Parenteral cephalothin therapy for pelvic gonococcal infections. The efficacy of intravenous cephalothin was studied prospectively in 20 patients with acute pelvic inflammatory disease, all of whom presented with lower abdominal pain, cervical and adnexal tenderness, fever, and leukocytosis. Blood, cervical, and cul-de-sac cultures were obtained on admission. The latter was transported anaerobically and inoculated in routine and prereduced medium. Transgrow medium with trimethoprim was used for endocervical cultures. Neisseria gonorrhoeae was isolated from the endocervix in 15 patients and from the cul-de-sac in four patients. All received intravenous cephalothin, 2 gm every four hours for seven days. Clinical improvement was observed in 48 to 78 hours. The cervical cultures were negative for N. gonorrhoeae after 48 hours, at the completion of treatment, and two weeks post-treatment. The drug was well tolerated. It was concluded that cephalothin intravenously is an acceptable alternative antibiotic for the treatment of gonococcal pelvic infection.


Syphilis and pelvic inflammatory disease. Since screening every patient in the emergency department for venereal disease is impractical, we hypothesized that patients with the clinical diagnosis of pelvic inflammatory disease (PID) might be at higher risk and a group that should be screened. Seventy women with a clinical diagnosis of PID treated in our adult emergency department from July to November 1976 were screened for syphilis using three separate serologic tests: Venereal Disease Research Laboratory, fluorescent treponemal antibody absorption, and treponema pallidum hemagglutination. The incidence of positive serologies in our study group was significantly higher (11.4%) than that of 100 controls (4%). All patients with a clinical diagnosis of PID should be screened for syphilis using both FTA-Abs and TPHA tests, as well as a VDRL.


Emergencies in dialysis patients.

Emergencies in dialysis patients. Specific emergencies occur in patients maintained on hemodialysis that often require evaluation and treatment in the emergency department, including infection of the access, cardiovascular disease, blood pressure abnormalities, pericarditis, cardiac arrhythmias and headache. Specific recommendations for treatment are presented.


Paramedic services: nationwide distribution and management structure. A paramedic clearinghouse to provide information on the status of advanced life support systems in the United States is being established at the Center for the Study of Emergency Health Services, University of Pennsylvania. Philadelphia. As the first phase of this project a list of paramedic services categorized by location, population of area served, and management structure was compiled. A total of 310 paramedic services was identified, the majority fairly evenly distributed through midpopulation ranges, the largest number in the 50,000 to 100,000 range. Paramedic services operated by fire departments were most common. As the second phase, a survey of the operation, paramedic certification and education, and the organization of financing of these services is planned. Six services, each representing a different management or educational approach, were selected to test the survey instrument.


Paramedic use of intracardiac medications in prehospital sudden cardiac death. The intracardiac administration of medications in cardiac arrest is advocated when an intravenous route cannot be established. Although warnings of complications of this mode of therapy are reiterated throughout the literature, their careful documentation is lacking. Paramedics were trained to administer intracardiac medications, under strict criteria, in patients with prehospital sudden cardiac death. Long-term survivors who received intracardiac medications from paramedics were compared to a control group resuscitated by paramedics with intravenous medications alone. By far, the patients who received intracardiac medications were more nearly refractory to resuscitation because of the criteria for intracardiac medication use. Potential complications of the intracardiac route were identified and sought. However, complications were no more common in this group of patients than in the control group. Paramedics can successfully administer intracardiac medications when indicated.


Phencyclidine deaths.

Phencyclidine deaths. The potential for a pharmacologic "overdose" and the cause of death associated with phencyclidine abuse is discussed. Nineteen deaths associated exclusively with phencyclidine intoxication have been documented. In 13 cases the immediate cause of death was asphyxia by drowning or trauma with lower levels of phencyclidine present suggesting behavioral toxicity. In two cases, the presence of phencyclidine in high concentrations constituted the only finding, and the probable cause of death was primary respiratory depression accompanied by seizure activity. A secondary drug effect or concurrent disease process may have contributed to the death of the remaining four individuals.


Autotransfusion of blood contaminated by intestinal contents. In a series of 183 emergency operations in which intraoperative autotransfusion was used, 14 patients received blood contaminated by intestinal contents. Six of the 14 patients died early in the postoperative period, four of whom had received more than 16 liters of blood. Only two of the eight survivors had received comparable amounts of blood (13 and 17.5 liters). All eight received antibiotics upon admission; four had positive blood cultures within 24 hours of operation. Complications included acute tubular necrosis in three patients and bowel obstruction with intra-abdominal abscess in another. One of the patients with acute tubular necrosis died six weeks later; all others recovered. We believe this procedure may be life-saving in some cases.


Evaluation of an Emergency Department Patient Advocacy Program. In the Patient Advocacy Program at the Adult Emergency Department of The Johns Hopkins Hospital, first year medical and health associate students provide patient teaching, crisis intervention, emotional support, assistance in patient-provider-family communication, resource referrals, information and assistance in maintaining patients' rights. The advocacy program was evaluated through a three-month trial of a Control Group, Patient Advocacy Group, Halo Group and Placebo Group, including 412 study subjects in all. It was hypothesized that patients' satisfaction, behavior and knowledge would improve significantly as a result of the advocate's intervention in this order: Patient Advocacy, Halo, Placebo and Control. Patient interviews and medical reports were used to assess the impact of patient advocacy. Results did not support the hypotheses of either improvement or the ranked order. Competition with traditional roles, identification of advocates with providers rather than patients, and placing the needs of the institution over patients were suggested as explanations for the advocacy program's failure.


Basic decisions in Emergency Department cases: a logical approach. In the emergency department teaching program at Brooke Army Medical Center, housestaff rotating through the emergency department are given an algorithm for use in making basic diagnostic decisions. Housestaff frequently believe that the result of their contact with a patient should be establishment of the correct pathophysiological etiology of the patient's chief complaint followed by definitive therapy and feel anything less is unacceptable. The algorithm, which had been in use for nine months at the time of this report, was formulated in an attempt to deal with the problems such views may create, such as inappropriate management of patients who obviously require admission, second-best care, and delays for patients requiring emergency department evaluation. The algorithm has been successful in changing housestaff attitudes and actions and will continue to be used.


Emergency Department treatment, triage and transfer protocols for the burn patient. Emergency department treatment, triage and transfer protocols for patients with major thermal injury have been devised by the three burn centers in Virginia. A burn nurse educator has presented these guidelines to the emergency departments of Virginia. The development of these protocols has considerably improved the immediate care of the victims of thermal injury who are transferred to the burn centers in the Commonwealth of Virginia.


Femoral shaft fracture with ipsilateral hip dislocation in a child. A child victim of low speed violence was found to have a fractured femur and dislocation of the ipsilateral hip. This combination of injuries in a child is very rare. The dislocation was not initially recognized because of absence of suggestive history, symptoms, and signs. After recognition, open reduction of the hip dislocation was achieved through a posterior approach. One month later an osteotomy at the femur fracture allowed the leg to fall to neutral while maintaining the femoral head in the most desirable position.


[Hemodynamic effects of obzidan in vasorenal hypertension in dogs in ontogeny]. Vasorenal hypertension was reproduced in experiments on 18--22 day-old and 2--3-month-old puppies and on sexually-mature dogs by bilateral stenosis of the renal arteries. Two weeks later all the animals were given intravenous infusion of obzidan in a dose of 2 mg/kg. The arterial pressure, the minute and systolic volumes (MV, SV), total peripheral resistance (TPR), and the work, strength, and phase structure of the left ventricle were recorded. In animals aged 18--22 days with elevated pressure, obzidan infusion promoted its normalization, led to a decrease in the increased MO to subnormal values, a decrease in TPR and the heart beat rate, and normalization of the increased SV. In puppies aged 2--3 months, obzidan normalized the pressure by causing a fall in the minute output which was already reduced in hypertension, and a certain decrease in TPR with hardly any changes occurring in SV. In adult dogs, despite a sharp decrease in MV, arterial pressure did not significantly change due to the increase in TPR. Energy expenditure per each liter of MV was normalized by obzidan only in puppies.


[Functional and structural myocardial changes in experimental glomerulonephritis]. Functional structural changes in the myocardium in different developmental phases of nephrotoxic glomerulonephritis were studied in rats. Electrocardiography, electron microscopy, and biochemical study of respiration, linked with oxidative phosphorylation, by polarography in the fraction of mitochondria isolated by differential centrifugation were employed. In experimental glomerulonephritis the ECG shifts were attended with diminished oxidative phosphorylation in the myocardial mitochondria, destructive changes in the cardiomyocytes (disorganization of mitochondria, myofibrils, endoplasmic reticulum), loosening and swelling of the basilar membranes, and changes and swelling in the capillaries and interstitium. The functional structural changes in the heart are reversible in character but persist for a longer period of time than the clinical manifestations of glomerulonephritis.


[Role of prostagladin synthesis inhibitors in the development of arterial hypertension. II]. Arterial hypertension was induced in experiments on rats by chronic injection of indometacin, an inhibitor of prostaglandin synthesis, combined with a salt load or unilateral nephrectomy. A twofold rise in arterial pressure, on average, was noted at the end of the 6th week of the inhibitor injection. The development of arterial hypertension following indometacin injection and a salt load led to reduced excretion of sodium and water, increased intravascular volume, and increased sodium content in the aortic wall. In the group of nephrectomized and indometacin treated animals, on the contrary, sodium and water excretion increased, intravascular volume diminished, and the content of sodium in the aortic wall decreased. Chronic injection of indometacin alone into intact animals did not lead to a rise of arterial pressure within the same periods of time and did not induce changes in the renal excretory function. It is presumed that disorder of water-salt homeostasis is one of the mechanisms of the increase in arterial pressure.


[Importance of the thrombocytes and hemolytic syndrome in the pathogenesis of transient cerebral circulatory disorders in hypertension patients]. Study of the blood platelet functional activity and intensity of hemolysis in 41 patients with transient disorders of cerebral circulation and comparison of the results with the corresponding indices in healthy individuals, in 40 patients with hypertensive disease free of crisis, and in 25 patients with cerebral atherosclerosis led to the conclusion that the character of cerebral stroke is already determined in the pre-stroke period. It depends on the functional state of the blood platelets in many respects. In patients with hypertensive disease in a period clear of crisis, for instance, there is a tendency towards hypoaggregation possible associated with the presence of latent hemolysis. Platelet hypofunction progresses in the period of hypertensive encephalopathy and still more during its transformation into hemorrhagic stroke. On the contrary, in patients with atherosclerosis but no symptoms of cerebral ischemia the adhesion-aggregation activity of the platelets does not differ essentially from that in healthy individuals. With the development of signs of ischemia of the brain, the platelet activity grows considerably, particularly when transient cerebral circulatory disorders transform into ischemic stroke.


[State of the hemodynamics in pregnant women suffering from mitral stenosis]. Hemodynamics was studied in different trimesters of pregnancy in 94 women with mitral stenosis and in 32 healthy women with pregnancy following a normal course. Each trimester in women with mitral stenosis was marked by different changes in hemodynamics. Study of the state of hemodynamics allows preclinical signs of cardiac insufficiency to be already detected in the early periods. This makes it possible to assess the risk of pregnancy and delivery in women with mitral stenosis at the right time and more correctly. The disclosure of unfavourable signs of changes in hemodynamics in conjunction with the clinical signs of cardiac insufficiency aids in the choice of the therapeutic and obstetrical tactics.


[Differential diagnosis of cardialgia].

[Differential diagnosis of cardialgia]. Three hundred and sixty-six patients (281 males and 85 females) were examined, 316 of them complained of pain the heart and retrosternal pain. Bicycle ergometry was conducted in all cases and the soft tissues of the neck, chest, and shoulder girdle were palpated carefully. In patients with angina pectoris tolerance to physical exertion was clearly diminished while palpation did not reveal, as a rule, disorders of sensibility in the soft tissues of the chest and shoulder girdle. Patients with pain in the heart of a neurotic character tolerated physical exertion fairly well and often had increased sensibility of the soft tissues in the left side of the chest and shoulder girdle. The intensity of cardialgia may be judged objectively by the degree of soft tissue tenderness and its spread.


[Rhythm of the daily fluctuations in lipid metabolic and fibrinolysis system indices in ischemic heart disease]. The study was conducted on 22 patients with ischemic heart disease (I stage atherosclerosis according to the classification suggested by A. L. Myasnikov). Phase 24-hour fluctuations of the indices of lipid metabolism, blood coagulation, and fibrinolysis were revealed clearly. It was established that in the initial stage of the disease the diurnal rhythm of lipid metabolism does not differ from that in healthy persons. The rhythm of diurnal fluctuations in the function of the hemostasis system was marked by an increase in blood coagulation and decrease in the activity of fibrinolysis early in the morning, which created the conditions for intravascular thrombus formation.


[Disorder in the circladian rhythms of calcium, magnesium and phosphorus excretion in hypertension (use of the "cosinor" method)]. The daily rhythms of calcium, magnesium, and phosphorus excretion were studied in 10 healthy individuals and in 43 patients with hypertensive disease. All the subjects under study followed the standard regimen of wakefulness, sleep, and meals. The transverse "cosinor" method of rhythm study was used. Statistically significant daily rhythms of calcium, magnesium, and phosphorus excretion were revealed in healthy individuals, in which case the phenomena of internal synchronization were encountered. Daily rhythms of phosphorus and calcium excretion were revealed in patients with stage IB hypertensive disease, while the rhythm of magnesium excretion was statistically insignificant. In stage IIA the rhythms of calcium, magnesium, and phosphorus excretion are demonstrated, but desyncronization as compared to the findings in healthy individuals is observed. There are no statistically significant daily rhythms of calcium, magnesium, and phosphorus excretion in patients with stages IIB and III hypertensive disease. The change in the rhythm of magnesium excretion in patients suffering from IB stage hypertensive disease points to the early inclusion of the disturbance of its homeostasis in the development of this disease. The control mechanisms of the daily rhythms of calcium, magnesium, and phosphorus excretion are not clear to date. The study of the daily rhythms of these elements is nevertheless of definite importance in revealing disturbances in their homeostasis.


[Ways to increase the information content in the automatic processing of instrumental data in cardiology]. New algorithms for the analysis of sinus rhythm and doppler-cardiogram of the posterior wall of the left ventricle are suggested. Clinically invormative signs have been revealed: number of classes of R--R intervals, distance between the centers of the classes, regular distribution of R--R intervals according to classes, and the value of the doppler-cardiogram spectrum harmonics I/II ratio. The possibility of using these signs in the systems of automatic analysis of data in examination of patients with ischemic heart disease is shown.


[P-controlled electrical heart stimulation in complete transverse block in acute myocardial infarct]. The article discusses the results of the comparative study of certain hemodynamic indices in patients with myocardial infarction complicated by complete atrioventricular block, during routine electric stimulation of the ventricles and during P-controlled electric stimulation of the ventricles. Changes in hemodynamics were more marked in the last case, but only the values of the minute cardiac volume and of central venous pressure were found to differ substantially in these two groups. The authors presume that such a hemodynamic situation may occur in myocardial infarction in which P-controlled electric stimulation will produce more essential changes in hemodynamics that those induced by routine electric stimulation. Synchronized electric stimulation may be more preferable in such cases.


[Parameters of the bioelectrical activity of the heart conduction system in virtually healthy persons]. Intracardiac conduction was studied on the basis of the conception of the atrial spike potentials. Intracavitary electrograms were recorded from the right atrium, zone of the bundle of His, and the esophagus in 110 persons in 35 of whom no abnormalities were found in the heart and the results of the examination were accepted as control indices. On the grounds of the investigations conducted by them, the authors determined the shape, amplitude, and time of appearance of the spike potentials of the sinus rhythm, atria, and the bundle of His and also the duration of the intervals of intracardiac conduction. Study of the phenomena of bioelectric activization of the atria and the system of the bundle of His in a complex significantly widens the possibilities of selective assessment of disorders of intracardiac conduction at various levels of propagation of the stimulation.


[Bicycle spiroergometric studies in the diagnosis of ischemic heart disease]. The indices of pulmonary ventilation and gas exchange, oxygen consumption per 1 kgm of work, the restoration coefficient, the effectiveness of work, etc. were studied at rest, during dosaged physical exertion on a bicycle ergoraph, and in the restoration period in 50 healthy individuals and in 175 patients with ischemic heart disease. Selective coronary angiography was conducted in all of the patients. Spiro-bicycle-ergometry is an informative method in the diagnosis of ischemic heart disease, enabling the physician to presume the presence of coronary sclerosis and judge the degree and extent of involvement of the coronary arteries before performing coronarography. With the gradual increase in the number of involved arteries, there were noted a gradual decrease of the restoration coefficient, diminution of the effectiveness of work, and an increase in oxygen consumption per 1 kgm of load. Changes in spiro-bicycle-ergometric indices in patients with ischemic heart disease and normal coronary arteries had the same trend as those in patients with coronary atherosclerosis.


[Possibilities of utilizing integral topography, vectorometry and spectral analysis of the complexograms for the diagnosis of ischemic heart disease]. Three approaches to the study of electric and mechanical heart activity were used, which were significant in the diagnosis of various variants of ischemic heart disease. The method of integral topography proved most applicable in the diagnosis of microfocal myocardial infarction. Infarctions which were marked by a typical clinical picture and the corresponding laboratory data (changes in enzymes, leukocytosis, etc)., but could not be sufficiently revealed in the commonly applied 12 leads of the ECG, were successfully identified due to changes in the ST--T zones of the topogram. In the diagnosis of ischemic heart disease attended with disorders of hemodynamics it is advisable to apply the histogram method of identification on the basis of spectral analysis of the complexograms, ballistocardiograms, arteriovenous pulsograms, and phonooscillograms. This method may also be used to assess the stage of circulatory insufficiency. In preventive examination for detecting ischemic heart disease, its painless variants in particular, it is advantageous to use the method of vectorometry of the ECG in in orthogonal leads with the subsequent solution of the diagnostic discrimination polynomials on a computer.


[Diagnosis of left ventricular congestive heart failure at the onset of acute myocardial infarct]. According to the results of X-ray examination conducted in the first 2 days of the disease, 143 patients with myocardial infarction were separated into 2 groups: those with a normal pulmonary pattern and those with congestion or edema of the lungs. In pulmonary congestion the clinical data were at disparity with the X-ray findings in more than half of the patients. At the same time, comparison of the values of volumetric pulmonary rheography and accelerative kinetocardiography, treated by the method of linear discriminant functions, with the findings of pulmonary roentgenography showed only a small percentage (lesser than that in the clinic) of non-coincidence in the diagnosis of congestive left-ventricular failure.


[Echography of the right sections of the heart (methodological aspects of ultrasonic location)]. In location of the cardioelements from the intercostal spaces at the left sternal border, the anteroposterior directions of the ultrasonic beam are called standard positions of the sensor, while the right directions of the beam--the right positions of the sensor. In definite cases the use of the right positions of the sensor makes it possible to record the right cavities of the heart. Depending on the foreshortening of the locating impulse, considerable variability of the shape of triacuspid valve movement is noted. The pulmonary valve is usually represented on the echogram at a depth of 3--5 cm by a thin linear structure which moves away from the thoracic wall rapidly during the ejection period. It is presumed that the recording of the right parts of the heart will yield valuable diagnostic information in echocardiographic examination.


[Echocardiographic diagnosis of mitral valve insufficiency]. Seventy-two persons with various forms of mitral insufficiency of rheumatic and non-rheumatic etiology and 17 healthy individuals (control group) were examined. The results of echocardiography in 35 patients were compared with operative (mitral commissurotomy, valve plastics) findings. Several typical variants of a mitral echogram in patients with "pure", predominant and concomitant mitral insufficiency were distinguished. The predominantly "valvular" mechanism of mitral insufficiency in patients with rheumatic disease and the predominant role of "subvalvular" pathology in nonrheumatic insufficiency were revealed. The diagnostic value of determining the indices of cardiac activity and the size of the left parts of the heart by means of echocardiography is confirmed.


[Comparative diagnostic importance of 2 triaxial electrocardiographic systems (the Neba and McPhee-Parungao systems) in focal-cicatricial myocardial lesion of varying localization]. Comparison of two triaxial systems of an ECG record--the Neba system and the corrected McFee--Parungao system--showed that the second system possesses a greater number of informative signs than the first for differentiating the localization of a focal-cicatricial affection of the myocardium and comes close to the 12-axial system in informativeness: in focal-cicatricial lesion of the myocardium of a low localization they are recorded from lead Y, in anterior septal localization from lead Z, in anterolateral localization from lead X, in extensive affection (anterior septal, apico-lateral regions) from leads Y and Z. The Neba system proved unsuitable in the diagnosis of focal-cicatricial affection of low (postero-diaphragmatic) localization.


[Postoperative astigmatism and visual acuity after cataract extraction with various operative methods (author's transl)]. The postoperative findings after cataract extraction with corneoscleral incision were compared with those after corneal incision in two groups consisting of 70 patients each. The criteria used were the degree and axis of postoperative astigmatism evaluated ophthalmometrically and the postoperative visual acuity. The preoperative values were taken into account. The mean values of astigmatism shortly after corneal incision were very much higher than those after corneoscleral incision, and they approached each other 6 months after cataract extraction. Patients who had an operation done with corneoscleral incision had a better visual acuity than those with corneal incision.


[The natural course of temporal branch vein occlusion (author's transl)]. The knowledge of the individual collateral circulation is mandatory to judge the natural course and the prognosis of temporal branch vein occlusion. When collateral circulations are present a favourable final result can be anticipated even in cases with pronounced decreased visual acuity. To determine the time for coagulation treatment the differentiation between reversible and irreversible retinal lesions following branch vein occlusion is helpful. Particularly attention has to be paid to save those vessels, serving as a drainage function of the macula. On the other hand those neovascularisations have to be eliminated, leading ultimately to vitreous hemorrhage.


[Applanation tonometry within medical diagnostic "check-up" programs (author's transl)]. Within medical diagnostic "check-up" programs intraocular pressure measurements by applanation tonometry from 8899 patients (5924 men, 66.6%; 2975 women, 33.4%) were statistically evaluated. The frequency of each i.o. pressure show no Gaussian distribution but is skewed to the right with marked excess to higher values of i.o. pressure. Correlation of mean i.o. pressure with age shows (starting in the group of the 20-24 years old to the 75-79 years old persons) a rather linear progression of i.o. pressure. The mean value of i.o. pressure (n = 17,798 eyes) was x = 16.25 mm Hg, the standard deviation +/- 3.45, the standard deviation of the mean +/- 0.03 mm Hg. In men in 2.18% in women in 1.81% higher i.o. pressure than 21 mm Hg was found. I.o. pressure higher than 24 mm Hg have 0.66% of the men and 0.58% of the women. Patients forty years old and elder showing in 4.92% of the men and 4.88% of the women higher i.o. pressure than 21 mm Hg. In patients fifty-five years old and elder in 5.75% of the men and respectively in 6.69% of the women i.o. pressure higher than 21 mm Hg was found. Incidences of elevated i.o. pressure from patients over forty years old in ten years steps are presented. In 103 patients with unilaterally i.o. pressure higher than 24 mm Hg 12% presents manifest diabetes mellitus. The usefullness of applanation tonometry as a practicable screening method for early glaucoma detection within medical diagnostic "check-up" programs is outlined. Advantages of data-aquisition and -processing systems to continue those studies are emphasized.


[Growth hormone and diabetic retinopathy (author's transl)]. Changes in the serum level of growth hormone have been studied in 28 diabetics (6 exhibiting no diabetic retinopathy (d. r.), 10 displaying a non proliferative d. r., 6 having proliferative d. r., and 6 Brittle-diabetes) together with a control group consisting of 11 subjects (5 being totally healthy, and 6 having acromegaly without d. r.). Blood samples were obtained before and after arginine and glucagon administration and also following controlled exercise on the ergometer with 50% of the actual working capacity during 20 minutes. The presence of d. r. and its stage has been determined by fluorescein angiography. Our results demonstrate that an increased secretion of growth hormone in diabetics actually constitutes a manifestation of metabolic instability. Apparantly no correlation exists between the appearance of d. r. or its stage and the degree of growth hormone release.


[On the prophylactic treatment in retinal detachment (author's transl)]. Within a period of three years, 152 eyes in 149 patients underwent prophylactic treatment for retinal lesions. The elements are considered that would move the surgeon to propose to the patient a prophylactic treatment. No complications were found in any of the eyes that were treated, however a retinal detachment occurred in two eyes, 6 to 8 months after treatment. Retinal lesions treated by prophylactic means are compared with those found in 500 eyes operated for retinal detachment during the same period. The results of this study leads to the conclusion that a real risk of retinal detachment is more dangerous than the possible consequences of prophylactic treatment.


[Ocular blood flow of cats after local administration of pilocarpine, phenylephrine, and of a mixture of both drugs (author's transl)]. Radioactively labelled microspheres (size 15 micron) were used to determine the regional blood flow in cats before and 15, 30 and 45 minutes after unilateral drug administration. In four experimental groups, each consisting of five animals, two drops of the drug were administered into the conjunctival sac. The blood flow increased in both eyes after administration of 2% pilocarpine and of Glauko Biciron, a mixture of 2% pilocarpine and 0.06% phenylephrine. No significant differences in the regional blood flows between the treated and untreated eye were found. After administration of 2% phenylephrine a decrease in blood flow was observed in both eyes, however earlier and more pronounced in the left eye. Thus, phenylephrine evoked the expected vasoconstrictive effect on the treated side. In the control group, which received physiological salt solution, the blood flow on the treated side decreased in most tissues, while an increase was observed on the untreated side.


[Investigation in patients with central serous retinopathy with the MMPI Saarbrücken (author's transl)]. Patients with angiographically proven C.S.R. were investigated with the MMPI. They showed significantly higher scores on the hypochondria and hysteria-scale. The idea, that C.S.R. is an ocular psychosomatic disease is supported by the profile pattern, which shows an elevation of the "Neurotic Triad" with the characteristically depressed "Psychosomatic Valley".


[Pneumatotomography of the orbit (author's transl)]. After a description of the technique of -examination appropriate to pneumatotomography of the orbit the efficiency of this diagnostic method is discussed with regard to 8 personnally performed examinations. 5 cases are discussed in detail with illustrations. The indication for pneumatotomography should only be given when an orbitotomy is necessary. Serious complications are not known. Temporary increase of exophthalmos with emphysema of the eyelids, however, definitely uncomfortable for the patient.


[A-scan echography of a hemangiopericytoma (author's transl)]. The echographic characteristics of hemangiopericytomas were previously described as being similar to those of the sarcomas, with relatively low spikes. A case with high spikes is presented, which could not be differentiated echographically from a cavernous hemangioma.


[30 SL/M-conception of a general utility instrument for ophthalmology (author's transl)]. In respect to the instrument practice the slit lamp holds an eminent place in ophthalmology. The 6th generation of slit lamps after Gullstrand is now presented as a new development. The slit lamp 30 SL/M has been designed as a basic instrument which can be used with accessories to measure characteristics of the eye and to document actual shapes. With that the increasing demand for quantity and objectivity has been answered.


[The myogenic basis of smooth muscle motility (author's transl)]. Many mammalian smooth muscle tissues are able to produce spontaneous, myogenic activity. Five types of phasic-rhythmic activity can be distinguished: 1) Spikes: brief depolarizations of the membrane which trigger calcium release and contraction; 2) oscillations of the membrane potential of the second-rhythm type (SR) generating the spikes; 3) various organ-specific rhythms such as gastric and ureteral peristalsis which can be grouped together as basic organ-specific rhythms (BOR); 4) slower fluctuations of the minute-rhythm type (MR); 5) an hour-rhythm (HR) as the slowest type. In addition, some tissues generate tonic activity by special processes which can operate without spike discharges of the cell membrane. A selective blockade of phasic and tonic components is possible with some members of the group of so-called calcium antagonists. This indicates that two different calcium activation systems exist in the membrane of smooth muscle cells (P- and T-systems). Selective P- and T-blockade offers new possibilities for pharmacological influences on the smooth muscle system.


PAS-positive lymphatic cells in angioimmunoblastic lymphadenopathy. Cytological preparations have been investigated with the PAS-reaction in 8 cases of angioimmunoblastic lymphadenopathy, 7 of which were angioimmunoblastic lymphadenopathy, 7 of which were malignant, including 2 cases of "plasmoblastic" sarcoma. The two sarcoma cases showed intensely PAS-positive tumor cells similar to those known from acute leukemias and malignant lymphomas. Two cases of malignant angioimmunoblastic lymphadenopathy disclosed very many, two more such cases only occasionally positive cells. One malignant case only was completely negative. Some positive cells were found in the case that appeared benign. The PAS reaction is recommended as a diagnostic aid in angioimmunoblastic lymphadenopathy.


[Biosynthesis of C19- and C21-steroids in tissue slices of paraganglioma and pheochromocytoma (author's transl)]. The biogenesis of C19- and C21-steroids has been studied in tissue slices of a paraganglioma, of a pheochromocytoma and of human adrenal cortex using radioactive steroids. Slices of paraganglioma as well as of pheochromocytoma metabolise 17-hydroxyprogesterone to cortisone, cortisol, 11-deoxycortisol and testosterone. The rate of formation of these steroids, however, by the two tumours is 8--15 times less than that in normal adrenal cortex tissue. After incubation of dehydroepiandrosterone with tissue slices of paraganglioma and pheochromocytoma, 7alpha-hydroxydehydroepiandrosterone, 11beta-hydroxy-4-androstene-3,17-dione and 4-androstene-3,17-dione were found as metabolites; testosterone was converted by both tissues to 4-androstene-3,17-dione. 17-Hydroxypregnenolone was converted to a small extent (1.7%) to dehydroepiandrosterone by slices of paranganglioma. These results show that enzymes of steroid biosynthesis (hydroxylases, oxidoreductases, delta4(-5)-isomerases, C17(-20)-desmolases) are present in both paraganglioma and pheochromocytoma.


[Studies on the pre- and posthepatic plasma histamine concentrations and their possible pathophysiological effects in liver cirrhosis (author's transl)]. Fluorometric estimations of plasma histamine in the peripheral venous blood were performed in a control group of 16 subjects with normal liver values and normal liver biopsy specimen. Two further groups with liver changes were studied: Ten patients with fatty liver (stage I-II) and 22 cases suffering from liver cirrhosis, including 7 patients with portocaval shunt. Additionally, plasma histamine concentrations were determined in the blood of the portal vein, hepatic vein, cubital vein and in the femoral artery of another 11 normal subjects and 8 cirrhotic patients, some of them with portocaval shunt. The elimination of histamine by the liver was calculated. In healthy humans about two thirds (67.8 plus or minus 11.4 per cent; n=11) of the histamine content in the portal vein is eliminated by liver passage. This is due mainly to liver uptake and catabolism of histamine. It could be shown, that the elimination rate (41.0 plus or minus 15.1 per cent, n=8) is diminished in cirrhotic livers. Therefore, the plasma histamine content measured in the peripheral venous blood is significantly higher (p less than 0.001) in cirrhotic patients (1.2 +/- 0.3 ng/ml; n=22) than in healthy subjects (0.7 +/0 0.2 ng/ml; n=16). The expected pathophysiological effects of the elevated plasma histamine levels in liver cirrhosis are discussed with respect to circulatory changes ("hyperdynamic circulation") and their possible role in the development of "hepatogenic" ulcers of the stomach.


[Interference of the tissue concentration of antibiotics with a salidiuretic. Behaviour of cephradine and cephalothin in brain tissue after additional administration of furosemide (author's transl)]. Serum and brain tissue concentrations were determined after i.v. administration of 4 g cephradine to 11 patients of whom 6 were additionally receiving 40 mg furosemide t.i.d. peroral. Five further patients were given 4 g cephalothin i.v. All patients were undergoing a brain operation at the time of antibiotic administration. Between 60 and 100 min after dosage, cephradine decreased in the serum from 104.9 mcg/ml to 56.7 mcg/ml and in the brain tissue from 13.02 mcg/g to 8.37 mcg/g in the mean. Cephradine concentrations in serum were higher and in brain tissue lower when furosemide was given as well. These differences are statistically significant (p less than 0.01). Serum concentrations of cephalothin over the same period and in the absence of furosemide were very low with 32.2 mcg/ml at 60 to 70 min, and extremely low in the brain tissue (0.55 mcg/g in the mean) so that a trial with furosemide was not performed. Neither antibiotic was detectable in the cerebrospinal fluid. The differences in serum and brain tissue concentrations of cephradine in the presence and absence of furosemide demonstrate that special care must be taken when administering more than one drug.


Renal hypotension in sodium and fluid deprivation: experimental findings in renin-depleted rats. Arterial hypotension of renal origin occurred as consequence of low plasma renin activity in the presence of sodium and extracellular fluid volume depletion. Secretory insufficiency of the renin-producing juxtaglomerular cells and sodium and volume deprivation, simultaneously, were achieved by removing the "clamped" kidneys in renal hypertensive, sodium- and volume-depleted rats leaving in situ the contralateral kidneys deprived of renin during the preceding period of hypertension. It is suggested that renal hypotension after acute losses of sodium and extracellular fluid may also develop in patients with chronically depressed renin-angiotensin system.


Elevated serum calcium concentrations in mammary tumor bearing C3H/Fg mice without bony metastases. Sera from eight adult C3H/Fg mice bearing spontaneous mammary gland tumors were analyzed for calcium content in two successive weekly samples. The sera from six mice were fount to have significantly elevated serum calcium concentrations while sera from two were normocalcemic. Intramuscular implantation of mammary gland tumors into 12, 3-month-old female C3H/Fg mice resulted in significant and progressive increases in serum calcium concentrations over a 4-week period. Subcutaneous implants had a similar effect, but gave less consistent results. These data supported the hypothesis that mammary gland tumors are capable of inducing elevated serum calcium concentrations in C3H/Fg mice. It was concluded that low grade elevation of serum calcium occasionally seen in adult female C3H/Fg mice may be caused by incipient mammary gland tumors.


Germfree mice reared on an "antigen-free" diet. Germfree mice were fed through three generations a water soluble, chemically defined, "antigen-free" diet with a supplement of oil and oil-soluble vitamins. Second generation animals were compared to germfree and specific-pathogen-free mice fed a natural-type commercial diet. The ceca of the germfree mice fed the antigen-free diet were smaller than those of germfree mice fed the natural-type diet but larger than those of specific-pathogen-free mice fed the natural-type diet. Their mean spleen size was between that of germfree and specific-pathogen-free mice fed the natural-type diet, but the differences were of borderline significance. Germfree mice fed the antigen-free diet had fewer leukocytes than the other groups. Their serum immunoglobulin G level was one-tenth that of germfree mice fed the natural-type diet and one-hundredth that of specific-pathogen-free mice fed the natural-type diet. Their serum immunoglobulin M was only slightly below germfree, natural-type diet levels. Immunoglobulin A could be detected in the intestinal wall and contents of specific-pathogen-free mice fed the natural-type diet but not in either of the germfree groups.


Hexamitiasis in a laboratory mouse colony. An acute fatal disease occurred in a mouse colony at the authors' institution. The disease caused 50% mortality among weanling mice, and was characterized clinically by depression, rough hair coat, and distention of the abdomen. The most prominent gross lesions were watery fluid and gas in the small intestine. Numerous organisms identified as Hexamita muris were seen in direct smears of the intestinal fluid. Microscopic and electron microscopic examination revealed the same organisms in the intestinal crypts, within the mucosal epithelium, and in the lamina propria. Treatment with dimetridazole controlled the clinical disease but did not eliminate the infection.


Anesthesia in the mouse using a combination of ketamine and promazine. An anesthetic combination of ketamine and promazine was tested in 25 male and 25 female mice of each of two strains. The mean induction time was 5 minutes for the C57BL/6We mouse and 8 minutes for the DBA/2We mouse. No sex differences were observed. The mean duration time was 45 minutes for the C57BL/6We male, 53 minutes for the C57BL/TWe female, 29 minutes for the DBA/2We male, and 35 minutes for the DBA/2We female. The mean recovery time was 39 minutes for the C57BL/6We male, 38 minutes for the C57BL/6We female, 21 minutes for the DBA/2We male, and 24 minutes for the DBA/2We female. The drug combination provided effective anesthesia for these strains of the laboratory mouse for a period of 30--50 minutes after a single intramuscular injection.


Growth and development of the European ferret (Mustela putorius). Body weight, body length, and other developmental parameters were studied in the European ferret, Mustela putorius, from birth to 26 weeks of age. Males and females did not differ in weight until the seventh week of live, and they did not differ in length until the ninth week of life, when the males began to grow faster. Adult males (1400--1500 g) were heavier than adult females (800--900 g), but females reached adult size faster than males.


A tool and an instrument modification to facilitate aortic flow probe placement. A tool was designed and fabricated to simplify the procedure of placing a flow probe around the aortic root in acute animal experiments. The tool was made from a section of silicone rubber tubing which was flattened and tapered at one end. The flow probe was inserted into the open end of the tool, and the tapered end was drawn under the aorta, thus pulling the probe into position. Grooves were also ground into the probe body to ease the installation of the slot cover. During the 2 years that the tool and modified probes were used, they saved time and eliminated rupture of vessels as complications of aortic root flow probe placement.


Radiation injury in the neonatal canine kidney. II. Quantitative morphology. Quantitative morphology was used to investigate injury induced in the developing canine kidney by ionizing radiation. Irradiation at 2 days of age destroyed nephrogenic tissue in the outer renal cortex and significantly reduced kidney weight and volume through 70 days of age. However, as early as 14 days of age and continuing through 200 days of age, hypertrophy was demonstrated in the surviving middle and inner cortical nephrons of these kidneys. Both corpuscular and tubular components of the nephrons grew at an accelerated rate as compared to controls. The corpuscular volume per nephron increased 559 per cent in irradiated dogs and only 249 per cent in controls from 14 to 200 days of age. The tubular volume per nephron increased 519 per cent in irradiated dogs and 303 per cent in controls during the same period. As a result of the compensatory growth in individual nephrons, the kidneys of irradiated dogs at 200 days of age were as large as the controls when compared on the basis of body weight. The extensive hypertrophy is associated with accelerated development of intercapillary glomerulosclerosis in dogs irradiated around the time of birth.


Unilateral obstructive nephropathy in the rabbit. II. Late morphologic changes. The late histologic and ultrastructural effects of complete unilateral ureteral obstruction in the rabbit kidney were studied from 7 to 32 days postobstruction. Papillary necrosis occurred in all animals by the 7th day. There was progressive widening of the cortical interstitial space with proliferation of fibroblasts. Increased interstitial collagen fibers first became apparent on the 7th day and showed a progressive increase with time. The fibroblasts underwent myofibroblast transformation beginning on the 7th day. All segments of the nephron showed ultrastructural evidence of sublethal cell injury with loss of cell specialization. The dedifferentiation of the tubular cells was associated with a repetitive formation of new lamellae of basement membrane on the luminal side of the original basement membranes beginning on the 16th day of obstruction. These morphologic changes are discussed in terms of the physiologic changes previously reported in this model and the known clinical abnormalities found in obstructive uropathy.


Coronary risk factors and autopsy findings in Japanese-American men. During the years 1965 to 1974, 481 men who had participated in a standardized examination at the Honolulu Heart Study died. Autopsies were conducted in 226 of the men, and in 137 the extent of coronary and/or aortic atherosclerosis was estimated by the American Heart Association panel method. This method was found to be simple and highly reproducible. In multivariate analysis, statistically independent associations were found between aortic atherosclerosis and age at death, cigarettes per day, serum cholesterol, and systolic blood pressure; between coronary atherosclerosis and relative weight, cigarettes per day, and serum cholesterol; and between heart weight and height, relative weight, and systolic blood pressure. Alcohol consumption was lower and hematocrit was higher in men with infarcts than in other decedents, but no statistically significant relation between these variables and coronary or aortic atherosclerosis could be demonstrated.


A study of clients' perceptions of therapeutic effectiveness. A factor-analytic investigation was conducted to determine how adult communication-disordered clients perceive variables that speech-language pathologists feel are important to effective management. One hundred sixty-two subjects representing a relatively balanced distribution of sex, age, and disorder group responded to the study from private, hospital, and university speech clinics. The results indicated that clinician demographic characteristics contribute least to clients' perceptions of therapeutic effectiveness while technical and interpersonal skills are the more essential ingredients of clinical management. Similarities between clients', clinicians', and supervisors' perceptions are considered and implications are discussed.


Self-perception of speaking pitch levels. The literature has noted that speakers often perceive their own speaking pitch levels differently than listeners perceive them. However, little information is available regarding the specific characteristics of such perceptual differences. Speaking pitch level self-perception was explored in a group of 11 young adult males who served both as talkers and listeners. As a talker, each subject judged his own speaking pitch level in the process of speaking (live judgments) and during taped replay (taped judgments). The subjects' self-rankings in these two tasks and the rank order of taped voices as judged by listeners were compared to fundamental frequency rankings for the voices. The results indicated that the subjects judged their own taped voices in the same way that the listeners judged them, and the judgments corresponded to fundamental frequency rankings. During the live judgments, the subjects avoided extreme self-rankings, preferring to rank themselves closer to an average pitch level. The findings may have clinical significance in the remediation of certain voice disorders.


The aural-overload test: twenty years later. This paper reviews the underlying theory, the psychophysical test procedure, and the clinical applications of the aural-overload test. Clinical applications include (1) the delineation of persons susceptible to acoustic trauma, (2) the evaluation of post-exposure damage to the auditory system, (3) assistance in site-of-lesion testing, and (4) the assessment of loudness recruitment. The relationship between aural-overload thresholds and speech-discrimination scores for normal and pathological ears is also discussed.


Frequency and cooccurrence of vocal tract dysfunctions in the speech of a large sample of Parkinson patients. In this study, the frequency of occurrence of speech and voice symptoms in 200 Parkinson patients was defined by two expert listeners from high-fidelity tape recordings of conversational speech samples and readings of the sentence version of the Fisher-Logemann Test of Articulation Competence. Specific phonemes that were misarticulated were catalogued. Other vocal-tract dysfunctions, including laryngeal disorders, rate disorders, and hypernasality, were also recorded. Cooccurrence of symptoms in each patient was tabulated. Examination of the patterns of cooccurring dysfunctions permitted classifying the 200 patients into five groups: Group 1 (45% of the patients) with laryngeal dysfunction as their only vocal-tract symptom; Group 2 (13.5% of the patients) with laryngeal and back-tongue involvement; Group 3 (17% of the patients) with laryngeal, back-tongue, and tongue-blade dysfunction; Group 4 (5.5% of the patients) with laryngeal dysfunction, back-tongue involvement, tongue-blade dysfunction, and labial misarticulations; and Group 5 (9% of the patients) with laryngeal dysfunction and misarticulations of the back tongue, tongue blade, lips, and tongue tip. Disfluencies and hypernasality did not follow a systematic pattern of cooccurrence with other vocal-tract dysfunctions.


Elicitor effects on the language obtained from young language-impaired children. Language samples are typically obtained during speech and language evaluations by the speech-language pathologist to assess the level of expressive language development of young children. These samples are assumed to be accurate representations of the children's language skills. This study examines the effects of the elicitor on the language obtained from three- to six-year-old language-impaired children in a clinical setting. A corpus of nonimitated utterances was collected in 25 min from each of the nine subjects under two conditions: mother as elicitor and clinician as elicitor. The corpus of language collected under each condition was examined using the following measures: (1) numeric-number of utterances; (2) lexical-vocabulary type-token ratio: (3) grammatic-mean length of utterance, (4) percentage of one-morpheme utterances, (5) percentage of two-morpheme utterances, (6) percentage of three- or more morpheme utterances, (7) proportion of grammatical morphemes per utterance (8) semantic-percentage occurrence of semantic categories, and (9) type-token ratio for each of the 13 semantic categories. The data analysis revealed that the elicitor affected the number of utterances collected in a specific time period, but neither the lexical, grammatic, nor semantic aspects of the utterances were affected. The results state practical implications for evaluation procedures used in a clinical setting.


Modification of the eight-step continuum for treatment of apraxia of speech in adults. A previously reported treatment program for patients with severe apraxia of speech suggested that (1) some communicative ability could be restored, (2) it might be feasible to develop home programs from the original program, (3) the complete eight-step continuum may not be necessary, and (4) some patients had difficulty at step 4 in the program. Protocols from four severely apractic patients supported the contention that some communicative ability could be restored using this program. Effective home programs, based on the original program, were successfully developed. The complete program was not needed for two of the four patients. Finally, a methodology for reducing the difficulty at step 4 in the program was discussed.


EMG feedback and recovery of facial and speech gestures following neural anastomosis. A case report is presented of an attempt to increase muscle activity during nonspeech and speech activities through surface electromyographic feedback. The subject, a 25-year-old male, had a surgical anastomosis of the seventh cranial to the twelfth cranial nerve five years prior to the initiation of this therapy. The right side of the face was immobile. Frequency analogs of muscle action potentials from the right lower lip during pressing, retraction, eversion, and speech were presented to the subject. His task was to increase the frequency of the tone thereby increasing muscle activity. The subject made substantial improvement in the gestures listed above. Electrodes also were placed in various infraorbital positions for an upper lip lifting task. This gesture was unimproved. Pre- and posttherapy independence of facial gestures from conscious tongue contraction was found. Possible explanations were proposed for (1) increases of muscle activity in the lower lip, (2) lack of change of MAPs in the upper lip, (3) independence of the facial muscle activity from conscious tongue contraction, and (4) effectiveness of this feedback training.


Analysis of abnormal articulatory dynamics in two dysarthric patients. By means of pellet tracking techniques using an X-ray microbeam system, observations of the articulatory movements of various types of dysarthric subjects were conducted. In selected cases, electromyography (EMG) was also performed. The data were specifically examined for range, velocity, and consistency (reproducibility) of the movements of the articulators, as well as the pattern of coordination of the different articulators involved. It was found in the case of ataxic dysarthria of cerebellar origin, for example, that the dynamic patterns were best represented as a difficulty in the initiation of purposeful movements and an inconsistency of articulatory movements, particularly in the repetitive production of a monosyllable. On EMG, breakdown of the rhythmical patterns in the articulatory muscles was quite obvious in the repetition of a monosyllable. In the case of amyotrophic lateral sclerosis (ALS), decrease in the range and velocity of movements was noted. This resulted from reduced neuromuscular units (NMU) activities manifested in clinical EMG. Analysis of the dynamic aspects of the dysarthrias is a promising approach for elucidating the nature of central problems of speech production and for a differential diagnosis of various types of dysarthrias.


Biochemical correlates of ethanol-induced flushing in Orientals. Following the ingestion of alcohol, Orientals experienced smaller decreases in serum hydrocortisone levels than did Occidentals.


Alcoholics Anonymous in a Western U.S. city. Description of two groups of Alcoholics Anonymous includes data on the relationship between attendance during a 4-month period and abstinence at 6-month and 30-month follow-up studies.


Individual differences in response to alcohol. Vasoconstriction and vasodilation. Subjects who envidenced vasoconstriction after consuming alcohol did better than vasodilators on a simple motor task, but worse on more demanding tasks.


Children of alcoholics. Report of a preliminary study and comments on the literature. Familial relationships in 11 families in which 1 parent is an alcoholic are discussed in the context of literature on the children of alcoholics.


Usefulness of population controls in retrospective studies of alcohol consumption. Experience from a case--control study of esophageal cancer in Ille-et-Vilaine, France. Men from the general population of an area, interviewed in their homes, and men from the same area who were hospitalized (without alochol-related diseases) and interviewed in the hospital had similar distributions according to alcohol use.


On the probability of implanted disulfiram's causing a reaction to ethanol. Calculations indicate that patients with implanted disulfiram are unlikely to experience a pharmacologically induced disulfiram--ethanol reaction.


A comparison of two aversion treatment methods for alcoholism. In a follow-up study, patients who had received either chemical or electrical aversion treatment reported similar rates of abstinence.


Ethanol selection by inbred mice. Mode of inheritance and the effect of age on the genetic system. Ethanol intake by inbred and hybrid mice generally decreased after maturity, than increased in old age and senescence. Genetic differences in ethanol selection decreased with increasing age.


Prediction of posttreatment effectiveness in Navy alcoholics. Major predictors of the posttreatment effectiveness of 2195 alcoholics enlisted in the U.S. Navy were, for men 26 and over, abstinence during treatment, years of service and level of pay, and, for younger men, level of pay, not being demoted and not missing promotion to petty officer status.


Predicting length of stay by patients hospitalized for alcoholism of drug dependence. Involuntary admission, admission while intoxicated, hostility and denial of problems were associated with early dropout from an alcoholism treatment program, as were unemployment, younger age and having a spouse or someone else to live with.


Feasibility of determining blood alcohol concentrations in social drinking settings. Fifty-one per cent of persons leaving a variety of public and private drinking settings agreed to provide breath samples for blood alcohol determination.


Age-related trends in alcohol consumption. Data from a national survey of junior and senior high-school students and a survey of adults in Boston indicate that the frequency of drinking increases with age and the average quantity consumed on each occasion decreases with age.


Effect of ethanol preexposure on ethanol-induced conditioned taste aversion. In a taste-aversion test pairing saccharin and ethanol, rats that had recently ingest ethanol showed attenuated aversion to saccharin.


Factor structure of the Michigan Alcoholism Screening Test. A factor analysis of the Michigan Alcoholism Screening Test completed by motorists arrested for driving while intoxicated demonstrated four independent dimensions of alcoholic symptomatology--Help-Seeking, Discord, Alienation and Denial.


Relationships among control orientation, the FIRO-B, and the Ward Atmosphere Scale in hospitalized men alcoholics. Internally oriented patients' scores on Rotter's Internal-External Locus of Control Scale remained the same over treatment but those of externally oriented patients shifted toward greater internal control.


Effectiveness of assertiveness training with alcoholics. Alcoholics who recieved 10 hours of assertiveness training scored significantly higher than control and minimal training groups on three measures of assertiveness.


Attitudes toward problem drinkers. A critical factor in treatment recommendations. Problem drinkers who labeled themselves alcoholics tended to be assigned to a special Alcohol Team, whereas those who did not were referred for regular psychiatric treatment.


Acute thrombotic obstruction with Björk-Shiley valves: diagnostic and surgical considerations. Eight patients have had thrombotic obstruction of a prosthetic valve since 1971, six mitral valves and two aortic. All eight patients had a Björk-Shiley valve. During the same period 159 Björk-Shiley valves were placed, 85 in the mitral and 74 in the aortic area. This represents a valve thrombotic occlusive incidence of 4.4 percent in our series, 5.9 percent of mitral and 2.7 percent of aortic prostheses. Among the six patients with mitral prostheses only one survived. The two patients with occluded aortic valves survived. The onset of symptoms was very abrupt in most patients and progressed very rapidly. Acute pulmonary edema was observed in five patients. Anticoagulation was considered inadequate in all patients. Aspirin or dipyridamole was being used in seven patients at the time of thrombosis. The data indicate a high frequency of thrombotic occlusion of Björk-Shiley valves in the absence of full anticoagulation with warfarin derivatives and emphasizes the urgent need for surgery once valve thrombosis is suspected.


Surgical management of ventricular septal defects in infants. Infants with ventricular septal defect (VSD) who are symptomatic despite intensive medical therapy require surgical intervention. Choice of treatment depends upon the cumulative mortality and morbidity rates of the two-stage approach of initial pulmonary artery banding followed by debanding and VSD closure as compared to the risk of primary intracardiac repair in infancy. Sixteen infants underwent pulmonary artery banding at Columbia-Presbyterian Medical Center between 1967 and 1976, with one operative death but with a significant incidence of morbidity and late death. Forty patients underwent pulmonary artery debanding and closure of VSD with three operative deaths. This second-stage procedure was frequently complicated by repair of acquired lesions. During the same 10 year period 37 infants underwent primary closure of VSD with eight operative deaths. The morbidity related to this procedure is low. With the use of profound hypothermia and circulatory arrest, results have significantly improved and the risk of early correction now compares favorably with the cumulative mortality rate of the two-stage approach. Primary intracardiac repair is the procedure of choice.


Localized mesothelioma of the pleura: benign and malignant variants. Mesothelioma, even of the pleura alone, is a ubiquitous pathological designation. The diffuse variety is associated with an ominous prognosis. The localized mesothelioma generally has been assumed to be benign. A review of tumors from 60 patients with localized pleural mesothelioma seems to justify separation into benign (52 patients) and malignant (eight patients) variants. Histologic criteria are used primarily to make this division. No single clinical feature allowed preoperative predictability concerning benignity or malignancy, although extrathoracic osteoarthropathy was seen only with benign lesions (20 percent), usually those greater than 7 cm. Follow-up periods of as long as 24 years revealed recurrent tumor in only two of the 58 patients with benign lesions and revealed a survival curve identical to that of the general population. All of the patients with the malignant variety had recurrence or metastasis, and all but one were dead within 2 years of the initial operation. One patient died of tumor complications after 9 years. More aggressive local resection is indicated for the malignant variant.


Giant tracheoesophageal fistula: management by esophageal diversion. Giant tracheoesophageal fistulas complicating the management of respiratory insufficiency are often difficult to close successfully because of suture line tension and narrowing of the trachea or esophagus or both. Recovery of lung function often depends on successful diversion of gastrointestinal contents from the tracheobrachial tree. We have managed six patients with giant tracheoesophageal fistula. In three cases the lesions were related to overinflation of low-pressure balloon cuffs. The only survivors were two of three patients managed by esophageal diversion and reconstruction through extrathoracic incisions. The techniques, advantages, and disadvantages of esophageal diversion for giant tracheoesophageal fistula are presented.


Considerations in the management of open-heart surgery in uremic patients. Life-threatening complications involving the central circulation commonly occur in uremic patients. The growing number of individuals maintained on long-term hemodialysis along with repeated demonstrations of their ability to tolerate major operative procedures are responsible for increasing surgical experience in this group. Despite a high incidence of subacute bacterial endocarditis (SBE) and accelerated coronary atherosclerosis, exposure of such patients to open-heart operations has been limited. Our management of two patients who recently underwent valvular replacement is outlined and a review of the literature revealed that, during the past decade, 20 uremic patients have undergone a variety of cardiac procedures. The catastrophic results of medical therapy in such individuals with SBE are emphasized and early surgical intervention is recommended.


Functional evaluation of normothermic intermittent coronary perfusion. The myocardial contractility of papillary muscle from rabbit hearts was used to evaluate various techniques of normothermic intermittent coronary perfusion. A progressive decline of the myocardial contractility was noted as aortic cross-clamping and coronary reperfusion were repeated. After a net anoxic period of 90 minutes, the contractility fell to 58.67, 60.2, and 40 percent of the base line when single aortic cross-clamping time was 5, 10, and 15 minutes, respectively, interrupted by 5 minutes of reperfusion. Repeated application of single cross-clamping of 20 minutes or longer was not tolerated by the rabbit hearts. When the heart was reperfused for 10 minutes, between 15 minute periods of anoxia, the final recovery of contractility was 62 percent. Normothermic intermittent coronary perfusion has a significant adverse effect on the myocardial contractility. If this technique is to be used, single anoxic times should not be longer than 15 minutes and the heart must be reperfused for at least 10 minutes.


75Se-selenomethionine scintigraphy in mediastinal diseases. Chest scanning with 75Se-selenomethionine was performed in 59 cases of mediastinal diseases. All cases of vascular diseases, cystic tumors, and benign neurogenic tumor were negatively scanned. Parenchymatous teratoma, thymoma, malignant lymphoma, Castleman's tumor, epithelial tumors, tuberculous lymphadenitis, and sarcoidosis showed high positive rates. In myasthenic thymus without thymoma two out of 15 cases were positive. The scan images of the resected specimens and preoperative chest scannings coincided.


Lung biopsy with local anesthesia: report on 100 cases with the use of a recently introduced technique. A new technique for taking lung, pleural, and pericardial samples, under local anesthesia if required, is described. In the series presented in this article there have been no deaths, and complications which have been discussed are minimal. The experience gained in the use of this technique confirms that it is safe and provides a very high percentage of success in obtaining the required samples.


A method for experimental induction of bronchogenic carcinoma in subcutaneously implanted bronchial autograft in dogs. A method for induction of carcinoma in subcutaneously implanted bronchial autografts in dogs is described. Four to 6 weeks after successful bronchial autografting, 30 to 90 mg. amounts of 3-MC or B(a)P suspended in sterile saline solution containing 1 percent CMC was injected into the lumen of the graft. The mucosal changes were followed histologically by excision of biopsy specimens and cytologically by needle aspiration biopsies. Three dogs developed squamous cell carcinomas invading deep into the submucosal area as early as 13 to 30 weeks after the first carcinogen treatment. The remaining eight experimental dogs showed various grades of squamous cell metaplasia with atypia within 30 weeks. Subsequently examined specimens revealed atypical metaplastic and proliferative changes further advanced than those seen in the initial biopsy specimens. The advantages of this method for a better understanding of the development of bronchogenic carcinomas are discussed.


An improved design of temporary myocardial electrode. A new temporary myocardial electrode has a short piece of needle at one end of an electrode wire. Thus the electrode leaves no exposed areas when implanted. Only the tip is stiched into the myocardium. The device, tested in 20 patients who underwent cardiac operation, has significantly reduced the increase in myocardial threshold to pacing that occurs with the commonly used electrode. This new electrode can be much more easily fixed on both atrial and ventricular myocardium. On postoperative day 7 the threshold measured by Medtronic Model 5880 A was 1.6 mA. on the ventricle and 1.3 mA. on the atrium. The stimulation threshold of the right atrium is almost equal to that of the right ventricle.


Comparison of exercise and catheterization results following total surgical correction of tetralogy of Fallot. Although surgery may correct the hemodynamic abnormalities of tetralogy of Fallot (TOF), the long-term effects on exercise tolerance are uncertain. Twenty-eight patients, aged 7 to 30 years, had cardiac catheterization and maximal graded exercise testing to evaluate the adequacy of the ehmodynamic repair and its relation to exercise performance. Patients were tested 2 to 9 years after operation, and 13 previously had had palliative shunt procedures. At catheterization, 23 of the 28 patients had good surgical results. Despite the satisfactory hemodynamics, maximal working capcity (MWC), maximum heart rate, and exercise blood pressure were diminished when compared to normal values. In 10 patients who had exercise studies at catheterization, right ventricular systolic pressure (RVSP) and residual gradients were magnified by exercise. Abnormalities were independent of age at time of correction, time elapsed since surgery, use of patch in the outflow tract, or any antecedent procedures.


Contractile damage from reperfusion after transient ischemia in the dog. The patterns of regional contractile function were examined with ultrasonic crystals in "open-chest" anesthetized dogs. In normal myocardium, the base-line end-diastolic segment length (EDL) was 1.63 +/- 0.12 cm. and the mean systolic length (MSL) was 1.47 +/- 0.17 cm. Mean velocity of shortening over the first one third of systole (V1/3) was 15.9 +/- 2.3 mm. per second. Coronary occlusion induced regional ischemia with segmental dyskinesia (MSL = 1.84 +/- 0.12 cm). Reperfusion after 5 or 10 minutes of occlusion induced rapid recovery of contractile function that was independent of catecholamine release, as demonstrated in animals pretreated with 6-OH dopamine. After initial recovery, however, contractile function deteriorated. There were an increase in EDL (from 1.73 +/- 0.11 to 1.78 +/- 0.11; p less than 0.001) and the appearance of early systolic dyskinesia. V1/3 diminished from 5.6 +/- 4.6 to -6.6 +/- 2.5 mm. per second (p less than 0.005). Thus reperfusion damage, defined as late deterioration after recovery from brief periods of ischemia, may be partly distinct from ischemic damage per se. It is possible that the deterioration of myocardial function which accompanies reperfusion of previously ischemic myocardium may be a contributing factor in the transient myocardial dysfunction that is occasionally seen following cardiopulmonary bypass.


Value of preoperative radionuclide bone scan in suspected primary breast carcinoma. The value of radionuclide bone scanning performed before "curative" surgery in 100 female patients with suspected (91 patients) or known (9 patients) carcinoma of the breast was assessed. Limitations of the bone scan in this patient population were (1) a weak relationship between scan abnormalities and pathologic stage of the primary breast cancer, (2) a high incidence of equivocal scans, and (3) a low incidence of definite scan abnormalities which could not be accounted for by benign osseous disorders. The limited value of preoperative bone scanning in this study may be a result of the high proportion of patients with favorable breast lesions, who would be expected to have a low incidence of bone metastases at the time of primary surgical therapy. Guidelines for the use of bone scanning in the management of primary carcinoma of the breast are discussed.


Clinical value of the bile acid breath test. Evaluation of the Mayo Clinic experience. The Mayo Clinic experience with more than 200 bile acid breath tests was analyzed retrospectively to assess its clinical value. In patients with suspected bacterial overgrowth, the result of the bile acid breath test was compared with that of culture of aspirates of small bowel, and the test was found to have a sensitivity of 0.70 and a specificity of 0.90 (1.0 highest possible value). Although in one-third of the patients with a positive small-bowel culture the bile acid breath test failed to demonstrate the presence of bacterial overgrowth, analysis of the data according to the Bayes theorem showed that, compared with a routine evaluation without a small-bowel culture, the availability of breath test results will double the probability with which the clinician can be certain about the presence or absence of bacterial overgrowth. The test result appeared to influence the diagnosis in 83% and the management in 74% of the 163 patients in whom it was performed because of suspected bacterial overgrowth. In patients with suspected malabsorption of bile acids, on the other hand, the test that was performed without determination of fecal bile acid excretion appeared to be rather insensitive, and only rarely was information gained that was not already known from a routine workup of the patient.


Prinzmetal's variant angina--response to verapamil. A patient with frequent attacks of Prinzmetal's variant angina complicated by ventricular tachycardia and ventricular fibrillation is described in whom these episodes persisted daily during 4 weeks of hospital observation in spite of treatment with nitrates, alpha-adrenergic-blocking drugs, and anticholinergic agents. The oral administration of verapamil, an investigational vasodilator drug, led to prompt and complete resolution of the attacks.


Effect of phase of growth and hyperlipidemic serum on the synthesis of collagen in rabbit aortic smooth muscle cells in culture. The aim of this study was to elucidate wheter long-term cultivation in the presence of hyperlipidemic serum is able to induce changes in the rate of synthesis of collagen and other proteins by arterial smooth muscle cells. Rabbit aortic medial cells were grown in 10% sera and their collagen and total protein synthesis were studied by incubation of the cells with radioactive proline. When the cells were grown in fetal calf serum, their collagen synthesis was low after trypsinization but reached a constant level in one week, whereafter it remained within 4--5% of total protein synthesis for up to 30 days. Cultivation in hyperlipidemic rabbit serum for up to 14 days caused an accumulation of lipid droplets in the cells, but there were no detectable changes in the rate of collagen of total protein synthesis when compared with cells grown in normal rabbit serum.


Locus coeruleus fibre growth in oculo induced by trigeminotomy. Locus coeruleus from fetal donors was homologously grafted to the anterior eye chambers of adult rats whose eyes were sympathetically denervated. After intraocular maturation, outgrowth of noradrenaline-containing fibres from the locus coeruleus neurons on the host iris was studied by Falck--Hillarp fluorescence histochemistry. In control animals locus coeruleus grafts produce a halo of noradrenaline-containing nerve fibres around the graft, covering approximately one third of the surface of the host iris. Sensory denervation of host eyes carrying maturated locus coeruleus grafts was produced by intracranial lesions of the trigeminal nerve. Such lesions induced a rapid growth response in the grafted locus coeruleus neurons, leading within three weeks to complete innervation of the host iris. It was concluded that removal of non-sympathetic, non-parasympathetic nerve fibres on the host iris elicits a strong fibre-growth response in the grafted locus coeruleus.


Effect of lithium on voluntary alcohol consumption by low and high preference mouse strains. Lithium chloride was administered to high (C57/B1) and low (BALB/c) alcohol mouse strains. Experience with alcohol, lithium dosage, frequency of drug administration, concentration of alcohol solution, and sex were varied in four consecutive experiments. In contrast to previous findings no significant effects of lithium administration on alcohol consumption were observed.


A model of chronic alcohol intake under free-choice conditions. The preference of 42 Wistar male rats for alcoholic or non-alcoholic solutions of glucose was studied. Preference for the left or right position of drinking tubes did not appreciably influence the choice between the unequal solutions. Within the same strain of rats the majority of the animals had a high and a minority a low level of consumption of the glucose-alcohol solution. These groups were found only under conditions of systematic experimentation and the properties of each group became more marked in the course of these experiments.


Evaluating inpatient costs: the staging mechanism. Inpatient records at a short-term hospital over two years were analyzed according to the stage or degree of severity of their discharge diagnosis to examine their utilization of services. Patients with a more severe disease stage for surgical and medical conditions generated substantially higher total charges, ancillary charges, and had longer lengths of stay. At the 75th percentile (representing that value at which three-quarters of the cases fall below it in magnitude), increases in total charges from Stage I to II for ulcer of stomach, appendicitis, and diverticulitis were 103, 168, and 110 per cent, respectively. Ancillary charges for these diseases showed even greater increases, 167, 200, and 160 per cent, respectively. Components of ancillary charges revealed similar trends. The results suggest that a twofold review mechanism incorporating length of stay and charges, using the staging technique, would make the review procedure more discriminating in identifying cases appropriate for review.


The two dimensions in satisfaction with dental care. Satisfaction with health services is an aspect of quality of care that is of special importance for captive clients like low-income clinic users. Several methodologies have been reported, but validation has been difficult. This study compares two older scaling techniques with a new, nonmetric method to detect underlying dimensions. Unlike previous research, the typical satisfaction scale was found to be two-dimensional, with one dimension measuring latent hostility or resentment, and the other measuring general glorification of the health professional. The two components do not form polar opoosites of one attitude dimension. Latent hostility seems to be more related to personal experiences with providers than is general glorification.


Issues in family practice: medical student and practicing physician perspectives. The elevation of Family Medicine to the status of a recognized specialty is designed, at least in part, to enhance the attractiveness of family practice as a career alternative for physicians. This paper examines the attitudinal orientations of group of medical students and physicians toward family practice in an attempt to highlight some of the issues that might be anticipated as this new specialty develops. Based on the results, it is concluded that fundamental change in the nature of the medical education experience will be needed if greater numbers of physicians are to be involved in primary care.


Development of an index of health utilizing factor analysis. A multivariate technique, factor analysis, was used to calculate an index number for each county in Mississippi and an overall state index number for the year 1970. Data on 55 indicators of health were factor analyzed (Principal components, Varimax rotation) and eight factors were extracted. These eight factors were identified as Resource population, Economics, Geriatrics, Social problems, Preventive medicine, Nutrition, Mortality, and Disability. Sixty-two per cent of the total variance was explained by these factors. The index numbers were standardized as percentages for ease of comparison across all 82 counties. Therefore, a multivariate technique has been used to quantify the elusive multidimensional term "health" and that is something which has not previously been adequately accomplished.


Contacts with pharmacists before and after "free" medical care--the Quebec experience. This study reports the effects which the introduction of a national health insurance plan had upon established patterns of seeking health advice from pharmacists. Data were obtained from a household survey conducted in Montreal, Canada before and after the introduction of the government sponsored compulsory health insurance program. The report documents the extent to which the citizens of Montreal sought advice about health matters from pharmacists and describes the dramatic alteration in the pattern of advice seeking which occurred when the economic barriers to medical care were removed.


[Retroperitoneal fibrosis and pancreatitis (author's transl)]. A case of retroperitoneal fibrosis causing pancreatitis is reported; another case is reported as well, where chronic pancreatitis caused secondary symptomatic retroperitoneal fibrosis. Differential diagnosis of the 2 diseases is discussed. Surgical therapy has to eliminate complications and reduce retroperitoneal fibrous tissue structures; this has to be followed by continuous drug therapy aimed at slowing proliferation of fibrous tissue.


[Impairment of adrenergic innervation in achalasia (author's transl)]. Length tension diagrams and diagrams of isometrically developed active tension were set up for normal and aganglionic cardia-circular muscles. The effects of acetylcholin, adrenergic stimulating and inhibiting drugs were examined. The physiological parameters in healthy cardia and the cardia muscle system in achalasia did not vary significantly from one another. The acetylcholin threshold was higher in aganglionic cardia, while the maximum effective dose in healthy and aganglionic cardia remained the same. In achalasia no sensitisation to acetylcholine was detectable. There was a marked impairment in the balance between adrenergic alpha- and beta-receptors, with the contraction-inducing alpha-receptors obviously predominating.


[Unusual esophageal motility disorder (author's transl)]. A 31 year-old female initially presented with clinical features consistent with achalasia, which were relieved by the Heller procedure. Several years later manometric tracings excluded the diagnosis of achalasia, and suggested a motility disorder of the esophageal body. A long esophageal myotomy was performed and was followed by a marked improvement in symptoms and a normalization of the manometric tracing. Multiple histologic sections from the surgical specimen revealed the absence of ganglion cells, a feature not previously described in motor disorders other than achalasia. These findings suggest that classification of esophageal motility disorders on the basis of manometric and histologic findings might not be possible and that surgical treatment should be directed towards the predominant symptoms.


[Hyperplasia of duodenal lymph follicles accompanied by a defect of immune globulins (author's transl)]. A case report is given of a 60 year old man who complained about burning pain in the right upper abdomen and obstipation. Hyperplasia of the lymph follicles was diagnosed by duodenoscopy. An isolated defect of IgM-globulins was found. Lamblias were demonstrated in the duodenal juice as well. The hyperplasia of the lymph follicles is thought to be a manifestation of the IgM defect.


[Diagnostic relevance of computer tomography (CT) in pancreatic disease (author's transl)]. CT-x-ray examination of 98 patients yielded pathologic results in 42 patients; in 33 patients results of CT could be controlled by surgery or at autopsy. In 14 cases necrotizing pancreatitis or pancreatic pseudocysts were suspected and these cases were operated upon; only 1 case turned out to be a falsely positive diagnosis. In 15 cases pancreatic carcinoma were found at surgery; 13 of these cases had been diagnosed preoperatively by CT; the diameters of the 2 tumors not diagnosed were below 3-4 cm. Differentiation between cysts, pancreatitis and tumors was possible in 2/3 of all cases; in 1/3 of the cases differentiation was neither possible by applying morphological criteria nor by evaluating absorption spectra. It turned out to be advantageous to examine the parenchymatous organs surrounding the pancreas by CT as well; in about 12% of cases with pathological findings the processes were found to be localized extrapancreatically.


[Clinic and therapy of extragenital endometriosis (author's transl)]. Patients with endometriosis are rare in surgical departments, they are however routine in gynecology. Pathogenesis, diagnosis and treatment of this disease are outlined. Treatment with estrogens, androgens or gestagens does not have the desired effect in many cases; in recent time however good results have been reported when Danazol, a new synthetic steroid was used. Surgery is indicated when the intestines are obstructed or when drug therapy has no effects. The extent of surgery depends upon the localization of endometriosis and upon the age of the patient. During the fertile period the uterus and ovaries should be left intact, whereas both should be removed after the age of forty. If parts of the intestine are removed, end-to-end anastomosis is the method of choice. Castration is to be preferred to a remaining anus praeter naturalis.


[Surgery of chronic intestinal ischemia (author's transl)]. Chronic intestinal ischemia has to be diagnosed by an interdisciplinary approach. Clinical symptoms are unrevealing; usually the internist and the radiologist make the diagnosis after numerous special examinations and arteriography of the abdominal aorta in two planes. Indications for conservative treatment vs. surgery have to be discussed between the specialists involved, that is the internist, the radiologist, the anesthesist and the surgeon. Surgical problems in cases with chronic vascular occlusions are problems of vascular surgery and surgery may be well planned and performed electively. Acute occlusions of intestinal vessels however require mostly immediate surgery of the intestine itself which has to be performed as an emergency procedure because of the impending organ necrosis and complications; this is demonstrated in the case of ischemic colitis.


[Invagination of the blind loop--a complication after jejuno-ileal shunting (author's transl)]. Shunting of the jejunum and ileum has been used as a form of therapy in extreme obesity; this may be followed not only by metabolic, but also by surgical complications. A case report is given of a patient, who had an invagination of the excluded segment of the small intestine. Diagnostic difficulties and dangers arising from this complication are discussed as well as surgical techniques allowing to avoid it.


[Late results of surgery in 107 patients with anorectal fistulas (author's transl)]. Results are reported of 107 patients, which had been operated upon from 1969-1975 at the Innsbruck University Department of Surgery, because of anorectal fistulas. The standard procedure was splitting of the fistula and ample excision of the walls of the fistula down to the skin. This procedure yielded satisfactory results in 74% of all cases. Fistulas penetrating the musculus levator ani were excised below this muscle respectively extracted, whereas the part of the fistula duct reaching above this muscle was left and scratched out cautiously.


[Pseudomyxoma of the peritoneum (author's transl)]. A case report is given of a peritoneal pseudomyxoma originating from pseudomucineous cystadenomata of both ovaries. The diagnosis was established by peritoneoscopy and histological examination. Both ovaries were removed surgically and cytostatic treatment initiated thereafter; hyperthermic peritoneal perfusion was done as well. The patient lives after surgery now for more than a year without recurrence of the disease.


[Histometrical studies of liver parenchym in two cirrhotic livers (author's transl)]. Livers of two patients suffering from cirrhosis were weighed at post mortem, and found to have weights of 510 resp. 640 g. The quantity of hepatocytes was measured histometrically and estimated to be approx. 210 g in both patients; this means, that total liver mass in these patients was reduced to approximately 30% of normal, and that hepatic insufficiency had been incumbent in both of these patients. Difficulties in the methods of measuring the quantity of normal liver parenchyma in cirrhotic livers are discussed. Initiation of hepatic coma in liver cirrhosis is dependent in the first place, but not exclusively, upon the degree of reduction of liver parenchyma.


[Prognosis of acute viral hepatitis B (author's transl)]. Case reports of patients with acute viral hepatitis of the Medical Department of the Innsbruck University Medical School were evaluated in regard to prognosis. The following results were obtained: 1. Hepatitis B in the acute phase runs a severe course in more cases than non B hepatitis. 2. Disappearance of the HBs-antigen from the serum seems to be a reliable indicator for complete recovery; persistence of the antigen on the other hand indicates a chronic clinical course of the disease. 3. A difference in prognosis as to a chronic course of acute hepatitis B and non B hepatitis could not be found. Transition to a chronic stage seems to occur in about 3-15% of both forms of the disease together.


[Metabolism of endogeneous gastrin (author's transl)]. The localization of production of gastrin is rather well known, the localization of metabolic breakdown however is still being discussed. Liver, kidneys, musculature and small intestine are being taken into consideration. Experiments were performed demonstrating a definite increase of serum gastrin after removal of the small intestine; the duodenum was not removed in these experiments, since enterogastrone is formed mainly in this organ. These results would suggest, that gastrin is metabolized in the small intestine. In order to further prove this point, truncal vagotomy was performed in rabbits, producing elevated serum gastrin levels. In other series subtotal removal of the small intestine was combined with truncal vagotomy. Serum gastrin levels were definitely higher after this latter procedure than after truncal vagotomy alone. These findings seem to support the hypothesis, that endogeneous gastrin is metabolized in the small intestine.


[Plasma histamine concentration and hemodynamic changes in liver cirrhosis (author's transl)]. Different causal factors have been speculated about in regard to hemodynamic changes (hyperdynamic circulation) in liver cirrhosis. Effects of various vasoactive substances upon the increased arterio-venous intrapulmonary shunting in cirrhosis have been demonstrated, including reduced ferritin, bradykinin, prostaglandins, VIP and parenterally applied histamine. In cirrhotic patients pre- and posthepatic plasma concentrations of histamine are definitely elevated, and elimination of histamine by the liver is reduced. It is speculated, that elevated plasma concentrations of endogenous histamine may contribute to hemodynamic changes in liver cirrhosis.


[Benign tumors of the liver-diagnosis and therapy (author's transl)]. From 1971 to 1976 surgery was done on 11 patients with benign tumors of the liver in the Surgical Department of the University of Mainz. Histological examinations revealed focal nodular hyperplasia in 5 cases, liver cell adenoma in 2 cases, caverneous hemangioma in 2 cases, cystic liver disease in 1 case, and an idiopatic peritoneal liver cyst in 1 case. Benign tumors of the liver are rare. Clinical symptoms in these cases are inconspicuous. In 5 patients the diagnosis was made coincidentally. Preoperative diagnosis depends mainly on angiography. Since an exact histological diagnosis cannot be made otherwise, surgery is imperative. Big tumors leading to displacement of intestinal or biliary organs ought to be removed in toto; this allows complete histological work up and exclusion of malignancy, and it does prevent recurrence of the tumor as well. In 8 of 11 patients tumors localized peripherally in the liver could be removed surgically without complications.


Metabolism of linoleate versus linoelaidate in the laying hen. The metabolic fate in the laying hen of linolaidic acid, the trans,trans-geometric isomer of linoleic acid, was compared to that of the naturally occurring cis,cis linoleate. In two experiments, mixtures of radioisotope-labeled linoleate and linoelaidate were orally administered to a set of three laying hens. A third mixture consisting of linoleate-3H and linoleate-14C was fed to three hens to measure biological isotope effects. Isotopic ratios (3H/14C) of the neutral lipid and phospholipid fractions isolated from egg yolks and of the octadecadienoic acids from these fractions were compared to those of the administered mixtures. The 3H/14C ratios indicate that linoelaidic acid and linoleic acid are equally incorporated into egg yolk neutral lipids and phospholipids. Arachidonic acid was found exclusively in the phospholipid fraction and was radiolabeled with the isotope from the cis,cis octadecadienoate isomer only. Further detailed analysis of individual neutral lipid components indicated: (a) discrimination against the trans,trans isomer in cholesteryl esters and (b) no discrimination against either isomer in triacylglycerols.


Metabolism of a n-paraffin, heptadecane, in rats. 14C-heptadecane incorporated in rat diet was largely absorbed, and a balance study showed extensive 14CO2 excretion (65%). There was no elimination of the hydrocarbon in the urine, and only minute quantities of labeled metabolites. Radioactivity in the feces was entirely in heptadecane. About 7% of the heptadecane absorbed was stored in the carcass, whereas the rest was omega-oxidized to heptadecanoic acid. This fatty acid was incorporated into neutral lipids and phospholipids, underwent the normal fatty acid degradation pathway, and contributed to the synthesis of lipids, including fatty acids, squalene and cholesterol, and nonlipids (7-10%). Heptadecanoic acid was desaturated to heptadecenoic acid. The even distribution of radioactivity in the fatty acids of the various phospholipid classes indicated that heptadecane did not interfere with the biochemical mechanisms of these functional lipids.