Zinc and copper levels in whole blood and plasma from patients with squamous cell carcinomas of head and neck. Zinc in plasma and whole blood from 13 patients with squamous cell carcinoma of the head and neck was significantly decreased, and the copper:zinc ratio in the plasma was significantly higher than in healthy controls. The plasma zinc was significantly lower in patients who did not respond to therapy and who died within 12 months than in those who responded to therapy and had a remission within 12--15 months. In patients responding to therapy and alive after 12--15 months, zinc in the plasma and whole blood and the copper:zinc ratio became normal. These results suggest a potential screening and predicting value of zinc in the plasma and whole blood and the copper:zinc ratio in squamous cell carcinoma of the head and neck.


Arsenically associated cutaneous squamous cell carcinoma with hypercalcemia. Squamous cell carcinoma of the skin complicated by hypercalcemia is very rare. This report is of a patient with long-term exposure to medicinal oral arsenic who developed an extensive squamous cell carcinoma complicated by hypercalcemia.


Gliomatosis peritonei: the value of a "second look" operation. The case history of a 10-year-old black girl with gliomatosis peritonei, Grade 0, is presented. The primary tumour was resected and a "second look" operation carried out 3 months later. The glial implants demonstrated distinct circumferential and intra glial fibrosis (resolution). Because the peritoneal implants had undergone resolution, further therapy became unnecessary. We believe gliomatosis peritonei fully justifies a second laparotomy in order to be able to accurately grade the implants. The grade of the peritoneal implants influences the prognosis and therefore determines the type of therapy to be instituted.


Carcinoembryonic antigen (CEA) as prognostic marker in colonic cancer. Radioimmunoassay for serum carcinoembryonic antigen (CEA) was performed in 49 colonic cancer patients. The test results were positive in 42 patients (85.7%) in whom tumor was present at the time of assay. Preoperatively, CEA level suggested the extent and the prognosis of the disease. Strongly positive CEA test results in such patients correlated with metastatic tumors and poor prognosis. Postoperatively, a positive result for serum CEA indicated presence of residual tumor, while negative results did not exclude residual tumor. Periodic CEA determination in the patients who have undergone resection of colonic cancer may detect tumor recurrence that is at a treatable stage. The data show that patients in whom the immediate postoperative CEA concentration returns to normal have a much lower incidence of recurrent cancer of the colon than patients whose CEA level remains elevated.


Mutilating sclerosing basal cell epithelioma. A 59-year-old black woman presented with an ill-defined plaque on her nose. This appeared clinically suggestive of a sclerosing type of basal cell epithelioma (BCE). Microscopic sections demonstrated this diagnosis. Multiple excisions employing the microscopically controlled technique of Mohs traced the tumor deep into the nasal cartilage before histologic sections were free of tumor cells. This type of BCE deserves well planned therapy because of its destructive potential.


Results of treating 1,178 patients with breast cancer by radical mastectomy and postoperative irradiation where metastases to axillary lymph nodes occurred. A retrospective study of 1,178 females suffering from cancer of the breast and treated by radical mastectomy is presented. All operations were performed by essentially one group of four senior surgeons, each either trained or connected with Memorial Sloan Kettering Hospital in New York and spent practically all of his professional career in the treatment of cancer. The same techniques of surgery were practiced. The same principles of the overall treatment were utilized; namely, if there were no metastases to lymph nodes detected on histologic studies, no radiation therapy was given. If metastases were present in the axillary lymph nodes, each of the patients received postoperative radiation therapy. None received either chemotherapy nor immunotherapy, as primary treatment. The study includes all patients treated between 1930 and 1965 and complete follow-up data were obtained in 94.6% of all patients. Five hundred and ninety-six patients were classified histologically as Stage I (50.6%), 291 as Stage II (24.7%), 74 as Stage III (6.3%), and 217 patients (18.4%) were undetermined. The total number of patients who developed a second primary cancer in the remaining breast was 91 (7.7%), and only 51 patients (4.3%) developed local recurrences in the chest wall or axilla. The mean age of the patients was 51.9 years. The absolute 5-year survival of all patients was 64% and the 10-year survival equaled 54.6%. The 9.4% mortality between the 5- and 10-year survival emphasizes that the 10-year survival figures are a more accurate index of survival. The larger the tumor, usually the poorer the prognosis, except where the tumor was 8 cm or larger where the prognosis was rather good. This indicates some biologic resistance to the tumor, making patients with large tumors candidates for "curative" radical mastectomy. The delay in seeking treatment had minimal effect on the overall survival. Staging had a significant effect and the 5-year survival for the Stage I group was 81.7% which declined to 60.3% at the 10-year period. In the Stage II group, these values were less and averaged 63.7% 5-year survival and 47.2% 10-year survival. The 74 patients wiival at the 10-year period. It is concluded that radical mastectomy plays an important role in curing a significant number of patients with breast cancer. Whether it should be abandoned for more conservative surgery is a matter which further studies will indicate. This study presents a baseline investigation, under a more-or-less standard clinical situation for evaluating the accomplishments of the radical mastectomy.


Serum immunoglobulins in women with breast cancer. Serum immunoglobulins were determined in 120 women with breast cancer. A strong association between age at tumor diagnosis and serum IgA levels was noted. Relative hypoglobulinemia of IgA was associated with appearance of tumors early in life, and was more frequent among women with family history of breast cancer and among those with poor prognosis. A strong association between levels of serum IgG and parity was noted. Parous women and/or those who had good prognosis had higher levels of serum IgG, compared to nulliparous women and those with poor prognosis. The observations indicate that serum immunoglobulins may be useful in the identification of women who have a high breast cancer risk and poor prognosis.


Alterations in gastrointestinal contents induced by elemental diets. The effects of elemental diets on selected aspects of the rat colon were studied. Forty young male Sprague-Dawley rats were divided into 4 diet groups of 10 rats each: Purina Rat Chow (control); Flexical; Precision L-R; and Vivonex. All diets were fed ad lib to rats housed in pairs in wire-bottom cages. Two weeks after weight stabilization had been achieved all rats were killed and colon contents were collected for culture and short-chain fatty acid analysis on the Perkins-Elsoner 3920 gas chromatograph. Colon fecal butyric/acetic acid ratios of the rats in the 4 groups were: Rat Chow, 2.56; Flexical, 0.28; Precision L-R, 0.16; and Vivonex, 0.26. Bacterial cultures showed increased coliform and enterococcal species in the rats consuming elemental diets.


Chronic hematuria and localized bladder damage following combined cyclophosphamide and local radiotherapy. A 13-year-old white male had Ewing sarcoma of the right pubic and ischial bones. Initial therapy consisted of 5,400 rads in seven weeks to the right side of the pelvis and 14 intravenous injections of cyclophosphamide (Cytoxan, CTX) at 500 mg/m2; BCNU and Adriamycin maintenance therapy continued for a total of two years. He has now been disease-free for five years. Three months following the completion of the right pelvic radiotherapy (RT), while on intravenous CTX, severe hematuria appeared, which subsided, but at present he has continuous microscopic hematuria, as well as periodic episodes of gross hematuria. Serial cystocopies initially revealed thickening and hemorrhagic and edematous changes on the right (irradiated) side of the bladder, and recent multiple telangiectatic patches have been demonstrated as a late "healing" phase. This case demonstrates the additive toxicity to the bladder of CTX and RT, illustrating that the hemorrhagic cystitis can be extremely protracted lasting five years.


Spontaneous regression of a pulmonary metastasis after nephrectomy for renal cell carcinoma. Regressions of metastases following nephrectomy for renal cell carcinoma are rare. Most reported cases have involved pulmonary metastases. Hormonal and immunological mechanisms have been postulated. A case is described of a pulmonary metastasis which regressed after nephrectomy and which failed to recur despite the later appearance of new sites of pulmonary metastases. The literature is reviewed.


Comparison of bubble and membrane oxygenators in short and long perfusions. Eighty patients had cardiopulmonary bypass (CPB), half having short (109 +/- 11 minutes) perfusions and half having long (188 +/- 14 min) perfusions. Twenty patients in each group were perfused with bubble oxygenators (Bentley, Harvey, or Galen) and 20 with membrane oxygenators (Modulung or Teflo). Hemodilution to a hematocrit value of 22.5% +/- 1.4% and hypothermia to 28 degrees +/- 2 degrees C were used in all patients. Complete hemograms, sequential multiple analyzer 18 tests, coagulation profiles, blood gases and pH, three immunoglobulins, and two complement fraction proteins were sampled as follows: three times before perfusion, one to ten times during perfusion, 1 hour immediately after perfusion, and 4, 24, and 48 hours postoperatively. Data in concentration terms were compared statistically and reported as mean and standard error for each subset. Additionally, rates of gain or loss were calculated in terms of quantity per liter of blood pumped per minute. During perfusion for both duration sets, use of a membrane oxygenator resulted in greater pump flows (4.55 +/- 0.15 L/min versus 3.75 +/- 0.11 L/min), lower total peripheral resistances (1,125 +/- 63 dynes.sec.cm-5 versus 1,652 +/- 115 dynes.sec.cm-5), and greater urinary outputs (9.4 +/- 1.1 ml/min versus 2.2 +/- 0.6 ml/min) than in the bubble oxygenator subsets. Comparisons of measured and calculated data in the immediate postperfusion interval showed no differences between bubble and membrane oxygenator subsets for short perfusions. In long perfusions, the membrane subset had lower plasma hemoglobin and white cell concentrations and generation rates, smaller (3 to 8 1/2 times) losses of IgG, IgM, C3 and shed blood necessitating less transfusion, and greater C4 losses. The membrane oxygenator systems used were more complex and costly and offered no advantages for short perfusion in adults. In anticipated long perfusions or where bleeding may be a problem, a membrane oxygenator appears more efficacious than bubble systems. For perfusions of less than 2 hours, membrane oxygenators had no biochemical or hematologic advantage over the bubble devices used in this study.


Pulsatile perfusion versus conventional high-flow nonpulsatile perfusion for rapid core cooling and rewarming of infants for circulatory arrest in cardiac operation. Thirty consecutive infants undergoing hypothermia and circulatory arrest for repair of ventricular septal defect, transposition of the great vessels, or atrioventricular canal defects were alternately selected for conventional high flow nonpulsatile perfusion or pulsatile perfusion during core cooling and rewarming. All received morphine anesthesia, 30 mg/kg of Solu-Medrol, and 10 to 15 mcg/kg of phentolamine. Those receiving nonpulsatile flow were perfused at a rate of 160 to 180 cc/kg/min with a roller pump and oxygenator with arterial pressure of 50 to 55 mm Hg. In the pulsatile flow group, a roller pump and oxygenator were used, and an especially constructed Datascope PAD (pulsatile assist device) was interposed in the arterial line to provide pulsatile perfusion with 75/40 mm Hg pressure at slightly reduced flow (150 cc/kg/min). The average rectal, esophageal, and tympanic membrane temperatures were reduced to approximately 16 degrees C prior to circulatory arrest. Following repair, perfusion was resumed until these temperatures returned to 37 degrees C. Cooling and rewarming were enhanced by pulsatile perfusion, with over 30% reduction in total pump time. Additionally, the larger patients in the pulsatile group cooled almost as rapidly as the smaller. The rates of decline and subsequent rise of rectal, esophageal, and tympanic membrane temperatures were equal in the pulsatile group, but the rectal temperature lagged far behind in the nonpulsatile group. Urine production during bypass was 100% greater in the pulsatile group. The plasma free hemoglobin was similar in both groups. The average postrewarming pH was 7.31 in the nonpulsatile group and 7.42 in the pulsatile group. Infants receiving pulsatile flow awakened more quickly, were more alert, and required less postoperative mechanical ventilation. We suggest that pulsatile perfusion for core cooling and rewarming of infants is safe and is more rapid and physiological than conventional high-flow nonpulsatile perfusion.


Reversal of ischemic damage with secondary blood cardioplegia. After severe ischemic injury, it is usually necessary to prolong bypass to enhance recovery. This study tests the hypothesis that the best reversal of ischemic damage is achieved by briefly rearresting the postischemic heart with a continuous infusion of an oxygenated cardioplegic solution (secondary blood cardioplegia) during the period when bypass must be prolonged. Twenty dogs underwent 45 minutes of normothermic ischemic arrest. Fifteen minutes after unclamping, no heart could support the systemic circulation. In all dogs, oxygen demands were lowered by extending bypass for 30 minutes. In 10 of these dogs, demands were further lowered by rearresting the heart for 5 minutes with a continuous infusion of a 37 degrees C blood cardioplegic solution (K+28 mEq/L; pH 7.6; Ca++ 1 mEq/L) at a pressure of 50 mm Hg. Hearts treated with secondary blood cardioplegia showed greater recovery in the rate of contraction (-dP/dt 75% versus 62%, p less than 0.05) and relaxation (-dP/dt 76% versus 58%, p less than 0.05), better recovery of compliance (85% versus 51%, p less than 0.05), a higher stroke work index (0.72 versus 0.50 gm-m/Kg, p less than 0.05), and more ability to augment oxygen uptake (85% versus 45%, p less than 0.05) to meet the demands of the working heart than hearts treated by prolonging bypass alone. We conclude that rearresting the heart with a brief, continuous infusion of a blood cardioplegic solution results in more complete reversal of ischemic damage than possible by prolongation of a bypass alone. We believe that the increased recovery with secondary cardioplegia results from diversion of delivered oxygen toward reparative processes rather than its being expended needlessly on electromechanical work during the time when bypass must be prolonged.


Protection of myocardial function not enhanced by high concentrations of potassium during cardioplegic arrest. Myocardial performance was evaluated intraoperatively in 20 patients undergoing myocardial revascularization when hypothermic potassium cardioplegic arrest was used. High concentrations of potassium (20 mEq/L) were compared to normal concentrations of potassium (5 mEq/L) in hypothermic cardioplegic solutions. The cardioplegic arrest period averaged 53 +/- 3 minutes in the high potassium group and 54 +/- 4 minutes in the low potassium group, Intraoperative calculation of ejection fraction and end-diastolic volume was accomplished by the technique of radiocardiography. All data were grouped according to end-diastolic volume index (EDVI) for both high (HK) and low (LK) potassium comparisons. Comparisons between high and low potassium groups demonstrated no significant differences in ejection fraction (HK = 66%, LK = 61%), cardiac index (HK = 2.74 L/min/m2, LK = 3.0 L/min/m2), stroke work (HK = 36 gm.m/m2, LK = 30 gm.m/m2), oxygen consumption as measured by left heart double product (HK = 9,438; LK = 9,209), and myocardial compliance (HK = 2.8 cc/torr, LK = 4.2 cc/torr at the post-cardioplegic arrest period). The role potassium plays in producing a rapid cardiac arrest is well accepted. Its protective effect on the preservation of high-energy phosphate stores is postulated, but its addition to perfusion hypothermia does not appear to enhance the protective effect observed with perfusion hypothermia alone.


Modified Senning operation for treatment of transposition of the great arteries. Since February, 1978, 42 infants ranging in age from 15 days to 16 months (mean age 6 months) and weighing between 2.0 and 9.0 kg (mean weight 5.8 kg) underwent a modified Senning I operation. Eleven (26%) underwent operation during the first 3 months of life. Twenty-nine patients had dextro-transposition of the great arteries (d-TGA) and an intact ventricular septum (Group I), and 13 patients had d-TGA and a large ventricular septal defect (VSD) (Group 2). In addition to the Senning I procedure, 13 patients had transatrial closure of their VSD, eight had ligation of a patient ductus arterioses, two had removal of a pulmonary artery band, and four had trans-pulmonary artery resection of short-segment subpulmonary stenosis. Modification of the original Senning operation included (1) patch augmentation (pericardium or Gore-Tex) of the atrial septal flap and (2) pericardial patch enlargement of the pulmonary venous pathway. One patient in Group 1 (3%) and two patients in Group 2 (15%) died after operation. A 2-week-old infant (Group 1) was treated with prostaglandin E1 (PGE) for 2 weeks before operation. The other hospital deaths (Group 2) occurred in a 2-month-old infant with advanced ischemic damage to the right ventricle and a 4-month-old child with multiple VSDs and Grade IV pulmonary vascular disease. No caval gradients were found after modification of the right atrial incision. Two patients died later from pulmonary venous obstruction, one during attempted recatheterization and the other after repair of the pulmonary venous obstruction. One patient had transient complete heart block, and four were discharged in junctional rhythm. Thirty-four patients (87%) were in regular sinus rhythm when released from the hospital. Postoperative catheterizations in eight patients showed no significant gradients in six and severe pulmonary venous obstruction in two (late deaths). More late postoperative results are required, including postoperative catheterization and electrophysiological studies, before the relative merits of the Senning versus the Mustard operation can be assessed.


Complete transposition of the great arteries with intact ventricular septum and left ventricular outflow tract obstruction. Surgical management and anatomic considerations. Surgical management of patients with complete transposition and intact ventricular septum may become difficult in the presence of left ventricular outflow tract obstruction. A Mustard operation and direct resection of the obstruction through the pulmonary artery has been the treatment of choice for this combination. Our study of the structure of the left ventricular outflow tract in four specimens with the anatomic findings of complete transposition, intact ventricular septum, and subpulmonary stenosis suggests that direct resection of the stenosis through the pulmonary artery can seldom be adequate without major risk of damaging either the mitral valve or the conduction tissue. An alternative procedure, namely, a combined Mustard operation and insertion of an external conduit from the left ventricle to the main pulmonary artery, has been employed in the management of six patients with this combination of lesions. One early and one late death occurred. Postoperative cardiac catheterization performed in all of the survivors before discharge from the hospital showed good relief of the stenosis and no significant gradient across the conduit.


Transcatheter embolization of bronchial collateral arteries prior to intracardiac operation for tetralogy of Fallot. In a case of tetralogy of Fallot with numerous bronchial collateral arteries (BCA), the collateral arteries were successfully occluded by transcatheter embolization of Gelfoam and use of the Gianturco spring as a preliminary to intracardiac repair. Pulmonary embolism would not result from this procedure in the absence of large direct communications between collateral and pulmonary arteries. The femoral artery and vein were prepared for cannulation before the procedure, so that it would be possible to start assisted perfusion immediately if arterial PO2 fell after transcatheter embolization. The procedure is performed under fluoroscopic control.


Simplified method for total correction of interrupted aortic arch with ventricular septal defect in infancy. Type A interrupted aortic arch with a ventricular septal defect (VSD) in a 3-month-old infant was successfully corrected with the aid of profound hypothermia, limited cardiopulmonary bypass, and total circulatory arrest. The aortic arch was reconstructed by side-to-side anastomosis of the ascending aorta and the main pulmonary artery and then creation of a tube from the anastomotic orifice to the patent ductus arteriosus (PDA) by using a superabundant flap of the anterior wall of the main pulmonary artery. The pulmonary arteriotomy and VSD then were closed. The operative field can be approached easily through a median sternotomy with minimum dissection. Cardiac catheterization and angiocardiography 2 months later demonstrated a satisfactory reconstruction of both the aortic arch and the pulmonary artery.


Noninvasive assessment of hemodynamic effects of mitral valve commissurotomy during rest and exercise in patients with mitral stenosis. Noninvasive radionuclide angiocardiography (RNA) provides simple and accurate assessment of parameters of cardiac function during rest and during maximal exercise. Left ventricular function was assessed by RNA in nine patients with isolated mitral stenosis before and approximately 6 months after mitral commissurotomy. Before operation, the mean mitral valve gradient was 14.0 +/- 2.8 mm Hg, and the mean mitral valve area was 1.20 +/- 0.3 cm2. Each patient was evaluated at rest and during maximal exercise on an isokinetic bicycle ergometer before and after commissurotomy. Heart rate, ejection fraction, end-diastolic volume, stroke volume, pulmonary transit time, cardiac output, and diastolic ventricular filling rate were determined by the radionuclide technique. Before operation, patients with mitral stenosis had characteristic changes from rest to exercise which supported restriction to diastolic ventricular filling as the primary limitation in generating a cardiac output during exercise. The stroke volume was unchanged from rest to exercise. Thus the cardiac output during exercise was heart rate dependent. However, after commissurotomy the stroke volume increased from rest to exercise. Therefore, cardiac output during exercise was achieved by heart rate and an augmented stroke volume. Moreover, the pulmonary transit time was reduced during rest and exercise after operation. The maximum ventricular ejection and filling rates were markedly increased during rest and exercise after commissurotomy. These differences in hemodynamic parameters at rest and during exercise document the mechanics of increased exercise tolerance in patients with mitral stenosis after mitral commissurotomy.


Management of thoracic amebiasis.

Management of thoracic amebiasis. The thoracic complications of amebiasis frequently necessitate surgical intervention. Experience with 28 patients is presented. Involvement included the pleura in 19 patients, the lungs in 10, and the pericardium in five. In 25%, more than one site was involved. Treatment consisted of measures designed to obliterate the pleural space or widely drain the pericardial sac, as indicated. Concurrent drainage of the associated amebic liver abscess was done in half the cases. The mortality rate was 36%, generally related to the poor general condition of the patients and their delay in seeking hospitalization.


Measurement of ventilatory reserve as an indicator for early extubation after cardiac operation. The decision to perform tracheal extubation in 44 patients who underwent cardiac operation was based on an assessment of mental alertness, recovery of muscle strength, hemodynamic stability, and adequacy of pulmonary gas exchange. No patients required reintubation. Concomitant measurements of vital capacity (VC) and maximal inspiratory pressure (PImax) were made before a trial of spontaneous ventilation was commenced, after 45 minutes of spontaneous ventilation, and after tracheal extubation. By generally accepted criteria, these measurements suggested the need for continuing mechanical ventilation in 14 patients at the time mechanical ventilatory support was removed and in eight patients at the time of tracheal extubation. In this study, consideration of measurements of VC and PImax would have led to longer trachael intubation, especially in those patients who were extubated within 10 hours of the completion of anesthesia.


The hemodynamic effect of dopamine in children. Although dopamine is a useful therapeutic agent to augment cardiac function in adults, there is little information about the hemodynamic effects of dopamine in children. To delineate the hemodynamic effects of dopamine in children, we infused two doses of dopamine (2 and 7.75 micrograms/kg/min) into 10 children during diagnostic cardiac catheterization. We measured heart rate, systemic arterial, pulmonary arterial, right atrial, and pulmonary capillary blood pressure, and cardiac output. During infusion of 7.75 micrograms/kg/min of dopamine, cardiac index increased from 3.9 to 5.4 L/min/m2, stroke volume increased from 43 to 57 ml/stroke and systemic vascular resistance declined from 1,697 to 1,165 dynes-cm-5-sec-m2. These indices also were changed significantly from control during infusion of 2 micrograms/kg/min of dopamine. The ratio of mean pulmonary arterial blood pressure to mean systemic arterial blood pressure in one patient with pulmonary vascular obstructive disease increased from 0.73 to 1.15, and ventricular bigeminy occurred during infusion of 7.75 micrograms/kg/min of dopamine. Dopamine is a potentially useful inotropic agent in children, but the use of dopamine may be contraindicated in patients with elevated and fixed vascular resistance.


Plasma vasopressin levels and urinary flow during cardiopulmonary bypass in patients with valvular heart disease: effect of pulsatile flow. The effect of pulsatile flow on plasma vasopressin levels during cardiopulmonary bypass (CPB) was studied in 20 patients undergoing open valve replacement. Routine bypass was used in 10 patients and the AVCO pulsatile bypass pump was utilized in the other 10. In Group I (nonpulsatile) during CPB, the vasopressin level was markedly elevated (3.1 +/- 2 to 80 +/- 22 pg/ml) as was urine flow (0.6 +/- 0.2 to 5.9 +/- 2 ml/min) and urine Na+ concentration (69 +/- 19 to 116 +/- 7 mEq/L). In Group II (pulsatile) during CPB, the vasopressin level (3.8 +/- 3 to 54 +/- 14 pg/ml), urine flow (0.6 +/- 0.1 to 16.2 +/- 4.8 ml/min), and urine Na+ concentrations (61 +/- 13 to 97 +/- 10 mEq/L) were also elevated. The rise in vasopressin and urine Na+ was less in the pulsatile group (p less than 0.05) whereas the urine flow was higher (p less than 0.05). To maintain comparable blood pressure, the pulsatile flow group required significantly higher flows (4.5 +/- 0.2 compared to 3.8 +/- 0.2; p less than 0.05). These data suggest that CPB produces a marked vasopressin stress response which is beyond the physiological range for an antidiuretic effect on the kidney. At these levels vasopressin can exert a vasopressor effect to maintain resistance and affect renal blood flow, as well as producing an Na+ diuresis. The addition of pulsatile flow creates a more physiological situation attenuating the vasopressin response and producing a decrease in systemic resistance and a less pronounced Na+ diuresis.


Measurement of postoperative cardiac output by thermodilution in pediatric and adult patients. Serial cardiac output determinations were made by the thermodilution technique in 51 patients by means of a No. 2 Fr. thermistor catheter placed directly into the pulmonary artery at cardiac operation. Correlations were determined prospectively between thermodilution measurements of cardiac output and other commonly used indirect clinical parameters. Serial indicator dye-dilution curves were performed in 24 of these patients and compared with simultaneous thermodilution measurements. A high correlation (r = 0.97) was noted between dye curve measurements of cardiac output and thermal measurements. Statistically significant correlations were also seen between cardiac output and both the quality of the peripheral pulses and the duration of cardiopulmonary bypass, but no significant correlations were found between the measured cardiac outputs and other variables. This study confirms the necessity for direct measurement of cardiac output for its accurate assessment.


Food stimulated lymph flow in the neck region. Food stimulated lymph flow in the neck region was studied in 8 patients. In each patient there was a significant increase in lymph flow during eating. Changes in lymph flow occurred rapidly and it is suggested that lymph transport is an active process.


The effect of taste and mastication on lymph flow in the neck region. In 10 out of 12 patients, there was a significantly stimulatory effect on lymph flow during taste and in 9 out of 10 patients there was a significant stimulatory effect on lymph flow during mastication. The stimulatory effect of mastication could be a parallel to the conditions observed in the leg but the stimulatory effect of taste could also indicate an active process perhaps of neurogenic origin.


Cytoclasmosis in central lymph production. Electron microscopic observations and ancillary data are reviewed to show that lymphatic organs produce quantities of central lymph by releasing cytoplasm-depleted cells into colloidal hydrosols produced by cell fragmentation (cytoclasmosis).


A fine structural study of variations in protein concentration in lacteals during compression and relaxation. The ratios of plasma proteins and ferritin (introduced into the gut) were determined between the jejunal lacteals and the interstitial channels in puppies. This was done by fine structural densitometry and the counting of molecules, respectively. In the normal state this ratio was approximately 2. In portions of tissue whose smooth muscle had been relaxed by atropine the ratio was approximately 1; in others, where the muscle had been contracted by Carbacol, it was approximately 3. These latter correspond approximately to the filling-phase and the emptying-phase of the initial lymphatic cycle, respectively. Thus the evidence was strengthened for an hypothesis, which holds that the filling is caused by the high effective colloidal osmotic pressure of the concentrated lymph.


Electronmicroscopic studies on the peritoneal resorption of intraperitoneally injected latex particles via the diaphragmatic lymphatics. Intraperitoneally injected latex particles with a diameter of 1,1 mu are resorbed via the subperitoneal diaphragmatic lymphatics. The latex particles enter the lymphatics by stomata. These are formed by simultaneous intracellular gaps between neighbouring mesothelial and endothelial cells in the tissue barrier, between the lumen of the lymph vessels and the peritoneal cavity. A transcellular passage (cytopempsis) does not occur. Stomata occur where collagenous fibres and a submesothelial basement membrane are absent. Due to the complete absence of collagenous fibres in the area of the stomata particles smaller than the diameter of the stomata may be resorbed easily.


The demonstration of the lymphatic pathways of the Pacinian corpuscles in the mesojejunum of the cat. The possibilities of a combination of modified injection techniques are described. This allows the lymphokinetic effect of a drug to produce a definite improvement in the morphological demonstration of the lymphatics.


Time of exchange of 131I-labeled albumin between plasma and peripheral lymph in man. The passage from blood to peripheral lymph of 131I-labeled human serum albumin has been studied in 6 male patients (30-70 years) with malignancies without metastases. On the first day the concentration of radio-labeled albumin in the blood was kept almost constant by repeated i.v. injections. Lymph was collected continuously from a cannulated subcutaneous lymph vessel on the leg. Two hours after the first i.v. injection of radiolabeled albumin the lymph contained significant amounts of radioactivity in all patients. Equilibrium between radioactivity in blood and lymph was reached after 26 hrs. This indicates a long "wash out time" of unlabeled protein in the interstitial tissue from where lymph has been sampled.


Intrinsic contractility of leg lymphatics in man. Preliminary communication. Intralymphatic pressures were measured in subcutaneous trunks of 5 randomly selected healthy individuals. Rhythmic pulse waves of different frequency, amplitude of 1-33 mmHg, duration of 6-8 sec and steadily increasing mean pressure up to 50-120 mmHg were found, with subjects in the upright position and motionless. Coincidence of the rhythm of pulse waves with the rhythm of expression of drops of lymph from the cannula strongly suggests that pressures necessary to propel lymph were generated by the contractility of lymph vessel wall.


Histological and autoradiographic changes in locally irradiated lymph nodes (an experimental study on rabbits). The authors studied the local effect of 3000 Rxl X-ray irradiation on the popliteal lymph nodes of rabbits. Beside the morpho-histological description autoradiography was performed after injection of H3-thymidine in the afferent lymphatic of the irradiated knee node. The main finding is the appearance of newly-formed germinal centers between the 6-10. days after irradiation.


[Ultrastructure of the eye of the amber snail Succinea putris (L.) (Gastropoda, Stylommatophora)]. The structure and some aspects of the development of the eye of Succinea putris were studied with the aid of the electron microscope. The eye is of the closed vesicle type and is composed of retina, cornea, vitreous body, lens and optic nerve. Three different types of cell are to be found in the retina: (1) the small elongated pigment cell with an avoid nucleus, many pigment granulae and short microvilli at the apical end of the cell; (2) the sensory cell type I with a large irregular nucleus, long microvilli, which extend to under the surface of the lens, a large number of light-cored vesicles, 700 A in diameter and the axon; (3) the elongated slender sensory cell type II with many dense cored vesicles, several pigment granulae in the distal region of the cell and short irregular microvilli at the apical end of the cell. This type is few in number. Two results of the study of the embryonic eye are described: the cornea cells differ from those in the adult eye in the nucleus-cytoplasm relation and the optic nerve is smaller than in the adult eye.


The fine structure of the oocyte and follicle cells of Lymnaea stagnalis, with special reference to the nutrition of the oocyte. A description is given of the configuration of the surface membrane in the 3 zones of the polarised system of oocyte and follicle cells. Thus the cell contacts and relationships between these cells are considered and speculation on the significance of surface morphology in the passage of substances into the enlarging oocyte, is included.


[Electron microscoic study on the regeneration of the cerata]. The regeneration of the cerata was studied in Aeolidiella soemmeringi (Leuckart, 1828) by light and electron microscopy. After amputation of the tips of the cerata the edges of the epidermis and of the hepatopancreas are drawn together by muscular contraction. The restitution of the cnidosac and of the hepatopancreas begins within groups of reserve cells, which are to be found in the hepatopancreas at each time. The restitution of the epidermis starts from undifferentiated replacement cells in the epidermis. Undifferentiated cells, which probably are fibroblasts and amoebocytes form a loose, spongy blastema. The amoebocytes become more and more loaded with phagocyte material and often show a pycnotic nucleus with very densely packed chromatin, while the fibroblasts predominantly form the fibrocytes of the mesenchym of the growing ceras. Thus it seems, that to a certain extent each tissue, i.e. ectoderm, entoderm and mesoderm, retains its individuality and is repaired from its own elements.


Microelectrode investigations of learning phenomena in snail (Helix pomatia) neurones. We have examined changes of postsynaptic potentials and of pattern activity of the identified silent and oscillatory snail neurones in Helix pomatia during conditioning. Local changes of EPSP or IPSP have been recorded during association following the first stimulus in the silent cells, whereas spike discharges could be observed in response to the 2nd stimulus. In the oscillatory neurones changes of pattern activity have been recorded following the 2nd stimulus, while the first stimulus proved to be ineffective. The formation of temporary connections of snail neurones seemed to be a specific phenomenon, because it was necessary to pair stimuli of different inputs for the development of these modifications. These plastic changes seemed to depend on the interstimulus as well as on the intertrial intervals. Our experimental data underline the probable role of the stimulus parameters and of the electrical properties of neurones during the formation of learned neuronal responses.


Peripheral and central photoreception in Aplysia fasciata. Extraocular photosensitivity in Aplysia fasciata was studied in the skin and in the central nervous system (CNS). Local illumination causes contractions of the muscles of the body wall, which are obviously mediated by the peripheral nervous system (PNS). Afferent sensory activity is supposedly mainly dependent on stretch reception. Light-induced peripheral reflexes habituate after repetitive stimulation in preparations in which the CNS is present. In preparations without CNS light-induced contractions are remarkably stronger and do not habituate after repititive stimulation. Central responses to peripheral stimulation could be evoked by both "light on" and "light off" stimulation, indicating that 2 types of photosensitive elements are present in the periphery. Observations on isolated CNS-preparations revealed that in the central ganglia photoreceptive elements are also present. Here, too, elements responding to the onset as well as elements responding to the offset of light have been detected.


Axonal pathways and synaptic inputs of three identified neurons in the buccal ganglion of Helix pomatia. The axonal pathways and the synaptic inputs of the identified neurons B1 through B3 in the buccal ganglia of Helix pomatia were studied. The axons of neurons B1, B2 and B3 were found to run invariably within the ipsilateral posterior oesophageal nerve, ipsi- and contralateral salivary gland nerves, and ipsilateral cerebrobuccal connective, respectively. Synaptic responses could be elicited by stimulation of most of the nerves of the buccal ganglia. These consisted of an early depolarization which was most frequently followed by a longlasting de- or hyperpolarization. The shape of the synaptic response proved to be related to the different neurons.


The fine structural organization of sensory nerve endings in the lip of Helix pomatia L. The fine structural and cytochemical characteristics of sensory nerve cells have been studied in the lip of Helix pomatia. A ruthenium red positive cuticular layer was found on the surface of the sensory epithelium. Among the undifferentiated epithelial cells two types of sensory dendrites were observed, namely ciliated and non-ciliated ones. A large amount of smooth surfaced endoplasmic reticulum, microtubes and ribosomes were present in the neuroplasm of the sensory dendrites. However, rough surfaced endoplasmic reticulum, mitochondria, and electrodense bundles of long filaments were characteristic in the simple epithelial cells. The cell bodies of the sensory dendrites lie subepithelially among the muscle cells and they generally contain empty or dense core vesicles.


Electrophysiology of "yellow cells," neurosecretory neurones in Lymnaea. The thirty Yellow Cells of Lymnaea show single, double and other extra spike modes of firing. Yellow Cell bursts consist of various combinations of single, doublet and triplet spikes whose number per burst varies spontaneously. Single spike firing modes of activity can be converted into doublets or bursts (and vice versa) by applying steady currents of the appropriate polarity. Spike activity is basically endogenous although it is modulated by low frequency synaptic input originating from within the brain. Interburst interval is affected by the number of spikes occurring in the preceding burst. This varies spontaneously or can be induced by applying appropriately timed current pulses or occurs following synaptic input. Excitatory synaptic input often induces bursts which far exceed the duration of the input and which are followed by long periods of inhibition.


The central nervous control of the adductor behaviour of lamellibranch molluscs. In Egeria radiata (L.) and Mutela dubia (Gmelin) decerebration does not result in tonus of the posterior adductor muscle and each species continues to exhibit its characteristic rapid and slow rhythms. Excitatory and inhibitory nerve pathways originating in the cerebral ganglia terminate on the visceral ganglia. The cerebral ganglia alone do not exhibit any rhythm; the anterior adductor muscle remains relaxed after excision of the visceral ganglia. The mid-dorsal and the anterior lobes of the visceral ganglia in Scrobicularia plana (Da Costa) control all adductor activity. Groups of potentials in the posterior adductor nerves originate from the different lobes and are separate physiological mechanisms.


The influx of tryptamine into snail (Helix pomatia) ganglia: comparison with 5-hydroxytryptamine. Isolated ganglia possess the ability to concentrate tryptamine from an external medium by a process which is temperature sensitive and independent of sodium and other cations. Kinetic analysis of the accumulation process showed the influx of tryptamine to be a single mechanism with Km and Vmax values of 1.4 X 10(-4)M and 5 X 10(-8) mole/g/min. The influx of tryptamine is an unspecific process and is insensitive to a number of metabolic inhibitors and various analogues. The process of tryptamine influx is thus similar in principle to the low affinity uptake mechanism for 5-HT (see Osborne et al., 1975). The present data, which include some experiments on the release of 5-HT and tryptamine, are discussed from the point of view of a functional role for 5-HT and tryptamine in the snail CNS.


Cytological aspects of different nerve cell somata in the buccal ganglia of Helix pomatia L. In early September most of the neurons of the buccal ganglia of Helix pomatia contain neurosecretory material as membrane bound granules. There is only one, in exceptional cases 2 types of granules per cell. This suggests that different types of granules do not change into one another, and that each granule type contains a different secretory product. One granule type contains PAF-positive neurosecretory material, another one catecholamines, but most of the granules cannot be associated with special substances. The identified giant neurons B1-B4 contain granules in less density than the smaller neurons. B1 and B2 resemble each other in their granule type, whereas both B3 and B4 differ from B1 and B2.


Neurogenic contractile activity of the penis retractor muscle of Helix pomatia L. Using convential mechanical and electromyographic recording methods 2 distinct types of neurogenically elicited activity can be observed in the penis retractor muslce (PRM) of Helix pomatia: (1) rhythmic, phasic contractions correlated with single or a few compound action potentials and (2) intervening, strong, prolonged contractions accompanied by sustained, high frequency electrical muscle activity. The 2 distinct types of muscle activity which seem to play a part in the normal behaviour of the PRM in the intact animal are mediated by both the central nervous system and peripheral neurons. While central neuronal structures are involved in causing the strong, prolonged contractions, the phasic activity is initiated by peripheral neuronal structures located at the proximal end of the PRM. There is evidence that the transmission of the excitation at the neuromuscular level of central and peripheral origin is mediated by ACh.


Temperature dependent membrane potential changes in snail neurons and their relation to active ion transport. The mechanisms underlying the temperature response of the resting membrane potential (RMP) were investigated in 3 identified neurons of the buccal ganglion of Helix pomatia. Lowering the temperature evoked a decrease of the RMP and an increase in membrane resistance, and vice versa. The temperature response of the RMP had an equilibrium potential of ca, -60 mV. It is essentially evoked by changes in the potassium conductance. Indications of an electrogenic sodium transport were not detected.


Inhibition of hypertonic-saline stimulated neurosecretory changes in the freshwater bivalve Indonaia caeruleus (Prashad) by chlorpromazine and reserpine. In the present paper, the effects of reserpine (RSP) and chlorpromazine (CPZ) on the neurosecretory cells of a saline treated freshwater bivalve, Indonaia caeruleus have been tracked. After saline (0.1 ml of 1.5% NaCl per animal) treatment A and B cells of cerebral and visceral ganglia showed significant increase in cell area, nuclear diameter and decrease in the NSM, while administration of RSP (0.50 mg per animal) and CPZ (0.25 mg per animal), following the saline injection completely inhibited these changes. Physiological implications of these changes are discussed in the light of neurosecretory dynamics.


Environmental osmolarity and neurosecretory neurones in Lymnaea stagnalis (L.). Cell body volume and Alcian blue-Alcian Yellow staining properties of neurosecretory neurones in the brain of Lymnaea stagnalis were compared for snails kept in de-ionised water and standard tapwater. In the same experiment, the ionic content of the blood, blood volume and body weight and environmental ionic composition were measured. Five days of immersion in de-ionised water resulted in significant decreases in body weight, blood volume and blood, Na+ and Cl- concentrations but no change in blood Ca2+, K+,and HCO3- concentrations, compared with controls. No consistently significant differences across the 5 day period were found in cell body volumes for Dark Green Cells, Yellow Cells or Light Green Cells (used as a control) when these volumes were compared for large numbers of cells from snails kept in de-ionised water and standard tapwater. However, the number of Yellow Cells which could be counted in snails kept in de-ionised water was lower than the number from standard tapwater by day 2 of the experiment and lower for Yellow-green Cells by day 5. We interpret this lower number to be the result of depletion of Alcian blue-Alcian Yellow stained neurosecretory material in these cells which made them impossible to distinguish. This was confirmed by examination of visceral Yellow Cells which could be identified on the basis of known location close to the visceral-right parietal connective.


Limb fractures in a defined population. I. Frequency and distribution. This population-based study revealed that 2,519 limb fractures occurring during a 3-year period produced an age-adjusted incidence rate for all limb fractures of 1,596 per 100,000 person-years. Fractures of the upper limb had a bimodal age distribution and were commoner than those of the lower limb, which had a J-shaped age distribution. The most frequent anatomic site was the lower end of the radius and ulna. Limb fractures occurred as solitary events in 93% of cases; only 4% were classified as open and more than half of the total were closed and undisplaced. Fractures were distributed evenly throughout all time periods of the day. The commonest place of fracture occurrence was the home, and the most important direct cause was falls, particularly in females. A wide range of sports activities were a major source of fractures, particularly in younger males. Underlying bone pathology was uncommon, other contributory causes being more important, particularly in the elderly. The increased ratio of metaphyseal to diaphyseal fractures with age indicated a relative loss of cancellous bone in the elderly, but no evidence was found to suggest that elderly women had reduced resistance of bone to impact forces in comparison with elderly men.


Limb fractures in a defined population. II. Orthopedic treatment and utilization of health care. This study describes the orthopedic treatment and utilization of health care obtained by 2,333 patients in the population of Rochester, Minnesota, who suffered 2,519 limb fractures during the period 1969 through 1971. Overall, 24% of fracture occurrences required patient hospitalization, the remainder involving care on an ambulatory basis only. The mean number of physician visits was 4.5 per fracture, with the visits occurring during an interval of 103 days from the time of first evaluation. Fifteen percent of limb fractures were subject to at least one surgical operative procedure as part of their orthopedic treatment. The frequency of operative treatment increased markedly with patient age. Seventeen percent of patients with limb fractures received physiotherapy or occupational therapy or both, 4% were ambulatory patients, and the remainder were hospital inpatients. Fractures of the head and neck of the femur constituted only about 7% of fractures in the series, yet utilized an inordinate proportion of health care resources. Hip fractures were responsible for 27% of the hospital admissions, 52% of all bed days utilized, and 56% of the physiotherapy sessions.


Use of combined plasmapheresis and immunosuppression in the treatment of Goodpasture's syndrome. Five consecutive patients with well-documented Goodpasture's syndrome were treated with plasmapheresis and immunosuppression. In all patients, the antiglomerular basement-membrane antibody titers decreased with treatment. In three patients, hemoptysis responded promptly to plasmapheresis. Two patients presenting with severe renal failure required chronic dialysis, and three patients who had serum creatinine levels less than 2.1 mg/dl before treatment improved or had stabilization of their renal function. We confirm that the use of plasmapheresis and immunosuppression is a promising method of treatment in some patients with Goodpasture's syndrome.


Restoration of impaired immune functions in aging animals. III. Effect of mercaptoethanol in enhancing the reduced primary antibody responsiveness in vivo. The enhancing effect of 2-ME on the primary antibody forming capacity of young and old mice from 5 strains and hybrids was investigated by assessing the number of hemolytic antibody-forming spleen cells in response to sheep RBC stimulation. The following results were obtained: (1) the optimum dose of 2-ME is 4 micrograms per mouse; (2) the best time to administer 2-ME is just prior to, or at the same time as, antigen is given; (3) 2-ME can enhance response to suboptimum and optimum, but not supra-optimum doses of antigen; (4) 2-ME is effective in enhancing the primary antibody forming capacity of both young and old mice, with one exception, but the enhancement of old mice was greater than that of young mice (80% vs. 20%). The exception was old C57Bl mice, in which 2-ME was ineffective; (5) the level of primary antibody forming capacity of old mice can be restored to that of young mice by treating them with 3--4 weekly injections of 2-ME at a dose of 4 micrograms per injection.


Testosterone metabolism by the prostate of the aging canine. Examination of testosterone metabolism in the dorsal, lateral, and ventral regions of the beagle prostate showed an absence of regional heterogeneity for testosterone metabolite production and metabolic capacity. Testosterone metabolism by the hyperplastic prostate of aged beagles (11.1 years old) was distinguished from that of young mature (2.5-year-old) and mature adult (4.5-year-old) beagle prostate by increased reductive metabolism. The change was principally the consequence of increased production of 5 alpha-dihydrotestosterone and decreased production of 4-androstenedione. These alterations in testosterone metabolism occurred progressively and may be weakly linked to other changes in canine prostate which occur during aging. 5 alpha-Androstane-3 alpha, 17 beta-diol production was maximal for prostate from 4.5-year-old beagles and the amount of this metabolite produced appeared to be unrelated to prostate size. Co-incubation of prostate from any of the beagles with testosterone and estradiol showed that estradiol had no in vitro effect upon testosterone metabolism. Mean plasma testosterone content of aged beagles (11.1 years old) was not significantly different from that of younger individuals; however, the heterogeneity of the values for the subject groups was notable. The data demonstrate that the consequences of aging upon testosterone metabolism by canine prostate, which principally develops benign prostatic hyperplasia, are opposite to those characteristic of senescent rat prostate, which does not develop bening prostatic hyperplasia and has a high incidence of spontaneous adenocarcinoma.


Age related changes in auto-erythrocyte rosettes in the C57BL/6J and NZB/BINJ mice. The changes in the auto-erythrocyte rosetting thymic and splenic lymphocytes and the induction of autoimmunity was followed with age in C57BL/6J and NZB/BINJ mice. The auto-erythrocyte rosetting cells (auto-RFC) showed shifts in their pattern in both thymus and spleen in C57BL/6J and NZB/BINJ mice. Both strains had approximately the same percentage (approximately 3%) of thymic auto-RFC at 1 month of age. In C57BL/6J mice the rosette population increased to 6.6% by 2 months, declined after 3 months and subsequently increased gradually with age. In contrast, the NZB/BINJ thymic auto-rosettes peaked at 4 months and gradually declined thereafter. Both the NZB/BINJ and C57BL/6J strains were tested for the presence of anti-erythrocyte antibodies by the direct Coombs' agglutination test. The results showed that at 6 and 10 months 50% and 90% of the NZB/BINJ mice were positive for antibodies, respectively, and the thymic and splenic auto-RFC dramatically decreased in numbers. In the C57BL/6J mice during this same period, very low incidence of auto-antibodies was detected by the Coombs' test and auto-RFC increased in numbers.


Testosterone metabolism by the prostate of the aging AXC rat. Testosterone metabolism by the ventral prostate of inbred, senescent (36-month-old) AXC rats showed a shift to increased oxidative and diminished reductive metabolism when compared to young mature (3-month-old) or mature adult (6-month-old) AXC rats. The change was principally attributable to diminished production of 5 alpha-dihydrotestosterone and increased production of 4-androstenedione. By contrast, dorsolateral prostate testosterone metabolism in these same rats was always more reductive than that of ventral prostate and failed to show the post-maturation shift to oxidative testosterone metabolism which characterized ventral prostate. Co-incubation of either ventral or dorsolateral prostate from any of these rats with testosterone and estradiol showed that estradiol did not significantly affect prostate testosterone metabolism. Plasma testosterone content of senescent AXC rats was only 28% of that of mature adult rats. Chronic exogenous testosterone treatment enhanced reductive testosterone metabolism by ventral prostate and eliminated those changes in metabolite distribution which had differentiated testosterone metabolism by young and senescent AXC rats. The data support the interpretation that the aging-related diminution in AXC rat ventral prostate reductive metabolic capacity is primarily the consequence of diminished 5 alpha-dihydrotestosterone production secondary to diminished plasma testosterone content.


Mutagenicity and cytotoxicity of malonaldehyde in mammalian cells. Malonaldehyde (MA), a lipid peroxidation product derived from polyunsaturated fatty acids, is cytotoxic to a murine L5178Y lymphoma cell line cultured in vitro. Exposure of cells for 24 hours to as little as 20 microM MA produced detectable cytotoxicity as well as an increased number of mutants among survivors, using thymidine or methotrexate resistance as genetic markers. The induced mutation frequency, within the range of MA concentrations tested (10-100 microM), is dose-dependent. Significant division delay, which results in unbalanced growth, is also observed in MA-treated cells. It is suggested that MA crosslinks with DNA and mutagenizes cells through the error-prone repair system. In order to relate the degree of mutagenicity of MA in reference to other mutagenic agents in mammalian cells, the mutation frequency of the thymidine-resistance marker in L5178Y induced by X-irradiation is also presented. The significance of lipid peroxidation in relation to carcinogenesis and the various theories of aging will be briefly discussed.


A comparison of protein synthesis by liver parenchymal cells isolated from Fischer F344 rats of various ages. Rates of protein synthesis by intact liver parenchymal cells isolated from male Fischer F344 rats ranging in age from 2.5 to 30 months were determined by measuring the incorporation of [3H] valine into acid-insoluble material and the specific activity of the extracellular valine. The rate of protein synthesis decreased 44% from 2.5 to 18 months and then increased slightly (18%) from 18 to 30 months. There was no dramatic change in the types of proteins synthesized by isolated liver parenchymal cells isolated from 2- or 18-month-old rats as determined by SDS-polyacrylamide gel electrophoresis. The ribosomal-transit time by liver parenchymal cells isolated from 18-month-old rats was 60% higher than the ribosomal-transit time of liver parenchymal cells isolated from 4-month-old rats. The fidelity of protein synthesis by parenchymal cells isolated from 4- and 18-month old rats was compared by measuring the incorporation of p-fluorophenyl alanine (an analogue of phenylalanine) into acid-insoluble material. Although protein synthesis decreased significantly from 4 to 18 months, the fidelity of protein synthesis remained constant.


Access to dental care: a comparison of medicine/dentistry and the role of a regular source. Recent studies have found more equal access to physicians, both in terms of volume of visits and having a regular source. This paper compares physician care with dental care, looking particularly at a regular source of dental care. A regular source should be very important in dental care, given the emphasis on prevention and regular visits. This paper examines data from a statewide sample of 1,329 Rhode Island residents in 1974 to determine what percentage of the population has a regular source and what the relationship is with socioeconomic variables. Most persons (91 per cent) report a regular source of medical care. The figure is somewhat lower (73 per cent) for reporting of a regular source of dental care. Socioeconomic differentials are still important, as only one-half of those in families earning less than $5,000 and 59 per cent of those in families where the head of the household has less than an eighth grade education have a regular source of dental care. The relationship held when controlling for variety of social and demographic variables and partial correlation analysis was used to determine that income, as compared with education, is the more important variable in explaining differentials. Using discriminant function analysis, age, sex, race, education and income allowed one to correctly predict 70.7 per cent of those who have a regular source of dental care and 61.5 per cent of those without a regular source of dental care.


Continuity of medical care: its impact on physician utilization. Past research in continuity of medical care has generally examined its determinants or its consequences. A model is proposed which combines these lines of research and incorporates a continuity measure as a process and specifying variable. The validity of this model is tested with a set of data consisting of 1,410 persons with major illness episodes. Results show that the model is supported, at least in part. Variables that significantly influence the number of ambulatory visits to a physician include the patient's payment method, the severity of his illness and his referral status. Moreover, the practice type of the usual physician emerges as a significant determinant of physician utilization when the level of continuity is controlled. The use of this more comprehensive model in future studies on continuity is indicated.


The competitive response of Blue Cross and Blue Shield to the health maintenance organization in Northern California and Hawaii. The health maintenance organization (HMO) can provide an alternative to the predominant form of health care delivery in the United States, fee-for-service. Although market penetration of the HMO is relatively low in most parts of the country, the HMO has achieved a significant market share in a number of states. This paper examines the competitive response of Blue Cross and Blue Shield to the introduction of the HMO in two geographic regions with significant HMO activity, northern California and Hawaii. The evidence obtained from extensive interviews indicates that Blue Cross and Blue Shield plans have responded to HMO competitive pressure by establishing their own HMOs and by altering traditional procedures. HMO competition has stimulated Blue Cross and Blue Shield to make greater cost control efforts and to offer larger benefit packages. These results can have important policy implications for the role that HMOs are to play in cost containment.


Hospital cost per case: analyses using a statewide data system. In this paper, we establish relationships between hospital cost per case and the independent variables; case mix complexity, case mix severity, factor input prices, and hospital characteristics. Two hundred and sixteen thousand discharges from Maryland's acute general hospitals are grouped into 383 Diagnostic Related Groups which are used to compute an information theoretic measure of case mix complexity. Multiple linear regression equations are developed which predict up to 88% of the variance of between-hospital cost per case. The most highly significant predictors of cost per case are complexity, patient age, proportion of high risk patients, average length of stay, and nonphysician salary levels. Two distinct groups of hospitals, metropolitan and rural, are defined and models are developed for each. We discuss the implications of these findings for the identification and regulation of unexpectedly high cost hospitals and for prospective cost per case reimbursement.


Continuing medical education before audit. Patient-care-assessment systems have failed to demonstrate efficiency in detecting continuing education needs or in influencing clinical practice. We believe that one of the weaknesses in retrospective audit systems is their tendency to result in the ratification of criteria which match past practices rather than criteria which incorporate new, science-based information. This is in spite of the fact that for many years guidelines for medical audit processes have encouraged physicians to develop science-based criteria. This study was undertaken to determine whether continuing education programs preceding patient care audits can induce physicians to choose criteria beyond their own experience. A highly significant difference was found between audit criteria developed after education programs and those which were developed without such programs. The results indicate that educational efforts can have a striking effect on the criteria ratified by audit committees.


Alternative methods of evaluating health manpower distribution. Four desirable characteristics of an ideal method of evaluating health manpower distribution are postulated. Current approaches are evaluated using these criteria and are shown to be unsatisfactory. An alternative method, based on the economic theory of production, is then described. The paper concludes with some recommendations for further research.


Increased access to medical care: the impact on health. Many federally financed programs have been launched to improve the access of the poor to medical care, under the assumption that this will improve their health. The effectiveness of these programs, however, has generally been measured by increased utilization rather than by improved health. The few studies which have considered health status have shown small or negative effects. Here, data are presented from a project which provided fully prepaid care to near poor families through existing sources in the community. A group of 748 enrollees was found to report worse health on four of five health indicators after one year of enrollment in the program; further, they appeared sicker on all five measures than a group without free medical care. It is suggested: 1) that the impact of health programs on the health of a population is a complex and poorly understood issue; and 2) that increasing access to health care may not be an effective way to improve health.


[Sjögren's syndrome, mixed cryoglobulinemia and Waldenström's purpura (author's transl)]. A 66-year-old patient was hospitalized after the appearance of a deep ulcer in the posterior face of the right calf. She had purpuric spots on the lower limbs only, as well as parotiditis, especially on the left side, and was affected with dryness of the mouth but not of the eyes. The patient also presented, in contact with the cold, Raynaud's phenomenon. Physical examination revealed as pathologic signs: purpura of the lower limbs, a deep ulceration on the right calf, parotiditis, and a reduction in the pallaesthesia of the lower limbs. Biologically an increased sedimentation rate, elevation of the total proteins (particularly the gammaglobulins), positive antinuclear factor, reduction of the total complement and of the C3 fraction, circulating immunocomplexes, positive latex test, positive Sia test, and the presence of mixed cryoglobulin IgG-IgM type kappa, stood out. The patient was diagnosed as having Sjögren's syndrome, mixed cryoglobulinemia and Waldenström's purpura. Probably the two latter conditions characterized by the presence or circulating immunocomplexes are part of the same process. According to recently studies described in the literature the relationships between these three entities are discussed, as well as the possibility of developing lymphoproliferative syndromes under certain immune stimuli.


[Tuberculous cerebral abscess. Morphopathologic study (author's transl)]. A 73-year-old patient with a cerebral abscess of tuberculous etiology localized in the left parietooccipital region is presented. Clinically it had behaved like an expansive process. The inside of the abscess contained a purulent exudate with polynuclear cells and necrotic material. The wall of the abscess was formed by a predominantly histiocytic internal layer and an external one composed by histiocytes with the morphology of epithelioid cells. No tuberculous granulomas were found. The histiocytes contained a large number of acid-alcohol resistant bacilli. In the exudate Mycobacterium tuberculosis hominis was bacteriologically isolated. After the surgical operation the patient developed an acute tuberculous sepsis with tuberculous exudative meningitis and miliary dissemination in various organs. As regards the pathogenesis of the tuberculous cerebral abscess the authors consider the possible influence of a deficitary immune state of the patient and the aggressiveness of the infective organism.


[Sea-blue histiocyte syndrome (author's transl)]. The literature published before October, 1977 on the so-called sea-blue histiocyte syndrome is reviewed. This is a new lipid thesaurismosis, and from a morphological point of view it is characterized by the appearance of large histiocytes in the organs of the reticuloendothelial system with numerous intracytoplasmic granules which take on a typical sea-blue or greenish color with Wright's or Giemsa stain. The exact nature of the accumulated substance has not yet been specifically determined, though it appears to be gluco- and/or phosphosphingolipid, essentially sphingomyelin. The specific biochemical alteration responsible for this chronic deposit has not been established, though a partial sphingomyelinase deficiency has been detected. Sea-blue histiocytes have been observed in two different situations, either as an acquired phenomenon or as a primary condition. Of the latter there have been sporadic cases and cases with a definite familial incidence. The clinical manifestations include enlargement of the liver and spleen, neurological symptoms, cirrhosis of the liver, hemorrhagic diathesis and purpura, chronic pneumopathies, eye or cutaneous disturbances, or no symptoms at all. The disease has a benign clinical course, and the prognosis is less favourable when clinical manifestations appear early in life. These cases have a greater tendency to develop neurological alterations. The final definition of the syndrome must await the clear identification of the accumulated material and the altered enzyme or metabolic pathway.


Writing man-machine dialogues for a MUMPS system using the Application Controller Language (ACL). The Application Controller Language (ACL) was designed to facilitate the development of man-machine dialogues. An exact specification of such a dialogue before programming begins is unlikely to be implemented without many changes. Immediately a dialogue is used, the 'hands-on' experience suggests many improvements. ACL was designed to serve as a flexible tool to enable easy re-shaping of this dialogue. For this reason, ACL is structured, allows documentary comments, and may be easily edited. ACL complements MUMPS and encourages the writing of small modular MUMPS programs to carry out well-defined tasks. For this purpose, ACL serves as the 'top' of a top-down written structure, with calls to MUMPS programs being made from ACL statements. A smooth dialogue is made easier to achieve by having all ACL statements use a single I/O processor giving a uniform terminal behaviour and appearance to the display. The programmer is encouraged to call this same I/O processor from his MUMPS application programs. ACL was used extensively for the development of a data management systems for hospital critical care.


Computer-assisted patient-care management. A computer-assisted patient-care management system is currently operating in two patient-care units as part of a pilot project at the Hôpital Cardiologique, a member institution of the Hospices Civils de Lyon. The system includes the management of administrative records (notice of admission set to the patient-care unit, appointment for admission sent to the patient, notice of admission set to the physician requesting hospitalization, admissions and discharges, patient census) and of patient-care records (orders, examinations, laboratory tests, medications, injections and treatments, a summary list or orders to be carried out during the day, labels for laboratory specimens and requistions for the tests and examinations to be performed); and the medical management of the patient (clinical summary of patient status at admission, results of tests and examinations, summary of hospitalization, data for research and statistics). Computerization was begun in 1977, following the implementation of individualized patient-care records in 1976. The system will be evaluated in 1978 and extended to the remainder of the hospital (18 patient-care units) by the end of 1979.


Designing computer support for daily hospital staffing decisions. This paper relates issues encountered in extending a centralized computer-based nurse scheduling system to support daily staffing decisions in a hospital environment. When calculating the daily staffing needs on each nursing unit, the conceptually simple interactive staffing system incurred considerable costs in categorizing patients according to level of care required. Two years of historical data collected daily in a 568 bed St. Louis hospital were used to test the sensitivity of relative staffing requirements to daily fluctuations in patient-care distributions. A periodic sampling plan appears adequate for updating distributions which can then be applied to current census in estimating daily staffing needs. Recommendations for implementing such a system are offered.


Characteristics of the software for computer applications in medicine. The requirements of clinical medicine which have tended to make the design and implementation of software for hospital computer systems more difficult than that elsewhere, are discussed in this paper. Specific constraints on the software for selected computer-assisted activities in a hospital environment are examined in considerable depth. It is shown that since some of these activities have counterparts elsewhere, hospital computing can benefit from the accumulated experience in dealing with similiar problems in business and scientific environments. The argument is put forward that developing countries, with their characteristic problem of acute shortage of skilled manpower in both medicine and computing, should initially concentrate on applying computers to these activities alone. Furthermore, medical education in such countries should incorporate programmes relating to computer technology in general and the software aspects in particular.


Experience of transferring an integrated hospital-administration system from a CODASYL data-base to a standard MUMPS file structure. University College Hospital, a teaching hospital situated in Central London, has been using computers since 1964. Development of an integrated on-line hospital administration computer system was started in 1974. By mid 1977, the components of the system which had been implemented included a patient Master Index, Registration of new patients, Waiting Lists, Bed State, Out-patient Appointments, X-ray, Microbiology and Disease Index. The system was implemented using the Rank Xerox Data Systems (CODASYL based data-base management software, with the majority of applications running on a terminal network supported by transaction processing programs. The experience gained during three years of using such a system is reviewed, with particular emphasis on the ways in which the system matched up in practice to the expected benefits of data-base management facilities. In early 1977, it was decided to replace the Rank Xerox mainframe with a minicomputer which was considered to be a more cost-effective solution to the hospital's computing requirements. The machine selected a PDP 11-70, is running the Digital Equipment Corporation's implementation of Standard MUMPS, an interpretive language developed in a hospital environment, with its own file management software. The decisions which were made in redesigning the existing computer systems for the new machine are discussed. The progress made to date in the transfer of applications from the mainframe to the mini is reviewed, and some of the features of the software available on each machine and its suitability for the implementation of on-line data management and retrieval systems are compared.


[Spontaneous intestinal biliodigestive fistula and its treatment (author's transl)]. The current clinical and therapeutic status of spontaneous intestinal biliodigestive fistulae in 14 of the author's own cases is presented. Two groups are distinguished: those "short-circuit" connections to the gastro-intestinal tract due to biliary disease--the biliodigestive fistula in the narrower sense as well as enterobiliary fistulae caused by gastro-intestinal disease. Differences in etiology, clinical presentation, therapy and operative lethality make it seem advisable to form two categories, A and B, and to compare the one with the others.


[Fibrous capsule formation after augmentation mammaplasty. Experimental study (author's transl)]. The reaction of X-rays on the incapsulation of subcutaneous implantation of silastic prosthesis and further development of the capsules was studied in an experimental investigation on the basis of 14 rabbits. An influence of X-rays on type and thickness of the capsule as well as constrictive fibrosis was not ascertained. On account of our histological investigations we may say that the cause for a fibrous capsule formation is a similar process which causes Dupuytren's contracture.


Hypothyroidism and the ear: electrophysiological, morphological, and chemical considerations. There is both clinical and laboratory evidence that hearing loss can result from congenital and acquired hypothyroidism. The reversibility of this process, however, and its incidence and pathophysiology are not universally agreed upon. Laboratory animals rendered hypothyroid with radioactive iodine 131 or propylthiouracil demonstrated normal perilymph sodium and potassium levels but increased auditory thresholds for N1N2 response and brain stem evoked audiometry as well as a crystallized consistency of the bone of the bullae and cochleae, ossicular abnormalities, obliteration of the oval and round window, large dark staining lipid accumulations in Hensen's cells, large intercellular spaces in the stria vascularis with degeneration of the marginal and intermediate cells, inner and outer hair cell degeneration, debris in the cochlear duct, and tectorial membrane irregularity. Otic capsule biochemical alterations were identified which may account for the osseous changes observed morphologically. The morphological, biochemical, and electrophysiological findings in this study support the hypothesis that the cochlea is a site of lesion for sensorineural hearing loss in hypothyroidism. Middle ear changes identified could be responsible for the conductive component.


[Acute hepatic amebiasis (author's transl)]. A case report is given of severe extraintestinal hepatic amebiasis without diarrhea. Formation of an hepatic abscess could be avoided by early institution of appropriate antiamebic treatment, following the diagnosis using sonography and specific serological methods.


[Chronic recurrent intestinal amebiasis in Israel (author's transl)]. Abdominal pain, nausea, flatulence and diarrhea are the main clinical symptoms in chronic amebiasis; diarrhea and constipation may alternate in many cases, whereas constipation alone does occur only rarely. These symptoms may persist over years, with long asymptomatic intervals. In most cases cysts of entameba histolytica can be demonstrated in the feces, accompanied rather often by dientameba fragilis in Israel. 835 carriers of entameba histolytica were found among our patients between 1968 and 1974. Patients exhibiting 3 of the above mentioned clinical symptoms and having entameba histolytica in the stools are defined to be suffering from chronic recurrent amebiasis; 371 (= 44%) of our patients could be classified in this group. In spite of the fact, that the number of cases of acute amebiasis and its complications in Israel has been reduced considerably in the past, chronic amebiasis continues to be a clinical and epidemiological problem, its incidence being scarcely diminished.


[Echinococcus cysticus (author's transl)]. Echinococcus cysticus is a parasite; the human organism is invaded by cysticercus of the dog tape worm. In liver 60% of all viable embryos are retained, 30% in the lung, the last 10% spread via the arterial system into all other organs. Diagnosis can be established by serology, sonography, scintigraphy as well as invasive and non-invasive radiological examinations. Case reports of 20 patients with Echinococcus cysticus are given; the disease was localized 16 times in the liver, 3 times in the lung and once in the spleen. Drugs or x-ray treatment have no sufficient therapeutical effect. Trivial trauma can cause rupture of the cysts; therefore surgery is indicated.


[The liver in a case of protoporphyria (author's transl)]. A 18 year old man with protoporphyria had discrete, sunlight-induced skin changes at the nose and the back of his hands, and liver disease. The transaminases ranged from 30 to 200 U/1, uro- and coproporphyrins in the urine were in the normal range. There was no evidence of a progression of the liver disease during 4 years. At peritoneoscopy the liver was yellow-brown with a granular surface. Microscopically fibrosis was present and globular pigment was distributed mostly in hepatocytes. These findings had been misinterpreted as "chronic active hepatitis with choletasis and fibrosis". This observation shows that liver disease in protoporphyria may be present with a normal urinary excretion of uro- and coproporphyrins and suggests that in cases of chronic liver disease of unknown origin the gastroenterologist ought to pay attention to sunlight intolerance and the pathologist to the yellow-brownish pigment of protoporphyrin.


[Ultrastructure of the liver in patients with cholesterol stones receiving chenodesoxycholic acid (author's transl)]. The ultrastructure of the liver was investigated in 5 normal persons and 10 patients with cholesterol stones. In the patients numerous intramitochondrial crystals could be found; precipitated cholesterol-digitonin complexes were found as well in the canaliculi, the sinus and the pericanalicular areas. 5 patients received chenodesoxycholic acid (10 mg/kg/day); liver biopsies taken 3 and 6 months after start of treatment did not show any more the changes described above.


[Experimentally induced pancreatitis (author's transl)]. Pancreatitis was produced in 29 mini-pigs by partial occlusion of the pancreatic duct; occlusion was performed by implanting a T-drain into the duct. Inflammatory changes were induced additionally by applying radiopaque material in excess. Acute and chronic pancreatitic lesions could be diagnosed by X-ray examination, evaluation of blood chemistry and by histology.


[Pharmacoangiography of the pancreas in cases of chronic pancreatitis and carcinoma of the pancreas (author's transl)]. Pancreatic angiography was performed in 246 patients using various vasodilating drugs. A pancreatographic effect could be found in 79% of all cases; Tolazolin was particularly efficient, since the effect could be found in 91% of the cases receiving the drug. The diagnostic value of different parameters was assessed in patients with chronic pancreatitis and in patients with carcinoma of the pancreas, in particular concerning the presence or absence of the pancreatographic effect, and the structure, width and contours of this organ. Evaluating the pancreatographic effect and vascular changes a correct diagnosis could be obtained in 69% of all cases with chronic pancreatitis and in 78% of all cases with carcinoma of the pancreas. The pancreatographic effect was diagnostically essential in 26% of all cases, and turned out to be rather useful in patients with chronic pancreatitis, whereas its diagnostic value was less in patients with carcinoma. The diagnostic value of angiography can be improved by the superselective technique and by applying the vasodilator Tolazolin, which is well tolerated and gives an excellent pancreatographic effect.


Differential alteration of delta 9 and delta 6 desaturation of fatty acids in rat brain preparations in vitro. Developing rat brain has the capacity for either delta 9 or delta 6 desaturation of fatty acids. In liver, evidence supports the existence of separate enzymes for each reaction, but it is not known whether in brain delta 9 or delta 6 desaturation of saturated fatty acids involves distinct enzymes. We have used fatty acids, including the cyclopropene fatty acid, sterculic acid, to alter desaturation activities with substrates that are desaturated predominantly in the delta 9 position or in the delta 6 position. In addition, differential alteration of desaturation of palmitic acid, a substrate that can be desaturated in either the delta 9 or delta 6 positions by brain preparations from neonatal rats, was examined. Sterculate reduced delta 9 desaturation of palmitate 80--90% but reduced delta 6 desaturation only 35%. In contrast, linoleic acid preferentially reduced delta 6 desaturation of palmitate. Thus, delta 9 desaturation of saturated fatty acids appears to be catalyzed by an enzyme or enzyme site distinct from that for delta 6 desaturation. Accordingly, these activities may be independently regulated during crucial stages of brain development.


Lipid oxidation products and chick nutritional encephalopathy. Safflower oil and its distilled methyl esters were thermally oxidized and fed to young chicks in a vitamin E deficient diet. At a dietary level of 10%, the oxidized lipids caused more severe nutritional encephalopathy (NE) than the unoxidized methyl esters, indicating that factors other than dietary linoleic acid and vitamin E affect the development of NE. A polar lipid extract from oxidized methyl esters accelerated the induction of NE, as did the synthetic methyl esters of keto-octadecenoic and keto-octadecadienoic acids. Dicumarol exerted a protective action against NE. The possibility is discussed that conjugated keto-polyenoic fatty acids, provided by oxidized oils or formed endogenously in vitamin E deficiency, may play a role in causing NE.


Lipid composition of Morris hepatoma 5123c, and of livers and blood plasma from host and normal rats. The lipid composition of Morris hepatoma 5123c was analyzed together with that of liver and blood plasma from both normal and tumor-bearing rats. The results showed that the liver of tumor-bearing rats contained higher amounts of glycerides, choelsteryl esters, free fatty acids and phospholipids than the liver of normal rats. In the blood plasma of tumor-bearing rats, there was an increase of free cholesterol and triglycerides; this latter difference, however, was not statistically significant. Acyl chain changes in the liver of tumor-bearing rats consisted of an increase of palmitic and oleic acids and a decrease of stearic and arachidonic acids in phosphatidylinositol. Morris hepatoma 5123c contained a lower amount of triglycerides than the livers (both host and normal) and showed a significant decrease of total phospholipids when compared to the host liver. The major acyl chain changes found in Morris hepatoma 5123c compared with both normal and host rat livers were: a) a higher percentage of arachidonic acid together with a lower proportion of palmitic acid in cholesteryl esters; b) an increase of stearic and arachidonic acids and a decrease of palmitic acid in triglycerides; and c) a higher level of palmitic and oleic acids associated with a lower percentage of stearic and C22 polyunsaturated acids in phosphatidylcholine.


Geometrical and positional isomer content of the monounsaturated fatty acids from various rat tissues. The percentage distribution of the geometrical and positional isomers in the hexadecenoates and octadecenoates isolated from triglycerides, phosphatidylcholines, and phosphatidylethanolamines of brain, heart, kidney, liver, lung, muscle, spleen, and adipose tissues from normal rats maintained on a laboratory diet has been determined. All of the octadecenoates and most of the hexadecenoates from the lipid classes of all the tissues consisted of more than 95% cis isomers. Generally, palmitoleic was the predominant hexadeceonate, but many of the tissue phospholipids contained relatively high percentages of the delta 6 and delta 7 isomers. Oleate and vaccenate were the predominant octadecenoates in all tissues. Except for brain and adipose tissues, the oleate to vaccenate ratios differed for each lipid class, as well as between most tissues. In contrast to the monoenes of the phospholipids, the triglyceride monoenes exhibited the same approximate: percentage composition; percentage of geometrical isomers; and percentage distribution of hexadecenoate and octadecenoate positional isomers. These data add to our basic information about the percentage distribution of geometrical and positional isomers of naturally occurring unsaturated fatty acids in the major lipid classes of various normal tissues. Some new concepts were advanced as possible explanations to some of the observed positional isomer distributions.


Fatty alcohols in capelin, herring and mackerel oils and muscle lipids: I. Fatty alcohol details linking dietary copepod fat with certain fish depot fats. It is shown that the shorter chain (C14-C18) minor fatty alcohols in copepods, fish body lipids, and commercial fish oils are all qualitatively present, and quantitatively similar in proportions to acids found in the depot fats of capelin and mackerel, and in some herring. Although these fatty acids can be formed de novo in fish, copepod alcohols offer an alternative dietary source. Monoethylenic fatty alcohol details, especially for the 22:1 isomers, are reviewed, and the latter are discussed as precursors of the 22:1 fatty acids of fish depot fats, specifically of the dominant 22:1 omega 11 isomer.


Fatty alcohols in capelin, herring and mackerel oils and muscle lipids: II. A comparison of fatty acids from wax esters with those of triglycerides. The fatty acids recovered from the triglycerides and wax esters of common northwest Atlantic copepods are compared with the fatty acids of wax esters recovered intact from certain fish skin and body lipid, and from commercial fish oils. The fish species, herring, capelin and mackerel, all feed on copepods, and many resemblances of the copepod lipid fatty acids to those of a previous analysis of similar copepods suggest that the basic dietary fat input for these fish may be quite constant. The two copepod fatty acid analyses differed quantitatively in triglyceride 20:1 and 22:1 and also in 20:5 omega 3 and 22:6 omega 3, confirming the primary role of the wax esters in copepods. Selectivity factors are discussed in comparing the copepod wax ester fatty acids with the fatty acids of the wax esters recovered intact from the fish lipids and oils. The basic role of copepods in supplying all types of fatty acids to fish depot fats is considered to be strongly supported by these findings.


The role of gastric lipolysis on fat absorption and bile acid metabolism in the rat. In vivo studies were carried out in young Sprague-Dawley rats to examine the role of gastric lipolysis on fat absorption and bile acid metabolism. When fed by gastric perfusion 5 times (corn oil, 4 g/day) their usual dietary intake of fat, rats deprived of lingual lipase by the creation of an esophageal fistula had a significant degree of fat and bile acid malabsorption as well as a shortened bile acid half-life when compared to animals with a gastrostomy. The % fat absorption, bile acid loss and bile acid pool were normal in 2 groups of esophageal fistula rats fed the same quantity of corn oil or twice (8 g/day) that amount as a fine emulsion. In view of a negligible gastric lipase activity in animals with an esophageal fistula and of decreased hydrolysis of a triglyceride test meal, these data suggest that gastric lipolysis is of physiological importance in situations where lipolytic mechanisms are stressed by a large fat intkae. Its principal role is to potentiate intestinal lipolysis by facilitating the emulsification of dietary lipids through its formed products and, therefore, the contact of pancreatic lipase with its substrates.


Correlations between surface area and the rate of enzymatic desaturation with methyl branched 8, 11, 14-eicosatrienoic acid. Methyl-branched derivatives of methyl 8,11,14-eicosatrienoate form stable liquid-expanded monolayers. Surface areas are expanded by the methyl branch. The expansion effect is a function of surface pressure. At high surface pressure, the greatest expansion occurs with a mid-point methyl branch. At low surface pressure, surface area increases continuously as the methyl group is moved along the carbon chain from carbon 19 to carbon 5. Desaturase activity varies inversely with surface area, and a linear correlation exists between surface area at low surface pressure and the desaturation rate. These data support the concept that lipid structure and its effect on short range forces between molecules is an important factor in desaturase activity.


Forces exerted during exercises on the uneven bars. The purposes of this study were (1) to develop a technique to measure the force exerted on uneven bars during a gymnast's performance, and (2) to determine the magnitudes of the maximum forces exerted on the bars during normal use. Strain gages, a UV recorder, and motion-picture cameras were used to record the forces exerted against the bars and the motions with which they were associated. Three college gymnasts were used as subjects. Each performed several repetitions of an exercise sequence judged to result in the maximum loading of the bars she might produce under normal conditions. The maximum forces recorded were 3500 N (low bar) and 2140 N (high bar). These values were recorded during a sharp impact between the subject's thighs and the bar during the passage of the subject beneath the bar in a giant swing, respectively. Making due allowance for possible measurement error and for the estimated effects of the bars being used by gymnasts of greater mass than those in this study, it was concluded that bars should be designed to withstand repeated loads of at least 4205 N.


The pull in olympic weightlifting.

The pull in olympic weightlifting. Data from five experienced weightlifters on the vertical forces applied to the barbell and system (barbell and lifter) during the pull were in excellent agreement with earlier displacement-time descriptions of the double knee bend as consisting of two stages of extension interrupted by a period of realignment (second knee bend). The vertical component of the ground reaction force (Rz) consisted of three phases: Weighting I, Unweighting, and Weighting II. The relative magnitude of the Rz impulse with respect to the system weight impulse (as an indicant of the proportion of the Rz impulse contributing to system acceleration) ranged from 118--141% for Weighting I, 74--89% for Unweighting, and 122--135% for Weighting II. In agreement with published theoretical calculations the most experienced and successful lifter produced the larger phase of positive acceleration first. The rebending of the knees was associated with the Unweighting phase. Although this latter interval corresponded to a phase of barbell deceleration, it appeared that the concomitant enhancement of the back, hip, and knee extensor activity outweighed any adverse effects.


Football helmets and neurotrauma--an epidemiological overview of three seasons. During the 1975, 1976, and 1977 football seasons, the National Athletic Injury/Illness Reporting System (NAIRS) obtained records of the nature and severity of injuries and illnesses experienced by an annual average of 5361 high school and college athletes. Associated circumstances, including type and brand of helmets being worn by the injured and non-injured, also were obtained. From these data, and against specified epidemiologic criteria for significance, the possibility that particular helmets were associated unduly with cerebral and spinal neurotrauma was examined. The results revealed that (1) one permanent severe neurological injury (cervical spinal cord) was experienced, the mechanism of which was unrelated to helmet design; (2) cerebral concussions were infrequent (one significant concussion per 10,000 athlete exposures) and of a consistent rate from year to year; and (3) no particular helmet was associated with a disproportionate number of concussions or cervical spine fractures within those experienced. Continuing surveillance with multivariate analysis of possible causal relationships among all factors associated with these injuries is in progress.


Intrinsic motivation in a competitive setting. The purpose of the present investigation was to determine the effects of success-failure and monetary reward on intrinsic motivation of males and females competing on a motor task. Results indicated a significant main effect for feedback with subjects exhibiting more intrinsic motivation after success than after failure. The Sex x Feedback interaction showed that males displayed more intrinsic motivation than females after success whereas females exhibited more intrinsic motivation than males after failure. Results are discussed in terms of Deci's cognitive evaluation theory and sex-role appropriate behaviors for males and females. Implications for competitive physical activity are drawn.