The mechanisms underlying attributive projection. The experiment investigated the validity of the cognitive dissonance reduction and stimulus generalization explanations of attributive projection. Subjects in a high dissonance condition were informed that they possessed considerable hostility (a negative trait), while those in a low dissonance condition were told that they possessed a great deal of assertiveness (a desirable trait). The dissonance mechanism received support in that (a) subjects' reports of their anxiety indicated that an ego threat was produced only in the high dissonance condition, as expected; and (b) hostility was projected onto others to a significantly greater degree than was assertiveness. The existence of only a weak relationship between degree of ego threat produced by the personality feedback and subsequent amount of projection, however, throws into question the validity of the hypothesized defensive function of projection. No support for the generalization mechanism was obtained since the subjects did not project a greater amount of either trait onto the similar targets (college students) than onto the relatively dissimilar targets  (middle-aged lawyers); possible reasons for this negative result were discussed, as well as suggestions for future research.


Effect of autonomic neural blockade on verapamil-induced suppression of the accelerated ventricular escape beat in ouabain-treated dogs. The effect of autonomic neural blockade on verapamil-induced suppression of the accelerated ventricular escape beat (AVE) was evaluated in anesthetized dogs pretreated with ouabain. Ouabain (53 +/- 2 microgram/kg, n = 45) was administered in divided doses until simultaneous electrical stimulation of the right atrium and ventricle triggered an AVE. The escape interval of the AVE was stable over a 150-min time period in a group of control animals. Verapamil was infused (20 microgram/kg/min) until the escape interval increased at least 50% or until the AVE was abolished. The total amount of verapamil in milligrams per kilogram that produced this effect was defined as the verapamil endpoint. The verapamil endpoint in vagotomized animals was not significantly different from a group of intact controls. In contrast, the verapamil endpoint in animals pretreated with propranolol, hexamethonium, guanethidine, bretylium or spinal section was significantly less than the control group. Propranolol, hexamethonium, guanethidine or spinal section alone increased the escape interval by a maximum of 12%. Infusion of norepinephrine in spinal animals treated with verapamil restored the AVE. These data indicate that sympathetic nerve activity contributes to the genesis of the AVE and antagonizes the antiarrhythmic effect of verapamil on the escape beat.


Histamine-induced negative inotropism: mediation by H1-receptors. Histamine is known to enhance left ventricular contractility in the guinea-pig heart by interacting with H2-receptors. We have observed that when the H2-receptor antagonists metiamide and cimetidine (3 X 10(-6) and 10(-5) M) block the positive inotropic effect of histamine, a negative inotropic effect is unmasked. This negative inotropic effect is independent of changes in rate or coronary flow, is mimicked by the selective histamine H1-receptor agonists, pyridylethylamine and thiazolylethylamine (0.3--30 microgram) and is abolished by the H1-receptor antagonist chlorpheniramine (10(-7) and 10(-6) M). Thus, the negative inotropic effect of histamine appears to be mediated by H1-receptors. Our results demonstrate that the inotropic response to histamine consists of two opposing components: an increase in contraction, mediated by H2-receptors, and a decrease in contraction, mediated by H1-receptors.


The effect of propranolol and its analogs on Ca++ transport by sarcoplasmic reticulum vesicles. Vesicular fragments of sarcoplasmic reticulum were used as a model system to investigate the mechanism of propranolol inhibition on various steps of the Ca++ transport cycle, It was found that Ca++-dependent transfer of ATP terminal phosphate to the sarcoplasmic reticulum protein and formation of the phosphorylated enzyme intermediate are not inhibited by propranolol concentrations effective on Ca++ transport. Rather, a specific step following enzyme phosphorylation and corresponding to Ca++ translocation across the membrane is primarily inhibited. The consequent hydrolysis of phosphorylated enzyme is then secondarily inhibited, while "Ca++ independent" ATP hydrolysis remains unchanged. Comparison of the relative potencies of several propranolol analogs yields similar patterns for Ca++ transport inhibition in sarcoplasmic reticulum vesicles and negative inotropic effects on cardiac muscle. These patterns are at variant with those displayed by these agents with respect to beta adrenergic blockade.


Electrically induced opiate-like inhibition of the guinea-pig ileum: cross-tolerance to morphine. The guinea-pig myenteric plexus-longitudinal muscle (MPLM) preparation electrically stimulated at 0.1 Hz is very sensitive to the inhibitory effects of opiates. We used this preparation to detect an inhibitory response (IR) which was produced by electrical stimulation at 5 to 20 Hz. The magnitude and duration of the IR are determined by the parameters of the stimulation, mainly by the frequency and duration of the period of stimulation. Maximal IR is obtained with symmetrical biphasic stimuli of 2 msec duration and supramaximal voltage at 20 Hz applied for a period of about 5 min. The IR is calcium-dependent, cannot be attenuated by washing and is mediated by several components. About 55 to 70% of the IR can be reversed by specific narcotic antagonists and therefore it is considered to be produced by the release of endorphins. There are at least two additional components, one small, adrenergic in nature, and a third one which has not been identified. The offset rate of the IR is measured in minutes, while enkephalin and human beta-endorphin have half-lives of 10 and 85 sec, respectively, after washing. This suggests that the endorphin that mediates the opiate component of the IR may be a different one with slower offset rates. Myenteric plexus-longitudinal muscle strips obtained from guinea pigs which were made tolerant to morphine by subcutaneous implantation of three pellets were cross-tolerant to the opiate component of the IR elicited by electrical stimulation.


Tachyphylaxis to d-amphetamine: a reexamination of the phenomenon. Single or multiple injections of d-amphetamine (10(-3)--10(0) mg/kg) were administered to rats, after which steady-state blood levels of drug were determined. After single injections of d-amphetamine, there was a linear relationship between amount of administered drug and steady-state blood level of drug. After multiple injections of d-amphetamine, steady-state blood levels of drug conformed to the equation D = Doe--kappaepsilont. An attempt was made to relate steady-state blood levels of drug to steady-state responses (e.g., increase in blood pressure or heart rate). At steady-state, amphetamine-induced pressor responses were too small to be analyzed, but tachycardic responses were easily analyzed. It was found that steady-state heart rate responses were dose related to steady-state blood levels of drug. This was true regardless of whether d-amphetamine was administered once or repeatedly. The data indicate that, when tested in rats at sub-toxic doses, d-amphetamine does not evoke tachyphylaxis in relation to heart rate responses which are measured under steady-state conditions.


Specificity of a rat behavioral model for serotonin receptor activation. Pharmacological stimulation of central serotonin (5-HT) receptors causes a behavioral syndrome characterized by simultaneous side-to-side head weaving or head tremor, forepaw padding and splayed hindlimbs. This syndrome has been proposed and used as a model for 5-HT receptor activity. Questions have been raised about the possible involvement of catecholamines. This study was designed to differentiate behavioral signs contributed by 5-HT from those that might be due to catecholamines. Depletion of catecholamines by alpha-methyl-p-tyrosine, or depletion of 5-HT by either p-chlorophenylalanine or 5,7-dihydroxytryptamine, did not prevent the syndrome caused by 5-methoxy-N,N-dimethyltryptamine, a 5-HT receptor agonist. Pretreatment with methysergide, but not phenoxybenzamine or pimozide, prevented the syndrome caused by 5-methoxy-N,N-dimethyltryptamine. Conversely, 5-HT depletion prevented the syndrome caused by monoamine oxidase inhibitor and levodopa; behavioral response was restored in p-chlorophenylalanine-pretreated rats by 5-hydroxytryptophan. Methysergide prevented the syndrome caused by monoamine oxidase inhibitor and levodopa, but phenoxybenzamine or pimozide did not. Intraventricular 5-HT or dopamine also caused the behavioral syndrome after monoamine oxidase inhibition. p-Chlorophenylalanine pretreatment prevented the syndrome caused by dopamine, but did not prevent the syndrome caused by 5-HT. Our results suggest that systemic levodopa or intraventricular dopamine produces the behavioral signs through 5-HT mechanisms; endogenous catecholamine mechanisms are not involved directly in either the cause or expression of the behavioral syndrome.


Lead blockade of norepinephrine-induced inhibition of cerebellar Purkinje neurons. Biochemical studies showing that lead (Pb++) inhibits cerebellar adenylate cyclase (IC50 = 2 micrometer) prompted us to test the effects of this cation on the depression of spontaneous discharge of Purkinje (P) cells produced by iontophoresis of norepinephrine (NE). Previous studies have suggested that the effects of NE on P cell discharge may be mediated by activation of a NE-sensitive adenylate cyclase. Iontophoresis of Pb++ in situ, and in cerebellar transplants in oculo, reliably antagonized NE responses in over 80% of the P cells studied in both preparations. Blockade was readily seen at iontophoretic currents of 5 to 10 nA. Superfusion of PB++ (5--10 micrometer) into the anterior eye chamber also antagonized NE responses in P neurons of the transplant. Spontaneous discharge rate was either unaffected or slightly elevated at Pb++ levels that almost completely blocked NE. Barium, a heavy metal which does not inhibit adenylate cyclase in vitro, did not block NE effects. Stimulation of parallel fibers or iontophoresis of acetylcholine excited P cells. No antagonism was seen, however, between Pb++ and these acetylcholine or parallel fiber excitations. These results raise the possibility that blockade of brain catecholamine receptors may partially underlie the central nervous system toxicity seen with lead administration.


The binding of [3H]diazepam to rat brain homogenates. A technique is described for the measurement of specific [3H]diazepam binding to subcellular fractions of rat brain. Binding occurred in fresh or hypotonically shocked, frozen and thawed preparations; was independent of the buffer used; and was concentrated in the synaptosomal fraction. The total binding capacity of crude brain homogenate was entirely recovered in the particulate fractions (P1, P2 and P3). Binding was saturable and reached 34 pmol/g of tissue; half-maximal binding (KD) occurred at 3.2 nM. Hill and Scatchard analysis indicated that the binding was noncooperative and to a single class of sites. Binding was time dependent and reversible; the bimolecular association constant (K1) was 1.13 . 10(6) sec-1 M-1 and the first order dissociation constant (K-1) was 2.69 . 10(-3) sec-1. Binding was highest in cerebral cortex, hippocampus and cerebellum; intermediate in midbrain, hypothalamus, corpus striatum and medulla oblongata/pons; and lowest in spinal cord. Benzodiazepines inhibited binding of [3H]diazepam in a manner correlated with pharmacological activity in vivo, and binding was not inhibited by non-benzodiazepine anxiolytics, muscle relaxants, anticonvulsants or by strychnine and glycine. Distribution of [3H]diazepam binding in several regions of the rat central nervous system correlated with Na+-independent binding of gamma-aminobutyric acid in the same regions. The results may be in accord with the possible involvement of gamma-aminobutyric acid in the mechanism of action of the benzodiazepines but provide no support for a mechanism based on the interaction of benzodiazepines with central glycine receptors.


The influence of indomethacin on the pharmacokinetics, diuretic response and hemodynamics of furosemide in the dog. Indomethacin has the potential to interact with furosemide in a number of different fashions. We have investigated some of these possibilities in seven mongrel dogs that received furosemide (2 mg/kg i.v.). Plasma and urinary concentration of furosemide were measured by high performance liquid chromatography, diuretic response was assessed by urinary sodium excretion and renal blood flow and its distribution were estimated using the radioactive microsphere technique. Furosemide induced a prompt diuresis associated with a 50% increase in total renal blood flow. Intrarenal blood flow was preferentially increased in the inner cortical zones. Furosemide was rapidly eliminated with a renal clearance that was 35% of the total systemic clearance. Maximal sodium excretion was attained at plasma furosemide concentrations greater than 0.8 microgram/ml; below this concentration there was a linear relationship between plasma concentration and rate of sodium excretion. The ratio of sodium/furosemide concentration in urine rose to a plateau, then remained constant. Indomethacin pretreatment inhibited the hemodynamic response to furosemide. In addition, indomethacin reduced the renal and extrarenal clearance of furosemide by approximately 30%, but did not change the proportion of unchanged drug excreted in the urine. Although the diuretic response for any given plasma concentration of furosemide was reduced, the ratio of urinary sodium/furosemide concentration was not changed by indomethacin. Since the amount of furosemide reaching the urine was not altered, the total diuretic response was not significantly affected by indomethacin. From these observations we conclude that indomethacin alters the pharmacokinetics of the disposition of furosemide and furosemide-induced renal hemodynamic changes. However, our data indicate that the response of the renal tubule to furosemide secreted into tubular fluid is not changed by indomethacin.


The effect of pregnancy on the metabolism of [14C]phenytoin in the isolated perfused rat liver. The metabolism of [14C]phenytoin (DPH) was measured in isolated perfused livers from non-pregnant female rats and rats at 13, 15, 17, 19 and 21 days of gestation. The half-life of [14C]phenytoin in the perfusate was not significantly altered by pregnancy in livers perfused with 20% blood at 2 ml/min/g of liver but was increased from 38 min in control livers to 158 min in livers from rats at 21 days of gestation when livers were perfused with 10% blood at 1 ml/min/g of liver. Secretion of the glucuronide conjugate of 5-[14C]phenyl-5-parahydroxy-phenylhydantoin into the bile was markedly inhibited during the latter stages of pregnancy such that a 4-fold decrease in the cumulative secretion into the bile was present at 21 days of gestation. The bile/perfusate concentration ratio of the glucuronide after 30 min was 148 in control livers but decreased to 6 in livers from rats at 21 days gestation.


Long-term reduction of brain serotonin by p-chloroamphetamine: effects of inducers and inhibitors of drug metabolism. The present experiments were designed to test the hypothesis that the long-term effects of p-chloroamphetamine (PCA) on serotonergic neurons in rats are mediated by a neurotoxic metabolite. The effects of well-known inducers and an inhibitor of hepatic microsomal drug-metabolizing enzymes on the PCA-induced decreases in brain levels of 5-hydroxytryptamine (5-HT) and tryptophan hydroxylase activity and the half-life of PCA in brain were examined. All of these modified the half-life of PCA in a predictable manner: 3-methylcholanthrene and, to a much lesser extent, phenobarbital decreased the half-life of PCA while piperonyl butoxide markedly increased it. Fluoxetine, an inhibitor of 5-HT uptake, also increased the half-life of PCA in brain. In addition, fluoxetine blocked the long-term effects of PCA on 5-HT levels and tryptophan hydroxylase activity. Of the classical metabolic tools, only 3-methylcholanthrene provided complete protection from the long-term, neurotoxic effects of PCA. Although the mechanism of this protection is unknown, it is not mediated by a blockade of 5-HT uptake since 3-methylcholanthrene did not decrease the synaptosomal uptake of 5-HT. Piperonyl butoxide pretreatment markedly increased the half-life of PCA in brain, but it failed to modify consistently the effects of PCA. The results indicate that the long-term, neurotoxic effects of PCA are not mediated by the major, hepatic metabolites of the drug, but leave open the possibility of a minor, neurotoxic metabolite.


Hydrolysis and metabolism of N-benzoyl-L-tyrosyl-p-aminobenzoic acid in normal and pancreatic duct-ligated animals. Hydrolysis and metabolism of N-benzoyl-L-tyrosyl-p-aminobenzoic acid (Bz-ty-PABA), a synthetic peptide used for the assessment of exocrine pancreatic function, were studied in normal and pancreatic duct-ligated rats and guinea pigs. Bz-ty-PABA was specifically cleaved by chymotrypsin to N-benzoyl-L-tyrosine and p-aminobenzoic acid (PABA) in mucosal homogenates of the intestine. Both of the resultant products were rapidly absorbed and excreted in the urine after oral administration of two kinds of radioactive Bz-ty-PABA (Bz[14C] and PABA[14C]) to animals. The absorption rate was correlated to the intestinal chymotrypsin activity obtained from in vitro studies. Benzoic acid and p-acetaminobenzoic acid were predominant in the urine after dosages of Bz-ty-PABA with Bz[14C] and PABA[14C], respectively, in both species. Additionally, a small amount of unchanged form of Bz-ty-PABA was excreted in the urine and bile without being cleaved by chymotrypsin. These results and the study using intravenous injections suggest that the absorption of this intact peptide may be almost 10% of the dose.


Seminal excretion, vaginal absorption, distribution and whole blood kinetics of d-methadone in the rabbit. The disposition of 40 mg of d-methadone HCl was studied in New Zealand White rabbits. After an intravenous infusion to male rabbits, the beta phase half-life was 106 +/- 21 min and the apparent volume of distribution was 12.6 liters/kg b.w. After an i.m. injection, the peak drug concentration in arterial blood (1.02 microgram/ml) occurred 10 min after the injection, whereas the peak concentration in semen (2.58 microgram/ml) occurred 140 min later. The semen/blood drug concentration ratio was 6.8 at 150 min after the injection. The concentration of d-methadone was measured in blood, spleen, liver, lung, prostate, seminal vesicle, testis and heart 130 minutes after an i.m. dose. All tissues had drug levels that exceeded the concentration in blood (0.42 microgram/ml). The concentrations in lung (33.5 microgram/g), kidney (15.2 microgram/g) and spleen (30.6 microgram/g) were particularly elevated. After intravaginal implantation, d-methadone was rapidly absorbed into the systemic circulation of female rabbits; the peak drug level in blood (0.94 microgram/ml) occurred 60 min after drug administration.


A survey of ethnic and sociocultural issues in medical school education. A survey of 113 medical schools was conducted to determine whether sociocultural issues in the treatment of minority group patients were dealt with in their curricula. The inclusion of factors such as different value systems, attitudes, early experiences, and economic and ethnic backgrounds and their influence upon the delivery of health care services to minority groups was found to be minimal. The variables which appeared to facilitate ethnic and sociocultural courses in medical education are contrasted with those which result in exclusion of this information from the curricula. These findings emphasize the need for a greater commitment to offering such courses.


Equal educational opportunity programs in American medical schools. In the four-year period 1968 to 1972 most medical schools in the United States initiated programs to increase the enrollment of selected minority group students. Their number increased sixfold in Caucasian-dominated medical schools during these years, and the enrollment of such students rose from 1 to 5.3 percent of the total undergraduate population, with the impetus for this policy originating from within the schools. All schools recruited applicants from among the minority races, and two-thirds of the schools altered their admission procedures, often so as to permit minority group participation in the selection process. Schools which modified their procedures in this manner had the highest proportions of these students. Three-fourths of the schools changed their admission criteria, and most of them provided special tutoring and other academic support. Ninety percent of the schools evaluated their programs as at least somewhat successful.


Survey of graduates of a traditionally black college of medicine. Over 700 Howard University medical alumni of seven representative classes graduating from 1955 to 1975 were surveyed by questionnaire in 1975-76. Replies of the 311 respondents confirm that this college of medicine has trained a substantial number of physicians who are providing care to blacks, the economically disadvantaged, and residents of inner city areas. Survey findings may also be useful in reaffirming the necessity for training more minority physicians, assessing the impact which the increasing number of minority physicians will have on health care delivery in this country, and suggesting the probable practice patterns of future minority graduates of U.S. medical schools.


Recruitment and retention program for minority and disadvantaged students. Attracting ethnic minority and disadvantaged students to health careers and facilitating their successful completion of training program requirements have been major activities of the University of Colorado Medical Center since 1969. As a result of extensive college campus recruitment efforts, high school and college level preprofessional programs, and the participation of ethnic minority faculty members in the medical school admissions process, the number of applicants to the medical school increased from 45 in 1971 to 265 in 1977. Concurrently, medical school matriculants increased from 12 in 1971 to 24 in 1977, with a maximum of 30 in 1975. However, significantly fewer minority students have shown interest in nursing, dentistry, or allied health professions careers. Because of support programs for matriculants (including preadmission and postadmissions personal, academic, study skills, and test-taking counseling and a prefreshman year summer orientation course), 71 percent of the minority students entering medical school in 1971-73 have received the M.D. degree.


A premedical summer program for disadvantaged students. In this paper five years of summer program experience with minority and disadvantaged students are examined and an attempt is made to provide an overview of the impact of summer programming on medical school admission and academic performance in the first year of medical training. A well-organized correlated academic curriculum of anatomy, biochemistry, and physiology, coupled with an intensive counseling program, has proved to be the basis of a sound reinforcement program for minority and disadvantaged students who are preparing for medical school.


A preliminary study of student learning in interdisciplinary health teams. Self-reported learning in a 12-week interdisciplinary health team training experience at the University of Nevada, Reno, was measured. Fourteen students from seven disciplines participated on health teams in three settings. All students were in early stages of their professional training. A self-report inventory with four general areas was administered before and after the experience. Four analyses of covariance were used to compare participant scores with those of a control group in each area using initial scores as the covariate. There was significant learning in the areas of team skills and processes and in knowledge of and abilities in client communication but not in physical assessment.


Teaching medical students about treatment compliance. Poor patient compliance is common in clinical practice but difficult to demonstrate to medical students in a convincing manner. To accomplish this, the authors asked medical students who preregistered for a conference on patient compliance to adopt the role of "patient" and to take "medication" (Vitamin C) for one week, to observe certain dietary restrictions, and to complete an attitude and health beliefs questionnaire. The educational impact was intensified by making prior predictions about outcome which were almost exactly confirmed. The predictions concerned failure to fill the prescription, extent and type of noncompliance, and significant differences in attitudes between compliant and noncompliant students. The attitudes of the students resembled those of noncompliant patients asked to take medication for nonsymptomatic disorders (such as hypertension). Those students who participated in the drug-taking experience rated the educational impact of the conference more highly than did those students who attended the conference but did not take part in the drug project.


Novobiocin resistance and virulence of strains of Staphylococcus saprophyticus isolated from urine and skin. A method was developed to study virulence of coagulase-negative staphylococci. Our results showed that coagulase-negative staphylococci injected into adult mice by the intracerebral route did not give rise to lethal infections, whereas mice aged 2 days were much more susceptible. Novobiocin-resistant strains of Staphylococcus saprophyticus were more virulent than strains of Staphylococcus epidermidis. Strains of S. saprophyticus biotype 3 of Baird-Parker's classification varied in virulence according to novobiocin sensitivity. In the classification of Kloos and Schleifer, S. saprophyticus biotype 3 can be subdivided into four distinct staphylococcal species, namely S. saprophyticus , S.cohnii, S.haemolyticus and S.warneri. S. chonii and S. saprophyticus were equally virulent for mice aged 2 days, but novobiocinsensitive S. haemolyticus was less virulent. On epidemiological grounds, however, it would seem that S. saprophyticus has some undefined advantage in invading the urinary tract.


Observations by light microscopy on the cytopathogenicity of Naegleria fowleri in mouse embryo-cell cultures. Naegleria fowleri, strain HB-1, caused a destructive cytopathic effect (CPE) in secondary mouse-embryo (ME) cells. No evidence was found to suggest that cell-free cytotoxic factors secreted by the amoebae play a part in ME-cell destruction. In culture systems designed for the study of cytopathic factors, mammalian-cell damage seemed to occur only as a result of direct contact with active amoebae. This was confirmed when the progressive destruction of individual ME cells was observed continuously by direct microscopy and time-lapse cinemicrography. The cytoplasmic shrinkage characteristic of naegleria-induced CPE appeared to be associated with phagocytic activity of trophozoites. Adjacent ME cells remained undamaged until they themselves were physically attacked. The apparently intracellular location of amoebae seen in fixed and stained preparations was considered to be an artefact created when trophozoites and ME cells were superimposed.


Mycoplasma infection in pregnant rats: low viability of foetuses and newborn offspring. The controversy regarding the possible role of genital mycoplasma infection in human reproductive failure gave rise to a study in which pregnant rats, previously shown to be of normal fertility, were inoculated 7-11 days after conception with either Mycoplasma arthritidis or an equal volume of sterile broth medium. Repeated observations during the course of pregnancy revealed several pathogenic effects. A statistically significant decrease was observed in the mean litter size of infected mothers. Furthermore, the offspring showed low viability at birth and, still more, at 10 days after birth. Our data are compatible with the hypothesis that genital mycoplasma infection plays a role in reproductive failure.


Effect of bursectomy and thymectomy on Pasteurella multocida infection in chickens. The effects of various treatments on the immune response of chickens to vaccine prepared from Pasteurella multocida strain P1059 were investigated. The treatments, given on or before the day of hatching, consisted of surgical bursectomy (SB), hormonal bursectomy (HB), surgical thymectomy (ST) and X-irradiation (X). In chickens subjected to SB, SBX or HB before vaccination, the production of agglutinin and immunoglobulin was impaired, but the production of resistance against challenge was not. In chickens subjected to ST or STX before vaccination, the production of agglutinin and immunoglobulin was unimpaired, but the production of resistance against challenge was diminished. Protection was therefore thymus-dependent.


The isolation and characters of L-forms and reversions of Bacillus licheniformis var. Endoparasiticus (Benedek) associated with the erythrocytes of clinically normal persons. Thirty-eight strains of the Gram-positive bacterium identified as Bacillus licheniformis var. endoparasiticus (Benedek), referred to as BLE, were isolated in various stages of reversion form the L-forms, from 28 out of 100 samples of whole blood or erythrocytes from normal healthy subjects, after prolonged incubation. Similar results were obtained from 100 samples from hospital patients with conditions not usually associated with blood infection. BLE was isolated from only one of 125 samples of plasma, including those separated from infected erythrocytes. Isolates from cultures incubated for up to 4 months were usually in the form of spheroplasts or diphtheroid bacilli; the fully reverted phase, resembling B. licheniformis, with the capacity to form endospores, was isolated occasionally from cultures aged 1--6 months, and it constituted about half the isolates recovered from cultures aged 6--25 months. BLE was isolated in subculture, and with the usual frequency, in previously unopened, primary cultures. It did not occur in 1200 subcultures of 150 control cultures made with autoclaved or irradiated blood cells; it was not detected in the environment of the laboratory or blood-sampling areas, or on the skin or in the respiratory passages of the operators and other persons associated with the laboratory, where typical, saprophytic B. licheniformis was very rare. It is concluded that this Bacillus species exists as an L-form, associated with the erythrocytes of a large proportion of normal persons, as previously recorded by several observers. Some of the morphological variants associated with the L-cycles have in the past been described as different organisms, for example L-forms of various bacteria or mycoplasmas, and the diphtheroid stage has been thought to belong to the genera Corynebacterium and Listeria. The sporogenous stage, although frequently described, has normally been discounted as a contaminant. These observations do not admit of any conclusion in respect of the claims that such bacteria may have a role in arthritis, cancer or other diseases.


The routine application of a microtechnique for the demonstration of leptospiral antibodies. The microtechnique of Galton et al. (1965) for the routine screening of blood samples for leptospiral antibodies was used to examine more than 8000 serum samples from animals that had aborted and from herds in which leptospiral antibodies had previously been demonstrated. The method gave consistently accurate results. In respect of ease and speed of performance, it was superior to the microscopic agglutination test and it required only minute volumes of serum and antigen suspension. Its most important advantage was that the agglutination reaction could be read directly on the plate, and the removal of samples for microscopical examination was therefore unnecessary.


An image reversal process for electron microscope film. An improved technique has been developed to produce a positive image directly on some standard electron microscope films (Kodak 4489, SO 163, and Ilford Electron Microscope Film). This technique has been useful for processing micrographs of freeze-etched and shadowed specimens, and eliminates the need for producing positive image transparencies before printing.


Calculation of surface area and volume of human erythrocytes from scanning electron micrographs. This article demonstrates that surface and volume measurements of individual human erythrocytes with varying shapes can be obtained from scanning electron micrographic stereopairs using an approach based on established principles of photogrammetry. Instead of calculating the coordinates of several hundred points plotted for each cell, a procedure that proves tedious and time-consuming, we show that a reasonable approximation of cell surface and volume can be achieved from simple geometrical models constructed with a small number of carefully measured points and angles, using a stereocomparator. The values obtained for two normal erythrocytes and for two distorted red cells from a patient with congenital pyruvate kinase deficiency haemolytic anaemia are consistent with available information on the geometry of these cells. Because scanning electron microscopy requires extensive manipulation of the cells, the values obtained cannot be applied to fresh living material, but appear fairly accurate for the purpose of comparison between cells prepared in the same manner.


Sephadex globules placed as landmarks in combined stereo microscopy, scanning and transmission electron microscopy. Regions of specific interest in tissue blocks were localized in a stereo microscope and landmarked with Sephadex spheres (10-40 micron in diameter). This procedure made it possible to recognize these regions easily and quickly in the scanning electron microscope. When the tissue was later embedded in Epon the spheres facilitated orientation when sectioning. Thus it was possible with great certainty to determine the level at which ultrathin sections should be cut for transmission electron microscopy to attain an exact correspondence between scanning and transmission electron microscopic observations. The procedure is described and an example of its application is shown in a study of experimental hypertensive endothelial changes.


Differential leucocyte counts: a comparison of results using light and electron microscopy. A method is described for handling leucocytes from an inflammatory peritoneal exudate prior to electron microscopy, which allows differential counts from ultra-thin sections to be made. The results of counts from ultrathin sections, viewed on the electron microscope, are compared with samples from the same cell populations prepared on a cytocentrifuge and counted by light microscopy. The results from several cell populations of widely different compositions show clearly that with suitable care taken over preparation and orientation, ultrathin sections can yield comparable differential counts to those obtained by standard light microscope procedures. Possible sources of error are discussed and the advantages of ultrastructural counting assessed. The method has a wide application wherever accurate differential counts are required from cell suspensions processed for electron microscopy.


Effect of exposure to lead on maturation of intestinal iron absorption of rats. The influence of lead on iron absorption was investigated at various stages of development in rat pups exposed to lead first through mothers' milk and later in their solid diet. Hematocrit, hemoglobin, iron absorption, and tissue iron concentration were measured on d 14, 20, 23, 29, 35, 42, and 63 after birth. Both hematocrit and hemoglobin in the lead-exposed group were significantly below control levels at all periods earlier than d 42 and 63, respectively. Absorption of iron ([59Fe]-ferrous citrate in 10(-4)M FeSO4) from intestinal loops measured over 1/2 h remained at preweaning levels (10-12% of total activity added to the loop) for at least 1 wk after weaning in the lead-exposed rats, whereas in control animals iron absorption fell to adult levels (3-4%) at weaning. Spleen weight was significantly elevated in lead-exposed rats compared with control rats at all ages beyond d 14. However, spleen iron content (micrograms of Fe per gram of tissue) was not significantly elevated in the lead-exposed group before d 42. The results indicate that exposure to lead does not reduce iron absorption from the intestinal tract; thus alteration of intestinal iron absorption does not contribute to lead-induced anemia. Indeed, lead-exposed rats demonstrated increased iron uptake.


Histopathologic effects of dietary cadmium on kidneys and testes of mallard ducks. Mallard ducks fed 2, 20, or 200 ppm cadmium chloride were sacrificed at 30, 60, and 90 d. No mortality occured during the study and body weights remained unchanged. Kidney weights of the 200-ppm group were significantly greater after 60 and 90 d than those of controls; also, testis weights were significantly lower after 90 d. Kidneys of ducks fed 2 and 20 ppm cadmium were relatively unaffected; however, slight to severe kidney lesions were found in the 200-ppm group after 60 d of treatment. No significant lesions were found in mallard testes after feeding 2 ppm cadmium in the diet, and only a few birds in the 20-ppm group showed slight to moderate gonad alterations. After 90 d of treatment, however, testes of males fed 200 ppm had atrophied and the spermatogenic process had ceased. This study should provide important information for the interpretation of cadmium levels found in kidneys and testes of wild ducks.


Studies of the lymphatic drainage of dog lungs. The lymphatic system of the lungs has proved difficult to study and characterize because it is technically complex to investigate, its properties are difficult to quantitate, and anatomically it is extraordinarily variable. This study was part of a more comprehensive effort to understand the nature of lymphatic permeation by extrinsic materials (e.g., dusts) arising from alveolar deposition, and had three main objectives; (1) to develop a reliable surgical approach for the collection of lymph from the right duct; (2) to investigate some of the inconsistencies in lymphatic structure and function, especially the relationship of the right lymph duct (RLD) and thoracic lymph duct (TLD) outflows to the pulmonic lymph; and (3) to begin a systematic investigation of lymphatic uptake of administered materials by varying their physicochemical parameters. Ultimately, we utilized a modification of the surgical approach of Meyer, which we believe is less prone to blood contamination than the venous-sac procedure of Leeds and Uhley and provides purer pulmonic lymph. By this means we obtained average RLD flow rates of 4.5 ml/h or 0.35 ml/h . kg body weight in 24 dogs, which are comparable to those in the recent literature. For demarcation of the pulmonic drainage in relation to the RLD and TLD, we found in 13 dogs that 75% or more of the lung lymph returned to the venous circulation through the RLD, wheras less than 3% of the thoracic lymph entered the RLD. Radioactive tracers were administered by intralymphatic, intrabronchial, inhalation, and intravenous routes to obtain these findings and the uptake data. Lymphatic uptake values for iron, cadmium, and lead were obtained principally after intrabronchial administration. The uptake data, while preliminary, indicate that both the chemical species and their physical states are important in affecting alveolar permeation into the pulmonic lymph. Evidence for varying lymphatic roles in the alveolar retention of these heavy metals is also presented.


Effects of atropine and methacholine on deposition and clearance of inhaled particles in the donkey. The influence of sympathetic and parasympathetic controls on regional particle deposition and mucociliary clearance rates was studied in the donkey in vivo. The deposition and clearance characteristics for gamma-tagged monodisperse ferric oxide microspheres were determined for inhalation tests after atropine and methacholine injections and were compared with the characteristics determined for control tests with the same animals and aerosols. Additional tests were performed in which methacholine was injected immediately after the test aerosol inhalation and 2 1/2 h before the particle inhalation. Particle deposition is shifted distally by atropine. Methacholine produces a proximal shift initially and a distal shift 2 1/2 h later. Atropine slows mucociliary transport. Methacholine produces an acceleration in bronchial clearance initially but causes a reduced rate of clearance 2 1/2 h later. Atropine slows mucociliary transport. Methacholine produces an acceleration in bronchial clearance initially but causes a reduced rate of clearance 2 1/2 h later. It also produces an initial surge in tracheal transport, which frequently leads to tracheal mucus refluxing and thereby an increase in average tracheal residence time. The drugs were used to modify the normal deposition and clearance characteristics of a particular animal so that they resembled the normal characteristics of a different animal, suggesting that much of the large intersubject variability may be attributable to different levels of autonomic tone.


Hematotoxicity of inhaled benzene to Sprague-Dawley rats and AKR mice at 300 ppm. Sprague-Dawley rats and AKR/J mice were exposed to 300 ppm benzene vapor for 6 h/d, 5 d/wk, for life. Rats exhibited lymphocytopenia, mild anemia, and moderately decreased survival. Mice showed severe lymphocytopenia and anemia accompanied by granulocytosis and reticulocytosis. Treated mice also showed significantly decreased survival and weight gain. No indications of a leukemic or preleukemic response were observed in either species.


Respiratory response to iodine vapor alone and with sodium chloride aerosol. Respiratory function measurements in guinea pigs were used to evaluate the irritant response to 1-h exposures to iodine vapor and the effect of 10 mg/m(3) submicrometer sodium chloride aerosol on this response. Iodine alone at 0.5 ppm produced no detectable response. Concentrations of 3-4 ppm increased resistance and decreased frequency and minute volume. The response appeared to be upper respiratory. At 7 ppm there was also a decrease in compliance, suggesting pulmonary effects. The response was potentiated by the sodium chloride aerosol. Increased resistance and decreased compliance and frequency were observed at 0.4 ppm. The changes at concentrations of 1-2 ppm were greater when the aerosol was present and included a decrease in compliance. The comparative effects of the sodium chloride aerosol on iodine, sulfur dioxide, and formaldehyde are discussed.


Methodology of the study of carcinogens in human populations. Epidemiology, including occupational tumors and other groups at risk; experimental studies; and physiochemical methods of evaluation of environmental carcinogens form the basis of cancer prevention. Hygienic measures of limitation (maximum allowable concentrations) are also discussed.


Induction of pulmonary carcinoma in rats by chronic inhalation of dust from pulverized asbestos pipe covering. Rats and hamsters were exposed to the dust of pulverized asbestos pipe covering at an average concentration of 85 mg/m(3) for 6 h/d, 5 d/wk, for 7 mo, followed by a lifetime observation period. In rats, the pulmonary responses were alveolar adenomatous proliferation, nonprogressive fibrosis, squamous metaplasia, and a substantial incidence of pulmonary carcinoma formation. A smaller group of hamsters exposed under these conditions experienced an earlier onset of mortality than control hamsters, which were not subjected to the exposure regimen. Although this prevented conclusive evaluation of the pulmonary response in this species, no pulmonary neoplasms were noted in the surviving hamsters.


The Laskin aerosol generator.

The Laskin aerosol generator. This paper describes construction details and operating characteristics of a nebulizer developed by Sidney Laskin and used over a period of 30 yr in various laboratories to generate respirable aerosols for whole-animal inhalation exposure studies. Under the proper operating conditions, the device is capable of producing nearly monodisperse aerosols in the respirable size range (1.5 micron volume median diameter with a geometric standard deviation of 1.1) for long periods of time


Effects of DDT on stable laboratory mouse populations. Four stable laboratory mouse populations were established; each contained approximately 400 mice of both sexes and all ages postweaning living in a single cage, as well as neonates caged in separate nesting boxes with their dams. Two were used to determine the effects of continuous exposure to a dietary level of 100 ppm DDT while the other two served as controls. The results indicated a significant decrease (p less than or equal to 0.05) in neonatal survival (lactation index) within 20 wk after the beginning of exposure to the toxicant in one of the exposed populations and by 30 wk in the other. This deleterious effect of the DDT continued through each succeeding generation. On the other hand, improved postweaning survival in DDT-fed mice was noted. Histological examination showed no tumors in test or control animals; other pathology was seen more frequently in control than in test animals.


Head injury watch sheet modified for a digital scale. A zero to 100 digital scoring system for brain injury has been devised. Items scored are vital signs, ability to speak and follow commands, or when unable to do so, a nonverbal response to pain, pupillary reactivity and equality, eyelid opening, and extremity strength. Certain parameters are weighted more heavily than others. The system also allows the examiner to modify serial scores by up to four points in a positive or negative direction based on clinical judgment of improvement or worsening. Over 100 adult patients have been scored, and when evaluated simultaneously by two physicians, the two objective scores usually are within 1 to 3 points of each other and the subjective score varies less. It is possible to express the clinical course of brain-injured patients numerically. Those with an initial score of 25 or less have an extremely poor prognosis and those with 75 or more do very well.


Off-road vehicle accidents: a new spectrum of trauma. A survey of off-road vehicle accident injuries indicates a significant incidence of trauma: means of 931 serious injuries and 15 fatalities/year were reported for a three-county region of Southern California. A representative 78-bed community hospital in the desert region saw 542 patients with injuries related to off-road vehicle accidents over 3 years. Characteristic injuries often could be related to the type of accident and vehicle involved. A survey of off-road vehicle enthusiasts showed that 21% had had an accident resulting in injury. Driver immaturity, poor judgment and alcohol were identified as causative factors. Future planning must include attention to the sports enthusiast and medical services planning as well as an appreciation of the characteristic injuries resulting from this sport.


Rollover injuries of the upper extremity. Eleven patients were treated for rollover injuries of the upper extremities from 1971 to 1976 resulting from the rollover accidents of off-road vehicles in rough terrain. Injuries to the volar surfaces of the extremity were most common, but injury to the extensor surfaces seemed to be more severe. Soft-tissue injuries predominated as did injury to the nondominant hand. The majority of patients returned to their original jobs after sometimes prolonged recovery and rehabilitation. A redesign of the rollover cage with interior hand holds could reduce the frequency and severity of these novel injuries.


Urinothorax following blunt trauma to the kidney. A case of urinothorax is reported in a 19-year-old girl with multiple injuries sustained in an auto accident. Thus blung injury to the right kidney was followed 8 days later by reduced urinary output and serous chest tube drainage. Intravenous dye injection showed dye in urine and in chest tube fluid, and the macerated right kidney was removed. The right pleural effusion then cleared with further drainage. The mechanism by which urine is transferred across the intact diaphragm is thought to be lymphatic drainage.


The Andy Gump fracture of the mandible: a cause of respiratory obstruction or distress. Bilateral body fractures of the elderly edentulous atrophic mandible can cause a characteristic facial deformity and prolapse of the tongue into the pharynx, obstructing the airway (3). Early clinical and radiographic diagnosis of this injury is important. Stabilization of the fracture fragments restores the bony support for the tongue and helps establish patency of the airway.


Intrarenal arteriovenous fistulas: transcatheter steel coil occlusion. Intrarenal arteriovenous fistulas are either congenital (cirsoid), acquired or idiopathic. Transcatheter occlusion of these fistulas was accomplished using the Gianturco stainless steel coil. The anatomical configuration of the feeding and draining vessels dictated the technical approach. There was considerable conservation of renal tissue as the result of this non-surgical therapeutic alternative.


Treatment of pyonephrosis: a comparative study. Our study is a comparison of treatments used for 97 patients with pyonephrosis. The patients were divided into 3 groups: 1) cases in which a primary nephrectomy was done, 2) cases in which nephrectomy was secondary to drainage through a nephrostomy and 3) cases in which nephrectomy was secondary to drainage through a translumbar percutaneous puncture with an Ingram catheter indwelling. Patients in whom nephrostomy and puncture were used had the highest percentage of complications, while primary nephrectomy produced the best results. Therefore, we believe that primary nephrectomy is the procedure of choice, using drainage through a puncture only when the general status of the patient does not permit primary nephrectomy.


Non-efflux as a factor in vesicoureteral reflux. A prospective study was begun to determine the role of non-efflux as a factor in the etiology of vesicoureteral reflux. Fifteen patients who had had 1 kidney removed for reasons other than reflux were available for study. Voiding cystourethrograms were done in all 15 cases to ascertain whether the remaining defunctionalized ureter was subject to reflux. In no instance was reflux demonstrated into the non-effluxing ureter.


Rheumatoid factor in bladder tumors.

Rheumatoid factor in bladder tumors. We used the standard latex fixation test to screen 71 patients with bladder tumors and appropriate controls for the rheumatoid factor. The rheumatoid factor was present in transitional and squamous cell carcinoma of the bladder. Positivity was correlated with staging and histological grading of the tumor. In control subjects it was present in squamous cell carcinoma of the penis and anal canal. The possibility of the circulating immune complex with tumor antigen and its antibody has been discussed.


Management of the urethra in patients undergoing radical cystectomy for bladder carcinoma. Computerized data on 174 male patients who underwent radical cystectomy for bladder carcinoma were studied in relationship to the incidence of urethral involvement. Simultaneous or delayed urethrectomies were done on 32 patients, 7 of whom had overt urethral carcinoma (4 per cent of the total number of male patients) and 10 of whom had carcinoma in situ (5.7 per cent of the total number of male patients). The low incidence of these 2 phenomena leads us to the conclusion that routine urethrectomy need not be done on patients undergoing radical cystectomy unless overt urethral carcinoma or positive margins are found at cystectomy. We believe that the use of urethral cytologies is crucial to the routine followup of patients who have undergone radical cystectomy for bladder cancer and should be combined with clinical followup to establish the indication for urethrectomy.


Biopsy and clinical course after cryosurgery for prostatic cancer. Open perineal cryosurgical prostatectomy has been reported previously in 154 consecutive prostatic cancer patients at our center. In 37 of these patients post-cryosurgery biopsies of the prostate were obtained. In the present report we compare this tissue to the preoperative biopsies. The data suggest that well differentiated cancers are associated with advantageous survival in cryosurgery patients. Lymphoid and eosinophilic cell infiltrates may represent post-cryosurgical local immune responses, with improved survival. Estrogen therapy seems to suppress this local immune response. One month or more after cryosurgery cancer in the biopsy correlates with palpable local recurrence but prior to 1 month it does not correlate. Cryosurgery by the open perineal approach has been an effective method to eliminate the primary lesion in localized and extensive prostatic cancer.


Ultrasonically guided antegrade pyelography. Guided by ultrasound percutaneous antegrade pyelography can be accomplished with great ease in patients with obstructive hydronephrosis. The exact location and the depth of the dilated renal pelvis can be determined accurately with the use of ultrasound and the procedure is similar to that of a cyst puncture. Antegrade pyelography provides significant diagnostic information on the nature of the obstructive lesion and can be performed as an adjunct to a retrograde study or as an alternative to a retrograde pyelogram. Ultrasound is considered a most advantageous aid to the performance of antegrade pyelography.


The anticholinergic effects of dicyclomine hydrochloride in uninhibited neurogenic bladder dysfunction. A preliminary study to assess objectively the effects of dicyclomine upon uncontrolled detrusor contractions and bladder capacity was undertaken in 14 patients with a cystometric diagnosis of uninhibited neurogenic bladder. Response was measured by cystometry performed 1, 2 and 4 hours after a 20 mg. oral dose. Of the 14 patients 11 had significant blockade of uninhibited contractions and a concomitant increase in bladder capacity. Similar but less dramatic changes were noted in the remaining 3 patients. Dicyclomine seems to have effective anticholinergic properties. No remarkable side effects were observed.


Results of ureteral reimplantation in patients with intrarenal reflux. Intrarenal reflux was diagnosed in 6 male and 3 female children between 3 weeks and 11 years old, with 13 kidneys affected. One kidney was removed and 12 were managed successfully by antireflux ureteral reimplantation. Followup examination showed satisfactory growth of 10 of the 12 kidneys with intrarenal reflux.


Non-operative treatment of vesicoureteral reflux. Varying degrees of vesicoureteral reflux in 193 ureters were followed conservatively. Prediction of in which ureters reflux would stop could not be made from an evaluation of the configuration and position of the orifice, the presence or absence of infection, the grade of the reflux or the age of the patient. The management of such patients is discussed.


In vivo trigonal measurements and their relationship to competence of the ureterovesical junction. In vivo measurements of the trigone were obtained in 73 children undergoing cystourethroscopy for evaluation of urinary tract infection with and without associated vesicoureteral reflux. These data revealed greater mobility or distensibility of the trigone in children with reflux. In addition, those children with large trigones had shorter submucosal tunnels. Bladder capacity was not statistically different between the 2 groups.


Localization of pheochromocytoma by computerized axial tomography. A hypovascular pheochromocytoma not visualized by nephrotomography or arteriography but demonstrated successfully by computerized axial tomography is described. We propose that this non-invasive test be used alone or in conjunction with other modalities to assist in the localization of this elusive and potentially fatal tumor.


Pheochromocytoma presenting as middeldorpf tumor: case report. Pheochromocytoma is a tumor that characteristically arises in the adrenal medulla. Extra-adrenal tumors make up approximately 10 per cent of all pheochromocytomas, with those occurring in the organ of Zuckerkandl being the most common. Others may occur anywhere along the sympathetic chain, including a number of reported cases in the bladder. A case is reported in which the tumor occurred deep in the presacral pelvic area, retroperitoneal and retrorectal, a so-called Middeldorpf tumor. Its rare presentation and technical demand of its removal underscore the importance of preoperative and intraoperative medical and pharmacologic management.


Ureteropelvic junction obstruction: its occurrence in 3 members of a single family. A mother and 2 children with ureteropelvic junction obstruction are described. This is the eighth instance of familial hydronephrosis secondary to ureteropelvic junction obstruction. In this family 10 months elapsed between the diagnosis in the first sister and the realization that an obstruction also was present in the sibling. With the recognition that ureteropelvic junction obstruction can be familial it is hoped that earlier, possibly correctable cases will be found. An autosomal dominant form of inheritance with variable penetrance is suggested in this family.


Ureteral rupture and bone scintigraphy.

Ureteral rupture and bone scintigraphy. The scintigraphic findings are described of upper ureteral rupture seen incidentally on bone scan in a 30-year-old patient after retrograde pyelography. This case is presented to alert physicians to look for non-osseous abnormalities on the bone scan.


Prolapsing single orthotopic ureterocele in a boy: case report. Single orthotopic ureteroceles are uncommon in childhood. A recent case of such a ureterocele causing obstructive symptomatology is presented. A similar case has not been specifically reported previously.


High grade invasive ureteral transitional cell carcinoma with a congenital solitary kidney: long-term survival after ureterectomy and radiation therapy. The circumstances surrounding the treatment of a primary high grade invasive transitional cell carcinoma occurring in the ureter of a solitary kidney indicate that the combination of surgery and radiation therapy occasionally may be markedly effective for controlling this generally lethal disease.


Arteriovesical fistula after ureterolithotomy: a case report and review of the literature. A case is reported of massive recurrent hematuria after ureterolithotomy caused by a fistula between a branch of the hypogastric artery and the bladder.


An unusual solution to complicated prostatic urethral stricture: modified pull-through urethroplasty-urethroneocystostomy. A modified transpubic pull-through procedure was used in a failed Solovov-Badenoch pull-through repair of a traumatic prostatomembranous urethral stricture. The modification consisted of an incision of the intracrural septum through which the mobilized bulbous urethra was then passed and anastomosed to the most available dependent portion of the anterior bladder wall. The outcome was an unexpectedly good result that has persisted for more than 30 months. A review of the literature revealed no absolutely similar procedure.


Idiopathic priapism in the newborn.

Idiopathic priapism in the newborn. Priapism in children usually results directly or indirectly from an underlying cause. Secondary priapism is extremely rare in neonates and idiopathic priapism has not been described previously.


Chylous ascites complicating retroperitoneal lymphadenectomy for testis tumors: management with peritoneovenous shunting. Two cases of chylous ascites secondary to lymph node dissection for testicular tumors are reported. Non-surgical management failed to control the ascites in either patient. The use of the LeVeen shunt promptly and permanently controlled the ascites in 1 patient.


Adenoid cystic carcinoma of the prostate: report of a case. Adenoid cystic carcinoma of the prostate is a rare but distinctive variant of prostatic adenocarcinoma. A case report is presented and the pathology, differential diagnosis and treatment modalities are discussed.


Conservative surgery for refractory sickle cell hematuria. Two cases of recurrent hematuria from sickle cell disease are described. The technique of "calyoscopy" is presented, whereby the bleeding is localized, enabling a partial renal resection to be done. During a 5-year followup neither patient has had significant hematuria.


Peliosis hepatis in hematologic disease. Report of two cases. Two patients with hematologic disease, one of whom had received androgenic steroids, had liver damage associated with peliosis hepatis. In one patient with spherocytic hemolytic anemia, peliosis hepatis was an incidental postmortem finding. In the other patient, who was treated with androgenic-anabolic steroids for aplastic anemia, hepatic failure associated with peliosis hepatis developed. Splenic involvement by peliosis was present in both patients. Peliosis hepatis should be considered in the differential diagnosis of hepatic disease in patients with hematologic disorders, especially if treatment has included androgenic-anabolic steroids.


Aspiration of intrathoracic abscess. Resultant acute ventilatory failure. Three cases illustrate that acute respiratory failure may be precipitated by spontaneous drainage of lung abscess or pleural empyema intrabronchially with diffuse aspiration of the contents bilaterally. This condition is especially hazardous if the cavity is large and the patient is debilitated or obtunded. The acute onset may mimic aspiration of gastric contents. Immediate studies of tracheal aspirate and roentgenograms of the chest should define the aspiration of intrathoracic abscess contents as the cause of acute respiratory failure.


A national study of medical and surgical specialties. II. Description of the survey instrument. The survey instrument used in the national study of physician activities conducted by the University of Southern California, Division of Research in Medical Education, is a log-diary in which physicians kept a record of their actual professional activities. The log-diary focused on use of physician time and patient encounters and employed numerical coding of activities and patient encounters in a highly structured format. Compared with instruments used in similar studies, this log-diary appears to gather a greater breadth and depth of information about physician practice patterns.


Legionnaires' disease. Clinical findings and one-year follow-up. The cases of six patients with Philadelphia Legionnaires' disease were studied during the acute phase and throughout the following year. This multisystems disease process developed abruptly with symptoms of chills, fever, myalgias, and headache. The unusual clinical association of fever with relative bradycardia was noted frequently. Pneumonia developed after the first few days and rapidly progressed to life-threatening respiratory failure despite penicillin and cephalosporin therapy. Improvement occurred within 48 hours after tetracycline or chloramphenicol was administered. No permament sequelae were noted on the one-year follow-up examination, and no secondary cases of infection occurred.


Aerosol beclomethasone treatment of chronic severe asthma. A one-year experience. After one year's use of beclomethasone dipropionate aerosol, 43 of 61 asthmatic patients who were originally dependent on oral corticosteroids were able to reduce and 38 to completely eliminate use of oral corticosteroids. Most patients maintained or improved their pulmonary functions. Exacerbation of rhinitis during oral corticosteroid withdrawal and emergence of nasal polyps were problems for 25 patients. Exacerbation of asthma with upper respiratory infection was an important event: 21 patients required supplemental oral corticosteroids to control asthma. Oral candidiasis occurred in only three patients.


The multiproblem patient. A goal-oriented approach. With greater accessibility of patients from lower socioeconomic backgrounds to medical care, the physician in private or clinical practice is increasingly confronted with patients whose medical problems either become quickly overshadowed by or entwined with seemingly hopeless socioeconomic or legal problems. Traditionally, these patients have sought help in charity hospitals and emergency rooms that are staffed with social workers, rehabilitation counselors, and other trained personnel who could deal with problems that were not specifically medical. As accessibility to physicians in private or clinical practice increases, the need for specific techniques in working with persons from this population becomes critical.


Treatment of intractable uremic pericardial effusion. Avoidance of pericardiectomy with local steroid instillation. Forty-five patients with uremic pericardial effusion were treated with local instillation of nonabsorbable steroid through an indwelling pericardial drainage catheter and followed up from one to 54 months. In these patients previous intensive dialysis and other attempts at control of the effusions were unsuccessful. The average hospitalization for percutaneous therapy was eight days. An asymptomatic internal mammary artery fistula developed in one patient. Another had resolution of her pericardial effusion but not of associated pericardial pain. She subsequently underwent pericardiectomy (stripping), without resolution of her pain. One patient had a recurrence of her effusion six months after therapy. Complications of this technique are rare. The relatively noninvasive drainage and local instillation of a nonabsorbable steroid is almost universally effective.


Screening and prevention of nutritional anemia during infancy. A prospective study of food fortification. No important differences in hemoglobin and hematocrit values occurred among subgroups of a cohort of 295 healthy, mature infants who were fed various dietry regimens of iron-fortified products, including cereal, whole milk, and corn syrup. Among all infants between the ages of 4 and 27 months, the incidence of hematocrit readings and hemoglobin levels below 30% and 10 g/dl, respectively, was 0.6%, and below 33% and 11 g/dl, respectively, was 3.2%. Because of the low incidence of nutritional anemia after age 4 months, initial screening should be done at 1 to 4 months of age, and selectively thereafter. A formula of evaporated milk and corn syrum plus iron-fortified cereal during early months, then whole milk and a more diversified diet including continued use of iron-fortified cereal during later months of infancy, provides a nutritionally sound and economical diet with sufficient iron.


Internal fixation by the Ender method.

Internal fixation by the Ender method. A new method for the intramedullary fixation of trochanteric fractures with prebent, 4.5-mm, round, semielastic nails has theoretical advantages over use of nail-plate devices. Use of the method in 25 patients suggest that it is mechanically sound, relatively easy to learn, and easier for the patient to tolerate. Operating room time is reduced and blood replacement was not necessary. No infections were encountered, and all patients who were ambulatory preoperatively remained ambulatory postoperatively.


Abuse of amitriptyline.

Abuse of amitriptyline. Amitriptyline hydrocholride (Elavil) is frequently used in treating mild to moderate depressive states. A survey of 346 persons enrolled in a methadone maintenance program showed that 86 (25%) had admitted taking amitriptyline with the purpose of achieving euphoria. Thin-layer chromatography of random urine specimens over five months showed that 34% of the patients had a positive result for amitriptyline at least once during this time. These results suggest that misuse of amitriptyline is not uncommon and should be carefully considered prior to prescribing this agent to narcotic dependent persons.


Tetraethyl lead poisoning from gasoline sniffing. In two cases of organic lead poisoning due to habitual gasoline sniffing, one patient had temporary hypomania and recovered with treatment, while the other patient (who died) had signs of severe CNS and peripheral nervous system, muscle, hepatic, and renal damage. In addition he had features of long-term inorganic lead poisoning. This and the response of both cases to chelating agents suggest that organic lead is degraded in vivo to inorganic lead.


Short-term adaptation to moderate altitude. Patients with chronic obstructive pulmonary disease. Eight patients with mild-to-moderate chronic obstructive pulmonary disease (COPD) and average resting Pao2 of 66 mm Hg were studied clinically and physiologically at sea level and after ascent to 1,920 m. At sea level the patients were symptomatic but not disabled. After ascent the patients had only mild symptoms of fatigue and insomnia, and one had severe headache during exercise on the first day. Funduscopic changes were not observed, nor did cardiac or pulmonary findings change. Resting sea level Pao2 dropped to 51.5 mm Hg within three hours of ascent, and the Paco2 fell from 37.8 to 33.9 mm Hg. Over the next three days, the Pao2 increased to 54.5 mm Hg as hyperventilation continued. At exercise, sea level Pao2 dropped from a mean value of 63 to 46.8 mm Hg at altitude. Pulse rates at rest or exercise did not change. Normal values for 2,3-diphosphoglycerate (2,3-DPG) did not change after ascent at 16 and 42 hours. We believe aircraft flight or travel to moderate altitudes for this type of COPD patient is safe. Preexisting hypoxemia resulting from disease may facilitate the adaptation of patients to severe hypoxia and may prevent symptoms similar to acute mountain sickness.


Disseminated histoplasmosis in corticosteroid-treated patients. Report of five cases. Although Histoplasma capsulatum is not generally considered an opportunistic organism, we have seen five corticosteroid-treated patients in whom disseminated histoplasmosis (DH) developed. Persistent, unexplained fever was the predominant symptom in each. Death was directly attributable to DH in four. The interval from onset of symptoms to diagnosis ranged from 11 to 75 days; delay in diagnosis adversely affected prognosis. Culture of the bone marrow appears to be the best diagnostic study. The pathologic features of DH in immunocompromised hosts are the presence of large numbers of Histoplasma yeast forms within macrophages, absence of discrete granulomas, and a reduced or absent inflammatory response. Histoplasma capsulatum should be considered as a possible cause in any immunosuppressed patient with unexplained fever, especially if the patient has been receiving corticosteroid therapy.


Fatal Rocky Mountain spotted fever.

Fatal Rocky Mountain spotted fever. Forty-four fatal cases of Rocky Mountain spotted fever (RMSF) occurring in 1974 were compared with 50 nonfatal cases of similar age, sex, date of onset, and place of occurrence. Diagnosis and initiation of treatment in fatal cases were substantially delayed compared with nonfatal cases. Several reasons for this delay were identified: (1) the rash appeared later in the course of illness in the fatal cases, often not until the patient was terminal, (2) a history of tick bite was less often obtained during life or obtained late in the clinical course in fatal cases, and (3) initial nonspecific symptoms or unexpected symptoms led to an initial diagnosis of more common diseases. Only two fatal cases were treated with either tetracycline or chloramphenicol before the sixth day of illness. Presumptive diagnosis of RMSF and initiation of tetracycline therapy before onset of rash may be necessary to reduce mortality.


Parathyroid cysts. Medical diagnosis and management. Two patients had asymptomatic neck masses that proved to be cystic. In each case, the lesions resolved after needle aspiration of 25 ml of clear, colorless fluid. Serum thyroid indexes and calcium levels were normal. Cyst fluid parathyroid hormone (PTH) levels were 0.56 and 1.50 ng/ml, respectively. The serum PTH level in case 1, determined at the same time, was less than 0.05 ng/ml (normal, 0 to 0.3 ng/ml). These observations indicate that (1) clear, colorless cyst fluid may indicate a parathyroid cyst, (2) serum and cyst fluid PTH levels can confirm the diagnosis, and (3) needle aspiration may be appropriate therapy for the benign, nonfunctioning parathyroid cyst.


Asplenia syndrome. A study of congenital anomalies in 16 cases. Sixteen new cases of the asplenia syndrome with autopsy findings had a female preponderance of 2:1. Racial incidence of splenic agenesis was nine whites and seven blacks. The average life span of the infants born alive was approximately 38 days. All infants with the asplenia syndrome had recorded weights and lengths below normal standard values. Surgical palliation of the cardiovascular anomalies in the asplenia syndrome was attempted in two cases. The incidence of the asplenia syndrome from the large autopsy series at the Medical University of South Carolina is one case per 2,000 autopsies.


A modern view of the surgical treatment of peripheral arterial disease. As life expectancy increases, more patients will harbor atherosclerotic conditions that portend disability and death. Due basically to a communication gap, sizable numbers of these patients who stand to benefit from vascular reconstruction are not being referred or are being referred too late to vascular surgeons. Vascular surgery currently can save limbs, extend productivity and life expectancy, ameliorate hypertension, and prevent stroke more reliably and with less risk than ever before. As the subspeciality of vascular surgery has matured, has incorporated additional fellowship training, and now approaches potential recognition in some yet to be determined form by The American Board of Surgery, it is incumbent on general physicians and vascular surgeons alike to develop appropriate channels that can transmit clinical concepts, educational information, and clinical results, as well as refer patients.


[Experimental studies on the passage of antibiotics into cerebrospinal fluid in staphylococcal meningitis in rabbits. II. Cephaloridine, cephalothin and cefazolin (author's transl)]. Passage of cephaloridine, cephalothin and cefazolin into cerebrospinal fluid (CSF) was evaluated in Staphylococcus aureus meningitis in rabbits and the following results were obtained. 1. Concentration in CSF (microgram/ml) [CSF/serum ratio (%)] was determined 1/2, 1 and 2 hours after a single intravenous injection of 100 mg/kg of each antibiotic, respectively; cephaloridine-7.5 [8.9], 9.7 [13.8], 9.1 [22.6]; cephalothin-0.42 [3.6], 0.23 [6.4], not detectable [0]; cefazolin-7.5 [11.8], 5.2 [19.3], 2.0 [17.5]. 2. When results with cefazolin after an intravenous injection 100 mg/kg and 200 mg/kg were compared, a definite dose response was noted in blood concentration but not in CSF concentration. 3. A standard error of CSF concentrations of each antibiotic was larger than that of penicillins, and "Unpredictability" of their passage into CSF was considered to be one of the characteristics common to these three drugs in respect of their passage into CSF. 4. There was no significant difference noted in antibiotic passage into CSF between cephaloridine of low protein binding rate and cefazolin of very high binding rate. Cephalothin, of which binding rate was intermediate, showed a remarkably lower passage into CSF. These results indicate that a correlation does not always exist between protein binding rate of the antibiotics and their passage into CSF. 5. Based on the above results, a review of the literature was made on clinical applicability of these three antibiotics in the treatment of bacterial meningitis. Low transport rate of cephalothin into CSF and nephrotoxicity of cephaloridine make them to be unsuitable for bacterial meningitis. Cefazolin is considered to be suitable in the treatment of ampicillin-resistant Escherichia coli meningitis and Gram-positive coccal meningitis in which penicillins are not applicable.


Experimentally-induced agammaglobulinemia in Japanese quails. Induction of agammaglobulinemia in Japanese quails was attempted by various procedures of bursectomy (BX) including hormonal BX (H-BX) with testosterone, surgical BX (S-BX), chemical BX (C-BX) with cyclophosphamide and irradiation with gamma-ray. Immunosuppressive effect of BX was evaluated by antibody production in response to immunization with bovine serum albumin and sheep red blood cells, by the level of natural antibody, and by the amount of immunoglobulins in sera. As a result, two procedures, i.e. combination of H-BX, S-BX, and C-BX and combination of H-BX, S-BX and irradiation were found to induce most frequently complete aggamaglobulinemia in which neither immunoglobulin nor antibody production was detected. Mechanisms of immunosuppression of these BX procedures were discussed from the morphological aspect of development of the bursa.


On the serology of Plesiomonas shigelloides. The serology of 87 strains of Plesiomonas shigelloides was studied. Thirty O antigenic groups and 11 H antigens were defined within the 87 strains, and an antigenic schema consisting of 40 serovars was established. Some O antigens of P. shigelloides were identical or closely related to those of some Shigella serovars.


Mouse-strain difference in immunoprophylactic and immunotherapeutic effects of BCG on carcinogen-induced autochthonous tumors. The prophylactic and therapeutic effects of BCG on the tumors induced by 3-methylcholanthrene (MCA) were studied comparatively between two inbred mouse strains, SWM/Ms and C3H/He, the first tumor appeared 5 weeks after MCA and the cumulative tumor incidence reached almost 100% within 20 weeks. On the other hand, the first tumor appeared 8 weeks after MCA in SWM/Ms, the number of tumor-bearers increased more slowly than in C3H/He, and the final tumor incidence (at 30 weeks) was about 90-80%. Single subcutaneous injection with BCG 2 weeks prior to MCA significantly protected SWM/Ms from tumor development, but not in C3H/He. These tumors, once appeared grew progressively and killed the hosts equally in both the strains. Intratumor (i.t.) injection with BCG showed more or less therapeutic effects in SWM/Ms; most tumors regressed or retarded after BCG. The time period after tumor-appearance to tumor-death was prolonged in most of SWM/Ms mice given i.t. injection with BCG, except a few mice that died earlier than non-treated controls after BCG. Contrary, no therapeutic effect of i.t. injection with BCG was observed in C3H/He. different host responses to BCG between SWM/Ms and C3H/He were found by the peritoneal macrophage disappearance test and the footpad reaction test; SWM/Ms was a high-responder to BCG and C3H/He was a low-responder. The marked differences between SWM/Ms and C3H/He in prophylactic and therapeutic effects of BCG on the autochthonous tumors were discussed in terms of difference of the host immune response to BCG that is defined genetically.


Attempts at analysis of toxicity of pertussis vaccine. III. Effects of endotoxin on leukocytosis in mice due to lymphocytosis-promoting factor and reference preparations for determination of lymphocytosis-promoting factor. The effect of bacterial endotoxin on the change in peripheral leukocyte population in mice due to the lymphocytosis-promoting factor (LPF) was investigated. Endotoxin affected not only the total leukocyte count but also the leukocyte proportions at any observation time. Both the coefficient and the intercept of regression of the leukocytic response on dose of LPF were modified by endotoxin. Therefore, in a valid biological assay for LPF using the peripheral leukocyte count as a response, a common reference preparation available for any test materials, irrespective of presence or absence of endotoxin, will be impracticable. Two reference preparations were tentatively established, one being a vaccine and the other an LPF preparation containing little endotoxin. A unitage of LP activity was assigned to each reference preparation. The results also showed that an LPF material to be tested for its possible effects on the lymphatic tissues or the reticuloendothelial system should be free from endotoxin.


Segmental blood pressure of the leg and its clinical use. Systolic blood pressure at various levels of the leg was measured in 80 normal subjects by photoelectric plethysmography with a blood pressure cuff. Due to the higher pressure value at the thigh, calf, ankle, and foot and lower pressure value at the toe, the pressure gradient between each proximal site and the toe was significantly higher in the older (50-82) than in the younger age group (17-49). Therefore, normal values were determined separately in these two groups. In 64 limbs of 42 patients with arterial occlusive disease, a comparison between segmental blood pressure and arteriographic findings was made. Segmental blood pressure may be a rough indicator of the severity of arterial occlusion present and may refrect the status of the major conduits of the leg. An abnormal ankle-toe pressure gradient was found in only 52 per cent of limbs, although all 64 limbs had undergone an occlusive process distal to the ankle. In limbs with significantly low ankle blood pressure due to proximal lesions, less frequency and severity of an abnormal ankle-toe pressure gradient were seen than in limbs with normal ankle blood pressure. When pressure gradients between two different levels are used in clinical work, the blood pressure at the more proximal level should be always considered.


Histological evaluation of the effect of 5-FU emulsion on lymph node metastasis of stomach cancer. In order to evaluate the effect of anticancer drugs on the metastatic lesions of the regional lymph nodes from stomach cancers removed after oral administration of 5-FU emulsion, histological examinations of the specimens obtained from 107 surgical cases were carried out. In additional 13 cases with gastric cancer, the active 5-FU concentrations in the regional lymph nodes were determined. The effect of 5-FU emulsion in metastatic lesions as determined was histologically classified into Grades 0 to III according to the severity and extent of damaged cells and cell nests Grades II and III were judged to demonstrate the beneficial effect of the 5-FU emulsion. Such changes were identified in 62.0 per cent of the 242 metastatic lymph nodes, and the effectiveness increased as the total dose of the 5-FU emulsion administered increased (50.9 per cent for 5,000 mg or less, 70.9 per cent for 5,000 to 6,000 mg, and 72.7 per cent for 6,000 mg or more). The rate of effectiveness also varied with the histological type of the primary carcinoma, i.e. the differentiated type being more sensitive. The mean active 5-FU level in the regional lymph nodes was higher after the administration of 5-FU emulsion than of 5-FU solution supporting the earlier animal experiments.


Entire colon aganglionosis, and extensive aganglionosis: analysis of 94 cases in Japan. Incidence, sex distribution, length of the involved bowel, associated malformations, treatment and operative results were analysed in 94 cases of entire colon aganglionosis, 87 of which were collected from 42 institutions in Japan and seven treated in our department. In this series, 62 were entire colon aganglionosis and 32 were extensive aganglionosis. Incidence of entire colon aganglionosis was four per cent of all aganglionosis seen, and that of extensive aganglionosis was two per cent. Male: female ratio was 2:1 in cases with entire colon aganglionosis and 1.3:1 in extensive aganglionosis. Associated malformation was rare in both of entire colon, or extensive aganglionosis. Of the 94 cases, 41 cases survived neonatal period, and cure was obtained in 23 of entire colon aganglionosis and three of extensive aganglionosis.


Successfully resected carcinoma of the bifurcation of the main hepatic ducts--report of two cases. Two cases of carcinoma of the bifurcation of the main hepatic ducts are presented. The tumors were successfully removed by resection of the bifurcation in one case, and by left hepatic lobectomy in the other. Some other 38 cases of the same condition collected from the world literature are briefly reviewed and discussed with particular reference to their surgical interventions.


Arrangement pattern of new-lining endothelial cells. New-lining endothelial cells in the neointimae of two types of synthetic vascular prostheses were examined by light- and electron microscopy. Examination was carried out at one to 846 days post implantation of the prostheses in the thoracic aortae of 57 canines. The surfaces of both types of prostheses were covered by a continuous layer of endothelial cells. The long axes of the cells were found to be parallel to the blood stream. This observation indicates that the arrangement pattern of endothelial cells in the neointimae is largely dependent on the direction of the blood stream rather than on the direction of the tension exerted on the vascular prostheses.


A study on electrocardiographic changes during long-term cardiac pacing. This report describes the clinical evaluation of chest wall stimulation (CWS) follow-up studies in patients implanted with pacemakers and the value of this method for the observation of intrinsic rhythm. The CWS method was used to periodically check the intrinsic rhythm in 25 long-term pacemaker cases with atrioventricular block. After an average of 26.6 months, an improvement of conduction disturbance was seen in four cases (16 per cent), aggravation was noted in 11 cases (44 per cent), and no change was found in 10 cases (40 per cent). In five patients exhibiting aggravation, no intrinsic rhythm could be detected. Improvement was noted only in atrioventricular and not in intraventricular conduction. Six generators with demand failures were also detected during the course of this study.


Surgical treatment of the aortic aneurysm. For 93 cases of thoracic and 118 cases of abdominal aneurysms, the over-all operative mortality rate was 24.7 per cent and 9.3 per cent, respectively. Although the over-all operative mortality rate for 37 patients with aneurysms of the ascending aorta or aortic arch had been 40.5 per cent, recent advances in surgical technique led to a higher survival rate so that since 1975 no death occurred among 14 consecutive surgery cases. Cardiopulmonary bypass with or without selective perfusion of the carotid arteries or temporary external bypass procedures were employed in these 14 cases. The over-all operative mortality rate for 56 patients with aneurysms of the descending thoracic aorta was 14.3 per cent. Temporary external bypass procedures were employed in 49 cases. The operative mortality rate for 99 patients with unruptured abdominal aneurysms was five per cent, and that for 19 patients with ruptured aneurysms was 31.5 per cent.


The estimation of blood platelet survival. VI. Evaluation of the graphical method. An experiment was performed in which 13 scientists experienced in analyzing data on platelet survival were sent blind duplicate sets of ten platelet survival curves and requested to fit the "best" straight line through the data by eye and determine its point of intersection with the time axis. The duplicate sets labeled "control" and "aspirin" respectively were artificial data generated from evaluation for various times of a gamma curve of order five and adding random independent normal (Gaussian) errors having a standard deviation of 0.03. The results were analyzed to examine inter- and intra-observer variance, reproducibility and bias. The range of means of estimated survival was 8.68 days to 11.59 days and in the control data showed about 63 times as much variance among observers as that due to random error of measurement alone. The "aspirin" data showed similar results. Correlation coefficients within observers for the pairs of estimates varied from -0.307 to +0.920. Three observers showed strong systematic differences between the duplicate readings. These results provide clear evidence of the need for formal, rather than graphical, analysis of the data.


[State of the central circulation in prolonged hypokinesia in patients with a locomotor apparatus lesion]. Long-term bed rest of patients with tuberculous affection of the locomotor system results in gradual change in the circulatory system. The initial stage of hypokinesia is characterized by diminution of the total and central blood volume, by reduction of the arterial and venous pressure bringing to a decrease in the cardiac out-put volume. Then stabilization of the hemodynamics at the new level takes place due to the intensive action of certain compensatory mechanisms.


[Results of correcting isolated secondary defects of the interatrial septum under moderate hypothermia]. Operative treatment of isolated secondary interatrial septal defects in 236 patients is analysed. The results testify to the small degree of risk in suturing interatrial septal defects under conditions of moderate hypothermia. A study of central and intracardiac hemodynamics made it possible to reveal the development of acute pulmonary hypertension in some patients after the operation, which may be of a reflex character or a consequence of left ventricular insufficiency. A differential diagnosis and a therapeutic test are suggested for the differentiation and therapy of these conditions.


[Heart operations on young children under deep hypothermia]. The authors discuss their clinical experience in the use of deep hypothermia in combination with auxiliary extracorporeal circulation. Operations were performed on 124 children (total mortality 23.4%). Lowest mortality was noted in correction of ventricular septal defect; 12 out of 82 patients died, which accounts for approximately 14.6%. A follow-up of the remote results shows that the method has no harmful effect on the central nervous system.


[Late results of the radical correction of Ebstein's anomaly]. The results of a follow-up of 35 patients (including 18 children and adolescents) for periods of 6 months to 11 years after radical correction of Ebstein's anomaly are analysed. The results were good in 25 patients, satisfactory--in 6 and poor--in one patient; 3 patients died. The result was poor in one of the patients because the thin walled arterialized part of the right ventricle was not plicated. Death in the remote period was caused by disorders of the cardiac rhythm (atrioventricular block--Morgagni-Adams-Stokes syndrome), "prosthetic" endocarditis, and influenzal pneumonia. Complications of the remote period are analysed and the measures for their prevention and treatment substantiated.


[Late results of the surgical treatment of tetralogy of Fallot in children operated on in the 1st year of life]. Thirty-seven children who had been operated on for tetralogy of Fallot during the first year of life were examined in remote postoperative periods (in 5 years and 5 months, on the average). They all underwent palliative operations. The condition of 78.4% of them in remote postoperative periods was found to be good or satisfactory; in 8 patients (21.6% the result of the operation was poor. With prolongation of the follow-up period, the effect of the operation tends to be less favourable than in the initial period. The causes aggravating the patients, condition in the remote periods are: an anatomically unfavourable variant of the anomaly, the development of hypo- or hyperfunction of the anastomosis, faults in the surgical techniques of the operation.


[Late results and rehabilitation of patients with secondary interatrial septal defects]. The remote results were studied in 194 patients operated on for secondary atrial septal defects at ages of 18 months to 41 years. The follow-up period ranged from 5 months to 11 years. The ECG was normal in 74.7% of patients, its improvement was noted in 8.7% of patients. Disorders of rhythm were encountered in 10.3% of patients, their incidence being 2 1/2 times higher among adults than among children. The systolic murmur disappeared in 29.8% and diminished in 50.8% of patients. The diastolic murmur was corrected in 92.2% of cases. Splitting of the second sound disappeared in 66% and diminished in 6% of patients. The size of the heart on a radiogram became normal in 32.2% and its enlargement became less in 41% of the patients examined. The heart grows smaller within 2--3 years and the pulmonary pattern becomes normal in 1--2 years. The process is more rapid in children. The postoperative result was good in 90% of patients.


[Counterpulsation by means of a new device with a pulsatile blood flow in open heart operations (author's transl)]. A new counterpulsation method in operations on an open heart is described. Clinical experience in the use of the new device in 124 patients, which also makes it possible to produce a pulsatile flow of blood in the system of extracorporeal circulation, testifies to its effectiveness. The authors claim that the positive changes in cardiac output, diastolic and systolic pressure, and coronary circulation are among the factors which cause an improvement in the final result of the operation in patients with severe valvular diseases and ischemic heart disease.


[Thrombocyte aggregating capacity in ischemic heart disease caused by coronary arteriosclerosis]. A distinct increase in the aggregative property of blood platelets, displayed by an increased degree of aggregation and enlargement of the platelet aggregates, was revealed in patients with ischemic disease of the heart. The more severe the atherosclerotic process in the coronary arteries (according to the findings of selective coronarography), the more is the aggregative property of platelets intensified. The stimulating effect of smoking on platelet aggregation was also established.


[Characteristics of blood coagulation and of the red blood in patients with an arteriosclerotic lesion of the abdominal aorta]. The values of blood coagulation and red blood were studied in 74 patients with various forms of atherosclerotic affection of the abdominal aorta and its branches. Tendency towards hypercoagulation both before operation and in various periods after it was revealed in these patients. The development of thrombotic complications is preceded by a marked increase in the fibrinogen level and in the blood platelet count. High hematocrit with a relatively small erythrocyte count and hemoglobin concentration was revealed, which was linked with the spheric shape of the erythrocytes. It is concluded that a complex of antithrombotic therapy is necessary; it should be begun before the operation and continued particularly actively in the first two postoperative weeks.


[Importance of correlating catecholamines and acetylcholine in the acute period of complicated and uncomplicated myocardial infarct]. The data obtained by the author testifies to the fact that in various clinical forms of myocardial infarction, there are definite correlations between biologically active substances, reflecting the reactivity of the cholinergic and adrenergic systems. In non-complicated myocardial infarction the predominance of catecholamines is noted, as a rule. In complicated course of the disease with a favourable outcome, the absolute content of the biologically active substances is at maximum and the predominance of catecholamines remains; in some cases, however, the predominance of acetylcholine is observed. In myocardial infarction with a fatal outcome, there is practically no stable predominance of this or that substance with a distinct tendency to the growth of the acetylcholine content and an inadequate change in the content of catecholamines.


[Effect of infection foci and preexisting pathology on immunological shifts and the course of the disease in myocardial infarct patients]. The course of the disease and the dunamics of immunologic shifts were compared in 277 patients suffering from myocardial infarction, 87 of whom had foci of infection and chronic infectious-allergic diseases while 190 had no complications. In patients of the first group the disease was usually of a lingering character and anticardiac antibodies were found in circulation for lengthy periods of time. The incidence of chronic tonsillitis and odontogenous infectious foci was higher among patients with myocardial infarction complicated by the postinfarction syndrome than among those with a noncomplicated course of the disease (in 12 out of 20 and in 3 out of 20 patients, respectively).


[Problems of the pathogenesis of cor pulmonale in chronic nonspecific lung diseases]. The article discusses the values of 22 external respiration indices reflecting the condition of the lung volumes and their ratios, the irregular distribution of the ventilation-perfusion ratios, the alveolar ventilation, the diffusion property of the lungs, and the gas composition of the alveolar air in patients with chronic nonspecific diseases of the lungs before and after the development of chronic cor pulmonale and in its stages of compensation and decompensation. Correlative and regressive analysis of the main pathogenetic mechanisms was conducted, making it possible to reveal the contribution made by each of them to the pathogenesis of cor pulmonale.


[Method for the quantitative assessment of myocardial overload in cardiac fibrillation]. The dependence of the pulse pressure and cardiac output on the duration of the preceding cardiac cycle (R--R) in cardiac fibrillation was studied. The stress experienced by the myocardium due to deterioration of the pumping activity of the heart in arrhythmia may be calculated quite precisely by the method suggested by the authors. The "coefficient of myocardial overexertion" introduced in the work shows the percentage by which the heart has to increase the number of contractions so as to provide for a stable minute volume in arrhythmia.