Ectopic liver.

Ectopic liver. Abnormally positioned liver tissue is rare but can occasionally cause clinical symptoms. The four main types are: 1. Accessory liver lobe that can reach a considerable size and is attached to the liver by a stalk. 2. Small accessory liver lobe which is attached to the liver but is usually small, about 10-30 g in weight. 3. Ectopic liver which is situated outside the liver without any connection with it. It is usually attached to the gallbladder or intra-abdominal ligaments. 4. Microscopic ectopic liver which is found occasionally in the wall of the gallbladder. The literature is reviewed and two cases of ectopic liver are described.


Duplicated inferior vena cava in a patient with an abdominal aortic aneurysm. The incidence of duplication of inferior vena cava ranges between 0.5 and 2.2% according to published reports. A patient with intermittent claudication and angiographic findings of a stenosis of the left common iliac artery was selected for operation. At exploration an aortic aneurysm below the renal arteries was diagnosed and a duplication of the inferior vena cava was found. Resection of the aortic aneurysm could be performed between the two branches of the inferior vena cava. The significance of the anomaly at exploration of the major abdominal vessels is here pointed out.


Melorheostosis. A case report with special reference to bone mineral density, bone circulation and bone scan. A new case of melorheostosis is presented. Bone mineral density, and bone circulation were determined and bone scan carried out in the patient. The bone mineral density measured by photon absorption in the region of the distal radius of the patient's left forearm was found to be within normal limits, the bone blood circulation determined by Xc-133 clearance method was better in the affected side, and an area of increased uptake of Tc99m was found by bone scanning in the affected extremity.


Sexual dysfunction following proctocolectomy. 122 patients, 66 men and 56 women, operated upon by proctocolectomy were interviewed by means of a detailed questionaire regarding any significant change in sexual function. In the majority of the patients (70% of the men and 87% of the women) the sexual relationships were considered to be unchanged or even enhanced. Impaired function was reported by 19 men (29%) and seven women (12%). Male sexual dysfunction consisted of impotence and abolition of ejaculation. True impotence occurred in five men, all above 40 years of age, corresponding to an incidence of 25%. Loss of ejaculation occurred even in young people (about 7%) but was more common in elderly patients (15%). Female dysfunction consisted of dyspareunia and/or inability to achieve orgasm. On the basis of the present results it appears unlikely that impotence is caused by the operative trauma per se. On the other hand loss of ejaculation is probably due to injury of the presacral nerves. Postoperative impotence might probably be improved by medical information and encouragement. Particular precautions during operation might reduce ejaculatory disorders. Careful handling and proper treatment of the perineal wound might prevent scarring and stricture of the posterior aspect of the vulva, a condition that appears to be a common cause of dyspareunia.


Measurement of serum ferritin by radioimmunoassay. A direct radioimmunoassay for ferritin in serum is described in which Bolton and Hunter reagent is used to label ferritin. The detection limit of the assay is 150 pg; 95% reference ranges were found to be 12-200 microgram/l for men and 5-76 microgram/l for women. Ferritin concentrations in patients with iron deficiency anaemia were found to be uniformly low in subjects with uncomplicated iron deficiency but were normal or even raised in subjects with iron deficiency anaemia associated with malignant or inflammatory conditions.


An improved automated method for the analysis of inorganic phosphate without dialysis. A procedure is described for automating the analysis of inorganic phosphate in physiological media without dialysis. Sodium dodecyl sulphate is used to maintain protein solubility during the analysis. Sample analysis was measured at 60 and 90 samples an hour. The inorganic phosphate results obtained for a series of human plasma and for various internal control sera by non-dialysis and dialysis showed good agreement.


Identification of an unusual gamma counter fault using Trigg's technique for trend detection. A simultaneous deterioration in performance of several radioimmunoassays suggested that equipment was malfunctioning. Replicate counts from an automated gamma counter showed unacceptable variation during a 24-hour period; this variation was detected using Trigg's technique, a sensitive method for trend analysis, and was not identified by the usual laboratory testing procedures. A defective capacitor was found in the voltage stabilisation unit in the gamma counter, which probably made it responsive to small variations in the power supply to the laboratory. It is suggested that the analysis of replicate counts using Trigg's technique is a valuable test of gamma counter function which should become routine.


Quantitative estimation of clinically important monosaccharides in plasma by rapid thin layer chromatography. A method is described for the quantitative estimation of clinically important monosaccharides in plasma or whole blood by direct densitometry of chromatographically-separated zones on silica gel layers. Simple modifications of technique originally introduced to improve the reproducibility of paper chromatography have now been adapted for thin layers. The present method is based on peak height measurement with an internal marker correction. Galactose, fructose, D-xylose, and 3-O-methyl glucose can be estimated in addition to glucose, either singly or in combination, within three or four hours, using an initial sample volume of 0.5 ml. With reasonable experience and skill a coefficient of variation of 3 to 6%, depending on sugar concentration, can be achieved without replication, and the limit of sensitivity is about 0.05 mmol/l. When the performance was compared with an automated glucose oxidase/peroxidase system for glucose and the recovery for the other monosaccharides was calculated, the results were satisfactory.


An evaluation of the Hyland laser nephelometer PDQ system for the measurement of immunoglobulins. The Hyland laser nephelometer PDQ system for the assay of specific proteins is described. The results of evaluating the system to measure immunoglobulins IgA, IgG, and IgM are summarised. Within-batch and between-batch precision, accuracy, reliability, and safety are discussed. This instrument represents an important development in the immunochemical assay of proteins in clinical medicine. The speed, precision, and convenience of this new generation of discrete nephelometric analysers make such systems attractive to the clinical chemist.


Rapid semiautomated method for the differential determination of urinary catecholamines. A semiautomated method is presented for the determination of adrenaline and noradrenaline by a combination of the trihydroxyindole procedure for total catecholamines and a new procedure for the specific direct determination of adrenaline without interference from noradrenaline at physiological levels. This new procedure involves the reaction of adrenaline with alkaline thiosemicarbazide to produce a fluorophor of acceptable stability for use in automated procedures. Its structure is as yet unknown. The within-batch standard deviation for the trihydroxyindole and alkaline thiosemicarbazide procedures respectively were 0.005 mumol/24h at a concentration of 0.368 mumol/24h and 0.012 mumol/24h at a concentration of 0.133 mumol/24h. The between-batch standard deviations of the two procedures were respectively 0.018 mumol/24h at a concentration of 0.388 mumol/24h and 0.015 mumol/24h at a concentration of 0.111 mumol/24h. Normal ranges for urine are presented for 24 healthy ambulant laboratory staff.  The total catecholamine concentration (calculated as adrenaline) was 0.452 +/- 0.069 mumol/24/ (SD), range 0.349-0.616 mumol/24h. Using the alkaline thiosemicarbazide procedure, the normal range which was determined for adrenaline was 0.100 +/- 0.054 mumol/24h, range 0.022-0.207 mumol/24h. Noradrenaline calculated by difference was 0.355 +/- 0.081 mumol/24h, range 0.195-0.497 mumol/24h.


[Racial characteristics from the industrial anthropology aspect]. Often industrial-anthropological research cannot be limited to a particular population. Whenever export and/or migration brings people and conditions together which go beyond the usual area of a population characterized by a particular morphological trait, the question arises as to how technical conditions can best be adapted to humans. The automobile seat is used to illustrate to what extent race-specific size and body proportion differences effect technical practice. Since the safety of an automobile is in part dependent upon an efficient adaptation of the vehicle to the user, these investigations have considerable practical importance.


[Body proportions and designing of the working sites]. The demands of practical ergonomics often require measurement not only of one body dimension, but a combination of several, since work-environments and consumer goods can often be developed only through a combination of different measurements. An empirical study of 8,000 males, in which 43 body proportions were measured, shows that unexpected disturbances occur in the extreme values of an otherwise symetrical distribution curve when more than two traits are combined. This build-up effect takes on added significance when seen in relation to accident protection.


Colorimetric quantitation of albumin in microliter volumes of serum. Various non-immunochemical approaches to the quantitation of albumin in serum are reviewed. Salt fractionation techniques are unreliable, with substantial errors in estimating hypoalbuminemic states. Electrophoresis displays biases owing to irregular dye-binding or to densitometric scanning of irregular globulin bands. Currently, the most reliable colorimetric procedure for albumin quantitation is the rapid reaction with bromcresol green. By measuring final absorbance within fifteen seconds of mixing serum with reagent, the interference of globulins is eliminated. A microscale (5 microliter serum) rapid reaction for albumin assay has been developed; it can be readily automated on kinetic or centrifugal analyzers.


Differentiation of strains of Staphylococcus epidermidis biotypes 1 and 4 by aminopeptidase profiles. Seven different strains of Staphylococcus epidermidis and one strain of S. aureus were catagorized by their aminopeptidase activity. Eight different profiles were obtained: five profiles for S. epidermidis biotype 4 (each representing a different known serotype), two profiles for S. epidermidis biotype 1 (one for each strain used) and one for the strain of S. aureus used. Despite some similarities, distinct patterns of the hydrolysis of 22 different amino acid-beta-naphthylamides were evident for each individual strain. The evaluation of aminopeptidase profiles provides another means for distinguishing between strains of the same species and can, therefore, be used advantageously and in combination with serotyping as an epidemiological tool.


[Form of the hand and designing of the handle]. The usefulness of a handle is greatly dependent upon the correlation of grip circumference to the diameter of the hand. Since up to now, industry has produced handles primarily to fit men's hands, the question as to what extent women can use a normal hammer with a 20 to 30 mm shaft diameter without disadvantage, has remained open. The research results show that grip circumferences measured on a Herig cone show a much smaller sexual dimorphism than many other body measurements. Sexual differentiation is shown to be so small that it can be neglected in practice.


[Distribution of the seating pressure on unupholstered chairs]. A majority of the population in industrialized countries does its work while sitting. The necessity of morphologically and physiologically adapting body-supporting systems to the human body cannot be limited to the use of traditional body measurements and certain inclination angles. An investigation of the sitting-pressure distribution is also necessary. The instruments developed for this purpose, the pressure-measuring chair and the sitting pressure simulator, are presented, and their results illustrated by specific examples. As a result of these investigations, sitting-pressure distribution and sitting behaviour have become test-criteria for the suitability of sears, office chairs, etc.


Serum proteins in hepatic disease.

Serum proteins in hepatic disease. The serum protein changes occurring in liver disease associated with parenchymal damage are characteristically decreased in serum albumin and increased in gamma globulin levels. Beta-gamma bridging in the electrophoretogram is highly characteristic of hepatic cirrhosis. Variation of alpha 1, alpha 2 and beta fractions is inconstant and is not of great diagnostic or prognostic value. The increase in gamma fraction is polyclonal in nature and is due first to increase in IgM fraction followed by an increase in IgG fraction. Elevation of IgA fraction is not as constant or prominent.


[Standardization of anthropometric technics]. The problem of the unification of anthropometrical examination methods was solved for decades by Rudolf Martin in his standard work. The demands now placed on anthropometric examination techniques by industrial anthropology and legislators can no longer be met by Martin's system, and a demand for clearer and more exact measurement definitions and procedures has arisen. In year-long cooperation with industrial anthropologists the German Institute of Industrial Standards has established standards for body-measurements, measurement methods, and definitions in DIN 33 402. A reciprocal international standard (ISO) can be expected. The present paper presents the anthropometric part of the new standard which contains 56 body measurements.


Role of metallothioneins in disease.

Role of metallothioneins in disease. Metallothioneins are small proteins (6,000 to 10,000 mw) with similar amino acid compositions, high content of sulfhydryl amino acids and no aromatic amino acids. Emax at 250 nm is due to cadmium mercaptide bond. Synthesis is induced by a number of metals including zinc, cadmium, mercury, copper, bismuth, gold and silver. These proteins function as a mechanism of intracellular storage of some essential metals such as zinc and copper. Binding of potentially toxic metals like cadmium may be protective; but with saturation of protein by metal, toxicity may occur. Excessive cadmium-thionein may have a role in the pathogenesis of cadmium induced kidney disease. A more sensitive method for detection adn measurement of this protein will greatly enhance future studies, particularly the potential for clinical application.


A study of relationship between pulmonary tuberculosis and palmar dermatoglyphic traits. Bilateral inked palmar impressions of 150 male tubercular patients and those of 150 normal controls (males) have been studied comparatively. Patients and controls show deviation from each other with respect to 1. biological concordance-disconcordance in line C and hypothenar patterns, 2. bilateral and left-homolateral (not right) differences in Plato's modal types of line C and 3. occurrence of hypothenar (R + L only) and III interdigital patterns (L-homolateral only). It is significant that tubercular patients do not show any difference with the normal controls in a reliable measure like main-line-index and by and large in occurrence of patterns also (with two exceptions only). Natural selection does not seem to be operative on palmar dermatoglyphic traits.


[Dissociation of a Candida tropicalis culture and its capacity to stimulate levorin synthesis when cultured together with Actinomyces levoris]. Dissociation of the yeast-like fungi C. tropicalis used for mixed cultivation with the levorin-producing organism was studied. It was shown that colonies of 2 types were grown on wart-agar. They differed in the morphology and capacity for stimulation of the antiobiotic synthesis in mixed fermentation with 2 organisms. The colonies of the S-form increased the antibiotic production by 50--60 per cent, while the R-forms increased the antibiotic production only by 25--30 per cent. The strains of C. tropicalis differed in the ratio of the S- and R-forms in both the initial cultures and the cultures stored for prolonged periods of time. Addition of KH2PO4 to the agarized in the amount of 0.5 per cent promoted preservation of the S-forms in the population. Repeated subsequent transfers of the S-variants (10 generations) on wart-agar did not decrease the stimulating effect of C. tropicalis on the actinomycete. An increase in the amount of the inoculum of the yeast-like fungi promoted a decrease in the time of their preliminary cultivation.


[Electron microscopic study of active and inactive variants of Proactinomyces (Nocardia) mediterranei, a producer of rifamycin B]. Four mutants of Proactinomyces (Nocardia) mediterranei, an organism producing rifamycin B were subjected to electron microscopic investigation. The mutants differed in the biosynthetic activity. The investigation showed correlation between the length of the hyphal fragments of the over-substrate mycelium and the level of the organism activity. The study of the fine structure of the mycelium revealed changes in the structure of the cell wall, character of the nuclear material and hyphae vacuolization.


[Spectrophotometric method of determining the oxacillin in oxacillin preparations]. The early described procedure for quantitative determination of oxacillin with the spectrophotometric method was used for the assay oxacillin tablets, capsules and injection preparations. It was shown that the excipients used in tablets and capsules did not interfere with oxacillin determination. The reproducibility of the method is +/- 1.5--2 per cent. The results of oxacillin determination with the new method and the currently used methods were compared.


[Effect of auxiliary substances on the bioavailability of tetracycline hydrochloride capsules (an in vitro study)]. The rate of tetracycline hydrochloride transfer into solution from capsules containing different auxiliary substances was studied. It was shown that the dispersity level of tetracycline hydrochloride powder had no significant effect on the capsule disintegration and the rate of the antibiotic transfer into solution. The effect of the auxiliary substance composition on the capsule disintegration and the rate of the antibiotic dissolution was shown. The rate of tetracycline liberation from the capsules containing tetracycline hydrochloride without additives or the antibiotic in combination with 23 per cent of lactose was 4 to 6 times higher than that from the capsules with magnesium carbonate or calcium phosphate as the auxiliary substances.


[Effect of "pasteurizing" doses of ionizing radiations on the drug resistance of microorganisms isolated in pharmaceutical chemical manufacture]. Changes in the antibioticograms after a single irradiation of dry cultures of microorganisms isolated at a pharmaceutical factory were noted in 0.5 per cent of 686 microbial strains tested. Restoration of sensitivity to one or more often several antibiotics was found in the microbes with the changed antibioticograms. After a three-fold irradiation the value increased to 9 per cent. Development of the drug resistance in the microbes neither after the single nor after the three-fold irradiation was observed.


[Flora of the purulent foci of patients at an orthopedic traumatology clinic and its sensitivity to antibiotics]. A total of 4664 bacteriological analyses of the wound and purulent discharge from orthopedo-traumatological patients were performed within a 6-year period, i.e. from 1971 to 1976. Staphylococci were the dominating microbes of the purulent-inflammatory foci. Its part in the monoculture amounted to 64.5--82 per cent. The specific weight of the monocultures of various microbes decreased during the last 3 years, while the number of the microbial associations increased from 11.6 to 25.4 per cent Staph. aureus predominated in the inflammatory processes (65.8 to 86.5 per cent). Still, during the last 3 years the number of Staph. epidermidis increased from 16.8 to 26.2 per cent. The number of the so called "intermediate" or dissociated type of Staphylococcus, i.e. Staph. albus usually amounted to 7.5--8.1 per cent. In 1976 its number was 12.5 per cent. The pathogenic microbes of the coccal group were usually sensitive to erythromycin, monomycin, levomycetin and kanamycin. Among these microbes only staphylococci preserved their sensitivity to penicillin. The causative agents of purulent processes, i.e. Escherichia, Proteus, Pseudomonas were resistant to most of the antibiotics. Sensitivity to monomycin was preserved by 50 per cent only in Proteus. The microbial associations were mainly sensitive to monomycin and kanamycin.


[Tetracycline hydrochloride complex formation with collagen]. The quantitative indices and regularities of tetracycline hydrochloride binding with colelagen in the process of complex formation were studied in vitro. It was found that tetracycline-interacted with collagen. The amount of the antibiotic bound depended on its initial concentration in the mixture and the aggregate state of the protein: the amount of tetracycline hydrochloride absorbed by dissloved collagen was 10 times higher than that absorbed by polymerized collagen. The antibiotic bound with collagen did not lose its specific antibacterial activity.


[Experimental study of a gentamycin ointment]. Technology of 0.1 per cent gentamicin ointment production was developed. The ointment base consisted of vaseline and parafin (95:5). Pharmacokinetics and innocuousness of the gentamicin ointment were studied. It was shown that the ointment provided gentamicin diffusion through the skin utegument during a long period of time. Histological studies showed no local irritating effect of the ointment on the skin in its local use.


[Increased streptomycin sensitivity and its associations with microbial allergy]. Regularities of streptomycin hypersensitivity development and its association with microbial allergy were studied on 75 guinea pigs. A model of retarded allergy was obtained by the animal sensitization with streptomycin in doses of 20 000 gamma per 1 kg of the body weight. Two procedures were used for the animal sensitization, i.e. with the use of the Freund adjuvant or without it. Positive skin-allergic tests to streptomycin (mainly 24-hour) were registered 2 weeks after discontinuation of the sensitization and persisted for the whole observation period (up to 6--8 weeks). The tests for the leucocyte migration were also positive and precipitating antibodies were found in the serum according to the Hoigné method. Simultaneous sensitization with streptomycin and staphylococci resulted in some suppression of the development of retarded hypersensitivity to the microbial antigen. Subsequent sensitization at first with staphylococci and then with streptomycin favoured a mutual increase in the allergic reconstruction to both antigens. The histomorphological studies confirmed the data of the immunoallergological examination.


[Antibacterial therapy of liver abscesses of varying etiology]. The investigation of microbial flora and its sensitivity in 196 patients with the kidney abscesses of various etiology showed expediency of the use of aminoglycosides, ampicillin and lincomycin. The local use of colloid iodine promoted rapid inhibition of the microbial flora. The dynamic observations showed an increase in the number of gramnegative pathogens by the 7th--10th day of the treatment. Rational surgical intervention, the antibiotic use with control of the microbial flora sensitivity, specific chemotherapy provided a decrease in the lethality up to 6.7 per cent.


Identification of enterotoxigenic staphylococci from sheep and sheep cheese. The total of 127 Staphylococcus aureus strains obtained from sheep and sheep cheese were examined for their biochemical activities, biotypes, phage patterns, and ability to produce enterotoxins. Of the 83 staphylococcal strains isolated from animals 77 (93%) were classified as the C biotype. Of this group of sheep-adapted strains, 61 (79%) were sensitive to phage 78, and 46 (60%) produced enterotoxin C exclusively. The three isolated belonging to the A biotype produced enterotoxin D, and two of the three unclassifiable strains produced enterotoxin A. Of the 44 staphylococcal strains isolated from sheep cheese, there were 37 (84%) identified as the C biotype. From this series, 31 (84%) strains were lysed with phage 78, 6 (16%) strains produced enterotoxin C, and 1 strain produced enterotoxin A. One of the six strains determined as the A biotype produced enterotoxin D. C biotype strains, especially of ovine origin, are an exception among animal staphylococci, because a large number of them are enterotoixgenic. The C antigenic type is the most usual of the known enterotoxins in staphylococci of animal provenance.


Isolation and properties of fecal proteins and fecal alkaline phosphatase from germfree and conventional rats. Fecal proteins from germfree and conventional rats were isolated. The proteins from the two kinds of feces differed in molecular weight, judging from Sephadex gel filtration and sodium dodecyl sulfate-polyacrylamide gel electrophoresis. The conventional feces contained a greater amount of high-molecular-weight and a lesser amount of low-molecular-weight proteins than did the germfree feces. The fecal proteins of both kinds contained carbohydrates. Both feces contained considerable enzyme activity. The germfree feces contained extremely high activity in alkaline phosphatase and leucine aminopeptidase. Both feces showed the same level of trehalase activity. The conventional feces contained higher levels of activity of protease and acid phosphatase than did the germfree feces. Lactase activity was observed only in the conventional feces. The fecal alkaline phosphatase resembled the intestinal enzyme in response to L-phenylalanine inhibition and urea denaturation. From these results it was inferred that the germfree feces contained some of the intestinal proteins and that the conventional feces contained bacterial proteins in addition to intestinal proteins.


Cometabolism of DDT analogs by a Pseudomonas sp. A Pseudomonas sp. capable of growth on several nonchlorinated and mono-p-chloro-substituted analogs of DDT as a sole carbon source degraded bis(p-chlorophenyl)methane and 1,1-bis(p-chlorophenyl)ethane only in the presence of diphenylethane. The products p-chlorophenylacetic acid and 2-(p-chlorophenyl)-propionic acid were not further metabolized by the bacterium. Other chlorinated analogs of DDT were found to be recalcitrant to cometabolic degradation with diphenylethane.


Resistance of pathogenic Naegleria to some common physical and chemical agents. Resistance of pathogenic Naegleria to drying, low and high temperature, and two halogens was studied. Dying made trophozoites nonviable instantaneously and cysts nonviable in less than 5 min. Trophozoites degenerated in hours at temperatures below 10 degrees C and in minutes when frozen; cysts survived according to the equation th - t0/theta 1,440/1.122T (t0 is survival at 0 degrees C; Tis temperature between 0 and 10 degrees C), but 1.5 h at --10 degrees C to 1 h at --30 degrees C. At 51, 55, 58, 63, and 65 degrees C, trophozoites survived about 30, 10, 5, 1 and less than 0.5 min, respectively, cysts survived three to four times longer at 51 degrees C  and six to seven times longer at 55 to 65 degrees C. Cyst destruction rates by heat indicated first-order kinetics with 25,400 cal/1 degree C for energy of activation. Cyst destruction rates by free chlorine and I2 also conformed to first-order kinetics. Concentration-contact time curves yielded concentration coefficient values of 1.05 for free chlorine and 1.4 for I2 and point to superchlorination as an effective means of destroying the cysts if free residuals are used as a guide and allowance is provided for low temperature and/or high pH waters.


Significance of low-temperature growth associated with the fecal coliform response, indole production, and pectin liquefaction in Klebsiella. In the genus Klebsiella, the growth respnse in nutient broth at 10 degrees C correlates inversely with the operational definition of a fecal coliform and not merely with the ability to grow at 44.5 degrees C. Of the fecal coliform-positive Klebsiella, 97% did not grow at 10 degrees C after 72 h of incubation. Conversely, 97% of the fecal coliform-negative isolates grew at 10 degrees C. The amount of growth at 10 degrees C varied among the fecal coliform-negative isolates and was found to correlate with indole production and pectin liquefaction. Low-temperature growth associated with specific biochemical tests can be used to differentiate several groups in the genus Klebsiella. Three main groups were discerned. Group I consists of indole-negative, pectin-nonliquefying, fecal coliform-positive isolates that do not grow at 10 degrees C. Group II isolates are differentiated from group I by a fecal-coliform-negative response and growth at 10 degrees C. Group III are indole-positive, pectin-liquefying, fecal coliform-negative isolates that grow at 10 degrees C. In our culture collection, isolates of group I are most frequently of human/animal clinical origins, whereas isolates of groups II and III are predominantly derived from the environment.


Production of Venezuelan equine encephalitis virus in cells grown on artificial capillaries. Primary cell cultures, a continuous cell line, and a diploid cell line were grown on an artificial capillary system. The cells were subsequently infected with Venezuelan equine encephalitis virus, and viral replication was studied. Extracellular fluids harvested from this system contained high titers of virus and were relatively free of cell debris.


Colonial variation, capsule formation, and bacteriophage resistance in Bacteroides thetaiotaomicron. A Bacteroides thetaiotaomicron strain segregated two unstable colonial variants at high frequency. There is a correlation between colony morphology, encapsulation, Giemsa staining, and bacteriophage resistance.


Spatial relationship of the genital microflora to the vaginal epithelium of femal rats: transmission electron microscopy. Bacterial associations with vaginal epithelium were examined by transmission electron microscopy in castrate rats before and after estrogen treatment. Bacteria were associated with keratinized epithelium and appeared to be most abundant on exfoliated vaginal cells.


Tryptophan excretion by a bradytroph of Hansenula polymorpha growing in methanol. The growth of a bradytrophic mutant isolated from the methanol-utilizing yeast Hansenula polymorpha was found to be stimulated by both tyrosine and phenylalanine. The mutant contained about half as much chorismate mutase activity as the wild-type strain. When grown in a medium containing 2% mehtanol as the major carbon and energy source, the bradytroph excreted a low but significant level (28 mg/liter) of L-tryptophan.


Adaptational change in proline and water content of Staphylococcus aureus after alteration of environmental salt concentration. Adaptation of Staphylococcus aureus to a change in salinity was studied by estimating the intracellular content of water and proline after alteration of the salt concentration of the culture medium. The intracellular water content of S. aureus cultured in normal broth was 1.70 g/g (dry weight). After transfer to 1.8 M NaCl-containing broth, the water content decreased to 0.80 g/g (dry weight) within 1 min. After changing the salt concentration of the medium, intracellular free proline (assumed to be one of the osmoregulators in S. aureus) increased gradually from 0 to 1,400 mumol/g (dry weight) during 30 min of incubation at 37 degrees C. The water content rose to 0.88 g/g (dry weight) in 30 min. Proline was not taken up at 0 to 4 degrees C, suggesting that the process was one of active transport. The salt tolerance of S. aureus, therefore, appears to occur initially by dehydration of the cell after transfer from a medium of low salinity to one of high salinity and then by accumulation of proline, which carries water into the cell with it.


Rapid test for the serological separation of staphylococci from micrococci. A simple test for the serological separation of staphylococci from micrococci is described, which is based on the quite different cell wall peptidoglycan structures of these two genera. Antisera to (pentaglycyl-epsilon-amino-n-hexanoic acid)20-albumin agglutinated without exception all staphylococci and gave no positive reaction with micrococci or other bacterial cells. To obtain a good reaction, it was necessary to extract the cells with hot trichloroacetic acid for 30 min. Antisera to (tri-L-alanyl-epsilon-amino-n-hexanoic acid)22-albumin reacted strongly with micrococci containing oligo-L-alanine bridges in their peptidoglycan, but did not agglutinate staphylococci or other bacteria lacking alanine interpeptide bridges.


Distribution of the genus Leptospira in soil and water. The distribution of the aerobic spirochetes Leptospira in surface waters, soil, and aquatic animals was investigated. Isolates from water and soil exhibited physiological characteristics common to members of the "biflexa complex," none were capable of infecting experimental animals, and leptospires could not be isolated from the eight genera of aquatic animals examined. The isolation frequencies from surface waters were: stream, 100%; lake, 65%; spring, 28%; bog lake, 5%; and marsh, 0%. With the exception of the stream, more isolations were obtained from the soil adjacent to the water than from the water. Leptospires were most frequently associated with soils of high moisture and organic matter content.


Bacterial and spontaneous dehalogenation of organic compounds. Only 3 of more than 500 soil enrichments contained organisms able to use 1,9-dichlorononane as a sole carbon source. One isolate, a strain of Pseudomonas, grew on the compound and released much of the halogen as chloride. Resting cells dehalogenated 1,9-dichlorononane aerobically but not anaerobically. Pseudomonas sp. grew on and resting cells dehalogenated 1,6-dichlorohexane, 1,5-dichloroheptane, 2-bromoheptanoate, and 1-chloro-, 1-bromo-, and 1-iodoheptane, but the bacterium cometabolized but did not grow on 3-chloropropionate. p-Methylbenzyl alcohol, chloride, and p-methylbenzoate were formed when resting cells were incubated with alpha-chloro-p-xylene; the first two products were also formed in the absence of the bacteria. Similarly, o- and m-methylbenzyl alcohols were generated from the corresponding chlorinated xylenes in the presence or absence of Pseudomonas sp. The formation of m- and p-chlorobenzoic acid from m- and p-chlorobenzyl chloride proceeded only in the presence of the cells, but p-chlorobenzyl alcohol was generated from p-chlorobenzyl chloride even in the absence of the bacterium. These results are discussed in terms of possible mechanisms of dehalogenation.


Influence of water activity on the production of extracellular enzymes by Staphylococcus aureus. Two enterotoxigenic strains of Staphylococcus aureus were examined for their ability to produce a number of extracellular enzymes at various water activity (alphaw) levels. Supernatant, dialyzed culture media were analyzed for total and relative levels of enzyme activity. With the exception of protease, enzyme activity was greatest in spent media obtained from cultures grown at 0.996 alphaw, the highest level tested. Enzyme activity in spent media from an enterotoxin B-producing strain was generally more sensitive to alphaw reduction than activity from an enterotoxin A-producing strain. Unlike the other enzymes assayed, acid and alkaline protease activities were greatest when the organism was grown at 0.94 alphaw.


Microbial transformations of natural antitumor agents: oxidation of lapachol by Penicillium notatum. The naphthoquinone lapachol (1) is readily metabolized by several fungi and streptomycetes. Preparative-scale fermentations with Penicillium notatum (UI 1602) provided a major polar metabolite (4), which was isolated and identified as an intermediate of the Hooker oxidation. The metabolite was synthesized by reacting lapachol with hydrogen peroxide under alkaline conditions.


Biological dinitrogen fixation (acetylene reduction) associated with Florida mangroves. Biological dinitrogen fixation in mangrove communities of the Tampa Bay region of South Florida was investigated using the acetylene reduction technique. Low rates of acetylene reduction (0.01 to 1.84 nmol of C(2)H(4)/g [wet weight] per h) were associated with plant-free sediments, while plant-associated sediments gave rise to slightly higher rates. Activity in sediments increased greatly upon the addition of various carbon sources, indicating an energy limitation for nitrogenase (C(2)H(2)) activity. In situ determinations of dinitrogen fixation in sediments also indicated low rates and exhibited a similar response to glucose amendment. Litter from the green macroalga, Ulva spp., mangrove leaves, and sea grass also gave rise to significant rates of acetylene reduction. Higher rates of nitrogenase activity (15 to 53 nmol of C(2)H(4)/g [wet weight] per h were associated with washed excised roots of three Florida mangrove species [Rhizophora mangle L., Avicennia germinans (L) Stern, and Laguncularia racemosa Gaertn.] as well as with isolated root systems of intact plants (11 to 58 mug of N/g [dry weight] per h). Following a short lag period, root-associated activity was linear and did not exhibit a marked response to glucose amendment. It appears that dinitrogen-fixing bacteria in the mangrove rhizoplane are able to use root exudates and/or sloughed cell debris as energy sources for dinitrogen fixation.


Bacteria associated with the gastric epithelium of neonatal pigs. Light and electron microscopy showed lactobacilli and, to a lesser degree, streptococci to be closely associated with the squamous area of the pig stomach known as the pars esophagea. Several different types of extracellular layers were seen on bacteria attached to the epithelial surface. The total number of bacteria per square centimeter did not change with age up to 10 days, and there was no effect of weaning at 2 days. Lactobacillus fermentum, L. salivarius, and Streptococcus salivarius were isolated more frequently from sucking pigs than from those that were early weaned, whereas the reverse was true of L. acidophilus and S. bovis. All isolates recovered from washed macerated pars esophagea adhered to pig esophageal epithelial cells when tested in vitro.


Evaluation of thermal disinfection procedures for hydrophilic contact lenses. The kinetics and efficacy of moist heat disinfection for hydrophilic contact lenses were investigated by using representative microorganisms of ophthalmic concern and several heat-resistant species. In replicate challenges, 80 degrees C for 10 min and 75 degrees C for 5 min were proven efficacious for moist-heat disinfection.


Simple procedure for disruption of fungal spores. A simple, inexpensive method for disrupting dormant fungal spores is described.


Dynamics of ultraviolet dermatitis as studied with the mouse tail technique. Time course and dose-response relationships have been studied for medium-wave ultraviolet radiation (UVB) in the mouse by measuring the inflammatory oedema of tail tissue. The time course was shown to be dose dependent, larger doses peaking earlier than smaller ones. For intermediate doses the reaction culminated after 48 h. Dose-response curves were sigmoid-shaped with good linear correlation in the region of maximal slope. The dose-response curve was studied at varying intervals after irradiation and the relationship could be shown to be time dependent. UVB differs in some of these respects from phototoxic reactions to chlorpromazine and 8-methoxypsoralen.


On the influence of an external therapy with dexamethasone-21-sodium-m-sulfobenzoate on the amount of free fatty acids in the skin surface lipids. A lipid-free preparation containing 0.076% dexamethasone-21-sodium-m-sulfobenzoate (corresponding to 0.05% dexamethasone) has been applied to the right side of the back and the same vehicle without the agent to the left side of the back of 16 male subjects without any skin diseases. The applications were made twice daily over a period of 26 days. Two days after the final application the skin surface lipids were analysed quantitatively by means of the direct extraction method and the paper absorption method. Thin layer chromatograpical analyses were also carried out. The sum of skin surface lipids is not altered by dexamethasone-21-sodium-m-sulfobenzoate. This agent does, however, induce a significant increase in the free fatty acids at the expense of the triglycerides. The importance of this result is discussed with reference to the pathogenesis of steroid acne.


[Comparison of the epidermodysplasia verruciformis Lewandowsky-Lutz with the other Papova virus acanthomas by light and electron microscopy (author's transl)]. Based on histology and electron microscopy, a series of Papova virus acanthomas consisting of 300 common warts and Condylomata acuminata as well as primary efflorescences of 7 typical and 7 questionable cases of Epidermodysplasia verruciformis have been classified. Four cytological types expressing different cytopathogenic viral actions were established. Typ 4 ("basophilic foamy giant keratinocytes") seems to be specific for Epidermodysplasia verruciformis which thus can be differentiated histologically against ordinary warts (type 1-3).


Collagen polymorphism in pathologic human scars. The collagen type composition of normal and pathologic scars was examined in comparison with normal skin from the same individual. Particular care was taken to separate scar tissue from adjacent normal dermis. After urea extraction, the tissue specimens were cleaved with cyanogen bromide. The presence of the dermal collagen types I and III was deduced from the electrophoretic distribution patterns of the CNBr peptides in 12% SDS-polyacrylamide gels. The intensity of the type III specific peptide bands correlates with the type III content of the samples. Using this method, the presence of both type I and III collagen can be proved in normal as well as pathologic scars. The type III content in older normal scars is slightly increased, whereas the type III content of pathologic scars is significantly increased in comparison with the type III content of normal skin. The electrophoretic CNBr peptide distribution pattern of pathologic scar tissue is almost the same as that of fetal skin. Both are clearly different from the peptide pattern of normal adult skin.


[Erythema elevatum diutinum. I. Electron microscopy of a case with extracellular cholesterosis (author's transl)]. 1. A typical case of Erythema elevatum diutinum (E.e.d.) with extracellular cholesterosis is described clinically and histologically in a 48-year-old woman. The disease had a course of 15 years. 2. Electron microscopy confirmed the histological and immunfluorescent findings of leucocytoclastic vasculitis. In older lesions, histiocytes/macrophages predominate. Intra- and extracellular lipid depositions showed a variety of ultrastructural characteristics which differed from electron microscopical findings described in other disorders associated with lipid deposition. 3. The findings are in accordance with the hypothesis that the primary event in E.e.d. is a special type of chronic leukocytoclastic vasculitis. Subsequently, the damage of the vessel walls and focal necrosis may lead to secondary lipid deposition.


An analysis of recurrent esophagitis following posterior gastropexy. Surgical therapy for reflux esophagitis remains controversial. Sixty-five patients who underwent posterior gastropexy between November, 1970 and February, 1976 are presented. Indications for surgery were: esophagitis, 43 patients; esophagitis with stricture, 12 patients; paraesophageal hernia seven patients; incapacitating postfundoplication syndrome, three patients. The average follow-up was 15.6 months. Eighty-two per cent of the patients had a good to excellent result. Twenty-three per cent of the patients developed radiographically recurrent hiatus hernia; however, the incidence of recurrent esophagitis was only nine per cent. Two patients developed postoperative strictures (one de novo, one recurrent). Two patients ultimately required a fundoplication for control of their esophagitis; one patient required a Thal-Nissen procedure. Lower esophageal sphincter pressure on patients with satisfactory results increased from 6.3 +/- 1.3 cm H2O SEM preoperatively, to 17.4 +/- 3.0 cm H2O SEM postoperatively. This increase achieved a statistical significance of p less than 0.001. In patients who had an unsatisfactory result, postoperative sphincter pressures were unchanged from preoperative values. All unsatisfactory results were obtained in patients with complicated esophagitis, i.e., Barrett's ulcer or stricture, alkaline esophagitis, or previous hiatal surgery. Posterior gastropexy appears to constitute effective therapy in the treatment of uncomplicated reflux esophagitis and paraesophageal hiatus hernia without the distressing morbidity associated with the postfundoplication syndrome.


Splenic epidermoid cysts.

Splenic epidermoid cysts. Four patients with splenic masses were operated upon and found to have epidermoid cysts of the spleen, a rare lesion comprising less than 10% of benign, nonparasitic splenic cysts. The patients were young and had vague, non-specific symptoms which were related to the size of the slowly enlarging splenic mass. Three patients had palpable masses. Contrast gastrointestinal studies and intravenous urography will help exclude mass lesions of the gastrointestinal or genitourinary tract. Sonar scan may confirm the cystic nature of the lesion and localize it to the spleen. A review of 42,327 autopsy records at the Los Angeles County--University of Southern California Medical Center revealed 32 benign splenic cysts found incidentally at autopsy. Hemorrhage, infection, rupture, and rarely, malignant change are complications of splenic cysts. Splenectomy is recommended to eliminate the symptoms produced by the cyst and prevent the potential complications.


Benign solitary lung lesions in patients with cancer. The appearance of a lung opacity on a chest film of a patient with known cancer may present a diagnostic dilemma. From 1940 through 1975, over 800 patients with this problem underwent thoracotomy for confirmation of diagnosis. In some 500 of these patients, the lesion proved to be primary cancer of the lung; in 196 they were solitary metastases and in 11 patients the lesions were benign. There were six additional patients in whom multiple opacities were found which proved to be benign conditions. An approach to the investigation, diagnosis, and surgical management of such solitary pulmonary lesions is presented. It is emphasized that the appearance of a solitary pulmonary shadow in a patient with a history of cancer should not be assumed to be a metastasis. Appropriate investigations should be performed without delay in an effort to define the nature of the lesion by microscopic analysis permitting definitive therapy to be administered and a more accurate prognosis provided.


Treatment of pneumatosis cystoides intestinalis with hyperbaric oxygen. The use of hyperbaric oxygen for the treatment of pneumatosis cystoides intestinalis is reported. The pathophysiology, etiology and previous treatment reports are discussed, as are the advantages of hyperbaric oxygen therapy over normobaric oxygen therapy or surgery. The use of hyperbaric oxygen appears to represent a significant advance in the treatment of pneumatosis cystoides intestinalis.


Gastric carcinoma following operation for peptic ulcer disease. Gastric carcinoma following operation for benign peptic ulcer disease has been considered rare but nine patients have been seen during the past five years. All were male patients, the average time interval from prior ulcer operation to development of cancer was 17 years, but was a short as ten years. The symptoms of cancer are vague and the diagnosis is often delayed. Fiberoptic endoscopy with biopsy of suspicious areas is the most accurate diagnostic approach. Resection of the tumor is indicated if feasible. The poor prognosis of this malignancy is documented. The evidence is reviewed that the creation of achlorhydria with bile reflux increases the risk of development of gastric carcinoma. All patients who undergo peptic ulcer operation require careful long-term follow-up. Vague gastrointestinal symptoms occurring ten years or more after peptic ulcer operation require full evaluation to exclude the presence of gastric cancer.


Retroperitoneal liposarcoma.

Retroperitoneal liposarcoma. A group of patients with retroperitoneal liposarcoma is presented and general guidelines of management reviewed. It is suggested that aggressive, radical total surgical excision followed by adjuvant postoperative irradiation be used as the treatment of choice. Although the management of recurrent disease may be discouraging in terms of ultimate cure, reasonable palliation and prolonged survival may result from aggressive therapy.


Surgical management of massive hemoptysis. A ten-year experience. Pulmonary bleeding was defined as massive when the collected blood was 600 ml or more in 24 hours. Hemoptysis of this magnitude carries more than 50% mortality when managed without surgical intervention, For this reason all patients admitted, bleeding massively, in the past ten years were considered candidates for surgical therapy. Localization of the bleeding was done by bronchoscopy. Pulmonary reserve was evaluated by clinical and radiological observation and, when feasible, by spirometry. Of the 75 patients seen with massive hemoptysis, 68 were operated. Seven patients were excluded for various reasons. Five of these patients died during the acute bleeding episode. Sixt-five resections were performed with 11 deaths (17%) and three cavernostomies with one death. Of 51 lobectomies, seven expired (14%). One segmentectomy survived. Other than the magnitude of the surgical resection, the mortality was related to the amount of bleeding in the 24 hours preceding the surgical procedure. Severe bleeding at the time of resection requiring one-lung ventilation also significantly influenced the mortality (33% against 7%). This experience shows that pulmonary resection is the treatment of choice in patients with massive hemoptysis.


Management of congenital choledochal cyst with intrahepatic involvement. The clinical features and surgical treatment of 75 patients with choledochal cysts with intrahepatic involvement (Type IV-A) were evaluated. Seventeen were in this series and 58 were reviewed from the literature. It was of interest that the incidence of Type IV-A choledochal cysts was nearly 30%, considerably higher than had been previously assumed. This type is commonly found in older children and young adults. Abdominal pain and fever indicative of biliary tract infection are more frequent seen than in patients with Type I, and a mass is not commonly palpable. Surgical treatment of Type IV-A must achieve bile drainage from the intrahepatic cysts as well as from the choledochal cyst. For this reason, as well as the prevention of later development of cancer in the wall of the cyst, hepaticoenterostomy at the porta hepatis with partial resection of the wall of the intrahepatic cyst (or partial hepatectomy if possible) combined with excision of the intrahepatic cyst is recommended as the procedure of choice for type IV-A cysts.


Hepatic--portal venous gas in adults: etiology, pathophysiology and clinical significance. The roentgenographic finding hepatic--portal venous gas (HPVG) has been reported extensively in the pediatric and radiology literature. The surgical implications and clinical significance have yet to be fully defined. This study reviews the 60 reported cases in the literature and adds four new cases. HPVG appears as a branching radiolucency extending to within 2 cm of the liver capsule. HPVG is associated with necrotic bowel (72%), ulcerative colitis (8%), intra abdominal abscess (6%), small bowel obstruction (3%), and gastric ulcer (3%). Mucosal damage, bowel distention and sepsis predispose to HPVG. The current mortality rate of 75% represents an improvement from previous experience. Analysis of survivors indicates that the finding of HPVG requires urgent surgical exploration except when it is observed in patients with stable ulcerative colitis.


Lung water changes after thermal burns. An observational study. Pulmonary extravascular water has been measured as lung thermal volume (LTV) in a group of nine burned patients. Transducer-detectable indicators were used to permit frequent repetition and quick results. Concurrent recordings were made of cardiac output, pulmonary capillary wedge pressure and the usual hemodynamic variables. Moderate elevation of LTV was seen in all, reaching a maximum value before peripheral edema formation was complete. Left heart filling pressures were low as plasma albumin concentration. Clinical pulmonary edema occurred in one patient treated mostly with crystalloid solution. In several, a secondary peak coincided with edema mobilization.


Heparin in the treatment of experimental peritonitis. Two experiments were performed to determine the effect of heparin on experimental fibrinopurulent peritonitis in dogs. Peritonitis was induced by the creation of a 10 cm long isolated loop of terminal ileum. In a first experiment comprising 24 dogs the necrotic loop was removed 24 hours later without cleaning or irrigating the peritoneal cavity. All dogs showed fibrino-purulent peritonitis at that time. No antibiotics were given. All dogs received 500 ml of Ringer's lactate during surgery and were allowed p.o. fluids on the first postoperative day. At the time of excision the dogs were blindly randomized into a control group and two treatment groups receiving heparin 100 u/kg i.p. or s.c. respectively. Of the eight animals in the control group, five died of peritonitis and two showed residual intraperitoneal sepsis at the time of sacrifice 14 days after the initial surgery. Thus, only one dog cleared his peritoneal infection spontaneously. Of the heparin treated dogs six out of eight in the i.p. treated and seven out of eight in the s.c. treated group cleared their peritonitis spontaneously within 14 days (p </= 0.05 and 0.02 respectively). In a second experiment peritonitis was induced in 24 dogs as described above, but the necrotic loop was not removed. The dogs were blindly randomized to daily low dose heparin (50 u/kg s.c. b.i.d.) or no therapy. Only two out of 12 dogs of the control group survived the observation period of 14 days compared with eight out of 12 of the heparin treated group (p </= 0.05). However, in all dogs in this experiment residual i.p. sepsis was found. We conclude that heparin has a therapeutic effect in experimental canine peritonitis by preventing the additional apposition of fibrin and, thus, rendering the bacteria more susceptible to cellular and noncellular clearing mechanisms.


Hepatic blood flow measurement III. Total hepatic blood flow measured by ICG clearance and electromagnetic flowmeters in a canine septic shock model. The validity of the ICG clearance method for the measurement of THBF in abnormal circulatory states remains questionable. In this study THBF measured by this method is compared with the electromagnetic flow technique in a canine spetic model. Good correlation is demonstrated between the two in normal control animals. However, in the septic animals the ICG underestimated the electromagnetic flow result by 20%. This is true in both the high and the low cardiac output septic shock pictures that emerge. In the septic animals, the total hepatic blood flow as measured by the ICG was almost equal to the portal vein flow alone measured by the electromagnetic flowmeters suggesting that this was the quantity it was measuring in this abnormal state. Pathophysiologic mechanisms that may explain the discrepancy are given.


The effect of fat on secretin release.

The effect of fat on secretin release. The effect of graded doses of intravenously infused secretin and intestinally perfused sodium oleate and HCl on pancreatic exocrine secretion and plasma secretin was determined in cats and dogs prepared with pancreatic fistulas. The pancreatic dose--response curves for bicarbonate following duodenal perfusion of oleate and HCl in cats were almost identical and paralleled the response to exogenous secretin. Although the bicarbonate response to oleate in dogs was less pronounced than the response to HCl or secretin, the bicarbonate output was observed to increase relative to protein output with increasing doses of the intestinally perfused fat. These observations suggested that secretin or a substance with secretin-like activity may be released from the intestine on contact with fat. The inability to detect changes in secretin immunoreactivity in both cats and dogs with increasing doses of oleate suggests that if secretin is released, it is in amounts undetectable by our radioimmunoassay or that some other unknown substance with secretin-like activity may be released.


The entrapped intestinal balloon: deflation by hyperbaric therapy. The problem of an entrapped, distended intestinal tube balloon has been successfully resolved on four occasions by hyperbaric therapy. At four to five atmospheres absolute, the volume and diameter of the balloon in all four cases was reduced sufficiently to allow easy and safe extubation. The alternative approaches of forceful, traumatic extubation or laparotomy and enterotomy with their inherent dangers and problems were thus avoided.


Prospective evaluation of endoscopic retrograde cholangiopancreatography in the diagnosis of periampullary cancers. In a prospective study of 112 patients suspected of periampullary cancer endoscopic retrograde cholangiopancreatography (ERCP) was successfully performed in 87 patients (78%). Technical failures were due to gastric outlet obstruction in four patients and inability to cannulate the ampulla of Vater in 21 patients. Successfully performed ERCP had both a high sensitivity (92%) and specificity (90%) for periampullary cancer. The few errors in pancreatogram interpretation were due to juxta-ductal cancers and difficulty in differentiating duct changes of cancer from those of chronic pancreatitis. Pancreatic cytology, performed in 21 patients, was reliable, diagnosed two pancreatic cancers when the pancreatogram failed and, if used routinely, assists interpretation of the pancreatogram. Retrograde cholangiography provided a correct diagnosis in six jaundiced patients with normal pancreatograms. Three complications of ERCP occurred in this series.


The surgical treatment of chronic intestinal ischemia. The mortality in acute intestinal ischemia is high, and 50% of such patients have previous attacks of abdominal angina due to chronic intestinal ischemia. Vascular reconstruction is remarkably successful in relieving the symptoms of chronic intesintal ischemia and for this reason angiographic examination is recommended in all patients in whom chronic intestinal ischemia is suspected. If the diagnosis is established by arteriography with appropriate supporting evidence, vascular reconstruction should be performed.


Abdominal aortic aneurysm with rupture into inferior vena cava associated with horseshoe kidney. The first patient with an abdominal aortic aneurysm with rupture into the inferior vena cava associated with a horseshoe kidney is reported. Rupture of an aortic aneurysm into the inferior vena cava with formation of an aortocaval fistula has been reported in 100 patients. Aortic aneurysm in combination with horseshoe kidneys has been described in 34 patients. The diagnosis was made by an abdominal aortogram. The patient's preoperative condition was characterized by circulatory and renal failure subsequent to the development of a large aortocaval fistula. Operative repair was performed by dividing and rotating the kidney, dividing a renal polar artery, incising the aneurysm, and over-sewing the fistula from within. The patient's postoperative course was complicated by renal failure and sepsis and he died two months later. It is essential to preserve renal function in patients with this combination of anomalies.


Comparison of regional versus systemic chemotherapy with adriamycin. TO ACHIEVE THE HIGH DRUG CONCENTRATIONS IN A TARGET TISSUE (TUMOR) WITH MINIMAL DRUG LEVELS IN ORGANS NOT INVOLVED BY CANCER, THEREBY AVOIDING SERIOUS SYSTEMIC SIDE EFFECTS, THREE METHODS OF ADRIAMYCIN ADMINISTRATION: 1) Isolation perfusion, 2) Intra-arterial infusion, and 3) Intravenous infusion were studied in 22 dogs. Latter two methods were studied in several patients with soft tissue sarcoma of the extremities. Isolation perfusion of the hind extremity was done through the femoral vessels; intra-arterial and intravenous infusions were done through the femoral artery and cephalic vein, respectively. Adriamycin levels in tissues of the hind extremity and blood were determined. The highest Adriamycin levels in tissues could safely be achieved by isolation perfusion. Drug concentrations in regional tissues were not significantly different after intra-arterial infusion as compared to those after intravenous infusion. Much of the drug went into systemic circulation after intra-arterial infusion and almost none after isolation perfusion. Hematologic and histologic evidence of lethal systemic toxicity was noted only in dogs receiving Adriamycin by infusions. Edema, patchy muscle necrosis, hemorrhages, and skin ulcerations were observed in the perfused extremities only. In human studies, drug levels in blood were comparable to those in animal study when Adriamycin was administered by the latter two methods.


Alterations in plasma and CSF amino acids, amines and metabolites in hepatic coma. The dog with an end-to-side portacaval shunt (PCS) has been extensively used as a model to investigate hepatic encephalopathy (HE) as it demonstrates a plasma amino acid pattern similar to patients with chronic liver disease. In adult mongrel dogs, the effect of PCS on plasma and CSF amino acids, octopamine (OCT), phenylethanolamine (PEA) and CSF 5-hydroxyindolacetic acid (5-HIAA), were studied. Moreover, the effect of correction of plasma amino acids by infusional techniques was investigated.Tyrosine, tryptophan and phenylalanine levels increased dramatically during the development of HE in plasma and CSF, while valine, leucine and isoleucine decreased in plasma only, but CSF levels remained stable. Plasma and CSF octopamine and phenylethanolamine and CSF 5-HIAA increased markedly as clinical features in the dogs' behavior, characteristic of hepatic encephalopathy occurred, including hypersalivation, ataxia, flapping tremor, somnolence and finally coma. Once in coma, the dogs were infused with an amino acid mixture (F080) calculated to normalize the plasma amino acid pattern. After one to eight hours, the dogs began to awake. Simultaneously, blood, and CSF aromatic amino acids returned to their control values, as did OCT, PEA and CSF 5-HIAA. If F080 infusion was stopped, biochemical alterations would appear within one week, again accompanied by clinical hepatic encephalopathy.The results indicate that the altered levels of aromatic and branched chain amino acids, octopamine and PEA in plasma and CSF correlate well with the development of HE and that correction of the plasma amino acid abnormalities improves encephalopathy simultaneously with correction of neurotransmitter derangements in CSF.


Bronchial atresia.

Bronchial atresia. Bronchial atresia is a rare congenital anomaly usually producing an extrahilar mass and associated distal hyperinflation on chest roentogenogram. Bronchography reveals nonfilling of the atretic bronchus and displacement of neighboring normal bronchi. Characteristically, the patient is young and asymptomatic but has an abnormal chest roentgenogram. The only physical finding may be decreased breath sounds over the affected parenchyma. Treatment is surgical excision to prevent recurrent or persistent infection and encroachment on normal tissues by the hyperinflated lung. A case report and a review of 34 patients are presented.


Chest dimensions in young adults with spontaneous pneumothorax. Chest dimensions measured from standard chest roentgenograms of 46 young adult patients with pneumothorax were compared with measurements from an age- and sex-matched control group. The ratio of men to women was 3:1. On the average, the male patients had longer chests and greater height-to-width ratios than the controls. The only significant difference between female groups was a diminished anteroposterior diameter in the patients with pneumothorax. The study suggests that the physical shape of the chest, probably because of stress distribution in the lungs, can play a major role in the development of spontaneous pneumothorax.


Retrograde coronary sinus perfusion for myocardial protection during cardiopulmonary bypass. The pathophysiology of retrograde coronary sinus perfusion was studied in a vented, nonworking heart in vitro. The fraction of nutritional blood flow, estimated with the trapping index of radioactive microspheres (15 +/- 5 mu), is approximately one-fifth of total flow. The funoff is primarily through the thebesian system and venovenous channels, as is shown with Microfil injection studies. These results suggest that retrograde coronary sinus perfusion would be of marginal value in revascularizing a working heart but would be effective in protecting a hypothermic, nonworking myocardium. Canine experiments indicate that retrograde coronary sinus perfusion can provide efficient core cooling of the myocardium during cardiopulmonary bypass even in the presence of complete coronary artery occlusion. It is technically simple, delivers cardioplegic solutions to the myocardium without the risk of coronary ostial injury, and can be employed in the presence of severe aortic insufficiency and open aortic root. Retrograde coronary sinus perfusion therefore appears to be a valuable alternative mode of myocardial protection during cardiac operations.


Transapical aortic perfusion with a double-barreled cannula. The transapical aortic perfusion method is a new approach to cardipulmonary bypass and is performed with an infusion cannula placed in the ascending aorta through the left ventricular apex. The technique is applicable to almost all varieties of open-heart surgery, and is the most efficient method in infants and small children. A double-barreled forked cannula performs the two functions of aortic infusion and left ventricular decompression. With a Bakelite obturator, its cannulation to the aorta is very quick and easy. The transapical aortic perfusion method with a double-barreled cannula has been utilized in 156 open-heart operations with 17 perioperative fatalities and 1 late death. The 138 surviving patients have done well for periods up to four years. The perfusion method was developed from the left heart bypass and assisted circulation technique independently invented by Chardack's group and by us in 1966 and 1969, respectively.


The Blalock-Taussig shunt in the neonate. With improvements in the techniques of microvascular surgery, the Blalock-Taussig shunt has been applied to smaller infants. We report our experience in 17 neonates (mean age 9 days, mean weight 3.2 kg) who underwent emergency shung operations. The early mortality was 17.6% (3 of 17), with only 1 death (7%) from renal failure and sepsis, in the last 14 patients. Three shunts were patent but inadequate and required a secondary procedure, which was successful in all 3. There were 3 patients with late shunt failures at a mean of 15 months postoperatively, while 2 are still doing well at 15 and 18 months. No patients developed congestive cardiac failure. The late mortality was high (5 of 14), but was due to late shunt failure and was preventable in only 1 patient. These results are encouraging, and we continue to perform the Blalock-Taussig shung in neonates. It is hoped that improvements in technique will reduce the incidence of inadequate shunts.


Growth after surgical repair of simple D-transposition of the great arteries. The effect of the Mustard procedure on growth was assesed in 45 patients with simple D-transposition of the great arteries (DTGA) surviving for at least one year after operation. Growth failure (below the third percentile for height, weight, or both) was found in 25 of the 45 patients preoperatively and in 8 patients postoperatively. The principal factors associated with poor growth before repair were advancing age, increased pulmonary and systemic flow, and subpulmonic stenosis. In those patients without postoperative growth failure, growth had returned to the normal range within two years. All patients wit retarded growth after the Mustard procedure had had preoperative growth failure as well. In addition, all 8 patients with postoperative growth failure had one or more amjor residual hemodynamic abnormalities, whereas residual lesions were present in only 10 of 37 patients with normal postoperative growth.


Tracheal compression by the aortic arch following right pneumonectomy in infancy. Uneventful pneumonectomy was carrried out in a 10-month-old infant for hypoplastic right lung associated with esophageal origin of the right main bronchus. Eight months after operation, symptoms of tracheal compression began. This compression was due to the aortic arch, which was stretched across the lower trachea following the displacement of the heart to the posterior right chest after pneumonectomy. Successful relief of the airway obstruction was achieved by inserting a 20 mm woven Dacron graft between the ascending and the descending aorta, with division of the aortic arch between the left carotid and the left subclavian arteries. An aortogram performed two years after operation confirmed good patency of the graft and normal flow through the descending aorta. The child remains well two years after operation but continues to have mild residual tracheomalacia and limited exercise tolerance, compatible with the presence of only one lung.


A simplified plastic repair for aortic dissections. A simplified plastic repair for aortic dissection is described. The operation consists of noncircumferential resection of the aortic segment containing the intimal tear, leaving the posterior wall intact. The false lumen is obliterated by oversewing both lips of the aortic incision. Aortic continuity is restored either by primary closure or by the insertion of a diamond-shaped prosthetic patch. The simplified plastic procedure shortens cardiopulmonary bypass time and reduces bleeding from suture lines. The operation was employed in 2 patients with success.


A new coronary perfusion cannula.

A new coronary perfusion cannula. A flexible but rigid-walled nontraumatic cannula has been developed for perfusion of the coronary arteries or visceral branches of the aorta.


Relationship between platelet count and cardiotomy suction return. A simple, inexpensive, accurate method of measuring the amount of blood returned by the cardiotomy suction system was devised and calibrated. Preoperative and postoperative platelet counts were obtained in 76 patients with congenital heart disease in whom the amount of cardiotomy suction return was measured. The mean percentage of total perfusate returned by the cardiotomy suction system was 8.9%. Both postoperative platelet count and the percentage change between preoperative and postoperative platelet counts correlated with the amount of blood returned by the cardiotomy suction system, time on bypass, and the percentage of total perfusate aspirated by the system.


Postinfarction cardiac rupture: surgical success and review of the literature. Cardiac rupture following myocardial infarction has been reported as the cause of 4 to 24% of all infarction deaths. The rupture may occur from a few hours to several days after the myocardial infarction and is not a true "blowout" but rather a necrotic hemorrhagic area in the center of the infarction that extravasates blood and leads to pericardial tamponade. The most common findings when rupture occurs are renewed chest pain, bradycardia, and shock. Two patients with postinfarction myocardial rupture who were operated on successfully are reported. With prompt diagnosis and treatment, more of these patients would survive long enough to undergo operation. With cardiopulmonary bypass the repair of these ruptures is not difficult.


Restenosis of the mitral valve: surgical considerations and results of operation. Our experience over an eight-year period with 63 consecutive patients with mitral restenosis who underwent operation forms the basis for this report. Striking clinical disability was a notable finding. A majority of the patients were less than 30 years old. Embolic phenomena were rare. Closed transventricular valvotomy offers excellent low-risk palliation and good long-term results. Follow-up showed excellent or good results in 90.5% of the patients and poor results in 9.5%. Hemodynamic study of 6 patients demonstrated a pronounced decrease in the pulmonary artery pressure. Open valvotomy was performed in 6 subjects. The presence of intracardiac calcification together with mild mitral incompetence in 2 patients made valve replacement mandatory. The problem of restenosis of the mitral valve is complex, and only after further long-term results are available will the superiority of any one method be demonstrated.


Evaluation of regional myocardial nutrient perfusion following selective retrograde arterialization of the coronary vein. The effects of selective coronary vein occlusion (SCVO) and selective retrograde arterialization of the coronary vein (SRACV) on nutritional myocardial blood flow was evaluated in 10 dogs with radioactive microspheres. SRACV was performed with a shunt interposed between the aorta and the great cardiac vein (GCV). Following ligation of the GCV, measurements were performed before and after ligation of the middle portion of the left anterior descending coronary artery (LAD) and then after 15 and 30 minutes of SRACV. The myocardium was divided into three regions: circumflex coronary artery (served as control), high LAD (proximal to arterial occlusion; supplied by both SRACV and coronary flow), and low LAD (distal to arterial occlusion; supplied by SRACV alone). SCVO decreased mean myocardial blood flow with increased distribution to the endocardium. SRACV to normally perfused myocardium did not significantly change myocardial blood flow; however, SRACV to acutely ischemic myocardium restored less than 50% of the decrease in myocardial blood flow. SRACV does not appear to greatly enhance blood flow to ischemic areas of the myocardium and may significantly reduce flow on the basis of venous occlusion alone.


The effect of glucagon in animals on chronic propranolol therapy. Eleven adult mongrel dogs were divided into two groups. Group 1 animals served as controls and Group 2 received propranolol (6 mg/kg/day) orally in divided doses for 15 to 21 days. Prior to cardiopulmonary bypass, cardiac output, first derivative of left ventricular pressure (dp/dt), peak systolic pressure, heart rate, and central venous pressure were recorded. The animals were then placed on cardiopulmonary bypass and subjected to 30 minutes of global ischemia at the myocardial temperature of 32 degrees C. Following cessation of cardiopulmonary bypass the baseline studies were repeated. In Group 2 animals following the repeat studies, glucagon was administered at a rate of 0.13 microgram/kg/min. The cardiac index and dp/dt were decreased by 43.3% (p less than 0.001) and 40.5% (p less than 0.001) in comparison to Group 1 animals. In Group 2 dogs, after bypass and glucagon infusion, cardiac index increased by 38% (p less than 0.02), dp/dt rose by 78% (p less than 0.05), and peak systolic pressure increased by 24.8% (p less than 0.05). These studies show the benefit of glucagon in the treatment of low cardiac output in the presence of beta-adrenergic blockade.


Ruptures and perforations of the esophagus: the case for conservative supportive management. A series of 31 patients treated for ruptures and perforations of the intrathoracic esophagus is reviewed. Eighteen of these patients underwent major thoracotomy; 11 were treated with minor procedures. Two died before treatment could be implemented. Of the 18 undergoing major operations, 7 died; among the 11 managed conservatively there was only 1 death. Based on this experience, we conclude that major surgical repair for esophageal perforation is often unnecessary. It has the additional drawback of sometimes resulting in equally serious secondary procedures.


A simple method of cold coronary perfusion. Hypothermic coronary perfusion lengthens the safe duration of anoxic arrest. Intermittent selective hypothermic coronary perfusion provides extended myocardial protection. We describe a method of achieving profound myocardial hypothermia by selective deep hypothermic coronary perfusion using a cooling coil without a separate pump head.


Intraoperative assessment of mitral valve function. Clinical, echocardiographic, hemodynamic, and angiographic data can usually assess the preoperative status of the mitral valve quite accurately. However, there is need for an intraoperative method to observe the dynamic function of the mitral valve, particularly after an open commissurotomy, or to determine the efficacy of a valvoplasty. Our experience with more than 250 mitral annuloplasties has led to the development of a safe method for direct observation of the mitral closure mechanism using the left ventricular vent and a slight modification of the usual cardiopulmonary circuit.


Simplified insertion of left atrial pressure monitoring catheter. A simplified, safe, and reliable technique is described for intraoperative insertion of a left atrial monitoring catheter using modified, currently marketed plastic intravenous catheters.


Subclavian--coronary artery anastomosis in infancy for the Bland-White-Garland syndrome: a two-year angiographic follow-up. A 6-month-old female infant with anomalous origin of the left coronary artery underwent an end-to-end anastomosis of the left subclavian artery to the left coronary artery. A cuff of the pulmonary artery was used for the anastomosis. The child continued to have mitral regurgitation but has done well with medical treatment over the last four years. Cardiac catheterization 26 months after operation confirmed a patent graft without narrowing, improved contractility of the left ventricle, normal end-diastolic pressure of the left ventricle, and persistent mitral regurgitation. This technique is applicable in infants regardless of the size of the left coronary artery.


Antiarrhythmic, electrophysiologic and hemodynamic effects of lorcainide. Lorcainide hydrochloride or N-(4-chlorophenyl)-N-[1-(1-methyl-ethyl)-4-piperidinyl]benzeneacetamide mono-hydrochloride (R 15889) is a new anti-arrhythmic drug. Studies in dogs show that lorcainide is effective against post-infarction and ouabain-induced ventricular arrhythmias, and abolishes acetylcholine and aconitine-induced atrial fibrillation; it elevates the threshold of electrically induced ventricular fibrillation. In isolated dog and cow Purkinje fibers, in dog ventricular and in guinea-pig auricular muscle preparations, lorcainide decreases the rate of rise of the transmembrane action potential, the conduction velocity and spontaneous activity. It prolongs the refractory period of isolated Purkpinje and ventricular muscle preparations, and the functional refractory period of the AV node in the guinea-pig heart. It has no effect on Ca mediated electrical activity. Isometric force measurements in isolated cat papillary muscles and hemodynamic studies in anaesthetized and unanaesthetized dogs indicate that lorcainide moderately decreases myocardial contractility. Side effects observed at large doses are of central origin and include salivation, tremor and vomiting. Intravenous injection induces transient peripheral vasodilatation. Lorcainide is an antiarrhythmic of the local anaesthetic type. It is characterized by a good oral absorption, a long duration of action and a large safety factor.


Influence of intraventricularly applied apomorphine on somato-vegetative reflexes in cats. To obtain information about the dopaminergic neurotransmission processes taking part in the somatovegetative reflexes the effects of intraventricularly given apomorphine were studied in lightly anaesthetized cats. The level of blood pressure and the reflexogenic hypertension due to central sciatic nerve stimulation were not changed when apomorphine was applied into the lateral and third but was inhibited when given into the fourth ventricle. The nictitating membrane contractions elicited by sciatic nerve stimulation were inhibited by apomorphine when introduced into each part of the ventricular system. Thus the inhibitory dopaminergic synapses located in the structures lining the walls of the brain ventricular system reached by apomorphine appear to be involved in the central control of somato-vegetative reflexes.


The effects of intraventricularly administered GABA and picrotoxin and their interactions on somato-vegetative reflexes in cats. The effects of intraventricularly (third, fourth and lateral cerebral ventricles) applied GABA and picrotoxin on blood pressure and reflexogenic hypertension and nictitating membrane contractions after central sciatic nerve stimulation were studied in lightly anaesthetized cats. The interactions between both substances were also studied. It was shown that picrotoxin caused a strong elevation of blood pressure and a long lasting contraction of the nictitating membrane when infused into each part of the cerebral ventricular system. These effects of picrotoxin were antagonized by GABA. GABA inhibited the reflexogenic hypertension when given into the fourth ventricle and the reflexogenic nictitating membrane contractions given into the third and fourth ventricles. Picrotoxin antagonized the inhibitory effects of GABA on the reflexogenic nictitating membrane contractions. It is concluded that in the central regulation of some somato-vegetative reflexes the GABA-ergic transmitter system takes part.


Effect of 1-alpha-acetylmethadol (LAAM) on various physiological parameters in the conscious dog. LAAM was administered intravenously to conscious dogs at doses of either 0.1, 0.3 or 1.0 mg/kg. Cardiopulmonary responses were measured prior to drug administration, 0.5 hr post-drug and hourly thereafter. All doses produced a sleep-like state which was dose-related in duration (3-14 hr). Cardiac output, heart rate, respiratory rate and minute volume were decreased below mean pre-drug control values after drug administration in the two higher dosage groups; cardiac output in both groups failed to return to pre-drug control levels. Additionally, total peripheral resistance was elevated in these dosage groups although mean arterial pressure remained stable. Arterial pCO2 increased and arterial pH decreased as respiratory rate and minute volume decreased. Depression of rectal temperature occurred only in response to the highest dose.


The protective effects of ethylestrenol against acute poisoning by organophosphorus cholinesterase inhibitors in rats. Pretreatment of rats with 10 mg of ethylestrenol (17alpha-ethylestr-4-en-17beta-ol) by force feeding twice daily for three days and once on the fourth day decreased the severity of parathion (0,0-diethyl 0-4-nitrophenyl phosphorothioate) toxicity and caused a 150% increase in the parathion LD50 in male animals. It decreased by 51% cholinesterase inhibition in the brain caused by i.p. injection of 2 mg of parathion/kg body weight but not that of an equitoxic dose (0.5 mg/kg) of its active metabolite, paraoxon (0,0-diethyl 0-4-nitrophenyl phosphate). It decreased by 29% cholinesterase inhibition in plasma following i.p. administration of parathion but caused only a 16% decrease in cholinesterase inhibition following administration of the equitoxic dose of paraoxon. It did not protect against brain cholinesterase inhibition by 4 mg/kg of parathion given i.v.; however, brain parathion levels were 16% lower in rats pretreated with ethylestrenol than in control rats. It increased the rate of inactivation of both parathion and paraoxon by liver microsomal enzyme preparations. Thus enzyme induction seems to account for the protection afforded by ethylestrenol to toxicity following poisoning by organophosphates.


In vivo formation of dopamine from 3,4-methylenedioxyphenethylamine in the rat. Administered 1-C14-3,4-methylenedioxyphenethylamine led to the excretion of about 2% of the urinary C14 as conjugated dopamine and 3-methoxytyramine metabolites, in tranylcypromine treated rats. The amine was not excreted unchanged. The major metabolites were identified as conjugates of methylenedioxyphenylacetic acid, homovanilic acid and dihydroxyphenylacetic acid. The latter are derived by the further metabolism of conjugated methylenedioxyphenylacetic acid. Administered tranylcypromine doubled the excretion of conjugates of labeled dopamine and3-methoxytyramine. NADPH served as a cofactor for the microsomal demethylenation of the amine.


Effect of prazosin on norepinephrine concentration and turnover in rat brain and heart. Prazosin hydrochloride injected i.p. into rats markedly increased MOPEG sulfate (3-methoxy-4-hydroxy-phenylethylene glycol sulfate) concentration in brain and the rate of MOPEG sulfate accumulation after probenecid. The increase in MOPEG sulfate was dose-related over a 5-40 mg/kg dose range. After a 20 mg/kg dose of prazosin, the increase in MOPEG sulfate was greater than after the same dose of phenoxybenzamine and persisted for up to 24 hr. The rate of metaraminol disappearance from rat brain after alpha-methyl-m-tyrosine injection and the decline in brain norepinephrine after inhibition of its synthesis by alpha-methyltyrosine injection were increased in rats pretreated with prazosin. These findings indicate that prazosin increased brain norepinephrine turnover, probably via compensation to central alpha adrenoceptor blockade. Prazosin increased sertonin and 5-hydroxy-indoleacetic acid concentration and slightly decreased 3,4-dihydroxy-phenylacetic acid in rat brain. Although prazosin had little effect on brain norepinephrine concentration, heart norepinephrine was depleted for up to 16 hr after a 20 mg/kg dose of prazosin, and the depletion at 4 hr was dose-related down to 2 mg/kg of prazosin. These biochemical changes may all result from prazosin's block of alpha adrenergic receptors.


Calcium incorporation by canine aortic smooth muscle microsomes. The accumulation of calcium (Ca2+) and factors influencing Ca2+ incorporation in vascular smooth muscle were examined in a microsomal fraction prepared from canine aortae. The accumulation of Ca2+ required the presence of ATP and increased over time. Furthermore, the incorporation of 45Ca into the microsomal preparation was stimulated both in the presence of oxalate and when the Ca2+ concentration of the bathing media was elevated from 20 micron to 40 micron. Calcium uptake (with oxalate) was temperature-dependent; uptake was unaffected by azide. Both lanthanum (La3+) and phosphatidyl serine (PS) inhibited ATP-dependent uptake in a concentration-dependent manner. In the presence of ATP, calcium binding (without oxalate) was slightly inhibited by La3+, whereas PS had no effect under these conditions. When ATP was removed from the incubation medium, the presence of PS stimulated both the uptake and binding of 45Ca, whereas La3+ decreased both uptake and binding. These findings support the idea that La3+ binds on the surface of the vesicles and, in this manner, decreases available Ca2+ sites, whereas PS appears to increase the number of Ca2+ sites by either entering the membranes or adsorbing on it.


Interactions of narcotics and their antagonists with human serum esterase. VII: Further studies on the affinity of drugs for the substrate-binding site of the enzyme. Earlier studies on the competitive inhibition of human serum esterase by morphine and related compounds were continued. Very good correlation was found between the inhibitor constants of 57 compounds and an empirical function, the "hydrophobic factor," which contains a positive contribution from the hydrophobic nature of a compound and negative contributions from its hydrophilic characteristics and from strain in its molecule. However, structural factors plainly also play a role in the affinity of each compound for the active site of the esterase because it was found necessary to include another positive term for a flexible hydrophobic group and because as a rule stereoisomers--even enantiomorphs--with identical hydrophobic factors differ in affinity; but no correlation could be found between the absolute configurations of the enantiomorphs and their affinities for the active site.


delta9-Tetrahydrocannabinol: tolerance after noncontingent exposure in rats. Rats pretreated daily with delta9-tetrahydrocannabinol (delta9-THC, 8 mg/kg) during 14 days showed tolerance to THC-induced hypothermia and depression of CAR acquisition in a shuttle-box. The noncontingent exposure of THC also produced tolerance to spontaneous (unlearned) behaviors as measured in a open-field test. The data suggest no essential role for learned tolerance in the sense that animals have to to learn to perform under the influence of THC for several of these behaviors.


Effect of autonomic blocking agents on chronotropic actions of 1-alpha-acetylmethadol. The objective of this investigation was to determine whether or not autonomic receptors are involved in the chronotropic responses to 1-alpha-acetylmethadol (LAAM) and congeners (1-alpha-acetylnormethadol, norLAAM; 1-alpha-acetyldinormethadol, dinorLAAM). The effects of atropine were studied in vitro using isolated guinea-pig right atria and in vivo in anesthetized dogs. The effect of d,l-propranolol, a beta-adrenergic receptor blocking agent was studied in vitro only. Atropine attenuated, but did not block completely, the negative chronotropic responses to the narcotic agonists. Propranolol blocked completely the positive chronotropic response to norLAAM and appeared to increase the negative chronotropic response to dinorLAAM. It is concluded that: 1) muscarinic cholinergic receptors play a role in the negative chronotropic response; 2) the positive chronotropic response to norLAAM involves activation of beta-adrenergic receptors.


The action of prazosin in human vascular preparations. To identify the mode of action of prazosin, its effects on isolated human vascular preparations were studied. Isometric tension was recorded from spiral strips of dorsal metacarpal veins, common palmar digital arteries and uterine, splenic and ileocolic arteries. Prazosin was a potent antagonist of noradrenaline, but not 5-hydroxytryptamine or barium chloride in the metacarpal veins. Higher concentrations of prazosin were necessary to antagonize noradrenaline in the visceral arteries. The digital arteries were resistant to its sympatholytic effect. It is concluded that prazosin acts as an alpha-adrenoceptor antagonist of different potency in various vascular beds. It is postulated that the initial cardiovascular side effects of prazosin are due to venous pooling and that the long term antihypertensive effect is the result of reduced peripheral resistance because of interference with arterial sympathetic tone.


Effect of isoproterenol on myocardial creatine kinase activity in rats. Isoproterenol (0.1-500 mg/kg) decreased the myocardial creatine kinase (CK) activity in rats. The maximum effect was already reached with 10 mg/kg, decreasing the enzyme activity to 58.5% of the control values. The beta-blocking agents propranolol and practolol, and also glucocorticosteroids inhibited the isoproterenol effect. The relative CK isoenzyme composition of the myocardium was not grossly altered by isoproterenol, as shown by DEAE-Sephadex A-50 macrocolumn chromatography. --Serum CK was increased significantly after the administration of the excessive dose of 500 mg isoproterenol/kg.


Agranulocytosis secondary to pentazocine therapy. Agranulocytosis developed in three patients after prolonged oral pentazocine hydrochloride therapy. Two of the patients had a recurrence of their agranulocytosis within three weeks of reinstitution of pentazocine. Culture techniques in one patient indicate a probable metabolic effect.


Fever, rash, and muscle tenderness. A distinctive clinical presentation of disseminated candidiasis. Five patients had fatal, disseminated candidiasis. At the onset of candidemia, a remarkably similar and distinctive triad of high fever, papular erythematous skin lesions, and diffuse severe muscle tenderness developed in each patient. This previously unreported clinical syndrome is sufficiently unique to justify a presumptive diagnosis of disseminated candidiasis and the use of empiric antifungal therapy pending culture and biopsy results.


Heparin-induced thrombocytopenia.

Heparin-induced thrombocytopenia. Two patients with underlying thromboembolic disorders developed severe thrombocytopenia while receiving heparin sodium; one of these patients developed recurrence of the thrombocytopenia and possible heparin-induced pulmonary emboli when heparin was restarted. In a prospective study of patients receiving heparin in a coronary care unit (CCU), nine of 37 patients developed transient mild thrombocytopenia (platelet counts ranging from 88,000 to 150,000/cu mm). Heparin added to citrated platelet-rich plasma caused platelet aggregation in the two original patients. In three of six CCU patients tested, and in 17 of 87 other subjects, with maximum aggregation at concentrations of heparin likely to be present in vivo during therapy. We herein discuss evidence that suggests that heparin may cause or aggravate thrombosis by causing platelet aggregation. The occurrence of severe heparin-induced thrombocytopenia is well documented, and mild transient thrombocytopenia may be more common than has been recognized. Studies of heparin efficacy should take these responses into account.


The multiple factors affecting plasma renin activity in essential hypertension. Seventy-nine patients with essential hypertension were evaluated for peripheral renin activity in response to injection of 60 mg of furosemide and to upright posture. Age and supine diastolic blood pressure were found to be significant determinants of responsiveness, with contributions from sex and race. Patients with impaired responsiveness were predominantly older and female, while the group of hyperresponders was younger, male, and had significantly lower supine diastolic pressures. Aldosterone responses in relation to changes in peripheral renin activity were found to be nearly random with both furosemide and with posture. Thus, patients could be subdivided into renin subgroups, but not into parallel aldosterone subgroups. Data on four patients with primary hyperaldosteronism were discussed for comparison.


Incidence of pituitary tumors following adrenalectomy. A long-term follow-up study of patients treated for Cushing's disease. The long-term follow-up of 21 patients who had undergone bilateral adrenalectomy for Cushing's disease has revealed eight definite and two suspected cases of pituitary tumors. The average time from adrenalectomy to the diagnosis of the pituitary tumor was 6 1/2 years, with a range of 1 1/2 to 12 years. The incidence of tumors in this study (38%) is higher than that reported by others and may reflect (1) that none of these patients received pituitary irradiation in addition to adrenalectomy, (2) the length of follow-up, and (3) the high index of suspicion and early diagnosis of pituitary tumors in recent years. These data raise the question of whether bilateral adrenalectomy alone is an acceptable form of therapy for Cushing's disease. For patients treated in this way, a life-long commitment should be made to undergo annual reexamination for the possible occurrence of a pituitary neoplasm.


Myelofibrosis associated with multiple myeloma. Two patients had both multiple myeloma and myelofibrosis. One, who had both conditions, had autopsy confirmation of diagnosis three months later. The typical picture of agnogenic myeloid metasplasia with myelofibrosis developed in the second patient almost four years after the onset of k light chain myeloma. At this time all evidence of multiple myeloma had disappeared perhaps related to cyclophosphamide therapy. We were able to find two similar cases described in the English language literature. The two conditions may be related.


Splenectomy for Felty's syndrome. Clinicopathological study of 27 patients. The major clinical and pathological features and the long-term follow-up of 27 patients with Felty's syndrome who were treated with splenectomy for sever granulocytpenia and for acute, chronic, or recurrent infection were studied. Granulocyte counts rose within days in most patients, although slow responses and transient granulocytopenia did occur; only 12% of the patients had persistent or recurrent granulocytopenia. Infections resolved promptly in 77% of the patients, more slowly in the remainder, and only one patient had new problems of infection after aplenectomy. Splenic enlargement, present in all but one case, was attributable to expansion of the sinusoidal pulp. The most substantial pathological features of immune stimulation included germinal center hyperplasia and prominent clusters of plasma and preplasma cells within sinuses.