Muscle spindle discharge in normal and obstructed movements. 1. The discharge activity of muscle spindle endings located in tail and hind limb muscles was recorded during voluntary movements in the cat. 2. During active shortening of the receptor-bearing muscles, both primary and secondary endings tended to fall silent. This was more pronounced, the higher the rate of muscle shortening. We suggest that in unobstructed movements in which muscle velocities exceed 0.2 resting lengths per second (lr/sec), the firing patterns of spindle afferents are dominated by their responses to the length variations. At velocities lower than 0.2 lr/sec, fusimotor action may predominate. 3. When active muscle shortening was unexpectedly halted, both primary and secondary endings resumed firing, but the increases in discharge rate were not as abrupt as might have been expected had there been strong co-activation of fusimotor and skeletomotor neurones. Rather, for the types of movements studied, fusimotor action appears to have been quite modest.


[Releasing of plasminogen-activator from the kidney to the blood (author's transl)]. When fibrinolytic activity in blood samples from various vessels was examined by the dilute-blood-clotlysis-time method (DBCLT), it was found to be noticeably high in the renal venous blood, though the activity was not detected by usual blood clotlysis time method. Plasmin was not detected in any blood samples examined, and the contents of fibrinogen and fibrin (or fibrinogen) breakdown products in the renal venous blood were not significantly different from those in the blood from other vessels. However, the high activity of plasminogen-activator was found only in the renal venous blood. Inhibitors on plasmin and plasminogen-activator (urokinase) were detected in almost the same amount in the blood samples from the various vessels. The amount of the inhibitors was sufficient to inhibit the plasminogen activation by urokinase, whose activity was equivalent to the plasminogen-activator activity in the renal venous blood. These results indicate that the high activity by DBCLT in the renal venous blood was derived from the high activity of plasminogen-activator, which was inactivated by inhibitors in undiluted blood. Plasminogen-activator may be released from the kidney to the blood, and immediately inactivated by the inhibitors in renal vein, and then diluted with systemic blood which contains little plasminogen-activator.


Response of physicians to medical complaints in men and women. Workups by physicians in response to five common complaints in a sample of 104 men and women--52 married couples--were evaluated by chart audit. For the total group of complaints, back pain, headache, dizziness, chest pain, and fatigue, the physicians' workups were significantly more extensive for men than they were for women. These data tend to support the argument that male physicians take medical illness more seriously in men than in women.


Literature survey of bacterial, fungal, and Drosophila assay systems used in the evaluation of selected chemical compounds for mutagenic activity. Literature reports were surveyed, with results noted from experiments in seven nonmammalian assay systems used for the detection of mutagenicity or other related genetic effects. A comparison was made of the activities of 54 selected noncarcinogens, procarcinogens, and ultimate carcinogens as revealed by these test systems. Of the compounds tested, 49 (91%) were active in one or more of the assays, and 42 (78%) were positive in at least one system without having to be metabolically activated. In one or more test systems, 17/17 (100%) of the ultimate carcinogens, 27/28 (96%) of the procarcinogens, and 6/9 (67%) of the noncarcinogens were positive. The Ames Salmonella-microsome assay responded with increased mutation frequency to 37/44 (84%) of the carcinogenic compounds but to only 2/8 (25%) of the noncarcinogens tested. The Drosophila system responded to 19/21 (90%) of the carcinogens and to 3/6 (50%) of the noncarcinogens. Prophages were induced when lysogenic bacteria were exposed to 12/21 (57%) of the carcinogens, but not enough tests were done with the noncarcinogens (1/3, or 33%) for a comparison. The other systems reviewed, such as the killing of repair-deficient bacteria, mutations in Escherichia coli and Neurospora crassa, and the host-mediated assay, were not challenged by enough of the compounds for valid comparisons.


[Distribution of the electrocardiographic changes characteristic of ischemic heart disease among the male population of Leningrad in comparison with the clinical biochemical indices]. The authors studied the peculiarities of electrocardiograms recorded under conditions of rest in 1,022 males from 40 to 59 years of age, who reflected representatively a selected unorganized population of 1,250 persons. The ECG were analysed according to the Minnesota code. Among the examined persons 9.6% were found to have "coronary" ECG changes indicating to ischemic heart disease. The tread-mill test conducted in individuals chosen for scrupulous examination made it possible to make a diagnosis of ischemic heart disease in 19.6% of 219 persons (72 of whom had hyperlipidemia). A tendency toward relative decrease in high-density lipoproteins was noted in individuals with clearly manifested signs of coronary pathology on the ECG.


Integrating the physically handicapped child. This paper will serve several purposes: (1) to provide information on the incidence of physically handicapped children (exclusive of the blind and deaf) who are likely to be integrated into schools for normal non-physically impaired children, (2) to describe briefly the major handicapping conditions and their educational implications, (3) to comment on why integration has come about and why it promises to enrich the lives of normal children, (4) to suggest how physicians, physical therapists, and occupational therapists might help to make schools programs successful, (5) to comment briefly on financial implications of this program and to suggest ways in which the complexity of the medical management might be simplified, (6) to provide factual knowledge about the handicapped child and his potential to teachers who are already on the firing line to "improve" the academic achievement of the alleged normal child.


Administrative concerns and schools' relationship with private practicing physicians. In this discussion of four administrative concerns, there has been an effort to suggest school-sponsored activities leading to close productive relationships with community physicians and optimum use of medical information available for maintaining adequate medical component in the school management of children with handicapping conditions. A recurring theme is that to attack these concerns, there must be administrative leadership which sees them as important and knowledgeable staff members who are available, assigned and supported to perform the necessary task.


Modulator binding protein antagonizes activation of (Ca2+ + Mg2+)-ATPase and Ca2+ transport of red blood cell membranes. Red blood cells contain a protein that activates membrane-bound (Ca2+ + Mg2+)-ATPase and Ca2+ transport. The red blood cell activator protein is similar to a modulator protein that stimulates cyclic AMP phosphodiesterase. Wang and Desai [Journal of Biological Chemistry 252:4175--4184, 1977] described a modulator-binding protein that antagonizes the activation of cyclic AMP phosphodiesterase by modulator protein. In the present work, modulator-binding protein was shown to antagonize the activation of (Ca2+ + Mg2+)-ATPase and Ca2+ transport by red blood cell activator protein. The results further demonstrate the similarity between the activator protein from human red blood cells and the modulator protein from bovine brain.


Dacron patch enlargement of anterior wall of left ventricle after aneurysmectomy with concomitant infarctectomy. The basis for left ventricular aneurysmectomy with cardiopulmonary bypass was established 20 years ago. There is a higher risk in patients who undergo operation within 2 months of myocardial infarction. In these patients there may be no clear demarcation between devitalized tissue and residual healthy myocardium. A case is reported in which anterolateral aneurysmectomy with concomitant infarctectomy so compromised left ventricular size that the anterolateral wall of the left ventricle had to be reconstructed with a Dacron patch graft.


[Embolism caused by a fiber from a synthetic vascular prosthesis]. Authors report on an embolization due to synthetic thread following inplantation of a vascular prosthesis, demonstrated by means of polarization optics in the spleen, corresponding to the dacron threads of the prosthesis. Complications of that type following vascular operations should be taken into account.


[Classification of electrocardiographic patterns by full machine descriptions of the electrocardiograms]. To classify the electrograms due to their complete, computer-produced description, an algorithm for automatic formation of electrocardiographic inference, is offered. Some results reached with this algorithm in solution of practical problems met in electrocardiographic diagnosis were presented.


Relationship between specialized cells, capillaries and intermediary cytofibrillary elements. XIth note. Biological evolution of the emunctory subsystem and stereotype in vertebrates. This note completes in vertebrates the study of the emunctory subsystem and stereotype in invertebrates (Xth note). The theory of systems (and of open biological systems) of Bertalanffy, the theory of internal laws and limits of each organizational level (Needham) and the theory of biological stereotypes and of their morphofunctional expression (Mârza, Repciuc and Eskenasy) are also corroborated. In this light there were studied: the characters of the emunctory stereotype in vertebrates, its similar formation mode by three links (extracting, conveying and excretory links) as in the coelomatous invertebrates, and the passage of the emunctory stereotype from invertebrates to vertebrates. The present-day Acraniata and their offsprings, the Protocraniata, Agnatha and aquatic Gnathostoma, have an emunctory stereotype identical in its essential characters, without discrepancies between its links. The passage does not occur, however, from the metanephridia to the pronephros, but to the mesonephros. This latter reaches its highest functional limits in Dipnoi and Amphibia. The author indicates the mechanisms which, in its opinion, play a role in the activation of organo-genetic capacities of the metanephros in the caudal nephrogenic area. The importance of the three nephrogenic areas of the vertebrates, their succession and interdependence are also discussed. The problem of the archi(holo)nephros is critically reviewed, and the author's hypothesis that the glomerular ultrafiltrate and the coelomic liquid of invertebrates with metanephridia had the same composition and underwent the same processes of reabsorption-secretion is dwelt upon. A conclusion is drawn from these two notes, according to which stability--directed by the stabilizing selection--plays a directional role in the evolution of the new organizational levels, in the maintenance and development of the characters of the emunctory stereotype within the emunctory subsystem (EMSS). Between variability and stability strong relations are established and hereditarily transmitted.


6-Aminonicotinamide-induced eye defects in rats. The pathological changes and structural anomalies induced by 6-aminonicotinamide (6-AN) in the developing eye were studied in rats (Wistar and hooded randombred strain). The substance was administered in aqueous solution intraperitoneally (4 mg/kg on day 9--10 of pregnancy: 5 mg/kg on day 11 of pregnancy; 8 mg/kg on day 13--17 of pregnancy) and in physiological saline intraamniotically (0.01 ml of a 1% solution in physiological saline on day 15 of pregnancy). Embryos and foetuses from experimental series and from untreated control series were macro- and microscopically examined on day 10--20 of pregnancy. Control foetuses from mothers injected with distilled water on day 9--17 of pregnancy were examined on day 20 of pregnancy. The pathological changes and structural anomalies detected at successive developmental stages are presented. They reveal an obvious phase specificity and attest that the same substance may act through both of the main teratogenic pathways hypothetically put forward by Menkes et al. (1970). Based upon the present findings (and some previous results obtained in experiments with bisazo dyes) a working hypothesis is tentatively presented, as to the possible determination of the uni- or/and bilateral distribution of chemically induced developmental defects. In connection with some reversible or transitory pathological changes the role of recovery in teratogenesis is pointed out.


Differentiation of human anterior hypophysial cells during fetal life. This paper deals with cell differentiation in the anterior hypophysis of the human fetus, as may be stated by electronmicroscopy. In the 9 cm fetus the greater number of cells are devoid of granules; this was the reason for their being considered as nondifferentiated cells. A small number of cells however contain granules which vary from cell to cell in number and size and may be considered as cells with different functions. Usually the granules secreted within the same cell have very close diameters. The number of such cells increases with the age of the fetus; thus, in 170 mm fetal length there remain very few nondifferentiated cells. Some cells have their granules located centrally, while in others they are closer to the cell membrane, suggesting that the product of cell secretion is extruded in the nearby lumen of capillaries. The shape of the cells, their location, as well as the features of the cell organelles are similar to those described for adults, but in the fetus they are proportionally fewer. The electronmicroscopic pattern does not seem to be a sufficient criterion for the specification of the type of cells, except ACTH-MSH secreting cells.


Histopathology of thyroid carcinoma. A review of 500 cases. A lot of 500 thyroid cancers were studied. The following histological aspects were found: folliculo-papillary carcinoma (60.6%), follicular carcinoma (20.6%), anaplastic carcinoma (15,4%), medullary carcinoma (3.2%), malignant lymphoma (0.2%). The sex distribution showed a strong predominance of women as compared to men, in a ratio of 3/1. The highest incidence appeared between 30 and 50 years of age. The histopathological and cytological features in fine needle biopsy are discussed.


Morphopathologic changes of enteropathies in 161 children's intestinal endobiopsies. The authors examined microscopically 161 jejunal biopsies of which 142 presented a pathologic mucosa. The two sexes were equally represented and the prevalent age was between 1 and 2 years. Nearly one third of the cases were acute enteritides and the remaining ones--granulative and atrophic enteritides; none of them was hypertrophic. The causes of these enteropathies are various.


Sister chromatid exchange detection. The method and its usefulness in genetic counseling. The sister chromatid exchange (SCE) detection was performed in the blood cultures from two human subjects, progenitors of some congenitally malformed children and from one patient with presumed symptoms of Bloom's syndrome. The usefulness of the SCE detection in genetic counseling and for the estimation of induced chromosomal lesions is discussed.


Investigations on the action of neurotoxic agents present in the urine of patients suffering from hepatitis. (Biological test). Injecting urine obtained from patients suffering from hepatitis (acute and chronic-active), into the dorsal lymph sac of 336 frogs, the authors repeatedly observed serious motor disturbances, which caused the death of animals, in proportion of 66%. Histologically, in the treated animals grave neuronal lesions appear (reaching sclerosis and disintegration of motor neurons) at the level of the midbrain, pons and medulla oblongata, attaining the highest degree in the motor zones of the ventral horns, of the spinal cord. In the control group (200 frogs), treated in the same manner with urine originating from healthy persons, the mortality was only 6%. It is concluded that in the active stage of hepatites, in the urine of the patients cytolytic substances of a definite neurotoxic action appear, which is manifest by motor disorders and grave dystrophic lesions of the brainstem and spinal cord.


[Fine-structure and function of the primary proliferative layer of the embryonal central nervous system]. Results obtained by mechanical isolation of neuroblasts from the primary proliferative layer of the central nervous system in chick embryos by the aid of an original method and by electronmicroscopic investigations are consistent with Sauer's concept on neuroepithelial cell proliferation. The bipolar form of the undifferentiated neuroblast is maintained--at the beginning--by external factors of cell contact only. Each end-feet contains two centrioles, one of which represents the basal body of a cilium. During mitosis, the position parallel to the lumen of the spingle axis and the subsequent appearance of two identical daughter cells depend on the behaviour of the centrioles. The later may move in an abnormal direction, and induce thus an obliquely or perpendicularly laying spindle axis. These changes may influence--on the other hand--the mechanism of proliferation.


Immunocompetence of patients with transitional cell carcinoma as measured by dinitrochlorobenzene skin tests and in vitro lymphocyte function. Patients with transitional cell carcinoma of the bladder have a highly significant stepwise decrease in responsiveness to challenge with DNCB with advancing stage of disease. Seventy-five percent of those patients with superficial tumors are skin-test positive versus only 35% for those having tumors that are locally advanced and/or metastatic. MLC response and ability to stimulate in this culture as well as PHA and Con A response of blood leukocytes have been studied in relation to stage of disease and therapy. Recent irradiation appears to inhibit significantly MLC responsiveness, and PHA and Con A blastogenesis. Although responsiveness for this group of patients is decreased from normal, a further decrease occurs in responsiveness to Con A with advancing stage of disease. Blood leukocytes from some patients with urinary bladder carcinoma appear to have a decreased ability to function as stimulator cells in one-way MLC. This ability to stimulate returns to normal levels with tumor removal.


In vitro immune parameters in relation to clinical course in transitional cell carcinoma. Longitudinal experiments were performed in which lymphocytes from patients were compared with simultaneously studied normals. Patient lymphocytes were examined for their ability to function as stimulator and responder cells in a one-way MLC. Additionally, lymphocyte mitogenic response to PHA and Con A were examined. We observed changes in these parameters that could be correlated with the clinical course of the patients.


Mixed leukocyte culture reactivity of lymph node cells regional to transitional cell carcinoma of the bladder. Regional lymph node cells from some patients with bladder cancer exhibited a suppressive effect on the ability of autologous and allogeneic blood leukocytes to function as stimulator cells in one-way mixed leukocyte culture. The appearance of the suppressor activity was significantly correlated to advancing stage of disease and to the histology of the regional lymph nodes.


Effect of p-chlorophenylalanine on avoidance learning of two differentially housed mouse strains. The effect of p-chlorophenylalanine (PCPA) has been studied on the acquisition of avoidance learning and on brain concentrations of 5-hydroxytryptamine, 5-hydroxyindoleacetic acid and tryptophan of differentially housed male mice of Albino Swiss and DBA strains. The results obtained do not support the hypothesis that learning ability varies inversely with the concentration of brain 5-hydroxytryptamine. PCPA can appear as influencing learning ability of different strains of mice differentially housed, depending more on the emotional baseline of the animals than on brain 5-hydroxytryptamine modification.


[Effect of an adrenergic-parasympatholytic aerosol combination on the respiratory function]. The ventilatory and cardiocirculatory effects of salbutamol-ipratropium aerosol were examined in 27 subjects with bronchial obstruction. The activity of the association was compared with that of the two components at therapeutic doses. Then the effects and possible side-effects of the association were assessed at increasing doses. Lastly, the association was compared with its components. The association had the same latency time, but a more prolonged effect (still effective after 120'), when compared with salbutamol. It was decidedly superior to the parasympatholytic. No side-effects of any kind were observed.


Cell-mediated immune response to dog pulp tissue altered by Grossman's formula sealer via the root canal. Pulp tissue from three experimental dogs was tested for its antigenicity before and after incubation with Grossman's formula sealer (GS). Cellmediated skin-test reactions showed an increased response to pulp that had been incubated in Grossman's formula sealer, washed, and then injected as compared with pulp or GS alone. In vitro analysis of cell-mediated immune response (lymphocyte proliferation) showed a marked increase when pulp tissue was incubated in GS and washed as compared to saline-treated pulp. Comparing the saline-incubated pulp to the GS-altered pulp revealed that the increase in radioactivity was statistically significant at p less than 0.0001. Therefore, Grossman's formula sealer altered dog pulp tissue and rendered it antigenically active, and a specific cell-mediated lymphocyte response was produced.


Genetic counseling and the pediatrician. The assistance of the pediatrician, following diagnosis of a child with a genetic disorder, towards his family consists today in giving genetic counseling for prevention of recurrence in future pregnancies. The process of genetic counseling, once the right diagnosis is made, should not be difficult as concerns Mendelian inheritance. It is well known that several chromosomal disorders follow the rules of Mendelian inheritance. The theory of polygenic or multifactorial inheritance may create problems in the accurate estimation of risks. An effort is made to discover the mechanisms of genetic "predisposition" or the adverse environmental factors, in order to minimize the occurrence of such disorders. An important tool in prevention of several genetic disorders, which should be mentioned in genetic counseling, is prenatal diagnosis.


Common skin problems in the pediatric office. Skin diseases represent a major problem in everyday practice. This article discusses the most common dermatological entities as seen in the pediatrician's office with practical guidelines for their therapy. Acne, eczema, diaper rash, verruca vulgaris, impetigo and skin infestations are among those topics discussed.


Effect of ischemia on contractile and histochemical properties of the rat soleus muscle. Ligature and section of the abdominal aorta results in only minor and temporary functional and metabolic changes in the slow soleus muscle of the rat. A very small decrease in maximal tetanic tension corresponds to a few scattered areas of damaged and necrotic muscle fibres, in which decreased succinic dehydrogenase and loss of phosphorylase activity was observed. A new experimental approach, i.e. ligature and section of the abdominal aorta combined with terminal devascularisation, preserving intact tendons and innervation of the muscle causes maximal muscle ischemia, followed by an almost complete loss of tetanic tension output, marked shortening of contraction time and profound morphological and histochemical changes. The decrease in succinic dehydrogenase and ATPase activities and loss of phosphorylase activity occur in the majority of degenerating muscle fibres except for a thin rim of peripheral fibres during the first 4 days. Subsequently, the contractile properties recover gradually and enzyme activities reappear in the regenerating muscle fibres simultaneously with new revascularisation. Thirty days after the operation all the parameters observed returned to control values.


Sixty latissimus dorsi flaps.

Sixty latissimus dorsi flaps. In clinical experiences with 60 cases, we have found the latissimus dorsi to be a reliable and versatile flap. We describe its use for a functional muscle transfer (in restoration of elbow flexion and repair of abdominal wall defects), for arm and shoulder coverage, for breast reconstruction, and as a free flap.


Effects of sodium pentobarbital on rat heart sarcolemma. The effects of sodium pentobarbital on ATPase, Ca2+ binding and adenylate cyclase activities of the rat heart sarcolemmal preparations were investigated. The Na+ - K+ ATPase activity was diminished by pentobarbital in concentrations as low as 0.3 mM. Mg2+ ATPase, Ca2+ ATPase and adenylate cyclase activities were also depressed but required 10 to 15 mM of this agent. Pentobarbital in concentrations of 10 mM, however, caused an increase in sarcolemmal Ca2+ binding. Mitochondrial and microsomal ATPase activities were decreased by 1 and 5 mM concentrations of pentobarbital respectively, while myofibrillar ATPase activity was unaltered even at a concentration of 20 mM. These data suggest that cardiodepressant effects of high doses of pentobarbital may partly be explained on the basis of its actions on heart sarcolemma.


Work and disability at the age of 30 years. A sociomedical study of a birth-cohort from Bergen. IV. Economic activity, occupation, and earned income. On the basis of interviews and data collected from various files and registers, the present study will analyse the work situation at the age of 30 years related to the type of school attended at age 14 years. The study is based on a cohort of 1,570 persons, all live births in the year 1940 of mothers then residing in Bergen. A sample was taken after stratification of the cohort according to type of school attended at age 14 years. This sample was supplemented with persons who had attended Special Schools for the educable mentally retarded (EMR) and with persons who had received care from the national services for the mentally retarded (SMR). The final sample consisted of 262 persons. An association is found between economic activity, occupation, and earned income at the age of 30 years and type of school attended at age 14 years. Former pupils of Special Schools for the educable mentally retarded clearly belong to a marginal group, as regards "self-support". Former pupils of Elementary School classes for slow learners are also a high-risk group concerning the development of work-insufficiency.


Pharmacology and toxicology of Atrovent. The anticholinergic drug ipratropium bromide (Atrovent) can be described as having pharmacologically a high degree of activity and a certain bronchoselectivity when administered intravenously. Inhalation studies, however, indicate that this is the most suitable route of administration. Inhalation provides with small doses the most effective concentration locally at the smooth muscle of the airways without producing anticholinergic side effects due to absorption from the airways or from the gastrointestinal tract. In certain experimental models of allergic asthma, ipratropium bromide was shown to be capable of influencing favourably bronchoconstriction and mediator release. Extensive toxicological examinations revealed with high doses all typical symptoms of overdosing an anticholinergic drug, like mydriasis, dryness of the mucosae and meteorism with coprostasis. Acute and long term inhalation studies gave no evidence for a functional and morphological impairment of the lungs and airways.


A double blind cross-over study of maximal expiratory flows and arterial blood gas tensions in normals, asthmatics and bronchitics after salbutamol and ipratropin. 8 normals, 8 asthmatics and 8 bronchitics inhaled comparable doses of ipratropin and salbutamol. Five different flow-volume parameters were measured before and at intervals from 3 to 360 minutes after inhalation, on a total number of 2880 maximal effort expiratory flow-volume curves. Arterial blood gas tensions were measured before and 60 minutes after inhalation. In all parameters a significant larger effect (p less than 0.05) of ipratropin was found in normals, but in different time intervals. The parameter FEV1 and MEF at 50% of FVC showed the largest effect of salbutamol during the interval from 3 to 60 minutes in the asthma patients. None of the parameters showed significant difference in drug effects in the bronchitis patients. The findings suggested a more peripheral action of ipratropin than of salbutamol in the normals. No significant change in gas tensions were found after inhalation in any of the three groups.


A comparative study of the bronchodilatating effects of ipratropium and terbutalin inhaled with Monaghan IPPB-M 515 by 19 patients with chronic obstructive airways disease. The effect of ipratropium (Atrovent) 0.125 mg x 4 daily was compared to terbutalin (Bricanyl) 5 mg x 4 daily, given to 19 patients with chronic obstructive airways disease (15 with chronic bronchitis, 10 bronchial asthma, 7 pulmonary emphysema) as inhalation therapy with Monaghan IPPB-M 515, during 2 treatment periods of 3 days. The investigation was carried out as a controlled, double-blind, cross-over comparison. The effect of treatment was evaluated by measurement of PEFR, symptom scores, including the side-effects and the use of rimiterol MDI for the treatment of acute attacks. The PEFR values were all higher than the initial values (P less than 0.001) during the period of treatment (08.00-20,30 hrs). The highest values were recorded at 16.30 hrs, these were PEFR + 31.7% for the Atrovent period and PEFR + 28.0% for the Bricanyl period. No statistically significant difference was observed in the PEFR, symptom scores, side-effects and the use of rimiterol during the Atrovent and Bricanyl treatment periods. The authors suggest that Atrovent is a wellsuited alternative bronchodilatator, particularly for patients with tremor, muscle cramp, and "inner restlessness" following treatment with a beta 2-stimulator.


SCH 1000 in psychogenic asthma.

SCH 1000 in psychogenic asthma. The effects of a beta 2-sympathomimetic (salbutamol or fenoterol) and the anticholinergic SCH 1000 administered both in combination and with placebo were compared in a double-blind random crossover design. Thirty-three patients with atopic, non-atopic and psychogenic asthma were studied. After inhalation of the sympathomimetic in combination with SCH 1000 or placebo the increase in FEV1 was significantly better for three hours (p less than 0.05) than after inhalation of SCH 1000 alone. There was no difference in the response to SCH 1000 in the atopic or non-atopic groups. However, in patients with a major psychogenic component to their asthma the FEV1 response to SCH 1000 was significantly better (p less than 0.05) than in other asthmatics from four to seven hours past inhalation. These findings suggest that SCH 1000 might be a valuable therapeutic agent in patients with psychogenic asthma.


ASD in patients over 40 years of age.

ASD in patients over 40 years of age. To evaluate the benefits of operative treatment of congenital heart disease in older age groups, a clinical study on patients over 40 years of age with atrial septal defect was carried out. The series consisted of 125 consecutive patients operated on between 1966 and 1974. There were 8 cases with a primum, 12 cases with a sinus venosus type of secundum and 105 cases with a simple secundum defect. The operative mortality was 2 patients (1.6%). It was due to myocardial infarction in one case and high pulmonary vascular resistance in the other. On re-examination 3-6 months postoperatively, 107 patients were improved, 13 patients unchanged and 3 patients were worse than before operation. On re-evaluation after an average period of 6 years, 88 patients were still improved. 32 patients unchanged and 3 patients were worse compared with their pre-operative status. On the basis of the results and the previous reports on atrial septal defect without operation, the surgical correction of ASD even in older age groups can be recommended. The problem of deterioration of some patients, despite a good immediate postoperative result, is discussed.


Clinical and haemodynamic observations after combined aortic and mitral valve replacement with the Björk-Shiley tilting disc valve prosthesis. Early and late results in 25 patients. Combined mitral and aortic valve replacement with the Björk-Shiley tilting disc valve (pyrolite) was performed in 25 unselected patients characterized by markedly impaired functional capacity, hypokinetic central circulation and cardiomegaly before operation. Surgery was performed during extracorporeal circulation with deep hypothermia. The mitral valve was replaced first in all cases. There were no intra-operative deaths, but 2 patients died while still in hospital (8.0%). One patient died 2 months postoperatively due to progressive heart failure. The remaining patients--with the exception of one who had died of cancer of the ovary--were re-examined in average 28.7 (18-40) months postoperatively. Most patients had improved symptomatically and were in functional classes I-II (N.Y.H.A.). The haemodynamic findings indicated restoration to normal resting values of cardiac output, pulmonary artery pressure and pulmonary vascular resistance, but with an increase in left ventricular end-diastolic pressure (LVEDP). The mean diastolic gradient across the mitral prosthesis varied from 0 to 11 mmHg, while simultaneous pressure recordings from the left ventricle and the aorta, with one exception, disclosed no systolic pressure gradients (peak) across the aortic valve. Postoperative arterial thrombo-embolic complications occurred in 2 patients, resulting in only minor neurological sequelae.


Successful replacement of the aortic valve, mitral valve and ascending aorta with re-implantation of the coronary arteries. A 63-year-old man was operated upon with replacement of the aortic valve, mitral valve and ascending aorta with re-implantation of the coronary arteries. A composite graft with a 27 mm Björk-Shiley tilting disc prosthesis was inserted with 3 continuous Prolene sutures in the aortic position. The coronary arteries were thereafter re-implanted in holes made in the graft. A 31 mm Björk-Shiley valve was sutured in the mitral position with about 20 isolated mattress sutures of Ti-Cron. Selective myocardial hypothermia was instituted with Ringer's solution of 4 degrees C. The total perfusion time was 185 min compared with 240 and 275 min in two previously reported, similar cases. We consider that the use of cardioplegia, a composite graft and continuous sutures makes it possible to reduce the operation time in these complex cases. Our patient is in good condition 9 months postoperatively.


[Value of sonography in the diagnosis of obscure cholestasis]. A retrospective study has been conducted in 36 cholestatic patients to determine the diagnostic accuracy of ultrasonography in preliminary differentiation of obstructive from non-obstructive hepato-biliary disease. Due to the high rate of correct biliary duct caliber evaluation, ultrasonography has proved itself an excellent screening method in patients with cholestasis of uncertain origin. The choice of the subsequent more invasive diagnostic examinations (ERC, PTC, laparoscopy) depends on the ultrasonic findings.


Fibrinopeptide B and aggregation of fibrinogen. Removal of fibrinopeptide B from human fibrinogen by reaction with the procoagulant enzyme from copperhead snake venom below 25 degrees C resulted in tight aggregation of the fibrinogen, which, in turn, progressively blocked a concomitant but sluggish release of fibrinopeptide A by the enzyme. When the clots obtained at less than 25 degrees C were warmed, they dissociated into soluble aggregates and monomers. Release of fibrinopeptide A then resumed, and a secondary coagulation followed. The aggregation induced by release of fibrinopeptide B itself involves a plasmin-susceptible segment located just distal to B in the B beta chain of fibrinogen, a segment previously shown to be of little importance in the aggregation induced by release of fibrinopeptide A.


Calcium transport across the plasma membrane: stimulation by calmodulin. Active transport of calcium into inside-out vesicles of red blood cell membranes was stimulated equally by (i) the purified protein activator of calcium-activated, magnesium-dependent adenosinetriphosphatase isolated from red cell hemolyzates and (ii) calmodulin, a protein activator of cylic nucleotide phosphodiesterase isolated from bovine brain. The results provide further evidence for the identity of red blood cell activator and calmodulin and show that this cytoplasmic protein may participate in the regulation of plasma membrane calcium transport.


Pneumococcal endocarditis in infants.

Pneumococcal endocarditis in infants. A case of pneumococcal endocarditis in an infant is reported together with a review of seven cases previously described in the literature. The prominent presenting symptoms of this usually fatal disease consisted of tachycardia, tachypnea, and cardiomegaly. A new murmur was heard in six of the eight patients. Fever was infrequent. Blood cultures were positive when done. The mitral valve was the site of infection in seven of the patients. In contrast to adult patients, pneumonia and meningitis are rarely encountered in children with pneumococcal endocarditis. The disease was fatal in all four patients before the penicillin era and in three of four patients who received penicillin.


An outbreak of plague in Hlegu, Burma in 1977. An outbreak of plague occurred in Hlegu Town, Burma in February and March 1977. Altogether 14 bubonic plague cases, with 2 deaths were reported, mostly children under 15 years of age. Twice as many males as females were affected. A retrospective investigation showed that a rat fall took place in the last week of January. Only 9.5% of the rodents which died in the epizootic were found to be infected with Y. pestis; this apparent low infection rate probably resulted from the inclusion in the survey of some dead rats which died of other causes. 14.5% out of 48 trapped rodents were found to be serologically positive. The general flea and cheopis indices were rather high, perhaps because fleas were found to be partially resistant to DDT and also because spraying of insecticide did not effect fleas on the hosts. The cheopis index in Hlegu Town was 1.17, and less than 0.5 in Hlegu suburb (Yankin-Yat) where no epizootic was reported. An active case search revealed 76 suspected plague cases out of which 11 were found to have bubonic plague. A field trial showed that plague vaccination during the outbreak did not result in a rise of detectable antibodies in persons inoculated.


Another case of human gnathostomiasis in Indonesia. A male Gnathostoma spinigerum was removed from the abdominal wall of a 29-year-old woman, who was in the habit of eating "naniura", a dish containing raw carp (Cyprinus carpio). After the removal of the worm she still had pain in her chest and noticed intermittent swelling of her right lower arm. Probably the patient still had one or more Gnathostoma worms migrating in her body.


Inferior mesenteric artery aneurysm: case report and discussion. Although visceral artery aneurysms are uncommon, an isolated inferior mesenteric artery aneurysm is reported. A  55-year-old man underwent aortofemoral reconstruction with resection of the aneurysm and replantation of the artery into the Dacron graft. This unusual entity is discussed.


Chemotherapy of gastric and pancreatic carcinoma: a controlled evaluation of combinations of 5-fluorouracil with nitrosoureas and "lactones". By random assignment a total of 176 eligible patients with advanced nonmeasurable pancreatic carcinoma were treated with 5-fluorouracil (5-FU) either alone or in combination with a nitrosourea (streptozotocin), in combination with a "lactone" (spironolactone), or in combination with both. By random assignment a total of 179 patients with advanced nonmeasurable gastric carcinoma were treated with 5-FU either alone or in combination with a nitrosourea (methyl CCNU), in combination with a lactone (testolactone), or in combination with both. The median survival period for all pancreatic carcinoma patients was 17 weeks, and for all gastric carcinoma patients 30 weeks. The addition of the nitrosoureas or the lactones or a combination of both produced no improvement in length of patient survival for either primary carcinoma when compared to treatment with 5-FU alone.


The MMPI as a predictor of outcome in low-back surgery. Between 1965 and 1975, 103 low-back patients were rated preoperatively for general level of functioning, and each completed a Minnesota Multiphasic Personality Inventory (MMPI) test. Following surgery, patients were rated in terms of treatment effectiveness at 6 months and 1 year. The MMPI hypochondriasis and hysteria scales were moderately related to surgical success, as were the severity of initial restriction in the level of functioning and the number of operations performed during the study. However, the MMPI profiles were strikingly similar for all patients. Factors which were not predictive of surgical outcome included age, sex, duration of symptoms, number of back surgeries prior to entering this clinic, and the degree of pathologic condition discovered at operation. The failure to find a potent prediction scheme confirms that MMPI information must be used with considerable caution in treatment planning and only as an adjunct to other clinical and psychological data.


Anterior spinal tenderness in low-back pain syndromes. This paper describes the clinical sign of anterior tenderness of the lumbar spine in patients with low-back pain, the method of examination recommended, and the possible significance of such tenderness. The precise mechanism of this tenderness is not clear because of a lack of knowledge of the neuroanatomy of the anterior part of the spine. Anterior palpation of the lumbar spine should be considered part of a full routine examination in patients with low-back pain. Long-term follow-up and observations will be required before the full significance of this sign is revealed.


The disability oriented rehabilitation unit--a major factor influencing stroke outcome. Many investigators have analyzed the effectiveness of the cardiac care unit (as a model of a disability oriented, specially staffed, geographically isolated unit) in altering outcome following acute myocardial infarction. Little data are available, however, on the efficacy of caring for patients with stroke on specially staffed disability oriented units. Of 667 patients with stroke recently discharged from the Burke Rehabilitation Center, 589 were admitted to the stroke unit (SU group) and 78 were admitted to other units (NSU group). Statistical analysis showed that the SU patients were significantly weaker, had longer onset-admission intervals, and exhibited more concurrent medical problems and neurologic deficits. There were no statistically significant intergroup differences in age, sex, and distribution of weakness. Both groups had similar treatment programs provided by staff who had rotated through the stroke unit. Ability to perform activities of daily living (dressing, feeding, hygiene, bowel and bladder routines) and length of hospitalization were similar for both groups. SU patients walked better and went home more frequently than NSU patients. These data indicate than even in a rehabilitation center specializing in treating functional disabilities, patients with stroke are more likely to improve if placed on a disability oriented unit than if they are admitted to mixed disability units which are scattered throughout the hospital.


An enzymatic method permitting early determination of histocompatibility in mixed lymphocyte culture. The standard mixed lymphocyte culture assay, which measures the incorporation of [3H]thymidine into DNA, usually requires 5 days. We describe a more rapid assay based on changes in the activity of ornithine decarboxylase. An increase in the activity of ornithine decarboxylase was observed in mixed lymphocyte cultures from genetically defined, major histocompatibility complex (MHC)-nonidentical miniature swine as early as 18 hr after plating. No increase was found in mixed cultures from inbred MHC-identical animals. Similar results were obtained with the enzyme S-adenosylmethionine decarboxylase with the increase in activity starting at about 32 hr. There was a good correlation between the ornithine decarboxylase values at 18 hr and the results of the [3H]thymidine incorporation assay on day 5. Preliminary experiments with human lymphocytes revealed similar results.


Stimulation of allogeneic lymphocytes by skin epidermal cells in the rat. The ability of skin epidermal cells to induce allogeneic lymphocytes into proliferation was examined in mixed skin cell-lymphocyte culture reaction (MSLR). The stimulating capacity of skin cells was reduced significantly by trypsin digestion, although the damage was repaired by incubation at 37 C for 3 hr. The optimal concentration of mitomycin C for treatment of stimulating cells in the MSLR differed from that in mixed lymphocyte culture reaction (MLR). Irradiation rendered them three to four times more stimulatory than did mitomycin C. Removal of adherent cells from responding cells by passage through a nylon-wool column gave a substantial elevation of the MSLR. The lymphocytes cocultured with skin cells in the primary MSLR incorporated 3H-thymidine, with the peak at the 6th day of culture. If the lymphocytes primed in the MSLR were restimulated with skin cells from the same stimulating strain, the primed lymphocytes responded promptly and in great magnitude.


Sodium and potassium changes in blood bank stored human erythrocytes. Storage of red cells for three weeks at 4 C under blood bank conditions resulted in a rise in intracellular Na+ and a fall in intracellular K+ with concomitant opposite changes in Na+ and K+ levels in the suspending plasma. A decline in red blood cell ATP during the storage period did not appear to be contributing to the changes. Increasing red blood cell ATP to levels 2 to 3 times normal did not prevent the cation changes from occurring. When assayed at 37 C in the presence of added Mg++, ouabain-sensitive membrane ATPase activity and kinetics of activation by Na+ were unaffected by the three week period of cold storage. However, when assayed at 4 C without added Mg++, simulating the conditions of storage, ATPase activity was negligible. Sodium and potassium did not change when red blood cells with normal ATP content were stored at 20 to 24 C even in the absence of added Mg++. Thus, a major cause for the development of cation changes in the red blood cell during blood bank storage in the temperature which inhibits membrane ATPase, allowing cations to leak unopposed into and out of the red blood cells.


Efficacy of febantel in sheep experimentally infected with five species of gastrointestinal nematodes. The anthelmintic activity of the guanidine derivative febantel was tested in a total of 76 experimentally infected lambs in two control tests. Doses of 5.0 and 7.5 mg per kg body-weight were administered orally against fourth and pre-adult fifth or adult stages of Haemonchus contortus, Ostertagia circumcincta, Trichostrongylus colubriformis, B unostomum trigonocephalum and Oesophagostomum columbianum. The efficacy was between 98.5 and 100 per cent. The drug was well tolerated.


[Pathogenetic therapy of mastopathies in the prevention of breast cancer]. The breast cancer morbidity among the population of the city of Leningrad has been analysed. It was shown that there is a tendency to the increased number of breast cancer patients. In this respect attention is given to the prophylactic measures, accomplished in Leningrad City oncological dyspensary. As proved statistically, the pathogenetic therapy of mastopathy is a factor contributing to less risk of malignant transformation. For the statistical analysis the authors used the data of 132 breast cancer patients; previously operated upon for local fibroadenomatosis, and the data of 259 control patients. It was found that among the patients with fibroadenomatosis who subsequently developed cancer of the mammary gland, the proportion of untreated patients was 2.8 times as much as in the control group.


[Late manifestation of a burn of intestine caused by laparoscopic tubal sterilization (author's transl)]. 12 days after laparoscopic tubal sterilization by unipolar high-frequency current the clinical picture of an acute abdomen developed as sequel of a burn of small intestine followed by perforation and peritonitis. Symptomatology and therapy are discussed.


[Metaphylaxis, protection of the disabled and assessment of impairments by extra-pulmonary tuberculosis (author's transl)]. Problems of metaphylaxis, the care of disabled and impairments by extrapulmonary tuberculosis need special attention in the care of patients by the Policlinical Department for lung-diseases and tuberculosis. In order to realise and to approve the specific control recommendations for the follow-up and examination of impairments are given by which the work of care-services and the execution of control-measure on the appointed day in their daily activities is facilitated. Bacteriological control by culture and special X-ray-examination must be performed with superior rank. The assessment of impairments and the protection of the disabled correspond to the opinion of experts in these special fields where extrapulmonary tuberculosis has any importance.


Mucopolysaccharides in bronchial secretion of children. The diseases of respiratory system are nowadays one of the important medical, economical and social problems of modern civilization. A common symptom of these diseases regardless of their etiology, character, klinical manifestation and morphological findings is hypersecretion of bronchial sputum. Tracheobronchial mucus is produced by mucous bronchial glands and goblet cells. This mucus represents at physiological condition about 5 micrometer thick cover on mucous of nasopharynx, larynx, trachea, bronchi up to terminal bronchioles. Protective function of mucus cover resposes in mechanical and humoral barrier and also in removing the inhaled particles and their transport to the upper part of the respiratory system. In spite of the fact, that bronchial secretion has an important role in protective mechanism and in thermal and water exchange of respiratory tract, this secretion is not sufficiently scrutinized mainly of children yet.


[Isolation of influenza virus with the antigenic formula Hav4 Nav2 and Hav5 Nav2 during epizootic infection among sea gulls in the Astrakhan district in the summer of 1976]. Virological examinations of nesting colonies of Laridae birds in the avandelta of the Volga, Astrakhan region, during an epizootic in July, 1976, yielded 5 strains of influenza virus: 3 from Sterna albifrons, 1 from S. hirundo and 1 from Larus genei, identical with A/Sterna hirundo/S. Africa/61 (Hav5 Nav2) virus. At the same period two strains were isolated from Larus genei showing a previously unknown composition of the surface antigens: Hav4 Nav2. All the strains were isolated only from cloacal washings.


[Hygienic evaluation of the nutrition of the population in relation to endemic urolithiasis in the Chuvash ASSR]. By looking into the alimentary habits of the rural population residing in the urolithiasis endemic and non-endemic districts of the Chuvash ASSR the author ascertained definite differences in the content of calcium, silicon, strontium, manganese and cadmium in food rations of representative population groups under comparison. In the authors' opinion an elevated content of calcium, strontium, silicon, manganese and cadmium in food rations in inhabitants of the urolithiasis endemic districts is responsible for the urolithias endemy in the south-western areas of the republic.


[Various problems of epidemiology of viral hepatitis]. Because a rise in incidence of virus hepatitis observed in some years and showing an epidemic nature begins in one year and continues in the first quarter of the following year, it is recommended to register the incidence not from January to December, but from July to June of the next year in studies of some regularities of the epidemic process. Also, since in Baku a rise in incidence begins in July, it is suggested that planned gamma globulin prophylaxis be carried out not in September, but in early July. It has been established that children under 14 have virus hepatitis type A 10--24.4 times as frequently as adults.


A comparison of the lytic activity of poultry, human, and bovine phages with staphylococci of different origin. The total of 625 staphylococcal strains of different origin were typed with 22 Shimizu's poultry phages. For comparison all these strains were also investigated with the 24 phages of the international basic set for typing human staphylococci and with the 12 phages for typing bovine staphylococci. Of the 325 Staphylococcus aureus strains 50 from humans belonged to A biotype, 100 from chickens to B biotype and further 175 animal strains (of swine, rabbit, bovine, sheep, and hare provenance) to B, C, and D biotypes. Lytic activity of the poultry phages used at routine test dilution showed marked specificity related to the chicken strains were lysed. They were predominantly susceptible to phages CH4, CH14, CH15, CHA1, CHA2, CHA3, and CHA4. Most of the strains thus belonged to phage group I (74.0%), the others to phage groups II and III (18.0% and 2.0%). The examined strains of the other origins were either typable only sporadically (human in 4.0%, rabbit and bovine in 6.7%) or completely resistant. When the poultry phages were used at 100 x RTD the number of typable strains increased more significantly only in swine, rabbit, and bovine strains (23.3%, 60.0%, and 56.6%). On the contrary, human and bovine phages lysed chicken strains merely in 14.0% and 1.0% at RTD and in 20.0% and 3.0% at 100 x RTD respectively. All the 200 Staphylococcus intermedius and 100 Staphylococcus hyicus strains were resistant to the used 58 phages at RTD. When examined at 100 x RTD three Staph. hyicus strains were typable with the group IV phage CH11 from the poultry set, only.


[Serovars of NAG vibrios isolated from the water of open reservoirs]. Composition of serological types of NAG-vibrios isolated from the river water contaminated by effluents was found to be more varied than in uncontaminated water body. Vibrios of serological types 6, 8, 39, 41, 50, 53, 55 revealed frequently and in great amounts apparently inhabit the mentioned water bodies for prolonged periods.


Dynamic properties of in vitro enzyme systems containing phosphofructokinase. The dynamic properties of a series of in vitro reaction systems with increasing complexity and containing phosphofructokinase as central enzyme have been investigated. An experimental strategy and a principal mathematical treatment was elaborated to search for the minimum requirements with respect to the enzyme composition of a reaction system for generating limit cycle behaviour. As a criterion, such models have been developed which permit experimental realization by application of a specially designed flow-through equipment. In addition to phosphofructokinase, the following enzymes have been stepwise included into the reaction systems composing the Models 1 through 6: pyruvate kinase, adenylate kinase, hexokinase, and glucose 6-phosphate isomerase. It turned out that only a minimum dynamic system containing phosphofructokinase and pyruvate kinase as well as excesses of adenylate kinase and glucose 6-phosphate isomerase for maintaining equilibrium conditions between the respective reacting species, acquires the property of limit cycle behaviour and, hence, to generate sustained self-oscillations. The approach permits to compute the region of the experimentally variable parameters (influx rates of fructose 6-phosphate and ATP, maximum rate of pyruvate kianse) for which self-oscillatory behaviour can be predicted.


An indirect method to examine forces affecting Courvoisier's oblique gall-bladder incision. The aim of this study is to establish a method by which the maximum forces attacking Courvoisier's oblique gall-bladder incision can be evaluated. Nine well-informed patients served as subjects. Four investigations were made: pre-, per-, and two postoperative. The pre- and postoperative maximum isometric muscle strength in pulling forward were measured with a dynamometer. Simultaneously the IEMG was obtained. A muscle tensiometer was used for registration of the peroperative muscle pull of the right abdominal rectus muscle, and IEMG obtained simultaneously. The IEMG makes a calculation of the pre- and postoperative rectus muscle pull possible. The study seems to indicate that the most realistic estimation of the forces attacking the wound in the early postoperative phase is a preoperative measurement of the maximum force in pulling forward (attempted trunk bending). If ruptures in the wound occur during the extubation, ruptures would very likely also occur in the early postoperative phase. Eight weeks after the operation the right rectus muscle has regained its preoperative strength.


Biologically active luteinizing hormone (LH) in plasma. III. Validation of the in vitro bioassay when applied to male plasma and the possible role of steroidal precursors. An in vitro bioassay method for measuring LH activity was applied to male plasma. This method is based on the specific testosterone response to LH activity by interstitial cells from mouse testes. In contrast to assays conducted on female plasma, non-parallel response lines were obtained between serial dilutions of untreated male plasma and the International Reference Preparation for Human Pituitary Gonadotrophins FSH and LH/ICSH) for bioassay (code no. 69/104). In an attempt to eliminate this source of error, which would invalidate the assays, plasma was subjected to either ether extraction or charcoal adsorption prior to assay. While ether extraction was ineffective, charcoal treatment eliminated the source of non-parallelism. Evidence is presented indicating that the inclusion of a charcoal pre-treatment step provides an assay method for LH which fulfils the recognized criteria of reliability when applied to male plasma. An investigation of the likely causes of non-parallelism was undertaken by incubating mouse interstitial cells with various steroids and steroid sulphates at concentrations likely to be present in plasma. While most of the presumed precursors of testosterone were converted to testosterone, steroid sulphates (dehydroepiandrosterone sulphate and pregnenolone sulphate) at high concentrations as present in male plasma were the most active compounds in forming testosterone. However, the amount of testosterone produced from these precursors under controlled conditions was insufficient to account entirely for the deviation from parallelism observed with male plasma. Hence, the non-parallelism observed with untreated plasma samples cannot be entirely explained by the presence of steroidal testosterone precursors in male plasma.


Early changes in the arterial endothelium under various pathological conditions: an electron histochemical study with visualization of altered permeability using electron microscopic tracers. The authors have studied the endothelial changes in the aorta and the arteries of heart, kidney and other organs in cholesterol fed rabbits and endotoxin administrated rats through electron histochemical and vascular clearance methods. The vascular changes are variable presumably due to the functional and morphological difference of vessels. The administration of cholesterol and endotoxin may result in increased vascular permeability which is directly related to the qualitative increase and decrease of hydrolytic enzymes in the vascular wall. The permeability of high molecular substances was enhanced with the widening of the intercellular space in contraction of endothelium and the changing of molecular structure of plasma membrane accompanied with plasma lipid, platelets and hemodynamic stress. This fact was confirmed by use of horseradish peroxidase and dextran fesin as tracers of different molecular sizes. The authors emphasize that direct injury and subsequent abnormal contraction of the endothelial cell may initiate increased permeability of plasma protein and lipid in the medial layer and eventually may develop and enhance arteriosclerosis.


Disease pattern among 942 mentally retarded persons in a Danish county. An analytical description is presented of 942 mentally retarded persons from the county of West Zealand. The prevalence of mental retardation (i.e. persons who were registered with an IQ below 75) was 0.36%. Almost half of the patients were living in institutions. Of the patients 43% were women and 57% men. Important aetiological factors are listed. In almost one third of the patients, similar cases were present among the closest relatives; 30% of the patients were born as the fourth or subsequent child in the family; one sixth of the mothers were more than 35 years old at the birth of the handicapped child. Twenty-two percent of the patients with IQs below 50 had Down's syndrome. Seventeen percent of the patients had epilepsy had 11% cerebral palsy. In the central institution all patients had psychiatric or somatic complications.


Tryptophan-nicotinamide, imipramine and their combination in depression. A controlled study. In a double-blind controlled study lasting 4 weeks 25 newly admitted severely depressed patients were randomly assigned to tryptophan-nicotinamide or imipramine or tryptophan-nicotinamide-imipramine combination. Nicotinamide was given to reduce peripheral breakdown of tryptophan. Although there were no substantial differences between the three treatments, the efficacy of tryptophan-nicotinamide tended to diminish after 2 weeks when the dose of tryptophan was increased from 4 g/day to 6 g/day and that of nicotinamide from 1.0 g/day to 1.5 g/day. The therapeutic response of patients treated with tryptophan-nicotinamide was significantly correlated with the rise in plasma tryptophan. For the tryptophan-nicotinamide-imipramine group, however, therapeutic response and rise in plasma tryptophan were negatively correlated, implying that tryptophan levels were too high in some patients. The data suggest that tryptophan-nicotamide may be as effective as imipramine in unipolar patients providing the dose is kept within the therapeutic window, and that at low doses it could also potentiate the action of tricyclic antidepressants. Bipolar patients seem to require higher doses of tryptophan than unipolar patients.


[Properties of protamine-heparin complexes]. Protamine-heparin complexes have a considerable resistance to physical factors of the environment such as a high ion strength and acid or alkaline pH. Free protamine is digested by plasmin giving products with a greatly decreased ability to form complexes with heparin and lower antiheparin action. Bound protamine, on the other hand, is resistant to the action of plasmin as a result of which the enzyme does not release heparin from the complexes.


Clinical comparison of locetamic acid (cholebrine) and ipodate sodium (Orgrafin). Locetamic acid (Cholebrine) and ipodate sodium (Oragrafin) were compared in a double blind study of 503 patients. The radiographs were evaluated for contrast density, visualization of common duct, gallstones, residual in the intestinal tract, and side effects. Cholebrine demonstrated better opacification, fewer repeat examinations, slightly greater common duct opacification, and more frequent visualization of gallstones. Oragrafin had less residue. Side effects were minimal with both contrast agents.


ECG pattern of left ventricular hypertrophy in nonobstructive hypertrophic cardiomyopathy: the significance of the mid-precordial changes. A review of electrocardiograms from 33 patients with nonobstructive hypertrophic cardiomyopathy was made. In 22 patients there was noted a high QRS voltage, depression of the ST segment, and inversion of the T wave, satisfying the diagnostic criteria of left ventricular hypertrophy with the abnormal changes not only extending to the midprecordial leads but showing the most striking abnormal changes in Lead V4 in 20 patients. The frontal plane electrical axis was normal (around 60 degrees), with the most remarkable changes in Lead II. In the VCG, the magnitude of the QRS loop was increased and directed anteriorly and to the left, and the T loop was deviated posteriorly and to the right opposite the QRS loop. The asymmetric septal and apical hypertrophy was noted on echocardiography and/or angiocardiography. The coronary arteries were normal without significant obstruction in selective coronary angiography. It was postulated that the asymmetric septal and apical hypertrophy was reflected in this ECG pattern. The recognition of this ECG pattern provides pertinent information in the clinical detection of nonobstructive HCM.


Influence of preoperative left ventricular function on results of homograft replacement of the aortic valve for aortic stenosis. The effect of preoperative left ventricular function on early and late prognosis was assessed in 103 patients with aortic stenosis who underwent left ventricular cineangiography before homograft replacement of the aortic valve. The patients were separated into two groups: Group A (58 patients) with an ejection fraction of 0.46 or more and Group B (45 patients) with an ejection fraction of 0.45 or less. The two groups were compared with respect to clinical and hemodynamic data as well as operative result. There was poor correlation between clinical data and left ventricular function. In Group A there were three early deaths (5.2 percent) and three late deaths (5.2 percent) compared with no early and six late deaths (13.3 percent) in Group B during the follow-up period of 12 to 102 months (mean 43 months). Most patients in Group B showed considerable symptomatic improvement but less than that observed in Group A. Forty-two patients (13 in Group A and 29 in Group B) underwent repeat cardiac catheterization and coronary angiography. Improvement in left ventricular function as assessed by radial analysis of segmental wall motion and ejection fraction was observed in 20 of the 29 patients in Group B. Failure of left ventricular function to improve was associated with additional coronary artery disease in the majority of patients. It is concluded that poor left ventricular function does not increase the risk of aortic valve replacement for aortic stenosis and that improvement in left ventricular function can be expected in the majority of patients.


Familial occurrence of gastroschisis. Four new cases and review of the literature. In two unrelated families, there was familial occurrence of gastroschisis. In one family, a boy and girl were affected and there was a family history of stillbirth, abortion, prematurity, and esophageal obstruction. In the second family, two boys were affected and there was a family history of spontaneous abortion, inguinal hernia, and umbilical hernia. The recurrence of gastroschisis, generally considered a sporadic congenital effect, suggests that the condition may be genetic in nature. Furthermore, the pedigree of one of the families suggests that gastroschisis may be a severe expression of umbilical hernia or other abdominal wall defects. Autosomal dominant inheritance with variable expressivity or multifactorial inheritance may explain the occurrence of gastroschisis in the two families. Thus, a family history of abdominal wall defects may increase the risk for gastroschisis.


Acne vulgaris. Current concepts of pathogenesis and treatment. Although the basic cause of acne vulgaris remains unknown, considerable data that concern its pathogenesis and that have been accumulated in recent years allow a rational and therapeutically successful approach to the management of this disorder. To date, there is no single treatment for acne. Therapy must be individualized, with appropriate variations and modifications as the degree or severity of this disorder fluctuates. Today, this goal can be achieved by proper selection of available medications, coupled with the cooperation of the patient, and the knowledge, continued interest, and enthusiasm of the physician and his staff.


Steroid-sulfatase deficiency in sex-linked ichthyosis. Steroid-sulfatase activity was absent in the cultured fibroblasts of nine affected members of eight families with sex-linked ichthyosis. An intermediate value of enzyme activity was found in an obligate heterozygote and a normal value in a patient with ichthyosis vulgaris. Cultured epidermal cells of an affected individual also had no enzyme activity, while normal cultured epidermal cells did.


Abnormal skin fibroblast cytogenetics in four dysmorphic patients with normal lymphocyte chromosomes. Four patients with features suggestive of chromosome disorders but with normal lymphocyte karyotypes were found to have chromosome aberrations in skin fibroblast karyotypes. Although mosaicism for chromosome abnormalities in lymphocyte cultures is common, apparent restriction of mosaicism to one tissue is unusual. We suggest that after examination of lymphocyte karyotypes, certain patients warrant cytogenetic evaluation of a second tissue, usually cultured skin fibroblasts.


Phosphorylation of a bovine cardiac actin complex. A bovine cardiac actin-tropomyosin-troponin complex was phosphorylated in the presence of [gamma-32P]ATP, Mg2+, adenosine 3',5'-monophosphate (cyclic AMP), and bovine cardiac cyclic-AMP-dependent protein kinase. Approximately 81% of the [32P]phosphate incorporated was identified as phosphoserine and phosphothreonine. Gel electrophoresis studies showed that 55% of the [32P]phosphate was associated with the inhibitory component of troponin (Tn-I) and 24% with a protein resembling the tropomyosin-binding component of troponin in the actin complex, respectively. The phosphorylation of Tn-I in the actin complex was inhibited 30% when Ca2+ was increased from 0.1 to 50 muM, but phosphorylation of other components was not affected by increasing Ca2+ concentration. Half-maximal calcium activation of the ATPase activity of reconstituted actomyosins made with the [32P]phosphorylated cardiac actin complex and cardiac myosin was shifted to Ca2+ values higher than those of actomyosins made with the nonphosphorylated actin complex.


Anion-stimulated ATPase activity of brush border from rat small intestine. Differential centrifugation of rat small intestinal homogenates produced a crude brush border (BB) fraction that was enriched 15-fold for the marker enzymes, alkaline phosphatase and sucrase; contamination with mitochondrial enzymes, monoamine oxidase and succinate dehydrogenase, was minimal. ATP hydrolysis by this BB fraction was stimulated by addition of several anions to the incubation medium: HCO3 and Cl were equally effective in this regard, with NO3, NO2, SO4, and acetate being less stimulatory. SCN and CNO inhibited ATPase activity, whereas the divalent anion SO3 was stimulatory at low concentrations (less than 25 mM) but inhibitory at 100 mM. Maximum anion stimulation was observed at a Mg concentration of 0.5 mM, and pH optimum was 8.5. Kinetic analysis showed that HCO3 increased the Vmax without altering the Km for ATP; the Ka for this effect of HCO3 was 35 mM. This enzyme activity was completely inhibited by 20 mM L-phenylalanine, 10 mM L-cysteine, and 3 mM EDTA, compounds that also inhibited intestinal alkaline phosphatase. These results demonstrate the presence of anion-stimulated ATPase activity in rat small intestinal brush border and suggest that this activity may be related to intestinal alkaline phosphatase. The role of this enzyme in intestinal transport is not known, but could relate to the regulation of intestinal absorption and secretion.


Extracellular space, water, and ion concentration in the hypertrophied rat myocardium. Extracellular space (ECS), water, and intracellular ion concentration were determined in the normal and hypertrophied rat myocardium. Theoretical measurements of myocardial ECS based on a mathematical model (9.31%) closely approximated the observed results in the normal myocardium (12.8%) and hypertrophied myocardium (11.7%). Observed results confirmed theoretical considerations of no change in ECS with hypertrophy. ECS and water content were higher in the right ventricle than the left ventricle, but intracellular electrolytes remained unchanged. Myocardial hypertrophy did not alter these relationships.


Fructose-6-phosphate substrate cycling and glucose and insulin regulation of gluconeogenesis in vivo. The question whether glucose or insulin regulates gluconeogenesis by effecting changes in the fructose-6-phosphate (F-6-P) substrate cycle (phosphofructokinase (PFK), fructose-1,6-diphosphatase (FDPase)) was investigated in vivo in fasted normal rats using [3-3H,U-14C]- or [3-3H,6-14C]glucose. The plasma glucose 3H/14C ratio was used as an index of substrate cycling because 3H loss from the liver hexose phosphate pool is limited by the activities of PFK and FDPase during gluconeogenesis and glycolysis, respectively. The 3H/14C ratio was corrected where necessary for glucose or insulin-induced changes in reincorporation of 14C from C-6 to C-1-3 of plasma glucose. A glucose infusion producing hyperglycemia and insulinemia was accompanied by decreased hepatic glucose production and diminished F-6-P substrate cycling, i.e., decreased FDPase activity. When insulin was infused along with glucose to produce high plasma insulin levels and avoid hypo- or hyperglycemia, the 3H/14C decay rate did not change, suggesting that the hormone does not influence basal rates of gluconeogenesis or PFK or FDPase activities. These in vivo results suggest that increased blood glucose levels inhibit gluconeogenesis and depress F-6-P substrate cycling. Whether these cycle changes constitute primary regulatory actions of glucose or occur secondarily to other metabolic events resulting from excess hexose (e.g., increased glycogen synthetase activity) cannot now be concluded.


Effects of starvation and diabetes on protein synthesis in lung. Metabolism of lung proteins was investigated in rats starved 3 days or made diabetic with streptozotocin. Body weight was below normal in both groups, but lung weight decreased only in starved animals. Total lung protein and RNA (mg/lung) decreased during starvation and diabetes. Protein concentration (mg/g) was unchanged in either group of animals; RNA concentration decreased only during starvation. Protein synthesis, estimated in lungs perfused in situ, was reduced 22% in starvation, but remained unchanged in diabetes. Inhibition of protein synthesis was accounted for by loss of RNA. Ribosomal profiles were unchanged by starvation, suggesting an unaltered relationship between rates of peptide-chain initiation and elongation in vivo. Activity of an eIF-2-like initiation factor decreased during starvation in proportion to the loss of RNA. In diabetes, factor activity remained normal. Thus, starvation but not streptozotocin-induced diabetes, reduced the capacity of the lung to synthesize protein. No evidence for reduced efficiency of synthesis was observed.


Natural biventricular hypertrophy in normotensive rats. I. Physical and hemodynamic characteristics. The Wistar-Kyoto strain of normotensive rats (WKY) is being used as a control animal for studies involving the spontaneously hypertensive rats (SHR). A subset of the WKY demonstrating an inheritable transmission of biventricular cardiac hypertrophy (BVH) has been identified. The cardiac enlargement is pronounced, with right and left ventricular weights greater than twice normal in some animals. This natural development of BVH appears to be in response to an increased cardiac output. Blood pressure is normal and, therefore, peripheral resistance is reduced. Left ventricular injection of 15-micrometer radioactively labeled microspheres demonstrated that WKY with BVH had a substantial shunt fraction of their cardiac output (45 +/- 7% radioactivity recovered in the lungs vs. 3 +/- 2% in normal WKY). This subset of WKY with BVH provides a natural model of volume-load hypertrophy. In addition, investigators using the WKY for comparison with SHR should exclude animals with BVH.


Reconstruction of the anterior cruciate ligament in the dog. Comparison of results obtained with three different porous synthetic materials. The anterior cruciate ligaments in 17 knees of 12 mongrel dogs were replaced with one of three porous minimally reactive prosthetic (synthetic) materials. The results show that while the porous materials support the ingrowth of fibrous tissue from the bone of the dog's knee, fatigue failure occurred before sufficient fibrous tissue was incorporated to reconstitute a functional ligament. Further laboratory investigation is necessary before prosthetic materials, currently available, can be used in the unstable human knee.


Experimental uveitis in isolated humoral and cellular immunity. Passive transfer of homologous immune serum in rabbits followed by intravitreous injection with the corresponding antigen resulted in an uveal inflammation which resembled the Arthus-type reaction. Clinically and histologically, the reaction was maximal 24 h after antigen injection. The histologically observed cell infiltration consisted predominantly of polymorphonuclear leukocytes. Passive transfer of sensitized homologous thymocytes followed by intravitreous injection with the corresponding antigen resulted in an uveal inflammation which resembled the delayed-type hypersensitivity reaction. Tissue infiltration of polymorphonuclear cells as well as mononuclear cells occurred predominantly during the first day following antigen injection. An exudate containing almost exclusively eosinophils was present in the aqueous humor and/or vitreous body of most of these rabbits. During the second day an increase in the ratio monomuclear cells/polymorphonuclear cells could be observed.


Gonorrhea. Center for Disease Control recommended treatment schedules, 1979. These recommendations specify appropriate treatment, including dosage of antibiotics for uncomplicated gonococcal infections in adults, infections with penicillinase-producing Neisseria gonorrhoeae, acute salpingitis, acute epididymitis, disseminated gonococcal infections, and gonococcal infections in pediatric patients (including neonatal infections). Special attention is given to important diagnostic considerations, relation of gonococcal infections to concomitant venereal infections, treatment of sexual partners, follow-up, treatment failures, treatments not recommended, allergic problems in treatment, needs for hospitalization, and prevention of gonococcal ophthalmia. Attention is called to the importance of using no less than the recommended dosages of antibiotics.


[Repeated abortions, sterility and systemic dysimmunopathy (author's transl)]. A patient with lupus disease had a previous medical history of five recurrent temporary bouts of thrombopenia which were followed by spontaneous abortions. This raises the two-fold problem of the relationship between circulating immune complexes disease and thrombopenia, and dysimmunopathy and pregnancy disorders. The hypothesis is raised of a trophoblastic necrotizing angeitis due to abnormal immunity processes involved in some cases of sterility, spontaneous abortions, and even nephropathies during pregnancy.


Heart muscle mechanics.

Heart muscle mechanics. The goal implicit in the research reviewed above is to describe the contractile behavior of heart muscle in terms of crossbridge and filament behavior. It is necessary to elucidate these details in cardiac muscle because of the distinct biochemical differences between skeletal and cardiac myosin. As is evident in this review, significant advances have been made toward describing unique mechanical properties of cardiac muscle crossbridges. Several major problems now require attention: (a) Activation parameters are labile, making mechanical measurements sensitive to measurement perturbation; (b) significant structural inhomogeneities at the cellular and sarcomere level prevent precise assignment of externally measured force to internal structures (force generators, passive elements) within whole cardiac muscle and individual cells; (c) high resting stiffness and forces of poorly understood origin and properties confound attempts to interpret force measurements and dynamics. The differences between heart and skeletal muscle myosin may provide the means for identifying structural counterparts of the Huxley-Simmons model (33); they may also be useful in evaluating the electrostatic and quantum-mechanical models.


Molecular aspects of cardiac hypertrophy. Despite continuous interest in cardiac hypertrophy, our knowledge of its molecular aspects is still elementary. Recently, however, several advancements of particular interest have been made: (a) Nuclei of muscle and nonmuscle cells have been separated, allowing for the first time the study of nuclear activity in specified cells (18). (b) Cardiac growth induced by pressure-overload (72) or by hormone treatment (26) has been shown to lead to myosin of altered ATPase, and strong evidence suggests that new species of myosin molecules thus appear. (c) The basis for assessment of protein synthesis and degradation has been established (46, 48). (d) Methods are being developed to supplement radioautography in evaluating cell proliferation (42, 59, 69). (e) In spontaneously hypertensive rats it has been shown that blood pressure might not be the sole factor responsible for cardiac enlargement, but that hypertrophy can be the result of genetic cardiovascular abnormality (19, 66). (f) A hypothesis relating the extent of energy utilization to the nuclear activity via NAD+ metabolism has been proposed, which allows for experimental verification (43).


Modulation of membrane-bound enzyme activity by binding of antibodies to major histocompatibility complex antigens. The preparation of right side-out vesicles from mouse plasmocytoma plasma membranes can be used to study the early functionnal events of the plasma membrane upon binding of ligands. Activation of two membrane-bound enzymes, 5'-nucleotidase and Na+/K+ ATPase, induced specifically by several anti-H-2 antisera was investigated. A simultaneous stimulation of these two enzymes was reported at high dilutions of antisera directed against antigens of the MHC. Comparison between the enzyme activation test and the classical cytotoxicity test showed the former being more sensitive than the latter by at least one order of magnitude. A structural coordination between some histocompatibility antigens and/or other cell surface receptors and the membrane-bound enzymes could be envisionned for the initiation of lymphocyte activation.


The arthritic in an urban environment.

The arthritic in an urban environment. Ninety-five patients with rheumatoid arthritis or osteoarthrosis were interviewed and questioned in their homes, being randomly selected from 354 outpatients with these diseases. The findings were compared with answers from 30 matched able-bodied controls. The handicapped were mainly female and elderly; over half were severely or appreciably handicapped; nearly one-third lived alone. The average weekly income of these households was pound25, at least pound6 a week less than their age-matched counterparts. Very few subjects lived in adapted or specially designed housing, and half the housing had at least 2 steps to street level. A third of the sample could not walk more than 10 yards (9 m), and only half could walk 100 yards (90 m); yet only one-third had a bus stop, one-quarter a local park, and one-third a local shop within this distance. One-third of the patients could not shop for themselves. Powered wheelchairs were not used. Buses were rarely or never used by nearly half these arthritics because of severe disability. Cars were owned by less than a quarter of the sample, and only by those financially better off. Over a third were unable to get a lift when wanted. Cars ameliorated much of the frustration and lack of social contact caused by physical disability. Adequate financing would enable those with severe disability to engage in normal activities. Better designed buses stopping nearer the homes of handicapped would improve independence for those less severely disabled. Correct siting of mobility housing, shops, community facilities, and parks would be greatly appreciated, as would removal of all unnecessary steps and kerbs.


Diabetes mellitus and neuropathy following Vacor ingestion in man. Two patients ingested Vacor, a rodenticide containing the active ingredient N-3 pyridylmethyl-N'-p-nitrophenyl urea. Both patients developed ketosis-prone diabetes mellitus and severe autonomic neuropathy. Niacinamide therapy given nine hours after Vacor ingestion in one patient and 14 hours after ingestion in the other was not successful in preventing these sequelae. Physicians need to be aware of the toxicity of Vacor, and the potential therapeutic benefit of early niacinamide therapy.


[Familial congenital muscular dystrophy caused by phosphofructokinase deficiency]. Two children, born to related parents, presented since birth a muscular defect rapidly complicated by painful joint stiffness. The oldest child died at 6 months of age, from respiratory complications. The second-14 month old- does not sit without support. The muscle fibres are of unequal calibre and numerous fibres have under-sarcolemmal PAS positive areas contain glycogen, as seen on electron microscopy. In the second patient, the biochemical analysis showed a moderate glycogen accumulation and muscular enzymatic studies demonstrated an isolated and major deficiency in phosphofructokinase activity. Activity was normal in red blood cells and in fibroblasts cultured in vitro. Hence, these cases should be distinguished from formerly reported cases of phosphofructokinase deficiency. This type of P.F.K. deficiency should be looked for in patients with severe congenital muscular dystrophy and early joint involvement.


Studies on the human mixed lymphocyte culture. I. The influence of the irradiated autogenic and allogenic lymphocytes on DNA synthesis. Fourteen patients with chronic renal failure and their prospective living donors were examined. DNA uptake by donors' monocultures, recipients' monocultures and mixed cultures was measured. The influence of X-ray treated cells on proliferative capacity of untreated cells in these three types of cultures was studied. The suppressing effect of irradiated cells was found in 52%, the enhancing one in 7% and no effect was observed in 41% of lymphocyte cultures. The possible explanations of the findings are discussed.


Studies on the human mixed lymphocyte culture. II. Comparison of one-way and two-way test performed on lymphocytes of patients with end-stage renal failure and their prospective living donors. The results of DNA synthesis in human one-way and two-way mixed lymphocyte cultures were compared. Twenty patients with chronic renal failure and their twenty six prospective living donors were investigated. Statistical correlation was found on the level alpha = 0.01 between the stimulation index value calculated for one-way and two-way technique. Two-way MLC, the rapid and simple and simple assay detecting lymphocyte activation is a very useful tissue typing test.


Immunosuppressive effect of concanavalin-A. I. Suppression of generation of cytotoxic lymphocytes in MLC. The effect of Con-A on the generation of cytotoxic lymphocytes (CL) in one way MLC was studied using mouse model. Mitogenic doses of Con-A substantially inhibited primary and secondary CL responses. Spleen cells after in vivo activation by Con-A revealed complete lack of ability to respond in allogeneic MLC. When such cells were added to normal responding cells, even at low proportion, CL generation in primary MLC was also diminished. These observations support the hypothesis that immunosuppressive effect of Con-A is exerted by stimulation of suppressor cells.


The appearance of factors influencing migration of lymphocytes (LyMIF and LyMSF) in rabbit mixed lymphocyte cultures. In vitro migration of mixtures of peripheral blood lymphocytes derived from 26 pairs of rabbits was significantly suppressed in 73% of cultures, significantly enhanced in 4% and unchanged in 23%, as compared to the corresponding monocultures. Sensitization of 26 rabbits by kidney graft resulted in more frequent appearance of migration enhancing factor. Six days after grafting 54% of donor-recipient mixed cultures showed enhancement of migration, 31% inhibition and 15% no effect. No enhancing factors were produced on the 9th day.


The effect of ATG treatment on LyMIF and LyMSF production in mixed lymphocyte cultures of rabbits after renal allotransplantation. Rabbit lymphocytes, settled up in microcappillary tubes migrate into culture medium. In the previous communication we have shown that migration of mixture of lymphocytes derived from two blood donors was significantly inferior in 73% of cultures as compared to the corresponding monocultures. 4% of mixed cultures exhibited significant enhancement of migration and in 23% no effects were seen. Use of lymphocytes from rabbits 4-6 days after kidney allotransplantation and their corresponding donors resulted in conversion of this ratio. Percentage of cultures exhibiting enhancement of migration (production LyMSF) rose to 39, 46% of cultures were inhibited (produced LyMIF) and 15% did not show any significant effect. Treatment of kidney recipients with ATG exerted strong inhibitory effect on the appearance of LyMSF and on the appearance of LyMIF in mixed cultures. These results suggested that LyMIF and LyMSF were produced by separate cell populations.


Steroids and immunosuppression. Effect on anastomotic intimal hyperplasia in femoral arterial dacron bypass grafts. The effects of steroids and immunosuppression on 6-cm long bilateral femoral arterial Dacron bypass grafts were studied in 30 adult mongrel dogs. The dogs were serially placed into one of the following three groups: control, steroid, and immunosuppression. The control and steroid groups each had a 70% graft patency rate, whereas the immunosuppression group had a 100% eight-week graft patency rate. The results in the steroid group were not statistically different from the control group, whereas the results in the immunosuppression group were statistically different from the control. The decrease in internal diameter was secondary to a localized accumulation of tissue at the anastomotic site, which histologically appeared to be a hyperplastic intima morphologically different in each group. There is a substantial decrease in intimal hyperplasia at anastomotic sites and a higher graft patency rate in dogs treated with low-dose azathioprine as compared with control of steroid-treated animals. The mechanism seems to be a slower and more orderly intimalization rather than suppression of any specific intimal cellular elements.


Axillo-axillary bypass for subclavian steal syndrome. Since 1972, 14 patients with subclavian steal and four with primary vascular insufficiency of the arm have been operated on using the axillo-axillary bypass graft. Two grafts have been replaced, one after nine months for threatened erosion, and the other after three years for thrombosis due to disease progression in the donor artery. The new grafts were patent at three and at 2 1/2 years. One graft was occluded at six months and was not replaced. All other patients under observation in 1978 have grafts patent at one month to 6 1/2 years (average 2.2 years). Life table analysis shows the probability of graft patency (20 grafts) is 76% at three years. In the subclavian steal group steal on the left side predominated 2:1. Cerebral symptoms predominated with arm symptoms less often seen, although six patients had both. Associated vascular disease and hypertension were common. There was no mortality and few complications. Axillo-axillary bypass grafting is considered the operation of choice for patients with subclavian steal syndrome.


Suture material as a factor in the occurrence of anastomotic false aneurysms. An analysis of 26 cases. False aneurysm formation is a well-recognized late complication of prosthetic graft insertion. Despite the fact that other etiologic factors may be involved, the behavior of the suture material remains of central importance. In a retrospective review of 1,330 peripheral vascular cases, we found 26 cases involving a total of 39 false aneurysms, or an incidence of 2% (26/1,330). Twenty-four of these were directly attributable to failure of the monofilament plastic suture or silk suture material. Braided Dacron suture was used in the original anastomosis in another seven cases, and in these instances the false aneurysms were not related to suture failure but were association with such factors as previous endarterectomy, failure of arterial wall, and chronic hypertension. None of the 39 aneurysms was secondary to infection or trauma. These results emphasize the importance of using a braided, nonabsorbable suture material to ensure the continued integrity of an anastomosis involving prosthetic grafts.


[Lengthwise splitting of myocardial cells and nuclei]. A possibility of a peculiar method for division of myocardial cells and nuclei--longitudinal splitting--has been studied in hypertrophic hearts of 19 corpses. Morphological examination of the myocardium (separate weighing of the cardiac ventricles, measuring of myocardial components and muscular fibres in microphotos of transversal sections) has not revealed any signs of longitudinal fibres splitting: their average thickness either increase or remain the same with growth of muscular mass, and per cent of thin and thick fibres remains within limits of unreliable fluctuations. Analysis of serial transversal sections of muscular fibres and their micrometry confirm the reality of longitudinal splitting of the nuclei which is realized through several steps and depends on the degree of hypertrophy of muscular fibres.


[Alterations in the secretory glandulocytes of the stomach in the presence of an imbalance in adrenal cortex and thyroid gland hormones]. Gastric secretory granulocytes in Wistar rats were studied electron microscopically and microspectrophotometrically. Injection of L-thyroxin for 10--30 days resulted in decrease of acid phosphatase and ATPh-ase activity in the main and parietal granulocytes. Injection of hydrocortisone after or simultaneously with saturation of the organism with L-thyroxin results in increasing acid phosphatase activity of these cells. After simultaneous prolonged injection of these two hormones, the number of lysosomes increased in parietal glandulocytes and mitochondrial membranes were destroyed in the main and parietal glandulocytes. Together with these phenomena, changes in the activity of oxidative-reductive enzymes were observed, demonstrating a sharp decrease of energetic importance of the main oxidation way in Krebs cycle.


The improving hematologic picture in long-term surviving calves with total artificial hearts. A coagulopathy associated with severe hemolysis was a limiting factor in obtaining long-term survivors among calves with total artificial hearts in 1969. Conversion of design from sac-type hearts to flexible diaphragm hearts, and from Silastic Dacron-fibril intimas to smooth polyurethane intimas, resulted in an abatement of the coagulopathy. In the most recent series of animals studied at this laboratory, platelet counts are normal and platelet survivals are half of normal. Plasma hemoglobins are normal. The coagulation system is still activated at specific loci within the total artificial heart, but is best compensated for in calves treated with antiplatelet drugs, having polyurethane hearts.


Interface radiation dosimetry in mandibular reconstruction. When a beam of radiation crosses the interface between two substances, secondary electrons are generated. This results in enhancement of the absorbed dose of radiation roughly proportional to the difference in atomic numbers. Interfaces are created in reconstruction of the mandible with implantable trays containing hematopoietic bone marrow and cancellous bone chips. Radiation was measured in tissue-equivalent material surrounding mandibular tray implants of titanium, vitallium, stainless steel, and Dacron/polyetherurethane. The absorbed dose was enhanced by 29% to 36% adjacent to the metallic trays; 1% dose enhancement was noted adjacent to the Dacron/polyetherurethane tray. We conclude that, when radiation therapy is necessary following mandibular reconstruction, homogeneity of dose is maintained and local soft-tissue reactions to excessive irradiation may be avoided by using a nonmetallic tray.


Stenotic conditions of the lumbar spinal canal: changes in surgical techniques in the management of low back disability. The diagnostic recognition of acquired stenotic conditions in the lumbar spinal canal occurring from the fifth to the eighth decades of life had led to a significant change in surgical techniques during the last ten years. This communication presents a comparison of surgical techniques used by the author in two consecutive series of patients operated for low back, lumbosciatic, and spondylotic caudal disability syndromes during the period 1965 to 1969 inclusive (100 patients) and 1976 and 1977 (105 patients). Interlaminar discectomy was carried out in 88%, and laminectomy with spinal nerve nerolysis in 12%, of the 1965  - 1969 series. Discectomy by interlaminar approach was carried out in only 10% of the 1976 - 1977 series; all other patients had laminectomies with or without discectomies. Early follow-up results in the recent series indicate a significant (20%) increase in the number of patients who resumed their previous occupations as compared with those in the previous series.