Essential considerations in the use of EMG biofeedback. In light of a developing, widespread interest in electromyographic biofeedback as both a clinical and research modality, this article reviews basic factors that the physical therapist must consider for successful biofeedback applications. These factors include the proper use and care of electrodes, correct grounding procedures, and appropriate feedback displays.


Antibiotic iontophoresis in the treatment of ear chondritis. This apparently successful management of suppurative ear chondritis by employing antibiotic iontophoresis does suggest a clinical potential for the use of the procedure. The authors recommend further research to document the efficacy of this procedure as this clinical report does not involve a large sample or sufficient experimental controls, such as selection of medication, dosage values, and confirmation of tissue content of the medication. Factors favoring the trial use of antibiotic iontophoresis, particularly before the permanent disfigurement of extensive chondrectomy or amputation, are 1) reported past experimental confirmation of the effectiveness of iontherapy, 2) the expected small incidence of procedural complications, 3) the ease of application, and 4) the usual absence of discomfort.


The effect of verticality perception on body balance in normal subjects. The relation between verticality perception and body balance as influenced by perceptual style, age, and sex was investigated in 100 subjects. Perceptual style was measured by the Rod and Frame Test. Body balance data were obtained by two electromechanical force plates. The results of the measurements of perceptual style indicated that the younger groups were more accurate in estimating verticality than the older groups and that men were more accurate than women. With regard to the body balance shift data, however, no significant differences relative to age, sex, or perceptual style were found. The rejection of the hypothesis concerning body balance shift was interpreted in terms of the dominant influence of proprioceptive cues over visual cues in maintaining body balance. In normal standing activities, as long as the neuromuscular system is intact, conflicting stimuli from the visual field appear to have little effect on modifying body balance.


Isometric torque of the finger extensors at the metacarpophalangeal joints. A pilot study was undertaken to evaluate the isometric torque produced at the metacarpophalangeal joint during finger extension. Fifteen women with normal right hands, aged 21 to 29 years, participated. Each subject was tested for maximal force of isometric extension at the metacarpophalangeal joint angles of 0, 30, and 60 degrees on each of the four fingers. Torque was computed by multiplying the recorded tension and measured length of the proximal phalanx (lever arm). The mean torque for the long finger was significantly greater than the average torque for each of the other three fingers. The mean torque at the joint angle of 60 degrees was significantly greater than at 0 degrees but not at 30 degrees. Reasons for the findings are discussed.


Revascularized periosteal grafts--a new method to produce functional new bone without bone grafting. Rib periosteum was transplanted to the groins of 9 dogs. In half of the periosteal grafts, no microvascular anastomoses were done (free grafts); at 6 weeks after grafting they had become resorbed. The other periosteal grafts were revascularized by microvascular anastomoses of the intercostal vessels to local muscular vessels; at 6 weeks those with confirmed vascular patency had all formed substantial amounts of new bone. Five cm, full-thickness defects were created in the tibias of 10 dogs. The control animals (without grafting) did not heal in two months. However, the experimental dogs, with vascularized periosteal grafts in the defects regenerated their tibias with healthy new bone by 6 weeks--and were walking on them then.


A transaxillary incision for gynecomastia. The transaxillary approach for excision of gynecomastia has been used in 7 patients, with good results. The lack of any visible scar on the chest is a worthwhile advantage.


Replacement of damaged arteries and veins with vein grafts when replanting crushed, amputated fingers. Two cases are presented in which multiple vein grafts were used to revascularize several digits in hands injured by severe crushes. One case had partial amputations of 4 digits, and the other had 4 complete amputations. After debriding the damaged parts of the vessels, we interposed vein grafts in both the arterial and venous circulations to the digits. Seven of 8 revascularized digits survived. In crushing injuries, it is essential to debride the vessels proximally and distally to where the intima has not been injured. To bridge the gaps, vein grafts can be used successfully where other methods are undesirable or impossible.


Use of rotation scalp flaps for treatment of occipital baldness. We have used 25 rotation scalp flaps to treat occipital baldness associated with fronto-parietal baldness (the third flap), and 35 such flaps for the correction of isolated occipital baldness. We have not had any flap necrosis, and our patients have been well satisfied with the results of this surgery.


Reduction mammaplasty: nipple-areola survival on a single breast quadrant. Nipple viability was retained in 165 breasts undergoing reduction mammaplasty without dermal pedicles--even when 3 quadrants of the breast were excised. This technique adds versatility in shaping the breast and permits resection of the hypertrophied portions of the breast, rather than predetermined segments. It allows one to translocate and reposition the nipple-areola without tension or kinking of the breast parenchyma. It gives the patient esthetically pleasing breasts.


Importance of the ribbon sign, indicating unsuitability of the vessel, in replanting a finger. A marked tortuosity of the digital arteries ("ribbon" sign) at the site of a digit amputation is a sign of a severe avulsion injury to the neurovascular bundles. When this finding is present, the artery should be resected and the gap bridged by a vein graft, if revascularization is attempted.


Face-lift complications: a study of 922 cases performed in a 6-year period. A positive correlation between nausea and vomiting and the occurrence of postoperative hematoma was demonstrated in a series of 922 consecutive face lifts during the past 6 years. Intraoperative or postoperative hypertension did not play a statistically significant role in hematoma formation. Establishment of good patient rapport, conservative management of complications, and judicious revision of disfiguring scars are most important in dealing with the inevitable problems which arise following face lift operations.


Can one muscle reinnervate another? A preliminary study of muscular neurotization in the rabbit. A laboratory model for study of possible reinnervation at the muscle level is presented. The preliminary histochemical results suggest that muscular neurotization occurs following removal of the investing fascia. However, the muscle atrophy (which follows denervation) continues to take place in spite of such reinnervation. The potential clinical relevance of these findings to free muscle grafting is discussed.


Experience with malignant melanoma of the head and neck. Data on 127 patients with malignant melanoma who had a minimum 5-year follow-up have been analyzed. A good, though not yet significant, correlation appears to exist between length of survival and the diameter and the thickness of the primary lesion, the level of the tumor invasion, and the type of melanoma. A further analysis of patients with Stage I disease lends support to the use of "prophylactic" node dissection when the primary lesions penetrate to levels 4 or 5, or when they are 1.5 mm or greater in thickness. Our current overall approach to the management of malignant melanoma of the head and neck is outlined.


Ten years of experience in managing patients with burn contractures of axilla, elbow, wrist, and knee joints. An analysis of 625 patients who had sustained burns across the axillae, elbows, wrists, or knee joints indicates that the use of splints and pressure across these joints will not only greatly decrease the incidence of contractures but will also reduce the frequency and need for release operations. However, these appliances must be used for at least 6 months (longer, if possible), if substantial benefits are to be obtained.


Immediate insertion of silicone rubber rods in fingers with cut flexor tendons. In 7 patients with cut flexor tendons of the hand, we did an immediate quantitative bacterial analysis of the wounds. These showed fewer than 10(5) bacteria per gram of tissue, so we inserted silicone rubber rods in 10 of these fingers. All healed without infection, and this shortened the reconstruction. In retrospect, we believe it best not to insert the rods primarily in crush injuries. However, this seems to be a safe, worthwhile measure for those patients with sharp injuries of the tendons.


Fibrinolytic activity in vascular grafts. We have demonstrated the absence of tissue fibrinolytic activator for 11 days following the transplantation of vascular grafts in dogs. The lack of a local tissue fibrinolytic activator (to dissolve intravascular thrombi) is suggested as an etiological factor in losses which occur during the first 11 days after digital replantation.


Angiographic diagnosis of renal tumors associated with polycystic disease. Two cases of renal cell carcinoma associated with polycystic disease of the kidney are presented. The literature is reviewed and the angiographic findings are discussed. These cases suggest that angiography is necessary to make the diagnosis of renal tumors associated with renal polycystic disease.


Biplane arteriography in ischemia of the lower extremity. A technique for simultaneous bilateral biplane arteriography of the abdomen, pelvis, and lower extremities is described. The biplane views provided clinically significant information in approximately 40% of cases.


Xeromammographic automatic exposure termination. A method of automatic exposure termination (AET) for xeromammography has been devised, significantly reducing the rate of repeat exposures due to poor choice of manual exposure factors. AET images are of good quality and are reliably produced. The concept of AET is based on the existence of an optimal transmitted exposure to the selenium plate, which is easily determined experimentally. In routine clinical xeromammography, a repeat rate of 20% was eliminated by the use of AET.


Assessment of the radiologist's work load as related to various examinations and clinical departments. Results obtained from Roentgen-Tele-Data, an automatic data processing system, and the Scandinavian point system are described. The point system is based on time studies for radiolodiagnostic examinations, including special techniques. The radiologist's work load for various examinations is analyzed. The resultant survey of departmental activities based on examinations versus point values differs significantly; point values better evaluate departmental efficiency and future planning.


Computed tomography of the thorax.

Computed tomography of the thorax. Computed tomography (CT) provides a valuable new perspective in assessing abnormalities of the thorax. In the patient with a mediastinal mass or widening detected by plain chest radiography, a definitive diagnosis is sometimes possible which would not be obtainable by conventional noninvasive radiological techniques. In certain clinical situations, CT is a highly sensitive modality for examining the lungs. The proved and potential clinical uses of CT in solving diagnostic problems of the thorax are discussed.


Spectrum of medulloblastomas demonstrated by computed tomography. Twenty-two patients with medulloblastomas were evaluated by computed tomography. Pretreatment evaluation in 13 patients has shown the various presentations of the tumor. Eighteen of the patients have had post-therapy computed tomographic studies. Computed tomography is sensitive in detecting residual and locally recurrent tumor as well as tumor seeding by cereborspinal fluid pathways. Computed tomography has proved to be valuable in patient management and in evaluating the effectiveness of various forms of treatment. The present group of medulloblastomas is compared to other pediatric posterior fossa tumors and differential diagnoses are discussed.


Complementary use  of ultrasound and computed tomography in studies of the pancreas and kidney. 113 cases of pancreatic and renal disease studied by both ultrasound and computed tomography (CT) were analyzed retrospectively. CT provided a diagnosis when pancreatic ultrasound was unsuccessful due to overlying bowel gas or obesity and when renal ultrasound was unsuccessful due to obesity, reverberations from ribs, small lesions, or multiple lesions. Conversely, ultrasound provided a diagnosis when CT was unsuccessful due to lack of fat planes or respiratory motion. CT usualy distinguished carcinoma from pancreatitis when ultrasound showed a focal echogenic mass. CT resolved renal cyst from neoplasm when ultrasound showed a mixed echo pattern mass.


CT scanning and ultrasound in the evaluation of pancreatic pseudocysts: a preliminary comparison. A retrospective review of 12 surgically proved cases of pancreatic pseudocyst was performed. CT correctly demonstrated 6/8 uncomplicated pseudocysts and 4/4 infected pseudocysts. Ultrasound identified 7/8 uncomplicated and 2/4 infected pseudocysts. Errors by one modality are due to limitations not shared by the other method. This suggests a basis for the complementary use of CT scanning and ultrasound in the evaluation of suspected pancreatic pseudocysts.


CT-pathologic correlations in Hodgkin's disease and non-Hodgkin's lymphoma. In order to assess its potential uses in the staging and treatment planning of lymphoma, CT was performed in 27 newly diagnosed, previously untreated patients with Hodgkin's disease or non-Hodgkin's lymphoma; 18 staging laparotomies provided pathologic correlations. CT detected and defined disease in areas not well evaluated by conventional techniques (high para-aortic, mesenteric, splenic hilar nodes). CT interpretation of splenic size and weight correlated well with splenic weight confirmed at pathology. Nodules were identified in several spleens containing foci of lymphoma.


An evaluation of current diagnostic radiologic modalities in the investigation of acoustic neurilemmomas. The radiologic investigation of patients with suspected acoustic neurilemmomas may include specialized plain films, thin-section tomography, CT scanning with intravenous contrast enhancement, Pantopaque cisternography, radionuclide scanning, angiography, and pneumoencephalography. Recently we have used intrathecally enhanced (Amipaque)2 CT cisternography tostudy the cerebellopontine angles and fourth ventricle. An assessment is made of the differential diagnostic value and limitations of radiologic modalities both in tumor detection and in accurate localization. A protocol designed to optimize use of the available radiologic modalities is projected from 30 patients with acoustic neurilemmomas.


CT determination of parameters for inhomogeneity corrections in radiation therapy of the esophagus. Accurate dose prediction for megavoltage photon therapy of carcinoma of the esophagus requires information on tumor depth, lung thickness, and lung density. The authors found that CT localization of internal and external contours is accurate within +/- 1 mm. Lung density can be measured with an error of less than 0.02 g/cm3 in the range 0.25-1.00 g/cm3. Variance between predicted and measured dosage was less than 3% in all patients and in most RANDO phantom measurements. Accurate radiation therapy planning is possible with CT information from a commercial scanner.


Radionuclide imaging in herpes simplex encephalitis. Eight patients with herpes simplex encephalitis among the 10 cases diagnosed at the University of Kansas Medical Center from 1966 to 1976 were studied with 99mTc early in their diagnostic work-up. The images were unilaterally positive in the temporal lobe area in all 8 patients. Radionuclide studies can suggest herpes simplex as the specific etiology in cases of encephalitis and can also indicate the best site for brain biopsy to confirm the diagnosis by fluorescent antibody techniques. Appropriate antiviral therapy should be instituted as soon as possible to alter the course of this destructive form of viral encephalitis.


Ratio of late to early radionuclide uptake: a method for distinguishing osteoporosis from osteomalacia in animal models. The ration of late to early uptake of several radionuclides was examined as a method for distinguishing states of abnormal bone metabolism. Nutritional osteoporosis (secondary hyperparathyroidism) and osteomalacia were produced in young rats and compared to a control group. The ratio of early (3-6 hrs.) to late (4-6 days) uptake of barium-131, nitrate, indium-111 EDTMP, and lead-203 were studied, as was that of strontium-85 chloride, a calcium analogue. Ratios of late to early uptake were found to distinguish osteomalacia from osteoporosis in the models when strontium-85 or barium-131 were used. Barium-131 may be a clinically useful alternative to strontium-85 in the evaluation of metabolic bone disease due to its shorter half-life and lower radiation dose.


Unilateral pulmonary edema.

Unilateral pulmonary edema. Unilateral pulmonary edema was found to occur following or in conjunction with 18 different clinical situations. In half of them the edema developed on the same side as the causative factor and was related to conditions altering the delicate balance at the alveolar-capillary interface. In the other situations, pulmonary capillary perfusion was deficient on the opposite side prior to the onset of edema.


Accumulation of 99mTc-diphosphonate in hepatic neoplasm. Bone images revealed excessive accumulation of radionuclide within a lesion in the liver which was suspected to be a metastasis from a primary carcinoma in the gastrointestinal tract. A "doughnut sign" of the liver with 99mTc-diphosphonate is rare, and the possibility of specific tumor uptake of this nuclide should be kept in mind.


The in vivo measurement of the total iodine content of the thyroid gland by x-ray fluorescence. An accurate, in vivo Am-241 excited x-ray fluorescence techniques was investigated for exploring the correlation between thyroid iodine content (TIC) and various thyroid disorders. The correction for fluorescent x-ray absorption by overlying tissues was made by using the x-ray to gamma ray peak ratio from administered I-123 as an index of thyroid gland depth. In a series of phantom studies, TIC was measured with an uncertainty of +/- 11%, and the depth correction added another +/- 26% error. Radiation doses to the patient were estimated with TLD measurements to be about 15 mrem from I-123, and 13 mrem from Am-241.


The persistent loop sign in neonatal necrotizing enterocolitis: a new indication for surgical intervention? A new radiographic sign in neonatal necrotizing enterocolitis is described. Five patients with necrotizing enterocolitis exhibited an unchanging dilated loop of small bowel, which was followed by perforation in 3 infants; the other 2 had surgical and/or autopsy corroboration of profound bowel-wall necrosis. It is suggested that infants with a "persistent loop" be considered candidates for laparotomy.


Measurement of vesicoureteral reflux with intravenous 99mTc-DTPA compared to radiographic cystography. The results of a 99mTc-DTPA study of vesicoureteral reflux in 51 children with recurrent urinary tract infections were compared with those of radiographic micturition cystourethrography. Reflux, shown by either of the two methods, was regarded as an indication of the disorder. Neither method was regarded as a standard reference method. Agreement between the two methods was obtained in 90 of 102 renal units, i.e., ureter and/or renal pelvis (88%). Statistical analysis performed on the remaining 12 cases showed that the two procedures usually gave similar results.


Comparison radiographs in extremity injuries of childhood: current application in radiological practice. Comparison radiographs may be used to confirm subtle extremity fractures or dislocations in children. Some suggest that such views be routinely obtained. As determined by questionnaire, however, a clear majority (2:1) of pediatric radiologists do not currently utilize this procedure. Factors determining this are discussed.


Problems in the application of ultrasonography for the evaluation of pleural opacities. Fifty-nine patients with pleural abnormalities on chest radiographs were evaluated by B-mode ultrasonography; the lesions were categorized as echo-free or complex. Echo-free lesions included pleural fluid collections, and abnormalities which did not yield "fluid" through an appropriately positioned large caliber needle. "Complex appearing" lesions yielded fluid through a needle in all cases. Ultrasonography could not accurately predict which lesions were amenable to successful thoracocentesis. Findings from recent radiographs and clinical history must be known when the ultrasonographic findings in patients with chest abnormalities are interpreted.


Grey scale ultrasonography in the diagnosis of ectopic pregnancy. Grey scale pelvic ultrasonography was performed in 36 patients with suspected ectopic pregnancy and in 3 with pelvic mass and bleeding. Thirteen cases were diagnosed as extrauterine pregnancy which was confirmed at operation. There were one false-positive and 2 false-negative studies. The overall diagnostic accuracy was 92.3%. The major diagnostic criteria in unruptured ectopic pregnancy were an extrauterine gestational sac or fetus and an abnormal uterine echo pattern. In addition, a complex mass due to hematoma was seen in ruptured ectopic pregnancy. Chronic ruptured ectopic pregnancy simulated pelvic inflammatory disease and was difficult to diagnose.


The unsoftened portion of the uterus: a pitfall in gray-scale ultrasound studies during mid-trimester pregnancy. A review of 322 second-trimester gestations evaluated with gray-scale ultrasound frequently revealed a locally thickened or "unsoftened" portion of the uterus. The texture and gray-tone patterns of this region as well as the other gestational components are reviewed; pitfalls in identification are outlined, and factors responsible for difficulty in amniocentesis are reported.


Reexamination of the deleterious effects of gastrointestinal contrast material on abdominal echography. Diagnostic ultrasound examinations of the abdomen are usually performed prior to barium studies due to deleterious effects of gastrointestinal contrast material on abdominal echography, as demonstrated by Leopold. The authors repeat the classic in vitro study, extending the time of the experiment. As barium settles, ultrasound is able to penetrate barium filled masses. A clinical case of barium filled stomach secondary to gastric outlet obstruction is presented in support of the in vitro findings. Patients with persistent collections of barium of one or two days' duration may undergo abdominal ultrasonic examinations.


Gray-scale echographic visualization of a parathyroid adenoma. A large parathyroid adenoma and a smaller follicular thyroid adenoma were visualized with a combination of radionuclide imaging and gray-scale ultrasound in a patient with primary hyperparathyroidism.


The effectiveness of radiation therapy in the treatment of bone metastases from breast cancer. The authors studied 75 patients with 158 areas of bone metastases from breast cancer treated by radiation therapy. The treatment regimen used was usually 2000 to 2500 rads delivered over a period of 2 weeks. Both subjective and objective responses were evaluated. This dose schedule proved to be highly effective in symptomatic relief and in healing osteolytic lesions; various levels of pain relief for about one year were observed in 96% (151/158 treatment areas), and radiographic evidence of recalcification was observed in 78% (73/94 treatment areas examined by serial radiography). After cases from previous studies were incorporated, the subjective response rate of the overall group was 91% (191/212) for a mean duration of 12 months, and the objective response rate was 75% (151/202) for a mean duration of 9 months.


Spinal cord protection during cross-fire irradiation of the intrathoracic esophagus: tube-tilt vs. Shielding. The protection of the upper thoracic spine achieved by a tube-tilt technique was found to be comparable to that obtained from direct shielding during cross-fire therapy of the intrathoracic esophagus. An isocentric technique was utilized which included one anterior and two posterior-oblique fields. Significant underdosages to the esophagus at levels superior to the isocenter are caused by tube-tilt, whereas direct shielding resulted in a uniformity of esophageal doses to within 5%. The need for a tissue compensator for the anterior field must be assessed on an individual basis from off-axis treatment planning.


The intensity of scattered radiation in mammography. The ratio of scattered-to-primary radiation has been measured for a range of x-ray tube voltages, field sizes and phantom thicknesses that typify clinical mammographic situations. The relative intensity of scattered radiation measured was essentially independent of kVp but increased as the phantom thickness and radiation field size increased. For the range of field sizes and phantom thicknesses that typify clinical situations the intensity of scattered radiation varied from about 40 to 85% of the primary beam intensity indicating that only from about 54 to 71% of the primary beam contrast is imaged in mammography.


Effect of air space and depth dose in electron beam therapy. In electron beam therapy, alterations in dosimetry occur as a result of air space between the end-of-treatment cone and the skin surface. A large air gap may be introduced in order to obtain a field size larger than that available at the cone end. Needed dosimetry corrections related to these air space problems are discussed, along with a proposed method of measuring effective source-to-cone end distance. Data presented show the modifications of a dosimetric field which occur with an increase in the air space below the treatment cone.


Pulmonary steal syndrome: an unusual case of coronary-bronchial pulmonary artery communication. The authors report a patient with angina pectoris in whom selective left coronary angiography demonstrated that the pulmonary artery branch to an apical lung segment was supplied by a bronchial collateral vessel which arose from the left circumflex artery. The anatomic and physiological developmental mechanisms, and the clinical implications, are discussed. Relief of the patient's angina following ligation of the pulmonary artery branch indicated the development of a form of pulmonary steal syndrome.


Time-dose effects in the matching of adjacent radiotherapy fields. When adjacent radiotherapy fields are treated in different times, the dose fraction at the junction of the fields is different from that within the portals. When the width of the gab between the fields is adjusted to produce equality of dose at the junction, it will not give equality with respect to radiobiological effect. The authors have used Ellis's NSD equation to take into account time-dose relationships in the matching of adjacent fields. Distribution of physical dose and biologically effective dose in the region near the junction of opposed pairs of parallel 60Co fields are given.


Split-detector computed tomography: a preliminary report. A split-detector system, consisting of a thin CaF2 scintillator followed by a thick Nal crystal, was installed in an EMI Mark I scanner. Energy discrimination is possible because the CaF2 crystal responds primarily to low-energy photons; dual-energy images can be obtained from only one scan. Calculations and preliminary experiments show that the split-detector separates energies better than the 100-140 kVp method. It was possibel with the split detector to differentiate between two weak solutions of CaCl2 and Kl which had the same computed tomography number (44 H), under normal scanning conditions.


A whole body repositioning system.

A whole body repositioning system. A versatile and easily used whole body repositioning system is described. It may be quickly and inexpensively constructed. The system has been found to be particularly helpful in the extended field treatment of Hodgkin disease, head and neck treatments, and in tumors of the abdomen and pelvis.


Electron beam calibration constants.

Electron beam calibration constants. Electron treatment beam calibration constants are tabulated in a convenient form for mean incident electron energies, Eo, of 6 to 21 MeV; and practical reanges, Rp, of 2.75 to 10.53 cm of water. Values of mean electron energy at depth Ed, chamber radius correction factors (Kp), and CE factors may be readily obtained from this chart.


A device for insuring the congruency of opposed irregularly blocked fields. A device for insuring the congruency of opposed irregularly blocked fields has been developed which permits the treatment of both fields of a parallel opposed pair without the realignment of any field-shaping standard non-divergent blocks. The device is an adaptor which attaches directly to the shadow tray or wedge holder and provides 2 channels for 1 Lucite shadow tray. A mirrow-image field is obtained without disturbing the position of the blocking array. Set-up times are decreased.


Direct serial magnification angiography applied to cerebral aneurysms. High-resolution radiographic images may be obtained by using direct serial 4X angiographic magnification with a microfocus 0.05-mm x-ray tube. This technique provides more highly detailed views of cerebral aneurysms than does normal angiography, while lowering the total radiation dosage.


On "conservative" estimates of radiation hazards. The problem of extrapolating radiation hazard risks from high doses to low doses is analyzed in regard to the controversy surrounding mammography in screening women under age 50 for breast cancer. The problem of faulty risk/benefit analysis based on an erroneously high estimate of risk is discussed. The author concludes that a conservative view of risk/benefit ratios is not possible, because equal risk may be associated with performing or not performing a particular radiological procedure.


The natural history of the double pylorus. A study of 11 patients with "double pylorus" revealed that a second channel between the gastric antrum and the duodenal bulb is the result of ulcer penetration. The fistula can be a sign of spontaneous recovery from ulcerative disease; the fistula occurred in conjunction with clinical improvement in the majority of the patients. The advantages of radiological vs. endoscopic diagnostic procedures are discussed.


Retractile mesenteritis: initial presentation as colonic obstruction. Retroperitoneal fibrosis has been associated with a variety of sclerosing diseases. Among these is the variant known as retractile mesenteritis, which involves predominantly the mesentery of the small intestine and associated vessels; involvement of the mesocolon and the colon is less frequent. Two patients with a dominating clinical picture of colonic obstruction are described. The radiographic presentations were similar and should serve to remind radiologists and clinicians of this entity.


Manitoba barium enema efficacy study.

Manitoba barium enema efficacy study. Claims analysis and efficacy study are two new methods of evaluating medical services. In Manitoba, with a 1974 population of 1,053,382, approximately 100,000 patient-physician interfaces resulted in 16,594 barium enema examinations; 1,000 significant abnormalities were discovered, and the referring physician was unusally perceptive in predicting the likelihood of these abnormalities. It is estimated that a 10% reduction in the use of barium enemas could be achieved by referring physicians with no deterioration in the care of patients.


Splenosis simulating an intramural gastric mass. A case of splenosis simulating a fundal intramural gastric mass in a patient with leiomyoblastoma is presented. Splenosis should be included in the list of differential possibilities of intramural or exogastric lesions when previous splenectomy has been performed, either secondary to trauma or surgical laceration of the splenic capsule. The absence of the spleen makes splenosis a diagnostic consideration.


Splenic cystic lymphangiomatosis: an unusual cause of massive splenomegaly. Two unusual cases of massively enlarged spleens occupied by numerous lymphangiomatous cysts are described. Both angiography and pathology confirm the pathognomonic appearance.


Arterial changes during treatment with intrahepatic arterial infusion of 5-fluorouracil. Changes in the liver arteries ranging from minimal irregularities in occlusions and development of aneurysms were investigated in 27 patients who received intra-arterial infusion of 5-FU in the hepatic artery. Variations in the arterial caliber peripheral to the hilum of the liver were noted in 13 of the patients. Further investigation of such arterial changes may be important in controlling the growth of liver metastases.


Complications of wedge hepatic venography. During wedge hepatic venography, mechanical injection should be accomplished at the lowest possible rate in order to avoid hemorrhagic infarction. Small amounts of contrast material should be administered. Hepatic angiography may result in an area of tumor blush at the site of a previous wedge injection.


A roentgenologic study of cortical bone resorption in chronic renal failure. Periosteal, intracortical, and endosteal resorptive changes were evaluated in both hands and the proximal radius in 161 chronic renal-failure patients by microradioscopy, radiographic morphometry, and photodensitometry. These changes were compared to abnormalities found in skeletal surveys. A combination of microradioscopy and morphometry of hand bones was sufficiently sensitive for early detection of bone loss in renal osteodystrophy in 61% of the patients. Intracortical resorption in metacarpals appeared to be a sign of more advanced renal osteodystrophy than subperiosteal resorption in phalanges. Photodensitometric findings in the radius generally agreed with microradioscopic and morphometric findings in hand bones.


Post-traumatic abnormalities of the pubic bone simulating malignancy. Three cases are presented in which unusual healing patterns of pubic features simulated malignant processes. Consideration of trauma as an etiologic factor in such cases may obviate the need for extensive clinical and histologic evaluation.


Primary and secondary aneurysmal bone cyst: a radiological study of 75 cases. Radiological findings in 75 cases of aneurysmal bone cyst were analyzed. Sixty-five per cent were primary or simple and 35% were secondary, the aneurysmal bone cyst being combined with other osseous lesions. A primary aneurysmal bone cyst can be diagnosed with a high degree of certainty, but only 20% of secondary forms had the radiological appearance of aneurysmal bone cyst; in the other 80% the associated lesion dominated the radiological picture, particularly when it was malignant. In the secondary form a small biopsy specimen may show the features of aneurysmal bone cyst only; without radiological assistance a concomitant malignant lesion may be missed. Therefore, there must be close collaboration between the radiologist and and the pathologist.


Buckled meniscus.

Buckled meniscus. Normal menisci may show transient distortion during knee arthrography. This usually results from intermittent visualization of the meniscus out of direct profile to the x-ray beam. Similar transient distortion may result from actual buckling of an anatomically normal meniscus during stressful maneuvers in young individuals.


Neural tumors of the thorax: subject review from the AFIP. 160 tumors of neural origin occurring in the thorax were analyzed. The major histological features of schwannoma, neurofibroma, neuroblastoma, ganglioneuroblastoma, ganglioneuroma, and paraganglioma are described. Radiological analysis emphasized shape and location. Calcification was relatively uncommon but may be specific. The comparatively low figures on incidence of rib and vertebral abnormalities might be increased by special studies, including vertebral tomography. Evidence of local spread such as pleura-based nodules and pleural effusion constitutes evidence of malignancy. Age may be the most important clinical parameter for distinguishing between histological types.


Multiple aneurysm formation as a complication of interventive angiography. The authors describe a case in which transcatheter embolization was used to treat a large arteriovenous malformation of the scalp (cirsoid aneurysm), with subsequent development of multiple aneurysms at the embolization sites. This previously unreported complication may have far reaching implications in treatment modality selection.


Arterial embolization of malignant tumor: report of two cases with angiographic findings. Two patients with malignant arterial emboli, one from a renal cell carcinoma and the other from a squamous cell carcinoma of the trachea, are described. Both patients had typical radiographic features of emboli on angiography. The origin of such arterial emboli is most probably a chest metastasis involving a pulmonary vein.


Hamartoma of the breast: diagnostic observation of 16 cases. Of 10,000 mammographies done over a 9-year period, 16 cases of hamartoma of the breast were diagnosed. The entity is a well delimited mass composed of dysplastic-appearing mammary tissue admixed to fat. It can be readily recognized and should not be confused with fibroadenoma or mammary dysplasia. The accuracy with which it can be diagnosed by mammography makes possible the avoidance of surgical excision in selected patients.


Urographic findings in homozygous sickle cell disease. A prospective study of the renal abnormalities on excretion urography in 189 patients with homozygous sickle cell disease is presented. Demonstrable abnormalities were present in 69% but there was no correlation with symptomatology. Calyceal clubbing was the most common abnormality occurring in 39% of cases and its incidence increased with age. An unexpectedly high prevalence (23%) of papillary necrosis occurred and both sinuses and cavities were demonstrated. The reasons for this high prevalence are discussed. The urographic findings did not correlate significantly with hematological features of the disease.


[A propos of 3 cases of Richter's syndrome]. Richter's syndrome is characterized by the association of malignant lymphoma with chronic lymphatic leukemia. Three new cases of this syndrome are reported and compared with those previously reported in the world literature. The relationship between the two lymphoid neoplasms is discussed.


[Diagnostic value of the myocardium-specific isoenzyme creatinephosphokinase (CK-MB)]. In 150 ambulatory and 155 hospitalized patients the normal values for creatine phosphokinase (CK) and the isoenzyme CK-MB were determined using a simple test with inhibiting antibodies. In a series of 100 consecutive patients hospitalized for chest pain, CK-MB was measured over a 72-hour period in 6- to 12-hourly intervals. The results were compared to the clinical findings, ECG, total CK and SGOT. In addition, CK-MB was determined after elective DC countershock and intramuscular injections (12 patients in each group). Normal values for CK-MB were found to be less than or equal to 10 U/1 in all patients, whereas the values for total CK turned out to be male less than 125 U/1, female less than 100 U/1 in ambulatory patients and less than 50 U/1 in hospitalized patients. In 68 of the 100 patients hospitalized for chest pain, acute myocardial infarction was found. The specificity of CK-MB in patients with transmural infarction was calculated as 100%, and the sensitivity as 97%. After DC countershock and intramuscular injections, CK was markedly elevated whereas CK-MB only rose after cardioversion. We conclude that CK-MB may be of considerable value for the differential diagnosis of elevated total CK activities of unknown origin. It is a very specific and a sensitive parameter for the diagnosis and exclusion of acute myocardial infarction.


[Cutaneous plasmacytosis and polyclonal cryo-immunoglobulinemia]. A 65-year-old male patient is described who presented with (1) large violet cutaneous plaques on the left side of the body, characterized by dense plasmocyte infiltration of the dermis which appeared benign and largely negative to immunofluorescence, (2) massive polyclonal cryoglobulinemia (type III) without paraproteins, and (3) intermittently marked peripheral monocytosis and thrombopenia without significant medullary changes. Compared with the cases reported in the literature, and after a thorough immunological investigation, this syndrome cannot be entirely assimilated to any entity described up to the present time. Hypothetically, a reactional disorder is the most likely.


Zinc deficiency in murine milk underlies expression of the lethal milk (lm) mutation. The inability of nursing pups to survive on milk of mice homozygous for the recessive mutation, lethal milk (lm), is correlated with a reduction in zinc levels of both milk and pup carcass. Administration of zinc to pups nursing on lmlm dams reduces the observed mortality and morbidity. It is suggested that lm alters zinc transport from maternal blood to milk and that its study may provide useful information for understanding the rare human disease, acrodermatitis enteropathica.


Costae of Tritrichomonas foetus: purification and chemical composition. The costa is an intracellular organelle common to all trichomonads. Costae from Tritrichomonas foetus have been purified by a method which involves lysis of T. foetus with the heat-stable hemolysin produced by Pseudomonas aeruginosa, followed by differential centrifugation. Analysis of the purified costae demonstrated that the organelle is composed of 95 percent carbohydrate and 5 percent protein. The carbohydrate moiety, probably a polysaccharide, consisted of glucose (95 percent), mannose (0.4 percent), glucosamine (1.4 percent), ribose (0.6 percent), and an unidentified sugar (2.6 percent). The kinetosomal complex was attached to the costa after initial lysis of cells but was separated from the costa during purification.


Maculotoxin: a neurotoxin from the venom glands of the octopus Hapalochlaena maculosa identified as tetrodotoxin. Maculotoxin, a potent neurotoxin isolated from the posterior salivary glands of the blue-ringed octopus. Hapalochlaena maculosa, has now been identified as tetrodotoxin. This is the first reported case in which tetrodotoxin has been found to occur in a venom.


Eyes transplanted to tadpole tails send axons rostrally in two spinal-cord tracts. Axons from eyes transplanted to the tail in Xenopus larvae enter the caudal spinal cord and follow two adjacent tracts rostrally to the level of the cerebellum. When eyes are transplanted to the ear area, optic axons enter the hindbrain and follow the same tracts rostrally and caudally. These sensory pathways normally contain the embryonic sensory system of the Rohon-Beard axons and the descending and ascending tracts of nerve V. We propose that the transplanted optic axons have followed a continuous substrate sensory pathway normally shared by a number of different sensory tracts.


Science centers: a potential for learning. The past decade has witnessed a proliferation of science-technology centers, or public places for informal learning about science and technology. Science centers are the only institutions that can provide the general public with participatory exhibits and experiences, together with an accurate scientific interpretation of the materials that are involved. The dramatic rise in attendance and the enthusiasm of repeat visitors to science centers reflect a strong public demand for exhibits designed to help the visitor develop a better understanding of the contemporary scientific issues of society.


Vasopressin analog with extraordinarily high antidiuretic potency: a study of conformation and activity. Application of information derived from a three-dimensional model of vasopressin bound to its antidiuretic receptor has resulted in the design and synthesis of a potent analog, [1-deamino, 2-phenylalanine, 7-(3,4-dehydroproline)]-arginine vasopressin; this analog has a specific antidiuretic activity of 13,000 +/- 1,250 units per milligram; noteworthy at these doses is the absence of any detectable pressor activity. Three modifications based on conformational considerations were introduced into the vasopressin molecule in preparing the analog: (i) to enhance binding, a double bond was introduced into the side chain of an amino acid residue occupying a corner position of a beta turn in the vasopressin conformation, (ii) the hydroxyl moiety was deleted from Tyr2, and (iii) to tighten the backbone structure and to enhance the enzymatic resistance of the analog, the NH2-terminal amino group was deleted.


Perfusion preservation of hearts for 6 to 9 days at room temperature. The combination of a defined medium with single-pass perfusion has made possible long-term maintenance of beating rat hearts at 22 degrees C in vitro. The 6- to 9-day survival period appears to be the longest so far reported for hearts. This method provides a stable system which should be useful for investigating the role of single factors in myocardial preservation and evaluating the effects of exposure to pharmacological and toxicological agents.


Spinal fluid differences in experimental allergic encephalomyelitis and multiple sclerosis. The spinal fluid of sheep with experimental allergic encephalomyelitis contains myelin basic protein (6 to 18 nanograms per milliliter) bound to antibody as well as excess free antibody. This bound myelin basic protein appeared concurrently with the onset of the disease and remained elevated until death. In contrast, in active multiple sclerosis, the spinal fluid contains free myelin basic protein and there are no detectable levels of antibody. The results indicate that the antibodies enter the spinal fluid from the serum by passive diffusion. This mechanism may also explain the presence of viral antibodies in the spinal fluid of multiple sclerosis patients.


Nicotine in breast fluid of nonlactating women. Using a combination of gas chromatography, mass spectrometry, and selected ion recording techniques, we have identified nicotine and its major metabolite, continine, in the breast fluid of nonlactating women smokers. As little as 25 picograms could be measured by using the deuterated variants, [5',5'-2H]nicotine and [3,3-2H]cotinine, both as internal standards and as carriers in an inverse isotope dilution method.


beta-Glucuronidase catalyzed hydrolysis of benzo(a)pyrene-3-glucuronide and binding to DNA. beta-Glucuronidase catalyzes the hydrolysis of benzo[a]pyrene-3-glucuronide to 3-hydroxybenzo[a]pyrene. During the enzymatic hydrolysis, a benzo[a]pyrene derivative is formed which binds to DNA to a far greater extent than either the 3-hydroxybenzo[a]pyrene or its glucuronide. These results suggest that conjugates of benzo(a)pyrene may be converted by beta-glucuronidase at intracellular and organ sites distal to the initial sites of oxygenation and conjugation of benzo(a)pyrene to activated intermediates that are possibly carcinogenic.


Precocious cardiac orienting in a human anencephalic infant. An anencephalic infant, 3 to 6 weeks old, responded to acoustic stimulation with cardiac decelerations typical of the response pattern seen in normal, older infants. Such precocity implies unexpected competence of lower brain structures and suggests that, in the normal infant, feedback from immature higher centers may sometimes interfere with rather than modulate the functioning of lower centers.


Memory: modification of anisomycin-induced amnesia by stimulants and depressants. Mice were trained in a passive (foot shock)avoidance task. When administered after training, the stimulants caffeine or nicotine blocked amnesia for the task that had been produced by injections of the protein synthesis inhibitor anisomycin given prior to training. With foot shock at a higher intensity, anisomycin did not produce amnesia by itself, but the administration of the depressants chloral hydrate or sodium phenobarbital after training did cause amnesia. Stimulants and depressants did not have an appreciable influence on the overall degree of protein synthesis inhibition produced by anisomycin. The results support the hypothesis that arousal after training is an important factor in the conversion of short-term to long-term memory.


Far-ultraviolet stopped-flow circular dichroism. A stopped-flow circular dichroism instrument, with a total accessible wavelength range of 200 to 750 nanometers, has been constructed and provides a spectroscopic method for kinetic investigations of a wide array of fast reactions in which optical activity changes in absorbing regions are involved. An important biochemical application depends on the far-ultraviolet capability, which allows observation of the rapid alterations in backbone conformation associated with folding and unfolding reactions of proteins. Results obtained by following two such reactions at 222 nanometers represent direct monitoring by circular dichroism of rapid secondary structure changes in proteins.


Inherited medullary thyroid carcinoma: a final monoclonal mutation in one of multiple clones of susceptible cells. Inherited medullary thyroid carcinomas contain one form of glucose-6-phosphate dehydrogenase (G6PD) in black female patients who are mosaic in normal tissues for G6PD types A and B. The same individual may have several tumors each containing either G6PD A or G6PD B. The data suggest that the inherited defect is an initial mutation producing multiple clones of defective cells; each tumor then arises as a final mutation in one clone of these cells.


Ammonia intoxication in the near-adult cat as a result of a dietary deficiency of arginine. Near-adult cats, fasted overnight, and given a single meal of a complete amino acid diet without arginine, developed hyperammonemia and showed clinical symptoms of ammonia toxicity within 2 hours. One cat (2.7 kilograms) died 4.5 hours after ingesting only 8 grams of the diet. Since ornithine also prevented hyperammonemia, it appears that the domestic cat cannot synthesize ornithine.


Pharmacologic effects in man of a specific serotonin-reuptake inhibitor. Fluoxetine (Li-ly 110140) caused a 63 percent inhibition of [3H]serotonin uptake into platelets obtained from normal volunteers to whom the drug was administered daily for 7 days. This dose had no effect on the usual pressor response produced by injections of norepinephrine or tyramine.


Silicon identification in prosthesis-associated fibrous capsules. The use of correlated microscopic techniques, including the scanning electron microscopic modes of backscattered electron imaging and energy dispersive x-ray analysis, aid in defining the process of dispersion of silicon-containing material around silicone rubber (polydimethylsiloxane) prosthetic devices.


Glutamine-selective membrane electrode that uses living bacterial cells. A novel bioselective membrane electrode for L-glutamine has been constructed by coupling living bacteria of the strain Sarcina flava to a potentiometric ammonia gas sensor. Tests in aqueous standards and human serum show that the electrode combines excellent sensitivity and selectivity with rapid response and a useful lifetime of at least 2 weeks.


Neural factors contribute to atherogenesis. Electron microscopic evidence of early atherogenic changes in the aorta and coronary arteries was obtained in normal fed, conscious, unrestrained rats receiving electrical stimulation in the lateral hypothalamus for periods of up to 62 days. Hypertension and hypercholesterolemia were not etiologic factors. In view of recent observations concerning neuropsychological mechanisms in human ischemic heart disease, the findings raise the possibility that the human central nervous system has a role in the development of atherosclerotic lesions.


Spinal cord damage in surgery of the abdominal aorta. The incidence, etiology, and clinical manifestations of spinal cord damage after abdominal aortic operations and abdominal aortography are defined on grounds of the authors' experience and of a survey of the pertinent literature. In the authors' experience the incidence of cord damage was 0.25% (three of 3,164) after abdominal aortic operations and 0.01% (two of 17,494) after abdominal aortography. As regards postoperative cord complications in the authors' series, they occurred only in cases of aneurysm, were 10 times more common in ruptured than in unruptured aneurysms, and the neurological loss usually was complete flaccid paraplegia (five of eight or 62%) with high mortality (three of eight or 38%), and rare partial (two of eight or 25%) or complete (one of eight or 13%) recovery. Recovery was more likely the lesser than neurological loss. The cause of postoperative spinal cord damage was ischemia resulting from the interruption of a critical radicular artery at the lower thoracic or high lumbar vertebral levels in the presence of anomalously located greater radicular or infrarenal radicular arteries. High aortic clamping and hypotension increased the probability of this occurrence, which essentially was unpredictable and, therefore, unavoidable. In postartographic cases the cord damage is more variable in its extent, and its cause is a chemical insult brought about by flooding the anterior spinal artery with contrast medium to which the patient probably is hypersensitive. In both groups treatment of the established clinical picture (paraplegia) is confined to support and rehabilitation.


Routine operative arteriography during carotid endarterectomy: a reassessment. One hundred and thirty-one consecutive operative arteriograms done in conjunction with carotid endarterectomy are reported. Radiographically obtrusive defects were found in 5.3% of arteriograms, with 1.5% in the common carotid artery, 2.3% in the external carotid artery, and 1.5% in the internal carotid artery. Potential complications were introduced by the operative arteriograms in 2.3% of the patients. One patient developed a persistent hemiparesis thought to be related directly to the performance of the arteriogram. On the basis of this review, routine operative arteriography as an adjunct to carotid endarterectomy has been discontinued at out institution. Specific indications for obtaining operative arteriograms are outlined.


Renal injury by companion kidney during hypothermic pulsatile perfusion. To study possible deleterious effects of traumatized kidneys on well harvested ones during hypothermic pulsatile perfusion, paired dog kidneys were monitored on two separate MOX-100 machines connected to pool a common perfusate. First kidneys were optimally harvested and baseline renal vascular resistance (RVR) calculated from pressure divided by flow (mm Hg/ml minute). After 1 hour second kidneys were added and observation was continued for an additional 3 hours. RVR in first kidneys increased immediately and doubled by 3 hours when ischemic traumatized second kidneys were added, 0.70 +/- 0.07 to 1.37 +/- 0.15 (p less than 0.001). No change in RVR was noted when second kidneys were optimally retrieved or if the dogs were heparinized prior to nephrectomy. Histological examination showed no evidence of vascular obstruction in any kidney, but only tubular necrosis in nonheparinized, traumatized second kidneys. Weight gain in optimally removed kidneys was 41%, but only 8% in ischemic kidneys. RVR decreased unexpectedly in ischemic kidneys during 3 hours of perfusion (p less than 0.01). Release of vasoactive substances by damaged kidneys and arteriovenous shunting may explain these findings. Separate perfusion systems seem to be justified when one of two cadaver kidneys is of marginal quality.


Augmentation of wound tensile strength in rats by induction of inflammation with autogenous blood. Accelerated wound healing should be possible if one could eliminate the lag phase, a period of time when the wound is quite weak while the building blocks of collagen are being brought into the wound. In the present experiments injection of autogenous blood into the skin and fascia of rats initiated a response characterized by vasodilatation, accumulation of inflammatory cells, and proliferation of capillaries and fibroblasts. During the first week of healing, wounds made in areas injected with blood 2 days prior to wounding were up to twice as strong as controls.


Medical adrenalectomy and plasma steroids in advanced breast carcinoma. Aminoglutethimide and dexamethasone were administered for 3 months to 11 postmenopausal women with advanced breast cancer. During initial in-hospital studies, there was uniform suppression of plasma cortisol (0.23 microgram/100 ml), androstenedione (8.3 ng/ 100 ml), estrone (0.44 ng/100 ml), and estradiol (0.32 ng/100 ml) to concentrations indistinguishable from those after surgical adrenalectomy. Eight of the 11 patients maintained this degree of suppression for 3 months. The other three patients may have taken inadequate amounts of dexamethasone, as evidenced by plasma steroid patterns characteristic of aminoglutethimide alone, that is, partial cortisol suppression (3.6 microgram/100 ml) and markedly increased androstenedione (355 ng/100 ml) with low estrone (0.54 ng/100 ml) and estradiol (0.61 ng/100 ml) concentrations. This apparent block in the aromatization of androstenedione to estrogens may be a feature important to the effectiveness of the regimen in sporadically noncompliant patients. After 3 months of therapy, return of resting plasma cortisol values to normal occurred within 3 to 4 days after cessation of the regimen and pituitary-adrenal responsiveness to surgical stress was demonstrable. This regimen is capable of maintaining an effective, reversible suppression of plasma steroids considered to be relevant to estrogen-dependent breast cancer.


Concentrations of gastrin and secretin in the alimentary tract of the cat. The distribution of gastrin and secretin in the alimentary tract of the cat was determined from the esophagogastric junction to the ileocecum. The total content and concentration of each of these hormones in mucosal extracts taken from the gastric fundus, gastric antrum, proximal and distal duodenum, proximal and distal jejunum, and ileum were measured with specific radioimmunoassays. The gastric antrum contained the highest concentration of gastrin, but appreciable amounts also were found in the duodenum. The highest concentrations of secretin were found in the duodenum, but impressive quantities were measured in the jejunum. The role of extra-antral gastrin and of those stores of secretin beyond the proximal duodenum (where the pH probably never falls to levels associated with release of secretin) currently are unknown.


[Developments in research on and treatment of cancer (author's transl)]. The epidemiology of cancer is reviewed with particular emphasis on the geographic variations in the incidence of certain types of cancer. Several new developments in the prevention and treatment of cancer are discussed. The main advance in the results of treatment is due to chemotherapy, preferably in conjunction with radiotherapy and surgery. Much is expected of this procedure for the future.


Effect of cortisone acetate on effector cells for antibody-mediated cytotoxicity in mouse and rat. We have looked at the effect of in vivo cortisone acetate treatment on effector cells for antibody-dependent cell-mediated cytotoxicity in mice and rats, using both chicken erythrocytes and the mouse lymphoma cell line AKR.A as target cells, since the AKR.A cell line is susceptible to antibody-dependent cell-mediated cytotoxicity killing only by the lymphoid effector cell, whereas a wide variety of effector cells will lyse chicken erythrocytes in the presence of antibody. The lymphoid K cell, detectable in rat spleen and blood, was unaffected by steroid treatment sufficient to cause lymphopenia, whereas splenic anti-chicken erythrocyte cytotoxicity of whole spleen and of phagocyte-free spleen was depressed in mice and rats. The greatest suppression was seen with nonphagocytic mouse spleen, and may have been in part attributable to steroid-induced redistribution of the effector cell(s), since the cytotoxic capacity of nonphagocytic bone marrow cells was increased by 70% at a time when the activity in spleen was 25% of normal.


Electron-microscopic analysis of the mouse facial nerve near the geniculate ganglion. An electron-microscopic analysis of the mouse facial nerve near the geniculate ganglion shows that there are, on the everage, 603 more nerve fibers in the portion of the nerve distal to the geniculate ganglion than there are in the part proximal to the ganglion. The average distal increase in the number of unmyelinated fibers is 444 and that in the myelinated fibers is 165. The somatic motor nerve fibers and the parasympathetic fibers in the mouse facial nerve may not contribute to the distal excess. It is possible that the increase in the number of unmyelinated fibers distal to the geniculate ganglion is mainly due to the presence of postganglionic sympathetic fibers in the facial trunk distal to the geniculate ganglion and the greater petrosal nerve. The distal increase in the number of myelinated fibers may be mainly contributed by the sensory fibers.


Surface coat in steroid-secreting cells of the mouse ovary. Steroid-secreting cells (luteal, thecal and interstitial cells) of the mouse ovary have been studied with the ruthenium red method to stain the "cell coat". The results showed that a typical cell coat covers the entire surface of the plasma membrane except where the cells are connected by specific cell junctions. Further, particularly heavy concentration of ruthenium-red-reacting material was demonstrated in pericapillary and intercellular spaces. The differences in the thickness of the cell coat and its topographical modifications among different groups of steroidogenic cells may be related not only to intercellular adhesion and interactions but also concerned with a function of control in which the cell permeability is modified in relation with phenomena of cell recognition.


Study on the morphology of the gall-bladder of the goat. 200 gall-bladders of goat were studied for histology and histochemistry. The lining epithelium is tall columnar with striated border. The glands are mucous and serous, and the secretion of both surface and glands is a polyssaccharide-protein complex. The regional differences at neck, body and fundus of the gall-bladder are described. Few enterochromaffin cells with granules, which are PAS-positive and contain 5-hydroxytryptamine, are encountered at the wedge between the granular epithelial cells and the cells lining the crypts. The relationship between these cells and lymphocytic infiltration is discussed. The thick circular muscle layer at the neck region is considered a sphincter of the gall-bladder.


Seasonal changes in the testes of a hill stream teleost, Garra gotyla (Gray). The cephalic, middle and posterior regions of the testes in Garra gotyla are identical in structure and function. The spermatogenetic activity starts in the month of October reaching its peak in April and May. Spawning takes place in June and July followed by a brief resting period. Spermiation appears to be intermittent. Six stages of spermatogenesis have been described. New crop of germ cells appears to arise from the resting spermatogonia. Both the interstitial and the lobule boundary cells were observed. The gonosomatic index shows correlatation between the rise in water temperature and the volume of the testes.


Localization of radioactively labelled serotonin in the nucleus of adrenal medulla cells. After treatment of rats with 3H-5-hydroxytryptophan, grains indicating the presence of serotonin could be demonstrated in the adrenal medulla. In the beginning, the label is mainly found in the cytoplasm, later, more and more it appears in the nucleus, primarily above the heterochromatin.


An electron microscope study of the effects of acute ischaemia in the brain. The structural changes in the CNS of cats subjected to periods of 10 and 20 min of eschaemia have been studied. After 10 min of ischaemia the neurons show loss of granular endoplasmic reticulum and vacuolation of the persisting endoplasmic reticulum. After 20 min of ischaemia there is neuronal cell death, some synaptic degeneration. Glial foot processes swell and occlude the lumen of vessels. The significance of these changes is discussed.


Origin and development of the septum primum. Based on the study of ten hearts of human embryos from the Orts Llorca collection in Madrid, comprising stages 12-17 of O'Rahilly, the origin of the septum primum was analyzed. The septum referred to has its origin in the dorsocaudal part of the common auricle starting from the cells of the lower cushion which makes contact with the wall of the auricle referred to. The closure of the atrioventricular canal is due to the introduction of the spina vestibuli of the septum primum between the two endocardial cushions. The foramen primum is formed in the human species in the same way as in the rest of the most highly developed vertebrates.


Human coronary arteries. II. Branching anatomical pattern and arterial wall microarchitecture. A study on 22 pairs, including subjects of similar age, sex and cause of death but with different branching anatomical patterns, shows, that the amount and structural organization of elastic and muscular tissue of the thickened intima are strongly influenced by (a) the size, length, mode of ramification of the parent vessels of the coronary tree; (b) the number of branch orifices in a given arterial segment, and (c) the collateral or terminal character of certain daughter branches.


An analysis of molar tooth form.

An analysis of molar tooth form. The maxillary first permanent molars of different human population samples were compared by multivariate analysis of two-dimensional coordinates of datum points defining the occlusal surface and periphery of the crown. This technique proved that discrimination was possible between teeth which could not be discriminated visually or by analysis of the mesiodistal or buccolingual diameters.


Observations on the ultrastructure of ganglion cells in the circumvallate papilla of rat and mouse. Ganglion cells in the circumvallate papilla of adult rodents are described as typical autonomic neurons. Some neurons are aggregated to form a discrete structure in the base of the papilla; others are scattered through the core, along the nerve bundles, and particularly near the dome. The term "circumvallate ganglion" is applied to the entire population. Satellite cells completely ensheathe each neuron. Preganglionic fibers, containing clear vesicles, synapse on the soma and stumpy dendrites of the neurons. Axons, containing dense-cored vesicles, are observed in close proximity to the neurons. However, these fibers do not establish true morphological synaptic contacts with the neurons. We have not observed serial or reciprocal synapses on or in the vicinity of the ganglion cells. The hypothesis that the axons of the circumvallate ganglion neurons act as parasympathetic vasodilators is indicated by the proximity of the two structures and by nerve terminations on the arteriole muscle cells. Direct modulation of taste transduction by these neurons is ruled out.


Adrenergic innervation of the coronary arteries and the myocardium. The monoaminergic innervation of the coronary vessels and myocardium in the dog was studied by means of the histochemical fluorescence method. The distribution of monoaminergic terminals in the arterial wall depends on the diameter of the artery. In large arteries, the terminals are regularly distributed around the entire circumference, the fibres being situated between the elastic lamellae of the adventitia. The terminals within the media could not be detected. In small arteries, the sympathetic ground plexus aggregates in two parallel strands, the artery being between them. In arterioles, two thick fibres only accompany the vellel. The myocardium is innervated by means of a three-dimensional sympathetic ground plexus distributed between the myocardial cells independently of vessels. No difference in density of innervation was found between the right and left heart. The point-counting method, on the other hand, has revealed that the density of innervation in the left auricle is nearly twice as dense as in the left ventricle. The terminals innervating the myocardium are markedly thinner than the fibres innervating the arteries. Two-dimensional plexuses innervate the epicardium, endocardium and valves.


Arterial supply to the human rectum.

Arterial supply to the human rectum. The arterial supply to the human rectum was studied in 42 autopsy specimens. 32 were fixed in formalin and dissected. Five were radiographed after filling their arterial bed with a radio-opaque substance. The remaining five specimens were used to prepare plastic casts of the arterial bed. The superior rectal artery is the chief rectal artery. It forms a recto-sigmoid branch, an upper rectal branch and then divides into right and left terminal branches. Terminal branches extend downwards and forwards around the lower two thirds of the rectum to the level of the levator ani. The middle rectal artery, of appreciable diameter, on one or both sides of the rectum, is found supplying a limited part of the rectum in 12% of the specimens. Its presence can be anticipated by observing the diameter of the superior rectal artery and its two terminal branches. The inferior rectal artery supplies the anal canal below the levator ani. Rectal twigs of other pelvic arteries terminate at the pararectal tissues occasionally reaching the wall of the rectum. Extramural anastomoses were not observed between the main rectal arteries, but intramural ones were present, mainly between the superior and the inferior rectal arteries.


Neural tube lesions in the offspring of hamsters given single oral doses of lathyrogens early in gestation. The lathyrogens aminoacetonitrile, D-penicillamine and semicarbazide were tested for their teratogenicity in hamster on day 7 of gestation at three different dose levels. The results showed that aminoacetonitrile and penicillamine were typical teratogens in hamsters, capable of causing significant embryotoxic effects consisting of increased fetal mortality, growth retardation and malformation. Semicarbazide at a dose of 100 mg/kg had only minor teratogenic effects, while slightly higher doses were lethal to the dams. The most severe fetal malformations following maternal exposure to aminoacetonitrile or penicillamine were exencephaly and encephalocele. Since lathyrogens inhibit the process of collagen cross-linking, the results of this study indicate that there may be an important relationship between collagen fiber formation in the embryo and neural tube closure.


Electron-microscopic study of the rat masseter muscle following injection of lidocaine. The ultrastructure of rat masseter muscle was examined at 15 min, 1 and 6 h, and 1 and 2 days following a single injection of 2% lidocaine. Lesions developed within 15 min. The plasma membrane was disrupted and invaginated. The nuclei were pyknotic and the mitochondria appeared swollen. The myofibrils separated and became disoriented. By 1 and 6 h, these changes were severe. By 1 day, the macrophages appeared in damaged myofibers. The presence of a few presumptive myoblasts signaled the onset of regeneration. By 2 days, presumptive myoblasts formed within the basement membrane. The basal lamina proved most resistant to injury. Regeneration of masseter muscle following the damage produced by lidocaine appeared discontinuous in nature. The singly nucleated presumptive myoblasts seemed to arise within the lesions.


[Development and topography of the ganglion pelvinum in the gerbil]. In the gerbil the nerve cells of the plexus pelvinus are concentrated on each side in a solid glanglion pelvinum. This deviates essentially from the pattern in man and the domestic animals where these cells are scattered all over the plexus pelvinus. The large ganglion pelvinum is connected craniodorsally with the nervus hypogastricus and dorsally with the nervi pelvini (from the first 2 or 3 sacral nerves and the last lumbar nerve). The apertura pelvis cranialis appears long and very oblique and, therefore, in the gerbil the ganglion pelvinum is located on each side cranially to the corpus ossis pubis and can be reached by a ventral laparotomy.


Surgical implications of pulmonary hypertension in congenital heart disease. The effects of pulmonary vascular disease on the results of surgical closure of single large ventricular septal defects are reviewed. Hospital mortality in infants was not affected by the presence of preoperative pulmonary vascular disease. The late results were clearly related to age at operation, preoperative pulmonary vascular resistance, and pulmonary artery pressure. Probability of event analysis allows selection of the optimal age for elective repair of large ventricular septal defects.


Effect of premature stimulation on fast and slow excitation channels in cultured myocardial cells. Myocardial cells from chick embryos were cultured using a method which results in cell morphology and action potentials showing greater similarity to that of adult cells than to cells grown with standard methods of culture. The cells were paced by means of rectangular field stimuli (2 msec 2-5 times diastolic threshold). When the stimulus was given during the descending branch of the previous action potential, the action potential developed dissociation between a fast-rise component with short duration and a slow-rise component with longer duration. This dissociation was best in cells with an intermediate rate of rise of the spontaneous action potential and may be caused by different rates of reactivation of the slow and fast membrane excitation channels.


Local potential gradients as a unifying measure for thresholds of stimulation, standstill, tachyarrhythmia and fibrillation appearing after strong capacitor discharges. The pattern of arrhythmias following capacitor discharges of increasing amplitude, which have been observed by the authors in cultured myocardial cells from chick embryos, was compared to the arrhythmia patterns caused by similar discharges in experimental animals and humans, as reported in the literature. While the absolute voltages and currents causing each type of arrhythmia showed great variation, the scatter decreased considerably when the stimulus level was recalculated on the basis of peak current density in myocardial tissue, and was reduced further when the peak potential gradient at the cell level was used as the common basis of comparison. The similarity in the arrhythmia patterns and in the voltage gradients at which they occur indicates that the mechanism of these arrhythmias may be similar in cultured cells and intact animals and humans.


An approach to inverse calculation of epicardial potentials from body surface maps. The inverse problem of evaluating epicardial potentials from a knowledge of heart and torso geometry as well as body surface potentials is here formulated as a problem in control theory. As is well known, such an inverse problem is ill-posed and a regularization technique has been devised to overrun this difficulty. The resulting regularized problem is well-posed and requires the minimization of a cost function including, besides the square distance of any predicted surface potential distribution from the experimental one, a regularization term involving the second derivatives of the identified epicardial potentials. The results here presented were obtained on a model problem for a plane geometry. Surface potentials generated by multipoles and perturbated with a noise level reflecting both instrumentation and electrode placement uncertainties were fitted by the proposed method and 'epicardial potentials' were determined with a maximum sum square relative error of 15%. The results suggest that by introducing suited regularity constraints, the a priori difficulties inherent to the problem of computing epicardial potentials from torso potentials, can be overcome.


Computational reconstruction of body surfact isopotential maps in myocardial infarction: comparison between nontransmural and transmural infarction. The relationship between the lack of electromotive force in myocardial infarction and body surface potential distribution was investigated on maps reconstructed from a simulated heart model and transfer impedance vectors of human torso model. The heart model, a cluster of 3-mm cubic blocks, was stored in the memory of a computer. Transfer impedance vectors between 81 lead points on the human torso model and 392 positions covering ventricular areas in the torso were measure. Body surface potential values were calculated mathematically by summing up scalar products between the electromotive force of the heart model and the measured transfer impedance vectors. Thus, reconstructed maps changed in their patterns with the alternation in lacation and/or extent of infarcted region in the heart model. In particular, the appearance of the abnormal potential minimum, which projects the infarcted region in the heart model onto the torso surface, was characteristic in both transmural and subendocardial infarction. In addition, delayed activation in the intact layer of the epicardium overlying the infarcted region produced a potential maximum on the same place as the abnormal potential minimum appeared previously.


Use of techniques from communication analysis in diagnosis of myocardial infarction from body surface potential maps. A correlation test was applied to superimposed plots of partial body surface potential maps in order to distinguish between normal subjects and those with independently diagnosed myocardial infarction. The reference waveform is determined by means of a gradient-search algorithm.


The effects of exercise on the amplitude of the first heart sound in normal subjects. The cardiovascular responses to isometric and dynamic exercise have been studied in six normal subjects, before and after intravenous propranolol, using the amplitude of the first heart sound (S1), measured from an ultra-low frequency phonocardiogram, as an index of left ventricular mechanical performance. Dynamic exercise caused significant increases in heart rate and S1 amplitude which were largely inhibited by beta-adrenergic blockade. Isometric exercise also produced increases in heart rate and blood pressure, but a decrease in S1 amplitude. Propranolol had no significant effect on the cardiovascular response to isometric exercise. These results confirm previous suggestions that, in contrast to dynamic exercise, the normal cardiovascular responses to isometric exercise are relatively independent of the beta-adrenergic nervous system. Possible reasons why the improvement in left ventricular performance, which has previously been shown to occur during isometric handgrip, was not reflected in the phonocardiogram, are also discussed.


A possible role of noradrenaline in the development of myocardial infarction: an experimental study in the isolated rat heart. Isolated rat hearts were perfused with buffer containing noradrenaline 10(-7) to 10(-4) M. A dose-dependent depletion of glycogen and ATP were seen together with a leakage of ASAT and creatine phosphokinase (CK). The damage induced by noradrenaline could be prevented by addition of a beta-blocker (metoprolol), verapamil, or lidocaine to the perfusion medium. When the endogenous myocardial stores of noradrenaline are rapidly depleted by perfusion with tyramine a similar cell damage was demonstrated. Electron micrographs from hearts subjected to noradrenaline showed three different types of cell damage that could be correlated to earlier described findings. The importance of noradrenaline for the ischemic injury was demonstrated. It was hypothesized that acute myocardial infarction may start because of a sudden release of endogenous noradrenaline.


Detection of myoglobin by radioimmmunoassay in human sera: its usefulness and limitations as an emergency room screening test for acute myocardial infarction. The results indicate that serum myoglobin determinations may be obtained by radioimmunoassay utilizing time periods for the testing which allow more useful clinical evaluation of patients. The data also demonstrate, however, that there are important temporal considerations in using serum myoglobin levels for the detection of acute myocardial infarcts and, if this test is used to determine in the Emergency Room whether patients have had acute myocardial infarcts, these limitations will have to be kept in mind. In addition, three other patient subgroups that might be expected to have elevated serum myoglobin levels by radioimmunoassay have been determined. These include patients with shock (irrespective of etiology), patients with severe renal insufficiency, i.e., those with serum creatinine levels equal to or greater than 8 mg. per cent, and possibly patients who have been on alcohol binges immediately prior to being seen in the Emergency Room.


Effect of saralasin upon plasma catecholamines in hypertensive patients. The effect of saralasin, a clinically employed angiotensin antagonist, upon hemodynamics and plasma catecholamine concentration was compared to the infusion of noradrenaline. These studies were carried out to determine if a transient pressor effect frequently observed during saralasin infusion might be mediated by release of catecholamines from the adrenal medulla. After five minutes of saralasin infusion, mean arterial pressure rose significantly, pulse rate fell slightly, and plasma noradrenaline increased by 115 +/- 28 pg./ml. Plasma adrenaline was unchanged. After 30 minutes of saralasin infusion, mean arterial pressure was at control levels and plasma catecholamine concentrations were also no different from pre-infusion levels. Infusion of noradrenaline produced a hemodynamic pattern similar to that observed during the first five minutes of saralasin infusion. However, there was a thirteen-fold increase of plasma noradrenaline observed when compared to the first five minutes of saralasin infusion. It was concluded that the transient pressor action of saralasin could not be explained by release of catecholamines from the adrenal medulla. However, the very slight increase in plasma norepinephrine observed during the first five minutes of saralasin infusion may imply altered function of sympathetic neurons.


Relationship between myocardial infarction and preinfarction angina: a histopathological study of coronary arteries in two sudden death cases employing serial section. Two patients who had previously experienced old myocardial infarction and who died suddenly after an attack of chest pain were examined and discussed. In both cases two of the three main coronary arteries showed severe stenosis with canalization. Ruptured atheromatous plaque was found in the unblocked coronary artery. Fibrin was already formed and surrounded the fractured intimal collagen fiber, foam cells, and cholesterin clefts, but a luminal thrombi had not yet been formed. Fresh occluding thrombi were formed at the site of the ruptured atheromatous plaque. Coronary thrombi containing abscess components such as foam cells, cholesterin clefts, and the fractured intimal collagen fiber were found in our preliminary study. These views support the supposition that this fracture between the lumen and the plaque might precede and be responsible for the formation of the thrombus and the onset of acute myocardial infarction. It was confirmed that the attack of preinfarction angina occurred at the time of the rupture of the atheromatous plaque. The rupture of the atheromatous plaque plays an important part as an initiating factor of peinfarction angina and myocardial infarction. Thus, it is necessary to examine coronary arteries by serial histopathological section method.


Food iron absorption in iron deficiency. The absorption of food iron in relation to the diet was studied in 10 phlebotomized normal young male subjects during 3 to 5 months. The iron absorption was calculated from the net increase of the hemoglobin mass. There was pronounced individual variation in the mean dietary absorption ranging between 1.9 and 5.0 mg. There was no correlation between the amount of iron absorbed and the amount of iron ingested. There was no apparent influence of a high or a low intake of animal products, cereals, vegetables, tea, or alcohol on the individual absorption values. A negative correlation between the iron absorption and the total amount of fecal dry substance was observed. This might be ascribed to an influence of dietary fibers on the absorption of food iron.


Altered taste thresholds in lung cancer. Taste threshold levels for the four basic taste modalities were determined in 30 male lung cancer subjects and 30 male control subjects who had no history of malignant disease. Lung cancer patients demonstrated significant alteration in taste recognition for sour but not for bitter, sweet, or salt. There were, however, quantitative differences between cancer patients and control subjects in recognition thresholds for the sweet taste modality. Some of the lung cancer subjects had demonstrated greater sensitivity to the taste of bitter than the control subjects and others were less sensitive. These alterations may account in part for the reduction of intake and for the aviodance of certain food items by lung cancer subjects. Dietary histories should be taken on all cancer patients in order to individualize dietary management, thereby improving the nutritional intake.


Estimation of available dietary iron.

Estimation of available dietary iron. Dietary iron requirements are dependent on the amount and availability of food iron ingested. On the basis of recent studies of food iron absorption employing extrinsic tag techniques, the availability of heme iron has been defined and estimates of the availability of nonheme iron based on the amounts of enhancing substances appear possible. A model has been developed whereby the availability of iron in a given meal may be estimated. Calculations are made on a meal basis of 1) the amount of heme iron and its availability, and 2) the amount of nonheme iron and its availability as influenced by the meal's content of enhancing factors. Examples of these calculations are provided.


Lactation and pregnancy in Iran. I. Social and economic aspects. Adequacy of lactation was assessed in Teheran women of low (LSE) and lower-middle (MSE) socioeconomic status in the third month postpartum, as part of a study linking nutrition, hormonal status, and lactation. Methods of assessment of nutritional adequacy are discussed. Characteristics of the socioeconomic groups, infant mortality, food beliefs related to lactation, and supplemental feeding practices are described. Of the LSE mothers 15 to 30% and of the MSE mothers 40 to 55% had a fully adequate milk supply in the third month. Substitutes used and affordable by the LSE were nutritionally inadequate. LSE mothers were traditional in their food beliefs. MSE mothers demonstrate the influence of scientific nutrition knowledge. The low percentage of lactation adequacy even in the MSE indicates that other social or health factors associated with urban living conditions may be just as important as economic and nutritional factors in lactation failure.


Influence of diet on leg uptake of glucose during heavy exercise. Four young men each performed three treadmill walks to exhaustion at 70% of their respective O2 uptake maxima. Each walk followed 3 days consumption of either a normal mixed (M), high fat and protein (F-P), or high carbohydrate (CHO) diet. The fractional use of carbohydrates for energy during the initial 1/2-hr of work was significantly reduced following the F-P diet as compared with the M or CHO diets (P less than 0.005), averaging 38.2% (F-P), 69.9% (M), and 71.9 (CHO). Carbohydrates energy production was negatively correlated with blood levels of both free fatty acids ( r = -0.62, P less than 0.05) and beta-OH-butyrate (r = - 0.79, P less than 0.005). Work time to exhaustion was closely correlated with the fractional usage of carbohydrates for energy (r = 0.86, P less than 0.001). The femoral arteriovenous blood glucose difference was directly related to the pre-work dietary carbohydrate fraction, with the 30-min work means 0.25 mM (F-P), 0.34 mM (M), and 0.52 mM (CHO). Estimation of leg arteriovenous O2 difference indicated that leg uptake of blood-borne glucose provided approximately 23 +/- 10% (F-P), 30 +/- 8% (M), and 46 +/- 13% (CHO) of the legs' aerobic substrate during the first 30 min of work. These results provide further evidence for the shift from noncarbohydrate to carbohydrate energy sources during exercise as the carbohydrate fraction of the diet is elevated.


Adipose tissue cellularity in obese school girls before and after dietary treatment. Mean fat cell size and adipose tissue cellularity were studied in 18 grossly obese girls and 17 age-matched reference girls. The obese girls had a combined hypertrophic-hyperplastic obesity with increments in fat cell size as well as in fat cell number. High insulin levels were found in the obese girls and the levels correlated with fat cell size. The obese girls had higher serum triglyceride levels than the reference group but the cholesterol levels were similar. After dietary treatment and advice for increased physical activity of the obese group, both groups were re-investigated with respect to adipose tissue cellularity after 1.5 to 1.9 years. Fat cell number was unchanged in the reference group while the obese girls in spite of treatment increased their cell number significantly. The obese girls who were most successfully treated had the lowest increase in fat cell number. The results suggest that treatment of childhood obesity may be of importance for the prevention of obesity later in life.


The physical and neuromotor development of progeny of female rats fed graded levels of pyridoxine during lactation. Female rats were maintained throughout gestation on a control diet containing 400% of the National Research Council (NRC) recommendation for pyridoxine and transferred to purified diets containing 400, 100, 75, 50, 25, or 0% of the NRC recommendations for B6 during lactation. Physical development of the offspring was assessed by measuring body weight and the occurrence of physical features, for example: eye opening, eruption of incisors, and growth of the hair to obscure the genitalia. Development of reflex reactions, neuromotor skills and coordination were also observed. Grooming was assessed as a measure of spontaneous activity. Retardation of growth, delay in the onset of reflexes such as palmar grasp, vibrissa placing, visual placing, and audicular startle, and a delay in the onset of advanced neuromotor coordination such as standing and grooming were observed in the pups of pyridoxine-restricted dams. Even progeny of dams, receiving 100% of the NRC recommendations of B6 during lactation exhibited inferior performance of skills requiring advanced neuromotor coordination such as standing, either supported or alone. These animals had weight gains comparable to neonates of maternal animals receiving 400% of the NRC recommendations for pyridoxine. The importance of factors other than growth in the assessment of nutritional requirements is demonstrated.


Effect of diphenylhydantoin on the bioavailability of citrus folate. Long term use of the drug diphenylhydantoin (DPH) has been associated with biochemical evidence of folic acid deficiency and rarely with megaloblastic anemia. The mechanism of this nutritional deficiency is uncertain but is thought to result from DPH-induced alteration in the intestinal absorption of conjugated and/or free dietary folate. The effect of DPH on the intestinal absorption of free folates from a food source has heretofore not been reported. In this study triple lumen tube perfusion of the human jejunum was used to quantitate folate absorption from a control solution of orange juice and from an identical solution containing DPH. The results in eleven volunteers serving as their own controls indicate no effectof DPH at a concentration of 20 microgram/ml on folate absorption from this food source. The predominant form of folate in orange juice as determined by differential microbiologic assay is N-5-methyltetrahydrofolate. DPH does not appear to interfere with the absorption of free food folate which is both methylated and reduced.


Rehabilitating effect of vitamin E therapy on the ultrastructural changes in skeletal muscles of vitamin E-deficient rabbits. Ultrastructural repair of the morphological damages produced in nutritional muscular dystrophy was studied by refeeding dystrophic rabbits with vitamin E. Weanling (1.2 kg body weight) rabbits were fed a vitamin E-deficient diet for 24 days. Half of this group was then sacrificed and the remainder was given an initial oral dose of 50 mg of DL-alpha-tocopherol acetate and a vitamin E supplemented diet for 28 days. Control animals were fed a vitamin E supplemented diet with 50 mg of DL-alpha-tocopherol acetate per kilogram of diet. Abnormalities of dystrophic muscles included streaming Z-disk, degenerated mitochondria, fragmented sacroplasmic reticulum and development and aggregation of myelin figures. The effect of vitamin E therapy resulted in significant repair of the dystrophic muscle. Small localized sections of rehabilitated muscle revealed abnormal mitochondria and residual myelin figures.


Percentile estimates of reference values for fourteen chemical constituents in sera of children and adolescents. The concentrations of 14 chemical constituents in sera of 1,062 children and adolescents aged 4 to 20 years were measured and their 5th and 95th percentiles were calculated. The distribution of values for all constituents showed significant deviation from the gaussian when the results were combined, regardless of age and sex, except for magnesium. Although certain chemical constituents showed statistically significant relationships with age and sex, two additional criteria based upon the coefficient of variation of the method employed were utilized to judge the effectiveness of computing stratified reference values. After applying these corrections the reference values established were classified into three categories, viz. (1) those where the relationship to age and sex remained significant (inorganic phosphorus and creatinine); (2) those where the relationship to age only remained significant (total protein); (3) those where no significant relationship to age and sex was obtained (all other constituents).


The predictive value of clinical laboratory test results. Bayes' formula is being used with increasing frequency to calculate predictive values for positive and negative clinical laboratory test results. Because of its nonlinear form, however, it is difficult to visualize how changes in the test characteristics or disease prevalence will effect predictive values. This paper shows that Bayes' formula is transformed to a linear function through the use of odds, rather than probabilities, thus facilitating conceptualization, understanding, and memory.


Enumeration of platelets.

Enumeration of platelets. A correlation of the enumeration of platelets in peripheral smears with platelet counts performed by a direct method is presented. A ratio of 1 platelet per oil-immersion field for every 21,000 platelets of the chamber count indicates the normal average range of platelets to be approximately 7--21 per oil-immersion field.


Giant cell tumor of tendon sheath and pigmented villonodular synovitis: an ultrastructural study. The ultrastructures of five examples of giant cell tumors of the tendon sheath and one example of pigmented villonodular synovitis were studied. The giant cell tumors were composed mostly of A and B types of synovial cells. Also present were fibroblastic cells with intracytoplasmic filaments with densities (myofibroblasts) as well as "monocytic" and "lymphocytic" cells. The giant cells seemingly were derived from the fusion of synovial cells of A type, whereas foam cells were derived from both A and B cells. Both the giant cell tumors and the pigmented synovitis are considered to be reactive and borderline proliferative lesions of the synovial cells.


A multi-station gravity delivery system. In May 1974, New York University Hospital began testing an experimental system using gravity for the slow-speed transport of laboratory specimens. This experiment demonstrated that the system was safe and easy to use. Consequently, in February 1975, a second station was installed adjacent to the intensive care unit to serve as a pilot for a multi-station system. The pilot was 42 m high. All routine laboratory specimens, except 24-hour urines, were transported inside closed transparent cylinders that descend at velocities between 50 and 100 cm/sec. Between April and October 1975, about 2,000 deliveries were made monthly, and each often carried only one or two tubes of blood or urine. At times, however, as many as 15 blood tubes or two body-fluid containers were handled. The overall operating reliability was greater than 98%. The mechanical performance of the new equipment was excellent. Novel design features guaranteed users at both stations immediate access for dispatching containers. Instrumentation was designed to detect all problems rapidly and to correct some automatically. In October 1975, New York University Hospital approved installation of a permanent slow-speed transport system to serve all patient-care areas.