Primary lymphomas of the gastrointestinal tract. I. Plasma cell tumours. The histology of 125 cases of primary gastrointestinal lymphomas arising in the stomach and small and large intestine has been reviewed. The material was gathered from the Bland-Sutton Institute of Pathology at the Middlesex Hospital and from the Westminster Hospital. Of the initial total of 143 cases diagnosed, 18 were rejected. Of the acceptable 125 cases, 51 lymphomas were arising in stomach, 53 in the small intestine and 21 in the large intestine including rectum. Excluding the four children in the series, ages ranged from 18 to 82 and were fairly evenly distributed across the decades. There was no significant sex difference in the Middlesex Hospital cases but in the Westminster Hospital series the male to female ratio was approximately 2.6 to 1. One significant finding to emerge from this histological survey, and which forms the basis of this communication, is the proportion of lymphomas considered to be predominantly of plasma cell type. These plasma cell tumours, or extramedullary plasmacytomas, accounted for 49 out of the 125 cases (39%) of gastrointestinal lymphomas. They were less common in stomach and most common in the intestine, the majority occurring in the ileocaecal region. Conversely, Hodgkin's disease, in contrast to some series, was not encountered. Of the non-Hodgkin's lymphomas, grade I tumours were uncommon and true histiocytic lymphomas were distinctly rare. The high incidence of plasma cell tumours were uncommon and true histiocytic lymphomas were distinctly rare. The high incidence of plasma cell tumours in our series is in keeping with the morphological findings of a previous study carried out in patients with alpha-chain disease and in a small series of primary gastrointestinal lymphomas.


Undifferentiated carcinoma of the large intestine. Eight cases of the rare undifferented carcinoma of the large intestine are described. The histological distinction between undifferentiated and poorly differentiated colonic adenocarcinoma and malignant carcinoid is discussed. It is concluded that undifferented carcinoma is a variant of adenocarcinoma which tends to grow to a large size before symptoms are produced but which nevertheless has a good prognosis when locally resectable. Five patients survived between 6 and 28 years, one is well 6 months after operation and two cases where local removal could not be achieved, died within a year.


The carotid body--a quantitative assessment in children. The volume of the glomic tissue in the carotid bodies of 100 infants between the ages of 29 weeks gestation and 9 1/2 years has  been determined by serial sections and point counting. There is a 10-fold variation in the size of the carotid body and the volume of glomic tissue at all ages studied. Forty of the infants died as unexpected deaths at home. No increase in size of the carotid body is apparent in the majority of these deaths but there is a probability that enlargement occurs in some children dying at the age of one year or older. Ranges of values and means are presented for the carotid body glomic tissue volume from birth to 9 1/2 years.


Hyperplasia and prolapse of hepatocytes into hepatic veins during longterm methyltestosterone therapy: possible relationships of these changes to the developement of peliosis hepatis and liver tumours. We report the pathological changes in liver biopsies from 10 patients (four female transexuals and six impotent males) after treatment with 150 mg methyltestosterone daily for periods of up to 3 years, and in a hemihepatectomy specimen from a female transexual who developed a liver adenoma after 37 months of this treatment. Hepatocyte hyperplasia and mild focal sinusoidal dilatation was found in most cases. In some cases there were microcysts and dissociation of hepatocytes. In nine patients there was accumulation of hepatocytes between the endothelium and the supporting collagen of hepatic veins which often resulted in either partial occlusion of their lumina or disruption of their walls. These vascular changes do not appear to have been reported before. It is postulated that a single pathological process-hyperplasia, perhaps related to the anabolic effect of methyltestosterone--could be partly responsible both for the formation of cysts through mechanical obstruction of hepatic veins and for the formation of nodules and tumours.


Pacinian neurofibroma.

Pacinian neurofibroma. At rare intervals in the literature, reports have appeared of a skin tumour containing structures resembling Pacinian corpuscles. Four such tumours collected over the course of 20 years are described and the literature reviewed.


The surgical pathology of thoracic aortic aneurysms. In 63 resected thoracic aortic aneurysms, the commonest histological finding (45 cases, 71.4%) was cystic medionecrosis. These cases formed two groups, 29 with widespread fragmentation and loss of elastic tissue (elastopathy) and 16 cases without elastopathy who were older and included most of the 18 cases of dissecting aneurysms. Thirteen patients had the Marfan syndrome, 10 showing cystic medionecrosis with elastopathy, indistinguishable from the cases with no Marfan stigmata although partial 'dissections' were mainly found in the Marfan patients, Histological appearances ranged from normal to complete loss of media. Cystic changes in muscle fibres apparently preceded elastic fragmentation. Fourteen cases (22%) had aortitis: 4 were syphilitic and 3 of other known aetiology. In 7 patients the aetiology of the inflammatory process was unknown and appearances included granulomatous infarct-like lesions and necrotizing aortitis or changes indistinguishable histologically from syphilis.


Pigmented carcinoid tumour of the thymus. An asymptomatic thymic tumour, classified as a carcinoid tumour on the basis of its light and electron-microscopic appearances, is described. This tumour was atypical in having foci of melanin pigmentation, the pigment being contained in dendritic melanocytes and melanophages. We suggest that the pigmented cells are not neoplastic and represent latent thymic melanoblasts stimulated in some way by the carcinoid tumour. Alternative explanations are discussed.


Autofluorescent granular cells in oral mucosal hyperplasias. Four hyperplastic lesions of the hard palate are described. They were characterized by the presence of an atrophic surface epithelium, an oedematous matrix and the presence of large numbers of autofluorescent granular cells. In addition there were numerous mast cells. Histochemical and electronmicroscopical studies suggest that the granules are composed of lipofuscin. The pathogenesis of these lesions is discussed.


Idiopathic cholesterol pneumonitis.

Idiopathic cholesterol pneumonitis. The fiftieth case of idiopathic cholesterol pneumonitis (ICP)  is presented and the 49 previously reported cases have been reviewed. This review draws attention to certain features which have not previously been emphasized, including marked male predominance, single lobe involvement, the distribution of the lesions, dense pleural fibrosis, smoking history and the close histological association between giant cells and disrupted elastic fibres of the alveolar walls. The clinical and radiological similarity between ICP and primary bronchogenic carcinoma is described. Various aetiology theories are discussed, and the similarity between ICP and spontaneous lipid pneumonia in the mongoose is noted; the hypothesis is put forward that ICP, like the mongoose pneumonia, is an expression of disordered production or disposal of excessive surfactant.


Occult lupus nephropathy: a correlated light, electron and immunofluorescent microscopic study. Renal biopsies obtained from four adolescent girls who developed symptomatic thrombocytopenia with serologic evidence of systemic lupus erythematosus, without clinical signs of renal involvement, showed glomerular disease by electron and immunofluorescent microscopy with light microscopic changes in two cases. Subsequently, three of the patients developed proteinuria, and repeat biopsies from all four showed appearances ranging from resolution to significant glomerulitis. The findings illustrate the variable patterns of occult glomerulitis in lupus, and highlight the value of correlating light, electron and immunofluorescent studies in renal pathology.


Quantitative study of the lymphatic tissue and germinal centres in the spleen in infants dying from expected and unexpected causes (cot deaths). The amount of malpighian body lymphatic tissue and germinal centre tissue in the spleens of infants dying in hospital and dying unexpectedly at home have been examined in 471 cases. The total weight of the spleens in children dying at home unexpectedly do not differ significantly from children dying from expected causes. There is an increase in both the amount of lymphatic tissue and in the amount of germinal centre tissue in the children found unexpectedly dead. It is concluded that these children do not show any evidence of cellular immunological deficiency but that they have probably been subjected to recurrent or to a greater amount of antigenic stimulation during their brief post-natal existence.


Blue naevi of lymph node capsule.

Blue naevi of lymph node capsule. Blue naevi are reported for what is believed to be the first time in the capsule and fibrous trabeculae of lymph nodes. In one of the two cases that nodal blue naevus was accompanied by an ordinary blue naevus in the regional skin. These blue naevi are compared with the 'naevus-cell aggregates' in nodal capsule, the histogenesis of which is currently disputed. A developmental migratory arrest of melanocytes is thought to be the histogenetic mechanism involved in the production of these blue naevi in lymph nodes.


Mesangio-capillary glomerulonephritis associated with Q-fever endocarditis. A patient with nephrotic syndrome and Q-fever endocarditis (confirmed serologically and ultrastructurally) was found to have mesangio-capillary glomerulonephritis with parietal deposits of C3 and IgM and some IgM in the mesangium. Elution studies showed that IgM antibodies reactive against insoluble Coxiella antigens were present in the kidney. Review of the literature suggests that this type of immune complex nephritis may be associated with Q-fever. Possible reasons for the variability of the nephritis associated with infective endocarditis are discussed.


Chemical composition, particle form and annealing temperature of amalgam alloy versus creep of the resulting amalgam. The influence of the chemical composition, particle form and annealing temperature of the amalgam alloy upon the creep of the resulting amalgam was investigated by means of a multiple regression model. Because no, or only little, information was available about the heat treatments of the different commercial alloys, the alloys were subjected to additional heat treatments at four different temperatures. The influence upon the creep of the amalgam of the Zn content, particle form and annealing temperature was found to be very significant. A higher Zn content as well as a spherical alloy resulted in less creep of the corresponding amalgam. The dependence of the creep upon the annealing temperature showed a minimum: more creep was obtained for amalgams prepared from the alloys heat treated at 150 degrees C and 435 degrees C than those from the alloys annealed at 315 degrees C and 319 degrees C, respectively.


A simple cardiovascular system simulator: design and performance. A simple simulator has been constructed, evaluated and used for performance studies of prosthetic aortic valves, balloon assist devices and Koroktof sounds and ausculatory cuff blood pressure measurements. A direct drive piston pump is used. Elastic soft rubber tubes with distributed resistances allow modeling of normal and diseased pressure pulse waves. Pressure pulse amplitude amplification is modeled with tube segments of decreasing diameters. Satisfactory proximal pressure pulse shapes are obtained with a soft rubber tube of uniform diameter.


Effect of load, speed, and activity history on the EMG signals from the intact human muscle. A specially instrumented bicycle ergometer is utilized in this investigation to induce reproducable loading conditions on the muscles of the lower extremity at different speeds. Various tehcniques for evaluating the electromyographic signals from the vastas medialis muscle are investigated for different load and speed conditions and shown to be essentially equivalent. The RMS signal power computed by means of a real time spectral analyzer is shown to be a convenient means of quantification of the dynamic EMG signals. The electromyographic signals are shown to be stable under repeated static or dynamic conditions but not under sustained isometric static loading.


The microstructure of isotropic vapor-deposited carbon films. The structure of thin, vapor-deposited carbon films was characterized by transmission electron microscopy and electron diffraction. Selected area electron diffraction showed very weak and broad peaks, indicating that these carbons contain extremely small crystallites whose dimension in the crystallographic c-direction is about 8 to 10 a. The observed diffraction bands are (h, k, 1 = 0) type reflections, which suggests that individual crystallites consist of graphitic layer planes stacked in parallel groups but with no order between atoms in adjacent planes (turbostratic). The carbon films exhibit no preferred orientation, indicating that the small crystallites are randomly oriented in the film and that the films are therefore isotropic. The measured density (1.8 g/cm3) and the structure of the vapor-deposited carbons are accordingly similar to those of low-temperature isotropic (LTI) pyrolytic carbons.


High frequency components in the spectrum of the visual evoked potential. The occurrence of short term high frequency components in the spectra of the VEP is usually overshadowed by larger amplitude slow waves which occur simultaneously with the high frequency waves. The high frequency components become evident when the time varying power spectra of short duration (250 ms) segments of the VEP are examined. Two types of short duration time varying power spectra are considered: one is obtained directly from overlapping time segments of the average VEP; and, the other is obtained by computing the spectra from the average autocorrelation functions of overlapping time segments of the data following each stimulus. The first yields the time varying properties for the spectra of the stimulus-synchronized data while, the latter shows the time varying properties of both the synchronized and unsynchronized data present.


The design of a wireless-controlled intra-oral electrolarynx. Many patients who have failed to acquire esophageal speech after total laryngectomy are presently using artificial electrolarynges. Two of the principle objections to currently available devices are their bulkiness and visibility. The authors have developed and tested a wireless-controlled intra-oral electrolarynx which overcomes these main objections. In addition, it produces intelligible speech which compares favorably with other existing devices. In this paper, the design details will be presented which significantly influence the performance and the patients' acceptability of the new device.


Design of the pulsed oxygen cathode.

Design of the pulsed oxygen cathode. This paper presents a theoretical design of the pulsed oxygen cathode. The analysis concerns two major areas: First, a description of the oxygen diffusion currents during the initial 5 msec. after the application of the polarization potential. Second, a determination of the limiting sample rate imposed by a protective coating of given characteristics. It is shown that at 5 msec. after application of the polarization potential the 99% isoconcentration line is 11.8 micron from the cathode surface. The currents during this time can be modeled as linear diffusion. Also, for a minimum step response of 100 msec. the protective coating should have a thickness less than or equal to 13.6 micron.


The design of a monopole radiator to investigate the effect of microwave radiation in biological systems. The design of a microwave monopole radiator, using a hollow hypodermic needle, is described. This radiator has two unique features. It allows both i) irradiation of deep biological structures by simple needle injection and ii) simultaneous chemotherapic treatment of tissue. The matching characteristics of the monopole in saline solutions are given.


A model to predict the incidence of fracture in femoral components. The paper presents a probability model for the fracture of femoral components based on the assumption that the components are defect-free, and that they fracture by a fatigue process. The model predicts the probability of fracture for patients of different body weight, and the incidence of fractures versus body weight, and versus time. The results are compared with recently published survey data. In addition the model is used to demonstrate the effect of improvements in the mechanical properties of components. Finally the paper discusses the modifications needed to demonstrate the effect of variations in component design, prosthesis orientation, and level of patient activity, and the effect of time-dependent processes such as bone resorption, acrylic disintegration and shock loads.


Microscopic fracture aspects of impact tested human bones. The fracture aspects of impact twisted human femurs and tibias have been studied in their wet condition. The main tool used to correlate fracture behaviour with bone structure was the scanning electron microscope. Supplementary data were obtained from macroscopic fracture pattern analyses and stress coat experiments on slowly tested dried bone. The interest of the data reported concerns two major points. Firstly the analysis of the fractographic results leads to the conclusion that the fracture has presumably been initiated by shearing parallel with the torsion axis. The fracture propagates along so called spiral and oblique fracture lines. Secondly, the correlation of the macroscopic fracture pattern with microscopic fracture aspects indicates that the fracture is initiated along the cement lines, which can be considered as the weak matrix in an osteon-cement lining composite. The fracture propagates along the cement lines as well as through osteons and lamellae. Throughout the impact fracture surfaces ductile and brittle fracture aspects were observed, although the brittle fracture mode was predominant during propagation.


The wear of titanium, titanium alloy, and UHMW polyethylene caused by LTI carbon and Stellite 21. The comparative wear resistance of a commercially pure titanium (A-70), a titanium alloy (Beta III), and a UHMW polyethylene (Lennite) has been evaluated by employing a test procedure described previously. Either an LTI carbon or a Stellite 21 was the disk material. All material combinations exhibited a low volume wear rate ranging from about 1.2 x 10(-6) to 1.6 x 10(-6) mm3/km. The wear behavior of pure titanium seems to be related not only to its mechanical properties but also to its chemical reactivity with the test environment. A comparison of the current results with earlier data for LTI carbons suggests that LTI carbons may be used as a component material for many artificial joints.


Finite deformation theory for in vivo human skin. A finite deformation mathematical model of in vivo human skin has been developed for the normal physiological load range. Uniaxial load-deformation measurements were carried out with a non-invasive extensometer and utilized in formulating the model. The in vivo strain energy function was found to be a linear function of the first two strain invariants and a quadratic function of the third strain invariant. Only three independent constants were necessary to specify the strain energy function completely for the upper extremities of human volunteers.


Parameters of stimulation and perception in an artificial sensory feedback system. The relationships between stimulus parameters and perceptions in a prosthetic feedback system were measured using psychophysical methods. Electrical stimulation of the median nerve produced a monotonic relation between frequency of stimulation and the perceived magnitude of the stimulus. There were two qualitatively different perceptions of the stimulation; one for low frequencies and one for high. These two qualities fit different psychophysical continuua, kind of stimulation, and amount of stimulation.


Computed tomography in the diagnosis of disorders of excessive iron storage of the liver. Twelve of 14 patients clinically felt to be iron-overloaded demonstrated livers of higher density than 12 hospital controls. Computer tomography (CT) scanning may be useful in both the initial diagnosis of iron overload in the liver and as a method of following the course of treatment in this condition.


Diagnosis of intrasellar cisternal herniation (empty sella) by computer assisted tomography. Twenty-six cases of empty sella were studied using computer assisted tomography (CAT). Emphasis was placed on the technical factors controlling the pictures. The diagnosis seems to be feasible in a large number of cases provided movement artifacts are reduced and the angulation, thickness, and level of the cut are carefully chosen.


Emission computer assisted tomography with single-photon and positron annihilation photon emitters. Computed transverse section emission tomography using 99mTc with the Anger camera is compared to positron annihilation coincident detection using a ring of crystals and 68Ga. The single-photon system has a line spread function (LSF) of 9 mm full width at half maximum (FWHM) at the collimator and gives a transverse section reconstruction LSF of 11 mm FWHM with 144 views. The positron ring has a LSF of 6 mm at the center with a transverse section reconstruction LSF of 7.5 mm FWHM. Correction for uniformity of detector response and accurate center of rotation determination is essential in both techniques. The signal-to-noise ratio in a reconstruction is diminished by a factor of 1.2 x (number of resolution elements)1/4 over that expected from the average number of events per resolution element. Attenuation compensation causes more noise to appear in the center than the edge for both modes and an average increase in uncertainty of 30%. The effects of attenuation result in more loss of data for positron coincidence imaging than for single-photon imaging even at energies of 80 keV. For a 20-cm cylinder imaged in transverse section, only 20% of the positron annihilation events are not scattered; however, at 140 keV, 40% of the photons are not scattered. The relative crystal efficiency gives single-photon imaging an advantage of 5. On the other hand, the solid angle advantage of positron photon coincidence imaging is about 100 for the comparisons of this paper. Taking these factors into account, we find positron-computed section imaging has a tenfold increase in sensitivity over multiple-view imaging with the scintillation camera, which gives multiple sections but requires camera or patient rotation.


Computed tomography of cerebral venous angiomas. Six cases of venous angioma of the brain, a rare vascular malformation, were studied by means of computed tomography (CT), angiography, and other tests. In each case, angiography demonstrated the typical normal arterial phase and the network of abnormal veins that converge on a single large draining vein. In three cases, the CT scans showed rounded areas of high density not unlike neoplasms in appearance. In the other cases, the CT scan demonstrated the enlarged draining vein only. The CT scan findings, although not specific, may alert the radiologist to the possibility of this lesion and may lead to its demonstration through angiography.


Display of three-dimensional information in computed tomography. From a sequence of computed tomograms of two-dimensional transverse slices of a body one can build up a three-dimensional array of numbers containing spatial rather than cross-sectional information. We have developed computer methods to display a slice at arbitrary orientation through the three-dimensional object. The three-dimensional array of numbers can also be used to display what any particular organ would look like if it were removed from the body. This is done by a computer technique that first detects the surface of the organ of interest and then displays this surface on a screen.


Computed tomography for parathyroid localization. Computed tomography (CT) of the neck and mediastinum was performed in 10 patients with primary hyperparathyroidism. Nine had undergone previous surgery and were considered localization problems. Of four subsequently proven cervical adenomas, only one unusually large 19-g adenoma was visualized by CT. However, of two subsequently proven anterior mediastinal adenomas, CT scanning was positive in both; a single posterior mediastinal adenoma was not demonstrated. Of the remaining three patients, one was not operated on; in two others no adenoma was found at surgery. CT scanning is recommended prior to neck surgery in all patients with primary hyperparathyroidism to identify adenomas in the anterior mediastinum.


Use of automated measurements of mean density as an adjunct to computed tomography. A system integrated with a first-generation computed tomography (CT) head scanner is described. With the assistance of an additional program and minimal hardware changes, it was possible to examine specific areas on the preinfusion studies and obtain instantaneous printouts of a number of parameters including mean densities. This measurement technique was then applied to the preinfusion scans of "lucent" lesions--abscesses, glioblastomas--as well as "dense" lesions--recent hemorrhages, some uncalcified meningiomas, and some metastatic melanomas. These five lesions had characteristic mean attenuation values that seem to allow classification of each of the five entities. Hardware and software changes are described and practical application of the system is discussed.


Dynamic positron emission tomography for study of cerebral hemodynamics in a cross section of the head using positron-emitting 68Ga-EDTA and 77Kr. Dynamic positron emission tomographic studies were performed on over 120 patients with occlusive cerebrovascular disease, arteriovenous malformations, and brain tumors, using the positron section scanner, consisting of a ring of 32 scintillation detectors. The radiopharmaceuticals were nondiffusible 68Ga-EDTA for transit time and uptake studies and the diffusible tracer, 77Kr, for quantitative regional cerebral blood flow studies in every square centimeter of the cross section of the head. The results of dynamic positron emission tomography in correlation with the results from the gamma scintillation camera dynamic studies and computed tomography (CT) scans are discussed.


Variation with time of the attenuation values of intracranial hematomas. Fourteen cases of subdural, epidural, and intracerebral hematoma, in which the time of the trauma or bleeding was known, were selected. Attenuation of samples taken at surgery showed good correlation with attenuation values determined by computed tomography (CT). The decrease in the attenuation of the hematoma from the time of trauma or bleeding was studied.


Correction for collimator width (restoration) in reconstructive X-ray tomography. X-ray measurements made by scanning in a plane, in successive position angles, involve a degradation (smoothing, or blurring) associated with the nonzero width of the strip occupied by the X-ray beam. The collimating holes that define the X-ray beam cannot be made indefinitely small without increasing the X-ray source power indefinitely. However, making a tomogram from the strip integrals is usually handled as though the data consisted of line integrals. The result is that each infinitesimal element of the tomogram is spread out into a density distribution resembling a cone with a central crater. Restoration of the tomogram to correct for the blurring associated with the strip width is warranted and will receive greater attention as the precision of measurements increases and as demand for resolution approaching that of conventional radiography begins to push instrumental design against various limits. Restoration is a well-developed subject, but in each field of application has its own peculiarities. Systematic and statistical properties of tomograms, the character of their errors, and the desired information will influence the future development of restoration in tomography. X-ray tomography is also special in that diffraction of the rays is negligible and that sharp shadow edges may be formed.


Noise due to photon counting statistics in computed X-ray tomography. A general expression is derived for the noise due to photon counting statistics in computed X-ray tomography. The variance is inversely proportional to the cube of the resolution distance. For scanners using a water box, the noise in the reconstructed image depends inversely on the number of detected primary photons, summed over all angles, that have passed through a resolution element. Predictions of this formula agree well with the results of computer simulations. It is shown how this formula can be used to determine such parameters as required X-ray flux, detector counting rate, and dose, with special emphasis on tradeoffs between these parameters and resolution. It is also shown that to determine the X-ray attenuation coefficient of a resolution element to a given precision, the number of photons required by computed X-ray tomography is close to a theoretical limit.


Computed tomography of the skull base.

Computed tomography of the skull base. By applying a wide window to computed tomography (CT) images, excellent detail of the skull base has been obtained. This technique has been apllied to lesions involving the sellar, parasellar, sphenoid wing, petrous bone, clival, and foramen magnum regions. Thus, CT has proved to have an additional dimension in the delineation of pathology.


How well recommended are the recommended dietary allowances? The Recommended Dietary Allowances serve two basic uses: As guidelines for planning diets and food supplies and as a tool for evaluating nutritional adequacy of food consumed. Establishing standards to serve these functions is not simple. Differences in individuals in different population groups dictate allowances with relatively high margins of safety to prevent deficiencies. Even so, anomalies arise. Surveys have shown that intakes of vitamin A and protein are likely to exceed their respective allowances. On the other hand, calcium and thiamin intakes of older women and iron in teenage boys and women in the reproductive years are difficult to meet in terms of nutrient density ratios. In addition, insufficient data make it impossible to set allowances for some essential trace elements--and, other essential elements may yet be discovered. Thus the allowances are not guaranteed to represent the totality of nutritional needs.


Physicians' exposure to health topics through mass media: An avenue for improving the dietitian's image. Almost all (93 per cent of 150) of the physicians surveyed reported frequent exposure to mass media, and almost two-thirds (60 per cent) state that this exposure included health items. Over half replied that at least one mass media source was useful to them as a source of health information. And, one physician in five (21 per cent) indicated that mass media could influence his attitude about health. The success of the dietitian in the health care setting depends to a large extent on the physician's support. In view of the influence of the mass media on physicians, as reported in this survey, the recommendation is made that dietitians give more attention to this avenue of improving their image with the medical profession.


Comprehensive evaluation of fatty acids in foods. Based on production volume and value and on per capita consumption, shellfish are an important food group in the United States. The nutrient composition of shellfish indicates that this food group is low in fat and relatively high in protein. Tabulated data on fatty acids in the different edible portions of seven species of crustaceans and over twenty species of mollusks are presented. The proportionately high level of polyunsaturated fatty acids is shown by the polyunsaturation index calculated for some important species of shellfish.


Culture-conflict and psychotherapeutic approach. The world-view of a therapist is essentially determined by his own cultural milieu. This hypothesis was tested by involving four therapists from disparate cultural settings in an exercise of planning psychotherapy on the basis of the presentation of a clinical case of a patient treated by the author with a 'culturally relevant' therapeutic technique. The responses of the participants were compared with the process and outcome of the therapy actually carried out.


Racial awareness and social identity in young children. There is a growing body of evidence which demonstrates that racial awareness and even racial repugnance can be well developed in children of four or five years of age. The semi-projective techniques employed by some investigators have encouraged disputes in interpretation, but the substantive findings of out-group preference by the minority accompanied by pronounced ethnocentricity on the part of the majority is well supported by many sociometric studies. Since a child's sense of his social identity can only be achieved within the context of the system of preferences and biases which exist in a society, it will be argued that the development of prejudice in children is a product of the normal, necessary and rational process of progressively ordering the environment into manageable categories and their need to comprehend their place within it.


Emigration: psychopathologic reaction in the families left behind. In order to investigate whether emigration acts as a psychic stress on the families left at home, two groups of families were compared: In group A the head of the family had emigrated, in group B the head of the family was a candidate for emigration. Compared to group B, group A showed a significantly higher rate of psychopathology related to the stress of emigration. Wives and children were mainly affected. The stress of emigration on the wives was corroborated by finding a high proportion of separated couples in group A in comparison with none in group B.


The Peasant Connection: social background and mental health of migrant workers in western Europe. The paper represents an attempt to look at mental health and mental illness of migrant labourers in Western Europe in the context of their social background, current developments and the global processes they are involved in. Rates of mental illness among migrants are lower than would be predicted on the basis of the severity of the stress they face. Two facts--coming mainly from a peasant origin and perceiving themselves as peasants-in-town--were singled out as central aspects to the understanding of their capacity to cope with the stress due to migration. The main theories about migration are critically reviewed. It is suggested that peasants' strategies of survival in hostile environments underlie the explanation of the unexpected lower rate of mental illness. Phenomena of mental disturbances specific to the group are described and related to social and historical perspectives.


Problems of transcultural communication. Verbal and non-verbal communication occurs at various levels of meaning and explicitness. This is most obvious in transcultural exchanges and is therefore present in most of our psychological testing for which tests are used from other cultures. The confusion and invalid results of tests used with Ethiopian neurotic students and a group of normal students is used to demonstrate the point.


Notions of the emotions.

Notions of the emotions. The process of communication of emotional distress from patient to doctor is analysed into several components. The structure of language itself imposes certain limitations on what can be communicated. The doctor's preconceptions influence the way in which he perceives the patients' complaints. The doctor's preconceptions are bound up with his concepts of neurotic illnesses. The patient's complaints are partly determined by his concepts of emotional distress. A comparison of doctors' and patients' concepts of unpleasant emotions by means of a semantic differential technique reveals significant disparities.


Psychosocial first aid for refugees (an essay in social psychiatry). Post-war refugee resettlement schemes offer an opportunity for the study of contemporary social phenomena of compulsory mass migration. The process, set in motion by man-made disasters of war, oppression and persecution, deeply affects not only the victims but also the social institutions as they mobilize resources to accommodate the stateless and homeless new populations. The traditional focus on 'culture-change' is inadequate for the development of principles of aid to the refugees. In this paper, an operational definition of the structure and natural history of the social situation of resettlement is outlined, with reference to the working hypotheses of (1) the Social Displacement Syndrome and (2) the Psychosocial First Aid for Refugees Project. This has been derived from clinical and field studies of four successive refugee groups in Canada over the past 27 years, with specific focus on the social dynamics of the situation from immediately upon resettlement to one year after. In this early phase, the coexistence of personal and social disequilibrium in the refugees and among those who represent the institutions responsible for their management creates specific conditions, of which some enhance the disposition for recovery or 'repair' and some might reinforce the disposition for lasting 'social breakdown'. Some generalizations concerning practical and theoretical work in social psychiatry are made.


A study of reported hallucinations in a southeastern county. In traditional Western psychiatric theory, seeing or hearing things that other people do not think are there could be termed a hallucination which is often considered indicative of underlying psychopathology. The psychiatric interpretation of pathological meanings of these experiences for an individual can be contrasted with an anthropologic approach which considers whether there are underlying cultural influences to account for certain distributions of reported hallucinations and their content and to ask about the social and spiritual, as well as psychologic, meanings of such experiences. This paper presents data on reported hallucinations in a random sample of the general population of a county in north central Florida. When the results of the questions on hallucinations were compared in relation to sociodemographic variables, it was found that hallucinations were more commonly reported by the young, by blacks, by members of the lower socioeconomic quintiles and by those belonging to certain church types. These data will be discussed from the complementing and contrasting psychiatric and anthropologic viewpoints.


A comparision of percutaneous radiofrequency trigeminal neurolysis and microvascular decompression of the trigeminal nerve for the treatment of tic douloureux. In a 36-month period, 103 consecutive patients have been treated for classical trigeminal neuralgia with either percutaneous radiofrequency trigeminal neurolysis (PTN) (48 patients) or microvascular decompression (MVD) via a suboccipital craniectomy (55 patients). The results of these two procedures are tabulated, emphasizing especially the complications that have occurred with each. Successful initial relief of pain was achieved in 88% of the patients with PTN and 96% of the patients with MVD. Two significant complications occurred in the former group. Severe recurrences have occurred to date in 13% of the patients with PTN and in 5% of those with MVD. It is concluded that both procedures are effective, but that microvascular decompression offers the advantage of avoiding sensory loss and associated dysesthetic sensations. Follow-up is too short to conclude that MVD is a curative procedure, but the early results are very encouraging.


Complications of chemonucleolysis for lumbar disc disease. In 13,700 patients who received one or more lumbar disc injections of chymopapain, 401 complications, adverse reactions, and delayed untoward events were recorded, including eight deaths. The deaths were secondary to anaphylaxis, pulmonary embolism, discitis with subacute bacterial endocarditis, ruptured abdominal aortic aneurysms (two patients), encephalitis (of unknown etiology), and myocardial infarction. Of these, the deaths secondary to anaphylaxis and discitis with subacute bacterial endocarditis can be attributed directly to the procedure of chemonucleolysis.


Results of microsurgical extra-intracranial arterial bypass in the treatment of cerebral ischemia. The authors report the operative and follow-up results (3 months to 9 years) of 86 consecutive extra-intracranial bypass operations on 84 patients with cerebral ischemia, emphasizing both the prophylactic role of the operation in preventing further catastrophic cerebral ischemia, and the low morbidity and mortality of the operation.


Anatomical grading of supratentorial arteriovenous malformations for determining operability. After the study of over 300 angiograms of supratentorial cerebral arteriovenous malformations (AVM's), the authors have formulated an anatomical grading scheme of I to IV to correspond to the degrees of surgical difficulty for total obliteration. The grading is based upon the number of directly participating arteries for which there is a standardized nomenclature. Occasionally, allowance for clinical grading, in addition to this anatomical grading, must be made. Also, for the anticipation of morbidity, but not mortality, the location of the lesion is important. The authors present the postoperative results in a series of 49 patients to demonstrate the clinical usefulness of the grading scheme.


The infratentorial-supracerebellar exposure of tumors in the pineal area. Nine pineal area lesions were operated upon by the infratentorial-supracerebellar approach. There was one operative death and one death due to disseminated germinoma recurrence 2 1/2 years postoperatively. The remaining seven patients have shown no sign of recurrence and are neurologically normal. The surgical method that has evolved through these nine cases is discussed. The infratentorial-supracebebellar exposure is an excellent one for lesions in the region of the pineal gland, posterior 3rd ventricle, and superior cerebellar vermis. Access is less hampered by the major tributaries of the vein of Galen than with the supratentorial operations. This approach is also a useful extension of the standard posterior fossa exploration when dealing with primarily subtentorial lesions that involve the dorsal midbrain or herniate upward.


A study of experimental syringomyelia by scanning electron microscopy. Experimental hydromyelia and syringomyelia, induced by kaolin in dogs, has been investigated by scanning electron microscopy. This study demonstrated that communication between the 4th ventricle and the spinal central canal is normally occluded by a plug of acellular material lying within the central canal. This plug is broken down following the onset of hydrocephalus and communication is rapidly established between the ventricles and the central canal. The canal distends and ruptures dorsally into the spinal gray matter with the development of extensive intramedullary cavities, lined by glial and neuronal elements. The morphological changes demonstrated are consistent with a physical destructive process of the cord resulting from CSF dissection.


Recirculatory spinal subarachnoid perfusions in dogs: a method for determining CSF dynamics under non-steady state conditions. Open-ended ventriculocisternal perfusion techniques for determining cerebrospinal fluid production and absorption rates are severely restricted by the absolute requirement that steady state conditions be present. A new closed recirculatory spinal perfusion technique is described. Because steady state equilibrium is not necessary, numerous determinations at multiple intracranial pressures or under varied experimental conditions are possible within relatively brief perfusion periods. Cerebrospinal fluid (CSF) and nondiffusible albumin tracer are rapidly recirculated through the spinal subarachnoid space in a cephalad direction. The concentration of fluorescein-tagged albumin is continuously monitored as the CSF is circulated through a fluorometric flow cell. Measured continuously, intracranial pressure (ICP) is regulated by changing the volume of the external perfusion circuit with a syringe pump connected in series to the recirculatory spinal perfusion. CSF formation and absorption rates are calculated from measurements of albumin concentration, concentration changes with time, ICP, syringe pump infusion rate, and the external perfusion circuit volume. In dogs, data can be collected after only 45 minutes for mixing; perfusions at four or five intracranial pressures in addition to normal resting pressure can be completed within 2 to 3 hours. The data from 15 perfusions in 14 dogs are presented. The method provides normal resting pressure values of CSF production and absorption consistent with those values in the literature determined by traditional ventriculocisternal perfusion techniques. Determinations at multiple intracranial pressures suggest a proportional relationship between absorption and ICP. No consistent acute change in CSF formation with pressures to 50 mm Hg can be inferred from these data.


Cranial computed tomographic demonstration of intracranial penetration by an orbital foreign body. A 9-year-old boy suffered intracerebral penetration by a stick driven into his right orbit. Diagnosis was obtained by cranial computed tomography (CT), and this test directed appropriate immediate surgical intervention. Combined orbital exploration and craniotomy was followed by a gratifying recovery. The importance of CT in orbital and possible intracranial trauma is stressed.


Intraoperative intracranial angiography. Forty-one intraoperative angiograms were performed on 39 patients undergoing surgical therapy for aneurysms or excision of deep arteriovenous malformations. Good quality radiographs were produced in each case using commonly available equipment. One nonfatal stroke syndrome was the only serious complication possibly attributable to these angiograms. The techniques of opacifying the anterior and posterior intracranial circulations are described and the value of angiography in the intraoperative situation is discussed.


Computer processing of CT images: advances and prospects. Computerized tomography (CT) images are created by computer and as such are inherently amenable to computer image processing techniques. Advances have been made in the areas of alternative visualization (coronal views, etc.), image enhancement, feature extraction, and computer analysis of the extracted information. Further advances await imaginative application of these techniques and time; others will depend upon necessary advances in image processing methods.


Fractures of the second cervical vertebra: Internal fixation by interlaminar wiring. Fractures of the 2nd cervical vertebra are frequently undetected on initial evaluation. Tomography may be necessary to delineate the fracture. This is a report of 20 patients treated by internal fixation using interlaminar wiring. There was no operative mortality. Follow-up studies, an average of 25 months after operation, demonstrated satisfactory results and no evidence of delayed neurological deficit.


The microsurgical anatomy of the basilar artery bifurcation. The vascular microsurgical anatomy in the area of the basilar artery bifurcation is described in 30 autopsy dissections. Particular emphasis is placed on variations of the posterior thalamoperforators and their relation to the proximal posterior cerebral artery and basilar bifurcation.


The determination of speech organization in a patient with an arteriovenous malformation. A case is reported of an arteriovenous malformation in the left motor speech area which was successfully excised without aphasia in a right-handed man. Preoperative sodium amobarbital carotid infusion testing demonstrated that the patient had right hemisphere dominance for speech. A review of the literature suggests that this is not an uncommon occurrence in individuals with congenital lesions of the left cerebral hemisphere. Lateralization of speech dominance should be established through definitive testing in these cases, especially if surgical removal of the malformation is contemplated.


Self-contained tubular drill guard for anterior cervical fusion. A self-contained tubular drill guard was adapted for use in performing anterior cervical discectomies and interbody fusions. The use of this instrument eliminates steps, provides absolute safety against drilling too deeply, allows for adjustment in individual cases, provides for easy inspection of the trephine hole, permits electing the cephalocaudal angle of the drill, and gives a measurement of the ultimate depth of the trephine hole. In 171 consecutive operations only one neurological complication occurred, and total morbidity related to cervical surgery was 6% (7% morbidity was associated with surgery at the donor site). The data suggest that the technical modification herein advocated reduces the surgical complication rate.


The intracranial pressure-monitoring cup catheter: technical note. The author describes a simple catheter designed for use in the measurement of intracranial pressure, especially during the initial stage following craniotomy. The device has been studied in experimental animals, and has been used in 40 neurosurgical patients for periods up to 15 days.


Cerebral arterial spasm: A discussion of present and future research. The author presents a discussion of research on cerebral arterial spasm. Arterial smooth muscle contraction, receptor and relaxation mechanisms are presented in the context of what is known about cerebral arterial spasm and the biochemistry of vascular smooth muscle. Several new experimental approaches are suggested and a theoretical biochemical basis for the idea that damage to the artery alone could cause cerebral arterial spasm is postulated. Methods of determining cerebral arterial spasm and the need for a quantitative, in vivo method are discussed and the question of an irreversible stage of cerebral arterial spasm is considered. Finally, the problems associated with the delivery of a potentially successful treatment to the cerebral arterial smooth muscle cells are examined.


Long term results in the management of craniopharyngiomas. The results of surgical treatment, with and without radiotherapy, in 50 patients with craniopharyngioma treated over a 26-year period at the Cleveland Clinic are presented. Thirty-five patients were operated upon before the introduction of the operating microscope, and 30 of these survived operation. In this group of 30 patients, long term survival (5 to 24 years) occurred in 8 of 10 (80%) nonradiated patients who were considered to have had total excision. Nine of 11 patients (82%) who had aggressive subtotal excision and radiation therapy have survived from 3 to 17 years. Seven of nine patients (78%) died 1 to 14 years after subtotal excision without radiation therapy. Since the introduction of the operating microscope in 1972, 15 patients have had surgical treatment, and 12 of these have survived.


Brain vascularization by transplanted omentum: a possible treatment of cerebral ischemia. The authors report their experience with experimental brain vascularization with the use of transplanted omentum majus. The possibility of treating cerebral ischemia with this method is discussed.


How old people tolerate intracranial surgery for aneurysm. The purpose of this paper is to examine how well (or poorly) patients past the age of 60 tolerate intracranial surgery for aneurysms in all locations. The records of 93 consecutive good risk patients (Botterell Grades 1 and 2) have been reviewed. Co-existing chronic medical conditions, e.g., hypertension, were ignored in patient grading. The results indicate that, for treatment of aneurysms on the anterior circulation, older patients tolerate intracranial procedures as well as younger patients. This is not true for operations upon posterior circulation aneurysms. Some possible reasons for this discrepancy are suggested.


The use of a fiberoptic intracranial pressure monitor in clinical practice. Four years of clinical experience with a fiberoptic intracranial pressure monitor are presented. One hundred forty patients were monitored, of whom 80 had increased intracranial pressure. Of the patients with nontraumatic intracerebral hematoma and subarachnoid hemorrhage, 100% had increased pressure. Forty-seven of 69 patients with head injuries had elevated pressure; of these, 28 had pressure significant enough to require therapy. Both the patients with head injuries and those with nontraumatic hemorrhage were more effectively treated by using the results of pressure monitoring to determine when therapy was required and to indicate the response of the patient to that therapy. Despite the evidence, monitoring of intracranial pressure is not routine due to a lack of acceptance and effectiveness. To overcome such problems, a system must meet the criteria of ease of insertion, reliability, and lack of complications. These criteria are fulfilled by the fiberoptic system presented.


Cerebral vasospasm with ruptured saccular aneurysm--the clinical manifestations. Fifty cases of verified intracranial ruptured saccular aneurysm were analyzed to investigate the relationship of the development of a delayed cerebral ischemic deficit to the presence of cerebral vasospasm visualized on angiography. Twenty-five patients developed a delayed ischemic deficit (DID), and all showed Grade 3+ or 4+ vasospasm. Nineteen patients had Grade 0, 1+, or 2+ vasospasm, and none developed a DID. It was concluded that in this study vasospasm accounted for all DID's and that in the absence of vasospasm DID did not occur. The DID occurred most often on Day 8 (7 of 25 cases).


Intracranial dermoid tumor: diagnosis by computed tomography. A case report. Computed tomography (CT) of an intracranial dermoid tumor in a 43-year-old woman demonstrated a central soft tissue density (hair) in a low density (fat) cavity with a partially calcified wall. There was no contrast enhancement of the tumor. The CT findings were the most conclusive in the diagnosis and were helpful in the management of the patient.


Cranial epidermoid tumors: diagnosis by computed tomography. Using seven illustrative cases, the authors discuss the computerized tomographic (CT) appearance of cranial epidermoid tumors. These tumors are of low density (-2 to +10 EMI units), seldom show calcification, and do not enhance with contrast medium. Their differentiation from dermoid tumors and craniopharyngiomas is also discussed.


Large basal ganglia cyst in site of previously radiated glioma. Case report. A 3 1/2-year-old boy developed a mass lesion in the right basal ganglia and midbrain, compatible with glioma. During radiation therapy, aqueduct obstruction developed, necessitating a ventriculoatrial (VA) shunt. The child improved and remained well for 6 years, when he developed recurrent symptoms. A computerized tomographic (CT) scan and ventriculogram revealed a large cyst arising from the region of the right basal ganglia, the site of the previous tumor. The VA shunt was converted to a cyst atrial shunt. Subsequently, the cyst decreased in size, but hydrocephalus recurred, as demonstrated by a second CT scan. A Y-tube shunt (one catheter in the cyst, one in the ventricle) has controlled symptoms and signs since that time.


Spontaneous thrombosis of an arteriovenous malformation. Extensive thrombosis of a cerebral arteriovenous malformation, not associated with clinically recognizable hemorrhage, appears to be exceedingly rare. Angiographic and operative verification of such an occurrence is described in a 4-year-old child. Computed axial tomographic and ultrasonographic findings are discussed. It is proposed that thrombosis of the anomaly occurred as a result of intravascular turbulence, promoted by progressive elongation and increasing tortuosity of the lesion.


Aneurysms of the persistent hypoglossal artery. The primitive hypoglossal artery is one of four embryonic anastomoses between the carotid and basilar arterial systems. The so-called persistent hypoglossal artery is most likely a complex vessel comprised proximally of a persistent hypoglossal artery and distally of components of the primitive lateral basilar-vertebral anastomotic network. This is the sixth reported case of an aneurysm of the persistent hypoglossal artery, and it is unique in its association with two supratentorial aneuryms, one of which had ruptured. All three aneurysms were treated by a direct surgical approach (two operations). Review of the other published cases demonstrates that these aneurysms arise at the junction of the persistent hypoglossal with the basilar artery. Aneurysms of this vessel require direct surgical treatment, because the parent vessel is functionally the only artery supplying the brain stem and therefore may not be ligated. The aneurysms usually lie in the subarachnoid space, indenting the brain stem, and may be approached through a suboccipital craniectomy.


Hypogammaglobulinemia and Nocardia brain abscesses. The host defense responses to Nocardia asteroides are not known. We have investigated a patient with common variable adult onset hypogammaglobulinemia who developed fatal disseminated nocardiosis. The patient had low levels of serum immunoglobulins; the total lymphocyte count was normal as were the percentages of circulating T and B cells. Transmission electron microscopic studies demonstrated typical N. asteroides within the brain parenchyma and nonspecific inflammatory changes in the central nervous system. The findings suggest that humoral immunity may play a major role in the host defense of patients with this disease.


Rancho flotation bed.

Rancho flotation bed. The Rancho Flotation Bed provides hydrostatic support with maximum pressures over bony prominences of 15 to 25 mm Hg (measured with a pneumatic pressure transducer). This is generally below the levels normally quoted as conducive to the development of ischaemia. Clinical experience has shown the bed to be a successful aid to nursing by eliminating the need to turn the patients for pressure reasons, allowing patients with pressure sores to remain in a position which is more comfortable and more suitable for other nursing care. It also makes it easier for nurses to handle patients in order to care for the pressure sores.


A system of extension prostheses.

A system of extension prostheses. It is suggested that three basic types of extension prostheses are required as shown in Figure 1. Four methods of achieving these prescriptions using rigid, total-contact, polyester laminate sockets have been described, and the table (Fig. 6) indicates the correct method to be used for each type. These prostheses have proved very durable and repairs have been limited to replacing the straps and foot coverings. Advantages claimed are improved comfort, efficiency, and appearance, in addition to speed of fabrication and lightness when compared with conventional prostheses.


Acetate-free hemodialysis with a sorbent regenerative system. We conclude from this study that acetate-free, bicarbonate hemodialysis is well suited to the sorbent regenerative system. It can be performed safely and gives postdialysis patient values similar to standard dialysis. Long-term trials are presently being conducted at our institution. With modification of the cartridge pH by the manufacturer, it should prove simple and practical.


Nocturnal penile tumescence: an objective method for the evaluation of impotence in chronic renal failure. Using NPT monitoring, we have evaluated the complaints of impotency in 11 patients with chronic renal insufficiency. Eight of these 11 demonstrated objective evidence of sexual dysfunction. These findings support a predominant role for organic factors in the etiology of sexual dysfunction in this group of patients.


Cerebral atrophy in end-stage uremia.

Cerebral atrophy in end-stage uremia. This study suggests that 1) cerebral atrophy is present in end-stage uremia; 2) the degree of atrophy correlates best with the age of onset of end-stage uremia and is most marked during the ages of cerebral development, but is also present in adults. Further studies will be needed to elucidate causative factor(s) and the degree of cerebral functional impairment, if any.


Encephalopathy in children with chronic renal failure. The progressive encephalopathy observed in 5 children with chronic renal failure was clinically similar to the so-called dialysis encephalopathy of adults, except that it was not related to dialysis therapy. Renal osteodystrophy is more prevalent in children than in adults and often more severe. The attempt to control the crippling deformities of renal osteodystrophy in growing children with renal insufficiency has led to the use of large quantities of aluminum containing antacids. The encephalopathy observed in children with chronic renal failure may be related to the oral ingestion of aluminum containing compounds in the presence of persistent secondary hyperparathyroidism. We suggest that alternative methods for the adequate control of serum phosphorus levels should be sought and indications for parathyroidectomy in children reevaluated. During the past 18 mos we have lowered the dose of aluminum containing compounds to 50 to 100 mg/Kg/day in our patients with progressive renal failure and recommend parathyroidectomy. No new cases of the encephalopathy have occurred.


[Event-related slow potentials (ERSPs) of the brain in cases of temporal psychomotor and petit mal status]. Two cases have been studied by means of the usual method for eliciting CNV (S-1.5 OR 1 SEC-S-operant response) during and after the end of an episode of prolonged epileptic twilight state with almost continuous strictly unilateral temporal lobe discharge. From the clinical viewpoint in both cases the twilight state, lasting respectively about 12 and 48 hours, was characterized by a slightly clouded consciousness and moderate impairment of awareness and of psychic performances, at times associated with simple and complex psychomotor automatism and hallucinations. The EEG recorded an almost continous left temporal discharge of pseudorhythmic mixed slow waves and sharps. The third case had typical prolonged petit mal states with continuous spike-and-slow-wave activity, impaired intellectual and motor performances (very long reaction time etc.). In this patient for eliciting ERSPs, besides the standard method, we have used a paradigm in which S consisted of a colored slide, with various semantic contents, remaining visible for 5 seconds on a screen. At the trials of the standard paradigm during the epiliptic twilight state, all patients showed they had understood the signal to interrupt (S loud repetitive tone) in the shortest time possible and could clearly distinguish them from the S. The operant response was almost always made with sufficient precision and sometimes with fairly short reaction time, especially by the patients with temporal psychomotor status. During the episodes of prolonged clouded consciosness in all series of trials administered to the patients, no negative slow potential shifts were observed in the averaged EEG recordings obtained from F-T, F-T or  F, FCZ and referred to to linked mastoids. On  repetition of the examinations some time after the end of the epileptic twilight state, fairly normal ERSPs were obtained in all cases. Taking also into account the results of previous researches, these studies show that the temporal lobe and "centrencephalic" epileptic discharges, under certain conditions, may influence negatively the neurophysiological mechanisms which contribute to the information of complex contingent connections and which also underly the particular attentional, cognitive and sensorimotor functions involved in the inhibiting the appearance of ERSPs probably related to more specific perceptual and integrative functions. Some AA. maintain that negative slow potential shifts express the functional activity of the brain structures, particularly of determined cerebral cortex regions, involved not only in attentional, perceptual, cognitive and psychomotor functioning, but also in information processing (memory recording mechanism). Hence, the negative influence of prolonged temporal lobe or meso-diencephalic epileptic discharges on these structures may explain the almost complete amnesia that patients generally show at the termination of this kind of twilight state.


[Viloxazine: its antidepressant action and lack of concomitant anticholinergic effect]. Fourty in-patients suffering from depressive illness were treated with a new antidepressant drug, viloxazine. Apart from the already well-established antidepressant action, the authors emphasize the lack of anticholinergic effects; this illnesses with organic damage where usual antidepressant therapy is contraindicated


[Some observations on the ultramicroscopic organization of specialized connections amongst nervous fibres in the inferior olivary nucleus of the cat]. Some observations have been made on inferior olive specimens in the adult cat, with aldehydes fixation techniques through vascular perfusion suitable for electron microscropy. The results made it possible to recognise five types of vesicular structures present in different nerve endings (differences either in type or in number). A possible topographic organization of synaptic connections, between the afferent endings and the dendritic structures of the inferior olive has been considered and it seems that on every large dendrite, nearer the cell body, there is a development of numerous connection. As such connections give a great deal of information to the dendrites with much much interaction it seems possible that there is modulation in the activation of the postsynaptic element. On the other hand, in the periphery of the dendritic branch, many thin branches seem to make contact with few and large endings; this leads us to believe that the regulations of the information is not based only on the afferences but mainly on distribution, origin and number of the postsynaptic elements. A study of the interdendritic connections and of tubulo-vesicular structures showed that their diameter and dense content have a similar morphology with the big granulated vesicles, visible in the terminals, or along the fibres or, frequently, in the Golgi apparatus.


[Prevention of duchenne's muscular dystrophy: methodological problems in the detection of carriers (author's transl)]. In the last five years 48 possible carries and 13 known carriers of the gene for the Duchenne type of muscular dystrophy were studied in the Neurological Institute of the University of Milan. To achieve the most accurate detection, the following tests are recommended: a) the serum creatine kinase (CPK) estimation; b) quantitative EMB test on 3 muscles (deltoid, biceps and vastus medialis), in case of normal CPK level; c) histological and  histochemical studies, only if tests a) and b) are uniformative.


[EMG prognosis of facial palsy associated with herpes zoster oticus (Ramsay-Hunt's syndrome). A longitudinal study of 11 cases (author's transl]. Eleven patients with peripheral facial palsy associated with geniculate herpes zoster (Ramsay-Hunt's syndrome) have been followed-up clinically and electromyographically. Each patient was examined three times: within the first week, at the end of the third week and 3-4 months after the onset of symptoms. Only in three cases the facial palsy evolved satisfactorily, with an almost total recovery within three weeks. In eight cases the recovery was delayed and incomplete, with residual, and often severe, hemifacial spasm. This study confirms the rather poor prognosis of peripheral facial palsy in Ramsay-Hunt's syndrome. The importance of detecting even slight signs of herpetic eruption in any case of apparently "idiopathic" peripheral facial palsy is emphasized.


Determination of coagulation factors (II-VII-X) and kaolin partial thromboplastin time by the LKB 8600 Reaction Rate Analyser. Testing of a modified Reaction Rate Analyser 8600 in the automatic determination of coagulation time was accomplished with the assays Thrombotest Normotest and Kaolin Partial Thromboplastin Time. Variations in extinctions, from the adding of start reagent until coagulation, were recorded. The coagulation activities, found by the automatic method for the assays Thrombotest and Normotest, were compared with a manual method. Thrombotest showed a good correlation: 0.30 greater than P greater than 0.25 (paired t test). Normotest showed significantly different values by the methods: P less than 0.001 (paired t test). Kaolin Partial Thromboplastin Time (Activated Partial Thromboplastin Time with kaolin as activator) gave significantly lower vales--the difference was 3 sec--compared with a manual method, and the precision was considerably improved.


[Parkinson's disease and am-otrophic lateral sclerosis (case report) (author's transl)]. A 68 years old man affected by parkinson's disease for four years suddenly developed symptoms of a motor neuron disease. He also had a defect of his visual-spatial ability with an intra cerebral calcifications in right parieto-temporo-occipital region. The AA. discuss the nosological aspects of this case and do not accept the possibility of a chance occurrence of the two systemic degenerative diseases and favour a unification of nuerological abiotrophic diseases.


The degree of bone mineralization in different parts of human skeleton estimated from bone phosphorus/hydroxyproline. To evaluation the uniformity of the degree of mineralization in the skeleton the bone phosphorus/hydroxyproline ratio (bone P/Hypro) was determined in different localizations of ten human skeletons. Marked differences in bone P/Hypro were found between cortical bone and spongy bone. No difference was found between cortical bone from humerus, femur and cranium. But the mean value of these cortical bones was significantly higher than the mean value of the studied spongy bones. No significant correlation was found between the two bone types. Differences in bone P/Hypro were also found between different spongy bones. In pelvis the value did not differ between four spongy bone localizations but the mean value was significantly lower than for the other spongy bones (thoracal column, lumbal column and clavicle). Between these other spongy bones no difference was found in mean bone P/Hypro, and the mean of the pelvic bone localizations correlated significantly to the other spongy bones. The study demonstrates differences in the chemical composition of the human skeleton. A value of bone P/Hypro in the iliac crest can be used to estimation of bone P/Hypro in other spongy bones but not in cortical bones.


Mass fragmentographic demonstration of low amounts of beta-phenylethylamine in human urine. beta-Phenylethylamine (PEA) is determined with a simple, rapid and highly specific assay, 5 ml human urine, using GLC combined with mass fragmentography. The 24 h urinary excretion of PEA in ten healthy male subjects ranged from 28 to 131 nmol/24 h with a mean (+/- SD) of 66 (+/- 9) nmol/24 h. It is concluded that reinvestigation of PEA-excretion in psychiatric patients is needed, since earlier less specific methods have measured much higher levels of PEA in human urine.


[Possible activating effect of subnarcotic doses of some anaesthetic drugs in clinical electroencephalography (author's transl)]. The use of subnarcotic doses of anaesthetic agents has been proposed, in the last few years, as a practical method for enhancing EEG activities in epileptic patients. Barbiturates such as Evipan or Brietal were used in the present study. Both electrographic and clinical effects occurred not only with the intravenous administration fo Brietal and Evipan but also with Althesin (a new non-barbiturate drug), in two groups of suspected and confirmed epileptics having either a normal or specific EEG pattern. These results were then compared with a normal control group. In a high percentage of instances all these drugs were found to induce either focal or generalized increase of epileptiform activities, as well as the appearance of latent epileptic abnormalities. The AA. stress the advantages these new techniques as ascreening method in suspected epilepsy.


[CCNU in the chemotherapy of tumours of the central nervous system (author's transl)]. This study concerns 59 patients with primary and metastatic tumors of the CNS. After surgery, each patients followed a therapeutic protocol requiring Radiotherapy (5500 Rads for 6 weeks) and antiblastic monochemotherapy with CCNU (130 MG/M2/D p.o. every 8 weeks). The results were evaluated according to Wilson's (1975) criteria of response to therapy. CCNU significantly improved the survival time in comparison to the data given for conventional treatment.


A simple method for the estimation of glomerular filtration rate. A simple method is presented for indirect estimation of the glomerular filtration rate from two venous blood samples, drawn after a single injection of a small dose of [125I]sodium iothalamate (10 muCi). The method does not require exact dosage, as the first sample, taken a few minutes (t = 5 min) after injection, is used to normalize the value of the second sample, which should be taken in between 2-4 h after injection. The glomerular filtration rate, as measured by standard inulin clearance, may then be predicted from the logarithm of the normalized value and linear regression formulas with a standard error of estimate of the order 1-2 ml/min/1.73 m2. The slope-intercept method for direct estimation of glomerular filtration rate is also evaluated and found to significantly underestimate standard inulin clearance. The normalized 'single-point' method is concluded to be superior to the slope-intercept method and more sophisticated methods using curve fitting technique, with regard to predictive force and clinical applicability.


Application of the gamma function for the calculation of effective renal plasma flow by [131I]hippuran clearance. A simplified technique based on the gamma function was developed to determine the effective renal plasma flow (ERPF) by [131I]hippuran clearance. The method requires only one blood sample in addition to standard renography and the calculations can be performed on a small computer. A close correlation was found between the ERPF values obtained by the application of the gamma function and the values yielded by the conventional bi-exponential approach. The present method is well suited for clinical routine use in connection with standard renography.


The effect of inactivity on reactive hyperaemia in the human calf: a study with strain gauge plethysmography. In order to study the influence of muscular inactivity on reactive hyperaemia, postischaemic blood flow was measued with strain gauge plethysmography in the calf of twenty-nine patients, who had been treated with a plaster cast for a trauma of the lower limb. The contralateral leg served as a comparison. In all but two patients postischaemic maximal flow was lower in the immobilized calf. A negative correlation existed between maximal flow and the duration of immobilization. In the course of 6 weeks after removal of the cast, the difference in maximal flow between both sides became insignificant. Venous volume and venous emptying were not different in the two limbs. The effect of inactivity on reactive hyperaemic response may be explained by an effect of inactivity on the arterioles, muscle atrophy, a decrease in capillarization and in oxidative capacity of the muscle fibres. It is concluded that inactivity and atrophy of the lower limb musculature in patients with peripheral arterial disease may be a contributing factor to the low reactive hyperaemic response in the calf of such patients.


Tilted and non-tilted postischaemic exercise peak flow in the legs of normal human subjects. Peak flow was measured by radioactive xenon in fifteen normal subjects in the anterior tibial muscle after maximal ischaemic exercise. The postischaemic exercise peak flow was 75 +/- 13 ml/100 g muscle/min (mean +/- SD), when the test was performed while the subjects rested in the horizontal position. When the same test was performed with the subjects resting in a 45 degrees feet down tilted position, the peak flow increased very much, about 65%, and averaged 125 +/- 17 ml/100 g muscle/min. The increased peak flow in the feet tilted position is explained by passive dilatation of the vessels due to increased hydrostatic pressure. It is suggested, that measurement of maximal ischaemic exercise blood flow in the tilted position may be a more sensitive procedure for detection of minimal vascular changes due to the very high blood flow obtained.


The application of the Reaction Rate Analyser LKB 8600 as an automatic coagulometer. The application of the Reaction Rate Analyser LKB 8600 (RRA) as an automatic coagulometer is described. The RRA was slightly modified without interfering with its function as an enzyme reaction rate analyser. The endpoint of coagulation was recorded when the increase in absorbance exceeded 0.047 at lambda = 340 nm. The coagulation time was monitored by a counter with automatic print-out or by a recorder. The analytical dispersion, s(x)x, ranged between 0.01 and 0.05. Results (x, y) of the determination of the quantity of plasma coagulation factors (II + VII + X) by RRA and manually by visual recording could be expressed by y = 0.93x + 0.04, r = 0.96, n = 66 (method of Owren & Aas) or by y = 1.00x + 0.02, r = 0.98, n = 49 (Normotest). Similarly, plasma activated partial thromboplastin time (Activated Thrombofax) could be expressed by y = 0.99x + 5.00, r = 0.99, n = 23.


Closure of digital arteries in high vascular tone states as demonstrated by measurement of systolic blood pressure in the fingers. Finger systolic blood pressure (FSP) was measured indirectly in normal subjects and patients with primary Raynaud phenomenon by applying a thin-walled plastic cuff around the finger and a strain gauge more distally to detect volume changes. Inducing a high vascular tone in one or more fingers by direct cooling or intra-arterial noradrenaline infusion caused a marked drop in FSP in the exposed fingers, but not in the non-exposed fingers of the same hand. The fact that the non-exposed fingers retained the normal (arm systolic) pressure level is taken to indicate that palmar arch blood pressure also remained normal. In the high vascular tone state, a large transmural pressure difference must apparently be established before the digital arteries are forced open. The lowered opening pressure constitutes a manifestation of the closure phenomenon of the digital arteries described in patients with vasospastic arterial disease. It implies an underestimation of palmar arch systolic pressure measured indirectly on the fingers. FSP measured under these circumstances may be taken as an estimate of the vascular tone, and can be employed in diagnosis and quantification of vasospastic disorders.


Effects of local thrombinaemia and endotoxinaemia on hepatic circulation in the anaesthetized dog. The acute response of the hepatic circulation to thrombinaemia and endotoxinaemia were investigated in the anaesthetized dog. Small amounts of thrombin were infused into the hepatic artery and portal vein. The effects of thrombin were compared to those of minor amounts of portally infused endotoxin. Portal pressure increased significantly following portal infusion of thrombin and endotoxin. Both substances decreased the blood flow markedly in the hepatic artery, while that in the superior mesenteric artery and portal vein decreased only slightly. Heparin and polyphlorethin phosphate (PPP) abolished all effects of thrombin. Bradykinin infused simultaneously inhibited only the effect on the hepatic artery. Vasoactive intestinal peptide, which has the same vasodilatory effect in the liver, did not. It is believed that thrombin and perhaps endotoxin exert a vasoconstrictive effect mediated by products released from platelets.


Reference values for fibrinogen concentration and inhibitors of fibrinolysis. epsilon-Aminocaproic acid and tranexamic acid when added to whole blood will dissolve in the plasma and draw water from the cells in accordance with their concentration. When these compounds are added to whole blood in recommended amounts (10 mg/ml), the osmotic dilution of the plasma must be taken into consideration when concentrated solutions or dry substances are used.


A unified method for the determination of gold in biological fluids by flameless atomic absorption spectroscopy. A new simple non-flame method of assaying serum, urine, and synovial fluid for gold by atomic absorption spectrometry (AAS) is presented. Variable absorption not due to gold is avoided by wet ashing and extraction of gold into methylisobutyl ketone. The amount of gold is determined directly in the organic phase by AAS. A linear relation between standard concentrations for serum, urine, and synovial fluid and absorption meter read-out values is obtained over the ranges 0 to 800 microgram gold/dl in serum and 0 to 80 microgram gold/dl in urine and synovial fluid. The estimated calibration curves for gold in serum, urine, and synovial fluid are found to be identical. The elimination of interferences, the high sensitivity (0.01 ppm), and the simplicity make this method superior to any other AAS methods and excellently applicable for routine determinations of gold concentrations in patients on chrysotherapy, and for research in that field as well.


The influence of age on reactive hyperaemia in the human calf: a study with strain gauge plethysmography. Postischaemic reactive hyperaemia in the calf was investigated by strain gauge plethysmography in four groups of ten subjects. The mean age of the different groups was 6, 13, 24 and 57 years respectively. Basal calf flow, repayment and recovery time in the 6-year-old children were greater than in the other groups, which may be related to a higher metabolic rate in young children. Maximal flow in the four groups was not significantly different, which indicates that the arteriolar response to circulatory arrest is not altered by increasing age. The cause of delay in maximal flow in the group of 6-year-olds is not clearly understood. Basal and postischaemic lowest peripheral resistance increased with age, which is probably caused by changes of the arterioles due to ageing and possibly inactivity. The fall in peripheral resistance induced by 3 min of ischaemia was positively correlated with mean blood pressure. This may be due to a greater net reduction in blood pressure during ischaemia, which brobably elicits a stronger myogenic response of the vessel wall. It is concluded that in clinical use of the reactive hyperaemia test in the calf, the influence of age is of minor importance, whereas postischaemic peripheral resistance is a more accurate measure of vasocilation for comparison of subjects with different blood pressure.


Reactive hyperaemia in the calf of trained and untrained subjects: a study with strain gauge plethysmography. Postischaemic reactive hyperaemia in the calf was investigated by strain gauge plethysmography in three pairs of trained and untrained groups of different ages. Maximal flow and repayment in the trained adults were greater than in corresponding untrained groups. This may be due to training effect on the arterioles and a relatively great muscle volume and vascular bed in athletes. The 58-year-old trained men revealed a postischaemic hyperaemic response of approximately the same magnitude as the 25-year-old athletes. Training in old age may result in less degeneration of vascular smooth muscle as well as striated muscle and may induced a relatively great cardiac stroke volume, factors which probably influence reactive hyperaemia in the calf. Hyperaemia in 13-year-old children of different conditions of training was approximwtely the same. It is concluded that the influence of training state on postischaemic calf flow may be considered when reactive hyperaemia is used as a test of the peripheral circulation.


Inhibition of furosemide-induced natriuresis by acetylsalicylic acid in dogs. The effect of intravenously administered acetylsalicylic acid (ASA) has been investigated in two sets of experiments in conscious dogs. In the first part of the study ASA 70-90 mg/kg was infused for 40 min. Urine flow, free water clearance, renal blood flow and urinary excretion of sodium did not change significantly as compared to placebo treated animals. This is in contrast to the effects of comparable ASA doses in the pentobarbital anaesthetized dog. In the second part of the study the effects of pre-treatment with the same ASA doses of 5 ml 0.6% NaCl (placebo) on some renal effects of furosemide 1 mg/kg (intravenously) were investigated. In the placebo group acute furosemide treatment increased CIN in five out of six dogs and CPAH in all six dogs, these increases being most prominent the first 10 min after drug administration. After pre-treatment with ASA the initial increases in CIN and CPAH were almost abolished. CIN was reduced by 23.8% and CPAH by 30.6% during the first six clearance periods (0-6- min) after diuretic treatment in the ASA group as compared to the placebo group. Although urinary sodium excretion also increased in ASA pre-treated dogs, the effect of furosemide was greater in all dogs in the placebo group (P less than 0.05), and the effect of furosemide on fractional tubular reabsorption of sodium was significantly attenuated after pre-treatment with ASA.


Creatinine clearance, urinary excretion of glomerular basement membrane antigens and renal histology in congenital nephrotic syndrome of Finnish type. The endogenous creatinine clearance and urinary excretion rate of glomerular basement membrane (GBM) antigens were followed from 2 to 19 months in fifteen patients with congenital nephrotic syndrome (CNF). The quantitative examination of renal morphology was made on fourteen of these patients. Creatinine clearance increased during the first few months of life and thereafter gradually decreased. The urinary excretion rate of GBM antigens rose during the course of the disease. The creatinine clearance did not correlate significantly with glomerular fibrosis but it did correlate with tubular atrophy and interstitial fibrosis. The urinary excretion of GBM antigens correlated significantly with glomerular and interstitial fibrosis and with tubular atrophy. It is concluded that there is a clear progress in the disease and the renal histological changes probably are caused by accumulation of GBM material in glomeruli.


Effect of Verapamil on pancreatic glucagon release from the isolated, perfused canine pancreas. The effect of Verapamil, a potent calcium antagonist, upon pancreatic glucagon release was investigated in the isolated, perfused canine pancreas. Verapamil at concentrations ranging between 10(-5)-10(-4) mol/l caused a dose-related inhibition of glucagon release at a glucose concentration of 25 mg/dl. The inhibition was an immediate and reversible phenomenon. The inhibitory effect was reduced when the Ca2+ concentration was increased from 1.3 to 5.0 mmol/l. The results are compatible with earlier findings from our laboratory demonstrating that calcium plays a key role in the stimulus-secretion coupling of glucagon release.


Cigarette smoking and maximal oxygen consumption rate in humans. The relationship of maximal oxygen uptake with tobacco consumption was investigated in sixty-one young males. There was a significant negative correlation between daily consumption of tobacco and measured maximal oxygen uptake (Vo2max) expressed relative to body weight (r = -0.368, P less than 0.01) and to lean body mass (r = -0.497, P less than 0.001), respectively. No correlation could be demonstrated with regard to predicted maximal oxygen uptake (Vo3maxp). No difference was demonstrated between Vo2maxp and Vo2max in nonsmokers and heavy smokers, whereas Vo2maxp was significantly higher (P less than 0.01) in the group of moderate smokers than Vo2max. It is concluded that tobacco smoking decreases Vo2max even in young moderate smokers. Smoking habits should be considered among factors affecting Vo2maxp from cardiac frequency at submaximal levels.


A rapid and precise sequential saturation radioimmunoassay for thyroxine. A radioimmunoassay for the measurement of total thyroxine in unextracted serum or plasma is described. The assay is performed according to the sequential saturation principle in less than 4 h. The entire assay is carried out at room temperature. An antiserum of high affinity was used as binder, ammonium 8-anilino-1-naphthalene-sulphonate as displacing agent, and activated charcoal as adsorbent in the separation step. The standard curve was linear in the range 0-136 nmol/l serum. The precision in terms of SD was nearly the same through-out this range. Estimates of within-assay SD varied from 1.3 to 4.1 and between-assay SD from 0 to 3.3 nmol/l. The recovery of thyroxine added to normal plasma was 100% and the sensitivity was 6 nmol/l. Mean thyroxine concentration in plasma from young bulls was 92 nmol/l. The assay appears to be very well suited for experimental purposes when high precision is essential.


Radioimmunoassay of secretin in plasma.

Radioimmunoassay of secretin in plasma. A sensitive and specific radioimmunoassay for secretin has been developed. 125I synthetic porcine secretin was used as label. Antibodies were raised against synthetic pocrine secretin. Pure natural porcine secretin was used as standard and free and bound hormone was separated by plasma-coated charcoal. Nonspecific interference with the assay system by plasma factors was abolished by extraction of plasma samples. The detection limit was 1.3 pmol/l. Within and between assay reproducibility (five triplicate determinations in each of eight assays) was 0.7 and 0.9 pmol/l respectivel  (1 SD) at a concentration of 4.7 pmol/1. Fasting level in seventy normal persons ranged from less than 1.3 to 5.3 pmol/1. High concentrations were found in two patients with Zollinger-Ellison syndrome. In six normal persons intraduodenal acidification was immediately followed by an increase in secretin concentrations in peripheral venous blood to 7.7-23.6 pmol/1 (range), with a median of 15.5 pmol/1. In six anaesthetized pigs a fifty-fold increase in portal plasma secretin concentration after duodenal acidification was followed by a thirty-fold increased in the flow rate of pancreatic juice.


Free choline in human plasma analysed by simple radio-enzymatic procedure: age distribution and effect of a meal. Ultrafiltration of plasma was shown to be a simple and rapid method to obtain a stable sample for direct measurement of free choline (Ch) in plasma by a radioenzymatic procedure. Free Ch was analysed in plasma from healthy volunteers fasted 12-15 h and 1 h after a meal. The free Ch concentration was found within narrow limits with a mean of 10.6 +/- 0.4 mumol/l in the fasted subjects and 11.5 +/- 0.3 mumol/l 1 h after a meal. The difference is significant (paired t test, P less than 0.01, n = 23). Dietary influence on the free Ch concentration in human plasma is suggested. In three newborn infants (1-3 min post partum) the Ch concentration in plasma from the umbilical vein was 24.5 +/- 1.9 mumol/l.


The mechanism of orthostatic and haemorrhage fainting. In order to study the adjustment of central circulation to postural changes and the mechanism of orthostatic fainting, the pressure in the brachial artery, the pulmonary artery, the right ventricle and heart rate (HR) were recorded in sixteen healthy young men, both supine and after tilting to 45 degrees and 90 degrees head up, before (normovolaemic, NV) as well as after (hypovolaemic, HV) withdrawal and reinfusion of (mostly) 950 g blood (about 15% of blood volume, BV). Two subjects fainted in supine HV, two in 90 degrees NV, four disclosed impending symptoms of fainting, and two fainted in 90 degrees HV. 'Fainters' differed from the others by smaller BV in relation to body height, higher HR in 90 degrees NV and lower arterial mean pressure in HV. In the three fainting situations, right ventricular enddiastolic pressure (PRveD) was markedly lowered to or below 0 mmHg. Arterial diastolic pressure (PaD) was not correlated with PRveD, but the pulse pressure decreased with the fall in PRveD. In 90 degrees HV, PaD fell in the six subjects who fainted or disclosed impending symptoms. Irrespective of the situation, the fainting attack involved a sudden decrease of HR and arterial pressure, concomitantly with a first unchanged then increased PRveD and/or pulmonary artery diastolic pressure. A reflex control of the filling volume/pressure of the heart is assumed to precipitate fainting by counteracting the arterial blood pressure regulation.


Increased transcapillary escape rate of albumin and IgG in essential hypertension. Transcapillary escape rates of albumin and IgG (fractions of intravascular mass of albumin and IgG that pass to the extravascular space per unit time) were determined simultaneously from the initial disappearance of intravenously injected 131I human albumin and 125I human IgG in seven untreated subjects suffering from essential hypertension. The average mean arterial blood pressure of these subjects 193/119 mmHg; four subjects had grade I-III funduscopic changes. Transcapillary escape rates of albumin (TERalb) and IgG (TERIgG) were found significantly increased in the hypertensive subjects, average 7.8 +/- 0.9 (SD) and 4.7 +/- 1.0 (SD) %/h, respectively, compared with normal values of mean 5.2 +/- 1.0 (SD) and 3.0 +/- 0.7 (SD) %/h, respectively (P less than 0.01). There was a statistically significant positive correlation between the mean arterial blood pressure and TER of albumin and of IgG (P less than 0.001). The TERIgG/TERalb ratio was about the same in the hypertensives and the normals. Confirming a previous observation, we found an increase in the daily urinary albumin excretion rate from a normal average of 9.1 (range, 2.4-20.4)mg/24 h to 96 (range, 5.6-565) mg/24 h, P less than 0.05. The present findings can best be explained by increased filtration through normal pores between the endothelial cells in the microvasculature, due to the high arterial blood pressure.


Forearm glucose uptake during glucose tolerance tests in chronic alcoholics. In twelve chronic alcoholics the glucose uptake in a forearm segment was studied during glucose tolerance tests. The tests were performed twice in each case, on the 3rd and on the 10th to 14th days after admission to hospital in an intoxicated state after a period of excessive alcohol intake. The total forearm glucose uptake following an oral glucose load almost doubled from the first to the second examination. Arterial glucose and insulin concentrations were similar on the two occasions. The findings indicate that the disposal of an oral glucose load is altered during the recovery after a period of excessive alcohol intake. The contribution made by muscle tissue increases twofold while that of the liver decreases.


Effects of different doses of acetylsalicylic acid on renal oxygen consumption. The aim of the present study was to examine the acute effect of acetylsalicylic acid (ASA) on renal oxygen consumption (Qo2) and renal sodium excretion (UNaV) in anaesthetized dogs. With plasma salicylic acid (SA) concentrations ranging from 200-400 microgram/ml, Qo2 increased 36% (P less than 0.05) in spite of a 16% decrease in renal blood flow. At plasma SA concentrations of 80-200 microgram/ml Qo2 was significantly increased 45 min after the onset of ASA infusion. UNaV decreased from 97.7 to 21. 5 mumol/min (P less than 0.05). Glomerular filtration rate and absolute tubular reabsorption of sodium (RNa) was unchanged. The ratio RNa/Qo2 decreased from 31.0 to 21.3 (P less than 0.05). Renal lactate uptake increased. The results are most consistent with an uncoupling affect of ASA on oxidative phosphorylation in the kidney.


Serum lipids and latent coronary insufficiency. A group of 2014 'healthy' men were examined clinically, by resting ECG/exercise ECG and by the estimation of serum cholesterol and triglycerides. On repeated collection of specimen, standardization of factors related to the individual and influencing serum lipids was difficult to obtain. Thus, serum triglycerides were higher early in the week, at least partly due to habits of alcohol consumption. 140 of the participants (7.0%) were suspect of coronary heart disease (CHD) according to their symptoms/signs, and coronary angiography in 105 of them showed sixty-nine cases (3.4%) with pathological angiograms. Values for serum cholesterol and triglycerides are presented from a subgroup of 1832 men where no signs of CHD were found. Serum cholesterol and triglycerides were significantly higher in the group with pathological angiograms.


Binding of bilirubin and long-chain fatty acids to human serum albumin with general remarks on displacement of firmly bound ligands. Binding of bilirubin to human serum albumin was studied by estimation of the free bilirubin concentration from the rate of oxidation with hydrogen peroxide and peroxidase, and by spectrophotometry: nI = 1, kI = 7 x 10(7) l/mol; nII = 1, kII = 5 x 10)5) l/mol, at pH 7.4, 37 degrees C, ionic strength 0.1. Palmitate or oleate in excess of 4 mol per mol albumin, influences the high-affinity binding of bilirubin as described by an empirical equation. Theoretical consideration of competitive displacement of a biologically active substance, firmly bound in an inactive state to a macromolecular carrier, demonstrates that significant displacement may occur on addition of another ligand with a lower binding constant. Displacement of bilirubin from its high-infinity site by fatty acids and drugs is thermodynamically feasible and probably clinically important.