Intrapericardial bronchogenic cysts.

A rare case of large intrapericardial bronchogenic cyst with superior vena caval obstruction is reported. The cyst was successfully removed and the superior vena cava, which was narrowed by pressure fibrosis and thrombosis, was reconstructed satisfactorily and has maintained patency. In another case a large cyst of the same type without vena caval obstruction was successfully treated surgically. The features of these 2 cases are compared with those of 20 reported cases. The angiographic data in these cases appear to be sufficiently characteristic to suggest the nature of the lesion and the clinical finding of pericarditis early in the course of the disease may also suggest the diagnosis.


Optimal resources for cardiac surgery. Guidelines for program planning and evaluation.

This updated and expanded planning guideline describes the optimal environment in which cardiac surgery can be performed effectively and safely and suggests criteria for evaluating existing facillities and for long-range hospital planning. The status of cardiac surgery is reviewed and measures are provided for assessing a hospital's ability to support a cardiac surgical service. Recommendations are given for appropriate case loads, administrative arrangements, and professional staff qualifications and relationships. The emerging role of the nurse is considered and requirements are enumerated for allied clinical supporting services. Special criteria are provided for pediatric cardiac surgical units and detailed specifications are given for the hospital's physical plant and equipment including a protocol for checking the electrical safety of surgical suites. A data base is suggested for taking regular inventory of community cardiac surgical programs.


Chronic right bundle branch block and left posterior hemiblock. Clinical, electrophysiologic and prognostic observations.

Twenty-one patients with long-term right bundle branch block and left posterior himiblock were studied electrophysiologically and then followed up prospectively. The group consisted of 19 men and 2 woman aged 61 +/- 2.7 years (mean +/- standard error of the mean). The majority of patients had either hypertensive cardiovascular disease (48 percent) or primary conduction disease (33 percent). Initial electrophysiologic studies revealed A-H intervals of 58 to 152 msec (mean 98 +/- 7.7) and H-V intervals of 40 to 80 msec (mean 52 +/- 2.1). Six patients (29 percent) had prolonged H-V intervals. The follow-up period ranged from 91 to 1,231 days (mean 671 +/-68). Three of 21 patients (14 percent) needed a permanent pacemaker after development of the following symptomatic conduction disease: sinoatrial block on day 3 of follow-up; second degree atrioventricular (A-V) block, site undetermined, on day 118; and second degree A-V block proximal to the His bundle on day 398. One patient died suddenly (on day 571), and two others died of noncardiac causes. In conclusion, combined right bundle branch block and left posterior hemiblock was associated with less trifascicular disease than reported previously. The clinical course of most of the patients was benign and the incidence of sudden death was relatively small. Symptomatic conduction disease occurred but could be definitely related to trifascicular disease in only one patient. These short-term data suggest that prophylactic pacemaker insertion is not routinely indicated in patients with chronic right bundle branch block and left posterior hemiblock.


Mahaim and James fibers as a basis for a unique variety of ventricular preexcitation.

This report concerns pathologic findings in a 54 year old woman with intermittent preexcitation who died of carcinoma of the breast. Electrocardiograms revealed predominantly normal sinus rhythm with a normal P-R interval and narrow QRS complex. Episodes of sinus rhythm, short P-R interval and QRS widening (with delta wave) were also recorded. During preexcitation QS complexes were noted in leads II, III, aVF, V1 and V4 to V6. Delta waves were negative in leads II, III, aVF and V1 isoelectric in leads V4 to V6 and positive only in leads I, aVL, V2 and V3. This case thus defies classification into any known variety of preexcitation. Complete serial sections, cut through the entire conduction system and both atrioventricular (A-V) rims, totaled 18,600 sections. These revealed no bundle of Kent. Instead, Mahaim fibers histologically identified as His bundle tissue gave off from the A-V bundle to both the right and the left sides of the septum associated with the normal fibers of James. This case reveals that (1) fibers of James can bypass the A-V node, (2) fibers of Mahaim can conduct, and (3) there are types of preexcitation in addition to types A and B.


Comparative cardiac dynamic effects of dobutamine and isoproterenol in conscious instrumented dogs.

The cardiac dynamic consequences were evaluated of constant infusions of dobutamine and isoproterenol at graded dose levels into conscious, healthy instrumented dogs. Measurements were made of simultaneous changes in left ventricular internal diameter, pressure, aortic pressure and rate of rise of left ventricular pressure(dP/dt), as well as the left ventricular electrogram. From these primary variables, derived variables were computed using programs in a minicomputer system. The data showed that, with increasing doses of dobutamine there were significant linear increases in all measured indexes of myocardial contractility, such as the rate of rise of left ventricular pressure at a developed isovolumic pressure of 40 mm Hg (dP/dt/P40), mean velocity of left ventricular fiber shortening, ejection fraction and stroke work. These changes in myocardial contractility occurred without changes in end-diastolic volume, mean aortic pressure or heart rate when dobutamine was infused in doses of 5 to 20 mug/kg per min. Isoproterenol also produced linear changes in indexes of myocardial contractility but in doses of 0.02 to 0.10 mug/kg per min, it produced a significantly higher heart rate at any given level of contractility than that produced by dobutamine. Cardiac minute work (heart rate X stroke work) was increased by both drugs. However, with infusions of isoproterenol the amount of cardiac minute work was significantly limited because of the changes in heart rate, whereas with dobutamine cardiac minute work could be increased to a higher level as a function of changes in myocardial contractility alone without changes in heart rate. These data suggest that dobutamine selectively increases myocardial contractility.


Effects of ischemia and coronary reperfusion on myocardial digoxin uptake.

The effects of coronary reperfusion on the uptake of digoxin by ischemic myocardium were studied in 17 open chest dogs undergoing anterior wall infarction produced by snaring confluent branches of the left coronary arterial system. Epicardial electrograms delineated ischemic, border and nonischemic zones. The hearts were reperfused by snare release after 1, 2 and 6 hours of occlusion. After 15 minutes of reperfusion, 1.0 mg of tritiated digoxin (3H-digoxin) was given intravenously, and 2 hours later the hearts were excised and endocardial and epicardial samples from each zone were analyzed for 3H-digoxin concentration. In another group of eight dogs regional myocardial blood flow was assessed utilizing 15 mu of radio-labeled microspheres administered during occlusion and reperfusion. In five dogs with 1 hour of coronary occlusion and subsequent reperfusion, 3H-digoxin uptake was comparable in endocardial and epicardial layers of all three zones. In six dogs undergoing reperfusion after 2 hours of occlusion, mean 3H-digoxin concentration was significantly (P less than 0.001) reduced from the mean nonischemic concentration, by 54 percent in endocardial and 35 percent in epicardial layers of the ischemic zone. Border zone endocardial and epicardial 3H-digoxin uptake was reduced by 21 percent and 16 percent, respectively (P less than 0.05). In six dogs undergoing reperfusion after 6 hours of occlusion, 3H-digoxin uptake in the ischemic zone was significantly (P less than 0.001) reduced by 85 percent in endocardial and 60 percent in epicardial layers from the concentration in the nonischemic zone. Border zone uptake was decreased by 54 percent in endocardial and 36 percent in epicardial regions (P less than 0.01). These alterations of in vivo digoxin binding could not be explained by impaired reflow of blood to ischemic myocardium. We conclude that coronary reperfusion after 2 to 6 hours of occlusion is associated with a marked reduction in myocardial digoxin uptake, which is more pronounced in subendocardial than in subepicardial regions of ischemic tissue.


Congenital and surgical atrioventricular block within the His bundle.

In three patients with congenital heart disease the site of atrioventricular (A-V) block was localized within the His bundle with the aid of His bundle electrograms. In one patient with first degree A-V block and normal QRS configuration, electrophysiologic studies revealed "split" His potentials. The other two patients had complete A-V block, and their His bundle electrograms revealed His spikes both proximal and distal to the site of block. One of the two patients, who had a pattern of left bundle branch block in the electrocardiogram, had surgically induced complete A-V block after repair of an ostium primum atrial septal defect. The other patient with congenital A-V block had a narrow QRS complex and, in addition to complete block within the His bundle, prolonged A-V nodal conduction time but no associated cardiac anomaly. Both patients with complete heart block required pacemaker insertion. The natural history of intra-H-is bundle block is not known, and it is difficult to recommend appropriate therapy. More electrophysiologic studies are needed in patients with A-V block to determine the prognostic significance of such block or conduction delay in the His bundle.


Long-term follow-up of two infants with an implanted cardiac pacemaker.

The clinical course of two patients with congenital heart block who had pacemaker implantation at age 7 and 8 months, respectively, is reviewed. One patient at age 10 years has had nine pulse generators inserted; the other has had six implantations, the most recent a lithium iodine pacemaker, during 8 1/2 years of observation. Both patients have shown normal physical development and emotional maturation despite multiple hospitalizations and pacemaker replacements, thus demonstrating that electrical pacing, initiated in infancy, can be maintained through childhood without adverse effects.


Handy heart sound simulator.

A simple bedside technique of heart sound simulation using hand and stethoscope is described. The technique utilizes tissue vibration and sound conduction with the usual air column of a stethoscope to reproduce auscultatory events accurately without the distortion that often accompanies electrical production of heart sounds.


Effects of glucose-insulin-potassium on myocardial substrate availability and utilization in stable coronary artery disease. Studies on myocardial carbohydrate, lipid and oxygen arterial-coronary sinus differences in patients with coronary artery disease.

To assess the metabolic effects of myocardial substrate alteration in patients with coronary artery disease, glucose-insulin-potassium solution was administered intravenously for 30 minutes to 14 men with stable angiographically documented coronary artery disease. The glucose-insulin-potassium solution (300 g of glucose, 50 units of regular insulin and 80 mEq of potassium chloride per liter of water) was infused at a constant rate in each patient, but individual infusion rates ranged from 0.013 to 0.032 ml/kg per min (4 to 10 mg glucose/kg per min) in the 14 patients. Simultaneous arterial and coronary sinus samples were obtained at 15 minute intervals during a stable 30 minute control period and again at 15 minute intervals during the infusion; samples were assayed for glucose, lactate, free fatty acid and oxygen content. In all 14 patients, during the glucose-insulin-potassium infusion, arterial glucose and lactate increased and arterial free fatty acid levels fell; the magnitude of the changes in arterial lactate and free fatty acids was related to the rate of infusion. Arterial-coronary sinus differences (A-Cs) for glucose, lactate and free fatty acid levels correlated with the arterial concentrations of these substrates (r = 0.66, 0.87 and 0.79, respectively). Regression analyses demonstrated myocardial thresholds for the uptake of these substrates as follows: glucose 79 mg/100 ml; lactate 300 mu mole/liter; and free fatty acids 100 to 200 mu Eq/liter. Finally and most importantly, the reduction in A-Cs oxygen values after glucose-insulin-potassium infusion correlated with the reduction in A-Cs free fatty acid levels (r = 0.64, P less than 0.0001). This observation suggests that, in patients with coronary artery disease, glucose-insulin-potassium infusion may significantly diminish myocardial oxygen requirements by reduction of myocardial free fatty acid utilization and simultaneous enhancement of myocardial carbohydrate utilization. Myocardial substrate availability may be an important determinant of myocardial oxygen demand in patients with coronary artery disease. Infusion of glucose-insulin-potassium solution has the potential to alter myocardial substrate availability, thus improving the balance between myocardial oxygen demand and supply.


Echocardiographic diagnosis of a mobile, pedunculated tumor in the left ventricular cavity.

A mobile left ventricular tumor was detected by echocardiography. The tracing showed a cluster of echoes in the left ventricular cavity corresponding to the location of the tumor as seen in angiograms. At surgery the tumor was attached to the interventricular septum by a thin fibrous stalk.


Constrictive pericarditis in procainamide-induced lupus erythematosus syndrome.

A rare case of constrictive pericarditis in procainamide-induced lupus erythematosus syndrome is reported. After 6 months of procainamids therapy fever, pleuritic chest pain, arthralgia and muscle soreness developed in a 47 year old man. These symptoms were soon followed by the onset of acute pericarditis and rapidly accumulating massive pericardial effusion. After withdrawal of procainamide therapy and administration of corticosteroids in large doses, there was marked subjective improvement and rapid reduction in pericardial effusion. However, constrictive pericarditis with massive leg edema and ascites developed 6 weeks after admission as corticosteroid therapy was gradually discontinued. These manifestations subsided after pericardiectomy was performed.


Correlative microscopy of enamel prism orientation.

Both mature and developing human enamel were studied by correlative light and electron microscopic techniques. Ordinary light microscopic observations of routinely prepared ground sections produced a totally inaccurate impression of enamel prism direction. In contrast, ground sections which were acid-etched and viewed with phase contrast optics, as well as thin (0.5 mum) sections, were in concert with further electron microscopic preparations. The appearance of longitudinally sectioned prisms as demonstrated on thick ground sections is often the result of structural interrelation between groups of obliquely sectioned prisms. The arrangement between enamel prism heads and tails is often such as to produce the light microscopic appearance of classical enamel cross striations. The production of such optical artifacts may be related to conflicting interpretations concerning enamel cross striations as well as light microscopic descriptions of the histopathology of enamel caries.


Intercellular relationships in the external glial limiting membrane of the neocortex of the cat and rat.

The external glial limiting membrane of the cerebral cortex appears to be a complete astrocytic mantle covering the pial surface of the molecular layer. It consists of flattened cell bodies arranged singly or in small groups spaced about 100 mu apart and multitudes of interdigitating processes arrayed in layers. The glial mantle is thicker in the sulci than on the gyri. It is covered externally by a basal lamina which is associated with collagenous fibrils and cells of the pia mater. The extracellular space in aldehyde-perfused material appears as a regular, electron-lucent interval 150 A wide between adjacent cell membranes. Gap junctions are frequently encountered in the external glial limiting membrane; desmosomes are present between astrocytic processes but are seen much less often.


Patterns of mitosis in hamster epidermis.

Alignment of the flattened keratinizing cells of the upper strata of mammalian epidermis leads to the formation of columnar units of structure. In mouse epidermis, mitoses have been found to occur relatively infrequently in the region beneath the center of each cell column where a non-keratinocyte dendritic cell, usually with freatures typical of an epidermal Langerhans cell, is situated. The observed pattern of mitosis could therefore be due either to displacement of central keratinocytes by Langerhans cells or indicate some control of keratinocyte proliferation related either to the Langerhans cells or to the over-lying cell columns. No relationship exists between the position of Langerhans cells and epidermal cell columns in hamster epidermis but measurement of the position of mitosis has shown a reduced frequency of occurrence of mitosis beneath the central region. This pattern of mitosis is therefore unrelated to Langerhans cells and appears to reflect differences in the mitotic potential of basal keratinocytes which could be associated with feedback from the overlying cell columns or with an intrinsic pattern of basal cell activity.


The cytochemical localization of adenyl cyclase activity in rat sublingual gland.

Adenyl cyclase activity in mucous acinar cells and serous demilune cells of the rat sublingual gland was localized cytochemically. After incubation with adenylyl-imidodiphosphate (AMP-PNP) as substrate, deposits of reaction product are found along the cell membranes  bordering the secretory surfaces of serous demilune cells. These are the membranes which participate directly in secretion by fusing with the granule membranes. The granule membranes of the demilune cells do not reveal reaction product, but the membranes of the granules which are fused with and become part of the cell membrane do show deposits. Thus, it appears that the cell membranes which fuse with granule membranes during secretion are associated with a high level of adenyl cyclase activity. In support of this, the luminal membranes of the mucous acinar cells which do not fuse with granule membranes during secretion are not associated with detectable amounts of adenyl cyclase activity.


Light, fluorescence and electron microscopic studies of rabbit subclavian glomera.

The subclavian glomera (aortic bodies) of young New Zealand white rabbits were studied with the light, fluorescence, and electron microscopes. Two cell types were identified: type I, granule-containing (chief) cells, and type II, agranular (sustentacular) cells. The type I cells possessed large nuclei, the normal complement of cytoplasmic organelles and numerous electron-opaque cytoplasmic granules. The type II cells were agranular with attenuated cytoplasmic processes which partially or completely ensheathed the type I cells. The glomera were well vascularized. Capillary endothelial cells contained numerous pinocytotic vesicles, but few fenestrae. Two profiles of nerve terminals were observed. One, apposing the type I cells, contained numerous electron-lucent vesicles, several dense-cored vesicles, mitochondria and possessed membrane specializations resembling those usually observed in synaptic zones. The other profile contained abundant mitochondria and a few electron-lucent and dense-cored vesicles. Structural specializations were not observed on the apposed membranes of these terminals or adjacent to type II cells. Fluorescence histochemistry revealed an intense yellow-green fluorescence in the glomera, which indicated the presence of biogenic amines, possibly primary catecholamines or an indolamine. The electron-opaque granules observed in the type I cells were believed to be the storage sites for these amines. The subclavian glomera were found to be morphologically similar to the carotid body which is a known chemoreceptor.


An electron microscopic study on the effects of reserpine on the subclavian glomera of the rabbit.

Young male and female New Zealand white rabbits were given a daily subcutaneous injection of reserpine (Serpasil, Ciba; 3 mg/kg) for two days and were sacrificed 24 hours after the last injection. The subclavian glomera (aortic bodies) were processed for electron microscopy to determine the effects of this biogenic amine depleting agent on the electron-opaque cytoplasmic granules of the parenchymal type I cells. Observations of glutaraldehyde-osmium tetroxide fixed glomera from reserpinized animals showed a slight decrease in granule density of the type I cells. Glomera fixed in glutaraldehyde and incubated in potassium dichromate (pH 4.1) demonstrated a reduction in granule opacity following reserpine treatment. Control glomera incubated in potassium dichromate displayed electron-opaque granules. These results indicate that reserpine does deplete the amines without granule disappearance or changes in granule population. The positive reaction of the control tissue granules to potassium dichromate incubation suggests that the predominant biogenic amines in the electron-opaque granules are unsubstituted monoamines. Persistence of the opaque granules following reserpinization and glutaraldehyde-osmium tetroxide double fixation, may be due to amine-binding protein within the granules. The mode of granule depletion could not be ascertained with certainty.


Distribution of 125I-labeled rat growth hormone in regional brain areas and peripheral tissue of the rat.

The uptake of intraperitoneally injected 125I-labeled rat growth hormone into brain and peripheral tissues was measured in normal and hypophysectomized adult rats. A significant level of radioactivity was observed in the seven brain regions examined -- the telencephalon, diencephalon, midbrain, pons-medulla, cerebellum, pineal and pituitary glands. The pineal and pituitary glands, which are outside the blood-brain barrier, contained three to four times the concentration of radioactivity of the other brain regions. Compared to brain, the level of radioactivity was much higher in peripheral tissues (the diaphragm, kidney, serum and liver). For example, the serum contained ten times the level of radioactivity of most brain regions. For a given tissue, however, the normal and hypophysectomized rats showed a comparable amount of 125I-growth hormone. Trichloroacetic acid precipitates from each tissue sample showed that peripheral tissues had a higher proportion of radioactivity (35-48% of total tissue radioactivity) than the brain samples (13-26%). The data support the view that growth hormone, or a metabolite can enter the central nervous system and may directly affect on-going metabolic processes.


The two to four-cell embryos as source tissue of the tetrapeptide preventing ovulations in the hamster.

A tetrapeptide compound, derived from oviductal contents at 40 hours post-coitus, prevents ovulation when injected subcutaneously into cyclic hamsters (Kent, '73). The present experiments were designed to determine whether the source of the tetrapeptide is from the ova, embryos, oviducts or semen. Oviducts were either untouched or ligated at the ovarian or uterine end to limit contents to embryos, semen or ova and the contents then recovered at 40 hours pc and injected into cyclic hamsters. The results indicate that the source of the tetrapeptide is the embryos.


Anti-horseradish peroxidase associated with tubular structures in the endoplasmic reticulum of plasma cells in stimulated lymph nodes of mice.

Tubular structures are described in dilated cisternae of the endoplasmic reticulum in plasma cells of lymph nodes stimulated with horseradish peroxidase (HRP). A positive reaction for anti-HRP antibody suggests that they are formed of immunoglobulins or are at least closely associated with them.


Immunocytochemical localization of somatostatin in cell bodies of the rat hypothalamus.

Cell bodies of small to moderate-sized neurons in the female rat hypothalamus were stained specifically for somatostatin (SRIF) by means of the unlabeled antibody-peroxidase-antiperoxidase immunocytochemical method. SRIF-positive perikarya were scattered throughout the periventricular nucleus in a limited region extending from the middle of the optic chiasm to the rostral margin of the median eminence. The same neurons were revealed with either rabbit (R) or guinea pig (GP) anti-SRIF antisera. Positive cell bodies were more readily assessed with GP antibodies because nonspecific background staining was much less with these than with R anti-SRIF. Positive perikarya were not observed in other hypothalamic nuclei and ependymal elements were also immunocytochemically negative.


The effects of anesthetics on an in-vivo oxygen electrode.

The IBC in-vivo oxygen electrode may be used during anesthesia. The possibility that three common inhalation anesthetics--halothane, enflurane, and methoxyflurane--might be reduced at the electrode, thereby changing the PO2 value, was tested. Enflurane and methoxyflurane do not affect the current produced at the electrode; halothane significantly increases PO2 readings at oxygen tensions below 105 torr. It is suggested that PaO2 readings below 105 torr be confirmed by the standard bench method.


Comparison of eight kits for the diagnosis of pregnancy.

The results obtained with eight pregnancy kits on 735 urines were compared. Overall accuracies were similar and fairly high (93.4 to 95.37%), although only 78.28% of all pregnancies were simultaneously detected by all eight kits. It is suggested that the different performances of each kit could be accounted for not only by lack of product homologation, differences in kit sensitivity, and laboratorian error, but also by the presence of various hormonal components in various concentrations in the urines of pregnant women, and by the presence of different antibodies against these hormonal components in various concentrations in the antisera included in the various kits.


Prompt regression of cystic vaginal adenosis following cessation of oral contraceptive therapy.

Cystic vaginal adenosis was diagnosed in a 31-year-old woman. This lesion regressed promptly following the cessation of an oral contraceptive (Ovulen-21) which had been used continuously for 5 years. The temporal relationship between discontinuation of contraceptive treatment and the regression strongly suggests that the medication played a causal role in producing cystic vaginal adenosis. A possible mechanism may have been the stimulation of quiescent glands to growth and cystic dilatation, which finally produced a lesion associated with clinical symptoms.


Detection of fibrin degradation products. A simplified technic.

An agglutination inhibition technic using CrCl3-treated erythrocytes for the quantification of circulating fibrin degradation products in patients with thromboembolic and fibrinolytic states is described.


Hemalog-D and manual differential leukocyte counts. A laboratory comparison of results obtained with blood of hospitalized patients.

A clinical comparison of a new automated cytochemical leukocyte differential analyzer with standard 200-cell manual differential counts showed good agreement. The new apparatus (Hemalog-D) introduces a rapid, precise technic for the differentiation of peripheral-blood leukocytes.


Leukocyte migration test in a modified agarose medium.

The medium used for the leukocyte migration test contained 1% agarose, 0.003 M HEPES, TC medium 199, and 10% horse serum. The pH was adjusted to 7.3 with 2 N NaOH. The leukocyte migration test in this medium correlated with the intradermal test in 36 subjects when PPD was used as antigen, and the results were comparable to those of the reference technic. Addition of HEPES to the original medium enables the test to be performed in a standard incubator.


Postpneumonectomy empyema due to Neisseria mucosa.

N. mucosa, a normal inhabitant of the oropharynx, rarely causes serious infection. We report a case of empyema caused by N. mucosa which was diagnosed a year after pneumonectomy.


Bacteremia due to Succinivibrio dextrinosolvens. Report of a case.

An unusual case report of a patient with bacteremia due to Succinivibrio dextrinosolvens is presented. Heretofore, Succinivibrio spp. were thought to occur only as organisms in the rumens of herbivorous animals. Succinivibrio is an anaerobic, Gram-negative, curved, spiral bacillus with a polar monotrichous flagellar pattern. Volatile acids produced from glucose metabolism include succinic, acetic, formic and lactic. Various carbohydrate substrates are fermented to produce strong or weak acid end-points. Succinivibrio spp. will grow in bile, will not hydrolyze esculin or starch, and do not produce indol, catalase, lecithinase, lipase, or hemolysis. Bacteremia in this case was thought to have been the result of hypotension in the course of severe gastrointestinal hemorrhage. This is thought to represent the first published case of human infection due to Succinivibrio spp.


Mycotic granuloma caused by Phialophora repens.

This is the first reported infection by the saprophytic fungus, Phialophora repens. The infection was a solitary granulomatous nodule in the scalp of a Zaïrian man with advanced lepromatous leprosy. The patient was being treated by long-term prednisolone therapy. In tissue sections there were nonpigmented microcolonies composed of irregularly branched septate hyphae. A darkly pigmented fungus was isolated on Sabouraud's medium. The mycologic features of the etiologic agent were typical of P. repens. The infection was treated successfully by excision of the nodule.


Localized deposition of calcium oxalate around a pulmonary Aspergillus niger fungus ball.

A case of pulmonary Aspergillus niger fungus ball is presented. Crystals of calcium oxalate, presumably derived from oxalic acid produced by the fungus, were deposited in tissues around the fungus ball. The crystals were identified by x-ray diffraction analysis. Histochemical technics for the identification of calcium oxalate were applied, and evaluation of those showed Yasue's silver nitrate-rubeanic acid method to be the most satisfactory. More frequently used methods for identifying calcium salts in tissues may give equivocal reactions. Oxalic acid may cause localized tissue damage, and if this affects blood vessels severe hemorrhage may follow.


Hepatitis B antigen in infants born to mothers with chronic hepatitis B antigenemia in Taiwan.

Hepatitis B antigen (HB Ag) was detected by complement fixation (CF) in serum samples of 7.5% of 1,106 pregnant Chinese women tested in Taipei, Taiwan. HG Ag persisted in all but one of 42 women followed for 1 to 18 months (average, nine months) after delivery, and 27 of the 43 infants (63%) born to those women became antigen-positive. Persistance of the antigen was more common than transient or intermittent antigenemia. Twelve had antigenemia when first tested, while 15 later developed antigenemia, usually during the first six months of life. Only one infant developed antibody to HG Ag (anti-HB Ag), and this occurred after transient antigenemia. The HB Ag was found in two of 32 (6%) fathers, and in 18 of 27 (67%) older siblings. The antigen was more common among siblings of antigen-positive than among those of antigen-negative infants. These findings demonstrate that in Taiwan, infants born to mothers who are asymptomatic carriers of HB Ag commonly become infected by heaptitis B (HB) virus. Exposure of infants near the time of birth may be important maintaining the high, chronic HB Ag carrier rate in Taiwan.


A review of pediatric inpatient care.

Between 101 and 188 medical records of children hospitalized in each of three community hospitals and one major teaching hospital were examined to determine need for admission and quality of care administered. Two of the hospitals had been similarily studied two years before. Twenty-five percent of all admissions and 17% of all patient days were considered unnecessary. The smallest number of inappropriate admissions was found in the major teaching institution, but one of the community hospitals without any teaching affiliation was notably better than the other two. The teaching hospital and the same community hospital also achieved the lowest questionable management rates. Significant (P less than 0.5) but minimal reduction had occurred in number of unnecessary admissions when first and second utilization studies in these two hospitals were compared.


Aspirin hepatitis.

Adverse reactions to aspirin, a potentially hepatotoxic drug, are believed to be dose related. This article reviews the medical literature and described two children with aspirin hepatitis. Hepatic dysfunction recurred in one of these patients at salicylate concentrations in serum previously considered nontoxic.


Aneurysm of the posterior inferior cerebellar artery of a 5-year-old girl.

A case of a congenital aneurysm located on the left posterior inferior cerebellar artery, which ruptured producing subarachnoid hemorrhage and death in a 5-year-old girl, is presented. The very low incidence of congenital aneurysms in young children and the relatively rare occurrence of aneurysms of the vertebral-basilar system are two additional unusual features of this case.


The Ask-Upmark kidney. Roentgenographic and pathological features.

The Ask-Upmark kidney represents an unusual manifestation of a segmental hypoplastic kidney in which the lesion may be local or diffuse, and may involve one or both kidneys. It is almost always associated with hypertension and is, therefore, potentially curable when localized to a single kidney. It is imperative to recognize this disease in order to distinguish it from other entities that cause hypertension.


Streptococcal osteomyelitis and arthritis in a neonate.

A 42-day-old female infant had neonatal pyogenic arthritis and osteomyelitis due to an unusual combination of streptococcal organisms. Group B streptococci produced an osteolytic lesion in the proximal end of the humerus and suppurative arthritis of the corresponding shoulder. An enterococcus was responsible for the occurrence of arthritis and subluxation of the hip.


The role of urinary indican as a predictor of bacterial colonization in the human jejunum.

To evaluate the role of urinary indican excretion and several common absorptive tests as predictors of bacterial colonization in the human jejunum, we analyzed the relationship between indican excretion and quantitative jejunal cultures, tryptophan absorption, enteric protein loss, fecal nitrogen excretion, D-xylose and lactose tolerance tests, and B12 and fat absorption in 40 subjects. Indican excretion correlated poorly with jejunal colony counts (r = 0.22). Neither tryptophan load or absorption, nor nitrogen excretion were related to indicanuria, but there was a modest correlation between enteric protein loss and urinary indican values (r = 0.54). Lactose tolerance tests and D-xylose, B12 and fat absorption showed no predictive value for identifying patients with high colony counts. Compared to quantitative small bowel culture, none of the tests studied provided suitable methods for screening for bacterial contamination of the human jejunum.


Pancreatic excretion of 5, 5-dimethyl-2, 4-oxazolidinedione in normal subjects.

Pancreatic excretion of 5,5-dimethyl-2,4-oxazolidinedione (DMO) was studied in 25 normal subjects using the technique of the traditional pancreatic secretory test. The pancreozymin-secretin test was performed 4 days after the oral administration of trimethadione (3,5,5-trimethyl-2,4-oxazolidinedione, the precursor of DMO) for 3 consecutive days. When a dose of 1 unit/kg of pancreozymin was administered intravenously, both DMO concentration and output of a 10-min fractional specimen were rapidly increased and then decreased gradually. When a dose of 1 unit/kg of secretin was injected 30 min after pancreozymin, DMO concentration in duodenal aspirate showed no significant alteration, while DMO output of the aspirate was remarkably increased and then diminished in parallel to flow rate. DMO concentration in plasma varied widely from subject to subject, but was fairly constant during the course of the test in the same subject. Total DMO output in the postpancreozymin 30-min and postsecretin 60-min periods was linearly related to plasma DMO concentration. The output of DMO, when expressed as the output at a level of 10 mg/100 ml of plasma DMO, was linearly related to secretory volume and bicarbonate and amylase outputs in the postsecretin period. These results led to the conclusion that the human pancreas was capable of excreting a week organic acid of DMO with a molecular weight of 129.1 and that the excretion of DMO in normal subjects was a funciton of two factors: plasma DMO concentration and pancreatic secretory volume.


Pancreatic excretion of 5,5-dimethyl-2,4-oxazolidinedione in patients with chronic pancreatitis.

Abnormal pancreatic excretion of 5,5-dimethyl-2,4-oxazolidinedione (DMO) was demonstrated in 44 patients with chronic pancreatitis (14 with calcification and 30 without calcification). Pancreatic excretion of DMO in patients with chronic pancreatitis, as well as in normal subjects, depended on plasma DMO concentration and secretory volume. In the postsecretin 60-min period, almost all patients showed a decrease in total DMO output of duodenal aspirate over the observed range of plasma DMO concentration. More than half the patients without calcification gave a discordant pattern between the DMO output and volume, ie, decreased DMO output with normal volume secretion, while most of patients with calcification had low DMO output with decreased volume flow. The data of the pancreozymin-secretin test suggested that chornic pancreatic inflammation was moderate or minimal in patients without calcification and far advanced in those with calcification. From these results the hypothesis was advanced that DMO diffusion into the pancreatic ducts might be primarily impaired in the relatively early stage of chronic pancreatitis, and as the inflammation progressed to the final stage, DMO outflow from the ducts to the duodenum would be disturbed with evolving diffusion impairment of the compound. Total DMO output, when expressed as the output at a level of 10 mg/100 ml of plasma DMO (standard DMO output), was significantly reduced in chronic pancreatitis during a 60-min period after secretin stimulation. DMO in duodenal content, when expressed in terms of maximal concentration ratio of duodenal juice/plasma for the compound (maximal J/P ratio), was significantly low in chronic pancreatitis during the last 40-min period after secretin stimulation. These two parameters can therefore be used as indices of pancreatic excretion of DMO. The present technique may well become an effective diagnostic tool for early detection of chronic pancreatitis.


Electrical activity of the ovine jejunum and changes due to disturbances.

Spike potential activity of the jejunum was recorded from chronically implanted electrodes in conscious sheep. The activity was summed at 20-sec intervals before, during, and after induction of diarrhea, small-bowel obstruction, and after nerve section. Sheep on a normal diet regimen exhibited migrating myoelectric complexes at a frequency of 18/24 hr. These complexes displayed irregular and regular activities which occupied 67% of the recording time. A common pattern observed during the manipulations was disorganization of the motor profile. The normal pattern was replaced by continuous spiking activity followed in many cases by total quiescence. After vagotomy the complexes still occurred but the duration of irregular spiking activity was decreased. These experiments suggest that the migrating myoelectric complex acts as a regulating factor and suggests that the ratio of irregular to regular activity is dependent on the influence of extrinsic nerves.


Electrical activity and intraluminal pressures in the lower small intestine of turkeys.

To study ileal motility, 14 young turkeys were surgically prepared with a fistula and 3 bipolar Ag/AgCl electrodes in the ileum. Electric slow waves were recorded which averaged 0.45 mV in amplitude and 6.1 waves/min in frequency. They seldom waned, had no wave-form characteristic of a particular region of the ileum, and action-potential bursts did not occur at a particular phase of the slow wave. Action potentials, associated with contractions, averaged 0.21 mV in amplitude. An average of 4.0 pressure changes occurrd per minute and their amplitude averaged 16.2 mm Hg. Slow waves apparently were the primary regulators of ileal motility, although another type of activity may also have been involved. The latter activity consisted of intensive action-potential activity associated with high-frequency, high-amplitude contractile activity which appeared to move periodically aborally down the ileum.


Gastroduodenal electrical activity in turkeys.

Bipolar Ag/AgCl electrodes were implanted in the stomach and duodenum of 21 turkeys to study electrical activity in those organs. Intraluminal pressure changes were also monitored. For comparative purposes, electric slow waves were recorded from the stomach of turkeys. Although slow waves were recorded from the duodenum of turkeys, the waves were observed to wax and wane and were possibly not the major regulators of duodenal contractile activity. Several bursts of action potentials and several contractions usually occurred in the duodenum during one slow-wave cycle. Duodenal motility appeared to be totally coordinated with the gastric cycle. Impulses conducted over intrinsic nerves from a gastric pacemaker (15) were proposed as a possible mechanism for initiating and coordinating gastroduodenal motor activity.


Measurement of gastric emptying time--a comparative study between nonisotopic aspiration method and new radioisotopic technique.

A comparative study between modified conventional saline load test and the more recently introduced radioisotopic method was run in 8 normal volunteers. Each subject underwent at least three studies by each of the two methods: (1) aspiration method of Goldstein and Boyle incorporating our modification, and (2) an isotopic method employing a gamma camera with a computer. A liquid meal of isotonic saline was used with or without (997) MTc-DTPA. The results indicated that the gastric emptying T 1/2 (8.8 +/- 3.5 min) obtained by saline load test was shorter than that obtained by isotopic method (12 +/- 3 min). This discrepancy was most likely due to inherent error (incomplete aspiration of the gastric fluid) in the former method giving rise to a false faster emptying time. Moreover, the variations in T 1/2 value in the same individual was much more in the aspiration method than it was in the isotopic method.


Complication of prolonged intestinal intubation: gaseous distention of the terminal balloon.

A patient with regional enteritis was treated with a Cantor tube for relief of intestinal obstruction. Gaseous distention of the terminal balloon of the tube occurred necessitating removal by laparotomy and enterostomy. This rare complication is reviewed and discussed with special reference to etiology and prevention. The relationship of this complication to prolonged intubation is emphasized.


Cystic lymphangiomyoma of the colon causing protein-losing enteropathy.

This report documents a case of cystic lymphangiomyoma of the sigmoid colon in a 35-year-old woman who presented with symptoms of a protein-losing enteropathy. This case was unique in that it involved not only the colonic wall and mesentery but also extended into the retroperitoneum. Surgical excision of the affected segment has resulted in reversal of hypoproteinaemia and return to normal of the excessive faecal loss of 51Cr-labeled protein over a 2-year follow-up period.


Pancreatic ascites: diagnostic importance of ascitic lipase.

10 cases of pancreatic ascites are presented. Ascitic fluid lipase is complementary to the determination of ascitic amylase in the diagnosis of pancreatic ascites and may be a more reliable diagnostic indicator of pancreatic ascites on a random ascitic fluid sample. Conservative management, consisting of abdominal paracentesis with or without diurectics, proved to be the treatment of choice in 3 of our patients who failed to reveal an associated pseudocyst.


Mallory-Weiss syndrome in perspective.

Nineteen patients with the Mallory-Weiss lesion diagnosed by panendoscopy are presented. This represents 10.5% of 180 acute upper-gastrointestinal bleeders. Only 36.8% of these 19 patients had a history of heavy ethanol intake and 26% had hiatus hernias. In addition to the Mallory-Weiss lesion, abnormalities in 63% were noted on endoscopy. None of the patients required surgery for control of the bleeding. Two patients were treated with selective arterial-vasopressin infusion. The importance of a high index of suspicion for this lesion in spite of the lack of a classical alcoholic or recurrent retching history and the value of intensive medical therapy, including early panendoscopy, is emphasized.


Pancreatic ascites. A case report and review of the literature.

A case of pancreatic ascites is reported and compared with 55 previously reported cases. A 42-year-old black male chronic alcoholic presenting with abdominal pain was found at operation to have chronic pancreatitis with no pseudocyst formation or overt duct disruption, in contrast to the majority of cases reported. The diagnosis and differentiation from cirrhosis of the liver were based on the operative findings, elevated serum amylase level, ascitic fluid amylase value, and protein content. Surgical exploration alone has proven beneficial--the patient has done well in the past 2 years with no recurrence of the ascites and continued weight gain. The clinical course was compatible with pancreatitis although the radiographic and angiographic studies were not diagnostic. It is suggested that the clinical entity of pancreatic ascites occurs more often than reported and a workup for it should be done even in the face of unconvincing radiographic and angiographic evidence.


Reye's syndrome in an adult.

Reye's syndrome (fatty infiltration of the liver with encephalopathy) is an uncommon disease of children and has not previously been noted in adult patients. We present a 25-year-old male who survived this syndrome after presenting a stuporous state. Etiologic and pathophysiologic mechanisms are considered.


Endoscopic, radiologic and manometric correlation in small sliding hiatal hernia.

Of the three methods employed, endoscopy seems to be the most accurate since it permits identification of both anatomical structures and serves as a basis for interpretation of radiology and manometry. Cardial incisura was the easiest and most constantly identifiable structure by the three methods. It must be considered as the union between esophagus and stomach. In small sliding hiatal hernia, the cardial incisura remains below the diaphragm and the gastric mucosa slides up into the chest, resulting in a partial prolapse (hiatal hernia of sliding mucosa). This concept would clarify the difference in interpretation of the most commonly used procedures in diagnosis of sliding hiatal hernia.


Radiographic and endoscopic features of colonic ulcers in systemic lupus erythematosus.

The radiographic and endoscopic features of the colonic ulcers during the course of a case of systemic lupus erythematosus are illustrated. Barium enema revealed the "collar button" type of penetrating ulcers in the left half of the colon and endoscopy demonstrated multiple round- or oval-shaped discrete ulcers, so-called "punched-out" ulcers with pale mucosa. These findings are compared with those of the reported cases of systemic lupus erythematosus and ulcerative colitis. Steroid and 6-mercaptopurine therapy was effective in this case.


Pentagastrin-stimulated gastric acid secretion in acute and chronic gastritis. Histological and secretory correlations.

Basal and pentagastrin-stimulated gastric acid secretion were determined in 122 patients with various types of gastritis and in 20 control subjects. All the gastritis patients and the control subjects were adult Chinese. The histological diagnosis was based on gastric biopsy specimens obtained through a fibergastroscope. Statistical analysis of the results in the various histological groups of gastritis and controls indicated that chronic superficial gastritis and chronic atrophic gastritis are not associated with reduced gastric acid secretion in Chinese subjects. In addition, analysis of combinations of the groups of patients with various types of gastritis showed no significant difference in the mean basal acid output but the mean peak acid output of patients with chronic gastritis was significantly higher than that of patients with chronic atrophic gastritis.


Crohn's disease of the colon. V. Retroperitoneal lumbocrural abscess in Crohn's disease involving the colon.

Retroperitoneal lumbocrural abscess occurred in 12 patients of 231 with Crohn's colitis or ileocolitis. Although all patients with this complication fell within the group of 175 ileocolitis patients, at least four originated in fistulous tracts of the colon. Eleven of the 12 abscesses developed spontaneously as the first major complication of the disease. The prominent clinical features included pain radiating down the thigh, hip joint flexion, difficulty in walking, hydronephrosis and hydroureter. Internal and external fistulas were significantly more common in the abscess group of 12 patients than in the 219 patients without retroperitoneal abscess. Radiological evidence of granulomatous disease was found in all patients; fistulous tract formation was characteristic and the development of extraperitoneal gas bubbles, in four patients, pathognomonic of abscess with gast-forming organisms. In the presence of established retroperitoneal abscess, the surgical sequence suggested is drainage synchronous with, or followed by diversion and ultimately definitive resection. Resection with anastomosis should not be carried out in the presence of an acute inflammatory process with frank abscess or free pus communicating with the peritoneal cavity. The spontaneous development of retroperitoneal abscess is a serious development in the natural history of Crohn's (ileo) colitis. It frequently heralds the first of a series of operative procedures to deal with the abscess. It sequels are enterocutaneous fistulas and further extension of the disease process.


Deficiency of secretory Ig-A and intestinal malabsorption.

A patient under treatment with hemodialysis suffered increasing clinical and laboratory evidence of intestinal malabsorption. Jejunal aspirates revealed heavy bacterial and mycotic flora within the proximal jejunum. Secretory Ig-A and secretory component were present only in trace amounts. The deficiency of the generally ubiquitous secretory component is particularaly striking. Oral administration of 20-30 ml. colostrum daily reversed not only the clinical evidence but also laboratory findings of intestinal malabsorption.


Postgastrectomy bezoars.

Sixteen cases of postgastrectomy bezoars were diagnosed and treated in the period of five years. Various mechanisms of their information, symptomatology and therapy are discussed. We believe postgastrectomy bezoars are relatively frequent but often missed entities. Considering the relative frequency of this entity and ease of therapy, this condition should not be missed if one is aware of its existence.


The radiology corner. Malignant melanoma of the gallbladder.

An unusual case of melanoma of the gallbladder is reported. It is the fourth reported case with roentgenographic demonstration. It presented clinically as cholecystitis and radiologically as a larger solitary defect within the gallbladder accompanied by cholelithiasis. It is probably a metastatic deposit although no other metastases were demonstrated.


Epidemiology of lumbar disc lesions in the military in World War II.

A study was carried out in 1095 first Army hospital admissions for lumbar herniation of the nucleus pulposus (HNP) who were individually matched on age and period of service during World War II to holders of Army National Service Life Insurance policies. For both the cases and the comparison group, data were obtained from military records, particularly records of induction into service. Factors showing a statistically significant positive association (p less than 0.05) with admission for HNP in the entire sample and also among enlisted cases matched to enlisted members of the comparison group were: occupation of craftsman or foreman, married status, rural residence, excess height, excess weight, heavy frame, good posture, defects relating to back or legs, military occupation specialty of ground combat, and rank of sergeant or staff sergeant. Factors showing a negative association with admission for HNP in these same groups were: clerical occupation, two or more battle stars earned and officer rank. Essentially the same relationships were found among cases with surgically confirmed diagnoses of HNP, less than 30 years old at hospital admission, and with recent onset of symptoms, when the cases in these groups were compared with their matches in the comparison group. Mechanical factors related to body build as evaluated by height and weight measurements appear to be of significance in the etiology of HNP. Occupational factors also appear to be of importance. Some cases and some controls were hospitalized prior to the first hospital admission of the case for a disease possibly related to HNP. For that time period there were no remarkable differences between cases and controls in service hospital diagnoses, including those of trauma.


A controlled prospective study of the effect of endurance training on the recurrence rate of myocardial infarction. A description of the experimental design.

A multicenter prospective study has been designed to determine whether participation in an exercise program which produces a significant training effect will affect the recurrence rate in men who have survived an initial myocardial infarction. The control group consists of subjects who participate in a program involving low intensity activities designed to avoid a significant training effect. The subjects will be followed for a period of 4 years and a reduction of 50 per cent in the risk of recurrence will be considered clinically significant. The criteria for entry, the method of allocation, the structure of the exercise program and method of assessing cardiorespiratory fitness are described.


Some childhood antecedents of drug and alcohol abuse.

Unsatisfactory intrafamilial relationships and child-rearing practices have frequently been implicated as prime determinants of personalities that are susceptible to drug and alcohol abuse. Five thousand forty-four US Army soldiers were surveyed by anonymous questionnaires. The reported occurrence of a variety of activities, events and behaviors in childhood among drug and alcohol abusers were compared to non users. Childhood antecedents that were associated with non-use of illegal drugs and which showed as much as a 20% difference in reported occurrence between abusers and non-users of illegal drugs were: spanking, church attendance, first alcoholic drink after 15 years, and perceived "happy" parental marriage. These associations were found uithin white and non-white groups and in subjects with divorced or separated parents. There was no antecedent that showed as much as a 20% difference in reported occurrence between alcohol abusers and non-users.


Toxoplasma gondii and Coxiella burneti antibodies among Brazilian slaughterhouse employees.

Previous studies have indicated toxoplasmosis and Q fever are potential hazards to persons who handle raw meat or who work in slaughterhouses. The prevalence of antibodies to T. gondii and C. burneti was studied among 144 employees of an abattoir in Belo Horizonte, Brazil, to determine what environmental factors may be associated with the occurrence of these agents among persons who handle meat but who have not reported having toxoplasmosis or Q fever. Seventy-two per cent of the 144 employees were serologically positive to T. gondii and 29% were serologically positive for C. burneti. The highest prevalence of antibodies to T. gondii (92%) occurred among meat inspectors, who also had a geometric mean titer (GMT) of 1400. The prevalence levels of antibodies to T. gondii for employees who handled meat in the deboning and sausage departments were 80% and 79% with GMT's of 412 and 340, respectively. These levels exceeded the antibody prevalences of 60% and 65% and GMT's of 168 and 120 for employees who worked with cattle in the corrals or who worked on the killing floor, respectively. Conversely, the prevalence of antibodies to C. burneti was highest (40%) among employees working in the corrals and who were exposed to dust and hides. A similar prevalence of antibodies to C. burneti was found in employees on the killing floor (36% positive) who were exposed to hides and viscera, but employees handling meat in the deboning or sausage section had prevalence levels of 20% and 14% respectively. Serologic testing of zebu cattle processed at the abattoir indicated that 10% of 124 tested had antibodies to T. gondii and 29% of 156 tested had antibodies to C. burneti. These levels in cattle are probably adequate to expose (and infect) persons who process meat daily. Continuous daily exposures to chronically infected cattle may result in sporadic undiagnosed illnesses or seroconversions from subclinical infections.


Undiagnosed bacterial meningitis in Vermont children.

Community-acquired bacterial meningitis in Vermont children under 5 years of age was recognized less frequently in 1967-1970 in those towns with low total hospitalization rates than in towns with hospitalization rates above 15 admissions per 100 population. Using the towns with high hospitalization rates as a norm, it was found that towns with fewer recognized meningitis cases than expected had significantly greater rates of death from obscure causes in children 1-59 months of age in 1967-1970. It is suggested that about 17 deaths in 1967-1970 in Vermont children 1-59 months of age were associated with the failure to recognize bacterial meningitis in children from towns with low rates of medical care utilization.


Oral polio vaccination of children in the tropics. II. Antibody response in relation to vaccine virus infection.

Poliovirus antibody response rates following the administration of trivalent oral polio vaccine (OPV) have been poor in several developing countries. In an attempt to determine if poor seroresponse is due to poor rates of vaccine virus "take" or due to poor serum antibody response to intestinal virus infection, both vaccine virus take and serum antibody response were determined in a group of children given two doses of OPV. In the large majority of seronegative children there was good correlation between the absence or presence of vaccine virus excretion and negative or positive seroconversion, thus showing that the poor seroconversion rates were mainly due to poor rates of vaccine virus take. However, as in several studies from developed countries showing good seroconversion rates, a few instances of antibody response in the absence of detectable virus excretion and fewer instances of virus excretion without detectable antibody response were also found.


Oral polio vaccination of children in the tropics. III. Intercurrent enterovirus infections, vaccine virus take and antibody response.

The effect of intercurrent enterovirus infections on host responses to oral polio vaccine (OPV) was studied in groups of infants and children who were without antibodies to one, two or three serotypes of poliovirus. The prevalence of enterovirus infections as detected in fecal specimens collected at weekly intervals and inoculated in primary monkey kidney cell culture, HEp 2 cells and newborn mice ranged between 60 and 70 per cent. The presence of such infections at the time of, 1 week prior to, or during the 3 weeks prior to the administration of OPV did not appear to inhibit either vaccine virus take or antibody response. However, in both the infected and uninfected children the rates of vaccine virus take and seroconversion were found to be considerably lower than those reported from several temperate climate countries.


Chromosome 3 duplication q21 leads to qter deletion p25 leads to pter syndrome in children of carriers of a pericentric inversion inv(3) (p25q21).

Close phenotypic similarity between two cases carrying a rec(3) dup q,inv(3) (p25q21), 12 additional infants from the same inv (3)(p25q21) kindred who lived less than 1 year, and eight cases studied in other medical centers has led us to postulate the existence of a distinct chromosome 3 duplication-deletion syndrome. In the presence of trisomy for (3)q21 leads to qter and monosomy for (3)p25 leads to pter, the facial dysmorphy is unique: a distorted head shape due to irregular cranial sutures, thick low eyebrows, long eyelashes, persistent lanugo, distended veins on the scalp, hypertelorism, oblique palpebral fissures, a very short nose with a broad depressed bridge and anteverted nares, protruding maxilla, thin upper lip, micrognathia, low-set ears, and a short webbed neck. Port-wine stains, congenital glaucoma, cloudy corneas, cleft palate and harelip also occur frequently. Each infant has difficulty sucking and swallowing. Congenital anomalies of the cardiovascular system, of midgut rotation, and of the urogenital system are noted for the infants who died neonatally. Most frequent is a ventricular septal defect, followed by atrial septal defect, patent ductus arteriosus, patent foramen ovale, and coarctation of the aorta. Omphalocele, umbilical hernia, hyperplastic kidneys, polycystic kidneys, double ureter, hydro-ureter, hydronephrosis, and undescended testes often occur. The extremities are short in proportion to the length of the trunk. Clinodactyly, coxa valga, talipes, and spina bifida are frequently observed.


A G gamma type of the hereditary persistence of fetal hemoglobin with beta chain production in cis.

In a new subclass of G gamma HPFH which has been detected in a black family, beta A chains are produced in cis to the HPFH determinant (the G gamma-beta+ HPFH). No other instance of beta chain production in cis to HPFH has been reported. All individuals in this family are well even if Hb S is produced in trans to HPFH. Genetically, this new subclass requires a slightly smaller deletion in the gamma, delta, and beta complex of genes than do other forms of HPFH. It is speculated that a subclass (the G gamma-(G gamma A gamma)-beta+ HPFH) in which beta S chains are produced in cis to HPFH in conjunction with true beta S genes in trans may be responsible for "mild" cases of sickle cell anemia.


A note on goodness of fit of a population to Hardy-Weinberg structure.

The test of goodness of fit of a population to Hardy-Weinberg equilibrium given by Levene [2] and Haldane [1] is valid within a widely accepted recipe for testing goodness of fit of a composite hypothesis. The nature of the result of Cannings and Edwards [3] is described. The result was shown to be quite different than they claimed and, although possible of some interest, not relevant to the testing of goodness of fit to Hardy-Weinberg structure.


Liver alcohol dehydrogenase in Japanese: high population frequency of atypical form and its possible role in alcohol sensitivity.

Electrophoretic and quantitative studies reveal that 85% of Japanese carry an atypical liver alcohol dehydrogenase (ADH). The frequency of ADH polymorphism is identical with the reported frequency of alcohol sensitivity in the Japanese population. This identity in population frequencies points to a causative relationship between the two phenomena and suggests that alcohol sensitivity might be due to the increased acetaldehyde formation in individuals carrying the atypical ADH gene.


Linkage data on MN and the Hb beta locus.

A sample of 28 informative families was studied for linkage between Hb beta and MN. Values of the neuterized recombination fraction from these and other families from the literature excluded a recombination fraction of less than .30 between these loci. Our results support different recombination values for males and females (theta equals .34 abd .50, respectively). A simple approach to estimate the sample size required as well as a study of the relationship between sibship size and sample size under conditions of loose linkage are also presented.


Renal function in gout. IV. An analysis of 524 gouty subjects including long-term follow-up studies.

Renal function studies were performed in 524 gouty subjects, including follow-up studies at intervals up to 12 years in 112 of them. In 49 subjects, the glomerular filtration rate was less than 70 ml/min and Curate:glomerular filtration rate ratio tended to rise as the glomerular filtration rate decreased, reflecting a relatively stable urate excretion over varying filtered urate loads. The increment in Tsurate:glomerular filtration rate was small with spontaneous Purate between 7 and 9 mg/100 ml. It was modest with Purate up to 10 mg/100 ml. The increment in Tsurate:glomerular filtration rate became much higher beyond Purate of 10 mg/100 ml. Urinary urate levels above 800 mug/min, designated as excess urate excretion, occurred more commonly in subjects with Purate above 9 mg/100 ml, and with better preserved renal function. Tophi were more frequently observed in subjects with low glomerular filtration rate and proteinuria; but incidence of urolithiasis seemed to be less affected by a decrease in the glomerular filtration rate. Hyperuricemia alone had no deleterious effect on renal function as evidenced by follow-up studies over periods up to 12 years. Deterioration of renal function was largely associated with aging, renal vascular disease, renal calculi with pyelonephritis or independently occurring nephropathy. In only very few instances was diminished renal function ascribable to gout alone.


Acute interstitial nephritis. A clinical and pathologic study based on renal biopsies.

To define interstitial nephritis without preselection bias, 25 consecutive renal biopsy specimens from patients with tubular damage, interstitial damage and interstitial inflammation were analyzed in detail. In four patients (all with acute renal failure), tubulitis, and interstitial eosinophil and lymphocyte infiltration were found, but no glomerular abnormalities. In four others, the findings were similar but some glomerular abnormalities were noted. Two patients had probable healed interstitial nephritis. The clinical presentation varied from transient renal insufficincy to oliguric renal failure. Three of the patients with glomerular abnormalities had significant proteinuria. When the 10 patients with interstitial nephritis were compared with the other 15 serving as controls, striking features in the former group were skin rash, eosinophilia, the absence of hypertension and the frequency of administration of penicillin and its analogs. Serum immunoglobulin E (IgE) levels were elevated in three of the patients. The striking eosinophilia, interstitial eosinophil infiltration and increased IgE levels suggest that allergen-reaginic complexes may be involved in the pathogenesis of the lesion.


Occupational lead nephropathy.

Among eight subjects suspected of excessive occupational exposure to lead, detailed examination of renal function identified abnormalities in four. Glomerular filtration rate was less than 87 ml/mim/1.73 m2 in one subject with asymptomatic renal failure, and in three subjects with preclinical renal dysfunction. In the subject with asymptomatic renal failure, chelation therapy increased the glomerular filtration rate, p-aminohippurate (PAH) extraction, the maximal PAH secretion rate (TmPAH) and improved proximal tubule ultrastructure, despite decreased renal plasma flow. This improvement in PAH transport was associated with correction of a proximal tubule defect in tritiated PAH uptake detected by section freeze-dry autoradiography of renal biopsy specimens. In three subjects, the etiologic diagnosis of lead-induced nephropathy was established by exclusion, but tubular dysfunction did not obviously exceed the reduction in blomerular filtration. Proximal tubule abnormalities were seen in each of the three patients who underwent biopsy. These studies suggest that lead nephropathy may be an important occupational hazard in the United States lead industry.


Left atrial transport function in myocardial infarction. Importance of its booster pump function.

After myocardial infarction (MI), left ventricular (LV) end-diastolic pressure (EDP) is higher than mean pulmonary artery wedge pressure because of powerful atrial contraction. To evaluate the significane of atrial contraction to left ventricular function we studied 10 control (C) patients without cardiac disease and 17 patients from three to six weeks after acute myocardial infarction. Cardiac catheterization with simultaneous left ventricular diastolic pressure (DP) and left ventricular cineangiograms were obtained. Left ventricular volumes and pressure were (mean +/- SD): (SEE ARTICLE). Although left ventricular stroke volume was lower in the patients with myocardial infarction than in the control subjects (46 versus 56 ml/m2), atrial contraction contributed more to left ventricular filling during diastole (which is the same as left ventricular stroke volume) in the patients with myocardial infarction than in the controls (16 versus 10 ml/m2). The average atrial contribution to left ventricular end-diastolic volume was 11.9 per cent (C), 15.4 per cent (MI); to left ventricular end-diastolic pressure 20 per cent (C), 38.7 per cent (MI); and to left ventricular stroke volume 21.7 per cent (C), 35.1 per cent (MI). Atrial contribution to left ventricular stroke volume was 56 per cent in patients with a cardiac index less than or equal to 2.0 liters/min/m2 and 31 per cent in those with a cardiac index greater than 2 liters/min/m2 (p less than 0.01). Atrial contraction contributed 35 per cent to left ventricular stroke volume in patients with normal end-diastolic volume and in those with increased end-diastolic volume and 10 per cent to end-diastolic volume in patients with increased end-diastolic volume (p less than 0.001). In patients with myocardial infarction, atrial contraction made a large contribution to left ventricular filling and stroke volume irrespective of the type of left ventricular functional derangement that was present. The "booster pump" function of the atrium cannot be ignored in assessing left ventricular performance.


Infections in 92 splenectomized patients with Hodgkin's disease. A clinical review.

Infections that occurrred in 92 previously untreated patients with Hodgkin's disease were reviewed from the time of laprotomy and splenectomy. Pneumonias occurred in nine patients with urinary tract infections in twelve during the immediate postoperative period. Severe bacterial infections did not occur in any patients during initial radiation therapy, adjuvant chemotherapy (stages I through IIIA), initial intensive chemotherapy (stages IIIB and IV) or during remission. Severe infections occurred in eight profoundly granulocytopenic patients with recurrent Hodgkin's disease. Streptococcus (Diplococcus) pneumoniae and Hemophilus spp infections were distinctly uncommon during the remission period. Herpes zoster, however, was very common developing in 22 of 92 (24 per cent) patients. Predisposing factors to herpes zoster included sex (female more than male), therapy (radiation plus chemotherapy more than chemotherapy alone), and age (less than 30 years of age more often than 30 to 50 years of age). Severe infection was uncommon in these patients except in ascociation with specific predisposing factors such as the immediate postoperative state of prolonged granulocytopenia associated with recurrent Hodgkin's disease or its therapy. Splenectomy per se did not affect either the incidence or the severity of infection during this period of 12+ months of observations per patient.


Unusual echographic manifestations of right and left heart myxomas.

Although echocardiography has provided a useful noninvasive means for detecting cardiac myxomas, the ultrasound manifestations of these tumors may be variable. We describe our experiences with unusual echographic features encountered in left and right heart myxomas. Thus the left atrial tumor may be manifested predominantly by multiple, discrete, linear echoes behind the mitral valve, the anterior leaflet of which may exhibit an abrupt mid-systolic posterior movement. In right heat myxomatous tumor arising from the septal tricupsid leaflet and adjacent interventricular septum, the echographic characteristics include a cloud of echoes throughout the cardiac cycle in the right ventricular outflow tract which are present in the right ventricle body only during relaxation and are anterior to the tricuspid valve in early diastole. Therefore, discrete linear echoes may be the principal echographic presentation of left atrial myxoma, and special attention should be focused on all areas of the tricuspid valve and right ventricle by ultrasound in patients in whom diagnosis of myxoma is suspected.


Multiple myeloma, cryoglobulinemia and xanthomatosis. Distinct clinical and biochemical syndromes in two patients.

Studies were carried out in two patients with multiple myeloma (immunoglobulin G, [IgG], K light chain), cryoglobulinemia and xanthomatosis with clinical features and lipid transport abnormalities which were quite different. One patient had nodular xanthomatosis and lipemia with delayed triglyceride and apolipoprotein removal. In vivo heparin resistance was present and heparin-paraprotein interaction was shown in vitro. The lipoprotein removal defect may have been due to impaired uptake of the "remnants" of glyceride-rich lipoproteins. Abnormalities were found both in primary platelet aggregation and in the platelet release reaction. The second patient had diffuse plane xanthomatosis with normal lipids. An orange cryoprecipitate contained IgG, beta- and prebeta lipoproteins, albumin, carotenoids and about half of the serumcholesterol. Triglyceride turnover was normal. These observations show that M-proteins may interfere with lipid transport by at least two mechanisms and illustrate the clinical diversity of xanthomatous myeloma.


Hypoglycemia and endogenous hyperinsulinism complicating diabetes mellitus. Application of the C-peptide assay to diagnosis and therapy.

Described here is a patient with insulin-requiring diabetes mellitus in whom spontaneous fasting hypoglycemia developed. Endogenous hyperinsulinism was considered after the systematic exclusion of other causes of hypoglycemia, and this possibility was confirmed by measurement of serum C-peptide reactivity (CPR), an indicator of beta cell secretory function. Subtotal pancreatectomy relieved the fasting hypoglycemia, and was associated with a marked decline in CPR levels. The pancreatic islets showed hyperplasia and the beta cells were degranulated.


Paradoxical glucose-induced hyperkalemia. Combined aldosterone-insulin deficiency.

Severe hyperkalemia associated with spontaneous hyperglycemia as well as with the intravenous infusions of glucose occurred in an insulin-requiring diabetic patient in the absence of potassium administration, the use of diuretics which inhibit urinary potassium excretion or acidemia. Metabolic balance studies revealed, in addition to diabets, the presence of isolated aldosterone deficiency of the hyporeninemic type. Intravenous glucose infusions (0.5 g/kg body weight) produced significant hyperkalemia but desoxycortisone acetate (DOCA) therapy (10 mg/day) prevented the glucose-induced hyperkalemia. In this patient, the serum potassium concentration increases after the intravenous infusions of glucose because there is insufficient aldosterone and insulin to reverse the transfer of potassium to the extracellular fluid which normally occurs after hypertonic infusions of glucose. Although DOCA replacement modifies the distribution of potassium in the extracellular fluid and blunts the hyperkalemic effect of intravenous infusions of glucose, a rise in the insulin level is required for the usual hypokalemic response to intravenously administered glucose. These studies illustrate the risk of raising blood glucose levels in patients with combined aldosterone and insulin deficiency and the tendency towards hyperkalemia in diabetic patients under certain clinical conditions.


Pelvic hemangiopericytoma. Report of 4 patients and review of the literature.

Review of the literature revealed 42 patients with uterine hemangiopericytoma (HPC) and nine with extrauterine tumors. Three additional patients with uterine and one with extrauterine are described. The primary treatment should be aggressive surgery, but high doses of irradiation and chemotherapy may be of benefit in extensive disease or recurrences. The prognosis of uterine HPC is better than that of the extrauterine tumors. Cells from the extrauterine tumor were grown in tissue culture. The culture consisted of two cell types resembling pericytes and endothelial cells. The cells in culture retain most of the ultrastructural characteristics of the in vivo tumor.


The lymphatic dissemination in endometrial carcinoma. A study of 188 necropsies.

To more clearly define the biologic activity of endometrial carcinoma, 188 cases selected at random were studied at necropsy. In 51 per cent of the cases death was attributed to the endometrial carcinoma. Observations demonstrate that dissemination is more scattered and less predictable than noted in cervical cancer; that the biologic potential is not invariably based on the site of the primary lesion, the depth of invasion, or the histologic differentiation. Difficulties in performing a thorough examination of the lymphatic system in this series include the increased age of the patients and a higher incidence of medical diseases and surgical procedures. The reported data illustrate the erratic natural history of the disease but do not permit the factual incidence of node or organ involvement. However, the potential viciousness of the disease is clearly demonstrated.


Antacids for obstetric patients.

The aspiration of regurgitated or vomited gastric contents is the most common cause of maternal deaths associated with anesthetics, causing an estimated 2 per cent of all maternal deaths in the United States. The incidence of aspiration is estimated to be one of every 430 patients who undergo cesarean section with general anesthesia. The pulmonary complications of aspiration are improved or avoided if the pH of the gastric contents is higher than 2.50. The oral administration of 30 c.c. of magnesium trisilicate has been shown to increase the pH of the gastric contents to above 2.50 in 100 per cent of treated patients, whereas only 60 per cent of the control group were found to have a pH above 2.50. Oral preoperative or predelivery antacid therapy may help to eliminate the morbidity and deaths secondary to aspiration and as such may be an adjuvant to, but not a substitute for, the safe management of the obstetric patient.


Expansion of intravascular volume and fetal outcome in patients with chronic hypertension and pregnancy.

Measurements of blood volume were carried out between 24 and 40 weeks of gestation in 20 multiparous patients with chronic hypertension and pregnancy. Hypertensive patients had both reduced blood volume and infants of smaller weight (p less than 0.01) than nonhypertensive control subjects. There was a significant difference (p less than 0.01) in the degree of blood volume expansion in hypertensive mothers who were delivered of infants who were adequate for gestational age (AGA), term, or premature, compared to those who were delivered of infants who were small for gestational age (SGA) or stillborn. Classification of chronic hypertension during pregnancy according to the American Committee on Maternal Welfare classification or according to severity of the hypertension was of no value in identifying the mothers at risk of delivering intrauterine growth-retarded infants. However, failure in achieving a blood volume expansion of at least 60 c.c. per kilogram clearly identified those pregnancies leading to growth retardation and fetal death. The decrease or lack of intravascular volume expansion was reflected in the presence of creatinine clearance values at nonpregnant levels in the mothers who were delivered of SGA infants and in a significant reduction below the nonpregnant levels in those who were delivered of stillborn infants. These data suggest that measurement of blood volume and endogenous creatinine clearance in patients with chronic hypertension and pregnancy is a useful parameter in the identification of those patients who will have a poor fetal outcome.


Furosemide action on the creatinine concentration of amniotic fluid.

Creatinine concentration in the amniotic fluid (A.F.) of pre-eclamptic patients without treatment with furosemide was compared to the values obtained in normal pregnant women at the same stage of gestation. These values increased significantly when a diuretic treatment was started; no correlation was found with either maternal serum level or the A.F. volume. Furosemide treatment had no significant effect on A.F. volume in the pre-eclamptic group.


Midtrimester pregnancy termination by intramuscular injection of a 15-methyl analogue of prostaglandin F2 alpha.

Fifty patients between 12 and 20 weeks' gestation were treated with prostaglandin 15 (S) 15-methyl F2 alpha by repeated intramuscular injection of 250 mug at intervals of not less than 2 hours in order to evaluate its efficacy as an abortifacient. A success rate of 96 per cent was achieved with a mean initiaation-abortion interval of 16.5 +/- S.E.M. 1.12 hours. There were no serious complications. The most common side effects were vomiting in 82 per cent and diarrhea in 66 percent of cases. The abortifacient activity was correlated with serial serum progesterone determinations and continuous intra-amniotic pressure recordings in selected cases.


Fetal risk in hyperextension of the fetal head in breech presentation.

An evaluation of the possible etiologic factors in hyperextension of the fetal head in breech presentation and a discussion of management are presented. Our seven cases plus a review of the literature led to the conclusion that hyperextension of the aftercoming head is a dangerous malpresentation that should not be underestimated. For this reason, we strongly suggest an x-ray of all breech presentations in early labor, not only to evaluate pelvic adequacy but also to determine the attitude of the head. In persistent hyperextension, cesarean section is the management of choice.


Activity of alkaline RNase in placentas of malnourished women.

Pregnancies were compared in 18 Ecuadorian women of low socioeconomic status and 11 of high socioeconomic status. Objective evidence of malnutrition was demonstrable in virtually all of the women from the low socioeconomic group and in none from the high socioeconomic group. Birth weight and placental weight were significantly lower in the malnourished group. Nucleic acid and protein content of placentas were slightly lower and activity of alkaline ribonuclease was markedly elevated. The data reinforce animal studies and demonstrate for the first time in human subjects that alkaline RNase activity is increased in placentas from malnourished women. We suggest that activity of this enzyme in placenta may prove to be a useful marker of maternal and fetal nutritional status.


Influence of ionizing radiation on fetoplacental growth in mice.

The effects of single doses of 60Co whole-body irradiation were studied in about 600 inbred primiparous Swiss-Webster mice on gestational day 9, 10, 11, or 12. The embryos and their placentas were weighted from day 13 to 18. A reference model surveyed the response of the conceptus to varying doses. A significant reduction in the fetal wet weight was observed as follows: day 9, 150-175 r.; day 10, 125-150 r.; day 11, 75-175 r.; day 12, 125-450 r. Beyond the upper-limit doses, a high mortality rate was detected, i.e., 64.5 per cent on day 10 at 175 r. and 63 per cent on day 11 at 200 r. The rapid growth period of the placenta extended from day 13 to 15. By this latter stage it had practically reached its maximum development. The placental index decreased progressively from day 13 to 18; however, this index was higher than the control on day 12 in treated animals, while lower on day 9, 10, or 11.


Elevation of the fetal presenting part: A method of intrauterine resuscitation.

Traditional methods of diagnosing fetal distress have become obsolete. This diagnosis should be suggested by fetal heart rate patterns that demonstrate recurrent late or severe variable decelerations. Based upon our understanding of these patterns, methods of treating fetal distress in utero have evolved. This paper presents several cases in which elevation of the fetal presenting part was employed in an attempt to improve severe variable decelerations.  It is suggested that this might be a salutary procedure when other methods of intrauterine resuscitation have failed.


Initiation of human parturition. II. Identification of phospholipase A2 in fetal chorioamnion and uterine decidua.

In this study, the presence of a phospholipase has been demonstrated in the human chorioamnion and uterine decidua. That the chorioamnionic enzyme is of the phospholipase A2 type was established by product identification following the incubation of the enzyme with either radioactive phosphatidylcholine or phosphatidylethanolamine. The potential relationship between the expression of the activity of this enzyme and the regulation of arachidonic acid release, prostaglandin formation, and the initiation of labor is considered.


Midtrimester abortion induced by serial intramuscular injections of 15(S)-15-methyl-prostaglandin E2 methyl ester.

Midtrimester abortion was successfully induced in 29 of 30 patients with serial intramuscular injections of 15(S)-15-methyl-prostaglandin E2 methyl ester (15-ME-PGE2). The mean abortion time was 9.52 hours; parous patients aborted somewhat faster (mean, 8.76 hours) than nulliparous patients (mean, 10.47 hours). Eight patients were monitored throughout the abortion procedure and uterine activity was calculated and analyzed. Uterine response to a single injection of 5 mug 15-ME-PGE2 was characterized by the rapid appearance of low-amplitude, high-frequency contractions accompanied by a rise in intrauterine baseline tonus. Uterine activity rose to a mean of 500 Montevideo Units within 40 minutes of the initial intramuscular injection of 15-ME-PGE2. The most frequently encountered side effect of intramuscular injections of 15-ME-PGE2 was temperature elevation of 2 degrees F. or higher, which occurred in 29 of 30 patients. Five patients complained of shaking and chills but only five patients had any gastrointestinal side effects. From this study it appeared that on a weight-for-weight basis 15-ME-PGE2 is at least 20 times more potent than 15-ME-PGE2alpha and 1,000 time more potent than the naturally occurring PGE2.


Oral prostaglandin E2 for induction of labor at term. II. Comparison of two low-dosage regimens.

Prostaglandin E2 was administered orally for induction of labor in 100 normal term gravidas with two dosage regimens. The data derived were compared with comparable data from gravidas matched with study patients according to prelabor cervical preparation and other relevant obstetric and actuarial features. Analysis of patterns of cervical dilatation and station vs. time was carried out. A dose of 0.5 mg. hourly was found to be effective in inducing labor of good quality with minimal side effects, providing a better balance between efficacy and adverse reactions than the higher dosage level.


Low birth weight subsequent to induced abortion. A historical prospective study of 948 women in Skopje, Yugoslavia.

In the fall of 1972, interviews were conducted with 948 Yugoslavian women whose first pregnancies had been terminated by induced abortion (222) or delivery (726) during 1968-1969. Subjects were indentified from records of the Obstetrics and Gynecology Clinic of Skopje University, Macedonia. Subsequent pregnancies were studied to determine the relative effects of first-pregnancy abortion or delivery on incidences of adverse outcomes. No significant difference were found between first-pregnancy aborters and deliverers for subsequent conception rates, spontaneous abortions, or low-birth-weight rates. The data suggest that while induced abortion of the first pregnancy did not protect against the greater risk of low birth weight for a primiparous birth, neither did it increase that risk. The high proportion of women who denied their abortion raises questions about results of retrospective abortion studies which depend on patient recall.


Relationships between prenatal medical and nutritional measures, pregnancy outcome, and early infant development in an urban poverty setting. I. The role of nutritional intake.

Repeated nutritional assessments were made on 118 low-income women who registered at an urban hospital clinic prior to the twenty-eighth week of pregnancy and then on 122 comparable women who were provided with protein-mineral supplementation. Demographic and background information were obtained. Medical assessments were carried out throughout pregnancy, labor, delivery, and the postpartum period. The infants were assessed both medically and with Brazelton Neonatal Behavioral Assessment Scales. In spite of their low-income status, the subjects did not appear nutritionally deprived. Few significant relationships were obtained between maternal nutritional intake and measures of maternal or infant medical status or infant psychological status. A limited number of consistent relationships were obtained when the supplemented and nonsupplemented groups were compared. Although consistent infant medical and psychological benefits were not noted, mothers in the supplemented group developed fewer parameters of pre-eclampsia and had fewer complications during labor and delivery.


Routine pregnancy test on admission to hospital.

A pregnancy test should be done routinely on all women of childbearing age upon their admission to any hospital. Some women do not suspect that they are pregnant and some conceal the fact; therefore many pregnancies are interrupted or aborted by procedures contraindicated in pregnancy. A questionnaire was sent to all hospitals of 200 beds or more in the United States and the replies were tabulated. Many do not routinely test for pregnancy.


Prenatal karyotyping of twins by ultrasonically guided amniocentesis.

Twins were diagnosed with ultrasound in two women who had been referred because of a higher than normal risk of having malformed children. Amniocentesis was carried out under the guidance of ultrasound and amniotic fluid from both fetuses was removed for diagnostic procedures. Injection of Congo red proved that the amniocentesis needle was not re-entering the same amniotic cavity at repeated puncture. In both mothers the fetuses were found to be of different sexes. Mixture of maternal cells was excluded by means of quinacrine staining, allowing evaluation of chromosome markers.


Intervillous space during uterine contractions in human subjects: an ultrasonic study.

Six patients at term were examined by ultrasound during uterine contractions. The length, thickness, and surface of the placental area were found to increase during uterine contraction compared to relaxation. The conclusion is drawn that during uterine contractions the intervillous space is distended. During uterine contraction more maternal blood is available for exchange with the fetal compartment.


Fertility and irradiation: a preconceptional investigation in teratology.

The effects of preconceptional irradiation on female fertility were investigated in six groups of 35 nulliparous Swiss-Webster mice whole-body irradiated with single doses of 25, 50, 75, 100, 150, and 300 rads of 60Co. They were mated with nontreated males and killed on gestational day 18. The litters were recorded in the chronologic order of their occurrence within each group. The percentage of pregnancies decreased with the dose, while the prenatal loss increased. Up to 100 rads, the middle group of pregnancies was devoid of resorptions, fetal death, and congenital anomalies, thus giving rise to a "maximum viability enclave." Beyond this level those three adverse effects were more or less homogeneously distributed over the whole period for which pregnancies were recorded. Exencephaly, microcephaly, and eye defects were the most frequent malformations. Among other sequelae, hypertrophy of the higher pole occurred in the left kidney in the surviving infertile females killed 5 months after treatment.


Plasma renin activity and plasma aldosterone during the normal menstrual cycle.

Six normal women were studied under metabolic balance conditions during the menstrual cycle. Plasma renin activity (PRA) and plasma aldosterone were estimated throughout the cycle under standardized, uniform conditions with sensitive radioimmunoassays. There is a linear increase in PRA and plasma aldosterone during the luteal phase of the cycle provided ovulation occurs. If ovulation fails, no rise is seen in either parameter. Thus, a functioning corpus luteum seems to be essential for the production of these hormonal changes.


Effect of intrauterine devices on sperm transport in the human being: preliminary report.

This investigation was designed to determine the effect of the intrauterine contraceptive device (IUD) on the early phase of sperm transport. Previously we have shown that in normal midcyle subjects the maximal number of sperm recovered from the oviducts occurred between ten and 45 minutes after vaginal insemination. Four normal subjects, three of whom had IUD's in situ for at least eight months (copper T, Dalkon shield, and loop) and one a loop for one month, were studied in a similar manner. All subjects were inseminated at midcycle and had bilateral abdominal salpingectomies 15 to 30 minutes after insemination. No sperm were present in the oviducts of any of the subjects. The results of this study indicate that the IUD interferes with sperm transport in the human being. Additional subjects are now being studied at different time intervals after insemination in order to determine the entire effect of the IUD upon sperm transport.


Effect of contraceptive steroids on serum lipids.

Serum triglycerides, free fatty acids, phospholipids, and cholesterol were estimated in groups of women who were taking either norgestrel, megestrol acetate, daily combination tablet, once-a-month pill, or once-a-month injection as a method of contraception. These estimations were done prior to and during therapy at specific times over a period of 2 years. A significant reduction in serum lipids was observed in women taking norgestrel. The women on megestrol acetate showed practically no changes. All the lipid fractions were significantly elevated in women taking combination pills. Raised serum cholesterol was observed in women receiving once-a-month injection.


Danazol: an antigonadotropic agent in the treatment of pelvic endometriosis.

Danazol, an antigonadotropic agent, was administered in a dosage of 800 mg. daily for six months to 32 patients with pelvic endometriosis. Twenty-eight patients (87.5 per cent) were found to have a marked improvement of both clinical and subjective symptoms of endometriosis. Furthermore, Danazol was found to be effective in three patients with chronic cystic mastitis and one patient with fibrocystic disease. There was no change in uterine size in two patients with uterine adenomyosis and one patient with uterine myomas during the treatment period. Danazol was ineffective in relieving the symptoms of the menopausal syndrome in one patient. The main side effects of Danazol treatment were weight gain and water retention which were maximal at four months of treatment and then decreased. Other side effects such as acne, oiliness of skin, and voice change were rare in this series. Danazol therapy was found to be very effective in this study for the treatment of pelvic endometriosis, and the drug was well tolerated by the patients.


Chlamydial infection in women with cervical dysplasia.

The prevalence of antibodies to chlamydiae, particularly to TRIC (trachoma-inclusion conjunctivitis) agents, was studied in women with cervical dysplasia and in women attending selected clinics (obstetrics, cancer-screening, and gynecology). In addition, attempts were made to isolate TRIC agents and herpesviruses from the cervices of these women. TRIC agent recovery rates 4.1 per cent for women with dysplasia, 5.4 per cent for pregnant women, 7.8 per cent in the women's clinic, and 0.8 per cent in the cancer-screening clinic. Herpesvirus recovery rates were lower, on the order of 1 per cent or less in each clinic. Complement-fixing antibodies to chlamydial group antigen were detected in 21.5 per cent of women with dysplasia. With a more sensitive fluorescent antibody method, 77.6 per cent of the women with dysplasia or cervical cancer were shown to have antibodies to chlamydiae. In general, antichlamydial antibodies were less prevalent in the other clinic populations. The results of this study indicate that women with cervical dysplasia or cancer may have a high prevalence of antibodies to sexually transmitted agents other than herpesvirus type 2.