The role of sodium depletion in hydrochlorothiazide-induced antidiuresis in Brattleboro rats with diabetes insipidus. 1. The mechanism of the antidiuretic effect of hydrochlorothiazide in diabetes insipidus was studied in anaesthetized Brattleboro rats with the hereditary hypothalamic form of the disease. 2. The antidiuresis caused by acute administration of hydrochlorothiazide followed an increase in sodium excretion and was associated with a significant fall in the plasma sodium concentration. There were concomitant falls in effective renal plasma flow and glomerular filtration rate. 3. When sodium depletion was prevented by adjusting the infusion of sodium chloride, the falls in plasma sodium concentration, effective renal plasma flow and glomerular filtration rate were abolished. Under these circumstances there was an increase in urine volume, which suggests that hydrochlorothiazide may inhibit fractional fluid reabsorption in the proximal convoluted tubule. 4. The results indicate that the antidiuresis caused by hydrochlorothiazide in diabetes insipidus results, at least in part, from falls in effective renal plasma flow and glomerular filtration rate. These in turn seem to be entirely secondary to the drug-induced sodium depletion.


The degradation of human glomerular basement membrane with purified lysosomal proteinases: evidence for the pathogenic role of the polymorphonuclear leucocyte in glomerulonephritis. 1. Human polymorphonuclear leucocyte elastase and cathepsin G were incubated with preparations of isolated human glomerular basement membrane at neutral pH and 37 degrees C. 2. The ability of these enzymes to degrade glomerular basement membrane was followed by the release of hydroxyproline. Both proteinases released considerable amounts of hydroxyproline. 3. By using Sephadex G-100 it was shown that the solubilized basement membrane fragments appeared as a single peak and had a molecular weight of over 100 000. These proteins after reduction were analysed by sodium dodecyl sulphate-gel electrophoresis to examine their subunit pattern and determine their molecular size. 4. The released basement membrane proteins gave at least four precipitin lines with a rabbit anti-(glomerular basement membrane) antiserum. 5. These results support the concept that polymorphonuclear leucocyte neutral proteinases play an important role in the pathogenesis of glomerulonephritis. 6. At acid pH values cathepsin B also released hydroxyproline from human glomerular basement membrane but the lysosomal carboxyl proteinase, cathepsin D, had no action.


Tidal pressure/volume and flow/volume respiratory loop patterns in human neonates. 1. Tidal pressure/volume and flow/volume respiratory loops were constructed from records obtained during 98 studies on 48 neonates of various ages and gestations. Records were obtained with a total body plethysmograph and an oesophageal balloon. Total pulmonary resistance was computed at five separate levels in the breathing cycle and results were expressed graphically as tidal resistance profiles by plotting total pulmonary resistance against percentage tidal volume above functional residual capacity. 2. Values obtained for standard pulmonary mechanical measurements and thoracic gas volume were similar to those of other workers. In addition six distinctive resistance profile patterns were found and related to different breathing patterns. 3. The technique appeared to be particularly useful in identifying air trapping and also demonstrated that total pulmonary resistance is open to misinterpretation when measured only at the mid-tidal-volume level, as is the present convention.


Evidence of increased oxalate absorption in patients with calcium-containing renal stones. 1. The possible roles of the diet and of intestinal absorption in the increased excretion of oxalate by patients with renal calcium stones have been studied. 2. Dietary surveys showed that the mean daily intake of oxalic acid by stone-formers was not significantly different from that of non-stone-formers. 3. The mean urinary excretion of oxalate, expressed as an oxalate/creatinine molar ratio, was significantly reduced by fasting, the change being more marked in the stone-formers than in the normal subjects. Moreover, fasting abolished the difference in mean oxalate/creatinine ratios between stone-formers and control subjects. 4. These results are compatible with the hypothesis that the small increases in urinary oxalate excretion which occur in some idiopathic calcium oxalate stone-formers are due to increased absorption of oxalate from the intestine, which may be due to a reduction in intraluminal calcium concentration.


Control of breathing in patients with chronic obstructive lung disease. 1. Using the mouth occlusion pressure technique, we have studied the control of breathing in seven hypercapnic and eight non-hypercapnic patients with chronic obstructive lung disease. 2. When breathing room air, pulmonary ventilation, mean inspiratory flow and P0.1 (mouth occlusion pressure developed 0.1 s after the onset of occluded inspiration at functional residual capacity) were not significantly different between the two groups of patients. Tidal volume, however, was significantly lower in the hypercapnic than in the non-hypercapnic patients, as a result of a significantly lower duration of inspiration. 3. The lower tidal volume in the hypercapnic patients leads to decreased alveolar ventilation, and appears to be the main cause of retention of carbon dioxide.


A radioimmunoassay for 1,25-dihydroxycholecalciferol. 1. 1alpha,25-Dihydroxy-25-hemisuccinate cholecalciferol has been synthesized and conjugated to bovine serum albumin. 2. This conjugate is immunogenic; when injected into rabbits antibodies of high affinity for 1alpha,25-dihydroxycholecalciferol were obtained. 3. Vitamin D metabolites lacking the 1alpha-hydroxy group were of lower cross-reactivity with the antibodies. 4. By using these antibodies and 1alpha,25-[23,24-3H]dihydroxycholecalciferol as tracer a sensitive radioimmunoassay has been developed capable of detecting 20 pg of 1alpha,25-dihydroxycholecalciferol.


The effect of acute extracellular volume expansion on sodium chloride reabsorption in the diluting segment in man. 1. The effect of extracellular volume expansion (ECVE) during water diuresis, and of water diuresis alone, on the formation of free water in man was compared. 2. ECVE reduced free water formation at any given rate of distal delivery compared with water diuresis. Thus, ECVE depresses distal sodium chloride reabsorption. 3. This attenuation of free water formation occurred both when urine flow (V/100 ml glomerular filtration rate) and distal chloride delivery [(Cwater + Ccl)/100 ml glomerular filtration rate] were used as the terms for distal delivery. 4. We suggest that the distal depression of sodium chloride reabsorption after ECVE is robably due to a direct inhibition of distal sodium chloride transport mechanisms, and not to the flooding of the diluting site by the poorly reabsorbable bicarbonate ion.


A pharmacokinetic study of pentachlorophenol poisoning and the effect of forced diuresis. A pharmacokinetic study of an intentional pentachlorophenol ingestion by an elderly human has been undertaken. Information on the presence or absence of forced diuresis either continuously or for a short restricted period indicates that such treatment would materially reduce the body burden of pentachlorophenol. It is suggested that forced diuresis is the treatment of preference for such intoxication at this time.


Teratogenic effects in cattle of Conium maculatum and conium alkaloids and analogs. The plant Conium maculatum produced congenital defects in calves born to cows gavaged the fresh green plant during days 50-75 of gestation. Both arthrogryposis and spinal curvature were produced and were similar to the defects produced by the piperidine alkaloid coniine. The arthrogrypotic manifestations of the condition markedly increased in severity as the animals aged. Animals gavaged dry plant had either normal or equivocally deformed offspring. A number of chain length and ring saturation analogs of coniine were not teratogenic. No congenital defects arose in offspring from maternal inhalation of either the teratogenic alkaloid coniine, or from the teratogenic green plant.


Gas chromatography-mass spectrometry of fluorocarbons 11 and 12 in biologic specimens. Fluorocarbons 11 and 12 were detected and identified in tracheal air, blood, liver, lung, and brain specimens by head-space analysis utilizing a GC-MS. The individual spectrum for each of the fluorocarbons was obtained. The method is easily adaptable to other volatiles.


Transplacental carcinogens.

Transplacental carcinogens. Cancer can metastasize to the placenta and to the fetus, and it may arise in man without familial predisposition in fetal or early postnatal life. Carcinogens administered to the mother can induce cancer in the human fetus and experimental animals. Many potential carcinogens tend to act as abortifacients and teratogens as well as carcinogens. Carcinogens administered to mothers can be dispersed by all their metabolic pathways and can be transferred transplacentally. In each exposed fetus, further metabolic pathways, or absence therof, as well as the individual gene makeup, influence the expression of an agent's potential. In the future, experimental evidence defining the pathways of carcinogenesis in adults will provide clearer insight into how cancers arise. This will be most helpful in unraveling the more complex issue of transplacental carcinogens.


Training parents as mental health agents. The utilization of parents as mental health agents for their children is a service delivery strategy likely to have major impact on enhancement of normal families. Using an educational enhancement model, a parenting relationship training program was designed and implemented. Initial evaluation of specific short-term effects and differences between mothers and fathers is discussed. Implications for further program development and evaluation are noted.


How therapists perceive and treat suicidal patients. A review of literature on suicide shows a focus on early detection of those at risk of suicide and on the traits of those who actually commit suicide, but little attention to the therapeutic decisions of those who treat suicidal patients. Through in-depth interviews, 27 therapists from an interdisciplinary mental health center were asked about their theoretical formulations regarding suicide and their therapeutic preferences in working with suicidal clients: Significant differences were found between the nine respondents who had experienced the suicide of a patient in their caseload and the others who had not.


Mexican-American mental health service utilization: a critical examination of some proposed variables. A number of reports indicate that Mexican-Americans have a lower prevalence of mental health service usage than other ethnic groups. Although a number of factors have been proposed to account for their underutilization, none of the factors have been adequately supported by existing research. Variables associated with the responsiveness and quality of mental health services, particularly the availability of bilingual-bicultural staff, are advocated as the most relevant areas for future research.


Community mental health services in rural areas: some practical issues. Several critical issues involved in successfully initiating and maintaining a community mental health center program in a rural setting are discussed. These include the necessity of accurately assessing the existing social, cultural, and political system, and of fitting the mental health center program into these systems as smoothly as possible; the special problems faced in maintaining confidentiality; and the importance of recognizing and dealing with the front-line pressures on professional staff that are peculiar to the rural setting. Advantages as well as disadvantages of working in a rural program are considered.


Community characteristics that affect hospitalization and rehospitalization rates in a municipal psychiatric hospital. Age-specific rates of psychiatric admissions for Brooklyn are almost exclusively explained by socioeconomic measures. A measure of interpersonal contact explains an additional small increment of the variance. When the same age-specific rates are compared for whites and blacks, the relative importance of socioeconomic measures lessens and social and family structures emerge as significant predictors. The existence of unique ethnic-related factors as intervening variables in hospital admissions is strongly suggested by the data. A measure of interpersonal contact best predicts the percentage readmitted. In contrast the percentage admitted is strongly related to social and family structure measures.


Presurgical care of the equine colic patient. The pathophysiology, diagnostic evaluation and medical management of the horse with intestinal obstruction is outlined. Emphasis is on early and accurate determination of the need for surgery and on providing optimal preoperative medical support.


Anesthesia for small animal geriatric patient. The decreased adaptability normally associated with aging animals is described. Anesthetic evaluation and management of these alterations can be successfully completed if wide variations in organ functions are not required of the patient by the surgeon or anesthetist.


Bovine disease control problems in the northeast. IB. Brucellosis--current status. Brucellosis continues to be a very important disease in the United States and throughout the world. In the past year, New York State has experienced a significant increase in the number of infected dairy herds. Increased movement of cattle, including importations, has contributed to its spread. Prevention, control and eradication have been impeded by present housing and management practices and the frequent apathy on the part of the herd owner in implementing prescribed recommendations for the elimination of brucellosis.


Johne's disease and the practitioner.

Johne's disease and the practitioner. Mycobacterium paratuberculosis infections and the disease states resulting in cattle are defined as spectral in nature. There is a spectrum of immunological response which complicates tests based on this. It is recommended that initial diagnosis of suspicious clinical cases be confirmed by direct fecal smears and a serological test such as immunodiffusion. Herd evaluation requires the application of fecal cultures plus immunodiffusion. Control requires rigid management hygiene measures, surveillance of the herd status and post mortem confirmation of salvaged animals.


An approach to defining the etiology of animal abortions. Attempts to define the etiology of abortions on a regular continuing basis have been few, and largely unsuccessful. Problems of such a project include cost, difficulty of securing satisfactory samples, a laboratory organization of sufficient breadth, capacity and dedication to perform and interpret the necessary examinations, knowledgeable cooperation of the practitioner, and past reliance on isolated findings substituting for sound criteria for diagnosis. A program was created which was intended to overcome the difficulties. The plan was so constructed as to permit addition or removal of procedures as indicated.


Abortion storms--projection for the future. Most abortions are of an endemic and sporadic nature but some problems reach epidemic (storm) proportions. In many laboratories, the etiological agent is determined in about 25% of the cases. In the future, practitioners and laboratories working together can: 1) respond to owner concern, 2) quickly determine if one of the better defined contagious diseases is present, and 3) cooperate in developing a responsive, field oriented diagnostic and investigative program designed to better define factors concerned in abortion problems. A program for meeting these needs is suggested.


A report on the student affairs and admissions programs of the New York State College of Veterinary Medicine. The student administration and admissions functions of the College respond to numerous and diverse students needs and interests. The complexity of these programs, and the concept of this report precludes offering exacting detail or even mention of all activities encompassed under the concept of academic support services. The increased public interest in veterinary medicine has prompted significant increases in the number who apply each year. This causes particular emphasis to be given to the College Admissions program. Rapidly escalating costs of education mean increased dependency of students on our financial aid program at a time of static and potentially decreasing financial aid resources. Placement of graduates in the best possible employment opportunities has been and will continue to be vital to our overall missions. Involvement by students in activities beyond those purely curricular in nature, will always be critical to the health and growth of the College and the public it serves.


Differential diagnosis and treatment of bovine abdominal distention and the acute bovine abdomen. Physical diagnostic techniques as well as ancillary aids used to differentiate the various causes of bovine abdominal distention will be discussed. Both chronic and acute disorders are included. Therapy will be suggested or outlined for each, but the emphasis here will be on diagnosis. Several acute abdominal disorders which may or may not cause abdominal distention will also be discussed.


General anesthesia in pleasure horses.

General anesthesia in pleasure horses. Anesthetic management of the pleasure horse consists of the appropriate selection and administration of pre-anesthetic medications including anticholinergics, tranquilizers and narcotics followed by appropriate techniques of anesthetic induction. The anesthetic induction must vary somewhat for the pleasure horse practice since many of the procedures are completed on farms and ranches. As a result the inducing of anesthesia will frequently be with the same agent which will be used to maintain anesthesia. Noticeably will be the reduction and duration of anesthesia and surgical time. The induction of anesthesia will predominately be with ultra-short barbiturates alone or in combination with muscle relaxants or combinations of tranquilizers and dissociative anesthetics. Supplemental injections of intravenous agents or halothane, methoxyflurane or enflurane may be used to maintain anesthesia. Recoveries can be expected to vary according to the duration of anesthesia and the selection of agents that have been used. Anesthetic complications predominately consist of cardiopulmonary responses and those associated with recovery.


An improved procedure for genetic selection against hip dysplasia in dogs. Rapid weight gain can educe hip dysplasia of dogs with normal hip joints. It is proposed that progeny whose parents have "excellent genotypes" would not be susceptible to this stress and would develop normal hip joints. The method for reducing the incidence of hip dysplasia in dogs would be to use stress to identify carriers (parents) and potential carriers (progeny), and select for breeding only dogs with proved genotypic value and those progeny with the best hip joint conformation.


Anesthesia for small animal pediatric and geriatric patients. I. Anesthesia for small animal pediatric patients. Anesthetic management of the pediatric patient is a challenge which can give rise to a most rewarding anesthetic management if one takes into consideration the normal physiological function of the pediatric patient. One should choose the appropriate medications which may safely be administered to an animal of this age. Control of anesthesia through the use of appropriate anesthetic equipment and the use of appropriate monitoring will aid safe management. The selection of adjunct medications can achieve control of complications and aid ultimate uncomplicated recovery.


Treatment of vaginal candidiasis with miconazole. An open trial was carried out in 50 women with clinical signs and mycological evidence of vaginal candidiasis to compare the effectiveness of treatment with 2% miconazole cream with that of nystatin pessaries. Both groups were given intravaginal treatment for 14 days and were followed up at monthly intervals for 3 months. Relief of symptoms and clinical signs was comparable in the two groups but the mycological cure rate at 1 month was higher with miconazole. At 2 and 3 months, however, there was no significant difference between the cure rate obtained with the two treatments in the patients still included in the study.


Multiple premalignant fibroepitheliomas of Pinkus: a case report and review of the literature. An eighty-one year old man is presented who had multiple (four) premalignant fibroepitheliomas of Pinkus. A review of the literature and our case material revealed that multiple lesions account for 36 percent of the total cases reported. The clinical and pathologic features of these unusual variants of basal cell carcinoma are discussed.


The effect of propranolol on the pressor response to exercise in coarctation of the aorta. In a patient with coarctation of the aorta, blood pressure and heart rate were measured during graded exercise on a bicycle ergometer. After no treatment, and after oral hydrallazine, exercise produced large rises in systolic and diastolic blood pressures, and in heart rate. During exercise after oral propranolol, systolic and diastolic pressures did not increase, and there was a less marked tachycardia. These results suggest that propranolol should be used to minimize the dangers of elevated blood pressure associated with exercise in patients with coarctation.


Effect of dietary bran on serum lipids in patients with previous myocardial infarction, with gallstones, and in normal subjects. Sixteen subjects received between 50 g to 121 g of wheat bran in their diet for between 6 to 26 weeks. Five were normal subjects, 5 had gallstones, and 6 young men had suffered a previous myocardial infarction. The serum cholesterol did not show any consistent change in the normal subjects, but there was a fall in cholesterol at 20 weeks in patients with gallstones; patients with previous myocardial infarction had a rise in cholesterol which returned to normal at 20 weeks. There was no significant change in the serum triglyceride.


Office surgical management of recalcitrant axillary lesions. Hidradenitis suppurativa, hyperhidrosis, and Fox-Fordyce disease represent some of the surgical conditions seen by the dermatologist in office practice. These chronic, distressing, socially inhibiting diseases are extremely difficult to treat conservatively and ultimately require surgical intervention. Using local anesthesia, we have successfully managed these disorders on an outpatient basis by surgical excision, achieving excellent cosmetic and functional results, minimal discomfort, and absence of recurrence.


Experimental in vitro and in vivo comparison of modern antimycotics. Studies were carried out with the current leading antimycotic agents, using identical test methods, to compare their activity in vitro and in animal in vivo experiments. In the broth dilution test, the minimum inhibitory concentrations against approximately 50 strains of the most important species of yeasts, dermatophytes and moulds were determined using different culture media. Efficacy against yeasts was examined in experimentally-induced candidosis in mice treated orally, and against dermatophytes in experimentally-induced trichophytia in guinea pigs receiving topical treatment. The results showed that the imidazole derivatives studied can be regarded as true broad-spectrum antimycotics, and clotrimazole, in particular, had a well-balanced overall effect. The significance of the experimental data with respect to therapeutic efficacy in man in various indications is discussed.


Metabolic effects and anti-obesity action of fenfluramine in prolonged-acting form. In a single-blind trial, 15 obese patients, selected because of their poor response to a weight reducing diet, were treated for 1 month with placebo plus a 1600 calorie diet and then for a further 2 months with a single daily dose of 120 mg fenfluramine plus diet. After the placebo period, the mean weight loss was only 0.89 kg. After the 2-month period on fenfluramine, there was a highly significant (p less than 0.001) additional mean weight loss of 10.18 kg. Biological investigations of the metabolic effects of fenfluramine showed that compared with the placebo period there was an improved glucose tolerance and insulin response after active treatment as well as statistically significant decreases in serum cholesterol (p less than 0.001) and triglycerides (p less than 0.01). During active treatment none of the patients complained of feeling hungry and only a few transient side-effects were reported at the start.


Suntan localization of varicella exanthem. The case history of a Caucasian child in whom the exanthem of varicella appeared to be related only, and directly, to the darkness of skin suntan is presented and discussed.


Acebutolol (400 mg) given as a single daily dose to hypertensive patients previously stabilized on 400 mg acebutolol daily in divided doses: an open multicentre study. An open multicentre trial was carried out in 13 hypertensive patients, who had responded satisfactorily to and been stabilized on treatment with 400 mg acebutolol daily in divided doses, to assess the effectiveness and tolerance of the same daily dosage given as a single morning dose. On admission, patients were changed over immediately to the new dosage regimen and continued on it for 3 months. Blood pressure and pulse rate measurements were made on the day before change over and then at the end of each month. The results  indicated that once-a-day 400 mg acebutolol gave satisfactory continued control of blood pressure. Side-effects reported spontaneously by the patient, observed by the physician, and elicited in response to a questionnaire, diminished in incidence and severity in most of the patients during the trial period.


Recurrent cutaneous herpes simplex: comments on diagnosis in an unusual case. A patient with undiagnosed recurrent cutaneous herpes of twenty-four years' duration is described. The probable reason for the failure to recognize this disease on numerous occasions was the rapid progression of the lesions to the pustular stage within one day.


Invisible dermatoses.

Invisible dermatoses. An invisible dermatosis is defined as a skin disease manifesting no clinically apparent lesion but histologic changes of a characteristic nature. An example of an invisible form of transient acantholytic dermatosis is presented. Invisible forms of pseudoxanthoma elasticum, sarcoidosis, lepromatous leprosy, and lichen planus are reviewed. Dermal deposits may also be found on biopsy of clinically normal skin in amyloidosis, Hunter's and Hurler's syndromes, and thyroid disease.


Long-term follow-up evaluation of patients with electrosurgically treated warts. Questionnaires were sent to one hundred consecutive dermatologic patients with essentially digital warts, who had been treated an average of 12.7 years previously by electrocautery and curettage. It was determined from the twenty-three responses that the treated warts had been cured in twenty-two patients.


Use of a polyester fiber sponge as an adjunct in the treatment of psoriasis. Twenty patients with symmetric lesions of psoriasis were asked to use a polyester fiber sponge in addition to their other anti-psoriatic medications. The sponge was used to remove scales from those lesions on the left side only. The hypothesis was that removal of scales would enhance penetration by topical corticosteroid and/or coal tar preparations. At the end of four weeks, as well as at each weekly evaluation, all patients showed a statistically significant difference between the treated and control sides. In 70 percent of the subjects, results were graded good to excellent when the treated side was compared with the control side after four weeks' evaluation.


Correlation of exercise 201thallium myocardial scan with coronary arteriograms and the maximal exercise test. Myocardial scans obtained by injecting radioactive 201thallium during exercise were correlated with electrocardiograms obtained at rest and during exercise, with coronary arteriographic abnormalities, and with left ventriculograms in 55 patients suspected of having coronary arterial disease. Thirty-nine patients had significant coronary arterial disease, 34 of whom had abnormal myocardial scans after exercise and 21 of whom had abnormal ECGs during exercise. The myocardial scan after exercise was most frequently abnormal in the presence of significant abnormalities in the Q wave or localized left ventricular asynergy and when ST-segment depression persisted for longer than ten minutes after exercise. All patients with single-vessel disease had abnormal myocardial scans after exercise, whereas five of 29 patients with two or more abnormal vessels had normal scans. Patients with coronary arterial disease were more likely to have a normal myocardial scan after exercise when the resting ECG and left ventriculogram were normal and when exercise-induced ST-segment depression persisted for less than ten minutes. The combination of the myocardial scan after exercise and the ECG during maximal exercise had a sensitivity of 98 percent. The myocardial scan after exercise alone had a specificity of 100 percent. These observations indicate that the myocardial scan obtained by injecting 201thallium during exercise is an important diagnostic adjunct in the identification of patients with coronary arterial disease.


Crackles (rales) in the interstitial pulmonary diseases. There is renewed interest in the classification and methods of recording adventitious pulmonary sounds. This is a study of the importance of fine crackles (rales) in the diagnosis and estimation of the severity of diffuse infiltrative pulmonary disease. Among 272 cases documented by lung biopsy, bilateral fine crackles were heard in 60 percent of those with interstitial pneumonias and asbestosis but in only 20 percent of those with sarcoidosis and other granulomatoses. These incidences were identical in 335 patients diagnosed clinically. In 322 selected ambulatory patients with chronic obstructive pulmonary disease, fine crackles were recorded in only 10 to 12 percent, while coarse crackles were not uncommon in patients with chronic bronchitis. In workers exposed to asbestos, crackles correlated with exposure. In serial studies of such workers, the occurrence of crackles alone appeared to be a random event, while among those with crackles together with one other of five criteria, almost one-half developed asbestosis within four to six years. Fine crackles correlated with pathologic severity, with radiographic honeycombing, and with physiologic abnormalities.


Clinicopathologic correlations demonstrating the failure of 67gallium scanning in determining response to radiotherapy. Scanning of the chest using radioactive 67gallium citrate was performed in 12 patients with stage 3MO bronchogenic carcinoma prior to and following preoperative radiotherapy (3,000 rads). This was done to determine if scanning with 67gallium would be predictive in determining radiotherapeutic response. All 12 patients underwent resection of their primary bronchogenic carcinoma, and comparisons of chest x-ray films and 67gallium scans obtained before and after irradiation and of surgical specimens were made. The scan using 67gallium showed improvement in nine of the 12 patients; however, in five of these nine patients, the improvement on the scan using 67gallium was not paralleled by objective regression of the tumor on the chest x-ray film. Viable tumor was observed in the resected specimen in all 12 patients. We conclude that a scan with 67gallium should not be used to evaluate radiotherapeutic response.


Impairment of pulmonary function in acute pancreatitis. Arterial blood gas levels, lung volumes, and diffusing properties for carbon monoxide were measured in 22 patients with uncomplicated acute pancreatitis who had no clinical or radiographic evidence of pulmonary involvement. Mild arterial hypoxemia (less than 75 mm Hg) was present in four patients. The mean values of inspiratory lung volumes were clearly reduced, and the diffusing properties were sharply altered; the mean value for the diffusing capacity of carbon monoxide per unit of lung volume (Krogh's constant [KCO]) was 78 percent of predicted. Four patients with a low KCO in the first four days after an acute episode had normal values when reevaluated one week later. These findings suggest the occurrence, even in mild acute pancreatitis, of transient pulmonary injury mainly localized at the level of the capillaries, leading to decreased gas transfer.


Human alveolar macrophage proteolytic enzyme activities in chronic obstructive pulmonary disease. Lack of correlation with functional abnormalities. The occurrence of emphysema in people deficient in alpha1-antitrypsin and the production of emphysema in experimental animals with elastolytic enzymes suggest proteolysis as a mechanism for the development of emphysema. To investigate the possible role of pulmonary alveolar macrophages in the pathogenesis of emphysema, we measured elastase, acid protease, and elastase-like esterase activities in macrophages from patients with chronic obstructive lung disease and attempted to correlate the level of enzyme activity with the severity of pulmonary function abnormality measured in these patients. Compared to values for cigarette smokers with normal pulmonary function, these macrophage enzyme activities were not increased in patients with chronic obstructive lung disease, and there was no correlation of high elastase activity with more severe degrees of pulmonary function abnormality. These findings lead us to believe that the absolute level of proteolytic enzymes in pulmonary alveolar macrophages is not in itself a determinant of emphysema.


The efficacy of rifampin as adjunctive therapy in selected cases of staphylococcal endocarditis. Three patients with bacterial endocarditis (one case due to Staphylococcus aureus and two to S epidermidis) failed to improve on standard therapeutic regimens which were judged adequate by in vitro testing for sensitivity. Rifampin was added to the regimen in each case and resulted in increased bactericidal activity in the serum, sterilization of the cardiac valves, and clinical cure. The apparent clinical success that was achieved suggests that further investigation of the effectiveness of therapy with rifampin in selected cases of staphylococcal endocarditis is warranted.


Delayed peak of the posterior wall. A new echocardiographic index of posterior wall aneurysm. Delayed posterior wall (PW) peak in the detection of PW asynergy was studied by M-mode echocardiography in 53 patients with angiographically proven PW aneurysm, hypokinesis and normal PW. The timing of the PW peak was evaluated by the intervals between (1) the aortic valve closure (Ac) and the PW peak, and (2) the R wave of the electrocardiogram and the PW peak (R-peak). The PW excursion predicted only 39 percent with aneurysm and none with hypokinesis. In contrast, 13 of 18 patients with aneurysm and 4 of 13 patients with hypokinesis demonstrated significantly delayed PW peaks occurring between 0.05 and 0.1 sec following Ac (normal 0 to 0.05 sec). A new index, a ratio of R-peak to ejection time (R-peak/ET) of 1.35 or greater was found to be highly indicative of PW aneurysm in 16 of 18 patients.


Recurrent spontaneous pneumothorax after radiation therapy to the thorax. Two patients who received radiation therapy to the thorax and who developed recurrent spontaneous pneumothoraces are presented. Patients with recurrent pneumothoraces secondary to radiation have not been described previously. Pleural changes secondary to radiation may contribute significantly to the complicated clinical course of these patients.


Ventricular ectopic rhythms due to rapid runaway pacemaker. A patient initially had syncope due to a runaway pacemaker firing at an unusually rapid rate (30 impulses per second). The ventricular arrhythmia was characterized by numerous ectopic beats, with coupling intervals related to the length of the preceding cycle and runs of ventricular tachycardia with slight variations in the intervals between beats. This case demonstrates the clinical characteristics of a very rapidly firing, low-intensity, ventricular parasystolic focus.


Sarcoidosis initially occurring as apical infiltrate and pleural reaction. A 21-year-old black man had pleuritic pain as the initial symptom of his sarcoidosis. Chest roentgenographic examination showed an infiltrate in the left upper lobe and a left pleural thickening. Sarcoidosis was diagnosed by pulmonary biopsy. Thus, sarcoidosis may closely mimic tuberculosis by initially occurring as predominantly apical infiltrates and pleural reaction.


The mitral knock with atrial fibrillation. A possible source of auscultatory confusion. A 29-year-old woman with atrial fibrillation and severe rheumatic mitral regurgitation initially had a very loud third heart sound with high-frequency components (mitral knock), as well as with a first heart sound of widely varying intensity. After long diastoles a faint first heart sound was heard, with distinct separation from the third heart sound of the preceding cycle; however, on short cycles the loud and high-pitched third heart sound combined with a loud first heart sound to simulate the combination of a first heart sound with an ejection click. Phonoechocardiographic studies clarified the identity of the transients.


Existence of Sporothrix schenckii as a pulmonary saprophyte. A 48-year-old male custodian and part-time gardener was hospitalized for treatment of renal tuberculosis. Sputum cultures failed to reveal mycobacteria, but Sporothrix schenckii was isolated over an eight-month period. In the absence of clinical or roentgenographic evidence of active lung disease, we postulate the saprophytic existence of S schenckii in this patient's tracheobronchial tree. Recognition of this state would obviate the need for the commonly accepted therapy for pulmonary sporotrichosis, amphotericin B.


Malformation of bronchopulmonary foregut with systemic and pulmonary arterial blood supply. A case of congenital malformation of the bronchopulmonary foregut with communication between the esophagus and sequestered lobe is reported in a six-month-old boy. Only 29 similar cases have been reported previously, and this case was especially unusual in that the communication was from the middle portion of the esophagus to a right apical sequestration. Another unusual feature was that the sequestered segment was supplied by four systemic arteries from the thoracic aorta, as well as by branches from the right pulmonary artery. Within the sequestration, there was shunting of blood from the systemic to pulmonary arterties with reversal of flow in the pulmonary arterial branches.


Asthma due to dust from redwood (Sequoia sempervirens). An atopic patient with adult onset of asthma due to sawdust from redwood (Sequoia sempervirens) is described. Specific late asthmatic reaction developed after challenge with inhalation of his own redwood sawdust. No subjective or objective immediate reactions were detected. Avoidance of exposure resulted in improvement. There were no pulmonary or systemic responses to challenge with inhalation of sawdust from pine wood.


Cavitary pneumonia associated with tularemia. A wide range of microorganisms has been associated with cavitary pneumonia and pulmonary abscess. We present a case of serologically documented tularemia in an animal-hide handler who demonstrated multiple pulmonary infiltrates with cavitation. Inclusion of tularemia in the differential diagnosis of cavitary pneumonia in patients with exposure to animals is emphasized.


Mitral and aortic valve replacement in valvular rheumatoid heart disease. Specific endocarditis involving the aortic and mitral valves in a patient with peripheral rheumatoid arthritis is reported. The patient underwent prosthetic replacement of both valves. Typical rheumatoid nodules were detected histologically in the valvular tissues.


Dissimilar atrial rhythms diagnosed by echocardiography. A 27-year-old woman with ectopic atrial rhythm and apparent atrioventricular dissociation was found to have A waves on the mitral echocardiogram that bore no relation to the P wave on the surface electrocardiogram. The ECG did not reflect the presence of dissimilar atrial rhythms, and their presence became apparent only during the echocardiographic studies. The mechanism of this phenomenon and its clinical implications are discussed.


Angiographic evidence of myocardial squeezing accompanying tachyarrhythmia as a possible cause of myocardial infarction. The coronary arteriogram of a 52-year-old man with Basedow's disease and who was suffering from myocardial infarction following rapid atrial fibrillation, showed severe myocardial squeezing without organic stenosis. Angiographically, the functional obstructive lesion was always observed both at systole and diastole during atrial pacing, 150 beats per minute, and suggests that myocardial squeezing may be the cause of myocardial infarction following tachyarrhythmia.


Echocardiographic evidence of left ventricular tumor in a neonate. We present the case of a ten-hour-old infant with clinical findings suggestive of hypoplastic left-heart syndrome. A diagnosis of left ventricular tumor was made by echocardiographic examination. This diagnosis was confirmed at autopsy, when a large rhabdomyoma was found in the interventricular septum, obliterating the major portion of the left ventricular cavity. The echocardiographic findings are discussed.


Right ventricular thrombosis.

Right ventricular thrombosis. We report a case of right ventricular obliteration and tricuspid obstruction by organized thrombi. Thrombectomy relieved the tricuspid obstruction, and the sign of right heart failure was alleviated; however, the movement of the right ventricular wall remained poor, and right atrial contraction played the main role in ejecting blood into the pulmonary artery.


Supraventricular tachyarrhythmias in hospitalized adults after surgery. Clinical correlates in patients over 40 years of age after major noncardiac surgery. To assess the clinical correlates and therapeutic outcome of new postoperative supraventricular tachyarrhythmias, 916 patients who were in sinus rhythm throughout the course of surgery were prospectively followed after major noncardiac surgery. The 35 patients (4 percent) who developed new postoperative supraventricular tachyarrhythmias frequently had concurrent medical problems, such as the following: other acute cardiac conditions, 16 patients (46 percent); major infections, 11 patients (31 percent); preexisting hypotension, ten patients (29 percent); anemia, nine patients (26 percent); metabolic derangements, eight patients (23 percent); parenteral therapy with new medications, eight patients (23 percent); and hypoxia, seven patients (20 percent). The arrhythmias of all treated patients reverted to sinus rhythm; 40 percent (14 patients) required no new therapy with cardiac medications, and only two patients required electrical cardioversion. No deaths were related to the supraventricular tachyarrhythmias, but 49 percent (17) of the patients died from their concurrent medical problems. The onset of a new postoperative supraventricular tachyarrhythmia should prompt a search for remediable medical problems. Direct antiarrhythmic therapy is often unnecessary and is usually secondary in importance to correction of the causes of the arrhythmia.


Clinical toxocity of theophylline in relation to cigarette smoking. A report from the Boston Collaborative Drug Surveillance Program. Adverse reactions to derivatives of theophylline were studied among 2,766 medical inpatients. The primary diagnosis at discharge was cardiac disease in 23 percent, chronic obstructive pulmonary disease in 22 percent, asthma in 13 percent, pulmonary infection in 10 percent, and other disorders in 3 percent of the patients. Eight hundred seven of the patients were current cigarette smokers, and 1,209 denied smoking. Adverse effects of administration of theophylline were reported in 298 patients (10.8 percent). Gastrointestinal disturbances, reported in 7.8 percent of the recipients, were the most common adverse effects. Others were cardiovascular disturbances (1.2 percent), effects on the central nervous system (0.9 percent), and miscellaneous adverse reactions (0.9 percent). A higher frequency of adverse reactions was associated with higher doses of theophylline; however, cigarette smoking was negatively correlated with the frequency of adverse reactions. Adverse effects were experienced by 13 percent of the nonsmokers, by 11 percent of those who smoked up to 20 cigarettes daily, and by 7 percent of those who smoked more heavily. This association was most apparent among young patients with normal renal function and was least evident among the elderly.


Pulmonary embolism in respiratory failure. The occurrence of pulmonary emboli in 617 patients admitted to a respiratory intensive care unit was studied. Pulmonary emboli were found in 18 (27 percent) of 66 autopsies. Half of these pulmonary emboli were not diagnosed before death, despite persistent aggressive attempts to document pulmonary emboli. In this subpopulation of patients with respiratory failure, the usual clinical manifestations of pulmonary emboli (symptoms, signs, chest x-ray film, electrocardiogram, and changes in arterial blood gas levels) frequently are already present, due to the severe underlying pulmonary disease, and any superimposed manifestations of pulmonary emboli are often inapparent. In this group under study, the ventilation/perfusion lung scan correlated poorly with pulmonary angiographic results and with examinations at autopsy; the scan generally was inadequate to rule in or rule out pulmonary emboli. Again, this was due to the distortion of both ventilation and perfusion by the severe underlying pulmonary disease. Currently, pulmonary angiographic studies remain the only reliable technique to confirm or exclude pulmonary emboli in patients with respiratory failure.


Disproportionate ventricular thickening in patients with systemic hypertension. To determine the prevalence and characteristics of disproportionate ventricular septal thickening (septal-free wall ratio of greater than or equal to 1.3) in a population of patients with severe chronic hypertension, which was unassociated with coronary arterial disease, 33 patients were studied at necropsy. The overall prevalence of disproportionate septal thickening was relatively low, ie, two (6 percent) of the 33 patients. The septal-free wall ratio in both of these patients was 1.3. Disproportionate septal thickening appeared to be secondary to the left ventricular pressure overload, rather than to coexistent genetically transmitted hypertrophic cardiomyopathy. This conclusion was based on the following facts: (1) numerous disorganized cardiac muscle cells, characteristic of hypertrophic cardiomyopathy, were not present in the ventricular septum of either patient with disproportionate septal thickening; and (2) echocardiographic studies performed in first-degree relatives of one of the two patients did not disclose disproportionate septal thickening. Hence, disproportionate septal thickening may occur as a secondary manifestation of left ventricular pressure overload that is present in patients with systemic hypertension, but this association appears to be relatively uncommon.


Effect of therapy with methylprednisolone on the size of myocardial infarcts in man. The use of steroids to decrease the size of the infarct and the mortality in patients with acute myocardial infarction has long been the subject of controversy. In the present study, two large doses of methylprednisolone were administered intravenously to 14 patients with relatively uncomplicated myocardial infarction within 17 hours after the onset of symptoms, whereas a comparable group of 15 patients with myocardial infarction served as controls. The size of the infarct was assessed utilizing serial measurements of serum levels of creatine phosphokinase and its myocardial isoenzyme, the MB form of creatine phosphokinase. There was no significant difference between the two groups of patients with regard to peak cumulative levels of total creatine phosphokinase and the MB form of creatine phosphokinase. Similarly, there was no difference between the two groups in mortality or in the incidence of malignant ventricular arrhythmias, atrioventricular block, congestive heart failure, or extensions of the infarct. We conclude that high intravenous doses of steroids given early in the course of myocardial infarction have neither deleterious nor beneficial effects.


Mediastinitis from odontogenic and deep cervical infection. Anatomic pathways of propagation. Potentially lethal consequences can quickly occur once the mediastinum is subjected to the ravages of an anaerobic infection. Mediastinitis from odontogenic or deep cervical infections is extremely rare in the era of antibiotic drugs. We have recently encountered five such cases, with a rapid spread of the inflammatory process into the mediastinum resulting in a number of local and systemic complications. All were caused by anaerobic bacteria. Awareness of such complications and early roentgenographic diagnosis lead to prompt surgical drainage, proper antibiotic therapy, and survival after a stormy clinical course. The anatomic pathways between the various fascial planes of the neck and mediastinum will be described.


Alveolar-capillary oxygen disequilibrium in hepatic cirrhosis. Hypoxemia is a frequent occurrence in patients with severe hepatic disease. Multiple mechanisms have been implicated in the production of such hypoxemia. The case of a 35-year-old man with cyanosis, clubbing, and cirrhosis is presented. Physiologic data from this patient revealed normal pulmonary function, except for a low diffusing capacity and a 28 percent shunt while the patient was breathing 100 percent oxygen. A perfusion scan with radioactive 99mtechnetium-labelled macroaggregated albumin revealed 67 percent of the labelled macroaggregated albumin in the systemic circulation. Post-mortem examination demonstrated normal pulmonary parenchyma, markedly dilated intraparenchymal capillaries and arterioles, subpleural angiomata, and cirrhosis. No anatomic arteriovenous connections were demonstrated before or after death. We conclude that the arterial hypoxemia of some patients with hepatic cirrhosis results from dilated gas-exchanging blood vessels. These widened vessels prevent end pulmonary capillary oxygen tension from reaching equilibrium with alveolar gas, perhaps because of the widened distance for diffusion.


Echinococcosis complicated by purulent pericarditis. Three patients are described in whom purulent pericarditis arose as a complication of hydatid disease. In one patient a myocardial cyst ruptured into the pericardial cavity and subsequently became superinfected, probably from a coexisting bronchopneumonia. This patient also had widespread intravascular dissemination of germinal membrane. Two patients had echinococcal cysts of the liver, which became infected following surgery. This led to formation of a fistula between the hepatic hydatid and the pericardium, resulting in purulent pericarditis. The cases illustrate the protean nature of echinococcosis, especially the cardiac form, and emphasize the difficulty of recognizing purulent pericarditis as a complication of other conditions.


Differential response in the male and female tracheal epithelium following exposure to tobacco smoke. Histochemical quantification of goblet cells and measurements of the epithelial thickness were made in the trachea of male and female rats exposed to fresh whole tobacco smoke for 30 consecutive days. Exposure to tobacco smoke resulted in an increase in the total goblet cell count in both sexes, with the female rats differentially responding to a greater degree than the male rats. There was a shift from PAS-positive to alcian blue-positive goblet cells, an increase in the number of both "large" and "small" goblet cells, and an increase in the epithelial thickness. PAS-positive "small" cells, the major glycoprotein-reactive cell in the rat tracheal epithelium, increased in the female rats but showed no increase in the male rats. On the other hand, male rats contained a substantially higher proportion of alcian blue-positive cells than did female rats, both before and after exposure to the smoke. The significance of these observations in relation to the prevalence of chronic bronchitis in human smokers is discussed.


Coexistent Wenckebach phenomenon in the distal branches of the specialized conduction system. A patient in whom Wenckebach phenomenon was observed to coexist in the three distal branches of the specialized ventricular conduction system, with an intermittent trifascicular block producing a second degree A-V block, is described. Surface electrocardiogram demonstrated the presence of this phenomenon in the right bundle branch (RBB) and the anterior division of the left bundle branch (LBB). Evidence of the presence of Wenckebach phenomenon in the remaining fascicle was provided by His bundle recording.


Survival of a patient with pancytopenia and disseminated coagulation associated with miliary tuberculosis. A 56-year-old man with histologically and bacteriologically proved disseminated tuberculosis in association with pancytopenia responded to antituberculosis chemotherapy with bacteriologic cure of his tuberculosis and concomitant resolution of the pancytopenia. This association has been generally believed to have a nearly 100 percent mortality. In addition, the patient developed laboratory evidence of disseminated intravascular coagulation (DIC). The single and simultaneous occurrence of these two hematologic abnormalities is extremely rare. A number of factors possibly relating to the development of pancytopenia and DIC in conjunction with miliary tuberculosis are briefly discussed.


Bronchogenic cyst mimicking a pulmonary varix. A 14-year-old boy initially had severe hemoptysis and a coin lesion in the left lower lobe on the chest x-ray film. Pulmonary arteriographic studies suggested the presence of a pulmonary varix. Pathologic examination of the specimen obtained at surgery revealed a bronchogenic cyst. Pulmonary varices are extremely rare. Bronchogenic cysts must be included in the differential diagnosis of these lesions.


Successful medical therapy for endocarditis due to Candida parapsilosis. A clinical and epidemiologic study. A heroin addict with asymmetric septal hypertrophy and persistent fungemia with Candida parapsilosis was treated with amphotericin B and flucytosine (5-fluorocytosine). The diagnosis of endocarditis was based on the subsequent development of a murmur of mitral regurgitation and echocardiographic evidence of prolapse of the posterior leaflet of the mitral valve. Cure was effected with antifungal therapy alone. Thus, when the diagnosis of fungal endocarditis is made early in its course, open-heart surgery may not be needed. To investigate the relative frequency of isolation of C parapsilosis from particular sites, a mycologic survey was conducted in our hospital. Among the isolates of yeasts, C parapsilosis represented 8.0, 17.1, and 26.7 percent of those from all cultured sites, from contaminated intravenous catheters, and from cultures of blood, respectively. Since this trend to cluster in cases of fungemia was not seen with other yeasts, C parapsilosis appears to be more invasive than other species of Candida.


Violent families: coping responses of abused wives. A theoretical schema analyzing and categorizing responses of abused wives is useful to the social worker in understanding the problems and helping to effect change in the situation.


Foster home care for mentally retarded children: can it work? The 2-year experience of a foster home program for retarded children illuminates the problems of administration, staff and foster parents in preparing retardates to return to community life. The report on the experiment is hopeful.


Techniques for recruiting foster homes for mentally retarded children. A survey indicates that a mass media campaign increases awareness of a foster care program for mentally retarded children, but personal contact, especially with a current or former foster parent, is a decisive factor in the decision to apply.


Children's services and Title XX from a national perspective. The Social Security Act's Title XX, which became law in 1975, has brought many changes in social services. This article examines problems, confusions and opportunities that accompany the new regulations.


A model for training foster parents in behavior modificiation techniques. A training program for foster parents applying the techniques of behavior modification produced measurable gains in parenting and in the management of the children.


External drainage for ventricular infection following cerebrospinal fluid shunts. 57 children with shunt-related ventricular infection were treated with external ventricular drainage and a combination of systemic and intraventricular antibiotics. For persistent infection or inadequate drainage volume the external ventricular drain was promptly changed. Cerebrospinal fluid cultures of 54 (95%) of the children became sterile within an average of 5.1 days. As soon as three consecutive 48-hour cultures of the cerebrospinal fluid were negative, the external ventricular drainage was removed and a new ventriculoperitoneal shunt was inserted. Provided that three consecutive 48-hour cultures of the cerebrospinal fluid were negative at the time of reinstitution of ventriculoperitoneal shunting, low cerebrospinal fluid glucose readings were not associated with any greater risk of recurrent infection than following primary ventriculoperitoneal shunting.


Pyocephalus of the newborn child.

Pyocephalus of the newborn child. 3 cases of pyocephalus (ventricular empyema) in newborn children are described and 16 cases from the literature are analyzed. Half of the previously published cases of pyocephalus are secondary to cerebral abscesses. Neuroradiological findings and especially the necroscopic study of a case demonstrated the existence of membranous blockages inside the ventricles which may make the circulation of CSF impossible. Our treatment of choice consists of repeated punctures and evacuations of purulent content and topic as well as parenteral administration of antibiotics. Further CSF derivative measures are almost always necessary. By these means, we believe the high mortality of these cases could be lowered.


Computerized axial tomography in the preoperative evaluation of posterior fossa tumors in children. 22 cases of pediatric posterior fossa tumors that underwent preoperative evaluation by computerized tomography are presented. 8 of the cases, in the latter part of the series, were successfully operated upon on the basis of computerized tomography alone. In 14 other cases, additional angiographic investigation was carried out. In only 1 case of multiple hemangioblastoma did angiography provide further significant information. On the basis of this experience, it is suggested that computerized tomography is usually sufficient and further contrast studies are unnecessary in the preoperative evaluation of pediatric posterior fossa tumors.


Long-standing myelomeningocele associated with spinal subarachnoid hemorrhage. Case report. The fate of a giant sacral myelomeningocele in a boy aged 7 years is reported. A striking feature of this case is its unusual conjunction to subarachnoid hemorrhage from vascular hamartoma of its wall. The pathophysiological and clinical implications of this observation are reviewed.


In situ hybridization of nuclear and cytoplasmic RNA to locus 2-48BC in Drosophila hydei. The maximum grain density over the "heat-shock" locus 2-48BC of Drosophila hydei polytene chromosomes obtained after in situ hybridization of nuclear RNA extracted from tissue culture cells labelled during incubation at 37 degrees C is five times higher than that obtainable by using polysomal RNA isolated from the same cells. Furthermore, the addition of a large excess of unlabelled polysomal RNA reduced the amount of in situ hybridization of nuclear RNA by only 20% showing that nuclear 2-48BC RNA contains sequences not present in polysomal 2-48BC RNA.--The polysomal 2-48BC RNA is polyadenylated, as are the RNA sequences present in the polysomes complementary to the other two major "heat shock" loci 2-32A and 2-36A. Polyadenylated RNA, with an apparent size of 15S, complementary to locus 2-48BC is also found in the cytoplasm of D. hydei salivary glands.


Chromosome location of the ribosomal genes in Triturus vulgaris meridionalis (Amphibia Urodela). III. Inheritance of the chromosomal sites for 18S + 28S ribosomal RNA. In Triturus vulgaris meridionalis, the 18S + 28S rDNA sequences have been shown to be located in a number of additional chromosomal sites besides the nucleolus organizing region. The additional ribosomal sites have been found to vary as to their number and chromosomal location in different individuals of the species.--The data presented in this study concern the chromosomal distribution of the ribosomal sequences as analyzed by in situ hybridization technique in two individuals as well as in their offspring. The evidence obtained by this analysis indicates quite clearly that all 18S + 28S rRNA sites present in each individual genome are inherited according to simple mendelian principles.


Human spinal fluid methadone levels.

Human spinal fluid methadone levels. Cerebral spinal fluid (CSF) levels of methadone were measured in nine methadone maintenance patients requiring lumbar punctures for medical or surgical treatment. Concurrent serum methadone levels were also determined. The CSF concentration of methadone in all cases was a fraction of the corresponding serum level--ranging from 2 to 73%. The CSF concentrations of methadone ranged from 0.010 to 0.097 ng%. Peak methadone levels in CSF appeared approximately 3 - 8 hours after methadone administration.


The iceberg of opium addiction. An epidemiological survey of opium addiction in a rural community. As part of a medico-social survey in a rural population in the northern part of Iran, data concerning opium users was collected from randomly chosen households. The addiction rate was found to be 69/1000. The rate of registered addicts in the same population is 11/1000. The population in terms of registered addicts seems to be very small, but this is only the tip of the iceberg and does not reflect the true picture within the society. In view of the traditional use of opium in the country, the problem of addiction may become serious unless adequate and effective measures are taken.


Acceptability of methadyl acetate (LAAM) as compared with methadone in a treatment program for heroin addicts. Heroin addicts who had been maintained for at least three months on LAAM (levo-alpha-acetylmethadol, methadyl acetate) and at least three months on methadone were asked to compare the two drugs on a number of criteria. The responses were highly selective, indicating that a desire to please the investigators was not an important factor. Overwhelmingly, the majority of patients reported that LAAM provided better heroin "blockade", that it was more effective in reducing craving, and that actual use of heroin was less on LAAM than on methadone. In other respects, such as sexual performance, sleep, and appetite, most patients perceived no difference between the drugs. In no respect was methadone preferred by a majority, although methadone was viewed more favorably on some criteria by some patients. These findings indicate that for most heroin addicts LAAM will be an acceptable maintenance drug.


Pupillography response to methadone challenge: aid to diagnosis of opioid dependence. Diagnostic pupillography, under blind conditions, produced constrictions greater than 0.75 mm in 25 opiod addicts and no change or dilation in 82 others. Placebo use produced no constrictions in 99 subjects. Methadone test dose pupillography provides significant information useful in diagnosing opioid dependence and is more acceptable to addicts than naloxone testing.


Ethnic variation in use and effects of alcohol. Americans living in Hawaii were questioned about their use of alcoholic beverages. Although alcohol use was widespread in all ethnic groups included in the study, comparisons among groups showed that (a) a larger proportion of Orientals than Caucasians reported no use of alcohol, (b) Caucasians reported heavier use, and (c) a larger proportion of Oriental users reported facial flushing as a sequel to alcohol consumption. Persons with one Oriental and one Caucasian parent were intermediate with respect to (a) and (b), but were more similar to Orientals on (c). Other symptomology reported appeared to be associated with amount imbibed, not with ethnicity per se. Compared to current users, former users reported a larger number of problems and symptoms associated with alcohol use.


Veterans Administration hospital staff attitudes toward alcoholism. Attitudes toward alcoholism among psychiatrists, psychologists, social workers, registered nurses, licensed practical nurses, and nursing assistants (464 subjects) were surveyed. A nine-factor questionnaire was utilized (emotional difficulties, character defect, social status, illness conception, harmless indulgence and addiction liability). All groups were homogeneous in their perceptions about emotional difficulties contributing to alcoholism, alcoholics not coming from the lower socioeconomic strata of society, and the belief that alcoholics did recover and could be helped by treatment. Age, sex, and special training in the treatment of alcoholism did not have any significant influence on attitudes. All groups believed that periodic excessive drinkers could be alcoholics. None of the groups believed that the alcoholic had a character defect. Psychologists disbelieved the concepts of illness and addiction liability. All groups disagreed with harmless indulgence. Nursing assistants tended to see the alcoholic as a harmless heavy drinker. Working on a special alcoholism treatment unit did not alter the perceptions of psychiatrists, psychologists and nursing assistants. Social workers and registered nurses showed only a minor trend toward a positive attitude change, while the trend went in the opposite direction for licensed practical nurses.


An addiction treatment program in Laos: the first year's experience. In late 1972 a treatment program for narcotic addicts was begun in Vientiane, Laos. Medical and social treatment modalities were emphasized: withdrawal from narcotic drugs, care for chronic health problems, a highly structured milieu program with explicit rules, and careful discharge planning with family counseling. Patients were accepted on a voluntary basis only. The first year's patient population were mostly married, employed, addicted to opium, and from rural areas. They comprised a diversity of ethnic groups. A smaller group of young, single, male heroin addicts (a type of addict new to Laos) also appeared in this group of patients. This treatment program proved highly acceptable to a large number of addicted people from various age groups and ethnic backgrounds. It was successfully undertaken by medical personnel who had minimal or no experience in the addiction field prior to work at this facility. Among opium addicts, twice-a-day methadone dosage for withdrawal treatment was superior to once-a-day dosage. Opium addicts required a longer detoxification regimen than did heroin addicts.


[Bone scan in the diagnosis of renal osteopathy (author's transl)]. Biochemical tests (serum calcium, inorganic phosphate and alkaline phosphatase), as well as clinical, radiological, scanning and histological investigations were undertaken in 24 patients in chronic renal failure. The frequency with which the diagnosis of renal osteopathy could be made depended in the method of investigation, the biochemical findings proving to be completely unreliable. There were positive radiological signs in ten patients and clinical signs in 12, predominantly in the progressive stages of osteopathy. A positive scan was obtained in 23 patients, typical histological bone changes in an equal number. Since it correlates so well with the histological findings, bone scan is suitable particularly in the early diagnosis of osteopathy. Since this test is easily performed and hardly stresses the patient, it should routinely be the initial one for the diagnosis of renal osteopathy.


[Long-term treatment of cerebrovascular changes in the elderly (author's transl)]. A prospective study over 15 months in 100 elderly patients with signs of cerebro-vascular impairment demonstrated by psychometric testing that Hydergine (an ergot alkaloid preparation: 4.5 mg daily) compensated the signs of dementia, present in the placebo group, and in some patients actually brought about a significant improvement in mental activity. Similar compensatory effect was also demonstrable in cerebral haemodynamics: in the placebo group there was a progressive increase in cerebral circulation time, an expression of decreased cerebral blood flow, while with Hydergine cerebral circulation time was shortened and stabilized. Serial EEGs, obtained in parallel with psychometric and circulation time tests, demonstrated a marked increase in the 8-10 Hz pattern which corresponds to the physiological alpha activity in this age group. Furthermore, there was a diminished variability in performance in the tested frequency bands with Hydergine, the opposite tendency being obtained in the placebo group.


[The importance of ureaplasma urealyticum in non-specific prostato-urethritis (author's transl)]. 312 patients with non-specific prostato-urethritis were investigated with a standardised procedure using the four glass test. In 42.3% of patients mycoplasma was isolated which in almost all cases was Ureaplasma urealyticum. Clinically patients were symptom-free after eradication of mycoplasma in cases where previously urea-plasma counts of more than 10,000 CFU/ml prostatic secretion and of more than 1000 CFU/ml urine had been demonstrated. In cases where there were smaller counts of Ureaplasma urealyticum and where Mycoplasma hominis had been demonstrated tetracycline therapy did not lead to cure in any case.


[Oral psoriasis treatment with a new aromatic retinoid (Ro 10-9359): a multi-centre controlled study of 291 patients (preliminary results) (author's transl)]. In a multi-centre study 291 patients with psoriasis were treated with (a) oral doses of the recently developed retinoid Ro 10-9359, (b) classical local dithranol application, and (c) both. In a preliminary evaluation of 203 patients treated orally excellent or good results were obtained in 120 (61%), no response in 31 (15.8%). The initial dose was 1.0 mg/kg body-weight daily, i.e. 50-75 mg, which was then reduced to 25-50 mg daily. A clinical response was noted after 2-3 weeks. Particularly, severe erythrodermic and pustular forms of the disease responded surprisingly well to the drug so that cytostatic agents were avoided. Under long-term administration, however, relapses were still seen. Most side-effects were reasonably well tolerated. But in 14% of patients the drug had to be discontinued because of hair loss, paronychia or slight elevation of transaminases (up to 40 U/I). This new drug is thus a potent antipsoriatic agent: it is effective, easily controlled and causes only moderate side-effects.


[Are clotting disorders a pathogenetic factor in nephrosclerosis and hypertension? (author's transl)]. The clinical course of the haemolytic-uraemic syndrome in four patients suggests that hypertension may result from it. The morphological changes in the kidney are those of primary malignant nephrosclerosis. Hypercoagulability is thought to be an important pathogenetic factor in the development of the disease. But irreversible renal failure is not, contrary to typical primary malignant nephrosclerosis, an inevitable sequel. Abortive forms with predominant involvement of glomerular vessels have a more favourable prognosis than those forms with additional preglomerular vascular changes, in which a more or less marked impairment of renal function and hypertension persists. These forms are of particular interest because they indicate a renal pathogenetic mechanism of chronic hypertension. The described observations--taken together with those on the pathogenesis of hypertension caused by oral contraceptives--provide a pointer to the importance of clotting disorders in the initiation and development of some forms of hypertension.


[Endoscopic transpapillary splitting of a choledochocele (author's transl)]. A choledochocele with obstruction to outflow from the biliary and pancreatic duct systems was diagnosed by endoscopic retrograde cholangio-pancreatography in a 67-year-old man with radiating upper-abdominal pain and constantly elevated gamma-glutamyl transferase. After distension of the choledochocele with contrast medium a papillotome was introduced across the papilla and the choledochocele was split open. There were no complications and flow from both systems became normal. The symptoms disappeared and the patient required neither anaesthesia nor an abdominal operation.


[Basilar or vertebral artery aneurysm as a cause of presumed cervical spine injury (author's transl)]. The characteristic clinical features and morphological findings of five cases of (clinically not diagnosed) fusiform aneurysm of the basilar or vertebral arteries were recurring attacks of positional occipital headache, pain and stiffness in the neck, cranial nerve disturbances, expecially oculomotor palsies and anisokoria, nystagmus, attacks of nausea, vomiting and sweating, tachycardia, pyramidal tract symptoms, and pareses. Severe hypertension had been present in four instances. The aneurysm, which is usually thrombosed, pressed against the pons and medulla oblongata as a space-occupying mass. In addition to hypertension and atheromatosis, congenital defect in the arterial wall are probably significant causative factor. To mistake an aneurysm for a cervical syndrome may be fatal to the patient.


[Early diagnosis of cancer of the prostate by rectal palpation (author's transl)]. Transrectal biopsy was performed on 173 unselected patients, aged 45-85 years, with disease of the prostate, who had previously had a screening examination. The findings on palpation by the referring doctor and the authors' own assessment were compared with the histological findings. Of 37 histologically confirmed cases of carcinoma of the prostate 16 (44%) had been correctly diagnosed by the referring doctor and 28 (76%) after examination at hospital. On the other hand, of 136 histologically negative cases the referring doctor's diagnosis had been correct in 112 (81%) instances and at hospital 94 (69%).


[Microrheological studies in healthy subjects. Effect of cigarette smoke and oral contraceptives on erythrocyte flexibility]. Erythrocyte flexibility was tested in 29 healthy subjects, using whole-blood filtration through membrane filters with 5 micron pores, special attention being given to cigarette smoking and oral contraceptives as risk factors. Red cell flexibility was significantly reduced in male smokers compared with non-smokers (P is less than 0.0001), and in all male and female smokers (P is less than 0.05) An influence of oral contraceptives to erythrocyte flexibility could not be found. Reduced erythrocyte flexibility in smokers as a factor contributing to an abnormal microcirculation and to the development of arterial occlusive disease is discussed.


[Early detection of abdominal tumours in preventive medicine in childhood (author's transl)]. Out of 51 abdominal tumours diagnosed in the age group subject to preventive screening eight tumours were detected during preventive investigations. Children up to one year were mainly involved. The additional investigation at 6-7 months and careful palpation of the abdomen and further investigations following questionable results lead to the assumption that the rate of early diagnosis of abdominal tumours at preventive investigations in childhood may still be improved. The importance of early diagnosis suggests that the disease group should be included in the code catalogue of diseases which should be actively sought in preventive medicine.


[Hypertension and multiple renal arteries. Comparative studies on the frequency of multiple renal arteries in hypertensive patients and normotensives]. The frequency of multiple renal arteries in 394 aortographies was found to be 29.2%. The results were then grouped according to the indication for the investigation and according to the recorded blood pressure readings into a hypertensive and a normotensive group. Comparison of these two groups showed no significant difference in the frequency of multiple renal arteries. There were also no significant differences comparing double and multiple arterial supply of one kidney or one-sided or double occurrence of multiple renal arteries.


[Heart trauma caused by central venous catheter (author's transl)]. Four cases of extensive traumatic lesions of the right atrium induced by central venous catheter, are reported. In one case there was beginning in the other complete perforation of the right atrium. Such lesions can be caused by horizontal fixation of the intracardiac portion of a catheter due to wall-adherent thrombi; catheters held near the coronary sinus by a so-called Chiari net; or by coiling of the catheter within the atrium. Central venous catheters often cause endothelial lesions and thrombotic changes in the veins near the heart. Possible trauma to the right atrium, which could provoke fatal complications (e. g. haemopericardium or arrhythmias) must, therefore, be given special attention.


[Dopamine action on the basal pancreatic secretion in man (author's transl)]. In contrast to observations in dogs dopamine infusions (4 microgram kg-1min-1) in 5 healthy volunteers did not influence the basal bicarbonate and enzyme secretion of the pancreas. Thus dopamine may be infused for circulatory shock in acute pancreatitis without reservations.


The effective placement of Miller-Abbott-tubes under endoscopic guidance. Technical improvements. In an earlier publication, the intestinal placement of Miller-Abbott-tubes using routine gastroscopic equipment was proposed for the conservative treatment of intestinal obstruction. In addition to the technical advices presented at this early stage of personal experience, we now recommend to 1. insert the tube primarily through the nostrils, 2. extract the tip through the mouth, 3. grasp the leading ligature of the tube tip extracorporally by means of the biopsy instrument and 4. guide the tube tip to the target area by orogastric approach. This technical improvement excludes difficulties in respect to patient cooperation or other special disadvantages and made 26 intestinal intubations in an uninterrupted series an easy and worthwhile procedure.


Santorini's Duct--an insignificant variant from normal or an important overflow valve? In a retrospective examination 250 consecutive pancreatograms obtained by ERCP were controlled on the existence of a D. Snatorini. Starting from the genetic development of the pancreatic ducts the question is investigated whether a second open pancreatic duct is responsible for a better drainage of the pancreas. Thus this duct may prevent hyperamylasemia and hyperlipasemia following ERCP. From an etiological point of view the elevation of these pancreatic enzymes is insufficiently understandable. If a D. Santorini is detectable the results demonstrate a reduction of the increased pancreatic enzymes in a statistically significant manner. A valve mechanism of the D. pancreaticus minor with volume or pressure reduction is postulated.


Renal excretion of contrast medium after endoscopic retrograde investigations. Endoscopic retrograde investigations are often performed as diagnostic procedures. The investigation of urine after such procedures in 21 patients has shown that appreciable amounts of contrast medium can be excreted renally. No such excretion could be shown when the contrast medium was injected into the gut lumen. The fact that contrast medium can be absorbed into the liver the pancreas during endoscopic retrograde procedures should influence the decision to perform these studies in patients with known allergies.


Follow-up endoscopic study of gastric mucosal changes secondary to gastric ulcer. A long-term follow-up gastrocamera photographic study of 481 patients with gastric ulcer was conducted at intervals of 3 weeks to 6 months. It showed that gastric ulcers could remain healed for 2 months to 6 years of observation, yet, recurrence of ulceration occurred in 79% including 18% with multiple occurences. Gastric polyp developed in 8 patients whose initial gastrophotography showed no such lesion in the original study. Furthermore, 7 cancers of the stomach developed at sites away from the initial benign ulcer foci. Six of these cases proved to be mucosal cancer and one was an advanced cancer. In 5 of 7 cases of malignancy, the cancer occurred distal to the initial ulcer foci and anaplastic adenocarcinoma was seen in 3 of these. The others were well differentiated adenocarcinomas. No correlation was found among histopathological type of cancer, depth of malignant invasion, location of the new growth or gastric juice acidity in these 7 cases of malignancy. It is concluded that a thorough and routine gastroscopic examination is indicated for all sorts of gastric disorders whether they are initial or follow-up cases.


Functional lymphangiectasia of the duodenal mucosa. Tiny millet-like prominent villi with dilated lymphatics may be part of a food-induced functional lymphangiectasia. Peroral olive oil load causes diffuse transient lymphangiectasia, the gross aspect, histological findings and electron-microscopy of which is described in detail.


A preliminary report about transcervical embryoscopy. Transabdominal amniocentesis and occasionally fetoscopy are used as a means of early diagnosis of fetal damage or abnormality after the 14th week of pregnancy. For medical reasons a still earlier method of diagnosis is desirable. We report about the transcervical approach- using CO2-gas-hysteroscopy to visualize the amnion sac and its contents.


A case of amyloid tumor of the stomach.

A case of amyloid tumor of the stomach. A 68-year-old female was admitted to hospital with a 5 month history of epigastric distress. Radiological and gastrofiberscopic examinations revealed a tumor of the stomach which was strongly suggestive of gastric carcinoma. Microscopic examination of the removed stomach, however, revealed no tumors in the stomach, but instead, there a localized amyloidosis was found in the antrum, the patient died of hepatic failure 10 months after the operation. Autopsy demonstrated no evidence of systemic deposit of amyloid substance. The amyloid tumor of the stomach is rare, and the present case is believed to be the fifth of the reported cases of this lesion and, at the same time, the first case in which the solitary nature of amyloidosis was verified at autopsy.


Endoscopic assessment in abetalipoproteinemia (Bassen-Kornzweig-syndrome). Duodenal mucosal changes in a 26-year-old patient with Bassen-Kornzweig-syndrome are presented.


Malignant transformation of hyperplasiogenic polyps of the stomach--case report. Case report of a 71 years old female with multiple hyperplasiogenic gastric polyps with malignant transformation of two polyps. So far, the hyperplasiogenic polyp was considered to be only an "indicator lesion" because the incidence of gastric cancer (apart from the polyps themselves) was found to be increased in these patients. This opinion has to be revised in view of the present case. The consequences for diagnosis, treatment and nosologic classification of hyperplasiogenic gastric polyps are discussed.


Contagious equine metritis.

Contagious equine metritis. An outbreak of contagious equine metritis that occurred on stud farms in the Newmarket area during 1977 is described. A Gram-negative coccobacillus was isolated from field cases and the disease was reproduced experimentally by inoculating a pure culture of the organism through the cervix of clean pony mares. Natural spread of the disease occurred by venereal transmission and following the handling, examination or teasing of infected mares. Bacteriological screening of the genital tract of mares and stallions before covering plus stricter standards of hygiene on the stud farms have been recommended as the methods to control the disease. A great deal more information about the disease is required before it can be confidently stated that it can be adequately controlled.


The development of a radio-stethoscope for use in the horse at rest and during exercise. The development of a radio-stethoscope for horses is described. The equipment consisted of a sound transducer applied to the skin adjacent to the trachea and a radio transmitter attached to the saddle. The signals emitted were detected by telemetry and recorded on a magnetic tape-recorder. The recorder incorporated a monitor earphone so that sounds could be reproduced at the time of recording. The frequency response obtainable ranged from a few Hz to 4 KHz. This technique provided an objective means of studying the respiratory sounds generated during exercise although absolute values could not be measured.


Recovery from anaesthesia in ponies: a comparative study of the effects of isoflurane, enflurane, methoxyflurane and halothane. The duration and quality of recovery after separate 2 hour anaesthetic periods with equipotent alveolar concentrations of isoflurane, enflurane, halothane and methoxyflurane were evaluated in experimental ponies. Recovery was shortest after isoflurane anaesthesia, followed by enflurane, halothane and finally methoxyflurane, although standing was achieved more rapidly after enflurane than after isoflurane. This sequence of recovery times was compatible with the respective solubilities of the 4 agents. The smoothest recovery was obtained after isoflurane anaesthesia, followed by methoxyflurane, halothane and then enflurane. The isoflurane recovery was characterized by very quiet and prolonged sternal recumbency with excellent coordination upon standing. The chief difficulties with halothane recovery were shivering and delayed coordination upon standing. Enflurane anaesthesia was followed by a very brief period of sternal recumbency but there was considerable shivering and incoordination upon standing. This may have been due to central nervous stimulation during anaesthesia producing a residual excitatory effect. On the basis of this investigation, isoflurane was considered to be the most satisfactory volatile anaesthetic for the horse.


Prevalence of latent cases of Babesia equi infection in some parts of North West India as measured by the capillary agglutination test. The prevalence of Babesia equi infection in north west India was assessed by means of the capillary tube agglutination (CA) test. The particulate antigen used in the test was potent and no cross reaction with other related haemaprotozoa was observed. The serological survey showed that from 323 horses from 3 localities there was an overall incidence of 50.1 per cent. In Haryana the incidence was 38.3 per cent in the 196 horses tested, in Uttar Pradesh it was 47.2 per cent from 72 animals and in Rajasthan it was 96.4 per cent from 55 horses.


On the watering of horses: a review.

On the watering of horses: a review. The literature published over the last 150 years provides confusing and often conflicting advice on the ideal way to water horses. Many of the problems associated with watering appear to be caused by either mismanagement or ignorance. An obvious way to prevent trouble is to provide adequate water at all times when a horse is at rest and to allow sufficient opportunity to drink while working.


Chlamydia psittaci infection of horses with respiratory disease. Two strains of Chlamydia psittaci were isolated from the nasal tract of horses with acute respiratory disease. These 2 isolates (NS 121 and NS 172) were characterized as chlamydia on the basis of their morphology, tinctorial property, growth in chicken embryos, inability to grow on bacterial media and their possession of chlamydial common complement fixing group antigen. They were identified as C. psittaci on the basis of resistance to sodium sulphadiazine. The present strains were not pathogenic to mice and guinea pigs and non-toxigenic. They induced antibodies and caused latent infection in mice and guinea pigs. Acute and convalescent sera were avaliable from one of the horses and rising levels of specific antibody were demonstrated. No chlamydia were isolated from the materials of 14 aborted foals, 4 synovial fluids from horses with acute polyarthritis and nasal, tracheal and lung material from another 276 horses.


Studies on the faecal egg output of horses after treatment with fenbendazole. Examination of faecal egg counts in horses and ponies has shown that after treatment with fenbendazole at dose levels of 7.5, 45 and 60 mg/kg, faeces remained free from strongyle eggs for periods of 6 to 18 weeks. The significance of these results is discussed in relation to routine anthelmintic treatment of horses. In particular, the activity of fenbendazole against mucosal stages of strongyle parasites allows for treatment to be recommended at less frequent intervals than when using other anthelmintics.


The influence of neuroleptanalgesia on the serum activity of muscle enzymes in ponies. The serum activities of creatine kinase (CPK), aldolase (ALD) and alpha-hydroxybutyrate dehydrogenase (HBD) were determined in a group of Welsh Mountain ponies before and after a 30 minute period of neuroleptanalgesia induced by i.v. injection of Immobilon and terminated by i.v. injection of Revivon. There were slight but significant increases in the serum activities of CPK and HBD following neuroleptanalgesia, but no change in the serum activity of ALD. It is suggested that this form of neuroleptanalgesia may be associated, in ponies, with a degree of reversible myocardial hypoxic change, possibly as a result of coronary insufficiency.


Response to dietary nitrogen in ponies.

Response to dietary nitrogen in ponies. Utilisation of nitrogen was studied in 4 crossbred ponies. A latin square design was used to study the effects of corn gluten meal, casein or urea when added to a low protein basal diet. Apparent nitrogen digestion, nitrogen retention, total plasma protein, plasma urea and plasma-free amino acids were measured. The addition of corn gluten meal, casein or urea to the basal ration increased apparent digestion of nitrogen. Casein produced a significantly greater (P less than 0.05) nitrogen retention than corn gluten meal or urea. Plasma urea nitrogen increased significantly (P less than 0.01) in ponies given the urea diet. Total plasma protein concentrations were essentially unchanged for all treatments. Elevated plasma levels of proline, valine, methionine, isoleucine, leucine, tyrosine, lysine, and arginine were observed with ponies receiving the casein supplement. The data support the hypothesis that the horse is capable of responding to quality of dietary protein.


Recuperation after muscular fatigue by "diverting activities". "Diverting activity" is defined as any physical or mental activity performed between or simultaneously with bouts of exhaustive, local muscular work. In the present experiments bouts of exhaustive work consisting of rhythmic lifting of weights were performed with the elbow flexors or with the flexors of the middle finger. Pauses of 2 min duration spent in complete rest or while performing diverting activities alternated between the bouts of work. As diverting activities were used: Physical activity, dynamic or static, performed with big or small muscle groups (other than the fatigued group), or mental activity (problem solving). It was found that the amount of work that could be performed after a pause with diverting activity was always larger than the amount of work performed after a passive pause. The beneficial effect was seen also when the blood flow to the exhausted muscles was interrupted by pneumatic cuffs. Determination of the blood flow in the exhausted muscles by means of Xe-133 clearance showed no systematic blood flow increases caused by the diverting activity. It is concluded that recuperation after local muscle fatigue is influenced by a central nervous factor (Setchenov phenomenon) that is largely independent of the local blood flow.


[Adaptive modifications of cold pain. II. Communication: long-term experiments with 24-h-intervals (author's transl)]. Ten healthy subjects were exposed to a single cold pain stimulus at one hand on each of 21 successive days. In order to follow up the subjective adaptation every other day an abbreviated version of the McGill-Pain-Questionnaire was issued. The initially wide spread protopathic irradiation of cold pain sensation was decreased by adaptation to a strictly localized perception related to the really exposed area. The number of the chosen affective-protopathic adjectives was significantly reduced, the number of sensory-epicrtic descriptions, however, remained constant. The overall evaluative estimation of pain intensity was also diminished. The course of objective adaptation parallels that of subjective adaptation. The relation between the evaluative intensity ratings and the affective-protopathic experience descriptions is discussed.


[The effect of an on the job training program -- stairclimbing -- on the physical working capacity of employees (author's transl)]. Following medical screening and physical fitness testing (W170) 52 voltuntary employees in a 31-story administration building were formed into matched pairs and randomly allocated into intervention (stairclimbing) and control (lift) groups. The intervention group was asked to climb at least 25 floors/workday or 125 floors/week. the control group was asked to use only the lift. The intervention time was 10 weeks. The physiological measurements were made before and after the intervention. The number of stairs climbed was recorded daily in a diary. The heart rate was recorded continuously over one workday before and during the interventions. The average quantity of training in the final intervention group (n = 19) was 29.9 floors/workday or 36,790 kpm/week and in the control group 4.6 and 5980 correspondingly. The average training frequency was 4.3 in intervention and 1.4 climbs/workday in the control group. The average number of continuous floors used during climbing was 7.0 in intervention and 3.4 in control group. The average number of minutes on heart rate level of 130-159 beats/min during one workday was 7.8 in intervention and 1.6 in control group. The W170 (W/kg) increased 17.8% and the predicted VO2max (ml/min/kg) 15.1% in intervention group. The difference between the intervention group and the control group was significant (p less than 0.01). It was concluded, that stairclimbing is a suitable on the job physical activity program for middle-aged, untrained men.


Mechanical energy states during running. Changes in total mechanical work and its partitioning into different energy states (kinetic, potential and rotational) during a step cycle of running were investigated on six well trained athletes who ran at the test speeds of 40, 60, 80, and 100% (9.3 +/- 0.3 m/s) of maximum. Cinematographic techniques were utilized to calculate the mechanical energy states as described by Norman et al. (1976), using a 13 segment mechanical model of a runner as the basis for the computations. The data showed that both the kinetic and rotational energy increased parabolically but the potential energy decreased linearly with increases in running velocity. The calculated power of the positive work phase increased quadratically with running speed. During the phase when the runner was in contact with the ground, the applied calculations gave similar increases for the positive and negative works, and the power ratio (Wneg/Wpos) stayed the same at all measured speeds. Therefore, it is likely that the method used to calculate the various mechanical energy states did not reflect accurately enough the physiological energy costs at higher running speeds. It may, however, be quite acceptable for estimating the mechanical energy states during walking and slow running, in which case the role of negative work is less and consequently the storage and utilization of elastic energy is small.


The lack of influence of reactive hyperemia on exhausting rhythmic or static exercise. Muller (1958) and Nukada (1955) claimed that the performance of exhausting exercise can be greatly prolonged if the exercise is begun at the start of reactive hyperemia. They reported that arrest of the circulation for 10 min immediately before beginning rhythmic exercise had increased the endurance time nearly 7-fold. We have repeated Muller's and Nukada's experiments. In one series we used rhythmic exercises on a bicycle ergometer, and in another sustained contractions on a hand-grip dynamometer. Our results failed to support those of the above authors. The endurance times for rhythmic and static exercise were unaltered by previous arrest of the circulation.


Effects of simulated altitude training on aerobic and anaerobic power. Five trained males aged 20-23 years undertook successive phases (2-5 weeks duration) of daily training in normoxia or hypoxia. Weekly exhaustive tests alternately in normoxia or hypoxia, throughout, assessed the comparative efficacy of the training. The relative contribution to endurance, aerobic (peak VO2) and anaerobic (deltaLa) power made by exercise or hypoxia separately was studied. In a stepwise increasing work test to exhaustion relative bradycardia developed during the first minute of exhaustive work at 1800 kgm/min in all subjects and aerobic power increased both in normoxia and hypoxia significantly by the end of the first phase hypoxic training. Endurance for exhaustive work increased in both environments as did aerobic and anaerobic power.