[Ventricullar fibrillation in the acute stage of myocardial infarct. II. The characteristics of the heart functional changes in experimental myocardial infarct complicated by ventricullar fibrillation]. In acute experiments on dogs, occlusion of the anterior descending branch of the left coronary artery induced two-phase changes in the cardiac and stroke output (which increased at first and then decreased), drop in arterial pressure, and decrease in the rate of cardiac contractions. The experiments which terminated in ventricular fibrillation were characterized by a number of peculiarities: a more rapid replacement of the phase of primary increase in the cardiac and stroke output by the phase of their decrease; a sharper drop in arterial pressure as compared with that in experiments without fibrillation; marked decrease in cardiac activity which in experiments without fibrillation underwent two-phase changes, it increased a little at first and then decreased.


Isolation and characterization of rat glomerular epithelial cells in vitro. Rat glomeruli were isolated by a graded sieving technique, and the nature and purity of the preparation were examined by scanning electron microscopy (SEM). A great majority of the glomeruli (86.0 +/- 6.0%) were not encapsulated, and there was very little contamination of the preparations with tubular fragments. By supplementing tissue culture medium with conditioned medium (CM) and insulin, we were able to grow single cells from dissociated rat glomeruli. From these single cells, we were able to clone and maintain in culture three distinct cell types. Also, with this specialized medium, we were able to clone these three cell types from outgrowths of whole golmeruli. One of these cell types was characterized as glomerular epithelial cells (GEC). GEC, as opposed to the other two cloned cell types obtained in this study, had cilia on their surfaces and also possessed receptors for complement (C3) in vitro. Low concentrations of the aminonucleoside of puromycin (AMNS), which have been shown to be specifically cytotoxic to GEC in vivo, were found to be cytotoxic to GEC but not to the other two glomerular cells in vitro. In addition, GEC did not contain antihemophilic factor (factor VIII), a marker for endothelium, nor were they able to phagocytose polystyrene spherules in vitro, as can mesangial cells in short-term culture.


Ischemic damage and repair in the rat proximal tubule: differences among the S1, S2, and S3 segments. Rats were subjected to 25 min of unilateral renal artery occlusion and were studied at 5, 15, and 30 min and at 1, 2, 4, 8, 16, 24, and 48 hr following ischemia. The patterns of epithelial injury and repair in proximal tubule (PT) segments S1, S2, and S3 were followed, and associated changes in renal function were determined. We found that S1 and S2 cells alike are only reversibly injured and recover completely to normalcy within 4 hr, whereas S3 cells selectively undergo progressive cell injury and death and are exfoliated into tubular lumina. The necrotic S3 cells are replaced by mitotic division of survivor cells 24 to 48 hr following the ischemic insult. In addition, there was selective damage within tubular cells. Wiithin 5 min of blood reflow following ischemia, the majority of brush border microvilli (MV) in all three PT segments underwent coalescence by membrane fusion and thus were interiorized into the cytoplasm of PT cells. A minority of MV fragmented and were shed into PT lumina, but nephron obstruction by shed membranes was only mild and transient, unlike in the 1-hr ischemia model. Loss of MV reached a maximum of 15 min. By 30 min, MV began to reappear; by 2 hr, large numbers of MV had been regenerated; and by 4 hr, S1 and S2 cells appeared normal. The regenerative process included the luminal repositioning of previously interiorized MV membrane. MV regeneration occurred in S3 segments also, but before the process was complete, the cells developed features of irreversible cellular injury. Glomerular filtration rate (GFR) was 22% of control at 30 min of reflow, rose progressively to 55% of normal by 7 to 8 hr, and was normal at 24 hr. Single nephron filtration rate (SNGFR) was not significantly different from normal throughout. Proximal tubular sodium reabsorption was depressed and urinary sodium excretion increased at 30 min and at 2 to 3 hr, i.e., at times when MV alterations were prominent, but both were normal by 7 to 8 hr when MV in S1 and S2 cells had been fully reconstituted. Our major conclusions are: 1) There is differential susceptibility by cell type to ischemic injury in rat PT. 2) A rapid brush border loss/regeneration cycle occurs after ischemic injury. 3) Intact brush border may be required for normal sodium reabsorption by PT. Reasons for the GFR/SNGFR discrepancy are unclear, but tubular malfunction may partly explain the phenomenon.


Relation of ammonia excretion adaptation to glutaminase activity in acidotic, subtotalnephrectomized rats. The response of renal ammonia excretion to acidosis was examined in adult rats with reduced renal mass (SNX). Three days after surgical ablation of 70% of renal mass, the activity of renal phosphate-dependent glutaminase (PDG) in SNX rats was 7.7 +/- 1.5 mu moles of ammonia/100 mg of protein min or approximately 50% of the activity in normal rats (14.5 +/- 2.6 mu moles of ammonia/100 mg of protein min), but enhanced ammonia excretion per unit weight was observed in SNX rats (7.2 +/- 0.7 in control vs. 14.6 +/- 3.2 mumoles/g of kidney.hr in SNX rats). The cause (s) of the reduction in the specific activity of PDG (as well as the increase in ammonia excretion) is unknown. The PDG decrease was not due to apparent tissue damage and appeared to be a specific change as the activity of renal succinate dehydrogenase, another mitochondrial inner-membrane enzyme, did not decrease (from the control level) in SNX rats. Ammonia excretion showed no significant response to an acute acid load (ammonium chloride, 5 mmoles/kg of body wt) in SNX rats. Ammonia excretion, however, did adapt to repeated acid-loading (10 mmoles of ammonium chloride per kg of body wt per day for 3 days); ammonia excretion increased more than two-fold by third day of treatment. This adaptive response was associated with a two-fold rise in renal PDG. Administration of actinomycin D, at a dose which produced no gross toxic signs (100 microgram/kg/day i.p.) inhibited virtually all the increase in both ammonia excretion and PDG activity. The correlation of ammonia excretion and PDG adaptations in acidotic SNX rats was similar to that previously observed in infant rats.


Renal function and intrarenal hemodynamics in acutely hypoxic and hypercapnic rats. On the basis of microsphere distribution, inert gas washout, and standard clearance data, the effects of acute hypoxia and hypercapnia on the kidney were studied in anesthetized, mechanically ventilated rats. Moderate hypoxia (mean PO2, 48 mm Hg) did not significantly change diuresis, GFR, and tubular sodium rejection. Due to a decrease in renal vascular resistance (R) from 40.1 to 31.8 mm Hg ml-1 min, mean renal blood flow stayed constant in spite of a significant drop in mean arterial blood pressure. Hypoxic changes in R were not accompanied by significant changes in intrarenal distribution of blood flow (IDBF). In severe hypoxia (PO2 less than 45 mm Hg) with oliguria and marked arterial hypotension, R was the lowest of all groups (28.8 mm Hg ml-1 min). Hypercapnia did not significantly change the renal excretory parameters, although an increase in R (without change in IDBF), together with a decrease in MAP caused a marked drop in mean renal blood flow. From these studies we conclude: 1) in the anestheized rat, acute hypoxia caused significant changes in intrarenal hemodynamics without changes in excretory function, 2) hypoxic renal vasodilation persists even in severe hypotension with oliguria and anuria, 3) in acute hypoxia and hypercapnia, changes in renal blood flow and renal vascular resistance are not accompanied by significant changes in IDBF.


Hemodialysis bone disease: correlation between clinical, histologic, and other findings. This paper explores in patients with dialysis osteodystrophy the relationship between clinical features and histological, radiological, and biochemical findings. Eighty-five patients treated by hemodialysis for more than 6 months were studied. The following conclusions were drawn: 1) Bone pain in patients on regular hemodialysis is usually a symptom of developing osteomalacia but not of hyperparathyroidism or osteoporosis. 2) Many patients with histological osteomalacia and radiological features of osteomalacia, such as fractures or Looser zones, have no symptoms. 3)In dialysis patients, biochemical and radiological abnormalities are not a reliable means of predicting the presence of osteomalacia, but a raised serum alkaline phosphatase is a good indicator of the presence of osteitis fibrosa. For early detection of osteomalacia, bone biopsy in necessary. 4)A number of our dialysis patients develop an unusual form of osteomalacia characterized by absent or minimal histological osteitis fibrosa, a normal serum alkaline phosphatase, and a high incidence of myopathy and fractures.


Solute, amino acid, and hormone changes with coated charcoal hemoperfusion in uremia. This investigation assesses the effect of two-hour activated charcoal hemoperfusion using a column containing 300 g of acrylic hydrogel-coated activated charcoal either alone or combined with hemodialysis on small and "middle molecule" removal in uremic patients. Comparison was made with standard five-hour hemodialysis. Two patients with dialysis encephalopathy were treated with four-hour combined hemoperfusion/hemodialysis without beneficial clinical effects. Hemoperfusion increased the clearance rates of creatinine and urate when combined with dialysis. Hemoperfusion alone removed 1.3 +/- 0.6 g (mean +/- SD) of creatinine and 0.6 +/- 0.2 g of urate, while combined hemoperfusion/hemodialysis removed 1.7 +/- 0.6 g of creatinine and 1.0 +/- 0.5 g of urate in a two-hour period. Both treatment schedules removed less solute than standard five-hour hemodialysis but were associated with comparable "middle molecule" removal. Hemoperfusion accounted for additional amino acid removal when combined with hemodialysis, while hemoperfusion alone produced significant reduction only in the amino acid cystine. Changes in the hormones thyroxine, triiodothyronine, human growth hormone, and insulin were noted during the procedures. Acceptable falls in platelet counts and fibrinogen occurred with hemoperfusion. Coated charcoal hemoperfusion may prove to have a role in the management of uremic patients, although the acrylic hydrogel-coated charcoal hemoperfusion device requires combination with techniques allowing fluid and electrolyte removal.


[The influence of allopurinol on purine- and pyrimidinesynthesis (author's transl)]. Allopurinol inhibits xanthinoxydase. This results in a decrease of the serum and urinary uric acid. Simultaneously the renal excretion of hypoxanthine and xanthine increases. In most patients, however, the decrease of urinary uric acid is not completely replaced by the increase of oxypurines. This is attributed to an additional inhibition of de novo purine biosynthesis. The different effect of allopurinol on the endogenous and exogenous urates offers an alternative approach to explain the "purine deficit". The effect of allopurinol on the pyrimidine metabolism is due to an inhibition of orotidylic decarboxylase by the ribonucleotides of allopurinol, xanthine and oxipurinol. This inhibition is followed by an increase in the urinary excretion of orotidine and orotic acid. The additional administration of ribonucleic acid leads to a striking decrease of the allopurinol induced orotaciduria. The continuous administration of allopurinol also produces an increase in the activity of orotate phosphoribosyltransferase and orotidylic decarboxylase. At this time the mechanism of this increase in activity is not completely understood. Allopurinol is metabolized rapidly. Only 3-10% of an administered dose are excreted unchanged in the urine. Most of the allopurinol is oxidized to oxipurinol. A small portion is converted to the ribonucleosides and ribonucleotides1 of allopurinol and oxipurinol.


[Uptake of 2-C14 urate by erythrocytes in hyperuricemia and in gout (author's transl)]. The uptake of 2-C14 urate by erythrocytes was measured in 19 patients with primary hyperuricemia, 6 patients with secondary hyperuricemia, 17 patients with primary gout and 30 controls. The uptake of urate in patients with primary gout was significantly lower than in the controls. In contrast no such difference could be observed in patients with primary and secondary hyperuricemia. The uptake of labeled urate by erythrocytes from gouty patients is especially diminished in the early phase of the uptake kinetics. The possible relevance of this finding for the pathogenesis of urate precipitation in gout is discussed. Further, we consider the application of the tracer urate uptake by erythrocytes as an aid in the early diagnosis of gout.


[The specific effect of plasma proteins in erythrocyte sedimentation. An analysis of the correlation coefficients between ESR and the concentration of twenty individual plasma proteins in healthy and sick persons, with special reference to myocardial infarction (author's transl)]. 1. Spearman's rank correlation coefficient between erythrocyte sedimentation rate and the concentration of twenty individual plasma proteins was determined in 72 persons including 37 patients with recent myocardial infarction. The highest correlation coefficients with ESR could be demonstrated in the following proteins: fibrinogen, alpha-1-acid-glycoprotein, alpha-2-macroglobulin, alpha-1-antitrypsin, coeruloplasmin, Ig M. The closest correlation with ESR was found, when the molar concentrations of fibrinogen, alpha-2-macroglobulin and Ig M were summed up. 2. Subdivision of the examined group of patients according to their diagnosis showed that the degree of correlation with ESR in many plasma proteins essentially depends on the composition of the studied group of patients. The patients with myocardial infarction, with pneumonia and those with neoplasma all showed distinctly different patterns of correlation. These obviously reflect underlying changes in the concentrations of the studied proteins, that seem to be specific to the respective disease. 3. In 4 patients with myocardial infarction the changes in plasma protein concentrations together with ESR were followed over a period of 26 days after the infarction.


[The effect of oral butyl-biguanide on oral glucose tolerance and renal glucose reabsorption in normal human subjects in vivo (author's transl)]. 1. Oral glucose tolerance in 11 normal subjects was significantly improved after peroral administration of 150 mg of butyl-biguanide. 2. On the other hand maxiumum capacity of renal glucose reabsorption (TmG) and lowest glomerular glucose filtration rate at which glucosuria was recorded (F min) remained uninfluenced after 150 mg of butyl-biguanide in 7 normal subjects. 3. These results are compatible with the hypothesis that the oral administration of therapeutic doses of biguanides yields concentrations at the luminal face of the intestine which inhibit glucose resorption. Plasma concentrations following oral intake of the same dose of biguanide are too low to exert any inhibiting action on renal glucose reabsorption as demonstrated by the present in vivo studies. 4. Urinary flow rate and inulin clearance remained unaltered after butyl-biguanide in these normal subjects.


[Measurement of the conduction time within the fascicles of the His-Purkinje-system using endocardial detection (author's transl)]. The conduction time in the 3 fascicles of the His-Purkinje system can be measured by recording the local excitation in the peripheral His-Purkinje system of the right bundle and the anterior and posterior fascicle of the left bundle, in combination with His-bundle recordings. This technique allows a detailed study of the subjunctional conduction and gives information on the conduction pathways in ventricular arrhythmias.


[Thromboplastin activity of extracts of human thyroid glands (author's transl)]. Aqueous extracts of thyroid glands were prepared from 25 surgical specimens of 19 patients. The average prothrombin time of sixteen 3:4 diluted extracts of thyroids from 13 euthyroid patients was 16.8 +/- 2.3 sec as measured with 100% human plasma. Under similar conditions the average prothrombin time of extracts obtained from the grey matter of three human brains was 18.4 +/- 0.3 sec. The thyroid may thus be considered as an organ containing one of the highest concentrations of tissue thromboplastin.


[Enteric hyperoxaluria. I. Intestinal oxalate absorption in gastrointestinal diseases (author's transl)]. Oxalate-urolithiasis and hyperoxalaria have been reported to be a frequent complication in patients with small bowel disease, especially in patients with ileal resection due to Crohn's disease. Hyperabsorption of oxalate seems to be the main patholgenetic factor for "enteric" hyperoxalaria. Intestinal absorption and urinary excretion of oxalate was measured in patients with various gastrointestinal diseases after oral or rectal administration of 14C-oxalate. Kinetic data suggest that 14C-oxalate is absorbed in the small, the large bowel and the rectum as well. Oxalate absorption was decreased in patients with a colectomy and in active ulcerative colitis, but increased in patients with ileal resection, chronic liver disease, and steatorrhea due to chronic pancratitis or sprue. There existed a positive correlation between 14C-oxalate absorption and the amount of fecal fat excretion. The data suggest that hyperoxaluria and hyperabsorption of oxalate are not a specific finding in patients with bile acid malabsorption, but may occur too, in steatorrhea without alteration of bile acid metabolism.


[Porphyria erythropoietica congenita Günther and chloroquine (author's transl)]. Treatment of a six-year-old boy with porphyria congenita (Günther) by small amounts of chloroquine was followed by a sharp but transient increase of the urinary excretion of porphyrins. Moreover, a nearly complete normalization of the previously observed rigidity of the erythrocytes occurred. With respect to the possibility that this elevated rigidity plays an important role for the typical hemolysis connected with this porphyria, the application of chloroquine could be of therapeutic value for this disease.


[Effect of saralasin on plasma renin activity and arginine-vasopressin in patients with angiotensin-dependent hypertension (author's transl)]. A central stimulatory effect of angiotensin II (AII) on the secretion of arginine-vasopressin (AVP) has been described. The competitive blocker of AII, saralasin (SAR) has been used for diagnostic purposes in angiotensin-dependent hypertension. In addition SAR has a partially agnoistic effect. The aim of the present study was to demonstrate whether AVP-levels can be influenced during SAR-induced renin stimulation. In 9 patients with essential hypertension blood pressure dropped significantly under SAR (10 microgram/kg/min over a 30 min period). Before and after SAR plasma renin activity (PRA) and AVP were measured by RIA, SAR evoked significantly increments of PRA in all patients and of AVP in 6 patients. The increased serum concentrations of AVP following SAR may be explained either by the depressor effect of SAR, its diminished concentration at the central receptor, or a partial AII-agonistic effect.


Histochemical methods for the demonstration of Thomsen-Friedenreich antigen in cell suspensions and tissue sections. 1. Three different methods are described for the visualisation of the Thomsen-Friedenreich (TF) antigen on cell suspensions, formalin-fixed and paraffin embedded or frozen tissue sections: a) Rosette formation with chicken and sheep erythrocytes. b) Fluorescence-microscopy with fluorescein labelled peanut agglutinin. c) Autoradiography with 3H-labelled peanut agglutinin. 2. The TF antigen was shown, as far as presently investigated, to be exposed on various blood cells, glomerula of the kidney and normal mammary gland after neuraminidase treatment. Mammary gland was also shown to possess TF receptors without prior treatment with neuraminidase. 3. The exposure of this cryptantigen can be brought about by bacterial or viral neuraminidase and is followed by an antigen/antibody reaction, which can lead to possible pathological consequences.


[Kaliuretic function of the kidneys in humans with different degrees of motor activity and at bed rest]. The kaliuretic function of the kidneys was studied in 12 healthy test subjects during the 49-day head-down tilting (--4 degrees). The results suggest that the selection of optimal exercises and dietary potassium intake may prevent changes in the potassium metabolism and the renal kaliuretic function both during bed rest and weightlessness as well as facilitate a rapid recovery of potassium homeostasis on return to Earth.


[Assessment of regional blood filling by using the rheoplethysmographic method combined with functional tests]. Vascular responses of fingers and toes to the occlusion test as well as fingers, head, lungs and liver to the Valsalva maneuver were studied. The responses to the tests depended on the initial level of blood filling. The different level of blood filling was induced by orthostatic, head-down tilt and LBNP tests. It is recommended to use rheography (slow and pulse components) in combination with the occlusion test and Valsalva maneuver in order to assess regional blood filling and venous tone of crew-members in space flights.


[Dynamics of plasma free amino acid levels in humans during antiorthostatic hypokinesia]. The amino acid composition of plasma was investigated in 8 healthy male test subjects during 49-day head-down bed rest. The concentration of most free amino acids in plasma increased significantly. The content of urea and taurine in plasma also grew. These changes were reversible and after the termination of the bed rest experiment the levels of all components in plasma returned to normal. The findings suggest that changes in the aminogram recorded during bed rest reflect rearrangement of protein metabolism and are adaptive.


[Psychophysiologic aspects of pilot performance during short term exposure to intense photic stimuli]. Psychophysiological characteristics of pilot performance were studied during short-term exposures to intensive light stimuli. The experiments were carried out in the laboratory and in the flight trainer. Parameters indicating piloting qualities and physiological functions of the pilot were recorded. The effect of intensive light stimuli on the pilot eyes caused a high nervous-psychic tension (stress) during trainer flying. The flight results were at large dictated by erroneous actions of the pilot during the first seconds of blinding. Pilot training for such conditions has a very favorable effect.


[Several current problems in the physiologic-hygienic standardization of noise in aerospace medicine]. On the basis of an examination of the physical characteristics of noises accompanying the performance of flying vehicles, experimental investigations of the effects of acoustic energy in a wide range of intensity and exposure time on the human body were carried out. The findings were used to develop the standards "noise intensity--time of continuous exposure and "noise intensity--class of antinoise", taking into account corrections for the protective effect of antinoise. This allowed a more substantiated approach to the standardization of work in an environment of high intensity noise. Although general approaches to the standardization were developed as related to flying vehicles, they can be applied to other branches of industry and transport.


[Work capacity of permanent high and low altitude dwellers]. Lowland and highland natives of similar age and physical fitness showed similar parameters of hemodynamics, pulmonary ventilation and gas exchange at rest. However, highlanders displayed lower lung vital capacity. Maximal work capacity of highlandders was higher. It was provided by lower tension of the cardiovascular system and higher tension of the respiratory system as compared with those of lowlanders.


[Method of irradiating bioobjects and results of dosimetric measurements on the biosatellite "Cosmos-690"]. The paper describes the design and experimental conditions of rat irradiation aboard the biosatellite Cosmos-690. An essential dose gradient due to different distances between the gamma-source and irradiated rats as well as due to the presence of construction components and equipment in the beam was made up by a special dose-equilibrating filter. The spectral distribution of scattered radiation reached maximum in the region of 0.1--0.3 Mev. The average dosage in the location of the main group of animals was 800 +/- 85 rad and that in the location of an additional group was 220 +/- 25 rad.


[Histochemical study of the digestive organs of rats on board for the space flight of the satellite "Cosmos-690"]. The digestive organs of rats exposed to a combined effect of space flight factors and irradiation were examined. The surface and foveal epithelium of the stomach as well as mucocytes of the fundal glands showed a drastically reduced content of the neutral carbohydrate component. The foveal epithelium and mucocytes of fundal necks also exhibited a significant decrease of the sulfomucin content. The large and small intestines showed a lowered amount of goblet-cells and their secretion. Pancreatic acinar cells displayed different changes in the content of enzymic proteins having cation properties. The above histochemical changes did not return to normal 36 days after irradiation and 26--27 days after readaptation to the Earth environment.


[Effect of prolonged rotation on radiation injury to the body]. CBA mice were kept for three weeks in a rotating installation (velocity--7.5 rpm, rotation radius--110 cm, acceleration--0.07 g). As a result, their radiosensitivity reduced. The lethal effect and severity of radiation injury declined. The animals rotated and irradiated at a sublethal dose showed an enhancement of the reparation process in bone marrow and the thymus. Significant changes in radiosensitivity can be expected during an exposure to rotation and acceleration of 0.3--1.0 g.


[Possible role of lysosomal proteinases in the biological effects of G-forces]. Experiments on rats demonstrated that acceleration of 6 g for 10 min elevated significantly the activity of acid proteinases and the rate of their release from lysosomes into the incubation mixture. Hydrocortisone (1 mg/100 g body weight) also increased proteinase activity; however, this effect was transient and less expressed. Upon a combined effect of hydrocortisone and acceleration the effect of the latter on the activity of lysosomal enzymes weakened appreciably.


[Feasibility of using a test involving exposure of the lower half of the body to negative pressure for selection of cosmonaut candidates]. By means of regional rheography and electrocardiography cardiovascular reactions to LBNP (25 mm Hg--2 min; 35 mm Hg--3 min; 40 mm Hg--5 min; 50 mm Hg--5 min) were studied in 60 young male test subjects (aged 25--42). Changes in the content and excretion of catecholamines were followed before and after LBNP in II test subjects. The investigations helped to elucidate mechanisms of compensatory and related reactions of the cardiovascular and sympathoadrenal systems. Diagnostic and prognostic criteria to evaluate LBNP tolerance were established. The criteria can be used to assess functional capabilities of the cardiovascular system and to predict orthostatic tolerance of cosmonaut candidates.


[Changes in the electrocerebellogram and autonomic responses of mice to acceleration]. Nembutal narcotized white rats were exposed to + GZ accelerations of 10 g for 5 min. Changes in the frequency spectrum of the bioelectric spontaneous activity of the cerebellar cortex, respiration rate and heart rate were examined. A correlation between bioelectric reactions of the cerebellum and adaptive-compensatory responses of the cardiovascular and respiratory systems was established. The rats that showed no electrographic reactions of awakening at the onset of acceleration displayed a reduced resistance to acceleration.


[Morphologic study of the hematopoietic organs of rats during hypokinesia]. During 60-day hypokinesia the hemopoietic system of rats developed important changes typical of the stress-state (atrophy of thymico-lymphatic system, lymphopenia and neutrophilosis) and hypokinesia per se (activation at the early stage and inhibition at the late stage of bone marrow erythropiesis, reduction of the rate of lympho- and myelopoiesis by the end of the experiment, emergence of pathologically changed megakaryocytes).


Temperature preference of adolescent mice. The behavioral preference of mice for various ambient temperatures was investigated while the mice were housed in a wire mesh cage. The animals exhibited a significant avoidance of ambient temperatures of 22 degree C and lower, especially when they were in an inactive period. This result suggested that temperatures a little higher than those conventionally adopted might be appropriate for rearing mice in wire mesh cages.


Oxygen consumption of germfree and conventional mice. Oxygen consumption was determined in germfree and conventional mice using a respirometer which enabled us to make precise corrections for variations in temperature or barometric pressure. In 20, 3-minute observations on 21 germfree and 21 conventional mice, the germfree animals consumed an average of 2.11 ml of oxygen per gram body weight per hour in comparison to 2.37 ml for the conventional mice. This difference was not accompanied by a difference in rectal temperature.


[Protective effect of 2-aminobenzimidazole during hyperbaric oxygenation and the state of cerebral nitrogen metabolism]. The protective effect of 2-aminobenzimidazole (2-ABI) was studied on white rats exposed to oxygen at 4 and 6 ata. During an exposure to oxygen at 6 ata injections of 2-ABI (in 1 ml saline at a dose of 5 mg per 100 g body weight) 10 min prior to the exposure delayed significantly (3 to 4 times) the time when convulsions began and assured 100% survival after the exposure (30 days). During an exposure to 4 ata (prolonged exposure) the injections did not delay convulsions but alleviated them and provided 100% survival after the exposure (30 days). Variations in the content of ammonia, glutamine, glutamic and aspartic acids and GAMA in the brain of treated and untreated animals were examined. By the beginning of convulsions the content of dicarboxylic amino acids and GABA remained unchanged in the treated animals. The level of ammonia and glutamine was not controlled by 2-ABI. After the exposure 2-ABI accelerated the return of metabolic parameters to the normal.


Dentostomella translucida in the Mongolian gerbil (Meriones unguiculatus). Dentostomella translucida, an oxyurid, was found in the small intestine of 39 out of 43 Mongolian gerbils from a research colony and in five pet gerbils in Columbia, Missouri. This discovery established a new host record and a new georgraphic locality for the parasite. Diagnosis of parasitism was best made by direct observation of the nematodes in the host's intestine af necropsy. The average length of males was 10.3 mm, and that of females was 20.3 mm. Parasite numbers in infected animals ranged from to 11, with an average of four. No clinical manifestations of disease were associated with the parasitisms. The prepatent period of infection was determined to be determined to be between 25 and 29 days.


Gonadotropin induced reproductive cyclicity in the domestic cat. Adult queens were treated with one of two sources of follicle stimulating gonodotropin (follicle stimulating hormone or pregnant mares' serum gonodotropin) to induce ovarian follicle development and estrus. Treatment involving single injections of follicle stimulating hormone stimulated mature follicle development but resulted in inconsistent display of sexual receptivity and variable ovulation rates. Single or multiple injections of pregnant mares' serum gonadotropin induced follicel growth, but follicle rupture often occurred prior to estrus and the mating stimulus. When compared to results obtained from queens mated while in natural estrus, cats receiving a series of injections of follicle stimulating hormone or pregnant mares' serum gonadotropin demonstrated ovarian hypersensitivity and produced follicular cysts which failed to rupture. The most effective hormone regimen for inducing follicle growth and estrus consisted of 2.0 mg follicle stimulating hormone injected daily intramuscularly until estrus. Queens receiving this treatment were capable of ovulating following mating or human chorionic gonodotropin administration and were capable of conceiving if mated.


The Yucatan minature pig as a laboratory animal. Parent stock for a minature pig herd was obtained from the progeny of pigs imported from the Yucatan Peninsula of Mexico. The Yucatan miniature pig is slate-gray, essentially hairless, and has a docile temperament. The tractable nature of this pig minimized risks for animal handlers as well as researchers. With regular human contact, these pigs became amenable to handling and tolerated restraint well. The mean birth weight was 0.74 kg, and the mean weaning weight at 60 days was 6.47 kg. The mean weight of mature nonobese boars was 83 kg while mature sows averaged 70 kg. The height and length for mature pigs of both sexes averaged 57 cm and 76 cm, respectively. The mean range of plasma glucose was 86-117 mg/dl during the first 8 weeks of life. The Yucatan miniature pig is native to tropical regions. The Colorado cold winter weather caused life-threatening stress to animals housed outside; therefore, intensive management procedures were required during the winter months.


Anesthesia in the rabbit using a combination of ketamine and promazine. An anesthetic combination of ketamine and promazine (75mg/kg by ketamine content) was tested in 15 male and 15 female adult New Zealand white rabbits. The mean induction time was 9 minutes for both the  male and female. Mean duration for anesthesia was 61 minutes for the male and 49 minutes for the female. The mean recovery time was 22 minutes for the male and 33 minutes for the female. The drug combination provided effective anesthesia for a period of 50--60 minutes after a single intramuscular injection.


Chronic necrotizing mastitis in rats caused by Pasteurella pneumotropica. Sixty-one of 2500 F344 rats were observed to have one to three enlarged and firm mammary glands. Pasteurella pneumotropica was isolated from all affected mammary glands. It was also routinely isolated from the feces of all cages and from the oral cavity of rats up to 6 weeks old, but not from the oral cavity of rats over 4 months of age. The organism was not isolated from clinically normal lactating mammary glands. Histopathological diagnosis of affected glands was chronic necrotizing mastitis.


Derivation and maintenance of gnotobiotic dogs. Revised techniques for derivation and maintenance of gnotobiotic dogs for research purposes were outlined. Gravid uteri were removed from pregnant beagle bitches and passed through a germicidal trap into a flexible plastic isolation unit. Pups were raised on a milk replacement diet and weaned to solid food by 4 weeks of age.


Femoral venipuncture for repeated blood sampling in miniature swine. Repetitive blood sampling of miniature swine was accomplished by percutaneous puncture of the femoral vein. Swine were restrained manually in dorsal recumbency. The skin was penetrated in the inguinal area approximately 2.5 cm laterally to the most posterior mammary gland with a 21-gauge, 3 cm (1.5 inch) needle. Ten milliliters of blood were withdrawn of frequent intervals for 4 months without apparent harm to the animals.


Peripheral couplings in human skeletal muscle. The importance of peripheral couplings in muscle function has been uncertain because of the failure to demonstrate them in human skeletal muscle. This study has utilized ruthenium red staining to demonstrate peripheral couplings in human skeletal muscle biopsies. This finding supports the belief that the peripheral coupling is a basic component of striated muscle.


Ultrastructure of the fibrous ring in patient with discrete subaortic stenosis. Histologic and ultrastructural studies disclosed the presence of five tissue layers in fibrous rings excised at operation from five patients with discrete subaortic stenosis. These layers were: (1) a surface monolayer of endothelial cells; (2) a subendothelial layer rich in acid mucopolysaccharides and basement membrane-like material; (3) a fibroelastic layer containing collagen and small (1 micrometer or less in diameter) elastic fibers; (4) a layer of smooth muscle cells with thickened basement membranes, and (5) a central fibrous layer with large amounts of collagen and small amounts of elastic fibers. The connective tissue layers in the rings frequently were discontinuous. The layered arrangement of these rings resembles that of normal endocardium in the left ventricular outflow tract.


Collagens synthesized in vitro by diploid fibroblasts obtained from chronically inflamed human connective tissue. Collagen synthesis by fibroblasts obtained from healthy and diseased human gingiva was compared. The cells were labeled with radioactive amino acids and the collagenous proteins synthesized were characterized after NaCl fractionation by CM-cellulose chromatography and cyanogen bromide peptide analysis. Fourteen cell lines, six from healthy gingiva, six from gingiva with chronic inflammatory periodontitis, and two from acutely inflamed gingiva were studied. All of the cell lines synthesized predominantly type I collagen. Type III collagen was a minor product of all cell lines except one from diseased tissue. Five of six cell lines from diseased gingiva and two of two from acutely inflamed tissue synthesized a collagen that was soluble in 2.5 M NaCl. The alpha1/alpha2 ratio and cyanogen bromide peptide pattern indicated that this fraction contained a collagen of the type alpha1[I]3. The alpha1[I]3 collagen was not detectable in the fibroblast lines obtained from healthy gingiva. It appears that inflamed human gingivae contain fibroblasts which differ phenotypically from cells from normal tissue in that they are capable of synthesizing alpha1[I]3 collagen.


Effect of cortisone upon vascular permeability to antibody. In rabbits actively sensitized to bovine serum albumin, intracorneal injection of 1 mg. of fluorescein-labeled bovine serum albumin evokes a circular band of fluorescence secondary to precipitation of the diffusing antigen with antibody migrating from the limbal blood vessels. Cortisone treatment prevented or markedly decreased this phenomenon indicating that cortisone exerts a definite inhibitory effect upon vascular permeability to antibody molecules.


Ultrastructural localization of mitochondrial and ribosomal antigens by peroxidase-labeled human antibodies. Immunohistochemical techniques have facilitated the detection of a variety of antibodies to different cells and tissues  in patients with chronic active liver disease; however, the ultrastructural localization of the antigenic binding sites, particularly of mitochondrial antibody, has been controversial. Therefore, we have employed direct immunoelectron microscopy to compare the reactivity of mitochondrial antibody with that of ribosomal antibody using gastric and renal tissues as substrates. Mitochondrial antibodies from three patients with primary biliary cirrhosis and from one patient with chronic active hepatitis reacted with the inner membrane and cristae of all mitochondria in different cells, whereas a ribosomal antibody from a patient with ovarian carcinoma bound to the rough endoplasmic reticulum, and possibly free ribosomes and polysomes, of all cells observed. Identification and characterization of these antibodies is needed for the differential diagnosis of chronic active liver disease.


Origin of cells in human amniotic fluid cultures: ultrastructural features. Two classes of cells can be subcultured from human amniotic fluid (F and AF). Ultrastructural features of these cultrued cells were determined using scanning and transmission electron microscopy with particular attention to extracellular material. Results obtained from these two cell types are compared to one another and to cultured human dermal fïbroblasts. The F-type cultures have an abundance of extracellular type i collagen fïbers, identical with cultured human dermal fïbroblasts. No type I collagen fïbers are seen in cultures of AF cells. Instead, fïne fïlamentous material is admixed with amorphous material adjacent to cell membranes where epithelial basement membrane glycoprotein has been localized. By scanning electron microscopy parallel arrays of cells are present at confluency of F cultures, typical of cultured dermal fïbroblasts. AF cultures show a much looser growth pattern at confluency. On the basis of accumulated evidence, we believe that F-type cells arise from fïbrous connective tissue and are fïbroblasts, whereas AF cells, the predominant type in early cultures used for prenatal genetic diagnosis, arise from fetal membranes and retain features of trophoblast.


The role of protein A in the attachment of staphylococci to influenza-infected cells. The adherence of staphylococcal protein A-containing Cowan I bacteria to influenza-infected cells was enhanced up to 5 times following incubation of the monolayers with antiinfluenzal serum, but not following treatment with nomimmune serum. Significantly increased binding of Cowan I bacteria was detected at antiinfluenzal serum dilutions as high as 1:40,960. None of the several antibody concentrations tested enhanced the binding of staphylococcal protein A-negative staphylococci. In addition, extracellular staphylococcal protein A was found to inhibit complement-mediated cytolysis of antibody-coated, virus-infected cells. The possible significance of staphylococcal protein A in the synergistic interaction between staphylococcal and influenza virus infections is discussed.


Immunohistologic analysis of fetal and dermatosparactic calf and sheep skin with antisera to procollagen and collagen type I. Immunofluorescent analysis of bovine and sheep skin using antibodies to the biosynthetic precursor pn-collagen type I, demonstrated that the localization of pn-collagen is restricted to the stratum papillare in adult skin. In contrast, antibodies against pn-collagen type I stained the whole dermis in skin obtained from dermatosparactic cattle and sheep. Electron microscopy of dermatosparactic sheep skin stained with ferritin-labeled anti-pn-collagen type I antibodies further demonstrated that pn-collagen molecules are the structural components of the unusual, twisted collagen fïbers observed in dermatosparactic skin.


Morphologic effects following massive exchange transfusions with a stroma-free hemoglobin solution. I. Liver. Hepatic morphology was studied in rats that were exchange transfused with either a stroma-free hemoglobin solution (SFHS) or with various asanguineous resuscitative fluids. The animals under-went 75 per cent blood volume replacement and tissues were collected and fixed at timed intervals after the exchange transfusion. In addition, blood volumes were determined, using chromium labeled red blood cells, in both albumin and SFHS-treated rats at varying time periods after exchange transfusion. One hour following exchange transfusion, livers of animals infused with asanguineous fluids demonstrated marked centrolobular hepatocellular vacuolization and mitochondrial shape alterations consistent with the effects of hypoxia. SFHS appeared to protect the liver from these early abnormalities. However, at later time intervals livers of albumin-treated animals appeared normal, whereas those of SFHS-transfused rats exhibited centrolobular necrosis. Blood volume was reduced approximately 10 per cent during the first 18 hours after exchange transfusion with albumin, while SFHS-treated rats experienced a 42 per cent blood volume decrement in only 6 hours. Blood volumes were near normal in all animals by 48 hours. These findings suggest that SFHS protects the liver from hypoxia immediately after exchange transfusion, presumably by its ability to transport and release oxygen. However, the eventual disappearance of hemoglobin from the intravascular space is associated with a marked reduction in blood volume which is accompanied by hepatic ischemia and centrolobular necrosis.


Morphologic and cytochemical properties of a clonal line of rat adrenal pheochromocytoma cells which respond to nerve growth factor. The PC12 pheochromocytoma line is a clonal line derived from a rat adrenal medullary tumor. PC12 cells grown in vitro have morphologic and cytochemical features in common with normal chromaffin cells in varying stages of development, and with human pheochromocytomas. These features include catecholamine stores demonstrable by formaldehyde-induced fluorescence and argentaffinic secretory granules, measuring 30 to 350 nm. Dark "norepinephrine"- and light "epinephrine"-type granules are both present, despite the absence of epinephrine and of its synthesizing enzyme, phenylethanolamine N-methyltransferase. Addition of nerve growth factor to the culture medium causes the cells to stop dividing and to develop neurite-like processes. Nerve growth factor-treated cells also develop clusters of 30- to 120-nm. granules and of 30- to 70-nm. granular and agranular vesicles, which resemble the granules and vesicles in adrenergic and cholinergic neurons and in neuroblastomas. In the early stages of process formation, formaldehyde-induced fluorescence can be demonstrated both in cell bodies and in processes. In later stages there is a marked diminution of formaldehyde-induced fluorescence in cell bodies and processes and a decreased number of granules in cell bodies, except in occasional cells within large clumps. These residual, fluorescent, granule-containing cells also remain argentaffinic. Alterations of the cell surface and of cytoplasmic filament arrangements also occur in cells treated with nerve growth factor. Further studies of the PC12 line may help to clarify relationships between morphology and function in the developing and mature autonomic nervous system, and the influence of nerve growth factor on these relationships.


Differentiation of epithelial foot processes and filtration slits: sequential appearance of occluding junctions, epithelial polyanion, and slit membranes in developing glomeruli. The visceral glomerular epithelium of immature glomeruli from newborn rats was examined in order to determine the sequence of events that occurs during differentiation of foot processes and filtration slits. Four different stages of glomerular development were defined: vesicle, S-shaped body, developing capillary loop, and maturing stages. During the vesicle stage, the precursor cells of the glomerular and tubular epithelium are joined by occluding junctions at their apices. During the S-shaped body stage, the tubular and parietal visceral glomerular epithelium differentiate, and the occluding zonulae remain along the presumptive tubule lumen and Bowman's space, respectively. With the appearance of capillary loops the parietal and tubular junctions maintain this arrangement, but the junctions of the visceral epithelium are seen at various levels along the lateral cell margins, suggesting that they migrate along the lateral cell surfaces from apex to base. Initially, broad epithelial processes cover the entire outer aspect of the developing basement membrane. After junctional migration interdigitation of epithelial processes is seen, and the processes are joined by focal occluding junctions (maculae or fasciae). With more elaborate interdigitation, fewer and fewer intercellular spaces are closed by occluding junctions, the junctions become less and less extensive, and normal slit architecture with foot processes bridged by slit membranes predominate. Colloidal iron staining (i.e., epithelial polyanion) is first detected along the lateral epithelial cell surfaces early in the capillary loop stage and becomes concentrated along their basal cell surfaces facing the basement membrane at about the same time as interdigitation is occurring. Therefore, facing the basement membrane at about the same time as interdigitation is occurring. Therefore, sialoproteins appear on the epithelial cell surfaces prior to the development of foot processes and slits. This finding is in keeping with the assumption that epithelial polyanion may be required for development and maintenance of normal foot process and slit organization. Prior to the development of extensive interdigitation, the differentiating glomerular epithelium bears a number of striking similarities to the nephrotic epithelium: foot processes are broad, reduced in number, and often joined by focal occluding junctions; slit diaphragms are reduced in number and displaced away from the basement membrane; and ladder-like structures occur in the filtration slits. The epithelial changes seen in aminonucleoside nephrosis therefore appear to represent a "dedifferentiation" to a more primitive organization, and the events that occur early in this disease process represent a rerun inreverse of events that occur during normal glomerular development.


Myocardial protection by intermittent perfusion with cardioplegic solution versus intermittent coronary perfusion with cold blood. The myocardial protection provided by cardioplegic solution using buffered, isosmotic potassium (30 mEq. per liter) was compared with intermittent cold coronary perfusion for 2 hours of aortic cross-clamping in dogs. The cardioplegic solution (Group CS) or cold blood (Group CB) was infused every 15 minutes through a cooling coil to reduce the perfusate temperature to 5 degrees C. Myocardial function after 30 minutes of reperfusion and rewarming was reduced in Group CB with a significant reduction in peak systolic pressure at a left ventricular (LV) balloon volume of 20 ml. and a significant reduction of dp/dt. In contrast, in Group CS, LV function was unchanged from the base-line period. LV compliance also was significantly reduced in Group CB while being unchanged in Group CS. Myocardial extravascular water content, obtained by dessication, was significantly higher in Group CB than in Group CS, which may explain the reduction in compliance. Electron microscopy showed normal ultrastructure in Group CS but extracellular edema in Group CB. Total coronary blood flow showed a sustained increase during reperfusion in both groups. Oxygen consumption rose with rewarming to base-line levels in both groups, whereas lactate and pyruvate consumption was reduced in both groups, particularly Group CB. Cardioplegic solution thus appears to be superior to the intermittent perfusion of cold blood for myocardial protection. The addition of potassium arrest, by markedly reducing myocardial metabolism, improves the protection afforded by cold blood perfusion alone.


Benign tumors of right atrium necessitating extensive resection and reconstruction. Two patients with gigantic benign right atrial tumors were successfully treated at New York University Medical Center. Both patients required extensive resection and reconstruction for cure. Although these tumors are rare, thorough exploration employing cardiopulmonary bypass is required before an appraisal of resectability can be made. Reconstruction can be readily accomplished with autologous pericardium and thereby provides an opportunity for cure of these unusual and rare lesions.


Anomalous origin of circumflex coronary artery from right pulmonary artery: report of a rare anomaly. A heretofore unreported anomaly of the coronary arteries in which a large circumflex artery arises from the pulmonary artery is described. The circumflex coronary artery in an 8-year-old girl was filled in a retrograde fashion via collaterals from a dominant left anterior descending coronary artery, and the right coronary artery was small and nondominant. Successful surgical correction of this defect was performed by use of total cardiopulmonary bypass and cardioplegic arrest. The orifice of the anomalous vessel and detached from the right pulmonary artery and implanted into the posterolateral aspect of the ascending aorta. Cardiopulmonary bypass with cardioplegic arrest is recommended for reconstruction of coronary arterial anomalies with abnormal sites of origin.


Surgery for arteriovenous fistulas and dilated vessels in the right lung after the Glenn procedure. A superior vena cava-right pulmonary artery (SVC-RPA) anastomosis was constructed in a 2-year-old boy with tetralogy of Fallot. Ten years later and 5 years after "corrective" surgery without removal of the shunt, cyanosis and heart failure developed. Stereocineangiography and lung scanning revealed arteriovenous fistulas and dilated vessels in the right lung. The SVC-RPA anastomosis was taken down, the SVC being reimplanted in the right atrium and the RPA end being closed with a few stitches. Neither lobectomy nor pneumonectomy was performed. Immediately after the operation and during a follow-up period of almost 2 years, the boy has remained asymptomatic. Whenever a correction is planned in a patient with SVC-RPA anastomosis, the vessels of the right lung should be examined by scanning and angiography. If important arteriovenous fistulas do exist, the affected lung should be excluded from the pulmonary artery circulation.


Long-term follow-up of unusual ball-valve aortic substitute. On March 19, 1962, prior to the availability of Starr-Edwards ball-valve prostheses for aortic substitution, a mitral valve turned upside down was implanted for marked calcific aortic stenosis. It worked well and the patient was in good health for 15 years. Late annular calcification and loosening of sutures with marked perivalvular regurgitation made valve replacement necessary 16 years after operation. The original valve was perfectly preserved.


Optimizing myocardial supply/demand balance with alpha-adrenergic drugs during cardiopulmonary resuscitation. In 14 dogs the determinants of myocardial blood supply and metabolic demands were assessed during cardiopulmonary resuscitation (CPR) and under steady-state conditions in fibrillating hearts on cardiopulmonary bypass. During open chest cardiac massage (nine dogs), coronary diastolic blood pressure and blood flow were low. Vasopressor infusion (methoxamine or epinephrine) raised diastolic pressure from 33 +/- 3 to 55 +/- 3 mm. Hg and increased coronary blood flow (CBF) 124 percent (from 38 +/- 3 to 85 +/- 11 c.c. per 100 Gm. per minute. Comparison of these drugs in fibrillating hearts on cardiopulmonary bypass showed that epinephrine increased the "vigor of fibrillation" (intraventricular balloon pressure rose 24 percent and oxygen uptake increased 42%) but impeded subendocardial flow 53% (endocardial/epicardial flow ratio fell from 0.79 to 0.48). In contrast, methoxamine did not significantly change intraventricular balloon pressure, oxygen uptake, coronary flow, or its distribution. We conclude that augmentation of diastolic pressure with alpha adrenergic drugs during CPR improves coronary perfusion and that inotropic drugs may worsen myocardial ischemia during CPR by raising oxygen demands while simultaneously impeding subendocardial blood supply.


Massive pulmonary embolism with circulatory failure: survival following sixty hours' support with a membrane lung. A 62-year-old man had circulatory failure from massive pulmonary embolism following a road accident. Despite intensive therapy including urokinase infusion, inotropic drugs, and mechanical ventilation, the patient's circulatory status deteriorated. When it became impossible to maintain the mean systemic arterial pressure above 50 mm. Hg and the cardiac index above 1 L. per minute per square meter, circulatory support by partial cardiopulmonary bypass with a membrane lung was begun. Acute circulatory failure and acute pulmonary hypertension were promptly reduced by this procedure, and patient's status necessitated only intravenous heparin infusion and mechanical ventilation. After 60 hours of bypass the patient was weaned from the membrane lung, and 1 month later he was discharged from the hospital.


Leiomyoma of the lung.

Leiomyoma of the lung. A case of asymptomatic pulmonary leiomyoma diagnosed by routine chest radiography and treated by lobectomy is reported. There is no particular clinical pattern that distinguishes this lesion, and diagnostic maneuvers to identify its nature are generally unrewarding except for biopsy. Resection is the recommended treatment.


The role of bronchoscopy and needle aspiration in the diagnosis of peripheral lung masses. Sixty patients underwent flexible fiberoptic bronchoscopy and percutaneous needle aspiration of peripheral lung lesions with fluoroscopic monitoring. A single general anesthetic was used. We found that percutaneous needle aspiration was the more accurate of the two procedures in establishing a diagnosis but that flexible fiberoptic bronchoscopy proved complementary in some instances. The incidence of pneumothorax was 27% but aspiration was needed in only 8%. There were no other complications. In 84% of patients with primary carcinoma of the lung presenting as a peripheral lesion, the diagnosis was established by these procedures. The accuracy was less in metastatic lesions and considerably less in benign lesions.


Value of anterior mediastinotomy in bronchogenic carcinoma of the left upper lobe. Neoplasms of the left upper lobe may spread directly to the anterior mediastinal group of nodes without involving the inferior tracheobronchial, superior tracheobronchial, or paratracheal nodal chain. Routine cervical mediastinoscopy does not sample the anterior mediastinal node group. Parasternal anterior mediastinotomy was performed in 28 patients with left upper lobe carcinoma and normal findings from cervical mediastinoscopy. Despite the normal findings at cervical mediastinoscopy, 10 of the 28 patients were deemed to have inoperable disease because of spread of the neoplasm to the anterior nodal group or because of direct neoplastic involvement of the aorta or main pulmonary artery. All patients in whom results of anterior mediastinotomy were normal had resectable lesions at thoracotomy. Fourteen of the 16 patients who came to thoracotomy had normal hilar nodes. Parasternal anterior mediastinotomy, introduced by Chamberlain, should be performed in addition to standard cervical mediastinoscopy if the nodal drainage of left upper lobe neoplasms is to be more completely evaluated. Combining these two procedures samples all major drainage pathways except the posterior mediastinal nodal chain.


Clinical implications of postoperative unilateral phrenic nerve paralysis. Unilateral phrenic nerve paralysis (PNP) folowed 32 (1.7 percent) of 1,891 consecutive cardiac surgical procedures during an 8 year peroid. Diagnosis was based on radiographic criteria with comparison of preoperative and postoperative chest radiographs and was confirmed in all 21 evaluated by fluoroscopy. Six had persistent radiographic abnormality more than 12 months postoperatively. PNP occurred most frequently in association with Blalock-Taussig shunts. These operations represented 22 percent of this series, and PNP complicated 7 percent of all Blalock-Taussig shunts. PNP was less well tolerated in the 14 infants than in the 18 older children. Eleven infants had serious difficulties during weaning from mechanical ventilatory support. Five infants required tracheostomy, one underwent diaphragmatic plication, and three died. Infants had a mean duration of mechanical ventilation of 24 days and required prolonged intensive care and long-term hospitalization. In comparison, older children had a more benign postoperative course. Diaphragmatic plication should be considered in infants with paradoxical motion of the hemidiaphragm who remain dependent on mechanical ventilatory support for more than 2 weeks postoperatively.


The Senning operation for transposition of the great arteries. The original Senning technique of interatrial transposition of venous return was selectively employed for physiological correction in 24 patients with transposition of the great arteries (TGA) ranging in age from 74 days to 26 months (median 7 months). Twenty-three had intact ventricular septum and one had a large ventricular septal defect and diaphragmatic subpulmonary stenosis. There were no hospital or late deaths, and at follow-up examination 1.5 to 12 months postoperatively, each patient was asymptomatic, in normal sinus rhythm, and had no clinical evidence of caval or pulmonary venous obstruction. Nine patients underwent cardiac catheterization and angiocardiographic studies between 1.3 and 9 months postoperatively which demonstrated widely patent venous pathways and effective "left"  and "right" atrial contraction. This experience lends support to the continued use of the Senning technique for interatrial transposition of venous return.


Total correction of transposition of the great arteries. Conduction disturbances in infants younger than three months of age. Although total physiological correction of d-transposition of the great arteries (d-TGA) is technically feasible in infants, the optimal age for correction has remained controversial because of concern regarding major life-threatening arrhythmias and the long-term results of the intra-atrial baffle procedure. During a 3 year period, 54 children aged 4 days to 5 years, including 24 infants aged 3 months or younger, underwent the baffle procedure. Thirty-two children had simple transposition and underwent only placement of a pericardial baffle; no deaths occurred in this group. Twenty-two had complex transposition requiring in addition closure of a ventricular septal defect (VSD) and/or resection of outflow tract obstruction; there were four hospital and two late deaths in this group. A single operative approach was used in all patients. Sinus rhythm was present at discharge in 85 percent of the infants and 76 percent of the older children. Three factors--age, mode of cardiopulmonary support, and complexity of the lesion--influenced these results.


Surgical treatment of tetralogy of Fallot with pulmonary atresia. Thirteen (16 percent) of 80 patients with tetralogy of Fallot and pulmonary atresia undergoing corrective operations between Jan. 1, 1967, and Jan. 1, 1978, died in the hospital. The hospital mortality rate was 13 percent (10 deaths) among the 77 patients with confluent right and left pulmonary arteries. The risk of operation was not significantly affected by age at operation or by use of a valved external conduit versus a transannular outflow patch. It was affected (p = 0.008) by the ratio of peak right ventricular to left ventricular pressure (PRV/LV) immediately after repair. This (PRV/LV) was determined primarily by size of left and right pulmonary arteries. An equation was developed relating postrepair PRV/LV to diameter of right and left pulmonary artery (normalized by dividing by size of descending thoracic aorta), body surface area, and possible arborization abnormalities and stenoses of the right and left pulmonary arteries. Cardiac performance after repair was better in those in whom a transannular patch was used rather than a valved external conduit. Important pulmonary dysfunction postoperatively occurred more often in patients with large "bronchial" arteries than in those without them, but was less when these were not ligated. Four (8 percent) of 48 traced hospital survivors died late postoperatively. Reoperations late postoperatively were required only in patients receiving valved external conduits. Forty (91 percent) of 44 living traced patients are asymptomatic.


Surgical management of double-outlet right ventricle associated with atrioventricular discordance. Twenty corrective operations for this unusual syndrome have been performed since 1965. All but two patients also had pulmonary stenosis; one of the exceptions had had pulmonary arterial banding. Two patients had situs inversus of the atria and viscera. In only three of the 20 patients (15 percent) was the apex of the heart positioned normally. Six patients had an entirely intracardiac repair; two early and two late deaths occurred in this group. The other technique, performed in 14 patients, involved insertion of an extracadiac conduit between a ventriculotomy in the morphologically left ventricle and the distal end of the proximally oversewn pulmonary artery; one operative and two late deaths occurred in this group. Heart block occurred in six patients, including two among the eight who had technically satisfactory intraoperative mapping of the His bundle. The intraventricular course of the bundle was not consistently positioned, being anterior to the septal defect in four and posterior in four. No hospital deaths have occurred in the last 13 operations; all except one of the survivors are in New York Heart Association Class I or II. Thus correction currently provides a good early results but leaves the ventricles in an inverted relationship both functionally and anatomically.


Late hemodynamic and angiographic findings after ascending aorta--pulmonary artery anastomosis. Ascending aorta-pulmonary artery (Waterston) anastomosis was performed in 75 children, 51 of whom were younger than 1 month of age and 36 younger than 1 week of age at the time of operation. There were 21 operative and eight late deaths. Operative deaths occurred more frequently in infants with complex cardiac conditions and severe hypoxemia and acidosis preoperatively. The postoperative status of the pulmonary arteries or arterioles could not be correlate with the degree of cardiomegaly, the pulmonary vascular markings, or characteristics of the shunt murmur. Sixty-four percent of the patients catheterized had one or more postoperative structural abnormalities of the pulmonary arteries following the operation, most frequently kinking or narrowing of a pulmonary artery. Occlusion of a pulmonary artery occurred in five of 33 patients studied by angiography. Pulmonary vascular disease may also develop. Therefore, patients should be catheterized 1 year postoperatively to evaluate the level of pulmonary vascular resistance and the pulmonary arteries.


Effect of temperature of cardioplegic solution. This study tests the hypothesis that the efficacy of cardioplegic solution depends upon its chemical constituents rather than on its temperature alone. A standard preparation of right heart bypass in the dog was utilized. Left ventricular function curves were inscribed before and after 1 hour of aortic cross-clamping. No deterioration in function was observed in nonischemic control hearts or in hearts protected with cardioplegic solution consisting of potassium chloride (25 mEq. per liter) and mannitol (12.5 Gm. per liter in 5 percent dextrose and 0.2 percent saline at either 4 degrees C or 28 degrees C. Severe myocardial depression was observed in hearts rendered ischemic for 1 hour at 28 degrees C. without protection and also in hearts perfused with 5 percent dextrose and 0.2 percent saline at 28 degrees C. without the potassium chloride and mannitol. The evidence from this study indicates that cardioplegic solution exerts a protective effect beyond that which is afforded by hypothermia.


Modified technique for radical transmediastinal forequarter amputation and chest wall resection. Forequarter or interscapulothoracic amputation is a major surgical procedure indicated primarily in the treatment of malignant lesions involving the bony and soft tissue parieties of the upper part of the arm, shoulder, and scapula. It is also indicated in extensive trauma with irreparable damage to the shoulder area and as a palliative measure in intractable pain caused by incurable tumors of the shoulder girdle. Several operative techniques have been described: the classical Berger approach, an anterior pectoral approach, and posterior retroscapular approaches. A radical transthoracic approach has been described in cases in which the tumor had spread through the chest wall. The two main goals of these approaches have been early ligation of the subclavian vessels and immediate exploration for operability. This report details our experience with a modified technique for radical forequarter amputation and chest wall resection in which a transmediastinal approach is employed. This approach was used in two patients: One had a radiation-induced fibrosarcoma of the left axilla and adjacent chest wall following a radical mastectomy 19 years earlier, and the other patient had a recurrent rhabdomyosarcoma of the right axilla with invasion of the chest wall. This technique avoids time-consuming and individual excision of ribs and minimizes the amount of blood loss by early ligation of the internal mammary vessels. Safe and excellent exposure and division of the subclavian vessels and early exploration for mediastinal and intrathoracic involvement are made possible. Details of the procedure with illustrations are described.


Four decades of experience with resections for bronchogenic carcinoma at the Massachusetts General Hospital. Experience at the Massachusetts General Hospital (MGH) with resections for primary lung carcinoma is brought up to the clinical staging era (1971) with a 5 year cumulative survival statistic of 30 percent for the period 1964 through 1970. Comparison of four decades of experience reveals no change in cumulative survival for pulmomary resections for primary lung carcinoma in the years 1941 through 1970. Attention is directed to the hospital mortality rates for pneumonectomy and lobectomy and to the principal causes for these rates. Lymph node metastasis continues to be the single most ominous predictor of potential survival after pulmonary resection for carcinoma, particularly for all non-squamous cell types.


Development of left ventricular--coronary sinus fistula following replacement of mitral valve prosthesis. The features and course of a patient in whom a fistula developed between the left ventricle and the coronary sinus following replacement of a faulty mitral valve prosthesis are described. The subsequent deterioration of her condition was associated with a pansystolic murmur and periprosthetic regurgitation. Replacement by a third prosthesis was complicated in addition by tricuspid regurgitation. The fistula was not suspected until the fourth operation, when the right atrium was opened for tricuspid annuloplasty. The fistula was repaired successfully, and the woman has made good progress postoperatively.


Use of a ringed intraluminal graft in the surgical treatment of dissecting aneurysms of the thoracic aorta. A new technique. An intraluminal graft made of woven tubular Dacron with cloth-covered grooved rings at both ends is used to repair dissecting aneurysms of the thoracic aorta. Six consecutive white male patients ranging in age from 31 to 69 years with an average age of 55 years were operated upon with the use of this graft. Three patients had a dissecting aneurysm of the ascending aorta and three others had a dissecting aneurysm of the descending aorta. Total cardiopulmonary bypass was utilized in repairing dissecting aneurysms of the ascending aorta and left heart bypass was used in patients with dissecting aneurymsms of the descending aorta. The basic technique consists in inserting the whole ringed graft into the true lumen of the dissected aorta and circumferentially ligating the aorta against the groove in the rings. The proximal ring of the graft effectively stabilized the flail aortic valve in two patients with aortic regurgitation associated with dissection of the ascending aorta. There were no hospital deaths. All patients are doing well 1 year, 1 month to 2 years, 8 months after the operation.


Experience with and comparision of methods of reduction mammaplasty. Experinece with bilateral reduction mammaplasty in 213 patients has been reviewed. Complications, while not infrequent, are rarely of a serious or lasting nature. In the experience of the authors, the McKissock procedure has yielded the most consistently good results, although very good results were occasionally achieved with all of the other techniques employed.


Points of technique in reduction mammaplasty by the vertical-pedicle method. The technique of reduction mammaplasty by the vertical-pedicle method of McKissock has been enjoying increasing popularity, although there are some apparent drawbacks resulting in less than optimal results. The points of technique emphasized in this communication have proven helpful in eliminating most, if not all, of the less than satisfactory result frequently experienced with this approach. Consistently good experience can be expected if attention is paid to the details described.


Hematologic (cytopenic) manifestations of Wilson's disease (hepatolenticular degeneration). The records of 54 consecutive patients with Wilson's disease seen at the Mayo Clinic from 1952 through early 1977 were reviewed to determine the frequency fo hematologic abnormalaties in their evaluation. Leukopenia and thrombocytopenia sometimes have been ascribed to treatment with D-penicillamine and its toxicity; however, we have found cytopenia to be a frequent finding in the presenting laboratory data of patients with Wilson's disease. Twenty-eight patients (52%) had thrombocytopenia and 16 of these patients (30% of the total) also had leukopenia. Severe, acute, intermittent hemolytic episodes were the initial and only presenting complaint of one patient. Six of the patients with significant cytopenias had splenectomy, and in all cases the peripheral blood counts returned to normal values. Long-term treatment with D-penicillamine improved the hepatic and neurologic dysfunction in most patients; however, the cytopenias remained unchanged except in three patients (treated 2, 5, and 10 years).


Prospective analysis of psoriatic arthritis in patients hospitalized for psoriasis. Among 77 patients hospitalized with psoriasis, 30 (39%) had psoriatic arthritis. Arthiritis was more frequent (P less than 0.05) in those with extensive psoriasis (grades 3 and 4) than in those with less extensive psoriasis (grade 1 and 2). Temporally, flares in skin and joint disease were not closely related. The Moll-Wright classification of psoriatic arthritis into five clinical groups could be loosely applied to our patients. However, sacroiliitis (present in 33% of the patients) was seen in all five groups and was related to HLA-B27 antigen. Although there was no positive correlation between extent of psoriasis and serum urate level, four patients had gout. Mean serum urate level was higher (P less than 0.05) in females with psoriatic arthritis than in females with psoriasis alone. Antinuclear antibodies were found in 6 of 19 patients with psoriatic arthritis and in none of the 11 patients with psoriasis alone.


Myocardial ultrastructural changes after experimental ventricular fibrillation and anoxic arrest. A transmural myocardial biopsy method was used to study changed in ultrastructure after induced ventricular fibrillation or anoxic arrest in the canine heart. Interstitial edema, mitochondrial derangement, contraction bands, and swelling of capillary endothelium were more extensive in subendocardial than in subepicardial layer after anoxic arrest. Significant numbers of contraction bands were also seen in the myocardium after induced ventricular fibrillation. These changes appeared to be reversible at least in part in the group with induced ventricular fibrillation but generally not in the anoxic arrest animals. After anoxic arrest, preservation of the endocardial layer was significantly poorer than that of the epicardium; after ventricular fibrillation, there appeared to be no such difference. Myocardial mitochondria and glycogen granules were intact and more numerous after ventricular fibrillation than after anoxic arrest. The lesser damage after ventricular fibrillation than after anoxic arrest suggest that the myocardium may be affected less by the no-reflow phenomenon after normal coronary circulation is restored in ventricular fibrillation.


Fatal disseminated intravascular coagulation after peritoneovenous shunt for intractable ascites. Peritoneovenous shunt for intractable ascites was complicated by disseminated intravascular coagulation, which resulted in the death of the patient. Attention is called to this potentially serious complication. The cause of disseminated intravascular coagulation occurring after peritoneovenous shunt is uncertain. Patients at risk for this complication need to be identified if this shunt is being considered.


Meningitis due to group C streptococci in an adult. Group C streptococci are generally considered to be a rare cause of infection in man. Infections due to these microorganisms, however, are common in several animal species. To our knowledge, the literature contains only two previous cases of meningitis in man which were due to group C streptococci. In one of these cases meningitis developed as a complication of endocarditis due to group C streptococci. Our recent clinical experience with a patient with severe acute meningitis caused by group C streptococci is reported and the pertinent literature is reviewed. The illness manifested itself as a severe form of acute meningitis, with slow but statisfactory response to therapy with penicillin.


Recurrent Goodpasture's syndrome.

Recurrent Goodpasture's syndrome. A 49-year-old woman had three distinct episodes of pulmonary hemorrhage over a 11-year period separated by symptom-free intervals of 6 and 5 years. The first and third episodes were associated with mild glomerulonephritis and linear deposition of IgG along glomerular/tubular basement membranes. The first episode was associated with a rising influenza A2 titer. Investigation of the third episode revealed circulating antiglomerular basement membrane antibodies detected by radioimmunoassay but not by indirect immunofluorescence. Antilung basement membrane antibodies were detected by both direct and indirect immunofluorescence. Recovery from each hemorrhage followed blood transfusion and oxygen therapy. This case demonstrates that (1) Goodpasture's syndrome, predominantly manifest by pulmonary hemorrhage, may have circulating antibodies with greater affinity for lung membrane compared with glomerular basement membrane, and (2) the antiglomerular basement membrane antibody response is not necessarily an acute self-limited event but may be a chronic or recurrent phenomenon.


Double-outlet right ventricle. Anatomic and angiocardiographic correlations. A series of 72 patients with proved double-outlet right ventricle was studied with reference to the ability of angiocardiography to determine the location of a ventricular septal defect when it was associated with various great-artery relationships. Only 2 of the 72 patients had an intact ventricular septum. The other 70 patients had 16 possible anatomic variations based on four positions of the ventricular septal defect (subaortic, subpulmonary, subaortic and subpulmonary, and remote type) and four great-artery relationships (normal, side by side, dextromalposition, and levomalposition). Using the hemodynamic information regarding systemic and pulmonary arterial saturations, combined with biplane angiocardiographic data from the right ventricle (and if possible with left ventriculography), one can predict the location of ventricular septal defect. Because the different types of double-outlet right ventricle have different surgical approaches, this information can be important to the surgeon.


Effect of aspirin on prevention of coronary and cerebrovascular disease in patients with rheumatoid arthritis. A long-term follow-up study. Between 1950 and 1975, 473 Rochester patients had the diagnosis of rheumatoid arthritis and received aspirin treatment. These patients were followed for an average of 10 years to determine whether they experienced myocardial infarction, classic angina pectoris, sudden unexpected death, or cerebral infarction less often than expected on the basis of age- and sex-specific incidence rates of each event known for the Rochester population. In none of these disease entities, separately, or combined, was the expected number significantly different from the observed. However, when we examined these events separately by sex, observed numbers in males were 30 to 50% less than expected in all four studied end-events. Because the male population was small, none of these differences reached statistical significance. The possible effect of aspirin in the primary prevention of vascular disease in males is discussed in light of the recent similar reported results in secondary prevention.


Detection of hematoporphyrin fluorescence during fiberoptic bronchoscopy to localize early bronchogenic carcinoma. Photoelectric detection of fluorescence from hematoporphyrin-containing "occult" bronchogenic carcinoma is a potentially useful technique for localizing and delineating such cancers. A method is presented which would enable use of a fluorescence-detection system simultaneously with conventional illumination during flexible bronchofiberscopic examination. Preliminary data suggest that quantities of hematoporphyrin as small as 5 picograms can be detected on the surface of tumors by this method.


Surgical treatment of congenital pelvic arteriovenous malformation. Congenital arteriovenous fistulas often pose difficult diagnostic and management problems. Surgical therapy has been associated with a propensity for incomplete obliteration and recurrence. A case of a large congenital pelvic arteriovenous malformation, initially misdiagnosed as an atrial septal defect, was defined by selective roentgenographic and contrast echographic techniques and successfully treated by total surgical excision.


Barrett's esophagus occurring as a complication of scleroderma. Two patients had both scleroderma and a columnar epithelium-lined lower esophagus (Barrett esophagus). Features of Barrett's esophagus included high esophageal strictures in both patients and ulcer craters in the columnar area of one. Biopsy confirmed columnar epithelium in the lower esophagus of each patient. In these patients, the Barrett esophagus probably was a complication of scleroderma and resulted from long-standing gastroesophageal reflux.


Retention improvement by topical application of uridine monophosphate into different brain areas. This study aimed to demonstrate the effect of uridine monophosphate (UMP) on the consolidation of a brightness-discrimination reaction after topical application of this RNA precursor into the hippocampus, the neocortex or the mesencephalic reticular formation (MRF). Thirty minutes before the rats started their training in a Y-chamber, UMP was injected into each animal through cannula implanted into the particular brain area. When injected into hippocampus or MRF UMP exerted no influence on acquisition, but after epidural UMP injection an impairment of acquisition was observed. After intrahippocampal or epidural UMP application the retention test carried out 48 hour after training showed a significant improvement in retention performance, whereas UMP injection into MRF showed no influence on retention. Consequently, the retention-improving effect of UMP is probably not induced by activation of ascending neuronal systems.


Studies of hand blood flow of the Igloolik Eskimo. The hand blood flow of Igloolik Eskimos was measured by venous occlusion plethysmography. The purpose of the investigation was to study circulatory adjustments to cold exposure. Such adjustment can be anatomical or functional. Our attention was especially directed to maximal resting circulation with the aim of obtaining information about the capacity of the peripheral vascular bed in different age groups of cold-exposed people. Resting blood flow ml/100 ml handvolume/min in vasodilated Eskimo men did not appreciably differ from that of men of the same age in other ethnic groups. Women of 20-50 years of age had significantly higher circulation than men 20-50 years. This finding may be due to the smaller hand and the relative quantities of different tissues. Females above 50 years had a very low hand circulation compared with the younger females, in contrast to males above 50 years who did not differ significantly from their younger colleagues. Any explanation other than hormonal is not warranted at this time. The results show that cold stress to the skin does not induce hypertrophy of the peripheral vascular bed which can be detected during vasodilated conditions or reactive hyperemia after 5 minutes of arterial stasis.


Relative potency of some neuromuscular blocking drugs in vivo and in vitro. The relative potencies of alcuronium, d-tubocurarine, gallamine, pancuronium and succinylcholine as neuromuscular blocking agents were tested in vivo (acute toxicity in mice) and in vitro (rat phrenic nerve-diaphragm preparation). In vivo, pancuronium was about 4 times more potent than alcuronium or d-tubocurarine, whose LD50-values were of the order of 2 X 10(-7) mol/kg. On a molar basis, succinylcholine was about 5 times less potent and gallamine about 20 times less potent than alcuronium or d-tubocurarine. In vitro, succinylcholine was as effective as d-tubocurarine and alcuronium. The IC50-values for these drugs were of the drugs were of the order of 2 X 10(-6)M. Pancuronium was about 2 times less potent and gallamine about 100 times less potent than the other three drugs in vitro. The in vivo-potencies correlate better than those obtained in vitro with observations from the clinical use of these muscle relaxants.


The effect of peripherally administered 6-hydroxydopamine on food and water intake in rats. The effect of peripheral administration of a single dose of 6-hydroxydopamine (6-OHDA; 100 mg/kg i.p.) on ingestive behaviours in adult rats has been studied. Individual food and water intakes were measured daily for a period of 7 days following treatment. Most animals became hypophagic for up to 72 hours and hypodipsic for up to 24 hours. The possibility that peripherally administered 6-OHDA may enter the CSF by means of the circum-ventricular organs and thereby exert central behavioural effects is discussed.


The effects of 6-hydroxydopamine, atropin and propranolol on avidin synthesis by the chick oviduct. The systemic administration of 6-hydroxydopamine (6-OHDA) induced avidin production in the oestrogen-primed immature chick oviduct, whereas atropin and propranolol had no effect on avidin levels. 6-OHDA also significantly potentiated avidin synthesis induced by local tissue damage.


Imapct of a primary care group practice on emergency room utilization at a community hospital. This paper reports the effects on a community hospital's emergency room utilization that were brought about by the development of a primary care group practice. The practice, which has replaced the hospital's traditionally structured outpatient clinics, employs full-time, salaried physicians and provides evening office hours and 24-hour coverage. The primary care group appears to have effected a substantial reduction in pediatric emergency room use. To a lesser extent, utilization by former clinic users among the adult atients was also reduced. These reductions, however, created only modest impact in the context of the hospital's total emergency room use, owed in part to the relatively small size of the patient population who formerly had depended upon the hospital for primary care.


A multivariate analysis of the likelihood and volume of preventive visit demand in a prepaid group practice. An economic framework for the investigation of the demand for preventive medical care services is suggested and empirical models for the likelihood and volume of preventive physician visits are specified. These are tested using data on 3,892 individuals enrolled in the Kaiser Foundation Prepaid Health Plan of Portland, Oregon. Preventive visits, delineated by the Kaiser Clinical Behavioral Classification System, included general medical examinations, eye examinations, well-child care and immunization services. Multiple regression is used to estimate the likelihood of preventive visits for all persons and the volume of preventive visits for users. Income and coinsurance were the most significant economic variables in the likelihood equation, possessing the expected positive and negative signs, respectively. The usual findings of a positive education effect and negative family size effect were supported by the results. The economic variables were less significant in the volume equations than in the likelihood equations, suggesting that system and physician effects may neutralize these factors. Females were more likely to make a preventive visit than were males and the relatively young and old were the heaviest age-group users of preventive care. Perceived helath status did not appear to significantly affect preventive care demand.


Discrepancies between admission and discharge diagnoses in a university hospital. Admission screening and certification systems for utilization review are based on acceptance of attending physicians' admitting diagnosis. This study was conducted to: 1) determine the consistency of admission diagnosis as compared to discharge diagnosis: i) identify the characteristics of patients and diagnoses subject to higher rates of diagnostic discrepancy; and 3) analyze the apparent reasons for such discrepancies. The following methods were used: direct comparison of admission and discharge diagnosis on a sample (n = 955) of university hospital patients using a rating scale to measure the degree of change in specificity and category of diagnosis; analysis of diagnostic change by hospital service, demographic characteristics of patients, length of stay, and source of payment; review of charts with the greatest diagnostic discrepancy. Diagnostic changes were found in 26.8 per cent of all admissions (n = 230) and were most frequent in neurological, medical and pediatric patients. The rate of change varied with patient age and length of stay and was lowest in Medicaid patients. Changes were usually from general to more specific diagnosis in related categories, with 4.3 per cent being discharged undiagnosed and 2.9 per cent with unrelated diagnosis. Major causes for discrepancies were related to clinical and laboratory findings. No evidence was found for deliberate diagnostic manipulation to gain admission or to improve financial coverage.


A study of 128 deaths in New York City correctional facilities (1971-1976): implications for prisoner health care. During a 5 1/2 year period, January, 1971 through July, 1976, 128 deaths occurred in New York City. The epidemiology of prisoner deaths including suicide was examined in a large incarcerated population. Each death was categorized according to the International Classification of Diseases. The mean age of the prisoner death was 34 years. Only 3 deaths occurred among females. Ethnic distribution of these deaths was similar to the prison population. Deaths of prisoners fell into 2 categories: external causes (suicide, accidents, homicide, legal intervention) and nonviolent causes. External causes accounted for 71 deaths. The leading cause of death was suicide, accounting for 52 deaths. Suicides occurred in all time periods of incarceration. The highest rate was in the 35 to 44 year age group. History of drug or alcohol abuse was reported by 69 per cent of the suicides. One-third of the prisoners committing suicides had histories of previous attempts or previous mental hospitalizations. Except for 2 individuals, the method was hanging. For the most part, prisoners at risk for suicide exhibited a common pattern and were identifiable. During the last 2 1/2 years of the study period, deaths were reviewed by a prisoner death committee. Deficiencies of care in deaths of nonviolent causation were categorized as "provider," "corrections," or "system." The most common deficiency in care was delay in hospitalization of prisoners requiring care.


Encouraging behavior changes by use of client-held health records. A process was developed to encourage individuals to take more responsibility for their health by using a client-held health record. The motivation for the record, called a Personal Life Health Plan (PLHP), stems from the fact that the majority of ills which afflict an individual can be abated by behavior changes. The PLHP contains most of what is in a medical record but also has sections which deal with health maintenance; a past health history, a family health history, tables of individualized risks of morbidity and mortality, a health maintenance plan, and tables of physiological measurements. The PLHP process helps to make explicit the steps of 1) naming existing and potential health problems; 2) reflecting on their causes; and 3) taking actions to overcome them. Additionally, the record helps maintain continuity of care. Pilot studies made in two settings indicate that a significant percentage of individuals will use a PLHP and that physicians and nurse practitioners can incorporate it into their routine of providing care with minimal expenditures of time. Longer term studies will be required to determine effects on behavior, compliance and health services utilizations.


Increasing maternal participation in the hospitalization of young children. In an attempt to reduce the harmful emotional effects of separation for young children, hospitals in recent years have liberalized visiting hours, but parents have not taken advantage of their new privileges. The study described here sought to increase mothers' participation in their children's hospitalization by overcoming some of the psychological barriers believed to exist. The mothers of 48 children aged 1 to 5, to be admitted for elective surgery to a large, metropolitan pediatric hospital, constituted the primary sample and were divided into experimental and control groups. Mothers in the experimental group had an extra half-hour session in a pre-admission interview focusing on visiting, and specific suggestions were made about frequency and timing of visits, as well as the role of the mother during her visits. During the experimental period weekly meetings were held with the nursing staff to enlist their support for this change in visiting patterns. Results indicate that duration of visits, timing of visits, and behavior during them were all significantly modified for the experimental group of mothers. In contrast, the nurses did not significantly change their relationship with the mothers or the children. Clinical possibilities and limitations of such a program are discussed.


Mexican-American folk belief in a pediatric emergency room. The pattern, extent and patient care implications of medical folk belief in the Mexican-American population utilizing a pediatric emergency room were assessed. The parents of caretakers of 85 randomly selected patients were interviewed in the emergency room waiting area. The extent of knowledge and family history of four traditional folk diseases (magical fright, evil eye, surfeit, and fallen fontanelle) were determined, as was the utitlization of folk healers. The proportion of individuals with traditional knowledge varied with the specific folk disease and with demographic characteristics. Those born in Mexico were more likely to have knowledge of folk disease symptoms and treatment. Of 43 patients who had received treatment prior to coming to the emergency room, 13 had received an herbal folk remedy prescribed by a family member. Twenty-eight reported previous use of folk healers for pediatric illness although none had sought such care for the present illness. Of 57 informants who offered a cause for the child's present illness, two named a folk disease. Mexican-American folk belief is common in the population of Hispanic origin who utilize this pediatric emergency room. The illness for which care is sought, however, is felt to be amenable to scientific care and therfore medical folk belief is not often a clinically relevant factor in the emergency room setting.


The economic cost of illness: fiscal 1975. In 1963, Rice estimated the costs of illness and then allocated these costs by disease. She and Cooper in 1972 updated the original estimates and developed a more sophisticated methodological approach. This paper updates further the costs of illness to 1975 and presents further methodological changes. Analysis of the direct and indirect costs of illness for 1975 reveals that the upward trend into total costs continued, reaching $264 billion. The indirect costs are loss of earnings due to morbidity or premature mortality estimated at various discount rates allocated into 18 categories by disease. The direct costs include such payments as those made for hospital care, physician services, and drugs which are allocated by disease and unallocated costs such as construction and research. The proportion of total costs due to premature mortality were found to drop slightly from 1972 to 1975, while the morbidity share increased slightly. Direct costs account for approximately the same share of total illness in 1975 as in 1972. The proportion of total costs accounted for by direct costs varies directly with the discount rate selected, with the direct costs accounting for 50 per cent of the total at the 10 per cent discount rates and 37 per cent at 2.5 per cent rate. The proportion due to morbidity costs also varies directly with the discount rate, although the changes are small. There is an inverse relationship between the share for premature mortality costs and discount rate.