupied both the orbit and middle cranial fossa, where in one case the intracranial component was extradural and in the other intracerebral. Possible sites of tumour origin are discussed.


Rapid closed reduction of cervical fracture dislocations.

Indications and a procedure for rapid closed reduction and decompression of cervical fracture dislocations in less than two hours by tong traction are described. Large amounts of weight are utilized. Neurologic damage due either to the large amount of weight or to rapidity of reduction has not been observed. The procedure is advocated in appropriate patients, provided that both sequential neurologic and radiographic monitoring are carried out.


Post-traumatic syringomyelia.

Post-traumatic syringomyelia is uncommon. It is seen predominantly after injury to the thoracic or the lumbar spine and rarely after injury to the cervical spine. In this report, three cases of post-traumatic syringomyelia are presented. The injury was limited to the thoracic spine in one case and to the cervical spine in the rest. The symptoms began after two years in two cases and after fifteen years in the third. The diagnosis was suggested by radiographic examination and was confirmed at operation in each case. Following evacuation and drainage of the cyst, significant improvement occurred in two patients.


Non-tumoral stenosis of the aqueduct in adults.

Nine cases of non-tumoral stenosis of the aqueduct in adults are described. The deformed aqueducts are displayed diagrammatically. Patients may be divided into three groups, according to their presentation; papilledema with raised intracranila pressure, epilepsy, or intellectual impairment. Those patients in the first category tended to be younger, and to respond more favorably to treatment. A review of the literature is made.


Effects of local hypothermia and of steroids upon recovery from experimental spinal cord compression injury.

Canine spinal cords were compressed by a cylindrical balloon placed in the T-13 epidural space and maintained at 160 mm Hg for one hour. Fifteen minutes after deflation, either local hypothermia or parenteral dexamethasone therapy was initiated. Local hypothermia (dorsal dura mater at 6 degrees C for four hours) was achieved with a miniature epidural heat exchanger which kept cooling fluid isolated from tissue. At seven weeks, the treated groups achieved motor ratings which were significantly superior to those of the untreated group. The untreated group were unable to walk, while both treated groups were able to do so.


Observations of pressure waves in stomach, jejunal, and colonic loops used to replace the esophagus.

The motility characteristics of the stomach, upper jejunum, and right colon were studied in 25 patients in whom these organs were used to replace the resected esophagus. The pattern of motility in all three replacement organs generally was similar to that recorded in normal individuals by other workers. But the stomach replacement showed a greater percentage of Type 1 waves, and Type II contractions were weaker. Activity in the jejunal replacements was much reduced. A propagated pressure wave was observed on swallowing water in the jejunal replacements. The nature of this wave needs further elucidation. The functional result was good, except in patients with a weak or without an upper esophageal sphincter. Patients experienced no pain during the test and no side effects were observed.


Banding of arteriovenous dialysis fistulas to correct high-output cardiac failure.

Three patients with high output cardiac failure from arteriovenous dialysis fistulas are described. All three were treated successfully by banding the appropriate vessel while constantly monitoring flow rates.


Thigh emphysema and hip pain secondary to gastrointestinal perforation.

A patient presenting with thigh emphysema and hip pain may suggest intra-abdominal pathology. Three new and 19 previously reported cases of thigh emphysema secondary to bowel disease are reviewed. The thigh and hip manifestations can obscure the primary intra-abdominal process either due to the obvious emphysema or to the obtunded abdominal signs secondary to associated neuropathy. Only one of 22 patients with thigh emphysema secondary to bowel perforation had gas gangrene. Early diagnosis of this clinical association is essential since eight of the 11 deaths occurred within a few days after admission. Right-sided thigh emphysema suggests appendicitis, whereas left-sided emphysema is more likely to be secondary to left colonic diverticulitis or carcinoma.


Benign obstructing papilloma of the ampulla of Vater in infancy.

Obstructive jaundice due to benign neoplasms of the extrahepatic bile ducts is rare in all age groups. A case is reported which represents the first obstructing papilloma of the ampulla of Vater found in the pediatric age group and the literature pertaining to benign obstructing neoplasms is reviewed briefly. Differential diagnosis of persistent jaundice past the immediate neonatal period is discussed and the need for operative cholangiogram and open liver biopsy in difficult cases is stressed. Obstructing papillomas and other neoplasms of the extrahepatic bile ducts should be added to the differential diagnosis of jaundice in the pediatric age group.


Sacrococcygeal chordoma: Report of a case and review of the literature.

A review of 222 patients with sacrococcygeal chordoma from the English language literature since the first American case in 1913 reveals that men are affected twice as frequently as are women after age 40, but not before. A history of prior trauma can be found in about 20 percent of patients, but no clear etiologic relation can be proved. The evidence for a congenital origin from displaced notochordal tissue is equally inconclusive. Metastasis occurs in only about 10 percent of patients, but recurrence of the primary lesion is almost universal. Of 67 patients followed, 11 survived 10 years or longer after diagnosis of chordoma. Resection of the tumor rarely is complete. Preservation of sacral stability and of sacral nerve pathways to the rectum and the bladder limit the extent of permissable surgery. Repeated local excision of the tumor recurring after initial excision and irradiation remains the treatment of choice.


Peripheral embolism resulting from unsuspected atheromatous aortic plaques.

Three cases of peripheral embolism resulting from atheromatous aortic plaques are reported. Although the majority of arterial thromboemboli are believed to have originated from mural thrombi within one of the cardiac chambers, there is reason to believe that embolism from atheromatous material within a major artery may occur more often than is represented in current literature. Successful management of this condition will necessitate (1) clinical awareness, (2) careful scrutinization of material recovered from embolectomy, (3) angiography to demonstrate the embolic source in the aorta or its main braches, and (4) appropriate remedy by either endarterectomy or graft replacement of the diseased artery segment. The pitfalls in the diagnosis of this condition are discussed.


Post-traumatic aneurysms of the thoracic aorta.

Nineteen patients with histologically proved post-traumatic aneurysm of the thoracic aorta were reviewed. Only seven aneurysms were detected at the time of hospitalization for trauma. Eight of 12 patients with chronic aneurysms either became symptomatic or showed enlargment during a period of observation. Surgical excision was the recommended method of therapy.


The nature of arterial healing following dextran treatment of experimental small artery trauma.

Vascular thrombosis is a major cause of morbidity and death. Because of the many variables involved with thrombosis in patients, major advances in treatment often depend upon design and study of adequate experimental models which provide a degree of control of the variables. Arterial trauma was produced in small femoral arteries 3 mm. or less in diameter by a standardized intimectomy technique. One group of animals was treated with an equal volume of saline and served as controls. Serial sections of blood vessels at graded time intervals from one hour to 90 days were studied. The damaged blood vessels of dextran-treated animals did not thrombose and provided an opportunity for studying the mechanism of healing in traumatized blood vessels which remained patent. The damaged blood vessels of saline-treated animals uniformly thrombosed and eventually healed for scar formation with evidences of attempts at recanalization. The blood vessels of dextran-treated animals remained open for as long as 90 days and were re-endothelialized and healed. What appears to be beginning re-endothelialization of blood vessels of dextran-treated animals was observed as early as 48 hours. In a model experimental setting, dextran has been shown to prevent thrombosis and permit healing in small arteries subjected to a standardized surgical trauma.


Effect of ascorbic acid on rectal polyps of patients with familial polyposis.

Evidence for dehydrogenation by fecal bacteria in the genesis of colon cancer suggested that an antioxidant might modify these mechanisms. Ascorbic acid, 3 Gm. daily, was given to five patients who had active rectal adenomatous polyp formation long after ileorectal anastomosis for familial polyposis. During a 4 to 13 month study, rectal polyps disappeared in two, regressed partially in two, and increased in one. Among three additional treated patients with rectal polyps, one had a reduction in polyps and two were unaffected.


Acute mesenteric vascular occlusion: A review of thirty-two patients.

High mortality rates associated with mesenteric occlusion are a tremendous challenge. We reviewed 32 patients admitted to Beckley Appalachian Regional Hospital during the years 1965 to 1974. The majority of the patients were men. There was quite a variation in the symptoms and physical signs, with heart disease commonly associated with mesenteric occlusion. Massive gangrene involving the small and large bowels had the worst prognosis. Thrombectomy and anticoagulation did not prove beneficial in our series. Patients who survived massive resection are having intermittent diarrhea, responsive to medical treatment. The mortality rate in this series of 32 patients was 81.3 percent. It is hoped that with increased use of mesenteric angiography, early diagnosis, and prompt management the mortality rate can be brought down to acceptable levels.


The correlation of sequential changes in the distribution of pulmonary blood flow in hemorrhagic shock with the histopathologic anatomy.

Histopathologic changes were described and correlated with hemodynamic changes in a series of farm-reared dogs by a preparation and a protocol which were shown to simulate closely physiologic events in clinical hemorrhagic shock; neither anesthesia nor thoracotomy was used and flush solutions for catheters were strictly limited; a series of sham-treated controls was used for comparison. Five different isotopes were used to label microspheres to measure blood flow sequentially at the tissue level at various stages of the shock protocol. At death, multiple tissue sections were taken relative to six parallel segments of the lung arranged according to dependency so that correlations of structure and function might be related to the influence of gravity. The degrees of severity of atelectasis, hemorrhage, edema, congestion, inflammation, and hyperaeration were evaluated by rating scales. Tissues from the most dependent areas had a higher incidence and greater severity of histologic lesions. Tissues with mild histologic rating tended to have lower percentages of flow after hemorrhage, but normal or increased flow after reinfusion. The severely damaged tissue received greater than average flow throughout. Tissues with severe atelectasis paralleled the course of those with a high over-all severe pathologic rating. Tissues with severe inflammation had less blood flow in the control period, increased flow in Stages B1 and B2 and a subsequent return to control values. Those with severe edema had reduced flow in Stages B2 and B3, but high flows after reinfusion.


Results of left gastric vena caval shunt for esophageal varices: Analysis of one hundred clinical cases.

A new selective shunt operation, namely left gastric vena caval shunt, has been applied to 100 patients with esophageal varices, including 77 with cirrhosis of the liver and 19 with so-called idiopathic portal hypertension. Early death occurred in 3.0 percent and postoperative rebleeding from esophageal varices in 10.4 percent. The 5 year survival rate was 78.0 percent and the rehabilitation status of the surviving patients has been satisfactory, without any signs of hepatoencephalopathy. The shunt was proved to be patent in about 90 percent of the patients.


Aneurysm of a polar renal artery.

A patient with a saccular aneurysm arising from the left superior polar renal artery is presented together with a review of two further reports from the literature. The importance of selective arteriography and the interpretation of the "naked calyx" sign in the diagnosis of supernumerary renal arteries has been emphasized. We feel that this is the only report of an aneurysm of a polar artery successfully treated by excision and end-to-end arterial anastomosis.


Acute abdomen due to torsion of a pedunculated mesenteric fibroma.

A case history of a boy with an acute abdomen due to torsion of a pedunculated mesenteric fibroma is presented. A review of the literature shows that only a relatively small number of mesenteric fibromata have been reported. In these cases the tumor was described as growing between the two leaves of the mesentery. The symptoms these tumors gave usually were due to the size of the tumor and compression of adjacent organs. The present case is unusual because of the pedunculated nature of the fibroma and its presentation as an acute abdomen.


Iatrogenic entrapment of femoropopliteal saphenous vein bypass grafts by the gastrocnemius muscle.

Two patients are described in whom saphenous vein grafts placed distal to the knee joint were "entrapped" by the medial gastrocnemius tendon. In one, the superficial position of the graft was detected by postoperative angiography. In the other, a true aneurysm of the vein graft developed over a 3 year period. The similarity between the iatrogenic and congenital forms of the popliteal entrapment syndrome is noted.


Deep inferior epigastric arteriovenous shunt for hemodialysis.

The deep inferior epigastric artery and vein may be satisfactorily utilized for chronic hemodialysis in patients who have no extremity vessels available.


Postprandial rest pain and claudication of the lower extremity: A case report.

Postprandial rest pain and claudication in the lower extremities may occur in arteriosclerotic aortic occlusion when mesenteric and systemic collateral pathways provide inadequate blood flow to the extremity. The symptoms occur as a result of vasodilation of the distal mesenteric vascular bed with a concomitant increase in mesenteric blood flow which leads to a decrease in mesenteric artery to extremity collateral blood flow. This normal physiologic phenomenon, increase in mesenteric blood flow, causes the extremity pain. Such symptoms indicate a quite significant decrease in blood flow to the extremity, and prompt surgical correction is indicated. Aortofemoral reconstruction yields total reflief of the symptom complex.


Rejection and repair of endothelium in major vessel transplants.

Fresh saphenous vein homografts are gaining popularity as conduits for femoral-popliteal or distal bypass grafts. Aside from major blood group compatibility, there is little clinical evidence that rejection is a significant factor in long-term patency. Some have suggested that blood vessels are weakly antigenic and others indicate that rejection does not endanger long-term patency. Transplantation and toxic damage were produced in experimental animals in order to compare healing processes. Both types of injuries produced early significant endothelial cell proliferation detected by H3-thymidine uptake. This response peaked at 5 days in transplants and ever-expanding islands of proliferating endothelium were present in aortas exposed to 20 percent sodium chloride, leading to healing in 3 to 4 months. In the transplanted vessels, total endothelial destruction occurred at 11 to 28 days, and cells of host origin determined by sex chromatin analysis gradually resurfaced those grafts that maintained patency. At 4 months only two of six carotid artery homografts were patent in unmodified dogs, and eight of nine were patent in animals given 1 mg. per kilogram of Imuran. All patent grafts were resurfaced by host cells. We conclude that rejection does play a role in long-term patency; that donor endothelium of living vascular grafts cannot maintain sufficient proliferative capacity to repair immunological damage; that small doses of Imuran significantly alter the rate of destruction leading to more orderly repair and patency; and that clinical trials utilizing one half the dose of Imuran required for kidney graft survival are likely to improve significantly the long-term patency rate of fresh arterial or venous homografts in man.


Unusual problems of venous thrombosis.

Although venous thrombosis (thrombophlebitis) is well known, there are uncommon manifestations which are seen infrequently, discussed rarely, and documented poorly. Experiences with 38 patients in seven categories are discussed in terms of our results and the pertinent reports of others. Pulmonary necrosis after embolic pulmonary infarction (six patients) may require tube thoracotomy and/or lung resection and contraindicate further heparin therapy. Iliac and/or femoral vein thrombosis occasionally fails to recanalize. Long-standing occlusion (18 patients) may be benefited by a cross-over saphenous vein graft. Left iliac venous occlusion secondary to pressure from the crossing right iliac artery (four patients) may indicate repair or bypass. Budd-Chiari syndrome (thrombosis of the hepatic venous outflow) was, in a single patient, carried past a critical period by a long Dacron tube shunt graft from the umbilical vein to the azygos vein. Subclavian and axillary venous thrombosis due to thoracic outlet pressure syndrome (three patients) often responds to heparin but may require thrombectomy; later resection of the first rib is indicated. Phlegmasia cerulea dolens (blue phlebitis) with tissue gangrene (three patients) requires immediate venous thrombectomy and subsequent heparinization. The occluded inferior vena cava (three patients) remains a challenging unsolved problem.


The effectiveness and mechanism of collagen-induced topical hemostasis.

Microcrystalline collagen is a recently developed material possessing remarkable topical hemostatic properties. The potential utility of this substance for cardiovascular surgery was evaluated in a canine arterial bleeding model. A hemostatic protocol allowed comparison of initial and final hemostasis rates as well as the time required to accomplish hemostasis. The results of these studies revealed that microcrystalline collagen, or MCC, achieved hemostasis more frequently and rapidly than either pressure alone or oxidized cellulose cloth. MCC also was highly effective initially after large doses of heparin and in the presence of platelets with function rendered deficient by acetyl salicylate. Only in the presence of profound thrombocytopenia was any loss of initial effectiveness observed. Some delayed hemorrhage occurred in the heparin-treated groups leading to a lessened incidence of final hemostasis, a result intimately related to MCC's probable mechanism of action. However, even under the extreme conditions imposed by this severe experimental model, MCC remained effective in greater than 70 percent of the trials. On this basis MCC seems to possess great potential as a useful adjunct during cardiovascular surgical procedures.


The occluded renal artery.

Twenty-seven cases of renal artery occlusion are presented. In 16 patients the duration of occlusion could be determined and only two of 16 became hypertensive or experienced worsening of existing hypertension. Seven of 11 patients in whom the duration was unknown were hypertensive. Twelve patients were not treated and of these, ten are deceased with renal artery occlusion contributory in six deaths. Nine patients underwent nephrectomy and of eight hypertensive patients, five became normotensive. Six underwent revascularization and four were successful at 2 hours, 22 hours, 9 days, and 39 days, respectively, after occlusion. The experience leads us to conclude that viability can be proven only by direct observation and that revascularization with return of function and lowering of blood pressure is possible after prolonged periods of occlusion.


Flow and pressure characteristics of the portal system before and after splenorenal shunts.

The technique of percutaneous transhepatic portal vein cannulation provides a valuable means for determining portal pressure, direction of blood flow, and visualization of the entire portal system in the nonanesthetized patient. This technique, along with selective celiac arterial, superior mesenteric arterial, and renal venous catheterization, was used in the evaluation of a series of 17 splenorenal venous shunts [eight nonselective and nine selective (modified) distal splenorenal shunts]. As a result of these studies it is concluded that (1) prograde portal flow is maintained in the majority of patients following nonselective or selective (modified) distal splenorenal shunts; (2) bidirectional flow occurs in various branches of the portal system before and after splenorenal shunts; (3) a significant drop in portal pressure occurs following the establishment of either type of shunt; and (4) esophageal varices are decompressed by the trans-splenic route following either type of procedure used in this study.


Surgical management of penetrating injuries to the coronary arteries.

Among 76 patients with heart wounds treated over a 4 year period, nine had penetrating injuries to the coronary arteries with clinical presentations of pericardial tamponade, electrocardiographic abnormalities of bundle branch block or ST and T wave changes, and hemothorax. The right coronary artery was injured in two patients, the left anterior descending coronary artery in six patients, and the left circumflex coronary artery in one patient. All but one of these injured coronary arteries were treated by ligation. One patient with a proximal left anterior descending coronary artery transection presented with cardiac arrest and was managed successfully by emergency cardiopulmonary support and saphenous vein bypass with ligation of the transected ends of the artery. The only death occurred six days postoperatively in a patient with a right coronary artery laceration and was not related to the heart injury. No late symptomatic or hemodynamic sequelae have been noted among any of these patients. Principles of elective cardiac surgery are readily adaptable to the patient with a coronary artery injury.


Repair of truncus arteriosus in patients with prior banding of the pulmonary artery.

This is a review of the 25 patients with truncus arteriosus who have undergone corrective repair following prior banding of the pulmonary arteries. The early and late mortality rate was 20 percent, which has fallen to 6 percent for the most recent 17 operations. These results indicate that the probability of a successful repair for truncus arteriosus is not reduced for patients who have undergone prior banding of the pulmonary artery. In view of the current high mortality rate for corrective repair of the truncus arteriosus in the infant with refractory congestive failure, these results suggest that initial banding of the pulmonary artery for such infants, with later elective correction, may be an appropriate method of management at this time.


Clinical experience with nuclear pacemakers.

Approximately 1,400 nuclear pacemakers have been implanted in patients since April, 1970, without a single battery failure; 64 of these have been implanted at the Newark Beth Israel Medical Center. All except four of the 64 pulse generators were attached to transvenous electrodes, 39 to pacing wires already in place. Fifty-nine of the 64 units are in service and continue to function normally in a follow-up period of up to 2 years. In the total worldwide experience, 70 pacemakers are out of service, approximately half because of the patient's death, and the rest for infection or lead problems, and only three or four because of difficulties with components. The first 15 ARCO pacemakers implanted 2 years ago continue to function well. Of the 15 control pacemakers implanted at the same time, one unit has failed. We have concluded that a nuclear pacemaker should not be used in a patient with limited life expectancy or in an infant, but for the otherwise healthy young or middle-age individual, it should be the unit of choice.


An evaluation of electroencephalographic monitoring for carotid study.

Continuous electroencephalogram (EEG) monitoring was used during 213 carotid endarterectomies in 157 patients to identify cerebral ischemia. General anesthesia was used for all patients. An intraluminal shunt was not used routinely, but was inserted in 23 operations when EEG abnormalities associated with ischemia appeared. EEG changes occurred in 31 operations (14.5 percent). Four patterns of abnormal recordings were identified and are discussed. Six patients developed ischemic EEG changes in association with hypotension during endarterectomy. In two of these patients changes appeared with a blood pressure drop of only 20 mm. Hg below preoperative levels. Four patients with internal carotid artery back pressures of 75 to 100 mm. Hg developed EEG abnormalities which disappeared after shunt insertion. Our experience emphasizes the value of continuous EEG monitoring in detecting inadequate cerebral perfusion.


Intermittent claudication: its natural course.

Of more than 600 patients seen for intermittent claudication by this group and not primarily considered for surgery, 104 had angiographic studies and are the basis for this report. The follow-up period varied from 6 months to 8 years, with a mean of 2.5 years. Classification by severity of claudication revealed 33 with less than one block, 36 with two blocks, and 35 with two or more blocks, foot, calf, or thigh claudication. Eighty-two remained stable or improved and 22 worsened. Of the 22 who worsened, 16 had only worsening of claudication (six of them requiring arterial reconstruction) and six progressed to gangrene and required amputations. Of the 82, 66 either had marked improvement of claudication or remained sufficiently stable not to require any operative intervention. Sixteen required arterial reconstruction for persistent, intolerable, or incapacitating claudication. Five of the six amputees were from the less than one half block claudication group. Angiographic studies were significant only in relation to the below-knee runoff in that three of 25 with less than one vessel runoff, two of 23 with one to two vessel runoff, and one of 56 with two to three vessel runoff came to amputation, regardless of the pattern of more proximal arterial occlusions. The study suggests that intermittent claudication is relatively benign, with only 5.8 percent coming to amputation in a 2.5 year mean follow-up. Prognosis is determined by the severity of below-knee arterial involvement and apparent inability to compensate for ischemia via the collateral circulation since only 12.5 percent of those with the most pronounced involvement came to amputation.


Anastomotic aneurysms after vascular reconstruction: problems of incidence, etiology, and treatment.

To gain a better understanding of the pathogenesis, natural history, therapeutic response, and the potential of prevention of anastomotic aneurysms in general and those following aortofemoral interventions in particular, we have reviewed 4,214 reconstructive vascular operations performed in the past 15 years during which procedures (prosthetic bypass, autogenous vein graft, and endarteriectomy) of fairly uniform technical details have been used. Among these operations representing 9,561 anastomotic sites, we encountered 205 anastomic aneurysms, a per site incidence of 1.7 percent. By far the most common site of occurrence was the femoral artery following Dacron bypass procedures, with a per site incidence of 3.0 percent. The lowest rate of incidence was observed after endarteriectomies, regardless of anatomic location (0.4 percent). The most frequent causative factor was found to be structural deficiency of the parent artery, which accounted for 30.7 percent of the aneurysmal lesions. Other etiological agents, in order of importance, were arterial hypertension, mechanical stress, defect of the graft material, and noninfective healing complications. The therapeutic approach was an aggressive one and only patients with prohibitive operative risks were treated conservatively. In the elective surgical cases the rate of good results was 81.6 percent, with no operative deaths.


Traumatic arteriovenous fistulas and false aneurysms: a review of 558 lesions.

Through the Vietnam Vascular Registry which was established in 1966 at Walter Reed Army Medical Center, copies of medical records of 509 combat casualties with 558 arteriovenous fistulas and false aneurysms have been analyzed. This represents approximately 7 percent of the vascular injuries in American casualties from Southeast Asia, from 1963 to 1972, which are included in the Registry effort. Contributions of several hundred individuals are included in this documentation, however, more than one fourth of the patients, 149 or 29.3 percent, have been evaluated in our clinic. There were 296 false aneurysms and 262 arteriovenous fistulas. Multiple lesions occurred in 7.9 percent of the casualties. Fragment wounds accounted for 487 or 87.3 percent of the lesions with 85.5 percent in extremity vessels. Early recognition and definitive surgical treatment usually were accomplished: 52.8 percent within the first 30 days following injury. Ligation was either accepted or required in about 50 percent of the lesions. The mortality rate was 1.8 percent and the morbidity associated with the vascular injury was 6.3 percent. There were eight amputations for an amputation rate of 1.7 percent. Potential complications of heart failure, proximal arterial dilatation, and endocarditis were essentially absent.


World-wide environmental problems.

Man and the physical and natural resources necessary to support him in a civilized society are on a collision course. It is simple to say that man cannot continue to grow in number at an ever-increasing rate without a destructive effect upon the environment. Positive scientific proof for this impending calamity is not now available, yet many indications--sometimes physical and sometimes natural--point towards major world-wide environmental troubles in the near future. A number of environmental problems are described, particularly as they relate to the total world system. A computer model simulating future world-wide environmental trends from 1900 to 2100 A.D. is evaluated and suggested as a major tool for data-gathering purposes to determine the extent of world-wide environmental problems. It is suggested that scientists take an active role in the study of the environment, particularly in relation to man's future on earth. The problems for the future are so potentially dangerous that we must not wait for a global catastrophe and then rely on science to rescue us. The article is about human survival.


Some health aspects of high-energy society.

The intensive use of inanimate energy in industrialized or high-energy society has subsidized research, development, and higher education and has brought about changes in nutrition and life-style that have led to great advances in public health and medicine. The emergence of high-energy society, however, has brought with it a new set of health problems, within which the direct effects of measurable pollution may turn out to be more easily dealt with than some of the indirect and hard-to-calculate consequences of high energy use. High-energy society is critically dependent on energy-intensive transport systems, and these systems in turn are dependent upon a continual supply of petroleum products. In the short-term, the aorta of any industrialized nation is its petroleum-supply network. In the longer run, high-energy society faces the depletion and exhaustion of all the nonrenewable resources on which it has fed. Even if technology provides adequate substitute energy systems, high-energy society may deteriorate socially from inability to cope with affluence.


Community control of Strongyloides stercoralis by thiabendazole.

Mass treatment of a community in Costa Rica with thiabendazole in 1965 reduced the prevalence of S. sterocoralis from 19.2% to 0.3%, and the rates remained low 2 years thereafter. Re-examination of the treated population 7 years after initial treatment showed S. stercoralis prevalence still at a 0.5% level.


Preliminary studies on the metabolism of 3,2'-dimethyl-4-aminobiphenyl in the rat.

Distribution of 3,2-dimethyl-4-aminobiphenyl (DMAB) and its metabolites in vivo and the metabolism of DMAB by liver in vitro have been studied in the Wistar rat. DMAB-HCI purified by recrystallization and dissolved in ethanol was injected subcutaneously and extractions made from liver, feces, and urine. Similar technical procedures were used to study in vitro metabolism in rat liver homogenates. Two components were isolated from urine and liver having Rf values (thin-layer chromatography) of 0.13 and 0.59, respectively. Three additional metabolites were found in the hydrolyzed fecal fraction. Rechromatography of the major fecal component yielded 6 fluorescent compounds. Gas-liquid chromatography of the most highly fluorescent of these indicated at least 3 additional metabolites. The evidence presented indicates that the liver transforms DMAB to several metabolites which are rapidly transferred in conjugated form to the intestine via the bile. The urine does not appear to be the major excretory route. We have examined the purity of commercially available DMAB free base and DMAB-HCL and found an impurity that comprises approximately 10-24% of the total samle upon GLC analysis, depending upon the supplier. This contaminant was completely removed by recrystallization of the hydrochloride and the chemical identity of purified compound as DMAB confirmed. Recommendations are presented for the use of this purified compound in a biological system.


Patho-physiological studies on lactic acid-induced pulmonary thrombosis in rat. I. Effect of heparin, acetylsalicylic acid, urokinase and tranexamic acid.

The role of platelet aggregation and coagulo-fibrinolytic systems in thrombogenesis of lactic acid-induced pulmonary thrombosis in rat were studied using an anti-coagulant, platelet aggregation inhibitor, fibrinolytic or anti-fibrinolytic agents. In normal rat, heparin (2.5 mg/kg), acetylsalicylic acid (30 mg/kg) and tranexamic acid (100 mg/kg) suppressed specifically coagulation, platelet aggregation induced by collagen or thrombin and fibrinolysis respectively. Urokinase (10,000 units/kg) activated powerfully fibrinolytic system in addition to suppressing slightly platelet aggregation. The pretreatment with heparin, acetylsalicylic acid or urokinase markedly prevented the formation of thrombus initiated by the infusion of lactic acid at the doses used. Additive effect was also obtained by combined administration of these agents. On the other hand, it was interesting to note that tranexamic acid (100 mg/kg) did not affect the thrombus formation at all despite a potent anti-fibrinolytic effect of this agent. These results indicate that both platelet aggregation and enhancement of coagulation activity are important factors responsible for the formation of thrombi in DIC, while the fibrinolytic activity in blood seems not to be involved in it. On the basis of the findings, mechanism for triggering activation of coagulation and platelet aggregation is also discussed here.


The effects of infusion of thrombin or endotoxin in rabbits treated with cortisone.

Rabbits treated for 4 days with cortisone to prepare for the generalized Shwartzman reaction (GSR) were infused with thrombin or endotoxin. Whereas endotoxin induced the GSR, infusion of from 120--400 U/kg of thrombin over 1 to 2 1/2 hr failed to induce the GSR. Mean values for fibrinogen consumption after thrombin or endotoxin, calculated from changes in plasma fibrinogen concentration and plasma 125I-fibrinogen radioactivity, were as follows: for rabbits infused with thrombin, from 43 to 61 mg/kg over a 3 hr period; for rabbits infused with endotoxin, 58.5 mg/kg over a 6 hr period. A small peak of non-clottable protein radioactivity, indicative of secondary fibrinolysis, was found in animals infused with thrombin but not in animals infused with endotoxin. A striking late rise in plasma fibrinogen levels was noted in animals infused with endotoxin. It was not noted in animals infused with thrombin. This observation provides further evidence that endotoxin stimulates fibrinogen synthesis by mechanisms independent of intravascular clotting or fibrinolysis. The failure to produce the GSR with thrombin in cortisone-treated rabbits leads us to conclude that depression of reticuloendothelial cell clearance of fibrin can not account for the preparatory effect of cortisone for the GSR after endotoxin.


The influence of beta-adrenergic blockade upon baseline blood coagulation and fibrinolytic activity and upon the responses to venous occlusion.

Twenty volunteers were assessed for baseline coagulation (Thrombelastography, Factor VIII and platelet count) and fibrinolytic (Euglobulin Lysis Time and Fibrin(ogen) Degradation Products) activity two hours after ingestion of 60 mgm propranolol or an identical placebo administered on a double blind basis. The responses of these parameters to a fifteen minute period of venous occlusion was also assessed. Beta adrenergic blockade reduced baseline FDP titres but did not affect other parameters, nor the local response to venous occlusion. During occlusion no significant change in coagulation activity could be detected in the non-occluded arm, but a small but statistically significant shortening of ELT was observed. Since this effect was prevented by propranolol it is probably mediated through adrenergic mechanisms. Adrenergic stimuli appear to influence episodes of coagulation and fibrinolysis during everyday activity, but do not contribute to baseline levels of coagulation or fibrinolytic function.


Soluble fibrin monomer complexes demonstrated by agarose gel filtration and by adsorption on insolubilized fibrinogen: a comparative study.

Incubation of fibrinogen with small amounts of thrombin resulted in the occurrence of soluble fibrin monomer complexes. These complexes consisted predominantly of a derivative with a higher molecular weight than that of fibrinogen. It was characterized by its relative electrophoretic mobility in 5% PAA gel (0.28 X 10(-5) cm2/V X sec) and its elution position prior to the fibrinogen peak following gel filtration. Using adsorption chromatography on insolubilized fibrinogen the derivative dissociated at a ratio of almost 1 : 1 into one part which was adsorbed and into fibrinogen which was not adsorbed. The part which was adsorbed seemed to be the thrombin mediated fibrin monomer. This study confirms the concept that dissociable dimeric fibrinogen-fibrin monomer complexes occur after limited action of thrombin on fibrinogen.


Determinants of the formation and activity of factor V-phospholipid complexes. II. Molecular properties of the complexes.

The stability, buoyancy, and intrinsic activity for factor V-phospholipid complexes were investigated. The decay of factor V activity in the absence of phospholipid followed first order kinetics; however, in the presence of several phospholipids a biphasic decay curve was observed. The addition of phosphatidylethanolamine to factor V produced only a small loss of activity in the first 2 minutes but decreased the subsequent rate of inactivation fourfold. A PE-factor V complex with a low bouyant density was separated from uncomplexed factor V by sucrose density ultracentrifugation. The association constant for this complex was 5 X 10(6) M-1 with approximately 2 moles of factor V bound per mole of lipid micelle. The isolated complex was capable of increasing prothrombin conversion 10-fold without additional phospholipid. A still lighter complex increased the rate of prothrombin conversion 18-fold. Phosphatidyl serine produced a concentration-dependent loss of up to 95% of the factor V activity in the first 2 minutes. After ultracentrifugation on a sucrose density gradient, a PS-factor V complex of increased density was detected. This complex failed to accelerate prothrombin conversion in the intrinsic two-stage assay. Except at very high concentrations, phosphatidylcholine did not alter the kinetics of inactivation of factor V. A factor V-phosphatidylcholine complex could not be detected after ultracentrifugation. When added to factor V, cardiolipin (200 mug/ml), produced a rapid 50% decline in activity with a subsequent three-fold increase in the rate of inactivation. No activity was recovered after ultracentrifugation of factor V in the presence of cardiolipin. Saturated phosphatidylethanolamine produced a concentration dependent initial loss of activity, but only a minimal increase in the subsequent rate of inactivation. At 200 mug/ml almost no light complex was detected after ultracentrifugation, but at 800 mug/ml a light complex was observed. This behavior corresponds to the ability of saturated phosphatidylethanolamine to accelerate prothrombin conversion only at very high concentrations. Thus, phospholipids combine with factor V to form complexes which differ in their ability to accelerate prothrombin conversion. The most active species are stable lipoprotein complexes of lower buoyant density than factor V.


Fluid mechanical stress and the platelet.

Platelet thrombi in suspensions stirred in an aggregometer or subjected to shear flow in a Couette viscometer or circular tube can only form as a result of collisions between the cells. In whole blood, the presence of the red cells results in pronounced lateral displacements of the paths of the platelets through the vessel, which in turn increases the frequency of collisions between platelets and also makes possible platelet-wall interactions. In addition, blood cells in a suspension undergoing shear flow are subjected to fluid stresses which can result in their deformation. Such stresses may locally attain high values in the arterial circulation at bifurcations, sharp bends and stenoses where the flow is disturbed. Since platelet thrombi have been found downstream of sites of such geometry, the effects of high and variable shear stress on the platelet release reaction and aggregation were investigated. Washed platelets containing C14-serotonin in Tyrodes-albumin solution were subjected to oscillatory flow at 37 degrees C and provided the time average wall velocity gradient was above 2,000 sec-1, the thrombin-induced release of serotonin was appreciably greater than in the corresponding controls incubated at rest. No measurable serotonin was released as a result of flow alone. This synergistic effect of oscillatory shear flow was also noted in the presence of inhibitors of the release reaction.


Energy production and utilization by human platelets in the presence of some guanidines and phenols (uremic toxins) that inhibit aggregation.

Platelet aggregation induced by ADP can be inhibited by plasma from uremic patients or by toxins isolated from their plasma, e.g. guanidinosuccinic acid, methylguanidine, phenol and hydroxyphenylacetic acids. Since these chemical substances can interfere with energy metabolism in tissues other than platelets and since ATP production is needed for ADP-induced aggregation, alterations in platelet energy metabolism could underlie excessive bleeding in uremic patients. Platelets incubated with idioacetate and deprived of anaerobic glycolysis produced the same quantity of ATP through respiration in the presence of all the uremic toxins studied as in their absence. Similarly, platelets incubated with cyanide and deprived of the oxidative pathway utilized anaerobic glycolysis to produce normal quantities of ATP in the presence of all the uremic toxins. The utilization of ATP, as indicated by active transmembrane potassium transport, was also unaffected by the above listed guanidines and phenols. It is concluded that the in vitro inhibition of ADP-induced platelet aggregation by the guanidines and phenols studied is not due to inhibition of production or utilization of ATP.


Effects of vancomycin on platelets, plasma proteins and hepatitis B surface antigen.

The antibiotic vancomycin shares many similarities with ristocetin, an agent noted for its effects on platelets and plasma fibrinogen. Vancomycin did not aggregate platelets as ristocetin, but platelets were incorporated into precipitates induced by vancomycin. Fibrinogen and factor VIII were precipitated from plasma at low concentrations of vancomycin. The precipitated fibrinogen remained clottable. Hepatitis B surface antigen was selectively precipitated from serum and could be recovered from the precipitate. Rabbits receiving bolus intravenous injections of high doses of vancomycin developed hypofibrinogenemia and thrombocytopenia within minutes and often went on to die. Studies with 125I-vancomycin revealed little stable binding of the antibiotic to platelets or fibrinogen. A relationship is suggested between the potent protein precipitating effects and phlebitis at the infusion site commonly associated with vancomycin therapy.


Circulating plasma volume and renal function.

The relationships of circulating plasma volume (PV) to effective renal plasma flow and glomerular filtration rate (GFR) were investigated in reference to their interrelated changes induced by upright posture in normal subjects and patients with chronic glomerulonephritis. The following relation was obtained: (percentage change in GFR) = k(percentage change in PV). The values of k were 3.4 for the normal and 3.1 for the patients. There was no statistically significant difference between the two. On account of the above relation the recumbent level of glomerular filtration rate (GFR)r was derived from the recumbent level of circulating plasma volume (PV)r as follows: (GFR)r = Kp [(PV)r]k, where Kp is a constant. On the other hand, the decreases (percentage) in effective renal plasma flow were biphasically related to those in PV. Mean arterial pressure rose in upright posture in many cases, but its changes (percentage) showed no correlation with the changes (percentage) in GFR. These results suggest that in a small decrease in PV, GFR does not decrease with the fall in mean arterial pressure, but with the power function of PV. The possible mechanisms of these changes in renal function are examined with special reference to the structure of renal arterial system.


Lympho-reticuloendothelial activity of early gastric carcinoma.

The lympho-reticuloendothelial activities of 54 cases of early gastric carcinoma were studied. Morphological blastoid transformation of lymphocyte by the addition of phytohemagglutinin-P (PHA-P) was disturbed in half of the patients. The DNA synthesizing activity of lymphocyte was not stimulated by PHA-P in the cases of advanced carcinoma but it was stimulated in the cases of early carcinoma. The tuberculin reaction was negative in 30% of the cases of early carcinoma. The reticuloendothelial system (RES) activity studied through the congo red method revealed that 86% of the cases of early carcinoma had disturbed RES function.


Combined cancer chemotherapy with cyclophoshamide and an inducer of microsomal drug-metabolizing enzymes (cytochrome P-450) in tumor-bearing rats.

The fifty percent alive period in Yoshida sarcoma-bearing and AH66F-bearing rats was prolonged by an administration in a single dose of 100 mg cyclophosphamide/kg body weight in a group pretreated with phenobarbital as compared with that pretreated with saline. However, there was little difference in fifty percent alive period between AH109A (insensitive to cyclophosphamide)-bearing rats and controls even when they were pretreated with phenobarbital. In chemotherapy with anti-cancer drugs, inductive or inhibitory effects of the drugs on microsomal drug-metabolizing enzymes should be taken into consideration.


Renal effects of prostaglandin E1 in hypertensive patients.

The effects of prostaglandin E1 on fluid and sodium excretion, creatinine clearance and renin release were examined in 26 hypertensive patients including 9 cases of essential hypertension, 10 of renovascular hypertension and 7 of primary aldosteronism. When prostaglandin was infused intravenously in a total dose of 120 mug in 60 min, urine volume was increased in 70% of cases, and sodium excretion in 61%, but little changes were observed in creatinine clearance. The most prominent diuresis and natriuresis were obtained in primary aldosteronism (mean increase was 319% in urinary volume, and 222% in sodium output). The average increases in urinary volume were 61% in patients with essential hypertension and 97% in renovascular hypertension. And urinary output of sodium was increased by 63% in the former and 56% in the latter. The remarkable renal effects of prostaglandin E1 in primary aldosteronism were completely abolished after the administration of spironolactone. Significant elevation of plasma renin activity resulted from prostaglandin E1 infusion in essential hypertension, while no constant effect was obtained in renovascular hypertension and primary aldosteronism. The present experiments indicate that prostaglandin E1 has different effects on the kidney according to the types of hypertension and the effects correlate closely with patient's status of extracellular fluid volume or sodium balance.


Urinary kallikrein excretion and sodium metabolism in hypertensive patients.

Urinary kallikrein excretion was measured in 21 healthy subjects and 44 patients with various types of hypertension. The kallikrein activity was determined by the method of esterolytic assay. The excretion rates in normal subjects were 112.9 +/- 11.1 (S.E.) EU/day. The kallikrein excretion was decreased in patients with essential hypertension, the mean estimated values were 75.2 +/- 10.0 EU/day. In this disease, however, an enhancement of urinary kallikrein was observed after sodium depletion. An obvious increase in kallikrein excretion was found in the primary aldosteronism. In primary aldosteronism and renovascular hypertension, one of the secondary aldosteronisms, there was a good correlation between the urinary kallikrein output and the urinary sodium excretion. The present data indicate that the renal kallikrein-kinin system, one of the renal antihypertensive factors, is suppressed in essential hypertension and is under the influence of mineralocorticoid levels.


A new operative fiberpyeloscope.

Operative pyeloscopes developed up to now have been of limited effectivness because of an inadequate visual field and difficulties in handling procedure. The author has made up a flexible fiber pyeloscope with which it is possible to extract renal pelvic and caliceal stones easily. This pyeloscope has the following specifications: effective length, 630 mm; diameter, 8.5 mm; field of vision, 60 degrees. In addition, the tip of the scope can be deflected 90 degrees up or down from the basic position with a hand manipulated angle deflector knob on the scope grip. This allows the inside of the renal pelvis to be observed clearly from every direction. Through the channel of the scope, specially designed stone grasping forceps can be inserted into the renal pelvis, and it is possible to grasp renal pelvic stones under direct observation. The fiberpyeloscope has been used in 2 cases of renal pelvic stones, in which the pelvis was exposed by subcostal flank incision. The stones were successfully extracted with the scope which was introduced through a small incision on the renal pelvis.


Further studies on cross-immunity among syngeneic tumors in mice.

In the present studies employing 3-methylcholanthrene (MCA)-induced sarcomas of C3H/He mice, cross-immunity among syngeneic tumors was markedly demonstrated by immunization with living tumor cells after repeated inoculation of gamma-irradiated (13, 000 rads 60Co) tumor cells. Cross-immunity was also markedly shown in the challenge of the other MCA-induced tumor, which was induced in the same mouse in which the immunizing MCA-induced tumor originated, by repeated immunization with gamma-irradiated tumor cells only. On the contrary, cross-immunity was not observed between tumors induced on different mice by repeated immunization with gamma-irradiated tumor cells only. As the result of the immunization with gamma-irradiated tumor cells only, common antigenicity among syngeneic tumors seems to be hardly demonstrated, and antigenic indiviDuality among animals, in which MCA-induced sarcomas originated, seems to be remarkably demonstrated.


Mercury in red blood cells in relation to organic mercury in hair.

To check the usefulness of the hair mercury value for evaluation of intake of mercury, total mercury in red cells and organic mercury in hair were measured and compared on islanders whose fish consumption varied to a considerable extent. On both the male and female, correlations of these two mercury levels were significant. The slopes of regression lines did not differ between the male and the female, but the level of hair organic mercury was higher in the male than in the female. Age-differences were observed in the red cell-to-hair relationship of mercury, i.e. the age-group aged 50 and over had much milder slopes than the group aged 20-49 in both the male and the female. The importance of age-matching was mentioned.


Metabolic heterogeneity of lecithins in intestine.

The incorporation of [2-3H]glycerol and lysolecithin labeled with [2-3H]glycerol into lecithin and its subspecies was investigated in epithelial and muscular layers of rat small intestine. The labeled compounds were administered in two wways: the intraduodenal injection and the injection into femoral vein. The incorporation of glycerol into lecithin was distinctly higher in epithelial layer than in muscular layer in both administration routes, but the incorporation of lysolecithin into lecithin showed no marked differences between both layers. Among lecithin species, dienoic and monoenoic species were highly labeled with the injection of labeled glycerol, and dienoic as well as tetraenoic specied were markedly labeled with the injecttion of labeled lysolecithin. Anyhow, no marked differences were found on the incorporation pattern of any labeled compounds into lecithin between both layers and between both administration routes.


Diminished immune response in pregnant mice.

As pregnancy proceeded, humoral immune response to sheep red blood cells gradually decreased in a pregnant mouse. At the later stage of pregnancy, it showed significantly diminished immune response but it recovered immediately after delivery. The possibility was excluded by the hormone treatment that progesterone played in suppression of immune response in a pregnant mouse.


Defective DNA repair replication in xeroderma pigmentosum fibroblasts and DNA repair of somatic cell hybrids after UV irradiation.

Primary fibroblast cultures were obtained from 9 patients with xeroderma pigmentosum of various clinical types. Repair replication of the UV-damaged DNA in fibroblasts was studied by means of 3H-thymidine labeling and radioautography. A DNA repair replication was found to be decreased in all xeroderma pigmentosum fibroblasts as compared with the control cells obtained from normal donors. The repair activities in cells from patients ranged from nearly 0% in two infant cases and one case of De Sanctis-Cacchione syndrome to approximately 100% in adult moderate case. There was, however, no correlation between the level of repair replication and the severity of clinical symptoms. Since two cases which showed a lack of repair DNA replication were infant, it is assumed that these cases may develop De Sanctis-Cacchione syndrome in future. On xeroderma pigmentosum cells, a genetic analysis was performed with cell fusion methods using irradiated HVJ virus in order to determine the type of the complementation group. XP-1, XP-4 and XP-9 may be classified into the group D; XP-2, XP-7 and XP-8 into the group A; and XP-5 into the group E.


Inhibition of dopamine-beta-hydroxylase by carnosine.

Dopamine-beta-hydroxylase was partially purified from bovine adrenal medulla and the effect of carnosine on the dopamine-beta-hydroxylase activity was investigated. Carnosine significantly inhibited the enzyme activity at the concentrations higher than 0.5 mM. According to the Lineweaver-Burk plots, the inhibition observed appeared to be a non-competitive type with the substrate, tyramine.


Significance of gastric analysis with particular reference to the diagnosis of Zollinger-Ellison syndrome.

Various criteria in gastric analysis currently used for the diagnosis of the Zollinger-Ellison syndrome were assessed in cases of endoscopically normal gastric mucosa, gastric ulcer and duodenal ulcer. New criteria consisting of BSV greater than 350 ml/hr, BAO greater than 25 mEq/hr, MAO greater than 60 mEq/hr, and BAO/MAO greater than 0.7 were proposed to differentiate the Zollinger-Ellison syndrome and peptic ulcer.


Effects of eye movements upon excitability of the superior colliculus in cats.

Influences of saccadic eye movements upon excitability of cat superior colliculus (SC) were examined in chronic cats carrying implanted electrodes and in encephale isole cats. Excitability of SC was assessed by recording orthodromic responses of SC (SC ortho-response) to electrical stimulation of the optic chiasm. The SC ortho-response consisted of four components; i.e. presynaptic T1 and postsynaptic C1, C2 and C3. Eye movements suppressed the first two components (T1 and C1) and enhanced the latter two (C2 and C3). Retinal impulses caused by movements of images were found responsible for suppression of T1 and C1: 1) This was seen when cats moved eyes seeing external objects in light. In dark, neither T1 nor C1 received any influence from eye movements. 2) By moving visual stimuli rapidly before eyes of paralysed cats the same suppression of T1 and C1 was obtained. Suppression of C1 was deemed as a postsynaptic sign of SC for saccadic suppression. In contrast to suppression of T1 and C1, enhancement of C2 and C3 was dependent upon a central factor: 1) Enhancement of C2 and C3 followed eye movements, independent of the ambient illumination. 2) Saccade-like movements of a slit of light in front of immobilized eyes never induced enhancement of C2 and C3. 3) PRF stimulation, effective to cause saccade-like eye movements, always elicited enhancement of C2 and C3, independent of the ambient condition and even after eyes had been immobilized. This phenomenon was interpreted as indicating that corollary discharges are sent to SC.